Exam 2 Adult Health, Immune, Musculoskeletal, Neurological Disorders. final

ALS end of life

DNR? Advanced directive Dyspnea Opioids and Benzodiazepines : help with sleep, pain, muscle spasticity, and anxiety Respiratory Support- Mechanical Ventilation Referral to Hospice: Ongoing support to patient and family Advance Directives and Living Will

Drug therapy for Type I allergies

Decongestants antihistamines corticosteroids Mast cell stabilizers Leukotriene antagonists

causes of secondary osteoporosis

Diseases such as: Diabetes Cirrhosis Bone Cancer Rheumatoid Arthritis Hyperparathyroidism, Hyperthyroidism (causing excessive calcium removed from the bone). Chronic Drugs: Corticosteroids, Antiepileptic drugs, Barbiturates, ETOH, Immunosuppressants, Chemotherapy Loop diuretics (Lasix)—increases Ca loss .

RA assessment

Early joint stiffness, swelling, pain, fatigue, generalized weakness late joints become progressively inflamed and every painful •SYSTEMIC OSTEOPOROSIS SEVERE FATIGUE ANEMIA WEIGHT LOSS SUBCUTANEOUS NODULES PERIPHERAL NEUROPATHY VASCULITIS PERICARDITIS FIBROTIC LUNG DISEASE SJOGREN'S SYNDROME KIDNEY DISEASE FELTY'S SYNDROME CAPLAN'S SYNDROME

ALS assessment

Early symptoms include: Fatigue while talking, Tongue atrophy, Dysphagia (difficulty swallowing) Weakness of the hands and arms, Fasiculations (twitching) of the face, Nasal quality of speech, and Dysarthria (slurred speech)

MS Treatments

Exacerbation - steroids needed high dose of IV steroid Never stop abruptly Must tapper off ACTH = within one hour of them being their Immunosuppressive agents - must be on time Autoimmune disorder Once a. mounth or 6 weeks Remacade Humeria

Type II immune complex reactions

Excess antigens cause immune complexes to form in blood Circulating complexes lodge in small blood vessels Usual sites: Kidneys, skin, joints Deposited complexes trigger inflammation, resulting in tissue or vessel damage •Examples: -Rheumatoid arthritis -Systemic lupus erythematosus

Fractures

Fractures -A fracture is a break in the continuity of a bone -Classifications Complete or incomplete Closed or open Comminuted-mutiple bone fragments Linear: parallel to long axis of bone Oblique: fracture line at an angle to long axis of bone Spiral Avulsion: fragment of bone connected to a ligament of tendon breaks of main bone

osteoporosis risk factors

Generalized - common occurring in post menopausal women Thin woman (Asian higher risk) Men with slower loss of bone Women more rapid Caused by genetic, lifestyle and environmental factors Regional - secondary disease which occurs when a limb is immobilized due to fracture, injury or paralysis. Longer than 8-12 weeks

Definition of connective disorders

IT IS THE "CELLULAR GLUE" THAT GIVES YOUR TISSUES THEIR SHAPE AND HELPS KEEP THEM STRONG AND HELPS SOME OF YOUR TISSUES DO THEIR WORK. CARTILAGE AND FAT ARE EXAMPLES OF CONNECTIVE TISSUE. THERE ARE OVER 200 DISORDERS THAT IMPACT CONNECTIVE TISSUE. SOME ARE A RESULT OF INFECTION OTHERS ARE FROM INJURIES AND SOME ARE GENETIC. SOME HAVE NO CAUSE. •EACH DISORDER HAS ITS OWN SYMPTOMS AND NEEDS DIFFERENT TREATMENT.

Tensilon

If you respond the the treatment of this certain medication it is considered a positive Myasthenia Gravis test. What is the name of this medication?

chronic fatigue syndrome (CFS)

Incapacitating exhaustion following only minimal exertion, accompanied by fever, headaches, muscle and joint pain, depression, and anxiety. fatigue for 6 months or greater better sleep helps

Osteomyelitis

Infection of the bone different causative factors periodontal disease long term IV catheters UTIs Salmonella of GI tract MRSA Treatment surgery bone graft antimicrobial therapy need for PICC line COntrol pain Bone grafting

Lupus assessment

LABORATORY: SKIN BIOPSY (CONFIRMS DIAGNOSIS) IMMUNOLOGIC-BASED LABORATORY TESTS CBC (OFTEN SHOWS PANCYTOPENIA) ALL BLOOD CELLS ARE ATTACKED BODY SYSTEM FUNCTION ELECTROLYTES CARDIAC/LIVER ENZYMES CLOTTING FACTORS

