Med surg 3- test 4- musculoskeletal

A 34-year old woman hospitalized for aspiration pneumonia also has a 5-year history of scleroderma. 1. How could scleroderma have contributed to the aspiration pneumonia? 2. What strategies will you suggest to decrease the risk of pneumonia recurrence?

1. thickening of the esophagus 2. elevate HOB, fluids, chick residuals, give h2 inhibitor, keep sitting up for 1-2 hours after meals

what is the mortality of the severe form of tetanus?

100%

what is the ANA titer of diagnosis of scleroderma?

1:40

when do you get tested for lyme?

2-4 weeks not sooner

A client arrives at the health clinic and tells the nurse that she was just bitten by a tick and would like to be tested for Lyme Disease. The client tells the nurse that she removed the tick and flushed it down the toilet. Which actions are most appropriate? Select all that apply. 1.Tell the client that testing is not necessary unless arthralgia develops. 2.Tell the client to to avoid any woody, grassy areas that might contain ticks. 3.Instruct the client to immediately start taking the AB that are prescribed. 4.Tell the client to plan to have a blood test 4-6 weeks after a bite to detect the presence of the disease. 5.Tell the client, if this happens again, to never remove the tick but vigorously scrub the area with an antiseptic.

2.Tell the client to to avoid any woody, grassy areas that might contain ticks. 3.Instruct the client to immediately start taking the AB that are prescribed. 4.Tell the client to plan to have a blood test 4-6 weeks after a bite to detect the presence of the disease.

Incubation period of lyme disease is _____ days, it migrates outward in the skin forming a lesion

30

If open wound occurs- contact HCP and if no tetanus within last ____ years, then you have to get a booster.

5

___________________ is most sensitive for diagnosis of scleroderma

Antinuclear antibody (ANA)

when a patient has lyme disease _________ enters the skin at the site of the tick bite

Borrelia burgdorferi

What med is given for raynauds?

CCBs for vasospasm

The limited symptoms of scleroderma are referred to as _________

CREST

__________ is in the skin of the fingers, hands, and in the pressure points- sometimes the white deposits will open up and leak out white stuff

Calcinosis

what does CREST stand for?

Calcinosis Raynaud's Phenomenum Esophageal Motility Dysfunction Sclerodactyly Telangiectasias

Neurotoxin released by anaerobic bacillus _______________when a patient has tetanus

Clostridium tetani

_____________ and ____________ for end-stage renal disease related to scleroderma

Dialysis and kidney transplant

what are antibiotics that can be used to treat lyme disease?

Doxycycline, Tetracycline, Amoxicillin, Erythromycin

when testing for lyme disease antibodies to B. burgdorferi can be detected by either the _______ or___________methods within 2-4 weeks of the initial skin lesion

ELISA or Western blot

what can be used to confirm diagnosis of GBS?

EMG and nerve conduction studies

_________ may also affect the nose, bronchi, vagina, and skin.

Excessive dryness

A college student is recovering from Guillain-Barre'. The student asks the nurse, " Will having this disease affect my ability to learn and function mentally?" Which response is appropriate? A."Guillain-Barre' does not affect cognitive function." B."Don't worry about school at this time." C." I will ask your doctor for you." D."You should get in touch with your school because you will not be able to handle the stress of trying to learn."

GBS does not affect cognitive function

more likely- comes from a donor- interferes with antigen presentation and is given over 5 days

IV Ig

____________ is tightening of the skin and blood vessel constriction

Raynauds

Systemic sclerosis (__________)-known as "hardening of the skin" it is a chronic disease characterized by the formation of excessive fibrous connective tissue and diffuse fibrosis of the skin and/or internal organs.

