Final NR 324 Adult Health 1 Chamberlain University PDF

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NR 324 Final Exam 1. Priority labs for patient with HIV, how it is transmitted HIV-related testing include: HIV serology- If prior results demonstrating evidence of HIV infection (HIV antibody or viral load testing) are unavailable and the viral load upon presentation is expected to be undetectable (the patient is taking antiretroviral agents), serologic testing is warranted to establish the diagnosis. CD4 cell count and percentage- Patients with HIV should have a CD4 count and CD4 cell count percentage performed at initiation of care. Viral load-A baseline plasma viral load should be performed upon initiation to care. It affects the selection of antiretroviral regimen (ie, certain drugs should not be used in patients with high HIV RNA levels [ie, >100,000 copies/mL]) and is used to assess response to ART. Resistance testing- HIV genotype testing for mutations in the viral reverse transcriptase and protease associated with antiretroviral drug resistance is recommended for all patients with HIV entering care, regardless of whether ART is initiated. This should be performed as soon as possible, ideally during acute or early infection. Additional tests to inform ART selection- Prior to initiating certain antiretroviral agents, screening tests may be necessary to evaluate for potential adverse reactions and drug activity: HLA-B*5701 testing should be performed before initiating abacavir therapy. Patients who are positive for the HLA B*5701 haplotype are at high risk for hypersensitivity reaction and should not take this drug. General blood and urine testing , Complete blood count, Renal function, Hepatic function, Urine pregnancy test, Glucose and lipid profile, Screening for co-infections, Viral hepatitis, TB, STIs, cervical, bladder cancer etc. In HIV testing, the Western blot test separates the blood proteins and detects the specific proteins (called HIV antibodies) that indicate an HIV infection. The Western blot test is used to confirm a positive ELISA, and the combined tests are 99.9% accurate. Only certain body fluids from a person who has HIV can transmit HIV. These fluids include: blood, semen (cum), pre-seminal fluid (pre-cum), rectal fluids, vaginal fluids, and breast milk. HIV is not transmitted through saliva. We all know the normal routes; such as anal (riskiest) and vaginal sex, deep open mouth kissing especially with sores, sharing needles and sharp objects, sometimes from mother to baby, piercing and tattooing etc. The general idea is it is spread through contact between broken skin, wounds, or mucous membranes and HIV-infected blood or blood-contaminated body fluids. Deep, open-mouth kissing if both partners have sores or bleeding gums and blood from the HIV-positive partner gets into the bloodstream of the HIV-negative partner. HIV is not spread through saliva.

2. Focused assessment for patient with fractures Signs and Symptoms of a Bone Fracture “BROKEN” Bruising over the site (discolored with swelling) and pain Reduced movement of extremity or muscle Odd appearance (looks abnormal) Krackling sounds due to bone fragments rubbing together (crepitus) Edema and erythema at the site Neurovascular impairment…6 P’s (ischemia: pain, pallor, paralysis, paresthesia, pulselessness (late sign), poikilothermia) Assess neurovascular status- Assess the 6 P’s: this assesses the function of the nerves and blood flow for possible compartment syndrome (if not caught early this will lead to IRREVERSIBLE nerve, muscle, damage and tissue death). 6P’s: Pain (early sign), Paresthesia (can be an early sign too), Pallor, Paralysis, Poikilothermia, Pulselessness (late sign). Compartment syndrome can develop from the fracture itself, due to pressure from bleeding and edema. Or compartment syndrome may occur later, as a result of treatment for the fracture (such as surgery or casting). Acute compartment syndrome can also occur after injuries without bone fractures, including: Crush injuries. 3. Patient teaching for GERD, foods to avoid Foods to avoid include- Alcohol, caffeine, carbonated beverages, chocolate, citrus fruits and juices, tomatoes and tomato-based foods, garlic, mint, onions, spicy foods, fatty foods, and fried foods. 4. Priority actions for blood transfusion reactions Upon recognizing a blood transfusion reaction what you can do include: Stop the transfusion immediately, check and monitor vital signs, maintain intravenous (IV) access (Do not flush existing line and use a new IV line if required), check the pack to ensure the right pack has been given to the right patient. Notify the doctor ASAP. You might need to administer Tylenol and Benadryl. Febrile non-hemolytic and allergic reactions are the most common transfusion reactions, but usually do not cause significant morbidity. In an attempt to prevent these reactions, US physicians prescribe acetaminophen or diphenhydramine (Benadryl) premedication before more than 50% of blood component transfusions. If applicable, alert the blood bank of the reaction as soon as possible! 5. Interpretation of lab values for SLE, risk factors that exacerbate SLE, discharge teaching, signs and symptoms of SLE SLE is an inflammatory disease caused when the immune system attacks its own tissues. Lupus (SLE) can affect the joints, skin, kidneys, blood cells, brain, heart, and lungs. Symptoms vary but

