Management of Other Body Systems Flashcards
(154 cards)
1
Q
what is diabetes mellitus?
A
chronic metabolic disorder characterized by elevated blood glucose levels (hyperglycemia) caused by defects in insulin secretion (from the pancreas), insulin action, or both
2
Q
glucose can’t be utilized w/o ____
A
insulin
3
Q
what is type 1 DM?
A
autoimmune destruction of the pancreas beta cells resulting in absolute insulin deficiency (body doesn’t produce insulin)
4
Q
what are the key features of type 1 DM?
A
sudden onset, often in childhood/adolescence
presence of autoantibodies (ie islet cells antibodies)
dependence of exogenous insulin for survival
5
Q
what are the complications of type 1 DM?
A
ketoacidosis, microvascular, and macrovascular damage
6
Q
what is type 2 DM?
A
progressive insulin resistance and relative insulin deficiency
7
Q
which type of DM has genetic predisposition and lifestyle contributing factors?
A
type 2
8
Q
which type of DM has a gradual onset, typically in adults?
A
type 2
9
Q
what are the key factors of type 2 DM?
A
insulin resistance in target tissues (muscle, liver, adipose)
impaired insulin secretion by pancreatic beta cells
often associated with obesity and metabolic syndrome
10
Q
what are the complications of type 2 DM?
A
CV disease, neuopathy, nephropathy, retinopathy
11
Q
what is the fasting plasma glucose levels with type 2 DM?
A
greater than or equal to 126 mg/dL
12
Q
what is the 2 hour plasma glucose with type 2 DM?
A
greater than or equal to 200 mg/dL during OGTT
13
Q
what is the HbA1c with type 2 DM?
A
greater than or equal to 6.5%
14
Q
what does HbA1c measure?
A
blood sugar levels over the last 3 months
15
Q
what happens when glucose isn’t being taken up?
A
w/o insulin, glucose is unable to be processed by the body
liver produces more glucose to feed the body, but w/o insulin, the glucose accumulates in the bloodstream
the body needs an alternative energy source so it breaks down fat, the fat breakdown produces ketones which buildup in the bloodstream
ketones and glucose are transferred into the urine and the kidneys use water to clear the blood from excess glucose and ketones
while the body attempts to get rid of the ketones and glucose, a lot of water is lost which can lead to dehydration and may worsen ketoacidosis
16
Q
what is diabetic ketoacidosis?
A
when there is an insulin deficiency, the body breaks down fats bc it can’t use glucose for energy, which causes a buildup of ketones in the blood
17
Q
what is the primary trigger for diabetic ketoacidosis?
A
insulin deficiency
18
Q
what are the characteristics of diabetic ketoacidosis?
A
hyperglycemia
ketosis
metabolic acidosis
19
Q
what is hyperglycemia?
A
high blood sugar (>250 mg/dL blood glucose) leading to osmotic diuresis and dehydration
20
Q
what is ketosis?
A
accumulation of ketones caused by breakdown of fatty acid causing a metabolic acidosis
21
Q
what are the ketone bodies produced?
A
acetoacetate
beta hydroxybutyrate
acetone
22
Q
what may be the initial presentation in about 25-40% of type 1 diabetics?
A
ketoacidosis
23
Q
what may occur in at least 34% of those with type 1 DM
A
ketoacidosis
24
Q
what is the leading cause of morbidity/mortality in DM?
A
ketoacidosis
25
what are the clinical manifestations of ketoacidosis?
polyuria
polydipsia
polyphagia
altered mental status
nausea, vomiting, abdominal pain
rapid breathing
fruity breath odor
26
what is polyuria?
frequent urination
27
what is polydipsia?
excessive thirst
28
what is polyphagia?
excessive hunger
29
why does rapid breathing occur with ketoacidosis?
as a compensation for metabolic acidosis
30
why is there fruity breath with ketoacidosis?
acetone production
31
t/f: organs don't work as well with high ketones
true
32
what are the symptoms of ketoacidosis?
high BG
foul odor breath
stomach ache with or without vomiting
severe cases can have trouble breathing
33
what are the causes of high BG in ketoacidosis?
forgetting to take insulin
using expired insulin or insulin not properly stored
34
what is the treatment of high BG in ketoacidosis?
check ketones if the BG is >300 mg/dL or when sick
35
what is the cause of foul odor breath in ketoacidosis?
illness
36
what is the treatment of foul odor breath in ketacidosis?
call the doctor if ketones are present
37
what is the cause of nausea with or without vomiting in ketoacidosis?
wrong dose insulin
38
what is the treatment for nausea in ketoacidosis?
drink extra water or sugar free liquids to stay hydrated
39
what is the cause of trouble breathing in severe cases of ketoacidosis?
insulin pump NOT working
40
what is the treatment for trouble breathing in severe cases of ketoacidosis?
