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Final Review NUR 135
Final study guide for Nursing 135
| Question | Answer |
|---|---|
| How does COPD rank among leading causes of death in U.S.? | 4th |
| What is the basic definition of COPD | Limited airflow to the lungs |
| COPD is an umbrella term for what diseases? | Emphysema & Chronic Bronchitis |
| What genetic abnormality deficiency could cause COPD? | Alpha 1 Antitrypsin (A1A) |
| What does A1A do? | Protects the lungs; without this, natural body-made enzymes would attack the lungs |
| What causes Chronic Bronchitis? | Constant irritation, burn, that causes inflammation to the bronchi & bronchioles in the lungs |
| How is Chronic Bronchitis defined? | Presence of cough & sputum for at least 3 consecutive months, every year for two years |
| How does Emphysema develop? | Through constant exposure to an irritant |
| What happens to the alveoli with Emphysema? | They lose elasticity and are unable to close out and push out CO2 after exhalations |
| What's the difference between Chronic Bronchitis & Emphysema? | CB deals with bronchi & bronchioles; Emphysema deals with the alveoli |
| How do pts with Emphysema become barrel-chested? | The lungs lose elasticity and remain hyper-exteneded; over time, the ribs remain outward |
| How is COPD diagnosed? | CHAPP; Chest x-ray, History, ABG's, Pulmonary Function Test (PFT), & Pulse Oximetry |
| What is the management of COPD? | -High Fowler's as long as pt can tolerate it -TCDB -Use IS -Teach diaphragmatic breathing -Teach pursed lip breathing -May need to breath in tripod position -Upon inspiration, hold breath for once second and then release to facilitate gas exchange |
| What do bronchodilators do? | Relaxes smooth muscles in bronchioles and opens airways |
| How do you know if the correct dosage of corticosteroids is right when treating COPD? | The pt will develop Cushing's |
| What is asthma? | Abnormal airway condition characterized by reversible inflammation |
| What part of the lungs are affected with asthma? | Bronchioles are affected by the narrowing of airways & become hyper responsive to the the point of spasming |
| With asthma, what is produced in the bronchioles? | Mucus with edema present |
| What is mild asthma? | S/S occur less than twice a week |
| What is moderate/sever asthma? | Always having some sort of symptoms with frequent asthma attacks |
| With inhaler/neb use for asthma, how soon should you see some improvement? | 15 minutes after administration |
| When having an asthma attack without any response to usual treatments, when should you seek medical attention? | 30 minutes |
| What meds are used for acute asthma attacks? | Short acting bronchodilators such as Albuterol |
| How would asthma be treated in the ER? | With IV meds |
| how do you use an inhaler? | 1. Shake it 2. Couple of deep breaths, then insert it 3. Breath in as inhaler is depressed 4. Hold breath for 10 seconds 5. Wait 1 minutes before each puff; usually 2 puffs ordered |
| What is a peak flow meter? | Pt blows as hard as they can 3 times and highest number is recorded |
| What is Tuberculosis (TB)? | An infectious disease commonly caused by Myobacterium Tuberculosis |
| What size must a droplet be to be considered airborne? | Less than 5 microns |
| What is the center point of granulomas of TB called? | Ghon tubercle |
| What is used in a TB (Mantoux) test? | Purified protein solution of 0.1cc |
| What is a positive TB skin test result for the general public? | 10mm induration |
| What is a positive TB skin test result for the immunocomproised? | 5 mm induration |
| How long does it take to complete a sputum culture? | 2-4 weeks |
| How long does it take to treat an active infection of TB? | 6-12 months; if person is positive but not actively infected, they are given INH for a few months? |
| In the hospital, what type of room is a TB pt put in? | A negative pressure room |
| What do you wear on your race before entering an airborne precaution room? | A N95 respirator mask that you have to be fitted for |
| What does a Pulmonary Function Test do and how is it performed? | -Assess lung function -Pt breathes into tube a series of exhalations/inhalations & machine measures amount of oxygen/carbon dioxide going in & out -Pts shouldn't smoke 4-6 hrs before test -Some pts should abstain from using inhalers 24 hrs before test |
| What do ABG's measure and how is it performed? | -Measures pH and CO2 in arteries -Painful -Radial artery used, insert needle at 90 degree angle & aspirate blood |
| When is a pulse oximetry not reliable? | When the pt has high carbon monoxide levels |
| What should you always check for with a CT Scan? | If pt is allergic to dyes |
| What is important to remember with a pt before they undergo an MRI? | If they have metal in their bodies or patches on their bodies |
| What is the KEY test for finding a pulmonary emboli? | Lung Scan (Ventilation Perfusion Scan) |
| When is the best time to do a sputum study? | In the morning |
| What are nursing considerations for a bronchoscopy? | -Pt must sign an informed consent -Must be NPO 8-12 hours -RN is responsible on educating pt on test and expectations -Dentures must be removed |
| What is atropine used for? | Bronchoscopy- used to dry up secretions in the lungs |
| What does atropine block? | It blocks parasympathetic nerves allowing sympathetic nervous system to takeover; it's a cardiac drug |
| What is used in a bronchscopy for conscious sedation? | Versed |
| What is xylocaine spray? | It's a spray used to numb the throat and suppress the gag reflex. It can least up to three hours. |
| After a bronchoscopy is done, how long must a pt remain NPO? | Until the gag reflex comes back which could take 2-3 hrs |
| If a pt cannot sit up for a thoracentesis, how are they positioned? | Lying down on the unaffected side with the HOB elevated 30-50 degrees |
| Post-op for a thoracentesis, what tp of dressing is applied? | An air occlusive dressing, not gauze because gauze allows for air flow |
| What are complications of thoracentesis? | -Pneumothorax (collapsed lung; most common) -Hemothorax (blood enters space and collapses lung) -Punctured lung a.e.b. pin-tinged or red & bloody sputum |
| What illness has an organism leading to inflamed lungs, leading to exudates in the alveoli? | Pneumonia |
| Who is at risk for the worst s/s of pneumonia? | An immunocompromised person |
| What is another name for aspiration pneumonia? | Lobar pneumonia- a segment or entire lobe is affected by pt swallowing something that has entered the lung |
| What color is sputum from a person with pneumonia? | Yellow, blood streaked, rusty colored |
| What does pneumonia look like on a chest x-ray? | White, splotchy dots |
| If a pneumonia pt continues to spike a high temp of 104-105, what study is done | Blood cultures are done to see it it's spread, looking for sepsis |
| What is in the same family as penicillin? | CEF's; ceftriaxone, cefdinir; if allergic to cillin's, could be allergic to CEF's |
| What should you always educate a female pt about when they are on penicillin? | Oral contraceptives aren't as effective |
| How are mycin's given? | -PO -IV |
| How are mycin's NOT given? | IM, because it would be too painful |
| Since mycin's are stronger, what can this lead to? | GI bleeding by irritating the lining of the intestines; could also lead to liver toxicity |
| What does mycin potentiate? | Coumadin (anticoagulant) |
| Name a long acting beta 2 agonist? | Terbutaline |
| What is the definition of peripheral vascular disease? | A disease of blood vessels outside of the heart & brain |
| What is arteriosclerosis? | The hardening & thickening of the walls of the arteries |
| What is atherosclerosis? | A type of arteriosclerosis that involves the buildup of fat & fibrin on the walls of the artery |
