AHII - Exam 5
Which laboratory values would the nurse expect to find for Merlin? Select all that apply. A.Elevated serum cortisol level B.Decreased serum sodium level C.Elevated serum glucose level D.Decreased lymphocyte level E.Increased serum calcium level F.Decreased urine androgen level
A, C, D
The nurse is caring for a client with hyperaldosteronism who is not a candidate for adrenalectomy surgery. Which interventions would the nurse expect the HCP to prescribe? Select all that apply. A. Administer oral spironolactone. B. Monitor for and report dry mouth C. Avoid or limit potassium-rich foods. D. Glucocorticoid replacement therapy. E. Instruct client to report gynecomastia
A. Administer oral spironolactone. B. Monitor for and report dry mouth E. Instruct client to report gynecomastia Rationale• When surgery for hyperaldosteronism(adrenalectomy) cannot be performed,spironolactone (a potassium-sparing diuretic)therapy is continued to control hypokalemia andhypertension. Hyponatremia can occur withspironolactone therapy, and the nurse shouldmonitor for and report manifestations such as drymouth, thirst, lethargy, and drowsiness. Headachesare a common manifestation of hyperaldosteronism,so acetaminophen may be prescribed as atreatment. Side effects of spironolactone should alsobe taught to the patient. Examples includegynecomastia and erectile dysfunction, as well asdiarrhea, hives, hirsutism, and amenorrhea
Damian develops diaphoresis, an increased heart rate (124beats/min), and tremors. He also reports an increasing headache. Which action should the nurse take first? A. Check the fingerstick blood glucose level. B. Check the serum potassium level. C. Place the client on a cardiac monitor. D. Decrease IV fluids to 100 ml/hour.
A. Check the fingerstick blood glucose level. Rationale: The manifestations the client hasdeveloped are classic signs ofhypoglycemia, a complication ofadrenal gland hypofunction(Addison's disease). The nurse shouldcheck the client's glucose level first.If it is low, the client should receivesome form of glucose, most likelydextrose 50% IV.
The endocrinologist recommends to Jane to have an elective total thyroidectomy. Janeagreed to the treatment plan shared by her healthcare provider. Jane is scheduled tohave surgery tomorrow. Which of the following nursing interventions should be done before the surgery (pre-op)? Select All That Apply A. Check the surgical incision dressing. B. Teach how to support the head and neck. C. Administer SSKI or Lugols' solution via straw. D. Watch for clinical manifestations of hypocalcemia.
A. Check the surgical incision dressing. B. Teach how to support the head and neck. C. Administer SSKI or Lugols' solution via straw. D. Watch for clinical manifestations of hypocalcemia. Answer is B and C Let's Review the clinical manifestations of HYPOCALCEMIA and TREATMENT*What is the complication of Hyperthyroidism? Treatment?
Which laboratory values would the nurse expect to find for Merlin? Select all that apply. A. Elevated serum cortisol level B. Decreased serum sodium level - for Addison's C. Elevated serum glucose level D. Decreased lymphocyte level E. Increased serum calcium level - for Hypothyroidism F. Decreased urine androgen level - for Addison's
A. Elevated serum cortisol level C. Elevated serum glucose level D. Decreased lymphocyte level Rationale• A client with Cushing disease(hypercortisolism) would have lab values that include increased serum, salivary, and urinary cortisol levels. Other lab value expectations include increased blood glucose level, decreased lymphocyte count, increased serum sodium, and decreased serum calcium. In a 24-hour urine collection, there would also be increased levels of cortisol and androgens.
Damian is nauseous and vomited 560 ml of greenish fluid and undigested food from breakfast. The laboratory values from ER are located below. Based on the results, which of the following interventions should the nurse do? (Select 3 That Apply) Aldosterone level 3 ng/dL (low) (0.083 nmol/L) Cortisol level 2 mcg/dL (low) (55.18nmol/L) Potassium level 5.2 mEq/L (5.2 mmol/L) Sodium level 136 mEq/L (136 mmol/L) A. Hormone replacement with hydrocortisone B. Administration of potassium-sparing diuretics C. Hypoglycemia management with IV glucose D. Subcutaneous insulin before meals and at bedtime
A. Hormone replacement with hydrocortisone C. Hypoglycemia management with IV glucose
Jane was discharged after 48 hours of elective total thyroidectomy. Jane noticed that for the past 3-4 weeks, she had been gaining weight and felt sluggish/fatigued. She always complains that her room is so cold. In addition, she felt some involuntary tremors and facial twitches sometimes. Which of the following complications does Jane is currently experiencing? Select All That Apply.• A. Hypocalcemia• B. Hyperthyroidism• C. Hypothyroidism• D. Addison's disease
A. Hypocalcemia• B. Hyperthyroidism• C. Hypothyroidism• D. Addison's disease Answer is A and C * Can Jane still adhere to the treatment plan set prior surgery? What is the DTRs of a client that has hypo vs hypercalcemia?
Jane has a family history of "thyroid problems" and is being seen by the primary healthcare provider for unintentional weight loss, irritability, and chest discomfort. Her probable diagnosis is Graves' Disease. Which serum laboratory test results support this client's probable diagnosis? Select all that apply. A. Increased calcium B. Increased total thyroxine C. Increased parathyroid hormone D. Increased thyroid-stimulating hormone
A. Increased calcium B. Increased total thyroxine (T4) C. Increased parathyroid hormone D. Decreased thyroid-stimulating hormone (TSH) *LET'S REVIEW THE CLINICAL MANIFESTATIONS OF HYPERTHYROIDISM and DIET Therapy
Jane was prescribed different medications to manage her Graves' Disease. Which of the following should the nurse question? A. Propylthiouracil B. Methimazole C. Propranolol D. Levothyroxine
A. Propylthiouracil- Anti-thyroid B. Methimazole- Anti-thyroid C. Propranolol- Beta-blocker D. Levothyroxine- Thyroid hormone replacement for HYPOTHYROIDISM Answer is D.
The RN is supervising a nursing student who will assess MerlinWhich findings will the RN teach the student nurse to expect in aclient with Cushing disease? Select all that apply. A. Truncal obesity B. Weight loss C. Bruising D. Hypertension E. Thickened skin F. Dependent edema
A. Truncal obesity C. Bruising D. Hypertension F. Dependent edema Rationale • A client with Cushing disease typically has paper like thin skin and weight gain as a result of an increase in total body fat caused by slow turnover of plasma fatty acids. Weight loss is to be expected in a client with hypocortisolism (e.g., Addison disease). The other findings are typical of a client with Cushing disease.
Patient priority after surgery?
Airway
Exam 5: 15 Which of the following non-pharmacological interventions are appropriate for managing fibromyalgia symptoms in Elizabeth's case? (Select all that apply.) Application of hot packs to painful areas. Regular aerobic exercise. Limiting water intake. Consuming caffeine-rich beverages. Cognitive-behavioral therapy (CBT) for disease management.
Application of hot packs to painful areas. Cognitive-behavioral therapy (CBT) for disease management. Feedback Based on answering incorrectly Regular aerobic exercise, such as brisk walking or swimming: Regular exercise can help improve muscle strength, reduce pain, and enhance sleep quality in fibromyalgia patients. It is an essential component of non-pharmacological management. Cognitive-behavioral therapy (CBT) for pain management: CBT can help patients develop coping strategies and manage the psychological impact of fibromyalgia. It can be effective in reducing pain and improving overall well-being. Application of hot packs to painful areas: Heat therapy can provide relief from muscle pain and stiffness in fibromyalgia. It can help relax muscles and ease discomfort.
Stages of Gout
Asymptomatic Hyperurecemia (>6.8 mg/dL) - 1st thing that happens acid crystals form in big toe, called cadabra?? must change diet to prevent Acute Gouty Arthritis: big toe, spontaneously subsides in 3-10 days Intercritical Stage: follows acue attack, symptom free period Chronic Tophaceous Gout: client didn't stop/not working, Uris acid crystals still there (keep it this simple) 1. extensive tophaceous formation 2. tophi in various body parts 3. joint enlargement, loss of motion 4. uric acid deposits cause renal issues
Define intelligible
Avoid Sunlight recent surgery is important becuz it causes stress on the body, considered environmental becuz environment changed with doctors, white coats, etc. cigarette smoking stresses body, clogs arteries viral infections silica dust anything that would cause body to lose homeostasis
Which actions will the nurse delegate to the UAP in providing care for Damian? Select all that apply. A. Encouraging the client to take adequate fluids B. Measuring vital signs every 15 minutes C. Recording intake and output accurately every hour D. Getting a baseline weight to guide therapy E. Administering oral anti-nausea medication F. Assisting the client to go to the bathroom
B. Measuring vital signs every 15 minutes C. Recording intake and output accurately every hour D. Getting a baseline weight to guide therapy F. Assisting the client to go to the bathroom Rationale: The client is experiencing nausea and vomiting, so oral fluids are not appropriate at this time. The UAP can take frequent vital sign measurements, record intake and output, weigh the client, and assist the client to the bathroom. The nurse should instruct the UAP about which variations in vital signs must be reported. Administration of medications is appropriate to the scope of practice of licensed nurses. This could be assigned to an LPN/LVN.
