Final Exam Notes NURS 2012 PDF

**Final Exam Notes NURS 2012 - After midterm** **Week 8: Pain/Patient Education** **Define Pain** - - - ***Acute V.S Persistent/Chronic Pain - include medications*** +-----------------------+-----------------------+-----------------------+ | **Characteristic** | **Acute Pain**...

**Final Exam Notes NURS 2012 - After midterm** **Week 8: Pain/Patient Education** **Define Pain** - - - ***Acute V.S Persistent/Chronic Pain - include medications*** +-----------------------+-----------------------+-----------------------+ | **Characteristic** | **Acute Pain** | **Persistent/Chronic | | | | Pain** | +=======================+=======================+=======================+ | **Onset** | Sudden - warning | Gradual or sudden | | | something is wrong | | +-----------------------+-----------------------+-----------------------+ | **Duration** | Usually within the | May start as acute | | | normal time for | injury but continues | | | healing | past the normal time | | | | for healing to occur | +-----------------------+-----------------------+-----------------------+ | **Severity** | Mild to severe | Mild to severe | +-----------------------+-----------------------+-----------------------+ | **Causes of Pain** | Precipitating illness | May not be known | | | or event (e.g | | | | surgery) | - - | +-----------------------+-----------------------+-----------------------+ | **Course of Pain** | Decreases overtime | Pain persists and may | | | and goes away as | be ongoing, episodic | | | recovery occurs - | or both - longer than | | | temporary | 3 months | | | | | | | | Harder to see, | | | | identifiable cause or | | | | not, underdiagnosed | | | | and undertreated | +-----------------------+-----------------------+-----------------------+ | **Typical physical | Increased HR, | Changes in affect | | and behavioural | respiratory rate, | | | manifestations** | blood pressure | Decreased physical | | | | movement and activity | | | Diaphoresis, pallor | | | | | Fatigue | | | Anxiety, agitation, | | | | confusion | Withdrawal from | | | | people and social | +-----------------------+-----------------------+-----------------------+ | **Usually goals of | Pain control with | Minimizing pain to | | treatment** | eventual elimination | the extent possible; | | | | focusing on enhancing | | | | function and QOL | +-----------------------+-----------------------+-----------------------+ | **Medications** | - | | | | | | | | | | | | | | | | - - - | | | | | | | | | | | | | | | | - - | | | | | | | | | | | | | | | | - | | +-----------------------+-----------------------+-----------------------+ ***4 Steps to pain response*** 1. a. b. 2. c. 3. d. 4. e. ***3 types of injury*** 1. a. b. c. 2. d. e. 3. f. ***Pain perception responses*** - - - - - - - - - - - - - - - - - - - - - - ***Biopsychosocial Model*** - - - - - - - - - ***Pain Patterns/Intensity Assessment*** - - - - - - - - - -  - - ***Pain Behaviours*** - - - - - - - ***Acute Low Back Pain V.S Chronic Low Back Pain - include everything*** +-----------------------+-----------------------+-----------------------+ | **Characteristics** | **Acute Low Back | **Chronic Low Back | | | Pain** | Pain** | +=======================+=======================+=======================+ | **Prevalence** | \#1 cause of | | | | disability globally | | | | | | | | Defined by the | | | | location of pain, | | | | typically between the | | | | lower rib margins and | | | | the buttock creases | | +-----------------------+-----------------------+-----------------------+ | **Etiology/Pathophysi | Low back pain is a | | | ology** | common problem | | | | because the lumbar | | | | region | | | | | | | | 1. 2. 3. 