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173 Cards in this Set
- Front
- Back
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Hepatic Dysfunction |
-Can be Acute or Chronic -Cirrhosis of the liver -Most common cause is malnutrition related to alcoholism Also caused from infection, anoxia, metabolic disorders, and nutritional deficiencies. |
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Jaundice |
Yellow or green tinged body tissues; sclera and skin due to increased serum bilirubin levels of 2.5 or higher |
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Conjugated (Direct) Bilirubin |
Water soluble, secreted into bile. A type of bilirubin |
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Unconjugated (Indirect) Bilirubin |
Not water soluble: can not be filtered in the kidney; formed by breakdown of hemoglobin by macrophages. A type of bilirubin |
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Viral Hepatitis |
A systemic viral infection that causes necrosis and inflammation of the liver cells with characteristic symptoms and cellular and biochemical changes |
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Hepatitis A |
Trasmission: Oral-Fecal Prevention: Handwashing/Sanitation, Safe water, Vaccine *Anti-HAV IgM acute infection |
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Hepatitis B |
Trasmission: Through blood. Found in blood, saliva, semen and vaginal secretions, sexually transmitted, transmitted to infant at the time of birth. Prevention: Vaccine for persons at high risk, routine vaccination of infants, passive immunizations for those exposed, standard precautions/infection control measures, and screening of blood and blood products |
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Hepatitis C (HCV) |
Transmission: By blood and sexual contact, including needle sticks and sharing of needles, snorting cocaine Prevention: Screening of blood, prevention of needle sticks |
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Hepatitis D |
Transmission: Only people with hepatitis B are at risk. Through blood and sexual contact. Symptoms and treatment are similar to hepatitis B but more likely to develop fulminant liver failure and chronic active hepatitis and cirrhosis |
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Hepatitis E |
Transmitted: Fecal-Oral route Resembles hepatitis A and is self-limited with an abrupt onset. No chronic form. |
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Icteric (Physical manifestations of Hepatitis) |
2-3 weeks S & S include: jaundice, dark urine, clay-colored stools, pruritis, hepatomegaly, increased liver enzymes, fatigue. |
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Posticteric (Physical manifestation of Hepatitis) |
Convalescent 2-4 months S & S include: jaundice disappears. Fatigue, malaise, hepatomegaly continue. decreased splenomegaly, lab values return to normal, normal urine and stool color. |
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Hepatitis Nutrition |
-High carb and protein -Low fat -Adequate calories -Vitamen supplements -Small/frequent meals -Anti-nausea meds (not compazine orphenergan) -Adeqaute fluid intake (2500-3000ml/day) -NO ALCOHOL *Nutrition |
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Gallbladder |
Pear shaped organ that stores bile until needed for digestion |
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Biliary Obstruction |
Signs and Symptoms: Jaundice, Pain, N & V, fat intolerance, indigestion, RUQ tenderness, diaphoresis, biliary-colic spasms |
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Bilirubin |
WNL: Less than 1.2 mg/dl Increased in liver failure. Jaundice will show when reaches 2.5+ mg/dl |
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Amylase |
WNL: 30-110 u/l Used to identify acute pancreatitis (will increase). Can be decreased in severe liver disease |
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Lipase |
WNL: 0-60 u/l Assists in dx of acute/chronic pancreatitis or pancreatic cancer |
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ERCP (Endoscopic Retrograde Cholangiopancretography) |
Used to visualize/assess the pancreas and common bile duct for occlusion or stricture. Iodine contrast. Need to restrict food prior to procedure. Discontinue Metformin for 24 hours prior and 48 hours after |
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Liver Biopsy |
Assists in dx of liver cancer, hepatitis, cirrhosis. Usually done through needle aspiration. Major Complications: peritonitis from blood/bile (Check coagulation tests before procedure, treat abnormal results prior) Use different method if coagulation is an issue. |
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HIDA Scan (Hepatobiliary Scan) |
Visualization of cystic and common bile ducts of gallbladder. IV contrast medium needed. No food or liquid within 2-4 hours of scan. Bilirubin above 30 may impair clear imaging. |
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Gallbladder/Abdominal Ultrasound |
Used to visualize aorta, bile duct, gallbladder, kidneys, pancreas, spleen; done without contrast. |
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Acute Pancreatitis |