| With atherosclerosis, what does plaque formation affect? | The intima (innermost layer of the artery) of the large and medium arteries mostly |
| Where does plaque tend to accumulate in the arteries? | Where arteries biforcate |
| What are 2 types of lesions involved with atherosclerosis? | Fatty streaks and fibrous lesions |
| What type of lesion tends to be yellow & smooth, protrude slightly into the lumen of the artery, buildup but not obstruct, composed of lipid & elongated smooth muscle cells, found in ppl of ANY age, don't have s/s but considered a 'good' lesion to have? | Fatty lesions |
| What type of lesion is white to whitish yellow, composed of lipids, collagen, plasma components, are considered to be the 'bad' plaque, builds upon itself, obstruction is irreversible and only made better by angioplasty and not meds? | Fibrous streaks |
| What does carbon monoxide to do oxygen carried by hemoglobin? | Kicks them off |
| When gangrene occurs by severe obstruction, where is it most commonly seen? | The toes because they are the most distal |
| What are the s/s of intermittent claudication? | -Aching & cramping of the legs during ambulation because muscles aren't getting enough blood flow -Pain will usually stop 1-2 minutes after ambulation has ceased -Seems to be worse at night -Lowering the legs tends to make this better |
| If a carotid artery becomes blocked, what would you feel? | -Numbness, tingling & weakness on the side of the body oposite of the artery block, possible mini and full-blown strokes(TIA, CVA respectively), dizziness, and confusion |
| A blockage in the coronary artery could result in? | Angina & MI |
| What is a Doppler UTS and what is used with it at times? | It detects quality of peripheral blood flow to measure the pressure the blood flow in the legs and is used in conjunction with angiography |
| If a pt is found to have high cholesterol, what are they put on? | 'Statin' meds |
| What is an endarterectomy? | Used to 'clean out' artery and done mostly on the carotid artery. Considered a high risk procedure because plaque can break off and become an embolus |
| Why should you not use ice on a leg experiencing intermittent claudication? | Because it causes vasoconstriction |
| What is a thrombophlebitis (aka venous thrombosis)? | Inflammation of the walls of the vein & the presence of a clot in the flamed area |
| What is a phlebitis? | Inflammation of a vein without a thrombus |
| What is a phlebothrombosis? | A clot in the vein without inflammation |
| What is venous stasis? | It happens when blood collects & stagnates in the lower leg due to chronic venous insufficiency |
| What is a thrombus? | A clot due to clumping of platelets |
| What could happen when a thrombus get very large? | It could obstruct a vessel completely or break off, become an embolus and travel |
| Why does a DVT becomes red & swollen? | Because veins are supposed to return blood to the heart & due to a DVT, blood just accumulates and can't get back to the heart |
| What thrombus tends to be small, can dissolve on its own and doesn't tend to break off? | A thrombus in a superficial vein |
| What is a venogram? | Dye is injected into the vein, pics are taken to look at the perfusion of the legs and veins |
| How long is a pt on anticoagulant therapy? | They are on infusion 5-7 days to keep clot from getting larger& to prevent new ones from forming |
| How is Coumadin given? | It's given PO; pt may have to stay on med for 3+ months after diagnosis of DVT |
| Name 3 thrombolytics. | TPO, Urokinase, Streptokinase |
| If a pt doesn't qualify for thrombolytics, what do they have to undergo then? | Thrombolectomy |
| What are the contraindications of anticoagulant therapy? | basically anything that could rupture, has had trauma, or is recently healing: aneurysms, alcoholism, recent or impending surgery, severe renal or hepatic disease, infections, recent delivery of a baby |
| What does alcohol do with Coumadin? | It interferes with the way it works |
| What are leg ulcers mainly due to? | Chronic venous insufficiency |
| How does a leg ulcer occur? | Blood stagnates and can't be returned to heart and increases pressure in the area it's affecting. This can lead to compression of the arteries in the area; tissues don't get O2 and metabolic wastes aren't removed, eventually cells |
| What are s/s of arterial insufficiency? | Impaired blood flow, intermittent claudication, toes mainly affected, extremity tends to be cold,pale &numb, pain is better when leg dangles, ulcers tend to be large, irregular and superficial |
| What is the hallmark symptom of arterial insufficiency? | Intermittent claudication |
| What are s/s of venous insufficiency? | Aching & heavy feeling leg, brownish discoloration, swelling, extremity tends to feel warm, elevating leg tends to help with pain, avoid crossing legs & dangling, avoid constrictive clothing. |
| Which are higher up, venous or arterial ulcers? | Venous |
| What are four types of debridement? | Surgical, Nonselective, Meds, Hyperbaric Oxygenation |
| What insufficiency does gangrene usually result from? | Arterial |
| What is rheumatic endocarditis? | The endocardium (inside layer of the heart) is infected; rheuatic fever usually follows a strep throat infection and can lead to rheumatic endocarditis |
| What does rheumatic endocarditis mainly affect? | The valves in the heart- nodules form around or in the valves; can affect the way the valves open or close and lead to heart failure |
| What are s/s of rheumatic endocarditis? | Sore throat & pus pockets on the throat; usually a high fever from the strep, s/s of valve problems (murmurs), RA symptoms may develop, chorea may develop (rapid jerky movements of the face and extremities in severe cases). |
| How is rheumatic endocarditis diagnosed? | Throat culture (strep & rapid strep), echocardiogram, and a pt with no history of murmurs who now has a murmur |
| What is the treatment for rheumatic endocarditis? | Bedrest, antibiotics for the strep, corticoid steroids for the inflammation, aspirin for the pain |
| What is infective endocarditis? | The inside layer of the heart becomes infected but it's NOT CAUSED BY STREP. |
| Who are at greater risk for endocarditis? | Ppl with valve disorders |
| What forms as a result of the infection to the endocardium? | Platelets, fibrin and blood cells all cluster together to form tiny clots |
| What are Osler Nodes? | Very small painful nodes that form on the pads of fingers and toes with infective endocarditis |
| What are Janeway lesions? | They look like discolorations in the palms, fingers & hands; a s/s of infective endocarditis |
| How is infective endocarditis diagnosed? | Through a blood culture and echocardiogram |
| What is the definition of congestive heart failure? | Heart is failing and not adequately pumping; the amount of blood coming out is decreased and tissues aren't getting perfused adequately enough |
| What type of CHF is more common? | Systolic |
| What are causes of CHF? | CAD, MI, HTN, Valve Diseases, Hyperthyroidism |
| What is the lab value for BUN? | 10-20 |
| What is the lab value for creatinine? | 0.7-1.4 |
| What is the lab value for BNP? | 1-200 |
| What does it mean when the BNP increases? | The higher the level is, the worse CHF is |
| What measures the ejection fraction of the heart to see how much blood is pumping though the ventricles? | An echocardiogram, also used to diagnose CHF |
| What is looked at to see if atherosclerosis will lead to CHF? | Stress test & cardiac catheterization |
| What 5 meds are used to manage CHF? | ACE Inhibitors, Beta Blockers (olol), Diuretics, Cardiac Glycosides, Calcium Channel Blockers |
| What do ACE Inhibitors do? | They inhibit the conversion of A1 to A2 and reduct eh amount of aldosterone in the body |
