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298 Cards in this Set
- Front
- Back
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What are the three proteins in plasma?
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Albumin, globulins, fibrinogen
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Which plasma protein is responsible for increasing osmotic pressure and is a volume expander?
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Albumin
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Which plasma protein is responsible for transportation and protect against infection?
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Globulins
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Which plasma protein is responsible for clotting?
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Fibrinogen
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What is the recipe for Hgb?
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Iron, Vit B12, Folic acid, Copper, Pyridoxine, Cobalt, Nickel
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How does the body regulate RBC production?
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The kidney produces the RBC growth factor erythropoietin at the same rate as RBC destruction occurs to maintain a constant normal level of circulating RBCs
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What are immature and mature neutrophils called?
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Bands (immature); Segs (mature)
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Are immature neutrophils capable of phagocytosis?
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No, only mature, thus the higher number, the greater resistance to infection
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What are bands in the blood indicative of?
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Left shift
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What does the left shift indicate?
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The bone marrow cannot produce enough mature neutrophils to keep pace with continuing infections and is releasing immature neutrophils into the blood
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What can cause neutrophils to increase and/or decrease?
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Increase w/ bacterial infection; Decrease w/ chemo
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What roles do macrophages play in protection?
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Important in inflammatory responses, Stimulate the longer-lasting immune responses of antibody mediated immunity and cell mediated immunity
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Which WBC functions include phagocytosis, repair, antigen presenting/processing, secretion of cytokines?
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Macrophages
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What are the vasoactive amines that work on blood vessels in basophils?
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Heparin, Histamine, Serotonin, Kinins, Leukotrienes
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Which WBC contains enzymes that degrade the vasoactive chemicals of other leukocytes thus can limit the inflammatory response?
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Eosinophils
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What does the white pulp tissue of the spleen do?
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Stores WBCs (esp lymphocytes and macrophages) & removes unwanted cells (bacteria & old RBCs)
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What does the red pulp tissue of the spleen do?
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Contains enlarged blood vessels that store RBCs and platelets
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What is in the marginal pulp of the spleen?
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Contains the ends of many arteries and other blood vessels
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What are the functions of the spleen?
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Destroys old or imperfect RBCs, breaks down the hemoglobin released from these destroyed cells, stores platelets, and filters antigens
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What organ produces prothrombin and most of the blood clotting factors?
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Liver
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What clotting factors need Vit K to be produced?
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VII, IX, & X and prothrombin
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What organ converts bilirubin to bile and stores extra iron within the protein ferritin?
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Liver
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What are intrinsic factors?
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Problems or substances directly in the blood itself that first make platelets clump and then trigger the blood clotting cascade (circulating debris and prolonged venous stasis)
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What are extrinsic factors?
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Outside of the cell that can also induce platelet plugs to form, usually the result of changes in the blood vessels rather than in the blood
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What are platelets activated by?
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ADP calcium Thromboxane A2 and collagen
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What are changes in blood vessels that induce the extrinsic pathway?
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Damage that exposes collagen, inflammation, toxins, foreign proteins
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Does the clotting cascade start sooner with the extrinsic or intrinsic pathway?
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Extrinsic
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What is the process of fibrinolysis?
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Plasminogen's activated to plasmin. Plasmin, an enzyme, then digests fibrin, fibrinogen, and prothrombin, controlling the size of the fibrin clot.
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How does coumadin work and how is it reversed?
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Depresses hepatic synthesis of vit K–dependent coagulation factors (II, VII, IX, X); Vit K
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How does heparin work and how is it reversed?
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Prevents conversion of fibrinogen to fibrin and prothrombin to thrombin by enhancing inhibitory effects of antithrombin III; Protamine Sulfate
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How does plavix work and how is it reversed?
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Inhibits ADP-induced platelet aggregation by binding to them; none/ platelet transfusion
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What do the anti-clotting forces protein C & S do?
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Increase breakdown of factor V & VII
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What does the anti-clotting force antithrombin III do?
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Inactivates thrombin and factors IX & X
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If a person has anti-clotting force deficiencies what are they at risk for?
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PE, MI, and stroke
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What is the function of anti-clotting forces?
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Prevent the clot from becoming too large or forming where not needed
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What are the hematologic changes associated with aging?
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Total RBC and WBC (esp lymphocytes) are lower, WBC don't rise as high with infection, Hgb levels fall after middle age
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What are the assessment findings evident of hematologic disorders in the elder?
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Nails (pallor or cyanosis), Hair (thin or absent hair on trunk or extremities), Skin (dryness), Skin Color (pallor or jaundice)
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What type of diet can lead to anemia?
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High fat & carb but low in protein, iron and vitamins
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When are fibrinolytic drugs or thrombolytic drugs given and how do they work?
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Given within 6 hours of MI or thrombotic stroke and they break down fibrin threads
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What are the classes of anticoagulants?
