Med-Surg II SME Study Guide #33-48

35A. Safety for Older Adults

7 tasks of those who are chronically ill 1. Preventing & managing a crisis. 2. Carrying out prescribed treatment regimen. 3. Controlling symptoms. 4. Reordering time. 5. Adjusting to changes in course of disease. 6. Preventing social isolation. 7. Attempting to normalize interactions with others

44E. What can cause hypoglycemia in the absence of DM?

ANS: Pancreatic tumors, adrenal insufficiency, liver disease, pituitary disorders; sometimes no specific cause is identified What does nursing care of the nondiabetic patient who has hypoglycemia focus on? (Nursing diagnoses) 1. Deficient knowledge 2. Risk for injury 3. Impaired adjustment

47A. A client with AIDS is exhibiting shortness of breath, cough, and fever. The nurse most likely would suspect infection with which of the following?

ANS: Pneumocystis jiroveci

44D. A pt with diabetes has S&S of hypoglycemia. The pt has a blood glucose of 56 mg/dl, is not alert but responds to voice, and is confused and is unable to swallow fluids. what does the nurse do next?

ANS: administer D50 IV push

44C. A pt with diabetes has S&S of hypoglycemia. the pt is alert and oriented with a blood glucose of 56 mg/dl. what does the nurse do next?

ANS: give a glass of orange or other type of juice and continue to monitor the pt.

37. Osteoarthritis

Chronic joint disease involving progressive degenerative changes in articular cartilage covering joint surfaces and proliferation of bone and cartilage in joints; musculoskeletal disorder with progressive deterioration of cartilage in weight bearing joints Disease) RISK FACTORS: obesity and overuse S/S: joint atrophy or enlargement, localized joint pain, stiffness increased with exercise and decreased with rest, crepitus, mild tenderness, decreased ROM, joint enlargement and bony nodules (Herbeden's)

46A. HIV/ AIDS DIAGNOSTIC TESTS

Enzyme-linked Immunosorbent Assay (ELISA) - initial HIV testing - diagnostic test which determines the presence of HIV antibodies - may read false negative in the first few months after exposure - To diagnose HIV, must have 2 positive ELISA tests followed by a positive Western Blot test Western Blot Assay -reliable test used as a secondary diagnostic test to -confirm HIV diagnosis -test for the presence of HIV antibodies -Seropositive= HIV antibodies present -Seronegative= no HIV antibodies present Rapid HIV Antibody Testing -includes several HIV screening tests -fingerstick w/ blood sample -results in 20 mins -positive result must be confirmed by Western Blot

39. Lumbar Laminectomy

Excision of lamina (posterior arch of vertebrae) to relieve pressure on the spinal nerves r/t herniated disc PREOP CARE: Strict bedrest on firm mattress; neck traction if in cervical, pelvic traction if lumbar; local heat; analgesics; muscle relaxants; steroid injections POSTOP CARE: Keep bed flat, firm mattress, bedboards; logroll; when on back, don't flex just the knees (puts stress on spine), support entire length of legs on pillows; when on side, logroll into position keeping spine straight, support legs w/ pillow between knees, head w/ small pillow roll in continuous motion and support back with pillows.

39A. Lumbar Laminectomy

INTERVENTIONS: -May have drain. Assess ability to move & sensation of extremities (if c/o numbness and tingling in lower extremities, compare with preop status). -Check dressing for bleeding and CSF leakage (headache). -Monitor for urinary retention. -Postural hypotension. -Instruct pt to keep spine straight while doing ADLs. -Will be more comfortable lying in bed or walking than sitting. PATIENT EDUCATION: hard, firm mattress at home; straight, firm chairs; avoid driving, lifting weights, and stair climbing until permitted by physician; squat, don't bend.

