Exam 3 366 full study guide

Pruritus

Pruritus

itching, must break itch-scratch cycle to prevent excoriation, lichenification, and infection

eczema

red-brownish gray colored patches, severe itching at night, small raised bumps that might leak fluid and crust over, thickened scaly skin, related to asthma, hay fever, commonly found behind knees, arms, extensor surfaces

-comes in flares,

-related to allergies/genes

dermatitis

swollen, red, itchy lesions, various kinds

psoriasis vulgaris

bright red areas of red patches in skin covered by loose silvery scales

-itchy

-localized or general

-any part of body

acne vulgaris

blackheads, whiteheads, pustules on face, neck, upper back

skin tears

common in upper extremities

separation of dermis and epidermis

pressure ulcers

stage I: reddened area, non-blanchable,

stage II: skin blisters, open sore, red/irritated

stage III: crater damage to tissue or skin

stage IV: deep damage to muscle, bone, tendons, joints

sunburn

redness, blisters can lead to skin cancer

Cellulitis

Inflammation in the SQ tissue caused usually by S.aureus and streptococci, hot, tender, edematous, erythema, chills, fever, malaise

herpes zoster (shingles)

grouped vesicles, unilateral on trunk, face, lumbosacral

burning, can be mild-severe, neuralgia precedes outbreak

pallor

anemia

cyanosis

resp issues/low 02

jaundice

liver

Portal hypertension

Result of impaired blood flow to the liver, increased resistance from fibrosis and degeneration of liver hepatocytes

portal hypertension tx

Initial: Fluid resuscitation

- correct coagulopathy

- stop bleeding

- drugs to lower pressure: beta blocker

- Surgery: TIPS procedure, endoscopic sclerosing/ligation, transplant

Portal hypertension complications

ascites, caput medusae, esophageal varices, hematemesis, melena, hematochezia, hepatic encephalopathy

Acute inflammation of the pancreas patho

blockage of pancreatic duct causes spillage of pancreatic enzymes which leads to autodigestion and severe pain

-activation of trypsinogen to trypsin in pancreas leading to bleeding

causes: alcoholism, billiary tract disease, trauma, infection, drugs, post-op gi surgery

mild edema-severe necrosis

complications of acute inflammation of pancreas

psuedocyst, pancreatic abcess, systemic

psuedocyst

fluid, enzymes, and exudate surrounded by wall with abdominal pain and a palpable mass

s/s: N/V/anorexia

dectected by imaging

if perforates, becomes peritonitis

pancreatic abscess

infected psuedocyst from extensive necrosis and may ruptrure

s/s: upper abdominal pain, mass, high fever, leukocytosis

systemic complications of inflammation of the pancreas

pleural effusion, atelectasis,pneumonia, ARDs, hyponatremia, thrombi, PE, DIC, hypocalcemia, terany

Chronic pancreatitis

prolonged inflammation of the pancreas with eventual obstruction

Causes: alcohol, biliary obstruction, autoimmune diseases, cystic fibrosis, idiopathic, choledocholithiasis or cancer

elevated liver lab values in liver ailment

LFTS: AST, ALT, Bilirubin, ALP, GGT

Coags: INR, PT

Ammonia

decreased liver lab values in liver problem

albumin

protein

WBC

platelets

If someone has portal hypertension, what medications/ treatments/ procedures do we want to do?

Vasopressin (decreases liver perfusion decreases pressure)

Beta blockers

TIPS procedure

If someone has esophageal varices, what medications/ treatments/ procedures do we want to do?

Banding -- clip off bleeds

decreased ETOH (irritants)

Stool softeners/decrease straining

If someone has peripheral edema and ascites, what medications/ treatments/ procedures do we want to do?

Albumin given and paracentesis

Na+ restriction to decrease fluid retention

Diuretics (lasix, spironolactone)

Change positioning for peripheral edema

If someone has hepatic encephalopathy, what medications/ treatments/ procedures do we want to do?

Lactulose, DECREASE protein in diet at this point

high protein until encephalopathy, then lowww

If someone has hepatorenal syndrome, what medications/ treatments/ procedures do we want to do?

