exam 3 Flashcards by Bethany Rivera

Increase sodium intake especially during episodes of hot weather
Increase fluid intake
Limit potassium
high protein

Addison’s disease diet

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D5 NS fluid of choice, and dextrose

Addison’s crisis treatment

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Dark pigmented skin
Hypotension
Hyperkalemia
Hyponatremia
Muscle weakness
Low blood glucose levels
Confusion

Manifestations of Addison’s disease

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Hypotension
Cyanosis
Fever
Nausea/vomiting
Signs of shock

S/S of Addison’s crisis

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Hold live vaccines (like MMR) while receiving

Contraindications for Addison’s disease on Hydrocortisone treatment

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Give with food, PRIOR to 9am

Administration of Hydrocortisone

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too little steroids

Addison’s

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too much steroids

Cushing’s

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Weight gain
Central adiposity
Buffalo hump Hirsutism
Ecchymosis (bruising)
Hypertension

Manifestations of Cushing’s syndrome

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They are at risk for muscle wasting and osteoporosis
give meals that include: protein, calcium and vitamin D such as cheese and milk

Cushing syndrome diet

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excessive growth hormone in an adult; enlarged hands/feet, distortion of facial features, extremely tall, persistent headaches

Acromegaly

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excessive growth hormone in a child

Gigantism

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insufficient secretion of growth hormone during childhood

Dwarfism

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under secretion of ALL anterior pituitary hormones; thyroid gland, adrenal cortex and gonads atrophy (shrink)

Panhypopituitarism

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Take with full glass of water, coffee, tea, or fruit juice (acidic drinks enhance absorption)
Take with food
AVOID antacids, contraindicated because decrease absorption
Lowers production of androgen, must be given with steroid supplementation to prevent adrenal insufficiency
Adrenal enzyme inhibitor which is used to reduce hyper-adrenalism if the syndrome is caused by ectopic secretion by a tumor that cannot be eradicated
Adrenal ablating drug

Ketoconazole

teaching points (for Cushing’s)

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Used to shrink pituitary tumor
Given IM, intragluteal (butt)

Octreostide

(for Acromegaly)

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unchanged urine osmolarity

Fluid deprivation test

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unchanged urine osmolarity

Fluid deprivation test

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patient produces large quantities of urine and is unable to increase urine specific gravity and osmolarity even when the fluid is decreased

Diabetes Insipidus

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Closely monitor fluid balance by measuring/monitoring I&O, daily weights, morning labs
Do NOT need sodium restricted diet or desmopressin
Patient will likely be on fluid restriction

Nursing management of patients with SIADH including diet precautions

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Before giving, review vitals and labs
HOLD medication if creatine clearance is less than 50mL/ min (indicates renal impairment)

Desmopressin (DDAVP)

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hypotension, tachycardia, low urine osmolarity, polydipsia

Manifestations of Diabetes Insipidus: DDAVP

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Deformity
Crepitus
Swelling of the extremity
Bruising

Signs and symptoms of fracture

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Immobilize leg prior to moving to a safer spot
Cover with sterile dressing to prevent contamination (wet gauze)

Open fracture care precautions for leg fracture

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Takes 6-8 weeks to heal Start to see bone ossification after 2-3 weeks

Discharge teaching for patients with fracture

Medical emergency Increase in compartment volume (edema) Decrease in compartment size (restrictive cast): pain and decreased sensation of fingers, toes or affected extremity

Signs and symptoms of compartment syndrome

Pain Pallor Pulselessness Paresthesia Paralysis

5 Ps

Assess for developing pressure ulcers; reporting of burning pain, particularly over a bony prominence, you will notify provider for an intervention such as removing cast/splint, and assessing their skin

Care for patients with a cast

Encourage isometric exercises; muscles are tensed and relaxed without moving the bone Done every hour while awake

Teaching to prevent disuse syndrome

Serous drainage and redness at pin site is expected within first 48-72 hours; monitor Nurses NEVER adjust hardware frame

Assessment of pin site on orthopedic hardware

Patients must be able to push pain button on their own Nurse or family members NEVER press button Assess for inability for patient to perform; if patient unable to push button due to physical restraint, mental compromise then other routes of pain medication administration should be considered

PCA management and teaching

Anticipate a sling for immobilization Ice Pain medication

Care of a patient with a fractured clavicle

Pain Swelling Bruising Crepitus Decreased mobility

Manifestations of a fractured wrist

Hemorrhage Shock (hypovolemic) due to blood loss

Problems that could occur for a patient with a pelvic fracture

Pain in hip/groin Pain worsened with movement Muscle spasms in affected leg Muscle shortening in affected leg Bruising

