Unit 7 NOA

The nurse is providing education to a client who has osteoarthritis about activity and exercise. Which of the following should be included? Select all that apply * A. "Exercise when your joint pain is least severe" B. "Weight bearing exercise is most effective." C. "First thing in the morning is the best time to exercise." D. "Take hydrocodone/APAP at least 45 minutes prior to exercise." E. "Heat or ice are effective to use after exercising to reduce pain."

A. "Exercise when your joint pain is least severe" E. "Heat or ice are effective to use after exercising to reduce pain."

A nurse is performing health screenings at a health fair. Which of the following clients have a risk factor for osteoporosis? (Select all that apply.) A. A 40-year-old client who has been taking prednisone for 4 months B. A 30-year-old client who jogs 3 miles daily C. A 45-year-old client who takes phenytoin for seizures D. A 65-year-old client who has a sedentary lifestyle E. A 70-year-old client who has smoked for 50 years

A. A 40-year-old client who has been taking prednisone for 4 months C. A 45-year-old client who takes phenytoin for seizures D. A 65-year-old client who has a sedentary lifestyle E. A 70-year-old client who has smoked for 50 years

A nurse is assessing a client who has a casted compound fracture of the femur. Which of the following findings is a manifestation of a fat embolus? A. Altered mental status B. Reduced bowel sounds C. Swelling of the toes distal to the injury D. Pain with passive movement of the foot distal to the injury

A. Altered mental status

A nurse is completing discharge teaching to a client who had a wound debridement for osteomyelitis. Which of the following information should the nurse include? A. Antibiotic therapy should continue for 3 months. B. Relief of pain indicates the infection is eradicated. C. Airborne precautions are used during wound care. D. Expect paresthesia distal to the wound.

A. Antibiotic therapy should continue for 3 months.

A nurse is providing information to a client who has osteoarthritis of the hip and knee. Which of the following information should the nurse include in the information? (Select all that apply.) A. Apply heat to joints to alleviate pain. B. Ice inflamed joints for 30 min following activity. C. Reduce the amount of exercise done on days with increased pain. D. Prop the knees with a pillow while in bed. of motion is more E. Active range effective than passive.

A. Apply heat to joints to alleviate pain. C. Reduce the amount of exercise done on days with increased pain. of motion is more E. Active range effective than passive.

A nurse is planning care for a client who is arthroscopy of the postoperative following an knee. Which of the following actions should the nurse take? (Select all that apply.) A. Assess color and temperature of the extremity. B. Apply warm compresses to incision sites. C. Place pillows under the extremity. D. Administer analgesic medication. E. Assess pulse and sensation in the foot.

A. Assess color and temperature of the extremity. C. Place pillows under the extremity. D. Administer analgesic medication. E. Assess pulse and sensation in the foot.

5. A nurse is planning care for a client who will undergo an electromyography (EMG). Which of the following actions should the nurse include? (Select all that apply.) A. Assess for bruising. B. Administer aspirin prior to the procedure. C. Determine whether the client takes a muscle relaxant. D. Instruct the client to flex muscles during needle insertion. E. Expect swelling, redness, and tenderness at the insertion sites.

A. Assess for bruising. C. Determine whether the client takes a muscle relaxant. D. Instruct the client to flex muscles during needle insertion.

A nurse is admitting a client to the orthopedic a total knee arthroplasty. unit following Which of the following actions by the nurse are appropriate? (Select all that apply.) A. Check continuous passive motion device settings. B. Palpate dorsal pedal pulses. pillow behind the knee. C. Place a D. Elevate heels off bed. E. Apply heat therapy to incision.

A. Check continuous passive motion device settings. B. Palpate dorsal pedal pulses. D. Elevate heels off bed.

A nurse is completing a preoperative teaching plan for a client who is scheduled to have a total hip arthroplasty. Which of the following should the nurse include in the teaching plan? (Select all that apply.) A. Encourage complete autologous blood donation. B. Sit in a low reclining chair. C. Instruct the client D. Use an abductor pillow when turning the client. to roll onto the operative hip. E. Perform isometric exercises.

