NSG-170 Finals

Hypomagnesemia

"Dumb Blonde Heiress Running" *D:* dysphagia *B:* ↑ BP -- hypertension *H:* ↑ HR *R:* ↑ reflexes & respiratory paralysis

Hypermagnesemia

"LiViD Skunk" *L:* low everything (BP, HR, RR, DTR) *V:* vasodilation *D:* diaphoresis *S:* skeletal muscle weakness >2.3 mEq/L

ACE inhibitors

"PRIL" Captopril, Enalapril, Afosiopril Antihypertensive. Blocks ACE in lungs from converting angiotensin I to angiotensin II (powerful vasoconstrictor). Decreases BP, Decreased Aldosterone secretions, Sodium and fluid loss. Check BP before giving (hypotension) *Orthostatic Hypotension

Hypophosphatemia

"Rad Nurses Check Red Blood Cell Count In Lethargic Malnourished Clients" *R:* respiratory failure *N:* numbness *C:* confusion *R:* reduced O2 *B:* bone resorption *C:* cardiomyopathies *C:* convulsions *I:* irritability *L:* leukocyte/platelet dysfunction *M:* muscle/nerve dysfunction *C:* coma <2/5 mg/dL

Signs of BOTH Hyper and Hypoglycemia

"SUGAR" Slow wound healing blUrry vision Glycosuria Acetone breath *Mainly type 1 Rashes and Repeated Yeast Infections in Women

During assessment, note symptoms such as:

"feeling feverish" or "feeling hot," chills, general malaise, lethargy, weakness, dizziness, loss of appetite, or muscle cramps. Primary symptom of hypothermia is feeling cold

During post exercise recovery, muscle cells then replenish glycogen stores with additional glucose from the circulation also lowering glucose levels, and this is sometimes referred to as ____.

"lag effect."

Moderate Hypothermia

(30-34 C). Lethargy, sleepy, slow pulse. Loss of dexterity, may not be able to ambulate. pale or blue extremities. May no longer shiver.

Mild Hypothermia

(34-36 C); pt is usually alert and shivering in an attempt to generate heat; pulse rate and resp. are usually rapid; skin may be flushed (red) but may turn to pale due to bodies constriction of blood vessels at the skin to retain heat, than cyanotic; may have blue lips or fingertips

Celsius to Fahrenheit

(C x 1.8) + 32 = F

Severe Hypothermia

(less than 30 C); shivering stops and muscular activity decreases; pt becomes lethargic; LOC decreases; BP drops; poor condition and memory loss; reduced or complete loss of sensation of touch, mood changes, and impaired judgment; resp slow; @ 80 degrees or less, all cardiovascular activity may cease; pupil reaction is slow

Classic Heat Stroke

(nonexertional heat stroke) occurs over a period of time as a result of chronic exposure to a hot, humid environment such as living in a home without air conditioning

Hypokalemia

*A:* alkalosis *S:* shallow respirations *I:* irritability *C:* confusion *W:* weak/fatigue *A:* arrhythmias *L:* lethargy + leg cramps *T:* thready pulse <3.5 mEq/L

Hypercalcemia

*B:* bone pain *A:* arrhythmias *C:* cardiac arrest *K:* kidney stones *M:* muscle cramps/weak --> seizures *E:* excessive urination + polydipsia > 10.2 mg/dL

Hyponatremia (excess H2O or low Na+)

*C:* confusion *H:* hypotension *E:* edema (cerebral = seizures) *M:* muscle cramps/weakness *S:* seizures <135 mEq/L

Hyperphosphatemia

*C:* confusion + calcification *R:* ↑ reflexes *A:* anorexia *M:* muscle spasms, tetany, seizures *P:* positive trousseau's and pruritis *S:* signs of chvostek's >4.5 mg/dL

Hypocalcemia

*C:* convulsions *A:* arrhythmias *T:* tetany *S:* stridor, spasms, seizures <8.6 mg/dL

Pressure, Resistance, Flow

*Fluid flow through a vessel depends on:* - The *pressure* difference between ends of the vessel. - *Pressure* pushes the fluid through. - *Pressure* keeps the vessel from collapsing. *The vessel's resistance to fluid flow:* - Small vessels have more *resistance* - Longer vessels have more *resistance* - More viscous fluids have greater *resistance*

Hyperkalemia

*M:* muscle cramps/weakness *U:* urination changes (anuria/oliguria) *R:* respiratory depression *D:* decreased cardiac *E:* EKG changes *R:* reflexes >4.5 mEq/L

Hypernatremia (excess Na+ or loss of H2O)

*N:* Neurologic impairment: restlessness, confusion, weak, delusions *S:* Swollen, dry tongue >145 mEq/L

Blood Draw

*Saline Locks / Peripheral IVs* - May draw blood at the time of insertion - Do not draw blood after insertion *Central Lines and Ports* - May access blood draws at any time (RNs only) -- Waste amount -- Flushes

Sexual history

- Are you sexually active? - Do you use contraception? - how many sexual partners have you had in the past 6 months? - are your partners men, women or both? - have you ever been tested for HIV? - have you ever had a sexually transmitted disease? - do you have any concerns about sexual function?

Chemotherapy Administration

- Dosage - Extravasation - Hypersensitivity reactions

GTPAL

- Gravida - Term gestation (38-42 wks). - Preterm (>20 wks, but completing 37 wks). - Abortions (Pregnancies ending before 20 wks or viability. - Living (Living children).

2-hour postload glucose test (OGTT)

- Normal: <140 mg/dL - Impaired glucose tolerance (IGT): 140-199 mg/dL - DM: ≥ 200 mg/dL

Glucose Regulation: Sick Day Rules!

- Notify PCP that you are ill - Monitor BG q4H - Test urine for ketones when BG is >240 mg/dL - CONTINUE TO TAKE INSULIN/ANTIDIABETICS - Drink 8-12 oz of fluids q hour - Continue to eat regular meals - If unable to tolerate solid foods, eat tolerable foods or liquids - Get plenty of rest

ST - Teaching: Leg cramps

- Primarily occur in the ST & TT and could be related to the pressure of the gravid uterus on pelvic nerves and blood vessels. - Encourage to gently stretch the muscle by dorsiflexion - foot toward the body. -Advise placing a warm, moist towel around leg muscle to help it relax. -Avoid stretching legs, pointing toes, and walking excessively. - if cramps are due to mineral deficiency, eat more foods with those minerals. -Encourage to drink water throughout the day and take daily walks -Stand 3 ft from wall and lean toward the wall without lifting your heel - this may help reduce cramping if it is done before bed.

Third Trimester Discomforts

- Return of first trimester discomforts - Shortness of breath and dyspnea - heartburn and indigestion - Dependent edema - Braxton hicks contractions

Education for Glucophage (Metformin)

- Take missed doses as soon as possible -Teach to monitor BG -Explain risk of lactic acidosis -no alcohol

FT - Teaching: Cravings/Pica

- There seems to be to apparent physiological need causing cravings. - Craving of nonfood substances, pica, may indicate a severe dietary deficiency of minerals or vitamins or may have cultural roots.

Iron supplements

- should be taken with high-fiber foods to prevent constipation - avoid taking with milk because it interferes with absorption - take with vitamin C to improve absorption Ferrous sulfate is the usual oral replacement therapy and parenteral iron therapy may be used if ineffective

Promoting Self-Care: Medications FDA Risk Classification

--Category A: These drugs have been tested and found safe during pregnancy. Examples: folic acid, vitamin B6, and thyroid medicine. --Category B: These drugs have been used frequently during pregnancy and do not appear to cause major birth defects or other fetal problems. Examples: antibiotics, acetaminophen (Tylenol), aspartame (artificial sweetener), famotidine (Pepcid), prednisone (cortisone), insulin, and ibuprofen. (Ibuprofen should not be used after 36 weeks of pregnancy to avoid increased blood loss during parturition and to avoid premature closure of the ductus arterious in the fetus.) --Category C: These drugs are more likely to cause problems and safety studies have not been completed. Examples: prochlorperazine (Compazine), fluconazole (Diflucan), ciprofloxacin (Cipro), and some antidepressants. --Category D: These drugs have clear health risks for the fetus. Examples: alcohol, lithium (treats bipolar disorders), phenytoin (Dilantin); all chemotherapeutic agents used to treat cancer. --Category X: These drugs have demonstrated positive evidence of fetal abnormalities and are contraindicated in women who are or may become pregnant. Examples: Accutane (treats cystic acne), androgens (treat endometriosis), Coumadin (prevents blood clots), antithyroid medications for overactive thyroid; radiation therapy (cancer treatment), Tegison or Soriatane (treats psoriasis), streptomycin (treats tuberculosis); thalidomide (treats insomnia), diethylstilbestrol (DES) (treats menstrual disorders), and organic mercury from contaminated food.

Assessment: Chest

-Anticipate a soft systolic murmur caused by the increase in blood volume -Anticipate an increase in HR by 10-15 bpm. -Progesterone causes peripheral dilation to accommodate increased blood volume. -Estrogen promotes relaxation of the ligaments and joints of the ribs resulting in increase in the anteroposterior chest diameter. Expect slight respiratory rate increase to accommodate increase in tidal volume and oxygen consumption.

FT - Teaching: Leukorrhea

-Arises from high levels of estrogen which cause increased vascularity and hypertrophy of cervical glands as well as vaginal cells. -Advise to keep perineal area clean and dry, washing with mild soap and water. -Suggest use of cotton underwear and nightgowns rather than pajamas to allow airflow. -Avoid douching and tampon use.

Birth Settings: Home Birth

-As long as the woman falls unders certain criteria, such as low-risk pregnancy, singleton fetus, cephalic fetus at term, and the absence of pre-existing conditions. -Women choose home setting out of a strong desire to control their child's birth and to give birth surrounded by family members. -Most home birth caregivers are midwives who have provided continuous care to the women throughout the pregnancy. -Disadvantages include the need to transport the woman to the hospital in case of an emergency.

FT - Teaching: Fatigue

-Attempt to get a full night's sleep, w/o interruptions. -Eat a healthy balanced diet. -Schedule a nap in the early afternoon daily. -When feeling tired, rest. -During the first trimester, it may be due to the many physiologic (increased O2 consumption, increased levels of progesterone and relaxin, and increased metabolic demands) and psycological (mood swings, etc.,) changes happening.

Final Preparations pt 1

-Attended childbirth preparation classes and practiced breathing techniques -Selected a birth setting and made arrangements there -Know what to expect during labor and birth -Toured the birthing facility -Packed a suitcase to take to the birthing facility when labor starts -Made arrangements to have siblings and/or pets taken care of during labor -Been instructed on signs and symptoms of labor and what to do -Know what to do if membranes rupture prior to going into labor -Know how to reach their health care provider when labor starts

Promote Self-Care: Hot tubs and Saunas

-Avoid hot tubs, saunas, whirlpools, and tanning beds. -Increased heat may cause fetal tachycardia as well as raising maternal temperature. -Exposure to bacteria in improperly cleaned hot tubs is a reason to avoid them.

Travel (pregnancy)

-Avoid static positions (plane trips) get up and walk to avoid clots, -Bring copies of records -Awareness of Hospitals in area traveled to Avoid overseas in 3rd trimester

Second Trimester Discomforts

-Backache -Leg cramps -Varicosities -Hemorrhoids -Bloating/Flatus

Dick-Read Method

-Believed that the attitude of woman toward birthing process had considerable influence on the ease of her labor. He felt that fear builds a state of tension, creating an antagonistic effect on the laboring muscles of the uterus, which results in pain. -A private, undisturbed and dark environment, where women can feel safe can promote realease of oxytocin, the hormone responsible for uterine contractions and thought to promote the release of tension-relieving hormones, endorphins. -Dick-Read sought to improve circular pattern of fear, tension, and pain during birthing process by promoting the belief that the degree of fear could be diminished with increased understanding of the normal physiologic response to labor. -The woman achieves relaxation and reduces pain by arming herself with the knowledge of normal childbirth and using abdominal breathing during contractions.

Early Contractions: Braxton Hicks v. Labor contractions

-Braxton Hicks: Not true labor pains. They tend to go away while walking, resting, or when the woman goes to sleep. -True labor contractions: Contractions every 10 mi or more frequently, change in vaginal discharge, pelvic pressure, low, dull backache, pelvic cramps, and diarrhea.

Promote Self-Care: Traveling Abroad Recommendation

-Bring copy of maternal record in case of emergen -Carry foreign language dictionary -Travel accompanied -Check w/provider before receiving immunization necessary for foreign travel. -Avoid fresh fruit, veggies, and local water. -Only eat well cooled meat to avoid toxoplasmosis -Request isle seat and walk about the plane q2hr -Practice calf-tensing exercises to improve circulation. -Wear support hose while flying to prevent clots -Drink plenty of water

Promote Self-Care: Perineal Care

-Cervical and vaginal areas are more active and produce more secretions, especially in the last trimester. -Advise to shower frequently and wear all-cotton underwear to minimize effects of secretions. -Caution not to douche as it can increase risk for infection. DO NOT wear panty liners as they block air circulation and promote moisture. -Avoid perfumed soaps, lotions, perineal sprays, harsh laundry detergents to prevent irritation and potential infection.

Third Trimester Discomforts - Teaching: Shortness of Breath/ Dyspnea

-Common complain - physiologic and hemodynamic changes result in dyspnea. -Women who complain of dyspnea during normal daily activities can be a sign of heart or lung disease. -Growth of the uterus prevents full expansion of the diaphragm. -Dyspnea can occur when woman lies on her back as the gravid uterus puts pressure on vena cava and reduces venous return to the heart.

Final Preparations pt 2

-Communicated their needs and desires concerning pain management -Discussed the possibility of a cesarean birth if complications occur -Discussed possible names for the newborn Selected a feeding method (breast or bottle) with which they feel comfortable -Made a decision regarding circumcision if they have a boy -Purchased an infant safety car seat in which to bring their newborn home -Decided on a pediatrician -Have items needed to prepare for the newborn's homecoming: -Infant clothes in several sizes -Nursing bras -Infant crib with spaces between the slats that are 2 in or less apart -Diapers (cloth or disposable) -Feeding supplies (bottles and nipples if bottle feeding) -Infant thermometer -Selected a family planning method to use after the birth

Assessment: Pelvic measurements

-Diagonal Conjugate: Most useful measurement for estimating pelvic size. Distance between anterior surface of the sacral prominence and anterior surface of the inferior margin of the symphysis pubis. -True conjugate: Cannot be measured directly. It's estimated by subtracting 1-2 cm from diagonal conjugate measurement. -Ischial tuberosity diameter: Transverse diameter of the pelvic outlet. Measurement outside made outside the pelvis at the lowest aspect of the ischial tuberosities.

Breastfeeding Don't/Side effects

-Do not breastfeed if HIV+ and untreated, active TB, use illicit drugs, take prescribed cancer chemo. -Side effects: breast discomfort, sore nipples, mastitis, engorgement, milk stasis, vaginal dryness, and decreased libido. -Most common cause for nipple pain is improper latching. Such discomfort is piercing, immediate, and short lived.

Nursing Implications for Glucophage (Metformin)

-Does NOT cause hypoglycemia -Hold Metformin for imaging with contrast (48 hours before and after) -check renal function before beginning therapy: should not be used in hepatic/ renal disease - May cause DKA/ lactic acidosis if a patient becomes ill -Monitor folic acid and B12 levels

TT - Teaching: Shortness of Breath/ Dyspnea Recommendations

-Dyspnea will improve when the fetus drops into the pelvis (lightening). -Instruct to readjust position to allow for maximum expansion of the chest. -Avoid large meals. -Rest with head elevated while taking slow, deep breaths helps reduce shortness of breath symptoms. -Lying on left side will help displace fetus off the vena cava and improve breathing. -Periodically stand up and stretch arms above head and taking deed breaths is also helpful.

FT - Teaching: Nausea and Vomiting

-Eat a high protein snack before retiring to bed -Take ginger up to 1 g in divided doses-- 250mg capsules QID. -Open windows to remove odors. -Eat more protein than carbs. -Avoid fried foods. -Avoid highly seasoned foods. -Drink small amount of carbonated beverage (ginger ale) -Avoid Stress

TT - Teaching: Dependent edema Recommendations

-Elevate your feet & legs above heart level periodically t/o day. -Change position frequently -Walk at sensible pace to help muscles contract and promote venous retunr. -When driving long distances, stop and walk q2hrs. -When standing rock from ball of foot to toes to stimulate circulation -Lie on left side to relieve pressure off vena cava -Avoid foods high in Na, such as lunch meats potato chips, and bacon. -Avoid knee-high stockings. -Drink 6-8 glasses of water -Avoid high intake of sugar and fats- they cause water retention.

Promote Self-Care: Dental Care

-Elevations in estrogen and progesterone enhance inflammatory response and consequently alter gingival tissue. -Pregnancy is NOT a contraindication for dental trx. -Periodontal disease is a contributing factor to heart disease, diabetes, adverse pregnancy outcomes (preterm births, low-birth-weight infants, and small-for-gestational-age infants.) -Researchers have reported and association between prematurity and periodontitis (oral infection that spreads beyond gums to invade supporting tissues of the teeth.

Amniocentesis: Nursing Management

-Encourage woman to empty bladder to avoid risk of bladder puncture. -Administer RhoGAM IM if woman is Rh(-) -Assess Maternal V/S and fetal HR q15min for an hr after the procedure. -Instruct woman to rest after returning home and to report fever, leakage, vaginal bleeding, or uterine contractions or any changes in fetal activity.

Final Preparations: Nurse interventions

-Evidence shows that women have better outcomes when nurses intervene only when needed in the childbirth process. -Provide continuous support in labor -allow women freedom to move and change positions of choice -offer nourishment for body and spirit. -Use nonpharmacologic pain relief whenever possible, ensure seamless, collaborative teamwork.

Promote Self-Care: Exercise

-Exercise is well tolerated during pregnancy, except in women with preterm labor, poor weight, anemia, facial and hand edema, pain, HTN, threatened abortion, multiples, decreased fetal activity, cardiac disease, and palpitations. Promotes: -Feeling of well-being & increase energy -Improves circulation -Reduces constipation -Promotes muscle tone, strength, endurance and posture. -May improve ability to cope with labor -Helps sleep & promotes relaxation and rest. -May help relieve lower back discomfort. -Helps avoid excess wt and helps return body to good health after pregnancy.

Thresholds for overt diabetes diagnosis during pregnancy

-Fasting plasma glucose: 126 mg/dL -Hemoglobin A1c: at least 6.5% -Random plasma glucose: 200 mg/dL

Promote Self-Care: Sexual Activity and Sexuality

-Fatigue, nausea, vomiting, breast soreness, urinary frequency may reduce sexual intimacy. -Many women report increase in sexual desire due to increasing levels of estrogren. -Discuss expected changes in sexuality to improve couples' perception of possible sexual modifications. -An increase in pelvic congestion and lubrication secondary to estrogen may heighten orgasm for many women.

Breastfeeding teaching 😩

-Feed in semi-upright position using the cradle hold in the arms. Positions allows for face to face contact. -Hold bottle so that nipple is kept full of formula to prevent excessive air swallowing. -Feed q3-4hrs and adapt to infants as needed. -Frequent burping (every ounce) helps prevent gas from building up. -Caution not to prop-up bottle. it may cause choking.

Quickening

-Fetal movement which typically begins in the second trimester and may occur earlier in multiparous women. -Decreased fetal movement may indicated asphyxia and FGR. -Reduced fetal movement is thought to represent fetal compensation in a chronic hypoxic environment. -Other factors that may cause decreased fetal mvmts: Maternal use of CNS depressants, fetal sleep cycles, hydrocephalous, bilateral renal agenesis, stillbirth, placental dysfunction, and bilateral hip dislocation.

Fundal Height

-Fundal measurement should approximately equal the number of weeks of gestation until Wk 36 where fundal height may drop due to "lightening" (when the baby drops/settles into the mother's pelvis.) -If growth curve flattens or stays stable, it may be indicative of fetal growth restriction. -If fundal height measurement is greater then 4 cm from estimated gestational age, further evaluation is warranted if a multifetal gestation or hydramnios has not been ruled out.

Danger Signs: Third Trimester

-Gestational edema - Sudden weight gain; periorbital or facial edema; severe upper abdominal pain, or headache with visual changes. -Possible demise: Decrease in fetal movement for more than 24 hours. -Any of the S/S in the previous trimesters may be present.

Birth Settings: Freestanding Birth Setting

-Good choice for women who want a more personalized care than in hospital, but is not comfortable with at-home birth. -Designed to provide care to women judged to be low risk for obstetric complications. Care is often provided by midwives and is more relaxed with no routine intravenous lines, fetal monitoring, restrictive protocols. -Disadvantage is the need to transport woman to hospital quickly if an emergency arises. Some birthing centers are located on hospital property.

Variations in Fluid Content

-Healthy person: total body water is 50% to 60% of body weight -An infant has considerably more body fluid and ECF than an adult; more prone to fluid volume deficits -Gender and amount of fat cells affect body water; women and obese people have less body water

Breastfeeding Advantage

-Human milk is digestible and economical and requires no preparation. -Bonding between mother and child is promoted. -Cost is less than purchasing formula. -Ovulation is suppressed (however, this is not a reliable birth control method). -The risk of ovarian cancer and the incidence of premenopausal breast cancer are reduced for the woman. -Extra calories are used, which promotes weight loss gradually without dieting. -Oxytocin is released to promote more rapid uterine involution with less bleeding. -Sucking helps to develop the muscles in the infant's jaw. -Absorption of lactose and minerals in the newborn is improved. -The immunologic properties of breast milk help prevent infections in the baby. -The composition of breast milk adapts to meet the infant's changing needs. -Constipation in the baby is not a problem with adequate intake. -Food allergies are less likely to develop in the breast-fed baby. -The incidence of otitis media and upper respiratory infections in the infant is reduced. -Breast-fed babies are less likely to be overfed, thus reducing the risk of adult obesity. -Breast-fed newborns are less prone to vomiting

Assessment: Extremeties

-If edema is present early in the pregnancy, further inspection is needed to rule out gestational hypertension. -Dependent edema is a normal finding during the 3rd trimester. -Ask if there is any pain while ambulating. This may be indicative of DVT. Higher levels of estrogen during pregnancy place women at higher risk for DVT.

FT - Teaching: Breast Tenderness

-Increased estrogen and progesterone cause fat layer of breast to thicken and number of milk ducts and glands to increase during the first trimester leading to breast tenderness. -Advise to wear a larger bra with good support to possibly help alleviate discomfort, even sleeping. -Advise to change bra size to ensure adequate support.

FT - Teaching: Nasal Stuffiness, Bleeding Gums, Epistaxis

-Increased levels of estrogen cause edema of the mucous membranes of the nasal and oral cavities. Suggest: - Drink extra water for hydration or use a cool mist humidifier at night. - Blow nose one gently, one nostril at a time. - Avoid using nasal decongestants and sprays. - If nosebleed occurs, loosen clothes around neck, sit with head tilted forward, pinch nostrils for 10-15 minutes, and apply an ice pack to bridge of nose. - Bleeding gums: Good oral hygiene, floss daily, warm saline washes may relieve discomfort.

FT - Teaching: Constipation pt 1

-Increased levels of progesterone lead to decreased contractility of GI tract, slow movmt of substances through colon and increased water absorbtion. -Lack of exercise and little fiber may contribute to constipation.

ST - Teaching: Varicosities of the Vulva and Legs

-Increased progesterone relaxes vein walls, making it difficult for venous return. Genetic predisposition, inactivity, obesity, and poor muscle tone are also contributing factors. -Advise to elevate legs above heart level for 10 min before getting out of bed and applying hose. -Avoid crossing legs and knee-high stockings. -Encourage to elevate legs above heart level for 5-10 min 2x/day. -Avoid sitting/standing for too long, and frequently change position. Apply ice packs to affected area.

Assessment: Breasts

-Increases in estrogen, progesterone, and blood supply make the breast feel full and more nodular w/ increased sensitivity to touch. -Darker pigmentation of nipple and areolas along with enlargement of Montgomery glands. -Colostrum (yellow secretions precede breast milk) is typically excreted during the third trimester.

Amniocentesis: Third Trimester

-Indicated to determine fetal lung maturity after 35th wk gestation via lecithin-to-sphingomyelin ratios. -Evaluate fetal condition w/ Rh isoimmunization

Alpha-fetoprotein

-Initially produced by yolk sac and fetal gut, later produced by fetal liver. -elevated maternal serum alpha-fetoprotein may be indicative of fetal neural tube defects. It crosses placenta into maternal circulation. -Optimal time for screening is 16-18 wks. -Accurately determining window of 16-18 wks will help ensure results are correct.

TT - Teaching: Braxton Hicks Contrations

-Irregular and painless contractions that occur w/o cervical dilation. They intensify in TT in preparation for labor. Have been present since early in pregnancy, but may have been unnoticed. -Reassure these are normal and teach difference between true labor contractions: -True labor contractions grow longer, stronger, closer together, and occur at regular intervals. -Walking strengthens true labor contractions, whereas Braxton Hicks tend to decrease in intensity and taper off. -Keep hydrated and rest in a left-side-laying position to help relieve discomfort and suggest breathing techniques such as lamaze.

Promote Self-Care: Medications

-Less than 10% of medications approved by FDA have enough info to determine risks for birth defects. -Based on this it is best women not to take any medications during their pregnancy. -If woman is taking medicine for seizures, HTN, asthma, depression, the benefits outweigh the risks to the fetus. -Embryogenesis is completed by the end of the first trimester, when all fetal organs are complete. Thus, fetal drug exposure must occur in the first 12 weeks of gestation.

TT - Teaching: Heartburn and indigestion - Recommend

-Limit or avoid gas-producing or fatty foods and large meals. -Avoid caffeinated drinks, greasy, gas-forming, citrus, spiced foods, chocolate, coffee, alcohol, spearmint and peppermint, and chewing gum. -Consume small, frequent meals; Eat slowly and chew food thoroughly. to prevent excess swallowing of air. -Maintain proper poster and remain sitting for 1 to 3 hrs after eating. Elevate head of bed by 10-30 degrees. -Do not eat w/i 3 hrs of eating.

Assessment Abdomen

-Linea nigra may be present. -A decrease in muscle tone may be noted due to the influence of progesterone. -At 12 wks, the uterus can be palpated above the symphysis pubis. -At 16 wks, the uterus can be palpated between the symphysis pubis and umbilicus. -At 20, uterus can be palpated at the umbilicus. -At 36, it is just below the xiphoid process and measures approximately 36 cm.

Marker Screening Tests: Levels

-Low MSAFP, unconjugated estriol levels, and high hCG level may indicate the possibility of down syndrome. -Elevated MSAFP are associated with open neural tube defects, ventral defects,, some renal abnormalities, multiple gestation, certain skin deisorders, fetal demise, and placental abnormality. -A variation in 2 weeks gestational age determination can be misleading and lead to wrong interpretation.

Amniocentesis: Risks

-Lower abdominal discomfort and cramping-may last up 48 hrs after the procedure. -Spontaneous abortion (1 in 200). -Maternal or fetal infection -Postamniocentesis chorioamnionitis that has insidious onset -Fetal-maternal hemorrhage -Leakage of amniotic fluid in 2-3% women after procedure. -Higher rates of fetal loss in fetal loss in earlier amniocentesis procedures <15 wks.

ST - Teaching: Backache - Recommendations

-Maintain correct posture- head up, shoulders back. -Wear low heeled shoes with good arch support. -When standing for long, place one foot on a stool or box. -Use good body mechanics when lifting. -When sitting, use foot supports and pillows behind the back. -Try pelvic tilt or rocking exercises to strengthen back.

Bradley (Partner-Coached) Method

-Method stresses that childbirth is a joyful, natural process and emphasizes the partner's involvement during pregnancy, labor, birth, and the early newborn period. -Training techniques are directed toward the coach and not the mother. -Coach is educated in massage/comfort techniques to use on the mother throughout the labor and birth process.

Danger Signs: First Trimester

-Miscarriage - May notice spotting or bleeding. -Infection - May have painful urination. -Hyperemesis gravidarum - Severe persistent vomiting. Infection - Fever >100F -Ruptured ectopic pregnancy - Abdominal pain with dizziness and accompanied by shoulder pain.

Nursing Implications for Glipizide (Glucotrol)

-Monitor for hypoglycemia -Caution with renal/ hepatic failure -Should not be used in pregnancy - Monitor CBC periodically during therapy. Report ↓ in blood counts promptly

Birth Settings: Hospitals

-Most common site. -Indicated for women with serious medical conditions or at risk to develop one; high risk pregnancy. Advantages: best equipped, highly trained personnel, no transportation needed in emergency. Disadvantages: High-tech atmosphere; strict policies and restrictions that may limit who can be with the mother; medical model of care.

Diabetic Foot Care

-Nailcare: Podiatrist, cut nail straight across. -Wear Clean Cotton Socks/Closed Shoes -Do not soak feet or wear ointments -Clean with warm soap and water - Do not go barefoot - No sandals with open toes or straps between toes

Promote Self-Care: Employment

-Nearly three quarters of women will work until the last month of pregnancy. -For the most part, women can work until they give birth provided there have been no complications and there are no special hazards at work. -Hazardous occupations include health care workers, daycare providers, lab technicians, chemists, painters, hairstylists, vet workers, and carpenters? -aks about teratogens and physical demands of job - Prolonged periods in fixed position? Exposure to temperature extremes?

Breastfeeding Preparation

-Not necessary unless nipples are inverted and do not become erect when stimulated. -Breast shields exert continuous pressure around areola, pushing the nipple through the central opening in the inner shield. -Shields are worn inside bra for 1 hr initially and increasing the wearing time up to 8 hrs daily. Client maintains this schedule until after birth, then she wears the shields 24 hrs a day until infant latches on easily.

Nulli-, primi-, multi- para

-Nulli-: Not produced any viable offspring -Primi-: Given birth once after pregnancy of at least 20 wks. -Multi-: two or more pregnancies of at least 20 wks.

Bottle Feeding:

-Obtain adequate equipment (six 4-oz bottles, eight 8-oz bottles, and nipples). -Consistency is important. Stay with a nipple that is comfortable to the infant. -Frequently assess nipples for any loose pieces of rubber at the opening. -Correct formula preparation is critical to the health and development of the infant. Formula is available in three forms: ready-to-feed, concentrate, and powder. -Read the formula label thoroughly before mixing. -Correct formula dilution is important to avoid fluid imbalances. For ready-to-use formula, use as is without dilution. For concentrated formulas, dilute with equal parts of water. For powdered formulas, mix one scoop of powder with 2 oz of water. If the water supply is safe, sterilization is not necessary. -Bottles and nipples should be washed in hot, sudsy water using a bottle brush. -Formula should be served at room temperature. If the water supply is questionable, water should be boiled for 5 minutes before use. -Formula should NOT be heated in a microwave oven, because it is heated unevenly. -Formula can be prepared 24 hours ahead of time and stored in the refrigerator

ST - Teaching: Hemorrhoids

-Occur as a result of progesterone-induced vasodilation and from pressure from the uterus on lower intestine. -Increase fiber intake and water intake to at least 2L per day. -Recommend topical anesthetics (Prep-H, Anusol, witch hazel) to reduce pain, itching, and swelling. -Local comfort measures - sitz baths, witch hazel compresses, or cold compresses. -Elevate feet on stool (squatty potty) to minimize risk of straining.

FT - Teaching: Nausea and Vomiting

-Onset about 5th week from LMP. -Peaks at 8-12 weeks and resolved by 16-18wks. -Research suggest that unusually high levels of estrogen, progesterone, and hCG and Vit B6 deficiency may be contributing factors. -Advise to eat small, frequent meals that are bland and low in fat (5-6x/day) -Dry crackers, cheerios, cheese, or drinking lemonade before getting out of bed in the morning. -Increase intake as day goes with foods high in B6 such as meat, poultry, bananas, fish, green leafy veggies, peanuts, raisins, walnuts, whole grains, and B6 supplements. ***FDA has approved doxylamine-pyridoxine for use in pregnancy.

