Final Exam Flashcards
(321 cards)
1
Q
What factors influence endocrine function?
A
1) Aging
2) Chronic diseases
3) Medications/supplements
4) Stress
5) Environment
6) Genetics
2
Q
In the endocrine system, what kind of disorder is it characterized as if there is a problem in the target organ?
A
Primary
3
Q
In the endocrine system, what kind of disorder is it characterized as if there is a problem in the pituitary?
A
Secondary
4
Q
In the endocrine system, what kind of disorder is it characterized as if there is a problem in the hypothalamus?
A
Tertiary
5
Q
What is the best initial thyroid test that can be done?
A
TSH
6
Q
What does an increased TSH result mean?
A
Hypothyroid state –> thyroid not making enough hormone, primary problem
7
Q
What does a decreased TSH result mean?
A
Hyperthyroid state –> sometimes d/t pituitary problem
8
Q
What is the desired TSH range?
A
0.4 - 4.2
9
Q
Name the thyroid test:
1) Bound
2) Free
A
T4
10
Q
Name the thyroid test:
Can measure for hyperthyroid state, but not hypo
A
T3
11
Q
What is the most accurate measurement of thyroid function?
A
TSH & T4
12
Q
Name the thyroid test:
Can give insight as to what is causing the problem with the thyroid
A
Thyroid antibody test
13
Q
Name the thyroid test:
1) Based on ability of thyroid gland to uptake iodine
2) Can see where iodine is going
A
Radioactive Iodine Uptake
14
Q
What does an increased thyroid uptake result on a radioactive iodine uptake test indicate?
A
Hyperthyroid
15
Q
What does a decreased thyroid uptake result on a radioactive iodine uptake test indicate?
A
Hypothyroid state
16
Q
What are the 2 types of hypothyroidism?
A
1) Cretinism (infant)
2) Myexedema (adult)
17
Q
What causes hypothyroidism?
A
1) Autoimmune diseases (hashimotos thyroiditis)
2) Surgical removal
3) Radiation
4) Drug therapy
5) Pituitary gland malfunction (secondary)
6) Too much or too little iodine
18
Q
What is the most common primary cause of hypothyroidism?
A
Hashimotos (autoimmune)
19
Q
What drugs can cause hypothyroidism?
A
Amiodarone & lithium
20
Q
What are mild sx of hypothyroidism?
A
1) Mild cold sensitivity
2) Lethargy
3) Forgetfulness
4) Depression
5) Dry skin & hair, brittle nails
6) Weight gain
7) Anorexia (d/t increased Ca+)
8) Mental disturbances
***Sx can occur slowly over months to years
21
Q
What are the extreme sx of hypothyroidism?
A
1) Abnormally fatigued & apathetic (won’t seek tx)
2) Obesity
3) Puffy & edematous
4) Hair grows in dry & sparse
5) Skin is dry, flaky, inelastic
6) Severe cold intolerance
7) Constipation
8) Decreased sweating
9) Increased susceptibility to infection
10) Cardiac comps
22
Q
True or false:
Extreme hypothyroidism can cause hypersensitivity to narcotics, barbituates, and anesthetics which can lead to respiratory depression
A
True
23
Q
True or False:
Extreme hypothyroidism can lead to cardiac complications
A
True
24
Q
True or False:
Extreme hypothyroidism can cause increased serum triglycerides & cholesterol which can lead to clogged arteries
A
True
25
What is euthyroid?
Normal thyroid hormone levels
26
What do you do if your pt has hypothyroidism and says they are cold?
Give them a warm blanket
27
What kind of diet does someone with hypothyroidism need to have?
Low cal & high protein
28
What medication is given for hypothyroidism?
Levothyroxine (synthroid)
29
What teaching needs to be given for a pt taking levothyroxine?
1) Take on empty stomach with no other meds
2) Dosage adjusted based on TSH lab results
3) Can take up to 3 weeks for it to be therapeutic
4) Lifelong
30
True or false:
Thyroid drugs potentiate the effects of anticoagulants
True
31
True or False:
Thryoid drugs decrease the effects of digitalis compounds
True
32
What are assessment findings of myexedema coma?
1) Decreased temp
2) Decreased HR
3) Decreased BP
4) Respiratory acidosis
33
What is myexedema coma?
Uncontrolled hypothyroidism
34
What is a typical patient seen with myexedema coma?
1) Elderly woman
2) Not taking meds properly
3) Living alone
35
What is the tx for myexedema coma?
1) IV levothyroxine
2) Comfort measures
36
What is the mortality rate of myexedema coma?
60% --> d/t not getting to them in time
37
What is the most common form of hyperthyroidism?
Graves
38
What are causes of hyperthyroidism?
1) Pituitary tumors
2) Thyroid cancer
3) Thyroiditis
39
Who is most likely to develop hyperthyroidism?
20-40 yr old women
40
What is the etiology of Graves disease?
