Exam 3 Flashcards
(112 cards)
1
Q
Diabetes Mellitus definition
A
A chronic multisystem disease related to: Abnormal insulin production and or impaired insulin utilization, Leading cause of End-stage renal disease Adult blindness and Non-traumatic lower limb amputations
2
Q
Symptoms of type one diabetes
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Classic symptoms:Polyuria (frequent urination) Polydipsia (excessive thirst) Polyphagia (excessive hunger)
Also:Weight loss Weakness Fatigue
3
Q
Symptoms and signs of type two diabetes
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Increased frequency of infections, Blurred vision, Cuts and bruises slow to heal, Tingling or numbness in hands and feet, Recurring infections of gums, skin, and bladder, Erectile dysfunction
4
Q
pre-diabetes is a fast glucose of
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100-125
5
Q
diabetes diagnosing test
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Fasting plasma glucose level >126 mg/dl (Normal is 70-110)
Random or casual plasma glucose measurement ≥200 mg/dl plus symptoms
Two-hour OGTT level ≥200 mg/dl using a glucose load of 75 g
Hemoglobin A1c
6
Q
Hemoglobin A1c
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Also known as glycosylated hemoglobin test, Shows the amount of glucose attached to hemoglobin molecules over RBC life span, Regular assessments required, Ideal goal <6.5%, Normal A1C reduces risk of retinopathy, nephropathy, and neuropathy
7
Q
Carbohydrates
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recommends carbohydrates and monounsaturated fats should provide 45% to 65% of total caloric intake
8
Q
Fats
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Polyunsaturated fats should make up approximately 10% of caloric intake.
9
Q
Proteins
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15-20% of total caloric intake
10
Q
Alcohol
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High in calories, no nutritive value, detrimental effects on liver, Can cause severe hypoglycemia because of decreased gluconeogenesis, Light beer or dry, white wine are the recommended alcoholic drinks
11
Q
Exercise with diabetes
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Several small carbohydrate snacks can be taken every 30 minutes during exercise to prevent hypoglycemia, best done after meals, should be started
After medical clearance, Slowly with gradual progression Monitor blood glucose levels before, during, and after exercise
↑ Insulin receptor sites, lowers blood glucose levels and contributes to weight loss
12
Q
If the patient cannot eat after surgery
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IV dextrose will be given along with regular insulin given subcu every 6 hours
13
Q
Hypoglycemia
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Low blood glucose
Occurs when Too much insulin in proportion to glucose in the blood, Blood glucose level less than 70 mg/dl, Kusmal RR
14
Q
Treatment of hypoglycemia if pt is alert and can swallow
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If alert enough to swallow: 15 to 20 g of a simple (fast acting)4 to 6 oz. fruit juice, Regular soft drink8 oz., skim milk, Icing
Avoid foods with fat=Decrease absorption of sugar
Recheck blood sugar 15 minutes after treatment
Patient should eat regularly scheduled meal/snack to prevent rebound hypoglycemia
Check blood sugar again 45 minutes after treatment
15
Q
treatment of hypoglycemia if not alert or cant swallow
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If no improvement after 2 or 3 doses of simple carbohydrate or patient not alert enough to swallow, Administer 1 mg of glucagon (will vomit) IM or subcutaneously, Have patient ingest a complex carbohydrate after recovery
In acute care settings, 20 to 50 ml of 50% dextrose IV push
16
Q
Angiopathy macrovascular
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Diseases of large and medium-sized blood vessels, Occur with greater frequency and with an earlier onset in diabetics , Development promoted by altered lipid metabolism common to diabetes
17
Q
Angiopathy Microvascular
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Result from thickening of vessel membranes in capillaries and arterioles, In response to chronic hyperglycemia, Is specific to diabetes unlike macrovascular
18
Q
areas most affected by Angiopathy
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eyes kidneys skin, may only appear after 10-20 years of diabetes
19
Q
Diabetic retinopathy
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Microvascular damage to retina, results from chronic hyperglycemia, most common cause of new blindness in people 20-74 years old, early stages produce no change in vision. Causes spots in vision
20
Q
Diabetic nephropathy
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Damage to small blood vessels that supply the glomeruli of the kidney, leading cause of renal disease, yearly screening with microalbuminuria and creatinine
21
Q
Diabetic neuropathy
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60-70% have some type, damage to the nerves, can be sensory or autonomic neuropathy
22
Q
Sensory (peripheral) neuropathy
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Distal symmetric- most common form affects hands and feet by loss of sensation abnormal sensations pain or paresthesia, worse at night, foot ulcers can occur w/o knowing, may have decreased DTR
23
Q
Treatment of sensory neuropathy
