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Nurs. 401 > Exam 5 > Flashcards

Exam 5 Flashcards

1
Q

What is Cirrhosis?

A

Cirrhosis is extensive scarring of the liver, usually caused by a chronic reaction to hepatic inflammation and necrosis.
Complications depend on the amount of damage sustained by the liver.
In compensated cirrhosis, the liver has significant scarring but performs essential functions without causing significant symptoms.

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2
Q

Complications of Cirrhosis

A
  • Portal hypertension
  • Ascites
  • Bleeding esophageal varices
  • Coagulation defects
  • Jaundice (Table 61-1)
  • Portal-systemic encephalopathy with hepatic coma (Table 61-2)
  • Hepatorenal syndrome
  • Spontaneous bacterial peritonitis
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3
Q

Known causes of liver disease include?

A 
Alcohol (Laennec’s cirrhosis)
Viral hepatitis
Autoimmune hepatitis
Steatohepatitis
Drugs and toxins
Biliary disease
Metabolic /genetic causes
Cardiovascular disease
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4
Q

In early stages, signs of liver disease include?

A
  • Fatigue
  • Significant change in weight
  • GI symptoms
  • Abdominal pain and liver *tenderness
  • Pruritus
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5
Q

Abdominal assessment in liver disease

A

Massive ascites (measure abdominal girth)

Umbilicus protrusion

Caput medusae (dilated abdominal veins)

Hepatomegaly (liver enlargement)

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6
Q

Labs to assess in liver disease

A
  • Aminotransferase (AST,ALT)serum levels and lactate dehydrogenase (LDH) may be elevated.
  • Alkaline phosphatase levels may increase.
  • Total serum bilirubin and urobilinogen levels may rise.
  • Total serum protein and albumin levels decrease.
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7
Q

Other lab findings in liver disease

A
  • Prothrombin time is prolonged; platelet count is low.
  • Hemoglobin and hematocrit values and white blood cell count are decreased.
  • Ammonia levels are elevated.
  • Serum creatinine level is possibly elevated.
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8
Q

Nursing diagnosis for liver disease

A
  • Excess fluid volume
  • Risk for imbalanced nutrition
  • Ineffective breathing pattern
  • Chronic pain
  • Risk for infection
  • Ineffective coping
  • Sexual dysfunction
  • Disturbed body image
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9
Q

What is the most common nursing diagnosis for liver disease?

A

Excess fluid volume

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10
Q

Interventions for liver disease

A

Interventions:
Nutrition therapy consists of low sodium diet, limited fluid intake, vitamin supplements.
Drug therapy includes a diuretic, electrolyte replacement.
Paracentesis is the insertion of a trocar catheter into the abdomen to remove and drain ascitic fluid from the peritoneal cavity.
Observe for possibility of impending shock.

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11
Q

Comfort measures for liver disease

A

For dyspnea, elevate the head of the bed at least 30 degrees, or as high as the patient wishes to help minimize shortness of breath.
Patient is encouraged to sit in a chair.
Weigh patient in standing position, because supine position can aggravate dyspnea.

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12
Q

Surgical interventions for liver disease

A

Peritoneovenous shunt

Portocaval shunt

Transjugular intrahepatic portosystemic shunt (TIP) –nonsurgical

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13
Q

Potential for hemorrhage for liver disease

A

Screen for esophageal varices

Drug therapy–nonselective beta blocker to decrease heart rate/pressure gradient

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14
Q

Managing hemorrhage

A
  • Blood transfusions
  • Esophagogastric balloon tamponade
  • Vasoactive therapy (Octreotide)
  • Endoscopic procedures: *Endoscopic variceal ligation (EVL-banding) & Endoscopic sclerotherapy (EST)
  • Transjugular intrahepatic portal-systemic shunt (TIP)
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15
Q

Potential for Portal-Systemic Encephalopathy

A

Interventions include:

  • Ammonia & toxic metabolic by-products can not be converted by liver to less toxic form
  • Need to reduce ammonia levels
  • Nutrition therapy: moderate protein/fat & simple carbohydrates

*Monitor bleeding: intestinal bacteria metabolize blood cells that increase ammonia

*Drug therapy:
Lactulose
Neomycin sulfate
Metronidazole

*Check for asterixis (liver flap) &fector hepaticus

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16
Q

What is Hepatitis?

A

*Inflammation of the liver
Viral hepatitis

*Most common cause (Hepatitis A,B,C,D,E)
Other possible causes
Drugs (alcohol)
Chemicals
Autoimmune liver disease
Bacteria (rarely)
(Cytomegalovirus
Epstein-Barr virus
Herpes virus 
Coxsackievirus
Rubella virus)
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17
Q

Hepatitis A

A
  • 61,000 cases of hepatitis A occur annually in the United States
  • Rates declined 89% since vaccine available in 1995
  • 1.4 million cases of hepatitis A occur annually worldwide
  • Nearly universal during childhood in developing countries
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18
Q

Hepatitis A virus

A

Hepatitis A virus (HAV)
Transmitted fecal–oral route, oral-anal sexual activity, parenteral (rarely)
Frequently occurs in small outbreaks
Found in feces 2 or more weeks before the onset of symptoms and up to 1 week after the onset of jaundice
Present in blood briefly
No chronic carrier state

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19
Q

Hepatitis A causes

A

Similar to that of a typical viral syndrome; often goes unrecognized

  • Spread via the fecal-oral route by oral ingestion of fecal contaminants
  • Contaminated water, shellfish from contaminated water, food contaminated by handlers infected with hepatitis A
  • Also spread by oral-anal sexual activity
  • Incubation period for hepatitis A is 15 to 50 days.
  • Disease is usually not life threatening.
  • Disease may be more severe in individuals older than 40 years.
  • Many people who have hepatitis A do not know it; symptoms are similar to a GI illness.
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20
Q

Hepatitis B

A
  • Nearly 400 million people chronically infected with hepatitis B
  • 50% to 75% active viral replication
  • 73,000 new cases of hepatitis B annually in United States
  • 1.4 million Americans chronically infected
  • Incidence of new infections decreased due to HBV vaccine
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21
Q

How is Hep B transmitted?

A
  • Transmitted when infected blood or other body fluids enter the body of a person who is not immune to the virus
  • Spread is via unprotected sexual intercourse with an infected partner, sharing needles (IV drug use), accidental needle sticks, blood transfusions (before 1992), hemodialysis, perinatal, maternal-fetal route.
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22
Q

Symptoms of Hep B

A

Symptoms occur in 25 to 180 days after exposure; symptoms include anorexia, nausea and vomiting, fever, fatigue, right upper quadrant pain, dark urine, light stool, joint pain, and jaundice.

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23
Q

Hep C

A
  • 170 million people are infected with the hepatitis C virus (HCV)
  • 30,000 new cases diagnosed annually

8,000 to 10,000 people in the U.S. die each year from complications of end-stage liver disease secondary to HCV

*Approximately 30% to 40% of HIV-infected patients also have HCV

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24
Q

What are some risk factors for Hep C?

A 
Risk factors 
IV drug use
Hemodialysis
Blood products
Occupational exposure
High-risk sexual behavior
Perinatal transmission is rare
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25
Q

More information on Hep C

A
  • Acute symptoms of infection is not common, up to 10% of patients with HCV cannot identify a source
  • Most remain asymptomatic for months and years until liver impairment causes them to seek medical care
  • Most do not clear the virus and are chronically infected
  • Leading cause in U.S., after alcohol, for cirrhosis
  • Leading indicator for liver transplant in the U.S.; most transplanted livers become reinfected
  • Additional data needed regarding risk of body piercings, tattooing, and intranasal drug use in transmission of HCV
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26
Q

Hep D

A
  • Transmitted primarily by parenteral routes
  • Incubation period 14 to 56 days
  • Requires the helper function of HBV to replicate
  • Cannot survive on its own
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27
Q

Hep E

A
  • Present in endemic areas where waterborne epidemics occur and in travelers to those areas—most common mode of transmission is drinking contaminated water
  • Occurs primarily in developing countries
  • Transmitted via fecal-oral route
  • Resembles hepatitis A
  • Incubation period 15 to 64 days
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28
Q

Hep E symptoms

A
  • Abdominal pain
  • Changes in skin or eye color
  • Arthralgia (joint pain)
  • Myalgia (muscle pain)
  • Diarrhea/constipation
  • Fever
  • Lethargy
  • Malaise
  • Nausea/vomiting
  • Pruritus
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29
Q

Lab assessment for hepatitis

A

Hepatitis A, B, C—acute elevations in level of liver enzymes
Levels of ALT and AST may rise
Alkaline phosphatase level normal or elevated
Serum total bilirubin levels elevated
Hepatitis A—HAV antibodies in blood
Hepatitis B—Hepatitis B antigen-antibody & detectable viral count (HBsAg & anti-HBc IgM)
People vaccinated against HBV have a positive HBsAb as immunity against the disease

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30
Q

Preventing Hep A

A

*Proper handwashing, especially after handle shellfish
*Avoid contaminated food or water
*Receive immune globulin 14 days after expose
*Receive the HAV vaccine before traveling to
areas where common (Mexico, Caribbean)
*Receive vaccine if living enclosed with others (Havrix and Vaqta—inactive hepatitis A virus)

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31
Q

Hep B prevention

A

Vaccine—Engerix-B, Recombivax-HB
Immunizations for
People who have unprotected sex with more that one partner
Men sex with men
People with chronic liver disease
People exposed to blood or body fluids

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32
Q

Which statements about immunodeficiency are true?

A
  1. It may be acquired or congenital
  2. It occurs when a person’s body cannot recognize antigens
  3. It may cause very reactions from mild, localize health problems to total immune system failure
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33
Q

Which immune function abnormalities are a result of HIV infection?

A
  1. CD4 plus sell depletion

2. Lymphocytopenia

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34
Q

Which groups are experiencing increased numbers of HIV infections?

A
  1. Men having sex with other men
  2. IV drug users
  3. women having sex with men
  4. African-Americans
  5. Hispanics
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35
Q

Which descriptions are characteristic of a non-progresser?

A
  1. ?Has been infected for 10 years
  2. is asymptomatic
  3. is immunocompetent
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36
Q

Which statements about the transmission of HIV are true?

A
  1. Those with recent HIV infection and high viral load are very infectious
  2. Those with end-stage HIV and no drug therapy are very infectious
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37
Q

Which conditions may be the first signs of HIV and women?

A
  1. Vaginal candidiasis
  2. Cervical neoplasia
  3. Pelvic inflammatory disease
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38
Q

Which statements regarding HIV and AIDS among older adults are true?

