Test 3-ICU, Hepatic, Pancreas, Metabolic, Thyroid Flashcards
1
Q
3 chief hormones produced by the thyroid gland?
A
Thyroxin
Triiodothyronine
Calcitonin
2
Q
Which hormones produced by the thyroid gland regulate metabolic rate and increase protein synthesis?
Which hormone effects calcium and phosphorus balance?
A
Thyroxin and triiodothyronine
Calcitonin
3
Q
Def: Enlargement of the thyroid gland, usually due to the deficiency of iodine in one’s diet. Pressure on esophagus and trachea produces dysphagia, dizziness, horseness, and syncope
A
Goiter
4
Q
Def: Inflammatory autoimmune disease of the thyroid gland. It is leading cause of HYPOthyroidism. Fibrous tissue slowly replaces healthy tissue within the thyroid gland.
Common in middle aged women and children.
A
Hashimoto’s Thyroiditis
5
Q
Def: Disorders where there is excessive secretion of thyroid hormones. An excess of thyroid hormone causes an increase in metabolism.
A
HYPERthyroidism
6
Q
Def: Disease that occurs due to increased thyroid activity characterized by generalized enlargement of the gland and often protruding eyes caused by the retraction of eyelids and inflammation of the ocular muscles.
A
Graves disease
7
Q
Def: Associated with HYPERthyroidism; Inflammation that involves the periarticular structures including tendons, ligaments, and joint capsules. It is associated with pain and reduced range of motion. Occurs most commonly in the shoulder (can progress to adhesive capsulitis/frozen shoulder).
A
Chronic periarthritis
8
Q
HYPOthyroidism is the undersecretion of hormones by the thyroid gland. Hypothyroidism is called _____ when it appears as a congenital disorder, and is called _____ when it is acquired later in childhood or during adulthood.
A
Cretinism
Myxedema
9
Q
Def: Congenital thyroid deficiency whereby thyroxin is not synthesized. Thyroxine is essential to both physical and mental development. Lack of thyroxin in an infant or young child causes mental retardation and an abnormal dwarfed stature. The individual present with a stocky stature and a characteristically protruding abdomen.
A
Cretinism
10
Q
Def: Condition of inadequate levels of thyroxin. The patient’s face is bloated, the tongue is thick in the eyelids puffy. The skin is dry and scaly and there is little perspiration. The patient has no tolerance of cold environment.
S&S: Muscle weakness, excessive sleep; mental and physical processes are sluggish, speech is slurred, reflexes are slow. Heart rate is decreased and the slower circulation causes edema formation. The digestive system works sluggishly so patient suffers from constipation.
A
Myxedema
11
Q
Def: Occurs due to adrenal gland atrophy. The adrenal gland fails to secrete aldosterone which renders the patient unable to retain salt and water. This causes dehydration and the blood level of potassium elevates. BP is low due to electrolyte imbalance.
A
Addison disease
12
Q
The parathyroid glands (4 tiny glands) secrete ____ and functions in regulating the level of circulating ____ and ____. The balance between osteoblastic and osteoclastic activities are governed by the parathyroid hormone.
A
PTH (parathyroid hormone)
Calcium and phosphate
13
Q
Hyperparathyroidism (hypercalcemia)- Excessive PTH raises the level of circulating calcium, as calcium levels rise the ____ level falls.
What effect is this having on bones?
A
Phosphate levels fall
With calcium loss bones are weakened; they tend to bend and become deformed and fracture spontaneously
14
Q
HYPOparathyroidism: due to the undersecretion of PTH. Consequently, circulating concentrations of ____ are reduced, resulting in hypocalcemia. The principle manifestation is tetany, sustained muscle contraction. In this condition the muscles of the hands and feet contract. _____ muscles are very susceptible to spasms which can obstruct respiratory tract and death may follow. The low level of calcium makes the ____ system hyperexcitable.
A
Calcium
Laryngeal
Nervous
15
Q
The hepatic and biliary organs are: the ____, _____, and ____ ____ duct. These organs can mimic musculoskeletal disorders and present with symptoms in the midback, scapular, and right shoulder regions.
A
Liver, gallbladder, common bile duct
16
Q
The liver secretes ____ into ducts and is classified as an ____ gland. It is the largest gland in the body.
A
Bile
Exocrine
17
Q
The ____ ____ drains bile out of the liver.
The ____ ____ duct drains bile into the duodenum (small intestine). It is formed by the union of the ____ ____ duct with the ___ duct.
