Integumentary Disorders
What type of diet should be recommended for a patient with burns?
High calorie, high protein, high Vitamin C, high Zinc
What are 2 activity limitations a person needs to follow after a total hip replacement?
1.) no flexing the hip beyond 90 degrees (no sitting in low chairs, no bending over to tie shoe while sitting down, etc.)
2.) no adducting the leg (no sleeping with the knees together, no crossing the legs, etc.)
List 3 Drugs that are considered "ototoxic."
Vancomycin
Gentamicin
Aspirin
Loop diuretics (furosemide, bumetanide, etc.)
List 2 Benefits of Heat application.
List 2 Benefits of Ice application.
Heat Application:
Promotes vasodilation and improved circulation, helps muscles relax, promotes wound healing
Indicated for: chronic pain, muscle spasms, joint stiffness, chronic wounds (vasodilates to promote healing)
Cold Application:
Promotes vasoconstriction, reduces inflammation and swelling by decreasing blood flow.
Indicated for: acute orthopedic injuries (best applied within 48hrs of injury) sprained ankle and other acute orthopedic injuries, reduces fevers/swelling/bruising/bleeding/inflammation.
Remember: Never use extreme heat, and never put ice directly on skin. Do not keep ice on skin for longer than 20 min at a time. A minimum of 30 minutes should pass before cold therapy is reapplied. If numbness or mottling of skin occurs, this indicates that cold therapy is TOO cold and the ice should be removed.
Describe the steps to obtaining a wound culture.
What is the pathophysiology of Gout?
List 2 dietary recommendations you would educate the patient about?
Pathophysiology: caused by hyperuricemia (accumulation of uric acid in the blood). Uric acid crystallizes in body tissues (this is called Tophi) which causes local inflammation and irritation.
Patient Education: Low-purine diet (shellfish, shrimp, game meats, beer & alcohol), weight loss to decrease serum uric acid levels. To reduce the risk of kidney stones with gout, advise patient to drink 2 quarts of water daily.
How should you hold the ear when administering ear drop to a child?
Pull the pinna down & back.
BONUS: which is the #1 priority?
BONUS #2: what is the best way of assessing the effects of fluid resuscitation?
1.) smoke inhalation
2.) fluid & electrolyte balance / hypovolemic shock 3.) infection
BONUS: #1 priority = smoke inhalation (think ABCs)
BONUS #2: Urine output. Goal = 50mL/hr
List 3 Risk factors for Skin Cancer.
1. Family history
2. Exposure to UV rays
3. Tanning bed use
4. Outdoor profession (fisherman, truck driver, construction worker)
5. Fair skin
6. Older age
7. Large number of moles
List 2 examples of steroid medications.
List 5 side effects of steroids.
Corticosteroids: prednisone, methylprednisolone, dexamethasone, hydrocortisone, betamethasone,
Side effects: hyperglycemia, decreased bone density (osteoporosis), immunosuppression (decreased immune response), delayed wound healing, weight gain, sodium & water retention, edema, hypertension, irritability and mood changes, hunger, osteoporosis, peptic ulcers, GI discomfort, Cushing’s syndrome (moon face, buffalo hump, purple striae).
List 2 causes of Sensorineural hearing loss & 2 causes of Conductive hearing loss
Conductive: Impacted earwax, Foreign body, Trauma, Allergies, Middle ear Tumors
Sensorineural Hearing Loss: Trauma, Head injury, Excessive Noise / Exposure to explosions, Aging: Presbycusis, Ototoxic drugs (aminoglycosides such as vancomycin, salicylates such as aspirin, loop diuretics such as lasix), Ménière disease
A child weighing 25 kg is prescribed ibuprofen at 8 mg/kg/day to be taken in divided doses every 6 hours. The pharmacy provides the medication in 100 mg tablets. How many tablets should the child take per dose? Insert leading zeros. Eliminate trailing zeros. If necessary, round to the nearest tenth.
0.5 tabs per dose.
List 3 things a nurse can do to decrease the risk for skin breakdown.
Turn Q2hrs. No more than 30 degree HOB elevation. Avoid friction/shearing. Encourage high protein diet & adequate hydration. Keep patient dry (Apply barrier cream, frequent incontinence checks). Prop up heels with pillows.
