Test 4 / Immune, Mus. 1&2
THE NURSE IS CARING FOR A PATIENT WITH OSTEOPOROSIS WHO IS BEING DISCHARGED ON ALENDRONATE (FOSAMAX). WHICH STATEMENT WOULD INDICATE EFFECTIVE TEACHING?
" I should remain upright for 30 minutes after taking the medication"
A NURSE IS TEACHING A CLIENT WHO HAS OSTEOARTHRITIS. WHICH OF THE FOLLOWING INSTRUCTIONS SHOULD THE NURSE INCLUDE IN THE TEACHING?
"Take acetaminophen as the primary medication to treat the pain."
A NURSE IS PROVIDING NUTRITIONAL TEACHING TO A CLIENT WHO HAS OSTEOPOROSIS. WHICH OF THE FOLLOWING FOODS SHOULD THE NURSE RECOMMEND AS BEING THE HIGHEST IN CALCIUM?
3 oz canned salmon
Interventions for total hip arthroplasty
ABDUCTED legs, hip abductor pillow keeps pillows between knees, polar care, no crossing legs/NO leaning forward/NO tying shoes/NO sitting in chairs,
A NURSE IN A CLINIC IS TALKING WITH A CLIENT WHO HAS A NEW DIAGNOSIS OF OSTEOARTHRITIS. THE NURSE SHOULD ANTICIPATE THAT THE CLIENT WILL REQUIRE TEACHING ABOUT WHICH OF THE FOLLOWING MEDICATIONS?
Acetaminophen because its the primary choice drug
A nurse assessing a client who has multiple fractures in his left leg notes increasing edema. The nurse should recognize this finding as an early manifestation of which of the following complications?
Acute compartmentsyndrome
A nurse is caring for a client who has acute osteomyelitis. Which of the following interventions is the nurse's priority?
Administer antibiotics to the client.
A NURSE IS TEACHING A CLIENT WHO HAS GOUT ABOUT DIETARY RECOMMENDATIONS. THE NURSE SHOULD TEACH THE CLIENT THAT WHICH OF THE FOLLOWING BEVERAGES CAN TRIGGER AN AT TACK?
Alcohol
THE NURSE AT AN ORTHOPEDIC JOINT CLINIC IS ASSISTING WITH THE PREPARATION OF PRE -OPERATIVE TEACHING FOR CLIENTS SCHEDULED FOR TOTAL HIP REPLACEMENT SURGERY. WHICH WOULD BE INCLUDED IN THE TEACHING FOR POST-OPERATIVE PRECAUTIONS:
Avoid crossing the legs when sitting
A nurse is taking care of a patient with possible osteomyelitis. The RN knows that the definitive diagnosis for osteomyelitis is achieved through which of the following testing procedure?
Bone biopsy and culture
A NURSE IS TEACHING A CLIENT AT HIGH RISK FOR OSTEOPOROSIS ABOUT DIETARY MEASURES SHE CAN TAKE TO INCREASE HER CALCIUM LEVEL. WHICH OF THE FOLLOWING FOODS SHOULD THE NURSE ADVISE THE CLIENT TO INCREASE IN HER DIET ?
Broccoli
A patient arrives in the emergency room with a possible fractured femur. The nurse should anticipate an order for what intervention?
Buck's traction
Elevated levels of calcium ion in the blood stimulate the secretion of which of the hormone?
Calcitonin
A RN is assessing a patient with a fractured left tibia and fibula. Which data should the nurse report to the physician immediately?
Cap refill of 9 seconds and increasing pain
A NURSE IS ASSESSING A CLIENT WHO HAS PAGET'S DISEASE OF THE BONE. WHICH OF THE FOLLOWING FINDINGS SHOULD THE NURSE EXPECT ? (SELECT ALL THAT APPLY.)
Cranial enlargement, Skeletal pain, Waddling gait,Hearing deficit
Interventions after bone scan
DRINK 2500-3000 mL of fluids posttest to excrete radiation
THE NURSE HAS REINFORCED NUTRITIONAL TEACHING ON A PATIENT WITH GOUT WHO IS PLACED ON A LOW-PURINE DIET. WHICH SELECTION BY THE PATIENT WOULD INDICATE A NEED FOR FURTHER TEACHING?
Fish
Know your H&H values
HGB 12-18 risky 8-11 critical below 7 sends to heaven. HCT 36-54
The nurse is caring for a patient admitted with fractures to the pelvis, femur, and ulna. Which finding should be reported to the physician immediately?
Hematuria ( blood in the urine)
A NURSE IS CARING FOR A CLIENT WHO IS 1 -DAY POSTOPERATIVE FOLLOWING TOTAL HIP ARTHROPLASTY. IT IS 0830 AND THE CLIENT IS SCHEDULE FOR PHYSICAL THERAPY (PT) AT 0900. WHICH OF THE FOLLOWING INTERVENTIONS SHOULD THE NURSE TAKE?
Identify the client's pain level and medicate if needed
innate immunity
Innate, non specific immune system: immunity develops through exposure. Active aquired immunity, passive immunity
A PATIENT IS DIAGNOSED WITH OSTEOARTHRITIS. WHICH SIGN/SYMPTOM WOULD THE NURSE EXPECT THE PATIENT TO EXHIBIT?
Joint stiffness
The nurse is preparing discharge teaching for a 12-year old with a fractured humerus. Which of the following information should the nurse include regarding cast care?
