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3738 Exam 3
n/a
161
Nursing
Undergraduate 3
10/22/2014

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Term
Define anxiety
Definition
apprehanesion/dread from anticipation of danger; accompanied by autonomic response
Term
Anxiety is a ____ response
Definition
internal
Term
What are the 6 characteristic categories of anxiety?
Definition
behavioral, affective (fearful, focus), physiological (tension, tremors), cognitive (thought blocking), sympathetic (anorexia), parasympathetic (diarrhea)
Term
Anxiety may be the first clue of what?
Definition
medical illness
Term
What are two risks of patients with anxiety and heart disease?
Definition
myocardial ischemia and ventricular dysrhythmias
Term
How do you differentiate between anxiety and heart disease?
Definition
anxiety does not cause you to pass out, HR increases in anxiety in uniform matter (heart issues with cause irregularities)
Term
The co-morbidity between diabetes and what 2 conditions is most important?
Definition
depression and anxiety
Term
What're the observational signs of anxiety?
Definition
heart palpitations, shaking, sweating, nausea, pale, cold, clammy skin
Term
What're the observational signs of hypoglycemia?
Definition
hunger, slurred, speech, blank look
Term
Describe the breathlessness anxiety cycle
Definition
SOB-> panic ->increases anxiety-> difficulty breathing
Term
What two components of the nervous system make up the GI tissue?
Definition
CNS and enteric nervous system
Term
Medical problems in the elderly somatize ___ problems
Definition
psychiatric
Term
Define psychosis
Definition
hallucinations and delusions that reflects a person's loss of touch with external world
Term
Define hallucinaiton
Definition
perception experienced without external stimulation of sense organs
Term
Define delusion
Definition
persistent belief contrary to cultural or educational background of the person
Term
Define delirium
Definition
reversible change in someone's level of attention and concentration; from medical condition or metabolic abnormality
Term
Define dementia
Definition
chronic disorder of mental processes from brain disease or injury; marked by memory disorders and personality changes
Term
Describe primary psychosis
Definition
diagnosis of exclusion; need workup to exclude medical/toxic causes
Term
Describe secondary psychosis
Definition
from medical illness or substance
Term
What are some red flags of medically induced psychosis?
Definition
treatment resistance, absence of personal or family history, rapid onset of symptoms, flunctuations of mental symptoms
Term
What somatic signs rarely accompany mental disorders?
Definition
butterfly rash on nose (lupus), scarring over veins, bulging eyes, jaundice, blue lips
Term
Describe and name the symptoms of serotonin syndrome
Definition
accumulation of high levels of serotonin in the body; confusion, agitation, mental status change, myoclonus
Term
What is the 7th leading COD in the US?
Definition
Diabetes
Term
Diabetes is the leading cause of what 3 conditions?
Definition
adult blindness, end stage kidney disease, non traumatic lower limb amputations
Term
Women with gestational diabetes are at risk for what?
Definition
Developing diabetes later on
Term
Alpha cells in the pancreas produce what?
Definition
glucagon (increase release of glucose)
Term
Beta cells in the pancreas produce what?
Definition
insulin
Term
Delta cells in the pancreas produce what?
Definition
somatostatin (neurotransmitter that inhibits production of insulin and glucagon)
Term
Define glycosuria
Definition
when serum glucose exceeds renal threshold and appears in urine
Term
What are 3 effects of DM on injury complications?
Definition
basement membrane thickening, ischemia in small blood vessels (hypoxia), changes functional cell integrity
Term
What are 6 clinical manifestations of insufficient insulin?
Definition
hyperglycemia, polyuria, polydipsia, polyphagia, metabolic acidosis, kussmaul respirations (to reverse acidosis)
Term
What are 5 major components of DM treatment?
Definition
normal metabolic control; diet, exercise, med, monitoring, patient ed
Term
What are the pitfalls of meds for those with DM2?
Definition
Not effective with non functioning beta cells, may increase insulin binding sites, drug interaction potential
Term
What are the 4 categories of insulin?
Definition
ultra short acting (humalog), short acting (regular insulin), intermediate (NPH), long acting (lantas)
Term
What are 3 recommendations for insulin storage?
Definition
prevent exposure to sunlight, direct heat and excessive shaking
Term
How often should blood sugar in someone with DM be checked?
Definition
4-6 hrs
Term
What are 2 acute complications in someone with DM?
Definition
Hyper glycemia (DKA, Hyperglycemic hyperosmolar state) and hypoglycemia
Term
Describe DKA
Definition
Absolute deficiency of insulin, glucose not available for cellular metabolism; causes excessive ketones in urine, lungs and blood (ketoacidosis)
Term
Describe ketoacidosis
Definition
lower plasma pH, increased CO2 (kussmaul respirations), alterations in serum and tissue K
Term
Describe HHS in DM
Definition
hyperosmolar state cause by hyperglycemia; results in renal insufficiency and high blood glucose, osmotic diuresis, decreased blood volume further impairs renal function
Term
What are the SnS of HHS in DM?
