NU 300 EXAM 2
What is anemia?
Anemia is a deficiency in red blood cells or hemoglobin.
What factors increase infection risk?
Alcohol consumption Nicotine Chemical inhalation Vitamin deficiencies Malnutrition Diabetes Advanced age Steroid use
What are some issues with chemotherapy treatment?
All chemotherapy drugs may be absorbed through the skin and mucus membranes.
What psychosocial aspects do you assess for a patient with an infection?
Anxiety over pending Dx Social isolation Guilt over activity leading to the dx
What is bioculture ecology?
Biologic variations, drug metabolism differences, genetic/hereditary/endemic illnesses.
What is the care for a patient receiving photodynamic therapy before photosensitization?
Bring protective clothing (e.g., shirts with long sleeves and high collars, long pants or skirt, gloves, socks, wide-brimmed hat) and UV-protective sunglasses with you when you come to be injected with the photosensitizing agent. If possible, have someone else drive you home so that you can place a sheet or light blanket over yourself. Plan to avoid leaving your home during daylight hours for anywhere from 1 to 3 months. Cover all windows with light-blocking shades or heavy drapes/curtains. Replace high-wattage light bulbs with lower-wattage ones, and use as few as possible.
What are the positives of acculturation?
Has been linked to better health care access and utilization, cultural enrichment.
What is community associated MRSA?
Healthy non-hospitalized people infected
How is extravasation treated?
Heat or cold may be applied dependent on the particular agent used. Antidotes or chemoprotective agents may be injected into the site. Surgery may be needed.
What is the treatment of Lyme disease?
IV antibiotics for 30 days if severe
When should you use alcohol based rub?
If hands are not visibly soiled, use an alcohol-based hand rub (ABHR) for decontaminating hands or wash hands with soap and water.
What is inflamamtion?
Innate immunity provides immediate protection against foreign invaders Requires no previous exposure to the antigen Adaptive response to rid the body of foreign invaders Cannot be transferred from one person to another Non-specific process occurring the same way regardless where/why it occurs. Intensity, severity and duration of exposure determines the extent of the response. Immediate and short-term response.
What are the types of peripheral neuropathy?
Loss of sensation in the feet or hands Orthostatic hypotension Erectile dysfunction Neuropathic pain Loss of taste Constipation
What makes a person considerably immunocompetent?
Inflammation Cell - mediated immunity Antibody mediated (humoral) immunity
What is alopecia?
May be only thinning → full body loss. Temporary and grows back beginning about 1 month after Chemotherapy stops. New hair may be different in texture, color, & thickness. Cannot be prevented if the chosen drug causes it.
How do antibodies work?
Considered active immunity Antibodies are specific and only attach to one antigen Have memory May be transferred to other people Must bind to antigens to work Antigens are on cells/protein surfaces Agglutination-clumping of antigen/antibody complexes Precipitation occurs - large complexes precipitate and are removed Activate the complement system Inactivation or neutralization of antigens
What are the S&S of anemia?
FATIGUE, weakness, dyspnea, pallor, and INCREASED HR
How do you test for inflammation?
ESR C-reactive protein unusual antibodies
What home care should be taught to a patient with an infection?
Emphasize the need for a clean environment* Assess if refrigeration for drugs is available Teach proper storage of meds* Demonstrate and ask for a return demonstration of hand washing* Be sure everyone involved in home environment understands transmission prevention* Teach how and when meds should be taken* Teach side effects and allergic reactions and when to contact a health care provider for these effects* Encourage patient to express fears related to home care and the illness
What is transculture nursing?
Focus on health, care and illness patterns of people with similarities and differences in their cultural beliefs, values and practices.
What are droplet precautions?
For droplet transmission route Private room preferred Protect from droplets that may travel 3 feet but are not suspended for long periods Wear a mask when within 3 feet of the patient Transport with mask For influenza, mumps, pertussis, meningitis
What are contact precautions?
For known or suspected infections transmitted by direct contact or contact with items in environment For MRSA, VRE, pediculosis (lice), scabies, RSV, C. difficile Private room preferred Wear gloves when entering room Wear gown if body fluids are involved Travel only when necessary Have dedicated equipment
How do you don PPE?
Gown Masks - appropriate selection Goggles Gloves
What infections enter the body through the respiratory tract?
Mycobacterium tuberculosis, Streptococcus pneumoniae
What are the side effects of antimicrobials?
N/V constipation abdominal pain dry mouth headaches
What drug therapy is used for osteoarthritis?
NSAIDS acetaminophen
What drug therapy is used to treat rheumatoid arthritis?
NSAIDS methotrexate leflunomide corticosteroids
What oral medications can be used to treat OA?
NSIADS muscle relaxants mild opiods (tramadol)
What is the antidote to opioids?
Naloxone
What are the S&S of an allergic reaction to antibiotic therapy?
Nausea and/or vomiting Flushing Wheezing Sneezing Pruritus Urticaria Rashes Maculopapular to exfoliative dermatitis Vascular eruptions Erythema multiforme (Stevens-Johnson syndrome) Angioneurotic edema Serum sickness (headache, fever, chills, hives, malaise, conjunctivitis) Anaphylaxis (laryngeal edema, bronchospasm, hypotension, vascular collapse, cardiac arrest) Death
What problems arise from inadequate antimicrobial therapy?
Noncompliance/non adherence leads to inadequate Rx and the development of resistance Legal sanctions compelling a patient to complete treatment (e.g., TB- a healthcare worker must witness the taking of meds) More severe infections develop
What is used to stimulate platelet production?
Oprelvekin (Neumega) may be used to stimulate production of platelets
What are the S&S of increased vascular permeability?
Pain Heat Redness Swelling (edema) Decreased function
What physical things do you assess in a patient with an infection?
Physical Pain Swelling Redness Pus Fever (101oF) Malaise Chills Lymphadenopathy N/V/D
What is classified as thrombocytopenia?
Platelet counts <50,000/mm3 leads to prolonged bleeding Platelet counts < 20,000/mm3 leads to spontaneous and uncontrollable bleeding
What are the S&S of secondary RA?
Severe fatigue Fever Weight loss Anemia Subcutaneous nodules Vasculitis periungal lesions Peripheral neuropathy Pericarditis Fibrotic lung disease Sjögren's Syndrome Renal Disease Felty's Syndrome Iritis/Scleritis
What are the S&S of neutropenia?
Signs & Symptoms (S&S) of infection are likely to be vague because a patient on Chemotherapy has a depressed immune response - fever and purulent drainage may not manifest.
How do you care for the patient with alopecia?
The priority nursing interventions are directed at protecting the scalp from injury. oSunscreen oHead coverings that are soft and pleasing to the patient oCaution is using headphones, helmets, head sets, etc Cutting hair before Chemotherapy allows for a better wig fit. Getting the wig before chemotherapy gives the hair dresser the chance to make a wig resembling the patient's hairstyle. American Cancer Society will loan wigs
What are the risk factors for developing infection in the skin in older patients?
Thinning skin, decreased subcutaneous tissue, decreased vascularity, slower wound healing
What is the treatment for FMS?
antidepressant drugs NSAIDS Anticonvulsants sleep aids muscle relaxants physical therapy
What is Meperidine (demoral)?
any patient with impaired kidney function should not use this drug for pain
What are neutrophils?
are the major cells in the cellular stage; arrive first and engulf and eliminate invaders-Neutrophilia
When does peak immune function occur?
around 20-30 years of age
What is the etiology of Lupus Erythematosus?
autoimmune genetic and environmental factors systemic
What are the risk factors for rheumatoid arthritis?
autoimmune (genetic) emotional stress environmental factors
What is the ASKED model of consciousness?
awareness skill knowledge encounters desire
What is the purpose of bone marrow?
all stem cells originate here and develop into specific cell types based on maturational pathways and specific growth factors the cells are exposed to
What is the drug of choice for repeated episodes of acute gout or chronic gout?
allopurinol
When is the best time to teach a patient about the exercises they will have to do after surgery?
before surgery
What are side effects of NSAIDS?
bleeding dark tarry stool GI disturbances
What can cause neutropenia, anemia and thrombocytopenia?
bone marrow suppresion (myleosuppression)
What are the 7 warning signs of cancer?
changes in bowel or bladder habbits a sore that does not heal unusual bleeding or discharge thickening or lump in the breast or elsewhere indigestion or difficulty swallowing obvious change in a wart or mole nagging cough or hoarseness
What are pharmacogenomics?
checking the person's and tumor genome to determine which therapies will be most effective.