A
  1. Older adults to participate in high-risk behaviors are susceptible to HIV infection
  2. Cognitive deficits associated with the disease may appear earlier and older adults with HIV
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39
Q

What is the most important means of preventing HIV spreader transmission?

A

Education

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40
Q

HIV can be transmitted by which routes?

A

Sexual, parenteral, perinatal

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41
Q

Hi reactivated anti-retro viral therapy causes what a fact?

A

Decrease of the viral load

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42
Q

The patient is an IV drug user who regularly shares needles and syringe is with friends. What information does the nurse provide to decrease the patient’s risk of HIV through shared needles and syringe after each use

A

Phil and then flush the syringe with Clearwater, then fill the syringe with bleach, shake approximately 30 to 60 seconds, and rinse with Clearwater

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43
Q

Which practices are recommended by the CDC to prevent sexual transmission of HIV?

A

Use of the latex or polyurethane condom for genital an anal intercourse and or use of a late text barrier for genital an anal intercourse

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44
Q

Which opportunistic infections can be observed in AIDS?

A
  1. Protozoan
  2. viral
  3. bacterial
  4. fungal
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45
Q

A patient with new mall cytosis Jarabec idiot and ammonia usually presents with which symptoms?

A
  1. Dyspnea, tachypnea, persistent dry cough, and fever

2. fatigue, and weight loss

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46
Q

The patient presenting with toxoplasmosis may have which signs and symptoms?

A
  1. Speech difficulty
  2. visual changes
  3. impaired gait
  4. mental status change
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47
Q

Cryptosporidium else this is a form of intestinal infection in which diarrhea can amount to a loss of how many liters of fluid per day?

A

15 to 20

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48
Q

Where can candidiasis occur in the body?

A

Mouth esophagus and vagina

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49
Q

True or false

Cryptococcosis is a type of meningitis

A

True

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50
Q

True or false

Histoplasmosis is a localized respiratory infection

A

False, histoplasmosis progresses to a widespread infection

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51
Q

Where in the body can cytomegalovirus present with symptoms

A
  1. The eyes, causing visual impairment

2. respiratory tract causing pneumonitis 3.gastrointestinal tract, causing colitis

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52
Q

How does the herpes simplex virus manifest itself in patients with HIV and AIDS?

A
  1. A chronic ulceration after vesicles rupture
  2. Vesicles located in the perry rectal, oral, and genital areas
  3. Numbness and tingling occurring before the vesicle forms
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53
Q

Shingles results from vera Cella zoster virus leaving the nerve ganglia and entering the body by which route?

A

Body fluids and other tissue areas

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54
Q

Lymphoma is associated with AIDS include which types?

A
  1. Non-Hodgkin’s B cell
  2. immunoblastic
  3. Hodgkin’s
  4. Burketts
  5. primary brain
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55
Q

Which treatments are intended to boost the man system?

A
  1. Hematopoietic growth factors
  2. lymphocyte transfusion
  3. administration of interleukin 2
  4. infusion of lymphokines
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56
Q

Which conditions cause severe pain and HIV disease and AIDS?

A
  1. Enlarged organs
  2. peripheral neuropathy
  3. Rumors
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57
Q

What methods are agents are used to treat Kaposi’s sarcoma?

A

Radiotherapy, chemotherapy, cryotherapy

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58
Q

Which actions are useful in helping orient a patient?

A
  1. Repeating person, place, and time
  2. Using clocks and calendars
    3 having familiar items present
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59
Q

The nurse assesses the patient diagnosed with advanced it’s for malnutrition. Which findings that the nurse most likely assess?

A
  1. Pain
  2. Anorexia
  3. Diarrhea
  4. Vomiting
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60
Q

Corticosteroids perform which actions?

A
  1. Block the movement of neutrophils and monocytes through cell membranes
  2. reduce the number of circulating T cells, resulting in suppress cell mediated immunity and
  3. decrease intercranial pressure
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61
Q

True or false

The person with HIV infection can transmit the virus others at all stages of disease

A

True

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62
Q

True or false

Lesions resulting from Kaposi’s sarcoma are painful and have Prielin drainage

A

False

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63
Q

True or false

It’s dementia complex is caused by infection of the cells in the central nervous system by HIV

A

True

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64
Q

True or falsepatients with HIV you should know that his CD4 count slower, clinical manifestations decrease

A

False, clinical manifestations increase

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65
Q

True or false
The viral load test measures the pressure of HIV genetic material in the patient’s blood and helps with monitoring the disease progression

A

True

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66
Q

True or false

Antiviral drug therapy kills the virus before it is able to replicate

A

False, it only inhibits the virus not kill

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67
Q

True or false

HIV is more easily transmitted from infected female to uninfected mail them from infected mail to uninfected female

A

False, HIV is more easily transmitted from infected mail to uninfected female that infected female to uninfected mail

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68
Q

Which methods are items are means of transmitting HIV?

A

Sexual intercourse

breastmilk

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69
Q

The nurses teaching a patient about preventing HIV infection through sexual contact. Which statement made by the patient indicates effective teaching?

A

Mutually monogamous sex with and not infected partner will best prevent HIV infection

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70
Q

Patient diagnosed with HIV is receiving medications to reduce the viral load and improve CD for lymphocyte count. Which terms accurately describe this HIV-AIDS drug regimen?

A

HAART therapy

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71
Q

A client asked the nurse should I tell my partner I just found out I’m HIV-positive? What is the nurses most appropriate response?

A

You’re having difficulty deciding what to say

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72
Q

A client who abused IV drugs with sadness with the HIV virus several years ago. The nurse explained that the diagnostic criteria for acquired immunodeficiency syndrome has been met with the client does what?

A

Has a CD4 plus T lymphocytes level of less than 200 cells

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73
Q

A nurses caring for a client who is HIV-positive. For which complication associated with this diagnosis is it most important for the nurse to teach prevention strategies?

A

Infection

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74
Q

Mother with a diagnosis of AIDS states that she has been caring for her baby even though that she is not been feeling well. What important information to the nurse determine

A

If the baby is breast-feeding

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75
Q

A nurses caring for a client with diagnosis of AIDS. The IV infiltrates and Macy restarted. What is necessary to protect the nurse when are you starting the IV?

A

Gloves and hand hygiene

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76
Q

A nurse is planning to provide discharge teaching teaching to the family of a client with AIDS. Which statement should the nurse include in the teaching plan?

A

Wash use dishes in hot soapy water

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77
Q

During an AIDS education class for client states that Celine works great when I use condoms. Which conclusion of the clients knowledge economy is can the nurse draw from the statement?

A

Ignorance related to correct condom use

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78
Q

The client also has a nursing diagnosis of decreased cardiac output related to decreased plasma volume. Which assessment findings support this nursing diagnosis?

A

Flatten neck veins when the client is in the supine position

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79
Q

The nursing care plan for the client with dehydration includes interventions for oral health. Which interventions are within the scope of practice for an LPN being supervised by the nurse?

A

Reminding the client to avoid commercial mouthwashes
encouraging mouth rinsing with warm saline observing the lips, tongue, mucous membranes
providing mouth care every two hours with the client is awake

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80
Q

The healthcare provider is written on these orders for a client with a diagnosis of excess fluid volume. The clients morning assessment reveals bounding peripheral pulses waking up 2 pounds, putting ankle edema, moist crackles bilaterally. Which order takes priority at this time?

A

Administer forosemide or Lasix 40 mg IV push

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81
Q

You’ve been floated to the telemetry unit for the day. The monitor watch your informs you of the clients develop problem that you waves. Which lab value should you check Amilee?

A

Potassium

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82
Q

Clients potassium level is 6.7. Which intervention should you delegate to the first year nursing student when you’re supervising?

A

Administer sodium polystyrene sulfonate 15 g Orlean

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83
Q

A client is admitted to the unit with a diagnosis of syndrome of inappropriate antidiuretic hormone secretion. For which electrolyte abnormality would you be sure to monitor?

A

Hyponatremia

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84
Q

The charge nurse assigned the care of a client with acute kidney failure and hypernatremia to you, a newly graduated RN. Which action can you delegate to the UAP?

A

Providing oral care every 3 to 4 hours

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85
Q

The client has a history of hypothyroidism. Which skin condition should the nurse expect when performing a physical assessment?

A

Dry skin

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86
Q

A nurses caring for a client was experiencing in under production thyroxine. Which client response is associated with an under production of the Roxy or T4?

A

Myxedema

It is the severest form of hypothyroidism

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87
Q

Propylthiouracil or PTU is prescribed for a client diagnosed with hyperthyroidism. The client asked the nurse why do I have to take this medication if I’m going to get the atomic cocktail? The nurse explains that the medication is being prescribed because it decreases the?

A

Production of thyroid hormones

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88
Q

A nurses caring for a client with an underactive thyroid gland. Which responses should the nurse expect the client to exhibit as a result of decreased level of triode I thyronine T3 and T4?

A

Weight gain and cold intolerance

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89
Q

Which clinical findings should the nurse expect when assessing a client with hyperthyroidism?

A

Diarrhea and weight-loss

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90
Q

Nurses caring for a client after radioactive iodine is administered for Graves’ disease. What information about the clients condition after the therapy should the nurse consider when providing care?

A

Mildly radioactive but should be treated with her team safety precautions

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91
Q

The client is scheduled to have a thyroidectomy. Which medication does the nurse anticipate the healthcare provider will prescribe to decrease the size of vascularity of the thyroid gland before surgery?

A

Potassium iodide

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92
Q

Nurse is assessing a client for possible laryngeal nerve injury following a thyroidectomy. Which action should the nurse implement on an hourly basis?

A

Ask the client to speak

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93
Q

A nurse is caring for a newly admitted client with a diagnosis of graves disease. And preparing a teaching plan, the nurse anticipate switched I will be ordered for this client?

A

High calorie diet

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94
Q

A claim with hyperthyroidism asked the nurse about the test that will be ordered. Which diagnostic test of the nurse include in a discussion with this client?

A

TSH assay a and T3

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95
Q

A nurse in the post anesthesia care unit is caring for a client who just had a thyroidectomy for which client response is most important for the nurse to monitor?

A

Signs of respiratory obstruction

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96
Q

A nurses caring for a client who just had a thyroidectomy. For it’s Clara sponsor the nurse assessed the client one concern about an accidental remover of the parathyroid glands are in surgery?

