Exam 3 Changed Color Notes on Slides *Except Bone & Men/Women Health Flashcards
1
Q
insulin is always needed for treatment
A
type 1
2
Q
managing type one diabetics
A
insulin
3
Q
symptoms of type 2 diabetics
A
usually subtle or no symptoms in early stages
4
Q
glucose monitoring
- fasting blood glucose
A
126 or more
5
Q
glucose monitoring
- random glucose
A
200 or more
6
Q
glucose monitoring
- HgbA1C level
A
greater than 6.5%
7
Q
goals of A1C
A
less tha. 7%
8
Q
five components of diabetic care
A
nutritional therapy
exercise
monitoring
pharm
education
9
Q
nutritional therapy
A
maintain the pleasure of eating include personal and cultural preferences
promote exercise and activity
10
Q
meal planning
A
must be considerate of patient preferences
11
Q
diabetic diet should consist of
A
50-60% carbs
20-30% fat
10-20% protein
25g/day fiber
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
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
14
Q
rotation of diabetic injections
A
systematic rotation of sites within an autonomic area recommended
15
Q
how much should you use that exact site
A
not more than once in 2-3 weeks
16
Q
what about injecting before you exercise
A
do not inject in limb that will be exercised
17
Q
metformin
A
contraindicated in impaired kidney or liver function must be discontinued 48 hours prior to and after CT with contrast
18
Q
sulfonylureas
A
increased risk for hypoglycemia with elderly, beta blocker use may decrease or mask ss of hypo
19
Q
basic survival skills
A
defintion
normal BS ranges
effect of therapy
treatment modalities
complications
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
21
Q
severe hypoglycemia
A
glucose levels less than 40
22
Q
mild hypoglcyemia symptoms
A
SNS stimulation
sweating
tremor
tachycardia
palpation
nervousness
hunger
23
Q
moderate hypoglycemia symptoms
A
inability to concentrate
headache
lightheadedness
confusion
memory lapse
numbness of lips and tongue
24
Q
severe hypo symptoms
A
disorientation
seizure
difficulty arousal
loss of consiousness
25
who might have variable response to hypoglycemia
elderly
beta blockers
logn term diabetic
26
management of hypoglycemia
immediate treatment must be given
check blood sugar first step
27
emergency measures of hypoglycemia
glucagon 1mg IM or SQ (community)
25-50mL dextrose IVP
- careful assessment of IV site prior to administration and after
28
DKA manifesations
hyperglycemia
severe dehydration
metabolic acidosis
29
DKA common causes
missed insulin dose
illness
infection
undiagnosed
30
DKA assessment findings
blood glucose levels (300-800)
low pH, CO2, bicarb levels
ketones in urine and blood
electrolyte abnormalities
elevated BUN/CR and HCT
31
management of DKA
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
32
HHS defintion
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
33
assessment and diagnostic findings of HHS
BS level 600-1200
osmolality greater than 320
34
HHS treatment
similar to DKA
- rehydration with IV fluids
- insulin administration
- electrolyte replacement
35
macrovascucualr complication
accelerated atherosclerotic changes
36
neuropathic complication
peripheral neruopathy
autonomic neruopaties
hypoglycemic unawarness
neuropathy
sexual dysfunction
37
meticulous foot care
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
38
steps to lower risk of complications in diabetics
A1C less than 7
take care of your feet
get recommended screenings and early treatment for complications
39
most common non lymphocytic leukemia
acute myeloid leukemia
40
acute myeloid leukemia
- treatment
aggressive chemo
induction therapy
41
chronic myeloid leukemia
- manifesations
initially may be asymptomatic
malaise
anorexia
weight loss
confusion or shortness of breath caused by leukostasis
enlarged tender spleen
enlarged liver
42
acute lymphocytic leukemia
- manifestations
leukemia cell infiltration is more common with this leukemia
symptoms of meningeal involvement
liver/spleen/bone marrow pain
43
hodgkin disease treament
determined by stage of the disease and may include chemo, radiation therapy or both
44
non hodgkin lymphoma treatment
determined by type and stage of disease and may include interferon, chemo, or radiation
45
multiple myeloma treatment
include chemo, steroids, radiation, bisphosphonates
46
neutropenia risk
infection
47
neutropenia nursing management
patient education
- reverse isolation
48
immune thrombocytopenia purpura
low platelets
don't know why
ideopathic
high risk bleeding
pin point bleeding
49
thrombocytopenia
clinical manifesations
increased risk of bleeding
50
thrombocytopenia
patient safety and education
bleeding
no aspirin
anti platelet
51
hemophelia, how to get
inherited
52
hemophilia medical and nursing management
recumbent forms to factor 8 and 10 when bleeding or profilactically
53
DIC triggers
sepsis
trauma
shock
cancer
abrupto placenta
toxins
allergic reaction
54
DIC defintion
alerted hemostasis mechanism causes massive clotting in microcirculation