If thyroid hormones are high and thyroid gland is hyperactive, what is the blood pressure of pt?
BP - High HR - high Pt is restless becuz hyperactive thyroid
If pt has hypothyroidism, what is blood pressure?
BP - low HR - low because high thyroid homes circulating LOC - low, lethargic to drowsy, unresponsive T3 and T4 - low TSH - high
Side effects of beta blockers
BP will decrease HR will increase - if this happens, must notify healthcare provider
Based on Robert's chief complaint and case study background, which type of skin cancer is most likely suspected in his case? Squamous Cell Carcinoma (SCC) Actinic Keratosis Malignant Melanoma Basal Cell Carcinoma (BCC)
Basal Cell Carcinoma (BCC)
Thryroiditis pt will have hyperthyroidism sins and symptoms because ?because of inflammation,
Because of inflammation, will release a lot of thyroid hormones itis means infection, so pt will need antibiotics if there is a cardiac issue, especially if hyperthyroidism, treat with beta blocker - remember this, drug of choice is beta blocker - propanilol
If a pt has hyperthyroidism, thryoiditis, or Graves' disease they might be on what medication for cardiac symptom?
Beta blocker , propanilol
Aldosterone another name for ? Corticosteroids?
Blood pressure is low, retains fluids, causes vasoconstriction to hold the fluids, increases blood pressure when aldosterone is. Released. ''potassium is release - watch for hypokalemia ekg - will see hypokalemia androgen does this - promotes puberty, differentiate men vs women women start to have breast tissue, also facial hair in men, voices change glucocorticoid does this - stress, cortisone, glucose is high
Lani is admitted after experiencing intermittent episodes of high blood pressure accompanied by headaches, diaphoresis, and chest pain. The HCP is ruling out pheochromocytoma. The HCP orders a 24-hour urine collection for vanillylmandelic acid (VMA), metanephrine, and catecholamine testing. Which instruction given to Lani by a nursing student would cause the nurse to intervene? A. "You will be on a special diet for 2 to 3 days before the urine collection for this test." B. "You should not drink caffeinated beverages or eat citrus fruits, bananas, or chocolate." C. "You will take your usual medications, including the aspirin and the beta-blocker for your high blood pressure." D. "In 2 to 3 days, you will begin the 24-hour urine collection after discarding the first void in the morning."
C. "You will take your usual medications, including the aspirin and the beta-blocker for your high blood pressure." Rationale• During the 3- to 4-day VMA testingperiod, medications usually withheldinclude aspirin and antihypertensiveagents. Beta-blockers are avoidedbecause these drugs may cause arebound rise in blood pressure. All of theother instructions are appropriate for thisdiagnostic test.
The RN is teaching a UAP about fluid retention when a client such as Merlin is diagnosed with Cushing disease. Which method does the RN instruct the UAP is best for indicating fluid retention? A. Strict intake and output measures B. Measuring urine specific gravity C. Checking daily weights with the same scale D. Comparing ankle swelling on a day by day basis
C. Checking daily weights with the same scale Rationale• Fluid retention may not be visible. Rapidweight gain is the best indicator of fluidretention. The best and most accurate wayto detect fluid retention is to weigh the clienton a daily basis. Weigh the client at thesame time daily (before breakfast) using thesame scale. Have the client wear the sametype of clothing for each weight check. Summary• Cushing's Disease= High ACTH• AKA "Hypercortisolism"• High MAG (mineralocorticoid, androgen, glucocorticoids)• They can have Hyperaldosteronism due to highMineralocorticoid.
A nursing concern of risk for infection related to immuno-suppression and inadequate primary defenses has been identified for Merlin. Which nursing care actions should the RN delegate to the UAP in addition to the 2 tasks below? • Providing the client with a soft toothbrush • Reminding the client to change positions in bed every 2 hours A. Instructing the client to avoid activities that can result in skin trauma B. Assessing the client's skin for reddened areas, excoriation, and edema C. Ensuring that the client has tissues and a bag for disposal of used tissues D. Teaching the client to avoid crowded areas and people with cold symptoms
C. Ensuring that the client has tissues and a bag for disposal of used tissues Rationale • The UAP can provide articles for self-care(e.g., toothbrushes, tissues, small trash bags). The UAP can also remind the client about changing positions once the nurse has instructed the client to do this. Instructing and assessing are within the scope of practice of the professional nurse.
Client is admitted in ER due to motor vehicle accident. Client has hx of hyperthyroidism and COPD. CIENT IS ADMITTED TO ICU due to thyroidtoxicosis. This patient is having thyroid storm.
Check loc: anticipated administer lorazepam: non-essential acetaminophen for high fever: anticipated Rapid infusion of normal saline: anticipated Hyperthyroidism - high bp and high hr
The nurse is completing a health history with a client diagnosed with systemic lupus erythematosus (SLE). Which information will the nurse identify as triggers for the condition? (Select all that apply.)
Cigarette smoking recent surgery Stress Sunlight It is hypothesized that exogenous or environmental triggers are implicated in the onset of SLE. These triggers include stress, sunlight, stress on the body from surgery, and cigarette smoking. A vegetarian diet is not identified as a trigger for SLE.
The nurse is completing a health history with a client diagnosed with systemic lupus erythematosus (SLE). Which information will the nurse identify as triggers for the condition? (Select all that apply.)
Cigarette smoking recent surgery stress sunlight It is hypothesized that exogenous or environmental triggers are implicated in the onset of SLE. These triggers include stress, sunlight, stress on the body from surgery, and cigarette smoking. A vegetarian diet is not identified as a trigger for SLE.
*LET'S REVIEW THE CLINICAL MANIFESTATIONS OF HYPERTHYROIDISM and DIET Therapy
Client is diagnosed with Graves' Disease (hyperthyroidism)that have an overactive thyroid gland that secretesexcessive amounts of thyroxine and other thyroid hormonesthat control body metabolism. Therefore, they haveincreased amounts of circulating serum thyroxin (Choice B).In clients who have Graves' disease, the serum thyroid-stimulating hormone (TSH) is also low (Choice D).
Goiter looks like:
Compromised airway bloodwork thyroid ultrasound
Sylvia case study 45 years old hx of RA snnual appt has been on methotrexate
Concerned about immunosuppressants - vaccines lately? hands - look for nodules - Heberdens (distal) and Bouchard (proximal)
Merlin is diagnosed with Cushing disease or hypercortisolism(increased secretion of cortisol), and he is scheduled for anadrenalectomy. Which preoperative actions should the nurseassign to the LPN/LVN in addition to the 2 tasks listed below?• Checking blood glucose via fingerstick• Administering insulin based on sliding scaleA. Assessing cardiac rhythmB. Checking laboratory resultsC. Discussing goals and outcomes with the clientD. Giving the client oral pre-op medications
D. Giving the client oral pre-op medications Rationale • The educational preparation of the LPN/LVN includes fingerstick glucose monitoring and administering oral and subcutaneous medications. Assessing cardiac rhythms and reviewing laboratory results require additional education and skill and are appropriate to the RN's scope of practice.
Merlin is admitted to the acute medical-surgical unit for a workup for Cushing disease. Which vital sign value reported to the RN by the UAP is of most concern for a client with Cushing disease(hypercortisolism)? A. Heart rate of 102 beats/min B. Respiratory rate of 26 breaths/min C. Blood pressure of 156/88 mm Hg D. Oral temperature of 101.8°F (38.8°C)
D. Oral temperature of 101.8°F (38.8°C) Rationale• A client with hypercortisolism (Cushingdisease) is immunosuppressed becauseexcess cortisol reduces the number ofcirculating lymphocytes and inhibitsproduction of cytokines and inflammatorychemicals such as histamine. Theseclients are at greater risk for infection.Therefore, it is essential that the nursebe told about any temperature elevationwith this client.
Damian was admitted to ER at 0900 due to motor vehicularaccident. EMT already inserted 18 gauge of IV (left forearm) andstarted 0.9% NaCl @ 100 ml/hour. Vital signs: BP=118/80 mmHg; HR=82 beats/min; RR=26 breaths/min; oral temp=98.4°F(36.9°C). The UAP informs the nurse that the BP is now 84/50mm Hg. Which prescribed action by the HCP would the nurseimplement first?A. Infuse 0.9% NaCl @ 250 ml/hourB. Type and cross-match for 2 units of packed red blood cells.C. Insert a second large-bore IV catheter.D. Administer prednisone 10 mg PO.