What is the treatment for psoriatic arthritis?
•*Manage joint pain and inflammation* •Control skin lesions •Slow progression •Health teaching similar to skin care for lupus •Management similar to rheumatoid arthritis •MTX
What is the short Michigan alcoholism screening test for the geriatric?
•10 yes/no questions •Each "yes" answer = 1 point •Total score of 2 or more points = individual has problem with alcohol •Examples of questions •Do you drink to take your mind off of your problems? •When you feel lonely, does having a drink help?
What is a traditional incision?
•8 inch incision •Anterolateral thigh •More muscle damage but less risk for dislocation
What is dwarfism?
•A common biologic variation related to adult body size & type. Have a height below 4 feet 10 inches. Results from genetic mutations and hormone imbalance -Proportionate: Smaller versions of average-height people. -Disproportionate: Limbs and features that are not in proportion with the relative size of other parts.
What is culture shock?
•A disorder that occurs in response to transition from one cultural setting to another. A person's former behavior patterns are ineffective in such a setting and basic cues for social behavior are absent. Expressions of shock may range from silence, immobility, agitation, rage or fury. •Can occur in hospitalized patients that have to adapt to a foreign situation.
How do you prevent hip dislocation?
•Abduction Device (posterior approach) •Keep affected leg in neutral position •Teach patient & family to avoid flexing the hips for than 90 degrees at all times (posterior approach) •Avoid hyperextension (anterior approach) •Frequent neurovascular checks
What is delirium?
•Acute state of confusion, fluctuating onset •Usually short-term; reversible within 1 month or less •Often experienced by older adults in unfamiliar settings •Can include physical and emotional manifestations (including psychosis)
What are some age related changes to the effects of drugs?
•Affect absorption •Affect metabolism •Reduce liver blood flow and serum enzyme activity
What is psoriatic arthritis?
•Affects some people with psoriasis •30-50 years of age •Genetic, environmental, infectious agents, immune system dysfunction •Early morning stiffness •Neck and back pain •Fingernail and toenail lifting
How can you help with relocation stress?
•Allow for the person to assist with decision making. •Explain in detail all procedures and routines before they occur. •Have family provide familiar things or keepsakes for the bedside. •Reorient the older adult to their location if possible. •Encourage family and friends to visit . •Establish a trusting relationship. •Avoid moving from room to room. •Accompany the older adult for procedures or therapies so they do not feel alone.
What is acculturation?
•An involuntary process of adopting to a dominant culture. The non-dominant cultural group is often forced to learn the new culture to survive.
What are chemical restraints?
•Antipsychotics •Antianxiety drugs •Antidepressants •Sedative-hypnotics
How should you assess and teach older patients about medications?
•Assess medication use per Healthy People 2020 recommendations •Highlight all drugs that are part of Beers criteria •Perform medication assessment every 6 months or more often as needed •Collaborate with patient, family, providers, pharmacist •Give verbal and written information •Promote adherence to drug therapy regimen exactly as prescribed •Encourage lifestyle changes and nonpharmacologic interventions •Remind not to share/borrow drugs
What is polymyositis/dermatomyositis?
•Autoimmune •Inflammatory disease of skeletal muscle •Severe muscle weakness •Symmetric muscle atrophy •Dysphagia •When coupled with a rash-Dermatomyositis •Heliotrope rash (lilac) and periorbital edema •Exacerbations & Remissions •More women •Malignant neoplasms in older patients
How do changes in kidneys affect the effect of drugs?
•Changes in kidneys result in high plasma drug concentrations
What are the risk factors for fibromyalgia?
•Chronic fatigue syndrome •Lyme disease •Trauma •Flu-like illness
What is fibromyalgia syndrome?
•Chronic pain syndrome •30-50 years of age •Not inflammatory •Arthritis commonly present in patients with fibromyalgia
What is stage III of Lyme disease?
•Chronic persistent •Arthritis •Chronic fatigue •Memory and thinking problems •Months to years after bite
How do you maintain nutrition with scleroderma?
•Collaborate with speech pathologist for swallow study •May need small frequent meals •Collaborate with dietician for dietary changes (easy to swallow foods...mashed potatoes, pudding) •Small bites of food •Teach patient to chew carefully before swallowing
What is the treatment for polymyositis/dermatomyositis?
•Comfort measures •Swallowing precautions •Nutritional support • PT/OT •High dose steroids •Immunosuppressive agents •Health teaching progression of disease, comfort measures, dietary needs
What is ethnicity?
•Common social customs, values and beliefs of a group. Not race.
How can you screen for delirium?
•Confusion Assessment Method (CAM) •Delirium Index (DI) •NEECHAM Confusion Scale •Mini-Cog
What are the side effects of opioids?
•Constipation •Delayed gastric emptying, slowed peristalsis •Use stool softeners •Nausea •Vomiting •Pruritus •Antihistamines can exacerbate sedative effects •Miosis (pinpoint pupils) •Sedationà Respiratory depression •Assess at peak time •Difficult to arouseà stop drug, stay with patient •Naloxone (Narcan) reversal
What is the postoperative care for TKA?
•Continuous Passive Motion (CPM) machine •See chart 18-4 •Ice pack or other cold therapy •Usually more swelling and bruising than with THA
What is case management?
•Coordinates inpatient and community based care BEFORE discharge
What are the nurse safety priority boxes?
•Critical Rescue •Action Alert •Drug Alert
What can methotrexate do?
•Decreased WBCs •Decreased platelets •Elevated liver enzymes •Avoid alcohol •Elevated creatinine •Pregnancy not recommended •Birth defects •Strict birth control •Risk for infection •Avoid crowds
How does physical activity give an advantage over impaired mobility?
•Decreased fall risk •Weight loss/maintenance •Improved mood •Decreased disease risks
What are some considerations when treating veterans?
•Depression •PTSD •Severe anxiety •Substance use (especially alcoholism) •Homelessness
What are the complications of taking steroids?
•Diabetes mellitus •Infection •Fluid and electrolyte imbalances •hypertension •Osteoporosis •glaucoma
What is ADL independence?
•Do not perform the activities for the patient-most want to be independent •Collaborate with dietician in hospital regarding packaging and independence eating •Teach use of large joints or body areas when fine motor skills not possible •May refer to OT when adaptive devices are necessary
What are the hip precautions upon discharge?
•Do not sit or stand for prolonged periods •Do not cross legs beyond midline •Do not bend hips more than 90 degrees (posterior) •Do you hyperextend operative leg behind you (anterior) •Do not twist your body when standing •Use your ambulatory aid when walking •Use assistive devices •Sock aids •Shoe horns •Dressing sticks •Reachers •Do not put more weight on your leg than instructed •Resume sexual intercourse as usual (per surgeon)
What things can cause delirium?
•Drug therapy •Fluid and electrolyte imbalances •Infections •Fecal impaction or severe diarrhea •Surgery •Metabolic problems •Neurological, circulatory, renal, pulmonary disorders •Nutrition deficiencies •Hypoxemia
What is included in the skin assessment of Lupus?
•Dry, scaly, raised rash on the face (butterfly rash) •May appear on other sun exposed areas •Alopecia •Mouth ulcers •DLE-round coin-like scarring lesions
What is neuropathic pain?
•Due to abnormal processing of stimuli •May have no tissue damage or inflammation •Unclear origin •Difficult to treat •Burning, shooting, stabbing, pins and needles in nature
What is stage II of Lyme disease?
•Early disseminated •2-12 weeks after bite •Patient may develop •Carditis •Dysrhythmias •Dyspnea •Dizziness •Palpitations •CNS disorders •Meningitis •Facial paralysis •Peripheral neuritis
What are some common adverse side effects?
•Edema •n/v •Dehydration •Anorexia •Dysrhythmias •Fatigue/weakness •Dizziness/syncope •Urinary retention •Diarrhea/constipation/impaction •Hypotension •Acute confusion
What are the best safety practices?
