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Foundations 2 > Unit 3- test extras > Flashcards

Unit 3- test extras Flashcards

1
Q

glucose level hyperglycemia…when to notify MD

A

> 240

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2
Q

why polydipsia with DM

A
  • excessive thirst due to dehydration

* also have loss of skin turgor, warm/dry skin, hypotension, and weakness

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3
Q

why polyphagia with DM

A

•excessive starvation due to cells not receiving glucose for energy

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4
Q

why Kussmaul’s respirations during DM

A

•increased respiratory rate and depth (hyperventilation) in attempt to excrete CO2 and acid due to met. acidosis

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5
Q

impaired fasting glucose (IFG)

A
  • pre-diabetes

* 110-125

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6
Q

oral glucose tolerance test (OGTT)

A

•fasting drawn at start
•pt then consumes certain amnt of glucose
•glucose levels obtained every 30 min for next 2 hrs
*must assess for hypoglycemia throughout

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7
Q

glycosylated hemoglobin (HgbA1c) levels

A
  • 4%-6% in non-diabetic
  • 6%-8.5% in diabetic (<7 target for diabetic)
  • best indicator of avg blood glucose for pat 120 days
  • used to evaluate effectiveness of tx
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8
Q

A/E glucagon

A
  • n/v
  • hyperglycemia
  • hypokalemia
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9
Q

hypokalemia s/sx

A
  • hypotension, weak irregular pulse, rep. distress
  • weakness, cramping, hypoactive reflex, paresthesia
  • confusion
  • bradycardia, inverted T waves
  • decreased GI motility (constipation)
  • polyuria
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10
Q

Somogyi effect

A
  • hypoglycemia followed by rebound hyperglycemia
  • If the blood sugar level drops too low in the early morning hours, hormones (such as growth hormone, cortisol, and catecholamines) are released, which help reverse the low blood sugar level, but may lead to blood sugar levels that are higher than normal in the morning
  • tx by dec. intermediate insulin evening dose and having bedtime snack
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11
Q

dawn phenomenon

A

•normal rise in blood sugar as a person’s body prepares to wake up
•In the early morning hours, hormones (growth hormone, cortisol, and catecholamines) cause the liver to release large amounts of sugar into the bloodstream
•For most people, the body produces insulin to control the rise in blood sugar
•If the body doesn’t produce enough insulin, blood sugar levels can rise
*no preceding hypoglycemia

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12
Q

s/sx DKA

A 
•Kussmaul respirations 
•thirst/dehydration
•tachycardia
•BG > 240 mg/dl
•hyperkalemia 
•polyuria (FVD -> hyPOtension)
•fruity breath
•n/v
•visual disturbances
•somnolence (diabetic coma)
*seem like under influence of etoh
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13
Q

tx DKA

A

•hydration (.9%, then .45%)
•insulin (regular) IV (0.1 unit bolus) followed by continuous 0.1 kg/hr
•electrolyte replacement
•monitor K+ and for FV overload
•correct pH w/ NaHCO3
*Hi…E (hydration, insulin, electrolytes)

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14
Q

insulin and K+

A

•insulin drives K+ into cells

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15
Q

major clinical features of HHS

A
  • dehydration (thirst

* altered LOC

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16
Q

rehydration for DKA and HHS

A

•isotonic (.9%) followed by hypotonic (.45%)
-hypotonic drives fluid INTO cells
•monitor I/O and weight
•listen to lungs/bowel sounds

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17
Q

gastroparesis

A

•delayed gastric emptying
•damage to nerves innervating GI system
•complication of diabetes due to damaged vagus nerve when glucose levels too high for long
*important to assess bowel sounds

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18
Q

nurse recognizes that the client’s TSH is a reliable indicator of the efficacy of the levothyroxine Sodium because…

A

•The TSH will return to its normal reference range when an euthryoid state (normal) is re-established

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19
Q

The client who has been taking Synthroid for 3 months. Which condition indicates to the nurse that the drug dosage may need to be adjusted?

A

•difficulty sleeping

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20
Q

Which is the nurse’s MOST IMPORTANT assessment before giving the first dose of levothyroxine (Synthroid)

A

•measure HR and rhythm

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21
Q

TSH levels

A

0.3-5.0 ng/dL

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22
Q

T3 levels

A

70-205 ng/dl

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23
Q

T4 levels

A

4.0-12.0 mcg/dl

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24
Q

RN interventions hyperthyroidism

A
  • Minimize energy expenditure
  • Provide High Calorie Diet
  • Eye Protection for Exopthalmus
  • Monitor Vital Signs, CV Status, ECG and Temperature
  • Admin Anti-thyroid Med
  • Prep for Thyroidectomy or Radioactive Iodine
  • Monitor Mental Status
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25
Q

if pt develops stridor/obstruction s/s after thyroidectomy…

A
  • notify rapid response team

* make sure O2/suction at bedside

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26
Q

dangerous AEs post thyroidectomy

A

•hypocalcemia
•tetany
•s/s of muscle tingling
*due to possible parathyroid removal

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27
Q

A nurse is assessing a client who is 12 hours post-op following a thyroidectomy. What findings are indicative of thyroid crisis?

