Exam 3 study guide Flashcards
What does -1.0 T-score an a DEXA scan mean?
normal
DEXA Score below -1.0 is
Abnormal
T-score below -1.0 to -2.5
Indicates osteopenia
T-score on a DEXA scan below -2.5
Indicates osteoporosis
Teaching points about Fosamax
- Take first thing in the morning on an empty stomach. Sit up and nothing to eat or drink for 30 mins. Take with regular tap water.
- If bisophosphate Ibandronate nothing to eat or drink and sit or stand for 60 mins
- Can cause esophogitis, muscle pain, ocular problems
- Do not give to clients who have esophageal disorders and those who cannot sit or stand at least 30 mins after swallowing
Teaching points about calcitonin
- If calcitonin human can only be given SQ
- Calcitonin salmon can be given intranasaly, be sure to inspect each nares before admin and alternate each nare
- Monitor for hypocalcemia
Teaching points about estrogen/estrogen antagonist
- Stop 48-72 hrs before prolonged immobility
- Do not give if hx of DVT
Teaching points about parathyroid hormone/parathyroid hormone angonist
- Linked to causing bone cancer
- Given to clients at a very high risk for fractures
Teaching points about monoclonal activity
- Treats hypercalcemia
- Treats bone cancer and bone problems
Suppluments used for bone health and how they work
- Calcium assists in building strong bones early in life and maintain bone integrity later in life
- Vitamin D assists in the absorption of calcium
Client education for fall precautions
- Remove rugs
- Clearly mark doorways, steps, thresholds
- Clear pathways of clutter
- Provide adequate lighting
- Wear non-slip socks socks when walking in the house
- Properly instruct use of assistive devices
- Exercise regularly: correct body mechanics and proper posture. Stay independent for as long as you can with ADLs
- Review medications: pain relievers, muscle relaxants anti-inflammatory meds, neurological meds, bone support meds
- Yearly eye exams
- Handle bars in bathrooms
- Shower chairs
Dietary teaching for osteoporosis patients
- Vitamin C/D, calcium, protein, iron
- Adequate fluid intake to prevent kidney stones
Normal calcium levels
9-11
Calcium 8 or less
Calcium deficiency and osteoporosis
Normal vitamin D levels
30-50
Vitamin D of 20-30
indicates insufficiency
Vitamin D toxicity level? What can it cause?
above 50
Dehydration
Kidney damage
Hypercalcemia
D/C teaching for a patient with a knee arthroplasty
- Avoid knee gatch and pillows behind the knee
- Place one pillow under the lower calf and foot to cause a slight extension of the knee joint and to prevent flexion contractures.
- Knee can rest flat on bed
- To prevent pressure injury on the heels, place a small blanket or pillow slightly above the ankle area to keep heels off the bed.
- Ice or cold therapy to incisional area to reduce post op swelling
- Kneeling and deep knee bends are limited indefinitely after sx
Risk factors for back pain
- Obesity
- Cigarette smoking
- Occupation
- Poor posture
- Poor physical condition
- Poor sleeping condition
Stress
Nursing diagnosis r/t fibromyalgia
- Ineffective sleep patterns r/t chronic pain
- Chronic pain r/t disease process
- Depressed mood r/t chronic pain
- Ineffective coping r/t chronic pain
Pathophysiology of fibromyalgia
- A disorder of the SOFT connective tissue that causes widespread pain
- Acute episodes can be triggered by infection, stress, physical trauma or stress
- Pain -> Muscle tension -> daily stress -> limited activity -> fatigue -> Depression -> Muscle stiffness
Parkinsons medication that reduces tremors and drooling
Anticholinergics
Parkinsons medication that treats bradykinesia, tremors, and rigidity
Dopamine receptor agonist
or
Carbidopa-levidopa
Nursing interventions for bradykinesia
- Place patient on fall precautions
- Teach patient to take short deliberative steps, with feet somewhat spread
Appropriate interventions for patients with suspected fracture
- Immobilize the affected extremity with a cast or splint.
- Inspect site of injury
- Palpate injured extremity, noting the 6 Ps.
- Assess vital signs.
THe following are S/S of what?
- Pain out of proportion to injury
- Passive pain at rest (Pain will increase with movement)
- All 6 P’s are present
Compartment syndrome
Name the 6 P’s
- Pain
- pressure
- paralysis
- pallor
- paresthesia
- pulselessness
Presence of one or more of the 6 P’s indicate what?
- Presence of one or several 6 P’s indicate Neurovascular compromise.
- Presence can lead to hemorrhage, compartment syndrome, infection or permanent loss of function
Absence of 6 P’s
6 Ps indicate that proper treatment is being provided and there is no neurovascular compromise
Priority nursing actions for fractures
nursing actions for fractures – be able to apply these actions to scenarios
* Maintain pulmonary hygiene.
