HPA 2 Exam 3 prep
Hyperlipidemia
*Abnormally high concentrations of fats in the blood
Andropause
*"A collection of symptoms, including fatigue and a decrease in libido, experienced by some middle-aged or older men and attributed to a gradual decline in testosterone levels" *NOT like menopause, not every man goes through a process *Decline in testosterone levels *Does not occur in all men *Slower process *Symptoms: reduced muscle mass, energy, strength, stamina *Erectile dysfunction, shrinkage of tests, breast enlargement, osteopenia
High-density lipoprotein (HDL)
*"Good" cholesterol *Protects coronary arteries from heart disease *Transports cholesterol from the body's cells to the liver *Females > 55mg/dL *Males > 45mg/dL
Low-Density Lipoprotein (LDL)
*"bad" cholesterol *Transports cholesterol to the body's cells from the liver *Blood levels should be less than 100mg/dL
Groups at High risk for STIs
*Abused Youths *Homeless Youths *Young men having sex with men *LGBT youths
Fracture Complications (Compartment Syndrome)
*An elevation in pressure of an anatomic compartment (36 and 46 in extremities) *Causes: Edema, Bleeding, Restrictive cast *Occurs within 6-8 hr after initial injury or after fracture repair *Legs swollen, tight, pale, and shiny *Swollen muscle compresses blood vessels and nerves in leg
Coronary artery disease diagnostics
*Assessment *CRP (inflammatory marker) *Lipid profile *Framingham risk calculator
Hyperlipidemia Complications
*Atherosclerosis *Coronary artery disease *Angina *myocardial Infarction (MI) (blockage) *sudden cardiac arrest (Electrical issue)
Signs and symptoms of Osteoporosis
*Back pain *Loss of height *Stooped posture (kyphosis) *Fracture
Bone homeostasis and terms
*Bone is living tissue *Osteoclasts: involved in breakdown and resorption of bone *Osteoblasts: involved in formation and mineralization of bone *Building blocks of bone: Calcium, Phosphate (parathyroid), Vitamin D (Sun/diet), Calcitonin (Thyroid)
The patient has another question for the nurse and asks, "What foods should I avoid since I now have osteoporosis?"
*Caffeine *Alcohol *Sugary carbonated beverages
Terms to know (Fractures)
*Cast: Apply Ice, Neurovascular Checks, No Pressure on area, Elevate, Check 6 P's, Check Pain levels, Check for dampness of cast *Closed reduction: procedure to set (reduce) a broken bone without cutting the skin open *Compartment syndrome: when the pressure within a compartment increases, restricting the blood flow to the area and potentially damaging the muscles and nearby nerves *External fixation: device may be used to keep fractured bones stabilized and in alignment. *Fracture: a break in a bone *Internal fixation: a surgical procedure that treats an unstable bone fracture by surgically implanting plates, screws, or pins to hold the bone fragments *Open reduction: realignment of a fractured bone after incision into the fracture site. *Osteomyelitis: inflammation of bone or bone marrow, usually due to infection *Paresthesia: an abnormal sensation, typically tingling or pricking ("pins and needles"), caused chiefly by pressure on or damage to peripheral nerves. *Traction: pulling on part of the body
Acute Lymphocytic Leukemia (ALL)
*Cells Affected: Lymphocyte *Age: <15 or >45 *Clinical: Nonspecific, usually detected, incidentally may see CNS involvement such asa headaches *Management: Achieve remission through corticosteroids, and alkaloids
Chronic Lymphocytic Leukemia (CLL)
*Cells Affected: Lymphocyte *Age: Older adults, veterans *Clinical: Usually asymptomatic, detected incidentally lymphadenopathy *Management: Watch and wait; chemo agents
Chronic Myeloid Leukemia (CML)
*Cells Affected: Myeloid HSC *Age: Any *Clinical: Chronic Phase: Few symptoms; Accelerated phase: blood counts worsen, fatigue, anemia, splenomegaly, dyspnea, bone pain; Blast crisis phase: AML symptoms *Management: Control disease; tyrosine kinase inhibitors (TKIs)
Acute Myeloid Leukemia (AML)
*Cells Affected: Myeloid HSC *Age: Any *Clinical: Pancytopenic symptoms; enlarged liver/spleen, hyperplasia of gums, bone pain *Management: Achieve Remission through induction (chemo) consolidation, and stem cell transplant
How does neutropenia happen?