Damian was admitted to ER at 0900 due to MOTOR VEHICLE ACCIDENT. EMT already inserted on site 18 gauge of IV (leftforearm) and started 0.9% NaCl @ 100 ml/hour. Vital signs:BP=118/80 mm Hg; HR=82 beats/min; RR=26 breaths/min; oraltemp=98.4°F (36.9°C). The UAP informs the nurse that the BP isnow 84/50 mm Hg. Which prescribed action by the HCP wouldthe nurse implement FIRST? A. Infuse 0.9% NaCl @ 250 ml/hour B. Type and cross-match for 2 units of packed red blood cells. C. Insert a second large-bore IV catheter. D. Administer prednisone 10 mg PO. Answer is A The client is hypotensive and most likely hypovolemic. Becausethe client already has an IV line, the IV fluids should be startedfirst to address the primary problem. The second IV line andtyping and cross matching need to be accomplished rapidly, andthe blood sample may be drawn at the same time, that thesecond IV line is inserted.
Based on his symptoms and medical history, which condition is most likely causing his current presentation? Osteoarthritis Gout Rheumatoid Arthritis Bursitis
Gout Feedback Based on answering correctly William's sudden onset of a swollen and painful big toe, along with a history of hypertension and hyperuricemia, is suggestive of gout. Gout is a type of inflammatory arthritis caused by the deposition of uric acid crystals in the joints, leading to painful symptoms like podagra.
An older adult client, who is bedridden, is admitted to the unit because of a pressure injury that can no longer be treated in a community setting. During assessment, the nurse finds that the ulcer extends into the muscle and bone. At what stage should the nurse document this injury?
IV Stage III and IV pressure injuries are characterized by extensive tissue damage. In addition to the interventions listed for stage I, these advanced draining, necrotic pressure injuries must be cleaned (débrided) to create an area that will heal. Stage IV is an ulcer that extends to underlying muscle and bone. Stage III is an ulcer that extends into the subcutaneous tissue. With this type of ulcer, necrosis of tissue and infection may develop. Stage II involves a break in the skin that may drain. Stage I is an area of erythema that does not blanch with pressure.
Treatment for OA
Inflammation reduction, acetaminophen weight loss and acetaminophen (initial) exercise, use devices knee brace, Cain, walker to relieve pressure lose weight and gain muscle wedged insoles, knee braces, and other modalities splints, braces, canes transcutaneous electrical nerve stimulation (TENS), relaxes muscles NSAID and COX-2 enzyme blockers Tramadol, non-opiod pain reliever Opioids in severe cases Intra-articular corticosteroids (3x/yr) - remember only 3 x yr! (referees rebound effect when stop steroids, destroys tissue and cartilage) Capsaicin, methylsalicylate Methotrexate and colchicine in refractory (huge flare up) cases Viscosupplementation, take viscous fluid and insert it into the knee instead of steroids, acts as cushion between bones knee replacement if needed Osteotomy Arthroplasty
Fear after surgery is clump area on adrenal gland
Internal hemorrhage
Radioactive iodine therapy, what do you look for?
Internal radiation, pt ingests radioactive iodine, precautions are pt cannot be around people or pregnant women, no x=sex for two weeks, flush toilet at least 3 times, bed linens cannot be washed with same linens as family members.
Medications for hypothyroidsim
Levothyroxine (commonly tested with NCLEX) effect takes time, pt will complain, takes 4-6 weeks to take effect every drug that can effect hormones takes weeks to take effect
A nurse is providing care to a client with primary hyperparathyroidism. Which intervention would be included in the client's care plan? Monitor for signs and symptoms of diarrhea. Monitor for fluid deficit. Encourage intake of dairy products, seafood, nuts, broccoli, and spinach. Monitor for fluid overload.
Look this up, not dairy products Feedback General Feedback Excessive calcium in the blood depresses the responsiveness of the peripheral nerves, accounting for fatigue and muscle weakness. A large volume of fluid is encouraged to keep the urine dilute. Possible effects include nausea, vomiting, and constipation. Client would be on a calcium-restricted diet.
As the nurse, you closely monitor Sarah's condition for manifestations of acute myxedema ( severe hypothyroidism). Which of the following manifestations should you anticipate in Sarah? (Select all that apply.) Hypertension Bradycardia Profound diaphoresis Lethargy Hypothermia Restlessness
Lookup, not hypertension, profound disphoresis, or restleness Feedback Based on answering incorrectly Acute myxedema is a severe form of hypothyroidism characterized by life-threatening symptoms. Manifestations of acute myxedema include decreased body temperature due to the decreased metabolic rate, low heart rate due to reduced cardiac output, and extreme fatigue due to a slowed central nervous system. Profound diaphoresis and excessive sweating, hypertension and elevated blood pressure, and hyperactivity and restlessness are associated with thyrotoxicosis or hyperthyroidism.
Hypothyroiodism
Low t3 and t4 high tsh only doing blood work on this one lecothyroxine given st risk for mixedema coma, especially if not taking meds
Based on Lisa's chief complaint, which condition is most likely responsible for her symptoms? Fibromyalgia Allergic Reaction Lyme Disease Influenza (Flu)
Lyme Disease Feedback Based on answering correctly Lisa's symptoms of fatigue, muscle aches, and the presence of a bull's-eye rash are consistent with Lyme Disease. The characteristic bull's-eye rash, known as erythema migrans, is often the first sign of Lyme Disease and appears at the site of the tick bite.
Based on Lisa's chief complaint, which condition is most likely responsible for her symptoms? Fibromyalgia Allergic Reaction Lyme Disease Influenza (Flu)
Lyme Disease Feedback Based on answering correctly Lisa's symptoms of fatigue, muscle aches, and the presence of a bull's-eye rash are consistent with Lyme Disease. The characteristic bull's-eye rash, known as erythema migranes, is often the first sign of Lyme Disease and appears at the site of the tick bite.
Exam 5: 18 Based on Sarah's chief complaint and case study background, which type of skin cancer is most likely suspected in her case? Malignant Melanoma Basal Cell Carcinoma (BCC) Actinic Keratosis Squamous Cell Carcinoma (SCC)
Malignant Melanoma Feedback Based on answering correctly Sarah's chief complaint of a new, irregularly shaped, dark-colored spot with uneven borders on her back is concerning for Malignant Melanoma. Melanoma is the most serious type of skin cancer and often presents as an irregularly shaped, darkly pigmented lesion with uneven or irregular borders.
If pt has Systolic hypertension, what actions are needed?
Medications: propanolol - beta blocker, insert foley if pt is retaining fluids, monitor I and os and blood pressure altered mental status - oxygen, ask who president is close to nurse station - airway monitored, check alertness, temporary, respirations blood pressure to determine stability respirations Check temperature - because of heat intolerance
Risk Factors for Gout
Men, Age, BMI - men becuz what they eat and drink HTN, diuretics, low dose salicylates ETOH intake fructose rich diet, colas red meat rich diet shellfish rich diet
The nurse visits the home of a client recovering from a thyroidectomy. Which finding(s) indicates to the nurse that the client is developing hypocalcemia? Select all that apply. +3 pitting edema of the lower extremities Numbness and tingling of the hands New onset of dysphagia Hypoactive bowel sounds Report of stiff hands and feet
Numbness and tingling of the hands look this up, may have more answers Feedback General Feedback During thyroid removal surgery, the risk of removing the parathyroid glands is great. When these glands are removed, hypoparathyroidism occurs which leads to the development of hypocalcemia. Clinical manifestations of hypocalcemia include dysphagia, stiffness of the hands and feet, and numbness and tingling of the hands. Hypoactive bowel sounds and pitting edema are not manifestations of hypocalcemia.
Case Study I: Chief Complaint: joint pain, fatigue and rash No Significant medical hx Mother: RA arthritis Medications: none Allergies: n/a Denies smoking, alcohol, recreational drugs Butterfly rash on face (Lupus?) mild tenderness and joint swelling in bilateral wrists and knee joints Observed a red scaly rash over the cheeks and nose evident patchy hair loss on scalp multiple shallow ulcers on inside of mouth
Nursing Outcomes: relief and management of symptoms Anticipated lab Tests: ANA to detect disease associated autoantibodies Anti-d's DNA to assess disease activity ESR/CRP to evaluate inflammation
Hypoactive parathyroid gland
PPH is low calcium is low Watch for tetany tkngling sensarion spasms in smooth and skeletal muscles chvosteks sign - cheek twitches Trousseau - blood pressure cuff inflate and patient will ???
Thyroid and parathyroid are like husband and wife. When thyroid gland is partially removed, will parathyroid gland stay or be removed?
Parathyroid goes with thyroid gland, post-thyroidectomy we need to watch calcium pt will be at risk for hypocalcemia following this surgery
If parathyroid hormone is high, what is calcium level?
Parathyroid level is High PPH is high is calcium level is high PPH is low if calcium level is low
A client has been diagnosed with melanoma. What treatment option can the nurse expect will be used?
