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Med surg > Midterm 2 > Flashcards

Midterm 2 Flashcards

1
Q

Lab tests HF

A

electrolytes , HGB, HCT, BNP, Urinalysis, ABGs

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2
Q

Imaging HF

A

CX, electrocardiography, ECG, pulmonary artery catheter

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3
Q

interventions for HF and improving oxygenation

A

ventilation support, monitor RR 1-4 hrs, high fowler’s, keep that O2 at 90%

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4
Q

activity intolerance

A

dyspnea on exertion, associated with decreased cardiac output

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5
Q

Drugs that reduce preload

A

diuretics, oxygen, venous vasodilators

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6
Q

drugs that reduce afterload

A

ACE, ARBs, human BNP

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7
Q

first line drug for fluid overload

A

diuretics

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8
Q

causes of LHF

A

HTN, CAD, valvular disease

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9
Q

S/S LHF

A

Weakness, fatigue, dizziness, acute confusion, pulmonary congestion
LEFT LUNGS

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10
Q

Causes of RHF

A

Left heart failure, right ventricular Mi, pulmonary HTN

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11
Q

S/S of RHF

A

JVD, increased in abdominal girth, asities, dependent edema, hepatomegaly

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12
Q

1 thing for RHF

A

Daily weights and strict I/Os

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13
Q

pericarditis

A

inflammation of the pericardium

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14
Q

assessment of pericarditis

A

substernal precordial pain, pain worsens by swallowing, breathing, coughing, and supine positioning, pericardial friction rub

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15
Q

relieving pain of pericarditis

A

sit them up and lean them forward, NSAIDs, antibiotics

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16
Q

S/S of pericarditis

A

JVD, paradoxical pulses, decreased CO, muffled heart sounds, circulatory collapse

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17
Q

valve disease patient ed

A

importance of prophylactic antibiotic therapy before any invasive dental or oral procedure because of the risk of infection

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18
Q

TAVR

A

procedure for valve disease

Transcatheter aortic valve replacement

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19
Q

endocarditis

A

microbial infection of the endocardium

strep and staph

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20
Q

S/S of endocarditis

A

fever with chills, anorexia and weight loss, cardiac murmur, petechiae, osler’s nodes, janeaway lesions, positive blood cultures

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21
Q

digoxin

A

inotropic drug used to increase contractility, reduce HR, slows conduction through AV node in HF
not as common anymore

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22
Q

dig toxicity

A

associated with digoxin not being in therapeutic range (.5-2) and has associated symptoms of anorexia, fatigue, blurred vision, changes in mental status, PVCs( Watch those K levels)

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23
Q

examples of diuretics

A

lasix and hydralazine

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24
Q

things to watch for with diuretics

A

hypokalemia and hypernatremia

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25
Q

venous vasodilators

A

oxygen, nitric oxide, nitroprusside, sildefanil (all decrease preload)

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26
Q

beta blockers

A

metoprolol, carvedilol, atenolol, nadolol (decrease afterload)

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27
Q

beta blocker patient ed

A

take pulse for 1 minute and it should be greater thn 60 prior to taking the medication

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28
Q

AceI and ARBs

A

decrease afterload and are given first line with diuretics for HF, with aces look for angioedema

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29
Q

diabetic peripheral neuropathy

A

progressive deterioration of nerve functioning that results in loss of sensory perception

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30
Q

factors that lead to Peripheral neuropathy

A 
hyperglycemia
damaged blood vessels 
autoimmune neuronal infection 
genetic predispositions 
smoking and alcohol use
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31
Q

loss of integrity can cause

A

infection –> increased glucose levels –> decreased immunity –> more infection

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32
Q

PT ed for feet and diabetes

A

inspect your feet daily, wash your feet daily with lukewarm water, change for clean, cotton socks daily, trim your nails, do not smoke, do not wear tight socks/stockings. no really hot water (no more than 110)

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33
Q

DKA

A

uncontrolled hyperglycemia typically seen in patients with type 1 diabetes which leads to increased ketone production, metabolic acidosis

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34
Q

causes of DKA

A

insulin deficiency, dehydration

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35
Q

S/S of DKA

A

polyuria, polydipsia, polyphagia, Kussmal’s respirations ( deep, rapid respirations), fruity smelling breath, increased potassium

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36
Q

What to watch for in DKA when insulin is started

A

hyperkalemia becomes hypokalemia so watch for K levels because PVCs

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37
Q

Treatment of DKA

A

insulin regular in isotonic solution then switch to hypotonic

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38
Q

Type 2 diabetes

A

insulin resistance and usually adult in onset

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39
Q

risk factors for type 2 diabetes

A

BMI greater than 25, first degree relative with diabetes, hypertensive, HDL levels less than 35, GDM