*Chemo *Viral infection
Saturated Fats
*Contains more hydrogen *Most animal fats *Solid at room temperature *Raise serum cholesterol level
Normal Changes of Aging: Females
*Decreased estrogen effects include: thinning of vaginal walls, decreased or delayed lubrication, decreased fat "pad" over symphysis, labia become less full/atrophy -What might help? (Water-based lubricant, Alternative positions for intercourse) *Increased predisposition to UTI -What might help? (Cranberry extract, adequate fluid intake especially immediately before intercourse and empty bladder immediately after intercourse
Management of Osteoporosis
*Develop a plan of care for a patient newly diagnosed with osteoporosis *The plan of care will focus on the following -diet -exercise -medication -what not to do (Jarr, twist body, smoking, drinking, heavy lifting) -follow up care (Compliance, DEXA scans, med adherence
Preventing Osteoporosis
*Diet rich in calcium and Vitamin D *Sun exposure *Weight-bearing exercise
Complimentary Alternative Medicine Therapies (Menopause)
*Diet: Foods rich and estrogens (Apples, carrots, celery, nuts, wheat, whole grains) *Soy Products
Treatment for Hyperlipidemia
*Dietary modification *Weight loss *Cessation of smoking *Increased physical activity (increases HDL and decreases triglycerides *150 minutes per week of moderate activity *75 minutes of vigorous exercise per week *Muscle strengthening 2x per week *Be realistic with patient
Normal Changes of Aging: Males
*Difficulty in achieving erection *More direct stimulation of the penis is required to experience erection. Orgasms are fewer and sometimes subtler *Reduced Force and amount of ejaculation *The refractory period after ejaculation is increased *1 in 10 men is estimated to have ED at some point in his lifetime
Fracture causes
*Direct blows, crushing forces, sudden twisting & extreme muscle contractions *Pre-existing disease (Osteoporosis, Hypothyroidism, Untreated Hyperthyroidism) *What happens to adjacent structures when a bone is broke? (Inflammation, Swelling of soft tissues, Warmth, Bleeding - ecchymosis, Decreased distal pulse)
Current Thought on Hormone Replacement Therapy (HRT)
*Do not use for everyone *Casually monitored *Only really given to patients with severe s/s *Mammogram *Risk for DVT's
Menopause Nursing Education
*FSH is a good indicator and it will increase over time but typically not a lot of lab work is done.
Coronary artery disease non-modifiable risk factors
*Family history of CAD (first-degree relative with cardiovascular disease at 55 years. of age or younger for men and at 65 years of age or younger for women) *Increasing age (more than 45 years for men and more than 55 years for women) *Gender (Men develop CAD at an earlier age than women) *Race (Higher increase of heart disease in African Americans than in caucasians)
Cholesterol
*Fat-like substance *Not an essential nutrient because it is synthesized by the body *comes from dietary ingestion (animal products) *Lipid that is needed for hormone synthesis and cell membrane formation *Found in large quantities in the brain and nerve tissue *Synthesized in the liver
Factors Placing Teenagers at Risk for STIs
*Females' anatomy predisposing them to STIs (columnar epithelial cells sensitive to invasion) *Teenagers feelings of invincibility *Unprotected intercourse *partnerships of limited duration *Obstacles to using the health care system
Emergency Fracture Management
*First step: Immobilize the body part *Assess neurovascular status distal to the fracture -what would you assess and how? (Tingling, cap refill, pulses, movement) -What if the patient has an open fracture? Would emergency management be any different? (Cover it and stop the bleed. Immobilize, don't manipulate fracture
Considerations for Statins (Hyperlipidemia)
*Frequently given as initial therapy for significantly elevated cholesterol and LDL levels *Myalgia and arthralgia are common adverse effects *Myopathy and possible rhabdomyolysis are potential serious effects (CPK level) *Monitor liver function tests- contraindicated in live disease *Check for drug interactions *Indication for use now includes acute coronary syndrome (ACS) and stroke *Administer in evening
What interventions do we do for patients with anemia?
