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Adult Health II - (Josh) > T2 - Blueprint (Josh) > Flashcards

T2 - Blueprint (Josh) Flashcards

1
Q

What is the most common type of arthritis?

A

OA (Osteoarthritis)

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2
Q

What are Osteophytes and what are they associated with?

A

Bone Spurs

Associated with OA

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3
Q

OA:

ESR will be —- with OA. What are the normal values?

A

elevated

Normal:

  • Men 0-22
  • Women 0-29
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4
Q

OA:

Which nodes are more distal?

Which nodes are more proximal?

A

Haberden’s Nodes – DISTAL

Bouchard’s Nodes – PROXIMAL

***B is closer to beginning than H

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5
Q

OA:

What happens to skeletal muscles with OA?

A

atrophy due to immobility

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6
Q

OA:

Which gender is more affected?

A

female

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7
Q

OA:

What are some risk factors?

A

Joint Trauma (overuse)

Joint Sepsis

Smoking

Obesity

DM

Paget’s Disease

Sickle Cell

Age over 60

Women

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8
Q

OA:

What is the DOC?

A

Acetaminophen

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9
Q

OA:

Avoid NSAIDs if they have — and — issues.

A

Kidney

GI

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10
Q

OA:

Capsaicin is a — med. What should we know?

A

topical

  • Wear Gloves
  • Avoid tight dressings
  • Wash hands and avoid applying to broken skin
  • Some burning sensation is normal
  • Apply up to 4 times a day
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11
Q

OA:

What can Glucosamine do and what should we educate about?

A

rebuilds cartilage

may cause mild GI upset, nausea, and heartburn

caution with shellfish allergy

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12
Q

Arthritis:

— is usually bilateral and is NOT inflammatory.

— is usually symmetrical is IS inflammatory.

A

OA

Rheumatoid Arthritis

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13
Q

RA:

Which labs are INCREASED?

A

Anti CCP Antibodies

RF Factor

ANA Titer

ESR

Serum Immunoglobulins

WBCs

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14
Q

RA:

Which labs are DECREASED?

A

Serum Complement (C3 and C4)

Albumin

Hgb

HCT

RBC

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15
Q

RA:

What can occur with LATE RA?

A

Thrombocystosis

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16
Q

RA:

What are some medication classes for this?

A

DMARDs

NSAIDs

Cox-2 Inhibitors

BRMs (Biological Response Modifiers)

Glucocorticoids

Immunosuppressive Agents

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17
Q

RA:

What are some associated syndromes with RA?

A

Osteoporosis

Sjogren’s Syndrome

Felty’s Syndrome

Caplan’s Syndrome

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18
Q

RA:

Sjogren’s is an associated syndrome. What are signs and symptoms?

A

Dry eyes, mouth, vagina

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19
Q

RA:

What is characteristic of Felty’s Syndrome?

A

hepatosplenomegaly

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20
Q

RA:

Why would a client get Respiratory and Cardiac complications from RA?

A

because it’s a systemic disease

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21
Q

Scleroderma:

What is CREST Syndrome?

A 
Calcinosis
Raynaud's Phenomenon
Esophageal Dysmotility
Sclerodactyly
Telangiectasia
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22
Q

Scleroderma:

What are some systemic manifestations of Scleroderma?

A

Arthalgia

Renal (decreased function)

Cardiac (chest pain, dysrhythmia)

GI (GERD, dysphagia, etc)

Lung (Pulmonary HTN)

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23
Q

What is SLE?

A

Systemic Lupus Erythematosus

  • an autoimmune disease that often has kidney involvement
  • chronic, progressive, inflammatory connective tissue disorder
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24
Q

Lupus:

There are two types, what are they?

A

SLE (Systemic Lupus Erythematosus)

DLE (Discoid Lupus Erythematosus)

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25
Q

Lupus:

What are the risk factors?

A

Female age 20-40

African American, Asian, Native American

Med induced

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26
Q

Lupus:

What are some meds that can cause lupus?

