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MedSurgII Exam III
| Question | Answer |
|---|---|
| Which eye assessment finding is a "globe lag"? | upper eyelid pulls back faster than the eyeball when the pt gazes up |
| who has "globe lag"? | hyperthyroidism pts |
| what is exophthalmos? | exophthalmos is when pts have wide-eyed, startled, staring look all of the time |
| Which people have exophthalmos? | Graves disease |
| what is Graves disease? (hyper or hypo what?) | hyperthyroidism |
| what is patchy areas of pigmented loss on pts neck, face, etc? | vitiligo |
| which pts can have vitiligo? | hypo adrenal pts |
| Name 3 secondary causes of adrenal insufficiency. | Pituitary tumors hypophysectomy abrupt discontinuation of corticosteroids |
| what are 2 primary causes of adrenal insufficiency? | TB and autoimmune diseases |
| Which serum lab finding is the MOST important to monitor in someone diagnosed with diabetes insipidus? | sodium |
| which pituitary condition is decreased production of all hormones from the anterior pituitary? | panhypopituitarism |
| should diabetics put lotion on their feet and between their toes everyday? | not in between toes, but yes to rest |
| what is the most common cause of Sheehan syndrome? | postpartum hemorrhage |
| which is a common side effect of spironolactone therapy for hyperaldosteronism? | urticaria |
| what disease happens when the adrenal cortex secretes too much cortisol? | cushing disease |
| what causes Turner syndrome? | too much FSH (follicle stimulating hormone) |
| What causes Hashimoto's disease? | autoimmune disease that attacks the thyroid gland causing hypothyroidism |
| what is tissue overgrowth called? | hyperplasia |
| what is the most common type of thyroid cancer? | papillary |
| which demographic usually gets papillary thyroid cancer? | young women |
| Name 5 signs/symptoms of hyperaldosteronism | headache muscle weakness fatigue HTN fluid retention |
| if a person has acute adrenal insufficiency which two hormones will be in very low supply? | Cortisol and aldosterone |
| TRUE or FALSE? Most Type II diabetics are obese | true |
| What is the #1 thing you can do to slow down the progression of diabetic neuropathy? | maintain normal blood glucose levels |
| which condition could cause considerable weight loss without dieting ? | hyperthyroidism |
| which condition can cause hypercalcemia and hypophosphatemia? | hyperparathyroidism |
| name 5 pts/situations that might require a blood transfusion | blood loss from trauma/surgery thrombocytopenia active bleeding neutropenic oncology pts sickle cell disease |
| what size needle would you use for a blood transfusion? | 19 gauge |
| what blood type is the Universal donor? | type O |
| what blood type is the Universal Recipient? | type AB |
| can an Rh + patient get blood from an Rh - patient | yes |
| can an Rh - patient get blood from an Rh+ patient? | no |
| When might a pt receive packed red blood cells? | during surgery trauma extreme anemia |
| how long will it take to infuse packed red blood cells? | 4 h |
| which pt might need an infusion of platelets? | pt with platelet count of <10,000 |
| how long to infuse platelets? is type and cross match needed? special considerations? | platelets infuse in 15-30 min no matching needed use special filter to keep WBCs out of infusion |
| when is plasma used as an infusion? how long to infuse? type/cross match needed? | plasma is given to boost blood volume and to aid in clotting 200 mL will infuse in 30-60 min do have to type and cross match |
| who would get an infusion of WBCs? how long to infuse? special considerations? | WBCs infused for neutropenic pts 400 mL over 45-60 min VERY HIGH risk of adverse reactions! vitals every 15 min |
| What are the s/s of an acute transfusion reaction such as a FEBRILE REACTION? | tachycardia tachypnea chills fever HTN |
| What are the s/s of an acute transfusion reaction such as a HEMOLYTIC REACTION? | happens in first 15 min! tachycardia tachypnea chills fever HTN chest pain low back pain sense of impending DOOM |
