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adult health 1 > test 4 > Flashcards

test 4 Flashcards

1
Q

polycystic kidney disease

A

cysts on kidneys from mutations in genes
no cure
most common hereditary and autosomal deficit

*prevent infection of urinary tract

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2
Q

acute kidney injury

A

sudden onset
reversible but could lead to CKD
-commonly caused by acute tubular necrosis from shock

diagnosed by elevated BUN, creatine, K, and possible oliguria

primary cause of death is infection

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3
Q

chronic kidney disease

A

onset- months to years
irreversible
later stages will require dialysis

diagnosis- uremia/anuria, HTN

cardio issues is most common cause of death

also called chronic renal failure

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4
Q

BUN in kidney disorders

A

elevated

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5
Q

creatine in kidney disorders

A

elevated

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6
Q

glomerular filtration rate (GFR) in kidney disorders

A

low

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7
Q

potassium in kidney disorders

A

elevated

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8
Q

hemoglobin and hematocrit in kidney disorder

A

low

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9
Q

RBC in kidney disorders

A

decreases (less erythropoietin being made)

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10
Q

phosphorus in kidney disorders

A

elevated

magnesium also increases

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11
Q

calcium in kidney disorders

A

low

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12
Q

sodium in kidney disorders

A

low

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13
Q

risk factors for CKD

A

age over 60
heart issues
diabetes
ethnicity (Af amer, native amer)
HTN
Family hist
PKD

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14
Q

peritoneal dialysis

A

In peritoneal (stomach), done at home, higher risk for infection

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15
Q

hemodialysis

A

Artery and vein put together, cleaning blood and replacing. done at clinic about 3x weekly

Check for bruit and thrill, it should feel this way

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16
Q

benign prostatic hyperplasia (BPH)

A

Enlargement of prostate gland, disruption of urine outflow
- difficulty urinating
- decreased flow
-urinary frequency

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17
Q

BPH risk factors

A

aging
obesity
lack of physical activity
alcohol use
erectile dysfunction
smoking diabetes
family history

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18
Q

inflammatory urinary symtoms

A

from inflammation or infection

nocturia
urgency
frequency
dysuria
bladder pain
incontinence

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19
Q

obstructive urinary symptoms

A

from enlarged prostate

weak stream
difficulty initiating

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20
Q

diagnostics and care for BPH

A

rectal exam
urinalysis and culture
prostate specific antigen (PSA)
BUN, creatine
post void residual (ultrasound)

Drugs - 5a reductase inhibitors, a-adrenergic receptor blockers
TURP- surgery to remove prostate

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21
Q

Erectile dysfunction

A

inability to attain or maintain a erection for satisfactory sexual function

in younger people its from substance abuse, stress and anxiety

in older people its from chronic medical issues

treatments
erectogenic drugs- phosphodiesterase inhibitors, such as sildenafil (viagra). sex therapist, VEDs, penile implants

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22
Q

risk factors of ED

A

Diabetes, vascular disease, surgery, meds, trauma, chronic illness, stress, depression

reduced blood flow to penis

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23
Q

osteomyelitis

A

Infection of bone, bone marrow

microorganisms enter the blood causing inflammation and pressure - bone cant expand, leading to ischemia - infection spreads, blood flow is compromised - results in bone death from ischemia.
dead bone forms a sequestrum that is difficult for WBC and antibiotics to reach
can form a chronic sinus tract which can drain purulent drainage (late symptom)

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24
Q

what typically causes osteomyelitis

A

staphylococcus

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25
Q

direct entry osteomyelitis

A

Trauma, open wound, fracture, surgery, diabetes injuries

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26
Q

indirect entry osteomyelitis

A

from infection

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27
Q

ischemia

A

decreased blood flow

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28
Q

necrosis

A

dead tissue

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29
Q

local clinical manifestations of osteomyelitis

A

constant bone pain that worsens w activity and is relieved by rest
swelling, tenderness and warmth
limited ROM

if goes untreated or doesnt work, could lead to systemic clinical manifestations

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30
Q

systemic clinical manifestations of osteomyelitis

A

fever
night sweats
chills
restlessness
nausea
malaise
drainage (late sign)