A

Procainamide

Hydralazine

Isoniazide

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27
Q

Butterfly Rash is hallmark sign of —-

A

Lupus (SLE)

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28
Q

What is the most common cause of death with Lupus?

A

Renal (Lupus Nephritis)

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29
Q

Lupus:

Signs and Symptoms

A

Butterfly Rash and Alopecia

Polyarthritis

Osteonecrosis

Muscle atrophy

Fever, Fatigue, Malaise

Anorexia, weight loss

Pleural Effusions

Renal probs

Pericarditis

Raynaud’s

Migraine HA

Serositis

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30
Q

Lupus:

How is dx confirmed with DLE?

A

skin biopsy

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31
Q

Lupus:

What does CBC look like with SLE?

A

everything low

  • Anemia
  • Leukopenia
  • Thrombocytopenia
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32
Q

Lupus:

What are side effects of corticosteroid treatment?

A

CUSHINGOID

C - Cataracts
U - Ulcers
S - Skin thinning, bruising
H - Hyperglycemia, HTN, Hirutisim
I - Infections
N - Necrosis of femoral head
G - Glycosuria
O - Osteoporosis, Obesity
I - Immunosuppression
D - Diabetes
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33
Q

Gout:

What are the stages of Primary Gout?

A

Stage 1: asymtomatic increased uric acid level

Stage 2: acute gouty arthritis attack, increased ESR and uric acid (give IV NSAIDs)

Stage 3: chronic condition (tophi crystals under skin)

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34
Q

Gout:

What are trigger foods for Gout?

A

PROTEINS!!!

  • Organ Meats
  • Red Meats
  • Shellfish
  • Starvation Diets
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35
Q

Gout:

We need to increase — with — foods.

A

pH

alkaline

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36
Q

Lyme Disease:

What are the stages

A

Stage 1: Flu-like symptoms, Red Rash (bullseye), pain and stiffness of joints

Stage 2: Cardiac and Pulmonary involvement

Stage 3: Chronic arthritis, fatigue

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37
Q

Lyme Disease:

What is the skin reactions associated with it?

A

Erythema Migrans

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38
Q

Musculoskeletal System:

Calcium has an inverse relationship with —

A

phosphorus

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39
Q

MSK:

What happens to Alkaline Phosphatase when bone is damaged and diseased?

A

increases

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40
Q

MSK:

What are the muscle enzymes that are increased with muscle damage or trauma?

A

CK-MM
AST
ALD
LDH

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41
Q

Bone Scan:

What is injected?

A

radioactive material injected 2-3 hrs before scanning

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42
Q

Bone Scan:

What should we teach prior?

A

Empty bladder prior

Drink lots of fluids

No radioactive precautions needed

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43
Q

Arthroscopy:

To be able to do this, what must patient be able to do?

A

bend knee 45 degrees

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44
Q

EMG:

What does it diagnose?

A

neuromuscular, lower motor neuron, and peripheral nerve disorders

ex: Lou Gherig’s

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45
Q

EMG:

What meds need to be held for a few days prior?

A

muscle relaxants

***eat and drink before ok

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46
Q

DXA Scan:

What does it do?

A

two beams of radiation to analyze bone density

***detects osteoporosis

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47
Q

DXA Scan:

What do we need to teach?

A

not invasive

no contast media

patient can stay dressed by remove metallic objects

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48
Q

Osteoporosis:

Osteoclasts do what?

Osteoblasts do what?

A

Osteoclasts break bone down

Osteoblasts build bone up

  • **Clasts Cut down
  • **Blasts Build up
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49
Q

Osteoporosis:

There is an increase in — activity and a decrease in — activity.

A

osteoclast

osteoblast

50
Q

Osteoporosis:

What are some lifestyle changes to prevent?

A

No Smoking

Decrease ETOH

51
Q

Osteoporosis:

What is a T-score?

A

the number of standard deviations above or below the average young adult

-1 to -2.5 = osteopenia

52
Q

Osteoporosis:

What do we need to teach regarding Bisphosphonate therapy?

A

causes esophagitis

  • don’t lay down for 30 mins after
  • take with 8 oz of water
53
Q

Osteoporosis:

Report jaw pain with which med?

