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Adult Health III - NUR 254 > Unit 3 > Flashcards

Unit 3 Flashcards

(112 cards)

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1
Q

What causes diabetes insipidus?

A

caused by a deficiency of ADH from the posterior pituitary gland

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2
Q

How much urine do kidneys usually pass in a day?

A

1-2 quarts

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3
Q

How much urine do kidneys pass in a day with DI?

A

3-20 quarts

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4
Q

What are the signs and symptoms of diabetes insipidus?

A 
polyuria and polydipsia.
urine specific gravity <1.005
output not controlled by limiting intake causing dehydration with hypernatremia
nocturia
dry skin, dizziness, confusion, nausea
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5
Q

What is the characteristics of the urine with diabetes insipidus?

A

dilute, almost clear, and odorless.

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6
Q

What are causes of diabetes insipidus?

A

CVA, Head injury, aneurysm, intracranial tumor, irradiation of pituitary gland.

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7
Q

What are the diagnostic test for diabetes insipidus?

A

fluid deprivation test
decrease urine osmolality and urine specific gravity <1.005
CT or MRI to assess for tumors

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8
Q

What is a fluid deprivation test?

A

measures changes in patients body weight and urine concentration after restricting liquid intake. fluids withheld for 8-12 hours, BP monitored. if BP drops significantly or patient loses 3-5% of body weight. blood is drawn to check sodium levels

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9
Q

What is the results of a positive fluid deprivation test?

A

serum sodium >145 and serum osmolality >300

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10
Q

What are the goals of medical management of diabetes insipidus?

A

replace ADH
replace fluids
identify and correct the underlying cause

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11
Q

What medication is used to replace ADH?

A

Desmopressin (DDAVP), also known as vasopressin

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12
Q

What is important with I&Os for patients with diabetes insipidus?

A

do NOT limit PO intake. match I&Os to prevent dehydration, hypovolemia, and hypernatremia.

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13
Q

What is syndrome of inappropriate antidiuretic hormone (SIADH)?

A

excessive amount of ADH. causes kidney to reabsorb H2O and decreases urine output resulting in water retention. low sodium levels due to hemodilution.

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14
Q

What are the causes of SIADH?

A

CNS disorders, tumors to the brain and/or neck. pituitary tumors. or head injuries.
pain, stress, exercise, and low blood sugar levels.
secondary to meds, like NSAIDS or psychotropic meds.

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15
Q

What are signs and symptoms of SIADH?

A

hyponatremia- sodium <125
H2O retention progressing to H2O intoxication.
weakness, muscle cramps. anorexia. nausea, headache, diarrhea, lethargy, disorientation, irritability. weight gain. seizures.

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16
Q

What are the diagnostic tests for SIADH?

A

lab tests for serum sodium, serum osmolality. (both will be low)
high urine osmolality and urine specific gravity >1.030

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17
Q

What is the medical management of SIADH?

A

Eliminate underlying cause.
fluid restriction - 500 to 1000 mL/day
furosemide
monitor K, Na, I&Os, daily weights, and neuro checks

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18
Q

What hormones are secreted by the adrenal glands?

A 
glucocorticoids (cortisol)
mineralocorticoids (aldosterone)
sex hormones (androgens and estrogens)
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19
Q

What is cortisol?

A

is a glucocorticoid produced by the adrenal glands. helps maintain BP and heart and blood vessel function. slows the immune systems inflammatory response and regulates metabolism.

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20
Q

What is adrenocortical insufficiency (Addison’s disease)?

A

the adrenal glands are damaged and cannot produce enough of the adrenal hormones cortisol and aldosterone

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21
Q

What is aldosterone?

A

a mineralocorticoid produced by the adrenal glands. helps maintain BP, and balance sodium and potassium in the bloodstream.

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22
Q

What is the cause of Addison’s disease?

A

autoimmune disorders are the primary cause. or infections such as TB, HIV/AIDS, and meningitis. adrenalectomy, pituitary hypofunction, or metastatic tumors. or medications and stopping corticosteroid medications abruptly.

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23
Q

What are signs and symptoms of Addison’s disease?

