NUR 2571 / NUR2571 Exam 3: Professional Nursing 2 Exam 3 / PN2 Exam 3 Concept Guide (Lates, Exams of Nursing

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NUR 2571 / NUR2571 Exam 3: Professional Nursing 2 Exam 3 / PN2 Exam 3 Concept Guide (Latest 2021/2022) Rasmussen PN 2PN2 Exam 3 (1) Rasmussen College N2 Exam 3 ❖ Type 1 Diabetes – an autoimmune dysfunction involving the destruction of beta cells, which produce insulin in the islets of Langerhans of the pancreas. ❖ Type 1 is an absolute lack of insulin secretion o Absence of insulin production; patient is dependent on insulin to prevent ketoacidosis and maintain life o Onset is frequently in childhood; usually ages 10-15 o This is forever o First sign is often Diabetic Ketoacidosis ❖ Type 2 is a combination of insulin resistance and inadequate insulin secretion to compensate o Often linked to obesity, sedentary lifestyle, and heredity o Onset is predominately in adulthood, generally after the age of 35 o Usually controlled with diet, exercise and oral hypoglycemics o Usually found by accident; the patient keeps coming back for a wound that won’t heal or repeated vaginal infections ❖ Signs and Symptoms: o Both Type 1 and Type 2: 3 Ps: polyuria, polydipsia, and polyphagia o Fatigue o Increased frequency of infections ❖ Type 1: o Weight loss o Bed-wetting, blurred vision o Enuresis (involuntary urination, especially in children at night) in children, nocturia in adults o Abdominal pain o Rapid onset ❖ Type 2: o Weight gain, visual disturbances o Slow onset; usually around 40 years old NUR 2571 / NUR2571 Exam 3: Professional Nursing 2 Exam 3 / PN2 Exam 3 Guide (Latest 2021/2022) Rasmussen PN 2PN2 Exam 3 (1) Rasmussen Concept College NUR 2571 / NUR2571 Exam 3: Professional Nursing 2 Exam 3 / PN2 Exam 3 Concept Guide (Latest 2021/2022) Rasmussen PN 2PN2 Exam 3 (1) Rasmussen College o Fatigue and malaise o Recurrent vaginal yeast ❖ Diagnostics: NUR 2571 / NUR2571 Exam 3: Professional Nursing 2 Exam 3 / PN2 Exam 3 Guide (Latest 2021/2022) Rasmussen PN 2PN2 Exam 3 (1) Rasmussen Concept College NUR 2571 / NUR2571 Exam 3: Professional Nursing 2 Exam 3 / PN2 Exam 3 Concept Guide (Latest 2021/2022) Rasmussen PN 2PN2 Exam 3 (1) Rasmussen College ▪ Contains protamine (a protein), which causes a delay in the insulin absorption or onset and extends the duration of action of the insulin ▪ Give NPH insulin subQ only – can be mixed with short-acting or rapid-acting o Long-Acting Insulin: glargine (Lantus), detemir (Levemir) ▪ CANNOT be diluted or mixed with any other insulin ▪ Usually given at bedtime ▪ Onset: 2-4 hours ▪ No peak ▪ Duration: 24 hours ▪ Detemir may be given twice a day, dependent on dose ▪ Only given subQ ❖ Insulin starting dose is 0.4 – 1 unit/kg/day, the dose is adjusted until the blood sugar is normal and there is no glucose or ketones in the urine ❖ Basal/bolus dosing is the most common method of daily dosing; it is a combination of long-acting insulin and rapid-acting insulin ❖ Insulin pumps are an alternative to daily insulin injections o Pump is programmed to deliver insulin through a needle in the subQ tissue. The needle needs to be changed at least every 2-3 days to prevent infection o Only rapid-acting insulin is used in infusion pump o Complications: accidental cessation of insulin administration, obstruction of the tubing/needle, pump failure, and infection ❖ Insulin Pens are prefilled with 150-300 units of insulin o Convenient for travel o Used for patients who have vision impairment or problems with dexterity ❖ Insulin sites should be rotated to prevent lipodystrophy or lipohypertrophy – lumps under the skin from an