Final Exam Flashcards
Dbts: What is Type 1 diabetes?
Caused by dysfunctional beta cells in pancreas resulting in no insulin produced
AKA Juvenile Diabetes
Dbts: What is Type 2 diabetes?
Caused by an insulin resistance from consistently elevated blood glucose levels
AKA Adult onset diabetes
Clinical manifestations of Type I DM:
3 P’s, weakness, fatigue, weight loss, diabetic ketoacidosis
Clinical manifestations of type II DM:
3 P’s, fatigue, recurrent infections, vaginal yeast/candida infections, poor wound healing, numb fingers/toes, blurry vision
Treatment of HYPERglycemia:
Insulin therapy + FLUIDS (NS) Rapid Acting (Novalog, Humalog) Short Acting (Humalin R, Novalin R) Intermediate Acting (Humalin N, Novalin N) Long Acting (Levemir)
Treatment of HYPOglycemia
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
Normal Fasting BG vs diabetic
74-100mg/dL vs >126mg/dL
Normal HA1C vs Diabetic
4.0 - 6.0% vs > 6.5%
Normal 2hr plasma glucose vs diabetic
<140mg/dL vs >200mg/dL
Pna: respiratory assessment of pt w/ pneumonia
Crackles on auscultation, tachypnea, dyspnea, increased tactile fremitus, yellow/green secretions (bacterial), clear secretions (viral)
Pna: Abnormal findings of pt w/ Pneumonia
Elevated temp, elevated WBCs, positive C&S, dyspnea, anorexia, chills, fluid in the lungs (x-ray)
Pna: Treatments for pneumonia
- get the vaccine
- IV antibiotics for bacterial
- Comfort measures (positioning, pain medication, O2)
- breathing exercise
- ambulation
- fluids
- antipyretics
Pna: Nursing priorities for Acute exacerbations of pneumonia
- Culture & Sensitivity if indicated + administer antibiotics
- Fluids
- O2 therapy
- Ambulation
- Turn cough deep breathe
Pna: Pt education for Pneumonia
- 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!
TB: Respiratory assessment
adventitious sounds (crackles), hemoptysis, dyspnea
TB: abnormal findings for pt with TB
night sweats, hemoptysis, fever, increased WBC, positive C&S, anorexia, weight loss
TB: common treatments for pt w/ TB
- fluids
- RIPES –> rifampicin, isoniazid, pyrazinamide, ethambutol, streptomycin
- Directly-Observed therapy
TB: nursing priorities for pt w/ TB
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
TB: pt education for TB
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
Ast: Respiratory assessment for Asthma
Expiratory wheezing, hypoventilation, chest tightness, tachypnea
Ast: abnormal findings for pt w/ asthma
Anxiety, increased temperature, hyperinflation of the lungs, air trapping, diminished breath sounds and respiratory alkalosis are bad
Ast: common short term treatments for asthma
Bronchodilators (SABAs)
- albuterol
- ipratropium/Atrovent
Ast: common long term treatment for asthma
LABAs –> salmeterol
corticosteroids –> fluticasone, prednisone
-Theophylline
-Eliminate triggers
Ast: Nursing priorities for Acute Asthma attack
1) monitor vitals and respiratory status
2) monitor ABGs
3) administer medication as indicated SABA w/ LABA
- reduce anxiety
- fluids
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
copd: respiratory assessment of patient with COPD
Auscultation may show diminished breath sounds, hyperresonance, wheezing, prolonged exhale
copd: abnormal findings –> emphysema “pink puffer”
barrel chest, dyspnea, prolonged expiration, tripod position, pursed lip breathing, weight loss
copd: abnormal findings –> Chronic bronchitis “blue bloater”
cough, dyspnea on exertion, hypercapnia, hypoxemia, mild cyanosis
copd: common treatments for COPD
- O2 therapy w/ nasal cannula or venturi mask
- bronchodilators
- corticosteroids for management
- smoking cessation
- fluids!
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)
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
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
htn: Risk factors for hypertension
Age, Race, Family Hx, gender, stress, cholesterol, high sodium diet, sedentary lifestyle, obesity, alcohol, smoking
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+
htn: Clinical Manifestations of hypertension
Asymptomatic in the early stages
-headache, flushing, epistaxis (nose bleeding), increased BP
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
htn: Common treatments for hypertension
ACEs: "-pril" ARBs: "-sartan" Beta-Blockers: "-lol" Calcium Channel Blockers: "-dipine" DASH diet + lifestyle changes
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
cad: risk factors for CAD
High blood triglycerides, Low HDL, Sedentary lifestyle, Obesity, Smoking, High fat diet, Hypertension, diabetes
cad: assessment of CAD
Pain assessment: chest pain (when, where, quality, duration, etc.)
