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UTA NURS 3561 Final

UTA NURS 3561 Adults Final Exam

QuestionAnswer
HIV risk factors Blood transfusion or clotting factors given prior to 1985; Sharing of drug-using equipment; Unprotected sex (including anal and oral); Previous STI
Early chronic HIV (T-cell count > 500) manifestations fatigue, headache, low-grade fever, night sweats, persistent generalized lymphadenopathy (PGL)
Intermediate chronic HIV infection (T-cell count 200-500) manifestations persistent fever, frequent drenching night sweats, chronic diarrhea, recurrent headaches, and fatigue severe enough to interrupt normal routines, localized infections, lymphadenopathy, and nervous system manifestations
AIDS criteria (vs. HIV) one of the following: CD4 < 200; one opportunistic infections (e.g., candidiasis and PCP) or cancer (e.g., cervical cancer, KS, lymphoma); wasting syndrome (looses 10% or more of ideal body mass); AIDS dementia complex
normal CD4 T cell count 800-1200 cells/μL (>500 still considered “healthy” immune system, <200 criteria for AIDS)
Antiretroviral therapy (ART) the use of a minimum of three antiretroviral drugs from different drug classes
HIV teaching signs/symptoms to report (change in LOC, headache, vision changes, SOB, n/v, dehydration, jaundice, bleeding, flank pain, weakness of body part, chest pain, seizures, rash, oral lesions, depression); use of antiretroviral drugs; antibiotic-resistance
Fibroadenoma differentiating manifestations occurs in young women (Ages 15-40); masses are small, round, well-delineated, and mobile; absense of nipple discharge and retraction
Breast cancer differentiating manifestations occurs in older women (Age 50 or over); masses are hard, irregularly shaped, poorly delineated, and nonmobile; nipple discharge and retraction can occur
Mastectomy postoperative care considerations assess for lymphedema, administer analgesics, refer to support groups, protect arm/hand/fingers from trauma, take BP in unaffected arm
Positioning of arm post mastectomy elevated on a pillow not exceeding shoulder elevation
Lymphedema complication of mastectomy; an accumulation of lymph in soft tissue with swelling resulting from inflammation, obstruction, or removal of lymph channels and nodes; can cause too much pressure on the veins leading to nerve damage, cellulitis, and fibrosis
BPH manifestations urinary urgency, decreased force of urination, urinary hesitancy, urine dribbling, urinary retention, incontinence, nocturia, dysuria, feeling as if still has to go, bladder discomfort, and sexual dysfunction
BPH management “watchful waiting”, dietary changes, avoid decongestants and anticholinergics, restrict evening fluid intake, voiding schedule; drug therapy (5α-reductase inhibitors and α-adrenergic receptor blockers); minimally invasive therapy (TURP)
BPH diet decrease caffeine and artificial sweeteners, limit spicy or acidic foods
transurethral resection of the prostate (TURP) a surgical procedure involving the removal of prostate tissue with the use of a resectoscope inserted through the urethra
TURP postoperative care prevent complications (hemorrhage, bladder spasms, urinary incontinence, and infection); irrigate the bladder; administer analgesics; ensure adequate hydration
Hypothyroidism manifestations decreased metabolism causing weight gain, puffy face (periorbital edema), coarse facial features, dry skin, and dry coarse hair and eyebrows
Hypothyroidism management hormone replacement; low-fat, high-fiber diet; warm environment
Myxedema coma complication of hypothyroidism; manifestations include hypothermia, hypotension, and hypoventilation
Myxedema coma management Oxygen administered, followed by fluid replacement, keeping the client warm, monitoring vital signs, and administering IV thyroid hormones
Hyperthyroidism (Graves’ disease) manifestations increased metabolism, goiter, exophthalmos, weight loss, increased nervousness, tremors, palpitations, angina, bound/rapid pulse, systolic murmurs
Thyrotoxic crisis (Thyroid storm) complication of hyperthyroidism; tachycardia, HF, shock, hyperthermia, restlessness, agitation, seizures, abdominal pain, nausea, vomiting diarrhea, delirium, and coma
Thyrotoxic crisis management Oxygen administered, followed by fluid replacement, administering antipyretics, and treating the stressor
Thyroidectomy postoperative management assess for hemorrhage or tracheal compression; assess for tetany secondary to hypoparathyroidism (hypocalcimia), for Trousseau’s sign or Chvostek’s sign; place in semi-Fowler’s, support head with pillows, and avoid neck flexion and tension on suture lines
Hypoparathyroidism manifestations hypocalcemia causing tetany (Chvostek’s and Trousseau’s signs)
Trousseau's sign a carpal spasm induced by inflating a blood pressure cuff above the systolic pressure for a few minutes.