accumulation of extra fat at the site of many subQ injections NUR 2571 / NUR2571 Exam 3: Professional Nursing 2 Exam 3 / PN2 Exam 3 Guide (Latest 2021/2022) Rasmussen PN 2PN2 Exam 3 (1) Rasmussen Concept College NUR 2571 / NUR2571 Exam 3: Professional Nursing 2 Exam 3 / PN2 Exam 3 Concept Guide (Latest 2021/2022) Rasmussen PN 2PN2 Exam 3 (1) Rasmussen College ❖ Oral Medications: ❖ Sulfonylureas – glipizide, glimepiride, glyburide o Stimulates insulin release from the pancreas causing a decrease in blood sugar levels and increases tissue sensitivity to insulin o Monitor for hypoglycemia - biggest side effect of this medication NUR 2571 / NUR2571 Exam 3: Professional Nursing 2 Exam 3 / PN2 Exam 3 Guide (Latest 2021/2022) Rasmussen PN 2PN2 Exam 3 (1) Rasmussen Concept College NUR 2571 / NUR2571 Exam 3: Professional Nursing 2 Exam 3 / PN2 Exam 3 Concept Guide (Latest 2021/2022) Rasmussen PN 2PN2 Exam 3 (1) Rasmussen College o Given 30 mutes before meals o Avoid alcohol due to disulfiram effect ❖ Thiazolinediones – avandia (Rosiglitazone), and actos (Pioglitazone) o Reduces the production of glucose by the liver (gluconeogenesis) o Increases tissue sensitivity to insulin – does not increase insulin production o Reverse insulin resistance by acting on muscle, fat, and to a lesser extent the liver to increase glucose utilization and diminish glucose production o Monitor for fluid retention, especially in clients who have a history of HF o Monitor for elevation of ALT, LDH, and triglyceride levels o Patient should report rapid weight gain, shortness of breath or decreased exercise tolerance o Use additional birth control because this medication increases pregnancy risk ❖ Biguanides – metformin o Decreases sugar production by the liver (gluconeogensis) and helps the muscles use insulin to break down sugar o Increases tissue sensitivity to insulin o Slows carbohydrate absorption in the intestines o Monitor for lactic acidosis – especially in patients who have kidney disorders or liver dysfunction o STOP for 48 hours before any type of elective radiographic test with iodine contrast dye and restart 48 hours after test o Take with food – causes GI discomfort (diarrhea), this does stop o This medication lowers lipids and triglycerides ❖ Treatment is insulin for Type 1 diabetes ❖ Treatment for Type 2 diabetes – first diet and exercise, then oral hypoglycemics, then insulin ❖ Diet: calories should be complex carbohydrates, then fats, and lastly protein ***protein should be limited 10-20% because most diabetics have renal disease o Patient should get a high fiber diet because fiber slows the NUR 2571 / NUR2571 Exam 3: Professional Nursing 2 Exam 3 / PN2 Exam 3 Guide (Latest 2021/2022) Rasmussen PN 2PN2 Exam 3 (1) Rasmussen Concept College NUR 2571 / NUR2571 Exam 3: Professional Nursing 2 Exam 3 / PN2 Exam 3 Concept Guide (Latest 2021/2022) Rasmussen PN 2PN2 Exam 3 (1) Rasmussen College ❖ Diabetic Ketoacidosis (DKA) – an extreme increase in the hyperglycemic state; anything that increases blood sugar can throw a client in to DKA (illness, infection, skipping insulin) o ***DKA may be the first sign of Type 1 diabetes NUR 2571 / NUR2571 Exam 3: Professional Nursing 2 Exam 3 / PN2 Exam 3 Guide (Latest 2021/2022) Rasmussen PN 2PN2 Exam 3 (1) Rasmussen Concept College NUR 2571 / NUR2571 Exam 3: Professional Nursing 2 Exam 3 / PN2 Exam 3 Concept Guide (Latest 2021/2022) Rasmussen PN 2PN2 Exam 3 (1) Rasmussen College o Signs and Symptoms: ▪ Abdominal pain, anorexia, nausea, vomiting, diarrhea ▪ Confusion increasing to coma ▪ Warm, dry, flushed skin ▪ Tachycardia with a weak pulse ▪ Kussmaul’s respirations – trying to blow off CO2 to compensate for the metabolic acidosis ▪ Fruity, acetone breath ▪ Polyuria, Polydipsia, and Polyphagia ▪ Glucose will be greater than 300 mg/dL ▪ pH is low (less than 7.3), CO2 is normal, and HCO3 is low – metabolic acidosis ▪ Ketones are high ▪ Hematocrit is high due to dehydration ▪ Hyperkalemia – potassium follows sugar o The onset for this is rapid – think type 1 diabetes ❖ Hyperosmolar Hyperglycemia Nonketosis (HHNK) or Hyperglycemia Hyperosmolar State (HHS) – these people are making just enough insulin so that they are not breaking down fats – no fat breakdown=no ketones=NO acidosis o ***Think type 2 diabetes o Signs and Symptoms: ▪ More severe altered LOC ▪ Warm, dry, flushed skin ▪ Tachycardia ▪ Tachypnea ▪ Polyuria ▪ Greater than 600 mg/dL blood sugar ▪ NO acidosis ▪ Hematocrit is high due to dehydration o The onset is slow – think type 2 diabetes o Treatment for HHNK and DKA: ▪ Treat the underlying cause (infection) ▪ Regular insulin administered IV NUR 2571 / NUR2571 Exam 3: Professional Nursing 2 Exam 3 / PN2 Exam 3 Guide (Latest 2021/2022) Rasmussen PN 2PN2 Exam 3 (1) Rasmussen Concept College NUR 2571 / NUR2571 Exam 3: Professional Nursing 2 Exam 3 / PN2 Exam 3 Concept Guide (Latest 2021/2022) Rasmussen PN 2PN2 Exam 3 (1) Rasmussen College ▪ Kayexalate for hyperkalemia ▪ Sodium Bicarb for severe acidosis ▪ Once glucose gets closer to 250 mg/dL add glucose to the IV fluids to prevent cerebral edema and hypoglycemia NUR 2571 / NUR2571 Exam 3: Professional Nursing 2 Exam 3 / PN2 Exam 3 Guide (Latest 2021/2022) Rasmussen PN 2PN2 Exam 3 (1) Rasmussen Concept College NUR 2571 / NUR2571 Exam 3: Professional Nursing 2 Exam 3 / PN2 Exam 3 Concept Guide (Latest 2021/2022) Rasmussen PN 2PN2 Exam 3 (1) Rasmussen College ❖ Immunodeficiency is the inability to produce a normal complement of antibodies or immunologically sensitized T cells (cell-mediated immunity), especially in response to specific antigens ❖ Immunodeficiency disorders are due to dysfunction or impairment of one or more of the immune response mechanisms. The mechanisms include phagocytosis, humoral response, B cell- and T cell-mediated response or combination, the complement system, and a combined cell and humoral response. ❖ Primary Immune Response – occurs when an antigen is initially introduced into the system; it involves both mast cell degranulation and activation of the plasma proteins o Disorder: HIV ❖ Secondary or specific immune antibody response – includes the activation of B cells and the memory cells (IgG, IgM, IgA, and IgE); and activation of T cells, cytotoxic (killer) cells, lymphokine-producing cells, helper cells, and suppressor cells (humoral immunity) to a specific antigen o Disorders: Myasthenia gravis, Fibromyalgia, Rheumatoid arthritis (classified as a connective tissue disorder), Systemic Lupus Erythematosus (vascular and connective tissue disorder) ❖ HIV – a retrovirus that is transmitted through blood and body fluids; HIV targets CD4+ lymphocytes (T-cells or T-lymphocytes); both are part of specific acquired (adaptive) immunity ❖ Normally, CD4+ T cells orchestrate the immune system process in responding to foreign antigens. ❖ HIV is found in feces, urine, tears, saliva, cerebrospinal fluid, cervical cells, lymph nodes, corneal tissue, and brain tissue ❖ Progression of HIV infection: o Manifestations occur within 2-4 weeks of infection o Symptoms are similar to those of influenza (Flu-like symptoms) and can include a rash and a sore throat o This stage is marked by a rapid rise in the HIV viral load, decreased CD4+ cells, and increased CD8 cells o Lymphadenopathy persists