A. Encourage complete autologous blood donation. D. Use an abductor pillow when turning the client. E. Perform isometric exercises.

A nurse is providing teaching for a client who has a history of low back injury. Which of the following instructions should the nurse give the client to prevent future problems with low back pain? (Select all that apply.) A. Engage in regular exercise including walking. B. Sit for up to 10 hr each day to rest the back. C. Maintain weight within 25% of ideal body weight. D. Create a smoking cessation plan. E. Wear low-heeled shoes.

A. Engage in regular exercise including walking. D. Create a smoking cessation plan. E. Wear low-heeled shoes.

A nurse is assessing a client who has osteoarthritis of the knees and fingers. Which of the following manifestations should the nurse expect to find? (Select all that apply.) A. Heberden's nodes B. Swelling of all joints C. Small body frame D. Enlarged joint size E. Limp when walking

A. Heberden's nodes D. Enlarged joint size E. Limp when walking

A nurse is assessing a client who had an for external fixation device applied 2 hr ago a fracture of the left tibia and fibula. Which of the following findings is a manifestation of compartment syndrome? (Select all that apply.) A. Intense pain when the client's left foot is passively moved B. Capillary refill of 3 sec on the client's left toes C. Hard, swollen muscle in the client's left leg -D. Burning and tingling of the client's left foot - E. Client report of minimal pain relief following a second dose of opioid medication

A. Intense pain when the client's left foot is passively moved C. Hard, swollen muscle in the client's left leg -D. Burning and tingling of the client's left foot - E. Client report of minimal pain relief following a second dose of opioid medication

A nurse in an outpatient clinic is assessing a client who reports night sweats and fatigue. The client reports having a cough along with nausea and diarrhea. Their temperature is 38.1° C (100.6° F) orally. The client is concerned about the possibility of having HIV. Which of the following actions should the nurse take? (Select all that apply.) A. Perform a physical assessment. B. Determine when manifestations began. C. Teach the client about HIV transmission. D. Draw blood for HIV testing. E. Obtain a sexual history.

A. Perform a physical assessment. B. Determine when manifestations began. E. Obtain a sexual history.

The priority nursing concern for a client with Paget's disease is which of the following? * A. Risk for infection B. Risk for delayed wound healing C. Risk for injury D. Risk for fatigue

A. Risk for infection

The nurse is providing teaching to a client diagnosed with systemic lupus erythematous. Which of the following instructions would be included in the teaching plan? Select all that apply * A. Therapy includes monoclonal antibodies, corticosteroids, antimalarial agents, NSAIDs, and immunosuppressive agents B. Lupus only affects the skin and typically resolves completely within a few months C. Routine periodic screenings as well as health promotion activities are necessary D. Wear sunscreen with an SPF of at least 15 when out of doors E. Lupus tends to have periods of exacerbations and remission

A. Therapy includes monoclonal antibodies, corticosteroids, antimalarial agents, NSAIDs, and immunosuppressive agents C. Routine periodic screenings as well as health promotion activities are necessary D. Wear sunscreen with an SPF of at least 15 when out of doors E. Lupus tends to have periods of exacerbations and remission

Additional nursing interventions for rheumatoid arthritis include which of the following? Select all that apply. * A Recommending the use of braces and/or splints B Recommending regular weight-bearing exercises C Recommending joint preserving exercises such as swimming D Recommending exercises for less than 30 minutes/day E Recommending avoiding exercise as joint inflammation will eventually worsen

A. recommending the use of braces and/or splints C. recommending joint preserving exercises such as swimming

the nurse is assessing a client for immunodeficiency. Which of the following should the nurse note? SATA A. recurrent infections B. chronic diarrhea C. failure to thrive D. infections responsive to antibiotics E. candidiasis infections

