Exam 1
Nursing Interventions for Multiple Sclerosis
-prevent symptoms from getting worse by watching the heat, avoid infection, stressful events, overexertion -important to maintain regular exercise as tolerated but not too much -use assistive devices to help with walking and preventing injury -consult SLP, PT, and support groups -bladder and bowel: self-cath, stool softeners, high fiber diet, plenty of fluids, easy accessibility to bathroom
health education for a woman over age 50 includes providing information about the importance of adequate amounts of calcium and vitamin D to prevent osteoporosis. select the daily dosage of calcium and vitamin D that the nurse should recommend.
1,200 mg of calcium 1,000 IU of vit. D
what is the NPSG that addresses suicide
15
Osteoarthritis develops due to the deterioration of the synovium within the joint that can lead to complete bone fusion.
FALSE
a pt is taking Calcitonin for osteoporosis. the pt should be monitored for?
HYPOcalcemia because it decreases osteoclast activity which can decrease calcium levels
During a head-to-toe assessment of a patient with osteoarthritis, you note bony outgrowths on the distal interphalangeal joints. You document these findings as: A. Bouchard's Nodes B. Heberden's Nodes C. Neurofibromatosis D. Dermatofibromas
Herberden's Nodes --the proximal ones are Bouchard's nodes
The home care nurse is caring for an elderly female patient who has been diagnosed with osteoporosis. When explaining the disease and its treatment to the patient, what should the nurse identify as a potentially serious complication?
Bone fracture ---- estrogen deficiency and negative calcium balance contribute to osteoporosis and anorexia is a potential side effect of medications used to treat the disease
A client with confirmed low bone density asks the nurse if there is anything she can do to decrease the risk of trauma. The best response would be:
Brisk walking three times per week on a flat surface --- weight-bearing exercise such as walking, jogging, rowing, and weight lifting are important in the maintenance of bone mass.
the nurse is receiving a critical laboratory result from the laboratory personnel. What actions should the nurse take?
Identify yourself Acknowledge the laboratory person by name and title read back the critical result to the laboratory personnel notify the health care provider in a timely manner document the report in the health care record
Pharmacologic therapy of osteoporosis
CALCIUM AND VITAMIN D BISPHOSPHONATES calcitonin estrogen agonist PTH
Which of the following inhibits bone resorption and promotes bone formation?
Calcitonin --- calcitonin is decreased in osteoporosis; estrogen inhibits bone breakdown and decreases with aging; parathyroid hormone (PTH) increases with aging and increases bone turnover and resorption; corticosteroids place patients at risk for developing osteoporosis
While assessing a patient with Parkinson's Disease, you note the pt's arms slightly jerk as you passively move them toward the pt's body. This is known as:
Cogwheel Rigidity
What action is most appropriate to reduce the risk of surgical site infections for a client undergoing surgery?
Educate the client and family on hand hygiene
what is happening in Parkinson's disease to cause movement to become affected?
The dopaminergic neurons in the brain have started to die in the area of the midbrain that controls movement
what are the NPSGs that address surgical patients?
UP, 1, 6, 7
Which patients are at risk for osteoporosis?
a 50 year old female whose last menstrual period was 7 years Aho a 45 year old male patient who has been taking glucocorticoids for the last 6 months a 35 year old female who has a history of seizures and takes Dilantin regularly
You're caring for a patient with Parkinson's Disease that has tremors. Select the options that are correct about tremors experienced in this disease:
a common term used to describe the tremors in the hands and fingers is called "pill-rolling" tremors are one of the most common s/sx in Parkinson;s tremors in this disease can occur in the hands, fingers, arms, legs and even the lips and tongue tremors in Parkinson's tend to occur at rest and will actually improve with movement
the nurse has delegated skin care of a client with frequent urination to a new CNA on the unit. which action would improve the effectiveness of the care given?
accompany the nursing assistant the first time and demonstrate care needed
A nurse plans the nursing activities for the shift. Which of the following activities should the nurse assign to the nursing assistant?
assist a client to ambulate and sit on a bedside chair
what is an anticholingerid medication used to treat Parkinson disease?
benzotropine mesylate (cogentin) used to control tremor and rigidity and counteracts the action of acetylcholine with Parkinson disease
What are some complementary and alternative therapies for osteoarthritis?
bio-magnetic therapy acupuncture elimination of nightshade foods nutritional supplements herbal supplements massage therapy osteopathic manipulation vitamin therapy yoga
Various treatments for a bone fracture
bone reduction: putting the fractured bone back in its original state closed reduction: done manually/nonsurgically cast (plaster or fiberglass) to keep the bone in place
A pt with PD has slow movements that affects their swallowing, facial expressions, and ability to coordinate movements. As the nurse, you will document the pt has:
bradykinesia
signs and symptoms of a bone fracture
bruising over the site and pain reduced movement of extremity or muscle odd appearance (looks abnormal) krackling sounds due to bone fragments rubbing together (crepitus) edema and erythema at the site neurovascular impairment...6 P's (ischemia: pain, pallor, paralysis, paresthesia, pulselessness, poikilothermia)
your pt is scheduled for a DEXA scan this morning. the pt is having heartburn and requests a PRN medication to help with relief. which medications can the pt NOT have at this time?