| What do Cardiac Glycosides do? | They help a failing heart be more strong with what it has left tow work with by slowing it down and strengthening the force of it's contractions |
| What is the therapeutic window for Digoxin? | 0.5-2ng/ml |
| What potentiates Digoxin? | Low potassium |
| Before you administer Digoxin what must you do with the apical heart rate? | Assess it for one minute |
| When can you hold Digoxin? | When there is a fib present and the HR is less than 60 bpm |
| How many grams of Na should a cardiac pt be given? | 2-3 grams |
| Are there fluid restrictions in regards to a pt with CHF? | Yes! The normal amount for a person is 2-3 liters, a CHF pt needs to stay on the low end of that level. |
| What sort of weight gain should be reported with a CHF pt? | More than 2-3lbs in a day or 5lbs in a week |
| How can Lasix affect Digoxin? | It can drop the potassium level |
| ACE inhibitors can lead to hyperkalemia or hypokalemia? | Hyperkalemia |
| What is angina pectoris? | Pain/pressure in the chest caused by inadequate blood flow through the coronary arteries; with decreased blood flow, there is a lack of oxygen and this leads to ischemia |
| What is the main cause of angina pectoris? | Artherosclerosis, restricting blood flow; once stress appears, so does angina pectoris |
| What are some s/s of the chest pain of angina pectoris? | -Physical exertion -Exposure to cold -Eating a heavy meal -Emotional stress/reaction |
| What are the two types of angina? | Stable and unstable |
| What is stable angina? | Predictable pain that goes away |
| What is unstable angina? | Very unpredictable that has pain lasting longer than usual and pain can occur while at rest |
| What kind of EKG is used to measure the electrical activity of the heart? | 12 lead |
| What does a lipid panel have to do with CAD? | It's done to diagnose the risk factor of CAD |
| If a pt has a positive stress test, what is done next? | Cardiac catheterization where the blockage is visualized and identified |
| What is the main treatment for angina pectoris? | To decrease oxygen demand on the heart and increase supply of O2 to the heart |
| What is the first line of meds given for angina pectoris? | Nitrates in pill or spray form |
| When a pt is in pain from angina pectoris, what steps are taken? | -Assess them -Do VS -Listen to lungs & heart -Then administer med |
| How many doses of nitro do you give? | 3 is the max |
| What is the BP standard that you should assess for before giving each dose of nitro? | BP must be 90+ systolic |
| What is a common side-effect of nitro? | Headache |
| What is the difference between Beta 1 & Beta 2 blockers? | Beta 1 blockers affect the heart while Beta 2 blockers affect the lungs- both relax smooth muscles |
| What do Beta Blockers do? | They decrease HR, force of contraction and rate of AV conduction |
| Because some beta blockers are not cardio selective, who should not take these? | COPD or asthma pt shouldn't take Inderal for example because it will worsen their respiratory problems |
| What is a big reason men are non-compliant on beta blockers? | Because it decreases circulation enough for them to be impotent |
| Before giving beta blockers, what must you check first? | The pt's BP to make sure they aren't hypotensive since it decreases BP |
| What do calcium channel blockers do? | They block calcium from entering cells in cardiac and smooth muscles helping the coronary vascular smooth muscles to relax, dilating these arteries; it also slows down conduction between SA and AV node, slowing down the HR some |
| What are the calcium channel drugs? | *Very Nice Drugs -Verapanul -Nifedine -Diltiazem |
| What do anticoagulants do? | Prevent clot formation of arteries |
| What do antiplatelets do? | Prevent platelet aggregation |
| With Lovenox, what's looked at more, PT time or platelet count? | Platelet count |
| When an area of the heart doesn't get enough blood flow, how long can it take to die? | 20-45 minutes |
| What is the CKMB-isenzyme, when does it peak and return back to normal? | It's specific to the heart that increases with injury to the the heart. It peaks 24hrs after injury and returns to normal in about 2-3 days |
| What is Troponin I's normal lab value and when does it peak and return to normal? | 0.01-0.5 Elevates within 3-4hours of injury and it can stay elevated as long as 1-3 weeks |
| What is the dosage of aspirin given for an acute MI? | 162-325mg |
| What does morphine doe? | -Relieves anxiety -Takes care of pain -Dilates vessels -Relieves workload of the heart |
| Angioplasties can be performed on those that can't use what? | Thrombolytics |
| What can be used along with angioplasty? | Stents |
| What does a stent do? | Provides support to an artery but can get clogged again |
| How much drainage is expected within the first 24hrs after a neck dissection? | 80-120ml |
| How much drainage should raise a flag if under 24hrs after a neck dissection? | 300ml |
| What does albumin do in the body? | It's produced in the liver and maintains the colloidal osmotic pressure that keeps fluids where they should be; if pt has low level, you could expect some swelling in the body |
| What is the lab value for ALT? | 5-35 units |
| What is the lab value for AST? | 10-40 units |
| What is the lab value for LDH? | 100-200 units |
| What does a high level of bilirubin indicate? | A possible stone |
| In association with the liver, what does a high level of ammonia indicate? | Hepatic disease |
| What are the pancreatic enzymes? | Amylase- breaks down carbs Trypsin- breaks down protein Lipase- breaks down fat |
| What is acute pancreatitis? | A medical emergency; a blockage that occurs very fast and s/s manifest rapidly |
| What is chronic pancreatitis & when is pain noticeable? | Not a total obstruction, damage is done slowly over time; pain is noticed after alcohol or eating a heavy meal, can get worse when pt lays down |
| What is the referred pain for pancreatitis? | Left shoulder pain |
| Can alcoholism lead to pancreatitis? | Yes |
| What color will vomit be with pancreatitis? | Dark green, brown color |
| If bilirubin begins to elevate, what will be seen physically? | Jaundice |
| What two signs are looked for with pancreatitis? | Cullen sign- bluish discoloration to the umbilicus Turner's sign- bluish discoloration to the flank area |
| Will pt with pancreatitis show hyper- or hypocalcemia? | Hypocalcemia with the following symptoms: Tetany Muscle spasms Parasthesia Steatorrhea |
| What would a WBC count be with pancreatitis? | Greater than 12,000 |
| What is the normal lab value of Amylase? | 60-120 |
| What is the normal lab value of Lipase? | 40-140 |
| What used to be the drug of choice for treating pancreatitis? | Demerol |
| What used to be contraindicated to treat pancreatitis but is okay now? | Morphine |
| What drugs are used to treat pancreatitis? | Demerol Morphine H2 Blockers Antacid Enzyme replacement such as Viocase |
| What surgical method is used to treat pancreatitis other than gallstone removal? | Pancreaticojejunostomy- anastamose the pancreatic duct to the jejunum; it allow it to drain form the pancreas to the jejunum |
| When managing pancreatitis, what s/s should you observe that indicates hypocalcemia? | Trousseau's sign and Chvostek's sign |
| What does bile do? | It breaks down (emulsifies) fat |
| What causes cirrhosis of the liver? | *HAA Hepatitis Alcoholism Alcohol abuse |
| What are early s/s of cirrhosis? | -Asymptomatic at first -Fatigue -Anorexia -Swelling -Weight loss -Nosebleeds -Bleeding gums |
| What are late s/s of cirrhosis? | -Jaundice because bile isn't metabolized adequately -Petechiae -Easy bruising |
| What is the normal lab value of bilirubin? | 0-0.9 (start seeing jaundice at 2.5) |
