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NUR 171 Test 3

NUR 171 Block 2 test 3 study

QuestionAnswer
Polyuria Excessive urination
Polydipsia Excessive thirst
Polyphagia Excessive hunger
Polyuria in DM patho Glucose in the blood that kidney cannot reabsorb end up in urine increasing the osmotic pressure of urine so its harder for water to reabsorb back into the body.
Polydipsia in DM patho kidneys are getting rid of so much water due to polyuria a person with DM is very thirsty.
Polyphagia in DM patho Because of a lack of insulin glucose (our bodies preferred energy source) can’t get into the cells. The cells are starving so the diabetic person is always hungry.
Sulfonylureas Increases insulin production < risk for hypoglycemia Glimepiride (Amaryl) Glipizide (Glucotrol) Glipizide ER (Glucotrol XL) Glyburide
Biguanides < liver glucose production and > Insulin sensitivity Glucophage (aka Metformin) Glucophage XR
Alpha-Glucosidase Inhibitors Slows carb digestion, slows glucose production Glyset and Precose
Thiazolidinediones Insulin sensitizer Starch blocker Actos and Avandia
Meglitinides Increases insulin production Prandin and Starlix
Apidra (Insulin Glulisine) Onset <15 minutes Peak 1-2 hours Duration 3-4 hours
Humalog (Insulin Lispro) Onset <15 minutes Peak 1-2 hours Duration 3-4 hours
Novolog (Insulin Aspart) Onset <15 minutes Peak 1-2 hours Duration 3-4 hours
Regular (Humulin R and Novolin R) Onset 1/2 - 1 hour Peak 2-3 hours Duration 3-6 hours
NPH (Humulin N and Novolin N) Onset 2-4 hours Peak 4-10 hours Duration 10-16 hours
Levemir (Insulin Detemir) Onset 3/4 - 2 hours, minimal peak action, Duration up to 24 hours
Lantus (Insulin Glargine) Onset 2-4 hours, no peak, Duration 20-24 hours
What role does acetylcholine play in muscle contractions? Acetylcholine is a neurotransmitter present in neuromuscular junctions of skeletal muscles. Exhibits excitatory influence.
What is a PAP smear Pap (papanicolaou) test= microscopic study of exfoliated cells via special staining and fixation technique detects abnormal cells. Cells most commonly studied are those obtained directly from the endocervix and ectocervix.
should pap smears be started, and how often performed? Pap test, AKA smear, once every 3 years beginning 3 years after first sexual intercourse but no later than age 21.
Cystocele herniation or protrusion of the urinary bladder through the wall of the vagina, resulting from weakened connective tissue support between the vagina and bladder.
Rectocele herniation or protrusion of the rectum through the wall of the vagina, resulting from weakened connective tissue support between the rectum and vagina
Cystocele and rectocele treatment and prevention prevention- kegels. Treatment- surgery or pessary
pessary small medical device inserted into rectum or vagina used to support the structures
trigeminal neuralgia neurological condition of the trigeminal facial nerve, characterized by paroxysms of flashing, Stab like pain radiating along the course of a branch of the nerve from the angle of the jaw.
primary nursing dx for trigeminal neuralgia? Acute pain related to inflammation or compression of the trigeminal nerve.
Describe BSE S/S breast cancer? women starting age 20. Checking for new breast changes. (nipple discharge, lump, hard knot, thickening of tissue, shape change, dimpling of skin, nipple changes.)
S/S Hypoglycemia Headache, cold, clammy, numbness of fingers, toes, Nausea, Sweating, Tremor, Lethargy, Hunger, Confusion, Slurred speech, tingling around the mouth, Anxiety, nightmares.
s/s hypocalcemia Fatigue, depression anxiety, confusion, numbness and tingling in extremities and region around mouth, hyper-reflexia, muscle cramps, chvostek’s sign (face), trousseau’s sign (fingers), laryngeal spasm, tetany, seizures.
Glucocorticoid steroid hormone from adrenal cortex, regulates metabolism, increase blood glucose levels, critical in physiologic stress response (anti-inflammatory, Immunosuppressant, Maintenance of normal BP, carb and protein metabolism). Primary one is cortisol.
