NR 324 / NR324 Exam 2 (2026–2027 UPDATED) Adult Health I | Question & Answer Study Guide | 100% Accurate Solutions | Guaranteed Grade A – Chamberlain

NR 324 / NR324 Exam 2 (2026–2027 UPDATED) Adult Health I | Question & Answer Study Guide | 100% Accurate Solutions | Guaranteed Grade A – Chamberlain Q. What is RICE? ANSWER Rest Ice Compression Elevation Q. What are we doing when applying RICE? ANSWER Decreasing inflammation Good for sprains and strains Q. What are some things the nurse needs to assess, for a patient that has a fracture? ANSWER Assessment with the 5 P's - Stabalize the limp and keep it immobile Q. What are the Five P's ANSWER Pain/ Pressure Pulses Pallor Paresthesia Paralysis Q. What indicates an early signs of compartment syndrome? ANSWER Pain Q. What are some causes of compartment syndrome? ANSWER Early casting IV infiltration Trauma Q. What are some risk factors for colorectal cancer? ANSWER Family history RED meat diet History of polyps Q. What are signs and symptoms of colorectal cancer? ANSWER Changes in bowel patterns Rectal bleeding Weight loss Q. What do we educated when it comes to preventing colorectal cancer? ANSWER Get your scheduled colonoscopy Reduce red meat intake Increase fiber Q. What are signs and symptoms of GERD? ANSWER Tightening Burning Feeling of a lump in throat Metallic taste Q. What are some interventions for GERD? ANSWER Lifestyle changes such as keeping a food diary. Finding foods that triggers the reaction Q. What are some example of lifestyle changes when it comes to GERD? ANSWER After we eat, we need to sit up for a few hours NO eating before bed Avoid a heavy meal Q. When is the best time to take an anti acid ANSWER 1 hour after eating Q. What other medications can we use to treat GERD? ANSWER PPI Reglan (Metoclopramide) Antiacids Q. What is the difference between UC and Chrons disease? ANSWER Chrons: has skipped lesions, and fissures that turn into fistulas Q. What is ulcerative colitis? ANSWER Ulcerative inflammatory bowel disease, just in the LARGE intestine or colon. - Cannot process B12 and are iron deficient Q. What are similar signs and symptoms for UC and Chrons disease ANSWER Bloody Diarrhea Weight loss Fever Dehydration Q. What are some interventions when dealing with UC? ANSWER Is controlled through diet Ostomy is the last resort Diarrhea - PT is NPO. Q. A patient is dealing with Ulcerative colitis, what diet will they be put on, and what is a nursing intervention to follow? ANSWER Patient will be NPO Nurse will start enteral feedings so nutrition can be handled better. We want to calm the stomach down. Q. What medication is used to treat Ulcerative colitis or Chrons disease? Sulfasalazine (Azulfidine) ANSWER - When taking, the patient should avoid the sun Steroids Immunosuppressants - Be aware of infections (Fever etc.) Q. What is the difference between enteral and parenteral feedings? ANSWER Enteral feedings: Through the stomach Parenteral feedings: TPN through a central line Q. What type of nutrition do we prefer to use? ANSWER Enteral nutrition, prefer to get the stomach moving Q. What are some nursing interventions when a patient is receiving enteral feedings? ANSWER Keep the HOB above 30 degrees, worried about aspiration Check blood glucose Q. What are some causes of Peptic Ulcer Disease? ANSWER H. Pylori NSAIDS: Breakdown the mucosal barrier Stress Alcohol and smoking Hereditary Q. What is an acute PUD? ANSWER Broken down to the submucosal layer on the stomach or small intestine Q. What is chronic PUD? ANSWER ulcers that are present continuously for many months or intermittently throughout a person's lifetime and usually will require medication for the rest of their life - Broken down to the muscle layer Q. What are some complications when dealing with Peptic ulcer disease? ANSWER 1. Hemorrhage (board-like abdomen) 2. Perforation (board-like abdomen) 3. Gastric outlet obstruction (vomiting towards the END OF DAY) Q. What is an interventions regarding peptic ulcer disease? ANSWER NG tube decompression Q. What is an intervention for PUD when we suspect a perforation or hemorrhage? ANSWER SURGERY (Patch) Bilroth 1 Bilroth 2 Q. If a patient has PUD and obtains a Bilroth 2 surgery due to complications, what should the nurse watch out for? ANSWER Dumping syndrome: No control valve Post-pharyngeal hypoglycemia: Pancreases over achieves Q. What should we educate when a patient is dealing with PUD? ANSWER Limit carbs and sugar Encourage small and frequent meals Be careful with the amount of fluids they drink Q. A patient has a colostomy put in, what are some expectations regarding an illeostomy? What should the stoma look like? ANSWER -Ileostomy: Liquid -Fluid and electrolytes imbalance: Make sure to drink extra water -Stoma should look RED Q. Appendicitis signs and symptoms? ANSWER Starts in the periumbilicus then radiates down to the RLQ (McBurneys point) Rebound tenderness Elevated WBCs While waiting for appendicitis surgery, when will the nurse be concerned? Pain is gone. The appendix has ruptured Worried about peritonitis: Can lead to SHOCK How should we position the patient while we are waiting for surgery? Semi fowlers Knees up Can we apply heat to a patient with appendicitis? NO If a patient has sterile strips, is the patient allowed to shower? Yes, the strips will fall off when ready Watch for signs on infection If a patient undergoes appendectomy, how long a can they go without lifting things? 4-6 weeks What is sickle cell anemia? Deformed RBCs, and is sickle cell shaped Short life span What happens to a patient that is having a Sickle cell CRISIS? Pain due to lack of oxygen Jaundice What are the nursing interventions for sickle cell anemia? 1. Blood transfusion 2. Fluids and electrolytes 3. Pain management What are some teachings you can give to a sickle cell patient to avoid a CRISIS? Avoid high altitude areas When working out, they need to be in extreme climate controlled environment Avoid extreme temperature changes What is iron deficiency anemia? What is it a result of? Most common anemia Due to a strict vegetarian diet, pregnancy and bleeding What are signs and symptoms of iron deficiency anemia? Tired, pallor Angular Cheilosis, red sore tongue Cold intolerance If a patient just lost a lot of blood, what are some assessment to determine symptomatic anemia is present? Orthostatic hypotension, can hey sit up? LOC What are some medications we can give when dealing with a patient with iron deficiency? Iron replacement theory IV, IM: Watch for stains in the skin and anaphylaxis Liquid/ Oral: Take at the back of throat or with a straw What helps with the absorption of iron supplements? Orange juice What is megaloblastic anemia? What is deficient? Folic acids and vitamins B12 deficient What medications do we give to patients with megaloblastic or pernicious anemia ? B12 injections or a nasal spray Folic acid/ prenatal vitamins What is neutropenia? Low WBCs The patient cannot fight infections What does it mean when a patient is put on neutropenic precautions? Place a mask on the patient when they are out of the room Change out drinks, don't have they siting out for long What should we