Terlipressin -- new med to help kidney by increasing renal perfusion

treatment for hep A and B

vaccine is primary prevention

acute hepatitis tx:

symptom managment, nutrition, hydration, rest

chronic hepatitis tx

Hep B+C= antiviral tx

to prevent further injury: no alcohol, no tylenol, management

esophogeal varices tx

banding, reducing irritants, no alc, stool softeners, positioning, sodium restrictions, diuretics

Hepatic encephalopathy tx

lactulose (decrease ammonia in the brain) may limit protein

hepatorenal syndrome treatment

terlipressin to increase renal perfusion

Cirrhosis tx

rest, b-complex vitamins, avoiding alcohol, avoid NSAIDs, betablocker, sandostatin, vasopressin

Nursing care of patients with cirrhosis

- extensive history: alcohol usage, Hx of hepatitis, biliary obstructions, infections, Right sided heart failure, etc.

- health promotion: limit alcohol usage, reduce risk factors like obesity, malnutrition, obstruction, etc.

- acute care: fluid balance, conserve strength while maintaining muscle tone, relieve any itching with jaundice, etc.

cause of hep A

rna virus via fecal oral rt

hep b cause

blood born pathogen/exposure to blood

hep c cause

IV drug use, sexual behaviors (sexC), occupation hazards

hep d cause

percutaneosly, no vaccine

hep e cause

fecal oral (food, drinking water)

GERD

most common GI problem, stomach acid refluxes into esophagus, HCL and Pepsin cause irritation

Tests: H&P exam, EGD, Barium swallow, mobility studies

tx: identify cause, stop food 2hr before bed, avoid acid, PPI's and H2 blockers, antacids, pro kinetic therapy endoscopic/surgical therapy

Hiatal hernia

herniation of part of the stomach above diaphrahgm

- sliding: slides through diaphragm when lying supine

- paraesophogeal: greater curvature rolls up through and forms a pocket

Tests: barium swallow, EGD

Tx: avoid straining, similar tx to GERD, surgical-fundoplacations, mesh placements, herniorrhaphy, gastroplexy

gastritis

inflammation of the gastric mucosa tests: H&P-info on drug and alc use, CBC, EGD

tx: eliminate cause, supportive care, NPO if n/v, NG tube, clear liquids, PPI's, H2RB, ABX if bacterial, lifestyle changes

chronic ulcer disease

- Gastric: H.Pylori usual cause, NSAID if not, less common than duodenal, more common in women

- Duodenal: most common, high recurrence

Tests:H&P, EGD, labs, imaging, etc.

Tx: stop NSAIDs, ABX for H.Pylori, alcohol and smoking cessation, small meals, eliminate coffee, meds-H2 or PPI's

IBD

chronic inflammation of the GI tract

tests: H & P, EGD, imaging, labs, stool tests, etc.

tx: anti inflammatories, immunosuppressants, surgery, diet and lifestyle, no cure.

Chron's Disease

Inflammation of the digestive tract commonly seen in the ileum and start of the colon, cobblestone appearance from times of healthy and times of illness tx: diet, avoid irritants, drug therapy, physical and emotional rest, counseling, surgery

ulcerative colitis

inflammation only in the large intestine and colon, starts at the rectum, submucosa to the mucosa tx: diet, drug therapy, counseling, surgery

Etiology of n/v

pregnancy, infection, tumors, meningitis, MI, HR, metabolic disorders, stress, fear, GI irritated/distended, medications, excess exercise

nursing care for n/v

- assess: Hx, I/O's, TACO, frequency, triggers, electrolyte imbalances

- pharm tx: anticholinergics, antihistamines, cannabinoids, serotonin, phenothiazines, dopamine antagonist

- non pharm tx: nutrition, well ventilated environment, electrolyte/ fluid replacement, acupressure, peppermint oil, ginger, breathing exercises, etc.

diarrhea etiology

3 loose stools/day

-secrete too much fluid

-not absorbing enough water

-move too quickly through bowel

diarrhea tx

treat cause, fluid/electrolyte support, nutrition support, antidiarrheal meds, fecal transplant for severe C-Diff

constipation etiology

irregular/infrequent stool

caused by diverticulitis, too much water absorption, or a bowel obstruction

constipation tx

treat cause, increase fiber and water, limit low fiber, limit processed foods, increase exercise and activity, beware of laxatives

malnutrition etiology

inadequate intake

of energy and/or nutrients

etiology: starvation related, chronic disease-related, acute injury/disease related