Assessment findings of a patient with a hip fracture

Have patient dorsiflex the great toe -> diminished sensation within the first webbed space The branch of sciatic nerve supplies movement/sensation to the lower leg, foot and toes a type of peripheral neuropathy; they can present with numbness, tingling, pain, weakness, and possible foot drop (unable to bend/flex the foot upward from the ankle)

Assessment finding of a patient with peroneal nerve damage

Splinting with pillow Incentive spirometer use Pain medication AVOID using chest binders because it decreases lung expansion and increases the risk for atelectasis

Care of a patient with rib fractures

Splinting with pillow Incentive spirometer use Pain medication AVOID using chest binders because it decreases lung expansion and increases the risk for atelectasis

Care of a patient with rib fractures

done for arterial insufficiency, gangrene, uncontrolled diabetes, traumatic injury

Above the knee (AKA)

damage to the distal tibial and surrounding muscle can cause need for

Below the knee (BKA)

dislocation through a joint

Disarticulation

Elastic dressing: compression bandage to prevent swelling If it comes off with new amputation, immediately put it back on

Care of a patient with limb amputations

Provide an accepting and supportive atmosphere and allow the patient to talk about their feelings

Interpersonal communication skills for patients who are having problems with self- esteem

IV push: peaks 10-20 mins; assess for respiratory depression PO: peaks 30-60 mins

Morphine administration considerations to assess for

Avoid use of meperidine (Demerol) because it causes agitation, seizures and hallucinations

Medication considerations for elderly patients with amputations

Fatigue Depression Weakness Numbness Difficulty in coordination Loss of balance Muscle spasticity Pain Visual disturbances: diplopia

Manifestations of multiple sclerosis (MS)

poor muscle control, slurred speech

ataxia S/S

Impaired coordination of movement

ataxia

Baclofen: muscle relaxant

Drugs that treat muscle spasms

Vision changes Muscle weakness Ptosis Dysphagia NO problems with sensation/coordination

Myasthenia Gravis S/S

numbness ataxia gait Vision changes Muscle weakness Ptosis Dysphagia NO problems with sensation/coordination

MS S/S

Daily stretching exercises such as walking, swimming, riding stationary bike Avoid running/aerobics due to to risk of falls Avoid soaking in hot bath due to risk for burns due to sensory loss

Recommendations of caring for a patient with muscle spasticity

positive Tensilon test (acetylcholinesterase inhibitor test) Given IV; 30 seconds after injection, facial muscle weakness and ptosis should resolve for about 5 minutes Immediate improvement in muscle strength after administration indicatesa positive test Have Atropine available to control side effects -> bradycardia, asystole, bronchoconstriction, sweating, cramping

Diagnostic test confirms Myasthenia gravis

MRI confirms diagnosis

Diagnostic test confirms MS

Improve symptoms in 75% patients but only lasts for a few weeks Used to treat exacerbations of myasthenia gravis Treatment, NOT a cure

Teaching modalities of plasmapheresis (TPE), s/s, implications for use

Surgical removal of thymus gland

thymectomy

Can produce antigen specific immunosuppression and result in clinical improvement Performed in patients younger than 65 who have had MG diagnosed within the past 3 years

thymectomy implications for, care for (MG)

Educate patient take medications on time to keep stable blood levels

Caring and treatment for a patient with myasthenia gravis

Avoid tranquilizers because causes respiratory/cardiac depression If provider orders this, nurse should question it

Medications that should be avoided for patients with Myasthenia gravis while on ventilatory support

It improves skeletal muscle tone, Increases salivary gland production Increases tone of GI muscles Relaxes smooth muscles of the bronchioles Decreases heart rate

Neostigmine

Enoxaparin (lovenox) given subQ to prevent DVTs

Signs and symptoms of Guillain Barre syndrome

Diminished lower extremity weakness Symmetrical weakness History of a viral infection 2 weeks prior Areflexia: absence of deep tendon reflexes Ascending weakness: lower extremities and progress upward Dyskinesia: inability to execute voluntary movements

Signs and symptoms of early onset of Guillain Barre syndrome

inability to execute voluntary movements

Dyskinesia

absence of deep tendon reflexes

Areflexia

Impaired gas exchange Impaired mobility Anxiety

care planning for a patient with Guillain Barre syndrome, list nursing diagnoses

AVOID opioids if at all possible NSAIDS: used to treat the diffuse muscle aching and stiffness TCAs: Elavil Muscle relaxants: Flexeril SNRI: Cymbalta SSRI: Zoloft Anticonvulsants: Gabapentin

Fibromyalgia meds