FINAL EXAM: exam outline (by topic) Flashcards
(30 cards)
Osteoporosis
-Usually found out when the pt. breaks their bones.
-Risk factors: Weak boned elderly women; Hip fractures (constant).
-How is this disease affecting their everyday life?
-Assessment: Calcium and Vitamin D levels.
-Imaging: Dexa scan; Bone scan to (just look at the bones)
-Avoid alcohol and focus on nutrition (increase calcium and vitamin D levels please!).
-WEIGHT LIFTING HELPS -> builds muscle strength which helps support bones; Increase range of motion and strength.
-Fall risk.
-Can cause the hunchback effect.
Osteomyelitis
-Bone infection; Inflammation of the bone.
-Acute & Chronic
-Common causes: viruses and bacteria.
-#1 way to get it – infective pressure ulcers at the coccyx area.
-Very hard to treat, very bad bone pain.
-S/S: Fever, swelling, redness, ulcerations, constant bone pain.
-Treatment: IV antibiotics for up to 4-6 weeks if acute; Up to 3 months if it’s chronic; pain management, wound care (for ulcers).
-Surgical management – draining skin of necrotic tissue (debridement).
-Necrotic leg -> possible amputation if condition becomes severe or washout doesn’t work.
Kyphosis vs. Scoliosis
-Scoliosis: S-shaped back – lateral curvature of the spine.
-Kyphosis: Hunchback; Usually happens to the elderly – forward rounding of the upper back.
Osteoarthritis
-S/S: Joint pain, stiffness, joint deformity, inflammation
-Risk factors: Joint overuse, obesity, trauma, age.
-Chronic condition.
-Psychosocial: Depression, anxiety, decreased quality of life.
-Diagnostic: X-ray imaging, MRI, ESR (this will be elevated); crepitus!
-Interventions: NSAIDS, Tylenol (General pain management); Need a balance between rest and exercise; Internment heat & cold packs; promote mobility, proper posture/gait, supportive shoes, weight control by exercising, etc.
-Other risk factors: female, obesity, occupation, etc.
-Affects weight baring joints (MAINLY HANDS); #1 risk factor is aging.
-UNILATERAL! – only happens on one side!
Rheumatoid Arthritis
-Chronic, progressive, autoimmune, systemic, inflammatory disorder.
-This is a SYSTEMIC disorder.
-S/S: Weakness, stiff in the morning, weight loss, anorexia, fatigue, low grade fever.
-Could be depressed and have effect on daily living.
-Labs (there’s no definite test): Rheumatoid factor, Check ESR and ANA.
-Treat pain with NSAIDs, immunosuppressants (if needed), & DMARDs – used to treat inflammatory arthritis.
-Non-pharm interventions: varies & depends on the person –> possible: assistive devices, physical therapy, joint protection, acupuncture, heat/cold therapy, energy conservation, support groups.
-Promote mobility.
-Make sure these patients are getting enough calories.
-BILATERAL!- it’s a symmetrical issue, not one sided.
Gout
-Risk factors: Obesity, alcohol ingestion, starvation diet, cardiovascular disease.
-Males: higher risk factor for gout.
-Can affect all joints – affects mainly the BIG TOE and hands
-Caused by high levels of uric acid (liver, fish, kidney, muscles, goose, venison) – high purine diet.
-Labs: High levels of uric acid – indicator for gout.
-Synovial fluid builds up in the joints, also presence of uric acid there.
-Teach the patient about dangers of alcohol, purine diet, obesity (these are main risk factors).
-Deposits of crystals under the skin.
-Meds: Allopurinol (reduces levels of uric acid in the blood); Colchicine – helps prevent or treat gout flare, also NSAIDs.
Urinalysis
-Red or brown: blood in urine.
-Dark: concentrated.
-Odor: anything out of the ordinary (like an infection).
-Cloudy or foggy: Indicates infection or high level or protein in the urine.
-Normal pH: average is 4.6-8
-There should be no glucose. If there is – this indicates hyperglycemia.
This test evaluates the physical and chemical properties of urine.
Color and Odor: Cloudy or foul-smelling urine may indicate infection.
