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Immune/Musculoskelet

QuestionAnswer
DMARDS I med methotrexate
Methotrexate (DMARDS I) action & use slows the joint degeneration and progression of rheumatoid arthritis
Methotrexate (DMARDS I) complications (4) increased risk for infection, bone marrow suppression, GI ulcers/GI bleeding, & mouth ulcers (ulcerative stomatitis)
What would we be on the look out for, for the increased risk for infection with methotrexate (DMARDS I)? flu-like symptoms
What should patients keep in mind about social interaction while taking methotrexate (DMARDS I)? they should stay away from people who are sick since their immune systems are compromised
What forms does methotrexate come in (3)? oral, subcutaneous, & IM
Administration considerations for methotrexate (DMARDS I) (5) take with food, increase fluids, use reliable contraception (since this is a pregnancy category X), avoid alcohol, & give a folic acid supplement with it
What labs would we monitor for a patient taking methotrexate (DMARDS I) (2) & how frequently would we monitor them? RBC & platelets, monitor every 3-6 months
DMARDS II meds etanercept or adalimumab (Humira pen)
What are patients at an increased risk for while they're taking etanercept (DMARDS II)? TB & Hep B
Complications for etanercept (DMARDS II) (4) injection site irritation, risk for infection, *skin rash*, & heart failure
What would we look for when assessing if a patient taking etanercept (DMARDS II) is experiencing heart failure (3)? shortness of breath, jugular vein distension, & crackles in the lungs
Administration considerations with etanercept (DMARDS II) (1) avoid unnecessary vaccines
What route are etanercept & adalimumab (DMARDS II) taken & how frequently would we give them? subcutaneous & etanercept once or 2x a week *adalimumab every 2 weeks*
What should a patient avoid while taking etanercept & adalimumab (DMARDS II)? live vaccines since they can actually make them sick, their immune system is compromised
DMARDS III med cyclosporine
Cyclosporine use to treat severe RA
Complications for cyclosporine (1) risk for infection
Administration considerations for cyclosporine (3) shouldn't be used while pregnant, avoid live virus vaccines, & avoid erythromycin (since it increases the risk for toxicity)
What does SERMs stand for & what does it do? selective estrogen receptor modulators, & it mimics the effects of estrogen on the bones and bone tissue
SERMs med raloxifene
Raloxifene use to treat osteoporosis
Complications for raloxifene (3) increased risk for PE & DVT, & hot flashes
What would signs of pulmonary embolism look like, as a complication for raloxifene (2)? dyspnea upon exertion & sense of impending doom
What would a sign of deep vein thrombosis look like, as a complications for raloxifene (1)? pain in the calf
Administration considerations for raloxifene (5) take with no regards to food once a day, increase calcium & vitamin D, monitor bone density & serum calcium, increase weight-bearing activities, & use a reliable contraceptive
What lab would we monitor with a patient taking raloxifene & what range are we looking for? serum calcium & 9-10.5
Bisphosphonates med alendronate
Alendronate action increases bone mass by decreasing osteoclast activity
Alendronate use to treat osteoporosis
Complications for alendronate (4) esophagitis, musculoskeletal pain (muscle/joint pain), visual disturbances (blurred vision), & jaw pain
Administration considerations for alendronate (5) take either once a day or once a week, take 1st thing on an empty stomach, remain upright for 30 mins, monitor bone density & serum calcium, & increase weight-bearing activities
What lab would we monitor with a patient taking alendronate & what range are we looking for? serum calcium & 9-10.5
Calcitonin action increases calcium excretion
Calcitonin use to treat osteoporosis & hypercalcemia
Complications for calcitonin (3) hypersensitivity, hypocalcemia, & nasal irritation
What forms are calcitonin available in (3)? subcutaneous injection, IM injection, & intranasal
What should a patient do if they are administering calcitonin themselves through the intranasal route (3)? hold pump upright, primp the pump, & alternate nostrils
Administration considerations for calcitonin (2) don't give to patients with an allergy to salmon & refrigerate after opening
Calcium supplements med calcium gluconate
Calcium gluconate action maintains & raises serum calcium levels
Calcium gluconate use to treat hypocalcemia
Complications for calcium gluconate (2) hypercalcemia & kidney stones (renal calculi)
What are some symptoms we can monitor for hypercalcemia, as a complication for calcium gluconate (5)? nausea, abdominal pain, muscle weakness, confusion, & constipation
Administration considerations for calcium gluconate (5) take 1 hour from glucocorticoids, take 1 hour after meals, CHEW chewable tablets THEN swallow, drink water with tablets, & no more than 600mg at a time
What lab would we monitor with a patient taking calcium gluconate & what range are we looking for serum calcium & 9-10.5
SNRIs med duloxetine
Duloxetine action blocks the reuptake of serotonin & norepinephrine
Duloxetine use to treat fibromyalgia
Complications for duloxetine (1) withdrawal syndrome (so we taper the drug)
Administration considerations for duloxetine (2) administer without regard to food & swallow the capsules whole
Cholinesterase inhibitors med methylsulfate (neostigmine)
Methylsulfate (neostigmine) action improves muscle strength & endurance
Methylsulfate (neostigmine) use to treat myasthenia gravis
Complications for methylsulfate (neostigmine) (1) toxicity (use atropine)
What are some symptoms we would be on the lookout for with toxicity, as a complication with methylsulfate (neostigmine) (4)? bradycardia, salivation, respiratory paralysis, & muscle weakness
Administration considerations for methylsulfate (neostigmine) (3) assess swallowing ability prior to administering, assess pulse, & use caution if the patient has asthma