A

muscle weakness, anorexia, GI symptoms, fatigue, dark pigmentation of the skin and mucosa, hypotension, low blood glucose, low serum sodium. high serum potassium. mental changes. apathy. emotional lability, confusion.

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24
Q

What is Addisonian crisis?

A

severe adrenal insufficiency

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25
What are signs and symptoms of Addisonian crisis?
dehydration, sudden severe pain in lower back, abdomen, or legs. cyanosis. and the classic signs of circulatory shock: pallor, apprehension, rapid and weak pulse, rapid respirations, and low blood pressure
26
What can cause Addisonian crisis in Addison's disease patients?
overexertion, exposure to cold, or acute infection
27
What are risk factors for Addisonian crisis?
someone with underlying adrenal hypofunction who undergo stressful events such as trauma, surgery, pregnancy, and infections
28
What are the diagnostic tests for Addison's disease?
hormonal blood and urine tests, checking adrenocortical hormone levels and ACTH levels. ACTH stimulation test. labs checking for hyponatremia, hypoglycemia, and hyperkalemia. CT/MRI, Abdominal US Antibody tests checking for autoimmune disorders
29
What is an ACTH stimulation test?
injection of synthetic ACTH given, blood levels are then checked.
30
What results would people with Addison's disease have with an ACTH stimulation test?
would have little or no increase in cortisol levels
31
What is the treatment for Addison's disease?
monitor vitals - give vasopressors (dopamine) for persistent hypotension. antibiotics for infections to prevent crisis. Chronic Addison's disease - lifetime of replacement corticosteroids (prednisone, hydrocortisone, or dexamethasone) and mineral corticoids (fludrocortisone) if under stress, may need additional doses of corticosteroids to prevent crisis.
32
What is the recommended diet for patients with Addison's diease?
high in sodium, low in potassium
33
What is the priority with Addisonian Crisis?
Treat shock
34
How do you treat shock in Addisonian crisis?
IV fluids and corticosteroids (hydrocortisone or dexamethasone)
35
What must you assess with Addison's disease?
orthostatic BPs. skin turgor and color. weight loss. muscle weakness, or fatigue.
36
What are signs and symptoms of Addisonian crisis?
shock, hypotension, rapid/weak pulse, tachypnea, pallor, weakness.
37
What should you avoid with Addison's disease?
physical stressors, over exertion. cold exposure, infection, and emotional distress.
38
What is Cushing's Syndrome (Adrenocortical Hyperactivity)?
too much hormone cortisol is made
39
What are the causes of Cushing's syndrome?
long term, high dose use of cortisol-like glucocorticoids. Pituitary tumors, Ectopic ACTH-producing tumors, adrenal tumors.
40
Who is most likely to experience Cushing's syndrome?
``` women > men ages 30-50 people with Type 2 Diabetes HTN high BG levels over time ```
41
What are signs and symptoms of Cushing's disease?
moon face, buffalo hump, HTN, mood swings, increased hair, edema. truncal obesity with thinner extremities. muscle wasting. weakness. skin conditions. easy bruising, purpura, skin ulcers.
42
What are the diagnostic tests for Cushing's Syndrome?
``` two of the following to confirm: 24 hour urinary free-cortisol test late-night salivary cortisol test low-dose dexamethasone suppression test. labs - elevated cortisol, hyperglycemia, hypernatremia, hypokalemia Imaging Tests- CT/MRI ```
43
What is the medical management of Cushing's Syndrome?
treat causative factor. If removal of tumor, may need post-op hormone replacement to avoid Addison's disease. If not removed, adrenal inhibitors may be used (metyraprone, aminoglutethimide, mitotane, nizoral)
44
What are the complications of Cushing's syndrome?
``` osteoporosis, bone loss and fractures. heart attack, stroke, high BP, high cholesterol levels. DVT's/PE infection depression, memory loss insulin resistance, type 2 diabetes ```
45
What is a complication of Cushing's Syndrome treatments?
Addisonian Crisis
46
What are some adverse effects with Cushing's Syndrome?
hypokalemia hypernatremia hyperglycemia
47
What is an appropriate diet for someone with Cushing's Syndrome?
high protein, low carb, low sodium, high potassium, low calorie, fluid restriction
48
What is hyperparathyroidism?
elevated PTH hormone levels
49
What does the parathyroid hormone (PTH) regulate?
calcium and phosphorus
50
What does high PTH levels trigger?