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Tight glucose control, topical creams like capsaicin, tricyclics antidepressants, anti seizure Meds
24
Q
Autonomic neuropathy
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Can affect all body systems, can cause gastroparesis cardiovascular abnormalities incontinence ED decrease libido
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Semmes-Weinstein test
Touch foot with wire to check feeling
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Hordeolum (stye)
Infection of small glands of lid margins,Tender, swollen pustule, Treated with warm compresses 3-4 times per day for 10-15 minutes, antibiotic ointment, incision of pustule if it does not resolve
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Chalazion
Chronic inflammatory granuloma of the sebaceous gland in the lid, Hard, painless swelling, Treat with warm compresses and ophthalmic antibiotic ointment, Most resolve but can be surgically removed
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Blepharitis
Inflammation of the eyelids causing redness and scaling of the lids at the lash borders, Treated with daily facial cleansing & shampoo to remove scales; local antibiotics
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Keratitis (VERICELLA ZOSTER VIRUS)
May be caused by infection, trauma, or hypersensitivity disorders, Clinical Manifestations: Watery eyes Pain Photophobia Decreased visual acuity , Treatment is directed at treating underlying causes
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Corneal abrasions and Ulcerations
Corneal abrasions—disruption in the integrity of the corneal epithelium
Ulcerations—traumatic break in the corneal epithelium
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diagnosis of corneal problems
Fluorescein stain
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treatment of corneal disorders
Abrasions: prophylactic antibiotics, cycloplegics, and an eye patch
Ulcerations: ophthalmologic consultation, cultures, and antibiotic ointment
May need corneal transplant
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optic burn
Chemical burns may involve acid or alkali substance
| Treatment= opious flushing of the eye with water until medical person is there, Antibiotic ointment
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Orbital contusion
traumatic contact with a blunt object, S&S= Periorbital ecchymosis “black eye” Orbital pain Eyelid edema Diplopia
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eye penetrating injuries
have the poorest chance of retaining vision in the injured eye, S&S=eye pain with marked loss of vision entrance wound may be visible conjunctival laceration or edema hyphema (bleeding within the eye)
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treating penetrating eye injuries
Shield eye (cover up both eyes), Pain control, Semi-Fowlers position, Patient should not touch eye; rest until seen by MD, If there is a protruding body, don’t remove it, NPO; anti-emetics, Frequent eye exams as a follow-up
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Glaucoma
a condition characterized by optic neuropathy with a gradual loss of peripheral vision and increased intraocular pressure in the eye, two types=open-angle (some draining) and angle-closure (no draining)
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Normal Intraocular pressure IOP
10-21 mmHg
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Primary Open-Angle Glaucoma (POAG)
Most common form , Usually bilateral and asymptomatic in the early stages, reduced outflow fluid through the angle, S&S=Frequent lens changes in glasses Impaired dark adaptation Halos around lights Gradual reduction of visual fields Mild to severe increased intraocular pressure
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Acute Angle-Closure Glaucoma (AACG)
Uncommon, structural, Sudden onset, Treated as an emergency, Basic problems are a narrowed angle and forward displacement of the iris, S&S=Sudden excruciating pain around the eyes that radiates over the sensory distribution of the 5th cranial nerve Headache or brow ache N&V Fixed pupil Rapid, significant increase in intraocular pressure
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Diagnosis of glaucoma
Tonometry (air puff) , Glaucoma diagnostic test (GDx), Visual fields
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Drugs to treat glaucoma
work in two ways: Reduce aqueous inflow or Increase aqueous outflow, Categories of drugs: Sympathomimetics Paresympathomimetics Beta adrenergic agonists Carbonic anhydrase inhibitors Prostaglandin analogues
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surgery for glaucoma
either creates a new drainage channel for aqueous humor or destroys the structures responsible for its production, Trabeculoplasty and Trabeculectomy (cut on eye) Gonioplasty and laser iridotomy (drainage channels made through eye)
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cataract
An opacity of the lens that distorts the image projected onto the retina and that can progress to blindness, 50% to 70% of people over the age of 65 have some degree of cataract formation, Third leading cause of preventable blindness in the US
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risk factors of CATARAC
normally around 40's, Congenital, Aging, Toxicity, Accidents, Radiation, Altered metabolism, Cigarette smoking
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classification of cataract
