Medsurg 3 part 5 Flashcards
Dehydration: HR
increases
Dehydration: pulses
weak
Dehydration: BP
decrease
Dehydration: RR
increase
Assess older adult turgor at the __ or __
sternum or forehead
BUN range
5 to 25
2 biggest risks for fall in dehydrated pt
ortho hypo
AMS
Major role of the nurse in periop is
communicating
periop: assess the allergy to
pineapple/avocado (means latex allergy)
a major concern of post op is
hypothermia
malignant hyperthermia is a reaction to
anesthesia
To prevent malignant hyperthermia assess for
family history
In order to avoid electrical injury the pt must be
grounded
Stop taking ___ 2 weeks before surgery
warfarin
When considering anesthesia, assess for h/o
substance abuse
If CO is less than __ you may need to cancel surgery
35%
Before surgery the pt must be NPO for at least
8 hours
___ intolerance inhibits healing
glucose intolerance
Sequential pressure devices are contraindicated in
DVT
Vascular problems like PAD
Different sized pupils after surgery could mean
he had a cerebral event
Cancer surgery could be what category
palliative
Random antiplatelets
Vit E
Garlic
Laproscopic surgery has a risk for
damage to nearby structures
Pre op: take a __ bath
chlorhexidine bath (but can’t use for face and genitals)
Pre op, what should you ask women
LMP
Lamenectomy
spinal surgery
Before lamenectomy, assess for
muscular strength and sensory function in LOWER body
Cardiac surgery, assess for
6 p’s
If you can’t find a pedal pulse,
use a doppler
Retinal detachment manifested by
disturbed visual field
It’s an emergency
hemoglobin range
For men, 13.5 to 17.5
For women, 12.0 to 15.5
autologous transfusion could cause
fever
Moderate sedation
pt can still respond
pt has cough and gag reflex
closed-angle glaucoma
bad pain
redness
put them in fowlers to decrease pressure
PACU priorities
Breathing LOC Check operation site Connect to cardiac monitor Vitals
Don’t put a post op pt in the same room as
a vent pt
major risk for resp depression, should be assessed first
obesity \+ pain \+ opioid Assess first
Hemovac- if you drain more than __ ml its an oh shoot
100 ml
NG tube can be flushed with
NS
Concern for a post op pt who smokes
slower healing
dehiscence
What do you do for a dihiscence
cover with gauze soaked in saline
If Hg is less than __ you definitely need a transfusion
6
Types of transfusion reactions
febrile
hemolytic
allergic
fluid overload
a hemolytic transfusion reaction involves
antibody mismatch
you can’t start the transfusion if the pt has a
temp
Transfusion: each unit causes the Hg to increase by
1
After a hemolytic reaction, the Hg will be
decreased
s/s of hemolytic reaction
decrease BP
increase HR
Hypoxemia
Flank pain (bc of myoglobin clogging kidney)
What do you do if there’s a hemolytic reaction
stop infusion and start NS
If a pt is getting a transfusion but they have a weak heart,
give them lasix to prevent HF
Most common type of arthritis
OA
auditory finding of OA
crepitus
OA, if you touch the affected area you would find the patient has
mild tenderness
in OA the size of the joint is
enlarged
in OA the affected joints may “__” or “___ ___” as a result of advancing disease
lock or give way
where are Bouchard’s found?
proximal (b comes before h)
psychosocial consideration of OA
the pain may cause depression
OA lab tests
ESR
hsCRP (high sensitivity c reactive protein)
techie tests for OA
MRI
CT studies
is there a cure for OA
no
a modifiable risk factor that can decrease the impact of OA
weight loss
For OA is good to do ____ ___ exercise because leads to increased joint mobility, strengthens the joint’s supporting muscles, tendons, and ligaments
weight bearing
Cartilage growth can be stimulated by
exercise
___ is the key to successful treatment of OA
Education
OA treatment, you need to have a careful balance between
rest and exercise
OA, what kind of impact exercise should they do
low impact (like brisk walking)
OA, what kind of movement therapy?
