Exam 3 Flashcards
Sodium Potassium relationship
Inverse
Calcium/Phosphorus relationship
Inverse
Calcium/Vit D relationship
Similar
Magnesium/Calcium relationship
Similar
Chloride/Bicarbonate relationship
Inverse
Chloride/Sodium relationship
Similar
Third Spacing
Excess fluid where it shouldn’t be
S/sx: Edema, lower BP, high HR
Cations +
Sodium, Potassium, Calcium, Magnesium, Hydrogen
Anions -
Chloride, Bicarbonate, Phosphate/Phosphorus, Sulfate
Hormones that Anterior Pituitary gland secretes
Thyroid Stimulating Hormone (TSH)
Adrenocorticotropic Hormone (ACTH)
Luteninizing and Follicle Stimulating Hormone (LH,FSH)
Prolactin (PRL)
Growth Hormone (GH)
Melanocyte-Stimulating Hormone (MSH)
Posterior Pituitary hormones
Vasopressin/Anti-diuretic Hormone (ADH)
Oxytocin
Baroreceptors
Responds to blood pressure, constricts or dilates vessels by stimulating sympathetic and parasympathetic nerves
Natriuretic peptides
Hormone produced in myocardium that promotes diuresis
RAAS
Kidneys release Renin
Renin splits angiotensinogen into angiotensin I
ACE (lungs/kidneys) splits angiotensin I into angiotensin II
Angiotensin II causes constriction, increased BP, release of aldosterone by adrenal glands
P wave
SA node fires
Atrial Depolarization
PRi
Time from Atrial contraction to Ventricular Contraction
QRS
AV node, Bundle of HIS, and Purkinje fibers fire
Depolarization of Ventricles
Atrial Repolarization (hidden by ventricles)
T
Ventricular repolarization
QTi
Time from ventricles depolarizing to repolarizing
U
Repolarization of Purkinje fibers
How does hyperkalemia show on EKG
Tall T waves
Tx for hyperkalemia
Kayexalate
- IV gluconate or calcium chloride for severe
How does hypokalemia show on EKG
Flattened or inverted T waves
Prominent U wave
How does hypercalcemia show on EKG
Shortened QT - quickly relaxes after QRS
Heart block/dysrhythmias
How does hypocalcemia show on EKG
Prolonged QT
- Takes a long time to relax after QRS
How does hypermagnesemia show on EKG
Peaked T wave
How does hypomagnesemia show on EKG
Inverted T wave
Torsades de Pointes
Exocrine functions of the pancreas
Secretes digestive enzymes (high in bicarb) to neutralize gastric acid
Digests fats, proteins, and carbs
Endocrine functions of the pancreas
Contains islets of Langerhan
Produces insulin or glucagon
Alpha cells
Produce glucagon
Increases blood sugar
Pulls glucose from storage sites and sends into blood stream
Beta cells
Release insulin
Reduces blood sugar
Helps to store glucose in cells and fat cells
Fasting basal insulin (endogenous)
Pancreas releases a steady amount of insulin when you haven’t eaten
Insulin action
Stimulates liver to store sugar as glycogen
Signals liver to stop producing glucose
Moves amino acids into cells
Increases protein and fat synthesis
Promotes storage of triglycerides in fat cells
Where are fatty acids stored?
