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scc med/surg 2
| Question | Answer |
|---|---|
| s/s of rapid hypoglycemia | tachy, tremors, diaphoretic, dilated pupils, pale, clammy |
| s/s of prolonged hypoglycemia | restlessness, difficulty thinking, trouble speaking, visual disturbances, paresthesia change in LOC, convulsions |
| BS levels for mild, moderate, severe hypoglycemia | < 70 mg/dL -Mild <55mg/dL -Moderate <40mg/dL-Severe |
| Sz precautions- | suction device, padded side rails, oral airway, o2 use, anything that could harm or strangle |
| HgA1c norm | <5% /7% in DM |
| differnece between DKA & HHS | HHS-hyperosmolality 350, DM2,older adults,slow Insidious Onset, HYPERNATREMIA, BS >1000, incr glucose production DKA- DM1,young,quick onset, ketones formed, aidosis, kussmaul respirations, HYPERKALEMIA fruity breath,330 osmolality,BS avg.675 |
| comparison of DKA & HHS | Insulin deficiency in production & reaction; dehydration, hyperglycemia, osmotic diuresis, fluid volume deficit, electrolyte imbalance, tachy, hypotension |
| DKA & HHS interventions | 1.montior respiratory status 2.Redhydrate (bolus hypertonic) 3. establish K+ levels 4. administer insulin (bolus; then insulin drip) |
| normal plasma osmolality | 275-295 ml osmol/kg |
| ADH effects | vasoconstriction distal & collecting tubules reabsorb water |
| Diabetes Insipidus neurogenic patho | trauma to pos. pituitary or hypothalamus from surgery/trauma; more common pituitary can’t release ADH ↓ release ADH → free H2O loss Low urine osmolality w/ hi serum osmolality (r/t hypernatremia), decr in urine specific gravity 4-40 L/24hrs Sudden |
| Diabetes Insipidus nephrogenic patho | adequate ADH but kidneys not responding to it (or extreme H20 intake/2ndary DI) impaired renal conservation collecting ducts & distal tubules unresponsive to ADH slow onset HYPOKALEMIA/HYPERCALCEMIA |
| s/s DI | XS poliuria>3L/24hr sometime 4-6L s/s if awake-polydipsia/if unconscious signs of hypovolemia- tachy, hypotension, dry mucous, wt loss |
| DI labs | Low urine osmolality < 100 mOsm/kg H20 w/High serum osmolality > 295 mOsm/kg H20 Decr. urine specific gravity < 1.005 Elevated serum Na+ > 145 mEq/L Decreased plasma volume (xs urine low BP) |
| DI interventions | Volume replacement r/t hypovolemia I & O, wt. Q Day VS Qhr monitor Hemodynamics, urine Sp. Gr., Neuro's Hypotonic D5W or isotonic NS Hormone replacement Exogenous ADH- help kidneys reserve water Desmopressin- most common- then Monitor for fluid xs |
| SIADH Patho | Too much ADH; Problem of stimulation of hypothalamic/pituitary system or both malignant &,Non malignant,CNS disorders,Meds Secretion of adh unrelated to plasma volume feedback system not working properly |
| S/S SIADH | s/s of H2O intoxication CNS - ICP, Weak, confused, Sz, coma GI- decr motility r/t low Na, n/v anorexia, muscle cramps Cardio -pulm artery & central venous pressure incr , wt gain, incr BP Resp - s/s fluid overload, advent lung sounds, pink frothy sput |
| labs for SIADH | hynatremia, hypo-osmolality, hi urine Na+, hemodilution |
| Adrenal gland medulla- where?, releases?affects? | inner layer-secretes cathecomline-epihephrine, norepinephrin, dopamine- incr metabolic rate,incr. insulin levels,fight/flight |
| Adrena gland cortex- where?, releases?, affects? | outer-glucocorticoids-CORTISOL-help w/stress, suprress inflammation, incr BS, regulate metabolism of carbs, fats, protein, synthesis protein; ALDOSTERONE- Na & h20 retention; MINERALCORTICOIDS- K+ retention/excretion; ANDROGENS- growth & development |