34A. Cast Care

INTERVENTIONS: -Monitor 5 P's. Notify surgeon immediately if neurovascular compromise is suspected. Maintain extremity at heart level (not above), and opening and bivalving the cast w/ Ace bandages. -avoid covering cast until dry -avoid resting cast on hard surfaces or sharp edges -keep affected limb elevated above heart on soft surface until dry -watch for danger signs, elevate arm cast above level of heart -If pt with cast is feeling pain in affected limb with numbness or tingling - elevate limb and call provider WATCH FOR: blueness, paleness, pain, numbness or tingling sensations on affected area

36A. Rheumatoid Arthritis

INTERVENTIONS: -administer analgesics -encourage balance between rest and activity -promote independence -address self concept issues TREATMENTS: -salicylates or NSAIDs -analgesics -preservation of joint and muscle function -reconstructive surgery -corticosteroids -antidepressants

37A. Osteoarthritis

INTERVENTIONS: -administer narcotic and non narcotic analgesics -rest -temporary joint immobilization in functional position -weight loss -controlled heat application MANAGEMENT: -Meds: Tylenol, Synvisc (injection, acts as a shock absorber) -ROM exercises, muscle strengthening, aerobic exercises, * walking, yoga, tai chi, water exercises balance exercise and rest GOAL FOR CHRONIC PAIN: comfort level to perform ADLs

44A. Hypoglycemia

INTERVENTIONS: Mild hypoglycemia a. Give 10 to 15 g of a fast-acting simple carbohydrate (Box 54-19). b. Retest the blood glucose level in 15 minutes and repeat the treatment if symptoms do not resolve. c. Once symptoms resolve, a snack containing protein and carbohydrates, such as low-fat milk or cheese and crackers, is recommended unless the client plans to eat a regular meal within 60 minutes. INTERVENTIONS: Moderate hypoglycemia a. Administer 15 to 30 g of a fast-acting simple carbohydrate. b. Administer additional food such as low-fat milk or cheese and crackers after 10 to 15 minutes.

44B. Hypoglycemia

INTERVENTIONS: Severe hypoglycemia a. If the client is unconscious and cannot swallow, an injection of glucagon is administered subcutaneously or intramuscularly. b. Administer a second dose in 10 minutes if the client remains unconscious. c. A small meal is given to the client when the client awakens as long as the client is not nauseated. d. The physician is notified if a severe hypoglycemic reaction occurs. e. Family members need to be instructed about the administration of glucagon. WHY IS GLUCAGON GIVEN IN A DEXTROSE SOLUTION?Dextrose increases blood sugar levels at a controlled rate. Glucagon frees glucose from hepatic stores of glycogen

38B. Hip Replacement Postop Care

Too much drainage post op: review drainage care DISCHARGE TEACHING -maintain abduction -avoid stooping -do not sleep on operated side -flex hip only 90 degrees -never cross legs -avoid position of flexion -walk -pt should resume normal activity by 3 months after hip replacement

41B. What would the urinalysis show in a patient with SIADH? (What would the total osmolality show? What about sodium concentration?)

Urine concentration would be over 100 mOsm/kg overall. Urine sodium would be >20 mEq/L. (ADH causes the urine to be very concentrated)

44. Hypoglycemia

(Insulin shock); Abnormally low blood glucose (blood sugar) CAUSES: 1. excess insulin 2. deficient intake or absorption of food 3. exercise 4. alcohol intake ASSESSMENT: Skin: Cool & clammy Mental Status: Anxious, nervous, irritable, confused, seizure, coma S/S: double/blurred vision, hunger, tachycardia, palpitations Glucose: <70 mg/dl No Ketones

43. Type 1 Diabetes (Insulin-dependent)

-Occurs in people who are under 30 years of age, with a peak onset between ages 11 and 13, but can occur at any age. -End result of a long-standing process where the body's own T cells attack and destroy pancreatic beta cells, which are the source of the body's insulin. -Because the onset of type 1 diabetes is rapid the initial manifestations are usually acute. -Are caused by hyperglycemia and the accompanying spillover of excess glucose in the urine. -The individual with type 1 diabetes requires a supply of insulin from an outside source, such as an injection, in order to sustain life. -Without insulin, the patient will develop diabetic ketoacidosis (DKA), a life-threatening condition resulting in metabolic acidosis. CAUSES: Genetic, immunologic, and environmental CLASSIC SYMPTOMS: polyuria, polydipsia, and polyphagia

43A. Type 2 Diabetes

-Over 90% of patients with Type 2 diabetes -In type 2 diabetes, the pancreas usually continues to produce some endogenous (self-made) insulin. However, the insulin that is produced is either insufficient for the needs of the body and/or is poorly used by the tissues. RISK FACTORS: Obesity, sedentary lifestyle, family history, age 40 years and older, History of gestational diabetes, History of delivering infant 10 pounds. Ethnicity` -The manifestations of type 2 diabetes are more nonspecific, and include fatigue, recurrent infections, recurrent vaginal yeast or monilia infections, prolonged wound healing, and visual changes.

