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Nurs 332 Exam 6

Diabetes, Cardio, and Bioethics

What are some common risks associated with having diabetes? Retinopathy, cataracts, HTN, atherosclerosis, nephropathy, CAD, Islet cell loss, PVD, erectile dysfunction, peripheral neuropathy, & infections.
What is the most common endocrine problem? diabetes
What is diabetes? Abnormal insulin production or poor utilization of insulin, or both.
Which ethnic group is at highest risk of developing diabetes? Native Americans
T/F: eating too much sugar causes diabetes? False
What are the notorious P's related to the osmotic effect of hyperglycemia? Polydipsia: excessive thirst; Polyuria: excess urination; Polyphagia: excessive hunger/appetite
Which type of diabetes requires insulin injections? Type I: these patient do not produce any of their own insulin.
Which type of diabetes can usually be manages with oral medications? Type II: these patients produce some insulin.
What factors lead to metabolic syndrome? Central Obesity, sedentary lifestyle, and westernized lifestyle.
What are signs of metabolic syndrome? Insulin resistance, ↑ insulin levels, ↑ triglycerides, ↓ HDL, ↑ LDL, & HTN.
What is the best treatment option for Type II diabetes? Weight loss: 5-7% loss with exercise 5 times a week lowers risk up to 58%.
What are 3 life events that lead to elevated BG? Stress, illness, and surgery.
What medications can cause elevated BG? Caffeine, Ca++ blockers, morphine, lithium, birth control, and thiazides.
What medications and homeopathic remedies can ↓ BG levels? Aloe vera, fish oils, ginseng, and Beta Blockers.
What causes Type I diabetes? Destruction of beta cells in the islets of Langerhans in the pancreas.
What is the gold standard in testing for diabetes? Hgb A1C: > 5-7 on 2 tests
How many milliliters are in 100 units of U100 insulin? 1 ml
What is the goal for BG when treating a diabetic? 80 - 100
What does a slice of white bread rate on the glycemia index? 50 g of glucose or 1 slice white bread is 100- everything else is measured against the scale of 100.
What is a recommended diet of a diabetic for carbs, fat, & protein according to the American Diabetes Association? Carbs should be majority of diet, fat 7% (saturated) of total, protein 15-20% of total.
What are s/s of hypoglycemia? Cold & clammy skin, rapid heartbeat, faint, dizzy, and slurred speech.
What are s/s of hyperglycemia? N/V, HA, weakness, & fatigue.
What causes diabetic ketoacidosis (DKA) and which type of diabetes is affected by this? No insulin is getting into the cells, generally a type I issue.
What happens in the body during diabetic ketoacidosis? No insulin getting into cells, hyperglycemia > 300, body breaks down fat stores which results in ketone formation, ↓ pH, stimulates glucose production & protein breakdown. This leads to ketonemia &ketonuria = more diuresis.
What happens when a patient with diabetic ketoacidosis drinks water? They puke!
What are s/s of diabetic ketoacidosis? Dehydration, dry membranes, tachycardia, orthostatic hypotension, N/V, kussmaul respirations (fast breathing), acetone on breath, & serum bicarb < 15.
What tx will a pt with DKA receive? IV access, insulin gtt, 45% or 90% NS, monitor urinary output till 30 - 60 cc/hr, when BG ↓ to 250 add D5, supplement with K+.
Why do patients need K+ added to their treatment for DKA? Insulin drives K+ into cells. During DKA tx, the K+ is driven into the cells causing a significant ↓ in extracellular K+ availability.
What is Hyperosmolar Hyperglycemic Syndrome (HHS) & which type of diabetic is at risk of this? (Also known as Hyperglycemic Hyperosmolar Nonkdtonic Syndrome: HHNKS) Just enough insulin is produced so that ketoacidosis doesn't occur. Found in Type II diabetes since they produce some insulin.