Specific Gravity: Reflects urine concentration. High values suggest dehydration, while low values may indicate overhydration or kidney dysfunction.
pH: Indicates urine acidity.
Presence of glucose, ketones, or protein: May suggest diabetes, starvation, or kidney disease.
Red and White Blood Cells (RBCs and WBCs): Presence of WBCs often indicates infection, while RBCs may signal trauma or glomerular damage.
Casts: Cylindrical structures that can indicate kidney disease.
Urine Collection Methods:
Voided specimen: Collected naturally into a cup.
Clean-catch: Collected midstream to avoid contamination.
Catheterized specimen: Obtained via catheter.
24-hour collection: Used to assess creatinine clearance and other long-term indicators.
Renal Biopsy
-Procedure involved in the removal of kidney tissue
-A diagnostic procedure
UTI Prevention
Infection of the urinary tract.
-Is diagnosed through urinalysis and cultures.
-Diagnosis: Ultrasounds first & CAT scan.
-Lab: Urinalysis, culture, clean-catch.
-Antibiotic treatment (needs to be specific to the problem.
-Increase fluids! (#1 thing to tell the patient) – no dehydration.
-Sitz baths.
-No surgery unless there is a urinary obstruction.
-Possible training schedule.
-Wiping front to back and keep genital area clean.
-Cranberry juice.
-Limit alcohol, caffeine, urinate after sexual intercourse.
-Catheter care under sterile conditions.
-Common features: urinary frequency, painful urination, incontinence, hematuria, suprapubic tenderness, urinary urgency.
UTI Older Adult Considerations
-Can cause confusion and delirium!!! -> specifically in older adults.
-When older adults come in delirium, check for UTI’s first!
Renal Calculi: Patient Education
Kidney stones.
-MANAGING PAIN is #1 priority!
-Med: Toradol (Strong NSAIDs!)
-As painful as giving birth!
-S/S: Flank and back pain (severe pain); Pale, NV, painful urination, and frequency
-Diagnostics: CT scan, WBC, Ultrasound
-Treatment: Shock wave therapy to break the stones
-Surgical: stents are only placed if there is an obstruction.
-Pt. education: hydration!!!
-If going home to pass the stone, give the patient a strainer (to strain stones out of their urine); easier to provide the pt. a urinal.
Urinary Incontinence-Types & Nursing Management
Stress incontinence:
-Leakage (lower abdomen pressure, coughing, sneezing).
-Kegels to improve pelvic strength.
-Stop smoking and reduce weight.
Urge incontinence:
-Overactive bladder
-Loss of control
-Pee schedule, check in on the pt
AKI-Assessment & Treatment
Is reversible!
-3 causes: pre-renal (heart), intrarenal (in kidney), post renal (bladder and ureter).
-Pre: shock, burns, sepsis, some meds, hypertension
-Intra: nephrotoxic drugs
-Post: tumors and sores on kidney
-General causes: sepsis, shock, burns, dehydration, some medications.
-S/S: NV, abdominal pain, oliguria, retention
-Lab: CR!!! And urinalysis, ultrasound, CT scan, BUN, culture
Interventions:
-Drug therapy: IV fluids; Diuretics (helps flush out the patient).
-Dextrose, insulin, and calcium to decrease potassium.
-Kayexalate/polystyrene sulfonate: helps with bowel movement and getting out K+ ) which helps reverse kidney injury.
-AKI can cause hypokalemia
CKD-Causes
Systemic issue
-Chronic disorder
-Causes: HTN, DM, Lupus
-Dialysis (3 days a week)
-Psychosocial – A lot for the pt. to go through; will spend a lot of time in the hospital.
-Lab: Urinalysis, BUN, Creatine.
-S/S: Edema, Dyspnea, Fatigue, Oliguria, Difficulty peeing
-Imaging: Ultrasound and CT scan, possible X-ray
Interventions:
-May need to restrict fluids to prevent overload (to prevent hypertension) – you need to balance the fluids in general.
-Make sure HTN is controlled; Improve cardiac function (check daily).
-Enhance nutrition: diabetics need insulin, sugar, protein.
-Dialysis 3 times a week for 4 hours.
-Preventing injury – prevent brittle bones – calcium supplements!
