AH Exam III Flashcards
1
Q
Which type of cells are destroyed with Type I DM?
A
Beta Cells (they secrete insulin)
2
Q
Which type of DM is associated with a family hx?
A
Type II
3
Q
Treatment for Type I vs. Type II Diabetes
A
Type I:
insulin
diet
exercise
Type II: insulin diet exercise ORAL HYPOglycemics
4
Q
Which type of DM presents with Ketones
A
Type I
but Type II can present under stressful conditions (rare)
5
Q
Which type of DM presents with a positive DR/DQ antigen?
A
Type I
6
Q
Early symptoms of DM:
A
Polyuria
Polydipsia
Polyphagia
Weight LOSS
7
Q
What are 2 severe manifestations of DM?
A
ketoacidosis
shock
8
Q
What are 3 diagnostic criteria for DM?
A
Hemoglobin A1C > 6.5%
Fasting glucose > 126 on 2 readings
Postprandial glucose of 200
9
Q
Stressors that can lead to DKA?
A
Decreased electrolytes (except K, which will increase, then decrease as dehydration worsens)
10
Q
S&S of DKA?
A
fruity breath
Kussmaul breathing
ketones
11
Q
Mortality rate of hyperglycemic hyperosmolar nonketotic coma? Which type of DM?
A
70% - Type II
12
Q
5 Risk Factors for Metabolic Syndrome?
A
- large waist circumference
- high triglycerides
- Low HDL
- High glucose
- BP 130/85
13
Q
Info for Short Acting “Regular” (Humulin R) Insulin
A
onset 30min
peak 2-4 hrs
duration 5-7 hrs
14
Q
Info for NPH insulin:
A
onset 1.5 hrs
peak 4-12
duration 16-24
15
Q
How do you pull up insulin?
A
clear then cloudy
16
Q
Do you give Metformin before surgery?
A
NO - HOLD before surgery
17
Q
Somogi Effect:
A
HYPERglycemia in the morning r/t HYPOglycemic while sleeping
DO eat before bed
18
Q
Dawn Effect:
A
HYPERglycemia in the morning
Do NOT eat before bed
19
Q
HYPOglycemia is defined at what BG level?
A
< 70
20
Q
Mild, moderate and severe HYPOglycemia levels?
A
mild <70 (15g)
moderate <40 (15-30g)
severe <20 (no food - give 1mg glucagon)
21
Q
15g snack
A
6-10 hard candies 6 oz regular soda (not diet) 4 ox fruit juice 3-4 glucose tabs 3 gram crackers
22
Q
When should a diabetic NOT exercise?
A
< 80
>250
23
Q
When should diabetics buy their shoes?
A
in the evening
24
Q
Alcohol recommendations for diabetics:
A
men: 2 drinks/day
women 1 drink/day
25
Serum T3 levels:
70-205
26
Serum T4 levels:
4-12
27
Free T4 level:
0.8-2.8
28
TSH levels:
2-10
29
S&S of HYPERthyroidism
lookin hot
| soft, fine hair
30
Hallmark sign of Graves:
exopthalmous
31
Treatment of HYPERthyroidism:
Tapazole - birth defects
PTU - no crowds
Radioactive Iodine - your secretions are very toxic
32
Risk factors for Goiter?
iodine deficiency
cabbage, turnips, soybean
lithium
33
S&S of HYPOthyroidism?
```
low and slow
myxedema coma (high mortality)
```
34
Myxedema Coma S&S:
HYPOtension
HYPOthermia
HYPOnatremia
HYPOglycemia
35
Priority nursing action after thyroidectomy:
elevate the head of the bed
36
If you have Type II diabetes, what thyroid issue are you at risk for?
HYPERthyroidism
37
Which electrolyte should be monitored after a thyroidectomy?
calcium
38
Decreased insulin is related to:
Decreased storage of glycogen
Increased production of glucose
Increased metabolism of glycogen, lipids and ketones
39
What position should a patient be in after an endoscopy?
side lying to prevent aspiration
40
What is fundoplication?
a treatment for severe GERD
- on antacids 1 month
- NO driving 1 week
- NO heavy lifting
- NO carbonated beverages
41
What is the Stretta procedure?
GERD procedure
| - no NG tube for 1 month after procedure
42
Patho of gastritis:
H. pylori
43
Patho of peptic ulcer disease:
H. pylori
| chronic NSAID use
44
Which ulcer gives you pain at night?
duodenal (1-2am)
45
Which ulcer gives you pain in the RLQ?
duodenal
46
Which ulcer gives you pain in the upper epigastric region?
gastric
47
Which ulcer gives you hematemesis?
gastric
48
Which ulcer gives you melena?
duodenal
49
Which ulcer gives you risk for gastritis?
gastric
50
Which type of antacid can a renal px not have?
Mg based
51
Who would experience dumping syndrome?
pt after a gastric resection
52
S&S of EARLY dumping:
15-20 mins after eating
```
TACHYcardia
pale
palpitations
vertigo
sweating
```
53
S&S of LATE dumping:
2-3 hrs after eating
diarrhea
high pitched sound
cramping
distension
54
How do we avoid dumping syndrome?
