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67 Cards in this Set
- Front
- Back
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What are the health determinants? |
Income and Social Status Social Support Networks Education and Literacy Employment/Working Conditions Social Environments Physical Environments Personal Health Practices and Coping Skills Healthy Child Development Biology and Genetic Endowment Health ServicesGenderCulture |
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Define autoantigens |
an 'antigen' that is normal in the body however, the body produces auto-antibodies against it |
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Define auto-antibody |
An antibody that is produced by an organism in response to a normal part of its own tissues |
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What happens to cause a pt to develop Type 1 diabetes? |
1) a person with a genetic predisposition, must have experienced an environmental trigger, which causes an autoimmune response. 2) Auto-antigens are formed on insulin-producing pancreatic beta cells, which then circulate through the blood and into the lymphatic system. Antigen presenting cells then ingest circulating auto-antigens which activate T-cells, causing auto-antibodies to be made. The auto-antibodies and T cells then attack beta cells. Therefore, with less insulin producing beta cells, insulin production is decreased. 3)With the destruction of beta cells, there is not only a lack of insulin, but also amylin, and and an excess amount of glucagon since insulin and amylin normally suppress glucagon. When 80-90% of the beta cells are destroyed, that is when hyperglycemia occurs, which usually results in a diagnosis. |
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This is a hormone formed in the pancreas that promotes the breakdown of glycogen to glucose in the liver. |
Glucagon |
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Whats the primary difference between type 1a and type 1b diabetes? |
Type 1a- Autoimmune Type 1b-Diabetes is found secondary to other diseases that affect the pancreas. |
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What is the peak age onset for type 1 diabetes? |
11-13 |
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What ethnicity does type 1 a & b diabetes have a higher prevalence in? |
1a--> Asian or African decent 1b--> Caucasian |
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What are the clinical manifestations of type 1 diabetes> |
-Onset (hyperglycemia) is generally abrupt -Weight loss, fatigue and polyphagia (excessive hunger, increase in appetite) -Diabetic Keatacidosis -Osmotic diuresis -Polyuria, glycosuria, dehydration |
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Define Diabetic ketoacidosis |
A serious complication of diabetes that occurs when your body produces high levels of blood acids called ketones. The condition develops when your body can't produce enough insulin.
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What are some common complications/cormorbidities of diabetes? |
-Secondary Renal disease (leading cause of kidney failure) -Peripheral vascular disease -Coronary artery disease -Atherosclerosis -Vascular disease -Vision changes (retinopathy, macular edema) -Sexual dysfunction -Rates of MI's are higher in diabetic pts -Neuropathy(disease or dysfunction of one or more peripheral nerves, typically causing numbness or weakness.), PVD and immunocompromise -Hypertension -Depression |
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What lab tests are done to diagnosis a pt with diabetes? |
Fasting plasma glucose test (looks for elevated blood glucose levels with or without symptoms).(fasting for 8 hrs and then testing): level must be higher than 7.0mmol/L
Glycated Hemoglobin (A1C) (in adults, in the absence of other factors, ruling out type I): level must be 6.5% or more75g Oral Glucose Tolerance Test/ Random Glucose Level: a sample of 11.1mmol/L after either of these tests with symptoms constitutes a diagnosis of diabetes. |
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What is the age peak onset for type 2 diabetes? |
Risk of developing diabetes increases after age 40 yr; in general, incidence increases with age into the 70s;, incidence peaks between ages 40 and 50 yr, then falls.
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What ethnicity(ies) is type 2 diabetes more prevalent? |
African (Blacks) and Native (First Nations)
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Who is responsible for providing health benefits to First Nations individuals who live on reserves? |
The First Nations and Inuit Health Branch (FNIHB) of Canada |
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What type of diabetes do are oral antihyperglycemic medications used for? |
Type II |
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What do oral antihyperglycemic medications do in the body? |
They increase the tissues sensitivity to insulin allowing the cells to take up insulin |
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Why would a type II diabetic be on insulin vs. oral meds? |
Because orals are no longer working for for their specific diabetic needs |
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What is the mechanism of action of Rapid acting insulin? When should it be taken? |
Action: Regulates the metabolism of carbohydrates, protein, and fats. In the liver insulin will activate the synthesis of glycogen and fatty acids. In the muscle insulin will increase protein and glycogen synthesis and in the adipose tissue it will provide increased amounts of free fatty acids and trigceride synthesis.
