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NURS 723 Med/Surg 1 > Final Exam Review New Material > Flashcards

Final Exam Review New Material Flashcards

1
Q

What is one of the risk factors for osteoarthritis?

A

Obesity

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2
Q

What are the common manifestations of osteoarthritis?

A

Unilateral joint pain (before or after movement)

Pain less than 30 min in the AM

Pain improves with rest

Joint firm and tender on palpation

+Crepitus

+Joint effusions

Grating sensation/bone spurs

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3
Q

What are the pain control options for osteoarthritis?

A

Acetaminophen
Lidocaine 5% patches
NSAIDS
Hot/cold therapy

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4
Q

What is Rheumatoid Arthritis?

A

A chronic, progressive inflammatory autoimmune disease that damages synovial joints, articular cartilage, joint capsule, and affects surrounding ligaments/tendons

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5
Q

What are the Diagnostic tests for rheumatoid arthritis?

A

Rheumatoid factor
Antinuclear antibody test
Erythrocyte Sedimentation rate
C Reactive Protein
CBC for white count

RACCE

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6
Q

What will you see on an arthrocentesis if the patient has rheumatoid arthritis?

A

The synovial joint fluid will be cloudy if positive, it will be clear in a normal patient

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7
Q

What are the early joint manifestations of rheumatoid arthritis?

A

Morning stiffness for longer than an hour
Swelling with rest and movement
Joint will be spongy feeling

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8
Q

What are the systemic early manifestations of rheumatoid arthritis?

A

Low grade fever
Fatigue
Anorexia
Paresthesia (around joint)
Muscle atrophy

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9
Q

What are the advanced joint manifestations of rheumatoid arthritis?

A

Deformities (Swan neck, ulnar deviation, nodes)
Moderate to severe pain
Morning stiffness

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10
Q

What are the advanced systemic manifestations of rheumatoid arthritis?

A

Severe Fatigue
Anemia
Weight loss
Osteoporosis
SQ nodules
Peripheral neuropathy
Vasculitis
Pericarditis
Fibrotic lung disease
Renal Disease

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11
Q

What are the nutritional management strategies of rheumatoid arthritis?

A

Fish oil capsules for omega 3 FA
Gamma-linolenic acids for omega 6
Seeds and sunflower oils for omega 6

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12
Q

What are the medication mangagement for rheumatoid arthritis?

A

Methotrexate
Biological Response modifiers DMAR
Immunosuppressants
Corticosteroids
NSAIDS

My Dad Is Not Cool

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13
Q

What are the complications of rheumatoid arthritis?

A

Sjorgen’s Syndrome
Felty Syndrome
Caplan Syndrome
Secondary Osteoporosis
Vasculitis
Cervical Subluxation

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14
Q

What is Sjorgen’s Syndrome?

A

Secretory gland disfunction (dry mouth, dry eyes)

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15
Q

What is Felty syndrome?

A

Splenomegaly and neutropenia

Late Sign

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16
Q

What is caplan syndrome?

A

Inflammation and scarring of the lungs->RA nodules in the lungs

Late Sign

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17
Q

What is the difference in age onset for osteoarthritis and rheumatoid arthritis

A

Osteoarthritis: 60 years
Rheumatoid Arthritis: 35-45

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18
Q

What is the differences in the disease process for rheumatoid and osteoarthritis?

A

Osteoarthritis: Degenerative
Rheumatoid: Inflammation

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19
Q

What is the differences in the disease pattern for rheumatoid and osteoarthritis?

A

Osteoarthritis: Unilateral, single joint initially, affects weight bearing joints, hands and spine

Rheumatoid: Bilateral, symmetric involving multiple joints (soft/spongy), effects upper extremities first, systemic, + swan neck/ulnar deformity

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20
Q

What are heberden’s nodes?

A

Bony nodes at distal joint present in Osteoarthritis

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21
Q

What are Bouchard’s nodes?

A

Bony nodules at proximal interphalangeal joint present in osteoarthritis

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22
Q

What is systemic lupus erythmatosus?

A

A chronic autoimmune disease where the immune system triggers the destruction of healthy tissues (especially connective tissue)

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23
Q

What are the risk factors for system lupus erythmatosus

A

Female between 20-40 yrs
Triggers (Meds, toxins, bacteria..)