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40
Q

fasting blood glucose

A

normal less than 100

greater than 126 on two separate occasions is diabetes

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41
Q

glucose tolerance test

A

normal: greater than 140

greater than 140-200 on two separate occasions is diabetes

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42
Q

A1C test

A

4-6% is normal
5.7-6.4%- increased risk
>6.5% diabetes

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43
Q

2nd generation sulfonylurea

A

glipzide
MOA- insulin stimulators
considerations: s/s of hypoglycemia, take before or with meals, check with doctor with otc meds, side effects - nausea, vomiting, and weight gain

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44
Q

biguanides

A

metformin
MOA: insulin stimulators
NC: do not drink alcohol, diarrhea, nausea, indigestion, and abdominal pain are common side effects, monitor Cr levels

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45
Q

Thiazolidinedione

A

Pioglitazone
MOA: lower blood glucose levels by decreasing liver glucose production, and improve the sensitivity of insulin
NC: not used as much anymore due to the side effects of worsening HF and women at increased risk of bone fractures

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46
Q

S/S of hypoglycemia

A

weakness, fatigue, confusion, seizures, loss of consciousness, brain damage, shaky, heart pounding, sweaty, hungry, tingling

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47
Q

Causes of hypoglycemia

A

too much insulin with food intake and physical activity, insulin injected at the wrong time, wrong type of insulin, decreased food intake, decreased liver glucose production after alcohol ingestion

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48
Q

conscious treatment for hypoglycemia

A

4 glucose tablets, 4 oz fruit juice, 8 oz non-fat milk

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49
Q

Unconscious treatment for hypoglycemia

A

IM and SubQ glucagon

IV D50

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50
Q

Rapid insulin

A

humalog and aspart novalog
peak- 1 hr
take with food. give the shot when the food is hot

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51
Q

Short acting insulin

A

Novalin
peak 2.5-3
covers insulin needs for meals eaten within 30-60 mins
IV DKA and HHS

52
Q

Intermediate acting

A

NPH
peak 8 hrs
covers insulin needs for about half the day or overnight. this type of insulin is often combined with short acting insulin. Clear before cloudy(NPH)

53
Q

Long acting

A

Glargine
long-acting insulin needs for about one full day.
no peak time

54
Q

hyperglycemic hyperosmolar state

A

hyperglycemia typically seen in diabtetes type 2. Like DKA it is caused by hyperglycemia and dehydration there is no increased ketones Sustained osmotic diuresis. Decreased kidney perfusion

55
Q

HHS treatment

A

FLUID REPLACEMENT
rapid fluid infusion start
.9 NS and then switch to hypotonic .45

56
Q

diabetes type 1

A

no insulin production and pancreatic beta cell destruction

57
Q

S/S of IDDM

A

abrupt onset, thirst, hunger, increased urine output, weight loss, thin, always insulin dependent

58
Q

Exercise and diabetes

A

do it only if bg is between 100-250, do not exercise if insulin was given 1 hr ago, stay hydrated

59
Q

alcohol and diabetes

A

do not drink on metformin, and alcohol consumption can alter BG levels because of the amount of carbs

60
Q

Blood analysis for DKA

A

increased ketones and metabolic acidosis

61
Q

interventions for ICP

A

elevate head of bed 30 degrees, oxygen therapy, head midline, avoid clustering activities, hyper-oxygenate before suctioning, keep lights low to limit photosensitivity

62
Q

First sign of ICP

A

decreased level of consciousness

63
Q

cushings triad

A

widened pulse pressure, bradycardia, deep shallow respirations, HTN

64
Q

meds for ICP

A

Mannitol- strict I/Os (between 310-320)

65
Q

Seizures health history

A

how often they occur, date, time, and duration, change in pupil size, eye fluttering, aura before, body part first involved, level of consciousness

66
Q

aphasia

A

inability to speak or comprehend language

67
Q

hemiparesis

A

flaccid paralysis

68
Q

ataxia

A

gait disturbance

69
Q

hypotonia

A

weakness on one side of the body

70
Q

agonosia

A

inability to use an object correctly

71
Q

unilateral inattention - body neglect

A

unaware of body part

72
Q

parathesia

A

numbness, tingling, unusual sensation

73
Q

dysphagia

A

inability to swallow

74
Q

visual field defecit

A

unable to visualize entire field of vision

75
Q

gaze deviations

A

eye movement abnormalities

76
Q

dysarthria

A

cannot control mouth and tongue to form words

77
Q

generalized seizure

A

both hemispheres

78
Q

absence

A

blanking out

79
Q

tonic

A

stiffness and rigidity then loss of consciousness

80
Q

clonic

A

rhythmic jerking of extremities then relaxation

81
Q

myoclonic

A

jerking of extremities - unilateral or bilateral

82
Q

atonic

A

sudden loss of muscle tone, usually resulting in a fall

83
Q

partial

A

focal or local, begin in part of one hemisphere

84
Q

complex

A

may cause blackouts

85
Q

simple

A

aura and one sided movement

86
Q

idiopathic seizures

A

no brain abnormalities

87
Q

secondary seizures

A

metabolic disorders, alcohol withdrawal, heart disease

88
Q

management of seizures

A

AEDs , lorazepam, dilantin

89
Q

VNS

A

recognizes the aura of a seizure and a shock is sent. this should limit the amount of seizures a person has