A

pamidronate (bisphosphonate)

54
Q

Osteoporosis:

What do Estrogen Agonists Antagonists (Raloxifene) do?

A

increase risk of DVTs

55
Q

Osteomalacia:

What is the etiology?

A

loss of bone related to Vit D deficiency leading to softening of bone

56
Q

Osteomalacia:

What are signs and symptoms?

A

Muscle Weaknes (waddling gait)

Bone Tenderness

Bone Pain worse with activity and at night

57
Q

Osteomalacia:

What would X-ray reveal?

A

decrease in cancellous bone (spongy tissue on inside of bone)

58
Q

Osteomalacia:

What med do we give?

A

Ergocalciferol (Vit D)

59
Q

Paget’s Disease:

What is it?

A

excessive osteoclastic AND osteoblastic activity leading to structurally disorganized, weak bones

60
Q

What is Page’t Disease linked to?

A

hearing loss

61
Q

Paget’s Disease:

What are the phases?

A

Active - massive bone destruction

Mixed - osteoblast compensation by forming new, weaker bone

Inactive - bone becomes hardened and sclerotic

62
Q

Paget’s Disease:

What is diagnostic?

A

Serum ALP

24 hr urinary hydroxyproline

X-rays, bone scan, CT, MRI

63
Q

Osteomyelitis:

What is etiology?

A

infection of bone tissue

64
Q

Osteomyelitis:

What treatment can be used to increase viability of working cells?

A

HBO (Hyperbaric Oxygenation)

65
Q

Fractures:

A fatty embolism is most likely the result of which type of bone fracture?

A

Long Bone Fracture

66
Q

Fractures:

What is the characteristic of Fatty Embolism that separates it from VTE?

A

Petechia

67
Q

Fractures:

A Fatty Embolis is likely to occur within — of injury.

A

48 hrs

68
Q

Fracture:

Treatment plan for Fatty Embolism.

A

Oxygen (vent)

***heparin won’t work because it’s not a blood clot

69
Q

Fracture:

What are the 6 P’s of Compartment Syndrome?

A 
Pain
Pressure
Paralysis
Paresthesia
Pallor
Pulselessness
70
Q

Amputation:

What is a Neuroma and where is it most likely to occur?

A

tumor comprised of nerve cells at base of an amputation

most likely with UPPER EXTREMITY amputations

71
Q

Amputation:

What is a Flexion Contracture?

A

Complication from amputation when joint motion is restricted, the limbs or residual limbs of an amputee cannot move through the motion they need for function and regular activity.

72
Q

Amputation:

How do you prevent Flexion Contractures?

A

Elevate on pillow ONLY first 24 hr

Prone position for 20 min periods several times a day

Firm Mattress

73
Q

Amputation:

What are some meds for Phantom Limb Pain?

A

Calcitonin (IV infusion reduces PLP)

Beta Blockers (Propanolol)

Antiepileptics (gabapentin)

74
Q

Renal Assessment:

Urea is a byproduct of — metabolism.

Creatinine is a byproduct of — metabolism.

A

ammonia

protein

***Cr is a better indicator than BUN

75
Q

Renal Assessment:

How could kidney failure cause anemia?

A

kidneys secrete erythropoietin which controls erythrocyte production in bone marrow

76
Q

Renal Assessment:

How could kidney failure cause HTN?

A

kidneys control the RAA System

77
Q

Renal Assessment:

How could kidney failure cause bone disease?

A

kidneys convert Vit D into an active form and Vit D stimulates the absorption of calcium by the intestine

78
Q

Renal Assessment:

What will skin look like with kidney problems?

A

uremic frost

dry and itchy

79
Q

Renal Assessment:

What is normal Cr?

What is normal BUN?

A

0.5 - 1.5

10 - 20

80
Q

BUN Cr Ratio:

A ratio of 20:1 means they are elevated at — rates and indicates an — problem.

A ratio of 10:1 means they are elevated at — rates and indicates an — problem.

A

different

extra-renal problem

same

renal

81
Q

Urine Specific Gravity:

What is normal values?

