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NURS 723 Med/Surg 1 > Final Exam Review New Material > Flashcards

Final Exam Review New Material Flashcards

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1
Q

What is one of the risk factors for osteoarthritis?

A

Obesity

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2
Q

What are the common manifestations of osteoarthritis?

A

Unilateral joint pain (before or after movement)

Pain less than 30 min in the AM

Pain improves with rest

Joint firm and tender on palpation

+Crepitus

+Joint effusions

Grating sensation/bone spurs

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3
Q

What are the pain control options for osteoarthritis?

A

Acetaminophen
Lidocaine 5% patches
NSAIDS
Hot/cold therapy

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4
Q

What is Rheumatoid Arthritis?

A

A chronic, progressive inflammatory autoimmune disease that damages synovial joints, articular cartilage, joint capsule, and affects surrounding ligaments/tendons

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5
Q

What are the Diagnostic tests for rheumatoid arthritis?

A

Rheumatoid factor
Antinuclear antibody test
Erythrocyte Sedimentation rate
C Reactive Protein
CBC for white count

RACCE

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6
Q

What will you see on an arthrocentesis if the patient has rheumatoid arthritis?

A

The synovial joint fluid will be cloudy if positive, it will be clear in a normal patient

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7
Q

What are the early joint manifestations of rheumatoid arthritis?

A

Morning stiffness for longer than an hour
Swelling with rest and movement
Joint will be spongy feeling

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8
Q

What are the systemic early manifestations of rheumatoid arthritis?

A

Low grade fever
Fatigue
Anorexia
Paresthesia (around joint)
Muscle atrophy

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9
Q

What are the advanced joint manifestations of rheumatoid arthritis?

A

Deformities (Swan neck, ulnar deviation, nodes)
Moderate to severe pain
Morning stiffness

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10
Q

What are the advanced systemic manifestations of rheumatoid arthritis?

A

Severe Fatigue
Anemia
Weight loss
Osteoporosis
SQ nodules
Peripheral neuropathy
Vasculitis
Pericarditis
Fibrotic lung disease
Renal Disease

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11
Q

What are the nutritional management strategies of rheumatoid arthritis?

A

Fish oil capsules for omega 3 FA
Gamma-linolenic acids for omega 6
Seeds and sunflower oils for omega 6

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12
Q

What are the medication mangagement for rheumatoid arthritis?

A

Methotrexate
Biological Response modifiers DMAR
Immunosuppressants
Corticosteroids
NSAIDS

My Dad Is Not Cool

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13
Q

What are the complications of rheumatoid arthritis?

A

Sjorgen’s Syndrome
Felty Syndrome
Caplan Syndrome
Secondary Osteoporosis
Vasculitis
Cervical Subluxation

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14
Q

What is Sjorgen’s Syndrome?

A

Secretory gland disfunction (dry mouth, dry eyes)

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15
Q

What is Felty syndrome?

A

Splenomegaly and neutropenia

Late Sign

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16
Q

What is caplan syndrome?

A

Inflammation and scarring of the lungs->RA nodules in the lungs

Late Sign

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17
Q

What is the difference in age onset for osteoarthritis and rheumatoid arthritis

A

Osteoarthritis: 60 years
Rheumatoid Arthritis: 35-45

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18
Q

What is the differences in the disease process for rheumatoid and osteoarthritis?

A

Osteoarthritis: Degenerative
Rheumatoid: Inflammation

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19
Q

What is the differences in the disease pattern for rheumatoid and osteoarthritis?

A

Osteoarthritis: Unilateral, single joint initially, affects weight bearing joints, hands and spine

Rheumatoid: Bilateral, symmetric involving multiple joints (soft/spongy), effects upper extremities first, systemic, + swan neck/ulnar deformity

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20
Q

What are heberden’s nodes?

A

Bony nodes at distal joint present in Osteoarthritis

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21
Q

What are Bouchard’s nodes?

