Treatment
What is the primary treatment for Paget's Disease
Biphosphates
What is Osteoarthritis's pathophysiology?
Progressive cartilage destruction → joint space narrowing → bone articulates with bone → osteophyte formation (bone spurs) → subchondral bone thickening → synovial inflammation → joint deformity.
A client who weighs 70 kg is receiving a dopamine solution of 800 mg/500 ml normal saline at 5 ml/hour. How many mcg/kg/minute is the client receiving? (Enter numeric value only. If rounding is required, round to the nearest tenth.)
1.9
A teen comes in with persistent bone pain that worsens on night. What is this disease and what is the most common site for it?
Paget's disease and the distal femur
What are the four treatments for osteosarcoma?
Neoadjuvant chemotherapy
Surgical resection
adjuvant chemotherapy
amputation
Paget's Disease
Osteolytic Phase:
Excess osteoclast activity, Bone breakdown, Rapid resorption
Mixed Phase:
Osteoblasts attempt repair, Disorganized woven bone forms, Bone becomes enlarged
Sclerotic Phase:
Dense but brittle bone, Prone to deformity and fracture
A client is receiving an IV solution of sodium chloride 0.9% (Normal Saline) 250 ml with amiodarone (Cordarone) 1 gram at 17 ml/hour. How many mg/minute of amiodarone is infusing? (Enter numeric value only. If rounding is required, round to the nearest tenth.)
Convert grams to mg, 1 gram equals 1,000 mg. Using ratio and proportion - 1,000 mg : 250 ml :: X mg : 1ml 250X= 1,000 so X = 4 mg/ml is the solution concentration of amiodarone. The infusion rate (ml/hour) x concentration (mg/ml) divided by 60 minutes/hour 17 ml/hour x 4 mg/ml = 68/60 = 1.13 = 1.1 mg/minute.
A 65-year-old female obese patient comes in with pain in her knees. The patient reports having morning stiffness for less than 30 minutes. The pain worsens with activity but improves with rest. The nurse assess the patient and finds crepitation and swelling of the weight-bearing joints. What is this disease?
Osteoarthritis
A doctor diagnoses your patient with osteoarthritis. What would be the expected treatment for this patient? (5)
Weight Management for less pressure on joints
Exercise: Low-impact aerobic exercise,
Heat / Cold: Heat preferred for stiffness, Cold for acute swelling (15–20 minutes per session)
Joint Protection: Avoid prolonged kneeling/squatting, Use proper body mechanics, Avoid large pillows under knees (contracture risk)
Assistive Devices: Cane (held on opposite side of affected joint), Walker, Elevated toilet seat, Supportive footwear
Osteoporosis
This is the imbalance between osteoclast and osteoblast.
A client who weighs 176 pounds is receiving an IV infusion with esmolol hydrochloride (Brevibloc) at 48 ml/hour. The IV solution is labeled with the concentration of Brevibloc 10 mg/ml. How many mcg/kg/minute is the client receiving? (Enter numeric value only.)
100
Convert pounds to kg by dividing 176 pounds by 2.2 pounds = 80 kg. Convert the IV concentration from mg to mcg. 1 mg : 1000 mcg :: 10 mg : 10,000 mcg. Infusion rate (48 ml/hour) x concentration (10,000 mcg/ml) divided by 60 minutes/hour x 80 kg = 48 x 10,000 divided by 60 x 80 = 480,000 / 4800 = 100 mcg/kg/minute.
You suspect a patient has Gout based on the uric acid level of ?
more than 6.8
How would a nurse treat Acute attack of Gout versus a chronic prevention of gout?
Acute:
NSAIDs, Colchicine, Corticosteroids but not allopurinal
Chronic:
Allopurionol (XOI) or Febuxostate, Uricosuric Agent and Losartan
Raynaud
Endothelial dysfunction
Imbalance between vasodilators (↓ nitric oxide)
Increased vasoconstrictors (↑ endothelin-1)
Abnormal autonomic thermoregulation
Excessive vasospasm of digital arteries
Result → transient ischemia of digits.
The nurse is preparing the change-of-shift report for a client who has a 265 ml secondary infusion that was started 2 hours ago at a rate of 85 ml/hour via an infusion pump. The nurse should report that how many ml remain to be infused by the on-coming nurse? (Enter numeric value only.)
95
85 ml x 2 hours = 170 ml has infused. 265 ml (total amount to be infused) - 170 ml (amount infused) = 95 ml remain to be infused.
What are the expected clinical manifestations of Raynaud something?
Classic Triphasic Color Change:
⚪ White (Pallor):Vasospasm, Reduced perfusion, Cold, numb fingers
🔵 Blue (Cyanosis):Sluggish blood flow, Tissue hypoxia, Aching or pain
🔴 Red (Rubor): Reperfusion, Throbbing pain, Tingling, Swelling
Episodes last: Minutes to hours
Triggers 🚨: Cold exposure, Emotional stress, Tobacco, Caffeine, Sudden temperature changes
How would Raynaud Phenomena's treatment be expected pharmacological wise?
First-Line:
Sustained-release calcium channel blockers (Nifedipine)
Relax smooth muscle
Reduce frequency and severity of attacks
Second-Line:
PDE-5 inhibitors (Sildenafil)
PDE-5 inhibitors + nitroglycerin → severe hypotension
SLE
Immune system loses self-tolerance
Body makes autoantibodies (against its own DNA & proteins)
Autoantibodies bind antigens → form immune complexes
Immune complexes deposit in tissues leads to inflammation & tissue damage
This is mainly a Type III hypersensitivity reaction, “Antibody–antigen complexes get stuck in organs and cause inflammation.”
A male client receives a prescription for ondansetron hydrochloride (Zofran) 4 mg IV to prevent postoperative nausea after an inguinal hernia repair. The medication is available in 2 mg/ml. How many ml should the nurse administer? (Enter numeric value only.)
Use ratio and proportion, 4 mg : X ml = 2 mg : 1 ml 2X = 4 X = 2
What are the expected clinical Manifestations of SLE?
General: Fatigue, Fever, Weight loss, Flares and remissions
Skin: Butterfly (malar) rash 🦋, Photosensitivity, Oral ulcers (painless)
Joints: Symmetric joint pain and swelling, Non-erosive arthritis
Blood : Anemia, Leukopenia, Thrombocytopenia
Kidneys (Lupus nephritis): Proteinuria, Hematuria, Elevated creatinine, Can lead to renal failure
CNS: Headache, Seizures, Confusion, Mood changes