•Established protocols •Memory checklists •Bar Code Medication Administration
What is medication reconciliation?
•Evaluative Process •Actual current medications •Prescribed medications at the time of admission, transfer, or discharge
How do you manage pain immediately after surgery?
•Extended release epidural morphine (EREM) •Patient-Controlled Analgesia (PCA) •IV "push": •morphine •hydrocodone
What is acute gout?
•Extremely painful joint inflammation •Swollen and painful to touch §Manage pain! §Use a bed cradle or footboard to keep covers off feet
What is involved int eh psychosocial assessment of RA?
•Fear of becoming disabled •Altered body image •Depression •Role changes •Grief/helplessness •Evaluate support systems/coping strategies
What is on the Beer's list?
•First-generation antihistamines (ex: diphenhydramine, hydroxyzine, promethazine) •Alpha1 blockers (ex: doxazosin) •TCA (ex: amitriptyline) •Estrogens with or without progestins •Meperidine •Proton Pump Inhibitors
What are neumega side effects?
•Fluid retention •Congestive Heart Failure •Pulmonary Edema •Conjunctival bleeding •Hypotension •Tachycardia •May stimulate the growth of some cancers
How do you perform incisional care upon discharge?
•Follow instructions •Inspect incision daily •Do not apply anything to the incision unless instructed to do so •Shower according to surgeon's instructions
What is the CAGE test?
•Four questions •Have you ever tried to cut down on your drinking? •Have people annoyed you by criticizing your drinking? •Have you ever felt bad or guilty about your drinking? •Have you ever had a drink first thing in the morning to settle your nerves? (eye-opener)
What are normal H&H levels?
•HGB male 14-18 g/dL •HGB female 12-16 g/dL •HCT male 42-52% •HCT female 37-47%
What is acetaminophen?
•Hepatotoxic (4,000 mg/day max dose)à Liver function tests (ALT, AST) •First line for musculoskeletal pain (OA) •Often in combination with opioids (Percocet-oxycodone/APAP, Norco- hydrocodone/APAP) for moderate-severe pain
What are the risk factors for VTE?
•History of previous CLOTTING problems •Obesity •Smoking •Limited preoperative MOBILITY •Advanced age
What are the side effects of aranesp?
•Hypertension •Hypercoagulability •Stroke •MI (heart attacks) •Promotes growth of some forms of cancers
What happens in operative procedures?
•IV antibiotic 1 hour before initial incision •cefazolin (Ancef) General anesthesia or epidural/spinal
What are NSAIDS?
•Ibuprofen, Naproxen, Ketorolac (Toradol), Diclofenac (Voltaren Gel) •Watch renal function à BUN, Crt •Increased GI bleed, stomach ulcers, decreased platelet aggregation, CV complications •Helps with inflammatory pain (RA)
What drugs are used for renal in lupus?
•Immunosuppressive agents •methotrexate (Rheumatrex) •azathioprine (Imuran) •PATIENTS SUSCEPTIBLE TO INFECTIONS! •SEVERE Renal Involvement •Immunosuppressives AND Steroids •Plasmapheresis •Renal transplant
What is infectious arthritis?
•Infectious agent invades joint space •Destroys tissue •Local or • systemic • antibiotics • 6-8 weeks
What is chronic gout?
•Inspect skin for tophi •Outer ear •Arms and fingers near joints •Renal calculi or insufficiency •Severe pain changes in urinary output
What are the national patient safety goals?
•NPSG—must have program to prevent agency-associated pressure injuries •Nutrition support •Avoid friction, shearing •Reposition and provide support surfaces •Increase mobility and activity (when appropriate) •Clean skin, use moisture barriers
What is involved in the laboratory assessment of RA?
•No single test can confirm •Rheumatoid factor (RF) •Anti-cyclic citrullinated peptide (anti-CCP) •Antinuclear antibody (ANA) •Erythrocyte sedimentation rate (ESR) •Highly sensitive C-reactive protein (hsCRP)
What is neutropenia?
decrease in neutrophils
What is the disease process of osteoarthritis?
degenerative
What is the difference between dementia and delirium?
delirium is reversible, dementia is not
What is the geriatric depression scale?
questionaire with 15 questions about depression
What is the etiology of gout?
excess uric acid in the blood
What are extravasation of chemotherapeutic agents?
extravasation refers to the inadvertent infiltration of chemotherapy into the subcutaneous or subdermal tissues surrounding the intravenous or intra-arterial administration site
What is teletherapy?
radiation is delivered from outside the patient so the patient is not radioactive
What is brachytherapy?
radiation is delivered from within the patient therefore the patient is radioactive. oUnsealed isotopes are given IV or PO and the patient is radio active until the isotope is eliminated. Excreta is radioactive. oSealed isotopes are solids implanted in or near the cancer. The patient emits radio waves but excreta is not radioactive. Implants may be left in permanently or for short prescribed time periods.
What is a calssic sign of exacerbation in Lupus?
fever
What helps decrease constipation?
fiber motility 2 L water/day
When should you take steroids?
first thing in the morning
How is SVC compression treated?
high dose radiation, stents, angioplasty, surgery to de-bulk tumor
What are the 3 stages of gout?
hyperuricemia acute gouty arthritis chronic tophaceous gout
What are the risk factors for developing infection in function and cognition in older patients?
immobility, incontinence, dementia
How do you care for a patient in an emergency situation?
safety airway breathing circulation
What is the Beer's list?
medications that should not be given to older adults
What do you avoid when taking an opioid?
meperidine (Demerol) codeine
What infections inter the body through the skin or mucous membranes?
most enter via percutaneous means or broken skin. Treponema Pallidum enters through intact skin
What does rheumatic disease involve?
musculoskeletal system
Is it normal for an older patient to be confused?
no
What labs are associated with osteoarthritis?
normal or slightly elevated ESR
What is tumor lysis syndrome?
oAs cancer cells die from treatment, they degrade and release K+ and purines into the blood stream faster than the body can get rid of them. oPurines deposit uric acid crystals which deposit in the kidneys injuring the kidneys. oPatients develop hyperkalemia
What are the signs of SVC compression?
oEdema of head, neck, face, eyes in the morning → engorged blood vessels and erythema of the upper body, epistaxis, dyspnea → hemorrhage, cyanosis, mental status changes, ↓CO,↓BP & death
What is given to combat anemia?
oEpoetin Alfa (Epogen and Procrit) oDarbrpoetin Alfa ( Aranesp)
What causes cancer?
oExposure to Carcinogens •Chemical (80%) •Physical •Viral •Dietary oGenetic Predisposition oImmune Function
What are the side effects of biological response modifiers?
oFluid shifts oCapillary leaks with edema formation oFever, chills, rigors, flu like S&S oItching oSkin dryness - unscented moisturizers and mild soap
How is tumor lysis syndrome treated?
oHYDRATION, HYDRATION, HYDRATION •3-5L the day before, on, and 3 days after treatment •Some fluids should be alkaline •Prevent NV •Polystyrene sulfonate, glucose & insulin for K+ •Allopurinol for Uric Acid
What is the priority nursing intervention for the cognitively impaired patient?
oListen oReassure others have had the same experience and it is temporary oDiscourage activities that impair cognition
Why do females receive hormonal therapy?
oMasculine hair pattern oAmenorrhea oLoss of breast tissue oAcne oFluid retention oHypocalcemia oLiver dysfunction oVTE
· What is the stimulus for the conversion of normal cells to malignant cells?
oncogenes
How do you prevent DVT and PE?
one mg/kg Lovenox SCD and TED stockings (apply before surgery) warfarin LMWH Factor Xa inhibitors
What does localized scleroderma affect?
only skin
What is the pain assessment?
onset location duration characteristics aggravating factors relieving factors treatment impact coping emotion
What are antimetabolites?
similar to normal metabolites so the cancer cells ingest the antimetabolites leading to impaired cell division
What are oncologic emergencies?
spinal cord compression hypercalcemia superior vena cava syndrome
What drugs are used in scleroderma?
steroids immunosuppresants
What injections can be used to treat OA?
steroids (steroids) hyaluronic acid
What are the respiratory manifestations of anemia?
o• Dyspnea on exertion o• Decreased oxygen saturation levels
What are the integumentary infestations of anemia?
o• Pallor, especially of the ears, the nail beds, the palmar creases, the conjunctivae, and around the mouth o• Cool to the touch o• Intolerance of cold temperatures o• Nails become brittle and may lose the normal convex shape; over time, nails become concave and fingers assume clublike appearance
What are the cardiovascular manifestations of anemia?
o• Tachycardia at basal activity levels, increasing with activity and during and immediately after meals o• Murmurs and gallops heard on auscultation when anemia is severe o• Orthostatic hypotension
What is the halmark of gout?
pain
How do you check neurovascular status?
pain pulse pallor paresthesia paralysis
What are the s/s of extravasation?
pain, swelling, no blood return
What are T8 cells?
suppressor cells - suppress specific actions Cytotoxic T8 cells
what medication can be used to reduce the symptoms of OA?
tylenol advil topical salicylates lidocaine
How do you treat MRSA?
vancomycin linezolid
What is the pathophysiology of Lupus Erythematosus?
