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Assessment: Neuro assessment- A&O status + assessing cranial nerve function, NIHSS, Glasgow coma scale, mobility- assess for weakness or difficulty with mobility

Ischemic Tx: CT scan/MRI, tPA administration within 3.5 hour timeframe to bust clot, surgical intervention (thrombectomy), admin antiplatelet drugs (aspirin/clopidogrel), admin anticoagulants (warfarin), admin statins, rehab (PT, speech therapy, OT), BP >140 up to 220 systolic for first 48hrs

Hemorrhagic Tx: CT scan/MRI, admin antihypertensive meds, endovascular surgery to repair ruptured blood vessel, BP <140 systolic

Left sided: Language related deficits (expressive aphasia, receptive aphasia, dysarthria), anxiety, timid, right sided affected, slow + cautious behaviors

Right sided: left sided affected, aggressiveness, impulsive behaviors, vision deficits

Complications: Impaired communication, aspiration risk, fall risk, pulmonary embolism, cardiac arrhythmias such as atrial fibrillation, pressure sores, decreased sensation, contractures, seizure

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Assessment/Sx:

Symptoms-Tremors, Bradykinesia (slowness of walking), muscle rigidity (stiffness in the limbs), impaired balance, shuffling gait, sleep disturbances, cognitive changes, difficulty with speech or swallowing (dysphagia)

Assessments- Neurological function, motor function, mental health assessment, ADLs, communication and sensory assessment

Tx: Levodopa-Carbidopa (watch for dyskinesias/abnormal muscle movements), Dopamine agonists, anticholinergics, deep brain stimulation( helps regulates movement), PT, OT, speech therapy

Complications: worsening of tremors and ridigity, difficulty walking or with ADLs, difficulty swallowing/aspiration, nutritional deficiencies/weight loss, sleep disturbances, sleep disorder, autonomic complications (constipation, urinary incontinence, etc.)

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Mobility: Rheumatoid Arthritis vs Osteoarthritis

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Mobility: Rheumatoid Arthritis vs Osteoarthritis

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RA:

Assessment:

Tx/Interventions:

Teaching:

OA: Is the most common form of arthritis. Common in women >50 and adults >60. It is a progressive deterioration and loss of cartilage in one or more joints, primarily wight- bearing joints.

Assessment: Joint pain/stiffness (especially after activity), reduced range of motion, swelling around the joint, crepitus, muscle weakness around the joint, joint instability, Heberden's nodes & Bouchard's nodes, joint effusion, is diagnosed with a standard X- Ray and labs. Priority problems include: chronic pain, impaired physical mobility, risk of falls, sleep disturbances, & anxiety/depression.

Interventions: Medication Management: acetaminophen, NSAIDs (GI bleed), COX-2 inhibitors, Opioids, corticosteroids, adjunct neuropathic agents (monitor renal and liver functions w/ medications). Non- pharmacological tx: exercise, weight loss, PT, assistive devices, surgical management such as joint arthroplasty (surgical repair and replacement of the joint affected).

Teaching: Teaching include ensuring safety and prevention of injury, maintaining a physical regimen, educating about the disease process, reduce pain and inflammation through periods of rest. Alternating between ice and heat, ice helps reduce swelling and heat helps to increase blood flow to site. Hip replacements: do not cross legs, abduction of legs, get OOB, no flexion or hyperextensions, S/S PE/DVT/FE, infxn

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Complications:

Compartment Syndrome: increased pressure within a muscle compartment leads to decreased blood flow and potential damage to a muscle or nerve. 6 P's (check regularly!) - Pressure, paralysis, pallor, paresthesia (pins, needles, tingling), pain & pulselessness, poikilothermia (impaired thermoregulation)

Fat Embolism: Fat globules are released from bone marrow and enter the bloodstream. S/S: Sudden SOB, chest pain, hypoxia, petechial rash on chest, fever, tachycardia

Pulmonary Embolism: Blood clot travels to the lungs and blocks arteries. S/S: sudden SOB, hypoxia, chest pain, tachycardia, tachypnea

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PNA:

Assessment:

Tx/Interventions:

Teaching:

Influenza: Three types - A, B, C. Common infection of the respiratory tract, acute, highly contagious. Transmitted by inhaling a respiratory droplet from an infected person or by indirect contact

Assessment: Hx - recent exposure to a person with influenza, no vaccination Physical findings - dry cough, tachycardia, tachypnea, dyspnea, headache, fatigue, fever, nasal discharge, sore throat.

Tx/Interventions: Nasal swab flu test, chest x-ray, administer antivirals/other prescribed drugs, antipyretics as indicated, droplet precautions, O2 therapy if needed, hydrate pt

Teaching: Importance of yearly vaccination, encourage bed rest, hand hygiene, mouthwash or warm saline to ease sore throat, adhere to medications prescribed

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Chronic Bronchitis: Excess mucus production, inflammation of bronchi, airway narrowing, Frequent infections, cyanosis

Emphysema: Alveolar destruction, loss of elastic recoil, Barrel chest, pursed-lip breathing.

