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Exam 3 Review
Mods 9-11 incl. CAM meds
| Question | Answer |
|---|---|
| T2DM pathophys + etiology | Can be genetic; Metabolic factors (Insulin resistance, Decreased ability to make insulin, increased glucagon production, Inappropriate glucose production by liver, altered hormone production and cytokines; develop many beta cells are not secreting insulin |
| T2DM self-management | Exercise, Checking BG before meals & at bedtime, Check feet daily for wounds & wear shoes in the house, Increased insulin in times of illness, Medical Nutrition Therapy (MNT) |
| Patient-Centered Care & Culturally Relevant Care | 5% weight loss needed to benefit (T2DM + obesity); Frequent follow-up with providers; If culture fasts → work with patients to find solutions |
| Pathophys of DI | Low ADH, Polyuria , Hypovolemia, dehydration, High serum osmolaltiy, Low urine osmolality |
| Causes of DI | ADH deficiency or ADH insensitivity, Neurogenic/Central (Head trauma, tumors, cerebral edema, infection, idiopathic), Nephrogenic (Renal disease, ,nephrotoxic drugs [lithium, ampho B]) |
| DI Clinical Manifestations | Polyuria; Pale, dilute urine (Low urine osmolality); hypovolemia/dehydration (HoTN, tachycardia, weight loss, low CVP/PAOP, etc.); Serum concentrated → high serum osmolality (Increased Na. BUN/Cr, H/H) |
| DI Nursing Interventions | Central → give ADH (vasopressin); Nephro → thiazide diuretics & low sodium diet; Hypotonic fluid replacement (0.45% NS, D5W); Electrolyte replacement; Monitor VS, LOC, I&O, weight, urine specific gravity |
| SIADH Pathophys | High antidiuretic hormone, Too much water (retention), Fluid overload, Low serum osmolality, High urine osmalality |
| Causes of SIADH | Failure of negative feedback, unable to dilute urine; Head (Injury, infection, surgery, CVA); Malignancy; TB, pneumonia, COPD, and some medications |
| SIADH Clinical Manifestations | Neuro (weakness, lethargy, confusion, cannot concentrate, headache, seizures); Weight gain w/o obvious edema; Dilutional hyponatremia; Diluted serum → low serum osmolality (low BUN/Cr, albumin, electrolytes); Concentrated urine → high urine osmolality |
| SIADH Nursing Interventions | Furosemide; Declomycin (reduces kidney response to ADH); Phenytoin; Fluid restriction (800-1000mL/day); Seizure precautions; Admin 3% NaCl SLOWLY (rarely faster than 30 mL/hr), NO D5W |
| Primary Survey for SCI Pts | Airway + stabilize C-spine (patent, gasping /Speech, jaw thrust), Breathing (WOB, trachea position, hypoxic), Circulation (Pulses, BP, hypoperfusion?), Disability (Neuro check, deformities or pain?), Exposure (assess fully, keep dignity), care for family |
| Resuscitation adjuncts for SCI | Labs (Type + cross, CBC, CMP, alc + tox screen, ABGs, coags, cardiac biomarkers, pregnancy test, UA), monitor ECG, OGT for head/facial trauma → an NGT could enter the brain, assess pain |
| Secondary Survey for Trauma Pts | aim to identify ALL injuries, Hx and mechanism of current injury/illness, SAMPLE (symptoms, allergies + tetanus, med Hx, PMHx, last meal/PO intake, events or factors), logroll to inspect backside |
| Trauma Care for Peds + Adults | Check the head and head to toe (Lack of muscular support, Larger head size); Frequent serial assessments (Can’t always tell you what's wrong, Status can change rapidly); Thorough and accurate assessment of pupils |
| Neurogenic Shock Characteristics | Temporary loss of sympathetic input when injury is at T-6 and above ; Sympathetic input is lost which leads to massive vasodilation or “distributive shock”; duration variable, signaled by return of sympathetic tone |
| Neurogenic Shock Clinical Manifestations | Bradycardia, hypotension (regular or postural), relative hypovolemia, decreased CO |
| Neurogenic Shock Nursing Management | Fluid and pressors |
| Spinal Shock Characteristics | Begins within minutes of injury; Lasts up to 4-6 weeks when DTRs return; Loss of dec. motor, sensory, and reflex activity below level of injury; Permanence not known until shock resolves; Severity based off location → Can happen anywhere along the spine. |
| Spinal Shock Clinical Manifestations | Flaccid paralysis, Loss of reflexes and sensation |
