334 Exam 4
What are rheumatoid nodules?
firm subcutaneous nodules over extensor surface of joints such as fingers and elbows.
Clinical Manifestations of Cellulitis
hot, tender, erythematous and edematous area with diffuse borders, chills, malaise, and fever
What is an Ischemic Stroke?
inadequate blood flow to the brain from partial or complete occlusion of an artery Thrombotic or Embolic
What is IBD?
irritable bowel disease; recurrent inflammation of the intestinal tract, periods of remission & exacerbation; no cure
Right side brain damage
mean, excited, aggressive, cannot calm down
When does stiffness become localized rather than generalized?
over weeks to months Stiffness may last 60 or more minutes after periods of inactivity
Objective Data of Assessment in Parkinsons
"Pill Rolling" tremor Infrequent blinking Tremor at rest Poor coordination Shuffling gait
A nurse is providing discharge instructions to a client who has rheumatoid arthritis and a prescription for oral betamethasone. Which of the following statements should the nurse make about how to take this medication? 1. "Take the medication between meals" 2."Take the medication with orange juice" 3."Take the medication with milk" 4."Take the medication on an empty stomach"
3. Take the medication with milk Betamethasone is a steroid and can cause severe stomach pains when not taken with food. Milk can make it easier on the stomach.
A nurse in an urgent care center is caring for a client who experienced an ankle injury. Prior to examination by the provider, which of the following nursing actions should the nurse perform? (Select all that apply.) a. Apply ice to the affected area. b. Encourage range of motion of the foot c. Provide the client with a light snack d. Apply a compression bandange e. Elevate the foot
A. Apply ice D. Apply compression E. Elevate the Foot Remember RICE
A nurse is caring for a client who is being admitted for an acute exacerbation of ulcerative colitis. Which of the following actions should the nurse take first? A. Review Electrolytes B. Check Skin Integrity C. Investigate Emotional concerns D. Obtain Dietary history
A. Electrolytes Although all are appropriate actions, Diarrhea is common with UC. Excessive loss of fluid from the body can cause a shift in electrolyte balance and cause other issues.
A nurse in a medical clinic is providing teaching to an older adult client who has rheumatoid arthritis that is affecting her hands. Which of the following client statements indicates an understanding of the teaching? a. "I can use either heat or ice to help relieve the discomfort." b. "Ibuprofen is the first step in medication therapy for rheumatoid arthritis" c. "I should limit physical activity to prevent physical injury. d. "I will elevate my legs by placing two pillows under my knees when I go to bed"
A. Use Ice or Heat to help with comfort RA is an autoimmue disease - therefore there are other first line medications Patients with RA should be encouraged to perform physical activity to keep their joints moving. Instruct patients to avoid using pillows under their knees as they can develop flexion contractures.
What are they 3 types of inflammation?
Acute, Chronic, Autoimmune
Treatment of hemorrhagic stroke
Administer an anticoagulant DO NOT USE TPA --> May cause more bleeding
Treatment for ischemic stroke (Thrombolytic or embolic)
Administer blood thinner or clot buster (TPA)
What is ulcerative colitis?
Affects descending colon & rectal area Chronic with acute exacerbations
What does Rheumatoid Factor do in RA?
Antibody that forms RA Increases
What is ANA in RA?
Antinuclear Antibody Antibodies that are present in patients who's immune system can not identify "self" vs. "notself". Indicates Autoimmune Increases
What is Crohn's disease?
Anywhere from mouth to anus Chronic with acute exacerbations Autoimmue
5. A nurse is assessing a client following the application of a heating pad. Which of the following is the first indication to the nurse that the client is experiencing a superficial burn injury to the application site? A. Blistering B. Erythema C. Eschar D. Absence of Pain
B. Erythema Blistering is indicative of a second-degree burn Eschar is the scab or dead skin that falls off after a burn heals Absence of Pain is associated with a third-degree burn. Erythema (redness) is associated with a superficial burn.