What do increased values mean?

What do decreased values mean?

A

normal: 1.005 - 1.030

Increased: volume deficit, concentrated urine, PRERENAL AKI

Decreased: volume overload, dilute urine, INTRARENAL AKI

82
Q

Urine Osmolality:

What is normal values?

What do increased values mean?

What do decreased values mean?

A

normal: 50 - 1400

Increased: volume deficit, PRERENAL AKI

Decreased: volume excess, INTRARENAL AKI

83
Q

Urinary Diseases:

— is an inflammation of bladder due to infection and can be caused by indwelling catheters.

A

Cystitis

84
Q

Urinary Diseases:

— is an inflammation of urethra and STD’s can cause.

A

Urethritis

85
Q

Urinary Diseases:

Urethritis can also be caused by low —

A

estrogen

86
Q

Urinary Diseases:

— is a bacterial infection in kidney and renal pelvis (upper urinary tract).

A

Pyelonephritis

87
Q

Urinary Diseases:

What are the different types of Incontinence?

A

Stress

Urge

Functional

88
Q

Urinary Diseases:

What foods should be avoided or limited with Urolithiasis (Kidney Stones)?

A

spinach

black tea

ruhbarb

animal protein

sodium

phosphate (dairy, whole grains, organ meats)

purine (poultry, fish, gravy, red wines)

89
Q

Urinary Diseases:

What do we need to teach regarding BCG treatment for Urothelial Cancer?

A

bacille calmette, Guerin (BCG) is a live virus

  • don’t share toilet
  • pour bleach in bowl and let sit for 15 mins before flushing
  • clean with bleach after flushing
  • be careful not to splash yourself when peeing
  • wash clothes and undies separetely
  • no sex for 24 hrs
90
Q

Urinary Diseases:

What is difference between Hydronephrosis and Hydroureter?

A

Hydronephrosis is an obstruction in upper part of ureter

Hydroureter is an obstruction in lower part of ureter

91
Q

Urinary Diseases:

What is treatment for Hydronephrosis and Hydroureter?

A

cystoscope to remove stone

temporary stent placement to improve urine flow

nephrostomy to drain urine into bladder or outside into bag

92
Q

Kidney Diseases:

—- is a dominant or recessive inherited disorder with fluid-filled cysts developing in nephrons.

A

Polycystic Kidney Disease

**no cure, only manage symptoms

93
Q

Kidney Diseases:

— is an inflammation of glomerular capillaries, usually following a STREP infection.

A

Glomerulonephritis

94
Q

Kidney Diseases:

Types of Glomerulonephritis?

A

Acute

Chronic (develops over period of 20-30 yrs)

Latent

95
Q

Kidney Diseases:

Signs and Symptoms of…

  • Acute Glomerulonephritis
  • Chronic Glomerulonephritis
A

Acute:

  • JVD
  • S3 Heart Sound

Chronic:

  • dry itchy skin
  • changes in LOC
96
Q

Kidney Diseases:

With —, you want them on a fluid restrictions (no more than 24 hr output plus 500-600 mL).

A

Glomerulonephritis

***it causes volume overload

97
Q

Kidney Diseases:

What weight gain should be reported by client with Glomerulonephritis?

A

2 lbs in 24 hrs

or

5 lbs in a week

98
Q

Kidney Diseases:

What classes of meds are used to treat Glomerulonephritis?

A

Antibiotics (for infection)

Diuretics (for edema)

Vasodilators (for HTN)

99
Q

Kidney Diseases:

— is caused by increased glomerular permeability that allows larger molecules to pass through the membrane into urine and be excreted.

A

Nephrotic Syndrome

100
Q

Kidney Diseases:

What will protein and albumin look like with Nephrotic Syndrome?

A

Protein greater than 3.5 g in 24 h

Serum Albumin less than 3 g

101
Q

Kidney Diseases:

What does Nephrotic Syndrome ultimately lead to?

A

SEVERE LOSS OF PROTEIN

Edema

Decreased plasma albumin levels

102
Q

Kidney Diseases:

What meds for Nephrotic Syndrome?