educate when a patient is neutropenic? No flowers or fruits without the peel - Patient should avoid gardening - Avoid contact with sick people Watch for signs and symptoms of infection What are some signs and symptoms of HIV? Recurrent infections within the first 14 days are the most contagious Flu like symptoms What happens in the body when a patient has HIV? Bone marrow will start to compensate at first by making more Helper cells and eventually the CD4 cells will drop. What is the CD4 count when patient have AIDS? 200 and below - AIDS defining illness What is our goal with HIV patients? Decrease viral load making it untransmitable Teach about safe sex and needles What medication is used for HIV patients? ART 90% needs to be taken on time and correctly to be efficient What should we asses before an HIV patient states taking medication? We want to make sure they are ready to adhere treatment, and know the signs and symptoms What is a skeletal tractions? Skeletal: Down to the bone with pins, Is a heavier weights. We need to make sure the weight stays off the ground What is a skin tractions ? Helps with muscle spasms and keeps them immobile. Generally temporary before the patient gets surgery What should we assess when it comes to a bucks tractions? CMS: Color, motion, sensation - 5 P's Make sure the pulses are the same How often do we take a traction off and reset is? Every 2 hours When do we commonly use bucks traction? Can CNAs hook up a bucks traction ? For hip fractures NO a cna may not touch a traction What is rheumatoid arthritis? Autoimmune disease Inflammation in the joins that can cause issues What are some early sings and symptoms regarding rheumatoid arthritis? Fatigue and weakness Stiff, nodules that grow They lose the ability to use the extremity For rheumatoid arthritis it is always ___________ Bilateral What are some medications we can give when a patient has rheumatoid arthritis? Immunosuppressants Corticosteroids Methotrexate What is important to determine if we are giving a patient methotrexate Make sure the patient is not pregnant! Determine whether they are on birth control What are we worried about when we are giving immunosuppressants to patients? Infections How can a patient with rheumatoid arthritis exercise? What can they do? Slow burst, they should have small breaks in between. Refer to a PT or OT Splints can also help support What is osteoarthritis? Cartilage breakdown, results in crepitus. Wear and tear What type of medication do we use to treat osteoarthritis? NSAIDS Cortisone injections Lidocane and heat (Celecoxib): Reduce inflammation What does osteoarthritis end up becoming? Degenerative What are signs and symptoms of osteoprosis? " I heard a pop and I fell" What are some medications that we can give to a patient with osteoporosis? Fosamax: Take with water, and need to stay up within 60 minutes When taking Fosamax, what should you look out for? Osteomyelitis (Jaw and ear pain) What are you trying to prevent when dealing with a hip fracture? Do not want to ADDUCT (Place the hip inwards) it can cause the hip to pop back out What is a sign that there's a small obstruction ? The patient feels better when vomiting, Small: it is higher up What is a sign that there's a large obstruction? Lack of gas, nothing coming through Stomach is very distended and bloated What are some interventions when dealing with a bowel obstruction? Make the patient NPO NG low and intermittent suction Watch for fluid and electrolyte imbalances (Metabolic alkalosis) What is a top priority when giving a blood transfusion? STOP the transfusion if a reaction occurs Call the provider What do you check when giving a transfusion? 15 minutes vitals What are indications that an reaction with a blood transfusion is occurring? 1 degree temperature changes Chills, fever "Feeling of doom" Try not to change the environment How long do you have to transfusion a patient? 4 hours, from the time of retrieval How long can you keep the transfusion tubing for? A total of two transfusions How long will it take for a patient to get a HAI? Hospital acquired infection? 48 hours of hospitalization/ admission How can we determine if the patient has obtained a community acquired infection? After 14 days after a hospitalization This reaction reinforces the immune system and causes the artrioles to cause brief vasoconstriction. Inflammation Name some s/s of inflammation Itchy Hot to touch Redness Swelling What is the redness color caused by in acute inflammation? Vasoconstriction People with this condition usually have other autoimmune diseases such as RA and can lead to tumor necrosis factors (TNF). Chronic inflammation This condition is caused by a protein in your body that causes inflammation and helps coordinate processes. Tumor necrosis factor (TNF) This kind of medication helps reduce inflammation, and the shutdown response that can cause immunosuppresion. Steroids How do immunosuppressed patients present with infection? the signs and symptoms of infection (purulent exudate, odor, erythema, warmth, tenderness, edema, pain, fever, high WBC count) may not be present even when the areas of injury is infected What is an immediate response from vaccinations? Inflammation Why should patients not take NSAIDs before getting vaccines? They will not have an inflammatory response that will allow antibodies to form properly in their body These 2 groups of people are not able to receive a live virus vaccination. Immunosuppressed Pregnant patients These cells are first responders of the immune system, rapidly migrating into affected tissues in response to injury or infection Neutrophils How would a neutrophil count appear in patients with acute infections and chronic infections? Acute - high count Chronic - not as high Why is the neutrophil count not as high in chronic infections compared to acute infections? Long term infections cause an increase in monocyte cells (immature macrophages) How will a neutrophil appear when it dies? How does it result to wound healing? Will create pus Fibrin in pus fibrinogen traps bacteria becomes a scab This causes tightening of airway muscles/ the production of excess mucus and fluid and helps promote the production of inflammatory cytokines. Leukotreines Leukotrienes are mostly administered to what group of patients? Asthma patients How does croup sound and what creates that sound? Barking seal Sound is from edema causing inflammation, making the airway to become narrow and create a barking sound Where do high pitched sounds come from? Upper airway What group of people is croup more common in and why? Children Because their airways are smaller This condition causes widespread inflammation and causes fluid to shift into areas where it shouldnt be and can shut down gas exhange. Sepsis Patients with sepsis could eventually snowball into what 2 conditions? Acute respiratory distress syndrome Systemic inflammatory response syndrome (SIRS) This medication is given to stop vasoconstriction in the airway caused by fluid shifts and built up edema. Epinephrine What are two systemic manifestations of inflammation? Fever Tachycardia When do you treat patients with