A
Hepatic duct
Common bile duct
Common bile duct formed by the union of the common hepatic duct with the cystic duct
18
Q
Fat must be broken down into smaller particles to increase surface area for digestion. This is the function of the bile; bile _____ fats.
When chyme containing lipid or fat enters the duodenum, it initiates a mechanism that contracts the gallbladder and forces bile into the small intestine. Fats in chyme triggers the secretion of the hormone _______. This hormone then stimulates the contraction of the _____, and bile flows into the duodenum.
The gallbladder concentrates and ____ bile produced by the liver.
A
Bile emulsifies fats
Cholecystokinin
Gallbladder
stores
19
Q
Hepatic system skin changes can include:
A
Jaundice, pallor, orange or green skin. Bruising, spider angiomas, palmar erythema
20
Q
Pain associated with hepatic and biliary systems include thoracic pain between ____, ____ shoulder, ____ upper trap, ____ interscapular/subscapular areas.
A
Scapulae
R sho
R upper trap
R interscapular, etc
21
Q
Def: Not a disease but a symptom of other diseases and disorders of the liver and gallbladder. Causes yellowness of skin, sclera, mucous membranes, and excretion. The change in color is due to the excess of _____ in the blood.
A
Jaundice (icterus)
Excess of bilirubin
*Jaundice may be caused by hepatitis, gallstones, pancreatic cancer, cirrhosis etc.
22
Q
Def: An acute or chronic inflammation of the liver. It can be caused by a virus, chemicals, drug reaction, or alcohol abuse. It can also occur secondary to other diseases like the Epstein Barre Virus, which causes mononucleosis.
A
Hepatitis
23
Q
Def: Acute INFECTIOUS inflammation of the liver caused by viruses A, B, C, D, E
Affects individuals in 3 stages: initial, jaundice, and recovery stage
A
Viral Hepatitis
24
Q
Acute Hepatitis __ Virus: Found worldwide and is almost exclusively spread by the fecal-oral route. It occurs sporadically from close person to person contact or epidemic leave from the ingestion of water or food that is contaminated by human waste.
A
Acute Hep A Virus (HAV)
25
Def: Formally known as serum hepatitis; Transmitted through needle sticks, sexual relations, intravenous drug use and sharing needles, blood transfusions, dialysis, prenatal transmission from mother to child.
Major source of infection is blood serum, but body secretions of an infected person can also transmit the virus. *Health professionals are frequently exposed to this type
Acute Hepatitis B Virus (HBV)
***Can survive on environmental services for at least a week. Infection can cause chronic hepatitis and lead to carrier state and may also increase the risk of liver cancer.
26
Def: Formerly referred to as post- transfusion hepatitis. It occurs among illegal drug users and their sexual partners, hemophiliacs receiving blood drive replacement factor, dialysis users, recipients of liver transplants and allografts. The period of infectivity begins before onset of symptoms and the person may become a lifetime carrier of this virus.
*Primarily spread through blood products
Acute Hepatitis C (HCV)
*60-80% of all cases progress to cirrhosis
27
Def: A co-infection to HBV. This virus requires the HBV surface antigen for its replication. It is transmitted in the same manner as HBV and the same group of individuals are at risk. High mortality rate.
Acute Hepatitis D
28
Def: Non-fatal form of hepatitis except for pregnant women. The virus is transmitted through fecal contamination of water primarily in developing countries and it’s rare in the US
Acute Hepatitis E
29
Def: A blood-borne RNA virus whose presence lasts approximately 10 years. Does not appear to cause liver disease.
Hepatitis G (HGV)
30
Def: This illness represents a prolonged inflammation of the liver after unresolved viral hepatitis. This is an inflammation of the liver lasting for six months or more.
Metabolic diseases that may cause this are: Wilson’s disease and hemochromatosis
Chronic Hepatitis
*Subdivided into CAH (chronic active hepatitis) and CPH (chronic persistent hepatitis)
31
Def: Form of hepatitis that occurs as a result of exposure to certain chemicals and drugs which result in liver inflammation. It is considered to be toxic or drug induced Hepatitis
Nonviral Hepatitis
32
Def: A chronic, irreversible, degenerative disease of the liver characterized by the replacement of normal liver cells with fibrous scar tissue and other alterations in the liver structure. It is the consequence of the repeated traumatizing hepatic Tissue by toxic, infectious agents, metabolic diseases, and circulatory disorders.