The pancreatic duct becomes obstructed and enzymes back up into the pancreatic duct causing auto digestion and inflammation of the pancreas. Causes: ETOH (Alcohol) excess, stone in common bile duct, hyperlipidemia |
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Chronic Pancreatitis |
A progressive inflammatory disorder with destruction of the pancreas. Cells are replaced by fibrous tissue and pressure within the pancreas increases. Causes: ETOH and malnutrition, smoking |
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Potential Complications of Hepatitis |
Greater mortality in Hep B and C. Chronic Hepatitis with progression to cirrhosis of the liver. Fulminant hepatitis (sever liver failure resulting in death) |
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Potential Complication of Acute Pancreatitis |
Fluid and electrolyte disturbances. Absess fluid containing cavity within pancreas. Hypocalcemia. Necrosis of the pancreas. Shock. Multiple organ dysfunction syndrome. (DIC) disseminated intravascular coagulation |
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Liver Cancer |
Usually caused by chronic liver disease, Hep B/C or cirrhosis. HCC is most common type. Smoking is a risk factor. Usually caught too late for resection. |
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Grey-Turner's Sign |
Bruising of the flank, usually bluish in color due to hemorrhage in peritoneal space. Can be a sign of severe acute pancreatitis |
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Murphy's Sign |
Used to help dx cholecystitis Palpate below ribs in RUQ over gallbladder. Have patient take a deep break in and if pain occurs, can be a sign |
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Care of patient with acute pancreatitis |
Directed toward relieving s/s and preventing/tx of complications. NPO (use enteral nutrition, starting early) NG suction to relieve n/v,morphine, ranitidine (Zantac) or pantoprazole(Protonix) to inhibit secretion of gastric acid, fluid replacement via IV, may need insulin due to hyperglycemia, possible calcium replacement; low fat/protein diet, no alcohol/caffeine |
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Care of patient with Hepatitis |
.. |
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Cholecystitis |
A inflammation of the gallbladder that occurs most commonly because of an obstruction of the cystic duct from cholelithiasis. S&S: peritoneal irritation, pain in the RUQ, N&V, fever |
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Cholelithiasis |
The presence of gallstones, which are concretions that form in the biliary tract, usually in the gallbladder. Jaundice may develop due to blockage of the common bile duct |
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Cholecystectomy |
Surgical procedure to remove the gallbladder |
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Nutrition post-cholecystectomy |
Nutriton Post Surgery low fats, high carb and protein; fat restriction lifted within 4-6 weeks post op. usually have IV fluids immediately after or during procedure. |
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Acute Pancreatitis S&S |
S&S: -Severe Abdominal pain -Patient appears acutely ill -Abdominal Guarding -N&V -Fever, Jaundice, Confusion, agitation may occur -Grey-Turner Sign -Respiratory distress, Hypoxia, renal failure, hypovolemia, and shock |
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Chronic Pancreatitis S&S |
S&S: -Recurrent attacks of severe upper abd. and back pain accompanied by vomiting. -weight loss -Steatorrhea |
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Cirrhosis |
A condition in which the liver does not function properly due to long term damage |
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Pancreatic Cancer |
Usually presents after 45 y.o.; highest risk in African-American Males. cigarette smoking, diet high in fat, meat, or both, exposure to toxins are risks. S&S: pain, jaundice, weight loss, ascites, hyperglycemia, aggravation from meals; MRI and ERCP for dx. surgery for resection if localized, radiation/chemotherapy. pain management with opioids (PCA), mattress overlay to protect prominences, discuss hospice care. |
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Symptoms of Hepatitis |
S&S: -Loss of appetite -N&V -Abd. Pain -Gray-colored bowel movements -Fever -Fatigue -Jaundice -Joint pain |
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Interventions to prevent Hepatitis |
Screening of blood donors, use of disposable needles, needleless IV systems, sanitation of work areas, gloves worn, patient education, syringe locks, vaccinations for A and B *Interventions to prevent |
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Cancer |
Cell Proliferation: Uncontrolled growth with ability to metastasize and destroy tissue, and cause death Cell characteristics: Presence of tumor-specific antigens, altered of shape, structure, metabolism The more poorly differentiated the more aggressive |
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Non-Controllable risk factors for Cancer |
Heredity Age Gender Poverty *Risk factors |
