Exam 1 Flashcards

Question

Hodgkins lymphoma

Answer 1

``` painless, firm, enlarged lymph node, Reed-Sternberg cells present Anemia & altered WBC count Pruritus Frequent viral infections Rare High cure rate More common in men Fever Weightless Night sweats Chemo, radiation Stem cell for advanced disease Can start with a single lymph node and then develop other places Cad, dysrhythmia, cardiomyopathy seen in later stages ``` Educate about secondary malignancy- stop smoking, drinking, check breast, yearly skin check young adulthood and >55 most patients have a good prognosis

Answer 2

A malignant disease of the plasma cells Most common symptom is bone pain Most common areas- Back & ribs Increased with movement and decreased with rest No cure; treatment depends on age and includes: corticosteroids chemotherapy PAIN medication is the most important Plasma & pain Bone damage – pelvic, rib cage (prevent falls) Blood issues – anemia, clotting problem, infection Kidney problems – decreased kidney function, monitor UO, blood workhypercalcemia ``` management Pain Management NSAIDS and possible opioids monitor renal function (NSAIDS) Education of activity restrictions Education of manifestations of hypercalcemia Maintain mobility Hydration- to prevent hypercalcemia Infection prevention- Wear a mask Hand hygiene ```

Answer 3

Destruction of pancreatic beta cells Decreased insulin production, Increased glucose production by liver Fasting hyperglycemia Glucose derived from food cannot be stored in liver but instead remains in bloodstream = post-parandial (after meals) hyperglycemia

Answer 4

Insulin resistance = decreased tissue sensitivity to insulin Intracellular reactions are diminished – making insulin less effective at stimulating glucose uptake by the tissue Impaired insulin secretion Usually a slow progression and can go undetected for many years

Answer 5

1. Hyperglycemia: There is no insulin, so no glucose entering the cells, All the glucose is in the bloodstream , And production and release of glucose by the liver is increased 2. Dehydration and electrolyte loss: The kidneys attempt to rid the body of the excess glucose , Glucose – along with water and electrolytes – are excreted 3. Metabolic acidosis: Breakdown of fat (lipolysis) to free fatty acids and glycerol occur  The free fatty acids are then converted into ketone bodies by the liver  Ketone bodies accumulate leading to metabolic acidosis occurs with type 1 diabetes ``` clinical manifestations Clinical Manifestations Polyuria Polydipsia Marked fatigue Blurred vision Weakness Headache Orthostatic hypotension GI symptoms (nausea, vomiting, abdominal pain) Acetone breath (fruity odor) Hyperventilation w/ very deep (not labored) respirations - Kussmaul Mental status changes ``` Assessment and Diagnostic Findings High blood glucose (300-800 mg/dL) Low serum bicarbonate (0-15 mEq/L) Low serum pH (6.8-7.3) Presence of ketone bodies in blood and urine Depending on amount of water loss: Sodium and Potassium may be low, normal, or high Creatinine, BUN, and hematocrit may be high Decreased or missed dose of insulin Illness or infection Undiagnosed/untreated diabetes Management Rehydration: (Fluid loss from polyuria, hyperventilation, diarrhea, and vomiting) GIVE IV FLUIDS!!! May need as much as 6-10 L Start with NS at rapid rate – 0.5-1L per hour for 2-3 hours Then ½NS for continued rehydration for several more hours When blood glucose reaches 300 or less – switch to D5W to prevent decline in blood glucose level MONITOR FLUID VOLUME STATUS!!! Frequent vital signs Lung assessments Monitoring intake and output Monitor for signs/symptoms of fluid overload Restoring Electrolytes: IV potassium slowly POTASSIUM REPLACEMENT!!!! As much as 40 mEq/hour may be needed for several hours to avoid dysrhythmias that occur with hypokalemia Frequent ECG and lab monitoring Reversing Acidosis GIVE INSULIN!!!! IV Regular insulin is given at a slow, continuous rate Hourly blood glucose measurements Blood glucose levels are usually corrected before acidosis is corrected  IV insulin may be continued for 12-24 H until serum bicarbonate levels increase to at least 15-18 mEq/L SICK DAY RULES Never eliminate insulin doses when nausea and vomiting Take insulin dose and then attempt to consume frequent small portions of carbs Drink fluids every hour to prevent dehydration Assess blood glucose and urine ketones every 3-4 hours If patient cannot take fluids without vomiting, or if elevated glucose or ketone levels persist – call provider! Monitoring and Managing Potential Complications Fluid Overload Hypokalemia Cerebral Edema

Answer 6

1. Hyperglycemia: Lack of effective insulin to prevent hyperglycemia , but enough insulin is present to prevent the breakdown of fat , So no ketosis and acidosis occur 2. Hyperosmolarity: Persistent hyperglycemia causes osmotic diuresis , results in loss of water and electrolytes ``` Clinical Manifestations Hypotension Dehydration Tachycardia Variable neurologic signs ``` Assessment and Diagnostic Findings High blood glucose (600-1200 mg/dL) Osmolality (>320 mOsm/kg) High BUN and Creatinine Causes Infection or acute illness Medications that exacerbate hyperglycemia Treatments such as dialysis Management Rehydration Restoring Electrolytes Insulin Administration Rehydration Very similar to management in DKA Restoring Electrolytes Very similar to management in DKA Insulin Administration Less of important role because not needed for reversal of acidosis Insulin is given at a continuous low rate Monitoring and Managing Potential Complications Fluid Overload Hypokalemia Cerebral Edema

Answer 7

DKA More common Type 1 Rapid onset (<24 H) Blood Glucose >250 Arterial pH Level < 7.3 Serum and urine ketones present Serum osmolality 300-350 mOsm/L Plasma bicarbonate level <15 mEq/L BUN and creatinine elevated HHS More common in Type 2 Slower onset (over several days) Blood Glucose > 600 Arterial pH Level is normal Serum and urine ketones absent Serum osmolality >350 mOsm/L Plasma bicarbonate level is normal BUN and creatinine elevated

Answer 8

