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340 Final > Final Exam - New material > Flashcards

Final Exam - New material Flashcards

1
Q

What is the most common clinical manifestation of acute renal failure?

A

Oliguria
(Low Urine output)

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2
Q

Complications of AKI

A

Hyperkalemia *

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3
Q

Chronic Kidney Disease may result from

A

Diabetes
Hypertension
Glomerulonephritis
polycystic disease

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4
Q

A1C Normal range

A

4-7%

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5
Q

What range for A1C has the highest risk for diabates

A

5.7% - 6.4%

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6
Q

Actions of insulin

A

Promotes glucose uptake
inhibits gluconeogenesis
Promotes fat and glycogen breakdown
Increased protein synthesis

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7
Q

How does insulin effect Potassium?

A

Lowers K by driving K into the cell

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8
Q

Type 1 diabetics

A

Always insulin dependent

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9
Q

Three P’s of Diabetes

A

Polyuria
Polydipsia
Polyphagia

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10
Q

Insulin Aspart, glulisine, lispro (Short Acting)
Onset, Peak, Duration

A

5-15 mins
peak: 1-2 hours
Duration of action: 4-6 hours

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11
Q

Human Regular Insulin
Humulin R
Humulin R
onset, peak, duration

A

30-60 mins
2-4hours
6-8 hours

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12
Q

Human NPH
Humulin N
Novolin N
onset, peak, duration

A

2-4 hours
4-10hours
12-16 hours

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13
Q

Detemir
onset, peak, duration

A

1-2 hours
peak: flat
duration 24 hours

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14
Q

Glargine
(Lantus)
onset, peak, duration

A

2-4 hours
flat
24 hours

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15
Q

Hyperglycemia S/S

A

Hot and Dry
3 Ps
polyuria
polydipsia
polyphagua

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16
Q

Hypoglycemia S/S

A

Cool, Pallor, sweaty
Headache, irritability, weakness, anxious, sweaty, shaly, hungry

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17
Q

What is diabetic ketoacidosis

A

Life-threatening problem that occurs when the body starts to breakdown fats at a higher rate than carbohydrates

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18
Q

DKA S/S

A

Dry and High Sugar
Ketones and Kussmaul Respirations
Abdominal Pain
Acidosis
Hypovolemic

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19
Q

Hyperosmolar Hyperglycemic State

A

Happens slowly and to type 2 diabetics caused by illness, infections, older age

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20
Q

Should patients stop taking their insulin or oral agents when they’re sick

A

NO!

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21
Q

HHS S/S

A

Highest sugar - 600+
Extreme fluid loss
Change in LOC
No Ketones
Slower onset

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22
Q

Kussmaul Respirations (DKA)

A

Deep/Rapid/Regular Respirations

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23
Q

Onset of DKA

A

Happens Suddenly

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24
Q

Medical Management of DKA

A

Correct insulin deficiency
Insulin First
Avoid hyperglycemia by switching fluids to dextrose

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25
Q

Nursing priorities of DKA

A

Insulin drip until ketoacidosis is reversed

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26
Q

HHS Management

A

Hydration status
Neurologic status

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27
Q

HHS Priorities

A

Fluids First
Insulin Second

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28
Q

Diabetes Insipidus

A

Insufficiency or hypofunction of antidiuretic hormone (ADH)
Not enough ADH

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29
Q

Diabetes Insipidus results in

A

Extracellular dehydration
Hypernatremia
Hypotension and Hypovolemia

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30
Q

Assessment and Diagnosis of DI

A

Urine output over >300ml/hr or more
Specific Gravity <1.005

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31
Q

Medical Management of DI

A

Hourly urine output
vasopressin for BP
DDAVP-synthetic ADH

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32
Q

Syndrome of inappropriate Antidiuretic Hormone
(SIADH)

A

Opposite of DI
TOO MUCH ADH

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33
Q

SIADH Assessment and Diagnosis

A

Dilutional Hyponatremia
Lethargy and confusion
Anorexia
Seizures, coma, and death
Lab Results Na <120
Urine output below normal

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34
Q

Medical Management SIADH

A

Fluid Restriction
Na Replacement

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35
Q

Nursing Management SIADH

A

Hydration Status
Neurological Status
Seizures precautions due to low Na

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36
Q

Cushing Syndrome

A

Hyper-secretion of CORTISOL

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37
Q

Cushing Syndrome

A

Caused by an outside cause or medical treatment such as glucocorticoid therapy

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38
Q

Cushing Disease

A

Caused from inside source due to the pituitary gland producing too much ACTH which causes adrenal cortex to release too much cortisol

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39
Q

Cushings Disease S/S

A

Skin fragile
Truncal Obesity
Rounded (MOON) face
Ecchymosis
Stria
Sugar (Hyperglycemia)
Excessive body hair
Dorsocervical fat pad (buffalo hump)

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40
Q

Cushings Disease Treatment

A

Removal of pituitary tumor
or
Adrenalectomy

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41
Q

Addisons Disease

A

Hyposecretion of Aldosterone and Cortisol

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42
Q

What can cause Addisons Disease?

