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40 Cards in this Set

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Hyperglycemia
High blood sugar - excessive amts of glucose are in the blood stream
Certain medications increase the risk of hyperglycemia, including beta blockers, thiazide diuretics, corticosteroids, niacin
hypoglycemia
lower than normal level of glucose in the blood
the principal problems arise from an inadequate supply of glucose as fuel to the brain, resulting in impairment of function (neuroglycopenia)
would not give cardioselective beta blockers which have the side effect of hypoglycemia
ketones
Ketones are elevated in blood after fasting including a night of sleep, and in both blood and urine in starvation, hypoglycemia due to causes other than hyperinsulinism, various inborn errors of metabolism, and ketoacidosis (usually due to diabetes mellitus). Although ketoacidosis is characteristic of decompensated or untreated type 1 diabetes, ketosis or even ketoacidosis can occur in type 2 diabetes in some circumstances as well.
glycogen
Glycogen is a polysaccharide of glucose (Glc) which functions as the primary short term energy store in animal cells. When the blood sugar begins to fall below normal, glucagon is secreted in increasing amounts. It stimulates glycogen breakdown into glucose even when insulin levels are abnormally high.
polyuria
Polyuria is the passage of a large volume of urine in a given period (>= 2.5L/24 hours in adult humans)
polydipsia
Polydipsia is a medical condition in which the patient ingests abnormally large amounts of fluids by mouth
polyphagia
meaning excessive hunger and abnormally large (poly-) intake of solids by mouth.
glycogenolysis
deconstruction of glucogen into glucosea -hormonal response to epinephrine (e.g., adrenergic stimulation) and/or glucagon, a pancreatic peptide triggered by low blood glucose concentrations
myxedema
is a skin and tissue disorder usually due to severe prolonged hypothyroidism.
tetany
muscle cramps due to lack of calcium
hyperkalemia
is an elevated blood level (above 5.0 mmol/L) of the electrolyte potassium. The prefix hyper- means high (contrast with hypo-, meaning low). The middle kal refers to kalium, which is Latin for potassium. The end portion of the word, -emia, means "in the blood". Extreme degrees of hyperkalemia are considered a medical emergency due to the risk of potentially fatal arrhythmias.
Caton-Exchange Resins decrease this
Dig or Thiazides(Diuril) and loop (Lasix) (diurectic)- do not use with drugs that decrease this
if taking K+ suppliments do not give Ace inhibitors,
effects of thyroid hormones on the body
Increases cardiac output
Increases heart rate
Increases ventilation rate
Increases basal metabolic rate
Development of brain
Thickens endometrium
how low parathyroid (PTH) and calcitonin regulate serum calcium levels
The sole function of the parathyroid glands is to maintain the body's calcium level within a very narrow range, so that the nervous and muscular systems can function properly.

When blood calcium levels drop below a certain point, calcium-sensing receptors in the parathyroid gland are activated to release hormone into the blood. Parathyroid hormone has effects antagonistic to those of calcitonin. It increases blood calcium levels by stimulating osteoclasts to break down bone and release calcium. It also increases gastrointestinal calcium absorption by activating vitamin D, and promotes calcium uptake by the kidneys.Specifically, calcitonin reduces blood Ca2+ levels in three ways:

Decreasing Ca+ absorption by the intestines[3]
Decreasing osteoclast activity in bones[4]
Decreasing Ca+ and phosphate reabsorption by the kidney tubules[
functions of the hormones released from the anterior and posterior pituitary
Under the influence of the hypothalamus, the anterior pituitary produces and secretes several peptide hormones that regulate many physiological processes including stress, growth, and reproduction.
Insufficient secretion of vasopressin is central diabetes insipidus, in which the body loses the capacity to concentrate urine. Affected individuals excrete as much as 20 L of dilute urine per day.

Oversecretion of vasopressin causes the syndrome of inappropriate antidiuretic hormone.
compare S&S of hypothyroidism and hyperthyroidism
Poor muscle tone (muscle hypotonia)
Fatigue (physical)
Cold intolerance, increased sensitivity to cold
Constipation
Weight gain
Muscle cramps and joint pain
Thin, Brittle fingernails
Thin, brittle hair
Paleness