38A. Hip Replacement Preop Care

-abduction of affected extremity (wedge pillow or 2-3 normal pillows between legs) -Ice, trapeze for lifting -DVT prophylaxis -ambulate with walker at first -don't sleep on operated side -don't flex hip more than 90 -report increased pain -cleanse incision daily -inspect for infection

46. AIDS

A disease that causes inadequate immunological response by the body. Progressively fatal disease that destroys immune system and body's ability to fight infection. DIAGNOSED WHEN ALL ARE PRESENT a) CD4 count <200 b) HIV viral load elevated c) opportunistic infections S/S: Pneumonia, TB, candidiasis (oral and GI), herpes, HPV, HIV encephalopathy, crypto, wasting syndrome, Kaposi sarcoma, secondary cancers. CD4 count Diagnostic test used to determine the progression of HIV/AIDS: -Norm value: 800-1200 -AIDS: < 200 -Treatment for HIV/AIDS needed when < 350 Lack of CD4 causes immunosuppression HIV/ AIDS window period: -the time from initial HIV infection until the time the body develops antibodies in response to the infection 6 weeks- 6 months

45. DKA

A life-threatening complication of type 1 diabetes mellitus that develops when a severe insulin deficiency occurs. ASSESSMENT: -Ketosis: Kussmaul's respiration, "fruity" breath, nausea, abdominal pain -Dehydration or electrolyte loss: Polyuria, polydipsia, weight loss, dry skin, sunken eyes, soft eyeballs, lethargy, coma TREATMENT: Treat dehydration with rapid IV infusions of 0.9% or 0.45% normal saline (NS) as prescribed; dextrose is added to IV fluids (D5NS, or 5% dextrose in 0.45% saline) when the blood glucose level reaches 250 to 300 mg/dL. WATCH FOR: The potassium level will fall rapidly within the first hour of treatment as the dehydration and the acidosis are treated.

33. Osteomyelitis

A severe infection of bone, bone marrow, and surrounding soft tissue. MECHANISMS OF DISEASE: 1. microorganisms invade the bone by indirect or direct entry. 2. they grow and increase pressure, resulting in ischemia. 3. this causes bone death S/S: Fever, night sweats, malaise, constant bone pain, and swelling, warmth and restricted movement at the infection site. DIAGNOSTIC TEST: A bone or soft tissue biopsy TREATMENT: Vigorous and prolonged IV antibiotic therapy. TREATMENT OF CHRONIC OSTEOMYELITIS: It is treated with oral antibiotics, hyperbaric oxygen therapy, and surgery. It is a persistent infection with periods of exacerbation and remission. NURSING DIAGNOSES: acute pain, impaired physical mobility, and impaired self-help management.

48. Lyme Disease

A spirochetal infection transmitted by bite of an infected deer tick. S/S: -erythema migrans (EM), a skin lesion occurring at the site of a tick bite 2 to 30 days after exposure. -Viral-like symptoms such as low-grade fever, chills, headache, swollen lymph nodes, and migratory joint and muscle pain, also occur. If Lyme disease is not treated the spirochete can disseminate within several weeks or months to the heart, joints, and central nervous system. The diagnosis of Lyme is often based on clinical manifestations in particular the EM lesion, and a history of exposure in an endemic area. A two-step laboratory testing process is used to confirm the diagnosis. Antibiotics are used for active Lyme disease and to prevent late disease. Reducing exposure to ticks is the best way to prevent Lyme disease.

36F. An older adult client who lives with her daughter is admitted to the hospital. During the admission assessment, the nurse notes strong body odor, several large pressure ulcers, and limb contractures. What does the nurse do first? A. Asks the daughter about the ulcers and contractures B. Contacts the hospital social worker C. Gives the client a bath D. Notifies the health care provider

ANS: B. Contacts the hospital social worker The social worker will assess the client's situation and will contact the appropriate authorities if needed.

