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139 Cards in this Set
- Front
- Back
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what is the most insulin resistant tissue in the body?
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Belly fat - lose it to reduce DM2
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your pt has high levels of anti-gad antibodies (over 1.4 u/ml), what do you suspect?
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Type I DM
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your pt has low C-peptide levels (less than 0.5 mg/ml) what do you suspect?
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type 1 DM because C-peptide is directly related to insulin levels.
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what causes gestational DM?
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human placental lactogen (hPL) and other hormones produced by placenta
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your ob pt is over 25, overweight hand has had a LGA baby in the past, what is she at risk for?
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Gestational Diabetes
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what is secondary diabetes?
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diabetes caused by other disorders: pancreatic, hormonal, drug induced (glucocorticoids, chemotherapy, hiv/aids meds, anti-rejection meds, nicotinic acid) and infection/trauma
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what level of fasting blood glucose is indicative of DM?
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more than or equal to 126 mg/dL
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what 2 hours after a meal level of Blood glucose is diagnostic for DM?
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greater than or equal to 200 mg/dL.
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what is normal fasting BG?
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70-99
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what A1C level is diagnostic of DM?
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greater than or equal to 6.5%
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at what BG level do WBC's no longer work?
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180 mg/dL
(220 impairs WBC for 2 weeks) |
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your kidny failure pt's dr has prescribed metformin to reduce insulin resistance and reduce hepatic glucose production. What do you do?
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Call physician - metformin is not safe for pt with kidney failure.
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which sulfonylureas is safe for chronic renal failure
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glipizide
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what is IIT?
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intensive insulin therapy - treatment with goal of near-normal glycemia through the use of multiple daily injections of insulin or insulin pump therapy
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what does "basal insulin" do?
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manages the hepatic glucose output (basal rate of glucose produced all the time by the liver)
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which insulins are good for managing basal insulin levels?
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intermediate acting (humulin and novolin NPH)
Long acting (lantus, levemir) |
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how often is basal insulin therapy dosed?
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intermediates - BID
Long acting - QD at a consistent time |
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what is bolus insulin going to consist of?
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short or rapid acting insulin to manage glucose elevations following meals or snacks.
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what are the rapid acting insulins?
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humalog/lispro
novolog/aspart |
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what are the short acting insulins?
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humulin R (regular)
Novolin R (regular) |
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when does the RN administer short acting insulin?
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right before a meal is eaten
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Regular insulin is usually given when? Why?
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at breakfast and supper cuz you get overlap duration if given at lunch too.
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what is amylin? When is it used?
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another hormone that you probably don't make if you don't make insulin. used if insulin is not working to control sugar?
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describe DKA (diabetic ketoacidosis)
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Body can't use sugar, so body breaks down fat for energy which produces fatty acids, which when further broken down, produce ketones. High levels of ketones cause the body to be in a state of metabolic acidosis.
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your pt's s/sx include:
•Deep, rapid breathing •Dry skin and mouth •Flushed face •Fruity smelling breath •Nausea and vomiting •Stomach pain What do you suspect and what should you do? |
DKA
get a blood glucose level and call the doc. |
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Hyporeflexia, hypotonia, lethargy, hyptension, dehydration are all related to what?
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DKA
Low potassium in DKA |
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in your T2DM pt, what is the likely cause of DKA?
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infection
pneumonia, UTI, gastrenteritis, sepsis |
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your T1DM pt has had an infarction, what additional possible sequela are you concerned about?
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DKA
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what are nursing interventions in DKA
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hydrate and insulin admin.
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your T1DM pt has BG of greater than 250, has abnormal ptoassium and low phosphate levels. Creatinine is increased and CO2 serum is less than 15 (acidotic), arterial pH is less than 7.3 and has an increase anion gap. What do you suspect?
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DKA
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your ketoacidotic pt requires what type of monitoring?
What type of diet? |
Vital signs qhour
intake/output cardiac/telemetry monitoring NPO until n/v have resolved and BG<250. |
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what is number one nursing intervention in DKA?