In fat cells as triglycerides
What happens during prolonged fasting
Insulin production is decreased
Liver and kidneys increase glyconeogenesis
Proteins and fatty acids are broken down into glucose
Blood sugar is maintained between 60-150
What happens when you eat
Insulin released by the pancreas stops glycogen production
Insulin turns excess glucose in the liver into free fatty acids and are deposited as fat in fat cells
T1DM patho
Beta cells are damaged = no insulin production
S/Sx of T1DM
3 P’s
Polyuria
Polydypsia
Polyphagia
T2DM patho
Insulin is less effective at moving glucose into cells
Pancreas produces more insulin, but it cannot be used - insulin resistance
Gestational Diabetes
Onset in 2nd-3rd trimester
Gestational diabetes characteristics
Large at birth, 30-40% of moms within 10 years
Ketone bodies
Without insulin the body breaks down fat cells, ketones are a byproduct
- Excess ketones = Metabolic Acidosis
What type of breathing leads to metabolic alkalosis
Kussmauls breathing - long, deep breaths indicating DKA
- Along with fruity breath
What level of HgA1C indicates DM
Above 6.5
HgA1C for diabetics
Below 7
Normal fasting glucose (with and without DM)
Without DM: Below 100
With DM: 60-110
Normal pre meal glucose (with and without DM)
Without DM: 70-99
With DM: 80-130
Normal post meal (post prandial) glucose (with and without DM)
Without DM: Below 140
With DM: Below 180
Rapid Acting Insulins
Insulin Aspart (Novolog)
Lispro (Humalog)
Insulin Aspart (Novolog) Onset, Peak, Duration
Onset: 5-30 mins
Peak: 30mins-3hrs
Duration: 3-5hrs
Lispro (Humalog) Onset, Peak, Duration
Onset: 10-30mins
Peak: 1h
Duration: 3-5hrs
Short-Acting insulin
Regular human (Humulin R, Novolin R)
Regular human (Humulin R, Novolin R) Onset, Peak, Duration
Onset: 30mins-1hr
Peak: 2-5hrs
Duration: 5-8hrs
Intermediate Acting Insulin
NPH (Novolog N)
70/30 Aspart (Novolog Mix)
75/25 Lispro (Humalog Mix)
NPH (Novolog N) Onset, Peak, Duration
Onset: 1-5hr
Peak: 4-12hrs
Duration: 12-18hrs
Long-Acting insulin
Glargine (Lantus)
Detemir (Levemir)
Lantus/Levemir Peak, Onset, Duration
Onset: 1-4 hrs
Peak: No peak
Duration: 16-24 hrs
When to give rapid-onset insulin
15 mins before meal
When to give short acting insulin
30-60 mins before meal
How to inject/mix insulin
Roll NPH (cloudy)
Inject air into NPH, then Reg
Withdraw Reg, then NPH
Clear before Cloudy
Sick day rules for diabetics
Test BG and ketones Q4H
Supplemental insulin Q4H
Soft foods and liquids to prevent dehydration
Report N/V/D to provider
Dehydration leads to DKA
Acute Pancreatitis patho
Inflammation caused by:
Gall stones
Trauma
Tumors
ETOH
Viral infections
What is the result of acute pancreatitis
Loss of exocrine function - poor digestion
Necrotic pancreas
Labs that indicate acute/chronic pancreatitis
Increased amylase, lipase, bilirubin, and alk phos
Elevated serum BG
Nursing interventions for acute/chronic pancreatitis
Pain control
GI - N/V
Monitor diet
I&O’s - monitor for low albumin/kidney failure
Chronic pancreatitis patho
Progressive destruction of pancreas caused by:
Alcohol, smoking, malnutrition
Chronic pancreatitis s/sx
Severe UQ abd and back pain, weight loss
Chronic pancreatitis tx
Endoscopy to relieve obstruction
Non-opioid pain relief, nerve block
Pancreatic enzymes - malabsorption and steatorrhea
Surgery - if pt refrains from ETOH
Pancreatic cancer/tumor tx
Surgical removal - whipple procedure
- Pt will have drain, monitor for hemorrhage due to deficient Vit K
- Possibly chemo
Nursing care for pancreatic cancer/tumors
Skin care - from jaundice/weight loss
- Monitor bony prominences
Pancreatic cysts patho
Pancreatitis leading to necrotic areas/cysts
Pancreatic cyst s/sx
May displace the stomach/colon
Abd pressure or infection d/t drainage
ERCP
Endoscopic retrograde cholangiopancreatography (ERCP)
- a procedure that combines upper gastrointestinal (GI) endoscopy and x-rays to find and treat problems of the bile and pancreatic ducts
Pancreatic cyst tx
Drainage of cysts
Pancreatic islet tumors patho
Some tumors secrete insulin, some don’t
Insulinomas
Pancreatic islet tumor that hyper-secretes insulin
Pancreatic islet tumor s/sx
May have low BG
- Leads to confusion, seizures, weakness
Pancreatic islet tumor tx
Glucose (monitor for hypoglycemia)
Surgical removal
Gall bladder function
Stores bile
Bile
Created and excreted by the liver
Composed of water, electrolytes, fatty acids, cholesterol, bilirubin, bile salts
Bile salts
Along with cholesterol, bile salts are used to break down fats
- Fats are returned to the liver and excreted in bile
Bilirubin
Byproduct of RBC breakdown
Cholecystitis
Acute/chronic inflammation of gallbladder
- Either Calculous (due to gall stones) or Acalculous (hypoglycemia or CA)
Cholecystitis s/sx
RUQ abd pain radiating to midsternal area or right shoulder, abd rigidity
Cholelithiasis patho
Inflammation caused by gallstones
What are most gallstones made of
Cholesterol
What areas can a gallstone block?
