med surg 2 - final

what is bell’s palsy?

what is bell’s palsy?

sudden onset weakness of one side of the face

• inflammation of CN VII

• HSV-1 may be involved

what are the clinical manifestations of bell’s palsy?

ear pain, noise sensitivity, change in taste, speech difficulty, numbness

how is bell’s palsy treated?

acyclovir, steroids

what is some education for bell’s palsy?

use of eye protection

what is systemic lupus erythematosus?

chronic autoimmune inflammatory disease that can affect any organ system

how is systemic lupus erythematosus diagnosed?

labs (ANA confirms autoimmune disease but is not specific to SLE)

history & physical (4 of 17 clinical manifestations for diagnosis)

what are the clinical manifestations of systemic lupus erythematosus?

varies person to person - related to buildup of immune complexes in the tissues

butterfly rash, HTN, oral or nasal ulcers, dry eyes or mouth, etc.

how is systemic lupus erythematosus treated?

non-pharm: sunscreen, adequate nutrition, regular exercise

antimalarials (hydroxychloroquine), Ballista, NSAIDs, glucocorticoids, methotrexate

renal replacement for lupus nephritis, joint replacement for avascular necrosis

what is some education for systemic lupus erythematosus?

daily sunscreen use (due to photosensitivity), avoid live vaccines & oral contraceptives

what is trigeminal neuralgia?

sudden onset, sharp, brief pain occurring in the trigeminal nerve (CN V)

how is trigeminal neuralgia diagnosed?

rule out other diseases

neurological assessment (trigeminal reflex testing)

what are the clinical manifestations of trigeminal neuralgia?

sharp, throbbing, shock-like pain

pain occurring after facial trauma, dental surgery, MVA, etc.

how is trigeminal neuralgia treated?

non-pharm: meditation, acupuncture (has similar efficacy to carbamazepine), support groups

antiepileptics (carbamazepine)

what is some education for trigeminal neuralgia?

identify & avoid exacerbating factors, antiepileptics are used for neuropathic pain in this case & not epilepsy

what are some nursing interventions for trigeminal neuralgia?

assess pain impairment altering oral intake, assess for weight loss

what is rheumatoid arthritis?

inflammation of the joints by autoimmunity causing pain & swelling primarily targeting the synovial membrane

how is rheumatoid arthritis diagnosed?

history & physical + radiograph or ultrasound

labs may show rheumatoid factor

what are the clinical manifestations of rheumatoid arthritis?

swan neck deformity, boutonniere deformity, ulnar deviation, stiffness lasting 30 minutes to over 60 minutes, joint pain/stiffness following inactivity

how is rheumatoid arthritis treated?

non-pharm: ROM, aerobic exercise, PT/OT, proper nutrition

analgesics + NSAIDs + glucocorticoids (prednisone)

• if these don’t work, DMARDs (ex: methotrexate) are gold standard

total joint replacement, bone fusion

what is some education for rheumatoid arthritis?

adhere to treatment plan, report s/s of infection, discontinue immunosuppressive therapy with active infection

what is lyme disease?

tick-borne illness caused by Borrelia burgdorferi

what are the clinical manifestations of lyme disease?

low-grade fever, chills, headache, stiff neck, swollen lymph nodes

how is lyme disease treated?

antibiotics for 2-3 weeks

what is gout?

monosodium urate crystals deposit in joints, bone, & soft tissues causing inflammation

how is gout diagnosed?

visualization of crystals in synovial fluid or tophaceous material

what are the clinical manifestations of gout?

swelling, redness, acute onset of pain

chronic: tophi, joint destruction

how is gout treated?

non-pharm: weight management, splinting of affected joint

NSAIDs (indomethacin, colchicine)

uric acid-lowering agents (allopurinol) - NEVER FOR ACUTE GOUT

what is some education for gout?

avoid alcohol, report flare-ups, avoid high purine foods (red meat, liver, fish)

what is fibromyalgia?

chronic pain disorder of soft connective tissue (theorized to be caused by abnormal processing of stimuli by the CNS)

how is fibromyalgia diagnosed?

history & physical (appears normal but patient complains of widespread pain or feeling as if they have the flu)

what are the clinical manifestations of fibromyalgia?

widespread pain, insomnia, fatigue, stiffness, cognitive dysfunction

how is fibromyalgia treated?

non-pharm: strength training, aerobic exercise, cognitive behavioral therapy, self-management skills

serotonin/norepinephrine, sleep aids, non-opioid analgesics, anti-seizure medications

what is osteoarthritis?

deterioration of the joints

how is osteoarthritis diagnosed?

history & physical + radiograph or ultrasound (radiograph may not show evidence until well-advanced)

what are the clinical manifestations of osteoarthritis?