calcium carbonate --before this bone density tests, the pt should not take any type of calcium supplements or vitamins containing calcium
which measures should a public health nurse recommend to middle-aged women to reduce their chances of developing osteoporosis later in life
calcium supplementation and regular weight-bearing activity
a female athlete has been diagnosed with amenorrhea due to intense training for a spot on the olympic swimming team. as a health care provider, which of the following should be implemented to prevent premature osteoporosis?
calcium/vitamin D supplements to support bone mineral density
Derrick is the nurse manager for the psychiatric unit. There are major conflicts between the day and night shift staff. Derrick suggests that each shift put aside their differences for a time and determine a common major goal. Which of the following conflict resolution styles does Derrick display? a) Avoiding b) Competing c) Smoothing d) Collaborating
collaborating
Where does OA occur most often?
commonly occurs in the hands, knees, hips, and spine and it does NOT affect other systems in the body and its unsymmetrical; it happens and worsens over time. This is a degenerative joint disease affecting the cartilage (not the synovium)
what might a pt with osteoarthritis complain of?
complaints of palpable bony joint enlargement, morning stiffness lasting less than 30 minutes, and pain when doing activity at her knees and fingers hard to open jars and squat down swelling at knees when taking runs with hills
what are some clinical manifestations of a bone fracture?
deformity, pain/tenderness/guarding, hypovolemic shock, ecchymosis, swelling, numbness, crepitus, muscle spams
Other s/sx of Parkinson's disease that are non-motor
depression, constipation, loss of smell
What should the diet of a pt with Parkinson's disease be?
diet high in bulk with fluids and fiber give milk at bedtime
Explain open reduction of bone fractures
done surgically to put the fractured bone back in its original state and a fixation device is used (internal or external)
What are some nursing interventions for a pt with osteoporosis
education relieving pain - short periods of rest, supportive mattress, heat and back rubs improving bowel elimination r/t to immobility - high fiber diet, increase fluids, stool softeners physical activity - strengthen muscles, improve balance, and prevent atrophy
True or false. Osteoporosis is a disease process that results in the thinning of the matrix of pore-like structures within the spongy bone
true
Medications related to osteoarthritis
Intra-articular injections of corticosteroids to reduce inflammation of tendons and ligaments pain relief: Acetaminophen, NSAIDs, topical creams Duloxetine (Cymbalta) injections of hyaluronic acid
how might one define leadership?
Leadership is the process of guiding, educating, motivating, and directing others.
What is the purpose of traction?
Reduce muscle spasms Reduce, align, and immobilize fractures Reduce deformity Increase space between opposing forces
clinical manifestations of back problems
acute or chronic pain changes in gait, mobility, reflexes, leg length, motor strength, and sensory perception nerve root involvement most problems resolve in a month with pain meds, rest, and avoidance of strain
the new graduate nurse is having difficulty managing the time required to care for a group of complex clients and is several hours behind in completing nursing interventions. of the following outstanding tasks, which nursing intervention should the nurse complete first?
administer a dose of digoxin (Lanoxin) that is two hours behind schedule
the charge nurse on a unit receives a report that a LPN is taking client's narcotics and hiding them in the nurses' lounge. The charge nurse disregards the report and continues to work on a scheduled task. Which conflict resolution style is the charge nurse using?
avoiding
how should a nurse leader best address nurses' resistance to a change in the shift-scheduling protocol on their hospital unit?
explain the benefits of the change and elicit honest feedback
a nursing facility has recently implemented new policies regarding nurse-to-patient ratios. The nursing staff seems very resistant to the change. How can the nurse manager help the staff accept the change?
hold a unit meeting to discuss how the changes will benefit staff
Signs and Symptoms of Parkinson's Disease
mainly motor symptoms: affects how the pt is able to move tremors at rest that improve with movement pill-rolling: tremors of hands and fingers stiffness of extremities - akinesia (inability to move the muscles voluntarily shuffling of gait (extremities can freeze while walking) cogwheel rigidity (arms jerk or push back) bradykinesia - movements are slow, difficulty swallowing (drooling) issues with the muscles for chewing food, swallowing, and speaking: soft or slurred speech, problems swallowing (aspiration)
how do you treat compartment syndrome
notify phsycian cast may be removed emergency fasciotomy may be necessary
Types of Bones Fractures
open and closed complete and incomplete greenstick and comminuted transverse and oblique spiral
-----are found within the spongy bone and responsible for building up the bone matrix while --- which are also found in the spongy bone, breakdown the bone matrix
osteoblasts osteoclasts
what is akathisia?