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31
Q

acute vs chronic osteomyelitis

A

acute- less than 1 month, same S&S

chronic- longer than a month or doesn’t respond to antibiotic therapy
- can be from inadequate therapy or exacerbations
- scar tissue forms which makes it hard for antibiotics to penetrate
- could lead to sepsis, septic arthritis, fractures

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32
Q

diagnostics for osteomylelitis

A

wound culture and sensitivity
WBC count
ESR
CRP
x-ray
CT/MRI
radionuclide bone scans

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33
Q

osteomyelitis nursing care

A

assess past history, signs of infection, ROM
dressing changes
monitor labs

Prevention is key! prevent extra infections and foot drop

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34
Q

osteomyelitis wound care

A

get rid of dead tissue- debridement
dry dressings
saline/antibiotic
wet to dry
wound vac

Dress one dressing at a time, wash hands, change gloves, then move to next- avoid cross contamination

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35
Q

diagnostic test to tell if something is systemic

A

blood culture

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36
Q

osteomyelitis meds

A

antibiotics- Vancomycin, gentamycin, ceftriaxone, cefazolin
-long term use: ototoxicity, nephrotoxicity, neurotoxicity, allergy development, c-diff
***Start on antibiotic as soon as get wound culture, even if there Is no results

NSAIDs
opioids
Muscle relaxants- baclofen, cyclobenzaprine (these are addictive and make you drowsy)

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37
Q

gentamycin med alert

A

assess dehydration before starting, ensure proper kidney function, monitor levels

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38
Q

fluoroquinolone med alert

A

may cause tendinitis, tendon rupture

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39
Q

Muscular dystrophy

A

group of genetic disorders characterized by progressive SYMMETRIC wasting of SKELETAL muscle
- can’t make dystrophin
causes gradual loss of strength, increasing disability
- no evidence of neuro involvement
-Duchenne is most common type

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40
Q

diagnostics and care for MD

A

genetic testing DMD gene mutation
muscle enzymes
Electromyogram
muscle fiber biopsy
ECG for cardiac dysrhythmias

no definite therapy to stop progression, corticosteroids can help, as well as gene therapy, stem cell therapy, PT, orthotic jacket

trach or vent may be needed in future
*proper nutrition needed
*dysrhythmias are most common cause of death in this

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41
Q

localized back pain

A

patient can pinpoint where

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42
Q

diffuse back pain

A

back pain over a large area

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43
Q

radicular low back pain

A

comes from nerve; sciatica

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44
Q

referred back pain

A

in lower back but can be caused by something else; such as kidney

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45
Q

chronic low back pain

A

3 months or longer

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46
Q

causes of low back pain

A

degenerative conditions such as arthritis
osteoporosis
metabolic bone disease
weakness from scar tissue due to prior injury
chronic strain from obesity, pregnancy, posture
congenital spine issues

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47
Q

nursing management : back pain and post op back surgery

A

back pain
- past med hist
-assess mobility and reflexes
diagnostics- CT, MRI, XRAY- fractures, swelling
-refer to PT
educate on body mechanics, sleeping positions, weight
-NSAIDS, Corticosteroids if needed

Post op
-assess for CSF leakage (headache is sign)
-assess surg site, bowel & urinary function
patient education, ensure pt in right position for post op

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48
Q

osteoporosis

A

chronic, progressive, metabolic deterioration of bone tissue. causes bone fragility

manifestations
- could be in any bone, common in hip, spine, wrist
- back pain
- fractures
- weakness
- loss of height from spinal fracture
- kyphosis (dowagers hump)

typically not diagnosed until 25-40% calcium loss
- deca scan
- bone mineral density (BMD) test

