N351 Exam 2

when the cells lack glucose, the body:

-secretes counterregulatory hormones -causes glucose to be mobilized from the liver -causes fat to be mobilized from adipose tissue -excess sugar and free fatty acids cause dehydration and acidosis

osteoblasts

bone forming cells

considerations with tizanidine hydrochloride

caution with elderly patients

black box warning for codeine

cautious use of codeine in children due to reports of death of children taking codeine who are ultra rapid metabolizers of the drug

neuropeptides of endogenous analgesia system

endorphins, enkephalins, dynorphins

why do patients need to sit up for 30 minutes after taking Alendronate?

esophageal ulcers

symptoms of hyperglycemia

extreme thirst, frequent urination, dry skin, hungry, blurred vision, drowsy, slow-healing wounds

treatment of hypoglycemia

fast-acting carbs, glucagon, 50% dextrose in water IV, follow-up with dextrose IV fluids in hospital until stabilized

Parts of a basic metabolic panel

glucose, BUN, creatinine, carbon dioxide, calcium, chloride, potassium, sodium

black box warning for dantrolene sodium

hepatotoxicity; should take liver function tests

insulin pump

individual will self administer insulin dose through a programmable pump; typle 1 ONLY

rapid acting insulins

lispro, aspart, glulisine

flatfoot

longitudinal arch of the foot is diminished by congenital abnormalities, trauma, or excessive pressure

opioid receptors

mu, kappa, delta

which medication to treat osteoporosis would be contraindicated for a client who has a history of renal calculi? os-cal raloxifene ibandronate zoledronic acid

os-cal

Why will should you educate your patients to sit up for 30 minutes after taking Alendronate therapy?

possible esophageal ulcers and reduce GI upset

dynorphins

produce analgesia

What kind of snack should be given after BG is returned to above 70?

protein snack to maintain glucose level

which information would the nurse include when teaching a client with coronary artery disease about aspirin therapy? SATA take aspirin with food report ringing in the ears monitor and report excessive bleeding and bruising do not mix aspirin with meds for ED avoid OTC pain meds that contain aspirin

-take aspirin with food - report ringing - monitor and report excessive bleeding and bruising - avoid OTC pain meds that contain aspirin

Which client with complications of fracture would the nurse expect may be treated with a fasciotomy? acute respiratory distress syndrome compartment syndrome venous thromboembolism fat embolism syndrome

compartment syndrome

patient education with insulin

correct admin, ability to determine correct dose, notice symptoms of hypoglycemia/hyperglycemia and adjust dosing, how to test BG, keeping BG and diet records, lifestyle changes, follow up

risk factors of diabetes

family history of diabetes- parent or sibling obesity sedentary lifestyle certain ethnic groups age greater than 45 previously identified impaired fasting glucose or impaired glucose tolerance hypertension hight HDL or triglyceride history of gestational diabetes

a-delta fibers

faster transmission, rapid reflex, glutamate transmit, thermal and chemical stimuli

systemic effects of inflammation

fever, leukocytosis, malaise, anorexia, sepsis

hammer toe

flexion deformity of the interphalangeal joint that may involve several toes

ingrown toenail

free edge of nail plate penetrates the surrounding skin

A child with type 1 diabetes is receiving 15 units of regular insulin and 20 units of NPH insulin at 7:00 AM each day. Which time would the nurse anticipate a hypoglycemic reaction from the NPH insulin to occur before noon in the afternoon within 30 minutes during the evening

in the afternoon (peak @ 6-8 hours)

Which withdrawal signs and symptoms would the nurse assess for in a recently hospitalized client with an opioid use disorder? SATA lacrimation yawning drowsiness constipation muscle aches

lacrimation yawning muscle aches

what causes swelling and pain?

localized tissue congestion

basal only insulin schedule

long acting taken 1-2 times daily

histamine

mast cells, vasodilation, increased capillary permeability

cachexia

weakness and wasting of the body due to severe chronic illness.

arthography

x-ray of a joint taken after the injection of a contrast medium into the joint

bone densitometry

x-ray technique for determining density of bone

normal ABG CO2

35-45 mmHG

fasciotomy

a surgical incision through the fascia to relieve tension or pressure; blood supply with compartment syndrome

MRI (magnetic resonance imaging)

a technique that uses magnetic fields and radio waves to produce computer-generated images of soft tissue. MRI scans show brain anatomy.