restlessness, an urgent need to move around, and agitation
what is a cast
rigid external immobilizing device molded to contours of body part made out of plaster or fiberglass
what are some solutions to preventing wrong-site surgeries
scheduling - confirm accuracy of OR schedule, build relationships with physician offices pre-op handling - confirm presence and accuracy of documents before day of surgery OR- mark site for every surgery organizational culture - celebrate success, provide ongoing education, create safe environment, utilize a team approach
What will an x-ray of a patient with OA show?
sclerosis of bones, decreased joint space, osteophytes/bone fragments in the joint space, osteophytes (bone spur) formation
the nurse teaches the client with a high risk for osteoporosis about risk-lowering strategies, including which action?
walk or perform weight-bearing exercises --- along with increasing dietary calcium and vitamin D intake, quitting smoking, and consuming alcohol and caffeine in moderation
What are principles to an effective traction system?
weights must hang freely knots and footplates must not touch the foot of the bed traction must be continuous a counterforce is necessary
diagnostic procedures for low back pain
x-ray of spine bone scan and blood studies CT scan MRI EMG and nerve conduction studies myelogram ultrasound
A nurse is teaching a client with osteoporosis about dietary selections. What client statement indicates the teaching was effective?
"I will eat more dairy products to increase my calcium intake."
Select all the TRUE statements about the pathophysiology of multiple sclerosis
"The myelin sheath, which is made up of Schwann cells, is damaged along the axon." "This disease affects the insulating structure found on the neuron in the CNS."
A 63 yr old pt has severe osteoarthritis in the right knee. The pt is scheduled for a knee osteotomy. You are providing pre-op teaching about this procedure to the pt. Which statement made by the pt is correct about this procedure?
"This procedure will realign the knee and help decrease the amount of weight experienced on my right knee."
a 65-year-old women is admitted to the ER with severe pain in her hip. After an x-ray, the woman is diagnosed with a broken hip. the woman states, "I didn't fall or anything!" what is the nurses's best response?
"We will evaluate you for osteoporosis." --- if a client has osteoporosis, fractures can occur without the usual force associated with broken bones
In a nursing unit, the RN delegates nursing tasks to the nursing assistant. Keeping in mind the delegation guidelines, which statement denotes the right communication for the nursing assistant?
"dispose of the disconnected IV set"
a postmenopausal female comes to the clinic for a checkup. what does the nurse tell the client about her chances of having osteoporosis?
"postmenopausal osteoporosis is often caused by an estrogen deficiency."
the nursing instructor is teaching about osteoporosis and tells students that reduced physical activity can contribute to the loss of bone mass. what does the nurse tell students is the rationale for this?
"reduced physical activity increases the rate of bone loss, as mechanical forces are important stimuli for normal bone remodeling."
a client who has been admitted for a pelvic fracture is diagnosed with osteoporosis. the client states, "How could I not have known I had this?" What is the nurse's best response?
"this is typically a silent disorder without symptoms until something like this happens."
discuss traction of bone fractures
-align the bones with a constant steady pulling action make sure the weights are hanging freely and not on floor never remove weights without an order pin care and monitor for infection neurovascular status: 6 P's overhead trapeze bar to move around in bed
How can you prevent osteoporosis?
-eat a balanced diet high in calcium and vitamin D -use of calcium supplements in divided doses with vit. C -regular weight-bearing exercises -weight training to stimulate bone mineral density
causes of bone fractures
-happens because bone cannot withstand force trauma (fall, call accident, etc.) twisting (sports injury, abuse0 diseases (bone cancer, osteoporosis)
Nursing Interventions for Compartment Syndrome
-keep the extremity AT HEART level (not below because you want to maintain arterial pressure and elevating it above heart level will cause more ischemia) -loosen and remove restrictive items -perform neurovascular checks
which requirements are included in the NPSG "the organization identifies safety risks inherent in its patient population"?
-the organization screens all patients for suicidal ideation who are being treated for behavioral health conditions with a valid-screening tool -the organization identifies risks associated with long-term oxygen therapy such as home fires -monitor implementation and effectiveness of policies for screening patients at risk for suicide
Medications for Parkinson's disease (side effects and teaching)
-there is no cure but meds can help make s/sx more manageable -Carbidopa/Levodpa - adds more dopamine to the brain: takes up to 3 weeks to notice anything, may turn body fluids dark, long term use may wear off effectiveness, don't take with MAO inhibitors... Hypertensive emergency, don't take with high amounts of food/supplements w/ vit. B6 because it decreases effectiveness, and avoid taking with high protein foods because it decreases the amount of drug absorbed, side effects include nausea and involuntary movements -Anticholinergic - decreases cholinergic activity like tremors -MAO inhibitors, dopamine agonists
what is the NPSG that addressed falls risk clients
6
What are the five rights of delegation?
