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LCCC Nursing > Chapter 65: Med Surg > Flashcards

Chapter 65: Med Surg Flashcards

1
Q

osteoarthritis

A

slowly progressive noninflammatory disorder of synovial joints r/t age, genetics, obsesity, frequent kneeling, lack of exercise

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2
Q

Men with OA

A

men after more often affected than women before age 50, hip OA more common after 55, knee OA more common in men before age 45

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3
Q

women with OA

A

affected more after age 50 thought to be caused by estrogen reduction at menopause

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4
Q

OA results from

A

cartliage damage leading to cartilage and bony growth increasing at joint margins causing uneven distribution of stress across joint and reducing motion

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5
Q

s/s of OA

A

no systemic (unlike RA!), joint pain and may be referred to groin, butt, thigh or knee, early morning stiffness but resolves within 30 min

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6
Q

heberden’s nodes

A

occur in distal interphalangeal joints as an indication of osteophyte formation and loss of joint space, red, swollen, tender

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7
Q

bouchard’s nodes

A

affects proximal interphalangeal joints, red, swollen, tender

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8
Q

diagnostics of OA

A

bone scan, CT, MRI detect early joint changes and x rays confirm disease and stage progression such as joint space narrowing and osteophyte formation, synovial fluid clear yellow and not inflammed (unlike RA!)

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9
Q

tx of OA

A

managing pain, preventing disability, and maintaining and improving joint fx, rest should not exceed 1 week, heat used more than ice, arthroscopy to repair cartilage or remove bone bits

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10
Q

alternative therapy of OA

A

glucosamine and chondroitin sulfate helpful in resolving moderate to severe arthritis pain and improving joint mobility

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11
Q

drug therapy for OA

A

tylenol 1000 mg q6h do not exceed 4 g/day, Zostrix topical cream, no NSAIDs with Coumadin or anticoagulants or Aspirin

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12
Q

hyaluronic acid

A

viscosupplementation contributes to viscosity and elasticity of synovial joints

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13
Q

spondyloarthropathies

A

inflammatory disorder that affects the spin, peripheral joints, negative for rheumatoid factor, HLA-B27 gene associated, difficult to distinguish types early in disease

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14
Q

ankylosing spondylitis

A

chronic inflammatory disorder affecting axial skeleton, highest incidence 25-34 yeras of age, men more likely to develop

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15
Q

s/s of ankylosing spondylitis

A

low back pain, stiffness, limitation of motion, pain in other areas such as hands, extraarticular inflammation in eyes, lungs, heart, etc

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16
Q

diagnostics for ankylosing spondylitis

A

pelvic x ray is essential for characteristic changes of sacroiliitis, may see “bamboo spine” which is the result of calcifications that bridge from one vertebra to another

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17
Q

tx of ankylosing spondylitis

A

maintain maximum mobility while decreasing pain and inflammation, local corticosteroid injections, once pain and stiffness are gone exercising is essential, spinal osteotomy and total joint replacement are most frequent procedures

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18
Q

nursing management of ankylosing spondylitis

A

ROM should include chest expansion (breathing exercises), no smoking, firm mattress and sleep on back with flat pillow avoiding flexion, swimming, racquet games

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19
Q

psoriatic arthritis

A

progressive inflammatory disease that can involve primary small joints of hands and feet, can involve asymmetric extremities resembling OA, can involve symmetric extremities resembling RA, can involve sacroiliac joints and spine

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20
Q

diagnostics of psoriatic arthritis

A

x ray looks similiar to erosion in RA, widened joint spaces, elevated ESR, mild anemia, elevated blood uric acid (gout must be excluded)

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21
Q

tx of psoriatic arthritis

A

splinting, joint protection, physical therapy, DMARDS such as methotrexate

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22
Q

reactive arthritis

A

occurs more commonly in young men, urethritis, conjuncitvitis, and mucocutaneous lesions included, etiology unknown but associated with GI infections

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23
Q

tx for reactive arthritis

A

prognonsis is favorable, pt recovers in 2-16 weeks, Vibramycin 100 mg BID

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24
Q

diagnostic for reactive arthritis

A

up to 50% of people have a recurring disease, x ray in chronic conditions resemble ankylosing spondylitis

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25
Q

septic arthritis

A

invasion of joint cavity with microorganisms resulting in hematogenous seeding of joint, can be caused by gonorrhea, large joints frequently involved

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26
Q

s/s of septic arthritis

A

severe pain, erythema, swelling, fever, chills

27
Q

diagnostics for septic arthritis

A

arthrocentesis to do a culture of synovial fluid

28
Q

tx for septic arthritis

A

antibiotics promptly to prevent joint destruction, monitor joint inflammation, pain, and fever

29
Q

lyme disease

A

spirochetal infection transmitted by the bite of an infected deer tick, not transmitted person to person, occurs most during the summer

30
Q

s/s of lyme disease

A

erythema migrans (EM) is a skin lesion that occurs at the site of the tick bite within 2-30 days of exposure, low grade fever, stiff neck, swollen lymph noteds, migratory joint and muscle pain, untreated can migrate to- CNS, heart, and joints

31
Q

diagnosis of lyme disease

A

based on clinical manifestations (EM lesion in particular) and a history to endemic area, ELISA test and western blot to confirm

32
Q

tx of lyme disease

A

tx with antibiotics such as Doxycycline, no vaccine available

33
Q

where do you commonly find lyme disease?

