NS II assessment 1
can HIV be cured?
no but it can be delayed
prevention of T1D
no prevention but prevention of short-term and long-term complications through management of glucose levels
is there a vaccine for hepatitis C?
no vaccines for Hep C
what does it mean if viral load is undetectable?
-"Undetectable" indicates the viral load is lower than the test is able to report; -"undetectable" does not mean that the virus has been eliminated from the body or that the individual can no longer transmit HIV to others.
nursing interventions for HIV (8)
(1) adhere to drug regimens (2) promote a healthy lifestyle that includes avoiding exposure to other sexually transmitted and blood-borne diseases (3) protect others from HIV (4) maintain or develop healthy and supportive relationships (5) maintain activities and productivity (6) explore spiritual issues (7) come to terms with issues related to disease, disability, and death (8) cope with symptoms caused by HIV and its treatments.
interventions that may be provided including teaching for ART are...(5)
(1) advantages and disadvantages of new treatments, (2) dangers of poor adherence to therapeutic regimens, (3) how and when to take each drug, (4) drug interactions to avoid, (5) side effects that must be reported to the health care provider.
hyperglycemic levels
180 to 200 mg/dL
asymptomatic infection of HIV
-many do not know infected status and continue usual activities -typically lasts 11 years between initial infection and diagnosis of AIDS -CD4 and T cells remain above 500 cells/μL (normal or only slightly decreased) and viral load is low
diet management patient teaching (1)
-meal planning to obtain consistent glucose and carb intake
treatment for hyperthyroidism (pharmacological 2, surgical 1, other)
-methimazole and PTU (Propylthiouracil) (antithyroid meds) -removal of thyroid gland (thyroidectomy) -Radioactive Iodine Therapy (RAI)
pro of Self-monitoring of blood glucose (SMBG)
Allows individual with diabetes to achieve metabolic control via monitoring
hepatocellular jaundice (what it is and 3 things that cause it)
Altered ability of liver to take up bilirubin from blood, conjugate or excrete it (hepatitis, cirrhosis, hepatic carcinoma)
plasmapheresis is
Blood put through machine and spin off antibodies giving blood back to person and reduce exacerbation
pharmacologic treatment for osteoporosis (2)
Calcium gluconate, Bisphosphonates
systemic lupus erythematosus (SLE)
Chronic, inflammatory connective tissue disease Affects almost all body systems
treatment for Hepatitis C
Combination antivirals MOST COMMONLY acyclovir
hyperglycemia complications type 1 (1) and 2 DM (1)
DKA (T1 DM) HHS (T2 DM)
calcium-rich foods (3)
Dairy, vegetables, beans
Rheumatoid Factor (RF) determines
Determines the presence of abnormal antibodies seen in connective tissue disease
how long does it take for chronic complications to develop for diabetics?
Develop over ≥10 years
most used test to diagnose osteoporosis
Dual-energy x-ray absorptiometry (DEXA)
Hyperthyroidism: Effects are caused by _____ circulating levels of ______
Effects caused by increased circulating levels of TH
why is potassium given during DKA treatment?
Essential for preventing cardiac dysrhythmias Cardiac rhythms, potassium levels monitored every 2-4 hours
s/sx of asymptomatic infection (5)
Fatigue, headache, low-grade fever, night sweats, PGL (persistent general lymphadenopathy) & other symptoms
hepatitis A mode of transmission
Fecal-oral route
foods rich in a vitamin D (2)
Fish, sun
HIV is a _____ that causes ______
HIV is a retrovirus that causes immunosuppression
individuals with a family history of graves disease should be educated about _____ ______ of _______ and should be encouraged not to _______
Individuals with family history should be educated about increased risk of hyperthyroidism and should be encouraged not to smoke
cause of HHS (4)
Infection Therapeutic agents Acute, chronic illnesses Acute illness is most common precipitating factor
Protease inhibitors (HIV)
Interfere with activity of enzyme protease
DKA
Mostly T1 DM. absolute deficiency of insulin. Causing for the body to break down fats and protein which creates ketones as a biproduct. excess ketones causes metabolic acidosis
HHS
Mostly T2 DM. it is a serious and life threatening situation that results in severe dehydration.
Asterixis
Muscle tremor that interferes with ability to maintain position of extremities
is it okay to take any prescription or OTC/herbal remedies with ART drugs?
NO, they may have dangerous or potentially lethal interactions with other medications/herbs. Check with provider
normal range of CD4 and T-cells
Normal range is 800 to 1200 cells/μL
Insulin glargine (Lantus) (onset(duration), classification, when given, when not to use 3)
Onset: 24hr classification: long-acting when given: given to create a constant effect, not peak time when not to use: not recommended for pregnancy, should not be mixed with other insulins, cannot be used in insulin pumps
osteoporosis is a _________ _________ _________ characterized by 3 things
Osteoporosis is a metabolic bone disorder characterized by -Loss of bone mass -Increased bone fragility -Increased risk of fractures
individuals with osteoporosis should participating in ______-______ exercise for ____ min/day ______ per week such as ......
Participate in weight-bearing exercise for ~30 min/day 4×/week (dancing, walking, bowling, strength training...)
Hgb values for SLE and RA
SLE and RA: 12g/dl or less for females and 13.5g/dl or less for males
Severe problems develop when < _____ CD4+ T cells/μL
Severe problems develop when < 200 CD4+ T cells/μL
C-Reactive Protein (CRP) shows
Shows presence of abnormal glycoprotein due to inflammatory process
Issue of alcohol drinking with diabetes
Signs of intoxication and hypoglycemia are similar. Can cause hypoglycemia so it should be consumed with meals
Since HIV infection can be prevented, nursing care for individuals not known to be infected with HIV should focus on ______ _______ _______
Since HIV infection can be prevented, nursing care for individuals not known to be infected with HIV should focus on preventing disease transmission.
pharmacologic treatment for SLE (skin/arthritic manifestations and acute exacerbation 2, immunosuppressive agents 3)
Skin, arthritic manifestations/acute exacerbation -Antimalarial drugs -Corticosteroids (methyloprednisolone) immunosuppressive agents: -azathioprine, cyclophosphamide, or cyclosporine
promote healthy behavior by _____ cessation, avoid excessive _____ intake, and limit ______ intake
Smoking cessation, avoid excessive alcohol intake, and limit caffeine intake (in large quantities)
Combination antiretroviral therapy:
Three or more drugs from different groups are prescribed at full strength
diagnostic tests for hyperthyroidism (2)
Thyroid antibody (TA) test -thyroxine (T4) and triiodothyronine (T3) tests
Anti-DNA measures
Titer measurement of antibody to double-stranded DNA
treatment for hyperthyroidism focuses on....
Treatment focuses on reducing production of TH, establishing euthyroid(normal thyroid) state
untreated thyroid disorders can result in _____ ______ and _______
Untreated, can result in cardiac disease, death
high or low in SLE: WBC Hgb Hct Plt Anti-DNA ESR CRP
WBC: low Hgb: low Hct: low Plt: low Anti-DNA: high ESR: high indicating lupus active CRP: high
laryngeal stridor
a harsh, high-pitched sound heard on inspiration and expiration that indicates respiratory obstruction. Nurse should take immediate action to preserve client's airway
what is methyloprednisolone used for in SLE (2)
acute exacerbation -Topical for skin lesions -High-dose for severe and life-threatening manifestations
HIV infections are divided into different stages which are (4)
acute, asymptomatic, symptomatic, and AIDS.
Oral hairy leukoplakia
an Epstein-Barr virus infection that causes painless, white, raised lesions on the lateral aspect of the tongue, can occur at this phase of the infection and is also an indicator of disease progression.
