Heath & Illness Exam 3

What is the most common anemia worldwide?

Iron-deficiency anemia

What are some causes of iron deficiency anemia?

Inadequate iron intake, rapid metabolic activity (infection, pregnancy), blood loss, poor GI absorption, chronic alcoholism.

What is the key assessment for iron deficiency anemia?

Assess for bleeding & diet patterns.

What are some signs and symptoms of iron deficiency anemia?

Pallor, weakness, shortness of breath, fatigue, activity intolerance.

What lab confirms iron deficiency anemia?

low ferritin levels

First line management of iron deficiency anemia?

increase our intake; iron supplements (PO or IV) as indicated

What vitamin source can be used to help with the absorption of oral iron?

vitamin c

What are some iron rich foods that could help?

all options are correct sources

What are some causes of B12 deficiency?

vegan/low protein, intake, malabsorption

What causes pernicious anemia?

lack intrinsic factor (GI mucosa) which is needed to absorb B12, gastrectomy

What is a key finding of B12 deficiency?

smooth, beefy red tongue (glossitis)

What neuro signs should someone with B12 deficiency need to look out for?

Paresthesias and poor balance

Signs and symptoms of B12 deficiency?

pallor, jaundice, fatigue, weight loss, paresthesia and poor balance

If increasing oral intake is recommended for treating B12 deficiency, when is IM injections needed?

for severe cases or pernicious anemia

What are some dietary sources of B12?

fish, eggs, dairy, brewers yeast, dried beans, nuts, citrus, fruits, and green leafy vegetables.

What are some causes of folic(folate) acid deficiency? 

Poor nutrition, malabsorption(crohns, celiac disease), anticonvulsants, oral contraceptives

What is the difference between folate and B12 deficiency?

folate presents with the same symptoms of B12, but without neurologic involvement.

What is the treatment for folate deficiency?

increase intake + folic acid supplementation.

What are the best folate food sources?

green leafy vegetables, dried beans, nuts, and citrus juices/fruits

What are some causes of aplastic anemia?

radiation, sulfonamides, hepatitis B, epstien-barr virus, cytomegalovirus 

Signs and symptoms of aplastic anemia

weakness, pallor, petechiae/ecchymosis

What labs identify aplastic anemia?

Pancytopenia: low RBCs, WBCs (leukopenia), and platelets  (thrombocytopenia)

True or false? For aplastic anemia blood transfusion if severe and immunosuppressive drugs if autoimmune?

True

When should a splenectomy be considered for aplastic anemia?

if the spleen is destroying RBCs

What's the first step in treating drug induced aplastic anemia?

discontinue the responsible drug

Pain

All statements are true

Addiction:

impaired control over drug use, compulsive use, continued use despite risk of harm; this is a chronic & biological disease that is treatable.

Pseudo-addiction:

symptoms suggestive of addiction but pain relief releaves these symptoms, usually associated with inadequate pain management.

Tolerance:

Occurs with regular administration of opioid, decrease in the side effects of the opioid (dec. pain relief, does not sedate them and no resp. depression. The body adapts and needs more drug to achieve desired effect.

Physical dependence:

Not addiction, Response happens with repeated exposure to opioids. Accompanied by withdrawal symptoms when opioid is stopped abruptly or not tapered.

Breakthrough Pain:

exacerbation of pain – when patient had relatively controlled base-line pain.

Who is at risk for pain?

everyone

Acute:

sudden onset, sharp/stabbing, improves over time, linked to illness or an event, severe

Chronic:

pain last more than 3 months to years, gradual onset, and can be accompanied with depression

Cancer Pain:

pain from the pathology of the tumor

Non-cancer pain:

aching, cramping, burning.  EX: OA, injury, medical treatment, inflammation

What are the signs & symptoms of pain?

sharp, stabbing, dull ache, throbbing, pinching, stinging, burning, sore, uncomfortable

Somatic pain

localized, tissue damage or injury: develops in your skin, muscles, ligaments, tendons, joints, or bones; sharp, aching, cramping, throbbing

Examples of somatic pain

Sunburn, surgery (case study today), trauma, sprained ankle, cut finger, broken bone

Visceral pain

poorly localized, happening from within the body, can develop in the internal organs

Examples of visceral pain

inflammation (ulcerative colitis), arthritis, osteoporosis, appendix, cardiac, gallbladder (thorax, abdomen, pelvis)

Neuropathic pain

Nerve damage secondary to a pathology, burning, shooting, sharp, prickling sensation – we usually know where the pain is coming from

Examples of neuropathic pain

phantom limb pain, slipped discs, shingles, diabetes (peripheral neuropathy)

What is phantom limb pain?

Pain in the missing body part, this pain is real.

Mixed pain

both nociceptive and neuropathic

Examples of mixed pain

low back pain, migraines, fibromyalgia, tumors can also cause mixed pain

How would you know which type of pain the patient was experiencing?

Assess and ask them what the pain feels like.

How do you assess pain?

