NP235 Exam 2 Review Practice questions for this set Terms in this set (53) What is Adrenal Crisis? Physical stress from the flu or other infection, or from surgery, can send a patient with Addison disease into Addisonian crisis. Another situatio

NP235 Exam 2 Review Practice questions for this set Terms in this set (53) What is Adrenal Crisis? Physical stress from the flu or other infection, or from surgery, can send a patient with Addison disease into Addisonian crisis. Another situation that can cause symptoms of acute lack of cortisol results from prescribed treatment. What are s/s of adrenal crisis? The patient experiences generalized malaise and muscle weakness, muscle pain, orthostatic hypotension, and vulnerability to cardiac dysrhythmias. Insufficiency of the glucocorticoids affects blood glucose levels and causes symptoms of hypoglycemia. There is also decreased secretion of gastrointestinal enzymes, which results in anorexia, nausea and vomiting, flatulence, and diarrhea. These symptoms, as well as anxiety, depression, and loss of mental acuity, have been correlated with the absence of the peaks of cortisol output that normally occur every 24 hours. What is DIC? Damaged tissue liberates tissue thromboplastin, creating a state of excessive clotting in the microcirculation throughout the body. When excessive clotting depletes the body's clotting factors, hemorrhage follows, leading to hypotension or shock. What are s/s of DIC Continued bleeding from an injection or IV site, extensive bruising in areas of injury, ecchymoses where there has been no trauma, and petechiae. There may be oral, vaginal, or rectal bleeding. Laboratory studies will reveal a decreased hemoglobin and low platelet count. The prothrombin and activated partial thromboplastin times will be increased. The fibrinogen level is reduced, and the fibrin degradation products level is increased. The D-dimer result is elevated. What are s/s of hypoglycemia? Increase pulse, confusion, HA, Nervous, Nausea, Cool and clammy skin, shaking where is insulin manufactured in the body The pancreas is both an endocrine (secretes into the bloodstream) and exocrine (secretes through a duct to the target tissues) gland. Its endocrine function is to produce the hormones insulin and glucagon. What is diabetes mellitus type 2 formerly called non-insulin-dependent diabetes mellitus (NIDDM)—makes up 90% to 95% of all known cases of diabetes. Type 2 diabetes is believed to begin with insulin resistance, in which insulin interaction with glucose becomes less efficient, and therefore glucose metabolism is abnormal. More insulin is produced by the pancreas to maintain cellular metabolism. Type 2 diabetes has a tendency to develop later in life than does type 1, and patients with type 2 rarely develop diabetic ketoacidosis. What are some risk factors for DM type 2? obesity asian, hispanic, african american, American Indian In type 2 diabetes there also seems to be a relationship to aging and a reduction in the function of the pancreatic beta cells and how they synthesize insulin. Raynaud's disease characterized by spasm of the arteries of the upper and lower extremities with an exaggerated response to cold and stress, resulting in bilateral vasospasm. what education would you provide to your patient to prevent complications of Raynauds disease protect the extremities from cold, stress, vasoconstriction! The patient should be taught to: Dress warmly when in cold environments. Clothing should be layered and nonrestrictive. Hat, gloves, and warm socks should be worn. Wear protective gloves when reaching into ovens and when handling extremely cold items. Avoid cold temperatures when possible, to manage stress, and to stop tobacco use. Caffeine intake should be limited. If appropriate, the patient should be referred to a smoking cessation program. What does a patient take thrombolytics for give to stroke pts. they disolve clots. at risk for hemorrage. Anticoagulants work by preventing blood clots from forming. Some do this by preventing the body from making clotting factors. Others keep the clotting factors from working or prevent other chemicals from forming so that clots can't develop What is the priority in treating sickle cell patients administration of oxygen, pain-relieving drugs, and oral and intravenous fluids to reduce pain and prevent complications. Doctors also may recommend blood transfusions, folic acid supplements, and antibiotics. A bone marrow transplant may be an effective treatment in some circumstances What would be the plan of care for a patient with Peripheral Vascular Disease? Reduction of high blood pressure(2) Long-term control to decrease the risk of stroke, heart attack, loss of vision, and kidney disease. The target is to control blood pressure at or below 120/80 mm Hg. Sodium should be kept to less than 2400 mg/day. Alcohol intake should be moderated. Aerobic exercise of 30 to 45 minutes most days of the week is recommended. What is Percutaneous Transluminal Coronary Angioplasty aka PTCA? a nonsurgical interventional technique to open blocked coronary arteries. It is performed in the cardiac catheterization laboratory using fluoroscopy. A catheter with a balloon tip is threaded into the blocked artery, and when the narrowed area is reached, the balloon is inflated, pushing aside the plaque and widening the interior of the artery and a stent is usually placed. What are some signs and symptoms of Thrombocytopenia? Bleeding into the joints (hemarthrosis) is not uncommon in