Final Exam Review New Material Flashcards
What is one of the risk factors for osteoarthritis?
Obesity
What are the common manifestations of osteoarthritis?
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
What are the pain control options for osteoarthritis?
Acetaminophen
Lidocaine 5% patches
NSAIDS
Hot/cold therapy
What is Rheumatoid Arthritis?
A chronic, progressive inflammatory autoimmune disease that damages synovial joints, articular cartilage, joint capsule, and affects surrounding ligaments/tendons
What are the Diagnostic tests for rheumatoid arthritis?
Rheumatoid factor
Antinuclear antibody test
Erythrocyte Sedimentation rate
C Reactive Protein
CBC for white count
RACCE
What will you see on an arthrocentesis if the patient has rheumatoid arthritis?
The synovial joint fluid will be cloudy if positive, it will be clear in a normal patient
What are the early joint manifestations of rheumatoid arthritis?
Morning stiffness for longer than an hour
Swelling with rest and movement
Joint will be spongy feeling
What are the systemic early manifestations of rheumatoid arthritis?
Low grade fever
Fatigue
Anorexia
Paresthesia (around joint)
Muscle atrophy
What are the advanced joint manifestations of rheumatoid arthritis?
Deformities (Swan neck, ulnar deviation, nodes)
Moderate to severe pain
Morning stiffness
What are the advanced systemic manifestations of rheumatoid arthritis?
Severe Fatigue
Anemia
Weight loss
Osteoporosis
SQ nodules
Peripheral neuropathy
Vasculitis
Pericarditis
Fibrotic lung disease
Renal Disease
What are the nutritional management strategies of rheumatoid arthritis?
Fish oil capsules for omega 3 FA
Gamma-linolenic acids for omega 6
Seeds and sunflower oils for omega 6
What are the medication mangagement for rheumatoid arthritis?
Methotrexate
Biological Response modifiers DMAR
Immunosuppressants
Corticosteroids
NSAIDS
My Dad Is Not Cool
What are the complications of rheumatoid arthritis?
Sjorgen’s Syndrome
Felty Syndrome
Caplan Syndrome
Secondary Osteoporosis
Vasculitis
Cervical Subluxation
What is Sjorgen’s Syndrome?
Secretory gland disfunction (dry mouth, dry eyes)
What is Felty syndrome?
Splenomegaly and neutropenia
Late Sign
What is caplan syndrome?
Inflammation and scarring of the lungs->RA nodules in the lungs
Late Sign
What is the difference in age onset for osteoarthritis and rheumatoid arthritis
Osteoarthritis: 60 years
Rheumatoid Arthritis: 35-45
What is the differences in the disease process for rheumatoid and osteoarthritis?
Osteoarthritis: Degenerative
Rheumatoid: Inflammation
What is the differences in the disease pattern for rheumatoid and osteoarthritis?
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
What are heberden’s nodes?
Bony nodes at distal joint present in Osteoarthritis
What are Bouchard’s nodes?
Bony nodules at proximal interphalangeal joint present in osteoarthritis
What is systemic lupus erythmatosus?
A chronic autoimmune disease where the immune system triggers the destruction of healthy tissues (especially connective tissue)
What are the risk factors for system lupus erythmatosus
Female between 20-40 yrs
Triggers (Meds, toxins, bacteria..)
Which disease is known as the “Great Imitator”?
Systemic lupus erythmatosus
What are the objective manifestation of systemic lupus erythmatosus?
Red, macular face rash (“butterfly rash”)
Discoid rash on the scalp/sun exposed areas
Fever during exacerbation
Lymphadenopathy
Raynauld’s
Oral mucosal mouth sores
What are the nutritional considerations for Systemic Lupus Erythmatosus?
Small frequent meals with limited salt intake, nutritional supplements
Which medications are used in the treatment of Systemic Lupus Erythmatosus?
Topical Corticosteroids (for rash)
Systemic immunosuppressants
Immune modulators
Corticosteroids
NSAIDs
Anti-Malarial
What are the complications of Systemic Lupus Erythmatosus?
Lupus nephritis->Glomerulonephritis
Pericarditis
Myocarditis
What are the different types of Anemia?
Iron deficiency
B12 deficiency
Folic Acid Deficiency
Anemia of chronic disease
Aplastic
What are the causes of iron deficiency anemia?
Acute:
Blood loss
Menorrhagia
Surgery
Trauma
Chronic:
Nutrition
Pregnancy/Lactation
Slow blood loss
Celiac Disease
What are the SSAs for iron deficiency anemia?
Weakness
Pallor
Fatigue
Reduced exercise
Fissures on corner of mouth
Nail changes (spooning/clubbing)
Intolerance to cold
Tachycardia
What are the lab values for Serum Ferritin?
<10ng/mL for diagnostic for iron deficiency anemia
Normal are 13 to 300
What is the goal of treatment for iron deficiency anemia?
Fe stores to raise by 2mg/mL in 4 weeks
What medication is given for mild to moderate iron deficiency anemia?
FeSO4 mg qd BID
What medication is given for severe iron deficiency anemia?
Iron dextran by Z track
What are the SSAs for Vitamin B12 Deficiency Anemia?