35D. The nurse is teaching a group of older adults at an assisted-living facility about age-related physiological changes. Which question would be the most important to ask this group? A. "Are you able to hear the tornado sirens in your area?" B. "Are you able to read your favorite book?" C. "Are you able to remember the name of the person you just met?" D. "Are you able to open a jar of pickles?"

ANS: A. "Are you able to hear the tornado sirens in your area?" The ability to hear safety alerts and seek shelter is imperative to life safety. Although age-related changes may cause a decrease in sight that affects reading, and although difficulties in remembering short-term information and opening jars as arthritis sets in are important to patients and to those caring for them, being able to hear safety alerts is the priority.

47B. A patient who tested positive for HIV 3 years ago is admitted to the hospital with Pneumocystis jiroveci pneumonia (PCP). Based on diagnostic criteria established by the Centers for Disease Control and Prevention (CDC), the patient is diagnosed as having A. early chronic infection. B. HIV infection. C. AIDS. D. intermediate chronic infection.

ANS: C. AIDS Rationale: Development of PCP pneumonia meets the diagnostic criterion for AIDS. The other responses indicate an earlier stage of HIV infection than is indicated by the PCP infection.

35E. A 72-year-old client admitted to the hospital for congestive heart failure has a history of a fractured hip due to a previous fall. The client is taking oxycodone-acetaminophen (Tylox) as needed for pain secondary to a recent dental procedure. Which risk factor puts this client at greatest risk for a fall? A. Age B. Diagnosis C. History of a fall D. Narcotic use

ANS: C. History of a fall

37C. Assessment data in the patient with osteoarthritis commonly include A. gradual weight loss. B. elevated WBC count. C. joint pain that worsens with use. D. straw-colored synovial fluid.

ANS: C. joint pain that worsens with use.

35C. A home health nurse is performing a home assessment for safety. Which of the following comments by the patient would indicate a need for further education? A. "I will schedule an appointment with a chimney inspector next week." B. "Daylight savings is the time to change batteries on the carbon monoxide detector." C. "If I feel dizzy when using the heater, I need to have it inspected." D. "When it is cold outside in the winter, I can warm my car up in the garage."

ANS: D. "When it is cold outside in the winter, I can warm my car up in the garage." Allowing a car to run in the garage introduces carbon monoxide into the environment and decreases the available oxygen for human consumption. Garages should be opened and not just cracked to allow fresh air into the space and allay this concern. Checking the chimney and heater, changing the batteries on the detector, and following up on symptoms such as dizziness, nausea, and fatigue are all statements that would indicate that the individual has understood the education.

46F. A pregnant woman with a history of asymptomatic HIV infection is seen at the clinic. Which information will the nurse include when teaching the patient? A. Although infants of HIV-infected mothers always test positive for HIV antibodies, most infants are not infected with the virus. B. Because she has not developed AIDS, the infant will not contract HIV during intrauterine life. C. The infant will be started on zidovudine (AZT) after delivery to prevent HIV infection. D. It is likely that her newborn will develop HIV infection unless she takes antiretroviral drugs during the pregnancy.

ANS: A Although infants of HIV-infected mothers always test positive for HIV antibodies, most infants are not infected with the virus. Rationale: Because antibodies are transmitted from the mother to the fetus during intrauterine life, all infants of HIV-positive mothers will test positive at birth. Ongoing antibody (or viral) testing is needed to determine whether the infant is infected with HIV. Transmission of the virus can occur during fetal life even if the mother does not have AIDS. Infants of HIV-positive mothers are not routinely started on antiretroviral therapy (ART). Only 25% of infants born to HIV-positive mothers develop HIV infection, even when the mother does not use ART during pregnancy.

40B. At what position would you place the remaining extremity following a below-the-knee amputation during the first 24 hours after surgery? A. elevated above the level of the heart B. lower then the rest of the body C. crossed over the intact extremity D. level with the rest of the body

ANS: A Elevated above the level of the heart

33A. A patient with acute osteomyelitis of the left femur is hospitalized for regional antibiotic irrigation. Which intervention will be included in the initial plan of care? A. Immobilization of the left leg B. Positioning the left leg in flexion C. Assisted weight-bearing ambulation D. Quadriceps-setting exercise repetitions

ANS: A Immobilization of the affected leg helps decrease pain and reduce the risk for pathologic fractures. Weight-bearing exercise increases the risk for pathologic fractures. Flexion of the affected limb is avoided to prevent contractures.