Acute Seizure Management

Lorazepam (Ativan) Diazepam (Valium) To stop clusters and prevent development of status epilepticus IV phenytoin (Dilantin) or fosphenytoin (Cerebyx) Used for all type seizures Can be taken as prophylasis or given IV during acute seizure Signs of toxicity: nystagmus, ataxia, confusion, nausea, slurred speech and dizziness Give only in NSS if administering IV

RA medication therapy

METHOTREXATE (RHEUMATREX) {ONCE A WEEK)} TAKES 4-6 WEEKS TO WORK SE: DECREASED WBC & PLATELETS OR ELEVATED LIVER ENZYMES OR SERUM CREATININE. LEFLUNOMIDE (ARAVA) SLOW-ACTING HELPS WITH STIFFNESS/JOINT SWELLING SE: HAIR LOSS, DIARRHEA, DECREASED WBC & PLATLETS IMPORTANT TO EDUCATE ABOUT BIRTH DEFECTS - STRICT BIRTH CONTROL. HYDROXYCHLOROQUINE (ANTIMALARIAL) PLAQUENIL

MS diagnosis

MRI* and/or CT Scan Dissemination of Lesions over time Cerebral Spinal Fluid (CSF) Elevated t lymphocytes elevated IgG (Immunoglobulin G)

Chronic MG management

Most often at home May require assist devices Health teaching: Medication regiment Take medications on time to maintain blood levels Do not take over the counter drugs S/S crisis Risks for exacerbations Infection, stress, extreme heat/cold, surgery, hard exercise, sedatives, enemas or strong cathartics Family education: CPR training

Care of Huntington's disease

No cure or treatment Avoid having biologic children Genetic counseling / At risk get tested Drugs to help symptoms: Tetrabenazine (Xenazine)- helps decrease chorea (jerky movements) Risk of drug- increases risk of depression, suicide ideation

Fat embolism syndrome

Obstruction of the pulmonary vascular bed by fat globules Within 12-48 hours after an injury. (Pelvic fx. Up to 72 hours after injury) Common in total joint replacements Men 20-40 highest risk Mainly from long bone fractures Altered Mental Status**** Increased respirations Chest Pain, Crackles in lungs Hydration, bedrest, oxygen and possible steroids

Surgical Management of bones

Open Reduction and Internal Fixation (ORIF) Permits early mobility Surgeon views site Uses metal pins, screws, rods, plates immobilizes during healing Cast, boot or splint helps maintain immobilization after surgery After union - metal hardware may be removed External Fixation (External Fixator) Alternative for management Pins and wires inserted Open fx - wound care Removed - placed in cast or splint

seizure precautions

Oxygen Suction equipment Airway IV access Siderails up Using padded rails is debatable No tongue blades NEVER insert into the patient's mouth because the jaw is often clenched as soon as a seizure begins Can chip teeth, cause soft tissue damage, or obstruct the airway

ALS interventions

Pharmacological Riluzole (Rilutek): is the only FDA approved drug for ALS, it is not a cure, but it does extend survival time. Check liver function tests. Nutrition Fluid intake Small, frequent, high-nutrient meals Suction equipment available during meals When muscles become weak may insert a feeding tube and have enteral feedings Speech and Language Assessing swallowing Develop communication system

Parkinson's disease

Progressive neurodegenerative disease Common with older adults Affects motor ability

Crisis (MG)

Rapid progressive respiratory and bulbar (facial) muscle weakness Underlying Causes: infection, electrolyte abnormalities, stress, excessive use of cholinesterase inhibitors, post-op status. May be unknown Suspect when presenting symptoms are: Sleeping difficulties, tachycardia, dyspnea, and dysphagia

GBS manifestations

Respiratory atelectasis / Pneumonia Acute respiratory failure Inability to swallow or clear secretions Immobility Venous thrombosis Muscle wasting / joint contractures Hyporeflexia and weakness may progress to tetraplegia Parasthesias of the hands and feet (unpleasant burning, stinging or prickly feeling) Cardiovascular Hypertension/postural hypotension Bradycardia ** No cognitive impairment

Osteoporosis nursing care

Risk for Fractures Nutritional therapy Adequate protein, magnesium and Vitamin K (trace minerals) Increase Ca and Vitamin D If fracture - increase intake of Ca, Iron and Vitamin C - helps healing! Exercise helps w/pain, cardiovascular function, weight bearing Lifestyle changes Avoid tobacco One alcoholic drink a day

Huntington disease (Huntington chorea)

