T3 New Flashcards

Question

``` BS normal lab values Lab values Fasting levels- ? Oral glucose tolerance test- A1C- 4-6 Less than 5.7 A1C = 5.7-6.4= 6.5 or over = ```

Answer 1

``` Lab values Fasting levels- less than 100 Oral glucose tolerance test- BS every 30 min for 2 hours after fasting for 10-12 hrs. less than 140 A1C- BEST indicator of blood glucose over 3-4 months 4-6 is usually normal range Less than 5.7 A1C = no diabetes 5.7-6.4= prediabetes 6.5 or over = diabetes ```

Answer 2

Fasting blood glucose greater than or equal to 126 mg/dL (7.0 mmol/L). Fasting is defined as no caloric intake for at least 8 hours. Or Two-hour blood glucose equal to or greater than 200 mg/dL (11.1 mmol/L) during oral glucose tolerance test. The test should be performed using a glucose load containing the equivalent of 75 g anhydrous glucose dissolved in water. Or In a patient with classic manifestations of hyperglycemia or hyperglycemic crisis, a random blood glucose concentration greater than 200 mg/dL (11.1 mmol/L). Casual is defined as any time of the day without regard to time since last meal. The classic symptoms of diabetes include polyuria, polydipsia, and unexplained weight loss. NOTE: In the absence of unequivocal hyperglycemia, the first three criteria should be confirmed by repeat testing.

Answer 3

hemoglobin A1C

Answer 4

Ketone assessment

Answer 5

100 to 250 mg/dL (5.6 to 13.8 mmol/L) and no ketones are present in the urine.

Answer 6

elevation in blood ketone concentration (measured as serum β-hydroxybutyrate). Accumulation of ketoacids results in an increased anion gap metabolic acidosis. A normal anion gap is between 7 and 9 mEq/L (mmol/L); an anion gap greater than 10 to 12 mEq/L (mmol/L) indicates metabolic acidosis.

Answer 7

Mild-to-moderate hyperkalemia is common in patients with hyperglycemia. Insulin therapy, correction of acidosis, and volume expansion decrease serum potassium concentration. To prevent hypokalemia, potassium replacement is initiated after serum levels fall below normal (5.0 mEq/L [mmol/L]). Assess for signs of hypokalemia, including fatigue, malaise, confusion, muscle weakness, shallow respirations, abdominal distention or paralytic ileus, hypotension, and weak pulse. An ECG shows conduction changes related to alterations in potassium. Hypokalemia is a common cause of death in the treatment of DKA.

Answer 8

that the urine output is at least 30 mL/hr.

Answer 9

300 mg/dL 250

Answer 10

* Classic symptoms of DKA include polyuria, polydipsia, polyphagia, a rotting citrus fruit odor to the breath, vomiting, abdominal pain, dehydration, weakness, confusion, shock, and coma. * Mental status can vary from total alertness to profound coma. * As ketone levels rise, the pH of the blood decreases, and acidosis occurs. * Kussmaul respirations (very deep and rapid respirations) cause: respiratory alkalosis in an attempt to correct metabolic acidosis by exhaling carbon dioxide * low sodium * Initial potassium levels depend on how long DKA lasts before treatment. • After therapy starts, serum potassium levels drop quickly.

Answer 11

* First assess the airway, level of consciousness, hydration status, electrolytes, and blood glucose level of any patient with diabetic ketoacidosis. * Use blood glucose values to assess therapy effectiveness and determine when to switch from saline to dextrose-containing solutions in a patient with diabetic ketoacidosis.

Answer 12

• BS usually around 300-600 with ketones present

Answer 13

 Pathophysiology affects people with diabetes. It occurs when the body starts breaking down fat at a rate that is much too fast. The liver processes the fat into a fuel called ketones, which causes the blood to become acidic. Insulin deficiency, increased insulin counter-regulatory hormones (cortisol, glucagon, growth hormone, and catecholamines) and peripheral insulin resistance lead to hyperglycemia, dehydration, ketosis, and electrolyte imbalance which underlie the pathophysiology of DKA

Answer 14

 Treatment Planning: Expected Outcomes. The patient is expected to have few episodes of hyperglycemia and avoid diabetic ketoacidosis. Indicators include that the patient consistently demonstrates these behaviors: * Maintains blood glucose levels within the prescribed target range * Adjusts insulin doses to match eating patterns and blood glucose levels during illness * Maintains easily digestible liquid diet containing carbohydrate and salt when nauseated * Describes correct procedure for urine ketone testing Describes when to seek help from health care professional * Fluid replacement/ Electrolyte replacement. * You'll receive fluids — either by mouth or through a vein (intravenously) — until you're rehydrated. Give pt. 5% dextrose in 0.45% saline- This solution helps prevent hypoglycemia and cerebral edema, which can occur when serum osmolarity declines too rapidly. Insulin therapy. regular insulin by continuous IV infusion is the usual management., – insulin to correct acidosis/hyperkalemia

Answer 15

HHS occurs most often in older/dehydrated patients with type 2 DM, many of whom are unaware they have the disease Mortality rates in older patients are high. The onset of HHS is slow and may not be recognized. The older patient often seeks medical attention later and is sicker than the younger patient. HHS does not occur in well-hydrated patients. Older patients are at greater risk for dehydration and HHS because of age-related changes in thirst perception, poor urine-concentrating abilities, and use of diuretics. Assess all older adults for dehydration, regardless of whether they are known to have DM.

Answer 16

Both HHS and diabetic ketoacidosis (DKA) are caused by hyperglycemia and dehydration. HHS differs from DKA in that: ketone levels are absent or low and blood glucose levels are much higher. Blood glucose levels may exceed 600 mg/dL and blood osmolarity may exceed 320 mOsm/ L. Table 64-13 lists the differences between DKA and HHS.

Answer 17

When you notice changes in the level of consciousness; changes in pupil size, shape, or reaction; or seizures, respond by immediately notifying the primary health care provider. Continually assess fluid status and level of consciousness in a patient with hyperglycemic-hyperosmolar state (HHS) during the resuscitation period. • Immediately report indications of cerebral edema (abrupt changes in mental status; changes in level of consciousness; changes in pupil size, shape, or reaction; seizures) in a patient with HHS to the primary health care provider.

