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7th Semester > 400 Exam 5 > Flashcards

400 Exam 5 Flashcards

1
Q

ϖ Gallbladder is not essential for life because ?

A

because liver produces the fats

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2
Q

but it helps to store bile so that when person eats it can respond to the amount of food ingested and let out bile as needed.

A

gallbladder

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3
Q

ϖ Gallbladder’s main function is to

A

store and concentrate bile that is formed in the liver (“considered a store house for bile”)

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4
Q

ϖ Acute or chronic inflammation of the gallbladder—can occur with or without stones or obstruction

A

cholecystitis

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5
Q

symptoms of cholecystitis

A 
fever
leukocytosis
jaundice
RUQ/back/shoulder pain
fullness
abd. distention
anorexia
N/V
dark urine
pale poop
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6
Q

labs with cholecystitis

A

elevated ALT, AST, and bilirubin

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7
Q

ϖ Calculi, or gallstones, usually form in the gallbladder from the solid constituents of bile—

A

CHOLELITHIASIS (GALLSTONES)

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8
Q

mostly made of cholesterol

A

cholelithiasis

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9
Q

risk factors for gallstones?

A 
women over 40
Oral contraceptives
GI disease
T-tube fistula
hypercholesterolemia
anticholestrol meds
rapid weight loss
type 1 DM
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10
Q

sx of gallstones

A

no pain
mild GI symptoms
epigastric distress

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11
Q

acute sx of gallstones

A

RUQ pain
N/V
fever
increased WBCs

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12
Q

chronic sx of gallstones

A

“flare ups”
pain
dyspepsia

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13
Q

simplified sx of gallstones

A 
RUQ pain that radiates
jaundice
clay stool
fever
WBC elevation
N/V
murphy's sign
dark urine
vit. def. (ADEK)
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14
Q

♣ Palpate under right subcostal area—when pushed on and released they will do a preinspirtory arrest (like a gasp) causes pain to that area

A

murphy’s sign

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15
Q

what is avoided because it could cause spasm of sphincter of Oddi with gallstone patients?

A

o Morphine

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16
Q

instead of morphine use _____.

A

meperidine (Demerol)

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17
Q

• Occurs in a few patients with gallbladder disease—usually with obstruction of common bile duct (biliary obstruction)

A

jaundice

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18
Q

dx of CHOLECYSTITIS and CHOLELITHIASIS

A

Abd. x-ray
Abd. Ultrasound
Endoscopic Retrograde Cholangiopancreatography (ERCP)

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19
Q

o least invasive

Can rule out other causes (Ex. paralytic ileus)—not helpful in dx gallbladder disease

A

abdominal XRAY

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20
Q

• Normally can’t see gallstones on x-ray, if we can it means ?

A

it’s really bad

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21
Q

o most commonly done

• Diagnostic procedure of choice—95% accuracy

A

Abdominal ultrasound

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22
Q

education before abdominal ultrasound

A

NPO after midnight before test to give the gallbladder time to fill up with bile

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23
Q

• Provides direct visualization into hepatic biliary system with side-viewing fiberoptic camera introduced into esophagus to the descending duodenum

A

Endoscopic Retrograde Cholangiopancreatography (ERCP)

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24
Q

pre op education with ERCP

A

multiple position changes are used beginning in left semi-prone position

NPO several hours before and until gag reflex returns

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25
Q

• Not just done for cholisisthiasis helpful to determine reason patient is jaundice (Ex. From liver disease or a stone)

A

o PERCUTANEOUS TRANSHEPATIC CHOLANGIOGRAPHY (PTC)

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26
Q

o Water soluble contrast agent (dye) injected directly into biliary tract outlines visual of whole biliary tract on a radiologic instrument—shows any obstruction

A

PERCUTANEOUS TRANSHEPATIC CHOLANGIOGRAPHY (PTC)

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27
Q

pre op PTC

A

fasting
check H and H
check platelet count

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28
Q

post op PTC

A

monitor for bleeding, infection, and peritonitis

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29
Q

IV dye. bile duct and liver problems are seen with X-ray.

Need IV and fast for 4 hours!!

A

Hida Scan

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30
Q

intra op with PTC:

A

administer broad spectrum ATB

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31
Q

when pt comes into hospital with acute cholecystitis what do we do?

A 
NPO
IV fluids
NG tube
pain meds
IV ATB
consider for surgery
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32
Q

diet education when they’re sent home without surgery

A

low fat liquids first
gradually progress to a low fat diet with high protein
avoid fatty foods and alcohol

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33
Q

chronic cholecystitis patients

A

monitor diet
keep log of triggers
OTC pain meds
surgery referral for gallbladder removal

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34
Q

non surgical removal of gallstones

A

oral dissolution therapy

stone removal by instrumentation

intracorporeal lithotripsy

ESWL

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35
Q

meds used with oral dissolution therapy

A

ursodeoxycholic acid (actual)

chenodeoxycholid acid (Chenix)

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36
Q

o May be used as therapy, before surgery, or during surgery—remove the stones in the tracts

A

• Stone Removal by Instrumentation

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37
Q

2 ways for Stone Removal by Instrumentation to be completed?

