Up Next. The patient may have morphea which are waxy patches from the collagen buildup, or linear spots. 2. Recite: Cover the note-taking column with a sheet of paper. . Select all that apply. 1. Preparing for your NCLEX can feel overwhelming. So if the patient has limited scleroderma, it develops slowly and is less widespread. 36 Views. The patient has scleroderma and is experiencing hypertension. So this patient should stay active, even through the pain they may have to try and battle any stressors initiating this autoimmune response in the body. Others were kindly provided by the Khan Academy under a Creative Commons Attribution-NonCommercial-ShareAlike 3.0 United States License. About Mometrix Test Preparation. 1. If you believe this change is due to medication, which of the following … Each question comes with a … 2001 Apr. . A. Obstructive uropathy Incorrect B. Goodpasture syndrome C. Chronic glomerulonephritis Correct D. Calcium oxalate urinary calculi Hypertension occurs with chronic glomerulonephritis that may be found in patients with scleroderma. Get instant access to all 1,600+ original NCLEX written exam practice questions in 65 realistic tests. Dermatology. Lungs become fibrosed where the lung tissues are like scar tissue. If you believe this change is due to medication, which of the following patient’s medication does not cause urine discoloration? Complications in the kidneys include. In women, decreased lubrication and constricting of the vaginal opening are the common worries. The digestive symptoms can vary depending on the organ affected. CREST syndrome is a mnemonic often used to remember the effects of scleroderma. Pathophysiology: Scleroderma is caused by an autoimmune disorder where there is injury to the vascular injury and an increase in the amount of protein in the skin. St. Louis, MO: Elsevier. Effects more women than men. Biopsy – tissue sample from the affected skin is examined for abnormalities. Young children, young adults and older adults can also develop scleroderma Autoimmune Disorders, Nursing Care Plans, Nursing Study Guides Raynaud’s disease is highly associated with scleroderma. We want to assess their respiratory status, especially if they have that pulmonary fibrosis. Administer nicotine patch as prescribed. Scarring in the lungs can cause reduced lung function that can affect the ability to complete vigorous activities. Encourage the patient to cooperate in the smoking cessation program. Protection of cold will help to decrease the effects of the Raynaud’s on the fingers and toes where there is decreased blood flow. Immune: SLE, systemic sclerosis Discussion NCLEX-style Question Dropbox This assignment is part of the module Grand Rounds Presentations and Learning Engagement Group assignments and hasn't been unlocked yet. Let’s explore two different types of scleroderma. Sclerodactyly is the tight thick skin on the fingers. The diagnosis of scleroderma typically starts with Raynaud’s disease. Manage tobacco withdrawal symptoms as they appear. Therapies. Method for Mastering Nursing Pharmacology, 39 Things Every Nursing Student Needs Before Starting School, Kidney (affected blood flow) ->sclerodermic renal crisis, Check pulses and skin (restricted bloodflow), Linear scleroderma- streak of hard waxy skin, BUN and Creatinine (damaged kidneys aren’t filtering out creatinine and BUN), Protein in urine (damaged kidneys aren’t preventing protein release), Calcinosis (calicum deposits in connective tissue), Raynaud’s (cold white/blue hands and feet), Esophageal dysmotility (difficulty swallowing), Sclerodactyly (tight thick skin on fingers), Telangiectasia (very visible swollen small blood vessels), Immune system suppression meds (methotrexate) ->stop/slow T cell attack, Pill to decrease acid in stomach (tightened esophagus), Immunity -> autoimmune disorder involving T cells, Tissue/Skin Integrity ->excess collagen in tissues, Gas exchange -> pulmonary fibrosis = lung thickening and tightening. Osmosis has changed my study life. This is the part 1 of the HIV/AIDS and ART quiz series. Amputation may be required to save the rest of the fingers/limb. NCLEX Review-Multiple Sclerosis. Medical-surgical nursing: Concepts for interprofessional collaborative care. Hard and tight patches of skin – The patches of hard and tight skin can vary in shapes and sizes. To maintain patient safety and reduce the risk of falls. Localized scleroderma – commonly affects the skin only, Systemic scleroderma – includes the involvement of internal organs such as the heart, lungs, or kidneys. Which of the following care plans should the nurse implement? The GI tract is affected, especially the esophagus causing reflux of acid. Nothing by mouth (NBM) status can help rest the bowel by decreasing peristalsis. Many of the questions were created by our authors. We designed them to simulate the real exam provided by the National Council of State Boards of Nursing (NCSBN). Digestive symptoms – The digestive tract can be affected by the damage caused by scleroderma. Localized and systemic scleroderma show different histological responses to methotrexate therapy. These questions resemble those on the NCLEX. Buy on Amazon. 2. CREST C-Calcinosis R-Raynaud’s E-Esophageal dysmotility S-Sclerodactyly T-Telangiectasia Description Calcinosis-deposits of calcium in the connective tissue. Scleroderma is an umbrella term for a group of autoimmune diseases that result in the hardening and tightening of the skin and connective tissues. Nursing Study Guide on Scleroderma. We should assess the patient’s lungs for shortness of breath and oxygen levels because remember that build up of collagen in the lungs causes pulmonary fibrosis which is not stretchy so it’s hard to expand the lungs. The medications used in scleroderma will not cure the disease, but they can help manage symptoms: Steroid creams or tablets to treat the hard and tight skin patches, Medications to suppress the immune system, Painkillers may also be given to relieve any pain if present. This lesson is part of the NURSING.com Nursing Student Academy. Our priority nursing concepts for the patient with scleroderma are immunity, tissue/skin integrity, and gas exchange. Lastly, telangiectasia are those visible swollen small blood vessels like people sometimes get in their face like spider veins. Then, looking at the