Senile (associated with aging) Traumatic (associated with injury) Congenital (present at birth) Secondary (occurring after other eye diseases)
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clinical manifestation of cataracts
Gradual, painless blurring and loss of vision (peripheral vision may be affected first), Glare at night and in bright light, Halos around lights, Loss of ability to discriminate between hues, Pupil may appear cloudy gray or white rather than black
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diagnosis and treatment of cataracts
Diagnosis: based on history and ophthalmoscopic exam (absence of the red reflex) Snellen Visual Acuity Test
Treatment: surgical removal of cataract and lens and an intraocular lens is implanted to restore visual acuity
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Cataract surgery
Extracapsular: phacoemulsification (lens implant)
| Aphakic vision-absence of crystalline lens of the eye (cant get lens- not covered by insurance, Really thick glasses)
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retinal detachment
Separation of the retina or sensory portion of the eye from the choroid, the pigmented vascular layer, Although they may be precipitated by trauma, it usually occurs spontaneously, Medical emergency
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clinical manifestations of retinal detachment
Floaters (lots), Flashes of light, Blurred vision, Sensation of a curtain being drawn across the field of vision, Loss of a portion of the visual field, No pain
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treatment of retinal detachment
Treatment is surgery, Laser photocoagulation or cryotherapy, Injection of gas bubbles(pushes retina toward wall), silicone oil into vitreous cavity (pneumatic retinopexy), Surgical repair- to place the retina in contact with the underlying structures (scleral buckling- pulls retina toward wall)
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Age related macular degeneration
painless disease in which the macula gradually breaksdown from the development of fatty waste products that accumulate in the retina, Types: Neovascular (exudative or wet) and Non-neovascular (nonexudative or dry)
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S&S and treatment of age related macular degeneration
Visual blurring & distortion of vision in one eye, Some degree of central vision loss, Decreased ability to distinguish colors, Amsler Grid
treatment: no treatment for dry AMD but it can be slowed by the use of high dose antioxidants and zinc
Wet AMD is treated with a laser
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3 symptoms of inner ear disease
Vertigo (spinning), Sensorineural hearing loss, Tinnitus (roaring sound)
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Menieres disease
chronic disorder from endolymph in the labyrinth (fluid in the ear), fall risk, feels like being pulled to the ground, can be from high sodium intake stress allergies and vasoconstriction
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management of meniers disease
diuretic, antihistamine, antiemetic, and surgical intervention endolymphatic decompression and labyrinthectomy
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endolymphatic decompression and labyrinthectomy
endolymphatic decompression- insertion of shunt, preserves hearing, relieves most pts vertigo
Labyrinthectomy- last resort therapy
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acoustic neuroma (schwannoma)
benign tumor, damage of hearing facial movements and sensation can occur, S&S- tinnitus hearing loss and nystagmus, diagnosed with CT scan or MRI, Treatment- surgical removal via craniotomy
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condutive hearing loss
occurs when sound waves are blocked from contact w/ inner ear nerve fibers b/c of external or middle ear disorders, can be from inflammation obstruction damage to middle ear tumors or scar tissue build up
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sensorineural hearing loss
when the inner ear nerve or sensory fibers that lead to the cerebral cortex are damaged, can be from damage to inner ear or auditiory nerve prolonged exposure to loud noise ototoxic drugs infections and fever
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ototoxic drugs
antibiotics- eythromycin gentamicin kanamycin neomycin streptomycin tobramycin vancomycin, Diuretics- ethacrynic acid furosemide acetazolamide, NSAIDS- ibuprofen indomethacin naproxen salicylates, Misc. Carbamazepine cisplatin quinidine
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cochlear implants
may help with sensorineural hearing loss
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tympanoplasty
reconstructs the middle ear to improve hearing caused by conductive hearing loss
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stapedectomy
a partial or complete stapedectomy with a prosthesis effectively corrects hearing loss (best outcome with pts with hearing loss from otosclerosis)
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Myasthenia Gravis definition
Disorder affecting the neuromuscular transmission of impulses in the voluntary muscles of the body *watch respirations and muscle strength
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Myasthenia Gravis Clinical manifestations
Fluctuating weakness muscle usually less severe in the morning and worsening during the day, There is no sensory loss, reflexes are normal, and muscle atrophy is rare, Drooping eyelid (ptosis), Blurred or double vision (diplopia), Slurred speech (dysphonia), difficulty chewing, or swallowing, Weakness in arms or legs, Chronic muscle fatigue, Difficulty breathing