| Spinal Shock Nursing Management | stabilizing the patient and preventing further injury by maintaining hemodynamic and respiratory stability, monitoring for complications, and providing supportive care |
| SCI Nursing Management | Immobilization (Maintain neutral position, C collar, backboard, LOGROLLING, Traction), BP Stabilization, Treatment (Baclofen, Gabapentin, Antidepressants, Abx for prophylaxis), Rehabilitation |
| Skin Care Issues w/ SCI | q2 hr turns in bed, q15-20 mins when in chair, comprehensive daily skin exam, adequate nutrition, wound care, unable to regulate body temperature |
| GI Issues w/ SCI | neurogenic bowel (voluntary control may be lost), high-fiber diet, adequate fluid intake, timing, position, activity, drug treatment (suppositories, small-volume enemas), digital stimulation, valsalva maneuver |
| GU Issues w/ SCI | neurogenic bladder (minimize UTIs, bladder stones, preserving renal function), drainage systems (catheters) |
| Spasticity Issues w/ SCI | can be both beneficial and undesirable (aids in mobility, improves circulation, difficult positioning and mobility from spasms), treatment (ROM exercisies, antispasmodic drugs, botox) |
| Pain w/ SCI | nociceptic pain (dull, aching, cramping), neuropathic pain (hot, burning, tingling), Acute pain: assess, evaluate, treat, Chronic pain: overuse of muscles, sleep may be disruptive, pain management specialist |
| Psychosocial Considerations in SCI | Grief and depression; Sensory deprivation; Problems with sexuality |
| Collaborative Care for SCI | Assess + stabilize airway; O2 PRN; Immobilize + stabilize with c collar, backboard straps; start large bore IVs x2; stabilize vitals; Assess sensation + mobility; Obtain hx incl incident; Assess injury extent ; =neuro assessment (ASIA tool); Diagnostics |
| Autonomic Dysreflexia | episodic; SCI at t6 or higher → massive uncompensated CV reaction mediated by sympathetic nervous system (SNS) caused by a stimulus BELOW the level of injury (most common: distended bladder or rectum) |
| Autonomic Dysreflexia Clinical Manifestations | Hypertension (up to 300mG SBP), HA, Diaphoresis, Bradycardia (30-40 bpm), Piloerection as a result of pilomotor spasm, Flushing of skin above level of injury, Blurred vision, Nasal congestion, Anxiety, nausea |
| Autonomic Dysreflexia Nursing Interventions | Elevate HOB, Notify HCP, Assess for + remove cause (Immediate catheterization, Remove stool impaction if cause, Remove constrictive clothing/tight shoes), Monitor and treat BP, Patient and caregiver teaching |
| Autonomic Dysreflexia Rehabilitation | Goal - to function at the highest level of wellness Retraining focus, Interprofessional team effort, Organized by patient’s goals/needs, Patient involved, learn self-care, Stressful |
| Autonomic Dysreflexia Respiratory Rehab | Ventilated patients (injury C3 and above), Need constant care, Respiratory hygiene & trach care, Phrenic nerve stimulator, Diaphragmatic pacemaker, Mobile ventilators, Patient teaching |
| SCI Clinical Manifestations based on injury location | C1-3 - apnea, no cough C4 - poor cough, hypoventilation (diaphragm) C5-6 - dec. respiratory reserve T5 - GI/GU problems → neurogenic bowel/bladder, delayed gastric emptying, possible dysphagia, paralytic ileus T6 + above - risk for NEUROGENIC SHOCK |
| Scalp Laceration Clinical Manifestations | MAJOR RISKS: blood loss, infection Scalp has lots of vasculature → profuse bleeding + poor constrictive abilities Obvious to see |
| Basilar Skull Fractures Characteristics | Linear fracture at the base of the skull Severity varies May include a tear in the dura → leads to CSF leakage May include CN deficits |
| Basilar Skull Fractures Clinical Manifestations | CSF or brain draining from the ear and nose Bulging tympanic membrane Tinnitus, hearing issues Facial paralysis Weird eye movement Vertigo Battle’s sign: bruising behind the ear Periorbital ecchymosis (raccoon eyes) |
| Concussion Characteristics | Minor “diffuse” head injury Sudden, transient mechanical head injury + disruption of neural activity & change in LOC |
| Concussion Clinical Manifestations | Usually short Typically brief disruption in LOC Retrograde amnesia Headache Post-concussion syndrome - (2 wks-2 mos post injury; HA, lethargy, behavior changes, shortened attention span, decreased STM) |