How often: no longer than 30 mins before meals (at risk for hypoglycemia if dont eat after insulin is taken) Ex. Humalin R |
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What is the mechanism of action of Long acting insulin? When should it be taken?
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Action: Regulates the metabolism of carbohydrates, protein, and fats. In the liver insulin will activate the synthesis of glycogen and fatty acids. In the muscle insulin will increase protein and glycogen synthesis and in the adipose tissue it will provide increased amounts of free fatty acids and trigceride synthesis.
How often: SQ once daily at the dame time to maintain steady levels of BG Ex. Lantus |
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What is the difference between fast acting and long acting insulin's? |
Using short or intermediate acting insulin's avoids many acute diabetic complications |
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What is the Prochaska and DiClemente’s Transtheoretical Model of Change?
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Transtheoretical Model of Change is a conceptual framework used to guide planned change. Planned change is a well thought out effort designed to make something happen, all efforts are directed and targeted to produce change. This model suggests how an individuals’ behavior changes through the planning process.
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What are the stages of Prochaska and DiClemente’s Transtheoretical Model of Change? |
Pre-contemplation (PC): still engages in risky behavior and has no intention of changing in the next 6 months client may be uninformed or in denial, defensive or resistant to change
Contemplation (C): Still engages in risky behavior but is aware of the problem. Seriously consider change but haven’t made that commitment because they are indecisive and lack commitment Preparation (P): Still engages in risky behaviors but intends to take action soon, with some significant action being taken within the past year. Needs to set goals Action (A): Overt behavioral changes have been made to modify behavior, experiences and/or environment within last 6 months requires considerable time and energy Maintenance (M): Works to prevent relapse and is less tempted to relapse Confidence towards continued change has increased Termination (T):Feels zero temptation and complete confidence. New healthier behavior has become second nature |
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What are the primary health care principles? |
1)Accessibility 2)Public participation 3)Health promotion 4)Appropriate skills and technology 5) Intersectoral cooperation (Apple Pies Have Apples Inside) |
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What stage of Erickson's theory of the 8 stages of life does a 12 year fall under? |
Identity vs. Role confusion -Adolescence: ages 12-18 -Acquiring a sense of identity -New social demands, opportunities, and conflicts Question: "who am I, and what are my beliefs, feelings, and attitudes?" |
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What stage of Erickson's theory of the 8 stages of life does a 77 year fall under?
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Integrity Vs. despair -Old age: age 65 and older
Question:"Has my life been worthwhile?" |
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What stage of Erickson's theory of the 8 stages of life does a 27 year fall under?
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Intimacy Vs. Isolation -Young adulthood: Ages 18-35 Question: "Can I fully give myself to another?" |
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What stage of Piaget's theory of cognitive development does a 12 year-old fall under? |
Period 4: Formal operations -11 years- adulthood -Starts thinking more abstractly -Allows for more far-reaching problem solving. |
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What is the calgary family intervention model (CFIM)? and how is it different than CFAM? |
-CFIM is a structured framework for conceptualizing the intersection between a particular domain of family functioning and a specific intervention offered by the nurse
-The CFIM recommends many related aspect of nursing practices that promote family health and functioning such as asking intervention questions, offering commendations, providing information, validating emotional responses, encouraging illness narrative, supporting family caregivers and encouraging respite. -CFIM focuses on promoting and improving on any or all of the three domains of family functioning that is the behavioral, cognitive and affective domains. -CFIM is a companion to CFAM and can be used as a guide for nurse’s intervention with the family. |
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The scope of practice of both a registered nurse and social worker overlap tremendously in the holistic aspect. Registered nurses are more experienced in the_____1_______ aspect of client health, while social workers are well versed in ____2_____and ____3____ elements.
