exam1

Buergers Disease: risk factors

• most common in men younger than 45 yrs

• Hx of

Tobacco, marijuana

Buergers Disease

• Intermittent claudication of ____, _____ or ________

• Rest pain

• ____________

• ___________

• Changes in color & temperature

• Sensitive to ________

• Superficial vein thrombosis

Feet, hands, arms, ischemic ulcerations, paresthesia, cold

__________ Disease: tx

• tobacco & marij. CESSATION

Conservative management includes:

• avoiding limb exposure to cold temps

• Supervised _____ program

• Antibiotics for infected ulcers

• Analgesics to manage ischemic pain

teach pts to AVOID trauma to the extremities

Buergers, walking

Buergers Disease: drug of choice

___________- promotes dilation; decrease need of amputation

IV iloprost

Buergers Disease: surgery

• ________ of a nerve OR implanting a _________ (both increase blood flow back)

• severe ischemia- bypass surgery

• _________ promotes ulcer healing, new blood vessel formation, and nerve cell regeneration.

Transection, spinal cord stimulator, stem cell therapy

Raynaud’s Phenomenon: primary

Can trigger by exposure to:

_____________

Stress

Cold weather

Raynaud’s Phenomenon: secondary

Can be a symptom of certain disease conditions

I.e., _________, RA, atherosclerosis, ________

Lupus, scleroderma

Raynaud’s Phenomenon: risk factors

Sex: _______ are more likely to get it

Age: It usually occurs in people younger than age ___.

Family history: People with a family member who has Raynaud’s phenomenon have a higher risk.

Underlying conditions: Connective tissue diseases (scleroderma, lupus, rheumatoid arthritis, Sjogren's syndrome), diseases of the blood vessels.

Women, 30

Raynaud’s Disease: s/sx

• Color goes from ______, _______, with rewarmth- _______w/ throbbing pain

White, blue, red

Raynaud’s Disease: s/sx

• ____ finger and toes

• Numbness and tingling

• Skin discoloration

Cold

Raynaud’s Disease: tx

Stay OUT of COLD

• wear insulated _____

• Keep whole body warm

Gloves

Borrelia burgdorferi causative agent of

Lyme disease

Lyme disease: s/sx

• _______________

• Low-grade fever

• Headache

• ________

• Fatigue

• Anorexia

• Joint & muscle pain

• _______

• ___________

• ____________

• Inflammation of spinal cord and brain

• SOB

• dizziness, numbness, tingling

Erythema migrans, neck stiffness, arthritis, Lyme carditis, Bell’s palsy

Lyme disease prevention

• Use tick repellents

⚬Spray your outdoor clothing, shoes, tent and other

 camping gear with a repellent that has 0.5% __________

• Dress for protection

⚬Wear light-colored clothing that makes it easier for you or others to see ticks on your clothing

⚬Avoid open-toed shoes or sandles

⚬Wear long-sleeved shirts tucked into your pants

⚬Wear long pants tucked into your socks

• Check for ticks

⚬Use a mirror to check your body well, paying attention to underarms, hair, and hairline

Also check ears, waist, between your legs, behind your knees, and inside your bellybutton

Permethrin

Lyme disease: tx

First-line standard of care treatment is __________

10-14 days

Other anbx include amoxicillin & ceftin

Doxycycline

Systemic Lupus Erthematosus (SLE): s/sx

• fever

• Weight loss

• __________

• Joint and muscle pain

• ________

• Chest pain

• Headaches

• _______________

• Swelling in feet and around the _____

• Depression & anxiety

Photosensitivity, alopecia, malar rash, eyes

Lupus increases the risk of vascular inflammation, atherosclerosis, and ________ (inflammation of the lining around the heart). Management: risk factors____ like high blood pressure, cholesterol, and inflammation, along with medications to prevent clotting.

Pericarditis

Lupus nephritis can lead to renal failure if not treated, and it is one of the most serious complications of lupus. kidney dialysis or a ________ in severe cases

Transplant

SLE: Lung Problems

•Cause: The immune system can target the lungs and the lining surrounding them, leading to inflammation.

