Deck 2 Flashcards
What is myelosuppression?
Decrease in bone marrow activity
LOW RBC, WBC, and platelets
Main cause is chemo and radiation therapy
Sickle cell
autosomal recessive
abnormal hemoglobin.
Oxygen molecules cannot attach due to the abnormal sickle shape of the cell
The sickle cells get into log jams causing vascular occlusion which causes ischemia = pain
Treatment for sickle cell (SATA)
oxygen
IV push pain medications
IV fluids to help get blood flowing.
Hydroxyurea (sickle cell crisis) (its a chemotherapy agent which causes myelosuppression(clinical benefit is it stops production of red blood cells)
blood transfusion of pack red blood cells.
What patient population does sickle cell mainly effect?
Africans and African Americans
What is DKA? (Know this Patho)
Diabetic ketoacidosis matchy-match fatty acidosis.
-effects patients with type-1 diabetes
-Islets of Langerhans do NOT produce insulin (or enough insulin)
Therefore, body isn’t getting glucose to the cells and is craving fuel for energy
- the liver breaks down fatty acids for fuel, which produces waste byproducts called ketones.
Clinical Findings of DKA
Hyperglycemia > 300
ketonemia and ketonuria
Kussmaul Respirations (rapid, deep breathing) - this is to try and blow out CO2
pH < 7.3
fruity odor breath
polyuria
abdominal pain
N/V (gastroparesis)
Initially, they’re going to be HYPERkalemic → metabolic acidosis initially results in hyperkalemia - then after all the polyuria they become hypokalemic
Cerebral angiogram with contrast, what would we report to doctor? SATA
-High creatine levels
-shellfish allergies
-pregnancy
-warfarin/coumadin (blood thinners)
-they ate a light breakfast
Brain tumor, craniotomy, removed part of the brain, removal of brain tissue, or piece of the skull (bone would be harvested in the body. What medications would we avoid giving them if their respiratory rates are at 12?
Opioids
Don’t want to further depress respiratory rate
Diabetes insipidus: needs. antidiuretic hormone
-Findings: low ADH, peeing nonstop as you no longer have an antidiuretic effect, copious amounts of diluted urine, signs of dehydration, hypovolemic shock
-lab values:
hypernatremic
high serum osmolality
urine will have a very low osmolality and low specific gravity.
What is ADH?
antidiuretic hormone
the hormone that tells your kidney’s to hold onto water
If you do not have ADH?
Your body get rid of fluid, hold salt and urine will look like water due to low osmolality (concentration) (patient with diabetes insipidus)
SIADH: Syndrome of inappropriate antidiuretic hormone
they are going to be opposite of diabetes insipidus
they will be hypovolemic
they will retain water and won’t be able to release all of the fluid from their body.
Salt will be diluted.
-low serum osmolarity
-high urine osmolarity
-high specific gravity
hyponatremia
clinical findings: Neuro declines whether too high or too low, seizures, coma, and death.
Cushing’s disease = high ACTH (cortisol)
-caused by a pituitary tumor
-buffalo hump
-non-healing wounds-lower legs
-infection
-truncal obesity
-renal calculi
-mental lability (mood swings)
-irritability
-osteoporosis (bone fractures)
-abdominal striae
-hyperglycemia- from taking prednisone
-moon face
Cushing disease treatment
-treatment; remove the pituitary gland and then have HRT (hormone replacement therapy) for life
Hypothyroidism: T3, T4 hormones will be missing or will be low
-Findings: hair loss, fatigue, weight gain, constipation, briter nails, mental illness, and mental dullness.
-Treatments: synthetic hormones (Synthroid), levothyroxine
*-Labs: TSH, T3 and T4 levels.
TSH will be high and T3, T4 will be low
Hyperthyroidism: T3, T4 hormones will be high
-Findings: Weightloss, insomnia, tachycardia, hypermetabolic state, graves disease, bulging eyes is exophthalmos, cardiac issues, palpitations (secondary to arrhythmias), impending thyroid storm which. starts from fever (evaluate temperatures as this is a warning sign of a thyroid storm)
-Treatments: Thyroidectomy, methimazole, iodine 131, PTU (propylthiouracil)
*Labs: TSH, T3 and T4 levels
TSH will be low and T3, T4 will be high
Thyroid storm (thyrotoxic crisis)
overactive thyroid
Findings:
Non-infectious fever (fever without other signs of infection)
Symptomatic Tachycardia
Low TSH, High T3 & T4
Exophthalmos (fatty tissue behind eyes) (PROTECT EYES)
Graves Disease
How to diagnose hypo/hyperthyroidism?
physical characteristics and TSH level, T3 and T4
Intracranial brain bleed, where are they bleeding into?
The brain; they are bleeding into brain tissue
Pheochromocytoma: Tumor in the adrenal glands; too much ACTH
What are the clinical findings? SATA
5H’s
-headache
-hypertension
-hyperhidrosis (excessive sweating)
-hyperglycemia
-hyper-metabolic state
-Hyper-metabolic state: too much catecholamine (3) (dopamine, epinephrine and norepinephrine)
-adrenalectomy: a surgical procedure to remove one or both adrenal glands
Addison’s disease
LOW ACTH
Adrenal glands don’t produce enough aldosterone, cortisol, and sometimes catecholamines
Clinical Manifestations:
● Hypoglycemic → because of no/lack of cortisol
● Hypotensive → due to low catecholamines, lacking aldosterone (less fluid volume)
● bradycardia→ low catecholamines so it’s not stimulating heart rate
● hyponatremic → lack of aldosterone so no sodium
● hyperkalemic → lack of aldosterone = no sodium in cells so potassium fills
ACTH stands for?
adrenocorticotropic hormone
aka: cortisol
Pituitary disorders
-diabetes insipidus
-SIADH
Number 1 gold standard diagnostic for stroke is a non contrast CT
After the CT, the only person you want to listen to
is the neurologist.
-DO NOT administer any medications until the CT results
-ischemic stroke? Hold antihypertensive medications
ALWAYS ask patient if they are on anticoag therapy
A nurse is providing teaching with a newly licensed nurse about the manifestations of stroke. Match the finding of stroke to the corresponding term
1.) Agnosia: Inability to recognize familiar objects by sight, hearing or touch
2.) Aphasia: Inability to speak or understand language
3.) Agraphia: Difficulty writing
4.) Ataxia: Loss of balance of coordination
5.) Apraxia: Inability to perform simple commands
