Exam 1 Flashcards
what is a nurse’s role in pain?
assessment and management; make sure to use PQRST
consequences of untreated pain
unnecessary suffering, physical and psychosocial dysfunction, immunosuppression, sleep disturbances
behavioral pain
observable actions used to express or control pain
physiologic pain
genetic, anatomic, and physical determinants influence how stimuli are recognized and described
explain the affective dimension of pain
how the patient perceives pain; their emotional respons to pain experience like anger, fear, depression, anxiety; severe distress
cognitive dimension of pain
it is culturally driven
sociocultural dimension of pain
includes demographics, support systems, social roles, and culture
nociception of pain
physiologic process that communicates tissue damage to the CNS
transduction of pain
conversion of noxious, mechanical, thermal, or chemical stimulus into a neuronal action potential
what is nociceptive pain?
pain you expect; damage to somatic or visceral tissue like surgical incision, broken bone, or arthritis
what is somatic pain?
deep aches; arises from bone, joint, muscle, skin, or connective tissure
neuropathic pain
damage to peripheral nerve or CNS; phantom limb pain and diabetic neuropathy are examples
visceral pain
tumor involvement of obstruction; arises from internal organs like intestine or bladder
do we want the patient to be at 0 pain?
no, we want them to feel some pain so they don’t overwork whatever is hurting
what is an analgesic ceiling?
if something is not working and you take more, it’s not really going to do anything
what are some rules when scheduling a pain medication?
- do not wait for sever pain
- make a plan with the patient
- use the smallest dose to provide effective pain control with fewest side effects
tolerance
need more of the drug; patient is adapted to it
physical dependence
normal response to ongoing exposure to pharmacologic agents manifested by withdrawal when drug is abruptly decreased
pseudoaddiction
mimics addiction, but behaviors resolve with adequate treatment of the patient’s pain
addiction
still want drug
what occurs in the older population with drugs?
- they metabolize drugs more slowly
- risk of GI bleeding with NSAIDs
- polypharmacy
- cognitive impairment, ataxia can be exacerbated by analgesics
define malnutrition
deficit, excess, or imbalance in essential components of balanced diet
malabsorption syndrome
impaired absorption of nutrients from the GI tract
what might malabsorption syndrome result from?
- decreased enzymes
- drug side effects
- decreased bowel surface area
- fever increases BMR
what kind of people are incomplete diets found in?
- alcoholics
- drug abusers
- chronically ill
- those with poor dietary practices
what are the primary sources of energy?
carbohydrates
where can you find monosaccharides (simple) sugars?
glucose, fructose, fruits and honey
where can you find disaccharides (simple) sugars?
sucrose, maltose, lactose, table sugar, malted cereal, milk
where can you find complex carbs (polysaccharides)?
starches such as cereal grains, potatoes, and legumes
examples of harmful fats
saturated fat and trans fat
examples of healthier fats
monounsaturated and polysaturated fats
example of heart-healthy fats
polyunsaturated, omega-3 fatty acids; avocado, canola, corn, grapeseed, olive, peanut, safflower, sesame, soybean and sunflower oils
what are proteins essential for?
tissue growth, repair, and maintenance
where must amino acids come from and what do they do?
must come from dietary sources and they build and repair
what would be a problem in someone with a vegan diet?
they can develop megalobastic anemia and neurologic signs of deficiency
when is enteral tubing a good idea?
when their GI tract is still working
what is another name for enteral nutrition?
tube feeding
where is a tube feed inserted into?
the stomach, duodenum or jejunum
why is enteral nutrition better than parenteral?
- it is safer
- more physiologically efficient than parenteral
- less expensive
when would a tube feeding be used?
for those who need feedings for extended periods of time
when can feedings start with enteral nutrition?
usually 24 hours after placement
when tube feeding, how should the patient be positioned?
HOB at 30-45 degrees and remains there for 30-60 minutes
what should occur before/after each feeding and drug administration?
residual checks
what if there is too much residual?
stop feeding and call provider
what are methods used to check tube placement?
