Detailed Pathophysiology Exam 3 Study Guide
Hydrocele and Hematocele
●Hydrocele •Collection of serous fluid in the scrotum •Swelling and feeling of heaviness •Wait to see if body will reabsorb the fluid ●Hematocele •Collection of blood in scrotum •Often caused by trauma or infection, same with hydrocele •Wait to see if body reabsorbs the blood
Systemic Effects of Hypothyroidism
●Hyperlipidemia ●Yellow-orange skin (elevated carotene levels) ●Anemia ●Decreases filtration by kidney ●Pendred's syndrome: defective iodine incorporation into thyroid hormone ●Myxedema: Adult severe hypothyroidism ●Subclinical hypothyroidism: present in elderly
Hypoadrenalism and Glucocorticoids
●Hypoadrenalism can also be due to exogenous glucocorticoids •With prolonged glucocorticoid use, CRF-ACTH signals to adrenal cortex suppressed •Adrenal gland down regulates receptors •Steroid usage should not be abruptly stopped ‒Individual may be unable to respond to stressor ●Smallest dosage of steroid needed should be given to patient to lessen adrenal atrophy
Disorders of the Breast
●Mastitis •Inflammation of breast, most commonly occurs with lactation ●Galactorrhea •Secretion of breast milk in non-lactating breast •Prolactin-secreting pituitary tumor may cause ●Mammary duct ectasia •Inflammation in subareolar ducts •Common in postmenopausal women •Small, calcified mass •Biopsy usually performed
Pelvic Inflammatory Disease (PID)
●May lead to infertility ●Infection ascending into internal upper reproductive organs ●Acute, chronic, or silent infection •Acute: pelvic pain and possible fever •N. gonorrhoeae: common cause of acute •C. trachomatis: asymptomatic ●Women most at risk have history of multiple sex partners, past STI's, intrauterine device use ●Can be difficult to diagnose ●Physical and pelvic examinations, sexual history •Pain with cervical motion during pelvic exam •Chandelier sign ‒Exquisite tenderness of the cervix on a pelvic examination ●Specific symptoms and laboratory tests •Fever, vaginal or cervical discharge, elevated ESR and C-RP, gonococcus or chlamydia positive test
Uterus- endometriosis
●May occur in conjunction of infection of other tissues •i.e., uterine tubes, ovaries ●Usually a mixed infection, often ascending from vagina •Gonococcus, Chlamydia trachomatis, Enterococcus ●Symptoms •Vaginal bleeding, uterine tenderness, fever, malodorous discharge ●Antibiotic treatment based on causative organism ●Growth of endometrial tissue outside of uterus •~15% of women •~80% of women with pelvic pain ●Ovaries, uterine ligaments, pelvic peritoneum, myometrium of uterus (adenomyosis) are locations for endometrial growth ●Displaced tissue responds to hormonal signals, causing bleeding, pain, infertility Definitive diagnosis •Laparoscopy ●Treatment •Surgery •NSAID's •Oral contraceptives •Long-acting GnRH
More menstrual disorders
●Menorrhagia •Excessive menstrual bleeding •Menses lasts greater than 7 days ●Metrorrhagia •Excessive uterine bleeding •Both at time of normal menstrual period and more frequency ●Oligomenorrhea •Infrequent periods •Prolonged time between periods
Insulin Therapy
●Mimic physiological control of BG •Basal insulin: during fasting •Postprandial insulin: after eating ●Types •Conventional insulins ‒Synthetic human insulins •Insulin analogues ‒Synthetic preparations, pharmacokinetic profile mimics physiological response ‒Both come in forms of short-, intermediate-, and long-acting Conventional ●Regular •Rapid-acting, short duration ●NPH •Intermediate-acting, longer duration ●Lente •Intermediate-acting, longer duration ●Ultra lente •Long-acting, long duration Insulin Analogues ●Lispro (Humalog) •Rapid-acting ●Aspart (Novolog) •Rapid-acting ●Glargine (Lantus) •Long-acting ●Detemir (Levemir) •Long-acting
Hyperosmolar Hyperglycemic Syndrome (HHS)
●More common in T2DM than T21M ●Ketones not present, as some insulin present •BG greater than 600 mg/dL •pH greater than 7.3 •HCO3- greater than 18 mEq/L •Blood osmolarity greater than 320 mOsm/L ●Hyperglycemia and increased plasma osmolarity ●Hyperglycemia •Can not adequately facilitate glucose uptake •Gluconeogenesis and glycogenolysis further increase BG ●Hyperosmolarity •Osmotic diuresis: high BG •Polyuria ●Can develop insidiously over day to weeks ●Presentation •Weakness, poor tissue turgor, tachycardia, rapid and thready pulse, confusion • 25% of patients present in coma ●Causes •Infection (pneumonia, sepsis) •Noncompliance of DM management •Substance abuse •Coexisting diseases
Somogyi Effect
●Morning hyperglycemia present ●Due to: •Insulin therapy (excessive dosage) or insulin peak during sleep causes hypoglycemia •Compensatory mechanisms raise BG by morning ●Adjust insulin as needed
Dawn phenomenon
●Morning hyperglycemia present ●Due to: •Nocturnal elevations of growth hormone •Decrease cell utilization of glucose, raising BG levels ●Nocturnal hypoglycemia does not occur ●Adjust medications, exercise, eating patterns
thyroid nodules
●Most asymptomatic ●Hypothyroidism or hyperthyroidism •Single nodule ‒Increased malignancy risk •Multiple nodules ‒Often benign ●Ultrasound and needle biopsy for diagnosis ●Technetium scan •Uses radioactive isotope •Hot nodule ‒Hyperfunctioning tumor •Warm nodule ‒Normal tissue •Cold nodule ‒Hypofunctional tissue, sometimes malignant
Testicular cancer
●Most common cancer in males age 15 to 35 years in U.S. ●High cure rate if detected early •Germ cell tumors most common type •Risk increases with cryptorchidism ●Painless swelling, nodule, or mass on one testicle is most common sign •On physical exam, mass can not be separated from testis •Dull ache or heavy sensation in abdomen may be present Diagnostic tests •Chemistry profile, tumor markers ‒AFP and b-HCG •CT scan and lymph node assessment ●Treatment •Orchiectomy •Radiation •Chemotherapy
Testicular torsion
●Most common in adolescents ●Twisting of spermatic cord, can obstruct blood flow leading to ischemia and infarction ●Sudden, severe unilateral pain is a primary symptom, as is swelling ●Surgical correction is necessary (urological emergency) •Few complications if detorsion is initiated within 6 hours of pain onset •Loss of testicle may occur if surgery delayed
Protozoal—Trichomonas vaginalis
●Most common nonviral STI worldwide ●Common coinfection with bacterial vaginosis ●Women •Asymptomatic or pruritus, dysuria, green-yellow vaginal discharge ●Men •Asymptomatic or urethritis ●Diagnosis •NAAT, rapid ID tests Treatment •Metronidazole (also treat partners)
endocrine regulation
●Negative feedback mechanism •End-product hormone negatively feeds back to prevent further stimulatory signals ‒Example: thyroid hormones suppress thyroid-stimulating hormone production ●Receptor activity •Upregulation ‒Increased receptor sensitivity and number •Downregulation ‒Decreased receptor sensitivity and number
Bacterial—Gonorrhea
●Neisseria gonorrhoeae ●Cervicitis, proctitis, urethritis, PID, conjunctivitis, pharyngitis •Complications ‒Ectopic pregnancy, infertility, increased HIV infection risk •Vaginal delivery ‒Newborn conjunctivitis, ophthalmia neonatorum ●Multiple sex partners, MSM increase risk •MSM: increased carrier status, antibiotic-resistant strains
Bacterial—Mycoplasma Genitalium
●Nongonococcal urethritis in men •Painful urination, discharge ●PID in women •May be asymptomatic ●Often coinfection with chlamydia ●Diagnosis •NAAT ●Treatment •Antibiotics (partners should be treated as well)
Blood Glucose Levels
●Normal BG •70-100 mg/dL (fasting) •Hypoglycemia ‒BG less than 70 mg/dL ‒Brain functioning affected •Hyperglycemia ‒BG greater than 200 mg/dL ●Fasting BG •100-125 mg/dL ‒Impaired glucose tolerance (IGT) = "prediabetes" •Greater than 126 mg/dL = diabetes ●Postprandial BG •Glucose after eating •Greater than 200 mg/dL = diabetes
Chlamydia—Diagnosis
●Obligate intracellular bacterium •Extracellular infectious elementary body ‒Similar to infectious spores •Noninfectious intracellular reticulate body ●In women with PID •Fitz-Hugh-Curtis syndrome ‒Fibrotic adhesions around liver •Reiter's syndrome ‒Autoimmune reactive arthritis following infection External signs may be absent •Urethritis may be present in males •Vaginal bleeding after intercourse ●NAAT's used for diagnosis •Obtain endocervical, rectal, urethral, oropharyngeal secretions Pap smear
Bacterial Infections—Chlamydia
●One of the most common STI's ●Often asymptomatic •May cause cervicitis, urethritis, PID, conjunctivitis •Can lead to infertility in women ●Unprotected sexual activity •Vaginal, anal, or oral sexual practices •Vaginal delivery can lead to infection of infant ‒Pneumonia or conjunctivitis
Gonorrhea
●Resistant to many of body's defenses (high mutation rate) ●Carry antibiotic-resistant genes (penicillinases) ●Men •Dysuria, purulent discharge ●Women •Asymptomatic purulent vaginal discharge or genital pruritus •PID •Fitz-Hugh-Curtis syndrome •Reiter's syndrome
Assessment of Male Reproductive Disorders
●Risk factors •Injury/trauma •Teratogens •Testicular dysgenesis syndrome (TDS) ‒Results from disruption of embryological programming and gonadal development ●Signs and symptoms •Physical exam of lower pelvis, inguinal and scrotal region •Digital rectal exam (DRE) ‒Assess prostate gland ●Diagnosis •Genetic and hormonal testing •STI's •DRE •PSA (prostate cancer)
Adrenal insufficiency
●Secondary •Decreased ACTH ●Primary •AKA: Addison's disease •Autoimmune destruction adrenal cortex ‒Antibodies to adrenal cortex ‒Antibodies to steroid enzymes
Delayed puberty
●Secondary sex characteristics have not appeared by age 13 ●Most cases are genetic •Constitutional growth delay (CGD) ●Other causes •Chronic illness, eating disorders, strenuous exercise
Diagnosis of Syphilis
●Serological tests •Antibody levels may remain elevated after treatment ●PCR ●Venereal disease research laboratory (VDRL) ●Rapid plasma reagin (RPR) ●ICE syphilis recombinant antigen test ●Fluorescent treponemal antibody (FTA-ABS) test
Diagnosis of Hyperadrenalism
●Serum levels •Elevated WBCs, hyperglycemia, hypokalemia ●Salivary levels of cortisol, 24-hour urine cortisol ●Dexamethasone suppression test •Administer dexamethasone •Serum cortisol should be suppressed •Cushing's syndrome: no cortisol suppression with dexamethasone ●MRI, CT scan
Multiple Endocrine Neoplasia (MEN)
●Several forms ●MEN1 is most common ●Defective tumor suppressor gene ●Allows tumor growth in several different endocrine glands •Parathyroid, pituitary, and pancreas most commonly affected
Clinical presentation of STIs
●Some STI's are asymptomatic ●Women •Lower tract infection (vulva, vagina, cervix) or upper tract •Purulent vaginal discharge •Bleeding •Pelvic or abdominal pain are signs ●Men •Urethritis (burning upon urination) •Discharge from penis •Inflammation of other reproductive structures
Which of the following are waste products that may elevate in the serum when the kidneys are failing? Select all that apply. Glomerular filtration rate Albumin Creatinine Leukocyte esterase Blood urea nitrogen
5,3
GFR (glomerular filtration rate)
90-120 mL/min Renal function
Lack of Erythropoietin (EPO)
- Usually, due to kidney failure, hypothyroidism may also decrease EPO - Recombinant EPO can be given
Hypothalamus
A neural structure lying below the thalamus; it directs several maintenance activities (eating, drinking, body temperature), helps govern the endocrine system via the pituitary gland, and is linked to emotion and reward.