A

Tetany

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97
Q

I’m taking the blood pressure of a client who had a thyroidectomy, the nurse identifies the claim is pale and have spasms of the hand. The nurse notified the healthcare provider. What should the nurse expect the healthcare provider to prescribe?

A

Calcium

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98
Q

What should a nurse do immediately when a client returns from the postanesthesia care unit filing a subtotal thyroidectomy?

A

Place a tracheostomy set at the bedside

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99
Q

On the first postoperative day finally thyroidectomy a client tolerates a full fluid diet. This is changed to a soft diet on the second postoperative day. The client reports having a sore throat and swollen. What should the nurse do for us?

A

Administer analgesics as prescribed before meals

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100
Q

A nurse is assessing a client with a diagnosis of hypothyroidism. Which clinical manifestations to the nurse expect when assessing a client?

A

Dry skin and brittle hair

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101
Q

Level thyroxine 0.125 mg by mouth is prescribed for a client with hypothyroidism. The only tablets available contain 25 µg per tablet how many tablets should the nurse administered?

A

5 tablets

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102
Q

The client is diagnosed with hyperthyroidism is in experiencing exophthalmia. Which meds or should the nurse include one teaching the client how to manage the discomfort associated with XFL man?

A
  1. Use tinted glasses
  2. elevate the head of the bed 45°
  3. tape Eyelids shut at night if they do not close
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103
Q

For which client response to the nurse monitor when assessing for complications of hyperparathyroidism?

A

Bone pain

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104
Q

Nurses caring for a client who is admitted to the hospital with a diagnosis of primary hyperparathyroidism. Which action should be included in this clients plan of care?

A

Ensuring a large fluid intake

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105
Q

Client lab values demonstrating increased serum calcium level, and further diagnostic tests reveal hyperparathyroidism. For what clinical manifestations to the nurse assesses client?

A

Correct dysrhythmias and hypoactive bowel sounds

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106
Q

A nurses caring for a client newly admitted with a diagnosis of pheochromocytoma. Which clinical findings as a nurse expect when assessing this client?

A

Headache, palpitations, diaphoresis

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107
Q

Preparation of the client for a subtotal thyroidectomy may include that ministration of potassium iodide solution. The client refuses to take the medication. What explanation to the nurse give us the wife medication should be taken?

A

It will reduce the risk of hemorrhage during surgery

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108
Q

The nurse is interviewing a patient who is newly admitted to the unit with a diagnosis of anemia which assessment findings does the nurse expect?

A 
Dyspnea on exertion 
orthostatic hypotension 
intolerance to cold temperatures 
club like appearance of the nails 
pallor of the ears 
headache

All OF THEM

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109
Q

Patient with sickle cell crisis is admitted to the hospital. Which questions does the nurse asked the patient to elicit information about the cause of the current crisis?

A

Ask the patient about recent airplane travel determine the patient’s perceived energy level using a scale from 0 to 10
review all activities and events during the past 24 hours
ask the patient about the ability to climb stairs ask the patient about symptoms of infection

ALL OF THEM

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110
Q

Patient is scheduled to undergo lab testing to diagnose sickle cell anemia. For which diagnostic test of the nurse provide patient teaching?

A
  1. White blood cell count
  2. hemoglobin S
  3. red blood cell count
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111
Q

The student nurses caring for a patient with sickle cell crisis which action by the student warrants intervention by the supervising nurse?

A

Keeping the patient’s room cold

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112
Q

A patient with vitamin B12 deficiency anemia is being discharged home with primary care responsibility being assume by the family. The patient and family about dietary modifications to manage this condition. Which statement by the family indicates additional teaching as needed about dietary modification?

A

Dairy products will be omitted from the diet citrus fruits will be omitted from the diet
green leafy vegetables will be omitted from the diet

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113
Q

Which statement is true about the pattern of inheritance for sickle cell disease?

A

If a patient with sickle cell disease has children each child one here at one of the two abnormal gene or wheels and at least have the sickle cell trait

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114
Q

The nurses caring for a patient in sickle cell crisis which I already interventions for this patient?

A

Pain management and assessing oxygen saturation

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115
Q

The nurses aide is providing care to a patient in sickle cell crisis. Which action by the nurses aide requires intervention by the supervising nurse?

A

Obtaining the patient’s blood pressure with an external cuff

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116
Q

A patient admitted for sickle cell crisis is being discharged home. Which statement by the patient indicates the need for food further postoperative discharge instruction?

A

I will visit my friends in Denver

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117
Q

When reviewing the procedure for administering I am medications by the track method which statement by the student nurse indicates that further instruction is needed?

A

I will use the ventral gluteal site for the injection

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118
Q

A patient with polycythemia vera is being cared for by a nurses aide. Which action by the nurses aide requires intervention by the supervising nurse?

A

Assisting the patient to flosses teeth

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119
Q

A patient with a low white blood cell count is being discharged home in what situations with the patient be instructed by the nurse to contact his or her healthcare provider?

A

For temperature greater than 100° if a persistent cough develops with or without sputum is plus or foul-smelling drainage develops from any open skin area or normal body opening if a boil or abscess develops for year and it is cloudy or foul-smelling or if burning on urination is experienced

ALL OF THEM

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120
Q

Which food should a patient with low white blood cell count the encourage to eat?

A

A well-done steak

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121
Q

The nurses caring for a patient with acute leukemia which characteristics is the nurse assessed the patient for?

A
  1. Hematuria
  2. Orthostatic hypotension
  3. bone pain
  4. joint swelling
  5. fatigue
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122
Q

Which factors are associated with an increased risk for lymphoma?

A
  1. Autoimmune disease and immunosuppressive disorders
  2. chronic infection from helical backed or pylori
  3. Epstein-Barr virus infection
  4. inherited genes damage
  5. pesticides and insecticides
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123
Q

Which disorder make the patients at high risk for the development of infection?

A

Sickle cell crisis

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124
Q

Which medication place is a patient at risk for infection?

A

Steroids

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125
Q

The nurse is caring for a patient with thrombocytopenia which order does the nurse question?

A

Edminister enema

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126
Q

A patient undergoing bone marrow or stem cell transplant patient reports severe fatigue to assist the patient with energy management, what does the nurse encourage the patient to do?

A
  1. Verbalize feelings about limitations
  2. monitor nutritional intake to ensure adequate energy resources
  3. limit the number of visitors as appropriate
  4. plan activities for. When the patient has the most energy
  5. monitor overall response to self-care activities
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127
Q

The Homecare nurses is it a patient who had at Sam’s cell transplant. Which observation by the nurse requires immediate action?

A

The patients grandson is visiting after receiving in MMR vaccine

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128
Q

The patient has been taught how to care for his central venous catheter at home with statements by the patient indicate that further instruction is necessary?

A

I will flush the catheter with heparin three times a day

I will change the Luer lock On each catheter daily

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129
Q

The nurse instructed patient at risk for bleeding about techniques to manage this condition which statement by the patient indicates that the teaching have been successful?

A
  1. I will take a stool softener to prevent straining during about movement
  2. I won’t take aspirin or aspirin containing products
  3. I won’t participate in any contact sports
  4. I will report a headache that is not responsive to acetaminophen
  5. I will avoid bending over at the waist
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130
Q

The new registered nurse is giving a blood transfusion to a patient which statement by the new nurse indicates the need for action by the supervising nurse?

A

I’ll be sure to complete the red blood cell transfusion is within six hours of removal from refrigeration

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131
Q

The new registered nurse is identifying a patient for blood transfusion which action by the new nurse wants intervention but supervising nurse?

A

Uses the patient’s room number is a form of identification

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132
Q

A patient receiving a stem cell transplant from an identical twin is receiving which type of transplant?

A

Syngeneic

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133
Q

A patient with hemophilia VIII will most likely receive which components of blood for management of the disease

A

Cryiprecipitate

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134
Q

Patients with sickle cell disease are more susceptible to infection specifically streptococcus pneumonia and hemophilia’s influenza A which actions help prevent infection?

A 
1. Consistent good handwashing technique
2 yearly flu vaccination 
3. twice daily oral penicillin 
4. monitoring CBC
5.  assessment of vital signs at least every four hours
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135
Q

The nurses caring for a patient who is donated bone marrow. In addition to having the aspiration safe monitored the nurse would anticipate the need for which interventions?

A
  1. Fluid for hydration
  2. pain management
  3. possible RBC infusion
  4. anabiotic therapy
  5. assessment for complications of anesthesia
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136
Q

When caring for a patient after bone marrow stem cell transplant Tatian, when does the nurse expect engraftment to occur?

A

12 to 28 days after infusion

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137
Q

A patient is at high risk for the development of venoocclusive disease what assessments does the nurse performed for early detection of this disorder?

A

Jaundice
Hepatomegaly
right upper abdominal pain
ascites

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138
Q

Hodgkin’s lymphoma

A

Pain in lymph nodes brought on are made worse with ingestion of alcohol
one of the more treatable type of cancer fevers, drenching night sweats, and unexplained weight loss
of viral infections and exposure to chemical agents
read stern big cells
Enlarged painless lymph nodes
more common in teens

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139
Q

Non-Hodgkin’s lymphoma

A
  1. Over 60 subtypes

2. associated with autoimmune disorders

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140
Q

Alogenic

A

From a sibling or HLA match

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141
Q

Syngeneic

A

From an Identical twin

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142
Q

Autologous

A

From own stem cells

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143
Q

Well being interviewed for admission a patient tells the nurse that he has Christmas disease. What does the nurse document?

A

Hemophilia B

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144
Q

Which characteristics described patients who have hemophilia?

A
  1. Bleeding for a long period of time

2. exhibit abnormal bleeding a response from

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145
Q

What size of an IV needle is best for administering a blood transfusion and

A

20 gauge needle

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146
Q

A patient is receiving a blood transfusion. Which solution does the nurse administered with the blood?

A

Normal saline

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147
Q

A nursing student has to registered nurse why D5W is contra indicated when transfusing blood. How does the nurse respond?

A

It causes hemolysis of blood cells

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148
Q

Patient is receiving a blood transfusion through a single lumen peripherally inserted central catheter the patient has two peripheral IVs one is And the other has D5 45 and running at a rate of 50 mL an hour what infusion is acceptable to add to the blood products?

A

Normal saline

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149
Q

The nurse realizes that he will let it reactions to blood transfusions occur most often within the first how many milliliters of the infusion?

A

50 mL

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150
Q

Which type of medication is used for patients receiving a platelet transfusion as a pre-medication to prevent a reaction?