certain kinds of anemia or in hemophilia. for hospitalized pts. abdominal girth should be measured daily to detect internal bleeding Blood loss in the GI tract from an ulcer, tumor, or hiatal hernia can be in small amounts or in a large enough amount to make stool appear black (melena). Loss of 50 to 75 mL of blood from the upper GI tract is required before melena will appear. What are some signs and symptoms of anemia? Pigment loss and yellowish cast to the skin paleness in the conjuntevia of the eyes and mucous membranes. fatigue, malaise How do you treat Inappropriate Antidiuretic Hormone? correcting the underlying cause; restricting fluids to 500 to 1000 mL/day; and administering sodium chloride, diuretics, and demeclocycline (a tetracycline) to increase excretion of water. Tolvaptan (Samsca) is approved for the treatment of hyponatremia in SIADH. Tolvaptan improves serum sodium levels within 8 hours when given as an IV infusion by blocking the action of ADH; however, there is a danger of overcorrection, and sodium levels need to be closely monitored. What are some signs and symptoms of an Acute Myocardial Infarction? Chest discomfort, including feeling of tightness, aching, burning Chest pain (angina pectoris) radiating to the arm, jaw, or back Dyspnea (shortness of breath) Palpitations or tachycardia Nausea and vomiting Cold, clammy skin Undue fatigue (particularly in women) Weakness and inability to complete usual activities without chest pain or dyspnea NP235 Exam 2 Review What are some characteristics seen in females? With Myocardial Infarction? women are more likely to have other symptoms along with chest discomfort, such as shortness of breath, nausea and extreme fatigue. What is Diabetes Insipidus? occurs after trauma or surgery in the area of the pituitary or hypothalamus and may be temporary or permanent. Characterized by the production of copious amounts of dilute urine. DI results from decreased production of antidiuretic hormone (ADH), which regulates reabsorption of water in the kidney tubules. When ADH is not present in a sufficient amount, the water is not reabsorbed from the tubule and is excreted as urine. What are some signs and symptoms of Diabetes Insipidus? profound diuresis (production of a large amount of urine), often as much as 3 to 20 L in every 24-hour period. Other signs and symptoms include thirst, weakness, and fatigue, often from nocturia (urination at night). The patient will exhibit signs of deficient fluid volume, such as tachycardia, hypotension, weight loss, constipation, and poor skin turgor. If untreated, the patient will demonstrate signs of shock and central nervous system manifestations progressing from irritability to eventual coma from hypernatremia and severe dehydration. . What is the Somogyi phenomenon follows a period of hypoglycemia, often during sleep. When hypoglycemia occurs, the body secretes glucagon, epinephrine, growth hormone, and cortisol to counteract the effects of low blood sugar. The patient may report nightmares and night sweats along with morning elevated serum glucose; if the patient increases the insulin dose, it worsens the problem. What is Diabetic Ketoacidosis? caused by incomplete metabolism of fats resulting from an absence or insufficient supply of insulin. When insulin is not present in adequate amounts to meet metabolic needs, the body breaks down protein and fat for energy. This produces an abundance of the by-products of fat metabolism, which are potent organic acids called ketones. s.s of diabetic Ketoacidosis? Increased thirst (polydipsia) Increased urination (polyuria) Acetone breath odor ("fruity") Dry mucous membranes and sunken eyeballs (dehydration) Nausea and vomiting Deep respirations (Kussmaul respirations) Abdominal pain and rigidity Paresthesia's, weakness, paralysis Hypotension Minimal urine output (oliguria) or none (anuria) (late sign) Stupor or coma (late sign) What is Buerger Disease? inflammation and thickening of small and medium-sized arteries. Occlusion of the vessels in the hands and feet is usually noted first. It may be classified as an allergic response in some people in whom the body reacts to properties in nicotine. What would you educate your patient on who has Buerger Disease? Cigarette smoking must be stopped immediately. Those who do not stop smoking are at great risk for gangrene and amputation of fingers or toes. Exercise may be used to increase circulation in the legs and feet. What is Polycythemia Vera? blood disorder that results in uncontrolled RBC production causing hyperviscosity & hypercoagulation. Causes thick blood. . What are the actions taken when a patient has a blood transfusion reaction? Stop the transfusion run the saline check the vitals call the doctor document What is Addison's Disease? pts have a decrease or absence of adrenal cortical secretions, primarily cortisol. Because cortisol is released in response to ACTH from the pituitary gland, abnormalities in ACTH release can also cause a reduction in circulating cortisol. What would the plan of care be for a patient that has hyperthyroidism with exophthalmos? manage side effects from this disease like temp, heat, high calories for metabolic needs, eye drops for bulging eyes. PTU, beta blockers, removal of the thyroid dry eyes! Treated medically by administering radioactive iodine and antithyroid drugs, mild sedatives, and beta-adrenergic blocking agents to control tremor, temperature elevation, restlessness, and tachycardia. The diet of patients with hyperthyroidism