NR 463 Exam 2 Flashcards
1
Q
- What should you monitor for in a casted extremity?
- When should you notify HCP
- What is a client with osteoporosis at risk for?
A
- Pain, Swelling, Discoloration, Tingling, Numb, Cool, diminished pulse
- Circulatory compromise
- Pathologic fractures
2
Q
- What diagnosis can an xray detect dec bone density?
- When can an Xray detect bone loss
A
- Osteoporosis
- 25-45%
3
Q
- 3 Factors that regulate calcium in the body
- Asorption of vitamind D is increased by..
- Which type of drug decreases calcium absorption?
A
- Parathyroid hormone, Vitamin D, Calcitonin
- PTH
- Glucocorticoids
4
Q
- What foods can interfere with calcium absorption?
- Hypercalcemia tx
A
- Spinach, Whole grain cereal, Bran
- fluids, loop diuretics, phosphates, glucocorticoids, calcitonin, bisphophonates
5
Q
- How does calcitonin work?
- Why take bisphophonates
A
- inhibits osteoclasts (dec bone resorption), inhibits tubular resorption of CA & inc calcium excretion
- postmenopause, glucocorticoid induced, paget’s disease, hypercalcemia
6
Q
- Adverse effect of aldendronate (fusomax)
- What is a class of agents known as selective estrogen receptor modulator?
A
- Esophagitis (bone resorption inhibitor)
- Raloxifene (Evista)
7
Q
- Antiresorptive therapy drugs x4
- Risk factor for osteoporosis
A
- Estrogen, Raloxifene, Biphosphanates, Caclitonin
- Smoking, >65w, >75m, dec estrogen, low weight, Caucasian/Asia, sedentary, glucocorticoids, antiseizure, family hx, alcohol
8
Q
- Diagnostic screening used for osteoporosis?
- Osteopenia T-score
- Osteoporosis T-score
A
- Dual Energy Xray Absorptiometry Scan (Bone Mineral Density)
- -1 to -2.5 (drug therapy
- >-2.5 (high risk fracture)
9
Q
- Patien Ed for Alendronate
- Why take with Vit D & Ca supplements
A
- Take med with 8oz of water upon arising, upright 30 min prior, notify HCP for jaw pain, vomit, ab pain
- building blocks, healing.
10
Q
- Nonpharm prevention bone loss
- Types of Exercises
- Ca foods
A
- quit smoking, exercise, diet, vit D/Ca
- Weight bearing, 30 min 3x/wk
- Milk, cottage cheese, yogurt, dark greens
11
Q
- Protein foods
- Vit D foods
- Therapeutic communication lifestyle changes
A
- meat, cheese nuts
- dairy, salmon, mackerel, tuna, sardines, mushrooms
- Let patient choose with problem to approach first
12
Q
- Patho of OA
- What are osteophytes
- OA joints affected x5
A
- DJD, Cartilage erosion, Bone overgrowth, Spurs (osteophytes)
- Irregularity of joint surface and narrowed spaces
- Hips, knees, hands, feet, spine
13
Q
- OA Characterists
- OP characteristics
A
- not systemic, external, painful
- systemic, internal bone changes (porous, fragile), painless
14
Q
- Risk Factor for OA
- Meds for OA
- Patient Ed for NSAIDS
A
- Joint use/stress, trauma, obesity, age, femal >50
- NSAIDS
- with food, gi bleeding, tarry stools
15
Q
- Celebrex Concerts for OA
- TKA education
A
- Bleeding, cardiac (mi, stroke, thrombosis)\
- relieves pain, improves ROM, correct deformity.
16
Q
- Nonpharm procedures for OA
- Risk factors for hip fracture
A
- Rest, heat/cold, exercises (swimming), Cane, yoga, lose weight, reduce hazards
- age, falls, gender, postmeno w/o HRT, dec estrogen, smoking sedentary, cortico, antimetabolite, RA, longterm PPI
17
Q
- Enoxaprin/Warfarin post op hip fracture
- Use of metal pins, screws, rods, plates to immobilize fracture
A
- dec risk for DVT/PE
- Open Internal Fixation (ORIF)
18
Q
- Intraoperative Blood Salvage, infusion of own blood
- Risks for infusion of own blood
A
- collected in a cell saver, must be infused within 6 hours, 50% rbcs are saved
- not the same as donor, circulatory overload, bacterial contam
19
Q
- Hip Post op Complications
- Blood Loss Assessment
A
- Peripheral neurovascula dysfxn, fat emboli, bleeding, atelectasis, pneumonitis, DVT/PE, dislocation, infection, pressure ulcer
- Dressing drainage, VS- BP drop, HR high, Occult stools, bleeding at other sites, neuro/pain
20
Q
- Goals for alignment post op hip
- Wound infection assess
A
- abduction w/ pillows, must preved adduction of hip joint, HOB
- LOC, VS q4h, , CBC, nutrition
21
Q
- Immobility complication prevention
- What is pulmonary hygiene/toilet
- What factor contributes risk for infection, bleeding, anemia
A
- pain, stools softener, high protein, zinc, calcium, mag, ACEK, ROM, ADLs, Ted hose, Skin care, Reposition q 2h, Pulmonary toilet
- IS, DB/C, breath sounds
- Methotrexate, leucopenia, thrombocytopenia, anemia, chronic immunosuppression from steroid tx.
22
Q
- Nutrition post op hip
- What can blood loss indicate
A
- limit kcal 1400-1600, high protein, calcium, Vit C, iron, glucosamine, folic acid, methotrexate.
- ferrous sulfate supplement/iron
23
Q
- tPA stands for
- What does AKA stand for
A
- tissue plasminogen activator- thromoblytic
- Above the Knee Amputation
24
Q
- What is hyperbaric treatment delivered
- What does hyperbaric tx optimize
A
- an enclosed chamber at increased pressure (high than sea, underw dive)
- hypoxic tissue, hyperoxygenates.
25
Q
- Amputation grief/loss considerations
- What is an important assessment post amputation
- What is prone position
A
- explain procedure, simply, resources (children), case mgmt, chaplain
- Pain
- lying on stomach
26
Q
- Why would surgeon order prone position for amputee
- Intervention for amputee
A
- prevention of hip contractures (hardening of muscle)
- diabetes consult, long acting insulin, family coop for nutrition restriction, PT consult to increase activity/expend calories
27
Q
- Assessment of dressing of amputee
- Risk factors
- Why should you inquire about tighter glucose control
A
- snug to prevent edema but not tight for circulation, edema, erythema, amount/drainage
- Diabetes, atherosclerosis,
- To facilitate wound healing
28
Q
- GERD
- Hiatal Hernia
- Peptic Ulcer Disease
A
- backward flow of gastric contents into esophagues, inappropriate closure of esophageal sphincter
- Stomach into esophagus through an opening in the diaphragm
- Erosion of GI mucosa from HCL acid and pepsin
29
Q
- Gi Bleeding
- Peritonitis
- Inflammatory Bowel diseases
A
- Loss of blood from GI tract
- inflammation of peritoneum (lining the cavity of the abdomen and covering the abdominal organs.)
- chronic inflamed, exacerbation/remissions
30
Q
- Intestinal Obstruction
- Colorectal Cancer
- Ostomy
A
- mech/nonmech occulsion of the instestinal lumen
- cancer in the intestine
- surgical creation of a fecal diversion
31
Q
- Diverticulosis/itis
- GERD causes
A
- saccular dilations or outpouching of the mucosa of the colon
- incompetent les, hernia, obesity, prego, smoking, caffeine, choco, peppermint, high fat, age