1) Autoimmune
2) Role of TSI
41
What are some assessment findings of hyperthyroidism?
1) Fine tremors
2) Ravenous appetite
3) Weight loss
4) Diarrhea
5) Heat intolerance (always hot)
6) Profuse diaphoresis
7) Arrhythmias (tachy, afib)
8) Warm, smooth, silky skin
9) Smooth, soft, fine hair
10) Emotional disturbances
11) Goiter
12) Exophthalmos
42
What is the cardinal sign of Graves disease?
Exophthalmos (caused by edema & messed with visual acuity)
43
In someone with hyperthyroidism, what would their TSH labs be?
Low
44
In someone with hyperthyroidism, what would their T3 & T4 labs be?
High
45
In someone with hyperthyroidism, what would their RAIU labs be?
High
46
How many calories should someone with hyperthyroidism eat per day?
4-5,000/day & 6 full meals a day
47
True or False:
Someone with hyperthyroidism should avoid stimulants like coffee or soda
True
48
What are the 3 main types of therapy for hyperthyroidism?
1) Drug therapy
2) Radioactive iodine therapy
3) Surgery
49
What are the 3 types of drugs that are given for hyperthyroidism?
1) Beta blockers (--olol)
2) Antithyroid drugs
3) Radioactive iodine
50
What are the 2 types of antithyroid drugs?
1) Methimazole (MMI)
2) Propylthiouracil (PTU)
51
What do antithyroid drugs do?
1) Block thyroid hormone synthesis
2) Reverse Graves in 4-8 weeks
52
True or False:
PTUs have less SEs than MMIs
False -- MMIs have less SEs
53
What are SEs of antithyroid drugs?
Liver injury & agranulocytosis (decreased WBCs)
54
What happens if a pt abruptly stops taking antithyroid drugs?
Thyroid storm -- all kinds of thyroid hormone released at once
55
How long after normal thyroid levels are reached can antithyroid drug therapy continue & what needs to be avoided?
1) 6-15 months after
2) Avoid salt with iodine & shellfish
56
What does RAI do to the thyroid?
Destroys overactive cells/thyroid tissue (toxic to thyroid)
57
True or False:
In Graves disease, a dose of RAI just enough to shrink the thyroid & permanently cause hypothyroidism is given
True
58
True or False:
Hyperthyroidism is more manageable than hypothyroidism
False -- hypothyroidism is more manageable
59
What are SEs of getting 1 big dose of RAI?
1) Hypothyroidism
2) Dryness/irritation of the mouth
60
What pt instructions are given to those receiving RAI?
1) Gargle with salt water
2) Radiation precautions (flush toilet 2-3x, use private restrooms, pregnancy test prior to therapy, use separate laundering facilities/loads, do not touch others' foods with bare hands, do not be around pregnant people or children for at least 7 days after dose)
61
When is a high quick dose of RAI given?
Prior to surgical removal of thyroid galnd -- helps reduce size & vascularity of thyroid
62
What are the types of iodine preparations?
SSKI or Lugol's solution
63
What are the SEs of iodine preparations?
1) Iodine toxicity
2) N/V
3) Swelling of buccal mucosa (causes extreme salivation)
64
What are pt instructions for those taking SSKIs or Lugol Solution?
1) Can take 10-15 days to work
2) Given in fruit juice with straw d/t teeth staining
65
What are preop requirements of a thyroidectomy?
1) Euthyroid state
2) Optimal health
3) Contolled CV problems (why we see BBs used)
66
What are comps of a thyroidectomy?
1) Hemorrhage
2) Respiratory obstruction
3) Bilateral laryngeal nerve damage (weakness/hoarseness)
4) Hypocalcemia
5) Thyroid storm
67
What are S&S of a thyroid storm/major hyperthyroid?
1) Irritability
2) Tachycardia
3) Fever
4) Shock
5) Delerium
68
What tx is necessary for those hospitalized for a thyroid storm?
1) Beta blockers
2) O2 therapy
3) Hyperthermia protocol
4) Fever reducers (tylenol)
5) Antithyroid drugs
69
True or false:
Thyroid is in charge of calcitonin release
True
70
What happens to calcium levels when the thyroid gland is removed?
Hypocalcemia (numbness/tingling around the mouth)
71
How frequently postop will Ca+ levels be drawn
q8h
72
How long after a thyroidectomy will hypocalcemia manifest?
1-7 days
73
What are post op nursing interventions of a thyroidectomy?
1) Maintain airway
2) Semi fowlers
3) Measure drainage output
4) Give ice chips, cool drinks, and chloroseptic spray if c/o something stuck in throat
74
What is one important teaching post op of thyroidectomy?
Avoid lifting anything > 2 lbs or any strenuous activity for 2 weeks
75
Name the disorder:
1) High levels of glucocorticoids (high BG, susceptible to illness)
2) Results from chronic exposure to excess corticoids
3) Potential for glucocorticoids to attach to mineralcorticoids
Cushings
76
What are the S&S of Cushings primarily caused by?
