T2 - Blueprint (Josh) Flashcards
What is the most common type of arthritis?
OA (Osteoarthritis)
What are Osteophytes and what are they associated with?
Bone Spurs
Associated with OA
OA:
ESR will be —- with OA. What are the normal values?
elevated
Normal:
- Men 0-22
- Women 0-29
OA:
Which nodes are more distal?
Which nodes are more proximal?
Haberden’s Nodes – DISTAL
Bouchard’s Nodes – PROXIMAL
***B is closer to beginning than H
OA:
What happens to skeletal muscles with OA?
atrophy due to immobility
OA:
Which gender is more affected?
female
OA:
What are some risk factors?
Joint Trauma (overuse)
Joint Sepsis
Smoking
Obesity
DM
Paget’s Disease
Sickle Cell
Age over 60
Women
OA:
What is the DOC?
Acetaminophen
OA:
Avoid NSAIDs if they have — and — issues.
Kidney
GI
OA:
Capsaicin is a — med. What should we know?
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
OA:
What can Glucosamine do and what should we educate about?
rebuilds cartilage
may cause mild GI upset, nausea, and heartburn
caution with shellfish allergy
Arthritis:
— is usually bilateral and is NOT inflammatory.
— is usually symmetrical is IS inflammatory.
OA
Rheumatoid Arthritis
RA:
Which labs are INCREASED?
Anti CCP Antibodies
RF Factor
ANA Titer
ESR
Serum Immunoglobulins
WBCs
RA:
Which labs are DECREASED?
Serum Complement (C3 and C4)
Albumin
Hgb
HCT
RBC
RA:
What can occur with LATE RA?
Thrombocystosis
RA:
What are some medication classes for this?
DMARDs
NSAIDs
Cox-2 Inhibitors
BRMs (Biological Response Modifiers)
Glucocorticoids
Immunosuppressive Agents
RA:
What are some associated syndromes with RA?
Osteoporosis
Sjogren’s Syndrome
Felty’s Syndrome
Caplan’s Syndrome
RA:
Sjogren’s is an associated syndrome. What are signs and symptoms?
Dry eyes, mouth, vagina
RA:
What is characteristic of Felty’s Syndrome?
hepatosplenomegaly
RA:
Why would a client get Respiratory and Cardiac complications from RA?
because it’s a systemic disease
Scleroderma:
What is CREST Syndrome?
Calcinosis Raynaud's Phenomenon Esophageal Dysmotility Sclerodactyly Telangiectasia
Scleroderma:
What are some systemic manifestations of Scleroderma?
Arthalgia
Renal (decreased function)
Cardiac (chest pain, dysrhythmia)
GI (GERD, dysphagia, etc)
Lung (Pulmonary HTN)
What is SLE?
Systemic Lupus Erythematosus
- an autoimmune disease that often has kidney involvement
- chronic, progressive, inflammatory connective tissue disorder
Lupus:
There are two types, what are they?
SLE (Systemic Lupus Erythematosus)
DLE (Discoid Lupus Erythematosus)
Lupus:
What are the risk factors?
Female age 20-40
African American, Asian, Native American
Med induced
Lupus:
What are some meds that can cause lupus?
Procainamide
Hydralazine
Isoniazide
Butterfly Rash is hallmark sign of —-
Lupus (SLE)
What is the most common cause of death with Lupus?
Renal (Lupus Nephritis)
Lupus:
Signs and Symptoms
Butterfly Rash and Alopecia
Polyarthritis
Osteonecrosis
Muscle atrophy
Fever, Fatigue, Malaise
Anorexia, weight loss
Pleural Effusions
Renal probs
Pericarditis
Raynaud’s
Migraine HA
Serositis
Lupus:
How is dx confirmed with DLE?
skin biopsy
Lupus:
What does CBC look like with SLE?
everything low
- Anemia
- Leukopenia
- Thrombocytopenia
Lupus:
What are side effects of corticosteroid treatment?
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
Gout:
What are the stages of Primary Gout?