§Antinuclear Antibodies (ANA) affect DNA, RNA, other components with the cell nuclei §Immune complexes form in serum and organ tissues §Inflammation, damage, destruction §Complexes invade organs or vessels §Deprives organs and tissues of arterial blood and oxygen
What is systemic necrotizing vasculitis?
§Arteritis-primary manifestation •ischemia •Severe pain •Necrosis of toes/fingers §Organ involvement •Kidney •Heart
What is the etiology of Systemic Sclerosis (Scleroderma?
§Connective Tissue Disease §Exact cause unknown §Women more than men §Uncommon §Chronic §Inflammatory §Autoimmune §Not always progressive
What is the pathophysiology of scleroderma?
§Early inflammatory process similar to SLE §Inflamed tissue becomes sclerotic §Renal involvement is the leading cause of death §Respiratory involvement and hypertension common
What are the S&S of diffuse systemic scleroderma?
§FIRST sign: hand and forearm edema §GERD (diffuse and limited)
What are COX enzymes?
perpetuate the inflammatory response
When can you place patients in the same room?
placing multiple patients with the same organism in rooms together Used a lot with MDROs
What is the TNM staging of cancer?
primary tumor: Tx=primary tumor cannot be assessed T0=no evidence of primary tumor Tis= carcinoma in situ T1, T2, T3, T4= increasing size and/or local extent of primary tumor regional lymph nodes (n) Nx= regional lymph nodes cannot be assessed N0= no regional lymph node metastasis N1, N2, N3= increasing involvement of regional lymph nodes distant metastasis (m) Mx= presence of distant metastasis cannot be assessed M0= no distant metastasis M1= distant metastasis
What is the pathophysiology of osteoarthritis?
progressive deterioration and loss of cartilage and bone in 1 or more joints joint space narrows cartialge disintegrates
What is the antidote to Lovenox LMWH?
protamine sulfate
What are 1st generation antihistamines?
(ex: diphenhydramine, hydroxyzine, promethazine)
What is involved in adaptive immunity?
T cells
How does the body differentiate between self and nonself cells?
The body is capable of recognizing self or non-self cells due to protein markers on self cells
What are the drugs of choice for chronic gout?
•allopurinol (Zyloprim) DOC •(may be used for recurrent episodes of acute gout) •xanthine oxidase inhibitors
What are the side effects of relocation stress syndrome?
•sleep disturbance, GI distress, withdrawal, anxiety, anger, and depression
How is the geriatric depression scale scored?
>5= possible depression >10=depression
What do you test for in Lupus?
ANA
What is cultural humility?
Ability to maintain an interpersonal stance that is other-oriented (or open to the other) in relation to aspects of cultural identity that are most important to the person.
What are private rooms necessary for?
Airborne precautions Extremely high risk Contact precautions - if possible Droplet Precautions - if possible
What are malignant cells?
Anaplastic growth - looses parent morphology Loses parent function- cells have no useful purpose. Loses adherence Migrates and invades other tissues Rapid and uncontrolled growth Larger nucleus Chromosomal abnormalities
How do you decrease incidence of biofilm developing on a catheter?
Antimicrobial catheters (silver alloy or antimicrobial coating) recommended to decrease encrustation Best management - mechanical disruption
What is stereotyping?
Assuming that all people from a particular culture are the same.
What are some side effects of chemotherapy?
Cardiac muscle damage Loss of bone density Bone marrow depression Nausea Vomiting Alopecia Mucositis Anxiety Insomnia Altered bowel elimination Changes in cognitive function Psychosocial problems
What is neglect?
Caregiver failure to provide basic needs
What are the S&S of leukemia and lung cancer?
Change in bowel habits Encourage baseline colonoscopy Pain on urination Cloudy urine Urinary -smaller stream/ urgency/frequency/hesitancy
What changes in the elderly might indicate cancer?
Change in bowel habits Encourage baseline colonoscopy Pain on urination Cloudy urine Urinary -smaller stream/ urgency/frequency/hesitancy
How does chemotherapy work?
Chemotherapy is systemic and kills cancer cells making it necessary for metastatic cancers. Chemotherapy also kills healthy cells, particularly rapidly dividing cells (skin, hair, intestinal tissues, sperm and blood forming cells)
What are biofilms?
Complex group of microorganisms attach Urinary catheters Orthopedic implants Feeding tubes Teeth Wound edges
What is the nurse's role with surgery?
Coordinate care Encourage patient to express their feelings Encourage patient to look at and touch the operative site Encourage patient to participate in care - dressings for example Provide support group contact for patients and families Have some who has coped with the same issue come for a visit Referral to a mental health care provider may be needed if the patient has persistent depression Develop exercise regimes to maintain strength and function.
What labs do you acquire for a patient with an infection?
Culture Sensitivity CBC with diff Left shift ESR > 20mm/hr Serologics/antibody titers Imaging X-Rays CT scan MRI Ultrasound
What are the drugs of choice for RA?
DMARDS methotrexate (immunosuppressive)
What is the most life threatening complication after THA?
DVT PE
What are the risk factors for developing infection in the GI tract in older patients?
Decreased acid and motility
What are the risk factors for the immune system in older patients?
Decreased antibodies, lymphocytes & fever response
What are risk factors that may increase infection in the respiratory sytem in older patients?
Decreased cough and gag reflex
What is cultural diversity?
Differences among people which may or may not be visible
What are health disparities?
Differences in the incidence of health problems in minority groups compared to the majority.
When do you NOT use alcohol based hand rub?
Do not use ABHRs when instilling anything into the eyes due to burning and irritation of the eye. Do not ABHRs after caring for a patient with a spore forming bacteria like c. diff
What do you teach a patient with thrombocytopenia?
During the time your platelet count is low:•Use an electric shaver. •Use a soft-bristled toothbrush. •Do not have dental work performed without consulting your cancer health care provider. •Do not take aspirin or any aspirin-containing products. Read the label to be sure that the product does not contain aspirin or salicylates. •Do not participate in contact sports or any activity likely to result in your being bumped, scratched, or scraped. •If you are bumped, apply ice to the site for at least 1 hour. •Avoid hard foods that would scrape the inside of your mouth. •Eat warm, cool, or cold foods to avoid burning your mouth. •Check your skin and mouth daily for bruises, swelling, or areas with small reddish purple marks that may indicate bleeding. •Notify your cancer health care provider if you: o•Are injured and persistent bleeding results oHave excessive menstrual bleeding oSee blood in your urine or bowel movement •Avoid anal intercourse. •Take a stool softener to prevent straining during a bowel movement. •Do not use enemas or rectal suppositories. •Avoid bending over at the waist. •Do not wear clothing or shoes that are tight or that rub. •Avoid blowing your nose or placing objects in your nose. If you must blow your nose, do so gently without blocking either nasal passage. •Avoid playing musical instruments that raise the pressure inside your head, such as brass wind instruments and woodwinds or reed instruments.
What do you teach a neutropenia patient about avoiding infection?