Alpha-fetoprotein: Increased & decreased levels

-Other situations leading to INCREASED levels: underestimation of gestational age, multiple fetuses, GI defects, low-birth weight, olygohydramnios, maternal age, diabetes, decreased maternal weight. -LOWER Levels: overestimation of fetal gestational age, fetal death, hydatidiform mole, increased maternal weight, maternal type 1 diabetes, fetal trisomy 21 (Down syndrome), trisomy 18 (edward's syndrome).

Nursing Management

-Overall of any methods is to promote an internal locus of control that will enable each woman to yield her body the process of birth. -Nursing measures should be adapted to individual patients. Offer encouragement (great job, you can do it) to help reinforce their efforts and empower them. -Respect involvement of partner. offer to stay with mother to give him a break to allow him to meet his needs. -Offer to do a lot unrealistic stuff.

Marker Screening Tests: PAPP-A

-PAPP-A: Pregnancy-associated plasma protein. Key regulator of insulin-like growth factor for normal fetal development. -Routinely used for Down Syndrome screening. -↓Levels at 11-13 is assoc with stillbirth, infant death, preeclampsia, chromosomal abnormalities.

Second Trimester Discomfort Teaching: Backache Explanation

-Pain can be lumbar or sacroiliac. May only be present at night. May be due to: -Shifting of center of gravity due to enlarging uterus -Increased joint laxity due to incresed relaxin -Stretching of ligaments and pregnancy related circulatory changes.

Danger Signs: Second Trimester

-Preterm Labor - Regular uterine contractions -DVT - Pain in calf, often increased with foot flexion. -Premature rupture of membranes - Sudden gush or leakage of fluid from vagina. -Possible fetal distress or demise - Absence of fetal movement for more than 12 hours.

Lamaze Method

-Psychoprophylactic method of preparing for labor and birth that promotes the use of specific breathing and relaxation techniques. -Lamaze includes information on toning exercises, relaxation exercises and techniques, and breathing methods. -The goal is for women to become aware of their own comfortable rate of breathing inorder to maintain relaxation and adequate oxygenation of fetus. -Paced breathing, slow-paced breathing, modified-paced breathing, patterned-paced are effective attention-focusing strategies to reduce pain. -Focal poins (fixation on an object), effleurage (Light abdominal massage by woman or partner), massage, imagery are also aids in relaxation.

Initial health history includes:

-Reason for seeking care -Client's past medical, surgical, and personal hx, including that of the family and her partner. -Client's reproductive hx.

Promote Self-Care: Dental Care Recommendations

-Recommend Brushing and flossing 2x/day with fluoride toothpaste. -Floss daily and rinse with plain water. -Reassure it is safe to seek dental trx. Seek care in the first trimester for assessment, care, pain, and infection. -Avoid sugary snacks. -Eat healthy snacks especially those rich in Vit A, C, and D. -Chew sugar-free gum for 10 MIN (may cause bloating if chewed too long), when brushing is not possible. -After vomiting rinse mouth with baking soda and warm water to neutralize acid.

Promote Self-Care: Exercise Recommendations

-Recommended at least 150 min/wk of mod exercise. -Consume liquids before, during, & after. -Stop if vag bleeding, dizziness, chest pain, leakage, contractions, headache, calf pain/swell, -3/4x per wk, not sporadic. -Avoid to overheat, and do not exercise to exhaust -Start with 5-10 min streching & engage in brisk walk, swimming, biking, or low impact aerobics - reduce intensity in TT. No jerky or bouncy mvmts. -Use pelvic tilt and rocking to relieve backache.

TT - Teaching: Heartburn and Indigestion

-Result from high progesterone levels which cause relaxation of the cardiac sphincter allowing food and digestive juices to flow backward into the esophagus. -Results from eating too much too fast; eating when tense, tired or emotionally upset; eating fatty, spicy, heavy, undercooked food. -Stomach is displaced upward in the TT limiting the stomach's ability to empty quickly.

TT - Teaching: Dependent edema

-Result of increased capillary permeability caused by elevated hormone levels and increased blood volume. Edema at the legs and feet throughout the day occurs due to gravity. -Sodium and water are retained and thirst increases. -Generalized edema in the face, hand, and feet, can signal preeclampsia IF accompanied by dizziness, blurred vision, headaches, uppr quadrant pain, or nausea. This SHOULD BE REPORTED.

37-40 Wks Gestation

-Same previous assessments. -Additionally, screening for group B Streptococcus, gonorrhea, and chlamydia is done. -Fetal presentation and position are assessed via Leopold maneuvers. -Remind client infant car seat is required by law to drive infant home.

Amniocentesis: Second trimester

-Second trimester (15-20wks): -used to detect chromosomal abnormalities and to evaluate fetal condition when woman is sensitized to Rh(+) blood -Diagnose intrauterine infection -investigate amniotic fluid AFP when MSAFP is elevated.

Promote Self-Care: Sexual Activity and Sexuality pt 2

-Sexual intercourse is safe in the absence of ruptured membranes, bleeding, or placenta previa. Sexual activity is permissible unless: -Vaginal bleeding -Risk of preterm labor -Cervical insufficiency -presence of infection. -all mentioned in first bullet. Other forms of sexual expression: mutual masturbation, foot massage, holding hands, kissing, and hugging.

Assessment: External Genitalia

-Should be free from lesions, discharge, hematomas, varicosities, and inflammation. -A culture for STIs may be collected at this time.

Promote Self-Care: Sleep and Rest

-Stay on reg schedule of going to bed and waking up. Set up a bedtime routine and follow it. Set up proper sleep environment (i.e. dim lights and lowering room temp.) -Eat meals at regular times to keep external body cues consistent. Limit caffeine and fluids after dinner. -Exercise daily to improve circulation and well being. -Use modified sims to improve circulation to improve circulation. Avoid lying on your back after the fourth month as it may compromise uterus circulation. -Avoid bending knees as it promotes venous stasis.

Promote Self-Care: Breast Care

-Stress the need to wear a firm, supportive bra with wide straps to balance the weight of the breast. Anticipate to buy a bra mid-pregnancy. -Avoid using soap on the nipple area as it can be very drying. Rinse with plan water. -Montgomery glands in the areola part of nipple secrete lubricating substance that keeps nipples moist and discourages bacterial growth. No need for alcohol or antiseptics.

Promote Self-Care: Employment Recommendations

-Take 2 10-15 min break in an 8 hr shift. -Avoid strenuous workloads; if not possible request modification -Change position from standing to sitting q2hrs. -Ensure you are allowed time off w/o penalty to ensure a healthy outcome for you and your fetus. -Make sure work environment is free of toxic subs -Ensure it is a smoke-free environment -Minimize heavi lifting if assoc w/ bending.

Education for Glipizide (Glucotrol)

-Teach signs of hypoglycemia -Take with or just before meals -check with Dr. about interactions with OTCs and supplements

Ultrasonography

-Transvaginal: May be used to exclude ectopic (implanted egg in another cavity other than the main uterine cavity) or molar pregnancy(tumor), and to confirm cardiac pulsation. -Abdominal: -18-20 weeks may be performed to look for congenital malformations, exclude multifetal pregnancies, and verify dates and fetal growth. -Around 34 wks may be done to eval fetal size, growth, and verify placental position

Promote Self-Care: Traveling

-Travel is safe throughout pregnancy, but ST is perhaps the best time to travel because there is the least change of complications. -Women in TS should be advised to defer overseas travel because of concerns to medical care in case of problems such as HTN, phlebitis, or preterm labor. -Seek medical attention while traveling if vaginal bleeding, passing tissue or clots, abdominal pain or cramps, contractions, ruptured membranes. excessive leg swelling or pain, headaches, or visual problems

Marker Screening Tests: Triple/Quad marker screen tests

-Tripe Screening tests: AFT, hCG, unconjugated estriol. -Quad screening test: Three tests above and inhibin A. Inhibin A is used to increase accuracy of screening for Down syndrome in women younger than 25 yrs of age. -Low inhibin A indicate the possibility of down syndrome. -Most screening test should be performed between 15-22 wks gestations, ideally 16-18 weeks.

First Trimester Discomfort - Teaching: Urinary Frequency/Incontinence

-Try pelvic floor exercises (Kegel) -Empty bladder at first sensation -Avoid caffeinated drinks (diuretic) -Reduce fluid intake after dinner to reduce nighttime urination.

Preterm Labor Symptoms:

-Uterine contractions -Dull backache -Feeling of pressure in the pelvic area or thighs -Increased vaginal discharge -Menstrual-like cramps -Vaginal bleeding -If the woman has experienced preterm labor she is at risk fro another.

Promoting Self-Care: Immunizations

-Vaccines That Should be Considered if Otherwise Indicated Hepatitis B Influenza (inactivated) injection Tetanus/diphtheria (Tdap) Meningococcal Rabies -Vaccines Contraindicated During Pregnancy Influenza (live, attenuated vaccine) nasal spray Measles Mumps Rubella Varicella BCG (tuberculosis) Meningococcal Typhoid

Promote Self-Care: Personal hygiene

-Wash hand and nails frequently. -Sebaceous glands are more active bc of hormones and sweating is more profuse. -May need stronger deodorant and shower more frequently. -Cervical/Vaginal glands produce more secretions. Frequent showering helps keep area dry and promotes better hygiene. Recommend using COTTON underwear to allow great air circulation. -Baths are permitted early in the pregnancy, but are not recommended later as the center of gravity shifts.

Promote Self-Care: Traveling by Car

-Wear 3-point seat belt, no matter how short the trip -Apply nonpadded shoulder strap properly. it should cross the breasts and over the upper abdomen, above the uterus. -No seat belts available (e.g. buses or vans), sit in the back. -Deactivate airbag if possible, if not, move the seat back as much as possible from the dashboard.

Promote Self-Care: Clothing

-Wear loose fitting and layered clothes. Clothes can be removed or added as temperature fluctuates. -Do not wear constricting clothes around the abdomen. -Do not wear knee-high hose that might impede lower-extremity circulation and increase risk for DVT. -Low-heeled shoes will minimize pelvic tilt and possible backache.

Follow-up visits: assessments to be completed

-Weight and BP and compared to baseline -Urine: test for protein, glucose, ketones, and nitrites. -Fundal height to assess fetal growth. -Assessment for quickening/fetal movement to determine fetal well-being. -Assessment of fetal heart rate (110 to 160 bmp)

temporal temperature measurement

-across the forehead -can be used on any patient -almost as accurate as rectal -normal temp 100.4

Active external rewarming

-body to body contact -fluid or air filled warming blankets -radiant heat lamps

The vessel's resistance to fluid flow

-constricting arterioles increasing resistance -increased hematocrit increasing resistance

ST - Teaching: Flatulence w/bloating

-decreased GI motility secondary to progesterone's influence. Delayed passage of food allows for more time for gas to be formed by bacteria. -Woman may report increased passage of rectal gas (farts), abdominal bloating, and belching (burp). -Avoid gas forming foods (beans, cabbage, onions, and foods with high content of white sugar). -Add more fiber and water to diet and increase physical exercise. -Do not chew gum. Reduce intake carbonated drinks, cheeses, and eating mints. -Knee-to-chest position may help with discomfort from unexpelled gas.

Factors Affecting Sexuality

-developmental considerations -culture -religion -ethics -lifestyle -health state

PICC lines

-placed by compentency validated RN -dwell time 7 days to over 1 year -used to deliver all types of therapy -inserted into peripheral site and advanced to superior vena cava

Hypoglycemia causes

-too much insulin or oral hypoglycemic agent -too little food -excess physical activity

Phlebitis scale

0 = No symptoms 1 = Erythema at access site with or without pain 2 = Pain at access site with erythema and/or edema 3 = Pain at access site with erythema and/or edema, streak formation, palpable venous cord 4 = Pain at access site with erythema and/or edema, streak formation, palpable venous cord >1 inch in length, and purulent drainage

Onset of Insulin Glulisine (Apidra)

0.3 hour

Peak of Insulin Glulisine (Apidra)

0.5-1.5 hour

Peak of Lispro (Humalog)

0.5-1.5 hr

Infiltration scale

0: No symptoms 1: Blanched, <1 edema, cool, w/ or w/o pain 2: Blanched 1-6" edema, cool, w/ or w/o pain 3: Blanched, translucent, >6" edema, mild-mod pain, numb 4: Blanched, tight, leaking, bruised/swollen, gross edema/deep pitting, circulatory impairment, mod-severe pain

4 Levels of Sexual History

1 - Sexual history as part of comprehensive history and obtained by nurse 2 - Sexual history that is obtained by a nurse with education and training in sexuality 3 - Sexual problem history obtained by sex therapist 4 - Psychiatric/psychosocial history obtained by psychiatric nurse clinician

DKA occurs most often in patients with type ___.

1 DM but also can occur in those with type 2 DM who are under severe stress (e.g., trauma, surgery, infection)

BPP Components

1) Fetal breathing movements 2) Gross body movements 3) Fetal tone 4) Reactive fetal heart rate 5) Qualitiative amniotic fluid volume 8-10 points is normal if amniotic fluid is adequate, 6 or less is suspicious

Onset of Intermediate Acting Insulin

1-1.5 hours

Peak of Novolin 70/30

1-4 hours

Which racial and ethnic populations have greater genetic predisposition to insulin resistance, leading to a higher risk for type 2 diabetes?

1. American Indians/Alaska Natives 2. African Americans 3. Hispanic/Latino 4. Asian Americans

Improving body self image (nursing care of pt with cancer)

1. Assess feelings about body image 2. Identify potential threats to this & validate concerns with patient 3. Encourage continued participation in activities and decision making 4. Encourage pt to verbalize concerns & individualize care 5. Assist pt in self-care when symptoms prevent independence 6. Assist pt in selecting cosmetics, scarves, clothing, etc to promote sense of attractiveness 7. Encourage patient and partner to share concerns about altered sexuality and to explore alternatives

Decreasing fatigue (nursing care of pt with cancer)

1. Assess patient and treatment factors that are associated with or increase 2. Institute interventions to address factors contributing to fatigue 3. Encourage balance of rest and exercise; avoid inactivity; promote normal sleep schedule 4. During active treatment, rearrange daily schedule and organize activities to conserve energy 5. Encourage fat, protein, and calorie intake at least equal recommended for general public

Health conditions that lead to poor thermoregulation:

1. Autoimmune conditions- hyperthermia 2. Burns 3. Chronic medical conditions (such as congestive heart failure, diabetes, or gait disturbance - risk for hyperthermia) 4. Hypothalamic injury 5. Traumatic brain injury 6. Stroke 7. Brain neoplasm 8. Infection - hyperthermia 9. Inflammation - hyperthermia 10. Long surgical procedures -risk for hypothermia 11. Metabolic conditions 12. Hyperthyroidism 13. Hypothyroidism 14. Prematurity/preterm birth 15. Protein calorie malnutrition - hypothermia 16. Traumatic injury - hyperthermia

Therapeutic Management of Gestational Diabetes

1. Diet 2. Exercise 3. Glucose Level Monitoring 4. Fetal Surveillance

Hyperthermia occurs as a result of:

1. Environmental: temperature, humidity, and lack of air movement 2. excessive physical exertion (particularly in hot, humid environments without sufficient water replacement) 3. genetic abnormality 4. metabolic diseases 5. injury to the hypothalamus 6. as a result of pharmacologic agents

Criteria (diabetes diagnosis)

1. FBG ≥ 126 mg/dL 2. 2hr plasma glucose ≥ 200 mg/dL during OGTT 3. A1C ≥ 6.5% 4. random plasma glucose ≥200 mg/dL

Signs & Symptoms of Heat Exhaustion

1. Flu-like symptoms: headache, weakness, nausea, vomiting 2. Body temp may not be significantly elevated 3. Patient may continue to perspire, although dehydrated

What type of dietary choices influence insulin resistance?

1. High intake of saturated and trans-fatty acids (with the excess caloric intake leading to obesity) 2. Low fiber intake 3. High intake of calories, particularly carbohydrates, will also adversely impact glucose metabolism, regardless of the presence of insulin resistance or type 2 diabetes.

Mixed insulin (Intermediate/Rapid Acting)

1. Humulin 70/30 70% NPH/30% Reg 2. NovoLog Mix 70/30 70% aspart protamine/30% NovoLog

The four major complications of maternal diabetes for the newborn are:

1. Hypoglycemia 2. Hypocalcemia 3. Hyperbilirubinemia 4. Respiratory distress syndrome

Airway obstruction in asthma

1. Inflammatory mediators 2. airway inflammation, 3.increased mucociliary function 4. edema 5. epithelial injury 6. increased airway responsiveness 7. bronchospasm 8. airflow limitation

Long Acting Insulin

1. Insulin Glargine (Lantus) 2. Insulin Determir (Levemir)

Primary prevention measures for optimal glucose regulation:

1. Maintaining optimal body weight 2. Exercise 3. Diet

Intermediate Acting Insulin

1. NPH 2. Humulin N 3. Novolin N

Diabetes mellitus can lead to blood vessel complications and result in which disorders?

1. Nephropathy (kidney dysfunction) 2. Neuropathy (Nerve dysfunction) 3. Retinopathy (Vision problems)

Collaborative intervention measures for optimal glucose regulation:

1. Patient Education for Self-Management 2. Monitoring and Managing Blood Glucose

Caring for a patient with hypothermia:

1. Remove the individual from the cold 2. Passive measures include dry and warm clothing, warm drinks, and exercise 3. active rewarming measures may be necessary and include providing warm blankets or heating pads, drawing a warm water bath, and placing the patient in a heated environment 4. When core body temperature falls below 30°C, active core rewarming measures are indicated a. should be done slowly and carefully to minimize the risk of triggering dysrhythmias b. continuous cardiac monitoring and core body temperature observation are necessary c. include infusion of warm intravenous solutions, gastric lavage with warm fluid, peritoneal lavage with warm fluid, and inhalation of warmed oxygen 5. If severe, cardiopulmonary bypass or arteriovenous rewarming may be indicated.

Relieving pain (nursing care of pt with cancer)

1. Use pain scale to assess 2. Assure pt you know it is real 3. Assess prior pain and strategies they found successful 4. Assess other factors contributing: fear, fatigue, psychosocial distress 5. Provide education to patient and family + address myths or misconceptions 6. Collaborate with pt, HCP, and other health care team members 7. Explore nonpharmacologic and complementary strategies to provide relief

Four common causes of hypoglycemia

1. excess insulin 2. deficient intake or absorption of food (from inadequate or incorrectly timed meals) 3. exercise (type 1 DM) 4. alcohol intake (inhibits liver glucose production)

Three factors that lead to hypothermia:

1. excessive heat loss 2. insufficient production of heat, 3. dysfunction of hypothalamic regulatory mechanisms

Three mechanisms that lead to hyperthermia:

1. excessive heat production 2. inadequate ability to cool 3. hypothalamic regulator dysfunction

The most common major congenital malformations associated with preexisting diabetes are .......

1. neural tube defects 2. caudal regression syndrome (failure of the sacrum, lumbar spine 3. lower extremities to develop), and cardiac defects.

Magnesium

1.3-2.3 mEq/L #2 electrolyte in ICF Metabolism, enzyme regulation, & pH

Magnesium

1.3-2.3 mEq/L - 2nd in ICF after K+ Required for calcium + vitamin D absorption Metabolizes of carbohydrates and proteins, activates many enzyme systems, vasodilation Role in neuromuscular fxn Regulated by PTH and eliminated by kidneys

An early burst of insulin secretion occurs within ___ minutes of eating, followed by an increasing release that lasts until the blood glucose level has returned to normal.

10

Peak of Long Acting Insulin

10-30 hours

Normal blood glucose level in the 2-hour postprandial state

100-140 mg/dL

A fasting glucose level greater than ___ and less than ___ mg/dL is indicative of prediabetes or impaired fasting glucose

100; 126

Fetal Heart Rate

110-160 bpm

First trimester (by end)

12 weeks, kidney secretion begins, heartbeat can be heard via doppler, sex of fetus distinguishable

Women with a fasting glucose level greater than ___ mg/dL or a nonfasting level of more than ___ mg/dL meet the criteria for GDM, and no added testing is needed

126 mg/dL; 200 mg/dL

2nd trimester

13-24 weeks; fetal heartbeat can be heard via stethoscope, hair forms, sleep-wake patterns present, eyelids open, and surfactant produced

Sodium

135-145 mEq/L #1 electrolyte in the ECF Regulates blood pressure, blood volume, and pH

Stage 1 Hypertension

140-159/90-99

Onset of Lispro (Humalog)

15 min

Onset of Novolin 70/30

15 min

When the patient is hypoglycemic, start prescribed carbohydrate (CHO) replacement, usually ingestion of ___ to ___ g of glucose.

15 to 20 If the patient can swallow, give a liquid form of CHO, although any CHO source can be used. Ingestion of 15 to 20 g of glucose is the preferred management for blood glucose levels less than 70 mg/dL (3.9 mmol/L), repeated in about 15 minutes if symptoms have not improved or if blood glucose levels are still less than 70.

Duration of Intermediate Acting Insulin

18-24 hours

Programs of increased physical activity and weight loss reduce the risk for type ___ in patients with impaired glucose tolerance

2 Diabetes Mellitus

Adult Hemoglobin

2 alpha chains and 2 beta chains Each protein chain holds one iron-containing heme group O2 binds to the heme groups

Peak of Humulin 70/30

2-12 hours

Peak of Short Acting Insulin

2-3 hours

Phosphate

2.5-4.5 mg/dL Major ICF anion pH, energy, bone + teeth formation

Phosphate (PO4-)

2.5-4.5 mg/dL - major ICF anion Bone _ teeth formation, helps regulate Ca2+ (low = high Ca2+ and vice versa), and promotes energy storage Activated by vitamin D and regulated via PTH Eliminated via kidneys

Average neonate

20 inches long and 7.5 pounds

Purkinje fibers intrinsic rate

20-40 bpm

A random blood glucose measurement greater than ___ mg/dL with signs and symptoms of diabetes is conclusive.

200

What is the limit of glucose that the kidneys can reabsorb? (Renal Threshold)

220 mg/dL This means that at a blood glucose of 220 mg/dL or less, all glucose is reabsorbed and returned to the blood, with no glucose present in final urine.

Circadian rhythms

24 hour interval of heat change. Morning temperature is 1-2 degrees lower than in the late afternoon Variation tends to be greater in infants and children

Duration of Humulin 70/30

24 hours

Duration of Novolin 70/30

24 hours

Second trimester (by end)

24 weeks; fetal heart tones audible via stethoscope, liver + pancreas functioning, hair forms, sleep-wake patterns, lung surfactant, eyelids open

All pregnant women are screened for gestational diabetes during the __ to __ week gestational mark.

24- to 28

Bicarbonate (HCO3-)

25-29 mEq/L; major chemical base buffer in both ICF and ECF Regulates Acid-Base Balance Levels regulated primarily by the kidneys Readily available as a result of carbon dioxide formation during metabolism

3rd trimester

25-40 weeks; testes descend if fetus is male; alveoli form, fat is deposited, and fetus actively kicks By birth, fetus weighs about 7.5 lbs and 20 inches long

Chill stage of fever

2nd stage of fever associated with sensation of being chilled although temperature is rising.

The 3 P's of hyperglycemia include

3 P's: 1. Polyuria: Frequent and excessive urination 2. Polydipsia: Excessive thirst 3. Polyphagia: Excessive hunger/eating

Clinical Manifestations (diabetes)

3 P's: polyphagia, polyuria, polydipsia Fatigue, weakness, sudden vision changes, paresthesias, dry skin, lesions/wounds, recurrent infections

Syphilis

3 stages Primary - painless genital lesion Secondary - skin rash, enlarged lymph nodes, fever, may last several years Latent - usually no clinical symptoms present for as long as 20 year, may include neurologic and cardiovascular organ damage Dementia, confusion, paralysis, paresis and can cross the placenta to infect fetus

Duration of Insulin Glulisine (Apidra)

3-4 hours

Duration of Insulin Aspart (Novolog)

3-5 hours

Potassium

3.5-4.5 mEq/L # 1 electrolyte in ICF Muscles, enzymes, pH

The amount of CHO is increased to ___ g for glucose levels less than 50 mg/dL (2.8 mmol/L).

30 g

Onset of Humulin 70/30

30 min

Onset of Short Acting Insulin

30 minutes to 1 hour

Peak of Insulin Aspart (Novolog)

30-60 min

Duration of Long Acting Insulin

36+ hours

flush stage of fever

3rd stage of fever associated with the hypothalamus reaching a new set point due to shivering causing warmth.

In extreme heat, an individual can lose as much as ___ L of fluids in an hour.

4

Assessment: Pelvic Shape

4 types: Gynecoid, android, anthropoid, and platypelloid.

Glycosylated hemoglobin (A1C) test normal range

4%-6%

Onset of Long Acting Insulin

4-8 hours

third trimester (by end)

40 weeks; testes descend, alveoli form, subcut fat deposited, and fetus kicks

AV node intrinsic rate

40-60 bpm

defervescence stage of fever

4th stage of fever: initiation of sweating

Diabetes management

5 components: nutritional therapy, exercise, monitoring, pharmacologic therapy, and education

Duration of Lispro (Humalog)

5 hours

Approximately ___% of women who develop gestational diabetes will have persistent hyperglycemia after pregnancy and be diagnosed with type 2 diabetes.

5-10%

Onset of Insulin Aspart (Novolog)

5-15 min

Duration of Short Acting Insulin

5-7 hours

Healthy (fluid volume)

50-60% of body weight; in older adults (60+) about 45%, in infants about 80%

A reading of ___% or greater on the HgbA1C is indicative of diabetes and can be obtained if the patient has not been fasting.

6.5%

SA node intrinsic rate

60-100 bpm

In DKA, blood glucose levels may exceed ___ mg/dL

600

Sweat normally accounts for ___ mL of water loss per day

600

Normal pH

7.35-7.45 - humans are more alkalotic

Normal blood glucose level in the fasting state

70-99 mg/dL

Peak of Intermediate Acting Insulin

8-12 hours

Calcium

8.6-10.2 mg/dL #1 electrolyte in the body Bones (composition), beats (muscle/neuro), blood (coagulation)

Calcium

8.6-10.2 mg/dL - #1 electrolyte in body -- 99% in bones Functions - 3 B's = bones, blood (clot), beats (heart) Regulates nerve impulse, blood clotting, muscle contraction/relaxation, & B12 absorption Controlled by PTH + calcitonin Excreted mainly by GI (some by kidneys)

1st trimester

9-12 weeks into pregnancy; some reflexes are present, heartbeat can be heard via Doppler and sex is distinguishable

Integumentary Adaptations (pregnancy)

90% of women will experience hyperpigmentation and this is usually seen on nipples, areola, umbiliucs, perineum, and axilla Many disappear after birth but some only fade

Adult body temperature

96.7-100.5

Chloride

97-107 mEq/L Major ECF anion Acts with Na+ for osmotic pressure, combines with H+ to make hydrochloric acid

Chloride (Cl-)

97-107 mEq/L - major ECF anion Blood volume, blood pressure, and pH balance, major part of interstitial + lymph fluid -- produces hydrochloric acid Acts with Na+ to maintain osmotic presume Regulated by aldosterone along with Na+ and excreted by kidneys

Newborn body temperature

97.9-99.7

Newborn temperature

97.9-99.7 (36.6-37.6)

Fasting blood sugar normal range

<100 mg/dL

Normal BP

<120/<80 mmHg

Stage 2 Hypertension

>160/>100

Random plasma glucose

>200mg/dL on more than one occasion to diagnose diabetes

Trick to Remember Rapid Acting Insulins

A LOG rolls quickly down the hill.... 1. HumaLOG 2. NovoLOG For Apidra, place the R in front...Rapidra "15 minutes feels like an hour during 3 rapid responses." Onset: 15 minutes Peak: 1 hour Duration: 3

Cardiac Cycle

A complete heartbeat consisting of contraction and relaxation of both atria and both ventricles

Exchange lists

A diet-planning tool that groups foods together based on their carbohydrate, protein, and fat content. One food on the list can be exchanged for another food on the same list.

Sponge with spermicide

A disk-shaped polyurethane device with the spermicide nonoxynol-9; remove after 24 hours and can fall out while voiding

The term diabetes mellitus is used to describe...

A group of disorders characterized by chronic hyperglycemia and disturbances in carbohydrate, protein, and fat metabolism.

Corticosteroids

A group of hormones, including cortisol, released by the adrenal glands at times of stress

G6PD deficiency

A hemolytic anemia that is a condition causing red blood cells to break down in response to certain medications, infections, or other stressors

Malignant Hyperthermia

A hereditary condition of uncontrolled heat production that occurs when susceptible people receive certain anesthetic drugs.

Erythropoietin

A hormone produced and released by the kidney that stimulates the production of red blood cells by the bone marrow.

low birth weight (LBW)

A leading cause of infant mortality and #1 cause in the first month of life 12% of US births were premature or less than 37 weeks

Lamaze Method

A method of "prepared" childbirth involving relaxation and controlled breathing.

Nagele's Rule

A method of determining the estimated due date (EDD) 1st day of last period + 7 days - 3 months add 1 year

Progestin only OC

A pill containing only progestin that thickens cervical mucus to prevent sperm from penetrating Less effective than combination pills - take same time every day

Spontaneous pneumothorax

A pneumothorax that occurs when an air-filled blister on the lung ruptures

Sexual expression

A process through which we reveal our sexual selves; touch, sight, smell, sounds, feelings, thoughts, and fantasy can all contribute to sexual fulfillment

Trousseau's sign

A sign of hypocalcemia . Carpal spasm caused by inflating a blood pressure cuff 20 mmHg above the client's systolic pressure and leaving it in place for 3 minutes.

Female condom

A soft, thin plastic tube with two end rings--one to fit over the cervix and one to serve as an anchor outside the entrance to the vagina; also called a vaginal pouch.

Open pneumothorax (traumatic)

A traumatic pneumothorax where air enters pleural cavity through wound on inhalation and leaves on exhalation

Tension pneumothorax (traumatic)

A traumatic pneumothorax where air enters pleural cavity through wound on inhalation but cannot leave on exhalation More severe than open pneumothorax due to increasing pressure

The patient is prescribed 30 units of regular insulin and 70 units of insulin isophane suspension (NPH insulin) subcutaneously every morning. The nurse should provide which instruction to the patient for insulin administration? A. "Draw up the regular insulin into the syringe first, followed by the cloudy NPH insulin." B. "Inject the needle at a 30-degree angle." C. "Rotate sites at least once or twice a week." D. "Use a 23- to 25-gauge syringe with a 1-inch needle to increase insulin absorption."

A. "Draw up the regular insulin into the syringe first, followed by the cloudy NPH insulin." When insulins are mixed, withdraw the regular insulin (clear) first, followed by withdrawing the NPH insulin (cloudy).

The elementary school nurse is teaching children how to prevent injuries from cold exposure in the winter. Which student statement demonstrates that the teaching has been effective? A. "Dressing in layers is important." B. "I will drink lots of water when I exercise." C. "Taking frequent breaks will help me rest." D. "Wearing three pairs of cotton socks is very important."

A. "Dressing in layers is important." Teaching has been effective when the student states that "Dressing in layers is important." Layering is very helpful in preventing cold injuries. The inner layer of clothing will provide insulation and the outer layers will help protect from wind and moisture. Lightweight and synthetic fabrics are preferable.Drinking lots of water and taking frequent breaks are more often associated with heat-related injuries. Although wearing layers is important, cotton socks are not the best choice as they will prevent evaporation of any moisture and can lead to hypothermia. Wearing three pairs of socks can decrease circulation to the toes increasing the risk of frostbite.

Assuming the patient eats breakfast at 8:30 AM, lunch at noon, and dinner at 6:00 PM, he or she is at highest risk of hypoglycemia after an 8:00 AM dose of NPH insulin at what time? A. 5:00 PM B. 2:00 PM C. 10:00 AM D. 8:00 PM

A. 5:00 PM Breakfast eaten at 8:30 AM would cover the onset of NPH insulin, and lunch will cover the 2 PM time frame. However, if the patient does not eat a mid-afternoon snack, the NPH insulin may be peaking just before dinner without sufficient glucose on hand to prevent hypoglycemia.

The nurse is directing the care of a newly admitted client who is severely hypothermic. What does the nurse advise the rapid response team (RRT) to do first? A. Apply electrocardiographic (ECG) monitor leads to monitor cardiac activity. B. Draw blood samples to rule out coagulation problems. C. Insert a nasogastric tube for rewarming purposes. D. Obtain intravenous (IV) access to provide fluids and administer drugs.

