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NUR 211 Krissa > Exam 3 study guide > Flashcards

Exam 3 study guide Flashcards

1
Q

What does -1.0 T-score an a DEXA scan mean?

A

normal

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2
Q

DEXA Score below -1.0 is

A

Abnormal

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3
Q

T-score below -1.0 to -2.5

A

Indicates osteopenia

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4
Q

T-score on a DEXA scan below -2.5

A

Indicates osteoporosis

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5
Q

Teaching points about Fosamax

A
  • 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
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6
Q

Teaching points about calcitonin

A
  • 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
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7
Q

Teaching points about estrogen/estrogen antagonist

A
  • Stop 48-72 hrs before prolonged immobility
  • Do not give if hx of DVT
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8
Q

Teaching points about parathyroid hormone/parathyroid hormone angonist

A
  • Linked to causing bone cancer
  • Given to clients at a very high risk for fractures
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9
Q

Teaching points about monoclonal activity

A
  • Treats hypercalcemia
  • Treats bone cancer and bone problems
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10
Q

Suppluments used for bone health and how they work

A
  • Calcium assists in building strong bones early in life and maintain bone integrity later in life
  • Vitamin D assists in the absorption of calcium
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11
Q

Client education for fall precautions

A
  • 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
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12
Q

Dietary teaching for osteoporosis patients

A
  • Vitamin C/D, calcium, protein, iron
  • Adequate fluid intake to prevent kidney stones
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13
Q

Normal calcium levels

A

9-11

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14
Q

Calcium 8 or less

A

Calcium deficiency and osteoporosis

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15
Q

Normal vitamin D levels

A

30-50

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16
Q

Vitamin D of 20-30

A

indicates insufficiency

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17
Q

Vitamin D toxicity level? What can it cause?

A

above 50
Dehydration
Kidney damage
Hypercalcemia

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18
Q

D/C teaching for a patient with a knee arthroplasty

A
  • 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
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19
Q

Risk factors for back pain

A
  • Obesity
  • Cigarette smoking
  • Occupation
  • Poor posture
  • Poor physical condition
  • Poor sleeping condition
    Stress
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20
Q

Nursing diagnosis r/t fibromyalgia

A
  • 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
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21
Q

Pathophysiology of fibromyalgia

A
  • 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
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22
Q

Parkinsons medication that reduces tremors and drooling

A

Anticholinergics

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23
Q

Parkinsons medication that treats bradykinesia, tremors, and rigidity

A

Dopamine receptor agonist
or
Carbidopa-levidopa

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24
Q

Nursing interventions for bradykinesia

A
  • Place patient on fall precautions
  • Teach patient to take short deliberative steps, with feet somewhat spread
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25
Q

Appropriate interventions for patients with suspected fracture

A
  • Immobilize the affected extremity with a cast or splint.
  • Inspect site of injury
  • Palpate injured extremity, noting the 6 Ps.
  • Assess vital signs.
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26
Q

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
A

Compartment syndrome

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27
Q

Name the 6 P’s

A
  • Pain
  • pressure
  • paralysis
  • pallor
  • paresthesia
  • pulselessness
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28
Q

Presence of one or more of the 6 P’s indicate what?

A
  • Presence of one or several 6 P’s indicate Neurovascular compromise.
  • Presence can lead to hemorrhage, compartment syndrome, infection or permanent loss of function
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29
Q

Absence of 6 P’s

A

6 Ps indicate that proper treatment is being provided and there is no neurovascular compromise

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30
Q

Priority nursing actions for fractures

A

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

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31
Q

Client education for casted extremities

A
  • 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.
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32
Q

Traction that utilizes tongs, screws, and wires are surgically secured to the bone. Weight is applied to provide alignment

A

Skeletal Traction

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33
Q

This type of traction uses a flexible harness, boot, or belt to secure the extremity with 5 to 10 lbs.

