Sickle Cell Anemia

& Pernicious Anemia

Med Surg: Hematology

Sickle Cell Anemia

Normal Cell Sickle Cell
The RBCs have a distorted shape, transforming from a nice round plumb O2

shape to a skinny sucked in sickle shape. These misshaped RBCs die O2

O2

O2 O2
quicker than normal RBCs, carry less oxygen to the body & get clogged O2 O2
O2

O2
O2
O2
in tiny blood vessels - blocking or occluding the blood supply causing O2
O2

O2
O2 O2
O2
ischemia (low oxygen) to the organs. A vaso-occlusive crisis or
O2

“sickle cell crisis” can occur, causing extreme pain from the lack of oxygen!

Signs & Symptoms Complication Splenomegaly

Splenic sequestration crisis

One-sided arm weakness Kaplan Question
Rapidly enlarging spleen
Swelling of the feet and Client experiencing a
vaso-occlusive crisis. The nurse Low blood pressure
hands (Dactylitis) determines care is appropriate
if which observation is made?

NCLEX TIP
● The client receives regular
neurological assessments Treatment Higher doses
New-onset paralysis of Hydration: IV fluids
extremities Bed rest
Pain Control NCLEX TIP
Sudden inability to be • PCA - patient control
aroused analgesia pump
• Call the HCP for
Higher doses

Pernicious Anemia
The body can not absorb B12, which is a vital building block to create RBCs. HESI Question
Clients lack intrinsic factor in the GI tract, which helps the body take in B12. Which factor results from
pernicious anemia?
B12
B12 The absence of intrinsic
B12 B12 factor secreted by the
B12
gastric mucosa
B12

Signs & Symptoms Treatment

Kaplan Question Kaplan Question
Clinical manifestations • B12 - Injection: IM or IV Client diagnosed with pernicious
anemia asks why vitamin B12 cannot
of pernicious anemia? be given in pill form. Which response
• NOT orally (PO) by the nurse is best?
● Glossitis: A smooth,
Glossitis: EXAM TIP red tongue ● “Stomach doesn’t secrete the
necessary substance for B12
• Inflamed red smooth tongue to be absorbed orally.”

Extreme weakness HESI Question

HESI Question A client asks the nurse how long
A nurse is caring for a patient injections of vitamin B12 will be
Jaundice: “pale yellow skin” The nurse is caring for a patient with pernicious anemia needed. Which response by the
who reports extreme weakness
secondary to total gastrectomy. nurse is best?
and glossitis, and the nurse
identifies pale yellow skin. Which
The nurse would question which ● You may need lifelong injections
type of anemia does the nurse provider's order?
anticipate in the patient?
● Vitamin B12 supplement, PO
● Pernicious anemia
B12
B12
B12
B12 B12
B12
B12 B12 B12

B12
B12
B12 B12
B12
B12 B12
Hemophilia
Med Surg: Hematology

Pathophysiology Hemophilia A
Inherited bleeding disorder in which the blood doesn't clot normally, Lack of clotting factor VIII (8)
increasing the risk of excessive bleeding after any type of small injury Hemophilia B
like a paper cut or a fall on the ground.
Lack of clotting factor IX (9)
Clotting factor VIII Clotting factor IX
HESI Question
A nurse is caring for a patient diagnosed
with hemophilia A. The nurse knows this
type of hemophilia is caused by an absence
of which clotting factor?

Hemophilia A Hemophilia B • VIII

Signs & Symptoms

HESI Question
A nurse is caring for a patient with
hemophilia. Which concerns
Pain, Bruising, & Petechiae would be expected on the nursing
care plan?
Ineffective tissue perfusion Select all that apply.

Joint stiffness & Pain

Anxiety
Lack of mobility Deficit of fluid volume
Ineffective tissue perfusion

Treatment Kaplan Question

Q1 Client with hemophilia develops painful
swelling of the knee after bumping the
leg... which initial action is most
AVOID Injections: IV, IM, SQ appropriate for the nurse to take?
Apply ice to the knee and
Administers coagulation elevate the leg

replacement factors Q2 The nurse reviews the medical record for

4 hr
a client diagnosed with hemophilia. It is
Ice packs & most important for the nurse to question

Elevate the affected area which entry?