A. Right task - one that is delegable for a specific patient B. Right circumstance - appropriate patient setting, available resources, and other relevant factors considered C. Right person - right person is delegating the right task to the right patient to be performed on the right person D. Right direction or communication - clear, concise description of the task, including its objective, limits, and expectations E. Right supervision - appropriate monitoring, evaluation, intervention, and feedback as needed
during an outpatient visit, you are assessing the pt's understanding about the s/sx associated with osteoporosis. select all of the signs and symptoms stated by the pt that are correct
Dowager's hump loss of 2-3 inches in height compared to young adult height some patients are asymptomatic fractures most commonly in the hips, wrist, and spine
Signs and Symptoms of Multiple Sclerosis
Emotionally and cognitive: drained, fatigued, depressed, trouble articulating speech, issues swallowing, mood swings, trouble thinking sensation issues: involuntary tremors, spasm, clumsiness, numbness/tingling, electric shock sensation, dizzy muscles that hard to move and affect coordination vision: double vision, blurry vision, blindness, seeing dark spots, painful eye movement, issues controlling eye movement elimination: can't hold urine, overactive bladder leads to nocturia, problems urinating, constipation/diarrhea or incontinence ---- early s/sx include vision issues, tingling numbness, weakness, dizziness, balance issues, bladder problems, cognitive issues, issues speaking, weakness, spasms symptoms can get worse due to heat from weather, physical exercise, etc.
True or false. A pt's unrelieved pain should be reported to the physician 30 minutes after administered pain medication.
FALSE - a pt's unrelieved pain must be immediately reported to the physician to avoid possible paralysis and necrosis
a patient with osteoarthritis is describing their signs and symptoms. which s/sx below are NOT associated with osteoarthritis? Select all that apply.
NOT ---morning stiffness greater than 30 minutes, fever and anemia, symmetrical joint involvement YES ---experiencing grating during joint movement and pain and stiffness tends to be worst at the end of the day
Which national patient safety goal (NPSG) addresses safety in the operating room environment?
NPSG-UP
Your patient is scheduled for a lumbar puncture to help diagnose multiple sclerosis. The pt wants clarification about what will be found in the cerebrospinal fluid during the lumbar puncture to confirm the diagnosis of MS. You explain that ----- will be present in the fluid if MS is present.
Oligoclonal bands...which are immunoglobins that indicate inflammation in the CNS
What are signs and symptoms of osteoarthritis?
Outgrowths that are bony, especially on the hands due to bone spur formation (Herbeden's and Bouchard's Node) Sunrise stiffness (morning) less than 30 minutes...pain will be the worst at the end of the day from overuse than compared to morning time Tenderness at joint site with bony overgrowths...joints will be bony and hard Experience grating (crepitus) of the bones Only the joints: asymmetrical/uneven, limited to joints along with limited mobility
What are the six P's to assess in regards to bone fractures and compartment syndrome?
Pain: worst with movement, touch, elevation, pressure, stretching, and is not relieved by pain meds (early indicator) Paresthesia: 'pin and needle' sensation Pallor: pale or dusky and have a capillary refill greater than 2 seconds Paralysis: decreased or inability to move Poikilothermia: cooler to touch compared to other extremity Pulselessness: late sign of syndrome
Bones play an important role in the body. What are function performed by the bones?
Provide protection and support for the organs give the body shape store calcium and phosphorus bone marrow are responsible for red blood cell, platelet, and white blood cell production
The nurse is caring for a client scheduled for oral surgery in the morning. The client reports Warfarin 5 mg by mouth daily as a medication taken at home. Last dose was six days ago. The nurse receives a call from the lab with the following results PT = 11.5 and INR = 1.5 Which action should the nurse perform next?
Read back the results; document the results in the chart with the name an title of the person calling the results and notify the physician of result and last dose of warfarin
Nursing Interventions for Parkinson's Disease
Safety Issues - soles should be smooth and not slick balance - move slowly and use rubber tip cane education psychosocial issues - autonomy is very important, use local support groups, exercise digestion/nutrition - at risk for weight loss, food needs to be soft, easy to swallow and chew prevent constipation - drink plenty of fluids with high fiber foods, assess last BM and bowel sounds along with palpation of abd
At the beginning of the day (0700-1500) shift, the nurse requests that a CNA change all the linens and give bed baths to four different clients on the unit. At 1400, the nurse asks the CNA to transport one client to another unit. The CNA replies that two clients still need linen changed and baths given. What is the nurse's best response to this situation in order to be a more effective supervisor in the future?