A nurse is evaluating a patient's risk for renal disorders. Which of the following increase the risk for renal dysfunction? Select all that apply. A patient with diabetes mellitus A patient with severe hypertension A patient with systemic lupus erythematosus A patient with cirrhosis A patient with peptic ulcer disease
A patient with diabetes mellitus A patient with severe hypertension A patient with systemic lupus erythematosus
medications for pulmonary disorders
-antibiotics -bronchodilators -decongestants -antitussive meds -antihistamine -antiviral drugs
What treatment option should be considered first for George's condition? Peritoneal dialysis Antibiotics Hemodialysis Adequate fluid maintenance
Adequate fluid maintenance In prerenal acute kidney injury, maintaining adequate perfusion to the kidney is key. In George's case, adequate fluid maintenance will be required to ensure the kidneys receive enough blood flow to maintain GFR and filter wastes.
Who has an increased risk of kidney disease?
African Americans
Tuberculosis
An infectious disease that may affect almost all tissues of the body, especially the lungs Most common in the world Transmitted through inhalation of airborne droplets of mycobacterium tb Once inhaled bacteria settle in the lungs WBCs are unable to kill the organism, but can wall off the infection Resulting in a lesion called a tubercle Lung tissue damage occurs- causing cheese like appearance know as caseous necrosis Clinical signs include: chronic cough Hemoptysis Weight loss 20% may present with no symptoms
pneumonia
An inflammation of lung tissue, wherer the alveoli in the affected areas fill w/fluid
Pneumonia
An inflammation of lung tissue, wherer the alveoli in the affected areas fill w/fluid Bacteria, viruses, and fungi especially in immunocompromised individuals may cause pneumonia S.pneumoniae - community acquired pneumonia Staphylococcus aureus - hospital acquired forms Ventilator associated pneumonia may also occur Bacterial pneumonia may develop from a secondary infection following a virus like the flu
TB symptoms
Chronic cough Purulent sputum Hemoptysis Weight loss Anorexia Low grade fever Night sweats
ketones in urine
Diabetic ketoacidosis or starvation
Which of the following bacterial infections is most worrisome to the clinician in regards to glomerular damage? Staphylococcal Clostridial Neisseria Streptococcal
D
Basic Concepts
Female reproductive organs •Ovaries, uterus, fallopian tubes, vagina, and breasts ●Menstrual cycle •Hormonal, uterine, and ovarian changes •Estrogen and progesterone produced by ovaries
Fibrocystic Breast Disease and Fibroadenoma
Fibrocystic breast disease •Largely benign •1 in 3 women age 35-50 years of age •Granular breast masses prominent in second half of menstrual cycle •Ultrasound and mammogram to diagnose ●Fibroadenoma •Benign breast mass, common in 25-45 year-olds, premenopausal women •May indicate increased risk for breast cancer •Single, "rubbery" mass
Which term refers to distention of the renal calyces and pelvis?
Hydronephrosis
To determine if a patient is suffering from pheochromocytoma, which laboratory value would you examine? Aldosterone Norepinephrine Cortisol Adrenocorticotropic hormone
Norepinephrine
Lymphogranuloma Venereum (LGV), Chancroid, and Granuloma Inguinale
Once uncommon in U.S. ●Increasingly diagnosed in HIV-infected ●Chancroid •Transmitted through casual sexual contact ●LGV and granuloma inguinale •More prevalent in tropical climates •Incidence of LGV has increased among MSM
hypercapnic respiratory failure
INCREASED CO2 (greater than 45mm Hg) and DECREASED pH (less than 7.35), Telling us it's a VENTILATION problem, pt either not breathing enough or has an airtrapping diagnosis such as asthma or COPD
Pylonephritis treatment
MUST GET CULTURE Treat for 14 days total PO levo/Cipro for 7 days
A patient presents with secondary hyperthyroidism. Which of the following values does the nurse expect to see reduced on the chart? Thyroid stimulating hormone (TSH) Thyroxine Thyrotropin releasing hormone (TRH) Triiodothyronine
Thyrotropin releasing hormone (TRH)
The kidneys synthesize what?
Vitamin D
Thyroid
Triiodothyronine (T3) and thyroxine (T4) •Iodine required for synthesis •Thyroxine ‒Regulate body metabolism ●Thyroid disorder more common in women ●Primary thyroid disorders most common ●Enlarged thyroid can indicate hypo- or hyperfunction
uterine prolapse
Uterine prolapse •Protrusion of uterus into vagina •Multiparous women •Degrees of prolapse •Pessary ‒Supportive device that is inserted to hold uterus in position
When we encounter the rhinovirus
We are likely to suffer from acute rhinitis, or common cold. Common symptom of green or yellow nasal discharge It can also result from allergies- but with clear nasal discharge
Mycoplasma
What genus is known as the smallest free living bacteria? (hint: has no cell wall and has sterols in the membrane)
renal osteodystrophy
a general term that refers to bone disease related to CKD and caused by over- or underproduction of parathyroid hormone or by exposure to aluminum
lung abscess
a pus-containing lesion of the lung parenchyma that results in a cavity formed by necrosis of lung tissue.
Types of Renal Dysfunction:
Prerenal Intrarenal Postrenal
Lung pathology
Qi deficiency, Pallor, thin chest, sadness, skin problems, atopic constitution, phlegm, exterior invasions of wind
Apparatus is affected by:
Respiratory infection & Smoking
A patient has been diagnosed with syndrome of inappropriate anti-diuretic hormone (SIADH). Which of the following is the correct approach by the nurse? Frequently encourage the patient to drink water. Restrict fluid intake. Wait to see whether the patient stabilizes before any interventions. Plan to administer an IV for fluid restoration.
Restrict fluid intake.
albuminaria
albumin in the urine
Acute Bronchitis Treatment
Supportive care only Cough medications Self limiting usually caused by a virus Antibiotics for a bacterial cause
Kidney disease can present in a number of ways:
Step 1-Decreased perfusion of kidney Step 2-Activation of RAAS Step 3- Hypertension
Acute glomerulonephritis typically occurs after what kind of infection?
Streptococcal
Which type of infection most commonly causes damage to the kidneys? Neisserial Clostridial Streptococcal Staphylococcal
Streptococcal
urine analysis
looks at various lab values in the urine such as solute concentration, pH, electrolytes, cortisol, bacteria
nephrotic syndrome
loss of large amounts of plasma protein, usually albumin, through urine due to an increased permeability of the glomerular membrane
Olguria
low urine output
mucociliary apparatus
mechanism that traps inhaled particles in a mucus layer and moves it up and out of the respiratory tree
Epiglottitis
severe, life-threatening infection of the epiglottis and supraglottic structures that occurs most commonly in children between 2 and 12 years of age Air way becomes blocked This narrowed passageway appears as a steeple sign on an X-ray
A patient has a tumor that compresses the posterior pituitary. Which hormones are likely affected? Select all that apply. Adrenocorticotropic hormone (ACTH) Growth hormone (GH) Oxytocin Thyroid stimulating hormone (TSH) Antidiuretic hormone (ADH)
oxytocin and ADG
flank pain
pain located in the fleshy part of the side between the ribs and the hip
treatment for PKD
primarily supportive designed to limit cyst formation
Destruction or removal of the parathyroid glands will cause _________________. secondary hypoparathyroidism primary hyperparathyroidism primary hypoparathyroidism pheochromocytoma
primary hypoparathyroidism
ciliated pseudostratified columnar epithelium
protection (lining of airways)
Which of the following would alert the clinician that the patient may have acute glomerulonephritis? Select all that apply. Pain with urination Protein in urine Oliguria Blood in urine Fluid accumulation in renal pelvis
protein & blood in urine, oliguria
protienuria
protein in the urine
as glomeruli are destroyed what appears in the urine in good pastures syndrome?
proteins and red blood cell casts
Left ventricular heart failure often causes
pulmonary edema, an accumulation of fluid around the alveoli. As the left ventricle is unable to pump blood effectively, the blood backs up in the pulmonary system. Clinical manifestations include cough, dyspnea, stridor, pink sputum, and crackles on auscultation.
A patient is having a severe asthma attack. Which of the following may be elevated? Hemoglobin saturation Forced expiratory volume (FEV) 1.0/forced vital capacity (FVC) ratio Respiratory rate FEV1.0
respiratory rate
Hypocalcemia
an abnormally low level of calcium in the blood
acute bronchitis
an inflammation of the lower respiratory tract that is usually due to infection.
obstructive uropathy
anatomic changes in the urinary system caused by obstruction
Lung abscess treatment
antibiotics, perhaps surgical resection
Which of the following are associated with chronic bronchitis? Select all that apply. Cyanosis Air trapping Blue bloater Hyperresonance Problems getting air into the lungs
cyanosis blue bloater problems getting air into the lungs
glucose in urine indicates
diabetes mellitus
peritoneal dialysis
dialysis in which the lining of the peritoneal cavity acts as the filter to remove waste from the blood
Which condition causes a steeple sign on X-ray? Rhinitis Pneumonia Allergic rhinitis Epiglottitis
epiglottis
The kidneys produce what?
erythropoietin
Creatnine Clearance
estimates GFR procedure similar to 24 hr urine collection but may be over short period of time
ATN (acute tubular necrosis)
everything else other than autoimmune, infection contrast, hemolysis, mult myeloma, aminoglycosides, poisons such as ethylene/methanol, rhabdo not oligouric granular cast oligouria, less than 500ml/day in ischemia, trauma cause
Hyperfunction
excessive hormone production
A patient is diagnosed with nephrotic syndrome. Which of the following does the nurse expect to observe? Decreased serum blood urea nitrogen (BUN) Fatty casts in urine Absence of edema Patient in severe pain due to stone formation
fatty casts in urine
A woman is diagnosed with stress incontinence. Which of the following are risk factors for this disorder? Select all that apply. Multiple childbirths Low estrogen levels Female sex Young age Postmenopausal
female sex multiple childbirths post menopausal low estrogen
Ulcerative IC
hunner ulcer is present on bladder wall when over distended
Which of the following would you expect to see in a patient suffering from Addison's disease? Elevated cortisol Hypoglycemia Elevated norepinephrine Elevated serum calcium
hypoglycemia
Corticotropin-releasing factor is produced by which tissues? Hypothalamus Ovaries Anterior pituitary Adrenal glands
hypothalamus
urinary incontinence
inability to control urination (common in women) several forms exist including stress, overflow, and neurogenic bladder stress is most common due to loss of muscle support in the pelvic floor. Diagnosis can be performedwith a simple urinary cough test Treatments include exercises to strengthen the pelvic floor, medical devices such as urethral occlusive devices, and surgery
Hypofunction
inadequate amount of hormone secreted by the gland
kidney stone treatment
increase fluid intake, dietary modification, shock wave therapy (extracoprpreal lithotripsy), surgery
kidney stone diet
increased fluid intake, calcium-controlled, low-oxalate
pharyngitis
inflammation of the throat Commonly caused by viruses, it can also be caused by streptococcus pyrogenes Can lead to scarlet& rheumatic fevers Or glomerulonephritis
tracheitis
inflammation of the trachea
polysystic kidney disease (PKD)
inherited disease in which sacs of fluid called cysts develop in the kidneys
Pulmonary embolisms most commonly originate in the _______________. neck abdomen shoulder leg
leg
What indicates a UTI
leukocyte esterase & Nitrite
bilirubin and urobilinogen may indicate
liver disease
non-ulcerative interstitial cystitis
shows small tears and hemorrhages of a thinning bladder wall
chronic hypoxia
someone used to living with lower oxygen levels, see long term affects i.e.clubbing, decreased urinary output, systemic issues
Erythopoietin
stimulates the production of red blood cells
Nephrolithialisis
stone formation- caused by: hypercalcemia,hyperoxaluria, hyperuricemia,hyperparathyroidism, and gout. Dietary factors, intestinal absorption issues, and endocrine abnormalities contribute to these states.
