Unit 1 Flashcards
Labs used to diagnose Rheumatoid arthritis
ESR
Rheumatoid factor
Platelet
Patients with rheumtoid arthritis should plan for _______ in the morning and it can last __________
morning stiffness
30 mins
Medical management for Rheumatoid arthritis
ROM exercises, PT/OT, Aerobic exercises, proper nutrition, balance rest and activity
Medications used to manage Rheumatoid Arthritis
Glucocorticoid, NSAIDs, DMARD’s, Analgesics
What labs should be monitored when on a medication regimin for Rheumatoid arthritis?
Platelets, BUN, Creatinine
Priority Nursing diagnosis for rheumatoid arthritis
Joint pain (PQRST)
Mobility
Temp
Monitor labs
This medication classification is used to treat RA and can be given PO, IM, IV. It supresses inflammation. Pt’s taking this should have their blood sugar monitored, electrolytes( mainly potassium), CBC (hgb), needs to be taken at the same time each day and cannot be stopped suddenly
Glucocorticoid
This medication classification is given PO, for RA. can help with pain relief and decrease inflammation. pt’s taking this med should be taught to monitor for S/S of bleeding, not to take medication with alcohol, and that this medication can increase clotting times
NSAIDs
patient teaching with glucocorticoids
can cause insomnia
can decrease wound healing
can cause moon face
can cause weight gain
can cause fluid retention
patient teaching with NSAIDs
constipation
nausea
liver involvement
avoid alcohol
Assess for GI bleed
This medication classification can be given PO, SQ, IM, IV and is given to treat RA. It alters the inflammatory response, decreases inflammation, and slows disease progression. Patients should be monitored for bleeding, they shouldn’t be given any IM injections, and their CBC should be monitored.
DMARD’s
patient teaching for DMARD’s
Assess for S/S of bleeding
no IM injections
monitor CBC
Bleeding gums
bruising
petechiae
black tarry stools
these are all s/s of what?
bleeding
Rabies
polio
flu
hepatitis A
these are all examples of what type of vaccines
inactivated vaccines
Measles, Mumps, and rubella (MMR)
Rotavirus
smallpox
chicken pox
yellow fever
are all examples of what types of vaccines
live
When a DMARD is given IV it can cause what?
vein sensitivity
What type of chair should a person with RA sit in if they have deformities?
a chair with a straight and high back
If on immunosuppressive therapy and you have an active infection what should you do?
stop the immunosuppressive agent and contact PCP
Teaching points for RA patients
Adherence to treatment plan
Report s/s of infection
keep current on vaccinations
assist with referrals
ID safety hazards at home
proper use of assistive devices
energy conservation techniques
encourage consistent exercise program
Importance of follow up appointments
sit in high straigh back chair
Complications with RA
decreased function
permanent joint deformities
infection
cancer
RA patients are at an increased risk of developing what d/t the chronic inflammation
cancer
unprotected sex
IV drug use
blood transfusions
occupational exposure
Pregnant/breastfeeding women
older population
are all risk factors for what?
HIV/AIDS
fever
cough
weakness
nausea/vomiting
diarrhea
dysphagia
forgetfulness
skin lesions
ShOB, DOE
headache
vision changes
night sweats
lymphadenopathy
these are all clinical manifestations of what?
HIV/AIDS
A client expresses concern about being exposed to HIV/AIDS what should be done?
- A thorough physical assessment to determine any clinical manifestations, obtain a sexual history, and have them describe any high-risk behaviors that would indicate viral transmission has occurred.
persistent cough lasting more than 3 weeks
bloody sputum
weight loss
night sweats
high temperature
tired or fatigued
loss of appetite
swellings that haven’t gone away after few weeks
are all S/S of what?