A. Apply electrocardiographic (ECG) monitor leads to monitor cardiac activity. The nurse will advise the RRT to first place ECG leads on the client in order to monitor cardiac activity. People who are hypothermic are at risk for lethal cardiac dysrhythmias and need continual monitoring.Samples for laboratory testing and IV access would be implemented rapidly. Medications may not be effective until a client is normothermic, however warmed fluids may be administered to hasten the process. The same is true of inserting a nasogastric (NG) or orogastric (OG) tube as a means to rewarm the client.

A patient with hypothermia is brought to the emergency department. The nurse should explain which most likely treatment to the family members? A. Core rewarming with warm fluids B. Ambulation to increase metabolism C. Frequent oral temperature assessment D. Gastric tube feedings to increase fluids

A. Core rewarming with warm fluids Core rewarming with heated oxygen and administration of warmed oral or intravenous fluids is the preferred method of treatment. The patient would be too weak to ambulate. Oral temperatures are not the most accurate assessment of core temperature because of environmental influences. Warmed oral feedings are advised; gastric gavage is unnecessary.

(SATA) It is most important for the nurse to include which risk factors in a teaching plan associated with the development of type 2 diabetes mellitus? (Select all that apply.) A. Hypertension B. History of pancreatic trauma C. Weight gain of 30 pounds during pregnancy D. Body mass index greater than 25 kg/m E. Triglyceride levels between 150 and 200 mg/dL F. Delivery of a 4.99-kg baby

A. Hypertension D. Body mass index greater than 25 kg/m F. Delivery of a 4.99-kg baby Risk factors for type 2 diabetes include habitual inactivity, hypertension, delivery of a baby weighing over 9 pounds, a history of vascular disease, a body mass index greater than 25 kg/m, and triglyceride levels over 200 mg/dL.

The nurse is teaching a woman how to administer insulin sq. Which precautions should the nurse emphasize during the teaching session? A. Insulin is injected slowly (over 2 to 4 seconds) B. To prevent hypoglycemia, a meal should be taken 60 minutes after regular insulin is injected. C. Insulin should be injected with the needle inserted at a 45-degree angle D. Aspirating when injecting into subcutaneous tissue is necessary.

A. Insulin is injected slowly (over 2 to 4 seconds) Insulin is injected slowly (over 2 to 4 seconds) to allow tissue expansion and minimize pressure, which can cause insulin leakage. To prevent hypoglycemia, a meal should be taken 30 minutes after regular insulin is injected not 60 minutes. Unless the woman is very thin, insulin should be injected with the short needle inserted at a 90-degree angle so that the tip of the needle reaches the fatty tissue layer. Aspirating when injecting into subcutaneous tissue is not necessary.

Based on the nurse's assessment of a diabetic patient, which finding indicates the need for avoidance of exercise at this time? A. Ketone bodies in the urine B. Blood glucose level of 155 mg/dL C. Pulse rate of 66 beats per minute D. Weight gain of 1 pound over the previous week's weight

A. Ketone bodies in the urine Exercise would lead to further elevations in blood glucose levels due to inadequate insulin to promote intracellular glucose transport and uptake. Assessing for ketones in the urine may indicate insulin deficiency.

(SATA) Gestational diabetes mellitus (GDM) is a carbohydrate intolerance that develops during pregnancy. The following are factors associated with a higher risk for GDM. A. Overweight (body mass index [BMI] 25 to 25.9, obese (BMI 30 to 39.9), or morbidly obese B. Hypertension C. Member of a high risk ethnic group D. Maternal age younger than 18 years

A. Overweight (body mass index [BMI] 25 to 25.9, obese (BMI 30 to 39.9), or morbidly obese B. Hypertension C. Member of a high risk ethnic group

(SATA) Signs and symptoms of maternal hypoglycemia include the following: A. Shakiness (tremors) B. Dry mouth, excessive thirst C. Sweating D. Headache

A. Shakiness (tremors) C. Sweating D. Headache Signs and symptoms include shakiness (tremors), sweating, headache, and also pallor; cold, clammy skin, disorientation, irritability, hunger, and blurred vision. Dry mouth and excessive thirst are symptoms of hyperglycemia not hypoglycemia.

A homeless person is brought to the emergency department after prolonged exposure to cold weather. The nurse would assess the patient for what manifestations of hypothermia? A. Stupor B. Erythema C. Increased anxiety D. Rapid respirations

A. Stupor Stupor may occur with hypothermia because of slowed cerebral metabolic processes. Pallor, not erythema, would be present as a result of peripheral vasoconstriction. Drowsiness occurs; the patient would be unable to focus on anxiety-producing aspects of the situation. Respirations would be decreased.

Which major neonatal complication is carefully monitored after the birth of the infant of a diabetic mother? A. hypoglycemia B. hypercalcemia C. hypobilirubinemia C. hypoinsulinemia

A. hypoglycemia The neonate is at higher risk for hypoglycemia because fetal insulin production is accelerated during pregnancy to metabolize excessive glucose from the mother. At birth, the maternal glucose supply stops and the neonatal insulin exceeds the available glucose, leading to hypoglycemia. Hypocalcemia and hyperbilirubinemia are complications of infants of a diabetic mother. Because fetal insulin production is accelerated during pregnancy, the neonate shows hyperinsulinemia.

Breastfeeding length

AAP recommends infants be breastfed exclusively for the first 6 mos and continue to breastfeed for a year or until it is mutually desired.

Metastasis

Abnormal cells invade surrounding tissue and gain access to lymph and blood vessels carrying them to other areas of the body

Hypertension

Abnormally high blood pressure; most common chronic disease among adults 140-159/90-99 BP

Amenorrhea

Absence of menstruation; often due to anorexia, extreme weight gain, stress, exercise, PCOS, hypothyroidism, or congenital abnormalities Estrogen replacement or surgery may be needed; treat underlying cause if applicable

Diabetic ketoacidosis (DKA), is a hyperglycemic state (associated type 1 diabetes) whereby an ___.

Absolute insulin deficiency is accompanied by the use of fatty acids and subsequent excess of ketone bodies and metabolic acidosis

GI tract (as part of homeostasis)

Absorbs water and nutrients that enter the body through this route

Vein site selection

Accessibility of a vein - Do not use leg vein of adult unless others are inaccessible, avoid antecubital veins Condition of vein -should not make more than 2 attempts --> get person with advanced skills; older = prone to infiltration Type of fluid to be infused - viscous or hypertonic = large vein w/ large gauge needle Anticipated duration of infusion

When infant flexes, vasoconstriction occurs to decrease heat loss and may cause ____, or blue hands and feet.

Acrocyanosis

Once glucose enters the cell, it is oxidized through cellular respiration into ___

Adenosine Triphosphate (ATP)

Pyrogens trigger the hypothalamus in the brain to do what?

Adjust heat production, heat conservation, and heat loss mechanisms to maintain a higher core temperature. Representing an increased hypothalamic set point.

Pseudoephedrine (Sudafed)

Adregeneric decongestant; to decrease inflammation, increase airway patency, and a nasal decongestant P.O. taken every 4-6 hours or extended release q12h

Type 1

Affects 5% and characterized by destruction of beta cells May be genetic, immunologic, or environmental. Destruction of beta cells result in decreased insulin, increased glucose production, and fasting hyperglycemia More likely to get DKA

Higher rates of heat and cold related deaths are higher in this ethnic group ____

African-Americans

The basal metabolic rate changes with ___

Age

PMS Risk Factors

Age 25-35 years, psychiatric history, family history, unhealthy living habits, and stressful life events

Reproductive History

Age at menarche, days in cycle, flow characteristics, start of LMP Use of contraception and last used Establish EDD to provide tinming for testing Ultrasound is often most accurate method of dating pregnancy

Chemotherapy

Agents used in attempt to destroy cancer cells by interfering with cellular function, replication May be combined with surgery, radiation therapy, or both Curative, control, or palliative Cell kill & cell cycle

Endometriosis risk factors

Aging, family history in first degree relative, short cycle, long flow, high fat consumption, young menarche, few or no pregnancies,

Decreases BMR

Aging, prolonged fasting, and sleep

___ consumption affects blood glucose levels.

Alcohol Levels are not affected by moderate use of alcohol when DM is well controlled.

Direct Renin Inhibitors

Aliskiren (Tekturna) Binds with renin to inhibit production of angiotensin I, thus decreasing production of angiotensin II and aldosterone Treats HTN Adverse effects: allergic reaction (angioedema, rash), hyperkalemia, diarrhea Take at same time of day and avoid high fat foods

Developmental Considerations (sexuality)

All processes of human development affect sexuality; psychosocial, emotional, and biologic aspects

Ultrasonography

Allows visualization of fetus; provides info about activity, growth, and gestational age Determines need for more invasive tests Used to visualize placental location during CVS sampling

IV Labels

Always label your lines when you change or start them Always label your tubing, especially when multiple lines i.e. NSS ; Insulin ; Cardizem When you start an IV or Change the Dressing Always Include Initials, Date and Time

Medications (that affect sexuality)

Amyl nitrates, anticonvulsants, antidepressments, antihistamines, antipsychotics, antispasmodics, barbituates, and narcotics Some may use cocaine, ethyl alcohol, and marijuana to heighten sexual experiences

Cystic fibrosis

An autosomal recessive genetic disorder manifested by chronic lung disease, pancreatic exocrine deficiency, and elevation of sodium chloride in the sweat Causes exocrine gland secretions to become viscid and promotes colonization of RT with P. aeruginosa and other organisms such as S. aureus

Neutral thermal environment (NTE)

An environment that maintains body temperature with minimal metabolic changes and /or oxygen consumption.

Atelectasis

An incomplete expansion of the lung or a portion of the lung Tachypnea, tachycardia, dyspnea, cyanosis, signs of hypoxemia, diminished chest expansion, absence of breath sounds, and intercostal retractions

Inhibited Sexual Desire (female sexual dysfunction)

An inhibition in sexual arousal so that congestion and vaginal lubrication are absent or minimal; may be due to anxiety, negative emotions, fear, interpersonal problems, oral contraceptives, alcohol, depression, sexual abuse or physical factors

Transgender

An umbrella term describing those who feel that their assigned sex incompletely describes them

Insulin

Anabolic hormone secrete by Beta cells in islets of Langerhans While eating, insulin secretion increases and moves glucose from blood to muscle, liver, and fat cells

Megaloblastic anemias

Anemias including Vitamin B12 and folic acid deficiencies; impaired DNA synthesis enlarges RBCs and they are often oval in shape

Progression (carcinogenesis)

Angiogenesis -- moves through lymph and blood cells

Compazine (prochlorperazine)

Antiemetic

Ondansetron (zofran)

Antiemetic

Phenergan (promethazine)

Antiemetic; take oral form with food or milk

Paclitaxel (Taxol)

Antineoplastics - AIDS related Kaposi sarcoma and advanced ovarian/breast cancers

Doxorubicin (Adriamycin)

Antineoplastics - antibiotic Bladder, breast, lung, ovarian, stomach, and thyroid cancers

5-fluorouracil (5-FU)

Antineoplastics - colon and rectal adenocarcinoma, breast, gastric, pancreatic adenocarcinoma

Cyclophosphamide (Cytoxan)

Antineoplastics - nitrogen mustards Breast/ovarian cancer, Hodgkin lymphoma, Leukemia, Retinoblastoma, malignant lymphoma, multiple myeloma, mycosis fungoides

Aspirin

Antiplatelet used to lower risk of heart attack or stroke

Dextromethorphan (Robitussin)

Antiussive P.O. Used for nonproductive cough by suppressing cough reflex through action on medulla Don't exceed 4 doses in 24 hours Store at room temperature, use with chest physiotherapy, no analgesia Contact HCP if cough lasts longer than 1 week

ACDHO

Anxiety Cravings Depression Hydration Other

4 or less

Apgar score indicating neonate needing immediate life saving support

4-6 apgar

Apgar score indicating neonate requires special assistance

Nursing Management (chemotherapy)

Assessing fluid, electrolyte status Assessing cognitive status Modifying risks for infection, bleeding Administering chemotherapy Protecting caregivers

36 weeks

At what approximate week does the fundus meet it's highest point, the xiphoid process?

Acquired atelectasis

Atelectasis mainly occuring in adults Caused most commonly by mucus plug in the airway or by external compression by fluid, tumor mass, exudate, or other matter in the area surrounding the airway

Insulin resistance is understood to be a proinflammatory state, thus contributing to ____ and plaque formation, and is also thought to be associated with increased ___ risk, with hyperinsulinemia appearing to act as a cellular growth factor.

Atherogenesis; Cancer

Anti-cholinergics

Atropine and Scopolamine Parasympathetic system "Can't spit, can't pee, can't poop, can't see" dry you out -ine

A child is about to be admitted to the pediatric intensive care unit (PICU) after surgery for removal of a tumor in the hypothalamic region of the brain. The nurse manager should intervene immediately when observing the child's nurse perform which action? A. Places a hypothermia blanket at the bedside B. Adjusts the bed to the Trendelenburg position C. Obtains electronic equipment for monitoring the vital signs D. Secures a pump to administer the ordered intravenous fluids

B. Adjusts the bed to the Trendelenburg position It is not safe to put the bed in the Trendelenburg position, because raising the foot increases blood flow to the brain, thereby increasing intracranial pressure. Temperature elevations may occur after a craniotomy because of stimulation of the hypothalamus. A hypothermic blanket should be ready if the temperature becomes precipitously elevated. Monitoring vital signs is a critical component of postoperative care. Intravenous infusions must be regulated precisely to minimize the possibility of cerebral edema.

On a hot summer day, an older adult is found by a neighbor lying on the floor, agitated and confused. After calling 911, the neighbor places ice bags on the client's groin area and armpits. Upon arrival at the hospital, which action does the emergency department (ED) nurse perform first? A. Administer two acetylsalicylic acid (aspirin) tablets orally. B. Check the client's airway and administer high-flow oxygen therapy. C. Monitor the client's vital signs. D. Place a cooling blanket on the client.

B. Check the client's airway and administer high-flow oxygen therapy. The first action made by the ED nurse is to check the client's airway and give high-flow oxygen therapy. Once in a clinical setting, the nurse monitors and supports the client's airway, breathing, and circulatory status. High-concentration oxygen therapy and IV lines with 0.9% saline solution are also indicated.This client is at risk for aspiration. Nothing would be given by mouth when a client is at risk for aspiration. Vital signs must be monitored, but they are not the immediate priority in this scenario. Use of a cooling blanket is important although not a top priority, especially if ice bags are already in place.

The nurse will instruct the patient to treat hypoglycemia with which drug? A. Bumetanide (Bumex) B. Glucagon (GlucaGen) C. Acarbose (Precose) D. Propranolol (Inderal)

B. Glucagon (GlucaGen) Glucagon stimulates glycogenolysis, raising serum glucose levels.

Which long-acting insulin mimics natural, basal insulin with no peak action and a duration of 24 hours? A. Insulin glulisine (Apidra) B. Insulin glargine (Lantus) C. Regular insulin (Humulin R) D. NPH insulin

B. Insulin glargine (Lantus) Insulin glargine has a duration of action of 24 hours with no peaks, mimicking the natural, basal insulin secretion of the pancreas.

While at a soccer match, a player drops to the ground with heat exhaustion and a diminished level of consciousness. After ensuring the ABC's are intact, what does the team nurse do first? A. Give salt tablets. B. Move the player to the shade. C. Place ice packs under the arms. D. Provide a cool electrolyte fluid drink.

B. Move the player to the shade. After ensuring the ABC's are intact, the nurse would first move the player into the shade.After the player is in the shade, the nurse would place ice packs under the arms as well as in the groin to cool the client. Due to a diminished level of consciousness, nothing would be given by mouth to prevent aspiration. Salt tablets are not given.

The nurse recommends the pen-injector insulin delivery system for the client with which clinical presentation? A. Confusion and reliance on another person for insulin injections B. Requirements for intensive therapy with small, frequent insulin doses C. Visual impairment affecting the ability to draw up insulin accurately D. Frequent episodes of hypoglycemia

B. Requirements for intensive therapy with small, frequent insulin doses The pen injector allows greater accuracy with small doses of less than 5 units. It is not recommended for those with cognitive or visual impairments or those who suffer frequent hypoglycemic episodes.

(SATA) Which actions describe the beneficial effects produced by sulfonylurea oral hypoglycemics? A. Increase hepatic glucose production B. Stimulate insulin secretion from beta cells C. Enhance action of insulin in various tissues D. Inhibit breakdown of insulin by liver

B. Stimulate insulin secretion from beta cells C. Enhance action of insulin in various tissues D. Inhibit breakdown of insulin by liver The sulfonylureas stimulate insulin secretion from the beta cells of the pancreas; enhance the actions of insulin in muscle, liver, and adipose tissue; and prevent the liver from breaking insulin down as fast as it ordinarily would (reduced hepatic clearance). Increased hepatic glucose production would serve to increase serum glucose levels, the opposite effect of oral hypoglycemic drugs.

Beta Blockers (-lol)

BLOCK the sympathetic nervous system via beta-adrenergic receptors and produce a slower heart rate and lower BP Reduce HR in pt's with tachycardia and BP elevation Check HR before giving

Assessment

BP Pulse: Apical or peripheral Capillary refill Doppler flow studies ABI Electronic fetal monitoring 3-5 lead electrocardiogram

Blood pressure

BP = CO x Peripheral Resistance

Assessment: Internal Genitalia

Because of increased pelvic congestion, the cervix will exhibit: -Goodell Sign: Cervix will be softened. -Hegar sign: Uterine isthmus will be softened. -Chadwick sign: Bluish coloration of the cervix and vaginal mucosa.

Cervix Adaptations

Begins to soften at 6-8 weeks (Goodell's sign), glands increase cervical mucus and progesterone forms a thick mucus plug 4 weeks from birth Chadwick's sign can be observed due to increased vascularization of cervix

Gender role behavior

Behavior person exhibits about being male or female

Avoid contact with cold surfaces

Best way to prevent heat loss in newborns?

Gestational Edema

Between 29-36 weeks gestation: -Special attention is focused on the presence of edema. -Dependent edema of the extremities from constriction of blood vessels secondary to the heavy gravid uterus. -Periorbital edema around the eyes, hands, and pretibial edema are NOT common and could be a sign of gestational hypertension.

Insulin facilitates glucose metabolism by ....

Binding to insulin receptors on the cell wall, signaling glucose transporter molecules that facilitate glucose entry into the cell.

Without insulin, glucose builds up in the ___.

Blood

IV Access

Blood Draws Give Fluids Medications Blood Transfusion Nuclear Medicine/Radiology

Leukemia

Blood condition of white cells; malignant (cancerous) condition.

iron deficiency anemia

Blood loss or deficient diet Low hemoglobin and hematocrit, decreased iron stores Low serum iron and ferritin Hypochromic and microcytic erythrocytes Poikilocytosis (irregular shape) Anisocytosis (irregular size)

HbA1c

Blood test that measure glycated hemoglobin in the blood, the results determine the average blood glucose for the previous 2-3 months Normal 6% or less

Chadwick's sign

Bluish-purple coloration of the vaginal mucosa and cervix which indicates cervical ripening usually 4 weeks before birth

Infants have a propensity for heat loss due to a greater ____ to weight ratio

Body surface area Flexed posture moderates heat loss by reducing surface area exposure

What is glycogenesis?

Breakdown of glycogen to glucose

BETTER Model

Bring up the topic of sexuality Explain that you are concerned with all aspects of patients' lives Tell patient that sexual dysfunction can happen; that you will address their concerns Timing is important to address sexuality with each visit Educate patients about the side effects of their treatments Record your assessment and interventions in the patients' medical record

Central Line

Broad name used for Hickmans & Groshongs Also used by physicians in ER/ICU (subclavian + femoral)

Albuterol

Bronchodilator, Adrenergics: inhalation or P.O. Treats or prevents bronchospasm, prevents exercise-induced bronchospasm Warn about risk of paradoxical bronchospasm and stop if occurs Use corticosteroid first, 5 minutes before if prescribed

Ipratropium (Atrovent)

Bronchodilator, anticholinergic Used for COPD, allergic rhinitis, seasonal allergies, and common cold. Inhaler, nasal spray, solution for inhalation Wait 2 mins between puffs. Use this first and if prescribed, wait 5 mins then use corticosteroid

A newborn infant has a unique source of heat from ____.

Brown Adipose Tissue (BAT) Blood passes through BAT warmed by metabolism and carries heat to the rest of the body

Testing ketones

By-products of fat breakdown in blood and urine.

A high school athlete recently suffered heat exhaustion. The school nurse is instructing the student on how to prevent a recurrence of this situation. Which student statement demonstrates that the nurse's teaching has been effective? A. "I should try to exercise between noon and 3 PM." B. "I will limit my fluids to drinking 'sports' drinks after I exercise." C. "Taking frequent rests is important when in a hot environment." D. "Wearing dark-colored clothing to deflect the sun away from me will help me stay cooler."

C. "Taking frequent rests is important when in a hot environment." The statement that demonstrates that the teaching about heat exhaustion is effective is the comment that stresses the importance of frequent rest periods when in a hot environment. Frequent rest periods will decrease the risk of heat exhaustion.Exercising during times of peak sun exposure (midday) will increase the risk of heat exhaustion. Fluids, particularly water, have to be consumed throughout the exercise period and not be limited to a certain type. Light colored clothing, not dark, reflects the sun away from the individual.

When teaching a patient about insulin glargine (Lantus), which statement by the nurse about this drug is correct? A. "It is often combined with regular insulin to decrease the number of insulin injections per day." B. "You can mix this insulin with NPH insulin to enhance its effects on glucose metabolism." C. "You cannot mix this insulin with regular insulin and thus will have to take two injections." D. "The duration of action for this insulin is 8 to10 hours, so you will need to take it twice a day."

C. "You cannot mix this insulin with regular insulin and thus will have to take two injections." Insulin glargine is a long-acting insulin with duration of action up to 24 hours. It should not be mixed with any other insulins. It is usually dosed once daily, but it may be dosed every 12 hours depending on the patient's glycemic response.

The nurse is providing education to a patient for the prescription glipizide (Glucotrol). The nurse explains this medication is more effective when administered at which time? A. 15 minutes postprandial B. At bedtime C. 30 minutes before a meal D. In the morning

C. 30 minutes before a meal Glipizide works best if given 30 minutes before meals. This allows the timing of the insulin secretion induced by the glipizide to correspond to the elevation in the blood glucose level induced by the meal.

When planning care for a diabetic patient with microalbuminuria, it is important to include which goal to reduce the progression to renal failure? A. Decrease the total percentage of calories from carbohydrates B. Decrease the total percentage of calories from fruits C. Decrease the total percentage of calories from proteins D. Decrease the total percentage of daily caloric intake

C. Decrease the total percentage of calories from proteins Restriction of dietary protein to 0.8 g/kg body weight per day is recommended for clients with microalbuminuria to reduce the progression to renal failure. All other choices can increase blood glucose and total body weight but are not specific for progression to renal failure.

When caring for a pregnant patient with gestational diabetes, the nurse should question a prescription for which drug? A. Insulin glargine (Lantus) B. Insulin glulisine (Apidra) C. Glipizide (Glucotrol) D. NPH insulin

C. Glipizide (Glucotrol) Oral antidiabetic drugs are classified as pregnancy B or C drugs and are generally not recommended for pregnant patients.

What clinical indicator will the nurse most likely identify when assessing a patient with pyrexia? A. Dyspnea B. Precordial pain C. Increased pulse rate D. Elevated blood pressure

C. Increased pulse rate The pulse rate increases to meet increased tissue demands for oxygen in the febrile state. Fever may increase but does not cause difficulty in breathing. Pain is not related to fever. Blood pressure is not necessarily elevated in fever.

The nurse should institute which precaution for the hypoglycemic patient receiving intramuscular glucagon due to an inability to swallow the oral form? A. Elevate the head of the bed. B. Have a padded tongue blade at the bedside. C. Position the client face down or in a side-lying position. D. Apply pressure and massage the injection site for 5 minutes.

C. Position the client face down or in a side-lying position. Intramuscular injection of glucagon often causes vomiting, increasing the patient's risk for aspiration. Elevating the head of the bed, instituting the use of a padded tongue blade, or applying pressure at or massaging injection site is not a safe nursing practice.

(SATA) Which information should the nurse include in a teaching plan for patients taking oral hypoglycemic drugs? A. Explain dietary changes are not necessary. B. Instruct that it is okay to skip breakfast 1 to 2 times per week. C. Report symptoms of anorexia and fatigue. D. Advise to avoid smoking and alcohol consumption. E. Take your medication only as needed.

C. Report symptoms of anorexia and fatigue. D. Advise to avoid smoking and alcohol consumption. Oral hypoglycemic drugs must be taken on a daily scheduled basis to maintain euglycemia and prevent long-term complications of diabetes. Skipping meals can cause low blood glucose levels and should be avoided. Patients with type 2 diabetes mellitus are managed with lifestyle changes. All other options are correct.

Labs

CBC BMP - Na+ and K+ levels may affect heart Aspartate Aminotransferse (AST) = indicative of heart injury (10-40)

Heat stroke S&S

CNS issues: confusion, delirium, bizarre behavior, seizures; elevated temp (105+), anihidrosis, tachypnea, hypotension, and tachycardia

Sympathomimetic drugs

CNS stimulants such as noradrenergic drugs whose actions resemble or mimic those of the sympathetic nervous system: bronchodilation

Cardiac Output

CO = HR x SV CO = SV x Peripheral Resistance

Consequences of COPD

COPD leads to decreased ability to exhale, stale air in the lungs which leads to hypoxia and hypercapnia Exhalation is inefficient and O2 levels in lungs decrease, if blood goes through the lungs filled with stale air, it will not pick up much oxygen, it may pick up CO2

Glucose Regulation: Sick Day DANGER Signals!

Call PCP if you have any of these: - Persistent N/V - Moderate/Large ketones - BG elevated after two supplemental doses of insulin - High fever (101.5)/increasing fever OR fever for longer than 24h

Physician or Radiologist (who)

Can access: Central Line or Port

Diabetes Mellitus (sexuality)

Can affect sexuality due to hormonal changes - men may experience erectile dysfunction and women may experience dryness or inability to orgasm

Effects of Harassment

Can cause feelings of helplessness, worthlessness, and guilt in victim; anger is commonly experienced

Early contractions

Can lead to preterm birth, pain is felt in lower back every 10 minutes Lie down on left side, drink 2-3 glasses of water and call doctor if it doesn't change in 1 hour

SGLT-2 Inhibitors (-flozin)

Canagliflozin, Dapagliflozin Give before 1st meal of day, correct volume deficiency first, monitor for ketoacidosis Adjunct to diet & exercise

Blue Bloaters (Bronchitis)

Cannot increase respiration enough to maintain oxygen levels Cyanosis and polycythemia Cor pulmonale

Birth traumas (disappear)

Caput succedaneum (localized edema of scalp) Molding (elongation of skill) Subconjunctival hemorrhage

____ is a simple approach to NUTRITION and meal planning that uses label information of the nutritional content of packaged food items.

Carbohydrate (CHO) counting

Acquired hemolytic anemias

Caused by agents extrinsic to red blood cell, medications bacterial/toxins, antibodies, and physical trauma

Aplastic anemia

Caused by bone marrow suppression and usually results in a reduction of WBCs, platelets, and RBCs Causes include radiation, chemicals, and toxins that suppress hematopoiesis Often accompanied by petachiae, ecchymoses, bleeding from the nose, gums, vagina or GI due to decreased platelets Also low WBCs = increased infection risks

Exertional heat stroke

Caused by strenuous physical activity in hot environment

When glucagon is administered the mechanism of action is...

Causes the liver to release hepatic stores of glycogen

Nicotine in Cigarretes

Causes vasoconstriction in the mother, leading to reduced placental perfusion.

Characteristics of Benign and Malignant Neoplasms

Cell characteristics Mode of growth Rate of growth Metastasis General effects Tissue destruction Ability to cause disease

Malignant (cancer cells)

Cells or processes that are characteristic of cancer

Benign (cancer cells)

Cells that are not cancerous

Sterile dressing changes

Central lines and ports (changing)

Sustained high core body temperature coupled with reduced perfusion leads to _____, _____, and _____.

Cerebral edema, central nervous system degeneration, and renal necrosis.

Preemie risks

Cerebral palsy, mental retardation, and chronic respiratory problems

Musculoskeletal Adaptations (pregnancy)

Changes are progressive due to influence of hormones, fetal growth, and maternal weight gain; center of gravity shifts forward Ligaments and joints soften/relax, especially those of the sacroileum which may cause back pain

Exudative pleural effusion

Characterized by presence of proteins and/or elevated LDH levels in the pleural fluid Conditions that produce this are bacterial pneumonia, viral infection, pulmonary infarction, and malignancies

1st gen sulfonylureas (-amide)

Chlorpropamide Tolbutamide Tolazamide Rapidly absorbed in GI = usual side effects 1st oral antidiabetics, onset 1 hour

Chronic bronchitis

Chronic irritation of airways increase the number of mucous cells, which leads to mucus hypersecretion, and a productive cough

Secondary Diseases (hypertension)

Chronic kidney disease Heart disease Peripheral arterial disease Retinopathy Stroke or TIA

Secondary hypertension causes

Chronic kidney disease, renal artery stenosis, hyperaldosteronism, pheochromocytoma and sleep apnea Can also occur with pregnancy

Management (hypothermia)

Circulation, Airways, Breathing are #1 priority Vitals, CVP, I&O's ABG's should be evaluated Continuous ECG Arterial line to record BP Rewarming the patient External cardiac compressions as directed in temps >88 degrees

Vasopressors

Classification of drugs that act to increase blood pressure i.e. epinephrine used to treat anaphylaxis

Prediabetes

Classified as impaired glucose tolerance or impaired fasting glucose: Concentrations of blood glucose fall between normal levels and those that are diagnostic for diabetes

Metabolic Syndrome

Cluster of metabolic abnormalities (major risk factor for CVD), need 3+ of these conditions to be diagnosed: - Insulin resistancec (FBG >100 mg/dL) -Central obesity -Dyslipidemia >159 mg/dL -BP >130/85 -Proinflammatory or prothrombic state

Hydrothorax

Collection of serous transudate in the pleural cavity

Axillary temperature

Common site for measuring temperature in infants and children; however, it is an infrequently used site for temperature measurement in adults. Because it is not close to any major blood vessels and because the thermometer is placed between skin surfaces, the axillary site is thought to poorly reflect core body temperature.

Hickman (Central Line)

Commonly used for chemotherapy A tunneled IV catheter, tip reaches Superior Vena Cava Interventional Radiologist insertion Moderate time frame use Requires heparin flush Draw blood from line

Lab Studies to Assess for Imbalances

Complete blood count Serum electrolytes, blood urea nitrogen, and creatinine levels Urine pH and specific gravity Arterial blood gases

Diabetic neuropathy

Complication of long term diabetes mellitus; metabolic and vascular changes result in damage to peripheral + autonomic nerves Sensation of numbness, prickling, or parethesias. Sensory loss can result leading to injury, infection, and gangrene

First prenatal visit

Comprehensive Health History LMP, presumptive or probable signs, urine/blood test for hCG Any infections/chronic illness Mental issues or allergies Personal history Similar info about partner and family

Hypervolemia (causes)

Compromised renal (dysfunction), liver cirrhosis, CHF (overload)

4 mechanisms (heat loss)

Conduction (3%) Convection (34%) Evaporation (24%) Radiation (39%)

Ambivalence

Conflicting feelings at the same time, very common in the 1st trimester Influenced by way woman was raised, family situation, relationship with father, and hopes for the future

Hypomagnesemia "Can't Have Two Shots Now"

Confusion Hyperactive deep tendon reflexes Tremors Seizures Neuromuscular changes/neurological (numbness/tingling), painful muscle contractions

Hypercalcemia "Calcium Makes Bones Very Hard With Great Resistance"

Confusion Memory deficit Bone pain, fractures Ventricular dysrhythmias Hypertension Weakness GI issues Reflexes depressed

Hypocalcemia "CRAMPS"

Confusion Reflexes hyperactive Arrhythmias (ventricular tachycardia) Muscle spasms (muscle cramps, laryngeal spasms, hyperexcitability of muscles), seizures Positive Trousseau's (Tetany) Sign of Chvostek's (Tetany)

Premature ejaculation

Consistently reaches ejaculation or orgasm before or soon after entering vagina; partner does not usually have time to reach satisfaction Rarely physiologic; assess causative relationship factors such as anxiety, guilt, lack of time, and a new relationship

Evaporation

Conversion of a liquid into a vapor

Managing Hyperthermia

Cool IV fluids (NS or lactated ringers) Remove clothing - reduce temp to 102 ASAP Cool sheets, towel, sponging, ice, immersion in cold bath Electric fan (convection + evaporation) Cooling process should stop at 100.4 to prevent iatrogenic hypothermia

Newborn/Fetus (gestational diabetes)

Cord prolapse Congenital anomaly Macrosomia from hyperinsulinemia Birth trauma due to increased size of fetus Preterm birth Fetal asphyxia Death Polycythemia Larger baby + childhood obesity/carb intolerance

Hypothermia (2)

Core internal temperature less than 95 degrees, alcohol increases susceptibility due to systemic vasodilation. Wet clothing and immersion in cold water increases heat loss by 25%, trauma victims are also at risk.

