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med surge > nurs 360 exam 2 > Flashcards

nurs 360 exam 2 Flashcards

1
Q

stages of HIV infection

A

Stage 0: Acute phase or primary infection
high viral load, decrease of CD4+ count–> indicate early infection from lab testing (RNA is in the blood and they are infected during this time)
begins about a couple of weeks to a month after becoming infected and can spread to others.
Signs and symptoms: flu-like symptoms

stage 1: may present as asymptomatic bc there is still high CD4+ but decreases; based on CD4+ count

stage 2 and 3 are based on the CD4+ count

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2
Q

what is CD4+?

A

aka T Cells which are white blood cells that fight infection and play an important role in your immune system

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3
Q

What is viral load?

A

Viral load measures the amount of virus is in a given fluid

–> higher load= higher chance of transmission

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4
Q

How do you know when antivirals are working?

A

Viral load goes down
CD4+ goes up

Examples include penciclovir, peramivir, oseltamivir

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5
Q

How to prevent opportunisitic infections in HIV/AIDS patients?

A

water from treated sources, eat foods that are not raw, avoid sexual activity, keep vaccines up to date, take ART

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6
Q

what are the clinical manifestations of HIV/AIDS patients? What are some opportunistic infections related to HIV/AIDS?

A

1) Respiratory: SOB, dyspnea, cough, chest pain, and fever
☆ penumocytsitis pneumonia: pneumo vax
☆ mycobacterium avium complex
☆tuberculosis: night sweats, trouble breathing

2) GI: loss of appetite, nausea, vomiting, oral and esophageal candidiasis and chronic diarrhea
☆salmonella (avoid raw foods or contaminated water)
☆C. Difficile
☆ candidiasis (fungal infection, creamy white plaque lesions on the tongue or skin)

3) oncologic manifestations: Kaposi sarcoma (little brownish pink spots

4) neurologic: inflammation, atrophy, necrosis
☆ peripheral neuropathy
☆HIV encephalopathy: dementia complex

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7
Q

What is antiretroviral therapy?

A

AKA HAART; reduce hiv morbidity, restore and preserve immunologic function, suppresses HIV viral load, and prevent HIV transmission

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8
Q

What do you do if you’re started on post exposure prophylaxis (PEP):

A

❥ taken after a potential exposure of HIV.
❥ Has to be within 72 hours
❥ not for routine use but emergencies
❥taken for 28 days
❥HIV testing at 7 wks, 12 wks, and 6 months

medications include

  • truvada and isentress (raltegravir)
  • truvada and dolutegravir (tivicay)
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9
Q

How to prevent and treat HIV/AIDs?

A

1) screening: who is at risk? sexual behavior, drug usage, blood transfusion
2) educate about HIV
3) monitoring; nucleic acid tests, antigen/antibody tests, and antibody tests

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10
Q

What do you check for in an HIV antibody titer test?

A

There is no such thing.

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11
Q

Treatments of HIV symptoms include

A

Octreotide acetate, statin has been used for severe diarrhea; patho- inhibit GI motility

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12
Q

What type of vaccines do you avoid if you are ammunocomprimized? Give examples.

A

The flu vaccine is NOT a live vaccine so you can get it.

LIVE VACCINES→ 
Measles, mumps, rubella (MMR combined vaccine)
Rotavirus.
Smallpox.
Chickenpox.
Yellow fever.
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13
Q

How do you do an epinephrine injection? Where do you store an epi pen?

A

orange cap down, put it on the inner thigh and push for 10 seconds.

store epinephrine in a cool, dry place so dont do it in your car.

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14
Q

How often can you give epinephrine? Is there a limit? What meds do you give afterwards as a monitoring sign?

A

Give epinephrine 15 minutes in between; unlimited until they start feeling better

1) start IV epinephrine after SUBQ injections
2) then give corticosteroids and diphenhydramine afterwards
3) monitor for rebound 4-8 hours

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15
Q

Which drugs do you avoid during an allergy test?

A

antihistamine (diphenhydramine, fexofenadine) and corticosteroids (prednisone, cyrocortisone)

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16
Q

What happens when you stick yourself with a sharp?

A

go to employee health

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17
Q

What is a SED rate?

A

(erythrocyte sedimentation rate, also known as ESR) is a simple blood test that helps detect inflammation in the body.
Increased sed rate indicates inflammation.

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18
Q

What is CRP test?

A

C-reactive protein (CRP) is a protein made by the liver. CRP levels in the blood increase when there is a condition causing inflammation somewhere in the body. A CRP test measures the amount of CRP in the blood to detect inflammation due to acute conditions or to monitor the severity of disease in chronic conditions.

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19
Q

What is rheumatoid factor test?

A

A positive rheumatoid factor test result indicates that a high level of rheumatoid factor was detected in your blood. A higher level of rheumatoid factor in your blood is closely associated with autoimmune disease, particularly rheumatoid arthritis.

measures the amount of rheumatoid factor in your blood

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20
Q

Contraindication to diphenhydramine

A

drowsy, confusion, dizziness, dry mouth, nausea

anticholinergic effects

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21
Q

contraindication loratadine

A

2nd gen anti-histamine (non sedating)

headache, nervousness, edema, depression, increased appetite

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22
Q

What is allopurinol? What are the effects of allopurinol?

