Week Nine Modules Flashcards
what are some common s/s of arthritis?
with arthritis, symptoms can be _____ and may be mild, ____, or ____
severe arthritis can result in _____ and the inability to perform ____
common symptoms include swelling, pain, stiffness, and decreased range of motion
intermittent; moderate; severe
chronic pain; ADLs
what is osteoarthritis?
osteoarthritis is a ____, progressive, _______ disorder of the synovial joints
osteoarthritis affects joints _____
with osteoarthritis, there are no _____
the most common form of arthritis that affects over 30 million americans
slow; non-inflammatory
asymmetrically
systemic manifestations
osteoarthritis can affect any joint, but it most commonly affects what parts of the body?
who is the most at risk for developing osteoarthritis?
knees, hips, lower back, neck, finger joints, and bases of the thumb & big toe
athletes, military members, and people who work physically demanding jobs
is there a cure for osteoarthritis?
no, there is no cure
osteoarthritis may be caused by a known event that directly _____ cartilages
what are some causes of osteoarthritis?
damages
drugs, inflammation, joint instability, mechanical stress, neurological disorders, and skeletal deformities
what is the pathophysiology behind osteoarthritis?
as osteoarthritis worsens, the bones may _____ and develop ____ known as osteocytes
eventually, the cartilage wears away and leads to _______
cartilage breaks down and causes swelling, pain, and problems moving the joint
break down; growths
bone rubbing against bone
how is osteoarthritis treated?
treated with pain medications and then joint replacement
what are some modifiable risk factors for osteoarthritis?
what are some non-modifiable risk factors for osteoarthritis?
excess weight; joint injury; type of occupation
gender, age, genetics, and race
osteoarthritis tends to affect which gender more?
_______ estrogen during the menopausal transition may contribute to ____ incidence of osteoarthritis in women
what two types of osteoarthritis affect women the most?
what type of osteoarthritis affects men the most?
women
decreased; increased
hand & knee osteoarthritis
hip osteoarthritis
name some functions of estrogen?
bone growth; cholesterol levels; lubrication of joints; memory; and elasticity of the skin
what are some signs and symptoms of osteoarthritis?
joint pain that worsens with use, and is relieved by rest
joint stiffness that occurs after periods of rest
crepitation which is a grating sensation that is caused by loose cartilage
herberden’s nodes which is the formation of osteocytes
early morning stiffness that is caused by osteoarthritis usually resolves itself within ____ minutes
what are some diagnostic tests we could run to determine if the patient has osteoarthritis?
diagnostic tests like x-rays help to determine what?
30
bone scan, CT scan, MRI, and x-rays
help to confirm presence of the disease and the stage of joint damage
LABS AND OSTEOARTHRITIS:
with osteoarthritis, the patient’s ESR levels will be _____ and there will be a ______ during the acute inflammatory phase
with osteoarthritis, the synovial fluid with ___ or ____ with little or no sign of inflammation
within normal limits; slight increase
clear; yellow
what are the goals of care for a patient who has been diagnosed with osteoarthritis?
what are some nursing interventions we can perform for patients who have been diagnosed with osteoarthritis?
manage pain; prevent disability; maintain or improve joint function; improve activity tolerance
non-drug interventions tend to be the basis of OA management; rest and joint protection; nutritional therapy & exercise; and complementary/alternative therapies
as a nurse, how can we provide rest and joint protection?
teach the patient to balance rest and activity
keep joints in functional positions with braces or splints
avoid mobilization for more than one week due to the risk of joint stiffness
avoid standing, kneeling, or squatting for long periods of time
as a nurse, how can we provide heat and cold applications for nursing interventions?
heat therapy helps to ____ stiffness
heat tends to be used more often than ice with OA treatment
reduce
some examples of heat therapy are hot packs, whirlpool baths, ultrasound, and parrafin wax baths
nursing interventions for nutritional therapy and exercise
encourage the patient to maintain a ______ and help the patient evaluate their _____
you’ll want to discuss ____, ROM, and ____ the muscles around the affected area
healthy body weight; current diet
cardio exercise; strengthening
when it comes to complementary and alternative therapies what are some things we could do?
when it comes to drug therapy, what are some medications we might offer the osteoarthritis patient?
