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Med Surg 1 > Exam 3 Changed Color Notes on Slides *Except Bone & Men/Women Health > Flashcards

Exam 3 Changed Color Notes on Slides *Except Bone & Men/Women Health Flashcards

1
Q

insulin is always needed for treatment

A

type 1

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2
Q

managing type one diabetics

A

insulin

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3
Q

symptoms of type 2 diabetics

A

usually subtle or no symptoms in early stages

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4
Q

glucose monitoring
- fasting blood glucose

A

126 or more

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5
Q

glucose monitoring
- random glucose

A

200 or more

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6
Q

glucose monitoring
- HgbA1C level

A

greater than 6.5%

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7
Q

goals of A1C

A

less tha. 7%

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8
Q

five components of diabetic care

A

nutritional therapy
exercise
monitoring
pharm
education

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9
Q

nutritional therapy

A

maintain the pleasure of eating include personal and cultural preferences
promote exercise and activity

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10
Q

meal planning

A

must be considerate of patient preferences

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11
Q

diabetic diet should consist of

A

50-60% carbs
20-30% fat
10-20% protein
25g/day fiber

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12
Q

what do we do for high glycemic index foods

A

monitor BS after ingestion of certain foods to help ID personal glycemic index to improve glucose control

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13
Q

precautions of exercise

A

do not exercise if BS >250 and ketones in urine
may continue when ketones are negative and BS normal

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14
Q

rotation of diabetic injections

A

systematic rotation of sites within an autonomic area recommended

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15
Q

how much should you use that exact site

A

not more than once in 2-3 weeks

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16
Q

what about injecting before you exercise

A

do not inject in limb that will be exercised

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17
Q

metformin

A

contraindicated in impaired kidney or liver function must be discontinued 48 hours prior to and after CT with contrast

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18
Q

sulfonylureas

A

increased risk for hypoglycemia with elderly, beta blocker use may decrease or mask ss of hypo

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19
Q

basic survival skills

A

defintion
normal BS ranges
effect of therapy
treatment modalities
complications

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20
Q

sick day rules

A

take insulin or oral anti diabetic agent as usual
test blood glucose and urine ketones (every 3-4 hours)
report elevated BS levels or ketones
- increased insulin coverage may be required
take liquids more frequently to prevent dehydration
- sports drink, cola, or broth
consume soft foods (gelatin, soup, graham crackers) six to eight times a day if unable to follow normal diet
report nausea, vomiting, diarrhea to provider
- hospitlization maybe required if unable to keep fluids down

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21
Q

severe hypoglycemia

A

glucose levels less than 40

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22
Q

mild hypoglcyemia symptoms

A

SNS stimulation
sweating
tremor
tachycardia
palpation
nervousness
hunger

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23
Q

moderate hypoglycemia symptoms

A

inability to concentrate
headache
lightheadedness
confusion
memory lapse
numbness of lips and tongue

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24
Q

severe hypo symptoms

A

disorientation
seizure
difficulty arousal
loss of consiousness

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25
Q

who might have variable response to hypoglycemia

A

elderly
beta blockers
logn term diabetic

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26
Q

management of hypoglycemia

A

immediate treatment must be given
check blood sugar first step

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27
Q

emergency measures of hypoglycemia

A

glucagon 1mg IM or SQ (community)
25-50mL dextrose IVP
- careful assessment of IV site prior to administration and after

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28
Q

DKA manifesations

A

hyperglycemia
severe dehydration
metabolic acidosis

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29
Q

DKA common causes

A

missed insulin dose
illness
infection
undiagnosed

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30
Q

DKA assessment findings

A

blood glucose levels (300-800)
low pH, CO2, bicarb levels
ketones in urine and blood
electrolyte abnormalities
elevated BUN/CR and HCT

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31
Q

management of DKA

A

rehydration
- 6-10 liters
-0.9NS initially, changed to 0.45 after first few hours of hydration (.45 may be used with hypertensive patients or those with risk of heart failure) changed to D5W when the BS is at 250-300
- monitor fluid status
insulin
- continuous infusion of regular insulin (12-24hr)
-frequent blood sugar monitoring hourly
- IV solution D5 when blood sugar 250-300
electrolyte restoration
- cautious but timely replacement of K is vital

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32
Q

HHS defintion

A

metabolic disorder of type 2 diabetes resulting from relative insulin deficiency intimated by illness that raises the demand for insulin, more common in older adults

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33
Q

assessment and diagnostic findings of HHS

A

BS level 600-1200
osmolality greater than 320

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34
Q

HHS treatment

A

similar to DKA
- rehydration with IV fluids
- insulin administration
- electrolyte replacement

