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MedSurg > Exam 3 > Flashcards

Exam 3 Flashcards

1
Q

Sodium Potassium relationship

A

Inverse

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2
Q

Calcium/Phosphorus relationship

A

Inverse

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3
Q

Calcium/Vit D relationship

A

Similar

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4
Q

Magnesium/Calcium relationship

A

Similar

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5
Q

Chloride/Bicarbonate relationship

A

Inverse

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6
Q

Chloride/Sodium relationship

A

Similar

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7
Q

Third Spacing

A

Excess fluid where it shouldn’t be
S/sx: Edema, lower BP, high HR

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8
Q

Cations +

A

Sodium, Potassium, Calcium, Magnesium, Hydrogen

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9
Q

Anions -

A

Chloride, Bicarbonate, Phosphate/Phosphorus, Sulfate

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10
Q

Hormones that Anterior Pituitary gland secretes

A

Thyroid Stimulating Hormone (TSH)
Adrenocorticotropic Hormone (ACTH)
Luteninizing and Follicle Stimulating Hormone (LH,FSH)
Prolactin (PRL)
Growth Hormone (GH)
Melanocyte-Stimulating Hormone (MSH)

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11
Q

Posterior Pituitary hormones

A

Vasopressin/Anti-diuretic Hormone (ADH)
Oxytocin

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12
Q

Baroreceptors

A

Responds to blood pressure, constricts or dilates vessels by stimulating sympathetic and parasympathetic nerves

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13
Q

Natriuretic peptides

A

Hormone produced in myocardium that promotes diuresis

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14
Q

RAAS

A

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

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15
Q

P wave

A

SA node fires
Atrial Depolarization

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16
Q

PRi

A

Time from Atrial contraction to Ventricular Contraction

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17
Q

QRS

A

AV node, Bundle of HIS, and Purkinje fibers fire
Depolarization of Ventricles
Atrial Repolarization (hidden by ventricles)

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18
Q

T

A

Ventricular repolarization

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19
Q

QTi

A

Time from ventricles depolarizing to repolarizing

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20
Q

U

A

Repolarization of Purkinje fibers

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21
Q

How does hyperkalemia show on EKG

A

Tall T waves

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22
Q

Tx for hyperkalemia

A

Kayexalate
- IV gluconate or calcium chloride for severe

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23
Q

How does hypokalemia show on EKG

A

Flattened or inverted T waves
Prominent U wave

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24
Q

How does hypercalcemia show on EKG

A

Shortened QT - quickly relaxes after QRS
Heart block/dysrhythmias

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25
Q

How does hypocalcemia show on EKG

A

Prolonged QT
- Takes a long time to relax after QRS

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26
Q

How does hypermagnesemia show on EKG

A

Peaked T wave

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27
Q

How does hypomagnesemia show on EKG

A

Inverted T wave
Torsades de Pointes

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28
Q

Exocrine functions of the pancreas

A

Secretes digestive enzymes (high in bicarb) to neutralize gastric acid
Digests fats, proteins, and carbs

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29
Q

Endocrine functions of the pancreas

A

Contains islets of Langerhan
Produces insulin or glucagon

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30
Q

Alpha cells

A

Produce glucagon
Increases blood sugar
Pulls glucose from storage sites and sends into blood stream

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31
Q

Beta cells

A

Release insulin
Reduces blood sugar
Helps to store glucose in cells and fat cells

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32
Q

Fasting basal insulin (endogenous)

A

Pancreas releases a steady amount of insulin when you haven’t eaten

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33
Q

Insulin action

A

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

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34
Q

Where are fatty acids stored?

A

In fat cells as triglycerides

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35
Q

What happens during prolonged fasting

A

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

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36
Q

What happens when you eat

A

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

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37
Q

T1DM patho

A

Beta cells are damaged = no insulin production

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38
Q

S/Sx of T1DM

A

3 P’s
Polyuria
Polydypsia
Polyphagia

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39
Q

T2DM patho

A

Insulin is less effective at moving glucose into cells
Pancreas produces more insulin, but it cannot be used - insulin resistance

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40
Q

Gestational Diabetes

A

Onset in 2nd-3rd trimester

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41
Q

Gestational diabetes characteristics

A

Large at birth, 30-40% of moms within 10 years

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42
Q

Ketone bodies

A

Without insulin the body breaks down fat cells, ketones are a byproduct
- Excess ketones = Metabolic Acidosis

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43
Q

What type of breathing leads to metabolic alkalosis

A

Kussmauls breathing - long, deep breaths indicating DKA
- Along with fruity breath

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44
Q

What level of HgA1C indicates DM

A

Above 6.5

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45
Q

HgA1C for diabetics

A

Below 7

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46
Q

Normal fasting glucose (with and without DM)