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HYDRATE!
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WHAT is HHS
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hyperglycemic hyperosmolar nonketotic syndrome
BG>600, increase BG is hyperosmolar and causes osmotic kiuresis that leads to intravascular volume depletion, combined with inadequate fluid replacement = DEHYDRATION Non-ketotic cuz still producing insulin. |
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your pt has profound dehydration and hyperosmolality, what other findings would you expect?
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hypotension, tachycardia, and altered mental status, all related to HHS
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what is going to be the key lab finding in HHS?
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osmolality >350 (nl is 290) and increased creatinine = dehydration
potassium may be low or high |
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what is key intervetion in HHS?
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Fluids for the dehydration!
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your DM pt is diaphoretic, shaky anxious, and lightheaded. What do you need to do?
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Get a BG to check for hypoglycemia
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what are the two things that will quickly knock out your eyes and kidneys?
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Hyperglycemia and HTN
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what lab result indicates early kidney disease/glomerular damage?
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microalbumin over 30 mg
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proteinuria over 300 mg indicates what?
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overt nephropathy
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increased BUN and creatinine plus HTN is sign of what
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severe nephropathy
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ESRD diagnosis?
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end-stage renal disease is GFR<10ml/min
dialysis needed. |
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neuropathy / polyneuropathy/mononeuropathy involves what?
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distal sensory loss hyperesthesia and dysesthesia
numbness, tingling, sharpness, burning BEGINS at feed and spreads proximally. |
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nursing assessment for neuropathy would include?
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testing for diminished ankle reflexes
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autonomic neuropathy would involve
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resting tachy, ortho hyptotension,
reduced counter regulatory hormone release leading to decreased ability to sense hypoglycemia, gastrointestinal sx/gastroparesis |
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what is the #1 cause of death in people with DM?
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cardiovascular disease
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what are the main things to control in DM to reduce CVD?
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A1C
BP Cholesterol |
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heberden's nodes vs bouchard's nodes
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Heberden's nodes are bony enlargements of the joint closest to the fingertip -- also known as the DIP joint or distal interphalangeal joint. Bouchard's nodes are another sign of hand osteoarthritis. Bouchard's nodes are bony enlargements of the middle joints of the fingers -- also known as the PIP joint or proximal interphalangeal joint.
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what are the main things to control in DM to reduce CVD?
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A1C
BP Cholesterol |
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what test is used to dx osteoarthritis?
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CT scan
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management goal in osteoarthritis?
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maintain joint function and mobility using NSAIDS only as a last resort.
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what are posterior hip precautions for a total hip replacement pt ?
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posterior hip = most common - do not allow hip to bend more than 90 degrees, do not allow the surgical leg to roll inward or toes to point inward.
do not cross legs at knees or anklces while sitting, standing or lying, DO USE a pillow btw the legs. |
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anterior hip precautions
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don't extend leg out behind you
don't allow leg to roll outward or toes to point outward don't cross legs at knees or ankles while sitting, standing or lying |
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what is the #1 nursing priority for a total knee replacement pt?
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Fall precautions
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nursing goal for continuous passive motion therapy by POD #3
while resting in bed, what should the RN have the pt positioned at? |
0-90 degrees, increase 5-10 degrees q hours as tolerated.
Always have knee at full extension in bed - no pillow under knee |
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what is a complication of fractures that you need to be watchful for?
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compartment syndrome
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what are the sx of compartment syndrome?
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6 p's:
parasthesias, pressure increase in compartment, pallor, paralysis, pulselessness, and pain distal to the site. |
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what is compartment syndrome?
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increased pressure in a closed myofascial compartment causes edema which compromises neurovascular fxn and tissue oxygenation.
leads to tissue destruction and scarring: contracture, disability, loss of fxn |
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your fracture pt is having CP, tachypnea, cyanosis, tachycardia, dyspnea, apprehension and crackles are in his lungs. You notice small purple pin point areas on skin of trunk and neck. What are you suspecting and what are your interventions?
