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What are manifestations of systemic Lupus Erythematosis?
- Red butterfly rash across the cheeks and bridge of the nose.
- Malaise and weakness.
- Early morning joint stiffness.
What is the cause of Gout?
Hyper Uricemia- High levels of uric crystals.
What is the definitive Dx of Gout?
Microscopy of synovial fliud. (Joint fluid.)
What is Rheumatoid Arthritis? (RA).
A systemic inflammatory disease that affects the synovial linig of the joints.
Medications used for RA?
- NSAIDS, ASA (can cause tinnitus).
- Glucocorticoids (Prednisone).
- Corticosteroids (injectible at joints).
What are medications used for Gout?
- Uricosuic agent (Probencid).
- Antigout agents.
- Allopurinal (can cause low plts. and bone marrow suppression).
What is Scleroderma?
The connective tissue cells produce too much of the protein called Collagen.
What is C.R.E.S.T.?
- C- Calcium deposits.
- R- Raynauds phenomenon.
- E- Esophageal dysfunction (acid reflux).
- S- Sclerodactyly (thickening and tightening of skin and hands).
- T- Telangiectasias (dilation of capillaries causing red marks).
What is the labs used for Rheumatic disorders?
- Increased ESR (Erythrocyte Sedimentation Rate).
- Positive CRP.
- Decreased WBC's.
- Increased uric acid.
What meds are used for Rheumatic disease?
- Cortico steroids.
- Non opioid medications.
- Low dose antidepressants.
What are complications from a fracture?
- Muscle spasms.
- Compressed nerves.
- Fat embolisim.
What are S/sx of complications of a fracture?
- Pain with movement.
- Loss of function.
What is pt. teaching for a pt. with a cast?
Importance of reporting any s/sx of impaired circulation.
What is a complication that can occur if a pt. has a cast?
- Think 5 "P"s
What are some interventions for dislocation of a total hip?
- Affected leg should not cross the center of the body.
- Don't bend more than 90 degrees.
- Don't let affected leg turn inward.
- Maintain hips in abduction.
What is Osteoarthritis (OA)?
- Idiopathic secondary to trauma to a joint.
- Non-inflammatory joint disease.
What are S/sx of OA?
- Enlarged edematous joints.
- Joint stiffness.
- Heberdan's nodes and Bouchard's nodes.
- *Pain and stiffness* most common.
What is the x-ray findings in OA?
- Joint deformaties.
- Bone spurs.
- Narrowing of joint spaces.
What is Osteomyelitis?
Infection of the bone d/t extension of soft tissue infection or direct bone contamination.
Who is at high risk for developing Osteomyelitis?
- Poor nursed.
- Immunosupressive agents.
- Impaired immune system.
- Chronic illnesses.
- Long term corticosteroid use.
What are manifestations of Osteomyelitis?
- Localized edema and redness.
- Disorder known as Sepsis could be a possible test finding.
- Bone pain.
What are meds used for Osteoperosis?
- Estrogen ( not the first choice anymore) can cause spotting and weight gain.
- Increased risk for DVT's.
- Calcium and Vit. D supplement.
- SERMS (Selective Estrogen Receptor Modulatior).
- Evista (weight gain, vaginal spotting).
What is management of Tendonitis?
- Cold and heat applicatons.
What are clinical manifestations of a Fat Embolism?
- Cough produces large amounts of thick white sputum.
What is Barretts Esophagus?
A precancerous condition caused by untreated reflux.
What is pt. teaching in Barrets Esophagus?
Need to be screened (EGD) because it will roll into cancer.
What is pt. teaching in Bariatric Surgery?
- Psych evaluation.
- 100 lbs. greater than IBW.
What is Dumping Syndrome?
- Complication from bowel surgery.
- Happens 15 min. after eating, can cause hypoglycemia. No fluids with meals.
Nutritional therapy for pts. with diverticulitis.
Low fat, high fiber diet increases stool volume.
Pt. teaching for ulcerative colitis.
- Diet- low residue bland diet, high in protien.
- Stress reduction.
- Family and emotional support.
Nutritional therapy for pts. with IBS.
Bland, low residue, high protien, high vitamin.
Complication from cholecystectomy.
Bile duct injury is most serious(jaundice).
What are sick day rules for pt. with diabetes?
- Monitor BS every 3-4 hours.
- Continue meds.
- Call Dr. if BS>300 or unable to retain fluids.
Insulin storage at room temp?
- In use vials may be left at room temp for up to 4 weeks.
- Lantus only 28 days.
- Avoid direct sunlight.
Insulin for self injection.
- Give promptly.
- Rotate sites.
- Don't aspirate.
Type 1 diabetes management.
Adhere to meal plan and schedule diet and excercise.
BS criteria for Dx. type 1 diabetes.
- Casual BS of 200 or greater.
- Glucose tolerance test of >200.
What is Lipodystrophy?
Scar tissue formation d/t injecting insulin at the same site.
What are clinical manifestations of thyroid storm?
- High fever.
- Altered neurological and mental state.
What is a Peptic ulcer?
Erosion of the lining of the stomach or intestine. Caused by stress, anxiety, H-pylori infection.
Clinical manifestations of Peptic ulcer.
- Dull gnawing pain.
- Burning pain in midepigastrium or back.
- Pt. reports eating relieves pain.
Pt. teaching regarding Barium Swallow.