* Administer pain meds as ordered.
* Provide wound /pin care DAILY
* Elevation unless crushing injury
* apply ice.
* perform ROM exercise.
* repositioning as needed
* provide hydration and nutrition.
give positive feedback and encouragement
Client education for casted extremities
- Keep cast clean and dry
- Do not put anything in cast
- Cover cast with plasting bag when bathing or showering
- Use hair dryer on cool air setting to dry cast, if it gets wet by blowing air under cast
- Contact HCP if there is any red skin irritation, blisters, or sores around the edges of the cast
- Cover the rough edges of the cast with tape to prevent skin irritation
- Elevate the cast above the heart if increased swelling, pain numbness, tingling, or change in color
- Contact HCP if cast is damaged, cracked, or extremelt wet, cast will need to be changed.
Traction that utilizes tongs, screws, and wires are surgically secured to the bone. Weight is applied to provide alignment
Skeletal Traction
This type of traction uses a flexible harness, boot, or belt to secure the extremity with 5 to 10 lbs.
Skin traction
What is the purpose of the weight when the patient is in traction?
To relieve muscle spasms and maintain the length of the bone.
Nursing actions if you witness a fall with a suspected fracture
- ASSESS patient first.
- DO not move patient
- Immobilize the injured limb.
- Monitor for swelling
- assess for 6 Ps
- Position extremity above the level of the heart. ** ONLY if the extremity has been immobilized
Possible complications r/t casting
- Circulatory impairment
- Acute compartment syndrome
- infection / osteomyelitis
- VTE
- Fat emblism
- Rhabdomylosis
- Hypovolemia
Clincal manifestations of Osteoarthritis
- Progressive aching/pain over time increasing w/joint use
- Pain relived with rest
- Decreased ROM
- Tenderness to touch
- MORNING stiffness LESS than 30 mins
- Bony swelling (osteomyelitis)
- Soft tissue swelling
- Crepitus
- Deformity of joints (Bouchard’s/ Heberden’s Node)
- Joint instability
Medications used to treat OA
o Acetaminophen
o NSAIDS
o Corticosteroids
o Opioids
What type of patients should avoid tylenol?
- Alcoholics
What types of patients should avoid NSAIDS
ESRD
Hx GI bleed
If a diabetic is prescribed corticosteroids?
They need to monitor their blood glucose closly
Client teaching for MS patients
o Instruct on proper use of assistive devices
o Instruct on increased fluid intake
o Instruct on Low-fat, High-fiber diet
o Instruct on safety measures r/t: Temperatures (water /heating pads), Fall precautions
o Instruct on medication administration
o Inform family on community resources ( National MS Society)
o Encourage PT/OT and ROM exercises
o Administer corticosteroids during exacerbations d/t inflammation with flare
o Patch eye daily or as needed in patients with diplopia or visual deficits
How to ‘confirm’ MS dx
o 2 separate symptomatic events
MRI changes in 2 locations
Nursing interventions for MS patients
o Assess Neuromuscular function.
o Evaluate for changes in clinical presentation or for new symptoms that need to be addressed in disease.
o Assess vision/eye movement.
o Assess skin integrity d/t immobility.
o Evaluate the need for assistive devices if unable to perform ADLS
Assess bowel and bladder function
How long should a patient lay flat for after a lumbar puncture?
4-6 hr
If a patient does develop a headache after a lumbar puncture what can you do to reduce it?
Encourage fluid
What can be done if a patient has a prolonged headache after a lumbar puncture?
a blood patch
What needs to be done before a lumbar punture?
Hold NSAIDS
Hold blood thinners
HAve PLT/PT/INR drawn the morning of
Hasve signed consent
Clinical manifestations of TB
o Fatigue/ Lethargy
o Weight loss
o Low grade fever
o Night sweats / Chills
o Persistent cough w/blood -tinged sputum (Rusty color)
o Chest tightness, dull, aching
o Dyspnea, orthopnea & rales as disease progresses.
If a PPD skin test is positive what needs to be done and why?
A CXR to determine if TB is active or old
Positive PPD’s
- 5MM induration in immunocomprimised patients
- 10-15 MM in regular patients
How to determine effectiveness of TB treatment
Sputum cultures every 2-4 weeks
After 3 negative sputum cultures client is no longer considered infectious
What should be ephasized to TB patients about their treatment?
Client must understand treatment is a commitment. If not followed could turn into a resistance strained.
