NUR 2063 Pathophysiology Exam 2

NUR 2063 Pathophysiology Exam 2 What is gastritis? - ANS Inflammation of the stomach lining. The lining will be red and inflamed and irritated What are the causes of gastritis? - ANS Ingestion of irritating substances such a alcohol, aspirin, NSAIDS, viruses and bacteria What is GERD? - ANS the back flow of gastric contents into the esophagus through the lower esophageal sphincter. The inflammation occurs from the reflex of highly acidic stomach acid that comes up. What are the causes of GERD? - ANS Any condition or agent that alters closure of the lower esophageal sphincter or increases in abdominal pressure, fatty food, caffeine, large amounts of alcohol, smoking, pregnancy and anatomical features like hiatal hernia What are complications of GERD? - ANS Barrett's esophagus where columnar tissue replaces normal squamous tissue in the distal esophagus that carries a high risk for cancer. Progression can lead to ulcers and scarring. Esophageal strictures, pulmonary symptoms such as cough, asthma and laryngitis from reflux in breathing passages. What are the signs and symptoms of peptic ulcer disease? - ANS epigastric burning pain that is usually relieved by food or antacids (gastric ulcers present on empty stomach but can be after food, duodenal ulcers present 2-3 hours after food and is relieved by food). Can also be life threatening as GI bleeding can occur without warning and cause a drop in H/H and dark tarry stools and hematemesis. What is the role of H.pylori in peptic ulcer disease? - ANS promotes both gastric and duodenal ulcer formation and thrives in acidic areas. It slows down ulcer healing and can reoccur frequently, and taking it away can help ulcers heal. What is pseudomembranous colitis?(C.diff) - ANS acute inflammation and necrosis of large intestine. The intestinal lining cannot absorb well. What is the cause of pseudomembranous colitis? - ANS clostridium difficile, exposure to long term antibiotics that off set the and balance in intestine What are the manifestations of pseudomembranous colitis? - ANS foul smelling/bloody stool, abdominal pain, fever, leukocytosis, sepsis, colonic perforation. How do we treat pseudomembranous colitis? - ANS stop current antibiotics, treat ischemia and contributing conditions, give oral antibiotics like metronidazole or vancomycin, fecal transplant or colectomy if severe How do we prevent the spread of pseudomembranous colitis? - ANS wearing appropriate PPE and washing hands with soap and water only What are the signs and symptoms of appendicitis? - ANS Periumbilical pain, RLQ pain, presence of a positive McBurneys point with pain, nausea, vomiting, fever, diarrhea, RLQ tenderness, systemic signs of infection How do we assess for appendicitis? - ANS McBurney's point technique when pressing on the belly button and RLQ hip region and removing the pressure causes intense pain, indicates positive appendicitis What are the causes of bowel obstructions? - ANS previous surgery of the intestines with adhesions, congenital abnormalities of the bowel, metastatic cancer of the intestinal tract or female reproductive organs, accumulation of fluid, gas, water and electrolytes in the bowel. What is a functional bowel obstruction? - ANS a problem with the act of the bowel actually moving, such as things that inhibit movement from surgery, medications, opioids, low fiber diets that can slow motility or shut off the GI system from the SNS stimulation. What is a mechanical bowel obstruction? - ANS due to adhesions, hernia, tumors, impacted feces, volvus or twisting of the intestines, intussusception What are the signs and symptoms of liver disease? - ANS hepatocellular failure (jaundice, decreased clotting, hypoalbuminemia, decreased vitamin D and K) and portal hypertension (GI congestion due to blockage of blood, more esophageal or gastric varies, hemorrhoids, enlarged spleen,) Explain what jaundice is? - ANS green- yellow staining of tissues from increased level of bilirubin as the liver cannot metabolize extra bilirubin Where can you find jaundice on assessment? - ANS eyes, skin, and mouth Explain what ascites is? - ANS pathological accumulation of fluid in the peritoneal cavity due to the loss of albumin in the liver, causing fluid to be free amongst the cells. It can cause a lot of pain in the abdomen, and it must be drained with a parenthesis Explain hepatic encephalopathy? - ANS neuropsychiatric syndrome from too much ammonia in the blood as the liver cannot break it down. results in dementia and psychotic symptoms common along with jerking What is another name for end stage liver disease? - ANS cirrhosis What are the signs and symptoms of gallstones? - ANS sudden pain in the RUQ/ center of the abdomen, back pain, and nauseas and vomiting. Why do gallstones occur? - ANS due to often a blockage of a duct from a cholesterol filled stone What are the three stages of gallstone formation? - ANS supersaturation, nucleation, hypo motility Explain supersaturation phase - ANS bile is saturated with cholesterol, causing precipitation of cholesterol Explain nucleation phase - ANS the bile crystals begin to stick together and become larger stones Explain hypo motility phase - ANS the bile is stasis allowing the stones to grow more What are some of the risk factors for gallstones? - ANS prolonged fasting, rapid weight loss, pregnancy, estrogen, obesity What are the signs and symptoms of pancreatitis? - ANS steady and dull pain in the center or LUQ of abdomen, severe tenderness on palpation that radiates to the back, nausea and vomiting, abdominal distention with hypoactive bowel sounds, low grade fevers What are the causes of pancreatitis? - ANS alcoholism is most causes, biliary tract disease where the enzymes attack the pancreas, hypertriglyceridemia What are the three function of the kidneys - ANS excretion, elimination, regulation Explain what excretion is? - ANS removal of organic waste products from body fluids Explain what elimination is? - ANS discharge of the waste products from the body Explain what regulation is? - ANS regulating blood volume, ion concentration, blood pH and nutrients What are signs and symptoms indicating one may have a renal disorder? - ANS pain in the back flank area that is felt at the CVA angle on percussion, tenderness, abnormal urinalysis findings What types of things are abnormal regarding urinalysis? - ANS dark, strong smelling urine, bacteria in the urine, cloudy urine, ketones or glucose or proteins in the urine, blood in the urine (except during menses) What is polycystic kidney disease? - ANS an inherited condition of the kidney resulting in one having fluid filled cysts on one or both kidneys. if left untreated renal failure with need for dialysis or kidney transplant occurring What causes polycystic kidney disease? - ANS it is inherited genetically What are the types of polycystic kidney disease? - ANS autosomal recessive and dominant What is a nephron(s)? - ANS they are in the kidney and helps to filter blood and remove waste products How many nephrons do the kidneys have? - ANS 1-2 million What is hematuria? - ANS blood found in the urine not due to menstruation What is proteinuria? - ANS protein found in the urine What does it mean when one has ketones in their urine? - ANS they have type 1 diabetes What is nephrolithiasis? - ANS kidney stones that obstruct the ureters and kidneys that cause lots of pained urinary stasis What is another term for kidney stones? - ANS renal calculi What are kidney stones made up of? - ANS calcium deposits and uric acid What is pyelonephritis? - ANS infected and inflamed kidneys What causes pyelonephritis? - ANS from the lower urinary tract that ascends What are the signs and symptoms of pyelonephritis? - ANS CVA tenderness most common, fever, chills, N/V, anorexia or not willing to eat What can we do the prevent pyelonephritis? - ANS