Standard antibody tests for HIV
are done on blood or oral fluid specimens and are tested by a laboratory and provide results from a day to a week later.
etiology(cause) of hyperthyroidism (2)
autoimmune Grave's disease, increased iodine intake
NPH insulins (onset, classification 2, when given 2)
onset: 1-2 hr classification: intermediate or long-acting when given: small doses before meals for in-between meal coverage and a larger dose at night to cover longer time period.
regular insulin (onset, classification, when given 3)
onset: 30mins classification: short-acting when given: to treat DKA, initiate tx for newly diagnosed T1D, and in combo 3with intermediate-acting insulin for better glucose control **ONLY INSULIN THAT CAN BE GIVEN IV**
two types of osteoporosis
primary and secondary
A nurse is teaching a client who has diabetes mellitus about insulin injections. The client's prescription includes evening doses of insulin glargine and regular insulin. Which of the following instructions should the nurse take? - inject the insulins intramuscularly - shake the insolence vigorously prior to administration - draw up the insulins in two separate syringes - expect the insulins to appear cloudy
- draw up the insulins in two separate syringes(insulin glargine is not compatible with other insulins)
A nurse is reviewing the laboratory results of a client undergoing screenings for primary cushings disease. The nurse should expect an elevation in which of the following laboratory findings? - Lymphocyte count - potassium - calcium - glucose
- glucose
Anti-DNA normal result (dont need to know result)
negative
can HIV be spread through casual contact? (hugging, tears, dry kissing, emesis, sharing eating utensils, feces)
no
can graves disease be prevented?
no
A nurse is assessing a client who has a new diagnosis of cushing's disease. Which of the following findings should the nurse expect? - Decrease blood pressure - weight loss - hirsutism -increased skin thickness
- hirsutism (due to increased androgen production)
Fusion inhibitors (HIV)
Interfere with HIV CD4 receptor site binding & entry into cells
blood glucose level during illness that indicate a need to call doctor
>250 mg/dL
blood glucose levels for DKA
>250 mg/dL
A nurse is assessing a client who has diabetes mellitus and reports feeling anxious. which of the following findings should the nurse expect if the client is hypoglycemic? - Rapid, deep respirations - cold, clammy skin - abdominal cramping - orthostatic hypotension
- cold, clammy skin (hypoglycemia--> cool clammy skin, anxiety, nervousness, tachycardia, and confusion)
collaborative care of HIV-infected pt focuses on (7)
(1) monitoring HIV disease progression and immune function (2) initiating and monitoring antiretroviral therapy (ART) (3) preventing the development of opportunistic diseases (4) detecting and treating opportunistic diseases (5) managing symptoms (6) preventing or decreasing complications of treatment (7) preventing further transmission of HIV.
patient teaching/interventions for supporting a healthy immune system (10)
(1) nutritional support to maintain lean body mass and ensure appropriate levels of vitamins and micronutrients (2) moderation or elimination of alcohol, tobacco, and drug use (3) keeping up to date with recommended vaccines (4) getting adequate rest and exercise (5) reducing stress (6) avoiding exposure to new infectious agents (7) accessing mental health counseling (8) getting involved in support groups and community activities (9) developing a consistent relationship with health care providers, including attendance at regular appointments. (10) Teach patients to recognize symptoms that may indicate disease progression and/or drug side effects so that prompt medical care can be initiated.
Home health nurse is assessing a client who requires lifelong hormone replacement therapy for the treatment of hypothyroidism. The client has not been taking the medication regularly. Which of the following findings should the nurse expect? - Increased urine output - persistent diarrhea - tachycardia - hypotension
- hypotension
A nurse is assessing a client who is taking propylthiouracil. The nurse should identify which of the following findings as an indications that the medication has been effective? - Increased ability to sweat - increased bowel movements - increase body weight - increase libido
- increase body weight (suppresses the production of thyroid hormones and allows for weight gain. However, excessive weight gain could indicate that the dose of propylthiouracil is too high)
A nurse is assessing a client who has diabetes insipidus. The nurse should expect which of the following findings? - Decreased heart rate - increased hematocrit - high urine specific gravity - low BUN levels
- increased hematocrit
labs for TSH, T3/T4 (do they increase or decrease)
-decreased T3 and T4 -increased TSH
what is the 15/15 rule for hypoglycemia?
-take 15g of carbs and check in 15 min -if it's still below 70, repeat
issue with drug therapy for HIV and ways around it
A major problem with most drugs used in ART is that resistance develops rapidly when they are used alone or taken in inadequate doses. Thus, combinations of three or more should be used.
CRP result seen for SLE and RA
A positive reading indicates active inflammation.
Diagnosis of HIV infection is made by testing for____ ________and/or ______ in the blood.
Diagnosis of HIV infection is made by testing for HIV antibodies and/or antigen in the blood.
commonly prescribed drugs for hepatitis and cirrhosis (1 for ascites and 2 for ammonia and nitrogen load)
Diuretics: reduce fluid retention, ascites(spironolactone) Lactulose, neomycin: reduce nitrogen load, lower serum ammonia
s/sx of acute HIV infection (4 neurologic)
Fever, swollen lymph glands, sore throat, headache, malaise, nausea, muscle & joint pain, diarrhea, or a diffuse rash accompanies seroconversion. -aseptic meningitis, peripheral neuropathy, facial palsy, or Guillain-Barré syndrome.
focus of care planning and implementing interventions to ______ ______, its ______, and resulting ______
Focus of care is planning and implementing interventions to prevent disease, its manifestations, and resulting injuries
should you give the smallest, medium, or largest dose of ART right from the start of treatment?
Give highest dose right from the start
what happens to glucose when an individual with diabetes is sick or has surgery?
Glucose levels increase even with decrease in food intake
how does HIV cause immune issues
HIV destroys so many CD4 cells and T cells to where there are not enough left to regulate immune responses
health promotion for osteoporosis (3 things to implement)
Health promotion to slow osteoporosis focus on calcium intake, exercise, health-related behaviors
HbA1c for prediabetic and goal for diabetics
Hemoglobin A1C ≥6.5% goal: <7%
post-exposure prophylaxis for Hep B (2)
Hep B vaccine, HBIG-immune globulin
INR with liver problems (increase or decrease)
INR increased (clotting problems)
normal Hgb levels for men and women
MEN: 14.0 grams per deciliter (gm/dL) and 17.5 gm/dL. WOMEN: 12.3 gm/dL and 15.3 gm/dL
AIDS diagnostic criteria(5)
MUST have HIV and one of the following: -CD4 < 200 -Opportunistic infection -Opportunistic cancers -Wasting syndrome -Dementia
osteoporosis may result from ______ ______ or ______, most often associated with ______ and ______ ______ ______. In children, related to ______ ______ or ______ ______ ______
May result from endocrine disorder or malignancy. Most often associated with aging and inadequate calcium intake. In children, related to imbalanced nutrition or other pathologic conditions
White Blood Cell Count measures
Measures circulating leukocytes
Erythrocyte Sedimentation Rate (ESR) measures
Measures the rate at which RBCs settle out of unclotted blood in 1 hour
Hematocrit measures
Measures the size, capacity, and number of cells present in blood
hypoglycemia s/sx(mild 6, moderate 13, severe 4)
Mild: -SNS releases epinephrine and norepinephrine causing sweating, tremor, tachycardia, palpitations, nervousness, and hunger Moderate: -impaired CNS d/t lack of fuel for brain cells causing inability to concentrate, headache, lightheadedness, confusion, memory lapses, numbness of lips and tongue, slurred speech, impaired coordination, emotional changes, irrational or combative behavior, double vision, and drowsiness, along with adrenergic symptoms Severe: -CNS is so impaired pt needs assistance of another person for treatment of hypoglycemia. sx: disoriented behavior, seizures, difficulty arousing from sleep, or loss of consciousness
hepatitis C mode of transmission
Percutaneous/mucosal exposure/high-risk sexual contact/perinatal (bodily fluids)
what happens if a rapid HIV-antibody test comes back positive?