Radical excision The treatment of a melanoma involves radical excision of the tumor and adjacent tissues, followed by chemotherapy. Laser surgery and cryosurgery is not used in the treatment of melanoma. Radiation is used in some types of cancer
Exam 5: 1: Which of the following autoimmune disorders is most likely to be associated with Sarah Thompson's symptoms and clinical presentation? Systemic lupus erythematosus Hashimoto's thyroiditis Rheumatoid arthritis Fibromyalgia Answer is RA
Room 1 Name: Sarah Thompson Age: 32 Occupation: High school teacher Medical History: None Chief Complaint: "I've been experiencing joint pain, fatigue, and a rash on my skin." Upon initial assessment, Sarah appears fatigued and is experiencing pain in multiple joints, especially her knees and wrists. The nurse notes erythematous, butterfly-shaped rashes on her face, suggestive of a malar rash. The nurse takes a detailed medical history and performs a physical examination. The patient's vital signs are within normal limits. Lab Values CBC: Hemoglobin (Hb): 14.2 g/dLHematocrit (Hct): 42%White Blood Cells (WBC): 7.9 x 10^9/LPlatelet Count: 240 x 10^9/LErythrocyte Sedimentation Rate (ESR): 35 mm/h C-Reactive Protein (CRP): 18 mg/L Autoantibodies: Anti-Nuclear Antibody (ANA): Positive (1:320 titer)Rheumatoid Factor (RF): Positive (42 IU/mL) Infectious Disease Markers: Lyme Disease Antibodies (IgM): NegativeLyme Disease Antibodies (IgG): Negative
Pt complains of fatigue and lethargy, just wants to lie in bed, more prone to have what?
Skin breakdown no drugs that have edifice effects< educate pt constipation from drugs, everything slows down in hypothyroidism, even bowel use laxative for constipation
Marla - another follow up - changing mole
Skin cancer A - assymetry B - border C - color D - diameter above 1-2 cm problem - biopsy and treat/excise it!!! Remove the mole to biopsy E - evolving, is it growing or expanding?
Early RA Treatment (see table 24-2)
Start with DMARDs (disease modifying anti-rhuematic drugs), stops disease process non-biologic: methotrexate hydroxychloroquine JAK inhibitors in combination or as monotherapy (psoriasis) NSAIDs and Cox-2 blockers (non-steroidal NSAID) for pain relief
Based on Elizabeth's chief complaint and health background, which of the following conditions is most likely responsible for her symptoms? Rheumatoid Arthritis Multiple Sclerosis Fibromyalgia Osteoarthritis
fibromyalgia Fibromyalgia is a chronic pain disorder characterized by widespread musculoskeletal pain, fatigue, and cognitive difficulties. It is not associated with joint inflammation like osteoarthritis, or rheumatoid arthritis, and it is not a demyelinating disease like multiple sclerosis.
Exam 5: 6: The nurse is administering hydroxychloroquine (Plaquenil) to Sarah for the treatment of systemic lupus erythematosus (SLE). Which of the following are potential side effects associated with this medication? The nurse is administering hydroxychloroquine (Plaquenil) to Sarah for the treatment of systemic lupus erythematosus (SLE). Which of the following are potential side effects associated with this medication? Hair loss Gastrointestinal upset Photosensitivity Retinopathy Bradycardia
hair loss gastrointestinal upset photosensitivity
A client with rheumatoid arthritis (RA) is taking methotrexate. Which assessment findings indicate to the nurse that the client is experiencing side effects of this medication? Select all that apply.
hair loss skin rash gastric distress frequent infections Methotrexate is considered an immunosuppressive agent. Side effects of this medication include alopecia (hair loss), skin rashes, gastrointestinal ulcerations, and increased infections. Weight gain is not identified as a side effect of methotrexate.
What three meds can trigger lupus?
hydralazine (vasodilator) minocycline (antibiotic) procainamide (anti-arrhythmic)
NSAIDs
nonsteroidal anti-inflammatory eat while taking medication too much salicytates causes bleeding, spots on skin
Chronic RA Treatment
occupational and physical therapy Pacing activities, work simplification, exercises no repetitive movement, exacerbates issues Combination therapy: non-biologic and biologic DMARDs reconstructive surgery and corticosteroids topical analgesic agents (e.g. capsaicin, methylsalicylate, diclofenac sodium gel) capsaicin desensitizes nerves mental health status - therapy and antidepressants Address emotional burden: depression, sleep deprivation Short term use of low-dose antidepressants referrals for talk therapy or group support
The nurse is reviewing laboratory values for a client experiencing symptoms of systemic lupus erythematosus (SLE). Which findings indicate to the nurse that the client's symptoms are consistent with this condition? (Select all that apply.)
positive anti-DNA antibody Positive antinuclear antibody Blood tests are done to help validate the diagnosis of SLE. The anti-DNA antibody or the antibody that develops against the client's own DNA is present in SLE. The antinuclear antibody is positive in more than 95% of clients with SLE. Troponin level is used to diagnose cardiac damage after an acute myocardial infarction. SLE does not affect glucose level. The client with SLE may develop anemia and would not have an elevated level of red blood cells.
Stage 2 Proliferation Lyme Disease - adds neurological issues
presents within 4-10 weeks after bite joint pain, memory loss, poor motor coordination, adenopathy, cardiac abnormalities Facial nerve palsy is common - Bells Palsey biggest symptom
What is proper tick removal?
prevention is key straight upward pull until tick lets go tweezers as close to skin as possible grab tick and gently pull up tick will let go monitor site
What happens with Cushing excess adrenocortico hormone (aldosterone)
pt suffers from sodium and water retention and potassium excretion in addition, androgen is high first thing you will notice is facial hair Will see: high glucose high cortisol immunosupressed - will get infection right away in large groups Purple striae on belly will notice facial hair first purple striae on belly hump ecchymosis in arms and moon face - huge becuz of fluid retention
Which of the following is the causative agent of Lyme Disease? Streptococcus pneumoniae Escherichia coli (E. coli) Staphylococcus aureus Borrelia burgdorferi
Borrelia burgdorferi Feedback Based on answering correctly Borrelia burgdorferi is the bacterium responsible for causing Lyme Disease. It is transmitted to humans through the bite of infected black-legged ticks (Ixodes scapularis or Ixodes pacificus).
Thyroid storm: remember one thing: when patient has this, you have to give propanolol, how is the hr and bp?
Both are high, reason for beta blocker fever, treat the fever focus on cardiac - beta blocker
Hyperaldosteronism
Bp is high fluid is high potassium is low This is alll you need to remember for mamangement monitor bp, fluids and electrolytes, postwssium sparring diuretic please remember this! surgery for adrenal removal - adrenalectomy
Symptomatic treatment for Fibromyalgia
*Exercise to strengthen joints *Acupuncture *NSAIDS for muscle aches and stiffness, joints *Tricyclic Antidepressants (amitriptyline, nortriptyline) = sleep measures & mental health *Muscle relaxants (cyclobenzaprine) *CBT Cognitive Behavioral Therapy *SNRI's (duloxetine, venflaxine, milnacipran) *SSRI's (fluoxetine, paroxetine, sertraline) *Anticonvulsants (gabapentin, pregabalin), muscle rigidity
Risk Factors for RA
*HLA gene (antigen with genes that make it a powerful risk for RA) *nulliparity, if you don't go thru cycle, estrogen level rises *family hx *autoimmune *higher in women (20-30's) *diet *smoking *obesity
MAB's and immuno-suppressant meds
For severe RA cases skin rashes liver function test required educate to not breastfeed avoid pregnancy, very toxic to fetus increased risk of infection because it is suppressing immune system - no concerts
Treatment for Lupus (see table 34-2)
(*CANIMARCH) *Monoclonal antibodies, "MAB's" *Corticosteroids (topical and/or oral), *remember glucose will rise with this*, osteoporosis, immune suppression *Antimalarial agent: hydroxychloriquine *NSAID's used for minor clinical manifestations *Immunosuppressive agents (cyclophosphamide, azathioprine, mycophenolic acid, methotrexate)
Triggers of Fibromyalgia
(Discuss vaccines as preventative measures) (VAPES) viral infections anxiety/depression physical trauma emotional distress sleep disorders
Diagnostic Studies for Lupus
*Antinuclear Antibody (ANA) - Pos in 95% of Lupus patients, attacks body for no reason, 1st test run *Anti-DNA Antibodies: chemicals attack patients' own DNA *Anti-d's DNA Antibodies: highly specific to SLE
Triggers of Lupus
*Cigarette smoke #1, drinking *Silica Dust exposure in occupational settings "photosensitivity," ultraviolet rays *Medications (hydralazine (vasodilator), minocycline (antibiotic), procainamide (anti-arrhythmic) *Viral Infections (SC#1UMV)
Common manifestations and complications in RA
*symmetrical joint swelling *morning stiffness > 1 hour *ulnar deviation and swan neck deformity fever, weight loss, fatigue, anemia, lymph node enlargement Raynaud's phenomenon (decreased blood flow in fingers), avoid high altitudes, cold weather *arteritis, neuropathy, pericarditis (pleural friction rub, deep breath is very painful, act on this very quickly) splenomegaly (enlarged spleen), and Sjorens Syndrome (dry eyes, mouth, and mucous membranes)
What is priority if pt had surgery in thyroid gland or parathyroid gland?
Airway is priority becuz it's in neck, don't over analyze this if incision in neck, airway will be affected
Chronic conditions require
Addressing mental health status in chronic conditions
What is most important Pre-op nursing intervention before adrenalectomy for high hyoeraldosteronism?