Etiology: most commonly chronic alcoholism
Cirrhosis
33
The ___ is one of the most common sites of cancer metastasis from primary cancers affecting the stomach, colon/rectum, pancreas, esophagus, lungs, and breast. Most die of this cancer within 4 to 6 months if intervention fails.
Liver
34
Def: The formation or presence of stone-like masses called gallstones within the gallbladder or bile ducts. The stones may be formed of either a cholesterol or calcium based compounds.
S&S: Upper Right quadrant pain radiating to back and shoulders.
Cholelithiasis
35
Def: Severe inflammation of the interior wall of the gallbladder. Most Acute cases are secondary to the obstruction of the bile ducts by gallstones.
Acute Cholecystitis
36
Endocrinology is the study of ____ glands that produce _____.
Ductless glands
Hormones
37
The endocrine system as a means of communication between one body part and another. It also works with the ____ system to regulate: metabolism, water and salt balance, BP, response to stress, and sexual reproduction. All the glands of internal secretions are part of the system. These glands secrete directly into the ______ or lymph and possess NO ducts.
works with Nervous system
Bloodstream
38
Hormones may be ____, _____, or modified ____ ____.
Steroids, proteins, or modified amino acids
39
Most glandular activities are controlled by the ____ gland, while it is controlled by the ____.
Pituitary gland
Pituitary controlled by hypothalamus
40
The endocrine system works on a ____ feedback system that when hormone levels are adequate their release are ____.
Negative
Stopped
41
Def: Presents with polyuria and excessive thirst resulting secondary to an insufficient/low secretion of ______ from the pituitary.
Diabetes Insipidus
Vasopressin (ADH)
*ADH is an antidiuretic hormone which helps to regulate the amount of fluid the kidneys release as urine.
42
Def: Hypersecretion of the growth hormone (GH) by the pituitary gland. Two distinct conditions may result from this: gigantism and acromegaly
Gigantism: occurs during growing years, person is abnormally tall
Acromegaly: occurs during adulthood; life-shortening, overgrowth of bones and soft tissues
Hyperpituitarism
43
Def: When any hormone secreted from the anterior portion of the pituitary gland is hyposecreted. The deficient hormones are usually GH, gonadatropin, ACTH, and TSH
Hypopituitarism
44
Hypopituitarism:
Lack of ACTH causes ____ cortex to hypertrophy, which results in ____ imbalance and improper metabolism of nutrients.
The ____ and ____ cortex functions in body’s response to stress.
Adrenal
Salt
Medulla and adrenal cortex
45
Absence of the _____ hormones depresses sexual functions. If lack of hormone develops prior to puberty sexual development is impaired.
Gonadotrophic
46
Def: A form of hypopituitarism that sometimes occurs in children. The patient is mentally bright but small in stature and sexually under developed. All growth processes are under developed, teeth erupt late.
Dwarfism
47
Def: HYPERsecretion of the Adrenal glands, resulting in excess production of cortisol by the adrenal cortex.
Etiology: increased production of ACTH, or tumors of the adrenal cortex and can be secondary to long-term use of steroid drugs.
Symptoms: Moon shaped face with acne, more obese head and trunk with pencil thin arms and legs
Cushing Syndrome
48
The urinary system is responsible for the production and elimination of _____ and also regulates ______ processes.
Urine
Metabolic
49
```
Organs of the urinary system:
2 ____
2____
Urinary ____
______
```
2 kidneys
2 ureters
urinary bladder
urethra
50
The kidneys help regulate:
____ and ____ content of blood
___ ___ content of blood
Selectively filters out waste products of metabolism
Controls ____ ____ with renin
Formation of RBCs
Activation of Vitamin __ and calcium balance
Water and electrolytes
Acid base
Blood pressure
Vit D
51
The _____ are the principal functioning unit of the kidney.
```
It is here that the 3 part process of
- Selective ____ of waste
- _______ of vital minerals and fluid
- ______ of urine
takes place.
```
Nephrons
1) Selective filtration
2) Reabsorption
3) Secretion
52
Prostate carcinoma usually affects the posterior lobe of the prostate gland, which can cause severe urethral obstruction if it enlarged.
What does BPH stand for?