fever? When they are symptomatic What is a side effect of fever? Dehydration Name 3 signs of infection in wounds. Purulent drainage COCA Significant inflammation of the wound What is the difference in purulent and serous drainage? Purulent drainage- sign of infection Serous drainage- fine, sign of healing Name 4 kinds of medications that are given to treat wounds. NSAIDs Corticosteroids Cox inhibitors ***Celebrex The Braden Scale is used for? predicting pressure sore risk This stage is non-blanchable with redness on bony prominences/areas of constant pressure. Stage 1 This stage is non-blanchable with a red/pink wound bed and partial thickness broken skin. Stage 2 This stage presents as a crater, the skin is not intact, but not able to see any bones or tendons. Stage 3 Necrotic dead tissue that does not heal and requires debridement for removal Eschar How should healing wound beds present as? Moist, pink, no drainage This process can be performed on any type of wound on any stage, it helps promote a moist environment to heal from inside out. Wet to dry dressing This kind of healing takes place when wound margins are neatly approximated, as in a surgical incision or a paper cut. Primary intention This wound presents with large amounts of exudate and wide, irregular wound margins with extensive tissue loss; it may require debridement before healing can take place. Secondary intention This kind of healing occurs with delayed suturing of a wound in which 2 layers of granulation tissue are sutured together. Tertiary intention (delayed primary intention) Why are wounds more common in diabetics? Blood flow is destroyed and causes dead tissue to grow quickly This diet is promoted to enhance wound healing. Diet high in proteins, carbs and moderate fats High fluid intake Perform this intervention as soon as possible after injury to relieve pain and swelling and to promote healing and flexibility RICE—Rest, Ice, Compression, and Elevation This helps removes fluid from wound as well as the removal of fluid speeds healing process Jackson-Pratt Drain How do lymph nodes present in healthy people? Non palpable How do lymph nodes present in sick people? Palpable How do lymph nodes present with malignancies? Hard Stationary The directional migration of white blood cells (WBCs) to the site of injury, resulting in an accumulation of neutrophils and monocytes at the site Chemotaxis When do 'bands' form into circulation? the demand of neutrophils is very high, causing the bone marrow to release immature neutrophils (bands) These cells usually arrive at the site within 3 to 7 days after the onset of inflammation and transform into macrophages. Monocytes This is a powerful vasoconstrictor and platelet-aggregating agent by causing a brief vasoconstriction and skin pallor at an injury site and promotes clot formation. Thromboxane These cells form the slow-reacting substance of anaphylaxis (SRS-A) in order to narrow the airway, increase capillary permeability and cause airway edema. Leukotrienes Consists of fluid and WBCs that move from the circulation to the site of injury exudate The release of cytokines triggers the onset of ? fever Higher body temperatures may enhance the activity of _________, the body's natural virus-fighting substance interferon Patients who are taking this kind of medication on a regular basis (e.g., for rheumatoid arthritis) may have a blunted febrile response. nonsteroidal antiinflammatory drugs (NSAIDs) This is a key concept in treating soft tissue injuries and related inflammation Rest, ice, compression, and elevation (RICE) This promotes vasoconstriction and decreases swelling, pain, and congestion from increased metabolism in the area of inflammation Cold application This promotes healing by increasing the circulation to the inflamed site and subsequent removal of debris and is used to localize the inflammatory agents. Heat application This is a suction drainage device consisting of a flexible plastic bulb connected to an internal plastic drainage tube. Jackson-Pratt drain This kind of dressing can be used to absorb exudate and clean the wound surface and works by drawing excess drainage from the wound surface absorptive dressings This kind of dressing interacts with the exudate, forming a hydrated gel over the wound. When the dressing is removed, the gel separates and stays over the wound. hydrocolloid dressings (duoderm) This kind of therapy include a vacuum source creating a continuous or intermittent negative pressure inside the wound to remove fluid, exudates, and infectious materials to prepare the wound for healing and closure Negative-pressure wound therapy (NPWT) This kind of debridement is used when large amounts of nonviable tissue are present by preparing the wound bed for healing, skin grafting, or flaps Surgical/sharp debridement This supplement is needed for capillary synthesis and collagen production by fibroblasts Vitamin C This supplement is necessary as coenzymes for many metabolic reactions. If a deficiency develops, a disruption of protein, fat, and carbohydrate metabolism will occur. B-complex vitamins This supplement aids in epithelialization by increasing collagen synthesis and tensile strength of the healing wound. Vitamin A Untreated pressure injuries may lead to ________, the spreading of inflammation to subcutaneous or connective tissue. cellulitis What is the substance that elicits an immune response? Antigen This kind of immunity is present at birth. Its primary role is first-line defense against pathogens and is not antigen specific. Innate immunity This kind of immunity results from the invasion of the body by foreign substances and may result naturally from a disease or artificially through immunization. Active acquired immunity Lymphocytes are made in the ? bone marrow. This gland is involved in the differentiation and maturation of T lymphocytes and is therefore essential for a cell-mediated immune response. The thymus What happens to the thymus during puberty? it starts to slowly shrink and become replaced by fat Where do the antigens interact with B and T lymphocytes and macrophages in the body ? Lymph nodes This organ is important as the primary site for filtering foreign antigens from the blood. Spleen B cells differentiate into ______ _______ when activated to make antibodies; it does not exist in humans. plasma cells Cells that migrate from the bone marrow to the thymus differentiate into ? T lymphocytes (thymus-dependent cells) These cells make up 70% to 80% of the circulating lymphocytes T lymphocytes (thymus-dependent cells) This antibody is the only immunoglobulin that crosses placenta and is responsible for secondary immune response IgG This antibody is responsible for primary immune response and forms antibodies to ABO blood antigens IgM This antibody causes symptoms of allergic reactions, fixes to mast cells and basophils, and aids in defense against parasitic infections IgE These cells act as messengers among the cell types by instructing the cells to alter their proliferation, differentiation, secretion, or activity Cytokines This protein helps the body's natural defenses attack tumors and viruses. Interferon