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Controllable risk factors for Cancer |
Stress, diet, occupation, infection, tobacco use, alcohol use, drugs, obesity, sun exposure *Risk Factors |
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Universal Signs of Cancer |
-Change in bowel or bladder habits -A sore that does not heal -Unusual bleeding or discharge -Thickening of a lump in a breast or somewhere else -Indigestion or difficulty in swallowing -Nagging cough or hoarseness |
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Carcinogens |
Chemicals, physical factors, other agents that cause cancer; chemotherapeutic drugs, glucocorticosteroids, anabolic steroids, drugs, estrogen, testosterone |
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Primary Prevention |
Concerned with reducing cancer risk in healthy people providing health promotion Goal: Reduction of risk of the disease Ex. Application of sunscreen, avoid smoking |
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Secondary Prevention |
Involves detection, screening to achieve early diagnosis, intervention Ex. Screening mammograms, digital rectal exams, prostate specific antigen |
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Tertiary Prevention |
Focusing and monitoring for prevention of recurrence of primary cancers as well as secondary cancers ex. Development of leukemia or lymphoma after certain chemotherapeutic regimes |
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Staging (Cancer) |
Determines size of tumor, existence of local invasion, lymph nodes involvement and presence of distant metastasis Describes the the extent or severity of a person's cancer |
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Grading (Cancer) |
Pathologic classification of tumor cells. Seek to define the type of tissue the tumor cells originated from and if the retain the histological and functional characteristics of the tissue origin. (Differentiation) |
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Staging of Cancer |
Grade I- Cells differ slightly from normal cells and are well differentiated Grade II- cells are more abnormal and moderately differentiated Grade III- Cells are very abnormal and poorly differentiated Grade IV- Cells are immature and primitive and undifferentiated |
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Dysplasia |
Deranged cell, variable growth, size, shape, appearance |
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Poorly Differentiated / Undifferentiated Cells |
The specialization of the cell is mutated and is no longer recognizable (cannot trace origin of tissue); the more poorly differentiated, the more aggressive the cancer |
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The goals of treatment (Cancer) |
Cure- Complete eradication of the malignancy Control- Prolonged survival Palliation- Improvement of quality of life |
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TNM Classification System |
"Tumor, Nodes, Metastasis". ranks extent of primary tumor, involvement of lymph nodes, and whether distant metastasis has occurred. |
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Tumor Markers |
Analysis of substances found in tumor tissue to help identify cancerous cells; assists in dx, selection of tx, prediction of response to therapy, and risk of reoccurrence |
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In Situ Cancer |
An early stage cancer in which the cancerous growth or tumor is still confined to the site from which it started, and has not spread to surrounding tissue or other organs in the body; STAGE 0 |
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Methods of Diagnoses (Cancer) |
-Diagnostic Surgery -Biopsy -Tumor removal -Imaging -Symptomatology -Assessment |
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Surgery (Cancer) |
Initial or Debunking. Removal of entire cancer is ideal. Could be primary tx, palliative, prophylactic or reconstructive. |
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Chemotherapy (Cancer) |
Interrupts cellular function by cellular destruction and replication of DNA. Goal: to eradicate the malignant cells enough so the body's immune system can destroy the remaining cells. Drugs act in the cell cycle. Drugs are labeled cell cycle specific and non-specific. Depends on the propensity of DNA/RNA synthesis and response |
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Radiation Therapy (Cancer) |
Direct alteration of DNA. May be focused on control, prophylactic, palliative Two types: Electromagnetic and Particulate Can be delivered via external bean, internal via implant or via brachytherapy |
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Biological Therapy / Targeted Therapy (Cancer) |
Genetic engineering that alters the immunologic relationship between the tumor and the host (patient) |
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Nursing Exposure Concerns (Cancer) |
Internal Implants Time, Distance, And shielding wear. Dosimeter badge |
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Systems Affected by Treatment (Cancer) |
Gastrointestinal, Bone marrow, Renal, Cardiopulmonary, reproductive, neurologic, respiratory Chemotherapy = Systemic Treatment Radiation = Localized Treatment Biologicals = Tumor specific |