Administer potassium sparing diuretics because potsssium is already low
To manage chronic hyperuricemia and prevent gout attacks, which medication may be prescribed for William? Hydrochlorothiazide Losartan Allopurinol Metformin
Allopurinol Feedback General Feedback Allopurinol is a medication commonly prescribed to manage chronic hyperuricemia and prevent gout attacks. It works by inhibiting the production of uric acid in the body.
What do we give for A-fib?
Amiodirone
A client with fibromyalgia is prescribed medication to address sleep disturbances. Which class of medications is commonly used for this purpose?
Amitriptyline Tricyclic antidepressants, such as amitriptyline and nortriptyline, are commonly used to improve or restore normal sleep patterns in clients with fibromyalgia. They address the sleep disturbances associated with the condition.
Jane was placed on a 3-Lead EKG monitor. The monitor shows that she has dysrhythmias (see image) with a HR of 125 beats/minute. How should the nurse chart this dysrhythmia?
Atrial Fibrilation
Hyperthyroid disorders patient must avoid what?
Caffeine Anything high in fiber - already have diarrhea
Parathyroid glands effect what electrolyte?
Calcium
Client admitted with hyperthyroidism, bp is 170/90, he 10r, a fib, alert, awake and oriented x2
Close to nurse station - anticipated administer PPU - anticipated a(PPU is for hyper) administer Levothyroxine, contraindicated (for hypothyroidism) ck vital signs and heart rhythm - anticipated administer atenosine - nonessential and contraindicated
A client with early-stage Lyme Disease presents to the clinic. Which of the following oral antibiotic regimens, at the correct dose and frequency, is the first-line treatment for this condition? Ciprofloxacin - 500 mg orally twice daily for 14-21 days. Clindamycin - 300 mg orally every 6 hours for 14-21 days. Vancomycin - 500 mg IV every 6 hours for 14-21 days. Doxycycline - 100 mg orally twice daily for 14-21 days.
Doxycycline - 100 mg orally twice daily for 14-21 days. Feedback Based on answering correctly Doxycycline is the first-line treatment for early-stage Lyme Disease due to its efficacy against Borrelia burgdorferi, the causative bacterium. The recommended dose is 100 mg orally twice daily for 14 to 21 days, which is sufficient to effectively eliminate the infection. Vancomycin (a) is not indicated for Lyme Disease, and ciprofloxacin (b) is not the preferred treatment. Clindamycin (d) may be used in specific cases, but doxycycline is the primary choice for its effectiveness and favorable side effect profile.
Hypothyroidism
Everything slows down, metabolis, bp is low, hr is low, patient is at risk of coma, myxedema coma
Lookup summary of cushings on slide
Excess acth disgnostic tests need to be familair remove adrenal gland - priority is ______ adrenal crisis after surgery - bp is low, cardiac arrest, have to make sure you watch this
Dry eyes
Expected finding
Which of the following are common risk factors for the development of Malignant Melanoma? (Select all that apply.)
Fair Skin/Freckling Previous hx of psoriasis refer to pg 1856
Which of the following symptoms is commonly associated with hypothyroidism? Palpitations and irritability Swelling in the neck (goiter) Unexplained weight loss and increased appetite Fatigue and cold intolerance
Fatigue and cold intolerance Feedback Based on answering correctly Hypothyroidism is characterized by insufficient thyroid hormone production, leading to symptoms such as fatigue and cold intolerance due to a slowed metabolic rate.
Enema require what to be monitired
Fluids and electrolytes put in 18 inches? Lookup!
Case Study I continued (Labs):
Hemoglobin: 11.2 BUN: 15 mg Creatinine: 0.8 mg Antinuclear Antibodies (ANA) Titer: 1:640 Antinuclear Antibodies ANA Pattern: Homogenous Anti-double-stranded DNA (Anti-D's DNA): Positive Complement C4: 18 mg ESR Rate: 40 mm/hr C-reactive Protein (CRP): 1.5 mg/L Protenuria: 2+ Hematuria: Occasional RBC's Anti-Ro (SSA) Antibodies: Positive
What assessment findings require immediate follow up before radioactive Iodine uptake
High bp allergies - shellfish because of shellfish, concern anaphylaxis rr rate
Graves disease
High bp high hr restless common to women - hypo or hyper
Clinical manifestations of hyperthyroidism
High bp high hr restlessness Heat intolerance because everything is hyper metabolism is high weight is loss, lose weight faster imagine cardiovascular exercise all the time Pts look anorexic
parathyroid gland and it's function
If gland is removed, calcium will drop calcium within normal range is goal uptake and reabsorption from bones and intestines from urine thyroid hormone will release calcitonin to stabilize if increased calcium if release from bone and intestines = this is the effect of PPH
A client is admitted with an acute episode of gout. What nursing diagnosis should the nurse prioritize for this client?
Impaired Physical Mobility related to severe joint pain and inflammation Impaired Physical Mobility is a priority because the severe pain and inflammation associated with gout significantly limit joint movement, affecting the client's ability to perform activities of daily living. While other nursing diagnoses may be relevant, addressing impaired physical mobility focuses on the immediate impact of the condition and guides nursing interventions to alleviate pain and promote joint movement.
Corticosteroids, MAB's and immuno-suppressant meds put pt at risk for?
Infection
Manifestations and Complications for OA
Joint pain and morning stiffness (<30 minutes), asymmetrical Heberdens nodes, distal joints, calcifications from arthritis Bouchard nodes, proximal can happen in RA but mostly osteoarthritis Insidious onset progressing over years Common in weight bearing joints (hips, knees, cervical, lumbar spine) Proximal interphalangeal (PIP) and distal interphalnageal (DIP) joints Heberdens (DIP), Bouchards (PIP) Palpable crepitus, especially over the knee Mild joint effusion, sign of inflammation No systemic manifestations Diganosed s Xray of affected joints
A client is needs to be educated on how to properly manage hypothyroidism. Which medication is typically prescribed to replace deficient thyroid hormones in patients with hypothyroidism? Levothyroxine Methimazole Prednisone Propranolol
Levothyroxine Feedback Based on answering correctly Levothyroxine is a synthetic form of thyroid hormone used in thyroid hormone replacement therapy to replace deficient thyroid hormones in patients with hypothyroidism.
Marla Case Study: butterfly rash on face female student/age (20-30 yr age) Mother hx of RA, still puts at risk for Lupus because rheumatic condition assessment: bp: 128/86 alopecia ulcers
Lupus concerns nursing outcomes: relief and pain management anticipated labs: to see if it's lupus no definitive test for fibromyalgia, rule out others Labs: what to look at in lab values!! Know ESR and CRP ranges when looking for lupus CBC: Hgb, ........ CMP: creatinine low, BUN low (always look at these together) *multi-system organ dysfunction so look at kidneys and liver first!!!, keep an eye on these labs!!! Positive for immunology CRP: little high urine, hematuria - protein in urine
If thyroid gland is removed, what diet should they be put on?
Metabolism slows down gaining weight diet is not applicable after surgery
Hypothyroidism - both can have goiter
Must check blood work to differentiate T3 and T4 is low TSH - is high complication - must watch for myxedema coma, intubated, sedated, paralyzed, very sick in ICU
In addition to dietary modifications, what class of medications is commonly prescribed to manage acute gout attacks? Anticoagulants NSAIDs Beta-blockers Antibiotics
NSAIDs Feedback Based on answering correctly Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly prescribed to manage acute gout attacks and help reduce pain, inflammation, and swelling associated with gout flares. General Feedback William's sudden onset of a swollen and painful big toe, along with a history of hypertension and hyperuricemia, is suggestive of gout. Gout is a type of inflammatory arthritis caused by the deposition of uric acid crystals in the joints, leading to painful symptoms like podagra.
Thyroid gland is located where
Neck when you look at back, see nodules which are parathyroid glands
After surgery, thyroid has been removed, metabolism is slower. Can we still give high caloric diet?
No
Anthony follows up with right knee pain
Osteoarthritis lose weight stop playing basketball, cut back knee brace meds: NSAIDs 1st line to reduce swelling/inflammation
Treatment for hyperthyroidism
PPU is for hyperthyroidism - goal is to lower the hormones, the circulating t3 and t4 surgery, removal, thyroidectomy SSKI drug - given by a straw, because can stain teeth because has iodine in it, reason is to shrink vascularity of thyroid gland, to reduce bleeding during surgery, for safety purposes beta blocker - propanolol Thyrotoxicosis
Thyroid assessment
Palpate neck unless they have goiter (thyroid disorder) 'DO NOT PALPATE NECK! hypothyroidism, goiter, etc - will activate release of thyroid hormones
Thyrotoxicosis - what drug is administered?
Propanolol.