Urolithiasis
stones in the urinary tract
A patient arrives in the emergency department complaining of a kidney stone. Which of the following is the appropriate nursing intervention? Restrict all fluids. Withhold pain medications until the stone is passed. Strain urine. Offer sedative.
strain urine
What is the most common cause of acute glomerulonephritis? Streptococcal infection Epstein-Barr virus Staphylococcal infection Cytomegalovirus
streptococcal infection
A patient's chart lists the presence of incontinence. With no further information provided, which type of the incontinence is the nurse most likely to encounter in the patient? Overflow Stress Neurogenic Functional
stress
Cortisol
stress hormone released by the adrenal cortex
ESRD (end stage renal disease)
the last stage of chronic kidney disease requiring transplantation or dialysis
hemodialysis
the process by which waste products are filtered directly from the patient's blood
Bronchophony
the spoken voice sound heard through the stethoscope, which sounds soft, muffled, and indistinct over normal lung tissue
VAP
ventilator associated pneumonia
costovertebral angle pain
what is a way to test for renal inflammation on physical exam?
Management of DKA
●Evaluate BG every 1 to 2 hours ●Urinalysis for glucose and ketones ●Cardiac monitoring (due to electrolyte shifts) ●Fluid replacement ●Insulin ●K+ supplementation often necessary
Diabetic foot care
●Examine foot sensation with light touch ●Testing of Achilles tendon reflex ●Sense of toe position ●Examine for injuries or wounds
Antidiabetic Medications
As more than 1 drug often needed, presynthesized drug combinations are available ●Welchol •Bile acid sequestrant, helps with glycemic control ●Bromocriptine •Dopamine agonist shown to be helpful in regulating BG
Assessment of menstrual disorders
Assess systemic disorders and any pain presentation ●History •Date of last menstrual period (LMP) •Duration of period •Length between periods •Regularity of periods •Volume of blood loss (saturation of a tampon or pad per hour is excessive) ●Sexual history (5 P's) •Partners, practices, prevention of STI's, past history of STI's, pregnancy prevention ●Family history ●Women older than 18 or sexually active girls •Pelvic exam •Breast exam •Pap and HPV tes
Pylonephritis symptoms
- fever/chills - tachy (HR and RR) - flank, back, or loin pain - ab discomfort - N/V - urgency, frequency, nocturia - malaise/fatigue - tender costovertebral angle (CVA)
gas exchange in lungs
-primary function of lungs -each alveolus is surrounded by a network of capillaries which bring deoxygenated blood from pulmonary arteries (originate from right ventricle of heart) - the walls of alveoli are one cell thick which facilitates diffusion of CO2 from blood into lungs and O into the blood -oxygenated blood returns to left atrium of heart via pulmonary veins -driving force of gas exchange is pressure differential of gases -when blood initially arrives at alveoli, it has a low partial pressure of O and a high partial pressure of CO2 which facilitates transfer of each down its respective concentration gradient -no energy is required for gas transfer -respiratory system adjusts if moved to higher altitudes where less oxygen is available
stages of chronic renal failure
-stage 1: kidney damage with normal or increased GFR (>90) -stage 2: mild reduction in GFR (60-89) -stage 3: moderate reduction in GFR (30-59) -stage 4: severe reduction in GFR (15-29) -stage 5: kidney failure (<15)
A patient's glomerular filtration rate (GFR) is 110 ml/min. Which of the following interpretations is correct? Renal function is normal. The value is too high; the kidneys are not concentrating the urine. This value is too low; the patient is retaining fluids. The value is too low due to decreased renal perfusion.
A
A patient is suffering declining kidney function due to an autoimmune disease. The patient asks the nurse how much of his kidney must suffer damage to lead to end stage renal disease (ESRD). Which of the following is the appropriate response by the nurse? Usually ESRD develops when less than 10% of the nephrons are damaged. Usually ESRD develops when 10% to 20% of the nephrons are damaged. Usually ESRD develops when 65% to 75% of the nephrons are damaged. Usually ESRD develops when 90% to 95% of the nephrons are damaged.
D
Glomerular filtration rate (GFR) is recorded as 12 ml/min. What is the correct interpretation by the nurse? Renal function has returned to normal. The patient is ready to be discharged. Renal function is not normal, as the patient is in stage 3 chronic renal failure (CRF). Renal function is above normal levels. Renal function indicates stage 5 CRF.
D
A patient's laboratory results reveal elevated adrenocorticotropic hormone (ACTH) and cortisol with lower-than-normal corticotropic releasing factor (CRF). Which tissue is likely the cause of the patient's endocrine disorder?
anterior pituitary
Which of the following comments by a patient shows understanding of the dietary changes that may help in interstitial cystitis? "I should probably give up or limit my morning cup of coffee." "I need to become a vegetarian." "I need to drink less water each day in order to urinate less." "Spicy food may help alleviate my symptoms."
"I should probably give up or limit my morning cup of coffee."
Aldosterone
"salt-retaining hormone" which promotes the retention of Na+ by the kidneys. na+ retention promotes water retention, which promotes a higher blood volume and pressure
SaO2 (Oxygen Saturation)
*95 - 98%* Normal [> 90% is normal, < 86% is emergency; < 70% is life-threatening]
Which of the following hormones are not altered in a pheochromocytoma? Cortisol Aldosterone Epinephrine Norepinephrine Adrenal androgens
-Cortisol-Aldosterone-Adrenal androgens
Infection of the renal system may be evident by the presence of which of the following in a urine sample? Select all that apply. -Nitrite -Leukocyte esterase -Calcium -Glucose -Albumin
-Nitrite - Leukocyte esterase
Which statements are valid only for prerenal kidney injury when compared with both intrarenal and postrenal kidney injury? Select all that apply. -Can be caused by prostatic hyperplasia Is associated with a significant increase in the glomerular filtration rate (GFR) -Caused by any condition that decreases blood flow and renal perfusion -Can be caused by radiopaque dye used in imaging studies -Can be caused by hypovolemic shock
-Prerenal is caused by any condition that decreases blood flow and renal perfusion. -Prerenal can be caused by hypovolemic shock.
Which of the following are true? Select all that apply. -Renin levels increase with poor kidney perfusion. -Heart failure results in postrenal failure. -Nephrotoxic drugs are a cause of intrarenal failure. -Staphylococcal infections are common causes of kidney failure. -Spinal stenosis pain is common symptom of kidney dysfunction.
-Renin levels increase with poor kidney perfusion. -Nephrotoxic drugs are a cause of intrarenal failure.
Patients at risk for renal dysfunction are:
-Take nephrotoxic drugs -Streptococcus infections - Have Diabetes Mellitus or Hypertension -Have had major surgery
Goodpasture syndrome
-autoimmune condition -Acute rapidly progressive type of glomerulonephritis
A critical care patient is to receive continual renal replacement therapy (CRRT). What is an appropriate description to share with family members of the patient? The patient's blood will be purified over 24 hours. CRRT is a form of hemodialysis and is done every three days. CRRT is a form of plasmapheresis and removes antibodies from the plasma. CRRT provides IV infusions due to fluid loss.
A
hypoxic drive
A "backup system" to control respiration; senses drops in the oxygen level in the blood.
acute tonsilitis
A bacteria or virus infects the tonsils, causing swelling and a sore throat; may develop a gray or white covering
Urea
A chemical that comes from the breakdown of proteins
Epiglottitis
A disease in which the epiglottis becomes inflamed and enlarged and may cause an upper airway obstruction.
Epiglottis
A flap of tissue that seals off the windpipe and prevents food from entering.
TB
A positive Mantoux test indicates pt developed an immune response to TB. Acid-fast bacilli smear and culture:(+suggests an active infection) the diagnosis is CONFIRM by a positive culture for M TB A chest x-ray may be ordered to detect active lesions in the lungs QuantiFERON-TB Gold: DIAGNOSTIC for infection, whether it is active or latent
Which of the following are associated with chronic obstructive pulmonary disease? Select all that apply. Chronic bronchitis Hyperactive airways Bronchiectasis Emphysema Pleural effusion
ABD
A clinician is educating a patient who was recently diagnosed with chronic obstructive pulmonary disease (COPD). The clinician states that COPD is a collection of disorders. Which of the following contribute to the development of COPD? Select all that apply. Chronic bronchitis Pulmonary edema Pulmonary fibrosis Hypersensitive airways Emphysema
ADE
Contributors to male infertility
Abnormal production or function of sperm •Cryptorchidism, low sperm concentration, impaired sperm shape and movement ●Impaired delivery of sperm •Antisperm antibodies, no semen, psychological issues, erectile dysfunction ●General health and lifestyle •Alcohol or drug abuse, emotional stress, cancer and its treatments Overexposure to environmental elements •Overheating of testicles, substance abuse, environmental toxins
What is acute kidney injury?
Acute kidney injury is a sudden declining glomerular filtration that is usually reversible. it occurs in 3 forms: prerenal, intrarenal and postrenal, prerenal is ,most common
A nurse is treating a patient with kidney dysfunction. She notices that serum albumin levels are 2.8 g/dl. Which of the following is the appropriate interpretation by the nurse? Albumin levels are normal. Albumin levels are increased. Glomerular filtration rate (GFR) must be reduced. Albumin levels are decreased, due to loss in urine. Albumin levels are unaffected by renal function; thus, this value is not helpful.
Albumin levels are decreased, due to loss in urine.
menstrual disorders
Amenorrhea •Absence of menstrual period •Pregnancy must be ruled out ●Primary •Menses does not occur before age 16 •Often congenital, unrecognized until puberty •Mayer-Rokitansky-Kuster-Hauser syndrome (MRKH) ‒Uterus absent and vagina foreshortened, normal ovaries
BCG vaccine
Anyone who has had this will have a positive skin test and must be evaluated by a chest radiograph
Which of the following are obstructive lung diseases? Select all that apply. Pulmonary fibrosis Asthma Obstructive sleep apnea Pneumothorax Chronic obstructive pulmonary disease
Asthma Obstructive sleep apnea chronic obstructive pulmonary disease
Asymptomatic bacteriuria
Asymptomatic bacteriuria is treated in pregnancy to prevent progression to pyelonephritis with nitrofurantoin.
A patient is taking a nephrotoxic drug. Which type of renal dysfunction is the nurse most likely concerned about developing? Prerenal Intrarenal Postrenal Juxtarenal
B
A patient is to undergo renal ultrasound. Which of the following is the test most likely used to assess? Glomerular filtration rate (GFR) Hydronephrosis Casts Azotemia
B
A renal patient presents with edema. What may be the primary cause of this edema? Urinary stone causing backup Decreased serum albumin due to renal loss. Increased gluconeogenesis by the kidney Decreased erythropoietin synthesis
B
Which of the following substances may be needed as a supplement for a patient suffering renal osteodystrophy? Iron Vitamin D Glucosamine Vitamin E
B
Which are the major restrictive lung diseases? Select all that apply. Chronic bronchitis Pneumothorax Emphysema Pulmonary fibrosis Bronchiectasis
BD
Which of the following are forms of restrictive lung disease are caused by environmental exposure? Select all that apply. Pleural effusion Pneumoconiosis Bronchiectasis Silicosis Asbestosis
BDE
Which of the following statements are incorrectly matched? Select all that apply. Pleuritis - Inflammation of pleural membrane Pleural effusion - Trapping of air in lungs Idiopathic pulmonary fibrosis - "Ground glass" appearance on X-ray Cor pulmonale - Left-side heart failure Pneumothorax - Collection of fluid within chest wall
BDE
A nurse educator is speaking to students about a pulmonary condition that results in chronic bronchodilation. Which of the following conditions is he speaking about? Asthma Bronchiectasis Pulmonary fibrosis Emphysema
Bronchiectasis
A chest x-ray reveals hyperinflation of the lungs, increase anterior-posterior chest wall dimensions, and flattened diaphragm. Which of the following conditions does a nurse suspect? Tuberculosis Asthma Pulmonary fibrosis Chronic obstructive pulmonary disease (COPD)
COPD
A clinician has ordered an assessment of alpha-antitrypsin (AAT)-1 levels. The values came back much lower than normal. What condition may the patient have increased risk of developing? Pulmonary fibrosis Chronic obstructive pulmonary disease (COPD) Asthma Pulmonary hypertension
COPD
Epidemiology of Female Reproductive Tract Disorders
Common disorders •Dysmenorrhea ‒Painful menstrual periods •Dysfunctional uterine bleeding (DUB) •Menorrhagia ‒Excessive uterine blood loss •Premenstrual syndrome (PMS) ●Nearly 100% will experience disorder of menstrual cycle during their lifetime
Bacterial Vaginosis
Common, often due to changes in vaginal microbiota ●Gardnerella vaginalis ●Signs and symptoms •Vulvar and vaginal pruritus, "fishy odor" discharge, discharge contains "clue cells" (vaginal epithelial cells with adherent microorganisms) ●Diagnosis •Gram stain ●Male partners not affected by bacterial vaginosis ●Prevalent in WSW
azotemia (uremia)
Condition of increased amounts of nitrogenous waste products in the blood
Sternocleidomastoid
Contraction of one side: laterally flexes neck, rotates head to opposite side; Contraction of both sides together: flexes neck
A patient is given an adrenocorticotropic hormone (ACTH)-stimulation test. Which of the following results will confirm hypofunctioning of the adrenal gland? Elevated ACTH Suppressed corticotropin releasing factor Cortisol levels less than expected Suppressed thyroid hormone levels
Cortisol levels less than expected
Which of the following conditions are due to a hormone excess? Select all that apply. Cushing's syndrome Grave's disease Addison's disease Giantism Hashimoto's thyroiditis
Cushing's syndrome-Grave's disease-Giantism
pyelonephritis
inflammation of the renal pelvis and the kidney
Kidney failure may cause reduced vitamin ___________ synthesis, resulting in reduced _____________absorption. D, calcium E, calcium A, calcium D, potassium
D, Calcium
Blood in the urine detects what?