*Give iron *Give RBC *Rest
Statin Medications (Hyperlipidemia)
*HMG-CoA reductase inhibitors (statins) atorvastatin (lipitor) Simvastatin (Zocor) *Lowers total cholesterol *Lowers LDL *Raises HDL *Lowers Triglycerides *Inhibit enzyme involved in lipid synthesis (HMG-CoA) - favorable effects on vascular endothelium, including anti-inflammatory and antithrombotic effects
Arthritis and Sexual Health
*Have sex at whatever time of day is most comfortable *Plan a nap before sex *stay warm - use hot showers, electric blankets and heating pads *Take pain medication about a half hour before planning to have sex *Mutual message to warm-up/relax muscles/joints *Add extra pillows to support joints
Menopause: Medical Interventions
*Hormone Replacement Therapy (HRT) *Estrogen/Progestin if no hysterectomy *Estrogen only if hysterectomy *If using Estrogen patches - will still need progestin to oppose *Monitor for S/S of DVT, PE, SOB, annual mammogram *May have spotting with 25 day regimen *Estrogen cream, suppository, or estradiol rink (3 months) for vasomotor symptoms (hot flashes), Vaginal Dryness, or atrophy *Vaginal Lubricants: Water soluble lubricant (KY jelly) *Antidepressants: low dose venlafaxine (Effexor) may help with hot flashes. B6 and Vitamin E may be helpful
Menopause: Physical Symptoms
*Hot flashes *Fatigue *Vaginal Dryness, itchiness *Loss of subcutaneous fat in labia *Insomnia *Urinary tract changes (Due to decreased estrogen) *New onset of migraines *Symptoms of arthritis, fibromyalgia *Heart palpitations, atypical angina *Decreased metabolic rate, weight gain
Coronary artery disease modifiable risk factors
*Hyperlipidemia *Cigarette smoking, tobacco use *Hypertension *Diabetes *Metabolic syndrome *Obesity *Physical activity
Cancer and Sexual Health
*Individuals with a Penis -Erectile dysfunction (ED) occurs frequently with surgery for prostate cancer *Individuals with a vagina -Reproductive system cancers, difficulty adjusting to disease and treatment, changes affecting self image that impact sexuality *Debilitating effects of chemotherapy and radiation impact sexual desire along with fatigue
Diabetes and sexual Health
*Individuals with a penis -Erectile dysfunction is related to poor long-term blood sugar control --> damage to nerves and blood vessels *Individuals with a vagina -increased difficulty in experiencing orgasm, greater decrease in spontaneous lubrication than non-diabetic women of similar age
Heart Disease and Sexual Health
*Individuals with a vagina -Lack of sexual interest -Inability to relax during sexual activity -Arousal and orgasmic disorders general discomfort with sex *Individuals with a penis -Significant decline in sexual activity -Erectile dysfunction (ED) related to circulatory changes *Maintain general fitness through exercise (Typical energy expenditure for intercourse = climbing two flights of steps) *Avoid sexual activity inn hot or humid environment, emotionally stressful times or situations *Nitroglycerin before strenuous sexual activity if needed (if prescribed) *Consult primary care provider if chest pain during or after sexual activity, or breathlessness or heart palpitations more than 15 minutes after orgasm
Lipids (Fats)
*Insoluble in water *Insoluble in blood *95% of lipids in the diet are in the form of triglycerides *Triglycerides are the predominant form of fat in food and major storage for of fat in the body *9 calories per every gram (fat intake should be less than 10% of your total calories per day) *Improves taste of food *High satiety value *Delays gastric emptying time *Aids in the absorption of fat soluble vitamins *Provides insulation *Provides structure *Provides temperature control
External Fixation
*Keep the extremity in proper alignment and elevated to level of the heart *Frequent neurovascular checks (ever 2-4 hr) *Monitor for S/S of infection *Pain management *Care of pin insertion sites (Follow HCP orders) *Early mobility if no complications
How to lower cholesterol
*Limit cholesterol intake *eat less total fat (especially saturated and trans fat) *Eat more unsaturated fats *Increase fiber intake (Causes an increase in excretion of cholesterol)
Diagnostic Studies (Hyperlipidemia)
*Lipid Profile (all adults 20 years or older) *Blood specimen *Utilized to determine early detection of heart disease *Measures cholesterol, triglycerides, and lipoproteins (HDL) and (LDL) *12 hour fasting *Total cholesterol = HDL + LDL + 20% of triglyceride level
What is Osteoporosis?
