Exam 2 updated Flashcards
What are manifestations of fecal impaction?
Malaise, urinary retention, increased temp, incontinence, cognitive decline, hemorrhoids, intestinal obstruction.
What are etiologies of heart failure?
-damage from HTN and CHD
-ventricles enlarge and dilate
-results in weaker muscle
-EtOH, drug abuse
-chronic hyperthyroidism
-valvular
-chemo and radiation therapy near heart
What are symptoms of Parkinsonian crisis?
-Severe exacerbation of tremors, rigidity, and bradykinesia
-Anxiety
-Sweating
-Tachycardia
-Hyperpnea
What condition is Heberden’s nodes found in?
only in osteoarthritis (head of finger)
What condition is Bouchard’s nodes found in?
OA and Ra
What is the client education for medications such as selegiline and rasagiline?
-same time everyday
-report insomnia
-postural hypotension prevention
-skin exams, risk of melanoma
-avoid foods containing tyramine
What are client education for levodopa and amantidine?
-weeks-months to take effect
-decrease protein intake
-avoid foods with pyridoxine (pork, beef, avocado, beans, oatmeal)
-teach to report increase in symptoms and cardiac side effects
What is the client education for tolcaone and entacapone?
-take with food
-no EtOH or sedatives
-interventions to prevent postural hypotension
-do not stop abruptly
-report muscle control changes, jaundice, dark urine, hallucinations
What is the client education for anticholinergics? (Benztropine (cogentin) and trihexyphenidyl (artane)?
-avoid activity which promotes fluid loss
-dont stop abruptly
How is OP diagnosed?
dexa scan & t-score (2.5 or greater)
What are interventions for OP?
-Weight bearing and resistance training
-Adequate calcium and vitamin D intake
-Education about fall prevention
-Pharmacological therapy to prevent bone loss
What are interventions for OA?
-weight loss
-exercise
-physical therapy
-hot/cold therapy
-adaptive devices (cane, shoe lift, knee brace)
What is pharm therapy for OA?
-acetaminophen
-NSAIDs
-joint injections
-acupuncture
-surgical intervention (athroscopy, total joint replacement)
What is pharm therapy for RA?
-Pain management
-DMARDs (disease-modifying anti-rheumatic drugs) - methotrexate
-Biological response modifier - “-mab”
What is the presentation of older adults with hyperthyroidism?
-tachy
-tremors
-weight loss
-apathetic thyrotoxicosis (slowed movement and depressed affect)
What is the nursing care for hypothyroidism?
-Prevent: chilling, constipation, skin breakdown, infection
-Assess: cardiac complications, edema, tachycardia, skin
-Lifelong levothyroxine therapy
-Warning: levothyroxine can cause digoxin toxicity
How is delirium assessed/diagnosed?
-Confusion Assessment Method (CAM & CAM-ICU)
-Documentation should focus on specific indicators of altered mental status rather than “confused”
-Will lead to more appropriate prevention, detection, and treatment to prevent negative outcomes
What are ways to prevent delirium?
- Know baseline mental status, functional abilities, living conditions, medications taken, alcohol use.
- Assess mental status using Mini-Mental State Exam-2 Confusion Assessment Method, or NEECHAM Confusion
Scale, and document. - Correct underlying physiological alterations.
- Compensate for sensory deficits (e.g., hearing aids, glasses, dentures).
- Encourage fluid intake (make sure fluids are accessible).
- Avoid long periods of giving nothing orally.
- Explain all actions with clear and consistent communication.
- Avoid multiple medications, and avoid problematic medications (see Beers Criteria).
- Be vigilant for drug reactions or interactions; consider onset of new symptoms as an adverse reaction to medications.
- Avoid use of sleeping medications; use music, warm milk, or noncaffeinated herbal tea to alleviate discomfort.
- Attempt to find out why behavior is occurring rather than simply medicating for it (e.g., need to toilet, pain, fear, hunger, thirst).
- Avoid excessive bed rest; institute early mobilization.
- Encourage participation in care for activities of daily living (ADLs).
- Minimize the use of catheters, restraints, or immobilizing devices.
- Use least restrictive devices (mitts instead of wrist restraints, reclining geri-chairs with tray instead of vest restraints).
- Hide tubes (stockinette over intravenous [IV] line), or use intermittent fluid administration.
- Activate bed and chair alarms.
- Place the patient near the nursing station for close observation.
- Assess and treat pain.
- Pay attention to environmental noise, light, temperature.
- Normalize the environment (provide familiar items, routines, clocks, calendars).
- Minimize the number of room changes and interfacility transfers.
- Do not place a delirious patient in the room with another delirious patient.
- Have family, volunteer, or paid caregiver stay with the patient.
What is aphasia?
partial or total loss of the ability to articulate ideas or comprehend spoken or written language
What is apraxia?
partial or total loss of the ability to perform coordinated movements or manipulate objects in the absence of motor or sensory impairment
What is agnosia?
loss of the ability to interpret sensory stimuli, such as sounds or images
What are nursing interventions for wandering in AD?
Music, exercise, refreshments, social interaction
Camouflage doorways, enclosed areas for walking, electronic bracelets,
What is apathetic thyrotoxicosis?
slowed movement and depressed affect
Pre-op thyroidectomy care?
- give antithyroid medication called lugol’s solution
-it’s potassium iodine & iodide used to decrease thyroid gland perfusion & decrease T3, T4 production
-as gland is cut, TH is released. Bc of this, person has a high risk of having a thyroid storm or thyrotoxicosis which can be life-threatening - Want to promote reduction of anxiety to reduce risk of thyroid storm
