Unit one exam - Adult Health two Flashcards
Osteoporosis
what is it? a cellular in which bone loss cause significant decreased density and possible fracture
what causes it? it is known to involve imbalance osteoblast, osteoclast activity
what are the different kinds? primary (type 1 and type 2)
Type 1 estrogen deficiency from the bone Type 2 result from kidneys losing the ability to process vitamin D and lastly Secondary
What does it look like? fragility fractures (hip), increased loss of bone mass, increased bone fragility and increased risk of fractures
what are the etiology and genetic risk?
nutrition deficiency of calcium and vitamin D/ protein deficiency/ Hormone deficiency testosterone or estrogen
how to diagnose it? Lab assessment data is a increased serum calcium, Vitamin D decreased and bone turnover marker not commonly tested
some imaging assessment data is an X-ray of spine and long bones, DXA only as a screening tool, QCT measures volume of bone density, Vertebral imaging, and MRI
fragility fracture
caused by osteoporosis also called a bone attack
Osteomalacia
Bone loss related to the lack of vitamin D
Osteopenia
Loss of bone mass occurs when the osteoclasts are greater than the osteoclastic activity
what are the risk factors of Osteoporosis?
Non modifiable is Family History, age and gender, ethnicity, other chronic diseases and current low bone mass in children
Modifiable
poor nutrition, body weight, substance abuse, and sedentary lifestyle
what does access the pneumonic for osteoporosis stand for
Alcohol use, corticosteroid use, calcium low, estrogen low, smoking, sedentary lifestyle
what would you assess In a patients with osteoporosis
do a complete health history assessment of risk factors and fall risk factors
what is done for a psychosocial assessment of osteoporosis?
Body image, Negative association with women, less independence, Insomnia & Depression, fear of falling
What are the physical assessment and signs and symptoms of osteoporosis
Loss of height as vertebral bodies collapse, progressive curvature of spine ( lordosis, kyphosis, protrusion of abdomen, knees hips flex), low back pain, fractures of forearm spine and hip
Lordosis
excessive inward curvature of the spine
Kyphosis
Outward curvature of the thoracic spine
what is the pharmacological treatment for Osteoporosis
Calcium, Vitamin D, Biophosphonates (dronate), RANKL inhibitor(-mab)
what is the non pharmacological treatment of Osteoporosis
Dietary Management/Nutrition therapy, Lifestyle changes
what you should know about calcium before you take it
take with a meal or within one hour after a meal, adults greater than the age of 5 should take 1000-2000 mg of calcium a day
Adverse effects include hypercalcemia, lethargy, drowsiness, headache, anorexia, nausea, vomiting, increased urination or thirst
Contradicted with people with atrial fibrillation
do not administer with digoxin or calcium channel blockers
What should you know about Vitamin D in relation to treating Osteoporosis
can be taken in combination with calcium
Side effects: nausea, vomiting, poor appetite, weight loss, disorientation, kidney damage and stones
what are the vitamin D levels supposed to look like?
25-80 ng/mL
what should the patient know when prescribed vitamin D and calcium
Increase fluid intake to prevent kidney stones
What should you know about biophosphonates?
AE: nausea, vomiting, abdominal pain, esophageal irritation,
Pt education: take on an empty stomach take on a weekly basis as this can still be as effective as taking the dose daily
what should you know about RANKL inhibitors?
approved for osteoporosis when other lines of treatment are not effective
subcutaneous,
AE: musculoskeletal pain, back pain, general weakness, dyspnea, fatigue
Patient education: this can lower your calcium levels
Diabetes Mellitus
What is it? chronic disorder caused by impaired metabolism vascular complications and neurologic complications
what does It look like? elevated blood glucose level (hyperglycemia)or Decreased glucose level (hypoglycemia)
what causes it? absence of insulin production for type 1 and type 2 is the adequate production of insulin can be a genetic risk
what are the attributes? Polydipsia, polyuria, polyphagia
how do we diagnose it? Glycosolated hemoglobin (A1C) and FBG
what are the nursing interventions for Diabetes Mellitus? preventing injury from hypoglycemia, embracing surgical recovery, preventing injury from peripheral neuropathy, reducing the risk for kidney disease and preventing complications
what is the most important exercise for osteoporosis
walking for 30 minutes 5 times a week
what are the nursing interventions for Osteoporosis
Nutrition therapy, Lifestyle Changes, and drug therapy
what is an example of insulin resistance?