triggers bones to released increased calcium into the blood causing weak bones and elevated blood calcium levels.
51
What is a complication of increased blood calcium levels?
kidney stones
52
Who is more likely to have hyperparathyroidism?
women > men
53
What are the signs and symptoms of hyperparathyroidism?
may be asymptomatic. elevated serum calcium, polyuria. bone decalcification. renal calculi. fatigue. muscle weakness. N/V. constipation. HTN. cardiac dysrhythmias.
54
What are the diagnostic tests for hyperparathyroidism?
labs- elevated calcium and PTH levels.
55
What are causes of hyperparathyroidism?
a benign tumor (adenoma) on one of the parathyroid glands
56
What is a complication of hyperparathyroidism?
hypercalcemic crisis
57
What is the serum calcium level for a hypercalcemic crisis?
>15 mg/dL
58
What are normal calcium levels?
8.5-10.5 mg/dL
59
What is the treatment for a hypercalcemic crisis?
rehydration, diuretic agents to promote renal excretion of calcium.
60
What is used in emergent situations to decrease serum calcium levels quickly?
calcitonin, corticosteroids, and dialysis
61
What is the treatment for hyperparathyroidism?
parathyroidectomy. hydration therapy mobility to reduce calcium excretion from bones vitamin D supplements
62
What is hypoparathyroidism?
deficiency in PTH
63
What are factors that cause Hypoparathyroidism?
``` post-op hypoparathyroidism after accidental damage to the parathyroid gland autoimmune diseases heredity extensive radiation to face or neck hypomagnesemia. ```
64
Hypoparathyroidism results in what electrolyte imbalance?
hypocalcemia and hyperphosphatemia
65
What are signs and symptoms of hypoparathyroidism?
numbness and tingling in finger tips, toes, and lips muscle aches/cramps in legs, feet, abdomen, and face Tetany, twitching muscles bronchospasms, laryngeal spasm, carpopedal spasm anxiety, irritability, depression, delirium, and ECG changes
66
What are the signs of Tetany?
Chvostek's sign and Trousseau's sign
67
What is tetany caused by?
hypocalcemia
68
What are the diagnostic tests for hypoparathyroidism?
blood levels to include calcium, phosphorus, magnesium, PTH EKG, abnormal rhythms xrays and bone density tests
69
What is the goal in treatment of hypoparathyroidism?
increase serum calcium levels to 9-10 mg/dL
70
What is the treatment for hypoparathyroidism?
calcium gluconate IV. sedatives (pentobarbital) to decrease neuromuscular irritability. parathyroid hormone (Natpara) decrease environmental stimuli may need trach/mechanical vent or bronchodilators for respiratory distress Ca supplements or Phosphorus binders (aluminum carbonate) Vitamin D
71
What is the recommended diet for someone with hypoparathyroidism?
high in calcium, low in phosphorus
72
What are emergencies?
sudden, unforeseen events that threaten health or safety
73
What are disasters?
combined threat to life, public health, and environment. have little or no warning. initially overwhelm available personnel and emergencies.
74
What is a pandemic?
infection that spreads rapidly around the world
75
What is emergency preparedness?
plans to prevent, respond to, and recover from emergencies
76
What is surge capacity?
the ability to rapidly meet increased demand for qualified personnel and resources.
77
What is a disaster?
an event of destructive magnitude that kills, injuries, or causes human suffering to a significant number of people or the environment and requires that need for external assistance. it disrupts that infrastructure and normal functioning of a community or society.
78
What is a mass casualty event?
any large scale even in which emergency medical resources such as supplies, medical/rescue personnel, or equipment are overwhelmed by the number and severity of casualties, thus requiring prioritization of medical care by triage.
79
What are the four phases of emergency response?
mitigation preparedness emergency response recovery
80
What is the mitigation phase of emergency response?
both before and after emergency occurs. | warning systems and insurance claims.
81
What is the preparedness phase of emergency response?
before the emergency occurs. gain understanding of expected roles in emergency. develop emergency plan and designate meeting places.
82
What is the emergency response phase?
implementation of preparedness plans. victims are triaged and treated as soon as possible. search and rescue operations. shelter for survivors. repairing utility infrastructures.
83
What is the recovery phase of emergency response?