4. | | +-----------------------+-----------------------+-----------------------+ | **Risk Factors** | Lack of muscle tone | | | | | | | | Obesity | | | | | | | | Smoking (decreases | | | | bone strength/mass; | | | | decreases circulation | | | | to VD) | | | | | | | | Poor posture | | | | | | | | Stress | | | | | | | | Jobs with repetitive | | | | low back strain | | | | \*\*high incidence in | | | | nurses | | | | | | | | Prolonged sitting | | | | | | | | Repetitive heavy | | | | lifting/twisting | | | | | | | | Vibration (e.g., | | | | operating machinery ) | | +-----------------------+-----------------------+-----------------------+ | **Musculoskeletal | Disorders of the soft | | | Disorders** | tissues, including | | | | muscles, ligaments, | | | | tendons, nerves | | | | | | | | Other terms with the | | | | same meaning as MSD | | | | include: | | | | | | | | - - - - | | +-----------------------+-----------------------+-----------------------+ | **Common Causes of | Acute lumbosacral | | | LBP** | sprain (most common | | | | injury) | | | | | | | | Instability of | | | | lumbosacral vertebrae | | | | | | | | Osteoarthritis of | | | | lumbosacral vertebrae | | | | | | | | Degenerative disc | | | | disease (DDD) | | | | | | | | Herniation of | | | | intervertebral disc | | +-----------------------+-----------------------+-----------------------+ | **Course of Pain** | Lasts 6 weeks or less | Lasts more than 3 | | | | months | +-----------------------+-----------------------+-----------------------+ | **Causes** | Trauma/activity | Degenerative | | | causing undue stress | conditions such as | | | | arthritis or disc | | | | disease; | | | | | | | | Osteoporosis or other | | | | metabolic bone | | | | diseases | | | | | | | | Prior injury (scar | | | | tissue weakens the | | | | back) | | | | | | | | Chronic strain on the | | | | lower back muscles: | | | | obesity, pregnancy, | | | | job-related stooping, | | | | bending, or other | | | | stressful postures; | | | | | | | | Congenital | | | | abnormalities in the | | | | spine | | | | | | | | Spinal stenosis | +-----------------------+-----------------------+-----------------------+ | **Symptoms** | May be delayed - | Root cause must be | | | gradual increase in | ascertained | | | pressure by | | | | inflammation | Aching or throbbing | | | | | | | - - - | Burning | | | | | | | | Shooting | | | | | | | | Squeezing | | | | | | | | Stiffness | | | | | | | | Stinging | +-----------------------+-----------------------+-----------------------+ | **Diagnostic | Generally not done | Blood/urine tests | | Imaging** | unless their are red | | | | flags: | EMG | | | | (electromyography) | | | - - - - - - | | | | - - - | X-Rays | | | | | | | | MRI | | | | | | | | Nerve conduction | | | | studies | | | | | | | | Reflex and balance | | | | tests | | | | | | | | Spinal fluid tests | +-----------------------+-----------------------+-----------------------+ | **Assessment: | Acute or chronic | OPQRSTU | | Subjective** | strain or trauma | | | | | DN4 | | | Occupation/activities | | | | that may stress | Chronic strain or | | | | trauma | | | Prolonged | | | | sitting/standing/repe | Occupation/activities | | | titive | that may stress | | | strain | | | | | Prolonged | | | Red flags (NIFTI) | sitting/standing/repe | | | | titive | | | Cauda Equina Symptoms | strain | | | | | | | OPQRSTU | | | | | | | | DN4 (neuropathic) | | | | | | | | Brief Pain Inventory | | | | | | | | Use of any | | | | medications, OTC | | | | remedies | | +-----------------------+-----------------------+-----------------------+ | **Assessment: | MSK: asymmetry, poor | | | Objective** | posture, tense tight | | | | muscles, decreased | | | | ROM | | | | | | | | Neurologic: | | | | trendelenburg test, | | | | dermatomes, depressed | | | | or absent reflexes, | | | | straight leg raise, | | | | cross straight leg | | | | test | | +-----------------------+-----------------------+-----------------------+ | **Treatment** | OTC medicine | Mild analgesics, | | | | NSAIDs | | | Ice and heat | | | | | Opioids | | | Physical therapy | | | | | Heat application | | | Lifestyle changes | | | | | Biofeedback: | | | TENS | acupuncture, and yoga | | | | | | | Spinal manipulation | Weight reduction | | | | | | | Acupuncture, massage, | Tricyclic | | | yoga | antidepressants | | | | (e.g., amitriptyline | | | | \[Elavil\]) | | | | | | | | Selective serotonin | | | | reuptake inhibitors | | | | (e.g., sertraline | | | | \[Zoloft\]) | +-----------------------+-----------------------+-----------------------+ **Week 9: Neurologic Diseases** ***Headaches - Migraine V.S Tension V.S Cluster*** - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - ***Seizures V.S Epilepsy (driving, alcohol, pregnancy etc) - compare patho, diagnostics, s&s, collaborative care, drug therapy, surgical, management, interventions