-----------------------------
Major clinical weight loss (often accompanied by a ravenous appetite), intolerance to heat, fatigue, weakness, hyperactivity, irritability, apathy, depression, polyuria, and sweating. Additionally, patients may present with a variety of symptoms such as palpitations and arrhythmias (notably atrial fibrillation), shortness of breath (dyspnea), loss of libido, nausea, vomiting, and diarrhea. In the elderly, these classical symptoms may not be present and they may present only with fatigue and weight loss leading to apathetic hyperthyroidism.
what are the clinical uses, major adverse effects and nursing implications related to the admin. of thyroid agents
for relief of symptoms of hypo & hyperthyroidism,
adverse effects: tachycardia, dysrythmias, angina, myocardial infarction, CHF, wgt loss, nervousness, NVD,
nursing implications: observe for relief of symptoms
check lab reports for normal blood levels of TSH or thyroid hormones, observe for adverse drug effects, look for compliance
describe the mechanism of action, clinical uses, adverse effects and nursing implications related to the major anti-thyroid agents
for Grave's disease give this med. it reduces the amt of thyroid hormones circulating in the bloodstream
with major clinical weight loss (often accompanied by a ravenous appetite), intolerance to heat, fatigue, weakness, hyperactivity, irritability, apathy, depression, polyuria, and sweating. Additionally, patients may present with a variety of symptoms such as palpitations and arrhythmias (notably atrial fibrillation), shortness of breath (dyspnea), loss of libido, nausea, vomiting, and diarrhea. In the elderly, these classical symptoms may not be present and they may present only with fatigue and weight loss leading to apathetic hyperthyroidism.
with propylthiouracil and methimazole: Hypothyroidism-bradycardia, chf, anemia, vasular disease, slow speech and movements, dullness, sleepiness, wgt gain, constipation, skin changes, stomach problems-NVD
compare S&S of hypocalcemia and hypercalcemia
tingling and parasthesia, 'pins and needles' sensation over the extremities of hands and feet. This is the earliest symptom of hypocalcemia.
Tetany, carpopedal spasm are seen.
Latent tetany
Trousseau sign of latent tetany (eliciting carpal spasm by inflating the blood pressure cuff and maintaining the cuff pressure above systolic)
Chvostek's sign (tapping of the inferior portion of the zygoma will produce facial spasms)
Tendon reflexes are hyperactive
Life threatening complications
Laryngospasm
Cardiac arrhythmias
EKG changes Hypercalcemia per se can result in fatigue, depression, confusion, anorexia, nausea, vomiting, constipation, pancreatitis or increased urination; if it is chronic it can result in urinary calculi (renal stones or bladder stones). Abnormal heart rhythms can result, and EKG findings of a short QT interval and a widened T wave suggest hypercalcemia.
describe therapeutic uses, adverse effects and nursing implications for drugs affecting the pituitary gland
Desmopressin (DDAVP and Stimate) for diabetes insipidus and Vasopressin (Pitressin) for diabetes insipidus - desmopressin: headache, nasal congestion, nausea and increased BP
vasopressin, water intoxication, chest pain, myocardial infarction, increased BP, NVD
Growth hormone- mild edema, headache, localized muscle pain, weakness and hyperglycemia
dosage of all pituitary hormones must be indiidualized; help pts develop a daily routine, check urine specific gravity and replace fluids accordingly, for GH, help the family set reasonable goals. and comply with accurate drug admin and follow-up procedures.
differentiate btw the effects of the androgenic and anabolic steroid agents
stimulates or controls the development and maintenance of masculine characteristics in vertebrates by binding to androgen receptors. This includes the activity of the accessory male sex organs and development of male secondary sex characteristics.

anabolic-Anabolic steroids are a class of steroids that interact with androgen receptors to increase muscle and bone synthesis.
discuss major indications for use, adverse effects and nuring implications of selected steroid agents
to treat androgen deficiency states (hypogonadism,- also used in females for breast related disorders or cancer - adverse: premature development of male sexual chara. jaundice, edema, hypercalcemia, difficulty voiding
nursing implications: contraindicated for pregnancy, liver diseae, prostatic hypertrophy
check lab of liver function tests and serum, electroyte levels and serum lipid levels
assess wgt and BP regularly
For children check xray exam for bone growth,
discuss the dangers of anabolic steriod abuse
Serious health risks can be produced by long-term use or excessive doses of anabolic steroids. These effects include harmful changes in cholesterol levels (increased bad cholesterol and decreased good cholesterol), acne, high blood pressure, liver damage, and dangerous changes in the structure of the left ventricle of the heart
describe the major physiologic actions of estrogen and progesterone
Since estrogen circulating in the blood can negatively feed-back to reduce circulating levels of FSH and LH, most oral contraceptives contain a synthetic estrogen, along with a synthetic progestin.
C-21 steroid hormone involved in the female menstrual cycle, pregnancy (supports gestation) and embryogenesis of humans and other species.
describe the therapeutic uses and major adverse effects associated with estrogens and progestins
use as oral contraceptives, and to relieve the symptoms of menopause, replacement therapy for deficiency states
adverses effects:
drug interactions, menstrual disorders, NVD bloating, gallbladder disease- cancer, CNS disorders, wgt gain,
Describe how oral contraceptives prevent pregnancy
they inhibit ovulation -
progestins- help sustain prenancy
Discuss the nursing implications related to the admin of estrogens, progestins and oral contraceptives
if pt misses 1 take 2-next d
if misses 2 take 2 for 2 days & additional birth cont.
if 3 missed then discard and restart next mth
if miss 1 period continue taking
if miss 2 then stop and take pregnancy test
Discuss the causes of infertility- woman
anorexia nerovsa, chronic disease or malnutrition and long distance runners are amenorrhea
Ovulation can be seriously affected by:

Abnormalities of the thyroid gland
Overproduction of prolactin (a hormone leading to breast milk production)
Excessive male hormone (androgens)
Physical stress, psychological stress and extreme lifestyle changes
Inadequate or inhospitable cervical mucous
Cervical narrowing or "stenosis"
Infections of the cervix with common sexually transmitted diseases (chlamydia, gonorrhea, or trichomonas, as well as mycoplasma hominis and ureaplasma urealyticum)
Immune attack of sperm or "sperm allergy"
Scar tissue or "adhesions"
Endometriosis
Blocked, scarred, or distorted fallopian tubes
Benign tumors (fibroids) of the uterus
Thin or abnormal uterine lining
Anatomic problems (polyps, uterine fibroids, abnormal shape of the uterus, septum or "dividing wall" within the uterus)
infertility - men
Exposure to hazardous toxins, chemicals, or radiation
Infections such as mumps, or venereal diseases
Testicular injury (sports or work injury)
Childhood illness (failure of a testicle to descend properly)
Blockage of one of the ducts allowing flow of sperm from the testicle
Injury, infection or prior vasectomy
Genetic absence of these ducts (cystic fibrosis)
Immune reaction against sperm (antisperm antibodies)
Testicular failure and other hormonal problems
Chronic medical illness (thyroid disease, diabetes, and hypertension)
Spinal cord injuries and paralysis
Varicocele
describe the hormonal physiology of ovulation
The ovulatory mechanism also produces the two ovarian hormones, oestradiol and progesterone. Oestradiol is produced alone by the developing follicle before ovulation; it stimulates the glands of the cervix to secrete a particular type of mucus ("mucus with fertile characteristics") which is essential for the sperm to pass through the cervix and reach the ovum. Oestradiol also stimulates growth of the endometrium lining the uterus (womb). After ovulation, progesterone and oestradiol are produced by the corpus luteum which forms from the ruptured follicle. This progesterone causes the abrupt change in the mucus which occurs immediately after ovulation and defines the Peak symptom. Progesterone also prepares the oestrogen-primed endometrium for implantation of the fertilized ovum.
discuss the clinical indications, adverse effects and nursing implications for the major fertility agents
estrogen: used to treat symptioms of menopause and osteroporosis, men-prostate cancer, used as contracteptive, as replacement therapy
prolonges doses may cause endometrial and breast cancer
Progestins: used to treat various gynecologic conditions
may cause blood clot formation
there are drug interactions
dangers with cigarette smoking
see above - miss 1 dose etc
Distinguish btw uterine-stimulating agents and uterine-inhibiting agents, including principal action therapeutic uses
Oxytocin- functions in childbirth & lactation. It initiates uterine contractions at the end of the gestation to induce chilbirth
Vasopression- antiduritic- but used in stimulation of the uterus
adrengic Beta agonists-adrenaline, noadrenaline & histamine, progesterone
describe how cation exchange resins act to reduce elevated serum potassium levels
works by exchanging sodium ions for potassium ions, the K+ ions are then excreted in feces
discuss nursing implications related to Sodium polystyrene sulfate
(Caton-exchange resin)
monitor K+ levels, may cause hypokalemia
monitor Na levels- may cause hypernatermia
describe the mechanism of action, clinical, use, adverse effects and nursing implications for the major ammonia detoxicating agents
lactulose/Cephulac
used to lower serum ammonia levels in pts with hepatic encephalopathy and to treat constipation
not absorbed from the GI tract and draws water into the bowel, lowers the amt of ammonia produced in the intestine
compare the effects of insulin and glucagon on blood sugar levels
decreases levels by inhibiting glycogenolysis in the liver
glucagon promotes glycogenolysis and increases the levels
compare diff. sources and classes of insulins
see other slides
oral hypoglycemic agents
biguanides, glitazones, alpha-glucosidase inhibitors, meglitinides, sulfonylureas

see individual cards
biguanides
glitazones
alpha-glucosidase inhibitors
meglitinides
sulfonylureas
metformin/Glucophage
rosiglitazone/Avandia
carbose/Precose
repaglinide/Prandin
choloroprapamide/Diabenese
insulin drugs
Humulin R & Novolin R-used in ER
Humulin N & Novolin N
Insulin Zinc
Lispro - Humalog -most rapid acting - no hypoglycemia
Lantus- insulin glargine-sustained release
inhaled insulin only with adults
insulin mixtures-
new drugs for treating diabetes
Glucophage/metformin - may cause MALA,severe bloating
rosiglitazone/Avandia - works at cell level, may cause CHF
carbose/Precose- decreases complications such as hyperglycemia, but GI effects, severe flatulence-do not use with IBS(irrita)
repaglinide/Prandin - short half-life, less hypoglycemia-excreted by liver and not kidneys
chloropropamide/Diabenese- do not use for elderly or non-compliant pt