Maryville NURS 623 Exam 4 Questions and Answers Already Passed

Maryville NURS 623 Exam 4 Questions and Answers Already Passed What is important to note when a patient has traumatic injury If taking Blood Thinners Define delirium Underlying acute cause, abrupt onset, hours to days, reversible, hallucinations, incoherent speech, confusion Define Dementia Various causes, gradual change with mental status, months to years, progressive to irreversible (speech, memory, mood, judgment) An older adult with delirium would present with what type of behaviors? Agitation and restlessness At the onset of alzheimers, what category of medications should be initiated? Cholinesterase inhibitors what factors contribute to a patient being high risk for falls? History of falls medications vision impairment heart rate/rhythm abnormalities footwear issues home environment gait/mobility issues poor reflexes What is the primary reason people have long term effects after a Stroke living at home and calling PCP instead of 911 leads to prolonged stroke symptoms and long term effects S/S of an Absense Seizure Blank stare (upward rotation of eye) Red Flags of back/neck pain Incontinence Fever Cancers Unexplained wt loss Long term steroids Trauma IV drug abuse Intense local pain No comfy Position Diagnosing of Alzheimer's Impaired ability to learn new info along with a disturbance in language, function, or perception S/S of Alzheimer's *C/O memory problems * ↑ cognitive difficulty * ↑ slow response to cognitive challenge *Word-finding difficulty * ↑ difficulty with simple tasks cardinal features of Parkinson's (TRAP)? *T-remor at rest (or pill rolling) *R-igidity *A-kinesia/Bradykinesia *P-ostural Disturbances What disease is "freezing phenomenon" a characteristic of? Parkinson's A 62 y/o patient calls and c/o of a headache what statement would cause the most concern? It's the worst headache I've ever had the headache from a subdural hematoma is of venous origin, typically resulting from ahead injury that is usually mild and easily forgotten by the patient. Temporal arteritis s/s of temporal (giant cell) arteritis * unilateral HA (temporal artery, orbital) * jaw claudication (pain with chewing) * temporary blindness (Medical Urgency) Polymyalgia rheumatica (pain/stiff muscles shoulders and hips) What age group is at higher risk for temporal arteritis 50 Clinical manifestations of Articular disorders? *characterized by deep or diffuse pain, pain or limited ROM on active and passive movement *swelling *crepitus Clinical manifestations of Non-Articular disorders? *Tend to be painful on active but not passive (assisted) ROM. *Seldom demonstrate swelling, crepitus, instability, or deformity by itself. What diagnostic assessment is most useful in a patient who presents with lumbar radiculopathy? The straight leg raise (assesses L5-S1). pain would indicate most common disc herniation What cranial nerve is affected in Bell's Palsy? CN VII S/S of Bell's Palsy * Acute onset one-sided Facial paralysis with normal ocular movement and sensation * Affects CN VII (facial)-VII(vestibulocochlear) * Loss of taste (dysgeusia) * Postauricular pain * Sound sensitivity (hyperacusis) * Heavy feeling in face How is Bell's Palsy diagnosed? Clinical history and exam What is a serious risk in patients with Bell's Palsey? Loss of the ability to blink and close the eyelid subjects the cornea to drying and ulceration Patient teaching for Bell's Palsey *reassure it is self-limiting with 3-6 month recovery *prevent corneal ulceration/ use artificial tears *unilateral and tends to have a throbbing or pulsatile (head) *precipitated by aura *nausea *vomiting *photophobia *phonophobia S/S of Migraine H/A A patient reports seeing flashes 20 minutes before having a severe H/A what type of H/A is it? Classic migraine *unilateral orbital, supraorbital, and/or temporal (headache) *causes lacrimation, rhinorrhea, and nasal congestion) S/S of cluster H/A bilateral, non-pulsating, tightening (head) pain that is not aggravated by routine physical activity. It is usually not accompanied by nausea and vomiting or photophobia. S/S of tension headache If a patient c/o sudden 'thunder clap' H/A worst in their life what is a diff dx that should be considered? Aneurism (subarachnoid hemorrhage) potential complications of steroid use in a patient with impaired integrity of bone structure? Increased risk of fracture what maneuver should be used to assess CERVICAL nerve-root compression. Spurling Symptoms are related to compression of the median nerve, which results in