A

•tremors
•abd pain
•mental confusion
*s/sx similar to hyperthyroidism

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28
Q

A nurse if reviewing the clinical manifestations of hyperthyroidism with a client. What findings should the nurse include?

A
  • weight loss
  • heat intolerance
  • palpitations
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29
Q

The client admitted with hyperthyroidism is fidgeting with the bedcovers and talking extremely fast. What does the nurse do next?

A
  • encourage the pt to rest
  • pt with hyperthyroidism often has wide mood swings, irritability, decreased attention span, and manic behavior
  • accept the client’s behavior, and provide a calm, quiet, and comfortable environment
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30
Q

The nurse reviews the vital signs of the client diagnosed with Graves’ disease and sees that the client’s temperature is up to 99.6° F. After notifying the health care provider, what does the nurse do next?

A

•assess cardiac system completely

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31
Q

risk factors for UTI

A
  • female
  • catheter
  • stool incontinence
  • bladder distention
  • disease states
  • OA
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32
Q

pyuria

A
  • cloudy urine

* > 4 WBC in urine sample

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33
Q

s/sx UTI in OA

A
  • confusion
  • incontinence
  • loss of appetite
  • nocturia/dysuria
  • hypotension, tachycardia, tachypnea (sepsis)
  • fever
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34
Q

presence of glucose, ketones, proteins, nitrates, and leukocyte esterase in urinalysis indicates…

A
  • diabetes
  • fat metabolism (DKA)
  • infection
  • cancer
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35
Q

complications of UTI

A
  • urethral obstruction
  • pyelonephritis
  • severe kidney damage
  • urosepsis
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36
Q

risk factors for pyelonephritis

A
  • OA (esp. w/ BPH)
  • stones
  • spinal cord injury (reflux)
  • pregnancy
  • malformations
  • bladder tumor
  • illness
  • incomplete bladder emptying
37
Q

consequences pyelonephritis

A

•filtration, reabsorption, and secretion impaired
*decreased renal fxn
•septic shock
•chronic kidney dz (r/t fibrosis of kidney)
•HTN (dec. filtration causes fld retention)

38
Q

blood urea nitrogen (BUN)

A
  • breakdown of protein in liver creates by-product that is excreted by kidneys
  • affected by dehydration, infection, chemo, steroids, and liver damage
  • not indicative of UTI, but helpful if chronic
39
Q

normal BUN levels

A

•7-22 mg/dl

*elevated suggests kidney dz and dehydration

40
Q

serum creatinine

A
  • produced due to muscle breakdown
  • kidney dz is ONLY cause of elevated levels
  • specific to KIDNEY
41
Q

normal creatinine levels

A

•0.5-1.2

*elevated suggest kidney dz

42
Q

KUB x-ray

A
  • kidneys, ureters, bladder
  • used to detect calculi (stone), structural abnormalities, stricture, Ca2+ deposits, obstruction
  • pt in supine position
43
Q

diagnostic tests for calculi

A
  • KUB
  • IVP (unless suspect obstruction)
  • CT or MRI (if x-ray insuff.)
  • ultrasound
  • cystoscopy
44
Q

Ditropan

A
  • spasmolytic drug (anti-spasmotic)
  • tx for renal calculi
  • AE of inc. intraocular press use (not good for glaucoma)
  • monitor for dizzy, tachy, retention
45
Q

what intervention for urolithiasis

A

•strain all urine

46
Q

pt has hydronephrosis secondary to calculi. stone removed and post obstructive diuresis is occurring. What intervention should be taken?

A
  • assess urinary output every shift

* monitor electrolytes

47
Q

stone sent to lab to be analyzed for what…

A

•composition

48
Q

DC teaching for pt w/ uric acid calculi the RN should instruct to avoid which type of diet?

A

•high purine

49
Q

pt w/ urolithiasis has chronic UTIs, so likely has which type of urinary stone

A

•calcium oxalate

50
Q

priority after urography

A

•hydration b/c dye can cause dehydration

51
Q

What nursing activity illustrates proper aseptic technique during catheter care

A

•placing collection bag below level of bladder (prevents reflux)

52
Q

interventions to decrease the risk for cystitis

A

•drink 2.5 L fld daily

53
Q

Which nursing intervention or practice is most effective in helping to prevent urinary tract infection (UTI) in hospitalized clients

A

•Re-evaluating periodically the need for indwelling catheters

54
Q

A client is admitted for extracorporeal shock wave lithotripsy (ESWL). What information obtained on admission is most critical for a nurse to report to the health care provider before the ESWL procedure begin