offer acupuncture; massage; or tai chi
tylenol; capsaicin cream; bengay; nsaids like ibuprofen; and salicylates like aspirin
when would we give an osteoarthritis patient methylprednisolone or prednisone?
these two drugs are only used during life-threatening exacerbations
rheumatoid arthritis is a _____, systemic _____ disease
rheumatoid arthritis consists of inflammation in the ______ of the synovial joints
rheumatoid arthritis is marked by periods of ____ and _____
rheumatoid arthritis has been considered one of the most _____ forms of arthritis
chronic; autoimmune
connective tissue
exacerbations; remissions
disabling
without treatment, patients who have osteoarthritis may need ______ or joint _____
mobility; reconstruction
what kinds of things increase a person’s risk for rheumatoid arthritis?
what kinds of things decrease a person’s risk for rheumatoid arthritis?
gender/age –> females over the age of 60; genetics; smoking; and menstrual history
use of oral contraceptives; live birth history; and breastfeeding
what is the etiology behind rheumatoid arthritis?
rheumatoid arthritis attacks the ____ of the joints and affects joints _____
rheumatoid arthritis can lead to ____ of cartilage, ligaments, and the ___
the exact cause is unknown; however, the autoimmune theory is most widely accepted
lining; symmetrically
erosion; joint caps
what are some s/s of rheumatoid arthritis?
with rheumatoid arthritis, when does stiffness occur?
what are some deformities of the hands and feet that can occur with rheumatoid arthritis?
fatigue, anorexia, and weight loss
occurs after periods of inactivity and morning stiffness tends to last more than 60 minutes
hallux valgus; boutonniere deformity; ulnar drift; and swan neck deformity
rheumatoid nodules develop in about ___ the patients with rheumatoid arthritis
rheumatoid nodules often appear ___ the skin as ___, ____ masses
where are rheumatoid nodules mainly found?
half
under; firm; nontender
found on bony areas exposed to pressure like fingers and elbows
if a rheumatoid arthritis patient develops rheumatoid nodules in the heart what can occur?
pleurisy; pleural effusion; and pericarditis
what are some examples of extra-articular manifestations that can occur due to rheumatoid arthritis?
rheumatoid nodules; sjogren’s syndrome; mitral and aortic valve regurgitation; and restrictive lung disease
SJOGREN’S SYNDROME
- what happens to swallowing in sjogren’s syndrome?
- what happens to the skin?
- what happens to the mouth and nose?
- what are some neuro problems that can occur with sjogren’s syndrome?
there is difficulty swallowing followed by heartburn
the skin becomes dry and there’s vasculitis
dry mouth, mouth sores, dental decay; dry nose with reoccurring sinusitis
problems with concentration and memory
what are some lab tests we can perform in patients who have been diagnosed with rheumatoid arthritis?
rheumatoid factor test; anti-CCP tests; erythrocyte sedimentation; and c-reactive protein levels
what are some goals of care for rheumatoid arthritis?
what are some nonpharmacologic interventions we can perform for a patient who has been diagnosed with rheumatoid arthritis?
reduce inflammation; pain management; maintenance of joint function; prevention or correction of joint deformity
electrical stimulation; joint protection; splints; and self-help devices
what are some examples of drug therapy for rheumatoid arthritis?
drugs are the _____ of RF treatment
disease modifying anti-rheumatic drugs can ___ disease progression and ___ risk for joint erosion and deformity
what medication is preferred for early treatment of RA?
disease modifying anti-rheumatic drugs and biologic response modifier drugs
cornerstone
slow; decrease
methotrexate
if a rheumatoid arthritis patient is prescribed sulfasalazine, what do we need to look out for?
why are biologic response modifiers used?
what are some examples of TNF medications that are used in treatment of rheumatoid arthritis?
we need to make sure the patient is getting adequate amount of fluids in order to avoid crystal formation in the urine
used to slow disease progression
enbrel, remicade, and humira
why is corticosteroid therapy used in rheumatoid arthritis patients?
to temporarily reduce pain and inflammation but they do not affect disease progression
what are some nursing interventions for rheumatoid arthritis?
perform head to toe assessment; make sure psychosocial needs are met; reduce the chronic pain and help with disturbed body image
why would we use cold therapy for a patient who has rheumatoid arthritis?
with a rheumatoid arthritis patient we want to make sure they’re getting ___ - ____ hours of sleep
cold therapy is used to treat exacerbations
8 - 10
with rheumatoid arthritis patients do we place pillows under their knees?
