H356 Biophysical Processes: Exam 3
The first step in treating Type II Diabetes is
lifestyle changes (wt loss, diet changes, smoking cessation)
What is the treatment options for GER/GERD in the order that they are prescribed? 1. 2. 3.
lifestyle changes, medications, surgery
Increases reabsorption of water by the tubules of the kidney
ADH
Intermediate-acting insulin: name
NPH (Humulin N, Novolin N)
Two PPI examples
esomeprazole (Nexium), pantoprazole (Protonix)
4 big symptoms of dumping syndrome
nausea, vomiting, weakness, diarrhea
3 PPIs (generic name)
omeprazole (Prilosec), esomeprazole (Nexium), pantoprazole (Protonix)
With ____________ _________, the gland responds by increasing or decreasing the secretion of hormones based on feedback of various factors
negative feedback
Which system regulates hormonal secretion
nervous system
Gastric contents empty too rapidly into the small intestines causing decreased absorption, N/V, weakness, and diarrhea
dumping syndrome
Glucagon-Like Peptide-1 Receptor Agonists (2 examples)
exenatide (byetta, 2x/day), liraglutide (victoza 1x/day)
Released continuously into bloodstream in small increments with larger amounts released after food intake
insulin
portable device that contains a pre-filled cartridge of insulin
insulin pen
PPIs aside from ___________ as well as _____________ are safe to use during pregnancy for treatment of GERD
omeprazole, metoclopramide
How often are H2 receptor antagonists and PPIs taken?
once daily
Glipizide is taken _________ daily, ______ _________ __________ the ________ meal of the day
once, 30 minutes before, first
What are two classes of drugs that can cause secondary hypertension?
oral contraceptives, corticosteroids
The second step in treating Type II DM
oral drug therapy
Type 2 is most often treated with _______ and ______-_______ ________ agents to work on 4 defects of type 2 diabetes: - Increase ____________ _________ - Decrease ___________ __________ by the liver - Decrease ___________ _________ - Help with ___________ of insulin
oral, non-insulin injectable, insulin production, glucose production, adipose tissue, absorption
How and when should you give glipizide?
orally 30 minutes before selected meals
Which type of HTN is essential or idiopathic and accounts for 90-95% of all cases
primary
More prevalent type of obesity that results from excess calorie intake over expenditure for the body's metabolic demand
primary obesity
Chronic starvation, no inflammation (anorexia nervosa, no access to food)
primary/starvation-related PCM
DKA is caused by
profound deficiency of insulin
K-sparing diuretics
spironolactone
aldosterone antagonist examples (2)
spironolactone (Aldactone), eplerenone (Inspra)
Pediatric focused S/S (GER): Infants - __________ up, vomiting - __________/irritability with _________ of _______ - Weight ______, failure to ____________ - Gagging, __________ at the end of feedings - Respiratory problems (____________) - Apnea or _________
spitting, crying, arching, back, loss, thrive, choking, aspiration, ALTE
In some children, GER may resolve ____________ as their esophageal sphincter grows ____________ over the first year of life
spontaneously, stronger
What is prescribed to diabetics to prevent heart attack and stroke
statins (lipid-lowering agents, atorvastatin, Lipitor)
glipizide: class
sulfonylurea
ADH is a potent
vasoconstrictor
Calcium channel blocker example
verapamil (Calan)
What is the name of the non-insulin injectable?
victoza (1x/day)
- ERCP allows for _____________ of the gallbladder, cystic duct, common hepatic duct, and common bile duct. -_______ taken during ERCP is sent for _______ to identify potential infecting organisms. - Percutaneous transhepatic cholangiography is the insertion of a _____________ directly into the gallbladder _________, followed by injection of ________ materials. It is generally done after _____________ indicates a bile duct blockage
visualization, bile, culture, needle, duct, contrast, ultrasonography
Responsible for metabolism of amino acids, fats, carbohydrates
vitamins
twisting of the bowel on itself, causing mechanical obstruction
volvulus
Diabetes Illness Management Notify HCP if: - ___________ - ___________ odor to breathe - _____________ __________ - Decreasing level of ___________
vomiting, fruity, Kussmaul respirations, consciousness
HTN: Lifestyle Modifications - ___________ reduction - ____________ therapy (_________) - Dietary __________ reduction - Modification in ____________ consumption - Regular ___________ physical activity - Avoidance of ___________ products - __________ management A major problem in the long-term management of the patient with HTN is poor _____________ with treatment plan
weight, nutritional, DASH, sodium, alcohol, aerobic, tobacco, stress, compliance
Pain from gastric ulcers usually occurs
when eating or 1-2 hours after a meal
Cholecystitis: Laboratory Tests (ALL INCREASED) - ________ _______ _______ count - Serum ____________ level - ________ ____________ level (if obstructive process if present) - __________ _________ levels - Serum ____________ level (if pancreatic involvement)
white blood cell, bilirubin, urinary bilirubin, liver enzyme, amylase
Give metformin _______ or ________ _______ main meals
with, shortly after
Micro-hemorrhages and aneurysms that affect the retina & ultimately macula, more prone to cataracts and glaucoma
retinopathy
What are the three main microvascular complications with DM?
retinopathy, nephropathy, neuropathy
What are the three microvascular complications from diabetes?
retinopathy, neuropathy, nephropathy
Cortisol, produced by the adrenal cortex, __________ early in the day, _________ toward the evening, and _________ again toward the end of sleep to _________ by morning
rises, declines, rises, peak
Store insulin at
room temperature
The nurse administered 15 U NPH insulin (Humulin N) at 0800. Hypoglycemia would be most likely to occur between _______ and _______ (answer in military time)
1200, 2000
___________ exposure to some stressors can cause persistent elevation in heart rate and BP and changes in the endocrine system. This puts patients at risk for chronic diseases such as ______________ and cardiac disease.
chronic, hypertension
Intermediate-acting insulin: duration
12-18 hours
Long-acting insulin: duration
18-24 hours (24 +)
Short-acting insulin: peak
2-5 hours
A common physiologic rhythm is ________ __________. It is a 24-hour rhythm that can be driven and altered by sleep-wake or dark-light 24 hour (____________) cycles
circadian rhythm, diurnal
_____________ antagonize hypoglycemic effects of insulin, resulting in elevated blood glucose
corticosteroids
Metabolic syndrome is more prevalent in those over _____ ________ of age
60 years
Severe/morbid obesity BMI
40+
Average daily secretion of insulin in adults is ___-____ U daily
40-50
When should pregnant patients stop taking glipizide?
48 hours before delivery
Short-acting insulin: duration
5-8 hours
Prediabetes is defined as HbA1C from _______-_______%
5.7-6.4
What is the main glucocorticoid
cortisol
What is the most abundant and potent glucocorticoid that is necessary to maintain life
cortisol
What is the MAIN diagnostic study for cholecystitis?
endoscopic retrograde cholangiopancreatography
What is the main diagnostic test for peptic ulcers
endoscopy
Intervention for HHS: ___________ replacement, correction of _______________ _______________, _____________ administration Fluid replacement: Watch the ____________ for fluid volume excess
fluid, electrolyte imbalances, insulin, elderly
What WHR is optimal
< 0.8
Underweight BMI
< 18.5
What WHR indicates truncal fat
> 0.8
Blocks the action of angiotensin II so that veins and arteries dilate
ARBs (angiotensin II receptor blockers)
gastroduodenostomy name
Bilroth 1
Water-soluble vitamins
B and C
Cushing's or Addison's (C/A) Easy bruising
C
HHS is more common than DKA (T/F)
F (opposite)
Type (I/II) Diabetes occurs when the pancreas fails to produce insulin or when the insulin is defective
I
Two H2 receptor blocker examples
Ranitidine, famotidine
A person can have cholelithiasis without cholecystitis (T/F)
T
Reddish/brown round/oval patches from diabetes
dermopathy
Non-K+ sparing diuretic
furosemide
Increase insulin synthesis/release from the pancreas, inhibit glucagon secretion, decrease gastric emptying, increase feelings of satiety
glucagon-like peptide receptor agonists
Deficit, excess, or imbalance of essential nutrients
malnutrition
Chronic excessive intake of water; it is a common symptom of uncontrolled diabetes.
polydipsia
In an ill diabetic patient, encourage _________ to aid in clearing of _____________. Need to have an increase in intake of ____-________ ________, such as broth, water, diet gelatin, and other decaffeinated beverages
fluids, ketones, non-caloric fluids
Nissen Fundoplication Complications - ____________ __________ complications - ____________ - Tearing of the ____________ - ___________ of the _________
general anesthesia, bleeding, esophagus, slippage, wrap
Diabetes that develops during pregnancy. It may resolve after pregnancy but may also be a precursor of type 2 diabetes in later life.
gestational diabetes
Gastric bypass surgery decreases the amount of
ghrelin
Hypoglycemia by age: * Ages ___-____: < 100 * Ages ___-___: < 80 * Ages ____+: < 70
0-5, 6-12, 13
Short-acting insulin: onset
0.5-1 hour
Rapid-acting insulin: peak
0.5-3 hours
Long-acting insulin: onset
0.8-4 hours
Which drug stimulates insulin secretion from the beta cells of the pancreas, thus increasing insulin levels?
glipizide
Severe, steady, excruciating pain from cholelithiasis may last up to ___ _______, and when it subsides, there is _________ __________ in the _______
1 hour, residual tenderness, RUQ
A college student is newly diagnosed with type 1 diabetes. She now has a headache, changes in her vision, and is anxious, but does not have her portable blood glucose monitor with her. Which action should the campus nurse advise her to take? A. Eat a piece of pizza. B. Drink some diet pop. C. Eat 15 g of simple carbohydrates. D. Take an extra dose of rapid-acting insulin.
C
Obesity: Nutritional Therapy - Weight loss of ___-___ lbs per ________ may result from decreasing calories by ____-________ per day - Carefully supervise is diet contains ______ calories/day or less - Avoid _______ - Avoid ___________ and __________ beverages, which add calories but little/no ___________ - _______ usually lose weight faster than _____________
1-2, week, 500-1000, 800, fads, alcohol, sugary, nutrition, men, women
Intermediate-acting insulin: onset
1.5-4 hours
Most obesity interventions will result in ______% weight loss
10
Peak incidence of type 1 DM is between _____ and _____ years of age
10, 15
Type 1 DM: Nutrition Total carbs: Minimum of _______ g/day (____-___ g/meal) Protein: ____-____% of total calories Fat: Limit saturated fat to <_____% TDI Meal planning should be based on the individual's usual food intake and balanced with insulin and exercise patterns
130, 45-60, 15-20, 7
Hypertension- Stage 1 Systolic _____-_____ (and/or) diastolic _____-_____
130-139 or 80-89
Stage II HTN Systolic > ______ (and/or) diastolic >= _____
140 or 90
Hyperglycemia is defined as BG above __________ mg/dL, and severe hyperglycemia is defined as BG above ________ mg/dL
140, 180
Prediabetes can be defined as 2-hr oral GTT between ______ and ______
140, 199
Hypertensive Crisis: Treatment Goal: BP is ______/_____ or _______ over the next ____-____ _________ Interventions: ______ ______: (Nitropress), (Nipride), _____________ - BP and pulse taken every ____-____ __________ - __________ drug according to level of BP - __________ urinary _________ - ____________ - ______________ checks - Monitor cardiac, pulmonary, and __________ systems for decompensation
160/100, 110, 2-6 hours, IV meds, nitroglycerin, 2-3 minutes, titrate, hourly, output, bedrest, neurologic, renal
Normal weight BMI
18.5-24.9
Cushing's or Addison's (C/A) Adrenal hyperplasia/tumor
C
Pain from duodenal ulcers usually occurs
2-5 hours after a meal
Cushing's or Addison's (C/A) Bruising and petechiae (fragile blood vessels)
C
After IV administer of glucagon to an unconscious hypoglycemic patient, expect patient to regain consciousness in about ____ __________.
20 minutes
Cushing's or Addison's (C/A) Buffalo neck and fat deposition on abdomen
C
What percent of Americans have MS
25%
Screening for diabetes is recommended every ______ years for patients _____ years and older
3, 45
Diagnosing Metabolic Syndrome _____or more of these: - __________ __________: >= 40 in men, >= 35 in women - ______________: > ______ g/dL OR drug treatment for elevation - _______ cholesterol: <____ in men or <____ in women OR drug treatment for this problem - __________ ___________: >____ systolic OR >____ diastolic OR drug treatment for HTN - ___________ __________ ___________: > _____ g/dL OR drug treatment for elevated BG
3, waist circumference, triglycerides, 150, HDL, 40, 50, blood pressure, 130, 85, fasting blood glucose, 110
Rapid-acting insulin: duration
3-5 hours
Attacks of pain from cholelithiasis frequently occur ___-____ _______ after a _____-_____ _______ or when the patient _______ _________
3-6 hours, high-fat meal, lies down
When are antacids taken
30 minutes before or 1-3 hours after meals
Obesity BMI
30-39.9
Cushing's or Addison's (C/A) Central obesity with protruding abdomen and thin extremities
C
Cushing's or Addison's (C/A) Diarrhea is more likely
C
Cushing's or Addison's (C/A) Emotional irritability/depression
C
Cushing's or Addison's (C/A) Fluid retention (edema)
C
Peak incidence of GER is in infants _____ __________ of age and generally resolves spontaneously around _____ ___________ of age
4 months, 12 months
Intermediate-acting insulin: peak
4-12 hours
Diagnostic Evaluation: Type 1 DM - A1C >= ________% OR - ___-hour FBG level of > ______ mg/dL OR - Oral GTT of _______ or more in a ___-hour sample OR - Random blood glucose level of ________ mg/dL or more _________ by classic ________ of diabetes
6.5, 8, 126, 200, 2, 200, accompanied, signs
How long must a patient stop their metformin before getting a study done with contrast dye? How long after?
48 hours, 48 hours
Cushing's or Addison's (C/A) Gynecomastia in men
C
Cushing's or Addison's (C/A) Hypertension (Na and water retention, dependent edema)
C
PUD: Gerontological Considerations - Increased in patients > ____ ______ of age - Increased use of ___________ - First manifestation may be ________ ___________ ____________ or ___________ _____________ - treatment similar to younger adults - Emphasis placed on prevention of both ___________ and _______ __________
60 years, NSAIDs, frank gastric bleeding, decreased hematocrit, gastritis, peptic ulcers
Cushing's or Addison's (C/A) Hypervolemia
C
Cushing's or Addison's (C/A) Moon face
C
Cushing's or Addison's (C/A) Osteoporosis
C
Cushing's or Addison's (C/A) Severe acne
C
Cushing's or Addison's (C/A) Striae- reddened lines on abdomen
C
Glycemic goal of treatment for diabetes: HbA1C of less than ____% Fasting blood glucose goal is _____-______ mg/dL
7, 70-126
Hypoglycemia occurs when blood glucose is less than ________ mg/dL and severe hypoglycemia occurs when BG is less than ________ mg/dL
70, 50
Euglycemia is _____-_______ mg/dL
70-140
Cushing's or Addison's (C/A) Weakness, fatigue, sleep disturbances
C
Cushing's or Addison's (C/A) weight gain and increased appetite
C
the establishment of an anastomosis between the upper portion of the stomach and the duodenum
Bilroth 1
What waist circumference indicates obesity for a woman
>35 inches
What waist circumference indicates obesity for a man
>40 inches
Cushing's or Addison's (C/A) Bronze pigmentation of skin
A
A nurse is caring for a client with type 1 diabetes mellitus who reports feeling shaky and having palpitations. When the nurse finds the client's blood glucose to be 48 mg/dL on the glucometer, he should give the client which of the following? A. Graham crackers B. 1 tsp sugar C. 4 oz diet soda D. 4 oz skin milk
A (After establishing that the client has hypoglycemia, the nurse should give the client about 15 g of a rapid-acting, concentrated carbohydrate, such as 4 oz of fruit juice, 8 oz of skim milk, 3 tsp of sugar or honey, 3 graham crackers, or commercially prepared glucose tablets. The nurse should recheck the client's blood glucose level in 15 minutes. 1 tsp sugar does not contain enough carbohydrate to reverse hypoglycemia. The usual recommendation is 4 tsp of sugar or 1 tablespoon of honey. The client who has hypoglycemia requires treatment with15g of carbohydrates to raise the blood glucose level. Diet soda does not contain the required carbohydrates, but has artificial sweeteners. The nurse can administer 4 oz of regular soda, however. This does not contain enough carbohydrate to reverse hypoglycemia. The usual recommendation is 8 oz of skim milk in order to provide 15 g of carbohydrates.)