throughout the entire disease process NUR 2571 / NUR2571 Exam 3: Professional Nursing 2 Exam 3 / PN2 Exam 3 Guide (Latest 2021/2022) Rasmussen PN 2PN2 Exam 3 (1) Rasmussen Concept College NUR 2571 / NUR2571 Exam 3: Professional Nursing 2 Exam 3 / PN2 Exam 3 Concept Guide (Latest 2021/2022) Rasmussen PN 2PN2 Exam 3 (1) Rasmussen College o Chronic asymptomatic infection: ▪ This stage may be prolonged and clinically silent (asymptomatic) NUR 2571 / NUR2571 Exam 3: Professional Nursing 2 Exam 3 / PN2 Exam 3 Guide (Latest 2021/2022) Rasmussen PN 2PN2 Exam 3 (1) Rasmussen Concept College NUR 2571 / NUR2571 Exam 3: Professional Nursing 2 Exam 3 / PN2 Exam 3 Concept Guide (Latest 2021/2022) Rasmussen PN 2PN2 Exam 3 (1) Rasmussen College ▪ The patient may remain asymptomatic for 10 years or more ▪ Anti-HIV antibodies are produced (HIV positive) ▪ CD4+ cells are destroyed (these cells keep us immune) ▪ Dramatic loss of immunity begins o AIDS: ▪ This stage is characterized by life-threatening opportunistic infections ▪ This is the end stage of HIV infection – without treatment, death occurs within 5 years ❖ Risk factors for HIV: o Unsafe sexual practices o Rape o Prostitution o Multiple sexual partners o Exposure to contaminated blood and contaminated needles o Occupational ❖ Assessment: o Subjective Data (mostly stage 1 and 2): ▪ Chills ▪ Rash ▪ Anorexia, nausea, and weight loss ▪ Weakness and fatigue ▪ Headache and sore throat ▪ Night sweats NUR 2571 / NUR2571 Exam 3: Professional Nursing 2 Exam 3 / PN2 Exam 3 Guide (Latest 2021/2022) Rasmussen PN 2PN2 Exam 3 (1) Rasmussen Concept College NUR 2571 / NUR2571 Exam 3: Professional Nursing 2 Exam 3 / PN2 Exam 3 Concept Guide (Latest 2021/2022) Rasmussen PN 2PN2 Exam 3 (1) Rasmussen College o Positive result or report of a detectable quantity from any of the following HIV virologic (viral load) testing: ▪ RNA quantification (HIV viral load test) – determines viral load before beginning treatment; this test can be repeated to monitor disease progression, identify compliance, and determine medication resistance ❖ Nursing Care: o Assess risk factors – sexual practices, IV drug use o Monitor fluid intake and urinary output o Obtain daily weights to monitor weight loss o Monitor nutritional intake o Monitor electrolytes o Assess skin integrity – rashes, open areas, bruising o Assess the client’s pain status o Monitor vital signs – especially temperature o Assess lung sounds/ respiratory status – diminished lung sounds o Assess neurological status – confusion, dementia, visual changes ❖ Medications: o Highly active antiretroviral therapy (HAART) involves using 3 or 4 medications in combination to reduce medication resistance, adverse effects, and dosages o Fusion inhibitors: Enfuvirtide (Fuzeon)– blocks the fusion of HIV with the host cell o Entry inhibitors: Maraviroc (Selzentry) o Nucleoside reverse transcriptase inhibitors: Zidovudine (Retrovir) – interferes with the virus’s ability to convert RNA into DNA o Non-nucleoside reverse transcriptase inhibitors: Delavirdine (Rescriptor) and efavirenz (Sustiva) – inhibit viral replication in cells o Protease inhibitors: Raltegravir (Isentress) o Antineoplastic medication: Interleukin (Interferon) – immunostimulant that enhances the immune response and reduces NUR 2571 / NUR2571 Exam 3: Professional Nursing 2 Exam 3 / PN2 Exam 3 Guide (Latest 2021/2022) Rasmussen PN 2PN2 Exam 3 (1) Rasmussen Concept College NUR 2571 / NUR2571 Exam 3: Professional Nursing 2 Exam 3 / PN2 Exam 3 Concept Guide (Latest 2021/2022) Rasmussen PN 2PN2 Exam 3 (1) Rasmussen College the production of cancer cells (commonly used in