pain, paresthesia's, numbness and tingling, and associated weakness in the hand and wrist that radiate to the thumb, index finger, middle finger, and radial half of the ring finger Carpal Tunnel Syndrome Form of arthritis characterized by painful flare-ups in joints of distal extremities? Gout Pain on the inside of elbow, Elbow stiffness, Hand and wrist weakness, Tingling sensation or numbness in the fingers, especially the ring and little fingers, Difficulty moving the elbow Medial Epicondylitis (Golfer's Elbow) Can cause neck pain, radiating arm pain, shoulder pain, and numbness or tingling in the arm or hand. The quality and type of pain can vary from dull, aching, and difficult to localize to sharp, burning, and easy to pinpoint, Can cause weakness in arm (s) Ruptured Cervical Disc In elderly patients, fracture of WHAT would lead to potentially fatal outcomes or problematic long term issues in elderly patients, Hip Fracture What is gold standard test for dx osteoporosis? DEXA Bone Density test Was is an important step during examination of an ortho complaint to be able to have a comparative value of both extremities always exam the non-effected side and then effected side for comparison What medications cause a patient to be at risk for developing osteoporosis? • Glucocorticoids • Excessive thyroxine • Long-term phenytoin What populations are at risk for developing osteoporosis? • Age (65+) * medications • Family history • Menopause • Genetics In a patient who is elderly and falls (does not remember the fall), but there is no clear cause of falls, what should your workup center around? syncope associated with Cardiac and neurologic causes If a patient is alert and oriented and refuses to give consent for a procedure, how do you move forward as a provider? Respec their wishes, Discuss risks of NOT having procedure, abort procedure, document refusal In elderly patients, what factors can contribute to loss of appetite and malnourishment? *Diminished taste/smell/vision *dry mouth *poor dentition *chronic illness *meds *pain *depression *loneliness How would you assess for a suspected meniscal tear with a physical exam? McMurray circumduction test. Which test assesses the integrity of the anterior cruciate ligament? Lachman Which test assesses for De Quervain's Tenosynovitis? Finkelstein's Pt education for Carpal Tunnel Syndrome * prevent flexion and extension movements of the wrist. * Thumb Spika 24/7 x 3 weeks *ergonomic Modifications Patients who would like to incorporate non-traditional therapies for treatment of pain-how do you respond? Educate on efficacy of other treatments but ultimately allow them and support them on their own decision as long as the cessation of pharmacological intervention is not detrimental In terms of physical activity in a patient with Osteoporosis, what would encourage *Muscle strengthening activities (Weight Bearing) *Heat followed by ice *Physical therapy In terms of physical activity in a patient with Osteoporosis, what would Discourage strenuous activity Patient education for Osteoporosis * Home environment Safety * Adequate nutrition (Vit D, calcium, Protein) * Vit D & Calcium Supplements *Weight bearing exercises Nodes on (distal) DIP joints secondary to osteoarthritis Heberden's nodes bony nodes at the proximal interphalangeal joints associated with OA Bouchard's nodes Inflammation of the tendon sheath, also called "mommy thumb" DeQuervains Tenosynovitis Use Finkelstein test (tuck thumb, abduct wrist) Type of fracture secondary to systemic disease Pathologic fracture an injury to the bone caused by overuse Stress fracture Common cause of posterior knee pain Bakers cyst Secondary to other process - osteoarthritis #1 A distressing Unilateral, painful electric shock sensation (cranial nerve V) AKA: tic douloureux (unbearable painful twitch). Trigeminal Neuralgia Differentiate between dizziness and vertigo *Dizziness - sensation of unsteady, feeling of movement in the head *Vertigo - feeling of spinning when you are not moving involves vestibular system, most common causes are benign positional vertigo, vestibular neuritis, Meniere disease, Imbalance mild to moderate, able to walk, Latency usually 20 minutes Peripheral Vertigo result from lesions affecting the brainstem and cerebellum, imbalance severe cant walk, Latency usually 5 minutes Central vertigo What is used to treat edema in the labyrinth with Peripheral Vestibular Disease? Diamox What antibiotic would not require adjusting in the elderly? Tobramycin What is considered a normal age-related lab change Increased ESR