Avoid frequent hot baths with strong soaps, avoid massaging bony prominences, avoid donut pillows
Compare & Contrast Rheumatoid Arthritis vs. Osteoarthritis.
-Pathophysiology: describe the patho of RA vs. OA.
-Deformities: list 1 seen in RA and 1 seen in OA
-Characteristics: List 1 characteristic of RA and 1 of OA (hint: systemic? bilateral?)
Osteoarthritis:
Patho: "wear & tear" disease, chronic degeneration of cartilage in a joint. think "bone on bone"
Deformities: Heberden's nodes, Bouchard's nodes.
Characteristics: affects unilateral joints, weight-bearing joints, chronic "wear & tear," pain worse after activity & better after rest, often has "crepitus"
Rheumatoid Arthritis:
Patho: chronic inflammation due to autoimmune process. SYSTEMIC.
Deformities: Swan neck deformity, boutonniere deformity, ulnar deviation.
Characteristics: bilateral, autoimmune in nature, has exacerbations & remissions, has systemic symptoms (fever, fatigue, eye/skin/kidney problems), morning stiffness lasting at least 1 hour.
List 3 necessary instructions to provide when giving discharge education to a client after cataract surgery.
1. avoid anything that increases IOP (lifting >15 lbs, straining to have a BM, vigorous coughing, bending over at the waist)
2. wear a metal eye shield at night for 1 week
3. wear eye patch for 24 hrs after surgery
4. sleep on the NON-operative side
5. wear sunglasses when outdoors
6. don't immerse the eyes in water
7. vision may be blurry until healing is complete at 8 weeks.
8. watch out for signs of retinal detachment (flashes of light, curtain sensation, floaters, cobwebs, etc.)
List 3 Risk Factors for Skin Breakdown.
1. Low Braden scale score
2. Incontinence
3. Malnutrition
4. Smoking
5. Corticosteroid Use
6. Older age (>65yrs)
7. Immobility/Bedrest
8. Diabetes
What does the ABCDE acronym stand for in regards to concerning findings for malignant melanoma?
A: asymmetry
B: borders (uneven)
C: color (multi)
D: diameter (greater than 6mm or size of pencil eraser)
E: evolution
What does the acronym PRICE stand for and when should it be used?
PRICE is used for acute injuries (sprained ankle, strained knee, soft tissue injuries/bruising etc.)
Protection - from further injury (immobilization w/ cast, splint, or brace)
Rest
Ice - for first 24-48 hours
Compression - with elastic bandage (wrapping upward)
Elevation
Additional Treatment:
After 2 days, when swelling is no longer likely to increase, applying heat can reduce pain and improve circulation.
NSAIDs can be used to ease discomfort.
Identify the visual disorder associated with each of the following symptoms (each symptom corresponds to a different disorder):
-Loss of peripheral vision
-Blurred, cloudy, or hazy vision
-Loss of central vision
-Flashes of bright light, floaters, and sensation of a curtain being drawn over the field of vision
Loss of peripheral vision: glaucoma
Blurred or cloudy vision: cataracts
Loss of central vision: macular degeneration
Flashes of bright light, floaters, and sensation of a curtain being drawn over the field of vision: retinal detachment
Name 2 similarities between NSAIDS & Acetaminophen.
Name 2 differences between NSAIDS & Acetaminophen.
Similarities: both available over-the-counter. Both analgesics (pain meds). Both antipyretics (Fever reducers).
Differences:
NSAIDs: ibuprofen (Motrin, Advil), naproxen, celebrex, aspirin. These are anti-inflammatories (acetaminophen is NOT). Very irritating to GI tract. Can cause GI bleeds and stomach ulcers. Red flag symptoms are hematemesis (blood in vomit), coffee-ground emesis (indicates blood in vomit as well), and melena (dark black, tarry stools - also indicates a GI bleed). Very hard on the KIDNEYS.
Acetaminophen (Tylenol): Very hard on the LIVER. Do not take more than 4g (or 4,000mg) in 24 hours. This is the FIRST LINE treatment for osteoarthritis, before NSAIDs.