MEDSURG Final complete update A+ GRADED
Osteoarthritis (OA) Noninflammatory degenerative joint disorder characterized by the progressive deterioration of articular cartilage. Leads to erosion of cartilage and underlying bone. Ultimately, joint spaces become narrowed, resulting ...
Osteoarthritis (OA) Noninflammatory degenerative joint disorder characterized by the
progressive deterioration of articular cartilage. Leads to erosion of cartilage and underlying bone.
Ultimately, joint spaces become narrowed, resulting in pain. Typically unilateral, localized.
OA: Risk Factors ↠ Aging: Over 60 y.o.
↠ Acute or repetitive stress on joint predisposes later on. (obesity, joint injuries).
↠ Metabolic disorders DM, blood disorders.
OA Expected Findings ↠ Joint pain, stiffness, limping
↠ Crepitus (cracking or popping sound)
↠ Enlarged affected joint
↠ Heberden (distal) and Bouchard (proximal) nodes
↠ Pain with activity that improves with rest.
↠ Active ROM exercise is more effective than passive.
OA: Nursing Interventions ↠ APAP: Max 4 g/24 hrs.
↠ NSAIDs: Nephrotoxic → monitor BUN/Cr, report black tarry stools and blood in stools, take
with food.
↠ Cap. Cream: Apply 3-4 x's daily. BURNS → wear gloves, avoid touching face & eyes.
↠ Heat and Cold therapy (limit to 20 min.)
ATI Workbook
A nurse is assessing a client who has OA of the knees and fingers. Which of the following
manifestations should the nurse expect to find? (Select all that apply)
a. Heberden's nodes
b. Swelling of all joints
,c. Small body frame
d. Enlarged joint size
e. Limp when walking a. Heberden's nodes
d. Enlarged joint size
e. Limp when walking
ATI Workbook
A nurse is providing information to a client who has OA of the hip and knee. Which of the
following information should the nurse include in the information? (Select all that apply)
a. Apply heat to joints to alleviate pain
b. Ice inflamed joints for 30 min following activity.
c. Reduce the amount of exercise done on days with increased pain
d. Prop the knees with a pillow while in bed
e. Active ROM is more effective than passive a. Apply heat to joints to alleviate pain
c. Reduce the amount of exercise done on days with increased pain
e. Active ROM is more effective than passive
ATI Workbook
A nurse is providing information about capsaicin cream to a client who reports continuous knee
pain from OA. Which of the following information should the nurse include in the discussion?
a. Continuous pain relief is provided
b. Put on gloves before applying the cream to other parts of the body
c. Leave cream on the hands for 10 min following application
d. Apply the medication every 2 hr during the day. b. Put on gloves before applying the cream
to other parts of the body
Peripheral Vascular Disease (PVD) Includes PAD & Peripheral Venous Insufficiency, both of
which interfere with normal blood flow.
- PAD: affects arteries
- Peripheral Venous Disease: affects veins.
Peripheral Arterial Disease (PAD) Inadequate blood flow of the lower extremities due to
atherosclerosis. Arteries start to form plaque and become progressively stiffened and narrow,
decreasing blood flow.
- Disorders: Buerger's Disease, Raynaud's Disease, Subclavian Steal Syndrome, etc.
PAD: Expected Findings - Hypoxia in legs during exercise/activity (burning/pain) →
"Intermittent Claudication"
- Hairless, shiny skin on calves.
- Pain relieved by rest and placing legs in dependent position.
- Dependent rubor (redness) of the extremity → Change from pale to red to blue/purple.
- Thick toenails.
- Decreased Cap. refill
- Cold to touch.
,- Get sores that do not heal - usually on the TOES.. if client has Neuropathy they won't feel
wounds.
PAD: Client Education - Positions: Avoid crossing legs, wearing restrictive garments, keep
legs elevated to reduce swelling but not above heart
-Vasodilation: Maintain warm environment, avoid applying direct heat to extremity, avoid stress,
caffeine, nicotine (vasoconstrictor).
- Exercise
Clopidogrel: Client Education ↝ The medication's effects might not be apparent for
several weeks.
↝ Monitor for evidence of bleeding: abdominal pain, coffee-ground emesis, black, tarry stools.
↝ Avoid herbal supplements: as they increase the risk of bleeding.
PAD Procedures: Angioplasty Invasive procedure using a balloon and stent to widen and
restore narrowed arteries.
- NI: Observe for bleeding at the puncture site. Keep Pt on bed rest w/limb straight for 2-6 hrs
before ambulating.
PAD Procedures: Arterial Revascularization Surgery Bypass grafts are used to reroute
circulation.
- IND: Severe claudication and Pt's at risk for losing limb.
- NI: Monitor for adequate circulation checking distal pulses and mark with doppler. Monitor cap
refill & 6 P's (pain, pressure, paralysis, paresthesia, pallor, pulse).
Deep Vein Thrombosis (DVT) - Arises from Venous Stasis.
- Pt is usually bedbound or has venous insufficiency.
- If it breaks off it can travel in the blood to the lungs, causing pulmonary embolism (PE).
- DO NOT MASSAGE → Can lead to PE.
DVT: S/S - Unilateral Edema
- Pain, tenderness w/ palpation
- "Full" sensation in thigh or calf
- Red, warm to touch
DVT: Risk Factors - Anemia, Polycythemia (high RBCs) related to COPD.
- Smoking
- Burns
- Dehydration
, Pulmonary Embolism (PE) When a clot/thrombus is carried by the blood to the lungs and gets
stuck in a pulmonary vessel. EMERGENCY!
PE: S/S - Sudden Chest Pain → worsens w/ Deep breath or cough.
- Dyspnea/SOB
- Hypotension
- Hemoptysis (coughing up blood)
- Petechia over chest and axilla (usually fat embolism)
A nurse is providing health teaching for a group of clients. Which of the following clients is at
risk for developing peripheral arterial disease?
a. A client who has hypothyroidism
b. A client who has diabetes mellitus
c. A client whose daily caloric intake consists of 25% fat
d. A client who consumes two 12-oz (0.35-L) bottles of beer a day b. A client who has diabetes
mellitus
ATI Workbook
A nurse is assessing a client who has chronic PAD. Which of the following findings should the
nurse expect?
a. Edema around the ankles and feet.
b. Ulceration around the medial malleoli.
c. Scaling eczema of the lower legs with stasis dermatitis.
d. Pallor on elevation of the limbs, and rubor when the limbs are dependent. d. Pallor on
elevation of the limbs, and rubor when the limbs are dependent.
A client who is receiving heparin therapy is started on warfarin. Which nursing explanation is
appropriate?
A. "You will need both drugs long-term to provide long-term anticoagulation."
B. "Warfarin is easier on your stomach so you can take it long-term."
C. "It takes several days for warfarin to begin working, so both drugs are required for a short
time."
D. "These drugs work the same, but one is taken by mouth, so it is easier to take at home."
C. "It takes several days for warfarin to begin working, so both drugs are required for a
short time."
ATI Workbook
A nurse is teaching a client who has a new diagnosis of severe PAD. Which of the following
instructions should the nurse expect?
a. Wear tightly fitted insulated socks with shoes when going outside.
b. Elevate both legs above the heart when resting.
c. Apply a heating pad to both legs for comfort.
d. Place both legs in dependent position while sleeping. d. Place both legs in dependent
position while sleeping.
NCLEX Q's
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