Definition
3 Ps, aphasia, weakness, blood glucose 600-800, hypotension, tachycardia
Term
What is the goal of fluid therapy in HHS?
Definition
rehydrate pt and restore normal blood glucose within 36-72 hrs
Term
Describe hypoglycemia in type 1 DM
Definition
pancreas loses ability to secrete glucagon in response, no warning signs of impending hypoglycemia
Term
Patients with ___ do not have normal warning signs of hypoglycemia
Definition
neuropathy
Term
Describe asymptomatic hypoglycemia
Definition
medication induced (beta adrenergic blockers effect ANS response to hypoglycemia)
Term
Describe the somogyi effect
Definition
nocturnal hypoglycemia causing counterregulatory hormones to make high blood glucose around 0700; caused by excessive insulin
Term
Describe Dawn Phenomenon
Definition
early morning hyperglycemia caused by GH surge and reduced sensitivity to insulin between 05-08
Term
Describe the autonomic signs of neuropathy
Definition
hypotension, impotence, bladder paralysis, abnormal sweating; need protective shoes and regular foot inspections
Term
Describe the macrovascular complications of DM
Definition
CV and cerebral vascular disease and PVD; risks are HTN, tobacco and sedentary life style; Tx is good glycemic control
Term
What is a special concern for someone with DM who is sick?
Definition
Illness raises blood glucose so blood must be closely monitored
Term
Before conception is attemtped, women should know their ___
Definition
A1C levels
Term
Define MODY in DM?
Definition
Maturity Onset Diabetes of the Young; transmitted as genetic disorder with structurally abnormal insulin
Term
high glucose levels in the first trimester can cause what 2 outcomes?
Definition
miscarriage and spina bifida
Term
Poor glycemic control later in pregnancy increases the risk of ____
Definition
fetal macrosomia; excessive growth and birth weight >4k g; increases risk of injury during delivery
Term
Gestational diabetes can be controlled with what?
Definition
diet and exercise; resolves after birth
Term
Describe the GCT screening
Definition
glucose challenge test; non-fasting, 50g glucose solution given and blood drawn 1 hr after. Normal <140
Term
Describe 3hr OGTT
Definition
Diagnoses gestational diabetes; fast for 8 hrs with 3 days unrestricted carbs; ingest 100g glucose with blood drawn at 1, 2, and 3 hrs; 2 abnormal values = gestational diabetes
Term
What are the glycemic goals for pregnancy?
Definition
Fasting <95; Pre meal <100; 1 hr after meal <140; 2 hrs after meal <120; Hgb A1C <6%
Term
When should fetal testing occur in those with gestational DM?
Definition
32-34 wks
Term
Describe sleep
Definition
basic, dynamic highly organized and complex behavior
Term
The majority of sleep is spent in what phase? Describe
Definition
NREM; stage 1: transition from awake to sleep; stage 2: sound sleep, slow pulse; stage 3: deep sleep
Term
Is REM sleep before or after NREM?
Definition
after; vivid dreams occur here, diminished muscle tone
Term
Most healthy individuals dream for how long?
Definition
2 hrs
Term
Describe the newborn sleep cycle
Definition
sleep 18-20 hrs and enter REM immediately; need dim lights
Term
Describe the sleep cycle of older adults
Definition
go to bed and wake up earlier, more difficult to sleep (anxiety, chronic disease), PM drugs should be used with caution
Term
Define long sleep latency
Definition
difficulty falling asleep
Term
Define fragmented sleep
Definition
frequent awakenings
Term
Define non restorative sleep
Definition
awakening feeling unrefreshed
Term
What is common in abrupt withdrawal of insomnia meds?
Definition
rebound insomnia
Term
Describe the effects of benzodiazapines in treating insomnia
Definition
can lead to daytime sleepiness and tolerance can develop leading to increased risk of dependence; Use 2 wks or less
Term
What are the first choice drugs for insomnia?
Definition
benzodiazapine receptor like agents (ambian, sonata, lunesta); safe for 6 mo-1 yr and should be taken on empty stomach
Term
Describe the use of melatonin receptor agonists for insomnia
Definition
rapid onset, short duration; not always effective
Term
Melatonin is good for treating what?
Definition
jet lag; avoid in patients using coumadin, CNS depressants or antihypertensive meds
Term
What are the co morbidities for sleep apnea?
Definition
increased risk of stroke and CDV
Term
What are the psychological effects of immobility?