A
  1. catheter and instrument with basket attached are threaded through T-tube or fistula
  2. ERCP endoscope is inserted, a cutting instrument is passed through the endoscope into the common bile duct
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38
Q

o Go in with endoscope breaks up stones with laser pulse technology breaks up stones so they can pass

A

• Intracorporeal Lithotripsy

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39
Q

o Non-surgical fragmentation of gallstones – no incision – treated as outpatient

Sends repeated shock waves directed over the gallbladder to break up stones

o Very painful—not used often anymore

o Usually requires more than one treatment

A

• Extracorporeal shock wave lithotripsy (ESWL)

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40
Q

how are waves transmitted with ESWL?

A

through water

fluid-filled bag or by immersing the patient in a water bath

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41
Q

surgical management for gallstones

A

laparoscopic cholecystectomy

open cholecystecomy

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42
Q

o Usually same-day surgery go home that afternoon or next day

o 3-4 ½ inch incisions (1 to umbilicus, 1 to RUQ of abdomen, and few on sides) used to blow belly up with CO2 gas for better visualization

A

laparoscopic cholecystectomy

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43
Q

main post op intervention with laparoscopic

A

get up and moving or roll side to side to break up gas

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44
Q

open cholecystectomy is used when they can’t have laparoscopic due to

A

inflammation
perforation
other complications

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45
Q

they may come back with a ______ with open cholecystectomy

A

T-tube

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46
Q

Looks like T and fits into common bile duct to keep it open so that inflammation doesn’t cause an obstruction or remaining stones don’t cause an obstruction

A

♣ T-tube

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47
Q

high risk for what with open cholecystectomy

A

DVTs, bleeding, infection

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48
Q

o In pre-op you want consents for both ???? just incase

A

laparoscopy and open surgery

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49
Q

o Soft diet is started after bowel sounds return, which is usually the ___ ___ if laparoscopic approach is used.

A

next day

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50
Q

o With laparoscopy patient does not experience _____ _____ that occurs with open abdominal surgery less postop abdominal pain

A

paralytic ileus

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51
Q

post op with open??

A 
improve respiratory status
pain control
skin integrity
diet
diarrhea
education
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52
Q

post op cholecysteomy low fat diet for how long?

A

4-6 weeks

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53
Q

o Gas usually lasts about a ____; will be a problem for a little while

A

week

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54
Q

o Produces digestive enzymes in an inactive state. Once in the ________ the enzymes are activated.

A

duodenum

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55
Q

3 pancreatic enzymes

A

amylase
trypsin
lipase

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56
Q

o Amylase aids in digestion of _______

A

carbohydrates.

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57
Q

o Trypsin aids in the digestion of ______.

A

proteins

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58
Q

o Lipase aids in the digestion of ____.

A

fats

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59
Q

ϖ Inflammation of the pancreas and is very painful.

A

PANCREATITIS

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60
Q

causes of acute pancreatitis

A

alcohol

cholithiasis

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61
Q

sx of acute pancreatitis

A

pain
NV
Abd distention

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62
Q

if acute pancreatitis patients develop a rigid board-like abdomen they may be developing ______

A

peritonitis

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63
Q

complications of acute pancreatitis

A

ecchymosis
DIC
Hypotension (hypovolemia and shock)
cardiac ischemia

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64
Q
  • Advanced form of pancreatitis
  • Fluid shift albumin and proteins that are not in the right space; not in the vasculature
  • Abdominal distention
  • Hypovolemiadue to the fluid and electrolyte imbalance
  • Can occur in advance liver disease
A

o Ascites

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65
Q

bruising around the flank area

A

o Grey-Turner’s sign

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66
Q

bruising around the umbilicus (belly area)

A

o Cullen’s sign

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67
Q

Diagnosis of pancreatitis

A

serum amylase and lipase
CT scan of abdomen
Ultrasound/MRI
Hypocalcemia

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68
Q

is usually elevated within hours of symptom onset best indicator of acute pancreatitis combined with signs and symptoms.

A

♣ Amylase

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69
Q

is drawn takes a lot longer to elevate. It stays elevated longer after the episode is over but acutely the lipase may not be elevated.

A

♣ Lipase

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70
Q

medical management for pancreatitis

A

NPO
TPN
NG tube

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71
Q

meds for pancreatitis

A

histamine 2 antagonists
PPIs
Pain management

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72
Q

diet after acute pancreatitis

A

clear liquids then advance as tolerated

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73
Q

If you can’t get pain under control for pancreatitis?

A

call DR

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74
Q

ϖ The pancreas continues to get scarring, inflammation, and gets fibrous.

ϖ Eventually the endocrine and exocrine functions become damaged and the pancreas can no longer function as it should.

A

Chronic Pancreatitis

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75
Q

ϖ Most common cause of chronic pancreatitis is

A

Chronic alcohol abuse

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76
Q

sx of Chronic Pancreatitis

A

pain all the time or when they eat
N/V
steatorrhea stools
vitamin deficiencies

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77
Q

issues with chronic pancreatitis related to nutrition

A

malnutrition
malabsorption
weight loss

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78
Q

are not useful in chronic pancreatitis because it is a chronic disease.

