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- What is it? Inflammatory disorder of unknown cause that effects the synovial membrane of the joints. It is systemic!
- DX: Ra factor, joint inflammation, heat, and RA nodules.
Medications: NSAID's, cox-2 enzyme blockers, antimilarials, penicillamine, gold, and sulfosalazine.
Systemic Lupis Erythematosis
- Lupis- Autoimmune disease that destroys connective tissue.
- Manifestations: Butterfly rash acressed bridge of nose and cheeks, joint pain and swelling, fever, weight loss, oral lesions, renal damage, and personality changes.
- Gout= Hyperuricema grater that 7 mg/dl.
- Causative Agent- decreased renal excretion of uric acid, excessive intake of high purine foods.
- Definitive DX: Synovial fluid analysis, serum uric acid, and urine uric acid levels.
- Medications used: Allopurineol (Colcrys), Colchicine (Colcrys), NSAID's, and steroids.
- Side Effects: N/V/D, and bone marrow supression.
- Scleroderma=Hard skin and hard organs.
- C-calcium deposits
- R-Raynauld's phenoneum (blood vessel spasms)
- E- Esophageal dysfunction (esophagus stiffens)
- S- Scleredactyly- Thickening and tightening.
- T- Telargtectaslas dilation of capillaries causing red marks on skin.
- Labs=Ana, C-reacive protein, x-ray, RBC, C4 compliment, RF, CT/MRI/, Arthrogrophy.
- What lab indicated infection? CBC/Diff and elevated WBC Count.
- Medications- NSAID's, corticosteroids, low dose antidepressants, DMARDS, & non-opioid medications.
- Fracture= When bone is broken.
- Complications= Fat embolisms, nerve injury, shock, compartment syndrome, and clotts.
- S/S: Hypoxia, fever, petechie, cought thick white sputum, chest pain, dyspnea, & tachycardia.
- Casts- used to immobilize, correct, support, or stabilize weakened joints or limbs.
- Patient Teaching- watch for signs of impaired circulation, keep dry, etc.
- Complications for cast= compartment syndrome, contractures, and pressure ulcers.
- Total Hip= replacement of hip joint.
- Prevention interventions of dislocation= No internal rotation, keep hips highter than knees, don't bend hip over 90 degrees, and don't cross legs (Keep Abducted).
- Osterarthritis= Noninflammatory joind disease from wear and tare.
- S/S: joint pain, stiffness, limited movement, and Heberden's Nodes.
- X-Ray Finding- narrowing of joint space with bone spurs (osterphytes).
- Ostermyelitis= Bone infection caused by staph of pseudomonas.
- High Risk patients= elderly, ovese, malnourished, DM, and immunosuppressed.
- Manifestations- Painful, swollen, and tender bone.
- Osteoprosis= Bone reabsorpting leads to fragile, weak, and thin bones.
- Medications= Calcium/Vitamin D, Bisphosphonates, Calcitonin, estrogen, & Teriparatide.
- Side Effects: N/V/D, Sit up 30-60 Min after taking, hypotension, constipation, angina, cough, sweating, and syncope.
- Tendonitis= Chronic, painful condition caused by excessive and repetetitive motion of tendon causing inflammation.
- Management- Rest joint, ice, NSAID's, immobolize joint, steroid injection, and gentle exercise.
- Fat Embolism- Fatty globules may diffuse from bone marrow and occulde small vessels.
- Clinical Manifestation- Chest pain, dyspnea, white sputum, fever, hypoxia, tachycardia, and petechiae.
- Patient teaching regarding Barrett esophagus:
- A pre-cancerous condition that must be assessed q6-12 months to rule out cancer
- Criteria for selecting bariatric surgery pt.:
- Number of co-morbidities
- BMI > 30 or 100 lbs overweight
- Only after other methods of weight loss have been tried and failed
- Life Style change 6 small meals, 600-800 calories a day, lots of fluids to prevent dehydration, and vitamin and mineral suppliments.
- Complications of gastrectomy:
- Vit. and mineral deficiencies
- Dumping syndrome
- Dumping syndrome:
- Rapid stomach emptying into duodenum
- Complication of gastric bowel surgery
- Caused when high sugar liquids are ingested
- Diverticulitis= Is pockets in the signoid colon wall.