metabolic acidosis

accumulation or inadequate elimination of hydrogen ions OR inadequate production or excess elimination of bicarbonate

metabolic alkalosis

acid deficit caused by vomiting, gastric suctioning, or potassium depletion OR base excess by antacids OR excess bicarb

aspirin intermediate dose effects (325mg-2g/day)

analgesic, antipyretic for mild to moderate pain, dysmenorrhea

diabetes insipidus

antidiuretic hormone is not secreted adequately, or the kidney is resistant to its effect

considerations for lidocaine patch

-apply to most painful area - use gloves - remove after 12 hours and leave off for 12 hours - fold patch to discard - do not apply topical to non-intact skin

how to determine insulin dosing

-insulin sensitivity -insulin to carb ratio -food consumed -blood glucose targets -serum blood glucose level before admin

pathophysiology of type 1 diabetes/DKA

-lack of glucose causes catabolism of fats and proteins so increase of fatty acids and ketones in the blood - ketoacids bind with bicarbonate buffer which lowers pH - ketones spill into urine - dehydration worsens, GFR decreases which limits excretion of acids, causing metabolic ketoacidosis

renal and hepatic impairment and insulin

- renal= hypoglycemia b/c decreased filtration of insulin through kidneys - hepatic= hypoglycemia b/s decreased ability to produce glucose

Equianalgesic dosing

-Dose of one analgesic that is approximately equivalent in pain-relieving effects compared with another analgesic -Helps guide dosing when changing routes or when a drug is ineffective or causes intolerable side effects

fixed dosing insulin schedule

1-2 daily doses of NPH or NPH mix before breakfast and dinner or 12 hrs apart

regular insulin onset

1-3 hours

stages of bone healing

1. hematoma formation- 1-2 days after fracture 2. fibrocartilage callus formation- fibroblasts and osteoblasts migrate to fracture site 3. bony callus formation- ossification begins during 3rd or 4th week 4. bone remodeling- osteoclasts remove necrotic bone

treatment of hypoglycemia in unresponsive patient or BG below 50

1/2-1 amp of 50% dextrose solution IV OR glucagon 1mg

what to do FIRST when noticing hypoglycemia (50-70)?

10-15g of carbs, recheck BG in 15 minutes and repeat if needed

normal BUN value

10-20 mg/dL

prediabetic fasting BG

100-125

normal anion gap range

12-16 mmol/L

peak of short acting insulins

2-4 hours

Normal ABG Bicarbonate

22 - 26 mEq/l [ HCO3 ]

normal carbon dioxide bicarbonate levels

24-31 mg/dl

rapid insulin duration

3-5 hours

peak of rapid acting insulin

30 minutes to 1 hour

rapid insulin peak

30 min-1 hour

Symptoms of fat embolism syndrome

Confusion - earliest Dyspnea, tachycardia, fever, restlessness, pulmonary complications, petechiae, oliguria, Notify doctor immediately

What is the limit for daily acetaminophen?

4g a day

prediabetes A1C

5.7-6.4%

normal ABG pH

7.35-7.45

normal glucose level

70-100 mg/dL

Which statement reflects the progress of bone healing? A. All fracture healing takes place at the same rate no matter the type of bone fractured. B. Serial X-Rays are used to monitor the progress of bone healing. C. The age of the client is most influential factor affecting the rate of fracture healing. D. Adequate immobilization is essential until ultrasound shows evidence of bone formation with ossification.

B

osteoclasts

Bone-destroying cells

considerations for cyclobenzaprine hydrochloride

CNS depression -> monitor for sedation and coadmin of other sedatives

anion gap

Difference between the concentrations of serum cations and anions: determined by measuring the concentrations of sodium cations and chloride and bicarbonate anions.

Dupuytren's contracture

Dupuytren's contracture is a slowly progressive contracture of the palmar fascia.

dawn phenomenon

Early morning glucose elevation produced by the release of growth hormone, with no hypoglycemia during the night

effects of COX 1

GI protection - lower gastric acid secretion -increased mucus production -maintenance of GI mucosal perfusion Renal protection -maintenance of renal perfusion and function Relaxes muscle tone - vasodilation -bronchodilation regulates platelet aggregation

types of incretin hormones

GLP-1 and GIP

manifestations of type 1 diabetes

Hyperglycemia Polydipsia Polyuria Polyphagia Weight loss Fatigue

signs of sepsis

Hypothermia or hyperthermia Abdominal distention Anorexia Respiratory distress Vomiting Cool extremities Mottling Lethargy

insulin deficiency causes

Inability of cell to use glucose for energy Glycogenolysis: conversion of glycogen to glucose The breakdown of proteins and fats • AA and FA can be used for cellular energy Polydipsia, polyphagia, polyuria, blurry vision, weight loss, fatigue, poor wound healing...