Meperidine

Meperidine 75mg IM q 4 hr
for severe pain

Education

HESI Question
NO NSAIDS NSAIDs
Which statement by a patient with
hemophilia indicates the need for
NO Razors further teaching?
“I can learn to play contact sports
NO Contact sports for exercise.”
DIC: Disseminated Intravascular Coagulation
Pathophysiology Course

DIC is a serious disorder in which the proteins that control blood

Disseminated Intravascular Coagulation clotting become overactive, causing many blood clots to form all
over the body.

These blood clots block small blood vessels causing organs to

infarct & not function properly due to the lack of perfusion
(lack of oxygen).

0₂

The 2nd BIG event

Eventually the body uses up all the platelets & clotting factors resulting in
the body having NO ability to stop bleeding.

Therefore we see bleeding everywhere in the body, commonly seen right

beneath the skin, in the nose or mouth, or deep inside the body.

Patho Order
1. Overactive clotting
(Thrombi and infarcts
of organs) →
2. Depletion of platelets
& clotting factors for
normal clotting →
3. Massive bleeding all
over the body

Notes
 Disseminated Intravascular Coagulation
Med Surg: Hematology

Pathophysiology Causes
DIC is a deadly complication that begins rapidly, causing DIC is not a disease itself, it occurs as a complication from
both severe bleeding & blood clots inside blood vessels another disease like:
leading to organ failure. These abnormal clots use up the • Infection & Sepsis (blood infection)
blood's clotting factors, which leaves the body with no • After major trauma
means to stop bleeding! • Shock (severely low blood pressure)
• Cancer & Neoplastic disease (tumors)
Signs & Symptoms • OB complications

Think bleeding & blood clots! Treatments

• Severe bleeding everywhere
• Skin bleeding Petechiae & Purpura (purple spots on skin) Priority = Treat underlying cause!
• Eyes, gums, nose bleeding (epistaxis) Then blood transfusion
• Urine blood (hematuria) • Packed RBC (to replace blood loss)
• Stool blood “black tarry stool” (Melena) • FFP - Fresh frozen plasma (replaced deficits in coag
• Blood Clots factors)
• Brain = CVA (stroke) 1 sided weakness, slurred speech, • Platelets
facial droop • Cryoprecipitate (replaces fibrinogen)
• Heart = MI (heart attack) chest pain, diaphoresis • Heparin (to decrease the many clot formations)
• Lung = PE (pulmonary emboli) difficulty breathing
• Leg = DVT (deep vein thrombosis) Unilateral leg swelling Education & Inteventions
- 1 leg bigger than the other
• Monitor for bleed & do not clean clot formations
• Educate on bleeding risk!
• No razor shaving - only electric razor
Labs
• No brushing teeth hard - only soft bristle
• Prolonged clotting time for PT, aPTT, INR • No flossing
• Decreased Platelets (norm: 150 - 400k)
• D-dimer elevated (indicates clot risk)
Dumping Syndrome
Pathophysiology Course

Pathophysiology

Occurs when the stomach empties too quickly into the duodenum (small intestines)
after eating. This DUMPING causes a massive fluid shift leading to severe pain, low
blood pressure, & nausea/ vomiting 30 minutes after eating.
Commonly seen after any type of bariatric surgery like a gastric bypass or
gastrectomy (removal of the stomach), typically done for our bariatric clients
who are morbidly obese.

Causes
Key terms
Gastrojejunostomy (Billroth II surgery)
Partial Gastrectomy
Sleeve Gastrectomy

Signs & Symptoms

Common Exam Question

PRIORITY ACTION A client recovering from a
MEMORY TRICK partial gastrectomy presents
Report to HCP / Surgeon with vomiting, severe
abdominal pain, blood pressure
Hypotension & Tachycardia 105/62, heart rate of 122/min,
1
HCP/ Surgeon

Sweating, Dizziness, temperature of 100.5ᴼF. Which

action should the nurse take?
NORMAL

Severe abdominal pain, N&V

HIGH
LOW

30 minutes AFTER eating

1. Administer a bolus of IV fluid
2. Assess blood glucose for
Think for Dumping syndrome- hypoglycemia
NORMAL
we see DUMPing of Blood pressure 3. Immediately notify the HCP
or surgeon
HIGH
LOW