Positive antibody tests should be confirmed by another test, usually the Western blot.
nonpharmacologic therapy (3 primary objectives, and 4 other things)
Primary objectives -Reduce pain, inflammation -Preserve function -Prevent deformities -Rest and exercise -Physical and occupational therapy -Plasmapheresis
progression of HIV is monitored by _____ and ____ _____ and _____ _____
Progression monitored by CD4+ T-cell counts & viral load
Spironolactone benefits for liver problems
it is good at shifting fluid back into blood vessels
Polyneuropathies
bilateral sensory disorders involving multiple nerve fibers
hypoglycemic levels
blood glucose <70 mg/dL
etiology of rheumatoid arthritis (2)
cause is unknow but -Genetic factors account for 50% of risk ~60% of patients with RA carry specific genetic marker of HLA-DR4 cluster ALSO Infectious agents may play a role in initiating Especially Epstein-Barr virus
concerns about antimalarial drugs for tx
concerns about retinal toxicity and blindness
function of albumin
keep fluid in the blood vessels
Albumin with liver problems (increase or decrease)
decrease
does WBC increase or decrease in SLE without corticosteroids?
decrease
opportunistic disease
disease that occurs when the immune system is weakened
hypothyroidism
disorder that results when the thyroid gland produces insufficient amount of TH
in terms of medications what should be avoided in cirrhosis and hepatitis
drugs metabolized by the liver (ex: barbiturates, sedatives, acetaminophen)
foods supplemented with extra calcium (3)
enriched orange juice, breakfast cereals, breads
etiology of SLE
exact cause unknown but genetic, environmental, hormonal factors might play role
exact pathophysiology is unclear but known to involve ______ ______, ______ activity
exact pathophysiology is unclear but known to involve imbalanced osteoblast, osteoclast activity
other treatment for T1D and T2D (nonpharm.)
exercise and nutrition management
is vitamin D water soluble or fat soluble?
fat soluble
alpha cells produce
glucagon
HIV prevention nursing intervention (3)
goal is to develop safer, healthier, and less risky behaviors. -Avoid risky behaviors (abstinence) -Modify risky behaviors(use condom, barrier methods, dental dams that cover female genitalia for oral sex, NO SHARED NEEDLES) -Candid, culturally sensitive, language- appropriate, age-specific information & behavior change counseling
in SLE is an anti-DNA positive or negative
positive -High titer is seen in SLE; increases in titer may indicate an increase in disease activity.
etiology (causes) of hypothyroidism (primary 5, secondary 2, most common in..)
primary hypothyroidism:(more common) -Congenital defects in gland -Loss of thyroid tissue following treatment of hyperthyroidism with surgery or radiation -Antithyroid medications -Thyroiditis -Endemic iodine deficiency secondary hypothyroidism: -Results from pituitary TSH deficiency or peripheral resistance to TH -Common in women 30-60 years of age, especially after age 50
what happens after initial infection of HIV
prolonged period (years) of low viral load and clinical symptoms can be limited. Even without symptoms, HIV replication occurs at a rapid and constant rate in the blood and lymph tissues.
A nurse is caring for a client who has diabetes mellitus and has developed peripheral neuropathy. Which of the following measures should the nurse recommend to prevent injuries to the client's feet? - examine the skin of the feet weekly for alterations and skin integrity - monitor the temperature of the bath water with a thermometer - shop for shoes early in the day - round the edges of toenails when trimming them
- monitor the temperature of the bath water with a thermometer
A nurse is managing the care of a client who is postoperative and has acute adrenal insufficiency. which of the following actions should the nurse take? - Administer IV hydrocortisone sodium -give oral spironolactone -infuse 1 unit of platelets -restrict daily fluid intake
- Administer IV hydrocortisone sodium
A nurse is caring for a client who has pheochromocytoma. Which of the following actions should the nurse take? - Elevate the head of the client's bed - palpate the client's abdomen - monitor the client for hypotension - check the clients urine specific gravity
- Elevate the head of the client's bed (should elevate to reduce blood pressure and abdominal pressure)
A nurses and an outpatient clinic and is teaching a client who has a diabetic foot ulcer about foot care. Which of the following statements by the client indicates an understanding of the teaching? - I will let my feet air dry after washing - I will wear sandals to allow air to accumulate around my feet - I will buy over the counter medicines to treat my calluses on my feet - I will apply lotion to the dry areas of my feet but not in between my toes
- I will apply lotion to the dry areas of my feet but not in between my toes
A nurse is monitoring a client who is 24 hours postoperative after a total thyroidectomy. Which of the following findings should the nurse report to the provider? - Laryngeal stridor - productive cough - pain with hyperextension of neck - horse, weak voice
- Laryngeal stridor
A nurse is teaching a client who has an autoimmune disease about the adverse effects of long term corticosteroid therapy. Which of the following adverse effects should the nurse include? - Osteoporosis - moon shaped face - increased risk of infection - hearing loss - weight loss
- Osteoporosis - moon shaped face - increased risk of infection
A nurse has administered Propranolol by Ivy bolus to a client who is having thyroid storm. Which of the following findings indicates that the client is having a therapeutic response? - Reduction of the effects of thyroid hormone on the heart - blockage of the release of thyroid hormone from the thyroid gland - increase in the heart sensitivity to thyroid hormone - increase in the uptake of thyroid hormone by the thyroid gland
- Reduction of the effects of thyroid hormone on the heart
A nurse is teaching a client who is scheduled for a vanillylmandelic acid test to screen for pheochromocytoma. Which of the following statements should the nurse include in the testing? - Start fasting at midnight prior to the day of the test - begin the 24 hour urine collection with the 1st morning urination - take low dose aspirin for pain during the testing. - Restrict the coffee and take two to three days prior to the test
- Restrict the coffee and take two to three days prior to the test
A nurse is developing a teaching plan for a client who has a thyroidectomy and takes a thyroid hormone replacement period which of the following instructions should the nurse plan to include? - Take this medication on an empty stomach - take this medication with antacid - change position slowly while taking this medication - limit your fluid intake while taking this medication
- Take this medication on an empty stomach (do not eat or drink 30-60min after to promote proper absorption)
A nurse is providing discharge teaching to a client who has diabetes insipidus for a new prescription for desmopressin nasal spray. Which of the following instructions should the nurse include in the teaching? - Depress the pump once before using the nasal spray for the first time - blow your nose gently prior to using the nasal spray - administer the nasal spray in a side lying position - notify the provider if you develop numbness or tingling around the mouth
- blow your nose gently prior to using the nasal spray (this prevents dilution of the medication with nasal secretions)
A nurse is assessing a client who has adrenal insufficiency. Which of the following findings should the nurse expect? -Moon shaped face - weight gain - calcium 12.8 mg/dL - sodium 150 mEq/L
- calcium 12.8 mg/dL (client who has adrenal insufficiency will have hypercalcemia above 9.0-10.5 mg/dL)
A nurses planning teaching for a client who has type one diabetes mellitus. Which of the following instructions should the nurse plan to include? - Consume no more than three servings of alcohol per day - ingest food with alcohol to reduce alcohol induced hypoglycemia - increase insulin dosage before planned exercise - rest for three days between periods of vigorous exercise
- ingest food with alcohol to reduce alcohol induced hypoglycemia
tx for DKA if alterations in level of consciousness, vomiting, acidosis occur
-IV fluid replacement
A nurse is reviewing laboratory values for a client who has diabetic ketoacidosis. Which of the following results should the nurse expect? - pH 7.32, PaCO2 36mm Hg, HCO3 14 mEq/L -pH 7.38, PaCO2 55 mm Hg, HCO3 22 mEq/L -pH 7.44, PaCO2 40 mm Hg, HCO3 23 mEq/L -pH 7.50 PaCO2 42 mm Hg, HCO3 30 mEq/L
- pH 7.32, PaCO2 36mm Hg, HCO3 14 mEq/L
A nurse is preparing a teaching plan for a client who has diabetes insipidus and requires intranasal desmopressin. Which of the following information should the nurse include? - Drink at least three liters of fluid per day - weigh yourself weakly while wearing similar clothing at the same time of day - notify the provider of a weight loss of 1 LB or more per week - report nocturia because it requires a dosage adjustment
- report nocturia because it requires a dosage adjustment (the client should take initial dose during the evening. The provider will increase the dosage until client no longer has nocturia)
A nurse is caring for a client following a thyroidectomy. The nurse should assess for which of the following findings as an indication of hypocalcemia? - Strong, bounding pulse - decrease bowel sounds - tingling and numbness of the hands and feet - diminished deep tendon reflexes