Gallbladder neck, cystic duct, or common bile duct
Chronic cholelithiasis s/sx
Epigastric distress
Distention
RUQ pain after a fatty meal
Acute cholelithiasis s/sx
Distention
Severe RUQ pain
Risk factors for cholelithiasis
4 F’s:
Fat
Forty
Female
Fertile
Cholescintigraphy
Radioactive IV through biliary tract
Takes longer than ultrasound
First dx tools used for cholecystitis and cholelithiasis
Abdominal xray - shows calcified stones only
Ultrasound - quick, can be used on jaundice pt (no dye)
Nursing considerations for ERCP
Endoscopic Retrograde Cholangiopancreatohraphy
NPO
Moderate sedation
Monitor for perforation and infection
Percutaneous Transphepatic Cholangiography (PTC)
Dye injected into biliary tract
- Used if ERCP is not safe for pt
NPO
Sedation
Local anesthetic
Cholelithiasis tx
Lithotripsy: Shock waves break up stones
Lap-Chole
Laparoscopic Cholecystectomy
Removal of gallbladder
Treatment of choice
Open-Chole
Higher risk than Lap-Chole
Bone remodeling
Removal of old bone to allow osteoblasts to form
Osteocytes
Mature bone cells
Osteoclasts
Degrade bone for remodeling or pathological response
Synovium
Lining inside joint capsule; secretes synovial fluid to lubricate joint
Normal vs abnormal synovial fluid
Normal: Straw-colored, clear, slightly sticky (Egg white)
Abnormal: Cloudy or thicker than normal
- Cloudy = crystals/Gout
- Purulent = increased WBC
Bursa
Sacs filled with synovial fluid that protects bones
- Can become inflamed and restrict bone movement
Osteopenia
Loss of bone density
Precursor to osteoporosis
- Common in thin white elderly women
- Loss of estrogen
Osteoporosis
Chronic metabolic disease
Bone density loss is severe
Fractures are likely (hip/spine/wrist)
Medications for Osteoporosis
Calcium carbonate (Os-Cal, Citracal)
Bisphosphonates (Forsamax, Boniva): slow bone absorption
AP & Lat
Anterior, Posterior, and Lateral Xray
- Shows bone density, fractures, erosion
What do ultrasounds show r/t bones
Masses, fluid, bone density
Nursing considerations for CT scan
Check for shellfish allergy
Check kidney function with BUN
What does CT scan show r/t bones
Tumors, soft tissue injury
What does an MRI show r/t bones
Torn muscles or ligaments
- Magnetic, take out jewelry
EMG
Electromyography
Measures muscle action potential in nerves with electrodes
Dislocation
Complete displacement of joint
Sublucation
Partial displacement of joint
Tx for dislocation
Open or closed reduction
Surgical vs manual joint replacement
Repetitive strain injury
Trauma or stress to tendons, ligaments, muscles due to repetitive movement
Carpal tunnel syndrome
Inflammation of median nerve under transverse carpal ligament
Carpal tunnel syndrome tx
Surgical release of median nerve by cutting carpal ligament
Dupuytren’s disease
Slow contracture of 4th, 5th sometimes 3rd finger
Tx for Dupuytren’s disease
Stretching
Steroid injections
Fasciotomy
Impingement syndrome
Rotator cuff injury
Partial or complete tear causing inflammation
Loose bodies
A fragment of a cartilage tear or bone fragment came loose
Loose bodies tx
Arthroscopic removal
ACL stands for
Anterior Cruciate Ligament
Crutch techniques
2 point: Move opp leg and crutch at same time
3 point: Swing gait
4 point: Opp crutch then leg move all separately
Swing-To gait: Both legs swing through after both crutches
Swing-Through: Swing legs past crutches
Closed vs open fracture
Closed = nondisplaced
Open = compound, bone is displaced
Comminuted fracture
Fragmented fracture
Impacted fracture
Bone crushed with downward force
Greenstick fracture
Bone cracks and snaps into pieces
ORIF
Open reduction, internal fixation
OREF
Open reduction, external fixation
