Chapter 46
Arthritis
Arthritis
Does RA have morning stiffness or stiffness at the end of the day?
MORNING
RA is improved with range of motion exercises & movement
Name the accessory organs of blood formation and their function
Liver-produces prothrombin and other clotting factors. Liver function is needed to form vitamin K needed to produce clotting factors.
A patient begins to have breathing difficulty after starting a RBC blood transfusion. What should the nurse do first?
Stop the transfusion
Describe first aid care for patients with lightening strike injuries
THEN
Hospital care
ABC. CPR (NO rescuer harm)
Spine stabilization
12 lead ECG
Identify injuries
CT scan to identify intracranial hemorrhage
CK to check for rhabdomyolysis
Priority care for patients in Resuscitative/emergent phase of burns
Hemodynamic stability
FLUIDS
Assess BP, HR, RR, Color, Skin turgor, I&Os, etc.
What foods should a person avoid to prevent Gout flares?
Foods with PURINES
Organ meats, some seafood, red meats
Gout is a build up of uric acids that from from breakdown of purines
Describe the process of hemostasis
Injury, vasoconstriction, platelet aggregation/platelet plug, prothrombin, thrombin, fibrinogen, fibrin, formation of fibrin clot (mesh like base)
Describe a hemolytic reaction (patho) and signs/symptoms
Donor blood is incompatible
NEED T&S & MATCHED CORRECTLY
Low back pain, hypotension, hematuria, tachycardia, chest pain
Name ways to prevent snake bites
Do not keep them as pets
Avoid locations where they can hide
Do not suck the wound or put a tourniquet on
Do not capture the snake
Move away from the snake
Wear protective clothing & shoes
Phase of wound care that prioritizes wound care, nutrition and infection prevention
Acute phase
Name 5 signs and symptoms of OA
Progressive, noninflammatory deterioration and loss of joint cartilage
Pain & impaired mobility
Joint space narrows as cartilage erodes - causes bone spurs
Inflammatory cytokines enhance deterioration causing secondary joint inflammation & joint effusion
Red, warm, painful, swollen
Crepitus - pieces of bone and cartilage float
People 60 years and older, obesity
Heberden (DIP) & Bouchard nodes (PIP)
Page 1004
Describe the process of fibrinolysis
Once healed, plasminogen activates plasmin, plasmin digests fibrin, fibrinogen, and prothrombin
Main cause of iron deficiency anemia
Acetazolamide before trip 24 hours before and for the first 2 days
Explain suspected lab results of a person with a burn injury in the emergent phase
Hyperkalemia, hyponatremia, elevated Hemoglobin and hematocrit
Hemoconcentration
Signs of hip dislocation post total hip arthroplasty & nurses action
One leg shorter than the other & pain
CALL MD, assess neurovascular status (CMS), do not move extremity
Response of the kidneys to low oxygen
Describe the steps of a blood transfusion
Order, consent, T&S, IV, verify 2 RN, vital signs, blood bank, inspect, gently invert, 2 RN, hang, 15 mins monitor for rx. VS per policy
Teach a patient how to prevent high altitude illnesses
Acetazolamide, climb slowly to allow for acclimatization, descent if experiencing s/s of hangover, SOB, confusion
Pre-hospital care for burns
Move away from heat
Cool towels or blankets
Submerge in cold water
NO ICE or BUTTER or lotions
List 5 discharge instructions to give to a patient at discharge after a total hip arthroplasty
PAGE 1012
do not cross legs, do not twist while standing, nonslip socks/shoes, no bending greater than 90 degrees, sit in chairs with handles, shower chair, arm bars, infection prevention
Provide patient education who is going for bone marrow aspiration and biopsy
pg. 789
Local anesthesia, stinging or burning sensation,
heavy pressure and pushing, brief/sharp pain when needle enters bone
crunching sound
Iliac crest or sternum
5-15 minutes
Monitor patient for 24 hours. Assess q 2hr for active bleeding or bruising.
What is leukemia and what are some key features?
Blood cancer resulting in uncontrolled production of immature WBC (Blasts) resulting in overcrowding
Page 804 Key features
Ecchymosis, anorexia, enlarged liver and spleen, joint pain, tachycardia, orthostatic hypotension, dyspnea on exertion, headache, fatigue
Explain the difference between heat stroke and heat exhaustion
AND
Treatment for both
Heat stroke is a medical emergency. Hot and dry skin (can still perspire). Mental status changes, hypotension, tachycardia, oliguria. AIRWAY, Oxygen therapy and intravenous fluids should be provided, and baseline laboratory tests should be performed as quickly as possible. The client should be cooled until core body temperature is reduced to 102° F.
Heat exhaustion - primarily d/t dehydration, heavy perspiration. FLU like symptoms . Stop physical activity, go to a cool place, plenty of fluids, NO salt tablets, cooling packs to neck, chest, abdomen and groin
BEST way to prevent contractures after a burn injury
Range of motion exercises