During the times your white blood cell counts are low:•Avoid crowds and other large gatherings of people who might be ill. •Do not share personal toilet articles, such as toothbrushes, toothpaste, washcloths, or deodorant sticks, with others. •If possible, bathe daily, using an antimicrobial soap. If total bathing is not possible, wash the armpits, groin, genitals, and anal area twice a day with an antimicrobial soap. •Clean your toothbrush at least weekly by either running it through the dishwasher or rinsing it in liquid laundry bleach (and then rinsing the bleach out with hot running water). •Wash your hands thoroughly with an antimicrobial soap before you eat and drink, after touching a pet, after shaking hands with anyone, as soon as you come home from any outing, and after using the toilet. •Avoid eating salads; raw fruits and vegetables; undercooked meat, fish, and eggs; and pepper and paprika. •Wash dishes between use with hot, sudsy water, or use a dishwasher. •Do not drink water, milk, juice, or other cold liquids that have been standing at room temperature for longer than an hour. •Do not reuse cups and glasses without washing. •Do not change pet litter boxes. •Take your temperature at least once a day and whenever you do not feel well. •Report any of these signs or symptoms of infection to your physician immediately:•Temperature greater than 100° F. •Persistent cough (with or without sputum) •Pus or foul-smelling drainage from any open skin area or normal body opening •Presence of a boil or abscess •Urine that is cloudy or foul smelling or that causes burning on urination •Take all prescribed drugs. •Wear clean disposable gloves underneath gardening gloves when working in the garden or with houseplants. •Wear a condom (if you are a man) when having sex. If you are a woman having sex with a male partner, ensure that he wears a condom.
Why do males receive hormonal therapy?
Female hair pattern Thinner facial skin Female fat pattern Gynecomastia Bone loss Testicular and penile atrophy VTE Fluid retention Hypocalcemia Liver dysfunction
What is the grading system for cellular characteristics?
Gx= grade cannot be determined G1= tumor cells are well differentiated and closely resemble the normal cells from which they arose; low grade of malignant change, slowly growing G2= tumor cells are moderately differentiated; they still retain some of the characteristics of normal cells but also have more malignant characteristics than do G1 tumor cells G3= tumor cells are poorly differentiated, but the tissue of origin can usually be established; the cells have few normal cell characteristics G4= tumor cells are poorly differentiated and retain no normal cell characteristics; determination of the tissue of origin is difficult and perhaps impossible
What infections enter the body through the genitourinary tract?
HAI of CAUTI
What do you assess in a patient with an infection?
History Age Tobacco/alcohol/ illicit drug use Concurrent illnesses Medications Vaccinations Travel HX of MDROs infection Exposure to ill individuals, contaminated food/water Animal contact Leisure activities Sexual hx Transfusion hx S&S pattern
What are HLA's?
Human leukocyte antigens (HLAs) are the self markers (proteins) on the surface of all cells
What are the types of transplant rejections?
Hyperacute occurs immediately when the host has preformed antibodies to the organ Acute occurs within the first few months owing to vaculitis→hypoperfusion and T and NK cell activity Chronic- the donated organ is scarred and becomes non-functional
What prevent entry into the body?
Intact skin & mucous membrane Normal Skin Flora Chemicals on the skin
What is culture?
Integrated patterns of behavior acquired over time. They include beliefs, values, customs, norms, habits, language, thoughts and ways of life.
What is EBP?
Integration of the BEST current evidence and practices to make decisions about patient care.
What are biological response modifiers?
Interleukins and interferons used to boost the body's immune response and boost the tumor's response to other therapies.
How does radiation work in cancer therapy?
Ionizing radiation is directed at the tumor to kill or halt mitosis of tumor cells. Cells in the path of radiation are destroyed. The best kill occurs in dividing cells. Exposure refers to the amount of radiation delivered,. Radiation dose refers to the amount of radiation absorbed. Radiation is given over multiple doses/days to increase kill the patient.
What items must be sterilized?
Items used in sterile body cavities must be sterilized Items used in non sterile regions may be disinfected
What are the S&S of early RA?
Joint inflammation Fatigue weakness Anorexia Persistent low grade fever Upper extremity joints (PIP, MCP of hands) Reddened, warm, stiff, swollen, tender, or painful Typically bilateral and symmetric ONE hot, swollen joint could mean INFECTION
What are the S&S of late RA?
Joints progressively inflamed Frequent morning stiffness (gel phenomenon) may last hours Joints feel soft and look puffy Most synovial joints eventually affected Joint deformity Swan Neck Boutonniere Ulnar Deviation
Why should you take the full course of antibiotics?
Just because you are feeling better, it does not mean all of the bacteria has been killed and you could become sick again
How does our immune system change as we age?
Less leukocytosis (WBC) occurring in acute situations Diminished neutrophil production Poor fever response Decreased number and response of B cells/antibodies Decrease thymus activity= decreased T cells activity
What are the risk factors for MRSA?
Older adults Immunocompromised Invasive lines ICU patients
How are VISA and VRSA treated?
Linezolid (Zyvox) Quinupristin-dalfopristin (Synercid)
What are benign cells?
Maintain parent morphology Maintain parent function Maintain tight adherence/encapsulation Do not migrate to other areas Does not invade Controlled growth rate Most have 23 pairs of chromosomes Smaller cell nucleusContinuous or inappropriate cell growth that show specific morphology and have a small nuclear cytoplasmic ratio. Normal cells that grow in the wrong place at the wrong time. Perform differentiated functions. Adhere tightly together. Are nonmigratory. Grow in an orderly manner.
How do you primarily prevent cancer?
Modify lifestyle to avoid oSun oTobacco oAsbestos oHigh fat low fiber diets oMultiple sexual partners oProcessed meats Remove at risk tissues oMoles oPolyps oBreast oOvaries
What happens in the vascular stage?
Momentary vasoconstriction followed by vasodilatation and capillary leakage Increases the volume of blood delivered to the damaged tissue thereby delivering the necessary components of the blood to handle the injury. Hyperemia and edema occur Edema dilutes toxins and provides a cushion to prevent further injury Histamine, serotonin, and bradykinins cause the changes ? in the vascular stage. Macrophages are the major cells in this stage
What are airborne precautions?
Monitored negative airflow rooms required to prevent spread of microbes HEPA air filter N95 mask Limit patient movement Patient wears N95 mask to travel around hospital For TB, measles, chickenpox
Who is Madeline Leninger?
Nurse anthropologist that provided knowledge on transcultural nursing.
How do you care for a patient receiving radiation?
Patients are anxious and fearful so offer accurate, objective information about the process, purpose, and side effects. Skin in the path of radiation becomes very dry and may breakdown. Shield bone marrow, skin, mucous membranes, hair follicles, sperm & eggs when possible. Consult a dietitian as dysphagia and altered taste accompany radiation from chest level up. Head and neck radiation leads to xerostomia which leads to life long increased incidence of tooth decay.
What is photodynamic therapy?
Patients are given IV medications which deposit in all cells but dissipate from normal cells in a couple of days (2-3 days). After the dissipation time, the patient receives laser therapy which destroys the cancer cells with the medication still present. Patients have marked photosensitivity for 12 weeks following therapy and should be instructed on how to protect from light and to remain homebound for 3 months.
How do you decrease incidence of community associated MRSA?
Perform frequent hand hygiene, including use of hand sanitizers Avoid close contact with people with infectious wounds Avoid large crowds Avoid contaminated surfaces Use good overall hygiene
What happens in postoperative care for OA?
Prevent •Hip dislocation •Venous thromboembolism •Infection •Hypotension, bleeding, or infection
What are antimitotics?
halts mitosis in cancer cells
· Who is most likely to have a latex allergy?
health care workers
What is spirituality?
Religious beliefs & practices, use of prayer, practices that give meaning to life.
What is the care for a patient receiving photodynamic therapy after photosensitization?
Remember that the photosensitizing effects last from 1 to 3 months. Continue to wear all protective clothing, avoid sunlight in any form, and avoid high-wattage indoor lights. Drink plenty of water to prevent becoming dehydrated. Do not take any newly prescribed or over-the-counter drugs without contacting the physician who performed the photodynamic therapy. Some drugs make the light sensitivity even worse; others interact with the photosensitizing drug. When you do start to re-expose yourself to sunlight and other bright lights, do so slowly. Start out exposing only about 1 inch of your skin to sunlight at a time Start out with only 10 minutes, and increase the time only by about 5 minutes each day. Remember that sunscreen will not prevent severe sunburn during this time. If you experience pain or blistering, notify the photodynamic therapy health care team. Continue to wear dark glasses, even indoors, until you no longer have eye pain when in a normally lighted environment. When you no longer are photosensitive, see an ophthalmologist to check whether your retina has any damage.