This kind of immunity is also called antibody-mediated immunity; it is response for antibody production (the 5 classes). Humoral immunity These levels decrease with age, leading to a suppressed humoral immune response in older adults. Immunoglobulin levels (antibody) This is a type of hypersensitivity response, occurs when the body does not recognize self-proteins and reacts against self-antigens. Autoimmune disease Name 2 labs that are used to detect abnormalities of lymphocytes, eosinophils, and immunoglobulins Complete blood count (CBC) WBC differential (with lymphocyte count and eosinophil count) These are the best drugs for treatment of allergic rhinitis and urticaria and are less effective for severe allergic reactions Antihistamines When should you take an antihistamine to get the best result? they are best if they are taken as soon as allergy symptoms appear These drugs protect the skin and provide relief from itching; they are most effective when the skin is intact Antipruritic Drugs This is the recommended treatment for control of allergic symptoms when the allergen cannot be avoided and drug therapy is not effective Immunotherapy How is immunotherapy given? What is the goal Give small amounts of allergen extract in increasing strengths until hyposensitivity to the specific allergen is achieved ****Complete desenzitation of the allergy The IgE level is high in ? The reaction causes a release of histamine in various body tissues atopic people. Why should neuromuscular assessments be performed? To monitor for compartment syndrome What is the difference between a fracture and a break? Nothing, they are the same What group is most at risk for fractures/breaks? Older adults **longer to heal, may have other cormorbidities This tissue is where the ends of 2 bones are close and move in relation to each other. Joint (articulation) ________ attach muscles to bones as an extension of the muscle sheath that adheres to the periosteum. ________ connect bones to bones Tendons Ligaments Adequate intake of vitamins C and D, calcium, and protein is essential for ? healthy musculoskeletal system This condition increases the risk for cartilage deterioration and ligament instability. Obesity Extremes of activity related to occupation can affect the musculoskeletal system. For example, jobs that require heavy lifting or pushing can lead to _______ of joints and supporting structures damage Gathering a menstrual history is important because episodes of premenopausal amenorrhea can contribute to the development of ? osteoporosis This condition appears as a lateral S-shaped curvature of the thoracic and lumbar spine Scoliosis This kind of therapy is most useful when applied immediately after an injury has occurred and used for 24 to 28 hours Cold therapy What is cold therapy used for? reduce muscle spasms, inflammation, and edema How long should heat/ice be applied? 15-20 minutes What is heat therapy used for? reduce swelling and provide comfort What is the complete displacement or separation of the articular surfaces of the joint? Dislocation What is the partial or incomplete displacement of the joint surface? Subluxation How do dislocations occur? forces on the joint that disrupt the surrounding tissue What is the most obvious sign of a dislocation? deformity What is the first priority for dislocation management? realign the dislocated part of the joint to its original anatomic position Name a few factors of repetitive strain injuries. Poor posture/positioning Poor workspace ergonomics Badly designed workplace equipment Repetitive lifting of heavy objects without rest How can repetitive strain injuries be prevented? Education & ergonomics This condition is caused by compression of the median nerve, which enters the hand at the wrist through the narrow carpal tunnel Carpal tunnel syndrome (CTS) A patient with this condition will have a positive Tinel's sign and Phalen's sign Carpal tunnel syndrome (CTS) This sign made by tapping over the median nerve; positive response is a sensation of tingling in the distribution over the hand. Tinel's sign This sign made by letting the wrists to fall and maintain the position for 60 seconds; positive response is a sensation of tingling in the distribution over the hand. Phalen's sign A positive Lachman's test suggests ? an ACL tear. Test done by flexing knee 15-30 degrees and pulling the tibia forward while the femur is stabilized; positive if forward motion of the tibia occurs with the feeling of a soft or indistinct endpoint. Lachman's test This is a disruption or break in the continuity of bone; they can be caused by traumatic injuries, cancer or osteoporosis. Fracture This kind of fracture is characterized by having the ends of the bones protrude through the skin. Open fracture This kind of fracture occurs when the skin is still intact of the site. Closed fracture A fracture is _________ if the break goes completely through the bone. complete An ________ fracture occurs partly across a bone shaft, but the bone is still intact incomplete Fractures are identified based on what ? the direction of the fracture line This kind of fracture occurs when the 2 ends of the broken bone are separated from each other and out of their normal positions displaced fracture This kind of fracture occurs when the bone fragments stay in alignment. Nondisplaced fracture This is the nonsurgical, manual realignment of bone fragments to their anatomic position; it is done under local or general anesthesia Closed reduction This is the correction of bone alignment through a surgical incision by internal fixation of the fracture with wires, screws, pins, plates, intramedullary rods, or nails. Open reduction This immobilizes the joints above and below a fracture. cast This condition occurs if the brace is too tight, compressing the superior mesenteric artery against the duodenum. The patient generally has abdominal pain, abdominal pressure, nausea, and vomiting Cast syndrome How is treatment of cast syndrome conducted? gastric decompression with a nasogastric (NG) tube and suction & brace may have to be adjusted or removed Carisoprodol (Soma), cyclobenzaprine (Flexeril), or methocarbamol (Robaxin), may be given for ? pain management & muscle spasms These supplements supports bone healing. Vitamins (B, C, D) Calcium Phosphorus Magnesium Increase fluid & fiber What does pallor or a cool-to-cold extremity below the injury could indicate ? arterial insufficiency What would a warm, cyanotic extremity could indicate ? poor venous return Partial or full loss of sensation (paresis or paralysis) can be a late sign of ? neurovascular damage This is a condition in which swelling causes increased pressure within a limited space (muscle compartment). Compartment syndrome This condition is usually associated with fractures, extensive soft tissue damage, and crush injuries. Compartment syndrome Name some clinical manifestations of Compartment syndrome. Increased pressure Numbness/tingling Pallor/coolness Paralysis Pulselessness What are the two early signs of Compartment syndrome? Pain unrelieved by meds Paresthesia Ischemia in Compartment syndrome can occur within how much time after onset? 