Nursing102-Exam5

Gout is a kind of arthritis that occurs when uric acid builds up in the joints.Acute gout is a painful condition that typically affects one joint.Chronic gout is repeated episodes of pain and inflammation, which may involve more than one joint.

pallor or blanching of the foot in response to leg elevation

reactive hyperemia (redness) is observed when limb is hung in a dependent position

antiplatelet agent; inhibits platelet activation

drug for intermittent claudication; increases red blood cell flexibility and reduces blood viscosity which helps blood flow to ischemic muscle

involves catheter inserted into femoral artery; advanced to narrowed artery and balloon is inflated; blood vessel dilates and cracks the confining atherosclerotic intimal shell which also stretches the underlying media

high rate of stenosis; up to 50% at 1 year

opening the artery and removing the obstructing plaque; common with carotid artery

opening the artery, removing the plaque and sewing a patch to the opening to widen the lumen

assess Q15min initially then hourly for changes in color and temp, capillary refill, presence of peripheral pulses distal to operative site, and sensation and movement of the extremity

Loss of palpable pulses, dramatic increase in pain, extermity pallor or cyanosis, decreasing ABI, numbness or tingling, or cold extremity temp necessitate immediate notification of surgeon

adaptation of the ischemic limb to environmental temperature, most often cool

rare, nonatherosclerotic, segmental inflamatory disorder of medium-sized veins, arteries and nerves of the upper and lower extermities

highly cellular and inflammatory thrombus forms inside vessel causing tissue ischemia

begins with distal vessels progressing to more proximal vessels

strong relationship between tobacco use and illness; only occurs in smokers; when smoking stops, disease improves

avoid nicotine replacement products; same vasodilating effects

episodic vasospastic disorder of the small cutaneous arteries most frequently involving the fingers and toes

causes color changes of the fingers, toes, ears and nose (white, blue, and red); decreased perfusion due to arteriole vasospasm results in pallor (white; then digits appear cyanotic (blue) and followed by rubor (red) caused by hyperemic response that occurs when perfusion restored

client c/o coldness and numbness followed by throbbing, aching pain, tingling and swelling; may last minutes to hours

brought on by cold, emotional upset, caffeine, tobacco use or vibratory tools

recommend use of gloves when cold or handle cold objects; avoid temperature extremes; stop smoking; avoid caffeine

calcium channel blockers (e.g. Procardia, Cardizem) relax smooth muscles of arterioles and reduce the number of vasospastic attacks; side effects: tachycardia, headache, flushing, dizziness, and peripheral edema

• aPTT
• normal: 24-36 seconds
• therapeutic: 46-70 seconds

The therapeutic range of the APTT should be 1.5-2 times greater than the control.

• PT
• normal: 11-12.5 seconds
• therapeutic: 16-22 seconds

• INR
• normal: 0.75-1.7
• therapeutic: 2-3

• U - urge to move
• R - rest-induced
• G - gets better with activity
• E - evening or night

• Pain
• Pallor
• Pulse
• Paresthesia
• Paralysis

• Circulation
• Movement
• Sensation

• Right Circumstance
• Right Task
• Right Person
• Right Direction/Communcation
• Right Supervision

Deep Vein Thrombosis

• - Maintain bed rest to prevent dislodgement of thrombus
• - Frequently change position in bed to prevent problems of immobility
• - Leg exercises: dorsiflexion, plantar flexion, and ankle circles
• - do not cross legs
• - do not massage leg
• - keep leg elevated to promote circulation
• - avoid sudden movement of affected limb to avoid dislodging thrombus

• Lab Tests:
• INR
• platelet count
• chest xray
• D-dimer assay
• CBCs
• ABGs
• guiaic stool

• Adrenergic - Beta Blockers
• - end in -lol (e.g. propanolol, atenolol)
• - reduce BP by slowing heart rate; decreases peripheral vascular resistance

• ACE Inhibitors
• - end in -pril (e.g. captopril, enalapril, lisinopril)
• unique side effect: non-productive cough

• Calcium Channel Blockers
• - causes smooth muscle relaxation
• - decreases peripheral smooth muscle tone
• - decreases SVR (systemic vascular resistance)
• - decreases blood pressure
• - e.g. nifidipine (Procardia), amlodipine (Norvasc), verapamil (Calan, Isoptin)