A nurse in a provider's office is assessing a client who has RA. Which of the following finding is a late manifestation of this condition? A. Anorexia B. Ulnar Drift C. Low-grade fever D. Weight loss
B. Ulnar Drift All the other symptoms are commonly associated with RA first. Ulnar drift occurs late.
What vital sign is most effected for a patient experiencing a thrombolytic stroke?
BP
Causes of meningitis
Bacterial or viral
What is the laboratory CRP?
C-reactive Protein Elevates with inflammation
What diagnostics are used for inflammation?
CBC CRP ESR MRI CAT PET Colonoscopy
Why are drugs such as Levodopa used in Parkinsons?
Can cross the blood-brain barrier
What if cellulitis is not treated?
Can progress to gangrene
Example of Acute Inflammation
Cellulitis, Bronchitis, Bursitis, Acute infections, Joint Sprain, Tonsillitis Anything that can be "fixed"
Antibiotics for Purulent Cellulitis
Clindamycin Bactrim Doxycycline Linezolid
Antibiotics for Nonpurulent Cellulitis
Clindamycin Cephalexin Amoxicillin Tetracycline Linezolid
Thrombotic Ischemic Stroke
Clot build up Result of atherosclerosis, HTN, or DM. May occur during or after sleep
A nurse is caring for an older client who has RA and is taking aspirin 650mg every 4 hours. Which of the following diagnostic tests should the nurse monitor to evaluate the effectiveness of this medication? A. WBC B. Rheumatoid Factor C. ANA D. ESR
D. ESR WBC indicates infection, not inflammation Rheumatoid Factor is present always in patients with RA. ANA indicates an autoimmune disease and will not go down ESR indicated inflammation and will decrease when inflammation decreases.
4. A nurse is providing teaching to a client who has a prescription for heat therapy for treatment of cellulitis of the right lower leg. Which of the following client statements indicates an understanding of the teaching? a. "I will sit on the side of the tub and soak my right leg two times every day." b. "I'll keep a heating pad on the calf of my right leg when I am lying down." c. "I'll place my leg under a heat lamp every 3 hours." d. "I'll wrap a warm, wet towel around my right calf every 4 hours
D. Wrap warm wet towel Moist heat is more effective than dry heat since it increases blood flow to the affected area. Patients should also be instructed to elevate their leg 8-15 cm above the level of the heart.
Medications for RA
DMARDS Corticosteroids Biologics NSAIDS
Nonmotor symptoms of PD
Depression Anxiety Apathy Fatigue Pain Constipation Impotence Short-term memory Sleep problems
Clinical Manifestations of IBD
Diarrhea Bloody stools Weight loss Abdominal pain Fever Fatigue
What are DMARDS?
Disease-modifying antirheumatic drugs. - Used on diagnosis of RA, reduces damage on joints. - Taken for rest of life, regular blood tests to check for side effects. Examples: Methotrexate, Sulfasalazine
purulent exudate
Drainage which contains pus, usually yellow, green or brown; indicates infection
Treatments of Parkinson's
Drug therapy, deep brain stimulation, fetal cell transplant
What is the laboratory ESR?
Erythrocyte settlement rate Elevates with inflammation
hemorrhagic exudate
Exudate that contains blood and indicates bleeding
Manifestations of Rheumatoid Arthritis
Fatigue, Anorexia, Weight loss, Generalized Stiffness, Deformed joints, Rheumatoid nodules
What is an Icterus
Full seizure, the process of the person actually having the seizure
Antiseizure meds
Gabapentin, Lamotrigine, Oxcarbazepine, Levitiracetam, Zonisamide
What is an Aura
Gives a warning that a seizure is about to come Sensory warning: a smell, feeling, headache Usually repeats
Diagnostics for IBD
H&P Blood Studies -Occult blood from stool -CBC --> Hgb -CRP -ESR -Electrolytes -Protein levels -Stool Cultures
When is RICE useful?
Helpful after sprain, strain, or trauma Helps minimize swelling Most beneficial for 24-48 hrs after injury
What will synovial fluid look like in RA?
High WBC in the fluid
How do you know if tPA has been effective?
Improvement in neurologic function is more indicative than vitals.
When is the second peak of IBD?