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Thrombin inhibitors, Vit K antagonists, Indirect factor X inhibitors
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What is the most common sign/symptom of anemia?
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Fatigue
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What skin assessment findings may indicate a hematologic problem?
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Petechiae (heparin induced thrombocytopenia), pallor, jaundice
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What head and neck assessment findings may indicate a hematologic problem?
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Pallor or ulceration of the mouth mucosa, smooth tounge with pernicious anemia, lymph node enlargement
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What should focus on for a respiratory assessment for a person with possible hematologic problems?
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Rate and depth, SOB at rest or exertion, can complete a 10 word sentence without stopping for a breath, fatigues easily
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What should the nurse observe for during a CV assessment for a pt with possible hematologic problems?
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Chest heaves, distended neck veins, edema, phlebitis, murmurs, gallops, irregular rhythm, > BP w/ excessive RBCs, right ventricle enlargement w/ severe anemia
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What urinary assessment finding may be present with hematologic problems?
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Hematuria
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What musculoskeletal assessment finding may be present with hematologic problems?
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Rib or sternal tenderness (leukemia)
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What abdominal assessment findings may be present with hematologic problems?
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Enlarged spleen, liver borders, stool for occult blood
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How does Vit B12 deficiency affect the CNS?
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Impairs cerebral olfactory, spinal cord, and peripheral nerve function
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What do decreased RBC, Hgb, and Hct indicate?
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Possible anemia or hemorrhage
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What do increased RBC, Hgb, and Hct indicate?
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Chronic hypoxia or polycythemia vera
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What do increased MCV and MCH indicate?
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macrocytic cells, possible anemia
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What do decreased MCV and MCH indicate?
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microcytic cells, possible iron deficiency anemia
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What does increased MCHC indicate?
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spherocytosis or anemia
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What does decreased MCHC indicate?
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iron deficiency anemia or a hemoglobinopathy
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What does increased WBCs indicate?
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infection, inflammation, autoimmune disorders, and leukemia
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What does decreased WBCs indicate?
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prolonged infection or bone marrow suppresion
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What does increased reticulocyte count indicate?
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Chronic blood loss
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What does decreased reticulocyte count indicate?
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Inadequate RBC production
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What does increased TIBC indicate?
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Iron deficiency
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What does decreased TIBC indicate?
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Anemia, hemorrhage, hemolysis
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What do increased Fe and serum ferritin levels indicate?
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iron excess, hemochromocytosis, liver disorders, megaloblastic anemia
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What do decreased Fe and serum ferritin levels indicate?
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iron deficiency anemia, hemorrhage
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What does increased platelet count indicate?
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polycythemia vera or malignancy
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What does decreased platelet count indicate?
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bone marrow suppression, autoimmune dz, hypersplenism
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What does increased PT indicate?
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deficiency of clotting factors V and VII
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What does decreased PT indicate?
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Vit K excess
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What does increased bleeding time indicate?
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inadequate platelet function or number, clotting factor deficiencies
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what do increased fibrin degradation products indicated?
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disseminated intravascular coagulation of fibrinolysis
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What enzyme is needed to produce mature neutrophils?
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Leukocyte alkaline phosphatase
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What may an elevated neutrophil count without elevated LAP be seen in?
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Some leukemias
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What test is used for blood typing?
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Direct and indirect coombs test
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What does the direct coombs test look at?
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antigolbulins against RBCs - hemolytic anemia
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How does on perform a capillary fragility test?
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BP cuff inflated 1/2 b/w sys and dias for 5 min and observed for petichiae developing below. Norm 5-10
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How are bleeding time tests performed?
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Special lancet that makes a uniform wound depth is applied to the forearm while a BP cuff inflated to 40 and blood is blotted at 30 sec intervals. Norm 1-9 min.
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What do PT tests reflect?
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how much of the clotting factors II, V, VII, and X are present and how they're functioning
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What is the goal INR for a pt on coumadin?
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between 2 and 3
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When is platelet aggregation impaired?
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Von Willebrands dz, aspirin, NSAIDs, psychotroopic agents, platelet inhibitors
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How is hepatin therapy monitored and what is the therapeutic range for anticoagulation?
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PTT, 1.5 to 2 times normal
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What is the common site for bone marrow aspiration?
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Iliac crest
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What is used after a bone marrow aspiration of reduce bleeding at the site?
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pressure dressing or sandbags
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What's included in follow up care for bone marrow aspiration?
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Observe site for bleeding/infection for 24 hours, mild analgesic for discomfort, ice packs limit bruising, inspect site very 2 hours, avoid contact sports for 48 hours.
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What are urinary changes in the older adult?
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Decreased GFR, nocturia, decreased bladder capacity, weakened urinary sphincter, tendency to retain urine
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What is produced when protein and muscle breakdown and is excreted by the kidneys?
