Chapter 4 Med/Surg
Which patient statement indicates the need for additional teaching for a patient with rheumatoid arthritis who is taking meloxicam (Mobic)?
"I take aspirin at least 2 hours away from my Mobic."
Medical management for osteoporosis
- Aimed at promoting the increase of bone density, and prevent bone loss - Supplements: • Calcium- men (1000 mg) • Calcium- women (1500 mg) • Vitamin D needed for proper absorption of calcium • Vitamin K is important to bone health (green leafy vegetables) - Weight Bearing Exercises: • Walking 30 minutes 3x per week (forces calcium back into bones) • Walking down stairs is extremely helpful - Poss. estrogen Therapy (won't correct the problem but will help prevent fx) - Bisphosphonates: • alendronate (Fosamax) every week • risedronate (Actonel) every week - Ibandromate (Boniva) every month - zoledronic (Zometa) every year *****CAUSE HEARTBURN! Sit up for 30 min, give 1st dose in AM with H2O, and then 30 min before other meds/food*********
Medical management for gout
- Anti- Gout Colchicine usually po (acute cases) -usually better in 12 hours -side effects: blood dyscasia Allopurinal (Zyloprim)- po (chronic cases, decreases the production of uric acid) -prevents attacks buy initially may be worse Aspirin and corticosteroids
a nurse is teaching a client about methotrexate therapy for rheumatoid arthritis. which of the following information should the nurse include?
-avoid being near people who are sick with a communicable illness. -periodic laboratory tests are required. -report bruising or petechiae -avoid drinking alcohol
a nurse is teaching a client who has a prescription for prednisone and takes 1,500 mg/day of calcium carbonate to reduce the risk of osteoporosis. which of the following information should the nurse inculde?
-drink 240ml of water with the calcium tablets -chew calcium tablets before swallowing them -take the drugs 1 hour apart -divide the daily dosage of calcium into three 500-mg doses
a nurse is teaching a client about raloxifene. which of the following information should the nurse include?
-increase physical activity by taking walks -use a contraceptive if there is any possibility of pregnancy -increase intake of calcium and vitamin D
a nurse should instruct a client who is taking alendronate to monitor for which of the following adverse effects?
-jaw pain -blurred vision -muscle pain
A nurse is talking with a client who is postmenopausal about reducing her risk for osteoporosis. Which of the following recommendations for daily calcium intake should the nurse reinforce with the client?
1,500 mg/day 1,500 mg/day Postmenopausal woman 1500mg/day
When instructing a client about alendronate (Fosamax), which of the following information should the health care provider include?
1. Take the drug on an empty stomach 2. Sit upright for 30 min following dosage 3. Take with a full glass of water
calcium supplements medical management
1200mg for men and women 1500mg for women over 50 and in menopause or post menopausal
traction splint
A splint that holds a lower extremity fracture in alignment by applying a constant, steady pull on the extremity. *always assess pin sites as indicated*
bone cancer
Any malignancy of bone tissue. Can be primary or secondary Manifestations: spontaneous fractures, anemia, pain
Is Rheumatoid Arthritis a progressive disease or an autoimmune disease?
Autoimmune
bone healing process
Bleeding at the site a clot forms at the ends of the fractured bone Hematoma becomes organized and fibrin network is created OsteoBLASTS enter fibrous areas A callus forms Collagen strengthens, Calcium decreases Remodeling occurs
Certain foods may increase the pain associated with gout. Which foods have the highest concentration of purines?
Brain, liver, kidney "Rich mans diet"
Your patient who is diagnosed with RA, just began receiving the medication DMARDS (Disease Modifying Anti-Rheumatoid Drugs). You educate them that these medications could re-trigger old infections. All of the following infections can be re-triggered except:
Cholelithiasis
Goal of drug therapy for Rheumatoid Arthritis
Decrease joint pain and inflammation
Goal of drug therapy for Osteoporosis
Decrease the potential for fractures
You have an elderly patient that is receiving NSAID therapy. You educate her of a potentially dangerous side effect:
GI Bleed
Serious adverse reactions to Etranercept
Heart failure! Manifesting as shortness of breath, cough, elevated BP and heart rate, and pink-tinged sputum
Which of the following are side effects of long-term use of corticosteroids?
Hypertension, Diabetes, Immunosupression
a nurse is teaching a client about adverse effects of etanercept. which of the following statements by the client indicates understanding of the teaching?
I will need to get my blood drawn periodically while on this medication.
a nurse is teaching a client about methotrexate therapy for rheumatoid arthritis. which of the following statements by the client indicates understanding of the teaching?
I will take my birth control pills everyday
a nurse is caring for a client who has a prescription for methotrexate. which of the following drugs would likely be prescribed in conjunction during the initial treatment for rheumatoid arthritis?
Ibuprofen
Which foods should the home health nurse suggest for the patient with osteoporosis to help slow the disease?