Answer 18

The first priority for fluid replacement in HHS is to increase blood volume. In shock or severe hypotension, normal saline is used. Otherwise half-normal saline is used. Infuse fluids at 1 L/hr until central venous pressure or pulmonary capillary wedge pressure begins to rise or until.. blood pressure and urine output are adequate. The rate is then reduced to 100 to 200 mL/hr. Half of the estimated fluid deficit is replaced in the first 12 hours, and the rest is given over the next 36 hours. Body weight, urine output, kidney function, and the presence or absence of pulmonary congestion and jugular venous distention determine the rate of fluid infusion. In patients with heart failure, kidney disease, or acute kidney injury, monitor central venous pressure. Assess the patient hourly for signs of cerebral edema, abrupt changes in mental status, abnormal neurologic signs, and coma. Lack of improvement in level of consciousness may indicate inadequate rates of fluid replacement or reduction in plasma osmolarity. Regression after initial improvement may indicate a too-rapid reduction in plasma osmolarity. A slow but steady improvement in CNS function is the best evidence that fluid management is satisfactory.

Answer 19

o Insulin pumps | Continuous subcutaneous infusion of a basal dose of insulin (CSII)

Answer 20

Do not mix any other insulin type with long acting- insulin glargine, insulin detemir, or any of the premixed insulin formulations such as Humalog Mix 75/25. Rotate injection sites to prevent lipohypertrophy/scaring tissue Inject 2 inches from belly button at 45-90-degree angle Not rub site or put heat to site Draw up clear (shorter acting) before cloudy (long acting) insulin first: cloudy air first then clear air, clear insulin, then cloudy insulin Monitor for s/s of hypoglycemia (confusion, diaphoresis, headache, shakiness, blurred vision, and decreased coordination) Roll don’t shake vial Refrigerate until open- date for 28 days except toujeo

Answer 21

* Wash your hands. * Inspect the bottle for the type of insulin and the expiration date. * Gently roll the bottle of intermediate-acting insulin in the palms of your hands to mix the insulin. * Clean the rubber stopper with an alcohol swab. * Remove the needle cover and pull back the plunger to draw air into the syringe. The amount of air should be equal to the insulin dose. Push the needle through the rubber stopper and inject the air into the insulin bottle. * Turn the bottle upside down and draw the insulin dose into the syringe. * Remove air bubbles in the syringe by tapping on the syringe or injecting air back into the bottle. Redraw the correct amount. * Make certain the tip of the plunger is on the line for your dose of insulin. Magnifiers are available to assist in measuring accurate doses of insulin. * Remove the needle from the bottle. Recap the needle if the insulin is not to be given immediately. * Select a site within your injection area that has not been used in the past month. * Clean your skin with an alcohol swab. Lightly grasp an area of skin and insert the needle at a 90-degree angle. * Push the plunger all the way down. This will push the insulin into your body. Release the pinched skin. * Pull the needle straight out quickly. Do not rub the place where you gave the shot. * Dispose of the syringe and needle without recapping in a puncture-proof container. With a Pen Device * Wash your hands. * Check the drug label to be sure it is what was prescribed. * Remove the cap. * Look at the insulin to be sure it is evenly mixed if it contains NPH and that there is no clumping of particles. * Wipe the tip of the pen where the needle will attach with an alcohol swab. * Remove the protective pull tab from the needle and screw it onto the pen until snug. • Remove both the plastic outer cap and inner needle cap. * Look at the dose window and turn the dosage knob to the appropriate dose. * Holding the pen with the needle pointing upward, press the button until at least a drop of insulin appears. This is the “cold shot,” “air shot,” or “safety shot.” Repeat this step if needed until a drop appears. * Dial the number of units needed. * Hold the pen perpendicular to and against the intended injection site with the thumb on the dosing knob. * Press the dosing knob slowly all the way to dispense the dose. * Hold the pen in place for 6-10 seconds; then withdraw from the skin. * Replace the outer needle cap; unscrew until the needle is removed and dispose of the needle in a hard plastic or metal container. * Replace the cap on the insulin pen.

Answer 22

is related to the skill of the user and not to errors of the instrument. Common errors involve failure to obtain a sufficient blood drop, poor storage of test strips, using expired strips, and not changing the code number on the meter to match the strip bottle code. Help the patient select a meter based on cost of the meter and strips, ease of use, and availability of repair and servicing. Provide training, explain and demonstrate procedures, assess visual acuity, and check the patient's ability to perform the procedure using “teach-back” strategies. Glucose meters are designed to reduce user error as much as possible.

Answer 23

Patient education Teach patients who experience Somogyi phenomenon (early morning hyperglycemia) to ensure an adequate dietary intake at bedtime Teach patients with peripheral neuropathy to use a bath thermometer to test water for bathing, to avoid walking barefoot, and to inspect their feet daily. control over blood glucose levels reduces the risk for the vascular complications of diabetes. Teach patients to rotate insulin injection sites within one area rather than to other areas, to prevent changes in absorption. Teach patients who exercise to test urine for ketone bodies if blood glucose levels are greater than 250 mg/dL before engaging in strenuous exercise. Instruct all patients with diabetes to avoid becoming dehydrated and to drink at least 2 L of water each day unless another medical condition requires fluid restriction. Refer patients newly diagnosed with diabetes to local resources and support groups. • Remind patients with diabetes to have yearly eye examinations by an ophthalmologist. Urge patients newly diagnosed with DM to attend diabetes education classes to become a fully engaged partner in management of the disease. Help patients who have pain from peripheral neuropathy determine which pain-relieving drugs and techniques work best for them Instruct patients who are taking sulfonylurea drugs about an increased risk for hypoglycemic reactions. • Teach patients who are taking metformin the symptoms of lactic acidosis (fatigue, dizziness, difficulty breathing, stomach discomfort, irregular heartbeat). Start carbohydrate replacement per the primary health care provider's prescription or standing protocols immediately on identifying a patient with hypoglycemia. • Give glucagon subcutaneously or IM and 50% dextrose IV to patients identified with hypoglycemia who cannot swallow

Answer 24

Before self-management begins to home, the patient with diabetes or the significant other should be able to: • Tell why insulin or a noninsulin antidiabetic drug is being prescribed • Name which insulin or noninsulin antidiabetic drug is being prescribed, and name the dosage and frequency of administration • Discuss the relationship between mealtime and the action of insulin or the other antidiabetic agent • Discuss plans to follow diabetic diet instructions • Prepare and administer insulin accurately • Test blood for glucose or state plans for having blood glucose levels monitored • Test urine for ketones and state when this test should be done • Describe how to store insulin • List symptoms that indicate a hypoglycemic reaction • Tell which carbohydrate sources are used to treat hypoglycemic reactions • Tell which symptoms indicate hyperglycemia • Tell which dietary changes are needed during illness • State when to call the primary health care provider or the nurse (frequent episodes of hypoglycemia, symptoms of hyperglycemia) • Describe the procedures for proper foot care