``` Macrovascular Complications Results from changes in the medium-large blood vessels Coronary artery disease Myocardial infarction Cerebrovascular disease Transient ischemic attacks Strokes Peripheral vascular disease Occlusive peripheral arterial disease Prevention and treatment of atherosclerosis Nutrition therapy and exercise to manage obesity, HTN, HLD Medications to control HTN and HLD Smoking cessation Control of blood glucose levels MORE COMMON IN TYPE 2 ``` Microvascular Complications Results from changes in the capillary basement membrane (thickening) Diabetic Retinopathy Nephropathy ``` Routine eye exams Annual urine analysis for albumin Annual serum creatinine and BUN Control of HTN Prevention/Treatment of UTIs Avoidance of nephrotoxic Rx and contrast dye Low-sodium and Low-protein diet Smoking cessation Control of blood glucose levels MORE COMMON IN TYPE 1 ``` ``` Diabetic Neuropathies Results from changes in the nerves Peripheral Neuropathy Distal portion of the nerves, especially in lower extremities, affects both sides symmetrically Autonomic Neuropathy Broad range of dysfunction affecting almost every organ system COMMON IN BOTH TYPES parathesia burning decreased sensation of light touch decrease proprioception decrease pain & temperature Intensive insulin therapy FALL PRECAUTIONS! Pharmacologic treatment Foot checks and care ``` AUTONOMIC NEUROPATHY Ranges from tachycardia, orthostatic hypotension, to MI Urinary retention, decreased sensation of bladder fullness, neurogenic bladder Delayed gastric emptying “diabetic gastroparesis”, bloating, N/V, constipation or diarrhea Discontinue meds that interfere with autonomic nervous system responses Use sympathomeimetic meds that stimulate an autonomic response Low-fat diet, frequent small meals Use meds that increase gastric motility Frequent glucose monitoring Meds to help treat constipation/diarrhea Intermittent straight caths Foot and Leg Problems and Infections Results from neuropathy, peripheral vascular disease, and immunocompromised Neuropathy = loss of pain and pressure sensation PVD = poor circulation contributes to poor wound healing Immunocompromise = lowers resistance to infections FOOT CARE!!!! Inspect feet daily Do not allow moisture to accumulate between toes Wear closed-toed shoes that fit well Trim toenails frequently Protect feet from hot/cold Keep blood flowing to feet DO NOT – walk barefoot, use heating pads, wear open-toed shoes, soak the feet, shave calluses