- Medical management of diverticulitis:
- High fiber diet Low fat,
- Clear liquid
- Bowel rest
- IV fluid
- Stool characteristics of Ulcerative Colitis:
- Watery with blood and mucus
- Pt./family teaching for Ulcerative Colitis:
- Diet: bland, high protein, high calories, high vit. Low residue
- Relaxation techniques
- Small meals
- Avoid caffeine, alcohol, and smoking
- Avoid skin breakdown by cleaning the tushy after each poop session
Inflammatory Bowel Disease
- Nutritional therapy for Inflammatory Bowel Disease (IBD):
- Low residue
- High protein
- High Calorie
- What are some complications to a laparoscopic Cholecystectomy?
- Bile duct injuries
Diabetes Sick day Rule
- Sick-day rules related to diabetes mellitus:
- Monitor blood glucose q3-4hrs
- Continue medications as usual
- Diet of easily digested foods and liquids
- Call provider is blood glucose higher than 300 or unable to retain fluids
DM Type 2 Medications
- Oral hypoglycemics:
- -Sulfonylureas: stimulates beta cells to secrete insulin
- -Biguanides: increase body tissue sensitivity to insulin, Inhibit production of glucose by liver
- - Thiazolidinedilones: sensitize body tissue to insulin
Adrenal Cortex Produces What?
- What 3 steroids does the adrenal cortex produce?
Diabetes Rule of Thumb
- Cool and Clamy= Give some candy.
- Hot and Dry= Sugar to High, give insuline.
- Lipodystrophy (from insulin injection):
- Tough, lumpy areas of fat (Rotate injection sites to avoid)
- Insuline=key to get glucose into cells.
- Storage- keep out of direct sun light, store at room temperature less than 30 days. Refridgerate up opened vials.
- Self Injection- 500-1000 unit syringe, inject equal amount of air of insuline to be given, alcohol wipe area, give shot at 90 degrees angle bunck skin between fingers in back of arm, thigh, or abdomen, and rotate injection sites.
TYPE 1 DM
- Destruction of the beta cells of the pancreas possibly from infection/environment that triggers
- MANAGEMENT- Primary tx is insuline, diet, and regular exercise.
- BS criteria for DX: Fasting Gl 126 +, or casual Gl of 200 +.
- Thyroid Storm= To low of a level of thyroid hormones T3, TSH, TRH, and T4.
- Clinical Manifestations- Cardiac dyrithmias, neural imparements, and fever.
- Foods that contain Iodine- Salt, dairy products, sea food, eggs, and breads.
- Definition: A lesion in the lining mucosa of the digestive tract, usually caused by pepsin and stomach acid, or
- H. Pylori.
- Clinical manifestations of a peptic ulcer:
- Dull gnawing pain in mid-epigastric region Pain relieved/reduced from eating
- Medications to combat H. Pylori:
- Pepto Bismol
- Protein Pump Inhibitors
- Baruim Swallow- Patient is asked to drind a barium liquid and baking soda crystals to detect through x-ray and abnormalaties in upper GI system.
- Such As: tumors, ulcers, hernias, pouches, strictures, and swallowing problems.
Insulin Given IV is?
Regular/ Humalog R
- Esophageal Problems=cancer, tumor, swallowing problems, and etc.
- Complications-Dysphagia, malnurtition, dehydration, aspiration proplems, and can get aspiration pneumonia.
- Characteristics of Grave's Disease:
- Weight loss
- Increased appetite
- Heat intolerance
- Dry itchy skin
- Eyes bug-out
- Muscle weakness
- Complications of thyroidectomy:
- Swallowing problems
- Parathyroid damage (hypo-function=low calcium)
NPH insulin onset, peak, duration:
- NPH insulin onset, peak, duration:
- O= 3hrs
- P= 8hrs
- D= 18hrs
- Oral Hypoglycemics:
- Sulfonylureas (1st and 2nd generation)
- Stimulates beta cells to secrete insuline
- *(Diabinese) chlorpropamide
- * (Amaryl) glimepiride
- * (Glucotrol) glipizide
- * (Micronase) glyburide
- Cataract treatment
- Only cure is surgical removal
- Post op.:
- Eye drops
- Activity restrictions
- HOB 30 degrees
- Report new floaters and flashers to Dr
- Conjunctivitis= Pink Eye, and eye infection.
- Can easily spread from one eye to another (very contagious)
- Meniere's Disease
- Abnormality of inner ear which leads to hearing loss and vertigo
- What is best position for Orthopnea?= Can't breath laying down, must sit up to breath well.
- Upright sitting position slightly leaning forward
Respiratory and Metabolic acidosis and alkalosis
- What is the normal range for blood pH?
- What is the normal range for CO2 in the blood?
- Normal range for bi-carb (HCO3) ion the blood
- CO2 is respiratory.