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Fat Emboli = fat globules released from bones after a fx.
First intervention = O2!! |
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your fx pt is showing signes of acute renal insufficiency. what do you think is happening?
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myoglobin has been release into the bloodstream from the injured muscle tissue, causing myoglobinuria
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buck's traction and bryants tractions are examples of what type of traction?
describe each |
skin traction
buck = countertraction bryant = 90degree leg to hip angle pulling up |
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nursing goal in traction cases?
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skin assessment q8hrs, pin assessment, expect serous drainage, do not remove weight without an order
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what is a priority assessement for your pt with a large leg cast?
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neurovascular assessement: looking for the 6 P's
parasthesia (tingling, numbness) pain (out of proportion or unrelieved by drugs) pressure/sensation pallor/color paralysis pulselessness/circulation - cap refill and pulses temperature |
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fractures collaborative care involves;
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pain relief/analgesics
muscle relaxants tetanus vaccination proper nutrition pulmonary hygiene, ambulation, dvt prohylaxis, skin assessment and PU prevention, drain care/monitoring, adequate hydration to prevent kidney stones. |
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fracture pt in ED, what is most important nursing intervention?
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#1 Assess neurovascular status
#2 elevation to prevent edema |
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preoperative care before amputation includes what?
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education on what to expect after sx.
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post operative care of amputee
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1. monitor for hemorrhage
2. analgesia for phantom limb pain 3. stump care 4. proper bandageing 5. prevent flexion contractures 6. ROM exercises |
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what is hallmark sx of Rheumatoid arthritis vs OA?
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RA has symmetrical involvment of small joints of hands and feet, writis, elbows, shoulders, knees, hip, ankles and jaw.
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RA cause?
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autoimmune response, rheumotoid factor = abnormal IgG
Ab-Ag compleses deposit on synovial mebranes and an inflammatory response is intitated, dextroying cartilage and synovial membranes by neutorphils tissue overgrowth occurs(pannus) leads to further cartialge destruction, scarring and shorting of supporting structures, leads to joint laxity subluxation, and contracture. |
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rheumatoid nodules can cause what?
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cataracts, ulceration, hoarseness, vertebral body destruction, carpel tunnel syndrom, cardiopulmonary effects
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Goals of a neuro assessment:
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establish baseline
do assessment the same way every time Know normal for your pt Note subtle changes!!!! KEY!!! |
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your neuro assessment of your pt reveals bilateral dilated pupils, what could be the cause?
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hypoxia, atropine, or elevated ICP
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your pt's pupils are bilaterally pinpoint small, what could be the cause?
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injury to the pons or narcotics
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what is the indicator of the highest level of neuromotor function?
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the ability to follow commands with voluntary movements
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your pt is on benzadiazipines and some pain meds, what are you looking for?
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changes in LOC
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what are the 4 pieces to neuro assessments from most sensitive to least?
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1. LOC
2. Motor response 3. cranial nerves 4. Vital signs - last thing to change, look at trends |
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what are the pieces to an LOC assessment?
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attention span
memory - long and short term judgement language orientation |
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what is the first and foremost early indicator of changes in neuro status?
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Change in LOC
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your pt has changes in LOC, a headache, pupil dilation, vomiting, decrease HR, bounding pulse (inc. BP), and some posturing - what do you suspect?
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Increase in ICP/cerebral edema
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what is the Cushing's Triad?
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a clinical triad variably defined as either hypertension, bradycardia, and irregular respiration [1], or less commonly as widened pulse pressure (with elevated systolic and a either elevated or normal diastolic BP), irregular respiration, and bradycardia.[2] It is sign of increased intracranial pressure, and it occurs as a result of the Cushing reflex
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your pt has had a TIA, what drug therapy can you anticipate?
