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MS exam 3
n/a
105
Nursing
Graduate
10/07/2013

Additional Nursing Flashcards

 


 

Cards

Term
the three types of pain
Definition

visceral- dull, aching, cramping, burning... intestines esp.

parietal- more severe and steady pain. like appendisitis

referred- travels from primary site to distal site.

Term
how does pain affect the physical assess
Definition

the area with pain is always assessed last

they may gaurd that site

Term
clinical manifestations of endocrine and metabolic assessment
Definition

pain, infection/inflammation, GI, skin changes, vascular, loc, visual, urinary

watch for hx of diabetes, cancer treatments, heart disease, breaks in skin integrity(dental procedures), piercings(can cause infects), Allergies(Iodine, and shellfish)

Term
what meds should you be considered about?
Definition
hormones, and steroids, over the counter drugs that can be hepatotoxic (tylenol)
Term
Why look at the size of hands and feet?
Definition
diabetics, acromegaly (everything is bigger)
Term
auscultation assessment
Definition
listen to lungs, heart, valve sounds
Term
What is you percuss and the sound is dull
Definition

enlarged, or fluid involvement.

liver greater than 12 cm is englarged

Term
gynecomastia
Definition
males with enlarged breast. This means the liver is not functioning well enough to get the estrogen out of the system.
Term
acromegaly in children?
Definition
in children it is called giantism. Caused by a benign growth on the patuitary gland that can be removed with surgery and the process can be reversed
Term
pancreatic fx test
Definition
related to blood glucose test (fasting for 12 hrs). A1C is also looked at
Term
thyroid test
Definition
thyroid stimulating hormonesth. most thyroid diseases considered autoimmune.
Term
what is the T3 and T4 test
Definition
see if there is any problem with the thyroid. They inject a substance and run the test. *T4 can be decreased by strenous exercise and also so does heparin and lithium. these tests look at thyroid fx.
Term
adrenal fx test
Definition

adrenals sit on kidneys and need to be healthy. Urine and blood test done. ACTH stimulating test- which is a hormone and watch how your adrenals react to this hormone which is also produced by the pituitary gland.

Eat a high carb diet 24 hrs before test, sometimes they fast, or not prep at all. Draw blood as a base line and inject it and wait an hour before drawing blood again.

Term
Cushing's disease
Definition

too much cortisol in the system which causes a pituitary tumor that can cause the level to be higher.

you will see moonface with this disorder.

Term
Addison's disease
Definition

adrenal dificiency, a decrease in cortisol

fatigue and weight loss.

Term
Goiter
Definition

can be due to hyper and hypo thyroidism. Includes swelling around the neck that gets huger.

 

Term
cause of goiter
Definition

lack of idione-which affects sodium process

tumors

 

Term
sporatic goiter
Definition

defined to a geographical area. Genetic faulty mechanism that causes it or they eat a type of food that cause it: cabbage (inhibits T4), soybeans, spinache

Lack of idione... thyroid enlarges to try to compensate for the lack of it and gets bigger from overworking.

Term
Endemic goiter
Definition
happens everywhere caused by a lack of idione… more prevelant in the fall than winter and more so in women. More common in pregnant women. Growth spurts in children and adolescence.
Term
hypothroidism
Definition

inadequate T3 and T4 circulating which causes metablic rate to go down.

fatigue,unable to tolerate cold temps, constipation, weight gain, thin skin, brittle fingernails, depression, thinning of hair, joint aches and muscles

Late symptoms: slow thinking process, decrease sensations to taste and smell. This is usually not the primary diagnosis... usually found in other diagnosis going on. Tx is usually life long

Term
causes of hypothyroidism
Definition
surgical removal of the gland (have to be on medication), thyroid is tied into the lipid system, cholesterol, and triglycerides which goes up.
Term
hashimoto disease
Definition

mild type of hypothyroid disease

TH are low, but TSH are elevated. Pituitary is working but the thyroid is not.

Term
myxedema
Definition

most severe hypothyroidism

shows up with stress, drug use, trauma, resp failure, swelling around eyes, coma (100% mortality).

When they stop taking their thyroid meds.

Decrease in resp, hypoxia

If they become difficult to arouse... they are deteriorating.

