NR 302 Exam 2 Concept Review 1 CH.12 Structures and functions of skin, hair, nails Ski | Exams Nursing

NR i324 iFinal iExam iReview

1. Types iof iTraction

Skin: iWeights iattached ito ipatient’s iskin ito idecrease imuscle ispams iand iimmobilize ithe iextremity

ibefore isurgery. iEx iBryant itraction i(for ihip idysplasia iin ichildren) iand iBuck i‘s itraction ifor ihip

ifracture iin iadult ipatients).

Skeletal: iScrews iare iinserted iinto ibone. iUsed ifor ilong ibone ifractures isuch ias ifemur, itibia, ifibula,

ihumerus, iulna, iradius, imetacarpals, iphalanges iand imetatarsals.

Halo: iused ifor icervical ibone ifractures. iNurse ishould imake isure iwrench ito irelease irods iis

iattached ito ithe ivest, iso iCPR ican ibe iperformed.

Nursing iinterventions

•

Assess ineurovascular istatus ievery ihour ifor ithe i1st i24hrs iand ithen ievery i4 ihours.

•

Do inot ilift ior iremove iweights

•

Do inot ilet iweights irest ion ifloor i(make isure ithey iare ihanging ifreely)

•

Muscle ispams iare iexpected iand ishould ibe itreated iw/meds, irepositioning, iheat, ior

imessage. iUnrelieved imuscle ispasms ishould ibe ireported ito iprovider.

•

For ihalo itraction, imove ipatient ias ia iunit iand ido inot iapply ipressure ito irods.

•

Monitor ifor iskin ibreakdown

2. Lupus

Autoimmune idisorder ithat icauses ichronic iinflammation iin ithe ibody. iThere iis ino icure. iThere iare i2

itypes. iSystemic i– iaffects ithe iconnective itissues iin imultiple iorgans. iDiscoid i- iaffects iskin

i(butterfly irash).

Risk ifactors: iFemale, iages i20-40, irace i(Africa iAmerican, iAsian, iNative iAmerican)

iS&S: iFatigue, ijoint ipain, ifever, ibutterfly irash ion iface, idepression, iedema, iRaynaud’s

iphenomenon, ianemia, ipericarditis, ilymphadenopathy.

Lab: ipositive iANA ititer, idecreased iserum icompletement i(C3/C4), idecreased iRBC, iWBC, iplatelets.

iIncrease iBUN iand icreatinine iwith ikidney iinvolvement.

Med: iNSAIDs, iimmunosuppressant iagents i(prednisone, imethotrexate), iantimalaria idrugs

i(hydroxychloroquine), itopical isteroid icreams ifor irash.

Interventions: iAvoid iUV/sun iexposure, iavoid isick ipeople, istress, icold iweather, iinfection,

ipregnancy, ipatient ishould iuse imild iprotein ishampoo ito iwash ihair.

3. Gout

Inflammatory iarthritis, iresulting iin iformation iof iuric iacid icrystals iin ijoints iand ibody itissues.

Risk: iobesity, ialcohol, ihigh ipurine idiet i(meat), icardiovascular idisease, istarvation idieting.

iS&S: isevere ijoint ipain iin ithe igreat itoe, ierythema, iswelling, iwarmth iin iaffected ijoint, itophi

iw/chronic igout.

Med: icolchicine, iNSAIDs, iCorticosteriods, iallopurinol iand iprobenecid.

Interventions; iPt ishould iavoid ispicy ifood, ibalance idiet, istop ialcohol iconsumption, iand ieat i2hrs

ibefore ibedtime.

4. HIV/AIDS

Retrovirus ithat itargets iCD4+ ilymphocytes i(T-cells), iresulting iin idecreased iimmune ifunction iand

isusceptibility ito iinfections. iAIDS i= istage i3 i(end-stage) iHIV iinfection.