How often should diabetic patient go through risk factor assessment for HTN, DLD, smoking, family history, CAD, and presence of macroalbuminuria and microalbuminuria
At least annually
Which type of obstruction will most often result in diminished or absent bowel sounds? A. Mechanical B. Non-Mechanical
B
A nurse is caring for a client who has type 1 DM. Which of the following recommendations should the nurse make to the client for a sweetener? A. Corn syrup B. Natural honey C. Nonnutritive sugar substitute D. Guava nectar
C (Clients who have type 1 diabetes mellitus should limit carbohydrate intake. Corn syrup is high in carbohydrates and is not an appropriate choice to use as a sweetener. Clients who have type 1 diabetes mellitus should limit carbohydrate intake. Honey is high in carbohydrates and is not an appropriate choice to use as a sweetener. Clients who have type 1 diabetes mellitus should limit carbohydrate intake. Nonnutritive sugar substitutes allow the client to sweeten the taste of foods without increasing carbohydrate intake. Clients who have type 1 diabetes mellitus should limit carbohydrate intake. Guava nectar contains carbohydrates and is not an appropriate choice to use as a sweetener.)
BP =
CO x PVR
DKA or HHS or both Acidosis/ketones
DKA
metformin can be used to treat type I DM (T/F)
F
CO =
HR x SV
The third step in treating Type II DM
Insulin (when the above no longer provide glycemic control)
What secretes hormones into blood vessels in the pancreas
Islets of Langerhans
Mild-Moderate Hypoglycemia Treatment (awake, hungry, irritable, shaky, weak) - (cold, clammy skin; pale; rapid pulse; rapid/shallow respirations; change in mood; drowsiness)
Rule of 15
Intestinal obstruction primary diagnostic tool
abdominal x-ray
How often should diabetics test for nephropathy with albuminuria and serum creatinine screening
annually
Increase gastric pH by neutralizing acid
antacids
taken 30 minutes before/1-3 hours after meals to provide temporary relief (not for children)
antacids
Nutritional status assessment component? Height and weight, BMI, rate of weight change, amount of weight loss
anthropometric measurements (helps to assess nutritional status)
Older Adults are at risk for malnutrition d/t: - Decreased ____________ - ___________ - Limited or fixed _________ (choice between food and meds) - _____________ (secondary to stroke) - Gingivitis/missing ________ - Social __________ (living alone, lose desire to fix meals) - __________ can alter ________ of food or decreased ___________
appetite, depression, income, dysphagia, teeth, isolation, medications, taste, appetite
metformin: class
biguanide
What defines energy in terms of nutrition
calorie or kilocalorie
Interventions for Undernutrition - Therapeutic diets (High _________ and high _____) - Daily _________ _______/diet diary - Dietary ___________ (vitamins, ensure/promote) - __________ ________ meals - Appetite ___________ (Megace, Marinol) - Nutrition __________ - ___________ feedings (enteral) - Medical nutritional therapy (__________ ____________ nutrition)
calorie, fat, calorie count, supplements, multiple small, stimulants, consult, tube, total parenteral
What is the most common cause of mechanical colon obstruction
cancer
ACE inhibitor example
captopril (Capoten)
Provides a physically protective coating in patients with PUD and is used primarily as adjunct to other medications *interacts with digoxin , warfarin, and Dilantin
carafate/sulcrafate
Which drug interacts with digoxin warfarin and dilantin that is used for PUD?
carafate/sulcrafate
bolus dose of insulin to cover for carbs eaten, typically written as 1 unit divided by x grams of carbohydrates
carbohydrate coverage
main source of calories/energy
carbohydrates
What 3 main things does metabolic syndrome increase risk for
cardiovascular disease, stroke, diabetes
Intussusception in Adults: S/S RARE - Pain _________ and _______ - ___________ and __________ may occur - Causes: ___________, polyp or ________, __________, _________ disease
comes, goes, nausea, vomiting, surgery, tumor, adhesions, Crohn's
GER becomes GERD when
complications develop
What are the four early symptoms of hypoglycemia?
confusion, irritability, tremor, sweating
What is glucagon's expected pharmacological action?
converts glycogen in the liver into glucose (takes about 20 minutes)
bolus dose of insulin that takes into account insulin sensitivity factor & target blood glucose; number specific to each person and takes into account how sensitive individual is to insulin
corrective dose
What are the two ways of determining insulin dose for bolus dose
corrective dose and carbohydrate coverage
Intussusception in children: S/S - Sudden, loud ___________ - Infants may pull ________ to _________ - Pain ________ and _____, usually every _____-______ __________ at first, then _________ - ________ mixed with ________ and _________ - ___________ - ________ in abdomen - Lethargy - ________________ - _____________
crying, knees, chest, comes, goes, 15-20 minutes, longer, stool, blood, mucus, vomiting, lump, diarrhea, fever
Caused by over-secretion of the corticosteroids (endogenous and exogenous)
cushing's syndrome
How often should a diabetic client inspect their feet?
daily
What are 4 things a diabetic person can do to help reduce risk of complications?
daily physical activity, eating a healthy diet, taking one's prescribed medication, lowering cholesterol and blood pressure
Early morning glucose elevation produced by the release of growth hormone, which decreases peripheral uptake of glucose resulting in elevated morning glucose levels
dawn phenomenon
Hyperglycemia present upon waking that peaks in adolescent and young adulthood possibly d/t GH
dawn phenomenon
What is the leading cause of kidney disease
diabetes
Metformin will NEED to be ___________ if the patient is to undergo studies with _____________ _______ because of possible __________ effects; check with prescriber
discontinued, contrast dye, renal
what are the 6 main classes of antihypertensives?
diuretics, beta blockers, calcium channel blockers, ACE inhibitors, ARBs, Aldosterone Antagonists
Undernutrition: Clinical Manifestations - ______ scaly skin, rashes; __________/ulcerations around the mouth - _______ hair/loss - __________ nails - ____________ eyes - _____________ body temperature - ____________ muscle mass - ___________ _________ changes, difficulty concentrating, irritable, confused - Delayed _________ ___________ - Susceptible to ______________
dry, crusting, thin, brittle, sunken, decreased, decreased, mental status, wound healing, infection
Why can PUD cause hemorrhage
due to erosion
Complications of Gastric Surgery Associated with meals having a hyperosmolar composition: S/S generalized weakness, sweating, palpitations, and dizziness
dumping syndrome
Which type of ulcer has burning or cramp-like pain
duodenal
Which type of ulcer is associated with other diseases, such as COPD, pulmonary disease, pancreatic disease, hyperparathyroidism, Zollinger-Ellison Syndrome, and chronic renal failure
duodenal
Which type of ulcer makes mid-epigastric pain beneath xiphoid process or back pain
duodenal
Which type of ulcers are found more in men?
duodenal
Which type of ulcers are more related to alcohol ingestion and heavy smoking habits and stress
duodenal
Which type of ulcers occur at age 35-45
duodenal
Which ulcers may be relieved with food
duodenal
H. Pylori accounts for 90-95% of
duodenal ulcers
What is carafate used for?
duodenal ulcers
Which type of ulcers are more common (80%)
duodenal ulcers
GER/GERD Complications - ______________ (irritation of the lining of the esophagus) - _______________ __________ (resulting from scar tissue) - ____________ esophagus (precancerous lesions) - ______________ - ______________ (pneumonia) - Bronchospasms - Laryngospasms - _____________ of esophagus - Upper _____ ____________ - ___________ erosion
esophagitis, esophageal strictures, barrett's, bronchitis, aspiration, ulceration, GI bleeding, dental
How often should you test BG for someone with diabetes who is ill?
every 3-4 hours
Hypertensive Crisis: Causes - ______________ of chronic HTN - ____________ or _____________ - ________ (cocaine, amphetamines) - ____________ ________ (KNOW) - __________ injury (trauma) - Acute __________ __________
exacerbation, preeclampsia, eclampsia, drugs, rebound HTN, head, aortic dissection
Encourage ________ and ________ in ill diabetic patient
fluids, rest
OUTPATIENT- SEVERE hypoglycemia treatment - Administer ___________ _____ or ____ - _______ patient on _______ after administration-- danger of ___________ - Notify PCP immediately, and follow orders - If still unconscious, ______ ______ or transport to ______ - After recovery, have patient _________ a __________ __________
glucagon IM, SQ, turn, side, vomiting, call 911, ED, ingest, complex carbohydrate
Named for the effects on glucose metabolism. They inhibit the inflammatory response and are considered anti-inflammatory.
glucocorticoids
Adrenal Gland Hormones - Sugar (______________) - Salt (_______________) - Sex (_____________)
glucocorticoids, mineralocorticoids, androgens
one of the simple sugars that serves as a major source of energy. It is found in foods (e.g., refined sweets) and also is the final breakdown product of complex carbohydrate metabolism in the body; it is commonly referred to as dextrose
glucose
Obesity Diagnostic tests (for comorbidities) - ___________ and ___________/triglycerides - _____________ function tests - ___________ x-ray: ___________ __________
glucose, cholesterol, liver, chest, enlarged heart
Be aware that for severe hypoglycemia, IV _____________ is the treatment of choice because it acts faster than ______________
glucose, glucagon
a polysaccharide that is the major carbohydrate stored in animal cells
glycogen
breakdown of glycogen into glucose
glycogenolysis
Lifestyle Modifications for Infants with GER - Infants who are __________ with no ___________ complications do not need modifications - Change to _______ formula - Frequent ____________ - ___________ more __________ feedings - ____________ feedings with _______ ________ - ___________ monitoring
growing, respiratory, soy, burping, smaller, frequent, thicken, rice cereal, weight
What is the most common complication from PUD
hemorrhage
DKA: hyperkalemia or hypokalemia
hyperkalemia (•no insulin to draw the K into the cells)
Extreme hyperglycemia that occurs without ketosis or acidosis
hyperosmolar hyperglycemic state
a metabolic complication of uncontrolled type 2 diabetes, similar in severity to diabetic ketoacidosis but without ketosis and acidosis
hyperosmolar hyperglycemic syndrome
What are some modifiable risk factors someone with diabetes can change to help prevent vascular complications
hypertension, dyslipidemia, smoking
Term used to indicate either hypertensive urgency or emergency
hypertensive crisis
Signs and symptoms of _____________: - Reduced cognition - Tremors - Diaphoresis - Weakness - Hunger - Headache - Irritability - Seizure
hypoglycemia
a blood glucose level of less than 70 mg/dL or above 50 mg/dL with signs and symptoms of hypoglycemia
hypoglycemia
There will be (increased/decreased) BUN with DKA
increased
Symptoms of gastric outlet obstruction from PUD
increased gastric residual volume, vomiting, constipation
HHS Neurologic symptoms occur due to
increased serum osmolality
Cholecystitis: Manifestations In addition to pain: - ________________ - __________ - _______________ - ____________ & ___________ - Restlessness - _______________
indigestion, fever (leukocytosis), jaundice, nausea, vomiting, diaphoresis
Addisonian Crisis: Causes - Stress, __________ - Post _________ _________ - __________ _________ of __________
infection, adrenal surgery, abrupt withdrawal, corticosteroids
ERCP: Nursing Implementation Pre-Op - Check __________ ________ - _________ after _________ and day of test Post-Op - Assessment for ______________ - ______________ for several hours - _______ until return of _____ _________ - Patient teaching - follow-up if stent needs removed or changed Complications include pancreatitis, perforation, infection, and bleeding
informed consent, NPO midnight, complications, bedrest, NPO, gag reflex
Chronic Use of Corticosteroids can lead to: - Adrenal _____________ - ___________ - Risk for _____________ - Glucose ____________ - F&E Disturbances - _______________ disturbances
insufficiency, osteoporosis, infection, intolerance, psychological
A naturally occurring hormone secreted by the beta cells of the islets of Langerhans in the pancreas in response to increased levels of glucose in the blood.
insulin
Delivers a basal rate of regular or rapid-acting insulin AND/OR Program to deliver a bolus dose with each meal **Some models also continuously monitor blood glucose levels
insulin pump
Sulfonylureas (glipizide) increases the number and sensitivity of
insulin receptors
Gastric Ulcers: Manifestations - Pain in _______ ___________, ________, and _________ _____________ - "___________", "___________" pain - ____-____ _______ _______ a meal - If the ulcer is through the __________, pain is worse when ________
left epigastrium, back, upper abdomen, burning, gaseous, 1-2 hour after, mucosa, when eating
Metabolic Syndrome Pathway OBESITY can lead to __________ __________ which can lead to 1. Impaired ___________ _________ (leads to type 2 DM) 2. (increased/decreased) coagulation and (increased/decreased) fibrinolysis 3. _______________ 4. Hyper_____________ 5. Increased ____________ and decreased HDL All of which leads to: _____________ ____________
insulin resistance, glucose tolerance, increased, decreased, hypertension, insulinemia, triglycerides, cardiovascular disease
Type I diabetes is treated with
insulin therapy
Enough ___________ is present with HHS to prevent the breakdown of fats for energy, thus preventing _____________
insulin, ketosis
Which type of insulin is a sterile suspension of zinc insulin crystals that is cloudy or opaque
intermediate-acting
GER/GERD Predisposing Conditions - Incompetent _____________ ____________ _____________ (certain medications & foods exacerbate this) - Decreased esophageal ____________ - Decreased ___________ ___________ - Increased _________________ _________ (obesity, hiatal hernia)
lower esophageal sphincter, clearance, gastric emptying, intraabdominal pressure
Detectable occlusion of the intestinal lumen
mechanical obstruction
The adrenal _________ secretes catecholamines that are involved in the stress response and prolong effects of SNS
medulla
Other oral agents that increase insulin production from the pancreas (not sulfonylureas)
meglitinides (repaglinide, nateglinide)
Ectopic ACTH production by tumors outside the hypothalamic-pituitary-adrenal axis (usually of the lung or pancreas) is most common in _____.
men
Collection of risk factors that increase an individual's chance of developing cardiovascular disease, stroke, and diabetes
metabolic syndrome
Several Co-morbidities of Type 2 Diabetes Mellitus are known collectively as __________ ___________: - Abdominal obesity - Hypertriglyceridemia - Coronary artery disease - Dyslipidemia - Hypertension - Increased risk for thombrotic events
metabolic syndrome
Insulins restore the diabetic patient's ability to: - _______________ carbohydrates, fats, and proteins - Store ____________ in the __________ - Convert _____________ to ______ stores - Does not ____________ defects in insulin receptor _____________
metabolize, glucose, liver, glycogen, fat, reverse, sensitivity
Complications of ________________: - Nausea, diarrhea, and anorexia - Vitamin deficiencies (B12, folic acid) - Lactic acidosis (rare but potentially fatal)
metformin
Which medication (not glucagon) does NOT cause hypoglycemia?
metformin
What is the main gastrointestinal stimulant (generic)?
metoclopramide (Reglan)
Beta-blocker example
metoprolol (Toprol)
Awake, hungry, irritable, shaky, weak, headache
mild hypoglycemia
GERD is defined as _______ symptoms more than _________ per week or _________ symptoms ________ per week
mild, twice, severe, once
Rule of 15 is used for
mild-moderate hypoglycemia
Starchy Carbs - 1 c _______ - 6 saltines w/ _____ or ________ - 1/2 c __________ ________ - 1 slice _______ w/ _____
milk, PB, cheese, chocolate milk, bread, PB
Steroid hormones essential for maintaining fluid and electrolyte balance.