Damage to renal structures
Pregnancy
Dated in weeks, starting from the first day of a woman's LMP ●If menstrual periods are regular and ovulation occurs on day 14 ●Conception takes place about 2 weeks after the LMP ●Woman considered 6 weeks pregnant 2 weeks after the first missed period
Psychological Resistance
Depression 2X more common in those with DM •Guilt, discouragement, self-blame reported •Anxiety due to perceived inability to manage the disease •Denial and noncompliance ●Psychological insulin resistance •Refusal to comply with insulin management
Peripheral Neuropathy
Distal, symmetric polyneuropathy •Neural arteries damaged •Begins in feet, progresses superiorly ●Sensorimotor nerves •Burning, tingling •Pain sensation blunted ‒Signs of injury or serious disease (MI) may be missed by patient ("silent MI") •Motor weakness ‒Gait abnormality •Mechanics of foot altered ‒Charcot joint
A patient wants to know how he can prevent future kidney stones. Which of the following is an appropriate recommendation? Drink at least 3/L per day. Take calcium supplements. Maintain current dietary choices. Take a daily prophylactic antibiotic.
Drink at least 3/L per day.
Sinusitis
inflammation of the sinuses Facial pain and headaches are common symptoms
A patient with diabetes insipidus will likely have which of the following laboratory values? Elevated blood glucose Elevated plasma osmolarity Elevated urine osmolarity Elevated urine retention
Elevated plasma osmolarity
Why does George experience disorientation as a result of renal failure? Elevated toxin levels in the blood Anemia Hyperkalemia Elevated urine output by the kidney
Elevated toxin levels in the blood Encephalopathy may develop with acute or chronic renal failure when toxins buildup in the blood. These toxins begin to compromise brain function.
Benign Prostatic Hyperplasia (BPH)
Excessive cell growth of prostate, occurs with aging ●80% of men age 80 years or older ●Testosterone-sensitive growth of prostate ●Cellular growth encroaches on urethra, obstructs urine outflow Prostate gland adds secretions to semen and blocks off bladder opening during ejaculation ●Cell proliferation •Causes obstruction of flow of urine from the bladder •Bladder outlet obstruction (BOO) ●Diagnosis: Signs and Symptoms •Frequent need to urinate •Void small amounts of urine •Incomplete bladder emptying •DRE performed •PSA test to rule out prostate cancer ‒Cannot diagnosis prostate cancer solely with PSA
A patient is recommended for a urodynamic study. Which of the following pieces of information can be learned from this study? Select all that apply. Functioning of the bladder Postvoid volume Pyelonephritis Stones in the ureters Bladder filling and emptying
Functioning of the bladder Postvoid volume Bladder filling and emptying
What is the cause of polycystic kidney disease? Genetic disorder Autoantibody attack of the glomeruli Precipitation of crystals in filtrate Elevated blood sugar
Genetic disorders
Legionella
Genus of bacteria responsible for the disease legionellosis
Which of the following findings may encourage a clinician to begin considering discussing the possibility of a need for a kidney transplant? Damage to 50% of the nephrons Presence of periorbital edema Glomerular filtration rate (GFR) < 12 ml/min Protein in urine
Glomerular filtration rate (GFR) < 12 ml/min
Which of the following conditions result from autoantibodies attacking the glomeruli? Polycystic kidney disease Pyelonephritis Nephrolithiasis Goodpasture's syndrome
Good-pasture's Syndrome
Plasmapheresis would be a treatment option for a patient with which of the following conditions? Acute kidney injury End-stage renal disease Pyelonephritis Goodpasture's syndrome
Goodpasture's syndrome
An antibody test is ordered for an endocrine disorder. Which of the following conditions is commonly diagnosed by antibody test results? Multiple endocrine neoplasia Grave's disease Pheochromocytoma Cushing's syndrome
Graves disease
For which of the following would antibiotics be appropriate as the primary treatment? Select all that apply. Group A beta-hemolytic streptococci (GABHS) glomerulonephritis Nephrotic syndrome Pyelonephritis Goodpasture's syndrome Polycystic kidney disease
Group A beta-hemolytic streptococci (GABHS) glomerulonephritis Pyelonephritis
What may develop in kidney failure?
Hypocalcemia
Treatment of HHS
IV rehydration and insulin •Fluids first •If insulin before fluids, ECF water will move to ICF •Worsening of hypotension and possible shock •Once plasma osmolarity stabilized, give insulin ●Electrolyte replacement if needed
In a patient suspected of having an endocrine disorder, which of the following diagnostic options may be considered first? Immunoassay of blood hormone levels Computed tomography (CT) scan Magnetic resonance imaging (MRI) Antibody testing
Immunoassay of blood hormone levels
Protiens in urine
Intense exercise Glomerulonephritis
A patient complains that she feels she must urinate three times an hour or more. She says urinating helps relieve the discomfort she feels. But she says this is disrupting her life. Which of the following disorders is most likely present? Renal calculi Asymptomatic bacteriuria Interstitial cystitis Pyelonephritis
Interstitial cystitis
Erythropoietin levels in kidney failure
Kidneys produce erythropoietin. When kidney damage or failure occurs, synthesis of erythropoietin is compromised.
Lung Anatomy - Lobes
Left: two lobes- upper and lower Right:3 lobes- upper, middle, and lower Increased risk for pulmonary aspiration in right, middle and lower lobes
A nurse is reviewing urinalysis results. Which factors does she review to see whether the patient has a urinary tract infection? Select all that apply. Glucose Bilirubin Albumin Leukocyte esterase Nitrite
Leukocyte esterase Nitrite
A patient is unable to pass a renal calculi. Which of the following treatment options may the clinician consider? Insertion of medications in the bladder Lithotripsy Ingestion of a beverage formulation designed to break up the stone Immediate surgery
Lithotripsy
WSW
May also engage in sexual activity with men ●Unfounded belief that there is less risk of STI transmission in WSW •May lead woman to believing she does not need regular Pap smears ●Bacterial vaginosis increased risk in WSW
normal flora
Microorganisms that reside in or on the body without causing disease
Xpert MTB/RIF
Molecular technology originally developed to detect anthrax in the United States postal service is revolutionizing the diagnosis of tuberculosis, particularly in countries where tuberculosis is a common cause of death among people with HIV infection. The ___ is the first major breakthrough in tuberculosis diagnostics since sputum smear microscopy was developed more than 100 years ago.
intercostal muscles
Muscles located in between the ribs that play a role in ventilation.
disorders of the cervix
Nabothian cysts •Due to blockage of mucus-secreting gland in endocervix •Common, benign, no treatment needed ●Cervicitis •Inflammation of cervix •Often due to ascending infection from microorganisms of vagina •Erosion and epithelial cell changes apparent ●Cervical polyps •Usually result of benign, inflammatory changes of endocervix •May cause postcoital bleeding Pap smear needs to sample both exocervix and endocervix tissue •Exocervix = squamous epithelium •Endocervix = glandular epithelium ●Examine cells for dysplasia and neoplasia
Stone formation within the kidneys in known as _____________________. pyelonephritis polycystic kidney disease nephrolithiasis nephrotic syndrome
Nephrolithiasis
Nephrotoxic medications
Nephrotoxic medications, as the name implies, damage the kidneys. Because the kidneys are directly damaged, this is a form of intrarenal dysfunction.
Epinephrine
Neurotransmitter secreted by the adrenal medulla in response to stress. Also known as adrenaline.
A patient mentions that bladder cancer runs in his family. Which signs and symptoms may appear in this cancer? Blood in the urine with severe pain upon urination Increased urge to urinate No pain with urination, but blood appears in urine Urinating up to 50 times per day
No pain with urination, but blood appears in urine
Lung dysfunction
Obstructive & restrictive disorders
A nursing educator is discussing that urinary incontinence is often under-reported. What is the primary reason for this under-reporting that nursing students should know? Urinary incontinence is extremely rare. Patients may be embarrassed to share details of incontinence. Most patients do not know what urinary incontinence is. No documentation system tracks urinary incontinence.
Patients may be embarrassed to share details of incontinence.
secondary amenorrhea
Period absent 3 to 6 months •Rule out pregnancy ●Disruption hypothalamic-pituitary axis •Stress, excessive exercise, weight loss ●POI (primary ovarian insufficiency) •Idiopathic, chemotherapy, autoimmune ●Hypergonadotropic hypogonadism •High FSH/LH, low estrogen •Turner's syndrome most common example ●PCOS •Ovulation does not occur monthly ●Hyperprolactinemia ●Asherman's syndrome •Damage to uterine lining ●Imperforate hymen
Normal breath sounds: Bronchial
Pitch: High Quality: Harsh or hollow Amplitude: Loud Duration: Short during inspiration, long in expiration Location: Trachea and thorax
The urinalysis results of a patient in the end stage of chronic renal failure is likely to show which of the following? Presence of white blood cells (WBCs), red blood cells (RBCs), and protein Elevated leukocyte esterase Elevated ketones Elevated nitrite
Presence of white blood cells (WBCs), red blood cells (RBCs), and protein
Dermatological Complications of DM
Prolonged wound healing and ulcer formations ●Diabetic skin spots •Hyperpigmented areas ●Acanthosis nigricans •Tiny, hyperpigmented, macular lesions ●Lipoatrophy can occur at insulin injection site
precouious puberty
Puberty occurring earlier than in the past ●Secondary sex characteristics by 6 or 7 years of age ●Two types •Central ‒Hypothalamus-pituitary involvement •Peripheral ‒Independent of hypothalamus-pituitary (problems with ovaries, adrenal glands)
Poor blood supply to the lungs
Pulmonary vascular disorders
peripheral chemoreceptors
Receptors in the carotid arteries and the aorta that monitor blood pH to help regulate ventilation rate.
central chemoreceptors
Receptors in the central nervous system that monitor the pH of cerebrospinal luid to help regulate ventilation rate.
Increasing serum creatinine levels may indicate _________________. -decreased blood urea nitrogen -reduced glomerular filtration rate -azotemia -increasing glomerular filtration rate
Reduced glomerular filtration rate
posterior pituitary
Releases hormones synthesized by hypothalamus
Hematuria is most often a sign of?
Renal calculi or an infection
Shock
Shock can result from a number of causes. With this condition, inadequate perfusion of organs and tissues occurs, including the kidneys. As the problem involves delivery of blood to the kidneys, it is a prerenal condition.
kidney stones
Solid crystalline masses formed in the kidney, resulting from an excess of insoluble salts or uric acid crystallizing in the urine; may become trapped anywhere along the urinary tract. Renal Calculi
End organs
Targets for pituitary hormones, may or may not secrete additional hormones
As the glomeruli are damaged
The filtration barrier is compromised and cells appear in the urine,while serum levels of blood ureanitrogen and creatine elevate.
In a patient's file, it is noted, "Use of accessory muscles to breath." Which of the following is a correct interpretation? The breathing dynamics of the patient are normal. The patient is using additional muscles with each breath. The patient is making a snoring sound with each breath. The patient has a protruding diaphragm muscle.