Set a time frame for the completion of the task
True or false. The nurse never adjusts the clamps on the external fixator frame.
TRUE - it is the physician's responsibility to do so
Which vitamin supplements should the nurse recommend while a postmenopausal client is taking alendronate (Fosamax)?
Vitamin D and calcium --- an intake of 1500 mg calcium and 400-800 units of vitamin D are recommended daily while taking bisphosphonates
during discharge teaching to a pt at risk for developing osteoporosis, you discuss the types of exercise the pt should perform. which type of exercise is not the best to perform to prevent osteoporosis?
Walking. Instead you should do tennis, weight-lifting, and hiking as weight-bearing exercises instead of low impact exercises that aren't as beneficial in building bone mass
a nurse is caring for a male client who has been seen for numerous broken ribs over the past year. he is diagnosed with osteoporosis. the nurse knows that the only bisphosphonate approved for use treating osteoporosis in men is what?
alendronate (Fosamax)
The nurse is preparing a newborn for surgery. Which identification method is the safest for the nurse to use to identify the client?
apply a distinct armband with client's mother's first and last name; client's gender and barcode to two extremities
How is Multiple Sclerosis Diagnosed?
assess pt's s/sx to rule out other diseases, MRI to assess for lesions in brain and spinal cord, lumbar puncture to assess spinal fluid, and evoked potential studies (send electrical signals to CNS to see the response)
which of the following nursing care tasks is acceptable for a graduate nurse to delegate to a UAP?
assisting a patient with ambulation
what are some strategies for preventing acute low back pain
avoid high heels walk daily avoid jumping and twisting stretch push rather than pull keep load close to you lift with legs, not back use wide base of support
a health care provider diagnoses primary osteoporosis in a client who has lost bone mass. for which client is primary osteoporosis most common?
elderly postmenopausal woman = estrogen deficiency and sedentary lifestyle
Key points to remember about fractures
elevate injured extremity but not above heart use sterile technique for dressing change remember to check for pulses and assess sensation (6 Ps) monitor extremity for edema and swelling assess for deep throbbing unrelenting pain
Nurse L. is having an exceptionally busy shift on an obstetrical unit. Which of the following tasks is Nurse L. justified in delegating to a UAP?
emptying a patient's Foley catheter bag and reporting the volume to Nurse L.
the nurse is planning an education program for women of childbearing years. what does the nurse recognize as the primary prevention of osteoporosis?
ensuring adequate calcium and vitamin D intake
A nurse can improve his or her skill with time management by doing which of the following?
evaluating success with accomplishment of goals in client care
how often must the nurse inspect the traction pin site for signs of inflammation and evidence of infection?
every 8 hours
what are some criteria for delegation to a UAP?
frequently recur in the daily care of a client or group of clients are performed according to an standardized sequence of steps involve little or no modification from one client-care situation to another may be performed with a predictable outcome do not inherently involve ongoing assessment, interpretation, or decision making which cannot be logically separated from the procedure itself do not endanger the health or well-being of clients are allowed by agency policy/procedure
What are risks factors for osteoporosis
genetics - caucasian or asian, female, family history, small frame/anorexic age - post menopause, advanced age, low testosterone in men, decreased calcitonin nutrition - low calcium and vit. D exercise - sedentary, lack of weight bearing exercise, and low weight and BMI lifestyle choices - caffeine, alcohol, smoking, lack of exposure to sunlight medications and comorbidity - corticosteroids, antiseixure medications, heparin, thyroid hormone, anorexia, and disease involving inflammation, short gut syndrome, gastric bypass surgery, COPD
a registered nurse is delegating activities to a UAP on a hospital unit. Which activities could this nurse normally delegate? Select all that apply
giving a bed bath to a client obtaining routine vital signs
The OR nurses are developing a plan to reduce the harm associated with clinical alarm systems in the OR. Which best practices should the nurse include in their plan?
identify the most important alarm signals to manage identify appropriate alarm settings for alarm signals educate staff about alarm system operations establish monitoring and response criteria for alarm signals
what are some emergent collaborative care that should be provided to a pt with a fracture
immobilize the fracture, maintain perfusion, prevent infection cover open wounds, control bleeding splint fracture to normal alignment relieve pain, prevent further damage
What identifiers are appropriate to use?
individual's name, an assigned identification number, telephone number, or other person-specific identifiers
complications of a bone fracture
infection (osteomyelitis) compartment syndrome fat embolism
What is a bone fracture?
its a break or crack in bone
Describe osteoporosis
normal homeostatic bone turnover is altered where the rate of bone absorption is greater than the rate of bone formation, resulting in loss of total bone mass bones become porous, brittle, and fragile
What are some risk factors for osteoporosis?