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NR i 324 iFinal iExam iReview

1. Types iof iTraction Skin : iWeights iattached ito ipatient’s iskin ito idecrease imuscle ispams iand iimmobilize ithe iextremity ibefore isurgery. iEx i Bryant itraction i (for ihip idysplasia iin ichildren) iand i Buck i‘s itraction i for ihip ifracture iin iadult ipatients). Skeletal: i Screws iare iinserted iinto ibone. iUsed ifor ilong ibone ifractures isuch ias ifemur, itibia, ifibula, ihumerus, iulna, iradius, imetacarpals, iphalanges iand imetatarsals. Halo: i used ifor icervical ibone ifractures. i Nurse ishould imake isure iwrench ito irelease irods iis iattached ito ithe ivest, iso iCPR ican ibe iperformed. Nursing iinterventions - Assess ineurovascular istatus ievery ihour ifor ithe i 1 st^ i24hrs iand ithen ievery i 4 ihours. - Do inot ilift ior iremove iweights - Do inot ilet iweights irest ion ifloor i(make isure ithey iare ihanging ifreely) - Muscle ispams iare iexpected iand ishould ibe itreated iw/meds, irepositioning, iheat, ior imessage. iUnrelieved imuscle ispasms ishould ibe ireported ito iprovider. - For ihalo itraction, imove ipatient ias ia iunit iand ido inot iapply ipressure ito irods. - Monitor ifor iskin ibreakdown 2. Lupus Autoimmune idisorder ithat icauses ichronic iinflammation iin ithe ibody. iThere iis ino icure. iThere iarei 2 itypes. i Systemic i – iaffects ithe iconnective itissues iin imultiple iorgans. i Discoid i - iaffects iskin i(butterfly irash). Risk ifactors : iFemale, iages i 20 - 40, irace i(Africa iAmerican, iAsian, iNative iAmerican) i S& S: iFatigue, ijoint ipain, ifever, ibutterfly irash ion iface, idepression, iedema, iRaynaud’s iphenomenon, ianemia, ipericarditis, ilymphadenopathy. Lab: i positive iANA ititer, idecreased iserum icompletement i(C3/C4), idecreased iRBC, iWBC, iplatelets. iIncrease iBUN iand icreatinine iwith ikidney iinvolvement. Med: i NSAIDs, iimmunosuppressant iagents i(prednisone, imethotrexate), iantimalaria idrugs i(hydroxychloroquine), itopical isteroid icreams ifor irash. Interventions: i Avoid iUV/sun iexposure, iavoid isick ipeople, istress, icold iweather, iinfection, ipregnancy, ipatient ishould iuse imild iprotein ishampoo ito iwash ihair. 3. Gout Inflammatory iarthritis, iresulting iin iformation iof iuric iacid icrystals iin ijoints iand ibody itissues. Risk: i obesity, ialcohol, ihigh ipurine idiet i(meat), icardiovascular idisease, istarvation idieting. i S&S : isevere ijoint ipain iin ithe igreat itoe, ierythema, iswelling, iwarmth iin iaffected ijoint, itophi iw/chronic igout. Med: i colchicine, iNSAIDs, iCorticosteriods, iallopurinol iand iprobenecid. Interventions ; iPt ishould iavoid ispicy ifood, ibalance idiet, istop ialcohol iconsumption, iand ieat i2hrs ibefore ibedtime. 4. HIV/AIDS Retrovirus ithat itargets iCD4+ ilymphocytes i(T-cells), iresulting iin idecreased iimmune ifunction iand isusceptibility ito iinfections. iAIDS i= istage i 3 i(end-stage) iHIV iinfection.

RF: i Unprotective isex, imultiple isec ipartners, iperinatal iexposure, iIV idrug iuse, ihealth icare iworkers. S&S: i Flu-like isymptoms, iweakness, inight isweats, iheadache, iweight iloss iand irashiStage i 3 i(AIDS)