| Along with PTT and platelet count, what else is looked at before a liver biopsy is done? | PT time |
| After a liver biopsy is done, how should the pt lie? | Place the pt on the right side with a pillow under the intercostal margin and pt lays i that position for a few hours |
| What is portal hypertension? | It's the main complication of cirrhosis; it can develop from all the scar tissue that impedes the blood flow through the liver; if blood can't flow through, it will back up and into the esophagus and spleen |
| What is ascites? | Can result from hypotension and from liver's inability to make albumin; liver metabolizes aldosterone and if it can't , then it tends to stay in the body and make you retain sodium and water compounding ascites. |
| What are esophageal varices? | Stems from portal hypertension, increases the tension in the veins in the esophagus and they dilate, bulge and bleed |
| How many pts with cirrhosis, have esophageal varices? | 1/3 |
| How many pts with esophageal varices may not make it through an episode? | 30%-50% |
| What is variceal ligation? | A management therapy for esophageal varices where, using an endoscope, elastic bands are put on the varices to strangle them which keeps the;m from bleeding or growing further |
| What is endoscopic injection therapy? | A management for esophageal varices in which the varices are injected with a solution that will shrink them; risks of bleeding are minimal after procedure is done |
| How long can an ST-Blakemore tube stay in? | No longer than 48 hrs and it will be done while pt is in ICU |
| Is pressure important with an ST-Blakemore tube? | Yes, too much pressure can cause esophageal necrosis |
| What is the ultimate cure for cirrhosis? | A liver transplant |
| What is hepatic encephalopathy? | A very late complication of cirrhosis that occurs with PROFOUND liver failure |
| What is the definition of hepatic encephalopathy? | Liver metabolizes substances and if not working properly, these metabolites an build up in the body, enough so that it can lead to a life threatening hepatic coma |
| What are severe s/s of hepatic encephalopathy? | *CSS Coma state Seizures Slow and sluggish movements |
| What is lactulose? | A sugar that is broken down into acid by bacteria in the colon that draws water into the colon & softens stools; ammonia also moves from the blood into the colon & in pts with cirrhosis, it lowers ammonia in the blood thereby reducing the mental changes |
| With regular cirrhosis, do you increase or decrease protein? | Increase |
| With hepatic encephalopathy, do you increase or decrease protein? | Decrease, protein elevates ammonia |
| What is the thyroid, where is it and what does it do? | The thyroid is a very vascular, butterfly shaped gland located in the front of the trachea that releases 3 hormones: Thyroxine (T4), Triiodothyronine (T3) and Calcitonin |
| What do T3 & T4 do? | They control cellular metabolism and tell the body how fast to convert things into energy |
| What must the body have to make thyroid hormone? | Iodine and it's found in: -Table salt -Seafood -Some dairy products |
| What does the pituitary gland release? | TSH (Thyroid Stimulating Hormone) |
| When does the pituitary gland release TSH? | When it senses a change in the thyroid, it releases TSH which stimulates the thyroid to make and release more thyroid hormone |
| What is the main purpose of Calcitonin? | To control or lower blood calcium levels by sending calcium into the bone; too high a level makes calcitonin to kit it into the bones to lower it or simply get it out of the blood stream |
| What is another name for hyperthyroidism? | Grave's Disease |
| What is hyperthyroidism? | It's having too much thyroid hormone making metabolism very fast; body is in overdrive |
| What is it called when the thyroid enlarges? | A goiter and it could become toxic |
| Among whom is hyperthyroidism seen more frequently? | Women ages 20-40 |
| When diagnosing hyperthyroidism, what can you hear on a goiter if it's present? | A bruit |
| To diagnose hyperthyroidism, which thyroid hormone is looked at specifically? | T4 |
| What is the cortisol levels during a 24hr cycle? | 0800- 5-23 micrograms/dl 1600- 3-13 micrograms/dl |
| What is the normal level for T4? | 0.9-1.7mg/dl Hyperthyroidism will be greater than 1.7 |
| What is the normal level for TSH? | 0.4-6.15miliunits/ml Hyperthyroidism will make it low |
| What is the treatment for hyperthyroidism? | *RAT -Radioactive iodine -Antithyroid drugs -Thyroid surgery |
| What are the antithyroid meds? | -Propylthiouracil (PTU)-blocks synthesis of conversion of T3 to T4; s/e of agranulocytosis -Methimazole (Tapazole)- blocks synthesis of thyroid hormone; more toxic than PTU -Potassium iodide (Lugol's solution)- suppresses release of thyroid hormone |
| What is agranulocytosis? | Type of WBC that is drastically decreased s a result of taking PTU; client is at risk for infection |
| What is Lugol's solution? | It's given before thyroid surgery to decrease blood loss/hemorrhage; it's bitter and should be administered with water or OJ and should be sipped with a straw because it will stain teeth |
| What is the next step if meds don't work? | Pts will be given radioactive therapy known as I-131 which is administered by a radiologist to destroy the overactive thyroid cell |
| Is the pt who undergoes radioactive on any contact protocol? | Yes, isolation contact; have to keep room shut due to the radioactive pt; must flush toilet twice, men have to void sitting down, have them drink plenty of fluids to flush radioactive med out of body |
| How long will the pt be radioactive when undergoing I-131 therapy? | About a week and they should stay away from pregnant women & children |
| What is a subtotal thyroidectomy? | Pt will be given PTU and Lugol's solution and 5/6 of the gland can be removed or the entire thing; an incision will be made in the neck so assessment must be prompt because trachea can collapse resulting in respiratory distress |
| What is recommended that should be kept by the bedside after a subtotal thyroidectomy? | A tracheotomy tray for the first 24hrs |
| What is a huge risk factor with a subtotal thyroidectomy? | Hypocalcemia |
| What is the main purpose of the parathyroid hormone and where is it located? | To control calcium and is located behind the thyroid gland |
| What should be kept on a hospital floor in case a pt shows s/s of hypocalcemia? | Calcium gluconate |
| What position should the bed be in after a subtotal thyroidectomy? | Semi-fowler's position with neck support ( a couple of pillows) to decrease tension at the sutures |
| What is a complication of the surgery? | The laryngeal nerve can become damaged so note the tone of their voice; hoarseness is to be expected but it shouldn't continue to get more hoarse, if so, contact MD |
| What triggers a thyroid storm? | -Emotional Stress -Trauma -Infection |
| What are the s/s of a thyroid storm? | Same as with hyperthyroidism but more exaggerated and much worse: Temp >103 -Diaphoresis -Restlessness -Tachycardia >130 -BP >200 -Agitated -Begin to show signs of cardiac dysrhythmias |
| What is another name for hypothyroidism? | Myxedema |
| What is hypothyroidism? | Lack of thyroid hormone; metabolism slows down |
| Among whom is hypothyroidism more prevalent? | Women and the elderly population |
| What are some causes of hypothyroidism? | -Something wrong with the thyroid or pituitary gland -Radioactive killed too many cells -Thyroidectomy -Tumor in pituitary gland |
| How is hypothyroidism diagnosed? | By a decrease in T4 and increase in TSH; also looking at lab work |
| What med is given as management for hypothyroidism? | Synthroid (Levothroid) |
| Since pts with hypothyroidism are tired and slow, what do they need? | They need assistance and you may have to repeat instructions more than once for them |
