Exam 4 Notes Flashcards
1
Q
4 drug indications for endocrine disorders
A
- Replacement (HRT)
- Shrinking hormone-receptive tumors
- Processsing an exaggerated response
- Block endogenous hormone action
2
Q
nursing care for pituitary drugs
A
- Monitor for desired effect based on indication
- I&O and urine specific gravity
- Physical growth
- VS
- Blood sugar
- Electrolytes
- Assess for thirst
- Monitor correct use of meds
3
Q
addison’s disease
A
adrenal insufficiency
4
Q
3 steroid precautions
A
- Infection
- DM - causes hyperglycemia
- Peptic ulcer disease
5
Q
pt teaching for steroids
A
- Inform of side effects: delayed wound healing; masked infection; bone changes; Cushing’s (moon face, wt gain); ↑ appetite; CNS effects (euphoria, nervousness, insomnia, personality changes); acne; facial hair; menstrual changes; impaired ability to respond to stress; hyperglycemia
- Avoid areas where you could get an infection
6
Q
action of glucocorticoids (4)
A
- ↑ glucose levels, protein breakdown
- Formation/storage of fat
- Anti-inflammatory
- Immunosuppressive
7
Q
4 s/s of Cushing’s
A
- Hyperglycemia
- Fat to shoulders & face
- Muscle weakness
- Bruising - monitor K
8
Q
indications for glucocorticoids (9)
A
- Allergies
- Asthma
- Cancer
- Edema
- Inflammatory diseases
- Rheumatic diseases
- Shock
- Skin disorders
- Transplant rejection prophylaxis
9
Q
lethargy; apathy; memory impairment; emotional changes; slow speech; deep coarse voice; edema; thick dry skin; cold intolerance; slow pulse; constipation; wt gain; abnormal menses
A
hypothyroidism
10
Q
tachycardia; palpitations; dysrhythmias; diaphoresis; heat intolerance; nervousness; exophthalamos (bulging eyes); wt loss; confusion; behavioral changes; goiter
A
hyperthyroidism
11
Q
nursing care for thyroid meds
A
- Monitor VS - especially EKG
- Monitor wt
- Monitor drug-drug interactions
- Assess TH & glucose levels
- Regulate environmental temp
12
Q
pt teaching for thyroid meds
A
- Do not stop abruptly OR switch brands
- Take on empty stomach, same time of day
- Report sx
13
Q
insulin produced by…
A
pancreatic beta cells in Islets of Langerhans
14
Q
function of insulin
A
- Released in response to ↑ blood glucose
- ↓ blood glucose by promoting reuptake of glucose, aminio acids, fatty substances
- Stored glucose converted to glycogen, stored in liver & muscle
15
Q
glucagon produced by…
A
pancreatic alpha cells in Islets of Langerhans
16
Q
function of glucagon
A
- Released in response to ↓ blood glucose
- ↑ glucose
17
Q
normal fasting glucose
A
60-100 mg/dL
18
Q
high risk for DM fasting glucose level
A
100-125 mg/dL
19
Q
diabetes glucose levels
A
>125 mg/dL
20
Q
normal hemoglobin A1C
A
<5.3%
21
Q
high risk A1C
A
5.7-6.4%
22
Q
diabetes A1C
A
>6.5%
23
Q
IDDM
A
type 1
insulin dependent
24
Q
NIDDM
A
type 2
25
function of incretin enhancers
mimic glucagon like peptides
26
sx of hypoglycemia
* \<50 mg/dL glucose
* **Hunger**
* **Irritability**
* Cool, clammy skin
* **Diaphoresis**
* n/v
* **Tachycardia**
* h/a
* **LOC changes**
* Lack of coordination
* Seizures
* Death
27
insulin analogs
modifications of onset & duration of action
28
fastest absorbing site for insulin
abdomen
29
insulin that can be given IV
regular
30
70% NPH + 30% regular
Humulin 70/30
31
50% NPH + 50% regular
Insulin isophane NPH 50/50
32
75% lispro protamine + 25% lispro
Humalog 75/25
33
treats temporary anticipated glucose elevations (ex. pts on steroids, hospitalized pts)
sliding scale insulin
34
nursing care for DM drugs
* Diet, excercise
* Less sugar & simple carbs
* More fiber-rich carbs
* Follow up lab tests
* Teach s/s of hypoglycemia & action to take
* Teach self blood glucose monitoring
* Medic alert card, tag, bracelet
* No alcohol
* Report nvd, fever, inability to eat
35
autonomic NS influence - ↓ HR & conduction
vagus nerve
36
more dangerous type of arrhythmias
ventricular
37
AKA atrial arrhythmias
supraventricular
38
function of RAAS
increase BP
39
steps of RAAS system (7)
1. Activated with _↓ blood flow_ to kidneys
2. Kidneys release _renin_
3. _Angiotensinogen_ converted to _angiotensin I_