Answer 25

Teach the patient about the relationship between regularly scheduled exercise and blood glucose levels, blood lipid levels, and complications of diabetes. * Reinforce the level of exercise recommended for the patient based on his or her physical health. * Instruct the patient to wear appropriate footwear designed for exercise. * Remind the patient to examine his or her feet daily and after exercising. * Remind the patient to stay hydrated and not to exercise in extreme heat or cold. * Warn the patient not to exercise within 1 hour of insulin injection or near the time of peak insulin action. * Teach patients how to prevent hypoglycemia during exercise: * Do not exercise unless blood glucose level is at least 80 and less than 250 mg/dL. * Have a carbohydrate snack before exercising if 1 hour has passed since the last meal or if the planned exercise is high intensity. * Carry a simple sugar to eat during exercise if symptoms of hypoglycemia occur. * Ensure that identification information about diabetes is carried during exercise. • Remind the patient to check blood glucose levels more frequently on days in which exercise is performed and that extra carbohydrate and less insulin may be needed during the 24-hour period after extensive exercise.

Answer 26

perform vigorous exercise only when blood glucose levels are 100 to 250 mg/dL and no ketones are present in the urine. -Because of the potential for alcohol-induced delayed hypoglycemia, instruct the patient with DM to ingest alcohol only with or shortly after meals.

Answer 27

* Achieving and maintaining blood glucose levels in the normal range or as close to normal as is safely possible * Achieving and maintaining a blood lipid profile that reduces the risk for vascular disease * Achieving blood pressure levels in the normal range or as close to normal as is safely possible * Preventing or slowing the rate of development of the chronic complications of diabetes by modifying nutrient intake and lifestyle * Addressing patient NUTRITION needs, taking into account personal and cultural preferences and willingness to change * Maintaining the pleasure of eating by limiting food choices only when indicated by scientific evidence * Meeting the NUTRITION needs of unique times of the life cycle, particularly for pregnant and lactating women and for older adults with diabetes * Providing self-management training for patients treated with insulin or insulin stimulators (secretagogues) for exercising safely, including the prevention and treatment of hypoglycemia and managing diabetes during acute illness

Answer 28

Test at alternative sites.

Answer 29

``` Symptoms of hypoglycemia/hyperglycemia • Hypoglycemic unawareness • Periods of illness • Before and after exercise • Gastroparesis • Adjustment of antidiabetes drugs • Evaluation of other drug therapies (e.g., steroids) • Preconception planning • Pregnancy ```

Answer 30

Teach patients to refrigerate insulin that is not in use to maintain potency, prevent exposure to sunlight, and inhibit bacterial growth. Insulin in use may be kept at room temperature for up to 28 days to reduce injection site irritation from cold insulin. To prevent loss of drug potency, teach the patient to avoid exposing insulin to temperatures below 36° F (2.2° C) or above 86 F° (30° C), avoid excessive shaking, and to protect insulin from direct heat and light. Insulin should not be allowed to freeze. Insulin glargine (Lantus) should be stored in a refrigerator (36° to 46° F [2.2° to 7.8° C]) even when in use. Teach patients to discard any unused insulin after 28 days. Teach patients to always have a spare supply of each type of insulin used. A slight loss in potency may occur for bottles in use for more than 30 days, even when the expiration date has not passed. Prefilled syringes are stable up to 30 days when refrigerated. Store prefilled syringes in the upright position, with the needle pointing upward or flat, so insulin particles do not clog it. Teach patients to roll prefilled syringes between the hands before using. Proper dose preparation is critical for insulin effectiveness and patient safety. Teach patients that the person giving the insulin needs to inspect the vial before each use for changes (e.g., clumping, frosting, precipitation, or change in clarity or color) that may indicate loss in potency. Preparations containing NPH insulin are uniformly cloudy after gently rolling the vial between the hands. Other insulins should be clear when inspected in good lighting. If potency is questionable, another vial or pen of the same insulin type should be used. Syringes may be used to administer insulin. The standard insulin syringes are marked in insulin units. They are available in 1-mL (100-U)

Answer 31

Education on insulin: Before self-management begins to home, the patient with diabetes or the significant other should be able to: • Tell why insulin or a noninsulin antidiabetic drug is being prescribed • Name which insulin or noninsulin antidiabetic drug is being prescribed, and name the dosage and frequency of administration • Discuss the relationship between mealtime and the action of insulin or the other antidiabetic agent • Discuss plans to follow diabetic diet instructions • Prepare and administer insulin accurately • Test blood for glucose or state plans for having blood glucose levels monitored • Test urine for ketones and state when this test should be done • Describe how to store insulin • List symptoms that indicate a hypoglycemic reaction • Tell which carbohydrate sources are used to treat hypoglycemic reactions • Tell which symptoms indicate hyperglycemia • Tell which dietary changes are needed during illness • State when to call the primary health care provider or the nurse (frequent episodes of hypoglycemia, symptoms of hyperglycemia) • Describe the procedures for proper foot care

Answer 32

* Notify your primary health care provider that you are ill. * Monitor your blood glucose at least every 4 hours. * Test your urine for ketones when your blood glucose level is greater than 240 mg/dL (13.8 mmol/L). * Continue to take insulin or other antidiabetic agents. * To prevent dehydration, drink 8 to 12 ounces (240 to 360 mL) of sugar-free liquids every hour that you are awake. If your blood glucose level is below your target range, drink fluids that contain sugar. * Continue to eat meals at regular times. * If unable to tolerate solid food because of nausea, consume more easily tolerated foods or liquids equal to the carbohydrate content of your usual meal. * Call your primary health care provider for any of these danger signals: * Persistent nausea and vomiting * Moderate or large ketones * Blood glucose elevation after two supplemental doses of insulin * High (101.5° F [38.6° C]) temperature or increasing fever; fever for more than 24 hours * Treat symptoms (e.g., diarrhea, nausea, vomiting, fever) as directed by your primary health care provider. * Get plenty of rest.

Answer 33

* Notify your primary health care provider that you are ill. * Monitor your blood glucose at least every 4 hours. * Test your urine for ketones when your blood glucose level is greater than 240 mg/dL (13.8 mmol/L). * Continue to take insulin or other antidiabetic agents. * To prevent dehydration, drink 8 to 12 ounces (240 to 360 mL) of sugar-free liquids every hour that you are awake. If your blood glucose level is below your target range, drink fluids that contain sugar. * Continue to eat meals at regular times. * If unable to tolerate solid food because of nausea, consume more easily tolerated foods or liquids equal to the carbohydrate content of your usual meal. * Call your primary health care provider for any of these danger signals: * Persistent nausea and vomiting * Moderate or large ketones * Blood glucose elevation after two supplemental doses of insulin * High (101.5° F [38.6° C]) temperature or increasing fever; fever for more than 24 hours * Treat symptoms (e.g., diarrhea, nausea, vomiting, fever) as directed by your primary health care provider. * Get plenty of rest.

Answer 34

Increase in IOP due to issue with optic nerve-leading cause of blindness. the level of intraocular pressure is related to retinal ganglion cell death. Intraocular pressure can cause mechanical stress and strain on the posterior structures of the eye, notably the lamina cribrosa and adjacent tissues Glaucoma is a group of eye disorders resulting in increased intraocular pressure (IOP). As described in Chapter 46, the eye is a hollow organ. For proper eye function, the gel in the posterior segment (vitreous humor) and the fluid in the anterior segment (aqueous humor) must be present in set amounts that apply pressure inside the eye to keep it ball shaped. Usually about 1 mL of aqueous humor is always present, but it is continuously made and reabsorbed at a rate of about 5 mL daily A normal IOP requires a balance between production and outflow of aqueous humor If the IOP becomes too high, the extra pressure compresses retinal blood vessels and photoreceptors and their synapsing nerve fibers. This compression results in poorly oxygenated photoreceptors and nerve fibers. These sensitive nerve tissues become ischemic and die. When too many have died, vision is lost permanently. Tissue damage starts in the periphery and moves inward toward the fovea centralis. Untreated, glaucoma can lead to complete loss of visual SENSORY PERCEPTION. Glaucoma is usually painless, and the patient may be unaware of gradual vision reduction. In some cases of diabetic retinopathy, blood vessels on the retina are damaged

Answer 35

Open angle is most common- aqueous humor outflow is decreased which results in increased in IOP and loss of peripheral vision Closed angle: less common angle between iris and sclera closes completely- increase in IOP Normal IOP range: 10-21 mmHg- Measure using tonometry. Measure drainage angle with gonioscopy.

Answer 36

