Exam 2 papers/diagnostic tests Flashcards
hypoparathyroidism
papers
positive trousseaus
tingling lips
decrease calcium
hyperparathyroidism
increase calcium
increase risk of kidney stones
hyperglycemia
DKA
Bg>200
fruity breath
long term complication of paresthesia
polydyspia
polyuria
hyperthyroidism
intolerance to heat
weight loss
hand tremors
insomnia
exopthalamus
hypoglycemia
bg >50
slurred speech
decreases Loc
irritable
headaches
shakiness
hypothyroidism
levothyroxine treatment
preioribtol edema
listlessness
hoarsness
coarse, scaly skin
fatigue
intolerance to cold
pre op thyroidectomy
place
teach
expect
anser
place pt on antithyroid meds to bring thyroid back to normal baseline and reduce rusk of hemorrhage
teach to support neck after surgery
expect hoarseness and scar
anwer questions
post op thyroidectomy
resp distress
hemorage
laryngeal
tetany
Resp distress
Asses- RR, rhythm, effort, stridor// use humidified air, assist w cDB & keep suction equipment available at bedside
hemorrage-
assess- hem/edema at incision, dressing to make sure tis not too tight and for drainage//monitor BP and pulse for shock –greatest risk is 12-24 hrs
laryngeal
assist ability to speak, note quality of voice//edema will subside but harness and loss of voice volume
tetany
assess for calcium deficiency-tingling at feet, toes, fingers, twitches, Assess C+T/// monitor serum calcium levels, keep calc gluconate at bedside, thyroid surgery may injure parathyroid gland
impaired vision changes
thyroidectomy
monitor acuity of vision, photophobia, integrity of lid closure
teach pt to protect eyes using tinted glasses, artificial tears, eye patches, cool compress and to lift straining
elevte HOB and report and visual changes
nutrition thyroidectomy
limit
outcome
interventions
monitor
limit weight loss
outcome-weight approbate for height and free of NVD and AB pain
interventions-weigh daily
eat high protein, carbs and in small frequent meals
monitor labs data for albumin and lymphocytes
anxiety/body image
thyroidectomy
encourage pt to verbalize feelings about self
encourage self compassion
Pain interventions
preop
postop
vision
nutriton
anxiety
thyroidectomy
pre op-use antithyroid meds/ support neck when coughing
post op- narcotics can worsen respiratory distress, resp. 02 for hoarseness, calcium for teeny
vision-monitor for eye pain, exopthalmuas, cover and moisten eyes
nutrition-assess pain, analgesics, inc appetite
anxiety/body image-manage pain can decrease anxiety, establish trusting relationships
prostatectomy-waht looks like
activity-no/no/excercise
can occur
inc/inc
0
monitor
teach
urinary cath. (maybe drain)
Activity
* No strenuous activity for 6-8 weeKs
* No driving for a weeks
* Leg exercise dt inc risk of blood clots
Bleeding can occur w/ BM, coughing, or inc Exercise
inc fluids at rest until urine is clear
inc fluids, fiber. laxatives at staol softeners as needed to prevent straining
0 sex for 6 weeks
Monitor abilty to urinate, excessive bleeding, Chills, fever, abd pain, swollen or tender serotum
Teach Kegel exercises
Lithotripsy-pre op
Pre-DP
- assess knowlege and understanding of the procedure providing information as needed (anXiety reduced)
Lithotripsy-post op
-Monitor for hemorrhage -bloody urine
-monitor for cloudy urine
- monitor for decreased urinary output and flank Pain (Sighs of ObSurtive urine flow)
- Care for indeWelling cattacter
- increase fluid intake
- Monitor for stones
- encourage activity,
- diet low in Purines (goose, Sardines, chicken),
- encourage loW Sodium/ restrieted Protien diet
- reduce risk for UTI’s
Cystitis–manifestations
dysuria
urgency
noctura
foul/cloudy urine
Cystitis–manifestations
in elderly
_
thermia
inc
if untreated
fever
w/ hypothermia
inc risk of uti
if untreated can go into kidneys and develop bladder stones
Cystitis–type of meds and teaching
antibiotics
teaching
inc fluids
take full coarse of antibiotics
report/follow up if symptoms reside
TURP pre op
aware
signed
fluids?