Definition
altered perception of self and environment, sleep, helplessness
Term
Define traction
Definition
forward force made by attaching weight to distal bone fragment
Term
Define counter traction
Definition
backward force provided by body weight (elevate HOB)
Term
Describe frictional force traction
Definition
provided by patient's contact with the bed
Term
What is the purpose of traction?
Definition
fatigue muscle and reduce spasm for alignment which promotes healing
Term
What is an important complication of traction?
Definition
compartment syndrome; increased pressure in muscle compartment that causes excrutiating pain not made better by pain meds
Term
PE is most likely to occur with what kind of fracture?
Definition
femur
Term
What are the 5 Ps of extremity assessment?
Definition
pain and point of tenderness, pulse (distal to fracture), palloor, parasthesia, paralysis
Term
What is the most commonly broken bone in childhood?
Definition
clavicle
Term
What is the weakest point of long bones?
Definition
epiphyseal plate (cartilage growth)
Term
Describe comminuted fractures
Definition
small fragments of bone are broken from fractured shaft and lie in surrounding tissue
Term
Describe greenstick fracture
Definition
compresside side of bone bends but tension side of bone breaks; incomplete fracture
Term
What are the clinical manifestations of a fracture?
Definition
swelling, pain, diminished use, bruising, 5 Ps (n/v in older children)
Term
Describe DDH
Definition
Developmental Dysplasia of the Hip; abnormal development of one or all of hip components
Term
What are the abnormalities associated with DDH?
Definition
femoral head loses contact with acetabulum; femoral head is displaced posterior and superior
Term
What can increase your risk of DDH?
Definition
white, multiple births, large baby, breech, female
Term
What is the best indicator of DDH after two months?
Definition
incomplete abduction; shortening of limb on affected side; extra gluteal fold
Term
Describe the pavlik harness
Definition
up to 99% success, used for infants for flexion and abduction; adjusted q2wks
Term
What non surgical intervention for DDH is NOT recommended for infants?
Definition
double/triple diapering
Term
What types of non surgical interventions for DDH are used in toddlers?
Definition
bryant's traction; closed reduction with spica cast placement
Term
How often can Pavlic harnests be removed?
Definition
1 hr per day
Term
What is a complication of DDH?
Definition
avascular necrosis: femoral head dies off
Term
Describe club foot
Definition
dislocation of foot medially in relation to ankle; will almost always recur with treatment but won't improve without it
Term
Describe club foot treatment
Definition
serial casting to correct deformity (ponseti technique); may need brace forever or achilles tenotomy
Term
What 3 things can cause scoliosis?
Definition
lateral curvature, spinal rotation causing rib asymmetry, thoracic hypokyphosis; can be congenital or developed
Term
What is the most common location of elective amputation? Traumatic?
Definition
Lower extremity; upper extremity
Term
Describe rotationplasty
Definition
used to enhance function of prosthesis; not used as often; turn foot around to better fit prosthesis
Term
Describe neuroma
Definition
damaged nerve cells form tumor; complication of amputation
Term
Describe UTI
Definition
E coli is typically responsible; dilation of ureters in pregnancy increases risk of pyelonephritis
Term
What is the risk of untreated UTI in women?
Definition
increased incidence of preterm labor
Term
Why may children be at risk for UTI?
Definition
delayed voiding, children with incontinence or smelly urine
Term
Why are menopausal women at risk for UTI?
Definition
low estrogen decrease acidity of vagina increasing risk for UTI with drying of the GU
Term
What are some symptoms of UTI?
Definition
asymptomatic (pregnancy), poor feeding infants with cry during urination, failure to gain weight and dehydration; adults (lower) with dysuria, frequent urination, urgency
Term
What are some upper urinary symptoms in adults?
Definition
CVA tenderness, fever, chills anorexia
Term
Describe the diagnosis of UTI
Definition
presence of nitrites, wbc's, leukocyte esterase
Term
Is the use of cranberry juice to treat UTI effective?
Definition
yes but not in children
Term
What are the typical meds prescribed for UTI?
Definition
bactrim/septra, macrodantin, and macrobid; cipro and levaquin for complicated UTIs
Term
What drugs relieve the discomfort of UTI but may make the urine orange?
Definition
pyridium or AZO standard
Term
What are the bladder irritants?
Definition
caffeine, alcohol, citrus juices, chocolate and spiced foods; artificial sweeteners
Term
Describe acute pyelonephritis
Definition
most common cause bacteria infection (can be caused by others); usually begins in lower urinary tract; pre-existing factor of BPH, stone, long term catheters
Term
Define urosepsis
Definition
systemic infection from urologic source that can lead to sepsis and death
Term
Describe symptoms and treatment of acute pyelonephritis
Definition
same as UTI but include CVA tenderness; parenteral antibiotics given initially then followed by oral antibiotics; should see improvement within 72 hrs
Term
What is the most common cause of acute glomerulonephritis?
