Final Flashcards by Beth Cabrera

What is osteoporosis?

progressive deterioration and loss of articular cartilage and bone in one or more joints

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Teach adults with osteoporosis to

maintain proper nutrition
take care to avoid injuries
take adequate breaks at work when repetitive motion or joint stress is common
stay active and maintain a healthy lifestyle

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What is the recommended drug for osteoporosis?

Acetominophen (NSAIDs)

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what is RA?

chronic, progressive, systemic inflammatory autoimmune disease - affects synovial joints
autoantibodies attack healthy tissue causing inflammation

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What happens to the synovium in individuals with RA?

It thickens and becomes hyperemic, fluid accumulates in the joint space and a pannus forms

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what is a pannus?

vascular granulation tissues composed of inflammatory cells

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what are systemic complications of RA?

wt loss
fever
extreme fatigue
subcut nadules
respiratory, cardiac complications
vasculitis
periungual lesions
paresthesias

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What are priority problems with RA?

enhance body image
adequate rest
proper positioning
ice and heat applications
promotion of self management
management of fatigue

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what dietary considerations/modifications reduce risk of developing cancer

limiting red meat and alcohol consumption
avoiding excess intake of animal fat, and nitrates
increasing bran and water consumption and eating cruciferous vegetables (broccoli, cauliflower, brussel sprouts, cabbage)

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What are common side effects of zofran?

bradycardia
hypotension
vertigo
headache
constipation

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What is SVC?

compression by lymph nodes and tumors resulting in blockage of venous return
this leads to peri-orbital edema, and engorged blood vessels

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What is CIPN?

loss of sensory perception or motor function of peripheral nerves associated with exposure to anticancer drugs

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during the early stages of vomiting, a pt would be considered to be in

metabolic alkalosis

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For prolonged vomiting or diarrhea, the pt would be considered to be in

metabolic acidosis

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For individuals with COPD or emphysema, the pt would be considered to be in

respiratory acidosis

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hyperventilation may lead to an individual being in what kind of ABG interpretation?

respiratory alkalosis

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What is DKA?

When there is not enough insulin in the body resulting in high blood sugar, the breakdown of protein and fat into energy and the buildup of ketones

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what are signs and symptoms of DKA?

ketosis, acidosis
hyperglycemia
dehydration
kussmaul respirations
fruity breath

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A nurse is caring for clients with SLE plans care understanding the most common causes of death for these clients is which of the following? SATA
a. infection
b. cardiovascular impairment
c. vasculitis
d. chronic kidney disease
e. liver failure
f. blood dyscrasias

b. cardiovascular impairment
d. chronic kidney disease

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a client is being administered the first dose of belimumab for SLE flare. What actions by the nurse are most appropriate? SATA
a. observe the client for at least 2 hours
b. instruct the client about the monthly infusion schedule
c. inform the client not to drive or sign legal papers for 24 hrs
d. ensure emergency equipment is working and nearby
e. make a follow-up appt for a lipid panel in 2 months
f. instruct the client to hold other medications for 72 hours

a. observe the client for at least 2 hours
d. ensure emergency equipment is working and nearby

rationale:
this drug is a monoclonal antibody to tumor necrosis factor. the first dose would be administered in a place where severe allergic reactions and/or anaphylaxis can be managed. this includes having emergency equipment nearby. the client would be observed for at least 2 hours after the first dose. this drug does not cause drowsiness, so there would be no restrictions on driving or signing legal documents. elevated lipids are not associated with this drug. this drug is used in combination with other therapies, especially during a flare.

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The nurse is assessing a client for signs and symptoms of SLE. Which of the following would be consistent with the disorder? SATA
a. discoid rash on skin exposed to sunlight
b. urinalysis positive for casts and protein
c. painful, deformed small joints
d. pain on inspiration
e. thrombocytosis
f. serum positive for antinuclear antibodies

a. discoid rash on skin exposed to sunlight
b. urinalysis positive for casts and protein
d. pain on inspiration
f. serum positive for ANA

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The nurse is studying hypersensitivity reactions. Which reactions are correctly matched with their hypersensitivity types? SATA
a. type I = examples include hay fever and anaphylaxis
b. type 2 = mediated by action of immunoglobulin M
c. type 3 = immune complex deposits in blood vessel walls
d. type 4 = examples are poison ivy and transplant rejection
e. type 4 = involve both antibodies and complement

a. type 1 = examples include hay fever and anaphylaxis
c. type 3 = immune complex deposits in blood vessel walls
d. type 4 = examples are poison ivy and transplant rejection

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What are factors that influence sleep?

drugs and substances
lifestyle
usual sleep patterns
emotional stress
environment
exercise and fatigue
food and calorie intake

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A pt suffers from sleep pattern disturbance. To promote adequate sleep, the most important nursing intervention is:
a. administering a sleep aid
b. synchronizing the medication, treatment and vital signs schedule
c. encouraging the pt to exercise immediately before sleep
d. discussing with the pt the benefits of beginning a long term nighttime medication regimen

b. synchronizing the medication, treatment and vital signs schedule

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A 4 yo pediatric pt resists going to sleep. To assist this pt, the BEST action to take would be a. adding a daytime nap b. allowing the child to sleep longer in the morning c. maintaining the child's home sleep routine d. offering the child a bedtime snack

c. maintaining the child's home sleep routine

Normal sleep requirements and patterns (every developmental stage ranging from neonates to middle and older adults)

neonates - 16 hrs/day infants - 8 to 10 hrs at night; total of 15/day toddlers - total is 12 hrs/day; sleep through the night and daily naps preschoolers - 12 hrs at night; by age 5, naps are rare school age - (6yo = 11 to 12 hours/night) (11 yo = 9 to 10 hrs/night) adolescents - ~7 hrs/night young adults - 6 to 8.5 hrs middle and older adults - total number of hours declines