A

Bony nodules at proximal interphalangeal joint present in osteoarthritis

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22
Q

What is systemic lupus erythmatosus?

A

A chronic autoimmune disease where the immune system triggers the destruction of healthy tissues (especially connective tissue)

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23
Q

What are the risk factors for system lupus erythmatosus

A

Female between 20-40 yrs
Triggers (Meds, toxins, bacteria..)

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24
Q

Which disease is known as the “Great Imitator”?

A

Systemic lupus erythmatosus

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25
What are the objective manifestation of systemic lupus erythmatosus?
Red, macular face rash ("butterfly rash") Discoid rash on the scalp/sun exposed areas Fever during exacerbation Lymphadenopathy Raynauld's Oral mucosal mouth sores
26
What are the nutritional considerations for Systemic Lupus Erythmatosus?
Small frequent meals with limited salt intake, nutritional supplements
27
Which medications are used in the treatment of Systemic Lupus Erythmatosus?
Topical Corticosteroids (for rash) Systemic immunosuppressants Immune modulators Corticosteroids NSAIDs Anti-Malarial
28
What are the complications of Systemic Lupus Erythmatosus?
Lupus nephritis->Glomerulonephritis Pericarditis Myocarditis
29
What are the different types of Anemia?
Iron deficiency B12 deficiency Folic Acid Deficiency Anemia of chronic disease Aplastic
30
What are the causes of iron deficiency anemia?
Acute: Blood loss Menorrhagia Surgery Trauma Chronic: Nutrition Pregnancy/Lactation Slow blood loss Celiac Disease
31
What are the SSAs for iron deficiency anemia?
Weakness Pallor Fatigue Reduced exercise Fissures on corner of mouth Nail changes (spooning/clubbing) Intolerance to cold Tachycardia
32
What are the lab values for Serum Ferritin?
<10ng/mL for diagnostic for iron deficiency anemia Normal are 13 to 300
33
What is the goal of treatment for iron deficiency anemia?
Fe stores to raise by 2mg/mL in 4 weeks
34
What medication is given for mild to moderate iron deficiency anemia?
FeSO4 mg qd BID
35
What medication is given for severe iron deficiency anemia?
Iron dextran by Z track
36
What are the SSAs for Vitamin B12 Deficiency Anemia?
Pallor Jaundice Glossitis Fatigue Weight loss Paresthesia of hands and feet Poor balance Decreased B12 serum levels Neurochanges Memory loss Loss of Appetite
37
What are the different lab values for B12 deficiency?
Insufficiency <200 Deficiency <300
38
What is the shilling test?
Measures the amount of radiactive B12 in urine after administration of oral dose
39
What are the causes of Folic Acid Deficiency Anemia?
Poor nutrition Malabsorption (Crohn's, EtOH misuse Medications (AEDs, OCPs, Metformin, H2 blockers, PPI, Methotrexate)
40
What are the SSAs for Folic Acid deficiency anemia?
No paresthesia Pallor Jaundice Glossitis Stomatitis Ulcerations Dysphagia Fatigue Weight Loss
41
What is Aplastic Anemia?
Deficiency of RBCs due to failure of bone marrow that affects 3 types of cells effected
42
What are the SSAs for aplastic anemia?
dyspnea Fever Pallor Ecchymosis Purpura Petechia Heavy menstrual bleeding Palpitations Bleeding easily Infections Systolic ejection murmur
43
How do you diagnose Aplastic anemia?
CBC to look for RBC, WBC, and Platelets Bone marrow aspirations
44
What are the interventions for Aplastic anemia?
Blood transfusion Stem Cell transplantation Bone Marrow stimulants Immunosuppression
45
What is Polycythemia Vera?
Excessive bone marrow production of erythrocytes, leukocytes, platelets that create hypervicosity
46
What occurs to hematocrit in polycythemia vera?
Hematocrit will increase due to increase of cells nut not increase of plasma