Exaggeration of normal function of glucocorticoids
77
What are causes of Cushings?
1) Chronic glucocorticoid use
2) Cortisol-secreting tumor
3) Corticotropin-producing tumor in another organ
4) Excess corticotropin production in another gland/organ
5) Pituitary microadenoma
6) Autoimmune disorders
78
What are S&S of Cushings?
1) Hyperglycemia
2) Protein breakdown
3) Na+ & water retention
4) K+ excretion
5) Abnormal fat distribution w/ edema
6) Osteoporosis
7) Weakness
8) Increased susceptibility to infection
9) Decreased resistance to stress
10) CNS effects
11) HTN
12 ) Increased virility in women (increased body hair & acne)
79
What is a clinical feature of Cushings?
Purple striae
79
What are the dx tests of Cushings?
1) Dexamethasone suppression test
2) Salivary cortisol
3) 24 hr urine cortisol
80
What is the gold standard dx test for Cushings?
Dexamethasone suppression test
81
Name the dx test of Cushings:
1) Can do 1 mg or 8 mg to help see if its Cushings or tumor secreting ACTH on its own
2) Overnight test -- give 1 mg PO around 11 PM
3) Blood draw at 8 AM to measure cortisol levels
Dexamethasone
82
What is dexamethasone supposed to do in a non-Cushings pt?
Tell hypothalamus to shut off -- decrease ACTH & see decreased cortisol
83
What would the dexamethasone results look like for a person with Cushings?
Will still have high cortisol levels in the morning despite being given exogenous steroids
84
Name the dx test of Cushings:
1) Looking at levels throughout the day
2) Should fluctuate throughout day and decrease at night
Salivary cortisol
85
True or False:
Addison's disease is a secondary form of adrenocortical insufficiency
False -- it is a primary form
86
Name the disorder:
Adrenal tissues are being destroyed by antibodies & sx only appear once 90% of gland is destroyed
Addisons
87
What is the onset of sx for Addison's disease?
Slow onset w/ general sx (weakness, fatigue, nausea)
88
What are the sx of Addison's?
1) Aldosterone deficiency
2) Glucocorticoid deficiency
3) Androgen deficiency
4) Hyperpigmentation
89
What is the gold standard dx study for Addisons?
ACTH stimulation test
90
What do Na+ levels look like in a pt with Addisons?
Decreased
91
What do K+ levels look like in a pt with Addisons?
Increased
92
What do blood glucose levels look like in a pt with Addisons?
Decreased
93
What do BUN levels look like in a pt with Addisons?
Increased
94
What does a CXR show in a pt with Addisons?
Smaller heart r/t decrease in fluid volume
95
Name the dx study of Addisons:
1) Get baseline ACTH & cortisol
2) Inject ACTH
3) Retest cortisol levels
ACTH stim test
96
What does exogenous ACTH normally do?
Increase cortisol levels
97
What would the results of an ACTH stim test look like in someone with Addisons?
Cortisol levels remain unchanged b/c adrenal tissue is damaged & cannot release cortisol
98
Name the problem:
1) Life threatening, emergency
2) Caused by insufficient/sudden sharp decrease in adrenocortical hormone
3) Could lead to shock
Addisonian crisis
99
What are causes of an Addisonian Crisis?
1) Stress
2) Sudden withdrawal of therapy
3) Adrenal surgery
4) Sudden pituitary gland secretion
100
What are the S&S of an Addisonian Crisis?
1) Hypotension
2) Tachycardia
3) Dehydration
4) Hyponatremia
5) Hyperkalemia
6) Hypoglycemia
7) Fever
8) Weakness
9) Confusion
101
How do you tx an Addisonian Crisis?
1) Give bolus of NS to increase fluid volume (for shock)
2) Give dobutamine
3) Once stable -- D5 w/ electrolytes
102
Name the disorder:
1) Too much PTH secreted
2) Ca+ drains from bones OR excess Ca+ cannot be reabsorbed by kidneys (increased serum Ca+)
Hyperparathyroidism
103
What can hyperparathyroidism lead to?
Bone or kidney damage
104
What is the tx of hyperparathyroidism?
1) IV Ca+ if levels < 8 over 10 mins
2) PO Ca+ w/ Vit D once levels > 8
105
What is the tx for mild hyperparathyroidism?
1) Increase fluid intake to 3,000 mL/day
2) Avoid anything with Ca+
106
What is the tx for severe hyperparathyroidism?
