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Fall 2015 Nursing School > 314 Final > Flashcards

314 Final Flashcards

1
Q

Corticotropin Releasing Hormone –> (4)

A

Anterior pituitary –> ACTH –> adrenal cortex –> glucocorticoids/steroid hormones

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2
Q

Describe negative feedback loop

A

The hormone released by the target organ stops the hypothalamus and pituitary from releasing hormones that stimulate target organ

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3
Q

What is an example of a glucocorticoids?

A

Cortisol

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4
Q

Adrenal glands produce glucocorticoids but do not

A

Store them

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5
Q

4 key times in the cortisol circadian rhythm

A

Peak at awakening, 8:30AM

Decrease during the day

Lowest at midnight

Start rising around 2-3AM

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6
Q

What is the hypothalamus stimulated by? (2)

A

Stress

CNS stimuli

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7
Q

Physiological effects of glucocorticoids in terms of metabolism (6)

A

Increased gluconeogenesis

Increased glucose storage as glycogen

Increased lypolysis and fat redistribution

Decreased protein synthesis

Decreased glucose uptake into fat and muscle

Decreased peripheral to glucose use

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8
Q

Thyrotropin releasing hormone (TRH) –> (4)

A

Anterior Pituitary –> releases TSH –> Thyroid –> releases thyroid hormones

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9
Q

Physiological effects of glucocorticoids in CV system

A

Maintains vasculature integrity

Increased RBC

Decreased LEBM

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10
Q

Low dose glucocorticoids for endocrine treatment

A

Physiological

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11
Q

High dose glucocorticoids for non-endocrine treatment

A

Pharmacological

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12
Q

All glucocorticoids produce the same therapeutic effect but differ in three areas

A

Half life

Mineralocorticoid potency

Anti-inflammatory potency

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13
Q

Low dose glucocorticoids for endocrine treatment

A

Physiological

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14
Q

High dose glucocorticoids for non-endocrine treatment

A

Pharmacological

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15
Q

All glucocorticoids produce the same therapeutic effect but differ in three areas

A

Half life

Mineralocorticoid potency

Anti-inflammatory potency

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16
Q

Effects of pharmacological doses of glucocorticoids (4)

A

Decrease synthesis of chemical mediators

Decrease infiltration of phagocytes

Decrease proliferation of lymphocytes

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17
Q

Glucocorticoids inhibit chemical mediators such as (3)

A

Prostaglandins

Leukotrienes

Histamines

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18
Q

Inhibition of chemical mediators means decreased (4)

A

Pain

Edema

Erythema

Warmth

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19
Q

Why do glucocorticoids have greater anti-inflammatory effects than NSAIDs?

A

More diverse mechanisms

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20
Q

One side effect of pharmacologic doses of glucocorticoids is that

A

Physiologic effects are magnified

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21
Q

Therapeutic uses of pharmacologic glucocorticoids (10)

A 
Rheumatoid arthritis 
Lupus 
Inflammatory bowel disease 
Osteoarthritis 
Allergies 
Dermatology
Asthma
Neoplasms 
Immunosuppression for skin graft
Prevention of respiratory distress syndrome
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22
Q

4 systemic routes of glucocorticoid administration

A

Oral

IM

SQ

IV

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23
Q

Local administration routes (4)

A

Topical

Inhalation

Intranasal

Intra-articular

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24
Q

High lipid solubility increases the risk for

A

Systemic effects

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25
Q

Multiple small doses of glucocorticoids means better maintenance of blood levels within therapeutic range, but increases the risk of

A

Adrenal suppression

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26
Q

Large doses of intermediate acting glucocorticoids every other day

A

Alternate dosing

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27
Q

Alternate dosing decreases (3)

A

Adrenal suppression

Growth retardation

Toxicity

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28
Q

May fall to sub therapeutic levels

A

Alternate dosing

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29
Q

Normal body temperature range

A

36-37.5

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30
Q

When is the temperature highest?

A

Late afternoon/early evening

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31
Q

Temperature drops between

A

8-2AM

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32
Q

Heat producing behaviors (5)

A

Superficial vasoconstriction

Contraction of pilomotor muscles

Huddle position

Shivering

Increased epinephrine and thyroid hormones

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33
Q

Heat dissipation (2)

A

Superficial vasodilation

Diaphoresis

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34
Q

Superficial vasoconstriction allows heat loss through

A

Convection or radiation

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35
Q

Diaphoresis allows heat loss via

A

Evaporation

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36
Q

What substance increases thermoregulatory center set point?

A

Prostaglandin E2

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37
Q

Purpose of pyrexia (3)

A

Increased WBC activity

Increased interferon production

Activation if T cells

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38
Q

If the body temperature increases by 1°C, how much will the heart rate increase?