A

Allopurinol is used to treat gout and certain types of kidney stones. It is also used to prevent increased uric acid levels.

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23
Q

What are the foods associate with latex allergies>

A 
Pineapple 🍍
Banana 🍌
Kiwi 🥝
Mangos 🥭
Passion fruit 
Avocados 🥑
Chestnuts 🌰
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24
Q

What is Cyclobenzaprine? What are the adverse effects>

A

Cyclobenzaprine is a muscle relaxant. It works by blocking nerve impulses (or pain sensations) that are sent to your brain.

anti-cholinergic (cant see, cant, pee, cant spit, cant shit)

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25
Q

What is rheumatoid arthritis?

A

rheumatoid arthritis is an autoimmune condition where the immune system attacks the joints and attacks the synovial fluid of the joint. NO CURE.

characteristics include inflammation, autoimmunity, and degeneration

☑ inflammation of the synovial fluid, cartilage loss, exposed and pitted bones

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26
Q

What is DMARDS? Adverse effects?

A

Antimalarials: hydroxychloroquine, chloroquine

action: anti-inflammatory. inhibits lysosomal enzymes
slow acting

May be administered with NSAIDs. anticholinergic effects (visual changes0, GI upset, skin rash, headache bleaching of hair
exam for ophatmaology 6-12 months

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27
Q

What is Systematic lupus erythematous (lupus, SLE)?

A

Autoimmune chronic condition that causes inflammation (there may be flareups)
–> joints, skin, lungs, heart, kidneys, brain, and blood system can be affect.

signs and symptoms: memory loss, psychosis, memory loss

lupus can affect the hair and skin: skin rashes (malar discoid), alopecia

heart: murmur, pericarditis
kidneys: retain fluid, renal failure, lupus nephritis

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28
Q

What medications do you use for rheumatoid arthritis for the early stages

A

Methotrexate

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29
Q

Patient education about lupus

A

labs:
☑ anti-body labs; positive ANA (the body created against the nuclei of the cells)
☑anti-dsDNA (found in some pts with lupus and is not typcially presents in pts who dont have lupus
☑ CBC (white blood cells, anemia), metabolic panel (renal function)

medications:
☑steroids (prednisone, prednisolone)–> decreases inflammation quickly
☑ NSAIDs
☑anti-malarial : hydrocychlorquine: decreases antibodies attacking the body (does not see immediate results, tae with food must check eyes regularly, no smoking)
☑ immunosuppressants: azathioprine or mycophenolate mofetil; suppresses immune system
- steroid sparking, increases risk for infection and certain cancer
-educated about preventing infection and monitoring self for infection, NO LIVE VACCINEs

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30
Q

what are the long term effects of steroids?

A

steroids: prednisone etc.
decreases inflammation quickly
for severe cases; not for long term usage and must be tapered off

AE: weight gain, decrease bone health: osteoporosis!

31
Q

Gout

A

Maintenance drug for gout: allopurinol

The first dug: acute attacks are managed with Colchicine (oral or parenteral), an NSAID such as indomethacin, or a corticosteroid;

What to avoid: liver, organ meat, alcohol

labs: Utica acid

32
Q

Who would be at high risk for developing osteomyelitis?

A

bone infection found typically where you have a chronic or dirty wound/won’t heal over a bony prominence, it doesn’t have to be visible to cause infection

33
Q

Contusions, sprains, and strains

A

Rice

34
Q

Types of fractures

A 
Comminuted 
Spiral (broken at an angle, not as stable as transverse where the fracture is right on top) 
Greenstick (bone bends/splits)
Oblique
Transverse
35
Q

Methotrexate

A

Immunosuppressive; Used to treat rheumatoid arthritis first line

  • Assess for bone marrow suppression, GI ulcerations, skin rashes, alopecia, bladder toxicity, increased infections.
  • Monitor CBC, liver enzymes, creatinine at 6 wk after initiation, then every 2–3 mo or accordingly.
  • Advise patient of contraceptive measures because of teratogenicity.
36
Q

how to position hip fracture and otheroscorptic patients

A

The patient is most comfortable with the leg slightly flexed in external rotation. SUPINE POSITION

37
Q

What do you avoid when you have gout

A

Liver, organ meat, alcohol, shellfish

38
Q

What is the maintenance drug used for gout?

A

allopurinol

39
Q

Nursing implications for colchicine

A

Lowers the deposition of uric acid and interferes with leukocyte infiltration, thus reducing inflammation; does not alter serum or urine levels of uric acid; used in acute and chronic management

Acute management: Administer when attack begins; dosage increased until pain is relieved or diarrhea develops, then stop medication

Chronic management: Causes gastrointestinal upset in most patients.