Assessment: Barrel chest, Clubbing, Prolonged expiratory phase, Diminished breath sounds, Accessory muscle use, watch for inspiratory wheezing

Tx/Interventions: Positioning: High Fowler’s or tripod position, Oxygen therapy: Use caution in COPD (maintain SpO₂ 88-92%), Incentive spirometry, Breathing techniques: Pursed-lip breathing, Medications: Bronchodilators, corticosteroids, Hydration

Teaching: Small, frequent meals, High-protein, high-calorie diet, Limit carbohydrates (to reduce CO₂ production), Avoid gas-producing foods, Encourage hydration, Avoid being around sick people, vaccinations

Complications: Increased accessory muscle use, decreased SpO₂, worsening ABGs, Severe dyspnea, Change in mental status, Signs of respiratory failure

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Assessment: musculoskeletal assessment (limited movement of joint, tender/swollen/red or purple joint, Tophi in ears/hands/feet, warmth over joint), pain assessment, past medical history(illness like hypertension), lifestyle habits(sedentary)

Tx/Interventions: Elevate and remove restrictive clothing, Apply cold packs to affected area, identify triggers, smoking cessation, avoid alcohol, administer medications (NSAIDs and corticosteroids)

Teaching: Avoid alcohol and adjust diet (avoid foods high in purines, organ meats, fructose), adherence to medication regimen and potential side effects, drink fluids

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Erin:

Assessment: visual change in bone positioning, altered ROM, increased pain, XRAY, CT, MRI, open-break in skin, closed-no break in skin

Tx/Interventions: surgery, casting/traction, monitor for compartment syndrome, monitor for bleeding, monitor for circulation, immobilization/proper positioning, treat pain, mobility, infection control, monitor for fat embolism

Skeletal Traction: hardware goes into bone and is attached to weights to pull the bone into place and align the joint

Internal Fixation: pins are inside the body, less infection risk, wound care and infection prevention while surgical wound is healing

External Fixation: frame outside of the body with pins attached to the bone, higher infection risk due to pin going from outside to inside

Teaching: mobility/exercise and ROM, immobility of limb until healed, proper nutrition to promote healing

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Assessment: respiratory status by auscultating lung sounds pulse ox and RR , trach site integrity, and patients comfort and communication, monitor for cyanosis, monitor for infection such as WBC, increase in RR and temperature,

Tx/Interventions: keeping airway patent by proper suctioning of secretions, place patient in semi flowers position, promote drainage, minimize edema, and prevent strain on the suture lines, prevent infection, effective communication: call light, white board for communication ; pen and paper if nonverbal, verify position and compare desired placement, administer warm humidity, know when to stop suctioning (hypoxic or bradycardic)

Equipment: ambu bag with exact size of trach tube if cuffless, sterile gloves, goggles mask or face shield, sterile cotton tipped applicators, dispposable inner cannula size for patient, normal saline solution or sterile water, person to assist with changing the trach or tie/holder, additional ppe

Complications: bleeding, pneumothorax, air embolism, aspiration, subcutaneous or mediastinal emphysema, recurrent laryngeal nerve damage, and posterior tracheal wall penetration

long term: airway obstruction from accumulation of secretions or protrusion of the cuff over the opening of the tube, infection, rupture of innominate artery, dysphagia, tracheoesophageal, fistula, tracheal dilation, tracheal ischemia, necrosis, tracheal stenosis may develop after the tube is removed

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Jasleen:

RA- systemically affects the joints causing inflammation and pain (synovial membrane)

S+S- pain, swelling, tenderness, stiffness ( morning time), bilateral joint deformities, limited ROM, weakness, fatigue

Assessment- Health history, PE, functional assessment - dressing, getting out of bed, gait, appearance- posture, body alignment, X-ray, MRI

Labs- ESR, Cr- protein, ANA, RF

Nursing- Pain meds (NSAIDs), DMARDS/biologics (methotrexate)- teach about avoiding big crowds, avoiding live vaccines, hand washing, assist with ROM

P's education- activity to resolve stiffness, med adherence, heat or cold therapy, joint protection- to prevent fractures, assistive devices, PT and OT, less intense exercise- walking, swimming

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Laura:

Pneumonia

Assessment:

Adventitious lung sounds (crackles, wheezing, rhonchi)

fever (fever symptoms)

use of accessory muscles

sputum production

tachypnea

tachycardia

orthopnea

deceased SpO2 (if severe)

Tx/ interventions:

Administer oxygen if needed

administer antibiotics/ other prescribed medications

Sputum collection for culture

WBC

Xray

Monitor vital signs and respiratory status

Semi to High Fowler's position

breathing and coughing exercises

Teaching:

Risk factors (mechanically ventilation, aspiration, age (65+ or less than 5 yr old), other chronic medical conditions; COPD)

Pneumococcal vaccination

Drug therapy regimen

medication education and diagnosis education

importance of hand hygiene

stay away from people who are sick

aspiration risk

s/s of worsening