Final Exam Flashcards

1
Q

Dbts: What is Type 1 diabetes?

A

Caused by dysfunctional beta cells in pancreas resulting in no insulin produced
AKA Juvenile Diabetes

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2
Q

Dbts: What is Type 2 diabetes?

A

Caused by an insulin resistance from consistently elevated blood glucose levels
AKA Adult onset diabetes

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3
Q

Clinical manifestations of Type I DM:

A

3 P’s, weakness, fatigue, weight loss, diabetic ketoacidosis

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4
Q

Clinical manifestations of type II DM:

A

3 P’s, fatigue, recurrent infections, vaginal yeast/candida infections, poor wound healing, numb fingers/toes, blurry vision

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5
Q

Treatment of HYPERglycemia:

A
Insulin therapy + FLUIDS (NS)
Rapid Acting (Novalog, Humalog)
Short Acting (Humalin R, Novalin R)
Intermediate Acting (Humalin N, Novalin N)
Long Acting (Levemir)
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6
Q

Treatment of HYPOglycemia

A

Rule of 15s!
Take BG –> give 15g of carbs (3-4 glucose tabs, 1 glass OJ, 3-5 hard candies) –> wait 15 minutes –> reassess –> Administer carbs again if still low

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7
Q

Normal Fasting BG vs diabetic

A

74-100mg/dL vs >126mg/dL

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8
Q

Normal HA1C vs Diabetic

A

4.0 - 6.0% vs > 6.5%

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9
Q

Normal 2hr plasma glucose vs diabetic

A

<140mg/dL vs >200mg/dL

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10
Q

Pna: respiratory assessment of pt w/ pneumonia

A

Crackles on auscultation, tachypnea, dyspnea, increased tactile fremitus, yellow/green secretions (bacterial), clear secretions (viral)

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11
Q

Pna: Abnormal findings of pt w/ Pneumonia

A

Elevated temp, elevated WBCs, positive C&S, dyspnea, anorexia, chills, fluid in the lungs (x-ray)

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12
Q

Pna: Treatments for pneumonia

A
  • get the vaccine
  • IV antibiotics for bacterial
  • Comfort measures (positioning, pain medication, O2)
  • breathing exercise
  • ambulation
  • fluids
  • antipyretics
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13
Q

Pna: Nursing priorities for Acute exacerbations of pneumonia

A
  • Culture & Sensitivity if indicated + administer antibiotics
  • Fluids
  • O2 therapy
  • Ambulation
  • Turn cough deep breathe
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14
Q

Pna: Pt education for Pneumonia

A
  • Teach to take the full course of medication and how to take the med
  • educate on increasing fluid intake
  • possible follow up x-ray
  • Educate on the importance of the vaccine!
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15
Q

TB: Respiratory assessment

A

adventitious sounds (crackles), hemoptysis, dyspnea

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16
Q

TB: abnormal findings for pt with TB

A

night sweats, hemoptysis, fever, increased WBC, positive C&S, anorexia, weight loss

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17
Q

TB: common treatments for pt w/ TB

A
  • fluids
  • RIPES –> rifampicin, isoniazid, pyrazinamide, ethambutol, streptomycin
  • Directly-Observed therapy
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18
Q

TB: nursing priorities for pt w/ TB

A

1) place on airborne precautions (negative pressure room, N95 mask)
2) full medical workup w/ xray and C&S
3) begin treatment with anti-TB drugs

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19
Q

TB: pt education for TB

A

Meds: take course as prescribed for 6 - 12 months
lifestyle: proper hand hygiene, cover nose and mouth with tissue when coughing or sneezing
Management: must test negative 2 times, stay out of public places

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20
Q

Ast: Respiratory assessment for Asthma

A

Expiratory wheezing, hypoventilation, chest tightness, tachypnea

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21
Q

Ast: abnormal findings for pt w/ asthma

A

Anxiety, increased temperature, hyperinflation of the lungs, air trapping, diminished breath sounds and respiratory alkalosis are bad