A

15 bpm

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39
Q

If the body temperature increases by 1°F, how much will the heart rate increase?

A

10 bpm

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40
Q

Determining the underlying cause is important when treating

A

Fever

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41
Q

Fever treatments (5)

A

Cool sponge bath

Cooling blanket

Fluids

Carbohydrates

Antipyretics

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42
Q

Groups that may have blunted fever responses (3)

A

Infants

Immunocompromised

Eldery

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43
Q

Examples of immunocompromised individuals (3)

A

HIV

Chemotherapy

Organ transplant

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44
Q

Core temperature between 37.8°C and 40°C

A

Heat exhaustion

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45
Q

Core temperature above 40°C/104°F

A

Heat stroke

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46
Q

Hypothermia range

A

Below 93°F or 35°C

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47
Q

Most sensitive method for screening diagnosing and monitoring treatment of thyroid issues

A

Serum TSH

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48
Q

Which serum test can monitor thyroid hormone replacement therapy?

A

Serum T4

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49
Q

Used for the diagnosis of hyperthyroidism

A

Serum T3

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50
Q

Both tests for T3 and T4 are obtained after

A

Serum TSH

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51
Q

Lifelong levothyroxin (T4)

A

Hypothyroidism

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52
Q

A severe form if hypothyroidism

A

Myxedema

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53
Q

What is myxedema called in infants?

A

Cretinism

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54
Q

Does myxedema cause pitting edema?

A

No

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55
Q

Causes mucus type of edema

A

Myxedema

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56
Q

Drug for hypothyroidism (trade) (3)

A

Synthroid

Levoxyl

Levothroid

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57
Q

Generic name for hypothyroidism drug

A

Levothyroxine

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58
Q

Hypothyroidism during pregnancy can cause (3)

A

Retardation/low IQ

Impair development of muscle, bones and nerves

Permanent neuropsychological changes

59
Q

When is the baby most affected by the mother’s hypothyroidism?

A

1st Trimester

60
Q

Hyperthyroidism is important to diagnose early in mothers, but the symptoms are very nonspecific such as (3)

A

Tiredness

Irritability

Poor concentration

61
Q

Pregnant women required ___% more replacement therapy

62
Q

Causes of hyperthyroidism (6)

A 
Graves Disease 
Diffuse goiter 
Multinodular goiter
Adenoma of thyroid 
Thyroiditis
Iodine containing agents
63
Q

Hyperthyroidism symptoms (5)

A

Strong and rapid heartbeat

CNS stimulation

Skeletal muscle atrophy

Increased appetite

Weight loss

64
Q

Examples of CNS stimulation (3)

A

Nervousness

Insomnia

Rapid speech/thought

65
Q

Hyperthyroidism treatment (3)

A

Surgical ablation

Radioactive iodine

Anti-thyroid drugs

66
Q

Drugs to relieve symptoms of surgical ablation (2)

A

Calcium channel blockers

Beta blockers

67
Q

How long does the full effect radioactive iodine take?

A

2-3 months

68
Q

Anti-thyroid drug (2)

A

Propylthiouracil (PTU)

Methimazole

69
Q

Propylthiouracil blocks (2)

A

TH synthesis

Conversion of T4-T3

70
Q

Methimazole blocks only

A

Conversion of T4-T3

71
Q

What is the trade name of methimazole?

72
Q

Thyrotoxic crisis/thyroid storm is the increased release of thyroid hormones precipitated by (2)

A

Surgery

Severe illness

73
Q

Thyroid crisis/storm symptoms

A

Profound hyperthermia

Severe tachycardia and other heart issues

Restlessness/tremors

Coma

74
Q

Large myelinated fibers for “fast” pain

A

A-Delta fibers

75
Q

Small

Un myelinated

Slow

76
Q

Release glutamate at the synapse with spinal neurons

77
Q

Release both glutamate and substance P

78
Q

Barriers to pain management (7)

A 
Inadequate assessment 
Fear of side effects 
Fear of addiction/tolerance 
Fear of respiratory depression 
Fear of hastening death 
Healthcare systems 
Cost and reimbursement
79
Q

The goal is to eliminate pain by treating underlying cause. What kind of pain?

80
Q

What is the goal for chronic pain?

A

Maintain quality of life and function

81
Q

Pain is relayed from tissues by nerves

A

Nociceptive pain

82
Q

Pain is from the nerve itself

A

Neuropathic pain

83
Q

Character of nociceptive pain (4)

A

Dull

Aching

Pressure

Tender

84
Q

Character of neuropathic pain (4)

A

Shooting

Burning

Electric shock

Tingling

85
Q

Why is it important to identify whether the pain is nociceptive or neuropathic?

A

Because they require different treatments

86
Q

Which kind of pain responds to traditional pain medications and therapies?