CD4+ icount i< i 200 icells/mm
Symptoms: i Kaposi’s isarcoma, iTB, iPneumonia, iwasting isyndrome, icandidiasis iof ithe iairways, iherpes, iother iinfection Diagnosis: i positive iELISA itest, iconfirmed iwith iWestern iblot itest. Med: i 3 - 4 iAntiretroviral imedications i (ending iwith iVir) Patient iteaching:
Practice igood ihand ihygiene, ibathes idaily iwith iantimicrobial isoap
Avoid iraw ifoods
Don’t iclean icat ilitter iboxes
Avoid isick ipeople
Practices isafe isex
Ongoing imonitoring iof iCD4+ icounts 5. Rheumatoid iArthritis i(RA) Chronic, iprogressive iautoimmune idisease ithat icause iinflammation, ithickening iand ideformationiof ithe ijoints. iJoints iare iaffected ibilaterally iand isymmetrically. RF: i Female igender, iage i 20 - 50, igenetics S&S: i joint ipain, imorning istiffness, ifatigue, ijoint iswelling iwith ierythema iand iwarmth, iswan ineck iand iboutonniere ideformities iin ifingers, isubcutaneous inodules, ifever ired isclera iand ilymphadenopathy Labs: i positive iRheumatoid ifactor i(RF) iantibody, ipositive iANA ititer, iElevated iWBCs, iESR iand iCRP i Diagnosis : iArthrocentesis i(aspiration iof isynovial ifluid ifrom ijoint) ito itest ifor iWBCs iand iRF i Meds: i NSAIDs, iimmunosuppressants i(prednisone, imethotrexate), iantimalarial iagents i(hydroxychloroquine). Procedures: i Plasmapheresis i(to iremove iantibodies ifrom iblood) itotal ijoint iarthroplasty Complications: i Sjogren’s isyndrome i(dry ieyes, idry imouth, idry ivagina) Patient ieducation
Take ihot ishower ito irelieve imorning istiffness
Physical iactivity ito ipreserve iROM
Use iof iassistive idevices 6. Osteoarthritis Progressive idegeneration iof iarticular icartilage iin ijoints. RF: i Older iage, iwomen, iobesity, ismoking, irepetitive istress ion ijoints S&S: i Joint ipain/stiffness, icrepitus, ienlarged ijoints, iHerberden’s inodes i( idistal iinterphalangeal ijoints), iBouchard’s inode i( iproximal iinterphalangeal ijoints). Meds : iOral ianalgesics i(acetaminophen, iNSAIDs), iTopical ianalgesics i(capsaicin), iGlucosamine, iinjection iof iglucocorticoids, iand ihyaluronic iacid Surgery: i total ijoint iarthroplasty Interventions
Apply iIce i( iacute iinflammation) ior iheat

Comminuted ifracture : ibone isplit iin imultiple ipieces
Compression ifracture: i one ior imore ibones iin ispine iweaken iand icollapse i(due ito iloading iforce
Oblique ifracture: i fracture ioccurs iat ioblique iangle
Spiral ifracture: i fracture ifrom itwisting imotion i(sign iof iabuse, iespecially iin ichildren. 10. Fracture iComplications I. Fat iembolism: Fat iglobule ifrom ibone imarrow itravels ito ilungs, iimpairing irespirations. iLong ibone iand ihipifracture iare imost icommon. S/S: i Dyspnea, iconfusion i(early isign), itachypnea, itachycardia, ipetechiae ion iupper ibody i(late isign) II. Osteomyelitis: It’s ia ibone iinfection S/S: i bone ipain, ierythema, iedema, ifever, ielevated iWBC Treatment : iLong i-term iantibiotic itherapy, isurgical idebridement iof ibone, ihyperbaric ioxygen itherapy. 11. Casts Nurse iteaching iand icare
Handle iplaster icast iwith ipalms i(not ifingertips) iand iwear igloves iuntil icast iis idry.
Elevate icast iabove ilever iof iheart ifor ithe i 1 st^ i 24 - 48 ihours.
Capillary irefill
Tell ipatient inot ito iplace iobjects iunder icast
Itching ican ibe irelieved iby iblowing icold iair ifrom ia ihair idryer iunder icast.
Reports ito iprovider: ihot ispots, iareas iwith iincreased idrainage, imalodorous iareas. 12. Compartment isyndrome Increase ipressure iwithin imuscle icompartment iof ian iextremity ithat iimpairs icirculation. iAssessment iis ineurovascular iassessment. S&S: iIntense ipain iwith ipassive imovement, iparesthesia i(early isign), iparalysis i(late isign), ipallor, ipulselessness i(late isign) iand ihard/swollen imuscles. Treatment: iFasciotomy 13. Ulcerative icolitis iand iCrohn’s iDisease They iare iboth iinflammatory ibowel idisease ithat icause iinflammation iin ithe idigestive itract. iUlcerative icolitis iaffects ithe ilarge iintestine iand irectum icausing icontinuous ilesions, iwhile iCrohn’siis iwidespread ibecause iit ican iaffect iany ipart iof ithe idigestive itract iand ialso ihave ifistula. Lab: i decreased iHct/Hbg iand ialbumin. iIncreased iESR, iCRP iand iWBC RF: i genetics, iCaucasians, iJewish idescent, istress, iautoimmune idisorder. Meds: i 5 - aminisalicylin iacid i(ex: iSulfasalazine), icorticosteroids i(ex: iprednisone), iImmunosuppressant i(ex: icyclosporine), iantidiarrheals ie.g. iloperamide. Interventions