DON'T exercise until ketones are no longer present
41
why is reduced EF with HF an issue?
bc not as much blood is being pumped out leading to poor endurance, elevated HR, OH, and tiredness
42
what conditions may result from ketoacidosis that need medical management?
severe ischemic cardiomyopathy with acute HF with reduced EF
hypoxic respiratory failure
NSTEMI/acute coronary syndrome
hypokalemia/hypomagnesemia
43
what other organ systems should we consider with diabetic pts?
endocrine
cardiac
pulmonary
renal
liver
hematology
44
what systems are included in the PT systems review?
MSK
CVP
integ
neuro
45
what are the exercise considerations with DM?
insuline injection timing, place, and type
HR response
46
t/f: we want pts with DM to have stable glucose levels b4 working with them
true
47
b4 working with a pt with DM, where do we want there BG levels?
80-100
48
if a pt has low BG, what should we do?
give them juice or a sugar tablet
49
after a pt is extubated, what should we do?
a cough assessment and breathing exercises
50
during day 1 in acute care, what are we doing?
early mobilization
51
during day 3 in acute care, what are we doing?
EOB
52
during day 6 in acute care, what are we doing?
independent ambulation
53
during day 8 in acute care, what are we doing?
D/C?
54
what is hypovolemic shock a result of?
fluid loss
55
what is caridogenic shock a result of?
ineffective heart pump
56
what is septic shock a result of?
infection
57
what does any type of shock lead to?
multisystem organ failure
58
what is the renal function?
to filter the blood and tightly control electrolytes
59
what are the 4 major functions of the kidneys?
filtration of the blood and excretion to remove wastes
regulation of electrolyte balance for tight control of Na, K, Cl, and P
regulation of pH or acid/base balance
regulation of blood volume and BP
60
what is the renin-angiotensin-aldosterone mechanism?
decreased Bp stimulates special cells in the kidneys that release renin in the blood
renin cleaves off part of the plasma proteins, angiotensin, that triggers an enzyme cascaderesulting in conversion to angiotensin 2 (a potent stimulator of aldosterone release) leading to aldosterone release
61
what turns angiotensin 1 to angiotensin 2?
ACE
62
what is glomerular filtration rate (GFR)?
the volume of nitrate formed by both the kidneys per minute
63
the heart pumps about how many liters of blood per minute under resting conditions?
5L
64
the heart pumps about 5L of blood per minute under resting conditions, which is about ___% of CO
25
65
what % of blood pumped per minute enters the kidneys to be filtered?
20%
66
how many liters of blood are pumped per day in males?
180 L
67
how many liters of blood are pumped per day in females?
150 L
68
what % of the filtrate of blood is returned to circulation by reabsorption?
99%
69
about how many liters of urine are produced per day?
1-2 L
70
what are the characteristics of pre-renal failure?
drop in CO
reduced GFR
CMP changes
decreased urine output
71
t/f: there is s drop in blood volume due to GI loss leading to a drop in MAP in pre-renal failure
true
72
t/f: there is reduced renal blood flow and subsequent perfusion of fewer nephrons in pre-renal failure
true
73
what are the CMP changes in pre-renal failure?
reabsorption of Na to limited fluid loss in an attempt to increase blood volume
altered electrolyte balance: elevated K, BUN, and creatinine
74
what are the characteristics of renal failure?
prolonged drop in CO
decreased urine output
CMP changes
75
does pre-renal failure or renal failure have a drop in CO that is unresponsive to a fluid bolus (not peeing out what they are taking in) and acute tubular necrosis?
renal failure
76
decreased urine output in renal failure is due to what?
proximal and distal convoluted tubules not reabsorbing Na bc water follows Na
77
what are the CMP changes in renal failure?