bursitis and tendonitis

Inflammation of bursae or tendon sheath

long acting insulins

Insulin detemir (Levemir) Insulin glargine (Lantus)

C fibers

slow conduction, poorly localized pain, aching and burning, mechanical and thermal and chemical stimuli

Moderate hypoglycemia symptoms

LOC and mental status symptoms

Which medication would be administered to prevent symptoms of withdrawal in a laboring client who routinely uses heroin? Butorphanol Pentazocine Nalbuphine Methadone

Methadone

What insulin can be mixed with regular or rapid insulin?

NPH

intermediate acting insulins

NPH (Humulin N, Novolin N)

the nurse educator is providing information about different insulin types. Which type of insulin can be safely mixed with regular human insulin in the same syringe? insulin glargine insulin detemir insulin lispro mix 75/25 isophane insulin NPH

NPH (NPH safe with regular insulin)

opioid nursing considerations

Opioid tolerant vs. Opioid naïve Tolerant - at least 60 mg of morphine or equianalgesic dose of opioid for a week or more Naïve - Not had opioid dosages of above for a week or longer Pain assessment Sedation assessment Respiratory assessment Orders Treatment goals

short acting insulins

Regular (Humulin R, Novolin R)

a client with diabetic neuropathy reports a burning, electrical-type in the lower extremities that is not responding to NSAIDs. You anticipate that the provider will order which adjuvant medication for this type of pain? pregabalin ibuprofen lidocaine morphine sulfate

Pregabalin (neuropathic pain)

regulating factors of bone formation

Stress and weight bearing Vitamin D Parathyroid hormone and calcitonin Blood supply

CT scan

a series of x-ray photographs taken from different angles and combined by computer into a composite representation of a slice through the body

five signs of inflammation

redness, swelling, heat, pain, loss of function

Severe hypoglycemia symptoms

seizures/convulsions coma/unconscious death

considerations with thiazolidinediones

heart failure pts, education about heart failure worsening, caution with hepatic disease pts

incretins

hormones that increase insulin secretion

corn

hyperkeratosis of epidermis

Somogyi effect

hypoglycemia followed by rebound hyperglycemia

adverse effects of insulins

hypoglycemia, weight gain, hypokalemia, lipodystrophy at injection site, allergic reaction, drug interactions (thiazide diuretics/glucocorticoids may increase insulin needed OR beta blockers mask hypogylcemia)

impingement syndrome

impaired movement of the rotator cuff of the shoulder

causes of diabetes type 2

impairments in glucose metabolism, insulin secretion, or utilization (sensitivity)

osteocytes

mature bone cells

which assessment data would the nurse examine when planning the care for a client with Paget disease and taking zoledronic acid? SATA serum calcium serum creatinine liver function tests dental examination serum alkaline phosphatase

serum creatinine dental examination serum alkaline phosphatase

nursing considerations for metformin

severe kidney disease, GI distress (take with food), lactic acidosis, dehydration and heart failure, studies with contrast

symptoms of hypoglycemia

shaking, tachycardia, sweating, anxious, dizzy, hunger, blurred vision, weakness, fatigue, headaches, irritable

which action puts a client at risk for low back injury and pain? smoking tobacco regular swimming exercise vitamin D oral supplementation use of footstool with prolonged sitting

smoking tobacco

which MOA explains how glyburide decreases serum glucose levels? stimulates the pancreas to produce insulin accelerates the liver's release of stored glycogen increases glucose transport across the cell membrane decreases absorption of glucose from the gastrointestinal system

stimulates the pancreas to produce insulin

diabetes drugs at risk of hypoglycemia

sulfonylureas, DPP-4 inhibitors, SGLT-2 inhibitors, meglitinides

aspirin low dose effects (75-325 mg/day)

suppress platelet aggregation for ischemic stroke, TIA, angina, MI

arthocentesis

surgical puncture to remove fluid from the joint space

mild hypoglycemia symptoms

tachycardia, sweating, nervousness, shakes

Education points for ibuprofen

tarry stools (b/c bleeding) and stopping before surgery

carpel tunnel syndrome

the entrapment of the medium nerve in the carpel tunnel, swelling of the nerves and tendons will occur in the wrist

biopsy

the removal of living tissue from the body for diagnostic examination

callus

thickened area of skin that arises due to constant abrasion

exocrine secretes

through a duct

nociceptive pain process

transduction, transmission, perception, modulation

nociceptive transmission

transmission along a-delta or C fibers to dorsal root ganglia up the spinal cord to the brain

