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Med Surg > exam 3 > Flashcards

exam 3 Flashcards

1
Q

oliguria

A

decreased urine output, less than 400 mL / 24 hours

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2
Q

anuria

A

urine output of less than 100 ml in 24 hours

Normal urinary output for adult: 30 ml / hour

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3
Q

azotemia

A

syndrome that results from increased BUN & creatinine together

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4
Q

polyuria

A

increased urine output, more than 2000 mL in 24 hours

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5
Q

uremia

A

a raised level in the blood of urea and other nitrogenous waste compounds that are normally eliminated by the kidneys
Manifestation of renal failure

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6
Q

normal specific gravity

A

1.000 - 1.030

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7
Q

range of urine ph

A

4-8

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8
Q

serum creatinine normal level

A

0.2-1.0 mg/dl

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9
Q

normal BUN

A

8 - 20 mg/dl

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10
Q

is 50% of your kidney function is compromised, what will be elevated?

A

creatinine

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11
Q

urethral stricture

A

Narrowing of urethra
Causes obstruction of outflow of urine → can lead to urine stasis and UTI
Can develop overflow incontinence

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12
Q

how to tx urethral stricture (surgery)

A

urethroplasty - repair urethra

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13
Q

which is worse, AR or AD PKD

A

AR - 100% of nephrons are involved

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14
Q

4 common side effects of UTIs

A

Dysuria = painful when voiding
Frequency - peeing continuously
Urgency - have to go right now
Nocturia - have to go in the middle of the night

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15
Q

if BUN is rising more than creatinine…

A

may not be a renal issue

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16
Q

KUB films

A

kidney, ureter, and bladder x-rays
Aka flat plate of the abdomen
A to P view of what’s going on in abdomen

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17
Q

when would you use cystoscopy/cystography/VCUG (4)

A

Done to diagnose bladder or urethral trauma
Done to see why frequent UTIs
Remove tumor in urinary tract
Examine enlarged prostate

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18
Q

process for cystoscopy/cystography

A

Ask patient to void
Catheter
Sterile saline → fill bladder
Get pictures

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19
Q

Voiding cystourethrography (VCUG) process

A

have person stand, remove saline, and watch how bladder contracts to empty
Shows if there are problems with motion of bladder wall

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20
Q

do cystoscopy/cystography/VCUG require consent

A

yes

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21
Q

when you remove a foley, is it normal for first void to sting

A

yes

if it stings after that, need to call provider

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22
Q

causes of cystitis

A

Usually d/t infection but not always
Usually e.coli ascending urethra into bladder → infection
Can also be virus, fungus or parasites
Catheter related infections are common

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23
Q

what is the most common cause of sepsis

A

cystitis

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24
Q

what can cause non infectious cystitis

A

can be d/t chemo or chemical irritation

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25
Q

what is interstitial cystitis

A

unknown cause, not infectious

could be an allergic response

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26
Q

how to dx cystitis

A

Urinalysis with culture and sensitivity

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27
Q

for chronic, recurring infections of cystitis, how do you tx

A

long term antibiotics

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28
Q

what is urethritis

A

inflammation of urethra that causes s/s of UTIs

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29
Q

in what population is urethritis common in and how do you treat them

A

post menopausal women, especially if sexually active

tx with estrogen cream

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30
Q

what is urethral stricture and what type of incontinence can it lead to?

A

Narrowing of urethra

Causes obstruction of outflow of urine → can lead to urine stasis and UTI and overflow incontinence

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31
Q

stress incontinence cause

A

Due to weakening of the bladder neck, often associated with childbirth

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32
Q

stress incontinence s/s

A

Incontinence when sneezing, coughing, laughing, exercising

Small amounts leaked

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33
Q

stress incontinence tx

A

Pelvic floor exercises = Kegels
Spacing fluid during the day
Incontinence diary
Topical estrogen therapy for postmenopausal therapy
Reconstructive surgery for uterus or bladder prolapse
Implanted sacral nerve stimulator - reminder to kegel
Tens units

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34
Q

urge incontinence definition and cause

A
  • Loss of urine r/t strong need/desire to urinate and inability to suppress signal for same = overactive bladder
  • May be secondary to Parkinsons, MS, stroke
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35
Q

interventions for urge incontinence

A

Behavioral interventions
Diet therapy - stay away from caffeine, alcohol, stimulants
Drugs - anticholinergics for smooth muscle relaxation, antihistamines, etc.
Bladder training
Pelvic floor exercise
Interval training
Space fluid intake, and limit fluid after dinner

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36
Q

what causes overflow incontinence

A

Detrusor muscles fail to contract so bladder over extends –> Constant dribbling of urine to avoid bladder rupture = underactive bladder

Can be associated with meds
Diabetes, spinal cord injuries, MS, BPH, uterine prolapse

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37
Q

overflow incontinence interventions

A

Intermittent catheterization (maybe for spinal injury)
Surgery if outflow is obstructed (like BPH)
Meds - depends on cause
BPH - flomax

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38
Q

functional incontinence cause

A

Caused by factors other than urinary tract issues like
Loss of cognitive function
See this in Alzhemiers and other dementias but never assume dementia is the reason (could be BPH)

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39
Q

functional incontinence interventions

A 
Treat any reversible causes first
Skin protection
Urine containment
Caregiver would need the urinary training - i.e. walk patient to bathroom, etc.
Condom caths at night, Diapers for women
Intermittent catheterization
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40
Q

mixed incontinence

A

We don’t always figure out the reason for incontinence

Features of more than 1 type of incontinence

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41
Q

what is urolithiasis

A

Presence of calculi (stones) in urinary tract

Majority of stones are made of calcium but not all (some can be bacterial)

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42
Q

can stones damage the lining of the urinary tract

A

yes

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43
Q

risks d/t urolithiasis

A

Retention from retained urine
Hydronephrosis - stone in kidney
Can be seen in ureter

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44
Q

what can contribute to urolithiasis

A 
Metabolic defects
Immobilization 
Urinary retention
Loop diuretics
Antacids, steroid therapy, fiofelan
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45
Q

is a high calcium diet associated with urolithiasis

A

no - high calcium diet should not promote stone formation

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46
Q

s/s of urolithiasis

A 
Sudden onset of extreme pain
Hematuria
Oliguria
Ureteral spasm
N/V secondary to pain
Pallor and diaphoresis
Potential for shock d/t nearby SNS nerves
Potential for hydroureter &/or hydronephrosis = obstructive stone
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47
Q

does a stone that isn’t moving cause pain

A

no

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48
Q

what labs/tests do you do for urolithiasis

A

Lab assessment - chemistries, hematology, UA
Elevated WBC - infectious process
KUB x ray can see stones
CT scan w/o contrast

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49
Q

how do you treat urolithiasis pain

A

Opiates, injectable NSAIDs (toradol), antispasmodics
Complementary and alternative therapies
Heat → dilation

walking helps pass the stone

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50
Q

Shock wave lithotripsy (SWL) w/ stents

What type of sedation, how is it done, etc.

