Describe osteoarthritis and rheumatoid arthritis

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Describe osteoarthritis and rheumatoid arthritis (RA), and discuss the pathophysiology, clinical manifestations, evaluation, and treatment for each.

The onset of prodromal symptoms

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Describe the incubation periods, the onset of prodromal symptoms, duration, and characteristics of rashes and other clinical symptoms of the following viral diseases: rubella (German measles), rubeola (measles), roseola (exanthemasubitum), and varicella (chickenpox).

List the CDC-recommended childhood vaccination schedule applicable.

Describe multiple organ dysfunction syndromes

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Describe multiple organ dysfunction syndromes (MODS) and summarize the pathophysiology, clinical manifestations, evaluation, and treatment.

Mental health nursing

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Talk about the nurse-client relationship and the use of therapeutic communication as an important part of that relationship. Please answer the following questions:

What are your concerns or fears about mental health nursing in general? Are you interested in mental health nursing, or do you approach the topic with some anxiety?
What do you feel are essential aspects of a good nurse-client relationship?
Please include an example of how you established good rapport and a good professional relationship with a patient in the work or clinical setting. What nonverbal and verbal techniques did you use in this relationship?

Explain how a patient with hyperparathyroidism is at risk for bone fractures

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Explain how a patient with hyperparathyroidism is at risk for bone fractures. What serious consequences of hypoparathyroidism occur and why?

The hormones involved in intermediary metabolism,

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The hormones involved in intermediary metabolism, exclusive of insulin, that can participate in the development of diabetic ketoacidosis (DKA) are epinephrine, glucagon, cortisol, and growth hormone (insulin counter-regulatory hormones). Describe how they participate in the development of DKA.

The Widespread Pain Index (WPI) and the Symptom Severity Inventory

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The APRN tells the patient that the tender points are no longer used to diagnose FM. She suggests that the patient takes the Widespread Pain Index (WPI) and the Symptom Severity Inventory (SSI). The patient asks the APRN what these tests are for. What is the APRN’s best answer?

Risk of developing Lyme disease

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CASE STUDY

Stan is a 45-year-old man who presents to the clinic complaining of intermittent fevers, joint pain, myalgias, and generalized fatigue. He noticed a rash several days ago that seemed to appear and disappear on different parts of his abdomen. He noticed the lesion below this morning and decided to come in for evaluation. He denies recent international travel and the only difference in his usual routine was clearing some underbrush from his backyard about a week ago.

Past medical history non-contributory with exception of a severe allergy to penicillin resulting in hives and difficulty breathing. Physical exam: Temp 101.1 ˚F, BP 128/72, pulse 102 and regular, respirations 18. Skin inspection revealed a 4-inch diameter bullseye type red rash over the left flank area. The APRN, based on history and physical exam, diagnoses the patient with Lyme Disease. She ordered appropriate labs to confirm the diagnosis but felt it urgent to begin antibiotic therapy to prevent secondary complications.

Question:

What is Lyme disease and what patient factors may have increased his risk of developing Lyme disease? 

Radiographic evidence of osteoporosis

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CASE STUDY

A 72-year-old female was walking her dog when the dog suddenly tried to chase a squirrel and pulled the woman down. She tried to break her fall by putting her hand out and she landed on her outstretched hand. She immediately felt severe pain in her right wrist and noticed her wrist looked deformed. Her neighbor saw the fall and brought the woman to the local Urgent Care Center for evaluation. Radiographs revealed a Colles’ fracture (distal radius with dorsal displacement of fragments) as well as radiographic evidence of osteoporosis. A closed reduction of the fracture was successful, and she was placed in a posterior splint with an ace bandage wrap and instructed to see an orthopedist for a follow-up.

Question:

What is osteoporosis and how does it develop? 

Motion of hips and forward flexion

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CASE STUDY:

A 32-year-old Caucasian male presents to the office with complaints of back pain, stiffness, especially in the morning, interrupted sleep due to pain, and difficulty in leaning over to tie his shoes. The patient first noticed these symptoms about 6 months ago but attributed them to his weekend basketball team He said he is exhausted due to sleep interruption. He has taken acetaminophen with some relief but says the naproxen seems to be working better.

Married with 2 small children and works as a bank manager. Physical exam: Lungs clear but decreased chest excursion noted as well as decreased range of motion of hips and forward flexion, rotation, and lateral flexion restricted. Spine radiographs in the office revealed a slight kyphosis along with ankylosis at L5-S1. The APRN suspects the patient may have ankylosing spondylitis (AS). The APRN orders laboratory tests including an HLA-B27.

Question:

Why did the APRN order an HLA-B27 lab? How would that lab result assist in understanding what ankylosing spondylitis