Benign Prostatic Hypertrophy
53
Renal and urinary tract problems are categorized according to their causative factor:
1) ____/____
2) ______
3) ______ (neuromuscular disorders)
Infection/inflammation
obstructions
mechanical
54
Example of infectious/inflammatory urinary disorder:
UTI
*Burning during urination, more frequent feeling of need to urinate, odor is urine, altered mental status
55
Obstructive disorders of urinary tract: obstructions can occur at any point in the urinary tract and can be the result of primary urinary tract obstructions or secondary urinary tract obstructions resulting from disease processes outside the tract. Obstruction of any portion results in a back up or collection of urine behind it.
Due to the stagnation of the urine, the likelihood of infection and ____ formation is greater.
S&S?
Stone formation
```
S&S: Abdominal pain.
Continuous feeling of a full bladder.
Frequent urination.
Pain during urination (dysuria)
Problems starting urination
```
56
```
Mechanical (neuromuscular) disorders of urinary system:
These disorders are mechanical in nature and that there is difficulty with _____ the bladder. This retention of urine will result in impairment of voluntary bladder control (incontinence).
Possible causes:
-Mechanical stress
- ____ ____ injury
- ____ disease (Ex. MS, Guillain-Barre)
- UTI
-Trauma
-removal of prostate gland
```
Emptying bladder
Spinal cord injury
CNS disease
57
```
Def: The involuntary leakage of urine. Not a disease but a symptom of another condition.
5 primary types:
1) Stress
2) Urge
3) Mixed (urge and stress)
4) Overflow
5) Functional
```
Urinary Incontinence (UI)
*not a normal part of aging process
58
____ Incontinence: Occurs when the support for the bladder or urethra is weak or damaged, but the bladder itself is normal. Can occur when pressure is applied to the bladder from coughing, sneezing, laughing, exercising, or physical exertion that increases abdominal pressure and the pelvic floor cannot counteract the urethral/bladder pressure.
Stress Incontinence
59
Def: Type of UI More generally known as overactive bladder, and is the involuntary contraction of the detrusor muscle which presents with urgency and immediate release of urine. It is the involuntary loss of urine with a strong desire to void. The bladder involuntarily contracts or there may be involuntary sphincter relaxation.
Urge Incontinence
*Tx- ES and strengthening exercises
60
Def: Type of UI where there is an overdistention of the bladder and the bladder cannot empty properly. Urine leakage or dribbles occur and the bladder never feels full.
Overflow incontinence
61
Def: Type of incontinence where the bladder is normal but the body and mind are not working together. This can occur from mobility and access deficits such as being confined to a wheelchair or needing an assistive device to walk.
Functional incontinence
62
Types of neurogenic bladder (pathologies)
1)
2)
3)
Flaccid
Spastic
Uninhibited
63
_____ Bladder (hypotonic): Lower motor neuron dysfunction of the spinal cord involving the spinal reflex level for micturition. The result will be a limp bladder with increased capacity. The individual must empty the bladder mechanically by using some form of massage or internal pressure (valsalva)
Flaccid
64
_____ Bladder (hypertonic): The detrusor muscle contracts with minimal urine present, but reflex activity is normal. This is an upper motor neuron problem and the high rate of contraction will result in bladder destruction.
Spastic
65
____ Bladder: Patient has a lack of control or sensation of bladder activity and becomes incontinent.
Etiology: Related to cerebral lesion such a stroke, head injury, or impaired cerebral function
Uninhibited bladder
66
Def: The abrupt end of kidney activity, which usually occurs in a few hours to a few days. Often reversible with return of function in 3-12 months
Acute renal failure
67
Def: This condition is irreversible and is described as a progressive reduction of renal functioning resulting in permanent loss of kidney function. It is also known as ESRD (end stage renal disease)
Chronic renal failure
*Rhabdomyolysis can lead to kidney failure
68
Def: Removal of high concentrations of metabolic waste products in patients experiencing acute or chronic renal failure.
Dialysis
69
_____ Dialysis: This process uses the individuals own peritoneum as the dialyzing membrane. A plastic tube is inserted into patient’s abdomen into the peritoneal cavity and sutured in place. The contaminated fluid is drained and replaced by fresh fluid.
Peritoneal dialysis
70
____dialysis: Blood is drawn outside the persons body for dialysis in an artificial kidney, or dialyzer, and then return to the individual by means of tubes connected to the person circulatory system.
*most often seen
Hemodialysis
71
The primary purpose of a catheter is to ____ urine from the bladder when the patient is incapable of emptying the bladder.
Remove
72
You must monitor ____ ____ regularly for patients with ESRD.