Scleroderma

what is guillain barre syndrom characterized by?

acute onset of ascending motor paralysis

A client is diagnosed with scleroderma. Which intervention should the nurse anticipate to be prescribed? 1.Maintain bedrest as much as possible. 2.Administer corticosteroids as prescribed for inflammation. 3.Advise the client to remain supine for 1-2 hours after meals. 4.Keep the room warm during the day and cool at night.

administer corticosteroids as prescribed for inflammation

Which medication would the nurse expect the HCP to order to treat the client diagnosed with botulism secondary to eating contaminated canned goods? 1.An antidiarrheal medication 2.An Aminoglycoside antibiotic 3.An Antitoxin medication 4.An ACE inhibitor medication

an aminoglycoside antibiotic

treatment for lyme disease?

antibiotics, aspirin, NSAIDS

If botulism is diagnosed early, can be treated with an __________that blocks the action of toxin circulating in the blood.

antitoxin

where are telangiectasias?

anywhere

Which interventions should the nurse implement for the client diagnosed with systemic sclerosis (scleroderma)? 1.Instill artificial tears 4 times a day. 2.Apply moisturizers to the skin frequently. 3.Instruct client on how to apply braces. 4.Encourage the client to decrease smoking.

apply moisturizers to the skin frequently

treatment for sjogrens?

artificial tears, surgery, increase fluid intake, saliva substitute, chewing sugarless gum

what do you do for management of GBS in the acute phase?

assess respiratory staus continuously, assess ascending paralysis, reflexes, cranial nerve function, cardiac function, monitor ABGs and vitals

as the disease scleroderma progresses, what happens to the skin?

atrophies, becomes taut, shiny and hyperpigmented

tachycardia, bradycardia, hyper and hypotension, abnormal sweating, and paralytic ileus-they get this bc their muscles aren't moving around and they are not able to get up and move around

autonomic dysfunction

when do you give Tdap?

before symptoms occur

Rare but most serious type of food poisoning

botulism

what type of bacteria is most commonly linked to GBS?

camplobacter

where is erythema migrans?

can be anywhere

what is not affected with GBS?

cognition or LOC

what can trigger raynauds?

cold or stress

what is overproduced to cause scleroderma?

collagen

what meds are for scleroderma?

corticosteroids, CCBs for raynauds, H2 receptor blockers, tetracycline, ace inhibitors

how is lyme disease diagnosed?

culture of organism

In teaching a patient with Sjogren's syndrome about drug therapy for this disorder, the nurse includes instruction on use of which drug? 1.Pregabalin (Lyrica) 2. Etanercept (Enbrel) 3. Cyclosporine ( Restasis) 4. Cyclobenzaprine (Flexeril)

cyclosporine

what are the signs and symptoms of botulism?

descending paralysis, muscle incoordination, difficulty swallowing, seizures, respiratory weakness

what meds would you give to control spasms for sedation and skeletal muscle relaxation for tetanus?

diazepam, barbituates, nmbas

what other problems will a GBS patient have?

difficulty speaking, chewing, swallowing

what happens to the mouth with sjogrens?

dry mouth, affects taste, smell, chewing, swallowing, increased risk for cavities

what happens to the eyes with sjogrens?

dry, gritty feeling that leads to corneal ulcers

what visceral organ impairment is involved in scleroderma?

dysphagia, dyspnea, dysrhthmias, diarrhea, constipation, proteinuria, renal failure

It tests the condition of the nerves from the spine into the extremity to the foot or hand. There are two parts to the test, the nerve conduction study and the needle study.

electromyographic study

what lab value can help determine if a patient has GBS?

elevation of CSF

how do you treat scleroderma nonmedically?

encourage activity, constant room temp, small frequent meals, avoid spicy foods and alcohol

what is the initial symptom of lyme idsease?

erythema migrans

what does localized scleroderma involve?

face, distal extremities, fingers

what happens with raynauds?

fingers will turn white, then hemoglobin releases o2 to the tissues turning fingers blue, then when they warm up they turn bright red

what is erythema migrans?

flat or slightly raised red lesion (bullseye)

why would a patient with tetanus get tacheostomy?

for laryngospasm

what do patients with sclerodactyly do?

get devices so they can do things easily

what is the prognosis like for localized scleroderma?

good

Acute inflammatory demyelinating disorder of the peripheral nervous system

guillain barre syndrome

with GBS there is numbess and thingling where?