increased waist band size
what are the chronic complications of diabetes mellitus (macrovascular)
coronary heart disease, cerebral vascular disease, peripheral vascular disease
Metabolic Syndrome
precursor to diabetes
what does it look like? visceral obesity, hypertension, Hyperglycemia, elevated triglycerides, low LDL cholesterol
what are the microvascular complications of diabetes mellitus
Nephropathy, Neuropathy, retinopathy
what are some of the additional risk factors of type 2 DM
smoking, physical inactivity, obesity, hypertension, high blood fat and cholesterol levels.
what is the value for FBG for diabetic patients
> 126 mg/dL
What abnormal level means FBG of impaired fasting
100-126 mg/dL
what is the level for Hemoglobin A1C for normal
4%-6%
abnormal range for A1C of Prediabetes
5.4%-6.4% prediabetes
what does greater than 6.5% A1C mean
Diabetes
what is the level of A1c for poor diabetic control
> 8%
what is the reading of HgA1C based upon
in the 3 months or 90 days
when is the HgA1c recommended for diabetic patients
quarterly
what are the pharmacological treatment options for diabetic patients
Insulin, Glucagon, Hypoglycemic, lipid lowering agents (-statins)
what is a surgical procedure for diabetic patients
Pancreas Transplant
what are the signs of hyperglycemia
Hot and dry (dehydrated, kaussmal respirations (fast and deep), mental status altered, tachycardia, Nausea, and vomiting
greater than >250 mg/dL positive for ketones
what are the signs of hypoglycemia
cold and clammy
sweaty, anxious, nervous, irritable, hunger, palpitations, coma,
60-70 mg/dL moderate hypoglycemia
<50 mg/dL severe hypoglycemia
what are the nursing diagnoses related to Diabetes Mellitus
Deficient knowledge, impaired skin integrity, risk for infection, risk for injury, risk for deficient fluid volume, disturbed sensory perception, ineffective coping
Infection
Invasion of body tissue by microorganisms with the potential to cause illness or disease
Immune system
body’a major defense
Pneumonia
what is it? inflammation of the lung parenchyma as a result of infection
what does it look like? fluid accumulate in alveoli and fluid leaks in interstitial fluid, affects ability to breathe increased respiratory rate
why does it develop? from an inflammation of the alveoli air sacs are filled with fluid can also be caused by streptococcus pneumonia
what interventions can treat Pneumonia?
broad spectrum antibiotic, Oxygen, Steroids, Bronchodilators, Mucolytics
What would you educate your patient on?
eat while sitting up in bed do not eat when you are flat in bed, increase the amount of fluid intake (unless contradicted)
What would you do to prevent Pneumonia?
sit up in chair to eat or drink, walking them around if not on bedrest, use the incentive spirometer ordered by the doctor every hour
how do we diagnose Pneumonia?
CHest X-ray or CT scan/ sputum gram stain/ Sputum C & S/ Complete blood count/ Arterial blood gas/ Pulse oximetry monitoring/ Bronchoscopy
what are the 3 factors for transmission of infection
Reservoir, susceptible host, Route and Method
what is the etiology of pneumonia
Germs (bacteria, viruses, fungi)/ bacterial pneumoniae/ Viral pneumoniae/ Aspiration Pneumoniae/ Community-acquired, Hospital acquired/ heathcare associated/ ventilator associated
what type of pneumonia cannot be treated with antibiotics
Viral pneumonia
what happens to older adults when they have pneumonia
Confusion (cognition change)
Who are at risk of Pneumonia
Compromised immune system/ patients with chronic conditions including cardiac and respiratory conditions/ smokers and alcohol or drug use
What are the clinical manifestations of a person with pneumonia?
Fever, apnea, dyspnea, Tachypnea, Cough, Hypoxia, Chills, Crackles/ Decreased breath sounds, Pleuritic chest pain, Cyanosis
what should happen after administering medication for the fever?
it should disappear after 48-72 hours
Pleuritic pain
Intense, stabbing, sharp pain when inhale and exhale
what are the nonpharmacological therapies used to treat Pneumonia in patients
Supportive care (airway management, Incentive spirometry, Suctioning, Cough, deep breathing, Frequent positional changes, Chest physiotherapy such as percussion/ vibration/ and postural drainage
what is the nursing process for pneumonia?
