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Med Surg - Quiz 4
Immune, HIV, Endocrine
| Question | Answer |
|---|---|
| Hormones from the Adrenal Cortex gland | Mineralcorticosteroids Glucocorticosteroids Sex hormones |
| Hormones from the Anterior Pituitary gland | TSH FSH Andrenocorticotropic Leutenizing Growth Prolactin |
| Hormones from the Posterior Pituitary gland | Oxytocin ADH |
| Hormones from the Thyroid gland | Thyroxine (T4) Triodothyronine (T3) Calcitonin |
| Hormones from the Parathyroid gland | Parathormone (PTH) |
| Hormones from the Adrenal Medulla gland | Epinephrine Norepinephrine |
| Hormones from the Pancreas | Insulin Glucagon |
| Hormones from the Ovaries | Estrogen Progesterone |
| Hormones from the Testes | Testosterone |
| Hormones from the Thymus | Thymosin |
| Hormones from the Pineal | Melatonin |
| TSH | Acts on thyroid gland |
| FSH | Stimulates follicles in the ovaries |
| Adrenocorticotropic | Stimulates adrenal cortex |
| Leutenizing | Stimulates ovaries |
| Growth hormone | Accelerates breakdown of proteins |
| Prolactin | Stimulates breast development and milk production |
| Oxytocin | Promotes release of milk; aids in uterine contractions |
| ADH | Anti-diuretic hormone ("anti-pee"); constricts aterials; increases B/P |
| Thyroxine | T4; helps with growth and development; helps with metabolism |
| Triodothyonine | T3; activity of nervous system |
| Calcitonin | decreases blood calcium; causes calcium in blood; regulates phosphorus |
| Mineralcorticosteroids | water and electrolyte balance |
| Glucocorticosteroids | involved in gllucose metabolism; extra energy during stress; anti-inflammatory properties |
| Sex hormones | estrogen in the female; androgen in the male |
| Epinephrine | increases HR increases B/P |
| Norepinephrine | vessels constrict |
| Insulin | released with increase in glucose |
| Glucagon | released with decrease in glucose |
| Estrogen | responsible for secondary sex characteristics; build up endometrium |
| Progesterone | maintains reproductive organs; maintains endometrium |
| Testosterone | male sex characteristics |
| Thymosin | role in the immune system |
| Melatonin | sleep and mood; inhibits reproductive activity in children until adulthood (role in puberty) |
| Growth Hormone Diseases | Acromegaly, Gigantism, Dwarfism |
| Acromegaly | overproduction of growth hormone in adults; usually cause tumor growth; enlarged cranium and lower jaw; Cryosurgery Transsphenoidal removal of tissue |
| Gigantism | Occurs in a child before closure of the epiphyses; can be caused by a tumor; remove tumor; d/c life expectancy d/t heart issue |
| Dwarfism | underproduction of growth hormone; GH injections; remove tumor |
| Diabetes Insipidus | Deficiency of antidiuretic hormone (ADH); Give them DDAVP (Desmopressin) Polyuria, polydipsia; Can become dehydrated; |
| Hyperthyroidism | Also called Graves’ disease; Overproduction of the thyroid hormones; Tachycardia; hypertension; diaphoresis |
| Hyperthyroidism med mgt | Propylthiouracil – PTU d/c activity of thyroid gland Methimazole Radioactive iodine Subtotal thyroidectomy Readily available is a trach kit Increase calories d/t increased metab; Tracheotomy tray at bedside; semi-fowlers; Chvostek’s |
| Chvostek's sign | (tap facial nerve for response) and Trousseau’s signs (B/P cuff on for min or 3 min) |
| Hypothyroidism | TSH increased/T4 and T3 decreased; Insufficient secretion of thyroid hormones; low and slow; intolerance to cold; metab slows down; High fiber/high protein/low cal diet for constipation |
| Hypothyroidism med mgt | Synthroid - Adverse effects mimic hyperthyroidism; labs q 6-8 wks til levels are regulated; |
| Simple goiter | Simple goiter – enlarged thyroid d/t insuff. iodine |
| Simple goiter med mgt | Potassium iodide Diet high in iodine Surgery—thyroidectomy if necessary |
| Cancer of the thyroid | Firm, fixed, small, rounded mass or nodule on thyroid |
| CA of the thyroid med mgt | Total thyroidectomy Thyroid hormone replacement If metastasis is present: radical neck dissection; radiation, chemotherapy, and radioactive iodine |
| Hyperparathyroidism | pth is released; Overactivity of the parathyroid, Concern w/ calcium and phosphorus; Hypercalcemia Skeletal pain; pain on weight-bearing ***Pathological fractures d/t calcium coming out of the bone making them weak ***Kidney stones d/t calcium |
| Hyperparathyroidism med mgt | Surgical removal of tumor Removal of one or more parathyroid glands |
| Hypoparathyroidism | d/c in PTH; d/c in calcium; Decreased parathyroid hormone Decreased serum calcium levels; Concern w/ tetany (muscle contractions); Involuntary and uncontrollable muscle spasms Tetany d/t d/c calcium; Chvostek’s and Trousseau’s signs |