Term
hyperthyroidism
Definition
intolerance to heat, bulging eyes, facial fushing, increase bp, weight loss, muscle wasting, no period, increased diahrrea, tremors
Term
Graves disease
Definition

also affects pituitary, gonads, hypothalmic.

Lots of energy, cannot sleep, very nervous and irritable, decreased attention span, weight loss.

Term

hyperthyroidism

 

 

 

 

 

 

 

 

 

 

Definition

Excessive, circulating thyroid hormones in the body. Usually between ages of 20 and 40. More so in women. Normal body functions are increased.

they will have a staring gaze. elevated systolic bp, tachycardia, atrial fib,

Term
Exophthalmos
Definition

eyes feel griddy, cant stand bright lights, hard to time closing eye lids, bulging eyes

 

reduce stimuli, eye drops, eye patch, elevate bed, decrease salt intake.

Term
hyperthyroid lab values
Definition
increase in TH and decrease in TSH
Term
Thyroid storm
Definition

can be a fatal symptom

high fever

severe tachy

dehydrated

dilirium

irritability

extreme period of thyroid activity,

Term
drug of choice for thyroid storm
Definition

iodidepropythiouracil, decreases TH levels

drug of choice for pregnant women as well.

Tapazole can also be given.

Side effects alleviated in 4 to 8 weeks.

 

They have to take their medicine and in the right way. Do not stop the medication... being med compliant s key.

Term
hyperthyroid meds
Definition

helps the glands store the thyroid hormone, need to watch for palpitations and tremors... whcih is treated with Indedrol, propanolol, corqard.

 

These clients need a high calorie diet 4000 to 5000 per day.

Term
Interventions for thyroid storm
Definition
beta blockers, treat tachycardia, give iodide orally or IV
Term
removing thyroid gland
Definition

only needs 1/6 of the gland to function normally. Decreases the chance of hemorrhage if some is left and reduces chances of crisis.

Could change voice, swelling can cause resp problems, thyroid storm may occur

Term
thyroidectomy
Definition

could have thyroid storm(know symptoms)

become hypocalcemia(accidental removal of parathyroid)signs of hypocalcemia.... call the doctor, have calcium gluconate at the bed side. (patent IV line)

hemorrhage

Term
teaching after thyroidectomy
Definition

watch for signs of infection

neck exercises

life long therapy

watch for signs of hypocalcemia and call dr immediately

Term
Thyroiditis
Definition

acute- inflammation of thyroid gland.

acute cause of bacterial invasion in the thyroid which can cause an abscess which can be treated with antibiotics

Sub acute- viral infection, mostly women suffer from this 80%

chronic- hashimoto's disease, will destroy the gland which can be genetic.

Term
thyroid cancer
Definition

women are 3 x more likely to develop. peaks during the 60's but can occur at any age. Very curable because it is slow growing. Hard and irregular nodule in the glad.

Always make sure you have a trach kit at the bedside because of the swelling.

Term
Hyperparathyroidism
Definition

PTH is what the parathyroid produces.

Decreased calcium can leads to a negative feedback so it will keep excreting even when it doesnt need to. More women than men are affected, and clients with renal failure.

Term
symptoms of hyperparathyroidism
Definition

kidneys cant keep up, bone cannot keep up, organs are losing calcium

Kidney stones develope (overproduction of calcium)

Bone damage

hypercalcemia

vitamin D deficiency

SAFETY IS PRIORITY

back aches, joint pain, bone pain

Term
primary symptoms of hyperthyroid
Definition
depressed, psychosis
Term
primary hyperparathyroidism
Definition

calcium too high, excessive PTH

dont need to know secondary and tertiary

Term
parathyroidectomy indications and complications
Definition

indications- too much pth in the blood

 

complications- tingling, bleeding, trach kit ready (swelling0, tetany (calcium gluconate for that), digitalis if heart rate too fast.

Term
Nursing int for hyperparathyroidism
Definition

treating hypercalcemia- fluids to dilute calcemia in the blood... 3L per day. NS is fluid of choice which inhibits reabsorption of Ca. Lasix may also be presribed.

they can also place the parathyroids into a different area, muscle of forearm or brachial.

