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Adult Health II - (Josh) > T4 - Blueprint (Josh) > Flashcards

T4 - Blueprint (Josh) Flashcards

1
Q

DI:

If DI is caused by Lithium, what drug do we give?

A

Amiloride (potassium sparing diuretic)

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2
Q

What are the disorders of the Posterior Pituitary?

A

Diabetes Insipidus

SIADH

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3
Q

Which part of the Adrenal Gland is the Sympathetic Nerve Ganglion?

A

Medulla

***fight of flight

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4
Q

Ductal Ectasia:

What is it caused by?

A

dilation and thickening of collecting ducts in subareolar area

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5
Q

Addisonian Crisis:

What are the CV manifestations of Hyperkalemia we should watch for?

A

slow HR

Heart Block

Peaked T waves

Fibrillation

Asystole

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6
Q

— regulates Phosphorous and Calcium balance.

A

Parathyroid Glands

***via the Kidneys, Bones and GI tract

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7
Q

Hyperaldosteronism:

Increased Aldosterone triggers kidneys to — sodium and — potassium and hydrogen.

A

retain

excrete

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8
Q

Pap Smear:

Start at age —.

Recommended how often?

A

21

recommended q 3 yrs for ages 21-29 and 1 5 yrs for ages 30-65 if they are cotested with HPV or q 3yrs if NOT cotested

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9
Q

Which lab is good for testing hormone levels?

A

Stimulation - Suppression Tests

  • ** draw blood
  • ** give med to stimulate or suppress
  • ** draw blood again to check
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10
Q

Hyperpituitarism:

What is Postop care for a TPH (Transsphenoidal Hypophysectomy)?

A

Monitor Neurologic Response (vision, etc) q hr for first 24 then q 4 hrs

Monitor UOP (especially output greater than input)

Encourage deep-breathing exercises

Elevate HOB

Dental Floss and Mouth Rinse instead of Tootbrushing

Assess for CSF Leak

Assess for Meningitis

Avoid activities that increase ICP

Teach how to give Hormone Replacement meds

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11
Q

Lymphedema:

What are signs and symptoms they need to report?

A

Heaviness

Aching

Fatigue

Numbness, Tingling, Swelling of affected arm and chest

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12
Q

When does Cortisol levels peak?

A

in the AM and reach lowest 12 hrs later

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13
Q

Endocrine Changes with Aging:

Low Estrogen levels lead to VAGINAL DRYNESS.

What are nursing considerations?

A

Increased risk for cystitis so drink 2 L per day

Urinate immediately after sex

Use lubricant to reduce sexual discomfort

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14
Q

Hysterosalpingography:

When is this test best done?

A

first half of menstrual cycle

***should NOT be attempted for at least 6 wks after an abortion, delivery, or D and C

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15
Q

Cortisol affects…

  • Body’s response to —
  • CHO, Fat, and Protein —
  • — stability
  • — function
  • — and — balance
A

stress

metabolism

Emotional

Immune

Na+ and H2O

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16
Q

DI:

What are the management goals?

A

Fluid Replacement

  • Free Water
  • Hypotonic Fluids

Sodium Restriction

Prevent Water Loss

Correct underlying issue if it’s Nephrogenic

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17
Q

Endocrine Changes with Aging:

Decreased ADH leads to — and means what?

A

more dilute urine

Clietn is at greater risk for dehydration

***offer fluids q 2 hrs if not restricted

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18
Q

HPV Test:

Can be taken at same time as the — — but it cannot replace it.

A

Pap Smear

  • **age 30-65
  • ** q 5 yrs
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19
Q

Endocrine Changes with Aging:

Low Estrogen levels lead to decreased bone density.

What are nursing considerations?

A

engage in regular weight bearing exercise

handle client with care to prevent pathologic fractrures

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20
Q

With a Hysterosalpingography, what should we do first?

A

confirm the date of last period

ask about shellfish allergies

educate that they might have some pelvic pain

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21
Q

Lymphedema will take — measures to treat.

A

life-long

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22
Q

Breast Cancer:

What is the common chemo regimen?

A

CAF

  • Cytoxan
  • Adriamycin
  • Fluorouracil (5-FU)

***report cardiotoxic effects such as fatigue, SOB, chronic cough, and edema

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23
Q

RAI Therapy educatoin?

A

Use toilet not used by others

Sit to urinate

Flush 3 x’s after use

Men should use condome catheters instead of absorbant pads if they are incontinent

Use a laxative on 2nd and 3rd days to help you excrete the contaminated stools faster

Wash clothes seperately and run machine on fully cylce empty before washing other clothes

Avoid close contact with pregnant, infants, and young children during first week after therapy (remain 3 ft from them and limit to 1 hr day)

Radioactive Saliva so take precautions

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24
Q

Addisonian Crisis:

How do you manage the elevated K+?