Why must glucocorticoids be tapered and weaned? In cases where glucocorticoids are given reasons such as infection or transplant anti rejection, they should be tapered or weaned since supplementation will lead to suppression of natural body production.
Dilantin (phenytoin) sodium channel blocker. Uses as anti-seizure, specifically treatment of tonic-clonic and partial seizures
Dilantin (phenytoin) Side effects nystagmus, ataxia, dizziness, drowsiness, rash, gingival hyperplasia, lethargy, abnormal movements, mental confusion, cognitive changes, Long term- osteoporosis. Contraindicated-allergies, bradycardia, blockage of electrocardiac function.
S/S hyperglycemia Polydipsia, Polyuria, Polyphagia, Blurred vision, Weakness, Weight loss, Syncope, fatigue, headache, n/v, abdominal cramps.
Hyperglycemia treatment Diabetes medication, freaquent bs monitoring, urine for ketones, drinking fluids.
Common risk factors for type 2 DM? Obesity, 35+, Sedimentary lifestyle, race a factor.
Meningitis Meningitis is acute inflammation of the meningeal tissues surrounding the brain and the spinal cord specifically an infection of the arachnoid mater and the CSF.
Bacterial meningitis Bacterial organism causing infection. Medical emergency. Mortality 100% if untreated. S/S= fever, severe headache, nausea, vomiting, and nuchal rigidity (neck stiffness).
Bacterial meningitis Treatment antibiotics, dexamethasone, supportive care, prevention of increased ICP.
Viral Meningitis Most common causes are enteroviruses, arboviruses, HIV, and herpes. S/S- Headache, Fever, Photophobia, stiff neck. Managed symptomatically as disease is self limiting and full recovery is expected.
What function does PTH play in the maintenance of calcium levels in the body? PTH regulates Ca+ and Phos blood levels, promotes bone demineralization and increases intestinal absorption of Ca2+. Low Ca2+ blood levels cause the parathyroid gland to release PTH acting on bone, intestine, and kindneys to increase calcium levels.
Synthroid (levothyroxine) the drug of choice to treat hypothyroidism. Synthetic thyroid hormone
S/S hypothyroidism hypo= everything slows. generally nonspecific but intensify. Fatigue, memory loss, apathy, thin dry hair, skin, Thick brittle nails, Constipation, Bradycardia, hypotention, Goiter, Periorbital edema, facial puffiness, Cold, Weight gain,
Angiopathy damage to blood vessels
Macrovascular complications of DM Damage to large and medium blood vessels. atherosclerotic plaque formation, cerebrovascular, cardiovascular, and periperhal vascular disease.
Microvascular complications of DM From thickening of the vessel membranes in the capillaries and arterioles. eyes (retinopathy); kidneys (nephropathy); and the skin (dermopathy); and neuropathy.
Will a person with hypothyroidism have to take medication for life? Treatment is hormone replacement therapy, Levothyroxine (synthroid) is drug of choice. Lifelong therapy is usually required with frequent dosage adjustments.
Risk factors associated with ED? DM, vascular disease, meds, surgery, trauma, chronic illness, decreased gonadal hormone secretion. Phychological= stress, relationship issues, depression, low self esteem.
Define ED ED (erectile disfuntion)- inability to attain or maintain an erect penis that allows satisfactory sexual performance.
Treatments for ED? ED treatment is based on treating the cause. Also, Viagra, levitra, cialis, vacuum device, intraurethral medication, intracavernosal injections, penile implants, sexual counseling.
What treatments are available for hyperthyroidism? Thyroid ablation with medications, Radiation, Thyroidectomy, Adenoctomy of portion of the anterior pituitary to remove tumor.
What causes the bulging eyes in grave’s disease? Exophthalmos caused by infiltrative ophthalmopathy due to impaired venous drainage from the orbit causing fat deposits and fluid edema into the retroorbital tissues forcing eyeballs outward and protrude.
Exophthalmos bulging eyes found commonly in Graves disease.
Graves disease autoimmunte disease of unknown cause, marked by thyroid enlargement and excessive secretion.
Function disrupted by damage to the basal nuclei of the brain? Coordination and control of body movement (Parkinson's Disease)
Effect on vision from damage to the left occipital lobe? Loss of right visual field in both eyes
Aphasia? The inability to comprehend or express language
Expressive aphasia? The inability to write or speak fluently or appropriately.