A

Autoimmune due to the adrenal cortex becoming damaged due to the body attacking itself

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43
Q

Addisons Disease S/S

A

Sodium and low sugar
Tired and muscle weakness
Electrolyte imbalances
Reproductive changes
Low blood pressure
increased pigmentation
Diarrhea nausea, depression

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44
Q

Addisons Disease Nursing interventions

A

Watch K levels and glucose levels
Hormone replacement levels of cortisol and aldosterone

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45
Q

Addisons Crisis

A

Sudden pain
Syncope
Shocl
Super low blood pressure
Sever V/D + headache

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46
Q

Addison Crisis treatment

A

Need IV cortisol STAT
D5NS fluid to keep blood sugar and sodium levels good

47
Q

S/S of Thyroid Disorder

A

Weight loss
heat intolerance
tachycardia
hypertension
Diarrhea
Soft hair
Cardiac dysrhythmias

48
Q

Thyroid Strom

A

Life threatening Hyperthyroidism

49
Q

Clinical presentation of thyroid storm

A

Thermoregulation: Fever
Heart: Dysrhythmias
CNS: agitation, restlessness
GI: n/v/d
Hypocalcemia

50
Q

Graves Disease

A

Autoimmune disorder that produces high amounts of thyroid hormones

51
Q

Graves’ Disease S/S

A

Protruding eyeballs, goiters, thin body, jittery

52
Q

Myxedema Coma

A

Sever hypothyroidism with hypothermia and coma

53
Q

Myxedema Coma S/S

A

Confused, hypothermic, waxy buildup on skin

54
Q

Pheochromocytoma

A

Tumor of adrenal medulla secretes catecholamines

55
Q

Treatment for Pheochromocytomas

A

Must remove tumor

56
Q

Causes of Cushings Disease

A

Steroids long term use
Tumors (pituitary/adrenal)
Small cell lung cancer

57
Q

Shock Syndrome
(Result of All forms of shock)

A

All types of shock eventually result in impaired tissue perfusion and the development of acute circulatory failure

58
Q

Hypovolemic Shock

A

Inadequate intravascular volume, relative to the vascular space

59
Q

Cardiogenic Shock

A

Impairment of myocardial function

60
Q

Causes of cardiogenic shock may include

A

After cardiac surgery, drug toxicity, inflammatory heart disease

61
Q

Distributive Shock

A

Inappropriate distribution of blood flow, increased capillary permeability
(Septic and anaphylactic shock)

62
Q

Obstructive Shock

A

Mechanical obstruction to blood flow into and through the heart and great vessels resulting in low cardiac output

63
Q

Causes of Obstructive Shock

A

Cardiac Tamponade, PE, Critical aortic stenosis

64
Q

Multiple Organ Dysfunction Syndrome

A

Primary MODS directly results from well-defined insult in which organ dysfunction occurs early and is directly attributed to insult itself (trauma, aspiration, Rhabdo)

65
Q

Secondary MODS

A

Consequence of widespread systemic inflammation that results in dysfunction of organs not involved in initial insult

66
Q

Clinical Manifestations of MODS

A

Heart rate >90 (TACHY)
RR>20 (Tachypnea)
WBC >12
Bands >10%

67
Q

Conditions related to MODS

A

Infection
Ischemia
Trauma
Hemorrhagic Shock
Aspiration

68
Q

MODS Medical Management

A

Fluid resuscitation
Identification and treatment of infection
prevent infection
maintenance of tissue oxygenation
comfort and emotional support

69
Q

MODS Nursing Management

A

Hand washing for infection prevention
Oxygen delivery
nutritional support
comfort and emotional support
preventing complications

70
Q

Systemic Inflammatory Response Syndrome (SIRS)

A

Abnormal response characterized by generalized inflammation in organs that are remote from the initial insult

71
Q

Nursing Management for Septic Shock

A

Vasopressors
Fluid administration
blood cultures
antibiotics
emotional support
monitor for complications

72
Q

Cardiogenic Shock Assessment and diagnosis

A

Decline in CO
Chest pain
Tachycardia
Respiratory Alkalosis
Hypoxemia
Pulmonary Edema

73
Q

Becks Triade

A

Muffled Heart Sounds
JVD
Hypotension

74
Q

Treatment for Cardiac Tamponade

A

Needle Aspiration (Emergent)
Pericardial Window (Surgical)

75
Q

Pulmonary Embolism

A

Thrombolysis
Antocoagulation

76
Q

Tension Pneumothorax

A

Needle Decompression
Chest Tube Placement

77
Q

Treatment for Anaphylactic shock

A

Administer Epinephrine

78
Q

Neurogenic Shock Assessment and Diagnosis

A

Hypotension
Bradycardia
Warm, Dry skin
Hypothermia

79
Q

Toxic Epidermal Necrolysis

A

Caused the skin to peel and blister off
caused by drug reactions

80
Q

Steven-Johnson Syndrome

A

Steven Johnson’s Syndrome is a rare and serious disorder of the skin and mucous membranes. It’s usually a reaction to medication that starts with flu-like symptoms, followed by a painful rash that spreads and blisters.