``` Aging • Heredity Associated Glaucoma • Diabetes mellitus • Hypertension • Severe myopia • Retinal detachment ```

Answer 37

``` • Uveitis • Iritis • Neovascular disorders • Trauma • Ocular tumors • Degenerative disease • Eye surgery • Central retinal vein occlusion Risk is higher in African Americans over 40 and Hispanics or anyone over 60 years old. ```

Answer 38

Teach the patient that loss of visual SENSORY PERCEPTION from glaucoma can be prevented by early detection, lifelong treatment, and close monitoring. Use of ophthalmic drugs that reduce ocular pressure can delay or prevent damage. Chart 47-3 lists ways to help the older-adult patient with reduced visual SENSORY PERCEPTION to remain as independent as possible, Chart 47-4 provides a list of interventions to care for any patient who has reduced vision. These interventions can be very helpful when you care for hospitalized patients who have other disorders, yet also have sight problems.

Answer 39

* Having a neighbor, relative, friend, or visiting nurse visit once a week to measure the proper drugs for each day may be helpful. * If the patient is to take drugs more than once each day, it is helpful to use a container of a different shape (with a lid) each time. For example, if the patient is to take drugs at 9 AM, 1 PM, and 9 PM, the 9 AM drugs would be placed in a round container, the 1 PM drugs in a square container, and the 9 PM drugs in a triangular container. * It is helpful to place each day's drug containers in a separate box with raised letters on the side of the box spelling out the day. * “Talking clocks” are available for the patient with low vision. • Some drug boxes have alarms that can be set for different times. Communication • Telephones with large, raised block numbers may be helpful. The best models are those with black numbers on a white phone or white numbers on a black phone. • Telephones that have a programmable automatic dialing feature (“speed dial”) are very helpful. Programmed numbers should include those for the fire department, police, relatives, friends, neighbors, and 911. Safety • It is best to leave furniture the way the patient wants it and not move it. • Throw rugs are best eliminated. • Appliance cords should be short and kept out of walkways. • Lounge-style chairs with built-in footrests are preferable to footstools. • Nonbreakable dishes, cups, and glasses are preferable to breakable ones. • Cleansers and other toxic agents should be labeled with large, raised letters. • Hook-and-loop (Velcro) strips at hand level may help mark the locations of switches and electrical outlets. Food Preparation • Meals on Wheels is a service that many older adults find helpful. This service brings meals at mealtime, cooked and ready to eat. The cost of this service varies, depending on the patient's ability to pay. • Many grocery stores offer a “shop by telephone” service. The patient can either complete a computer booklet indicating types, amounts, and brands of items desired; or the store will complete this booklet over the telephone by asking the patient specific information. The store then delivers groceries to the patient's door (many stores also offer a “put-away” service) and charges the patient's bank card. * A microwave oven is a safer means of cooking than a standard stove, although many older patients are afraid of microwave ovens. If the patient has and will use a microwave oven, others can prepare meals ahead of time, label them, and freeze them for later use. Also, many microwavable complete frozen dinners that comply with a variety of dietary restrictions are available. * Friends or relatives may be able to help with food preparation. Often relatives do not know what to give an older person for birthdays or other gift-giving occasions. One suggestion is a homemade prepackaged frozen dinner that the patient enjoys. Personal Care * Handgrips should be installed in bathrooms. * The tub floor should have a nonskid surface. * Male patients should use an electric shaver rather than a razor. * Choosing a hairstyle that is becoming but easy to care for (avoiding parts) helps in independent living. * Home hair-care services may be available. Diversional Activity * Some patients can read large-print books, newspapers, and magazines (available through local libraries and vision services). * Books, magazines, and some newspapers are available on audiotapes or discs. * Patients experienced in knitting or crocheting may be able to create items fashioned from straight pieces such as afghans. * Card games, dominoes, and some board games that are available in large, high-contrast print may be helpful for patients with low vision.

Answer 40

* Always knock or announce your entrance into the patient's room or area and introduce yourself. * Ensure that all members of the health care team also use this courtesy of announcement and introduction. * Ensure that the patient's reduced vision is noted in the medical record, is communicated to all staff, is marked on the call board, and is identified on the door of the patient's room. * Determine to what degree the patient can see anything. * Orient the patient to the environment, counting steps with him or her to the bathroom. * Help the patient place objects on the bedside table or in the bed and around the bed and room and do not move them without the patient's permission. * Remove all objects and clutter between the patient's bed and the bathroom. * Ask the patient what type of assistance he or she prefers for grooming, toileting, eating, and ambulating and communicate these preferences with the staff. * Describe food placement on a plate in terms of a clock face. * Open milk cartons; open salt, pepper, and condiment packages; and remove lids from cups and bowls. * Unless the patient also has a hearing problem, use a normal tone of voice when speaking. * When walking with the patient, offer him or her your arm and walk a step ahead.

Answer 41

to reduce IOP in several ways. Eyedrop drugs can reduce the production of or increase the absorption of aqueous humor or constrict the pupil so the ciliary muscle is contracted, allowing better circulation of the aqueous humor to the site of absorption. These drugs do not improve lost vision but prevent more damage by decreasing IOP. The prostaglandin agonist drugs reduce IOP by dilating blood vessels in the trabecular mesh, which then collects and drains aqueous humor at a faster rate. The adrenergic agonists and beta-adrenergic blockers reduce IOP by limiting the production of aqueous humor and by dilating the pupil, which improves the flow of the fluid to its absorption site. Cholinergic agonists reduce IOP by limiting the production of aqueous humor and making more room between the iris and the lens, which improves fluid outflow. Carbonic anhydrase inhibitors directly and strongly inhibit production of aqueous humor. They do not affect the flow or absorption of the fluid. Most eyedrops cause tearing, mild burning, blurred vision, and a reddened sclera for a few minutes after instilling the drug. Specific nursing implications related to drug therapy for glaucoma are listed in Chart 47-5. It is important to teach the patient about potential interactions that may exist between medications and systemic effects that may occur when using these drugs.

Answer 42

Priority: Teach the patient that the benefit of drug therapy occurs only when the drugs are used on the prescribed schedule, usually every 12 hours. Teach patients the importance of instilling the drops on time and not skipping doses. When more than one drug is prescribed, teach the patient to wait 5 to 10 minutes between drug instillations to prevent one drug from “washing out” or diluting another drug. Stress the need for good handwashing, keeping the eyedrop container tip clean, and avoiding touching the tip to any part of the eye. Also teach the technique of punctal occlusion (placing pressure on the corner of the eye near the nose) immediately after eyedrop instillation to prevent systemic absorption of the drug (puncta). Most eyedrops used for glaucoma therapy can be absorbed systemically and cause systemic problems. It is critical to teach punctal occlusion to patients using eyedrops for glaucoma therapy.

Answer 43

Meds: Pilocarpine: (constricts the pupil) Beta blockers: timolol (reduces aqueous humor production) Mannitol- osmotic diuretic for closed angle glaucoma; quickly reduces IOP. Surgery Surgery is used when drugs for open-angle glaucoma are not effective at controlling IOP. Two common procedures are laser trabeculoplasty and trabeculectomy. A laser trabeculoplasty burns the trabecular meshwork, scarring it and causing the meshwork fibers to tighten. Tight fibers increase the size of the spaces between the fibers, improving outflow of aqueous humor and reducing IOP. Trabeculectomy is a surgical procedure that creates a new channel for fluid outflow. Both are ambulatory surgery procedures. If glaucoma fails to respond to common approaches, an implanted shunt procedure may be used. A small tube or filament is connected to a flat plate that is positioned on the outside of the eye in the eye orbit. (The plate is not visible on the front part of the eye.) The open part of the fine tube is placed into the front chamber of the eye. The fluid then drains through or around the tube into the area around the flat plate, where it collects and is reabsorbed into the bloodstream. Potential complications of glaucoma surgery include choroidal hemorrhage and choroidal detachment. Post- op teaching are the same as cataract surgery: avoid activities that increase IOP

Answer 44

Open- mild eye pain, loss of peripheral vision Closed angle s/s- Severe pain, nausea General- Foggy vision and headaches

Answer 45

Opacity in lens of an eye, impairing vision A cataract is a lens opacity that distorts the image With aging, the lens gradually loses water and increases in density Lens density increases with drying and compression of older lens fibers and production of new fibers and lens crystals. With time, as lens density increases and transparency is lost, visual SENSORY PERCEPTION is greatly reduced. Both eyes may have cataracts, but the rate of progression in each eye is different

Answer 46

