Final Exam Flashcards
(103 cards)
1
Q
Diabetes complications lead to…
A
Neuropathy, Retinopathy, Heart failure, Renal failure, CVA
2
Q
Diabetes Pathophysiology
A
BS increases when eating, Pancreas releases insulin from beta cells & enzymes to break down food, Insulin puts sugar & K+ into the cell and out of the blood.
3
Q
Glucagon
A
Breaks down stared glucose/glycogen = increases sugar in blood. “Glucagon = glucose gone.” From liver to blood
4
Q
When does BS increase and decrease?
A
Increases after eating. Decreases after exercising
5
Q
Diabetes Type 1
A
Born with it. Autoimmune. No insulin produced, body kills own pancreas. Insulin dependent for life. No risk factors, genetic. S/S: weakness, wt loss, fatigue
6
Q
Insulin
A
1) Peaks + plates
2) Deadly hypoglycemia
3) No peak no mix = long acting
4) IVP/IV only = regular
5) Draw up clear to cloudy
6) Rotate inj sites
7) DKA
7
Q
Diabetes Type 2
A
“Type 2 = cells are through. The problem is you.” Few insulin receptors work. Based on diet/exercise. Cells overused, insulin receptors overused.
8
Q
Risk factors for Metabolic Syndrome
A
Sedentary lifestyle, obesity, HTN, fasting BS >100, HLD
9
Q
Signs of insulin resistance
A
Brownish/dark thickening on neck/armpits, hyperpigmentation, skin tags
10
Q
Treatment for DM2
A
1) Diet/exercise
2) Oral meds if diet/exercise fails
3) Insulin as a last resort
11
Q
S/s of DM2
A
Recurrent infections, prolonged wound healing, visual changes, fatigue, yeast infections
12
Q
Insulin types
A
1) Long acting 24 hr duration
2) NPH intermediate Duration 14 hrs, peak 4-12 hrs
3) Regular only IV, Duration 5-8 hrs, Peak 2-4 hrs
4) Rapid Duration 3-5 hrs, Peak 30-90 min, Onset 15 min
13
Q
DKA
A
Diabetic ketoacidosis.
Caused by profound insulin deficiency. Fats metabolized instead of insulin = ketones formed. Metabolic acidosis. Ketones in urine, electrolytes depleted
14
Q
Kussmaul Respirations
A
Major sx of DKA. Rapid, deep respirations
15
Q
Random, Fasting BS. GTT. HgBA1c levels
A
Random: Normal <140, Fasting <100, GTT <140, A1c <5.7.
DM: Normal 200+, Fasting 126+, GTT 200+, A1c 6.5+
16
Q
GTT
A
Glucose tolerance test.
Pt given 8oz glucose drink. See if insulin is working by putting sugar into cell. If not working, sugar will increase during test.
Fasting BS taken before test and q30 min during for 2 hrs
17
Q
Hyperglycemia s/s
A
Sugar over 110 and A1c 6.5+.
3P’s: Polyuria, polydipsia, polyphagia. Visual changes, rapid pulse
18
Q
Causes of hyperglycemia
A
4S’s: Surgery, sepsis, skip insulin, steroids
19
Q
Hypoglycemia s/s & causes
A
Sugar <70. “Hypogly brain will die.”
HIWASH: HA, irritability, weakness, anxiety, shakiness, hunger.
Cool/pale skin.
Awake? Give 15g simple carb.
Sleep? Dextrose IV or glucagon if no IV site.
Causes: exercise, alcohol, insulin peak time
**Reassess q15 minutes
20
Q
CAD
A
Main cause: Arthersclerosis = soft deposits of fat that harden w/ age.
Risk factors: HLD, Sedentary lifestyle, Weight/BMI, Diet-Dash, Na & fat intake, Stress, DM-vascular changes, HTN, tobacco use, excessive alcohol intake, substance abuse
21
Q
Cardiac Troponin levels
A
Normal: <0.04, Abnormal 0.04 to 0.4, Probable MI >0.4.
Peaks within a few hrs of MI, elevated up to 2 wks
22
Q
STEMI
A
“Complete occulsion.”
ST elevation MI. Complete blockage of heart artery. Clots form d/t ruptured plaque/thrombi. Decresed O2 and heart muscle tissue death.
EKG ST elevation, trop elevated.
23
Q
NSTEMI
A
“Partial occulsion”
Elevated cardiac biomarkers. No EKG changes. Less damage to myocardium.
EKG normal, trop elevated.