A 
fluoroscopic procedure
Under moderate sedation 
IV
Cardiac monitoring
Aim a shock wave at location of the stone and blast it with sound/shock wave so they can pass it
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51
Q

what are 2 other surgical ways to treat urolithiasis

A

Retrograde ureteroscopy

Open surgical procedure (if the above and the shock waves don’t work)

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52
Q

pt teaching post surgery for urolithiasis (3)

A

Strain urine
stay hydrated
antibiotics

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53
Q

which PKD is more common: AR or AD and when does it manifest

A

AD, manifests later in life

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54
Q

how many nephrons are involved in AR PKD

A

100% of nephrons are involved from time they are born

Children usually die early in childhood

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55
Q

how does PKD impact the kidneys

A

Fluid filled cysts in nephrons → prone to rupture → pressure in kidney area
Pressure within kidney causes nephrons to become not functional
Grossly enlarged kidneys - look like grape clusters
Cysts damage glomerulus and tubules

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56
Q

where else can you get cysts from PKD (3)

A

Berry aneurysms
Liver cysts
Cardiac vasculature cysts

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57
Q

PKD pain: acute

A

when cysts rupture, sharp pain over flank, pain is worse

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58
Q

PKD pain: chronic

A

all the time because of cysts, pressure, discomfort

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59
Q

s/s of PKD

A

Distended abdomen - enlarged kidneys press on bowel
constipation
Hematuria/cloudy urine
Kidney stones are common
Nocturia & proteinuria
HTN b/c of renal ischemia → can lead to aneurysms
Edema b/c of high sodium levels (d/t renal ischemia)
N/V, anorexia
pruritis

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60
Q

what is an early sign of PKD

A

nocturia

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61
Q

how do you treat PKD

A
  • treat chronic and acute pain - can needle aspirate through the back to the cyst
  • antibiotics for infection
  • stool softener
  • BP medications
  • diet therapy - increase fiber and decrease Na+
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62
Q

are ASA or NSAIDs encouraged for PKD

A

no

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63
Q

self teaching for PKD (3)

A

Take temp if feel ill
See MD for unremitting headache or visual changes (could be cyst elsewhere)
Call MD for foul smelling urine = sign of infection

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64
Q

what can Hydronephrosis, hydorturerer and urethral stricture result in

A

overflow obstruction

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65
Q

causes of Hydronephrosis, hydroureter and urethral stricture

A 
Tumors
Stones
Trauma to renal system
Congenital defects
Scar tissue
Radiation therapy for urological cancers
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66
Q

how to dx Hydronephrosis, hydorturerer and urethral stricture

A

CT or US

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67
Q

interventions for Hydronephrosis, hydroureter and urethral stricture

A

Catheterization as needed
Double voiding
Monitor bladder distension - gentle palpation
Bladder scan

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68
Q

nephrostomy tube

A

If huge stone is obstructing - undergo fluoroscopy and drain ureter through the patients back→ reroute urine to decrease pressure

*do not have patient lie on their back

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69
Q

what to be mindful of before nephrostomy tube placement

A

NPO before
Clotting studies or correct if not normal before procedure
Pain control before procedure

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70
Q

how long is bloody urine expected for after nephrostomy tube placement

A

24 hours

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71
Q

if there is recurrence of pain after nephrostomy tube, what might that mean

A

tube could have been displaced

Check urine output and report to provider

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72
Q

acute pyelonephritis: cause

A

Bacterial infection of the kidney
Can be primary of urinary tract Or can be obstruction
Usually a bladder infection that has ascended!

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73
Q

s/s of acute pyelo

A 
Fever, chills, tachycardia and tachypnea
Flank or back pain
Abdominal discomfort
Significant N/V
May not be able to take PO antibiotics
May have urgency, frequency, nocturia
General malaise or fatigue
dehydration
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74
Q

chronic pyelo: 4 causes

A

numerous episodes of acute pyelo in the past
Stones
Neurogenic impairment of voiding
Kinked ureter

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75
Q

s/s of chronic pyelo

A

HTN!
Very dilute urine/nocturia - can’t concentrate
hyponatremia, hyperkalemia, acidosis

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76
Q

tx for chronic pyelo

A

Urinary diversion surgery
Unkink ureter via surgery
Antibiotic but might be long term

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77
Q

what is the leading cause of ESRD

A

diabetic nephropathy

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78
Q

what is the 1st manifestation of diabetic nephropathy

A

albuminuria

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79
Q

how do you prevent diabetic nephropathy

A

Manage glucose levels!

Check eyes yearly! Retinal changes parallel renal changes

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80
Q

how to tx diabetic nephropathy

A

Avoid nephrotoxic agents
Avoid dehydration
Might need to reassess insulin requirements because failing kidneys can lead to hypoglycemia

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81
Q

BPH population

A

Men, age 50, decrease in male hormones, Increase in DHT

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82
Q

physiologic manifestations of BPH

A

Detrusor muscle hypertrophies - can’t contract effectively

Prostate swells and puts outflow obstruction on urinary tract

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83
Q

what can BPH lead to

A 
Leads to UTI d/t retained urine
Acute or chronic urinary retention
Kidney stones, bladder stones
Hydroureter or hydronephrosis
Urinary overflow incontinence → dribbling
Can go into renal failure

plus lower urinary tract symptoms (hesitancy, difficulty maintaining stream, decreased force of stream, dribbling, hematuria, nocturia, etc.)

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84
Q

what is severe BPH

A

Higher levels of protein made by androgen related gene

bladder damage and more renal involvement

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85
Q

is there a link b/w BPH and ED

A

Coexist together in people with BPH

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86
Q

tx for BPH

A

Lifestyle: more frequent intercourse
meds:
- 5 alpha reductase inhibitors (procar)
-alpha antagonists (flomax) (don’t take w/ viagra!)
others: saw palmetto, botox, viagra (in testing)

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87
Q

PSA level less than 4 is..

