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Adult Health > Test3 > Flashcards

Test3 Flashcards

1
Q

Spleen

A
  1. filtration-removes old/defective RBCs from the circulation.
  2. immunological-filters circulating bacteria, has rich supply of lymphocytes, monocytes and stored immunoglobulins.
  3. storage-stores RBCs and platelets (person with a splenectomy has higher circulating platelets).

Remove for: sickle cell,thrombocytopenia, ITP, trauma; thalassemia; observe for hemorrhage post-op bc spleen is very vascular; increased risk for infection

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2
Q

polycythemia vera

A

=primary polycythemia

results from chronic myeloproliferative disorder arising from chromosomal mutaion–involving RBCs and WBCs and platelets

age of dx=60 yo males

splenomegaly, hepatomegaly

Tx=phlebotomy

angina, heart failure, intermittent claudication, and thrombophlebitis

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3
Q

Thrombocytopenia

A

Platelets below 150,000

usually acquired

immune (ideopathic) thrombocytopenia=abnormal destruction of circulating platelets (ITP)

platelets are destroyed by macrophages (autoimmune)

Tx=corticosteroids to supress the phagocytic response of splenic macrophages; increases life-span of platelets;splenectomy

If heparin induced-protamine sulfate

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4
Q

Thalassemia

A

decreased erythrocyte production

autosomal recessive

abnormal hemoglobin production

common: Mediterranean, equitorial Asia, Middle East, Africa

can cause growth and development defecits

Tx: transfusions to keep Hgb>10; remove spleen

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5
Q

Iron Supplements

A

give 1 hour before meals with acidic drink

changes stool dark, not tarry

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6
Q

Hemoglobin and transfusions

A

Transfuse if Hgb is 6-7

Normal Hgb 13-17 men, 12-15 women

normal platelets 150,000-450,000

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7
Q

Megaloblastic Anemia

A
  1. B12 deficiency (pernicious anemia)-give coalbumin injections (B12) bc they don’t have intrinsic factor
  2. Folic Acid deficiency-foods: whole grains
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8
Q

Aplastic Anemia

A
  • pancytopenia (decreased RBCs, WBCs, platelets)
  • 70% ideopathic
  • 30% chemical, congenital, meds (antisiezure)
  • whole blood transfusions or just platelets
  • bleed, infected
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9
Q

Sickle Cell Anemia

A
  • spleen starts to not work (remove by age 2-3)
  • worry about kidney failure, brain (stroke), lungs, heart (ischemia), eyes (retinal detachment)
  • hydration!!!
  • pain-past jam
  • fever, swelling (joints), increased RR, HR, N/V
  • pneumonia
  • keep still, rest, ice, pressure, no aspirin
  • morphine is drug of choice
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10
Q

Disseminated Intravascular Coagulation

A
  • pallor, petechiae, purpura, oozing blood, hematomas, GI bleed, tachy, hypoTN, cry blood, urine bright red
  • id quickly!
  • O2, fluids-fresh frozen plasma, blood, give clotting factors.
  • occurs in PG, septic, illness
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11
Q

Neutropenia

A
  • neutrophils < 1500 (first responders to infection) normal is 4,000-11,000)
  • usually due to immunosuppressive therapy
  • masks signs of infection (bc there’s no immune response)
  • strict infection prevention-reverse isolation, no fresh fruits, veggies, flowers
  • fever of 100.4 is a huge deal
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12
Q

Blood Transfusions

A
  • 2 RNs must check
  • bracelet, chart and blood
  • 18 guage needle
  • y-tubing with filter
  • saline flush (NO dextrose)
  • VS #1 priority-for baseline
  • use blood within 30 minutes
  • infuse over 2-4 h

(plasma/platelets-much faster)

  • reactions usually within first 15 minutes: SOB, throat closing, itchy, HA, flushing, anxiety, vomiting
  • circulatory overload
  • Acute hemolytic reactions-rare=fever, chills, back pain
  • TRALI-transfusion related acute lung injury (fever, chills, SOB. Caused by leukocytes from donor.
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13
Q

Prediabetes

A

fasting glucose

>100 but < 126

prediabetics should check BS once a day

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14
Q

Type II DM

A

fasting glucose >126

blurry vision

polydypsia, polyuria

fatigue

recurring infections

weight loss

slow healing cuts/bruises

loss of feeling in the feet/tingling (damage to endothelial lining)

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15
Q

Rapid Acting Insulin

(lispro, aspart, glutiene)

A

Onset: 15 minutes

Peak: 60-90 minutes

Duration: 3-4 hours

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16
Q

Short Acting Insulin

(Regular)

A

Onset: 30 min-1hour

Peak: 2-3 hours

Duration: 3-6 hours

regular insulin is the only one that can be given IV

17
Q

Intermediate Acting

(NPH or Lente)

A

Onset: 2-4 hours

Peak: 4-10 hours

Duration: 10-16 hours

18
Q

Long-acting

(glargine (Lantus), detemir)

A

Onset: 1-2 hours

Peak: no peak

Duration: 24 hr

Cannot be mixed with anything!

19
Q

Oral Drug Therapy for Type II DM

A
  • Sulfonylureas (Glipizide) - squeeze the pancreas
  • Biguanides (Glucophage) - decreased gluconeogenesis in liver
  • Alfa Glucosidase Inhibitors (Acarbose) - starch blockers - block the conversion of starch
  • Thiazolidinediones (Actos, Avandia) - make the tissue more susceptible to the insulin that’s there.
20
Q

Somogyi Effect

A

A rebounding high blood sugar that is a response to low blood sugar. When managing the blood glucose level with insulin injections, this effect is counter-intuitive to insulin users who experience high blood sugar in the morning as a result of an overabundance of insulin at night. Give them less at night so they don’t drop so low and then rebound..