- tingling and numbness of the hands and feet (hypocalcemia causes paresthesia, which usually starts in hands and feet)
A nurse is teaching a client who has type one diabetes mellitus about how to prevent complications during illness. Which of the following statements by the client indicates an understanding of the teaching -" I should stop taking my insulin if I feel nauseous" -" I will test my urine for protein when I start to feel ill" -" I will call my doctor if my blood sugar is more than 250" -" I should check my blood sugar levels every eight hours"
-" I will call my doctor if my blood sugar is more than 250"
A nurse is teaching a client about glycosylated hemoglobin (HbA1C) testing. which of the following client statements indicates an understanding of the teaching? -" I need to fast after midnight the night before the test" -" this test result is a good indicator of my average blood glucose levels" -" a level of 8 to 10% suggests adequate blood glucose control" -" I will use my hemoglobin A1C level to adjust my daily insulin doses"
-" this test result is a good indicator of my average blood glucose levels"
nursing interventions for hypoglycemia (1 regular tx, emergency tx: glucose range and other criteria to be considered emergency hypoglycemic and two kinds of treatments)
-15g of fast-acting concentrated source of carbohydrate(such as juice) -emergency: (for pts less than 54 mg/dL, unconscious, or cannot swallow) -glucagon may be administered IM or subq -25-50mL dextrose 50% in water(dextrose/D50W) may be administered IV
Ascites(what it is and two things that can cause it hypo_____ and hyper______)
-Accumulation of plasma-rich fluid in abdominal cavity -Hypoalbuminemia and hyperaldosteronism
A nurse is teaching a client about the adrenal corticotropic hormone (ACTH) stimulation test. the nurse should explain that the purpose of the test is to assess which of the following disorders? - Diabetes insipidus - hyperthyroidism -pheochromocytoma -Addison's disease
-Addison's disease
different kinds of cirrhosis (causes) 2
-Alcoholic (Laennec's) - ETOH related abuse -Post-necrotic - most common, related to hepatitis B, C(most common) & industrial chemical exposure
Azathioprine, cyclophosphamide, or cyclosporine (can be used with, increased risk for 3, nursing responsibilities 5)
-Alone or in combination with corticosteroids -Increased risk for: Infection, Malignancy, Bone marrow depression -Nursing responsibilities: Monitor blood count, especially WBC, platelets; Monitor renal, liver function studies; Monitor for signs of abnormal bleeding; Meticulous hand hygiene; Monitor pulmonary function studies; Be alert for dyspnea, cough
diagnostic tests for SLE (7)
-Anti-DNA antibody testing -Erythrocyte sedimentation rate -Serum complement levels -Complete blood count (CBC) -Urinalysis -Kidney biopsy -C-reactive protein
graves disease (what is it, is thyroid enlarged or small, eye issues, older patients, and reproductive issues)
-Autoimmune disorder -Enlarged thyroid gland (goiter) -Ophthalmopathy --> exophthalmos
prevention of disease flare-ups of SLE (5 points)
-Avoid excessive sun exposure -Reduce stress -Exercise regularly -Get flu, pneumococcal vaccines -Avoid high-dose birth control pills, penicillin, sulfonamides
goals/interventions for RA (4)
-Balance of rest, exercise -Physical therapy (OT/PT very important) -Suppression of inflammatory processes
Admission to hospital d/t DKA are (3)
-Blood glucose level >250 mg/dL -Decreasing pH -Ketones in urine
Splenomegaly (4 manifestations related to 2 complications)
-Blood shunted to splenic vein → enlargement of spleen -Greater rate of destruction of RBCs, WBCs, platelets → anemia, leukopenia, thrombocytopenia
risk factors of osteoporosis depends on...... (4)
-how much bone mass is achieved between ages 25 and 35 and how much lost after that -low BMI -alcohol intake -smoking
macrovascular complications of diabetes (5)
-CAD(major risk for MI and most prone for CHF, most common death in people with diabetes) -HTN (common comorbidity of DM major risk for CV disease and microvascular complications) -stroke (manifestations similar to HHS potentially life threatening, diabetes increases risk) -peripheral vascular disease of lower extremities (more common for T2D) -gangrene from PVD of lower extremities (usually begins in toes and moves proximally into foot, most common cause of nontraumatic amputations, caused by occlusion)
diagnostic tests for RA (6)
-CBC -RF -Antibodies to cyclic citrullinated peptide (CCP) -Elevated Erythrocyte sedimentation rate (commonly seen in autoimmune processes) -C-reactive protein -X-rays of affected joints
symptomatic infection of HIV
-CD4 and T cells drop to 200-500 cells/μL -viral load increases -symptoms in earlier phases worsen and other problems develop -HIV advances to a more active state
Perinatal(pregnant women) transmission of HIV and prevention of spread to baby
-Can occur during pregnancy, delivery, or breastfeeding -An average of 25% of infants born to women with untreated HIV will contract the infection -Fortunately, the risk of transmission can be reduced to less than 2% in settings where pregnant women are routinely tested for HIV infection and, if found to be infected, treated with antiretroviral therapy (ART).
nursing diagnoses for hypothyroidism (4)
-Cardiac Output, Decreased -Constipation -Skin Integrity, Impaired -Situational Low Self-Esteem
cause of systemic lupus erythematosus and when it is typically diagnosed
-Caused by deposition of antigen-antibody complexes in connective tissues -Most cases diagnosed in teen, early adult years
portal hypertension (2 manifestations related to 3 complications)
-Causes blood to be rerouted to adjoining vessels -Affected veins become engorged, congested (esophagus, rectum, abdomen) -Increased hydrostatic pressure in capillaries pushes fluid out → ascites
what is rheumatoid arthritis and where it occurs and 2 things it causes the patient to feel
-Chronic systemic autoimmune disorder that causes -Inflammation of connective tissues Primarily in joints (typically smaller joints such as fingers but can happen anywhere) -pt feels chronic pain and alterations in body image
glucagon (2 actions)
-Decrease glucose oxidation via glycogenolysis -Increase blood glucose levels via gluconeogenesis
drug therapy for HIV, main goals (5)
-Decrease viral load -Maintain/increase CD4+ counts -Prevent HIV-related symptoms & opportunistic diseases -Delay disease progression
RA affect on cardiovascular system
-Direct effects on blood vessels thus increased risk of coronary heart disease
Adherence to drug regimens is critical to prevent (HIV) (3)
-Disease progression -Opportunistic disease -Viral drug resistance
how is osteoporosis diagnosed (4)
-Dual-energy x-ray absorptiometry (DEXA) -Ultrasound of heel to measure bone density (screening purposes) -Laboratory tests: Alkaline phosphatase and Serum bone Gla protein (osteocalcin) (Most useful to evaluate effects of treatment)
alcoholic cirrhosis (what it is, how it damages liver, something that forms during final stage, and common causes for alcoholic cirrhosis)
-End result of alcoholic liver disease -Functional liver tissue is destroyed by inflammatory cells trying to rid the body of toxins -In final stage, regenerative nodules form, liver shrinks Causes: -Malnutrition common(drinking calories rather than eating it in nutrition) -alcohol causes metabolic changes in liver
Esophageal varices(large blood vessels)
-Enlarged, thin-walled veins that form in submucosa of esophagus. Result from portal hypertension -May rupture → massive hemorrhage
Exercise impact on treatment for diabetics
-Exercising at peak insulin action time may lead to hypoglycemia
Thyroid storm (thyroid crisis) (basic statement of what it is, cause, manifestations 10, and what should be done about it/consequence of not treating)
-Extreme state of hyperthyroidism CAUSE: Individuals with untreated hyperthyroidism or stressor -Hyperthermia, tachycardia, systolic hypertension (HTN), gastrointestinal (GI) symptoms, Agitation, restlessness, tremors progressing to confusion, psychosis, delirium, seizures -Rapid treatment essential to preserve life
insulin (4 actions)
-Facilitates movement of glucose across cell membranes into cells -Prevents excessive breakdown of glycogen in liver, muscle -Facilitates formation of lipid, inhibits breakdown of stored fats -Helps to move amino acids into cells for protein synthesis
A nurse is monitoring the laboratory values of a client who has diabetes mellitus and is taking insulin. Which of the following results indicates A therapeutic outcome of insulin therapy? -Fasting blood glucose 96 mg/dL -postprandial blood glucose 195 mg/dL -random blood glucose 210 mg/dL -pre-prandial blood glucose 60 mg/dL
-Fasting blood glucose 96 mg/dL
pharmacologic therapy for T2D
-Glucose levels usually controlled with oral hypoglycemic medication such as metformin -Patients with type 2 diabetes cannot be managed with oral medications when hospitalized
problems that impede HIV vaccine and microbicide development
-HIV lives inside cells, where it can "hide" from circulating immune factors. HIV also mutates rapidly, so that infected individuals develop HIV variants that may not respond to simple vaccines or microbicides. -two strains of HIV (HIV-1 and HIV-2) cause infection, and at least nine clades (subtypes) of HIV may be found around the world.
