My 2 Lads and Me

1. What kinds of drugs have to be kept in a medication cupboard?

S8s the narcotics (drugs of addiction)

S4D’s the sedatives (Potential for abuse)

2. What are the 5 Rights of safe medication admin?

Right patient, right med, right time, right dose, right route

3. When do the 3 checks happen in meds preparation, and what are they?

i. When ur about to administer meds, Check the Meds Packet against the Pt’s Meds Chart

ii. Check again as Meds are removed from packet (right dose, right blister pack)

iii.  Check 3rd time as u put the Meds away

4. What is an “adverse drug event”?

= an injury to a Pt caused by a med error, e.g. drug given to wrong Pt, or wrong drug given to Pt, or drugs given despite contrainidications.

= the most common adverse event in Hosp, aside from surgical mistakes

5. Just say you were administering 25mg oxycontin to a Pt but the only tablets left were 50mg. Would you:

a. give the Pt the whole tablet

b. break the tablet in half, give half to the Pt and eat the other half

c. break the tablet in half, give half to the Pt, and sell the other half at the local Westfield

d. break the tablet in half, give half to the Pt, destroy the remainder by flushing it down the toilet, have another RN witness this, and record it as destroyed in the register (both to sign)

RHEUMATOID ARTHRITIS

6. What happens inside joints that are affected by RA?

RA is an autoimmune disease in which the body’s defence system starts to attack the synovial membrane. The synovial membrane becomes inflamed. This is a problem for the articular cartilage because the cartilage doesnt have any real circulation of its own and so it sort of relies on the synovial membrane to bring nutrients etc which diffuse across to it. Pannus (granular tissue) forms at the edges of the cartilage and gradually replaces it all, causing joint stiffness. The joint space gets smaller and eventually the joint might fuse (bones stick together). The edges of the bones not covered by cartilage begin to wear away. Yow!

7. My neighbour Judy is a 40 year old piano teacher. Her finger joints are stiff and they are red, hot, and swollen. They look shiny. She admits she hasn’t been feeling all that well lately. She thought she had a virus 2 months ago, but since then she has lost 7kg. She has an itchy rash on her stomach, she feels tired and unwell, and when I take her temp. it is 38.9 C. Judy says her fingers are sore from playing the piano too much. How likely is this?

Not very likely. It sounds like she might have RA, as her condition is more systemic and not just localized to her fingers. Also, her small joints are affected on each hand. She is also female, 40, thin, and unwell. All these are pointers to RA.

8. What tests would you expect a Dr to order for Judy?

hands Xray, joint WBC count, ESR, rheumatoid factor test, and maybe a DNA test for the gene for Human Leucocyte Antigen production

About rheumatoid factor - if you have RA, that means your IgG antibodies go nuts and start attacking your own tissues rather than foreign invaders. A test for rheumatoid factor is counting how many of your IgG antibodies have crossed to the dark side.

9. What would u expect to see on Judy’s fingers Xray?

narrowed joint spaces, maybe fused bones

10. What is an ESR and what does it mean if your ESR is raised?

I dont know. Anybody? Anybody?

11. Your Dad is 50 years old and he’s getting pretty chubby from working too much at his computer. One night after a large dinner of steak and red wine, your Dad wakes up with a really, really sore R big toe. He hops down the hallway to the living room where you are hanging out. He hasn’t injured his toe exercising, and he’s otherwise well. What’s wrong with your Dad’s foot?

He most likely has gout. Gout most commonly onsets in obese middle aged men >40, and commonly affects the big toe.  It is extremely painful. It can be brought on by eating red meat too often. Gout can certainly happen to women but the age of onset is later. Alcohol abuse is also a risk factor. Maybe Dad should cut down on the red wine!

12 The Dr tells your dad that it’s gout, and he gives him some meds. Dad wants you to explain what causes gout…

Gout is caused by wonky metabolism of Purine (no idea what that is - just think of Pura milk, then make it into Purine - which could be the expelled waste of Pura milk - ha ha) which causes your blood to have a too high level of uric acid. Your body responds to the uric acid with an inflammation response to try and attack it and get rid of it. Unfortunately, uric acid precipitates in your joints as crystals, and then your inflammatory pac-mans attack inside your joints, which is VERY painful.

13. Later that evening, you notice that your Dad’s arm has quite a lot of tiny white nodules under the skin. Is this related to the gout, or has Dad got a mysterious rash?

a. It’s a rash unrelated to the gout, and you don’t want to know where he got it

b. It’s nodules called ‘tophi’, which are uric acid deposits under the skin

c. It’s a fungal infection called ‘fungi’

d. It’s suncream absorbed by Dad’s skin when he put too much on

14. Mr Singh is a 75yo man who comes to your local GP’s clinic with a sore R hip. He walks with a stick which he bought 6 months ago. Mr Singh used to be a marathon junky, but now he is elderly and overweight (120kg, 170cm). He says his hip is getting more painful and he can hear it creaking when he walks. It is stiff and sore in the mornings for <1hr. It gets worse with exercise. He has no other health problems. What is Mr Singh’s problem?

OA, because: he’s elderly, it’s a major joint that’s affected, he’s overweight, he’s otherwise generally well, his morning stiffness lasts <1hr; the joint pain gets worse with exercise, you can hear crepitus when he moves it, and the joint damage may be a result of many years of marathon running.

15. What happens inside a joint suffering from OA?

Chondrocytes (bone cells) turn evil and start to overgrow. The hyaline cartilage gets roughened and then worn away. The chondrocytes continue to multiply and cause bony overgrowth (osteophytes) at the edges of the joint, which sometimes break off (”joint mice”) and float around in the synovial fluid, causing pain and crepitus. What triggers chondrocytes to grow out of control? Genetic factors, trauma, chronic overuse - lots of factors.

16. What is an arthroplasty?

a. A nose job

b. An operation to scrape out the osteophytes in a joint

c. Surgery by a plastic surgeon on a joint

d. The replacement of a joint via surgery

17. What are the 4 main areas of nursing care that a Pt needs after a THR surgery?

i. Prevention of Infection (e.g., via surgical wound, the wound drain, or IDC)

ii. Prevention of acute pain, and monitoring of pain analgesia & side effects

iii. Exercises to regain joint mobility but avoid movements that might dislocate the hip joint

iv. Prevention of DVTs via assessment for DVT signs, leg exercises, Ted stockings etc

18. As luck would have it, you are working as an undergrad nurse in rehab and you are looking after Mr Singh after a THR. You have to help him get dressed. Are you going to:

a. Get him to put his knees together (adduct his legs)

b. Get him to bring his knees up to his chest

c. Move his legs apart wider than his hips (abduct his legs)

d. Absolutely NONE  of the above! Keep his legs about knee-width apart and don’t raise his knees above his hips