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Creatinine
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What elevates when 50% of renal function is lost?
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Creatinine
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What may be elevated in hepatic or renal dz, dehydration, decreased renal perfusion, high protein diet, infection, and steroid use?
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BUN
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What may indicate malnutrition and fluid volume excess with a decreased level?
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BUN
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What is indicated if the BUN/Creatinine ratio is increased?
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Fluid volume deficit, obstructive uropathy, catabolic state or high protein diet
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What is indicated if the BUN/Creatinine ratio is decreased?
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Fluid volume excess or acute renal tubular acidosis
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What is indicated if the BUN/Creatinine ratio is normal but they both increase?
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Renal dz
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What are abnormal findings in a urinalysis?
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Glucose, Ketone bodies, Protein, Microalbuminuria, Leukoesterase, Nitrates
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When is glucose present in the urine?
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When blood level reaches 220 mg/dl the renal threshold for reabsorption is exceeded
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When are ketone bodies present in the urine?
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Formed from incomplete metabolism of fatty acids
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When is protein present in the urine?
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Infection, inflammation or immunologic problem
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What's microalbuminuria?
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Presence of albumin in the urine which can indicate early kidney dz esp in diabetic pt
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How does leukoeesterase get in the urine?
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From lysed WBCs
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How do nitrites get in the urine?
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From bacteria converting nitrate into nitrite
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Where does the presence of leukoesterase and nitrites in the urine indicate?
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UTI
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How long must a pt be NPO before a renal biopsy?
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4-6 hours
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How is a renal biopsy generally performed?
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Percutaneously using ultrasound or CT guidance
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What lab tests must be performed before a renal biopsy?
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Platelet count, aPTT, PT, and bleeding time (HTN and uremia increase the risk for bleeding)
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What is included in post-op care for renal biopsy?
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Risk for bleeding (VS, dressing, H&H), retrograde bleed (flank pain, decreasing BP, decreased U/O), strict BR with rool for 2-6 hours, monitor for hematuria, pain, avoid lifting and strenuous activity for 1-2 weeks.
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What is the onset of ARF?
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Hours-days
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What is the duration of ARF?
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2-4 weeks but less than 3 months
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What is the prognosis for ARF?
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good for return of renal function with supportive care
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What is the rapid decreased kidney function that leads to collection of metabolic wastes in the body
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ARF
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What type of ARF includes conditions that reduce blood flow to the kidney?
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Prerenal failure
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What type of ARF includes damage to glomeruli, intersitial tissue or tubules?
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Intrarenal/intrinsic renal failure
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What type of ARF includes the obstruction of urine?
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Postrenal failure
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What is the term for urine output less than 100cc/day?
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Anuric
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What is the term for urine output less than 400cc/day?
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oliguric
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How does the kidney compensate with shock or reduction in blood flow?
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Activating the renin-angiotension releasing ADH which improves blood volume and kidney profusion but decrease urine output which cases a build up of nitrogen waste
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What are the causes of prerenal azotemia?
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Poor blood flow usually shock or CHF
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What are the causes of intrarenal RF/ATN?
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Infections, drugs, invading tumors, inflammation of flomeruli, obstruction or renal blood flow
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What are the causes of postrenal azotemia?
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Obstruction of outflow
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What is the most common cause of ARF?
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Volume depletion which is reversible with prompt intervention
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What's included in the onset phase of ARF?
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Precipitating event, hrs to days, beginning accumulation of nitrogenous wastes
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What's included in the oliguric phase of ARF?
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U/O of 100-400cc/24 hrs that doesn't respond to fluid challenges or diuretics, lasts 1-3 weeks, metabolic acidosis, increasing BUN & cr, hyperkalemia, hypocalcemia, hypermagnesemia, hyperphosphatemia
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What's included in the diruectic phase?
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Urine flow increases, 2-6 weeks after oliguric stage, can result in U/O of 10L/day
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How long may the recovery phase last for ARF?
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Make take up to 12 months
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How much fluid should a person be instilling to prevent ARF?
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2-3 L fluids daily
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What's included in nursing interventions to prevent ARF?
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Early recognition (assessment, monitor labs), monitor drugs that are hephrotoxic
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What drugs are nephrotoxic?
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NSAIDs, ACE inhibitors, antibiotics, contrast dye
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What are the clinical manifestations of Prerenal RF?
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Hypotension, tachycardia, decreased urine output, decreased CO, decreased CVP, lethargy
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What are the clinical manifestations of Intrarenal RF?
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Oliguria, anuria, edema, HTN, tachycardia, SOB, distended neck veins, elevated CVP, wt gain, respiratory crackles, anorexia, N/V, lethargy
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What are the clinical manifestations of Postrenal RF?