TB
List the S/S of TB
persistent cough lasting more than 3 weeks
bloody sputum
weight loss
night sweats
high temperature
tired or fatigued
loss of appetite
swellings that haven’t gone away after few weeks
Diagnostic testing for HIV/AIDS
ELSIA and HIV VIrus Antibodies
Maintenance labs for someone who has HIV/AIDS and is receiving drug therapy
CD4+, Viral load
What is the relationship between the CD4+ and the viral load?
as CD4+ increases viral load decreases
Vital signs to monitor for HIV/AIDS
Temp ^
pulse
resp
o2
What would be a concern when assessing a HIV/AIDS GI system
difficulty swallowing
N/V/D
Weight loss
What would be a concern when monitoring an HIV/AIDS pt’s neuro system
LOC
Mental status
memory recall
headache
vision changes
What to would be a concern when assessing a HIV/AIDS patients respiratory system
ShOB or DOE
Presence of cough
color of sputum
S/S of TB
Nursing interventions for an HIV/AIDS patient
Universal precautions
monitor for S/S of infection
Administer ART as prescribed and on time
Nutritionally dense foods & small frequent meals
Provide respiratory support
Provide emotional support
Administer IV fluids as ordered
Provide meticulous skin care
Swollen and painful lymph glands (neck, axillae, groin, LUQ)
Increased infections - causing neutropenia (low grade fever in response to minor infections)
Anemia (fatigue, pallor, weakness, ShOB)
Bleeding (bruising, petechiae, nosebleeds, bleeding gums)
are all s/s of what?
Leukemia
List s/s of Leukemia
Swollen and painful lymph glands (neck, axillae, groin, LUQ)
Increased infections - causing neutropenia (low grade fever in response to minor infections)
Anemia (fatigue, pallor, weakness, ShOB)
Bleeding (bruising, petechiae, nosebleeds, bleeding gums)
leukemia nursing assessment
Vital SIgns:
^ temp
^resp
^HR
Respiratory:
ShOB
Integumentary:
Pallor
Bruising, patechiae
MS:
fatigue
Sensory:
dizziness
Immune system:
swollen lymph nodes
GI:
Anorexia
Bleeding gums
Rectal bleeding
Treatment for leukemia
chemotherapy
radiation
blood/blood products
granulocyte colony-stimulating factors
bone marrow transplant
A leukemia treatment that destroys cells
chemotherapy
A therapy that kills cancer cells or slows growth by damaging their DNA
Radiation therapy
Describe chemotherapy
A leukemia treatment that destroys cells
describe Radiation therapy
A therapy that kills cancer cells or slows growth by damaging their DNA
a supportive care measure for leukemia, used to care for low RBC and Plt count
Blood/product transfusions
Describe Blood/product transfusions
a supportive care measure for leukemia, used to care for low RBC and Plt count
Describe granulocyte colony-stimulating factors (GCSFS)
supportive care for neutropenia to prevent post-chemo infections
what is a supportive care for neutropenia to prevent post-chemo infections
Describe granulocyte colony-stimulating factors (GCSFS)
Describe a Bone Marrow/Stem cell transplant
curative treatment used for leukemia that replaces unhealthy marrow/cells with healthy ones
What is a curative treatment used for leukemia that replaces unhealthy marrow/cells with healthy ones
Bone marrow/stem cell transplant
this medication is given to leukemia patients, it kills or inhibits the reproduction of cancer cells. It can kill normal healthy cells. Dosing based on total body surface area
Antineoplastic meds
desribe Antineoplastic meds
this medication is given to leukemia patients, it kills or inhibits the reproduction of cancer cells. It can kill normal healthy cells. Dosing based on total body surface area
List side effects of antineoplastic medications
Mucositis
Alopecia
anorexia N/V
Diarrhea
Anemia
Neutropenia
THrombocytopenia
Infertility
Neuropathy
Gout
Mucositis
Alopecia
anorexia N/V
Diarrhea
Anemia
Neutropenia
THrombocytopenia
Infetility
Neuropathy
Gout
are all side effects of what medication class?
antineoplastic medications
Nursing implications for antineoplastic medications
Monitor for anaphylaxis
Monitor labs: CBC, WBC, Plt, uric acid, electrolytes
Bleeding precautions
If neutropenic stop medication
Initiate neutropenic precautions
Monitor S/S of infection
encourage hydration 2000 mL
Antiemetics as ordered
what does body surface area include?