questions or cue-words in the question and cue column only, say aloud, in your own words, the answers to the questions, facts, or ideas indicated by the cue-words. Connective tissue disease characterized by inflammatory, degenerative, and fibrotic changes in skin, blood vessels, synovial membranes, skeletal muscles, and internal organs; thickening of tissues. Nursing Diagnosis: Ineffective Tissue Perfusion (Peripheral) related to decreased peripheral blood flow (Raynaud’s disease) secondary to Scleroderma, as evidenced by pale, reddish, or bluish hands or feet, pain on the affected area, Raynaud’s phenomenon (fingers and toes turn pale when exposed to cold), digital numbness and weakness. Age most commonly is between 35-50 years. In response to the COVID-19 pandemic, NCSBN introduced several carefully evaluated and tested modifications to the NCLEX examinations. Congestive Heart Failure 3. Assist the patient during exercises and when performing activities of daily living. There is no cure for scleroderma, however, treatments are available to manage symptoms and improve the quality of life. Leave a comment Check that the call bell is within reach, the bed rails are up when the patient is on the bed, the bed is in the lowest level, the room is well-lit, the floor is not slippery, and that important things like phone and eyeglasses are easy to reach. It is one of the earliest signs of scleroderma. Copy link. Record: During the lecture, use the note-taking column to record the lecture using telegraphic sentences. Assess the patient’s vital signs at least every 4 hours, or more frequently if there is a change in them. Rationale: Scleroderma is an autoimmune disorder that can impact different parts of … Gradual progression from NBM up to a low fat and low fiber diet can help manage the symptoms of diarrhea. Desired Outcome: The patient will be able to return to a more normal stool consistency and frequency.eval(ez_write_tag([[300,250],'nursestudy_net-banner-1','ezslot_10',128,'0','0'])); Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Risk for Infection NCLEX Review Care Plans Nursing Care Plans for Risk for Infection Risk …, Your email address will not be published. Administer steroid creams or tablets as prescribed. NCLEX Practice Questions; NCLEX Practice Questions. Hypertension 2. A nurse is assessing a client with scleroderma and knows that the client is at high risk for which of the following? Morphea are waxy patches on the skin, and linear scleroderma shows as streaks. It may be limited which is slow to come on and not as widespread, or diffuse which comes on quickly and spreads all over. (Cheat Sheet), Skin Tissue Menu. Shopping. (2020). Keep the room temperature warm during the day and cool at night. At NURSING.com, we believe Black Lives Matter ✊, No Human Is Illegal , Love Is Love ️‍, Women's Rights Are Human Rights , Science Is Real , Water Is Life , Injustice Anywhere Is A Threat To Justice Everywhere ☮️. NCLEX Questions. Review: Spend at least ten minutes every week reviewing all your previous notes. Cold drinks can increase intestinal motility. Nursestudy.net © Copyright 2021, All Rights Reserved, Scleroderma Nursing Care Plans Diagnosis and Interventions. They can also be small oval or linear patches. Assess the heart for irregular rates or rhythms and the blood pressure will likely be high from the tight thick vessels in the body. A. Obstructive uropathy Incorrect B. Goodpasture syndrome C. Chronic glomerulonephritis Correct D. Calcium oxalate urinary calculi Hypertension occurs with chronic glomerulonephritis that may be found in patients with scleroderma. Ensure the safety of the environment. For Mikael who is diagnosed of having allergic rhinitis, which nursing intervention is the most appropriate?. Preparation involves educating the patient, gaining their consent, and accomplishing a pre-operative checklist. Chronic Kidney Diseases 5. We will assess this patient’s skin for morphea or linear scleroderma. They can be small or big enough to cover wide areas such as the trunk or limbs. Reflect: Reflect on the material by asking yourself questions, for example: “What’s the significance of these facts? Medications. Nursing Diagnosis: Impaired physical mobility related to hardening and tightening of the skin secondary to scleroderma, as evidenced by presence of hard and tight patches in the affected skin, inability to do activities of daily living (ADLs) as normal, and verbalization of overwhelming tiredness/ fatigue. Raynaud’s disease – Raynaud’s disease is a common symptom both in localized and systemic scleroderma. reports fatigue, joint tenderness, swelling, and … A patient tells you that her urine is starting to look discolored. St. Louis, MO: Elsevier. What is multiple sclerosis (MS)?It’s an autoimmune disease that affects the myelin sheath of the central nervous system (CNS). Questions: As soon after class as possible, formulate questions based onthe notes in the right-hand column. practice.. To help you get the NCLEX questions practice you need to pass we have created a ton of resources including our 3,500 Question Bank (Nursing Practice Questions), to an NCLEX Question Podcast, to courses and so much more.. Sexual dysfunction. Anaphylactic shock occurs a foreign substance enters the body and causes the mast cells and basophils to release histamine and other inflammatory mediators system-wide. Scleroderma is an autoimmune disease that is thought to be triggered by some sort of stressor and results in T cell attack on normal cells. Kidney issues. What are the diseases treated by ARBs? Buy on Amazoneval(ez_write_tag([[300,250],'nursestudy_net-large-leaderboard-2','ezslot_16',131,'0','0'])); Silvestri, L. A. Immune system suppressors like methotrexate might be used to slow the T cell attack on the healthy cells. (Biodigital), Hypertension (High Blood Pressure) Increased blood viscosity is a contributory factor to clotting. Commence a stool chart. Assess the patient’s level of functional mobility and ability to perform ADLs. The exact cause of this immune-mediated disease is still unknown. Let’s now explore a mnemonic to help remember the effects of scleroderma. Also, scleroderma can lead to pulmonary hypertension. To help dilate the blood vessels and improve the blood flow to the affected area/s.
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