*Loss of bone density *Bones become fragile and weak *How does it occur? -Bone resorption is greater than bone formation -Increased osteoclastic activity -Decreased osteoblastic activity *Chronic metabolic bone disorder resulting in low bone density *The rate of bone resorption is greater than the rate of bone formation *Result: fragile bone tissue *Patients are at risk for fractures
Osteopenia
*Low bone density (diagnosis: DXA score -1 to -2.5) *A precursor to osteoporosis *Nursing care: diet (Skim milk, dairy products, orange juice fortified with calcium, streamed broccoli, salmon with bones), exercise (Walking/weights), Lifestyle changes (Alcohol less than 3 times a day, stop smoking, caffeine/ sugar reduction, less carbonated beverages)
What are signs and symptoms of thrombocytopenia?
*Low platelets (normal range 150,000-400,000) *Bleeding in gums/GI tract *Bruising (Ecchymosis) *Purapura (dots on body, red/purple) *Bone marrow depression *Meds (Heparin) *Post - chemo
Hyperlipidemia Dietary management
*Low saturated fat and high fiber diet *Fruits and vegetables *whole grains *Beans and legumes *Nuts and seeds *fish (preferably oily fish with omega-3 fatty acids) *Skinless poultry and lean animal proteins *Plant-based proteins
Trans Fats
*Manufacturers partially hydrogenate liquid oils (they become more stable and solid) *Trans fat (raises serum cholesterol) *Count trans fats in with your daily total fat *Trans fats must be on labels (FDA requirement) *Limit as much as possible
Menopause: Emotional Symptoms
*Moodiness *Depression *Memory problems *Fuzzy thinking *Lack of concentration *Greater impatience *Anxiety, restlessness
What is Leukemia?
*Neoplastic Proliferation of a particular cell type *Leads to overcrowding in the bone marrow -Results in impaired hematopoietic cell function -Can affect other organs like skin, spleen, lymph nodes
How do we teach our patients to be safe when they are neutropenic/receiving treatment for leukemia?
*No flowers *No Fresh fruit/flowers *Monitor Temp (NOT RECTAL) *Wash hands *Distance (Avoid crowds) *Nurse wears surgical mask *Patient wears surgical mask when leaving room
Compartment Syndrome Treatment
*Notify the surgeon immediately -Delay may result in permanent nerve and muscle damage, necrosis, infection, rhabdomyolysis with AKI, and amputation *Conservative Measures -Relieve pressure by splitting the cast or unwrapping the compression bandage *Fasciotomy- surgical decompression with excision of the fascia -Wound is not sutured to allow for muscle expansion -Moist sterile saline dressings or vacuum dressing -After decreased swelling and improved perfusion, wound debrided and closed (possible skin grafts)
Osteomyelitis
*Nursing management -Pain management -Elevate the extremity -Frequent neurovascular checks -frequent monitoring of temp and s/s of infection (check WBC) *Complications -Gangrene -Amputation *Treatment -Supportive measures -Immobilization -Longterm antibiotic therapy -Debridement -Bone grafting
Complications of a Fracture (Fat embolism)
*Occur after an orthopedic trauma, especially a long bone, such as the femur. • Mechanism: fat globules move from the bone marrow into the vascular space (blood vessels) • This becomes a fat emboli (emboli travel through the blood system and occlude end organ perfusion). • ONSET: Rapid - 12 to 72 hours after injury • Classic triad of clinical manifestations: (Hypoxemia, Neurologic compromise, petechial rash
Fat Digestion
*Occurs mostly in the small intestine *Bile emulsifies fat *Pancreatic lipase breaks down fat *Most fats are absorbed into the lymphatic tissue and transported to the liver *If 100g of fat (900 cal) is consumed, only 3g (27 cal) are excreted in the feces
Types of Fractures
*Open Fracture - Compound fracture (Involves skin/mucus membranes) *Closed fracture -Simple Fracture (Does not cause break in skin) *Compression Fracture (Bone is compressed) *Comminuted Fracture (Bone splinters into several fragments
