Exam 6: Units 11, 12, & 13 Flashcards
part of the brain that coordinates the production and release of hormones
hypothalamus
this gland secretes hormones that regulate most of the other endocrine glands
pituitary gland
endocrine function of the pancreas
secreting insulin and glucagon to regulate blood glucose levels
exocrine function of the pancreas
secretes enzymes for digestion such as amylase and lipase
glucagon is released from
pancreatic ALPHA cells
insulin is released from
pancreatic BETA cells
after a meal, the digestive system breaks down carbohydrates to simple sugars called
glucose
Insulin is produced in the pancreas by
Islets of Langerhans in the beta cells
process that generates glucose from non-carbohydrate sources such as proteins, lipids, pyruvate, or lactate
gluconeogenesis
process of breaking down glycogen into glucose for energy
glycogenolysis
for a non-diabetic patient, a fasting glucose of ______ is normal
60-110
a patient can be diagnosed with DM if this glucose reading is given on 2 separate occassions
at or above 126
pre-diabetes glucose reading (must be consistently for dx)
100-125
HbgA1C AKA
glycosylated hemoglobin
a HbgA1C of ______ must be taken for a DM diagnosis
6.5%
expected HgbA1C for a non-diabetic person
4%-6%
HgbA1C reading that is considered prediabetic
5.7% - 6.4%
acceptable HgbA1c range for diabetic patients
6.5% - 8%
TARGET goal of HgbA1C for a diabetic patient
less than 7%
an HbA1C of 6% correlates with this blood glucose level
126
an HbA1C of 7% correlates with this blood glucose reading
154
an HbA1C of 8% correlates with this blood glucose reading
183
an HbA1C of 9% correlates with this blood glucose reading
212
an HbA1C of 10% correlates with this blood glucose reading
240
3 P’s of hyperglycemia
Polyuria
Polydipsia
Polyphagia
excessive urination
polyuria
feeling of extreme hunger
polyphagia
feeling of excessive thirst
polydipsia
a patient may have these kinds of respirations with hyperglycemia
Kussmaul respirations (deep, labored)
a fasting blood glucose of _____ indicates hyerglycemia
> 125
a postprandial blood glucose of _____ indicates hyperglycemia
postprandial: after lunch or dinner
> 180
this test is the average blood glucose level over the previous 2-3 months
HbA1C
the non-diabetic goal range for the HbA1C
4% - 6%
hypoglycemia is a blood glucose of
70 or less
this hormone taps into glucose reserves to release it to the blood
epinephrine/norepinephrine
pancreas releases _____ to raise blood glucose
glucagon
3 key clinical presentations of hypoglycemia (think brain)
confusion
mental fogginess
poor cognition
newborns will have an initial ____ in glucose
drop in glucose
a healthy newborn can tolerate a blood glucose of
30
this IV fluid may be given to a patient experiencing hypoglycemia
dextrose
genetic, autoimmune disease involving the death of beta cells in the pancreatic Islets of Langerhans
T1D
T1D usually occurs in (age range)
adolescence
3 P’s of T1D
Polyuria
Polyphagia
Polydipsia
a patient with T1D may have this non-fasting blood glucose reading
200
a patient with T1D may have this fasting blood glucose reading
greater than or equal to 126
a patient with T1D may have an HbA1C of
greater than or equal to 6.5%
C-peptide levels with a patient with T1D will be
decreased
serum ketones will be _____ in T1D
present
a patient with T1D will have a blood gas pH _____ than 7.35
less than 7.35
a T1D urinalysis will be positive for both
glucose and ketones
an HgbA1C should be tracked every
3 months
diabetic patients who are sick should increase their
blood glucose monitoring
a diabetic patient who is sick should never omit
their insulin
a diabetic patient who is sick should drink plenty of
fluids
a diabetic patient who is sick needs to contact their provider if blood glucose reaches this level, or if this is identified in the urine
> 250
ketones are present in urine
regular insulin is diluted with
normal saline ONLY
lispro and aspart insulin are (class)
rapid-acting insulin
regular insulin is (class)
fast-acting insulin
NPH/isophane insulin is (class)
intermediate-acting insulin
glargine and detemir insulin are (class)
long-acting insulin
onset of lispro
15-30 minutes
peak of lispro
30 min - 3 hour
duration of lispro
3-5 hours
onset of regular insulin
30-60 minutes
peak of regular insulin
2-4 hour
duration of regular insulin
4-12 hour
onset of NPH insulin
1-2 hours
peak of NPH insulin
4-12 hour
duration of NPH insulin
14-24 hour
onset of glargine
2-4 hour
peak of glargine
NO PEAK FOR LONG-ACTING
duration of glargine
up to 24 hours
only kind of insulin that can be given IV
regular
1st line oral hypoglycemic medication for T2D
metformin
metformin is contraindicated in (x2)
renal impairment
metabolic acidosis
Some T2 diabetics are insulin dependent. Another medication that can be used is
GLP1 to increase insulin sensitivity
DKA is typically seen in this kind of DM
T1D
Hyperosmolar Hyperglycemic State (HHS) is typically seen in this kind of DM
T2D
DKA has a pH of (think acidic)
<7.35