A

Benadryl and Tylenol

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151
Q

Patient has been receiving frequent blood transfusions soon after this transfusion has begun the patient develops a fever and report a racing heart does not report any pain. The nurse notes that the patient is also hypotensive clinical manifestations may be the cause of which type of transfusion reaction?

A
  1. Hemolytic
  2. bacterial
  3. febrile
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152
Q

A client expresses concern about being exposed to radiation therapy because it can cause cancer. Which of the nerds emphasize one informing the client by exposure to radiation?

A

Only a small part of the body is a radiated

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153
Q

A client who is to receive radiation therapy for cancer says to the nurse my family said I will get a radiation burn. What is the nurses best response?

A

I look like skin reaction usually occurs

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154
Q

I nurse is caring for a client who had an insertion of radium for cancer of the cervix. For what radium action should the nurse assess the client?

A

Pain

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155
Q

Read inserted into the vagina have a client is now been removed. What safety precaution to the nurse employee when assisting with the radium remove all?

A

And stir that long for steps are available for moving the radium

156
Q

A nurse is checking the Predium of a client with a radium implant for cervical cancer observe the packing protruding from the vagina. When is the next notify the healthcare provider to remove it immediately?

A

Radioactive packaging will enjoy a healthy tissue

157
Q

A nurse is caring for a client who has a radium implant for cancer of the cervix. What is the priority nursing action?

A

Restrict visitors to a 10 minute say

158
Q

The client was treated with the reading implant for cancer of the cervix. What information is important for the nurse to teach the client when giving discharge instructions?

A

Return for follow-up care

159
Q

Postmenopausal women who has cancer of the breast besides Avalon back to me followed by chemotherapy. After receiving chemotherapy for several weeks, she says to the nurse at the clinic I don’t feel well. The nurse reviewed the chemotherapy medication for client is receiving and check the lab values obtained the clients vital signs. Based on this information what does the nurse include in this clients priority need?

A

Preventing infection

160
Q

The client with upper G.I. bleeding developed mild anemia. What should the nurse expect to be prescribed for this client?

A

Iron salts

161
Q

The client has a low hemoglobin level, which is attributed to nutritional deficiency, and the nurse provides dietary teaching. Which food choices by the client indicates that the nurses instructions are effective?

A

Raisins and spinach

162
Q

The client is admitted with a higher than expected red blood cell count. What physiological alteration is the nurse expect will result from this clinical finding?

A

Increase blood viscosity

163
Q

A transfusion of packed red blood cells in order for a client with anemia. List the following actions in order in which they should be performed by the nurse

A
  1. Ensure that the client signed a consent form
  2. Determine clients vital signs
  3. Compare the number on the blood product and lab record
  4. Donna pair of clean gloves
  5. Run the transfusion slowly
164
Q

A client of the bone marrow aspiration perform. After the procedure what is the first nursing action?

A

Briefly apply pressure over the aspiration side

165
Q

The client is diagnosed with Hodgkin’s disease. Which lymph node does the nurse expect to be affected first?

A

Cervical

166
Q

What group of clients to the nurse anticipate to have the highest incidence of non-Hodgkin lymphoma

A

Older adults

167
Q

Nurses teaching a client with Hodgkin’s disease about response to whole body radiation which clinical indicator increase to the nurse include?

A

Susceptibility to infection

168
Q

Acclimate started on a continuous infusion of heparin. Which finding does the nurse used to conclude that the interventionist therapeutic?

A

APTT is 2 times he control value

169
Q

A client is receiving Coumadin. The nurse explained the need for careful regulation of dietary intake of vitamin K. What physiological processes vitamin K promote that this makes this instruction essential?

A

Prothrombin formation by the liver

170
Q

A nurses caring for a client with a diagnosis of policies in the vera. The client asked why do I have an increased tendency to develop blood clots? Which effect of the policy theme yeah vera explain increases the risk of these thrombosis?

A

Increase blood viscosity

171
Q

A female client has a low hemoglobin level, which is attributed to an iron deficiency which food should the nurse recommended client increase in their diet?

A

Spinach, beef liver, and baked beans

172
Q

The client is receiving epoetin for the treatment of anemia associated with chronic renal failure. Which client statement indicates the nurse that further teaching about this medication is necessary?

A

I really that important to take this medication because it will cure my

Wrong because epoetin one creates a sense of well-being but I will not cure the underlying medical problem

173
Q

You are reviewing the complete blood count for a patient who is abatement a minute for knee arthroscopic knee. Which value is the most important to report to the physician before surgery?

A

White blood cell count of 16,000

174
Q

You are providing orientation for a new RN who is preparing to administer pack red blood cells to a patient my blood loss during surgery. Which action by the new RN requires that you intervene immediately?

A

Priming the transfusion that using 5% dextrose and lactated ringer solution

175
Q

A 32-year-old patient with sickle cell anemia is admitted to the hospital during a sickle cell crisis which action prescribed by the healthcare provider will you implement first?

A

I minister 100% oxygen using a non-rebreather mask

176
Q

These activities are included in the care plan for 70-year-old patient admitted to the hospital with anemia caused by possible gastrointestinal bleeding. Which activity can you delegate to an experienced UAP?

A

Obtaining stool samples first fecal blood test slides

177
Q

As a charge nurse you’re making the daily assignments on the MedSurg unit. Which patient is best assigned to a float nurse who has come from the post anesthesia care unit?

A

52-year-old patient with chronic gastrointestinal bleeding was returned to the unit after a colonoscopy

178
Q

You’re making a room assignment for newly arrived patient was lab test results indicate Pancytopenia. Which patient with be the best roommate for this new patient?

A

Patient with digoxin toxicity

179
Q

A 67-year-old who is receiving chemotherapy for lung cancer is admitted to the hospital with thrombocytopenia. Which statement made by the patient when you are obtaining the admission history is most of most concern?

A

I take one aspirin every morning because of my history of angina

180
Q

After a car accident, patient with a medical alert bracelet indicating hemophilia A is admitted to the emergency department. Which action prescribed by the healthcare provider will you implement first?

A

Transfuse factor VII concentrate

181
Q

As a home health nurse, you are obtaining an admission history for a patient who has the van thrombosis and is taking Coumadin 2 mg daily. Which statement by the patient is the best indicator that additional teaching about Coumadin may be needed?

A

I have started to eat more healthy food like green salads and fruit

182
Q

A patient is admitted to the intensive care unit with disseminated intravascular quite elation associated with the gram-negative infection. Which assessment information has the most immediate implications for the patient’s care?

A

The patient’s oxygen saturation is 87%

183
Q

A 22-year-old was stage one Hodgkin’s disease is admitted to the oncology unit for radiation therapy. During the initial assessment the patient tells you sometimes I’m afraid of dying. Which response is most appropriate at this time

A

Tell me a little bit more about your fear of dying

184
Q

You received a change of shift report about the following patients. Which one were you with us first?

A

69-year-old with chemotherapy induced neutropenia with an oral temperature hundred and one

185
Q

A patient in a long-term care facility who have chronic lymphocytic leukemia has a nursing diagnosis of activity intolerance related to weakness and anemia. Which nursing action will you delegate to the UAP?

A

Checking the patient’s blood pressure and pulse rate after ambulation

186
Q

A transfusion of packed red blood cells has been abusing for five minutes with the patient becomes flesh to And says I’m having chills please give me a blanket. Which action should you take first?

A

Stop the transfusion

187
Q

A group of patients is assigned to an RN LPN team. The OPN should be assigned to provide patient care and administer medications to which patient?

A

36-year-old with chronic kidney failure who will need a subcutaneous injection of Procrit

188
Q

You obtain the following dad about a patient admitted with multiple myeloma. Which information has the most immediate implications for the patient’s care?

A

The patient reports new onset leg numbness

189
Q

The nurse in the outpatient clinic is assessing a 22-year-old required a splenectomy after recent motor vehicle accident. Which information obtained during assessment will be of most immediate concern to the nurse?

A

The oil temp is 100°

190
Q

A patient my graft versus host disease after bone marrow transplant patient is being cared for in the medical unit. Which nursing activities best delegated to the travel RN?

A

Infusing 5% dextrose and 0.45% saline at 125 mL an hour into the patient

191
Q

You’re the charges on an oncology unit want to patient was an absolute neutrophil count to 300 and submitted with staff member should you decide to provide care for this patient, under the supervision of an experience oncology RN?

A

LPN with two years of experience on the oncology unit

192
Q

You’re transferring a patient with newly diagnosed chronic myeloid leukemia to an LTC facility. Which information is most important to communicate to the LTC charge nurse before transferring the patient?

A

The patients chemotherapy has resulted in neutropenia

193
Q

A patient with acute Milo Janice leukemia is receiving induction phase chemotherapy. Which assessment finding requires the most rapid action?

A

Serum potassium level of 7.8

194
Q

Patient has been receiving cyclosporine following an organ transplantation is experiencing the following symptoms. Which one is of most concern?

A

Nontender lump in the right groin

195
Q

Patient with Hodgkin’s on Phoma is receiving radiation therapy to the groin area has skin redness and tenderness in the area being irradiated which nursing activities should you delegate to be UAP caring for the patient?

A

Cleansing the skin over the area daily with a mild soap

196
Q

After you receive the change of shift report, which patiently with us first?

A

20-year-old with possible acute Milo leukemia I was just arrived on the medical unit

197
Q

Autoimmune thrombolytic purpura

A
  1. Also called idiopathic
  2. Antibodies directed against own platelets
  3. Women age 20-40
  4. pre-existing autoimmune condition
  5. Immunosuppressive therapy to reduce intensity
  6. Corticosteroids and azathioprine
198
Q

Thrombotic thrombocytopenia purpura

A
  1. Platelets clump
  2. Plasmopheresis
  3. Inappropriate aggregation of platlets
199
Q

True or false
Cirrhosis is extensive, irreversible scarring of the liver usually caused by chronic reaction to hepatic inflammation and necrosis

A

True

200
Q

True or false

Most common cause for cirrhosis in the United States are alcoholic liver disease and hepatitis C

A

True

201
Q

True or false

Laennecs cirrhosis is caused by viral hepatitis and exposure to drugs or chemicals

A

False this type of cirrosis is caused by alcohol abuse

202
Q

True or false
Ascites the accumulation of free fluid within the peritoneal cavity caused by increased hydrostatic pressure from portal hypertension

A

True

203
Q

True or false

Massive ascites may cause renal vasoconstriction triggering the angiotension system resulting in sodium and water loss

A

False massive ascites may cause renal vasoconstriction, Trigal triggering the running angiotensin system resulting in sodium and water retention

204
Q

True or false

Esophageal varies occurs when fragile thin walled esophageal beans become distended from increased pressure

A

True

205
Q

True or false

Melena is the term that refers to black tarry stool

A

True

206
Q

Patients with cirrhosis are susceptible to bleeding and easy bruising because they’re lacking and factors II, VII, IX , X

A

True

207
Q

True or false

Hepatorenal syndrome is often the cause of death in patients with cirrhosis

A

True

208
Q

True or false

cirrhosis has a rapid onset was severe and specific early manifestations

A

False

209
Q

When admitting the patient was cirrhosis, the nurse assesses for which conditions as possible complications of the disease

A
  1. Ascites
  2. bleeding esophageal variances
  3. Hepatorenal renal syndrome
  4. Coagulation defects
  5. portal hypertensive gastropathy
210
Q

Patient with roses are susceptible to bleeding and easy bruising because there is a decrease in the production of bile in the liver preventing them which vitamin?