40
Q

nursing implications for allopurinol, febuxostat

A

Xanthine oxidase inhibitors; interrupt the breakdown of purines before uric acid is formed; inhibit xanthinoxidase because uric acid formation is blocked

Monitor for side effects, including bone marrow depression, nausea, vomiting, diarrhea, abdominal pain, or rash. Avoid starting medication or increasing dose if active flare present.

41
Q

How to prevent back injuries

A

Learn how to lift, lift with the knees

42
Q

Geriatric considerations with an RA patient

A

The pt who is an older adult or frail, has RA that limits function significantly and lives alone may need referral for home care. assess home environment and its adequacy for patient safety

43
Q

Lupus

A

autoimmune disease

  • -> inspect the skin for rashes
  • -> cardio assessment for pericardial friction rub (heart murmur)
  • -> joint swelling
  • -> abnormal lung sounds
  • -> neuro: psychosis

–> ANA labs for lupus

44
Q

Osteomalacia

A

deficiency in vitamin D (which promotes calcium absorption from the GI tract) which causes the skeleton to soften and weaken

44
Q

Osteomyelitis

A

Bony prominence dirty, chronic wound
Infection of the bone
amputation

look at WBC

45
Q

Alendronate, Risedronate

A

Alendronate, Risedronate

  • Treatment of osteoporosis in women who are postmenopausal
  • Treatment of osteoporosis in men, and in women and men taking corticosteroids

Administer PO, either daily or weekly

Advise patient to take in AM on empty stomach with 250 mL of water while sitting upright and to remain upright for at least 30 min

Effects of alendronate may be diminished in older adult patients who take proton pump inhibitors

46
Q

cyclobenzaprine

A

cyclobenzaprine ← its for low back pain

47
Q

avascular necrosis

A

death of tissue due to insufficient blood supply

48
Q

greenstick

A

a fracture in which one side of a bone is broken and the other side is bent

49
Q

oblique fracture

A

a fracture occurring at an angle across the bone (less stable than a transverse fracture)

50
Q

transverse

A

a fracture that is straight across the shaft

51
Q

can plaster casts get wet

A

nah

52
Q

fiberglass casts

A

increasing warmth; can get wet

53
Q

Potential complications of amputation include

A

Hemorrhage
•Infection
•Skin breakdown

lower limb- proper positioning and promoting venous return. turning side to side. ROM exercises. Limb should be elevated for 24 hrs after amputation. DO NOT place the residual limn on a pillow because a flexion contracture of the hip may result.

54
Q

complications of casts

A

monitor for infection-foul smelling casts (fever), monitor for skin breakdown

55
Q

cast care

A

Cast might get warm
Don’t get it wet but it depends on the cast
Elevate

56
Q

neurovascular assessment

A

pain, pulse (dorsal, posterior, radial), pallor, paresthesia (can you feel this) , Paralysis (can you move this)

57
Q

what do you monitor with patients taking methotrexate

A

kidney function; creatinine (used in first line for RA)

also dont get pregnant

58
Q

osteoporosis with steroid use

A

bone density test

59
Q

how long are patient’s on colchicine?

A

until they have diarrhea. of inflammation decreases

60
Q

What complications is a patient at risk for after a total hip replacement

A

dislocation

61
Q

Post op complications

A

atelectasis, dvt, pe, hypovolemia, pressure injury

62
Q

What is associated with stage 3 HIV?

A

CD4 <200; AIDS

63
Q

What do you look out for when taking hydroxychloroquine?

A

routine eye exams

64
Q

side effects of saliycates

A

Gi bleed, tinnitus

65
Q

vancomycin adverse effects

A

antibiotic

watch for renal function

66
Q

what is kaposi sarcoma

A

affects the skin or mucous membranes that line the GI tract. These tumors appear as purple patches or nodules on the skin and/or mucous membranes and can spread to lymph nodes and lungs.

67
Q

Rheumatoid arthritis is associated with what…

A

morning stiffness

68
Q

Osteo arthritis is associated with what

A

Heberden’s nodes are small bony growths that appear on the joint closest to the tip of your finger. Along with Bouchard’s nodes, Heberden’s nodes are a symptom of osteoarthritis of the hands.

hurts later in the day’,

69
Q

treatment for low back pain

A

Cycbenzoprime

70
Q

medication for osteoporosis

A

Alendronate
Risedronate

  • Treatment of osteoporosis in women who are postmenopausal
  • Treatment of osteoporosis in men, and in women and men taking corticosteroids

Administer PO, either daily or weekly

Advise patient to take in AM on empty stomach with 250 mL of water while sitting upright and to remain upright for at least 30 min

Effects of alendronate may be diminished in older adult patients who take proton pump inhibitors

71
Q

Amphotericin:

A

used in the treatment of Cryptococcal meningitis among patients with HIV infection.

72
Q

Sulfamethoxazole

A

used in the treatment of integumentary issues with HIV patients

73
Q

what is used to treat pneumocystis

A

opportunistic infection in HIV patients.Trimethoprim Sulfamethoxazole is typically used to treat these patients

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