Neurovascular Check (The 6 P's)
*Pain (Compartment syndrome, patient would have increased pain) *Poikolothermia (Ambient temp - assumes temp of its surroundings) *Pallor (Pale) *Pulselessness (If you can't find a pulse check cap refill) *Parestesia (Numb/tingling) *Paralysis
Fracture Clinical manifestations
*Pain (Continuous + Worsens with time, muscle spasms) *Loss of function (d/t effect on muscles attacked to fractured bone) *Deformity (Compared to other extremity) *Shortening (d/t compression of fractured bone) *Crepitus (Crumbling sensation of feet or hands, Rubbing of bone fragments together) *Localized edema and ecchymosis (Result of trauma/bleeding into the tissues)
Erectile Dysfunction medical treatments
*Penile injection (Alprostadil, papaverine, phentolamine) Injection 20 minutes before intercourse *Penile Suppository (Alprostadil) inserted 10 minutes before intercourse *Penile Implant *Penile vacuum pump
Menopause
*Permanent cessation of menses for at least one year *Occurs between age 40-55; most often at age 47-51 *"Marks the entry into a new season of life, characterized by wisdom and satisfaction"
PLISSIT Model (Sexuality OA)
*Permission (Nursing) -2 Components: Asking permission of the individual to talk about sexual activity, reassurance that their thoughts/concerns are normal *Limited Information (nursing) -basic information of anatomy and physiology *Specific Suggestions (Nursing) - *Intensive Therapy -referral
What are nursing interventions for thrombocytopenia?
*Platelet infusion only typically seen with active bleeding / extremely low platelet count *Environmental surveillance (fall risk) *soft tooth brush *soft diet *keep fluid intake up to avoid constipation/straining *stool softeners *Electric razor *Avoid unnecessary sticks such as IM injections *monitor temp (NOT RECTAL) *give nail file *Moisturize *Hold pressure on IVs / after accu checks
Leukemia Nursing Interventions
*Prevent or manage infection/bleeding (Wash hands, wear mask, avoid crowds, no flowers, soft toothbrush, avoid rectal temps, no IM injections) *Manage mucositis *Improving nutritional intake (High Calorie) *Ease pain and discomfort *Decrease fatigue and activity intolerance *Maintaining fluid/electrolyte imbalance *Improving self-care: Bathing, dressing, toileting *Managing anxiety and grief.
Erectile dysfunction
*Psychogenic causes: Anxiety, depression, anxiety, negative body image, absence of desire *Organic causes: cardiac, renal, DM neurologic disorders, alcohol *Medications: SSRI, Antihypertensives (Beta blockers, methyldopa, ACE inhibitors, Diuretics, Calcium Channel Blockers), Antihistamines, Sedatives/hypnotics/opioids, NSAIDS, Histamine-2 antagonists, nicotine
Traction
*Purpose: Application of a pulling force to a part of the body to aid in bone realignment *Types are skin Traction and skeletal traction Management *Proper positioning, keep extremity in neutral position *Prevent Skin Breakdown *Neurovascular checks - initially Q1 and then Q4 *At risk for pressure injury and DVT
A nurse is speaking with a patient who is newly diagnosed with osteoporosis. The patient asks the nurse "can you give me an example of some foods that I could eat at dinner time?" The nurse responds by saying
*Salmon with bones *Steamed Broccoli *Whole Grain *Cereal with Milk *Other Diary Products
sexual intamacy
*Sexual intimacy is the interpersonal relationship between people who may or may not be engaging in sexual activity, placing an emphasis on the emotional experience and feeling of closeness *Works well with life span as many may choose more passive forms of sexual expression - touching *Higher quality of life - increased mood and function
The patient would like to resume working out at the gym and asks the nurse "what exercises should I do at the gym to help with my osteoporosis?" "Also, are there any exercises I should avoid?"