remove catheters are early as possible to prevent UTIs and possible spread What are the signs and symptoms of post infectious acute glomerulonephritis? - ANS Smoky or coffee colored urine, proteinuria, edema as they cannot urinate, decreased output What is the cause of post infectious acute glomerulonephritis? - ANS type b hemolytic strep; follows impetigo and strep throat What age group is most affected by post infectious acute glomerulonephritis? - ANS children in developing countries What are the signs and symptoms of acute kidney injury? - ANS Sudden reduction in kidney function, decreased urine output, although occasionally urine output remains normal Fluid retention, causing swelling in your legs, ankles or feet Shortness of breath Fatigue Confusion Nausea Weakness Irregular heartbeat Chest pain or pressure Seizures or coma in severe cases What are the 3 stages of causes of acute kidney injury - ANS pre renal, intrarenal or intrinsic, post renal What are the pre renal causes of AKI? - ANS disruption in renal perfusion and blood flow. It can cause low blood pressure, low blood volume, heart failure, renal artery obstruction, fever, vomiting, diarrhea, burns that lead to dehydration, Drugs such as ACE inhibitors or angiotensin 2 blockers, NSAIDs that can drop the blood pressure or cause bleeding What are the intrarenal/intrinsic causes of AKI? - ANS damage or disruptions within the kidney blood vessels, tubules, or glomeruli. It can cause reduced blood supply within the kidneys, toxic injury with medications, chemo, and contrast medias, renal inflammation, or prolonged prostate/ stones/ in the post renal stage What are the post renal causes of AKI? - ANS caused by an obstruction in the urinary collecting system, urethra, bladder, or ureters due to stone, tumor, or enlarged prostate that results in elevated pressure in the Bowman's capsule that impedes glomerular filtration. Prolonged injury can lead to intrinsic injury and irreversible damage What are the 3 stages of AKI presentation? - ANS prodromal, oliguric, postoliguric Explain what happens during prodromal presentation of AKI - ANS normal or declining urine output, The BUN and creatinine levels rise, showing there is a problem. Duration of this phase depends on cause of injury, amount of toxin, duration of hypotension Explain what happens during oliguric presentation of AKI - ANS lasts up to 8 weeks with usual urine output being 50ml-400 mls, when normal output is 30 ml per hour. Characterized by oliguria, lower GFR, and hypovolemia. S/S of fluid excess, hyperkalemia, uremic syndrome. Dialysis may be needed. Explain what happens during postoliguric presentation of AKI - ANS Urine volume increases, leaving patient at risk for dehydration and electrolyte imbalances they are ridding themselves of too much fluids. Higher GFR, and can last 1 week-1 year. Full recovery when BUN and creatinine levels are normal, but renal insufficiency may occur. (early recovery of the condition, but not all recover) What happens if AKI does not resolve? - ANS chronic kidney disease What are the causes of chronic kidney disease? - ANS outcome of progressive and irrevocable loss of the nephrons, associated with hypertension, diabetes, recurrent pyelonephritis, glomerulonephritis, polycystic kidney disease, history, toxins, age. Leading from AKI What are the complications one may have from chronic kidney disease? - ANS cardiovascular disease, hypertension, uremic syndrome, metabolic acidosis, electrolyte imbalance, malnutrition, anemia, pain, depression Explain the the complication of hypertension/cardiovascular disease from CKD - ANS causes excess fluid in the blood, increase of plaque in the vessels, hypervolemia, the heart must work harder Explain the the complication of uremic syndrome from CKD - ANS metabolic waste can't leave, it can precipitate on the skin as frost Explain the the complication of metabolic acidosis from CKD - ANS there is retention of acidic wastes that can cause hyperkalemia and arrhythmias Explain the the complication of electrolyte imbalances from CKD - ANS there will be more potassium, phosphorus and magnesium retained Explain the the complication of bone and mineral disorders from CKD - ANS elevated phosphorus and PTH causes altered bone or mineral metabolism as the kidneys cannot reabsorb calcium Explain the the complication of malnutrition from CKD - ANS decreased food intake, depression, dietary limitations with what they can eat Explain the the complication of anemia from CKD - ANS lack of erythropoietin that the kidney produces to make new RBC's. Uremia shortens RBC lifespan Explain the the complication of pain from CKD - ANS : from disease, treatment, comorbidities Explain the the complication of depression from CKD - ANS from the disease, disruption of social interactions and relationships due to long hours and days at dialysis What happens when CKD is not treated? - ANS end stage renal disease What are some of the types of urinary incontinence? - ANS urge, stress, overflow, reflex Explain what urge incontinence is - ANS the sudden need to void with an involuntary leakage of urine. sometimes this occurs at night. overactive bladder What is nocturia? - ANS frequent urination at night Explain what stress incontinence is - ANS small amounts of urine are voided involuntarily when there is an increase in intraabdominal pressure.Can happen when one sneezes, laughs, picks up heavy objects, etc What population are we most likely to see stress incontinence with? - ANS pregnant women Explain what overflow incontinence is - ANS occurs when the bladder becomes full and overflows. Often see when one has an obstruction in the urethra such as an enlarged prostate, prolapsed uterus, or urethral stricture. Dribbling of the urine occurs What populations are we most likely to see overflow incontinence with? - ANS clients with diabetes, MS or spinal cord injury Explain what reflex incontinence is - ANS from a disruption of the central nervous system communication that controls micturition.The person will have difficulty starting a stream. It will be painful and retention of urine is the result What populations are we most likely to see reflex incontinence with - ANS clients who have a stroke, Parkinson's, spinal cord injury What is cystitis? - ANS inflammation of the bladder lining. What are the main causes of cystitis? - ANS Most cases are based from an infection and most are due from E.coli entering. Can also be from infection, chemical irritants, stones and trauma What are some predisposing factors to ones development of cystitis? - ANS being female and having a shorter uterus and being closer to anus, increased age, catheterization, diabetes, bladder dysfunction, poor hygiene, and urinary stasis What are the clincial manifestations of cystitis? - ANS frequency, urgency, dysuria, suprapubic pain, and cloudy urine, delirium, and incontinence, and can be streaked and present on urinalysis What can happen specifically in older adults who develop cystitis? - ANS delirium What are of the things we can educate for cystitis? - ANS urinate before and after sex, wipe front to back, take antibiotics are prescribed, increase fluids, do not resist urges to urinate What can happen if cystitis is not treated? - ANS the infection can migrate to the kidneys and cause irritation (pyelonephritis) What is BPH (benign prostatic hyperplasia)? - ANS due to an enlarged prostate in males; causes urinary retention What are the manifestations of BPH? - ANS urinary retention, obstruction to flow of urine, decreased urine stream, hesitancy, difficulty initiating stream, interruption of stream, infection caused by retention What is hydrocele? - ANS fluid collection surrounding the testicle or spermatic cord Why does hydrocele occur? - ANS develops secondarily to scrotal injury, radiation therapy, infection of the epididymis, or