Hemiarthroplasty
Part of joint is replaced
Buck’s traction
Used for hip or proximal femur fractures before surgery
Foot in a boot is pulled with counter weights
Type of skin traction
Nurse’s role during Buck’s traction
Pulse
Signs of DVT: Calf pain, warmth, edema
Skin condition
CMS - Circulatory Motor Sensory (wiggle toes)
Russell’s traction
Self trapeze traction used for distal femur fracture
Type of skin traction
Dunlop’s traction
Counter weight traction used for humerus fracture
Type of skin traction
Skeletal traction
Pins or wires screwed into bone with weights
Used before surgery
Gallows traction
Pediatric skin traction
Child on back with legs up, feet pulled by weights
Used for hip dislocation or femur fracture
Stryker frame
Moves patient with back fracture as one unit
Front and back piece hold patient in place
Spica cast
Cast with rod between body parts
- Shoulder or pelvic injuries requiring joint immobilization
Monitor for bowel obstruction - abd assessment
Acute Compartment Syndrome
Increased pressure within a fixed space
Complication of fractures
Tx for Acute Compartment Syndrome
Remove cast or fasciotomy to relieve pressure
Thromboembolism
Blood clot
Complication of fracture
Prevented with Lovenox/Heparin
- Monitor PTT and platelets, s/sx of bleeding
Fat embolism
Fat globules released from yellow bone marrow
- Complication of fractures
- Usually from long bone fractures
- 24-48 hrs post op
Disuse Syndrome
Muscle atrophy
Complication of fractures
- Prevented with isometric exercises
Crush syndrome
Reperfusion after crushing injury causes traumatic rhabdomyolysis
- Cardiac arrest and kidney failure due to sudden shift of electrolytes
Tx for compression fracture
Vertebroplasty
- Outpatient procedure
Osteomyelitis
Bacterial, viral, or fungal infection in bone
Osteomyelitis s/sx
Fever over 104
Increased WBC and ERS
Positive blood cultures
Osteochondroma
Most common benign bone tumor
Osteosarcoma
Most common primary bone tumor
Ewing’s sarcoma
Less common
Most malignant bone tumor
- Affects pelvis and lower extremities
Muscular dystrophy
Progressive muscle weakness
Major cause of death is respiratory failure
Muscular dystrophy tx
Steroids
Low back pain characteristics
Radiculopathy: Radiating pain
Sciatica: Nerve pain that runs down leg to foot
What does a myelogram show
Herniated or compressed disc
Low back pain tx
Short term: NSAIDs and muscle relaxant
Long term: Neurontin or antidepressant
Intervertebral disc disease
Repeated stress/trauma thins or herniates the disc, putting pressure on nerves
Laminectomy
Takes out part of vertebrae
Tx for intervertebral disc disease
Discectomy
Removes all or part of the herniated disc
Tx for intervertebral disc disease
Spinal fusion
Used for spinal instability
Hallux valgus
Bunion
Big toe drifts laterally
Onychocryptosis
Ingrown toenail
Morton Neuroma
Swelling of third branch of plantar nerves
Due to tissue or pressure/injury
- Feels like walking on a marble
Pes Cavus
High arch
Pes Planus
Low arch/flat foot
Plantar fasciitis
Inflammation of fascia over heel bone
- Tx with overnight dorsiflexion
Osteomalacia
Demineralization of bone related to Vit D deficiency leads to soft bones
- Caused by lack of sunlight or medications
- Bow legs, kyphosis
Paget’s disease
AKA Osteitis Deformans
Paget’s disease patho
Too many osteoclasts breaking down bone
Osteoblast production increases
Leads to weak bones - fractures
Paget’s disease S/sx
Thick skull
Bow legs
Pain in hips/pelvis
Vertigo/hearing loss - bone in ears effected
Paget’s disease tx
NSAID’s
Bisphosphonates (Foramax, Boniva): Slows bone reabsorption
Calcitonin: Stops bone reabsorption by decreasing osteoclasts