Receptive aphasia? The inability to understand written or spoken language.
What causes seizures? Excessive, spontaneous firing of neurons in the brain.
Common triggers of seizures Hypoxia, inflammation, fever, hemorrhage in the brain, or traumatic injury to the brain
S/S Increased Intracranial Pressure Decreasing level of consciousness, headache, vomitting, increased BP, decreased HR, fixed and dilated pupils
What reflex does pressure on emetic center in the medulla cause? Vomitting
What is the first sign of increased intracranial pressure? Decreasing level of consciousness
What's one main difference between a transient ischemic attack and a cerebrovascular accident? In a transient ischemic attack there is no cell death where there is cell death in a cerebrovascular accident
Carbohydrates The body’s primary source of energy, 4 kilocalories per gram. Simple- monosaccharides (glucose, fructose), disaccharides (sucrose, maltose, and lactose) Complex- polysasacharides appear in the diet as starches, cereal grain, potatoes and legumes
Fat One gram of fat yields 9 calories. Besides being a major source of energy, fats act as insulation.
Proteins One gram of protein yields 4 calories.
15/15 rule? BS <70mg/dl, Give pt 15g simple sugar(4-6 oz of fruit juice or regular soft drink, glucose gels,Life savers, jelly, syrup, honey, regular soda, OJ), Then recheck BS in 15 minutes. If pt BS>70 then give meal or snack to eat.
How often is a mammogram recommended? At what age does it start? Yearly mammograms starting at age 40 and continuing as long as a woman is in good health
What time of the day are thyroid supplements most commonly prescribed? Why? Important the drug is given at the same time daily to maintain consistent levels of the drug. It’s best to administer Thyroid drugs once daily in the morning to decrease likelihood of insomnia.
Therapeutic Dilantin level 10-20 mcg/ml
Patho of DM type 1 body’s own T cells attack and destroy pancreatic beta cells, which are the source of the body’s insulin. Autoantibodies to the islet cells cause a reduction of 80%-90% of normal B cell function before hyperglycemia and other manifestations occur.
Patho of DM type 2 Pancreas continues to produce some endogenous insulin. However, the insulin that is produced is either insufficient for the needs of the body and/or is poorly utilized by the tissues.
3 types of Strokes Thrombotic stroke, Embolic Stroke, Hemorrhagic stroke
Thrombotic stroke injury to a blood vessel wall and formation of a blood clot. The lumen fo the blood vessel becomes narrowed and, if it becomes occluded, infarction occurs. (most common)
Embolic Stroke Embolus lodges in and occludes a cerebral artery, resulting in infarction and edema of the area supplied by the involved vessel. (2nd most common)
Hemorrhagic stroke A rupture of a vessel bleeding into the brain tissue itself or into the subarachnoid space or ventricles.
MRI Magnetic resonance imaging is used to determine the extent of brain injury. It uses magnetic energy to detect strokes, MS, tumors, trauma, herniation, and seizures. Not invasive. Contrast may be used.
CT computer assisted x-ray of the body parts are done to detect problems such as hemorrhage, tumor, cyst, edema, infarction, brain atrophy and other abnormalities. Contrast may be used to enhance visualization of the brain structures.
Why would a diabetic have ketones in their urine? Circulating insulin insufficient so glucose cannot be used for energy, body breaks down fat for fuel. Ketones- acidic by-products of fat metabolism causing serious problems when they build up. Ketosis alters pH balance, causing metabolic acidosis.
Embolic stroke S/S rapid occurrence of severe neurologic effects
Hemorrhagic stroke S/S Characterized by sever headache, vomiting, loss of the ability to walk, dysphasia, pysarthria, and eye movement disturbances
Ischemic Stroke S/S LOC unlikely in the 1st 24 hrs. If a lacunar stroke motor hemiplegia, pure stroke sensory, collateral leg and face weakness w/ arm and leg ataxia,
Risk factors for stroke Nonmodifiable=age, gender (men), race, family history. Modifiable= Hypertension, heart disease, smoking, excessive alcohol consumption, obesity, sleep apnea, metabolic syndrome, lack of physical exercise, poor diet and drug abuse.