hands, feet, lips

what does it mean if ELISA is positve?

have to do western blot test to confirm

how do you diagnose sjogrens?

health and physical, schrimers test, ocular staining, slit lamp

if the patient gets a lumbar puncture, what are they checking for?

high protein

what are the manifestations of lyme disease like?

highly individualized

how do you find out if a patient has GBS?

history and physical and symptoms

why would a patient with GBS get vasopressors or volume expanders?

hypotension

when is the only time a patient with GBS would get antibiotics?

if they develop a fever

how do you manage tetanus?

immunization, booster every 10 years

The client admitted with rule out Guillain-Barre' syndrome has just had a lumbar puncture. Which intervention should the nurse implement post- procedure? 1.Monitor client for hypotension. 2.Apply pressure to puncture site. 3.Test the clients cerebrospinal fluid. 4.Increase the client's fluid intake

increase the clients fluid intake

Exocrine glands in many areas of the body are destroyed by __________ and deposits of immune complexes.

infiltration of lymphocytes

what do you do if a patient needs Tdap and has symptoms

larger Tdap dose

what does the patient have to do after a lumbar puncture?

lie flat for 24 hours and get plenty of fluids

how can you prevent lyme disease?

light colored tight clothing, DEET

whats another name for tetanus?

lockjaw

how does the facial appearance change when a patient has scleroderma?

loss of skin lines and pursed lips

Inflammatory disease caused by the spirochete Borrelia burgdorferi, which transmitted primarily by ticks.

lyme disease

what are some other ways lyme disease can spread?

lymph, blood, organs

what can carry lyme disease?

mice, deer, dogs, cats

what med do you give for pain of tetanus?

morphine, fentanyl

GBS is the destruction of __________ covering the axons of the peripheral nerves.

myelin sheath

The ___________ portion of the study involves the insertion of very thin pin electrodes into the skin. The electrode is moved around slightly after insertion. Several muscles are tested in each extremity. You will fell a _________ sensation at the area of needle insertion. The electrodes that are used are disposable electrodes. They are designed for minimal pain and discomfort.

needle EMG, cramping

what does it mean if ELISA is negative?

negative

During the _________ portion of the study, mild electrical impulses are sent along the course of a nerve in the arm or the leg. You will feel a brief snapping sensation on the skin. The intensity of the impulse will be increased until ___________ is obtained. The electrical impulse will make the muscles in your arm and leg _________. The sensation you feel is much like ________.

nerve conduction, the desired response, contract, static electric shock

It is thought that the ________ destroys or inhibits neurotransmission of acetylcholine resulting in interrupted muscle impulse transmission.

neurotoxin

is there a vaccine for batulism?

no

Symptoms of GBS usually start with ______________, followed by weakness in ____________ that develops over a period of days to weeks. Hospital treatment is often needed during this time. The progression of weakness usually does not last longer than about __________. The weakness then stabilizes and gradually improves within_______.

numbness or tingling in the fingers and toes, leg and arm muscles, 4 weeks, a few weeks

what kind of moisturizer should a person with scleroderma use?

oil based, rub in for a few minutes because it takes so long to absorb through the skin

what determines how bad GBS is?

other health problems

During a routine assessment of a patient with Guillain-Barre' syndrome, the nurse finds the patient is short of breath. The patient's respiratory distress is caused by: a.elevated protein in the CSF b.immobility resulting from ascending paralysis c.degeneration of motor neurons in the brainstem and spinal cord. d.paralysis ascending to the nerves that stimulate the thoracic area.

paralysis ascending to the nerves that stimulate the thoracic area

remove antibodies and other immune factors- done 5 times every day or every other day

plasmapheresis

who is at risk for scleroderma?

plastic, silk, coal factory workers

what does GBS cause?

poor nerve impulse conduction, sudden muscle weakness, loss of reflex response.

what is the focus of nursing care for lyme didsease?

prevention

what is scleroderma like?

