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Adult Health III - NUR 254 > Unit 3 > Flashcards

Unit 3 Flashcards

1
Q

What causes diabetes insipidus?

A

caused by a deficiency of ADH from the posterior pituitary gland

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2
Q

How much urine do kidneys usually pass in a day?

A

1-2 quarts

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3
Q

How much urine do kidneys pass in a day with DI?

A

3-20 quarts

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4
Q

What are the signs and symptoms of diabetes insipidus?

A 
polyuria and polydipsia.
urine specific gravity <1.005
output not controlled by limiting intake causing dehydration with hypernatremia
nocturia
dry skin, dizziness, confusion, nausea
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5
Q

What is the characteristics of the urine with diabetes insipidus?

A

dilute, almost clear, and odorless.

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6
Q

What are causes of diabetes insipidus?

A

CVA, Head injury, aneurysm, intracranial tumor, irradiation of pituitary gland.

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7
Q

What are the diagnostic test for diabetes insipidus?

A

fluid deprivation test
decrease urine osmolality and urine specific gravity <1.005
CT or MRI to assess for tumors

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8
Q

What is a fluid deprivation test?

A

measures changes in patients body weight and urine concentration after restricting liquid intake. fluids withheld for 8-12 hours, BP monitored. if BP drops significantly or patient loses 3-5% of body weight. blood is drawn to check sodium levels

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9
Q

What is the results of a positive fluid deprivation test?

A

serum sodium >145 and serum osmolality >300

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10
Q

What are the goals of medical management of diabetes insipidus?

A

replace ADH
replace fluids
identify and correct the underlying cause

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11
Q

What medication is used to replace ADH?

A

Desmopressin (DDAVP), also known as vasopressin

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12
Q

What is important with I&Os for patients with diabetes insipidus?

A

do NOT limit PO intake. match I&Os to prevent dehydration, hypovolemia, and hypernatremia.

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13
Q

What is syndrome of inappropriate antidiuretic hormone (SIADH)?

A

excessive amount of ADH. causes kidney to reabsorb H2O and decreases urine output resulting in water retention. low sodium levels due to hemodilution.

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14
Q

What are the causes of SIADH?

A

CNS disorders, tumors to the brain and/or neck. pituitary tumors. or head injuries.
pain, stress, exercise, and low blood sugar levels.
secondary to meds, like NSAIDS or psychotropic meds.

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15
Q

What are signs and symptoms of SIADH?

A

hyponatremia- sodium <125
H2O retention progressing to H2O intoxication.
weakness, muscle cramps. anorexia. nausea, headache, diarrhea, lethargy, disorientation, irritability. weight gain. seizures.

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16
Q

What are the diagnostic tests for SIADH?

A

lab tests for serum sodium, serum osmolality. (both will be low)
high urine osmolality and urine specific gravity >1.030

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17
Q

What is the medical management of SIADH?

A

Eliminate underlying cause.
fluid restriction - 500 to 1000 mL/day
furosemide
monitor K, Na, I&Os, daily weights, and neuro checks

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18
Q

What hormones are secreted by the adrenal glands?

A 
glucocorticoids (cortisol)
mineralocorticoids (aldosterone)
sex hormones (androgens and estrogens)
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19
Q

What is cortisol?

A

is a glucocorticoid produced by the adrenal glands. helps maintain BP and heart and blood vessel function. slows the immune systems inflammatory response and regulates metabolism.

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20
Q

What is adrenocortical insufficiency (Addison’s disease)?

A

the adrenal glands are damaged and cannot produce enough of the adrenal hormones cortisol and aldosterone

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21
Q

What is aldosterone?

A

a mineralocorticoid produced by the adrenal glands. helps maintain BP, and balance sodium and potassium in the bloodstream.

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22
Q

What is the cause of Addison’s disease?

A

autoimmune disorders are the primary cause. or infections such as TB, HIV/AIDS, and meningitis. adrenalectomy, pituitary hypofunction, or metastatic tumors. or medications and stopping corticosteroid medications abruptly.

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23
Q

What are signs and symptoms of Addison’s disease?

A

muscle weakness, anorexia, GI symptoms, fatigue, dark pigmentation of the skin and mucosa, hypotension, low blood glucose, low serum sodium. high serum potassium. mental changes. apathy. emotional lability, confusion.

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24
Q

What is Addisonian crisis?

A

severe adrenal insufficiency

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25
Q

What are signs and symptoms of Addisonian crisis?

