Med Surg Quiz 3
Sequestrum (in osteomyelitis)
Dead bone tissue
Management of Osteoarthritis
Decrease pain and stiffness Improve joint mobility Aerobic exercise and lower extremity strength training Weight loss Occupational therapy Physical therapy
Assessment for HIV/AIDS patients
Identification of potential risk factors Physical status Immune system functioning Nutritional status Respiratory status Neurological status Fluid and electrolyte balance Knowledge level
Methotrexate for RA Patient
Immunosuppressive, increases risk for infection when patients are in this medication j
HIV Nursing Diagnosis
Impaired nutritional intake Social isolation Grief Lack of knowledge
Nonunion
Incomplete healing of fracture and results from failure of ends of a fracture to unite
The nurse is teaching a client about rheumatic disease. What statement best helps to explain autoimmunity?
"Your symptoms are a result of your body attacking itself."
Treatment of closed fracture
Manipulation and manual traction
Assessment for Compartment Syndrome
5 ps Pain Pallor Pulselessness Paresthesia Paralysis
HIV/AIDS diagnostic tests
Antibody, antigen/antibody, RNA tests
Osteomyelitis Clinical Manifestations
Area becomes painful, swollen, tender Constant pulsating pain intensified with movement
Phantom limb pain medications
Beta blockers relieve continual dull and burning sensation
Kaposi Sarcoma is diagnosed through
Biopsy
HIV Stage 2
CD4+ 200-499 cells/mm3 Symptomatic stage
HIV Stage 3
CD4+ below 200 cells/mm3 PT has AIDS
Osteomyelitis Risk factors
Elderly Poorly nourished Obese Impaired immune systems Chronic illnesses Long-term corticosteroid or immunosuppressive agents Ilicit drugs Post-op Infected wounds
Fat embolism
More frequent in closed fractures
SLE Complications
Pericarditis Nephritis Psychosis Cognitive impairment Seizures Peripheral and cranial neuropathies Transverse myelitis Strokes
Chronic osteomyelitis causes
Result from infected sequestrum that remains and produces recurring abscesses
Early complications of fractures
Shock Fat embolism Acute compartment syndrome
Which is an inaccurate principle of traction?
Skeletal traction is interrupted to turn and reposition the client.
Which client(s) is most likely to have compartment syndrome after sustaining a fracture?
The client with elevated pressure within the muscles. The client with hemorrhage in the site of injury The client with a plaster cast applied immediately after injury
After amputation what should be readily available at the bedside
Tourniquet
Amputation risk factors
Vascular disease due to diabetes and trauma
Complication of Kaposi's Sarcoma
Venous stasis, lymphedema, pain, ulcerative lesions, infection, internal organs involvement
What test will the nurse assess to determine the client's response to antiretroviral therapy?
Viral load
Wasting Syndrome
a loss of more than 10% of body weight due to fever or diarrhea for more than 30 days
The result of which diagnostic study is decreased in the client diagnosed with rheumatoid arthritis?
red blood cell count
Malunion
healing of a fractured bone in a malaligned position
Systemic lupus Erythematous Triggers
Cigarette smoke UV rays Exposure from sunlight and fluorescent light bulbs Medications (hydralazine, minocycline, or procainamide) Viral infections Emotional stress Stress on the body
Amputation patient education
Encourage active participation in care Handle limb gently, change positions Realistic goal setting Self-care Independence
A client asks the nurse why his residual limb cannot be elevated on a pillow. What is the best response by the nurse?
"Elevating the leg might lead to a flexion contracture."
Which is one of the most common causes of death in clients diagnosed with fat emboli syndrome?
Acute respiratory distress syndrome
A client being treated for HIV/AIDS has a decreased appetite, almost to the point of anorexia. What is the best action by the nurse?
Administer megestrol acetate
When do most perinatal HIV infections occur?
After exposure during delivery
SLE Patient blood tests
Anti-ds DNA (specific to SLE) ANA Anti-DNA
Osteomyelitis patient education
Antibiotic regimen adherence Maintain and manage IV access Medication education Aseptic dressing and warm compression techniques
Hip Fractures Clinical Manifestations
Pain over outer thigh or in the groin Limited ROM Discomfort with attempt to flex or rotate hip Shortening of leg
Hydroxychloroquine assessment
Assess for visual changes, GI upset, skin rash, headaches, photosensitivity, hair bleaching
Traction considerations
Assess skin Assess anxiety Assist with self care Monitor for atelectasis, pneumonia, constipation, urinary stasis, infection, VTE
Which is usually the most important consideration in the decision to initiate antiretroviral therapy?