15:1 ratio of BUN:Cr
altered electrolyte balance: low K, high BUN, high Cr
78
what are the different types of renal replacement therapy (RRT)?
IHD (intermittent)
CRRT (continuous)
PIRRT (peritoneal)
79
t/f: CRRT provides more gradual fluid removal and solute clearance over prolonged treatment times compared to intermittent
true
80
what pts often use CRRT?
hemodynamically unstable pts
81
where are the common access points for RRT?
subclavian
internal jugular
femoral
82
what is the progression of liver failure?
healthy liver-->fatty liver-->liver fibrosis-->liver cirrhosis
83
what is the most common form of liver failure we will see?
fatty liver disease (alcoholic of non-alcoholic)
84
what are the various causes of liver disease?
fatty liver diseases
viral (hep B, C, D)
autimmune
chronic biliary disease
cardiovascular
storage diseases
other rare causes
85
what is the score used to classify liver one year survival rates?
Child-Pugh score
86
what is the score used to determine the severity of liver disease for transplantation?
MELD (model for end-stage liver disease)
87
what is the MELD score?
a combo of INR, creatinine, bilirubin, and sodium to create a score of 0-40 (higher score=higher severity) to determine liver disease severity for transplant
88
pts with a MELD score >___ will have their MELD re-calculated weekly
25
89
if sarcopenia is accounted for in MELD, how many points are added?
10
90
what causes jaundice?
increased bilirubin
91
if someone has liver necrosis, what are two key signs to look for?
light color stool
dark urine
92
t/f: alcoholic liver disease is a spectrum of disease which includes fatty liver w/ or w/o hepatitis, alcoholic hepatitis to cirrhosis
true
93
pt with severe alcohol use disorder mostly develop what disease?
chronic liver disease
94
what is the most frequent cause of CLD (chronic liver disease)?
severe alcohol use disorder
95
what is at risk drinking for men?
>14 drinks/week
OR
>4 drinks/occasion
96
what is at risk drinking for women and those over 65?
>7 drinks/week
OR
>3 drinks/occasion
97
more than ___ drinks/week in men is severe drinking from a liver toxicity standpoint
21
98
more than ___ drinks/week in women is severe drinking from a liver toxicity standpoint
14
99
what % of pts w/liver cirrhosis have hepatopulmonary syndrome?
5-32%
100
what is hepatopulmonary syndrome?
a combo of liver dysfxn or portal HTN, intrapulmonary vascular dilation, and abnormal oxygenation
101
what are the s/s of hepatopulmonary syndrome?
SOB (esp with sitting, standing, or exertion)
digital clubbing
spider angioma
cyanosis
102
what is spider angioma?
like varicose veins but much smaller and seen throughout the body
103
t/f: spider angioma is NOT a good sign
true
104
t/f: SpO2 can drop very quickly with hepatopulmonary syndrome, but we still have to mobilize them
true
105
the initial screening for hepatopulmonary syndrome involved what VS?
pulse ox to evaluate PaO2
106
O2 sat <____% indicates PaO2<70mmHg and is considered a (+) screen for hepatopulmonary syndrome
96
107
how is hepatopulmonary syndrome treated?
transplant
108
what are the implications of hepatopulmonary syndrome?
pace activities or maybe not able to treat
109
what is portal HTN?
when pressure of the blood entering the liver (via portal veins) is greater than the pressure of the blood in the inferior vena cava blood gets backed up and causes engorged veins (esp at the stomach and esophagus) and can lead to varicies and gastroesophageal bleeding
110
how is portal HTN treated?
beta blockers
transjugular intrahepatic portosystemic shunt (TIPS)
111
what is TIPS?
it's a shunt that creates a bypass bw the portal vein and the hepatic vein
112
what are the implications of portal HTN?
make sure the pt is breathing (look for Valsalva)
highest pressures occur at night, after eating, and in response to coughing, sneezing, and exercise
GI bleeds
113
when a pt has portal HTN, what should we teach them?
how to modify and reduce pressure with anything that increases intraabdominal pressure (ie, coughing, straining at stool, improper lifting)
114
what should we do with pts with portal HTN and GI bleeds?