Drugs for neuropathic pain

tricyclics, antidepressants, anticonvulsants, local anesthetics (Tramadol, gabapentin, pregabalin)

creatinine normal value

0.7-1.3 mg/dL

ideal BG range in hospital

140-180

oral glucose tolerance test prediabetes

140-199 mg/dL

rapid insulin onset

15 minutes

signs of serotonin syndrome

agitation, pressured speech, mydriasis, tachycardia, hypertension, increased bowel sounds, shivering, sweating, diarrhea

delta receptors

analgesia

mu receptors

analgesia, respiratory depression, euphoria, miosis, reduced GI motility

kappa receptors

analgesia, sedation, respiratory depression, dysphoria, miosis

what lab tests to evaluate metabolic states (acid/base)?

arterial blood gas (ABG) and venous blood gas (VBG)

What is ringing in the ears a sign of when taking aspirin?

aspirin toxicity

a client who recently had surgery on her shoulder is reporting severe pain 40 minutes after the nurse administered hydromorphone IVP. Which interventions should the nurse implement first? - administer another hydromorphone - decrease stimulation and provide nonpharmacologic comfort - assess affected arm for alignment - call provider

assess patient's affected arm for alignment

diabetes medication classes

biguanides (metformin), GLP-1 receptor agonists, sulfonylureas, thiazolidinediones, DPP4 inhibitors, SGLT2 inhibitors, insulin

glutamate

bind to NMDA receptor, promotes pain transmission, secreted by A-delta fibers

what happens when glucose builds up in your blood

binds the hemoglobin in your red blood cells

Fat embolism syndrome

blocking of small blood vessels by fat globules subsequent to a fracture, especially one of long bones or pelvis I (when emboli are deposited in lungs): anxiety, agitation, acute confusion, fever >103, chest pain, dyspnea, tacky, tachypnea, thick white sputum, petechiae (on chest, neck, shoulder, axillae, flank, abdomen), sudden onset, 24-72 hrs after fracture NI: High Fowler's position, oxygen in high concentrations, possibly with positive/expiratory pressure, corticosteroids, vasoactive meds to prevent hypotension and shock, fluid replacement guided by accurate I & O

Which physiological changes would the nurse expect to find in a client with a 20-year history of type 2 diabetes? blurry, spotty, or hazy vision arthritic changes in the hands hyperactive knee and ankle jerk reflexes dependent pallor of the feet and lower legs

blurry, spotty, or hazy vision (diabetic retinopathy)

chemical mediators of inflammation

bradykinin, histamine, prostaglandins

nociceptive perception

brain perceives pain

why don't we want to rapidly decrease BG glucose?

can cause cerebral edema and rapid shifts in potassium (dysrhythmias)

black box warning for ketamin

can produce emergence delirium, hallucinations, unpleasant dreams

black box warning for celecoxib

cardiac and vascular risks (MI and CVA)

is NPH clear or cloudy?

cloudy

parts of the comprehensive metabolic panel

same aspects of BMP and: albumin, total protein, alkaline phosphates, alanine transaminase, aspartate aminotransferase, bilibrubin

substance P

secreted at C fibers, blocked by opioids

referred pain

pain that is felt in a location other than where the pain originates

what do incretins stimulate?

pancreatic beta cells to secrete insulin in response to rising blood glucose

black box warning for butorphanol

potentially fatal respiratory depression, coma, death, drug dependence and abuse potential