| What is a myxedema coma? | It is a MEDICAL EMERGENCY; same s/s of a thyroid storm but worse |
| What triggers a myxedema coma? | -Emotional stress -Trauma -Infection |
| What are s/s of a myxedema coma? | -Almost unconscious person -Respirations very low -Low BP -Low HR -Extremely cold |
| What are the three hormones released by the adrenal gland? | 3 S's -Salt (mineral corticoid) -Sugar (glucocorticoid) -Sex (androgen) |
| What is the outer and inner part of the adrenal gland called respectively? | Adrenal cortex & medulla |
| In regards to the adrenal gland, who is the pituitary gland to it and what does the pituitary gland release affecting it? | Pituitary gland is the boss; It releases ACTH (adrenocorticotropic hormone) |
| What does ACTH (adrenocorticotropic hormone) do? | Stimulates the adrenal cortex to release the salt, sugar & sex hormones |
| What is the main hormone of the glucocorticoid and what do they do? | Cortisol; glucocorticoids affect metabolic glucose in the body and directly affects the blood glucose level; they try to keep you happy & emotionally stable; they help you deal with stress |
| What is a mineral corticoid and what does it do? | Aldosterone; it affects electrolyte metabolism and is very important in controlling sodium |
| What does the androgen hormone do? | It gives masculine features. If a female has too much, she can grow facial hair |
| What is Cushing's syndrome? | Having too much of the salt, sugar, & sex hormones |
| What is the cause of Cushing's syndrome? | Taking too many corticosteroid meds that may affect the adrenal cortex and if it becomes enlarged, it can lead to an excess of the salt, sugar & sex hormones being released |
| What does cortisol affect? | It affects the way that protein, carbs & fat are metabolized |
| What happens if you have too much excess of protein, carbs & fat in the body? | It can lead to fatty deposits such as a 'Moon Face' with fat deposits in the fact but other areas as well like the back of the neck & abdomen |
| How does Cushing's affect calcium? | It keeps it from entering the bones and then bones become more prone to fractures |
| What happens if you take too much glucocorticoids? | -It can mask infection -Decrease immune response -Decrease inflammatory response |
| How is Cushing's diagnosed? | By checking serum cortisol levels (their levels will be elevated and stay elevated instead of dropping in the afternoon) and by an ACTH Suppression Test |
| What is an ACTH (adrenocorticotropic hormone) Suppression Test? | It suppresses the pituitary gland from releasing ACTH so levels would be low; if it's high, then it's Cushing's |
| With Cushing's, how would potassium and glucose be? | Both potassium & glucose would be high |
| How do you treat Cushing's? | Take away drugs such as steroids, but taper them off, never abruptly |
| Med wise, how would you treat Cushing's? | By giving them glucocorticoid inhibitors such as: -Mitotane (Lysodren) -Ketoconazole (Nizoral) -Metyrapon (Metopirone) |
| What surgery is involved for treating Cushing's? | Transsphenoidal Hypophysectomy- a surgery to remove a tumor off of the pituitary gland |
| With the interventions involved for treating Cushing's, what crisis should you monitor for? | Adisonian- occurs if the treatment is so strong that it throws client into the opposite extreme (Addison's) |
| What is the definition of Addison's Disease? | An insufficiency of the salt, sugar, & sex hormones (adrenal cortex does not release the hormones in adequate amounts) |
| What causes Addison's Disease? | Anything that causes adrenal cortex to atrophy; if the adrenal glands are removed, you end up with Addison's or if the pituitary is not producing enough ACTH |
| How is Addison's diagnosed? | Through serum cortisol levels, serum glucose will be low |
| What is the relationship between potassium and sodium? | Potassium will be high, sodium will be low |
| What is the treatment of choice for Addison's? | A corticosteroid known as Prednisone- it's action is to erase inflammation and replaces; the hormones that the body is not creating |
| What is an Adisonian Crisis? | Same s/s of Addison't only worse; hypotension, rapid weak pulse, rapid respiratory rate, pallor, extreme weakness |
| How is an Adisonian Crisis treated? | With Solu-Cortef IV, a strong steroid |
| What is cataracts? | An opacity or cloudiness of the lens; a leading cause of blindness in the world |
| What is basically the treatment for cataracts? | Removal of the cloudy lens with an emulsification and put in an IO (intraocular lends) implant |
| What is the name of the surgical procedure for cataracts? | Phacoemulsificaton (Phaco)- a common procedure |
| What drop are used in pre-op for Phaco? | Mydriatics because they dilate the pupils; miotics constrict the pupils |
| Post-op for Phaco, what is usually prescribed medicinally? | Antibiotics or steroid drops to decrease chance of infection |
| Why is cataracts the #1 surgery in most hospitals? | Because the elderly are living longer |
| What is the leading cause of blindness in the U.S.? | Glaucoma |
| What is glaucoma? | Increased IOP (intraocular pressure) causes optic nerve damage; vitreous/aqueous humor in the eye can't drain and float through the eye so pressure in the eye increases |
| What is the normal pressure in the eye? | 10-21mm/Hg |
| How wide is the trabecular meshwork? | 1/50th of an inch wide |
| How do you treat open angle glaucoma? | With miotics (constricts, ex. Pilocarpine); works by causing pupil to constrict which increases the amount of aqueous and more fluid can drain through meshwork |
| How do you treat closed angle glaucoma? | Basically, it's closed angle because of a blockage so surgery is going into the eye to remove the blockage: -Laser Trabeculoplasty -Trabeculectomy -Iridotomy |
| What is macular degeneration? | Affects central vision, center part of retina and is characterized by Drusen (yellow spots) beneath the retina |
| Who is at risk for cataracts? | Ppl over the age of 40 |
| What is the percentage of the population has dry macular degeneration? | 85%-90% |
| What is the wet version of macular degeneration? | Abnormal blood vessels under the retina cause leak & swelling and hardening of the retina and vision changes quickly |
| What is the earliest and most reliable way to detect changes with macular degeneration? | Amsler grid |
| What are the two ways wet macular degeneration are treated? | -Photodynamic Therapy (PDT)- abnormal vessels are zapped by laser -Angiogenesis research- drug therapy at stunting abnormal vessel growth |
| What should a pt avoid for five days after PDT (photodynamic therapy)? | The sun |
| What is retinal detachment and the s/s? | The retinal layers separate; s/s are: -Floaters or spots -Lines or flashes of light -Like a curtain was pulled over the eyes |
| What are the risk factors for retinal detachment? | -Diabetes -Severe myopia -Trauma |
| What surgery can be done for retinal detachment? | Scleral buckle- buckle of silicone goes around the eyeball to hold the layers together; MD may inject an air bubble called a gas tamponade to assist it but pt has to be in prone position for 2-4 weeks |
| What is the definition of low vision? | Best corrected visual acuity of 20/70- 20/200 |
| What is the definition of legal blindness? | Visual acuity of 20/200 or less in the BETTER eye with the best correction possible OR widest visual field is 20 degrees or less |
| What is the definition of blindness? | Best corrected visual acuity of 2400 to no light perception |
| What's the difference between an ophthalmologist and an optometrist? | An ophthalmologist is a medical dr |
| What two methods of tonometry are there to check for glaucoma? | Contact and Non-Contact |