testicular neoplasms, swollen scrotum What is testicular torsion? - ANS the twisting of the spermatic cord due to trauma, there will be a compromised vascular supply and ischemia if not treated, lots of pain. Is Testicular Torsion an emergency? - ANS yes it is due to a compromised vascular supply and ischemia and necrosis that could occur if not treated. What is endometriosis? - ANS the presence of endometrial tissue outside of the uterus on other organs. What does endometriosis cause? - ANS bleeding, pain,dysmenorrhea or painful periods, pain in lower abdomen, vagina, posterior pelvis, and back, pain with intercourse, pain with defecation, excessive menstrual bleeding When does endometriosis present itself in relation to menstruation? - ANS It will start 5 to 7 days before a cycle and lasts 2-3 days after What is uterine prolapse? - ANS occurs when the uterus sinks into the vagina from pelvic structures relaxing. It will protrude What signs and symptoms will the client have with uterine prolapse? - ANS vaginal discomfort, discomfort walking and sitting, difficulty urinating due to excess pressure on the bladder, bleeding and ulceration of the cervix from friction What are the complications of having a uterine prolapse? - ANS the uterus becoming dried out and not sterile, prone to infection Should the RN attempt to place back a prolapsed uterus into the client? - ANS No, it is out of scope of practice. must call the provider about it What is pelvic inflammatory disease? - ANS occurs from bacteria that enter through the vagina up into the cervix What are things pelvic inflammatory disease can cause? - ANS abdominal tenderness, pelvic pain, cervical/adnexa pain or tenderness on palpation, fever, high wbc count, purulent, white vaginal discharge Which organism causes pelvic inflammatory disease? - ANS Neisseria gonorrhoeae, chlamydia trachomatis Which organism causes cervical cancer? - ANS human papillomavirus or HPV Which organism causes UTI (cystitis)? - ANS E.coli Which organism causes herpes? - ANS herpes simplex virus Which organism causes syphillis? - ANS Treponema pallidum What are the stages of syphillis? - ANS incubation, primary, secondary, latent, late Explain incubation stage of syphillis - ANS occurs for 10 to 90 days after first infected. No symptoms are noted Explain primary stage of syphillis - ANS a painless, single chancre ulcer is formed at the port of entry, usually on the genitals. May resolve in 3-6 weeks Explain secondary stage of syphillis - ANS a person will have a head to toe rash accompanied by hepatitis, meningitis and nephritis, fevers, malaise, sore throat, headache, and lymphadenopathy. Bacteria spreads Explain latent stage of syphillis - ANS no symptoms present but the person still has the bacteria in their body, person still contagious and can last up to 40 years Explain late stage of syphillis - ANS most destructive phase, causes major cardiovascular and central nervous system damage, blindness and paresis to bones. It is fatal What is pregnancy induced hypertension/ preeclampsia? - ANS occurs when there is a rapid rise in arterial blood pressure assoicated with loss of large amounts of protein in the urine What are the chacteristics with one who has pregnancy induced hypertension/preeclampsia? - ANS proteinuria, weight gain, edema, arterial spasms in kidneys, brain and liver, decreased renal flow and GFR, kidneys retain salt and water. If severe: can cause convulsions, coma, renal failure, liver malfunction and hypertension What is hyperemesis gravidarum? - ANS excessive vomiting during pregnancy that is form response to large amounts of HCG What are the manifestations of hyperemesis gravidarium? - ANS dehydration, electrolyte imbalances hepatic or renal damage or death What is the concern with chlamydial infections during labor and delivery? - ANS The mom can pass it onto the baby through vaginal delivery, potentially causing optic issues in the newborn and blindness What do we do to prevent chlamydial infections in the infant? - ANS Give antibiotic eyedrops right after birth prophylactically What is the problem with the hormone involved in gigantism? - ANS too much growth hormone What is the pathophysiology behind gigantism? - ANS Occurs before skeletal plates fuse at the ends of bones. Leaves client with increased risk for cardiac problems. The client will also be very tall. What is the problem with the hormone involved in dwarfism? - ANS too little growth hormone What is the pathophysiology behind dwarfism? - ANS It causes short stature, hypoglycemia, delayed dental eruption, thin hair, poor nail growth, greater fat mass, decreased muscle mass, and delayed bone formation and puberty. is congenital or idiopathic What is the problem with the hormone involved in acromegaly? - ANS too much growth hormone What is the pathophysiology behind acromegaly? - ANS Occurs when the cells grow width wise amongst the bones When does gigantism occur in the life span? - ANS childhood, before growth plates at ends of bones fuse When does acromegaly occur during the life span - ANS adulthood, after fuseing of growth plates What is the problem with the hormone involved in diabetes insipidus? - ANS Too little ADH, causes the body to not retain enough water What is the pathophysiology behind diabetes insipidus? - ANS Results in the kidneys being unable to retain water in the body and a lot of urine output that is dilute. Extreme thirst. Lack of water leads to dehydration. Can be caused by trauma to the head What are signs and symptoms of diabetes insidious? - ANS dizziness, disorientation, nausea, tachycardia, headaches, low blood pressure, hypovolemia, high electrolytes in the blood- sodium. High risk for hypovolemic shock, increased urine output, high electrolytes What is the problem with the hormone involved in SIADH? - ANS too much ADH. cause body to retain too much water What is the pathophysiology behind SIADH? - ANS Causes the body to retain too much water. Causes hypotonic hydration. There is low urine output, high osmolarity, electrolytes are at a lower concentration. Results in edema, weight gain, and hyponatremia due to excess water retention. What are the signs and symptoms of SIADH? - ANS cerebral edema due to low sodium, seizures, confusion, coma, death, swollen cells, low urine output, low electrolytes, edema What is ADH? - ANS antidiuretic hormone What is ADH purpose in the body? - ANS it helps the body keep water balance, and for more fluid retention. Prevents the body from being dehydrated, regulates thirst, and causes water to be reabsorbed What is the electrolyte most affected by ADH - ANS Sodium- inversely affected (low ADH=high Na, high ADH=low Na) What is hypothyroidism caused by? - ANS cells attacking the thyroid gland or surgical removal of tissues, iodine deficiency. Leads to a lack of T3/T4 and too much of TSH.The TSH recognizes the lack of the T3/T4 so more is pushed into it yet the thyroid cannot produce it. Causes goiters Lab results in one that has hypothyroidism - ANS high TSH, low T3/T4 What are the clinical manifestations for hypothyroidism? - ANS low metabolism, weakness, lethargy, cold intolerance, low appetite, bradycardia, weight gain, dry skin, constipation, depression, difficulty concentrating, menstrual problems What is hyperthyroidism caused by? - ANS overstimulation of the thyroid gland and autoimmune conditions like graves disease. The autoantibodies bind and stimulate TSH receptors Lab results in one that has hyperthyroidism - ANS High T3/T4 levels and low TSH What are the clinical manifestations for hyperthyroidism? - ANS exophthalmos or eye budging, lid lag, vision changes, light sensitivity, high metabolism, rapid weight loss, insomnia, restlessness, cannot concentrate, tremors and irritability, palpitations, heat intolerance, diaphoresis, diarrhea, amenorrhea What is the purpose of parathyroid hormone