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