| What is the fluid restriction for a glaucoma test? | No more than 2 cups of fluid 4 hrs before the test |
| When should you cease drinking alcohol before a glaucoma test? | Don't drink any alcohol 12 hrs before the test |
| When should you cease smoking marijuana before a glaucoma test? | Don't smoke any marijuana 24 hrs before the test |
| What are the three classifications of SLE (systemic lupus erythematosus)? | -Drug-induced- associated with the use of Apresoline (BP med), INH (TB med) and others -Discoid lupus- involves the skin only -Systemic lupus- involves one or more systems such as cardiovascular, central nervous, renal, lungs, etc |
| What is Lupus? | A chronic, inflammatory connective tissue disease of unknown origins that affects almost all body systems; a disturbed immune response with exaggerated production of autoantibodies that has remissions & exacerbations |
| Among whom is Lupus more prevalent? | Seen 9 times more in women than men; usually diagnosed in teens or early adulthood |
| What are some common s/s of Lupus? | Butterfly rash, painful or swollen joints, unexplained fever, unusual loss of hair, pale and cyanotic fingers, extreme fatigue, ulcers in the mouth, (reynaud's phenomena, vasculitis- not common but occurs) |
| What can you hear in the chest to be diagnosed with Lupus? | A pericardial friction rub |
| What would you see confirmed on a blood test for Lupus? | Decreased C4 or C4 compliment Increased anti-DNA antibodies Increased ANA titer |
| With Lupus, would the WBC be high or low? | WBC would be low (<5000) |
| What meds are used with Lupus? | -NSAIDs (along with aspirin for the antiplatelet affect) -Corticosteroids -Antimalarial (ex. Plaquenil) -Immunosupressive (ex. Cytoxan but can cause pulmonary fibrosis) |
| What diet would a pt with Lupus be on? | Low fat, low sodium, high fiber keeping portion control in mind |
| What is gout and how is it characterized? | It's a condition that results from uric acid depositing in tissues in the body and characterized by recurring attacks of joint inflammation and hyperuricemia (>7mg/dl) |
| What is uric acid? | A by product of breaking down purines |
| What are tophi? | Deposits of uric acid crystals in the peripheral areas of the body such as the big toes, the hands or the ears; kidney stones can result as well |
| How would tophi feel upon palpation? | Hard and irregular in shape |
| What is primary gout? | Results from excessive dieting or intake of foods high in purines |
| What is secondary gout? | Results from cancers, anemias, psoriasis, drug-induced renal failure |
| Who is more at risk for gout, men or women? | Men, seen in 9 times more men than women and diagnosed between puberty and a peak age of 75; women usually see it after menopause |
| What is the most common site for gout? | The joint at the base of the big toe 90% of the time |
| What is the normal level of uric acid? | 3-7 |
| What is the normal amount of uric acid we excrete in 24 hours? | 250-750mg |
| What is the most reliable test for gout? | Aspirating and looking for uric acid crystals during artherocentesis |
| What are some early s/s of gout? | -Acute arthritis is the most common early symptom -Occurs at night -Big toe inflammation -Subsides after 3-10 days |
| What are some late s/s of gout? | -Tophi -Attacks last longer -More joint involvement -Renal stones |
| What are the meds used to control gout? | -Analgesics -NSAIDs -Colchicine- one of the first drugs for gout in 1936 (KEY drug) -Probenecid (Benemid)- used for chronic attacks -Allopurinol (Zyloprim)- used for chronic attacks -Corticosteroids |
| Why should you avoid alcohol with gout? | Because it can lead to dehydration which would lead to a slowing down of the excretion of uric acid, building up uric acid leading to gout attacks |
| How long does the PO form of Colchicine take and the IV form of Colchicine take? | PO takes 12-48 hrs IV takes 4-12 hrs |
| How does Colchicine work? | It suppresses inflammation in acute gout attacks |
| How does Allopurinol (Zyloprim) work? | It blocks uric acid formation |
| What is the definition of osteomyelitis? | It's an infection in the bone |
| What are three ways of getting osteomyelitis? | 1. Soft tissue infected, it can move to the bone 2. Direct communication of bone from surgery fractions 3. Bloodstream |
| If osteomyelitis is blood borne, how is it manifested? | You will see signs of flu-like symptoms: chills, high fever, rapid pulse, malaise.... |
| If osteomyelitis is NOT blood borne, how is it manifested? | You will see local, physical s/s: pain, warmth, swelling... |
| What will happen if osteomyelitis isn't treated quickly? | An abscess will form and chronically infect the pt for life |
| How can you prevent osteomyelitis? | -Do do surgery with a pt that has an infection -Give prophylactic antibiotics prior to dental work/surgeries -Early removal of catheter and drains |
| How much drainage would you expect from a correction of an osteomyelitis wound? | First 24hrs- 200-500cc The next 48hrs- 25-30cc |
| What is CPM? | Continuous Passive Motion- it helps increase circulation & prevents adhesions from forming |
| What is C-reactive protein (CRP)? | It's more sensitive than ESR and with osteomyelitis, you should see elevated WBC and ESR |
| Why would you use an MRI for osteomyelitis? | Because it shows osteomyelitis earlier and more intense elevations |
| Why is an abscess a complication of osteomyelitis? | Because it steals the bones blood supply and contains sequestrum (dead bone tissue) |
| How could osteomyelitis spread through the body? | Through the blood, could result in a continuously draining sinus opening for life |
| How are antibiotics given for osteomyelitis? | They are given around the clock for 3-4 months and then switched from IV to PO |
| What does osteoporosis make you susceptible to? | Fractures of the hips & wrists |
| What is osteoporosis? | Compression fracture of the spine and other parts of the body; affects 50% of women over 80 years of age |
| Why does osteoporosis affect so many elderly? | Because they may excrete too much calcium through the kidneys |
| When do we reach peak bone mass? | Between the ages of 35-40; as we get older, calcitonin is decreased and calcitonin inhibits bone reabsorption & promotes bone formation |
| Why do women develop osteoporosis ore frequently than men? | Because women have a lower peak bone mass |
| What is a great preventative strategy for osteoporosis? | Exercise is a great preventative strategy |
| What are a few risk factors for osteoporosis? | White women, hyperparathyroidism, 3 months steroid use, low body weight, excessive alcohol intake, too little calcium in diet |
| What are some osteoporosis s/s that occur late in stage? | Pain or tenderness, fractures, loss of height, low back pain, neck pain, stooped posture (Kyphosis) |
| How is osteoporosis examined? | -DEXA scan -Spine CT -Spine or hip x-ray (but not enough to confirm but can see fracture or collapse) |
| What are osteoporosis meds? | -Bisphosphonates -Calcitonin -Parathyroid hormone -Raloxifene |
| How should you take bisphosphonates? | If taken PO, you should take it on an empty stomach and drink a full glass of water with it and be upright 30-60 minutes afterward |
| What is a rare s/e of bisphosphonates? | Osteonecrosis of the jaw |
| What does Calcitonin do in regards to osteoporosis? | It slows the rate of bone & relieves bone pain; can come as an injection or nasal spray and is less effective than bisphosphonates; unlabeled use for it is for phantom limb pain |
| What are a few things about calcium you should teach your pt? | -Chronic use of laxatives decreases absorption of calcium -They should be taken with or after meals & to increase absorption -Absorption is highest in doses less than 500mll -Protein & Vitamin D are needed to enhance calcium absorption |