4. Insert nasogastric tube

HR > 100

GI SURGERY Post-Operative Care

Gastrectomy Priority action: Education 4 NCLEX TIPS

Dehiscence / Evisceration
1. NPO until bowel sounds return NCLEX TIP 1. HIGH protein, fiber, & fats foods
1. Stay with client & call for help
2. Apply SCD (sequential compression devices) Low carbohydrates
2. Position: Low Fowler’s with knees bent
3. Early ambulation 2. Small, frequent meals
NCLEX TIP
4. Incentive spirometer Q Hour
3. LIE DOWN after eating (left side)
5. Teach splinting the incision when coughing
3. Sterile gauze & saline to cover the wound
4. No fluids with meals
4. Report to HCP / Surgeon
(30 min before / after food)
Priority

NCLEX TIPS
!!!

0.9%
Sodium Chloride
250 mL
Dumping Syndrome & GI Surgery
Med Surg: GI - Gastrointestinal

Pathophysiology
Occurs when the stomach empties too quickly into the duodenum (small intestines)
after eating. This DUMPING causes a massive fluid shift leading to severe pain, low
blood pressure, & nausea/ vomiting 30 minutes after eating.
Commonly seen after any type of bariatric surgery like a gastric bypass or
gastrectomy (removal of the stomach), typically done for our bariatric clients
who are morbidly obese.

Causes GI SURGERY Post-Operative Care

Key terms Priority

Gastrectomy
Gastrojejunostomy (Billroth II surgery)
Partial Gastrectomy 1. NPO until bowel sounds return NCLEX TIP !!!

Sleeve Gastrectomy 2. Apply SCD (sequential compression devices)

3. Early ambulation
4. Incentive spirometer Q Hour
5. Teach splinting the incision when coughing

Signs & Symptoms

Priority action:
PRIORITY ACTION
Dehiscence / Evisceration NCLEX TIPS
Report to HCP / Surgeon NORMAL

1. Stay with client & call for help

HIGH
LOW

Hypotension & Tachycardia 2. Position: Low Fowler’s with knees bent 0.9%
Sodium Chloride
250 mL

Sweating, Dizziness, NCLEX TIP

3. Sterile gauze & saline to cover the wound
Severe abdominal pain, N&V HR > 100

4. Report to HCP / Surgeon

30 minutes AFTER eating

MEMORY TRICK

Education 4 NCLEX TIPS

NORMAL

1. HIGH protein, fiber, & fats foods

HIGH
LOW

Low carbohydrates
2. Small, frequent meals
3. LIE DOWN after eating (left side)
Think for Dumping syndrome-
4. No fluids with meals
we see DUMPing of Blood pressure
(30 min before / after food)
Common NCLEX Question
A client recovering from a
partial gastrectomy presents KAPLAN HESI
with vomiting, severe Following a gastrectomy … What instructions
abdominal pain, blood pressure Priority action for a client with bowel should the nurse include ... to prevent
protruding through abdomen dumping syndrome?
105/62, heart rate of 122/min,
temperature of 100.5 F. Which
1
HCP/ Surgeon ● Divide meals into 6 small feedings
● Call for help (the client needs
action should the nurse take?
emergency surgery and the nurse
should not leave the client) Which nursing action is important after a
patient has a partial gastrectomy to prevent
1. Administer a bolus of IV fluid further complications?
2. Assess blood glucose for Help!!
hypoglycemia ● Measure the patient’s serum vitamin
B12 level
3. Immediately notify the HCP
or surgeon
4. Insert nasogastric tube B12

Notes
Burns
Pathophysiology Course

Types & Causes

As you know the skin is made of 3 layers - Epidermis,
Burn injuries caused by direct tissue damage Dermis, & subcutaneous tissue (that fatty bubble
from exposure to: looking tissue) under the skin we find fascia, muscle,
• Sun & bone.
• Chemicals
• Thermal (boiling liquids)
• Electricity Epidermis

Dermis

Subcutaneous tissue

First-degree (superficial)
• Dry with blanchable redness ! !
Second-degree (partial thickness) ! !
• Painful Blisters NCLEX TIP ! !
!
• “Red, moist, shiny fluid filled vesicles”

Third-degree (full-thickness)
!
• Dry waxy white, leathery, or charred ! ! !
black color, Non-blanchable
! !
! !
Fourth-degree (full-thickness) ! !