this electrolyte imbalance accompanies DKA
potassium imbalance
a person with DKA may have this kind of breathing pattern
Kussmaul respirations
HHS has a pH of (basic)
> 7.4
there are more profound ______ manifestations with HHS
neurological
HHS is a _____ disease
thromboembolitic disease - increased clot risk
there is SIGNIFICANT ______ in HHS
dehydration
a person with HHS may have this kind of electrolyte imbalance
potassium imbalance
a key s/s with DKA is a
flushed face
nurse should administer these 4 things to a patient with DKA
1) FLUIDS
2) Insulin
3) Potassium
4) Bicarb - assess need first
onset of HHS is _____ than in DKA
much slower
serum and urine ketones are ______ in HHS
absent
serum and urine ketones are _____ in DKA
present
mortality rate for DKA
1% - 5%
mortality rate for HHS
10% - 20%
main goal in treating DKA and HHS
restoring circulatory volume
part of treating DKA and HHS is treating
hyperglycemia
goal range for potassium when treating DKA and HHS
4.0 - 5.0
sodium is corrected in DKA and HHS using
IV fluids
main health condition that contributes to metabolic syndrome
insulin resistance
if metabolic syndrome is left untreated, it can lead to (x2)
T2D
Cardiovascular disease
main health impact of metabolic syndrome
damage to vasculature and nerves
waist circumferences that accompany metabolic syndrome (males and females)
Males: >40
Females: >35
2 medications that can be used for metabolic syndrome
Glucophage
Statins
outer layer of skin composed of mainly keratinocytes and other cells
epidermis
largest portion of the skin made of connective tissue, blood vessels, lymph vessels, nerves, sweat/sebaceous glands, and hair roots
dermis
subcutaneous fat that insulates the body, absorbs shock, and pads the internal organs and structures
subcutaneous tissue
this refers to interior body forces upon the skin when moving in the opposite directions and may result in deep tissue injury
shearing
a mechanical force caused by dragging the skin across a surface, such as changing position in bed
friction
3 phases of the wound healing process
1) Hemostatic/Inflammatory
2) Proliferative
3) Remodeling
phase of the wound healing process where new collagen fibers are formed, a new wound bed is created, and new capillaries are formed
Proliferative
phase of the wound healing process where stronger collagen replaces the gelatinous collagen
remodeling
phase of the wound healing process where damaged tissue releases cytokines, which trigger blood coagulation, and the wound begins to heal
hemostatic/inflammatory
type of wound healing that involves the skin being closed with adhesives or sutures
primary intention
type of wound healing that involves the wound being left open to view
second intention
type of wound healing that is a combination of primary and secondary intention, where the wound is left open for 5-10 days before being closed with sutures
tertiary intention
delayed primary closure
second intention requires a _____ healing time compared to primary intention
longer healing time
two types of wounds
acute and chronic
incisions, skin tears, abrasions, and moisture-associated damages are this type of wound
acute wounds
arterial ulcers, venous ulcers, and diabetic ulcers are this type of wound
chronic wounds
excessive/hypertrophic wound healing can result in
keloids
this color of wound indicates healthy regeneration of tissue
red
this color of wound indicates presence of purulent drainage and slough
yellow
this color of wound indicates the presence of eschar, which hinders wound healing and requires removal
black
drainage is AKA
exudate
1 gram = ____ mL drainage
1 gram = 1 mL
type of drainage that is normal for the healing process, characterized by clear, thin, watery, and pale yellow appearance
serous drainage
type of drainage that is bright red, appearing as blood leaking from the wound
sanguineous drainage
type of drainage that is a combination of serous and sanguineous drainage that is pink/watery
serosanguineous drainage
type of drainage that is thick and foul-smelling
purulent
this type of therapy increases oxygen availability for wound healing
Hyperbaric Oxygen Therapy
when irrigating a wound, clean it in this order
from the least contaminated area towards the most contaminated
these. kinds of solutions remain the preferred cleansing agents for wound irrigation
isotonic solutions
procedure where biofilm and dead tissue are removed with a scalpel and scissors
surgical debridement
procedure where foam strips are laid into the wound bed with an occlusive sealed drape, suction with negative pressure is applied in attempts to decrease swelling and enhance healing in a moist environment
Vacuum-assisted closure system (wound vac)
partial or total rupture of a sutured wound, usually with separation of underlying skin layers
dehiscence
a dehiscence that involves the protrusion of visceral organs through a wound opening
evisceration
evisceration or dehiscence require
emergency treatment
the nurse should administer antibiotic therapy at this time