Budesonide (Pulmicort)

Corticosteroid Preventative in maintenance of asthma or seasonal allergic rhinitis, prevents inflammation Intranasal and inhalational (1-2 times per day) Contraindicated in pt's with hypersensitivity to milk Rinse mouth after inhaled to prevent thrush

Radiation Therapy

Curative, control, or palliative External radiation, internal radiation Radiation reactions Brachytherapy Toxicity

____ is a rare disorder resulting in excessive corticosteroid secretion leading to hyperglycemia.

Cushing's syndrome

Hypoxemia (signs & symptoms)

Cyanosis Agitate/combative Euphoria Impaired judgment Convulsion Delirium Stupor Coma Retinal hemorrhage Hypotension + bradycardia Sympathetic nervous system activation - compensation

Central cyanosis

Cyanosis evident in tongue and lips - an increased amount of deoxygenated Hgb in arterial blood

A diabetic patient has proliferative retinopathy, nephropathy, and peripheral neuropathy. What should the nurse teach this patient about exercise? A. "Jogging for 20 minutes 5 to 7 days a week would most efficiently help you to lose weight." B. "One hour of vigorous exercise daily is needed to prevent progression of disease." C. "Avoid all forms of exercise because of your diabetic complications." D. "Swimming or water aerobics 30 minutes each day would be the safest exercise routine for you."

D. "Swimming or water aerobics 30 minutes each day would be the safest exercise routine for you." Exercise is not contraindicated for this client, but modifications are necessary to prevent further injury. Swimming or water aerobics provides support for the joints and muscles while increasing the uptake of glucose and promoting cardiovascular health. Jogging, vigorous exercise, or no exercise would increase the pathologies of this patient.

Which client is at greatest risk for heat exhaustion? A. A 24-year-old construction worker B. A 34-year-old police officer C. A 42-year-old swimming instructor D. A 78-year-old gardener

D. A 78-year-old gardener Older adults are particularly at risk for heat-related illnesses because of decreased body fluid volume. Heat exhaustion is a condition whose symptoms may include heavy sweating and a rapid pulse as a result of the body overheating. It's one of three heat-related syndromes, with heat cramps being the mildest and heatstroke being the most severe. Older adults may also be at risk due to medications they are taking that lead to electrolyte imbalances for treatment of medical co-morbidities.The young construction worker is at risk, but is not the one at highest risk. These workers will typically have a "thirst" response and will keep hydrated as needed. The police officer is a young adult who is probably in an acceptable state of fitness. The swimming instructor may also be at risk but has the ability to cool off rapidly by getting into the water.

Which priority intervention will the nurse initiate for the patient having Kussmaul's respirations due to diabetic ketoacidosis? A. Administration of oxygen by nasal cannula at 15 L/min B. Intravenous infusion of 10% glucose C. Implementation of seizure precautions D. Administration of intravenous insulin

D. Administration of intravenous insulin The Kussmaul's respirations pattern is the body's attempt to reduce the acids produced by utilization of fat for fuel. Administration of insulin will reduce this respiration pattern by assisting glucose transport back into cells to be used for fuel instead of fat. Nasal cannula oxygen is given at 1 to 6 L per minute; intravenous glucose administration will not have the desired effect of treatment; and although seizure precautions may be implemented, they will not have any effect on glucose transport into cells.

The nurse teaches which action to the diabetic client who self-injects insulin to prevent local irritation at the injection site? A. Be sure to aspirate prior to injecting insulin. B. Massage the site after injecting insulin. C. Use a 1-inch needle for the injection. D. Allow the insulin to warm to room temperature before injecting it.

D. Allow the insulin to warm to room temperature before injecting it. Cold insulin from the refrigerator is the most common cause of irritation. Aspiration of insulin is not recommended; massaging the site can cause irritation; and a 1-inch needle is the improper size for insulin injections.

Which factor is most important in diminishing maternal/fetal/neonatal complications in a pregnant woman with diabetes? A. the women's stable emotional and psychological status B. evaluation of retinopathy by an ophthalmologist C. total protein excretion and creatinine clearance within normal limits D. Degree of glycemic control before and during pregnancy

D. Degree of glycemic control before and during pregnancy The occurrence of complications can be greatly diminished by maintaining normal blood glucose levels before and during the pregnancy. Evaluating the woman's emotional status, ophthalmic examinations, and assessment of renal status are an important part of prenatal care, but not the most important factors to reduce complications.

Which is a rapid-acting insulin with an onset of action of less than 15 minutes? A. Regular insulin (Humulin R) B. Insulin glargine (Lantus) C. Insulin detemir (Levemir) D. Insulin aspart (NovoLog)

D. Insulin aspart (NovoLog) Insulin aspart is a rapid-acting insulin. Insulin glargine and insulin detemir are long-acting insulins. Regular insulin is short acting.

The nurse is preparing a patient for a computed tomography scan using iodine contrast media. Which medication should the nurse question if prescribed one day before the scheduled procedure? A. Pioglitazone (Actos) B. Acarbose (Precose) C. Repaglinide (Prandin) D. Metformin (Glucophage)

D. Metformin (Glucophage) The concurrent use of metformin with iodinated (iodine-containing) radiologic contrast media has been associated with both acute renal failure and lactic acidosis. Therefore, metformin should be discontinued the day of the test and for at least 48 hours after the patient undergoes any radiologic study that requires the use of such contrast media.

Which insulin can be administered by continuous intravenous (IV) infusion? A. Insulin aspart (Novolog) B. Insulin detemir (Levemir) C. Insulin glargine (Lantus) D. Regular insulin (Humulin R)

D. Regular insulin (Humulin R) Regular insulin is the only insulin used for IV therapy.

The nurse identifies which priority nursing invention for a patient with hyperthermia? A. Initiating seizure precautions B. Limiting oral intake C. Providing a blanket D. Removing excess clothing

D. Removing excess clothing The priority nursing intervention would be removal of excess clothing. Seizures may occur because of a high body temperature, so decreasing heat absorption through clothing is the highest priority. Oral intake, especially of fluids, should not be limited for a patient with hyperthermia, because of the dangers of dehydration. Blanketing, like clothing, should be removed.

A diabetic patient is receiving intravenous insulin. Which laboratory results should the nurse anticipate as a potential problem? A. Serum chloride level of 90 mmol/L B. Serum calcium level of 8 mg/dL C. Serum sodium level of 132 mmol/L D. Serum potassium level of 2.5 mmol/L

D. Serum potassium level of 2.5 mmol/L Insulin activates the sodium-potassium adenosine triphosphatase (ATPase) pump, which increases the movement of potassium from the extracellular fluid into the intracellular fluid, resulting in hypokalemia. The chloride, calcium, and sodium levels are in normal parameters.

Which clinical manifestation of decreased renal function in the diabetic clinic should the nurse anticipate as a potential problem? A. Elevated specific gravity B. Ketone bodies in the urine C. Glucose in the urine D. Sustained increase in blood pressure from 130/82 mm Hg to 150/110 mm Hg

D. Sustained increase in blood pressure from 130/82 mm Hg to 150/110 mm Hg Hypertension is both a cause and a result of renal dysfunction in the diabetic client. Although ketones and glucose in the urine are findings in diabetes mellitus, they are not specific for renal function. Specific gravity is elevated with dehydration.

Which clinical manifestation indicates to the nurse a patient's hyperosmolar nonketotic syndrome (HNKS) therapy needs to be adjusted? A. Ketone bodies in the urine have been absent for 3 hours. B. Blood osmolarity has decreased from 350 to 330 mOsm. C. Serum potassium level has increased from 2.8 to 3.2 mEq/L. D. The Glasgow Coma Scale is unchanged from 3 hours ago.

D. The Glasgow Coma Scale is unchanged from 3 hours ago. Slow but steady improvement in central nervous system functioning should be seen with effective therapy for HNKS. An unchanged level of consciousness may indicate inadequate rates of fluid replacement. Ketone bodies, blood osmolarity, and serum potassium levels are consistent with improvement.

The nurse admitting a patient to the emergency room on a cold winter night would suspect hypothermia when the patient demonstrates A. increased respirations. B. rapid pulse rate. C. red, sweaty skin. D. slow capillary refill.

D. slow capillary refill. With hypothermia, there is slow capillary refill. There is an increased respiration rate with hyperthermia. The heart rate increases with hyperthermia. The skin is usually pale or cyanotic with hypothermia.

The use of drug called ____ can reverse the effects of malignant hyperthermia.

Dantrolene Sodium In an episode of MH, muscle metabolism is dramatically increased secondary to an increase in calcium within the muscle. Dantrolene is skeletal relaxant that inhibits calcium release during muscle contraction

Period of greatest environmental sensitivity

Days 17-56 after conception is the period of greatest risk

Hair and Nail Changes (pregnancy)

Decline in hair growth for some, nails grow faster but are often brittle, discolored, or grooved

Thiazide Diuretics

Decrease blood volume, renal blood flow, and CO Directly affect vascular smooth muscle Enhances other antihypertensive medications

Beta blockers

Decrease heart rate and dilate arteries by blocking beta receptors; used for high blood pressure, heart failure Vasodilation -olol

3-5 degrees

Decrease in temperature within minutes of delivery

Hypovolemia (causes)

Decreased fluid intake, diarrhea/vomit, diaphoresis, polyuria, diuretics, trauma (blood loss)

Sweating in older adults is _____.

Decreased or Absent

The third phase of a fever, known as ____ occurs as diaphoresis and flushing promote heat loss through evaporation and radiation; hypothalamus resets to euthermic level.

Defervescence

Folic Acid deficiency.

Defiency of this vitamin may cause neural tube defects. It is recommended to increase folic acid supplements at least 400 mcg.

A potential consequence of severe hyperglycemia is ___ because of a water deficit resulting from osmotic diuresis.

Dehydration

Replacing fluids and electrolytes are is essential to preventing ____

Dehydration

Cold stress complications

Depleted brown fat stores, increased O2 need, respiratory distress (priority), increased glucose consumption (hypoglycemia), metabolic acidosis, jaundice, hypoxia, and decreased surfactant

Diagnosis (of cancer)

Determine presence, extent of tumor Identify possible spread (metastasis) of disease or invasion of other body tissues Evaluate function of involved, uninvolved body systems, organs Obtain tissue, cells for analysis, including evaluation of tumor stage, grade

Tumor Staging

Determines the size of the tumor, the existence of local invasion, lymph node involvement, and distant metastasis

Pulmonary embolism

Develops when a blood-borne substance lodges in a branch of the pulmonary artery and obstructs blood flow Can consist of a thrombus, air, fat, or amniotic fluid The most common form is thromboemboli arising from deep venous channels of the lower extremities

Many medical conditions are associated with impaired glucose regulation, such as ___ and ___.

Diabetes and Metabolic Syndromes

The prevalence of neonatal hypoglycemia is also higher among infants whose mothers had ___.

Diabetes during pregnancy

___ is characterized by uncontrolled hyperglycemia, metabolic acidosis, and increased production of ketones.

Diabetic ketoacidosis (DKA)

Gestational Diabetes (Dx)

Diagnosis requires Fasting plasma glucose: 126 HbA1c: 6.5%+ Random plasma glucose: 200

Surgical Treatment

Diagnostic surgery Biopsy Tumor removal Prophylactic surgery Palliative surgery Reconstructive surgery

Adverse effects of Glucophage (Metformin)

Diarrhea, nausea, flatulence, indigestion and abdominal pain

Hypovolemia (S&S)

Diarrhea/vomit, polyuria, polydipsia, dry mouth, low BP, thready pulse, sunken eyes, ↑ HR (tachycardia), fever, weightloss, decreased urine output, concentrated dark urine, low specific gravity

DASH diet

Dietary Approaches to Stop Hypertension Grains, vegetables, fruits, low fat or fat free dairy, lean meat, fish, + poultry, nuts, seeds, and dry beans

Initial Management (gestational diabetes)

Dietary modification + glucose monitoring If hyperglycemia persists, insulin is prescribed Goals for blood glucose levels during pregnancy are 95 mg/dL (5.3 mmol/L) or less before meals and 120 mg/dL (6.72 mmol/L) or less 2 hours after meals Treatment of GDM includes close observation of mother and fetus because even mild hyperglycemia has been shown to be detrimental to the fetus

Implementing

Dietary modifications Modifications of fluid intake Medication administration IV therapy Blood and blood products replacement TPN Allaying patient anxiety as needed Appropriate patient and family teaching

Radiation

Diffusion or dissemination of heat by electromagnetic waves (60%) Varies with temperature of environment; temperature must be lower than body for heat loss to occur

Neuropathic pain

Direct consequence of a lesion or disease affecting abnormal functioning of PNS or CNS; exact cause unknown but may originate peripherally or centrally Can be short in duration but usually chronic - described as burning, electric, tingling, or stabbing

Cancer

Disease process that begins when a cell is transformed by genetic mutation of cellular DNA Metastasis Malignant, or Benign cells

Fundal height measurement

Distance in cm measured from top of pubic bone to fundus with client lying on back and knees slightly flexed; not accurate after 36 weeks

K+ sparing diuretics

Diuretic that blocks sodium reabsorption = causes K+ retention Acts on distal tubule independently of aldosterone Monitor for hyperkalemia

Chronic blood loss anemia

Does not affect blood volume but instead leads to iron-deficiency anemia with depleted iron stores It is commonly caused by gastrointestinal bleeding and menstrual disorders

Gestational Diabetes Screening

Done between 24-28 wks, unless screening is warranted during the first trimester (high-risk - obesity, >25yo, Hx of diabetes, and selected ethnic groups). -at 24-28 wks give oral 50-g glucose followed by 1 hr plasma glucose. If result is more than 130-140 mg/dL further testing is required, such as 3-hr 100 g glucose tolerance test. *Insulin resistance increases as pregnancy advances so testing at this stage yields higher rate of abnormal results.

Persons under the influence of ___ or ___ are at risk because sensory alterations affect judgment

Drugs or alcohol Alcohol also acts as vasodilator (dilation of surface blood vessels = loss of body heat)

Alpha1 blockers

Drugs that primarily cause arterial and venous dilation through their action on peripheral sympathetic neurons

Mixed insulin has a rapid onset but a longer ____.

Duration

Fasting (effects)

During fasting the pancreas releases basal insulin (small), glucagon via alpha cells released when blood glucose levels decrease This stimulates liver to release stored glucose Insulin & glucagon maintain constant level of glucose in blood by stimulating liver

Hyperglycemic Disorders (pregnancy/1st prenatal visit)

During the first prenatal visit, measure fasting blood glucose, HbA1c, or random blood glucose of all women or all high-risk women based on her risk factors, weight status, and family history Repeat at 24-28 weeks with an oral glucose tolerance test

Core rewarming must be done SLOWLY to avoid risk of ___

Dysrhythmias

Emergency IV

ER/ICU Nurses often make determination prior to written orders - Standard IV Access Only - Usually standing orders for emergencies - With experience, physician will usually back up

Apgar score

Each category is rated as 0, 1, or 2. The rating for each category is then totaled to a maximum score of 10. Normal neonates score between 7 and 10. Neonates who score between 4 and 6 require special assistance; those who score below 4 are in need of immediate life-saving support. Used 1 minute and 5 minutes after birth

Tertiary prevention

Efforts focus on monitoring for and preventing recurrence of the primary cancer as well as screening for development of secondary malignancies in cancer survivors e.g. treatments, procedures, palliative care, etc.

Chylothorax

Effusion of lymph in the thoracic cavity (chyle = milky fluid containing chylomicrons - found in lymph fluid Results from trauma, inflammation, or malignant infiltration obstructing chyle transport from the thoracic duct into the central circulation Most common cause of pleural effusion in the fetus and neonate

HHNS is more common in ___ patients and can present with glucose levels greater than 600 mg/dL.

Elderly

Radiation occurs through a process of ____ that emit heat from skin surfaces to the air.

Electromagnetic waves The degree of heat loss through radiation is directly related to the difference between ambient air temperature, skin temperature, and exposure.

AFP (Alpha-Fetoprotein Screening)

Elevated levels indicate neural tube defects

Elevated respiratory rates are seen among individuals with ___, and lower respiratory rates are seen in individuals with ___.

Elevated temperature; Hypothermia

Fever

Elevation in body temperature caused by an upward displacement of the set point of thermoregulatory center in the hypothalamus Most prominent manifestations of the acute phase response

Pulmonary Hypertension

Elevation in the pulmonary arterial pressure, it may arise as a secondary disorder associated with other disease conditions (usually cardiac or pulmonary), or as a primary disorder

Nonshivering Thermogenesis (NST)

Elevation of heat production for thermoregulation by means other than shivering. Involves increased metabolism and oxygen consumption to offset heat loss.

Centracinar emphysema

Emphysema that affects the bronchioles in central part if respiratory lobule, with initial preservation of the alveolar ducts and sacs Most common type of emphysema and seen predominantly in male smokers

Sexual identity

Encompasses a person's self-identity, biologic sex, gender identity, gender role behavior or orientation, and sexual orientation or preference

Basal Metabolism

Energy required to carry on involuntary activities of body at rest Men have a higher BMR due to larger muscle mass

Emphysema

Enlargement of air spaces & destruction of lung tissue "pink puffer"

Neutral thermal environment

Environment in which body temperature is maintained without an increase in metabolic rate or oxygen use.

Effects (cold environment)

Environmental temp decrease = increased O2 consumption, tachypnea, and increased metabolic rate

Chemical thermogenesis occurs as a result of ____ release, which increases metabolic rate

Epinephrine

Implementing Sexuality

Establish trusting nurse-patient relationship Teaching about sexuality & sexual health Promoting responsible sexual expression Considering contraception and education about options Advocating needs of patient Abortion counseling

Menopause Treatment

Estrogen therapy is most advantageous but not suitable for all Assess patient's sleep pattern, monitor for complaints of pain or discomfort Obtain vaginal smear for culture Assess genitalia, encourage patient to maintain bone health, and reduce fat and caloric intake

What is another name for blood glucose within a normal range?

Euglycemia

Physical Assessment

Examination of reproductive of genitourinary system is necessary for either male or female patients as part of a routine physical examination OR: annual women's exam, suspected STI, suspected pregnancy, workup for infertility, unusual lump, discharge, or appearance of genital organs, request for birth control, and change in urinary function

Exercise (diabetes)

Exercise 3 times a week, don't skip more than 2 days. Perform resistance training twice a week Use proper footwear, inspect feet after, and avoid when metabolic control is out of control

Guaifenesin (Mucinex)

Expectorant; P.O. q4h Increases production of RT fluids to liquefy and reduce viscosity of secretions Can cause GI upset, drowsiness, rash Should increase fluid intake Shouldn't be used for chronic/persistent cough

Male factors of infertility

Exposure to toxic substances Cigarette or marijuana smoke Heavy alcohol High temperatures exposed to genitals Obesity STIs

RN or Provider (who)

External Jugular PICC Intraosseous RNs only permitted by state & hospital regulations -- ACLS certified or Flight Nurses

What causes excessive birth weight in babies born from mothers with gestational diabetes?

Extra glucose in the bloodstream crosses over the placenta which causes the baby's pancreas to release more insulin which causes the baby to grow bigger.

The concepts _____ influence the behavioral changes needed for optimal health promotion or disease management.

Family Dynamics, Adherence, and Culture

Non-modifiable Risk Factors (heart disease)

Family history of early heart disease Age (55+) History of preeclampsia during pregnancy

Estrogen

Female hormone that promotes enlargement of genitals, uterus, breasts, and increases vascularity Relaxes pelvic ligaments and joints Associated with hyperpigmentation, and aids in forming breast ductal system for lactation

Zygote

Fertilized ovum containing genetic information provided by each parent that determines gender and influences personality, intellect, and physical + psychological traits

____ results when elevated levels of blood glucose stimulate excessive production of fetal insulin, which acts as a powerful growth hormone.

Fetal Macrosomia (large fetal size)

Remittent fever

Fever does not return to normal temperature and fluctates between a few higher and lower

Neurogenic fever

Fever with an origin in the CNS usually caused by CNS trauma, intracranial bleeding, or increase in ICP. Resistant to antipyretics and not associated with sweating.

When blood glucose levels are greater than 220 mg/dL some glucose stays in the ____ and is present in the ____.

Filtrate; Urine

Women with known prediabetes or multiple risk factors for type 2 diabetes are screened at the ___ prenatal visit

First

Follicular phase

First phase of ovarian cycle that beings on day 1 of menstrual cycle until ovulation; not consistent in time Estrogen induces growth of follicle cell and proliferation of endometrium and myometrium Luteinizing hormone causes final development and rupture of follicle FSH and LH are at their highest levels

Intermittent fever

Fluctuating fever that returns to or below baseline then rises again.

______ are affected by thermoregulation. Efficient perspiration requires adequate fluid balances.

Fluid and Electrolytes

ECF (extracellular fluid)

Fluid outside cells, includes intravascular and interstitial fluids

ICF (intracellular fluid)

Fluid withing cells - 70%

Hyperglycemia clinical manifestations

Flushed, hot, dry skin -- give insulin or oral hypoglycemic agent 3 P's, dry mouth, blurred vision, weakness, headache, dyspnea, acetone breath, drowsy, lethargic, unconsciousness Low BP, weak rapid pulse

Immediate goal (precision medicine)

Focus on preventing and curing cancers

Introversion

Focusing on oneself during pregnancy, common during early part of pregnancy and 3rd trimester May withdraw and become preoccupied with self + fetus May possibly be passive to family and participate less with outside world

____ consumption, ____ activity, and _____ levels affect the amount of heat produced.

Food; Physical; Hormone

The vascular damage to small blood vessels in the lower extremities leads to impaired blood supply to the lower extremities and peripheral vascular disease, increasing the risk of ____.

Foot ulcers and chronic wound infection (sometimes leading to amputation).

Loop diuretics

Furosemide (Lasix) Bumetanide (Bumex) Volume depletion, blocks reabsorption of sodium, chloride, and water in kidney Action rapid, potent, used when thiazides fail or pt. needs rapid diuresis

Metoclpramide (reglan)

GI stimulant -- calms the GI tract

Chemotherapy Toxicity

Gastrointestinal Hematopoietic Renal Cardiopulmonary Reproductive Neurologic Cognitive Fatigue

Cell Proliferation (malignant process)

Genetically altered cells clone and proliferate abnormally Start to evade normal intra/extracellular processes such as growth regulating and immune system defenses, abnormalities in cell signaling processes lead to cancer development --ultimately metastasis occurs

Vaginal intercourse

Genital penetration of vagina; most common position in Western cultures is missionary Period after is just as important as foreplay

Individuals living in very hot or very cold areas are at risk for poor thermoregulation due to their ___.

Geographical Location

RhoGAM

Given when mother is Rh(-): -Used to prevent development of Ab to Rh(+) RBCs when fetus may be Rh(+). -Given: -When suspected Rh(+) cells have entered maternal circulation due to spontaneous abortion or during amniocentesis. -Prophylactically at 28 weeks gestation and following birth if infant is Rh(+).

Long-acting

Glargine (Lantus, Toujeo, Basaglar) Detemir (Levemir) Degludec (Tresiba) Subcut. only, lasts 24 hours or more; used as a basal dose

2nd gen sulfonylureas

Glimepiride (DiaBeta) Glipizide (Glucotrol) Glyburide (Amaryl) 1 hour onset, may only need 1-2 doses per day Hypoglycemia most common side effect

Sulfonylureas Medications

Glipizide (Glucotrol)

An unresponsive pt has a glucose of 32 mg/dL, what would be ordered?

Glucagon

The alpha cells in islet cells secrete ___.

Glucagon

Cortisol is a type of lipid hormone that raises the blood glucose through ____.

Gluconeogenesis

Biguanides Medication

Glucophage (Metformin)

What is the preferred energy source for most cells in the body?

Glucose

Glyconeogenesis

Glycogen broken down in time of need to supply a ready source of glucose

Insulin suppresses glucagon secretion and facilitates ____.

Glycogen storage

____ is a laboratory measurement reflecting the average blood glucose reading and estimates glucose control for the prior 3 months.

Glycosylated hemoglobin (also known as HgbA1C)

Diabetes

Group of metabolic diseases characterized by increased levels of glucose in blood (hyperglycemia) due to defects in insulin secretion, insulin action, or both

Respiratory Adaptations (pregnancy)

Growing uterus and increased progesterone cause lungs to alter function during pregnancy Oxygen intake increases 20%-30% by full term Deeper + faster breathing due to less room for diaphragm which causes maternal hypocapnia

Uterus Adaptations

Grows at a steady predictable rate via estrogen stimulation, weight increases, capacity increases from 10 milliliters to 5,000 milliliters, walls thin, blood vessels elongate + dilate and sprout new branches Shape changes from pear to solid globe in 1st trimester and then expands to hollow vessel

Fetus growth

Growth and development stages are orderly and continuous including pre-embryonic, embryonic, and fetal stages

Increases BMR

Growth, infection, fever, emotional tension, extreme environmental temperatures, and elevated levels of certain hormones (thyroid + epinephrine)

GI System Adaptations (pregnancy)

Gums swell and become friable, saliva becomes more acidic and some women experience ptyalism, dental plaque increases, bloating and constipation may occur due to increased progesterone, heartburn, morning sickness

Pelvic shapes

Gynecoid Anthropoid Android Platypelloid

AIDS

HIV virus; fatigue, diarrhea, weightloss, enlarged lymph nodes, fever, anorexia, night sweats, common in IV drug users and homosexuals

Currently, there are at least 40 known genetic markers, including ___ genes, associated with the risk of diabetes.

HLA

0.45% NaCl

Half normal saline; hypotonic solution used to maintain fluid intake

Hypertonic solution

Has a greater osmolarity, causing water to move out of the cells and to be drawn into the intravascular compartment, causing the cell to shrink.

Ethics

Healthy sexuality depends on freedom from guilt and anxiety; what one person views as wrong may be the opposite for another person

Blood flow (through a vessel depends on)

Heart creating pressure difference between ends of the vessel -Heart pushing the blood through - Blood pressure keeping the vessels open

Cardiovascular Adaptations (pregnancy)

Heart rate increases 25% or 10-15 beats per minute Cardiac output increases Blood volume dramatically increases Increased plasma volume may lead to physiologic anemia Blood pressure slightly decreases during 2nd trimester

2 Apgar Score

Heart rate: >100bpm Respiratory effort: good, crying Muscle tone: active motion Reflex irritability: Vigorous cry Color: pink

1 Apgar Score

Heart rate: Slow (<100) Respiratory effort: slow, irregular Muscle tone: some flexion of extremities Reflex: weak cry/grimace Color: body pink, blue extremities

0 Apgar Score

Heart rate: absent Respiratory effort: absent Muscle tone: flaccid Reflex irritability: no response Color: blue pale

____ occurs as a result of multiple mechanisms, including radiation, conduction, convection, vasodilation, evaporation, reduced muscle activity, and increased respiration

Heat Loss

ii. If untreated, heat exhaustion can lead to ___, which is a true emergency condition that has a very high mortality rate

Heat stroke

Adrenal glands (as part of homeostasis)

Help the body conserve sodium, save chloride and water, and excrete potassium

Alpha Thalassemia

Hemolytic anemia including a defective gene for alpha chain synthesis 1-4 defective genes Affects both fetal & adult Hb In fetus, gamma 4 Hb may form; in adult beta4 Hb may form More common in asians

Beta Thalassemia (Mediterranean anemia)

Hemolytic anemia including a defective gene for beta chain More than 100 different mutations Affects only adult Hb Alpha4 Hb may form

Membrane disorders

Hemolytic anemias that include hereditary spherocytosis, hemolytic disease of the newborn, and acquired hemolytic anemias

What is hyperglycemia?

High blood glucose levels Greater than 100 mg/dL in the fasting state Greater than 140 mg/dL 2 hours postprandial

Secondary hypertension

High blood pressure caused by the effects of another disease

Primary hypertension

High blood pressure, the cause of which is unknown; also known as essential hypertension 95% of all hypertension - often asymptomatic and called the silent killer

Heat exhaustion S&S

High temperature accompanied by headache, anxiety, syncope, profuse diaphoresis, goose flesh, and orthostasis

Brown fat

Highly vascular specialized fat able to convert chemical energy directly to heat via SNS Produced in 3rd trimester Capable of intense metabolic activity

The ___ population is particularly at high risk for hyper- and hypothermia.

Homeless

____ is shown as a close interrelated concept because of the significant influence that hormones have on the regulation of glucose.

Hormonal Regulation

epineprhine and norepinephrine

Hormones released to alter metabolism when additional heat is required to maintain temperature

Menopause signs and symptoms

Hot flashes, interrupted sleep, night sweats, dyspareunia, vaginal dryness, itching/burning vulva, weight gain, insomnia, mood swings, libido changes, skipped periods, most women 48-55 years old Possible osteoporosis -- take calcium Increased risk for CVD

120 Days

How long do RBCs live?

1 in 6

How many American women have been victims of attempted or completed rape in her lifetime?

Rapid acting insulin

Human Lispro (Humalog) Insulin Aspart (Novolog) Insulin Glulisine (Apidra)

Short acting

Humulin R, Novolin R Regular insulin - can be given IV (lasts 4 hours) subcut lasts 13-24 hrs Should eat within 20-30 minutes after taking

___ leads to osmotic diuresis with dehydration and electrolyte loss.

Hyperglycemia Closely assess the patient's FLUID AND ELECTROLYTE BALANCE. Assess for acute weight loss, thirst, decreased skin turgor, dry mucous membranes, and oliguria with a high specific gravity. Assess for weak and rapid pulse; flat neck veins; increased temperature; decreased central venous pressure; muscle weakness; postural hypotension; and cool, clammy, and pale skin to determine if the patient is at risk for dehydration.

Symptoms of Cushing's syndrome

Hyperglycemia, elevated blood pressure, hypokalemia, central fat distribution, dark purple striae, ruddy facial complexion, hirsutism, weight gain, easy bruising, and muscle weakness.

The pancreas overproduces insulin to compensate for reduced cellular glucose update, resulting in ____.

Hyperinsulinemia

Hyperkalemia "HEAD LICE"

Hyperkalemia Elevated Potassium Abdominal cramping Dysrhythmia Lower extremity weakness Irritability Cardiac Arrest ECG changes

____ is a state characterized by hyperglycemia, hyperosmolarity, and dehydration without acidosis.

Hyperosmolar Hyperglycemic Nonketotic Syndrome (HHNS)

Hyperinsulinemia causes ___ through its role in reducing elasticity of blood vessels

Hypertension

Chronic hyperglycemia further damages medium and larger blood vessels, leading to ____.

Hypertension and cardiovascular and peripheral vascular disease

Cardiovascular disease (sexuality)

Hypertension medications may change sexual functioning, especially beta-blockers After a myocardial infarction, sexual activity needs to wait for 3 months and then gradually increase

Hyperthermia vs. Fever

Hyperthermia: abnormal temperature regulation, but set point unchanged Fever: normal thermoregulatory system, but at a higher set point

Chronic hypoglycemia leads to the condition of ___ in which the counterregulatory hormonal response is blunted, describing a state of autonomic failure.

