(Kennedy-Malone 402) Kennedy-Malone, Laurie, Kathleen Fletcher, Lori Martin-Plank. Advanced Practice Nursing in the Care of Older Adults. F.A. Davis Company, 2014-01-14. VitalBook file. Question 2. Question : Your 63-year-old Caucasian woman with polymyalgia rheumatica (PMR) will begin treatment with corticosteroids until the condition has resolved. You look over her records and it has been 2 years since her last physical examination and any laboratory or diagnostic tests as she relocated and had not yet identified a health-care provider. In prioritizing your management plan, your first orders should include : Recommending she increase her dietary intake of Calcium and Vitamin D Ordering once a year bisphosphonate and a proton pump inhibitor Participate in a fall prevention program CORRECT Dual-energy X-ray (DEXA) scan and updating immunizations Instructor Explanation: Follow-up: Assess the patient for proximal pain, morning stiffness, resolution of constitutional symptoms, and adverse reaction to corticosteroids (Dasgupta et al., 2010). For patients with PMR, the ESR and/or C-reactive protein need monitoring until the levels decrease and previously reported symptoms are alleviated. The CBC can be repeated to determine if the anemia has resolved. Initially, the patients will need to return every couple of weeks to evaluate the clinical response to therapy; this is followed by approximately an every-3-month surveillance to determine response to treatment and any adverse reactions to the long-term corticosteroids. Additional monitoring of urea and electrolytes and glucose should continue every 3 months while on corticosteroids (Dasgupta et al., 2010). Follow up on the results of the dual-energy x-ray absorptiometry scan. Consider prophylactic therapy to prevent osteoporosis with bisphosphonates with calcium and vitamin D supplementation. Patients also presenting with GCA need to be monitored in the same way, with repeated eye examinations as warranted, including examination for cataracts resulting from corticosteroid therapy (Paget & Spiera, 2006). Because patients with GCA are at risk for developing aortic aneurysm, follow-up abdominal examination for aortic aneurysm is needed. This complication is of great concern especially with patients who are at high risk for developing aortic aneurysms such as patients who smoke, are hypertensive, and have arteriosclerotic heart disease (Unwin et al., 2006). (Kennedy-Malone 407) Kennedy-Malone, Laurie, Kathleen Fletcher, Lori Martin-Plank. Advanced Practice Nursing in the Care of Older Adults. F.A. Davis Company, 2014-01-14. VitalBook file.
South University NSG6420 81 Question 3. Question : In providing health teaching related to dietary restrictions, the nurse practitioner should advise a patient with gout to avoid which of the following dietary items: Green leafy vegetables CORRECT Beer, sausage, fried seafood Sugar Gluten and bread items Instructor Explanation: Contributing factors: Factors associated with primary gout in men
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