• Diuretics
• - accelerate the rate of urine formation; results in removal of water and sodium
• - decreases plasma and ECF
• - first line antihypertensives

• Vasodilators
• - relaxes arteriolar and/or venous smooth muscle

• adverse effects: hypotension, dizziness, fatigue
• take in morning to avoid interference with sleep patterns
• do not stop antihypertensives abruptly
• give with meals for gradual and effective absorption
• avoid smoking; avoid foods high in sodium
• change positions slowly to avoid orthostatic hypertension

• promote:
• weight loss
• stress management
• supervised exercise
• dietary measures

• causes:
• inadequate dietary intake
• malabsorption
• blood loss
• hemolysis

• S&S:
• pallor (palms, ear lobes, conjunctiva)
• fatigue
• activity intolerance
• weakness
• shortness of breath
• tachycardia
• signs of bleeding
• glossitis
• cheilitis
• headache
• paresthesias
• burning senstation of tongue

• dietary sources:
• - meats, certain green leafy vegetables and grains, fish liver, legumes
• - must be converted by gastric juices before absorption
• - some foods enhance absorption e.g. OJ, ascorbic acid
• - some foods impair absorption e.g. milk, dairy, corn, eggs, beans
• - take between meals for maximum absorption, but can be taken with meal if GI distress

• adverse effects:
• - most common cause of pediatric poisoning
• - causes NVD (nausea, vomiting, diarrhea), constipation, cramps, and pain
• - causes black, tarry stools
• - oral preparations may stain teeth; use straw
• - may cause injection pain; use Z-track method

• assess:
• lab values especially Hb, Hct
• improved nutritional status
• increased weight and activity tolerance
• absence of fatigue

ACUTE HEMOLYTIC TRANSFUSION REACTION

• S&S:
• fever, tachycardia, hypotension, chest and back pain, pain at IV site

• STOP TRANSFUSION.
• Notify physician.
• Replace IV tubing.
• Infusion of 0.9% sodium chloride (NS)
• Lower head of bed and administer O2 via NC at 4L/min

• CIRCULATORY OVERLOAD
• S&S: dyspnea, tachypnea, tachycardia,chest discomfort, cough, distended neck veins, crackles and rales, apprehension (sense of doom), restlessness, sudden increase in SBP

• treatment:
• place in upright position with O2 via NC at 2L/min
• furosemide (Lasix) to elminate fluid through diuresis

associated with fractures of long bones

• S&S:
• 1. neurologic abnomalities (confusion, irritability, restlessness)
• 2. respiratory distress: tachycardia, tachypnea, dyspnea
• 3. petechiae on anterior thorax
• 4. rapid temperature spike

• treatment:
• O2 on non-rebreather
• correct fluid volume deficits

• - develops when pressure within muscle compartment rises to a level that compromises blood supply to nerve and muscles
• - increase in pressure due to cast or muscle fascia that is too tight or increase in compartment contents from hemorrhage or edema
• - pain that is unrelieved with opioids; on active/passive motion

• treatment:
• relieve pressure (e.g. bivalves on cast or fasciotomy or removing fluid)
• DO NOT ELEVATE.

• while drying, do not place under blanket
• not bear weight (if weight-bearing) until 24-72 hours
• keep cast clean and dry
• do not put powders or lotion inside cast
• do not insert objects between cast and skin to scratch
• report numbness, tingling, burning, pallor, cyanosis, change in temperature, tenderness, drainage and worsening of pain, foul odor

• Rest
• Ice - 20 minutes per hour alternate with 20 min heat, then 20 minutes off
• Compression
• Elevate

• Single knee-to-chest
• Abdominal curl
• Pelvic tilt
• Hamstring stretch

• Grade 5: Muscle contracts normally against full resistance.
• Grade 4: Muscle strength is reduced but muscle contraction can still move joint against resistance.
• Grade 3: Muscle strength is further reduced such that the joint can be moved only against gravity with the examiner's resistance completely removed. As an example, the elbow can be moved from full extension to full flexion starting with the arm hanging down at the side.
• Grade 2: Muscle can move only if the resistance of gravity is removed. As an example, the elbow can be fully flexed only if the arm is maintained in a horizontal plane.
• Grade 1: Only a trace or flicker of movement is seen or felt in the muscle or fasciculations are observed in the muscle.
• Grade 0: No movement is observed.