A

Skin traction

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34
Q

What is the purpose of the weight when the patient is in traction?

A

To relieve muscle spasms and maintain the length of the bone.

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35
Q

Nursing actions if you witness a fall with a suspected fracture

A
  • 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
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36
Q

Possible complications r/t casting

A
  • Circulatory impairment
  • Acute compartment syndrome
  • infection / osteomyelitis
  • VTE
  • Fat emblism
  • Rhabdomylosis
  • Hypovolemia
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37
Q

Clincal manifestations of Osteoarthritis

A
  • 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
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38
Q

Medications used to treat OA

A

o Acetaminophen
o NSAIDS
o Corticosteroids
o Opioids

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39
Q

What type of patients should avoid tylenol?

A
  • Alcoholics
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40
Q

What types of patients should avoid NSAIDS

A

ESRD
Hx GI bleed

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41
Q

If a diabetic is prescribed corticosteroids?

A

They need to monitor their blood glucose closly

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41
Q

Client teaching for MS patients

A

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

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42
Q

How to ‘confirm’ MS dx

A

o 2 separate symptomatic events
MRI changes in 2 locations

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43
Q

Nursing interventions for MS patients

A

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

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44
Q

How long should a patient lay flat for after a lumbar puncture?

A

4-6 hr

45
Q

If a patient does develop a headache after a lumbar puncture what can you do to reduce it?

A

Encourage fluid

46
Q

What can be done if a patient has a prolonged headache after a lumbar puncture?

A

a blood patch

47
Q

What needs to be done before a lumbar punture?

A

Hold NSAIDS
Hold blood thinners
HAve PLT/PT/INR drawn the morning of
Hasve signed consent

48
Q

Clinical manifestations of TB

A

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.

49
Q

If a PPD skin test is positive what needs to be done and why?

A

A CXR to determine if TB is active or old

50
Q

Positive PPD’s

A
  • 5MM induration in immunocomprimised patients
  • 10-15 MM in regular patients
51
Q

How to determine effectiveness of TB treatment

A

Sputum cultures every 2-4 weeks
After 3 negative sputum cultures client is no longer considered infectious

52
Q

What should be ephasized to TB patients about their treatment?

A

Client must understand treatment is a commitment. If not followed could turn into a resistance strained.
Therapy can take 6 months to 2 years

53
Q

Patient education for Rifampin

A

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

54
Q

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

A

Rifampin

55
Q

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

A

Isoniazid

56
Q

What kind of foods are these?

 Cured / smoked/ processed meats
 Pickled vegetables
 Soy sauce
 Smoked aged cheese
 Beer

A

Tyramine containing foods

57
Q

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

A

Ethambutol

58
Q

Client education for Ethambutol

A

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

59
Q

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

A

Pyrazinamide

60
Q

Client education for Pyrazinamide

A

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

61
Q

Patient education about sputum sample collection

A

 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

62
Q

Manifestations of alcohol withdrawl

A

 Abdominal cramping
 Vomiting
 Tremors
 Restlessness
 Inability to sleep
 Tachycardia
 Hallucinations
 Illusions
 Increased BP
 Tachypnea
 Increased temp
 Tonic-clonic seizures

63
Q

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

A

Alcohol withdawl

64
Q

The following are S/S of what?

 Severe disorientation
 Psychotic manifestations (hallucinations)
 Severe hypertension
 Cardiac dysrhythmias
 Delirium

A

Alcohol delirium

65
Q

S/S of alcohol delirium

A

 Severe disorientation
 Psychotic manifestations (hallucinations)
 Severe hypertension
 Cardiac dysrhythmias
 Delirium

66
Q

When does alcohol delirium start?