Kaposi’s sarcoma) o Long-term effects of HAART therapy are hypertension, diabetes, osteopenia, and hyperlipidemia NUR 2571 / NUR2571 Exam 3: Professional Nursing 2 Exam 3 / PN2 Exam 3 Guide (Latest 2021/2022) Rasmussen PN 2PN2 Exam 3 (1) Rasmussen Concept College NUR 2571 / NUR2571 Exam 3: Professional Nursing 2 Exam 3 / PN2 Exam 3 Concept Guide (Latest 2021/2022) Rasmussen PN 2PN2 Exam 3 (1) Rasmussen College ❖ Patient Education: o Frequent hand hygiene to reduce the risk of infection o Avoid crowded areas or traveling to countries with poor sanitation o Avoid raw foods (fruits and vegetables) and undercooked meats, fish, or eggs o ***Avoid cleaning the pet litter boxes to reduce risk of toxoplasmosis ❖ Opportunistic infections: o Bacterial diseases: tuberculosis, bacterial pneumonia, and septicemia (blood poisoning) o HIV-associated malignancies: Kaposi’s sarcoma, lymphoma, and squamous cell carcinoma o Viral diseases: cytomegalovirus, herpes simplex, and herpes zoster virus o Fungal diseases: pneumocystitis jirovecil pneumonia (PCP – do drugs), candidiasis, crytospoidiosis, and pencilliosis o Protozoal diseases: such as PCP, toxoplasmosis, microsporidiosis, crytospoidiosis, isosporiasis, and leishmaniasis ❖ Wasting syndrome: o Maintain nutrition orally or by TPN if indicated o Monitor weight, calorie counts, and I&O o Provide between-meal supplements/snacks o Decrease fat content of foods to prevent complications of fat intolerance o Six small feedings, high in protein ❖ Seizures (HIV encephalopathy): o Maintain safety o Implement seizure precautions ❖ Systemic Lupus Erythematosus (SLE) ❖ SLE is an autoimmune disorder that affects multiple organs – it is characterized by a diffuse production of autoantibodies that attack and cause damage to body organs and tissue ❖ In autoimmune disorders, small antigens may bond with healthy tissue. The body then produces antibodies that attack the healthy tissue. This may NUR 2571 / NUR2571 Exam 3: Professional Nursing 2 Exam 3 / PN2 Exam 3 Guide (Latest 2021/2022) Rasmussen PN 2PN2 Exam 3 (1) Rasmussen Concept College NUR 2571 / NUR2571 Exam 3: Professional Nursing 2 Exam 3 / PN2 Exam 3 Concept Guide (Latest 2021/2022) Rasmussen PN 2PN2 Exam 3 (1) Rasmussen College Spasms of arteries and arterioles occur spontaneously, usually due to exposure to cold or emotional stress. o Esophageal movement is decreased because of deposits of collagen and muscle atrophy. NUR 2571 / NUR2571 Exam 3: Professional Nursing 2 Exam 3 / PN2 Exam 3 Guide (Latest 2021/2022) Rasmussen PN 2PN2 Exam 3 (1) Rasmussen Concept College NUR 2571 / NUR2571 Exam 3: Professional Nursing 2 Exam 3 / PN2 Exam 3 Concept Guide (Latest 2021/2022) Rasmussen PN 2PN2 Exam 3 (1) Rasmussen College o Sclerodactyly of the fingers and toes. o Telangiectasia: A permanent dilation of the capillaries, arterioles, and venules. ❖ Diagnostics: o Antinuclear antibodies (ANA): antibodies produced against one’s own DNA; positive titers in 95% of patients who have lupus o Erythrocyte sedimentation rate (ESR): elevated due to systemic inflammation o BUN and serum creatinine: Increased with kidney involvement o BUN = 5-20 o Creatinine = 0.4-1.5 ❖ Medications: o NSAIDs ▪ Used to reduce inflammation and arthritic pain. ▪ NSAIDs are contraindicated for clients who have renal compromise. ▪ Monitor for NSAID-induced hepatitis. ▪ ***Liver enzymes o Corticosteroids (prednisone [Deltasone]) ▪ Used for immunosuppression and to reduce inflammation. ▪ Monitor for fluid retention, hypertension, and renal dysfunction. ▪ Do not stop taking steroids or decrease the dose abruptly. ▪ ***Cushing’s o Immunosuppressant agents – methotrexate and azathioprine (Imuran) ▪ Used to suppress the immune response. ▪ Nursing Considerations – Monitor for toxic effects (bone marrow suppression, increased liver enzymes). o Antimalarial – hydroxychloroquine (Plaquenil) ▪ Used for suppression of synovitis, fever, and fatigue. ▪ Nursing Considerations – Encourage frequent eye examinations. Meds can damage eyes NUR 2571 / NUR2571 Exam 3: Professional Nursing 2 Exam 3 / PN2 Exam 3 Guide (Latest 2021/2022) Rasmussen PN 2PN2 Exam 3 (1) Rasmussen Concept College NUR 2571 / NUR2571 Exam 3: Professional Nursing 2 Exam 3 / PN2 Exam 3 Concept Guide (Latest 2021/2022) Rasmussen PN 2PN2 Exam 3 (1) Rasmussen College ❖ Complications: o Lupus nephritis (renal failure/glomerulonephritis) NUR 2571 / NUR2571 Exam 3: Professional Nursing 2 Exam 3 / PN2 Exam 3 Guide (Latest 2021/2022) Rasmussen PN 2PN2 Exam 3 (1) Rasmussen Concept College NUR 2571 / NUR2571 Exam 3: Professional Nursing 2 Exam 3 / PN2 Exam 3 Concept Guide (Latest 2021/2022) Rasmussen PN 2PN2 Exam 3 (1) Rasmussen College ❖ RA is also a systemic disease that can affect any connective tissue in the body. Common structures that are affected are the blood vessels, pleura surrounding the lungs, and pericardium. Iritis and scleritis can also develop in the eyes. ❖ Rheumatoid arthritis is most often seen in older adults and usually progresses to systemic stages involving the heart, lungs, and other vital organs. Comorbid diseases complicate symptom management. ❖ Older adults often hesitate to exert themselves and frequently delay seeking help because they believe that nothing can be done for them. Fear and anxiety of the possible flare-up episodes and eventual disability outcomes are contributing factors to depression. ❖ Risk Factors o Female gender (3:1) o Age 20 to 50 years o Genetic predisposition o Epstein-Barr virus o Stress o Environmental factors ❖ Signs and Symptoms: o Subjective Data ▪ Pain at rest and with movement ▪ Morning stiffness ▪ Pleuritic pain (pain upon inspiration) ▪ Xerostomia (dry mouth) ▪ Anorexia/weight loss ▪ Fatigue ▪ Paresthesias ▪ Recent illness/stressor ▪ Joint pain ▪ Lack of function ❖ Common early clinical manifestations include diffuse musculoskeletal pain, low-grade fever, possible anorexia, and loss of weight. ❖ Later, articular (within the joint) manifestations include synovitis, which is NUR 2571 / NUR2571 Exam 3: Professional Nursing 2 Exam 3 / PN2 Exam 3 Guide (Latest 2021/2022) Rasmussen PN 2PN2 Exam 3 (1) Rasmussen Concept College NUR 2571 / NUR2571 Exam 3: Professional Nursing 2 Exam 3 / PN2 Exam 3 Concept Guide (Latest 2021/2022) Rasmussen PN 2PN2 Exam 3 (1) Rasmussen College inflammation of the synovial capsule that causes escape of synovial fluid into the synovial capsule. Subsequent hypertrophy and symmetrical joint deformity (particularly wrists, hands, or knees) occur. Pain; muscle spasm; NUR 2571 / NUR2571 Exam 3: Professional Nursing 2 Exam 3 / PN2 Exam 3 Guide (Latest 2021/2022) Rasmussen PN 2PN2 Exam 3 (1) Rasmussen Concept College NUR 2571 / NUR2571 Exam 3: Professional Nursing 2 Exam 3 / PN2 Exam 3 Concept Guide (Latest 2021/2022) Rasmussen PN 2PN2 Exam 3 (1) Rasmussen College and weakness, because of contractures of muscles, tendons, and ligaments; and muscle and soft tissue damage greatly impact the person’s daily activities. o Objective Data ▪ Clinical findings depend on the area affected by the disease process ▪ Joint swelling and deformity, warmth, and erythema. ▪ Finger, hands, wrists, knees, and foot joints are generally affected. ▪ Finger joints affected are the proximal interphalangeal and metacarpophalangeal joints. ▪ Joints