- BiCarb is metabolic.
Dizziness and Vertigo
- Sensation the individual is moving rather than the environment. Increased risk for falls.
- Sensation of movement of environment, episodic, worsens with movement. Increased risk for falls.
- AtelectasisClosure or collapse of alveoli.
- First line measure to prevent/treat atelectasis Incentive Spirometer.
- Retinal Detachment= Separation of the retinal pigment epithelium.
- S/S: Shadows, bright flashing lights, Curtin of light.
- DX: Visual acuity test, fundus exam.
- TX: Surgery.
Chemical burn to Eyes
Chemicla Burns to eyes= Immediately Irragate eyes for 10 minutes. Then seek medical help, eye exam, and etc.
- Abnormally high levels of nitrogen-containing compounds in urine
- Blindness in one half of the visual field of one or both eyes
- Management- Approach on side of good vision, explain to patient to look in sweep room to see everything.
- Eairly S/S: HTN, Severe HA, Change in LOC, and Vomiting.
- What is the primary focus of assessment for ischemic and hemorrhagic stroke?
- Cardiac and respiratory function
- During a hemorrhagic stroke why should nurse raise HOB?
- Decrease intracranial pressure in subarachnoid space
- How is hemorrhagic stroke diagnosed? CT scan
Dilantin for long-term tx. of seizure?
- What is a side effect of Dilantin for long-term tx. of seizure?
- Gingival hyperplasia
- Provide really good oral care
- Theraputic level:10-20 mcg
Thrombolytics (TPA)=Tissue Plasminagin Activator
- tPA in tx of stroke
- Continuous monitoring of cardiac after admission of tPA
- Must be given within 3 hrs of stroke
- Not for hemorrhagic strokes
- Risks for using thrombolic agent
- Bleeding Contraindicated of already on anticoagulants
Risk Factors For Stroke
- Non-modifiable risk for stroke:
- Over 55 yrs old, Male, and Black
- Modifiable risk for stroke:
- Hypertension is primary risk factor
Numbness, weakness, facial droop, confusion, Change in LOC, trouble speaking, HA, visual disturbances, dizziness, difficulty walking, & loss of balance or coordination.
Myasthenia Gravis- Autoimmune
- Clinical manifestation of Myasthenia Gravis (MG)
- Generalized weakness of muscles in extremities and intercostal muscles Motor disease only
- *Do not have sensory or coordination deficits
- *Very high risk for aspiration
- Mesitinon Main medication used for Myasthenia Gravis (MG)
- Start with this Rx first as others have more side effects
- Must be taken on time or weakness sets in quickly
- MYASTHENIA GRAVIS- Test to r/o
- Tensilon (eproponium chloride) given IV to see if muscle strength increases after 0 - 40 seconds.
- If not have MG you will get muscle twitches in < then 5 minutes.
- Tensilon side effects are bradycardia, have Atropein to counter -act it.
- Multiple Sclerosis
- Auto immune DI9SEASE THAT ATTACKS MYELINSHEATH.
- MULTIPLE SCLEROSIS- Pathophysiology
- Brain and spinal canal are effected. The immune system destroys the myelin sheath, plaques develop and slows transmission of impulses.
- MULTIPLE SCLEROSIS- Clinical Manifestations
- Numbness, weakness, loss of coordination, fatigue, dizziness, blurred vision and diplopia (double vision)
- MULTIPLE SCLEROSIS- Patient Teaching
- Avoid triggers, heat sun and stress.
- Others: Exercise and rest, assistive devices, Rest in cool environment, bladder and bowel training.
Total knee Replacement
- Total Knee Replacement= Replace knee with a man made one.
- Assessment needed before DC= Prophylactic antibiotic, antithrombolitic, and 5 P's.
- 5 P's of Circulatory Checks
- Hypoxia, or O2 lack there of chronic.
- What does finger clubbing indicate?
- Chronic hypoxic conditions
- No urine output or less that 100 ml in 24 hr.
- Very little urine output (30 mL/hr) or 400 in 24 hr.
- Sleep Apnea= Periods of decreased to absent respirations while sleeping. Causes: Obesity, enlarged uvula, or partially blocked airway.
- S/S: Fatigue, not rested after awakening, frequent HA, history of snoring.
- Cheyne-Stokes= Abnormal breating pattern by progressive deeper breathing, faster breathing, followed by a gradual decrease apnea.
- Patterns repeats from 30 sec.- 2 min.
Airway obstruction caused by either constriction, bronchospasm, or inflammation.