A

2-3 days after alcohol cessation

67
Q

S/S of a possible assaultive behavior victim

A

 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

68
Q

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

A

An assaultive behavior victim

69
Q

Phases of the assault cycle

A

 The triggering event
 Escalation
 Crisis point
 Recovery
 Post-crisis depression

70
Q
A

Complete fracture

71
Q
A

Incomplete fracture

72
Q
A

Closed simple fracture

73
Q
A

Closed simple displaced fracture

74
Q
A

Open (Conpound) fracture

75
Q
A

Avulsion fracture

76
Q
A

Comminuted fracture

77
Q
A

Compression fracture

78
Q
A

Depressed fracture

79
Q
A

Greenstick fracture

80
Q
A

Oblique fracture

81
Q
A

Spiral fracture

82
Q
A

Impacted fracture

83
Q

Labs to monitor for Rifampin?

A
  • CBC
  • PTNINR
  • PTT
  • Uric Acid
84
Q

Rifampin will stain what red/orange

A
  • Urine
  • feces
  • sweat
  • tears
  • contact lenses
85
Q

Rifampin patients should be taught to be monitor for what?

A

Bleeding i.e. bleeding gums, stool color change, nose bleeds

86
Q

S/S of neurotoxicity

A
  • Muscle numbness
  • seizures
  • tingling
  • twitching
87
Q

Patients on Pyrazinamide should be taught to do what to prevent gout and kidney problems?

A

Increase fluids

88
Q

Pyrazinamide can be given with what medication?

A

Isoniazid

89
Q

Labs to monitor for Pyrazinamide or Tebrazid

A

Hepatic function (every 2-4 wks during and every 2-4 wks after)
Uric acid
Urine ketones

90
Q

What should Ethambutol or Myambutol should be given with what and why?

A

Milk to avoid GI irritation

91
Q

When taking Ethabutol(Myambutol) and Pyrazinamide(Tebrazid) how long after initiation of therapy should improvement be seen and what should be done?

A

Cough should stop within 2-3 weeks if not call PCP

92
Q

Labs to monitor for Ethambutol or myambutol

A
  • Reanal function
  • Hepatic function
  • CBC
  • Uric acid
93
Q

continual/recurrent feeling of needing to poop

A

tenesmus

94
Q

S/S of Colitis

A

colicky abdominal pain
urgency
diarrhea
tenesmus (continual/recurrent feeling of needing to poop)

95
Q

Contraindications for rifampin

A

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

96
Q

S/E of Rifampin

A

Hypersensitivity reaction
heartburn
N/V/D
red-orange colored body secretions hepatitis/hepatotoxicity
increased uric acid levels
blood dyscrasias
colitis

97
Q

S/S of hypersensitivity rxn

A

Fever
Chills
Headache
Muscle and bone pain
Dyspnea

98
Q

How to reduce the risk of neurotoxicity in patients taking isoniazid

A

Pyridoxine or Vitamin B-6

99
Q

Nursing interventions for Isoniazid (INH)

A

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

100
Q

How do you administer a PPD skin test with

A
  • with a 1/4-1/2 in 27 g needle
  • 0.1 mL of PPD
  • intradermally into forearm
101
Q

When should a PPD skin test should be read?

A

48-72 hrs after administration

102
Q

After a positive skin test is observed what needs to be done and why?

A

CXR to rule out active TB or to detect old, healed lesion

103
Q

Expected inflammatory response in TB patients

A

Unexplained weight loss
night sweats
fever
chills

104
Q

Primary Progressive (symptomatic) TB infection follows the same patho as?

A

Primary TB infection

105
Q

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
A

Primary Progressive TB Infection

Symptomatic

106
Q

What kind of seizures are are patients suffering from alcohol widrawl would have?

A

Tonic-clonic

107
Q

How long does it take for a wet plaster cast to dry?

A

24-72 hrs

108
Q

How long should a synthetic cast be allowed to dry?

A

20 min

109
Q

Fibromyalgia cycle

A
  1. pain
  2. muscle tension
  3. daily stress
  4. limited activity
  5. fatigue
  6. depression
  7. muscle stiffness

NUR 211 Krissa (16 decks)

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