| What are the s/s of an acute transfusion reaction such as an ALLERGIC REACTION? | almost like an anaphylactic reaction: itchy bronchospasm dyspnea CAN HAPPEN WITHIN FIRST 24 HOURS! |
| What are the s/s of an acute transfusion reaction such as a BACTERIAL INFECTION? | s/s: tachycardia, fever, chills - RAPID ONSET! wear a mask! scrub the hub!! cap all tubing THIS IS ENTIRELY PREVENTABLE! |
| what are the s/s of CIRCULATORY OVERLOAD? | bounding pulse dyspnea HTN (happens when blood is transfused too fast) |
| What should you do if you suspect a problem with a transfusion? | STOP THE INFUSION check vitals give O2 (if needed) give Benadryl (if needed) call Rapid Response (if needed) notify physician notify blood bank and keep all tubing and donor bag to send to blood bank document EVERYTHING! |
| what is an analogous blood transfusion? | when you go in ahead of time to donate blood to yourself before surgery in case you need it |
| what is the start of all diseases? | stress |
| Endocrine assessment - Patient History - top 4 things to include are? | 1)age - some issues more common in older and in younger pts 2)gender - esp. women - ask when menarche? menopause? sexual disfunction? 3) use of hormone replacements 4)steroid use |
| which gender are thyroid problems more common in? | women |
| what is impt to note in nutrition history? what should you ask about specifically? | changes in nutrition habits and GI tract issues (N/V/abd pain) increased thirst? (diabetes insipidus) increased salt craving? (hypo function of adrenal glands) rapid change in weight without dieting? (hyperthyroidism) ASK for last 24 h food/fluid list |
| which types of family history info could point toward genetic hormonal issues? | obesity growth or development difficulties diabetes mellitus infertility thyroid issues |
| physical appearance changes that point to hormone issues are | hair texture and distribution facial contours and eye protrusion voice quality body proportions increase/decrease in facial hair |
| s/s of hormonal imbalance | prominent forehead/jaw dull or flat expression exophthalmos (protruding eyeballs and retracted upper lids) enlarged thyroid in neck vitiligo hirsutism |
| what is an ASSAY? | an assay is a special test to measure the level of a specific hormone in the blood or urine |
| how are assays performed? | assays often use a mass spectrometer to measure the presence of a hormone |
| important questions to ask in pt history during endocrine assessment | energy level? elimination changed? sex/reproductive issues? changes in physical appearance? |
| what are provocative tests? | provocative tests - measured amounts of specific hormone given to provoke target gland to max prod. - does it work? if not then that gland has HYPOfunction |
| what are suppression tests? | drugs that are known to suppress hormone levels are given and if suppression of hormone is not achieved then pt is HYPERfunction |
| two causes of diabetes insipidus | deficit of ADH lack of response to ADH by kidneys |
| what does ADH - Anti-Diuretic Hormone do? | diuretic makes you pee an ANTI - diurectic makes you retain water BUT this is a LACK of that so you pee your brains out! |
| what is range of urine output in diabetes insipidus? | 4 - 30 LITERS/day |
| are you losing electrolytes when you have diabetes insipidus | NO |
| what are s/s of diabetes insipidus? | extreme output - way higher than input dehydration thirst tachycardia dry mucous membranes fatigue poor skin turgor low BP |
| non-surgical treatment for diabetes insipidus | MEDS: desmopressin acetate given for diabetes insipidus |
| what endocrine issue do you have if you have diabetes insipidus? | HYPOactive posterior pituitary |
| nursing interventions for diabetes insipidus | daily weights I/O specific gravity meas. encourage pt to drink fluids equal to urine output |
| compare the concentration levels of blood and urine with diabetes insipitus | blood - highly concentrated urine - highly diluted - specific gravity < 1.005 |
| what is the opposite of diabetes insipitus? | SIADH - Syndrome of Inappropriate AntiDiuretic Hormone |