4-8 hours What are the 3 treatment interventions for Compartment syndrome? Relieve pressure Surgical decompression (fasciotomy) Amputation What can cause compartment syndrome? Casts & splints If an open fracture were to occur, how should the bone itself be managed? Make sure it does not get dry, will cause osteomyelitis This kind of fracture is commonly associated with child abuse. Greenstick fracture Bones that are transverse, spirals or green sticks are considered ? Nondisplaced Bones that are often comminuted or oblique are considered ? Displaced This fracture healing complication occurs when the healing is progressing more slowly than expected. Delayed union This fracture healing complication occurs when it heals in an abnormal position in relation to the midline of the structure. Angulation This fracture healing complication occurs when the fracture heals in the expected time but in an unsatisfactory position. Malunion This fracture healing complication occurs when the fracture does not heal despite the treatment and there is no evidence of callus formation. Nonunion This fracture healing complication occurs when a new fracture occurs at the original fracture site. Refracture This is the application of a pulling force to an injured or diseased body part or extremity. Traction Name some reasons why Traction is used Reduce pain Reduce muscle spasm Immobilize joint from body Reduce fracture/dislocation This traction is used short-term (48 to 72 hours); tape, boots, or splints are applied directly to the skin, help decrease muscle spasms extremity. **5 to 10 lb Skin traction This traction is used to align/treat joint contractures/hip dysplasia from long-term pull that keeps bones and joints aligned. Pin or wire inserted into the bone, weights are attached to align and immobilize the injured body part. ***5 to 45 lb Skeletal traction This generally immobilizes the joints above and below a fracture. This restricts tendon and ligament movement, thus assisting with joint stabilization while the fracture heals. Cast The 2 most common cast materials are ? natural (plaster of Paris) and fiberglass These cast are used more often because they are lighter, relatively waterproof and allow for early weight bearing fiberglass casts This helps support the extremity with elevation and helps reduce edema. Sling This is used for immobilization and support for stable spine injuries of the thoracic or lumbar spine. The body jacket brace What do you not do for compartment syndrome? no ice or elevate Always _______ lower leg injuries unless compartment syndrome is suspected. elevate This is mainly used for femur fractures in children to immobilize the affected extremity and trunk The hip spica cast This is composed of metal pins and wires that are inserted into the bone and attached to external rods to stabilize the fracture while it heals An external fixator What must you assess for with external fixators? Pin loosening Infection What is used pin care cleaning for external fixators and how often should it be cleaned? Chlorohexidine Once a day This is a severe infection of the nervous system affecting spinal and cranial nerves. Tetanus (lockjaw) How does an individual get tetanus (scientifically)? The neurotoxin (tetanospasmin) released by C. tetani that enters the body through a wound Reactions associated with this medication include hives, severe or watery diarrhea, blood in stools, and throat or mouth sores. cephalosporins (e.g., cefazolin) Peripheral area should be assessed for these findings during a neurovascular assessment? color, temperature, capillary refill, peripheral pulses, edema, sensation, motor function, pain ***assess bilaterally when should a neurological assessment be performed? before and after treatment Diagnosis of an initial VTE is based on the assessment combined with ________ testing and/or _______. D-dimer Ultrasound How many compartments are in the lower and upper extremities? 38 What 2 area does compartment syndrome commonly develop? Distal humerus Proximal tibia Treatment and prevention for this condition includes using antiembolism stockings, exercising and intermittent pneumatic compression devices. venous thromboembolism VTE Is osteoarthritis symmetrical? No, only affects one side What are the three diagnostic imaging procedures that are used for osteoarthritis? X-ray CT MRI Where does osteoarthritis mainly occur (4)? Hips & knees Cervical & lumbar vertebrae What is done during the treatment for osteoarthritis? Treating the structure of the cartilage What age does the cartilage destruction begin for osteoarthritis? What age does they begin to manifest? Begins 20-30's Symptoms 50-60's More than 50% over age ____ have x-ray evidence of osteoarthritis in at least 1 joint 65 years What is secondary osteoarthritis caused by? Direct damage or joint instability What is idiopathic osteoarthritis caused by? Cause unknown; genetics may contribute Name some risk factors for osteoarthritis Age Decreased estrogen at menopause Obesity Anterior cruciate ligament injury Frequent kneeling and stooping What helps lower the risk of osteoarthritis? Regular moderate diet How does the cartilage appear after being destroyed? Dull, yellow and granular osteoarthritis Destroyed cartilage from osteoarthritis causes the narrowing of the ? Joint space Cartilage from heavy usage after becoming more destroyed is ? Less able to resist wear with heavy use Destruction of articular cartilage causes narrowing of joint space formation of ? osteophytes (bone spurs) What are the 3 inflammatory markers of destroyed cartilage? SR, CR, CRP Inflammation and thickening of capsule and synovium can cause (20) early stage pain stiffness How is joint pain relieved in the early stages? Rest Describe the pain in the later stages of osteoarthritis. Pain while rest. Trouble sleeping, What may cause the pain to get worst with osteoarthritis? Lower barometric pressure Are the clinical manifestations of osteoarthritis curable? No, can only modify Pain contributes to _______ and loss of ______ as osteoarthritis progresses disability loss of function What areas (3) of the body are affected with referred pain from osteoarthritis? Groin Buttock Outside thigh/knee Osteoarthritis in ____________ joints causes local pain and stiffness intervertebral (apophyseal) When does joint stiffness occur with osteoarthritis? How long does it take for morning stiffness to resolve? Pain occurs after rest/unchanged positions Resolves within 30 minutes _________ with osteoarthritis leads to mild joint effusion, temporarily increasing stiffness (fluid in the space) Overactivity This clinical manifestation is termed as a grating sensation when bones are rubbing together with osteoarthritis. Crepitation How is fluid in the space with osteoarthritis resolved? Stick needle in, pull out fluid Varus deformity (bowlegged) in osteoarthritis affects the ______ knee medial Valgus deformity (knock-kneed) in osteoarthritis affects the ______ knee lateral Heberden's (DIP) and Bouchard's (PIP) nodes are small, swollen bumps that grow on the joints of your ? finger How do Bouchard's nodes (PIP) appear? Appear