3313 Exam 1

Front 1

treatment usually requires that a person make one or more lifestyle changes to carry out specific activities that promote and maintain health.

Back 1

Adherence

Front 2

Therapeutic Regimen variables

Back 2

complexity of the regimen and uncomfortable side effects

Front 3

Teaching programs are more likely to succeed if

Back 3

the variables affecting patient adherence are identified and considered in the teaching plan

Front 4

Factors to motivate patient learning

Back 4

choice, establishment of mutual goals, and quality of the patient–provider relationship

Front 5

Readiness is based on...

Back 5

culture, personal values, physical and emotional status, and past experiences

Front 6

The “teachable moment” occurs when

Back 6

the content and skills being taught are congruent with the task to be accomplished

Front 7

Effective teaching strategies are (3)

Back 7

slow pace
reinforcement
small amounts each time
repitition

Front 8

Healthy People 2010

Back 8

to increase the quality and years of healthy life for people

to eliminate health disparities among various segments of the population

Front 9

Components of Health promotion (4)

Back 9

self responsibility
nutritional awareness
stress management
exercise

Front 10

Transtheoretical Model

Back 10

the motivation stages of a person to make decisions that promote healthy behavior changes

Front 11

Stage of Trans Model (6)

Back 11

Precontemplative
Contemplative
Decisions Making
Action
Maintenance
Termination

Front 12

Precontemplative

Back 12

Not thinking about making a change

Front 13

Contemplative

Back 13

Thinking about change in the near future

Front 14

Decision Making

Back 14

Constructs plan to change behavior

Front 15

Action

Back 15

Takes step to plan

Front 16

Maintenance

Back 16

prevent relapse and sustain goals

Front 17

Termination

Back 17

ability to resist relapse

Front 18

Cardiovascular Geriatric Changes

Back 18

Decreased CO, Decreased Stress response, HR and SV dont increase with demand, slow recovery, Increased BP

Front 19

Cardiovascular Diet

Back 19

Low fat, low salt, no smoking, control weight

Front 20

Respiratory geriatric changes

Back 20

Increase in Lung volume, Decrease muscle strength, Decrease VC, Decrease gas exchange, Cough

Front 21

Elderly have problems ____ involving respiratory..

Back 21

coughing up secretions, exhaling

Front 22

Respiratory Promotion
what age do i take a pneumonia vaccine?

Back 22

Take adequate fluids to liquefy secretions, flu shots YEARLY, pneumonia vaccine at 65

Front 23

Integumentary Geriatric Changes

Back 23

Decreased subq fat, int fluid, muscle tone, gland activity. temp extremes, more prone to sun exposure and trauma, capillary fragility.

Front 24

Integumentary Promotion

Back 24

Lotion with petroleum and mineral oil, 10-15 min in sun (VitD), shower not bathe in hot

Front 25

Reproductive Geriatric Changes

Back 25

Vaginal narrowing, decreased elasticity and secretions, firmless testes, slower sex response

Front 26

Reproductive Promotion

Back 26

estrogen replacement, lubricate

Front 27

Musculoskeletal Promotion

Back 27

high calcium diet, low phosphorus, VitD tabs

Front 28

Genitourinary Promotion

Back 28

Limit drinks late, void frequently, empty all the way

Front 29

Gastrointestinal Promotion

Back 29

high fiber, low fat, limit laxatives and antacids, drink fluids

Front 30

Nervous Promotion

Back 30

encourage visitors, enhance sensory sensation, slow rise from sitting, find cause for confusion

Front 31

CCRC's

Back 31

communities for caring for elderly. Independent homes, assisted living, or full care

Front 32

Dementia includes.. (2)

Back 32

Alzheimer's and Vascular Dementia

Front 33

Chronic, irreversible, progressive, downhill, leads to death (malnutrition or infection)