heberden’s nodes (fingertips), bouchard’s nodes (middle joint), progressive pain over time worsening with use, stiffness lasting less than 30 min, crepitus, elevated serum creatinine & liver enzyme levels

how is osteoarthritis treated?

non-pharm: weight loss if necessary, ROM/aerobic & muscle strengthening exercise, heat or cold packs

acetaminophen, intra-articular corticosteroid injections, opioids

what is some education for osteoarthritis?

obesity is a modifiable risk factor that contributes to osteoarthritis, regular physical activity, report signs of NSAID toxicity or MI

what is alzheimer’s disease?

form of dementia with gradual loss of brain function

• theorized to be related to free radicals damaging the neurons

how is alzheimer’s disease diagnosed?

only definitive diagnosis is made by a brain biopsy after death

mini mental status exam (30 point scale; below 20 indicates cognitive impairment)

what are the clinical manifestations of alzheimer’s disease?

misplacing things, disorientation, forgetfulness

progressed: apraxia (unable to perform movements), visual agnosia (unable to identify objects), dysgraphia (unable to draw objects)

how is alzheimer’s disease treated?

cholinesterase inhibitors to increase availability of acetylcholine (donepezil, rivastigmine)

vitamin E to decrease damage of free radicals

SSRIs for depression

what is some education for alzheimer’s disease?

no cure, can be preventable with diet changes, teach family about care for patient (label & secure dangerous substances), monitoring systems

what are some nursing interventions for alzheimer’s disease?

safe environment (sitter, bed alarm, fall precautions), consistently reorient & reassure, encourage feeding (pureed food, thickened liquids, easy-grip utensils) & provide finger foods), maintain routine (no napping)

what is delirium?

acute decline in attention & cognition

common in older adults who have a short-term illness

how is delirium diagnosed?

confusion assessment method (CAM), history (with careful consideration of medications)

what are the risk factors for delirium?

male, age 65+, depression, dementia, use of physical restraints

how is delirium treated?

haloperidol, risperidone, olanzapine

what is some education for delirium?

possibly preventable, dementia patients may experience delirium but not all delirium patients have dementia

what are some nursing interventions for delirium?

eliminate precipitating factors, protect from harm, reorient & provide safe/quiet environment

what is actinic keratosis?

precancerous lesions that proliferate in the epidermis

• can progress to squamous cell carcinoma

more common in people with less melanin

how is actinic keratosis diagnosed?

examination

what does actinic keratosis look like?

skin-colored to reddish-brown macules, papules, or plaques

• range from a few mm up to 2 cm

• occur as multiple lesions, usually on sun-exposed areas

how is actinic keratosis treated?

topical chemotherapy over several weeks

what is some education for actinic keratosis?

limit sun exposure, sunscreen, skin self-examinations

what is asthma?

intermittent irreversible airway obstruction resulting from inflammation

how is asthma diagnosed?

patient history, PFTs, chest x-ray, pulse ox, possible ABGs

what are the clinical manifestations of asthma?

wheezing, dyspnea, coughing, increased sputum, elevated RR

how is asthma treated?

anti-inflammatories (ex: corticosteroids to reduce mucus & swelling - prevent thrush by rinsing mouth after use)

bronchodilators

anticholinergics

what is some education for asthma?

control environmental triggers, keep house clean, avoid cold air, administer bronchodilators before meals

how is hemophilia a differentiated from hemophilia b?

A = factor VIII deficiency

B = factor IX deficiency

what are the clinical manifestations of hemophilia?

significant blood loss from minor injury, possible spontaneous bleeding, easy bruising & petechiae

how is hemophilia treated?

replacement of clotting factors through recombinant DNA products, glucocorticoids, splenectomy

what is some education for hemophilia?

inheritance pattern

• carried by females on X chromosome, so female carrier has a 50% chance of passing the disorder to a male offspring

risk with injury

bleeding precautions

how is diabetes mellitus diagnosed?

hgbA1c greater than 6.5

fasting BG greater than 126

2-hr postprandial BG greater than 200

random BG greater than 200

insulin antibodies for type 1 vs type 2

how is diabetes mellitus treated?

non-pharm: diet, exercise

glucose control agents (ex: metformin - only for type 2)

insulin

what is the onset, peak, & duration of regular (Humulin) insulin?

short-acting

onset: 30-60 min

peak: 2-5 hr

duration: 5-8 hr

what is the onset, peak, & duration of NPH insulin?

intermediate-acting

onset: 1-2 hr

peak: 4-12 hr

duration: 18-24 hr

what is some education for diabetes mellitus?

nutrition

• carbohydrate recommendations

  • one serving is 15 g

  • general recommendation is 45-60 g at each meal & 15-20 g at each snack

exercise (150 minutes per week)

insulin dosing

self-management

what is furosemide, what does it do, & what is some education for it?