Term
hypoparathyroidism
Definition
Ca is low, phosphate levels increased, PTH controls these two. effects women more than men. Also have a low PTH with a decrease in urine calcium.
Term
2 types of hypoparathyroid
Definition

iatrogenic- accidental removal

idiopathic- autoimmune related.

Term
symptoms of hypoparathyroid
Definition

acute hypoparathyroidism- tetany, irritability, chevosteks sign, trach kit is needed

chronic- lethargy, dry skin, depression, brittle nails, calcification in the eyes.

 

If left untreated can also have heart failure.

Term
treatment of hypoparathyroidism
Definition

calcium and phosphorus supplements which is life long treatment.

 

teaching: high calcium, low phosphorus, vitamin d increase

omit cheese and milk to avoid phosphorus

Term

Hypofunction of adrenal glands

Addison's

Definition
rare and usually due to an autoimmune process and commonly seen in AIDs patients and 20% in TB.
Term
Sympstoms of Adrenal Crisis
Definition

profound fatigue

dehydration

vascular collapse, decreased BP

Renal Shut down (decreased NA, Serum K)

Term
Risk factors of Addison's disease
Definition
hx of other endocrine disorders; glucocorticoids, adrenalectomy;TB
Term
Symptom's of Addison's Disease
Definition

Bronze skin pigmentation

hypoglycemia

postural hypotension

GI disturbances

weight loss

weakness

salt craving

muscle, joint pain

irritability

depression

Term
Diagnosing Addison's
Definition
serum electrolyte levels (hyponatremia, hyperkalemia) blood glucose levels, CBC, CT.
Term
adrenal glands are important for...
Definition
Help body maintain balance between sodium and potassium, also keeps bp normal.
Term
addisonian crisis (acute adrenal insufficiency)
Definition

This occurs when patient is under stress w/o hormone replacement... youll see sudden severe pain in back, abdomen, legs, hypo tension, LOC, shock

 

includes correction of fluid and electrolyte imblanace

correct hypoglycemia

replace steroids

Main goal: prevent mortality.

Term

What should you watch for in addisonian crisis?

 

Definition

risk for injury

monitor for sudden weakness and other manifestations

reverse shock

restore blood circ.

replinish steroids

Term
correctiong hypotension and electrolyte imbalance in addison's
Definition

rapid hydration, 02, vasopressor, kayexalate resin that releases sodium ions in exchange for potassium.

 

Term
what can patient's carry with them for Addison's disease
Definition
Cortisol can be with patient
Term
What happens to addison pts regarding temp.
Definition
they cant tolerate cold, provide comfort measures
Term
correcting hypoglycemia in addisons
Definition

IV D5 or IV glucose push bolus

 

Can also be given Hydrocortisone 100 mg, tapered for steroid replacement.

Term
Cushing's syndrome (Hypercortisolism)
Definition

Over activity of the adrenal gland- hypersecretion of glucocorticoids (tumor or adrenal hyperplasia- overproduction of ACTH)

Condition is rare- mainly in women 20-40

Term
symptoms of Cushing's
Definition
muscle weakness, osteoporosis, thin skin, moon faces, hump on the back, most of the time they are benign, emotional disturbances,
Term
Cushing's syndrome can be cause by...
Definition
steroids on patients who have asthma, copd, arthritis... this is the most common cause. which makes them prone to infections
Term

surgical management for cushing's

and medical management

Definition

removal of both or one adrenal gland

 

Adrenal blocking agents (ACTH), ACTH-reducing agents (periactin). Radiation therapy

Term

Adrenomedullary disorder:

Pheochromocytoma

Definition
tumor that causes hyperactivity of the gland and is very dangerous. These are rare and caused by heredity for the most part. Excess amount of epinephrine and norepiniphrine in the system which increase BP, breathing, irritability.
Term
Risk factor for pheochromocytoma
Definition

middle aged individuals, not over 60

smoking, micturition, histamines, thymine, anesthetics, atropine, opiates, steroids, glucagon

 

Term
symptoms of pheochromocytoma
Definition

manifestations of diabetes

hypertension, hyperthyroidism, diaphoresis, agitation, rapid pulse, palpitations

 

Acute attacks, diaphoresis, dilated pupils, cold extremities

 

this is curable

Term
treatment of Pheochromocytoma
Definition

Regitime IV

surgery, adrenalectomy (avoid caffeine during this procedure).