A

dehydration, sudden severe pain in lower back, abdomen, or legs. cyanosis. and the classic signs of circulatory shock: pallor, apprehension, rapid and weak pulse, rapid respirations, and low blood pressure

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26
Q

What can cause Addisonian crisis in Addison’s disease patients?

A

overexertion, exposure to cold, or acute infection

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27
Q

What are risk factors for Addisonian crisis?

A

someone with underlying adrenal hypofunction who undergo stressful events such as trauma, surgery, pregnancy, and infections

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28
Q

What are the diagnostic tests for Addison’s disease?

A

hormonal blood and urine tests, checking adrenocortical hormone levels and ACTH levels.
ACTH stimulation test.
labs checking for hyponatremia, hypoglycemia, and hyperkalemia.
CT/MRI, Abdominal US
Antibody tests checking for autoimmune disorders

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29
Q

What is an ACTH stimulation test?

A

injection of synthetic ACTH given, blood levels are then checked.

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30
Q

What results would people with Addison’s disease have with an ACTH stimulation test?

A

would have little or no increase in cortisol levels

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31
Q

What is the treatment for Addison’s disease?

A

monitor vitals - give vasopressors (dopamine) for persistent hypotension.
antibiotics for infections to prevent crisis.
Chronic Addison’s disease - lifetime of replacement corticosteroids (prednisone, hydrocortisone, or dexamethasone) and mineral corticoids (fludrocortisone)
if under stress, may need additional doses of corticosteroids to prevent crisis.

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32
Q

What is the recommended diet for patients with Addison’s diease?

A

high in sodium, low in potassium

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33
Q

What is the priority with Addisonian Crisis?

A

Treat shock

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34
Q

How do you treat shock in Addisonian crisis?

A

IV fluids and corticosteroids (hydrocortisone or dexamethasone)

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35
Q

What must you assess with Addison’s disease?

A

orthostatic BPs. skin turgor and color. weight loss. muscle weakness, or fatigue.

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36
Q

What are signs and symptoms of Addisonian crisis?

A

shock, hypotension, rapid/weak pulse, tachypnea, pallor, weakness.

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37
Q

What should you avoid with Addison’s disease?

A

physical stressors, over exertion. cold exposure, infection, and emotional distress.

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38
Q

What is Cushing’s Syndrome (Adrenocortical Hyperactivity)?

A

too much hormone cortisol is made

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39
Q

What are the causes of Cushing’s syndrome?

A

long term, high dose use of cortisol-like glucocorticoids. Pituitary tumors, Ectopic ACTH-producing tumors, adrenal tumors.

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40
Q

Who is most likely to experience Cushing’s syndrome?

A 
women > men
ages 30-50
people with Type 2 Diabetes
HTN
high BG levels over time
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41
Q

What are signs and symptoms of Cushing’s disease?

A

moon face, buffalo hump, HTN, mood swings, increased hair, edema. truncal obesity with thinner extremities. muscle wasting. weakness. skin conditions. easy bruising, purpura, skin ulcers.

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42
Q

What are the diagnostic tests for Cushing’s Syndrome?

A 
two of the following to confirm:
24 hour urinary free-cortisol test
late-night salivary cortisol test
low-dose dexamethasone suppression test.
labs - elevated cortisol, hyperglycemia, hypernatremia, hypokalemia
Imaging Tests- CT/MRI
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43
Q

What is the medical management of Cushing’s Syndrome?

A

treat causative factor.
If removal of tumor, may need post-op hormone replacement to avoid Addison’s disease.
If not removed, adrenal inhibitors may be used (metyraprone, aminoglutethimide, mitotane, nizoral)

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44
Q

What are the complications of Cushing’s syndrome?

A 
osteoporosis, bone loss and fractures.
heart attack, stroke, high BP, high cholesterol levels.
DVT's/PE
infection
depression, memory loss
insulin resistance, type 2 diabetes
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45
Q

What is a complication of Cushing’s Syndrome treatments?

A

Addisonian Crisis

46
Q

What are some adverse effects with Cushing’s Syndrome?

A

hypokalemia
hypernatremia
hyperglycemia

47
Q

What is an appropriate diet for someone with Cushing’s Syndrome?

A

high protein, low carb, low sodium, high potassium, low calorie, fluid restriction

48
Q

What is hyperparathyroidism?

A

elevated PTH hormone levels

49
Q

What does the parathyroid hormone (PTH) regulate?

A

calcium and phosphorus

50
Q

What does high PTH levels trigger?