rheumatoid arthritis patients should avoid what two things?
no, we don’t b/c we want to avoid contractures
avoid climbing stairs and avoid repetitious movement
what are some instructions we can give to patients who have hip replacements?
don’t cross your legs at the knees for at least 6 - 8 weeks; don’t bring you knee higher than your hip; don’t lean forward while sitting; don’t try to pick something up from the floor while you’re sitting; don’t bend at the waist beyond 90 degrees
with joint replacement surgery what are some post operative conditions to keep in mind?
when we assess patient casts what are we looking for?
how can we decrease swelling?
the risk of infection; DVT; pain; and mobility
circulation; compartment syndrome; infection; and pain
elevate the legs
what is compartment syndrome?
with compartment syndrome, capillary perfusion is ____ below a level needed for tissue life
how can we treat compartment syndrome?
a condition in which swelling causes increased pressure within a limited space like a cast or muscle compartment
reduced
the cast or dressing must be removed by the orthopedic surgeon and if that doesn’t relieve the pressure then fasciotomies are performed
what are the 6 Ps of compartment syndrome?
if any of the 6 Ps are assessed, then we must call ____ b/c compartment syndrome is a _____
pain; increasing pressure; paresthesia; pallor; paralysis; and decreased pulse
the provider; medical emergency
MULTIPLE SCLEROSIS
- is an ____ disease
- the immune system attacks and damages the _____ in the ____
- multiple sclerosis is a ___, _____, and degenerative disorder
- multiple sclerosis is characterized by damage to the ____ of the nerve fibers that run along the axon of the neurons
inflammatory
nerve tissue; CNS
chronic; progressive
myelin sheath
- the cause of multiple sclerosis is ____
- MS is the leading cause of ____ in the young and middle age groups
- there is ____ prevention for multiple sclerosis
unknown
disability
no
people with multiple sclerosis tend to have a leakage in the ____ that allows immune cells through and enables them to ___ the nerve tissue
within
with multiple sclerosis, is the nerve fiber damaged?
multiple sclerosis ____ the flow of information along the nerve pathway
with multiple sclerosis the transmission of the impulse is ____
blood brain barrier; attack
no, it is not damaged
disrupts
slowed
what are some environmental risk factors for multiple sclerosis?
what are some other risk factors for multiple sclerosis?
where you live, vitamin d deficiency, viral infections, and smoking
being between the ages of 15-40; being a female; other autoimmune diseases like thyroid, type 1 diabetes; and inflammatory bowel disease
what are some signs and symptoms of multiple sclerosis?
widely varying as it depends on the extent and location of nerve damage; can produce almost any neurological symptom; affects the autonomic nervous system
MULTIPLE SCLEROSIS
with the central nervous system what are some signs/symptoms we would expect to see?
with vision what are some signs and symptoms we’d expect to see?
what are some musculoskeletal s/s we’d expect to see?
what can we expect to see with sensation in a multiple sclerosis patient?
fatigue; cognitive impairment; depression; unstable mood
diplopia; nystagmus
weakness, spasms, and ataxia
pain and paranesthesia
what can multiple sclerosis do to the bowels?
what can multiple sclerosis do to the urinary tract?
can cause constipation; diarrhea; incontinence
incontinence or urine retention
is there a specific test we can use to determine if that patient has MS?
there is no specific test
when it comes to laboratory findings in multiple sclerosis what are some things we might see in cerebrospinal fluids?
csf appearance will be clear
leukocytes and total protein levels will be normal
IgG ratio will be elevated in 90% of cases
what is the diagnostic criteria for multiple sclerosis?
- patient must be between the ages of 15 and 40
- have s/s of MS
- 2+ lesions seen on an MRI
- one episode of MS s/s
how can we treat acute attacks of multiple sclerosis?
we can treat acute attacks of MS with medications like corticosteroids and immunomodulatory therapy
what does corticosteroid treatment do for a MS patient
what does immunomodulatory therapy treatment do for a MS patient?
mainly works to reduce inflammation;
slows progression of disease; reduces severity and frequency of attacks and decreases the accumulation of lesions
what are some examples of corticosteroids that are used for MS patient treatment?