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35
Q

macrovascucualr complication

A

accelerated atherosclerotic changes

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36
Q

neuropathic complication

A

peripheral neruopathy
autonomic neruopaties
hypoglycemic unawarness
neuropathy
sexual dysfunction

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37
Q

meticulous foot care

A

have podiatrist check feet once a year
- toenails inquire about best way to manage toenails
check feet daily
wash feet daily
keep skin soft
do not walk barefoot
protect from hot and cold

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38
Q

steps to lower risk of complications in diabetics

A

A1C less than 7
take care of your feet
get recommended screenings and early treatment for complications

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39
Q

most common non lymphocytic leukemia

A

acute myeloid leukemia

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40
Q

acute myeloid leukemia
- treatment

A

aggressive chemo
induction therapy

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41
Q

chronic myeloid leukemia
- manifesations

A

initially may be asymptomatic
malaise
anorexia
weight loss
confusion or shortness of breath caused by leukostasis
enlarged tender spleen
enlarged liver

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42
Q

acute lymphocytic leukemia
- manifestations

A

leukemia cell infiltration is more common with this leukemia
symptoms of meningeal involvement
liver/spleen/bone marrow pain

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43
Q

hodgkin disease treament

A

determined by stage of the disease and may include chemo, radiation therapy or both

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44
Q

non hodgkin lymphoma treatment

A

determined by type and stage of disease and may include interferon, chemo, or radiation

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45
Q

multiple myeloma treatment

A

include chemo, steroids, radiation, bisphosphonates

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46
Q

neutropenia risk

A

infection

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47
Q

neutropenia nursing management

A

patient education
- reverse isolation

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48
Q

immune thrombocytopenia purpura

A

low platelets
don’t know why
ideopathic
high risk bleeding
pin point bleeding

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49
Q

thrombocytopenia
clinical manifesations

A

increased risk of bleeding

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50
Q

thrombocytopenia
patient safety and education

A

bleeding
no aspirin
anti platelet

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51
Q

hemophelia, how to get

A

inherited

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52
Q

hemophilia medical and nursing management

A

recumbent forms to factor 8 and 10 when bleeding or profilactically

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53
Q

DIC triggers

A

sepsis
trauma
shock
cancer
abrupto placenta
toxins
allergic reaction

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54
Q

DIC defintion

A

alerted hemostasis mechanism causes massive clotting in microcirculation
as clotting factors are consumed bleeding occurs
symptoms are related to tissue ischemia and bleeding

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55
Q

DIC treatment

A

treat underlying cause
correct tissue ischemia
replace fluids and lytes
maintain blood pressure
replace coag factors
use heparin

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56
Q

heparin therapeutic test

A

aPTT

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57
Q

heparin aPTT time

A

1.5-2.5 times the lab control

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58
Q

heparin complications

A

heparin induced thrombocytopenia

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59
Q

warfarin reversal

A

vit K

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60
Q

warfarin test

A

INR

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61
Q

warfarin INR therapeutic range

A

2-3

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62
Q

most common hematological condition

A

anemia

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63
Q

clinical manifestations of anemia

A

fatigue
weakness
pallor or jaundice
cardiac and respiratory symptoms
tongue change
nail changes
pica
angular cheilosis

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64
Q

goals of anemia

A

decreased fatigue
attainment and or maintence of adequate nutrition
maintence of adequate tissues perfusion
compliance with prescribed therapy
absence of complications

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65
Q

most common type of anemia in all age groups

A

iron deficiencies

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66
Q

iron deficiency’s manifestations

A

typical presentations
- may have smooth sore tongue
- rigid nails
- angular cheilosis

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67
Q

anemia in renal disease
- occurs in association of a serum CR greater than

A

3

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68
Q

treatment of anemia in renal disease

A

recumbent erythropoietin
- epoetin alfa
- Epogen
- Procrit
- Aranesp

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69
Q

what is the best known secondary immunodeficiency in humans

A

HIV

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70
Q

prevention of HIV

A

standard precautions
safer sex practices and safer behaviors
do not share drug injection equipment
blood screening and treatment of blood products

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71
Q

prevention of HIV for health care providers

A

standard precatuions
PPE

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72
Q

post exposure prophylaxis

A

report it to supervisor
fill out form
labs drawn (baseline)
source testing patients blood
- not for treating patient but for testing for blood borne pathogens

73
Q

primary infection symptoms

A

none to flulike symptoms

74
Q

HIV asymptomatic
- upon reaching the viral set point what state is reached

A

chronic asymptomatic state begins

75
Q

AIDS
- CD4 count

A

less than 200

76
Q

AIDS
- as levels drop below ________ the immune system is significantly impaired

A

100

77
Q

one quarter of people living with HIV are older than

A

50

78
Q

treatment and protocols are continually

A

evolving

79
Q

PCP if untreated it can progress to

A

pulmonary impairment and respiratory failure

80
Q

complications of HIV

A

PCP
mycobacterium avian complex
tuberculosis
oral candudasis
diarrhea realted to HIV infection or enteric pathogens
wasting syndrome
kaposi sarcoma
B cell lymphoma
HIV encephalopathy