T/F: Bed rest does not guarantee that a patient will feel rested/refreshed

True

What are the 5 types of sleep disorders?

insomnia sleep apnea narcolepsy sleep deprivation parasomnias

Nursing diagnoses for sleep disorders

anxiety ineffective breathing pattern acute confusion compromised family coping ineffective coping insomnia fatigue sleep deprivation readiness for enhanced sleep

The 6 P's for a neurovascular assessment

pain pallor pulse deficit paresthesia paralysis poikilothermia (coolness)

which new onset condition or symptom in a client who has SLE now taking hydroxychloroquine does the nurse deem to have the HIGHEST priority for immediate reporting to PREVENT HARM? a. increased bruising b. increased daily output of slightly foamy urine c. failure to see letters in the middle of the word d. sensation of nausea within an hour of taking the drug

c. failure to see letters in the middle of the word

Preparing for self management of SLE

accept fatigue as continuing and MANAGEABLE avoid self blame health comes first establish good sleep patterns and a healthy diet prioritize rest stop smoking group errands plan ahead and prioritize activities - it is okay to say NO

What is osteomyelitis?

An infection in bony tissue

Severe osteoporosis is an _______________ ____________________ to joint replacement surgery

ABSOLUTE CONTRAINDICATION

interventions for osteoporosis include

safety precautions lifestyle changes meds = estrogen, calcium, vit D, bisphonates, hormones, raloxifene pain management diet therapy client teaching collaborative health care team roles community resources

Osteoporosis is due to a lack of

calcium and estrogen or testosterone

radiographic findings for osteoporosis includes

osteopenia and fractures

What is osteomalacia?

Demineralized bone

Osteomalacia is due to a deficit in which vitamin?

vitamin D

Radiographic findings for osteomalacia include

pseduofractures, looser's zones, fractures

What is paget's disease?

malformation of the bone resulting in weak, brittle bone

What are systemic effects of immobility?

metabolic - endocrine, calcium absorption and gi function respiratory - atelectasis and hypostatic pneumonia cardiovascular - orthostatic hypotension and thrombus musculoskeletal - loss of endurance and muscle mass; decreased stability and balance muscle - muscle atrophy skeletal - impaired calcium absorption and joint abnormalities urinary elimination - urinary stasis and renal calculi integumentary - pressure ulcer formation and ischemia

types of fractures

closed, nondisplaced compound fragmented displaced oblique spiral impacted greenstick

complications of fractures

shock fat embolism syndrome acute compartment syndrome - pain, pressures, paralysis, paresthesia, pallor, pulselessness venous thromboembolism infection peripheral neurovascular dysfunction impaired physical mobility chronic = ischemic necrosis, AVN, delayed healing complex regional pain syndrome

emergent management of fractures

assess client and site immobilize and elevate keep pt warm and supine 6 Ps transport ASAP if needed

Devices to maintain reduction

fixators traction casts

care of a client with TRACTION

T = TEMP R = Ropes hang freely A = alignment C = circulation check T = type and location I = increased fluids O = overhead trapeze N = no weights on bed or floor

the most frequent M/S disorder is

lower back pain

the cause of lower back pain is unknown, however a cause may be

herniated nucleus pulposus

Risk factors for low back pain include

age 20-40 physical labor jobs smoking arthritis osteoporosis poor physical health/overwight/poor posture pregnancy low pain threshold

Health promotion and maintenance for LBP

preventative measures !! - good posture - proper lifting - exercise - ergonomics - equipment

Lab assessment for cardiovascular assessment includes

troponin - 0-0.03 creatinine kinase - 0-5 myoglobin - 5-70 serum lipids homocysteine highly sensitive c-reactive protein microalbuminuria blood coag studies ABG RBC WBC hemoglobin and hematocrit serum electrolytes

normal ranges for Sodium, Potassium, Calcium, magnesium, phosphate, chloride

SODIUM = 135-145 POTASSIUM = 3.5-5 CALCIUM = 9-11 MAGNESIUM = 1.5-2.5 CHLORIDE = 95-105

normal ranges for hemoglobin and hematocrit, bun and creatinine

hemoglobin: men = 13-18 women = 12-16 hematocrit: men = 39-54% women = 36-48% BUN: 7-20 Creatinine: 0.6-1.2

Potassium imbalance can cause

cardiac dysrhythmias

What is positive troussaeu's sign?

carpal spasm caused by inflating a blood pressure cuff - associated with calcium imbalance

what is chvostek's sign?

contraction of facial muscles with light tap over the facial nerve - associated with calcium imbalance

A client with a calcium imbalance is at risk for pathological fracture therefore when moving or repositioning, it should be done

carefully and slowly

Hypovolemia causes

loss of fluid third spacing (ascites or burns) polyuria

hypervolemia causes

HF kidney dysfunction cirrhosis increased sodium intake

Finish the sentence: Where SODIUM goes, ___________ __________

WATER flows

What is the pathology behind UTIs?

infection within the urinary system caused by either a bacteria (most common is E. coli), virus or fungus

PT education when it comes to UTIs

take entire antibiotics course wipe from front to back void after intercourse avoid caffeine and ETOH void frequently avoid bubble baths, perfumes, or sprays wear non-tight cotton underwear