45C. A nurse is caring for a client admitted to the emergency department with diabetic ketoacidosis (DKA). In the acute phase, the priority nursing action is to prepare to:

ANS: Administer regular insulin intravenously.

33B. A 50-year-old patient is being discharged after a week of IV antibiotic therapy for acute osteomyelitis in the right leg. Which information will be included in the discharge teaching? A. How to apply warm packs to the leg to reduce pain B. How to monitor and care for the long-term IV catheter C. The need for daily aerobic exercise to help maintain muscle strength D. The reason for taking oral antibiotics for 7 to 10 days after discharge

ANS: B The patient will be on IV antibiotics for several months, and the patient will need to recognize signs of infection at the IV site and how to care for the catheter during daily activities such as bathing. IV antibiotics rather than oral antibiotics are used for acute osteomyelitis. Patients are instructed to avoid exercise and heat application because these will increase swelling and the risk for spreading infection.

39b. Following laminectomy with a spinal fusion to treat a herniated disc, a patient reports numbness and tingling of the right lower leg. The first action that the nurse should take is to A. report the patient's complaint to the surgeon. B. check the chart for preoperative assessment data. C. check the vital signs for indications of hemorrhage. D. turn the patient to the side to relieve pressure on the right leg.

ANS: B The postoperative movement and sensation of the extremities should be unchanged (or improved) from the preoperative assessment. If the numbness and tingling are new, this information should be immediately reported to the surgeon. Numbness and tingling are not symptoms associated with hemorrhage at the site. Turning the patient will not relieve the numbness.

48C. The incidence of Lyme disease is very high in a Pennsylvania county, so the public health nurse provides community education to increase the number of patients who seek health care promptly after a tick bite. Which information should the nurse provide in community teaching people who are at risk for a tick bite? A. The best therapy for the acute illness is an IV antibiotic. B. Check for an enlarging reddened area with a clear center. C. Antibiotics will prevent Lyme disease if taken for 10 days. D. Surveillance is necessary during the summer months only.

ANS: B. Check for an enlarging reddened area with a clear center. Following a tick bite, individuals should mark the area with a pen and watch for a reddened lesion that enlarges within 2 to 30 days after the bite, develops a clear center, has a bright red border, and is accompanied by flu-like symptoms and migrating joint and muscle pain. When Lyme disease is confirmed, oral doxycycline (Vibramycin) can be effective if started within 3 days of the bite, and 2 to 3 weeks of antibiotic therapy is usually effective. Although ticks are most prevalent during summer months, residents of high-risk areas should check for ticks whenever they are outdoors.

33C. A 67-year-old patient is receiving IV antibiotics at home to treat chronic osteomyelitis of the left femur. The nurse chooses a nursing diagnosis of ineffective health maintenance when the nurse finds that the patient A. is frustrated with the length of treatment required. B. takes and records the oral temperature twice a day. C. is unable to plantar flex the foot on the affected side. D. uses crutches to avoid weight bearing on the affected leg.

ANS: C Foot drop is an indication that the foot is not being supported in a neutral position by a splint. Using crutches and monitoring the oral temperature are appropriate self-care activities. Frustration with the length of treatment is not an indicator of ineffective health maintenance of the osteomyelitis

34B. While providing care to an older woman with a cast on her left lower arm (from below the elbow to above the fingers.), you perform a neurovascular assessment. which of the following assessments indicates a possible complication? A. slightly edematous fingers B. warm, pink skin above the cast C. pale, cool fingers D. pain rating of 2 on a 0 to 10 scale

ANS: C Pale, cool fingers

39B. The nurse should reposition the patient who has just had a laminectomy and discectomy by A. instructing the patient to move the legs before turning the rest of the body. B. having the patient turn by grasping the side rails and pulling the shoulders over. C. placing a pillow between the patient's legs and turning the entire body as a unit. D. turning the patient's head and shoulders first, followed by the hips, legs, and feet.