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Chemotherapy |
Administration can be given IV, intra-arterial, PO, administered intra-operatively by "washing" the tissue Dosage limitations are based on cumulative lifetime dose also on BSA of the patient |
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Extravasation |
Escape of vesicant or irritant into the surrounding tissue by infiltration. Stop infusion immediately begin __________ protocol. Aspirate and treat with steroids / antidotes |
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Vesicant |
Agents that cause tissue damage, irritation and possible necrosis if left untreated. Stop infusion with S/S of redness, warmth, pain; never use peripherally, have antidote on hand |
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Alkylating Agents (Chemotherapy) |
Directly damage DNA to prevent the cancer cell from reproducing. These agents are not phase-specific. Used to treat many different cancers. Can do long term damage to the bone marrow. Can lead to acute leukemia. Classes include: Nitrosoureas, Nitrogen mustards, Alklysulfonates, Triazines, etc |
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Antimetabolites (Chemotherapy) |
Class of drug that interfere with DNA and RNA growth by substituting the normal building blocks of RNA and DNA. Damage cells during the S-Phase. Includes: 5-Flurouracil, 6-mercaptopurine, capecitabine, cladrlbine, clorarabine, etc |
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Anthracylines (Chemotherapy) |
Anti-Tumor antibiotics that interfere with enzymes involved in DNA replication. Work in all phases of the cell cycle. Widely used for a variety of cancers. Can permanently damage the heart if given in high doses. Include: Daunorubin, Doxorubicin, Epirubicin, Idarubicin |
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Topoisomerase Inhibitors (Chemotherapy) |
These drugs interfere with enzymes called topoisomerase, which help separate the strands of DNA so they can be copied. Topoisomerase I inhibitors include topotecan and irinotecan (CPT-11), Topoisomerase II inhibitors inblude etoposide and teniposide. II inhibitors increases the risk of a second cancer - leukemia. can be seen as early as 2 to 3 years after drug is given |
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Mitotic Inhibitors (Chemotherapy) |
Often plant alkaloids and other compounds derived from natural products. They can stop mitosis or inhibit enzymes from making proteins needed for cell reproduction. Work in the M phase but can damage cells in all phases. |
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Corticosteroids |
Commonly used as anti-emetics to help prevent nausea and vomiting caused by chemotherapy. They are used before chemotherapy to help prevent severe allergic reactions too. when used to prevent vomiting or allergic reaction it is not considered chemotherapy |
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Nursing Measures for Chemotherapy |
-Assesing fluid, electrolyte status -Modifying risks for infection, bleeding -Administering chemotherapy, PICC lines or implanted ports, imperative that the patient has a patient line -Protecting caregivers/special equipment and PPE if mixing |
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Neutropenia |
Low neutrophil count; the lower the count, the more vulnerable to disease. Less than 500 = reverse isolation necessary. fever threshold is lower, bring to ER if above 100.5. An ANC can be done to determine risk |
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Thrombocytopenia |
Decreased platelets, check for bleeding, changes in LOC, and bruising- numbers usually lowest 1-2 weeks after beginning chemotherapy |
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Superior Vena Cava Syndrome |
-Compression or invasion of vena cava by tumor, lymph nodes, or thrombus- usually with lung cancer; can lead to cerebral anoxia, laryngeal edema, bronchial obstruction, and death. -S/S: SOB, chest pain, facial swelling, cough, edema of neck, arms, hands, thorax, skin tightness, difficulty swallowing, stridor, JVD, visual disturbance, headache, AMS -Use CXR, CT scan, MRI, venogram -Apply 02, diuretics for fluid overload, use lower extremeties for BP, venipuncture. bed rest, SEMI-FOWLER's (avoid supine/prone) |
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Hypercalcemia |
-Abnormally high Ca+; can result from production of cytokines/hormones from cancer cells- usually seen in breast/lung/renal cancers. -S/S: fatigue, weakness, confusion, decreased LOC, hyporeflexia, n/v, constipation, ileus, polyurea, polydipsia, dehydration, dysrhythmia -CA+ greater than 10.5; need to consume 2-4L/day, use of laxative plus antiemetic, promotion of mobility |
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Tumor Lysis Syndrome |
-Release of tumor intracellular contents that can lead to rapid hyperkalemia, hyperphosphatemia, hypocalcemia, hyperuricemia. -S/S: fatigue, AMS, muscle cramps, paresthesia, seizures, elevated BP, dysrhythmias, anorexia, n/v, diarrhea, hyperactive BS, flank pain, renal failure, gout, pruritis |