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)
Gout:
What are trigger foods for Gout?
PROTEINS!!!
- Organ Meats
- Red Meats
- Shellfish
- Starvation Diets
Gout:
We need to increase — with — foods.
pH
alkaline
Lyme Disease:
What are the stages
Stage 1: Flu-like symptoms, Red Rash (bullseye), pain and stiffness of joints
Stage 2: Cardiac and Pulmonary involvement
Stage 3: Chronic arthritis, fatigue
Lyme Disease:
What is the skin reactions associated with it?
Erythema Migrans
Musculoskeletal System:
Calcium has an inverse relationship with —
phosphorus
MSK:
What happens to Alkaline Phosphatase when bone is damaged and diseased?
increases
MSK:
What are the muscle enzymes that are increased with muscle damage or trauma?
CK-MM
AST
ALD
LDH
Bone Scan:
What is injected?
radioactive material injected 2-3 hrs before scanning
Bone Scan:
What should we teach prior?
Empty bladder prior
Drink lots of fluids
No radioactive precautions needed
Arthroscopy:
To be able to do this, what must patient be able to do?
bend knee 45 degrees
EMG:
What does it diagnose?
neuromuscular, lower motor neuron, and peripheral nerve disorders
ex: Lou Gherig’s
EMG:
What meds need to be held for a few days prior?
muscle relaxants
***eat and drink before ok
DXA Scan:
What does it do?
two beams of radiation to analyze bone density
***detects osteoporosis
DXA Scan:
What do we need to teach?
not invasive
no contast media
patient can stay dressed by remove metallic objects
Osteoporosis:
Osteoclasts do what?
Osteoblasts do what?
Osteoclasts break bone down
Osteoblasts build bone up
- **Clasts Cut down
- **Blasts Build up
Osteoporosis:
There is an increase in — activity and a decrease in — activity.
osteoclast
osteoblast
Osteoporosis:
What are some lifestyle changes to prevent?
No Smoking
Decrease ETOH
Osteoporosis:
What is a T-score?
the number of standard deviations above or below the average young adult
-1 to -2.5 = osteopenia
Osteoporosis:
What do we need to teach regarding Bisphosphonate therapy?
causes esophagitis
- don’t lay down for 30 mins after
- take with 8 oz of water
Osteoporosis:
Report jaw pain with which med?
pamidronate (bisphosphonate)
Osteoporosis:
What do Estrogen Agonists Antagonists (Raloxifene) do?
increase risk of DVTs
Osteomalacia:
What is the etiology?
loss of bone related to Vit D deficiency leading to softening of bone
Osteomalacia:
What are signs and symptoms?
Muscle Weaknes (waddling gait)
Bone Tenderness
Bone Pain worse with activity and at night
Osteomalacia:
What would X-ray reveal?
decrease in cancellous bone (spongy tissue on inside of bone)
Osteomalacia:
What med do we give?
Ergocalciferol (Vit D)
Paget’s Disease:
What is it?
excessive osteoclastic AND osteoblastic activity leading to structurally disorganized, weak bones
What is Page’t Disease linked to?
hearing loss
Paget’s Disease:
What are the phases?
Active - massive bone destruction
Mixed - osteoblast compensation by forming new, weaker bone
Inactive - bone becomes hardened and sclerotic
Paget’s Disease:
What is diagnostic?
Serum ALP
24 hr urinary hydroxyproline
X-rays, bone scan, CT, MRI
Osteomyelitis:
What is etiology?
infection of bone tissue
Osteomyelitis:
What treatment can be used to increase viability of working cells?
HBO (Hyperbaric Oxygenation)
Fractures:
A fatty embolism is most likely the result of which type of bone fracture?
Long Bone Fracture
Fractures:
What is the characteristic of Fatty Embolism that separates it from VTE?
Petechia
Fractures:
A Fatty Embolis is likely to occur within — of injury.
48 hrs
Fracture:
Treatment plan for Fatty Embolism.