Leafy green vegetables
3 main type of drugs to treat rheumatoid arthritis
Non steroidal Anti-Inflammatory Drugs (NSAIDS) Glucocoricoids Disease-modifying antirheumatic drugs (DMARDS)
A nurse is reinforcing discharge teaching with a client who has osteoarthritis. Which of the following statements by the client indicates an understanding of the teaching?
Osteoarthritis occurs due to the aging process and results in disintegration of cartilage in a joint
How is rheumatoid arthritis distinguished from osteoarthritis?
Rheumatoid arthritis is an autoimmune, systemic disease; osteoarthritis is a degenerative disease of the joints.
4 main types of drugs to prevent or treat osteoporosis
Selective Estrogen Receptor Modulators (SERMs) Biophosphonates Calcitonin Calcium Supplements
Why should clients take a calcium supplement one hour before one one to two hours after they take a glucocorticoid?
The glucocorticoid can reduce the absorption of calcium
A client has a prescription for calcitonin-salmon and the nurse is teaching the client about manifestations. What should she include in the teaching?
The nurse should teach the client that rebound hypercalcemia can occur when taking this drug. Manifestations of hypercalemia include nausea, vomiting, flank pain, lethargy, and deep bone pain.
Knee Arthroscopy
Total Knee Replacement indications include meniscus tears, ACL tears, loose bodies *DO NOT CROSS LEGS*
Is osteoporosis more common in men or women?
Women due to menopause
traumatic injury
a disease process that results from injury that causes tissue damage -Contusion (Bruise) - Sprains (ligaments) -whiplash - Strains (tendons) -Dislocation Assessment: Edema, discoloration, disfigurement, pain
Neurotransmitter for skeletal muscles
aceylcholine
a nurse is caring for a client who has a new prescription for etanercept. which of the following actions should the nurse take?
administer a Tuberculin skin test prior to starting the medication.
a nurse is teaching a client about methotrexate. the nurse should inform the client to monitor for which of the following as an adverse effect of this drug?
black, tarry stools
a nurse is planning care for a client who has a new prescription of methotrexate. the nurse should plan to monitor the client for which of the following adverse effects?
bone marrow depression
a nurse is teaching client about raloxifene therapy to prevent osteoporosis. the nurse should instruct the client to monitor for which of the following indications of an adverse reaction to this drug?
calf pain
Neurotransmitter for the muscular system (breaks downs so the muscle can relax)
cholinesterae
a nurse is caring for a client who is taking alendronate to treat postmenopausal osteoporosis. the nurse should explain to the client that alendronate increases bone mass by which of the following actions?
decreases activity of osteoCLASTS
a nurse is teaching about self-administering methotrexate to a client who has rheumatoid arthritis. which of the following statements should the nurse make?
drink 2-3 liters of water per day to promote the drug's excretion.
alendronate is contraindicated for administration to clients who have which of the following conditions?
inability to sit upright
a nurse is caring for a client who has a prescription for etanecept. the nurse should identify that etanercept treats rheumatoid arthritis by which of the following actions?
inactivation of tumor necrosis factor.
a nurse should identify that. a client who has diabetes mellitus and is taking etanercept is at an increased risk for which of the following adverse effects?
infection
gouty arthritis (gout)
inflammation and painful swelling of joints caused by excessive uric acid in the body
a nurse is preparing to administer alendronate to a client who has osteoporosis. the nurse should recognize which of the following as an adverse effect of alendronate?
joint pain
Medications for Rheumatoid Arthritis
meloxicam (Mobic) -anti-inflammatory, analgesic -AVOID ASPIRIN napraxen (Naprosyn) -anti-infalammatory, analgesic -side effects are similar to ibuprofen methorexate (Rheumatrex) -reduces symptoms, alters the way fokic acid is used etanercept (Enbrel) -blocks normal immune response
which of the following is a therapeutic action of raloxifene?
mimics the effects of estrogen on bone tissue.
phantom pain
pain or discomfort felt in an amputated limb
The nurse explains to a patient who has had a knee replacement that warfarin (Coumadin) is ordered to:
prevent formation of emboli.
a nurse is teaching a client about calcitonin-salmon intranasal spray to treat osteoporosis. which of the following information should the nurse include?
report rash or itching prime the pump before the first dose report nasal irritation
a nurse is teaching a client who is taking etanercept for rheumatoid arthritis. the nurse should instruct the client to monitor which of the following indications of an adverse reaction to this drug?
skin rash
a nurse is caring for a client who is currently taking methotrexate for rheumatoid arthritis. the nurse should identify that which of the following is an adverse effect of this medication?
thrombocytopenia
hip arthroplasty
total hip replacement - raised seat to prevent hip dislocation and reduce hip flexion - keep hip angle < 90
a nurse is caring for a client who was diagnosed with postmenopausal osteoporosis. which of the following actions should the nurse take prior to administering calcitonin-salmon to the client for the first time?
use skin testing to check the client for allergies.
Complications of fractures
• Acute compartment syndrome • Crush syndrome • Hemorrhage and hypovolemic shock • Fat embolism syndrome • Venous thromboembolism • Infection • Chronic complications, such as ischemic necrosis, delayed union, and complex regional pain syndrome (CRPS)