progressive, remission is rare, but can slow the progression

The client with Guillain- Barre' syndrome has ascending paralysis and is intubated and receiving mechanical ventilation. Which of the following strategies would the nurse incorporate in the plan of care to help then client cope with this illness? 1.Giving client full control over care decisions and restricting visitors. 2.Providing positive feedback and encouraging ROM. 3.Providing information, giving positive feedback, and encouraging relaxation. 4.Providing IV administered sedatives, reducing distractions, and limiting visitors.

providing information, giving positive feedback, and encouraging relaxation

how does GBS leave when the patient gets better?

proximal to distal (opposite of how they got it)

what will happen if lyme disease is untreated?

recurrent arthritis, permanent disability, neuropathies, myocarditis, heart block, memory loss, shooting pain

Need to monitor __________ because if they get too much then it can lead to vomiting which can lead to aspiration

residual of NG

what do you need to make sure you assess with GBS? and why?

respiratory function, because if not treated it will go into respiratory thoracic muscles

what is usually a precipitating event that leads to GBS?

respiratory or GI viral or bacteria infection 1-3 weeks before onset of symptoms

Sjogren syndrome may be primary disorder, but often associated with other ___________

rheumatic disease

what is primarily affected with sjogrens syndrome?

salivary and lacrimal ducts

how do you care for botulism?

same as GBS

what is thickening and tightening of the skin on the fingers and hands?

sclerodactyly

what does the myelin sheath do?

sends signals

what should a patient do after eating meals?

sit up for 1-2 hours

Autoimmune disorder that causes inflammation and dysfunction of the exocrine glands (dump into ducts) throughout the body.

sjogrens syndrome

what are the manifestations of scleroderma?

skin thickening with non pitting edema

how do you clean tetanus?

soap and water

Spores for tetanus are present in ___________

soil, garden mold, and manure

where is botulism found?

soil, improper canning

what stage of GBS is: Severe & rapid weakness; loss of muscle strength progressing to quadriplegia and respiratory failure; decreasing deep tendon reflex; paresthesia; numbness; pain

stage 1 acute stage

what stage of GBS is: Occurs 2-3 weeks after initial onset, Marks the end of the condition, Autonomic functions return

stage 2 stabilizing stage

what stage of GBS is: May take several months to 2 years, Marked by improvements in symptoms, Muscle strength and function return in descending order

stage 3 recovery stage

what is ascending motor paralysis?

starts at toes and goes up

when are lyme disease outbreaks more common?

summer months

what are some other things that can lead to GBS?

surgery, viral immunization, trauma, viral illnesses

For wound botulism, ___________of the source of the toxin- producing bacteria and then antibiotics may be prescribed.

surgical removal

what are the manifestations of GBS?

symmetrical weak muscles in lower extremities that ascends to upper extremities

Dilation of capillaries causing red marks on surface of skin

telangiectasias

Infection of the nervous system affecting spinal and cranial nerves

tetanus

Stiffness of the jaw (trismus) Signs of infection (fever) Rigidity of neck muscles, back, abdomen, and extremities If severe, continuous tonic seizures with extreme arching of the back Laryngeal and spasm can cause apnea and anoxia

tetanus

plasma exchange or high dose IV img are most effective if administered within ___________

the first two weeks of symptom onset

how does tetanus enter the body?

through a wound

what can scleroderma cause?

tissue fibrosis and blood vessel occlusion

why would a patient with tetanus get AB therapy?

to inhibit further growth of c. tetani

why would a GBS patient get anticoagulents?

to prevent DVT and PE becasue they arent moving around

what does systemic scleroderma involve?

trunk and internal organs

what is the cause of GBS?

unknown

what is the cause of scleroderma

unknown, genetic

what is the prognosis like for systemic scleroderma?

variable

if a patient with tetanus has a trach what else with they have?

vent

**what is the main focus when treating GBS?

ventilation

what is eryhema migrans like?

warm to touch but not painful or itchy

who is more affected by sjogrens?

women

who usually has an 80-90% spontaneous recovery with little to no residual disabilities?

young and healthy