risk factors (who's most likely to get it) hypothyroidism
-Hashimoto thyroiditis (more common in women) -being female aged >50 years
normal Hct ranges for men and women
-Hct: men- 42-52% women- 36-48%
four diagnostic tests for diabetes
-Hemoglobin A1C ≥6.5% -Symptoms of diabetes + casual plasma glucose (PG) concentration >200 mg/dL -Fasting plasma glucose (FPG) >126 mg/dL -Two-hour PG >200 mg/dL during oral glucose tolerance test (OGTT)
Methotrexate - Disease-modifying antirheumatic drugs (DMARDs) (anti-autoimmune drugs) (what they do, how long it takes for effects, effects on inflammation)
-Immunosuppressive drugs that Modify immune, inflammatory responses. also are Tumor necrosis factor inhibitors -Beneficial effects may take weeks, months -Clinical improvement, decreased disease activity -Minimal anti-inflammatory effect, NSAIDs continued during DMARDS therapy
s/sx of hyperthyroidism (8)
-Increased appetite with weight loss -Hypermotile bowels, diarrhea -Heat intolerance -Insomnia -Palpitations -Increased sweating -Hair changes(Hair becomes fine, Hair loss in scalp, eyebrow, axillary, or pubic areas) -Emotional lability
pathophysiology of hyperthyroidism (5 physiological changes)
-Increases metabolic rate -Heightens SNS's response -Resulting increase in cardiac output, peripheral blood flow -Increased carbohydrate, protein, lipid metabolism -Eventual caloric, nutritional deficiencies
nursing diagnoses may include (3)
-Injury, Risk for -Imbalanced Nutrition: Less Than Body Requirements (low calcium) -Pain, Acute
clinical manifestations of RA (6)
-Joint deformity -Redness, warmth, pain, swelling of affected sites(inflammation) -during active phase: Symmetrical joint deformity -anemia -may damage all organs of body -Negative effects on sleep patterns, psychosocial well-being, overall quality of life
Myxedema coma (what it is, manifestations 6)
-Life-threatening complication of long-standing, untreated hypothyroidism Manifestations: -Severe metabolic disorder -Hypothermia -Shallow edema, especially around hands, eyes, feet -Cardiovascular collapse -Impaired mentation -Coma
diagnostic tests for hepatitis (12)
-Liver function studies -Complete blood count (CBC) with platelets -Coagulation studies -Serum electrolytes, albumin, ammonia, glucose, cholesterol -Bilirubin -Abdominal ultrasound -Esophagoscopy -Liver biopsy
treatment for myxedema coma (4)
-Maintain patent airway and fluid, electrolyte, acid-base balances -Maintain cardiovascular status -Increase body temperature, TH levels
Kaposi Sarcoma
-Malignant vascular lesions such as KS lesions can appear anywhere on the skin surface or on internal organs. -Kaposi sarcoma is caused by human herpesvirus 8. -Lesions vary in size from pinpoint to very large and may appear in a variety of shades. -Most common form of cancer seen in AIDs pts
Spontaneous bacterial peritonitis (5 manifestations and what it is)
-May develop in absence of known contamination of peritoneal cavity -Inflammatory response to peritonitis -Manifestations may be subtle: -Increased abdominal discomfort or pain -Fever -Increasing ascites -Worsening encephalopathy -Overall decline in condition
Dual-energy x-ray absorptiometry (DEXA)
-Measures bone density in lumbar spine or hip -Considered highly accurate
normal ESR range (men under 50 and over 50, women under 50 and over 50) (dont need to know values)
-Men under 50 yr: <15 mm/h -Men over 50 yr: <20 mm/h -Women under 50 yr: <20 mm/h -Women over 50 yr: <30 mm/h
functions of the liver: -Metabolism of _____, and ______ -Metabolism of ______ hormones, and most _____ -Detoxifies ______, and other substances -Synthesizes essential blood ______(______) -Converts _____ to ______ for elimination by ______ -converts _____ to _____ -Produces ______ for ______ ______, eliminating _____ from body -Stores ______, ______-_______ _______, _______ -_____ ______ phagocytize _____ ______, damaged ______ ______ -Clotting ______ 1-12
-Metabolism of proteins, and carbohydrates -Metabolism of steroid hormones, and most drugs -Detoxifies alcohol, and other substances -Synthesizes essential blood proteins (albumin) -Converts ammonia to urea for elimination by kidneys -converts glucose to glycogen -Produces bile for absorbing fats, eliminating bilirubin from body -Stores minerals, fat-soluble vitamins, glycogen -Kupffer cells phagocytize foreign cells, damaged blood cells -Clotting factors 1-12
nursing implementation for RA (7)
-Monitor and treat chronic pain -Monitor level of pain, duration of stiffness -Teach use of heat, cold applications -Encourage balance of periods of activity/rest to prevent fatigue -Perform most important activities early in day -Encourage regular physical activity -Range-of-motion exercises
implementation for hyperthyroidism (4)
-Monitor cardiac output (CHF, arrhythmias) -Promote visual health (exophthalmos) -Promote balanced nutrition (eat more with frequent small meals) -Improve body image
risk factors (who's most likely to get) hyperthyroidism (4)
-Most common among female gender -Family history of Graves disease -Increased iodine intake -Age between 20 and 40 years
pharmacologic therapy for RA (, two is most important and most used)
-NSAIDs are NO LONGER INITIAL TREATMENT CHOICE -Corticosteroids(in an acute flare up, RA pt will be on predinosone..) -Disease-modifying antirheumatic drugs (DMARDs) (anti-autoimmune drugs)
cartilage damage occurs in Rheumatoid arthritis through three processes
-Neutrophils, T cells, other synovial fluid cells activated, degrade surface layer of articular cartilage -Cytokines cause chondrocytes to attack cartilage -Synovium digests nearby cartilage
pathophysiology of Rheumatoid arthritis
-Normal antibodies become autoantibodies called rheumatoid factors which cause leukocytes(neutrophils and macrophages) to be attracted to synovial membrane to attack complexes
alcohol consumption
-Not encouraged, not totally prohibited -Signs of intoxication and hypoglycemia are similar
insulin lispro (Humalog) (onset, classification, when its given)
-Onset: less than 30 mins -classification: rapid-acting (more rapid than regular insulin) -when given: 15 min before meal
Who gets rheumatoid arthritis? (3 one is typical age range)
-Osteoarthritis most common form of arthritis in older adults -RA affects more women than men -onset between ages 40-60
how is RA different than osteoarthritis
-Osteoarthritis occurs when the smooth cartilage joint surface wears out. Osteoarthritis usually begins in an isolated joint. "normal wear and tear" Rheumatoid arthritis is an autoimmune disease, which means that the immune system malfunctions and attacks the body instead of intruders.