Tai Chi
OA, a brace can be used to
reduce pain
If you need to immobilize a joint in someone with OA, the max time should be
1 week
OA, Heat applications help with
stiffness by collagen elasticity
OA, Cold applications are used less frequently than heat, and may be beneficial during (3 things)
episodes of acute inflammation,
immediately after exercise,
or for relief of spasms.
complication of Capsaicin cream:
can irritate skin
topical intervention for OA
Capsaicin cream
In OA, Capsaicin cream can be applied to the skin __ times
several times a day
anelgesic of choice of OA
Acetaminophen
OA clients should be switched to NSAID when pain becomes severe on maximum dose of Acetaminophen; for clients with history of GI upset, _____ should be used.
Celebrex
Intra-articular injection of a polysaccharide given to OA pts
Viscosupplementation
Dietary supplement that makes and repairs cartilage
Glucosamine
Dietary supplement that contributes to joint elasticity
chondroitin
SAM-e, s-adenosylmethionine contributes to the production of proteoglycans for
cartilage repair
SAM-e, s-adenosylmethionine are useful in __ OA only
early
arthroplasty
articular surface of a musculoskeletal joint is replaced, remodeled, or realigned
Arthroscopy
looking at the joint with a camera
Osteotomy
bone is cut to change it’s length or alignment
RA: Systemic manifestations: ___ and ___ nodules
subcutaneous nodules and pulmonary nodules
RA: Systemic manifestations: something to do with blood vessels
vasculitis
RA: Systemic manifestations: something to do with scarring
interstitial fibrosis
RA: Systemic manifestations: something to do with the heart
pericarditis
One of the not obvious manifestations of RA
Anorexia
RA has especially bad swelling and stiffness in the
morning
Most commonly effected joints in RA
fingers, hands, wrists, knees and feet
RA can involve ___ deformity and ___ deformity
Swan-neck deformity
Boutonniere deformity
RA frequently affects the knees and feet, ___ cysts and ___ cysts , may develop behind the knee joint
Popliteal cysts and Baker’s cysts
2 RA syndromes
Sjőgren’s syndrome
Feltys syndrome
gritty eyes
Sjőgren’s syndrome (in RA)
Combination of RA, splenomegaly, leukopenia, leg ulcers, lymphadenopathy, thrombocytopenia
Feltys syndrome
Anti-nuclear Antibody Testing (ANA) tests for
RA
Anti-nuclear Antibody Testing (ANA) positive result is
1:10 to 1:30
positive Rheumatoid Factor test
1:20
accurate detection of RA
Cyclic Citrullinated Peptide antibodies
C-Reactive Protein: ___ with active RA
elevated
X-rays of affected RA joints: Early disease
soft tissue swelling and effusions
X-rays of affected RA joints: Late disease
joint space narrowing and erosions
RA drug that modifies immune and inflammatory responses: may decrease disease activity
DMARDs
These are examples of gold salts antimalarial agents Sulfasalazine D-penicillamine
DMARDs
DMARDs are not able to
slow bone erosion or facilitate healing
RA Tx: Low-dose oral corticosteroids are used to
reduce pain and inflammation
The long-term effects of corticosteroid is associated with (just say them out loud)
poor wound healing, increased risk of infection, osteoporosis, gastrointestinal bleeding, hyperglycemia Cushingoid appearance
drug for aggressive RA
Methotrexate (just call it Metho)
Methotrexate is usually given with
NSAIDs
Methotrexate SE’s can be controlled by giving with
folic acid
w oncology pt the ___ acid is given as a rescue, NEVER concurrently
folic
RA: i____ exercises to improve muscle strength
Isometric
RA: Synovectomy—removal of synovia to maintain
joint function
RA: Arthrodesis — fusion of a joint for clients with bone loss; aids in
regaining some mobility
More than 90% of people w sle are
women
3 Drugs that can cause a syndrome that mimics lupus: (h.i.p.)
Hydralazine and INH and Procainamide
2 leading causes of death in SLE
Pneumonia and sepsis
One of the SLE neuro effects is
psychosis
which disease: blood counts: anemia, thrombocytopenia, neutropenia
SLE
SLE: serum protein electrophoresis test shows: increased ___ and decreased _____
increased gammaglobulin and decreased albumin
SLE tests of kidney involvement show: increases in serum ___ and ___
BUN and creatinine
SLE testing show increased muscle enzymes (such as ___) if muscle involvement is present.