24
Q
Unstable vs stable angina
A
Unstable: Unpredictable pain unrelieved with rest/Nitro. Normal EKG and trop.
Stable: Predictable, constant pain relieved with rest/Nitro. Normal EKG and trop.
25
Causes of MI
```
"Davinci"
D: Deposits of plaque in arteries, DM.
A: Angina hx
V: Vasospasm
I: Increased cholesterol >200
N: Narcotic use
C: CAD
I: Inflammation of heart walls
-HTN
-Heart failure
-Tobacco use
-Male gender
-Family hx
```
26
S/s of MI
```
Due to low O2:
Dizzy/lightheaded, fainting/syncope, lethargy/weak, left sided chest pain radiating to arm/jaw "stabbing or crushing pain," indigestion, heart burn, JVD, n/v, decreased UOP, pale/cool skin
COLAPSED:
C: Chest pain
O: Oxygen low
L: Lethargy
A: Anxiety
P: Palpitations
S: SOB
E: Elevated HR
D: Dizziness, Diaphoresis
```
27
PT, APTT/PTT, INR, EF
PT 10-20 sec
APTT/PTT 25-35 sec (Heparin)
INR 1.1, on tx 2-3 (Warfarin)
Ejection factor 50-75%
28
Hgb & Hct
Hgb 14-16.5 M, 12-16 F
| Hct 45-52% M, 37-48% F
29
Diagnostic Tests: MI
EKG, troponin #1 indicator, CK-MB 0-5%, Stress test, Angiography.
Surgeries "ABCs" : Angioplasty (stents used to visualize & move blockage), Bypass CABG (use vein from leg to go around clot), Cut out fatty blockage (Endarterectomy).
30
Treatment: MI
"MONA"
| Morphine, Oxygen, Nitro, Aspirin
31
Nitro
Max 3 doses 5 mins apart.
Sublingual.
Call 911 after 1st dose & still have pain after 5 mins
No Viagra
Side effects: HA, orthostatic hypotension
32
Risk factors for DVT/PE
Women on BCP, postmenopausal, elderly, immobility, smoking, ortho surgery, trauma, bleeding disorders.
Virchow's Triad: venous stasis, endothelial damage.
33
Lipid Panel
Triglycerides <150
HDL >40 F, >50 M
LDL <130
Cholesterol <200
34
D-Dimer
DVT/PE
Normal <250
Determines if clot present
35
Peripheral Arterial Disease
Oxygen problem, no/low O2. Narrowed arteries. Low blood flow. Complete/partial arterial obstruction.
ARTS: Absent pulses, Round/red sores, Toes/feet pale, Sharp calf pain (intermittent claudication)
36
5P's - PAD
```
Pain **
Pallor
Paresthesia "pins & needles" **
Pulselessness
Palpable coolness
** = Priority
```
37
Right sided heart failure s/s
```
Diastolic Heart Failure. "Whole body sx"
Dependent edema
Hepatomegaly
Ascites
Wt gain
Nausea
Anorexia
Abd pain
JVD
Low EF
```
38
Left sided heart failure s/s
```
Systolic Heart Failure. "Lungs"
Congestion
Dyspnea
Orthopnea
Paroxysmal noctural dyspnea
Cough
Crackles
Wt gain
Fatigue
Sleep disturbance
Low O2 sat
S3 heart sound
Normal EF
```
39
HF medications
```
ACE inhibitors
Beta blockers "lol"
Diuretics
Vasodilators
Digitalis
ARBs (Sartans)
```
40
BNP
>100 for HF
41
Kidney Stones s/s
```
Ureteral colic
Acute excruciating colicky pain
Desire to void but minimal urine
Irritation
UTI sx
Hematuria
Poss infection
Intense deep ache
Pyuria
Diarrhea, n/v
Renal colic
```
42
Kidney Stones DX tests
Urinalysis, 24hr urine, straining urine, blood chemistries (Calcium, uric acid, electrolytes, phosphorus), CT Scans, Xrays
43
Chronic Venous Insufficiency
Brown pigmentation
Edema
Warm to touch
Pt edu: Walk to promote venous return
44
HHS
Dangerously high glucose levels. Absence of acidosis
45
Dx tests for PAD
U/S, ABI
46
Most common kidney stones
Calcium oxalate & Calcium phosporus
Pt edu: Limit calcium intake - milk, dairy, legumes, dried fruit. Avoid oxalate foods: Spinach, chocolate, tomatoes. Pain meds. Hydration 2000-3000 mL/day
47
Ileal Conduit
Change application q3-7 days. Empty pouch when 1/3 full/ Urine deverted by implanting ureter into ileum through abd wall
48
Healthy Stoma
Color red, pink, moist, round/oval, skin around clean/dry, skin around sensitive to urine, measured q3-6 wks for first few wks post-op
49
Fluid Volume Excess tx
Tx underlying cause. Assess lung sounds, edema, daily weights, I&Os, monitor responsiveness to meds, promote rest, semi-fowlers to alleviate orthopnea
50
Isontonic IV fluids
No fluid shifts. Same consistency as human blood.