etc*** +-----------------------+-----------------------+-----------------------+ | **Characteristic** | **Seizure** | **Epilepsy** | +=======================+=======================+=======================+ | **Description** | Transient, | At least 2 | | | uncontrolled electric | spontaneous seizures | | | discharge of neurons; | more than 24 hours | | | interrupts normal | apart | | | function | | | | | Higher incidence in | | | Spontaneous with no | first year of life; | | | known cause or known | plateaus in middle | | | underlying cause | age; rises sharply in | | | | elderly | +-----------------------+-----------------------+-----------------------+ | **Pathophysiology** | Common causes during | | | | first 6 months of | | | | life | | | | | | | | - | | | | | | | | Common causes ages 2 | | | | to 20 | | | | | | | | - | | | | | | | | Common causes between | | | | ages 20 and 30 | | | | | | | | - | | | | | | | | Common causes after | | | | 50: | | | | | | | | - - | | | | | | | | | | | | | | | | - | | +-----------------------+-----------------------+-----------------------+ | **Diagnostics** | Health history and | | | | physical | | | | | | | | EEG - done within 24 | | | | hrs of seizure | | | | | | | | MEG in conjunction | | | | with EEG | | | | | | | | Video EEG - for | | | | consciousness | | | | impairment | | | | | | | | CBC, serum chem, | | | | liver + kidney, | | | | urinalysis | | | | | | | | CT or MRI | | | | | | | | Cerebral angiography, | | | | SPECT, MRS, MRA, PET | | +-----------------------+-----------------------+-----------------------+ | **S&S** | See phases | | +-----------------------+-----------------------+-----------------------+ | **Complications** | Status epilepticus | | | | | | | | Trauma ( *e.g. head | | | | injury)* | | | | | | | | Lifestyle limitations | | | | | | | | Social stigma | | | | | | | | Discrimination in | | | | employment & | | | | educational | | | | opportunities | | | | | | | | Transportation | | +-----------------------+-----------------------+-----------------------+ | **Emergency | Pt airway | | | Management** | | | | | Oxygen PRN | | | | | | | | Anticipate need for | | | | intubation | | | | | | | | Suction PRN | | | | | | | | Protect from injury | | | | (pads, remove | | | | glasses, pillow under | | | | head) | | | | | | | | IV access if possible | | | | | | | | Loosen clothing or | | | | remove | | | | | | | | Monitor stats | | +-----------------------+-----------------------+-----------------------+ | **Interprofessional | Seek immediate | | | Care** | emergency care (911) | | | | for tonic-clonic | | | | | | | | - - - - | | +-----------------------+-----------------------+-----------------------+ | **Drug Therapy** | Carbamazepine | | | | (Tegretol) - no | | | | grapefruit, avoid | | | | abrupt withdrawal | | | | | | | | Phenytoin (Dilantin) | | | | - protein binding, | | | | hold feeds 1 hr | | | | before and after, | | | | gingival hyperplasia | | +-----------------------+-----------------------+-----------------------+ | **Surgical Therapy** | Stereoelectroencephal | | | | ography | | | | (SEEG) | | | | | | | | Grid Implantation | | +-----------------------+-----------------------+-----------------------+ | **Alternative | Ketogenic diet - 90% | | | Therapies** | fat diet | | | | | | | | Biofeedback - sensors | | | | to scalp | | +-----------------------+-----------------------+-----------------------+ | **Nursing | Prevention: wear | | | Management** | helmet, improved | | | | perinatal, labour and | | | | delivery care to | | | | reduce trauma, | | | | hypoxia, and brain | | | | trauma | | | | | | | | Care of client: | | | | general health | | | | habits, assist to | | | | identify starting | | | | symptoms, instruct to | | | | avoid alcohol, | | | | fatigue, malaise, | | | | stress, oxygen and | | | | suction set up | | +-----------------------+-----------------------+-----------------------+ | **RN Interventions | Remain calm, call for | | | During** | help, observe time, | | | | duration, keep pt | | | | comfortable, loosen | | | | clothing, allow | | | | seizure to end, | | | | recovery position, | | | | stay with them | | +-----------------------+-----------------------+-----------------------+ | **RN Interventions | Remain with