Chvostek's sign contraction of facial muscles in response to a light tap over the facial nerve in front of the ear
Hypoparathyroidism management Emergency: IV calcium (calcium gluconate or calcium chloride) with ECG monitoring; rebreathing; Long-term: calcium & vitamin D (e.g., calcitriol, calciferol) supplements
Hyperparathyroidism manifestations hypercalcemia which is either asymptomatic or causes muscle weakness, loss of appetite, constipation, fatigue, emotional disorders, shortened attention span, loss of calcium from bones (osteoporosis), fractures, and kidney stones (nephrolithiasis)
Hyperparathyroidism management parathyroidectomy; encourage ambulation to prevent renal calculi
Parathyroidectomy postoperative management assess for hemorrhage and fluid electrolyte disturbance, especially Tetany d/t hypocalcemia, Chvostek’s and Trousseau’s signs
Laryngeal stridor parathyroidectomy post-op sign of hemorrhage, an acute emergency; a harsh, high-pitched sound heard on inspiration and expiration caused by compression of the trachea, leading to respiratory distress.
Glucocorticoid (cortisol) action regulate metabolism, increase blood glucose levels, and are critical in the physiologic stress response
Mineralocorticoid (aldosterone) action regulate sodium and potassium balance
Cushing syndrome a metabolic disorder resulting from the chronic and excessive production of cortisol by the adrenal cortex or by the administration of glucocorticoids in large doses for several weeks or longer
Cushing syndrome manifestations centripetal (truncal) obesity or generalized obesity; “moon facies” (fullness of the face) with facial plethora; purplish red striae on the abdomen, breast, or buttocks; hirsutism and menstrual disorders in women; HTN; and unexplained hypokalemia.
Cushing syndrome management treat underlying cause—transsphenoidal resection and radiation therapy (pituitary adenoma) OR adrenalectomy and ketoconazole (Nizoral) and aminoglutethimide (Cytadren) (adrenocorical adenoma, carcinoma, or hyperplasia)
Cushing syndrome postoperative risks increased risk for hemorrhage (rapid or significant changes in BP, respirations, or HR), increased susceptibility to infection, delayed wound healing
Cushing syndrome diet low-carb, low-sodium, high-protein, high-potassium
Addison’s disease a metabolic disorder resulting from the reduced excretion of all three adrenal corticosteroids
Addison’s disease manifestations very slow (insidious) onset; progressive weakness, fatigue, weight loss, anorexia, hyperpigmentation, orthostatic hypotension, hyponatremia, salt craving, hyperkalemia, nausea and vomiting, diarrhea, irritability and depression.
addisonian crisis life-threatening emergency caused by insufficient adrenocortical hormones or a sudden sharp decrease in these hormones
Addison’s disease management replacement therapy—Daily glucocorticoid replacement; Daily mineralocorticoid; Salt additives for excess heat or humidity; Increased doses of cortisol for stress situations (e.g., surgery, hospitalization)
UTI manifestations hesitancy, intermittency, postvoid dribbling, urinary retention or incomplete emptying, dysuria, pain on urination, urinary frequency, urgency, incontinence, nocturia, and nocturnal enuresis
UTI risk factors urinary stasis; foreign bodies; anatomic factors (fistula, obesity); immune factors (aging, HIV, DM); functional disorders (constipation, voiding dysfunction); women (pregnancy, multiple sex partners, spermicidals, short urethra); poor hygiene
Upper UTI differentiating manifestations fever, chills, and flank pain
Lower UTI differentiating manifestations no systemic manifestations (fever, chills, etc.)