A

normal

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88
Q

PSA greater than 10

A

associated w/ prostate cancer

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89
Q

should labs be drawn before or after digital exam

A

Labs need to be drawn and sent off before digital exam

If not before, you can have falsely elevated PSA

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90
Q

general characteristics of surgery for BPH

A

All can be done outpatient
Local anesthesia
No foley, few complications
Removes excess prostate tissue

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91
Q

what is thermotherapy and what is it used for

A

BPH
destroy tissue and stents are placed to keep prostate patent
ex: tuna, tunt, and Ilc

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92
Q

when would you use more traditional therapies for BPH

A

Used when other complicating issues are involved

Acute urinary retention, hematuria, chronic UTIs, high urinary residuals, hydroureter, hydronephrosis

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93
Q

Transurethral resection of the prostate = TURP

A

Excess prostate issue is removed via endoscope under epidural or spinal anesthesia
Stricture, might need repeat surgeries
No surgical incision line
Long term sexual function should not be affected

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94
Q

adverse effect of the TURP

A

Can have retrograde ejaculation for some time → into bladder

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95
Q

2 other surgeries for BPH w/ other factors

A

TUIP - transurethral incision of prostate

Open prostatectomy. -Entire prostate is removed under general

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96
Q

after BPH surgery, how long do you have CBI for

A

24 hours

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97
Q

characteristics of foley for post BPH surgery

A 
3 way catheter w/ 30-45 ml balloon (Normal foley = 10ml balloon)
Tape to leg 
Run irrigant (NS) into bladder
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98
Q

how often should you look at urine outputs post BPH surgery while foley is in

A

hourly

need to get out what you’ve put in plus a little more!

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99
Q

what is the most common cancer in men

A

prostate cancern, slow growing, predicatble

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100
Q

when do you screen for prostate cancer

A

over 50, annually

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101
Q

risk factors for prostate cancer

A

Diet high in animal fats
Age
Vietnam vets d/t agent orange

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102
Q

what is EPCA-2

A

early prostate cancer antigen

New serum marker just for prostate cancer

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103
Q

prostate cancer surgery: types and indication

A

Can be indicated if cancer is resistance to radiation

MIS - usually minimally invasive
Open radical surgery
Laparoscopic radical prostatectomy (LRP)

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104
Q

what are complications post radical prostatectomy

A

Usually sterile after
Urinary incontinence - might be permanent
Impotence (ED) - lasts 3-18 months

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105
Q

what are non surgical options for prostate cancer

A

Radiation seed implants
External radiation
hormonal therapies - androgen deprivation
chemotherapy
cryotherapy —> can lead to ED and incontinence

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106
Q

what are precautions for radiation seed implants

A

Anyone under 3 should not be in lap

Less than 5 mins per day per child

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107
Q

what are s/s of androgen deprivation therapy

A

LH releasing hormone agonists to release more testosterone

s/s: onset of ED, hot flashes, gynecomastia

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108
Q

what is a fistula and where is it located

A

Attaching artery to vein

forearm, upper arm or thigh

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109
Q

what to know about a AV fistula, graft or shunt

A

No BP readings in the affected extremity
No venipuncture
Palpate for thrills; auscultate for bruits
Assess distal pulses - want to ensure good blood flow
Encourage routine ROM of extremity
Check for bleeding at the site
Assess for manifestations of infection
Teach patient how to guard their graft/shunt

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110
Q

for patients w/ renal failure, how do you manage excess fluid volume

A

Daily weights!
Fluid restrictions
Assess for overload/crackles and JVD

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111
Q

what are dietary considerations for renal failure patients

A

Protein - restrict as renal failure worsens
Fluid (urine output + 500 ml/day usually for all input)
K+
Na+ - limit b/c of thirst and HTN
Phosphorus - limit
Water content of foods

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112
Q

does hemodialysis or peritoneal dialysis have more dietary restrictions

A

hemodialysis

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113
Q

what are neuro changes in the elderly

A

Intellect does not decline with age
Perceived changes are related to drug interactions, less sleep
Response time - can take longer for older adults to learn or process something new

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114
Q

what causes memory changes in the elderly

A

Decreased number of neurons
Brain size atrophies
Recent memory is less clear than distal memories

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115
Q

sensory changes in the elderly (3)

A

Touch sensation is diminished with age
Hearing is less acute
Pupils are smaller in general - need more light to see

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116
Q

motor changes in the elderly (4)

A

Movement is slower
Balance changes
Coordination changes
Postural changes

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117
Q

before doing a neuro check on a patient, what must you know

A

their baseline

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118
Q

what could cause acute changes in mental status

A

infectious process elsewhere in the body

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119
Q

what is the first sign CNS function has declined

A

changing LOC

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120
Q

stuporous characteristics

A

can be roused with vigorous painful stimuli

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121
Q

comatose

A

cannot increase LOC no matter what

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122
Q

PERRLA

A

Equal, round, reactive to light and accommodate

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123
Q

what can alter the shape/appearance of pupils

A 
Surgeries
Eye meds
Cataracts
Dry eye syndrome
Traumatic injury
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124
Q

what is a late sign of neuro deterioration

A

can have dilated pupil or non reactive pupils

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125
Q

lowest score of glasgow coma

A

3

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126
Q

highest score of glasgow coma

A

15 = higher functioning

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127
Q

when do you test response to painful stimuli

A

GSC score of less than 6

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128
Q

1st way to get test response to painful stimuli

A

use normal voice, then go to loud voice then give gentle tap or shake (not for trauma pt)
Supraorbital pressure: Feel ridge of eye socket - gentle pressure
Trapezius squeeze - thumb in juncture of neck and chest and squeeze
Sternal rub w/ knuckles - should be last

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129
Q

2nd way to test pain response

A

peripheral pain assessment
Test all extremities for responsiveness
Press pencil on cuticle

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130
Q

how to assess motor function

A

MAE - moving all extremities
Assessment of strength in each extremity
Grasps
Push on the gas, pull your toes up to toward your head

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131
Q

how to test sensory function

A

Sharp vs dull

2 point discrimination - close their eyes and ask them to tell you which toe you’re touching

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132
Q

what does a CT look at

A

w/ or w/o contrast
Contrast is iodinated
Looks at structural changes

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133
Q

what is a magnetic resonance spectroscopy used for

A

alzheimers

strokes

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134
Q

what is an MRI used for

A

Looks at soft tissues
Also MRA/MRV
Uses gadolinium (not iodine)

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135
Q

what is a PET scan used for and how do you prep a patient for it

A

Malignancies
Cerebral blood flow

Prep:

  • NPO 6 hours before
  • Should not get insulin 6 hours before and no metformin to avoid lactic acidosis
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136
Q

what does an EEG do (6)

A 
Evaluate brain activity
Determine site of seizure origin
Diagnose sleep disorders
Monitor activity during anesthesia
Determine brain death
Degenerative brain disease
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137
Q

how to stimulate brain for EEG

A

Photo stimulation
Auditory stimulation evoked potential to assess hearing loss or auditory nerve damage
Somatosensory evoked potential - delivery tiny shocks to check for nerve degenerative disease/disorders

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138
Q

what are migraines

A

Associated w/ spasm of cerebral arteries
Chronic, episodic disorder, usually 4-72 hours
Pain usually worse behind one eye or ear

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139
Q

if someone has a migraine new onset after 50

A

have neuro imaging done

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140
Q

s/s of migraine

A

Unilateral, fronto temporal throbbing pain, with phonophobia, photophobia, N/V, sensitive scalp