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49
Q

mineral to look at in blood for bone formation

A

calcium and phosphorus

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50
Q

osteoblast

A

build bone

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51
Q

osteoclast

A

break down bone

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52
Q

osteoporosis risk factors and treatment

A

risk factors
- menopause, IBD/malabsorption, kidney disease, RA, alcoholism
meds can cause- corticosteroids, antiseizure, antacids, heparin, chemo

treatment
vitamin D, calcium, bisphosphonates, human PTH, selective estrogen receptor modulator (SERM)

53
Q

osteoarthritis

A

decreased lubrication of joints, causing bones to rub together. sometimes forms bone spurs
-Slow progression
*noninflammatory of synovial joints

not normal part of aging, usually happens by age 40
- can be from repetitive work/sports movements, obesity, menopause, previous injury

clin manifestations
- joint pain, loss of function, referred pain, crepitation, stiffness (usually feels better after movement), red swollen joints

diagnosed by MRI, XRAY, CT bone scan
avoid repetitive movements
NSAIDs, tylenol, hot showers can help

54
Q

ankylosing spondylosis (marie-strumpell disease)

A

chronic progressive disease affecting the spine

  • begins w synovis (joint inflammation), moves to fibrosis, then ankylosis which causes fusion of spine, “bamboo spine”

s&s
- pain and stiffness
- kyphosis
- iritis (inflammation of eye) or uveitis - could lead to vision loss
- decreased resp function - diaphragm can’t fully move

diagnosed by x ray

decrease pain, increase mobility, get vaccinations

treatment- corticosteroids, PT, analgesics, anti inflammatories

55
Q

pagets disease

A

enlargement of bones, bone deformities. Unknown cause. More common in men over 50
- osteoblast and osteoclast not working in unison
- genetic identification of bone destruction
- leads to fragile expanding bones

S&S
compression of nerve
constipation/loss of appetite
pain from fractures, deformed bones
overgrowth in head causing headache
weakness, fatigue

provide pain relief, encourage rest, prevent falls
monitor calcium

meds to prevent- calcitonin, etidronate disodium, alendronate, bisphosphonates

56
Q

osteomalacia

A

decalcification of bones, leading to porosity and softening of bones

caused by inadequate intake, absence of sunlight exposure, malabsorption, chronic renal disease

s&s
- bone pain and tenderness
- muscle weakness
- bowed legs (later sign)
- kyphosis

diagnosed by xray

  • pain relief, safety, rest, body alignments, sunlight, vit D/ca

meds- glucosamine, chondrotin

57
Q

foods w vitamin D

A

milk, eggs, enriched cereals, bread

58
Q

why is osteoporosis more common in women

A

less calcium, less bone mass, menopause

59
Q

what 2 diseases is diabetes often accompanied with

A

HTN, hyperlipidemia

60
Q

what is diabetes characterized by

A

hyperglycemia related to abnormal insulin production, impaired insulin utilization, or both

61
Q

complications of diabetes

A

stroke
heart disease
blindness
end stage renal disease
lower limb amputations

62
Q

what does insulin do? what makes it

A

allows for glucose to get into cells
made by beta cells

63
Q

what ethnicites are more at risk for diabetes

A

american indian, hispanic, blacks

64
Q

type I diabetes

A

pancreas cannot make insulin.
Autoimmune disease

65
Q

type II diabetes

A

pancreas cannot make enough insulin, or cells are resistant

can be prevented with good diet and staying active

66
Q

gestational diabetes

A

occurs during pregnancy. BG usually returns to normal after birth.
Higher risk for developing diabetes in future

67
Q

type I diabetes symptoms

A
  • usually develops in younger ages, quickly
    weight loss
    polyuria
    polydipsia
    ketones in urine (ketoacidosis)
    polyphagia
    weakness
    fatigue
68
Q

type II diabetes symptoms

A

-progressive onset, adults
obesity- lifestyle related
polyuria
polydipsia
polyphagia
fungal infections/yeast infections
slow healing wounds
vision changes

69
Q

meds and issues that could cause diabetes

A

corticosteroids
thiazides
phenytoin
atypical antipsychotics

cushing syndrome
hyperthyroidism
recurrent pancreatitis
cystic fibrosis
hemochromatosis
parenteral nutrition