•Complications:

•Pleuritis (inflammation of the pleura, the lining around the lungs), causing chest pain and difficulty breathing.

•Lupus pneumonitis (inflammation of lung tissue), which can cause difficulty breathing and impaired oxygen exchange.

•Pulmonary hypertension, which is high blood pressure in the arteries of the lungs, can develop and lead to heart failure over time.

•Infections: People with lupus may also be more susceptible to respiratory infections due to a weakened immune system and immunosuppressive treatment.

Management: Medications for _________ and monitoring for ________, along with supportive care for lung function

Inflammation, infections

SLE: Neurological Complications

•Cause: Lupus can affect the brain and nervous system, leading to inflammation and other neurological issues.

•Complications:

•_______ dysfunction, often called "lupus fog," which involves memory problems, difficulty concentrating, and confusion.

•________ due to inflammation in the brain.

•Strokes caused by blood clot formation in the brain.

•Headaches, including migraines and cluster headaches.

•Psychiatric issues: Depression, anxiety, and mood disorders can occur as part of lupus or as a result of coping with the chronic disease.

Management: Medications like antiepileptics for seizures, antidepressants for mood disorders, and immunosuppressive drugs for inflammation.

Cognitive, seizures

SLE: Blood Disorders

•Complications:

•Anemia (low red blood cell count), leading to fatigue and weakness.

•Leukopenia (low white blood cell count), increasing susceptibility to infections.

•Thrombocytopenia (low platelet count), which can lead to easy bruising or bleeding.

•__________ syndrome: A condition where the immune system produces antibodies that increase the risk of blood clots. It can cause deep vein thrombosis (DVT), pulmonary embolism, stroke, and pregnancy complications like miscarriages.

Management: Blood tests to monitor blood counts, medications to prevent clotting in ** syndrome, and treatments to manage anemia and other blood disorders

Antiphospholipid

SLE: Skin Problems

•Complications:

•Malar rash (butterfly-shaped rash across the cheeks and nose), which is a hallmark of lupus.

•_______ lupus: A form of lupus that primarily affects the skin, causing circular, scarring rashes.

•Photosensitivity: Increased sensitivity to sunlight, which can worsen skin symptoms and trigger lupus flares.

•Alopecia (hair loss), which is often temporary but can be distressing.

Management: Use of sunscreen, topical treatments, and sometimes oral medications like antimalarials (________) to manage skin symptoms

Discoid, hydroxychloroquine

SLE: Musculoskeletal Problems

•Cause: Lupus can lead to inflammation in the joints and soft tissues, resulting in pain and stiffness.

•Complications:

•_________: Joint pain, swelling, and stiffness, which is a common symptom of lupus.

•Osteonecrosis: Bone tissue death due to poor blood supply, often a result of long-term use of corticosteroids.

•Muscle weakness and pain.

Management: Pain relief (NSAIDs, corticosteroids), immunosuppressive drugs, and physical therapy for joint and muscle issues.

Arthritis

SLE: Gastrointestinal Problems

•Complications:

•Lupus-related liver disease, though rare, can cause liver inflammation and damage.

•Irritable bowel syndrome (IBS), nausea, and abdominal pain.

•_______________: Inflammation of the blood vessels supplying the intestines, which can lead to severe abdominal pain and even intestinal ischemia.

Management: Treatment may include immunosuppressive medications, gastrointestinal medications, and lifestyle changes.

Mesenteric vasculitis

SLE:

• _________ with morning stiffness

• Diffuse swelling, some stiffness

• Can cause deformities:

  • _____________

  • __________

  • ________ with hyperlaxity of joints

• Increased risk of bone loss and fracture

Polyarthralgia, swan neck deformity in fingers, ulnar deviation, subluxation

SLE: diagnosis difficult

• 97% contain ____ antibodies

• Testing for anti-DNA antibodies, ______ antibodies, ________ antibodies

ANA, anti smith, antiphospholipid

T of F?