-Psychosocial issues!!! Be mindful of the psych implications
Kidney Transplant
-Complication, Rejection, Infection.
-Rejection: Signs of fever, pain, and decreased urine output.
-Infection: Due to immunosuppression (hand washing is important).
-Thrombosis/Ischemia: Can threaten graft viability.
-Definitive treatment for End Stage Renal Disease
-CBI, continuous bladder irrigation to break up clots!
-Wash your hands!!!
Hemodialysis Dialysis
-Blood filtered outside of the body into the machine.
-Done in the hospital/at home.
-Takes blood out, cleanses the machine, and it goes back inside.
-High flow rate!
-Fistula – surgical procedure.
-You need a fistula; takes time to heal; no blood draws/blood pressure; fistula takes time to heal. Either fistula or graft on the arm.
-Weighing before and after dialysis to confirm effectiveness.
-Complications: could develop a blood infection; thrombosis; internal bleeding.
-Monitor vital signs and blood pressure (before and after) as well.
-Lifelong treatment.
Peritoneal Dialysis
-Uses peritoneum to filter waste through the dialysate.
-A treatment for kidney failure that uses the lining of your abdomen, or belly, to filter your blood inside your body.
-Doctors will place a catheter inside your belly (soft tube) in your belly.
-Risks include peritonitis (abdominal pain rigid abdomen, cloudy outflow).
-Done at home, catheter, few times a day.
-Maintain strict aseptic technique.
TURP
-TURP – surgical procedure for BPH (enlarged prostate).
-Procedure to help with urine elimination.
CBI
-3 ports
-Post-op
-Light red to yellow
-Continuous bladder irrigation
-1 port saline, 2 bubble, 3 Just pee
Primary Lesions
Macules – flat, non-palpable discoloration (like freckles)
-Papules – raised/solid (warts) – raised areas of the skin w/o puss
-Nodules – like a skin tag; elevated lumps
-Plaques – like psoriasis
-Vesicles – chicken pox – fluid filled lumps
-Pustules – superficial lesions that are filled with puss (acne)
-Cysts – blisters (can happen when you get bug bites)
-Wheals - (hives)
Secondary Lesions
-Typically developed from primary lesions or consequence of the pt.’s actions.
-Ulcers, Fissures, Athletes foot, Scales, etc
Integumentary Assessment
Assessment Components:
History: Medical history, nutrition, genetic/family risk. Also, occupation, hobbies, time spent outdoors, nutrition, etc.
Inspection: Color, pigmentation, lesions, symmetry. Any rashes, wounds, or pigmentation?
Palpation: Moisture, temperature, turgor, texture. Any skin lesions, masses, lumps, etc.?
Smell: Infected wounds or necrosis.
What would you find abnormal when assessing hair/nails?
-Hair:
-nits (lice)
-dandruff, excess hair (hirsutism) – related to a hormonal issue
-are there any bald spots?
-Nails:
-cap refill
-color (white, yellow/brown, red, blue)
-shape (clubbing, spooning, pitting, etc.)
Skin Cancer
-Risk factors: fair skin, blue eyes, sunburn history, high UV exposure, outdoor jobs, personal/family history.
-Skin biopsy: testing a small piece of your skin and studying it in a lab.
ABCDE’s of Melanoma:
-Asymmetry, Border irregularity, Color variation, Diameter (6mm +), Evolution (changes in size and shape).
-Does color/border change over time???
Types (depends on ABCDE):
- Basal Cell Carcinoma
- Squamous Cell Carcinoma
3.Melanoma
Prevention & Teaching:
-Avoid direct sun! (10 AM – 4 PM)
-Use sunscreen, wear hats, long sleeves, sunglasses, avoid tanning beds, monthly self-skin checks with body map.
Interventions: Cryo surgery, chemo/radiation/immunotherapy
Older Adult Integumentary Assessment
-Delayed wound healing – the older you get.
-Epidermis becomes transparent and frail – more at risk for getting skin tears.
-Dermis – becomes dry, and there’s reduce sensory response – potential for injury.
-SubQ becomes thin – that’s why skin sag, loss of SubQ tissues puts them at risk for pressure injury.
-Color change, hair loss, thicker nails (high risk for fungal infections)