Exam 5: 20 What characteristic feature of Malignant Melanoma helps in distinguishing it from other skin cancers? Rapid growth and tendency to metastasize Asymmetry, irregular borders, and varied colors Rolled edges and central ulceration Presence of a darkly pigmented lesion
Refer to pg 1852, not rapid growth and tendency to metastisize
Devices to prevent DVT
Remember these
Pituitary - anterior and posterior glands
Secrete different hormones thyroid stimulating hormone (TSH) (thyroid gland disorders) adrenocorticotropic hormone (adrenal gland disorders) ADH
Which of the following clinical manifestations is most indicative of systemic lupus erythematosus (SLE) in Sarah's case? Positive Rheumatoid Factor (RF) of 42 IU/mL , Not Selected Correct answer: Erythematous, butterfly-shaped rash on the face Elevated Erythrocyte Sedimentation Rate (ESR) of 35 mm/h , Not Selected Positive anti-Nuclear Antibody (ANA) with a titer of 1:320
See question 92 for case study Answer is Erythematous, butterfly shaped rash on face Feedback Based on answering correctly Erythematous, butterfly-shaped rash on the face Rationale: The malar rash, characterized by a butterfly-shaped rash on the face, is a classic clinical manifestation of systemic lupus erythematosus (SLE).
Nutrition
The process by which your body takes in and uses food high calcium, recommend broccoli, tofu, cabbage, oranges, shrimp, okra, milk, almonds, beets LOK at this!! Educate pat to stay away from!
The nurse is caring for a client who has been diagnosed with hyperthyroidism. Which of the following symptoms is commonly associated with hyperthyroidism? Unexplained weight loss and increased appetite Fatigue and cold intolerance Weight gain and constipation Dry skin and hair loss
Unexplained weight loss and increased appetite Feedback Based on answering correctly Hyperthyroidism is characterized by excessive thyroid hormone production, leading to symptoms such as unexplained weight loss and increased appetite.
Post-thyroidectomy - need to Monitor JP drain?
Yes, for bleeding.
Removal of pituitary gland, if this is cause of cushings
approach is from nose to ? trans ——-hyposectomy? if main problem is adrenal gland - remove how? See slide
Laryngo nerve damage
asses pt by asking how are you doing? If hoarseness in voice, later losing voice, possible vocal cord paralysis. This is why we need teach setup at bedside in case this happens.
Symptoms of lupus erythematosus
auto-immune - usually effects all of body Skin conditions - butterfly rash (malar rash) on face alopecia oral ulcers issues with heart, gut, every system is at risk with Lupus
Risk Factors for Lupus
autoimmune - usually affects multiple parts of body higher in women of BIPOC (biracial indigenous people of color) Linked to estrogen
Hypocalcemia
deficient calcium in the blood< low calcium
DMARDs
disease-modifying antirheumatic drugs specifically for rheumatoid arhtirthis hydroxychloriquine, must get eye exam 2x year (useful in RA and ?, nothing else) SE: visual changes, gi upset, skin rash, photosensitivity, stay out of sun, sunglasses, sunscreen
How to avoid GI bleeds from sodium salicytates (aspirin)
eat while taking medication too much salicytates causes bleeding, spots on skin
Theochromocytoma ?)
headache sweating high bp priority stabile bp surgery remove adrenal gland' this is all you need to remember
Exam 5 : 5: Which of the following organs is often affected in systemic lupus erythematosus (SLE), requiring careful monitoring of its function? Which of the following organs is often affected in systemic lupus erythematosus (SLE), requiring careful monitoring of its function? Thyroid Kidney Liver Spleen
kidney
Adrenal cortex gland
located on top of kidney, have medulla at top, secretes catcholamines cortex secrets MAG what do you remember?
Define osteoarthritis
lose weight increase walking everyday increase muscles *pain meds not necessary for every exercise, only when necessary, meds given for PAIN, not exercise worried about kidneys and liver when taking NSADs for exercise, is it necessary?
Clinical manifestations
low bp low hr Lethargic cold intolerance weight gain
Exam 5: 9: Which of the following medications is commonly used as the first-line treatment for rheumatoid arthritis (RA) to control inflammation and slow disease progression? Which of the following medications is commonly used as the first-line treatment for rheumatoid arthritis (RA) to control inflammation and slow disease progression? Acetaminophen Naproxen Prednisone Methotrexate
methotrexate
Exam 5: 11: Which of the following medications can be used for inflammatory relief in John's case of rheumatoid arthritis (RA)? Infliximab Methotrexate Acetaminophen Celecoxib Prednisone
methotrexate celecoxib prednisone refer to table 34-2
Antonine case study: has Lyme disease
put on doxycycline stat
Endocrine in canvas
questions and rationales see nearpod link here
Exam 5: 4: Sarah's nurse observes a malar rash on her face during the assessment. Which of the following statements about the malar rash in SLE is correct? The malar rash is a sign of photosensitivity and worsens with sun exposure. The malar rash is associated with elevated levels of anti-CCP antibodies. The malar rash is usually confined to the cheeks and spares the bridge of the nose. The malar rash is typically itchy and resolves spontaneously within a few days.
sunlight exposure
Exam 5: 13: Which of the following symptoms commonly coexist with fibromyalgia in patients? Respiratory distress and shortness of breath Memory difficulties and cognitive issues Elevated blood pressure Swollen and tender joints
swollen and tender joints Feedback Based on answering correctly Memory difficulties and cognitive issues are common in fibromyalgia patients and are often referred to as "fibro fog." Swollen and tender joints, elevated blood pressure, and respiratory distress are not typical symptoms of fibromyalgia.
Corticosteroids
turns off auto-immune process stops inflammation process KNOW SIDE EFFECTS TO ALL MEDS!
Diagnostics:
use RAUI for dx, but for treatment use RAI meds PPU metmasol complication is Thyrotoxicosis
A diagnostics for cushing
Draw blood to check cortisol levels of patient urine sample to check cortisol if elevated ACTH will be high Potassium is low
A client diagnosed with Bell's palsy and a positive Western blot test for Lyme disease is in which stage, and what medication(s) would be anticipated by the nurse?
Early disseminated stage - Doxycycline In the early disseminated stage of Lyme disease, when there is involvement of the nervous system (such as Bell's palsy), the recommended antibiotic treatment is usually doxycycline. Doxycycline is effective against the causative agent of Lyme disease, which is the spirochete bacterium Borrelia burgdorferi. Other antibiotics, such as amoxicillin or cefuroxime, may also be used depending on the specific circumstances and the patient's medical history. However, doxycycline is a common choice for early disseminated Lyme disease, particularly when neurological symptoms are present.
The nurse is caring for a client with bilateral Heberden's nodes. What assessment should the nurse prioritize?
Finger joint flexibility in the distal interphalangeal joints Heberden's nodes are bony enlargements that occur at the distal interphalangeal (DIP) joints, which are the joints closest to the fingertips. A normal CRP level is usually less than 10 milligrams per liter (mg/L). the reference range for ESR is typically 0-15 millimeters per hour (mm/hr) for men and 0-20 mm/hr for women.
Diagnostics for hyperthyroidism
Bloodwork high metabolism t3 and t4 are high tsh is low radioactive iodine uptake; patient ingests radioactive iodine, shows activity of thyroid Graves' disease - too much thyroid activity = hyperthyroidism
Marla one week later - complains of acute pain in her left toe, appears inflamed
Gout? RA? to distinguish between RA and Gout, ask what they've been eating lately, look at ESR and CRP prob both elevated, hyperurecemia
Hyperthyroidism
High calcium, want it to drop phsophorus level is low has hyperthyroidism after cat scan, Dexa scan, yellow or Origen in Dextro's scan means calcium is leaving bone, osteopenia very common to women mri caused by another problem? Tx: remove parathyroid gland, very small incision in neck Stabilize calcium see summary in slides for hypo and hyperthyroidism secret is create a table and compare them
Thyroid Disorders
Hormones involved are thyroid secretes T3 and T4 and TSH and calcitonin separate calcitonin from others hyperactive thyroid - T3 and T4 are high if hyperactive, TSH is low because if high already, TSH will say I don't need to be elevated calcitonin drops calcium - in thyroid disorders
Check endocrine disorder before deciding which diet to put them on.
Hyper is losing weight so need more calories hypo is gaining weight so need less/restricted calories
Given Mary's clinical presentation, which of the following might be an additional endocrine disorder she could be at risk for? Hyperparathyroidism Pheochromocytoma Diabetes insipidus Hypoparathyroidism
Hyperparathyroidism Feedback Based on answering correctly Mary's presentation of fatigue, bone fragility, and elevated blood pressure raises concern for hyperparathyroidism, an endocrine disorder characterized by excessive parathyroid hormone production, leading to elevated serum calcium levels and potential bone demineralization.
Thyroiditis
Hyperthyroidism
Which of the following dietary factors can contribute to elevated uric acid levels in individuals with gout? Low intake of water. High intake of fruits and vegetables Low intake of purine-rich foods High intake of red meat and shellfish
Look this answer up! Low intake of water? Feedback Based on answering incorrectly High intake of purine-rich foods, such as red meat and shellfish, can contribute to elevated uric acid levels in individuals with gout. Purines are broken down into uric acid, and reducing the consumption of purine-rich foods is often recommended for gout management.