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141
Q

what are triggers for migraines

A

Dietary - cheese, chocolate, nuts, caffeine, yeasts, smoked foods, artificial sweeteners, red wine
Physiologic changes: sudden drops in blood glucose, skipping meals, anger, mood changes, fatigue
Meds: missed medications, nifedipine, nitroglycerin, estrogens
Big changes in barometric pressure and weather

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142
Q

stage 1 of migraine: prodrome

A

mood changes, cravings, behavioral changes

143
Q

stage 2 of migraines: aura

A

warning sign that something is coming
Visual changes associated with it (i.e. flashing lights, double vision)
Paresthesia sometimes
Phonophobia, photophobia

144
Q

stage 3 of migraine: headache

A

wanes in intesnity over time

145
Q

stage 4 of migraine: post prodrome

A

Exhaustions, muscle pain, irritation, no appetite

146
Q

how to relieve pain w/ migraines

A

ice packs
head elevated
dark room

147
Q

meds for migraines

A

NSAIDs, tylenol, or OTC preps w/ caffeine
Ergotamine derivatives - nasal sprays or injections (DHE or cafergot)
Triptans - Imitrex, Relpax, Zomig, Maxalt, Frova
Opiates and barbs
Antiemetics and antidpressants

148
Q

preventative therapy for migraines and when is it indicated

A

more than 2x in a week
Avoid triggers: Eating regularly, rest, diet
Beta blockers (timolol, propranolol)
Antiepileptics (topamax, depakote)

149
Q

other therapies for migraines (CAMs and herbs)

A

Acupuncture
Massage
Willow, ginger, valerian, lavender, peppermint

150
Q

when do cluster headaches onset

A

Onset with relaxation, nap or REM

-Seasonal

151
Q

how long do cluster headaches last

A

30-90 minutes but recur q 8-12 hours for 4-12 weeks followed by a period of remission (9-12 months)

152
Q

s/s of cluster headaches

A

Excruciating, boring, non throbbing frontal or oculo temporal pain which may radiate
Pt may sit and rock or pace during episode
Ipsilateral tearing of eye and diaphoresis on one side
Rhinorrhea
Ptosis - drooping eyelid
Eyelid edema and bilateral pupillary miosis (constriction)
N/V

153
Q

tx for cluster headaches

A

Triptans, ergotamines, antiepileptic drugs
Verapamil, lithium, corticosteroids, and OTCs (melatonin, glucosamine)
Oxygen mask x 10-15 mins during headache to decrease cerebral blood flow until headache gets better
Sunglasses, avoid direct light
avoid precipitating factors

154
Q

surgery for cluster headaches

A

last resort
Deep Brain stimulation (DBS) - stimulate subthalamus and implanted unit
Percutaneous stereotactic rhizotomy (PSR) - needle into trigeminal nerve

155
Q

what is the most common chronic headache

A

tension headaches

156
Q

s/s of tension headaches

A

-present w/ neck, shoulder, muscle tenderness
-bilateral pain at base of skull and forehead
-lasts > 4 hours
- different presentations
can also have N/V, photophobia and phonophobia

157
Q

how to tx tension headaches

A

NSAIDs, ASA, muscle relaxants, OTCs

Prophylaxis is similar to migraines

158
Q

what is a seizure

A

abnormal, sudden, excessive, uncontrolled electrical discharge of neurons within the brain
is A SYMPTOM

159
Q

epilepsy

A

chronic disorder with recurrent unprovoked seizures; may be caused by abnormality in electrical neuronal activity and/or imbalance of neurotransmitters

160
Q

what can trigger epilepsy

A 
Physical activity
Stress
Fatigue
Alcohol
Caffeine
Specific food intolerances  (wheat, soy, sugar, dairy)
Medication intolerances
Flashing lights (strobe)
161
Q

primary/idiopathic epilepsy

A

Not associated with anything identifiable

162
Q

Secondary epilepsy

A

d/t another disorder like…
Metabolic disorders
heart disease
Brain lesions/tumors, stroke or head injury
Acute alcohol withdrawal or substance abuse

163
Q

generalized seizures

A

involve entire brain and both hemispheres

tonic, clonic, tonic-clonic, absence, myoclonic, atonic

164
Q

tonic seizure

A

abrupt increase of sig muscle tone

Stiffening of the muscles

165
Q

clonic

A

rhythmic jerking of all extremities

166
Q

tonic-clonic

A

both tonic and clonic

167
Q

absence seizure

A

brief, blank stare, no postictal period, (avg 10-30 seconds), automatisms (like lip smacking, or patting)

168
Q

myoclonic

A

brief, involves extremities either singly or in groups, symmetric or asymmetric
Can happen after brain injury

169
Q

atonic

A

drop attack, sudden loss of muscle strength

Resistant to drugs

170
Q

postictal period characteristics

A

pt is confused, disoriented, silent, awaken over time, gargled speech, emesis

171
Q

partial seizures

A

Less responsive to treatment
Begin in one cerebral hemisphere (can progress to general)
2 types exist: complex and simple

172
Q

complex partial seizures

A 
(psychomotor): 
Lose LOC
May have automatisms
Unaware of environment
Might wander
Involves temporal lobe
173
Q

simple partial seizures

A 
Remains conscious
May have aura
May have deja vu phenomenon 
May have unilateral limb movement
Automatisms potentially 
Autonomic symptoms - increased HR, flushing, GI discomfort
Fear, anger, sadness
Difficult speech 
Hallucinations but aware it's a hallucination
174
Q

unclassified seizures

A

no known reason, don’t fit into category, idiopathic

Half of all seizures

175
Q

drug drug concerns w/ seizures

A

antibiotics will alter anticonvulsant levels
more than one anticonvulsant will affect another
Ginkgo decreases anticonvulsant level

176
Q

drug food concerns w/ seizures

A

Phenytoin blocks absorption of folic acid

Folic acid, vitamin D - can be interfered w/ by anticonvulsants

177
Q

can you administer warfarin and phenytoin - what does warfarin do to phenytoin

A

no - warfarin Increases serum half life of phenytoin

178
Q

what should you have in the room of an epileptic pt

A

airway, suction and O2 available, IV access, side rails up and padded
No tongue blades or restricting movement!