Sad Genetic disorder Single gene disorder caused by mutation More common in males Passed down What happens: 1.First stage acts like dementia 2.Jerky movements 3.Avoid having children 4.Very few know they have hunting's 5.More makes affected

Viral Meningitis

Self limiting; complete recovery expected, an result from viral infections (measles, mumps, herpes simplex and herpes zoster inflammation over cerebral cortex, white matter and meninges

Parkinson's disease symptoms

Shuffling, propulsive gait Teach patients to stand straight Stops as at lines, pivoting very hard, hours to pivot through door ways Cog Wheel, Jerky same repetitive motions over and over Depression They have a super hard time to fall alseep- trying to lay still Best part of their day is sleeping Need pills to sleep High risk for suicide Educate them on depression and suicide prevention

Evaluation of PD

Strives towards improved mobility Progresses towards self-care Maintains bowel function Attains improved nutritional status Achieves a method of communication Copes with the effects of PD

angioedema

Swelling Assess ABC Mucosa accumulates fluid swelling can cause airway to collapse

Lupus Drug therapy

TOPICAL CORTISONE DRUGS PLAQUENIL DECREASES ABSORPTION OF UV LIGHT - PREVENTS SKIN LESIONS TYLENOL OR NSAIDS CHRONIC STEROID THERAPY IMMUNOSUPPRESSIVE AGENTS METHOTREXATE AND/OR IMURAN FIRST DRUG APPROVED IN 60 YEARS FOR SLE BELIMUMAB (BENLYSTA) DECREASES SURVIVAL OF THE B-CELL

A

The nurse considers that a 70-year-old female client can best limit further progression of osteoporosis by doing what? A. Taking supplemental calcium and vitamin D B. Increasing the consumption of eggs and cheese C. Taking supplemental magnesium and vitamin E D. Increasing the consumption of milk and milk products

CD

The nurse is assessing a client with severe nodule-forming rheumatoid arthritis for possible Felty syndrome. Which assessment findings are consistent with Felty syndrome? *Select all that apply.* A. Itchy eyes B. Dry mouth C. Leukopenia D. Spenomegaly E. Photosensitivity

B

The nurse is preparing an individualized teaching plan for a client with osteoarthritis. The nurse recognizes which abnormality specific to osteoarthritis? A. Ulnar drift B. Heberden nodes C. Swan-neck deformity D. Boutonnière deformity

A

The nurse is providing education to a client with systemic lupus erythematosus. Which education will the nurse consider as high priority? A. Instructing about ways to protect the skin B. Helping the client to identify coping strategies C. Teaching methods to monitor body temperature D. Teaching about the effects of the disease on lifestyle

anaphylaxis

This is the worse type I hypersensitivity reaction that can occur, it is rapid, systemic and can be fatal.

MG management

Treats the Symptoms Cholinesterase Inhibitors Mestinon & prostigmin most common Immunosuppression Glucocorticoids (Prednisone) Azathioprine (Imuran) Cyclosporine (Neoral, Sandimmune) Plasmaphoresis short solution, surgery, refraction to other Rx IVIG Improvement ≥ 50% Remove Thymus - not always effective

Triad of symptoms

Triad of symptoms: 1.Tremor 2.Rigidity 3.Bradykineasia (abnormally slow movements) 4.Postural instability 5.Dopamine is affect- (oil of care, fire ups and makes motor movements smooth) 1.Without the dopamine in the body movements wont be smooth 2.Body freezes

Latex allergy

Type I hypersensitivity reaction Protein found in natural latex rubber products is specific allergen Allergen causes interaction with IgE Incidence of latex allergy is increasing Health care workers especially susceptible

Types of Siezures

Types of Seizures: Generalized / Partial/ Unclassified (Idiopathic) Generalized: Tonic/Clonic Seizure: Tonic: stiff/rigid muscles Clonic: rhythmic jerking of extremities Partial Seizures: Focal/Local Seizures Unclassified : also called idiopathic seizure: occur for no reason

Progressive Muscular Dystrophies

Unknown pathophysiology Primary problem - muscle weakness Major cause of death is respiratory failure Cardiac failure - dystrophin is need for muscle contraction Most common are Duchenne and Becker (X-linked genetic disorders)

MS symptoms

Visual Acuity Problems (Optic Neuritis) Fatigue Muscle Weakness/spasticity Dysarthria Dysphagia Diplopia Bowel and bladder dysfunction Decreased visual and hearing acuity Alterations in sexual dysfunction Cognitive Changes! Depression Nystagmus Ataxia Paresthesia

Termer, rigidity, Bradykineasia

What are is the triad of symptoms for Parkinson's disease?

azathioprine (Imuran), cyclophosphamide (Cytoxin)

What are the main immunosuppressants For MS?