ANS: C The spine should be kept in correct alignment after laminectomy. The other positions will create misalignment of the spine

46E. The occupational health nurse will teach the nursing staff that the highest risk of acquiring HIV from an HIV-infected patient is A. a needle stick with a suture needle during a surgical procedure. B. contamination of open skin lesions with vaginal secretions. C. a needle stick with a needle and syringe used to draw blood. D. splashing the eyes when emptying a bedpan containing stool.

ANS: C a needle stick with a needle and syringe used to draw blood. Rationale: Puncture wounds are the most common means for workplace transmission of blood-borne diseases, and a needle with a hollow bore that had been contaminated with the patient's blood would be a high-risk situation. The other situations described would be much less likely to result in transmission of the virus.

43C. The nurse is working with an overweight client who has a high-stress job and smokes. This client has just received a diagnosis of Type II Diabetes and has just been started on an oral hypoglycemic agent. Which of the following goals for the client which if met, would be most likely to lead to an improvement in insulin efficiency to the point the client would no longer require oral hypoglycemic agents? A. Comply with medication regimen 100% for 6 months B. Quit the use of any tobacco products by the end of three months C. Lose a pound a week until weight is in normal range for height and exercise 30 minutes daily D. Practice relaxation techniques for at least five minutes five times a day for at least five months

ANS: C. Lose a pound a week until weight is in normal range for height and exercise 30 minutes daily When type II diabetics lose weight through diet and exercise they sometimes have an improvement in insulin efficiency sufficient to the degree they no longer require oral hypoglycemic agents.

43B. When taking a health history, the nurse screens for manifestations suggestive of diabetes type I. Which of the following manifestations are considered the primary manifestations of diabetes type I and would be most suggestive of diabetes type I and require follow-up investigation? A. Excessive intake of calories, rapid weight gain, and difficulty losing weight B. Poor circulation, wound healing, and leg ulcers, C. Lack of energy, weight gain, and depression D. An increase in three areas: thirst, intake of fluids, and hunger

ANS: D An increase in three areas: thirst, intake of fluids, and hunger The primary manifestations of diabetes type I are polyuria (increased urine output), polydipsia (increased thirst), polyphagia (increased hunger).

40C. The day following a below-the-knee amputation, your patient tells you that he feels as though his toes are cramping in the amputated foot. what is this experience called? A. chronic stump pain B. contractures C. attention-seeking D. phantom limb pain

ANS: D Phantom limb pain

45A. A client with a diagnosis of diabetic ketoacidosis (DKA) is being treated in an emergency department. Which finding would a nurse expect to note as confirming this diagnosis?

ANS: Elevated blood glucose level and low plasma bicarbonate level

42C. A condition caused by hyposecretion of parathyroid hormone by the parathyroid gland can occur following thyroidectomy because of removal of parathyroid tissue?

ANS: Hypoparathyroidism

45B. A client is admitted to a hospital with a diagnosis of diabetic ketoacidosis (DKA). The initial blood glucose level was 950 mg/dL. A continuous intravenous infusion of regular insulin is initiated, along with intravenous rehydration with normal saline. The serum glucose level is now 240 mg/dL. The nurse would next prepare to administer which of the following?

ANS: Intravenous fluids containing 5% dextrose

42B. A client postop surgery for a thyroidectomy presents with respiratory obstruction, dysphonia, high pitched voice, stridor, dysphagia, and restlessness. What does the nurse suspect?

ANS: Laryngeal Nerve Damage

35B. Safety for Older Adults

Acronym to remind you of important nutritional indicators in older adults. S-C-A-L-E-S Sadness, or mood change Cholesterol, high Albumin, low Loss or gain of weight Eating problems Shopping and food prep problems S-P-I-C-E-S An effective tool for obtaining assessment data in the older adult. Sleep disorders Problems with eating or feeding Incontinence Confusion Evidence of falls Skin breakdown

46C. AIDS

Antiretroviral meds: - given to AIDS patients to improve CD4 count and lessen opportunistic infections - inhibit viral replication ONLY (do not kill existing virions) Nursing implications for care of patients with AIDS: - Use HAART protocol (cocktail of 3-4 antiretroviral meds) - monitor CD4 (should remain > 500) and CBC - Recommended vaccinations: 1) Pneumonia 2) Influenza 3) Hep B 4) Hib *NO LIVE VIRUS VACCINES (ex. MMR or oral polio)*