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22
Q

Ast: common short term treatments for asthma

A

Bronchodilators (SABAs)

  • albuterol
  • ipratropium/Atrovent
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23
Q

Ast: common long term treatment for asthma

A

LABAs –> salmeterol
corticosteroids –> fluticasone, prednisone
-Theophylline
-Eliminate triggers

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24
Q

Ast: Nursing priorities for Acute Asthma attack

A

1) monitor vitals and respiratory status
2) monitor ABGs
3) administer medication as indicated SABA w/ LABA
- reduce anxiety
- fluids

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25
Ast: Pt education for asthma
Meds: take medication as prescribed, do not overuse SABAs (palpitations) Lifestyle: physical activity + sleep, reduce allergens, smoking cessation Management: learn to use Peak flow Meter and have an action plan
26
copd: respiratory assessment of patient with COPD
Auscultation may show diminished breath sounds, hyperresonance, wheezing, prolonged exhale
27
copd: abnormal findings --> emphysema "pink puffer"
barrel chest, dyspnea, prolonged expiration, tripod position, pursed lip breathing, weight loss
28
copd: abnormal findings --> Chronic bronchitis "blue bloater"
cough, dyspnea on exertion, hypercapnia, hypoxemia, mild cyanosis
29
copd: common treatments for COPD
- O2 therapy w/ nasal cannula or venturi mask - bronchodilators - corticosteroids for management - smoking cessation - fluids!
30
copd: Nursing prioritis for accute COPD exacerbation
1) treat the underlying cause (pneumonia, infection, heart failure) 2) O2 therapy (keep sat at 90% on low flow) 3) rescue inhaler (SABAs)
31
copd: pt education for COPD
Meds: do not overuse bronchodilators (palpitations), store O2 away from flames Lifestyle: smoking cessation, infection prevention Management: take medication as prescribed, teach pursed lip breathing Rest 30 minutes before eating
32
Cor Pulmonae Progression...
The right side of the heart has to pump/work harder to get blood flow to the lungs caused by pulmonary hypertension which is a normal complication of CHRONIC BRONCHITIS --> the increased workload of the heart causes it to increase in size and decreases its contractility which leads to right sided heart failure
33
htn: Risk factors for hypertension
Age, Race, Family Hx, gender, stress, cholesterol, high sodium diet, sedentary lifestyle, obesity, alcohol, smoking
34
htn: Assessing BP
``` Normal BP: <120/80 -make sure the cuff size is correct Stage 1 = 130-139 or 80-89. Stage 2 = 140+ or 90+ Hypertensive Crisis (call your doctor immediately) = 180+ and/or 120+ ```
35
htn: Clinical Manifestations of hypertension
Asymptomatic in the early stages | -headache, flushing, epistaxis (nose bleeding), increased BP
36
htn: disease progression of hypertension
*think: BP affects ALL systems in the body and can cause ALL bad things CV: damage to blood vessel walls leads to inflammation and cholesterol deposits in the damaged areas, these harden and lead to atherosclerosis and CAD Kidney: nephrosclerosis leads to CKD PVD: atherosclerosis leads to PVD, aortic aneurysm, aortic dissection, and intermittent claudication Eyes - retinal damage
37
htn: Common treatments for hypertension
``` ACEs: "-pril" ARBs: "-sartan" Beta-Blockers: "-lol" Calcium Channel Blockers: "-dipine" DASH diet + lifestyle changes ```
38
htn: Nursing priorities for hypertension management
- give antihypertensives as prescribed and monitor BP - Promote healthy lifestyle changes!! - Smoking cessation - Encourage low sodium and low saturated fat diet - Increase exercise - Lose excess body weight - Medication compliance! - EMERGENCY: >180 SBP and >120 DBP
39
cad: risk factors for CAD