Methylprednisolone, Prednisone

What are the main two corticosteroids for treating MS?

A

What does the nurse suspect from the image? A. Rash due to tick bite B. Rash due to bee sting C. Rash due to bedbug bites D. Rash due to body lice bites

Avoidance Therapy

What is one of the best interventions for hypersensitive allergies?

Respiratory failure (must intubate)

What is one of the biggest risk factors of GBS?

Plasmapheresis (plasma exchange)

What is the main medical intervention for GBS?

Know what they are allergic to and how to use an EPIpen

What needs to be done for a patient to be successful once discharged from the hospital for anaphylaxis?

increased eosinophils, and IgE

What two laboratory Assessments will be increased that could me a possible allergy to something.

C

What type of hypersensitivity reaction is the cause of systemic lupus erythematosus? A. Type I B. Type II C. Type III D. Type IV

AB

Which are examples of a type IV hypersensitivity reaction? *Select all that apply.* A. Poison ivy allergic reaction B. Sarcoidosis C. Myasthenia gravis D. Rheumatoid arthritis E. Systemic lupus erythematosus

AB

Which conditions may result from immunoglobulin IgE antibodies on mast cells reacting with antigens *Select all that apply.* A. Asthma B. Hay fever C. Sarcoidosis D. Myasthenia gravis E. Rheumatoid arthritis

BCD

Which emergency care actions are priority for a hospitalized client who develops an anaphylactic reaction after receiving a medication? *Select all that apply.* A. Raise the feet and legs. B. Assess the respiratory status. C. Call the Rapid Response Team. D. Discontinue the intravenous drug. E. Keep the head of the bed elevated to 10 degrees.

B

Which nursing intervention is most appropriate for a client in skeletal traction? A. Add and remove weights as the client desires. B. Assess the pin sites at least every shift and as needed. C. Ensure that the knots in the rope are tied to the pulley. D. Perform range of motion to joints proximal and distal to the fracture at least once a day.

BCD

Which symptoms are observed in a client with Sjögren's syndrome? *Select all that apply.* A. Angioedema B. Tooth decay C. Corneal ulcers D. Vaginal dryness E. Pulmonary hemorrhage

Venus Thromboembolism

a blood clot or obstruction of congregated group of blood cells

Diplopia

a disorder of vision in which two imagines of a single object

Paresthesia

a sensation of pricking, tingling, or creeping on the skin that has no objective cause

serum sickness

a type III hypersenstiivty reacton to nonhuman proteins characterized by vascultitis resultign from tissue depostion of ciruclating immune complexes. Clinical findings include fever, pruritic skin, rash, arthralgias, and low serum C3 and C4 complement levels.

Type IV hypersensitivity Treatment

administer corticosteroids and cannot give histamine or Benadryl because they won't work

Foods that cause migraines

alcoholic drinks aged cheese caffeine/caffeine with draw MSG Artificial sweeteners smoked fish

Osteoporosis Drugs

alendronate (Fosamax) raloxifine (Evista) Calcitonin Vitamin D, C and K lots of protein

Allergic Rhinitis

an allergic reaction to airborne allergens that causes an increased flow of mucus seasonal allergies hay fever Plant pollens Molds Dust Animal Dander Wool Food Air pollutants

Guillian-Barre Syndrome (GBS)

autoimmune attack on the peripheral nerve myelin Acute inflammatory condition involving the spinal nerve roots, peripheral nerves and possibly cranial nerve. antecedent (viral infection, trauma, surgery or immunization) event precipitates the clinical presentation

Sjogren's syndrome

autoimmune destruction of minor salivary glands and lacrimal glands associated with autoimmune disorders dry eyes, dry mouth, tongue, xerostomia often found with patients with Rheumatoid arthritis or fibromyalgia.

myasthenia gravis (MG)

autoimmune neuromuscular disorder characterized by weakness of voluntary muscles Chronic autoimmune, gets worse and then better, Progressive, exacerbation Mostly women younger than 40, men older than 60 MG acetylcholine destroyer- meds that we give will improve that

Marfan Syndrome

autosomal dominant; pleiotropic; tall, weak heart- causes heart to fail life span is early 30s

Latex Shellfish iodine

biggest three allergies that are affected in the hospital?