PTH? - ANS increases the calcium levels in the blood to be released from bone reservoirs by activating osteoclasts. It also increases calcium absorption in the intestines and excretion in urine Which electrolyte is most affected by PTH disorders - ANS calcium What is Cushings disease caused by? - ANS caused by excessive glucocorticoids from either a pituitary tumor or tumor or adrenal cortex or secondary to prescribed glucocorticoids What happens to corticosteroid levels during Cushings disease? - ANS Will increase What are signs and symptoms of Cushings disease? - ANS Buffalo hump, moon face, thin extremities, pendulous abdomen stirae, hyperglycemia, loss of muscle and bone, excess water and salt retention, weight gain, edema, hypernatremia, and redistribution of fat. What are the causes of Addison's disease? - ANS caused by adrenocortical insuffiency from not having enough steroids or glucocorticoids. Primarily from autoimmune conditions or removal of the adrenals, secondary to removal of corticosteroid therapy What happens to corticosteroid levels during Addison's disease? - ANS Will decrease What are the signs and symptoms of Addisons Disease? - ANS weight loss, salt wasting of fluids, weakness, malaise, hyperpigmentation or bronzing of skin, hypoglycemia, and hyperkalemia. Reduced cardiac output, inadequate blood volume, low blood pressure What is the causes of type 1 diabetes? - ANS caused by the inability for one to produce insulin needed to transport glucose into cells. They are insulin dependent. It is common in young kids and adolescents. The beta cells in the pancreas are destroyed or not present. No insulin stimulate overproduction of glucagon, causing glucose levels to rise. What are the causes of type 2 diabetes? - ANS caused by the cells of the pancreas becoming resistant to insulin, and decrease of receptors on the target cells. They lose the ability to respond to cells. Results in decreased insulin production. How can diabetes be diagnosed? - ANS random sampling of blood glucose over 200 mg, fasting blood glucose level of 126, or and Hgba1C over 6.5. Normal A1c is 4-5.6, but those with diabetes they should aim to have it less than 7 What is the signs and symptoms of hypoglycemia? - ANS cold, pale, sweating, sleepy, lack of coordination, irritability, hunger Why does hypoglycemia take priority over hyperglycemia? - ANS There is not enough sugar to sustain energy for the cells here. What are the signs and symptoms of hyperglycemia? - ANS Dry mouth, increased thirst, blurry vision, weakness, headache, frequent urination What is normal blood sugar? - ANS 60-120 What are the 3 P's for diabetes? - ANS polydipsia, polyuria, polyphagia Explain polydipsia - ANS increased thirst Explain polyphagia - ANS increased hunger Explain polyuria - ANS increased urination When does Type 1 diabetes present? - ANS childhood and adolescence When does Type 2 diabetes present? - ANS adulthood What is diabetic ketoacidosis? - ANS occurs when a type 1 diabetes has a very high sugar and insulin deficiency that leads to breakdown of fat for energy instead of glucose What happens during diabetic ketoacidosis? - ANS The metabolism of fat leads to free fatty acids in the blood that are transformed into ketones, leading to ketoacidosis and the body's pH dropping under 7.35. excessive ketones place the body in metabolic acidosis and in a hyperkalemic state induced by the acidosis. What are the signs and symptoms of DKA? - ANS deep and fast kussmal respirations (to compensate to bring more co2 and acid out of the body) , acetone fruity breath, confusion, lethargy, polydipsia, polyphagia, and polyuria, dehydration, nausea and blurred vision, ketones in the urine What do clients need who have DKA? - ANS These clients will often need insulin and electrolyte replacements in order to get the high sugar and high electrolytes and fluids replenished and replaced Why does DKA occur? - ANS The diabetes is not diagnosed with diabetes and has not taken their insulin, or the type 1 diabetic becomes sick and does not take their insulin due to not eating or drinking, when they need to be. What is the role of calcitonin? - ANS lowers calcium levels in the blood and increases bone formation and inhibits bone breakdown. Where is calcitonin secreted from? - ANS thyroid What is nonketotic hyperglycemic hyperosmolar syndrome? - ANS severe hyperglycemia in type 2 diabetics that is usually untreated, without ketones What is significant about the nonketotic hyperglycemic hyperosmolar syndrome - ANS there are no ketones found in urine, type 2 diabetics affected What are clinical manifestations of chronic hyperglycemia? - ANS hypertension, cardio vascular disease from damage to the blood vessels from excessive sugar, retinopathy or blindness from excessive sugar, neuropathy, nephropathy What types of disorders are Ulcerative colitis and Crohn's disease? - ANS inflammatory bowel disorders What is diverticulosis? - ANS the out pocketing of the walls of the bowel, making it so that fecal material can become trapped in the intestine What is diverticulitis? - ANS inflammation of the diverticulitis due to retained fecal material What changes are associated with esophageal cancer? - ANS GERD associated, Barretts esophagus due to the tissue changes in the esophagus from the regurgitation of acids What disorder is based from overuse of broad spectrum antibiotics? - ANS pseudomembranous colitis What is intussusception? - ANS telescoping of the bowel into each other What type of blockages does intussusception lead to? - ANS mechanical obstructions What is a classic symptom of a glomerularnephorpathy? - ANS proteinuria; when protein spills into the urine What things will diabetics possibly have in their urine? - ANS ketones and glucose What things will someone who is pregnant have in their urine? - ANS protein What are example of post renal causes for AKI - ANS stones, bladder tumors, enlarged prostate What are example of pre renal causes for AKI - ANS hypertension, hypotension, hyper/hypovolemia, low kidney perfusion, renal artery occlusion What are example of intra renal causes for AKI - ANS from medicine, contrast, chemo, or prolonged post renal failure What is the disorder that causes tissue growth outside of uterus - ANS endometriosis What two things cause pelvic inflammatory disease - ANS chamydia and gonorrhea What things is one with hyperemesis gravidarium at risk for - ANS dehydration and loss or electrolytes as well as hypovolemia What are some signs one has Diabetes insipidous - ANS dilute urine, hypovolemia, concentrated electrolytes and high osmolarity What are some signs one has SIADH - ANS concentrated urine, hypervolemia, low numbers of electrolytes and low osmolarity What is the concern with Cushings disease and Addisons disease? - ANS they cause or have been caused by fluctuations in glucocorticoid levels, causing different things What is cholecystitis - ANS inflammation of the gallbladder What type of pain does one experience with cholecystitis? - ANS Boring RUQ pain What type of disorder is type 1 diabetes - ANS insulin dependent due to destruction of the beta cells of pancreas or receptors not present for insulin What type of disorder is type 2 diabetes - ANS insulin resistant because over time the cells desensitize to insulin or receptor numbers decrease on the cells What disorder causes inflammation of bladder lining - ANS cystitis What disorder causes inflammation of the kidneys - ANS pyelonephritis Which hormone increases calcium in blood stream - ANS PTH Which hormone put calcium back in the bones - ANS Calcitonin What type of bowel obstruction is based on movement of the intestine, medication, diet or anesthesia given - ANS functional- how it functions to move things through What lowers blood glucose level by putting glucose into cells - ANS insulin What increases sugars from the pancreas - ANS glucagon What is the name of the infection given to newborns who have blindness at birth from chlamydia - ANS Ophthalmia Neonatorum How is syphillis transported in the body? - ANS through the vascular system and blood stream What is rebound tenderness? - ANS occurs when there is pressure taken off the abdomen. indicative of appendicitis When do gastric ulcers form? - ANS right after eating When do duodenal ulcers form? - ANS 2-3 hours after eating Why might someone have confusion or dementia when they have liver disease? - ANS they have high ammonia levels in their blood which can affect the brain and neurological pathways What does someone loose in their cellular fluids that causes ascites in one with liver disease - ANS albumin; it will cause hypo albumin from the condition since there is more fluid accumulation outside of the cells that leads into the peritoneum, causing the problem What is gastritis? - ANS Inflammation of the stomach lining. The lining will be red and inflamed and irritated What are the causes of gastritis? - ANS Ingestion of irritating substances such a alcohol, aspirin, NSAIDS, viruses and bacteria What is GERD? - ANS the back flow of gastric contents into the esophagus through the lower esophageal sphincter. The inflammation occurs from the reflex of highly acidic stomach acid that comes up. What are the causes of GERD? - ANS Any condition or agent that alters closure of the lower esophageal sphincter or increases in abdominal pressure, fatty food, caffeine, large amounts of alcohol, smoking, pregnancy and anatomical features like hiatal hernia What are complications of GERD? - ANS Barrett's esophagus where columnar tissue replaces normal squamous tissue in the distal esophagus that carries a high risk for cancer. Progression can lead to ulcers and scarring. Esophageal strictures, pulmonary symptoms such as cough, asthma and laryngitis from reflux in breathing passages. What are the signs and symptoms of peptic ulcer disease? - ANS epigastric burning pain that is usually relieved by food or antacids (gastric ulcers present on empty stomach but can be after food, duodenal ulcers present 2-3 hours after food and is relieved by food). Can also be life threatening as GI bleeding can occur without warning and cause a drop in H/H and dark tarry stools and hematemesis. What is the role of H.pylori in peptic ulcer disease? - ANS promotes both gastric and duodenal ulcer formation and thrives in acidic areas. It slows down ulcer healing and can reoccur frequently, and taking it away can help ulcers heal. What is pseudomembranous colitis?(C.diff) - ANS acute inflammation and necrosis of large intestine. The intestinal lining cannot absorb well. What is the cause of pseudomembranous colitis? - ANS clostridium difficile, exposure to long term antibiotics that off set the and balance in intestine What are the manifestations of pseudomembranous colitis? - ANS foul smelling/bloody stool, abdominal pain, fever, leukocytosis, sepsis, colonic perforation. How do we treat pseudomembranous colitis? - ANS stop current antibiotics, treat ischemia and contributing conditions, give oral antibiotics like metronidazole or vancomycin, fecal transplant or colectomy if severe How do we prevent the spread of pseudomembranous colitis? - ANS wearing appropriate PPE and washing hands with soap and water only What are the signs and symptoms of appendicitis? - ANS Periumbilical pain, RLQ pain, presence of a positive McBurneys point with pain, nausea, vomiting, fever, diarrhea, RLQ tenderness, systemic signs of infection How do we assess for appendicitis? - ANS McBurney's point technique when pressing on the belly button and RLQ hip region and removing the pressure causes intense pain, indicates positive appendicitis What are the causes of bowel obstructions? - ANS previous surgery of the intestines with adhesions, congenital abnormalities of the bowel, metastatic cancer of the intestinal tract or female reproductive organs, accumulation of fluid, gas, water and electrolytes in the bowel. What is a functional bowel obstruction? - ANS a problem with the act of the bowel actually moving, such as things that inhibit movement from surgery, medications, opioids, low fiber diets that can slow motility or shut off the GI system from the SNS stimulation. What is a mechanical bowel obstruction? - ANS due to adhesions, hernia, tumors, impacted feces, volvus or twisting of the intestines, intussusception What are the signs and symptoms of liver disease? - ANS hepatocellular failure (jaundice, decreased clotting, hypoalbuminemia, decreased vitamin D and K) and portal hypertension (GI congestion due to blockage of blood, more esophageal or gastric varies, hemorrhoids, enlarged spleen,) Explain what jaundice is? - ANS green- yellow staining of tissues from increased level of bilirubin as the liver cannot metabolize extra bilirubin Where can you find jaundice on assessment? - ANS eyes, skin, and mouth Explain what ascites is? - ANS pathological accumulation of fluid in the peritoneal cavity due to the loss of albumin in the liver, causing fluid to be free amongst the cells. It can cause a lot of pain in the abdomen, and it must be drained with a parenthesis Explain hepatic encephalopathy? - ANS neuropsychiatric syndrome from too much ammonia in the blood as the liver cannot break it down. results in dementia and psychotic symptoms common along with jerking What is another name for end stage liver disease? - ANS cirrhosis What are the signs and symptoms of gallstones? - ANS sudden pain in the RUQ/ center of the abdomen, back pain, and nauseas and vomiting. Why do gallstones occur? - ANS due to often a blockage of a duct from a cholesterol filled stone What are the three stages of gallstone formation? - ANS supersaturation, nucleation, hypo motility Explain supersaturation phase - ANS bile is saturated with cholesterol, causing precipitation of cholesterol Explain nucleation phase - ANS the bile crystals begin to stick together and become larger stones Explain hypo motility phase - ANS the bile is stasis allowing the stones to grow more What are some of the risk factors for gallstones? - ANS prolonged fasting, rapid weight loss, pregnancy, estrogen, obesity What are the signs and symptoms of pancreatitis? - ANS steady and dull pain in the center or LUQ of abdomen, severe tenderness on palpation that radiates to the back, nausea and vomiting, abdominal distention with hypoactive bowel sounds, low grade fevers What are the causes of pancreatitis? - ANS alcoholism is most causes, biliary tract disease where the enzymes attack the pancreas, hypertriglyceridemia What are the three function of the kidneys - ANS excretion, elimination, regulation Explain what excretion is? - ANS removal of organic waste products from body fluids Explain what elimination is? - ANS discharge of the waste products from the body Explain what regulation is? - ANS regulating blood volume, ion concentration, blood pH and nutrients What are signs and symptoms indicating one may have a renal disorder? - ANS pain in the back flank area that is felt at the CVA angle on percussion, tenderness, abnormal urinalysis findings What types of things are abnormal regarding urinalysis? - ANS dark, strong smelling urine, bacteria in the urine, cloudy urine, ketones or glucose or proteins in the urine, blood in the urine (except during menses) What is polycystic kidney disease? - ANS an inherited condition of the kidney resulting in one having fluid filled cysts on one or both kidneys. if left untreated renal failure with need for dialysis or kidney transplant occurring What causes polycystic kidney disease? - ANS it is inherited genetically What are the types of polycystic kidney disease? - ANS autosomal recessive and dominant What is a nephron(s)? - ANS they are in the kidney and helps to filter blood and remove waste products