| 0.9% NS, LR. D5W (hypotonic in body)
51
Hypotonic IV fluids
"Hippo" Used for cellular dehydration/hypernatremia.
Lower concentration of salt/solute than ICF. Diluted less salt/more water.
1/2 NS 0.45%
1/3 NS 0.33%
1/4 NS 0.225%
2.5% Dextrose in water
52
Hypertonic IV fluids
```
Fluids escape from in cell to outside into vascular space.
Cell shrink. Higher concentration of salt/solute than ICR. Higher osmality
3% NS
5% NS
D10W
D5 1/2 NS
D5LR
D50W
```
53
Types of Catheters, risks, reasons
Intermittent, indwelling, suprapubic
Risks: UTI, trauma, sepsis, pain, bladder spasm.
Reasons: Relieve retention, sterile specimen, accurate measurement of UOP, Increase comfort for end-of-life care, prolonged pt immobilization
54
Electrolyte Normal Values
```
K+ 3.5-5
Na 135-145
Mg 1.8-2.4
Ca 8.6-10.2
Phosphorus 2.5-4.5
```
55
Hyperkalemia
"Tight & contracted"
Causes: burn pts, kidney problems, multiple traumas, oliguria, blood transfusions
S/s: hyperactive bowel sounds, paralysis in extremities, increased DTRs, irregular HR, cardiac dysrhythmias, anxiety, n/v, abd cramping
56
Hyopkalemia
"Low & slow"
Causes: GI loss, meds, ileostomy, tumor of intestines, alteration of acid base balance, poor diet, hyperaldosteronism, diuretics, vomiting, diarrhea, laxatives
S/s: fatigue, n/v, muscle weakness, polyuria, low BP, Increased HR, Hypoactive reflexes, Cardiac dysrhythmias, decreased bowel motility
57
Hypernatremia
"Big & bloated"
Causes: Excessive sweating, fever, dehydration, excessive NA intake, edema, heat stroke, diarrhea, renal failure, wt gain
S/s: thirst, n/v, dyspnea, neuro changes (restlessness, weakness, hallucinations, seizures), fever, Increased HR and BP
58
Hypermagnesemia
"Calm & quiet"
Causes: Kidney injury, DKA, hypothyroidism, adrenal insufficiency, excessive IV mag admin
S/s: Bradycardia, hypotension, hypoactive reflexess, cardiac dysrythmias, decreased RR, drowsiness, diaporesis
59
Hypomagnesemia
"Buck wild"
Causes: Prolonged fasting/starvation, alcoholism, diarrhea, vomiting, diuretics, poorly controlled DM, malabsorption
S/s: tachycardia, diarrhea, hyperactive reflexes, tremors, muscle cramps, increased BP, cardiac dysrythmias, + Chvostek's & Trousseau's
60
Hypercalcemia
"Moans, groans, and stones"
Causes: Malignancy, hyperparathyroidism, bone loss r/t immobility
S/s: muscle weakness, decreased reflexes, constipation, n/v, bone pain, polyuria, polydipsia, dehydration, bradycardia, weakness, renal stones
61
Hypocalcemia
Causes: multiple blood transfusions, pancreatits, Vit D def, alcoholism, diuretics, malabsorption, decreased albumin
S/s: + Chvostek's & Trousseau's, decreased BP, tingling around mouth/fingers/toes, Increased DTRs, irritability, Cardiac dysrythmias
62
HIV transmission
Unprotected sex w/ infected partner, sharing needles, mom-breastfeeding/birth/pregnancy, needle stick, rare: blood transfusion/oral sex.
NOT by: mosquitos, ticks, saliva, tears, hugging, kissing, sharing toilets.
Lives in vaginal fluids, sperm, blood, breast milk
63
HIV Dx tests
Enzyme immunoassay (EIA): HIV antibody test, allows for early dx before sx onset
1) Antibody: Detects antibodies not HIV
2) Antigen/antibody: Detect HIV
3) RNA: Detects HIV
F/u testing if +: antibody differentiation test, HIV-1 nucelic acid tests
64
Lab Values HIV/AIDS
CD4 T cell count: major lab indicator of immune function, guides prophylaxis for opportunistic infection therapy, strong predictor of survival.