Malnutrition tx

pharm: Enteral nutrition, TPN, supplements, IV fluids

non-pharm: promoting balanced diet, dealing with underlying issues, dietician consult, regularly measure weight

nc for Enteral nutrition

check tube placement

assess bowel sounds

flush tube

evaluate

use liquid meds only

HOB 30-45

nc for TPN

aseptic tecnique

change q24 hrs

control rate with pump

check pump

label solution

2nd rn should verify

check formula

obesity:

excessively high body fat or adipose tissue

rf: leading cause of death, DM,CAD, cancers, CV, resp, sleep, msk problems

tx: holisitic is most effective

nutrition, excersise, behavioral therapy

short term defecit, long term behavior changes

aging and the GI system

- dental caries, periodontal disease
- decreased tastebuds
- sense of smell lessens
- less saliva
- delayed emptying of the esophagus
- decreased HCl acid secretion
- constipation
-liver size decreased
- gallbladder disease
- risk for decreased food intake
- inability to obtain food

compartment syndrome

increased pressure in a limited anatomical space i.e splint, cast, crush injury, edema, fascia in the bones become hypoxic

tx: fasciotomy, early detection, neurovascular checks on pts with fractures

fat emboli

catecholamines mobilize fatty acids from adipose tissue causing respirtory distress, neuro changes, and petichial rash

tx: respiratory support, IV fluids, vasculature drugs, cardiac support

traction patients

-weights kept hanging
-maintain wts over midline
-maintain alignment
-assess skin throughout

age related adult MSK

- bone loss
- decreased muscle mass
- joint stiffness due to cartilage loss
- decreased range of motion
- altered posture

post op management and education

monitor vs, LOC, TCBD, pain, nutritio, prevention of infection, watch for complications, bleeding, correct position of operative extremity, neurovascular checks, progressive ambulation
at home: 1-3 day low impact, anticoags, pumps, scds, blood tranfusion, wt. bearing restrictions

lumbar laminectomy

back pain that interferes w/ ADLS may require surgery

-removes all or part of vertebrae bone to relieve compression of cord or nerve by injury, disk , spinal stenosis, or tumors

dc teaching: gradually return to ADLs no heavy lifting for 4-6 yrs, post-op, no bending, twisting, sitting for extended periods of time, work return depends on occupation

developmental dysplasia of the hip

higher in girls, family history =high risk, breech intrauterine position, no straight leg swaddle, x-rays not reliable

Three degrees of DDH

*Acetabular dysplasia* (preluxation): Mildest form; osseous hypoplasia of the acetabular roof, Femoral head remains in the acetabulum

*Subluxation*

-incomplete dislocation of the hip

*Dislocation*

-femoral head loses contact with the acetabulum and is displaced posteriorly and superiorly; ligaments are elongated and taut

osteogenesis imperfecta

inherited condition of deformed and abnormally brittle bones, 12 kinds ranked by severity -teaching: careful handling of the child/infant, limitation/suitable activities for the child, genetic counseling, etc.

Scoliosis therapies

- bracings
- surgical management for severe cases
- exercises and PT

Scoliosis post-op management and nursing care

- log roll to move pt.

- wound assess

- skin assess

- pain assess

- VS

- circulation

- neuro checks

- ambulate when approved

- s/s of complications or infection

Nursing care for idiopathic arthritis

- relieve pain

- promote general health and comfort

- facilitate adherence to therapies for management

- exercise

- family support

What are the differences between osteomyelitis and septic arthritis?

Osteomyelitis is an infection to the bone whereas septic arthritis is an infection to the joints, both has varied causes with age but osteomyelitis is usually cause by Staphylococcus aureus

cerebral palsy etiology

- Prenatal infections, or diseases of the mother

- Mechanical trauma to the head before, during, or after birth

- Exposure to nerve-damaging poisons or reduced oxygen supply to the brain

cerebral palsy problems

disturbances of sensation, perception, communication, cognition, and social behavior, musculoskeletal problems

Myelomeningocele (spina bifida) clinical manifestations

- neural tube fails to close in utero

- sensory disturbances, motor dysfunction

- varies by location

- below 2nd lumbar vertebra: flaccid, partial paralysis, etc.