red, swollen, and tender around the knuckles Are there any systemic manifestations of osteoarthritis? No systemic symptoms What organ in the body can osteoarthritis affect/ heart These three diagnostic studies are able to diagnose osteoarthritis and also show any joint changes. Bone scan CT scan MRI This diagnostic is able to detect joint space narrowing, increased bone density, and osteophytes for osteoarthritis? X-ray This diagnostic study is helpful for determining the underlying cause of osteoarthritis, particularly for septic or crystal-induced arthritis? Synovial fluid analysis ________ interventions are the basis for osteoarthritis management. Nonpharmaceutical When patients with osteoarthritis are experiencing acute inflammation with rest, what should they do to avoid the stiffness and pain? (2) Functional positioning with splints or braces Avoid increased stiffness by limiting immobility to less than 1 week True or false? Patients with osteoarthritis need to avoid prolonged standing, kneeling or squatting. True _____ is used for acute inflammation; whereas _____ is used for the stiffness. Ice- inflammation Heat- stiffness Name 3 alternative therapies that can be used for osteoarthritis. Acupuncture Massage Tai Chi This medication may be used to help relieve mild to moderate joint pain from osteoarthritis. Acetaminophen (Tylenol) These medications may be used to help relieve moderate to severe joint pain from osteoarthritis. NSAIDs ***start low dose, increase if needed Intraarticular corticosteroid injections should not be given systemically. Where should it be given? Into the joint This procedure is performed for patients with loss of function, unmanaged pain, and decreased independence. It is commonly given with knee osteoarthritis. Arthroscopic surgery This medication should not be given to patients with osteoarthritis because it can cause bleeding or mess up their stomach. Ibuprofen Cortisone injections have a ______ effect, and the patient will not develop __________. local immunosuppression These 2 nutritional supplements may be helpful in some patients for relieving moderate to severe arthritis pain in the knees and improving joint mobility. glucosamine chondroitin sulfate Rheumatoid arthritis involves periods of ________ and __________ remission exacerbation This is an systemic autoimmune disorder that causes inflammation of connective tissue in arthrodial (synovial) joints. Rheumatoid arthritis Rheumatoid arthritis has this kind of manifestations that can affect the other body systems. Extraarticular This is a group of medications commonly used in people with rheumatoid arthritis. Disease-modifying antirheumatic drugs (DMARDs) What is the term for the autoantibodies against IgG immunoglobins and is found in 70-80% of patients suffering from chronic rheumatoid arthritis? Rheumatoid factors These group of patients have the potential to develop symptoms of rheumatoid arthritis due to their state of condition. Pregnancy What type of hypersensitivity is RA? Type III These cells are activated to secrete proinflammatory cytokines with RA. T helper cells (CD4) This predisposition is an important factor in RA development. Genetic predisposition These 2 antigens are part of the genetic link in RA that represents the possible history of the disease. HLA-DR4 & HLA-DR1 antigens ________ increases risk in patients genetically predisposed to RA and may interfere with treatment Smoking How do general stiffness progress in patients that have RA? Becomes localized stiffness with progress Fatigue, anorexia, weight loss and generalized/localized stiffness is are symptoms of what condition? rheumatoid arthritis How does RA affect the body (symmetrical/asymmetrical)? Symetrical The _____ are most commonly affected in patients with RA. Hands In patients with RA, how do their joints progress to become more stiff? The less they use the joints the stiffer they get. Triggered by inactivity How long does morning stiffness last in patients with RA? Anywhere from 60 minutes to several hours, or longer Tenosynovitis affects wrists in patients with RA, causing them to develop symptoms of what condition ? Carpal Tunnel Syndrome What body systems are affected by RA? affects all body systems These are firm, nontender masses found on bony areas exposed to pressure in patients with RA Rheumatoid nodules How does RA affect the eyes? Cataracts and vision loss RA causes this disease characterized by inflamed muscles, which can cause prolonged muscle fatigue and weakness Nodular myositis Name The 4 P's & 1 C cardio conditions that RA can develop. Pleurisy Pleural effusion Pericarditis Pericardial effusion Cardiomyopathy Dry, gritty eyes and photosensitivity - RA Sjögren's syndrome Enlarged spleen and low WBCs result in increased risk of infection and lymphoma - RA Felty syndrome Decreased self-care - RA Flexion contractures Pain and disability - RA Increased C-reactive protein levels - RA Depression Increased joint inflammation Gradual destruction in joint cartilage Narrowing joint space from loss of cartilage Stage II rheumatoid arthritis Formation of synovial pannus X-ray: extensive cartilage loss, erosion at joint margins, possible deformity Stage III rheumatoid arthritis Inflammatory process subsides Loss of joint function Formation of subcutaneous nodules Stage IV rheumatoid arthritis The ESR and CRP lab tests are used to confirm ? Active inflammation ***RA The Anti-CCP diagnostic lab test is used to confirm the presence of ? The antibody specific to RA This drug is used to help slow the RA disease process and decrease the risk of any joint deformities and erosions. Disease-modifying antirheumatic drugs (DMARDs ) How are Disease-modifying antirheumatic drugs (DMARDs ) chosen for each patient? Disease activity Functional level Lifestyle choices This DMARD drug is used for early treatment for RA, with a lower toxicity risk. It will take 4-6 weeks to see results. Methotrexate This is very important to administer and encourage for patients who are on Methotrexate. Fluids For Sulfasalazine (Azulfidine) & Hydroxychloroquine (Plaquenil), what are 3 important patient teachings for these 2 DMARD medications? Drink fluids Wear sunscreen Eye exam 6-12 months This medication class is used in combination with DMARDs for RA, but can also be given alone as well. Biologic Response Modifiers (BRMs) Clients on this medication should have TB test and chest xray before start of therapy, monitored for infections and should not be given any live vaccines throughout therapy. Tumor necrosis factor (TNF) inhibitors What must be monitored on clients that are on (TNF) inhibitors? Bruising Bleeding Fever Signs of infection This BRM medication is given via IV; it is a monoclonal antibody and targets B cells. Rituximab (Rituxan) Name 2 complications from corticosteroid therapy. osteoporosis avascular necrosis This medication is a COX inhibitor (NSAID) which increases the risk of blood clots, heart attacks and strokes. Celecoxib (Celebrex) These are possible diagnostic findings of ? Positive RF Positive ANA Positive AntiCCP Elevated ESR Anemia Elevated WBC rheumatoid arthritis What are the 5 levels of BMI? 18 underweight 18-24 normal 25-29 overweight 30 obese 40 extreme obesity What are the criteria guidelines for bariatric surgery? BMI 35+ with co-morbidities BMI 40 These two interventions would reduce the risk for venous thromboembolism (VTE). Intermittent pneumatic compression devices Compression stockings with low-dose heparin Excess body weight places more demands on these areas of the body. arthritic joints The mechanical strain on weight-bearing joints can lead to ? premature immobility Excess intraabdominal weight can cause problems with ? urinary incontinence Excess weight may contribute to hypoventilation and ? sleep apnea This condition is a group of metabolic risk factors that increase a person's chance of developing CVD, stroke, and diabetes. Metabolic syndrome What age group is more affected by Metabolic syndrome? 