``` Causes: Age-Related Cataracts • Lens water loss and fiber compaction Traumatic Cataracts • Blunt injury to eye or head • Penetrating eye injury • Intraocular foreign bodies • Radiation exposure, therapy Toxic Cataracts • Corticosteroids • Phenothiazine derivatives • Miotic agents ``` ``` Associated Cataracts • Diabetes mellitus • Hypoparathyroidism • Down syndrome • Chronic sunlight exposure Complicated Cataracts • Retinitis pigmentosa • Glaucoma • Retinal detachment ```

Answer 47

o Prevention 1. have regular eye examinations. Eye examinations can help detect cataracts and other eye problems at their earliest stages. ... 2. Quit smoking. ... 3. Manage other health problems. ... 4. Choose a healthy diet that includes plenty of fruits and vegetables- vit A,C,E, and omega 3-fatty acids 5. Wear sunglasses. ... 6. Reduce alcohol use Best vision occurs 4-6 weeks after surgery.

Answer 48

* Bending from the waist * Lifting objects weighing more than 10 lbs * Sneezing, coughing * Blowing the nose * Straining to have a bowel movement * Vomiting • Having sexual intercourse * Keeping the head in a dependent position * Wearing tight shirt collars

Answer 49

Post-surgery teachings: wear sunglasses, avoid increasing IOP (don’t bend over at waist, avoid sneezing/coughing/straining, avoid hyperflexion of head and restrictive clothing, avoid tilting head back to wash hair, limit housework and rapid/jerky movements)

