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