Back 33

Alzheimer's Disease

Front 34

Vascular Dementia etiology

Back 34

CV disease, cerebrovascular disease, hypertension

Front 35

abrupt, follows TIA or stroke, 50-70 yrs onset, males, chronic, irreversible, fluctuating

Back 35

Vascular Dementia

Front 36

Delirium Etiology

Back 36

toxicity, trauma, acute/chronic disease, F&E disorders

Front 37

Delirium

Back 37

rapid, acute onset, any age 1 day-1 month, reversible with treatment, can progress to death if ignored, fluctuating symptoms

Front 38

destruction of pancreatic beta cells which results in decreased insulin production, unchecked glucose production, fasting hyperglycemia

Back 38

Type 1 Diabetes

Front 39

Juvenile Diabetes

Back 39

Type 1

Front 40

Autoimmune response

Back 40

Type 1, may be genetics

Front 41

3 Polys

Back 41

Polydipsia
Polyuria
Polyphagia

Front 42

Polydipsia

Back 42

Increased thirst

Front 43

Polyphagia

Back 43

Increased appetite (carbs and sweets)

Front 44

Type 1 symptoms

Back 44

weight loss, fatigue, nausea, vomiting, 3 p's, abdominal pain (DKA)

Front 45

Sugar that comes from food stays in the bloodstream and cannot be digested by the liver

Back 45

postprandial hyperglycemia

Front 46

excess glucose excreted in the urine causes excessive loss of F&E

Back 46

osmotic diuresis

Front 47

impaired glucose tolerance, risk of developing type 2. no sypmtoms, already damaging heart and blood vessels and/or organs

Back 47

Pre-Diabetes

Front 48

insulin resistance, impaired insulin secretion bc of decreased sensitivity to insulin. Receptors that usually recognize insulin and metabolize it are diminished.

Back 48

Type 2 Diabetes

Front 49

High levels of insulin are secreted to maintain level. if the beta cells can't keep up with these higher demand then type 2 develops.

Back 49

Metabolic Syndrome

Front 50

Metabolic Syndrome includes: (3)

Back 50

hypertension
hypercholesterolemia
abdominal obesity

Front 51

DKA doesn't occur in Type 2 bc

Back 51

there is enough insulin to prevent the breakdown of fat and ketones

Front 52

Type 1 is needs ____ insulin and Type 2 has _____ insulin

Back 52

Exogenous
Endogenous

Front 53

Type 2 is gradual or rapid?

Back 53

Gradual

Front 54

Which Type can be prevented or delayed?

Back 54

2

Front 55

Secretion increases with Eating. What does this mean for Diabetes?

Back 55

The more people with Type 2 eat the more their resistance, which means weight loss and control is prevalent. The more insulin the less glucose.

Front 56

Low levels of glucose= ?

Back 56

Glucagon enacted

Front 57

Glucagon goes where and does what?

Back 57

Liver, increases glucose

Front 58

high glucose goes where and does what?

Back 58

pancreas, release insulin, lowers glucose from metabolism

Front 59

Type 2 Diabetes:

Back 59

insufficient or "dumb" insulin produced by pancreas. body tissues dont respond to insulin.

Front 60

Foods with HIGH glycemic index

Back 60

white bread
white rice
donuts
bagels
potatoes
cereals
corn syrup

contribute to Type 2

Front 61

Diabetics eat carbs bc:

Back 61

they are converted to glucose easily

Front 62

Diabetics eat fiber bc:

Back 62

decrease need for insulin, lower cholesterol.

Front 63

Gestational Diabetes: what does hormones cause?

Back 63

glucose intolerance during pregnancy. Hyperglycemia. Hormones cause insulin resistance.

Front 64

Tips for lowering glycemic index..