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Oliguria, anuria, symptoms of uremia
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What is characterized by an absolute lack of endogenous insulin caused by autoimmune destruction of the pancreatic beta cells in the islets of Langerhans, or possibly idiopathic in cause?
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Type 1 diabetes
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What is characterized by peripheral insulin resistance, impaired insulin secretions, and excessive hepatic glucose production?
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Type 2 diabetes
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Which hormone is produced by the beta cells of the pancreas which controls teh level of glucose in the blood by regulating production and storage of glucose?
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Insulin
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How is the diagnosis of DM made?
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2 separate test results on subsequent days > 126 mg/dL, random or casual plasma glucose > 200 plus manifestations of DM 3 and unexplained wt loss, 2 OGTT level > 200 using a glucose load of 75 g
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Lispro (Humalog), clear aspart (NovoLog), clear glulisine (Apidra), clear are what types of Insulin?
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Rapid-acting
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Regular (Humulin R, Novolin R, ReliOn R), clear are what types of insulin?
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Short-acting
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NPH (Humulin N, Novoiln N, ReliOn N), cloudy are what types of insulin?
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Intermediate-acting insulin
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Glargine (Lantus), clear detemir (Levemir), clear are what types of insulin?
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Long-acting insulin
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What's the skin feature difference b/w hypo and hyperglycemia?
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Hypo: Cool, clammy; Hyper: Hot, dry
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What's the dehydration feature difference b/w hypo and hyperglycemia?
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Hypo: Absent; Hyper: Present
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What's the respiration feature difference b/w hypo and hyperglycemia?
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Hypo: No particular or consistent change Hyper: Rapid, deep, kussmaul type acetone odor (fruity) to breath
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What's the mental status feature difference b/w hypo and hyperglycemia?
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Hypo: Anxious, nervous, irritable, mental confusion, sizures, coma Hyper: Varies from alert to stuporous, obtunded, or frank coma
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What's the symptom difference b/w hypo and hyperglycemia?
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Hypo: Weakness, double vision, blurred vision, hunger, tachycardia, palpitations
Hyper: Non specific for DKA, acidosis, hypercapnia, abdominal cramps, N/V, decreased neck vein filling, thostatic hypotension, tachycardia, poor skin turgor |
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What's the glucose difference b/w hypo and hyperglycemia?
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Hypo: <70; >250
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Which glycemic extreme are ketones present in?
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Hyperglycemia
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How's type 2 DM controlled?
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Diet, exercise, oral agents, insulin injections
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What BS level should critically ill t be maintained b/w?
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80-110 mg/dL
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What BS level should nonintensive care pts be maintained b/w?
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pre-meal level of no more than 110 and a max no more than 180
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Why is the elderly pt at risk for hypoglycemia?
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When on oral meds r/t age related changes in liver and kidney function
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What are the 3 acute glucose related emergencies in the DM pt?
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DKA, Hyperosmolar Hyperglycemic Nonketotic Syndrome (HHS), Hypoglycemia
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What is caused by an absence or markedly inadequate amount of insulin?
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DKA
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What are the 3 main clinical features of DKA?
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Hyperglycemia, Dehydration and electrolyte loss, Acidosis
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What are the symptoms of DKA?
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Abdominal pain, N/V, hyperventilation, fruity breath, AMS (if untreated)
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What is a life-threatening emergency resulting from a lack of effective insulin, or severe insuiln resistance, causing extreme hyperglycemia?
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Hyperosmolar Hyperglycemic Nonketotic syndrome (HHS)
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What are the symptoms of Hyperosmolar Hyperglycemic Nonketotic syndrome (HHS)?
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Hypotension, profound dehydration, poor skin turgor, tachycardia, variable neuro signs (AMS, seizures, hemiparesis)
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What are the factors you need to assess in the DM pt?
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3 P's, fatigue, weakness, sudden vision changes, tingling or numbness in hands and feet, dry skin, skin lesions or wounds that heal slowly
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What are the chronic eye complications of DM?
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Diabetic retinopathy, cataracts, lens changes, extraocular muscle palsy, glaucoma
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What is the result of neuropathy which involves cranial nerves in ocular movement and lead to double vision?
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Extraocular muscle palsy
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What is the deterioration of small vessels that nourish the retina and is the leading cause of blindess in people 20-74 y/o?
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Diabetic retinopathy
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What's the leading cause of death among pt w/ DM?
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MI
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What are the types of neuropathies associated w/ diabetes?
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Distal symmetric polyneuropathy, autonomic neuropathy, focal ischemia, entrapment neuropathies
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What are the signs of peripheral neuropathy?
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Paresthesia and burning sensation particularly at night, decreased proprioreception, decreased sensation to light touch and unsteady gait, Charcot joints
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How is pain managed in a pt peripheral neuropathy?