Hypoglycemia unawareness This includes diabetes neuropathy and other symptoms of gastroparesis with associated symptoms of early satiety, poor food absorption, constipation, fecal incontinence, and diarrhea.

____ establishes a set point for core body temp

Hypothalamus

Urban hypothermia

Hypothermia associated with high mortality rate especially in older adults, infants, people with concurrent illnesses, and those who are homeless

Causes of Respiratory Failure

Hypoventilation, ventilation/perfusion mismatching, impaired diffusion

Intraosseous Access

IV access into the bone, used as last resort in emergencies Physician/Paramedic or certified RN initiated 24 hr use or less

Nursing Assessments

Identify patients at risk for imbalances. Determine that a specific imbalance is present and its severity, etiology, and characteristics. Determine the plan of care, nursing diagnoses or collaborative problems. Identify specific outcomes and associated interventions. Determine effectiveness of the plan of care.

Unconjugated bilirubin

If RBC's breakdown is greater than bilirubin removal Causes jaundice

Promote Self-Care: Immunizations

If client comes for preconception visit discuss immunizations such as MMR, Hep B, & diphtheria and tetanus. -Routine immunizations are not usually indicated during pregnancy. However, there is no evidence of risk from vaccinating pregnant women with INACTIVATED virus or bacterial vaccines or toxoids. -Women should avoid LIVE virus vaccines (MMR and varicella. Should also avoid becoming pregnant w/i 1 month of receiving one of those vaccines.

Preterm labor symptoms

If woman experience menstrual-like cramps q10min, accompanied by low, dull backache, she should stop what she's doing and lie on her left side for 1 hr. if symptoms do not subside, she should contact health care provider.

Those with ____ are at risk for imbalanced temperature because of the potential inability to recognize dangerous environmental exposures or the inability to react appropriately

Impaired Cognition

Nursing Management in HSCT

Implementing pretransplantation care Providing care during treatment: care for recipients and donors Hyperthermia

How does HHS differ from DKA?

In HHS ketone levels are absent or low and blood glucose levels are much higher

Cultural considerations (infertility)

Inability to conceive may be considered a violation of cultural norm and represent a crisis

Immunizations to be considered (pregnancy)

Inactivated influenza, Hepatitis B, TdAP, and Rabies

Infiltration

Inadvertent leakage of IV solution into surrounding tissue Swelling, pallor, coldness, pain, decrease in flow rate

Changing Nutritional Needs (pregnancy)

Increase 300 calories over normal intake, prenatal vitamins, take iron and folic acid; protein intake should be 80g a day Skip processed foods; eat 2 servings of low mercury fish per week 2 quarts of water daily Do not skip meals - 3 meals with 1 or 2 snacks Limit caffeine intake

Fever Tx

Increase comfort and prevent complications. Administer any ordered antibiotics or antivirals Antipyretics may be used Modify external environment: cool sponge baths, cool packs, hypothermia blankets Increase oral fluids (3L/day) and add simple carbs

Breast Adaptations

Increase in fullness, become tender, and grow larger due to estrogen and progesterone Become highly vascular, nipples become harder and deeply pigmented, tubercles of Montgomery become more prominent to keep nipples lubricated Colostrum can be expressed by 3rd trimester

Pink puffers (emphysema)

Increase respiration to maintain oxygen levels Dyspnea; increased ventilatory effort Use accessory muscles; pursed-lip breathing

Peripheral vasodilation in infants leads to ___ insensible fluid loss.

Increased Sweating may occur but is often delayed because sweat glands are immature.

Polycythemia

Increased RBC count and hematocrit greater than 50% Relative polycythemia: loss of plasma volume Absolute polycythemia: increased red cell mass --Primary: neoplastic --Secondary: increased erythropoietin

Renal Adaptations (pregnancy)

Increased blood flow to kidneys and renal pelvis dilates Each increases in length and weight, ureters elongate, widen, and become more curved, the right especially. Increases risk for UTI

Ovarian Adaptation

Increased blood supply causes them to enlarge until about 12-14 weeks of pregnancy; very active in hormone production until placenta takes over major production of progesterone

Fever (pyrexia)

Increased body temperature caused by pyrogens to increase thermoregulatory set point in hypothalamus or by chemicals

Small for gestational age and premature infants are at risk of hypoglycemic states because of ____.

Increased energy needs and insufficient glycogen stores

Blood volume (pregnancy)

Increases approximately 1,500 milliliters or 50% higher than non-pregnancy levels Directly correlates with fetal weight to provide adequate hydration and compensate for blood loss after birth

Thyroid gland (as part of homeostasis)

Increases blood flow in the body and increases renal circulation

Meth abuse (pregnancy)

Increases the probability of congenital anomalies, prematurity, low birth weight, and drug withdrawal symptoms Decreases fetal blood flow and oxygenation May feed poorly, be jittery, irritable, and intolerable to cuddling

Sick or preterm infants have weaker muscle tone and are unable to maintain flexed position, ____ heat loss

Increasing

Primary atelectasis

Infant's lung fails to expand at birth Seen in premature & high risk infants

When ___ is present, physical symptoms often include fever and chills.

Infection

Monitoring & Managing Potential Complication

Infection Septic shock Bleeding, hemorrhage

Bronchiectasis

Infection and inflammation destroy smooth muscle in airways, causing permanent dilation

Mechanisms of COPD

Inflammation and fibrosis of the bronchial wall Hypertrophied mucous glands lead to excess mucus that causes obstructed airflow Loss of alveolar tissue leads to decreased surface area for gas exchange Loss of elastic lung fibers leads to airway collapse, obstructed exhalation, & air trapping

Pleuritis

Inflammation of pleura; causes unilateral pain that is abrupt in onset and exaggerated by respiratory movements Made worse by deep breathing and coughing - tidal volumes kept small & breathing becomes more rapid NSAIDs may reduce inflammation but not discomfort with deep breathing or coughing

Immunizations Contraindicated (pregnancy)

Influenza, Measles, Mumps, Rubella, Varicella, BCG, Meningococcal, and Typhoid vaccines

Sources of Fluids

Ingested liquids = 1,300 mL Food = 1,000 mL Metabolic oxidation = 300 mL Total about 2,000 mL/day

Nervous system (as part of homeostasis)

Inhibits and stimulates mechanisms influencing fluid balance

Shivering

Initiated by impulses from hypothalamus that can cause body temperature to increase 3-5 times; increases heat production by muscles Contraction of pilomotor muscles reduces surface area available for heat loss

Injection (Depo-Provera)

Injectable progestin that inhibits ovulation that has a duration of 3 months

When do you administer fast acting insulin?

Injected at the beginning of a meal.

Endoderm

Inner germ layer that becomes repsiratory system, digestive systemm, liver, and pancreas

Endoderm

Inner layer of zygote that becomes the respiratory system, digestive system, liver, and pancreas

Gluconeogenesis is required if blood glucose and glycogen stores are ____.

Insufficient and can also occur with stress conditions, or from use of steroid medications, with resulting increased risk of loss of muscle mass.

Hypoglycemia occurs as a result of ___.

Insufficient nutritional intake, adverse reaction to medications, excessive exercise, and/or as a consequence of disease states

Hyperglycemia occurs as a result of insufficient ___ production or secretion

Insulin

___ is the only hormone produced that lowers elevated BG levels after carbohydrate intake.

Insulin

Secretagogues

Insulin Stimulator: Lowers BG levels by triggering the release of preformed insulin from beta cells

Elevated cortisol levels also exacerbates ____.

Insulin resistance

Persons with a family history of type 2 diabetes, obesity, or factors associated with metabolic syndrome are at increased risk of ___ and ___.

Insulin resistance and type 2 diabetes.

Acanthosis nigricans is a physical exam finding frequently seen in individuals who are ___.

Insulin resistant

Although there are too many to list, some of the most common medications that can affect glucose regulation are:

Insulin, oral hypoglycemic agents, corticosteroids, estrogen, ACE inhibitors, β-blockers, potassium-depleting diuretics, bronchodilators, antipsychotics, and many antibiotics.

Contraception

Intentionally preventing pregnancy from occurring Most common in U.S. are oral contraceptives, female and male sterilization.

Short acting insulin may be combined with ____.

Intermediate acting insulin

___ fever is associated with spikes interspersed with a return to normal temperature levels at least once within 24 hours.

Intermittent

Because the hypothalamus regulates body temperature, _____ is closely associated with thermoregulation. Traumatic brain injury, with its associated cerebral edema, ischemia, energy failure, oxidative stress, and neuronal death, may directly affect the temperature control center.

Intracranial Regulation

Fluid imbalances

Involve either volume or distribution of water or electrolytes

Convection

Involves flow of heat from body surface to cooler surrounding air i.e. near cool drafts Use clothing/blankets to reduce exposure and work in warm areas

Sexuality

Involves how a person exhibits and experiences maleness or femaleness physically, emotionally, and mentally

Hypothyroidism

Iodine deficiency during pregnancy may produce

Electrolytes

Ions -Cations: positive charge -Anions: negative charge

Iron cycle

Iron (Fe) is also recycled made possible by the plasma carrier, transferrin.

Deficient RBC Anemias

Iron deficiency anemia Megaloblastic anemias: -Cobalamin (vit. B12) deficiency -Folic acid deficiency Aplastic anemias (bone marrow depression) Chronic disease anemias -chronic inflammation -chronic renal failure

Hypoproliferative anemia Types

Iron deficiency, b12 deficiency, folate deficiency, decreased erythropoietin productio, and cancer/inflammation

Checking blood glucose which of the following characterize hypoglycemia?

Irritability, cool pale clammy skin, slurred speech

The pancreas contains clusters of cells called ____ that produce hormones.

Islet cells

The endocrine portion of the pancreas has about 1 million small glands scattered through the organ called ___.

Islets of Langerhans

Risk Factors for Adverse Pregnancy Outcomes

Isotretinoins Alcohol misuse Anti-epileptic drugs Diabetes (preconception) Folic acid deficiency HIV/AIDS Hypothyroidism Maternal phenylketonurea Rubella seronegativity Obesity Oral anticoagulant STI Smoking

Insulin is secreted daily directly into liver circulation during which two-step manner?

It is secreted at low levels during fasting (basal insulin secretion) and in a two-phase release after eating (prandial).

When stored fat is used for energy, ___ bodies (small acids) provide a backup energy source.

Ketone

Urine Ketone Test

Ketones are by-products of fat metabolism (triglycerides), acetoacetic acid, acetone, and b-hydroxybutyric acid Abnormal: ketones present in urine, indicating carb dehydration, which may suggest DKA, starvation, or a metabolic complication of TPN and can occur with high-fat diets, prolonged vomiting, or diarrhea

Are ketones found in HYPO or HYPERglycemia?

Ketones are positive in hyperglycemia

Nursing Management (Preconception Care)

Key areas of preconception care include determining: Immunization status, underlying medical conditions, reproductive health data, STIs, sexuality and practices, nutrition, psychosocial issues, medication and drug use, and support system

___ impairment in HHS allows for extremely high blood glucose levels.

Kidney

Primary organs of homeostasis

Kidneys, cardiovascular system, lungs, adrenal glands, pituitary gland, thyroid gland, nervous system, parathyroid glands, and GI tract

Fluid losses

Kidneys: urine = 1,500 mL Intestinal tract: feces = 200 mL Skin: perspiration = 600 mL Lungs = 300 mL Insensible water loss Total about 2,000 mL/day

Trick to Remember Long-Acting Insulins

LLong 1. Insulin Glargine (Lantus) 2. Insulin Determir (Levemir) "The two long nursing shifts never peaked but lasted 24 hours." Onset: 2 hours Peak: NONE Duration: 24 hours

Blood vessel size

Large vessels = low BP and easier flow Smaller vessels = high BP and harder flow

Fetal stage

Lasts from 9 weeks to birth, all body organs and systems continue to grow and develop

Fetal alcohol syndrome (risk)

Leading cause of birth defects include: Growth retardation, developmental delay, and impaired intellectual ability.

Low birth weight

Leading cause of infant death during first month of life

Infiltration

Leaking of fluid from vein

Hypotonic

Lesser concentration of particles than plasma -used to maintain fluid intake, 0.45% NaCl

Hypermagnesemia "LETHARGIC"

Lethargy EKG changes, prolonged PR & QT Tendon reflex absent/diminished Hypotension Arrhythmia; Bradycardia Respiratory Arrest GI issues (N&V) Impaired breathing due to skeletal weakness, impaired swallowing Cardiac arrest

Hypokalemia "The 8 L's"

Lethargy Low, shallow respirations Lethal Cardiac dysrhythmias Lots of vomiting/nausea Low reflexes Leg cramps Limp muscles Low BP&HR

Risk Factors

Lifestyle choices: smoking, drinking, diet, exercise, stress Comorbidities: Stroke, organ failure, heart disease, renal failure/disorders Genetics: highest risks are male African Americans

Trick to Remember Short-Acting Insulins

Lin is a short lady... 1. HumuLIN R 2. NovoLIN R (both SHORT acting insulins) "Short-staffed nurses went from 30 patient to (2) 8 patients." Onset: 30 minutes Peak: 2 hours Duration: 8 hours

Parietal pleura

Lines the thoracic wall and superior aspect of the diaphragm

Solvents

Liquids that hold a substance in solution (water)

Rapid-acting

Lispro (Humalog) Aspart (Novolog) Glulisine (Apidra) Inalational - Afrezza Can be given IV - usually to treat postprandial hyperglycemia and lasts 5 hours or less

Physical effects (fever)

Loss of appetite Headache Hot/dry skin Flushed face Thirst Fatigue Muscle aches Tachypnea + tachycardia Seizures (young) Confused (older)

Radiation

Loss of body heat to cooler, solid surfaces that are in proximity but not in direct contact with the newborn Keep cribs/isolettes away from outside walls, cold windows, and A/C units

Evaporation

Loss of heat when liquid is converted to a vapor Dry immediately after birth and baths and change any wet linens/clothes promptly

Angiotensin II Receptor Blockers (ARBs)

Lower blood pressure by blocking the angiotensin II enzyme from causing vasoconstriction

Biguanides MOA

Lowers BG levels by increasing use of glucose by muscle and fat cells, inhibiting hepatic glucose production, decreased intestinal absorption, increases glucose sensitivity

Acute Respiratory Failure

Lungs fail to oxygenate the blood adequately or prevent inappropriate retention of CO2 Treatment is directed toward treatment of the underlying disease, maintenance of adequate gas exchange and tissue oxygenation, and general supportive care

Osmosis

MAIN method of transporting body fluids; water passes from an area of lesser solute concentration to greater concentration until equilibrium is established (low --> high)

Labeling the Specimen

MUST Have: Patient Name Account Number Birthdate Today's Date Time of Draw Your Initials

Expected Outcomes

Maintain approximate fluid intake and output balance (2,500-mL intake and output over 3 days). Maintain urine specific gravity within normal range (1,010-1,025). Practice self-care behaviors to promote balance.

Iron Balance

Maintained by the absorption of 0.5 to 1.5 mg daily to replace the 1 mg lost in the feces - when RBCs are broken down their iron is released and reused in production of new RBCs

Graft vs host

Major cause of morbidity and mortality in the allogenic transplant population Occurs when donor lymphocytes initiate an immune response against recipients tissues during the beginning of engraftment To prevent GVHD, patients receive immunosuppressant drugs, such as cyclosporine May be acute (100 days) or chronic (after 100 days)

What is glycogen?

Major form of stored glucose, primarily in the liver and muscle cells.

Buffer systems

Major homeostatic regulators of hydrogen ions: - Carbonic acid-sodium bicarbonate - Phosphate - Protein

The risk for heat and cold related deaths are twice as high for ___.

Males

Carcinogenesis

Malignant transformation -- 3 step process Initiation Promotion Progression

True

Malignant tumors spread by way of blood and lymph channels to other areas of the body True or false?

Coitus Interuptus/Withdrawal

Man withdraws before ejaculation, failure rate of 27%

Vascular Related Skin Changes

Manifested by varicosities on the legs, vulva, and perineum Women should: elevate legs, avoid prolonged sitting or standing, rest side-lying Others include: vascular spiders, and palmar erythema

Nuchal Translucency Screening

Marker for chromosomal abnormalities, and is associated with a wide spectrum of structural abnormalities, genetic syndromes, and high risk abortion and fetal death. -Ultrasound is used to identify and increase in nuchal (neck) translucency, which is due to the subcutaneous accumulation of fluid behind the fetal neck. -Fetal translucency is associated with chromosomal abnormalities such as trisomy 21, 18, and 13. Infants with trisomies tend to have more collagen and elastic connective tissue allowing for accumulation.

Chvostek's Sign

Masseter spasm when cheek is tapped, associated with hypocalcemia

Ovulation

Mature follicle ruptures in response to LH surge, releasing mature oocyte on about day 14 of cycle Cervix produces thin slippery mucus to catch sperm and nourish it 14 days before menstruation

PICC (peripherally inserted central catheter)

May be inserted by RN (certified or permitted) Ultrasound Guidance Incision in arm Moderate time frame use (2 weeks to 6 mos) Used to: chemo, poor vascular access, draw blood

Doppler Flow Studies

May be used to measure the velocity of blood flow via ultrasound. -The velocity of the fetal RBCs can be determined by measuring the change in the frequency of the sound wave reflected off the cells. -IN pregnancies complicated by hypertension or FGRs diastolic blood flow may be absent or even reversed. -Doppler studies may be used to evaluate blood flow through fetal blood vessels, such as the aorta and those in the brain.

diaphragm with spermicide

Mechanical contraception that is a shallow latex cup with spring mechanism; must leave in place for 6 hours, clean, inspect and check sizing

Supportive care (hypothermia)

Mechanical ventilation with PEEP and heated + humidified O2 Warmed IV fluids Sodium bicarbonate Antiarrhythmic meds Catheter insertion Over-the-bed heaters to extremities Forced air warming blankets

What is an antipyretic?

Medication used to reduce a fever

Vasodilators

Medications that cause dilation of blood vessels

Vasodilators

Medications that cause vasodilation and some decrease peripheral resistance along with relaxing smooth muscles

Gonorrhea "The clap"

Men experience purulent penile discharge, dysuria, and polyuria Women experience dysuria, abnormal menses, vaginal discharge, PVD Can cause blindness in infants via birth May lead to infertility, rash, lesions, and arthritis

Untreated hyperglycemia result in what?

Metabolic acidosis

Heat is produced through _____ in the cells.

Metabolic activity (chemical reactions) Metabolic activity involves the ingestion and metabolism of food and the basal metabolic rate

DKA

Metabolic derangement that occurs most commonly in persons with type 1 diabetes and results from a deficiency of insulin; highly acidic ketone bodies are formed, and metabolic acidosis occurs DKA is commonly preceded by a day or more of polyuria, polydipsia, nausea, vomiting, and fatigue with eventual stupor and coma if not treated Breath has a characteristic fruity odor due to the presence of ketoacids

Biophysical Profile (BPP)

Method for evaluating fetal status during the antepartum period based on five variables originating with the fetus: fetal heart rate, breathing movements, gross body movements, muscle tone, and amniotic fluid volume.

Mesoderm

Middle germ layer that becomes skeleton, connective tissue, circulatory system, lymphoid, reproductive, and urinary systems

Mesoderm

Middle layer of zygote that becomes the skeleton, CT, cartilage, muscles, circulatory, lymphoid, reproductive, and urinary systems

Administering Meds

Mineral-electrolyte preparations Diuretics Intravenous therapy

nonelectrolyte

Molecules in the body's chemical compounds that remain intact

Neonate reflexes

Moro, stepping, grasp, hand to mouth, sucking, swallowing, blinking, sneezing, yawning

Nonstress Test (NST)

Most common method of prenatal testing used in practice that provides indirect measurement; usually fetal heart rate increases with fetal movement Recommended twice weekly in high risk pregnancies Encourage woman to eat meal to stimulate activity

Nonexertional heat stroke

Most common type of heat stroke, usually in environmental temp of 102.5+ (heat index 95+) in those that are older, very young, not acclimatized, and certain medications.

Respiratory & Circulation

Most important physiologic adjustments after birth

Chlamydia (NGU)

Most prevalent STI in U.S., vaginal discharge, burning upon urination, urinary frequency, dysuria, Many women are asymptomatic

Oral Glucose Tolerance Test (OGTT)

Most sensitive method of evaluating borderline cases of diabetes mellitus, monitors plasma glucose levels 2 hrs. after ingestion of a challenge dose of glucose to assess insulin secretion and the body's ability to metabolize glucose

Heat stroke

Most serious, acute medical emergency caused by failure of heat-regulating mechanisms of body Inability to maintain cardiac output and associated with dehydration Usually occurs in extended heat waves, esp. with humidity Causes thermal injury at cellular level. Thick blood = damage to heart, liver, and kidneys

The contraction of muscles produces heat through _____ and _____.

Muscle Tone; Shivering

Heat cramps S&S

Muscle cramps with profound diaphoresis, and thirst

The greatest amount of heat is produced by the ____ and through metabolic activity in the ____

Muscles; Liver

Trick to Remember Intermediate-Acting Insulins

N=Ntermediate 1. NPH 2. Humulin N 3. Novolin N "Nurses Play Hero to (2) eight 16 year olds." Onset: 2 hours Peak: 8 hours Duration: 16 hours

Intermediate acting

NPH (Humulin N, Novolin N) CLOUDY Usually given after food, duration up to 24 hours Subcut. only

Process for Mixing Insulins

NPH can be mixed with regular and rapid acting insulins. This is done by first drawing up the clear insulin to a syringe (regular or rapid-acting insulin) and then drawing up the cloudy insulin (NPH). In a mix, the first number is the % of the long-acting intermediate insulin (N also written as NPH, or aspart protamine or lipsor protamine), followed by the % of the shorter-acting insulin (R, for regular or rapid acitng aspart for lispor) Ex. Humulin 70/30 contains 70% NPH and 30% regular insulin. They are named after the regular or rapid-acting insulin (ex. Novlog 70/30 contain 70% insulin aspart protamine and 30% insulin aspart.

Antipyretic Medications

Naproxen (Aleve) Ibuprofen (Motrin) Acetaminophen (Tylenol) Aspirin is also useful for reducing fever but should be used with caution; aspirin is not recommended for children because of the risk of Reye's syndrome.

Chloraprep

National Standard to clean IV sites Mandatory for Central Line Dressing Changes Mandatory for Port Dressing Changes and Access

Adverse effects of Glipizide (Glucotrol)

Nausea, headache, weight gain; hypoglycemia, hyponatremia, APLASTIC ANEMIA

Biopsies

Needle, excisional, and incisional

Hypoglycemia is generally attributed to ______ that occurs in response to elevated glucose levels in utero.

Neonatal hyperinsulinemia

The ___ system is dependent on glucose for energy needs.

Neurologic

Emphysema

Neutrophils in the alveoli secrete trypsin; increased amounts of neutrophils due to inhaled irritants can damage alveoli α1-antitrypsin inactivates the trypsin before it can damage the alveoli -- genetic defect in α1-antitrypsin synthesis leads to alveolar damage.

Conserving heat (newborn)

Newborn attempts via increasing metabolic rate, increasing muscular activity, vasoconstriction, and assuming fetal position

Cold stress S&S

Newborn esp. at risk 12 hours after birth, greatest risk are preterm newborns As temp lowers newborn becomes less active, lethargic, hypotonic, and weaker

____ do NOT have heat-conserving capacity.

Newborns

Sexual Activity not permissible (pregnancy)

No Sex if history of: Vaginal Bleeding Placenta previa Risk of preterm labor Cervical insufficiency Premature membrane rupture Presence of infection

Can long-acting insulin be mixed?

No, it cannot be mixed with other insulin

Prodomal period (fever)

Nonspecific complaints such as mild headache and fatigue

Fetal Heart Rate

Normal fetal heart rate is 110-160 bmp.

Sodium

Normal levels: 135-145 mEq/L, MAIN electrolyte in ECF Controls and regulates volume of body fluids: blood pressure, blood volume & pH balance Role in muscle contraction, nerve impulse transmission, and acid base balance

Potassium

Normal levels: 3.5-5.0 mEq/L - MAIN ICF cation Regulated by aldosterone Chief regulator of cellular enzyme activity and water content Functions = heart & muscle contraction Acid base regulator + eliminated via kidnets

25-35 pounds

Normal weight women, BMI of 18.5-24 should gain this many pounds while pregnant

Amniotic Fluid: Glucose

Normal: < 45 mg/dL Abnormal: Excessive increases at term or near term indicate hypertrophied fetal pancreas and subsequent neonatal hypoglycemia.

Amniotic Fluid: Creatinine

Normal: > 2 mg/dL in mature fetus. Abnormal: decrease may indicate immature fetus < 37wks.

Amniotic Fluid: Acetylcholinesterase

Normal: Absent Abnormal: Presence may indicate neural tube defects, exomphalos, or other serious malformations.

Amniotic Fluid: Bilirubin

Normal: Absent at term. Abnormal: High levels indicate HDN in isoimmunized pregnancy.

Amniotic Fluid: Meconium

Normal: Absent, except in breech presentation. Abnormal: Indicates fetal hypotension or distress.

Amniotic Fluid: Bacteria

Normal: Absent. Abnormal: Presence indicates chorioamnionitis.

Amniotic Fluid: Color

Normal: Clear with white flecks of vernix caseosa in mature fetuses. Abnormal: "Port wine"- fluid may indicate abrubtio placentae. Fetal blood may indicate damage to the fetal, placental, or umbilical cord vessels.

Amniotic Fluid: Lecithin-to-sphingomyelin ratio (L/S ratio)

Normal: More than 2 indicates fetal pulmonary maturity. Abnormal: < 2 indicates pulmonary immaturity and subsequent pulmonary distress.

Amniotic Fluid: Chromosomes

Normal: Normal karyotype Abnormal: Abnormal karyotype may indicate fetal sex and chromosome disorders.

Amniotic Fluid: Phosphatidylglycerol

Normal: Present Abnormal: Absence indicates pulmonary immaturity.

Amniotic Fluid: Alpha-fetoprotein

Normal: Variable, depending on gestational age. Highest concentration occurs at 13-14 wks. Abnormal: Inappropriate increases indicate neural tube defects such as spina bifida or anencephaly, impending fetal death, congenital nephrosis, or contamination of fetal blood.

Kidneys (as part of homeostasis)

Normally filter 170 L of plasma and excrete 15 L of urine

Assessment: Head and Neck

Note any edema of the nasal mucosa or hypertrophy of gingival tissue in the mouth. These are typical responses to increased estrogen levels in pregnancy.

Which mixed insulin is the only one that can be combined with other insulin?

Novolog Mix

Abortions

Number of pregnancies ending before 20 weeks

Parity

Number of pregnancies, not the number of pregnancies (e.g., twins), carried to the point of viability, regardless of the outcome.

Preterm births

Number of preterm pregnancies ending after 20 weeks and before 37 weeks

Term births

Number of term gestations delivering at 38-42 weeks

Gravidity

Number of times a woman has been pregnant.

Para

Number of times given birth of fetus 20+ weeks, viable or not; multiple births count as 1 event

Pregnancy and Sexuality

Numerous changes, possibly stressing sexual relationship Changes in sexual desire with each trimester: 1st & 3rd may be too uncomfortable, 2nd often increases libido Sexual health and link to self-image

Parameters of Assessment

Nursing history and physical assessment Fluid intake and output Daily weights Laboratory studies

Malnutrition increases risk for hypothermia because of an inability to generate adequate heat. For this reason, ____ is interrelated with thermoregulation.

Nutrition

Nutritional Therapy

Nutrition, meal planning, weight control, and increased activity are the foundation of diabetes management

Proper ____ and regular physical activity (___) are needed for optimal regulation of glucose concentration and management of conditions in which regulatory mechanisms are impaired.

Nutrition; Mobility

Promoting nutrition (nursing care of pt with cancer)

Nutritional impairment Anorexia Malabsorption Cancer-related anorexia-cachexia syndrome

Screening of gestational diabetes

Obesity Personal gestational diabetes Hx Glycosuria Strong family Hx of diabetes Ethnic groups at risk: Hispanic Americans, Native Americans, Asian Americans, African Americans, and Pacific Islanders. If these women are not positive at first screening should be retested between 24-28 weeks of gestation

Risk factors for Gestational Diabetes Mellitus (GDM) include:

Obesity, past history of GDM, age older than 25 years, and family history of type 2 diabetes.

Probable Signs

Objective or physical signs detected on examination Physical signs include: Hegar's sign, Goodell's sign, Chadwick;s sign, ballottement, and abdominal enlargement Pregnancy tests indicate higher levels of hCG

Care Providers

Obstetrician: 4-year residency on top of med school. handle high-risk pregnancies and delivery emergencies; administer & order pain-relief meds. Family practice Dr. can also provide maternity, woman's care, and well-baby care. -Midwifes: Graduate degree required. Usually care for low-risk women in variety of settings. Able to write prescriptions, provide prenatal care, childbirth care, postpartum care, newborn care and well-baby care. Work in hospitals, birthing centers, and home settings. -Doula: "Woman's servant." A laywoman trained to provide encouragement, emotional, and physical support, and information through late pregnancy, labor, birth, and postpartum. DO NOT perform any clinical procedures.

Chronic obstructive bronchitis

Obstruction of small airways

adaptive sexual behaviors

Occur in private between two consenting adults, and are satisfying and not forced upon each other

Acid-Base Imbalances

Occur when carbonic acid or bicarbonate levels become disproportionate

Acceptance

Occurs during second trimester due to physical changes of growing fetus and bring reality of [pregnancy She becomes able to identify fetus as a separate individual and accepts this Many will verbalize positive feelings about pregnancy

Embryonic stage

Occurs from 4th to 8th weeks; Rapid growth and cell layer differentiation take place All basic organs established, bones ossify, and some features are recognizable by the end Especially vulnerable to any factor that might cause congenital anomalies

Peripheral cyanosis

Occurs in the extremities and on the tip of nose or ears - caused by slowing of blood flow to an area of the body with increased extraction of oxygen from the blood Results from vasoconstriction and diminished peripheral blood flow - e.g. cold exposure, shock, heart failure, or PVD

quid pro quo harassment

Occurs when a person's employment or well-being is dependent upon agreeing to unsolicited and unwelcome sexual commands -- usually by a person in authoritative position

hostile environment harassment

Occurs when sex or gender based behaviors create a hostile, intimidating environment that hurts a person's work performance, classroom performance, or general sense of well being

Hypertension risk factors

Old age African American Drinking too much Family history Male Obese Poor diet, esp. salt Sedentary lifestyle Smoking Stress Sleep apnea

___ are at greater risk for impaired glucose metabolism and hyperglycemia because of an increase in visceral fat and associated reduction in lean muscle mass, where most glucose is metabolized.

Older adults

Age + Gender

Older adults lose thermoregulatory control (lower average temperature) Very young + very old more sensitive to temperature extremes Women increase in temperature due to hormonal changes (0.5-1 degrees)

First Prenatal Visit

Once a pregnancy is expected, the woman should seek prenatal care An ideal time to screen for factors that may place the woman and/or fetus at risks and to begin education

Recurrent (relapsing) fever

One or more episodes of fever, each as long as several days, with one or more days of normal temp between episodes -infectious diseases

Rapid acting (onset, peak, duration)

Onset - 5 to 15 minutes Peak - 30 minutes to 1 hour Duration - 2 to 4 hours

Long-acting (onset, peak, duration)

Onset: 1 or 6 hours NO PEAK - continuous Duration: 24 or 24-36 hours

Intermediate acting (onset, peak, duration)

Onset: 2-4 hours Peak: 4-12 hours Duration: 16-20 hours After eating

Short acting/Regular (onset, peak, duration)

Onset: 30-60 minutes Peak: 2-3 hours Duration: 4-6 hours 20-30 mins before meals

For a patient with frostbite, give ___ for pain (with PCA).

Opioid

Types of IV Access

Ordered by MD/DO/NP/PA - Need order 1st

Ectoderm

Outermost germ later that becomes brain, nervous system and integumentary system

Female factors of infertility

Ovarian dysfunction Tubal/pelvic pathology Overweight/underweight Uterine fibroids Chromosomal abnormalities STIs -- PID Chronic illnesses Immune disorders Blockages

Infants may be ___ by poorly regulated equipment designed to keep them warm.