| Why are calcium supplements and HRT (Estrogen) rarely used as treatment for osteoporosis? | Because they increase the risk of breast & endometrial cancer |
| What are some life threatening s/s of HRT? | -Thromboembolism -Stroke -PE -MI |
| What is the Parathyroid Hormone (Forteo)? | It contains huma parathyroid hormones and is approved for treatment of osteoporosis for women at hight risk |
| What is Raloxifene (Evista)? | It is used for prevention & treatment in osteoporosis & breast cancer prophylaxis; reduces spinal fractures by 50% |
| If women are on estrogen, taking calcium, what exams should they get? | -Regular exams -Mammograms qyr -Pelvic -Pap |
| How much calcium should you get a day? | 1200mg |
| How much Vitamin D should you get a day? | 400-600IU |
| What are some early complications of fractures? | *SDFC -Shock -DVT -Fat Embolism -Compartment syndrome |
| When you're in hypovolemic shock from hemorrhage, how can you tell the difference between compensated and decompensated? | -Compensated is increased HR & RR and normal BP -Decompensated is increased HR & RR and decreased BP |
| What has a very rapid onset after injury and is an early complication of fractures? | Fat embolism; it's onset is 24-72 hrs after injury but can occur up to a week after injury; pt will shows signs of respiratory distress and if it's systemic then petechiae will show |
| How do you reduce the risks of a fat embolism? | -Immobilize the fracture immediately -Minimal manipulation of fracture -Maintain F&E balance |
| What is compartment syndrome? | The elevation of tissue pressure within a closed fascial compartment; it can compromise circulation & function and can be seen in that part of the body that can lead to irreversible nerve injury and muscle necrosis |
| What early complication of a fracture requires immediate intervention or it can lead to muscle necrosis in a few hours? | Compartment syndrome |
| With compartment syndrome, if s/s aren't relieved in a few minutes, what should be done next? | Surgery |
| With compartment syndrome, where should the limb sit? | At heart level, elevation is contraindicated |
| What is checked for with a neurovascular check? | The 5 P's: -Pallor -Pain -Parasthesia (early sign) -Paralysis (late sign) -Pulselessness (very late sign) |
| With NV checks, what do cyanotic nail beds (fingers and toes) suggest? | Venous congestion |
| With NV checks, what do pallor or blue, dusky look of the fingers themselves suggest? | Diminished arterial perfusion |
| What occurs with a delayed union? | Healing doesn't occur at a normal rate for the fracture |
| What results from failure of the ends of a fractured bone to unite in normal alignment? | Malunion |
| What results from failure of the ends of a fractured bone to unite? | Nonunion |
| What occurs after fracture with disruption of blood supply? | Avascular Necrosis (AVN) |
| How is AVN treated? | With bone grafts, replacement with prosthetic bone or fusions |
| How long does it take a plaster cast to dry? | Up to 72 hrs |
| How often should you encourage toe and finger exercises for body parts in a cast? | Hourly while awake |
| While wearing a cast, what can help to avoid disuse syndrome? | Isometric exercises such as knee pushes or making a fist |
| What are the two types of traction used? | Skin and skeletal |
| When is skin traction used? | To control muscle spasms and immobilize an area after surgery; accomplished by using a weight to pull on traction tape or on a foam boot attached to the skin |
| When is skeletal traction used? | To treat fractures of the: -Femur -Tibia -Cervical spine Applied directly to the bone with a metal pin or wire |
| How often must you remove the foam when in traction? | TID |
| What are the potential complications of Buck's traction? | -Skin breakdown -Circulatory & nerve impairment |
| How should the body be aligned when in traction? | Down the center of the bed |
| What is recommended to clean pins used in traction? | Chlorhexidine but sterile water and saline are alternates (betadine may damage healthy tissue) |
| What are some isometric exercises of the immobilized extremity? | Quadriceps-setting & gluteal setting |
| With a THA (total hip arthroplasty), what is normal drainage? | 200-500ml the first 24 hrs < 30ml at 48 hrs |
| To avoid hip dislocation, what should you keep between your legs? | A pillow to maintain abduction |
| What type of chair should be used to avoid hip dislocation? | A high seated chair, same with toilet, you want the hips to be higher than the knees |
| How long should you keep up precautions to avoid a hip dislocation? | 4-6 months |
| After a THA, how far do you want to flex? | No more than 90 degrees |
| How high should you elevate the HOB after a THA? | No more than 60 degree |
| What accounts for most of the amputations of lower extremities? | PVD |
| Why do amputations of upper extremities usually occur? | Because of either traumatic injury or a malignant tumor |
| The amputations that occur due to PVD occur with pt that suffer from what? | Diabetes; 50%-75% of all amputations are performed on pt with diabetes |
| How is phantom limb pain relieved? | -TENS (transelectrical nerve stimulation) -Beta Blockers -Tricyclic Antidepressants |
| What 3 things must you avoid with a lower extremity amputation? | Avoid: -Abduction -External rotation -Flexion |
| If lower extremity is to be elevated after an amputation, how is it done? | By raising the FOB |
| What can an amputee pt do to stretch flexor muscles and prevent flexion contractions? | Turn from side to side & assume prone positions several times throughout the day |
| How long should an amputee pt sit at a time? | No more than 30 mins |
| How can an amputee pt prevent abduction deformity? | By keeping legs together |
| What type and peak do Lispro (Humalog) & Aspart (Novolog) have? | They are rapid acting insulin and have a peak of 1 hr |
| What type of insulin is Regular (Humalog R, Novolin R, Iletin II Regular) and what is it's peak? | It's short acting and it's peak is 2-3hrs |
| What are intermediate acting insulins and what are the peaks? | -NPH (Neutral Protamine Hagedorn) -Humlin N, Iletin II Lente, Iletin II NPH, Novolin L [Lente], Novolin N[NPH]) And the peak is 4-12 hrs |
| What is a long acting insulin and what is it's peak? | Ultralente ("UL") and it's peak is 12-16hrs |
| What is Glargine (Lantus)? | A very long acting insulin that is continuous, it doesn't have a peak |
| Which type of diabetes is due to no insulin being produced? | Type 1 |
| Which type of diabetes is usually diagnosed under the age of 30? | Type 1 |
| Which type of diabetes is made up of 90%-95% of all diabetes? | Type 2 |
| DKA would occur with a pt with which type of diabetes? | Type 1 |
| HHNK would occur with a pt with which type of diabetes? | Type 2 |
| Which type of diabetes is usually controlled with diet and exercise? | Type 2 |
| For a hypoglycemic pt, when you have to give rapid acting insulin, what should you have nearby? | Food |
| How is a dose of glucogon administered? | Administered either IM or Subq Takes 20-30 mins to work and doesn't last long, once the pt is able to eat, you should give them some protein |
| What is an abnormally low bgl? | <50-60mg/dl |
| What are some examples of 15gram fast acting carb snacks? | -2 tspn molasses -2-3 tspns honey -3-4 glucose tablets -4-6 ozs of juice or regular soda -6-10 hard candies |
| After giving some fast acting carb snacks, when should you retest the bgl? | After 15 mins and if it's still <70, then retreat |
| If a pt is unconscious and/or can't swallow, how do you treat hypoglycemia? | -IM or subq glucagon 1mg -25-50ml 50% dextrose solution IV |