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Hospice Nursing |
Focus on quality of life, palliation of s/s, and support for patient and family; referral should be done in timely fashion <6months |
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Pain Management (Cancer) |
Can be irreversible and not quickly resolved; can be increased from fear/anxiety; Step 1: pain persisting/increasing (use of nonopioid w/ adjuvant). Step 2: pain increasing (use of mild opioid with nonopioid/adjuvant). Step 3: Opioid for severe pain with non-opioid or adjuvant |
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Allopurinol |
Inhibit conversion of nucleic acids to uric acid *Drug |
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Internal Radiation |
Delivers dose of radiation localized area. Is implanted. Can be administered in high doses for short periods or low dose for longer periods *Radiation |
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External Radiation |
Most commonly used; can be used in conjunction with CT/MRI to set up beans directly on tumor; less side effects/toxicity due to less effect on surrounding tissues *Radiation |
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Benign Tumor |
A mass of cells (tumor) that lacks the ability to invade neighboring tissue or metastasize. These characteristics are required for a tumor to be defined as cancerous and therefo are non-cancerous. |
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Malignant Tumor |
Are cancerous and are made up of cells that grow out of control. Cells in these tumors can invade nearby tissues and spread to other parts of the body. Sometimes cells move away from the original (primary) cancer site and spread to other organs and bones where they can continue to grow and form another tumor at that site. |
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Stages of Cancer Development |
1. Initial tumor growth 2. Growth towards other tissues 3. Metastasis |
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Biopsy |
Helps determine whether adjacent lymph nodes contain tumor cells and determines treatment for cancer |
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Normal Value for alanine aminotransferase (ALT) |
10-40 IU/L Normal lab values |
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Liver dysfunction |
ALT and AST indicate what |
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Rapid weight loss related to crash diet |
Factor that increases the risk of developing gallstones |
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50-80% |
what percentage of new injection drug users will become Hep C positive within the first 6-12 months? |
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Nursing interventions for side effects of radiation and chemotherapy |
alopecia- provide encouragement, self-confidence fatigue- placed on bed rest, education that it is effect of medicine, not worsening of disease mucous membranes- encourage frequent oral care with SALINE, no flossing or hard tooth brush if decreased platelets N/V- administration of IV fluids, anti-emeticsanorexia- PEG tube, dietician/speech consult, supplements. HIGH PROTEIN, HIGH CALORIE |
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Bone marrow transplant |
Pre: nutritional, physical, social, financial, insurance assessments, blood work, past infectious antigen exposure assessment During: monitor v/s and blood o2 sat, check for fever, chills, SOB, chest pain, n/v, hypotension, tachycardia, anxiety, taste change, educate and provide ongoing support After: common side effects: sterility, infections, pneumonia, cataracts, frequent psychosocial assessments DONORS: mood alterations, decreased self-esteem, and guilt if transplant fails |
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Schizophrenia and psychotic disorders |
Increased levels of dopamine related to mental illness |
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Parkinson's disease and degenerative neuromuscular disease |
Decreased levels of dopamine related to mental illness |
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Mania |
Increased levels of norepinephrine related to mental illness |
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Depression |
Decreased levels of norepinephrine related to mental illness |
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Depression and Suicide |
Decreased levels of serotonin related to mental illness |
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Alzheimer's Disease |
Low levels of acetylcholine related to mental illness |
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Anxiety |
Low levels of GABA related to mental illness |
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Acetycholine |
-Signals muscles to become active -Plays a role in sleep-wake cycle |
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Glutamate |
-Role in long term memory and learning -Too much = toxic -Plays a role in brain damage caused by CVA's and Huntington's chorea |
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Gamma Aminobutyric Acid (GABA) |
-Acts as an inhibitory neurotransmitter -Low levels = Anxiety -Anxiety is a dysregulation of _____ |