osteoblast vs osteoclast
-Osteoblast: bone deposition, build bone -Osteoclast: bone resorption (break down), crush bone
evaluation of T1D, Expected outcomes may include (4)
-Patient demonstrates age-appropriate understanding of self-management through medication, exercise, diet, blood glucose self-monitoring -Patient's skin integrity remains intact -Patient remains free of infection -Patient remains free of injury
Expected outcomes for osteoporosis may include: -Patient identifies, implements strategies to change or modify lifestyle factors such as ______, ______, and ______ -Patient achieves adequate ______ and _____ __ intake -Patient identifies, eliminates _____ _____ -Patient experiences relief from _____ _____
-Patient identifies, implements strategies to change or modify lifestyle factors such as Smoking, exercise, and alcohol use -Patient achieves adequate calcium and vitamin D intake -Patient identifies, eliminates safety hazards -Patient experiences relief from acute pain
goals for hypothyroidism (7)
-Patient will not exhibit arrhythmias -Patient's skin will remain warm and dry to touch -Patient will remain free of edema -Patient will maintain visual acuity -Patient will participate in activities without heart rate exceeding or falling below established limits -Patient's elimination pattern will return to normal -Patient's skin will remain intact
Hepatitis B mode of transmission
-Percutaneous/mucosal exposure/sexual contact/perinatal (through body fluids)
complications of hepatitis
-Portal hypertension -Splenomegaly -Ascites -Esophageal varices(large blood vessels) -Portal systemic encephalopathy (hepatic encephalopathy) -Hepatorenal syndrome -Spontaneous bacterial peritonitis
Rheumatoid factor (RF) blood test seen in SLE and RA
-Positive titer >1:80 -The higher the titer (number at right of colon), the greater the inflammation. -Present in 80% of those with RA -Positive RF may also suggest SLE,
Opportunistic diseases complicate management of HIV infection, what is the key actions for opportunistic diseases in HIV (3)
-Prevention is key -Onset can be delayed with adequate measures -Effective management has significantly increased life expectancy
pathophysiology of SLE (how it forms complications and most common organ that takes deposition damage along with the rest that can 8)
-Production of autoantibodies -React against normal body components they form immune complexes --> deposit into connective tissues --> deposits cause inflammatory response --> local tissue damaged -Kidneys frequent side of deposition damage -Musculoskeletal system, brain, heart, spleen, lung, gastrointestinal (GI) tract, skin, peritoneum
Radioactive Iodine Therapy (RAI) (how it works, contraindication 1, AE 2)
-RAI concentrates in thyroid, damages or destroys thyroid cells → produce less TH -contraindicated in pregnant women -may develop hypothyroidism or cardiac instability
acute management for hepatitis (what to tell your patient to do to feel better) (4)
-REST!!!!!!!!!!!!!!!!!!!!! No work, "lay low" -RISK of bleeding -PROPER hygiene and prevention (hand washing and use of condoms for sexual intercourse) -monitor weight
clinical manifestation of SLE (8)
-Red butterfly rash (most commonnnn) -Alopecia -Painful, swollen joints -Extreme fatigue -Renal manifestations -Ocular manifestations -Prognosis(course of disease) depends on severity of internal -organ involvement -sun sensitivity
nursing implications for administering insulin (2)
-Regular or rapid-acting insulins used in continuous subcutaneous insulin infusion (CSII) devices -Maintaining normal blood glucose levels during hospitalization decreases risk of postoperative infections, shortens hospital stays
Hepatorenal syndrome (manifestations 4, how it results, and possible triggers 2)
-Renal failure with azotemia, sodium retention, oliguria, hypotension -In patients with advanced cirrhosis and ascites which is a result of imbalanced blood flow -May be triggered by GI bleeding, aggressive diuretic therapy, unknown cause
Portal systemic encephalopathy (hepatic encephalopathy) (10 things cause this but 2 are specific to hepatitis, and three manifestations )
-Results from cerebral edema and accumulation of neurotoxins(ammonia) in the blood -Narcotics, tranquilizers may contribute -Other factors: constipation, blood transfusions, gastrointestinal (GI) bleeding, hypoxia, high-protein diet, severe infection, surgery -Manifestations include changes in personality, mentation, Asterixis
prevention of hepatitis from getting worse (4)
-See healthcare provider regularly. Especially important for patients diagnosed with hepatitis -Maintain healthy weight -Avoid alcoholic beverages, illegal drugs -Take all medications as prescribed. Especially important for patients diagnosed with autoimmune hepatitis
liver function tests (9)
-Serum Bilirubin(>1.1...) -Alkaline phosphatase (ALP) -↑ with biliary obst -Aspartate aminotransferase (AST)- ↑ liver damage, inflammation -Alanine aminotranferase (ALT)-↑ liver damage, inflammation -Liver Biopsy- percutaneous(through skin) needle between 6th&7th rib. risk of bleeding, bedrest, close monitoring, lie flat on R side to splint site -INR time, albumin, tsp, and ammonia(are other labs) -INR: may be prolonged in liver failure (normal <1.0 second)
other infections that can occur during symptomatic infection (5)
-Shingles -Persistent vaginal/oral candidal infections -Herpes -Bacterial infections -Oral hairy leukoplakia
s/sx of hypothyroidism (16)
-Slow onset, manifestations appearing over months or years -Goiter -Fluid retention and edema -Decreased appetite, weight gain, constipation -Dry skin -Dyspnea -Pallor -Hoarseness -Muscle stiffness -Decreased senses of taste, smell -Menstrual disorders -Anemias, cardiac enlargement -Abnormalities in lipid metabolism
Toxic multinodular goiter (what it is, manifestation of..., who its most common in, and 2 things it presents as)
-Small, independently functioning nodules secrete excessive amounts of TH -Manifestations of hyperthyroidism develop slowly -Most common in postmenopausal women -Present as both hypothyroidism and hyperthyroidism
s/sx symptomatic infection of HIV
-Symptoms seen in earlier phases become worse, leading to persistent fever, frequent drenching night sweats, chronic diarrhea, recurrent headaches, and fatigue severe enough to interrupt normal routines. -Other problems, including infections, lymphadenopathy, and nervous system manifestations, may occur.
other manifestations of RA (4)
-Systemic disease -Anemia resistant to iron therapy -Skeletal muscle atrophy -Subcutaneous nodules
Labs for TSH, T3/T4 for hyperthyroidism (do they increase or decrease)
-TSH: decreased -T3/T4: increased
-Teach adolescents, pregnant or lactating women, adults through age 35 to eat high-calcium foods, maintain calcium intake of ____-____ mg/day -Encourage postmenopausal women to maintain calcium intake of ____-____ mg/day
-Teach adolescents, pregnant or lactating women, adults through age 35 to eat high-calcium foods, maintain calcium intake of 1200-1500 mg/day -Encourage postmenopausal women to maintain calcium intake of 1000-1500 mg/day
myxedema coma cause (6)
-Trauma -Central nervous system (CNS) depressants -Failure to take thyroid replacement medications -Use of CNS depressants -Infection -Exposure to cold
primary osteoporosis type I and type II
-Type I: linked to estrogen deficiency resulting in increased calcium reabsorption from bone -Type II: results from kidneys losing ability to process vitamin D
joint manifestations of RA (2)
-Typically polyarticular(many joints), symmetrical -Stiffness In morning, lasting more than 1 hour
initial infection of HIV
-Viremia (large viral levels in blood) for 2 to 3 weeks -Transmission is more likely when viral load is high
pathophysiology of hypothyroidism
-When TH production decreases, thyroid gland enlarges in attempt to produce more hormone -Resulting goiter is usually simple, nontoxic
risk factors of SLE (3 and 4 ethnicities at high risk)
-Women (90%) typically of childing bearing age -higher risk for siblings -people with other autoimmune diseases -most common among African Americans, Hispanics, Native Americans, Asians
how to relieve acute pain for osteoporosis?