A
  • I take over-the-counter naproxen (Aleve) twice a day for joint pain
  • Because a high risk for bleeding during ESWL has been noted, clients should not take NSAIDs before this procedure
55
Q

what is important about hx before taking BP

A
  • smoking
  • caffeine
  • food
56
Q

high preload and/or afterload

A

•BP higher

*lots of meds work by reducing pre or after load

57
Q

what maintains peripheral vascular resistance

A
  • ANS

* hormones epinephrine/norepinephrine cause vasoconstriction/vasodilation

58
Q

4 mechanisms that help regular BP

A
  1. arterial baroreceptors
  2. regulation of body-fluid volume
  3. renin-angiotensisn system
  4. vascular autoregulation
59
Q

arterial baroreceptors

A
  • located in carotid sinus, aorta, L ventricle and send stretch signals to CNS
  • control BP by altering HR
  • also cause vasoconstriction/dilation
  • short term effect
60
Q

regulation of body fluid volume

A

•properly fxning kidneys retain (hypotensive) or excrete (hypertensive) fluid

61
Q

renin-angiotensin system

A

•vasoconstricts
•controls aldosterone release, which causes kidneys to reabsorb Na+ and inhibit fluid loss
*increases blood volume and pressure

62
Q

vascular autoregulation

A

•maintains consistent levels of tissue perfusion

63
Q

what organs get blood in critical situation

A
  • brain
  • kidneys
  • heart
64
Q

primary (essential) HTN

A
  • most common HTN
  • no known cause
  • results in damage to vital organs caused by medial hyperplasia (thickening) of arterioles
  • end result = MI, stroke, PVD, renal failure
  • short life expectancy
65
Q

secondary HTN

A
  • caused by certain dz states or an adverse effect of some meds
  • tx involves removing the cause (adrenal tumor, med, etc)
66
Q

dz states that can cause HTN

A
  • renal dz
  • RAS- renal artery stenosis
  • Cushing’s syndrome
  • Pregnancy (preeclampsia)
67
Q

drugs that cause HTN

A
  • estrogen

* glucocorticoids

68
Q

isolated systolic HTN (ISH)

A 
•systolic > 140
•diastolic < 90
•major concern for OA
-systolic BP better indicator of risk for heart dz, stroke, PVD as people age
*pulse pressure widens
69
Q

malignant HTN

A

•severe elevated BP that rapidly progresses
•systolic > 200
•diastolic > 150
•age 30-50
*must treat promptly to avoid renal/LV failure and stroke

70
Q

s/sx malignant HTN

A 
•severe headache 
•blurred vision
•dyspnea
•uremia 
*most prevalent in the morning
71
Q

tx malignant HTN

A
  • recognize clinical manifestations
  • admin IV antihypertensives (nitroprusside, nicardipine, labetalol)
  • assess neuro status: pupils, LOC, muscle strength
  • monitor ECG
72
Q

most accurate way to measure BP

A

•arterial

73
Q

CCB vs. ACEI

A

•ACEI prevent vasoconstriction
•CCB cause vasodilation
*same net effect

74
Q

aldosterone receptor antagonists

A

•block action of aldosterone, promoting retention of K+ and excretion of Na
*Inspra

75
Q

beta blockers

A

•lower BP by decreasing CO and blocking release of renin

-decrease pulse AND vasodilate

76
Q

central alpha agonists

A

•decrease BP by reducing PVR and inhibiting reuptake of NE
•not a first line med b/c causes sedation, orthostatic hypotension, impotence
*clonidine (Catapres)

77
Q

hypertensive crisis

A
  • malignant HTN
  • occurs when pt doesn’t follow medication therapy regimen
  • true medical emergency
78
Q

s/sx hypertensive crisis

A 
•severe headache
•extremely high BP
-systolic > 240
-diastolic > 120
•blurred vision, dizziness, disorientation
•epistaxis
79
Q

hypertensive crisis tx

A 
•IV anti-hypertensive
-monitor BP every 5-15 min
•assess neurological status (pupils, LOC, strength)
•monitor ECG
•provide O2
•place in semi-Fowlers
80
Q

The nurse is caring for a patient who has severely elevated blood pressure. What symptom supports this condition

A

•epitaxis

81
Q

What is true about the management of HTN?

A

•lifestyle changes are indicated for persons with HTN

82
Q

The patient has a long history of HTN and has developed heart failure. The nurse would anticipate giving meds to do what?

A

•decrease after load

83
Q

What is NOT considered an influence on BP?

A

•respiratory rate

84
Q

A nurse is working with a newly diagnosed HTN patient who smokes, is overweight, and has never taken medication. What should the nurse take into consideration when educating this patient on lifestyle changes needed to regulate his BP?

A

•the patient should develop small measurable goals to achieve which will be more effective in the long run

85
Q

A patient who enters the ED has an initial BP reading of 160/96. What should the nurse do?

A

•take the BP again to ensure an accurate reading before proceeding

86
Q

hyperkalemia s/sx

A
  • hypotension, weak irregular pulse
  • weakness, restlessness, paresthesia
  • confusion
  • peaked T waves
  • increased GI motility (diarrhea)
  • oliguria
87
Q

hypocalcemia s/sx

A
  • paresthesia
  • muscle twitch/spasm
  • hyperactive DTRs
  • positive Chvostek’s/Trousseau’s
  • dec. HR, hypotension (dec. contractility)
  • hyperactive bowel, diarrhea, cramping
88
Q

major electrolyte imbalance following diuresis…

A
  • hypokalemia

* reason why DKA and HHS tx involves insulin replacement

Foundations 2 (10 decks)

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