A

triggers bones to released increased calcium into the blood causing weak bones and elevated blood calcium levels.

51
Q

What is a complication of increased blood calcium levels?

A

kidney stones

52
Q

Who is more likely to have hyperparathyroidism?

A

women > men

53
Q

What are the signs and symptoms of hyperparathyroidism?

A

may be asymptomatic.
elevated serum calcium, polyuria. bone decalcification. renal calculi. fatigue. muscle weakness. N/V. constipation. HTN. cardiac dysrhythmias.

54
Q

What are the diagnostic tests for hyperparathyroidism?

A

labs- elevated calcium and PTH levels.

55
Q

What are causes of hyperparathyroidism?

A

a benign tumor (adenoma) on one of the parathyroid glands

56
Q

What is a complication of hyperparathyroidism?

A

hypercalcemic crisis

57
Q

What is the serum calcium level for a hypercalcemic crisis?

A

> 15 mg/dL

58
Q

What are normal calcium levels?

A

8.5-10.5 mg/dL

59
Q

What is the treatment for a hypercalcemic crisis?

A

rehydration, diuretic agents to promote renal excretion of calcium.

60
Q

What is used in emergent situations to decrease serum calcium levels quickly?

A

calcitonin, corticosteroids, and dialysis

61
Q

What is the treatment for hyperparathyroidism?

A

parathyroidectomy.
hydration therapy
mobility to reduce calcium excretion from bones
vitamin D supplements

62
Q

What is hypoparathyroidism?

A

deficiency in PTH

63
Q

What are factors that cause Hypoparathyroidism?

A 
post-op hypoparathyroidism after accidental damage to the parathyroid gland
autoimmune diseases
heredity
extensive radiation to face or neck
hypomagnesemia.
64
Q

Hypoparathyroidism results in what electrolyte imbalance?

A

hypocalcemia and hyperphosphatemia

65
Q

What are signs and symptoms of hypoparathyroidism?

A

numbness and tingling in finger tips, toes, and lips
muscle aches/cramps in legs, feet, abdomen, and face
Tetany, twitching muscles
bronchospasms, laryngeal spasm, carpopedal spasm
anxiety, irritability, depression, delirium, and ECG changes

66
Q

What are the signs of Tetany?

A

Chvostek’s sign and Trousseau’s sign

67
Q

What is tetany caused by?

A

hypocalcemia

68
Q

What are the diagnostic tests for hypoparathyroidism?

A

blood levels to include calcium, phosphorus, magnesium, PTH
EKG, abnormal rhythms
xrays and bone density tests

69
Q

What is the goal in treatment of hypoparathyroidism?

A

increase serum calcium levels to 9-10 mg/dL

70
Q

What is the treatment for hypoparathyroidism?

A

calcium gluconate IV.
sedatives (pentobarbital) to decrease neuromuscular irritability.
parathyroid hormone (Natpara)
decrease environmental stimuli
may need trach/mechanical vent or bronchodilators for respiratory distress
Ca supplements or Phosphorus binders (aluminum carbonate)
Vitamin D

71
Q

What is the recommended diet for someone with hypoparathyroidism?

A

high in calcium, low in phosphorus

72
Q

What are emergencies?

A

sudden, unforeseen events that threaten health or safety

73
Q

What are disasters?

A

combined threat to life, public health, and environment.
have little or no warning.
initially overwhelm available personnel and emergencies.

74
Q

What is a pandemic?

A

infection that spreads rapidly around the world

75
Q

What is emergency preparedness?

A

plans to prevent, respond to, and recover from emergencies

76
Q

What is surge capacity?

A

the ability to rapidly meet increased demand for qualified personnel and resources.

77
Q

What is a disaster?

A

an event of destructive magnitude that kills, injuries, or causes human suffering to a significant number of people or the environment and requires that need for external assistance. it disrupts that infrastructure and normal functioning of a community or society.

78
Q

What is a mass casualty event?

A

any large scale even in which emergency medical resources such as supplies, medical/rescue personnel, or equipment are overwhelmed by the number and severity of casualties, thus requiring prioritization of medical care by triage.

79
Q

What are the four phases of emergency response?

A

mitigation
preparedness
emergency response
recovery

80
Q

What is the mitigation phase of emergency response?

A

both before and after emergency occurs.

warning systems and insurance claims.

81
Q

What is the preparedness phase of emergency response?

A

before the emergency occurs.
gain understanding of expected roles in emergency.
develop emergency plan and designate meeting places.