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Analgesics, tricyclic anti-depressants, phenytoin, anti-seizure meds, mexiletine and TENS
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What are the 3 manifestations of autonomic neuropathies?
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Cardiac (Tachy, ortho hypotension, silent MI), GI (delayed gastric emptying, diabetic diarrhea/constipation), GU & Sexual (bladder, urinary retention, erectile dysfunction)
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What is sudomotor neuropathy?
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Decrease absence of sweating (anhidrosis) of the extremities with compensatory increase in upper body sweating
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What's included in the management of problems of the feet?
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Take care of DM, inspect feed daily, wash feet daily, keep skin soft and smooth, trim toenails weekly, wear shoes and socks, protect form hot or cold, keep blood flowing, check with health care provider
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What's hyperglycemia that is present on awakening in the morning due to the release of couterregulatory hormones in the predawn hours?
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Dawn Phenomenon
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Through what ages is the dawn phenomenon most severe?
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When GH is at its peak in adolescence and young adulthood
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What's a rebound effect in which an overdose of insulin induces hypoglycemia that usually occurs during the hours of sleep?
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Somogyi Effect
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How often does the pt perform SMBG?
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pt receiving insulin - 4x day; pt not receiving insulin - 3x week ( at least 1 2-hour post-prandial test
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What's included in SMBG teaching?
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1. Wash hands in warm H20, finger should be dry before puncture
2. If it's difficult to obtain adequate blood, warm the hands in warm H20 or let the arms hang dependently for a few minutes before the puncture 3. If punctures made, use side of finger pad rather near the center 4. Puncture should only be deep enough to obtain a sufficiently large drop of blood. 5. Follow monitor instructions for testing the blood 6. Record results, compare to personal target blood glucose goals |
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What can go wrong with SMBG?
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Improper application of blood (drop too small)
Damage to reagent strips caused by heat or humidity Use of outdated strips Improper meter cleaning or maintenance Lack of comparison to a lab (should be every 6-12 months) Runs controls whenever reading is in doubt |
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How do you calculate caloric need?
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Minimum number of calories by multiplying your current or desired weight in pounds by 10 if female and 11 in male
For activity level: Sedentary wtx14; Moderately active wtx17; Active wtx20 |
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What should ones caloric distribution be?
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50-60% from CHO, 20-30% from protein, 10-20% from fat
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What is a loss of fat tissue in areas of repeated injection that results from an immune reaction to impurities in insulin?
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Lipoatrophy
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What is an increased swelling of fat that occurs at the site of repeated insulin injections in which the overlying skin has decreased sensitivity, and the area can become large and unsightly?
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Lipohypertrophy
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What are the factors that contribute to a UTI?
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Obstruction, stones, vesicoureteral reflux, DM, characteristics of urine, gender, age, sexual activity, recent use of antibiotics
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What is inflammation of the bladder most commonly caused by bacteria?
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Cystitis
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What are the clinical manifestations of a UTI?
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Frequency, urgency, dysuria, hesitancy or difficulty in initiating urine stream, low back pain, nocturia, incontinence, hematuria, pyuria, bacteriuria, retention, suprabuic tenderness or fullness, feeling of incomplete bladder emptying
Rare: fever, chills, N/V, malaise, flank pain |
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What drugs are used in tx of cystitis?
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Antiboitcs, antispasmodics, urinary analgesics, urinary antiseptics
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What is the most common cause of urethritis in men?
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STD
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What is post menopausal urethritis related to?
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Tissue changes with decrease in estrogen
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What are the treatments for urinary incontinence?
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Drugs (anticholinergics, estrogen, tricyclic antidepressants), behavioral interventions, surgical management
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What are the manifestations of Urolithiasis?
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Severe pain (renal colic) - flank pain extends toward abd and to scrotum and testes or vulva, N/V, pallor, diaphoresis
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Formation of kidney stones seems to involve what 3 conditions?
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1. Slow urine flow, resulting in supersaturation of the urine with the particular element (e.g., calcium) that first becomes crystallized and later becomes the stone
2. Damage to the lining of the urinary tract 3. Decreased inhibitor substances in the urine that would otherwise prevent supersaturation and crystal aggregation |
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What are the nursing management techniques involved in urolithiasis?
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Pain management, prevent infection, strain urine, dietary intervention for renal stones
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What are the medical and surgical management techniques involved in urolithiasis?
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Lithotripsy, stent, retrograde ureteroscopy, percutaneous ureterolithotommy, drugs to alkalize urine (allopurinol), drugs to lower cystine levels (Capoten)
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What's the treatment of urethelial cancer?
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Surgical removal of tumor, superficial cancers (BCG instillation), multiagent chemotherapy, radiation, cystectomy
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What's the only significant finding on a urinalysis of urethelial cancer?
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Gross or microscopic hematuria
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What are pigmented (light tan to black) growths seen on neck chest back, can be warty, scaly or greasy in appearance often called wisdom sports or barnacles of time?