- Keep upright fpr at least 2 hours.
- Elevate HOB.
Why would a laproscopic surgery be surgeon preferred ?
because it is less invasive
What are some foods that contain iodine?
iodized salt and shellfish
what are some complications with esophageal problems?
- diffuse spasms
- achalasia(absence of peristalis in esophagas)
What are complications from hyperthyroidism?
- thyroid storm-tx:131 I , destroys overreactive thyroid cells
- thyroidectomy-parathyroid can be damaged, watch for s/s of hypocalcemia
Why is the pt kept upright after repair of retinal detachement?
- special positioning may be used to help with the eye healing properly
- pt will be on bedrest
what are precautions for conjunctivitis?
- it can be spread to both eyes
- it is very contagious
- WASH HANDS
What is the intervention for a chemical burn of the eye?
wash it out
What are s/s of cateract extraction that need to be reported and why?
floaters, flashers; can mean retinal detachment
What are pts with Menieres disease at risk for ?
What is managament of Hemianopia?
approach and talk to pt on the unaffected side
What are early s/s of deterioration in a hemorrhagic stroke?
- Severe headache d/t increased crainial pressure from blood in the subarachnoid space.
- decrease in LOC
What is your priority goal in a pt with a hemorrhagic stroke?
Focus on cardiac and respiratory status
When is a thrombolytic contraindicated?
in a hemorrhagic stroke, and if pt is on anticoagulants
What is managment of Myasthenia gravis?
- maintain airway,
- take meds as directed
What are clinical manifestations of multiple sclerosis?
- intentions tremors
- urinary hesitancy
- difficulty in coordination
- blurred vision
- plaques on ct
What is the assesments are needed before discharge on a pt with a total knee replacement?
- s/s of infection
- pt teaching
- coumadin teaching
- PT consult
- surgical site care
- s/s of DVT
What is finger clubbing indicitive of ?
Bronchiectasis- is not COPD but can be a secondary problem with COPD. is caused by an airway obstruction.
S/s of obstructive sleep apnea?
Occurs when the spft tissue in the back of your throat relaxes causing blockage of the airway
What are cheyne stokes?
abnormal pattern of breathing characterized by progressively deeper and sometimes faster breathing, followed by a gradual decrease that results in a temporary stop in breathing called an apnea.
chronic inflammatory disease of the airways
s/s of hypoxia
- Rapid Breathing
- Executing Poor Judgment
Pts that are at a high risk for aspiration?
- stroke pts,
- intubated pts
What is the purpose of IS?
To measure and improve the volume of air inhaled by your lungs
What are communication techniques for the patient that is mechanically ventilated?
use alteranative communication techniques such as writing, yes and no questions, etc
What is the orthopnea position
a body position that allows the pt to breathe easier. usuall sitting up leaning forward
how does smoking damage the Respiratory tract
increases mucous production and all around damages!!
What is positive PPD, treatment steps?
- Antituberculosis agents
- Isoniazid (INH)
- INH used as prophylaxis for those at risk
Why is a cardiac cath done?
to obtain info about pressure readings within the heart. used to diagnose CAD, determine the extent of atherosclerosis, assess coronary artery patency, stent
What are complications that can occur with CAD and exercise?
too heavy of exercise causes angina. so use a mild to moderate exercise in pts with CAD
What is the patho of ANGINA
recurring pain/discomfort in the chest that happens when some or part of the heart doesn't recive enough blood
What is the priority plan of car in a pt with cardiomyopathy?
- identify and manage the cause
- improve cardiac output
What is the White coat syndrome regarding HTN
HTN that occurs when the pt is at the drs office but is lower at home
What is pt teaching on Heart failure?
- Daily weights
- control anxiety
managment of PAD
Protect from and wear well fitting shoes d/t parasthesia and ischemia. avoid tight fitting shoes, walking and exercise program
Why is walking a part of Cardiac rehab?
because moderate exercise is good for the heart.
How will body compensate if has low blood pressure?
increasing blood pressure
What are diseases that cause ESRD?
When does dialysis occur?
- When GFR is <15.
- Renal Failure
What are the causes of urinary retention?
- pelvic injury
- neurological disorders
What is pt teaching regarding self cath?
What is nursing interventions for a pt with an indwelling catheter
How is hepatitis C transmitted?
Blood and semen
How does basal cell cancer develop?
extensive xposure to the sun
What is home tx for lice?
- Creams, shampoos,
What are some side effects of anti-inflammatory agents?
- kidney failure
- prolonged bleeding
What is pt teaching for antibiotics?
- take entire prescribed amount.
- watch for an alergic reaction if its pts first time taking it
What are some adverse reactions to Digoxin?
- ventricular arrhythmias
- digoxin toxicity
What is pt teaching for anticoagulants?
- avoid activities that could cause injury and bleeding
- soft toothbrush
- oral care
- correct labs to check for theraputic range
What are some s/e of propranolol hydrochoride?
- orthostatic hypotension
What is pt teaching for a pt taking alpha adrenergic blockers?
- Orthostatic hypotension, so get up slowly.
- headache, pounding heartbeat, nausea, weakness, weight gain and small decreases in low-density lipoprotein (LDL) cholesterol
What is the purpose of taking kayexalate?
if pt has a high potassium, kayexalate helps the body get rid of the excess K+
What is the lab to monitor when a pt is taking aldactone
Potassium and BUN and Creatnine