loop diuretic

decreases preload

can cause hypokalemia (consume foods with potassium to prevent)

what is digitalis, what does it do, what are some nursing interventions for it, & what is some education for it?

inotropic agent

increases contractility

take apical HR for 1 full minute before administering (hold the medication if HR is less than 60)

take at same time every day, separate by 2 hr from antacids, report manifestations of toxicity (fatigue, muscle weakness, confusion, loss of appetite)

what is carvedilol, what are some nursing interventions for it, & what is some education for it?

beta blocker

monitor BP & HR

daily weight, check BP daily

what is captopril, what does it do, what are some nursing interventions for it, & what is some education for it?

ACE inhibitor

reduces afterload

monitor for hypotension, monitor for increased potassium

adverse effects include dry cough, angioedema, rash, & decreased sense of taste

what is the staging for pressure ulcers?

1 = non-blanchable redness

2 = partial thickness loss (exposed dermis)

3 = full thickness loss with visible adipose tissue

4 = full thickness loss usually with visible bone

what are some risk factors for pressure ulcers?

patients that are completely dependent on the nurse are most susceptible

other risks: decreased mobility, increased age, comorbid conditions, use of steroids, impaired blood flow, cognitive impairment, urinary or fecal incontinence, nutritional deficiencies, dehydration, history of pressure injuries, terminal illness

what are the clinical manifestations of prostate cancer?

slow-growing & asymptomatic until advanced

trouble urinating, weak urine stream

what are some risk factors for prostate cancer?

age 55+, african american, family history, diet high in red meat, high calcium consumption, high BMI

how is prostate cancer diagnosed?

digital rectal exam

PSA (elevated indicates enlargement)

biopsy

how is prostate cancer treated?

cryotherapy

brachytherapy (radioactive pellets; no sex for 2 weeks, then condoms to protect from radiation exposure; may lead to incontinence or impotence)

ablative hormone therapy

chemo/radiation

radical prostatectomy

how is vitamin B12 deficiency diagnosed?

vitamin B12 serum assay blood test, intrinsic factor (for pernicious anemia), MMA, gastrin

what are some causes of vitamin B12 deficiency?

insufficient B12, malabsorption, stomach surgery

what are the clinical manifestations of vitamin B12 deficiency?

depression, confusion, symptoms of anemia

how is vitamin B12 deficiency treated?

prevention (animal protein intake), B12 injections

what are some complications of vitamin B12 deficiency?

impaired functional ability, psychiatric conditions, visual disturbances

what are some dietary sources of vitamin B12?

milk, eggs, meat, seafood

how is iron deficiency anemia diagnosed?

CBC, serum ferritin/iron

what are some causes of iron deficiency anemia?

inadequate intake, blood loss, GI problems

what are the clinical manifestations of iron deficiency anemia?

glossitis, spoon-shaped nails, symptoms of anemia (pallor, fatigue, tachycardia)

how is iron deficiency anemia treated?

diet changes, iron supplements (don’t take with milk), IV or IM iron infusions

what are some dietary sources of iron?

leafy greens, beets, meat, beans/grains

how is folate deficiency diagnosed?

CBC, serum folate, MMA

what are some causes of folate deficiency?

inadequate intake, extreme diet, alcohol abuse

what are the clinical manifestations of folate deficiency?

neuro issues

how is folate deficiency treated?

folate intake & supplementation (prenatals)

what are some dietary sources of folate?

dark green vegetables, nuts, beans, yeast

how is erectile dysfunction diagnosed?

patient complaint

what are the clinical manifestations of erectile dysfunction?

inability to maintain an erection sufficient for sexual intercourse

how is erectile dysfunction treated?

PDE-5 inhibitors, alprostadil pellets, intercavernosal injection

penile prosthesis

what is some education for erectile dysfunction?

treatment options, smoking & obesity can contribute, side effects of medication

how is renal failure diagnosed?

GFR (less than 60 for 3 months or longer)

renal ultrasound/CT/biopsy

what are the clinical manifestations of renal failure?

alterations in sodium & fluid balance (leads to HTN, HF, & pulmonary edema)

altered potassium excretion (leads to fatal arrhythmias)

impaired metabolic waste elimination (leads to N/V, anorexia, & neuro symptoms)

frequent urination (due to inability of kidneys to concentrate urine, usually at night)

skin issues (pruritus, xerosis)

altered calcium (low) & phosphorus (leads to bone breakdown, osteodystrophy, & defective bone)

decreased acid clearance & bicarbonate production (leads to metabolic acidosis)

infertility, amenorrhea, hyperparathyroidism, & thyroid abnormalities

chronic anemia