- below 3rd vertebra: no motor impairment, bladder/anal sphincter paralysis

- joint deformities

Myelomeningocele (spina bifida) associated medical problems

- hydrocephaly

- latex hypersensitivity

- exposed nerve endings

- neurogenic bladder

- UTI risk

Duchenne muscular dystrophy etiology

X-linked recessive disorder that mostly effects males, 1/3 of mutations mother is not the carrier, most sever MD

Duchenne muscular dystrophy clinical manifestations

- muscle weakness around 3-7 years

- progressive muscle weakness/wasting

- calf muscle hypertrophy

- loss of independent ambulation by 9-12yrs

- progression to death from resp/cardiac failure

-Gower sign

Guillain-Barre syndrome etiology

acute demyelinating polyneuropathy with progressive, ascending flaccid paralysis, immune mediated: approx 10 days after a nonspecific viral/bacterial infection

Guillane Barre Syndrome clinical manifestations

- initially, muscle tenderness/weakness

- paresthesia

- paralysis rapidly ascends from lower extremities

- may involve trunk, arms, and face

- flaccid paralysis

- intercostal and phrenic nerves involved

Causes of spinal cord injury in children

- MVA is most common

- sport injuries

- birth trauma

- non-accidental trauma

Nursing care for spinal cord injuries in children

- respiratory support

- cardiovascular support

- temperature regulation

- skin care

- physical therapy

- neurogenic bladder care

- bowel training

- autonomic dysreflexia care

- remobilization if possible

- rehabilitation

- sexuality counseling

- transition to adulthood

Skin lesions assessment

- erythema
- ecchymoses (bruises)
- petechiae: pinpoint spots
- primary lesions: macules, papules, and vescicles, produced by causative factor
- secondary lesions: alteration in primary lesions
- distribution pattern
- configuration and arrangement: ABCDE's

peds skin infection: impetigo contaginosa

staph, simple skin irritation, vescicular regains w/ exudate HONEY COLORED CRUSTS
very contagious, itchy, around mouth, nose,
preschool/toddlers
topical and oral antibiotics

peds skin infection: cellulitis

skin and subq skin inflamamtion
intense redness and swelling, firm infiltration, strep, staph, hae influenza
oral/IV antibiotics , warm compress,
facial w/ otitis media

Nursing care and family education for bacterial skin infections

- prevent spread of infection
- prevent complications
- caution child not to touch infected area as self inoculation can occur
- emphasize handwashing to both child and family
- educate to not squeeze or pop lesions
- effected eyes are wiped from inner to outer corner
- educate on full antibiotic therapy regimen

peds skin infection: viral warts

well-circumscribed gray or brown elevated firm papules w/ roughened papillomatous texture
human papillomavirus
tx: local destructive therapy, can reinfect self

peds skin infection: HSV

cold sore, fever blister is type I
type II: genital
grouped vescicular regions
-pain, burning, tingling, itching, crusts over 2-8 days, compelte in 8-10 days, oral/topical antiviral

peds skin infection: molluscum contagiosum

benign, superficial skin disease, pox virus, self limited if left alone, small, pearly, flesh covered papules, cheesy core, contact, autoinocuable, mostly unnecessary to treat

Nursing care and family education with viral skin infections

- educate that diseases are typically Autoinoculable and contagious
- infections May be superimposed on eczema
- never squeeze or destroy lesions
- hospitalization may be necessary
- some secondary infection can occur

tinea capitis

ringworm of the scalp

tinea corporis

ringworm of the body, Arms, legs, trunk, neck, and other exposed body areas

tinea pedis

fungal infection of the foot; athlete's foot

nursing care and family education of ringworm/fungal infections

- emphasize good health and hygiene
- no exchanging grooming items
- can be spread through animals: check household pets
- certain shampoos to assist
- griseofulvin therapy
- maintaining antibiotic therapy management

scabies (peds)

minute grayish brown threadlike black dot at end of burrow, puritic, hands, armpit, knee, groin
under 2 hads and wrist
over two feet and ankles
permethrin, take 2-3 week, treat whole family

pediculosus capitus

head lice, common in school age, nits on hair shaft, diffrentiate from lint/dandruft, occipital, behind ears and neck, pediculide, and mannual removal, transferred person to person

nursing care and family education for lice

- teach about removal of nits and eggs
- lice do not jump or fly, explain transmission
- teach prevention measures to prevent reccurance

eczema peds

inflammation of dermatis, itching, defective epidermal barrier, asthma, ellergic rhinitis, food allergies, family hx, antecubital, extensor surfaces, control not cure (hydrate, diet, steroids)