Blood pressure
73
Renal caculi, also known as ____ ____.
Etiology: Results from a disturbance in the kidneys balancing act between preventing water loss while at the same time eliminating water soluble waste
*you need to increase fluid intake
Kidney stones
74
1) Def: Inflammation of the bladder
2) Def: Inflammation of urethra
Etiology: infection by the bacteria Escherichia coli
Bladder- cystitis
Urethra- urethritis
75
_____ Catheter used when urethra is damaged or injured, if the pelvic floor muscles are weakened, for long-term use (more comfortable and easier to change than urethral catheter)
Suprapubic catheter
76
____ catheter: for single time use to check for residual urine after voiding
Straight catheter
77
____ catheter (external catheter for women): Relatively new device to collect urine without indwelling catheter, used when patient is immobile or incontinent, easily disconnected for mobility
Purewick
78
_____ line: Used when limited access via vein available, used for strong medications that smaller veins can’t tolerate; Catheter dumps into superior vena cava area
PICC line (Peripherally inserted Central Catheter)
79
Hemovac drain: Drain collection and used more with ortho/joint postop fluid/blood
*usually don’t initiate ___ if there is still hemovac in joint
CPM
80
Purpose of SCD (sequential compression device):
Used on low mobility patience for a calf/lower extremity compression
For DVT prophylaxis (prevention)
81
Types of restraints:
Soft restraints, mitts, leather restraints, Roll belt, vest
82
Patients who cannot breathe on their own will be put on a ventilator either through a tube down her throat or through a ______.
Tracheostomy
83
3 types of catheters you will encounter:
Condom
Foley
Suprapubic
84
Catheter Associated urinary tract infections(CA-UTIs) occur at a rate of 3-10% per day of catheterization.
Incidence approaches 100% within a ___ day hospital stay.
Can lead to _____, one of the leading causes of mortality and morbidity among hospitalized patients.
30 day
Bacteremia
85
For LONG Term use (IV administration) you will see a ____, typically placed in chest.
CVC (central venous catheter)
* Another form of CVC, but placed in superior and medial portion of arm is called a PICC (peripherally inserted central catheter)
86
A ____ _____ line is administered when your patient has a need for acute measurement of blood pressure or when there is a need for regular blood monitoring. This medical application requires extreme care and caution when moving your patient. The line is directly inserted into an artery either in the arm or leg.
Peripheral Arterial Line (PAL)
87
Def: Feeding tube used for short term/acute need
Def: Feeding tube used for long-term or permanent feeding. Used by placing a line through the abdominal wall, directly into the stomach or portion of the small intestine
Short term- NG Tube (nasogastric)
Long term- Gastrostomy “G-tube” or “PEG tube”
88
Def: A medical device that is commonly used as a post-operative drain for collecting bodily fluids from surgical sites. The process of draining fluids is facilitated by squeezing the bulb causing mechanical suction to the surgical site.
JP Drain (Jackson-Pratt Drain)
*fasten them to patient’s gown
89
Def: Flexible plastic tube that is inserted through the chest wall and into the pleural space. It is used to remove air or bodily fluids from the intrathoracic space
Chest tube
90
Before entering a patient’s room, You should ALWAYS :
Review your patient’s chart
Be particularly mindful of orthostasis and weight bearing restrictions
Always make contact with your nurse to make sure that the patient is OK for therapy there
Always be aware of required PPE
Be mindful that your patient is not feeling well and should be treated as such
Wash your hands
91
Device implanted in your chest. It helps pump blood from the left ventricle of your heart and on to the rest of your body. A control unit and battery pack are worn outside your body and are connected to the LVAD through a port in your skin.
Left ventricular assist device (LVAD)
92
Trendelenburg position: Head of bed____, foot of bed ____
HOB down, foot of bed up
93
Blue and Pink stretcher chairs. Which is for higher weight?
Blue
94
Def: Continuous monitoring of heart rate, blood pressure, SPO2, ICP
Telemetry
95
DynaMapp is a portable ___ monitor (BO, SpO2, HR, temp)
Vitals
96
Airborne Precautions: can stay in air >1 hour, can travel
Potential pathogens-
Measles
Chicken Pox
Tuberculosis
SARS
97
Droplet Precautions-
Potential pathogens:
*requires mask if within 3 feet of pt
Influenza
Mycoplasmal and streptococcal
Mumps
Rubella
98
Contact Precautions:
| Potential pathogens-
C. difficile
E. Coli
MRSA
Norovirus, Rotavirus
99
What are Neutropenic precautions?