How many nephrons do the kidneys have? - ANS 1-2 million What is hematuria? - ANS blood found in the urine not due to menstruation What is proteinuria? - ANS protein found in the urine What does it mean when one has ketones in their urine? - ANS they have type 1 diabetes What is nephrolithiasis? - ANS kidney stones that obstruct the ureters and kidneys that cause lots of pained urinary stasis What is another term for kidney stones? - ANS renal calculi What are kidney stones made up of? - ANS calcium deposits and uric acid What is pyelonephritis? - ANS infected and inflamed kidneys What causes pyelonephritis? - ANS from the lower urinary tract that ascends What are the signs and symptoms of pyelonephritis? - ANS CVA tenderness most common, fever, chills, N/V, anorexia or not willing to eat What can we do the prevent pyelonephritis? - ANS remove catheters are early as possible to prevent UTIs and possible spread What are the signs and symptoms of post infectious acute glomerulonephritis? - ANS Smoky or coffee colored urine, proteinuria, edema as they cannot urinate, decreased output What is the cause of post infectious acute glomerulonephritis? - ANS type b hemolytic strep; follows impetigo and strep throat What age group is most affected by post infectious acute glomerulonephritis? - ANS children in developing countries What are the signs and symptoms of acute kidney injury? - ANS Sudden reduction in kidney function, decreased urine output, although occasionally urine output remains normal Fluid retention, causing swelling in your legs, ankles or feet Shortness of breath Fatigue Confusion Nausea Weakness Irregular heartbeat Chest pain or pressure Seizures or coma in severe cases What are the 3 stages of causes of acute kidney injury - ANS pre renal, intrarenal or intrinsic, post renal What are the pre renal causes of AKI? - ANS disruption in renal perfusion and blood flow. It can cause low blood pressure, low blood volume, heart failure, renal artery obstruction, fever, vomiting, diarrhea, burns that lead to dehydration, Drugs such as ACE inhibitors or angiotensin 2 blockers, NSAIDs that can drop the blood pressure or cause bleeding What are the intrarenal/intrinsic causes of AKI? - ANS damage or disruptions within the kidney blood vessels, tubules, or glomeruli. It can cause reduced blood supply within the kidneys, toxic injury with medications, chemo, and contrast medias, renal inflammation, or prolonged prostate/ stones/ in the post renal stage What are the post renal causes of AKI? - ANS caused by an obstruction in the urinary collecting system, urethra, bladder, or ureters due to stone, tumor, or enlarged prostate that results in elevated pressure in the Bowman's capsule that impedes glomerular filtration. Prolonged injury can lead to intrinsic injury and irreversible damage What are the 3 stages of AKI presentation? - ANS prodromal, oliguric, postoliguric Explain what happens during prodromal presentation of AKI - ANS normal or declining urine output, The BUN and creatinine levels rise, showing there is a problem. Duration of this phase depends on cause of injury, amount of toxin, duration of hypotension Explain what happens during oliguric presentation of AKI - ANS lasts up to 8 weeks with usual urine output being 50ml-400 mls, when normal output is 30 ml per hour. Characterized by oliguria, lower GFR, and hypovolemia. S/S of fluid excess, hyperkalemia, uremic syndrome. Dialysis may be needed. Explain what happens during postoliguric presentation of AKI - ANS Urine volume increases, leaving patient at risk for dehydration and electrolyte imbalances they are ridding themselves of too much fluids. Higher GFR, and can last 1 week-1 year. Full recovery when BUN and creatinine levels are normal, but renal insufficiency may occur. (early recovery of the condition, but not all recover) What happens if AKI does not resolve? - ANS chronic kidney disease What are the causes of chronic kidney disease? - ANS outcome of progressive and irrevocable loss of the nephrons, associated with hypertension, diabetes, recurrent pyelonephritis, glomerulonephritis, polycystic kidney disease, history, toxins, age. Leading from AKI What are the complications one may have from chronic kidney disease? - ANS cardiovascular disease, hypertension, uremic syndrome, metabolic acidosis, electrolyte imbalance, malnutrition, anemia, pain, depression Explain the the complication of hypertension/cardiovascular disease from CKD - ANS causes excess fluid in the blood, increase of plaque in the vessels, hypervolemia, the heart must work harder Explain the the complication of uremic syndrome from CKD - ANS metabolic waste can't leave, it can precipitate on the skin as frost Explain the the complication of metabolic acidosis from CKD - ANS there is retention of acidic wastes that can cause hyperkalemia and arrhythmias Explain the the complication of electrolyte imbalances from CKD - ANS there will be more potassium, phosphorus and magnesium retained Explain the the complication of bone and mineral disorders from CKD - ANS elevated phosphorus and PTH causes altered bone or mineral metabolism as the kidneys cannot reabsorb calcium Explain the the complication of malnutrition from CKD - ANS decreased food intake, depression, dietary limitations with what they can eat Explain the the complication of anemia from CKD - ANS lack of erythropoietin that the kidney produces to make new RBC's. Uremia shortens RBC lifespan Explain the the complication of pain from CKD - ANS : from disease, treatment, comorbidities Explain the the complication of depression from CKD - ANS from the disease, disruption of social interactions and relationships due to long hours and days at dialysis What happens when CKD is not treated? - ANS end stage renal disease What are some of the types of urinary incontinence? - ANS urge, stress, overflow, reflex Explain what urge incontinence is - ANS the sudden need to void with an involuntary leakage of urine. sometimes this occurs at night. overactive bladder What is nocturia? - ANS frequent urination at night Explain what stress incontinence is - ANS small amounts of urine are voided involuntarily when there is an increase in intraabdominal pressure.Can happen when one sneezes, laughs, picks up heavy objects, etc What population are we most likely to see stress incontinence with? - ANS pregnant women Explain what overflow incontinence is - ANS occurs when the bladder becomes full and overflows. Often see when one has an obstruction in the urethra such as an enlarged prostate, prolapsed uterus, or urethral stricture. Dribbling of the urine occurs What populations are we most likely to see overflow incontinence with? - ANS clients with diabetes, MS or spinal cord injury Explain what reflex incontinence is - ANS from a disruption of the central nervous system communication that controls micturition.The person will have difficulty starting a stream. It will be painful and retention of urine is the result What populations are we most likely to see reflex incontinence with - ANS clients who have a stroke, Parkinson's, spinal cord injury What is cystitis? - ANS inflammation of the bladder lining. What are the main causes of cystitis? - ANS Most cases are based from an infection and most are due from E.coli entering. Can also be from infection, chemical irritants, stones and trauma What are some predisposing factors to ones development of cystitis? - ANS being female and having a shorter uterus and being closer to anus, increased age, catheterization, diabetes, bladder dysfunction, poor hygiene, and urinary stasis What are the clincial manifestations of cystitis? - ANS frequency, urgency, dysuria, suprapubic pain, and cloudy urine, delirium, and incontinence, and can be streaked and present on urinalysis What can happen specifically in older adults who develop cystitis? - ANS delirium What are