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Antiemitics |
-Manage N+V, use general measures to decrease nausea -Brat diet, small at first -May cause drowsiness -slow position changes *Nursing Considerations for Drug |
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Opioids |
-To manage pain -When and how to ask for pain meds -Causes drowsiness and dizziness -Turn cough to prevent atelectasis *Nursing Considerations for Drug |
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Diuretics |
-To tx edema due to CHF -I+D's lung sounds -Advise to continue meds -Monitor I&O, weight, BP |
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Anticholinergics |
-Reduce symptoms of EPS -Pt to rinse mouth -No driving until med effects are known -vision changes may be temporary *Nursing Considerations for Drug |
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Beta blockers |
-Manage angina -Hypertension -Headaches -CHF (hyperthyroid symptom only) -Do not discontinue -Monitor BP -Follow up *Nursing Considerations for Drug |
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Benzodiazapines |
-For anxiety associated with depression -Check Sodium -Dont miss dose or double -Don't take antacids *Nursing Considerations for Drug |
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Anxiolytics |
-Help pt develop healthy coping/sleeping strategies -Change position slowly -Call for assistance -Report increasing lethargy, disorientation, confusion, slurred speech or ataxia -AVOID ETOH/caffeine/smoking/drugs |
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Antipsychotics |
-Include other forms of therapy -Take meds as prescribed -Change position slowly -Report EPS symptoms -Use sunscreen/sunglasses -AVOID ETOH/drugs/caffeine *Nursing Considerations for Drug |
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Antidepressants |
.. |
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Therapeutic Milieu |
Every action should have a therapeutic purpose and offer opportunity for growth (assist with ADL, med admin and education, psychosocial care, mental health education, interdisciplinary team) |
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Anticholinergic Side Effects |
Increased body temperature, blurry vision (dilated pupils), flushed face, dry mouth, dry eyes, decreased sweat, delirium. (hot as a hare, dry as a bone, blind as a bat, red as a beet, mad as a hatter) *Side effects |
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Extrapyramidal Symptoms |
"pseudoparkinson's" drug induced parkinsonism as a result of antipsychotic agents: akinesia (w/o movement), bradykinesia (slow movement), rigidity of muscles, tremors; caused by antipsychotics |
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Genogram |
Pictorial display of a person's family relationships and medical history. Helps recognize familial patterns |
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Acute dystonia |
Muscle spams of the face, head, neck and back |
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Akathisia |
Regular rhythmic movements of the lower extremities; constant pacing is also seen |
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Tardive Dyskinesia |
Tongue rolling, lip smacking; may be irreversible; late effect, AIMS scale |
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Neuroleptic Malignant syndrome |
High fever, AMS, Rigidity, unstable BP, sweatingl; potentially fatal |
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Pros and Cons of Group Therapy |
Pros: cost effective, decreases isolation, encourages sharing/learning Cons: confidentiality issues, intimidation |
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MAO Inhibitors |
Last choice drug due to the amount of interactions with foods and any other meds Inactivates NT allowing serotonin and norepi to increase (antidepressant effect), increased risk for bleeding with NSAIDS, increase risk for serotonin syndrome, NOT A FIRST LINE DRUG, restrict tyramine (cheeses, meats) |
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Safety measures related to psychotherapeutic agents |
.. |
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Mental status exam components |
-Appearance (hygeine, dress, disheveled) -Behavior (cooperative, angry) -Attitude -Speech (quality/quantity) -Affect (mood) -Thought content (delusions, hallucinations, preoccupations), -Orientation, -Memory, -Intellectual functioning (calculations, abstract reasoning, insight/judgment), -Suicidal/homicidal ideation |
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Group Phases |
Orientation -Nurse gathers information, needs assessments, establishes trust Working -Evidenced by changes in thoughts, feelings and behaviors Termination -Summary of progess |
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Group Therapy leadership styles |
Autocratic - "My way or the highway" Democratic - shared decision making Laissez-Faire - "what will be will be" |
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Group Roles |
coordinator, facilitator, initiator, evaluator, harmonizer, supporter, compromiser, (own agendas) controller, silent, nay sayer, seducer, aggressor, complainer, monopolizer, intimidator, dominator, blocker |