mineralocorticoids
For GASTRIC ulcers only
misoprostol/Cytotec
Autonomic Neuropathy: Urinary Effects - ____________ __________ - Urinary __________ - ___________ or difficulty voiding - _________ stream of urine
neurogenic bladder, retention, infrequent, weak
Non-mechanical obstructions can result from _____________ or ____________ disorders
neuromuscular, vascular
Type 1 DM: Exercise - Important for normal G&D - Encouraged and ___________ ___________ - Enhances ____________ ____________ - __________ blood glucose levels * Eat a _________ __________ exercising or exercise _________ a meal - Insulin adjustment if needed - Check BG _________, ___________, and __________ activity
never restricted, insulin absorption, lowers, snack before, after, before, during, after
Can children take antacids?
no
is thiazide diuretic k-sparing
no
Obstruction that results from a neuromuscular or vascular disorder
non-mechanical
Long-acting insulin: peak
none
GER may be considered __________ for some children and adults after meals
normal
PUD: Perforation treatment - _______ ACP Immediately! - ______ ________ to _________ - _____________ - ___ __________ --- usually __________ ____________ - Prepare for ____________ __________
notify, NG tube, suction, antibiotics, IV fluids, Lactated Ringer's, emergency surgery
The science of optimal cellular metabolism and its impact on health and disease; the sum of processes by which on takes in and utilizes nutrients
nutrition
PUD Surgery: Postoperative care - Post-surgical patient is at risk for ___________ __________ - Maintain ____ _______ until fluid can be tolerated; ____ ________ before then - Careful GI assessment and incision care - ___________ portions of ________ and ________ daily (small, frequent meals) - ______ _____________ - Restricted _________ with meals - ___________ amounts of _________ and _______ - ___ ___________ of ________ after each meal
pernicious anemia, NG tube, IV fluids, small, fluid, food, low carbohydrates, sugar, moderate, protein, fat, 30 minutes, rest
Nutritional status assessment component? Physical appearance, muscle mass, and strength, dental or oral health, cognitive status
physical examination (helps to assess nutritional status)
Addison's D/C Teaching - Client lacks endogenous corticosteroids which leads to an inability of __________ reaction to _____________ - ____________ replacement therapy required - Must wear ________ _________ ________ or have ID card - Short-term use of steroids is ___________ until body produces its own again
physiological, stressors, lifetime, medic alert bracelet, tapered
The hypothalamus and ___________ gland integrate communication between the nervous and endocrine system
pituitary
Excessive eating; it is a common symptom of uncontrolled diabetes.
polyphagia
increased frequency or volume of urinary output; it is a common symptom of diabetes
polyuria
What are the three P's of Type I DM
polyuria, polydipsia, polyphagia
Complications of Gastric Surgery A bolus of fluid high in carbs goes into small intestine causing excessive amounts of insulin into circulation (S/S sweating, weakness, mental confusion, palpitations, tachycardia, and anxiety)
postprandial hypoglycemia
Autonomic Neuropathy: CV Effects - _____________ ____________ - Resting _____________ - Painless ___________ _____________
postural hypotension, tachycardia, myocardial infarction
blood glucose is higher than normal, but not high enough to be considered diabetes
prediabetes
Major contraindication Cytotec
pregnancy
What are the three contraindications for glipizide?
pregnancy, lactation, diabetic ketoacidosis
intermediate-acting insulin is usually combined with ______________ insulin to reduce the number of insulin ________________ per day
regular, injections
When drawing up two types of insulin in one syringe, always withdraw the ____________ or ___________-________ insulin before the ______ insulin
regular, rapid-acting, NPH
Cholecystitis: Surgical Therapy Open (incisional) cholecystectomy - _____________ of __________ through ________ ________ ___________ - ___-_________ inserted into ________ ________ _________ to ensure _________ of ________ and to allow ________ ________ to __________
removal, gallbladder, right subcostal incision, T-tube, common bile duct, patency, duct, excess bile, drain
Preventing Hypoglycemia - Don't ______ or _________ meals or snacks (if you take insulin or oral diabetes meds be consistent with amount eaten and timing) - __________ your ______ ______ (may check and record BG several times a week or day) - __________ medication carefully and take it ____ _______ - ________ your medication or eat ________ snacks if you increase physical ________ - Eat a meal or snack with ___________ - ________ your low glucose __________ (This can help health care team to see patterns contributing to hypoglycemia) - ________ some form of diabetes ____ so that in emergency others will know you have diabetes)
skip, delay, monitor, blood sugar, measure, on time, adjust, additional, activity, alcohol, record, reactions, carry, ID
Growth hormone (GH), thyroid-stimulating hormone (TSH), and prolactin levels peak during
sleep
Most mechanical obstructions occur in the
small intestine
GER/GERD Lifestyle Modifications- Adults - _______, ___________ meals (4-6 per day) - Drink adequate _________ _______ ________ to aide food passage - Eat ___________ and ______ well to add saliva to the food - Avoid extremely _____ or ______ foods, ________, fats, alcohol, coffee, chocolate, and citrus - Avoid eating and drinking for _____ ________ before __________ to prevent ____________ ____________ - _____________ the head of the bed - Lose ________ if overweight to decrease the gastroesophageal ____________ gradient - Avoid _____________ and salicylates
small, frequent, fluids with meals, slowly, chew, hot, cold, spices, 3 hours, retiring, nocturnal reflux, elevate, weight, pressure, tobacco
Utilize ________ ________ ______ and group _________ for nursing implementation of weight loss interventions
smart phone apps, therapy
Obesity: Psychosocial Factors Eating habits are related to: - Marketing - ___________ environment - Family ___________ - ________ or ___________ - Availability of food - _____________ - Level of _____________
social, traditions, stress, depression, association, activity
Hypoglycemia TIRED acronym
tachycardia, irritability, restlessness, excessive hunger, diaphoresis
Hormones exert their effects on
target tissue
Other oral agents, improve insulin sensitivity so no hypoglycemia concerns but linked to cardiovascular problems so rarely used
thiazolidinediones (pioglitazone, rosiglitazone)
What is the best way to reduce risk for vascular complications in diabetic patients
tight or intensive therapy
Diagnostic Testing: Endocrine Important to put ________ on the lab slip and sample with hormones that fluctuate with ____________ ____________
time, circadian rhythm
Several hormones secreted by the anterior pituitary are referred to as __________ hormones, including TSH, ACTH, FSH, LH, ICSH
tropic
Diabetes mellitus that is a genetically determined autoimmune disorder characterized by a complete or nearly complete lack of insulin production; it most commonly arises in children or adolescents.
type 1 diabetes mellitus
Cause of Cholelithiasis
unknown
When should a person with type 1 diabetes have a dilated eye exam and then how often should they have exams thereafter?
within 5 years of onset of diabetes, annually
Adrenal tumors are most common in __________, ____ to ____ years of age.
women, 20, 40
Clinical Manifestations: Type 2 DM - May go _________ with ___________ hyperglycemia - May have typical ________ ___ symptoms - Typically ____________ - Chronic hyperglycemia - Fatigue, recurrent __________, vaginal yeast infections or candida infections, ______________ wound healing, _________ changes - Often diagnosed during routine physical
years, undetected, type 1, overweight, infections, prolonged, vision
Long duration, eroding through the muscular wall with the formation of fibrous tissue, present continuously for many months or intermittently throughout the person's lifetime
chronic peptic ulcer
Produce and release chemical messengers called hormones (hypothalamus, pituitary, thyroid, parathyroid glands, adrenals, pancreas, ovaries, testes, pineal gland)
endocrine glands
4 actions with pre-diabetes to prevent the development of type 2 DM
lose weight, exercise, monitor a1c, eat healthy
What are the 5 exogenous causes of cushing's (not steroid use)
organ transplant, chemotherapy, autoimmune diseases, severe allergies, chronic inflammatory condition
Primary or secondary cause of Addison's? Suppression of the adrenal gland to produce endogenous cortisol due to long-term administration of exogenous corticosteroids; abrupt steroid withdrawal; hypophysectomy
secondary
Rapid-acting insulin: onset
10-30 minutes
Peptic Ulcer: Diagnostic Studies - _____________ with or w/o biopsy - Tests for ___ _________ - __________ ________ studies - ___________ analysis - Labs: ________, __________ ________ studies, and ________ examination
endoscopy, H pylori, barium contrast, gastric, CBC, liver enzyme, stool
Prediabetes is defined as fasting plasma glucose levels higher than or equal to _______ mg/dL or less than ________ mg/dL
100, 126
Hypoglycemia by age: * Ages 0-5: < _____ * Ages 6-12: < _____ * Ages 13+: < ______
100, 80, 70
Intervention for urinary retention autonomic neuropathy and what risk does it impose
self-catheterization, infection
Type II Diabetes is defined as FBS > _______ mg/dL
126
Type 1 DM: Treatment Multidisciplinary Approach Glucose monitoring; goal, near normal levels of < _____ mg/dL * 13-19 years: _____-_____ * 6-12 years: ______-______ * <6 years: _____-______ Laboratory measurement of ____________ ______, goals: * Under 19 yr: <= ______ % * Goal of ______% if no excessive hypoglycemia Insulin therapy - __________ control: decreases risk of long-term complications - Selection of appropriate insulin preparation
126, 90-130, 90-180, 100-180, hemoglobin A1C, 7.5, 7, glycemic
The nurse is reviewing laboratory results for the clinic patients to be seen today. Which patient meets the diagnostic criteria for diabetes mellitus? A. A 48-year-old woman with a hemoglobin A1C of 8.4% B. A 58-year-old man with a fasting blood glucose of 111 mg/dL C. A 68-year-old woman with a random plasma glucose of 190 mg/dL D. A 78-year-old man with a 2-hour glucose tolerance plasma glucose of 184 mg/dL
A
surgery that reduces acid production
vagotomy
Obstruction that results from an interference with blood supply to a portion of the intestines
vascular obstruction
The adrenal glands are small, paired, highly ____________ glands located on the _________ portion of each ____________
vascularized, upper, kidney
DKA or HHS or both Extremely severe fluid deficit
HHS
DKA or HHS or both Hyperglycemia, >600 mg/dL
HHS
The nurse is teaching a 60-year-old woman with type 2 diabetes mellitus how to prevent diabetic nephropathy. Which statement made by the patient indicates that teaching has been successful? A. "I can help control my blood pressure by avoiding foods high in salt." B. "Smokeless tobacco products decrease the risk of kidney damage." C. "I should have yearly dilated eye examinations by an ophthalmologist." D. "I will avoid hypoglycemia by keeping my blood sugar above 180 mg/dL."
A
DKA or HHS or both Mortality rate 10-15%
HHS
DKA or HHS or both Type 2 DM
HHS
DKA or HHS or both focal neurologic deficit (stroke-like) common
HHS
What is a common surgical treatment for infants with GERD?
Gastric tube, jejunal tube, or both (G-tube, J-tube, G/J tube)
3 antacid examples
Gaviscon, Mylanta, Tums
What are ACE inhibitors used for?
HTN
Cushing's or Addison's (C/A) Hyperpigmentation
A
Cushing's or Addison's (C/A) Hypoglycemia
A
Cushing's or Addison's (C/A) Hyponatremia
A
Cushing's or Addison's (C/A) Hypotension
A
Cushing's or Addison's (C/A) Nausea and vomiting
A
Cushing's or Addison's (C/A) Orthostatic hypotension -- dizziness
A
Cushing's or Addison's (C/A) Salt cravings
A
A client received 14 Units of regular insulin (Humulin R) before breakfast at 8 am. If the client doesn't eat any breakfast, what symptoms should the nurse assess for at 10 am. A. Profuse sweating and lethargy B. Fatigue and blurred vision C. Excessive amounts of urine D. Hunger and intense thirst
A
Cushing's or Addison's (C/A) Adrenal atrophy (autoimmune, infection, tumor metastasis)
A
Cushing's or Addison's (C/A) Constipation and diarrhea
A
Cushing's or Addison's (C/A) Dehydration/hypovolemia
A
The nurse teaches a 38-year-old man who was recently diagnosed with type 1 diabetes mellitus about insulin administration. Which statement by the patient requires an intervention by the nurse? A. "I will discard any insulin bottle that is cloudy in appearance." B. "The best injection site for insulin administration is in my abdomen." C. "I can wash the site with soap and water before insulin administration." D. "I may keep my insulin at room temperature (75 o F) for up to a month."
A
A nurse is assessing a client who is admitted for elective surgery and has a history of Addison's disease. Which of the following findings should the nurse expect? A. Hyperpigmentation B. Intention tremors C. Hirsutism D. Purple Striations
A (Addison's disease is an endocrine disorder that occurs when the adrenal glands do not produce enough of the hormone cortisol, and in some cases, the hormone aldosterone. The disease is characterized by weight loss, muscle weakness, fatigue, low blood pressure, and hyperpigmentation (darkening) of the skin in both exposed and non-exposed parts of the body.)
A nurse is caring for a client who has Cushing's disease. The nurse should identify that clients who are at risk for which of the following? (Select all that apply). A. Infection B. Gastric ulcer C. Renal calculi D. Bone fractures
A, B, D (Suppression of the immune system places the client at risk for infection. Clients are at higher risk for bone fractures due to decrease calcium absorption which leads to osteoporosis. These clients are a risk for gastric ulcers due to the overproduction of cortisol inhibits the production of the protective lining in the stomach. Clients with Cushing's do not have a risk for the development of renal calculi.)
A nurse is assessing a client who has Cushing's syndrome. Which of the following interventions should the nurse expect to perform? (Select all that apply.) A. Assess blood glucose level B. Assess for neck vein distension C. Monitor for an irregular heart rate D. Monitor for postural hypotension E. Weight the client daily
A, B, E
A 78-year-old patient is admitted with a BP of 180/98 mm Hg. Which age-related physical changes may contribute to this patient's hypertension (select all that apply)? A. Decreased renal function B. Increased baroreceptor reflexes C. Increased peripheral vascular resistance D. Loss of elasticity in large arteries from arteriosclerosis E. Increased adrenergic receptor sensitivity
A, C, D (The age-related changes that contribute to hypertension include decreased renal function, increased peripheral vascular resistance, increased collagen and stiffness of the myocardium, and decreased elasticity in large arteries from arteriosclerosis.)
Fat-soluble vitamins
A, D, E, K
Help relax your veins and arteries to lower your blood pressure. These medications prevent an enzyme in your body from producing angiotensin II, a substance that narrows your blood vessels. This narrowing can cause high blood pressure and force your heart to work harder.
ACE inhibitors
Which anti-hypertensives are prescribed to diabetic patients
ACE inhibitors (lisinopril), ARBs (losartan, Cozaar)
Most common cause of endogenous Cushing syndrome.
ACTH-secreting pituitary adenoma
What are two endogenous causes of Cushing's Syndrome that aren't iatrogenic admin of corticosteroids
adrenal carcinoma, congenital adrenal hyperplasia
___________ ____________, as compared to other ethnic groups, have the highest prevalence of HTN in the world
African Americans
Secretes GH, prolactin, and other tropic hormones
Anterior pituitary
Treatment for H. Pylori
Antibiotics (clarithromycin, amoxicillin, etc.)
Gallbladder disease is more common in ___________ Americans and __________ Americans. There is an especially high incidence of gallbladder disease in the Native American population, particularly in the _________ and ______ tribes.
Asian, African, Navaho, Pima
High blood glucose damages what?
Blood vessels, nerves
He presents with nausea and vomiting. Abdomen is distended. Bowel sounds are present, slightly hyperactive. He has not had a bowel movement in 6 days. Consider AD's symptoms, and explain why the physician (and you!) would suspect a bowel obstruction rather than Cholelithiasis. Answer like this:: If it were cholelithiasis he would...... But instead, AD............ The way these are kind of similar.....