Oxygen (vent)
***heparin won’t work because it’s not a blood clot
Fracture:
What are the 6 P’s of Compartment Syndrome?
Pain Pressure Paralysis Paresthesia Pallor Pulselessness
Amputation:
What is a Neuroma and where is it most likely to occur?
tumor comprised of nerve cells at base of an amputation
most likely with UPPER EXTREMITY amputations
Amputation:
What is a Flexion Contracture?
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.
Amputation:
How do you prevent Flexion Contractures?
Elevate on pillow ONLY first 24 hr
Prone position for 20 min periods several times a day
Firm Mattress
Amputation:
What are some meds for Phantom Limb Pain?
Calcitonin (IV infusion reduces PLP)
Beta Blockers (Propanolol)
Antiepileptics (gabapentin)
Renal Assessment:
Urea is a byproduct of — metabolism.
Creatinine is a byproduct of — metabolism.
ammonia
protein
***Cr is a better indicator than BUN
Renal Assessment:
How could kidney failure cause anemia?
kidneys secrete erythropoietin which controls erythrocyte production in bone marrow
Renal Assessment:
How could kidney failure cause HTN?
kidneys control the RAA System
Renal Assessment:
How could kidney failure cause bone disease?
kidneys convert Vit D into an active form and Vit D stimulates the absorption of calcium by the intestine
Renal Assessment:
What will skin look like with kidney problems?
uremic frost
dry and itchy
Renal Assessment:
What is normal Cr?
What is normal BUN?
0.5 - 1.5
10 - 20
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.
different
extra-renal problem
same
renal
Urine Specific Gravity:
What is normal values?
What do increased values mean?
What do decreased values mean?
normal: 1.005 - 1.030
Increased: volume deficit, concentrated urine, PRERENAL AKI
Decreased: volume overload, dilute urine, INTRARENAL AKI
Urine Osmolality:
What is normal values?
What do increased values mean?
What do decreased values mean?
normal: 50 - 1400
Increased: volume deficit, PRERENAL AKI
Decreased: volume excess, INTRARENAL AKI
Urinary Diseases:
— is an inflammation of bladder due to infection and can be caused by indwelling catheters.
Cystitis
Urinary Diseases:
— is an inflammation of urethra and STD’s can cause.
Urethritis
Urinary Diseases:
Urethritis can also be caused by low —
estrogen
Urinary Diseases:
— is a bacterial infection in kidney and renal pelvis (upper urinary tract).
Pyelonephritis
Urinary Diseases:
What are the different types of Incontinence?
Stress
Urge
Functional
Urinary Diseases:
What foods should be avoided or limited with Urolithiasis (Kidney Stones)?
spinach
black tea
ruhbarb
animal protein
sodium
phosphate (dairy, whole grains, organ meats)
purine (poultry, fish, gravy, red wines)
Urinary Diseases:
What do we need to teach regarding BCG treatment for Urothelial Cancer?
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
Urinary Diseases:
What is difference between Hydronephrosis and Hydroureter?
Hydronephrosis is an obstruction in upper part of ureter
Hydroureter is an obstruction in lower part of ureter
Urinary Diseases:
What is treatment for Hydronephrosis and Hydroureter?
cystoscope to remove stone
temporary stent placement to improve urine flow
nephrostomy to drain urine into bladder or outside into bag
Kidney Diseases:
—- is a dominant or recessive inherited disorder with fluid-filled cysts developing in nephrons.
Polycystic Kidney Disease
**no cure, only manage symptoms
Kidney Diseases:
— is an inflammation of glomerular capillaries, usually following a STREP infection.
Glomerulonephritis
Kidney Diseases:
Types of Glomerulonephritis?
Acute
Chronic (develops over period of 20-30 yrs)
Latent
Kidney Diseases:
Signs and Symptoms of…
- Acute Glomerulonephritis
- Chronic Glomerulonephritis
Acute:
- JVD
- S3 Heart Sound
Chronic:
- dry itchy skin
- changes in LOC
Kidney Diseases:
With —, you want them on a fluid restrictions (no more than 24 hr output plus 500-600 mL).