______ is also a corticosteroid that is used to remove _____ and ____ from your blood plasma
prednisolone and methylprednisolone
plasmapheresis; immune cells; factors
what are other types of treatment options for acute MS attacks?
medications like muscle relaxants which treat muscle stiffness (diazepam, baclofen)
PT/OT for strength to perform ADLs
it has also been discovered that there is a link between _____ deficiency and MS development
another treatment option for MS patients would be to correct the _____ deficiency
vitamin D
vitamin D
what would be some nursing diagnoses for MS?
impaired physical mobility; impaired urinary elimination; ineffective health management
what would our nursing care plan consist of when it comes to providing care for our MS patients?
maximize neuromuscular function; maintain independence in ADLs, manage fatigue, and optimize psychosocial well-being
if the MS patient is immobile or confined to the bed what are some nursing interventions we could perform?
help with turns, bathing, and cleaning the patient during an exacerbation
ask the pt. what triggers exacerbations, and search for pressure ulcers and educate the pt how to avoid them
if the MS patient has impaired urinary elimination what are some nursing interventions we could perform?
we might consider teaching the patient how to self-catheterize to help avoid incontinence at home/when out in public
when MS patients experience constipation, we should educate them to _____ fiber intake and/or use a ______ if they don’t have a BM in 2 days
if the MS patient is prescribed beta-interferon we must educate them to wear _____ when they’re outside and remind the pts. that _____ symptoms are common after starting beta-interferon therapy
increase; stool softener/laxative
sunscreen; flu-like symptoms
parkinson’s disease is a chronic, progressive _____ disorder
parkinson’s disease causes _____ which is slow initiation and execution of movement
with parkinson’s, there is ____ muscle tone which results in ____, and oftentimes, there’s ____ at rest
degenerative
bradykinesia
increased; rigidity; tremor
the exact cause of parkinson’s disease is ____; however a ______ exists in this disease
the deficit of dopamine creates an _____ between dopamine and the excitatory neurotransmitter_____
unknown; deficit of dopamine
imbalance; acetylcholine
what are some secondary symptoms of parkinson’s disease?
micrographia; mask-like expression; stooped posture; shuffling; dystonia (tremors); impaired coordination; slow slurred speech; drooling and difficulty swallowing
dopamine is essential for things like what?
control of posture; voluntary motion; affects emotions; and starting movement
what does treatment for parkinson’s disease look like?
what are some examples of dopamine receptor agonists?
what kinds of medications are used to treat tremors in a parkinson’s patient?
lastly, there is also _____ which is used for deep brain ____
levidopa with carbidopa is the primary treatment for symptomatic pts.
dopamine receptor agonists are also prescribed to the patient
requip and mirapex
antihistamines like diphenhydramine are used
surgical therapy; stimulation
what are some nursing interventions we can perform to prevent poor nutrition?
encourage the patient to eat 6 small meals a day rather than eating 3 large meals; cut the patient’s food into bite sized pieces
sometimes patients with parkinson’s disease have difficulty swallowing so we want to make sure to give the patient foods that are _____ and easy to ____
a parkinson’s patient diet should consist of ____and _____ of the patient’s preference
appetizing; swallow
fiber; fruits
with a parkinson’s patient we want to make sure that when it comes to movement we are providing ______ and making sure they have a ____ to walk
stand by assist; clear path
we also want to educate the patient about ______ meaning they have a clear schedule for brushing their teeth; changing into pajamas; reading before bed, etc…
sleep hygiene
with parkinson’s disease we want to educate the patient to practice _____, place the patient in a chair or increase the HOB to ____, always have suction at the bedside; assess the patient for _____
coughing and deep breathing exercises; 90 degrees; depression
what is a rapid response?
rapid responses are instituted to prevent ____
rapid responses are used to _____ the amount of unnecessary transfers to the ICU
a rapid response is called when a patient on the acute care floor is decompensating
code blue calls
decrease
who consists of the rapid response team?
an ICU nurse, a respiratory therapist; and a medical provider
what consists of the rapid response criteria?
what are some changes we might see in mental status?
what are some changes we might see in respiratory status?
acute change in mental status and acute change in respiratory status
we can’t wake the patient; somnolence; confusion
stridor (noisy airway); respiratory rate <10 or >32; increased effort to breath; O2 saturation less than 92%
what are some other requirements in relation to CV status we would expect to see before calling a rapid response?
if the patient is experiencing a new onset of chest pain, first we would perform an _____, then for treatment options we might do an _____, or give medications _____, _____, or _____
HR < 55 or > 120
SBP < 90 or > 170
assessment; EKG; troponin; SL NTG; and morphine
a lot of the times, patients who are in need of a rapid response will present himself as very ____ and ____
agitated; restless
if one of our patients is experiencing a fever greater than 38.5 what of the following will need to be done?