*Suggested Exercises -Light weight lifting -Walking *Avoid these exercises -Sudden twisting -Heavy weight lifting
DXA Scan (Osteoporosis)
*T-score of -1.0 or above is normal bone density (Example +5 or 0) *T-score between -1.0 and -2.5 is low bone density or osteopenia (Example -1.6 or -2.4) *T-score of -2.5 or lower is osteoporosis (Example -2.7 or -3.2) *Recommended for age 65, 50 and up post menopausal with risk factors, any age with risk factors *FRAX analysis indicates 10 year fracture risk
Open Fracture Complications (Osteomyelitis)
*Treatment: Wound irrigation and debridement during the surgical procedure, Wound culture and antibiotics *Nurse should assess for Swelling, Purulent drainage, pain, and if the extremity is hot
Unsaturated Fats
*Vegetable fats *Remain liquid at room temperature *referred to as oils *Lower serum cholesterol level
Mucositis
*White patches *Ulcers *Redness *Pain control: Suck on ice chips or ice pops, use medicine advised by your doctor *Dietary modifications: Eat moist, soft foods. Avoid foods that require a lot of chewing. Avoid acidic, spicy, salty, and hot foods *Oral Care: Rinse mouth 5-6 times each day with a soft toothbrush *Patient will be on nystatin (Swish swallow) coats ulcers
What are signs/symptoms of anemia?
*fatigue *Pale *SOB w/ movement *Cold *Dark under eyes
Framingham risk calculator
*tool used to estimate the risk of a cardiac event within 10 years *Age 20 and above, gender, total cholesterol, HDL cholesterol, smoking, diabetes, systolic b/p and need for antihypertensive
Diagnosis for Leukemia
1) CBC 2) Bone Marrow Biopsy
Drugs for treatment of penile erectile dysfunction
Adverse Effects: *Edema, Headache, dizziness, syncope, angina, dyspnea Drug-to-Drug Interactions: *PDE5 inhibitors combined with organic nitrates or alpha blocker can cause (Hypotension, and dangerous cardiovascular effects including death Careful Patient teaching: *Food Interactions -no grapefruit juice -avoid high fat foods
A nurse is admitting a patient who has osteoporosis. Which of the following are expected findings? (SATA) A. A history of consuming one glass of wine daily B. Loss of height of 2 inches (5.1cm) C. Body mass index (BMI) of 21 D. Kyphotic curve at upper thoracic spine E. History of lactose intolerance
B. Loss of height of 2 inches (5.1cm) D. Kyphotic curve at upper thoracic spine
What are the signs & symptoms of a patient who has a fat emboli? (Select all that apply) A. fever of 102⁰ or higher B. hypoxemia C. bradycardia D. substernal chest pain E. clear breath sounds F. dyspnea
B. hypoxemia D. substernal chest pain F. dyspnea
Pharmacological Agents for Treatment of Osteoporosis
Bisphosphonates • Alendronate (Fosamax)- oral • Limit use to 3 to 5 years. • Patient Education -Take immediately after getting up in the morning before eating -Sit upright for 30 minutes after taking alendronate -Wait at least 30 minutes before eating anything -Calcium or iron supplements, coffee, tea, antacids, mineral water and calcium enriched juices must be taken 2 hours after taking this medication
•Chart 42-2**** •A 72-year-old patient is admitted to the Emergency Department with a fractured left hip. The patient has a history of osteoporosis, COPD rheumatoid arthritis, and smoking. This patient does not exercise due to pain from rheumatoid arthritis. •Which factors inhibit the healing of a fracture for this patient?