after collecting specimens for culture and sensitivity testing
most susceptible areas for pressure injuries
over bony prominences
pressure injuries are classified by
how much tissue loss is observed in the wound
stage of pressure injury with nonblanchable erythema of intact skin
Stage 1
stage of pressure injury with partial-thickness skin loss with exposed dermis. Wound bed is reddish-pinkish WITHOUT slough, eschar, or granulation tissue
Stage 2
stage of pressure injury with full-thickness skin loss, SOME slough and eschar is present
Stage 3
stage of pressure injury with full-thickness skin loss and tissue loss. Cartilage, bone, fascia, muscle, ligaments, or tendons are exposed
Stage 4
stage of pressure injury with obscured full-thickness skin and tissue loss
Unstageable
stage of pressure injury with persistent nonblanchable deep red, maroon or purple discoloration. Eschar or slough obscures staging.
Deep Tissue Pressure Injury (DTPI)
TIME mneumonic
T: Tissue integrity
I: Inflammation/Infection
M: Moisture
E: Edge of wound
this tool is used to assess the patient’s risk of developing a wound ulcer
Braden scale
nerve damage due to uncontrolled diabetes
diabetic neuropathy
during inflammation, this series of events usually occurs (x3)
1) Vasodilation
2) Increased vascular permeability
3) Leukocyte cellular infiltration
5 cardinal signs of inflammtion
Heat
Redness
Pain
Swelling
Loss of Function
this is released by mast cells and causes vasodilation and vascular permeability
histamine
a group of substances that are released in response to injury that can cause vasodilation/increased permeability and attract neutrophils
kinins
a group of compounds released that can cause vasodilation/increase permeability, cause swelling, and cause pain
prostaglandins
2 types of inflammation
chronic
acute
condition that is characterized by a progressive deterioration of joint cartilage
osteoarthritis
osteoarthritis is not
inflammatory or autoimune
osteoarthritis has a ____ onset
slow onset
osteoarthtitic pain is usually
asymmetrical (affects ONE joint)
in osteoarthritis, the patient may feel pain/stiffness in joints at this time
after weight-bearing activities
this protects the ends of the bone, allowing the bone to move seamlessly over each other in a joint
articular cartilage
osteoarthritis occurs when there is damage to the ____ cartilage
articular cartilage
this gender is more at risk for osteoarthritis
female
in osteoarthritis, these nodes may present at the DIP of fingers
Heberden’s nodes
“Heberden’s are Higher on the finger”
in osteoarthritis, these nodes may occur at the PIP of the fingers
Bouchard’s nodes
“Bouchard’s are closer to the Body”
a main risk factor for osteoarthritis
(NOT the only risk factor, though)
obesity (increased weight/wear on joints)
medication of choice for managing osteoarthritis
acetaminophen
these medications can be used on a short-term basis for managing osteoarthritis
opioids
these two supplements can be taken for osteoarthritis
glucosamine and chondroitin
topical ______ can be used for osteoarthritis
topical capsaicin
replacement or reconstruction of the joint
arthroplasty
this is a chronic inflammatory type of arthritis, also an autoimmune disease
rheumatoid arthritis
patient with rheumatoid arthritis will have a
+ rhematoid factor
rheumatoid arthritis usually affects the ____ joints first
upper joints
rheumatoid arthritis has a ____ onset
rapid onset
pain associated in rheumatoid arthritis is located
bilaterally and asymmetrically
a person with rheumatoid arthritis will usually have joint pain/stiffness at this time
in the mornings
rheumatoid arthritis is a _____ disease that can affect any connective tissue in the body
systemic disease
this kind of rheumatoid arthritis affects joints and organs of children under 16
juvenile RA
(children CAN outgrow this)
(bone development is affected)
gender that is more at risk for rheumatoid arthritis
female
this virus may pose a risk factor for rheumatoid arthritis
Epstein-Barr virus
removal of synovium
synovectomy
joint fusion
arthrodesis
joint deformities are _____ signs of rheumatoid arthritis
late signs
2 types of finger contractures that are common in rheumatoid arthritis
Swan neck
Boutonniere
morning stiffness, joint swelling/deformity, and _____ are common clinical presentations of rheumatoid arthritis
subcutaneous nodules
this lab will be elevated in a patient with rheumatoid arthritis
ESR (erythrocyte sedimentation rate)
this blood cell count will be high with rheumatoid arthritis
WBC (inflammation)
this blood cell count will be low with rheumatoid arthritis
RBC (due to anemia)
synovial fluid aspiration
arthrocentesis
alternate this when treating rheumatoid arthritis
alternate hot and cold
3 classes of medications used to manage rheumatoid arthritis
NSAIDs
Corticosteroids
DMARDs (disease-modifying anti-rheumatic drugs)
complication of RA: autoimmune disease where the body attacks the glands that produce tears/saliva and result in drying of other parts of the. body.