older age (45+), being a woman, caucasian or asian, post-menopause, glucocorticoids therapy, anticonvulsants (Dilantin), regular alcohol usage, smoking, sedentary lifestyle, BMI < 19, family history
a pt is prescribed 10 mg per day Alendronate (Fosamax) at 0800 for the treatment of post-menopause osteoporosis . As the nurse, you know you must administer this medication:
on an empty stomach with a full glass of water and keep the pt upright for 30 minutes to prevent esophageal problems -this medication is known for causing GI upset, especially inflammation of the esophagus. do not take with other meds and wait an hour to eat afterwards
What are some complications of Parkinson's disease?
paranoia and hallucinations impaired communication falls infection malnutrition skin breakdown depression, social isolation sleep disturbances constipation
What are some nursing interventions to do in order to prevent falls?
patient gown/clothing should not cause tripping check floor surfaces for spills and unevenness proper lighting and night lights avoid bare feet identify clients who are high risk use bracelets and signs to identify
The nurse is caring for a client scheduled for an appendectomy. What action by the nurse reduces the client's risk for health-care associated infection as identified in National Patient Safety Goal #7?
perform hand hygiene before and after contact with the client
What are some common causes of organizational conflict?
poor communication, inadequately defined organizational structure, individual behavior, unclear expectations, individual or group conflicts of interest, operational or staffing changes, and diversity in gender, culture, or age
What are some complications a patient in traction might have?
pressure ulcer atelectasis and pneumonia constipation anorexia urinary stasis infection DVT
Megan is the nurse manager for a surgical unit and is planning a significant change in how the unit functions. She plans to include some things that will help to overcome any resistance to the change from the staff. Which of the following might help overcome resistance to Megan's planned change? a) Refuse to hear any discussion b) Demand loyalty and commitment c) Threaten to end staff's employment d) Provide incentives, such as time off
provide incentives, such as time off
How is osteoarthritis diagnosed?
radiologic presence of osteophytes radiologic joint space narrowing clear synovial fluids in labs
Which NPSG will the operating room nurse follow when caring for a client transferred to the OR for a left-leg amputation?
read the client's identification arm band conduct a time our prior to surgery allow the client to sign the surgical consent form
What describes the focus of the national patient safety goals
reduce the risk of medical errors and to increase patient safety
the nurse asks the nursing assistant to weight a client. the CNA carefully assists the client out of bed to stand on the scale, weighs the client, and safely returns the client to bed. Later, when the nursing assistant reports the weight to the nurse, it is discovered that the client had been placed on bed rest and should not have been allowed out of bed. which right of delegation does this situation violate?
right direction and communication
a nurse is performing discharge teaching for an elderly client with osteoporosis. which instruction about calcium supplement should the nurse include?
take the supplement with meals or with orange juice. --- take with meals or with a beverage high in vitamin C for increased absorption
what is the pathophysiology of OA
tends to develop gradually over several years where the joint cartilage wears away and eventually the bones just rub against each other
What is osteoarthritis?
the most common type of arthritis that develops due to the deterioration of the articular/hyaline cartilage. When this happens, it leads to bone break down because the bones within start to rub one another causing abnormal hardening (sclerosis) and osteophytes formation (bone spurs)
a nurse on the unit refuses to utilize the CNA and is consistently late leaving the unit at the end of the shift. Why is the nurse jeopardizing effective care?
the nurse believes that others cannot perform tasks
the RN wants to delegate a task to a UAP but is unsure if the task can be delegated. What is the best resource for the RN to use in determining if the task is appropriate?
the nurse practice act or facility's policy and procedures
the nurse has assigned vital signs and personal care for several clients to the CNA. Why should the nurse plan to reassess each client throughout the shift?
the nurse remains accountable for the client's care
The RN wants to delegate measuring a client's urinary output to a UAP. Which factors should the nurse consider before delegating the task?
the stability of the pt's condition potential for harm and complexity of the activity
What happens in osteoarthritis?
the top layer of cartilage begins to breakdown and wear away which leads to a loss of joint space within the joint which allows the bones to grate upon each other. This leads to eroding of the bone and osteophyte formation. Furthermore, pieces of cartilage and bone can break off and float around in the joint space. All of this leads to extreme stiffness and pain.
What is the role of these dopaminergic neurons?
they release the neurotransmitter dopamine which allows us to have accuracy with movement. Therefore, if they are dying this will lower the amounts of dopamine available to our body to for normal movement.