CHOLELITHIASIS SIGNS If it were cholelithiasis, AD would have more PAIN in the RUQ/back. More likely female. He would report fat intolerance and possibly be jaundiced. OBSTRUCTION SIGNS But instead AD...... He has not had a bowel movement in 6 days. No complaints of pain. SIMILAR. Nausea/vomiting. Abdominal distention.
Regulation of hormonal secretion Nervous system control - Initiated by ______ and implemented by ________ - Directly affects some __________ glands - ________, ______, and other stressors can stimulate the nervous system to modulate hormone secretion
CNS, SNS, endocrine, pain, fear
Long-term Use of Corticosteroids - __________- relaxes smooth muscle in the lungs - _______-_______ COPD - _____________ diseases
COPD, end-stage, autoimmune
Intestinal Obstruction: - ______ scan and ___________ __________ - Sigmoidoscopy or ____________ - _______, ________, ________
CT, abdominal x-ray, colonoscopy, CBC, WBC, BUN
Diagnostics for Cushing's syndrome
Checking serum levels of cortisol, 24-hour urine collection for free cortisol (increased levels --> Cushing's)
DKA or HHS or both Hyperglycemia, >300 mg/dL
DKA
DKA or HHS or both Kussmaul respirations, ketonuria
DKA
36 hours (1.5 days) after surgery, you are once again A.D's nurse A.D. reports that he feels slightly nauseated. His abdomen is soft and only tender at his incision site. You auscultate and hear no bowel sounds. At this time, you are concerned A.D. has developed a bowel obstruction. Which type of bowel obstruction would you expect? Explain WHY.
Due to the fact that A.D. has no bowel sounds, the most likely scenario is that he has a non-mechanical bowel obstruction. More specifically, a paralytic ileus caused by abdominal surgery. (Hopefully, this ileus will resolve on its own. Anesthesia and surgery on the abdomen can cause the GI system to "shut down" in response to this stress. For some patients, it can unfortunately take a while for the GI system to wake up again.)
Main complication of Roux-en-Y Gastric Bypass
Dumping syndrome
Main question to ask for nursing assessment of patients who may be undernourished
Have you unintentionally lost weight in the last 6 months?
Nutritional status assessment component? Personal and family history Acute or chronic illnesses Current medications Herbs, supplements Depression Diet history
Health history
Decreases HCl acid secretion by blocking action of histamine on H2 receptors
Histamine Receptor blockers
What are potassium-sparing diuretics used for?
Hypertension, hyperaldosteronism, edema, diuretic-induced hypokalemia
What are the two main treatments for MS
Lifestyle modification, medications
Stage II Hypertension interventions
Lifestyle modifications and two-drug combination for most (usually thiazide-type diuretic and ACE inhibitors, ARB, BB, or CCB)
Individual Risk Factors: Malnutrition - Genetics - _____________ - Inconsistent __________ patterns - Conditions affecting ________ intake - Conditions associated w/impaired __________ - Conditions associated with impaired __________ - _____________
Lifestyle, eating, oral, digestion, metabolism, medications
Cholecystitis: Collaborative Care -Pain control: ___________ and ___________ (these decrease secretions and counteract smooth muscle spasms) - Infection control: ____________ treatment or _____________ (to drain purulent material from the obstructed gallbladder) - Maintenance of F&E: _____ _________ with _________ __________ if severe nausea/vomiting Treatment is mainly supportive and symptomatic.
NSAIDs, anticholinergics, antibiotic, cholecystostomy, NG tube, gastic decompression
Treatment of DKA: - Rapid IV of _________ (dextrose added when BG level reaches 250-300 mg/dL) - Insulin IV: ________-_______ ONLY - Correct _____________ imbalances - Watch for lowering __________ because as insulin is provided more will enter the cells causing lowered levels of this electrolyte - Monitor electrolytes and for _______: If the BG falls too far or too fast before the brain has time to equilibrate, water is pulled form the blood to the CSF and the brain, causing _______________ ____________
NaCl, short-acting, electrolyte, potassium, ICP, cerebral edema
a surgical technique used to suture the fundus of the stomach around the esophagus to prevent reflux
Nissen fundoplication
What are PPIs used for?
PUD and GERD
Autonomic Neuropathy: Reproductive Effects - ___________ ___________ - Decreased _________ - ____________ and nonspecific __________
erectile dysfunction, libido, candidal, vaginitis
What is glucagon's therapeutic use?
Treats hypoglycemia from an insulin overdose
Intussusception diagnosing tests (2)
X-ray, ultrasound
Match the characteristic with the correct type of insulin. 1. Mealtime carb coverage, given as close to mealtime as possible. 2. Typically injected once per day 3. Usually given 2-3 times per day, peaks at about 4-12 hours a. Rapid/Short acting -- lispro (Humalog) or regular (Humulin R) b. Intermediate Acting -- NPH (Humulin N) c. Long Acting -- glargine (Lantus)
a, c, b
What is the fastest absorption sites for insulin in order
abdomen, arm, thigh, buttock
Causes of Paralytic Ileus: - ____________ _____________** - _____________ or other inflammatory process - ______________ abnormalities (HYPOKALEMIA) - ____________ ____________*
abdominal surgery, peritonitis, electrolyte, spinal fractures
What is the most common diagnostic test ordered to diagnose a bowel obstruction?
abdominal x-ray
Metformin decreases blood glucose in three ways: 1. Decrease ________________ of glucose from the ___________ 2. Decrease ______________ of glucose by the _____________ 3. Increase ____________ of insulin _______________ in the ____________
absorption, intestines, synthesis, liver, sensitivity, receptors, tissues
PUD: Etiology & Pathophysiology - __________ __________: An increase in acid in the gastric mucosa causes inflammation and histamine release, which leads to vasodilation, increased capillary permeability, and more secretion of acid and pepsin - ______________ ___________: bacterial infection - Medical-Induced Injury: __________ and __________ - Lifestyle factors: ___________, ________, psychologic _________, and __________
acid environment, helicobacter pylori, NSAIDs, aspirin, alcohol, coffee, stress, smoking
Burns, traumas, and major infections can cause this (in relation to nutrition)
acute disease/injury-related malnutrition
What are three things that may evoke a counter regulatory hormone response resulting in hyperglycemia
acute illness, injury, surgery
Superficial erosion with minimal inflammation, short duration, and resolves quickly when cause is identified and removed
acute peptic ulcer
Which body shape poses risk for heart disease, diabetes, breast CA, endometrial CA, HTN, HLD
android
excess body fat that is placed predominantly within the abdomen and upper body, as opposed to the hips and thighs
android obesity
How often should diabetic do exercise stress testing including ECG, stress echo, etc?
as needed based on risk factors
DKA Treatment •Rapid ______________ •___________ Support •____________ ____________ •Obtain _____ ________ & Labs •_________ resuscitation •________ _________ ______
assessment, oxygen, cardiac monitor, IV access, fluid, regular insulin drip
Gastric & Duodenal ulcers: Both may be ___________ until complications occur
asymptomatic
HTN: Clinical Manifestations - Mainly _______________ Secondary Symptoms - Fatigue - Reduced ___________ tolerance - ____________ - _______________ - ___________ - ______________
asymptomatic, activity, dizziness, palpitations, angina, dyspnea
When should a person with type 2 diabetes have their vision checked through a dilated eye examination and then how often should they have exams thereafter?
at time of diagnosis, annually
Primary causes of Addison's: - Idiopathic ____________ dysfunction - ____________ - ___________ectomy - ____________ of the abdomen
autoimmune, cancer, adrenal, radiation
Cholelithiasis Develops when ___________ that keeps __________, _______ _______, and ___________ in solution is altered, leading to _________ *** _______ secreted by the ________ is ___________ with ___________
balance, cholesterol, bile salts, calcium, precipitation, bile, liver, supersaturated, cholesterol
Long-acting insulin is sometimes referred to as ____________ ____________ because it keeps blood glucose level consistent
basal insulin
____________-____________ insulin dosing is the preferred method of treatment for hospitalized patients with DM, because it mimics a healthy pancreas by delivery basal insulin constantly as a basal and then as needed as a ___________
basal-bolus, bolus
insulin is released from the ________ cells of the pancreas
beta
Causes the heart to beat slower, with less force. It slows the heart mainly by blocking the action of epinephrine.
beta blockers
For the use of sulfonylureas, _______ _______ function must be present
beta cell
Type 1 DM - Absolute insulin deficiency due to destruction of _________ __________ - Onset typically in ____________ and adolescence but can occur at any age - Most childhood cases of DM are _________ ____
beta cells, childhood, type 1
Which oral agents: - Reduces glucose production by the liver - Enhances insulin sensitivity at tissues - Improves glucose transport into cells - May cause weight loss - Beneficial against plasma lipids - May damage kidneys
biguanides (metformin)
Cortisol Functions - Regulation of _________ _________ - ___________ of inflammatory action - Support in response to __________ - Promotes ___________
blood sugar, inhibition, stress, metabolism
Diagnostic Testing: Endocrine - Labs: _________ and __________ provide direct measurement of the hormone level, or by evaluating blood or urine components affected by the hormone e.g. _____________
blood, urine, electrolytes
DKA or HHS or both Fluid deficit/fluids required
both
DKA or HHS or both Mental status changes
both
DKA or HHS or both Pre-renal azotemia (lots of urinating)
both
Because biguanides (metformin) decreases intestinal absorption of glucose, the patient will have an increased amount of _____________ _______________.
bowel movements (sometimes diarrhea)
Intestinal Obstruction: Nursing Assessment - ________ ________ - Abdominal _________ - Signs of ___________ - _______ and _______ - __________ - Labs
bowel sounds, girth, tenderness, intake, output, pain
lower your blood pressure by preventing calcium from entering the cells of your heart and arteries. Calcium causes the heart and arteries to contract more strongly. By blocking calcium, calcium channel blockers allow blood vessels to relax and open.
calcium channel blockers
List three macrovascular complications of DM
cerebrovascular disease (risk of stroke), cardiovascular disease (risk of MI), peripheral vascular disease (risk of peripheral neuropathy)
Intussusception is most common in
children younger than 2 years of age
HTN: Complications - ___________ ___________ __________ mainly due to __________ ___________ ___________ - Heart ____________ - _________________ disease - TIA's, stroke - _______________ vascular disease (one or more major pulses in the extremities are reduced or absent; intermittent claudication) - _____________________ - _____________ damage (hemorrhages or exudates, with or without papilledema, blurring of vision, loss of vision)
coronary artery disease, left ventricular hypertrophy, failure, cerebrovascular, peripheral, nephrosclerosis, retinal
The adrenal ___________ is the outer part of the adrenal gland. It secretes several __________ hormones, including glucocorticoids, mineralocorticoids, and androgens
cortex, steroid
Hormones synthesized by the adrenal cortex excluding androgens
corticosteroids
These drugs stop, control or reduce the inflammatory response (local or systemic) in any part of the body by suppressing the immune system
corticosteroids
Undernutrition: Labs *prealbumin is best marker for malnutrition - Iron (increased/decreased) - RBCs (increased/decreased) - Albumin/pre-albumin** (increased/decreased) - Electrolytes - BUN and Creatinine - Liver enzymes - WBCS (increased/decreased)
decreased, decreased, decreased, decreased
Nissen Fundoplication- Post Surgical Care - _________ ________, control n/v and _______ - Start on __________ diet and slowly advance to ________, then __________ - Side effects: Difficulty __________, __________ and increased __________
deep breathing, pain, liquid, soft, solids, swallowing, bloating, flatulence
Type II DM is caused by insulin _________ and insulin ________. Many tissues are resistant to insulin: Reduce number of insulin __________, or insulin receptors are less _____________
deficiency, resistant, receptors, responsive
When taking corticosteroids, there is normally a slow ____________ of the body. Trade off is treatment with a steroid in a chronic or autoimmune disorder will usually keep the body healthier than if the ___________ process was left unchecked
deterioration, inflammatory
A severe metabolic complication of uncontrolled diabetes that, if untreated, leads to diabetic coma and death.
diabetic ketoacidosis
The major complication associated with Type I Diabetes is
diabetic ketoacidosis
Mild cases of hypoglycemia can be treated with ________- higher intake of __________ and lower intake of _____________- to prevent rebound postprandial hypoglycemia
diet, proteins, carbohydrates
Malabsorption can be due to: - Decreased ___________ _________ - _______ side effects - Decreased _________ __________ _________
digestive enzymes, drug, bowel surface area
The dose amount and duration of use of corticosteroids dictate the extent of dependency and damage to the body. Watch for _________, _________ _______, _________ wound healing, _____________, and infections
edema, peptic ulcers, delayed, osteoporosis
HTN: Gerontologic Considerations - Loss of ____________ in the large arteries --- _______________ - Increased ___________ and ___________ of the ____________ - Increased ___________ _________ ________ - Decreased _________ function
elasticity, atherosclerosis, collagen, stiffness, myocardium, peripheral vascular resistance, renal
Main cause of vascular obstruction
emboli and atherosclerosis of the mesenteric arteries
Hypertensive crisis can lead to either hypertensive urgency or hypertensive ___________, the latter of which can lead to hypertensive ______________
emergency, encephalopathy
Intervention for normal BP
encourage lifestyle modification
Chronic complications of diabetes are primarily those of ________-__________ ______________ from damage to blood vessels (______________) secondary to chronic ______________
end-organ disease, angiopathy, hyperglycemia
Diabetic nephropathy is the leading cause of what in the US?
end-stage renal disease
Therapeutic Management Type 1 DM - Nutrition - ___________ - ____________ measurement for ____________ - Illness management - Management of acute complications - Prevent or prolong time before long-term complications occur
exercise, morning, hyperglycemia
Do not inject insulin in site to be
exercised (example stay away from arms and legs day of tennis match)
These secrete their substances into ducts that then empty into a body cavity or onto a surface
exocrine glands
Patients affected with Type I DM need ______________ __________
exogenous insulin
Obesity: Geriatric Considerations - Decreased energy ____________ increases body _______ - _____________ age-related problems - ________ventilation - ______________ - _________________ problems Decreases ________ _________ by ____-____ _________ Decreases __________ of life
expenditure, fat, exacerbates, hypo, incontinence, cardiovascular, life expectancy, 6-7 years, quality
Cholelithiasis: Collaborative Care - _________________ _______-_______ ___________ ***If stones cannot be removed via ___________ - High-energy shock waves ___________ stones - Takes ___-___ _________ - Used in conjunction with ________ ________
extracorporeal shock-wave lithotripsy, endoscope, disintegrate, 1-2 hours, bile acids
Provides satiety and other energy source
fat
Nutritional status assessment component? Ability to perform ADLs, handgrip strength, performance test (timed walk test), chewing and swallowing ability
functional status
loop (non k-sparing) diuretic example
furosemide
Loop diuretic
furosemide (Lasix)
Hormonal factors during pregnancy may cause delayed emptying of the ___________, resulting in _______ of bile
gallbladder, stasis
What are the two most common complications of cholecystitis in older patients and those with diabetes
gangrenous cholecystitis, bile peritonitis
Cholecystitis: Complications - ______________ cholecystitis - _____________ ____________ - ____________titis - __________itis - ______________ ___________ - ____________ - _____________ ___________ --> _____________
gangrenous, subphrenic abscess, pancrea, cholang, biliary cirrhosis, fistulas, gallbladder rupture, peritonitis
Which type of ulcer causes pain in the left epigastrum, back, and upper abdomen
gastric
Hypertensive Emergency --> Hypertensive Encephalopathy Hypertensive emergency may be manifested as hypertensive encephalopathy, a syndrome in which a sudden rise in BP is associated with - ____________ - ____________ & ____________ - _____________ - Confusion - ___________ - __________ - ____________ vision - Transient ____________
headache, nausea, vomiting, seizures, stupor, coma, blurred, blindness
Pediatric focuses S/S (GER): Children - _____________ - ________________ pain - Non-cardiac _________ pain - Chronic ________ - Dysphagia - ______________ asthma - Recurrent ________________
heartburn, abdominal, chest, cough, nocturnal, pneumonia
GERD S&S: Adult - ____________ (pyrosis) - _____________ - ____________/wheezing - _____pnea - Postprandial _________ - Belching - Early __________ - __________________ - Hypersalivation - Nausea & vomiting - Feeling of _________ in throat or food stopping - Dys__________ - Sore throat
heartburn, dyspepsia, coughing, dys, bloating, satiety, regurgitation, lump, phagia
Hemoglobin molecules bound to glucose molecules; blood levels of hemoglobin A1C are used as a diagnostic measure of average daily blood glucose levels in the monitoring and diagnosing of diabetes; it is also called glycosylated hemoglobin and most commonly referred to as A1C.