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1)Physiological aspects 2)Emotional 3) Financial |
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What are indigenous/Aboriginal liaison? |
-Aboriginal liaisons help build and maintain positive and effective relationships between Aboriginal (First Nations, Metis and Inuit) and non-Aboriginal peoples who work for or are served by the liaison's employer.
-Provides support and health information to healthcare providers, Indigenous patients/clients and their families through personal visits, including: -Case management -Patient advocacy -Cultural teaching -Patient/client language interpretation -Health literacy support -Logistical support for discharge planning for Indigenous people |
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What areas of the body provide the most accurate blood sugar test? |
The fingers or palm provide the most current Blood glucose rating whereas other sites will tell you what the blood sugar was 20-30 minutes ago. If your sugars are erratic, using alternate sites could pose a big problem, because your blood glucose levels could be changing quickly and you might not know it.
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How often should a diabetic patient take their blood sugars?
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Type 1- should test their blood sugar 3 times a day or more and include both preprandial (before meal) and postprandial (after meal) testing
Type 2 – once a day or more When ill, the blood glucose should be tested at 4-hour intervals to determine the effects of this stressor on the blood glucose level |
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Why cant insulin be taken orally? |
Because insulin is inactivated by gastric juices
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Where should a pt administer their insulin?
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abdomen (Fastest route), arm, thigh, buttock/hips (Slowest route).
-When administering insulin anatomic sites, no longer have to be rotated, however it is still helpful to rotate injection sites within the anatomic site. |
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What is the Dawn phenomenon? |
high blood sugar in the morning “due to the release of counter regulatory hormones in the morning” ( Med Surg, page 1345).
-many people with Diabetes are affected by this -tends to be most severe when growth hormone is at its peak in adolescence and young adulthood” |
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What are the general guidelines regarding nutrition and diabetes? |
General Guidelines regarding nutrition and Diabetes:
-Eating three meals per day at regular times and eating at intervals no more than 6 hours apart (Plan meals to include food from all the food groups). -Limiting sugars and sweets such as sugar, regular pop, desserts, candies, jam, and honey. -Limiting the amount of high-fat food such as fried foods, chips, pastries -Eating more high fibre foods (whole-grain breads and cereals, lentils, dried beans and peas, brown rice, fruits, and vegetables). -Drinking more water if thirsty -Adding physical activity to the lifestyle |
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What is happening in the body when someone goes through DKA?
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-insulin is decreased, counter regulatory hormones such as catecholamines, cortisol, glucagon and GH are increased
-glucose production is increased, tissue use of glucose is decreased -there is “accelerated gluconeogenesis and ketogenesis,” . [The gluconeogenic and ketogenic pathways are in the liver] - “Hepatic overproduction of beta-hydroxybutyrate and acetoacetic acids causes an increased ketone concentration” - “Hyperketonemia (increased blood ketone levels) may be a result of impairment in the use of ketones by peripheral tissue, which permits strong organic acids to circulate freely. Bicarbonate buffering then does not occur and the individual develops a metabolic acidosis” |
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Whats the difference between OT and PT? |
As compared with Physical Therapy, occupational therapy tends to focus more on evaluating and improving a persons functional abilities. An occupational therapist often does not directly treat a person’s injury using techniques such as manual therapy or acupuncture like a physical therapist would but more commonly helps a person optimize their independence and their ability to accomplish their daily activities following an injury or in situations of physical impairment.