as clotting factors are consumed bleeding occurs
symptoms are related to tissue ischemia and bleeding
55
DIC treatment
treat underlying cause
correct tissue ischemia
replace fluids and lytes
maintain blood pressure
replace coag factors
use heparin
56
heparin therapeutic test
aPTT
57
heparin aPTT time
1.5-2.5 times the lab control
58
heparin complications
heparin induced thrombocytopenia
59
warfarin reversal
vit K
60
warfarin test
INR
61
warfarin INR therapeutic range
2-3
62
most common hematological condition
anemia
63
clinical manifestations of anemia
fatigue
weakness
pallor or jaundice
cardiac and respiratory symptoms
tongue change
nail changes
pica
angular cheilosis
64
goals of anemia
decreased fatigue
attainment and or maintence of adequate nutrition
maintence of adequate tissues perfusion
compliance with prescribed therapy
absence of complications
65
most common type of anemia in all age groups
iron deficiencies
66
iron deficiency's manifestations
typical presentations
- may have smooth sore tongue
- rigid nails
- angular cheilosis
67
anemia in renal disease
- occurs in association of a serum CR greater than
3
68
treatment of anemia in renal disease
recumbent erythropoietin
- epoetin alfa
- Epogen
- Procrit
- Aranesp
69
what is the best known secondary immunodeficiency in humans
HIV
70
prevention of HIV
standard precautions
safer sex practices and safer behaviors
do not share drug injection equipment
blood screening and treatment of blood products
71
prevention of HIV for health care providers
standard precatuions
PPE
72
post exposure prophylaxis
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
primary infection symptoms
none to flulike symptoms
74
HIV asymptomatic
- upon reaching the viral set point what state is reached
chronic asymptomatic state begins
75
AIDS
- CD4 count
less than 200
76
AIDS
- as levels drop below ________ the immune system is significantly impaired
100
77
one quarter of people living with HIV are older than
50
78
treatment and protocols are continually
evolving
79
PCP if untreated it can progress to
pulmonary impairment and respiratory failure
80
complications of HIV
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
kaposi sarcoma is what
cutaneous lesions that involve multiple organs
lesions cause discomfort, disfigurement, ulcerations and potential for infection
82
what is included in OTC. herbal, and prescription medications assessment before a transfusion
NSAIDS
ASA/salicylates
steroids
antibiotics
cytotoxic medications
history of transfusions
83
diagnostic evaluation before transfusion
CBC and coagulation studies
84
bone marrow aspiration
patient preparation
careful explatinaton
premedication
85
bone marrow aspiration what to expect
pressure
pain
86
bone marrow aspiration complications
bleeding and infection
avoid asa products
87
pre transfusion assessment
history of previous transfusions
history of previous reactions
88
physical assessment pretransfusion
baseline vitals
lung sounds
JVD
edema
skin assessment (observe for petechiae, rash
89
s/s of reactions
rash
fever
chills
low back pain
pain at IV site
anything unusual
90
complications
febrile non hemolytic reactions
acute hemolytic reaction
circulatory overload
91
how to prevent circulatory overload
administer slowly to high risk patients
92
circulatory over load S/S
orthopena
JVD
tachycardia
dyspnea
sudden anxiety
crackles in lungs
increase BP
pulmonary edema
- pink frothy sputum
93
treatment for circulatory overload
upright position
notify MD
oxygen
diuretics
94
nursing interventions for sickle cell
pain management
infection prevention
95
generalized seizure
involve whole brain
96
both sides of body react during seizure
tonic clonic
97
partial seziures
begin in one part of brain
98
simple partial
consciousness remains intact
99
complex partial
impairment of consciousness
100
aura
portion of seizure that occurs before cosniousness is lost
101
post ictal
time after seizure event
102
epilepsy
group of syndromes characterized by unprovoked reoccurring seizures
103
complications of seizures
injury
aspiration
status epilepticus
104
seizure
- depletes the energy stores, increases O2 consumption, increases metabolic demands
cerebral anoxia and edema
105
meds to halt seizure activity
benzos
106
meds to maintain seizure free state
phenytoin and phenobarbital
107
seizure assessment and diagnostics
labs
CT
MRI
108
seizure interventions for seizures
ABC
safe environment
patent IV
observe and record seizure activity and length
109
seizure meds for prevention
dilantin
depakote
tegretol
110
medical management for seizures
keto diet
vagus nerve stimulaor
111
headache medication history
nitrates
vasodilators
histamines
alcohol
112
types of meningitis
bacterial
viral
fungal
113
meningitis classic triad
fever
headache
nuchal rigidity
114
meningitis
kernigs
knee flexion and cannot straighten
115
meningitis
brudzinskis
neck flexed and knees flexed