The patient is using additional muscles with each breath.
respiratory failure
The reduction of breathing to the point where oxygen intake is not sufficient to support life
Breasts
Thelarche •Development of breast tissue ●Occurs at about the same time first menstrual period ●Breast contain lobules which drains into lactiferous duct ●Lactiferous duct empties into nipple surface •Prolactin: Milk formation •Oxytocin: Milk release
HSV and the Fetus
Transmission transplacentally ●More common: transmission of infection during delivery •Maternal transmission can occur whether the mother is symptomatic or asymptomatic •Cesarean delivery in women with active genital lesions ●Newborn •Herpes encephalitis or meningitis
The following assessment results for a patient are reviewed: urine culture revealed a high level of colony-forming units. Urine was cloudy in appearance and the patient reports pain with urination. No fever or other symptoms are present. What conclusion may the clinician make? Interstitial cystitis Asymptomatic bacteriuria Urinary tract infection (UTI) Bladder cancer
UTI
Tonsillitis
Upper RI inflammation of the tonsils Swallowing becomes difficult The tonsils become reddened and enlarged
The respiratory system has 2 sections
Upper respiratory tract and lower respiratory tract
Varicocele, Hematocele, Hydrocele
Varicocele •Dilation of veins within scrotum •Can affect 15%-20% of males, often asymptomatic •Can contribute to infertility •Can present with scrotal heaviness or tenderness •Palpation may elicit "bag of worms" sensation •Surgical repair
incentive spirometry
a common postoperative breathing therapy using a specially designed spirometer to encourage the patient to inhale and hold an inspiratory volume to exercise the lungs and prevent pulmonary complications
Diaphragm
a dome-shaped, muscular partition separating the thorax from the abdomen in mammals. It plays a major role in breathing, as its contraction increases the volume of the thorax and so inflates the lungs.
dialysis
a procedure to remove waste products from the blood of patients whose kidneys no longer function
Plasmapheresis is..
a process by which the glomeruli damaging antibodies are removed from the body
Primary hyperparathyroidism is most commonly caused by ______________. a tumor of the anterior pituitary a tumor of the parathyroid glands excess adrenocorticotropic hormone secretion elevated serum calcium levels
a tumor of the parathyroid glands
whispered pectoriloquy
a whispered phrase heard through the stethoscope that sounds faint and inaudible over normal lung tissue
Egophony
abnormal change in tone of voice that is heard when auscultating the lungs
uretolithiasis
abnormal condition of stone in ureter
hydronephrosis
abnormal condition of water in the kidney
abnormal breath sounds
abnormal sounds or noises heard over the lungs and airways, commonly leading to a diagnosis of a respiratory or cardiac condition; also called adventitious breath sounds
dialyzer
artificial kidney; contains a semipermeable membrane through which particles of a certain size can pass
vesicoureteral reflux
backflow of urine from the bladder into the ureters
hematuria
blood in the urine
BUN
blood urea nitrogen
Bronchiole dilation resulting from chronic infections is present in ____________. bronchiectasis asthma chronic obstructive pulmonary disease obstructive sleep apnea
bronchiectasis
bladder cancer
cancerous tumor that arises from the cells lining the bladder; major sign is hematuria
post renal dysfunction
caused by obstructive uropathy; urine is toxic to nephrons and urine stagnation increases risk of infection
IC (Interstitial cystitis)
chronic inflammation of the bladder wall
atelestasis
collapsed lung; occurs when intrapleural pressure becomes equal to atmospheric pressure
cystolithiasis
condition of stones in the bladder
nephrolithiasis
condition of stones in the kidney
Struvite stones
contain bacteria that produce ammonia and make the urine alkaline
Pherenic nerve
controls diaphragm originates as C4
An order for a 24-hour urine collection has appeared. Which hormone is most likely being assessed? Oxytocin Thyroid stimulating hormone Cortisol Thyroxine
cortisol
hemoptysis
coughing up blood
signs of renal dysfunction
elevated BUN and creatinine blood in urine costovertebral angle pain
Urinalysis for Pyelonephritis will include
elevated nitrates bacterial presence elevated leukocyte esterase no gross hematuria
A patient has polycystic kidney disease. The nurse correctly determines which of the following is the cause? Bacterial infection Autoimmune disorder Genetic disorder Too much calcium in the diet
genetic disorder
Oxhemoglobin
hemoglobin rich in O2
increased serum creatinine
indicates kidney impairment
Pylonephritis
infection of the kidney and renal pelvis
bronchitis
inflammation of the bronchi Commonly due to viral infections Bronchioles become instructed by mucus and leukocytes Wheezing and production of red sputum may occur
latyngitis
inflammation of the larynx
renal dysfunction
insufficient filtration of the blood of waste; nitrogen buildup causes RBC and platelet lysis hemolysis, thrombocytopenia, and confusion, stupor: encephalopathy does not develop a concentrated urine secretes excess renin to raise BP does not secrete erythropoietin to manufacture RBCs does not maintain acid-base balance does not excrete excess K+ does not synthesize a component of vitamin D; decreases Ca++ absorption
Respiratory Muscles
intercostal muscles and diaphragm
Chromic kidney failure
is progressive and irreversible. It is commonly caused by diabetes mellitus and hypertension, and usually develops into end stage renal disease
IV contrast-enhanced imaging studies should be avoided in patients with renal impairment because
it can cause renal failure, so can dehydration
A patient is taking a medication for asthma, which is a beta-2 agonist. The patient wants to know the purpose of the medication. Which of the following is the appropriate response by the nurse? It decreases mucus production. It dilates your airways. It decreases your coughing spells. It facilitates gas exchange in the lungs.
it dilates your airways
Nephoric syndrome meds
make patient more susceptible for infection
Ventalation-perfusion coupling
match perfusion to the part of the lung that are being ventilated - increase BF to ventilated areas
Creatinine
nitrogenous waste excreted in the urine
The upper airways closing during sleep is known as ____________.
obstructive sleep apnea
UTI urinalysis
positive for nitrates positive for leukocyte esterase (LE) Increased WBC may see bacteria (over 100,000 to be positive) E. Coli most common bacteria
For a confirmative diagnosis of Goodpasture's disease, the nurse anticipates which of the following? Glomerular filtration rate (GFR) measurement decreases. Positive immunoglobulin results. Intravenous pyelogram (IVP) shows obstruction. Urinalysis shows the presence of casts.
positive immunoglobulin results
George, age 72, recently suffered a heart attack, damaging his left ventricle. He appears to be suffering from left-sided heart failure. Stroke volume, blood pressure, and cardiac output are all reduced.George's renal function may be impaired. Serum blood urea nitrogen (BUN) and creatinine (Cr) levels are increasing and glomerular filtration rate (GFR) is significantly reduced. Oliguria is present, as is edema of the face and extremities.George seems to be becoming more confused and disoriented. Further blood laboratory values reveal hypocalcemia, hyperkalemia, and anemia. Based on the information provided, which type of renal dysfunction is most likely in George's case: prerenal, intrarenal, or postrenal? Prerenal Intrarenal Postrenal None. Based on available data, George's renal function appears normal.
prerenal The most likely renal failure type is prerenal. Prerenal failure occurs when the kidneys are not adequately perfused. In George's case, his heart failure is likely resulting in reduced blood flow to the kidneys. The increasing levels of BUN and Cr, along with decreasing GFR, shows George's kidneys are not functioning normally.
A nursing student suspects that a patient has a lower urinary tract infection (UTI). The nursing educator, however, believes that the patient may have pyelonephritis. Which of the following signs or symptoms did the nursing educator notice that may indicate pyelonephritis? Presence of leukocyte esterase in the urinalysis results Level of pain the patient is self-reporting Presence of fever Patient's past medical history
presence of fever
pyruia
presence of pus in the urine
function of kidneys (excretory system)
regulate amount of water and salts in blood
goblet cells
secrete mucus
hydroureter
the distention of the ureter with urine that cannot flow because the ureter is blocked
●Link between hypothalamus-pituitary-end organ ●Pituitary (hypophysis)
•Anterior pituitary (adenohypophysis) ‒Blood vessel connection with hypothalamus (hypothalamus-hypophyseal portal system) ‒Releases tropic hormones •Posterior pituitary (neurohypophysis) ‒Neural connection with hypothalamus ‒Hormones made by hypothalamus, stored and released by posterior pituitary
dysmeorrhea
•Painful periods •75% of 15- to 25-year-olds •Prostaglandin release (particularly prostaglandin F) within 48 hours menstruation ●Diagnosis •Rule out pelvic pathologies ●Treatment •Oral contraceptives •Anti-prostaglandins
PMS (premenstrual syndrome)
•Physical, emotional, behavior changes prior to menstrual cycle •50% of women have mild to moderate PMS •Abnormal response to neurotransmitters prior to menstruation •Treatment with selective serotonin receptor inhibitors (SSRI's) have been helpful •Premenstrual dysphoric disorder (PMDD) ‒More severe form of PMS, interferes with work, school, social activities, and relationships
●Three levels of dysfunction
•Primary ‒Endocrine gland itself •Secondary ‒Abnormal pituitary activity •Tertiary ‒Dysfunction of hypothalamic origin
Malignant Thyroid Nodule
●Age younger than 20 years or older than 70 years ●Male sex ●History of neck irradiation ●Firm, hard, or immobile nodule ●Presence of cervical lymphadenopathy
Erectile Dysfunction Causes
●Alcoholism and other forms of substance abuse ●Atherosclerosis ●Certain prescription medications ●Diabetes ●Fatigue ●Heart disease ●High blood pressure ●Low testosterone ●Mental health conditions such as depression and anxiety ●Metabolic syndrome ●Multiple sclerosis ●Obesity ●Parkinson's disease ●Peyronie's disease •Development of scar tissue inside the penis ●Stress ●Surgeries or injuries that affect the pelvic area or spinal cord ●Tobacco use ●Treatments for prostate cancer or enlarged prostate
Male infertility
●10%-15% of couples •Unprotected, frequent intercourse for a year ●Obstructive causes •Repeated infections, swelling, vasectomy ●Nonobstructive causes •Deficiencies in sperm formation, oligospermia, azoospermia (no sperm in ejaculate) ●Low sperm count or poor semen quality account for 90% of male infertility •Genetic factors in poor spermatogenesis ‒Androgens and functional androgen receptor (AR) are needed for normal male development and function
Benign Prostatic Hyperplasia: Medications
●5-alpha-reducatase inhibitors •Block testosterone •Increase urinary flow, help shrink prostate •Drugs for 6 to 12 months to achieve full benefit •Decreases PSA levels, which may mask cancer •Women should not handle finasteride tablets when pregnant ●Phosphodiesterase-5 (PDE5) inhibitors •Relax lower urinary tract •Cialis
Viral—Human Papilloma Virus (HPV)
●70 distinct types •Some associated with warts (types 6 and 11) •Some recognized as oncogenic ‒Cancers of cervix, vagina, penis, anus, back of throat •HPV vaccine ●Most common STI in world ●Highest incidence in the 20 to 24 age group ●Condylomata acuminata: small, wart-like lesions
Ovarian teratoma
●AKA: dermoid cyst ●Cyst made of various embryonic tissues ●Often benign ●Become symptomatic when complications, such as ovarian torsion, are present ●Diagnosis •Imaging studies ●Treatment •Surgical excision
hyperadrenalism
●AKA: hypercortisolism •Cushing's disease ‒Elevated ACTH, tumor in pituitary •Cushing's syndrome ‒Elevated cortisol, hyperfunction of adrenal cortex ●Exogenous steroids most common cause of Cushing's syndrome ●Causes •Pituitary adenoma ‒Cushing's disease •Cushing's syndrome ‒Adrenal hyperplasia, adrenal neoplasm ‒Carney complex ●Genetic disorder ‒McCune-Albright syndrome ●Cushing's syndrome and precocious puberty ‒Secretion of ACTH from tumors
DM and Atherosclerosis
●Acute cardiac events 2 to 4 times more likely in DM patients ●Increased risk of atherosclerosis in both large and small arteries ●Vascular damage occurs due to several processes all resulting from hyperglycemia leading to oxidative stress
Pheochromocytoma
●Adrenal medulla tumor •Secrete norepinephrine and epinephrine •Excessive sympathetic stimulation ●Hypertension, tremors, increased cardiac contractility, cardiac arrhythmias, tachycardia ●Diagnosis •24-hour urine for catecholamine metabolites
A patient has unexplained hematuria with no pain. Which diagnostic follow-through may be most helpful? IV pyelogram procedure Postvoid volume measurement Straining the urine Cystoscopy
cystoscopy
Diagnosis of bladder cancer
cystoscopy Urine cytology alone isn't sensitive enough, but can be done in addition to find cancer that isn't seen on scope
In Cushing's syndrome, a ____________ adrenal gland causes elevated levels of _____________. hypoactive; cortisol hyperactive; adrenocorticotropic hormone hypoactive; adrenocorticotropic hormone hyperactive; cortisol
hyperactive; cortisol
CRRT (continuous renal replacement therapy)
typically done in the ICU. It is special because *never more than 80ml is out of the body at one time*. Thus, it does not stress the cardiovascular system as much
Chlamydia—Treatment