Adequate assessment and implementation of medical and nursing interventions is vital to the healing process/ frequent pulmonary assessments and aggressive interventions to help to prevent problems/ restoring and maintaining mobility improves ventilation and helps to mobilize secretions/ promoting adequate fluid intake is necessary to help liquify secretions
Chronic Obstructive Pulmonary Disorder
what is it? collection of lower airway disorders that interfere with airflow and gas exchange
what do these disorders include? Emphysema and chronic bronchitis
what causes it? the interference of airflow and gas exchange it can also be caused by smoking
what does it look like? barrel chest and clubbing of the fingers and a 90% on room air
how is it diagnosed? spirometry test or ABG
Emphysema
destructive problems of lung elastic tissue that reduces its ability to recoil after stretching, leading to hyperinflation of the lung
Chronic bronchitis
inflammation of the bronchi and bronchioles characterized by increased mucus and chronic productive cough
Myocardial infarction
what is it? most serious acute coronary syndrome it is the end resylt of untreated angina
what causes it? myocardial tissue is abruptly and severely deprived of oxygen
what interventions can the nurse use?
what are the clinical manifestations?
what are the key features of Myocardial Infarction? NSTEMI / STEMI
Heart failure
what is it? general term for the inability of the heart to work effectively as a pump and is usually a chronic health problems with acute episodes
what causes it? various acute and chronic cardiovascular problems
what interventions can the nurse use? Drug therapy (ACE Inhibitors, Beta blockers, Diuretics, Nitrates and digoxin) Nutrition therapy ( fluid/sodium restriction), CPAP, CRT cardiac resynchronization therapy (biventicular pacing)
what can they use to diagnose? CXR, Echocardiography, Radionucleotide studies, MUGA
what are the lab tests that are drawn for heart failure? Serum electrolytes, Hemoglobin and hematocrit, BNP, Urinalysis, ABGs
what are the clinical manifestations?
what would you educate the patient on?
what would be the attributes of this? Left Sided Heart failure, Right sided Heart failure, and High-output Heart failure
Coronary artery disease
what is it? disease affecting the arteries that provide blood, oxygen, and nutrients to the myocardium; also known as coronary heart disease or simply heart disease
what causes it? atherosclerosis is the primary factor in the development of CAD/ metabolic syndrome or called insulin resistance
what interventions can the nurse use?
what are the clinical manifestations?
what medications could the nurse use to treat the persons condition?
what are the mechanical properties of the heart?
Cardiac output, heart rate, stroke volume, preload and afterload
what is the Pharmacological treatment for acute coronary syndrome
MONA/ P2Y 12 platelet inhibitors/ Anticoagulation therapy/ Statin therapy/ Antihypertensives (Beta, ACE, Calcium channel blockers)/ Invasive non-surgical procedure (Percutaneous coronary intervention)/ Surgical intervention (coronary artery bypass graft surgery)
what is the abbreviation MONA stand for and what is it used for?
Used for acute coronary syndrome
Nitroglycerin first (check blood pressure first)/ Morphine sulfate (BP)/ aspirin/ oxygen
Angina Pectoris
what is it? chest pain caused by a temporary imbalance between the coronary arteries’ ability to supply oxygen and the cardiac’s muscles’s demand for oxygen it is the stable chest pain
what does it look like? PREDICTABLE chest discomfort that occurs with moderate to prolonged exertion in familiar pattern
what causes it? inadequate supply of oxygen caused by Coronary artery disease
what does the nurse educate the patient on? when to take nitroglycerin
what medications are provided for the patient? Nitroglycen, drug therapy and rest
what are the clinical manifestations? Coronary artery diseae
what is the etiology or pathophysiology of why it occurs? lack of adequate oxygen supply to the heart
Atypical angina
nausea or vomiting/ jaw, neck, or upper back pain/ pain or pressure in the lower chest or upper abdomen/ shortness or breath/ fainting/ indigestion/ extreme fatigue
Cardiac catheterization
Coronary circulation
Chronic unstable angina or acute coronary syndrome
what is it?chest pain or discomfort that occurs at rest with exertion and causes severe activity limitation
what causes it?
what does it look like? lasts longer than 15 minutes can be poorly relieved by rest it can present with st changes on a 12 lead ecg but does not present with troponin/ the pain can occur arm shoulder jaw or neck can feel like a vise like squeeze or smothering or burning
what are the symptoms associated with this condition? decreased tissue perfusion, diaphoresis and N/V
what interventions are needed?