In SLE increased ESR, CRP indicate inflammation

T

SLE: drug: for mild joint pain

• need to try several to find most effective

• Monitor for _____ & ____ effects long-term

NSAIDs, GI, renal

SLE: drug: For fatigue, skin& joint problems; reduce flares

Monitor for _____ with high doses

Antimalarials, retinopathy

SLE: drug: suppress immune system

• Lowest dose for shortest possible time

Taper slowly

Corticosteroids

SLE: immunosuppressive drugs

Suppressive immune system, reduce _________ damage

Monitor for toxicity and s/e

End-organ

SLE: drugs -prevent life threatening blood clots

Anticoagulants

SLE: drug: serious skin conditions (Butterfly rash; Discoid lesions)

• suppress immune activity of the skin

Topical immunomodulators

SLE common in women of childbearing age

⚬Plan pregnancy when disease activity is minimal

⚬Some drugs need stopped or switched up to 3 months before pregnancy

•________ may have occurred from renal involvement, high-dose corticosteroids, immunosuppressive drugs

⚬Spontaneous abortion, stillbirth, and intrauterine growth retardation are common

⚬Renal, CV, respiratory, and CNS systems may be affected during pregnancy

•Flares are common postpartum

Infertility

SLE

_______ function and _________ antibodies should be checked to assess any risks before pregnancy. It's important to evaluate any existing organ damage from lupus, as it may influence pregnancy outcomes.

Renal, antiphospholipid

Connective tissue disorder

Affects: skin, blood vessels, synovium, skeletal muscle, internal organs

• too much collagen

Scleroderma

Scleroderma: damage to blood vessels, heart & lungs, joints & muscles, esophagus, intestines

S/sx

• shortness of breath

• _____________

• Heart failure

Pulmonary HTN

Scleroderma: CREST syndrome

Calcinosis, Raynaud’s phenomenon, esophageal dysfunction, sclerodactyly, telangiectasia

Painful deposits of calcium in skin (mainly fingertips)

Calcinosis

Intermittent vasospasm of fingertips

Raynaud’s phenomenon

CREST: tightening of skin on fingers and toes

Sclerodactyly

CREST: red spots on skin from capillary dilation

Telangiectasia

Scleroderma: diagnostics

• physical exam

• Blood: ANA, anti-Scl-70, anticentromere antibodies

• Skin biopsy

• Imaging

• Pulmonary test

• Echocardiogram

Scleroderma risk factors

• genetics

• Environmental (__________, coal, plastics)

Silica dust

Scleroderma tx:

Topical creams for skin changes

• ____________

• Lifestyle changes such as diet, exercise, stress management

Immunosuppressants

Methotrexate, mycophenolate mofetil, cyclophosphamide

Drug type

Immunosuppressive

Sjögrens Syndrome: s/sx

• _____________

• ___________

• FATIGUE

• JOINT PAIN

• difficulty swallowing, dental problems

Dry eyes, dry mouth

Sjögrens Syndrome: diagnostics

• Symptoms, pmhx, physical

• Blood: ANA, _________

• Salivary gland biopsy

• Eye tests: Schirmers test & Rose Bengal staining

Anti SS A (Ro)

Sjögrens Syndrome: complications

Dry mouth leads to _______ and _________

Tooth decay, gum disease

Sjögrens Syndrome

Dryness in lungs can cause persistent cough, _________, and infections

Bronchitis

Sjögrens Syndrome Tx.