60 years + Name 2 interventions that are used to help manage metabolic syndrome. Reduce risk factors of CVD & type 2 diabetes This medication can lower glucose levels and enhance the cells' sensitivity to insulin Metformin (Glucophage) What is Zofran, Finnigan and Prochlorperazine (Compazine) used for? Antiemetic medications to help with nausea & vomiting What kind of ECG change is prevalent with Zofran? QT longation This antiemetic medication can be given orally, IV or rectal. It should never be IV pushed fast. Finnigan Bright red blood emesis would characterize ? Active bleeding above the stomach (ex. ulcer, varices, cancer) Coffee ground colored emesis would characterize ? Gastric bleeding Antiemetic drugs will increase the risk of ? falls This lifestyle induced condition is characterized by the reflux from the lower esophageal sphincter not closing properly. GERD Name 3 foods/drinks that trigger GERD. Caffeine Chocolate Spicy food Name 3 clinical manifestations of GERD. Heartburn (pyrosis) Dyspepsia (pain in upper abdomen) Regurgitation What is the most common clinical manifestation of GERD? Heartburn (pyrosis) What is a risk factor of ulcerations from esophagitis? The destroyed cells turning into cancer cells This diagnostic procedure is most commonly used to look for H. pylori. Upper GI endoscopy Long term use of reflux medications can lead to ? pernicious anemia What are two classes of medications thats used for GERD? Proton pump inhibitors (PPI) **ends in -zole Histamine (H2) receptor blockers (carafate) Name 2 education points given to patients that are taking Cytoprotective (Carafate). Take with empty stomach Do not take with tums because it neutralizes stomach acid This medication class is most effective for healing esophagitis by decreasing HCl secretion and irritation. Proton pump inhibitors This medication class is given orally or IV combined with an antiacid and helps by decreasing HCl secretion and irritation. H2 receptor blockers This medication can be given for reflux for burning in the throat and the mouth Maalox This medication is made with magnesium and will counteract the acid in the stomach, they are made out of calcium carbonate. Tums These medications increase gastric emptying & motility. It can also increase anxiety and cause mental health issues. Prokinetics (metoclopramide (Reglan)) These medications should be given cautiously in patients with liver and renal disease. **tums is safe, can deposit excess calcium in bones Antacids Name 4 causes of peptic ulcer disease. NSAIDs Stress H. pylori Alcohol Name 3 causes of gastric ulcers. NSAIDs H. pylori Bile reflux These ulcers have a higher mortality rate because they can perforate and cause chronic blood loss. Gastric Ulcer This specific gastric ulcer does not perforate. Duodenal ulcers Gastric ulcer perforations must be fixed within 6-12 hours in order to lower the risk of developing ... Bacterial peritonitis What is done in the body throughout gastric perforation procedures? Get all food out of stomach Stop spillage Restore blood volume What is the difference between small and large perforations? Small perforation are self healing Large require surgery This condition occurs when the stomach fills and dilates causing discomfort and pain. Gastric outlet obstruction What helps comfort patients that have gastric outlet obstructions? Belching & vomiting What are the 3 treatments given to patients with gastric outlet obstructions? Suction with NG tube PPI H2 receptor What is a major sign of hemorrhaging in the body? Change in vital signs What is the diet for patients with hemorrhages? NPO orally What age group is more likely to suffer perforations? Caused by? Aging adults from NSAID use What will be the first two symptoms of hemorrhages/perforations in aging adults? GI bleed Anemia This is an acute GI diarrheal condition that can last 14 days or less. Gastroenteritis (stomach flu) How does e. coli appear in stool? Bloody diarrhea How is Giardia transmitted? fecal-oral **intestinal parasite How is C. diff transmitted? fecal-oral **hospital acquired **contact isolation This diarrheal condition is associated with antibiotic usage, and is potentially fatal from perforations. C. diff Spores in C. diff can live for how long? 70 days C. diff can be prevented by giving? lactobacillus Do not take this medication if suffering from gastroenteritis. Imodium Name 2 lower GI conditions that affect malabsorption. Celiac disease Short bowel syndrome What kind of GI infection is this? Large volume Watery stools Cramping Periumbilical pain Nausea and vomiting Low grade fever Upper GI What kind of GI infection is this? Small volume bloody diarrhea Fever Lower GI Severe diarrhea can cause dehydration and what kind of electrolyte imbalance? Potassium Why are antidiarrheal medications contraindicated with IBD? It can cause toxic megacolon What 2 medications are given for C. diff patients and for how long? Oral vancomycin or fidaxomicin for 10 days Recurrent C. diff can be treated with this procedure via enema, nasoenteral tube or colonoscopy. fecal microbiota transplantation (FMT) What is the difference between IBS and IBD? IBS does not have inflammation This is a genetic autoimmune disease triggered via environment/bacteria and causes inflammation and widespread tissue destruction. Inflammatory Bowel Disease (IBD) Inflammation from Inflammatory Bowel Disease (IBD) is accompanied with what 2 manifestations? Diarrhea Pain Where does Crohn's disease occur? anywhere in GI tract from mouth to anus Where does Crohn's disease most commonly occur in the GI tract? Ileocecal valve This condition is characterized by weight loss, skipped lesions, fistulas, bloody diarrhea with mucus, fever and abdominal pain. Crohn's disease Where does ulcerative colitis occur? colon and rectum What are the risk factors for polyps with ulcerative colitis? Polyps are benign tumors that can become cancerous This GI disease is a high risk for colorectal cancer and multiple sclerosis. They will also need a bone density scan & calcium supplements. Ulcerative colitis A double contrast enema study in rectum or a contrast small bowel series are two imaging procedures to diagnose what disease? Ulcerative colitis Steroids & Sulfasalazine help control inflammation in what condition? Ulcerative colitis This is the first line and cheapest drug used for treating Ulcerative colitis. 