Answer 50

``` Decreased visual acuity, progressive/painless loss ofvision, diplopia (double vision), halo around lights, photosensitivity, absent red reflex. ``` Early signs and symptoms of cataracts: are slightly blurred vision and decreased color perception. At first the patient may think that his or her glasses or contact lenses are smudged. As lens cloudiness continues, blurred and double vision occurs, and the patient may have difficulty with ADLs. Without surgical intervention, visual impairment progresses to blindness. No pain or eye redness is associated with age-related cataract formation. Examine the lens with an ophthalmoscope and describe any observed densities by size, shape, and location. As the cataract matures, the opacity makes it difficult to see the retina, and the red reflex may be absent. When this occurs, the pupil is bluish white

Answer 51

Central loss of vision. Number one cause of vision loss over the age of 60. No cure. Maintain a healthy weight. Eat a nutritious diet that includes green leafy vegetables, yellow and orange fruit, fish and whole grains. Don't smoke. Maintain normal blood pressure and control other medical conditions. Exercise regularly. Wear sunglasses and hats when you are outdoors. Get regular eye exams, and consult your doctor if you notice vision changes.

Answer 52

Blurred vision, loss of central vision, blindness.

Answer 53

A detached retina happens when the retina peels away or detaches from its underlying layer of support tissue at the back of the eye. The retina is a thin layer of light-sensitive nerve cells at the back of the eye. We need a healthy retina to be able to see clearly

Answer 54

S/s: bits of debris (floaters), sudden flashes of light, or a shadow in the vision field are symptoms. blurred vision, inability to see in dim light, partial loss of vision, seeing flashes of light, seeing spots, sensitivity to light, temporary loss of vision in one eye, tunnel vision, or vision loss, dilated pupil or redness Tx: Prompt medical treatment can often save vision in the eye.

Answer 55

Inflammatory arthritis, resulting in formation of uric acid and crystals in joints and body tissues.

Answer 56

include obesity, alcohol consumption, high purine diet (meat), cardiovascular disease, starvation dieting. S/s: severe joint pain (most common in metatarsophalangeal joint in great/big toe) Erythema, swelling, warmth in affected joint.

Answer 57

Tophi with chronic gout.

Answer 58

Meds: o Acute gout: colchicine, NSAIDS, corticosteroids o Chronic gout: allopurinol, probenecid.

Answer 59

Osteoarthritis

Answer 60

S/s: Joint pain/stiffness, crepitus, enlarged joints, Herberdens nodes (distal tips of fingers), Bouchard’s nodes (proximal/middle of finger joints) o Pain with activity, gets better with rest o Affects specific joints, not symmetrical o Negative Rheumatoid factor o Risk factors: older women, obese, smoker, repetitive stress on joints. o Treatment options: o Apply Ice (acute inflammation) or heat o Splinting and/or use of assistive devices o Physical Therapy o TENS unit device o o Meds: o Oral analgesics (acetaminophen, NSAIDS) o Topical analgetics (capsasin): wear gloves, burning sensation is normal, do not apply on broken skin areas. o Glucosamine: Increases synovial fluid production and helps rebuild cartilage. o Injection: glucocorticoids, hyaluronic acid o Surgery: Total joint arthroplasty

Answer 61

o Inner ear disorder That may result from overproduction or decreased absorption of endolymph—the fluid contained in the labyrinth of the ear.

Answer 62

Signs and symptoms of meneires Disease: - Recent viral/bacterial infection or ototoxic medications. - Tinnitus (ringing in ears), unilateral sensorineural hearing loss, vertigo, vomiting, balance issues. o Otoscope examination: pull auricle back and up for adults and children, and back and down for children under 3 years old. Tympanic membrane should be pearly gray and intact. Light reflex should be at 5 o’ clock for right ear, 7 o’clock for left ear. o Treatment o Avoid caffeine and alcohol. Rest in quiet, dark place when experiencing severe vertigo. Space intake of fluids throughout the day, decrease salt intake. o Meds: o Antihistamines, anticholinergics, antiemetics (meclizine, droperidol, diphenhydramine, scopolamine) Watch for signs of urinary retention, and sedation. o Surgeries: Stapedectomy, cochlear implant, labryintectomy.

Answer 63

Ototoxic meds : NSAIDs Diuretics SSRIs ????

Answer 64

o rheumatoid arthritis RA

Answer 65

o o Signs and symptoms o Pain after rest/immobility, get better with movement o Affects all joints symmetrically o Swan neck and boutonniere deformities in fingers o Positive rheumatoid factor o o Joint pain, morning stiffness, fatigue, swelling in joints with erythema, and warmth, subcutaneous nodules, fever, red sclera, lymphadenopathy. o o Complications: o Can cause: Sjogrens Syndrome (dry eyes, dry mouth, dry vagina) o o Risk Factors: female, aged 20-50, genetics o o Labs: Positive Rheumatoid factor (RF) antibody, positive ANA titer. Elevated WBC’s, ESR, and CRP. o o Diagnosed by: Abnormal Arthrocentesis (aspiration of synovial fluid from joint) to test for WBCs, RF. o Treatment o Meds: NSAIDS, immunosuppressants (prednisone, methotrexate), antimalarial agents (hydroxychloroquine) o o Procedure: Plasmapheresis (to remove antibodies from blood), Total joint arthroplasty. o o Take a hot shower to relieve morning stiffness o Physical activity to preserve ROM o Use of assistive devices if needed.

Answer 66

o Scleroderma

Answer 67

o Keep the patient's head elevated at least 60 degrees during meals and for at least 1 hour after each meal. * Provide small, frequent meals rather than three large meals each day. * Give the patient small amounts of food for each bite and explain the importance of chewing each bite carefully before swallowing. * Provide semisoft foods such as mashed potatoes and pudding or custard; liquids are most likely to cause choking. * Collaborate with the dietitian about the patient's diet. * Teach the patient to avoid foods that increase gastric secretion such as caffeine, pepper, and other spices. * Give antacids or histamine antagonists as needed. ``` o Systemic steroids and immunosuppressants are used in large doses and often in combination. o Relieve pain o Prevent infection o Dilate blood vessels o Surgery ```

Answer 68

Lupus o Discoid: affects the skin (butterfly rash) o Systemic: affects the connective tissues in multiple organs

Answer 69

o Risk factors: Female, ages 20-40, race African American, Asian, Native American. o S/s: Fatigue, joint pain, fever, butterfly rash on face, Raynauds phenomenon, anemia, pericarditis, lymphadenopathy. o Knees joints inflamed o The major skin manifestation of DLE and SLE is a dry, scaly, raised rash on the face (“butterfly” rash o Labs: positive ANA titer, decreased serum complement C3/C4, decreased RBC, WBC, platelets, increased BUN, creatinine with kidney involvement. o Because SLE is an inflammatory condition, fever and fatigue are common findings. Fever is the classic sign of a flare, or exacerbation. Various degrees of generalized weakness, fatigue, anorexia, and weight loss may occur o Treatment o Meds: o NSAIDS, immunosuppressant agents (prednisone, methotrexate), antimalarial drugs (hydroxychloroquine)-may cause retinal damage-eye exam every 6 months with drug, topical steroid creams for rash. o Avoid UV sun exposure, avoid sick people due to risk of infection with immunosuppressants. o Remind patients to take their medication early in the morning before breakfast because that is the time when the body's natural corticosteroid level is the lowest. o o SPF sunscreen 30 or higher, avoid prolonged exposure to sunlight and other forms of ultraviolet lighting, including certain types of fluorescent light. Remind them to wear long sleeves and a large-brimmed hat when outdoors. o o Patient and Family Education o Preparing for Self-Management Evidence-Based Practice for Skin Protection in Patients With Lupus Erythematosus • Cleanse your skin with a mild soap such as Ivory. • Dry your skin thoroughly by patting rather than rubbing. • Apply lotion liberally to dry skin areas. • Avoid powder and other drying agents such as rubbing alcohol. • Use cosmetics that contain moisturizers. • Avoid direct sunlight and any other type of ultraviolet lighting, including tanning beds. • Wear a large-brimmed hat, long sleeves, and long pants when in the sun. • Use a sun-blocking agent with a sun protection factor (SPF) of at least 30. • Inspect your skin daily for open areas and rashes. ``` Factors contributing to exacerbations o UV sun exposure- o stress o Decreased immunity function/sickness/infections o Alcohol o Drugs o vaccines o Cigarette smoke o Sex hormones ``` Complications: Renal failure may occur-called lupus nephritis—the leading cause of death from the disease. Other causes of death are cardiac and central nervous system involvement.

Answer 70

o Allergic response

Answer 71

o Degrees of severity may vary: o Uncomfortable (itchy, watery eyes; sneezing) o Life threatening (allergy asthma, anaphylaxis, bronchoconstriction, circulatory collapse

Answer 72

o Caused by increased production of immunoglobulin E (IgE) antibody which causes inflammation o Allergens contracted by: o Inhalation (pollens, spores, animal dander, dust, grass, ragweed) o Ingestion (foods, food additives, drugs) o Injection (bee venom, drugs, biologic substances) o Contraction (latex, pollens, foods, environmental proteins)

Answer 73

o Anaphylaxis

Answer 74

o s/s: o Feelings of uneasiness, apprehension, doom o Generalized itching, urticaria o Erythema, angioedema of face o Wheals or hives o Congestion, rhinorrhea, dyspnea, bronchoconstriction, wheezing/stridor, respiratory distress & failure due to edema, suffocation, & hypoxemia

Answer 75

Angioedema

Answer 76

ACEI’s & NSAIDS

Answer 77