• immunosuppressive drugs

• ________________for controlling inflammation

• Corticosteroids: to treat inflammation in severe cases

Hydroxychloroquine

Sjögrens Syndrome: symptom management

For dry eyes: artificial tears

Dry mouth: saliva substitutes

Hydration

• avoid smoking

• Good oral hygiene

• _________

Humidifiers

Fibromyalgia: abnormal processing of pain input

Spinal fluid contain _____ linked to neuroinflammation

Proteins

Fibromyalgia: s/sx

• widespread ___________

• Head or facial pain from stiff or painful neck and shoulder muscles

• TMJ dysfunction

• Trouble determining location of pain

T/F

Fibromyalgia- ¼ pts have TMJ dysfunction

F, 1/3

T/F

New meds for Fibromyalgia include

pregabalin, Duloxetine

T

Fibromyalgia main drugs

Acetaminophen, NSAIDs

Musculoskeletal disorder

• lateral curvature and rotation of the spine

• Idiopathic or congenital

Scoliosis

Scoliosis: contributing factors

• heavy ________

• Bags

• Carrying children on hips

Backpacks

Scoliosis: tx

• _________

• __________(supports and braces)

• ____________ which usually is _________ with rods

Observation, Orthosis, operations, spinal fusion

T/F

development follows growth and chronological age

F

Anterior fontanel close?

12-18 mon

Posterior fontanel closure?

2-3 mon

15 month - milk intake

2-3 C

Hydrocephalus: s/sx

• bulging fontanels with head enlargement

• Dilated scalp veins

• Depressed or _____________

• Irritability and changes in the LOC

• high-pitched cry

• ______________

Sunken eyes, setting sun sign

Hydrocephalus: tx

VP shunt

Hydrocephalus: Postop VP shunt

• Measure head circumference

• Assess for bulging fontanels and _____________

• Monitor the temperature

• _____________ position

Widening cranial suture lines, supine

Hydrocephalus frequently associated with myelomeningocele (Spina bifida)

• protect the sac, DO NOT let it rupture

• baby should lie __________

• Cover sac with moistened dressing

Prone

Rhythm Recognition- one small box measurement of time

0.04 sec

Rhythm Recognition- one large box measurement of time

0.20 sec

Rhythm Recognition- measurement of time

five large boxes

1 sec

PR interval normal time

0.12-0.20 sec

QRS duration normal

0.06-0.11 sec

QT interval normal

<0.45 sec

Fluid Volume Deficit (FVD): s/sx

• decreased capillary refill

• Confusion, ________, drowsiness, lethargy

• Cold clammy skin

• Postural hypotension

• _______ pulse, decreased CVP

• __________respiratory rate

• Seizures, coma

• Thirst, dry mucous membranes

• Decreased urine output

• Urine is ____________

• Weakness, dizziness

• Weight loss

Restlessness, increased, increased, concentrated

FVD: care

Replace both water and electrolytes

Mild- PO

Sev.- _______ or ____________

Blood, isotonic iv solutions

Fluid Volume Excess (FVE): s/sx:

• Bounding pulse, increased BP, increased CVP

• Confusion, _________, lethargy

• Dyspnea, crackles, pulmonary edema

• Edema

• JVD

• Muscle spasms

• Polyuria

• S3 heart sound

• Seizures, coma

• Weight gain

Headache

FVE: care

• diuretics

• Fluid restriction

• Sodium restrictions

• If fluid excess leads to ascites or pleural effusion- _______ or __________

abd paracentesis, thoracentesis

Hypernatremia: decreased ecf vol

• Agitations, restlessness, ________, seizures, coma

• Dry swollen tongue, intense thirst, sticky mm

• Postural hypotension, decreased CVP, weight loss, increased pulse

• __________

Lethargy, weakness, muscle cramps

Hypernatremia w/ increased ECF

• agitations, restlessness, _________, seizures, coma

• Edema, peripheral and pulmonary

• Intense thirst, _________

• Weight gain, increased BP, increased CVP

Twitching, flushed skin

Hyponatremia: with decreased ECF volume

• apprehension, irritability, confusion, dizziness, personality changes, ________

• Seizures, coma

• Cold, clammy skin

• Dry mm

• Postural hypotension, decreased CVP, decreased jugular venous filling

• Pulse _______

Tremors, increased thready

Hyperkalemia s/sx:

• abdominal ______, diarrhea, vomiting

• ______

• Fatigue, irritability

• Irregular pulse

• ______________

• Muscle weakness, cramps

• Paresthesia, decreased reflexes

• _______

Cramping, confusion, loss of muscle tone, tetany

Hypokalemia s/sx

• ________, nausea, ___________

• Fatigue

• _____________

• Irregular weak pulse

• Muscles:_______ n _________

• Muscle weakness, leg cramps

• Paresthesia, decreased reflexes

• _________________

Constipation, paralytic ileus, hyperglycemia, soft, flabby, shallow respirations

severe Hyperkalemia tx: force potassium from ecf to icf

Combo of ________ with ________ and a beta-adrenergic agonist

Stabilize cardiac membranes: ____________

IV regular insulin, dextrose, IV calcium chloride or calcium gluconate

Hypercalcemia s/sx:

• BP ________

• Bone pain, fractures

• Confusion, psychosis

• Fatigue, ______, weakness

• ___________

• Decreased memory

• ____________

• N/v, anorexia

• Polyuria, dehydration

• Seizures, coma

Increased, lethargy, depressed reflexes, kidney stones

Hypercalcemia tx:

• 3-4/L daily

• iv isotonic saline, ____ and ________

• Life threatening: dialysis

Biphosphonate, calcitonin

Hypocalcemia s/sx:

• BP ______

• __________, _________

• Confusion, ________, irritability

• Fatigue, weakness

• ___________, muscle cramps

• ________________

• Numbness and tingling in extremities and around mouth

• ______, seizures

Decreased, Chvostek sign, Trousseau sign, depression, hyperreflexia, laryngeal spasms, tetany

Hypocalcemia tx:

• mild- calcium-rich foods, ca & Vit D supplements

• Tenany & ECG changes: IV calcium gluconate

• Promote ________

CO2 retention

Hypermagnesemia: s/sx

• flushing and ________

• Vasodilation

• DECREASED DTRs

• Muscle tone: _______, weak

• INCREASED arrhythmias

• DECREASED LOC

• DECREASED PULSE

• DECREASED RESPIRATIONS

Warmth, flaccid

Hypermagnesemia: tx

• ventilator

• Dialysis

• Antidote for Mg toxicity: __________

• Safety precautions

Calcium gluconate

___________: s/sx

• bones brittle

• Kidney stones

• DTRs DECREASED

• MUSCLES FLACCID N WEAK

• INCREASED ARRHYTHMIAS

• DECREASED LOC

• DECREASED PULSE

• DECREASED RESPIRATIONS

Hypercalcemia

Hypercalcemia: tx

• move!

• Fluids to prevent kidney stones

• Add phosphorus foods to diet (eggs, protein)

• _________

• Safety precautions

• Medications that decrease serum Ca+

  • ______________

  • ______________

Steroids, biphosphates, calcitonin

Hyperthyroidism (Grave’s Disease) : tx

Anti-thyroids: ______________, ______________

Methimazole, propylthiouracil

Hyperthyroidism (Grave’s Disease) : tx

Iodine compounds- _______________

• decrease size and vascularity of the gland

• Give in milk or juice, and use a STRAW

Potassium iodine

Hyperthyroidism (Grave’s Disease) : tx

Beta blockers- supportive therapy - __________

Propranolol

Hyperthyroidism (Grave’s Disease) : Radioactive iodine therapy

• given PO

• STAY AWAY from babies & don’t kiss anyone for _______

WATCH FOR _________

1 week, thyrotoxicosis

Hyperthyroidism (Grave’s Disease) : thyroidectomy

Post-Op priority: hemorrhage

• report feelings of __________

• Check for bleeding: neck incision, ___________

• assess for recurrent laryngeal nerve damage by listening for hoarseness

  • if leads to vocal cord paralysis → airway obstruction → immediate ________

• Assess for accidental parathyroid removal (Hypocalcemia)

Pressure, inside back of neck, trach

Hypothyroidism: tx

Levothyroxine, __________

Take on an ________

Worry about ____ when these meds started

Liothyronine, empty, MI

Pheochromocytoma

• Triad of symptoms: ________, _________, ___________

Pounding headache, tachycardia, profuse sweating