5- ASA What conditions do these medications treat? 5- ASA Antimicrobials Corticosteroids Immunosuppressants Ulcerative colitis Patients with Ulcerative colitis will need what kind of test done if put on immunosuppressive therapy. TB test These medications are used short term and help decrease inflammation and helps with acute flare ups with ulcerative colitis. Corticosteroids This immunosuppressant drug should not be given during pregnancy and can cause aplastic anemia. Methotrexate Which GI condition is recommended treatment via surgical therapy? Which one is not? Not recommended for Crohn’s **only done for complications Curative with Ulcerative colitis What is done during a surgical procedure for treatment of ulcerative colitis. Cut out rectum Make ileal pouch to act as a new colon and rectum Why is surgical therapy treatment not recommended for Crohn's disease? Can cause more complications to cut more in surgery and can cause short bowel syndrome Patients on sulfasalazine must take _______ supplements everyday folic What is the peak age for IBD? What sided condition is more common. Peak age in 60's Left sided ulcerative colitis more common GERD-related chest pain is relieved with what kind of medication? antacids Respiratory complications are common in people with this condition. GERD Patients taking corticosteroids or anticoagulants with NSAIDs have a higher risk for ? peptic ulcer disease These kind of ulcers are more prevalent in women and those over 50 years of age Gastric ulcers These ulcers can occur at any age, but the incidence is especially high between 35 and 45 years of age Duodenal ulcers This is a rare condition characterized by severe peptic ulceration and HCl acid hypersecretion Zollinger-Ellison syndrome (ZES) What kind of ulcer is this? -high in epigastrium -pain occurs 1-2 hours after meals -burning/gaseous feeling Gastric ulcer What kind of ulcer is this? -occurs 2-5 hours after meals -burning/cramplike feeling -midepigastric region -back pain Duodenal ulcers This diagnostic study the most accurate procedure to determine the presence and location of an ulcer Endoscopy What is the gold standard test for diagnosing H. pylori infection? urease (rapid urease testing) Name 4 tests used for diagnosing H. pylori. Urease Serology Stool Breath test What are antibody test not used to determine an H. pylori infection? H. pylori can remain positive for years What would a CBC test show on a patient that had a bleeding ulcer? Anemia This laboratory test evaluates pancreatic function to confirm duodenal ulcer penetration of the pancreas. Serum amylase How is the onset of a perforated ulcer characterized? Sudden, serve abdominal pain that quickly spreads throughout the abdomen Blood in the urine can be a sign of ? kidney or bladder damage IBS is diagnosed solely on _______. symptoms What is the Rome IV criteria for diagnosing IBS? the presence of abdominal pain and/or discomfort at least 1 day/week for 3 months that is associated with change in stool frequency or form People at average risk for colorectal cancer should undergo colonoscopy how often, starting at what age? every 10 years beginning at age 45 This condition leaves the person unable to meet energy, fluid, electrolyte, and nutritional needs to stay healthy on a normal diet. Short bowel syndrome (SBS) Damage of the intestinal mucosa or surgical removal of too much small intestine causes what condition? Short bowel syndrome (SBS) This condition is a retrovirus that causes immunosuppression; they are more susceptible to infections that people normally control through immune responses. HIV What are the 4 ways HIV can be transmitted? infected blood maternal milk vaginal secretions semen When do people receive antiretroviral therapy (ART)? When women are detected with the HIV infection, its used to suppress the replication of HIV This enzyme is involved in the replication process, cleaves the newly formed strands of HIV genetic material into smaller pieces. Protease What is the term for infections and cancers that occur in immunosuppressed patients? opportunistic diseases What is the main cause of disease, disability, and death in patients with HIV infection? opportunistic diseases During the first 2-4 weeks when someone is infected with HIV, what is happening in the blood? there is a high viral load, the amount of HIV circulating in the blood When are people most infectious with HIV? During the acute infection stage because of the high amounts of circulating HIV. After the initial reaction, how do people infected with HIV appear? asymptomatic and have no symptoms/limited signs of infection. As the CD4 cell count declines closer to 200 cells/μL and the viral load increases, HIV advances to a more active stage termed as a ? Symptomatic infection What are some symptoms of a symptomatic infection of HIV? persistent fever, frequent night sweats, chronic diarrhea, recurrent headaches, and severe fatigue One of the more common infections associated with the symptomatic infection phase of HIV is ? oropharyngeal candidiasis (thrush) When is AIDS diagnosed? at CD4 200 cells and/or presence of opportunistic infection Diagnosis of HIV infection is made by testing for ? testing for HIV antibodies and/or antigens This weeks of before a screening test can detect any evidence of HIV is termed as.. window period What 2 lab tests are used for monitoring HIV progression? CD4 cell count viral load This lab test is a marker of immune function; as the disease progresses, the number usually decreases CD4 cell count This lab test measures viral levels and provides an assessment of disease progression. The lower the level, the less active the disease. Viral load Abnormal _____ ______ results are common in HIV infection. blood test HIV, antiplatelet antibodies, or drug therapy can cause ? low platelet counts (thrombocytopenia) This condition is associated with the chronic disease process and adverse effects of antiretroviral therapy (ART). Anemia Resistance tests can determine if a patient's HIV is ??? resistant to drugs used for ART This strategy is used to reduce the risk for sexually acquired HIV infection in adults and should also be utilized with using condoms, risk reduction counseling, and regular HIV testing. Preexposure prophylaxis (PrEP) The best way to prevent HIV infection in infants is to ? prevent HIV infection in women What are the options for HIV+ women that are wanting to get pregnant to reduce the risk of passing it to the child? use ART to decrease the risk for transmission or have an abortion. ________ _______, or recurring problems, characterize chronic diseases to where those with HIV disease in which infections, cancers, debility, and psychosocial or economic issues may interact to overwhelm the patient's ability to cope Acute exacerbations Some HIV-infected patients, especially those who have been infected and on ART for a long time, are at risk to develop ? metabolic disorders How do you manage metabolic disorders with HIV patients? By detecting problems early, dealing with symptoms, and helping the patient cope with emerging problems