A

Without DM: Below 100
With DM: 60-110

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47
Q

Normal pre meal glucose (with and without DM)

A

Without DM: 70-99
With DM: 80-130

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48
Q

Normal post meal (post prandial) glucose (with and without DM)

A

Without DM: Below 140
With DM: Below 180

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49
Q

Rapid Acting Insulins

A

Insulin Aspart (Novolog)
Lispro (Humalog)

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50
Q

Insulin Aspart (Novolog) Onset, Peak, Duration

A

Onset: 5-30 mins
Peak: 30mins-3hrs
Duration: 3-5hrs

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51
Q

Lispro (Humalog) Onset, Peak, Duration

A

Onset: 10-30mins
Peak: 1h
Duration: 3-5hrs

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52
Q

Short-Acting insulin

A

Regular human (Humulin R, Novolin R)

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53
Q

Regular human (Humulin R, Novolin R) Onset, Peak, Duration

A

Onset: 30mins-1hr
Peak: 2-5hrs
Duration: 5-8hrs

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54
Q

Intermediate Acting Insulin

A

NPH (Novolog N)
70/30 Aspart (Novolog Mix)
75/25 Lispro (Humalog Mix)

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55
Q

NPH (Novolog N) Onset, Peak, Duration

A

Onset: 1-5hr
Peak: 4-12hrs
Duration: 12-18hrs

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56
Q

Long-Acting insulin

A

Glargine (Lantus)
Detemir (Levemir)

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57
Q

Lantus/Levemir Peak, Onset, Duration

A

Onset: 1-4 hrs
Peak: No peak
Duration: 16-24 hrs

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58
Q

When to give rapid-onset insulin

A

15 mins before meal

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59
Q

When to give short acting insulin

A

30-60 mins before meal

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60
Q

How to inject/mix insulin

A

Roll NPH (cloudy)
Inject air into NPH, then Reg
Withdraw Reg, then NPH
Clear before Cloudy

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61
Q

Sick day rules for diabetics

A

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

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62
Q

Acute Pancreatitis patho

A

Inflammation caused by:
Gall stones
Trauma
Tumors
ETOH
Viral infections

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63
Q

What is the result of acute pancreatitis

A

Loss of exocrine function - poor digestion
Necrotic pancreas

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64
Q

Labs that indicate acute/chronic pancreatitis

A

Increased amylase, lipase, bilirubin, and alk phos
Elevated serum BG

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65
Q

Nursing interventions for acute/chronic pancreatitis

A

Pain control
GI - N/V
Monitor diet
I&O’s - monitor for low albumin/kidney failure

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66
Q

Chronic pancreatitis patho

A

Progressive destruction of pancreas caused by:
Alcohol, smoking, malnutrition

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67
Q

Chronic pancreatitis s/sx

A

Severe UQ abd and back pain, weight loss

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68
Q

Chronic pancreatitis tx

A

Endoscopy to relieve obstruction
Non-opioid pain relief, nerve block
Pancreatic enzymes - malabsorption and steatorrhea
Surgery - if pt refrains from ETOH

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69
Q

Pancreatic cancer/tumor tx

A

Surgical removal - whipple procedure
- Pt will have drain, monitor for hemorrhage due to deficient Vit K
- Possibly chemo

70
Q

Nursing care for pancreatic cancer/tumors

A

Skin care - from jaundice/weight loss
- Monitor bony prominences

71
Q

Pancreatic cysts patho

A

Pancreatitis leading to necrotic areas/cysts

72
Q

Pancreatic cyst s/sx

A

May displace the stomach/colon
Abd pressure or infection d/t drainage

73
Q

ERCP

A

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

74
Q

Pancreatic cyst tx

A

Drainage of cysts

75
Q

Pancreatic islet tumors patho

A

Some tumors secrete insulin, some don’t

76
Q

Insulinomas

A

Pancreatic islet tumor that hyper-secretes insulin

77
Q

Pancreatic islet tumor s/sx

A

May have low BG
- Leads to confusion, seizures, weakness

78
Q

Pancreatic islet tumor tx

A

Glucose (monitor for hypoglycemia)
Surgical removal

79
Q

Gall bladder function

A

Stores bile

80
Q

Bile

A

Created and excreted by the liver
Composed of water, electrolytes, fatty acids, cholesterol, bilirubin, bile salts

81
Q

Bile salts

A

Along with cholesterol, bile salts are used to break down fats
- Fats are returned to the liver and excreted in bile

82
Q

Bilirubin

A

Byproduct of RBC breakdown

83
Q

Cholecystitis

A

Acute/chronic inflammation of gallbladder
- Either Calculous (due to gall stones) or Acalculous (hypoglycemia or CA)

84
Q

Cholecystitis s/sx

A

RUQ abd pain radiating to midsternal area or right shoulder, abd rigidity

85
Q

Cholelithiasis patho

A

Inflammation caused by gallstones

86
Q

What are most gallstones made of

A

Cholesterol

87
Q

What areas can a gallstone block?