can include fatigue, joint pain, rash, and fever. These can periodically get worse (flare-up) and then improve. While there's no cure for lupus, current treatments focus on improving quality of life through controlling symptoms and minimizing flare-ups. This begins with lifestyle modifications, including sun protection and diet. Further disease management includes medications, such as anti-inflammatories and steroids. 11 signs of lupus- Butterfly-shaped rash, raised red patches on your skin, you're sensitive to light, ulcers in your mouth or nose, arthritis in two or more joints, plus swelling or tenderness, inflammation in the lining of your heart or lungs, seizures or other nerve problems, too much protein in your urine, low blood cell counts, certain antibodies in your blood, results from a blood test called an ANA test that suggest you may have too many "antinuclear" antibodies (ANA). 98% of all people with systemic lupus have a positive ANA test, making it the most sensitive diagnostic test for confirming diagnosis of the disease. Population at risk: SLE can affect people of all ages, including children. However, women of childbearing ages—15 to 44 years—are at greatest risk of developing SLE. Women of all ages are affected far more than men (estimates range from 4 to 12 women for every 1 man). Some potential triggers include: 

Sunlight. Exposure to the sun may bring on lupus skin lesions or trigger an internal response in susceptible people.

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Infections. Having an infection can initiate lupus or cause a relapse in some people.

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Medications.

Emotional stress such as a divorce, death in the family, or other life complications and anything that causes physical stress to the body such as surgery, physical harm, pregnancy, or giving birth are examples of triggers that can set off lupus or bring about a lupus flare.

6. Risk factors for AIDS patients with low CD4 count and discharge teaching for AIDS Risk for opportunistic infection. Teach about oral hygiene, mental health, ways to prevent spread etc. 7. Patient teaching about low-FODMAP diet for IBS A low-FODMAP diet is designed to help people with irritable bowel syndrome (IBS) have better control over their symptoms by limiting certain foods. FODMAPs stands for fermentable oligo-saccharides, di-saccharides, mono-saccharides and polyols. List of low FODMAP foods to eat may include- Alfalfa sprouts, Bean sprouts, Bell pepper, Carrot, Green beans, Bok choy and Cucumber.

8. Foods that promote wound healing Among the best foods for wound healing are proteins such as: Meat, poultry or fish also, tofu, beans, eggs, milk, cheese, Greek yogurt, soy nuts etc. 9. Reasons for increase WBC The main causes of elevated white blood cells include: To fight a viral, fungal, bacterial, or parasitic infection. A negative reaction to a drug that triggers an immune and white blood cell response. Disease or malfunction that causes the bone marrow to overproduce white blood cells.KEY WORD- INFECTION! 10. Rationale for patient having idiopathic thrombocytopenic purpura (ITP). Idiopathic thrombocytopenic purpura (ITP) may occur when the immune system mistakenly attacks platelets. In children, it may follow a viral infection. In adults, it may be chronic. Symptoms may include easy bruising, bleeding, and pinpoint-sized reddish-purple spots on the lower legs. In children, ITP usually resolves without any treatment. Adults commonly need treatment with medications for bleeding. Rarely the spleen may need to be removed. 11. Foods for iron deficiency anemia Red meat, pork and poultry, seafood, beans, dark green leafy vegetables, such as spinach, dried fruit, such as raisins and apricots, iron-fortified cereals, breads and pastas and peas. 12. Types of blood transfusion reactions Acute transfusion reactions are typically classified into the following entities:  Transfusion-related acute lung injury (TRALI)  Circulatory (volume) overload.  Bacterial contamination and endotoxemia.  Acute hemolytic reactions.  Nonhemolytic febrile reactions.  Allergic reactions. Note that delayed reactions can also occur. 13. Medications to prevent osteoporosis and medications that are risk factors, patient teaching on prevention of osteoporosis Medications usually tried first- Alendronate (Fosamax), a weekly pill, Risedronate (Actonel), a weekly or monthly pill, Ibandronate (Boniva), a monthly pill or quarterly intravenous (IV) infusion and Zoledronic acid (Reclast), an annual IV infusion. Also, calcium and vitamin D supplements. Patients should be told to do strength training such as lifting weight. They can also eat food rich in calcium and vitamin D- Milk, fish etc.