Caused by too much insulin at bedtime

21
Q

Dawn Phenomenon

A

An early-morning (usually between 2 a.m. and 8 a.m.) increase in blood sugar

Different from Somogyi rebound in that dawn phenomenon is not associated with nocturnal hypoglycemia.

Treat by increasing the insulin dose and an appropriate bedtime snack.

22
Q

AC/HS

A

Before Meals / Before Bed

23
Q

DKA

(diabetic ketoacidosis)

A

lethargy, weakness

severe dehydration

abd pain, anorexia, vomiting

labored breathing

polyuria, polydypsia

breath odor (ketones)

BG > 300

pH < 7.3

positive ketones (blood, urine)

elevated anion gap

usually Type I

ABCD

give fluids, IV access

IV drip insulin 0.1 U/kg/hr

24
Q

HHS

(hyperosmolar / hyperglycemic state)

A

life threatening-enough insulin to prevent DKA, but not enough to prevent hyperglycemia and hypovolemia

no ketones, pH is normal

type II

extreme hyperglycemia > 400

severe osmotic diuresis-profound dehydration

low Na, K, P

decreased renal perfusion, hypotension, hemoconcentration

pump fluids, insulin drip

25
Q

Hypoglycemia

A

T - tachy

I - irritable

R - restless

E - excessive hunger

D - diaphoretic / depression

give glucagon IM

reasses q15 min

don’t need an order to check blood sugar

26
Q

BID

A

before breakfast

and before dinner

27
Q

Endocrine Problems

A
  1. Cushings (too much cortisol)
  2. Addisons (not enough cortisol)
  3. Hyperthyroid
  4. Hypothyroid

Cortisol increases in the AM, decreases in the PM, increases during times of stress

28
Q

Cushings Syndrome

A
  • moon face
  • personality changes
  • hyperglycemia
  • CNS irritability
  • Na+/fluid retention (edema) and HTN
  • high susceptiblity to infection (high blood sugar)
  • gynecomastia
  • fat deposits: face, back of shoulders (buffalo hump is permenant)
  • osteoporosis
  • thin extremeties (loss of muscle mass)
  • GI distress (too much acid)
  • thin skin
  • purple striae
  • bruises, petechiaetism, amenorrhea
  • hirsuitism
  • hypokalemia

Nurse: 24 hr urine (free cortisol), CT/MRI of pituitary and adrenal glands (ACTH-adrenocorticotropic hormone is secreted from anterior pituitary), high protein diet

Caused by: meds (corticosteroids), pituitary problems, adrenal problems

Tx: adrenalectomy, meds (Mitotane) to decrease cortisol production, taper off corticosteriods if this is cause.

29
Q

Addison’s Disease

A
  • low cortisol
  • bronze skin
  • body hair changes: female moustache

-hypoglycemia (diaphoresis)

  • GI disturbances
  • weakness
  • weight loss
  • postural hypoTN
  • massive dehydration/electrolyte disturbances
  • hyperkalemia, hyponatremia, hypochloremia

Adrenal Crisis: fatigue, dehydration, vascular collapse (low BP), renal shut-down, hyponatremia, hyperkalemia.–give fluids IV

30
Q

Hyperthyroidism

A
  • heat intolerance
  • fine, straight hair
  • bulging eyes (fat deposits-see entire iris)
  • facial flushing
  • enlarged thyroid
  • tachy
  • increased systolic BP
  • weight loss
  • muscle wasting
  • finger clubbing
  • tremors
  • diarrhea
  • amenorrhea
  • localized edema
  • Labs: T3 and T4 (TSH will be decreased)

Tx: radioactive iodine therapy, antithyroid meds (PTU)-block produciton of T3,T4 (this causes TSH to increase), subtotal thyroidectomy

Thyroid storm: if left untreated complications-CHF, pulmonary edema

31
Q

Hypothyroidism

A
  • hair loss, receding hairline
  • brittle hair, nails
  • apathy, dull, blank expression
  • lethargy, fatigue
  • dry skin (coarse & scaly)
  • muscle aches/weakness
  • constipation
  • cold intolerance
  • facial/eyelid edema
  • thick tongue, slow speech
  • menstrual distrubances
  • Late manifestations: subnormal temp, bradycardia, wt gain, decreased LOC, thickened skin, cardiac complications (heart can stop), decreased RR
  • Myxedema coma-ICU for IV hormone replacement–triggered by infection and certain meds
  • Labs: TSH is high, T3 and T4 are low
  • Med=Levothyroxine (Synthroid)-take bf breakfast; may cause insomnia; may fight for O2-monitor for chest pain.
32
Q

Diabetes Complications

A

o Macrovascular Diseases – Comobordidites ** your Kidneys are begging for mercy**
 HTN
 MI
 Atherosclerosis
 Increased risk of stroke
o Microvascular Disease
 Foot problems – diabetic foot
 Nephropathy
 Renal Insufficiency
 Retinopathy

o Kidney and eye problems because they are being washed over repeatedly with glucose
 This is VERY damaging because they have no glucose receptors

33
Q

Iron Deficiency Anemia

A
  • Low H&H (transfuse for Hgb 6-7)
  • take iron supplements 1 hour bf meal with acidic drink

Adult Health (9 decks)

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