82
Q

What is the emergency response phase?

A

implementation of preparedness plans. victims are triaged and treated as soon as possible. search and rescue operations. shelter for survivors. repairing utility infrastructures.

83
Q

What is the recovery phase of emergency response?

A

designed to returned community to normal or create new, safer normal. rebuilding, reemployment, repair, and reconstitution of government operations.

84
Q

Who is responsible for emergency management and response?

A

local governments.
state divisions of emergency management.
US department of homeland security.
community emergency response team program.clinician outreach communication activity program.

85
Q

What is the nurses role in disasters?

A

vary based on type of disaster, location, number and condition of victims, personnel, and supplies available.
never jeopardize own safety.
must operate within the defined scope of practice

86
Q

What is the hospital’s response to a disaster?

A

staff safety and availability of PPE.
decontamination equipment and processes
surge capacity, evacuation plans, addressing mental health or psychosocial issues, debriefing plans and maintaining readiness.

87
Q

What is hospital triage?

A

sorting of patients based on their need for treatment and resources available to provide treatment.

88
Q

What is hospital triage based on?

A 
ABCD priorities
a-airway with c-spine precautions
b-breathing
c-circulation with hemorrhage control
d-disability and resource management
89
Q

What are the categories for hospital (ED) triage?

A

emergent(immediate)
urgent (delayed)
non-urgent (minor)

90
Q

What is considered emergent (immediate) in ED triage?

A

life-threatening issues that require prompt treatment and care. stabilization of the patients condition is critical.

91
Q

What is considered urgent (delayed) in ED triage?

A

serious health conditions in which delay of treatment and care would result in life-threatening situatuions.

92
Q

What is considered non-urgent (minor) in ED triage?

A

minor issues that do not require prompt care. can ambulate and are stable in their conditions

93
Q

What is the purpose of start triage (reverse triage)?

A

used in mass casualty incidents.

doing the greatest good for the greatest number of people.

94
Q

What is triage?

A

prioritizing clients for treatment based on the severity of illness or injury and in light of supplies and resources available.

95
Q

What observations is start triage based on?

A

respirations
perfusion
mental status

96
Q

What are the tags for START triage?

A

black tags - expectant
red tags - immediate
yellow tags - delayed
green tags - minor

97
Q

What does a black tag indicate?

A

deceased or those whose injuries are so extensive that they will not be able to survive given the care that is available.

98
Q

What does a red tag indicate?

A

those who cannot survive without immediate treatment but who have a chance at survival. includes compromised to patients ABCs.

99
Q

What does a yellow tag indicate?

A

those who require observation. they do have life threatening injuries, but their condition is stable for the moment and they are not in immediate danger of death.

100
Q

What does a green tag indicate?

A

patients are “walking wounded” require medical care at some point, after more critical injuries have been treated

101
Q

How do you assess for assigning tags?

A

RPMs
respirations
perfusion
mental status

102
Q

What is assessed with respirations?

A

if breathing, <30 bpm move to perfusion. >30 bpm red tag.
if not breathing, reposition air way. do they start breathing? Red tag
If they do not start breathing, black tag.

103
Q

What is assessed with perfusion?

A

radial pulse and cap refill.
no radial pulse and cap refill >2 sec, red tag.
radial pulse and cap refill <2 sec, move to mental status

104
Q

What is assessed with mental status?

A

can they follow simple commands?
no - red tag
yes - yellow tag

105
Q

When do you use green tags?

A

walkie-talkie patients

106
Q

What are the site specific disaster zones?

A

hot zone
warm zone
cold zone

107
Q

What is the hot zone?

A

initial site of incident

only personnel with appropriate protective equipment are allowed in hot zone

108
Q

What is the warm zone?

A

decontamination

109
Q

What is the cold zone?

A

where decontaminated victims are triaged and treated

110
Q

What is bioterrorism?

A

deliberate release of viruses, bacteria, or other microbes as weapons

111
Q

What are the primary agents of bioterrorism?

A 
bacillus anthracis (anthrax)
clostridium botulinum toxin (botulism)
Yersinia pestis (plague)
viral hemorrhagic fevers
variola major (small pox)
francisella tularensis (tularemia)
112
Q

What do we have to treat bioterrorism attacks?

A

immediate treatment is limited.
homeland security and CDC has preassembled “push packages” that are delivered within 12 hours after attack if location permits.

Adult Health III - NUR 254 (2 decks)

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