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Seborrheic keratosis
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What are sun spots/age spots called?
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Senile lentigines
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What are yellowish slightly elevated dome shaped found on forehead, lower lid, nose and checks?
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Sebaceous hyperplasia
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What is the treatment for dry skin?
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restrict use of harsh soaps, bath 2-3x/wk in tepid H20, apply emollient after bathing while skin is still wet, enc use of sunscreen
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What shit happens to your chest and thorax when you're old?
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Alveoli become less elastic more fibrous and contain fewer function capillaries so the body's exertional capacity decreases
Loss of lung resiliency coupled with the loss of skeletal muscle results in barrel chest Decalcification of ribs and increased calcification of costal cartilages |
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What are the changes in the heart that occur in the elderly?
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Remains same size or becomes slightly smaller
HR slows SV decreases CO reduced Ectopic beats are common |
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What are the changes in the stomach that occur in the elderly?
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Decreased acidity and loss in IF
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What are the changes in the intestines that occur in the elderly?
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Fewer absorbing cells
Decreased peristalsis |
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What are the changes in the liver that occur in the elderly?
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Decrease in size
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What are the changes in the kidney that occur in the elderly?
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Decreased filtration
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What are the treatable causes of constipation?
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inadequate fluid intake
lack of exercise or inactivity Drugs Laxative misuse or abuse diet high in fat and refined sugar and low in fiber neglecting to respond to the defecation urge mental stress or depression |
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What are the remedies for constipation?
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2 quarts of H20
regular exercise limit use of OTC drugs reduce or eliminate use of laxatives eat at least 4 servings of fresh fruit and veggies a day try to develop a regular elimination schedule by attempting to have a BM after a meal |
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What are the musculoskeletal changes that occur in the elder?
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Overall muscle mass, tone and strength decrease
Muscle rigidity increases, ROM decreases Shrinkage and sclerosis of tendons and muscles result in delayed response during DTR testing |
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What are the neurological system changes that occur in the elderly?
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Decreased velocity of nerve impulse
Changes in sleep patterns Reaction time slows Agility and fine motor coordination may be impaired Touch and pain may be diminished |
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What are the urinary changes in the older patient?
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Decreased GFR
Nocturia Decreased bladder capacity Weakened urinary sphincter Tendency to retain urine |
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What lab finding is indicative of very early kidney dz?
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Microalbuminuria
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What are the best ways to collect a urine specimen for C&S?
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Clean catch or catheter specimen
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What is a sonography(bladder scan) used for?
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Determine the need for intermittent/straight cath and to screen for PVR
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What is a disorder characterized esp. by a compulsion to exhibit the genitals in public?
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Exhibitionism
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What is the compulsive use of some object, or part of the body, as a stimulus in the course of attaining sexual gratification, as a shoe, a lock of hair, or underclothes?
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Fetishism
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What is a practice of achieving sexual stimulation or orgasm bytouching and rubbing against a person without the person's consent and usually in a public place called also frottage?
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Frotteurism
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What's the sexual desire in an adult for a child?
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Pedophilia
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What is engaging in or frequently fantasizing about being beaten, bound, or otherwise made to suffer, resulting in sexual satisfaction?
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Sexual masochism
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What is sexual gratification gained through causing pain or degradation to others?
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Sexual sadism
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What refers specifically to cross-dressing; sexual arousal in response to individual garments that only occurs in men?
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Transvestic fetishism
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What's the practice of obtaining sexual gratification by looking at sexual objects or acts, esp. secretively?
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Voyeurism
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What is the process in which semen empties into the bladder instead of being ejaculated thru urethra and usually does'nt occur because the internal bladder sphincter closes int eh orgasmic phase?
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Retrograde Ejaculation
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What are the causes of retrograde ejaculation?
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Medications, prostate surgery, spinal cord injury
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What is the time difference between depression, delirium, and dementia?
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Depression: weeks to months
Delirium: hours to days Dementia: months to years |
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STI characterized by inflammation of the cervix
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Gonococcal Cervicitis
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What is the gender identity differs from apparent biological identity?
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Transgendered
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This type of ulcer is the first sign of syphilis
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Chancre
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What gender identity is when one feels trapped in the body of the opposite sex?
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Transsexual
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What are the 4 stages of syphilis?
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Primary, secondary, latent, and tertiary
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This stage of syphilis is characterized by the presence of chancres
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Primary, secondary, latent, and tertiary
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What is the most common STI in the U.S.?
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Genital herpes
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What medication is used to treat erectile dysfunction caused by poor blood flow?
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Nitric oxide-releasing medications
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Most nongenital lesions are caused by which type of herpes?
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HSV-1
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Most types of genital lesions are caused by which type of herpes?
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HSV-2
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During herpes, the patient is infections when?