1) IV NS
2) Diuretics (avoid thiazide)
3) Biphosphonates
107
True or False:
Hyperparathyroidism is a lifelong issue
False-- it is not typically a lifelong issue
108
Name the med tx for hyperparathyroidism:
1) Inhibits bone breakdown to help normalize Ca+ levels
2) Take w/ 8 ox of water 1st thing in morning
3) Can't lie down for 30 mins after
Biphosphonates
109
Name the disorder:
1) Decreased serum Ca+
2) Increased serum phosphate (pronounced neuromuscular excitability/tetany)
3) Problems caused by low Ca+
Hypoparathyroidism
110
What causes hypoparathyroidism?
1) Removal of parathyroid
2) Iodine therapy for hyperthyroid (reversible)
3) Autoimmune
111
What are S&S of hypoparathyroid?
1) Numbness/tingling
2) Muscle cramps/spasms
3) Tetany
4) + Chvosteks (cheek tap/spasm)
5) + Trousseau's (BP cuff/claw contract)
112
What is the tx for acute hypoparathyroidism?
1) IV Ca+ then oral -- if CV problems, admin slower than over 10-15 min
2) Vit D supplements
112
What is the tx for chronic hypoparathyroidism?
1) Ca+ -- may be lifelong
2) Vit D supplements -- Calciferol
3) Foods rich in Ca+, but decreased in phosphorus
113
What are foods rich in Ca+ but low in phosphorus?
1) Almonds
2) Salmon
3) Tofu
4) Broccoli
114
Name the disorder:
1) When post. pituitary fails to release ADH (not enough ADH to hold onto water)
2) Passage of large amounts of DILUTE urine
3) Polydipsia
Diabetes Insipidus
115
What is a normal UO?
1.5 - 2 L/day
116
How much UO is being put out for someone with DI?
Up to 20 L/day
117
What can cause ADH deficiency?
1) Trauma-- TBI
2) Cranial surgery
3) Prolonged anesthesia
4) Pituitary tumor
5) Meningitis
118
What are the S&S of DI?
1) Increased UO
2) Decreased weight
3) Decreased SGOU
4) Decreased BP
5) Increased HR
6) Increased H&H
7) Increased Na+
8) Decreased K+
119
What would Na+ levels look like in someone with DI?
150-160
120
What would serum osmolality levels look like in someone with DI?
> 295
121
What would urine specific gravity levels look like in someone with DI?
< 1.005
122
What would urine osmolality levels look like in someone with DI?
100-200
123
What are the dx studies of DI?
1) 24 hr urine
2) Water deprivation test
124
What are the fluid and hormone therapies for DI?
1) IV hypotonic or D5% in water
2) Desmopressin acetate (DDAVP -- synthetic ADH)
125
Name the disorder:
1) Destruction of beta cells, cannot make insulin
2) Usually triggered by autoimmune process (celiac chrons, lupus)
T1DM
126
Name the disorder:
1) Defects at cell membrane that prevent insulin action
2) Insulin resistance (cells not responsive to insulin)
3) Most common
T2DM
127
What are the modifiable RFs of T2DM?
1) Obesity
2) Physical Inactivity
3) Lipid levels -- high tris, low HDL
128
What are the non-modifiable RFs of T2DM?
1) 1st degree relative
2) Ethnicity (NAs have highest, then hispanics & AAs)
3) Birthing big baby > 9 lbs
4) HTN
5) PCOS
129
What are the S&S of T1DM?
1) Polyuria
2) Polydipsia
3) Polyphagia
130
What are the S&S of T2DM?
1) Slower onset general sx (wt loss & fatigue)
2) Recurrent infections
3) Poor wound healing
4) Blurred vision
131
What are the dx tests for DM?
1) Sx w/ random plasma glucose > 200 mg/dL -- only done 1x
2) HA1C --> if 7% redo
3) Fasting Plasma Glucose ( >/= 126)
4) OGTT (>/= 200 mg/dL)
132
What is the goal HA1C for someone with DM?
133
What is the normal HA1C in non-diabetic pts?
4-6%
134
What HA1C result would indicate DM?
>/= 6.5%
135
True or False:
HA1C is not influenced by eating and stress
True
136
True or False:
Anemia could impact HA1C results?
True
137
Name the problem:
BG levels > 250 --> body kicks on compensatory mechanisms --> fat breakdown to increase amount of glucose cells are receiving --> doesn't work b/c there is no insulin to get glucose into cells --> body keeps burning fat
DKA
138
What are comps of insulin therapy?
1) Hypoglycemia
2) Allergic reactions
3) Lipodystrophy
4) Dawn Phenomenon
5) Somogyi effect
139
Name the comp of insulin therapy:
1) Increased BG in early AM caused by hormone release
2) Body doesn't have sufficient insulin to deal with increased BG
3) Most common in T1D
Dawn Phenomenon
140
Name the comp of insulin therapy:
1) Excessive insulin dosage at night --> increased BG in AM
2) Should eat snack with insulin at night to prevent this
Somogyi Effect
141
If you check BG in the morning (2-3 AM) for several nights and BG is low, what does this indicate?