CD4+ counts
Avascular Necrosis (AVN) Pathophysiology
Bone loses blood supply and dies
HIV Stage 1
CD4+ levels 500-1500 cells/mm3 Viral set point Chronic stage
In an adult client, which stage of HIV infection is indicated when the results are more than 500 CD4+ lymphocytes/mm?
CDC Stage 1: Acute HIV infection
Phantom limb pain
Pain perceived in the amputated section is caused by severing of peripheral nerves
Which finding is consistent with the diagnosis of rheumatoid arthritis?
Cloudy synovial fluid
Which is a hallmark sign of compartment syndrome?
Pain that occurs or intensifies with passive range of motion
Other than abstinence, what is the only proven method of decreasing the risk of sexual transmission of HIV infection?
Consistent and correct use of condoms
Fractures Patient Education
Consume adequate calories and vitamins Appropriate analgesic use Wound care via aseptic technique Exercise and ambulation
Kaposi's Sarcoma Clinical Manifestations
Cutaneous lesions, brownish pink to deep purple, flat or raised, surrounded by ecchymosis and edema
Delayed complication of fractures
Delayed union Malunion Nonunion Avascular Necrosis of bone
Acute Compartment Syndrome (ACS) Pathophysiology
Elevation of pressure within an anatomical compartment above normal perfusion prefigure. From increase in compartment volume. Leads to necrosis and permanent dysfunction
Which actions by the nurse demonstrate an understanding of caring for a client in traction?
Ensuring that the weights are hanging freely Assessing the client's alignment in the bed Frequently assessing pain level Placing a trapeze on the bed
Patient education for Hip Fractures
Exercise Use of overhead trapeze Appropriate fluid intake Ankle exercises to prevent VTE Signs of DVT Coughing and deep breathing
Rheumatoid Arthritis Risk Factors
Family Hx. Smoking Obesity Age (above 60y/o)
The nurse assesses subtle personality changes, restlessness, irritability, and confusion in a client who has sustained a fracture. The nurse suspects which complication?
Fat Embolism Syndrome
Avascular Necrosis (AVN)
First most affected is the HIP Second most affected is the KNEE
Late Signs and Symptoms of HIV Encephalopathy
Hallucinations Tremor Incontinence Seizures Mutism Global cognitive impairments Verbal response delay Vacant stare Spastic paraparesis Hyperreflexia Death
Delayed union
Healing does not occur within expected timeframe for location and type
Complications of Amputations
Hemorrhage Infection Skin breakdown Phantom limb pain Joint contracture Hypovolemic shock Osteomyelitis
Complications of hip fracture
Hemorrhage Peripheral neuromuscular dysfunction VTE Pulmonary complications Skin breakdown Loss of bladder control
Which factor inhibits fracture healing?
History of diabetes Smoking Local malignancy Bone loss Extensive local trauma Age greater than 40 Infection
Osteomyelitis Pathophysiology
Infection that results in inflammation, necrosis and formation of new bone
RA and SLE have in common
Joint swelling and pain
HIV Patient/Caregiver Education
Keep immunizations up to date, avoid high-risk situations, adhere to medication regimen, signs & symptoms to report, avoid crowded areas, avoid cleaning litter boxes, avoid raw and undercooked foods
Pulselessness, a very late sign of compartment syndrome, may signify
Lack of distal tissue perfusion
The nurse teaches the client that reducing the viral load will have what effect?
Longer survival
Early Signs and Symptoms of HIV Encephalopathy
Memory deficit Apathy Headache Ataxia Difficulty concentrating Progressive confusion Psychomotor slowing
Acute Compartment Syndrome (ACS)
Most common in tibial fractures
Hydroxychloroquine Patient education
Need for ophthalmologist examinations
Assessment for Amputation Patients
Neuro vascular and functional status Signs and symptoms of infection Nutritional status Concurrent health problems Psychosocial, grief, coping
HIV Stage Unknown
No CD4+ count or % information
Systemic lupus Erythematous Pathophysiology
No known cause Body's immune system recognizes one or more components of cell's nucleus as foreign is seen as an antigen.