A

Vitamin K

211
Q

Which lab value as the usual I didn’t indication of Hepatic encephalopathy

A

Elevated ammonia level

212
Q

Which elevated lab test results indicate the hepatic cell destruction?

A
  1. Serum aspartame aminotransferase
  2. Serum alanine aminotransferase
  3. Lactate dehydrogenase
  4. Serum total bilirubin
  5. Urine urobilinogen
  6. INR

ALL OF THEM

213
Q

The patient is scheduled for a procedure to place a stent in the biliary tract. For which procedure does the nurse provide patient teaching?

A

Endoscopic retrograde cholangiopancreatography

214
Q

When caring for a patient with cirrhosis who has Puritius The nurse delegates which task to the UAP?

A

Use of lotion to soothe the skin

215
Q

The nurses teaching a patient with cirrhosis about nutrition therapy. Which statement by the patient indicates teaching has been effective?

A

I will read the sodium content labels on all food and beverages

216
Q

I’m preparing a person for Perry centesis what does the nurse do?

A

Ask the patient to void before the procedure obtain the patient’s heart rate
assess the patient’s respiratory rate
obtain the patient’s blood pressure

217
Q

Patient will undergo an abdominal paracentesis. Which factor provides an additional safety measure?

A

The procedure is performed using ultrasound

218
Q

The student nurses caring for a patient with cirrhosis. Which action by the student nurse causes a supervising nurse to intervene?

A

Uses a straight edge razor to shave the patient

219
Q

The nurse who is assessing a patient with portosystemic and slept a lot but the find that the patient has better hepaticus, positive events he signed, and seizures but no Asterix. The nurse identifies the patient is being which stage of portosystemic encephalopathy?

A

Stage IV comatose

220
Q

True or false
All patients with the roses should be screened for esophageal varies by endoscopicy to detect them early before they bleed

A

True

221
Q

True or false

Bleeding esophageal varies our medical emergencies

A

True

222
Q

True or false

Nonselective beta blocker engage in such as Inderal is usually prescribed to prevent esophageal varies from bleeding

A

True

223
Q

True or false

IV octreotide is the mainstay for acute hemorrhage dude esophageal berries in the United States

A

True

224
Q

True or false
It’s off of gastric balloon tamponade is really used today because it is difficult to use, uncomfortable for the patient, and prone to dangerous complications

A

True

225
Q

The nurses teaching a patient with psoriasis about lactulose therapy. Which statement by the patient indicates the teaching is been effective?

A

This therapy will promote the removal of ammonia in my stool

226
Q

How is mycifeadin in used to treat patients with cirrhosis

A

It destroys the normal flora of the bowel, diminishing protein breakdown and decreasing the rate of ammonia production

227
Q

True or false

Hepatitis D is the leading cause of cirrhosis and liver failure in the United States

A

False , hepatitis C is

228
Q

True or false

Appetite is a spread via the fecal oral route

A

True

229
Q

True or false

Hepatitis B can be transmitted by unprotected sexual intercourse with an infected partner

A

True

230
Q

True or false

Hepatitis carries have chronic obvious signs of hepatitis B

A

False no signs

231
Q

True or false

Hepatitis C is transmitted by casual contact or intimate household contact

A

False not transmitted through that type of contact

232
Q

True or false

Hepatitis D only occurs with hepatitis B to cause viral replication

A

True

233
Q

True or false

Hepatitis is transmitted via the fecal oral route

A

True

234
Q

When teaching a group of adult patients measures for preventing hepatitis A what information does the nurse include?

A
  1. Perform proper handwashing especially after handling shellfish
  2. Receive immune globulin within 14 days of expose the virus
  3. Receive the HAV vaccine before traveling to Mexico or the Caribbean
  4. Receive the vaccine of living in a college dorm
  5. Receive the vaccine if working in a long-term care facility
235
Q

Which people are in need for immunization against hepatitis B?

A
  1. People have unprotected sex with more than one partner
  2. men want sex with men
  3. people with any chronic liver disease 4. firefighters
  4. police officers
236
Q

True or false

Needlesticks are the major source of hep B transmission in healthcare worker

A

True

237
Q

True or false

The hepatitis B vaccine is administered in a series of two injections

A

False it’s administered in a series of three injections

238
Q

True or false

Hepatitis B vaccine also prevents hepatitis E

A

False only hepatitis B

239
Q

True or false

It’s a healthcare worker is exposed to hepatitis a, immunoglobulin should be administered immediately

A

True

240
Q

True or false

All cases of hepatitis should be reported to the health department

A

True

241
Q

True or false

A person who has a history of being infected with hepatitis C me never donate blood, body organs, or other body tissue

A

True

242
Q

True or false

A person with viral hepatitis can no longer transmit the disease once the jaundice this is resolved

A

False they can continue to transmit the disease

243
Q

True or false

Patient with hepatitis should eat small frequent meals with a high carb, moderate fat, and moderate protein content

A

True

244
Q

True or false

People of been vaccinated against HPV have a positive HB a B because they also have immunity to the disease

A

True

245
Q

Which lab test results indicate permanent immunity to have a?

A

Immunoglobulin G antibodies

246
Q

Which antiviral drugs are given to patients with hep B virus?

A
  1. Lamivudine
  2. Entecavir
  3. Telbivudiene
  4. Pegylated interferon alpha 2b
247
Q

Which conditions place of patients at high risk for the development of fatty liver?

A

Diabetes
mellitus obesity
elevated lipid profile
alcohol abuse

248
Q

In performing an assessment on a patient with liver trauma, what is the nurse expect to find?

A

Positive kerhs sign
Guarding of the abdomen
Abdominal distention

249
Q

True or false

Liver cancer is most often seen in regions of Asia and the Mediterranean

A

True

250
Q

True or false

Risk factors for the development of liver cancer include use of anabolic steroids, androgens, or estrogens

A

True

251
Q

True or false

Alpha fetiprotein is a tumor market for cancers of the liver

A

True

252
Q

True or false

Chemotherapy is the treatment of choice for cancer of the liver

A

False selective internal radiation is the treatment of choice for cancer of the liver

253
Q

True or false

Liver transplantation maybe use for the patient with the primary liver tumor

A

True

254
Q

True or false

Patients with advanced cardiac disease are not considered candidates for liver transplantation

A

True

255
Q

True or false

The success of all transportation has greatly improved since the introduction of cyclosporine in immunosuppressive drugs

A

True

256
Q

True or false

Transplant rejection is treated aggressively with immunosuppressive medications

A

True

257
Q

True or false
Clinical manifestations of organ rejection may include tachycardia, fever, right upper quadrant or flank pain, decreased bile pigments volume, and increasing Johnese

A

True

258
Q

What is thyrotoxicosis?

A

The manifestations of hyperthyroidism.

259
Q

Negative feedback system of the brain in regards to hyper and hypothyroidism

A

The hypothalamus gets info from what is in the blood, if body needs more t4 or T3 is needed then sets out thyroid release of hormone to anterior pituitary. The pituitary then sets out a thyroid stimulating hormone which goes to the thyroid gland. It tells it to produce more or less of T4 or T3 depending on condition of body

260
Q

HIV and the immune response

A

HIV disrupts this process by directly infecting the helper T-cells. Your initial immune response does get rid of a great deal of HIV, but some of it manages to survive and infect these important cells. Once the infected helper T-cells are activated, they work to create new viruses instead of doing the job they are supposed to do in your immune system. In addition, many helper T-cells are destroyed in the HIV replication process.

261
Q

Normal T3 levels

A

Serum T3(Triiodothyronine):70-205 ng/dL or 1.2-3.4 SI unit

262
Q

Normal T4 levels

A

Serum T4 (Thyroxine): 4-12 mcg/dL or 51-254 SI units

263
Q

Normal TSH levels

A

TSH (Thyroid Stimulating Hormone): 0.3-5.0 uU/mL or

0.3-5.0 SI units

264
Q

What is anemia?

A 
Reduction in either the number of red blood cells, the amount of hemoglobin, or the hematocrit
Clinical sign (not a specific disease); a manifestation of several abnormal conditions
265
Q

What is sickle cell disease?

A

Genetic disorder resulting in chronic anemia, pain, disability, organ damage, increased risk for infection, and early death
Sickle cell disease state and sickle cell trait
Carrier will have one hemogobin A and one hemogobin S

266
Q

Sickle cell path

A

Main problem of the disorder is formation of abnormal hemoglobin chains
HBS: decreased oxygenation
Sickle cells are sticky and start clumping up together which causes a vasocclusive disorders
Hypoxia, anesthesia dehydration, venoustasis, alcohol ad drugs, high altitudes, temp changes all cause sickling

267
Q

Sickle cell manifestations

A

Cardiovascular: risk high-output HF,fatigue
Skin: pallor, cyanosis, jaundice, sores
Abdominal changes: spleen, liver enlarge
Renal and urinary: damaged nephrons
Musculoskeletal: necrotic degeneration;
reduced ROM; pain
CNS: seizures, stroke, gait, coordination

Psychosocial: Behavioral from hypoxia,
Lifestyle changes

268
Q

Sickle cell lab assessment

A

Hemoglobin S (HbS) SC trait-40% HbS;
SC disease 80-100%HbS
Number of RBCs with permanent sickling
SC trait-5-50%; SC disease 90%+
Hematocrit-low
Reticulocyte count-high
Total bilirubin-high
Total white blood cells-high
Imaging assessment-bone changes;
joint necrosis and destrucion

269
Q

What is the most common problem in sickle cell disease?

