Exam 3 Flashcards
1
Q
main adrenal problems
A
cushing’s, addison’s, hyperaldosteronism
2
Q
what occurs in cushing’s syndrome?
A
increase in adrenal hormones
3
Q
causes of cushing’s
A
- excess corticosteroids
- ACTH-secreting pituitary adenoma
- tumors
4
Q
manifestations of cushing’s
A
buffalo hump, moon face, striae on stomach, weight gain, increased BG, muscle wasting, thin hair and skin, acne, male characteristics in females (hair on body), female characteristics in males (gynecomastia)
5
Q
treatment of cushing’s
A
- decrease corticosteroids
- surgery to remove tumor
6
Q
what occurs in addison’s disease?
A
decrease in adrenal hormones
7
Q
addison’s is a _______ disease
A
autoimmune
8
Q
causes of addison’s disease
A
- all 3 corticosteroids are decreased (glucocorticoids, mineralocorticoids, androgens)
- pituitary disease or suppression
9
Q
manifestations of addison’s disease
A
weight loss, hyperpigmentation of skin, cold intolerance, weak, fatigued, orthostatic hypotension, anorexia, nausea, abdominal pain, diarrhea, headache, salt craving, joint pain, depression, irritability
10
Q
addisonian crisis
A
sudden decrease in hormones due to stress, sudden withdrawal of steroids, adrenal surgery or pituitary gland destructions
11
Q
manifestations of addisonian crisis
A
- decreased BP, increased HR
- dehydrated: decreased Na+ and increased K+
- decreased BG
- fever
- weakness, confusion
12
Q
treatment of addison’s
A
lifelong hormone therapy (hydrocortisone)
13
Q
when should hormone therapy be increased?
A
when stressed
14
Q
when should hormone therapy be taken and why?
A
in the AM due to GI upset
15
Q
causes of hyperaldosteronism
A
- Na+ retention
- K+ and hydrogen ion excretion
16
Q
manifestations of hyperaldosteronism
A
HTN with hypokalemic alkalosis
17
Q
treatment of hyperaldosteronism
A
- surgical removal of adenoma
- K+ and diuretics
18
Q
main thyroid problems
A
- graves disease
- hypothyroidism
19
Q
graves’ disease
A
increased thyroid hormone
20
Q
graves’ is an ____________ disease
A
autoimmune
21
Q
causes of graves’
A
- toxic nodula goiter
- thyroiditis
- increased iodine intake
- pituitary tumors
- thyroid cancer
22
Q
manifestations of graves’
A
goiter, exopthalamous, weight loss, clubbing of fingers, anxiety, palpitations, tremors
23
Q
treatment of graves’
A
- antithyroid meds
- radioactive iodine
- surgery
24
Q
thyrotoxic crisis/thyroid storm
A
increased thyroid hormone is released from stressors or being on meds for hypothyroidism
25
manifestations of thyroid storm
- increased HR, HF, shock
- hyperthermia
- agitation, delirium, seizures
- abdominal pain, vomiting, diarrhea
- coma
26
what occurs in hypothyroidism
- decreased thyroid hormone
- slow metabolic rate
27
causes of hypothyroidism
- iodine deficiency
- destruction of thyroid tissue
- defective hormone synthesis
- pituitary disease with decreased TSH
- hypothalamic dysfunction with decreased TRH
28
manifestations of hypothyroidism
- tired, lethargic, neuro changes
- weight gain
- decreased CO
- decreased exercise tolerance, SOB
- increased cholesterol and triglycerides
- cold and dry skin, hair loss, cold intolerance
- constipation
29
treatment of hypothyroidism
- low calories
- levothyroxine lifelong
30
myxedema
severe, longstanding hypothyroidism
31
manifestations of myxedema
* alters physical appearance
- puffiness, periorbital and facial edema
- mask-like effect
32
what can myxedema lead to?
myxedema coma
33
what is myxedema coma precipitated by?
infection, drugs, cold, trauma
34
type 1 DM
no insulin from pancreas; need to give a lot of insulin
35
type 2 DM
diet, exercise, etc. are factors
36
normal BG
60-100
37
most common manifestations of DM
polyuria, polydipsia, polyphagia
38
goal of an A1C
< 7.0%
39
who is HHS more common in?