70
Q

hemoglobin A1C

A

avg blood sugar over past 3 months

good is between 4% to 8%

71
Q

rapid acting insulin

A

onset 10-30 mins
peak- 30 mins-3 hours
duration 3-5 hours

ex- insulin humalog

72
Q

short acting insulin

A

onset 30 mins-1 hour
peak 2-5 hours
duration 5-8 hours

clear
regular insulin

73
Q

intermediate acting insulin

A

onset 1.5-4 hours
peak 4-12 hours
duration 12-18 hours

cloudy
NPH insulin

74
Q

long acting insulin

A

onset 0.8-4 hours
peak- none
duration 16-24 hours

glargine (lantus)

75
Q

metformin

A

oral drug
most effective 1st line treatment for type II diabetes

reduces glucose production
enhances insulin sensitivity
improves glucose transport

may cause gas/bloating and diarrhea

must hold before and after IV contrast

rare comp- lactic acidosis

76
Q

sulfonylureas

A

increases insulin production from pancreas, increases cellular sensitivity to insulin

adverse- hypoglycemia possible

ex- glipizide, glyburide

77
Q

diabetes diet

A

Complex carb- brown rice, lean protein, non starch veggies- broccoli

limit alcohol

78
Q

exercise and diabetes

A

30 mins day/5 days weekly- aerobic activity
resistance training 3x weekly for type II

Avoid exercise if hyperglycemic WITH KETONES IN URINE

79
Q

hyperglycemia symptoms

A

excessive hunger, excessive thirst, weakness, frequent urination, nausea,
blurred vision, sores not healing properly, sleepiness after eating

80
Q

hypoglycemic symptoms

A

hunger
shakiness
fast HR
anxiety
sweating
dizziness
blurred vision
weakness
headache
irritability

81
Q

diabetic ketoacidosis

A

usually occurs in type 1 diabetics
high blood glucose, muscle and lipid cells starved for glucose due to lack of insulin. Cells start using fat as a source of energy. liver cells produce ketones, making urine acidic. Could lead to coma or death.

Different breathing (kouzmal)- body is trying to excrete extra acid
Fruity smelling breath

82
Q

hyperosmolar hyperglycemic nonketotic syndrome (HHNS)

A

usually occurs in type II diabetes
high blood sugar increases urination, if these liquids arnt replaced, the individual can become severely dehydrated
- can be from impaired thirst mechanism or inability to get fluids

High BG can lead to altered mental status, confusion, seizures, coma or death

83
Q

what is given to hypoglycemic patients

A

Glucose tab or gel if conscious in hospital

if unconscious, 50% dextrose

if somewhere else, give hard candy

84
Q

assessing resp

A

lung sounds, breaths/min, effort of breathing, cough, o2 sat, nailbed, color, dyspnea, SOB, history, pain, tracheal deviation

85
Q

acute vs chronic resp illness skin color

A

acute- cyanotic, pallor
chronic- grey

86
Q

6 Ps of dyspnea

A

1- Pulmonary bronchial constriction- asthma or anaphylaxis
2- Possible foreign body
3- Pulmonary embolus
4- Pneumonia
5- pump failure
6- pneumothorax

87
Q

tuberculosis

A

infectious disease caused by mycobacterium tuberculosis
- most common in lungs, but can affect brain, kidney, joints

*This must be reported to CDC if positive

88
Q

why does drug resistance occur in TB

A

incorrect prescribing
Lack of case management- follow up
non adherence- compliance

89
Q

TB risk factors

A

homeless
resident of inner city neighborhood
foreign born persons
living or working in institutions
poverty- bad access to health care
IV drug users
immunosuppressants (cancer, HIV)

90
Q

leading cause of death of HIV patients

A

TB

91
Q

How does TB spread

A

airborne particles- can stay in air for minutes to hours since they’re small
- sneezing, breathing, talking, singing, coughing

transmission requires close, frequent, or prolonged exposure
- Based on how many organisms fly out
Concentration- how much space?
Length of time of exposure
Immune system of person exposed