- Hypoxia= Dificiency in the amount of O2 reaching the tissues.
- S/S:Poor coordination, rapid breathing, poor judgment, cyanosis, lethargy, HA, Air hunger, dizziness, euphoria, tingling, and visual impairment.
Heart Failure- L/R
Left-sided S/S: Crackles in the lungs, and pink frothy sputum, Dyspnea, Decrease O2 sats, HTN, Tachycardia, tachypnea Right-sided: S/S: Jugular vein distention/ and edema
- Pediculosis Capitis- Head Lice
- Pediculosis Corporis- Body Lice
- Pediculosis Pubis- Crabs Pubic lice
- Lice TX: Shampoo and topical cream used to paralyze and kill lice. Use 1 time every 7-10 days, may take 2 treatments. Comb out lice with fine tooth comb and dont share hats, combs, or etc..
- Aspiration= Food, fluid, or other substance goes in lungs.
- High Risk Patients: Stroke, MS, ALS, MG, etc.
- Helps to open up lungs and prevent atelectasis.
- Use 10 x every hr while awake.
- Mechanical Ventilation- Artifical way to make a person breathe mechanically.
- Communication: Hand writing, Shake head yes or no, one way valve to speak through, or mouth words.
- Breath Sounds- Crackles, ronchi, and wheeze.
- Crackles= high pitched heard on inipiration, sounds like plasitc paper crinkled.
- Ronchi= Loud, low coarse sounding, sounds like a snore.
- Wheeze= musical whistling sound during inspiration or expiration.
Smoking= damages respiratory track, and number 1 cause of lung cancer.
- What is the definitive test for Tuberculosis?
- PPD (purified protein derivative)
- Tx: Antituberculosos agents for 9-12 months.
- Drugs to TX:
- INH prophylaxis for those at risk.
- INH, Rifampin, Ethambutol, Pyrazinamide.
- Read PPB test 48-72 hr after, 7-10 mm is positive reaction.
- MONA treatment MI
- M= Morphine; decrease pain, anxiety, workload on heart
- O= Oxygen; increased O2 will decrease workload on heart
- N= Nitrates; relieve angina pain
- A= ASA
CAD- Coronary Artery Disease
- CAD- when blood frow to heart is reduced or stopped deprivig the heart of O2.
- Fibrous plaque associated with Coronary Artery Disease
- Progressive change in the arterial wall Normally endothelium cells repair themselves, but with CAD endothelium cells slow repair allows LDL to thicken arterial wall.
Used to DX: CAD, assess coronary artery patency, determine extent of atherosclerosis, and revascularization (Stent).
- What causes Angina?
- Pain caused by insufficient coronary blood flow; atherosclerosis AND increased demand for O2
- Anxiety attack can mimic chest pain
- Diabetics will not experience chest pain
- Nitrates=Vasodilator *Decreases myocardial oxygen consumption
Cardiomyopathy= Heart Disease
- What are clinical manifestations of restrictive cardiomyopathy?
- Swollen feet/hands
- Dyspnea w/ exertion
- Tx: Diet: Low sodium, fluid restriction.
- Medications: Ace Inhibitors, digitalis (digoxin), beta blockers, anticougulants, antidysrhthmics, and vasodilators.
- Surgery: Implanted defibrillator or heart transplant.
- Elevated BP 140/90.
- Primary HTN= High blood pressure where the cause is unknown.
- Risk Factors- Overweight, smoking, and drinking too much alcohol.
- The Diagnosis of HTN have elevated reading 3x in several weeks.
- The Silent Killer!
- Antihypertensive Drug= Decrease Blood Pressure
- Goals of Treatment- Lower high blood pressure and prevention of CVA or stroke.
- White coat syndrome- Blood pressure is elevated only in Dr office and not anywhere else.
- Lifestyle modification for pt.s with HTN
- *Self monitor BP*
- Weight loss
- Reduce sodium
- Regular physical activity
- Medication education for HTN patients
- Names, actions, doses, side effects of all drugs
- Do not abruptly d/c
- Never double-up to account for a missed dose
- Watch for orthostatic hypotension
- Monitor OTC ingredients
- Peripheral Arterial Occlusive Disease=
- Clinical Manifestations-
- Peripheral Arterial Occlusive Disease= When artery stenosis occurs an ther is insufficient blood flow to the tissue.
- Occurs at neck, abdomen, and extremities.
- Thin, shinny, and taught skin.
- Loss of hain on lower legs.
- Diminished pulses in legs.
- Pallor and unequal pulses.