In sixth decade (60s)
Symptoms of Systemic inflammation
Increased WBC Fever Malaise Loss of Appetite Fatigue Increased Plasma Proteins
What is local inflammation?
Inflammation at the direct site.
What is systemic inflammation?
Inflammation's impact on the entire body.
Examples of Biologics
Infliximab & adalimumab
subarachnoid hemorrhagic stroke
Intracranial bleeding into CSF fluid filled space Commonly caused by rupture of aneurysm Treatment: clipping or biologic or synthetic wrap to secure site.
First drug used for Parkinsons
Levodopa with carbidopa
Nursing care for patient during seizure
Loosen clothing, assess airway, apply oxygen, lateral side lying position, remove harmful surroundings
The tremors of Parkinson's will affect what early on?
May only affect handwriting initially Often not visible, so frustrating
Treatment for Cellulitis
Moist Heat Immobilize and Elevate Antibiotics
Nursing priorities during first 24 hours after a stroke
Monitor BP, assess vital signs and level of conciousness
When is tPA used for a stroke?
Must be administered within 3-4.5 hours of onset of stroke. It reestablished blood flow through a blocked artery to prevent cell death.
Care of Parkinsons
No Cure Management is aimed at relieving symptoms
Collaborative Cares for RA
Nutritional and weight management Physical Therapy Use of assistive devices Heat & Cold application Reconstructive therapy
embolic ischemic stroke
Occlusion of artery from traveling blood clot or broken piece of atherosclerosis. Result of Afib or MI Warning signs are sudden, occurs rapidly Recurrence is common Headache is common
What is a postictal state
Post seizure; the recovery stage May have incontinence, tiredness, no memory of the seizure, lethargy
Examples of Corticosteroids
Prednisone Hydrocortisone Methyprednisolone acetate --> injected into joint, local effect
What type of Exudate indicates an infection?
Purulent
How does NPO help during an exacerbation of UC?
Regular diet may not be tolerated Liquid enteral feedings are preferred high in calories & nutrients Lactose free easily absorbed
What does RICE stand for?
Rest, Ice, Compression, Elevation
What should a nurse NOT do for a patient having a seizure?
Restrain the patient
Example of Autoimmune Inflammation
Rheumatoid Arthritis, Chron's Disease, Asthma Also a chronic thing that never "goes away", but develops due to the own body attacking healthy cells.
intracerebral hemorrhagic stroke
Rupture of a vessel HTN most important cause Symptoms occur suddenly: headache, nausea, decreased level of conciousness
Why is a PET scan beneficial?
Shows areas of increased metabolism; Bone scan. ** Can not differentiate between inflammation and cancer.
Left side brain damage
Slow
What is Bradykinesia
Slowness of movement reduced arm swing, blinking, swallowing
symptoms of meningitis
Stiff neck, light sensitivity, wants to sleep a lot(harder to wake up), high pitched cry, bulging fontanels
Symptoms of Local Inflammation
Swelling (Edema) Pain Head Redness (erythema) Exudate
Diagnostic Tests for RA
Synovial fluid CBC Rheumatoid Factor CRP ESR ANA X-rays
Patient Teaching for Antiseizure Meds
Take at the same time. Most drugs are best absorbed with food Watch for drowsiness, sedation, ataxia, diplopia, rash, nystagmus
Classic Triad of Parkinson's
Tremor, Rigidity, Bradykinesia 2 or more must be present for diagnosis
IBD can be classified as either...
Ulcerative Colitis or Crohns
Example of Chronic Inflammation
Ulcerative Colitis, Cirrhosis, COPD, Diverticulitis These will never go away, rather they flare up.
What causes seizures?
Uncontrolled electrical discharge of neurons in the brain, interrupting normal function due to a congenital defect, fever, drugs, trauma, genetics, or brain tumor.
Serous Exudate
Watery exudate: indicates early inflammation. Normal response.
Surgical treatment for a patient who has seizures
When all other types of medications fail, the goal is to remove the seizure focus.
What is a Hemorrhagic Stroke?
a burst blood vessel may allow blood to seep into and damage brain tissues or into the subarachnoid space or ventricles
When is peak onset of IBD?
between age 15-25