Care for Minor Burns

Prehospital Care
C C C
ANTIBIOTIC
OINTMENT

Cool water Cover the area Clothing removal C - Cool water

� Briefly soak area
• NO ice, creams, antibiotic !

ointment to open skin !

!

C - Cover area “Clean dry cloth”

HCP remove anything
sticking to the skin

C - Clothing & Jewelry removal

• Not adhered

Notes
Burns

Types & Causes Care for Minor Burns

Burn injuries caused by direct tissue damage C C C
from exposure to: Cool water Cover the area Clothing removal
• Sun
• Chemicals
• Thermal (boiling liquids)
• Electricity

Prehospital Care
ANTIBIOTIC

C - Cool water
OINTMENT

� Briefly soak area

As you know the skin is made of 3 layers - • NO ice, creams, antibiotic
ointment to open skin
epidermis, dermis, & subcutaneous tissue
!

!
!

(that fatty bubble looking tissue) C - Cover area “Clean dry cloth” HCP remove anything
sticking to the skin
under the skin we find fascia, muscle, & bone.
C - Clothing & Jewelry removal
• Not adhered
Epidermis

Dermis Saunders
The nurse instructs firefighters
Subcutaneous tissue that in the event of a tar burn,
which is the immediate action?
• Cooling the injury with water

First-degree (superficial) Chemical burn injury... The nurse

REMOVING ALL
• Dry with blanchable redness instructs the employees that
what is the first consideration in
Second-degree (partial thickness) immediate care?
• Painful Blisters NCLEX TIP • Removing all clothing,
! including gloves, shoes,
• “Red, moist, shiny fluid filled vesicles” and any undergarments

Third-degree (full-thickness)
Kaplan Question
!
• Dry waxy white, leathery, or charred
black color, non-blanchable
The nurse is caring for a client
Fourth-degree (full-thickness) with full thickness burns
covering 20% of their body.
What is the priority of care
after ensuring a patent airway:
! ! ! ! !
! !
! ! !
!
● IV fluids
! ! ! !

Notes
Major Burns

Pathophysiology
Saunders
Massive tissue damage & cellular destruction leads to
widespread systemic inflammation that increases vascular Extensive burn injury ... 45% of
total body surface area… 45%
permeability (leaky blood vessels that fill up the body like a
planning for fluid resuscitation, !
water balloon). This results in low fluid volume within the the nurse should consider that
blood vessels leading to Hypovolemic Shock & then death! fluid shifting to the interstitial !
!
spaces is greatest during which
Low fluid volume
time period?
18 - 24 hours
! • Between 18 and 24 hours
after the injury
!
!

Signs & Symptoms

First 24-hours Over 5.0

Saunders
HEMATOCRIT
K
High Potassium (Hyperkalemia)
Severe burn injury that
Over 5.0
covers 35% of the total 60% (0.60)
� Potassium Priority Pumps heart
� HIGH Potassium = HIGH Pumps body surface area (TBSA).
� Tall, Peaked T Waves on ECG The nurse is most likely to
NCLEX TIP
note which finding on the
Fluids FLOW - electrolytes GO!!!
Low Sodium (hyponatremia) HEMOGLOBIN HEMATOCRIT
laboratory report?
Below 135 NCLEX TIP 12-18 normal 36-54% normal

!
• Hematocrit 60% (0.60)
Elevated H/H
� Hemoglobin: 12 - 18 normal
! Na
!
� Hematocrit: 36 - 54% normal

Treatments 1 2 3
≥ 30 mL/hr
90
KEY Term
LACTATED RINGER’S 0.9%
Sodium Chloride
250 mL

#1 Intervention first 24-hours

IV Lactated Ringer’s (LR) solution
IV Normal Saline Saunders
A client is undergoing fluid
replacement after being burned
on 20% of her body 12-hours LACTATED RINGER’S

