Celecoxib should not be taken if patient suffers from which conditions ?
Hypertension
Kidney disease
cardiovascular disease
taking this medication for long term, puts you at risk for bleeding and acute kidney disease?
Celecoxib
why should Celecoxib be taken with food?
to reduce GI distress
when taking Celecoxib report which issues to your dr?
dark tarry stools, shortness of breath, edema, frequent dyspepsia (heart burn)
hematemesis (blood vomit)
How can Celecoxib cause CVD?
by vasoconstriction and platelet clumping (HTN and myocardial infarction)
Mr Johnson came in complaining of pain and limping you suspect he has dislocated his hip what is your nursing intervention?
immobilization, neurovascular check, notify the dr/surgeon.
for pre-op nutrition assessment then assess pain
Which disease is associated with Crepitis (grinding sound in the knees)?
Osteoarthritis
Which disease is associated Bouchard and Heberden Nodes?
Osteoarthritis
Which disease gives you morning stiffness and is relieved with activity?
Rheumatoid Arthritis
Which disease is Degenerative with Secondary Inflammation?
Osteoarthritis
Which disease affects the upper extremities first?
Rheumatoid Arthritis
Which lab levels should you look out for Rheumatoid Arthritis?
Elevated Rheumatoid Factor, Elevated ANA and Elevated ESR
What are the side effects of a low chronic dose of Prednisone?
- Diabetes
- Impaired Immunity (Stay away from sick people, low immune system)
- Hypertension
- Osteoporosis
- Glaucoma
- Fluid and Electrolyte Imbalance
- Adrenal Insufficiency
Which Medication is given for Rheumatoid Arthritis?
Sulfasalazine
What symptoms can Sulfasalazine cause?
- Nausea
- Vomiting
- Skin Rash
If your are allergic to ___________you should not take Sulfasalazine?
Sulfa Allergy
Clinical presentation of hip fracture in the older adult?
- Groin Pain
- Pain behind the knee
- Pain in lower back or no pain at all
- Patient cannot stand without pain
- May have no pain and walk with a limp
- Have a bulge
What to do if you can't palpate a peripheral pulse( What is the next step)
Check a doppler first
What to do for a traumatic amputation in the community?
- 1st call 911
- ASSESS patients ABC
- Examen Amputation site
- Apply pressure with gause
- Elevate above the patients to decrease bleeding
- Do not remove the dressing to prevent dislodging the clot
- Covered severed finger with sterile gauze, place in water tight sealed plastic bag , place the bag in ice water, NEVER DIRECTLY ON ICE
-
Therapeutic communication with a patient s/p amputation?
- Do not use the word "Stump"
- Coordinate meeting with active amputee about same age as patient
- Do not underestimate loss of body part
-
(RICE Mneumonic) is used for what kind of injury?
Knee Injury
What does RICE Mneumonic stand for?
KNEE INJURY
- Rest
- Ice
- Compression
- Elevate
Which syndrome do you perform a Phalens Maneuver?
- Carpal Tunnel
Which GI organ starts of Carbohydrate Digestion with Alpha-Amylase in Saliva
Oral
What is the role of the Esophagus?
- Moves food/fluids from Pharynx to stomach
- LES malfunction causes GERD
What is the role of the stomach ?
Storage/ movement/ breakdown of food
secrete HCI, Secrete pepsinogen (digestive enzyme) , Intrinsic factor
Which GI organ makes insulin and glucagon ? (Endocrine Part)
Pancreas
What is the pancreas exocrine role ?
secretes enzymes needed for digestion (protease, amylase, lipase)
what the the Liver/gallbladder store ?
stores Fe, magnesium, Vitamins A,D,E.K, and B12
aids in protein
Synthesis of plasma proteins (albumin, prothrombin, and fibrinogen
stores glucagon, fatty acids, and TG's
what is the role of the small intestine ?
movement (mixing and peristalsis) (moving food) digestion and absorption
enzyme aid in digestion of protein, carbs, lipids
What is the role of the large intestine?
movement, absorption and elimination
absorption of water and some electrolytes
What are some changes in the GI system with aging ?