When the patient needs to be protected from the caregiver. The patient is vulnerable to infection because of the low counts associated with their condition or as a result of chemo treatment
100
The two phases of metabolism are:
Anabolic phase
Catabolic phase
101
Which phase of metabolism is the phase of conversion of simple compounds into substances that the body cells can use?
Anabolic
102
Which phase of metabolism is a destructive phase where organized substances are converted into simpler substances with the release of energy?
Catabolic
103
Def: Metabolic disturbance causing the excessive accumulation of uric acid in the body and is a chronic, episodic disorder. Crystals of uric acid appear in the synovial fluid of joints. The disease is also marked by deposits of urate compounds called___ in and around the joints of extremities which can lead to joint deformity.
S&S: Sudden onset of excruciating joint pain usually affecting the joints of the big toe
Gout
Tophi
104
2 types of Gout: Renal and Metabolic
- Which is thought to be inherited? Body produces more uric acid than can be cleared by the kidneys into the urine.
- Which is caused by one of many possible renal dysfunction? Body may produce normal levels of uric acid, but the action of the kidneys is insufficient to clear the compound from the blood.
Metabolic Gout
Renal Gout
105
Treatment for Gout may involve:
Bed rest
Immobilization
Anti-inflammatory agents (colchicine)
Increased ____ intake and diet low in ____
Fluid
Purines
106
Def: A disorder of iron metabolism with excess deposition of iron in the tissues, and bronze skin pigmentation that you can’t get rid of. Sometimes this pathology is referred to as bronze diabetes and iron storage disease.
Hemochromatosis
107
Def: A disease in which there is defective mineralization of the bone-forming tissue. The disease is characterized by increasing softness of the bone, so they become flexible and brittle causing deformities.
When the disease occurs in children before epiphyseal plate closure it is called _____.
Osteomalacia
Rickets
*infant gets inadequate exposure to sunlight
108
Def: Due to poor intake or utilization of vitamin D, with consequent improper deposition of calcium and phosphorus and bone. It is usually due to inadequate diet or malabsorption of vitamin D.
Adult Osteomalacia
109
Def: An inherited condition characterized by abnormally brittle and fragile bones that are subject to fracture. It is a result of an in balance between bone deposition and bone resorption.
Osteogenesis imperfecta
110
Def: A metabolic bone disorder that affects men more than women in the over 40 population. It is characterized by slowly progressive enlargement and deformity of multiple phones. This is associated with a high rate of bone deposition and resorption. Bone is rapidly resorbed and replaced with bone of irregular consistency (thicker, but softer).
Paget’s Disease (osteitis deformans)
*Frequent sites are the femur and humerus (Bowing of femur causing impaired ambulation)
111
The pancreas acts as an ______ gland secreting _____ and _____.
It acts as an _____ gland excreting _____ enzymes.
Endocrine gland secreting insulin and glucagon
Exocrine gland excreting digestive enzymes
112
Insulin is secreted by _____ cells located in the Islets of Langerhans.
Glucagon is secreted by the ____ cells.
BETA cells
Alpha cells
113
Insulin and glucagon work antagonistically to one another.
Insulin _____ the level of blood glucose.
Glucagon ____ the level of blood glucose.
Insulin LOWERS
Glucagon ELEVATES
114
Glucose enters primarily ____ ____ cells and ____ cells.
As glucose enters cells, the level of blood glucose ____.
When the level of blood glucose falls below normal, _____ is released. It circulates to the liver and stimulates the release of glucose from it stored form of _____.
Skeletal muscle cells and fat cells
Falls
Glucagon
Glycogen
*it is mainly stored in liver and skeletal muscles
115
Summation of glucose control:
High blood glucose> ____ cells > ____>Glucose enters cells>Blood glucose lowered
Low blood glucose> ____ cells> ____> ____ releases glucose from glycogen> blood glucose raised
BETA cells, Insulin
Alpha cells, Glucagon, Liver
116
Def: Disease process whereby the Beta cells failed to secrete insulin or the target cells failed to respond to insulin. In the absence of insulin, glucose cannot enter the cells. The glucose levels in the blood increases greatly resulting in hyperglycemia.
*The cells are deprived of their principle nutrient, glucose, for production of energy.