High blood triglycerides, Low HDL, Sedentary lifestyle, Obesity, Smoking, High fat diet, Hypertension, diabetes
40
cad: assessment of CAD
Pain assessment: chest pain (when, where, quality, duration, etc.)
41
cad: clinical manifestations of CAD
- MI: SOB, nausea, arm/jaw pain - High CK, BNP, troponins - Chest pain (unstable, stable, prinzmetal angina) * ST elevation in STEMI
42
cad: disease progression of CAD
Eventually the coronary arteries won’t allow enough blood flow to the heart muscle --> This can cause a myocardial infarction due to hypoxia and damage the heart
43
cad: common treatments for CAD
-Cardiac catheterization -Stent -Coronary bypass -Statin medications incase of MI... M-morphine O-oxygen N-nitro A-aspirin
44
cad: Nursing priorities for CAD
1) administer Nitro in the case of chest pain and assess for MI of an EKG 2) if having an MI --> MONA - educate on lifestyle changes - medication compliance is important
45
pvd: risk factors for peripheral artery disease
atherosclerosis, arterial insufficiency, diabetes (#1)
46
pvd: risk factors for peripheral venous disease
venous stasis, increased coagulability, varicose veins, diabetes (#1)
47
pvd: assessment of peripheral arterial disease
Neurovascular assessment: pale, cool, dry, thin skin on the lower legs, slow capillary refill, hairless
48
pvd: assessment of peripheral venous disease
Neurovascular assessment: warm, red, erythematous, swollen lower leg
49
pvd: manifestations of peripheral arterial disease
punched out ulcers on the foot and ankle and bony protrusions, sharp pain, relief from pain while standing
50
pvd: manifestations of peripheral venous disease
seeping ulcer on lower leg above the ankle, brown with a lot of drainage, dull pain, worsens when standing
51
pvd: disease progression or peripheral vascular disease
- Eventually the lower limbs could lose their function - DVT - Infection - Wounds/necrosis - amputation
52
pvd: common treatments for peripheral arterial disease
dangling the legs (dependent), stent in artery, aspirin, statin medications, VTE prevention like "lovenox," smoking cessation, lifestyle change
53
pvd: common treatments for peripheral venous disease
elevate the legs above heart level, aspirin, statin medications, VTE prevention like "lovenox," smoking cessation, lifestyle change
54
pvd: nursing management for peripheral vascular disease
``` Treat the underlying cause! Medication education (aspirin, statins, diabetes management), Promote comfort at rest ```
55
hf: risk factors for heart failure
COPD, Pulmonary hypertension, Hypertension, Obesity, Smoking, Dyslipidemia, Physical inactivity, gender, diabetes
56
hf: assessment labs for heart failure
Increased BUN, creatinine, high BP | Ejection fraction!
57
hf: manifestations of Right Heart Failure
"Rest of body" - distended jugular veins, ascites, peripheral edema, hypertension, oliguria
58
hf: manifestations of Left Heart Failure
"Lungs" - crackles in the lungs, pink frothy sputum, low O2, dyspnea, fatigue, cyanosis
59
hf: disease progression
RHF will lead to LHF - decreased heart contractility will decrease the body's ability to perfuse blood to vital organs - this lessens the O2 delivered to the body and damages vital organs
60
hf: common treatments for heart failure
"UNLOAD FAST" Upright position, nitrates, Lasix or spironolactone, O2, ACE inhibitors ("-pril"), Digoxin, Fluids (decrease), Afterload (decrease), Sodium restriction, Test (digoxin, ABGs, K+)
61
hf: nursing priorities for heart failure
- Improve myocardial contractility/systemic perfusion - Reduce fluid volume overload (monitor I&O) - monitor Fluid and electrolytes - Prevent complications - Provide information about disease/prognosis, therapy needs, and prevention or recurrences
62
Cancer: Delivering chemotherapy agents