Somogyi --> insulin still working
142
If you check BG in the morning (2-3 AM) for several nights and BG is high, what does this indicate?
Dawn --> know it is from hormones
143
What is the tx for Somogyi effect?
1) Decrease nighttime dosage or 2) Add snack with this (cheese & cracker, peanut butter & toast, cottage cheese & fruit)
144
What is the tx for Dawn Phenomenon?
1) Increase insulin dosage at night
2) Adjust timing of insulin dose
145
What are the sick day rules for DM?
1) Monitor BG q4h
2) Test urine for ketone q4-6h
3) Continue DM meds
4) Sip 8-12 oz of fluids/hr
5) If solid foods not tolerated or appetite changes --> substitute for easily digestable liquids or soft foods
6) Call diabetes HCP
146
What do the sick day rules of DM focus on?
Preventing dehydration & providing nutrition
147
True or False:
Carbs impact BG
True
148
What are the 3 main types of carbs?
1) Starches
2) Fibers
3) Sugars
149
What kind of carbs need to be eaten more?
1) Green beans
2) Cucumbers
3) Broccoli
4) Tomatos
150
What carbs should diabetics eat less of?
1) Soda
2) White bread
3) Surgary cereal
151
What types of carbs should only be eaten sometimes in diabetics?
1) Fruits
2) Brown rice
3) Whole wheat bread
4) Starchy veggies (potatoes, corn)
5) Beans
152
What is an example of an insulin to carb ratio?
For every 15 g of carb, you get one unit of insulin
153
What are examples of rapid acting insulins?
1) Lispro
2) Aspart
3) Glulisine
154
What is the onset of rapid acting insulin?
10-30 min
155
What is the peak of rapid acting insulin?
30 mins - 3 hrs
156
What is the duration of rapid acting insulin?
3-5 hrs
157
What are examples of short acting insulin?
Regular
158
What is the onset of short acting insulin?
30 mins - 1 hr
159
What is the peak of short acting insulin?
2 - 5 hrs
160
What is the duration of short acting insulin?
5 - 8 hrs
161
What is an example of intermediate acting insulin?
NPH
162
What is the onset of intermediate insulin?
1.5 - 4 hrs
163
What is the peak of intermediate insulin?
4 - 12 hrs
164
What is the duration of intermediate insulin?
12 - 18 hrs
165
What are examples of long acting insulin?
1) Glargine
2) Determir
3) Degludec
166
What is the onset of long acting insulin?
0.8 - 4 hr
167
What is the duration of long acting insulin?
16-24 hrs
168
What are the different options of combo insulin?
1) Intermediate & short
2) Intermediate & long
169
How do you draw up 2 different insulins?
Regular before intermediate (clear before cloudy/NPH)
170
True or False:
When exercising, you are burning glucose for energy & require less insulin
True
171
Name the membrane layer of the heart:
Inside lining, continuous closed system
Endocardium
172
Name the membrane layer of the heart:
Actual muscle with its own blood supply
Myocardium
173
Name the membrane layer of the heart:
Thin, fibrous, outer layer of the heart
Epicardium
174
Name the membrane layer of the heart:
Fluid-filled sac heart sits inside of, doubled-lined, 10-30 mLs of fluid in between layers & acts as a protector of heart to prevent friction during contraction
Pericardium
175
Name the membrane layer of the heart:
Lays against the heart
Visceral pericardium
176
Name the membrane layer of the heart:
Further away from the heart, type of pericardium
Parietal
177
What do the arteries do?
Carry oxygenated blood
178
What do the arterioles do?
Help control BP & blood flow
179
What do the capillaries do?
Cellular respiration & nutrient exchange
180
What do the venules do?
Receive deoxygenated blood
181
What do veins do?
Return deoxygenated blood to the heart & have valve to maintain correct blood flow
182
What are the 2 major veins?
SVC & IVC
183
What are the 2 major arteries?
Pulmonary & aorta
184
What is Starling's law?
A measure of extensibility -- how much the heart can stretch is how much it snaps back
185
Name the vocab:
Hearts ability to respond to stress?
Irritability
186
Name the vocab:
Help make contractility better, more effective, and stronger
Ionotropes
187
True or False:
During diastole in relation to relative refractiveness, the heart cannot receive another signal until it relaxes
True
188
Name the vocab:
Charge right before you contract again
Repolarization
189
What is the intrinsic rate of the SA node?
60-100 bpm
190
What is the intrinsic rate of the AV node?
40 - 60 bpm
191
What is the intrinsic rate of the purkinje fibers?
20 - 40 bpm
192
Name the vocab:
Volume of blood in the ventricles at the end of diastole right before the next contraction
Preload
193
Name the vocab:
Resistance the LV must work against to pump blood into the system
Afterload
194
What 2 factors can alter afterload?