Key Points about Parkinson's Disease
this disease tends to occur in older age 60+, there is no cure, s/sx are subtle and become worse over time, s/sx may present on one side and progress to others overtime
What are some nursing interventions to keep in mind when providing care for a patient who recently had a hip replacement surgery done?
use abduction when turning and adduction when transferring limit flexion of hip <90 degrees ambulate early with walker assess drains prevent infection prevent DVT
what is the typical loss of height associated with osteoporosis and aging
15 years post menopause height loss is 1.5 inches 25 years post menopause height loss is 3.5 inches
A pt with osteoarthritis has finished their first physical therapy session. As the nurse you want to evaluate the pt's understanding of the type of exercises they should be performing regularly at home as self-management. Select all the appropriate types of exercise stated by the patient
Water aerobics, weight lifting, and walking DONT do jogging or tennis
a nurse is teaching a wellness group among a group of older adult women. one of the women has asked for advice about preventing osteoporosis, which affects many of her friends. what is the nurse's best response to the woman's query?
"Weight-bearing exercise is helpful, as are calcium supplements."
Nursing Interventions for Bone Fractures
-immobilize the fracture by a device or splint it -stop bleeding by applying pressure -if fracture is open, cover with sterile dressing -elevate extremity to decrease swelling -apply ice to decrease swelling to prevent excessive swelling due to risk of compartment syndrome -x-ray will be ordered to diagnose -pain management with meds -monitor for fat embolism -assess neurovascular status
what should you remember about casts
-monitor for the 6 P's -monitor for infection -keep the cast and extremity elevated above the heart level (to decrease swelling) -apply ice packs to decrease swelling -maintain skin integrity -keep cast dry and don't stick anything inside
what are the five stages of Parkinson's disease?
1.) unilateral involvement, minimal impairement 2.) bilateral or midline involvement w/o impairment of balance 3.) evidence of unsteadiness 4.) able to walk, stand, markedly incapacitated 5.) client confined to bed, wheelchair
True or false. Multiple Sclerosis tends to affect more men than woman and occurs during the ages of 50-70 years.
False - MS affects women more than men and shows up during the ages of 20-40 years
true or false. the nurse must never remove weights from skeletal traction unless a life-threatening situation occurs
TRUE - removal of weights completely defeats their purpose and may result in injury to the pt
a nurse manager and the charge nurse have two employees who are disagreeing with the accomplishment of client care. the manager determines a mutually agreed-upon time to discuss this situation with all the members involved. this activity is known as what?
conflict resolution
A spouse of a husband who has PD explains that her husband experiences episodes while walking where he freezes and can't move. She asks what ca be done to help with these types of episodes to prevent injury. select all options that are correct
have the husband try to change direction of movement by moving in the opposite direction when the freeze ups occur use a cane with a laser point while walking encourage the husband to consciously lift the legs while walking (as with marching)
List some appropriate strategies for successful delegation
identify necessary skill and education levels to complete the delegated task plan ahead select and empower capable personnel communicate goals clearly empower the delegate set deadlines and monitor progress monitor the role and provide guidance evaluate performance reward accomplishment
the nurse and UAP are working together to admit a pediatric client to a nursing unit. Which task would be inappropriate to delegate to the UAP?
initiating intravenous therapy
a nursing assistant has previously performed client transfers safely (bed to chair) on many occasions. Under which condition would it be inappropriate to delegate this unsupervised task to the nursing assistant?
it was the client's first time out of bed since surgery
What measure should be taken for adequate nutrition in a pt undergoing orthopedic surgery
large amounts of milk should not be given to orthopedic pmts on bed rest
What is compartment syndrome?
occurs when too much pressure is exerted within the muscle compartments found within the fascia. this can occur when there is bleeding or swelling present after a bone fracture. all this can increase the pressure within the compartments. as the pressure builds, this will cut off the blood supply and nerve function this muscle. if not corrected, damage is permanent.
A pt newly diagnosed with osteoarthritis asks about the medication treatments for their condition. Which medication is NOT typically prescribed for OA? a. NSAIDs b. topical creams c. oral corticosteroids d. acetaminophen (Tylenol)
oral corticosteroids because OA is within the joint and not systemic so oral corticosteroids are not as effective
What should you educate your patient on that has a cast?
pad rough edges with tape or moleskin blow with hairy dryer to relieve itching do not stick foreign objects into cast report signs of persistent pain and swelling, changes in sensation, temperature, skin color, movement, and signs of infection or pressure area do not get plaster cast wet
what are some complications of the disease: osteoarthritis
rapid, complete breakdown of cartilage deterioration of tendons and ligaments pinched nerve bone death stress fractures bleeding and infection in the joint
describe physical assessment findings of a pt with osteoarthritis
reduced range of motion malignant of joints crepitus
what are the main causes of wrong site surgeries
scheduling - non affiliated physician offices supplying info pre-op handling - incomplete/incorrect/missing documents, changes made to consent in pre-op without OR notification OR - unapproved site marking pen, mark not visible after prep and drape, staff is rushing during Time-Out and critical steps are missed organizational culture - leadership not actively engaged, staff is not empowered to speak up, policy changes made with not enough education, pressure to increase surgical volume leads to shortcuts
Parathyroid hormone plays an important role in bone health. When the parathyroid gland secretes PTH, it causes:
the body to increase the calcium levels by stimulating osteoclast activity
Causes of back problems
trauma, sudden injury, degenerative disorders, GI causes, pregnancy, muscular irritation, joint dysfunction, strain, poor body mechanics, lifting improperly abnormal stress or overuse kyphosis (hunchback) lumbar lordosis scoliosis
Medications for Multiple Sclerosis
corticosteroids and anticholinergic
which patients below are at risk for developing osteoarthritis? Select all that apply.