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MG triggers
Exposure to sunlight, Exposure to viruses, Surgery, Immunizations, Emotional stress, Menstruation, Infections, Medications
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Diagnosis of MG
History and physical (including neurological exam), Serum Assay-acetylcholine antibodies, EMG, CT or MRI, Tensilon test (endorphonium chloride)
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Myasthenic crisis
acute exacerbation of disease, Signs and symptoms: increased weakness of skeletal muscles & dyspnea, can be life threatening
Treatment-increase anticholinesterase meds
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Treating MG
Drug therapy: Pyridostigmine (Mestinon)-anticholinesterase
Surgical therapy: thymectomy, Plasmapheresis- removal of serum antibodies
IV: immunoglobin G
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Cognition
Cognition is the ability of the brain to process, store, and retrieve information, Attention and concentration, Judgment and perception, Learning, Memory, Communication and language, Speed of information processing
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Multiple Sclerosis (MS) definition
Chronic, progressive, degenerative disorder of the CNS characterized by disseminated demyelination of nerve fibers in the brain and the spinal cord, Known for its combination of remissions and exacerbations
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MS risk factors
Age (20-50) Sex Temperature Ethnicity
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MS clinical manifestations
Motor symptoms, Sensory symptoms, Bowel and bladder dysfunction, Sexual dysfunction, Emotional issues, Cognitive issues
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diagnosis of MS
History and physical, CSF analysis, Evoked response testing, CT scan, MRI
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Treatment of MS
Drug therapy :Immunomodulators, Corticosteroids, Muscle relaxants, Anticholinergics, Tricyclic antidepressants
Physical and speech therapy
Surgical interventions
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Goals for pt with MS
Maximize neuromuscular function, Maintain independence in ADL for as long as possible, Manage disabling fatigue, Optimize psychosocial well-being, Adjust to the illness, Reduce factors that precipitate exacerbations
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Parkinson's Disease definition
Chronic, progressive neurodegenerative disorder characterized by slowness in the initiation and execution of movement, increased muscle tone, tremor at rest, and gait disturbance
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Etiology of Parkinson's
Genetic link, Decrease in dopamine in the brain which leaves an imbalance with acetylcholine
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S&S of Parkinson's
masking facial expression, drooling, stooped posture, urgent bladder, shuffling gait, * tremor rigidity and bradykinesia (need 2)
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Diagnosis of Parkinson's
History and physical, Must have 2 of the 3 triad symptoms, Positive response to drugs
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non- motor symptoms of Parkinson's
Emotional /psychological, Fatigue, Pain, Sleep problems, Elimination problems, Swallowing issues
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drug therapy for Parkinson's
Levodopa, Cardopa/levodopa (Sinemet), Bromocriptine (Parlodel), Donepezil (Aricept)—mild to moderate PD
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surgery for Parkinson's
Ablation (Pallidotomy), *Deep brain stimulation (DBS) most common, Stem Cell Transplantation
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nutrition for pt with Parkinson's
Should contain adequate roughage and fruit, Bite sized pieces, Allow ample time, Levodopa absorption can be impaired by vitamin B6, Monitor for constipation & tongue movements
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Kidneys, Ureters, Bladder (KUB)
X-ray of abdomen and pelvis
Delineates size, shape, and position of kidneys
No specific preparation is necessary
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Intravenous Pyelogram (IVP)
Visualizes urinary tract after IV injection of contrast media
Position, size, and shape of kidneys, ureters, and bladder can be evaluated, Contrast media can be nephrotoxic
Inform patient of possible throat irritation, flushing of the face, warmth, or a salty or metallic taste during the test
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Post procedure implications of IVP
Monitor VS
Instruct patient to drink at least 1 liter of fluid
Assess venipuncture site for bleeding
Monitor urinary output
Assess for signs of possible allergic reaction
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Renal Angiogram (arteriogram)
An injection of a radiopaque dye through a catheter inserted in the femoral artery and iliac artery to visualize renal blood vessels
Can assist in diagnosing renal artery stenosis, renovascular hypertension, and cyst/tumor
Inform patient about a possible feeling of burning or heat along the vessel when the dye is injected
Instruct patient to void immediately before procedure
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Dyes used in a renal angiography and IVP