Plasma HIV RNA (viral load): Quantifies HIV RNA vs DNA levels in plasma, better risk of disease progression, lower viral load/longer time to AIDs dx, used to guide ART therapy
65
HIV tx
Pt edu, assess/manage sx, Pt advoacy.
| ART - suppress HIV replication, restores immune function, started as soon as pt gets dx
66
Stages of HIV
Stage 0: Early HIV infection from lab tests
Stage 1: CD4 over 500, period from infection to development of AIDs
Stage 2: CD4 200-499
Stage 3: CD4 <200, showing opportunistic infections, dx of AIDs
Unknown: no info on CD4 count or %
67
Opportunistic Infections
Seen in pts with suppressed immune system.
| TB, PCP pneumonia, Herpes simplex 1, Candidiasis, Salmonella, Kaposi Sarcoma
68
COPD exacerbation assessments
```
Listen to lung sounds
Assess for cough, sputum production
Assess risk factors
Assess use of accessory muscles
Cyanosis evident?
CBC
```
69
COPD exacerbation interventions
High Fowler's to help with breathing
PRN meds as ordered
Teach purse lip breathing
Admin ABX if d/t infection
70
COPD medications
Bronchodilators
Corticosteroids
Mucolytics
71
COPD Pt teaching
```
High protein, high calorie diet
Fluids 2-3L/day
Small frequent meals
Cold foods make pt feel less full
Avoid exercise & tx 1 hour before/after meals
Avoid gassy foods
Smoking cessation
DM pts check glucose frequently d/t steroids
No opiods, no benzodiazpines
Pursed lip breathing
Mucinex & humuidifer at night time
```
72
COPD ABGs
pH >7.45, PaCO2 <35. Respiratory Alkalosis
73
Warning signs of cancer
```
CAUTION
Change in bowel/bladder habits
A sore that doesn't heal
Unusual bleeding/discharge from body orifice
Thickening or lump in breast or elsewhere
Indigestion, difficulty swallowing
Obvious change in wart/mole
Nagging cough/hoarsness
```
74
Chemotherapy Abnormal Labs
Low RBC/CBC (Anemia) - Monitor CBC
Low Plt (Thrombocytopenia) - Assess for bleeding/bruising
Low WBC/Neutrophils - Monitor VS, esp temp q4 hrs
75
Nursing Interventions - TPN
```
Infuse through central line
Compatibility alert
Monitor IV pump
Monitor weight daily, I&Os, VS/temp, BG
Monitor electrolytes
**Use Dextrose 10% & water if TPN runs out & none available
```
76
Complications & Risks of TPN
```
Infection/sepsis
Hyper/hypoglycemia
Altered renal function
Electrolyte/vitamin excess or deficiency
HLD
Air embolus
Pneumothorax
Hemorrage
Catheter displacement
Phlebitis
```
Risks: Alcoholism, N/v, Chemo, major surgery
77
BPH Clinical manifestations
Decreased force of urinary stream (early sign)
Nocturia
Urinary urgency and frequency
Post void dribbling from overflow (late sign)
78
BPH Labs
PSA
Post void residual (<50mL middle age, <50-100 elderly)
DRE
U/S
79
BPH Tx
Less invasive to more invasive
Meds
TUMT, TUNA heat & steam based therapies
TURP, resection (surgery)
80
Post TURP interventions
```
Fluid intake 3L/day
Avoid alcohol, coffee
ABXs if prescribed
No heavy lifting or straining for BM
Monitor VS, UOP volume and color
Hematuria normal post-op
Catheter insterted
Catheter removed when urine is light pink or yellow
```
81
Medical vs Surgical Aespsis
Medical "Clean technique"
Reduces # of pathogens
Used for: Meds, tube feedings, enemas, daily hygiene
Surgical "Sterile technique"
Eliminates ALL pathogens
Used for: Dressing changes, catheters, surgical procedures
82
Cardiomyopathy
"Disease of heart muscle inhibits effective pumping"
Cardiac muscle gets too thin, too hard, or too big/thick
Leads to weaker pump = decreased CO & decreased O2 in body
3 types: 1) Dilated = distended, too thin
2) Restrictive = "rock hard" heart muscle
3) Hypertrophic = too big, trophy like
2 causes: Primary & Secondary
83
Preload & Afterload
Preload: Filling and stretching (Distole)
Afterload: Pressure to pump aganist (Systole)
s/s: Low BP, syncope, restlessness, agitation, angina, S3 murmur, regurgitation (tricupsid & bicupsid valve)