A

Gallbladder neck, cystic duct, or common bile duct

88
Q

Chronic cholelithiasis s/sx

A

Epigastric distress
Distention
RUQ pain after a fatty meal

89
Q

Acute cholelithiasis s/sx

A

Distention
Severe RUQ pain

90
Q

Risk factors for cholelithiasis

A

4 F’s:
Fat
Forty
Female
Fertile

91
Q

Cholescintigraphy

A

Radioactive IV through biliary tract
Takes longer than ultrasound

92
Q

First dx tools used for cholecystitis and cholelithiasis

A

Abdominal xray - shows calcified stones only
Ultrasound - quick, can be used on jaundice pt (no dye)

93
Q

Nursing considerations for ERCP

A

Endoscopic Retrograde Cholangiopancreatohraphy
NPO
Moderate sedation
Monitor for perforation and infection

94
Q

Percutaneous Transphepatic Cholangiography (PTC)

A

Dye injected into biliary tract
- Used if ERCP is not safe for pt
NPO
Sedation
Local anesthetic

95
Q

Cholelithiasis tx

A

Lithotripsy: Shock waves break up stones

96
Q

Lap-Chole

A

Laparoscopic Cholecystectomy
Removal of gallbladder
Treatment of choice

97
Q

Open-Chole

A

Higher risk than Lap-Chole

98
Q

Bone remodeling

A

Removal of old bone to allow osteoblasts to form

99
Q

Osteocytes

A

Mature bone cells

100
Q

Osteoclasts

A

Degrade bone for remodeling or pathological response

101
Q

Synovium

A

Lining inside joint capsule; secretes synovial fluid to lubricate joint

102
Q

Normal vs abnormal synovial fluid

A

Normal: Straw-colored, clear, slightly sticky (Egg white)
Abnormal: Cloudy or thicker than normal
- Cloudy = crystals/Gout
- Purulent = increased WBC

103
Q

Bursa

A

Sacs filled with synovial fluid that protects bones
- Can become inflamed and restrict bone movement

104
Q

Osteopenia

A

Loss of bone density
Precursor to osteoporosis
- Common in thin white elderly women
- Loss of estrogen

105
Q

Osteoporosis

A

Chronic metabolic disease
Bone density loss is severe
Fractures are likely (hip/spine/wrist)

106
Q

Medications for Osteoporosis

A

Calcium carbonate (Os-Cal, Citracal)
Bisphosphonates (Forsamax, Boniva): slow bone absorption

107
Q

AP & Lat

A

Anterior, Posterior, and Lateral Xray
- Shows bone density, fractures, erosion

108
Q

What do ultrasounds show r/t bones

A

Masses, fluid, bone density

109
Q

Nursing considerations for CT scan

A

Check for shellfish allergy
Check kidney function with BUN

110
Q

What does CT scan show r/t bones

A

Tumors, soft tissue injury

111
Q

What does an MRI show r/t bones

A

Torn muscles or ligaments
- Magnetic, take out jewelry

112
Q

EMG

A

Electromyography
Measures muscle action potential in nerves with electrodes

113
Q

Dislocation

A

Complete displacement of joint

114
Q

Sublucation

A

Partial displacement of joint

115
Q

Tx for dislocation

A

Open or closed reduction
Surgical vs manual joint replacement

116
Q

Repetitive strain injury

A

Trauma or stress to tendons, ligaments, muscles due to repetitive movement

117
Q

Carpal tunnel syndrome

A

Inflammation of median nerve under transverse carpal ligament

118
Q

Carpal tunnel syndrome tx

A

Surgical release of median nerve by cutting carpal ligament

119
Q

Dupuytren’s disease

A

Slow contracture of 4th, 5th sometimes 3rd finger

120
Q

Tx for Dupuytren’s disease

A

Stretching
Steroid injections
Fasciotomy

121
Q

Impingement syndrome

A

Rotator cuff injury
Partial or complete tear causing inflammation

122
Q

Loose bodies

A

A fragment of a cartilage tear or bone fragment came loose

123
Q

Loose bodies tx

A

Arthroscopic removal

124
Q

ACL stands for

A

Anterior Cruciate Ligament

125
Q

Crutch techniques

A

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

126
Q

Closed vs open fracture

A

Closed = nondisplaced
Open = compound, bone is displaced

127
Q

Comminuted fracture

A

Fragmented fracture

128
Q

Impacted fracture

A

Bone crushed with downward force

129
Q

Greenstick fracture

A

Bone cracks and snaps into pieces

130
Q

ORIF

A

Open reduction, internal fixation

131
Q

OREF

A

Open reduction, external fixation

132
Q

Hemiarthroplasty

A

Part of joint is replaced

133
Q

Buck’s traction

A

Used for hip or proximal femur fractures before surgery
Foot in a boot is pulled with counter weights
Type of skin traction