current weight, current height
What is mucositis
mouth or gut is sore and inflamed, usually pretty painful
What to do if your patient has an anaphylactic reaction IN ORDER
- Assess respiratory status
- stop medication
- Contact PCP
- Administer supplumental oxygen
- Maintain IV with NS
- raise client’s feet and legs, if not contraindicated (to help maintain BP)
- Administer presribed emergency meds
- Monitor VS
- Document the event, actions taken, clients response
Healthcare worker safety when adminstering antieoplastic medications
Wear Special PPE
Prepare IV chemo in a biological safety cabinet with an air-vented hood
Nurses who are pregnant should avoid administering or preparing chemo
discard biohazard only
Chemo can be a vesicant, so it should be administered through a central like
A drug class used to treat leukemia that if given IV can cause phelbitis and needs to be monitored for extravation?
antieoplastic meds
When giving antieoplatic meds IV a nurse should be aware it can cause what?
Phlebitis and extravation
Why do uric acid levels need to be monitored in patients reciving antieoplastic medications?
Antioplastic meds can cause cell destruction which relases uric acid. Increased uric acid can cause gout
Fluid intake for a patient on antieoplastic meds
2000 mL
These types of medications are given to help treat leukemia and it interferes with DNA replication, can cause hormone insuffincensy
Alkylating medications
Alkylating medications can cause what kind of toxicity which leads to what?
Pulmonary toxicity
pulmonary fibrosis
What should be assessed when taking alkylating medications?
pulmonary function
Nursing implications for alkylating medications
Monitor for anaphylaxis
Monitor labs: CBC, WBC, Plt, uric acid, electrolytes
Bleeding precautions
If neutropenic stop medication
Initiate neutropenic precautions
Monitor S/S of infection
encourage hydration 2000 mL
Antiemetics as ordered
Side effects of Alylating medications
Anorexia N/V
Stomatitis
Rash
IV site pain
Sex alterations
Ototoxicity
Tinnitus
Hypokalemia
Nephrotoxicity
Pulmonary Toxicity
A medication class used to treat Leukemia that interferes with DNA and RNA synthesis, can affect cardiac status, lung sounds, and cause pulmonary toxicity
Antitumor Antibiotic meds
Side effects of antitumor antibiotic medications
N/V
Fever
Bone marrow suppression
Raash
Alopecia
Stomatitis
Hormones (sex alterations)
Hyperuricemia
Vesication
CHF/ dysrhythmias, cardiomyopathy, pulmonary toxcicity
What should be monitored when taking antitumor medications
pulmonary function
cardiac status
ECG changes
Adventitious lung sounds
A medication class that is used to treat leukemia, stops the synthesis of cell protein, which impairs cell division. Affects the cell cyle specifically in the s-phase
antimetabolite medications
side effects of antimetabolite medications
Anorexia N/V
Stomatitis
Alopecia
Depression of bone marrow
Cytarabine and Mecaptopurine S/E
Anorexia N/V
Stomatitis
Alopecia
Depression of bone marrow
hyperuricemia and hepatotoxicity
Fluorouracil S/E
Anorexia N/V
Stomatitis
Alopecia
Depression of bone marrow
Phototoxicity
cereberal dysfunction
Methotrexate S/E
Anorexia N/V
Stomatitis
Alopecia
Depression of bone marrow
Phototoxicity
hepatotoxicity
hematological
GI
Skin toxicities
Cerebellar Dysfunction S/S
DANISH
D-dysdiadochonkinesia
A-Ataxia
N-Nystagmus
I-Intention Tremor
S-Slurred or Staccato speech
H-Hypotonia/Heel-shin test (floppy)
Inability to preform rapid alternating movements
dysdiadochokinesia
No coodrination in gait or posture
Ataxia
Uncontrolled movement of the eyes
nystagmus
Antidote for methatrexate
Leucovorin
Leucovorin is the antidote for what?