- Treatment: Protect from trauma, ware well fitting clothes, and avoid tight fitting socks.
- General care for PAD
- Protect from trauma
- Wear well-fitting shoes
- Avoid tight-fitting socks
Phases of cardiac rehab
- Phase1: Inpatient; measures abilities, light walking, pt. & family education of lifestyle changes
- Phase2: Closely supervised ambulatory outpatient program
- Phase3: Lifetime maintenance
- Cardiac Rehab
- Why is walking part of plan of care?
- I-Diagnosis of Atherosclerosis
- II-After discharge, exercise, diet, and eduction. 1-6 months
- III- Long-term outpatient program.
Low Blood Pressure
- LBP how does body compensate=
- Renin-Angiotension System
- Vasa Recta in kidneys detect a decrease in BP
- Low BP stimulates renin secretion
- Renin converts angiotensin to angiotensin I
- ACE from lungs converts angiotensin I to II
- Vasa Recta senses increase in BP and secretion of rennin ceases
- Renin-angiotensin system=
- R/T Hypovolemia and Hypotension
- Renin-Angiotensin system= Vasarecta cells monitor BP for: low blood pressure and low blood volume, which causes the release of renic due to low BP.
- Renin changes to Angiotensin.
- Angiotension I converst to Angiotension II, by ace enzyme in the lungs.
- Angiotension II causes vasoconstriction and alderstrone production with ADH to retain sodium and water to raise fluid levels in the cardio vascular system. Which raises BP.
- ESRD (End Stage Renal Disease)= Renal Failure
- Disease that increase risk of developing- Risks- Diabetes, HTN, Chronic Glomerulonephritis, obstruction of urinary tract, medications, or toxic agents.
- Phosphorus-binding medications-
- (Patient teaching)
- Teaching- This drug may cause hypotension, dyspepsia, N/V. Patient should take drug with meals and adhere to perscribed diet.
Dialysis occurs when= When kidneys fail. Kidneys are responsible for filtering waste products from the blood. Dialysis does the job of the failed kidneys.
- Urinary Retention= Inability to empty bladder completely.
- Causes- Uti, prostate enlargment, medication, bladder stone, constipation, urethral stricture, greneral anesthesia, DM, BPH, pelvic injury, and pregnancy.
Self-Catheter patient teaching= Intermittent selfcatheterization use mirror, wash area well, use sterile technique to prevent infection.
Indwelling catheter interventions- Good parenial are care, empty when needed, flush if needed, patent catheter, and good cleaning around catheter area and catheter.
- Hep C= is an infectious disease affecting the liver caused by (HCV).
- Transmission mode- Blood and Sex though infrequent.
- Cancer= Disease when an abnormal cell is transformed by the genetic mutation of cellular DNA.
- Basel Cell Carcinoma- Arises in basal keratinocytes in the deepest layer of the epidermis, hair follicles, and sweatducts.
- Causes: Chronic sun exposure, sun burns, immune suppression, HIV, Fair skin or with freckles.
Anti-Inflammatory Agents- NSAID's
Systemic effects- GI irritation, GI bleeding, HTN, edema, and respiratory problems.
Antibiotics- kill bacteria, or inhibit growth. Antibiotics Patient Teaching= Take perscription until gone as directed, eat acidophilus, or yogert with live cultures after taking and antibiotic.
- Side Effects- This drug may cause D/N/V, HA, Visual disturbances, or cardiac dysrhythmias.
- Other S/E= renal impairment, risk of toxicity.
- See hayllows around lights, and see yellow.
- Patient Teaching- Use soft tooth brush, dont shave with a wet razor, caution on dangerous activity, & increased bleeding risk or hemorrhage.
- Limit vitamin K intake, and cranberry intake.
- Don't drink alcohol while taking this drug. Don't double up if missed a dose, wait til next dose.
Propranolol Hydrochloride- Beta Blocker
- S/E: Drug may cause bradyarrhythmias, cold extremities, anorexia, N/V, insomnia, paresthesias, dyspnea, and wheezing.
- Others: Pruritus, urticaria, dizziness, and fatigue.
- TX: HTN, and Migranes.
- Patient Teaching- This drug may cause syncope, LOC, hypotension, dizziness, somnolence, angina, palpitations, tachyarrhythmias, nausa, and astenia.
- Dx: HTN
- Don't stop taking it suddenly, taper off slowly.
Kayexalate- TX for hyperkalemia or excessive potassium.
- Aldactone- Chemistry lab, Serum potassium, and serum creatinine.
- Monitor: BP, urine output, and VS.