A

maryland to massachusetts, wisconsin and minnesota, california and oregan

34
Q

gout

A

increase in uric acid production, underexcretion of uric acid, increased foods in purines, recurrent attacks of acute arthritis

35
Q

causes of gout

A

drugs that increase cell death such as chemotherapy, thiazide diuretics, postmenopausal women, immunosuppresant pt, obesity in men, excessive alcohol, prolonged fasting

36
Q

what foods are high in purine?

A

shellfish, lentils, asparagus, spinach, beef, chicken, pork

37
Q

acute s/s of gout

A

arthritis may occur in one or more joints, but less than 4, joints dusky or cyanotic, tender, inflammation of great toe, subsides in 2-10 days

38
Q

chronic s/s of gout

A

multiple joint involvement and visible deposits of sodium urate crystals (tophi), chronic inflammation, cartilage destruction may precede OA, kidney or urinary tract infection

39
Q

diagnostics of gout

A

uric values 6+, synovial fluid aspiration to eliminate possibility of other diseases

40
Q

tx of gout

A

Colchicine, NSAIDs for pain management, avoid alcohol and purine foods, adequate hydration

41
Q

Uloric

A

given for long term gout

42
Q

nursing management for gout

A

supportive care of the inflamed joints, avoiding precipitating factors that can cause the disease- excess calories, alcohol, purine foods, starving, aspirin, diuretics, MI

43
Q

systemic sclerosis

A

connective tissue disorder, degenerative, occassionally inflammatory changes in skin, blood vessels, internal organs, more common in african americans women, overproduction of collagen

44
Q

causes of systemic sclerosis

A

exposure to coal, plastics, and silica dust

45
Q

CREST

A

s/s of systemic sclerosis: calcinosis, raynaud’s phenomenon (abnormal blood flow in response to cold or stress), esophageal dysfunction, sclerodactyly (tightening of skin on fingers and toes), telangiectasia (red spots on hands, forearms, palms, face, lips)

46
Q

raynaud’s phenomenon

A

most common symptom in limited systemic sclerosis (more common disease), decreased blood flow in response to cold, cyanosis, and then erythema, numbling and tingling

47
Q

limited cutaneous disease

A

more popular systemic sclerosis, skin thickening does not extend above elbows or above the knee

48
Q

diffuse cutaneous disease

A

less popular systemic sclerosis, skin loses elasticity and becomes taut and shiny producing expressionless faces with tightly pursed lips

49
Q

diagnostic studies for systemic sclerosis

A

mild anemia, SCL-70 gene, lab findings generally normal

50
Q

tx for systemic sclerosis

A

no long term effects, attempt to prevent or treat secondary complications of involved organs, calcium channel blockers for early tx

51
Q

nursing management for systemic sclerosis

A

don’t have finger sticks because of poor circulation and poor healing of fingers, use moist heat to promote flexibilty of hands and feet, lotions must be rubbed in for long time, small frequent meals to reduce dysphagia, oral hygiene

52
Q

polymyositis and dermatomyositis

A

diffuse, idiopathic, inflammatory myopathies that produce bilateral weakness, PM is more serious

53
Q

s/s of polymyositis and dermatomyositis

A

weight loss, gradually weakness of muscles, discomfort and tenderness of muscles is uncommon, dysphagia and dysphonia (hoarse voice)

54
Q

s/s of dermatomyositis

A

violet colored or cyanotic edema around eyelids, violet colored (heliotrope), cyanotic, or erythematous rash with edema around eyelids

55
Q

diagnostics for polymyositis and dermatomyositis

A

confirmed by MRI, EMG findings (bizarre high discharges and positive spikes at rest), muscle biopsy reveals necrosis, degeneration

56
Q

tx for polymyositis and dermatomyositis

A

high dose corticosteroids, immunosuppresives, massage, passive movement

57
Q

sjogren’s syndrome

A

autoimmune that targets moisture producing glands, lymphocytes attack and damage lacrimal and salivary glands

58
Q

s/s of sjorgren’s sydrome

A

gritty sensation in eyes, burning and blurred vision, photosensitivity,

59
Q

tx of sjorgren’s sydrome

A

instillation of preservative free tears such as cyclosporine (Restasis), increased fluids with meals, dental hygiene, increased humidity at home

60
Q

fibromyalgia syndrome

A

chronic pain with multiple tender points, nondegenerative, nonprogressive, noninflammatory

61
Q

s/s of fibromyalgia

A

nonrestorative sleep, morning stiffness, IBS, anxiety, widespread burning pain and improves through course of day

62
Q

diagnostics for fibromyalgia

A

muscle biopsy may reveal nonspecific moth-eaten appearance of fiber atrophy, pain experienced in 11 of the 18 tender points, widespread pain for 3 months

63
Q

tx for fibromyalgia

A

antidepressants and muscle relaxants, long acting opioids not recommended, benzo with ibuprofen to treat anxiety as well as muscle spasms

LCCC Nursing (15 decks)

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