A

o Blood test

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79
Q

treatment for chronic pancreatitis

A 
NPO
bed rest
NG tube
opioid administration
same diet as acute
diabetes education
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80
Q

with a side-to-side anastomosis or joining of pancreatic duct to jejunum allows drainage of pancreatic secretions into jejunum—pain relief occurs in 6 months; usually returns

A

o Pancreaticojejunostomy

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81
Q

ϖ Controlled diabetes can result in long-term damage of

A

many tissues and organs

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82
Q

ϖ Affects 29.1 million people 8.1 million undiagnosed

ϖ 3rd leading cause of death in U.S

A

DM

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83
Q

DM is the leading cause of new cases of ______ ages 20-74

A

blindness

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84
Q

DM is a disorder of ____, _____, and ____ metabolism

A

carb, protein, and fat metabolism

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85
Q

risk factors for Diabetes

A 
family history
obesity
race
age above 45
HTN
HDL cholesterol <35
Hx of gestational diabetes
insulin deficiency
impaired release of insulin by pancreas
inadequate receptors to insulin
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86
Q

acute complications of DM

A

hyperglycemia
DKA
HHNS

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87
Q

chronic complications of DM

A 
diabetic neuropathy
renal insufficiency
cardiovascular risk (stroke and heart attack)
retinopathy
wounds
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88
Q

o Diabetes Mellitus associated with other conditions and syndromes such as

A

pancreatitis, overuse of corticosteroids

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89
Q

insulin dependent

usually before 30 years old

A

type 1 diabetes

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90
Q

with type 1 diabetes the body’s immune system does what?

A

destroys the beta cells and they can no longer produce insulin

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91
Q

what causes keotacidosis with type 1 diabetes

A

hyperglycemia and breakdown of body fat and protein

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92
Q

type 1 DM patients need ____ to survive

A

insulin

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93
Q

risk factors of type 1

A

genetic problem
autoimmune problem
environmental risk factors

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94
Q

sx of type 1 DM

A 
3Ps
blurred vision
weight loss
ketoacidosis
fatigue
hungry/thirsty
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95
Q

2 things that mean its most likely type 1 DM

A

ketoacidosis

rapid onset

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96
Q

ϖ Body can still make insulin, but impaired function, usually resistance in tissue
ϖ Usually those older than 30 and obese – incidence is increasing in those younger than 30 though because of the growing epidemic in obesity

A

TYPE 2 DIABETES

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97
Q

how does TYPE 2 DIABETES occur?

A

liver produces too much glucose and they can’t keep up with balancing insulin and glucose

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98
Q

ϖ Two main problems related to insulin in type II

A

insulin resistance and impaired insulin secretion

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99
Q

risk factors for type 2

A 
sedentary lifestyle
familial tendency
age
gestational diabetes
HTN
hyperlipidemia
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100
Q

sx of type 2 dm

A 
slow progressive onset
damage to eye
neuropathy
recurrent infections
fatigue
decrease energy
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101
Q

ϖ Combination manifestations of type 2 diabetes and heart disease

A

metabolic syndrome

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102
Q

metabolic syndrome is at least 3 of the following:

A 
increased waist circumference
triglycerides above 250
HDL lower than 35
high BP
Fasting Plasma Glucose greater than 110
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103
Q

– haven’t been fasting, just checking sugar

A

♣ Casual glucose

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104
Q

♣ Fasting plasma glucose greater than ____ on two separate occasions to diagnose diabetes

A

126

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105
Q

education for fasting plasma glucose

A

NPO 8 hours before

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106
Q
  • Large dose of sugary drink

* Blood sugar remains elevated – body not producing enough insulin to return to normal range

A

♣ OGTT (oral glucose tolerance test)

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107
Q

ϖ Normal AIC is usually between

A

4-6 %

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108
Q

Long-term glycemic controls in pts with diabetes is best achieved by monitoring glyscosylated hemoglobin (HAIC) which reflects the:

A

ϖ Average blood glucose level over a period of time (2-3 months)

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109
Q

ϖ Often use AICs for people with _______ or to diagnose earlier to prevent complications

A

metabolic syndrome or those with family history

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110
Q

treatment of type 1 dm

A

insulin

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111
Q

treatment of type 2 dm

A

oral hypoglycemic
diet
insulin

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112
Q

o Pancreas works in two different phases–determine whether person will need rapid or long-acting insulin

A

Phase I bolus phase

Phase II basal phase

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113
Q

during phase 1 (bolus phase) what happens?

A

♣ release of insulin in response to glucose (food)

o Prevents postprandial hyperglycemia (after eating)

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114
Q

during Phase II basal phase what happens?

A

body releases insulin b/w meals to keep blood glucose stable b/w fasting times (purpose of long-acting)

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115
Q

U100 means

A

100 unites per mL

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116
Q

how to mix insulin

A

clear to cloudy

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117
Q

what type of insulin in used in pumps?

A

short acting (regular insulin)

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118
Q

how often to change locations with pump?

A

q 3 days

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119
Q

o Should check BS at least ____ times a day with insulin pumps

A

3

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120
Q

what is the only insulin that could be used in an IV

A

regular

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121
Q

education on insulan storage

A

can be stored in the fridge while unopened

can stay at room temp for 4 weeks once open

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122
Q

don’t shake insulin _____ it

A

roll

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123
Q

only cloudy insulin =

A

intermediate

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124
Q

how to clean site before insulin admin at home

A

soap and water

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125
Q

where does insulin absorb the fastest at?

A

in the abdomen

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126
Q

TRIANGLE OF DIABETES MANAGEMENT

A

meds
diet
exercise

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127
Q

ADA goals

A

o Maintain glucose levels in near normal range
o Reduce risk of CV disease
o Modify lifestyle as appropriate to prevent/treat obesity, hyperlipidemia, CV disease and nephropathy
o Respect personal and cultural preferences

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128
Q

carbs should be what % of daily diet

A

50-60%

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129
Q

what type of protein

A

non animal

130
Q

fiber helps diabetic patients do what?