Co-morbidities
Fracture Care (Fracture Reduction)
Surgical Intervention *Open Reduction (Surgical procedure, the bone ends are anatomically aligned) *Internal Fixation (Screws, pins, rods, wires, nails and or plates) hospital stays usually shorter *External Fixation: External metal frame attached to bone fragments to stabilize them Non-surgical intervention *Closed Reduction (Bring bone ends into alignment through manipulation and or manual traction) *Cast (Rigid external immobilizing device that is molded to the contours of the body *Splint (Used in the acute care setting such as the ED, and for a fracture that will eventually require casting
Barriers: Families and Providers (Sexuality OA)
Family Members: *Fear sex is unsafe for their loved one, that their parent is not interested and is being "preyed" upon, hostile to a new partner entering the family circle Providers: *Subject to myths and attitudes of sexuality and aging *May be insensitive to older adults needs *Don't know how to manage sexual health issues *Experience discomfort in managing sexual issues Individuals *Deficient Knowledge -need for/methods of safer sex -Alternative Sexual acts and positions to accommodate health needs *Hesitation to discuss/discomfort with sexual health issues *Past poor/unhappy/difficult experiences *Lack of opportunity (Men/women ratio) *Cultural attitudes/beliefs about sexual practices Institutional Settings *Discomfort with intimacy among older adults *Fail to recognize the benefits *Fail to recognize their rights as adults *Resistance to accommodating needs that require change *Complexities of identifying competence to make decisions about sexual activity
Lipid Profile
Lipids *Cholesterol (total) - less than 200mg/dL *Low-density lipoprotein (LDL) - less than 100mg/dL *High-density lipoprotein (HDL) - 45mg/dL or higher for males; 55mg/dL or higher for females *Triglycerides - less than 150mg/dL Purpose *Screening for heart disease *Evaluates the patient's risk for heart disease *"bad" cholesterol - transports cholesterol to the body's cells *"good" cholesterol - protects coronary arteries by transporting cholesterol from the body's cells to the liver
Vaginitis: Vulvovaginal Candidiasis
Not Sexually Transmitted (Can put person at risk for STI predisposing factors *Pregnancy *Use of oral contraceptives with high estrogen content *Use of broad-spectrum antibiotics *Diabetes Mellitus *Use of steroid and immunosuppressive drugs *HIV infection *Wearing tight, restrictive clothes and nylon underpants *Trauma to vaginal mucosa from chemical irritants, douching Presentation: *Pruritus *Vaginal discharge (thick, white, curd-like) *Vaginal soreness *Vulvar burning *Erythema in the vulvovaginal area *Dyspareunia (pain during sex) *External dysuria Diagnosis: White plaques on vaginal walls, Vaginal pH in normal range. Wet Smear: Hyphae and spores characteristic of fungus. Nursing Management: (Teaching Preventative Measures) *Cotton underwear *Avoidance of irritants, douching *Good body hygiene *Avoidance of douching or super-absorbent tampons *Shower *Reduce dietary intake of soda and sugars *In DM -keep glucose level under tight control Medications: *Use Antifungals
Risk Factors for osteoporosis
Primary osteoporosis *Female Gender (from the book) *Family History *White and asian women *Thin, small bone frame *Age greater than 60 years *History of low calcium and/or vitamin D intake *history of GI bypass surgery *Low estrogen levels *Alcohol Intake *Smoking Secondary Osteoporosis (More common in men) *Hyperparathyroidism *Hyperthyroidism *Diabetes mellitus *Rheumatoid arthritis *COPD *Asthma *Prolonged medication use -Loop diuretics, corticosteroids, thyroid medications, anticonvulsants (Literally like always its everything you could possibly think of)
Leukemia Pharmacological and Medical management
Tyrosine Kinase Inhibitors (TKI)** *CML, ALL, certain CLL *Block signals within the leukemic cells that express the BCR-ABL protein - stops abnormal cells from growing and dividing *SA: fatigue, weakness, pruritus, headache, skin rash, oropharyngeal pain *Monitor for EKG changes, and myelosupprerssion Hematopoietic Stem Cell Transplant (HSCT) - also called bone marrow transplant *1) Autologous: Give own stem cells *2) Alogenic: Donated stem cells
The patient returns from surgery with the completion of the following procedure: open reduction and fixation (external fixation) of the open fracture of the right tibia. During surgery, the wound was irrigated with normal saline and antibiotic beads were placed in the open wound. A sterile dressing was applied to the lower right extremity wound.