A. recurrent infections B. chronic diarrhea C. failure to thrive E. candidiasis infections

Which of the following are interventions the nurse can suggest to reduce joint stiffness related to rheumatoid arthritis? Select all that apply. * A Slowly stretching joints to improve mobility B Take opioid analgesics routinely C Take antirheumatoid medications as prescribed D Localize application of heat E Avoid exercise during times of exacerbations

A. slowly stretching joints to improbe mobility C. take antirheumatoid medications as prescribed D. localize application of heat

Which of the following are common signs and symptoms of rheumatoid arthritis? Select all that apply * A symmetrical joint pain B unilateral joint pain C morning joint stiffness D joint stiffness with exercise E Ulnar deviation F Swan neck deformity

A. symmetrical joint pain C. morning joint stiffness E. Ulnar deciation F. swan neck deformity

Which of the following are common signs and symptoms of fibromyalgia? Select all that apply * A. widespread chronic pain B. sleep disturbances C. unilateral joint pain D. joint swelling E. shortness of breath

A. widespread chronic pain B. sleep disturbances D. joint swelling

A nurse is teaching a client how to follow a low-purine diet as prescribed by the provider for the management of gout. Which of the following statements indicates the client understands the teaching? Select all that apply * A. "I will need to limit the number of fruit servings each day." B. "I should avoid eating liver and other organ meats." C. "I can drink only white wine." D. "I should choose red meat instead of poultry." E. "I should drink at least 2-3 liters of fluid/day."

B. "I should avoid eating liver and other organ meats." E. "I should drink at least 2-3 liters of fluid/day."

A nurse is completing preoperative teaching for a client who is to undergo an arthroscopy to repair a shoulder injury. Which of the following statements should the nurse include? (Select all that apply.) A. "Avoid damage or moisture to the cast on your arm." B. "Inspect your incision daily for indications of infection." C. "Apply ice packs to the area for the first 24 hours." D. "Keep your arm in a dependent position." E. "Perform isometric exercises."

B. "Inspect your incision daily for indications of infection." C. "Apply ice packs to the area for the first 24 hours." E. "Perform isometric exercises."

A nurse is reviewing strategies to promote comfort with a client who received an immunization. Which of the following information should the nurse include? (Select all that apply.) A. Massage the injection site. B. Apply a cool compress to the injection site. C. Take acetaminophen or ibuprofen. D. Use the affected extremity. E. Apply an antimicrobial ointment to the injection site.

B. Apply a cool compress to the injection site. C. Take acetaminophen or ibuprofen. D. Use the affected extremity.

A nurse is preparing to administer a scratch test to a client who has possible food and environmental allergies. Which of the following actions should the nurse perform prior to the procedure? (Select all that apply.) A. Cleanse the client's skin with povidone-iodine. B. Ask the client about previous reactions to allergens. C. Ask the client about medications taken over the past several days. D. Inform the client to expect itching at one site. E. Obtain emergency resuscitation equipment.

B. Ask the client about previous reactions to allergens. C. Ask the client about medications taken over the past several days. D. Inform the client to expect itching at one site. E. Obtain emergency resuscitation equipment.

A nurse in the emergency department is planning care for a client who has a right hip fracture. Which of the following immobilization devices anticipate in the plan of care? should the nurse A. Skeletal traction B. Buck's traction C. Halo traction D. Bryant's traction

B. Buck's traction

A family member is caring for an older adult client with osteomalacia in the home. When the home health nurse comes to evaluate the client, what should be a focus point of the visit? * A. Making sure the client receives a daily bath B. Ensuring the client is eating enough C. Observing for safety hazards that could be a fall risk D. Making sure the client has adequate financial resources

B. Ensuring the client is eating enough

A nurse is caring for a client who has a WBC count of 20,000/mm3. The nurse should conclude that the client has which of the following? A. Neutropenia B. Leukocytosis C. Left shift D. Leukopenia

B. Leukocytosis

A nurse is admitting an adult client who has suspected osteoporosis. Which of following findings are risk factors for osteoporosis? (Select all that apply.) A. History of consuming one glass of wine daily B. Loss in height of 2 in (5.1 cm) C. Body mass index (BMI) of 18 o. Kyphotic curve at upper thoracic spine E. History of lactose intolerance