Answer 9

Blood glucose levels tend to increase due to stress Management of glucose control very important during perioperative period Frequent blood glucose monitoring May need to use IV insulin Monitor closely post-operative for cardiovascular complications, wound infections, and skin breakdown change in diets NPO Usual dosage of rapid or intermediate acting insulin must be changed Continue to give basal dose insulin Frequent blood glucose monitoring Clear Liquids A lot of clear liquids contain simple carbohydrates – try to use diet types Glucose tests and insulin administration should match mealtimes Enteral Tube Feeding Often results in increased levels of glucose If continuous tube feeding, regularly scheduled intervals of insulin given Must be cautious if tube feeding is temporarily discontinued or paused HYPERGLYCEMIA DURING HOSPITALIZATION Reasons: Changes in usual treatment regimen New medications introduced or routine medications changed Use of IV dextrose in fluids Overly vigorous treatments for hypoglycemia Inappropriate withholding of insulin Inappropriate use of “sliding scales” Mismatched timing of meals and insulin NURSING INTERVENTIONS Nursing Interventions: Assess patient’s usual home routine and try to mimic Monitor blood glucose levels Test blood glucose before a meal served and administer insulin at that time Use NS as much as possible, and not IV fluids with dextrose Avoid overly vigorous treatment of hypoglycemia HYPOGLYCEMIA DURING HOSPITALIZATION Reasons: Overuse of “sliding scale” insulin Not changing insulin dosage when dietary intake is decreased Overly vigorous treatment of hyperglycemia Delayed meal after administration of insulin NURSING INTERVENTIONS Nursing Interventions: Follow hospital protocol Assess patient’s pattern of glucose levels Avoid giving doses of insulin repeatedly Arrange for snacks to be giving if meals are going to be delayed

Answer 10

high osmolality > High concentration of particles Low concentration of water > high adh > KIDNEYS KEEP WATER URINE MORE CONCENTRATED low osmolality > Low concentration of particles High concentration of water > low adh > KIDNEYS EXCRETE WATER URINE LESS CONCENTRATED 1.005-1.030- normal specific gravity Urine Osmolality 100-900

Answer 11

DEFICIENCY OF ADH ``` CAUSES Head Trauma Brain Tumor Surgical/Irradiation of pituitary gland Infections of CNS Failure of renal tubules to respond to ADH ``` Diagnosis: Urine specific gravity Urine osmolality Fluid deprivation test Treatment: Replace ADH Desmopressin (DDAVP) – synthetic vasopressin, intranasally once to twice daily Ensure adequate fluid replacement Identify and correct underlying pathology ``` LARGE VOLUMES OF DILUTE URINE: Greater than 250 mL per hour Low urine specific gravity(1.001-1.005) POLYDIPSIA: Intense thirst Drinking 2-20 L daily Craves cold water ``` OSMOLALITY <100 for DI DRY INSIDE

Answer 12

EXCESS OF ADH ``` Causes: Non-endocrine origin Disorders of the lungs (pneumonia, pneumothorax) Head injury Brain surgery/tumor CNS infection Some medications ``` ``` Treatment: Identify and correct underlying pathology Restrict fluid intake Use of hypertonic IV solution Diuretics may be used ``` CANNOT EXCRETE A DILUTE URINE: Urine is very concentrated Elevated urine specific gravity RETAIN FLUIDS Euvolemic No edema present ``` DILUTIONAL HYPONATREMIA Nausea Vomiting Headache Weakness Fatigue Confusion ``` Sticky and stinky pee Not going to see edema, see body holding water in intravascular space- hypertension Watch for seizures – seizure precautions SIADH- soaked inside 3% NS

Answer 13

``` DI low ADH, low water in body High UO, polyuria high sodium high h&h and serum osmolality from dehydration risk: hypovolemic shock tx: DDVAP (ADH) ``` ``` SIADH high ADH, water intoxication low UO, oliguria low sodium (dilution) weight gain risk: seizures tx: hypertonic saline ```

Answer 14

drink plenty of fluids when exercising or in hot weather obtain early medical attention with illness or trauma and with any evidence of dehydration or bleeding educate about manifestations of dehydration, including thirst, decreased UO, and dizziness ``` chest pain lethargy somnolence restlessness anxiety dyspnea diaphoresis thirst muscle weakness nausea constipation ```

Answer 15

educate about ways to reduce the risk of a MI, such as exercise, diet, stress, reduction, and smoking cessation ``` chest pain lethargy somnolence restlessness anxiety dyspnea diaphoresis thirst muscle weakness nausea constipation ```

Answer 16

hgb: men: 13.5 to 17.5 women: 12.0 to 15.5 hct: men: 41% to 50% women: 36% to 48%

Exam 1 Flashcards

(40 cards)