Term
|
Definition
| apprehanesion/dread from anticipation of danger; accompanied by autonomic response |
|
|
Term
| Anxiety is a ____ response |
|
Definition
|
|
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
|
|
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
|
|
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
|
|
Term
|
Definition
| hallucinations and delusions that reflects a person's loss of touch with external world |
|
|
Term
|
Definition
| perception experienced without external stimulation of sense organs |
|
|
Term
|
Definition
| persistent belief contrary to cultural or educational background of the person |
|
|
Term
|
Definition
| reversible change in someone's level of attention and concentration; from medical condition or metabolic abnormality |
|
|
Term
|
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
|
|
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
|
|
Term
| Delta cells in the pancreas produce what? |
|
Definition
| somatostatin (neurotransmitter that inhibits production of insulin and glucagon) |
|
|
Term
|
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
|
|
Term
| What are 2 acute complications in someone with DM? |
|
Definition
| Hyper glycemia (DKA, Hyperglycemic hyperosmolar state) and hypoglycemia |
|
|
Term
|
Definition
| Absolute deficiency of insulin, glucose not available for cellular metabolism; causes excessive ketones in urine, lungs and blood (ketoacidosis) |
|
|
Term
|
Definition
| lower plasma pH, increased CO2 (kussmaul respirations), alterations in serum and tissue K |
|
|
Term
|
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
|
|
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
|
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
|
|
Term
|
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
|
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
|
|
Term
|
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
|
|
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
|
Definition
|
|
Term
| Define non restorative sleep |
|
Definition
| awakening feeling unrefreshed |
|
|
Term
| What is common in abrupt withdrawal of insomnia meds? |
|
Definition
|
|
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
|
Definition
| forward force made by attaching weight to distal bone fragment |
|
|
Term
|
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
|
|
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
|
|
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
|
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
|
|
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
|
|
Term
| What is a complication of DDH? |
|
Definition
| avascular necrosis: femoral head dies off |
|
|
Term
|
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
|
Definition
| used to enhance function of prosthesis; not used as often; turn foot around to better fit prosthesis |
|
|
Term
|
Definition
| damaged nerve cells form tumor; complication of amputation |
|
|
Term
|
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
|
|
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
|
|
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
|
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
|
|
Term
ID incontinence type:
random overuse of detrusor muscle; leakage is periodic, frequent and large in volume |
|
Definition
|
|
Term
ID incontinence type:
pressure of urine in overfull bladder overcomes sphincter control in small amounts |
|
Definition
|
|
Term
| Describe mixed incontinence |
|
Definition
| stress and urge incontinence together |
|
|
Term
|
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
|
Definition
| risk in those 60-70, men more than women and increase in smokers; most are superficial; treated with chemo |
|
|
Term
|
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
|
|
Term
ID type of grief:
In denial for years |
|
Definition
|
|
Term
ID the type of grief:
person remains in anger stage; dysfunctional |
|
Definition
|
|
Term
ID type of grief:
problem when behavior is attempt to keep loved one alive; eats meal at holiday grave |
|
Definition
|
|
Term
| the SA node produces _____ waves with ___ contraction |
|
Definition
|
|
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
|
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
|
|
Term
| What is the normal QRS interval? |
|
Definition
|
|
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
|
|
Term
| What is the normal rate for the AV node? |
|
Definition
|
|
Term
| What is the normal rate for the purkinje fibers? |
|
Definition
|
|
Term
| What two drugs elongate the QT interval? |
|
Definition
|
|
Term
| EKG paper is marked in ____ intervals |
|
Definition
|
|
Term
| Describe the 6 second rule |
|
Definition
| count the # of R waves in 6 seconds and multiply by 10 for the hr |
|
|
Term
|
Definition
| impulse formation somewhere other than SA node; identified by where they came from |
|
|
Term
|
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
|
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
|
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
|
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 |
|
|