``` Assessment: o History o Physical assessment o Deep, firm swelling o Face, lips, tongue, and neck o Immediate intervention for inability to swallow, feeling a lump in the throat, & stridor o Psychosocial assessment o Nursing priorities o Maintaining a patent airway o Minimizing anxiety o Severe angioedema is an acute emergency ```

Answer 78

``` Assess GAS EXCHANGE first! o Establish or stabilize airway o Stay with patient o Ensure airway care is available o Epinephrine-IV preferred or IM o Antihistamines o Oxygen, ABG’s, suction o Beta-adrenergic agonist o Corticosteroids, oral steroids o -avoid allergens whenever possible o -Medical alert bracelet o Carry anaphylaxis kit or epinephrine injector ``` o Medical records should prominently display list of specific allergens o Precautionary measures if drug or agent must be used despite history of allergic reaction

Answer 79

``` A1C-6= BS=126 A1C=7 BS=154 A1c=8 BS=183 9 BS=212 10 BS=240 11 BS=269 12 BS=298 ```

Answer 80

Do not sit or stand for prolonged periods. • Do not cross your legs beyond the midline of your body. • For posterior surgical approach patients: Do not bend your hips more than 90 degrees. • For anterior surgical approach patients: Do not hyperextend your operative leg behind you. • Do not twist your body when standing. • Use the prescribed ambulatory aid such as a walker when walking. • Use assistive/adaptive devices as needed (e.g., sock aids, shoehorns, dressing sticks, reachers [also see Chapter 6]). • Do not put more weight on your affected leg than allowed and instructed . • Resume sexual intercourse as usual on the advice of your surgeon. Pain Management • Report increased hip or anterior thigh pain to the surgeon immediately. • Take oral analgesics as prescribed and only as needed. • Do not overexert yourself; take frequent rests. • Use ice as needed to operative hip to decrease or prevent swelling and minimize pain. Incisional Care • Follow the instructions provided regarding dressing changes. Some surgeons use specialty dressings that do not need to be changed. No dressing may be needed if a skin sealant was used. • Inspect your hip incision every day for redness, heat, or drainage; if any of these are present, call your surgeon immediately. • Do not bathe the incision or apply anything directly to the incision unless instructed to do so. Shower according to the surgeon's instructions. Other Care • Continue walking and performing the leg exercises as you learned them in the hospital. Do not increase the amount of activity unless instructed to do so by the therapist or surgeon. • Do not cross your legs to help prevent blood clots. • Report pain, redness, or swelling in your legs to your surgeon immediately. • Call 911 for acute chest pain or shortness of breath (could indicate pulmonary embolus). • If you are taking an anticoagulant, follow the precautions learned in the hospital to prevent bleeding; avoid using a straight razor, avoid injuries, and report bleeding or excessive bruising to your surgeon immediately. • Follow up with visits to the surgeon's office as instructed.

Answer 81

RHEUMATOID ARTHRITIS

Answer 82

OSTEOARTHRITIS

Answer 83

``` Joint • Inflammation Systemic • Low-grade fever • Fatigue • Weakness • Anorexia • Paresthesias Late Signs and Symptoms Joint • Deformities (e.g., swan neck or ulnar deviation) • Moderate-to-severe pain and morning stiffness Systemic • Osteoporosis • Severe fatigue • Anemia • Weight loss • Subcutaneous nodules • Peripheral neuropathy • Vasculitis • Pericarditis • Fibrotic lung disease • Sjögren's syndrome • Kidney disease • Felty's syndrome ```

Answer 84

* Cleanse your skin with a mild soap such as Ivory. * Dry your skin thoroughly by patting rather than rubbing. * Apply lotion liberally to dry skin areas. * Avoid powder and other drying agents such as rubbing alcohol. * Use cosmetics that contain moisturizers * Avoid direct sunlight and any other type of ultraviolet lighting, including tanning beds. * Wear a large-brimmed hat, long sleeves, and long pants when in the sun. * Use a sun-blocking agent with a sun protection factor (SPF) of at least 30. * Inspect your skin daily for open areas and rashes.

Answer 85

``` Ankylosing spondylitis (AS) • Autoimmune hemolytic anemia • Autoimmune thrombocytopenic purpura • Celiac disease (CeD) • Crohn's disease (CD) • Diabetes (type 1) • Dermatomyositis • Erythema nodosum leprosum (ENL) • Glomerulonephritis • Goodpasture's syndrome • Grave's disease • Hashimoto's thyroiditis • Idiopathic Addison's disease • Irritable bowel disease (IBD) • Multiple sclerosis (MS) • Myasthenia gravis • Pernicious anemia • Psoriasis (PS) • Psoriatic arthritis (PSA) • Rheumatoid arthritis (RA) • Reiter's syndrome • Scleroderma • Sjögren's syndrome (SS) • Systemic lupus erythematosus (SLE) • Ulcerative colitis (UC) • Uveitis • Vasculitis ```

Answer 86

Teach the patient to check the cornea for abrasions or trauma. Drugs should not be used when the cornea is not intact. Remind the patient that, over time, the eye color darkens, and eyelashes elongate in the eye receiving the drug. Knowing the side effects in advance reassures the patient that their presence is expected and normal. If only one eye is to be treated, teach the patient not to place drops in the other eye to try to make the eye colors similar. Using the drug in an eye with normal IOP can cause a lower-than-normal IOP, which reduces vision. Warn the patient that using more drops than prescribed reduces drug effectiveness. Drug action is based on blocking receptors, which can increase in number when the drug is overused.