designed to returned community to normal or create new, safer normal. rebuilding, reemployment, repair, and reconstitution of government operations.
84
Who is responsible for emergency management and response?
local governments. state divisions of emergency management. US department of homeland security. community emergency response team program.clinician outreach communication activity program.
85
What is the nurses role in disasters?
vary based on type of disaster, location, number and condition of victims, personnel, and supplies available. never jeopardize own safety. must operate within the defined scope of practice
86
What is the hospital's response to a disaster?
staff safety and availability of PPE. decontamination equipment and processes surge capacity, evacuation plans, addressing mental health or psychosocial issues, debriefing plans and maintaining readiness.
87
What is hospital triage?
sorting of patients based on their need for treatment and resources available to provide treatment.
88
What is hospital triage based on?
``` ABCD priorities a-airway with c-spine precautions b-breathing c-circulation with hemorrhage control d-disability and resource management ```
89
What are the categories for hospital (ED) triage?
emergent(immediate) urgent (delayed) non-urgent (minor)
90
What is considered emergent (immediate) in ED triage?
life-threatening issues that require prompt treatment and care. stabilization of the patients condition is critical.
91
What is considered urgent (delayed) in ED triage?
serious health conditions in which delay of treatment and care would result in life-threatening situatuions.
92
What is considered non-urgent (minor) in ED triage?
minor issues that do not require prompt care. can ambulate and are stable in their conditions
93
What is the purpose of start triage (reverse triage)?
used in mass casualty incidents. | doing the greatest good for the greatest number of people.
94
What is triage?
prioritizing clients for treatment based on the severity of illness or injury and in light of supplies and resources available.
95
What observations is start triage based on?
respirations perfusion mental status
96
What are the tags for START triage?
black tags - expectant red tags - immediate yellow tags - delayed green tags - minor
97
What does a black tag indicate?
deceased or those whose injuries are so extensive that they will not be able to survive given the care that is available.
98
What does a red tag indicate?
those who cannot survive without immediate treatment but who have a chance at survival. includes compromised to patients ABCs.
99
What does a yellow tag indicate?
those who require observation. they do have life threatening injuries, but their condition is stable for the moment and they are not in immediate danger of death.
100
What does a green tag indicate?
patients are "walking wounded" require medical care at some point, after more critical injuries have been treated
101
How do you assess for assigning tags?
RPMs respirations perfusion mental status
102
What is assessed with respirations?
if breathing, <30 bpm move to perfusion. >30 bpm red tag. if not breathing, reposition air way. do they start breathing? Red tag If they do not start breathing, black tag.
103
What is assessed with perfusion?
radial pulse and cap refill. no radial pulse and cap refill >2 sec, red tag. radial pulse and cap refill <2 sec, move to mental status
104
What is assessed with mental status?
can they follow simple commands? no - red tag yes - yellow tag
105
When do you use green tags?
walkie-talkie patients
106
What are the site specific disaster zones?
hot zone warm zone cold zone
107
What is the hot zone?
initial site of incident | only personnel with appropriate protective equipment are allowed in hot zone
108
What is the warm zone?
decontamination
109
What is the cold zone?
where decontaminated victims are triaged and treated
110
What is bioterrorism?
deliberate release of viruses, bacteria, or other microbes as weapons
111
What are the primary agents of bioterrorism?
``` bacillus anthracis (anthrax) clostridium botulinum toxin (botulism) Yersinia pestis (plague) viral hemorrhagic fevers variola major (small pox) francisella tularensis (tularemia) ```
112
What do we have to treat bioterrorism attacks?
immediate treatment is limited. homeland security and CDC has preassembled "push packages" that are delivered within 12 hours after attack if location permits.

Adult Health III - NUR 254 (2 decks)

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