| Hypoparathyroidism med mgt | Calcium gluconate or calcium chloride IV Vitamin D to aid in absorption of calcium |
| Syndrome of inappropriate antidiuretic hormone | causes fluid retention; treatment is decrease fluid intake; tumor extraction; declomycin inhibits the ADH |
| Cushings syndrome | Adrenal hyperfunction: Plasma levels of adrenocortical hormones are increased - steroids; overuse of corticosteroids; |
| Clinical signs of Cushings syndrome | Moonface Buffalo hump (looks like a goiter on the back of the neck – lump of fat); Hypokalemia; proteinuria |
| Cushings med mgt | Adrenalectomy for adrenal tumor Radiation or surgical removal for pituitary tumors Lysodren Low-sodium, high-potassium diet |
| Addison’s disease | Adrenal hypofunction; Adrenal glands do not secrete adequate amounts of glucocorticoids and mineralocorticoids; Related to imbalances of hormones, nutrients, and electrolytes Craving for salt; |
| Addison's med mgt | Addison’s crisis d/t stopping steroids cold turkey: Can cause this disorder; Titrate steroids down instead; Adrenal crisis IV corticosteroids in a solution of saline and glucose |
| Pheochromocytoma | disorder of adrenal gland; Chromaffin cell tumor; usually found in the adrenal medulla Causes excessive secretion of epinephrine and norepinephrine; causes HTN could be as high as 300/180; removal of tumor to treat |
| Diabetes mellitus | disorder of the pancreas; improper metabolism of carbohydrates, fats, and proteins |
| The 3 "Ps" of diabetes mellitus | Polyuria Polydipsia Polyphagia |
| Glycohemoglobin – A1-C | Measures effectiveness of diabetic therapy for preceeding 8-12 wks |
| Insulin | Classified by action: Regular; Lente and NPH; Ultralente Classified by type: beef/pork: Humulin/Novolin Injection sites should be rotated to prevent scar tissue formation Sliding scale IV is REG only Administer @ room temp 25-32 guage needles |
| Diabetic retinopathy | Loss of vision d/t excessive blood vessels in eye that burst; Laser to correct |
| HIV is an obligate virus, what does that mean? | It can't survive long outside of the human body |
| 3 most common modes of HIV transmission | blood; semen/cervicovaginal secretions; breast milk |
| Transmission of HIV | Sexual transmission; Parenteral exposure; Transfusion of blood and blood products; Occupational exposure; Perinatal (vertical) transmission (Transmission from mother to child) |
| Pathophysiology of HIV | T-cells or CD4+ lymphocytes are destroyed by HIV; HIV is then able to reproduce in the lymphatic system and eventually “spills over” into the blood; Decreases resistance to life-threatening infections |
| CD4+ levels | CD4+ 500-1200 normal CD4+ 200-499 minor immune problems CD4+ below 200 severe immune problems |
| Spectrum of HIV | Acute retroviral syndrome; Early infection; Early symptomatic disease; AIDS |
| Acute retroviral syndrome | Initial exposure; Primary HIV infection Flu-like symptoms; Develop antibodies to HIV in 1-12 weeks; Asymptomatic HIV infection; HIV seropositivity (seroconversion); Positive HIV antibody test; 95% within 3 months; 99% within 6 months; Infectious; no illn |
| Early infection | Early HIV disease; Signs and symptoms may not appear until 10-14 years after exposure; Symptomatic infection; Persistent, unexplained fever; Night sweats; Diarrhea; Weight loss; Fatigue |
| Early symptomatic disease | CD4+ cell count drops below 500 cells/mcl Persistent, unexplained fevers Drenching night sweats Chronic diarrhea Headaches Fatigue Lymphadenopathy Recurrent or localized infections Neurological manifestations |
| AIDS | The end-stage, or terminal, phase of the HIV infection HIV positive and CD4+ (T4) count below 200 or one or more AIDS-indicator conditions |
| Term for development of antibodies from HIV | Seroconversion: Positive HIV antibody test 95% within 3 months; 99% within 6 months |
| Aids is used to describe the terminal stage (end stage) of HIV, what dx criteria must be applied in order to make the dx? | CD4+ (T4) count <200 or 1 or more Aids indicator conditions is present |
| What blood test is associated with screening of HIV? | Elisa |
| What blood test is commonly used as a confirming test for HIV? | Wester Blot |
| ELISA | Detects the presence of HIV antibodies If positive, test is done a second time |
| Western Blot | Done if second ELISA is positive More sensitive than ELISA |
| Seropositive | All three tests are positive (ELISA x 2 and Western blot); Does NOT mean the person has AIDS |
| Seronegative | Not an assurance that an individual is free from HIV infection Seroconversion may not have occurred yet |
| CD4+ lymphocyte count | Normally 500-1200 mcl; Decreases as the disease progresses; Best marker for the immunodeficiency associated with HIV infection |