UTI management antibiotic therapy, usually Trimethoprim/sulfamethoxazole (TMP/SMX) (Bactrim, Septra) or nitrofurantoin (Macrodantin), adequate fluid intake
Nitrofurantoin (Furadantin, Macrodantin) drug classification/alert Urinary tract antiinfective; Avoid sunlight; use sunscreen, wear protective clothing; Notify health care provider if fever, chills, cough, chest pain, dyspnea, rash, or numbness or tingling of fingers or toes develops.
urinary tract calculi risk factors increased urine calcium, oxaluric, uric, or citric acid levels; warm climates; large intake of proteins, tea/fruit juice, calcium and oxalate, and low fluid intake; family hx, cystinuria, gout, or renal acidosis; sedentary occupation, immobility
Reason urine is strained to collect renal stones important in diagnosing underlying problem
Mild anemia clinical manifestations palpitations, exertional dyspnea, and possibly mild fatigue
Moderate anemia clinical manifestations bounding pulse, dyspnea, roaring in ears, and fatigue
Severe anemia clinical manifestations dyspnea at rest, pallor, jaundice, pruritus, tachycardia, systolic murmurs/bruits, angina, MI, HF, cardiomegaly, pulmonary and systemic congestion, ascites, and peripheral edema
anemia acute management blood or blood product transfusions, drug therapy (e.g., erythropoietin, vitamin supplements), volume replacement, and oxygen therapy to stabilize the patient.
CKD effect on hematologic system anemia due to decreased production of the hormone erythropoietin by the kidneys; may require oral iron supplements
Hgb normal levels Male: 13.2-17.3 g/dL Female: 11.7-15.5 g/dL (Severe anemia: <6, moderate anemia 6-10)
Hct normal levels Male: 39%-50% Female: 35%-47%
RBC normal levels Male: 4,300,000-5,700,000/μL Female: 3,800,000-5,100,000/μL
Iron-deficiency differentiating manifestations pallor, glossitis, cheilitis, headache, paresthesias, burning sensation on tongue
Iron-deficiency anemia management indentify underlying cause, iron supplements, nutritional and diet therapy, and RBC transfusion if symptomic
Sickle cell disease (SCD) manifestations chronic health problems and pain; pallor (grayish cast); jaundice; prone to gallstones (cholelithiasis)
Sickle cell disease (SCD) management alleviating the symptoms from the complications of the disease, minimizing end-organ damage, and promptly treating serious sequelae
Clostridium difficile (C. difficile) manifestations moderate to severe watery diarrhea, fever, anorexia, nausea, abdominal pain/cramping; can progress to fulminant colitis, intestinal perforation, paralytic ileus or toxic megacolon.
C. difficile management Flagyl, Vancomycin
C. difficile precautions contact precautions (gloves and gowns); disinfect with bleach
pancreatitis causes Biliary tract disease, Alchoholism, Trauma (post surgical & abdominal), Viral infections (mumps & coxsackievirus B), Penetrating duodenal ulcer, Cysts, abscesses, Cystic fibrosis, Kaposi’s sarcoma, Certain drugs
pancreatitis clinical manifestations Epigastric pain, N/V, Abdominal tenderness, Low-grade fever, Leukocytosis, Hypotension, Tachycardia, Jaundice, ↓ or absent BS, Hypovolemia, Grey Turner’s spots & Cullen's sign
Cullen’s sign bluish periumbilical discoloration caused by seepage of blood-stained exudate from the pancreas
Grey Turner’s spots bluish flank discoloration caused by seepage of blood-stained exudate from the pancreas
Pancreatitis complications pseudocyst, abscess, pleural effusion, Atelectasis, pneumonia, hypotension, hypocalcemia
pancreatic pseudocyst complication of pancreatitis; a cavity continuous with or surrounding the outside of the pancreas
pancreatic pseudocyst manifestations abdominal pain, palpable epigastric mass, n/v, anorexia, elevated serum amylase
pancreatic pseudocyst treatment Internal drainage procedure with an anastomosis between pancreatic duct and the jejunum
pancreatic abscess complication of pancreatitis; a large fluid-containing cavity within the pancreas
pancreatic abscess manifestations upper abdominal pain, abdominal mass, high fever, leukocytosis
pancreatic abscess treatment Prompt surgical drainage to prevent sepsis
Most effective means of relieving pain associated with acute pancreatitis NPO status
HF manifestations fatigue (earliest symptom), dyspnea (orthopnea and paroxysmal nocturnal dyspnea), tachycardia, edema, nocturia, skin changes, behavioral changes, chest pain, weight changes
HF exacerbation manifestations development of dependent edema or a sudden weight gain of more than 3 lb (1.4 kg) in 2 days, behavioral changes
Sodium nitroprusside (Nipride) drug use/complications IV vasodilator that reduces preload and afterload, improving myocardial contraction, increasing CO, and reducing pulmonary congestion; complications include hypotension and thiocyanate toxicity—monitor BP frequently (5-10 minutes)
Dopamine drug alert Monitor IV site for signs of extravasation; Tissue necrosis with sloughing can occur with extravasation of the drug; High dosages may produce ventricular dysrhythmias.