●Amoxicillin or erythromycin commonly used ●Reinfection likely if sexual partner untreated ●Newborns •Treated with antibiotic ophthalmic ointment ●Repeat NAAT 3 weeks after initial treatment •Positive test likely indicates noncompliance with treatment or reinfection
Treatment of Hyperthyroidism
●Antithyroid hormone medication propylthiouracil (PTU) ●Radioactive iodine treatment ●Surgery •If gland removed, replacement thyroid hormone (levothyroxine) needed for life
Long term effects of DM
●Arteriosclerosis •Myocardial infarction ●Peripheral angiopathy •Limb ischemia ●Diabetic retinopathy •Blindness ●Diabetic neuropathy •Lack of sensation in lower limbs, burning, tingling ●Autonomic neuropathy •Poor autonomic control ●Diabetic nephropathy •Kidney failure ●Poor wound healing •Gangrene ●Immunosuppression •Infection
Long term complications of DM
●Arteriosclerosis ●Peripheral angiopathy (lack of circulation) ●Diabetic retinopathy ●Diabetic neuropathy ●Autonomic neuropathy ●Diabetic nephropathy ●Poor wound healing ●Immunosuppression ●Chronic hyperglycemia leads to damage of small and large arterial vessels •Endothelial cells lining arterioles and arteries •Vascular damage (angiopathy) leads to downstream end-organ damage ‒Retina, glomeruli, neurons ‒Autonomic neuropathy •Poor wound healing (WBC functioning reduced) •Macrovascular angiopathy: CVD, PVD
Disorders of vagina
●Atrophic vaginitis •Inflammation of vagina after menopause ●Bartholin cyst or abscess •Small spherical structures at entry to vagina •Release secretions •When the ducts of these glands become obstructed abscess and tender cysts may form •Treatment includes antibiotics
Endocrine dysfunction causes
●Autoimmune •Antibodies target endocrine gland, may cause hypofunction or hyperfunction ●Neoplasia •Hypofunction or hyperfunction of gland itself or any endocrine tissue the gland affects •Some cancers: paraneoplastic disorder in which cancer cells secrete hormone-like substances ●Endocrine-disrupting compounds (EDC's) •Chemical in environment that can alter endogenous hormone functions
Polycystic Ovarian Syndrome (PCOS)
●Autosomal dominant genetic disorder ●Women: puberty to age 30 years ●Most common endocrine disturbance in young women, leading cause of infertility in U.S. ●Anovulation •Follicular cysts ●Hypothalamic-pituitary-ovarian axis dysfunction ●Androgen excess, anovulation, hyperinsulinemia ●38% of women with PCOS are obese ●PCOS can be part of metabolic syndrome ●Treatment •Suppress excess androgens •Increase insulin sensitivity •Stimulate cyclic menstruation
Hypoglycemia
●BG less than 70 mg/dL •Excessive exogenous insulin •Inadequate food intake •Excessive physical activity •Infection, illness, drug interaction ●Compensatory response to raise BG •Epinephrine, glucagon, activation SNS ●Activation of SNS accounts for many signs and symptoms •Sweating, hunger, dizziness, headache, heart palpitations, confusion ●Need action plan to address hypoglycemia •Fast-acting carbohydrates (15 g) •Avoid fats (delay glucose absorption) •Transient response ‒Provide meal or snack even if BG greater than 70 mg/dL ●IV glucose can be provided ●Glucagon by subcutaneous injection ●Repeated episodes of hypoglycemia can blunt compensatory response ●Autonomic neuropathy may cause patient to miss warning signs of hypoglycemia ●Hypoglycemia is a medical emergenc
Individualized Insulin Regiment
●Based on individual needs •Diet, exercise, etc. ●Basal-bolus regimen •Basal: once-daily injection of a long-acting insulin to control the fasting BG •Bolus: after eating ●Forms of insulin therapy can be combined in premixed formulations ●Insulin delivery •Subcutaneous injection, infusers, insulin pump, inhalable powder
Sexual Health Care and LGBTQ Population
●Biological sex ●Gender identity •Internal sense of male, female, both or neither; may not correspond with biological sex ●Sexual orientation •Physical and/or emotional attraction to others ●LGBTQ: lesbian, gay, bisexual, transgender, questioning (queer)
Effects of High Cortisol Levels
●Block the action of insulin •Glucose intolerance and hyperglycemia ●Inhibit bone formation and accelerates bone reabsorption •Osteopenia, osteoporosis ●Suppress immune response ●Hypertension
To Reduce Risk of Cardiovascular Disease
●Blood pressure: less than 130/80 mm Hg ●LDL cholesterol: less than 100 mg/dL ●HDL cholesterol: greater than 60 mg/dL ●Triglycerides: less than 150 mg/dL ●Aspirin therapy ●BMI less than 25 ●Cessation of smoking ●Exercise: 150 minutes per week
Diagnosis
●Blood tests to assess hormone levels •Pituitary, hypothalamic, and end-organ levels may be needed ●Corticotropin stimulation test: give ACTH •Cortisol levels should rise ‒If cortisol levels rise with ACTH administration: pituitary problem ‒If cortisol levels do not rise with ACTH administration: adrenal gland problem ●MRI, CT scan
Complications of DM
●Both acute and long-term ●Hypoglycemia and hyperglycemia ●Acute •DKA (T1DM) •HHS (T2DM) ●Long-term systemic •Blindness, kidney failure, neuropathy, cardiovascular disease, amputation
Syphilis Phases
●Can span decades ●Primary •Lesion (chancre) appears, heals within a week ●Secondary •2 to 10 weeks, rash all over body •Both primary and secondary forms are highly infectious ●Latent •Spontaneous healing may occur •Patient may be asymptomatic •May progress to tertiary form •Gummas ‒Granulomas may form in many different tissues and organs ●Tertiary •Neurological changes •Neurosyphilis may cause meningitis and stroke
Autonomic Neuropathy
●Cardiac system affected •Tachycardia, hypotension ●GI system •Gastroparesis, gastric emptying abnormality •Anorexia, nausea •Bowel dysfunction ●Bladder problems •Increased UTI risk ●Erectile dysfunction ●Hypoglycemia •Signs and symptoms not as apparent ●Decreased sweating •Hyperthermia, dry skin
Ovary—Premature Ovarian Insufficiency
●Cessation of ovarian function in woman less than 40 years of age ●Underfunctioning ovaries or a deficiency in the number of follicles •Causes include genetic, autoimmune •Affects ~1% of female population ●Symptoms include irregular menstrual cycles, infertility, hot flashes ●Physical signs may be absent unless part of another disorder (Turner syndrome, hypothyroidism, etc.) ●Diagnosis •FSH elevation is key •Examine other hormones ‒Estradiol, cortisol, thyroid hormones ●Treatment •Cyclical hormone therapy with estrogen and progestins
Syphilis—Clinical Presentation
●Chancre •Observable, heals within 1 to 2 weeks ●Rash •May appear on palms and soles, accompanied by fever, malaise, sore throat ●Condyloma lata •Wart-like lesion in genital area ●Rash fades and latent period may last for years ●Tertiary syphilis may present with tabes dorsalis: posterior spinal cord affected
Hypothyroidism S/S
●Cold intolerance ●Weight gain ●Lethargy ●Fatigue ●Memory deficits ●Poor attention span ●Muscle cramps ●Constipation ●Decreased fertility ●Puffy face ●Hair loss ●Brittle nails
Leiomyomas (uterine fibroids)
●Commonly known as fibroid tumors ●75% of women at some point in their lives ●Most commonly found in myometrium ●Most asymptomatic ●If signs/symptoms are present: bleeding, pain, infertility ●Diagnosis most commonly through ultrasound ●May regress at menopause ●Surgical excision can be performed, GnRH
Infection
●Commonly represent with lesions on penis and discharge ●Urination may be painful ●Condyloma •Wart-like lesions that may appear with syphilis and HPV ●Orchitis •Inflammation of testes (can be unilateral) •Mumps virus
Erectile Dysfunction (ED)
●Complete ED defined as: •Total inability to obtain/maintain an erection •Absence of nocturnal emissions ●Vascular disease ●Usually combination of causes Diagnosis •Often patient self-report •Sexual history •Hormones (LH, testosterone) •Urinalysis •Penile blood flow studies ●Treatment •Oral phosphodiesterase (PDE) inhibitors ‒Block PDE, enhance effects of nitric oxide (NO) ●Increase vasodilation in penis •Sildenafil (Viagra), tadalafil (Cialis) •Contraindicated in patients taking nitrates (hypotension may result)
Diagnosis of STIs
●Culture and serology ●Polymerase chain reaction (PCR) •Detect DNA or RNA of microorganism for diagnosis •Number of microorganisms •PCR is a type of nucleic acid amplification testing (NAAT)
Assessment of endocrine disorders
●Current and past medical history ●Some endocrine disorders present with wide-ranging, multi-system signs and symptoms ●Endocrine dysfunction may affect mood and behavior, can be misinterpreted as psychological issues
Susceptibility to Infection
●Decreased WBC function ●Increased colonization: S. aureus ●Candida (yeast) •High glucose changes the pH of vagina, allowing Candida to proliferate •Chronic Candida vaginitis may be a presenting feature of diabetes
Signs and Symptoms of Hypopituitarism
●Depend on pituitary hormones suppressed •Most serious concerns are adrenal insufficiency, hypothyroidism, and diabetes insipidus ●Age of onset •Children with hypopituitarism will have different complications than adults ●If hypopituitarism acute, rapid deterioration of patient Neonate and infant ●Dwarfism ●Developmental delay ●Various visual and neurological symptoms ●Seizure disorder ●Congenital malformation Adults ●Weakness ●Weight loss or gain ●Hypotension caused by adrenal insufficiency ●Sluggishness ●Depression ●Excessive urination and dehydration
Syphilis—Treatment
●Depends on phase of infection ●Benzathine penicillin •Administered intramuscularly •Repeat testing at 6 and 12 months to assure efficacy ●Notify partners ●Jarisch-Herxheimer reaction •Large number of bacteria killed by antibiotic release endotoxins •Fever, chills, myalgias, and exacerbation of skin lesions occur
Diabetic Ketoacidosis (DKA)
●Develops in those with no insulin reserves ●High levels of ketone formation ●1/3 of children with T1DM first present with DKA ●DKA is a critical condition requiring immediate treatment
Diabetes Mellitus and Amputation
●Diabetic foot complications •Most common cause of nontraumatic lower extremity amputation ●Peripheral neuropathy, poor circulation, suppressed immune response ●Increased infection susceptibility ●Can lead to gangrene and amputation ●Osteomyelitis (bone infection) can also occur
Gonorrhea—Diagnosis and Treatment
●Diagnosis •Culture •NAAT's ●Treatment •Antibiotic sensitivity testing ‒Dual drug therapy: cephalosporin and azithromycin •Notify sexual partners •Ocular antibiotics for newborns
Adrenal Insufficiency (continued)
●Diagnosis •Rapid ACTH test ‒With ACTH administration, cortisol should rise within 30 minutes ‒No cortisol rise: adrenal cortex insufficiency ●Treatment •Daily replacement of glucocorticoid and mineralocorticoid •Parenteral steroid coverage in times of major stress, trauma, surgery
Diabetes Mellitus (DM)
●Disorder of carbohydrate metabolism ●High levels of blood glucose ●Body's inability to produce or utilize insulin ●Increased: •Morbidity and mortality •CVD, renal damage •Peripheral vascular disease, neurological disorders •Blindness •Amputation
Uterus—Dysfunctional Uterine Bleeding (DUB)
●Disturbance of menstrual cycle ●Excessive blood loss or lack of normal menstruation ●Anovulatory cycles •PCOS, POF, obesity ●Ovulatory •Excessive bleeding ●Diagnosis •Rule out pregnancy, ultrasound ●Treatment •Hormonal regulation •If no period 3 or more months, give progesterone to induce period •Danazol ‒Suppress excessive bleeding
Hyperthyroidism
●Elevated free T3 and free T4 ●Graves' disease •Most common cause •Autoimmune stimulation of the thyroid gland ●Other causes •Subacute thyroiditis •Thyroid adenoma •Excessive TSH •Subacute thyroiditis •Toxic multinodular goiter •Excessive iodine ingestion ‒Jod-Basedow syndrome •Secondary to pregnancy, HCG is similar to TSH
Different causes of hypopituitarism
●Empty sella syndrome •Herniation of meningeal membrane compresses pituitary gland against bone ●Traumatic brain injury ●Hypothalamic dysfunction •May impair pituitary function
Goiter
●Enlargement of the thyroid ●May or may not present with thyroid dysfunction signs and symptoms ●May develop with: •Excess TSH •Low iodine levels •Goitrogens ‒Foods or other substances that promote thyroid gland enlargement
Nagele's Rule
●Estimated date of childbirth ●Add year to the LMP, subtract 3 months, and add 7 days ●Childbirth: approximately 40 weeks after the LMP
ADH --> SIADH
●Excessive ADH •Causes: brain injury or neurosurgery •Paraneoplastic disorder ●Causes fluid retention •Concentrated urine, dilute plasma, hypervolemia ●Treatment •Fluid restriction •Slow correction of hyponatremia •ADH receptor antagonists may be used
Role of insulin
●Facilitates glucose uptake by cells ●Muscle, adipose, liver •Glycogenosis in liver and muscle •"Fat sparer" •Anabolic hormone ●Hyperinsulinism •Increased insulin level to overcome insulin resistance ●Hyperinsulinism hypoglycemia •Low blood glucose levels from too much insulin
treatment of pneumonia
-antibiotics if infectious -possibly ventilation, increase fluids
Which of the following are common signs of kidney dysfunction? Select all that apply. Proteinuria Decreased serum creatinine Rash Hematuria Costovertebral angle pain
1,4,5
Infertility
10%-15% of couples ●Unprotected, frequent intercourse for a year ●40%-50% of cases: female infertility ●Ovulation disorders account for 25% of infertility issues ●Disruption of FSH/LH signal (stress, very low or high body weight, excessive exercise) Polycystic ovarian syndrome (PCOS) •Overproduction of androgens, ovary does not release ovum ●Premature ovarian failure (POF) •Body develops antibodies against ovarian tissue ●Endometriosis •Uterine tissue outside the uterus ●Fallopian tube damage •Ectopic pregnancy, infection, or inflammation Cervical obstruction •Inherited malformation of damage to cervix ●Uterine fibroids
A patient's chart shows blood urea nitrogen (BUN) is 22 mg/dL and creatinine is 2.0 mg/dL. The nurse is asked to report the BUN-to-creatinine level. What is the correct response for the nurse to make, expressed as a ratio? Enter numeral online.