| Viral load monitoring | Level of virus in the blood; Provides significant information toward predicting the course of the disease |
| HIV Therapeutic management focus | Monitoring HIV disease progression and immune function Preventing the development of opportunistic diseases Initiating and monitoring antiretroviral therapy Detecting and treating opportunistic diseases Managing symptoms Preventing complications of t |
| Seroconversion | period of time for development of HIV antibodies |
| Kaposi's Sarcoma | reddish purple lesions |
| Most common opportunistic diseases with HIV | associated with HIV Pneumocystis carinii pneumonia (PCP); Kaposi’s sarcoma; Cytomegalovirus (CMV); Cryptococcal meningitis; Toxoplasma encephalitis; Mycobacterium (avium complex and tuberculosis); |
| Rehabilitation Act of 1973 | prohibits discrimination against the handicapped and the disabled HIV and AIDS are included |
| Describe PCP (pneumocystis carinii pneumonia) | Fever; night sweats; productive cough; SOB |
| Describe Variclla Zoster Virus (Shingles) | |
| What therapy is an important component in the mgt of HIV? | combination |
| List some psychosocial implications for a patient w/ HIV | depression, fear, suicidal ideation |
| Nurses have a duty to treat. What legal Acts cover HIV/AIDS patients? | Rehabilitation Act of 1973; American Disabilities Act |
| The storage area in which HIV reproduce in the human body is: | lymph nodes |
| Vertical transmission of HIV occurs from? | mother to child |
| What are some barriers to the prevention of HIV? | not enough supplies, culture, lack of education |
| What is the purpose of doing a viral load study once q 3-4 months in an HIV positive person? | Viral load should decrease; CD4+ count decreases (>500) |
| Branch of med that deals with the study of tumors | Oncology |
| A substance known to increase the risk for the development of cance | Carcinogens |
| Carcinogenesis | The process by which normal cells are transformed into cancer cells |
| Risk factors for the development of cancer | Smoking, dietary habits, exposure to radiation, exposure to environmental causes, smokeless tobacco, alcohol consumption |
| About 90% of cancers are NOT inherited. True or False? | True |
| Screening tests for cancer | Colorectal tests Prostate cancer detection Pelvic examination with Papanicolaou (Pap) smear for women Breast cancer detection (self-exams) Skin examinations |
| Neoplasm | Uncontrolled or abnormal growth of cells |
| Benign | not recurrent or progressive; nonmalignant |
| Malignant | growing worse and resisting treatment; cancerous growths; tumors |
| Metastasis | Tumor cells spread to distant parts of the body |
| Carcinoma | malignant tumors composed of epithelial cells; tend to metastasize |
| Sarcoma | malignant tumor of connective tissues, such as bone or muscle |
| Immunocompetence | when the immune system responds appropriately to a foreign stimulus |
| 4 categories of the body's inappropriate response to the immune system: | Hyperactive Response – e.g. Allergy; Inability to protect the body – e.g. HIV; The body attacks itself – e.g. Autoimmune diseases; They body attacks beneficial foreign tissue – e.g. Rejection of transplanted organs, blood transfusion reactions. |
| The 4 R’s of the immune system: | Recognize Respond Remember Regulate |
| Innate or Natural Immunity, the first line of defense includes | Skin, mucous membranes, tears, saliva. |
| Adaptive or Acquired Immunity, the second line of defense includes | Vaccines, Breast milk, Exposure – anything producing antibodies. |
| Antigen | is a substance recognized by the body as foreign that can trigger an immune response. |
| Antibody | protein on the surface of B cells that is secreted into the blood or lymph in response to an antigen. |
| Anaphylaxis | the most severe of allergic reactions. Causes include: Bee stings, foods, drugs and venoms. |
| Symptoms of Anaphylaxis | Airway constriction – bronchospasm/laryngeal spasm; wheezing (high pitched) |
| Treatment of Anaphylaxis include | Epinephrine – 0.5 mL SubQ q15 minutes per MD Benadryll – 50-100 mg IV or IM Steroids IV access and Intubation may be necessary |
| Autoimmune disorders | disorders where the body fails to tolerate itself, attacking itself. Diseases in this category include: Lupus, Rheumatoid Arthritis, Multiple Sclerosis, Myasthenia Gravis, ALS/Lou Gehrig’s. |
| Plasmapheresis | The Treatment for many autoimmune diseases; process of removing and stripping the plasma of the antigens causing the response. |
| The nurse should be aware of Latex allergy because it's hazardous to both patient and nurse. T or F? | T |
Created by:
MarieG
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