NR 324 FINAL EXAM REVIEW
1. Types of Traction
Skin: Weights attached to patient’s skin to decrease muscle spams and immobilize the extremity
before surgery. Ex Bryant traction (for hip dysplasia in children) and Buck ‘s traction for hip
fracture in adult patients).
Skeletal: Screws are inserted into bone. Used for long bone fractures such as femur, tibia, fibula,
humerus, ulna, radius, metacarpals, phalanges and metatarsals.
Halo: used for cervical bone fractures. Nurse should make sure wrench to release rods is
attached to the vest, so CPR can be performed.
Nursing interventions
Assess neurovascular status every hour for the 1 st 24hrs and then every 4 hours.
Do not lift or remove weights
Do not let weights rest on floor (make sure they are hanging freely)
Muscle spams are expected and should be treated w/meds, repositioning, heat, or
message. Unrelieved muscle spasms should be reported to provider.
For halo traction, move patient as a unit and do not apply pressure to rods.
Monitor for skin breakdown
2. Lupus
Autoimmune disorder that causes chronic inflammation in the body. There is no cure. There are
2 types. Systemic – affects the connective tissues in multiple organs. Discoid - affects skin
(butterfly rash).
Risk factors: Female, ages 20-40, race (Africa American, Asian, Native American)
S&S: Fatigue, joint pain, fever, butterfly rash on face, depression, edema, Raynaud’s
phenomenon, anemia, pericarditis, lymphadenopathy.
Lab: positive ANA titer, decreased serum completement (C3/C4), decreased RBC, WBC,
platelets. Increase BUN and creatinine with kidney involvement.
Med: NSAIDs, immunosuppressant agents (prednisone, methotrexate), antimalaria drugs
(hydroxychloroquine), topical steroid creams for rash.
Interventions: Avoid UV/sun exposure, avoid sick people, stress, cold weather, infection,
pregnancy, patient should use mild protein shampoo to wash hair.
3. Gout
Inflammatory arthritis, resulting in formation of uric acid crystals in joints and body tissues.
Risk: obesity, alcohol, high purine diet (meat), cardiovascular disease, starvation dieting.
S&S: severe joint pain in the great toe, erythema, swelling, warmth in affected joint, tophi
w/chronic gout.
Med: colchicine, NSAIDs, Corticosteriods, allopurinol and probenecid.
Interventions; Pt should avoid spicy food, balance diet, stop alcohol consumption, and eat 2hrs
before bedtime.
4. HIV/AIDS
, Retrovirus that targets CD4+ lymphocytes (T-cells), resulting in decreased immune function and
susceptibility to infections. AIDS = stage 3 (end-stage) HIV infection.
RF: Unprotective sex, multiple sec partners, perinatal exposure, IV drug use, health care
workers.
S&S: Flu-like symptoms, weakness, night sweats, headache, weight loss and rash
Stage 3 (AIDS)
CD4+ count < 200 cells/mm3
Symptoms: Kaposi’s sarcoma, TB, Pneumonia, wasting syndrome, candidiasis of the
airways, herpes, other infection
Diagnosis: positive ELISA test, confirmed with Western blot test.
Med: 3-4 Antiretroviral medications (ending with Vir)
Patient teaching:
Practice good hand hygiene, bathes daily with antimicrobial soap
Avoid raw foods
Don’t clean cat litter boxes
Avoid sick people
Practices safe sex
Ongoing monitoring of CD4+ counts
5. Rheumatoid Arthritis (RA)
Chronic, progressive autoimmune disease that cause inflammation, thickening and deformation
of the joints. Joints are affected bilaterally and symmetrically.
RF: Female gender, age 20-50, genetics
S&S: joint pain, morning stiffness, fatigue, joint swelling with erythema and warmth, swan neck
and boutonniere deformities in fingers, subcutaneous nodules, fever red sclera and
lymphadenopathy
Labs: positive Rheumatoid factor (RF) antibody, positive ANA titer, Elevated WBCs, ESR and CRP
Diagnosis: Arthrocentesis (aspiration of synovial fluid from joint) to test for WBCs and RF
Meds: NSAIDs, immunosuppressants (prednisone, methotrexate), antimalarial agents
(hydroxychloroquine).
Procedures: Plasmapheresis (to remove antibodies from blood) total joint arthroplasty
Complications: Sjogren’s syndrome (dry eyes, dry mouth, dry vagina)
Patient education
Take hot shower to relieve morning stiffness
Physical activity to preserve ROM
Use of assistive devices
6. Osteoarthritis
Progressive degeneration of articular cartilage in joints.
RF: Older age, women, obesity, smoking, repetitive stress on joints
S&S: Joint pain/stiffness, crepitus, enlarged joints, Herberden’s nodes ( distal interphalangeal
joints), Bouchard’s node ( proximal interphalangeal joints).