pt, | | | After** | assess breathing | | | | pattern and airway, | | | | maintain recovery | | | | position, no food or | | | | liquid, check for | | | | injuries, ensure IV | | | | access, postictal | | | | (LOC, vitals, memory | | | | loss, muscle | | | | soreness, speech, | | | | weakness, paralysis, | | | | ataxia, lethargy, GI | | | | symptoms), notify MRP | | +-----------------------+-----------------------+-----------------------+ | **Alcohol + | --- | Alcohol increases the | | Epilepsy** | | sedative effect of | | | | antiepileptic drugs | | | | (AEDs). | | | | | | | | AEDs may weaken a | | | | person's tolerance to | | | | alcohol, making it | | | | easier to become | | | | intoxicated. | | | | | | | | Alcohol can alter a | | | | person's rate of AED | | | | absorption and | | | | produce the following | | | | results: | +-----------------------+-----------------------+-----------------------+ | **Pregnancy + | --- | More than 90 per cent | | Epilepsy** | | of women with | | | | epilepsy have healthy | | | | babies without | | | | seizure disorders | | | | | | | | All women have a 2 to | | | | 3 percent risk of | | | | having a child with a | | | | birth defect | | | | | | | | V[[alproate]{.underli | | | | ne}](http://epilepsyo | | | | ntario.org/about-epil | | | | epsy/treatments/medic | | | | ations/valproic-acid/ | | | | ) | | | | (Epival) are | | | | associated with a | | | | higher risk of birth | | | | defect | | | | | | | | Approximately 50 | | | | percent of all women | | | | with epilepsy have | | | | increased seizure | | | | frequency during | | | | pregnancy | +-----------------------+-----------------------+-----------------------+ | **Driving + | --- | May drive if: | | Epilepsy** | | | | | | Medication appears to | | | | have prevented your | | | | seizures | | | | | | | | You have been free | | | | from seizures for 6 | | | | months and your | | | | medication does not | | | | impair your | | | | consciousness | | | | | | | | Physician provides a | | | | recommendation | | | | | | | | Under regular medical | | | | supervision | +-----------------------+-----------------------+-----------------------+ ***Phases of Seizures*** - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - ***Generalized Seizures - Tonic V.S Clonic V.S Atonic V.S Absence V.S Tonic-Clonic V.S Atypical absence V.S Myoclonic absence V.S Eyelid myoclonia*** - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - ***Focal Seizures - Focal Aware V.S Focal Impaired Awareness*** - - - - - - - - - - - - - - - ***Status Epilepticus*** - - - - - - - ***Multiple Sclerosis V.S Myasthenia Gravis V.S Parkinsons*** +-----------------------------------+-----------------------------------+ | **Characteristics** | **Multiple Sclerosis** | +===================================+===================================+ | **Description** | Chronic, progressive, | | | degenerative, autoimmune disorder | | | of the CNS characterized by | | | demyelination of nerve fibers of | | | the brain, the spinal cord, and | | | the optic nerves | +-----------------------------------+-----------------------------------+ | **Pathophysiology** | Unknown -- develops in | | | genetically susceptible | | | individuals after exposure to | | | environmental agent -- eg. | | | infection, smoking, injury, | | | stress, pregnancy, fatigue, poor | | | health | | | | | | Can be triggered with | | | exacerbations | | | | | | Family history increases risk; | | | likely multiple genes | | | | | | Autoimmune process driven by | | | Activated T-cells go to CNS and | | | disrupt blood brain barrier | +-----------------------------------+-----------------------------------+ | **Process** | Early: myelin sheath damage, | | | nerve intact | | | | | | - | | | | | | Myelin replaced by glial scar | | | tissue | | | | | | - | | | | | | Axon destroyed, no nerve | | | conduction | +-----------------------------------+-----------------------------------+ | **Clinical Manifestations** | Slow, gradual onset | | | | | | Progressive deterioration | | | | | | Motor manifestations | | | | | | - - - | | | | | | Sensory manifestations | | | | | | - - - - - - - | | | | | | Cerebellar manifestations | | | | | | - - - - | | | | | | Bowel and bladder functions | | | | | | - - - - - | | | | | | Sexual Issues | | | | | | - - - - - | | | | | | Emotional | | | | | | - - - | +-----------------------------------+-----------------------------------+ | **Diagnosis** | HISTORY | | | | | | MRI OF BRAIN, SPINAL CORD | | | | | | Analysis of csf through spinal | | | tap may show changes | | | | | | Evoked response test delayed | | | | | | To Dx must have: | | | | | | 1. 