Pallor
Jaundice
Glossitis
Fatigue
Weight loss
Paresthesia of hands and feet
Poor balance
Decreased B12 serum levels
Neurochanges
Memory loss
Loss of Appetite
What are the different lab values for B12 deficiency?
Insufficiency <200
Deficiency <300
What is the shilling test?
Measures the amount of radiactive B12 in urine after administration of oral dose
What are the causes of Folic Acid Deficiency Anemia?
Poor nutrition
Malabsorption (Crohn’s, EtOH misuse
Medications (AEDs, OCPs, Metformin, H2 blockers, PPI, Methotrexate)
What are the SSAs for Folic Acid deficiency anemia?
No paresthesia
Pallor
Jaundice
Glossitis
Stomatitis
Ulcerations
Dysphagia
Fatigue
Weight Loss
What is Aplastic Anemia?
Deficiency of RBCs due to failure of bone marrow that affects 3 types of cells effected
What are the SSAs for aplastic anemia?
dyspnea
Fever
Pallor
Ecchymosis
Purpura
Petechia
Heavy menstrual bleeding
Palpitations
Bleeding easily
Infections
Systolic ejection murmur
How do you diagnose Aplastic anemia?
CBC to look for RBC, WBC, and Platelets
Bone marrow aspirations
What are the interventions for Aplastic anemia?
Blood transfusion
Stem Cell transplantation
Bone Marrow stimulants Immunosuppression
What is Polycythemia Vera?
Excessive bone marrow production of erythrocytes, leukocytes, platelets that create hypervicosity
What occurs to hematocrit in polycythemia vera?
Hematocrit will increase due to increase of cells nut not increase of plasma
What are the SSAs for polycythemia vera?
Facial skin & mucous membranes dark purple or cyanotic
Intense itching
HTN
Tinnitus
Headache
Visual Disturbances
Dyspnea
Heart Failure
What are the diagnostics for polycythemia vera?
Increased Hgb (>18g/dL)
Hct (>55)
What are the possible complications from polycythemia vera?
Thrombosis from vascular statis
Necrosis
Poor Gas exchange
Coagulapathies
Fatal if untreated
What are the interventions for polycythemia vera?
Hydration
Anticoags
Plasmaphereisis
Radiation
Antiplatelets
Exercise slowly
Report chest pain
Monitor for infection
TED stockings
What are the labs and diagnostics for sickle cell disease?
Hbs%
Decrease in hematocrit during crisis
Increased reticulocyte count
Normal iron levels
Increased WBC due to inflammation
What are the medications for sickle cell?
IV opioids
PCA with morphine
Hydromorphone (Dilaudid)
What are PRBCs?
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
What are platelets given for?
Thrombocytopenia
Active bleeding
Invasive procedures
1 hr with max of 4 hours
What is FFP?
Fresh Frozen Plasma
Replaces clotting factors in hemorrhages, DIC, coagulapathies, prolonged bleeding time, mass transfusion
30 to 2 hours/Max 4 hours
Patients that cannot tolerate excessive FFP/fluid can be given?
Cryoprecipitate and plasma protein products
What should the RN be examining before a blood transfusion?
Blood Bag label
Attached tag
Requisition slip
ABO and Rh compatability
Unit #
Expiration date
What kind of line should be used for blood products?
Y blood tubing with a dedicated line (no other meds or fluids) with normal saline only
What are the times to assess a patient during a transfusion?
Q15 minutes x2 (x4 for peds)
Q30 minutes x2
Q1 hr for duration of infusion
What are the signs of a transfusion reaction?
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
What are the symptoms of neutropenia?
Fever >100
Cough
Gingival pain/edema
Sore throat
Chills
Diaphoresis
Frequent/painful urination
fatigue
recurrent infections esp of mucous membranes and skin
What are the two diagnostic values of neutropenia?
Absolute neutrophil count of under 1,500
SEVERE neutropenia is absolute neutrophil count of <500
What are the lab values for agranulocytosis?
ANC<100-200
What are the SSAs for thrombocytopenia?
Purpura
Petchiae
Ecchymosis
Difficulty controlling bleeding
Fecal occult blood
Hematuria
Epistaxis
Bleeding gums
Mucousal bleeding
What are the diagnostic lab values for thrombocytopenia?
Platelets <50,000
Severe risk <10,000
What constitutes and AIDS diagnosis?
CD4 count of under 200
What are the CD4 counts to look for in regards to HIV?
Normal: 800-1000
Symptoms begin: 500
AIDS diagnosis: <200
What are the two most common antiretroviral therapies used in the treatment of HIV?
NRTI (Nucleoside/tide reverse transcriptase inhibitors)
INSTI (integrase inhibitors)
What is the monitoring during ATY HIV treatment?
VL and CMP 4-5 weeks after ART initiation
CD4 and VL every 3-5 months once undetectable
What drugs are used to prophylactically treat Pneumocystis Jiroveci when the CD4 count is under 200?
Bactrum
Dapsone
What drugs are used to prophylactically treat Mycobacterium avium complex when the CD4 cound is under 100?
Azithromycin
Clarithromycin
What are the two PrEP drugs?
Truvada (emtricitabine + TDF)
Descovy (emtricitabine + TAF)
What is the most common drug used for PEP?
Biktarvy