| What is the process with DKA? | Blood sugar is so high, it spills into the kidneys and begins to build up ketones i the blood stream leading into metabolic acidosis so then you need to administer sodium bicarb for metabolic acidosis; the high blood sugar damages blood cells |
| What is the major electrolyte to worry about with DKA? | Potassium; K level may stay the same or go up slightly with kDKA but drops quickly once DKA treatment starts |
| How is DKA treated? | By HIE -Hydration -Insulin -Electrolyte replacement |
| How should you hydrate a pt with DKA? | Hydrate with isotonic solution NS 0.9%, then will be switched to hypotonic solution, NS 0.45% when a pts blood sugar drops to 250-300 |
| When treating DKA, what type of insulin is given and in what form? | Regular and in IV form |
| What does DKA have in the blood and urine that HHNS doesn't? | Ketones |
| What is the onset of hypoglycemic complications from fastest to slowest? | -Hypoglycemia -DKA -HHNS |
| What is the best way to manage diabetes? | DIME -Diet -Insulin -Meds -Exercise |
| What test can you perform on a pt post-op to check for thrombophlebitis? | Homan's test- Pain would be exhibited in the calf upon dorsiflexion of the foot. This is a + sign and mean ls thrmombophlebitis may have developd; if so, look at legs for redness and/or edema. This blood clot could travel to the lungs and become a PE |
| What is the minimum amount of urine output we want to see in a post-op pt? | They can be voiding as little as 30cc/hr but we would like to see 50cc/hr |
| What is hypertonic solution? | A solution with an osmolality higher than that of serum |
| Which solution has an osmolality lower than that of serum? | A hypotonic solution |
| What is an isotonic solution? | A solution with the same osmolality as serum and other body fluids |
| What is the normal range for serum osmolality? | 280-300mOsm/kg |
| What are some isotonic solutions? | -0.9 NaCl (Normal saline) -Lactated Ringer's solution (Hartmanns' solution) -5% dextrose in water (D5W)- does convert to hypotonic solution over time |
| What is a hypotonic solution? | 0.45 NaCl (Half strength saline) |
| What is a hypertonic solution? | 3% NaCl (hypertonic saline) 5% NaCl (hypertonic solution) |
| What is fluid volume deficit (FVD)? | The loss of extracellular fluid exceeding the intake ratio of water |
| What does dehydration refer to? | The loss of water alone with the increased serum sodium level (hyperosmolar deficit) |
| What is an iso-osmolar deficit? | The equal loss of water and electrolytes; caused by GI wounds, v/d, third spacing (burns ascites, bowel obstruction) |
| What lab values should you see with FVD? | Elevated BUN in relation to serum creatinine Increased hematocrit increased hemoglobin Possible serum electrolyte changes |
| What is fluid volume excess (FVE) due to? | It's due to a fluid overload or diminished homeostatic mechanisms |
| What is the normal level of central venous pressure (CVP) when measured by a watermenometer? | 4-10mm/Hg; however with FVE, it's increased |
| What is the medial management of FVE? | -Restriction of fluids and sodium -ADministration of diuretics |
| What is the average intake of Na/day? | 3000mg |
| What is the hospitals low sodium diet? | 2000mg |
| What are the PMS foods that can be cut down for sodium's sake? | PMS -Processed -Milk; dairy products -Salt |
| In FVE, what is BUN, hemoglobin and hematocrit? Increased or decreased? | Decreased |
| What renal treatment can also be a treatment for FVE? | Dialysis |
| What level is considered hypokalemia? | <3-5mEq/l |
| What are some causes of hypokalemia? | -GI losses -Meds -Hyperaldosteronism |
| How can hyperaldosteronism be a cause of hypokalemia? | Too much aldosterone which r/t Na & H2o retention and too much of that makes potassium decrease |
| What low level of an electrolyte can cause paralytic ileus? | Potassium |
| What can a low level of potassium eventually do to the heart? | Stop it and this is known as a cardiac standstill; Flat T wave on the ECG |
| What should be dealt with first, potassium or sodium? | Potassium |
| What is the major player in the ICF compartment? | Potassium |
| What is the normal level of potassium? | 3.5-5.0 |
| What level is considered hyperkalemia? | >5.0 |
| What are some causes of hyperkalemia? | -Impaired renal function -Hypoaldosteronism -Tissue trauma -Acidosis |
| What are the biggest regulator of potassium? | Kidneys |
| What can a high level of potassium eventually do to the heart? | Make it stop beating, this is known as ventricular fibrillation |
| What forces potassium back into the ICF compartment? | -Restricting potassium in diet -Dialysis -Combination of insulin and glucose |
| What type of diuretics should not be used with pts who have hyperkalemia and renal dysfunction? | Potassium-sparing diuretics because they may cause elevation of potassium |
| With an acid-base imbalance, what is the pH level base? | 7.35-7.45 |
| With an acid-base imbalance, what is the pCO2 level? | 35-45 |
| With an acid-base imbalance, what is the HCO3 level | 22-26 |
| With acid=base imbalances, what do the lungs help with? | CO2- carbonic acid |
| With acid-base imbalances, what do the kidneys help with? | Bicarbonate level |
| With acid-base imbalances, what does plasma pH indicate? | H+ (hydrogen ion) concentration |
| What three mechanisms come into play when dealing with F&E imbalances? | -Buffer -Kidneys -Lungs |
| Out of pH, CO2 & HCO3, which one is is the more critical one to look at? | pH |
| What is the normal pH ration? | 20:1; 1 part carbonic acid to 20 parts sodium bicarbonate |
| How should you systematically approach the cause of an ABG disorder? | First look at the pH Second, look at the pCO2 (respiratory) Third, look at the HCO3 (metabolic) |
| With F&E imbalances, what is compensation done by and what is correction done by? | Compensation is done by the body & correction is done by medical intervention |
| What pneumonic is good for remembering F&E imbalances? | ROME -Respiratory -Opposite -Metabolic -Even |
| How long does it take for kidneys to compensate for respiratory problems? | 3 days |
| How long does it take for lungs to compensate for metabolic problems? | Immediately |
| What are the six rights of med administration? | Right dose Right med Right pt Right route Right time Right documentation |
| What are the components of a drug order? | -date and time order is written -drug name -drug dosage -route of administration -frequency and duration of administration -special instructions |
| How many times do you read a drug label? | 3 times |
| What sort of drug labels order shoiuld be checked agisnt the original order? | -First dose -One time -PRN |
| What is the longest needle? | IM |
| What are the gauges and lengths of an ID needle? | Gauges -25, 26 Lengths -3/8 -1/2 -5/8 |
| What are the gauges and lengths of an SC needle? | Gauges -23, 25, 26 Lengths 3/8, 1/2, 58 |
| What are the gauges and lengths of an IM needle? | Gauges -19, 20, 21, 22 Lengths -1, 1 1/2, 2 |
| What is an allergic reaction to ACE inhibitors? | Angioedema |
| What is the antidote to Heparin & Lovenox? | Protamine Sulfate |
| What is the antidote for Coumadin? | Vitamin K |
| What do you not take with antiplatelets? | Heparin |
| What two diseases are diuretics widely used for? | HTN & heart failure (also used for fluid volume overload) |
| What kind of diuretic is Aldactone? | K sparing |
| What kind of diuretics are Lasix & Demadex? | Loop |
| What suffixes do ACE Inhibitors have? | -pril |
| What's a big sign of Digoxin toxicity? | Yellow or green halos-blurred vision |
| What are the two most prescribed antihyperlipidemics? | Zocor & Lipitor |
| With what group of meds should you avoid drinking more than one quart of grapefruit juice a day? | Antihyperlipidemics |
| Antihyperlipidemics can be very damaging to what? | The liver |
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