Best indicator of fluid status weight
HF teaching when to call doctor (weight gain), cluster activity to decrease fatigue, elevate bed to decrease SOB
Tranquilizer effect on surgery/healing potentiate effect of opioids and barbiturates (anesthetics)
Antihypertensive effect on surgery/healing predispose to shock when combined with anesthetics
Insulin/hypoglycemic agents effect on surgery/healing dose may need to be changed d/t increased metabolism, decreased caloric intake, stress, and anesthesia
Aspirin, Plavix, & NSAID effect on surgery/healing inhibit platelet aggregation, contributing to bleeding problems
Corticosteroid effect on surgery/healing delayed wound healing
Preop assessment goals determine physholgoic status, establish baseline, identify site/side, identify medications that may result in interactions, review labs and diagnostic tests, identify cultural and ethnic factors affect surgery, witness consent
Preop labs ABGs & pulse ox; glucose; BUN/creatinine (renal function); CBC (anemia, immune status, infection); electrolytes; hCG (pregnancy); LFTs; PT, PTT, INR, platelet count (coagulation status); albumin (nutritional status); urinalysis (renal status)
Intraop assessment goals establish baseline; allergies; skin integrity; skeletal muscle impairments; perceptual difficulties; LOC; NPO status; pain/discomfort
Postop assessment goals monitoring/managing respiratory and circulatory function, pain, temperature, and the surgical site
HAV transmission Fecal-oral (primarily fecal contamination and oral ingestion)
HBV transmission Percutaneous (parenteral)/permucosal exposure to blood or blood products; sexual contact; preinatal transmission
HCV transmission Percutaneous (parenteral)/mucosal exposure to blood or blood products; High-risk sexual contact; Perinatal contact
HDV transmission same as HBV: Percutaneous (parenteral)/permucosal exposure to blood or blood products; sexual contact; preinatal transmission
HEV transmission Fecal-oral
Jaundice symptom of yellowish discoloration of body tissues that results from an increased concentration of bilirubin in the blood
Asites effect on patient pushes up diaphragm and affects breathing
Normal Potassium 3.5-5.0 mEq/L
Elevated Potassium etiology Addison's disease, diabetic ketosis, massive tissue destruction (e.g., burn patients), renal failure
Decreased Potassium etiology hyperaldosteronism, Cushing syndrome, diarrhea (severe), diuretic therapy, gastrointestinal fistula (colitis), pyloric obstruction, starvation, vomiting
Effect of thiazide and loop diuretics on potassium risk for hypokalemia; supplements may need to be given with them
Hyperkalemia manifestations irritability, anxiety, abdominal cramping, diarrhea, weekness of lower extremities, parathesias, irregular pulse, cardiac arrest if sudden or severe
Hypokalemia manifestations fatigue, muscle weakness, leg cramps, n/v, paralytic ileus, soft, flaby muscles, paresthesias, decreased reflexes, weak, irregular pulse, polyuria, hyperglycemia
Organ affected by Potassium Heart
Normal Calcium 8.6-10.2 mg/dL
Elevated Calcium etiology Acute osteoporosis, hyperparathyroidism, vitamin D intoxication, multiple myeloma
Decreased Calcium etiology tumor lysis syndrome (TLS), Acute pancreatitis, hypoparathyroidism, liver disease, malabsorption syndrome, renal failure, vitamin D deficiency
Hypercalcemia manifestations apathy, depression, fatigue, muscle weakness, ECG changes, polyuria and nocturia, anorexia, nausea, and vomiting.