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The patient is infectious when they are shedding
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This STI is characterized by swelling and inflammation of the urethra
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Gonococcal Urethritis
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What drugs that have a + effect are frequently given to pt with DM, or beta-adrenergic blocking agents?
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sidenafil citrate (Viagra), vardenafil (Levitra), radalafil (Cialis)
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This STI is characterized by itching of the inner thighs, discomfort during intercourse, thin greenish discharge. In men, burning after urination or ejaculation, and discharge from the urethra. There are a reported 7.4 million cases every year making it the most common STI.
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Trichomoniasis
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What is included in the desire phase of the sexual response cycle?
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Majority of women and minority of men don't experience desire until after they've become aroused
Physical excitement prompts desire for sex |
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What is included in the excitement phase of the sexual response cycle?
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Increased HR, BP, RR
Muscles tense Nipples become erect Vasocongestion of the genital and pelvic regions Does not necessarily progress to next phase |
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What is included in the plateau phase for the female of the sexual response cycle?
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Areolae become larger
Clitoris retracts into the clitoral hood Bartholin's glands lubricate Vagina tightens around the penis |
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What disorder occurs when semen empties into the bladder instead of being ejaculated thru urethra?
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Retrograde Ejaculation
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What is included in the plateau phase for the male of the sexual response cycle?
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Ridge of glans become more prominent
Pre-ejaculate (2-3gtts of fluid) Testes rise closer to body |
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What is included in the orgasm phase for the female in the sexual response cycle?
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Spinal cord reflexes cause rhythmic contractions of vagina, uterus, anus, and pelvic floor
Cervical canal dilates Lasts a few seconds up to nearly a minute |
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What is included in the orgasm phase for the male in the sexual response cycle?
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Spinal cord reflexes cause the urethra, anus, and pelvic floor muscles to contract
Thrusting movement of pelvis and penis occurs followed by ejaculation Lasts for no more than 30 seconds |
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What changes occur in the excitement/plateu phase in elderly women?
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Reduced vaginal expansion, lubrication, and vaginal tone
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What changes occur in the excitement/plateu phase in elderly men?
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Delayed and less-firm erection, longer excitement stage, shorter phase of impending orgasm, may require more direct stimulation to achieve and maintain erection
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What changes occur in the orgasm phase in elderly women?
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Reduced spread of sexual flush
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What changes occur in the orgasm phase in elderly men?
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Shorter ejaculation time, fewer ejaculatory contractions, reduced volume of ejaculate
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What changes occur in the resolution phase in elderly women?
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no cervical dilation
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What changes occur in the resolution phase in elderly men?
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More rapid loss of erection, longer refractory period
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What sexual response disorder is characterized by painful intercourse?
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Dvspareunia
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What sexual response disorder is characterized by intense involuntary contractions of perineal muscles preventing penile penetration?
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Vaginismus
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After having an orgasm it is uncommon to lose the ability unless what has happened?
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Sexual trauma, poor communication, conflicted sexual relationship, mood disorder, medical condition, medication
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What is the pathophysiology of type 1 diabetes?
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Absolute lack of endogenous insulin, caused by autoimmune destruction of pancreatic beta cells or idiopathic
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What is the pathophysiology of type 2 diabetes?
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Peripheral insulin resistance, impaired insulin secretion, and excessive hepatic glucose prodcution- no autoimmune destruction of pancreatic beta cells
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What is the pathophysiology of gestational diabetes?
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Glucose intolerance with onset of first recognition during pregnancy- diagnosis is based on results of a 100-g oral glucose tolerance test during pregnancy
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What are the types of diabetes?
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1) Type 1
2) Type 2 3) Gestational |
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What is the age of onset for type 1 diabetes?
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More common in young persons but can occur at any age
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What is the age of onset for type 2 diabetes?
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Usually age 35 or older, but can occur at any age
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What is the type of onset for type 1 diabetes?
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May be present for several years but signs and symptoms are abrupt
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What is the type of onset for type 2 diabetes?
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Insidious and may be undiagnosed for years
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Which type of diabetes is most prevalent?
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Type 2 (90%)
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What are environmental factors that may lead to type 1 diabetes?
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viruses and toxins
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What are environmental factors that may lead to type 2 diabetes?
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obesity and lack of exercise
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WHat is the primary defect of type 1 diabetes?
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absent or minimal insulin production
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WHat is the primary defect of type 2 diabetes?
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inuslin resistance, decreased inuslin production over time and alterations in production of adipokines
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In which type of diabetes is endogenous insulin present (possibly excessive)?
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type 2
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In which type of diabetes is endogenous insulin minimal or absent?
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type 1
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How does the nutritional status differ from type 1 diabetes patient from type 2?
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type 1- thin, catabolic state
type 2- obese or normal |
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What are the symptoms of type 1 diabetes?