Overheated Alarms to signal that the infant's temperature is too high or too low should be functioning properly.

OGTT

Overnight fasting, avoid caffeine, no smoking for 12 hours prior to test, fasting glucose is obtained, 100 g glucose load is given, and serum glucose levels are determined at 1, 2, and 3 hours following ingestion

Hypercapnia

PCO2 greater than 50 mm Hg Respiratory acidosis Decreased nerve activity Decreased muscle contraction

CVADs (central venous access devices)

PICCs - (2-6 weeks) Nontunneled percutaneous central venous catheters - (3-20 days) avoid femoral vein Tunneled central venous catheters - long term; once healed, site dressing not required Implanted ports - long term; lowest risk for infections

Hypoxemia

PO2 less than 60 mm Hg Impaired function of vital centers Activation of compensatory mechanisms Body compensates by increased ventilation, pulmonary vasoconstriction, and increased production of RBCs

Allodynia

Pain due to a stimulus that does not normally provoke pain

Braxton Hicks

Painless, irregular contractions that are usually relieved with walking -- begin in 1st trimester but often not felt; function is to efface cervix

Hypothermia S&S

Pale skin, apathy, poor judgement, ataxia, dysarthria, drowsiness, coma, hypotension, bradycardia, acidosis

Hypoglycemia clinical manifestations

Pale, cold, clammy -- give 50 Dextrose or OJ with sugar packet Impairment of brain function Sweating, palpitations, sleepiness, anxiety, tremors + irritability/aggression Blurred vision, headache, slurred speech, lack of coordination, weakness, hunger, loss of consciousness, convulsions

HPV

Pale, soft, papillary lesions that vary in size Profuse watery vaginal discharge Dyspareunia, intense pruritis, vulvar irritation Women at risk for cervical cancer Males may not have lesions

Pneumothorax

Partial or complete collapse of the affected lung Air enters the pleural cavity and the air takes up space, restricting lung expansion Spontaneous or traumatic

Excision (FGM)

Partial or total removal of clitoris and labia minora, with or without excision of labia majora

Tumor Grading

Pathologic classification of tumor cells I-IV

Risk Factors for Imbalances

Pathophysiology underlying acute and chronic illnesses Abnormal losses of body fluids Burns Trauma Surgery Therapies that disrupt fluid and electrolyte balance

____ is a cornerstone of treatment and has a tremendous impact on outcomes for those with impaired glucose regulation.

Patient Education

Ventricular fibrillation and hypothermia

Patient with temperature lower than 90 degrees experiences spontaneous ventricular fibrillation if touched of moved Defibrillation doesn't work with temp <88 degrees, must be rewarmed first Watch for V fib while rewarming from 88-90 degrees

Anal intercourse

Penis enters the rectum, should not enter vagina after entering rectum. Lubrication is essential

15%

Percent of sexual assault and rape victims under the age of 12

Fetal movement determination

Perception begins in 2nd trimester; decreased may indicate fetal asphyxia Count to 10 movements, side-lie, drink a glass of water Longer than 2 hours; Call HCP

____ is impacted by body temperature. Measures to minimize or maximize heat loss include vasodilation and vasoconstriction within the blood vessels; severe extremes in body temperature can result in cardiovascular collapse.

Perfusion

Long-term consequences of hyperglycemia lead to micro- and macrovascular changes (____), poor wound healing (____), impaired immune function (____), reduced renal function (____), and changes in vision and peripheral sensation (____).

Perfusion; Tissue Integrity; Immunity; Elimination; Sensory Perception

What does damage to the microvascular system in diabetes results in?

Peripheral Neuropathy, retinopathy, gastroparesis

Hyperglycemia is toxic to nerves, resulting in nerve damage and leading to ____ causing symptoms such as burning and numbness in the lower extremities.

Peripheral neuropathy

Heat loss can be increased through ____, which brings greater vol. of blood to body surface.

Peripheral vasodilation

Menstrual phase

Phase of uterine cycle that begins as the spiral arteries rupture secondary to ischemia, releasing blood into uterus Marks end of one menstrual cycle and beginning of a new one; women bleed 3-7 days

Obesity and a lack of ___ also contribute to insulin resistance.

Physical activity

Once an individual requires insulin therapy to maintain glucose control, creating a ____ regimen while avoiding hypoglycemia can be difficult.

Physiological insulin replacement This is one of the great challenges of caring for patients with diabetes

Oral contraceptives (combination)

Pill that suppresses ovulation by combined action of estrogen and progestin Protects against ovarian and endometrial cancer

Thiazolidinediones (-glitazone)

Pioglitazone (Actos) Rosiglitazone (Avandia) Monitor liver enzymes every 2 months for 1st year May exacerbate CHF Take without regard for food, notify any vision changes

Traumatic pneumothorax

Pneumothorax where air enters lungs; caused by penetrating or non-penetrating injuries Can be tension or open

What are signs and symptoms of gestational diabetes?

Polyuria, frequent vaginal and bladder infections, blurred vision

Infants respond ___ to hyperthermia.

Poorly

What is most affected by hyperglycemia?

Potassium

Pedophilia

Practice of adults gaining sexual fulfillment sexual acts with children

___ occurs more often in women with diabetes than in the unaffected population

Preeclampsia

Chorionic Villus Sampling

Prenatal test that diagnoses chromosomal abnormalities such as down syndrome, as well as a host of genetic disorders.

Hydrostatic pressure

Pressure exerted by a volume of fluid against a wall, membrane, or some other structure that encloses the fluid.

Blood pressure

Pressure exerted by the blood upon the walls of the blood vessels, especially arteries, usually measured by means of a sphygmomanometer and expressed in millimeters of mercury.

Calcium Channel Blockers

Prevent caclium from entering cells of heart and blood vessels, lower blood pressure via vasodilation -dipine

Respiratory alkalosis

Primary deficit of carbonic acid in ECF; low PaCO2 due to alveolar hyperventilation. Low CO2 = medulla stimulates slower or shallower breaths Longer than 6 hours --> kidneys increase bicarbonate excretion or retain H+ High pH, low PaCO2, lower HCO3-

Metabolic alkalosis

Primary excess of bicarbonate in ECF; high pH and a high plasma bicarbonate concentration due to a gain of bicarbonate or a loss of hydrogen Breaths becomes slow/shallow, apnea may occur - kidneys attempt to excrete excess H2O and Na+ (w/ excecssive bicarbonate) and retain H+ High pH, high HCO3-, high PaCO2

Respiratory acidosis

Primary excess of carbonic acid in ECF; high PaCO2 due to alveolar hypoventilation High CO2 = lungs attempt to increase RR to expel If respiratory response not effective --> CO2 stimulates kidneys to eliminate H+ and conserve bicarbonate & sodium ions Low pH, higher PaCO2, elevated HCO3-

Heat production

Primary source is metabolism (increased by hormones + exercise)

nonshivering thermogenesis (NST)

Process in which brown fat is oxidized in response to cold exposure

Thermoregulation

Process of maintaining balance between heat loss and heat production in order maintain core internal temperature Related to newborn's rate of metabolism and O2 consumption

Exogenous pyrogens are:

Products of infectious agents: bacterial endotoxins, viruses, antigen-antibody complexes, etc.

Nursing Care (radiation therapy)

Promote healing, patient comfort, quality of care Assessment: skin, nutritional, well-being Protecting caregivers

Preconception Care

Promotion of health and well-being of a woman and her partner before pregnancy; goal is to identify and modify biomedical, behavioral, and social risks to a woman's health or pregnancy through prevention and management interventions

acute respiratory distress syndrome (ARDS)

Pronounced inflammatory response that affects the lung and may result in systemic organ failure Severe hypoxia that is resistant to O2 therapy is common

Metabolic acidosis

Proportionate deficit of bicarbonate in ECF; low pH (increased hydrogen ion concentration) and a low plasma bicarbonate concentration due to a gain of hydrogen or loss of bicarbonate Breaths become deeper/faster and kidneys retain bicarbonate and excrete H+ Low pH, low HCO3-, low PaCO2 Hyperkalemia frequently present

Trichomoniasis

Protozoan, may be ID'd with Pap Usually asymptomatic in males Foul-smelling vaginal discharge that is thin, frothy, and green Causes itching of vulva and vagina; burning upon urination and pain with sex Strawberry cervix may be seen

Cardiovascular system (as part of homeostasis)

Pumps and carries nutrients + water in body

Carbohydrates

Quickly digested and 100% is converted to glucose CNS relies on carbs almost exclusively Liver stores glucose and regulates entry into blood

Blood Loss Anemia

RBC loss from GI, epistaxis, trauma, bleeding from GU tract Can be acute or chronic External leads to iron loss and possible iron deficiency, which can hamper restoration of the red cell count.

Breakdown of RBCs

RBCs break as they squeeze through spleen capillaries Phagocytes of spleen, liver, bone marrow, and lymph nodes ingest + destroy RBCs Heme is processed to bilirubin

Standard IV Access (who)

RN or LPN

How is heat lost from skin?

Radiation + conduction

An initial formula of 1 unit of ____ insulin for each ___g of carbs provides flexibility to meal plans.

Rapid-acting; 15g

Vaginismus

Rare condition where vaginal opening closes tightly and prevents penile penetration due to involuntary spastic contractions of muscle Often due to sexual trauma

Mneumonic for Order of Insulins: Ready, Set, Inject, Love!

Ready: Rapid Set: Short Inject: Intermediate Love: Long Acting

Precision Medicine

Recent development of biologic databases (human genome sequencing) Technologic advances that can identify unique characteristics of individual persons (genomic, cellular assay tests) Computer-driven systems that can mine and analyze datasets

When an individual has hyperthermia or hypothermia, the most reliable means available for assessing core temperature is a ___ temperature

Rectal

The most reliable site for core temperature is the ____

Rectum

bone marrow, spleen

Red blood cells (erythrocytes) are made in the ________ and destroyed in the _________.

Due to slower metabolism and and less physical activity, older adults have ____ heat production.

Reduced Older adults also have a reduced perception to environmental temp.

Primary prevention

Reducing the risks of disease through health promotion and risk reduction strategies e.g. nutrition, physical activity changes, HPV vaccine, HBV vaccine

Empyema

Refers to an infection in the pleural cavity that results in exudate containing glucose, proteins, leukocytes, and debris from dead cells + tissue

sexual orientation

Refers to preferred gender or person's partner; sometimes can be dictated by culture or by opportunity

Abstinence

Refrain from sex, no failure or STI risk Difficult to maintain

Which type of insulin is used in the emergency treatment of dka and hhns? (Also the only one that can be given IV)

Regular Humulin-R

Short Acting Insulin

Regular: 1. Humulin R 2. Novolin R

Lungs (as part of homeostasis)

Regulate oxygen and carbon dioxide levels of the blood

Parathyroid gland (as part of homeostasis)

Regulate the level of calcium in ECF

Physiologic anemia

Relative excess of plasma leading to a decrease in hemoglobin concentration and hematocrit; normal adaptation during pregnancy Hgb <10 g

ACE inhibitors

Relax blood vessels, prevent enzyme from producing Angiotensin II and used for treating high blood pressure -pril

Beta-adrenergic agonists

Relax muscles of the airways which widen airways and result in easier breathing. Sympathetic nervous system: bronchodilation

Meglinitides (-nide)

Repaglinide (Prandin) Nateglinide (Starlix) Onset 15-60 minutes, may be given with metformin. Give 30 mins before meals If meal is skipped, skip next dose to prevent hypoglycemia

To prevent peripheral tissue ischemia, intermittent ___ of tissue occurs.

Reperfusion

Refractory asthma (severe)

Represents a subgroup (<10%) of people with asthma who have high medication requirements to maintain good symptom control, or who continue to have persistent symptoms despite high medication use Persons with severe asthma are at increased risk for a fatal or near-fatal asthmatic attack

Diagnosis of bronchitis

Requires a history of a chronic productive cough that has persisted for at least 3 consecutive months in at least 2 consecutive years

Pregnancy and the associated hormonal changes (specifically hormones produced by the placenta) produce a state of insulin ___ and associated risk for ____. .

Resistance; Hyperglycemia Especially postprandial hyperglycemia.

Hypercapnia (signs & symptoms)

Respiratory acidosis (increased respiration) Carbon dioxide narcosis Disorientation, somnolence, coma Vasodilation = headache; warmed flushed skin

Striae gravidarum (stretch marks)

Result from genetics and occur in up to 90% of pregnancies More common in younger women, those with large infants, and higher BMI Nonwhites at highest risk or those with family history

Hemolytic anemia types

Resulting from premature RBC destruction (intravascular destruction is less common) Altered erythropoiesis (sickle cell disease + thalassemia) Hyperslpenism Drug-induced anemia Autoimmune anemia Mechanical heart valve related anemia

Tourinquets

Reusable vs. Disposable Blood Pressure Cuffs - Different type of pressure Large, Superficial Veins - May actually cause the vein to blow *Do not leave on more than one minute-may cause lab sample to be hemolyzed

Cor pulmonale

Right heart failure caused by pulmonary disease and long-standing pulmonary hypertension

Nuvaring

Ring inserted into vagina that releases estrogen and progestin; can be expelled without noticing (if out for 3 hours use backup method)

Absolute polycythemia

Rise in hematocrit due to an increase in total red cell mass and is classified as primary or secondary

Heat loss

SKIN is primary site. Circulating blood brings heat to skin where it escapes via arteriovenous shunts that are controlled by the sympathetic nervous system Heat is transferred to external environment via radiation, convection, evaporation, and conduction

Peripheral IV

Saline lock/heparin lock Standard IV access Common in hand arm and head in newborns Not very common in neck, foot, distal chest

Chorionic Villus Sampling

Sample of chorionic villi from the placenta for prenatal eval of chromosomal disorders such as Down syndrome, cystic fibrosis, enzyme deficiencies, and fetal gender determination and to identify sex-linked disorders such as hemophilia, SCD, and Tay-sachs disease.

Secondary prevention

Screening and early detection activities that seek to identify precancerous lesions and early stage cancer in individuals who lack signs and symptoms of cancer e.g. ACS screening is advocated for many types of cancer, mammograms, pap test, fecal occult blood test, colonoscopy, low-dose helical CT, digital rectal examination, prostate-specific antigen test

Secondary Prevention

Screening individuals with a family hx of Malignant Hyperthermia

Embryonic stage

Second stage of prenatal development occurring from the 4th to 8th week; rapid growth and cell differentiation takes place By the end, all organs have been established, bones begin to ossify, and embryo is especially vulnerable to factors that cause congenital abnormalities

Peripheral IV Insertion

Select vein Open IV packaging, prime if needed Reapply tourniquet Cleanse site-chloraprep-scrubbing motion(unless fragile skin-blot). Allow chloraprep to dry completely Hold skin taut 1-2 inches below insertion site (non dominant hand) Enter skin gently, bevel side up, 10-15 degree angle See flashback, advance catheter into the vein Release tourniquet Flush with saline, check for infiltration or pt complaints of pain Secure IV, label dressing, document

Hypocalcemia

Serum calcium <8.9 mg/dL; Trousseau's/Chvostek's Signs Numbness/tingling of fingers, mouth, or feet; tetany, muscle cramps, and seizures (poss. diarrhea) May be caused by malabsorption, vit D deficiency, acute pancreatitis, and nicotine/alcohol can lower levels

Hypercalcemia

Serum calcium >10.1 mg/dL; "Swollen & Slow" Nausea/vomiting, constipation, bone pain, polyuria, renal calculi thirst, confusion, lethargy, and slurred speech, muscle weakness, and decreased DTR Severe (>17 mg/dL): cardiac arrest may occur - EMERGENCY

Hypochloremia

Serum chloride <97 mEq/; very similar to hyponatremia (only difference = FEVER) Excessive diarrhea, vomit, sweating, tetany, increased DTR, weak/muscle cramps, Causes: severe vomit/diarrhea, GI tube drain, metabolic acidosis, diuretics, and burns

Hyperchloremia

Serum chloride >107 mEq/L; very similar to hypernatremia Nausea/vomiting, swollen dry tongue (severe), confusion Tachypnea, weakness, lethargy, diminished cognitive ability, hypertension, decreased cardiac output, dysrhythmias, and coma

Hypomagnesemia

Serum magnesium <1.5 mEq/L; "Buck wild" Cardiac - ST depression, T wave inversion, heart block, tachycardia, SEVERE = V fib Increased DTR, tremors, tetany, muscle weakness, respiratory paralysis, nystagmus, and diarrhea Poss. change in mental status

Hypermagnesemia

Serum magnesium >2.5 mEq/L; "Calm & Quiet Cardiac - Heart block, bradycardia, hypotension, long PR -- cardiac arrest Neuromuscular - Decreased DTR (hyporeflexia), depressed respirations or respiratory paralysis, lethargy -- coma GI - hypoactive bowel sounds Causes: renal failure, adrenal insufficiency

Hypophosphatemia

Serum phosphate <2.5 mg/dL or 1.8 mEq/L; "Swollen and Slow" -- increased risk of infection 1. Constipation 2. Decreased DTR + weak muscles 3. Decreased HR and RR 4. Increased BP irritability, fatigue, weakness, paresthesias, confusion, seizures, and coma -- cardiomyopathy Often caused by refeeding after starvation, parenteral nutrition, alcohol withdrawal, diabetic ketoacidosis, and respiratory alkalosis

Hyperphosphatemia

Serum phosphate >4.5 mg/dL or 2.6 mEq/L; "Weak B's" (inverse of Ca2+) - Trousseau's or Chvostek's sign Weak bones (fracture risk), weak blood (no clotting), weak beats (dysrhythmias) Tetany, anorexia, nausea, muscle weakness, and tachycardia. Causes: kidney excretion, hypo-parathyroidism, and chemo

Hypokalemia

Serum potassium <3.5 mEq/L; "Low & Slow" Heart - depressed --> dysrhythmias Muscular - low DTR, muscle (leg) cramps, flaccid paralysis, parethesias, weakness, GI - low motility, constipation, abdominal distension or paralytici ileus Other S&S: anorexia, nausea/vomit, fatigue, polyuria May occur in alcoholics

Hyperkalemia

Serum potassium >5 mEq/L; "Tight and Contracted" Heart - Increased ST, hypotension, bradycardia' severe = v fib or cardiac arrest Neuromuscular = flaccid/weak muscles, paresthesias, increased DTR, extremity paralysis GI - diarrhea, hyperactive bowel sounds May be caused by renal failure, hypoaldosteronin, or K+ sparing diuretics

Hypernatremia

Serum sodium >145 mEq/L, excess water loss or excess sodium "Big and Bloated" Cells shrink, and CNS is affected especially --> neurologic impairment signs. Other S&S: restlessness, weakness, disorientation, delusion, and hallucinations, red & rosy skin, edema, excessive thirst SEVERE: Swollen dry tongue, nausea/vomit, increased muscle tone Permanent brain damage (esp in children) can occur

homosexual

Sexual attraction to the same sex. one who experiences sexual fulfillment with a person of the same gender. Homosexual males often use the term gay; homosexual females use the term lesbian

Erectile Dysfunction Treatment

Sexual counseling, include partner if possible, assist in determining underlying cause and treat first, possible surgery for insertion of penile prosthesis

Sadism

Sexual pleasure while inflicting abuse on another person

___ insulin is the only insulin that can be administered through IV.

Short acting

Hospice

Should be referred in a timely fashion Comprehensive, multidisciplinary approach to care of patients with terminal illness, their families Focuses on: quality of life, palliation, psychosocial, and spiritual care

Assessing Male Factors

Should include a reproductive history and a semen analysis Should abstain for 24-48 hours from sexual activity Normal = 20 million/mL with 50%+ motility

Assessing Female Factors

Should include thorough history of factors associated with ovulation and pelvic organs; diagnostic testing may include: ovulation predictor kits, urinary LH levels, Pap smears, cervical culture, ultrasound to view structures, assessment of ovarian function

Breastfeeding

Shows improved outcomes to infants with regard to otitis media, lower respiratory problems, grastroenteritis, atopic dermatitis, childhood asthma, childhood obesity, type 1 & 2 diabetes, childhood leukemia, SIDS, and cognitive development. -for mothers showed improvement with regard to breast cancer, ovarian cancer, and type 1 & 2 diabetes.

Sickle cell disease

Sickle cell disease is an inherited disorder in which abnormal hemoglobin (hemoglobin S [HbS]) leads to chronic hemolytic anemia, pain, and organ failure two major consequences of red blood cell sickling—chronic hemolytic anemia and blood vessel occlusion mean life span of RBCs lasts about 20 days Approximately 25% of persons have neurologic complcations related to vessel occlusion (stroke)

Sickle Cell Consequences

Sickled cells are more likely to be destroyed Sickled cells block capillaries which can cause acute pain, infarctions leading to damage, acute chest syndrome, and stroke

Positive signs

Signs that confirms a fetus is present; fetus on ultrasound, palpating for fetal movements, fetal heartbeat Use Doppler, ultrasound, and palpation

Presumptive signs

Signs that indicate to a woman that she may be pregnant but are the least reliable indicators ; cessation of her menstrual cycle is the most obvious Others Include: Fatigue, breast tenderness, nausea and vomiting, quickening

Peripheral (dressing changes)

Simple Clear Window Dressing Additional tape for secured placement Be careful of tape allergies Q 48 Hours

Peripheral thermoreceptors are located in the _____

Skin

Kangaroo care

Skin to skin contact with mothers is recommended as initial method for maintaining newborn body temperature; this should be first line of treatment for hypothermia and as a measure to reduce discomfort from painful procedures

Fluid Imbalance (assessment)

Skin turgor, tongue turgor, oral mucosa, tearing/salivation (infants), skin temperature/appearance, facial appearance, edema, fever, pulse, RR, BP WEIGHT, reflexes, fluid wave test Blood/Lab tests

Other risk factors (heart disease)

Sleep apnea Stress or depression Too much alcohol Birth control pills (esp. women who are 35+ and smoke) Anemia Unhealthy diet

What is a major sign of hypothermia?

Sleepiness

Older adults have ___ circulation and ____ vasoconstrictor and shivering response.

Slower; Decreased

What size

Small veins = small line Emergencies - get what you can where you can Testing: #20 necessary for CT angiogram in antecubital space Depends on medication

Modifiable Risk Factors (heart disease)

Smoking High blood pressure High blood cholesterol and high triglycerides Overweight/obesity Physical inactivity Diabetes/prediabetes Metabolic syndrome

Hyponatremia

Sodium <125 mEq/L, loss of sodium or gain of water - "Depressed & Deflated" (swollen cells = edema, dry skin) Neuromuscular = seizures (cerebral edema), coma, confusion, weak muscles/cramps Heart = Tachypnea, weak/thready pulse, hypotension Respiratory arrest SEVERE: nausea, vomit, increased muscle tone Permanent neurologic damage and death can result

Religion (Sexuality)

Some people view organized religion as having a generally negative effect on the expression of sexuality

Cancer Management

Specific to type, stage, grade of cancer Cure, control, palliation

Aldosterone Receptor Blockers

Spironolactone Eplerenone Competitive inhibitors of aldosterone binding Indicated for patients with heart issues

Pre-embryonic Stage

Stage of conception that lasts about 3 weeks; zygote implants in uterine wall and has 3 layers: the endoderm, the mesoderm, and the ectoderm

Pre-embryonic Stage

Stage that lasts about 3 weeks, zygote implants in uterine wall. Made of 3 cell layers

Central Lines & Ports (dressing changes)

Sterile Technique Mask Use Cleanse site with ChloraPrep Usually ordered Q7 days and PRN Biopatch Anchor

Maintaining tissue integrity (nursing care of pt with cancer)

Stomatitis Radiation - associated impairment of skin integrity Alopecia Malignant skin lesions

Pituitary gland (as part of homeostasis)

Stores and releases ADH

STI: Chlamydia trachomatisi & Neisseria gonorrhea

Strongly associated with ectopic pregnancy, infertility, and chronic pelvic pain. STIs during pregnancy might result in fetal death or substantial physical and development disabilities, including intellectual disability and blindness.

Hyponatremia "SALT LOSS"

Stupor/coma Anorexia; nausea/vomitting, diarrhea, NPO status Lethargy Tendon reflexes decreased Limp Muscles (weakness) Orthostatic hypotension Seizures/headaches Stomach cramping

Infants have limited insulation due to a thin layer of ___ and their blood vessels are ___ to the skin, increasing heat loss

Subcutaneous fat; Closer

Alpha-fetoprotein

Substance made in the liver of the unborn fetus. The amount of AFP in the blood of the pregnant woman can help see whether the baby may have such problems such as spina bifida and anencephaly.

Solutes

Substances dissolved in a solution (electrolytes and nonelectrolytes)

Biologic response modifiers

Substances produced by normal cells that block tumor growth or stimulate the immune system to fight cancer.

Nagele rule

Subtract 3 mos. from LMP, Add 7 days Add 1 year Date has a margin of error of 2 weeks. Method is less accurate if the woman has an irregular menstrual cycle

FT - Teaching: Constipation pt 2

Suggest: - Eat fresh or dried fruit daily. - Eat more raw fruits and veggies including skin - Eat whole grain cereals and breads such as raisin bran or bran flakes. - Participate in physical activity. - Eat meals at regular intervals. - Drink 6-8 glasses of water. - Decrease refined carbs - Drink warm fluids on arising to stimulate GI mvmt. - Avoid eating large amounts of cheese. ** If all methods are ineffective, suggest woman use bulk-forming laxative such as Metamucil.

Palliative surgery

Surgery performed to relieve symptoms of a disease process, but does not cure Ex. Colostomy, Nerve root resection, Tumor debulking, Ileostomy

Port Access (portacaths or passport)

Surgical or Interventional Radiology Insertion Long term use Draw blood from site Once accessed, continuous fluid infusion is often ordered Use Huber Needle to Access

____ fever is the body temperature that is constant, with a little fluctuation.

Sustained

The term "diabetes mellitus" means

Sweet Urine

The hypothalamus also stimulates the ____ system, which triggers the adrenal cortex to increase muscle tone and initiate a shivering and vasoconstriction response.

Sympathetic nervous

Prehypertension

Systolic: 120-139 Diastolic: 80-89

TRUE or FALSE: Newborn infants generally do not shiver

TRUE

TRUE or FALSE: If the mother is hyperglycemic, so if the fetus.

TRUE! In women without vascular impairment, glucose and oxygen are easily transported to the fetus

Hyperchloremia

Tachypnea Low cardiac output Hypertension Weak Lethargic Coma Decreased cognitive ability >107 mEq/L

Assessing newborn (temperature)

Temperature q30mins for first 2 hours, then according to hospital protocols Thermistor probe on abdomen for continuous temp Assess frequently for metabolic acidosis, hypoglycemia, and hypertension along with signs of cold stress

CMP (Complete Metabolic Panel)

Test includes levels of: BMP + LFT's (liver function) = albumin, protein, bilirubin, alkaline phosphatase, ABT, ALT

BMP (Basic Metabolic Panel)

Tests levels of: Na (sodium) K (potassium) BUN (blood urea nitrogen) Creat (creatine) Gluc (glucose)

Ovarian Cycle

The 28 days of the menstrual cycle as they apply to events in the ovary. The ovarian cycle has three subphases: the follicular phase, ovulation, and the luteal phase.

Afterload

The amount of resistance to ejection of blood from the left ventricle

Evaporation

The change of state from a liquid to a gas

Xanthines

The class of chemicals to which caffeine belongs, a bronchodilator mostly in treating asthma -phylline, -lline, -llin

Autologous transfusion

The collection and later reinfusion of a patients own blood or blood components. Requires at least 5 weeks pre-planning

Temperature

The difference between amount of heart produced by the body and the amount of heat lost to the environment measured in degrees

Conduction

The direct transfer of heat from one object to another object that it is touching e.g. contact with cold mattress, scale, etc. Put baby skin-to-skin

Conduction

The direct transfer of heat from one substance to another substance that it is touching Blood conducts heat to skin surface i.e. cooling blankets, cold surfaces

Bronchial asthma

The general term for recurrent and reversible shortness of breath resulting from narrowing of the bronchi and bronchioles; it is often referred to simply as asthma Key characteristics are inflammation, bronchial smooth muscle spasticity, and sputum production; inflammation is the most important.

17-56 days after conception

The greatest environmental sensitivity and consequent risk for embryo is how many days after conception

Relative polycythemia

The hematocrit rises because of a loss of plasma volume without a corresponding increase in red cells This may occur with water deprivation, excess use of diuretics, or gastrointestinal losses Corrected by increasing the vascular fluid volume

Sexual intercourse

The insertion of the penis into the vagina, anus, or mouth

Renal threshold for glucose

The limit to the amount of glucose that the kidney can reabsorb as glucose is filtered from the blood

Folic acid deficiency anemia

The most common causes of folic acid deficiency are malnutrition or dietary lack, especially in the elderly or in association with alcoholism Malabsorption of folic acid may be due to syndromes such as celiac disease or other intestinal disorders megaloblastic anemia and symptoms referable to changes in the mucosal surface of the gastrointestinal tract

Carbonic acid-sodium bicarbonate buffer

The most important buffer system of the body, buffering as much as 90% of the hydrogen of ECF. Buffers attempt to bring a body fluid as close as possible to the pH of normal body fluid (7.35-7.45).

Gestational hypertension

The new onset of hypertension without proteinuria after week 20 of pregnancy Systolic greater than 140 mm Hg OR Diastolic greater than 90 mm Hg

Placental Secretion

The only endocrine "organ" that has ability to form protein and steroid hormones hCG, hPL, relaxin, progesterone, estrogen

pulmonary circulation

The passage of venous blood from the right atrium of the heart through the right ventricle and pulmonary arteries to the lungs where it is oxygenated and its return via the pulmonary veins to enter the left atrium and participate in systemic circulation.

Secretory phase

The phase of the uterine cycle that begins at ovulation to about 3 days before next menstrual period; endometrium thickens further due to progesterone Typically lasts days 15-28 and coincides with luteal phase

Proliferative Phase

The phase of the uterine cycle that corresponds to follicular phase of ovarian cycle; blood vessels dilate and endometrium thickens to prepare for implantation Cercival mucus becomes thin, stretchy, and more alkaline to protect sperm from acidic vagina

Every 4 weeks

The prenatal office visit should be how often during first 28 weeks?

Every 2 weeks

The prenatal office visit should be how often during weeks 29-36?

What is glucose regulation?

The process of maintaining optimal blood glucose levels

What is gluconeogenesis?

The process of producing glucose from non-carbohydrate sources (proteins and fats)

Normal body temperature range

The range is from 36.2°C to 37.6°C (97°F to 100°F) The average temperature is 98.6°F (37°C).

Thermoneutral Zone (TNZ)

The range of temperatures over which an endotherm does not have to expend extra energy to thermoregulate.

Normothermia

The state in which body temperature is within the "normal" range

tympanic temperature

The temperature reading obtained by placing an aural (ear) thermometer in the patient's ear

Luteal Phase

The third phase of the ovarian cycle that begins with ovulation or day 14 and continues until menstruation Corpus luteum secretes progesterone to prepare endometrium for implantation FSH and LH are usually at their lowest levels

Cardiac output

The volume of blood ejected from the left side of the heart in one minute. Heart rate x Stroke Volume

Anemia Manifestations

These are caused by decreased hemoglobin in blood, pallor; tissue hypoxia due to deficient oxygen transport, weak/fatigue; and compensatory mechanisms to increase O2 delivery, tachycardia and palpitations

Myocardium

Thick middle muscle layer of the heart

Heat loss (predisposition)

Thin skin Lack of shivering ability Limited metabolic stores Limited voluntary muscle use Lack of subcut fat Can't change posture, adjust clothing/blankets, or communicate

Colostrum

Thin, creamy, yellowish breast fluid that provides nourishment for newborn during first few days of life Can be expressed in 3rd trimester

Transfer of heat

This depends on temperature of environment, air speed, and water vapor pressure (humidity)

Skin

This is the primary source of heat loss

Shivering (hypothermia)

This may be suppressed at temperatures under 90 degrees, self warming mechanisms become ineffective

Seizure (hyperthermia)

This may occur after a recurrence of hyperthermia 3-4 hours after first episode

Obesity

This risk factor can increase risk of hypertension, diabetes, and thromboembolic disease and perhaps a c-section

Preconception Assessment

This should include questions about personal and family history, lab screenings, review of the reproductive plan, nutrition, weight, exercise, and vaccinations A physical exam should also be performed Encourage 400-800 mcg per day

Preconception Care (2)

This type of care should occur any time an HCP sees a woman of reproductive age; for women not intending to become pregnant, preconception care should focus on contraception counseling Should be an integral part of care from menarche to menopause

Transsexual

Those who live as members of sex other than that assigned at birth

Gender dysphoria

Those with a gender identity that's different that their biological sex

Symptoms of hypoglycemia do not occur until glucose levels are dangerously low, and frequent hypoglycemia is associated with a ___.