What are standard precautions?
Respiratory hygiene/cough etiquette (RH/CE) Patient, staff, and visitor education Posted signs Hand hygiene Cover nose/mouth with tissue and quickly dispose tissue Cough into shirt sleeve rather than covering with hand Safe injection practices Single use sterile needle
How do you decrease incidence of MRSA?
health teaching chlorhexidine
What infections enter the body throught the GI tract?
Salmonella enteritiditis, Salmonella typhi, Shigella, millions of other food borne illnesses
What is secondary prevention of cancer?
Screening is key as early detection = better outcomes oMammography (40+) oBreast and testicular exams oColonoscopy (50 then every 10 years) oYearly fecal occult blood for all adults oYearly PSA and rectal exam for males over 50
What is SBAR?
Situation Background Assessment Recommendation
How long does the inflammatory process last and why does it start?
Starts both antibody and cell mediated immune responses. Typical acute response lasts 24-72 hours
What are the negatives of acculturation?
Stress, anxiety, similar health outcomes as the dominant culture in future generations of first generation immigrants, alienation from culture of origin.
How do you counteract neutropenia?
Suggest biological response modifiers (BRM) and growth factors to counteract the myelosuppression. Be aware most infections are caused by the patient's normal flora and may be fungal, bacterial, or viral. Blood counts generally return to normal once therapy is stopped, however sometimes therapy is aborted due to infection or infection risk. The PRIORITY nursing interventions for neutropenic patients are to protect the patient from infection in the hospital and to educate the patient and family on how to prevent infection in the home.
What is the priority nursing intervention for neutropenic patients?
The PRIORITY nursing interventions for neutropenic patients are to protect the patient from infection in the hospital and to educate the patient and family on how to prevent infection in the home.
What are T4 cells?
helper cells - organize/enhance the response
What is cultural sensitivity?
When a person is aware of and respects cultural differences therefore, avoiding language or actions that may be offensive when interacting with people of diverse cultures.
When should you wash your hands?
When hands are visibly soiled or contaminated with proteinaceous material or are visibly soiled with blood or other body fluids, wash hands with soap and water.
What is extravasation?
When the IV infiltrates, the drug is given into soft tissue and due to the vesicant nature, the tissue is destroyed
What is involved in the imaging assessment of RA?
X-Ray CT Scan Bone scan MRI Arthrocentesis •Monitor for bleeding and leakage of synovial fluid!
The patient taking ibuprofen for the pain of OA. What should be included in the patient teaching for this medication? Notify the HCP if: a. you have dark, tarry stools b. your urine output decreases c. you have frequent indigestion d. you have frequent headaches e. you plan to leave the country f. you operate heavy machinery
a. you have dark tarry stools b. your urine output decreases c. you have frequent indigestion
Who is at risk for Vancomycin-resistant Enterococcus (VRE)?
abdominal surgery, long hospital stays, enteral feedings, severely ill, immunocompromised
What are the types of non-opioids?
acetaminophen NSAIDS
What is the antidote to acetaminophen?
acetylcysteine (Mucomist)
What are monocytes?
actions similar to neutrophils but have a longer life span and mature into macrophages
Is acute or chronic more important?
acute is priority since chronic pain has adapted to change
What is the etiology of osteoarthritis?
aging genetics weight
What are the risk factors for osteoarthritis?
aging obesity trauma occupation
What are the S&S of limited systemic scleroderma?
calcinosis raynauds esophageol dysfunction sclerodactyl telangelctasis
What do the elderly have an increased need for?
calcium- bones vitamin A- eye sight Vitamin C- immune system Vitamin D fiber- decreases constipation
What are the drugs of choice for acute gout?
colchicine NSAIDS
What is rheumatic disease?
connective tissue disease; progressive joint deterioration
What kind of precautions are taken for MRSA?
contact
What does a histamine do?
dilates blood vessels; opens capillary space
What are topoisomerase inhibitors?
disrupts an enzyme needed for DNA synthesis and cell division.
What antibiotic is used to treat Lyme disease?
doxicycline amoxicillin
What are the S&S of Sjorgens syndrome
dry eyes dry mouth dry vagina
What labs are associated with rheumatoid arthritis?
elevated rheumatoid factor antinuclear antibody ESR
How do the elderly get vitamin D?
go for walks 3-4 times a week
What is the disease process of rheumatoid arthritis?
inflammatory
What is arthritis?
inflammatory or degenerative diseases affecting joints
What are alkylating agents?
inhibits cell division by tightening the bond between the two DNA strands
What are antitumor antibodies?
interrupt DNA or RNA synthesis
What infections enter the body through the bloodstream?
invasive devices, bites
What is impaired mobility?
related to joint pain and muscle atrophy
What is chronic pain?
related to joint swelling and deterioration
What are some non pharmalogical interventions for RA?
rest proper positioning ice heat
What are non pharmalogical interventions used to treat OA?
rest balanced with exercise joint positioning heat or cold weight control acupuncture massage dietary supplements
What are the S&S of neutropenia?
s/s of infection, temps of 100.5 is of great concerns.
How do you protect patients from infection?
• Assess patients for risk for infections. • Monitor for signs and symptoms of infection. • Monitor laboratory tests results, such as cultures and white blood cell (WBC) count and differential. • Screen all visitors for infections or infectious disease. • Inspect skin and mucous membranes for redness, heat, pain, swelling, and drainage. • Promote sufficient nutritional intake, especially protein for healing. • Encourage fluid intake to treat fever. • Teach the patient and family the signs and symptoms of infections and when to report them to the health care provider. • Teach the patient and family how to avoid infections in health care agencies and the community.
How do you care for a patient with sealed implants of radiation?
• Assign the patient to a private room with a private bath. • Place a "Caution: Radioactive Material" sign on the door of the patient's room. • If portable lead shields are used, place them between the patient and the door. • Keep the door to the patient's room closed as much as possible. • Wear a dosimeter film badge at all times while caring for patients with radioactive implants. The badge offers no protection but measures a person's exposure to radiation. Each person caring for the patient should have a separate dosimeter to calculate his or her specific radiation exposure. • Wear a lead apron while providing care. Always keep the front of the apron facing the source of radiation (do not turn your back toward the patient). • Pregnant nurses should not care for these patients; do not allow pregnant women or children younger than 16 years to visit. • Limit each visitor to one-half hour per day. Be sure visitors stay at least 6 feet from the source. • Never touch the radioactive source with bare hands. In the rare instance that it is dislodged, use a long-handled forceps to retrieve it. Deposit the radioactive source in the lead container kept in the patient's room. • Save all dressings and bed linens in the patient's room until after the radioactive source is removed. After the source is removed, dispose of dressings and linens in the usual manner. Other equipment can be removed from the room at any time without special precautions and does not pose a hazard to other people.
How do you remain safe when undergoing radiation therapy?
• Assign the patient to a private room with a private bath. • Place a "Caution: Radioactive Material" sign on the door of the patient's room. • If portable lead shields are used, place them between the patient and the door. • Keep the door to the patient's room closed as much as possible. • Wear a dosimeter film badge at all times while caring for patients with radioactive implants. The badge offers no protection but measures a person's exposure to radiation. Each person caring for the patient should have a separate dosimeter to calculate his or her specific radiation exposure. • Wear a lead apron while providing care. Always keep the front of the apron facing the source of radiation (do not turn your back toward the patient). • Pregnant nurses should not care for these patients; do not allow pregnant women or children younger than 16 years to visit. • Limit each visitor to one-half hour per day. Be sure visitors stay at least 6 feet from the source. • Never touch the radioactive source with bare hands. In the rare instance that it is dislodged, use a long-handled forceps to retrieve it. Deposit the radioactive source in the lead container kept in the patient's room. • Save all dressings and bed linens in the patient's room until after the radioactive source is removed. After the source is removed, dispose of dressings and linens in the usual manner. Other equipment can be removed from the room at any time without special precautions and does not pose a hazard to other people.
How do you protect skin with lupus?