A

Pain is the most common problem:
Drug therapy—48 hours of IV analgesics;
avoid PRN and IM meds

270
Q

Number 1 treatment of sickle cell

A

IV solution at high rates because they are very suspectible to dehydrations: number #1 treatment
Then treat pain, morphine PCA
Crisis will decline after 5-7 days then morphine can go to PRN

271
Q

Sickle cell and sepsis

A

Highly suspectible to sepsis: practice infection control: educate

Drug therapy—prophylactic therapy (Pcn BID),
flu & pneumonia vaccine

272
Q

Sickle cell interventions

A

Hydration: hypotonic solution to flush those sickle cells and prevent clumping

Hydration, pain management and oxygenate (hydration is number one) ON TEST

273
Q

Preventing sickle cell crisis

A

Patient and family ed. Chart 42-3, p. 898
Drink 3-4 liters liquid daily
Avoid alcoholic beverages & tobacco
Call at first sign of illness or infection
Flu shot yearly & ask pneumonia vaccine
Avoid extremes of hot and cold
Wear sock & gloves on cold days
Avoid high altitudes (planes, Denver)
Tell health providers you have Sickle Cell
Avoid strenuous exercise; do mild exercise

274
Q

Glucose-6-Phosphate Dehydrogenase (G6PD) Deficiency Anemia

A

Most common type of inherited hemolytic anemia
Effect of exposure to some drugs, benzene and other toxins
Screening for this deficiency necessary before donating blood, because cells deficient in G6PD can be hazardous
Hydration
Osmotic diuretics
Transfusions

275
Q

Immunohemolytic Anemia

A

Immune system attacks person’s own RBC

Warm antibody anemia—IgG antibody+++

Cold antibody anemia—IbM 86 F (30 C)

Management—steriods, splenectomony, immunosuppressive therapy

276
Q

Iron Deficiency Anemia (Microcytic)

A

This common type of anemia can result from blood loss, poor intestinal absorption, or inadequate diet.
If mild—symptoms of weakness and pallor.
Evaluate adult patients for abnormal bleeding, especially from the GI tract.
Treatment—increasing oral intake of iron from food sources, oral iron supplements, or IM iron solutions.

2/3 of iron is contained in hgb, 1/3 in bone marrow

Spinach, kale, red meat high in iron (need to take iron supp with meals)

277
Q

Pernicious Anemia

A

Anemia resulting from failure to absorb vitamin B12 caused by a deficiency of intrinsic factor

Treatment:
Vit B 12 injections,
Cyanocobalamin (CaloMist)

278
Q

Aplastic Anemia

A

Deficiency of circulating RBCs because of failure of the bone marrow to produce these cells
Injury to the pluripotent stem cell
Pancytopenia common
Nursing: Assess bone marrow failure, poor oxygenation
Treatment:
Blood transfusions,Immunosuppressive therapy,Splenectomy

Anemia: decreased white blood cell and thrombocytopenia

Can get allogenic stem cell transplant

279
Q

Polycythemia Vera

A

Polycythemia vera is a chronic myeloproliferative disorder characterized by increased red blood cell mass (RCM), or erythrocytosis
The resultant hyperviscosity of the blood predisposes such patients to thrombosis

280
Q

Polycythemia Vera cont..

A

Disease with a sustained increase in blood Hgb levels to 18g; RBC count of 6million; or a Hct of 55% or greater
Patients may present with complaints of pruritus after bathing, burning pains in the distal extremities (erythromelalgia), gastrointestinal disturbances, or nonspecific complaints such as weakness, headaches, or dizziness.
Pruritus results from increased histamine levels released from increased basophils and mast cells and can be exacerbated by a warm bath or shower.
This occurs in up to 40% of patients.
Other patients are diagnosed after an incidental finding of an elevated hemoglobin and/or hematocrit level on a complete blood count.
Headache, dizziness, vertigo, tinnitus, visual disturbances, angina pectoris, or intermittent claudications

281
Q

Polycythemia Vera—Cancer of the RBCs

A 
Disease with a sustained increase in blood hemoglobin (18 g/dL)or hematocrit (55%+)
Massive production of red blood cells
Excessive leukocyte production
Excessive production of platelets
Blood poor O2, thick blood moves slow-HTN, vascular stasis-thrombosis
Treatment:
Phlebotomy
Hydration
Anticoagulants
282
Q

What is leukemia?

A

Cancer with uncontrolled production of immature white blood cell in bone marrow

Classified by cell type:
Lymphocytic or lymphoblastic
Myelocytic or myelogenous

283
Q

Etiology of leukemia

A

Etiology: basic is damage to genes controlling cell growth

284
Q

Myloid displatic syndrome (know)

A

The myelodysplastic syndromes (also known as MDS or myelodysplasia) are hematological (i.e., blood-related) medical conditions with ineffective production (or “dysplasia”) of all blood cells.[1]

Patients with MDS can develop severe anemia and require blood transfusions. In some cases, the disease worsens and the patient develops cytopenias (low blood counts) caused by progressive bone marrow failure.

The outlook in MDS depends on the type and severity. Many people live normal lifespans with MDS. Often, people are asymptomatic and are unaware they even have MDS until it shows up in a routine blood test.

285
Q

Key features of acute leukemia

A

Cardiovascular—heart rate inc.; B/P dec.
Respirations—dyspnea on exertion
Skin—pallor & cool result of reduced tissue perfusion. Petechiae.
Intestinal—bleeding gums, weight loss, nausea, anorexia, constipation
CNS-cranial nerve disturbance, headaches, papilledema, seizures, coma
Miscellaneous—bone & joint tender, lymph nodes enlarged, fatigue

286
Q

Leukemia lab values

A

Decreased hemoglobin and hematocrit levels
Low platelet count
Abnormal white blood cell count; may be low, normal, or elevated but is usually quite high
Bone marrow aspiration and biopsy
Blood-clotting times
Chromosome analysis
Imaging assessment

287
Q

Leukemia :major cause of death

A

Infection is a major cause of death and sepsis is a common complication (ON TEST)

288
Q

Chronic leukemia treatment

A

Chronic leukemia get bone marrow transplant and chemo

289
Q

Bone marrow transplant

A

Allogeneic : sibling or matched unrelated donor (stem cells from bone marrow or umbilical cord)

Autologous: self-donation (own stem cells before high-dose chemo therapy)

Syngeneic : patients’s HLA identical twin

290
Q

True or false

Less than 10,000 wbc doctors order transfusion

A

True

291
Q

What is hodgkins lymphoma

A

Cancer that starts in a single lymph node or a single chain of nodes
Marker—Reed-Sternberg cell
Large, painless lymph node, usually in the neck, spreads from one to next node in orderly fashion
Becomes painful when alcohol ingested; fever, drenching night sweats, and unexplained weight loss

292
Q

Hodgkins lymphoma interventions

A

One of the most treatable types of cancer

External radiation—Stage I and II

Chemotherapy—more extensive disease

Combination radiation and chemotherapy

Nursing: focuses on manage side effects (pancytopenia, N/V, skin, constipation, diarrhea, long term follow-up)

Chronic infection from h.pylori

293
Q

Non-hodgkins lymphoma

A

All lymphoid cancers that do not have the Reed-Sternberg cell

More than 12 types of non-Hodgkin’s lymphoma

Staging similar for Hodgkin’s lymphoma

Treatment varies
Nursing care similar to Hodgkin’s Lymph

294
Q

Multiple myeloma

A

White blood cell cancer that involves a more mature lymphocyte called a plasma cell—over growth of B-lymphocyte plasma cells in bone marrow overproduce anti-bodies. Result fewer RBC, WBC, platelets
Assessment: fatigue, anemia, bone pain, infections, fractures, renal dysfunction
Interventions: Chemo, Autologous stem cell transplant, Analgesics, Alternative pain

295
Q

Multiple myeloma lab values

A

CBC: blood counts all over the place

Decreased albumin increased calcium

296
Q

Medications that alter hematologic function

A

RBC: Erythropoetin stimulating agents: arensep, epogen, proctir
WBC: filgrastin,
Platlets: by transfusion

Don’t give ibuphron, nsaid, coumadin, heparin with low platletes

297
Q

What is hemophilia?

A

Hemophilla: hereitary bleeding disorder, clotting deficentcy

Hemophilia A: deficiency factor 8
Hemophilia B: christmas disease, deficiency factor of 9

Labs: prolonged PTT, normal PT
#1 problem degenerating joint function from chronic bleeding into joints (hips and knees)
298
Q

Acute chest syndrome :)

A

WHEN YOU ARRIVE at Nia Robinson’s room in response to the call bell, you find her in visible distress and complaining of chest pain and shortness of breath. Her vital signs are BP, 146/88 mm Hg; pulse, 104; temperature, 100o F (37.8o C); respirations, 30; and SpO2, 91% on room air.
Ms. Robinson, a 25-year-old African-American woman with a history of sickle-cell disease, was admitted to your unit earli- er today with a diagnosis of vaso-occlusive crisis. This is her second admission this month. She’s receiving I.V. fluids and morphine. On morning assessment, she was resting comfort- ably in bed and her vital signs were BP, 132/86 mm Hg; pulse, 78; temperature, 98.2o F (36.8o C); respirations, 20; and SpO2 of 98% on room air.
Suspecting acute chest syndrome (ACS), a potentially life- threatening complication of sickle-cell disease, you activate the rapid response team and administer supplemental oxy- gen at 2 L/minute via nasal cannula. After the rapid response team assesses Ms. Robinson and reviews her medical record,
42 | Nursing2009 | June
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a stat chest X-ray is ordered with arte- rial blood gas (ABG) analysis, com- plete blood cell (CBC) count, blood cultures, and chemistry panel.
Because it can lead to respiratory failure, ACS is the leading cause of death among patients with sickle-cell disease.1 Sickle-cell disease affects about 80,000 Americans

299
Q

What is vas occlusive crisis

A

In a vaso- occlusive crisis, low oxygen tension causes the abnormal red blood cells (RBCs) to lose their round, pliable shape and become deformed, rigid, and sickle-shaped. The abnormally shaped and inflexible sickled RBCs can adhere to each other and also to the vascular endothelium, compromis- ing circulation and leading to pain, edema, fever, tissue ischemia, and
infarction. A crisis can be triggered by exposure to cold, excessive physical exertion, late pregnancy, infection, dehydration, and emotional or mental stress. In some cases, the cause of the crisis is unknown.3