47. Pneumocystis carinii pneumonia (PCP)

Bactrim or Septra; pentamidine; steroids (specific tx) Most common opportunistic diseases/ infections associated with HIV S/S: Fever; night sweats; productive cough; SOB, Respiratory isolation NURSING IMPLICATION: Wear gown, mask, and gloves during patient care

34. Cast Care

CAST - A "compartment" is an area of the body encased by bone or fascia (connective tissue). Involves a sudden & severe decrease in blood flow to the tissues distal to an area of injury that results in ischemic necrosis if not intervened. Prevention: Elevation, ice. -Deep, throbbing, unrelenting pain that continues to increase despite opioid administration. Pain intensifies w/ stretching. -Fasciotomy - slice down dead tissue so pt's extremity can "breathe"

48A.

CLINICAL MANIFESTATION: - "Bull's eye" rash - Fever, arthritis, malaise, muscle and joint aches Stage 1 lyme disease process: - 3-32 days after tick bite - treat with doxycycline, amoxicillin, cefuroxime for 10-21 days Stage 2 lyme disease process - Early disseminated, after first 32 days - Cardiac: carditis, dysrhythmias, dyspnea, dizziness, palpitations - CNS: meningitis, facial paralysis, peripheral neuritis - Treated with IV antibiotics for severe disease (ceftanaxone, cefataxime) Chronic lyme disease - Can persist if untreated or treatment failure - Causes chronic arthralgias, fatigue, memory/thinking problems for weeks or years - If unresponsive to therapy can result in permanent damage to joints and nervous system

38. Hip Fracture

External rotation and short leg. Thromboembolism most common complication. Prevention includes passive ROM exercise, use of elastic stocking, elevation of HOB 25 degrees, low-dose heparin.(given in love handles, flank) S/S: leg shorter, adducted, externally rotated, pain, hematoma, ecchymosis ASSESSMENT: Frequent neurovascular checks (5 P's) distal to injury, skin color, temperature, sensation, cap refill, mobility, pain, pulses, CMS (circulation, movement, sensation). Factures of bone predispose client to anemia, especially if long bones are involved. Check hematocrit and hemoglobin every 3-4 days to monitor erythropoiesis. Hemoglobin around 8 = transfusion. NURSING DIAGNOSES: -acute pain -risk for peripheral neurovascular dysfunction -risk for infection -impaired physical mobility PAIN MANAGEMENT: Analgesics, NSAIDs, corticosteroids, muscle relaxants

41. SIADH

It stands for "Syndrome of Inappropriate Antidiuretic Hormone Secretion." For whatever reason, your body has too much ADH being secreted (not necessarily from the posterior pituitary). Levels of ADH are inappropriately elevated compared to body's low osmolality, and ADH levels are not suppressed by further decreases in blood osmolality. S/S: Conserves too much water: Decreased/low urine output -Signs of hyponatremia: lethargy, apathy, disorientation, muscle cramps, anorexia, agitation (decreased serum sodium osmolality) -Signs of water toxicity: nausea, vomiting, personality changes, confused, combative -Serum Na < 135 (Na is diluted by excessive free water re-absorption) -Serum osmolality low, normal is ~ 270 -If Na < 110 mEq/L, seizures, bulbar palsies, hypothermia, stupor, coma

37B. Osteoarthritis

PATIENT EDUCATION: -exercise while maintaining joint protection -balance exercise with rest -weight control -heat applications -relaxation strategies -assistive devices available -explore sexual activity concerns and suggest -modifications NONPHARMACOLOGICAL INTERVENTIONS: -rest of painful joints -apply heat -proper posture -good body mechanics

40A. Amputation

POSTOP CARE: - prevent hip contractor by doing ROM - place pt prone for 20 to 30 min. every 3 - 4 hours - DONT elevate residual limb on a pillow after the immed.. post-op period - after the pressure dressing and drains are removed, inspect the wound for inflammation - dressing changes are daily until the sutures are removed - residual limb is wrapped w/ an elastic bandage to shape the residual limb and keep the dressing in place - observe for s/s of inadequate tissue perfusion. - drains may be used to control hematomas if a soft dressing (dressing and elastic bandage or stump sock) is used