monitor hemodynamics
weigh the risks vs benefits of mobilization with a recent bleed
s/s monitoring
115
what are the s/s of a GI bleed?
anemia
fatigue
SOB
dark stool is above the stomach (upper GI bleed)
116
what is hepatic encephalopaty (HE)?
a significant complication from liver disease caused by liver insufficiency and/or portal systemic shunting that results in elevated ammonia and systematic inflammation that causes significant neurocognitive changes
117
a pt with HE may have elevated levels of what?
ammonia (a neurotoxin)
118
t/f: HE causes significant neurocognitive changes
true
119
what are the symptoms of HE?
change in personality
agitation
lethargy
inappropriate behavior
confusion
coma
120
what is the incidence of HE?
30-40% of pts with liver disease develop HE
121
how is HE treated?
lactulose to release ammonia production and absorption
anti-microbials
122
what grade HE is a pt dependent but good for d/c?
grade 1
123
what grade HE is the goal to protect the pt from harm?
grade 2
124
what grade HE is the priority positioning?
grade 4
125
what is sarcopenia?
a condition of low muscle mass as evidenced by reduced muscles cross sectional area cause by an imbalance bw protein synthesis and breakdown
126
what may sarcopenia be caused by?
dietary intake
portal HTN complications
pro-inflammatory cytokines
hyperammonemia
limited physical activity
127
what is the incidence of sarcopenia?
as high as 30-70% of pts w/liver failure
128
how is sarcopenia treated?
nutrition (specifically protein and BCAA)
physical exercise
meds (vit D in geriatrics but not researched)
129
what are the implications of sarcopenia?
there is a higher risk for complications, longer LOS in hospital, poorer clinical outcomes post-transplant, and mortality
anticipate fxnal mobility deficits
130
what % of pts with liver cirrhosis have ascites?
5-10%
131
what is the most common complication of cirrhosis resulting from portal HTN and liver insufficiency?
ascites
132
what is the theory behind why ascites occurs?
reorganization of hemodynamics (inc hydrostatic pressure)-->inc vasodilation--> sodium and water retention
133
how is ascites treated?
diuretics
regular out of bed activities
large volume paracentesis (needle draws out fluid)
sodium restriction
albumin infusion
134
when would we use large volume paracentesis removal with ascites?
when there is so much fluid the pt can't breathe
135
what are the implications of ascites?
physical exam
monitor body mechanics
assess for edema
balance
positioning considerations for respiratory function
136
what position should be avoided with ascites?
supine bc it makes it difficult for them to breathe
137
what is the reference range for bilirubin?
0.2-1.3 mg/dL
138
what is bilirubin?
an orange-yellow colored waste formed in the liver from the breakdown of hemoglobin that is normally excreted by bile
139
if bilirubin is high, what does this mean?
the liver isn't flushing waste efficiently
140
what physical exam findings would be present with high bilirubin?
jaundice
yellow sclera
141
what is the reference range for ammonia?
15-60 mcg/dL
142
what is ammonia?
a nitrogen waste product normally excreted via urine
143
if ammonia is high, this could mean that kidney/liver fxn is correlated to what?
HE
144
what is the reference range for creatinine?
0.38-1.02 mg/dL
145
what is creatinine?
a waste products produced by muscle breakdown of creatine
normally flushed from the body via the kidneys which filter almost all of it from the blood to urine
146
if creatinine is high, what could this mean?
kidney problems
147
t/f: if a pt has high creatinine, they may have a reduced ability to clear medications
true
148
what is the reference range for albumin?
3.5-5.2 g/dL
149
what is albumin?
a liver protein that maintains osmotic pressure of the blood compartment
provides tissue nourishment
transports hormones, vitamins, drugs, and other substances throughout the body
150
what is the reference range for INR?
0.8-1.3
151
how is the INR calculated?
fromt he PTT (# of sec it takes for a sample of blood to clot when a reagent is added)
152
if INR is high, what is the risk?
bleeding
fall risk
exercise intolerance
153
what is included in observation for liver disease?
abdominal girth
muscle wasting
integ color integrity, edema
154
what is included in the physical exam for liver disease?
abdominal palpation for hepato/splenomegaly
posture
strength testing
balance
endurance