| s/s of SIADH | no pee fluid volume overload HTN HYPOnatremia - same amount of sodium, but it is so diluted! |
| non-surgical treatment of SIADH | fluid restriction (500-1000 mL/day) MEDS: convaptan or tolvaptan - makes you eliminate water and keep Na |
| what is a side effect of desmopressin? | respiratory infection |
| what can happen if you are hyponatremic? | seizures |
| what does aldosterone do in our bodies? | aldosterone promotes Na and H2O reabsorption and prevents hypoglycemia it also promotes potassium excretion |
| what does cortisol do in our bodies? | increases glucose in bloodstream metabolism regulation immune response regulation |
| what are the natural steroids produced by the adrenal glands | aldosterone cortisol |
| three things cortisol does | 1) when we're stressed we have inc cortisol which causes inc glucose 2) it breaks down collagen and connective tissue 3) it is the determining factor for our behavior and mood |
| what is caused by ADRENAL HYPOtension? and what are its characteristics? | addison's disease (autoimmune disorder) = "not enough" HYPOnatremia HYPOvolemia HYPOglycemia but... HYPERkalemia |
| what disease is caused by ADRENAL HYPERtension? and what are its characteristics? | cushings disease - "too much" HYPERnatremia HYPERvolemia HYPERglycemia but HYPOkalemia **reduced immunity |
| what does a lot of cortisol do to the immune system | high cortisol is bad for immunity - it inhibits production of WBCs |
| If the adrenal gland is not causing Cushings then what else might be the problem? | the pituitary might be the problem because it is pushing the adrenal glands to make too much cortisol |
| what is bromocriptine used for? | bromocriptine is used for hyperpituitarism of the anterior pituitary gland |
| what are the side effects of bromocriptine? | side effects of bromocriptine: Audry nausea constipation abdominal cramps *if post nasal drip or watery discharge from nose - EMERGENCY -could be CSF |
| what drugs are given if you have HYPERpituitary in posterior pituitary gland? and what is special rule? | conivaptan tolvaptan cannot give longer than 30 days or risk liver failure! |
| what is HYPERpituitary of posterior pituitary gland called? | SIADH |
| what is the peak time for INSULIN ASPART? | 1-3 h - rapid acting insulin category (duration 3-5h) |
| what is the peak time for HUMAN LISPRO? | 0.5 - 1.5 h - rapid acting - take with meal (duration 5h) |
| what is the peak time for REG HUMAN INSULIN? | 2 - 4 h - short acting - take with meal (duration 5-12h) |
| what is the peak time for INSULIN DETEMIR? | 6- 8 h - long acting (duration 24h) |
| what is the peak time for INSULIN GLARGINE? | 12 h (or none) - long acting (duration 24h) |
| what is the peak time for NPH? | 4-12 h - intermediate acting (duration 10-24h) |
| what are the 7 D's of diabetes insipidus? | Diurese - high urine output Diluted urine - low specific gravity <1.005 Dry inside - hyperosmolarity (high) and hypernatremia Drinking a lot - thirsty Dehydrated - dry mucosa and skin Decreased BP Desmopressin - vasopressin, decreases urine output, |
| What are the 7 S's of SIADH? | Stops urination - low urine output Sticky and thick urine - SG>1.03 Soaked inside - low osmolarity Sodium low - headache early sign Seizures Severe high BP Stop all fluids and give salt + diuretics |
| What does the anterior pituitary gland have to do with thyroid hormones? | anterior pituitary gland makes TSH which makes thyroid makes t2, t4, calcitonin |
| what does the parathyroid gland do? | parathyroid gland regulates the Ca and P in the blood |
| what gland is responsible if there is too much or too little calcium in the blood? | parathyroid gland |
| name 8 things thyroid gland does in adults | controls metabolic rate controls pituitary secretion of GH & gonad reg. metabolism of proteins, fats, carbs HR and contractility inc RBC production affects RR inc bone formation insulin antagonists |
| what are GAGs? | metabolites of proteins and sugars that build up inside cells because of slow metabolism |