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Platelet inhibitors ie. aspirin
anticoags for atrial fibrilation statins |
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what surgical interventions might you see for a pt with TIA's
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carotid endarterectomy - rotor rooter
transluminal angioplasty without stenting |
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what is the primary site of ischemic strokes?
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middle cerebral artery
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your pt's stroke symptoms developed over 24 hours, what type do you suspect?
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a hemorrhagic stroke
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your pt's stroke sx's had rapid onset and she complained of the worst headache of her life - what do you suspect?
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embolic stroke
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what type of stroke is most common? what are the s/sx
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thrombotic (ischemic)
caused by atherosclerosis, HTN, or DM hypercoag disorders or even severe dehydration abrupt onset with evolving dequeli |
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your pt's stroke sx's had rapid onset and she complained of the worst headache of her life - what do you suspect?
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embolic stroke
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your pt's stroke occurred during a high level of activity. What type is it?
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hemorragic
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your pt's stroke occurred during rest. what type?
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embolic or thrombotic ischemic
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your pt has had an atrial fibrillation, what is he at risk for?
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embolic stroke
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where/why do hemorrhagic strokes occur?
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subarachnoid: usually due to rupture of cerebral aneurysm, bleeding into spaced betw arachnoid and pia mater membranes
Intracerebral: due to rupture of vessel - may occur at night |
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suden onset, headache, altered LOC, neck pain, and vasospasm. What type?
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subarachnoid hemorrhage
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right brain damage sx/s
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left side hemiplegia/paresis
spatial perceptual deficit, short attention span, impulsive, impaired judgement, impaired time concept |
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left brain damage s/sx
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right hemiplegia/paresis
impaired speech/language slow performance aware of deficits impaired comprehension or memory related to language |
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your pt has a suspected hemorrhagic stroke. What type of diagnostic test would you know to question?
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any test with contrast
Should be a non-contrast CT or MRI to determine so contrast won't leak into brain tissue. |
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what is the crucial window of time that a pt needs treatment within after a stroke?
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3-4.5 hours
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nursing inteventions for a stroke pt within first 96 hours.
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neuro assessment - LOC
Vitals - trends monitor ICP cardiac monitoring anticoag and fibrinolytics antihypertensives corticosteroids decrease metabolic demands |
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what is the number one complication from strokes?
Number two? |
UTI's - get the catheter out asap
Chest infection/pneumonia - put the pt on aspiration precautions (swallow eval, 30degree HOB) |
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what are the common comorbidities that occur with stroke?
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hyperglycemia
hypertension hyperlipidemia |
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bacterial meningitis often exhibits rapid deteriation due to what?
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increased intercranial pressure related to increased csf production and edema from the inflammatory process.
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your ischemic stroke pt's blood pressure is 200/100. What do you do?
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Monitor closely, but this is permissive HTN which has a protective effect in the first 24 hours because it maximizes perfusion
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what precautions will your meningitis pt be on?
TEST QUESTION |
Droplet isolation precautions and respiratory isolation
Masks required! |
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your pt has a throbbing HA, changing LOC, and nucal rigidity, photophobia, fever, malaise, incre. WBC, n/v
Suspicion? |
Meningitis
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your pt with meningitis has what lab results that helped diagnosed it?
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Blood cultures
CSF shows increased WBC, increase Protein, and decrease glucose |
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west nile virus is most likely the cause of what neuro disorder?
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enchephalitis
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your pt hs fever, HA, n/v, altered LOC, seizures, cranial nerve palsies, paralysis, and inc. ICP. What do you suspect?
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encephalitis
overwhelming inflammatory cerebral insult, meningeal and cortical inflammation, massive ICP increase from global cerebral edema |
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Nursing care of meningitis or encephalitis?
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droplet isolation precautions/respiratory precautions
VS/LOC and ICP assessment IV fluids Pain mgmt temperature control antibiotics |
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key differences between delerium and dementia?
