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