92
Q

TB pathophys

A

Primary- active
Latent- not causing issues
Reactivated- had it in body but randomly became active

When TB is inhaled, it may go latent and lodge in bronchioles and alveoli until possibly reactivating. If caught, we still treat to avoid it going active
- only 5-10% will develop active TB

TB is aerophilic (oxygen loving) that is why it is most common in lungs

93
Q

TB pathophys

A

Primary- active
Latent- not causing issues
Reactivated- had it in body but randomly became active

When TB is inhaled, it may go latent and lodge in bronchioles and alveoli until possibly reactivating. If caught, we still treat to avoid it going active
- only 5-10% will develop active TB

TB is aerophilic (oxygen loving) that is why it is most common in lungs

94
Q

symptoms of TB

A

active
- dry cough that will become productive
- weight loss
- low-grade fever
- night sweats
- malaise
- dyspnea and hemoptysis (bloody sputum) are late symptoms
- pleuritic pain
- adventitious breath sounds

latent
No symptoms, positive PPD test

95
Q

immunocompromised and TB

A

less likely to have a fever and other signs of infection

PPD skin test won’t have as big as a reaction- smaller bump >5mm are considered positive

96
Q

TB diagnostics

A

purified protein derivative (PPD)- positive = induration, palpable, raised hardened area at injection site. Must be >15mm induration in not compromised people

Two step test

blood test

chest x-ray (may appear normal, can’t use as only diagnoses)

3 consecutive sputum cultures (Not negative for TB until all 3 test are negative)
- examines acid fast bacteria (AFB)
-results can take up to 8 weeks, start therapy until results are back

97
Q

care for TB

A

infectious for first 2 weeks of treatment- wear mask, avoid crowds

Four drug regimen
-Isoniazid
-rifampin (rifadin)
-pyrazinamide - dont take when pregnant
-ethambutol

These drugs will be taken for 6-9 months, and they must be taken in front of hospital staff daily. Avoid alcohol with these and monitor liver levels

98
Q

does latent TB need treatment

A

yes to avoid it becoming active

99
Q

TB vaccine

A

BCG
causes PPD skin test to be positive
- not in US unless needed for select induviduals

100
Q

goals for TB

A

COMPLIANCE
prevention
normal pulmonary function

101
Q

hospital care for TB

A

airborne isolation room with negative airflow (airflow goes outside), 6-12 airflow exchanges/hour

healthcare workers wear HEPA masks (N95)

only visors who have been in contact with patient already can visit in hospital
- screen these patients to make sure they dont have it

102
Q

restrictive lung diseases

A

breathing in has been effected.

could be:
extrapulmonary -brain issues, meds, chest wall problems, or spinal cord issues
intrapulmonary- elasticity, diaphragm, inflammation

103
Q

obstructive pulmonary issues

A

inability to exhale all the air out the lungs

can be from lung tissue problems, bronchial narrowing or excessive mucus production

104
Q

idiopathic pulmonary fibrosis

A

characterized by scar tissue in the connective tissue of the lungs leading to inflammation or irritation

low survival rate

management : o2 therapy and lung transplant

105
Q

sarcoidosis

A

chronic, multisystem, granulomatous disease of unknown cause that primarily affects lungs, but could affect others such as lymph nodes, heart, skin, eyes, etc

Treatment is to suppress inflammatory response: steroids

106
Q

cystic fibrosis

A

autosomal recessive, multisystem disease with altered sodium and chloride ions in and out of epithelial cells causing:
1-thick secretions obstructing bronchioles, leading to air trapping
2-obstruction of pancreas
3- difficulty reproducing (reproductively)
4- GI malabsorption, obstructions

Low in sodium and water= thick mucus

107
Q

signs of CF

A

newborn:
- meconium ileus- GI obstruction cause baby can’t poop meconium out
- resp issues
- failure to thrive/malnutrition
-steatorrhea- fatty poop, does not sink

adults:
-large, protuberant abdomen
-skinny arms and legs from malnutrition
-productive cough
-DIOS- bowel blockage
-Diabetes