A

feel full

and

lower serum lipid levels

131
Q

alcohol can cause ______

A

hypoglycemia

132
Q

o How much of that particular food is expected to increase BS
o Good whole foods, raw vegetables actually lower glycemic response
Eating whole fruit instead of drinking fruit juice also lowers this

A

glycemic index

133
Q

BENEFITS OF EXERCISE

A 
ϖ	Improves insulin sensitivity 
ϖ	Decreases blood glucose during and after exercise – get your patient moving 
ϖ	Improves circulation and muscle tone
ϖ	Assists with weight loss
ϖ	Improves lipid profile and BP
134
Q

ϖ Good glucose control before, during and after surgery! why?

A

o Promote healing
o Will be sedated in surgery will be hard to determine hypo and hyperglycemia
o Fluid and electrolyte imbalance
o Prevent complications

135
Q

may need more insulin after surgery

A

o Type 1’s

136
Q

o Oral hypoglycemic usually held __-___ days before surgery (renal function)

A

1-2

137
Q

o Can occur in both—exact cause is unknown
o Rise in early morning blood sugar
o May be level of cortisol or growth hormone during the day

A

ϖ Dawn phenomenon

138
Q

o Sugar goes high at night and crashes in the morning but can happen anytime during the day
o Alternating b/w hyper/hypoglycemia – yoyo effect on BS
o Insulin resistance several hours after event

A

ϖ Somogyi phenomenon

139
Q

o Non-ketotic – no breakdown of fats/proteins
o Can occur in Type I or Type II, most common in Type II
o Many things can cause stress, illness, infection, MI, stroke
o More prevalent in older adult
o Usually more of a gradual onset
o Extreme rise in glucose (600-800)

A

ϖ Hyperosmolar Hyperglycemic State (HHNS)

140
Q

Common in Type I
o Could be related to illness, infection, stroke, heart attack
o Sudden onset of hyperglycemia—usually over 250
o Get acidosis because of the presence of ketones

A

DKA

141
Q

hypoglycemia is a blood sugar around ___ or less

A

70

142
Q

ϖ

Causes of Hypoglycemia

A

o May result when a diabetic omits a meal, takes excessive insulin, vomits a meal/meals, over exercises
o May also be precipitated by the overproduction of insulin due to an insulin producing tumor or autoimmune disease

143
Q

what to do if your patient has hypoglycemia if they can swallow

A

admin 15 g of carbs:

fast acting carbs
sugar packet
OJ
glucose tablets

144
Q

if they can’t swallow?

A

1 mg glucagon SQ/IM

IVP 50 ml of 50% dextrose

145
Q

ϖ Notify health care professional when:

A

diarrhea more than 5 times or longer than 6 hours
unable to eat for 24 hours
difficulty breathing
BG higher than 300 two times

146
Q

when glucose gets around __-___ start checking for urine ketones

A

240-250

147
Q

chronic complications with DM

A 
peripheral neuropathy
nephropathy
retinopathy
macrovascular
infection
148
Q

damage to peripheral nerves resulting in miscommunication with the brain and other body parts

A

ϖ Peripheral neuropathy

149
Q

ϖ Peripheral neuropathy can be _____ or ____

A

somatic or autonomic

150
Q

feeling of touch; may just be decreased sensation overall, or some complain of a burning/stinging feeling

A

♣ Somatic –

151
Q

– things that happen inside of body that they don’t feel; GI motility, bladder problems, cardiovascular problems

A

♣ Autonomic

152
Q

leading cause of ESRD

Presence of albumin in the urine

A

nephropathy

153
Q

at risk for cardio disease because of neuropathy and atherosclerotic changes

A

ϖ Macrovascular

154
Q

microvascular can lead to:

A

CAD
CVD
PVD

155
Q

most common complication leading to hospitalization among diabetics

A

Diabetic foot ulcers

156
Q

o Full foot exam ____ by physician or practitioner

A

yearly

157
Q

(anti-inflammatory/ immunosuppressive properties): secreted during times of stress; helps to maintain BP and heart function; slows immune process down; assists in balancing effects of insulin to break down sugars for energy;

A

o Cortisol

158
Q

o Cause glycogenesis, protein catabolism, and immobilizes fatty acids

A

corticosteroids

159
Q

ϖ Hypersecretion of adrenal medulla

A

PHEOCHROMOCYTOMA

160
Q

with Pheochromocytoma there is a small tumor that does what?

A

secretes large amounts of epic (vasoconstriction)

161
Q

Pheochromocytoma is more common in who?

A

women 40-50

162
Q

sx of Pheochromocytoma

A 
HTN
HA
Hyperdiaphoresis
hyperglycemia
heart palpitations
163
Q

diagnosis of Pheochromocytoma by?

A

24 hour urine test for catecholamines

MRI/CT scan

Vanillymandelic

164
Q

education before vanillymadelic

A

no vanilla, caffeine, chocolate, aspirin prior to test

165
Q

treatment of Pheochromocytoma

A

treat symptoms

or

removal of tumor

166
Q

♣ Careful monitoring of BP after _____ or ___ _____ d/t hypotensive shift that usually occurs

A

surgery or after acute event

167
Q

after an acute even to pre-op with Pheochromocytoma

A

ICU on continuous ECG monitoring
Nipride drip
CCB
BB

168
Q

how do they remove the tumor?