Therapy can take 6 months to 2 years
Patient education for Rifampin
o Urine , feces , sweat and tears will be red orange color
o Soft contact lenses can become permanently discolored as well as other items
o Monitor CBC/PTINR/PTT
o At risk for gout d/t increased uric acid levels
o Notify PCP if bleeding gums, stool color change and nose bleed occurs
What is this medication?
o Urine , feces , sweat and tears will be red orange color
o Soft contact lenses can become permanently discolored as well as other items
o Monitor CBC/PTINR/PTT
o At risk for gout d/t increased uric acid levels
o Notify PCP if bleeding gums, stool color change and nose bleed occurs
Given to treat TB
Rifampin
What medication is this
o Monitor pt for s/s of hepatitis and hepatoxicity
o do not use if clients have acute liver disease or hypersensitivity
o contradicted in patients w/ renal impairment or ETOH abuse
o s/s of neurotoxicity
o AVOID tyramine containing foods
Given to treat TB
Isoniazid
What kind of foods are these?
Cured / smoked/ processed meats
Pickled vegetables
Soy sauce
Smoked aged cheese
Beer
Tyramine containing foods
What medication is this?
o Contradicted in patients with renal impairment, hepatic impairment, hypersensitivity and Optic neuritis
o Assess visual function during therapy, report any blurry vision or constriction
o Assess lung sounds and character of sputum periodically during therapy
o Monitor renal and hepatic functions, CBC and uric acid levels routinely.
o At risk for gout d/t increased uric acid levels.
o Administer with food or milk to avoid GI irritation
o Notify PCP if improvement in cough is not seen in 2-3 weeks
Given to treat Pyrazinamide
Ethambutol
Client education for Ethambutol
o Contradicted in patients with renal impairment, hepatic impairment, hypersensitivity and Optic neuritis
o Assess visual function during therapy, report any blurry vision or constriction
o Assess lung sounds and character of sputum periodically during therapy
o Monitor renal and hepatic functions, CBC and uric acid levels routinely.
o At risk for gout d/t increased uric acid levels.
o Administer with food or milk to avoid GI irritation
o Notify PCP if improvement in cough is not seen in 2-3 weeks
What medication is this?
o Inform patient with diabetes that medication may interfere with urine ketone measurements
o Notify PCP if no improvement after 2-3 weeks of therapy.
o Report any fever, anorexia, malaise, N/V, darkened urine, yellowish discoloration of skin and eyes, pain and swelling of the joints occurs.
o Advise to wear sunscreen and protective clothing
o Monitor hepatic function before and every 2-4 week during therapy. (AST and ALT may come back normal)
o Monitor serum uric acid concentrations, urine ketones
o Patients w/ impaired liver function should receive Pyrazinamide treatment only
o This medication may be given w/ Isoniazid
Given to treat TB
Pyrazinamide
Client education for Pyrazinamide
o Inform patient with diabetes that medication may interfere with urine ketone measurements
o Notify PCP if no improvement after 2-3 weeks of therapy.
o Report any fever, anorexia, malaise, N/V, darkened urine, yellowish discoloration of skin and eyes, pain and swelling of the joints occurs.
o Advise to wear sunscreen and protective clothing
o Monitor hepatic function before and every 2-4 week during therapy. (AST and ALT may come back normal)
o Monitor serum uric acid concentrations, urine ketones
o Patients w/ impaired liver function should receive Pyrazinamide treatment only
o This medication may be given w/ Isoniazid
Patient education about sputum sample collection
Sputum culture confirms TB diagnosis.
Obtain EARLY MORNING SPUTUM SAMPLES
Samples to be obtained in a negative airflow room
Sputum cultures are obtained during therapy to evaluate ttmt effectiveness.
Sputums need to be collected every 2-4 weeks after initiation of therapy
3-4 negative results are needed to declare patient non-infectious and regular activity can be resumed
Manifestations of alcohol withdrawl
Abdominal cramping
Vomiting
Tremors
Restlessness
Inability to sleep
Tachycardia
Hallucinations
Illusions
Increased BP
Tachypnea
Increased temp
Tonic-clonic seizures
All of the following are clinical manifestations of what?
Abdominal cramping
Vomiting
Tremors
Restlessness
Inability to sleep
Tachycardia
Hallucinations
Illusions
Increased BP
Tachypnea
Increased temp
Tonic-clonic seizures
Alcohol withdawl
The following are S/S of what?
Severe disorientation
Psychotic manifestations (hallucinations)
Severe hypertension
Cardiac dysrhythmias
Delirium
Alcohol delirium
S/S of alcohol delirium
Severe disorientation
Psychotic manifestations (hallucinations)
Severe hypertension
Cardiac dysrhythmias
Delirium
When does alcohol delirium start?
2-3 days after alcohol cessation
S/S of a possible assaultive behavior victim
Anxious
Depressed
Loss of confidence
Unusually quiet
Physical injuries (bruises, broken bones, sprains, cuts etc) w/ unlike explanations
Children seem afraid, have behavior problems, withdrawn or anxious.