4. Angiotensin I travels to lungs - _angiotensin-converting enzyme_ (ACE) converts it to _angiotensin II_
5. Angiotensin II causes widespread vasocontriction
6. _Aldosterone_ released from adrenal cortex - causes Na+ and water retention
7. _ADH_ released from posterior pituitary - causes water retention
40
amt of blood pumped from each ventricle with each contraction
stroke volume
41
resistance of muscular arteries to blood being pumped
peripheral resistance
42
send info to brain about blood pressure
baroreceptors
43
elevated BP
120-129 and \>80
44
HTN stage 1
130-139 and 80-89
45
HTN stage 2
140-179 and 90-119
46
hypertensive crisis (HTN stage 3)
180+ and 120+
47
nonpharm methods to decrease BP
exercise, ↓ alcohol and Na+, weight reduction
48
classes of drugs used for HTN (8)
* Alpha 1 blockers
* Alpha 2 blockers
* ACE inhibitors
* Angiotensin receptor blockers (ARBs)
* Beta blockers
* Calcium channel blockers
* Direct vasodilators
* Diuretics
49
first line anti-HTN
* ACE inhibitors
* ARBs
* Thiazide diuretics
50
second line anti-HTN
* Beta blockers
* Centrally acting alpha & beta blockers
* Direct acting vasodilators
* Direct renin inhibitors
* Peripherally acting adrenergic neuron blockers
51
first line drugs for mild HTN
diuretics
52
nursing care for diuretics
* Monitor I & O; lab values (electrolytes, glucose); sx electrolyte imbalance (especially Na+ and K+); _dehydration_; compliance; pulse and BP
* Teach pt to read labels & watch Na+ and K+ intake
* Pt may be on fluid restriction - make sure they get all they are allowed to have
* Give drugs in AM
53
nursing care for anti-HTN
* Monitor VS; F & E
* Teach adverse effects
* Low Na+ diet
* Teach nonpharm methods to reduce BP—Na+ restriction, fluid restriction, caffeine restriction, weight control
* Sit or stand slowly
* Adherence to regimen
* Lab tests may be necessary
54
who is more at risk for HTN?
African Americans
men
55
how do African Americans differ in responsiveness to anti-HTN drugs?
Most responsive to _single drug_ therapy
_MORE_ responsive to diuretics, Ca channel blockers, alpha blockers
_LESS_ responsive to ACE inhibitors, ARBs, renin inhibitors, beta blockers
56
HF results from… (4)
* CAD (↓ blood flow to heart, hyperlipidemia)
* Cardiomegaly & cardiomyopathy
* HTN
* Valvular disease
57
CO =
stroke volume x HR
58
preload
volume of blood in ventricles at end of diastole
59
afterload
resistance the LV must overcome to eject blood into aorta/through circulation
60
sx of RSHF
* Fatigue
* ↑ peripheral venous pressure
* Ascites
* Hepatomegaly & splenomegaly
* Distended jugular
* Anorexia
* Wt gain
* Dependent edema
61
sx of LSHF
* Paroxysmal nocturnal dyspnea
* Orthopnea
* Pulmonary congestion (crackles; cough; wheezes; bloody sputum; tachypnea)
* Tachycardia
* Confusion
* Restlessness
* Fatigue
* Cyanosis
62
drug classes used to treat HF
* ACE inhibitors & ARBs
* Beta blockers
* Diuretics
* Cardiac glycosides
* Vasodilators
* Phosphodiesterase inhibitors
* Combination drugs - inhibit RAAS, ↓ afterload
63
goals of drugs for HF
↑ cardiac output; ↓ vasoconstriction; loss of excess fluid
64
nursing care for HF drugs
* Monitor VS; serum digoxin; electrolyte levels; daily weight
* Teach low Na+ diet & fluid restriction
* No smoking, alcohol - limit caffeine
* Teach sx to report:
* Dyspnea
* Frothy sputum
* Excessive fatigue
* Edema
65
stable vs unstable angina
stable - predictable based on exertion/activity
unstable - unpredictable
66
goal of antianginal drugs
reduce O2 demand of myocardium
67
how to antianginals achieve their goal? (5)
* Slow HR
* Dilate veins - ↓ preload
* Dilate coronary arteries
* ↓ force of contraction
* Lower BP - ↓ afterload
68
desirable lipid labs (total, LDL, HDL, triglycerides)
* \<200 total
* \<130 LDL
* \>50 HDL
* \<200 triglycerides
69
borderline high lipid labs (total, LDL, HDL, triglycerides)
* 200-239 total
* 130-159 LDL
* 40-49 HDL
* 200-399 triglycerides
70
high lipid labs (total, LDL, HDL, triglycerides)
* 240+ total
* 160 + LDL
* \<40 HDL
* 400+ triglycerides
71
non-diet intervention that raises HDL
exercise