preop
prep
Assess Knowledge of surgery,
make aware of catheter + possible drains,
consent signed
, NPO,
prè op Vitals,
I-O bowel prep
TURP Post op
monitor
assess
applye
inv
reduce
make
monitor I and O//vitals
assess pain/hematuria
apply teds/sODs,
Inc fluids,
reduce strain
make aware of possible bladder spasms
, Asses for TuRP-sundrome,
Lispro (Humalog)
O
P
D
when eat
Rapid acting
O-15 mins
P-1-1.5 hrs
D-3-4 hrs
Need to start eating 15 mins after
Regular insulin
O
P
D
short acting
O-30-60 mins
P-2-3 hrs
D-4-6 hrs
NPH insulin
O
P
D
O2 hrs
P6-8 hrs
D-12-16 hrs
Glargine
O
P
D
O-1 hrs
P-3-4 hrs
D-10-24 hrs
what insulins can mix/cant mix
CAN-NPH and regular
CANT-glargine
what happens to insulin if you exercise
required insulin should go down
depends on wt loss, cals loss, and blood glucose
what happens if pt is on sick day
take bs every4 hrs
glucose will rise even with no food
still take insulin
ketones in urine
encourage fluids
s/s hyper/o glycemic
where is insulin admisterd
SUBQ
fatty tissues-abdomen, arms, thighs
how is insulin stored
room temperature
, no sun
for 30 days
how is insulin given in body
90 degree angle
45 if skinny
BUN-diagnostic test
used when
normal value
when can they be elevated
used to determine renal function and elimination of nitrogenous waste. Urea rises in AKI and CKD.
Normal Value: 5-25mg/dl-
sometimes can be elevated dt dehyfration-encourage fluid
Urine Culture-diagnostic test
why conducted
normal values
how do
Conducted to identify causative organism of UTI.
Normal <10,000 organisms/ml, values >100,000 organisms/ml indicate UTI
-urin in steril cup, start voiding,then stop, then fill cup-preferef in morning-constituted
Creatinine-diagnostic test
why used
normal value
when different
Used to evaluate kidney function, this is a by product of the breakdown of muscle & excreted by kidneys.
Normal Value: 0.5-1.5 mg
/dl-if patenti is in fluid volum overload then level may be lower thn actual
creatinine clearance–diagnostic tests
why used
keep where
Blood sample and 24-hour urine test used to evaluate GFR & renal function –
keep container on ice or refigerated
CT of Kidneys -diagnostic tests
allows what
what helps visuale
assesss what
Allows evaluation of kidney size, tumors, obstructions etc.
oral or IV contrast dye used to help visualize –
assess allergies to iodion,shellfish or seafood, increase fkuids/know cretninrn and BUN before giving dye
Diagnostic Tests of Renal System
Cystoscopy
what does
done under
assess
Direct visualization of bladder wall and urethra. Can obtain tissue bx, stents can be placed, removal of calculi, assess for obstruction-
can be done under generl or local anethsia –
need to assess for hemorage, bladder perferaiton ,urinary reteion, any gross hermertraria
Intravenous Pyelogram-diangostic test
what does
diagnoses
can be performed
asses
Radiologic exam used to visualize the entire urinary tract
to diagnosis kidney disorders, stones, tumors, cysts.
Can be performed alone or in conjunction with cystoscopy –
assess allergies prior to admintration of dye
Renal Biopsy -diagnostic tests
used for
performed
have patient
Used to determine the cause of renal disease, to rule out cancer, check for metastasis.
Performed via excision or needle bx. –
have patient npo if gen anethia, wathc for external bleeding
Post Void Residual -diagnostic tests
measures
normal
measures amount of urine left in the bladder after voiding.
Normal value <50ml –use bladder scan and report any above 100
Urinalysis-diagnostic tests
used for
when to get
Examines the constituents of urine, to establish baseline, provide data for diagnosis, or monitor treatment results. –
early moring speicim, clean cut specimen, not if pt is menstrating
Hyperglycemia
Diabetes and complications
polys
DKA, HHS, vasculares, delayed wound healing
hypoglycemia
Diabetes and complications
somogoyami=hypo at nighy and rebound hyper in morning
cool clammy,pale
sweating shakiness
nausea, hypotension
DKA
Diabetes and complications
fruity breath
BS > 250
ketones in urine
treated w/ insulin
electrolyte imbalance/ dehydration
looking at glucose every hour
Macrovasular
Diabetes and complications
Pulmonary vascular disease
hypertension
Coronary artery disease
stroke
Microvascualr
Diabetes and complications
capillary leak,
microthromobossos
decreased transport of oxygen leading to tissu e perufsion
Infection
Diabetes and complications
delayed healing
inadequate bowel emptying-leads to uti
sensory defect
foot complications and wind healing
Diabetes and complications
nephorpathy, and infection
most common ia crack, dry skin
tissue perfusion and oxygnetion
may not be aware of problems
amputation w/ loose glycemic control
HHS
Diabetes and complications
elevated BG
Decreased LOC
medical emergency-high mortality rate
osmotic diueresis leading to kidney injury
severre dehydration
CBi
frequent checks. assess urine in tubing, admisnter normal saline,