What are the nursing interventions that are most important? (Pin care to prevent infection, Neurovascular checks Q1)
The patient is post-operative after 18 hours of having an open reduction and external fixation procedure of the right tibia. The patient has a splint on the right lower extremity. Upon assessment, the nurse identifies the following: • Right foot edema and pale in color • Right foot is cool to touch with no palpable pulse • The patient reports deep throbbing pain 8/10 on the right leg and burning/tingling feeling of right toes • BP 102/60, Pulse 128, RR 24 and O2 Saturation 93%, Temperature 100.1 (F) • Pt awake, anxious, following commands. Lungs clear. Abdomen soft with +BS. Patient has been voiding clear yellow urine.Which findings would you immediately *report to the orthopedic surgeon?
Which findings would you immediately report to the orthopedic surgeon? (Highlighted)
Which is the most common type of leukemia? a. AML b. CML c. ALL d. CLL
a. AML
A nurse is planning to teach a group in the community center about the prevention and risks of osteoporosis. Which statement by the nurse would be important to include in the teaching plan? a. Everyone, especially those at risk, should include adequate calcium in their diets. b. Genetics has no role in development of osteoporosis. c. Prevention of osteoporosis begins at age 65 years old. d. People who are less active are at less risk for fractures from osteoporosis
a. Everyone, especially those at risk, should include adequate calcium in their diets.
A patient is newly diagnosed with osteopenia and asks the nurse "what lifestyle changes should I expect?" The nurse responds by saying: a. you will need to incorporate less exercise and more rest into your routine b. It is recommended that you incorporate low-weight-bearing exercises into your exercise routine c. You need to incorporate more phosphorous-based foods into your diet d. t is suggested that you have a DXA scan every six months
b. It is recommended that you incorporate low-weight-bearing exercises into your exercise routine
A 12-year-old child arrives to their PCP for an annual physical and the parent requests blood work to assess titer levels for several vaccines that are required for school. The provided also orders a routine CBC and BMP. When the results come in, the child has a WBC count of 80,000. What type of leukemia does the RN suspect? a. AML b. CML c. ALL d. CLL
c. ALL (Most common in children)
A 74-year-old patient arrives to the clinic. In the history, you see the patient was a Vietnam War veteran. What question would you want to include in your assessment? a. How long were you there? b. How is your PTSD being managed? c. Are you aware of any exposure to agent orange? d. How many tours did you complete?
c. Are you aware of any exposure to agent orange?
A nurse is reviewing the DXA scan results for a patient and identifies a T-score measure of -3.0 The nurse understands that this measure means a. The patient has normal bone density b. The patient has low bone density (Osteopenia) c. The patient has very low bone density (Osteoporosis) d. The patient has a fracture
c. The patient has very low bone density (Osteoporosis)
Your patient is admitted with acute myeloid leukemia. Their neutrophil count is zero. What precautions should your patient be on? a. Standard b. Contact c. Airborne d. Neutropenic
d. Neutropenic
What is not a cause of leukemia? a. smoking b. chemical exposure c. chemotherapy d. coronary artery disease
d. coronary artery disease
What is neutropenia?
low neutrophil count, a type of WBC
A 45-year-old patient is in a motor vehicle accident. The patient arrives to the emergency department with a fractured right tibia with bone protruding through the skin. The right leg is bleeding at the site of the fracture. The patient reports pain 9/10.
• What are some important concerns you are thinking about? (Infection & Neurovascular status) • What are some priority interventions you will implement? (Cover with sterile gauze, Immobilize, Stop Bleed) • What would you NOT do? (Reset bone)