PRIORITY ago… blood pressure is 90/50, a

pulse rate of 110, and a urine
IV Lactated Ringer’s IV Normal Saline output of 20 mL over the past
(LR) solution (0.9% sodium Chloride) hour. The nurse ... anticipates
which prescription?
Increasing IV Lactated
LACTATED RINGER’S Ringer’s solution

NaCl 0.9%

#1

Administer enteral feedings ≥ 30 mL/hr

Once bowel sounds return

Kaplan Question
Assessment of ≥ 90 Systolic

Fluid Resuscitation
≥ 30 mL/hr
90 Patient with burns who is
immunocompromised….
1. Urine output
30 mL/hr or MORE NCLEX TIP What precautions should be
taken to prevent ... infection?
2. Blood pressure
(90/systolic Or MORE) Avoid placing fresh
3. Heart rate less than 120/min. < 120/min flowers or plants in or
near the client’s room
Burns II - Major Burns
Pathophysiology Course

Pathophysiology
Low fluid volume
Massive tissue damage & cellular destruction leads to
widespread systemic inflammation that increases vascular
!
permeability (leaky blood vessels that fill up the body like a !
water balloon). This results in low fluid volume within the
blood vessels leading to Hypovolemic Shock & then death! !

Signs & Symptoms

First 24-hours Over 5.0

K
High Potassium (Hyperkalemia)
Over 5.0
� Potassium Priority Pumps heart
� HIGH Potassium = HIGH Pumps
� Tall, Peaked T Waves on ECG
NCLEX TIP
Fluids FLOW - electrolytes GO!!!
HEMOGLOBIN HEMATOCRIT
Low Sodium (hyponatremia) 12-18 normal 36-54% normal
Below 135 NCLEX TIP
!
Elevated H/H
� Hemoglobin: 12 - 18 normal
! Na
� Hematocrit: 36 - 54% normal !

Treatments
PRIORITY
IV Lactated Ringer’s IV Normal Saline
KEY Term (LR) solution (0.9% sodium Chloride)

LACTATED RINGER’S

#1 Intervention first 24-hours

LACTATED RINGER’S 0.9%
Sodium Chloride
250 mL

NaCl 0.9%
IV Lactated Ringer’s (LR) solution
IV Normal Saline

Assessment of Administer enteral feedings

Fluid Resuscitation ≥ 90 Systolic
Once bowel sounds return
≥ 30 mL/hr
90

1. Urine output
30 mL/hr or MORE NCLEX TIP
#1
2. Blood pressure
≥ 30 mL/hr
(90/systolic Or MORE)
< 120/min
3. Heart rate less than 120/min.

Notes
 Burns III - Rule of 9s & Rehabilitation Phase
Pathophysiology Course

Rule of 9’s Rehabilitation Phase

The Rule of 9s is used to quickly estimate the percentage Happens after the wounds fully heal & typically takes
of the body affected by a burn, called Total Body Surface around 12 months or so depending on the severity of the
Area (TBSA). Used in order to calculate the necessary fluid burn.
resuscitation needed.

RULE OF NINES
4½% 4½%
4½%

4.5% anterior 9% 9%
Don’t let
4½%

4½%
4½%

4½%

4.5% posterior
9% 9%

1% THE NCLEX TRICK YOU

9% 9% 9% 9% 9%

Key point
Infection is NOT a big risk
RULE OF NINES

W W
4½% 4½%

4.5% front 9% 9%

4.5% back
4½%

4½%

4½%

4½%

9% 9%

1%

9% 9% 9% 9% 9%

W W
RULE OF NINES WATER-BASED LOTION HELPS Wear PRESSURE GARMENTS
4½% 4½%

9% front 9% 9%

9% back
4½%

4½%

4½%

4½%

9% 9%

Water based
1%
LOTION

18% 9% 9% 9% 9%

Patient Education
RULE OF NINES

NCLEX TIPs
4½% 4½%

1%
9% 9%
4½%

4½%

4½%

4½%

W - Water-based lotion helps

9% 9%

1%

For the perineum

W - Wear pressure garments

9% 9% 9% 9%

E - Exercise daily
(Range-of-motion)
Once the total body surface area is calculated then the
volume needed for emergency fluid resuscitation within
the FIRST 24 hours can be calculated using the
Parkland Formula.