179
Q

seizure mgmt

A 
Stay with pt
Time seizure
Observe
Document
Prevent injury
Bed in lowest position 
Prevent aspiration
Contact MD
180
Q

pt education for seizures

A

Need to take meds daily even if seizures stop
No ETOH can interfere w/ medications & lowest seizure threshold
Medic alert bracelet
Employment concerns - do they put others at risk
Driving - may have to be seizure free for a specific amount of time to get license back
Acceptance
Family should be involved as to what pt. can and can’t do

181
Q

parkinsons

A

progressive neurodegenerative disease affecting motor ability

  • cause: exact cause unknown, but suspect combo of environment and genetics (maybe well water?, over 40, decreased estrogen levels, exposure to chemicals or heavy metals)
  • can be secondary to other things
  • involves dopamine and NE loss
182
Q

early signs of parkinsons (3)

A

Loss of sense of smell
Constipation
Sleep disorders

183
Q

4 cardinal signs of parkinsons

A
  1. tremor at rest
  2. Rigidity - muscles are stiff and don’t fully relax
  3. problems with motor and fine movement: Akinesia or bradykinesia
  4. Postural instability: Freezing gait while walking
184
Q

stage 1 of parkinsons

A

Initial presentation - mild symptoms, unilateral and one limb involved, minimal weakness w/ tremors

185
Q

stage 2 of parkinsons

A

Mild parkinson’s disease - bilateral limb involvement, mask like face, slow shuffling gait

186
Q

stage 3 of parkinsons

A

Moderate - postural instability, increased difficulty with gait, need cane or walker

187
Q

stage 4 of parkinsons

A

Severe - akinesia and rigidity of muscles

188
Q

stage 5 of parkinsons

A

Dependent on caregiver for everything - can’t perform ADLs

189
Q

s/s of parkinsons

A

muscular rigidity, change in facial expression, difficulty chewing, swallowing, uncontrolled drooling, increasingly cognitively demented, can’t initaite volutnary movemements, orthostatic hypotension, perspiration
Forward tilted
Reduced arm swinging

190
Q

goal of tx for parkinsons

A

improve mobility for self care

191
Q

medications for parkinsons

A 
Anticholinergic drugs for tremor  (Cogentin - helps move but doesn’t help cognitively)
Dopamine agonists
levodopa/carbidopa (take w/ meals)
Bromocriptine (parlodel)
Amantadine (symmetrel)
Tasigna - tyrosine kinase inhibitor
COMT inhibitors
192
Q

concerns for parkinsons meds

A

Hallucinations
Over time, less effective
Doses have to be reduced over time b/c AE gets so bad
Medications have to be changed over time
“Drug holiday” and then restart at lower dose

193
Q

ways to manage parkinsons

A

exercise and ambulation for mood and mobility
need thickened liquids so they don’t aspirate
communication boards or speech therapy
psychosocial support
surgery as a last resort - deep brain stimulation or stereotatic pallidotomy

194
Q

dementia

A

syndrome of slowly progressive cognitive decline. Pt is chronically confused.
Most common dementia (60%) is Alzehimer’s disease
Second most common (20-25%) is multi-infarct dementia

195
Q

delirium

A

acute state of concussion which is reversible. Often seen in patients who are in an unfamiliar setting. Up to 50% of older pts who are hospitalized experience this.
May have physical and emotional components as well as cognitive

196
Q

hyperactive delirium

A

may climb out of bed, or become agitated, restless and aggressive

197
Q

hypoactive delirium

A

quiet, apathetic, withdrawn

198
Q

mixed delirium

A

may have a combo of both hyper and hypo manifestations

199
Q

unclassfiable delirium

A

cannot fit into any category
Can be d/t medications, infection, electrolyte imbalance, fecal impaction/diarrhea, hypoxia, nutritional deficiencies, relocation, major loss or disorders of any system

200
Q

nursing interventions for delirium

A

Assess patient with Confusion Assessment Method or similar tool
Verify pt’s baseline LOC with family/facility
Provide for pt safety
Speak in calm voice
Frequently re-orient pt
Provide with a fidget instrument
Have family provide a familiar item to patient

201
Q

lumbosacral back pain

A

Lower back pain

  • pain d/t muscle strain, spasm, ligamentous injury, spinal stenosis, spondylothesis
  • can be d/t herniated nucleus pulposus = herniated disk, bulging disc
202
Q

s/s of lumbosacral back pain

A 
Sciatica 
Continuous acute pain
Altered gait
Vertebral alignment
Paresthesia
Change of position is painful
203
Q

how to do you dx lumbosacral back pain

A

MRI or CT

204
Q

nonsurgical mgmt for lumbosacral back pain

A

Standing or lying rather than sitting
Williams position for comfort - lying down with knees to chest
Firm mattress
Exercise
Drug therapy
Heat and ice therapy
Diet therapy - more than 10% overweight - losing weight will help
Other pain relief measures ie TENS, ultrasound
CAMs - acupuncture, music therapy, bean bags you can heat

205
Q

surgical mgmt of herniation

A

Minimally invasive - percutaneous laser disk decompression
Diskectomy and laminectomy - open procedures
Spinal fusion may be done with open procedures if unstable

206
Q

risks for surgical mgmt of spine herniations

A 
Nerve injury
Discitis
Dural tears
Infection
Chronic pain d/t nerve injury
207
Q

where is cervical neck pain usually

A

Herniation of cervical disk, usually laterally

Usually C5 -C6

208
Q

how does cervical neck pain present

A

Radiating pain with neck movement
Headache
Numbness in arm

209
Q

how do you dx cervical neck pain

A

MRI

210
Q

surgery for cervical neck pain

A

anterior cervical disk, resection

Concern about swelling and bleeding for airway, swallowing

211
Q

post op mgmt for herniation surgery

A 
Distal neurovascular checks
Check patient’s ability to void
Pain control
wound/dressing checks
Positioning and mobility
Check sensation and mvmt
Log roll
212
Q

MS

A
  • chronic autoimmune disease affects the myelin sheath and conduction pathway of the CNS
  • characterized by periods or remission and exacerbation
  • inflammatory response results in demyelination of sheath, and decreased transmission of nerve impulses
213
Q

what can trigger ms

A

onset: virus, genetic predisposition, colder climates
exacerbations: Fatigue, stress, overly exerting oneself, temp extremes

214
Q

s/s of MS

A

Weak, fatigued, and activity intolerant
Muscle spasms at night, intention tremors in the day
Tinnitus and vertigo
Dysmetria
Visual changes - blurred or double vision, ↓ acuity, nystagmus
↓ hearing ability
Hypalgesia - ↓ ability to feel pain
Bowel or bladder dysfunction
May have personality and behavioral changes, poor decision making, attention loss
Cognitive changes appear later in disease

215
Q

relapsing/remitting MS

A

most common
Mild to moderate form of dz, decreasing fxn and development of new symptoms
Symptoms for weeks to months but can return to baseline functional level

216
Q

Progressive-relapsing MS

A

Frequently relapse, only partially recover, no remission

Never return to baseline

217
Q

primary progressive MS

A

Slowly deteriorate neurologically over time, no remission

Doesn’t have acute exacerbations

218
Q

secondary progressive MS

A

Starts as relapsing-remitting but progressively deteriorates

219
Q

tx for MS

A

Treat symptoms and slow progression
Biological response modifiers: Interferon beta-1a, Tysabri (*Significant side effects)
Immunosuppressives (steroids and antineoplastics)
Steroids
Antispasmodics
Adjunctive therapy