A

unilateral/bilateral adrenalectomy

169
Q

ϖ Hypofunction of adrenals

ϖ Most commonly seen in women

A

Addison’s Disease

170
Q

causes of Addison’s?

A

autoimmune problem that results in the destruction of the adrenal cortex

sudden corticosteroid discontinuation

TB of adrenals

CA of adrenals

Adrenaectomy

HIV/AIDs

171
Q

labs with Addison’s

A

low aldosterone/cortisol

high ACTH

172
Q

sx of Addison’s

A 
bronze skin
changes in distribution of body hair
GI disturbances
decreased cortisol 
(hypoglycemia)
postural hypotension
173
Q

what causes the postural hypotension with addison’s?

A

low aldosterone –> low sodium, high potassium and volume depletion (dehydrated)

174
Q

o Vascular collapse from severe hypotension

A

ϖ Adrenal (Addisonian) Crisis:

175
Q

sx of Adrenal (Addisonian) Crisis:

A 
o	Profound fatigue
o	Cyanosis
o	Fever 
o	N/V
o	Signs of shock—cold, pallor, clammy
o	Headache
o	Abdominal pain
o	Diarrhea
o	Confusion/Restlessness
o	Dehydration
o	Renal shut down
o	Decreased serum sodium
o	Increased serum potassium
176
Q

o Slight overexertion to extreme cold, infection, or decrease Na intake may lead to:

A

♣ Circulatory collapse
♣ Shock
♣ Death (if untreated)

177
Q

o The patient in addisonian crisis requires immediate treatment with

A

IV fluids,
glucose and electrolytes, especially Na,
replacement of missing steroids and
vasopressors.

178
Q

how to dx Addison’s dx

A 
cortisol levels 
low sodium
high potassium
low glucose
high plasma ACTH 
high WBCs
179
Q

when to check cortisol levels

A

(check in the morning because they should be high but they will still be low with them)

180
Q

tx for addison’s

A

o Preventing or reversing hypovolemic/circulatory shock

monitor VS

D5W

corticosteroid replacements lifelong

monitor sodium and potassium

181
Q

encourage sodium in diet with Addison’s to prevent

A

arrhythmias and weakness

182
Q

diet for Addison’s

A

o Increase salt (especially during GI disturbances and hot weather)
o Low potassium (too much=heart arrhythmias and weakness)
o Increase protein
o Stay hydrated

183
Q

what can decrease K+

A

exelate

184
Q

meds for Addison’s

A

corticosteroids

vasopressors

185
Q

o NEVER stop medications abruptly bc what will happen

A

addisonian crisis

186
Q

Addison’s patients should wear

A

medic alert bracelet

187
Q

ϖ Adrenal cortex hyperfunction

A

cushing’s syndrome

188
Q

what else could cause cushion’s

A

long term corticosteroid use

COPD

adrenal tumorr

189
Q

cushing’s labs

A

elevated cortisol
decreased ACTH
decreased K+

190
Q

sx of cushing’s

A 
round trunk area
think extremities
think skin
moon face
buffalo hump
hyperglycemia
infection
sodium and fluid retention
GI distress
osteoporosis
191
Q

dx of cushing’s

A

o Serum or urine cortisol level
o 24 hour urine to check for free cortisol
o If tumor is suspected CT or MRI for visualization

192
Q

o Medications with cushing’s are used to treat conditions that are

A

inoperable or if it is not a tumor of the pituitary or adrenals.

193
Q

o Meds revolve around inhibition of ____ production (controls symps/manifestations not the syndrome or disease)

A

cortisol

194
Q

examples of meds that inhibit cortisol production

A 
ketoconazole
mitotane
metyrapone
aminoglutethemide
somatostatin
sandostatin
195
Q

o If Cushing’s is caused by prolonged administration of corticosteroids

A

o Attempt to reduce or taper the dose
o Gradually discontinue the use all together
o alternate-day therapy .

196
Q

post-op adrenalectomy! at risk for

A

hemorrhage

197
Q

o Can dump excessive amounts of hormones into the blood stream during surgery so we need to monitor for?

A

BP
Fluid and electrolytes
hormone fluctuations

198
Q

o High doses of IV _____ are given after surgery for the first 24-48 hours then titrate down

A

steroids

199
Q

To decrease the chance of an addisonian crisis monitor for:

A 
hypotension
vomiting
weakness
dry tenting skin
tachycardia
dehydration
changes in LOC
200
Q

o Promote wound healing and minimize stress on the incision by?