may be nephrotoxic; therefore encourage increased fluids unless contraindicated and monitor urinary output
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Voiding cystourethrogram (VCUG)
Voiding study of the bladder opening and urethra
Bladder filled with contrast media
Films taken before and after voiding
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Cystoscopy
Inspection of bladder and urethra using a lighted scope
Can be used to insert urethral catheters, remove calculi, obtain biopsy, and treat bleeding lesions
Patient is in a lithotomy position under general or local anesthesia,May have burning and frequency on urination or pink tinged urine
**bright red urine is not normal
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Pyelonephritis
Bacterial infection of the kidneys, Begins as an UTI and may progress to acute or chronic pyelonephritis, can lead to septicemia or kidney damage, cant do cystoscopy- don't want to move infection
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Risk factors of Pyelonephritis
Inability to empty bladder, Being female, Sexually active women, Pregnant women, Diabetics, Compromised kidney function, Instrumentation
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diagnosis of pyelonephritis
Urinalysis: cloudy, foul smelling urine, WBC’s, hematuria
| Urine culture
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Renal calculi
Calculi are stones that can form anywhere in the urinary tract, Nephrolithiasis are stones in the kidney, Urolithiasis are stones in the ureters, Affect men more than women
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Calcium phosphate & Calcium oxalate stones
the most common and are associated with an increased concentration of calcium in the blood or urine
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Uric acid stones
more common in men; tend to form in acidic urine
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Cystine stones
rare; associated with genetic defect; associated with acidic urine
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Struvite (magnesium & ammonium phosphate) stones
associated with UTIs. Can be very large
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diagnosis of Renal calculi
KUB, IVP, CT, ultrasound, UA, Stone composition, Blood tests, Serum calcium, phosphorus, uric acid, BUN, creatinine, 24 hour urine, Cystoscopy
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Patients who are prone to calcium oxalate calculi should limit their intake of
beets, chocolate, nuts, rhubarb, spinach, strawberries, tea, and wheat bran
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treatment options for renal calculi
Indications for cystoscopy, lithotripsy, or open surgical stone removal= Stones too large, Stones associated with bacteriuria, Stones causing impaired renal function, Stones causing persistent pain or nausea, Instability of patient to be treated medically, Patient with one kidney
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Ureteroscopy
if small bladder stone or stone in lower ureter; No incision is made, Urethral catheters are inserted past the stone; stone dislodged and manipulated by catheter
Stents left in place for 24-48 hours, used to take out the stone or break it down
106
Extracorporeal Shock Wave Lithotripsy (ESWL)
Noninvasive mechanical procedure for breaking up stones located in the kidneys or upper ureters so they can pass on their own or be removed by other methods, No incision is made and no drains are placed; a stent may be placed to facilitate passing stone fragments, Ultrasound waves are directed at the area to disintegrate the stone, Stones are passed in the urine in a few days
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Benign Prostatic Hyperplasia (BPH)
Enlargement of the prostate that constricts the urethra, a benign enlargement of the prostate gland, the most common urological problem in males
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BPH S&S
Decrease in urine stream, Difficulty beginning to void, Stopping and starting of stream while voiding, Dribbling at the end of urination
Urinary frequency, Urgency, Dysuria, Bladder pain, Nocturia, Incontinence
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Diagnosis of BPH
American Urological Association (AUA) index= 7 questions, History and physical exam, Digital rectal exam (DRE), Urinalysis; creatinine level, Prostate-specific antigen (PSA), Cystoscopy
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treatment of BPH (non drug)
Decrease fluids in the evening,Decrease the use of caffeine, Avoid OTC medications with decongestants, Urinate q 2-3 hours
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treatment of BPH (drugs)
1)5a-Reductase inhibitors—reduce the size of the prostate months to work
Example: finasteride (Proscar) & dutasteride (Avodart)
May cause impotence, decreased libido, and decreased ejaculate, tablets should not be handled by pregnant woman
2)a-adrenergic blockers—promote smooth muscle relaxation in the prostate
Examples: prazosin (Minipress) doxazosin (Cardura) tamsulosin (Flomax)
May cause hypotension (take at night), Should not take OTC unless ordered by doctor, Saw palmetto
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TURP Transurethral Resection of the Prostate
Removal of prostate tissue using a resectoscope inserted through the urethra, the patient will have a standard indwelling catheter or a triple lumen catheter (Continuous Bladder Irrigation CBI),