| what do GAGs do in our bodies? | GAGs cause build up of mucous and water in our tissues and changes to our organ texture - they get mushy and bloated |
| what is myxedema? | myxedema is mucinous edema |
| what physical changes are seen because of myxedema? | non-pitting edema around eyes, hands, feet, between shoulder blades - thick tongue and husky voice - heart muscle becomes flabby and chamber sizes increase = dec. cardiac output ↓gas exchange |
| 3 secondary causes of hypothyroidism? | tumor trauma infection in pituitary gland |
| what causes Hashimoto's thyroiditis? | autoimmune thyroid disease |
| what are 3 primary causes of hypothyroidism? | Hashimoto's, cancer, iodine deficiency |
| key features of hypothyroid? | everything slows down except weight gain ↓body temp lethargy muscle aches thick brittle nails/hair scaly skin bradycardia hypotension menstral irreg dec libido constipation |
| what lab tests are done to diagnose hypothyroidism? | T3, T4, TSH |
| what med is given for hypothyroidism? | levothyroxin - start w/low dose then gradually increase until good level |
| what pts have to be especially careful with thyroid replacement therapy? | cardiac pts |
| what is mxyedema coma? | low body temp slurred speech resp distress/failure |
| what is an easy thing to use as a good parameter of thyroid dysfunction? | low temp |
| what is the treatment for mxyedema? | IV levothyroxin, warm blankets |
| do you have to taper when coming off of hormones | YES |
| what is disease associated with hyperthyroidism? | Graves disease |
| what are symptoms of Graves disease? | opposite of Hashimoto's - everything is high and fast |
| when might you see a pt with a goiter? | with hypo or hyper thyroidism |
| when might you see a pt with exphthalmos? | exphthalmos might be seen with hyperthyroidism |
| which demographic gets Graves disease most often? | women between 20-40 |
| what meds are given for hyperthyroidism and what are some side effects of those meds? | propylthiouracil methimazole lugol solution side effects - wt gain and fluid retention |
| what is a thyroid storm and what can trigger it? | EXTREMELY HIGH FEVER systolic HTN tachycardia triggered by trauma, infection |
| what non-surgical treatment is there for hyperthyroidism? | radiation therapy pt will EMIT RADIATION - take precautions - 6 ft away, wash clothes seperately, don't use same bathroom, isolation, etc |
| what is the last resort for hyperthyroid patients who don't respond to drug or radiation therapy? | surgery to remove all or part of thyroid gland |
| what has to happen FIRST before thyroid surgery can take place | pt has to have near-normal thyroid function = euthyroid done to avoid thyroid storm |
| what other gland could be affected by thyroid surgery? | parathyroid |
| what are 4 major complications of thyroidectomy? | post-op pt should be in icu type room hemorrhage - are they constantly swallowing? resp dist. - stridor is medical emerg. hypocalcemia - (if parathyroid removal/damage) - tingling around mouth & muscle twitch larangeal nerve damage - usually improves |
| where are blood cells made? | skull sternum hip end of long bones |
| what is main ingredient (besides water) of plasma? | albumin, globulin, fibrinogen |
| what does plasma do in body | maintains osmotic pressure |
| which type of unrelated transplant donor matches are MOST difficult to find for African-American pts? | bone marrow |
| which condition has decreased mean corpuscular volume (MCV)? | iron deficiency anemia |
| what does MCV measure? | MCV measures the size of a single RBC |
| which pts will have increased MCV? | megaloblastic anemia |
| which test is done to diagnose hemolytic anemia? | Coombs test |
| which type of anemia causes Cheillosis and what is it? | chelliosis is readness at the corners of mouth and is seen in pts with iron deficiency anemia |
| what symptoms do most anemias have in common? | decreased RBCs or destruction of RBCs decreased hemoglobin decreased hematocrit |
| Does sickle cell disease (SCD) cause destruction of RBCs? | yes |
| what types of cells are sickled hemoglobin and what is their lifespan? | HbS - lifespan 10-20 days (instead of 120 days in normal RBC) |