Reye's syndrome

potentially serious or deadly disorder in children that is characterized by vomiting and confusion

osteogenesis

process of bone formation

radiographs

records of ionizing radiation used to visualize internal body structures (x-rays)

aspirin high doses effects (2-8g/day)

reducing inflammation - for RA and OA

acidosis

retention of too much acid (CO2) or loss of too much base (bicarb)

alkalosis

retention of too much base or loss of too much acid

black box warning for aspirin

reye's sydrome

black box warning for Ketorolac

risk for GI irritation, inflammation, ulceration, bleeding, and perforation

ganglion

collection of neurologic gelatinous material near the tendon sheaths and joints that causes inflammation

hallux vagas (bunion)

deformity where great toes deviates laterally with prominence of the medial aspect of the first metatarsaopharengeal joint

special consideration for Zoledronic acid administration

dental examination b/c of jaw or maxillary osteonecrosis

nociceptive modulation

descending pathways to decrease pain transmission (endorphins, serotonin, NE)

lifestyle recommendations for diabetes

diet, exercise, weight loss, health maintenance, self-monitoring of blood glucose

nursing consideration for baclofen

don't stop taking medications abruptly, avoid CNS depressants, don't take if pregnant or breastfeeding

consideration/education with medication patches

don't use heating pad directly over the patch; increasing dosage and increase absorption

chronic complications of diabetes

increased glucagon secretion, impaired insulin secretion, decreased incretin effect, increased lipolysis, increased glucose reabsorption, decreased glucose uptake, neurotransmitter dysfunction, increased hepatic glucose production, microvascular disease (retinopathy and neuropathy), macrovascular disease (CAD, stroke, peripheral artery disease, dementia), infection

black box warning for ibuprofen

increased risk of CV events and GI bleeding (vasoconstriction, reversibly to platelets, ulceration)

effects of COX 2

inflammation -vasodilation -increased cap permeability -edema -pain leukocytosis activation of WBC releasing inflamm cytokines

prostaglandins

inflammatory response, COX enzymes metabolize arachidonic acid and produce prostaglandins

endorphins

inhibit pain signal transmission and induce euphoria

enkephalins

inhibits substance P release and modulate pain perception

compartment syndrome

involves the compression of nerves and blood vessels due to swelling within the enclosed space created by the fascia that separates groups of muscles

kidney response if blood pH is too low

kidneys hold onto more bicarb and return it to the blood to normalize pH

considerations for IV drugs

kinks in the admin line, slow vs. push medications, IV injection site for infections or problems

manifestations of HHS

lack of insulin, hyperglycemia, dehydration, slow onset, normal bicarbonate, normal pH, absent ketones, polyuria, polydipsia, polyphagia, loss of water and electrolytes

which adverse effect of metformin will a nurse teach a client with type 2 diabetes to monitor for when used as monotherapy? weight gain constipation lactic acidosis hypoglycemia

lactic acidosis

Benefits of PCA pump

more frequent smaller doses, decreases risk of OD

intensive dosing insulin schedule

multiple daily injections (MDI); meal correctional dose based on BG level

NPO diabetes patients

need to administer some sort of glucose/dextrose so there is something for the insulin to attach to; probably decreased insulin dosage

Perimeters for taking ibuprofen and aspirin together

need to take aspirin 2 hours before ibuprofen b/c ibuprofen can reduce the antiplatelet effects of aspirin by blocking access of aspirin to COX-1 in platelets

special consideration for meperidine

neurotoxic metabolite (normeperidine that accumulates, renal failure pts caution) - metabolite causes CNS stimulation

black box warning for morphine sulfate

no combination with other CNS depressants; respiratory depression, coma, death, drug abuse, and dependence

peak of long acting insulin

no real peak but small peak at 10-16 hours

nociceptive transduction

noxious stimuli nociceptor and inflammatory response start of action potential

bone scan

uptake of a radioactive substance is measured in bone

bradykinin

vasodilation, increased vascular permeability, attract neutrophils, associated with pain response

arthoscopy

visual examination of a joint

Opioid withdrawal symptoms

chronic use, anxiety, restlessness, insomnia, perspiration, pupil dilation, piloerection, anorexia, n/v/d, increased body temp and RR and BP, muscle cramps, dehydration

opioid toxicity symptoms

coma, pinpoint pupils, respiratory depression

signs of ketoacidosis

confusion, excessive thirst, acetone breath, frequent urination, n/v, abdominal pain, weakness or fatigue, and SOB

manifestations of DKA

lack of insulin, hyperglycemia, ketosis, acidosis, dehydration, electrolyte loss, rapid onset, polyuria, polydipsia, polyphagia, anorexia, n/v/abdominal pain, acetone breath, Kussmaul respirations, hypotension, hyperkalemia, decrease in pH, decrease in bicarbonate, fatigue and headache

which foods would the nurse teach the client who has gout to avoid? SATA eggs liver cheese salmon shellfish

liver and shellfish