Helping people improve their ability to carry out their daily tasks is a prime goal of the occupational therapist The physical therapy profession (also called ‘physiotherapy’ in many parts of the world) tends to be more focused on evaluating and diagnosing movement dysfunctions as well as treating a person’s injury itself. While an occupational therapist will often also do diagnosis, the physical therapist will be more likely to diagnose and treat the physical source of the problem; the injured tissues and structures. |
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What are some main points about the CFAM stage of 'joining families'? |
-Establishment of couple identity -Realignment of relationship with extended families to include spouse -Decisions about parenthood -Development of close emotional ties between the spouses -Do not have to break ties with families of origin, but rather maintain and adjust ties with them |
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What stage(s) of CFAM would Kokum be in? |
-Families with adolescents -Possibly families with young children as we do not know who she all still has at home, if she has other younger grandchildren living with her -Families nearing the end of life -Kokum is 77, she is probably starting to think about end of life |
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How does MS affect a couples intimacy and the ability to get pregnant? |
-Men with MS may experience erectile dysfunction due to the effects that MS has on their spinal cord
-“Women may experience decreased lipido, difficulty with orgasmic response, painful intercourse, and decreased vaginal lubrication” -“Diminished sensation can prevent a normal sexual response in both patients” -The physical alterations listed above, self-esteem and emotion can “contribute to loss of sexual response Pregnancy -Gestation Period – may “experience remission or improvement in their symptoms” -“hormonal changes associated with pregnancy appear to affect the immune system ”Postpartum Period- “women are at greater risk for exacerbation of the disease” |
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What are the three goals of care outlined in advanced directives? |
Medical Care: medical tests and interventions can be used to cure or manage an illness; can be used alone or in conjunction with resuscitative measures. This is appropriate when resuscitative and life support measures wont work or when the person chooses not to receive such treatments.
Resuscitative Care: focuses on prolonging or preserving life using any medical or surgical means including, if needed, resuscitation and admission to intensive care. Comfort Care: focus is to provide comfort to ease a person’s symptoms without trying to control the underlying illness – good for individuals who have a life-limiting illness, when treatments can’t influence the course of that illness |
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What is the Guardianship and Trusteeship act? What are the 4 guiding principles? |
-Came into effect October 2009 and took the place of the 30-year-old Dependent Adults Act (DAA)
-provide more options and safeguards to protect vulnerable adults who no longer have the capacity to make all of their own decisions -provides a range of decision making options to support adults who need help making personal and/or financial decisions 4 Guiding principals 1) the adult is presumed to have the capacity to make decisions until other wised determined 2)the ability to communicate verbally is not a determination of capacity; the adult is entitled to communicate by any means that enables them to be understood 3)focus on the autonomy of the adult 4)decision making focuses on the best interests of the adult and how the adult would have made the decision if capable |
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What is Supported decision making? |
when an adult has the capacity to make their own decisions but would like help they can sign a form that authorizes someone they trust to be their supporterthe adult can give their supporter legal permission to access relevant information that might otherwise be protected under privacy laws
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What is co-decision making? |
when an adults ability to make decisions is significantly impaired, but they can make decisions with good support the adult and the co-decision-maker make decisions togetherthe decision to grant a co-decision making order is made by the Court
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What is guardianship decision making? |
when the adult lacks the capacity to make personal decisions, the Court may appoint a guardian to make personal decions for themthe guardian can make decisions in some but not necessarily all areas of authority
– this depends on the adult’s need -usually a family member or friend applies for guardianship, but if no one is willing or available the Office of the Public Guardian can perform that role decision to grant guardianship is made by the Court |
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What is specific decision making? |
HCP may use specific decision –making to allow a relative to make a one-time decision on behalf of an adult who lacks capacity restricted to health care treatment or temporary admission to or discharge from residential facility
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What is money matters-trusteeship? |
when an adult lacks the capacity to make their own financial decisions the Court may appoint a trustee – family member or friend with the Office of the Public Trustee being a last resort
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Worldwide onset of MS is between ____&___ years
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20-40
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Although MS occurs in all races the highest prevalence is in ___________________ ancestry.
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Caucasians of Northern European
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Geographic prevalence of MS is highest in _______________.
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countries that are in Northern latitudes furthest away from the equator
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Where MS causes the demyelination Myelin sheaths, Huntington's causes ________. |
premature death of cells in the striatum of the basal ganglia, the region deep within the brain that is involved in the control of movement and the cortex (thinking, memory, judgment)
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Where MS causes the demyelination Myelin sheaths, Huntington's causes ________.
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is a rapidly progressive, invariably fatal neurological disease that attacks the nerve cells (neurons) responsible for controlling voluntary muscles (muscle action we are able to control, such as those in the arms, legs, and face).
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ALS (Amyotrophic lateral sclerosis) is also called what? |
Lou Gehrig's disease
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Whereas MS causes ataxia (loss of control of body movements), Huntington's causes ______. |
Chorea (jerky involuntary movements)
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Whereas MS causes ataxia (loss of control of body movements), ALS causes ______.