90
Q

TIA

A

transient ischemic attack
visual deficits: blurred vision, diplopia, blindness
motor: weakness and ataxia
speech: aphasia and dysarthria

91
Q

FAST

A

face, arms, speech, time

92
Q

MAWDS

A

medications, activity, weight, diet, symptoms

93
Q

IV thrombolytics

A

tpa - given 3-4.5 hours post stroke

10% bolus over 1 minute and then 90% over the next hour

94
Q

stage 1 PD

A

unilateral limb movement, minimal weakness, tremor

95
Q

stage 2 PD

A

bilateral limb movement, masklike face, slow shuffling gait

96
Q

stage 3 PD

A

postural instability, increased gait disturbances

97
Q

stage 4 PD

A

severe disability: akinesia, rigidity

98
Q

stage 5 PD

A

complete ADL dependence

99
Q

drugs for PD

A

Mao-B inhibitors and Sinemet

100
Q

Mao-B teaching

A

no foods high in tyramine and no alcohol

101
Q

things to look for with sinement

A

signs of depression -suicide

102
Q

exercises for PD

A

active and passive ROM activities

103
Q

hallmark symptoms of PD

A

tremor, stiffness, bradykinesia, unsteady gait

104
Q

Alzheimer’s

A

progressive, degenerative disorder of the brain

105
Q

plaques

A

clumps of protein fragments

106
Q

tangles

A

twisted microscopic strands of the protein tau

107
Q

loss of connection among brain cells

A

memory, learning, and communication problems

108
Q

eventual death of brain cells

A

severe memory problems

109
Q

stage 1 alz

A

general forgetfulness, independent in ADLs, forgets names, subtle changes in personality, problems with judgement

110
Q

stage 2 alz

A

wandering, neglect of hygiene, disoriented, money problems, progressive memory loss, dependent in ADls

111
Q

stage 3 alz

A

weight loss, loss of written and verbal communication, not recognizing family and objects, bowel and bladder incontinence, completely dependent in ADLs, loss of mobility, agonosia

112
Q

important questions for alz patients

A

onset, duration, and progression of symptoms. Changes in symptoms, ADL changes, financial charges,

113
Q

exercises for MS

A

ROM exercises, stretching and strengthening, no exercises that increase body temp because that can lead to increased fatigue and decreased motor ability

114
Q

primary MS

A

steady and gradual, 40-60 yrs in onset, no acute attacks, without remission of symptoms

115
Q

secondary MS

A

relapsing-remitting course

116
Q

progressive relapsing MS

A

frequent relapses, does not return to baseline, deterioration overall several years

117
Q

S/S of MS

A

muscle weakness and spacisity, fatigue, tremors, dysmetria, numbness and tingling, ataxia, dysphagia, diplopia, tinnitus, impaired sexual functioning, depression

118
Q

S/S of autonomic dysreflexia

A

sudden significant rise in BP, bradycardia, perfuse sweating, flushing, goosebumps

119
Q

interventions of autonomic dysreflexia

A

sit them up (number 1) and check for bladder distention

120
Q

S/S of MG

A

muscle weakness, poor posture, ocular palsies, ptosis, diplopia, respiratory compromise, loss of bowel and bladder control, fatigue, muscle achiness, decreased sense of smell and taste

121
Q

tensilon test

A

shows a positive diagnosis of MG

122
Q

myasthenic crisis

A

an exacerbation of MG symptoms caused by not enough anticholinesterase drugs

123
Q

cholinergic crisis

A

an acute exacerbation of muscle weakness caused by too much anticholinesterase drugs

124
Q

S/S Guillian Barre

A

ascending symmetric muscle weakness, flaccid paralysis, decreased deep tendon reflexes, respiratory compromise, paresthesia, pain, facial weakness, dysphagia, diplopia, difficulty speaking, labile blood pressure, cardiac dysrhythmias, tachycardia

125
Q

diagnostic test GB

A

lumbar puncture

126
Q

IVIG complications

A

used for GB, chills mild fever, myalgia, headache, anaphylaxis, aseptic meningitis, retinal necrosis, acute renal failure.

Med surg (2 decks)

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