hemoglobin a1c
What are the three main complications of PUD
hemorrhage, perforation, gastric outlet obstruction
Protrusion of a loop of an organ or tissue through an abnormal opening (mechanical obstruction)
hernia
Anti-secretory agents to decrease the secretion of HCl acid by the stomach (GER/GERD)
histamine 2 receptor antagonists
GER/GERD Diagnosis - __________ of symptoms - ____________ ___________ - _______________ - Esophageal ___________ - Gastric ____________/24 hour ____ _________ - _____________ (gastric emptying study)
history, barium swallow, endoscopy, biopsy, secretions, ph study, scintiscan
Populations at Risk for Malnutrition - All ____________ individuals are potentially at risk - Low ____________ status - Race - Ethnicity - Populations are greatest risk are: * _________ __________ ________ and _________ __________
hospitalized, socioeconomic, very young children, elderly adults
Diuretic of choice for hypertension
hydrochlorothiazide (Microzide)
DKA: - ________glycemia - _____________ in the serum - _________osis - _____________ - ______________ imbalances
hyper, ketones, acid, dehydration, electrolyte
Signs and symptoms of ____________: - Polyuria - Polydipsia - Dehydration - Fatigue - Fruit odor to breath - Kussmaul breathing - Weight loss - Hunger - Poor wound healing
hyperglycemia
a fasting blood glucose level of 126 mg/dL or higher or a non-fasting blood glucose level of 200 mg/dL or higher
hyperglycemia
Somogyi Effect - ___________ present upon waking - ____________ effect in which an ________ of insulin causes _________ between ___-___ am - ____________ _________ hormones released resulting in rebound ____________ in the am & ketosis - S/S: _________, night ________, __________ - Check BG levels between ___-___ am if suspected
hyperglycemia, rebound, overdose, hypoglycemia, 2-4, counter regulatory, hyperglycemia, headache, sweats, nightmares, 2-4
What are the three main complications of insulin?
hypoglycemia, hypokalemia, lipohypertrophy
HHS: hyperkalemia or hypokalemia
hypokalemia
DKA is precipitated by (6)
illness, infection, inadequate insulin, undiagnosed Type 1 DM, poor self-management, neglect
What is a risk factor for hypoglycemia in patients taking glipizide?
impaired liver or kidney function
Type 1 DM: Nutrition Management - Maintaining near-normal blood glucose by balancing food intake with ___________ and __________ - Achieving optimal ________ ________ levels - Providing appropriate ___________ for normal growth and development - Preventing and treating acute and long-term complications - Concentrated __________ are ____________ - Improving overall health through optimal nutrition
insulin, activity, serum lipid, calories, sweets, discouraged
Victoza® works in 3 ways like the hormone GLP-1 (7-37)b to help control blood sugar. -GLP-1 is normally released from your small intestine when you eat. It helps your pancreas produce more _______ - It helps keep your ________ from making too much ________. -GLP-1 also ______ _______ the process of food leaving your stomach, which helps control your blood sugar levels after meals.
insulin, liver, glucose, slows down
Occurs when intestinal contents cannot pass through the GI tract (small intestine or large intestine, partial or complete)
intestinal obstruction
The exact cause is unknown but in most cases, it is preceded by a virus that produces swelling of the lining of the intestine, which then slips into the intestine below (telescoping)
intussusception
________ ________ _____________ will determine if this is autoimmune type 1 diabetes or some other form of diabetes
islet cell autoantibody
areas of pancreatic cells that produce insulin and glucagon
islets of Langerhans
Cholelithiasis: Total Obstruction Symptoms - ____________ (lack of bile flow into duodenum) - _________ ________ urine (soluble bilirubin in urine) - __________-__________ stools (no bilirubin reaching small intestine to be converted to urobilinogen) - _________ (deposition of bile salts on skin) - Intolerance of _________ _________ (nausea, sensation of fullness, anorexia; no bile in small intestine) - _____________ tendencies (d/t lack of/decreased absorption of vitamin K) - _________________ (no bile salts in duodenum for fat emulsion/digestion)
jaundice, dark amber, clay-colored, pruritus, fatty foods, bleeding, steatorrhea
Provides long-term nutritional support, but has decreased absorption of meds and feedings and poses risk of skin breakdown, however, decreases risk of aspiration
jejunostomy tube
Fast-Acting Carbs - 1/2 c ________ or _______ - 5 lifesavers - 1 fruit roll up - 3 ______ glucose tabs -4 _______ glucose tabs - 4 starburst - 1 airhead - 15 skittles (1 fun bag size)
juice, soda, BD, Dex4
Organic chemical compounds produced through the oxidation of secondary alcohols (e.g., fat molecules), including dietary carbohydrates.
ketones
You should check urine for _________ with _______ voiding for an ill diabetic patient. They should report high levels to HCP
ketones, each
1 out of 4 diabetics will experience
kidney failure
Not Permanent, can be removed if needed Reduces size of stomach to feel full
lap band surgery
Sensory Neuropathy symptoms a. _________ of sensation/________ sensations (feeling of walking on pillows, ____________) b. ________ (burning, cramping, crushing, tearing, worse at __________) c. ______________ (tingling, burning, itching) d. ______________ (Increased sensitivity of senses) e. Complete or partial loss of ____________ to __________ and _____________
loss, abnormal, numbness, pain, night, paresthesia, hyperesthesia, sensitivity, touch, temperature
decreases hepatic glucose production, decreases intestinal absorption of glucose, and improves insulin sensitivity by increasing peripheral glucose uptake and utilization.
metformin
What are five examples of corticosteroids
methylprednisolone (Solu-Medrol), dexamethasone (Decadron), prednisone (Deltasone), hydrocortisone, cortisone
Some of these are electrolytes, includes Ca, Cl, Mg, Ph, K, Na, S, zinc, iron, and others
minerals
Synthetic prostaglandin that decreases acid secretion in the parietal cells of the stomach and provides some physical protection *Used primarily as adjunct to other medications
misoprostol/Cytotec
cold clammy skin, pale, rapid pulse, rapid/shallow respirations, change in mood, drowsiness
moderate hypoglycemia
What is the most important nursing intervention for glipizide?
monitor for signs of hypoglycemia (diaphoresis, tachycardia, fatigue, excessive hunger, tremors)
Prevention of Foot Ulcers/Amputation - Annual _____________ test - Carefully choose ________ that fit properly - Inspect feet _________ - No ___________ or ____/_____ extremes - Clean, _________, ________ socks - Skin hygiene and nail care, including ____________ - Report problems ____________
monofilament, shoes, daily, barefoot, hot, cold, cotton, white, moisturizing, immediately
Obesity Assessment Be sensitive and nonjudgemental - Rule out "__________" causes of obesity (___________ syndrome, hypothyroidism, polycystic ovary syndrome, hypothalamus tumor, etc.) - Vital signs - Respiratory and _____________ assessments - ________, ____________ ______________ - Mobility - Gynecomastia and ______________ (in men) - _________ use - _______________ list
organic, Cushing's, cardiovascular, BMI, waist circumference, hypogonadism, drug, medication
____________ is key to weight loss, and ___________ and encouragement are critical
motivation, coaching
Provides temporary nutrition and is used for suction and decompression of the abdomen. It provides good absorption of meds and tube feedings. Poses the risk for aspiration and skin breakdown.
nasogastric tube
Provides temporary nutrition and the end of the tube is past the stomach which poses less risk for aspiration. It cannot be used for suction and provides poor absorption of meds and tube feedings. Poses a risk of skin breakdown.
nasojejunal or nasoduodenal tube
___________ and ___________ Americans as well as _____________ are at an increased risk for Type 2 Diabetes
native, african, hispanic
After giving glucagon, nurses must monitor for persistent
nausea and vomiting
Excessively high amount of body fat or adipose tissue
obesity
What is a Roux-en-Y gastric bypass used for?
obesity
What is gastric sleeve used for?
obesity
What is lap band surgery used for?
obesity
Two examples of things that can cause intraabdominal pressure
obesity, hiatal hernia
Presenting Symptoms: Type 1 Diabetes Long pre-clinical period, manifestations develop once ________ can no longer produce __________ and then ________ ________ of symptoms, often present to ER with ________________ * ____________: elevated BG leads to osmotic diuresis * ____________: attempt to relieve dehydration * ____________: Attempt to compensate for lost calories - Hyperglycemia (Glucose in bloodstream) - ____________ - Weight _________ + Typical hyperglycemia symptoms
pancreas, insulin, rapid onset, ketoacidosis, polyuria, polydipsia, polyphagia, glycosuria, loss
Type 1 DM: New(er) Treatments - _____________ transplant * Usually with ___________ transplant in kidney failure patients * For patients with __________ difficulty controlling diabetes with ___________ * Downsides: Lifelong ____________; does not complete remove long-term renal & neurological _____________ - _________ _________ transplant * Islet cells from ____ or more pancreas donors are infused into the _________ _______ of the liver * Still experimental in the US * ______________ is a problem
pancreas, kidney, severe, insulin, immunosuppression, complications, islet cell, 2, portal vein, rejection
GLPRA Risks/SE - ____________ - ___________ problems with _________ - Delayed ___________ __________ may change absorption of oral meds - ___________
pancreatitis, kidney, byetta, gastric emptying, diarrhea
The most common cause of non-mechanical obstruction
paralytic ileus
The response of ___________-__________ insulin is like that of the endogenous insulin produced by the pancreas in response to a meal (often used within ____ minutes of mealtime)
rapid-acting, 15
Cardiac Output: Influencing Factors - Heart _________ - ______________ - Conductivity - ____________-___________-___________ system - ______________ peptides
rate, contractility, renin-angiotensin-aldosterone, natriuretic
This occurs when blood pressure rises after you stop taking or lower the dose of a drug (typically a medicine to lower high blood pressure).
rebound hypertension
Primary or secondary cause of Addison's? Idiopathic autoimmune dysfunction, cancer, adrenalectomy, radiation of the abdomen
primary
GERD/GER Pregnancy - Increased ______________ in pregnancy causes decreased tone and motility of smooth muscles, resulting in GER, slower __________ _________, and reverse ___________, which may cause acid indigestion or pyrosis.
progesterone, gastric emptying, peristalsis
Tissue growth, repair, maintenance, and energy
protein
Insulin stimulates ____________ synthesis and promotes intracellular shift of _______________ and _______________ into the cells
protein, potassium, magnesium
INPATIENT- Severe hypoglycemia - Follow hospital specific ___________ (practice in your activity binder) - Pediatrics typically treated __________ - Adults are typically treated with ______ _________ _____ ________ - _________ if patient unable to swallow and no IV access
protocol, orally, 50% dextrose IV push, glucagon
Decrease stomach HCl acid secretions by inhibiting the proton pump mechanism responsible for secreting H ions (GER/GERD)
proton pump inhibitors
Decreases HCl acid secretion by blocking enzyme that is important for the secretion of HCl acid
proton pump inhibitors
What are 3 examples of H2 receptor antagonists (generic name)
ranitidine (Zantac), Famotidine (Pepcid), Nizatidine (Axid)
Cholecystitis: Surgical Therapy Laparoscopic cholecystectomy (90% of cases) ***TREATMENT OF CHOICE - ___________ of___________ through ____ to ___ ________ _________ - ____________ postoperative pain - Resume normal activities, including work, within ___ __________ - _____ complications; main complication is _________ to the common bile duct - The few contraindications to laparoscopic cholecystectomy include peritonitis, cholangitis, gangrene or perforation of the gallbladder, portal HTN, and serious bleeding disorders
removal, gallbladder, 1, 4, puncture holes, minimal, 1 week, few, injury
Obesity: Behavior Modification - _______-__________: "Food Diary" - ___________ __________: Does the patient know their "eating cues" and learn to try to avoid them - _____________: Incentives for weight loss - __________ _________ help
self-monitoring, stimulus control, rewards, support groups
Foot ulcers/amputations Due to __________ deprivation, peripheral _________ damage, and increased risk of __________ as well as ____-__________ ________ & stepping on foreign objects
sensory, vascular, infection, ill-fitting shoes
HTN: Diagnostic Studies - ____________ elevated BP readings over ____________ ____________ - UA, BUN, Cr, CBC - Serum electrolytes - ECG - Serum lipid profile
several, several weeks
Unable to swallow, unconscious, convulsing
severe hypoglycemia
Cholecystitis: Clinical Manifestations Vary from _________ to _______ at all - Pain more severe when ________ ________ or ______________ Pain is ___________ and __________ - _________cardia - ___________ - Prostration - May be referred to __________/________ - Residual tenderness in _______ - Occur ___-___ ______ after _____-___ meal or when patient ______ _____
severe, none, stones moving, obstructing, steady, excruciating, tachy, diaphoresis, shoulder/scapula, RUQ, 3-6 hours, high-fat, lies down
Which type of insulin can be given IV?
short-acting (regular)
__________-________ insulin is given IV or SQ and is often used with ______________ ___________________
short-acting, diabetic ketoacidosis
Nutritional Therapy: Prevention of Cholelithiasis - People have fewer problems if they eat ___________ more _________ meals with some _____ each meal to promote gallbladder _____________ - The diet should be low in __________ ______ (e.g. butter, shortening, lard) and high in __________ and __________ - If obesity is a problem, a ___________-________ diet is indicated - ___________ __________ __________ should be avoided because it can promote gallstone formation
smaller, frequent, fat, emptying, saturated fats, fiber, calcium, reduced-calorie, rapid weight loss
Primary HTN: Contributing Factors - Increased __________ intake - Increased _______________ nervous system activity - Greater than __________ _________ _______ - Excessive _____________ consumption - _____________ use
sodium, sympathetic, ideal body weight, alcohol, tobacco
Rebound hyperglycemia upon waking d/t hypoglycemia between 2-4 a.m d/t overdose of insulin before bed
somogyi effect
Causes of Undernutrition - Inadequate food _________ - _________ _________ (burns, fevers, hospitalization) - _________ __________ (diabetes) - "____________" issues (chewing/swallowing) - Residents of __________ ________/rehabs - ___________ due to *decreased digestive enzymes *Drug side effects *Decreased bowel surface area
sources, acute illness, chronic illness, mechanical, nursing homes, malabsorption
When a stone is lodged in the ducts or when stones are moving through the ducts, what may result?
spasms
Cholelithiasis: Etiology & Pathophysiology - _______ of ______- --> Supersaturation and changes in composition of bile (________ ___________) - ___________, __________, and ____________ or _________ lesions of biliary system decrease bile _______ - Stones may ________ in gallbladder or _________ to _______ or ________ ______ duct - Cause ________ as they pass through ducts; may _________ in ducts and produce ___________
stasis, bile, biliary sludge, immobility, pregnancy, inflammatory, obstructive, flow, remain, migrate, cystic, common bile, pain, lodge, obstruction
glipizide: pharmacological action?
stimulate release of insulin related to blood glucose level (pt must have functioning pancreas)
Oral agents that increase insulin production from pancreatic beta cells, poses risk for weight gain
sulfonylureas
SQ rapid-acting (lispro) or short-acting (regular) insulin are adjusted according to blood glucose ________ results (several times a day, before meals and at bedtime)
test
cutting of certain branches of the vagus nerve, performed with gastric surgery to reduce the amount of gastric acid produced and thus reduce the recurrence of ulcers
vagotomy
Systemic Vascular Resistance: Influencing Factors SNS - a1 and a1-adrenergic receptors (____________) - B2-adrenergic receptors (______________) Neurohormonal - Vasoconstrictors: ____________ and _____________ Local Regulation - Vasodilators: __________, __________ __________ - Vasoconstrictors: ____________
vasoconstriction, vasodilation, angiotensin, norepinephrine, prostaglandins, nitric oxide, endothelin
What are loop diuretics used for?
