Exam 4
List s/s of Tb:
* Insidious onset *Low grade fever *Cough- non productive or hemoptysis. * night sweats * fatigue *wt loss
Who needs Tb prophylaxis?
*Household members exposed to active Tb *Pts with positive PPD test when their last one was negative
Name the 4 types of hypersensitivity reactions.
1. Analphylactic 2. Cytotoxic 3. Immune complex reaction 4. Delayed
In joint replacement infection can spread from one site to another in what time frame?
2 years
After tx is started when is a Tb pt considered noninfectious?
2-3 weeks of continuous tx
How long in a clavical fracture should the arm not be elevated above shoulder?
6 weeks
What causes Cerebral Palsy
ANY damage to immature developing brain. Genetics Preg HTN Anoxia Birth trauma Infections Stroke Poisoning
List hip replacement interventions:
Abduct leg- away from the midline Avoid internal rotation
Knee replacement interventions:
Active flexion exercises CMP devices- bends leg back and forth Ice CMS Monitor H/H for bleeding
What is autonomic Dysreflexia?
Autonomic nervous system responses are exaggerated
How should an amputated limb be positioned?
Avoid Abduction external rotation and flexion
What vaccine can show a positive Tb skin test reading?
BCG vaccine
When should neurovascular status be assessed?
Before and after splinting
What are the s/s of autonomic dysreflexia?
Bladder Bowel Flush of face HA Perspiration Runny nose
What can trigger Autonomic dysreflexia?
Bladder distention constipation skin stimulation
What is Myasthenia Gravis?
Breakdown of communication between nerves and muscle resulting in loss of function in voluntary muscles.
A client with a positive Mantoux test result is taking isoniazid (INH) and rifampin (RIF) for an initial treatment over a 2-month period for confirmed tuberculosis. The nurse should assess specifically for which finding during the clinic visit? A) Fatigue B) SOB C) yellowing of skin and eyes D)Peripheral edema
C- liver enzymes need to be monitored
At which spinal region is the diaphragm at that can produce respiratory problems?
C4
Which IBD causes Fistulae's and ileitus?
CD
What are some considerations for Myambutol?
Can cause optic neuritis- color vision
What is the difference in need between a cast and a splint?
Cast require rigid immobilization where a splint does not.
Which kind of SCI is at risk for becoming a quadriplegic?
Cervical spinal damage
What Dx is preferred for IBD?
Colonoscopy with biopsy
What does a UC colonoscopy look like?
Confluent inflammation
List examples of type 3 Delayed or cellular reaction:
Contact dermatitis graft vs host Hashimotos thyroiditis Sarcoidosis
Which IBD condition affects all layers of the intestine (transmural)
Crohns
What does Tb prophylaxis consist of?
Daily doses of INH 6-12 mos Check liver enzymes Monitor for AFB sputums
Where should the 5 P's be checked at?
Distal
What s/s are commonly seen with Type 4 reaction?
Erythemea and itching
List examples of type 1 reactions:
Extrinsic asthma allergic rhinitis sys. anaphylaxis reactions to stings
What is the surgical intervention for compartment syndrome?
Fasciotomy- cut fascia to relieve tension- restores circulation to the tissue
List examples of Cytotoxic Reactions:
Goodpastures Myasthenia Gravis Percinious anemia hemolytic disease Transfusion reaction thrombocytopenia
Explain what compartment syndrome looks like?
Hard to the touch Pain not relieved by med Pain distally with passive stretch of fingers/toes Late signs are: pallor,paralysis, pulselessness
What are the adverse affects of Pyrazinamide?
Hyperurecemia
What are alternative methods for pain management?
Ice elevation re positioning
Where does TB bacteria multiply?
In the alveoli - can travel to other parts of the body.
What kind of reaction does the body produce in reaction to Tb and what does this cause?
Inflammation response Pneumonia from accumulated exudation.
Where is Ulceratic Colitis mainly found?
Large bowel primarily the rectum
What is the preffered Dx test for CP?
MRI of brain for 45 minutes
Explain the patho of Tb?
Macrophages form a wall around the infection and then transforms the infection to a fibrous mass. This becomes necrotic and cheesy. Mass then becomes calcified and bacteria become dormant- possibility of being reactivated.
TB is caused from what bacteria?
Mycobacterium tuberculosis
In compartment syndrome what is happening?
Nerves and blood vessels become restricted.
Which kind of fractures require tx to prevent infection?
Open
What is the Tx for ananphylaxis?
Oxygen Epi 1:1000 dilution SQ IV infusion of Epi Vasopressors- BP control Antihistmaines Corticosteroids
Which medications commonly cause anaphylaxis reactions?
PCN (antibiotics) opioids radiocontrast dye IV anesthetics Aspirin and NSAIDS
What are the 6 P's of compartment syndrome?
Pain Pallor Parasethesia paralysis Pokiliothermia Pulselessness
What are some adverse effects of INH?
Peripheral neuropathies - take vitamin B6
Where are common pressure areas in long bone cast?
Peroneal nerve Tibial tuberosity lateral malleolus
What is a strain?
Pulled muscle
What are the Dx involved in Tb?
Quantiferon Gold test CXR Mantoux method Sputum culture
Where are common pressure areas in short arm cast?
Radial and Ulna styloid Olecranon and Lateral epicondyle
What is an adverse affect of Rifampin?
Red color to body secretions can alter affects of other meds
What are possible complications of pt's in traction?
Respiratory Integumentary GI GU Circulatory
List the different kinds of traction?
Skins traction - Bucks extension -cervical head halter -pelvic Skeletal General
What can be expected to see on a colonoscopy of a chron's disease pt?
Skip lesions
What constitutes a definitive diagnosis of Tb?
Sputum culture showing M. tuberculosis
Explain what the mantoux method is?
Tb skin test: - used for screening of latent - read 48-72 hours later ->5mm is positive in HIV/imm ->10mm is positive in at risk - doesnt mean active disease
What is Good pastures Syndrome?
The immune system attacks the tissues in the body. Most commonly in the lungs resulting in bleeding and the kidneys resulting in inflammation.
In pernicious anemia what is the body lacking?
Vitamin B-12
Explain what a type 2: Cytotoxic reaction is:
Where the body mistakes a normal constituent as foreign and activates an immune response.
How soon does an anaphylactic reaction occur?
Within minutes
Explain the initial tx regimen for Tb:
daily doses for 8 weeks and then continuation regimen for 4-7 months
What is an expectation to discuss with pt about cast application?
heat from hardening of plaster
What are symptoms of systemic reactions?
laryngeal stridor angioedema hypotension - may show a low MAP bronchial GI or uterine spasm
S/S of a dislocation:
pain change in contour length of limb loss of mobility THINK BLOOD SUPPLY