-application of heat -and OTC anti-inflammatories (careful- GI ulcers)
cause of T1D and who gets it
-autoimmune destruction of beta cells -juvenile onset but can be diagnosed at any age (can also be genetic)
nonpharmacologic therapy for SLE (4)
-avoid smoking -Consult with healthcare provider prior to receiving immunizations -Eat healthy diet that includes oily fish -Stress reduction
A nurse is teaching a client who has diabetes mellitus. Which of the following should the nurse include as an expected finding of diabetic ketoacidosis? - Decreased urine output - weight gain of 0.45 kg (1lb) in 24 hr -rapid, shallow respirations -blood glucose levels above 300 mg/dL
-blood glucose levels above 300 mg/dL
transmission(4) of HIV and major/most common route of transmission(action 1)
-blood, semen, vaginal secretions, and breast milk -unprotected heterosexual sex
dietary management for osteoporosis (3)
-calcium-rich foods -Foods supplemented with extra calcium -Foods rich in vitamin D
AIDS stage of HIV infection (when is it diagnosed, risk for _____ diseases, and some sx 3)
-cannot be diagnosed until HIV pt meets criteria established by CDC -Immune system severely compromised -Great risk for opportunistic disease -Possible malignancies, dementia, and Cachexia (wasting)
diet management for diabetes (6)
-carbohydrate intake of 45-65% of daily diet( grains, fruits, veggies, milk, and some dairy products) -protein intake 15-20% total daily kilocalorie intake (low fat and low cholestrol) -dietary fats less than 7% total kcal/day (limit fat) -dietary fiber recommended for 20-35 g/day (increase may cause nausea, diarrhea, constipation. helpful in treating constipation) -sodium 1000mg per 1000 kcal (DO NOT EXCEED 3000 mg, avoid processed foods and table salt) -restrict refined sugars (artificial sugars approved)
The major drug classifications for HIV include....(6)
-entry/fusion inhibitors -non-nucleoside reverse transcriptase inhibitors (NNRTIs) -nucleoside reverse transcriptase inhibitors (NRTIs) -nucleotide reverse transcriptase inhibitors (NtRTIs) -integrase inhibitors -protease inhibitors (PIs).
treatment for HHS
-establish and maintain adequate ventilation -correct fluid, electrolyte imbalances (K+) -lower blood glucose levels with insulin (until it reaches 250 mg/dL)
risk factors of RA (6)
-family history -heavy smokers (risk can be reduced by cessation) -obesity -physical/emotional trauma -pollutants -occupational exposure
T2D clinical manifestations (8)
-fatigue -extreme thirst (polydipsia) -Frequent urination (polyuria) -Extreme hunger (polyphagia) -Weight loss -Infection -Slow wound healing -Blurry vision
patient teaching for exercise with diabetes (3)
-food intake may need to be increased to compensate for activity -increase fluid intake -take carbohydrate source (5-10%) after 1 hour of exercise
types of jaundice (3)
-hemolytic -hepatocellular -obstructive
patient teaching intervention for T1D and T2D (9)
-how diabetes changes metabolism -diet keeps blood glucose in normal range -exercise lowers glucose -self-monitoring of glucose -medications -manifestations of acute complications -hygiene including skin/dental/foot care -sick-day management -teach safety maintenance
T1D clinical manifestations (7 important and 2 that are general to either types)
-hyperglycemia -breakdown of body fats, proteins (weight loss) -ketosis (fruity breath) (DKA) -Hyperglycemia acts as osmotic diuretic → increased urine output (polyuria) -Glucosuria(d/t polyuria) -Polydipsia -Polyphagia -malaise and fatigue
Myxedema (what it is, manifestations 4)
-hypothyroid state in adults -nonpitting edema, Patient's face puffy, tongue enlarged, voice hoarse
clinical manifestations as hepatitis progresses (2 big complications that lead to manifestations one has 6 and other has 5)
-impaired metabolism → bleeding, ascites, gynecomastia in men, infertility in women, jaundice, neurologic changes -Portal hypotension → ascites, peripheral edema, anemia, low WBC and platelet counts
how to prevent injury for osteoporosis pts (5)
-implement safety precautions -Avoid using restraints on hospitalized or long-term care (LTC) patient -Encourage use of assistive devices -Teach older patients about safety, fall precautions -Home assessment may reduce risk of fractures
Bisphosphonates (how it works, examples and suffix, side effects 4)
-inhibits bone resorption so it keeps calcium in the bones -suffix: -nate (Etidronate, Alendronate, Tiludronate, Pamidronate) -side effects: Nausea, vomiting, abdominal pain, Esophageal irritation
cause of T2D and who gets it
-insulin resistance of body cells or production of insulin is lower than demand -obese children and adults 30+years (most common in American Indians and Alaska natives)
cirrhosis (what it is and two ways it forms)
-is the End stage of chronic liver disease -Progressive, irreversible -Cirrhosis from chronic hepatitis C: most common type -Alcoholic cirrhosis: second most common type
issues with ART (5)
-it Is complex -Has side effects -Does not work for everyone -Is expensive -These factors can contribute to problems with adherence to treatment, a dangerous situation because of the high risk of developing drug resistance.
insulin storage/use (4)
-kept at room temp for 4 weeks -regular insulin requires no mixing -discard cloudy/discolored solution -other types require gentle rolling to disperse particles evenly
problems with rheumatoid arthritis (pathophys..)
-leads to greater loss of bone, cartilage -leads to formation of scar tissue that immobilizes the joint
clinical manifestations of osteoporosis (7)
-lordosis, kyphosis -protrusion of abdomen -knees, hips flex -lower back pain -fractures
WBC counts for systemic lupus erythematosus (low/shift to the left, high/shit to the right meaning)
-low/shift to left = low due to lupus -high/shift to right = may signal infection or when pt is on corticosteroids
prevention of hypothyroidism
-no prevention in developed countries -in countries where iodine deficiency is common, iodine supplements may help to prevent
who else gets osteoporosis? (3)
-older women (80%) -older men -those with poor calcium intake
calcium gluconate (how it works, when to take it in relation to meals, dosage size for age range)
-prevent, treat osteoporosis -Best taken with meals or within 1 hour after meal (absorbed better) -Adults ≥50 years of age should take in at least 1000-2000 mg calcium/day
Rapid HIV-antibody tests
-provide results in 20 minutes and are recommended by the CDC. -highly reliable and provides immediate feedback to patients who can then be counseled about treatment and prevention. This is an important advantage because many people do not return to get their test results when other testing methods (take longer to obtain the results) are used.
exercise benefit for diabetics (what it improves: 5)
-regular exercise improves fitness, emotional state, weight control, work capacity, and INCREASES UPTAKE OF GLUCOSE BY MUSCLE CELLS, REDUCING NEED FOR INSULIN
other tx given for DKA (2)
-regular insulin (only insulin given by IV), amount depends on severity -potassium replacement begins early
when is insulin used? (5 points)
-required for T1D lifelong -Person with diabetes experiences physical stress or is taking corticosteroids -Woman with gestational diabetes cannot control glucose with diet -Person with diabetes has DKA or HHS -Person with diabetes is receiving high-calorie tube feedings or parenteral nutrition
Microvascular complications of diabetes
-retinopathy (stage 1: nonproliferative, stage 2: preproliferative, stage 3: proliferative, leading cause of blindness in 20-74 yr old's) -nephropathy (thickening of glomeruli impairing function and HTN accelerates progression) -neuropathies (thickening of blood vessels that supply nerves and decreases nutrients, manifestation depends on nerve fibers involved)
acute HIV infection
-seroconversion (when HIV-specific antibodies develop) is often accompanied by a mononucleosis-like syndrome that may be mistaken for the flu. occuring 2-4 weeks after infection lasting 1-2 weeks. May also cause neurologic complications -there is a high viral load in the blood and CD4 and T cell counts fall but quickly return to baseline
A nurse is caring for a client who has type 2 diabetes mellitus and is experiencing a hyperglycemic hyperosmolar state (HHS). which of the following laboratory findings should the nurse expect? - serum pH 7.32 -blood glucose 250 mg/dL -blood glucose 425 mg/dL -serum pH 7.45
-serum pH 7.45
clinical manifestations of early stages of hepatitis (7)
-slightly enlarged and tender liver -dull, achy paint in RUQ -weight loss -weakness -anorexia -disrupted bowel function --> diarrhea or constipation
A nurse is assessing a client who has syndrome of inappropriate anti diuretic hormone (SIADH). which of the following findings should the nurse report to the provider? -sodium 110 mEq/L -2+ deep-tendon reflexes -potassium 3.7 mEq/L -urine specific gravity 1.025
-sodium 110 mEq/L (SIADH retains fluid causing dilutional hyponatremia)
insulin concentrations (standard concentration, rare cases that requires large dose)
-standard concentration: 100 unit/mL (U-100) -rare cases of insulin resistance when large dose required: 500 unit/mL (U-500)
The most useful screening tests for HIV are... and major problem with them
-those that detect HIV-specific antibodies. -The major problem is that there is a delay of 4 weeks after infection before antibodies can be detected. This creates a window period during which an infected individual may not test positive for HIV antibodies.