134
Q

Nurse’s role during Buck’s traction

A

Pulse
Signs of DVT: Calf pain, warmth, edema
Skin condition
CMS - Circulatory Motor Sensory (wiggle toes)

135
Q

Russell’s traction

A

Self trapeze traction used for distal femur fracture
Type of skin traction

136
Q

Dunlop’s traction

A

Counter weight traction used for humerus fracture
Type of skin traction

137
Q

Skeletal traction

A

Pins or wires screwed into bone with weights
Used before surgery

138
Q

Gallows traction

A

Pediatric skin traction
Child on back with legs up, feet pulled by weights
Used for hip dislocation or femur fracture

139
Q

Stryker frame

A

Moves patient with back fracture as one unit
Front and back piece hold patient in place

140
Q

Spica cast

A

Cast with rod between body parts
- Shoulder or pelvic injuries requiring joint immobilization
Monitor for bowel obstruction - abd assessment

141
Q

Acute Compartment Syndrome

A

Increased pressure within a fixed space
Complication of fractures

142
Q

Tx for Acute Compartment Syndrome

A

Remove cast or fasciotomy to relieve pressure

143
Q

Thromboembolism

A

Blood clot
Complication of fracture
Prevented with Lovenox/Heparin
- Monitor PTT and platelets, s/sx of bleeding

144
Q

Fat embolism

A

Fat globules released from yellow bone marrow
- Complication of fractures
- Usually from long bone fractures
- 24-48 hrs post op

145
Q

Disuse Syndrome

A

Muscle atrophy
Complication of fractures
- Prevented with isometric exercises

146
Q

Crush syndrome

A

Reperfusion after crushing injury causes traumatic rhabdomyolysis
- Cardiac arrest and kidney failure due to sudden shift of electrolytes

147
Q

Tx for compression fracture

A

Vertebroplasty
- Outpatient procedure

148
Q

Osteomyelitis

A

Bacterial, viral, or fungal infection in bone

149
Q

Osteomyelitis s/sx

A

Fever over 104
Increased WBC and ERS
Positive blood cultures

150
Q

Osteochondroma

A

Most common benign bone tumor

151
Q

Osteosarcoma

A

Most common primary bone tumor

152
Q

Ewing’s sarcoma

A

Less common
Most malignant bone tumor
- Affects pelvis and lower extremities

153
Q

Muscular dystrophy

A

Progressive muscle weakness
Major cause of death is respiratory failure

154
Q

Muscular dystrophy tx

A

Steroids

155
Q

Low back pain characteristics

A

Radiculopathy: Radiating pain
Sciatica: Nerve pain that runs down leg to foot

156
Q

What does a myelogram show

A

Herniated or compressed disc

157
Q

Low back pain tx

A

Short term: NSAIDs and muscle relaxant
Long term: Neurontin or antidepressant

158
Q

Intervertebral disc disease

A

Repeated stress/trauma thins or herniates the disc, putting pressure on nerves

159
Q

Laminectomy

A

Takes out part of vertebrae
Tx for intervertebral disc disease

160
Q

Discectomy

A

Removes all or part of the herniated disc
Tx for intervertebral disc disease

161
Q

Spinal fusion

A

Used for spinal instability

162
Q

Hallux valgus

A

Bunion
Big toe drifts laterally

163
Q

Onychocryptosis

A

Ingrown toenail

164
Q

Morton Neuroma

A

Swelling of third branch of plantar nerves
Due to tissue or pressure/injury
- Feels like walking on a marble

165
Q

Pes Cavus

A

High arch

166
Q

Pes Planus

A

Low arch/flat foot

167
Q

Plantar fasciitis

A

Inflammation of fascia over heel bone
- Tx with overnight dorsiflexion

168
Q

Osteomalacia

A

Demineralization of bone related to Vit D deficiency leads to soft bones
- Caused by lack of sunlight or medications
- Bow legs, kyphosis

169
Q

Paget’s disease

A

AKA Osteitis Deformans

170
Q

Paget’s disease patho

A

Too many osteoclasts breaking down bone
Osteoblast production increases
Leads to weak bones - fractures

171
Q

Paget’s disease S/sx

A

Thick skull
Bow legs
Pain in hips/pelvis
Vertigo/hearing loss - bone in ears effected

172
Q

Paget’s disease tx

A

NSAID’s
Bisphosphonates (Foramax, Boniva): Slows bone reabsorption
Calcitonin: Stops bone reabsorption by decreasing osteoclasts

MedSurg (5 decks)

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