11
A nurse is assessing the laboratory results of a client who is suspected of having glomerular damage. Which value of serum albumin is most indicative of the condition in this client?
2.5 g/dL
Pituitary as the "master gland"
Anterior ●Growth hormone ●Prolactin ●Adrenocorticotropic hormone ●Thyroid-stimulating hormone ●Follicle-stimulating hormone ●Luteinizing hormone Posterior ●Antidiuretic hormone •AKA: arginine vasopressin ●Oxytocin
A nurse is working with a patient who finds her incontinence to be very embarrassing. She is wondering if any medications are available that could help her. What class of medications does the clinician consider? Angiotensin receptor blockers Corticosteroids Anticholinergic Antileukotrienes
Anticholinergic
Intrarenal Dysfunction Is Caused by:
Any condition that directly harms the kidney Examples: trauma to kidney, infection of kidney, nephrotoxic drugs STREP
Prerenal Dysfunction of the Kidney Caused by:
Any condition that directly or indirectly decreases renal perfusion may lead to prerenal dysfunction. Prerenal dysfunction occurs because of reduced cardiac output or severe hypovolemia (low blood volume). Large blood loss from the body, as in hemorrhage, is a common cause of prerenal kidney injury because of ischemia.
A patient wants to know what "apnea" means, as he has been diagnosed with sleep apnea. Which of the following response by the nurse is appropriate? You have loss of consciousness from holding your breath at night. Your swallowing reflex disrupts your breathing. Apnea is cessation of breathing, which you experience during your sleep for brief moments. Apnea is when you hyperventilate because you cannot catch your breath. This is happening while you sleep.
Apnea is cessation of breathing, which you experience during your sleep for brief moments.
ABGs
Arterial Blood Gases pH 7.35- 7.45 HCO3 (Bicarbonate) normal values 22-26 mEq/L PaCO2 ( CO2 or carbon dioxide content) 35-45 mm Hg PaO2 (oxygen saturation in arteria blood)- 80-100 mm Hg
A patient has oliguria. Which of the following interpretations by the nurse is correct? The patient has increased urine output compared to normal. The patient has a urinary stone. The patient's urine output is less than 400 ml/day. The patient's glomerular filtration rate (GFR) must be elevated.
C
A patient passes a kidney stone. What is the most likely composition of the stone? Cystine Uric acid Calcium Magnesium
C
A patient's urinalysis reveals the presence of glucose. Which of the following should be considered first? The patient is eating too many carbohydrates. Decreased glomerular filtration rate (GFR) is concentrating the urine too much The patient may have diabetes mellitus. The patient has kidney failure.
C
In George's condition, why is GFR lower than normal? Decreased perfusion of the kidney Elevated pressure due to hydronephrosis Blockage of the glomerular membrane by antibodies Cyst formation within the kidneys
Decreased perfusion of the kidneys George's heart failure likely makes maintaining adequate perfusion of body tissues difficult. As perfusion of the kidneys declines, so does the GFR.
What causes kidney stones?
Chronic bacterial infection, urine retention, increased calcium in blood, and increased pH of urine
Additional disorders
Cystocele •Herniation of urinary bladder into vaginal canal ●Rectocele •Herniation of rectum into vaginal canal ●Enterocele •Herniation of intestine between uterine ligaments ●Herniation treatment •Surgical intervention
Which of the following is a cause of prerenal failure? Nephrotoxic medications Streptococcal infection Decreased perfusion Ureter obstruction
Decreased perfusion
Why are BUN and Cr levels higher than normal in George? Disruption of the buffering system Muscle breakdown is increasing serum levels of these factors Decreased GFR Antibody attack of the glomeruli have increased secretion of these substances
Decreased GFR George's BUN and Cr are increasing because normally these substances are filtered by the kidney and partially removed from the blood. When GFR decreases, these factors increase in the blood.
Which of the following may explain George's anemia? Select all that apply. Decreased erythropoietin Not enough protein intake Anemia commonly accompanies heart failure Lack of intrinsic factor Glomerular damage
Decreased erythropoietin, glomerular damage The kidneys produce erythropoietin to maintain red blood cells levels. If the kidneys are damaged, erythropoietin levels may fall. If the glomeruli are damaged, red blood cells may be filtered into the urine, leading to hematuria.
Why is oliguria occurring in George? Nephron cell necrosis Decreased renal perfusion and GFR Increased BUN and Cr are blocking renal filtration Cyst formation due to genetic disease is blocking renal blood flow
Decreased renal perfusion and GFR George is experiencing oliguria for the same reason BUN and Cr levels are elevating: the kidneys are not adequately perfused. Urine is only formed when the blood is filtered. If insufficient blood is available for filtration, urine formation decreases
A patient with chronic renal failure reports that he is feeling like his skin is "itching." What is an appropriate response by the nurse? Suggest that the patient switch to a different cream or lotion. Suggest that the patient switch laundry detergents. Evaluate laboratory values to assess toxin levels in the blood. Suggest the patient may be developing a sensitivity to the bed linen.
Evaluate laboratory values to assess toxin levels in the blood.
HPV vaccine
GardasilR ●Nearly 100% efficacy in preventing precancerous lesions of the cervix and vagina ●Vaccination of school-aged girls and boys recommended
A patient with emphysema is being assessed. Which of the following is an expected finding? Cyanosis Hyperresonance on percussion of the lungs Decreased chest volume Bronchial constriction
Hyperresonance on percussion of the lungs
Which of the following conditions reflects immunologically mediated lung disorder due to prolonged, intense exposure to organic dusts? Hypersensitivity pneumonitis Idiopathic pulmonary fibrosis Pneumoconiosis Tension pneumothorax
Hypersensitivity pneumonitis
A patient is treated for central diabetes insipidus. Which statement by the patient indicates that the treatment is working? I am going to the bathroom more now than ever. I don't feel as thirsty, and I am not drinking as much. I drink 1 L of water several times and day, and still it is not enough. I feel dehydrated all the time.
I don't feel as thirsty, and I am not drinking as much.
A patient with asthma completes a spirometry test and is then given a bronchodilator and a second spirometry test. What is the expected result for the second spirometry test? Increased forced expiratory volume (FEV)1.0 Decreased FEV1.0 Decreased forced vital capacity (FVC) Increased energy recovery ventilation (ERV)
Increased forced expiratory volume (FEV)1.0
Damage to the glomeruli may result in which of the following? Select all that apply. Increased serum blood urea nitrogen Increased serum creatinine Proteinuria Hematuria Albuminuria
Increased serum blood urea nitrogen Increased serum creatinine Proteinuria Hematuria Albuminuria
A nurse is speaking to a patient with nephrotic syndrome. Which recommendations will be helpful for the patient? Ingest a high protein diet (3 to 4 g/kg/day) Ingest a low-sodium diet (< 1500 g/day) Encourage overhydration Ingest a low-calorie/restrictive diet
Ingest a low-sodium diet (< 1500 g/day)
A nursing student is studying the progression of acute kidney injury. What is the proper order for the progression of acute kidney injury? Kidney function decreases Oliguria develops Initial insult or injury to the kidney Diuresis with reduced concentrating ability by kidney Recovery with return to normal urine concentration
Initial insult or injury to the kidney Kidney function decreases Oliguria develops Diuresis with reduced concentrating ability by kidney Recovery with return to normal urine concentration
Treating DM Lifestyle
Maintain ideal body weight ●Diabetic educator may assist with lifestyle changes ●General recommendations: •40%-50% carbohydrates, fats 25%-30% •Low-fat and low-salt diet •Low glycemic index carbohydrates should be included in diet ●Daily exercise •Helps with glucose uptake in muscle, increases HDL levels, collateral blood vessel growth ●Alert! Strenuous exercise can cause significant decrease in BG leading to hypoglycemia •Reduce insulin before physical activity •Carbohydrate source available •Diabetic ID card or bracelet
Based on Mary's laboratory results, which form of adrenal insufficiency does Mary have? Primary adrenal insufficiency Secondary adrenal insufficiency Tertiary adrenal insufficiency Pheochromocytoma
Mary's condition is a result of a problem in the adrenal glands not being able to produce cortisol. The adrenal glands are receiving a signal from the anterior pituitary, shown by the elevated ACTH; however, the glands are incapable of responding to this signal. A tertiary condition is a problem in the hypothalamus, and Mary's problem is located within the adrenal glands. A pheochromocytoma is a disorder of the adrenal medulla that would present with elevated epinephrine and norepinephrine levels.
The Adrenal Gland: Cortex and Medulla
Medulla ●Glucocorticoids •Cortisol ●Androgens ●Mineralocorticoids •Aldosterone Cortex ●Epinephrine ●Norepinephrine
Terminology
Nulliparous •Adult female, no pregnancies ●Multiparous •Multiple pregnancies ●Primigravida •Woman with first pregnancy ●Primiparous •A woman post-delivery ●Patient history •Gravidity = pregnancy •Parity = childbirth •"Gravida 2, para 2" (G2P2) ‒2 pregnancies and 2 deliveries after 24 weeks •"Gravida 2, para 0" (G2P0) ‒2 pregnancies, neither of which survived to gestational age of 24 weeks
Edema in kidney disease is most prevalent in the the region?