what would you educate your patient on? it is not predictable and it can happen at rest/ cannot be relieved by NTG or requires excessive dose of NTG
what are the cardiac labratory tests
Troponin T and I, Serum lipids (total cholesterol, triglycerides, HDL, LDL)
DIgoxin toxicity
what regulates Blood Pressure
Autonomic Nervous System/ Kidneys/ Endocrine system/ systolic and diastolic blood pressure and baroreceptors
Hypomagnesium
ventricular disarrhthmias
Digoxin toxicity
Nausea and Vomiting and dizziness and halo lights confusion fast heart beat
Hypercalcemia
shortened qt interval and causes atrioventricular blocks/ digitalis hypersensitivity and cardiac arrest
LDL value
lower than 130 mg/dL
HDL
45 mg/dL and greater
what are the diagnostic test for cardiovascular conditions
Pa and Lateral CXR (heart failure), Cardiac Catheterization, Echocardiography (HF)(CAD), Angiography (arteriography)(CAD), ECG (CAD)
Angiography
a coronary angioplasty with stenting is referred to as percutaneous coronary intervention
Left-sided Heart failure
or CHF the typical causes are hypertension, coronary artery disease, and vascular disease / not all cases involve fluid accumulation and the 2 types are systolic and diastolic
Ejection Fraction
percentage of blood ejected from the heart during systole
Systolic heart failure
Ineffective pumping of the ventricles below 40% EF
Manifestations of systolic Heart Failure
Symptoms of inadequate tissue perfusion, pulmonary
Diastolic Heart failure
it is from impaired filling of the ventricles or Stiffening
Right Sided Heart failure slide
caused by Left ventricular failure, Rigth ventricular MI, Pulmonary Hypertension / / the right ventricle cannot empty completely / / Increased volume and pressure in venous system and peripheral edema
High Output heart failure
Cardiac output remains normal or above normal / / caused by increased metabolic needs or hyperkinetic conditions such as septicemia, High Fever, Anemia, Hyperthyroidism
what are the compensatory mechanisms for cardiac output
Sympathetic nervous system/ RAAS / Other chemical responses / myocardial hypertrophy
what are the signs and symptoms of Left sided Heart failure
Dyspnea, exertional dyspnea, paroxysmal nocturnal dyspnea, Fatigue, Weakness, Arm Heaviness, Chest Pain or palpitation, skipped beats, fast rate
What are the signs and symptoms of Right sided Heart failure
JVD, increased abdominal girth, dependent edema, hepatomegaly, Hepatojugular reflux, Ascites, Weight more reliable indicator of fluid overload
what are examples of hemodynamic monitoring for heart failure
PAP / PAOP and it is a direct assessment of cardiac function and volume status
what is a pneumonic for treating congestive heart failure
unload fast
Upright position, Nitrates, Lasix, Oxygen, ACE inhibitors, Digoxin, Fluids (derease), Afterload (decrease), Sodium restriction, test (dig level, ABGs, Potassium level)
what is the surgical treatment for Heart failure
Heart transplantation, Ventricular Assist device, Left ventricular surgical reconstruction
what is the first clinical symptom that the patient has chronic heart disease
Unstable Angina
what are the key features of Acute Coronary syndrome
new-Onset angina, Vasospastic angina, Pre-Infraction angina
STEMI
total occlusion of coronary artery
NSTEMI
transient or partial occlusion of your coronary artery
what is a coronary artery bypass graft Surgery
it is indicated for when patients do not respond to medical management of Coronary artery disease or when disease progression is evident
what is a percutaneous coronary intervention
emergency option for treatment after an acute MI instead of fibronlolytic therapy or after fibronolytic therapy/ catheter through peripheral artery into the occluded coronary artery to compress the plaque this can be used with a multiple vessel disease preferred over bypass surgery done under local anesthetic (less risks)
how long do you push morphine sulfate through IVP
4-5 minutes
what interventions can the care team implement to prevent the arteries from narrowing after 6 months or occlusion of the percutaneous coronary intervention
put them on a platelet therapy and anticoagulation therapy
what is a common complication after a PCI
Hypokalemia
who are the candidates for CABG
angina with greater than 50% occlusions of the left main coronary artery that cannot be stented/ unstable angina with severe two-vessel disease in which stents could not be introduced/ Ischemia with heart failure/ acute MI with cardiogenic shock/ signs of ischemia or impending MI after angiography or PCI/ valvular disease/ Coronary vessels unsuitable for PCI