of the things we can educate for cystitis? - ANS urinate before and after sex, wipe front to back, take antibiotics are prescribed, increase fluids, do not resist urges to urinate What can happen if cystitis is not treated? - ANS the infection can migrate to the kidneys and cause irritation (pyelonephritis) What is BPH (benign prostatic hyperplasia)? - ANS due to an enlarged prostate in males; causes urinary retention What are the manifestations of BPH? - ANS urinary retention, obstruction to flow of urine, decreased urine stream, hesitancy, difficulty initiating stream, interruption of stream, infection caused by retention What is hydrocele? - ANS fluid collection surrounding the testicle or spermatic cord Why does hydrocele occur? - ANS develops secondarily to scrotal injury, radiation therapy, infection of the epididymis, or testicular neoplasms, swollen scrotum What is testicular torsion? - ANS the twisting of the spermatic cord due to trauma, there will be a compromised vascular supply and ischemia if not treated, lots of pain. Is Testicular Torsion an emergency? - ANS yes it is due to a compromised vascular supply and ischemia and necrosis that could occur if not treated. What is endometriosis? - ANS the presence of endometrial tissue outside of the uterus on other organs. What does endometriosis cause? - ANS bleeding, pain,dysmenorrhea or painful periods, pain in lower abdomen, vagina, posterior pelvis, and back, pain with intercourse, pain with defecation, excessive menstrual bleeding When does endometriosis present itself in relation to menstruation? - ANS It will start 5 to 7 days before a cycle and lasts 2-3 days after What is uterine prolapse? - ANS occurs when the uterus sinks into the vagina from pelvic structures relaxing. It will protrude What signs and symptoms will the client have with uterine prolapse? - ANS vaginal discomfort, discomfort walking and sitting, difficulty urinating due to excess pressure on the bladder, bleeding and ulceration of the cervix from friction What are the complications of having a uterine prolapse? - ANS the uterus becoming dried out and not sterile, prone to infection Should the RN attempt to place back a prolapsed uterus into the client? - ANS No, it is out of scope of practice. must call the provider about it What is pelvic inflammatory disease? - ANS occurs from bacteria that enter through the vagina up into the cervix What are things pelvic inflammatory disease can cause? - ANS abdominal tenderness, pelvic pain, cervical/adnexa pain or tenderness on palpation, fever, high wbc count, purulent, white vaginal discharge Which organism causes pelvic inflammatory disease? - ANS Neisseria gonorrhoeae, chlamydia trachomatis Which organism causes cervical cancer? - ANS human papillomavirus or HPV Which organism causes UTI (cystitis)? - ANS E.coli Which organism causes herpes? - ANS herpes simplex virus Which organism causes syphillis? - ANS Treponema pallidum What are the stages of syphillis? - ANS incubation, primary, secondary, latent, late Explain incubation stage of syphillis - ANS occurs for 10 to 90 days after first infected. No symptoms are noted Explain primary stage of syphillis - ANS a painless, single chancre ulcer is formed at the port of entry, usually on the genitals. May resolve in 3-6 weeks Explain secondary stage of syphillis - ANS a person will have a head to toe rash accompanied by hepatitis, meningitis and nephritis, fevers, malaise, sore throat, headache, and lymphadenopathy. Bacteria spreads Explain latent stage of syphillis - ANS no symptoms present but the person still has the bacteria in their body, person still contagious and can last up to 40 years Explain late stage of syphillis - ANS most destructive phase, causes major cardiovascular and central nervous system damage, blindness and paresis to bones. It is fatal What is pregnancy induced hypertension/ preeclampsia? - ANS occurs when there is a rapid rise in arterial blood pressure assoicated with loss of large amounts of protein in the urine What are the chacteristics with one who has pregnancy induced hypertension/preeclampsia? - ANS proteinuria, weight gain, edema, arterial spasms in kidneys, brain and liver, decreased renal flow and GFR, kidneys retain salt and water. If severe: can cause convulsions, coma, renal failure, liver malfunction and hypertension What is hyperemesis gravidarum? - ANS excessive vomiting during pregnancy that is form response to large amounts of HCG What are the manifestations of hyperemesis gravidarium? - ANS dehydration, electrolyte imbalances hepatic or renal damage or death What is the concern with chlamydial infections during labor and delivery? - ANS The mom can pass it onto the baby through vaginal delivery, potentially causing optic issues in the newborn and blindness What do we do to prevent chlamydial infections in the infant? - ANS Give antibiotic eyedrops right after birth prophylactically What is the problem with the hormone involved in gigantism? - ANS too much growth hormone What is the pathophysiology behind gigantism? - ANS Occurs before skeletal plates fuse at the ends of bones. Leaves client with increased risk for cardiac problems. The client will also be very tall. What is the problem with the hormone involved in dwarfism? - ANS too little growth hormone What is the pathophysiology behind dwarfism? - ANS It causes short stature, hypoglycemia, delayed dental eruption, thin hair, poor nail growth, greater fat mass, decreased muscle mass, and delayed bone formation and puberty. is congenital or idiopathic What is the problem with the hormone involved in acromegaly? - ANS too much growth hormone What is the pathophysiology behind acromegaly? - ANS Occurs when the cells grow width wise amongst the bones When does gigantism occur in the life span? - ANS childhood, before growth plates at ends of bones fuse When does acromegaly occur during the life span - ANS adulthood, after fuseing of growth plates What is the problem with the hormone involved in diabetes insipidus? - ANS Too little ADH, causes the body to not retain enough water What is the pathophysiology behind diabetes insipidus? - ANS Results in the kidneys being unable to retain water in the body and a lot of urine output that is dilute. Extreme thirst. Lack of water leads to dehydration. Can be caused by trauma to the head What are signs and symptoms of diabetes insidious? - ANS dizziness, disorientation, nausea, tachycardia, headaches, low blood pressure, hypovolemia, high electrolytes in the blood- sodium. High risk for hypovolemic shock, increased urine output, high electrolytes What is the problem with the hormone involved in SIADH? - ANS too much ADH. cause body to retain too much water What is the pathophysiology behind SIADH? - ANS Causes the body to retain too much water. Causes hypotonic hydration. There is low urine output, high osmolarity, electrolytes are at a lower concentration. Results in edema, weight gain, and hyponatremia due to excess water retention. What are the signs and symptoms of SIADH? - ANS cerebral edema due to low sodium, seizures, confusion, coma, death, swollen cells, low urine output, low electrolytes, edema What is ADH? - ANS antidiuretic hormone What is ADH purpose in the body? - ANS it helps the body keep water balance, and for more fluid retention. Prevents the body from being dehydrated, regulates thirst, and causes water to be reabsorbed What is the electrolyte most affected by ADH - ANS Sodium- inversely affected (low ADH=high Na, high ADH=low Na) What is hypothyroidism caused by? - ANS cells attacking the thyroid gland or surgical removal of tissues, iodine deficiency. Leads to a lack of T3/T4 and too much of TSH.The TSH recognizes the lack of the T3/T4 so more is pushed into it yet the thyroid cannot produce it. Causes goiters Lab results in one that has hypothyroidism - ANS high TSH, low T3/T4 What