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
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
cad: common treatments for CAD
-Cardiac catheterization
-Stent
-Coronary bypass
-Statin medications
incase of MI…
M-morphine
O-oxygen
N-nitro
A-aspirin
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
pvd: risk factors for peripheral artery disease
atherosclerosis, arterial insufficiency, diabetes (#1)
pvd: risk factors for peripheral venous disease
venous stasis, increased coagulability, varicose veins, diabetes (#1)
pvd: assessment of peripheral arterial disease
Neurovascular assessment: pale, cool, dry, thin skin on the lower legs, slow capillary refill, hairless
pvd: assessment of peripheral venous disease
Neurovascular assessment: warm, red, erythematous, swollen lower leg
pvd: manifestations of peripheral arterial disease
punched out ulcers on the foot and ankle and bony protrusions, sharp pain, relief from pain while standing
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
pvd: disease progression or peripheral vascular disease
- Eventually the lower limbs could lose their function
- DVT
- Infection
- Wounds/necrosis
- amputation
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
pvd: common treatments for peripheral venous disease
elevate the legs above heart level, aspirin, statin medications, VTE prevention like “lovenox,” smoking cessation, lifestyle change
pvd: nursing management for peripheral vascular disease
Treat the underlying cause! Medication education (aspirin, statins, diabetes management), Promote comfort at rest
hf: risk factors for heart failure
COPD, Pulmonary hypertension, Hypertension, Obesity, Smoking, Dyslipidemia, Physical inactivity, gender, diabetes
hf: assessment labs for heart failure
Increased BUN, creatinine, high BP
Ejection fraction!
hf: manifestations of Right Heart Failure
“Rest of body” - distended jugular veins, ascites, peripheral edema, hypertension, oliguria
hf: manifestations of Left Heart Failure
“Lungs” - crackles in the lungs, pink frothy sputum, low O2, dyspnea, fatigue, cyanosis
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
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+)
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
Cancer: Delivering chemotherapy agents
- Protection!! Always wear gloves and proper PPE
- Be careful when handling body fluids
- Monitor for adverse effects
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
heme: treatment for Cobalamin deficiency
B12 supplementation (parenteral, intranasal)
heme: treatment for Folic Acid deficiency
replace Folate in diet (green leafy veg, enriched grain products, breakfast cereals, orange juice, peanuts, avocado
heme: CMs of megaloblastic anemias
sore, red, beefy, shiny tongue anorexia nausea/vomiting abdominal pain weakness + paresthesias ataxia
heme: Anemia (lab values, signs & symptoms)
labs…
hgb: 12 - 15.5
Hct: 35 - 47%
RBC: 4.35 to 5.65/mcl
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)
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
hiv: HIV wasting syndrome
unintentional loss of 10% or more of your body weight
-caused by malnutrition and anorexia
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
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
ckd: Labs measuring renal function
BUN: 10 - 20mg/dL
Creatinine: 0.5 - 1.2mg/dL
Protein: negative in urine
GFR: >60%
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
gu: Kidney stone prevention
- Increase fluid 2L-3L every day
- Decrease type of food dependent on type of stone
- limit alcohol consumption and caffiene
gi: assessment findings of a small bowel obstruction
distended bowel (sometimes), abdominal pain, constipation, nausea/vomiting
gi: treatment of a small bowel obstruction
Treat with surgery, fluids, monitor F&E for metabolic acidosis enema, pain medication, surgery
gi: assessment findings in peritonitis
increased tem, increased WBCs, abdominal pain, muscle guarding, rebound pain
gi: treatment of peritonitis
antibiotics!
NPO
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
fx: surgical intervention and nursing care for fracture
- stabilize broken bone (prevent fat embolism syndrome)
- perform neurovascular assessment
- manage pain
fx: surgical intervention for fractures
-internal fixation
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
fx: Nursing assessment for fractures
Neurovascular assessment distal to the injury -color -sensation -capillary refill -temperature -mobility Pain assessment
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