Methatrexate
Nursing implications for Antimetabolite medications
Monitor renal function
Monitor for cerebrallar dysfunction
Assess for photosensitivity
Instruct client to wear sunscreen and protective clothing to prevent photosensitivity
A medication class used to treat leukemia that prevents mitosis, causes cell death. Stops the cell cycle in the M phase
Mitotic Inhibitor Medications
S/E of mitotic inhibitors
Leukopenia
ptosis
hoarsness
Motor instability
Peripheral neuropathy
Anorexia, N/V
Alopecia
Stomatitis
Hyperuricemia
Phlebitis at IV site
Nursing Implications for Mitotic Inhibitors
Monitor for hoarsness
Monitor for drooping eye lids
Initiate safety precautions for motor instabilities
Monitor for neurotoxicity
Monitor for constipation or paralytic ileus
Vincistine causes what kind of toxicity?
NUmbness/tingling in fingers and toes, constipation, paralytic ileus
This medication classis used to treat leukemia, blocks enzymes needed for DNA synthesis and cell division. It targets the cell cyle specifically in G2 and S phase
Topoismerase inhibitor
S/E of Topoisomerase Inhibitor medications
Leukopenia
Thrombocytopenia
Anemia
Orthostatic Hypotension
Hypersensitivity reactions
Anorexia, N/V
Diarrhea
Alopecia
Nursing Implications for Topoisomerase Inhibitors
Monitor for anaphylaxis
Monitor labs: CBC, WBC, Plt, uric acid, electrolytes
Bleeding precautions
If neutropenic stop medication
Initiate neutropenic precautions
Monitor S/S of infection
encourage hydration 2000 mL
Antiemetics as ordered
Treatments used uin the treatment of leukemia to suppress the immune system and blocks normal hormones in hormone sensitive tumors. Changes hormonal balance and slows the growth rates of certain tumors,
Hormonal Medications Enzymes
S/E of Hormonal Medications and Enzymes
Sex characteristics chage
Breast swelling
Hot flashes
Weight gain
HTN
Edema
Electrolyte Imbalances
Thromboembolic disorders
Anorexia, N/V
Leukopnia
Nursing Implications for hormone meds and enzymes
Monitor serum calcium levels
Monitor Uric acid, cholesterol, Triglyceride
Monitor for blood in urine
S/E of Mitotane
Hemorrhagic cystitis, hypouricemia, and hypercholesterolemia
S/E of Asparaginase
Imparied pancreatic function
S/E of Tamoxifen
Hypercalcemia, hypercholesterolemia, elevated tryglicerides
A medications class used to treat leukemia induce more rapid bone marrow recovery after immunosuppression by chemo therapy
Colony-stimulating(CS) medications
What does a is granulocyte macrophage CS factor do for leukemia patients?
Promotes differentiation of granulocytes and macrophages
What does Granulocyte CS Factor do for Leukemia patients
Stimulates bone marrow to make more blood cells
What does Erythropoetin do for leukemia patients?
Stimulates bone marrow to make more RBC’s
What does Thrombopoietic Growth Factor (Thrombopietics) do for leukemia patients
Stimulates bone marrow to make more platelets
Nursing interventions for leukemia patients
Only preform essential activities
Neutropenic precautions
Bleeding Precautions
Allow adequate rest during care
Administer blood products as ordered
Abx, antibacterials, antivirals, and antifungal as ordered
Colony-Stimulating Factors as ordered
Prepare client for transplant if indicated
Educate regarding home care measures, referrals for home care
Complications to monitor for in leukemia patients
Infection
Hemorrhage/bleeding
Anemia
A leukemia patient has a fatigue, pallor, ShOB, and decreased o2 what do you suspect and what action should you take and anticipate?
Anemia
Administer supplemental oxygen
anticipate giving blood/blood product transfusion
The nurse is planning care for a client with acute myeloid leukemia (AML). Which is priority nursing diagnosis to minimize the risk of complications associated with this diagnosis?