Reluctant to leave children with partner
If leaves the relationship, partner “stalks “to intimidate
The following are S/S of being what?
Anxious
Depressed
Loss of confidence
Unusually quiet
Physical injuries (bruises, broken bones, sprains, cuts etc) w/ unlike explanations
Children seem afraid, have behavior problems, withdrawn or anxious.
Reluctant to leave children with partner
If leaves the relationship, partner “stalks “to intimidate
An assaultive behavior victim
Phases of the assault cycle
The triggering event
Escalation
Crisis point
Recovery
Post-crisis depression
Complete fracture
Incomplete fracture
Closed simple fracture
Closed simple displaced fracture
Open (Conpound) fracture
Avulsion fracture
Comminuted fracture
Compression fracture
Depressed fracture
Greenstick fracture
Oblique fracture
Spiral fracture
Impacted fracture
Labs to monitor for Rifampin?
- CBC
- PTNINR
- PTT
- Uric Acid
Rifampin will stain what red/orange
- Urine
- feces
- sweat
- tears
- contact lenses
Rifampin patients should be taught to be monitor for what?
Bleeding i.e. bleeding gums, stool color change, nose bleeds
S/S of neurotoxicity
- Muscle numbness
- seizures
- tingling
- twitching
Patients on Pyrazinamide should be taught to do what to prevent gout and kidney problems?
Increase fluids
Pyrazinamide can be given with what medication?
Isoniazid
Labs to monitor for Pyrazinamide or Tebrazid
Hepatic function (every 2-4 wks during and every 2-4 wks after)
Uric acid
Urine ketones
What should Ethambutol or Myambutol should be given with what and why?
Milk to avoid GI irritation
When taking Ethabutol(Myambutol) and Pyrazinamide(Tebrazid) how long after initiation of therapy should improvement be seen and what should be done?
Cough should stop within 2-3 weeks if not call PCP
Labs to monitor for Ethambutol or myambutol
- Reanal function
- Hepatic function
- CBC
- Uric acid
continual/recurrent feeling of needing to poop
tenesmus
S/S of Colitis
colicky abdominal pain
urgency
diarrhea
tenesmus (continual/recurrent feeling of needing to poop)
Contraindications for rifampin
Do not use in clients with hypersensitivity
Use with caution in clients with liver impairment and ETOH use
Use with caution in clients taking anticoagulants, hypoglycemics, digoxin, antifungals, dilantin, and some cardiac meds
S/E of Rifampin
Hypersensitivity reaction
heartburn
N/V/D
red-orange colored body secretions hepatitis/hepatotoxicity
increased uric acid levels
blood dyscrasias
colitis
S/S of hypersensitivity rxn
Fever
Chills
Headache
Muscle and bone pain
Dyspnea
How to reduce the risk of neurotoxicity in patients taking isoniazid
Pyridoxine or Vitamin B-6
Nursing interventions for Isoniazid (INH)
Assess for hypersensitivity
Assess for hepatic dysfunction (What labs would you monitor, what S/S might you look for?)
Monitor for S/S of hepatitis: anorexia, N/V, weakness, fatigue, dark urine, jaundice
Monitor for S/S of neuritis: tingling, numbness, or burning of the extremities
Assess mental status and vision changes
Monitor glucose levels
Administer medication 1hr before or 2hrs after meals to avoid delayed absorption
Administer at least 1hr before antacids
Pyridoxine (Vitamin B-6) to reduce risk of neurotoxicity
How do you administer a PPD skin test with
- with a 1/4-1/2 in 27 g needle
- 0.1 mL of PPD
- intradermally into forearm
When should a PPD skin test should be read?
48-72 hrs after administration
After a positive skin test is observed what needs to be done and why?
CXR to rule out active TB or to detect old, healed lesion
Expected inflammatory response in TB patients
Unexplained weight loss
night sweats
fever
chills
Primary Progressive (symptomatic) TB infection follows the same patho as?
Primary TB infection
The following are S/S of what?
- Fatigue, lethargy
- Weight Loss, anorexia
- Low grade fever
- Night Sweats, chills
- Persistent cough with blood-tinged sputum
- Chest tightness & dull, aching chest pain
- Dyspnea, orthopnea, & rales as disease progresses
Primary Progressive TB Infection
Symptomatic
What kind of seizures are are patients suffering from alcohol widrawl would have?
Tonic-clonic
How long does it take for a wet plaster cast to dry?
24-72 hrs
How long should a synthetic cast be allowed to dry?
20 min
Fibromyalgia cycle
- pain
- muscle tension
- daily stress
- limited activity
- fatigue
- depression
- muscle stiffness