Hypocalcemia manifestations tetany, Chvostek’s sign, Trousseau’s sign, fatigue, diarrhea
Normal sodium 135-145 mEq/L
Hypernatremia manifestations extreme thirst, decreased urinary output, increased specific gravity
Hypernatremia etiology Dehydration, impaired renal function, primary aldosteronism, corticosteroid therapy
Hyponatremia sodium etiology Addison's disease, diabetic ketoacidosis, diuretic therapy, excessive loss from GI tract, excessive perspiration, water intoxication
Hyponatremia manifestations hyperactive bowel sounds, increased urinary output, decreased specific gravity
Normal phosphorus 2.4-4.4 mg/dL
hyperphosphatemia etiology Healing fractures, hypoparathyroidism, renal disease, vitamin D intoxication, tumor lysis syndrome
hypophosphatemia etiology malnutrition/starvation (alcoholism), antacid use, Diabetes mellitus, hyperparathyroidism, vitamin D deficiency
fluid volume deficit etiology vomiting, diarrhea, conditions that cause increased respirations or increased urinary output, insufficient IV fluid replacement, draining fistulas, and the presence of an ileostomy or colostomy
fluid volume deficit manifestations increased RR and HR, decreased CVP, weight loss, poor skin turgor, dry mucous membranes, decreased urine volume, increased specific gravity of the urine, increased Hct, and altered LOC
fluid volume deficit management LR; Isotonic (0.9%) sodium chloride (when rapid volume replacement is indicated); Blood (when volume loss is due to blood loss)
isotonic solutions D5, NS, D5 1/2NS, LR
hypotonic solutions 1/2NS
hypertonic solutions D5NS, D5 1/2NS
Lispro (Humalog) classification rapid-acting insulin
Aspart (Novolog) classification rapid-acting insulin
Glulisine (Apidra) classification rapid-acting insulin
Regular (Humulin R, Novolin R, ReliOn R) classification short-acting insulin
NPH (Humulin N, Novolin N, ReliOn N) classification intermediate-acting insulin
Glargine (Lantus) classification long-acting insulin
Detemir (Levemir) classification long-acting insulin
Rapid-acting insulin Onset/Peak/Duration Onset: 15 min; Peak: 60-90 min; Duration: 3-4 hrs
Short-acting insulin Onset/Peak/Duration Onset: 30-60 min; Peak: 2-3 hrs; Duration: 3-6 hrs
Intermediate-acting insulin Onset/Peak/Duration Onset: 2-4 hrs; Peak: 4-10 hrs; Duration: 10-16 hrs
Long-acting insulin Onset/Peak/Duration Onset: 1-2 hrs; Peak: none; Duration: 24+ hrs
Impact of exercise on blood sugar potentiates effect of insulin, putting patient at risk for hypoglycemia up to 48 hrs after; don’t exercise at time of peak drug action, do exercise 1hr after meals or after carb snack and glucose monitoring, carb snacks every 30 minutes during exercise
Insulin pump teaching monitor blood sugar three or more times a day; watch for complication (infection at insertion site, DKA)
Hypoglycemia manifestations ANS symptoms including shakiness, irritability, nervousness
Hypoglycemia management food or glucose (D50)
DKA manifestations decreased pH, decreased HCO3, elevated glucose, ketones in blood and urine, polyuria, Kussmaul’s respiration’s; can lead to coma
DKA management Emergent: IV NaCl and regular insulin; Once down to 250-300: reduce fluid rate and change to D5 1/2NS
Electrolyte impacted by DKA potassium (hypokalemia)
Ineffective Breathing pattern characteristics Alterations in depth of breathing; three-point position; bradypnea; decreased vital capacity; dyspnea; increased anterior-posterior diameter; nasal flaring; orthopnea; prolonged expiration phase; pursed-lip breathing; tachypnea; use of accessory muscles
Impaired Gas exchange characteristics Abnormal ABGs, pH; abnormal breathing (rate, rhythm, depth); abnormal skin color (pale, dusky); confusion; cyanosis; decreased CO2; diaphoresis; dyspnea; headache upon awakening; rritability; nasal flaring; restlessness, tachycardia; visual disturbance
Asthma manifestations wheezing, cough, dyspnea, and chest tightness after exposure to a precipitating factor or trigger
Frequent use of rescue inhalers Not well controlled: Mild severity (> 2 days/wk); moderate severity (daily), severe (several times per day)
Use of Peak Flow Meter move indicator to bottom, stand up, take deep breath, place mouthpiece in mouth and close lips around it, and blow as hard and fast as possible; write down number and repeat 2 more times (use best of 3)
β2-Adrenergic Agonists (SABA, LABA) drug classification/alert Bronchodilators used for rescue (SABA) or long-term control of moderate to severe persistent asthma (LABA); cause increased BP/HR, CNS stimulation/excitation, and increase risk of dysrhythmias; Overuse may cause rebound bronchospasms (short acting).