1) HTN
2) Hyperlipidemia
195
Name the vocab:
Amount of blood that is ejected from the LV with each beat (50-100 mL avg)
SV
196
True or False:
Anything that alters, preload, afterload, or contractility also alters SV & CO
True
197
What is a normal EF?
55-70%
198
Name the vocab:
How much blood you had in the heart vs how much you ejected
EF
199
Name the vocab:
Ability to respond to increased demand for CO
Cardiac reserve
200
What does SLUDD stand for in sympathetic control?
Salivation
Lacrimation
Urination
Digestion
Defaction
201
What does preload affect?
EF
202
True or False:
Older people have less volume so they have decreased afterload
False -- they have decreased preload
203
True or False:
With femurs, preload DECREAES because blood pools & cannot get back to the heart
True
204
What do baroreceptors respond to?
Changes in volume & pressure
205
What do chemoreceptors respond to?
Changes in arterial O2, CO2 & plasma pH
206
What do baroreceptors do in response to less volume?
Increase HR & RR to maintain CO
207
True or False:
Pts with HF have an increased preload & decreased HR
True
208
What is the cardiac biomarker for acute coronary syndrome?
Troponin
209
What is the cardiac biomarker for inflammation that is not specific to the heart?
C-reactive protein
210
Name the cardiac biomarker:
1) Elevated with protein breakdown
2) Don't run for acute MI
3) Can do at annual appts
Homocysteine
211
What cardiac biomarker is specific to the kidneys and hearts, but takes longer to peak so we only use for someone who already had MI, not currently c/o chest pain
CKMB
212
What CV dx study gives anatomy, coronary circulation & blood vessels?
Cardiac CT
213
What happens when preload is decreased?
Increased HR & Decreased Map
214
What happens when preload is increased?
Decreased HR, Decreased EF & Increased BNP
215
How do you tx decreased preload?
-Fluids
-Reverse trendelenberg
216
How do you tx increased preload?
-Diuretics
-Supplemental O2
217
What are sx of decreased preload?
1) Pallor
2) AMS
3) Diaphoretic
218
What are antiplt meds?
1) ASA
2) Plavix
3) Brilinta
219
What do antianginals do?
Vasodilate
220
What are examples of antianginals?
1) Nitroglycerin
2) CCBs
3) Beta blockers
221
What are the anticoagulants?
Warfarin & Heparin
222
What do anticoags do?
Thin blood to get past vlot
223
What are antiarrhythmics?
1) Digoxin
2) Adenosine
3) CCBs
224
What are RFs of CAD?
1) Middle-aged white man
2) Men > 45
3) Women > 55
4) 1st degree relative
5) Fatty diet
6) HTN
7) Obesity
225
What is the tx for CAD?
1) Diet
2) Exercise
3) Lipid-lowering agents
4) Antiplatelets
226
What sx of CAD?
1) Decreased perfusion
2) HTN
3) Angina***
4) MI
227
What is the tx for angina?
ONAM (O2, nitro, aspirin, morphine)
228
What is angina a manifestation of?
Ischemia
229
What are the comps of an MI?
1) Dysrhythmias
2) HF
3) Cardiogenic shock
4) Papillary muscle dysfunction
5) Ventricular wall aneurysm
6) Ventricular septal wall rupture
7) Pericarditis
8) Dressler's syndrome
230
What is the most common dysrhythmia after a MI?
A-fib
231
What is Dressler's syndrome?
Pericarditis w/ pleural effusion
232
What is a ventricular wall aneurysm?
Infarcted wall of ventricle starts to bulge out during contraction
233
True or False:
Pts with ED & taking viagra cannot take nitroglycerin
True
234
True or False:
Chemoreceptors kick in faster than baroreceptors
False -- baroreceptors kick in faster
235
If there is an MI in the inferior wall, what vessel is involved?
Right coronary artery
236
If there is an MI in the anterior wall, what vessel is involved?
Left descending artery
237
If there is an MI in the lateral wall, what vessel is involved?
Left circumflex artery
238
Name the CV surgery:
Open heart surgery with cardiopulmonary bypass machine -- use of other source of blood flow to "bypass" blockages
CABG
239
What are the dx tests for HF?
1) BNP -- fluid
2) CXR -- would show big, boggy heart
3) ECHO -- EF
4) EKG -- no STEMI
240
What are S&S of left-sided HF?
1) Decreased BP & CO
2) Decreased renal perfusion
3) Dyspnea
4) Exercise intolerance
5) Weakness & fatigue
6) Dysrhythmias
7) Nocturia
8) Orthopnea
9) Tachycardia
241
What is the most common left-sided HF sign that brings people to the hospital?
Dyspnea
242
What are the S&S of right-sided HF?
1) Fatigue
2) Anxiety & depression
3) RUQ pain
4) Anorexia/GI bleeding
5) Nausea
6) Wt gain/edema
243
What is the most common sx of r-sided HF?
Weight gain/edema
244
What does venticular hypertropy effect?