B. Loss in height of 2 in (5.1 cm) C. Body mass index (BMI) of 18 o. Kyphotic curve at upper thoracic spine E. History of lactose intolerance

A nurse is preparing to document administration of a meningococcal vaccine to a client. Which of the following information should the nurse include in the documentation? (Select all that apply.) A. Age of client receiving the vaccine B. Name of vaccine manufacturer C. Vaccine expiration date D. Date of administration E. Serial number of the vaccine

B. Name of vaccine manufacturer C. Vaccine expiration date D. Date of administration

A nurse is assessing a client who is scheduled to undergo a right knee arthroplasty. The nurse should expect which of the following findings? (Select all that apply.) A. Skin reddened over the joint B. Pain when bearing weight C. Joint crepitus D. Swelling of the affected joint E. Limited joint motion

B. Pain when bearing weight C. Joint crepitus D. Swelling of the affected joint E. Limited joint motion

A nurse is caring for a client who received a lower back injury during a fall and describes sharp pain in the back and down the left leg. In which of the following positions should the nurse plan to place the client to attempt to decrease the pain? A. Prone without use of pillows B. Semi-Fowler's with a pillow under the knees C. High-Fowler's with the knees flat on the bed D. Supine with the head flat

B. Semi-Fowler's with a pillow under the knees

4. A nurse is educating clients at a health fair about dual-energy x-ray absorptiometry (DXA) scans. Which of the following information should the nurse include? (Select all that apply.) A. The test requires the use of contrast material. B. The hip and spine are the usual areas the device scans. C. The scan detects osteoarthritis. D. Bone pain can indicate a need for a scan. E. Females should have a baseline scan during their 40s.

B. The hip and spine are the usual areas the device scans. D. Bone pain can indicate a need for a scan. E. Females should have a baseline scan during their 40s.

A nurse is preparing to administer a varicella immunization to a client. Which of the following questions by the nurse is appropriate? A. "Are you allergic to eggs?" B. "Are you allergic to baker's yeast?" C. "Are you pregnant?" D. "Do you have a history of Guillain-Barré syndrome?"

C. "Are you pregnant?"

A nurse is preparing to administer an IM injection of immune globulin to a client who has been exposed to hepatitis A. Which of the following statements by the nurse is appropriate? A. "This medication offers permanent immunity to hepatitis A." B. "This medication involves three injections over several months.' C. "This medication provides you with an immune response more quickly than your body can produce it." D. "This medication contains an attenuated virus to help your body create antibodies."

C. "This medication provides you with an immune response more quickly than your body can produce it."

A nurse is assessing a client who has systemic lupus erythematosus (SLE). Which of the following findings is priority for the nurse to report? * A. joint swelling and discomfort B. butterfly rash across the bridge of the nose C. chest pain and shortness of breath D. signs of depression

C. Chest pain and shortness of breath

A nurse is reviewing the laboratory findings of a client who has measles. The nurse should expect to find an increase in which of the following types of WBCS? A. Neutrophils B. Basophils C. Lymphocytes D. Eosinophils

C. Lymphocytes

A nurse is teaching a client who is going to have a bone scan. Which of the following statements should the nurse include? A. "You will receive an injection of a radioactive isotope when the scanning procedure begins." B. "You will be inside a tube-like structure during the procedure." C. "You will need to take radioactive precautions with your urine for 24 hours after the procedure." D. "You will have to urinate just before the procedure."

D. "You will have to urinate just before the procedure."

5. A nurse in a clinic is caring for a client who is to receive an immunization. The client asks about contraindications to immunizations. Which of the should the nurse make? following responses A. "The use of insulin is a contraindication." B. "An anaphylactic reaction is a contraindication for administration of any type of immunization." C. "The commoni cold is a contraindication for receiving an immunization." D. "Your provider will weigh the risks if you have experienced any adverse effects."