type 2 diabetics
40
causes of HHS
UTIs, newly diagnosed type 2, sepsis, acute illness, pneumonia
41
manifestations of HHS
- increased BG (>600) leading to neuro problems: coma, somnolence, seizures, hemiparesis, aphasia ~ looks like a stroke
- lethargic
- decreased BP, increased HR
- peeing a lot (can't replace fast enough), BUN and creatinine increased
- no or little ketones
42
treatment of HHS
- immediate IV insulin and NaCl (be careful with large volume fluids, they might have HF or kidney issues)
- when BG reaches about 250, start IV dextrose to prevent hypoglycemia
43
who is DKA more common in?
type 1 diabetics
44
DKA characteristics
- increased BG
- ketosis
- acidosis
- dehydration
45
causes of DKA
- illness
- infection
- inadequate insulin dosage
- undiagnosed type 1
- lack of education
46
how do ketones form in DKA?
since body can't use glucose for energy, it breaks down fat instead -> ketones -> ketosis -> acidosis
47
manifestations of DKA
- increased HR, orthostatic hypotension
- dehydration
- lethargic, weak
- anorexia, N/V
- acetone, sweet fruity breath
- kussmaul RR
48
treatment of DKA
F/E replacement, starts dextrose when BG around 250
49
what do you want to check for before starting insulin?
potassium levels ~ it can decrease it even more ~ replace first before starting insulin
50
immunologic disorders of the kindeys
- glomerulonephritis
- APSGN
- chronic glomerulonephritis
- goodpasture syndrome
- rapidly progressive glomerulonephritis
- nephrotic syndrome
51
prerenal AKI
factors that reduce systemic circulation -> decreased BF
52
example of prerenal AKI
- dehydration
- HF
- decreased CO
- nonretaining BF
53
intrarenal AKI
includes problems that cause direct damage to kidneys
54
examples of intrarenal AKI
- prolonged ischemia
- nephrotoxins
- Hgb. released from hemolyzed RBCs
- myoglobin released from necrotic muscle cells
- acute tubular necrosis
55
postrenal AKI
involves mechanical obstruction in the outflow of urine
56
examples of postrenal AKI
- BPH
- prostate cancer
- stones
- trauma
- extrarenal tumors
- leads to hydronephrosis
57
which two types of AKI resolve quickly if treated?
prerenal and postrenal
58
three phases of AKI manifestations
oliguric, diuretic, recovery
59
oliguric phase
- occurs within 1-7 days and can last for 2 weeks
- S/S: no or little urine output (<400 mL/day), hypovolemia, fluid retention, metabolic acidosis, increased K+, decreased Na+, leukocytosis, increased BUN and creatinine, fatigue, seizures, coma
60
diuretic phase
- can last 1-3 weeks
- S/S: daily urine output is 1-3 L, up to 5 L, inability to concentrate urine, hypovolemia, hypotension, F/E imbalance
61
recovery phase
- up to 12 months
- S/S increased GFR, BUN and creatinine decrease
62
what happens if a patient does not recover from AKI?
CKD -> ESRD
63
a good diagnostic test for AKI at first
US
64
treatment of AKI
- eliminate cause
- manage S/S
- prevent complication
- diuretics
- adequate calories to prevent breakdown of proteins
- Na+ restriction
- increased fat intake
65
method for treating AKI
CRRT
66
CRRT
- continual renal replacement therapy
- uremic toxins and fluids removed, taking workload off heart
- ultrafiltrate should be clear yellow
67
what is more prevalent: AKI or CKD?