47
What are the SSAs for polycythemia vera?
Facial skin & mucous membranes dark purple or cyanotic Intense itching HTN Tinnitus Headache Visual Disturbances Dyspnea Heart Failure
48
What are the diagnostics for polycythemia vera?
Increased Hgb (>18g/dL) Hct (>55)
49
What are the possible complications from polycythemia vera?
Thrombosis from vascular statis Necrosis Poor Gas exchange Coagulapathies Fatal if untreated
50
What are the interventions for polycythemia vera?
Hydration Anticoags Plasmaphereisis Radiation Antiplatelets Exercise slowly Report chest pain Monitor for infection TED stockings
51
What are the labs and diagnostics for sickle cell disease?
Hbs% Decrease in hematocrit during crisis Increased reticulocyte count Normal iron levels Increased WBC due to inflammation
52
What are the medications for sickle cell?
IV opioids PCA with morphine Hydromorphone (Dilaudid)
53
What are PRBCs?
Packed red blood cells that are used to replace RBCs from trauma, surgery, bleeding or anemia in 1-2 hours with a max of 4 hours
54
What are platelets given for?
Thrombocytopenia Active bleeding Invasive procedures 1 hr with max of 4 hours
55
What is FFP?
Fresh Frozen Plasma Replaces clotting factors in hemorrhages, DIC, coagulapathies, prolonged bleeding time, mass transfusion 30 to 2 hours/Max 4 hours
56
Patients that cannot tolerate excessive FFP/fluid can be given?
Cryoprecipitate and plasma protein products
57
What should the RN be examining before a blood transfusion?
Blood Bag label Attached tag Requisition slip ABO and Rh compatability Unit # Expiration date
58
What kind of line should be used for blood products?
Y blood tubing with a dedicated line (no other meds or fluids) with normal saline only
59
What are the times to assess a patient during a transfusion?
Q15 minutes x2 (x4 for peds) Q30 minutes x2 Q1 hr for duration of infusion
60
What are the signs of a transfusion reaction?
Chills/shivering Fever (>1degree increase) Diaphoresis Restlessness Tachycardia/tachypnea Hypotension Rash Flushing Flank/low back pain Shortness of breath Wheezing Blood in urine N/V Sense of impending doom
61
What are the symptoms of neutropenia?
Fever >100 Cough Gingival pain/edema Sore throat Chills Diaphoresis Frequent/painful urination fatigue recurrent infections esp of mucous membranes and skin
62
What are the two diagnostic values of neutropenia?
Absolute neutrophil count of under 1,500 SEVERE neutropenia is absolute neutrophil count of <500
63
What are the lab values for agranulocytosis?
ANC<100-200
64
What are the SSAs for thrombocytopenia?
Purpura Petchiae Ecchymosis Difficulty controlling bleeding Fecal occult blood Hematuria Epistaxis Bleeding gums Mucousal bleeding
65
What are the diagnostic lab values for thrombocytopenia?
Platelets <50,000 Severe risk <10,000
66
What constitutes and AIDS diagnosis?
CD4 count of under 200
67
What are the CD4 counts to look for in regards to HIV?
Normal: 800-1000 Symptoms begin: 500 AIDS diagnosis: <200
68
What are the two most common antiretroviral therapies used in the treatment of HIV?
NRTI (Nucleoside/tide reverse transcriptase inhibitors) INSTI (integrase inhibitors)
69
What is the monitoring during ATY HIV treatment?
VL and CMP 4-5 weeks after ART initiation CD4 and VL every 3-5 months once undetectable
70
What drugs are used to prophylactically treat Pneumocystis Jiroveci when the CD4 count is under 200?
Bactrum Dapsone
71
What drugs are used to prophylactically treat Mycobacterium avium complex when the CD4 cound is under 100?
Azithromycin Clarithromycin
72
What are the two PrEP drugs?
Truvada (emtricitabine + TDF) Descovy (emtricitabine + TAF)
73
What is the most common drug used for PEP?
Biktarvy

NURS 723 Med/Surg 1 (6 decks)

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