CK
which disease has Urine with mild proteinuria, hematuria, and blood cell casts during exacerbations
SLE
Anti-nuclear antibody test (ANA) is to determine if
autoantibodies to cell nuclei are present in the blood
Anti-Sm antibody test to determine if there are antibodies to Sm, which is a ____ found in the cell nucleus
ribonucleoprotein
If the total blood complement level is low, or the C3 or C4 complement values are low and the person also has a positive ___, then
ANA
the dx is prob lupus
Low C3 and C4 complement levels in individuals with a positive ANA may signify the presence of active disease, especially ___ disease.
kidney
Disease activity correlates with a rise in: C__
CRP (C reactive protein)
Disease activity correlates with a rise in: E__
ESR
Disease activity correlates with a rise in: Anti-__
Anti-DNA
Disease activity correlates with a rise in: Liver and kidney function tests like ___ and ___
BUN and creatinine
Disease activity correlates with a rise in: CPK which is a
(muscle enzyme)
Disease activity correlates with a rise in: Urine ___ or __ casts
Urine protein or cellular casts
Disease activity also correlates with a fall in: C__
CBC
Disease activity also correlates with a fall in: _____ components
Complement components
Disease activity also correlates with a fall in: Serum ___
albumin
psychosocial goals for SLE
Reducing stress
Maintaining emotional well-being
Pharmacological treatment of SLE: 2 drugs for inflammation
NSAID
Corticosteroids (prednisone)
Pharmacological treatment of SLE: prednisone per day initially for
severe exacerbation
Pharmacological treatment of SLE: Some clients require long-term steroids to manage symptoms and prevent major
organ damage
Pharmacological treatment of SLE: Anti-malarial example
Plaquenil
Pharmacological treatment of SLE: Plaquenil adverse rxns (2)
Renal toxicity and retinal damage
Pharmacological treatment of SLE: for lupus arthritis, skin rashes, mouth rashes, give the pt
Plaquenil
Pharmacological treatment of SLE: Other possible benefits of anti-malarials include
reducing the risk of blood clots
lowering cholesterol levels.
Anti-malarials are generally not recommended for
pregnancy
shortly after starting treatment, there may be a temporary mild blurring of vision, which resolves on its own
Plaquenil
All cytotoxic immunosupressive drugs are thought to increase a person’s risk for developing
cancer
These drugs are used for SLE; what class are they
azathioprine (Imuran)
cyclophosphamide (Cytoxan)
methotrexate
cyclosporine
Cytotoxic, or immunosuppressive
azathioprine SE
Allergic-type hepatitis, pancreatitis
cyclophosphamide SE
Alopecia, bladder complications (hematuria), sterility
methotrexate SE
Hepatic complications, lung toxicity, bone marrow depression
cyclosporine SE
hypertension and may lead to kidney damage.
Nursing care r/t medication regimen: Notify the HCP if platelets
75,000
Pulmonary ___ is a potential adverse effect of cyclophosphamide
fibrosis
End-stage lupus nephropathy are managed with dialysis or kidney ___
transplantation
There is an increased incidence of ___ among SLE clients on dialysis.
infections
SLE Clients are at risk for psychosis related to
inflammation of the central nervous system, and steroid use
SLE Clients may also have seizures, generally preceded by throbbing
headache
A shift to the __ (increased numbers of immature leukocytes) may be an early indication of infection
left
every six months, SLE pts should have
eye exams
Pregnancy and SLE
not contraindicated