300
Q

Hyperthyroidism lab values

A

T3, T4 higher

TSH decreased

301
Q

Hypothyrodism lab values

A

T3, T4 lower

TSH increased

302
Q

Causes of hyperthyroidism

A

Graves disease;
Toxic multinodular goiter;
Excess thyroid replacement hormone

303
Q

Causes of hypothyroidism

A

Hashimoto thyroiditis;
Cretenism(Infant); iodine def
Excess hyperthyroid med (PTU);
Lithum inhibits thyroid hormone radiation; Pituitary or_hypothalamic disorder

304
Q

Symptoms of hyperthyroidism

A

Enlarged thyroid gland
VS: inc HR, inc B/P, inc temp, inc resp rate ; increased cardiac output; increased metabolism
Graves disease-exophtahlamos with lid lag; pretibial myxedema

305
Q

Symptoms of hypothyroidism

A

Myxedema features( non-pitting edema –eyes, hands, feet, tongue thick, husky deep voice)
Impaired growth in child
Depression; tired; fatigue; cold
Libido dec; infertility; impotence

306
Q

Blood cholesterol levels in hyperthyrodism

A

Decreased

307
Q

Blood cholesterol levels in hyporthyrodism

A

Increased

308
Q

Treatments of hyperthyroidism

A

Radioactive Iodine; surgery____
Anti-thyroid: (Tapazole) methi-mazole,(PTU)prophylthiouracil ;
Beta blockers to ↓ HR ; Iodine_
↑ calories, proteins, carbs___

309
Q

Treatments of hypothyroidism

A

Levothyroxin; Synthroid (for life)

310
Q

Hyperparathyroid lab values

A

Calcium high

Phosphate low

311
Q

Hypoparathyroid

A

Calcium low

Phosphate high

312
Q

Causes of hyperparathyroid

A

Parathyroid adenoma or carcinoma; neck trauma; radiation; Vit D deficiency;
Benign tumor in one gland

313
Q

Causes of hypoparathyroid

A

Iatrogenic: removal of all parathyroid with thyroidectomy or intentional surgically removal
Idiopathic :autoimmune
Hypomagnesemia as in alcoholics & pt w malabsorption, chronic kidney & malnutrition causes ↓ PTH secretion

314
Q

General features hyperparathyroid

A

↑PTH act on kidney causing ↑kidney reabsorption of Ca++ & excretion of PO4;
Reduced bone density as ↑PTH =↓osteoblastic &↑ osteoclastic
production=osteoporosis,fractures
↑PTH=renal calculi & deposits of Ca++ in soft tissue of kidney
GI=N/V, epigastric pain; fatigue;
Ca++ >12 mg/dL psychosis, confusion, coma, death

315
Q

General features hypoparathyroid

A

Tingling & numbness mouth & hand.
Trousseau’s sign (BP cuff 3 min)= flexion at wrist
Chvostak’ sign (touch cheek)=ipsilateral (same side) facial contraction
Muscle cramps hand, feet, seizures; Mental changes; bands or pits encircle teeth

316
Q

Treatment for hyperparathyroidism

A

Hydration with IV saline;
diuretics (Lasix);
Surgery-parathyroidectomy (support neck to elevate head, observe resp distress, ER trach kit, ck serum Ca++ immed after surgery & q 4 hr; ck Trousseas’s & Chvostek’s signs);
Prevent fractures; fall prevention, use of lift sheets; ck cardiac; I&O;

317
Q

Treatment for hypoparathyroidism

A

IV 10% Calcium Chloride or Calcium gluconate for acute & severe ↓Ca++.
IV calcitriol for acute Vit D def
IV 50% Magnesium sulfate for
hypomagnesemia

318
Q

Diet changes in hypoparathryodism

A

High calcium, but avoid dairy as dairy has phosphates

319
Q

Medications for hyperparathyrodism

A

Lasix to↑ kidney excretion ofCa++
Calcitonin ↓ release if skeletal Ca++ & ↑ kidney excretion if Ca++
Calcium chelators bind Ca++ reducing free Ca++: Mithramycin, Penicillamine (Cuprimine, Pendramine)

320
Q

Medications for hypoparathyrodism

A 
Vitamin D (Ergocalciferol) &
Calcium long term
321
Q

What are the top 3 most common causes of cirrhosis?

A
  1. Hep C
  2. Alcoholism
  3. Biliary obstruction
322
Q

What is portal hypertension?

A

It’s when the backup of blood flow causes increased pressure on the portal veins, this leads to ascites which then leads to bleeding esophageal varices because the veins of been dilated and stretch causing them to thin which means they can burst or develop holes lead into bleeding

323
Q

Clinical manifestations of late stage cirrhosis

A 
Jaundice 
Dry skin
Petechiae 
Spider Angie's
Warm red palms
324
Q

What is fector hepaticus

A

Fruity bad breath

325
Q

What are two signs of hypocalcemia ?

A
  1. Chvostek sign

2. Trousseaus sign

326
Q

What is chvosteks sign

A

Elicit action: Tapping on the face at a point just anterior to the ear and just below the zygomatic bone

Positive response: twitching of the ipsilateral facial muscles, suggestive of neuromuscular excitability caused by hypocalcemia

327
Q

What is trousseaus sign?

A

Elicitation: inflating a blood pressure cuff above systolic blood pressure for several minutes

Positive response: muscular contraction including flexion of the wrist and marred metacarpal joints, hyper extension of the fingers and flexion of the thumb of the palm, suggestive of neuromuscular excitability caused by hypocalcemia

328
Q

What is ast test?

A

Aspartate aminotransferase test measures the amount of this enzyme in the blood. Low levels of AST are normally found in the blood. One body tissue organ organ such as the heart or liver is the third damage additional AST is released into the bloodstream. The higher the AST the higher the damage

329
Q

Normal ast levels

A
  1. 14-20 u/l (0.23-0.33) males

2. 10-36 u/l ( 0.17-0.60)

330
Q

What is the alt test?

A

The alanine aminotransferase rest is used to detect liver injury. Hi levels of AL T mean that there is injury somewhere. Normal range between 7-56

331
Q

Hepatic renal syndrome

A

Ammonia, creatine, Billy Ruben are all going to be elevated

332
Q

What type of fluids do you give before a paracentesis

A

You give albumin and IV fluids before and after a paracentesis

333
Q

What kind of medication do you give for your cirrhosis patient with a diagnosis of excess fluid volume

A

Give diuretics, potassium sparing diuretics AKA spironolactone or furosemide

334
Q

What is the normal amount of fluid to be drained from a pleurex

A

A pleurex drain to be placed to remove excess fluid, normal amount drained is 4 liters

335
Q

Potential for hemorrhage

A
  1. Screen for esophageal varies
  2. Drug therapy: nonselective beta blocker to decrease heart rate/pressure gradient

Selective beta blocker the agent is propanol, you don’t want to use atenolol or Metropolol

GI bleed: put on antibiotic
Bacterial med: sipro, floxacin, cephtiaxon

336
Q

Management of hemorrhage

A

Make sure the patient is sitting up for balloon tamponade, suction and watch for aspiration

337
Q

What is terlipressin?

A

It is used as a vasoactive drug in the management of low blood pressure. It has been found to be effective when norepinephrine does not help. Indications for use include hepatic renal syndrome and esophageal varices.

338
Q

Octrotide and somatostatin

A

Octreotide: decreases portal venous outflow
Somatostatin: it inhibits the secretions of growth hormone, insulin and gastrin

339
Q

Drug therapy for portal systemic encephalopathy

A

1: Lactulose
2: neomycin sulfate
3. Metronidazole

340
Q

Asterisk

A

Shivering hands

341
Q

Neomycin

A

Antibiotic

342
Q

Long term drug therapy for portal systemic encephalopathy

A

Rifaximim

343
Q

What is hepatitis?

A

Inflammation of the liver

344
Q

What is the leading indicator for a liver transplant in the US?

A

Hepatitis C most transplanted livers become reinfected

345
Q

What hepatitis has a vaccine for?

A

There is a vaccine for hepatitis B

Energix-B and recombivax HB

346
Q

True or false acetaminophen is very bad to take if you have liver damage

A

True

347
Q

Carrier of sickle cell disease

A

Carrier will have one hemoglobin a and one hemoglobin S

348
Q

Sickle cell disease

A

HBS: decreased oxygenation
Sickle cells are sticky and start clumping up together which causes a vasocclusive disorders
Hypoxia, anesthesia dehydration, venoustasis, alcohol ad drugs, high altitudes, temp changes all cause sickling

349
Q

Sickle cell interventions

A

Highly suspectible to sepsis: practice infection control: educate
Interventions include:
Prevention of infection–strict asepsis

Early detection strategies—assess, monitor CBC, WBC, inspect mouth, lungs sounds, vs, urine color

Drug therapy—prophylactic therapy (Pcn BID),
flu & pneumonia vaccine

350
Q

Sickle cell cont

A

Hydration: hypotonic solution to flush those sickle cells and prevent clumping

Hydration, pain management and oxygenate (hydration is number one) ON TEST

351
Q

Iron deficiency

A

Sentences and phrases
2/3 of iron is contained in hgb, 1/3 in bone marrow

Spinach, kale, red meat high in iron (need to take iron supp with meals)

352
Q

Vitamin B12 defciency

A

Lack of vitamin B12 causes improper DNA synthesis of RBCs.

Poor intake of foods containing vitamin B12 —vegetarian diet or lack dairy
.
Tx: Foods-animal protein, eggs, dairy

Symptoms: Pallor ,jaundice, fatigue, weight loss, glossitis

353
Q

Calcintonin, phosphorus, vit D

A 
Calcitonin:
Released from thyroid in response to high levels of serum calcium
Inhibits release of calcium from bone
Phosphorus:
Inversely related to calcium
Increases as Ca+ decreases
Vitamin D:
Promotes calcium absorption through the intestines, Ca+ resorption from the bone, and kidney reabsorption of Ca+
354
Q

Aplastic anemia

A

Deficiency of circulating RBCs because of failure of the bone marrow to produce these cells
Injury to the pluripotent stem cell
Pancytopenia common
Nursing: Assess bone marrow failure, poor oxygenation
Treatment:
Blood transfusions,Immunosuppressive therapy,Splenectomy

Anemia: decreased white blood cell and thrombocytopenia

Can get allogenic stem cell transplant

355
Q

What is Polycythemia vera?