T/F: artificial sweeteners are especially dangerous for diabetics? False
What are the consequences of long-term hyperglycemia? Damaged nerve cells, atherosclerosis, thickening of capillaries and arterioles especially in the kidneys, eyes and skin.
What are s/s of neuropathy? Loss of sensation, pain, paresthesias, tingling, burning, and itching.
What should a diabetic do to avoid or treat neuropathies? STOP SMOKING and wear protective footwear.
Which type of insulin would be drawn into the syringe 1st: regular or NPH? Regular then NPH: clear before cloudy.
What is the physiology behind Syndrome of Inappropriate Antidiuretic Hormone (SIADH)? Too much ADH is being secreted by the posterior pituitary gland. This leads to water retention and concentrated urine.
What is Diabetes Insipidus? A deficit of ADH: leads to urine volume of 5 -20 L/day. Patient will be dehydrated, have excess thirst, dilute urine, fatigue, & irritability.
A nurse is preparing to teach a patient about proper foot care. What should the nurse teach about applying lotion to the feet? Apply to dry feet but not between the toes.
A patient is brought to the ER with ↓ LOC & a diagnosis of HHNS. What would the nurse expect to hydrate the pt with? IV infusion of normal saline
What is the functionality of an insulin pump? Gives a small continuous does of regular insulin; the pt can self-bolus with an additional dosage from the pump prior to each meal.
What is an outcome of not rotating the sites of injection for insulin SQ? Lipodystrophy
What finding would a nurse expect of a pt with DKA being treated in the ER? Elevated BG and a low plasma bicarbonate.
A patient should notify his doctor when BG levels are higher than what? 250; dr will take steps to avoid DKA
A pt with type II diabetes mellitus has a BG over 600 mg/dl & is complaining of polydipsia, polyuria, weight loss, and weakness. What diagnosis should the nurse expect? Hyperglycemia hyperosmolar nonketotic syndrome (HHNS)
When is the best time for a patient with diabetes mellitus to exercise? After eating
What should a nurse do with the vial of insulin before injecting? Use insulin at room temp, roll vial before use, rotate site of injection, store in refrigerator.
T/F: Oral medication that increase production of insulin should not be used with ETOH? True
T/F: A patient should stop taking her insulin medication while ill? False: monitor BG carefully, sickness can elevate BG levels.
How should a patient with diabetes trim their toe nails? Straight across
Which type of cardiomyopathy is most common? How does it affect the heart? Dilated; all four chambers are enlarged, ↓ contractility and CO.
What is the least common type of cardiomyopathy? Restrictive: has a high risk of emboli, ventricle walls don't stretch, death within 3 years of diagnosis.
What are some common causes of cardiomyopathy? Viral infections, chronic alcohol abuse, pregnancy complications, and anorexia.
What are common findings during an assessment of a patient with cardiomyopathy? Fatigue, crackles, dyspnea, murmur, & S3 and S4 heart sounds.
Tests to diagnosis cardiomyopathy? Cardiac catheterization, chest x-ray, echocardiogram, TEE, ECG.
Treatments for cardiomyopathy? Rest (pace activities), psychological support (no cure), meds (diuretics, BP, ↓ sodium, fluid restriction, heart transplant.
What is pericarditis? What is the most common cause? Inflammation of the pericardium. Usually from viral infection (also: trauma, bacteria, parasites, syphilis)
What would common assessment findings of pericarditis be? Substernal pain (increased during inspiration), friction rub, ↑ WBC, low-grade fever, ST & T elevations.
T/F: Chronic pericarditis can lead to CHF? True
What is a major complication of pericarditis? Cardiac tamponade: medical emergency. S/s: pulsus paradoxus, weak peripheral pulse, ↓ LOC, narrowing pulse pressure.
What are common treatments for pericarditis? Analgesics, NSAIDS, Antibiotics, paricardiocentesis (draw fluid off), teach to report s/s since there are often repeat episodes.