• Cleanse skin with a soap, such as Ivory. • Dry skin thoroughly by patting rather than rubbing. •Apply lotion to dry skin areas. •Avoid powder and other drying agents, such as rubbing alcohol. •Use cosmetics that contain moisturizers. Consult medical cosmotologist •Avoid direct sunlight and any other type of ultraviolet lighting, including tanning beds. •Wear a large-brimmed hat, long sleeves, and long pants when in the sun. •Use a sun-blocking agent with a sun protection factor (SPF) of at least 30. •Inspect skin for open areas and rashes.
What is the mouth care for a patient with mucositis?
• Examine your mouth (including the roof, under the tongue, and between the teeth and cheek) every 4 hours for fissures, blisters, sores, or drainage. • If sores or drainage is present, see your health care provider to have these areas cultured. • Brush the teeth and tongue with a soft-bristled brush or sponges every 8 hours and before meals. • Rinse the mouth with a solution of one-half peroxide and one-half normal saline every 12 hours. • Avoid the use of mouthwashes that contain alcohol or glycerin. • Rinse your mouth four times daily with a bland rinse. • Drink 2 or more liters of water per day if another health problem does not require limiting fluid intake. • Take antimicrobial drugs as prescribed. • Use topical analgesic drugs as prescribed or as needed. • "Swish and spit" room-temperature tap water or normal saline as needed. • Apply a water-based moisturizer to your lips after each episode of mouth care and as needed. • Use prescribed "artificial saliva" or mouth moisturizers as needed. • Avoid using tobacco or drinking alcoholic beverages. • Avoid spicy, salty, acidic, dry, rough, or hard food. • Cool liquids to prevent burns or irritation. • If you wear dentures, use them only during meals. When not in place, soak dentures in an antimicrobial solution. Rinse thoroughly before placing them in your mouth.
How do you prevent injury to a patient with thrombocytopenia?
• Handle the patient gently. • Use and teach UAP to use a lift sheet when moving and positioning the patient in bed. • Avoid IM injections and venipunctures. • When injections or venipunctures are necessary, use the smallest-gauge needle for the task. • Apply firm pressure to the needle stick site for 10 minutes or until the site no longer oozes blood. • Apply ice to areas of trauma. • Test all urine and stool for the presence of occult blood. • Observe IV sites every 4 hours for bleeding. • Instruct patients to notify nursing personnel immediately if any trauma occurs and if bleeding or bruising is noticed. • Avoid trauma to rectal tissues: •Do not administer enemas. •If suppositories are prescribed, lubricate liberally and administer with caution. • Measure the patient's abdominal girth daily. • Instruct the patient and UAP to use an electric shaver rather than a razor. • When providing mouth care or supervising others in providing mouth care: o• Use a soft-bristled toothbrush or tooth sponges. o• Do not use water pressure gum cleaners. o• Make certain that dentures fit and do not rub. • Instruct the patient not to blow the nose or insert objects into the nose. • Instruct UAP and the patient that the patient should wear shoes with firm soles whenever ambulating. • Keep pathways and walkways clear and uncluttered.
How should you care for a patient with neutropenia?
• Place the patient in a private room whenever possible. • Use good handwashing technique or use alcohol-based hand rubs before touching the patient or any of the patient's belongings. • Ensure that the patient's room and bathroom are cleaned at least once each day. • Do not use supplies from common areas for patients with myelosuppression and neutropenia. For example, keep a dedicated box of disposable gloves in his or her room and do not share this box with any other patient. Provide single-use food products, individually wrapped gauze, and other individually wrapped items. • Limit the number of health care personnel entering the patient's room. • Monitor vital signs every 4 hours, including temperature. • Inspect the patient's mouth at least every 8 hours. • Inspect the patient's skin and mucous membranes (especially the anal area) for the presence of fissures and abscesses at least every 8 hours. • Inspect open areas, such as IV sites, every 4 hours for manifestations of infection. • Change wound dressings daily. • Obtain specimens of all suspicious areas for culture (as specified by the agency), and promptly notify the physician. • Assist the patient in coughing and deep-breathing exercises. • Encourage activity at a level appropriate for the patient's current health status. • Change IV tubing daily, or according to unit protocol. • Keep frequently used equipment in the room for use with this patient only (e.g., blood pressure cuff, stethoscope, thermometer). • Limit visitors to healthy adults. • Use strict aseptic technique for all invasive procedures. • Monitor the white blood cell count, especially the absolute neutrophil count (ANC), daily. • Avoid the use of indwelling urinary catheters. • Keep fresh flowers and potted plants out of the patient's room - hospital policy based. • Teach the patient to avoid eating raw fruits and vegetables; undercooked meat, eggs, and fish; pepper; and paprika
How do you protect the patient with chemo induced peripheral neuropathy?
• Protect feet and other body areas where sensation is reduced (e.g., do not walk around in bare feet or stocking feet; always wear shoes with a protective sole). • Be sure shoes are long enough and wide enough to prevent creating sores or blisters. • Buy shoes in the afternoon or evening to accommodate any size change needed for foot swelling. • Provide a long break-in period for new shoes; do not wear new shoes for longer than 2 hours at a time. • Avoid pointed-toe shoes and shoes with heels higher than 2 inches. • Inspect your feet daily (with a mirror) for open areas or redness. • Avoid extremes of temperature; wear warm clothing in the winter, especially over hands, feet, and ears. • Test water temperature with a thermometer when washing dishes or bathing. Use warm water rather than hot water (less than 105° F). • Use potholders when cooking. • Use gloves when washing dishes or gardening. • Do not eat foods that are "steaming hot"; allow them to cool before placing them in your mouth. • Eat foods that are high in fiber (e.g., fruit, whole grain cereals, vegetables). • Drink two to three liters of fluid (nonalcoholic) daily unless your health care provider has told you to restrict fluid intake. • Get up from a lying or sitting position slowly. If you feel dizzy, sit back down until the dizziness fades before standing; then stand in place for a few seconds before walking or using the stairs. • Look at your feet and the floor or ground where you are walking to assess how the ground, floor, or step changes to prevent tripping or falling. • Avoid using area rugs, especially those that slide easily. • Use handrails when going up or down steps.
How do you conserve energy for the patient with anemia?
• Reassure the patient that fatigue is temporary and energy levels will improve over a period of weeks to months. Stress that a return to previous energy levels may take as long as a year. • Teach the patient that shortness of breath and palpitations are symptoms of over-activity. • Instruct the patient to stop activity when shortness of breath or palpitations are present. • Space care activities at least an hour apart, and avoid the time right before or right after meals. • Schedule care activities at times when the patient has more energy (e.g., immediately after naps). • Perform complete bed bath only every other day. In between complete baths, ensure cleansing of face, hands, axillae, and perineum. • In collaboration with other members of the health care team, cancel or reschedule non-essential tests and activities. • Provide four to six small, easy-to-eat meals instead of three larger ones. • Urge the patient to drink small amounts of protein shakes or other nutritional supplements. • During periods of extreme fatigue, encourage the patient to allow others to perform personal care. • Help the patient identify one or two lead visitors (those designated as able to visit at any time and who do not disturb the patient). • Selectively limit non-lead visitors when the patient is resting or sleeping. • Remind families that, although independence is important, independence in ADLs during extreme fatigue can be detrimental to the patient's health. • Monitor oxygen saturation and respiratory rate during any activity to determine patient responses and activity tolerance.
When should you decontaminate hands?
• Use either ABHR or wash with soap and water (decontaminate hands) before having direct contact with patients. • Decontaminate hands before donning sterile gloves to perform a procedure, such as inserting an invasive device (e.g., indwelling urinary catheter). • Decontaminate hands after contact with a patient's intact skin (e.g., taking a pulse) or with body fluids or excretions/secretions. • Decontaminate hands after removing gloves. • Decontaminate hands after contact with inanimate objects (including medical equipment) in the immediate vicinity of the patient.
How do you protect skin during radiation therapy?