2. 3. | +-----------------------------------+-----------------------------------+ | **Interprofessional Care** | Treat disease process | | | | | | Provide symptomatic relief | | | | | | Physiotherapy and speech | | | therapists (enhance daily | | | functioning) | | | | | | Exercise - water exercise | | | | | | High protein; high roughage; | | | supplementary vitamins | | | | | | Megavitamin therapy (B12; C) | | | | | | Vitamin D supplementation | | | | | | Low-fat; gluten-free; raw | | | vegetables | +-----------------------------------+-----------------------------------+ | **Medication Therapy** | Corticosteroids | | | | | | - - | | | | | | Immunosuppressives | | | | | | - - | | | | | | Others | | | | | | - - | +-----------------------------------+-----------------------------------+ +-----------------------------------+-----------------------------------+ | **Characteristics** | **Myasthenia Gravis** | +===================================+===================================+ | **Description** | Chronic autoimmune disorder in | | | which antibodies destroy the | | | communication between nerves and | | | muscle (Attack acetylcholine | | | receptors), resulting in weakness | | | of the voluntary skeletal muscles | | | | | | Affects especially those that | | | control the eyes, mouth, throat | | | and limbs | +-----------------------------------+-----------------------------------+ | **Pathophysiology** | ANTIBODIES ATTACK ACH RECEPTORS | | | | | | PREVENT ACH MOLECULES FROM | | | ATTACHING AND STIMULATING MUSCLE | | | CONTRACTION | | | | | | USUALLY AFFECTS MOSTLY WOMEN IN | | | 20'S AND 30'S | | | | | | AFTER 50'S AFFECTS MORE MEN | | | | | | ETIOLOGY UNKNOWN -- AUTOIMMUNE | +-----------------------------------+-----------------------------------+ | **Patient Profile** | **W**-Weakness neck, face, arms, | | | legs | | | | | | **E**-Eyelids drooping (ptosis)-1 | | | or both | | | | | | **A**-Appearance mask-like-very | | | sleepy; no expression | | | | | | **K**-Keep choking/gagging when | | | eating | | | | | | **N**-No energy (better to do | | | activity in AM) | | | | | | **E**-Extraocular muscle | | | involvement (strabismus, | | | diplopia) | | | | | | **S**- Slurred speech | | | | | | **S-**shortness of breath | +-----------------------------------+-----------------------------------+ | **Clinical Manifestations** | Visual problems, including | | | drooping eyelids (ptosis) and | | | double vision (diplopia) | | | | | | Muscle weakness and fatigue that | | | may vary rapidly in intensity | | | over days or even hours and | | | worsen as muscles are used (early | | | fatigue) | | | | | | Facial muscle involvement causing | | | a mask-like appearance; a smile | | | may appear more like a snarl | | | | | | Trouble swallowing, chewing, | | | slurred speech | | | | | | Weakness of the neck or limbs. | | | MAY CAUSE GAIT IMPAIRMENTS | | | | | | Muscle weakness: generalized or | | | localized to oculomotor muscles, | | | respiratory muscles, and | | | pharyngeal muscles affecting the | | | ability to swallow | | | | | | Factors such as heat exposure, | | | stress, and infection also worsen | | | fatigue | +-----------------------------------+-----------------------------------+ | **Variable Progression** | Symptoms fluctuate over a | | | relatively short period of time | | | and then become progressively | | | severe for several years (active | | | stage). | | | | | | Active stage is followed by an | | | inactive state in which | | | fluctuations in strength still | | | occur but are attributable to | | | fatigue, illness, or other | | | identifiable factors. | | | | | | After 15 to 20 years, weakness | | | often becomes fixed and the most | | | severely involved muscles are | | | frequently atrophic (burnt-out | | | stage). | +-----------------------------------+-----------------------------------+ | **Myasthenic Crisis** | Acute exacerbation