Explain risk factors for breast cancer Heredity, Hormonal regulation of the breast, Sex hormones, weight gain, dietary fat intake, obesity, and alcohol intake. Environmental factors- radiation exposure.
Normal Calcium levels are 8.5-10.5
Nursing goals in the neuro patient -acute phase Goals for care during the acute phase are preserving life, preventing further brain damage, and reducing disability. Treatment differs according to the type of stroke and changes as the patient progresses from the acute to rehab phase.
Nursing goals in the neuro patient -rehab phase Focuses on maximizing the patients capabilities and resources to promote optimal functioning related to physical, mental, and social well being.
Menorrhagia Excessive or prolonged menstrual bleeding (more than 7 days). Treatment focuses on cause and minimizing bleeding.
Dysmenorrhea Abdominal cramping pain or discomfort associated with menstrual flow. Treatment- Heat, exercise, and drug therapy
Bacterial STD’s treatment Treated with Antibiotics to get rid of the bacteria in the body.
Viral STD’s (Herpes) treatment Antiviral agents which inhibit herpetic viral replication. They are not a cure but shorten the duration of viral shedding and the healing time of genital lesions & reduce outbreaks.
Bacterial STD’s (Genital Warts) treatment removal of symptomatic warts by chemical or ablative methods.
PSA ( Prostate-Specific Antigen) Glycoprotein produced by prostate. Elevated levels (normal level 0-4ng/ml) =indicate prostatic pathology, possibly prostate cancer. Mild elevations occur w/ aging, BPH, recent ejaculation, drugs, acute or chronic prostatitis or after long bike rides.
What important information is necessary to provide for the client newly started on anti-seizure medications? Faithfully take medications to avoid a seizure, have medical follow up to make sure that drug levels are therapeutic and make necessary lifestyle changes. Avoid excessive alcohol intake, fatigue, and loss of sleep.
The patho of a-fib that would render a person at risk for a stroke A- fib can often result in a decrease in CO because of ineffective atrial contractions or loss of atrial kick, and/or a rapid ventricular response. Thrombi may form in the atria as a result of blood stasis.
Atrial fibrillation (A-Fib) Characterized by a total disorganization of atrial electrical activity due to multiple ectopic foci resulting in loss of atrial contraction.
Medication of choice for acute seizures? Dilantin
Why does the nurse assess for tetany in a patient who has had his thyroid removed? Tetany-neuromuscular hyper-excitablilty due to low calcium levels (can occur with thyroid or parathyroid surgery). Assess pt for hypocalcemia. Treatment- calcium gluconate. Monitor Ca+, Phos, K, mag levels. Assess Chvostek and Trousseaus sign.
S/S of Stroke HA, lethargy, change in LOC, blurred vision, paralysis, paresthesia, difficulty speaking
Herpes Simplex occurs in both oral and genital. Determine similarities and differences. 2 different viruses. HSV1 usually causes infection above the waist. HSV2 usually causes infection below the waist. Both are treated with anti-virals.
TSE (testicular self-examination) Once a month, same day each month, during shower, use both hands, cover entire surface, Identify structures, Feel for changes (lumps, irregularities, pain or a dragging sensation). Notify PCP of changes.
S/S of Testicular cancer Painless lumps, swelling, heavyness in scrotum. Dull ache,heavy sensation in lower abd, perineal area. back pain, cough, dyspnea, hemoptysis, dysphagia, alterations in vision or mental status, papilledema, and seizures.
How does DM lead to blindness? Micro vascular complications cause thickened vessel membranes. Pt’s w/ DM are at increased risk for glaucoma and cataracts. The micro vascular damage can occur to the retina leading to some degree of retinopathy.
Non proliferative Retinopathy most common, partial occlusion of small blood vessels in the retina cause microaneurysms, microaneurysms leak capillary fluid casing retinal edema.
Proliferative Retinopathy most severe, involves both the retina and vitreous, Capillaries become occluded so body produces new blood vessels which are fragile and break. pt sees black or red spots or lines, can cause partial or complete retina detachment.
Multiple sclerosis Disease is chronic, progressive, degenerative, and has exacerbations and remission. Plaques develop on the myelin sheaths.