A

Insulin (20-50 U) with Dextrose (20-50 mg) in NS to shift K+ back into cells

Kayexalate

Furosemide or HCTZ (avoid spironolactone)

Potassium restriction

Monitor I and O and Telemetry

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25
Q

Thyroid Storm:

What glucocorticoids do we give?

A

Hydrocortisone (100-500 mg IV) or…

Prednisone (4-60 mg IV) or…

Dexamethasone (2 mg IV q 6 hrs)

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26
Q

Parathyroid Glands:

How do they use the kidneys to regulate Calcium and Phosphorous?

A

Cause kidneys too…

  • Activate Vit D
  • Increase reabsorption of Ca and Mag
  • Increase Phos, Bicarb, and Na+ excretion
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27
Q

SIADH:

How often for neuro checks?

A

q 4 hrs if no change in LOC

q hr if change in LOC

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28
Q

DI Labs:

Urine Osmolarity —

Urine Specific Gr —

Serum Osmolarity —

Serum Sodium —

A

less than 300

1.001 - 1.005

greater than 295

greater than 145

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29
Q

BPH:

What should we assess for with (-osin) meds?

A

orthostatic hypotension

***dose at bedtime to prevent falls

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30
Q

Cushing’s:

What will they look like?

A

Moon Face

Buffalo Hump

Truncal Obesity

Weight Gain

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31
Q

Toxic Shock Syndrome is typically caused by —

A

tampons

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32
Q

Laparascopy:

What should we teach

A

Observe for signs of infection or hematoma at incision site

Change bandage as needed

Avoid strenuous activity for about a week

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33
Q

Addisonian Crisis:

What should we do to manage the Hypoglycemia?

A

IV glucose

Glucagon

Maintain IV access

Monitor BG hourly

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34
Q

Hyperpituitarism:

What are some activities that increase ICP that should be avoided after TPH surgery?

A

Coughing too soon

Blowing nose - Sneezing

Bending at waist

Straining to poop

Using a straw to drink

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35
Q

– and – are catecholamines and secreted by — —

A

Epi

NE

Adrenal Medulla

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36
Q

What hormones are secreted by the Adrenal CORTEX?

Adrenal MEDULLA?

A

Cortex:

  • Cortisol (Glucocorticoids)
  • Aldosterone (Mineralcorticoids)
  • Androgens (Test. Estro. Pregest.)

Medulla: (Fight of Flight)

  • Epi
  • NE
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37
Q

Hyperparathyroidism:

What are we trying to do?

A

decrease serum calcium and increase serum phosphorous

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38
Q

Thyroid Storm:

Emergent Care

A

Maintain Patent Airway

Oral Antithyroid Meds

Sodium Iodine Solution ( 2 G IV)

Propranolol (1-3 mg) slowly over 3 mins

Glucorticoids

Continous Telemetry

VS q 30 mins

Cooling blankets of Ice Packs

Antipyretics (non-salicylate)

NS for rehydration

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39
Q

Fibrocystic Breast Condition:

Teaching

A

Mild Analgesics

Reduce salt intake prior to menses

Apply ice or heat to reduce pain

Wear supportive bra (even to bed)

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40
Q

Hypopituitarism:

What is the intervention necessary for this?

A

Lifelong replacement of deficient hormones

41
Q

SIADH:

What are the Vasopressin Receptor Antagonists that can be used to treat?

A

ConiVAPTIN

TolVAPTAN

42
Q

Parathyroid Glands:

How do they use the BONES to regulate Calcium and Phosphorous?

A

Cause Bones too…

  • Increase release of Ca and Phos into ECF
  • Decrease bone formation
  • Increase Bone breakdown
43
Q

TSS:

What should we teach regarding tampon use

A

wash hands

instert delicately

change q 3-6 hrs

use pads at night instead

don’t use if you’ve had TSS before

44
Q

BPH:

How long will it take meds to work?

What are adverse effects?

A

6 mths

orthostatic hypotension

decreased libido

ED

45
Q

Cushings is a result of — of the — —

A

hyperfunction

Adrenal Gland

46
Q

Breast Cancer:

Which type of work can increase risk?

A

Night shift work due to melatonin and light exposure)

47
Q

Ductal Ectasia:

What is a nursing action to remember?

A

send the discharge for lab assessment

48
Q

Cushings:

What are the Immune complications?