The nurse is reviewing the medication administration record of the client. Which medication would lead the nurse to suspect that the client is suffering from an acute attack of gout?
Colchicine is prescribed for the treatment of an acute attack of gout.
Define fibromyalgia
Complaint of deep aching all over body watch for "localized" in answer, this will be wrong
Beta blockers
Pt cannot stop medication abruptly must notify physician if any changes in swallowing if sudden weight gain or weight loss any side effects of n=meds
Heat intolerance
Pt thyroid hormones are not stable enough, pt will not tolerate therapy
Hashimoto's disease thyroiditis graves disease goiteer
Pts have Hyperthyroidism complication is thyroid storm becuz so much thyroid hormones are circulating in blood
A nurse is assessing a client with suspected fibromyalgia. What specific assessment findings are consistent with fibromyalgia?
Complaints of deep aching all over the body Clients with fibromyalgia often report a persistent deep aching all over the body. It is a diffuse syndrome, and pain is not localized to specific trigger points. The pain is typically not sharp or stabbing.
Exam 5: 3: Which of the following laboratory results does the nurse recognize as an indication of an inflammatory process? Erythrocyte Sedimentation Rate (ESR): 35 mm/hr White Blood Cells (WBC): 7.9 x 10^9/L Platelet Count: 240 x 10^9/L Hemoglobin (Hb): 14.2 g/dL
Answer is ESR
Know meds in powerpoint
Antriptyline, etc.
A client with rheumatoid arthritis tells the nurse about experiencing mild tinnitus, gastric intolerance, and rectal bleeding. What medication does the nurse suspect is causing these side effects?
Aspirin Salicylates like aspirin may have side effects such as tinnitus, gastric intolerance and bleeding. While celecoxib, methotrexate, and hydroxychloroquine have GI upset effects, the tinnitus is unique to aspirin. See Table 34-2
Risk factors for Fibromyalgia
Autoimmune Higher incidences in women (becuz of estrogen)
Pt had subtotal thyroidectomy develops laryngostridor and cramp in right hand upon returning to surgical nursing unit, which collaborative action will nurse anticipate next?
Cramp is sign of low calcium, must give calcium
What endocrine disorder is Mary likely experiencing, given her symptoms of fatigue, weight gain, mood swings, "buffalo hump," and round face? Cushing's syndrome Graves' disease Addison's disease Hypothyroidism
Cushing's syndrome Feedback Based on answering correctly Mary's symptoms, including fatigue, weight gain, mood swings, "buffalo hump," and round face (moon face), are consistent with Cushing's syndrome. This disorder is caused by excessive cortisol production, leading to a variety of physical and psychological changes.
Which assessment finding in bilateral adrenalectomy requires immediate action from nurse?
D - bp is priority
The nurse provides teaching to a client with osteoarthritis (OA). Which statement(s) indicate that teaching about pain management and functional ability were effective? (Select all that apply.)
I will need to lose some weight I will increase the amount of walking I do everyday. Pain management and optimal functional ability are the major goals of nursing interventions. With those goals in mind, nursing management of the client with OA includes pharmacologic and nonpharmacologic approaches as well as education. Weight loss is an important approach to lessen pain and disability caused by OA. Exercises such as walking should be begin in moderation and gradually increase. A sedentary lifestyle contributes to the development of OA so resting would not be encouraged. Canes or other assistive devices for ambulation should be considered, and any stigma about the use of these devices should be explored. Clients should plan daily exercise for a time when the pain is least severe or plan to use an analgesic agent before exercising
Post surgery, after adrenalectomy
Insert NG tube, foley, iv monitor bp meed to be on bed rest - bp can drop very low very st risk for infection
As a nurse, what is the priority intervention for Mary to manage her Cushing's syndrome? Administer ketoconazole (Nizoral) as prescribed. Administer Radioactive iodine (RAI) as prescribed. Encourage a low-purine diet to manage hyperuricemia. Monitor blood glucose levels and adjust diabetes medications as needed.
Look this answer up! not blood glucose levels... Feedback Based on answering incorrectly The priority intervention for managing Cushing's syndrome is administering adrenal enzyme inhibitors, such as ketoconazole or metyrapone, as prescribed by the healthcare provider. These medications help inhibit cortisol production and control the symptoms associated with excessive cortisol levels.
Nutrition - is hyperthyroidism pt gaining or losing weight?
Losing weight, must increase caloric intake
The nurse is reviewing medications prescribed for a client with rheumatoid arthritis. Which medications will the nurse expect to be prescribed for this client?
Methotrexate Celecoxib Methylprednisolone Medications are used with the rheumatic diseases to manage symptoms, to control inflammation, and, in some instances, to modify the disease. Medications used include the salicylates, NSAIDs, and DMARDs. Opioid and anticoagulants are not identified as being used to treat rheumatoid arthritis.
What are imp nursing interventions when caring for cushings patient?
Monitor blood glucose preorect or from exposure to infection
Slide 39 - very important slide
Neck supported' rom should be there we monitor sirway post surgery: calcium level can drop, monitor diet - NPO to regular diet tolerated exercise gaining weight watch for any signs and symptoms of hypothyroidism
Can we give PPU and atemosol after thyroid is removed?
No, because patient is at risk for hypothyroidism.
Are we still giving PPU and etemasol after thyroid has been removed?
No, because we're watching for hypothyroidism.
Risk factors for Osteoarthritis (OA)
Older age, women, obesity, everybody is at risk becuz diet athletes who overuse joints diet and lifestyle huge factors Hispanic, African Heritage Overuse (occupation/sports)
Myxedema Coma
Patient will be in ICU in a coma intubated sedated bed bound we stabilize heart is collapsing, will see very low blood pressure give fluids give medications that stabilize bp
Pt with hypothyroidism is treated with radioactive iodine, what info should nurse include in teaching?
Precautions symptoms of hypothyroidism will apour ? as the iodine therapy takes place in addition to the radio active precaution. Find this in q and A's
Disagnsotic Studies and Treatment for Lyme Disease
Prevention and remove tick immediately two-tier testing (EIA or IFA + Western Blot) Doxycycline, 100 mg BID, 2x day, 1st line of treatment Amoxicillin, 500 mg TID, given if Doxycycline doesn't work Cefuroxime, 500 mg BID Ceftriaxone, 2g BID (late stages, in hospital) Penicillin G, 18024 million U Q4H (late) 14-21 day medication regimen
With acute adrenal insufficiency, the nurse must be awareof three major areas of concern for treatment, which arehormone replacement, hyperkalemia management, andhypoglycemia management.• *What are the meds for hyperkalemia?
Rationale: Addison's Disease= low ACTH • LOW Mineralocorticoid (aldosterone)- low sodium & water retention, K retention • LOW Androgen • LOW Cortisol-low glucose What is/are EKG changes for Hyperkalemia?
Exam 5: 7: Based on John's medical history and chief complaint, which of the following conditions is most likely responsible for his symptoms? Rheumatoid Arthritis (RA) Gouty Arthritis Osteoarthritis (OA) Fibromyalgia
Refer to page 1078 for right answer, not OA
Exam 5: 8: Considering John's occupation as a construction worker, which of the following joint protection strategies should the nurse recommend to him? Considering John's occupation as a construction worker, which of the following joint protection strategies should the nurse recommend to him? Taking over-the-counter NSAIDs daily. Avoiding all physical activities that involve the joints. Applying heat to the affected joints Using proper body mechanics and lifting techniques.
Refer to pg 1078, not heat to affected joints
Which of the following non-pharmacological interventions are appropriate for preventing skin cancers like BCC and SCC? (Select all that apply.) Regular skin self-examinations Using broad-spectrum sunscreen with high SPF regularly Avoiding sun exposure during peak hours Consuming a diet rich in antioxidants Using indoor tanning beds for controlled UV exposure
Regular skin self-examinations Using broad-spectrum sunscreen with high SPF regularly Avoiding sun exposure during peak hours refer to pg 1852
Cushing disease
Remember MAG M - menololcorticoid? A - androgen G- glucocorticoid slll are high in Cushing disease most common causes of Cushing diseas adrenal tumor pituitary tumor and use of corticosteroids (be careful with this, can cause cushions syndrome)
Tests need for gland disorders
Remember hugs and lows with endocrine disorders create a table to separate them hyperactive means hormones are high - goal is to loweer hypoactive means hormones are low - goal is to increase to stabilize
Q: 31 Exam 5 Quiz Which of the following complications may arise if gout is left untreated or inadequately managed? Renal calculi Weight loss Hypertension Diabetes mellitus
Renal calculi Feedback Based on answering correctly Untreated or inadequately managed gout can lead to the formation of uric acid crystals in the kidneys, resulting in renal calculi.