| Diffuse Axonal Injury (DAI) Characteristics | Diffuse head trauma occurring after a TBI (mild, mod or severe) Axon damage in the subcortical white matter -- may take 12-24 hrs to develop |
| DAI Clinical Manifestations | Decreased LOC Increased ICP Decortication or decerebration Widespread cerebral edema |
| Epidural Hematoma Characteristics | Complication of head trauma Bleeding between the DURA and INNER SKULL May be venous or arterial-- NEURO EMERGENCY Venous develops slowly Arterial develops quickly |
| Epidural Hematoma Clinical Manifestations | 1st sign: loss of LOC at scene 2nd sign: brief lucid period 3rd sign: decreased LOC Other: headache, N/V Focal findings depend on location |
| Subdural Hematoma Characteristics | Bleeding between the DURA MATER and ARACHNOID layer Usually venous (develops slowly); may be arterial (develops quickly) Can be acute, subacute, or chronic |
| Subdural Hematoma Clinical Manifestations | Acute - Manifests within 24-48 hr of injury; LOC, headache, drowsy, confused or unconscious; Fixed ipsilateral pupil (1 does not react normally) - IICP; May cause cerebral edema; May be non-accidental Peds - assess for shaken baby syndrome |
| Scalp Laceration Nursing Interventions | Early assessments & identification Monitor for s/sx of bleeding and hemorrhage Monitor for s/sx of infection |
| Basilar Skull Fractures Nursing Interventions | Test drainage from ear to nose Monitor for complications: intracranial infection, hematoma, meningeal + brain tissue damage Frequent neuro assessments OGT tube over NG bc too many holes yk? 😏 Diagnostics: Halo test, test strips Craniotomy |
| Concussion Nursing Interventions | If no LOC or LOC is < 5 mns, D/C home Notify HCP if behavior changes noted or symptoms persist Do not “keep them awake” benign/goes away on its own serious if concussion Hx Peds - Closely assess LOC, too young to report HA, fussy, report seizures |
| DAI Nursing Interventions | Immediate transfer to ICU Frequent neuro assessments and vigilant monitoring Signs of increased ICP - Cushing’s triad: systolic HTN, widening pulse pressure, bradycardia, irregular breathing pattern; Vomiting, severe headache, sluggish or fixed pupils |
| Epidural/Subdural Hematoma Nursing Interventions | Best diagnostic: CT scans Rapid surgical intervention to evacuate the hematoma Craniotomy or burr holes for rapid decompression Prevent cerebral herniation Monitor for IICP: EVD or other ICP monitor Goal: maintain cerebral oxygenation and perfusion |
| Head Injury Nursing Interventions | Ongoing neuro assessments: GCS, pupils, limb strength, VS, ICP No further neuro deterioration, good vitals, normal ICP |
| Echinacea | stimulate the immune system, dec. inflammation, heals skin disorders, possibly treats viruses, ADRs (bitter taste, mild GI, fever, allergy) PO + topical; caution w/ immunocompromised dec. positive effects of TB, HIV, cancer meds |
| Feverfew | blocks platelet aggregation, block migraine factor ADRs (mild GI, post-feverfew syndrome [agitated, tired, can't sleep, HA, joint pain], allergy) ask about NSAIDs, heparin, warfarin use, D/C 2 wks b4 surgery inc. risk of bleeding w/ NSAIDs, + thinners |
| Ginkgo Biloba | promotes vasodilation, dec. platelet aggregation, dec. bronchospasm, can improve blood flow to brain ADRs (mild GI upset, HA, lightheaded, careful w/ seizures) interacts w/ antihists, antideps, antipsychs (lowers seizure threshold) interferes w/ coag |
| Glucosamine | stimulates cells to make cartilage + joint fluid, immune suppression, Tx for osteoarthritis ADRs (mild GI, careful w/ shellfish allergy) interacts w/ antiplatelets + anticoags (inc. risk of bleeding) |
| St. John's Wort | antidepressant effects, PO analgesic, topical infection ADRs (dry mouth, lightheaded, constipation, GI upset, skin rash w/ sun) use sunscreen, careful w/ SSRIs, amphetamines, cocaine dec. effects of many medications |
| Cannabis | cachexia, chemo-induced N/V, chronic/acute pain, neuropathies, spasticity ADRs (inc. HR + hunger, sleepy, dec. BP + urine, dry mouth + eyes,, hallucina., paranoia, anxiety, impair. attention + memory, asthma exac., addiction) careful w/ laws; autonomy |
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d_s
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