What happens when a valve has stenosis? valve doesn't open fully, stiff and narrow, leads to ↓ CO.
What happens when a valve has insufficiency or regurgitation? The valve isn't closing completely, causes back-fill, ↓ CO.
What are common test to evaluate a heart valve? Echocardiogram, Chest X-ray, ECG, transesophageal echocardiogram, cardiac catheterization.
What are expected symptoms of a heart valve issue? Shortness of breath, fatigue, cough, heart palpitations, swollen feet or ankles, heart murmur, excessive urination, regurg leading to CHF, at risk for thromboemboli.
What treatments might a patient expect with heart valve issues? Close monitoring, BP management, diuretics, ↓ Na+ diet, prophylactic antibiotics for certain procedures.
What s/s would indicate acute endocarditis? Spiking fever, chills, signs of heart failure, ↑ WBC. Often caused by Staph aureas infection.
What s/s would indicate subacute endocarditis? Fever of unknown orgin, cough, anorexia, malaise, and anemia.
What are some risk factors for developing endocarditis? Artificial heart valve, previous infection, rheumatic fever, congenital heart defects, hypertrophic cardiomyopathy, dental procedures, tonsillectomy, adenoidectomy, brochoscopic procedure, & gallbladder or prostate surgery.
What is a lifetime preventative measure of someone with a mechanical valve replacement? Anticoagulant therapy to decrease risk of thromboemboli.
What is the difference between an autograft, homograft, and heterograft valve? Auto: valve made from another valve within pt's own heart. Homo: valve from human donor. Hetero: valve from pig or cow.
Define ethics: The actions we wish people to take, not the actions they must take.
What are principles of morality? That which is good or desirable as opposed to that which is bad or undesirable.
What is common law? Principles, reason, common sense.
What is the difference between a civil case and criminal law? Civil law awards money for damages; criminal law deal with actions harmful to society and are either misdemeanors or felonies.
What branch of law do licensure laws fall under? Statutory Law
What branch of law does the State Board of Nursing operate under? Administrative Law
What is the ANA Code of Ethics? Provides services with respect for human dignity. Safeguards pt's right to privacy and pt's when healthcare is incompetent, unethical, or illegal, assumes responsibility for individual nursing judgments and actions, improves standards of care, etc.
What is bioethics? A term coined around 1970 which describes dilemmas/decisions applied to health care.
Define Autonomy: Personal freedom and self-determination. Right to choose what will happen to own person. Informed consent.
Define Beneficence: Actions should promote good. This is where "good" is defined.
Define Nonmaleficence: One should do no harm.
Define Veracity: Truth telling. Individuals should always be told the truth.
Define Fidelity: Keeping one's promises.
Define Paternalism: Allowing someone else to make decisions for another.
Define Justice: Treated fairly and equally.
What does Thiroux's MORAL framework mean? Massage the dilemma (get all the facts), Outline the options, Resolve the dilemma, Act by applying the chosen option, Look back and evaluate the entire process, including implementation.
What 4 catagories of information does the ethical decision-making framework Principalism address? MPQC Medical Indications, Patient preferences, Quality of life, Contextual Features.
What does patient preferences mean? Respect for autonomy.
What does contextual feature mean? Loyalty and fairness.
What is the drug of choice for treating central DI? Desmopressin acetate (DDAVP); it is an analog of ADH. Routs: PO, IV, SQ, or nasal spray.
What are the names of other ADH replacement drugs for DI? Vasopressin, chlorpropamide (Diabinese), and carbamazepine (Tegretol)
What is a common medication to treat neuropathy? Neurontin (Gabapentin)
What is Takotsubo cardiomyopathy? An acute, stress-related cardiomyopathy syndrome that is more common in post-menopausal women. Normal function returns in days to weeks following therapy.
Who defines the scope of practice for nurses? The State Boards of Nursing... covered by Administrative Law
Created by: ewooda05