- Protection!! Always wear gloves and proper PPE - Be careful when handling body fluids - Monitor for adverse effects
63
Cancer: Psychosocial assessment associated with Cancer
- Assess support system - Provide education on potential side effects of chemo-agents - Decide on prosthetics if needed - Promote positive self-concept
64
heme: treatment for Cobalamin deficiency
B12 supplementation (parenteral, intranasal)
65
heme: treatment for Folic Acid deficiency
replace Folate in diet (green leafy veg, enriched grain products, breakfast cereals, orange juice, peanuts, avocado
66
heme: CMs of megaloblastic anemias
``` sore, red, beefy, shiny tongue anorexia nausea/vomiting abdominal pain weakness + paresthesias ataxia ```
67
heme: Anemia (lab values, signs & symptoms)
labs... hgb: 12 - 15.5 Hct: 35 - 47% RBC: 4.35 to 5.65/mcl
68
heme: Priorities for transfusion therapy preparation
- Begin transfusion within 30 minutes of receiving blood - Crossmatch blood with patient - Observe patient for 15 minutes and finish transfusion w/in 4 hours - Watch for warning signs such as lower back pain, wheezing, flushing, etc. - Take vitals every 15 minutes (can be delegated)
69
hiv: Outcomes/goals of treatment for HIV/AIDS
- To reduce the amount of virus in circulation to an undetectable level - Manage symptoms - Keep patient free of infection - Improve quality of life
70
hiv: HIV wasting syndrome
unintentional loss of 10% or more of your body weight | -caused by malnutrition and anorexia
71
ckd: importance of I&Os
- In CKD there can be a fluid overload due to the kidneys not filtering out enough fluid - Monitoring I&O also gives an idea of the function of the kidneys
72
ckd: relationship between HTN and CKD
- Managing HTN keeps the kidneys from increased workload | - Also reduces the stress and scarring of the nephrons in the kidneys
73
ckd: Labs measuring renal function
BUN: 10 - 20mg/dL Creatinine: 0.5 - 1.2mg/dL Protein: negative in urine GFR: >60%
74
ckd: Treatment and care of AV fistula
- prevent infection by proper cleaning and dressing changes - Takes 6 months to heal fully - Must wait 3 months to use fistula - Bruit heard on auscultation, palpable thrill, strong radial pulse, normal appearance
75
gu: Kidney stone prevention
- Increase fluid 2L-3L every day - Decrease type of food dependent on type of stone - limit alcohol consumption and caffiene
76
gi: assessment findings of a small bowel obstruction
distended bowel (sometimes), abdominal pain, constipation, nausea/vomiting
77
gi: treatment of a small bowel obstruction
Treat with surgery, fluids, monitor F&E for metabolic acidosis enema, pain medication, surgery
78
gi: assessment findings in peritonitis
increased tem, increased WBCs, abdominal pain, muscle guarding, rebound pain
79
gi: treatment of peritonitis
antibiotics! | NPO
80
gi: Post op care for abdominal surgery
- protect from infection - use of bear hugger to prevent dehiscence - semi-fowler's position - assess pain frequently - assess site of surgery
81
fx: surgical intervention and nursing care for fracture
- stabilize broken bone (prevent fat embolism syndrome) - perform neurovascular assessment - manage pain
82
fx: surgical intervention for fractures
-internal fixation
83
fx: post-op complications of fractures
Fat Embolism syndrome: keep stable | Compartment syndrome: due to cast being on too tight (never remove the cast w/out an order from a provider
84
fx: Nursing assessment for fractures
``` Neurovascular assessment distal to the injury -color -sensation -capillary refill -temperature -mobility Pain assessment ```
85
fx: priorities for fractures
mobility: stabilizing the fracture is important to prevent mobility deficits Infection: if it is an open wound, or after a surgery (internal fixation/fasciotomy), infection prevention! Pain: pain assessment can indicate complications