Lyme disease

caused by the spirochete Borrelia burgdorferi and is transmitted to humans by the bite of an infected deer tick Chronic complications: arthralgias fatigue memory/thinking problems Lesion is bull like symptoms 3-30 days once you have lyme you have it for life

Fibromyalgia

chronic condition with widespread aching and pain in the muscles and fibrous soft tissue

rheumatoid arthritis (RA)

chronic systemic disease characterized by autoimmune inflammatory changes in the connective tissue throughout the body •35-45 AGE OF ONSET •FEMALE (3:1) •CAUSES: AUTOIMMUNE, EMOTIONAL STRESS, ENVIRONMENTAL FACTORS •PROCESS INFLAMMATORY •BILATERAL/SYMMETRICAL/MULTIPLE JOINTS •UPPER EXTREMITIES FIRST •DISTAL INTERPHALANGEAL - SPARED •LABS: ELEVATED RHEUMATOID FACTOR, ESR •COMMON THERAPY: NSAIDS, METHOTREXATE, BRM, IMMUNOSUPPRESSIVE AGENTS

lupus erthematosus (LE)

chronic, progressive, inflammatory connective tissue disorder can cause major body organs/system to fail

Nystagmus

crossed eyed

Nursing interventions

decreased stimulants Pain medication

Dysphonia

defective use of the voice

Amyotrophic Lateral Sclerosis (ALS)

degenerative disorder of motor neurons in the spinal cord and brainstem Progressive, degenerative disease that involves the voluntary motor system (upper and lower) Characterized by atrophy of the hands, forearms, and legs Mechanical ventilation prolongs survival but does not alter progression of disease Results in paralysis and death No know cause, cure, specific treatment

Autoimmunity

development of an inappropriate immunity antibodies/lymphocytes directed against healthy normal cells and tissue Immune system fails to recognize certain body cells/tissue as self, triggers immune reactions body attacks its own cells

Dyspnea

difficult or labored breathing

Dysarthria

difficult or unclear articulation speech

ptosis

drooping of the eyes or organ part

wheals

elevated patches of skin that can change shape, they are itchy

Uticaria

hives; an eruption of wheals on the skin accompanied by itch frequent hives

Lhermitte's sign

identifies dysfunction of spinal cord and/or an upper motor neuron lesion. Sign of MS chin to chest = test

Dysmetria

impaired ability to estimate distance in the muscular

GBS plan of care

improve respiratory function increase mobility Return to normal function/rehabilitation

Osteoarthritis (OA)

inflammation of the bone and joint; the most common type of arthritis in the United States and in people over 55 years of age progressive disorder that gets worse heberden's nodes Bushard's nodes

Bacterial Meningitis

inflammation of the protective membranes covering the brain and spinal cord caused by various types of bacteria can kill you HIV patients at very high risk

compartment syndrome

involves the compression of nerves and blood vessels due to swelling within the enclosed space created by the fascia that separates groups of muscles cast dressing

Rhabdomyolysis

is a life threatening complication of severe muscle trauma with muscle cell loss crush syndrome compartment syndrome classic train muscle pain, weakness, and dark urine (from myoglobin)

Diagnosing meningitis

lumbar puncture ct scan CBC

external fixator advantages

minimal blood loss allows for early mobilization maintains alignment in closed fracture permits easy access to wound or healing bone disadvantage infection due to poor pin care

Benign bone tumors

most common is Osteochondroma can spread to lung huge bone grow NSAIDS for pain surgery to remove giant cell

Osteomalacia

normal osteoblast production of bone collagen inadequate mineralization Malabsorption of vitamins from small bowel complications from gastrectomy bypass or resection of small intestine adult rickets softening of bone

Hives

patches that are raise a bit/red they come and go

Carpal Tunnel syndrome

pathophysiology phalanx test limitations after surgery high risk patients

Psoriatic arthritis

psoriasis, scaly, silver, red, itchy, inflamed. sausage fingers/toes. morning stiffness. decreased ROM. pitting or lifting up of nails. pain/swelling over tendons/ligaments 30-50 years of age

Type IV (delayed) hypersensitivity

reactive cell is T-lymphocyte antibodies local collection of lymphocytes and macrophages, causes edema, induration, ischemia, tissue damage at site contact dermatitis poison ivy skin rash Local response to bee sting Tissue transplant rejection Sarcoidosis reaction to nickel (earnings)

Migraines

recurrent episodic attacks of head/throbbing and unilateral S/S nausea/vomiting Photophobia Phono-phobia last 4 to 72 hours

Bone Fracture Treatment

reduction and immobilization, traction,

plasmapheresis

removal of plasma from withdrawn blood by centrifuge used to treat Cytotoxic hypersensitivity