A nurse is admitting a client who has hyperthyroidism. When assessing the client, the nurse should expect which of the following findings? -cold intolerance -lethargy -tremors -sunken eyes
-tremors (findings include tremors, diaphoresis, and insomnia)
treatment and first indication for nephropathy
-tx: aggressive antihypertensive management (ACE inhibitors, weight loss, reduced salt intake and exercise) -indication: microalbuminuria
AST normal value
10-40 U/mL
normal fasting blood glucose
100 mg/dL
PT normal value
11-13 seconds
normal blood glucose ranges for diabetics (target range)
140-180 mg/dL
ammonia normal value
15-45 mcg/dL
Plt normal value
150,000-450,000
normal Plt levels
150,000-450,000 cells/μL
normal levels for OGTT(oral glucose tolerance test)
2-hour PG <140 mg/dL
impaired glucose tolerance (GT)
2-hour PG >140 mg/dL but <200 mg/dL
Diagnosis of diabetes for OGTT
2-hour PG >200 mg/dL
ALP normal value
30-120 units/L
A1c levels for normal adults and when it is considered diabetic
4-6% is normal for adults 6.5% or higher can indicate diabetes
normal WBC count
5,000-10,000 cells/mm3
WBC normal value
5,000-10,000/mm3
fasting blood glucose
60-100 mg/dL
blood glucose for HHS
600 mg/dL<
normal blood glucose levels for individuals without diabetes
70-100 mg/dL
fasting blood glucose range that indicates insulin therapy is effective
70-110 mg/dL
preprandial blood glucose levels
70-130 mg/dL
ALT normal value
8-40 U/mL
c-reactive protein (CRP) normal values (dont need to know values)
<1 mg/dL (<10 mg/L)
INR normal value
<1.1
fasting glucose levels for diabetics
<100 mg/dL
premeal and random glucose targets for hospitalized diabetic patients
<140 mg/dL premeal <180 mg/dL random
Plt values for inflammation such as with SLE and RA
<150000 cells/μL -CAN BE HIGHER THAN NORMAL WITH MEDICATIONS USED TO TREAT DISORDERS
postprandial blood glucose goal
<180 mg/dL
random blood glucose draw goal
<200 mg/dL
blood pH during DKA
<7.35
impaired fasting glucose
>100 mg/dL but <126 mg/dL
diabetic fasting glucose
>126 mg/dL
diagnosis of diabetes fasting glucose level
>126 mg/dL
blood glucose for DKA
>250 mg/dL
blood glucose levels for HHS
>600 mg/dL
what is antimalarial medications (hydroxychloroquine) effective in managing in SLE?(3)
managing cutaneous, musculoskeletal, and mild systemic features of SLE
the pancreas produces hormones necessary for.....
metabolism, cellular utilization of carbohydrates, proteins, fats
Immune problems start when _____ and _____ counts drop to < ____ cells/μL (infection attacks these)
Immune problems start when CD4 and T-cell counts drop to < 500 cells/μL (infection attacks these)
issue with prednisone corticosteroid use over a long period of time
multiple side effects can occur
is hepatitis A infectious before or after s/sx?
Infectious 2wks before s/s & 1-2 wks after
is hepatitis B infectious before or after s/sx?
Infectious before & after s/s, 4-6 months
Nucleoside, non-nucleoside, & nucleotide reverse transcriptase inhibitors (HIV)
Inhibit the ability of HIV to make a DNA copy early in replication
reduced bone mass is caused by ______ in the processes that influence ______ ______ and ______
Reduced bone mass is caused by imbalance in the processes that influence bone growth and maintenance
pharmacologic therapy for hypothyroidism
Synthroid/levothroid (levothyroxine)
the lower the viral load the ______ active the disease (HIV)
The lower the viral load the less active the disease
normal Rheumatoid Factor (RF) test (dont need to know result)
negative
PT with liver problems (increase or decrease)
high, increased (clotting problems)
ESR (erythrocyte sedimentation rate) RA (increase or decrease)
increase
ammonia with liver problems (increase or decrease)
increase
serum bilirubin with liver problems (increase or decrease)
increase
sick day management for diabetics
increase fluid intake and keep in mind that glucose levels increase even with decrease in food intake
ALP with liver problems (increase or decrease)
increased
ALT with liver problems (increase or decrease)
increased
AST with liver problems (increase or decrease)
increased
is hepatitis C infectious before or after s/sx?
infectious 1-2 wks. before s/s, continues during clinical course, indefinite with carriers
beta cells produce
insulin
normal blood glucose in health patients is regulated by _____ and _____
insulin and glucagon
Mononeuropathies
isolated peripheral neuropathies affecting one nerve
drug to help remove ammonia resulting from portal systemic encephalopathy
lactulose: a laxative that also binds to ammonia to have it removed
does sucrose substituted for other carbs impair blood glucose control?
no
how many times should a T1 diabetic check blood glucose levels when ill
q4h
what two types of insulin are used in continuous subcutaneous insulin infusion devices
regular and rapid-acting
levothyroxine
replaces TH
secondary osteoporosis
result of disease process, deficiency, or effect of drugs (steroids)
Bilirubin normal value (serum and urine values)
serum: 0.1-0.4 mg/dL urine: 0.3-1 mg/dL
what should someone with osteoporosis avoid? (3)
smoking, alcohol, and caffeine intake
Anti-DNA antibody testing
tests for antibody that develops against the patient's own DNA
how does the length of time between the start of menstrual period to menopause effect the chances of getting osteoporosis?
the longer the period the more safe from osteoporosis because longer estrogen protection
seroconversion
the transition from the point of viral infection to when antibodies of the virus become present in the blood.
what are the most common endocrine disorders?
thyroid disorders
hyperthyroidism is also called
thyrotoxicosis
albumin normal value (total and serum)
total:7-7.5 g/dL serum: 3.5-5.2 g/dL
hyperglycemic interventions (treatment 2)
tx: -correct fluid and electrolyte imbalances (K+) -lower blood glucose levels with insulin
causes of DKA (3)
vomiting, severe dehydration, acidosis
prevention of T2D
weight loss and exercise
when to avoid exercising with diabetes
when ketones are present in urine
how hyperglycemia occurs (3)
when the body does not produce enough insulin or does not respond to insulin correctly -Mismatch between insulin intake, physical activity, lack of carbohydrate availability
hepatitis is a _____ ______ of ______ tissue causing hepatic cell ______& _____
widespread inflammation of liver tissue causing hepatic cell degeneration & necrosis
who bears a large part of the burden of HIV illness? (2)
women and children
if a pt with T1D uses insulin lispro do they need a longer-acting insulin product concurrently?
yes
is there a vaccine for hepatitis A?
yes and it gives immunity -given to children 14-20 yrs up to 25 yrs -effective if given up to 2 weeks after exposure
should calcium gluconate be taken with fat?
yes because it is fat soluble
do pts with hyperthyroidism have bruits?
yes typically over thyroid
is calcium gluconate taken with vitamin D?
yes, it is sometimes taken with vitamin D
is there a vaccine for hepatitis B?
yes, the hepatitis B vaccine is 95% effective
are kidneys vulnerable to injury in SLE?
yes, very vulnerable due to deposits