84
Metabolic
Vomiting/NG tube suction = acid out = Alkalosis
Renal failure = acid retained = Acidosis
Diarrhea = poop out HCO3 = Acidosis
DKA = Metabolic acidosis
85
Respiratory
Slow/low RR = Acidosis
Causes: Sleep apnea, head trauma, post-op, CNS depressants, opioids, alcohol intoxication, benzodiazepines, pneumonia, COPD, asthma
Fast RR = Alkalosis
Hyperventilation, panic attacks
Blow off CO2
86
ABSs
pH 7.35-7.45
PaCO2 45-35
HCO3 22-26
87
Respiratory Acidosis sx/tx/causes
Sx: Confusion, decreased RR & BP, neuro changes, cadiac dysrythmias
Tx: Hold resp depressants, admin O2, Resp tx, neuro checks, telemetry, monitor ABGs
Causes: Sleep apnea, COPD, asthma, PE, CNS depressants, alcohol intoxication
88
Respiratory Alkalosis sx/tx/causes
Sx: Increased RR & HR, confusion, lightheadedness, numbness/tingling, tetany
Tx: Monitor O2, telemetry, paper bag breathing, monitor ABGs
Causes: neuro injury, hyperventilation, panic attacks
89
Metabolic Acidosis sx/tx/causes
Sx: Increased RR, confusion, Low BP, n/v, drowsiness, cardiac dysrythmias
Tx: Neuro checks, telemetry, IV insulin for DKA, dialysisfor renal failure, monitor resp status
Causes: DKA, renal failure. diarrhea
90
Metabolic Alkalosis sx/tx/causes
Sx: bradypnea, tingling, tetany, cardiac dysrythmias, increased HR
Tx: D/c suctioning, d/c diuretics, telemetry, resp status, I&Os, Diamox, Zofran/antiemetics
Causes: Vomiting, NG tube suctioning
91
Neutropenic precautions
```
"Reverse isolation"
No fresh fruits/flowers
Avoid crowds/sick people
Private room
Monitor temp q4hrs
**Pts are at high risk of infection
```
92
Creatinie/BUN levels
Cr over 1.3 = renal failure
| BUN 10-20
93
Trach care when to suction
Suction: Pt feels/hears mucous rattling,
Mornings,
When increased RR,
Before meals, before bed
94
Trach ties
1) Wash hands
2) Take new ties out of package
3) Suction before changing ties (No more than 15 secs)
4) Hold trach tube
5) Remove old ties one at a time
6) Wash skin underneath w/ soap and water, pat dry
7) Secure ties
95
ART HIV considerations
1) The schedule for when to take medications
2) The importance of seeing the health care provider regularly
3) Avoiding driving or operating heavy machinery initially
4) Scheduling medications to allow for 8 hours of uninterrupted sleep
96
HIV - IV Zidovudine Considerations
- Infuse the drug over 60 minutes.
- Monitor the child for paresthesias.
- Give the drug in the morning and after lunch.
- Reinforce use of meticulous handwashing.
97
ART HIV reasons
- decrease morbidity associated with HIV
- promote increased adherence to antiretroviral drug therapy
- prevent development of drug resistance to antiretroviral drugs
- suppress the conversion to acquired human immunodeficiency syndrome (AIDS)
98
Clinical manifestations Newborn with HIV
- Weighing him to determine if he is gaining 1.5 to 2 pounds/month.
- Lack the coordination to play with toys/stuffed animals.
- History of repeated episodes of bacterial pneumonia and ear infections.
- Listlessness and poor eye contact.
99
HIV Disease Progession
-There is a rapid increase in viral replication, which leads to very high viral loads.
-Viral symptoms such as fatigue, lymphadenopathy, headaches, and gastrointestinal disturbances and the CD4+ T-cell count begins to fall.
-There is a period (up to 10 years) of being symptom-free as CD4+ T cells decrease.
CD4+ T-cell count is 200 cells/μL, confirming the diagnosis of AIDS.
-The risk of opportunist infection is highest.
-Death
100
Which IV solution is used for dehydration?
Isotonic
101
IV solution for hypovolemia
Isotonic and 5% in 0.9% NS used temporarily
102
IV solution used to replace blood volume
Colloidal
103
Cystoscopy
Visual exam of inside the bladder,
| Lighted tube with a telescopic lens