 

rest, sedatives, adequate diet, high in vit. minerals and calories.

Term
Types of Diabetes
Definition
T1, T2, Gestational
Term
Postload blood glucose
Definition
meal or glucose load 2 hours before the test specified by te patient's physician. patient is allowed to eat a meal within 15-20 mins. Specimen is to be collected 2 hours from beginning of meal. This is considered the best single sample of diabetes screening.
Term
A1C test
Definition
common test for t1 and t2 diabetes to gauge how well your managing your diabetes. (other names for test: glycated hemoglobin, glycosylated hemogloben, hemoglobin A1C and HbA1c.)
Term
Diabetes Insipidus
Definition

decrease in ADH and increased urination results. (Polyuria) sometimes up to 181 L a day. Urine would be clear and dilute.

weight loss, dry skin, chronic kidney disease.

removing the tumor will reverse these effects.

Term
SIADH
Definition

increase production of ADH and do not urinate at all. decreased NA level, less than 125 is critical.

fluid over load, mental status

 

hypertonic solution given to correct this.

Term
Diabetes
Definition

Insulin enters blood from pancreas, then to the liver, healthy balance in the blood of glucose. Your cell has to be receptive to the insulin to absorb it.

 

In T1, same thing happens, but unhealthy amounts of glucose is not in the blood stream. So nothing is there to bind to the cells to get glucose to the cells. So insulin is not effective to transport the glucose.

 

In T2, body needs more insulin but cant produce it. The body requires more. May have genetic resistance to their insulin. They dont exercise, too much animal food. Patients get overweight, all those fat cells absorb all the glucose.

Term
Predisposition to Diabetes
Definition

Genetics

Environmental stressors

Destruction of alpha and beta cells in pancreas.

 

You will see excess glucose in the body, which comes from protien and fat stores because insulin is not works. Failure to produce insulin as well.

Term
Diabetic symptoms
Definition

wasting lean body mass

increased ketones in the urine and blood

acidosis because of increase in ph, ketones

fatigue

weight loss

increased urination occurrs (kids will start wetting their beds at night)

Breath will smell like acetone(fruity)

Term
chronic increase in blood glucose
Definition

diabetic neuropathy, teach these clients about shoes because they lose sensation in hands and feet. They are prone to ulcers on their feet.

 

small vessel disease

can have diabetic retinopathy which can be treated through a laser.

 

Atherosclerosis can also occur

HTN occurs, CAD

 

Decrease in immune functioning

proned to infection, delayed wound healing

Term
T2 diabetes
Definition
more common in african americans, latinos, hawaiians, and pacific highlanders
Term
T1 diabetes and T2
Definition

T1 occurs <30 years of age

a more common disorder for children

 

T2 is more environmental. Usually happens over the age of 40 and more prevelant in africans and hispanics, obese adults.

Term
T2 Diabetes is different from T1 by
Definition
T2 can be reversed through, diet, weight loss. The beta cells function but not well. in T1 they do not function at all.
Term
how do kidneys respond to increased glucose
Definition
they secrete the glucose which causes the increased urination. This does not remove it all though.
Term
Fasting glucose test
Definition
to see if the liver, and glucose levels are being covered over the fasting period. 110-125 is a warning sign of diabetes.
Term
A1c
Definition
can go back 3 to 6 months and you usually want a level of 5 or 7
Term
home situations for diabetics
Definition

insulin pins

refrigerators

food situation

Term
Diabetic Ketoacidosis
Definition

increased respirations (extremely) in rate in depth

Kussmaul respirations

nausea and vomiting

loss of 10% of body weight

 

Treatement: NS-IV 1000ml an hour unless they have cardiac issues

Insulin

rehydrate

Teaching

 

These patients are acidotic, they can go into a diabetic coma if it is not treated.