81
Q

kaposi sarcoma is what

A

cutaneous lesions that involve multiple organs
lesions cause discomfort, disfigurement, ulcerations and potential for infection

82
Q

what is included in OTC. herbal, and prescription medications assessment before a transfusion

A

NSAIDS
ASA/salicylates
steroids
antibiotics
cytotoxic medications
history of transfusions

83
Q

diagnostic evaluation before transfusion

A

CBC and coagulation studies

84
Q

bone marrow aspiration
patient preparation

A

careful explatinaton
premedication

85
Q

bone marrow aspiration what to expect

A

pressure
pain

86
Q

bone marrow aspiration complications

A

bleeding and infection
avoid asa products

87
Q

pre transfusion assessment

A

history of previous transfusions
history of previous reactions

88
Q

physical assessment pretransfusion

A

baseline vitals
lung sounds
JVD
edema
skin assessment (observe for petechiae, rash

89
Q

s/s of reactions

A

rash
fever
chills
low back pain
pain at IV site
anything unusual

90
Q

complications

A

febrile non hemolytic reactions
acute hemolytic reaction
circulatory overload

91
Q

how to prevent circulatory overload

A

administer slowly to high risk patients

92
Q

circulatory over load S/S

A

orthopena
JVD
tachycardia
dyspnea
sudden anxiety
crackles in lungs
increase BP
pulmonary edema
- pink frothy sputum

93
Q

treatment for circulatory overload

A

upright position
notify MD
oxygen
diuretics

94
Q

nursing interventions for sickle cell

A

pain management
infection prevention

95
Q

generalized seizure

A

involve whole brain

96
Q

both sides of body react during seizure

A

tonic clonic

97
Q

partial seziures

A

begin in one part of brain

98
Q

simple partial

A

consciousness remains intact

99
Q

complex partial

A

impairment of consciousness

100
Q

aura

A

portion of seizure that occurs before cosniousness is lost

101
Q

post ictal

A

time after seizure event

102
Q

epilepsy

A

group of syndromes characterized by unprovoked reoccurring seizures

103
Q

complications of seizures

A

injury
aspiration
status epilepticus

104
Q

seizure
- depletes the energy stores, increases O2 consumption, increases metabolic demands

A

cerebral anoxia and edema

105
Q

meds to halt seizure activity

A

benzos

106
Q

meds to maintain seizure free state

A

phenytoin and phenobarbital

107
Q

seizure assessment and diagnostics

A

labs
CT
MRI

108
Q

seizure interventions for seizures

A

ABC
safe environment
patent IV
observe and record seizure activity and length

109
Q

seizure meds for prevention

A

dilantin
depakote
tegretol

110
Q

medical management for seizures

A

keto diet
vagus nerve stimulaor

111
Q

headache medication history

A

nitrates
vasodilators
histamines
alcohol

112
Q

types of meningitis

A

bacterial
viral
fungal

113
Q

meningitis classic triad

A

fever
headache
nuchal rigidity

114
Q

meningitis
kernigs

A

knee flexion and cannot straighten

115
Q

meningitis
brudzinskis

A

neck flexed and knees flexed

116
Q

meningitis
bedside risk score

A

increased age
HR >120
+ gram stain
cranial nerve palsy
decreased GCS

117
Q

meningitis
lumbar puncture

A

opening pressure increased
leukocyte count is elevated
protein is elevated

118
Q

meningitis
prevention

A

meningococcal vaccination

119
Q

meningitis
meds

A

antipyretic
antiseziure
IVF

120
Q

meningitis
treatment is __________ and directed at _________ management

A

supportive, symptom

121
Q

meningitis
consult with

A

epidemilogogy and infection control

122
Q

meningitis
monitor what status closely

A

neuro

123
Q

brain abscess
- higher rate in

A

immunocompromised

124
Q

brain abscess
- indicative of

A

underlying disease or use of immunosuppressive medications

125
Q

brain abscess
- intracranial brain

A

progressive symptoms
headache worse in morning
reduced vision

126
Q

brain abscess
- intracranial epidural abscess

A

nuchal rigidity

127
Q

brain abscess
- labs

A

increased WBC
elevated erythrocyte sedimentation rate
blood cultures

128
Q

brain abscess
- lumber puncture

A

elevated opening pressure
increased protein levels
increased lymphocytes

129
Q

brain abscess
- meds initiated ASAP

A

antibiotics

130
Q

brain abscess
- nursing management

A

monitor vs, Resp, neuro
encourage rest
administer antipyretic/analgesics
coordinate home health care for long term antibiotic therapy