A. Risk for bleeding
B. Impaired mobility
C. Imbalanced nutrition
D. Fluid volume excess
B. Impaired mobility
Rationale: Leukemia results in neutropenia and thrombocytopenia
The nurse provides discharge instructions to a client who is neutropenic. Which of the following statements indicate the need for additional teaching? SATA
A. “My plants are being moved outside”
B. “I will avoid eating raspberries and black berries.”
C. “I will use a humidifier to moisten the air at night.”
D. “I will wash all raw vegetables before eating them.”
E. “My prescribed antibiotic can be stopped once i feel better.”
C & E
The patient who is neutropenic is taught to avoid standing water appliances i.e. humidifiers bc they can hold mold and bacteria
If pt is started on a prophylactic abx, antiviral, and antifungal therapies, stress the importance of taking their medications daily and completing the entire course of abx, therefore this statement indicates the need for additional teaching
As a part of chemotherapy education, the nurse teaches a female client about the risk for bleeding and self care during the period of greatest bone marrow suppression. The nurse understands that further teaching is needed if the client makes which statement?
A. I should avoid blowing my nose
B. I may need a platelet transfusion if my platelet count gets too low.
C. I’m going to take aspirin for my headaches as soon as I get home.
D. I will count the number of pads and tampons I use when menstrating
C.
Rationale: Aspirin and NSAIDS should be avoided due to their antiplatelet activity
The nurse is monitoring the IV infusion of the antineoplastic medication. During the infusion, the client complains of pain at the site. On insepction of the site, the nurse notes redness and swelling and that the infusion of medication has a slowed in rate. The nurse suspects extravasation and should take which actions?
A. Stop the infusion
B. Prepare to apply ice or heat to the site
C. Restart the IV at a distal part the same vein
E. Preparing to administer a prescribed antidote into the site
F. Increasae the flow rate of the solution to the flush the skin and subq tissue
A, B, D, E
Rationale: If the nurse expects extravasation, the nurse take the followinf actions:
-Stop the infusion
-Notify the PHCP
-Ice or heat may be prescribed
-antidote may be prescribed into the site
This is a chronic inflammatory disease that can affect virtually any organ system. Body attacks own cells. Ag-Ab complexes form and complexes deposits into tissues.
Systematic Lupus Erythematosus
Triggering factors for lupus
Can be triggered by multiple factors
Pregnancy
Exposure to sunlight
Illness
Major surgerySilica dust
Medication allergies
Clinical manifestations of SLE
Butterfly rash
weakness, fatigue
HTN
Joint pain
Oral/nasal ulcers
Fingers or toes turn pale or white then blue when exposed to cold or during stress/upset. Is caused by restricted blood flow to skin
Raynaud’s Phenomena
positive ANA indicates what?
presence of autoimmune disease
Labs to monitor for SLE
ANA
ESR
CRP
BUN/Creatinine
SLE priority nursing assesments
Monitor skin integrety; observe for rash on face, upperbody, and/or palms
Monitor weight; assess for anorexia
Assess for anemia
SLE Medical management
Avoid prolonged sun exposure
Maintain proper nutrition
Ensure frequent rest periods
Maintain regular sleep schedule
Encourage regular exercise
DRESS Syndrome
Drug Rash with eosinophilia and systemic symptoms
Fever
rash
facial swelling
enlarged lymphnodes
kidney, liver, or cardiac involvement may be present
Increased level of eosinophils
When taking plaquenil what should the patient notify the provider immediately of?
sore throat
fever
unusual bleeding/blurred vision
visial changes
ringing in the ears
difficulty hearing
muscle weakness
This is a medication is used to treat SLE. It is a DMARD and antimalarial that inhibits protein synthesis. It is given PO and patients should be assessed for:
DRESS
Malaise, fatigue, muscle or joint aches
blisters
suicidal tendencies, depression or changes in behavior
Hydroxychloroquine or plaquenil
Nursing implications for plaquenil
assess for:
-DRESS
-Malaise, fatigue, muscle or joint aches
-blisters
-suicidal tendencies, depression or changes in behavior
This drug is used to treat SLE. It is a glucocorticoid that supresses inflammation and can be given PO, IM, IV, topical. Nurses should monitor blood sugar, electrolytes and watch for s/s of bleeding with this med
Methylprednisone
Nursing implications for methylprednisone
Monitor blood sugar
Electrolytes
S/S GI bleed
What do topical steroids help with what?