220
Q

is Guillain barre more common in men or women

A

women

221
Q

what kind of disorder is guillain barre

A

Acute autoimmune disorders, follows acute illness

222
Q

s/s of GB

A

Varying degrees of motor weakness and paralysis

Starts in legs and spreads to arms and upper body

223
Q

GB presentation

A 
Ascending symmetric muscle weakness
Decreased or absent DTRs
Respiratory compromise may be a problem
Paraesthesias and pain, muscle cramping
Labile blood pressure
Tachycardia and arrhythmias
Facial weakness and dysphagia
Diplopia
Bowel and bladder control issues in some
Cerebral function or pupillary signs are not affected
224
Q

are Cerebral function or pupillary signs affected in GB

A

no

225
Q

tx for GB

A

plasmapheresis to remove antibodies
Immunoglobulin (IVIG) - lessens immune attack on nerve system
NO STEROIDS

226
Q

GB outcomes

A

highly variable - can be months or years until recovery

Usually have residual muscle weakness up to 3 years later

227
Q

myasthenia gravis (MG)

A

Chronic autoimmune disease of neuromuscular junction

228
Q

characteristics of MG

A

fatigue and weakness
Primarily in muscles innervated by cranial nerves, skeletal and respiratory muscles
Progressive paresis of affected muscle groups partially resolved by resting

229
Q

cause of MG

A

formation of autoantibodies to Ach receptors

230
Q

complication of MG

A

thymus tumor

rare

231
Q

how does MG affect the eyes

A

Ocular palsies or ptosis
Diplopia
Weak or incomplete eye closure

232
Q

s/s of MG

A 
Resp distress
Facial expression change
Fatigue and poor posture
Speech change
Difficulty chewing
Limb weakness
Bowel and bladder function
Muscle weakness worsens when patient is fatigued
Decreased sense of smell and taste
233
Q

why is eye protection imp for MG

A

they cannot close eyes well → dryness, abrasions

Artificial tears, lubricant gels at night

234
Q

drugs for MG

A

Cholinesterase inhibitor drugs - drugs that include anticholinesterase drugs for increased muscle strength (Mestinon - pyridostigmine)
Immunosuppressants to decrease immune response: Chemo & steroids
IVIG (block harmful antibodies)
Plasmapheresis (to remove harmful antibodies)

235
Q

when should ACHE inhibitors be given

A

Administer within an hour before eating and on time

236
Q

Myasthenic crisis and tx

A

exacerbation of symptoms caused by undermedication of anticholinesterases
Tx: Tensilon given IVP

237
Q

Cholinergic crisis and tx

A

acute exacerbation of muscle weakness caused by overmedication of anticholinesterase drugs:
Tx: pt. Would not improve after Tensilon → give atropine IVP (antidote to tensilon)

238
Q

tensilon test

A

diagnostic test used to evaluate myasthenia gravis, which is a neuromuscular condition characterized by muscle weakness. The test involves an injection of Tensilon (edrophonium), after which your muscle strength is evaluated to determine whether your weakness is caused by myasthenia gravis or not.

239
Q

how long does improvement from tensilon last

A

5 mins

240
Q

priority nursing mgmt for MG

A

maintain adequate resp function

241
Q

what can exacerbate MG

A 
Infection
Stress
Heavy physical exercise
Surgery
Sedatives or analgesics, enemas, cathartics
242
Q

what causes Facial Paralysis/Bell’s Palsy (CN and virus and who do you see it in?)

A 
Acute inflammation of 7th cranial nerve
r/t dormant HSV-1 virus
Unilateral facial muscle paralysis
See in diabetics
Peaks in 48 hours
243
Q

medical mgmt of facial paralysis/bells palsy

A

Steroids (prednisone)
Analgesics for discomfort in face
Antivirals (acyclovir) not consistently
Anticonvulsants (neurontin)

244
Q

other mgmt for bells palsy/facial paralysis

A

Protection of eye
Nutrition
Massage, warm, moist heat, facial exercises

245
Q

can facial paralysis/bells palsy be permanent

A

yes

Most patients fully recover within a few weeks but not all, can be permanent

246
Q

bone changes with aging (3) and result

A

↓ bone density
Synovial joint cartilage less elastic
Muscle tissue atrophy
Result: ↓ coordination loss of strength, gait changes

247
Q

effusion

A

collection of fluid in a joint

248
Q

serum calcium normal

A

9.0-10.5

249
Q

serum phosphorous normal

A

3.0-4.5

inversely related to Ca

250
Q

serum alkaline phosphatase normal

A

30-120

elevated in bone cancner

251
Q

what muscles enzymes elevate in response to muscular damage

A

CK and LDH

252
Q

osteoporosis

A

Disease of demineralization of bones

Continue to break down but not rebuilding

253
Q

primary osteoporosis

A

Post menopausal w/ women

r/t to decreased estrogen

254
Q

secondary osteoporosis cause

A 
corticosteroids, alcohol, heparin, antidepressants, anticonvulsants, high levels of exogenous thyroid hormone 
Other conditions: 
Hyperthyroidism, hyperparathyroid and adrenal gland
Prolonged immobilization
Uncontrolled DM 
Cushing’s 
Metabolic acidosis
RA
Marfan’s 
Cirrhosis
Bone cancer
Low vit D or low Ca levels
Carbonated beverages
Caffeine and tobacco smoke
Exercissive exercise in females
255
Q

risk factors for osteoporosis

A 
Women
Age >60
Family hx
White or asian race
Thin, lean body type
Low lifetime Ca intake
Estrogen deficiency
Smoking history
High alcohol intake
Lack of physical exercise or immobility
256
Q

drug therapy for osteoporosis

A 
HRT
Parathyroid hormone (forteo)
Ca supplement + vitamin D
Biphosphonates (Boniva, Fosamaz, Actonel)
SERMs (evista)
Calcitonin
257
Q

how does PTH help treat osteoporosis

A

increases bone density and strength, decreases osteoporosis

258
Q

diet therapy for osteoporosis

A 
Adequate protein, Mg, Vit K, trace minerals
Minimize alcohol and caffeine
Vit C and iron
Calcium
Dietary consultation
259
Q

what is important for osteoporosis

A

fall prevention

260
Q

osteomyelitis: causes

A

Bacterial, fungal, viral
Cyclic process in bone ischemia/abscess/necrosis

Bacteriemia of any origin
Poor dental hygiene or gum disease
Non or penetrating trauma/bone necrosis, puncture wounds
Animal bites
Bone surgery
261
Q

acute osteomyelitis: s/s

A 
Fever > 101F
Localized swelling
Erythema, tenderness of area
Bone pain is constant, localized, pulsating, worse w/ movement
WBCs ↑
262
Q

chronic osteomyelitis s/s

A 
Ulceration of the skin
Sinus tract formation
Localized pain
Drainage from affected area
WBCs may be normal
263
Q

drug therapy: osteomyelitis

A

prevention = best option
prolonged antibiotic therapy
hyberbaric o2 therapy

264
Q

surgical therapy: osteomyelitis

A

Debridement of necrotic bone (sequestrectomy)
Bone grafts or bone segment transfers
Muscle flaps
amputation

265
Q

what are signs of neurovascular compromise

A

is an emergency!