Back 64

Starch with protein and fat- slow absorption

raw and whole foods- no chopped, pureed, or cooked.

fruit- for fiber, no juices

Front 65

3 polys
acute, rapid onset
weak
fatigue
weight loss
DKA

Back 65

Clinical Manifestations for TYPE 1

Front 66

often none
fatigue
recurrent infection- UTI
visual disturbance
delayed healing

Back 66

Clinical Manifestations for TYPE 2

Front 67

A1C good number, bad number

Back 67

under 6- Good (managed diabetes)
10- organ damage

Front 68

Fasting Plasma Glucose: what do we do for this test?

Back 68

NPO 8hrs, confirmed two tests on diff days. morning

Front 69

Random PG

Back 69

manifestations present, anytime. RPG > 200

Front 70

OGTT

Back 70

gestational testing

Front 71

Fasting Plasma scale

Back 71

99 below- normal
100-125 pre diabetes
126 above- diabetes

Front 72

Oral glucose scale

Back 72

139 below- normal
140-199- pre diabetes
200 above- diabetes

Front 73

hA1C- blindness?

Back 73

usually at 6.5% begins retinopathy

Front 74

Diabetic Diet

Back 74

1500-1800 cal/day
carbs 50-60%, low glycemic, whole
fat- 20-30% low sat fats
FIBER

Front 75

stimulates pancreas to release insulin

Back 75

Sulfonylureas

Front 76

stimulates pancreas to release insulin. min of 30 min before meals, work QUICK

Back 76

Meglitinides

Front 77

Sulfonylureas may cause:

Back 77

weight gain, nausea,nausea

Front 78

Chlorpropamide also known as and is a what?

Back 78

Diabinese; SULF

Front 79

control BG in Type 2. Stimulate secretion and improves binding

Back 79

1st Generation Sulf

Front 80

1st Generation Sulf nursing actions:

Back 80

monitor for Hypoglycemia
taking renal meds?- mask hypo
no alcohol

Front 81

2nd Generation used alongside:

Back 81

same as 1st generation- more POTENT.
may use with glucose or Metformin

Front 82

lower glucose production of the liver, enhances insulin sensitivity, improves transport of glucose

Back 82

Biguanides

Front 83

Nurse implications for Biguanides:

Back 83

lactic acidosis
hypoglycemia
renal function
48 prior and after contrast agent

Front 84

Meglitinides

Back 84

Rapid action; short life
only admin after meal
liver function impaired?

Front 85

insulin sensitizers, stimulate receptors. Use for insulin resistance

Back 85

Thiazolidinediones

Front 86

Nurse implications for Thiazolidinediones:

Back 86

Risk for pregnancy, monitor BG and liver/renal function

Front 87

DDP4 Inhibitor

Back 87

inhibits incretin hormone, inreases insulin release

Front 88

Alpha- Glucosidase Inhibitor

Back 88

Starch blockers, slow entry of glucose into body from carbs

Front 89

ALPHA take when?

Back 89

with first bite of food

Front 90

DDP4 causes what issues?

Back 90

upper respiratory symptoms

Front 91

DDP4 interventions

Back 91

once a day
taken alone
renal function
hypoglycemia

Front 92

DDP4 plus Sulf =

Back 92

hypoglycemia

Front 93

alpha interventions

Back 93

GI side effects
liver function
DONT GIVE SUCROSE

Front 94

Keeping Insulin

Back 94

Refrigerate if unopened until expired

once open only lasts 28 days room temp

syringes kept refrigerated up to 30 days needle up

Front 95

Humalog and Novalog

Back 95

Regular and rapid

Front 96

Short acting and long acting?