YES ---- a 65 yr old male with a BMI of 35 and a 55 yr old male with a hx of repeated right knee injuries NO ---a 59 yr old female with a hx of taking long term doses of corticosteroids and a 60 yr old female with high uric acid levels
Which clients are at an increased risk for development of osteoporosis. Select all that apply?
a client with Cushing syndrome (endocrine disorder) a client with adult onset diabetes mellitus (endocrine disorder) a young adult who has alcoholism (r/t calcium deficits) a postmenopausal 65-year-old woman (due to lack of estrogen) a 20-year-old female with hyperthyroidism (endocrine disorder) --- having multiple diseases does not necessarily put a client at higher risk but age related changes in bone cells and matrix do have an impact on bone metabolism. men are at less risk than women
Why is there s/sx of tremors, rigidity, etc. in Parkinson's disease?
a loss of dopamine leads to more acetylcholine being able to produce more excitatory affects to the neurons which leads to overstimulation
What is multiple sclerosis (MS)?
chronic demyelinating neurologic disease -- its an autoimmune disease that affects the myelin sheath of the central nervous system (CNS); it leads to inflammation and scarring of the nerve, which causes a decrease in nerve transmission and causes many pts to experience sensory and motor problems
a RN is delegating activities to UAPs on a hospital unit. which activities could this nurse normally delegate?
giving a bed bath to a patient taking routine vital signs transferring a patient to another floor
John is a nursing student who is working to improve his time management. which of the following would assist John in accomplishing his goal? Choose all that apply.
identify priorities for the day establish a reasonable time line evaluate at the day's end
The causes of OA include:
increased risk if pt... has had repeated joint injuries jobs that are strenuous occurs in older age 40+ overweight/obesity genetics women repeated stress/overuse bone deformities certain metabolic diseases posture
a nurse is considering the delegation of administering medications to an unskilled assistant. what is the first question the nurse must ask herself before doing so?
is the delegated task permitted by law?
What is Parkinson's disease?
it is a progressive, degenerative neurological disease that gradually starts to affect movement that is characterized by tremors, muscle rigidity, and bradykinesia
You're providing education to a local group about the s/sx of PD. Select all the s/sx a patient could experience with this disease:
loss of smell, constipation, shuffling of gait, freezing of extremities, and coordination issues
a nurse is performing patient education for a woman who has just been prescribed a bsiphosophonate. which diagnostic and history findings would have prompted the woman's care provider to prescribe a bisphosophonate?
low bone density and a family history of osteoporosis -- bisphosophonate drugs are recommended for long-term management of hypercalcemia to increase bone resorption of calcium, in treating and preventing osteoporosis in postmenopausal women
Treatment of OA
no cure, it gets worse overtime and can't be reversed; managed with lifestyle changes (exercise/losing weight), medication, surgery (hip/knee replacement or bone realignment "osteotomy", arthroscopic) assistive devices and braces/shoe inserts PT and OT heat or ice to relax muscles and relieve pain and swelling transcutaneous electrical nerve stimulation (TENS)
What are some common tasks generally considered appropriate for delegation to UAPs?
noninvasive and nonsterile treatments collecting, reporting, and documenting data including VS, height + weight, I&O's, capillary blood and urine tests ambulating, positioning, turning transportation of a client within a facility personal hygiene, elimination, including vaginal irrigations and cleansing enemas feeding, cutting up food, placing of meal trays socialization activities ADLs
a nurse on a telemetry unit is admitting a client and has an unlicensed assistive person helping with the admission process. which task can the nurse delegate to the UAP?
obtaining an admission weight for the client utilizing the client's bed scale
Which is a task that the nurse can delegate to the UAP?
obtaining intake and output on a client with a Foley catheter
you receive your pt back from radiology. The pt had an x-ray of the hips and knees for the evaluation of possible osteoarthritis. What findings would appear on the x-ray if osteoarthritis was present? Select all that apply. a. increased joint space b. osteophytes c. sclerosis of the bone d. abnormal sites of hyaline cartilage
osteophytes and sclerosis of the bone --- the joint space would be decreased and an x-ray cannot show hyaline cartilage
What are some nursing interventions for osteoarthritis?
pain assessment therapy exercise: low impact, strength training, ROM, avoid high impact and let irritated joints rest heat and cold compresses importance of weight loss