42A. Thyroidectomy

POSTOP INTERVENTIONS: -Monitor for respiratory distress -Have tracheostomy set, O2, & suction at bedside -Limit client talking and assess level of hoarseness -Monitor for laryngeal nerve damage (respiratory obstruction, dysphonia, high pitched voice, stridor, dysphagia, and restlessness -Monitor for hypocalcemia -Tetany -Monitor for thyroid storm -Pt in high fowler's position -Monitor surgical site for edema & bleeding

35. Safety for Older Adults

Prevention of chronic illness Preventative health has both a decision-making and an action phase. Primary prevention: refers to those measures such as proper diet, proper exercise, and immunizations that prevent the occurrence of a specific disease. Secondary prevention: refers to actions aimed at early detection of disease that can lead to interventions to prevent disease progression.

42. Thyroidectomy

Removal of the thyroid gland due to persistent hyperthyroidism PREOP INTERVENTIONS: -Vitals & weight -Assess for electrolyte levels -Assess for hyperglycemia -Educate client on coughing and deep breathing techniques -Administer antithyroid meds as prescribed

41A. SIADH

SIADH effect on urine osmolality: Conserving too much water will concentrate urine. Urine Na is inappropriately high, >20 mmol/L (water follows sodium, but since water is conserved, sodium loss is still occurring) Urine osmolality is inappropriately high, can range b/t 300-1400 mosm/L TREATMENT: -Fluid restriction due to retaining too much water, -Diuretics such as lasix - If symptomatic, may actually need to replace NaCl, can use hypertonic saline for example 3% -Stop hypertonic when Na+ >120 MeQ/dL **Careful - do not correct more than 2 mEq/ hr and not more than 10 -12 mEq/24 hrs - osmotic demylinazation -Demeclochlorotetracycline, blocks ADH receptors in the renal collecting ducts -In severe cases, hemodialysis -Again - be careful with correction of Na+ and monitor lytes closely.

40. Amputation

Surgical removal of a part of the body CAUSES: Peripheral vascular disease (80%, 75% are diabetics), trauma, deformities, malignant tumors, infection. INTERVENTIONS: -Keep lg tourniquet at bedside. -Elevate stump for the first 24 hrs postop. -Intermittently elevate after 48 hrs postop (contracture can occur). -Monitor for signs of infection (fever, tachycardia, redness). -Maintain proper body alignment in and out of bed. COMPLICATIONS - phantom limb pain - infection - hip contracture

36. Rheumatoid Arthritis

Systemic, chronic, progressive inflammatory connective tissue disease that affects joints. RISK FACTORS: - Family history - Female gender (20-50) - Obesity - European American descent - Second autoimmune disease S/S: joints that are painful, swollen, red, warm, and stiff (especially in the AM), fatigue, anorexia, weight loss, decreased mobility, DIAGNOSTIC TESTS: Combination of lab tests, X-ray, synovial fluid analysis, pt symptoms of 3-6 weeks duration ABNORMAL LABS: -Elevated Erythrocyte Sedimentation Rate (ESR) - indicates inflammation -Elevated WBC -Positive Rheumatoid Factor (RF) -C-Reactive Protein - due to inflammation -Anti-Nuclear Antibody (ANA)

46D. AIDS

TRANSMISSION: -Occupational exposure*-health care workers are at risk for exposure through needle sticks or contaminated blood and body fluids getting into an open cut or a mucous membrane such as eyes or inside of nose. Proper use of personal protective equipment such as gloves, gowns, and masks can greatly reduce exposure to pathogens. Activation of safety features on needles and other sharps, with proper disposal, will also protect health care workers. -Maternal transmission*-HIV can be transmitted to babies from their mothers before or during birth. HIV has been shown to be transmitted to newborns through breast milk. -Unprotected sexual contact -Sharing needles w/HIV infected person -Contaminated blood transfusion -Organ transplant from HIV infected person

36B. Prednisone 2mg qd is prescribed for a patient with rheumatoid arthritis. What important points should the nurse include when teaching the patient about this drug?

The dosage of prednisone must be increased and decreased gradually