Three- or four fold increased risk of death and a higher risk of chronic cognitive impairment and accelerated cognitive decline

How is glucose regulation achieved?

Through a delicate balance between nutrient intake, hormonal signaling and glucose uptake by the cell.

Endocrine Adaptations of Pregnancy

Thyroid enlarges slightly to provide TH to fetus Pituitary enlarges to adapt to hormonal secretions from placenta -- releases oxytocin, prolactin, growth hormone Adrenal glands increase cortisol due to increased estrogen levels and stress

Implant (nexplanon)

Time release implant of levonorgestrel for 3 years

The skin acts as a protective layer to reduce heat loss. In addition, thermoreceptors in the skin alert all individuals to extremes in temperatures, thus preventing injury. These mechanisms require intact skin and _____.

Tissue Integrity.

Culture (sexuality)

To some degree, this dictates the choice of sexual partner, duration of intercourse, methods of stimulation, and sexual positions

Fluid overload

Too large of a volume infuses into circulation S&S: engorged neck veins, increased BP, and dyspnea

Homeostasis

Total cations equal to total anions

Gravida

Total pregnancies; current included in the count

Gravida/gravidity

Total times pregnant, regardless if terminated or multiples

Neonate immunity

Transient immunity from infection due to maternal immunoglobulins crossing placenta Breastfeeding also provides further protection (leukocytes, immunoglobulins, antibodies, and high lactose with limited protein)

Insulin effects

Transports + metabolizes glucose for energy Stimulates storage of glucose in liver and muscle Signals liver to stop releasing glucose Enhances storage of dietary fat in adipose Accelerates transport of amino acids into cells Inhibits breakdown of stored glucose, protein, and fat

Functions of Water

Transports nutrients + wastes from cells Transports hormones, enzymes, platelets, RBCs, and WBCs Facilitates cellular metabolism and cellular chemical functioning Acts as a solvent Maintains body temp Facilitates digestion + elimination Acts as lubricant for tissue

Glucose regulation is also affected by physiologic stress such as ____.

Traumatic injury, cancer, and surgery

Management at home of MILD hypoglycemia (less than 60 mg/dL)

Treat the symptoms of hypoglycemia with 10 to 15 g of carbohydrate. You may use one of these: • Glucose tablets or glucose gel (dosage is printed on the package) • image cup (120 mL) of fruit juice • image cup (120 mL) of regular (nondiet) soft drink • 8 ounces (240 mL) of skim milk • 6 to 10 hard candies • 4 cubes of sugar • 4 teaspoons of sugar • 6 saltines • 3 graham crackers • 1 tablespoon (15 mL) of honey or syrup • Retest blood glucose in 15 minutes.

Hypernatremia "TON SALTY"

Tremors Orthostatic hypotension Not yourself (confusion, irritability, personality changes) Seizures (tremors, coma) Apprehension Low temperature; cold, clammy skin Tachycardia, thread pulse Y, so dry

Intrinsic (nonatopic) asthma

Triggered by respiratory tract infections, exercise (cold air), drugs, and chemicals, air-borne pollutants, and gastroesophageal reflux No allergic component

True

True or false? In patients with hypertension (high blood pressure), peripheral resistance is increased. In hypertension, blood vessels are constricted/narrowed. Smaller vessels increase resistance (it's harder to push the same amount of fluid/blood through a tube that has become smaller).

TNM

Tumor, modes, and metastasis

Groshong Catheter (Central Line)

Tunneled catheter (central line) that does not require heparin, three way valve controls flow of fluids and reduced clotting Moderate time frame, draw blood

Extrinsic (atopic) asthma

Type I hypersensitivity Allergen: Mast cells release inflammatory mediators which cause acute response within 10-20 minutes and WBCs enter region & release more inflammatory mediators Airway inflammation causes late-phase response in 4-8 hours

Panacinar emphysema

Type of emphysema that produces initial involvement of peripheral alveoli and later extends to involve the more central bronchioles More common in persons with α1-antitrypsin deficiency

Prophylactic surgery

Type of surgery being done when lesions that are likely to develop into cancer

Ultrasound

Typically the most accurate method of dating a pregnancy.

Administering Blood and Blood Products

Typing and cross-matching A, B, AB, and O type blood Rh factor Selecting blood donors Initiating transfusion Transfusion reactions 2 licensed professionals; 14-24 gauge PVAD, inline/add-on filter Reactions can be acute or delayed

Top step to prevent STI

Understanding basic facts about STIs, how they are spread, common symptoms, and how they can be treated

Laboratory Tests (Prenatal)

Urinalysis Blood studies: CBC, blood typing, Rh factos, glucose screening, rubella titer, STI screening Genetic screenings

First Trimester Discomforts

Urinary frequency or incontinence Fatigue Nausea and vomiting Breast tenderness Constipation Nasal stuffiness, bleeding gums, epistaxis Cravings Leukorrhea

Amniocentesis: First Trimester

Used to CONFIRM fetal abnormality when other screening test detect a possible problem. -Can be performed in any of the trimesters. -Early testing (11-14wks) has been associated with a high risk of spontaneous miscarriage and postprocedural amniotic fluid leakage compared with transabdominal chorionic villus screening.

5% dextrose in 0.45% NaCl

Used to maintain fluid intake - hypertonic

RhoGAM

Used to prevent an immune response to Rh positive blood in people with an Rh negative blood type Often given at 28 weeks

HSCT (Hematopoietic stem cell transplant)

Used to treat several malignant and nonmalignant diseases Types: -Allogenic -Autologous -Synergic -Myeloablative -Nonmyeloablative

Marker Screening Tests

Using materal serum is an effective, noninvasive method for identifying fetal risk for aneuploidy and neural tube defects

Type 2 Diabetes

Usually 30+ and obese, affects 95% of diabetics Insulin resistance or impaired insulin secretion May lead to metabolic syndrome Onset may last for years and be detected incidentally

Fundal height

Usually correlates with gestational weeks and is most accurate between 18-32 weeks, after this the head begins to lower

Short acting insulin is typically administered when?

Usually injected 15-30 min before a meal.

How often a day is long acting insulin taken?

Usually once a day

As an exercise interval lengthens, glucose stores are quickly depleted, and then glucose from the circulation and hepatic glucose stores is ____.

Utilized for energy, lowering blood glucose levels.

IV therapy

Vascular access devices Peripheral venous catheters Midline peripheral catheter Central venous access devices Implanted ports

Vaginal Adaptations

Vascularity increases die to estrogen and causes pelvic congestion + hypertrophy; mucosa thickens, connective tissue loosens, lengthens Leukorrhea may be expereinces

Alpha blockers

Vasodilate by blocking smaller blood vessels cells from receiving vasoconstriction signals: vasodilation -- treat high blood pressure -Doxazosin, Prazosin, Terazosin

Epinephrine

Vasopressors, adrenergic Relaxes smooth muscles via sympathetic nervous system: used for asthma, anaphylaxis, and cardiac resuscitation IM, Subcut, IV Autoinjectors into lateral thigh 2 times max - seek medical care asap

Systole

Ventricles contract, blood pushes against AV valves and they shut, and blood flows through semilunar valves into aorta and pulmonary trunk

Diastole

Ventricles relax, blood entering the atria, blood flows through AV valves into ventricles and semilunar valves are closed

Blood Draw (process)

Verify order Gather equipment needed, assemble Hand hygeine Identify pt, explain purpose and procedure Don gloves Select vein Apply tourniquet Cleanse site Anchor vein, insert needle 15- 30 degree angle into the vein Collect blood Remove tourniquet May need to invert lab samples with additives in vacutainer Label specimen and send to lab

Blood Transfusion

Verify order Verify completed consent Two nurses must verify blood product and patient Obtain baseline vitals RN must initiate the blood transfusion Begin administration slowly (25-50ml for first 15 minutes)- STAY WITH PATIENT Observe pt for flushing, dyspnea, itching, hives or rash, or unusual comments After observation period increase the infusion rate to complete within 4 hours or what is ordered Reassess vital signs after first 15 minutes Follow facility policy for additional monitoring

Carcinogenic Agents (+factors)

Viruses, bacteria Physical agents - sunlight, radiation, chronic irritation Chemical agents - tobacco, asbestos Genetic, familial factors Life style factors Diet Hormonal agents

Prolonged hypothermia leads to reduced perfusion in the microcirculation attributable to increased ____ of the blood and reduced blood flow and ____.

Viscosity; Coagulation

Follow-Up Visits (prenatal)

Vitals + Weight, compared to baseline Urinalysis Fundal height Assessment for quickening Assessing fetal HR

Which type of deficiency is caused by pernicious anemia?

Vitamin B12: Pernicious anemia destroys the gastric mucosa, producing antibodies that block the binding of vitamin B12 to the intrinsic factor, blocking its absorption into the bloodstream.

Malabsorption and resulting nutrient deficiencies required for cellular metabolism of glucose, including vitamin ___ deficiency, contribute to insulin resistance.

Vitamin D

Preload

Volume of blood in the ventricles at the end of diastole, immediately before ventricular contraction

During respiration, cool ambient air is inhaled and ___ in the respiratory tract and by the microcirculation within the ____.

Warmed; Alveoli Warmed air is then exhaled

___ surfaces lose heat to ___ surfaces.

Warmer; Cooler

Patients have been known to remove clothing due to a combination of reduced cognition and the false ____ of vasodilation.

Warming sensation

Conjugated bilirubin

Water soluble breakdown product of heme that is excreted in bile

Hypervolemia (S&S)

Weight gain, edema, ↑ BP (hypertension), bounding pulse, engorged neck veins, crackles/wheezes, ascites, low specific gravity

80-90%

What percentage of uterine blood goes to placenta with help of the main uterine artery doubling in size?

Hemolytic anemia

When RBC destruction occurs in blood Hemoglobin binds to haptoglobin and albumin When there is too much hemoglobin it turns plasma red and/or makes urine darker in color

Process of erythropoeisis

When blood oxygen is decreased, the kidneys secrete erythropoeitin which stimulates bone marrow to produce immature RBCs, reticulocytes, and mature RBCs

Primary prevention

When it is cold, physical activity helps to increase body temp Resting, adequate hydration, wearing appropriate clothing and seeking shelter reduces risk of hyperthermia

Glycogenesis

When muscle/liver glycogen stores are low, glucose is converted to glycogen and stored

What is proliferative diabetic retinopathy?

When retinal blood flow is poor and hypoxia develops, retinal cells secrete vascular endothelial growth factors that stimulate formation of new blood vessels in the eye. These new vessels are thin, fragile, and bleed easily, leading to vision loss.

Brown fat (2)

When the newborn is cold, norepineprhine is released to stimulate brown fat metabolism by breaking down triglycerides, which increases blood flow through brown fat by increasing cardiac output. This blood flow produces heat.

Tumor removal

Wide excision and local excision

When is mixed insulin administered?

Within 15 minutes of a meal

When to call HCP (amniocentesis)

Women needs to rest after an amniocentesis and report fever, leaking amniotic fluid, vaginal bleeding, uterine contractions, or any changes in fetal activity

Gestational Diabetes Risks

Women older than 25, overweight, polycystic ovary syndrome, history of gestational diabetes, or a family history

What is glucagon?

a "counterregulatory" hormone that has actions opposite those of insulin. It prevents hypoglycemia by triggering the release of glucose from storage sites in the liver and skeletal muscle.

Breast cancer

a carcinoma that develops from the cells of the breast and can spread to adjacent lymph nodes and other body sites

Hemothorax

a collection of blood in the pleural cavity

Endometriosis

a condition in which patches of endometrial tissue escape the uterus and become attached to other structures in the pelvic cavity Respond to same hormones that uterus does

Male condom

a contraceptive sheath that is placed over the penis

Gestational Diabetes

a form of diabetes mellitus that occurs during some pregnancies

Interstitial lung diseases

a group of almost 200 diseases that cause inflammation and scarring of the alveoli and their supporting structures Lungs become stiff and difficult to inflate which increases work of breathing causing dyspnea, decreased exercise tolerance r/t hypoxemia, without wheezing or signs of airway obstruction

Hemoglobinopathies

a group of related genetic blood diseases characterized by abnormal hemoglobin Include: sickle cell disease and thalassemia (alpha + beta)

Thalassemias

a heterogeneous group of inherited disorders caused by mutations that decrease the rate of synthesis of α- or β-globin chains

Colon Cancer

a malignant tumor of the colon

Bradley Method

a method of childbirth instruction that stresses the partner's role as birth coach and that seeks to avoid medical interventions

Primary polycythemia

a neoplastic disease of the pluripotent cells of the bone marrow characterized by an absolute increase in total red blood cell mass accompanied by elevated white cell and platelet counts Common in men at any age Thromboembolism and hemorrhage, due to hyperviscosity and platelet and neutrophil abnormal activation, are common complications - can be prevented by phlebotomy to reduce Hct

bisexual

a person who is sexually attracted to both sexes

Exudate

a pleural fluid that has a specific gravity greater than 1.020 and often contains inflammatory cells

Reye's syndrome (RS)

a potentially fatal condition that has been linked to giving aspirin to children suffering from viral infections. Characterized by vomiting and confusion.

Leukorrhea

a profuse, whitish mucus discharge from the uterus and vagina

What is diabetic peripheral neuropathy?

a progressive deterioration of nerve function that results in loss of SENSORY PERCEPTION. It is a common complication of DM and often involves all parts of the body.

Transdermal patch

a small patch with medication placed on the skin; releases estrogen and progestin May cause skin allergy or irritation, less effective on women 200 pounds or more Apply every week for 3 weeks and not during week 4

Heat Exhaustion

a syndrome resulting primarily from dehydration. It is caused by heavy perspiration and inadequate fluid and electrolyte intake during heat exposure over hours to days. i. Profuse diaphoresis can lead to profound, even fatal, dehydration and hyponatremia caused by excessive sodium lost in perspiration.

Heat Stroke

a true medical emergency in which body temperature may exceed 104° F (40° C). Has a high mortality rate if not treated in a timely manner.

Pelvic Examination

a visual and digital examination of the vulva and pelvic organs; woman is placed in the lithotomy position

secundigravida

a woman pregnant for the second time

nulligravida

a woman who has never been pregnant

The nurse is providing discharge teaching to a client with type 2 diabetes and peripheral neuropathy. Which statement by the client indicates a need for further teaching about injury prevention? a. "I can break in my shoes by wearing them all day." b. "I need to monitor my feet daily for blisters or skin breaks." c. "I will never go barefoot." d. "I need to quit smoking."

a. "I can break in my shoes by wearing them all day." Further teaching about injury prevention is needed when the client with diabetic peripheral neuropathy says that "I can break in my shoes by wearing them all day." Shoes need to be properly fitted and worn for a few hours a day to break them in, with frequent inspection for irritation or blistering.People with diabetes have decreased peripheral circulation, so even small injuries to the feet must be managed early. Going barefoot is contraindicated because if the client has diabetic neuropathy, stepping on something sharp or harmful would not be felt. Tobacco use further decreases peripheral circulation increasing the risk for vascular complications.

A client with type 1 diabetes arrives in the emergency department breathing deeply and stating, "I can't catch my breath." The client's vital signs are: T 98.4°F (36.9°C), P 112 beats/min, R 38 breaths/min, BP 91/54 mm Hg, and O2 saturation 99% on room air. Which action will the nurse take first? a. Check the blood glucose. b. Administer oxygen. c. Offer reassurance. d. Attach a cardiac monitor.

a. Check the blood glucose The nurse would first obtain the client's glucose level. Breathing deeply and stating, "I can't catch my breath" is indicative of Kussmaul respirations which is a sign of diabetic ketoacidosis.Based on the oxygen saturation, oxygen administration is not indicated. The nurse provides support, but it is early in the course of assessment and intervention to offer reassurance without more information. Cardiac monitoring may be implemented, but the first action would be to obtain the glucose level.

The nurse is teaching a client with newly diagnosed type 2 diabetes about the importance of weight control. Which comment by the client indicates a need for further teaching? a. "I will begin exercising for at least an hour a day." b. "I will monitor my diet and avoid empty calories." c. "If I lose weight, I may not need to use the insulin anymore." d. "Weight loss can be a sign of diabetic ketoacidosis."

a. I will begin exercising for at least an hour a day Further teaching is needed when the client says that "I will begin exercising for at least an hour a day." The goal of weight control for Type 2 diabetes is to change sedentary behavior to active behavior. This is begun by starting low-intensity activities in short sessions (less than 10 minutes). The client may increase sessions to moderate or vigorous aerobic physical activity to lose and or sustain weight loss.Monitoring the diet and avoiding empty calories is essential to managing type 2 diabetes. Weight loss can minimize the need for insulin and can also be a sign of diabetic ketoacidosis due to osmotic diuresis.

The nurse caring for four clients with diabetes has these activities to perform. Which activity is appropriate to delegate to unlicensed assistive personnel (UAP)? a. Perform a blood glucose check on a client who requires insulin. b. Verify the infusion rate on a continuous infusion insulin pump. c. Assess a client who reports tremors and irritability. d. Monitor a client who is reporting palpitations and anxiety.

a. Perform a blood glucose check on a client who requires insulin Performing bedside glucose monitoring is a task that may be delegated to UAPs because it does not require extensive clinical judgment to perform. There is no evidence the client is unstable at this time. The nurse will follow up with the results and insulin administration after assessing the less stable clients.Intravenous therapy and medication administration are not within the scope of practice for UAPs. The client with tremors and irritability is displaying symptoms of hypoglycemia requiring further assessment and intervention that are not within the scope of practice for UAPs. The client reporting palpitations and anxiety may have hypoglycemia, requiring further intervention. This client must be assessed by licensed nursing staff.

Signs of hyperthermia

a. Vasodilation occurs, causing the skin to appear flushed and warm or hot to touch b. Diaphoresis c. Dry skin and membranes d. Decreased urinary output (and other signs of dehydration) e. Seizures f. Cognitive changes: slightly confused or delirious to coma.

Signs of Inadequate Thermoregulation

a. poor feeding or intolerance to feedings in an infant who previously had little difficulty b. lethargy c. Irritability d. poor muscle tone e. cool skin temperature f. mottled skin g. Hypoglycemia and respiratory distress may be the first signs that infant's temperature is low.

Contractility

ability to shorten when an adequate stimulus is received

Pleural effusion

abnormal accumulation of fluid in the pleural space

What are ketone bodies?

abnormal breakdown products that collect in the blood when insulin is not available

Neoplasms

abnormal growths of new tissue that are classified as benign or malignant

Overhydration

above normal amounts of water in extracellular spaces

hyperphosphatemia

above-normal serum concentration of inorganic phosphorus

Diabetic Ketoacidosis is caused by...

absence of insulin and generation of ketoacids

edema

accumulation of fluid in extracellular spaces

cross-matching

act of determining the compatibility of two blood specimens

When a fever "breaks" a patient becomes ___.

afebrile

Respiratory Disturbances

affect the carbonic acid element; reflected in a PaCO2 level of an ABG Lungs attempt to retain or eliminate PaCO2 or kidneys attempt to restore balance via bicarbonate (HCO3)

Calcium Channel Blockers

agents that inhibit the entry of calcium ions into heart muscle cells, causing a slowing of the heart rate, a lessening of the demand for oxygen and nutrients, and a relaxing of the smooth muscle cells of the blood vessels to cause dilation; used to prevent or treat angina pectoris, some arrhythmias, and hypertension

Air embolus

air introduced into circulatory system, break in IV stem above heart level S&S: respiratory distress, increased HR, decreased BP, cyanosis, change in consciousness

agglutinin

an antibody that causes a clumping of specific antigens

Bimanual examination

an examination in which the physician places one hand on the abdomen and inserts fingers of the other hand into the vagina to feel the female organs between the two hands

hyperchloremia

an excess of chloride in the blood plasma

transgender

an inclusive term used to describe those who feel that the sex assigned to them at birth incompletely describes or fails to describe them

Individuals with long-standing or chronic hyperglycemia are at risk for developing several significant physiological complications attributable to ___.

angiopathy (damage to blood vessels)

Monitor blood glucose levels before giving ____ drugs, before ___, before ___, and when the patient is symptomatic.

antidiabetic; meals; bedtime

female genital mutilation

any procedure that involves partial or total removal of the external female genitalia or other injury to the female genital organs for nonmedical reasons

orgasm

apex of sexual activity in which rhythmic contractions of the genital organs and many other physiologic changes occur

erogenous zones

areas of the body that produce sexual desire and arousal when stimulated

ion

atom or molecule carrying an electric charge in solution

Kussmaul respirations are an indication that the body is:

attempting to eliminate acids from the blood.

The nurse is teaching a client about the manifestations and emergency management of hypoglycemia. Which response by the client indicates a correct understanding of what to do if the client feels hungry and shaky? a. "I will drink a glass of water." b. "I will eat three graham crackers." c. "I will give myself 1 mg of glucagon." d. "I will sit down and rest."

b. "I will eat three graham crackers." Correct understanding of what the client needs to do if the client feels hungry and shaky is to eat three graham crackers. This is the correct management strategy for mild hypoglycemia.Drinking a glass of water or sitting down and resting does not remedy hypoglycemia. Glucagon is generally administered for episodes of severe not mild hypoglycemia.

The clinic nurse is providing teaching to a client with newly diagnosed diabetes. Which statement by the client indicates a correct understanding about the need to wear a MedicAlert bracelet? a. "If I become hyperglycemic, it is a medical emergency." b. "If I become hypoglycemic, I could become unconscious." c. "Medical personnel may need confirmation of my insurance." d. "I may need to be admitted to the hospital suddenly."

b. "If I become hypoglycemic, I could become unconscious." The statement by the client that indicates a correct understanding about the need to wear a MedicAlert bracelet is, "If I become hypoglycemic, I could become unconscious." Hypoglycemia is the most common cause of medical emergency in clients with diabetes. A MedicAlert bracelet is helpful if the client becomes hypoglycemic and is unable to provide self-care.Hyperglycemia does not pose the same type of acute medical emergency as hypoglycemia unless it is severe and acidosis develops. Insurance information does not appear on a MedicAlert bracelet. Information on the MedicAlert bracelet may be helpful if a sudden hospitalization occurs when the client cannot communicate. However, it is standard procedure to assess blood glucose in that instance.

A client with type 1 diabetes mellitus received regular insulin at 7:00 a.m. The client will need to be monitored for hypoglycemia at which time? a. 7:30 a.m. b. 11:00 a.m. c. 2:00 p.m. d. 7:30 p.m.

b. 11am Regular insulin is a short-acting type of insulin. Onset of action to regular insulin is ½ to 1 hour. The peak effect time is when hypoglycemia may start to occur. Peak time for regular insulin is 2-4 hours. Therefore, 11:00 a.m. is the anticipated peak time for regular insulin received at 7:00 a.m.The other options for peak times for regular insulin are incorrect.

(SATA) A client newly diagnosed with diabetes is not ready to learn diabetes control during the hospital stay. Which information is the priority for the nurse to teach the client and the client's family? a. Pathophysiology of diabetes b. Causes and treatment of hypoglycemia c. Dietary control of blood glucose d. Insulin administration e. Physical activity and exercise

b. Causes and treatment of hypoglycemia d. Insulin administration The priority information the nurse needs to teach the client and family about diabetes are the causes and treatment of hypoglycemia and proper insulin administration. This information is essential for the client's survival and must be understood by both the client and family to ensure client safety.The pathophysiology of diabetes and hyperglycemia is a topic for secondary teaching and is not a survival need or the priority during hospitalization. Dietary control and exercise regimen are important, but are not the priority during the acute care stay.

The nurse is teaching a client with diabetes about proper foot care. Which statement by the client indicates that teaching was effective? a. "I will go barefoot in my house so that my feet are exposed to air." b. "I must inspect my shoes for foreign objects before putting them on." c. "I will soak my feet in warm water to soften calluses before trying to remove them." d. "I must wear canvas shoes as much as possible to decrease pressure on my feet."

b. I must inspect my shoes for foreign objects before putting them on The statement by the diabetic client that indicates that teaching was effective is, "I must inspect my shoes for foreign objects before putting them on." To avoid injury or trauma to the feet, shoes need to be checked for foreign objects before the feet are inserted in them.Clients with diabetes would not go barefoot because foot injuries can occur in those clients who lack sensation. To avoid injury or trauma, a callus needs to be removed by a podiatrist, not by the client. To prevent injury, the client with diabetes must wear protective shoes for support and not canvas shoes.

Hypothermia

below normal body temperature, occurs when body cannot compensate to retain heat Chronic conditions (alcoholism, hyperthyroidism, malnutrition) increases risk along with perioperative and very young/old

hypophosphatemia

below-normal serum concentration of inorganic phosphorus

Hypoglycemia may be difficult to recognize in those who take ___ drugs. Symptoms are less intense and less obvious.

beta-blocking

Intermediate acting insulin is used to control glucose ___ meals.

between

Metorrhagia

bleeding between periods, irregular bleeding

Fasting plasma glucose (FPG)

blood glucose determination obtained in the laboratory after fasting for at least 8 hours

Diabetes can be diagnosed by assessing _____.

blood glucose levels

Some antirejection drugs increase ___.

blood glucose levels

Causes of anemia

blood loss, hemolysis, impaired RBC production

Reinforcing hyperinsulinemia's influence on hypertension is the recognition that reducing carbohydrate intake can lower ___.

blood pressure levels

Bicarbonate-Carbonic Acid

body's primary buffer system

Major Homeostatic Regulators of Hydrogen Ions

buffer systems respiratory mechanisms renal mechanisms

A client with typically well controlled diabetes has a glycosylated hemoglobin (HbA1C) level of 9.4%. Which response by the nurse is most appropriate? a. "Keep up the good work." b. "This is not good at all." c. "Have you been doing something differently? d. "You need an increase in your insulin dose."

c. Have you been doing something differently? The most appropriate response by the nurse is telling the client that the level is high and then assessing the client's regimen or changes he or she may have made. This is the best format to formulate interventions to gain control of blood glucose. HbA1C levels for diabetic clients need to be less than 7%. A value of 9.4% shows poor control over the past 3 months.Telling the client to "keep up the good work" is incorrect. A(HbA1C) level of 9.4% is too high. Scolding the client by saying "this is not good," although true, does not take into account problems the client may be having with the regimen or an undiagnosed illness. Although it may be true that the client needs more insulin, an assessment of the client's regimen is needed before decisions are made about medications.

A client expresses fear and anxiety over the life changes associated with diabetes, stating, "I am scared I can't do it all and I will get sick and be a burden on my family." What is the nurse's best response? a. "It is overwhelming, isn't it?" b. "Let's see how much you can learn today, so you are less nervous." c. "Let's tackle it piece by piece. What is most scary to you?" d. "Many people live with diabetes and do it just fine."

c. Let's tackle piece by piece. What is most scary to you? The nurse's best response is to suggest that the client tackle it piece by piece and ask what is most scary to him or her. This is the best client centered response, and acknowledges the client's concern, letting the client master survival skills first.Referring to the illness as overwhelming may reflect the client's feelings, but is a closed-ended question and does not encourage the client to express his feelings about the underlying fear. Trying to see how much the client can learn in one day may add to his anxiety by overwhelming him with information and the need to "do it all" in one day. Suggesting that other people handle the illness just fine criticizes the client and does not recognize his concerns.

A client with type 2 diabetes controlled with Metformin is recovering from surgery. The primary health care provider has placed the client on insulin in addition to the metformin. What is the nurse's best response about why the client needs to take insulin? a. "Your diabetes is getting worse, so you will need to take insulin." b. "You can't take your metformin while in the hospital." c. Stress, such as surgery, increases blood glucose levels. You'll need insulin to control your blood glucose temporarily." d. "You must take insulin from now on because the surgery will affect your diabetes."

c. Stress, such as surgery, increases blood glucose levels. You'll need insulin to control your blood glucose temporarily The nurse's best response is that due to the stress of surgery and NPO status, short-term insulin therapy may be needed perioperatively for clients with diabetes who use oral antidiabetic agents. For those receiving insulin, dosage adjustments may be required until the stress of surgery subsides.No evidence suggests that the client's diabetes has worsened. However, surgery is stressful and may increase insulin requirements. Metformin may be taken in the hospital, but not on days when the client is NPO for surgery. When the client returns to his or her previous health state, oral agents will be resumed.

The nurse in the endocrine clinic is reviewing type 1 and type 2 diabetes with a group of nursing students. Which explanation by the students indicates their understanding of the types of diabetes? a. Most clients with type 1 diabetes are born with it. b. People with type 1 diabetes are often obese. c. Those with type 2 diabetes make insulin, but in inadequate amounts. d. People with type 2 diabetes do not develop typical diabetic complications.

c. Those with type 2 diabetes make insulin, but in inadequate amounts The explanation by the students that indicate understanding of the type of diabetes is "Those with type 2 diabetes make insulin, but in inadequate amounts." People with type 2 diabetes may also have resistance to existing insulin.Most clients with type 1 diabetes are not born with it. Although type 1 diabetes may occur early in life, it is considered an autoimmune disorder in which beta cells are destroyed in a genetically susceptible person. Risk for type 1 DM is determined by inheritance of genes coding for the HLA-DR and HLA-DQA and DQB tissue types (McCance et al., 2014). However, inheritance of these genes only increases the risk, and most people with these genes do not develop type 1 DM. Obesity is typically associated with type 2 diabetes. People with type 2 diabetes are at risk for typical diabetic complications, especially cardiovascular diseases.

Caloric requirements

calculate energy needs and caloric requirements based on age, gender, height, and weight with activity factored in

Patients with diabetes, prediabetes, or metabolic syndrome are at increased risk for ____.

cardiovascular disease (CVD) This risk affects women to a greater degree than men and is influenced by the patient's ethnic group.

pericardial cavity

cavity that surrounds the heart

Other autoimmune disorders are found in increased frequency among persons with type 1 diabetes, including: ____.

celiac disease, adrenal insufficiency, pernicious anemia, vitiligo, and autoimmune thyroid disorders.

poikilocytosis

cells are irregularly shaped

Aniscocytosis

cells that are irregular in size

Causes of increased cortisol secretion include _____.

chronic stress, pain, sleep deprivation, and acute injury or illness.

Vulvodynia

chronic vulvar pain - burning, stinging, irritation, or rawness that interferes with sexual activity

intercourse

coitus

Symptoms of MODERATE hypoglycemia

cold, clammy skin; pale; rapid pulse; rapid, shallow respirations

osmolarity

concentration of particles in a solution, or a solution's pulling power

acidosis

condition characterized by a proportionate excess of hydrogen ions in the extracellular fluid, in which the pH falls below 7.35

impotence

condition in which a man is unable to attain or maintain an erection to such an extent that he cannot have satisfactory sexual intercourse; synonym for erectile failure

sexual dysfunction

condition that prevents a person or couple from engaging in or obtaining satisfaction from sexual activity

alkalosis

condition, characterized by a proportionate lack of hydrogen ions in the extracellular fluid concentration, in which the pH exceeds 7.45

Arteriovenous shunts

connect veins to arterioles; bypass capillaries to bring heat to skin when open and retain heat when closed Controlled almost exclusively by sympatheric nervous system in response to changes in core and environmental temperatures

Fertility awareness-based methods

contraceptive or family planning method that involves identifying a fertile period in a woman's cycle and either avoiding intercourse or using contraception during this time High faulure rate

Antiemetics

control nausea and vomiting by blocking nerve impulses to the vomiting center of the brain

What is ketogenesis?

converting fatty acids to a ketone body

A hypothermia blanket is a

cooling blanket, should feel cool to the touch

The intensive care nurse is caring for a client admitted in a hyperglycemic-hyperosmolar state. Which of these prescriptions made by the primary health care provider will the nurse question? a. Add 20 mEq of KCl to each liter of IV fluid b. IV regular insulin at 2 units/hr c. IV normal saline at 100 mL/hr d. 1 ampule Sodium Bicarbonate IV now

d. 1 ampule sodium bicarbonate IV now Sodium Bicarbonate is given for the acid-base imbalance of diabetic ketoacidosis, not the hyperglycemic-hyperosmolar state that presents with hyperglycemia and absence of ketosis/acidosis.Insulin puts potassium into the cell. KCl 20 mEq for each liter of IV fluid will correct hypokalemia from osmotic diuresis and electrolyte shifts. IV regular insulin at 2 units/hr will help correct hyperglycemia. IV normal saline at 100 mL/hr will help correct dehydration.