are the clinical manifestations for hypothyroidism? - ANS low metabolism, weakness, lethargy, cold intolerance, low appetite, bradycardia, weight gain, dry skin, constipation, depression, difficulty concentrating, menstrual problems What is hyperthyroidism caused by? - ANS overstimulation of the thyroid gland and autoimmune conditions like graves disease. The autoantibodies bind and stimulate TSH receptors Lab results in one that has hyperthyroidism - ANS High T3/T4 levels and low TSH What are the clinical manifestations for hyperthyroidism? - ANS exophthalmos or eye budging, lid lag, vision changes, light sensitivity, high metabolism, rapid weight loss, insomnia, restlessness, cannot concentrate, tremors and irritability, palpitations, heat intolerance, diaphoresis, diarrhea, amenorrhea What is the purpose of parathyroid hormone PTH? - ANS increases the calcium levels in the blood to be released from bone reservoirs by activating osteoclasts. It also increases calcium absorption in the intestines and excretion in urine Which electrolyte is most affected by PTH disorders - ANS calcium What is Cushings disease caused by? - ANS caused by excessive glucocorticoids from either a pituitary tumor or tumor or adrenal cortex or secondary to prescribed glucocorticoids What happens to corticosteroid levels during Cushings disease? - ANS Will increase What are signs and symptoms of Cushings disease? - ANS Buffalo hump, moon face, thin extremities, pendulous abdomen stirae, hyperglycemia, loss of muscle and bone, excess water and salt retention, weight gain, edema, hypernatremia, and redistribution of fat. What are the causes of Addison's disease? - ANS caused by adrenocortical insuffiency from not having enough steroids or glucocorticoids. Primarily from autoimmune conditions or removal of the adrenals, secondary to removal of corticosteroid therapy What happens to corticosteroid levels during Addison's disease? - ANS Will decrease What are the signs and symptoms of Addisons Disease? - ANS weight loss, salt wasting of fluids, weakness, malaise, hyperpigmentation or bronzing of skin, hypoglycemia, and hyperkalemia. Reduced cardiac output, inadequate blood volume, low blood pressure What is the causes of type 1 diabetes? - ANS caused by the inability for one to produce insulin needed to transport glucose into cells. They are insulin dependent. It is common in young kids and adolescents. The beta cells in the pancreas are destroyed or not present. No insulin stimulate overproduction of glucagon, causing glucose levels to rise. What are the causes of type 2 diabetes? - ANS caused by the cells of the pancreas becoming resistant to insulin, and decrease of receptors on the target cells. They lose the ability to respond to cells. Results in decreased insulin production. How can diabetes be diagnosed? - ANS random sampling of blood glucose over 200 mg, fasting blood glucose level of 126, or and Hgba1C over 6.5. Normal A1c is 4-5.6, but those with diabetes they should aim to have it less than 7 What is the signs and symptoms of hypoglycemia? - ANS cold, pale, sweating, sleepy, lack of coordination, irritability, hunger Why does hypoglycemia take priority over hyperglycemia? - ANS There is not enough sugar to sustain energy for the cells here. What are the signs and symptoms of hyperglycemia? - ANS Dry mouth, increased thirst, blurry vision, weakness, headache, frequent urination What is normal blood sugar? - ANS 60-120 What are the 3 P's for diabetes? - ANS polydipsia, polyuria, polyphagia Explain polydipsia - ANS increased thirst Explain polyphagia - ANS increased hunger Explain polyuria - ANS increased urination When does Type 1 diabetes present? - ANS childhood and adolescence When does Type 2 diabetes present? - ANS adulthood What is diabetic ketoacidosis? - ANS occurs when a type 1 diabetes has a very high sugar and insulin deficiency that leads to breakdown of fat for energy instead of glucose What happens during diabetic ketoacidosis? - ANS The metabolism of fat leads to free fatty acids in the blood that are transformed into ketones, leading to ketoacidosis and the body's pH dropping under 7.35. excessive ketones place the body in metabolic acidosis and in a hyperkalemic state induced by the acidosis. What are the signs and symptoms of DKA? - ANS deep and fast kussmal respirations (to compensate to bring more co2 and acid out of the body) , acetone fruity breath, confusion, lethargy, polydipsia, polyphagia, and polyuria, dehydration, nausea and blurred vision, ketones in the urine What do clients need who have DKA? - ANS These clients will often need insulin and electrolyte replacements in order to get the high sugar and high electrolytes and fluids replenished and replaced Why does DKA occur? - ANS The diabetes is not diagnosed with diabetes and has not taken their insulin, or the type 1 diabetic becomes sick and does not take their insulin due to not eating or drinking, when they need to be. What is the role of calcitonin? - ANS lowers calcium levels in the blood and increases bone formation and inhibits bone breakdown. Where is calcitonin secreted from? - ANS thyroid What is nonketotic hyperglycemic hyperosmolar syndrome? - ANS severe hyperglycemia in type 2 diabetics that is usually untreated, without ketones What is significant about the nonketotic hyperglycemic hyperosmolar syndrome - ANS there are no ketones found in urine, type 2 diabetics affected What are clinical manifestations of chronic hyperglycemia? - ANS hypertension, cardio vascular disease from damage to the blood vessels from excessive sugar, retinopathy or blindness from excessive sugar, neuropathy, nephropathy What types of disorders are Ulcerative colitis and Crohn's disease? - ANS inflammatory bowel disorders What is diverticulosis? - ANS the out pocketing of the walls of the bowel, making it so that fecal material can become trapped in the intestine What is diverticulitis? - ANS inflammation of the diverticulitis due to retained fecal material What changes are associated with esophageal cancer? - ANS GERD associated, Barretts esophagus due to the tissue changes in the esophagus from the regurgitation of acids What disorder is based from overuse of broad spectrum antibiotics? - ANS pseudomembranous colitis What is intussusception? - ANS telescoping of the bowel into each other What type of blockages does intussusception lead to? - ANS mechanical obstructions What is a classic symptom of a glomerularnephorpathy? - ANS proteinuria; when protein spills into the urine What things will diabetics possibly have in their urine? - ANS ketones and glucose What things will someone who is pregnant have in their urine? - ANS protein What are example of post renal causes for AKI - ANS stones, bladder tumors, enlarged prostate What are example of pre renal causes for AKI - ANS hypertension, hypotension, hyper/hypovolemia, low kidney perfusion, renal artery occlusion What are example of intra renal causes for AKI - ANS from medicine, contrast, chemo, or prolonged post renal failure What is the disorder that causes tissue growth outside of uterus - ANS endometriosis What two things cause pelvic inflammatory disease - ANS chamydia and gonorrhea What things is one with hyperemesis gravidarium at risk for - ANS dehydration and loss or electrolytes as well as hypovolemia What are some signs one has Diabetes insipidous - ANS dilute urine, hypovolemia, concentrated electrolytes and high osmolarity What are some signs one has SIADH - ANS concentrated urine, hypervolemia, low numbers of electrolytes and low osmolarity What is the concern with Cushings disease and Addisons disease? - ANS they cause or have been caused by fluctuations in glucocorticoid levels, causing different things What is cholecystitis - ANS inflammation of the gallbladder What type of pain does one experience with cholecystitis? - ANS Boring RUQ pain What