A

Nociceptive pain

87
Q

4 other types of pain

A

Cutaneous

Deep somatic

Visceral

Referred

88
Q

This kind of pain is superficial. Can be localized or distributed along the dermatomes.

89
Q

This pain is deep, difuse, and sometimes radiating

A

Deep somatic

90
Q

This pain has small unmyelinated afferent nerve fibers

91
Q

Most common pain in elderly (5)

A

Back pain

Osteoarthritis

Diabetic neuropathy

Post-herpetic neuralgia

Cancer

92
Q

Veteran common pain (5)

A

Headache

Joint pain

Back pain

Muscle pain

Abdominal pain

93
Q

Patient report of pain is #1 priority. What is #2 priority?

A

Prior pain history

94
Q

3 priority in gauging pain is painful diagnoses. For example (5)

A 
Degenerative joint/disc disease 
Spinal stenosis 
Osteoporosis/compression fracture 
Cancer
Herpes zoster
95
Q

Pain assessment tools (4)

A

CNPI
NOPAIN
PAIN-AD
Wong-Baker FACES

96
Q

Causes of pain in dementia patients (5)

A

Constipation/diarrhea

Lodged food

Contracture

Pressure ulcer

UTI

97
Q

Empirical trials, lowest on the hierarchy, are useful in patients that are

98
Q

Non-opioids are (1)

A

COX inhibitors

99
Q

Two categories of COX inhibitors

A

Anti-inflammatory (NSAIDs)

Not anti-inflammatory

100
Q

Anti-inflammatory (NSAIDs) (2)

A

COX1 inhibitors

COX2 inhibitors

101
Q

COX1 inhibitors (3)

A

Ibuprofen

Aspirin

Naproxen

102
Q

COX2 inhibitors (1)

103
Q

Which cyclooxygenase inhibitor lacks anti-inflammatory properties?

A

Acetaminophen

104
Q

Opioid side effects (7)

A 
Constipation 
Sedation 
Nausea 
Myoclonus 
Respiratory distress 
Urinary retention 
Pruritus
105
Q

Examples of adjuvants (5)

A 
Antidepressants 
Anticonvulsants 
Corticosteroids 
Local anesthetics
Biphosphonates
106
Q

Pain 1-3

A

Non-opioid with potential adjuvant

107
Q

Pain 4-6

A

Weak opioid AND potential adjuvant or NSAID

108
Q

7-10

A

Strong opioid

Potential adjuvant

Potential NSAID

109
Q

3 times to avoid NSAIDs

A

Avoid in Renal disease

Avoid in Bleeding risk

Avoid with steroids

110
Q

Do not use acetaminophen if the patient has

A

Liver disease

111
Q

What % is an IR break through dose?

A

10-20% of 24 hour dose

112
Q

After initial IR is given, how long until calculating 24 hour dose?

A

25-48 hours

113
Q

Other pain therapies (3)

A

Neurolytic block

Neuroablative procedures

Vertebroplasty/kyphoplasty

114
Q

During REM sleep, acetylcholine and dopamine

115
Q

Secretes melatonin in darkness

A

Pineal gland

116
Q

During REM sleep brain metabolism

117
Q

Most dreaming occurs during

118
Q

RAS is inhibited during

A

NREM sleep

119
Q

Lightest stage of sleep in which eyes roll from side to side

120
Q

Light sleep, but eyes are still

121
Q

Deepest stages of sleep

A

Stage 3 and 4

122
Q

Delta sleep occurs during

A

Stage 3 and 4

123
Q

When does snoring occur?

A

Stage 3 and 4

124
Q

Which stage is essential for restoring energy and releasing GH

A

Stage 3 and 4

125
Q

HR and respiration drop 20-30% during

A

Stage 3 and 4

126
Q

Sleep is important for synthesis of

127
Q

How many hours a day do newborns sleep?

128
Q

Newborns instantly enter

129
Q

How long is a newborn sleep cycle?

A

50 minutes

130
Q

Do newborns have rapid eye movement?

131
Q

Awaken every 3-4 hours, eat, and then go back to sleep

132
Q

Sleep 14-15 hours a day

133
Q

Sleep 12-14 hours

134
Q

Afternoon naps still advised for

135
Q

Nighttime fears and nightmares begin with

136
Q

Enuresis with

A

Preschoolers

137
Q

Establishing a routine is key for

A

Preschoolers

138
Q

Who needs 11-13 hours

A

Preschoolers

139
Q

Who needs 10-11 hours

A

School aged

140
Q

7-9 hours for

A

Adults and elders

141
Q

Caused by lack of hypocretin

A

Narcolepsy

142
Q

CAGE screening for

A

Alcoholism

143
Q

What score is significant for the CAGE?

144
Q

PHQ-9 screens for

A

Depression

Fall 2015 Nursing School (17 decks)

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