108
Q

sweat chloride test

A

for CF,
if chloride concentration is high in sweat, suspected CF

109
Q

CF health complications

A

sinus issues
nose polyps
salty sweat
trouble breathing
abnormal pancreas function
fatty bowel movements
gallstones
trouble digesting food
enlarged heart
frequent lung infections

110
Q

treatment and care for CF

A

pancreatic enzyme with meals, many drugs

Assess lung sounds, and PFT.
ABG in ICU and emergency cases

111
Q

COPD

A

group of conditions with obstruction of airflow
-genetic or from environments

-3rd leading cause of death in US

112
Q

emphysema

A

destruction of alveoli without fibrosis

Can’t get oxygen out, trying to get rid of mucus

113
Q

diagnosing chronic bronchitis

A

2 consecutive years of 3 months or longer cough and sputum present

114
Q

COPD risk factors

A

-cigarette smoking
-air pollution, gas, asbestos exposure
-recurring severe resp infections
-A-antitrypsin deficiency (typically allows elastin from breaking down in lungs)
-age, gender- more common in men but more women die
-socioeconomics
-asthma

115
Q

air trapping

A

being unable to get CO2 out

116
Q

chronic bronchitis

A

chronic inflammation. Clogged with mucus. lungs not getting oxygen well

“blue bloater”

117
Q

chronic bronchitis symptoms

A

chronic productive cough
purulent sputum
hemoptysis
mild dyspnea
cyanosis (from hypoxia)
peripheral edema (from cor pulmonale)
crackles, wheezes
prolonged expiration
obesity (from fluid buildup)

118
Q

chronic bronchitis complications

A

-secondary polycythemia due to hypoxemia (low oxygen=extra RBC)
-pulmonary HTN due to reactive vasoconstriction from hypoxemia
-cor pulmonale from chronic pulmonary htn (rt sided hf)

119
Q

emphysema symptoms

A

dyspnea
minimal cough
increased minute ventilation
pink skin, purse lips
accessory muscle use (trying to get air out)
cachexia (weakness)
barrel chest (extra air)
decreased breath sounds
tachypnea

120
Q

emphysema complications

A

-pneumothorax due to bullae
-weight loss due to work of breathing (difficulty breathing)

121
Q

should you take cough suppressants to get rid of mucus in emphysema patients

A

no, we want them to get the mucus out

122
Q

difference between asthma and copd

A

asthma is inflamed airways, COPD is collapsed airways with damaged alveoli

123
Q

COPD diagnostics

A

chest xray - would show flat diaphragm
6 minute walk test
COPD assessment test (CAT)
clinical COPD questionnaire
ABG (low o2, low ph, high co2)
spirometry under 70 (normal is above 70)

124
Q

COPD exacerbations

A

primarily from bacterial and viral infections
- COPD gets worse after each exacerbation

severity depends on use of accessory muscles and central cyanosis

Avoid sick people to help prevent

125
Q

COPD exacerbations

A

primarily from bacterial and viral infections
- COPD gets worse after each exacerbation

severity depends on use of accessory muscles and central cyanosis

Avoid sick people to help prevent

126
Q

COPD care

A

meds will help but disease isn’t fully reversible
Inhaled drugs are preferred
-bronchodilators
-corticosteroids (rinse mouth after inhaled to avoid thrush)
-anticholinergics
-antibiotics
-humidified oxygen (keep sat over 90%)

encourage purse lip breathing, mucus clearance devices, chest physiotherapy, huff coughing

Patient needs to stop smoking, and get vaccinations

typically only hospitalized for acute resp failure or acute exacerbations

127
Q

Benefits of purse lip breathing

A

slows breathing down to help get rid of extra CO2

128
Q

Resp acidosis

A

too much co2 in lungs. acid builds up. could happen with COPD patients

adult health 1 (5 decks)

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