Multiple sclerosis treatment symptom relief, controlled by drugs including ACTH, methylprednisolone and prednisone to help treat the exacerbations by relieving the edema and inflammation at the site of demyelination. Nutritional therapy for proper diet.
Myasthenia Gravis Disease is characterized by fluctuating weakness of certain skeletal muscles.
Myasthenia Gravis Pt teaching follow med regimen, possible drug reactions, plan ADL’s to avoid fatigue, community resources, possible complications, therapy, MG support group, Schedule meds so that peak is at mealtime to make eating less difficult
Why would a person choose a vaginal hysterectomy over a TAH vaginal hysterectomy used for repair and removal of uterus. The TAH is done to remove large tumors, tubes and ovaries. The vaginal hysterectomy has better recovery. The TAH is more complicated and presents postoperative problems with incision in abd.
6. Explain the (2) most commonly used assessments that nurses use to determine hypocalcemia. Chvostek - contraction of the facial muscle in response to tap over the facial nerve in from of the ear. Trousseau’s sign- a b/p cuff is inflated on arm to above the systolic pressure, within 3 minutes pt will experience a carpal spasm.
Describe pathophysiology of Cushing’s syndrome. The body develops tumor which causes the pituitary to secrete adenocorticotropic hormone (ACTH). This ACTH causes the body to gain weight around the trunk and face and increases gluconeogenesis by the liver.
What is IGT Impaired Glucose Tolerance (borderline diabetes), blood glucose levels above normal but not enough for DX of DM. dx=fasting blood glucose level is >100 but <126 mg/dl. Random plasma glucose measurement or OGTT of >140 but <200 can also be done.
Pathophysiology of Parkinson’s Disease that would reflect the cogwheel rigidity. Disruption in Dopamine and acetylcholine levels causes abnormal functioning of voluntary motion causing resistance to passive motion, caused by a sustained muscle contraction.
Fasting Blood Glucose (FBG) 70-100 <100mg/dl
Random Blood Glucose 70-120 mg/dl But new info showing <100
Oral Glucose Tolerance Test (GTT) <140
Impaired Glucose tolerance (IGT) DX levels FBG: >100 <126 mg/dl Random: >200 mg/dl Oral GTT >140 <200
Diabetes Melites (DM) DX levels FBG: >126 Random: >200 Oral GTT: >200
What assessment finding would you expect with a right hemisphere stroke? Paralyed left side: hemiplegia, Left-sided neglect, Spatial-perception deficits, Tends to deny or minimize problems, Rapid performance, short attention span, Impulsive, safety problems,Impaired judgment, Impaired time concepts
S/S of hypothyroidism • Slowing body processes, Fatigue and lethargic, personality and mental changes (including impaired memory, slowed speech, decreased initiative and somnolence), appear depressed, Sleep a lot, Anemia, Bruise easily, Constipation, Cold intolerance
What hormone is released in the time of low BG? Counterreggulatory hormones (glucagon, epinephrine, growth hormone, and cortisol) are released to increase blood glucose levels by stimulating glucose production and output by the liver.
Describe function of insulin in the body Insulin enables glucose to pass into the cells to be used as energy.
Explain different Auras pre-seizure Feelings, sense, sensations, smell, taste.
PSA Prostatic Specific Antigen. Used to detect prostate cancer.
Triad of Diabetic care Maintain blood glucose, Nutritional Therapy, Drugs, Excercise. Yes thats 3 but I dont know what she wants.
Why is foot care so important in DM patients Pt can have sensory neuropathy causing decreased sensation so might not know if they have injury or breakdown leading to serious infection. This is caused by reduced blood flow to the feet and legs.
Why is the gonorrhea pt at risk for PID When left untreated it can cause an inflammatory response leading to fibrous tissue formation and adhesions.
How is herpes spread Enters through the mucous membrane or breaks in skin. Once infected it is generally present for life.
Why is ovarian cancer usually dx to late? Early s/s are vague and often dismissed. There are no reliable screening tests and only bimanual pelvic exam can be used to identify an ovarian mass.
Why is a person with PID at risk for infertility? PID can cause the formation of Adhesions and strictures in the uterin tubes causing obstructions and infertility.
Created by: 918rider