NUR 265 EXAM 4: HIGH-YIELD REVIEW
AND KEY CONCEPTS
Lupus: Hallmark sign
butterfly rash on face
Lupus: Indication of flare
Fever and fatigue
*also assess BUN function
*c reactive protein remains normal
Lupus: Interventions
-Falls precautions
-treat pain with tylenol and NSAIDS (monitor kidney function)
-AVOID SUNLIGHT
-REPORT FLARE IMMEDIATELY
-clean skin with mild soap and pat dry and apply lotion
Lupus: medical management
-hydroxychloroquine(anti-malarial) decreases absorption of UV light
Scleroderma
inflammatory, autoimmune connective tissue disease
Scleroderma: Hallmark Sign
Hard, leather-like edematous skin
Late: esophageal dismotility
Scleroderma: Assess
Swallow safety--esophageal dysmotility (ASPIRATION)
O2
,circulation
skin
Scleroderma: Interventions
aspiration precautions (keep HOB at 60 degrees during meals and after)
skin protection measures
small frequent meals--avoid caffeine and alcohol
-avoid spices, caffeine and pepper
fibromyalgia: S/sx
extreme fatigure
GI symptoms
dysuria
blurred vision
forgetfulness
fibromyalgia: Assess
pain level
extreme fatigue
GI symptoms
Fibromyalgia: Interventions
NSAIDS
Nuerontin (gabapentin)
Lyrica (pregabalin)
SNRI and tricyclic antidepressants (amitriptyline)
promote sleep and low impact exercise (stretching, walking, swimming, rowing, water exercise)
Lyme Disease: Hallmark sign
stage 1: "bulls eye rash" and flu-like symptoms
Stage 2: facial paralysis, carditis, meningitis
Lyme Disease: Assess
Skin
history of tick bites
Lyme Disease: Interventions
prevention!
Insect repellant with DEET
early stage--doxycycline antibiotics ORAL
late stage--Iv antibiotics (ceftriaxone)
avoid tall grass
, wear light colored clothing
have pets wear tick collars
Allergic Reaction Priority
STOP THE INFUSION/ELIMINATE the trigger, then STOP the immune response
Give Epi
maintain airway
Latex allergy: risks
-frequent use of latex condoms
-healthcare workers
-allergy to avocados, bananas, and some nuts
Anaphylactic shock
AIRWAY--give epi IV or IM STAT and intubate if needed
BREATHING--apply O2; mechanically ventilate
CIRCULATION--monitor for distributive shock; give fluids
Epinephrine Auto-injector teaching
always carry 2 devices
inject by "stabbing" into top of thigh with pants on (AVOID pockets)
call 911 immediately--patient still needs to be monitored
keep epi in cool dark place.
Immunocompromised Patient
-Do not drink anything that has been sitting out
-take temp at least once per day
-clean toothbrush once weekly in diswasher or bleach solution
-do not eat raw foods; salad, cottage cheese
-do not scoop litter boxes
-no plants or soil exposure
-antibacterial soap
-AVOID reptiles
HIV: Assess
CD4 count
ELISA test once per year for at risk patients
HIV: Interventions
PREVENTION:
-condoms
-PreP (truvada) must take 4 consecutive days in a row before protected; cant miss more than one dose
in a row
AND KEY CONCEPTS
Lupus: Hallmark sign
butterfly rash on face
Lupus: Indication of flare
Fever and fatigue
*also assess BUN function
*c reactive protein remains normal
Lupus: Interventions
-Falls precautions
-treat pain with tylenol and NSAIDS (monitor kidney function)
-AVOID SUNLIGHT
-REPORT FLARE IMMEDIATELY
-clean skin with mild soap and pat dry and apply lotion
Lupus: medical management
-hydroxychloroquine(anti-malarial) decreases absorption of UV light
Scleroderma
inflammatory, autoimmune connective tissue disease
Scleroderma: Hallmark Sign
Hard, leather-like edematous skin
Late: esophageal dismotility
Scleroderma: Assess
Swallow safety--esophageal dysmotility (ASPIRATION)
O2
,circulation
skin
Scleroderma: Interventions
aspiration precautions (keep HOB at 60 degrees during meals and after)
skin protection measures
small frequent meals--avoid caffeine and alcohol
-avoid spices, caffeine and pepper
fibromyalgia: S/sx
extreme fatigure
GI symptoms
dysuria
blurred vision
forgetfulness
fibromyalgia: Assess
pain level
extreme fatigue
GI symptoms
Fibromyalgia: Interventions
NSAIDS
Nuerontin (gabapentin)
Lyrica (pregabalin)
SNRI and tricyclic antidepressants (amitriptyline)
promote sleep and low impact exercise (stretching, walking, swimming, rowing, water exercise)
Lyme Disease: Hallmark sign
stage 1: "bulls eye rash" and flu-like symptoms
Stage 2: facial paralysis, carditis, meningitis
Lyme Disease: Assess
Skin
history of tick bites
Lyme Disease: Interventions
prevention!
Insect repellant with DEET
early stage--doxycycline antibiotics ORAL
late stage--Iv antibiotics (ceftriaxone)
avoid tall grass
, wear light colored clothing
have pets wear tick collars
Allergic Reaction Priority
STOP THE INFUSION/ELIMINATE the trigger, then STOP the immune response
Give Epi
maintain airway
Latex allergy: risks
-frequent use of latex condoms
-healthcare workers
-allergy to avocados, bananas, and some nuts
Anaphylactic shock
AIRWAY--give epi IV or IM STAT and intubate if needed
BREATHING--apply O2; mechanically ventilate
CIRCULATION--monitor for distributive shock; give fluids
Epinephrine Auto-injector teaching
always carry 2 devices
inject by "stabbing" into top of thigh with pants on (AVOID pockets)
call 911 immediately--patient still needs to be monitored
keep epi in cool dark place.
Immunocompromised Patient
-Do not drink anything that has been sitting out
-take temp at least once per day
-clean toothbrush once weekly in diswasher or bleach solution
-do not eat raw foods; salad, cottage cheese
-do not scoop litter boxes
-no plants or soil exposure
-antibacterial soap
-AVOID reptiles
HIV: Assess
CD4 count
ELISA test once per year for at risk patients
HIV: Interventions
PREVENTION:
-condoms
-PreP (truvada) must take 4 consecutive days in a row before protected; cant miss more than one dose
in a row