CHF, renal disease, hypertensive crisis
Normal BP: Systolic < _______ (and/or) diastolic <= ______
120 and 80
Hypertension exists when systolic BP is greater than _______ mmHg or diastolic BP is greater than ______ mmHg for extended periods of time
120, 80
Prehypertension Systolic ______-______ (and/or) diastolic <= ______
120-129 and 80
Hypertensive Crisis A severe and abrupt elevation in BP arbitrarily defined as DBP >= ______-_______ mmHg
120-140
Rule of 15: - ______ g of ___________ carbohydrates - __________ blood sugar _____ _________ after treatment - ___________ treatment if blood sugar still under specified range for age - ___________ HCP if no significant improvement after ___-___ _________ - Avoid foods with _______ (decreases ___________ of sugar) - Do not _____________ - Follow up with __________ carb if more than ___ ________ until next meal
15, simple, recheck, 15 minutes, repeat, contact, 2-3 doses, fat, absorption, overtreat, starchy, 1 hour
Cushing's or Addison's (C/A) Unexplained hyperkalemia
A
Cushing's or Addison's (C/A) Weakness and fatigue
A
Cushing's or Addison's (C/A) Weight loss
A
A client is admitted in a state of diabetic ketoacidosis. The Health Care Provider (HCP) prescribes insulin detemir 0.1 units/kg/hr to be administered via intravenous (IV) drip. What should the nurse do? A. Consult the prescriber STAT. B. Calculate the insulin dose and mix it with 100 mL of normal saline C. Calculate the insulin dose and infuse the solution prepared by the pharmacy. D. Calculate the insulin dose and mix it with 100 mL of D5W.
A (Insulin detemir is a long-acting or basal insulin. ONLY short or rapid-acting insulins can be administered via IV. Regular insulin is the most common insulin to be administered via an IV drip. Insulin apsart, insulin lispro, and insulin glulisine would also be acceptable to administer via IV as well, as they are all rapid-acting insulins.)
A client is admitted to the hospital with Cushing Syndrome. On the physical assessment of the client, what should the nurse expect to find? A. Hypertension, peripheral edema, and petechiae B. Weight loss, buffalo hump and, moon face with acne C. Abdominal and buttocks striae, truncal obesity, and hypotension D. Anorexia, signs of dehydration, and hyperpigmentation of the skin
A (The effects of Adenocorticotropic hormone (ACTH) excess, especially the glucorticoids-- leads to weight gain from accumulation and redistribution of adipose tissue.)
A nurse is caring for a child who has Addison's disease. Which of the following actions should the nurse take? A. Teach the parents about cortisol replacement therapy. B. Place the child on a low-sodium diet C. Monitor the child for fluid-volume excess D. Discuss the manifestations of hypoglycemia with the parents.
A (The nurse should plan to teach the child's parents about cortisol replacement therapy. Administration of glucocorticoids and mineralocorticoids is necessary because inadequate supplies or a sudden cessation of the medications can cause acute adrenal crisis.)
Five Years have passed. On a slow-ish Tuesday night you realize the next patient being worked up is you old friend, AD! He presents with nausea and vomiting. Abdomen is distended. Bowel sounds are present, slightly hyperactive. He has not had a bowel movement in 6 days. The physician suspects a bowel obstruction. What type of obstruction do you suspect? A. Mechanical due to surgical adhesions/scar tissue B. Non-Mechanical post operative ileus C. Mechanical - intussusception
A (Yes - with his history of abdominal surgeries, and presence of bowel sounds the most likely type of obstruction would be mechanical.)
The transfer of gastric contents into the esophagus
GER
High Intestinal Obstruction Onset: A. Acute B. Slow/insidious Pain: A: Less intensity, vague and mild or sharp and severe, depending on the cause B. Crampy pain, colicky, intermittent Vomiting: A. Late, feculent odor may be absent, but serious if noted B. Early, profuse, biliary Abdominal distension A. Greatly increased B. Increased Constipation: A. Absolute constipation with lack of flatus and some diarrhea B. +Feces for a short time? Electrolytes: A. Rapid loss of Cl, K, Na B. Late imbalance?
A, B, B, A, B, A
You client is diagnosed with Hyperosmolar Hyperglycemic Syndrome (HHS). Which of the following lab results are consistent with this diagnosis (SELECT ALL THAT APPLY). A. Urine: large amount glucose (normal is 0) B. Blood Glucose: 880 mg/dL C. Urine: Positive for large amounts of ketones (normal is 0_ D. Potassium (K+): 2.8 mmoL/L
A, B, D (In the case of hyperglycemia that we see in HHS, we expect to see elevated glucose in the blood, as well as in the urine. The kidneys are trying to help flush out the excess glucose by way of urination. Although we thank the kidneys for their effort, this is often unsuccessful and leads to extreme dehydration in your patient. The will get better faster with some insulin! Blood HYPERglycemia is the problem here. The high blood glucose causes polyuria and extreme dehydration in these patients. Due to excessive urination the K+ may be low in these clients. Remember that they do have some insulin to draw K+ into the cells, as well. Each patient will be different -- we want you to remember that in these cases, K+ is going to change rapidly, so you need to make sure you have frequent labs to monitor this important electrolyte.)
What are nonmodifiable risk factors for primary hypertension (select all that apply)? A. Age B. Obesity C. Gender D. Ethnicity E. Genetic link
A, C, D, E (Hypertension progresses with increasing age. It is more prevalent in men before early middle age and above the age of 64 years in women. Blacks have a higher incidence of hypertension than do whites. Children and siblings of patients with hypertension should be screened and taught about healthy lifestyles.)
A nurse is assessing a client who has Cushing's syndrome. Which of the following findings should the nurse expect? (Select all that apply): A. Alopecia B. Tremors C. Moon face D. Purple striations E. Buffalo hump
A, C, D, E (MY ANSWER Alopecia is correct. Clients who have Cushing's syndrome can develop hirsutism, which is excessive body hair. Women can also develop alopecia, in the form of male pattern baldness.Tremors is incorrect. Tremors are not a common manifestation of Cushing's syndrome.Moon face is correct. Moon face, which is manifested by a round, red, full face, is a common manifestation of Cushing's syndrome.Purple striations is correct. Purple striations on the skin of the abdomen, thighs, and breasts are common manifestations of Cushing's syndrome.Buffalo hump is correct. Buffalo hump, which is a collection of fat between the shoulder blades, is a common manifestation of Cushing's syndrome.)
After a few more days in the hospital, you are finally ready to discharge A.D. In his discharge instructions you will include: A. Eat small, soft, frequent meals B. Maintain a high carbohydrate, high protein diet C. Monitor incision for redness, swelling, or drainage. Notify health care provider if these occur. D. Report any increased nausea and/or vomiting, epigastric pain, bloody emesis, or tarry stools. E. Eliminate high concentrated sweets from the diet. F. Limit fluid intake to 1 quart a day. G. Avoid using NSAIDS for pain relief
A, C, D, E, G (A: eating smaller meals more frequently will decrease the risk of nausea and dumping syndrome. Softer foods will be better at first for his healing stomach. C. Signs of infection D. Would be a sign GI tract bleeding E: with removal of part of the stomach, he is at risk for dumping syndrome and post-prandial hypoglycemia, so less concentrated sweets will be best. G: We know AD is prone to ulcers, and since NSAIDs are linked to ulcer risk, he should avoid this category of medication.)
Mucosal damage caused by reflux (backflow) of stomach acid into the esophagus, causing irritation/esophagitis
GERD
What is Nissen fundoplication used for?
GERD
What is metoclopramide used for?
GERD, gastroparesis (diabetes)
Treatment for neuropathy
Gabapentin/Neurontin (anti-seizure, Pregabilin, Lyrica), Cymbalta (antidepressant)
Works by blocking the action of aldosterone, a natural substance in the body that causes sodium and water retention, therefore raising blood pressure.
aldosterone antagonists
A nurse is assessing four clients on a medical unit. The nurse should identify which of the following clients as exhibiting positive manifestations of hypercortisolism? A. A client who has a butterfly rash on his face B. Moon face C. A client who has a positive Chvostek's sign D. A client who has muscle hypertrophy
B (A client who has a moon face and fat pads on his neck, back and shoulders is exhibiting manifestations of hypercortisolism or Cushing's syndrome.)
A staff nurse is teaching a client who has Addison's disease about the disease process. The client asks the nurse what causes Addison's disease. Which of the following responses should the nurse make? A. "It is caused by the lack of production of insulin by the pancreas." B. "It is caused by the lack of production of aldosterone by the adrenal gland." C. "It is caused by the overproduction of growth hormone by the pituitary gland." D. "It is caused by the overproduction of PTH by the parathyroid gland."
B (Addison's disease is caused by a lack of production of the adrenocorticotropic hormones (cortisol and aldosterone) by the adrenal gland.)
What early manifestation(s) is the client with primary hypertension likely to report? A. Cardiac palpitations B. No symptoms C. Dizziness and vertigo D. Dyspnea on exertion
B (Hypertension is often asymptomatic, especially if it is mild or moderate, and has been called the silent killer. The absence of symptoms often leads to noncompliance with medical treatment and a lack of concern about the disease in patients. With severe hypertension, symptoms may include fatigue, palpitations, angina, dyspnea, and dizzines)
What does the nursing responsibility in the management of the patient with hypertensive urgency include? A. Monitoring hourly urine output for drug effectiveness B. Instructing the client to follow up with a health care provider within 24 hours after outpatient treatment C. Titrating IV drug dosages based on BP and HR measurements every 2 to 3 minutes D. Providing continuous electrocardiographic (ECG) monitoring to detect side effects of the drugs
B (Hypertensive urgencies are often treated with oral drugs on an outpatient basis, but it is important for the patient to be seen by a HCP within 24 hours to evaluate the effectiveness of the treatment.)
A nurse is teaching a client who has been taking prednisone to treat asthma and has a new prescription to discontinue the medication. The nurse should explain to the client to reduce the dose gradually to prevent which of the following adverse effects? A. Hyperglycemia B. Adrenocortical insufficiency C. Severe dehydration D. Rebound pulmonary congestion
B (Prednisone, a corticosteroid, is similar to cortisol, the glucocorticoid hormone produced by the adrenal glands. It relieves inflammation and is used to treat certain forms of arthritis, severe allergies, autoimmune disorders, and asthma. Administration of glucocorticoids can suppress production of glucocorticoids, and an abrupt withdrawal of the drug can lead to a syndrome of adrenal insufficiency.)
Which outcome is a priority for the client with Addison's disease? A. Adherence to a 2-gm sodium diet B. Maintenance of medication compliance C. Prevention of hypertensive episodes.
B (The maintenance of medical compliance is critical. Clients should never stop taking the prescribed medication without taking to their healthcare provider.)
What describes a primary difference in treatment for diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic syndrome (HHS)? A. DKA requires administration of bicarbonate to correct acidosis. B. HHS requires greater fluid replacement to correct dehydration. C. Administration of glucose is withheld in HHS until the blood glucose reaches a normal level. D. Potassium replacement is not necessary for the management of HHS.
B (The management of DKA is similar to that of HHS except HHS requires greater fluid replacement because of the severe hyperosmolar state. Bicarbonate is not usually given in DKA unless pH is <7.0 because administration of insulin will reverse the abnormal fat metabolism. Total body potassium deficit is possible in both conditions, requiring monitoring and possibly potassium administration, and in both conditions, glucose is added to IV fluids when blood glucose levels fall to 250 mg/dL.)
A nurse is providing dietary teaching for a client who has Cushing's disease. Which of the following recommendations should the nurse include in the teaching? A. Limit intake of potassium-rich foods B. Restrict sodium intake C. Increase carbohydrate intake D. Decrease protein intake
B (The nurse should recommend the client to restrict sodium intake to control fluid volume. This restriction can range from "no-added-salt" to table foods to a restriction of 2 g/day.)
A nurse is assessing a client who has Addison's disease and is at risk for Addisonian crisis. Which of the following actions should the nurse take? A. Provide a low-carbohydrate diet B. Weigh the client daily C. Administer oral corticosteroids D. Restrict fluid intake
B (Weigh the client daily. Addison's disease is an endocrine disorder that causes weight loss, muscle weakness, fatigue, low blood pressure, and hyperpigmentation (darkening) of the skin. Obtaining the client's daily weight will alert the nurse that dehydration is developing, which could indicate an impending crisis.)
The client with Cushing's disease needs to modify dietary intake to control symptoms. In addition to increasing protein. Which strategy would be most appropriate? A. Increase calories B. Restrict sodium C. Restrict potassium D. Reduce fat to 10%
B (restricting sodium thereby reduces fluid retention)
Low Intestinal Obstruction Onset: A. Acute B. Slow/insidious Pain: A: Less intensity, vague and mild or sharp and severe, depending on the cause B. Crampy pain, colicky, intermittent Vomiting: A. Late, feculent odor may be absent, but serious if noted B. Early, profuse, biliary Abdominal distension A. Greatly increased B. Increased Constipation: A. Absolute constipation with lack of flatus and some diarrhea B. +Feces for a short time? Electrolytes: A. Rapid loss of Cl, K, Na B. Late imbalance?
B, A, A, B, A, B
Until A.D's obstruction resolves, you anticipate orders for: A. Jejunostomy/J-Tube B. IV Fluids or TPN C. Activity: Strict Bedrest D. NG tube to low continuous suction E. Strict I/O F. Activity: Up with assist G. Regular diet H. NPO I. Chloraseptic or lidocaine throat spray J. IV Proton Pump inhibitor (such as Pantoprazole) K. Ibuprofen (Advil/Motrin) PO for pain
B, D, E, F, H, I, J (B: We need to make sure AD doesn't become dehydrated/under-nourished D: With a bowel obstruction (mechanical or non-mechanical) the course of treatment is NG to suction to remove all gastric contents to "decompress" the GI tract to prevent N/V E. We must ensure AD is not become dehydrated and I/O measurements are critical for this F. We want to avoid further complications d/t immobility (weakness/pneumonia, etc) H. No bowel sounds/obstruction= NPO status I. This can be an effective treatment for the sore throat may pts have d/t large tube in their throat. If allowed, lozenges or ice chips can also help J: We know that AD has problems with ulcers, so a PPI IV push would be reasonable for this pt to reduce any further acid production and ulcers. Once he can take the PPI orally, that would be a good option)
A priority in the first 24 hours after a bilateral adrenalectomy is? A. Beginning oral nutrition B. Promoting self-care activities C. Preventing adrenal crisis D. Ambulating up and down the hallway
C
Cushing's or Addison's (C/A) Evidence of decreased immune system: high risk for infections without fever --- poor wound healing
C
Cushing's or Addison's (C/A) Gastric upset/ulcers due to increase in hydrochloric acid
C
Cushing's or Addison's (C/A) Glucose intolerance (elevated BG)
C
Cushing's or Addison's (C/A) Hirsutism and amenorrhea in women
C
Cushing's or Addison's (C/A) Hypernatremia
C
Cushing's or Addison's (C/A) Thin, fragile skin, thinning balding hair
C
Cushing's or Addison's (C/A) Unexplained hypokalemia
C
The patient received regular insulin 10 units subcutaneously at 8:30 PM for a blood glucose level of 253 mg/dL. The nurse plans to monitor this patient for signs of hypoglycemia at which time related to the insulin's peak action? A. 8:40 PM to 9:00 PM B. 9:00 PM to 11:30 PM C. 10:30 PM to 1:30 AM D. 12:30 AM to 8:30 AM
C
A nurse is caring for a client who has diabetes mellitus who is prescribed regular insulin via a sliding scale. After administering the correct dose at 0715, the nurse should ensure the client receives breakfast at which of the following times? A. 0720 B. 0730 C. 0745 D. 0815
C (Five to ten minutes is the lag time suggested for rapid acting insulin, but regular insulin is the short acting type with an onset of 30 minutes. A fifteen minute interval between insulin administration and eating a meal is too short since the onset of regular insulin is 30 minutes. Regular insulin should be given 20 to 30 minutes before eating because the onset of action is 30 minutes. There are circumstances when this lag time guide can be adjusted. A one hour interval between insulin administration and eating a meal is too long since the onset of regular insulin is 30 minutes.)