Definition
strep infection: APSGN – Acute poststreptococcal glomerulonephritis
Term
What are the clinical manifestations of acute glomerulonephritis?
Definition
generalized edema, HTN, hematuria, proteinuria
Term
Describe the treatment of acute glomerulonephritis
Definition
Na, fluid and protein restrictions; diuretics, ant HTN meds
Term
Describe adult polycystic kidney disease
Definition
autosomal dominant, manifests from 30-40yo; most common COD is cerebral aneurysm
Term
Describe polycystic kidney disease on children
Definition
autosomal recessive; high mortality rate
Term
ID incontinence type:
sudden increase in intra abdominal pressure causes involuntary passage of small amount of urine
Definition
stress incontinence
Term
ID incontinence type:
random overuse of detrusor muscle; leakage is periodic, frequent and large in volume
Definition
urge incontinence
Term
ID incontinence type:
pressure of urine in overfull bladder overcomes sphincter control in small amounts
Definition
overflow
Term
Describe mixed incontinence
Definition
stress and urge incontinence together
Term
Describe renal calculi
Definition
kidney stones; more common in those who drink well water in SW and SE; manifestations occur when urine flow is blocked (pain, chills, n/v)
Term
Describe bladder cancer
Definition
risk in those 60-70, men more than women and increase in smokers; most are superficial; treated with chemo
Term
Describe pseudodementia
Definition
depressed individuals c/o memory problems but do well on cognitive tests; those with dementia do poorly on testing
Term
Who are the most common individuals (in order) to commit elder abuse?
Definition
son, daughter, random relative, spouse
Term
What 4 risk factors contribute to elder abuse?
Definition
longer life (75+), dependency, caregiver stress, learned violence
Term
What are the stages of grief according to kubler ross?
Definition
Denial, anger, bargaining, depression, acceptance
Term
What are the stages of grief according to john bowby?
Definition
numbness, disequilibrium, disorganization and dispair, reorganization
Term
What are the stages of grief according to george engel?
Definition
shock and disbelief, developing awareness, restitution, resolution, recovery
Term
ID type of grief:
detach prematurely from dying person
Definition
anticipatory
Term
ID type of grief:
In denial for years
Definition
delayed
Term
ID the type of grief:
person remains in anger stage; dysfunctional
Definition
distorted
Term
ID type of grief:
problem when behavior is attempt to keep loved one alive; eats meal at holiday grave
Definition
chronic
Term
the SA node produces _____ waves with ___ contraction
Definition
P; atrial
Term
The AV node produces ____ on the EKG from ____
Definition
PR interval; atrial slowing
Term
The purkinje fibers produce ___ on the EKG from _____
Definition
QRS complex; ventricular depolarization
Term
The T wave is produced by what?
Definition
ventricular repolarization
Term
Describe telemetry lead placement
Definition
smoke over fire, snow on grass, white is right, chocolate close to your heart
Term
Describe the EKG grid
Definition
Small block: .04 seconds
5 small blocks= 1 big block= .2 seconds
5 large blocks= 1 seconds
Term
What is the normal PR interval?
Definition
.12-.20
Term
What is the normal QRS interval?
Definition
.06-.12
Term
What is the normal QT interval?
Definition
.3-.45; notify doctor if >.49
Term
What is the normal rate for the SA node?
Definition
60-100 bpm
Term
What is the normal rate for the AV node?
Definition
40-60 bpm
Term
What is the normal rate for the purkinje fibers?
Definition
20-40 bpm
Term
What two drugs elongate the QT interval?
Definition
quinidine and amiodorone
Term
EKG paper is marked in ____ intervals
Definition
3 second
Term
Describe the 6 second rule
Definition
count the # of R waves in 6 seconds and multiply by 10 for the hr
Term
Describe ectopy
Definition
impulse formation somewhere other than SA node; identified by where they came from
Term
Describe bigeminy
Definition
every other complex on EKG is ectopic
Term
Describe Premature Atrial Contractions
Definition
PACs; normal QRS, normal beats fall early, irregular rhythm, p wave precedes premature complex
Term
Describe PJCs
Definition
premature junctional contraction; normal QRS, p wave absent or inverted, rhythm irregular
Term
Describe atrial fibrillation
Definition
absence of p waves; irregularly irregular
Term
Describe atrial flutter
Definition
sawtooth pattern (f waves/flutter waves); p waves loose appearance from rapid atrial rate
Term
Describe supraventricular tachycardia
Definition
general terms for all rhythms >150 bp that come from atria; p waves get buried under t wave and can't be seen examples: PAC, a fib, a flutter
Term
Define paraxysmal
Definition
sudden spasm, sudden recurrence of symptoms
Term
Describe a junctional rhythm
Definition
intrinsic rate at AV node; p wave may be absent, hidden or inverted
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