Parkland Formula
40.0
0
4 mL x kg of body weight x TBSA %

4 mL body weight %TBSA

Burns IV - Top Missed Questions
Pathophysiology Course

Top MISSED Exam Questions

Client has full thickness burns to
all posterior body surfaces. 4½ %

Using the rule of nines, calculate 9%

the % of total body surface area

4½ %

4½
%
9%
4.5% + 18% + 9% + 18%
affected. = 49.5% TBSA

Posterior body surfaces: 9% 9%

Head = 4.5%
Back = 18%
Right & left arm = 9% 50% of the body
Right & left leg = 18%

Answer = 49.5% TBSA

Client has partial thickness

burns to the anterior legs &
perineum.
Using the rule of nines, calculate
the % of total body surface area
4½% affected.
9%
1% peri-area
4½%

4½%

1% + 18%
18% Right & Left leg
9%

1%

= 19% TBSA
9% 9%

Answer = 19% TBSA

00
100.

Client weighed 100 kg with 19%

TBSA… calculate the lactated 4 mL 100 Kg 19%TBSA
Ringer’s fluid resuscitation
needed? 3,800 mL 3,800 mL

4 mL x 100 kg x 19 TBSA LACTATED RINGER’S LACTATED RINGER’S

Answer = 7,600 ml
(within the first 24 hours)
8 hours 16 hours
Burns
Top Missed Questions

Top MISSED Questions

Client has full thickness burns to
all posterior body surfaces.
4½ %

Using the rule of nines, calculate

9%

4½ %

4½
%
the % of total body surface area
9%
4.5% + 18% + 9% + 18%
= 49.5% TBSA
affected.
Posterior body surfaces:
9% 9%

Head = 4.5%
Back = 18%
Right & left arm = 9% 50% of the body
Right & left leg = 18%

Answer = 49.5% TBSA

Client has partial thickness

burns to the anterior legs &
perineum.
Using the rule of nines, calculate
the % of total body surface area
4½%
affected.
9% 1% peri-area
18% right & left leg
4½%

4½%

9%
1% + 18%
1%

= 19% TBSA

Answer = 19% TBSA

9% 9%

.00
100

Client weighed 100 kg with 19%

TBSA… calculate the lactated 4 mL 100 kg 19% TBSA
Ringer’s fluid resuscitation
needed? 3,800 mL 3,800 mL

4 mL x 100 kg x 19 TBSA
LACTATED RINGER’S LACTATED RINGER’S

Answer = 7,600 ml
(within the first 24 hours)

8 hours 16 hours
RA: Rheumatoid Arthritis
Pathophysiology Course

Pathophysiology

RA is an autoimmune disorder where the body attacks the joints

causing major inflammation & deformity. Mainly seen in the hand
joints, but can also involve other organs (skin, eyes, & lungs) with
collateral damage as the body attacks itself. Patho Test Tips
Autoimmune Disorder
More common in Women

Diagnostics
Synovial fluid aspiration
Arthroscopy
Blood tests:
� RF - Rheumatoid factor
� ESR - erythrocyte
sedimentation rate
� CRP - C-reactive protein

Signs & Symptoms

Early Signs Boutonniere deformity

Fatigue, anorexia (weight loss)

& morning joint stiffness Patho Test Tips
Symmetrical pain and swelling
in the small joints of the hands Swan-neck deformity
Inflamed synovium Pannus

Fingers: swan-neck and a Pannus (hard tissue around joints)

boutonniere deformity
Contractures of joints Loss of cartilage Fibrovascular

HIGH PRIORITY
= HIGH priority Ankylosis (stiffening and immobility)
Joint pain EXAM TIP
Iron deficiency anemia
Granulation

Pain relief with activity

MORE pain at rest

Education Pharmacology

Pain control - Assess pain levels

Do NOT elevate the knees with NSAIDs
pillows at night Methotrexate

Steroids “-sone”
NSAIDS

Exercise (low impact)

Swimming
EXAM TIP
Heat & Cold to affected joints
Prednisone
STEROIDS

Methotrexate
-SONE
Warm shower or bath
before bed
Rheumatoid Arthritis (RA)
Med Surg: Musculoskeletal

Pathophysiology RA is an autoimmune disorder where the body attacks the joints

causing major inflammation & deformity. Mainly seen in the hand
joints, but can also involve other organs (skin, eyes, & lungs) with
collateral damage as the body attacks itself.