The unit is very busy and short-staffed. What could the RN delegate to the unlicensed assistive personnel (UAP)? A. Check BP readings for the client receiving IV sodium nitroprusside B. Administer antihypertensive medications to stable clients. C. Obtain orthostatic BP readings of assigned clients D. Teach about BP monitoring and the use of automatic BP monitoring equipment
C (The UAP may check postural changes in BP as directed. The LPN may administer antihypertensive medications to stable patients. The RN must monitor the patient receiving IV sodium nitroprusside, as the patient is in a hypertensive crisis. The RN must also do the teaching related to home BP monitoring)
Caused by excessive corticosteroids, particularly glucocorticoids
Cushing's syndrome
A nurse is assessing a client who has Cushing's syndrome. Which of the following findings should the nurse expect? A. Weight loss B. Hypotension C. Diaphoresis D. Hyperpigmentation
D (Hyperpigmentation, bruising, and striae or stretch marks, are manifestations of Cushing's syndrome.)
When a client in diabetic ketoacidosis exhibits Kussmaul respirations, their body is attempting to correct the....... A. Respiratory Acidosis B. Hyperglycemia C. Hypoglycemia D. Metabolic Acidosis
D (In DKA, the acidosis is a METABOLIC acidosis. So -- to get rid of the acid, the body attempts to "blow it off" by making the patient take a lot of deep breaths. Their breathing pattern will be tachypnic (fast) and labored/deep.)
DKA or HHS or both Mortality rate 2-5%, up to 10%
DKA
DKA or HHS or both Type 1 DM
DKA
a complex disorder of carbohydrate, fat, and protein metabolism resulting from the lack of insulin secretion by the beta cells of the pancreas or defects of the insulin receptors; it is commonly referred to simply as diabetes. There are two major types of diabetes: type 1 or type 2
Diabetes Mellitus
Postop complications PUD surgery
Dumping syndrome, postprandial hypoglycemia, bile reflux gastritis
The client with diabetes is brought into the emergency department by his family members, who say that he has had an infection, is not acting like himself, and is more tired than usual. Prioritize the following nursing actions in the order of priority for this client A. Check blood glucose B. Begin continuous regular insulin drip C. Establish time of last food and drink D. Administer 0.9% NaCl IV infusion E. Ensure patent airway F. Establish IV access
E, A, F, D, B, C (As with all clients, first, establish an airway. With a client with diabetes and abnormal behavior, the blood glucose must first be checked to determine if the symptoms are related to diabetes. In this case, the symptoms are related to hyperglycemia, so an IV must be started for fluid resuscitation and insulin administration. The last food intake and mediations may establish a cause for the hyperglycemia and aid in determining further treatment)
PUD: Perforation - _____________! - In ___________ __________ ulcers or those on __________ __________ of stomach - Symptoms: Acute __________, ________/___________ _____________, elevated ______
EMERGENCY, large duodenal, lesser curvature, pain, rigid/boardlike abdomen, WBCs
Diabetic Ketoacidosis (DKA) and Hyperosmolar Hyperglycemic Syndrome (HHS) are linked to low blood glucose levels. (T/F)
F (both DKA and HHS are linked to very high blood glucose levels. What causes the patient's blood glucose to be high? As a nurse, we need to help figure this out! The most common causes are: - Patient is not taking their insulin or other glucose lowering agents as prescribed. Maybe they ran out and can't afford it....maybe it was their 21st birthday and they had a big party.... - Undiagnosed Diabetes (in other words, the patient didn't know they were diabetic, so they were not using any insulin or other glucose lowering drugs!) - Illness (in general, blood glucose levels rise when people have an underlying illness like urinary tract infection, pneumonia, etc.))
The adrenal medulla and cortex work together to perform the same functions (T/F)
F (each part has distinct functions, and they act independently of one another)
Obesity: Exercise - Increases appetite (T/F) - Diminishes appetite (T/F) - ________ is best, if possible. _____-____ minutes per day. - Promotes and maintains weight loss - Improves ___________ of weight - Even if weight loss does not result, __________ __________ are improved in people who are more active
F, T, daily, 30-60, distribution, health outcomes
Bowel obstruction will always present with absent bowel sounds TRUE/FALSE
False
PUD COMPLICATION: Less common: result of edema, inflammation, pylorospasm, fibrous scar tissue formation Pain: worse at the end of the day - relief may be obtained by belching or self induced vomiting constipations occurs because of dehydration & decreased diet intake secondary to anorexia
Gastric outlet obstruction
What are ARBs used for?
HTN (especially in clients who do not tolerate ACE inhibitors)
What are diuretics used for?
HTN, edema
HHS usually occurs with type (I/II) diabetes
II
Type (I/II) Diabetes occurs when insulin receptors on the cells fail to respond properly
II
Intestinal Obstruction: Nursing Implementation - ______ ________ as ordered (watch for fluid overload) - Maintain _____ _________ - _________ care - Skin care to ________ - Monitor _____________ - Education
IV fluids, NG tube, oral, nose, electrolytes
What is the treatment for Addisonian Crisis
IV hydrocortisone
In which form(s) can glucagon be given?
IV, IM, SQ
Health Risks Associated with Obesity (Increased/decreased) LDLs (Increased/decreased) triglycerides (Increased/decreased) HDLs - Liver _________ - Chole___________ - Chronic _________ disease - ________arthritis - Gout - GERD - HTN - ___________ veins (venous stasis) - _____________ irregularities in women - Infertility - Sexual dysfunction - Gynecomastia/hypogonadism - Sleep ________ - Asthma - Pulmonary HTN - Exercise intolerance - Obesity ____________ syndrome - Type 2 DM - ____________ syndrome - Polycystic ovary syndrome - Depression, low self-esteem, risk of suicide, social isolation - Cardiomyopathy - Atrial fibrillation
Increased, Increased, decreased, cirrhosis, lithiasis, kidney, osteo, varicose, menstrual, apnea, hypoventilation, metabolic
Nursing Care for Endoscopy - Prior: _______ for ______-_____ __________ - After: _______ until ______ _______ returns (1-2 hours) - Monitor for pain, bleeding, unusual difficulty __________, elevated __________ - Minor throat discomfort: __________, _______ gargle - ______ ________ until patient fully alert - Inform patient that they may experience some _________, belching, and _______________
NPO, 6-12 hours, NPO, gag reflex, swallowing, temperature, lozenges, saline, bed rest, bloating, flatulence
Intestinal Obstruction: Collaborative Care - _______ - Inserting _______ ______ to __________ ________ - _____ _______ therapy - _______ control - _____________ -- last resort
NPO, NG tube, decompress bowel, IV fluid, pain, surgery
What are the three macrovascular effects of diabetes?
MI, stroke, peripheral vascular disease
What is the most commonly used oral drug for the treatment of type 2 DM
Metformin
Which medication is used for PUD if aspirin and/or NSAIDs cannot be discontinued
Misoprostol/Cytotec
3 antacid examples
Mylanta, Maalox, Tums
Gastric outlet obstruction treatment
NG tube to suction and fluid and electrolytes
PUD: Hemorrhage treatment - ______ ________ to ________ for ____-____ _________ - ____ ___________ and __________, ________ __________ if needed - Careful ________ monitoring - _______________
NG tube, suction, 24-48 hours, IV fluids, electrolytes, blood transfusion, I/O, endoscopy
Nursing Care for ENDOSCOPY Prior: ______ for ___-___ ________ After: _____ until ____ _______ returns (__-___ ______) - Monitor for ______, ________, unusual difficulty ____________, elevated _________ - Minor throat discomfort: ___________, ________ gargle - _____________ until fully alert - Inform patient that they may experience some _________, belching, and ______________
NPO, 6-12 hours, NPO, gag reflex, 1-2 hours, pain, bleeding, swallowing, temperature, lozenges, saline, bedrest, bloating, flatulence
What are H2 receptor blockers used for?
PUD and GERD
What are antacids used for?
PUD and GERD
Secretes oxytocin and ADH (increases reabsorption of water by the tubules of the kidneys)
Posterior pituitary
Upon physical examination, someone with cholecystitis will exhibit
RUQ tenderness, abdominal rigidity
Short-acting insulin: name
Regular (Humulin R, Novolin R)
Bariatric surgery that involves stapling the stomach to decrease its size (gastric pouch) and then shortening the jejunum and connecting it to the small stomach pouch, causing the base of the duodenum leading from the nonfunctioning portion of the stomach to form a Y configuration, which decreases the pathway of food through the intestine, thus reducing the absorption of calories and fats
Roux-en-Y gastric bypass
Caloric intake should be sufficienct, but tissue needs aren't met d/t disease process (cancers, RA, etc.)
Secondary/chronic disease-related PCM
A child with type 1 diabetes is experiencing morning hyperglycemia and hypoglycemia between 2 am and 4am each night. The child may be experiencing ("Somogyi Effect"/"Dawn Phenomenon"). The nurse should expect ("a decreased evening insulin dose"/"an increased evening insulin dose") to be prescribed?
Somogyi Effect, a decreased evening insulin dose
neuropathy where it feels like they are wearing stockings/gloves all the time
Stocking-Glove Neuropathy
Always give insulin, even if child does not have appetite when they are sick (T/F)
T
Biguanides do not increase insulin secretion from the pancreas, therefore they do not cause hypoglycemia (T/F)
T
When a diabetic patient is ill they should just follow their usual meal plan (T/F)
T
Placed in the common bile duct to help drain bile from the liver. It is sometimes placed after a cholecystectomy, common bile duct (CBD) exploration or liver transplant. It will serve as a drain to drain excessive bile from the liver until the common bile duct is healed. (This helps until edema produced by the trauma of exploring and probing the duct has subsided, and allows drainage while the small intestine is adjusting to receiving a continuous flow of bile)
T-tube
In fact, it can be dangerous to treat hypertensive urgency or severe symptomatic hypertension in the same way as a true hypertensive emergency, because lowering blood pressure too rapidly can trigger _______ or ________ (because cerebral BP decreases too fast)
TIA, stroke
The most common endocrine disorder of childhood
Type 1 DM
Diabetes Mellitus - Partial or complete deficiency of the hormone insulin (________ ____) OR - The body's inability to use insulin (__________ ______)
Type 1, Type 2
What types of diabetes does insulin treat?
Type I, Type II, gestational
Metformin treats (Type I/Type II) DM, and is usually prescribed to ____________ ____________ diabetics
Type II, newly diagnosed
HHS precipitating factors
UTIs, pneumonia, sepsis, Acute illness, Newly diagnosed type 2 diabetes, Impaired thirst sensation and/or inability to replace fluids
What are the two diagnostic studies for cholecystitis?
Ultrasonography (Scope procedure), ERCP
Diabetes: Infection - Defective ______ ___________ - glucose feeds bacteria/fungi ---> __________ ____________ - Glucosuria ---> ___________ and ________ _________ ___________ Prevention - Recognize infections promptly and treat - Control BG - ____________
WBC mobilization, yeast infections, bladder, urinary tract infections, vaccinations
Life-threatening condition caused by stressors, infection, post-adrenal surgery that can also produce acute adrenal insufficiency, or abrupt withdrawal of corticosteroids
addisonian crisis
Somogyi effect interventions
adjust evening insulin dose down or add a bedtime snack
Dawn phenomenon treatment
adjust timing of insulin (closer to bedtime) or possibly increase insulin
What two parts make up the adrenal glands
adrenal medulla, adrenal cortex
Stimulates the adrenal cortex to secrete corticosteroids, secreted by anterior pituitary
adrenocorticotropic hormone (ACTH)
Risk Factors for Primary Hypertension - ___________ age - Alcohol - _____________ smoking - _____________ ____________ - Elevated serum __________ - Excess dietary ____________ - Gender (________ before age 50, _________ after age 50 d/t menopause) - Family history - _____________ - Ethnicity - _______________ lifestyle - Socioeconomic status - ___________
advanced, cigarette, diabetes mellitus, lipids, sodium, men, women, obesity, sedentary, stress
Intussusception conservative treatment
air or barium contrast enema
Regulates sodium and potassium balance, therefore regulates water balance
aldosterone
Short-term Use of Corticosteroids - ____________ reactions - Poison Ivy - __________ ________ response (i.e. pinched nerve, bursitis) - Reactive ___________ (asthma acute exacerbation)
allergic, acute inflammatory, airway
Obesity: Drug Therapy *** NOT TO BE USED __________ - Only for __________ with BMI _____ kg/m or greater with at least ______ _________-___________ ______________ - __________ ____________: (sympathomimetic, non-amphetamines) - ______________ _____________-___________: Blocks fat breakdown and absorption (Orlistat: Xenical, Alli) - ___________ __________: Works on the brain to decrease appetite, increase feelings satiety - _________ (Phenermine and Topiramate) Non-amphetamine & anti-seizure/migraine which may decrease appetite - Nurses need to know if patients are taking these drugs
alone, adults, 27, one weight-related condition, appetite suppressants, nutrient absorption-blocking, serotonin agonists, Qsymia
glucagon is released from the _________ cells of the pancreas
alpha
What are the potassium sparing diuretics?
amiloride, spironolactone, triamterene
Neurons from the hypothalamus create a circuit to facilitate coordination of the endocrine system and the ___________ nervous system
autonomic
Type 2 DM: Etiology Pancreas - Defective ________ ________ secretion of insulin - Insulin _________ stimulates ___________ insulin secretion - Eventual __________ of beta cells Liver - Excess _________ production - Inappropriate __________ of ___________ production Adipose tissue - Decreased ____________ and increased _________ - Results in altered __________ and _____ _____________ Muscle - Defective ___________ __________ - Insulin resistance - Decreased __________ of glucose by cells resulting in hyperglycemia
beta cell, resistance, increased, exhaustion, glucose, regulation, glucose, adiponectin, leptin, glucose, fat metabolism, insulin receptors, uptake
Complications of Gastric Surgery Prolonged contact of bile causes damage to gastric mucosa Administration of Questran relieves irritation
bile reflux gastritis
What is Questran used for
bile reflux gastritis
Spasms from stone movement produces severe pain, which is term _________ _________, even though the pain is rarely colicky; is it more often ________
biliary colic, steady
Effective oral anti-diabetic treatment involves: - Careful monitoring of __________ ___________ levels - Therapy with one or more _________ - Treatment of associated __________ conditions such as high cholesterol and high blood pressure
blood glucose, drugs, comorbid
The force exerted by the blood against the walls of the blood vessels
blood pressure
Symptoms of hemorrhage from PUD (3)
change in vital signs (if lots of blood loss), blood in stool or NG output, low RBC counts
Inflammation of the gallbladder
cholecystitis
stone in the common bile duct
choledocholithiasis
Cholecystitis is usually associated with
cholelithiasis
Most common disorder of the biliary system
cholelithiasis
Stones in the gallbladder
cholelithiasis
____________ is the precursor for steroid hormone synthesis
cholesterol
Endocrine System: Gerontological Considerations- Normal aging results in: - _____________ hormone production and secretion - Altered hormone __________ and biologic activity - _____________ responsiveness of target tissues to hormones - Alterations in ____________ _________ - Subtle changes of aging often ________ manifestations of ____________ disorders, resulting in delayed treatment (fatigue, constipation, mental impairment)
decreased, metabolism, decreased, circadian rhythms, mimic, endocrine
Hypertensive Crisis Rising BP triggers ____________ ___________ --> Release of _____________ substances --> ________ _________ _________
endothelial damage, vasoconstrictor, end organ damage
The major hormones secreted in the adrenal medulla are
epinephrine, norepinephrine, dopamine
Insulin has a direct effect on_______ metabolism: stimulates lipogenesis and inhibits lipolysis and the release of fatty acids from adipose tissue
fat
What are the four symptoms associated with chronic cholecystitis?