Term
hypoglycemia symptoms
Definition

get shaky and nervous

sweat

confusion

 

Blood tests confirm this diagnosis

emergency foods, .5 cup of orange juice, soda

8 life savers, gum drops

toats, fruit juice

Term
Pancreas
Definition

underneath the stomach

Acute pancreatitis, is very painful- severe upper abdominal pain resolves within dys of proper tx and medication. Alcoholics and pancreatic tumors are proned to this condition.

Term
tx of acute pancreatitis
Definition

wont let them eat or drink for several days

NG tube

IV

Term
Chronic pancreatitis
Definition

diarrhea, oily stools (steatorrhea), weight loss.

Treated:pain mainagement, fluid and nutritional supp, synthetic enzymes may be prescribed in the case of a normal diet. IV, NG tube

 

Teaching: no smoking or drinking alcohol.

Term
Gallstones, cholelithiasis
Definition

common

abdominal swelling distention or bloating with quick onset. Will occur within mins of a fatty meal.

Fever, chills, nausea, referred pain (abdomin to shoulder)

more likely to occur in women, overweight, older individuals.

 

Occurs do to cholesterol

 

NG tube to decrease comfort and meds.

 

Very light colored stools and heart burn that comes and goes.

 

Reduce pain, electrolyte and fluid, abdominal ultrasound, shockwave lithotripsy, gallbladder removal.

 

Term
laparoscopic cholecystectomy
Definition

contra- too large of a gall stones or gall bladder then they have to have cholecystectomy regular

 

Cough and deep breathing is important.

Term
Jaudice
Definition

sign of a disease process

yellow skin, sclear

high levels of billirubin

High billi, can be brown eyes.

clay colored feces, tea colored urine

pruritus

fatigue and anorexia

 

Med and surg management: cholesteromine resin, antihistimines, phenobarb

 

Whats cause the jaundice, maintain skin integrity, disturbed body image

Term
hep a
Definition

thought to be spread from an infected persons stool from no good hand hygiene. incubation: 2 to 6 weeks

Acute condition

Term
hep b
Definition

most serious condition

mother to child at birth, blood, needles, sexual contact

4 to 25 weeks for incubation period

90% is considered acute.

Term
Hep C
Definition

Direct blood contact, contaminated needles, blood transfusion

Careful when you get manicure and pedicure.

acupuncture needles.

5 to 10 weeks incubations

Term
Hep D
Definition

IV drug users

usually if they have HBV, you have to have HBV before you can have HDV

Term
alcoholic hep and drug hep
Definition

common precursor to cirrhosis

after several decades of alcohol abuse.

 

drug is through the inhalation of toxins... like what they use to treat TB, tylenol, some oral contraceptives, erythromycin.

 

Term
Acute hep phase
Definition

symptoms seem to be flu like, and you dont recover

nausea, vomiting, loss of appitite.

 

A, E, and nonviral can be recovered from the rest cannot.

Term
Diagnosis of hep
Definition

liver biopsy

 

Treatment: A resolves on its own, hep B is rest and high carb diet.

For drug hep C they can flush the stomach.

 

patients are usually very tired.

Term
treatment for hep
Definition

high calorie, low fat, high carbs, and high protient.

small meals and frequent snacks.

 

Questran can be combined with bile salts to get them out of the system.

 

Serum albumin IV which increases urine output and liver function

Term
Cirrhosis
Definition

Injures and kills liver cells. The liver begins to scar and cannot regenerate themselves when the cells die.

SS:

Can be very edeitimas,yellow eyes, itch, nose bleeds, redness in palms of hands, muscle wasting and weight loss

Term
Complications of cirrhosis
Definition

varisile bleeding, spleen enlarges (low platelet count), altered brain function, encephalopothy

 

Portal hypertension, the blood cannot flow from the liver to other organs do to the scarred tissue which puts pressure on to the veins leads to fluid build up and renal failure.

 

Go in and put stents to open it up

Term
ascites
Definition

major complication of cirrhosis

portal hypertension is the main reason for this.

Vasodialators may be used.

These patients have water retention/ Na retention.

0.25 Albumin given to reduce that extra fluid.

 

If color is translucent- it is normal

If color is brown- they have hyperbillirunemia

If color is cloudy or turbid- infection

if pink or bloody- trauma

grossly bloody- cancer

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