A

log rolling to sit them up

201
Q

3 main nursing dx with cushing’s

A

fluid vol excess
risk for injury
risk for infection

202
Q

diet for cushing’s

A

low calorie
low sodium
high protein
take vitamins B,C, D and calcium

203
Q

ϖ Master gland
ϖ Located at the base of the brain adjacent to the hypothalamus
ϖ Responsible for regulating endocrine function by producing hormones that affect body systems and stimulate other endocrine gland to secrete hormones

A

Pituitary Gland

204
Q

major hormones of the Pituitary Gland

A 
FSH
LH
Prolactin
ACTH (Adrenocorticotropic hormone)
TSH
GH
205
Q

hormones secreted by post. pituitary

A

ADH

Oxytocin

206
Q
  • Controls excretion of water by kidney

* Secretion is stimulated by an increase in the osmolality of the blood or by a decrease in blood pressure

A

o Antidiuretic hormone (ADH)—vasopressin

207
Q
  • Stimulated during pregnancy and at childbirth

* Facilitates milk ejection during lactation and increases the force of uterine contractions during labor and delivery

A
  • Stimulated during pregnancy and at childbirth

* Facilitates milk ejection during lactation and increases the force of uterine contractions during labor and delivery

208
Q

ϖ Most common conditions deal with the anterior pituitary that deals w/ growth and development
ϖ A result of over secretion of GH, prolactin and ACTH

A

Hyperpituitarism

209
Q

Deficiency in secretion of pituitary hormones

A

Hypopituitarism –

210
Q

Hypopituitarism can be caused by:

A

tumors of pituitary
surgical removal or pituitary
pituitary infarction

211
Q

− Postpartum pituitary necrosis

− Uncommon cause of failure of the anterior pituitary

− Most commonly occurs when there is a traumatic birth and mother goes into shock and has decreased vascularity to pituitary gland

A

• Sheehan’s Syndrome

212
Q

removal of pituitary tumor

treatment of choice

A

Hypophsectomy—

213
Q

Hypophsectomy is most often done through the ____ approach

A

transphenoidal approach

214
Q

o go up through lip and palate and through the skull, then use an instrument to retract tumor

A

transphenoidal approach

215
Q

worry about what with Hypophsectomy

A

increased ICP since its brain surgery

and infection

216
Q

pre op Hypophsectomy

A

ATB
teach them how to prevent increased ICP
tell them about the meds they will be on (hormone replacement)

217
Q

how to prevent increased ICP

A

• Avoid bending over, straining, sneezing (do through mouth), blowing nose, elevate HOB, may be placed on stool softeners so not straining to have a BM

218
Q

post op Hypophsectomy

A 
frequent vitals/neuro checks
monitor for infection
HOB at 30 degrees
mustache dressing
shouldn't have active bleeding
assess for clear drainage
assess for post nasal drip
strict I and Os
good oral care
219
Q

how to see if the clear fluid is CSF

A

if it has glucose in it

220
Q

after surgery they may be at a temporary risk for

A

diabetes insipidus

221
Q

ϖ Otherwise known as “tasteless urine” great volumes and so diluted it has no color or taste

A

Diabetes Insipidus

222
Q

____ insufficiency leading to large amounts of urine = polyuria; also have problems with nocturia

A

ϖ ADH

223
Q

ϖ If putting out a lot of diluted urine – _____ level increases

A

sodium (hypernatremia)

224
Q

ϖ Can have____ or more liters of urine in 24 hour period

A

12

225
Q

diabetes insidious can be caused 2 ways

A

neurogenic

nephrogenic

226
Q

o Absence of production or secretion of ADH

Often results from some type of head trauma, cerebral injury, brain surgery like the hypophysectomy, tumors, chronic

A

NEUROGENIC

227
Q

o ADH levels are normal in body, but renal tubules are not working so kidneys don’t respond to ADH
o Renal disease, disease of renal tubules – May be related to hypokalemia, hypercalcemia, variety of medications

A

NEPHROGENIC

228
Q

sx of diabetes insipidus

A

large amounts of dilute urine
extreme thirst
sx of dehydration
tachycardia

229
Q

o Dumping out a lot of fluid – can go into _____/______ shock if fluid is not replaced in a timely manner

A

cardiovascular collapse/hypovolemic shock

230
Q

dx of diabetes insipidus

A

specific gravity low

urine osmolality less than 300

231
Q
  • One of the most common tests – often used to identify the cause of polyuria
  • Administer ADH & hold fluids for 8-12 hours or until 3-5% of body weight is lost
  • Patient weighed frequently during the test
  • Combination of blood and urine tests (at beginning and end of the test)
A

o Water deprivation test

232
Q

• What would you assess for if sodium is high?

A

− Changes in vitals, poor skin turgor, thirsty, LOC, seizures, tremors, orthostatics, strict I/O’s, daily weights

233
Q

1 priority of care for diabetes insipidus

A

replacement of fluids

234
Q

with Diabetes Insipidus you will dminister IV fluids. Then monitor hydration status by ?

A

I/Os
Daily weights
monitor IV solutions

235
Q

if the DI is neurogenic you will admin _____ to treat it

A

admin analogue of ADH

desmopressin

236
Q

− Can be given orally, nasally, IV

− Monitor for opposite symptoms and report to doctor

A

desmopressin

237
Q

what to assess for with desmopressin

A

excessive weight gain
headaches
restlessness
chest pain

238
Q

− Giving vasopressin which causes ________ – so want to monitor cardiac findings such as chest pain

A

vasoconstriction

239
Q

if DI is nephrogenic what do we treat them with

A

low sodium diet
thiazide diuretics
prostaglandin inhibitors (NSAIDs)

240
Q

SIADH has too much _____

A

ADH (Vasopressin)

241
Q

o Results from failure of negative feedback system – ADH is released despite normal or low serum osmolality

A

SIADH

242
Q

what will SIADH patients have

A 
retained fluid (fluid overload)
concentrated urine (high specific gravity)
diluted blood (low serum level)
243
Q

causes of SIADH

A 
Stress, 
pituitary surgery, 
small cell lung cancer 
certain medications (barbiturates, some antidepressants), 
anesthesia, 
head injury,
diuretics
244
Q

SIADH is Characterized by dilutional _____ from water retention (a lot of water, little salt in body)

A

hyponatremia

245
Q

what will SIADH patients look/feel like?