Preload
245
What are the CV compensatory mechanisms for HF?
1) SNS -- release of epi & norepi
2) RAAS -- promote Na+ & H2O retention
3) Ventricular remodeling
4) Natriuretic peptides
5) Nitric oxide
246
Name the type of ventricular remodeling:
1) Pressures in LV are elevated
2) Affects preload & CO
**Remember Starling's Law
Ventricular dilation
247
Name the type of ventricular remodeling:
1) Thickened heart muscle
2) Prone to dysrhythmias
3) Affects preload
Ventricular hypertrophy
248
What is the normal urine specific gravity?
1.005 - 1.030
249
Name the type of bladder imaging:
1) X-ray of urinary tract after IV injection of contrast media
2) Assess for iodine or shellfish allergies
3) Structural evaluation
4) Shows if pt has decreased renal function
**Pre & pos-tx w/ saline
Intravenous pyelogram
250
Name the type of bladder imaging:
1) Conscious sedation vs gen anesthesia
2) Consent required
3) Visualization of interior bladder
4) IVF w/ gen anesthesia
Cytoscopy
251
What pt teaching is needed for a cystoscopy?
1) Expect pink tinged urine for a while
2) May feel more urinary frequency/burning with urination d/t probe insertion
3) S&S of orthostatic hypotension
4) Copious amts of bright red bleeding abnormal
5) Pain relief with mild analgesics (tylenol, sitz bath, warm pads)
252
What is cytitis also know as?
Urinary tract infection
253
Name the vocab:
Inflammation of the bladder
Cystitis
254
What does a uncomplicated UTI involve?
Bladder
255
What does a complicated UTI involve?
Structural or functional problems (DM, kidney stones, obstructions, caths)
256
What does a lower UTI involve?
Urethritis & Cystitis
257
What does a upper UTI involve?
Pyelonephritis
258
What are S&S of lower UTIs?
1) Dysuria
2) Frequency
3) Discomfort/pressure
4) Hematuria
5) Cloudy urine
259
What are S&S of an upper UTI?
1) Fever
2) Chills
3) Flank pain
4) Fatigue
5) Anorexia
260
What are the common causes of a UTI?
1) E. coli
2) Candida albicans
3) Fungal
261
Name the problem:
-Inflammation of the kidneys
-Bacteria have migrated up the ureters to the kidneys
Acute pyelonephritis
262
Name the problem:
Continued/persistent infection of the kidneys that is typically d/t structural abnormality/recurrent infection/did not finish antbx therapy
Chronic pyelonephritis
263
What antbx are prescribed for UTIs?
1) Sulfamethoxazole
2) Macrobid
3) Cephalexin
4) Fosfomycin
264
What medication is prescribed for chronic UTIs?
Fluoroquinolones
265
What can taking fluroquinolones cause?
Pain/numbness/tinging, monitor for prolonged QT interval
266
What antifungal is given for UTIs?
Fluconazole
267
What can fluconazole cause?
1) HA
2) Diarrhea
3) Chest tightness
4) Urine color changes
268
What urinary analgesic is prescribed to tx the sx of the UTI?
Pheanzopyridine
269
True or false:
Phenazopyridine turns urine red or orange
True
270
What is a commonly prescribed antbx for UTIs?
Bactrim
271
What teaching should be provided to a pt that has stress incontinence?
1) Pelvic floor exercises
2) Smoking cessation
3) Estrogen replacement
4) Wt loss
272
True or False:
Stress incontinence is when a pt urinates during activity
True
273
Name the problem:
1) Accumulation of urine d/t inability to empty the bladder when a person voids
2) Med emergency
Urinary retention
274
Name the problem:
-Increase in size of prostate gland (not cancer)
-Disrupts urine outflow
-Men > 50 common
-Incidence increases w/ age
BPH
275
What are the S&S of BPH?
1) Difficulty starting stream
2) Weaker flow of urine
3) Urinary frequency
276
What hormonal changes happem in BPH?
1) Decreased testosterone
2) DHT increases prostate growth
277
True or False:
Prostate enlargement compresses proximal urethra
True
278
What are RFs of BPH?
1) Age
2) Obesity/sedentary
3) 1st degree relative
4) High protein diet - lots of red meat
5) Alcohol, smoking
6) DM
7) ED
279
What is gold standard surgery for BPH?
TURP
280
What is a TURP?
Surgical removal of the prostate tissue
-Will have 3 way indwelling cath with 30 mL --> needs to be irrigated frequently
281
What are nursing interventions for continuous bladder irrigation?
1) Continuous inflow of sterile solution
2) Watch for color to lighten to pink
3) Ensure catheter is not kinked or clotted
4) Maintain asepsis
282
What class of meds are given for ED?
Erectogenics
283
What are examples of erectogenics given for ED?
1) Avanafil
2) Sildenafil (Viagra)
3) Tadalafil
4) Vardenafil
284
What are SEs of erectogenic drugs?