Answer 87

Ask whether the patient is taking any antidepressants from the MAO inhibitor class, such as phenelzine (Nardil) or tranylcypromine (Parnate). These enzyme inhibitors increase blood pressure, as do the adrenergic agonists. When taken together, the patient may experience hypertensive crisis. Teach the patient to wear dark glasses outdoors and also indoors when lighting is bright. The pupil dilates (mydriasis) and remains dilated, even when there is plenty of light, causing discomfort. Teach the patient not to use the eyedrops with contact lenses in place and to wait 15 minutes after using the drug to put in the lenses. These drugs are absorbed by the contact lens, which can become discolored or cloudy.

Answer 88

Ask whether the patient has moderate-to-severe asthma or COPD. If these drugs are absorbed systemically, they constrict pulmonary smooth muscle and narrow airways. Warn patients with diabetes to check their blood glucose levels more often when taking these drugs. These drugs induce hypoglycemia and also mask the hypoglycemic symptoms. Teach patients who also take oral beta blockers to check their pulse at least twice per day and to notify the primary health care and eye care providers if the pulse is consistently below 58 beats/min. These drugs potentiate the effects of systemic beta blockers and can cause an unsafe drop in heart rate and blood pressure.

Answer 89

Teach the patient not to use more eyedrops than are prescribed and to report increased salivation or drooling to the primary health care and eye care providers. These drugs are readily absorbed by conjunctival mucous membranes and can cause systemic side effects of headache, flushing, increased saliva, and sweating. Teach the patient to use good light when reading and to take care in darker rooms. The pupil of the eye will not open more to let in more light, and it may be harder to see objects in dim light. This problem can increase the risk for falls.

Answer 90

Ask whether the patient has an allergy to sulfonamide antibacterial drugs. Drugs are similar to the sulfonamides; and, if a patient is allergic to the sulfonamides, an allergy is likely with these drugs, even as eyedrops. Teach the patient to shake the drug before applying. Drug separates on standing. Teach the patient not to use the eyedrops with contact lenses in place and to wait 15 minutes after using the drug to put in the lenses. These drugs are absorbed by the contact lens, which can become discolored or cloudy. Combination Drugs Brimonidine tartrate and timolol maleate (Combigan) Latanoprost and timolol (Xalcom) Same as for each drug alone.

Answer 91

Reassure the patient that this is normal. When positioning a patient on the side, do not “fold” the ear under the head.

Answer 92

Reassure the patient that this is normal. | More frequent ear irrigation may be needed to prevent cerumen clumping.

Answer 93

Teach the patient and caregiver to irrigate the ear canal weekly or whenever he or she notices a change in hearing.

Answer 94

Do not use this finding as the only indication of otitis media.

Answer 95

Assess hearing with the voice test or the watch test. If a deficit is present, refer the patient to a specialist to determine hearing loss and appropriate intervention. Do not assume that all older adults have a hearing loss!

Answer 96

Provide a quiet environment when speaking (close the door to the hallway) and face the patient. Avoid standing or sitting in front of bright lights or windows, which may interfere with the patient's ability to see your lips move. If the patient wears glasses, be sure that he or she is using them to enhance speech understanding. Speak slowly, clearly, and in a deeper voice and emphasize beginning word sounds. Some patients with a hearing loss that is not corrected may benefit from wearing a stethoscope while listening to you speak.

Answer 97

* Position yourself directly in front of the patient. * Ensure that you are not sitting or standing in front of a bright light or window, which can interfere with the patient's ability to see your lips move. * Make sure that the room is well lighted. * Get the patient's attention before you begin to speak. * Move closer to the better-hearing ear. * Speak clearly and slowly. * Do not shout (shouting often makes understanding more difficult). * Keep hands and other objects away from your mouth when talking to the patient. * Have conversations in a quiet room with minimal distractions. * Have the patient repeat your statements, not just indicate assent. * Rephrase sentences and repeat information to aid understanding. * Use appropriate hand motions. * Write messages on paper if the patient is able to read.

Answer 98

no longer recognized self cells

Answer 99

Bone marrow

Answer 100

Bone marrow cant produce enough mature neutrophils to keep up with infection so it releases immature neutrophils or “bands” in the blood which is minimal benefit cause they are not capable of phagocytosis (kills invaders).

Answer 101

Eosinophils

Answer 102

Neutrophil Lymphocytes

Answer 103

Don’t flex or bend more than 90° Monitor for signs and symptoms of DVT Apply antiembolic stockings Please abduction device between legs No crossing legs Only externally rotate patients toes – do not internally rotate Monitor for joint dislocation such as severe pain or a pop noise from affected extremity Use elevated toilet seat and avoid low chairs

Answer 104

Left shift or banded neutrophils

Answer 105

Leukopenia

Answer 106

Leukocytosis Wbc greater than 10,000

Answer 107

Osteoporosis

Answer 108

Humpback/kyphosis, reduced height, fractures, back pain Xray

Answer 109

Meds Dash calcitonin, estrogen, relaxing, alendronate-remain upright for 30 minutes after taking Calcium and vitamin D, sun exposure using sunscreen, weight-bearing exercises, safety measures to prevent falls

Answer 110

Topical steroids-Do not apply to face, skin films, or broken skin Light therapy-eye protection and immunosuppressants such as methotrexate and cyclosporine

Answer 111

Arthroplasty

Answer 112

Continuous passive motion Do not please pillow under her name to prevent flexion Analgesics, Antibiotics, anticoagulants, ice therapy Neurovascular checks every 2 to 4 hours Do not Kneel or do deep knee bends

Answer 113

Heart/cardiovascular | Kidney

T3 New Flashcards

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