Diagnostic Studies for RA
Rheumatoid Factor is present, RF factor Anti-CCP (auto-antibody, patient's cells are seen as foreign) elevated ESR and CRP, tells is inflammation is present CBC, looking for anemia TB Skin Test (to rule out) Hep B (to rule out) Hep C (to rule out)
The nurse is planning care for a client with Cushing syndrome. Which complications will the nurse monitor for in this client? Select all that apply. Pain management Risk for infection Body image changes Potential for injury Sodium intake Fluid balance
Risk for infection Potential for injury Sodium intake not pain management Feedback Based on answering incorrectly Cushing syndrome can be caused by the use of corticosteroid medications or excessive glucocorticoid production caused by hyperplasia of the adrenal cortex. Problems that can occur in this syndrome include fluid balance since fluid retention occurs in this condition. Sodium intake is an issue as this contributes to fluid retention. The client is at risk for infection because of the effect of the corticosteroids on immune function. The client with Cushing syndrome is at risk for injury because of the effects of corticosteroids on muscle tissue and bone structure. Corticosteroids can cause muscle wasting and redistribution of fat. The face becomes moon-shaped and a hump of tissue at the base of the neck can develop. These body image changes will need to be addressed. Pain is not a problem typically associated with Cushing syndrome.
Exam 5: 19 Which of the following risk factors is most closely associated with the development of Basal Cell Carcinoma (BCC) and Squamous Cell Carcinoma (SCC)? Severe sunburns during childhood Personal history of melanoma Family history of skin cancer Tanning bed use
Severe sunburns during childhood Feedback Based on answering correctly Severe sunburns during childhood are a significant risk factor for the development of both Basal Cell Carcinoma (BCC) and Squamous Cell Carcinoma (SCC). Prolonged sun exposure and sunburns increase the risk of skin cancer.
Define inteligible
Staging: keep simple understand what all stages mean
Hyperthyroidism
T3 and T4 is high TSH is low
Hypoactive thyroid
T3 and t4 are low, TSH is high
Define intelligible
TCA's for sleep disturbances and depression meds - give TCA's, don't need to know names, know what they end in
Risk Factors for Lyme Disease
TICKS cause this, bite infected deer where you are places you at higher risk Common in grassy woods or wooded areas Borrelia burgdorfi infected tick bite inspect when come in from outside
As the nurse, which medication should you administer to help Emily manage her thyrotoxicosis? Prednisone - 5 mg orally once daily Propranolol - 20 mg orally every 6 hours Levothyroxine - 50 mcg orally once daily Methimazole - 10 mg orally twice daily
Table 45-1 lookup! Not methimazole
Exam 5: 17 What characteristic feature of Basal Cell Carcinoma (BCC) helps in distinguishing it from other skin cancers? Rapid growth and tendency to metastasize Rolled edges and central ulceration Telangiectasias and pearly appearance Presence of a darkly pigmented lesion
Telangiectasias and pearly appearance Feedback Based on answering correctly Basal Cell Carcinoma (BCC) often presents with telangiectasias (tiny blood vessels visible on the surface) and a pearly appearance. It tends to grow slowly and rarely metastasizes, making it different from other, more aggressive skin cancers.
A nurse is assessing a client for risk factors known to contribute to osteoarthritis. What assessment finding should the nurse interpret as a risk factor?
The client's body mass index is 34. Risk factors for osteoarthritis include obesity and previous joint damage. Risk factors of OA do not include smoking or hypertension. Incidence increases with age, but a client who is 58 years old would not yet face a significantly heightened risk.
Exam 5: 14: Elizabeth's complete blood count (CBC) and thyroid function tests are within normal limits. How do these lab results contribute to the diagnosis of fibromyalgia? They rule out other conditions that cause similar symptoms. They suggest possible thyroid dysfunction. They indicate the presence of anemia. They confirm the presence of an inflammatory process.
They rule out other conditions that cause similar symptoms. Feedback Based on answering correctly The normal CBC and thyroid function test results help rule out other conditions that could cause similar symptoms. Fibromyalgia is a diagnosis of exclusion, meaning other potential causes of the symptoms need to be ruled out through laboratory and clinical assessments.
Goiter Graves disease Hashimotos thyroiditis
Think of hyperthyroidism - high t3 and t4, low TSH
Which of the following diagnostic tests is commonly used to confirm Lyme Disease? Western blot test Enzyme-linked immunosorbent assay (ELISA) Indirect immunofluorescence assay (IFA) Chest X-ray
Western blot test Feedback Based on answering correctly The Western blot test is the confirmatory diagnostic method for Lyme Disease. It verifies the presence of specific antibodies against Borrelia burgdorferi, the bacterium causing Lyme Disease. The two-step process, starting with an initial Enzyme-linked immunosorbent assay (ELISA) screening and followed by the Western blot, ensures accurate diagnosis and reduces false-positive results.
JAK inhibitors
Work same way as DMARDS staves off auto-immune activity JAK inhibitors assist in this process usually combined with DMARD's Given for RA Liver must be checked and CBC x 2-3 months First two weeks need entire blood work up, making sure liver is not affected
The nurse is caring for a client with hyperaldosteronism who is not a candidate for adrenalectomy surgery. Which interventions would the nurse expect the HCP to prescribe? Select all that apply. A. Administer oral spironolactone. B. Monitor for and report dry mouth C. Avoid or limit potassium-rich foods. D. Glucocorticoid replacement therapy. E. Instruct client to report gynecomastia
a, b, e
Stage 1 Lyme Disease
acute localized bullseye rash 3-30 days after bite, white in middle of red circle flu-like symptoms: chills, fever, myalgia, fatigue, headache stop and treat here!
Exam 5: 10: Which of the following lifestyle modifications are appropriate for John to manage his rheumatoid arthritis (RA) symptoms? (Select all that apply.) Avoiding tobacco smoking and secondhand smoke exposure. Applying cold packs to inflamed joints for pain relief. Maintaining a high-stress work environment. Regular low-impact exercises, such as swimming or walking. Limiting dietary intake of foods high in omega-3 fatty acids.
avoid tobacco smoking and secondhand smoke regular low-impact exercises, such as swimming or walking
Stage 3 Chronic Lyme Disease
begins weeks to more than 1 year after bite chronic sequelae: arthritis, neuropathy, myalgia, myocarditis Neurologic symptoms may persist for 10+ years cardiac dysfunction
Pre-operation, before adrenalectomy
check fluids and aelectrolytes control bp
Meds for Gout
colchicine: for acute phase, call for help, lowers deposits of uric acid and interfers w leukocyte infiltration, thus reducing inflammation. Acute management: administer when attack begins, dosage increased until pain is relieved or diarrhea stops, the stop medication. Chronic mangement: causes gastrointestinal upset in most patients probenecid: Uricosuric agent; inhibits renal reabsorption of urates and increases the urinary excretion of uric acid, prevents tophi formation. be alert for nausea and rash. allpurinol, - for management of symptoms, febuoxostat: Xanthine oxidase inhibitors; interrupts the breakdown of purines before uric acid is formed, inhibit xanthinoxidase because uric acid formation is blocked. Monitor for side effects: including bone marrow depression, nausea, vomiting, diarrhea, Abd pain, or rash. Avoid starting med or increasing dose if active flare is present.
Name: Mary Johnson, Age: 45 Occupation: Teacher Medical History: Hypertension, Type 2 Diabetes Mary Johnson, a 45-year-old teacher, presents to the endocrinology clinic with a variety of symptoms. She has been feeling increasingly fatigued, gaining weight despite no change in diet or physical activity, and experiencing frequent mood swings. Mary also mentions that she has noticed a "buffalo hump" on her upper back and has developed a round, red face. She reports difficulty sleeping and feeling anxious. Her blood pressure has been elevated, and she has a history of type 2 diabetes that has been well-managed with medication. Mary's vital signs are within normal limits, except for elevated blood pressure (160/95 mmHg). A physical examination reveals the presence of the buffalo hump and moon face. Her skin is thin and fragile, and she has easy bruising. The nurse notes that Mary's thyroid gland is enlarged (goiter) and
continued... Laboratory Results Serum Calcium Levels: 11.2 mg/dL (elevated)Serum Parathyroid Hormone (PTH) Levels: Result: 85 pg/mL (elevated)Vitamin D Levels: 22 ng/mL (low)Serum Phosphorus Levels: 3.2 mg/dL (within normal range)Albumin Levels: 4.2 g/dL (normal)Bone Density Testing (DEXA Scan): T-score of -2.5 at the lumbar spine and hip (indicative of osteoporosis) Urinary Calcium Excretion: 300 mg/24 hours (elevated)Kidney Function Tests (BUN and Creatinine): BUN: 18 mg/dL (normal)Creatinine: 0.9 mg/dL (normal) Electrolyte Panel:Sodium: 140 mEq/L (normal)Potassium: 4.2 mEq/L (normal)Chloride: 102 mEq/L (normal)Complete Blood Count (CBC):Hemoglobin: 12.2 g/dL (normal)White Blood Cell Count: 6,500/mm³ (normal)Platelet Count: 250,000/mm³ (normal)
Manifestations and complications in Fibromyalgia
widespread pain, joint and muscle pain 11/18 tender points, both sides of body, top and bottom (serial testing if 11/18) chronic fatigue morning stiffness IBS anxiety/depression (Mia had chronic fatigue on 11/18)