- first we must call the provider
- check for urine, blood, and wound cultures
- urinalysis
- chest xray
- administer acetaminophen
what might cause the patient to have acute changes in their mental status?
what would we do if we noticed that our patient was having acute change in their mental status?
too much pain medications; low blood sugar; CVA ischemic stroke; or a head bleed
try to wake the patient; ask about the last dose of pain meds; perform a full set of VS; check the pts. blood sugar; stat head CT
if the patient has a heart rate less than ____ or greater than ___ that is sustained for 10 minutes what might be the cause?
sinus bradycardia due to head injury or beta blockers; sinus tachycardia due to pain, fever, or dehydration
if our patient is experiencing a HR <55 or >120 we would ______ to determine if its regular/irregular and perform an EKG to determine if the patient is experiencing ____, ____, or ___
feel the pulse; rapid a-fib; sinus tach; or sinus brady
what do you do if your patient’s SBP is less than 90 or greater than 170
assess the patient, ask them if they feel dizzy or nauseated; retake the BPl; and check the I&Os
what would be some reasons that the systolic blood pressure is less than 90?
what would be some of the reasons why the patient’s blood pressure is greater than 170?
dehydration; bleeding from the GI tract; beta blocker medications
pain; BP meds were held prior to OR; new HTN diagnosis;
what would you do if the patient’s temperature is less than 35 C or greater than 39.5 C?
assess the patient; check if they have too many blankets; did they just get back from the OR?; is the room too hot or too cold?
why would the patient have a temperature less than 35C?
why would the patient have a temperature greater than 39.5C?
decreased thermoregulation; para or tetraplegia; OR is cold; needs blankets
infection protocol; blood cultures + urine; IV fluid from insensible fluid loss; tylenol
if you have a feeling that “something just isn’t right” what would you do?
what could cause this to happen?
assess the pt.; get another set of eyes to look at the patient
look at the VS; perform a neuro assessment; medications; pain; ask the patient
what would you do if your patient’s RR is less than 10 or greater than 32?
what would be some interventions you could perform to help decrease/increase the RR?
assess the patient; take the RR; look at the O2 saturation
re-position; increase HOB; and consider a breathing treatment
what would cause your patient to have a RR less than 10?
what would cause your patient to have a RR greater than 32?
oversedation; PaCO2 levels
is this a change?; what is the patient’s O2 saturation? do the have pneumonia? do they have anxiety?
what would you do if your patient’s hematocrit levels were 6% or less in a span of 24 hours?
what would cause the patient to have low hematocrit levels?
assess the patient; VS, what is their prior Hct?; “did the patient have surgery?”
bleeding, loss of blood in the OR; dilutional –> due to a lot of fluids being administered
what would you do if your patient was experiencing chest pain?
assess the patient; ask them questions (rate your pain 0-10, what does it feel like?, would you point to it?); EKG if you’re suspicious; give troponin; NTG SL
what would cause your patient to have chest pain?
they’re experiencing angina; patient is having an MI; patient has indigestion; the ultimate goal is to relieve the pain
what is the pathophysiology behind HIV?
HIV can replicate only within ____ cell
what are the target cells in HIV?
HIV is a RNA virus that is called a retrovirus because it replicates backwards (RNA –> DNA)
one
CD4or T cell lymphocyte
with HIV, eventually there is a drop in the number of ____ cells which can lead to ____ or a ___ immune system
with decreased CD4 cells, the immune system cannot fight off ____ or ____ making the body vulnerable
CD4 cells; immunodeficiency; weakened
bacteria; viruses
how does one become infected with HIV?
how is HIV transmitted?
infection takes place when the virus enters the body through a wound or through your mucous membranes
through wounds or soft, moist areas inside your nose, mouth, rectum, vagina, or penis
the most common type of HIV transmission is ______ with an infected partner
_____ from other STIs also ____ the likelihood of HIV transmission
contact with ___, ____ and blood all contain lymphocytes which may contain ____
unprotected sex
genital lesions; increase
semen; vaginal secretions; HIV
what consists of HIV testing?