Theophylline drug classification/alert bronchodilator used for alternative therapy for step 2 care in mild persistent asthma; Instruct patient to report signs of toxicity: nausea, vomiting, seizures, insomnia; Avoid caffeine to prevent intensifying adverse effects.
Side effects of inhaled corticosteroids Oropharyngeal candidiasis (Thrush), hoarseness, and dry cough—use spacer and gargle with water or mouthwash after each use; glucose intolerance and diabetes—may need to take insulin
Chronic bronchitis manifestations “blue bloater”, form of COPD characterized by excessive production of mucus and chronic inflammatory changes in the bronchi
COPD management smoking cessation, drug therapy (stepwise fashion: bronchodilator, anticholinergic, ICS), O2 therapy, possible surgical therapy, breathing retraining (pursed-lip and diaphragmatic)
Peripheral Artery Disease (PAD) manifestations intermittent claudication, sexual dysfunction, parathesia; thin, shiny, and taut skin; hair loss on lower legs; diminished/absent pulse; pallor on elevation; redness in dependent position; rest pain
intermittent claudication manifestation of PAD; ischemic muscle ache or pain that is precipitated by a consistent level of exercise, resolves within 10 minutes or less with rest, and is reproducible
PAD management cardiovascular disease risk factor modification, treatment of claudication,nutritional therapy, proper foot care; worst case: amputation
Phlebitis inflammation (e.g., redness, tenderness, warmth, mild edema) of a superficial vein without the presence of a thrombus (clot)
Venous thromboembolism (VTE) risks Virchow’s triad: venous stasis, damage to inner lining of vein, and hypercoagulability of the blood
VTE manifestations may have unilateral leg edema, extremity pain, a sense of fullness in the thigh or calf, paresthesias, warm skin, erythema, and/or a systemic temperature greater than 100.4° F, positive Homans’ sign; legs, arms, neck, back, or face edematous and cyanotic.
VTE management ambulation, graduated compression stockings, SCDs, anticoagulants
HTN manifestation asymptomatic until severe; fatigue, reduced activity tolerance, dizziness, palpitations, angina, and dyspnea
DASH eating plan fruits, vegetables, fat-free or low-fat milk and milk products, whole grains, fish, poultry, beans, seeds, and nuts. Compared with the typical American diet, the plan contains less red meat, salt, sweets, added sugars, and sugar-containing beverages
Thiazide and loop diuretic adverse effects hypokalemia; supplement with potassium-rich foods
Potassium-sparing diuretics and aldosterone receptor blockers adverse effects hyperkalemia; avoid potassium
Doxazosin (Cardura) classification/alert α1-Adrenergic Blocker used to treat HTN; Use caution for initial dose; Syncope occasionally occurs 30 to 90 minutes following initial dose, a too-rapid increase in dose, or addition of another antihypertensive agent to therapy.