```
avoid sugar/milk/salt
low carb
small meals
avoid drinking with meals
lie down after meals
```
55
S&S of diverticulitis
fever 101
LLQ pain
rectal bleeding
constipation
56
Management of diverticulitis:
NPO for acute
fiber
antibiotics
surgery if nothing else works
57
What are expected finding for Chrone's?
```
fatty poopy (5-6/day)
b/c it's patchy all over
```
58
What are expected finings for UC?
```
bloody poopy (10-20/day)
just at the butt
```
59
Which urinary diversion do we use for bladder cancer?
Kock pouch - catheterize the stoma regularly
60
What are some complications of TPN?
electrolyte/metabolic px
61
Unexpected findings after bariatric surgery:
pulmonary emboli, anastomotic leaks, ascites
62
Colicysectomy post op care:
manage gas pains - tell them to walk and give PO pain med
63
What causes Hep A & E
food
64
What causes Hep B & D
body fluids
65
What causes Hep C?
needle stickies
66
S&S of Hepatitis:
Preicteric: elevated bili, NO jaundice
Icteric: elevated bili, jaundice, brown urine, light stools
Posticteric: normal bili, less jaundice, increased energy
67
How old can blood be when giving it to an older pt?
1 week
68
S&S of hemolytic rxn? nursing action?
low back pain, headache
| actions: SOP, CALL, FLUSH and IV antihistamine
69
S&S of febrile (most comm) rxn? nursing actions?
fever
| STOP, CALL, FLUSH and give acetaminophen
70
When do we see a graft vs. disease?
2 weeks after transfusion
71
What are the S&S of a mild allergic rxn to blood?
bronchospasm, urticaria, pruritus
72
Smallest gauge to give blood?
20 - pink
73
If blood is being given and a pt gets mm spasm, what do you give? crackles?
mm spasm - calcium
| crackles - diuretics
74
Acute glomerulonephritis:
ask about a recent strep infection
| recovery may be 2 years
75
Hallmark sign of nephrotic syndrome:
recent weight gain r/t edema
76
Renal artery stenosis assessment and interventions:
sudden onset HTN after 50
abdominal bruits
Tx:
Stop smoking
mangage HTN
77
Renal Calculi diet interventions:
Calcium stone:
avoid spinach, black tea, rhubarb, sodium, beets, pecans, peanuts, okra, chocolate
Phosphate Stone:
avoid animal protein, dairy, sodium
Struvite stone:
diary, organ meat, whole grains
Uric acid:
purine - organ meat, poultry, fish, red wine, sardine
78
Risk factors for nephrosclerosis:
HTN and diabetes
79
Bladder cancer incontinence management:
Kock pouch and conduits
80
TURP procedure indication:
BPH
81
TURP procedure pt teaching:
frequent Kock pouch catheterization
82
TURP procedure continuous bladder irrigation (CBI) management:
if the bladder spasms while administering CBI, slow the flow
83
Treatment for kidney stones?
Lithotripsy (shock wave)
pre - give anesthetic cream 45 min before procedure
post - check urine output, expect to see bruising
84
What should you NOT do with prostatitis?
DO NOT CATHETERIZE
85
What should you NOT do with prostatitis?
DO NOT CATHETERIZE
86
Consideration for a patient receiving PSA (prostate specific antigen)
do not ejaculate for 24-48 hrs before you receive it b/c it can increase the levels
87
Consideration for a patient receiving PSA (prostate specific antigen)
do not ejaculate for 24-48 hrs before you receive it b/c it can increase the levels
88
Polycystic kidney S&S:
cloudy urine
hematuria
nocturia
HTN
89
Polycystic kidney pt teaching:
avoid aspirin and do daily weights
90
Polycystic kidney pt teaching:
avoid aspirin and do daily weights
91
HgB levels for mild, moderate and severe anemia:
mild: 10-14
moderate: 6-10
severe: < 6
92
Patho of aplastic anemia:
Epstein-Barr or other virus fucks up bone marrow and causes decreased production of RBCs
93
Patho of aplastic anemia:
Epstein-Barr or other virus fucks up bone marrow and causes decreased production of RBCs
94
Which foods are high in iron?
```
dark leafys
organ meat
fortified cereal
beans
raisins
```
95
Iron supplement expected findings:
black tarry stools
96
Cause of B12 "pernicious" anemia?
gastric surgery/malabsorption
| lack of dairy
97
Cause of B12 "pernicious" anemia?
gastric surgery/malabsorption
| lack of dairy/B12
98
Which foods are high in B12?
meat, fish, eggs, nuts, dairy, citrus fruit
99
What precautions are put in place for thrombocytopenia?
bleeding precautions
100
Hallmark S&S of Hodgkin's?
Reed Sternberg cells
| night sweats
101
Which cells are present in Non-Hodgkin's?
B or T cells
102
S&S of sickle cell crisis?
acute chest syndrome
- cough
- SOB
- X-ray with infiltrates
103
S&S of sickle cell crisis?
acute chest syndrome
- cough
- SOB
- X-ray with infiltrates
104
When taking a 24 hour urine collection ________.
Get rid of the first specimen and start the count.
105
When taking a 24 hour urine collection ________.
Get rid of the first specimen and start the count.
106
What are the 2 main complications of chemo?
tumor lysis
| superior vena cava syndrome