- aspiration of stomach contents
- pH check (pH < 5 is indicative of stomach contents)
- most accurate assessment is an x-ray visualization
what can increased residual volumes lead to?
aspiration
when is pump tubing changed?
every 24 hours
what complications are the gerontologic population more vulnerable to?
nausea, vomiting, dehydration
parenteral nutrition
administration of nutrients by route other than GI tract
what is a regular IV solution?
dextrose in water or dextrose in lactated ringer’s, NO protein, 170 calories per liter (adults need 1200-1500 calories/day)
what are indications for parenteral nutrition?
injury, surgery, burns, malnourishment, chronic or intractable diarrhea and vomiting, complicated surgery or trauma, GI obstruction, GI tract anomalies and fistulae, malnutrition
what is parenteral nutrition composed of?
dextrose and protein in the form of amino acids, electrolytes, vitamins, fat emulsion
central line
long-term, top of heart (subclavian vein), needs multiple things through IVs, can’t access a good vein
how are PN solutions prepared?
under aseptic technique and must be refrigerated until 30 minutes before use
if a patient’s potassium is off, what is affected?
HR
if BP is low, what does that mean?
not enough fluids
what else do we monitor with those taking PN?
daily weights, BG, electrolytes, BUN, CBC, vital signs
if you suspect an infection with PN, when should you check cultures for infection?
before antibiotics
primary obesity
excess caloric intake for the body’s metabolic demands
secondary obesity
- chromosomal and congenital anomalies
- metabolic problems
- CNS lesions and disorders
what shape presents the highest cardiac risk?
visceral fat: fat around heart and lungs
concerning waist circumference in males and females
> 35 for females
40 for males
android obesity
apple-shaped body with fat located in abdominal area
gynoid obesity
pear-shaped body with fat located in upper legs
what does leptin do?
suppresses appetite, increases physical activity, increases fat metabolism
what does ghrelin do?
regulates appetite through inhibition of leptin
two major consequences of obesity
- increase in fat mass
- production of adipokines: contribute to insulin resistance and atherosclerosis
what density lipoproteins are the “bad guys”? “good guys”?
high LDLs are the bad guys
HDLs are the good guys
examples of HDLs
avocado, fish, nuts, omega-3
normal triglycerides
150
what can help someone with diabetes mellitus?
weight loss and exercise improve glucose control by helping insulin be more effective
what is a main respiratory problem that can occur with obesity?
sleep apnea ~ treat with CPAP
in doing a weight loss program, how much body weight might one lose?
10% and this is associated with significant health benefits
to achieve weight loss of 1-2 lbs/week, how much must calories be reduced by?
500-1,000 calories a day
how many calories are in a pound?
3,500 calories
how much is 1 portion of animal protein?
3 ounces
how much is one portion of chopped vegetables?
1/2 cup
how many glasses of water should you drink in a day?
8-10 glasses
what are the appetite-suppressing drugs?
amphetamines and nonamphetamines
what is important to watch for in those taking amphetamines?
- people might take their children’s ADHD meds which stimulates the CNS
- higher abuse potential
- not recommended or approved by the FDA
how do nutrient absorption-blocking drugs work?
by blocking fat breakdown and absorption in intestine, inhibits lipase; undigested fat is excreted in feces but fat-soluble vitamins may also be excreted
what might occur before a bariatric surgery takes place?
psychologic, physical, and behavioral conditions
what are some of the risks that can occur after a bariatric surgery?
- risk for deep venous thrombosis
- infection, dehiscence, delayed healing
metabolic syndrome
also known as syndrome X; collection of risk factors that increase an individual’s chance of developing cardiovascular disease, stroke, and DM
what factors make someone have metabolic syndrome?
three or more:
- waist circumference >40 in men and >35 in women
- treatment of triglycerides >150
- HDL cholesterol <40 men, <50 women
- BP >130 or >85
- fasting glucose >100
what can happen in someone with metabolic syndrome in terms of insulin?
insulin resistance related to excessive visceral fat
what is the DM the leading cause of?
- adult blindness
- end-stage kidney disease
- nontraumatic lower limb amputations
what is DM a contributing factor of?
- heart disease
- stroke
- hypertension
type 1 diabetes
- absent insulin
- autoimmune disorder
- B-cells self destroy
type 2 diabetes
- insufficient insulin or poor utilization of insulin
normal blood glucose level
70 - 120
what does insulin do?
promotes glucose transport in skeletal muscle and adipose tissue ~ stores calories
counterregulatory hormones
glucagon, epinephrine, GH, cortisol ~ increases BG
most prevalent type of diabetes
type 2
risk factors of type 2 diabetes
overweight, obesity (greatest risk factor), advancing age, family history
what happens in type 2 diabetes?