Meds: Oral analgesics (acetaminophen, NSAIDs), Topical analgesics (capsaicin), Glucosamine,
injection of glucocorticoids, and hyaluronic acid
1. Types of Traction
Skin: Weights attached to patient’s skin to decrease muscle spams and immobilize the extremity
before surgery. Ex Bryant traction (for hip dysplasia in children) and Buck ‘s traction for hip
fracture in adult patients).
Skeletal: Screws are inserted into bone. Used for long bone fractures such as femur, tibia, fibula,
humerus, ulna, radius, metacarpals, phalanges and metatarsals.
Halo: used for cervical bone fractures. Nurse should make sure wrench to release rods is
attached to the vest, so CPR can be performed.
Nursing interventions
Assess neurovascular status every hour for the 1 st 24hrs and then every 4 hours.
Do not lift or remove weights
Do not let weights rest on floor (make sure they are hanging freely)
Muscle spams are expected and should be treated w/meds, repositioning, heat, or
message. Unrelieved muscle spasms should be reported to provider.
For halo traction, move patient as a unit and do not apply pressure to rods.
Monitor for skin breakdown
2. Lupus
Autoimmune disorder that causes chronic inflammation in the body. There is no cure. There are
2 types. Systemic – affects the connective tissues in multiple organs. Discoid - affects skin
(butterfly rash).
Risk factors: Female, ages 20-40, race (Africa American, Asian, Native American)
S&S: Fatigue, joint pain, fever, butterfly rash on face, depression, edema, Raynaud’s
phenomenon, anemia, pericarditis, lymphadenopathy.
Lab: positive ANA titer, decreased serum completement (C3/C4), decreased RBC, WBC,
platelets. Increase BUN and creatinine with kidney involvement.
Med: NSAIDs, immunosuppressant agents (prednisone, methotrexate), antimalaria drugs
(hydroxychloroquine), topical steroid creams for rash.
Interventions: Avoid UV/sun exposure, avoid sick people, stress, cold weather, infection,
pregnancy, patient should use mild protein shampoo to wash hair.
3. Gout
Inflammatory arthritis, resulting in formation of uric acid crystals in joints and body tissues.
Risk: obesity, alcohol, high purine diet (meat), cardiovascular disease, starvation dieting.
S&S: severe joint pain in the great toe, erythema, swelling, warmth in affected joint, tophi
w/chronic gout.
Med: colchicine, NSAIDs, Corticosteriods, allopurinol and probenecid.
Interventions; Pt should avoid spicy food, balance diet, stop alcohol consumption, and eat 2hrs
before bedtime.
4. HIV/AIDS
, Retrovirus that targets CD4+ lymphocytes (T-cells), resulting in decreased immune function and
susceptibility to infections. AIDS = stage 3 (end-stage) HIV infection.
RF: Unprotective sex, multiple sec partners, perinatal exposure, IV drug use, health care
workers.
S&S: Flu-like symptoms, weakness, night sweats, headache, weight loss and rash
Stage 3 (AIDS)
CD4+ count < 200 cells/mm3
Symptoms: Kaposi’s sarcoma, TB, Pneumonia, wasting syndrome, candidiasis of the
airways, herpes, other infection
Diagnosis: positive ELISA test, confirmed with Western blot test.
Med: 3-4 Antiretroviral medications (ending with Vir)
Patient teaching:
Practice good hand hygiene, bathes daily with antimicrobial soap
Avoid raw foods
Don’t clean cat litter boxes
Avoid sick people
Practices safe sex
Ongoing monitoring of CD4+ counts
5. Rheumatoid Arthritis (RA)
Chronic, progressive autoimmune disease that cause inflammation, thickening and deformation
of the joints. Joints are affected bilaterally and symmetrically.
RF: Female gender, age 20-50, genetics
S&S: joint pain, morning stiffness, fatigue, joint swelling with erythema and warmth, swan neck
and boutonniere deformities in fingers, subcutaneous nodules, fever red sclera and
lymphadenopathy
Labs: positive Rheumatoid factor (RF) antibody, positive ANA titer, Elevated WBCs, ESR and CRP
Diagnosis: Arthrocentesis (aspiration of synovial fluid from joint) to test for WBCs and RF
Meds: NSAIDs, immunosuppressants (prednisone, methotrexate), antimalarial agents
(hydroxychloroquine).
Procedures: Plasmapheresis (to remove antibodies from blood) total joint arthroplasty
Complications: Sjogren’s syndrome (dry eyes, dry mouth, dry vagina)
Patient education
Take hot shower to relieve morning stiffness
Physical activity to preserve ROM
Use of assistive devices
6. Osteoarthritis
Progressive degeneration of articular cartilage in joints.
RF: Older age, women, obesity, smoking, repetitive stress on joints
S&S: Joint pain/stiffness, crepitus, enlarged joints, Herberden’s nodes ( distal interphalangeal
joints), Bouchard’s node ( proximal interphalangeal joints).
Meds: Oral analgesics (acetaminophen, NSAIDs), Topical analgesics (capsaicin), Glucosamine,
injection of glucocorticoids, and hyaluronic acid