The medications most commonly associated with osteoporosis include phenytoin, phenobarbital, carbamazepine, and primidone. These antiepileptic drugs (AEDs) are all potent inducers of CYP450 isoenzymes. Depo also puts patients at risk for osteoporosis!!! 14. Risk factors and patient teaching for osteoarthritis and osteoporosis See above- or just research more about this. Age is a factor, medication side effects, diet, exercise, pathological fractures may occur with osteoporosis etc. 15. Patient teaching on back pain Applying ice to the painful areas of the back may help reduce pain and inflammation from an injury. Do so several times a day for up to 20 minutes each time. Wrap the ice pack in a thin towel to protect your skin. Take medication as ordered. Go to physical therapy. Allow rest between activities. Use proper lifting techniques etc. 16. Late and early manifestation of rheumatoid arthritis Signs and symptoms of rheumatoid arthritis may include: Tender, warm, swollen joints. Joint stiffness that is usually worse in the mornings and after inactivity. Fatigue, fever and loss of appetite. In end-stage RA, people may still experience pain, swelling, stiffness, and mobility loss. There may be reduced muscle strength. The joints may become destroyed, and the bones become fused together (ankylosis). 17. Risk factors and Complications of peptic ulcer disease A bacteria causes most stomach ulcers- Helicobacter pylori (H. pylori). Complications include- Internal bleeding, bleeding can occur as slow blood loss that leads to anemia or as severe blood loss that may require hospitalization or a blood transfusion. A hole (perforation) in your stomach wall. Obstruction and Gastric cancer. Check out Barrett's esophagus- a potentially serious complication of GERD. Barrett’s esophagus is usually the result of repeated exposure to stomach acid. 18. Nursing interventions for pernicious anemia Nursing Interventions for Pernicious Anemia include- educating patients about importance of eating enough foods with iron, vitamin C, and folic acid because these nutrients play a role in red blood cell production as well. Maintain good oral hygiene due to changes to tongue. Provide supplemental oxygen therapy, as needed. Anticipate the need for the transfusion of packed RBCs. Educate energy-conservation techniques. Assist the client in developing a schedule for daily activity and rest. Stress the importance of frequent rest periods. Assist the client in planning and prioritizing activities of daily living (ADL).

19. Herbal supplements for chronic constipation Senna is a popular safe and effective herbal laxative that helps treat constipation 20. Complications of fractured femur Possible complications include: Infection, bleeding, nerve damage, blood clots, fat embolism, healing of the fractured bone in an abnormal alignment, irritation of the overlying tissue from the hardware, and complications from anesthesia. 21. Causes if Disseminated Intravascular Coagulation and priority lab values Blood transfusion reaction, cancer, especially certain types of leukemia, inflammation of the pancreas (pancreatitis), infection in the blood, especially by bacteria or fungus (SEPSIS), liver disease, pregnancy complications (such as placenta that is left behind after delivery), recent surgery or anesthesia, severe tissue injury (as in burns and head injury) and large hemangioma (a blood vessel that is not formed properly). In clinical practice, a diagnosis of DIC can often be made by a combination of the following tests: Platelet count, global clotting times (aPTT and PT), one or two clotting factors inhibitors (eg, antithrombin) and assay for D-dimer or FDPs. 22. Key nursing assessment prior to blood transfusion Patients should be under regular visual observation and, for every unit transfused, minimum monitoring should include: Pre-transfusion pulse (P), blood pressure (BP), temperature (T) and respiratory rate (RR). P, BP and T 15 minutes after start of transfusion – if significant change, check RR as well. If there are any symptoms or signs of a possible reaction – monitor and record P, BP, T and RR and take appropriate action. Post-transfusion P, BP and T – not more than 60 minutes after transfusion completed. Inpatients observed over next 24 hours and outpatients advised to report late symptoms (24-hour access to clinical advice). Research how often vitals should be checked during transfusion. 23. Assessment of clear drainage from head fractures Symptoms of CSF leaks include a constant dripping of clear fluid from the nose, severe headaches and meningitis. Leaks of CSF are usually caused by blunt trauma to the head and/or ears or prior sinonasal surgery. However, spontaneous CSF leaks can occur in patients with elevated intracranial pressure NOTE THIS!--> Clear fluid from the ears or nose – as in the case of a skull fracture, especially a fracture to the base of the skull, can allow cerebrospinal fluid to leak from the ears or nose.