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Axis I (DSM IV-TR) |
-assesses individual's present clinical status/condition -inclds CLINICAL SYNDROMES that may be focus of clinical attention, such as: schizophrenia, GAD, MDD, substance dependence -conditions are roughly analogous to illnesses/diseases in general medicine -more than one diagnosis permissible/encouraged |
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Axis II (DSM IV-TR) |
-PERSONALITY DISORDERS: longstanding personality traits (may or may not be involved in development of Axis I disorder) & MENTAL RETARDATION -encompasses problematic ways of relating to world, such as: histrionic personality disorder, paranoid personality disorder, antisocial personality disorder -more than one diagnosis permissible/encouraged |
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Axis III (DSM IV-TR) |
-GENERAL MEDICAL CONDITIONS potentially relevant to understanding/managing case such as:Cirrhosis, Overdose, Cocaine -more than one diagnosis permissible/encouraged |
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Axis IV (DSM IV-TR) |
-PSYCHOSOCIAL/ENVIRONMENTAL problems: STRESSORS that may contribute(d) to current disorder, part. those that have been present during prior year -checklist approach for various categories of problems:family, economic, occupational, legal -for example: "Problems with primary support group" |
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Axis V (DSM IV-TR) |
-GLOBAL ASSESSMENT OF FUNCTIONING: clinicians indicate how well individual is coping at present time -scale from 1 to 100 |
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Normal Value for AST |
12-31 IU/L |
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Type 1 Diabetes |
-Insulin producing beta cells in the pancreas are destroyed ban autoimmune process -absolute lack of insulin, sudden onset, usual onset before 30 y.o., life dependent on insulin replacement, can have DKA -5-10% of persons with diabetes |
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Type 2 Diabetes |
-Decreased sensitivity to insulin (insulin resistance) and impaired beta cell function results in decreased production of insulin -less insulin available than what body is demanding, can be caused by obesity, delayed response to glucose load with receptor impairment, usual slow, progressive onset after 30 y.o., may need insulin, less classic symptoms |
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Normal Blood range of Glucose |
70-110 mg/dl |
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Risk factors for developing type 2 diabetes |
-Obesity -Sedentary lifestyle -Family History -African/Hispanic -Elderly -Hypertension (140/90) -HDL (35 or less) *Risk factors that can lead to ________ |
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Diabetes Mellitus |
A group of diseases characterized by hyperglycemia due to defects in insulin secretion, insulin action or both Minority and elderly are disproportionately affected |
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Functions of Insulin |
-Transports and metabolizes glucose for energy -Stimulates storage of glucose in the liver and muscle as glycogen -Signals the liver to stop release of glucose -Enhances the storage of dietary fat in adipose tissue -Accelerates transport of amino acids into cell |
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Diagnostic criteria for diabetes mellitus |
1. casual glucose greater than 200 mg/dL with polyuria, polydipsia, weight lossOR 2. Fasting (8 hr) glucose of 126 mg/dLOR 3. 2 hr post load glucose of 200 mg/dL during oral glucose tolerance test (OGTT) |
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Diabetes Mellitus (Clinical Manifestation) |
Fatigue, weakness, vision changes, tingling or numbness in hands or feet, dry skin, skin lesions or wounds that are slow to halt, recurrent infections Type 1 may have sudden weight loss, N&V, and Abd pain if DKA has developed |
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180 to 200 mg/dl |
Renal threshold for glucose |
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Glycated Hemoglobin (A1C) |
Measure of glucose control that is a result of glucose molecule attaching to hemoglobin for the life of RBC (120 days) 4-6% WNL, goal for diabetic is less than 7% Uses a venous blood sample to show the average blood glucose over previous 3-4 months |
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Hypoglycemia |
Less than 70 mg/dl (severe=less than 40mg/dl) can occur with too much insulin, too little food, or excessive exercise |
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S/S of hypoglycemia |
(adrenergic) sweating, tremor, tachycardia, palpitations, nervousness, hunger, (CNS)headache, lightheadedness, confusion, numbness of mouth, double vision, irrational behavior |
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Foot care of Diabetic |
-Foot Care of Diabetic inspect feet everyday (blisters, cuts, red spots, swelling), -Wash feet everyday (warm water, be sure to dry, never soak feet), -Use thin coat of lotion, -Smooth corns and calluses with pumice stone, -Trim toenails prn, -Wear shoes and socks at all times, -Do not cross legs, -Put feet up when possible, -Follow up with primary provider |