| what percentages differentiate between someone who carries the trait for SCD and someone who has SCD? | <40% sickled = trait 80-100% = active form |
| what is the treatment goal in SCD? | to prevent crisis |
| what is it called when sickled RBCs clump together and block blood flow? | vaso- occlusive event |
| name some conditions that can cause a sickling event | hypoxia dehydration infection pregnancy alcohol consumption high altitudes high/low environmental/body temps acidosis strenuous exercise emotional stress cigarette smoking anesthesia |
| what is an SCD "crisis" | an SCD crisis is a vaso-occlusive event |
| what is the life cycle of a typical RBC | erythropoietin release by kidney tells bone marrow to make RBC 1) reticulyte is "baby" red blood cell - needs iron, cobalt, nickle, Vit B12, folic acid to grow into "adult" RBC 2) adult lives 120 days |
| what happens to RBCs when they die? | they divide into a) heme + iron and goes to liver - breaks down into bilirubin and out in feces - stercobilinogen/urine - urobilinogen b) globin attaches to CO2 |
| what happens to the iron in the blood when RBCs die? | it gets recycled and reused |
| what are effects of SCD crisis? | ↓Hematocrit inc reticulocytes (kidneys will try to make more RBCs) inc bilirubin inc WBCs |
| what diagnostic tests are done to diagnose crisis? | xray will show bone changes -bones are burned out from trying to make so many RBCs CT scan will show soft tissue damage to spleen and liver |
| what are the s/s of SCD crisis? | EXTREME pain all over body sweating fever dec O2 CNS changes - gait/stability, confusion |
| what is treatment for SCD crisis? | IV pain meds (morphine) first 48 h O2 hydration - 250 mL/hr x 4 h prophylactic antibiotic med: hydroxyurea - DROXIA - reduces sickling and pain transfusion - deferoxamine mesylate on hand for iron overload caution - pts VERY prone to infection |
| which anemias have decreased RBC production? | iron deficiency anemia vit B12 deficiency anemia - PERNICIOUS ANEMIA folic acid deficiency anemia aplastic anemia |
| what are causes of iron deficiency anemia? | inadequate diet blood loss poor GI absorption |
| how to diagnose iron deficiency anemia? | serum ferritin < 10 ng/mL CBC - H and H low |
| what are iron deficiency anemia meds? | PO iron - ferrous sulfate, Feosol IM - iron dextran - use Z track method IV - Venofer vitamin C enhances absorption of iron |
| what are s/s of iron deficiency anemia? | chelliosis - red in corners of mouth pica - eating weird shit not meant to be eaten weak, pale, fatigue |
| what are clinical manifestations of pernicious anemia? | pernicious (Vit B12) anemia s/s: beefy red tongue paresthesia and poor balance pallor, fatigue, jaundice, weight loss |
| how to diagnose pernicious anemia? | serum B12 level 24 h urine - Schilling's test MCV level - will be high - large RBCs |
| what does folic acid deficiency anemia mask? | folic acid deficiency anemia masks Vit B12 deficiency |
| which demographic will you see folic acid deficiency anemia in? | alcoholics ppl w/chronic GI issues bariatric surgery pts |
| what are causes (other than alcoholism) of folic acid deficiency anemia? | poor nutrition malabsorption (Crohn's disease) drugs |
| what are s/s of folic acid deficiency anemia? | pallor, fatigue, jaundice, weight loss beefy red tongue (same as Vit B12 def. anemia w/o NS symptoms |
| what are diagnostics for folic acid deficiency anemia? | serum folate level MCV level - will be high - large RBCs serum Vit 12 |
| what are s/s of Cushings disease? | moon face buffalo hump truncal obesity weight gain fragile fractures poor wound healing thinning, fragile skin |
| what disease is caused by hypofunction of adrenal glands? | addison's disease |
| what is an addisonian crisis and what is the treatment for it? | acute adreanal insufficiency treatment - infuse 15 units dextrose 5% in normal saline FIRST once fluid is balanced give H2 histamine blocker - cimetidine if hyperkalemic give kaoexalate if hypoglycemic give IV glucose |