Felty's syndrome

rheumatoid arthritis, an enlarged spleen, and an abnormally low white blood count (leukopenia)

Bradykinesia

slowness of movement and is one of the cardinal manifestations of Parkinson's

Siezures

sudden, excessive, uncontrolled electrical discharge of neurons in the brain that causes a change in LOC, motor or sensory ability, or behavior. Epilepsy: two or more seizures

Bone Traction

the application of pulling to a part of the body to provide reduction, alignment and rest, last resort to decrease muscle spasms helps relieve and prevent damage to tissue

Paget's disease

tinnitus, bone pain, elnargement of bone, thick bones uncontrolled destruction of bone by large osteoclasts w/haphazard formation of new bone by osteoblast weak bone that frackers genetic link 50 years or older Diagnosis Serum alkaline phosphatase (ALP) and urinary hydroxyproline levels (assess for the degree of severity). Increased uric acid levels X-rays, MRI or CT scan (if cancer is suspected

Reiter's syndrome

type of reactive arthritis that happens as a reaction to a bacterial infection in the body. Sx: fainting, weekness, bounding pulse, angina on occasion, SOB, fatigue Tests: palpation, increase pulse pressure and diastolic pressure, pulmonary edema present, auscultation, left heart cath, aortica angiography, dopper US, Echocardiogram Tx: digoxin, dieuretics, surgical aorta valve repair Monitor for: PE, Left-sided HF, Endocarditis

GBS (guillain-barre syndrome) Dx findings

weakness altered reflexes Labile BP cardiac dysrhythmias presence of Protein in CSF (lumbar puncture)

Butterfly rash

what is the most common clinical manifestation of Lupus?

Patch Tests

what test do you use for Type IV hypersensitivity?

Drug Therapy (Cont. PD)

•Anticholinergic drugs are also used in management -↓ Activity of acetylcholine -Benztropine (Cogentin), Procyclide (Kemadrin) -Considerations: •Antihistamines (Benadryl); anticholinergic properties •β-adrenergic blockers (Inderal) -Manage tremors •Antiviral agent are effective, although exact mechanism is unknown; early in disease; may be given with Sinemet to reduce dyskinesia -Amantadine (Symmetral)

Drug therapy for (PD)

•Dopamine agonists- mimics dopamine by stimulating dopamine receptors in the brain. Most effective 3-5 years of use •Fewer instances of dyskinesias (problems with movement); wearing-off phenomenon •Usually the first drug tried •Adverse effects: orthostatic hypotension, hallucinations, sleepiness, drowsiness »Pergolide (Permax) »Ropinirole (Requip) »Pramipexole (Mirapex)

Postural Instability (PD #4)

◦Development of postural and gait problems-loss of postural reflexes Head bent forward and walks with a propulsive gait Caused by the forward flexion of the neck, hips, knees, and elbows Walks faster and faster = shuffling gait Difficulty in pivoting

rigidity (PD)

◦Increased resistance to passive motion when limbs are moved through ROM 1. Cogwheel rigidity -rhythmic interruption of muscle movement 2. Plastic-mildly restrictive movements 3. Lead pipe- total resistance to movement ◦Movement: Inhibits the alternating contraction and relaxation in opposite muscle groups = slowing movement

Tremor (PD)

◦Minimal initially ◦More prominent at rest and is aggravated by emotional stress or ↑ concentration ◦Hand tremor = "pill rolling" because thumb and forefinger appear to move in rotary fashion as if rolling a pill, coin, or other small object

Bradykinesia (PD)

◦Slowing down in initiation and execution of movement ◦Evident in loss of autonomic movements Blinking Swinging of arms while walking Swallowing of saliva Self-expression with facial movements

Clinical Manifestations of meningitis

*Fever.* *Severe headache.* *Nuchal rigidity.* Nausea. Vomiting. *Macular rash, may appear as purpura.* *Photophobia.* Visual disturbances: diplopia; ptosis; unequal pupils. Tinnitus. Vertigo. Deafness. *Decreased LOC* S&S of IICP. The headache becomes progressively worse and may be accompanied by vomiting and irritability.