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Fasciculations (twitching)
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What are the different types of MS? |
Relapsing-remitting (RR) (initially 90% present with this classification)
-Clear relapses (called acute attacks or exacerbations) with either full recovery orwith partial recovery and lasting disability. -Between attacks there is noprogression (or worsening) of disease. RR is the most common course of MS. Primary progressive (PP) (initially 10% present with this classification) -Steady progression (or worsening) from onset, with only occasional plateaus orminor recovery. This is a fairly uncommon disease course and one that mayinvolve different brain and spinal cord damage than do the other forms. Secondary progressive (SP) -Begins with a pattern of clear-cut relapses and recovery but becomes steadilyprogressive over time with continued worsening between acute attacks (developsin ⅔ of individuals eventually). -Progressive remitting (PR) -A rare type that is steadily progressive from onset but also has clear acuteattacks. |
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What are anxiolytics used for? How do they work? |
-Treatment of anxiety disorders In the use of MS -Prevent/control muscle spasms -insomnia Mechanism of action -reduce overactivity in the CNS -Depress activity in the brainstem and limbic system -Depressed CNS via enhancing a major INHIBITORY transmitter in the brain. -Benzodiazepines are believed to increase the action of GABA, which is an inhibitory neurotransmitter (inhibits re-uptake of neurotransmitters such as serotonin, norepinepherine, and dopamine) in the brain that blocks nerve transmission in the CNS ex. Diazepam (Valium) |
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What are anti-spasmodic used for?
How do they work? |
-Used to relieve spasms (spasticity) of involuntary muscle contractions
-Most effective when used along with physiotherapy Mechanism of action -Inhibits transmission of reflexes at the spinal cord ex. Baclofen |
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What are anticonvulsants used for?
How do they work? |
medications that are used to prevent the convulsive seizures typically associated with epilepsy -In regards to MS -Neuropathic pain -older treatment, not seen as much anymore Mechanism of action - prevents or reduces discharge of neurons by blocking sodium and calcium influx into cells. |
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What are antidepressants used for?
How do they work? |
-Used for chronic or re-occurring depression syndromes
-These can be useful for treating certain types of longlasting pain, such as when skin becomes painfully sensitive to even the lightest touch. Action: increase monoamine neurotransmitter and acts on receptor site -blocks serotonin reuptake ex. Citalopram |
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What are antiemetic used for?
How do they work? |
Drugs used to relieve nausea and vomiting
Mechanism of action -most work by blocking one of the vomiting pathways, they block the neurological stimulus that induces vomiting ex. Diphenhydramine |
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What are immunosuppressants used for?
How do they work? |
“Immunosuppressive therapy has been used to treat multiple sclerosis (MS) for over 30 years based on the hypothesis that MS is a T cell-mediated autoimmune disease.”
-Used to prevent/reduce the frequency of relapse (exacerbation) in relapsing-remitting MS. Mechanism of action - used for fighting autoimmune or immune mediated diseases by suppressing the immune system - selectively suppress t lymphocyte cell lines = immune system ex. Mitoxantrone (Novantrone) |
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What are anti-inflammatory drugs (NSAIDs) used for?
How do they work? |
-inhibit inflammation pathways
-Indications: arthritis, rheumatic fever, persistent pain syndromes, gout Mechanism of action -Block the activity of the enzyme that promotes the synthesis of prostaglandins, which promotes inflammation Ex. Ibuprofen |
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What are Immune modifiers/modulators used for?
How do they work? |
“Targeted immune modulators, commonly referred to as biological response modifiers or simply biologics, are a relatively new category of medications used in the treatment of certain types of immunologic and inflammatory diseases”
- group of drugs that enhance or reduce immune responses ex. Interferon beta 1a (beta 1b is also important for MS) |
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To qualify for Medically assisted death, an individual must be 18 years or older and meet what four eligibility criteria?
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1. Have a serious and incurable illness, disease, or disability;
2. Be in an advanced state of irreversible decline in capability; 3. Endure physical and psychological suffering that is intolerable to them; and 4. Their natural death has become reasonably foreseeable. |