Back 96

Give at intervals- not sliding scale

Front 97

HypOglycemia

Back 97

too little food, too much insulin, med/food mismatch, too much activity

Front 98

HyPO patients may manifest:

Back 98

Coldness
Wetness
CNS (fast HR, anxious, unsteady, HA)

Front 99

HypERgylcemia

Back 99

too much food, too little insulin, illness or stress

Front 100

HypER patients manifest:

Back 100

Hot
Dryness
GI (nausea, hungry, thirsty, urine)

Front 101

Treating alert hypO pt:

Back 101

give 15-20 carb snack
4-6 oz fruit juice or Coke
8 oz low fat milk- slows absorption
Recheck 15 min, 45 min
Provide another snack

Front 102

Treating unalert hypO pt:

Back 102

1 mg of glucagon IM or SQ
20-50 mL of Glucose IV push

Front 103

Retinopathy

Back 103

occurs in both 1 and 2.
hemorrhage

Front 104

nephropathy

Back 104

constant elevation of BG stresses kidneys from filtering. proteins leak into urine which increases BP

Front 105

nephropathy treatment:

Back 105

ACE inhibitors
Angiotension II inhibitors
microalbumin checks

Front 106

sensory neuropathy

Back 106

hands and feet sensation
pain
parasthesis

Front 107

diabetic surgery

Back 107

IV dextrose during and after, no oral hypoglycemics

Front 108

during illnesses:

Back 108

carb snacks q 3-4 hrs
fluids q 15-30 min
BG > 250- check ketones

Front 109

IV use insulin

Back 109

REGULAR

Front 110

basal insulin; long acting

Back 110

absorbed very slow over 24 hrs, once a day

Front 111

Insulin that covers the glucose after meals:

Back 111

rapid and short acting

Front 112

Rapid-acting insulins: (3)

Back 112

Lispro (Humalog)
Aspart (Novolog)
Glulistine (Apidra)

Front 113

Short acting insulin (1)

Back 113

Regular

Front 114

Intermediate acting insulin (1)

Back 114

NPH

Front 115

DKA

Back 115

absence or inadequate amount of insulin resulting in metabolism disorders of carb, protein, and fat

Front 116

DKA features (3)

Back 116

hyperglycemia
Dehydration
Acidosis

Front 117

phlebitis

Back 117

inflammation of the vein

Front 118

thrombophlebitis

Back 118

blood clot causing phlebitis

Front 119

superficial thrombosis

Back 119

inflammation of a superficial vein
IV phlebitis pts

Front 120

Pulmonary embolus

Back 120

thrombus that has traveled to the pulmonary artery (heart to lungs artery)

Front 121

post thrombotic syndrome

Back 121

thrombus destroys delicate valves, blood in vein stagnates

Pain and swollen legs; varicose veins

Front 122

VTE etiology

Back 122

"Virchow's triad."
Venous stasis
endothelial damage
blood clots

Front 123

Treatment for Superficial thrombo

Back 123

remove aggravating factor (IV, solution)
elevate
warm, moist heat
socks (only after died down)
antibiotics if infection
oral analgesics

Front 124

Clinical Manifestations of DVT

Back 124

Edema
pain
warm skin
erythema
elevated temp >100.4

Front 125

Venous Stasis

Back 125

immobolized
stroke
age >40
cardiac/ pulmonary failure
sedated
obese
tight clothes
traveling

Front 126

DVT risk factors: hypercoagability

Back 126

cancer and treatment
sepsis
dehydrated
pregnant
estrogen therapy
high altitudes
smoking

Front 127

DVT risk factors: injury to venous wall

Back 127

injections
prior DVT
trauma
injury
xrays
central lines

Front 128

SCORE it risks:

Back 128

Surgery
Cancer/CVD
Obese
Respiratory Fail
Elderly
Infection/Immobility/ICU
Trauma/Thromboembolism hx

Front 129

SCORE values:

Back 129

1-6- low risk
7-12- moderate risk
> 12- high risk

Front 130

Low risk treatment for VTE:

Back 130

leg exercise
early ambulation

Front 131

Moderate risk treatment for VTE:

Back 131

mechanical methods
anticoagulation prophylaxis
leg exercise
early ambulation

Front 132

high Risk treatment for VTE:

Back 132

mechanical methods
anticoag therapy

Front 133

Anticoagulation Prophylaxis

Back 133

Low dose Unfractioned Heparin
LMWH q12 hrs SQ
Fonda
Warfarin low dose

Front 134

Dont use A prophlaxis when:

Back 134

bleeding
aneurysms
trauma
alcoholism
recent surgery
hepatic/renal failure
infection
open wound
had a baby

Front 135

heparin actions:

Back 135

antithrombin activity
neutralize thrombin
stops fibrin formation

Front 136

heparin effect (response time)

Back 136

IV- immediate
SQ- 20-60 min

Front 137

Heparin monitoring:

Back 137

aPTT prior to and during admin
Platelets every 2-3 days
abnormal bleeding

Front 138

Sulfate- Protamine

Back 138

reverses Heparin

Front 139

Low Weight Heparin (LMWH)

Back 139

inhibits Xa
use for extended treatment of DVT/VTE

Front 140

LMWH response time

Back 140

SQ- rapid, peak 4 hrs

Front 141

Fragmin

Back 141

LMWH lasts 24 hours

Front 142

Lovenox

Back 142

LMWH lasts 12 hrs

Front 143

Why use LMWH?

Back 143

less monitoring bc of predictability

Front 144

Xa Inhibitor

Back 144

doesnt affect platelets
prophylaxis during orthopedic surgery; SQ injection

No with renal pts

Front 145

Warfarin (Coumadin)

Back 145

antagonize VitK to prevent synthesis of Factors II, VII, IX, X
use with AFib, NOT when Pregnant

Front 146

Warfarin response time

Back 146

36-72 hrs, peak at 5-7 days

Front 147

Warfarin monitoring

Back 147

Prothrombin time
INR
bleeding

Front 148

Reversing Warfarin

Back 148

High dose VitK, discontinue,lower dose, AquaMEPH

Front 149

Why avoid IM injections with VTE chapter?

Back 149

Bc if anticoags get in the muscle there is high potential for bleeding

Front 150

aPTT values

Back 150

23-40 sec norm
45-100 therapeutic

Front 151

HIT-Heparin Induced Thrombocytopenia

Back 151

Antibody mediated
Adverse reaction
drop in PLATELETS- lowered
3-4 days after admin
Hypercoagulable

Front 152

Platelet

Back 152

promotes coagulation

Front 153

platelet value

Back 153

norm- 150,000-400-000
critical <50,000 bleeding
<5000 CNS bleed, GI hemorrhage

Front 154

HIT Treatment

Back 154

Thrombin Inhibitors (LEP & ARGA)
Platelets
No antidote

Front 155

LMWH (LOVENOX) facts

Back 155

smaller DVT
outpatient

Front 156

VitK foods:

Back 156

broccoli, cabbage, GREENS
Kiwi, blueberry
mayonnaise
margarine
liver

Front 157

Drugs increasing INR

Back 157

Corticosteroids
Cimetadine
Thyroid prep
Tamox

Front 158

Drugs lowering INR

Back 158

Calcium supp
Fiber supp
Sucralfate

Front 159

Herbs Increase INR

Back 159

Gingko
Garlic
Wintergreen

Front 160

Herbs that decrease INR

Back 160

Ginseng
Green tea
Rose hips

Front 161

Pulmonary Embolism treatment

Back 161

high fowlers
lung sounds?
spirometer
no anxiety

Front 162

Arteriosclerosis

Back 162

hardening of arteries

Front 163

atherosclerosis

Back 163

inflammation of arteries

Front 164

Arterial Disorders meds-

Back 164

Statins
Bile acid sequestrants
Cholesterol absorption inhibitors
Use of antiplatelet agents

Front 165

Nursing Management Arterial Disorders

Back 165

Improving circulation
Promoting vasodilation
Preventing vascular compression

Front 166

Lab tests Coumadin=? and
Heparin = ?