A client with type 2 diabetes who is taking metformin (Glucophage) is seen in the diabetic clinic. The fasting blood glucose is 108 mg/dL (6.0 mmol/L), and the glycosylated hemoglobin (HbA1C) is 8.2%. Which action will the nurse take next? a. Instruct the client to continue with the current diet and metformin use. b. Discuss the need to check blood glucose several times every day. c. Talk about the possibility of adding rapid-acting insulin to the regimen. d. Ask the client about current dietary intake and medication use.

d. Ask the client about current dietary intake and medication use The nurse's next action would be to assess the client's adherence to the currently prescribed diet and medications. The nurse would also check for any stressors or undocumented illnesses. Glycosylated hemoglobin (HbA1C) levels >8% indicate poor diabetes control and need for adherence to regimen or changes in therapy.Instructing the client to continue with current diet and metformin use is inappropriate without further assessment. Checking blood glucose more frequently and/or using rapid-acting insulin may be appropriate, but this will depend on the assessment data. The HbA1C indicates that the client's average glucose level is higher than the target range, but discussing the need to check blood glucose several times every day assumes that the client is not compliant with the therapy and glucose monitoring. The nurse would not assume that adding insulin, which must be prescribed by the primary health care provider, is the answer without assessing the underlying reason for the treatment failure.

Which nursing action will the home health nurse delegate to a home health aide who is making daily visits to a client with newly diagnosed type 2 diabetes? a. Assist the client's spouse in choosing appropriate dietary items. b. Evaluate the client's use of a home blood glucose monitor. c. Inspect the extremities for evidence of poor circulation. d. Assist the client with washing the feet and applying moisturizing lotion.

d. Assist the client with washing the feet and applying moisturizing lotion. The nursing action that the home health nurse can delegate to a home health aide who is making daily visits to a newly diagnosed type 2 diabetic client is assisting with personal hygiene. This action is included in the role of home health aides.Assisting with appropriate dietary selections, evaluating the effectiveness of teaching, and performing assessments are complex actions that would be performed by licensed nurses.

A client recently admitted with new-onset type 2 diabetes will be discharged with a meter for self-monitoring of blood glucose (SMBG) levels. When is the best time for the nurse to explain to the client the proper use of the glucose monitor? a. Day of discharge b. On admission c. When the client states readiness d. While performing the test in the hospital

d. While performing the test in the hospital Teaching the client about the operation of the machine while performing the test in the hospital is the best time for the nurse to introduce the client to SMBG. The teaching can be reinforced each time testing is performed on the client and again before discharge.Instructing the client on the day of admission or the day of discharge would not allow time for redemonstration and correction of the skill if needed. Other time-consuming activities are done on those days and could distract the client and make the client feel overwhelmed. Also, waiting for the client to state readiness may postpone the instructions too long.

Both men and women with diabetes can develop sexual dysfunction as a result of ____.

damage to both nerve tissue and vascular tissue

menopause

decrease of cyclic hormonal production and cessation of menses in females, usually between ages 45 and 60 years

Signs of hypothermia

decreased body temperature and respirations, pale and cool skin, hypotension (decreased blood pressure) decreased muscle coordination and urinary output, disorientation, and drowsiness progressing to coma.

Dehydration

decreased volume of both water and electrolyte change; a loss of total body water producing hypertonicity

dehydration

decreased water volume in body tissue

Hypovolemia

deficiency in amount of water and electrolytes in ECF with near-normal water/electrolyte proportions

hypovolemia

deficiency of blood plasma

hypochloremia

deficiency of chloride in the blood plasma

sexuality

degree to which a person exhibits and experiences maleness and femaleness physically, emotionally, and mentally

gender dysphoria

diagnosis for a person whose gender at birth is contrary to the one with which the person identifies

The pancreas' exocrine functions are related to:

digestion, and endocrine functions ensure blood GLUCOSE REGULATION

sexually transmitted infections (STIs)

disease that spreads from one person to another through intimate sexual contact

sexually transmitted infections (STIs)

disease that spreads from one person to another through intimate sexual contact Very often asymptomatic, especially women

Convection

dispersion of heat by air currents; areas of unequal density i.e. wind chill

Third-space fluid shift

distributional shift of body fluids into potential body spaces

Passive Rewarming

dry and warm clothing, warm drinks, and exercise

Antiepilectic drugs

e.g. Valproic acid - Recommendations suggest that before conception, women who are considering pregnancy should be prescribed a lower dosage of these drugs.

Isotretinoins

e.g., Accutane for the treatment of acne during pregnancy may cause congenital malformations.

Dick-Read method

education and relaxation techniques to interrupt the cycle

Hyperosmolar hyperglycemic state (HHS) usually presents as severe hyperglycemia (>600 mg/dL), dehydration and accompanied impaired mental status, and is more common in ___.

elders with type 2 diabetes

What are some hormones, other than Glucagon, that increase blood glucose levels?

epinephrine, norepinephrine, growth hormone, and cortisol

Hemoglobinemia

excess free hemoglobin buildup in circulation - causes red plasma

hypercalcemia

excess of calcium in the extracellular fluid

hypermagnesemia

excess of magnesium in the extracellular fluid

hypervolemia

excess of plasma

hyperkalemia

excess of potassium in the extracellular fluid

hypernatremia

excess of sodium in the extracellular fluid

Edema

excessive ECF accumulates in tissue spaces

What is hydramnios?

excessive amniotic fluid Resulting from fetal hyperglycemia and consequent fetal diuresis.

Cold stress (newborn)

excessive heat loss that requires newborn to use compensatory mechanisms (nonshivering thermogenesis + tachypnea) to maintain core body temp The biggest concern is respiratory distress.

menorrhagia

excessive menstrual bleeding

Hypervolemia

excessive retention of water and sodium in ECF

When urine ketones are present, the patient should not ___.

exercise Carbohydrate foods should be ingested to raise blood glucose levels above 100 mg/dL (5.6 mmol/L) before engaging in exercise.

pH

expression of hydrogen ion concentration and resulting acidity of a substance

Hyperpyrexia

extremely high body temperature or fever

Hyperpyrexia

extremely high body temperature or fever (106+) Medical emergency -- must be cooled to prevent brain damage

Zygote

fertilized ovum that contains all genetic information provided by each parent

Untreated ketoacidosis can progress to ____.

fetal and maternal death.

Fever of unknown origin (FUO)

fever with an undetermined cause; 101+ for 3+ weeks

Adults with diabetes are recommended to consume at least 25 g of ___ daily.

fiber

Primigravida

first pregnancy

Interstitial fluid

fluid in the spaces between cells

Extracellular fluid (ECF)

fluid outside the cells; includes intravascular and interstitial fluids

intravascular fluid

fluid within blood vessels; plasma

intracellular fluid (ICF)

fluid within the cell; synonym for cellular fluid

hydrostatic pressure

force exerted by a fluid against the container wall

antigen

foreign material capable of inducing a specific immune response

In the absence of insulin, ___ become the source of energy.

free fatty acids

Mood swings

frequent changes in emotional state - characteristic throughout most pregnancies May be hard for family members and partners to understand and cope without blaming themselves

Polymenorrhagia

frequent cycle interval (<21 days)

Low insulin levels trigger release of ___ and ___ (counterregulatory hormones) to increase liver glucose production, further raising blood glucose levels.

glucagon and epinephrine

A common prenatal screening test is the ____.

glucose challenge test (GCT) administered between 24 and 28 weeks.

The ____ is the most sensitive measure of glucose metabolism and can often detect early diabetes.

glucose tolerance test (GTT)

Transplantation requires lifelong drug therapy to prevent ____.

graft rejection

Voyeurism

gratification derived from observing others engaged in sexual acts or body other than partner; peeping tom or spying

GPTAL

gravidity, term, preterm, abortions, living children

Hypertonic

greater concentration of particles than plasma -used to replace ICF, 210W, 5% dextrose in 0.45% NaCl (half-strength NS)

Osmotic diuresis

greatly increased urination and dehydration that results when high levels of glucose cannot be reabsorbed into the blood from the kidney tubules and the osmotic pressure of the glucose in the tubules also prevents water reabsorption.

Danger signs of pregnancy

gush of fluid or bleeding from vagina, regular uterine contractions, severe headache, visual disturbances, abdominal pain, persistent vomiting,fever, chills, swelling face and fingers

Vitamin B12 deficiency anemia

hallmark of vitamin B12 deficiency is megaloblastic anemia When deficient, the red cells that are produced are abnormally large because of excess cytoplasmic growth and structural proteins The cells have immature nuclei with evidence of cellular destruction and delicate membranes that are oval rather than biconcave.

Exertional Heat Stroke

has a sudden onset and is often the result of strenuous physical activity (especially when wearing too heavy clothing) in hot, humid conditions.

hypertonic

having a greater concentration than the solution with which it is being compared

hypotonic

having a lesser concentration than the solution with which it is being compared

isotonic

having about the same concentration as the solution with which it is being compared

heterosexual

having sexual feelings for a person of the opposite sex

Heat illness

heat cramps, heat exhaustion, heat stroke Usually caused by loss of electrolytes

Malnutrition leads to depletion of glucose stores in the liver and adipose tissue and thus prevents ____.

hepatic mechanisms for maintenance of normal glucose levels

The most common environmental factors causing heat-related illnesses are ___ and ____.

high environmental temperature (above 95° F [35° C]); high humidity (above 80%)

What is hyperlipidemia?

high levels of lipids (cholesterol) in the blood

Progesterone

hormone produced by the corpus luteum in the ovary and the placenta of pregnant women Supports endometrium, inhibits uterine contractions, and assists breast development

nonshivering thermogenesis

how do newborns produce heat?

Symptoms of MILD hypoglycemia

hungry, irritable, shaky, weak, headache, fully conscious

Hypochloremia

hyperexcitability of muscles, tetany, hyperactive DTRs, weakness, and muscle cramps FEVER only difference from hyponatremia <96 mEq/L

Insulin prevents ____ by allowing body cells to take up, use, and store carbohydrate, fat, and protein.

hyperglycemia

Both HHS and diabetic ketoacidosis (DKA) are caused by ___ and ___.

hyperglycemia and dehydration

Exercise in the patient with uncontrolled DM results in further ___ and the formation of ___ bodies.

hyperglycemia; ketone

Insufficient insulin secretion results in a ___ state because glucose is unable to enter the cells for cellular metabolism.

hyperglycemic

The large for gestational age infant is at high risk for ___ after birth.

hypoglycemia

All patients who take insulin, those taking long-acting insulin and those taking metformin in combination with glyburide are at risk for ___.

hypoglycemia This risk is increased if they are older, have liver or kidney impairment, or are taking drugs that enhance the effects of antidiabetic drugs.

Treatment for Hypothermia

i. sheltered from the cold environment, have all wet clothing removed, and undergo passive or active external rewarming. ii. Passive warming: warm clothing and blankets iii. Active warming methods: heating blankets, warm packs, and convective air heaters or warmers to speed rewarming iv. Heating blanket: monitor patient's skins every 15-30 minutes to reduce risk of burn v. Have patient drink war, high carb liquids (no alcohol or caffeine)

antibody

immunoglobin produced by the body in response to a specific antigen

Erectile Dysfunction

inability to attain or maintain an erection; can be psychological or physiologic May be caused by medications, DM, spinal cord trauma, surgical procedures, alcoholism Depression, Beta blockers, or illicit drugs

Secondary infertility

inability to conceive after a previous pregnancy

Extravasation

inadvertent administration of a vesicant solution into surrounding tissue

Thyroid hormone

increases basic metabolic rate over time to generate heat

The most common precipitating factor for DKA is ___.

infection

Phlebitis

inflammation of a vein

Phlebitis

inflammation of the walls of a vein; local acute tenderness, warmth, slight edema of vein above insertion site

Initiation (carcinogenesis)

initial mutation occurs: apoptosis

During the ___ phase of fever, the body temperature rises and the patient may experience chills, shiver, and may ask for blankets.

initiation

menarche

initiation of the menstrual cycle

hypocalcemia

insufficient amount of calcium in the extracellular fluid

hypomagnesemia

insufficient amount of magnesium in the extracellular fluid

hypokalemia

insufficient amount of potassium in the extracellular fluid

hyponatremia

insufficient amount of sodium in the extracellular fluid

The beta cells in islet cells produce ___.

insulin and amylin

Hypokalemia (low blood potassium level) may occur and be made worse by ___ and ___ given during surgery.

insulin and glucose

Hyperglycemic-hyperosmolar state (HHS) is caused by ....

insulin deficiency and profound dehydration

Damage or destruction of the β cells results in insufficient or cessation of ___.

insulin secretion

Therapeutic Hypothermia

intentionally induced to reduce metabolism and thereby preserve tissue by preventing tissue ischemia

IUD

intrauterine device that works immediately and is highly effective, must check string for placement

anions

ion that carries a negative electric charge

cation

ion that carries a positive electric charge

The development of ___ is a threat to women who require insulin to properly control their diabetes.

ketoacidosis Ketoacidosis is often precipitated by infection or missed insulin doses, particularly in the woman with type 1 diabetes.

Some adults with type 2 DM have a syndrome known as ___ or KPD.

ketosis-prone diabetes

Thermostatic set point

level at which body temperature is regulated so that core temperature is maintained within the normal range Temperature <93.2 or 105.8> indicates impaired ability

Prolonged starvation and malnutrition can eventually lead to ___.

life-threatening hypoglycemia

solvents

liquid holding a substance in solution

Prescribed drugs that can increase the risk for heat-related illnesses:

lithium, neuroleptics, beta-adrenergic blockers, anticholinergics, angiotensin-converting enzyme (ACE) inhibitors, and diuretics

Convection

loss of heat by air currents (caused by wind or a fan) moving across the body surface

What is hypoglycemia?

low blood glucose levels Less than 70 mg/dL

Postprandial blood sugar

measurement of blood sugar level after a meal

Endocardium

membrane lining the cavities of the heart

premenstrual (tension) syndrome

menstrual cycle-related distress; occurs a few days before the onset of menstruation

Biguanide

metformin (Glucophage, Glumetza, Riomet) Monitor glucose levels frequently, assess renal function before beginning and yearly after. STOP for contrast/iodine after CT scan (about 48 hours)

Active internal rewarming

moderate to severe hypothermia (80-90 degrees) and include cardiopulmonary bypass, warm fluid administration, warm humidified O2 and peritoneal lavage MONITOR for V FIB as temp increases from 88-90 degrees

Oral glucose tolerance testing (OGTT)

most sensitive test for the diagnosis, used for gestational diabetes

Interstitial to plasma shift

movement of fluid from space surrounding cells to blood

active transport

movement of ions or molecules across cell membranes, usually against a pressure gradient and with the expenditure of metabolic energy

Infibulation

narrowing of the vaginal opening through the creation of a covering seal

Morning sickness

nausea during the first few months of pregnancy due to increased estrogen and progesterone along with hcG levels; most common in 6-12 weeks

Amniocentesis

needle puncture of the amniotic sac to withdraw amniotic fluid for analysis; used to confirm fetal abnormality Performed in 2nd trimester, usually between 15-18 weeks Assess vitals every 15 minutes for an hour after; RhoGAM IM if Rh-

Other conditions associated with insulin resistance and proinflammatory states are ____.

non-alcoholic steatohepatitis (fatty liver disease) and sleep apnea.

Transudate

noninflammatory fluid that resembles serum but with slightly less protein

Euglycemia

normal level of sugar in the blood 70-100

Hyperglycemia causes

not enough medication or missed insulin, excess food, illness, infection, stress, steroids,

Heart rate

number of beats per minute; higher usually indicates a high BP

Living children

number of children currently living

Carb counting

nutritional tool used for blood glucose management because carbs are the main nutrients in food that influence blood glucose levels - patients will be education to have a "carb budget" per meal (i.e. 45-60 g)

Ischemic phase

occurs if fertilization does not occur; spasm of arterioles of endometrium result in ischemia of basal layer Menstrual flow begins

autologous transfusion

occurs when a patient donates one's own blood for a transfusion

Frostbite

occurs when body tissue freezes and causes damage to the body tissue.

HHS occurs most often in ___ patients with type ___, many of whom are unaware they have the disease

older; 2 DM

Inhaled insulin

onset: < 15 min peak: about 50 min duration: 2-3 hr

Fellatio

oral stimulation of a man's genitals

Cunnilingus

oral stimulation of the female genitals

HHS results from a sustained ___.

osmotic diuresis Osmotic diuresis is increased urination due to the presence of certain substances in the fluid filtered by the kidneys. This fluid eventually becomes urine. These substances cause additional water to come into the urine, increasing its amount.

Parietal pericardium

outer layer of the pericardium, lines pericardial cavity

Ectoderm

outermost germ layer; produces brain, spinal cord, nervous system, and outer body parts (skin, hair, nails)

dyspareunia

painful intercourse; usually caused by physical issues but can be psychological May be due to diabetes, infection, endometriosis, medications, alcohol, lack of lubrication, positioning, and use of soaps/douches

Dysmenorrhea

painful menstruation: Primary: absent of any underlying pathology Secondary: due to underlying pelvic or uterine pathology Provide adequate pain relief and surgery or ovarian suppressive agents may be needed

Surgical interventions for DM include a ___ or ___ transplantations.

pancreas; islet cells When successful, these procedures eliminate the need for insulin injections, blood glucose monitoring, and many dietary restrictions.

Insulin is produced, stored, and released by ___.

pancreatic β cells (located in pancreatic islets).

osmosis

passage of a solvent through a semipermeable membrane from an area of lesser concentration to an area of greater concentration until equilibrium is established

capillary filtration

passage of fluid across the wall of the capillary; results from the force of blood "pushing" against the walls of the capillaries

Filtration

passage of fluid through a permeable membrane from the area of higher to lower pressure -colloid osmotic pressure -hydrostatic pressure

Obstetric history

past pregnancy, labor, birth, postpartum A history of tubal pregnancy increases risk for another GTPAL

Neonate

period from birth to 28 days of age

menstruation

periodic discharge of bloody secretions through the vagina; usually for 4-5 days each month

Aseptic dressing changes

peripheral lines (changing)

The body conserves heat through ____

peripheral vasoconstriction The process shunts warm blood away from the superficial body tissues and skin surfaces and increases muscle activity to minimize heat loss.

transsexual

person of a certain biologic gender with the feelings of the opposite sex

During the ___ phase of a fever, the patient may feel dry and warm.

plateau

Intersex

possessing biological sexual characteristics of both sexes, occurs in about 1 in 2,000 births

sexual orientation

preferred gender of the partner of an individual

Gravid

pregnant

What is glycosuria?

presence of glucose in the urine. Kidneys can't cope with extra glucose so it leaks into the urine.

Hemoglobinuria

presence of hemoglobin in the urine - causes darker urine

Colloid osmotic pressure

pressure exerted by plasma proteins on permeable membranes in the body; synonym for oncotic pressure

colloid osmotic pressure

pressure exerted by plasma proteins on permeable membranes in the body; synonym for oncotic pressure

contraception

prevention of conception or pregnancy; also used to describe methods used for birth control

Nonshivering Thermosis (NST)

primary method of heat production; the metabolism of brown fat to produce heat.

Female Genital Mutilation

procedures that intentionally alter or cause injury to the female genital organs for non-medical reasons Later in life it can cause cysts, infections, and infertility

Endogenous pyrogens or interleukin-1 (IL-1)

produced by phagocytic white blood cells as part of the immune response

Erythropoiesis

production of red blood cells

When exogenous pyrogens invade the body, endogenous pyrogens are released that trigger the production of ____.

prostaglandin E2

Central venous access devices

provide access for a variety of IV fluids, medications, blood products, and TPN solutions and allow a means for hemodynamic monitoring and blood sampling.

Active Rewarming

providing warm blankets or heating pads, drawing a warm water bath, and placing the patient in a heated environment

Fever is caused by

pyrogens (fever-producing agents)

Follow-up visits

q4wks up to wk 28. q2wks from wks 29 to 36. q1wk from 37 weeks to birth.

How do newborns lose heat quickly at birth?

radiation, convection, conduction, evaporation

Electrocardiogram

record of the electrical activity of the heart

most accurate temperature

rectal

Frost Nip

red or unusually pink color to skin or numbness, itching, and tingling in the area a type of superficial cold injury

The combination of vascular changes and hyperglycemia reduce IMMUNITY by _____.

reducing white blood cell activity, inhibiting gas exchange in tissues, and promoting the growth of microorganisms.

Hyperthermia

refers to a body temperature above normal range (>37.6°C)

Hypothermia

refers to a body temperature below normal range (<36.2°C)

What is insulin resistance?

refers to a state in which the body cells respond abnormally to the signaling action of insulin In other words, there is not a problem with insulin supply but, rather, with how the cell responds to insulin signaling due to a reduction of insulin receptors or glucose transporter molecules,1 resulting in sluggish glucose uptake by the cell.

abstinence

refraining from having sex

When a patient shows periods of febrile episodes alternating with acceptable normal body temperatures, with both often lasting longer than 24 hours, it is called ___.

relapsing fever

When fever spikes and falls without returning to normal temperature, it is called ___.

remittent fever

Clitoridectomy

removal of the entire external portion of the clitoris (glans, shaft, and hood)

Active Transport

requires energy for movement of substances through the cell membrane from the lesser solute concentration to the higher solute concentration (low --> high = ATP)

Kussmaul respirations cause

respiratory alkalosis in an attempt to correct metabolic acidosis by exhaling carbon dioxide.

Secondary polycythemia

results from a physiologic increase in the level of erythropoietin, commonly as a compensatory response to hypoxia which leads to kidneys releasing erythropoietin which causes the increased formation of red blood cells in the bone marrow Treatment of secondary polycythemia focuses on relieving hypoxia

Accidental Hypothermia

results from environmental exposure (including staying out in the cold too long, wearing insufficient clothing for weather conditions, wet clothing, and cold water submersion) or as a complication from serious systemic disorders.

Isotonic

same concentration of particles as plasma -used to replace ECF, 0.9 NaCl (NS), D5W, Lactated Ringers

Oligomenorrhea

scanty or infrequent menstrual flow; bleeding occurs at intervals of more than 35 days

Glucose tolerance test (GTT) and Normal range

screening test in which a dose of glucose is administered and blood samples are taken afterward at regular intervals to determine how quickly glucose is cleared from the blood <140 mg/dL

masturbation

self-stimulation for sexual satisfaction

Sadomasochism

sexual activities that combine sadism and masochism, called S&M

Masochism

sexual arousal from being subjected to pain, bondage, or humiliation

Fetishism

sexual attraction to nonliving things; more common in males than femeales

As core body temperature decreases, compensatory mechanisms including ____ and ____ occur.

shivering (muscle contraction to simulate warmth); vasoconstriction (to reduce heat loss)

Cervical cap with spermicide

small cup that fits over the cervix to prevent sperm from entering the cervical canal

Additional risk factors contributing to poor health outcomes for adults with DM include:

smoking, physical inactivity, obesity, hypertension, and high blood fat and cholesterol levels Many of these factors can be modified to reduce complications related to DM.

Goodell's sign

softening of the cervix

Hegar's sign

softening of the lower uterine segment or uterine softening Adds to urinary frequency

Central thermoreceptors are located in the _____

spinal cord, abdominal organs, and hypothalamus

During the first trimester, when major fetal organs develop, the effects of the abnormal metabolic environment (hypoglycemia, hyperglycemia, or ketosis) increase the incidence of ___ and ___.

spontaneous abortion and major fetal malformations.

With insulin deficiency, the body turns to ___ for energy, releasing free fatty acids.

stored fat

Doppler Flow Studies

study that uses ultrasound for a comprehensive assessment of fetal well-being Can measure velocity of blood flow Noninvasive and as no contraindications

electrolytes

substance capable of breaking into ions and developing an electric charge when dissolved in solution

acid

substance containing a hydrogen ion that can be liberated or released

Acid

substance containing hydrogen ions that can be liberated or released

solutes

substance dissolved in a solution

base

substance that can accept or trap a hydrogen ion; synonym for alkali

Base

substance that can trap hydrogen ions

buffer

substance that prevents body fluid from becoming overly acid or alkaline

Teach those who are at risk for or who have DM to avoid ___ beverages.

sugar-sweetened

Subcutaneous or IM glucagon and 50% IV dextrose are administered to patients who cannot ___.

swallow

Perspiration

sweat evaporation of moisture from the skin surface

insensible perspiration

sweat that evaporates from the skin before it is perceived as moisture Controlled by SNS using AH

Premenstrual Syndrome

syndrome involving physical and emotional symptoms occurring in the 10 days before menstruation; occur during luteal phase Resolve with onset of menstruation More than 150 symptoms associated PMDD is more severe

Masturbation

technique of sexual expression in which an individual practices self-stimulation

Core temperature

temperature of the deep tissues: 97-99.5

Sustained (continuous) fever

temperature remains above normal with minimal variations -often seen in inadvertent drug-induced fever

Rectal temperature

temperature taken in the rectum

Diffusion

tendency of solutes to move freely throughout a solvent ("downhill" = high to low) PASSIVE

diffusion

tendency of solutes to move freely throughout a solvent from an area of higher concentration to an area of lower concentration until equilibrium is established

lesbian

term for a homosexual female

Biologic sex

term used to denote chromosomal sexual development—male (XY) or female (XX)

biologic sex

term used to denote chromosomal sexual development—male (XY) or female (XX)

gay

term used to describe homosexual males

Fetal stage

the 3rd period of prenatal development that lasts from the ninth week until birth: all body organs and systems continue to develop

Afterload

the amount of resistance to ejection of blood from the ventricle

gender role behavior

the behavior a person conveys about being male or female, which may or may not be the same as biologic gender or gender identity

Speed shock

the body's reaction to a substance that is injected into the circulatory system too rapidly S&S: pounding headache, fainting, rapid pulse, apprehension, chills, back pain, and dyspnea

What is glucose in the blood after a meal controlled by?

the emptying rate of the stomach and delivery of nutrients to the small intestine, where they are absorbed into circulation

Menarche

the first occurrence of menstruation; usually about 12 years but can occur from 8-18 years old

Infertility

the inability to conceive a child after trying for at least a year

Retarded ejaculation

the inability to ejaculate when one wishes to during intercourse or delayed Usually due to interpersonal issues when occurring after normal ejaculations; possibly related to neurologic disorders or Parkinsons

Visceral pleura

the inner layer of pleura that surrounds each lung

Gender identity

the inner sense a person has of being male or female, which may be the same as or different from biologic gender

gender identity

the inner sense a person has of being male or female, which may be the same as or different from biologic gender; synonym is sexual identity

Sexual health

the integration of the somatic, emotional, intellectual, and social aspects of sexual being in ways that are positively enriching and that enhance personality, communication, and love

sexual health

the integration of the somatic, emotional, intellectual, and social aspects of sexual being in ways that are positively enriching and that enhance personality, communication, and love

blood typing

the laboratory examination to determine a person's blood type

Flash chamber

the portion of an over-the-needle catheter that allows observation of a blood return when the catheter enters a vein

Every week

the prenatal office visit should be how often from 37 weeks until delivery?

What is thermoregulation?

the process of maintaining the core body temperature at a nearly constant value

Lightening

the sensation of the fetus moving from high in the abdomen to low in the birth canal

Pleural cavity

the space between the two layers contains a thin layer of serous fluid

lactational amenorrhea

the suppression of ovulation and menstruation during breast-feeding - lasts about 6 months; must breastfeed on demand without supplementation Still a 1-2% failure rate

Menopause

the time of natural cessation of menstruation; also refers to the biological changes a woman experiences as her ability to reproduce declines Average age is 50-51 years old, but can be from 45-55 years old 1 year without a menstrual period

Perimenopause

the transition phase between regular menstrual periods and no periods at all, 2-8 years before menopause Can occur as early as 35 years old

Preload

the volume of blood in the ventricles at the end of diastole before the next contraction

Newborn Characteristics that lead to Heat Loss

thin skin, blood vessels closer to surface, little subQ white fat to insulate, 3X more surface area to body mass than adults

Hypoglycemia stems from....

too much insulin or too little glucose

Fibrous pericardium

tough, white fibrous connective tissue that is the outermost layer of the pericardium

Conduction

transfer of heat through direct contact of one surface to another

A fasting glucose level of 126 mg/dL or greater on ___ separate occasions is indicative of diabetes.

two

The risk for myocardial infarction and stroke is ___ times higher for those with type 2 diabetes compared to those without diabetes.

two to four

The risk for stroke is ___ to ___ times higher in adults with DM compared with those who do not have the disease

two to four

Hypoglycemia occurs two or three times more frequently in those with ___.

type 1 diabetes

Symptoms of SEVERE hypoglycemia

unable to swallow; unconsciousness or convulsions

Promotion (carcinogenesis)

unregulated, accelerated growth in already initiated cells - caused by various chemicals and growth factors - Reversible IF promoter substance is removed Preneoplastic/benign lesions

Sexual harassment

unwelcome behavior that is based on one's sex or gender; can be directed toward people of any age, gender, or sexual orientation

sexual harassment

unwelcome verbal or physical advance or sexually explicit statement (e.g., leers, pats, grabs, jokes, requests for dates, and even rape) that interferes with one's ability to do one's job by making one feel humiliated, intimidated, or uncomfortable

epicardium

visceral layer of serous pericardium; innermost part of pericardium

Afebrile

without fever

Multigravida

woman who has been pregnant more than two times

When a patient who has had reasonably controlled blood glucose levels in the hospital develops an unexpected rise in blood glucose values, check for ____.

wound infection

Characteristics of Type 2 Diabetes

• Adult-onset diabetes • Ketone-resistant • Onset is usually any age in adults • Frequently no symptoms; thirst, fatigue, blurred vision, vascular or neural complications • 60-80% obese • Insulin is required for 20-30% of those diagnosed

Management at home of SEVERE hypoglycemia (less than 20 mg/dL)

• Give 1 mg of glucagon as intramuscular or subcutaneous injection. • Give a second dose in 10 minutes if the person remains unconscious. • Notify the primary health care provider immediately and follow instructions. • If still unconscious, transport the person to the emergency department. • Give a small meal when the person wakes up and is no longer nauseated.

Characteristics of Type 1 Diabetes

• Juvenile-onset diabetes • Ketone-prone • Onset is usually younger than 30 y.o. • Abrupt onset, thirst, hunger, increased urine output, weight loss • Usually non-obese • All dependent on insulin

Signs of hyperglycemia

• Polyuria • Polydipsia • Dehydration • Fatigue • Fruity odor to breath • Kussmaul breathing (deep, labored breathing) • Weight loss • Hunger • Poor wound healing

Signs of hypoglycemia

• Reduced cognition • Tremors • Diaphoresis • Weakness • Hunger • Headache • Irritability • Seizure

Iron cycle

• The iron cycle revolves around the conversion of ferrous iron to ferric iron and back again • Ferric iron reduction is part of the respiratory pathway of some bacteria • Some bacteria can produce magnetite • Some bacteria can use ferrous iron as an electron donor

Management at home of MODERATE hypoglycemia (less than 40 mg/dL)

• Treat the symptoms of hypoglycemia with 15 to 30 g of rapidly absorbed carbohydrate. • Retest glucose in 15 minutes. • Repeat treatment if glucose is less than 60 mg/dL (3 mmol/L). • Eat additional food, such as low-fat milk or cheese, after 10 to 15 minutes.