Lupus Clinical Manifestations

- Skin involvement --- Butterfly rash - Polyarthritis - Osteonecrosis - Muscle atrophy - Fever and fatigue - Renal involvement - Pleural effusions - Pericarditis - Raynaud's phenomenon - Neurologic manifestation - Serositis arthritis of the Joints

Caplan's syndrome triad

-Pneumoconiosis -RA -Pulmonary "rheumatoid" nodules **Present with all pneumoconioses

Scleroderma (systemic sclerosis)

1. Autoimmune disorder causing overproduction of collagen 2. Porcelain doll appearance 3. Raynaud's Phenomenon: Episodic vasoconstriction of digits, white discoloration, related to cold 4. Oral finding: Widening of PDL space all teeth

Medication and Diagnosis

2 out of the 4 signs and symptoms they you go on the medication Meds can take approximately 4 months to build up in your system and work Medicine dont work fast, you start the process over and over and over again

C

A client admitted to the hospital with an acute episode of rheumatoid arthritis (RA) asks why physical therapy has not been prescribed. What is the most appropriate nursing response? A. "Your primary healthcare provider must have forgotten to prescribe it." B. "Your condition is not severe enough to have physical therapy approved." C. "Your joints are still inflamed, and physical therapy can be harmful." D. "Physical therapy is not helpful for persons who suffer from RA."

B

A client experiences an acute episode of rheumatoid arthritis. The nurse observes that the client's finger joints are swollen. The nurse concludes that this swelling most likely is related to which factor? A. Urate crystals in the synovial tissue B. Inflammation in the joint's synovial lining C. Formation of bony spurs on the joint surfaces D. Deterioration and loss of articular cartilage joints

BCD

A client is admitted to the emergency department with joint pain and swelling. Upon assessment the nurse suspects rheumatoid arthritis. Which findings support the nurse's conclusion? *Select all that apply.* A. Obesity B. Antinuclear antibodies C. Inflammatory disease pattern D. Disease in the bilateral symmetric joints E. Disease in the distal intrapharyngeal joints F. Disease in the weight-bearing joints and hands

ACD

A client is admitted with full-blown anaphylactic shock that developed due to a type 1 latex allergic reaction. Which findings will the nurse observe upon assessment? *Select all that apply.* A. Stridor B. Fissuring C. Hypotension D. Dyspnea E. Cracking of the skin

B

A client is experiencing an exacerbation of systemic lupus erythematosus. To reduce the frequency of exacerbations, what would be important for the nurse to include in the client's teaching plan? A. Basic principles of hygiene B. Techniques to reduce stress C. Measures to improve nutrition D. Signs of an impending exacerbation

D

A client reports redness, itching, burning, and pain in the palms and elbows. On assessing, the nurse finds demarcated, silvery, scaling plaques in the area. Which drug does the nurse expect in the client's prescription? A. Oral famcyclovir B. Intravenous ceftriaxone C. Topical benzoyl peroxide D. Intralesional injection of corticosteroids

B

A client suffered an injury to the leg as a result of a fall. X-ray films indicate an intertrochanteric fracture of the femur. The client will be placed in Buck traction until surgery is performed. When considering the client's plan of care, the nurse recalls that the primary purpose of Buck traction is to do what? A. Reduce the fracture. B. Immobilize the fracture. C. Maintain abduction of the leg. D. Eliminate rotation of the femur.

BE

A client with a fracture is found to have compartment syndrome. Which interventions will be contraindicated? *Select all that apply.* A. Splitting the cast in half B. Applying cold compresses C. Reducing the traction weight D. Loosening the client's bandage E. Elevating the extremity above heart level

D

A client with rheumatoid arthritis asks the nurse about ways to decrease morning stiffness. What should the nurse suggest? A. Wearing loose but warm clothing B. Planning a short rest break periodically C. Avoiding excessive physical stress and fatigue D. Taking a hot tub bath or shower in the morning

A

A client with rheumatoid arthritis has been taking a steroid medication for the past year. For which complication of prolonged use of this medication should the nurse assess the client? A. Decreased white blood cells B. Increased C-reactive protein C. Increased sedimentation rate D. Decreased serum glucose levels

A

A client with rheumatoid arthritis is to begin taking ibuprofen 800 mg by mouth three times a day. The nurse provides education about the medication's side effects. The nurse concludes that the teaching was effective when the client makes which statement? A. "I need to have my blood work checked periodically." B. "I need to balance exercise with rest." C. "I need to change positions slowly." D. "I need to take the medication between meals."

Osteoporosis

A condition in which the body's bones become weak and break easily.

Multiple Sclerosis (MS)

A demyelinating disease of the white matter of the brain and spinal cord characterized by exacerbations and remissions. Multiple mechanisms participate in the demyelination and axonal injury.