A

Increased risk for infection

Increased masking of signs of infection and inflammation

Decreased inflammatory response

49
Q

SIADH:

When replacing Sodium, how should it be given?

A

slowly

around 35 mL per hr and increasing around 0.5 mEq per L every hr

50
Q

Hypothyroidism:

What med and what do we teach?

A

Levothyroxone:

Take exactly as prescribed

Don’t change brands

51
Q

SIADH Labs:

Urine Osmolarity —

Serum Osmolarity —

Serum Sodium —

Urine Sodium —

Urine Sp. Gravity —

Urine Aldosterone —

GFR —

A

elevated (greater than 300)

decreased (less than 295)

less than 115

greater than 30

1.030 or more

decreased

increased

52
Q

Endocrine Changes with Aging:

Low Estrogen levels lead to THIN and DRY SKIN.

What are nursing considerations?

A

avoid pulling client

use minimal tape on skin

change position q 2 hrs

use skin moisturizers

53
Q

Fibrocystic Breast Condition:

What is treatment?

A

Oral Contraceptives

Reduction in dietary fat and caffeine

Diuretics

54
Q

Thyroid Storm:

What is it?

A

life-threatening event that occurs in patients with unontrollable hyperthyroidism (most often with Grave’s Disease)

55
Q

SIADH:

What are complication sof SIADH we need to watch for?

A

Osmotic Demyelinatoin

Pulmonary Edema

Seizures (neurogenic changes from too little sodium)

56
Q

What is the ADH Test and what does it Diagnose?

A

demonstrates that kidneys can concentrate urine in the presence of exogenous ADH

dx: Diabetes Insipidus

57
Q

Endocrine Changes with Aging:

Decreased Glucose Tolerance will cause mean what to the older client?

A

Gain weight (try to keep within 10 lbs of ideal)

Slow wound healing

Frequent yeast infections

Polydipsia and Polyuria

58
Q

Aldosterone is secreted by —

It’s action is to retain — and excrete —

A

Adrenal Cortex

Na+

K+

59
Q

Hypopituitarism:

What are some of the adverse effects of Androgen (Gonadotropin) replacement?

A

HTN (women on Estrogen)

Thrombosis (women on Estrogen)
***DVT

Gynecomastia (Men)

Acne

Baldness

Prostate Enlargement (Men)
***avoided in men with Prostate Cancer
60
Q

Hyperparathyroidism:

Medication Management

A

Furosemide to excrete Calcium

NS to hydrate

Calcitonin to decrease release of skeletal calcium

Cinacalet to reduce PTH production and release

61
Q

Addisonian Crisis:

What are our treatment goals?

A

Treat Low Sodium

Hormone Replacement

Hyperkalemia Managemt

Hypoglycemia Management

62
Q

Hyperparathyroidism:

Calcium is —

Phosphorous is —

A

elevated (greater than 10.2)

decreased (less than 3.0)

63
Q

Cushings:

What are CV complications?

A

HTN

Dependent Edema

Bruising

Petechiae

64
Q

Myxedema Coma is a complication of —

How do you treat?

A

hypothyroidism

Treatment:

  • Patent Airway
  • Repalce fluids with NS or Hypertonic Saline
  • Levothyroxine IV
  • Glucose IV
  • Corticosteroids IV
  • VS q hr
  • Warm Blankets
  • Aspiration Precautions
  • Turn q 2 hrs
  • Monitor for changes in LOC (Seizure or Coma)
65
Q

When are women most likely to have Fibrocystic Breast Condition?

A

Late teens and 20s (usually subsides after menopause)

**mostly in premenopausal women between 20-50 yo

66
Q

Cortisol is secreted by —

How does it prevent Hypoglycemia?

A

Adrenal Cortex

By increasing liver gluconeogenesis and inhibiting peripheral glucose use

67
Q

When should we recommend a Mammogram?

A

begin at age 40

68
Q

Radioactive Iodine Therapy (RAI) is used for —

A

Hyperthyroidism

69
Q

Cushings:

What are MSK complications?

A

Muscle atrophy of extremeties

Osteoporosis

  • pathologic fractures
  • decreased height due to vertebral collapse
  • asceptic necrosis of femural head
  • slow or poor wound healing of bone fractures
70
Q

DI:

What is the patho of DI?