| Addisons Disease patho | Decr corticosteroids/ dysfunction in hypothalamus or adrenal gland LOW CORTISOL L/T hypoglycemia LOW ALDOSTERONE L/T low blood volume Decr K+ excretion (hyperkalemia) Reabsorption of hydrogen ions acidosis Incr Na+ and H2O excretion (hyponatremia) |
| Addisons cause | Primary-idiopathic Secondary- abrupt steroid stop |
| s/s Addisons Disease | confusion, fatigue, hi K+, Hi BS, muscle spasms, hypotension, hyperpigmentation, hyponatremia, GI imbalance, wt loss, hypovolemia |
| Addisons Disease Tx | fluid balance Freq check wts, vs I&O’s,dysrhythmia labs- Na+, K+,pH (acidosis) Cortisol, aldosterone,Mineralocorticoid replace Meds-Solucortex,flucortisol, hydrocortisone h2 blockers/ K+ d5ns / diet restrict (k+)/ ECG/ IV glucose(hypoglycemia)/ fre |
| Cushing’s Disease patho | Produce too much steroids- xs secretion of cortisol/glucocorticoids from adrenal Altered nitrogen, mineral,fat metabolism redustributed fat decr in muscle mass D/T tissue protein breakdown hi BS liver stimulated to make glucose & insulin receptors de |
| Cushing's Disease cause | Primary-D/T adrenal or pituitary tumor Secondary- (little release of ACTH) Disorders of the pituitary or hypothalamus Iatrogenic- (most common cause) Long-term steroid therapy, xs cortisol levels |
| Cushing’s Disease s/s | buffalo hump, moon face, decr muscle mass, capillary bleeding, decr bone density at risk for fx, high BS,acne, lenugo, hypervolemia, edema, incr hr/BP r/t cardiac hypertrophy, trunkal obesity, emotional |
| Cushings Disease LAbs | Na incr, K+ decr, BS norm - incr, Ca decr, bicarb decr, BUN norm |
| Addison's Labs | Na decr,K+ incr, BS norm-decr, Ca incr, Bicarb incr, BUN incr |
| Pheochromocytoma patho, causes | Catecholamine-producing tumor on adrenal gland tumors store & release epi & norepi causes-=Triclycic, theophylizine, aged cheese , red wine |
| Pheochromocytoma s/s | recurrent episodes w/ severe super HA, diaphoertic, flushed, htn, angina, gi symptoms, n/v, cramping, heat intolerance, wt loss, tremors, easily go into htn crisis |
| Pheochromocytoma diagnosis/ treatment | Test 24 hr urine to measure catecholimines;Lab and radiography-ct or MRI- to confirm tumor Surgery Monitor BP Hydration and diet |
| Chronic Renal Failure patho | Insidious, progressive, irreversible destruction of kidneys Continues until nephrons are replaced with scar tissue Abnormal urine production hyperosmole Electrolyte /Metabolic abnormalities Isothenuria ↑ BUN and ↓urine output/Risk for fluid overload |
| Chronic Renal Failure cause | infection dm, htn, kidney damage/trauma |
| Chronic Renal Failure stages | At risk => 90 ml/min Mild CKD =60-89 ml/min Moderate CKD=30-59 ml/min Severe CDK=15-29 ml/min ESKD=< 15 ml/min |
| Chronic Renal Failure s/s | Hypertension Hyperlipidemia Health failure Pericarditis Anemia Halitosis and stomatitis Anorexia, n/v from uremia Peptic ulcer disease |
| Peritonitis types | Primary peritonitis-Common with cirrhosis Secondary peritonitis-Surgical peritonitis, gastric/intestinal ruptures appendix, perforated peptic ulcers, IBD |
| Peritonitis patho | Inflammatory response L/t massive fluid shifts (peritoneal edema) & adhesions as the body attempts to wall off the infection; hypovolemia-> shock |
| peritonitis s/s | acute severe distress pain, sudden onset, rebound tenderness, muscular rigidity, guarding, spasm, restlessness, n/v, anorexia, fever, altered bowel habits |
Created by:
cbohannan
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