HTN medication common side effects orthostatic hypotension, sexual problems
HTN management follow-up to check BP/adherence to medications
Orthostatic hypotension management rise slowly, don’t stand still for prolonged periods, do leg exercises (increases venous return), sleep with head of bed raised or on pillows, lie/sit when dizziness occurs
Myelosuppression complications anemia, leukopenia, thrombocytopenia (can cause infection, hemorrhage, overwhelming fatigue)
Myelosuppression lab monitoring Hgb/Hct for anemia, CBC (particularly the neutrophil) for leukopenia, platelet counts for thrombocytopenia
Foods that promote RBC growth red meats (especially liver), fish, poultry, eggs, enriched and whole grains, enriched bread/cereals, green leafy vegetables, legumes, dried fruits, citrus fruits, strawberries, cantaloupe, nuts, potatoes, wheat germ, cornmeal, bananas, milk products
Myelosuppression management infection prevention (including monitoring temperature); WBC growth factor administration
Care of cast keep dry; no weight bearing for 48 hrs; ice for 24 hrs; elevate above heart for 48 hrs; regular movement of joints above/below cast
Signs of cast complications Increasing pain; Swelling associated with pain and discoloration of toes or fingers; Pain during movement; Burning or tingling under cast; Sores or foul odor under the cast
Casting complications skin irritation/breakdown, neurovascular damage, cast syndrome (body cast too tight)
Cast assessment circulation, sensation and movement
Compartment syndrome manifestations 6 Ps: (1) paresthesia; (2) pain distal to injury not relieved by opioid analgesics and pain on passive stretch of muscle traveling through the compartment; (3) pressure increases; (4) pallor; (5) paralysis; and (6) pulselessness
Compartment syndrome management don’t elevate above heart; don’t apply cold compresses; remove/loosen bandage or split the cast; reduce traction weight; surgical decompression; apputation
Open fracture risk infection
Warfarin (Coumadin) lab monitoring INR – Therapapeutic value 2-3 (normal 0.75-1.25)
Heparin lab monitoring aPTT – therapeutic value 46-70 sec (normal 25-35)
Signs of bleeding r/t anticoagulant therapy hypotension, tachycardia, hematuria (bloody urine), melena (black or bloody stools), hematemesis (coffee-ground or bloody vomit), petechiae, ecchymosis, nosebleeds
Amputation complications hemorrhage, infection, flexion contractures
Fat embolism manifestations appear within 24-48 hrs of traumatic skeletal injury, include chest pain, tachypnea, cyanosis, dyspnea, apprehension, tachycardia, and decreased partial pressure of arterial oxygen (PaO2), changes in mental status, petechiae (distinguishing factor)
Fat embolism management prevention: immobilization of long bone fracture; treatment: fluid resuscitation to prevent hypovolemic shock, correction of acidosis, replacement of blood loss, cough and deep breath, O2 admin
Parkinson’s complications aspiration and malnutrition risk d/t dysphagia, fall risk d/t orthostatic hypotension and shuffling gait, risk for pneumonia, UTI, skin breakdown d/t debilitation, sleep disorders
Seizure complications status epilepticus (continuous seizure activity); injury/death from trauma suffered during a seizure
Seizure management antiseizure drug therapy, airway management (side-lying, nasotracheal suctioning), seizure safety (loosen clothing, remove harmful objects, padded side rails)
Antiseizure medication considerations titrate up; monitor serum levels; abrupt withdrawal may precipitate seizures
Lymphadenopathy Lymph nodes are enlarged (>1 cm); may be tender to touch
addisonian crisis triggers (1) stress (e.g., from infection, surgery, trauma, hemorrhage, or psychologic distress); (2) the sudden withdrawal of corticosteroid hormone replacement therapy; (3) after adrenal surgery; or (4) following sudden pituitary gland destruction.
emphysema "pink puffer", a form of COPD characterized by overinflation and destructive changes in alveolar walls
Nutrition Labs/Monitoring Albumin, protein, and daily weights
Normal Albumin 3.5-5.0 g/dL
Elevated Albumin etiology Dehydration
Decreased Albumin etiology Chronic liver disease, malabsorption, malnutrition, nephrotic syndrome
Normal Proteins 6.4-8.3 g/dL
Elevated Protein etiology Burns, cirrhosis (globulin fraction), dehydration
Decreased Protein etiology Liver disease, malabsorption
Created by: camellia