131
Q

encephalitis is located where

A

brain tissue

132
Q

encephalitis what is key for medicaitons

A

early administration

133
Q

encephalitis
nursing management

A

frequenct and ongoing neuro assessment
supportive care
pain meds
seizure prevention
injury prevention
patient safety

134
Q

multiple sclerosis
-what is happening to myelin

A

demyelinating

135
Q

multiple sclerosis
- characterized by

A

relapses and remission or slow steady progressive dysfunction

136
Q

multiple sclerosis
- age

A

young adults

137
Q

multiple sclerosis
- MRI findings

A

disruption of blood brain barrier
evidence of inflammation
plaques
axonal loss
brain atrophy

138
Q

multiple sclerosis
- disease state in every patient

A

varies in severity

139
Q

multiple sclerosis
- prediction of symptoms

A

no

140
Q

multiple sclerosis
- what occurs in relapsing and remitting course

A

residual deficits may occur

141
Q

multiple sclerosis
- s/s

A

weakness
spasticity
loss of coordination
cognitive changes
fatigue
loss of balance

142
Q

multiple sclerosis
labs

A

banding on CSF fluid

143
Q

multiple sclerosis
cure

A

none

144
Q

multiple sclerosis
- meds used for

A

relapse management and immune suppressants

145
Q

multiple sclerosis
spasticity

A

baclofen and benozs

146
Q

multiple sclerosis
ataxia

A

beta blockers and anti seizure

147
Q

multiple sclerosis
nursing intervention of fatigue

A

recommend energy conservation
recommend that patient avoid overheating
rehab
- Pt/Ot
- pressure ulcer prevention
lifestyle acitivyt level

148
Q

multiple sclerosis
nursing interventions for spasticity

A

assess sequelae of spasticity
- difficulty with gait/sitting
hygiene, comfort, energy level, sexual activity
mobile/transfer/safety
use of assistive devices

149
Q

MG
- autoimmune

A

yes

150
Q

MG
- affects

A

voluntary muscles groups including ocular, oropharyngeal, facial, shoulder girdle, limbs

151
Q

MG
- bulbar

A

involves breathing
swallowing
speach

152
Q

MG
- when intercostal muscles resulting in

A

decreased vital capacity
respiratory failure

153
Q

MG
- medical management

A

treat symptoms up to a level of maximum response
plasma exhange

154
Q

MG
- nursing interventions

A

assess respirations
monitor for myasthenic crisis
assist with mobility
assess for swallow and gag

155
Q

myasthenic crisis

A

failure of respiratory muscles to maintiain ventilation
priority interventions include airway management typically through intubation

156
Q

MG
- outcomes

A

patient is able to maintain own airway

157
Q

GBS
- weakness

A

ascending

158
Q

GBS
- autoimmune?

A

yes

159
Q

GBS
- CNS or perhierpal

A

peripheral

160
Q

GBS
- what happens to myelin

A

demyelination

161
Q

GBS
- gradual or rapid

A

rapid

162
Q

GBS
- weakness begins in

A

legs

163
Q

GBS
- may result in _________ when diaphragm is impacted

A

ineffective ventilation

164
Q

GBS
- progress to peak severity typically in __ weeks

A

2

165
Q

GBS
- autonomic dysfunciton

A

cardiac instability

166
Q

GBS
- lumbar puncture

A

increased protein

167
Q

GBS
- pulmonary function tests

A

vital capacity
negative inspiratory force

168
Q

GBS
- medical management

A

plasma exchange
monitor for hemodynamic compromise

169
Q

GBS
- nursing inteventions

A

monitor Resp status, VS, neuro, CN, increased weakness, respiratory failure, DVT

170
Q

parkinsons
- what type of neurological disorder

A

degenerative

171
Q

parkinsons
- caused by a depletion of

A

dopamine

172
Q

parkinsons
- characterized by

A

resting tremor, rigidity, bradykinseas, diminished postural stability

173
Q

rigidity

A

resistance of passive limb movement

174
Q

parkinsons
- what diagnostic testing to confirm

A

none

175
Q

parkinsons
- medicaiton

A

anticholinergics
symmetrel
dopaminergics
- levodopa

176
Q

levodopa benefits most pronounced for

A

1-2 years

177
Q

parkinsons
- surgical treatment

A

thalamotomy and pallidotomy
deep brain stimuation

178
Q

parkinsons
- nursing interventions

A

mobility: emphasis on safety
nutrition

Med Surg 1 (47 decks)

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