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delerium is quick onset, reversible
dementia is slow onset and not reversible. |
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key s/sx of parkinsons
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begins with unilateral limb weakness and mild hand trembling , progresses to bilateral limb weakness and rigid mvmnt
shuffling gait with no arm movment CLASSIC TRIAD: tremors, rigidity, akinesia (slow movent) masklike facial expression difficulty swallowing deepression |
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parkinson's is what
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degenerative disorder of basal ganglia involving loss of dopamine and destruction of nigra cells
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nursing care for multiple sclerosis
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steroids/immunosuppressives
urinary retention/frequency fatigue/promote sleep muscle spacicity/pain/stiffness supportive emotional care, increased sx with stress |
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first changes in multiple sclerosis are what?
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visual changes: nystagmus/dicopia (double/blurred vision)
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what is Lhermitte's phenomenon?
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transient extreme spinal/limb pain (sharp shooting pain at spine) that occurs with MS
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guillain barre syndrome s/sx
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rapidly progresses
autoimmune involves cranial, spinal and peripheral neres demyelization of nerves lasts months to year permanent neuro deficit in 10% of pts |
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your pt has plaques along spinal cord and brain, what is his dx?
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Multiple Sclerosis
classic signs |
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first changes in multiple sclerosis are what?
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visual changes: nystagmus/dicopia (double/blurred vision)
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your pt has a progressive weakness starting at her feet and moving up, we know there is demylinization occuring - what is this likely to be?
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guillain barre syndrome
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nursing care of Guillain-Barre pt?
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close monitoring of HR, RR, BP
aspiration precautions |
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myasthenia gravis is what
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autoimmune disease of the neuromuscular jxn preventing muscle contraction
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mask face, loose control of facial muscles, ptosis, chronic fatique and global weakness, with no ascending pattern,
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myasthenia gravis
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myasthenial gravis
care |
swallowing precautions, eye protection, airway protection, adequate breathing
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posterior cerebral artery occlusion could manifest how?
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with visual deficits because the posterior cerebral artery supplies the occipital lobe with blood (which is where the visual cortex is)
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dementia pt that is agitated - best nursing action?
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use distraction - let's go get a snack in the kitchen
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pt has been admitted with possible bacterial meningitis, during assessment, the nurse asks about h/o what?
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an upper respiratory tract infection
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hallmark characteristic of cancer no matter where it is?
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unchecked growth that progresses towards limitless expansion
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cancers share which characteristics which promote their unchecked growth?
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innate growth signals
insensitivity to anti-growth signals tissue invasion & metastasis Limitless replicative potential sustained angiogenesis evading apoptosis |
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oncogenes
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mutated genes that give rise to cancer = accelerator for cell growth
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absence of dna repair genes will what
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give rise to cancer
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Name an important tumor suppressor?
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P53 protein - acts as a break pedal and triggers apoptosis
Loss of P53 leads to cancer |
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carcinoma in situ
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uncontrolled growth of cells that remain in its original location (most severe case of dysplasia - but not considered to be offical "cancer") removed surgically
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are benign neoplasms well differentiated or undifferentiated?
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well differentiated
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warning signes of cancer
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CAUTION
change in bowel/bladder habbits a sore that does not heazl unusual bleeding or discharge thickening or lumps indigestion or difficulty swallowing obvious change in wart or mole nagging cough or hoarseness |
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Grade of cancer is what?
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relates to the histology: the severity of cell differentiation. The higher the grade, the poorer the prognosis.
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Stage of cancer is what?
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the extent of the disease, with higher stage related to poorer prognosis
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Stage
0 1 2 3 4 |
0 cancer in situ
1 tumor limited to tissue of origin/localized growth 2 limited local spread 3 extensive local and regional spread 4 metastasis - spread to other non-adjacent areas of the body |
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carcinomas involve what?
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lung, breast, colon, bladder, prostate
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leukemias involve what
lymphomas involve |
bloodstream
lymph nodes |
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sarcomas involve what?
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fat, bone, muscle
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TNM classification
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T = tumor size and invasiveness
N = spread to lymph nodes M = metastasis |