Remember diagram

Back 166

Coumadin = PT
Heparin = PTT, APTT

Front 167

Difference b/t primary and secondary HTN?

Back 167

secondary is due to a specific cause, non-modifiable. (meds, trauma..)

Front 168

things to look for that may signify pseudoHTN..

Back 168

long term HTN but no organ damage

after medicated BP plummets, severe symptoms

Front 169

resistant HTN

Back 169

doesnt respond to therapy. could be knowledge deficit of physicians or nurses

Front 170

thiazide diuretics

Back 170

prohibit Na reabsorption in distal tubule. Water retention, increase K secretion

Front 171

thiazide diuretics reduce what risk?

Back 171

dizziness and falling

bone breakdown

Front 172

Disadvantages to using thiazide diuretics

Back 172

hypokalemia
increased sensitivity to sun
dont become dehydrated

Front 173

Loop Diuretics

Back 173

treat fluid retention and HTN, inhibits reabsorption of Na from loop of henle

Front 174

side effects of loop diuretics

Back 174

blood clots
dizziness
insomnia
increased falls
CVAs
postural HTN

Front 175

cardiac pts should take what diuretic?

Back 175

Loop

Front 176

Potassium Sparing Diuretics

Back 176

rids of Na and H2O but keeps K

Front 177

side effects of K sparing Diuretics

Back 177

not recommended for elderly
Hyperkalemia
orthostatic HTN
damage to kidneys

Front 178

Spironolactone may casue..

Back 178

dizzy
erectile dysfunction
gynecomastia

Front 179

Amiloride may cause..

Back 179

constipation
nausea
vomiting

Front 180

triamterene may cause,...

Back 180

renal stones
anemia
thromboctyopenia

Front 181

anti adrenergic medications

Back 181

supress stimulation of sympathetic nervous systemand epinephrine

Front 182

non selective beta blockers may cause..

Back 182

bronchoconstriction
peripheral vasoconstriction

Front 183

Block beta 1 works for...

Back 183

cardiac

Front 184

beta 2 works for..

Back 184

smooth muscle of bronchi/vessels

Front 185

Cardioselective used with what pts?

Back 185

diabetic, pulmonary and PVD

Front 186

Alpha-Beta Blocking Agents

Back 186

used for HTN emergencies

Front 187

dpnt use Nonselective beta blockers in what pts and why?

Back 187

diabetic and pulmonary

bc mask signs of hypoglycemia and supress tachycardia

Front 188

Blocker one affects...

Back 188

Heart

Front 189

blocker 2 affects...

Back 189

lungs

Front 190

using beta blockers? look for these at home...

Back 190

<50 pulse
>2lbs per week
edema
SOB
fatigue
DONT STOP ABRUPTLY

Front 191

HTN diet

Back 191

rich in FV
low fat dairy
reduced chol
reduce sat fat
rich in K and Ca

Front 192

Alpha2 adrenergic agents acts with what lines?

Back 192

Central

Front 193

Clonidine and Methlydopa

Back 193

Lowers BP
inhibits cardio acceleration and vasoconstriction centers

Front 194

Clonidine and Methlydopa adverse effects

Back 194

depression
drowsy
ED
bradycardia

Front 195

Alpha 1 acts on what line?

Back 195

peripherally

Front 196

Alpha 1 does..

Back 196

lowers BP
dilates arteries and veins

Front 197

alpha 1 adverse effects..

Back 197

dizzy
HA
weak
1st dose ortho HTN
ED

Front 198

ACE inhibitor

Back 198

lowers SVR but doesn't raise cardiac rate, CO, or HR

Front 199

ACE meds end in...

Back 199

PRIL

Front 200

ACE side effects

Back 200

cough
Hypotension
angioedema
RHF

Front 201

ARBS

Back 201

reduces aldosterone
vasodilation

Front 202

Nitrates

Back 202

prevent chest pain caused by MI
dilates veins, arteries
may cause HA