Final Flashcards
What is osteoporosis?
progressive deterioration and loss of articular cartilage and bone in one or more joints
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
What is the recommended drug for osteoporosis?
Acetominophen (NSAIDs)
what is RA?
chronic, progressive, systemic inflammatory autoimmune disease - affects synovial joints
autoantibodies attack healthy tissue causing inflammation
What happens to the synovium in individuals with RA?
It thickens and becomes hyperemic, fluid accumulates in the joint space and a pannus forms
what is a pannus?
vascular granulation tissues composed of inflammatory cells
what are systemic complications of RA?
wt loss
fever
extreme fatigue
subcut nadules
respiratory, cardiac complications
vasculitis
periungual lesions
paresthesias
What are priority problems with RA?
enhance body image
adequate rest
proper positioning
ice and heat applications
promotion of self management
management of fatigue
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)
What are common side effects of zofran?
bradycardia
hypotension
vertigo
headache
constipation
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
What is CIPN?
loss of sensory perception or motor function of peripheral nerves associated with exposure to anticancer drugs
during the early stages of vomiting, a pt would be considered to be in
metabolic alkalosis
For prolonged vomiting or diarrhea, the pt would be considered to be in
metabolic acidosis
For individuals with COPD or emphysema, the pt would be considered to be in
respiratory acidosis
hyperventilation may lead to an individual being in what kind of ABG interpretation?
respiratory alkalosis
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
what are signs and symptoms of DKA?
ketosis, acidosis
hyperglycemia
dehydration
kussmaul respirations
fruity breath
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
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.
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
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
What are factors that influence sleep?
drugs and substances
lifestyle
usual sleep patterns
emotional stress
environment
exercise and fatigue
food and calorie intake
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
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