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Rapid Acting Insulin |
Onset: 5-15 minutes, Peak: 30 min-1hr, Duration: 2-4 hour *Tx for hyperglycemia, prevent nocturnal hypoglycemia (lispro [Humalog], aspart [Novolog], glulisine [Apidra]) |
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Short Acting Insulin |
Onset: 1-1.5 hr, Peak: 2-3 hr, Duration: 4-6 hour. *Admin 30 min before meal (Humalog R, Novolin R, Iletin II Reg) |
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Intermediate Acting Insulin |
Onset: 2-4 hr Peak: 4-12 hr Duration:16-20 hr *usually taken after food* (NPH, Humulin N,Novolin N, Iletin II NPH) |
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Long Acting Insulin |
Onset: 1 hr Peak: continuous Duration: 24 hour Glargine (Lantus), detemir (Levemir) |
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Nutritional guidelines for diabetic patient
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-control of total caloric intake, -normalization of lipids and blood pressure, -control of glucose Protein 10-20% Carb 50-60% Fat 20-30% |
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Treatment of Hypoglycemia |
-Tx with carbs -give 0.5 cup of fruit juice -If unconscious (1 mg glucagon injection), D50W IV for unconscious in ED or hospital setting |
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Diabetic Ketoacidosis (DKA) |
-Absence of insulin usually in type 1 -Quick onset -Hyperglycemia (300+) -Dehydration/electrolyte loss -Acidosis -Emergency situation Tx: IV fluid replacement (.9%NS) check K+, insulin at slow continuous rate (5 units per hour) |
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Hyperglycemic Hyperosmolar Syndrome |
-Metabolic disorder of type 2 diabetes resulting from insulin deficiency, -Slower onset -Hyperglycemia (600+) occurs most often in elderly, -Usually caused by infection -Do not have gi symptoms like DKA does because ketosis does not occur. s/s: hypotension, dehydration Tx: similiar to DKA Too much glucose in blood. |
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Long term complications of diabetes |
retinopathy, nephropathy, neuropathy, highly intensive treatment, amputations |
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Nursing intervention in administering insulin safely |
-Do Accucheck -Review Orders -Draw up units -Verify with another nurse *Med administration |
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First Gen. Sulfonylureas- ORAL |
chlorpropamide (Diabinese), tolazamide (Tolinase), tolbutamide (Orinase) Uses:type 2 diabetes. side effects: hypoglycemia, mild gi, weight gain, interaction with NSAIDs, warfarin, sulfonamides, skin rxn; Action: stimulates release of insulin from pancreas |
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Second Gen Sulfonylureas- ORAL |
Glipizide, glyburide, glimepiride Uses: type 2 diabetes Side effects: hypoglycemia, mild gi, interactions with warfarin, sulfonamides, and NSAIDs, weight gain |
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Biguanides- ORAL |
Metformin (Glucophage), metformin with glyburide (Glucovance): Uses: type 2 diabetes Side effects: lactic acidosis, hypoglycemia, gi disturbances, contraindicated in p with liver/kidney disease, ETOH, severe infection, respiratory insufficiency. Action: decreases sugar made by liver, increases glucose absorbed by muscle cells- should not cause weight gain |
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Alpha-Glucosidase Inhibitors- ORAL |
acarbose (Precose), miglitol (Glyset) Uses: in type 2 diabetes Side effects: hypoglycemia, abd discomfort, diarrhea, flatulence, drug-drug interactions |
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Non Sulfonylurea Insulin |
Repaglinide (Prandin), nateglinide (Starlix): Uses: type 2 diabetes Side effects: interactions with ABX |
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Thiazolidinediones |
pioglitazone (Actos), rosiglitazone (Avandia) Action: Sensitizes body tissue to insulin |
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Dipeptidyl Peptidase 4 Inhibitors |
Sitagliptin (Januvia), vildagliptin (Galvus) Action: increases insulin release. |
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Na (Sodium) |
135-145 |
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K (Potassium) |
3.5-5 |
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Cl (Chloride) |
98-106 |
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Ca (Calcium) |
8.5-10.5 |
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Facilitate glucose transport across cell membranes |
Major effect of insulin on cellular metabolism is to... |
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Regular insulin |
Insulin that can be administered intravenously |
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hypoglycemia |
A major risk of therapy to maintain a tight glucose control is... |
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Polyuria: urinate frequently Polydipsia: increase thirst polyphagia: increased appetite |
Three big signs of diabetes |