should be sufficiently high in calories to meet metabolic needs. Sometimes it is difficult for the patient's family to accept and deal with the emotional outbursts and mood changes that occur when the disease is not under control. why would a patient require B12 injections Becuase they have pernicious Anemia a decreased secretion of intrinsic factor from the stomach, Pernicious Anemia? lack of intrinsic factor necessary for vit b12 absorption a decreased secretion of intrinsic factor from the stomach, which is why you need a b12 injection. lack of mature erythrocytes caused by inability to absorb vitamin B12 into the bloodstream There is less antibody response to foreign proteins, a decreased secretion of intrinsic factor from the stomach, and decreased absorption of vitamin B12, leading to pernicious anemia from B12 deficiency. What is sickle cell anemia sickle cell crisis occurs when sickle-shaped red blood cells block blood vessels defective form of hemoglobin that forces red blood cells to assume an abnormal crescent (sickle) shape. These irregular blood cells die prematurely, resulting in a chronic shortage of red blood cells. Why do you add humidification to oxygen? so the nares and the mucus membranes do not dry out. What are foods high in Iron? Red meat, pork and poultry. Seafood. eggs nuts Beans. Dark green leafy vegetables, such as spinach. Dried fruit, such as raisins and apricots. Iron-fortified cereals, breads and pastas. Peas. What is Syndrome of Inappropriate Antidiuretic Hormone? Excessive amounts of Antidiuretic Hormone are produced, resulting in fluid retention. Numerous factors can cause SIADH, including malignancies and tumors pressing on the pituitary Give hypertonic solutions s/s confusion, seizures, and loss of consciousness accompanied by weight gain and edema.Hyponatremia from fluid excess, with serum sodium less than 120 mEq/L, occurs frequently. This causes muscle cramps and weakness. Urine output is diminished. What is the function of the Endocrine gland? works through the negative feed back produce the hormones or chemical messages that are passed through the blood stream to their target organs. Any dysfunction of a gland will affect one or more of the hormones, as well as their target te hormones directly into the bloodstream . What does iodized salt do for a patient with a goiter? it prevents the continued growth of a goiter. an overgrowth of the thyroid may be prevented by sufficient intake of iodine. Iodine is available in foods grown near the ocean and in seafood What does Nitroglycerin do? vasodialator to increase the blood flow to the heart. used in combination with drugs to lower cholesterol and prevent platelet aggregation. administered sublingually is the most common drug for treatment of angina. An aerosol spray and a buccal form of the drug are also available. What are some signs and symptoms of Congestive Heart Failure? hypoxia of the tissues throughout the body, which causes fatigue and dyspnea on exertion. Edema Chest pain altered tissue profusion weight greater than 3lbs. check for swelling What does antidysrhythmics do? slows the sodium channels and it prolongs depolorization maximizes the cardiac output prevent and treat abnormal heartbeats (arrhythmias). Problems with your heart's rhythm are caused by a disruption in the heart's electrical system. A drug called atropine may be prescribed if your heart beats too slowly (bradycardia). How would you give Ferrous sulfate to a patient? Why? give through a straw becuse it stains the teeth and dilute it becuase it tastes teribble. increases the iron content within the blood. Do not give with milk as it reduces absorption. Do not crush enteric-coated tablet. Teach the client about side effects including constipation, GI upsets, nausea, and vomiting. Also found in vitamin C rich foods. used to treat iron deficiency anemia What would the plan of care around safety for your patient with Addison;s disease be? s/s low blood pressure. orthostatic hypotension. make sure they get up slowly. plan of care would be. The patient experiences generalized malaise and muscle weakness, muscle pain, orthostatic hypotension, and vulnerability to cardiac dysrhythmias Do not allow anyone to stress them out and keep them away from infection. Physical stress from the flu or other infection, or from surgery, can send a patient with Addison disease into Addisonian crisis. Another situation that can cause symptoms of acute lack of cortisol results from prescribed treatment. cause of DIC sepsis, placentia abuptio resp, distress transfusion reaction, trauma surgery chronic pain from Diabetis Melitis type 1 neuropathy what is the period of time that the medication has the strongest effect peak what do we teach a diabetic about foot care monitor condition of feet, inspect the feet daily, always wear foot wear non modifiable risk factors for cornary artary disease age, race, gender, family history what is hemocrit % of whole blood that is RBCs if you have a pt. that is dehydrated would they have high or low hemocrit high it just changes the plasma not the hemocrit bone marrow transplant, where would you take a sample illiac crest, sternum Quiz Code GHIENDO6 What is peripheral Vascular Disease? put legs beneth the heart. keep room warm is a blood circulation disorder that causes the blood vessels outside of the heart and brain to narrow, block, or spasm. This can happen in the arteries or veins. PVD typically causes pain and fatigue, often in the legs, and especially during exercise.