A 
generalized weight gain (without edema)
muscle cramps
weakness
low urinary output
sodium below 120
246
Q

hyponatremia sxs

A 
restlessness/irritability
changes in LOC
lethargy
HA
vomiting
muscle twitches
seizure
247
Q

complications of SIADH

A

cerebral edema and coma

248
Q

diagnosis of SIADH

A

urine and serum osmolalit

249
Q

ultimate goal for SIADH

A

to increase sodium level and increase serum osmolality so they’re not so diluted

250
Q

treatment of SIADH

A

oral fluid restriction (800-1000 ml/day)

1/2 NS

Lasix

251
Q

how to assess for fluid volume excess with SIADH

A
  • Jugular vein distention
  • Skin taut and shiny
  • Possible increased BP
  • Crackles in lungs
  • Intake greater than output
  • Headache
  • Fatigue
  • Nausea
  • Muscle aches
  • Weight gain without edema
  • Progressive altered LOC
  • Seizures, coma
  • Small amount concentrated amber urine
252
Q

Nurse is establishing a plan of care for a patient newly diagnosed with SIADH. Priority nursing diagnosis would most likely be:

A

a. Excess fluid volume

253
Q

ϖ Butterfly-shaped organ located in lower neck – that area is very vascular
ϖ Consists of 2 lateral lobes connected by an isthmus

A

THYROID GLAND

254
Q

the thyroid produces what 3 hormones

A

T4
T3
Calcitonin

255
Q

_______ is essential to the thyroid gland for synthesis of its hormones

A

Iodine

256
Q

how are the thyroid hormones regulated?

A

negative feedback loop

257
Q

hyperthyroid levels

A

elevated T3/T4

decreased or no TSH

258
Q

hypothyroid levels

A

elevated TSH

decreased T3/T4

259
Q

Primary function of thyroid horomone is to maintain ______

A

metabolism

260
Q

how to diagnosis thyroid disorders

A 
H&amp;P
Blood tests
Ultrasound
Thyroid Scan
24 hour radioactive iodine uptake (RAIU)
Look for nodules
Thyroid antibodies
261
Q

(confirms how extreme the hyperthyroidism is)

A

• Free T4

262
Q

ϖ RAI is given IV or orally and thyroid is scanned to see what?

A

how much iodine the thyroid took in

263
Q

increased uptake of RAI means

A

hyperthyroid

264
Q

decreased uptake of RAI

A

hypothyroid

265
Q

warm nodule

A

benign

266
Q

cold nodule

A

CA

267
Q

• Serum test used to diagnose immune disorders of thyroid

A

ϖ Thyroid antibodies

268
Q

Decreased amount of thyroid hormone which leads to a decreased metabolic rate

Symptoms can develop very slowly, months to even years

A

hypothyroidism

269
Q

common causes of hypothyroidism

A

hashimoto’s thyroiditis
thyroid dysfunction
pituitary dysfunction

270
Q

sx of hypothyroidism

A 
always cold
very tired
numbness and tingling of fingers
husky/hoarse voice
menstrual disturbances
loss of libido
weight gain
facial and eyelid edema
constipation
271
Q

hypothyroidism more common in ?

A

women 40-70

272
Q

late sx of hypothyroidism

A 
subnormal temp
bradycardia
weight gain
decreased LOC
thick skin
cardiac complications
273
Q

ϖ Really severe form of hypothyroidism is called ______ – Chronic untreated hypothyroid state

A

Myxedema

274
Q

with myxedema there is edema as a result of?

A

water retention

non-pitting edema around face/tibial area

275
Q

• Tongue can become thick, speech slow, can have voice changes with ?

A

myxedema

276
Q

is even more extreme – pt has prolonged hypothyroidism and they start to develop cardiac effects

A

ϖ Myxedema coma

277
Q

• If myxedema coma is untreated for long period of time, will most likely have cardiac effects such as

A

– CAD, hypercholesterol

278
Q

with myxedema coma they get severe metabolic disorders such as:

A

hypothermia
cardiovascular collapse
resp failure (bc of CHF from prolonged bradycardia)

279
Q

• These symptoms along with cardiovascular collapse and shock require aggressive and intensive supportive and _______ therapy if the patient is to survive

(myxedema coma)

A

hemodynamic

280
Q

Medical Management for Myxedema

A

ϖ In extreme state, can give thyroid meds IV until they can tolerate regular doses

281
Q

primary goal for myxedema

A

replace thyroid hormone and reduce hypothyroidism effects

might be fixing acid-base imbalances

282
Q

ϖ Do not give ______ to patient’s with a severe form of hypothyroidism because their metabolic rate is already very slow – if we give sedatives, they could go into severe respiratory depression and could die

A

sedatives

283
Q

when patient starts taking meds for hypothyroidism the symptoms usually resolve when?

A

within a few days

284
Q

how are meds administered with hypothyroidism.