HESI Question Kaplan Question

A patient with rheumatoid arthritis A client asks the nurse, “What is the
asks the nurse about her condition. difference between rheumatoid
On which knowledge does the arthritis and osteoarthritis?” Which
nurse base patient teaching? response by the nurse is best?
Rheumatoid arthritis is thought Rheumatoid arthritis is a
to be an autoimmune disorder. systemic disease and
osteoarthritis is not

Diagnostics HESI Questions

A patient arrives at the clinic Which tests ... performed to
Synovial fluid aspiration with left knee pain that began confirm rheumatoid arthritis (RA)
1 month ago. The X-ray and rule out other diseases?
Arthroscopy Select all that apply.
examination and magnetic
Blood tests: resonance imaging (MRI) were Synovial fluid aspiration
� RF - Rheumatoid factor inconclusive. The nurse Rheumatoid factor (RF)
� ESR - erythrocyte anticipates which procedure
Erythrocyte sedimentation
sedimentation rate will occur next?
rate (ESR)
� CRP - C-reactive protein Arthroscopy

Signs & Symptoms SAUNDERS Question SAUNDERS Question

Early Signs Suspected rheumatoid arthritis Assessment on a client with ...
Fatigue, anorexia (weight loss)
Boutonniere deformity
(RA). The nurse would expect to rheumatoid arthritis (RA). The
& morning joint stiffness note which early signs and nurse checks for which assess-
Symmetrical pain and swelling symptoms? ment finding that is associated
in the small joints of the hands Swan-neck deformity Select all that apply. with RA?
Fingers: swan-neck and a
Fatigue Systemic symptoms such as
boutonniere deformity
Morning stiffness fatigue, anorexia, and
Contractures of joints HIGH PRIORITY

= HIGH priority weight loss.

Joint pain NCLEX TIP
Pain relief with activity
MORE pain at rest 40.0
0

Education Pharmacology
Kaplan Questions
Pain control - Assess pain levels A nurse is assessing a client
Which nursing intervention is
Do NOT elevate the knees with who has a diagnosis of
most appropriate for a client
pillows at night rheumatoid arthritis. Which of
diagnosed with rheumatoid NSAIDs
the following nonpharmaco-
Exercise (low impact) arthritis and reporting
logical interventions could the
generalized pain?
Steroids “-sone”
nurse suggest to help reduce
Swimming
NCLEX TIP pain? Assist the client with heat Prednisone
Heat & Cold to affected joints Alternate applying heat and application and range of
Warm shower or bath cold to the affected joints. motion exercises. Methotrexate
before bed

Methotrexate
NSAIDS
STEROIDS
-SONE
Sjogren’s Syndrome
Med Surg: Immunology

MEMORY TRICK
Pathophysiology
S S
Sjogren So Dry

Autoimmune disorder where the body attacks itself -

Jergens
mainly drying out the skin, eyes, joints, & mouth

Signs & Symptoms Causes & Risks

• Dry Eyes NCLEX TIP

Typically occurs in people with one or more known
• Dry Mouth
risk factors,including:
• Dry Skin, Vaginal, & Nasal Septum
• Joint pain
• Over 40 years old
• Women 10X more likely
• Rheumatic disease

Education Pharmacology

Eyes: Artificial tears

Nasal: humidifier
Immunosuppressants
Skin: NCLEX TIPS
• AVOID harsh soaps & hot • Hydroxychloroquine (brand: Plaquenil)
showers “lukewarm” • Methotrexate (brand: Trexall)
• Lubricants: Vagina
Mouth: NCLEX TIPS
• Regular dental exams
• Artificial saliva/chew gum
• Increase fluid intake
OQUINE
YCHLOR
HYDROX enil)
qu
(brand: Pla

Methotrexate
(brand: Trexall)
S M T W T F S

1 2 3 4 5

6 7 8 9 10 11 12

13 14 15 16 17 18 19

20 21 22 23 24 25 26

27 28 29 30

Notes