Assist with itching pain control
Asthma clients have an increased risk of what kind of reaction?
Hpersensitivity reactions
This is a medication given for SLE it is an NSAID that is given for pain relief and inflammation suppression. It is given PO. Pt’s taking this should be monitored for what:
Assess fir S/S of DRESS
Monitor for S/S of GI Bleed
Use cautiously in clients with asthma
Avoid drinking alcohol while taking meds
Fever, chills muscle aches/pains
Naproxen or Alleve
Pharmacological treatments for SLE are based on what?
Clinical manifestations
Nursing Implications for Naproxen
Assess for S/S of DRESS
Monitor for S/S of GI Bleed
Use cautiously in pt’ with asthma
Avoid drinking alcohol while taking meds
Report fever, chills muscle aches/pains
Hypotension
angioedema
urticaria
rash
pruitis
wheezing
dyspnea
Are S/S of what?
Anaphylaxis
This medication is used to treat SLE. It is an immunosuppressant that helps decrease the immune response that causes the symptoms of SLE. It can be given IV or SQ.
Pt’s takin ghtis medication should be monitored for:
Anaphylaxis
S/S of infection
Assess LOC and behavioral changes
Belimumab (Benlysta)
Lab values to monitor with SLE
Elevated BUN/creatinine->kidney involvement
Urinalysis-> proteinuria = decreased renal function
ESR CRP
Low plt
Low WBC
Managing clinical manifestations is important with SLE to prevent what?
Complications
Medications for SLE
NSAIDs
Gucocorticoids
Immunosuppressants
DMARDs
SLE patients need frequent what? You shoulc check them for what as well?
Mouth care, oral ulcers
Complications from SLE
Renal failure
Premature heart disease
Lung disease
Hypercoagulation
Stroke
Avascular necrosis of joints
Increased risk of infection
What is an early complication of SLE?
Lupus nephritis
Client teaching for SLE
Disease process and its unpredictability
Use sunscreen daily to help prevent rash
Activity prioritization &energy conservation
Keep current on immunizations but no live vaccines
Avoid oral contraceptives d/t risk of hyper coagulability cound increase risk of clots
Use mild soap to cleanse hair, avoid harsh perfumes
Encourage high vitamin and high iron diet if no kidney involvement
Assist in refferals-specialist or support groups
The nurse provides home care instructions to a client with Systematic Lupus Erythematosus and tells the client about methods to manage fatigue. Which statement by the client indicates a need for further instructions?
A. I should take hot baths because they are relaxing.
B. I should sit whenever possible to conserve energy.
C. I should avoid long periods of rest becuase it causes joint stiffness.
D. I should do some exercises, such as walking, when I am not fatigued
A.
Rationale: Hot baths exacerbate fatigue, therefore should be avoided
The patient enters the outpatient clinic and states to the triage nurse, “I think I have the flu. I’m tired, I have no appetite, and everything hurts.” The triage nurse assesses the client and finds a butterfly rash over the bridge of the nose and on the cheeks. The nurse correlates this data with the clinical maniestations of what disorder?
A. Gout
B. Lyme disease
C. Fibromyalgia
D. Systemic Lupus Erythematosus
D.
Rationale: BFFR
The nurse is providing health education to a diverse group at a neighborhood community center. The nurse includes information about signs and symptoms of SLE for which of the following reasons?
A. The neighborhood is composed of many young female children
B. The neighborhood has a large number of older adult women
C. The audience is mainly composed of caucasian women
D. The audience is mainly females of Asian-American descent
D.
Rationale: Among women who are of childbearing age, SLE is more common in a African-americans, hispanics, and Asain-americans than caucasians