Diabetes Mellitus (hyperglycemia)
117
Def: This form of the disease has an abrupt onset, usually appearing before the age of 25. It is frequently marked by the complete absence of insulin secretion, making this form of the disease quite difficult to regulate. This is the more serious form and usually requires daily injections of insulin.
Insulin-dependent diabetes mellitus (IDDM) * Type 1
118
Def: More common form of diabetes, typically has a gradual onset. Usually appearing in adults over the age of 40. Pancreas generally retains some insulin secreting ability making management of this disease less problematic.
Non-insulin-dependent diabetes mellitus (NIDDM) * Type 2
119
These are symptoms of which form of diabetes?
- Excessive urination (polyuria)
* Glucose acts as a diuretic. Usually glucose that enters the kidney tubules is reabsorbed and does not appear in the urine, however in this disease the amount of glucose is too much for the kidneys to reabsorb so it is excreted in the urine (glycosuria)
- Excessive thirst (polydipsia)
- Presence of ketones
- Acidosis could result
Diabetes Mellitus
120
Complications of Diabetes Mellitus: Lipid from fat tissue, and the level of blood lipid, particularly cholesterol increases. Much of the lipid is deposited within the walls of the blood vessels causing ______. This is one of the greatest dangers and uncontrolled long-term DM. Blockage of a coronary artery causes a myocardial infarction.
Another complication of diabetes is a vascular disorder of the retina that can result in blindness, it is called _____ _____.
Atherosclerosis
Diabetic Retinopathy
121
______ is the most common chronic complication of long-term diabetes mellitus. The most common form is _____, which affects peripheral nerves in distal extremities causing burning and numbness in the feet.
Neuropathy
Polyneuropathy
122
Def: Another form of diabetic neuropathy when there is ischemia of the median nerve due to microvascular damage.
Carpal Tunnel Syndrome
123
Def: A complication of DM, this condition is due to the loss of proprioceptive sensation that Mark’s diabetic neuropathy. The vessel changes that occur contribute to the feet problems of the DM patient. Sensory neuropathy that may lead to painless trauma and ulceration and can progress to infection.
Charcot joint
124
Why must insulin be given by injection?
Because it is a protein and would be digested in the Gastrointestinal tract if it was taken orally
125
Def: This develops when a severe diabetic fails to take enough insulin or deviates markedly from a prescribed diet. Acidosis and dehydration result and death can follow if proper treatment is not given immediately (Blood glucose too high)
Symptoms: Deep labored breathing, patient’s breath has a fruity acetone smell, skin is flushed and dry
Diabetic Coma
*Treatment of comatose patient requires a large dose of insulin and dehydration must be treated by administering fluids
126
Def: This is a result from too much insulin, not enough food, or excessive exercise. The patient feels lightheaded and faint and begins to perspire. Sugar needs to be administered in some form. The patient’s speech become thick and walking becomes unsteady because the low level of glucose affects the brain.
Symptoms: SHALLOW breathing, normal odor of breath
Insulin Shock (HYPOglycemic shock)
127
Factors that produce HYPOglycemia =
TOO MUCH ____, insufficient food intake and strenuous exercise, a patient with Addison disease, hypo activity of adrenal cortex
Too much insulin
128
Practical application of DM:
Exercise after insulin can increase its effects.
Location of insulin, avoid exercise in that extremity bc it speeds the effects
Ex. Guidelines:
___-___ mg/dL proceed with exercise program
> ____ mg/dL and on oral meds Try 10-15 min of activity, if BG rises STOP. If BG drops, continue, rechecking BG every 10-15 minutes
100-300
>300
129
Blood Glucose Levels:
Before a meal- __-__
1-2 hours after a meal ____ diabetes
80-130
<180
Fasting:
<100 normal
100-126
>126
130
Sit up on the side of the bed where the most important line is set up.
This is usually the ventilator or on the side of the bed with the shortest line (often the NG tube)
131
Arterial line: will usually have a splint on the wrist, be very careful.
No ____ or ____ at the wrist.
No ROM or WB
132
ECMO: wherever the lines are inserted (either neck or groin) don’t do ____ near that area. For the neck that means no ____ ROM on that side of the body, or if the line is in the groin, no ____ROM
No ROM near that area
No shoulder ROM
No hip ROM
133
CRRT: Continuous Renal Replacement Therapy-short term dialysis in the hospital.
No ____ of the shoulder on the side of the insertion since it is inserted near the shoulder
ROM
134
No rolling onto side of the ____ tube
Chest tube