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thirst, polyuria, polyphagia, fatigue, weight loss
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In which type of diabetes would symptoms possibly be absent?
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type 2
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What types of laboratory tests would be used to diagnose DM?
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fasting plasma glucose, random or casual plasma glucose, glycosated hemoglobin, glucose tolerance test, OGTT
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Which laboratory/diagnostic test is the most sensitive for diagnosing DM?
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OGTT (oral glucose tolerance test)
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Which type of diabetes is associated with HLA gene, therefore is a genetic disease?
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Type 1
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How is type 2 diabetes controlled?
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diet, exercise, oral agents, and insulin injections (if necessary)
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What should the HbA1c be?
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normal 3.5-5.5%
poor glucose control- greater than 8% |
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To avoid diabetes what does the ADA recommend that the HbA1c should be?
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below 7%
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What is DKA?
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diabetic ketoacidosis-a medical emergency caused by an absence of insulin or an inadequate amount of insulin
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What causes DKA?
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hyperglycemia, dehydration, electrolye loss and acidosis
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What are the symptoms of DKA?
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N/V, abdominal pain, fruity breath odor, hyperventilation
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What is HHS?
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hyperosmotic hyperglycemic nonketotic syndrome- a medical emergency cause by a lack of effective insulin causing hyperglycemia
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What causes HHS?
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a lack of effect insulin, severe insulin resistance, causing extreme hyperglycemia
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What are symptoms of HHS?
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hypotension, profound dehydration, poor skin turgor, tachycardia, variable neuro signs
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Who does Shelby find to be "dreamy"?
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Gavin DeGraw
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What are some chronic complications of DM related to the eyes?
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Diabetic retinopathy, cataracts, lens changes (lens swelling in response to increase glucose), extraocular muscle pulsy, and/or glaucoma
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What are some chronic complications of DM related to the kidneys?
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microalbuminemia
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How should you check a DM patient for microalbuminemia?
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test the urine anually
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What event would cause you to obtain a 24 hour urine sample from a DM patient?
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If albumin testing is greater than 30 mg/24 hour on 2 consecutive testing
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What are some chronic complications of DM related to the heart?
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Cardiovascular disease and MI
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What is the leading cause of death for patients with DM?
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MI
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what are some chronic complications of DM related to CNS?
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neuropathies-diffuse and focal
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What are the types of diffuse neuropathies?
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distal symmetric polyneuropathy and autonomic neuropathy
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What are the types of focal neurophaties?
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focal ischemia and entrapment neuropathy
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What is sudomotor neuropathy?
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1) decrease absence of sweating of the extremities with compensatory increase in upper body sweating
2) dryness of feet- increases the risk for foot ulcers |
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If someone has autonomic neuropathy, are they aware of their hypoglycemia?
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NO- autonomic neuropathy affects adrenal medulla which leads to absence of adrenergic symptoms of hypoglycmia- makes patient ASYMPTOMATIC
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What are contributing factors to foot and leg problems for DM patients?
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neuropathy, peripheral vascular disease, and immunocomprise
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What percentage of amputations r/t diabetes could have been preventable?
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FITTY! FITTY PERCENT! WE NEED TO GET OUR SHIET TOGETHER!
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What should DM patients do to manage their feet?
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1) manage their diabetes (thanks slack that's super specific and helpful)
2) inspect and wash feet daily 3) trim toenails straight across 4) wear shoes and socks at all times 5) protect from hot and cold 6) keep blood flowing |
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What slide are you going to look at to help you understand foot care for DM patients?
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slide 119 and 120 in dm, arf, and hemo powerpoint (explains how DM patients should wash their feet)
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What is the dawn phenomenon?
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hyperglycemia that is present on awakenings in the morning due to release of counterregulatory hormones in the pre-dawn hours (NOT AS SEVERE AS SYMOGI)
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What are possible factors that lead to dawn phenomenon?
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growth hormone and cortisol levels
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What is the somogyi effect?
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rebound effect in which an overdose of insulin causes hyperglycemia
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How should one speak when speaking to a client with a hearing deficit?
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Low tone, speak directly to them, eye level, reduce bg noise, ask if there is a good ear
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How should the elderly modify their diet?
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no more than 30% of fat, saturated fat should be less than 10% of calories, inc complex carbs and fiber, 5+ servings of fruits & vegetables, 6+ servings of grain products, inc calcium intake (1000-1500mg/daily), inc protein.
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How long should the elderly be exposed to sun?
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10-15 mins, 2-3x/week, avoid prolonged sun exposure.
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What are some recommendations for the elderly regarding psych/social health?
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reminisce about your life, get together w/ ppl in different settings, manage stress through coping mechanisms that have been successful in the past.
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What could cause malnutrition in the elderly?
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dentures, diminished senses (taste), depression (loneliness), sources
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