may become deformed merely by completing ADLs. ▪ Ulnar deviation, swan neck, and boutonniere deformities are common in the fingers. o Subcutaneous nodules ▪ Fever (generally low grade) ▪ Muscle weakness/atrophy ▪ Reddened sclera and/or abnormal shape of pupils ▪ Lymph node enlargement ❖ Diagnostics: o Morning stiffness lasting more than one hour o Arthritis of three or more joint areas o Arthritis of hand joints o Symmetrical arthritis o Rheumatoid nodules over extensor surfaces or bony prominences o Serum rheumatoid factors o Radiographic changes o Anti-CCP antibodies – Positive ▪ This test detects antibodies to cyclic citrullinated peptide (anti- CCP). The result is positive in most people who have rheumatoid arthritis, even years before symptoms develop. ▪ The test is more sensitive for RA than rheumatoid factor (RF) antibodies. o RF antibody ▪ Diagnostic level for rheumatoid arthritis is 1:40 to NUR 2571 / NUR2571 Exam 3: Professional Nursing 2 Exam 3 / PN2 Exam 3 Guide (Latest 2021/2022) Rasmussen PN 2PN2 Exam 3 (1) Rasmussen Concept College NUR 2571 / NUR2571 Exam 3: Professional Nursing 2 Exam 3 / PN2 Exam 3 Concept Guide (Latest 2021/2022) Rasmussen PN 2PN2 Exam 3 (1) Rasmussen College gastrointestinal (GI) distress. ▪ Nursing Considerations: NUR 2571 / NUR2571 Exam 3: Professional Nursing 2 Exam 3 / PN2 Exam 3 Guide (Latest 2021/2022) Rasmussen PN 2PN2 Exam 3 (1) Rasmussen Concept College NUR 2571 / NUR2571 Exam 3: Professional Nursing 2 Exam 3 / PN2 Exam 3 Concept Guide (Latest 2021/2022) Rasmussen PN 2PN2 Exam 3 (1) Rasmussen College • Request a concurrent prescription for a GI-acid lowering agent (histamine2-receptor antagonist, proton pump inhibitor) if GI distress is reported. • Monitor for fluid retention, hypertension, and renal dysfunction. ▪ Client Education: ▪ Instruct the client to take the medication with food or with a full glass of water or milk. If taking routinely, o H2-receptor antagonist may also be prescribed. ▪ Observe for GI bleeding (coffee ground emesis; dark, tarry stools). ▪ Avoid alcohol, which can increase the risk of GI complications. ▪ ***Check BUN and Creat! o Corticosteroids ▪ Corticosteroids (prednisone) are strong anti-inflammatory medications that may be given for acute exacerbations or advanced forms of the disease. They are not given for long- term therapy due to significant adverse effects (osteoporosis, hyperglycemia, immunosuppression, cataracts). ▪ Nursing Considerations: • Observe for Cushingoid changes. • Monitor weight and blood pressure. ▪ Client Education: • Instruct the client to observe for changes in vision, blood glucose, and impaired healing. • Instruct the client to avoid crowds. • Instruct the client to follow the provider’s prescription, such as alternate day dosing, tapering, and discontinuing medication. o Disease modifying anti-rheumatic drugs (DMARDs) ▪ DMARDs work in a variety of ways to slow the progression of RA and suppress the immune system’s reaction to RA that causes pain and inflammation. Relief of symptoms may not occur for several weeks. o Antimalarial agent – hydroxychloroquine (Plaquenil) o Antibiotic – minocycline (Minocin) NUR 2571 / NUR2571 Exam 3: Professional Nursing 2 Exam 3 / PN2 Exam 3 Guide (Latest 2021/2022) Rasmussen PN 2PN2 Exam 3 (1) Rasmussen Concept College NUR 2571 / NUR2571 Exam 3: Professional Nursing 2 Exam 3 / PN2 Exam 3 Concept Guide (Latest 2021/2022) Rasmussen PN 2PN2 Exam 3 (1) Rasmussen College o Sulfonamide – sulfasalazine (Azulfidine) NUR 2571 / NUR2571 Exam 3: Professional Nursing 2 Exam 3 / PN2 Exam 3 Guide (Latest 2021/2022) Rasmussen PN 2PN2 Exam 3 (1) Rasmussen Concept College