Antidote for methylsulfate (neostigmine) atropine (AtroPen)
Neuromuscular blocking agents med succinylcholine
Succinylcholine actions (2) inhibits muscle contraction & promotes muscle relaxation
Succinylcholine use to be used along with anesthesia
Complications for succinylcholine (3) hyperkalemia, respiratory arrest, & malignant hyperthermia
What are some symptoms we'd be on the lookout for with malignant hyperthermia, a complication of succinylcholine (3)? rigid muscles, tachycardia, & sudden spike in temperature
What route is succinylcholine available in (1)? IV
Administration considerations with succinylcholine (2) expect post-operative pain & educate the patient that the intubation is temporary
We'd use succinylcholine cautiously with patients who have...(3) electrolyte imbalances, respiratory depression, & myasthenia gravis
What lab would we monitor for while a patient is taking succinylcholine? serum K+ (potassium)
What do immunizations do? eradicate and prevent infectious diseases
Contraindications with general immunizations (3) anaphylactic reaction, severe febrile illness, & immunocompromised (w/live viruses)
Contraindication with varicella vaccine sensitivity to gelatin or neomycin
Contraindication with influenza vaccine sensitivity to eggs
Contraindication with MMR vaccine pregnancy
General precautions to vaccines (1) moderate to severe illnesses
Administration considerations with general vaccines (6) obtain consent, verify proper site, minimize discomfort, provide written VIS (vaccine information statement), educate the patient, & document
What are the 2 vaccines women can get while they're pregnant? Tdap & influenza
What is the Hep B shot? hepatitis B vaccine
What is the DTap shot? diphtheria-tetanus-pertussis vaccine
What is the RV shot? rotavirus vaccine
What is the Hib shot? haemophilus influenza type B vaccine
What is the IPV shot? polio vaccine
What is the PCV shot? pneumococcal conjugate vaccine
What is the MMR shot? measles-mumps-rubella vaccine
What is the Hep A2 shot? hepatitis A vaccine
What is the varicella shot? chickenpox vaccine
What shot does a patient get at birth (1)? Hep B
What shots does a patient get at 2 months old (6)? Hep B, DTaP, RV, Hib, IPV, & PCV
What shots does a patient get at 4 months old (5)? DTaP, RV, Hib, IPV, & PCV
What shots does a patient get at 6 months old (6-same as 2 months)? Hep B, DTaP, RV, Hib, IPV, & PCV
What shots does a patient get at 12-18 months old (6)? MMR, Hep A2, DTaP, Hib, PCV, & varicella
What shots does a patient get at 4-6 years old (4)? MMR, DTaP, IPV, & varicella
A nurse is reinforcing teaching with a client who has gout and a new prescription for allopurinol. For which of the following adverse effects should the client monitor? (select all that apply) Nausea Increased gout pain Stomatitis Insomnia Rash nausea increased gout pain rash
Based on the route of administration of adalimumab, what should the nurse plan to monitor? The subcutaneous site for redness following injection
A nurse is caring for a client who has a new diagnosis of fibromyalgia. Which of the following medications should the nurse anticipate being prescribed for this client? auranofin hydroxychloroquine colchicine duloxetine duloxetine
A nurse is reinforcing teaching with a client who has rheumatoid arthritis and a new prescription for methotrexate. What client statement indicates understanding? "I'll let the doctor know if I develop sores in my mouth while taking this medication."
Which of the following medications increases the risk of toxicity when taken concurrently with cyclosporine? rifampin erythromycin carbamazepine phenytoin erythromycin
Which of the following are possible adverse effects of raloxifene? (select all that apply) swelling or redness in the calf hot flashes difficulty swallowing shortness of breath lump in breast swelling or redness in the calf hot flashes shortness of breath
The nurse should monitor the client for which of the following manifestations as an indication of hypercalcemia? diarrhea abdominal pain blurred vision muscle weakness nausea abdominal pain muscle weakness nausea
A nurse is caring for a client who has a new prescription for calcitonin-salmon for osteoporosis. What test should the nurse expect before beginning this medication? skin test for allergy to the medication
A nurse is caring for a young adult client whose serum calcium is 8.8mg/dL. Which of the following medications should the nurse anticipate administering to this client? calcium carbonate calcitonin-salmon ibandronate zoledronic acid calcium carbonate
A nurse is reinforcing teaching with a client who has a new prescription for calcitonin-salmon for postmenopausal osteoporosis. What instructions should the nurse provide? alternate nostrils each time calcitonin-salmon is inhaled
A nurse in a public health clinic is caring for several clients who request seasonal influenza immunization. Which client has a contraindication to receiving the influenza immunization? a 2-month-old who has no health problems
A nurse is speaking to a group of new parents about immunizations. CDC recommendations call for completion of which of the following vaccines by the first birthday? varicella meningococcal conjugate pneumococcal conjugate rotavirus rotavirus
A nurse at a provider's office is preparing to administer RV, DTaP, Hib, PCV13, and IPV immunizations to a 4-month-old infant. What actions should the nurse plan to take? give the infant his pacifier during vaccine injections & administer subcutaneous injection in the anterolateral thigh
What are some reactions that can occur from the MMR vaccine (select all that apply)? headache bruising swollen glands inconsolable crying rash bruising swollen glands rash
The nurse should prepare to administer the varicella vaccine to which client? 32-year-old man who has essential hypertension
Created by: tiffhales
 

 



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