116
meningitis
bedside risk score
increased age
HR >120
+ gram stain
cranial nerve palsy
decreased GCS
117
meningitis
lumbar puncture
opening pressure increased
leukocyte count is elevated
protein is elevated
118
meningitis
prevention
meningococcal vaccination
119
meningitis
meds
antipyretic
antiseziure
IVF
120
meningitis
treatment is __________ and directed at _________ management
supportive, symptom
121
meningitis
consult with
epidemilogogy and infection control
122
meningitis
monitor what status closely
neuro
123
brain abscess
- higher rate in
immunocompromised
124
brain abscess
- indicative of
underlying disease or use of immunosuppressive medications
125
brain abscess
- intracranial brain
progressive symptoms
headache worse in morning
reduced vision
126
brain abscess
- intracranial epidural abscess
nuchal rigidity
127
brain abscess
- labs
increased WBC
elevated erythrocyte sedimentation rate
blood cultures
128
brain abscess
- lumber puncture
elevated opening pressure
increased protein levels
increased lymphocytes
129
brain abscess
- meds initiated ASAP
antibiotics
130
brain abscess
- nursing management
monitor vs, Resp, neuro
encourage rest
administer antipyretic/analgesics
coordinate home health care for long term antibiotic therapy
131
encephalitis is located where
brain tissue
132
encephalitis what is key for medicaitons
early administration
133
encephalitis
nursing management
frequenct and ongoing neuro assessment
supportive care
pain meds
seizure prevention
injury prevention
patient safety
134
multiple sclerosis
-what is happening to myelin
demyelinating
135
multiple sclerosis
- characterized by
relapses and remission or slow steady progressive dysfunction
136
multiple sclerosis
- age
young adults
137
multiple sclerosis
- MRI findings
disruption of blood brain barrier
evidence of inflammation
plaques
axonal loss
brain atrophy
138
multiple sclerosis
- disease state in every patient
varies in severity
139
multiple sclerosis
- prediction of symptoms
no
140
multiple sclerosis
- what occurs in relapsing and remitting course
residual deficits may occur
141
multiple sclerosis
- s/s
weakness
spasticity
loss of coordination
cognitive changes
fatigue
loss of balance
142
multiple sclerosis
labs
banding on CSF fluid
143
multiple sclerosis
cure
none
144
multiple sclerosis
- meds used for
relapse management and immune suppressants
145
multiple sclerosis
spasticity
baclofen and benozs
146
multiple sclerosis
ataxia
beta blockers and anti seizure
147
multiple sclerosis
nursing intervention of fatigue
recommend energy conservation
recommend that patient avoid overheating
rehab
- Pt/Ot
- pressure ulcer prevention
lifestyle acitivyt level
148
multiple sclerosis
nursing interventions for spasticity
assess sequelae of spasticity
- difficulty with gait/sitting
hygiene, comfort, energy level, sexual activity
mobile/transfer/safety
use of assistive devices
149
MG
- autoimmune
yes
150
MG
- affects
voluntary muscles groups including ocular, oropharyngeal, facial, shoulder girdle, limbs
151
MG
- bulbar
involves breathing
swallowing
speach
152
MG
- when intercostal muscles resulting in
decreased vital capacity
respiratory failure
153
MG
- medical management
treat symptoms up to a level of maximum response
plasma exhange
154
MG
- nursing interventions
assess respirations
monitor for myasthenic crisis
assist with mobility
assess for swallow and gag
155
myasthenic crisis
failure of respiratory muscles to maintiain ventilation
priority interventions include airway management typically through intubation
156
MG
- outcomes
patient is able to maintain own airway
157
GBS
- weakness
ascending
158
GBS
- autoimmune?
yes
159
GBS
- CNS or perhierpal
peripheral
160
GBS
- what happens to myelin
demyelination
161
GBS
- gradual or rapid
rapid
162
GBS
- weakness begins in
legs
163
GBS
- may result in _________ when diaphragm is impacted
ineffective ventilation
164
GBS
- progress to peak severity typically in __ weeks
2
165
GBS
- autonomic dysfunciton
cardiac instability
166
GBS
- lumbar puncture
increased protein
167
GBS
- pulmonary function tests
vital capacity
negative inspiratory force
168
GBS
- medical management
plasma exchange
monitor for hemodynamic compromise
169
GBS
- nursing inteventions
monitor Resp status, VS, neuro, CN, increased weakness, respiratory failure, DVT
170
parkinsons
- what type of neurological disorder
degenerative
171
parkinsons
- caused by a depletion of
dopamine
172
parkinsons
- characterized by
resting tremor, rigidity, bradykinseas, diminished postural stability
173
rigidity
resistance of passive limb movement
174
parkinsons
- what diagnostic testing to confirm
none
175
parkinsons
- medicaiton
anticholinergics
symmetrel
dopaminergics
- levodopa
176
levodopa benefits most pronounced for
1-2 years
177
parkinsons
- surgical treatment
thalamotomy and pallidotomy
deep brain stimuation
178
parkinsons
- nursing interventions
mobility: emphasis on safety
nutrition