A

Immunosuppressive Agents

ACE Inhibitors

Heparin

Mild Diuretics

103
Q

AKI:

What does RIFLE stand for?

A 
Risk
Injury
Failure
Loss
ESKD
104
Q

AKI RIFLE Classification:

What is GFR and UOP Criteria for RISK?

Injury?

Failure?

A

Risk:

  • Cr increased x 1.5 or GFR decrease by 25 percent
  • UOP less than 0.5 mg per kg per hr for 6 hrs

Injury:

  • CR increased x 2 or GFR decrease by 50 percent
  • UOP less than 0.5 mg per kg per hr for 12 hrs

Failure:

  • CR increased x 3 or GFR decreased by 75 percent
  • UOP less than 0.3 mL per kg per hr for 24 hrs or Anuria for 12 hrs
105
Q

AKI RIFLE Classification:

What is Criteria for LOSS?

A

complete loss of kidney function for more than 4 wks

106
Q

AKI:

— AKI is caused by a decrease in renal blood flow caused by decreased circulating volume SECONDARY to dehydration, hypotension, decreased CO, embolism, sepsis.

A

Prenenal

107
Q

AKI:

— AKI is also called Acute Tubular Necrosis and is a problem within the glomerulus or renal tubules.

A

Intrarenal

108
Q

AKI:

— AKI is due to an obstruction to urinary outflow from kidneys and is caused by stenosis, renal calculi, prostate disease, bladder obstruction, or infection.

A

Postrenal

109
Q

AKI:

What is Urine Sodium like for…

  • Prerenal AKI
  • Intrarenal AKI
  • Postrenal AKI
A

Prerenal: less than 20

Intrarenal: less than 40

Postrenal: 40

110
Q

AKI:

What is FeNa like for…

  • Prerenal AKI
  • Intrarenal AKI
  • Postrenal AKI
A

Prerenal: less than 1-3 percent

Intrarenal: greater than 2-3 percent

Postrenal: 1-3 percent

111
Q

AKI:

What is Specific Gravity like for…

  • Prerenal AKI
  • Intrarenal AKI
  • Postrenal AKI
A

Prerenal: greater than 1.030

Intrarenal: less than 1.010

Postrenal: 1.000 to 1.010

112
Q

AKI:

What is UOP like for…

  • Prerenal AKI
  • Intrarenal AKI
  • Postrenal AKI
A

Prerenal: normal

Intrarenal: Oliguria to Anuria

Postrenal: Oligura to Anuria

113
Q

AKI:

If there is urine sediments, what type of AKI is it?

A

Intrarenal AKI

114
Q

BUN Cr Ratio:

Prerenal AKI will have a ratio of —

Postrenal AKI will have a ratio of —

A

20: 1
10: 1

  • **Ischemic Intrarenal = 20:1
  • **Toxic Intrarenal = 10:1
115
Q

AKI:

What are the Phases of AKI?

A

Onset

Oliguric Anuric Phase

Diuretic

Recovery

116
Q

AKI:

During Onset Phase, what happens to UOP, BUN and Cr?

A

UOP decreases by 20 percent

BUN and Cr rise slightly

117
Q

AKI:

What is patho of Oliguric Anuric Phase of AKI?

A

flow of urine is blocked by necrotic cellular debris in tubular space

***begins 48 hrs after original event and lasts 1-3 wks

118
Q

AKI:

What UOP is Oliguric?

What UOP is Anuric?

A

Oliguric: UOP less than 400 mL in 24 hrs

Anuric: UOP less than 100 mL in 24 hrs

119
Q

AKI:

What acid-base disturbance is caused by the Oliguric Anuric Phase of AKI?

A

metabolic acidosis

  • **HIGH Cr, Urea, K+, PO4,
  • **LOW Ca2+
120
Q

AKI:

When would the Diuretic Phase of AKI begin?

A

2-6 wks after Oliguric stage

121
Q

Page 25 Assessment of AKI

A

page 25

Adult Health II - (Josh) (13 decks)

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