what is the western blot test?
first, you’d do a screening on the patient, if positive, you’d want to perform a confirmatory testing with the western blot test
looks at the proteins within the HIV virus, which are separated and blotted on a type of membrane paper
with an acute HIV infection what are some symptoms we would expect to see?
flu-like symptoms such as fever, headache, fatigue, swollen lymph glands, and liver/spleen enlargement
the symptoms of HIV usually last about ___ to ___ months, after the symptoms pass, you will develop _____
2; 3; HIV antibodies
if the patient has chronic HIV infection or they are in clinical latency, what will this look like?
the patient will have no symptoms because the immune system is in balance with HIV
how long does the clinical latency period last?
it can vary; however it usually last no more than 10 years
a patient cannot be diagnosed with AIDS until at least ____ of the CDC criteria is met
what consists of the CDC criteria?
one
CD4 count drops below 200 cells/ul; the patient has an opportunistic infection (fungal candidiasis, toxoplasmosis, pneumoniae); has an opportunistic cancer; or has a diagnosis of wasting syndrome
what are some examples of opportunistic infections according to the CDC?
what is wasting syndrome?
invasive cervical cancer; kaposi’s sarcoma; burkitt’s lymphoma
loss of 10% or more of ideal body mass
untreated HIV has a _____ pattern
when left untreated, HIV will progress in ____ stages
what are the three stages of HIV?
predictable
3
acute infection; clinical latency/chronic HIV; AIDS
______: a condition where the immune system is so weak, that it can no longer protect the patient from infection from other organisms
what are some symptoms of AIDS?
AIDS
rapid weight loss; night sweats; extreme fatigue; swollen lymph nodes; chronic diarrhea; sores in the mouth, anus, and genitals
what are some defining diseases of AIDS?
fungal infections like thrush (common in the mouth and throat); kaposi’s sarcoma; and pneumocystis pneumonia
with fungal infections it’s ____ to swallow which causes the patient to ____ their appetite
difficult; lose
what is kaposi’s sarcoma?
what are some s/s of kaposi’s sarcoma?
kaposi’s sarcoma can spread to the gut which can cause ____ and it can also spread to the lungs which can make it _____ to breathe
it is a tumor caused by human herpes virus
reddish brown/purplish lesions on the face, legs, and mouth
bleeding; difficult
pneumocystis pneumonia severely affects the ____
pneumocystis will have a _____ appearance on the xray
this is the most _____ infection of people with AIDS
what are some symptoms of pneumocystis pneumonia?
lungs
ground glass
common opportunistic
SOB, fever, cough, and chest pain
what can cytomegalovirus do to the eyes?
what can cytomegalovirus do to the gut?
once you have cytomegalovirus, you have it for ____
it can cause blindness
bloody diarrhea
life
mycobacterium avium complex (MAC) is another ______ of aids
MAC exists _____ in the environment
MAC can infect the ____ and _____ of AIDS patients
what are some s/s of MAC?
defining disease
everywhere
lungs; intestines
gastroenteritis; watery diarrhea; and weight loss
what consists of drug therapy for HIV?
drug therapy for HIV is used to ____ and _____ HIV replication
entry inhibitors like enfuvirtide; reverse transcriptase inhibitors like AZT and lamivudine; protease inhibitors; fixed dose combination products
control; suppress
what are the five goals of HIV drug therapy?
decrease the viral load; maintain or increase CD4 count; prevent HIV opportunistic infections; delay disease progression; prevent HIV transmission
when it comes to nursing management for AIDS, we want to ____ the patient
how would we educate our HIV/AIDS patient?
educate
adhere to drug management; protect others from HIV; maintain and develop healthy/supportive relationships; maintain activity and productivity
what are some nursing interventions we could perform in regards to teaching our HIV/AIDS patients?
assist the patient with mental health issues; refer to community resources; and teach the patient their options when it comes to their care
overall, what are some nursing interventions we could perform for our HIV/AIDS patients?
teach them the importance of condom use to protect others from infection; talk about having a specific time to take their ART/HIV drug therapy; know when to report s/s of headache and fever; SOB; dehydration; and bleeding