D. "Your provider will weigh the risks if you have experienced any adverse effects."

A nurse is reviewing the health record of a client who is to undergo total joint arthroplasty. The nurse should recognize which of the following findings as a contraindication to this procedure? A. Age 78 years B. History of cancer C. Previous joint replacement D. Bronchitis 2 weeks ago

D. Bronchitis 2 weeks ago

Based on the common signs and symptoms of fibromyalgia, which of the following may be recommended? * A. Regular administration of diphenhydramine to aide in sleep B. Increase in foods high in calcium such as milk and yogurt C. Reducing exercise during times of exacerbation D. Recommend cognitive behavior therapy and medications for symptoms

D. Recommend cognitive behavior therapy and medications for symptoms

arthrocentesis

DX study done to relieve joint pain due to effusion

EMG

Done to evaluate muscle weakness or pain -care with pts on anticoags -avoid procedure if skin infection is present

A nurse is providing teaching to a client who was recently diagnosed with a latex allergy, which indicates understanding?

I will use ink pens for writing

Nurse is performing an assessment for a patient who may have peripheral neurovascular dysfunction. What signs does the patient present that indicate circulation is impaired?

Mottled color, cool temp to extremity and cap refill of 5 seconds.

Assessment of the Musculoskeletal System

Pain--1st check when pain isnt responding to meds, do a CMS assessment -rest

Bone scan

Performed to detect metastatic and primary bone tumors, osteomyelitis, certain fractures and aseptic necrosis. ALLERGIES are priority because of dye

A nurse is providing information about capsaicin from osteoarthritis. Which of the following information cream to a client who reports continuous knee pain should the nurse include in the discussion? A. Continuous pain relief is provided. B. Put on gloves before applying the cream to other parts of the body. C. Leave cream on the hands for 10 min following application. 2 hr during the day. D. Apply the medication every

Put on gloves before applying the cream to other parts of the body.

A nurse is preparing a client with systemic lupus erythematosus (SLE) for discharge. Which vital sign should the nurse instruct the patient to monitor? *

Temperature

rheumatoid arthritis

a chronic autoimmune disorder in which the joints and some organs of other body systems are attacked (autoimmune) synovial inflammation and deformity of the joints

artificially acquired immunity

after exposure to illness or vaccine

IgE is involved in

allergic disorders causes s/s of allergies r/t hay fever, asthma, and skin reactions

examples of B lymphocytes

anaphylaxis, allergies (hay fever), some infections Immune response = histamine release and immunoglobulins

A nurse is planning discharge teaching for a client who had a total hip arthroplasty. Which of the following should the nurse include in the teaching? (Select all that apply.) and water. A. Clean the incision daily with soap B. Turn the toes inward when sitting or lying. C. Sit in a straight-backed armchair. D. Bend at the waist when putting on socks. E. Use a raised toilet seat.

and water. A. Clean the incision daily with soap C. Sit in a straight-backed armchair. E. Use a raised toilet seat.

chemical substances that deystroy foreign agents such as microorganisms, which decrease the risk of infection at the site?

antibodies

when lymphocytes respond to the antigen,

antibodies are produced

substance capable of inducing a specific immune response?

antigens

passive immunity

antitoxin to prevent from getting an illness -exposed to an illness and then reveive gamma globulin to prevent MOM to BABY

skin testing

apply allergens - positive if theres a wheel and flare reaction which is significant (red, swollen, and elevated) -HAVE emergency equipment available for anaphylaxis when doing skin testing -hold corticosteroids and antihistamines for 2-4 days prior- this can result in false positive

prior to planning care assess clients ability tp

balance, transfer, or use assistive devices

previous exposure to foreign antigens with transfusions can lead to abnormal immune function

blood transfusions -frequent transfusions -past transfusions

inactivity leads to osteoclast activity

bone reabsorption (destruction)

arthroscopy dx

direct visualization of joint w/ scope -CMS after Arthrocentesis can be done with arthroscopy - aspiration of joint synovial fluid for analysis

cast care

do not stick anything down, -hair dryer on cool -cover in ice pack -antihistamines position or elevate 24-48 hors signs of infection (fever, red streaks coming out of cast, odor or drainage) --report