| what are s/s of addison's disease? | fatigue lethargy joint/muscle pain vitiligo hypoglycemia hyponatremia hypotension hyperkalemia |
| what drugs are given for adrenal hypofunction (addison's disease) | cortisone - take with food hydrocortisone - report weight gain, fluid ret. prednisone - report illness fludrocortisone - mon. BP, report fluid ret. |
| what is the hormone of starvation? | glucagon - makes glucose when you don't eat |
| what is the hormone of plenty? | insulin - helps to take sugar out of blood so can be used by the cells to give you energy |
| which type of diabetes is an autoimmune disease? | type I - your body does not make insulin so you have very high blood sugar levels because it is not being used by cells to make energy |
| why is blood sugar high in type 2 diabetes | because you are eating too much carbs and insulin production can't keep up |
| what does activity do for your body with regards to diabetes? | activity stimulates insulin production so MOVE |
| what is MODY? | it is Maturity Onset Diabetes in Young diabetes in young people that resembles type 1 but is NOT autoimmune - is result of genetics |
| what are s/s of MODY? | polyuria - pee a lot polydipsia - excessive thirst polyphagia - hungry all the time because your body isn't making enough insulin to covert carbs to energy |
| what are ketones? | ketones are what you get when break down fat for energy when no or low insulin |
| Name 3 MACROvascular complications you could have if you have diabetes mellitus | 1) cardiovascular disease 2) cerebrovascular disease 3) decreased immunity |
| Name 3 MICROvascular complications you could have if you have diabetes mellitus | 1) increased chance of cataracts and glaucoma 2)diabetic peripheral neuropathy 3) nephropathy - bad changes in kidneys |
| who gets METABOLIC SYNDROME? | type 2 dm pts get metabolic syndrome |
| what are the s/s of metabolic syndrome? | 1) abdominal obesity - men girth >40" , women girth >35" 2) hyperlipidemia 3) HTN 4) hyperglycemia |
| what labs will diagnose diabetes mellitus? | fasting glucose glucose tolerance A1c >6.5% (normal is 4-6%) |
| what is a nurse's goal with pts who are prediabetic, diabetic, uncontrolled diabetic? | nurse's goal is to prevent pt from going to next level |
| what are s/s of hypoglycemia? | tinnitus headache sweaty tachycardia anxious, irritable weak/tired trembling blurry vision hunger |
| what is a PO med for Type 2 dm? | metformin (glucophage) |
| what is the progression of treatments for dm? | starts w/diet and exercise modifications then PO meds then insulin |
| how do you prepare an injection of NPH and regular insulin? | regular insulin first (it is clear) then NPH (cloudy) CLEAR over CLOUDY also reg insulin is short acting and NPH is intermediate acting |
| if you are carb counting how do you know how much insulin to give? | every 15g carbs = 1 unit insulin |
| how much fiber/day should a dm pt eat? | 25 g fiber/day for dm pts |
| what is 15 / 15 rule for hypoglycemia? | If patient is AWAKE and CAN SWALLOW if blood sugar <70 give sugar (honey, hard candy, reg soda) and check again in 15 min, repeat if needed |
| what to do if pt is unconscious and blood sugar is <70? | give 1 mg glucagon subQ or IM 25-50 mL 50% dextrose solution IV |
| what is blood sugar mnemonic? | hot and dry = sugar high cold and clammy = need some candy |
| name 3 DM2 oral meds | acarbose metformin (glucophage) glimepiride |
| which one DOES NOT have to be taken with food? | metformin |
| which DM2 med triggers release of insulin from beta cells in pancreas | glimepiride |
| which DM2 med delays breakdown of starches and delays intestinal absorption of glucose | acarbose |
| which DM2 med inhibits liver production of glucose and decreases absorption of glucose from intestine | metformin (glucophage) |
| what is a symptom of ketoacidosis? | kussmaul resps - deep and rapid |
| what causes ketoacidosis? | ketoacidosis is caused by low/no insulin and extremely high blood glucose |
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bevbalash
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