A

Polycythemia vera is a chronic myeloproliferative disorder characterized by increased red blood cell mass (RCM), or erythrocytosis
The resultant hyperviscosity of the blood predisposes such patients to thrombosis

356
Q

Polycythemia vera

A

Polycythemia vera is a chronic myeloproliferative disorder characterized by increased red blood cell mass (RCM), or erythrocytosis
The resultant hyperviscosity of the blood predisposes such patients to thrombosis

Disease with a sustained increase in blood Hgb levels to 18g; RBC count of 6million; or a Hct of 55% or greater
Patients may present with complaints of pruritus after bathing, burning pains in the distal extremities (erythromelalgia), gastrointestinal disturbances, or nonspecific complaints such as weakness, headaches, or dizziness.
Pruritus results from increased histamine levels released from increased basophils and mast cells and can be exacerbated by a warm bath or shower.
This occurs in up to 40% of patients.
Other patients are diagnosed after an incidental finding of an elevated hemoglobin and/or hematocrit level on a complete blood count.
Headache, dizziness, vertigo, tinnitus, visual disturbances, angina pectoris, or intermittent claudications
Complications
Shorter life span of cells causes rapid turnover and increases amount of cellular debris in the blood, increases ‘sludginess’, venous stasis, blood vessel occlusion
Hyperkalemia
Uric acid
Interdisciplinary care
Repeated phlebotomy
Patients with hematocrit values of less than 70% may be bled twice a week to reduce the hematocrit to the range of 40%.
Patients with severe plethora who have altered mentation or associated vascular compromise can be bled more vigorously, with daily removal of 500 mL of whole blood
Elderly patients with some cardiovascular compromise or cerebral vascular complications should have the volume replaced with saline solution after each procedure to avoid postural hypotension
Patients treated with phlebotomy alone benefit from low rates of malignancy but experience more thrombosis events during the first few years of treatment.
Patients treated with myelosuppressive agents and supplemental phlebotomy avoid this early thrombotic risk but in turn have significant rates of malignant transformation after about six years of therapy

357
Q

Polycethmia vera labs

A

Disease with a sustained increase in blood hemoglobin (18 g/dL)or hematocrit (55%+

358
Q

Leukemia and death

A

Infection is a major cause of death & sepsis is a common complication

359
Q

Mulitple myeloma labs

A

Decreased albumin increased calcium

360
Q

Hematology meds

A

RBC: Erythropoetin stimulating agents: arensep, epogen, proctir
WBC: filgrastin,
Platlets: by transfusion

Don’t give ibuphron, nsaid, coumadin, heparin with low platletes

361
Q

Hemophillia

A

Hemophilla: hereitary bleeding disorder, clotting deficentcy

Hemophilia A: deficiency factor 8
Hemophilia B: christmas disease, deficiency factor of 9

Labs: prolonged PTT, normal PT
#1 problem degenerating joint function from chronic bleeding into joints (hips and knees)
362
Q

Serum T4 (Thyroxine) lab values

A

4-12 mcg/dL or 51-254 SI units

363
Q

TSH (Thyroid Stimulating Hormone) lab values

A
  1. 3-5.0 uU/mL or

0. 3-5.0 SI units

364
Q

Thyroid regulation

A

Negative feedback system
Hypothalamus secretesThyrotropin Releasing Hormone (TRH)
Anterior pituitary secretes Thyroid Stimulating Hormone (TSH)
Thyroid gland secretes T3, T4
T3,T4 blood level relates need back to hypothalamus to ↑ or ↓ TRH

365
Q

Hormones of the thyroid

A

Tyrosine + Iodine = thyroid hormone
T4 - Thyroxine (normal 4-12 mcg/dL)
80-90% of thyroid hormone; weaker than T3
T3 – Triiodothyronine (normal 70-205 ng/dL)
10-20% of thyroid hormone; stronger and more biologically active than T4
Function: Control cellular metabolic activity and the rate at which cells “do business”
TSH –Thyroid Stimulating Hormone
(normal levels in adult 0.4 to 4.5 miu/L)

366
Q

Hyperthyrodism

A

Thyroid hormones affect metabolism in all body organs
“Hypermetabolism and increased sympathetic nervous system activity

Negative nitrogen balance from increased protein synthesis and degradation
Catabolism overtakes anabolism
Cellular resistance to glucose → hyperglycemia
Increased fat metabolism
Increased appetite
Weight loss
Chronic nutritional deficiency

367
Q

Causes of hyperthyroidism

A

Graves Disease
Most common & also called “toxic diffuse goiter
Autoimmune condition
Often associated with a family history
Onset of symptoms is gradual—exophthalmos, pretibial myxedema, goiter
Toxic Multi-nodular goiter
Milder symptoms than Graves Disease; no exophthalmos & pretibial myxedema
Exogenous Hyperthyroidsim
Excessive use of thyroid replacement hormones

368
Q

Lab values in hyperthyroidism

A

Decreased TSH levels(normal 0.4-4.5 miu/L)
Increased T3 levels (normal 70-205 ng/dL)
Increased T4 levels (normal 4-12 mcg/dL)
Thyroid scan–Measure RAI uptake
Ultrasonography
Electrocardiogram (EKG)
Tachy
A-fib, dysrhythmias
Changes in P & T waves

369
Q

Thyroid storm

A 
Thyroid Storm – excessive thyroid hormone release
Life-threatening
Manifestations develop quickly
Dramatic increase in metabolic rate
Fever
Tachycardia
Systolic hypertension
GI manifestations
Abd pain
n/v
Diarrhea
Anxiousness
Tremors
Increased restlessness
Confusion
Psychosis
Seizure
Coma
Mortality rate of 25%
Maintain airway patency
Provide adequate ventilation
Reduce fever
Stabilize BP
370
Q

THyroid storm cont..

A

Severe hyperthyroidism – abrupt onset
Extremely high fever, extreme tachycardia, altered mental state, elevated SBP
Life threatening – fatal if untreated
Usually precipitated by a stressor
Treatment: decrease temp and heart rate
NO ASPIRIN!!! ASA has greater affinity to thyroid binding sites and will worsen hyperthyroidism

371
Q

Hypothyroidsm

A 
Definition:  Lack of sufficient thyroid hormone
Types:
Primary Hypothyroidism:  due to a problem with the thyroid itself
Decreased thyroid tissue
Decreased thyroid hormone
Secondary– due to pituitary disorder
Tumor, infection, infarct
Hypothalamic defects
372
Q

Myxedema coma

A

Low metabolic rate affects tissues & organs
Metabolites glycosaminaoglycans (proteins & sugars) build inside of cell>increase mucus & water >cellular edema>changes in organ texture
Non-pitting edema forms everywhere
Physiologic function decreased
Myxedema coma—life threatening

373
Q

Mydexema cont..

A 
Most extreme stage of hypothyroidism
Precipitated by a “trigger event”
Rare but often fatal
Seizures, hypothermia, bradycardia
Treatment:
Maintain airway
Fluids
IV hormone replacement
Frequent VS & hourly temp checks
Myxedema coma
High mortality rate
Decreased metabolism causes heart muscle to become flabby
Decreased cardiac output
Decreased perfusion to brain and all vital organs
Worsens the already slowed cellular metabolism, leads to tissue and organ failure
“Trigger Events”
Acute illness
Hypothermia
Untreated hypothyroidism
Surgery
Sedatives/sedation
374
Q

Lab values in hypothyroidism

A

Elevated TSH (will be low only in secondary hypothyroidism)
Low T3 and T4
Diagnosis is based almost solely on measuring the circulating thyroid hormone in the blood

375
Q

Thyroditis

A 
Acute:  Bacterial infection
Subacute: Viral infection
Chronic:  Hashimoto’s Disease
Autoimmune disorder--thyroid destroyed
Triggered by bacterial or viral infection
Thyroid hormones low; TSH increased
Thyroid hormone replacement
376
Q

Ca++ (serum calcium): lab values

A

Ca++ (serum calcium): 8.2 (9.0) to 10.2 (10.5) mg/dL or 2.25-2.75 SI units

377
Q

PO4 (serum phosphate): lab values

A

PO4 (serum phosphate): 2.5 (3.0) to 4.5 mg/dL or 0.97 to1.45 SI units

378
Q

Serum parathyroid hormone lab values

A

Serum parathyroid hormone: C-terminal 50-330 pg/mL

379
Q

Parathyroid gland

A 
Parathyroid Hormone (PTH)
 Hormone that regulates
  calcium and phosphorus
  metabolism
Negative feedback  system regulates its’ release
Draws Ca+ from bones, increases absorption from kidneys and intestines
Increases phosphate excretion through
kidneys
380
Q

Calcintonin, phosphorus, vit D

A 
Calcitonin:
Released from thyroid in response to high levels of serum calcium
Inhibits release of calcium from bone
Phosphorus:
Inversely related to calcium
Increases as Ca+ decreases
Vitamin D:
Promotes calcium absorption through the intestines, Ca+ resorption from the bone, and kidney reabsorption of Ca+
381
Q

Causes of hypercalcemia

A 
Causes:
Hyperparathyroidism - most common 
Benign tumor in one gland
Cancer – second most common cause
Multiple fractures or prolonged immobilization
Hypophosphatemia
Abuse of certain medications
Antacids with Ca+, excessive Vit D, lithium, thiazide diuretics
382
Q

Hyperparathyroidsm

A

Parathyroid hormone (PTH) acts on kidney & increases kidney reabsorption of calcium and increases phosphate excretion.

Result: Hypercalcemia (serum Ca+ above 10.5 mg/dL )
Hypophosphatemia (serum PO4 below 3.0 mg/dL)

          High PTH increases bone resorption (loss of calcium from bone) by decreasing osteoblastic (build up) activity and increasing osteoclastic (bone destruction) activity== reduction of bone density, hypercalcemia and calcium deposits in tissue
383
Q

Labs of hyperparathyroidism

A

Elevated PTH (normal C-terminal 50-330 pg/ml)
Elevated serum calcium (normal 9.0-10.5 mg/dL)
Decreased serum phosphate (normal 4.64- 5.28 mg/dL)
X-rays
Calcium deposits; Bone lesions; fractures
CT scan
Kidney stones

384
Q

Hypercalcemia

A

Wait for atrophied glands to resume function
Be alert for hypocalcemic crisis
Monitor calcium levels immediately following surgery & q4h
Trousseau’s
Palmar flexion spasm
Chvostek’s
Tap facial nerve to elicit facial twitching of one side of mouth, nose, cheek

385
Q

Signs of hypocalcemia

A 
Tetany - most characteristic finding
Anxiety, irritability, confusion, delirium
Decreased cardiac output, hypotension
Muscle cramps in extremities
Tingling of fingers/toes or around mouth
Fractures
Bands or pits around teeth
Positive Chvostek’s (touch cheek) and Trousseau’s sign ( BP cuff  inflate 1-4 min)

Nurs. 401 (15 decks)

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