Decreased iron and B12 absorption
Decreased sensation to defecate (postponement of bowls)
leads to constipation and impaction
steatorrhea (fatty stool) occurs
Depresses drug metabolism which can cause toxicity
contributes to obesity, inflammatory disease and reduce immunity.
Patient education about oral care?
Stomatitis
Eat well balanced diet, weekly examinations of mouth,
stay hydrated, dentures should be in good repair and fit,
manage stress, brush and floss twice a day, avoid alcohol base mouth wash,
avoid drugs that increase inflammation of mouth or reduce saliva flow
active ingredient's of magic mouth wash
Stomatitis
Benadryl
hydrocortisone
nystatin
Patient education aphthous ulcers (canker sore)
Stomatitis
Antifungal (nystatin, swish and spit, or clotrimazole lozenges)
Bacteria ( chlorhexidine swish and sit)
remove your dentures if severe stomatitis/oral pain
perform oral hygiene 2x daily after meal or PRN
oral care every 2 hrs or more if stomatitis is not controlled
soft tooth brush or gauze, toothpaste free of sodium lauryl sulfate
avoid commercial mouth washes and lemon glycerin swabs
frequent rinse with warm saline/and or sodium bicarbonate(baking soda)
What is the nursing priority for a patient with an oral tumor?
oral tumor/cancer
AIRWAY
What are the nurses interventions given this priority?
oral tumor/cancer
Suction PRN, encourage hydration, chest physiotherapy(promote gas exchange)
place in semi or high fowlers position
feed patient small bites, or use thickened liquids (aspiration pre caution)
Assess LOC, gag reflux, (before liquids) and ck ability to swallow.
Which patients are at risk for oral cancer?
oral tumor/cancer
Tobacco/alcohol use, HPV,
occupation exposure (textile workers, plumbers, coal,/metal, workers
periodontal disease (gum disease) where mandibular bone loss occurred
inflammation of salivary gland is also called
which people are at risk?
Acute sialadenitis
immunologic compromise people (HIV)
Acute Sialadenitis is associated with ?
A symptom of Acute sialadenitis's is?
if untreated what can it create ?
bacteria or virus
decrease in saliva reduction
an abscess
Considerations for patients recovering from EGD
What is the top priority ?
GERD
to prevent aspiration.
what are some considerations for a pateint recovering from a EGD procedure
GERD
after the test check vital signs every 15-30 min until sedation wears off
side rails of bed up during this time
patient remain NPO until gag reflex returns (don't give anything until reflex intact)
IV fluids discontinued once patient can tolerate oral fluids w/o nausea/vomiting
monitor for signs of perforation (pain, bleeding, fever)
someone must drive patient home, patient cannot drive 12-18 hrs after procedure
hoarse voice/sore throat may persist for several days
indications for a EGD test, which signs or symptoms might a patient have to prompt a provider to perform a EGD?
GERD
general symptoms include
abdominal pain
difficulty swallowing
nausea/vomiting
bloody stools
heart burn
unexplained weight loss
anemia
testing Hpylori
Dietary recommendations for GERD
limit fatty foods, spicy foods, caffeine, coffee, tea, cola, chocolate, nitrates, citrus fruits, tomatoes, alcohol, peppermint, spearmint, smoking, high estrogen levels,NG placement, calcium channel blockers.
patient education LINX reflux manager, contact your provider before getting what kind of test ?
MRI
WHAT IS A LINX PROCEDURE
ring composed of magnets, effective for patients with GERD, it corrects a weak esophageal.
what are some risks for developing GERD ?
Hiatal hernias
overweight
Smoking, high estrogen/progesterone
NG tube placement, taking calium channel blockers
eating high fatty spicy foods
anything that lowers LES (lower esophageal sphinders) is a risk for GERD
Complications for extended use of PPI (proton, pump, inhibitors)
C-diff
bone fractures
chronic kidney injury
vitamin/mineral deficiencies
CAP (community acquired pneumonia)