- pancreas continues to produce some endogenous insulin
- insulin is insufficient or poorly utilized
prediabetes fasting glucose level
100-125: glucose should be under 100 if fasting
in gestational diabetes, do the moms usually become diabetic permanently?
50% of them will become type 2 diabetics
classic symptoms of type 1 diabetes
- polyuria
- polydipsia
- polyphagia
- weight loss
- fatigue
clinical manifestations of type 2 diabetes
- recurrent infection
- recurrent vaginal or yeast infection
what does an A1C show?
reflects glucose levels over the past 2-3 months
what is the goal of an A1C test?
less than 6.5%-7%
do all patients with type 1 diabetes require insulin?
YES
exogenous insulin
insulin from an outside source ~ required for type 1 diabetes and for those with type 2 who cannot control BG by other means
what should you do if a patient requires insulin and has food coming?
wait for their food to be in front of them
when are short-acting insulins onset of action?
30-60 minutes
what is (basal) background insulin used for?
to control glucose levels in between meals and overnight; it is long-acting and released steadily and continuously with no peak action
what insulin can you mix with short and rapid acting insulins?
intermediate
how long can in-use vials of insulin be used for?
they can be left in room temp. for up to 4 weeks
what should you do with extra insulin?
keep it refrigerated
how is insulin given?
- SQ injection (45-90 angle)
- regular insulin may be given IV
- absorbs fastest from abdomen, then arm, thigh, and butt
- must rotate injections!
when would oral agents be given?
after trying diet/exercise, then oral, then insulin
what do oral agents work on in type 2 diabetes?
- insulin resistance
- decreased insulin production
- increased hepatic glucose production
how much should a diabetic be exercising for?
150 minutes/week
benefits of exercising with diabetes
- dec. insulin resistance and BG
- weight loss
- dec. triglycerides and LDL
- inc. HDL
- improved BP and circulation
- glucose-lowering effect up to 48 hours after exercise
hypoglycemia
- too much insulin
- BG less than 70
- untreated can progress to loss of consciousness, seizures, coma, and death
what is the leading cause of diabetes-related death?
angiopathy
if someone had a post transsphenoidal hypophysectomy, what would be advised not to do?
- no teeth-brushing for at least 10 days
- no cough, deep breathing because blood can go to the brain
SIADH
pt. stops peeing; fluid in vascular space
S/S of SIADH
fluid retention, serum hypo-osmolality, dilutional hyponatremia, low sodium
treatment of SIADH
fluid restriction
treatment for DI
fluid and hormone therapy, adequate hydration
treatment of hyperthyroidism
anti-thyroid medications, radioactive iodine therapy, subtotal thyroidectomy
if there is too much T3 and T4, what happens with TSH?
it will be low
if there is too little T3 and T4, what happens with TSH?
it will be high
manifestations of thyroid storm
severe tachycardia, shock, hyperthermia, seizures, abdominal pain, diarrhea, delirium, coma
manifestations of hypothyroidism
fatigue, lethargy, personality and mental changes, decreased cardiac output, anemia, constipation
sign of thyroid cancer
presence of a hard, painless nodule or nodules on enlarged thyroid gland
hyperparathyroidism
increased secretion of PTH that leads to hypercalcemia and hypophosphatemia
hypoparathyroidism
inadequate circulating PTH resulting in hypocalcemia which leads to tetany
cushing syndrome
results from chronic exposure to excess corticosteroids
addison’s disease
autoimmune disorder where the adrenal cortex is destroyed by autoantibodies
manifestations of addison’s disease
weakness, weight loss, and anorexia and BUCCAL PIGMENTATION
what would need to happen in someone with addison’s?
corticosteroid administration (causes weight gain), lifelong hormone therapy, protection against infection
what is addisonian crisis triggered by?
stress, sudden withdrawal of corticosteroid hormone therapy, and post-adrenal surgery
manifestations of addisonian crisis
postural hypotension, tachycardia, dehydration, hyponatremia, hyperkalemia, hypoglycemia, fever, weakness, confusion