Pain intractable
Paresis or paralysis of extremity
Paresthesias
Pallor
Pulselessness
266
Q

types of fractures

A 
Complete or incomplete
Closed (simple) or open (compound)
Displaced vs. nondisplaced
Comminuted (fragmented)
Pathologic (spontaneous) d/t to another disease process
Stress (fatigue) fracture
Compression
267
Q

how long can bone healing take

A

6 weeks - 6 mos

268
Q

For assessing fractures of the shoulder and arm

A

Sitting upright

Support affected arm to promote comfort

269
Q

For assessing distal areas of the arm:

A

Assess in supine position

270
Q

Fractures of lower extremities or pelvis

A

assess in supine

271
Q

musculoskeletal assessment

A 
Observe for change in bone alignment
Alteration in the length of extremity
Rotation of a limb
Change in bone shape
Pain w/ mvmt/inability to move
Decreased ROM
crepitation/ecchymosis/swelling
Amount of soft tissue damage
272
Q

EBL: ankle fracture

A

250-1000 ml

273
Q

EBL humerus fracture

A

500-1500 ml

274
Q

EBL elbow fracture

A

250-750 ml

275
Q

EBL radius/ulna fracture

A

250-500 ml

276
Q

EBL tibia/fibula

A

250-2000 ml

277
Q

EBL femur

A

500-3000 ml

278
Q

EBL pelvis

A

750-6000ml

279
Q

fat embolism syndrome and s/s

A 
Syndrome resulting from release of fat globules into bloodstream from yellow marrow
First: altered LOC
Resp distress
Tachycardia, tachypnea
Fever
Chest pain
petechiae
280
Q

nonsurigcal mgmt: fracture

A

Early immobilization for best outcomes
Closed reduction and immobilization
Splint, bandage, cast, traction
Neurovascular checks hourly for 24 hours then every 4-8 hours as needed
Elevated injured extremity above level of the heart
Apply ice on/off for the first 24-48 hours
Watch for signs of Acute Compartment Syndrome

281
Q

what does eearly immobilization of an injury do

A

decreases pain, and negative outcomes

282
Q

complications of rigid devices

A

Infection
Circulation impairment
Peripheral nerve damage
Complications of immobility

283
Q

Open reduction and internal fixation = ORIF

A

Direct visualization
Permits early mobilization
Hardware may need to be removed in the future

284
Q

external fixation (EF)

A

self drilling pins implanted in bone, held in place by an external metal frame to prevent bone mvmt

285
Q

Types of hip fracture (2) and how to tx

A

Intracapsular (inside joint capsule of hip) vs. extracapsular (outside joint capsule)
Tx by ORIF usually
-Allows older client to get out of bed sooner
-May involve rod, pins, fixed plate or a prosthesis

286
Q

Is surgery required for a Non weight bearing pelvic fracture

A

surgery is not required

287
Q

weight bearing pelvic fracture

A

involves multiple fractures or pelvis or pelvic ring itself - will need ORIF or EF
May not be able to bear weight for 12 weeks

288
Q

second most common cause of death from trauma

A

pelvic fracture

289
Q

negative nitrogen balance and why it’s important

A

delays healing!

protein breakdown exceeds protein anabolism (buildup)
When trying to heal, metabolism increases - might break down nonessential organs and tissues
Healing won’t occur if negative nitrogen balance occurs

290
Q

kyphoplasty

A

insert bone cement to restore

used for compression fractures of the spin

291
Q

vertebroplasty

A

for compression fractures of the spine

Balloon catheter into vertebral body to restore height of vertebrae

292
Q

how to deal with traumatic amputations

A

Digit or part is wrapped with cool, dry cloth and just moistened with NS or bottled water
Placed in a sealed plastic bag which is placed in ice water

293
Q

when is surgical amputation indicated

A

d/t disease

294
Q

complications from amputations

A 
Hemorrhage
Infection
Phantom limb pain
Problems associated w/ immobility
Neuroma
Flexion contracture
295
Q

neuroma

A

cluster of nerve cells that grow after amputation

296
Q

what is phantom limb pain like

A

burning, crushing, cramping

297
Q

how to treat phantom limb pain

A

Opioids not as effective for PLP

Tx: calcitonin (IV infusion 1st week post op), beta blockers, anticonvulsants, antispasmodics

298
Q

levels of amputation

A 
Above knee
Below need
Mid foot amputation
Syme amputation - top of the foot below the leg
Toe amputation
299
Q

what is rheumatology

A

study of conditions or disease involving musculoskeletal system

300
Q

characteristics of osteoarthritis

A 
Weight bearing joints and hands/feet
Not systemic
Not inflammatory
Most common arthritis
Nodal (involving hands)
Non nodal (no hands)
301
Q

primary osteoarthritis

A

idiopathic

Triggered by age, obesity, genetic factors, smoking

302
Q

secondary osteoarthritis

A 
caused by something else
Other metabolic disorders (ex: DM)
Hemophilia
Sickle cell
Motor vehicle accidents
303
Q

manifestations of osteoarthritis

A 
Chronic pain
Loss of function d/t loss of cartilage
Not symmetrical
Not bilateral
Not progressive to other parts of the body
304
Q

will lab tests be normal or abnormal for osteoarthritis

A

normal

305
Q

what would pain be like early in osteoarthritis

A

Pain with mvmt

No pain in rest

306
Q

what would pain be like late in osteoarthritis

A

May not have pain relief when activity stops

307
Q

how would pt describe osteoarthritis pain

A

pain radiates down extremities

crepitus

308
Q

Herberden’s nodes (DIP)

A

distal joint nodules

309
Q

bouchard’s nodes

A

proximal nodules

310
Q

osteoarthritis: pt lived experiences

A 
Perm lifestyle changes
Pain, muscle spasm, crepitus
Quality of life changes
Role change
Body image and self esteem changes
Immobility and joint enlargement
Inflammation can result if synovitis has developed
Behavior changes: anger, depression
311
Q

heath promo for osteoarthritis

A 
Keep weight WNL
Limit activities that stress the joints
Shoes
Avoid repetitive activities
Avoid risk taking activities
Stop smoking
312
Q

drug therapy for osteoarthritis

A

OTCSs, Rx, injectables

Tylenols, NSAIDs, Cox 2 inhibitors, antispasmodics, hyaluronate, steroids, lidocaine patches, topical salicylates

313
Q

is heat or cold better for osteoarthritis

A

heat

314
Q

how to manage post op total joint arthroplasties

A

H&H every 4 hours
keep pt midline

hip: prevent dislocation w/ riser and abduction pillows
knee: CPM machines to maintain mobility, to decrease risk of scar formation or clots