of muscle | | | weakness triggered by: | | | | | | - | | | | | | Usually occurs in first two years | | | after diagnosis | | | | | | CAUSE: not enough | | | anticholinesterase medication | | | | | | Swallowing and breathing affected | | | -- may require support with | | | ventilator | | | | | | Symptoms typically progress to | | | include other bulbar (eye, | | | speech, swallowing) and limb | | | muscles in approximately half of | | | patients within two years | | | | | | Too little anticholinesterase med | | | | | | Too much Acetylcholine esterase | | | | | | Too little ACh at | | | NMJ....increased weakness | | | | | | Education: | | | | | | - - - - - - - | +-----------------------------------+-----------------------------------+ | **Cholinergic Crisis** | Overdose (too much) | | | anticholinesterase medication | | | | | | INcreased acetylcholine (Ach) at | | | neuromuscular junction | | | | | | Not recycling enough Ach | | | | | | Wears out muscle | | | fibres....weakness...respiratory | | | failure | | | | | | Too much anticholinesterase med - | | | weakness within 1 hr after | | | ingestion | | | | | | Too little Acetylcholine esterase | | | | | | Too much ACh at NMJ... | | | | | | muscle fibers wear | | | out...weakness... resp failure; | | | antidote is atropine) | +-----------------------------------+-----------------------------------+ | **Diagnosis** | History and physical exam | | | | | | Acetylcholine receptor antibodies | | | | | | Single fiber Electromyography | | | (emg) (show muscle's response to | | | electrical shocks) | | | | | | Repetitive nerve stimulation | | | testing | | | | | | Ct scan to rule out thymoma | +-----------------------------------+-----------------------------------+ | **Interprofessional + Medication | Anticholinesterase --e.g. | | Therapy** | Pyridostigmine-Inhibits breakdown | | | of ACh in synaptic cleft; | | | prolongs action of Ach-increased | | | transmission impulses at NMJ - | | | 30min to 1 hr before meals | | | | | | Corticosteroids & | | | Immunosuppressants -- suppress | | | immune response | | | | | | Plasmapheresis: plasma removed ( | | | Antibodies are in the plasma) and | | | replaced with donated plasma or | | | saline -- useful in crisis | | | | | | 80% have hyperplasia/20% have | | | tunors -- thymus increases | | | antibody formation | | | | | | Thymectomy-improves S&S | +-----------------------------------+-----------------------------------+ +-----------------------------------+-----------------------------------+ | **Characteristics** | **Parkinson's** | +===================================+===================================+ | **Description** | Disease of basal ganglia | | | | | | Diagnosis increases with age, | | | with peak onset being in the | | | sixth decade | | | | | | More common in men, ratio of 3:2 | +-----------------------------------+-----------------------------------+ | **Pathophysiology** | Pathological process involves | | | degeneration of | | | dopamine-producing neurons in | | | substantia nigra of the midbrain | | | | | | Disrupts dopamine-acetylcholine | | | balance in basal ganglia | | | | | | Symptoms of the disease do not | | | occur until 80% of neurons in the | | | substantia nigra are lost | | | | | | chemical intoxication (e.g. | | | carbon monoxide; manganese); drug | | | induced (e.g. antipsychotics; | | | neuroleptics); illicit drugs | | | (e.g. amphetamines; | | | methamphetamines); | | | | | | vascular (multiple small | | | strokes); | | | | | | Lewy body dementia; | | | | | | Post traumatic "punch-drunk | | | syndrome" e.g. severe head injury | | | or frequent concussions sustained | | | in football or boxing; can lead | | | to chronic traumatic | | | encephalopathy (CTE)-a form of | | | dementia (watch the movie | | | "Concussion" 2015) | | | | | | Essential tremor | | | | | | Normal pressure hydrocephalus | | | (NPH) | | | | | | Postencephalitic e.g. African | | | trypanosomiasis (\"sleeping | | | sickness\"), or by viral | | | infections that cause swelling of | | | the brain or spinal cord | +-----------------------------------+-----------------------------------+ | **Clinical Manifestations** | TRAP mnemonic | | | | | | - - - - - - | | | | | | - - - - - | | | | | | - - - - - - | | | | | | - - - | +-----------------------------------+-----------------------------------+ | **Complications** | Complications (as disease | | | progresses) | | | | | | - - - - - - - - | +-----------------------------------+-----------------------------------+ | **Diagnosis** | No specific tests | | | | | | Diagnosis based solely on history | | | and clinical features | | | | | | - - - | +-----------------------------------+-----------------------------------+ | **Medication Therapy** | Sinemet is often the first drug | | | used | | | | | | DRUG ALERT: Carbidopa-Levodopa | | | (Sinemet) | | | | | | - - - - - - - | +-----------------------------------+-----------------------------------+ | **Collaborative Care** | Drug therapy: anticholinergics, | | | antihistamine, amantadine | | | | | | Genome therapy | | | | | | - | | | | | | Surgical therapy | | | | | | - - - | | | | | | Nutritional therapy | | | | | | - - - | +-----------------------------------+-----------------------------------+ **Week 10: Musculoskeletal Disease** ***Osteoporosis*** +-----------------------------------+-----------------------------------+ | **Characteristics** | **Osteoporosis** | +===================================+===================================+ | **Etiology / pathophysiology** | - - - - - | | | | | | - | +-----------------------------------+-----------------------------------+ | **Risk Factors** | - - - - - - - - | +-----------------------------------+-----------------------------------+ | **CM** | - - - | +-----------------------------------+-----------------------------------+ | **Assessment Tools** | - - | +-----------------------------------+-----------------------------------+ | | - - | +-----------------------------------+-----------------------------------+ | **Key Diagnostic Studies** | - - - - - | | | | | | - - - | | | | | | - - | | | | | | - - | | | | | | - - | | | | | | - - - | +-----------------------------------+-----------------------------------+ | **Interprofessional team** | - - - - | +-----------------------------------+-----------------------------------+ | **Medications** | - - | | | | | | - - - - - - - | | | | | | - - | | | | | | - - - - | | | | | | - - - | | | | | | - - - - | +-----------------------------------+-----------------------------------+ ***Osteoarthritis (OA) V.S Rheumatoid Arthritis (RA)*** +-----------------------+-----------------------+-----------------------+ | **Characteristics** | **Osteoarthritis | **Rheumatoid | | | (OA)** | Arthritis (RA)** | +=======================+=======================+=======================+ | **Etiology / | - - - - - - | - - - - | | Pathophysiology** | | | +-----------------------+-----------------------+-----------------------+ | **Risk Factors** | - - - - - - | - - - - - - | | | - | - | +-----------------------+-----------------------+-----------------------+ | **Clinical | - - | - - - - - | | Manifestations** | | | | | - - | - - - - - | +-----------------------+-----------------------+-----------------------+ | **Key Assessments** | - | - - - - - - | | | | - - - | +-----------------------+-----------------------+-----------------------+ | **Diagnostic | - - | - - - - - - | | Studies** | | | +-----------------------+-----------------------+-----------------------+ | **Collaborative | - - - | - - - | | Care** | | | +-----------------------+-----------------------+-----------------------+ | **Health Teachings** | - - - - - - | - - - | | | | | +-----------------------+-----------------------+-----------------------+ | **Medications** | - - - - - | - - - - - - | | | | | +-----------------------+-----------------------+-----------------------+ | **Preventions and | - | - | | Management** | | | +-----------------------+-----------------------+-----------------------+ ***Gout*** +-----------------------------------+-----------------------------------+ | **Characteristics** | **Gout** | +===================================+===================================+ | **Etiology / Pathophysiology** | - - | +-----------------------------------+-----------------------------------+ | **Clinical Manifestations and | - - | | Complications** | | | | - - | | | | | | - | +-----------------------------------+-----------------------------------+ | **Diagnostic Studies** | - - - - | +-----------------------------------+-----------------------------------+ | **Interprofessional Care** | - - - - - | | | | | | - - | +-----------------------------------+-----------------------------------+ | **Nursing Care Management** | - - - - - | +-----------------------------------+-----------------------------------+ **Week 11: Chronic Kidney Disease** ***Chronic Kidney Disease (CKD)*** +-----------------------------------+-----------------------------------+ | **Characteristics** | **CKD** | +===================================+===================================+ | **Pathophysiology** | - - - | +-----------------------------------+-----------------------------------+ | **Risk factors** | - - - - - | | | | | | - - - - - | +-----------------------------------+-----------------------------------+ | **Medications** | - - - | +-----------------------------------+-----------------------------------+ | **Diagnosis** | - - - | +-----------------------------------+-----------------------------------+ | **Clinical Manifestations** | - - - - - - | | | | | | - - - - - - | | | | | | - - - - - - - | | | | | | - - - - | | | | | | - - - | | | | | | - - - - - | | | | | | - - - - | | | | | | - - - - - - | | | | | | - - - - | | | | | | - - | | | | | | - - - - - - - - - | | | - - - - - - - | | | | | | - - - - - - - - | | | | | | - - - | | | | | | - - - - - - | | | | | | - - - - - - - - - | | | - | +-----------------------------------+-----------------------------------+ | **Diagnostic Studies** | - - - - - - | | | | | | - - | | | | | | - - | +-----------------------------------+-----------------------------------+ | **Interprofessional Care** | - - - - - - | | | | | | - - | +-----------------------------------+-----------------------------------+ | **Meds and Drug Therapies** | Common Meds and the Patient with | | | CKD | | | | | | - - - - | | | | | | CKD & Predicting Complications of | | | Drug Therapy | | | | | | - - - - - - - - | +-----------------------------------+-----------------------------------+ | **Dialysis** | Peritoneal Dialysis | | | | | | - - - - - - - | | | | | | - - - - | | | | | | - - - - - | | | | | | - - - - | | | | | | | | | | | | - - - - - | | | | | | | | | | | | - - - - - - - | | | | | | - - | | | | | | - - - | | | | | | - - - - - - | | | | | | - - - - | | | | | | - - - - - - - | +-----------------------------------+-----------------------------------+ **Week 12: IBS, IBD, BPH, Crohn\'s and UC** ***Irritable Bowel Syndrome (IBS) V.S Inflammatory Bowel Disease (IBD)*** Etiology (IBS) - - - - - - ***Benign Prostatic Hyperplasia (BPH)*** Pathophysiology - - - - - - - - Etiology/Risk Factors - - - - - Clinical Manifestations - - - - - - - - - - - - - - - - Complications - - - - - - - - - - - - - - - - - - - - Diagnostic Studies - - - - - - - Diagnostics - - - - - - - - - Non-Pharmacological Interventions - - - - - Pharmacological Interventions - - - - - - - - - - - Therapies - - - - - - - - - Health Teachings - - - ***Crohn's Disease V.S Ulcerative Colitis (UC)*** Crohn's DIsease - Pathophysiology - - - - - - Crohn's Clinical Manifestations - - - Crohn's Complications - - - - - - Crohn's Diagnostics - - - - - - Crohn's Medication - - - - - - - - Crohn's Low Residue Diet - - - - - - - - - - - - - - - - UC - Pathophysiology - - - - - - UC - Clinical Manifestations - - - UC - Complications - - - - - - - - - - - - - - - - - - - - - - UC - Diagnostic Studies - - - - - - - SImilarities between Crohn's and UC - - - - - - - Differences - Crohn's - - - - - - Differences - UC - - - - - - **LAB VALUES** **Adult vital sign parameters** - - - - - - - - - - - **Normal blood gases -- memorize** - - - - - - - - **HDL and LDL lipid levels -- memorize** - - **Blood glucose levels (see chart below)** - - - - - - - - - - - - - - Diagnostic Test Normal Pre-diabetes Diabetes ------------------------------------ ------------------ -------------------------------- ----------------------------------------------- FPG - Fasting blood glucose \< less than 6.1 \> greater than 6.1 but \< 6.9 [\>] greater than or equal to 7.0 OGTT - Oral glucose tolerance test \< 7.8 \> 7.8 but \< 11.1 [\>] 11.1 A1c - Glycated hemoglobin \< 6.0 \> 6.0 \< 6.5 [\>] 6.5 **Normal BMI and waist circumference; measurements associated with obesity** BMI and Waist Circumference - - - - - -