1) HA
2) Skin flushing
3) Blurred vision
4) Erection > 4 hrs
285
True or false:
You cannot take nitrates with erectogenic drugs like PDE5 inhibitors
True
286
Name the vocab:
Alveolar sacs are filled with inspired air (inspiration + expiration)
Ventilation
287
Name the vocab:
Gas exchange
Respiration
288
What is a normal SPO2?
>/= 95%
289
What is a normal aPTT?
24-36
290
What is a therapeutic aPTT?
46- 70
291
What is a normal INR?
0.75 - 1.25
292
What is a therapeutic INR?
2-3
293
What are the adventitious breath sounds?
1) Pleural friction rub
2) Crackles
3) Rhonchi
4) Wheezing
5) Absent
294
Name the adventitious breath sound:
1) Pneumothorax
2) Pleural effusion
3) If someone had a lobectomy
Absent
295
Name the adventitious breath sound:
Long in duration, low-pitched, air passing through mucus, heard on inspiration, sounds like blowing a straw in water
Course crackles
296
Name the adventitious breath sound:
Shorter in duration, sounds like if you take some hair and roll it
-Can be early pulmonary edema or pneumonia before mucus builds up
Fine crackles
297
Name the adventitious breath sound:
1) High-pitched
2) Continuous --> usually start on expiration & moves to having it on both inspiration & expiration
3) COPD constriction happens in bronchioles
Wheezing
298
What is egophony?
When pt tries to say "EEEE" but it sounds like "AAA"
299
Name the problem:
1) Disease state characterized by the persistent airflow limitation that is slowly progressive
2) Associated with chronic inflammatory responses of the airways and lungs to noxious particles or gases
3) Accompanied by airway hyper-activity
4) Not fully reversible (can't get air out)
COPD
300
What other diseases does COPD include?
Emphysema & chronic bronchitis
301
Name the problem:
Walls between air sacs are damaged resulting in impaired gas exchange
Emphysema
302
Name the problem:
1) Lining of the airways are constantly inflamed
2) Mucus formation
3) Difficulty breathing
Chronic bronchitis
303
What are causes of COPD?
1) Smoking
2) Recurrent URI
3) Hereditary
4) Aging
5) Occupational -- chemicals & dust
6) Air pollution
7) Asthma
8) Males > females
304
What are the S&S of COPD?
1) Frequent productive cough
2) Air hunger
3) Bronchospasm
4) Frequent infections
5) Gradual DOE -- can get to SOB at rest
6) Hypoxemia & hypercapnia
7) Barrel chest
8) Edema
9) Increased compliance & decreased recoil
305
What are comps of COPD?
1) Cor pulmonale
2) Acute exacerbations
3) Acute respiratory failure
4) Depression/anxiety
306
Name the comp of COPD:
1) R-sided HF from enlarged ventricle
2) S&S of JVD, edema & wt gain
3) Mostly caused by pulmonary HTN from COPD
Cor pulmonale
307
Name the disorder:
1) Not a disease, but a sx of repeat mucosal damage
2) Reflux of gastric acid into lower esophagus
GERD
308
What are comps of GERD?
1) Esophagitis
2) Esophageal metaplasia
3) Dental erosion
4) Respiratory problems
309
Name the comp of GERD:
1) Irritation of esophagus leading to inflammation
2) Can ulcerate --> leading to esophageal faricies
3) Can experience dysphagia
Esophagitis
310
Name the comp of GERD:
1) Barrett's esophagus (non-cancerous)
2) Pre-cancerous lesions
3) Damage to lower portion
Esophageal metaplasia
311
What teaching is needed for GERD?
1) Don't eat 3 hrs before bed
2) Frequent small meals with water in between
3) Sit with HOB 30 or higher
4) Sit up for 2-3 hrs after meal
5) Weight management
6) Smoking reduction
312
What are nursing responsibilities for a pt having an x-ray with barium?
1) Assess for dye allergy
2) NPO or not
3) Monitor for bowel movement
4) Barium will come out in stool as white/grayish color
313
What are tx goals during the acute exacerbation phase of IBD?
1) Pain management
2) Hemodynamic stability
3) Nutrition & electrolytes
4) I&Os
5) Hematemesis or rectal bleeding
314
What classes of drugs are given to tx IBD?
1) Aminosalicylates
2) Antimicrobials
3) Corticosteroids
4) Immunosuppressants
5) Biologics
315
What IBD disorder are aminosalicylates most effective in treating?
Ulcerative colitis
316
What IBD disorder are immunosuppressants most effective in treating?
Crohns
317
What kind of diet does someone with IBD need to follow?
Low residue, high protein, high cal, no dairy
318
What foods need to be avoided in IBD?
1) Nuts
2) Beans
3) Popcorn
4) Fibrous fruits and veggies
319
What supplements will someone with IBD have?
Calcium and Vit D