fat intolerance, dyspepsia, heartburn, flatulence
Obesity Causes: 1. Increase in _______ _________ 2. Increased _________, which contribute to _________ resistance and atherosclerosis, and disrupt _________ function and predispose to certain ___________)
fat mass, adipokines, insulin, immune, cancers
In DKA, the ketoacidosis is caused by breakdown of _______ and __________ due to a lack of ___________
fat, muscle, insulin
Gallbladder Disease: Risk Factors - Gender (male/female) - (Nulliparity/Multiparity) - Age older than ____ years - __________ therapy - ______________ lifestyle - Genetics/ethnicity - ___________
female, multiparity, 40, estrogen, sedentary, obesity
Inflammation of cholecystitis produces the symptoms:
fever, leukocytosis
What is metformin used for?
first line of defense for type II diabetes
If a patient is experiencing N&V from glucagon, monitor _________ and __________ intake, and turn _________________ patients on their sides to prevent ______________ from vomiting
fluid, carbohydrate, unconscious, aspiration
Management of HHS •__________ (______ than dka) •_________ (usually ___ infusion) •___________ __________ •Follow electrolytes carefully •Check blood glucose every _______ •Strict I/O •__________ assessments (know the baseline)
fluids, more, insulin, IV, cardiac monitor, hour, neurologic
What should be provided to patient's after they take glucagon and regain consciousness from an episode of hypoglycemia
food
Type 2 Diabetes: Risk factors - Too much _________ with too much _________ ______ - Not enough ________ - _________ that cause greater insulin _________ and/or make you _________ LEADS TO - ___________: need extra insulin as body becomes resistant - ___________ deposits in __________ cause even more damage - Other set of genes inherited from parents make _______ _______ in pancreas wear out early; cannot make enough insulin RESULTS IN - Body needs more __________ but cannot __________ it TYPE 2 DIABETES
food, animal fat, exercise, genes, resistance, hungry, overweight, fatty, pancreas, islet cells, insulin, produce
Nursing Assessment: Malnutrition - _________ history for last week/day - ________ care; teeth intact? - Ability to __________ - Height/Weight, ______ - ___/_____ calculations - ________ signs - ________________ _____________ - ___________ circumference - ________________ strength
food, oral, swallow, BMI, In/out, vital, skinfold thickness, midarm, musculoskeletal
Intestinal Obstruction: Pathophysiology - Fluid, ______, and intestinal contents accumulate - __________ ___________ collapses - As the bowel becomes ___________, __________ bowel _________ rises - Increased ______________: Fluid cannot get ___________ properly (it is not reaching most of the intestine) --> Increased capillary _____________ and _____________ of fluids and electrolytes into the ____________ cavity - ______________ and _____________ _________ - May cause __________ bowel, or bowel ____________
gas, distal bowel, distended, intralumenal, pressure, pressure, absorbed, permeability, extravasation, peritoneal, hypotension, hypovolemic shock, necrotic, perforation
Which type of ulcer has burning/gaseous pain
gastric
Which type of ulcers are found more in women?
gastric
Which type of ulcers are increased with incompetent pyloric sphincter and bile reflux
gastric
Which type of ulcers are more related to NSAID use?
gastric
Which type of ulcers occur at age 50-60
gastric
Which ulcers may be worse when eating
gastric
Which ulcers have higher mortality
gastric (d/t increased age of incidence)
a surgical procedure to treat obesity that involves removing a large part of the stomach so the remainder resembles a tube or sleeve in order to limit the volume that the stomach can hold
gastric sleeve surgery
What is used to treat gastroparesis in autonomic neuropathy
gastric stimulant like metoclopramide
Ulcers found on the lesser curvature of the stomach
gastric ulcers
What is the main complication from glucagon
gastrointestinal effects (nausea and vomiting)
stimulate the smooth muscle of the GI tract and increases the rate of gastric emptying
gastrointestinal stimulants
Metformin primarily affects the _____________ ____________: abdominal ___________, nausea, cramping, diarrhea, feeling of ______________
gastrointestinal tract, bloating, fullness
What are the four main systems affected by autonomic neuropathy?
gastrointestinal, cardiovascular, reproductive, urinary
creation of an artificial opening between the stomach and jejunum
gastrojejunostomy
Autonomic Neuropathy: GI Effects Mainly caused by _____________ (delayed gastric emptying) - __________ - ___________ & __________ - Gastroesophageal ________ - Persistent feelings of __________ - ______________
gastroparesis, anorexia, nausea, vomiting, reflux, fullness, hypoglycemia
Provides long-term nutritional support but poses risk for aspiration and skin breakdown
gastrostomy tube
What is the treatment for someone suffering from hypoglycemia after being administered glipizide?
give 15-20g of carbs (if conscious: oral in pill form or as food. If unconscious: IV glucose if available, or 1 mg glucagon SQ or IM)
Long-acting insulin: name
glargine, detemir
Which med (not insulin) CAN cause hypoglycemia, as it makes the pancreas work harder
glipizide
what drug increases the number and sensitivity of insulin receptors?
glipizide
When the person is unable to remain conscious, ____________ is given SQ, IM, or IV for emergency replacement
glucagon
a hormone produced by the alpha cells in the islets of Langerhans that stimulates the conversion of glycogen to glucose in the liver
glucagon
Which body shape poses risk for osteoporosis, varicose veins, and cellulitis
gynoid
obesity pattern seen in people who store fat primarily around the hips and thighs
gynoid obesity
Hypertensive URGENCY - Develops over _______ to ______ - BP is severely elevated but there is ______ __________ __________ of __________ ___________ ____________ - Situation does ______ ________ ______ meds; oral antihypertensive medications (yes/no) - Client may not required to be hospitalized but requires frequent _________-_____ - Allow patient to _____ for _____-_____ ____________ in a ________ environment; may significantly reduce BP
hours, days, no clinical evidence, target organ damage, not require IV, yes, follow-up, sit, 10-20 minutes, quiet
Hypertensive EMERGENCY - Develops over _______ to _______ - A clients' BP is severely elevated _____ ___________ of ______ _________ ________ ________ especially to the _______ (>______/______) Can precipitate: - _______________** - Acute ________ ___________ failure with pulmonary ________ - MI - __________ failure - __________ ___________ ____________ - Intracranial or subarachnoid _____________ - __________pathy
hours, days, with evidence, acute target organ damage, CNS, 180/120, encephalopathy, left ventricular, edema, renal, dissecting aortic aneurysm, hemorrhage, retino
Pathophysiology: Type 1 DM With a deficiency of insulin, glucose in unable to enter the cell and remains in the blood. High levels of glucose in the bloodstream is called: _____________ - Liver and muscle cells store glucose in the form of ____________ Cells break down protein for conversion to glucose by the liver, _________________, this glucose then contributes to hyperglycemia - Elevated blood glucose leads to ___________ __________; this urinary fluid loss leads to ____________ Protein and fat breakdown lead to _________ ________ (the body is actually in a state of starvation) which leads to ______________ - Cells also break fat into ___________, which is converted to ___________ by the liver Accumulation of ketones causes a drop in pH (____________ __________) Acetone is blown off giving breath a fruity odor (__________ _________)
hyperglycemia, glycogen, glyconeogenesis, osmotic diuresis, polydipsia, weight loss, polyphagia, glycerol, acetone, metabolic acidosis, acetone breath
The hormones secreted by the posterior pituitary are produced in the
hypothalamus
Contributors to Obesity - ____________ imbalance --> Overeating - __________ _________(appetite suppressant that increases fat metabolism) - __________ ___________: This is in the gut and inhibits leptin which can lead to overeating.
hypothalamus, leptin deficiency, ghrelin excess
What are the four late symptoms of hypoglycemia?
hypothermia, seizures, coma, death
Several conditions can cause Cushing syndrome. The most common cause is ____________ _____________ of _____________ ______________ (e.g., prednisone). About 85% of the cases of endogenous Cushing syndrome are due to an ________-_____________ __________ ___________ (__________ ________). Less common causes include adrenal tumors and ectopic ACTH production by tumors (usually of the lung or pancreas) outside of the hypothalamic-pituitary-adrenal axis. Cushing disease and primary adrenal tumors are more common in __________ in the ____- to ____-year-old age group. Ectopic ACTH production is more common in ______.
iatrogenic administration exogenous corticosteroids, ACTH-secreting pituitary adenoma, Cushing disease, women, 20, 40, men
What is the most common cause of Cushing's Syndrome
iatrogenic administration of exogenous corticosteroids
Hyperventilation characteristic of metabolic acidosis, resulting from the respiratory system's attempt to eliminate excess CO2 by increasing depth and rate of respirations.
kussmaul respirations
Nutritional status assessment component? Glucose, electrolytes, lipid profile, BUN
laboratory data
Cholecystitis: Manifestations - Fever & __________ - _____________ - ___________ & ___________ - _________ - Abdominal ___________ - Feeling of __________ - ______ ______________ - __________! * Located in __________ _________ ________ or ________ _________; may radiate to __________, increases with ________ ________
leukocytosis, jaundice, nausea, vomiting, anorexia, distension, fullness, fat intolerance, pain, right upper quadrant, right shoulder, back, deep breaths
prehypertension interventions
lifestyle modifications and no drugs unless indicated
Stage I hypertension interventions
lifestyle modifications and thiazide-type drugs for most; may consider ACE inhibitors, ARB, BB, CCB, or combination
Which medications can be used for metabolic syndrome
lipid-lowering (statins), anti-hypertensives (diuretics, BBs, CCBs, ARBs, ACEs), metformin
Nutrition after laparoscopic cholecystectomy - __________ first day - _______ _________ for several ________
liquid, light meals, days
Nutrition after incisional cholecystectomy - Progress from __________ to a __________ diet once _______ _________ have returned - The amount of _____ in the postoperative diet depends on the patient's ____________. - A _____-____ diet may be helpful if the flow of _______ is reduced (usually only in the early postoperative period) or if the patient is _____________ - Sometimes, the patient is instructed to restrict fats for ___-___ __________ - Otherwise, no special dietary instructions are needed other than to eat nutritious meals and to avoid excessive fat intake
liquids, regular, bowel sounds, fat, tolerance, low-fat, bile, overweight, 4-6 weeks
Rapid-acting insulin: names
lispro, glulisine, aspart
If the blockage of the gallbladder occurs in the cystic duct, the bile can continue to flow into the duodenum directly from the __________. However, when the bile in the gallbladder cannot escape, this stasis of bile may lead to _______________.
liver, cholecystitis
Intestinal Obstruction: Clinical manifestations vary depending on ____________ Early S/S - __________ __________ _________ - ___________ and __________ - __________ ___________
location, colicky abdominal pain, nausea, vomiting, abdominal distension
It is a colorless solution with a pH of 4.0; once it is injected into the SQ tissue at physiologic pH, it forms micro-precipitates that are slowly absorbed over the next 24 hours
long-acting insulin
Pre-diabetes - ________-________ damage already occurring d/t glucose levels (heart, blood vessles) - Usually present with _____ ____________
long-term, no symptoms
ARB example
losartan (Cozaar)
characterized by lack of intestinal peristalsis and bowel sounds
paralytic ileus
Erosion of the GI mucosa due to digestive action of HCl acid and pepsin
peptic ulcers
What are Bilroth 1 and 2 used for?
peptic ulcers
Endoscopy: Potential Complications - ___________ of the esophagus, stomach, and/or duodenum - ____________ from a biopsy site - ____________ ___________ of gastric contents - Over-_______________ from the medication during test - _____________ induced by the sedative - Local IV ___________ reaction to the injection of _____________ sedative medication
perforation, bleeding, pulmonary aspiration, sedation, hypotension, phlebitic, sclerosing
Secondary HTN- Possible Causes - ___________ disease - _____________ disorders (i.e. thyroid disease, neurologic disorders like brain tumors) - _____________-induced HTN - ___________-induced (e.g. oral contraceptives, corticosteroids) - ______________ - narrowing of the aorta
renal, endocrine, pregnancy, drug, congenital
Hypertensive Encephalopathy: Manifestations - ____________ insufficiency (_________ impairment to complete _____________) - ____________ _________________ (Ranging from _________ angina to __________ and pulmonary __________) - ___________ ____________ (excruciating chest and back pain with diaphoresis and ________ of _________ in ____________)
renal, minor, shutdown, cardiac decompensation, unstable, infarction, edema, aortic dissection, loss, pulses, extremity
PUD: Conservative Therapy - Adequate _______ - ______________ modification - Cessation of ______________ and ____________ - Drug therapy: __________, ____ ___________ __________, __________ __________ ______________ - STOP ____________ and __________ if possible (switch to __________-_________) - __________ reduction - Long-term care and _________-_____
rest, dietary, smoking, alcohol, antacids, H2 receptor blockers, proton pump inhibitors, NSAIDs, aspirin, enteric-coated, stress, follow-up
__________ vials between hands instead of ___________ them to mix insulin suspensions
roll, shaking
What should the nurse do to prevent lipohypertrophy?
rotate injection sites
Which type of HTN accounts for 3-10% of HTN in adults and is related to an underlying cause?
secondary
Less common type of obesity d/t chromosomal/congenital anomalies, metabolic problems, CNS lesions/disorders
secondary obesity
CHOLECYSTITIS: Etiology & Pathophysiology - Most commonly associated with obstruction from ________ or ________ - _____________ ____________: Can occur in older adults and critically ill Inflammation - Confined to ___________ ________ or _______ ________ - Gallbladder is ___________ and __________ - May be _________ with ______ or _____ - _________ duct may become occluded - _____________ and __________ after attack
stones, sludge, acalculous cholecystitis, mucous lining, entire wall, edematous, hyperemic, distended, bile, pus, cystic, scarring, fibrosis
Bariatric Surgery Proven to have __________, _________ impact on weight loss Criteria: 1. BMI _____ kg/m2 or greater OR 2. BMI ______ kg/m2 with ______ or more ___________, __________-_________ medical complications AND 3. _____________ ___________ to ensure the patient can commit to a ____________ ____________ __________ and to screen for __________ and/or ______________ AND 4. No advanced ____________, ___________ and __________ disease and ______________ disease
successful, lasting, 40, 35, one, severe, obesity-related, psychological screening, lifelong behavioral change, depression, addiction, cancers, liver, kidney, cardiopulmonary
PUD: Gastric Outlet Obstruction - __________ onset of ___________ of _________ due to _______, _________, or ______ tissue
sudden, narrowing, pylorus, edema, inflammation, scar
glyburide and glimepiride are both
sulfonylureas
GER/GERD Teaching/Patient Education - Sleeping position (__________ for infants) - Feeding routines, _________ formula - Play times (limit to at least _____ ________ after __________) - Keep infants _________ during feeding to prevent regurgitation (aspiration) - _______ training
supine, thicken, 30 minutes, eating, upright, CPR
Secondary causes of Addison's - _____________ of the adrenal gland production of endogenous cortisol due to _______-________ administration of _____________ ____________ - Abrupt steroid ____________ - _________________
suppression, long-term, exogenous corticosteroids, withdrawal, hypophysectomy
Most common cause of mechanical obstruction
surgical adhesion
Mechanical Obstruction: Causes (5)
surgical adhesions, cancer, hernias, volvulus, intussusception
a type of diabetes mellitus that most commonly presents in adults and is becoming more common in children and adolescents due to inactivity and weight gain. The disease may be controlled by lifestyle modifications, oral drug therapy, and/or insulin, but patients are not necessarily dependent on insulin therapy
type 2 diabetes mellitus
Diabetes: Risk factors for amputation - Foot ____________ - ___________ neuropathy** - ____________ artery disease - ___________ abnormalities - Impaired __________ function - _____________ neuropathy
ulcerations, sensory, peripheral, clotting, immune, autonomic
