Neurological Disorders
What are the differences in CSF fluid with a bacterial or viral infection?
Bacterial: >30 pressure, turbid, increased protein, decreased glucose, positive gram stain, <0.4 glucose, predominately neutrophils
Viral: normal or mildly increased pressure, clear, normal to decreased protein, normal glucose, negative gram stain, >0.6 glucose, predominately lymphocytes
Name 4 risk factors for Primary Osteoporosis
Older age, parental history of osteoporosis especially in mothers, history of low-trauma fracture after age 50, low body weight, thin build, chronic low calcium or vitamin D, estrogen or androgen deficiency, current smoking, high alcohol intake (>3/day), lack of physical exercise or prolonged immobility
What is the maximum dose of Acetaminophen a day?
4000 mg/day or 3000 mg/day for long-term, alcoholism, and liver disease
Make sure to teach them to read OTC medications because many contain acetaminophen
What are the risk factors of breast cancer?
high dose RT to thorax, early menarche (<12 years), late menopause (>50 years), history of previous breast cancer, nulliparity, first birth after age 30 years, BRCA1 or BRCA2 genetic mutation
How long must you live in gender role before getting a gender reassignment surgery?
What is the difference between delirium and dementia?
Dementia: a chronic progressive cognitive decline, slow, over months to years, unknown cause possibly familial, not reversible, treat s/s, Nursing interventions: reorientation is not effective in late stages, use validation therapy, provide safe environment, observe for hallucinations & delusions
Delirium: acute fluctuating confusional state, fast, hours to less than a month, causes: surgery, infection, drugs; may be reversible, remove or treat cause, Nursing Interventions: reorient the patient to reality, provide a safe environment
Taking Ca++ supplements can cause GI upset. What teaching can you give a patient to prevent this?
Take with food and 6-8 oz of water
What are the contraindications to having a total joint arthroplasty?
Active infection anywhere in the body, advanced osteoporosis, or rapidly progressive inflammation.
CANNOT HAVE A FEVER
What are some health teaching points for patients having brachytherapy for gynecologic cancer?
Report s/s of heavy vaginal bleeding, urethral bleeding >24 hours, blood in urine, extreme fatigue, severe diarrhea, fever over 100, abdominal pain.
Teach she is not radioactive between treatments and there are no restrictions on her interactions with others.
What are some side effects of estrogen therapy?
VTE, increased BG, HTN, estrogen-dependent cancers, fluid retention, HA
What are some adverse effects of dopamine agonists?
Orthostatic hypotension, hallucinations, sleepiness, drowsiness.
Remind patients to avoid operating heavy machinery or driving if they have any of these symptoms. teach them to change from lying or sitting position by moving slowly.
What are important patient teaching points for cast care?
Elevate cast above level of heart: first 24 to 48 hr to prevent swelling, able to insert 1 finger between cast & the skin, report increase in amount of drainage, older patients at increased risk for impaired skin integrity
Do not place foreign objects under cast, relieve itching under cast (blow cool air w/ hair dryer), plastic cover over cast to avoid soiling, plastic bag during bath/shower
Differentiate the RA from OA
OA: older than 60; female (2:1); risk factors:aging, genetic factor, obesity, trauma, occupation; may be unilateral, single joint; affects weight bearing joints; nonsystemic; normal or slightly elevated ESR; Drug therapy: NSAIDs short-term, acetaminophen
RA: 35-45; female (3:1); autoimmune; emotional stress triggers exacerbation, environmental factors; inflammatory; bilateral, symmetric multiple joints, usually upper extremities first; systemic; elevated rheumatoid factor, antinuclear antibody & ESR; Drug therapy: NSAIDs short-term, Methotrexate, Corticosteroids, Biological response modifiers
What are the differences in the size and consistency of the prostate in BPH vs. Prostate cancer?
BPH: uniform elastic, nontender enlargement
Prostate cancer: stony hard nodule with palpable indurations
Reminder: prostate specific antigen (PSA) is elevated in BPH and prostate cancer
What are some common side effects of testosterone therapy?
DM, Heart disease, stroke
Edema, acne, seborrhea, HA, weight gain, psychotic symptoms, increased liver enzymes, increased BG, increased LDL & decrease HDL, decrease clotting factors
What is an important teaching point to someone with migraines who is going to take an ergotamine preparation
Don't take within 24 hours of triptan drug
What is the #1 nursing priority after a fasciotomy?
Prevent infections
What are the important hip precautions teaching points post THA?
What are complications of a Transrectal Ultrasound with Bx?
Infection (fever,chills), hematuria, perineal pain, difficulty voiding
Teach to avoid strenuous activity and increase fluid intake
What do you monitor Post-op vaginoplasty?
Monitor: LE neurovascular status, move legs often during first 24 hours post op. Report: continued numbness, inability to move LE
Vital signs, I&Os, icepack to perineum to decrease bruising, report oozing or bright red blood, remove JP drain in 3-5 days (<15-20 mL/24 hours), 1 week post-op remove surgical pressure dressings, packing, and external sutures
Patients with MS often exhibit impaired cognition what are some nursing interventions you can do for this patient?
Calendar in room, keep things in familiar places, do not move without permission of patient, frequent orientation
What are the early s/s of a fat embolism?
Altered mental status, dyspnea and chest pain, petechiae rash (over neck, upper arms or chest & abdomen)***, respiratory failure/death
What are interventions for esophageal involvement of Systemic Sclerosis?
When taking phosphodiesterase-5 inhibitors for erectile dysfunction what should the nurse instruct the patient to avoid?
Nitrates! Can cause profound hypotension- s/s chest pain, Irregular heart beat, SOB, Dizziness
How can you create a safe welcoming environment for LGBTQ+ patients?
Post the patient bill of rights and nondiscrimination policies in a visible place, make waiting rooms inclusive such as posting Safe Zone, rainbow or pink triangles, designate unisex or single-stall restrooms, ensure visitation policies are equitable, avoid assumptions about identity, include gender-neutral language, reflect patients choice of terminology, become knowledgeable, provide community resources