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24
Q

Which disease is known as the “Great Imitator”?

A

Systemic lupus erythmatosus

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25
Q

What are the objective manifestation of systemic lupus erythmatosus?

A

Red, macular face rash (“butterfly rash”)
Discoid rash on the scalp/sun exposed areas
Fever during exacerbation
Lymphadenopathy
Raynauld’s
Oral mucosal mouth sores

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26
Q

What are the nutritional considerations for Systemic Lupus Erythmatosus?

A

Small frequent meals with limited salt intake, nutritional supplements

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27
Q

Which medications are used in the treatment of Systemic Lupus Erythmatosus?

A

Topical Corticosteroids (for rash)
Systemic immunosuppressants
Immune modulators
Corticosteroids
NSAIDs
Anti-Malarial

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28
Q

What are the complications of Systemic Lupus Erythmatosus?

A

Lupus nephritis->Glomerulonephritis
Pericarditis
Myocarditis

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29
Q

What are the different types of Anemia?

A

Iron deficiency
B12 deficiency
Folic Acid Deficiency
Anemia of chronic disease
Aplastic

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30
Q

What are the causes of iron deficiency anemia?

A

Acute:
Blood loss
Menorrhagia
Surgery
Trauma
Chronic:
Nutrition
Pregnancy/Lactation
Slow blood loss
Celiac Disease

31
Q

What are the SSAs for iron deficiency anemia?

A

Weakness
Pallor
Fatigue
Reduced exercise
Fissures on corner of mouth
Nail changes (spooning/clubbing)
Intolerance to cold
Tachycardia

32
Q

What are the lab values for Serum Ferritin?

A

<10ng/mL for diagnostic for iron deficiency anemia

Normal are 13 to 300

33
Q

What is the goal of treatment for iron deficiency anemia?

A

Fe stores to raise by 2mg/mL in 4 weeks

34
Q

What medication is given for mild to moderate iron deficiency anemia?

A

FeSO4 mg qd BID

35
Q

What medication is given for severe iron deficiency anemia?

A

Iron dextran by Z track

36
Q

What are the SSAs for Vitamin B12 Deficiency Anemia?

A

Pallor
Jaundice
Glossitis
Fatigue
Weight loss
Paresthesia of hands and feet
Poor balance
Decreased B12 serum levels
Neurochanges
Memory loss
Loss of Appetite

37
Q

What are the different lab values for B12 deficiency?

A

Insufficiency <200
Deficiency <300

38
Q

What is the shilling test?

A

Measures the amount of radiactive B12 in urine after administration of oral dose

39
Q

What are the causes of Folic Acid Deficiency Anemia?

A

Poor nutrition
Malabsorption (Crohn’s, EtOH misuse
Medications (AEDs, OCPs, Metformin, H2 blockers, PPI, Methotrexate)

40
Q

What are the SSAs for Folic Acid deficiency anemia?

A

No paresthesia
Pallor
Jaundice
Glossitis
Stomatitis
Ulcerations
Dysphagia
Fatigue
Weight Loss

41
Q

What is Aplastic Anemia?

A

Deficiency of RBCs due to failure of bone marrow that affects 3 types of cells effected

42
Q

What are the SSAs for aplastic anemia?

A

dyspnea
Fever
Pallor
Ecchymosis
Purpura
Petechia
Heavy menstrual bleeding
Palpitations
Bleeding easily
Infections
Systolic ejection murmur

43
Q

How do you diagnose Aplastic anemia?

A

CBC to look for RBC, WBC, and Platelets
Bone marrow aspirations

44
Q

What are the interventions for Aplastic anemia?

A

Blood transfusion
Stem Cell transplantation
Bone Marrow stimulants Immunosuppression

45
Q

What is Polycythemia Vera?

A

Excessive bone marrow production of erythrocytes, leukocytes, platelets that create hypervicosity

46
Q

What occurs to hematocrit in polycythemia vera?

A

Hematocrit will increase due to increase of cells nut not increase of plasma

47
Q

What are the SSAs for polycythemia vera?

A

Facial skin & mucous membranes dark purple or cyanotic
Intense itching
HTN
Tinnitus
Headache
Visual Disturbances
Dyspnea
Heart Failure

48
Q

What are the diagnostics for polycythemia vera?