Most common form of joint disease
Osteoarthritis (OA)
HIV Stage 0
Primary infection of HIV Initially negative on HIV antibody test Highly contagious due to High Viral Loads Asymptomatic
HIV encephalopathy
Progressive cognitive, behavioral, and motor functions decline HIV is found in the brain and CSF
A client with a short arm cast is suspected to have compartment syndrome. What actions should the nurse include in the plan of care?
Provide support to the injured extremity Prepare to remove the cast
Efavirenz for HIV Patient Side Effects
Rash, neuropsychiatric symptoms, serum transaminase elevations, hyperlipidemia, QT interval prolongation.
HIV ART (antiretroviral) Goals
Recude HIV-associated morbidity and prolong survival quality, restore and preserve immune function, suppress plasma HIV viral load, prevent HIV transmission
Which device is designed specifically to support and immobilize a body part in a desired position?
Splint
Osteomyelitis common infectious agent
Staphylococcus aureus
SLE Cutaneous System Manifestation
Subacute cutaneous lupus erythematous Discoid rash Exacerbations by sunlight or artificial UV light Oral ulcers
Pneumocystis Pneumonia Clinical Manifestations
Subacute onset of progressive dyspnea Fever Nonproductive cough Chest discomfort Hypoxemia
Treatment of Open fracture
Surgical, internal fixation devices to hold bone fragments, ORIF
Which disorder is characterized by a butterfly-shaped rash across the bridge of the nose and cheeks?
Systemic lupus erythematosus (SLE)
Efavirenz for HIV Patient
Take medication on an empty stomach
Megestrol (Megace) for HIV Patient
Used for wasting syndrome. Promotes significant weight gain and inhibits cytokine IL-1 synthesis. Increases body weight by increasing body fat stores.
Octreotide (Sandostatin) for HIV Patient
Used to manage chronic diarrhea
Which diagnostic test measures HIV RNA in the plasma?
Viral load A viral load test measures the quantity of HIV RNA in the blood. Enzyme immunoassay (EIA) is a blood test that can determine the presence of antibodies to HIV in the blood or saliva; it is also referred to as an enzyme-linked immunosorbant assay (ELISA). A Western blotting assay is a blood test that identifies antibodies to HIV and is used to confirm the results of an EIA (ELISA) test.
Fat embolism signs and symptoms
Classic triad (Hypoxemia, neuro compromise, petechial rash) Hypoxia, tachypnea, dyspnea, tachycardia, substernal chest pain, low-grade fever
SLE Nursing Diagnosis
Fatigue Altered Skin Integrity Altered Self-Image
Osteoarthritis (OA) Pathophysiology
Non inflammatory degenerative disorder of joints Bone spurs (ostephytes) formation protrude into joint space
A client with rheumatoid arthritis reports joint pain. What intervention is a priority to assist the client?
Nonsteroidal anti-inflammatory drugs
Osteoarthritis (OA) Risk Factors
Older age Female gender Obesity Occupations Sport activities engaging History of previous injuries Muscle weakness Genetic predisposition Certain diseases
Nursing diagnosis RA
Pain Ineffective sleep patterns Self-care deficit
Osteoarthritis (OA) Clinical Manifestations
Pain aggravated by movement and relived by rest Morning stiffness lasts less than 30 min Functional impairment Crepitus over the knee Mild joint effusion Decreased ROM
Fractures clinical manifestation
Pain continuous and increases until immobile Loss of fxn. Deformity Shortening Crepitus Local swelling and discoloration
Rheumatoid Arthritis Clinical Manifestations
Symmetric joint pain, swelling, warmth, erythema, lack of fxn. Morning joint stiffness Spongy or boggy tissue when palpating joints Begins in small joints and progresses to large joints
Efavirenz for HIV Patient
Use of EFV may lead to false-positive results with cannabinoid and benzodiazepine screening.
HIV Healthcare Provider Safety
Use standard precautions. If exposed, post-exposure prophylaxis (PEP) within 72 hrs.
SLE Patient Education
Use sunscreen Avoid crowds and sick people No smoking Check body temperature regularly Energy conservation Keep immunizations up to date Report peripheral or preorbital edema