Black eyes and bruised skin behind the ears – this indicates that the force of the blow was sufficient to rupture blood vessels around the eyes and ears. 24. Pt teaching for patients taking naproxen for RA Naproxen is a medicine that reduces inflammation and pain in joints and muscles. It's used to treat diseases of joints, such as rheumatoid arthritis, osteoarthritis and gout. It's also used for period pain and muscle and bone disorders, such as back pain and sprains and strains. Even at the correct doses, NSAIDs generally need to be used for several weeks before taking full effect. If the initial dose of NSAIDs does not improve symptoms, a clinician may recommend increasing the dose gradually or switching to another NSAID. You should not take two different NSAIDs at the same time. Patients should take medication before pain occurs and should be on top of pain and not chase the pain. 25. Pt teaching for ferrous sulfate for iron deficiency anemia Generally I say take with vitamin C supplements or vitamin C reach products such as oranges or orange juice to help with absorption. Eating a well-balanced diet rich in iron would also help. Constipation may occur while on ferrous sulfate. Also, black tarry stool while on iron is normal. Spinach is rich in iron, but the iron in spinach is more when cooked. Red meat products are good as well. 26. Adverse effects of zidovudine as part of antiretroviral therapy for HIV Common side effects of Retrovir include: headache, nausea, vomiting, constipation, trouble sleeping (insomnia), loss of appetite, joint pain, and changes in the shape or location of body fat (especially in your arms, legs, face, neck, breasts, and trunk). 27. Signs of wound dehiscence and nursing action Some common symptoms of dehiscence are: Broken sutures that don't heal, bleeding from wound and bleeds at the surgical wound entry points, fever, inflammation, pain at the wound site with high sensitivity to touch, sudden opening of the wound, swelling, and wound drainage-pusfilled and frothy. Dehiscence and evisceration can be a life threatening emergency; do not leave the client immediately call for help and, using a clean, sterile towel or sterile saline dampened dressing, cover the wound. Superficial dehiscence usually just requires washing out the wound with saline and then simple wound care (e.g. packing the wound with absorbent ribbon gauze). The patient should be advised the wound will now be required to heal by secondary intention and that this can take several weeks. 28. Adverse effects of aspirin for clients with RA

Potential side effects are- Abdominal cramps, pain or discomfort; diarrhea; dizziness; drowsiness; headache; heartburn; nausea; swelling of the feet; vomiting, rash, gastrointestinal ulcerations, abdominal pain, upset stomach, gastritis, and bleeding. Nothing specific but note this- Aspirin has been linked with Reye's syndrome, so use caution when giving aspirin to children or teenagers for fever or pain. Though aspirin is approved for use in children older than age 3, children and teenagers recovering from chickenpox or flu-like symptoms should never take aspirin. NCLEX loves this Very high levels of aspirin in the blood can have toxic effects. Tinnitus, a ringing or whistling noise in the ear and hearing loss are among them. But there's no risk of that happening at an 81-mg dose. 29. Types of blood transfusion reactions Acute transfusion reactions are typically classified into the following entities:      

Transfusion-related acute lung injury (TRALI) Circulatory (volume) overload. Bacterial contamination and endotoxemia. Acute hemolytic reactions. Nonhemolytic febrile reactions. Allergic reactions.

30. Complications of B12 deficiency Complications of vitamin B12 deficiency include: vision problems, memory loss, pins and needles (paraesthesia), loss of physical co-ordination (ataxia), which can affect your whole body and cause difficulty speaking or walking, damage to parts of the nervous system (peripheral neuropathy), particularly in the legs. 31. Drugs for osteoarthritis eg Tylenol And other Nonsteroidal anti-inflammatory drugs (NSAIDs) meds such as- Over-thecounter NSAIDs. Including: ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve, others), taken at the recommended doses, typically relieve osteoarthritis pain. Stronger NSAIDs are available by prescription. 32. Complications of fractures e. Fat embolism See above for question 32. Wernicke syndrome and Korsakoff syndrome are related disorders that often occur due to a deficiency of thiamine (vitamin B1)....