Exam 7

Front 1

1) Osteoporosis risk factors

Back 1

1) steroid use; postmenopausal women, age, lifestyle (caffeene, alcohol cigarettes, carbonates soft drinks).lack of calcium. specific disease states (celicac disease and hypogonadism). medications (antiseizure agents, thyroid replacement agents, serotonin reuptake inhibitors, Proton pump inhibitors)/. (pg1141)

Front 2

osteoporosis

1) key Summary

2) What happens?

3) What is the pathophysiology of why it occurs in aging?

4) what particular back symptom occurs with aging in osteoporosis? And what other risks does this lead to?

5) how is this treated medically?

Back 2

1) "brittle bones"

2)rate of bone resorption of osteoclast is greaeter than rate of bone formation maintained by osteoblast.

3) calcitonin (which inhibits bone resorption and promotes bone formation) is decreased. estrogen (which 'inhibits bone breakdown') is decreased. PTH is increased.

4) kyphosis. this can lead to increased fall risk r/t balance issue. also pulmonary insufficiency.

5) ciet of calcium (cheese, dairy, brocclii, salmon) and vit d. weight bearing exercise. Aerobic exercise and weight training.

Front 3

1) first line meds for osteoporosis?

2) side effects of calcium?how should calcium be administered?

3) name the biphosphonates

4) s/e of biphosphonates

5) What do biphosphanate do? (mechanism of action)

Back 3

1) calcium, vit D and biphosphinates. "build bones".

2) taken w/ meals or beverage high in vit c to promote absorption. daily dose should be split and not taken as single dose. s/e=abd distention and constipation.

3))'dronates and dronic. alendronate (fosamax), risedronate (actonel), ibandronate (boniva), yearly IV zoledronic acid (reclast). They all 'inhibit osteoclast function'

4) GI symptoms (dypsepia, nausea, fart, diarrhea, constipation). take w/ empty stomachin morning w/ water, sit upright for 30-60 min after admin.

5) prevents bone resorption. "increase bone mass and decrease bone loss by inhibiting osteoclast function" (p1144).

Front 4

1) raloxifene (evista)

2) teriparatide (forteo)

3) denosumab (prolia)

Back 4

1) selective estrogen receptor modulator. reduce risk of OP in postmenopausal women w/out estrogenic effects on uterus ("act as estrogen?") contraindicate for women w/ vte

2) "stimulates osteoblast to build bone matrix and facilitates overall ca absorption. reserved for high fracture risk and longterm corticosteroid using pts (pg1144)

3) increase BMD. class: factor kappa b ligand (rankl). used for pts who do not respond to other meds and remain high risk (pg1144)

Front 5

1) s/s of cataracts

2) medical management of cataracts

Back 5

1) painless and blurry vision. diplopia (double vision). astigmatism. color changes as lens become more brown in color. surroundings are dimmer (as if glasses need cleaning). light scattering. reduced contrast sensitivity, sensitivity to glare, reduced visual acuity. myopic shift.

2) risk reduction strategie (smoking cessation, weight loss, blood sugar control 4 diabetes). . Wear sunglasses outdoors.

Front 6

1) s/s of glaucoma

Back 6

1) open angle glaucoma- painless and vision changes are slow. results in 'tunnel vision' (saunders p890)

2) closed angle glaucoma- blurred vision, halos around light, ocular erythema.

Accdg to brunner: "silent theif of night" (often asymptomatic.) blurred vision, halos, difficulty focusing, diffulcty adjusting eyes in low lighting, loss of peripheral vision, aching or discomfort around eyes, and headache.

Front 7

1) what is the preffered INITIAL topical medication for glaucoma?

2) what other types of meds are used to treat glaucoma?

Back 7

1) betblockers (p1855)

2) miotics (meds that cause pupillary constriction to increase outflow of aqueous humor); alpha 2 agonist;

-cholinergics: increase outflow of aqueous humor by affecting ciliary muscle contraction and pupil constriction, allowing flow through a larger opening between the iris and trabecular meshwork

Betablockers/Carbonic anhydrase inhibitors: decrease aqueous production.

prostglandin analgoues: reduce IOP by incrasing aquoues humor outflow

Front 8

1) s/s of acute otitis media

2) risk factors of acute otitis media

3) surgical interventions for acuteo otitis media

Back 8

1) otalgia (ear pain). also: drainage from ear, fever, and hearing loss.

2) age (younger than 12 months), chronic upper resp infection, medical condition (down syndrome, cystitic fibrosis, cleft palate), chronic exposure to second hand smoke.

3) myrigotomy (tympanotomy)- to drain fluids and relieve pressure from middle ear (pg1892)

Front 9

1) s/s of meniere's diseae

Back 9

1) triad: vertigo, tinnitus (unwanted noises in the head or ear), and fluctuating sensorineural hearing loss.

Front 10

1) s/s of osteomyleitis

Back 10

1) manifestations of sepsis (chills, high fever, rapid pulse, general malaise); infected area becomes painful, swollen, and extremely tender. constant pulsing pain that intensfies w/ movement as a result of the pressure of collecting purulent material.

Front 11

1) what are some measures to relieve pain in osteoporosis? (brunner 1145)

2) What types of physical activity should the nurse encourage to help osteoporosis? (pg 1145)

Back 11

1) to relieve back pain (resulting from compression fracture): use trunk orset, massage and local heat, use supportive mattress, knee flexion increase comfort by relaxing back muscles. avoid twisting.

2) isometric exercise, walking (walk daily), good posture, good body mechanics, daily weight bearing exercise. avoid sudden bennding, jarring, and strenuous lifting.

3)

Front 12

1) What are the classic symptoms of Rheumatoid arthritis?

2) What are systemic symptoms of RA?

3) Name the drugs used for RA treatment.

Back 12

1) symmettric joint pain, swelling, warmth, erythema, and lack of function. also morning stiffness lasting longer than 1 hour. p1066

2) Systemic s/s: fever, weight loss, fatigue, anemia, lymphnode enargement, raynaud's phenomenon (cold and stress induced vasospasm)... rheumatoid nodules for more advanced RA.

2) DMARDS (methotrexate/rheumatrex, antimalarial agents, leflunomide (arava) or sulfasalazine (azulfidine).

-nsaid and cox2 enzyme blockers.

-corticosteroids for erosive RA.