A

A nurse is performing an admission health history and physical assessment for a client who has severe rheumatoid arthritis. When assessing the client's hands, the nurse identifies that they are similar to the hand in the illustration. What should the nurse document in the medical record when describing this typical physiologic change associated with rheumatoid arthritis? A. Ulnar drift B. Hallux valgus C. Swan-neck deformity D. Boutonnière deformity

D

A nurse is taking the health history of a client who is to have surgery in one week. The nurse identifies that the client is taking ibuprofen for discomfort associated with osteoarthritis and notifies the healthcare provider. Which drug does the nurse expect will most likely be prescribed instead of the ibuprofen? A. Naproxen B. Aspirin C. Ketorolac D. Acetaminophen

A

A nurse plans care to prevent deformities in a client with rheumatoid arthritis. Which intervention should be alternated with periods of rest? A. Active exercises B. Passive massage C. Bracing of joints D. Isometric exercises

AD

A primary healthcare provider schedules a bone scan for a client with osteoporosis. Which nursing actions are beneficial for the client *Select all that apply.* A. Placing the client in the supine position B. Verifying if the client has a shellfish allergy C. Ensuring that the client has no metal on the clothing D. Instructing the client to empty the bladder before the scan E. Informing the client that the postprocedure headache resolves in 2 days

aura

A sensation experienced prior to a seizure; serves as a warning sign that a seizure is about to occur.

A

A student nurse is teaching a client about preventive measures for Lyme disease. Which instruction given by the student nurse indicates a need for correction? A. "Wear dark colored dresses." B. "Wear closed shoes or boots." C. "Tuck your shirt into your pants." D. "Bathe immediately after being in an infested area."

CDE

After providing epinephrine to a client experiencing an anaphylactic reaction, which second-line drugs should the nurse prepare to provide? *Select all that apply.* A. Dopamine B. Norepinephrine C. Dexamethasone D. Diphenhydramine hydrochloride E. Hydrocortisone sodium succinate

D

After treatment for Lyme disease, a child expresses fear of going camping again because of the ticks. What is the best response by the nurse? A. "Tell me more about your fears about camping." B. "Just think of all the fun you'll be missing if you don't go to camp." C. "It's hard to believe you're afraid to go camping just because of a tick." D. "I understand you are afraid. Frequently checking for ticks can help prevent re-infection."

lumbar puncture (LP)

Also called Spinal Tap Obtains CSF or injects anesthetics Not done on patients with high ICPs or skin infections at or near puncture sites. Have patient remain lying down for at least 12 hours after puncture or spinal headache. Complications : brainstem herniation, infection, CSF leakage (spinal headache), and hematoma formation.

Type I: Rapid Hypersensitivity Reactions

Also called atopic allergy; most common type Reaction of IgE antibody on mast cells with antigen, which results in release of mediators, especially histamine- causes allergic reaction Ex. Hay fever, Allergic asthma, Anaphylaxis

C

An older adult fell at home and fractured the left hip. Which response should the emergency department nurse identify as a typical clinical indicator associated with a fractured hip? A. Affected hip is ecchymotic. B. Left extremity is internally rotated. C. Left leg is noticeably shorter than the right. D. Affected hip is tender when touched.

Type II Cytotoxic Hypersensitivity

Antigen is present on cell membrane May be normal body component or exogenous Circulating IgGs react with antigen Destruction by phagocytosis or cytolytic enzymes Example Response to incompatible blood transfusion

anaphylaxis interventions

Assess respiratory function establish or stabilize airway Oxygen stay with patient Epinephrine given ASAP - beta-adrenergic agonist antihistaines treast angioedema and urtucaria oral steroids corticosteroids

MG (myasthenia gravis) manifestations

Bilateral symptoms Muscle fatigue motor function affected Dysphonia (Voice Impairment) Ptosis Impaired chewing and swallowing

osteoporosis diagnosis

Bone Mineral Density test results are compared to the ideal or peak bone mineral density of a healthy 30-year-old adult A score of 0 means your BMD is equal to the norm for a healthy young adult. A T-score between +1 and −1 is considered normal or healthy. A T-score between −1 and −2.5 indicates that you have low bone mass. A T-score of −2.5 or lower indicates that you have osteoporosis.

meningitis

Broad-spectrum antibiotic Hyperosmolar agents Anticonvulsants Steroids (controversial) Prophylaxis treatment for those in close contact with meningitis-infected patient

CREST syndrome

Calcinosis, Raynaud's, esophageal dysmotility, Sclerodactyly, Telangiectasia

Volkmann's contracture

Condition in which the muscles in the palm side of the forearm shorten, causing the fingers to form a fist and the wrist to bend