A

Increased Hgb (>18g/dL)
Hct (>55)

49
Q

What are the possible complications from polycythemia vera?

A

Thrombosis from vascular statis
Necrosis
Poor Gas exchange
Coagulapathies
Fatal if untreated

50
Q

What are the interventions for polycythemia vera?

A

Hydration
Anticoags
Plasmaphereisis
Radiation
Antiplatelets
Exercise slowly
Report chest pain
Monitor for infection
TED stockings

51
Q

What are the labs and diagnostics for sickle cell disease?

A

Hbs%
Decrease in hematocrit during crisis
Increased reticulocyte count
Normal iron levels
Increased WBC due to inflammation

52
Q

What are the medications for sickle cell?

A

IV opioids
PCA with morphine
Hydromorphone (Dilaudid)

53
Q

What are PRBCs?

A

Packed red blood cells that are used to replace RBCs from trauma, surgery, bleeding or anemia in 1-2 hours with a max of 4 hours

54
Q

What are platelets given for?

A

Thrombocytopenia
Active bleeding
Invasive procedures
1 hr with max of 4 hours

55
Q

What is FFP?

A

Fresh Frozen Plasma
Replaces clotting factors in hemorrhages, DIC, coagulapathies, prolonged bleeding time, mass transfusion

30 to 2 hours/Max 4 hours

56
Q

Patients that cannot tolerate excessive FFP/fluid can be given?

A

Cryoprecipitate and plasma protein products

57
Q

What should the RN be examining before a blood transfusion?

A

Blood Bag label
Attached tag
Requisition slip
ABO and Rh compatability
Unit #
Expiration date

58
Q

What kind of line should be used for blood products?

A

Y blood tubing with a dedicated line (no other meds or fluids) with normal saline only

59
Q

What are the times to assess a patient during a transfusion?

A

Q15 minutes x2 (x4 for peds)
Q30 minutes x2
Q1 hr for duration of infusion

60
Q

What are the signs of a transfusion reaction?

A

Chills/shivering
Fever (>1degree increase)
Diaphoresis
Restlessness
Tachycardia/tachypnea
Hypotension
Rash
Flushing
Flank/low back pain
Shortness of breath
Wheezing
Blood in urine
N/V
Sense of impending doom

61
Q

What are the symptoms of neutropenia?

A

Fever >100
Cough
Gingival pain/edema
Sore throat
Chills
Diaphoresis
Frequent/painful urination
fatigue
recurrent infections esp of mucous membranes and skin

62
Q

What are the two diagnostic values of neutropenia?

A

Absolute neutrophil count of under 1,500
SEVERE neutropenia is absolute neutrophil count of <500

63
Q

What are the lab values for agranulocytosis?

A

ANC<100-200

64
Q

What are the SSAs for thrombocytopenia?

A

Purpura
Petchiae
Ecchymosis
Difficulty controlling bleeding
Fecal occult blood
Hematuria
Epistaxis
Bleeding gums
Mucousal bleeding

65
Q

What are the diagnostic lab values for thrombocytopenia?

A

Platelets <50,000
Severe risk <10,000

66
Q

What constitutes and AIDS diagnosis?

A

CD4 count of under 200

67
Q

What are the CD4 counts to look for in regards to HIV?

A

Normal: 800-1000
Symptoms begin: 500
AIDS diagnosis: <200

68
Q

What are the two most common antiretroviral therapies used in the treatment of HIV?

A

NRTI (Nucleoside/tide reverse transcriptase inhibitors)
INSTI (integrase inhibitors)

69
Q

What is the monitoring during ATY HIV treatment?

A

VL and CMP 4-5 weeks after ART initiation
CD4 and VL every 3-5 months once undetectable

70
Q

What drugs are used to prophylactically treat Pneumocystis Jiroveci when the CD4 count is under 200?

A

Bactrum
Dapsone

71
Q

What drugs are used to prophylactically treat Mycobacterium avium complex when the CD4 cound is under 100?

A

Azithromycin
Clarithromycin

72
Q

What are the two PrEP drugs?

A

Truvada (emtricitabine + TDF)
Descovy (emtricitabine + TAF)

73
Q

What is the most common drug used for PEP?

A

Biktarvy

NURS 723 Med/Surg 1 (6 decks)

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