AA: eyes, mouth, vagin
Sjogren’s syndrome
inflammation of arteries that can disrupt blood flow, affecting mainly the smaller arteries of the skin, eyes, and brain
vasculitis
vasculitis can lead to
organ ischemia
disease that involves the buildup of collagen in the skin and other parts of the body
scleroderma
scleroderma is an _____ disease
autoimmune
gender more at risk for scleroderma
female
this kind of scleroderma only affects the skin on the chest, abdomen, or limb, but not usually the hands or face
localized scleroderma
localized scleroderma AKA
morphea
localized scleroderma/morphea develops
slowly
this kind of scleroderma may affect large areas of the skin and organs such as the heart, lungs, or kidneys
systemic scleroderma
systemic scleroderma AKA
sclerosis
there are two main types of scleroderma
Limited disease
Diffuse disease
Limited disease (systemic scleroderma/sclerosis) is associated with this syndrome
CREST syndrome
CREST syndrome stands for
C: calcinosis
R: Raynaud’s
E: Esophageal dysfunction
S: Sclerodactyly
T: Telangiectasias
part of CREST syndrome characterized by calcium deposits on the skin
calcinosis
part of CREST syndrome characterized by a spasm in the blood vessels as a response to cold or stress
Raynaud’s phenomenon
part of CREST syndrome characterized by acid reflux and decrease in motility of the esophagus
esophageal dysfunction
part of CREST syndrome characterized by thickening or tightening of the skin on the fingers and hands
sclerodactyly
part of CREST syndrome characterized by a dilation of capillaries causing red marks on the surface of the skin
telangiectasias
during an assessment, this kind of skin may indicate scleroderma
tight, thick skin on the fingers
during an assessment, if these appear on the fingers or toes, it may indicate scleroderma
ulcers on the fingertips or toes
these three parts of the body will be assessed for abnormalities when diagnosing scleroderma
heart, lungs, and abdomen
pharmacological treatment for scleroderma may include
corticosteroids
immunosuppressants (methotrexate)
for most people, scleroderma progresses like this
the disease gets worse, but slowly
type of arthritis caused by an increase of uric acid levels (hyperuricemia)
gout
two types of gout
primary and secondary
this type of gout is more common
primary
accumulation of sodium urate crystals in joints such as the big toe an hands, sometimes the ears
tophi
primary gout has three stages
1) asymptomatic hyperuricemia
2) Acute gouty arthritis
3) chronic gout
primary gout can be
genetic
secondary gout is caused by
another disease that causes excessive uric acid in the blood
treatment for secondary gout focuses on
treating the underlying condition
acute gout attacks should subside within
3-10 days
this joint is commonly affected by gout pain
metatarsophalangeal joint of the big toe
an antigout medication (for acute gout)
colchicine
2 other classes of medications that can be used for acute gout
NSAIDs
corticosteroids
antigout medication (for chronic gout)
allopurinol
MOA allopurinol
promotes uric acid secretion and decreases production or uric acid
a uricosuric medication that can be used for chronic gout
probenecid
MOA probenecid
promotes secretion of uric acid
a client should avoid this food while treating gout
organ meats/shellfish