CKD
68
5th stage of CKD meaning
GFR <15 -> dialysis or transplant
69
causes of CKD
- DM
- HTN
- obesity
- increased age
- glomerulonephritis, cystic disease, urologic disease
70
manifestations of CKD
- uremia, fluid retention
- hyperglycemia, hyperinsulinemia
- increased triglycerides, increased K+
- urine odor of breath
- neuro changes
- CKD-MBD
71
most common cause of death in CKD
CVD
72
how would insulin work in CKD?
they might require less
73
labs for CKD
decreased GFR, increased BUN and creatinine, proteinuria, albuminemia, biopsy
74
treatment for CKD
control BP, reduce CVD risks, protein restriction, fluid restriction with HD, Na+ and K+ restriction, phosphate restriction
75
gastric ulcer S/S
- 1-2 hours after meal
- burning or gaseous
- high recurrence
76
where do gastric ulcers occur
in any part of stomach
77
where to duodenal ulcers occur?
in the small intestine
78
S/S of duodenal ulcers
- 2-5 hours after eating
- burning or cramplike
- midepigastric pain
- back pain
- occur, disappear, recur
79
major risk factor for PUD
H. pylori infection
80
complications of PUD
bleeding, perforation, gastric outlet obstruction
81
types of upper GI bleed
hematemesis, melena, occult
82
fast bleeding =
bright red blood
83
slow bleeding =
coffee ground, black, tarry
84
how do we determine where an upper GI bleed is?
endoscopy
85
treatment of upper GI bleed
- IV fluids, blood, packed RBCs, plasma
- endoscopy
- surgery
- PPIs
- NGT
86
acute abdominal pain causes
damage to organs in abdomen or pelvis which leads to inflammation, infection, obstruction, bleeding, and perforation
87
acute abdominal pain manifestations
pain, N/V, diarrhea, constipation, fever, flatulence, fatigue, rebound, tenderness, bloating
88
fetal position meaning
peritoneal irritation (appendicitis)
89
supine position meaning
visceral pain
90
treatment for acute abdominal pain
treat cause, pain meds, surgery consult
90
restless meaning
kidney stones or gallstones
91
type of acute abdominal pain
abdominal trauma
92
what can abdominal trauma put you at risk for?
peritonitis
93
treatment for abdominal trauma
lavage, NG tube
94
should you remove impaled objects during an abdominal trauma?
no, it is stopping the bleeding
95
causes of chronic abdominal pain
IBS, PUD, chronic pancreatitis, PID, adhesions, vascular insufficiency
96
manifestations of chronic abdominal pain
dull, aching, diffuse
97
two forms of IBD
chron's and UC
98
chron's disease
- any segment of GI tract affected
- skip lesions ~ cobblestone appearance
- involves all layers of the bowel wall so abscess is common
99
ulcerative colitis
- limites to colon
- occurs in mucosal layer
- can go up to 20 times/day
100
manifestations of IBD
diarrhea, weight loss, abdominal pain, fever, fatigue
101
complications of IBD
hemorrhage, strictures, perforation, abscesses, fistulas, CDI, toxic megacolon
102
treatment of IBD
rest bowel, control inflammation, malnutrition, symptom relief
103
most common cause of acute pancreatitis
gallbladder disease
104
second most common cause of acute pancreatitis
alcohol use
105
manifestations of acute pancreatitis
abdominal pain in LUQ, N/V, fever, leukocytosis, hypotension, increased HR, jaundice, guarding, decreased bowel sounds, crackles, bruising, shock
106
complications of acute pancreatitis
- pseudocyst, abscess
- atelectasis
- tetany
- abdominal compartment syndrome
107
what labs are important in the pancreas?
amylase and lipase
108
treatment for acute pancreatitis
pain relief, correct F/E, suppress enzymes (NPO and NGT), prevent infection, surgery on gallbladder
109
most common cause of nonobstructive chronic pancreatitis
alcohol use
110
most common cause of obstructive chronic pancreatitis
gallstone inflammation and cancer
111
manifestations of chronic pancreatitis
abdominal pain more frequent, malabsorption with weight loss, constipation, jaundice, dark urine, steatorrhea, DM
112
treatment for chronic pancreatitis
- small, frequent bland diet
- decrease smoking, alcohol, and caffeine
- enzyme replacement with every meal
- insulin if becomes diabetic
- endo. therapy
- surgery
113
early S/S of cirrhosis
fatigue, enlarge liver, normal blood tests (compensated)
114
late S/S of cirrhosis
jaundice, portal HTN -> edema, ascites, skin lesions, coagulation problems, anemia, female characteristics in males
115
complications of cirrhosis
portal HTN, varices, peripheral edema, ascites, hepatic encephalopathy, hepatorenal syndrome
116
most life-threatening complication of cirrhosis
varices
117