Glomerulonephritis
***it causes volume overload
Kidney Diseases:
What weight gain should be reported by client with Glomerulonephritis?
2 lbs in 24 hrs
or
5 lbs in a week
Kidney Diseases:
What classes of meds are used to treat Glomerulonephritis?
Antibiotics (for infection)
Diuretics (for edema)
Vasodilators (for HTN)
Kidney Diseases:
— is caused by increased glomerular permeability that allows larger molecules to pass through the membrane into urine and be excreted.
Nephrotic Syndrome
Kidney Diseases:
What will protein and albumin look like with Nephrotic Syndrome?
Protein greater than 3.5 g in 24 h
Serum Albumin less than 3 g
Kidney Diseases:
What does Nephrotic Syndrome ultimately lead to?
SEVERE LOSS OF PROTEIN
Edema
Decreased plasma albumin levels
Kidney Diseases:
What meds for Nephrotic Syndrome?
Immunosuppressive Agents
ACE Inhibitors
Heparin
Mild Diuretics
AKI:
What does RIFLE stand for?
Risk Injury Failure Loss ESKD
AKI RIFLE Classification:
What is GFR and UOP Criteria for RISK?
Injury?
Failure?
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
AKI RIFLE Classification:
What is Criteria for LOSS?
complete loss of kidney function for more than 4 wks
AKI:
— AKI is caused by a decrease in renal blood flow caused by decreased circulating volume SECONDARY to dehydration, hypotension, decreased CO, embolism, sepsis.
Prenenal
AKI:
— AKI is also called Acute Tubular Necrosis and is a problem within the glomerulus or renal tubules.
Intrarenal
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.
Postrenal
AKI:
What is Urine Sodium like for…
- Prerenal AKI
- Intrarenal AKI
- Postrenal AKI
Prerenal: less than 20
Intrarenal: less than 40
Postrenal: 40
AKI:
What is FeNa like for…
- Prerenal AKI
- Intrarenal AKI
- Postrenal AKI
Prerenal: less than 1-3 percent
Intrarenal: greater than 2-3 percent
Postrenal: 1-3 percent
AKI:
What is Specific Gravity like for…
- Prerenal AKI
- Intrarenal AKI
- Postrenal AKI
Prerenal: greater than 1.030
Intrarenal: less than 1.010
Postrenal: 1.000 to 1.010
AKI:
What is UOP like for…
- Prerenal AKI
- Intrarenal AKI
- Postrenal AKI
Prerenal: normal
Intrarenal: Oliguria to Anuria
Postrenal: Oligura to Anuria
AKI:
If there is urine sediments, what type of AKI is it?
Intrarenal AKI
BUN Cr Ratio:
Prerenal AKI will have a ratio of —
Postrenal AKI will have a ratio of —
20: 1
10: 1
- **Ischemic Intrarenal = 20:1
- **Toxic Intrarenal = 10:1
AKI:
What are the Phases of AKI?
Onset
Oliguric Anuric Phase
Diuretic
Recovery
AKI:
During Onset Phase, what happens to UOP, BUN and Cr?
UOP decreases by 20 percent
BUN and Cr rise slightly
AKI:
What is patho of Oliguric Anuric Phase of AKI?
flow of urine is blocked by necrotic cellular debris in tubular space
***begins 48 hrs after original event and lasts 1-3 wks
AKI:
What UOP is Oliguric?
What UOP is Anuric?
Oliguric: UOP less than 400 mL in 24 hrs
Anuric: UOP less than 100 mL in 24 hrs
AKI:
What acid-base disturbance is caused by the Oliguric Anuric Phase of AKI?
metabolic acidosis
- **HIGH Cr, Urea, K+, PO4,
- **LOW Ca2+
AKI:
When would the Diuretic Phase of AKI begin?
2-6 wks after Oliguric stage
Page 25 Assessment of AKI
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