OLDCARTS

Treatment of Pain

NSAIDs, oral/IV opioids, patient controlled analgesia, epidural intrathecal, adjuvants

Non pharmacologic treatment of pain:

Transcutaneous electrical nerve stimulation, physical therapy, heat, cold, exercise, yoga, relaxation techniques, repositioning, acupressure

What should the nurse teach the patient and spouse when it comes to patient-controlled analgesia (PCA)

ONLY the patient may activate the PCA.

Which response by the nurse is appropriate for assessing pain?

All the responses are appropriate

Which statement by the nurse would be most helpful in determining if a patient has nociceptive or neuropathic pain?

Describe what your pain feels like

Pain often times described as sharp or stabbing

Acute

Pain that improves over time

Acute

Quick or sudden onset pain

Acute 

Pain often accompanied with depression

Chronic

Pain often at times described as aching, cramping, or burning

Chronic

Pain that lasts for over 3-6 months

Chronic

Gradual onset pain

Chronic

Which medication would be ideal for phantom limb pain?

gabapentin (Neurontin)

A nurse should never say a patient is exaggerating their pain.

True

Which of the following is a common side effect of the NSAID's?

GI irritation 

As a patient advocate, which action is the primary role of the nurse in pain management?

Accepting the patient's report of pain

If a patient is in a deep sleep and unresponsive to verbal and physical stimuli. Which Pasero Opioid-Induced Sedation Scale (POSS) score would the nurse document?

4

If a patient is experiencing N&V and states their pain is 7 on a 1 to 10 scale.  Which route of administration will the nurse most likely choose to administer their analgesic medication?

IV

Glasgow Coma Scale checks..

Eye, verbal, and motor response

Seizure

Abnormal, sudden , excessive, uncontrolled electrical discharge of neurons in the brain

Epilepsy

Two or more seizures experienced by a person

Seizure lasting longer than 10 minutes can cause

death

Things that causes status epilepticus 

stopping AEDS, infection, alcohol, metabolic imbalances, drug withdrawl

Multiple Sclerosis

a chronic, immune-mediated disorder of the central nervous system where inflammation damages myelin in the brain, spinal cord, and optic nerves.

Relapsing MS

most common, characterized by clearly defined relapses, followed by complete or partial recovery periods (remissions).

Primary Progressive MS

characterized by a steady worsening of symptoms from the beginning, without any relapses or remissions. (40-60 years old

Secondary Progressive MS

characterized by a steady worsening of symptoms, with or without occasional relapses and remissions.

Progressive-Relapsing MS

rare, but often characterized by a sudden onset of severe symptoms and rapid progression within days or weeks.

AS (Amyotrophic Lateral Sclerosis)

a progressive neurodegenerative disease that destroys upper and lower motor neurons in the brain and spinal cord. Life expectancy 2-4 years

AS (Amyotrophic Lateral Sclerosis) is most common in

men 40-60 years

Multiple Sclerosis is most common in

women 20-50 years

Guillain Barre Syndrome (GBS)

an acute, immune-mediated polyneuropathy in which the body’s immune system attacks the myelin of peripheral nerves, usually after a recent infection.

Out of Multiple Sclerosis, ALS, and Guillain Barre Syndrome which one is temporary?

Guillain Barre Syndrome

A client with amyotrophic lateral sclerosis (ALS) is experiencing difficulty swallowing. What intervention can the nurse implement to address this problem?

Offer thicken liquids or pureed foods.

Which of the following is a common treatment for Guillain Barre syndrome (GBS)?

Intravenous immunoglobulin (IVIG)

A client with amyotrophic lateral sclerosis (ALS) is experiencing weakness in the arms and legs. What intervention can the nurse implement to promote mobility?

Encourage the client to engage in physical therapy.

Primary symptom of amyotrophic lateral sclerosis (ALS)?

Muscle weakness and atrophy, difficulty with speech and swallowing, muscle twitching and cramping

Gait changes

Ataxia

Decreased visual acuity

Diplopia

Difficulty swallowing

Dysphagia

Muscle weakness or loss of muscle function beginning in the legs and spreads to the arms

Ascending paralysis 

Diffuse, random patchy areas of plaque along the CNS

Demyelination

Shortness of air

Dyspnea

Slurring speech

Dysarthria

Guillain Barre syndrome (GBS) is a rare autoimmune disorder where the immune system mistakenly attacks the peripheral nervous system.

True

Common symptoms of Guillain Barre syndrome (GBS)?

Paralysis, respiratory distress, numbness or tingling in the limbs

Which of the following diagnostic tests is commonly used to confirm a diagnosis of multiple sclerosis (MS)?

Magnetic resonance imaging (MRI)

Multiple Sclerosis cause

unknown: immune, environmental, genetic, and infectious factors.

Amyotrophic Lateral Sclerosis (ALS) is

chronic neurologic disease involving brain, spinal cord, and motor neurons. (upper and lower)

Guillain Barre Syndrome time course

rapid onset, few days to month

Guillain Barre Syndrome phases

acute (rise of symptoms), plateau (no changes or worsening), and recovery

Multiple Sclerosis hallmark symptoms

Spasticity, ataxia, paresthesias, dysarthria, tremors, fatigue; ↓ vision (diplopia) and later cognition changes.