A

excretion of large volume of dilute urine because the kidney tubules do not reabsorb water, leading to polyuria, dehydration, and disturbed fluid and electrolyte balances

71
Q

— is a complication from mastectomy where an accumulation of protein fluid in subq tissue

A

Lymphedema

72
Q

Addison’s is a result of — of —- —-

A

Hypofunction

Adrenal Gland

73
Q

Ductal Ectasia will have a — discharge from —

A

greenish-brown

nipple

74
Q

Endocrine Changes with Aging:

Decreased Estrogen leads to…

A

Decreased bone density

Thinner, drier, skin

Dry perineal tissue (increased risk for cystitis)

75
Q

Hyperaldosteronism is caused by — of the — —

A

Hyperfunction

Adrenal Gland

76
Q

Cushings:

What are the SKIN complications?

A

Thinning sking

Striae

Increased Pigmentation

77
Q

An Addisonian Crisis is when the need for — and — is greater than the supply.

A

Cortisol

Aldosterone

***usually in response to stressful event

78
Q

Endocrine Changes with Aging:

Decreased Metabolism will cause older client to be less tolerant of — weather.

A

cold

79
Q

DI:

How does HCTZ work to treat DI since it’s a diuretic?

A

causes a mild dehydration in kidney (diuresis at proximal tubules) leaving less fluid excretion at distal tubules (part most affected by DI)

therefore, there is less fluid to be lost by the most affected part of kidney

also causes excretion of sodium which helps with the hypernatremia

80
Q

Thyroidectomy:

What will hemorrhage look like?

A

either bleeding or swelling that causes compression of airway and respiratory distress (stridor)

81
Q

Post op care for Mastectomy.

A

VS (no BP, IV or blood draw in affected side)

HOB 30 degrees with affected arm on pillow (keeping affected arm elevated promotes lymphatic return)

Pain control

Drains monitored (ensure no kinking)

Monitor incision

Gradually increase activity

82
Q

Stimulation - Suppression Testing:

Stimulation testing is used for a client suspected of having hormone —

Suppression testing is used for a client suspected of having hormone —

A

Hyposecretion (low levels)

*** failure of hormone level to rise indicates hypofunction

Hypersecretion (high levels)

***failure of hormone production to slow indicates hyperfunction

83
Q

Parathyroid Glands:

How do they use the GI TRACT to regulate Calcium and Phosphorous?

A

enhance absorption of Ca and Phos from gut via activated Vit D

84
Q

Addisonian Crisis:

How do you Replace Hormones?

A

Hydrocortisone (100-300 mg) or Dexamethasone (4-12 mg) followed by continous infusion of Hydrocortisone over 8 hrs

Hydrocortisone 50 mg IM q 12 hrs

H2 Blocker for Peptic Ulcer prevention

85
Q

Addisonian Crisis:

How do you treat Low Na+?

A

rapid infusion of NS or D5W

86
Q

DI: ADH Test

In Central DI, the UOP will — and Urine Osmolarity will —-

In Nephrogenic, the UOP will — and Urine Osmolarity will —

A

decrease ***It’s working

increase (more concentrated)
***it’s working

not change ***not working

not change ***not working

87
Q

SIADH:

What should we check q 2 hrs?

A

Serum Sodium

Serum Omsolarity

88
Q

DI:

What meds are given for ADH replacement?

A

Desmopressin

Vasopressin

  • **weight themselves daily to identify weight gain
  • **use same scale at same time
89
Q

Serum — levels control ALDOSTERONE secretion.

A

K+

***aldosterone causes kidneys to reabsorb Na+ to bring plasma volume and osmolarity back to normal

90
Q

Hypopituitarism:

What are the clinical manifestations of low Growth Hormone?

A

Decreased Bone Density

Pathologic Fractures

Decreased Muscle Strength

Increased Serum Cholesterol

91
Q

Thyroid Storm:

Key Manifestations

A

fever

tachycardia

systolic HTN

may have anxiety and tremors

decreased LOC and increased restlessness if continues

***can lead to death even with treatment

92
Q

DI:

DI is considered if urine output is more than — during 24 hrs

A

4 L

93
Q

Thyroid Storm:

What antithyroid meds do we give?

A

Methimazole (up to 60 mg per day)

Propylthiouracil (300 -900 mg per day)

94
Q

SIADH:

What are the management goals?

A

Decrease fluid intake

Correct Na+ imbalance

95
Q

SIADH:

What meds can we give?

A

Furosemide

Phenytoin (inhibits release of ADH)

Demeclocycline (decrease renal tubule response to ADH)

Vasopressin Receptor Antagonists

96
Q

Addisons:

What is diagnostic?

A

ACTH Stimulation Test

97
Q

— regulates glucocorticoid (cortisol) release.

A

ACTH

***anterior pituitary hormone

98
Q

Hyperaldosteronism:

What will assessment look like?

A

Low Potassium

HTN

HA

Fatigue

Muscle Weakness

Nocturia

Adult Health II - (Josh) (13 decks)

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