A

ϖ Medications usually administered by themselves before meals

285
Q

proper education is crucial for hypothyroidism:

A
  • Educate to take 1 hour before meals or 2 hours after

* Need to take at the same time every day to mimic the body’s normal cycle of hormone production

286
Q

hypothyroidism medications May also increase the pharmacologic effects of

A

digitalis glycosides, anticoagulant agents , and indomethacin(Indocin)

287
Q

• could be at risk for ______ and ________ – monitor for these more often

A

bleeding tendencies and dig toxicity

288
Q

hypothyroidism meds can also exaggerate the effects of ____

A

sedatives

289
Q

nursing diagnosis for hypothyroidism:

A 
ϖ	At risk for Decreased Cardiac Output
ϖ	Activity Intolerance
ϖ	Altered nutrition: more than body requirements
ϖ	Ineffective therapeutic regimen
ϖ	Risk for impaired skin integrity 
ϖ	Constipation Prevention
290
Q

ϖ Increased metabolic rate from hypersecretion of T3/T4

A

HYPERTHYROIDISM

291
Q

ϖ Most common type of hyperthyroidism we see is

A

Graves’ Disease

292
Q

common causes of hyperthyroidism

A

thyroiditis
excessive ingestion of thyroid hormone/medications
Hashimoto’s thyroiditis

293
Q

sx of hyperthyroidism

A 
intolerance to heat
fine-straight hair
bulging eyes
facial flushing
enlarged thyroid
tachycardia
increased systolic BP
weight loss
diarrhea
amenorrhea
localized edema
294
Q

Extreme form of hyperthyroidism –

A

Thyroid Storm

295
Q

ϖ Life threatening – attention needed quickly to avoid further complications and even death

A

thyroid storm

296
Q

how to treat hyperthyroidism

A

anti-thyroid medications

297
Q

nursing diagnosis for hyperthyroidism

A

risk for injury
risk for decreased cardiac output/activity intolerance
altered nutrition
body image disturbances

298
Q

ϖ A patient with hyperthyroidism underwent three months of preoperative treatment with anti-thyroid medications and iodine preparations to establish a euthyroid state prior to her surgery – Why is it so important for the patient to be euthyroid (normal labs) prior to a thyroidectomy?

A
  • To reduce complications of cardiac problems
  • Decreases chance of thyroid storm after surgery—potentially fatal
  • If not in euthyroid state – at higher risk for hemorrhage
  • Use drug therapy and radioactive iodine prior to surgery to reduce size and put them in euthyroid state
299
Q

ϖ The nurse is preparing for the patient’s return to the surgical floor. What should be the nurse’s top patient priorities?

(hyperthyroidism)

A

risk for thyroid storm

risk for hemorrhage

300
Q

ϖ Risk for _______ if take out parathyroid gland – may be accidentally removed or on purpose w/ thyroidectomy

A

hypocalcemia

301
Q

what to look for to assess for hypocalcemia?

A

chvostek’s sign

trosseau sign

302
Q

BP cuff makes the arm turn in

A

Trousseau’s sign

303
Q

ϖ Sits on posterior side of the thyroid – can be removed on purpose when thyroid is removed or accidently

A

parathyroid glands

304
Q

main function of parathyroid glands

A

regulate calcium and phosphate metabolism

305
Q

ϖ Calcium level falls– parathyroid sends message to stimulates parathyroid stimulating hormone to get calcium – get calcium from 3 places:

A
  • Pulls it out the bone
  • Reabsorbs it from renal tubules
  • Dietary in presents of vitamin D
306
Q

ϖ Caused by overproduction of parathormone by the parathyroid glands

A

hyperparathyroidism

307
Q

hyperparathyroidism labs

A

increased calcium

decreased phosphorus

308
Q

hyperparathyroidism is characterized by:

A

renal damage

bone decalcification

309
Q

primary hyperparathyroidism can be cause by?

A

malignancy

unknown cause

310
Q

secondary hyperparathyroidism occurs in patients who have ?

A

chronic renal failure

311
Q

• Renal patients often get high ______ levels and x-rays will show porous bones from calcium being pulled out of them

A

phosphorus

312
Q

hyperparathyroidism symptoms:

A 
older females
bone pain (especially in the back)
bone demineralization
polyuria
renal colic
kidney stones
muscle weakness/fatigue
irritability
GI symptoms
313
Q

ϖ If having an acute hypercalcemic crisis– serum calcium level gets extremely high– high risk for ????

A

dehydration, cardiac arrhythmias and even cardiac arrest

314
Q

diagnostic tests for hyperparathyroidism

A

assess serum calcium and parathyroid hormone level

bone scan
CT scan
X-ray

315
Q

goal for hyperparathyroidism

A

decrease level of calcium

316
Q

immediate focus for hyperparathyroidism

A

to decrease/prevent dehydration

317
Q

ϖ If severe hypercalcemia – will probably be hospitalized and treated with:

A

• IV normal saline

Loop Diuretics – Lasix

318
Q

______ diuretics are contraindicated because they promote the renal absorption of calcium

A

Thiazide

319
Q

ϖ Medications to inhibit bone reabsorption therefore reducing hypercalcemia

A

calcitonin
biphosphonates
corticosteroids

320
Q

increases calcium deposition in bone

A

• Corticosteroids –

321
Q

inhibits bone reabsorption to keep calcium in the bone instead of in the bloodstream

A

• Bisphosphonates -

322
Q

Bisphosphonates examples:

A

pamidronate
alendronate
zoledronate

7th Semester (14 decks)

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