• Wash the irradiated area gently each day with either water or a mild soap and water as prescribed by your radiologist. • Use your hand rather than a washcloth to be gentler. • Rinse soap thoroughly from your skin. • If ink or dye markings are present to identify exactly where the beam of radiation is to be focused, take care not to remove them. • Dry the irradiated area with patting motions rather than rubbing motions; use a clean, soft towel or cloth. • Use only powders, ointments, lotions, or creams on your skin at the radiation site that are prescribed by the radiation oncology department. • Wear soft clothing over the skin at the radiation site. • Avoid wearing belts, buckles, straps, or any type of clothing that binds or rubs the skin at the radiation site. • Avoid exposure of the irradiated area to the sun. •Protect this area by wearing clothing over it. •Try to go outdoors in the early morning or evening to avoid the more intense sun rays. •When outdoors, stay under awnings, umbrellas, and other forms of shade during the times when the sun's rays are most intense (10 am to 7 pm). • Avoid heat exposure.
What can substance abuse cause?
•Isolation, depression, delirium can result
How do you assess polyarthritis in Lupus?
•Joint changes similar to RA •Osteonecrosis in patients treated with long term steroids •Muscle atrophy •Myalgia
How can you help impaired cognition?
•Learning new skills •Physical activity •Social engagement •Nutrition
What does systemic scleroderma affect?
•Limited or Diffuse •Affects skin and other body systems
What is stage I of Lyme disease?
•Localized •Flu-like symptoms •Round or oval, flat or slightly raised rash (erythema migrans) •Pain and stiffness in muscles and joints •Bull's-eye lesion •Symptoms usually 3-30 days after bite •ABX therapy 14-21 days
What is medical surgical nursing?
•Manage ACTUAL or POTENTIAL health problems affecting the individual, significant other, and community
What is creatinine clearance test?
•Measures glomerular filtration rate of kidneys
What are non-opioids used for?
•Mild-moderate nociceptive pain •Multiple routes or administration available •Acetaminophen and NSAID maybe given together (foundation for post-operative pain)
How do you manage gastric reflux with SLE?
•Minimize foods that increase gastric secretions (spicy, caffeine, alcohol) •Elevate HOB 60 degrees during meals and at least 1 hour following meal •Administer antacids or histamine H2 agonists •Pepcid (famotidine) •Zantac (ranitidine)
What is an opioid?
•Moderate-severe pain •Nursing Considerations: •Opioid naïve vs. opioid tolerant individual •Onset and duration of drug •Monitor side effects (peak time best)
How do you prevent infection after THA?
•Months to years after THA • •Monitor the incision and vital signs • •Observe for signs of infection • • •Obtain culture and sensitivity (C&S) Observe dressing Empty and measure drains • Monitor H&H
What is depression?
•Mood disorder having cognitive, affective, physical manifestations primary or secondary
How do you enhance body image?
•Verbalize feelings •Use personal items in hospital setting •Assess coping strategies
How do you manage fatigue?
•Pace activities Chart 18-10 •Allow for rest periods •Treat anemia with iron if iron deficient •Assess for blood loss from NSAIDS •Set priorities •Obtain assistance when needed
What are the S&S of FMS?
•Pain •Stiffness •Tenderness •Neck, upper chest, trunk, low back, extremities (trigger points) •Pain intermittent but worsens with stress, increased activity, weather •Burning, gnawing •Numbness or tingling in extremities •Sleep disturbances/fatigue •Sensitive to noxious odors, loud noises, bright lights
What are the 6 basic ethical principles?
•Patient autonomy •Beneficence •Nonmaleficence •Fidelity •Veracity •Social Justice
What is the discharge plan after a TKA?
•Patient should be able to walk independently with crutches, cane, or walker with adequate flexion in knee •Bear weight as tolerated •May use CPM or stationary bike at home •Usually return to work and other usual activities in 2-3 weeks •Usually resume activities in 6 weeks...make take longer with older adults
What is included in the cardiovascular assessment for SLE?
•Pericarditis (most common CV manifestation) •ASSESS: Report Chest Pain immediately •Raynaud's phenomenon •Other CV: anemia, leukopenia, thrombocytopenia
What are the forms of abuse?
•Physical—Use of physical force that results in bodily injury •Financial—Mismanagement or misuse of property or resources •Emotional—Intentional use of threats, humiliation, intimidation, isolation
What are Purnell's domains?
•Proposed 12 essential areas to assess and understand a culture. •Each domain includes concepts that need to be assessed when providing care to patients in various settings. •These domains can also be used to help nurses understand their own culture.
What is included in the neurological assessment for SLE?
•Psychoses •Paresis •Seizures •Migraines/headaches •Cranial nerve palsies
What are analgesics?
•Reduce pain and inflammation caused by cartilage destruction, muscle spasm, and/or secondary joint inflammation (synovitis) tylenol advil
What is included in preoperative care?
•Visit dentist BEFORE surgery •Pre-op labs •X-Ray if general anesthesia •Assess risk factors for VTE examine current drugs asses need for possible blood transfusion informa patient to shower with special antispetic soap
What drugs are used for musculoskeletal in Lupus?
•acetaminophen (Tylenol) •NSAIDS
How do you manage pain upon discharge?
•Report increased hip or thigh pain to •Take oral analgesics as prescribed and ONLY as needed •Do not over exert yourself •Use to decrease or prevent swelling and minimize pain
How do you manage pain after a TKA?
•Require parenteral pain medications longer •IV acetaminophen effective for pain control in some patients •Continuous femoral nerve blockade (CFNB) operative •Requires NV assessments every 2-4 hours
What is cultural competence?
•Respecting all differences and not letting one's biases influence others.
What are the 5 rights of delegation?
•Right Task •Right Circumstances •Right Person •Right Communication •Right Supervision
What is transition management?
•Safe/seamless movement among health care settings, health care providers, community
What is a minimally invasisve incision?
•Smaller incision/less cutting/stretching •Less pain •Not for obese or osteoporosis patients •Only for primary THA
How do you position the knee after a TKA?
•Special positioning to prevent adduction not required •Maintain knee in neutral position •Do not allow surgical knee to hyperextend •If no CPM, place a pillow under the lower calf and foot
What drugs are used for systemic lupus?
•Steroid Therapy •belimumab (Benlysta)
What is the drug of choice for systemic necrotizing vasculitis?
•Steroid therapy (prednisone) •May use immunosuppressive drugs •Vasodilators Manage organ dysfunction
What are the guidelines for patients with gout?
•Strict low purine diet AVOID: •Organ meats •Shellfish •Oily fish with bones (sardines) •Avoid excessive alcohol •Avoid fad diets avoid aspirin and diuretics
What is dementia?
•Syndrome involving slow, progressive cognitive decline (also known as chronic confusion) •Global impairment of intellectual function; generally chronic and progressive •Types •Alzheimer's disease •Multi-infarct dementia
What is Lyme disease?
•Systemic infectious disease •Borrelia burgdorferi spirochete •Bite of infected deer tick •Most common vector borne disease in US and Europe
How do you promote mobility and activity?
•THA patient usually out of bed on the night of surgery •Prevents other complications of such as atelectasis and pneumonia •Avoid flexing more than 90 degrees (posterior approach) • •Avoid hyperextension (anterior approach) • •Do not twist body or cross legs (all) • •May be allowed FWB or PWB status • •Collaborate with PT: Most older patients use a walker, younger patients may prefer crutches—advancing to a cane in 4-6 weeks
What should you teach a patient about steroids?
•Take steroids with calcium plus Vitamin D •Bisphosphonate drugs •DEXA scans •Rest and ice after injection in single joint
What self management education are you going to give and RA patient?
•Teach patients symptoms to report to health care provider •Teach about the disease process •Teach to consult health care provider before trying home remedies •Teach medications •Assess coping strategies •May need to anticipate lighter or decreased workload at place of employment •Arthritis Support groups
What drugs are used for the skin in Lupus?
•Topical Cortisone •Reduce inflammation and heal skin lesions •hydroxychloroquine (Plaquenil) •Anti-malarial agent •Decreases absorption of UV light by the skin
How do you treat depression?
•Treatment includes drug therapy, psychotherapy •Reminiscence or reflective therapies useful with older adults
What causes geriatric failure to thrive?
•Under-nutrition •Impaired physical functioning •Depression •Cognitive impairment
How should you use restraints for medical purposes?
•Use least restrictive device •Check patient every 30-60 minutes •Release restraint every 2 hours •Turn, reposition, toilet