Keep the arm at heart level
Active immunity
Natural contact w/ antigen .....
A 73-year old patient fell in her home and suffered a right hip fracture. She tells the nurse that she was walking in the kitchen, felt something "snap" and this made her fall. What type of fracture is the patient most likely to have?
Pathologic
THE NURSE IS ASSESSING THE PATIENT WITH A TOTAL KNEE REPLACEMENT 2 HOURS POST-OPERATIVE (POST-OP). WHICH INFORMATION REQUIRES NOTIFICATION OF THE DOCTOR?
Patient's hemoglobin is 6 g/dL
A nurse is caring for an adolescent client who has a newly applied fiberglass cast for a fractured tibia. Which of the following is the priority action for the nurse to take?
Perform a neurovascular assessment.
A nurse working in a community health center is preparing a flow sheet detailing essential screenings according to age group. At which developmental stage on the chart should the nurse add scoliosis screening?
Pre-adolescent/adolescent
Aminoglycosides
RENAL TOXICITY INCREASED AND OTOTOXICTY INCREASED
Osteomyelitis and why would not respond to antibiotics
SEVERE INFECTION OF BONE/MARROW AND SOFT TISSUE, makes a trail to get to the center of the bone, if it does get into the marrow cavity there is no need for antibiotics,
A 2-year old is admitted for repair of a fractured femur and is in Bryant's traction. Which finding indicates that the traction is working properly?
The buttocks are 15 degrees off the bed
Is the following statement true or false? Treatment and nursing interventions for a patient with scoliosis is determined by the degree of curve of the spine.
True
inflammatory response
a multi-staged process that involves vascular and cellular changes, non-specific, no long- lasting immunity is generated
Osteoarthritis treatment
acetaminophen for mild to moderate pain 4 grams max, NSAIDs such as. Ibuprofen/Motrin/Aleve for moderate to severe pain, Celebrex to reduce pain and inflammation, corticosteroids, balance rest and activity, hot or cold HEAT most common, exercise (yoga, tachi, acupuncture, reiki), nutrition, use of cane, rest
Risk factors for osteoarthritis
age, women, obesity, mechanical stress, prior injury, or congenital anomalies, legg- calve-perthes disease, smoking
Know foods high in calcium
dairy, leafy greens KALE, collard greens bahjoy, broccoli, seafood especially canned tuna, OJ, milk
Older adults
delayed inflammatory response, slight changes in VS act quickly, need immunized and boosted, stay away from people with colds, encourage good nutrition and healthy habits, defect in neutrophil function not #, leukocytosis may not occur, infection may be present but not noted on CBC.
Gout treatment/interventions
diet: alcohol in moderation, avoid beer/ales/wine, avoid fish, organ meats, weight management, fluids 2000 to 3000mL/day, splinting of joint, NSAIDS, colchicine, glucocorticoids, allopurinol (rash, decreased CBC), Uloric (rash, nausea, decrease liver function)
Long bone fracture complications
fat embolism, ARDS, dyspnea, tachypnea, tachycardia, cyanosis, LOC, petechiae on neck, chest wall
Muscular dystrophy definition
genetic disorder that causes muscle weakness, results in low production of protein dystrophin which is needed for muscle stabilization. motor weakness, waddling gait and difficulty climbing stairs,
s/s osteoporosis
kyphosis, hunchback, loss of height, Porosis bones, frequent fractures
A nurse is caring for a 60-year old female with osteoporosis. The nurse knows that which of the following is most likely the cause for her osteoporosis?
lack of calcium
MRSA precautions interventions
o treated by vancomycin, hand hygiene, proper use of PPE (contact, droplet, airborne), keep site/environment/instruments clean, screen visitors for infection, educate on how to take ABX correctly COMPLETE THE WHOLE DOSE EVEN IF FEELING BETTER, prevent infections
neutropenic precautions
o wash hands frequently and properly, screen visitors for illness, no undercooked raw foods no unwashed fruits or veggies, bathe daily, no plants or flowers in room, monitor for s/s of infection, educate the visitors regarding guidelines, brush teeth twice daily with soft toothbrush. o HAND HYGIENE
What to assess for with fractures
pain and swelling, crepitus, muscle spasms, hypotension, tachycardia, hematuria
Plantar neuroma and show to treat
pain in foot often burning and increase with walking, treated by icing, orthotics, anti- inflammatory meds, cortisone, and surgical removal
immunity
protection from disease / body's ability to resist disease
s/s osteogenic sarcoma
s/s osteogenic sarcoma
Know how to administer alendronate safely
take on empty stomach, sit up for 30 minutes after taking or it will cause esophagitis, monitor bone density
Why do we petal a cast
to prevent skin breakdown, don't get cast wet, don't insert anything into cast, report hot spots or drainage
pus/exudate is formed
transports leukocytes and antibodies to the inflammatory site, dilutes harmful bacteria/toxins and irritating substances, transports or brings oxygen and nutrients necessary for tissue repair, increased phagocytosis, increased proteins enclose site, changes into serous exudate to a creamy white fluid PUS containing dead neutrophils/digested bacteria and cellular debris, edema
Bucks traction
weights free hang always, traction ropes tight not resting or loose, keep limb in neutral position, assess for skin breakdown, lay flat no HOB elevation over 25 degrees