315
Q

CIs for osteoarthritis surgeries

A

Severe osteoporosis
Active infection
Uncontrolled DM

316
Q

osteotomy

A

Part of bone is resected to correct bone or joint deformity
Less invasive
Endoscopic

317
Q

Q ball

A

pinned to pt gown, filled w/ topical anesthetic - inserted by tube into surgical site and slowly released

*under osteoarthritis section

318
Q

how to prevent dislocation

A

No leg crossing, no hip flexion, use toilet risers

Progression of activity - up and out of bed

319
Q

RA

A

A chronic, systemic, progressive autoimmune process that destroys primarily the synovial joints
Inflammatory process!
Autoantibodies = RF
Affects synovial and other tissue anywhere in the body

320
Q

early RA disease s/s

A 
Fatigue
Morning joint stiffness, swelling, pain
Anorexia and small weight loss
Low grade fever
Symmetrical and bilateral in multiple joints (Usually upper body first)
Joint inflammation
321
Q

late RA disease s/s

A

Joint deformities
Moderate to severe pain + morning stiffness
Exacerbations: Moderate to severe weight loss, Anorexia, Fevers, Extreme fatigue, Peripheral neuropathy and paresthesias
Vasculitis (Ischemic skin lesions)

322
Q

lab test for RA

A 
CBC, anemia, increased WBCS
RF 
Antinuclear antibody
ESR
Serum complement (C3 and C4); decreased usually
323
Q

RA respiratory complications

A

Pleurisy
Pneumonitis
Fibrotic lung disease
Pulmonary HTN

324
Q

RA cardiac complications

A

Pericarditis

Myocarditis

325
Q

RA opthalamologic complications

A

Iritis or scleritis

326
Q

arthocentesis

A 
Aspirate of synovial fluid
Evaluated for RF, WBCs, etc
Local anesthesia only
Ice and rest the joint for 24 hours
Tylenol
327
Q

RA psychosocial issues

A

Depression, frustration, helplessness, isolation
Reality based fears b/c they will be dependent
Quality of life issues

328
Q

drugs for RA

A

NSAIDs
DMARDs
biologic DMARDs to decrease inflammation
glucocorticoids (steroids)

329
Q

3 other treatments for moderate to severe RA

A

Narcotic analgesics
Nonpharmacologic: heat and cold
Plasmapheresis

330
Q

goal of RA therapy?

A

Promotion of self care to limit the patient’s abilities - May lose fine motor skills first
Mgmt of fatigue
Enhanced body image
Teaching

331
Q

DLE

A

discoid - involves skin

332
Q

population most commonly impacted by SLE

A

More common with women 15-40 y.o onset

333
Q

SLE characteristics

A

autoimmune
Chronic, progressive, inflammatory connective tissue disorder
Can be fatal if not treated
Major organ systems may fail over time - kidney failure is leading cause of death

334
Q

SLE manifestations

A 
Characteristic butterfly rash - can see face or elsewhere, Sun exposed areas
Alopecia - head and body
Polyarthritis - can be seen early stages
Polymyalgia - muscle aches everywhere 
Joint inflammation
Osteonecrosis
335
Q

why can SLE result in osteonecrosis and where?

A

can be side effect b/c of steroids - lack of oxygen and blood flow
Hip or tibia

336
Q

DLE manifestations

A

round, scarring lesions only - can be seen in sunlight or UV

337
Q

complications of SLE

A 
Pleural effusion or pneumonia in 50%
Pericarditis - most common cardiac complication
Abdominal pain from multiple etiologies
serositis = peritoneal involvement
Lymphatic enlargement
Raynaud’s phenomenon
Paresis
Seizures
Migraines
Peripheral neuropathy
Marrow involvement - anemias, thrombocytopenia, pancytopenia, leukopenia
Psych issues
338
Q

how to assess for DLE

A

skin biopsy

339
Q

SLE lab assessments

A 
VDRL = can have false positive 
anti-Ro, anti-SS- a (or - b), anti DNA
Higher titers w/ SLE but not diagnostic
*Anti nuclear antibody test  (ANA)- more consistent with SLE
ESR rate might be elevated
CBC
RF might be drawn
340
Q

how to tx DLE

A

topical cortisone and hydroxychloroquine (plaquenil)

Prevents further skin lesions

341
Q

how to tx SLE

A

Aggressive steroid therapy until remission
Hydroxychloroquine to decrease inflammation and slow progression
Immunosuppressants (renal and CNS symptoms)
plasmapheresis if don’t respond to other treatments
Pregnancy is not advised
Renal transplant

342
Q

Fibromyalgia Syndrome: is it inflammatory?

A

Chronic pain syndrome, but not an inflammatory disease

343
Q

who do you see fibromyalgia in

A

women from 30-50 y.o and on

344
Q

what can contribute to fibromyalgia

A 
chronic fatigue, 
lyme disease, 
significant trauma, 
certain meds, 
flu like illness
345
Q

secondary fibromyaglia

A

often seen in combo w/ other connective tissue disorders

w/ Lupus, or RA

346
Q

characteristics of fibromyalgia

A

Fatigue and sleep disturbances
Paresthesias in extremities
Headaches and jaw pain
GI pain with diarrhea or constipation
GU discomfort
CV complaints - dysrhythmias, chest pain, dyspnea
Visual disturbances: Vertigo, Dizziness, Dry eye
Neurologic complaints: Forgetfulness, Problems with concentration
depression and anxiety

Muscle tenderness r/t inability to tolerate pain
Trigger points

347
Q

what are trigger points for fibromyalgia

A

burning, gnawing characteristic
When palpated
Neck, upper chest, trunk, low back

348
Q

how is fibromyalgia pain exacerbated

A

Stress
Increased activity
Changes in weather

349
Q

how to tx fibromyalgia

A 
Limit anything that can interfere with sleep: Alcohol, Caffeine, Other meds
Nerve pain - pregabalin
Antidepressant  - duloxetine
Physical therapy
Low impact exercise as tolerated
NSAIDs
CAMs
350
Q

chronic fatigue syndrome: who does it affect

A

mostly women, no specific age group

351
Q

dx: chronic fatigue syndrome

A

severe fatigue for >6 months post flu like symptoms
need to meet 4 criteria:
Sore throat
Impaired short term memory
Poor concentration
Tender lymph nodes
Myalgias
Multiple joint pain w/ redness or swelling
Headaches of new type, pattern or severity
Post Exertional malaise for more than 24 hours
Unrefreshing sleep

352
Q

is there a lab to verify chronic fatigue syndrome

A

no lab

353
Q

how to tx chronic fatigue syndrome

A

Supportive tx!
Antidepressants can be helpful
Improved health practices: Sleep, energy conservation, nutrition, regular exercise, stress mgmt
Complementary and alternative therapies may be useful

Med Surg (2 decks)

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