81
Q

Emergency Operations Plan
(Trauma)

A

Activation response
Internal and external communication plan
security plans
identification of external resources

82
Q

Triage

A

The sorting of patients to determine priority health care needs and the proper site of treatment

83
Q

North Atlantic Treaty Organization for Triage
(NATO)

A

Red
Yellow
Green
Black

84
Q

Phases of Trauma Care
Prehospital resuscitation

A

Golden Hour*
ABCDEs of Trauma = Primary survey

85
Q

ABCDEs

A

Airway
Breathing
Circulation
Disability
Exposure

86
Q

Phases of Trauma Care
ED and Hospital resuscitation

A

Damage control resuscitation
massive transfusion protocols

87
Q

Secondary Survey of Trauma Care

A

Allergies
Med list
past history
last meal
events related to injury

88
Q

Biggest sign of increased ICP

A

Change in LOC

89
Q

Quadriplegia with total loss of respiratory function occurs at what part of the spine

A

C1 - C4

90
Q

Quadriplegia with possible loss of respiratory function due to edema
Spasticity may occur

A

C4 - C5

91
Q

C5 - C6 Injury

A

Quadriplegia with gross arm movements; sparing the diaphragm

92
Q

C6 - C7 injuries

A

Biceps intact
diaphragmatic breathing
feeding and grooming independent

93
Q

C7 - C8 injuries

A

Triceps and biceps intact
no intrinsic hand muscles

94
Q

T1 - L2 injuries

A

Paraplegia with loss of varying amounts of intercostal and abdominal muscles
(In and out of wheelchair independently)

95
Q

Flail Chest

A

Fracture of two or more sites on three or more adjacent robs are no longer attached to thoracic cage

96
Q

Flail Chest results in

A

Ineffective ventilation
pulmonary contusion
lacerated parenchyma

97
Q

Flail Chest S/S

A

Dyspnea
Chest wall pain
Paradoxical chest wall movement

98
Q

Pneumothorax S/S

A

Dyspnea
tachypnea
tachycardia
hyperresonance on injured side

99
Q

Tension pneumothorax

A

Air enters pleural space on inspiration, but the hair cannot escape on expiration

100
Q

Tension Pneumothorax S/S

A

Severe respiratory distress
hypotension
distended neck veins
tracheal deviation

101
Q

Hemothorax

A

Accumulation of blood in the pleural space

102
Q

Hemothorax S/S

A

Dyspnea
tachypnea
chest pain
signs of shock
dullness to percussion

103
Q

Kehr’s sign

A

Sharp epigastric or chest pain radiating to the left shoulder

104
Q

Becks Triad

A

Distended neck veins
Muffled heart sounds
hypotension

105
Q

Pericardial/Cardiac Tamponade

A

Dyspnea
Becks triad
Discomfort that is relieved by sitting or leaning forward

106
Q

Cardiac Tamponade

A

Increase in intrapericardial pressure caused by accumulation of fluid or blood in pericardial sac; trauma, cardiac surgery, cancer, uremia, cardiac rupture

107
Q

Compartment Syndrome

A

Tissue compromise from pressure in the muscle compartment

108
Q

Hallmark sign of Compartment Syndrome

A

Pain out of proportion to the original injury

109
Q

What are the 5 P’s of Compartment Syndrome

A

Paresthesia, pallor, proprioception, pain, pulse

110
Q

Fat Embolism Syndrome

A

Fat droplets in small blood vessels of lung or other organs after a long bone fracture or other major trauma. Released from bone marrow or adipose tissue at fracture site into venous system; rare

111
Q

Complications of Fat Embolism

A

Respiratory failure, cerebral dysfunction and skin petechiae (does not blanch); symptoms within a few hours to 3-4 days. Initial findings subtle change in behavior and disorientation

112
Q

Meeting the Needs of Family

A

Incorporate family into all aspects of care

113
Q

Grey-Turner’s sign

A

Purplish discoloration on the flanks or near 11th/12th rib

114
Q

Acute Renal Failure

A

rapid decline (over hours to days) in glomerular filtration rate (GFR).

340 Final (3 decks)

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