Stages of rheumatoid arthritis

early intermediate late

Alkaline phosphatase

elevated with bone tumors or cancer metastasis

CBC with WBC differential

eosinophils --elevated during allergic response -eosinophils= allerg(E) -eosinophil count

passive immunity is after

exposure (they get a shot after being exposed to hep C)

external fixation

external device surgically placed for complex open fractures with soft tissue damage (no weights) --high risk for osteomyelitis-pins are applied directly into the bones

antigens =

foreign

impact CMS assessment has on ADLs

function abilities-this is priority on initial assessment -gait -bone integrity -joint function -muscle strength and size

major symptoms of musculoskeletal dysfunction by applying concepts from the patients

health hx and physical assessment findings

A nurse is planning discharge teaching on home safety for an adult client who has osteoporosis. Which of the following information should the nurse include in the teaching? (Select all that apply.) in walkways. I A. Remove throw rugs B. Use prescribed assistive devices. C. Remove clutter from the environment. D. Wear soft-bottomed shoes. E. Maintain lighting of doorway areas.

in walkways. I A. Remove throw rugs B. Use prescribed assistive devices. C. Remove clutter from the environment. E. Maintain lighting of doorway areas.

systemic lupus erythematosus

inflammatory autoimmune disorder affecting almost every organ in the body types- discoid or systemic

compartment syndrome

involves the compression of nerves and blood vessels due to swelling within the enclosed space created by the fascia that separates groups of muscles 6 ps

know s/s of infection

know s/s of infection

baseline VS prior to administering IV immunoglobulin

may need to be premediated with acetaminophen or diphenhydramine -slow; 3ml/min (100-200 mlhr) -STOP transfusion if a reaction occurs

What are some interventions you can suggest to manage pain from osteoarthritis? *

medication/exercise/biofeedback

main concern after cast application is

neuromuscular function

handle the cast with

only palms until completely dry -avoid fingerprint indentions -Can cause pressure points and lead to skin pressure or pressure ulcers

stress leads to osteoblast activity

ossification (formation)

the earliest signs is

paresthesia (pulseless and pallor are both late signs) -provide pain re;ief and report if unrelieved do not ignore pain reports---indicated impaired tissue perfusion.!!

blood transfusions

previous exposure to foreign antigens with transfusions can lead to abnormal immune function -frequent transfusions -past transfusions

IV immunoglobulin treatment

s/e- flank and back pain, chills, flushing, dyspnea, SOB, h/a, fever, muscle aches ANAPHYLAXIS possible

Bone Densitometry (DEXA)

shows how strong/dense the bones are -used to DX osteoporosis***

what to do after arthrocentesis

use cool packs/ice to help with pain (heat makes it worse) -elevate -pain meds -bruising or swelling is normal

Radioallergosorbent test (RAST)

used to measure IgE in pts serum specific for a given allergen

S&S for osteomyelitis

warmth and purulent drainage abnoramal as well as fever, increased WBC -CAN HAVE SERIOUS OR SEROSANG DRAINAGE -mild redness for the first 2-3 days after placement is normal -culture any drainage 0leukocytosis and bone pain****

skin for compartment syndrome

will be cool and pale, delayed cap refill, will have paresthesia's, unrelenting pain that intensifies with PROM -leads to ischemia, irreversible neuromuscular damage (loosen cast or brace and notify provider) (extreme cases = fasciotomy)

3. A nurse is providing dietary teaching about calcium-rich foods to a client who has osteoporosis. Which of the following foods should the nurse include in the instructions? A. White bread В. Kale C. Apples D. Brown rice

В. Kale

difference between bone pain and muscle pain

□ Bone pain is dull, deep ache, not r/t movement □ Muscle pain is soreness, achy; muscle cramps -Fracture pain is sharp and piercing. Relieved by immobilization

disuse syndrome

○ Occur with muscle atrophy and loss of strength; have patient contract muscles without moving underlying bone (make a fist or push down leg) ---tighten, relax, tighten, relax