Monitor ifor isigns iof iperitonitis i(rigid/board ilike iabdomen, irebound itenderness, ifever, itachycardia, inausea iand ivomiting)
Monitor iI&Os, ielectrolytes i(risk ifor ihypokalemia)
NPO iduring iexacerbation
East ifood ihigh iin iprotein iand icalories iand ilow iin ifiber
Avoid icaffeine iand ialcohol
East ismall imeals ifrequently Ulcerative icolitis Crohn’s iDisease Diverticulitis Inflammation iof ithe icolon, icausing icontinuous ilesions. iChronic iblood iloss ican icause anemia. Inflammation iand iulceration iof ithe ismall iintestine, icausing isporadic ilesions iand irisk ifor fistula Inflammation iof idiverticular i(small ipouched iin ithe icolon) ican iperforate iand icause peritonitis LLQ ipain, ifever, i 12 - 20 iliquid istools/day, iabdominal idistention iand ipain, mucus/blood/pus iin istools. RLQ ipain, ifever, i 5 iloose istools/day, imucus/pus iin istools, iabdominal idistention, iand ipain, steatorrea LLQ ipain, inausea, ivomiting, ifever, iand ichills. 14. Peptic iUlcer iDisease Is ian ierosion iin ithe istomach, iesophagus, ior iduodenum imucosa i. iPriority ifinding iis ihemetamesis RF: i H. ipylori iinfection, iNSAID iuse, istress. S&S: i nausea, ivomiting, iheartburn, ibloating, ibloody iemesis ior istools, iand ipain:
Gastric iUlcer : ipain i 30 - 60nmin iafter imeal, iworse iin ia iday, iworse iwith ieating.
Duodenal iulcer: i pain i1.5-3hrs iafter imeal, iworse iin inight, ibetter iwith imeal ior iantacids Diagnosis: i Esophagogastroduodenoscopy i(EGD) Meds: i antibiotic ito iprevent iresistance i(metronidazole, iamoxicillin, iclarithromycin iand itetracycline), iH2 ireceptor iantagonist i(ranitidine), iPPI i(pantoprazole), iAntacids i( itake i 1 - 3 ihrs iafter imeals, i 1 ihr iapart ifrom iother imeds) iand iMucosal iprotectant i( isucralfate, igiven i 1 ihr ibefore imeals iand iat ibedtime. Teaching: Avoid iacid-producing ifoods i(Milk, icaffeine, ispicy ifoods) iand iavoid iNSAIDs. Complications: Perforation iresulting iin ihemorrhaging: i s/s isevere iepigastric ipain, irigid/board-like iabdomen, irebound itenderness, ihypotension, iand itachycardia. 15. Gastroesophageal ireflux idisease i(GERD) Gastric icontents iincluding ienzymes ibackflow iinto iesophagus icausing ipain iand imucosal idamage i(esophagitis iBarrett’s iepithelium). iExacerbation iis ichocolate RF: i Obesity, ismoking, ialcohol iuse, iolder iage, ipregnancy, iascites, ihiatal ihernia, isupine iposition,idiet ihigh iin ifatty/fried/spicy ifoods, icaffeine, icitrus ifruits. S&S: i Dyspepsia i( iindigestion), ithroat iirritation, ibitter itaste, iburning ipain iin iesophagus, ipain iworsen iwhen ilaying idown, iimproves iwith isitting iupright, iand ichronic icough.

NR 302 Exam 2 Concept Review 1 CH.12 Structures and functions of skin, hair, nails Ski, Exams of Nursing

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