A nurse is teaching a client how to manage an external fixation device upon discharge. Which of the following statements by the client indicates understanding? (Select all that apply.) - A. "I will clean the pins more often if drainage from the pins increases." B. "I will use a separate cotton swab for each pin." C. "I will report loosening of the pins to my doctor." D. "I will move my leg by lifting the device in the middle." increased redness at the pin sites." E. "I will report

- A. "I will clean the pins more often if drainage from the pins increases." B. "I will use a separate cotton swab for each pin." C. "I will report loosening of the pins to my doctor." increased redness at the pin sites." E. "I will report

A 32 year old is admitted to the hospital for a hip replacement due to avascular necrosis from chronic steroid use as treatment for her juvenile rheumatoid arthritis. Describe how her altered immune function would impact her care.

- prevent the spread of infection with universal precautions -monitor for early signs of infection - higher risk for infection r/t surgery and chronic steroid use

s/s of rheumatoid arthritis

- symmetrical joint pain, multiple joints affected -morning stiffness -deformities -systemic findings

A nurse is providing care for a client who had a the following actions should the nurse take? vertebroplasty of the thoracic spine. Which of site. A. Apply heat to the puncture -B. Place the client in a supine position. 1 hr. C. Turn the client every D. Ambulate the client within the first hour postprocedure.

-B. Place the client in a supine position.

interventions for RA

-BRACES OR ASSISTIVE DEVICES -pacing activities -ROM and strengthening exercises -heat or cold to joints -progressive relaxation -non-pharmacologic pain relief methods -joint surgery -immunosuppressive agents

diagnostics for immune system

-CBC -Luekocytes and lymphocytes -WBC with diff***priority lab for autoimmune

gerontologic considerations with musculoskeletal dysfunctions

-Decreased bone mass and calcium absorption which leads to a chance for fractures -osteoporosis (high risk for elderly, postmenopausal) -encourage weight bearing exercises and intake of vit D with calcium to promote absorption -kyphosis -flexion of knees and hips -inactivity and nutritional deficiencies -osteoarthritis

Medications that can cause immune suppression

-NSAIDs -ATB -corticosteroids -biologic agents -immunosuppressants -cytotoxic agents -chemotherapy

Diagnostics for assessment of immune function

-WBC with diff*** Priority lab for autoimmune

Things that contain latex

-balloons -dishwashing gloves -elastic bandages -pencil erasers -ace wraps

rheumatoid arthritis late stage

-boutonniere deformity of thumb -ulnar deviation of metacarpophalangeal joints -swan neck deformity of fingers

6 P's

-check hourly for first 24 hours then every 1-4 hrs --check distally from where the cast is applied or where the procedure occured before and after casting

s/s of immune deficiency disorders

-chronic or recurrent infection -infections by unusual organisms -poor treatment response -chronic diarrhea -susceptibility to autoimmune disorders and cancer/failure to thrive

goal for rheumatoid arthritis

-decrease joint swelling -remission -minimize disability

education on infection prevention

-handwashing, good personal hygeine, avoiding sick people, clean bathroom/kitchen surfaces, dont change the cat litter, dont garden, may have to eliminate pets, avoid people who get live vaccines -strict aseptic techniques with invasive procedures -can eat fruits and veggies, but remove skin and wash, nothing raw -monitor for s/s of infection -genetic testing

CMS assessment (circulation, mobility and sensation)

-pain, pulse, pallor, paresthesia, paralysis, pressure ***paresthesia's is the first sign of CMS compromise***

DX rheumatoid arthritis

-rheumatoid factor -elevated ESR, CRP -ANA positive -Radiologic exams

natural immunity

-surviving an illness (chickenpox)

TX for allergic rhinitis

-trigger journal -avoidance therapy (picture) -medications(loratadine, cetrizine//dont use year round)** -immunotherapy (peanuts gradual increase)