Periorbital
What type of edema is George likely to experience with renal failure? Pulmonary edema Periorbital edema Dependent edema Localized edema in feet
Periorbital edema
Types of dialysis
Peritoneal dialysis and hemodialysis
Pharyngitis Assessment
Pharynx: fiery red w/ swelling, exudate, pain
Anatomical abnormalities
Phimosis •Foreskin too constricted ●Paraphimosis •Foreskin permanently retracted ●Peyronie's disease •Middle-age to elderly •Inflammatory vasculitis, unknown etiology •Penis takes on curvature ●Priapism •Abnormally prolonged erection •Painful •Drug: sildenafil •Sickle cell crisis
A patient is displaying signs and symptoms of an endocrine disorder. The patient also complains of headaches and visual disturbances. Which of the following tissues will likely require further evaluation? Parathyroid Thyroid Pituitary Adrenal cortex
Pituitary
signs of pneumonia
Pleuritic chest pain, productive cough with rust or green sputum, dyspnea, tachynea, fatigue, fever, generalized aches.
Which of the following statements are true about pneumonia? Select all that apply. Pneumonia is the most common infectious disease worldwide. Staphylococcus aureus commonly causes community-acquired pneumonia. Pneumonia is caused by fluid accumulation in the alveoli. Pneumonia is frequently caused by rhinovirus. Bacterial pneumonia may develop as a secondary infection.
Pneumonia is due to fluid accumulation in the alveoli.Bacterial pneumonia may develop as a secondary infection.Pneumonia is frequently caused by the rhinovirus.
On assessing a chest x-ray, the nurse finds a linear shadow of visceral pleura. The x-ray lacks the lung markings peripheral to the shadow, indicating a collapsed lung. Which condition does the nurse expect in this patient? Idiopathic pulmonary fibrosis Pneumothorax Pleural effusion Asbestosis
Pneumothorax
Classic signs for DM
Polydipsia ●High BG increases plasma osmolarity ●Fluid shifts from ICF into ECF (cellular dehydration) ●Increased thirst Polyuria ●Increased thirst and drinking (polydipsia) ●Osmotic diuresis •Glucose appears in urine (transport maximum of kidney exceeded) ●Water follows glucose, increasing urine output ●Blurred vision •Accumulation of glucose in aqueous fluid of eye •Changes refraction of light ●Electrolyte imbalance •Fluid shifts ‒ICF to ECF may cause dilutional hyponatremia •K+ moves out of cells (IC depletion of K+) •"False hyperkalemia" ‒Serum levels of K+ are elevated, but total body K+ not increased Polyphagia ●If body can not use glucose: •Fat and muscle breakdown occur •Weight loss with increased appetite •Ketone levels may elevate Glycogenolysis and Gluconeogenesis ●Increasing BG further, compounding problem ●Low BG is not the problem, the inability to use BG is the issue
A patient states that she once took a medication that turned her urine red. What medication does the nurse think the patient is referring to? Pyridium Fluconazole Methicillin Lasix
Pyridium
Endometriosis Causes—Theories
Regurgitation/implantation •Endometrial tissue forced up through uterine tubes and into pelvic cavity ●Metaplastic •During embryological development, endometrial tissue appears in abnormal areas ●Vascular or lymphatic •Endometrial tissue metastasized to other areas Immunological •Displaced endometrial tissue triggers an autoimmune attack ●Environmental toxicity •Associated with some chemicals (dioxin)
AKI (acute kidney injury)
This genitourinary disorder manifests as an oliguric phase followed by diuresis; Presents as decreased/absent UO, fluid retention, SOB, fatigue, confusion, N&V and seizures/coma in severe cases
A patient has been scheduled for a sleep study for obstructive sleep apnea. The patient wants to know what they will be looking for during the test. Which of the following is appropriate for the nurse to share? We will see whether you try to sleepwalk during the test. We will be looking to see whether you enter deep sleep and for how long. We will be looking to see whether you stop breathing, even briefly, during the night. We will see whether you have restless-leg syndrome.
We will be looking to see whether you stop breathing, even briefly, during the night
Which of the following is a primary treatment of pulmonary hypertension? Using a chest tube for suctioning Using mechanical ventilation to facilitate oxygenation of tissues Vasodilation of the pulmonary arterial vessels Re-inflating the lungs
Vasodilation of the pulmonary arterial vessels
A child frequently forgets to take his asthma medications and frequently has mild asthma attacks. Which of the following is an appropriate response? As long as the attacks are mild, it is OK that the medication is not being used. Rescue medications are the most important treatments in asthma. If he does not require use of rescue medications, then he is fine. Prevention of mild asthma attacks is important because even mild attacks can cause changes in the pulmonary structures. The child should be trained in breathing exercises. If effective, these can replace the use of medications.
prevention of mild asthma attacks is important because even mild attacks can cause changes in the pulmonary structures
Diabetes test
●Fasting and random BG tests ●Oral glucose tolerance test (OGTT) •75 g of glucose ingested, measure BG following ●Glycated hemoglobin (A1c) •Diagnose diabetes and assess BG levels over the preceding 3 months •Use may be limited due to variability in results •Pair with fasting BG on the same day ‒If values of both are in diabetic range, diagnosis of DM confirmed eAG •Average BG over the last few months ●Glucosuria •BG exceeds transport maximum for glucose of nephrons ●Ketonuria •Ketones are produced when glucose can not be utilized •Ketones appear in urine when ketone formation elevated •More common in T1DM ●Islet cell autoantibodies (ICA's) •Present in T1DM ●C-peptide test •Indicator endogenous insulin •C-peptide released when pancreas releases insulin •Differentiate between T1DM and T2DM
ectopic pregnancy
●Fertilized ovum implants outside the uterus ●98% occur in fallopian tubes •Pain, vaginal bleeding, and amenorrhea are present •Rupture of fallopian tube may cause intense pain ●Low level hCG (pregnancy hormone) •Culdocentesis (extraction of fluid behind the vaginal canal) - will reveal blood if rupture •Laparoscopic salpingostomy - remove ectopic pregnancy •Salpingectomy required if rupture
Gestational Diabetes Mellitus
●Fetal defects, premature delivery, hypoglycemia in newborn, and large-for-gestational-age infants (macrosomia) ●Hormone levels increase insulin resistance ●Women screened •2nd trimester OGTT (oral glucose tolerance test) ●GDM normally resolves after pregnancy •Can increase risk for T2DM
Ovary—Benign Ovarian Cysts
●Follicular cyst •Failure to eject ovum during ovulation •Usually asymptomatic, regress spontaneously ●Corpus luteum cyst •Occurs after ovulation •Usually causes symptoms, may rupture •Pelvic pain, amenorrhea, followed by irregular or heavy bleeding •Ultrasound confirms diagnosis •Rule out pregnancy •Laparotomy may be necessary to remove cyst
parathyroid gland
●Four pea-sized glands on posterior thyroid ●Secrete PTH (parathyroid hormone) •Released when blood calcium low •Activate bone resorption, intestinal calcium absorption by kidneys
Transgender individuals
●FtM: Female biological sex at birth with gender identity as male •Transgender man, trans man ●MtF: Male biological sex at birth with gender identity as female •Transgender woman, trans woman ●Transitioning to opposite sex can include hormone therapy, psychological therapy, and surgery
Viral—Herpes Simplex Virus (HSV)
●Genital herpes ●Acute and latent viral infections •Acute phase ‒Vesicular lesions on the skin •Latent ‒No viral proteins produced ●Two types herpes viruses •HSV-1 ‒Oral, "cold sores" •HSV-2 ‒Sexual activity ("genital") ‒HSV2 can be transmitted during symptomatic and asymptomatic periods •Both types can infect either region
Other Glucose-Regulating Hormone
●Glucagon •Alpha cells of pancreas •Released when BG levels are low •Glycogenolysis and gluconeogenesis •Stimulates lipase •Injectable form in severe hypoglycemia ●Somatostatin •Delta cells of pancreas •Diminishes secretion of insulin and glucagon •Decreases GI activity, slow absorption
Patient Self-Monitoring of Glucose
●Glucometer: measure BG ●Evaluate BG several times a day •Preprandial blood glucose: before eating •Postprandial glucose: 2 hours after eating •Bedtime
Blood Glucose Maintenance: Starvation
●Gluconeogenesis •Amino acids and glycerol of lipids (fats) converted to glucose ●Fatty acids remains as lipids •Converted to acetoacetic acid, beta-hydroxybutyric acid, and acetone •Known as ketones or ketoacids •Fruity odor: breath, saliva, sweat •Accumulation of ketones may lead to diabetic ketoacidosis (DKA)
Carbohydrate Metabolism
●Glucose •Used for energy, stored as glycogen, or converted to component of lipid molecules ●Glycogenesis •Glycogen formation •Primarily in liver and muscle ●Glycogenolysis •Glycogen breakdown •Occurs when blood glucose falls and body needs energy
Chancroid
●Haemophilus ducreyi ●Soft lesion (unlike solid chancre of syphilis) ●Painful ulcer ●Lymphadenopathy of inguinal lymph nodes ("buboes")
Hypothyroidism
●Hashimoto's thyroiditis •Autoimmune disorder •Anti-thyroglobulin antibody and anti-thyroperoxidase antibody ●Other causes •Drugs •Genetics •Thyroiditis (postpartum period especially high incidence) •Congenital hypothyroidism: cretinism
MSM
●High risk for STI's affecting rectum, genitalia, urethra, and oropharynx •STI screening recommended 1x per year •Safe sex practices should be discussed ●High risk for certain STI's •HIV, HPV (anal papilloma or anal cancer) •Also increased risk for hepatitis ●Shigella infection •Gay bowel syndrome ●Menigococcal meningitis •Increased prevalence of oropharyngeal colonization with N. meningitidis
3 major types of endocrine conditions
●Hormone deficiency •Gland destruction ‒Autoimmune, infection, tumor ●Hormone excess •Tumor, autoimmune, genetic mutation ●Hormone resistance •Usually genetic (lack hormone receptor or ability to respond)
Treatment of endocrine disorders
●Hormone replacement therapy •Dosage schedules attempt to mimic physiological effects •Glucocorticoids, thyroid hormones, sex steroids, ADH most common replacements ●Suppression of hormone overproduction •Medications, surgery, radiation
Treatment for Female Reproductive Disorders
●Hormone replacement therapy (HRT) •Menopausal symptoms, weigh risk and benefits of HRT ●Fertility drugs •Stimulate ovulation ●In vitro fertilization (IVF) ●Dilation and curettage (D & C) •Dilate cervix, surgical removal of lining of uterus ●Hysterectomy •Surgical removal of uterus ●Endometrial ablation •Removal of uterine lining ●Conization of cervix ●Cryosurgery •Remove portion of cervix for diagnosis
Diagnosis of Male Reproductive System
●Hormones: FSH, LH, testosterone ●Klinefelter: XXY ●Testicular cancer •Elevated alpha-fetoprotein or b-HCG ●Urine flow studies (BPH), PSA levels, culture of lesions ●Semen analysis •Patient should be abstinent for 2-3 days •Process sample within 1 hour; 2-3 samples should be evaluated due to daily variation
BG Control During Hospitalization
●Hospitalization is a stressor that may alter patient's glycemic control •Emotional stress, critical illnesses ●Less stringent guidelines ●Main goal to prevent hypoglycemia and hyperglycemia
Menstrual Cycle
●Hypothalamic (GnRH)-pituitary (FSH/LH)-ovarian (estrogen/progesterone) axis ●28-day cycle •Follicular phase ‒FSH stimulates ovarian follicles to produce estrogen ‒Days 1-14 •Ovulation ‒Positive feedback by estrogen causes surge in FSH/LH ‒Day 14 ‒Ovum released from ovary Luteal phase ‒Corpus luteum forms and produces progesterone ‒Days 14-28 ●Hormones stimulate changes in uterine lining •Estrogen ‒Stimulates uterine lining growth for implantation •Progesterone ‒Stabilizes uterine lining for implantation •If fertilization does not occur... ‒Corpus luteum degenerates, progesterone levels fall, and uterine lining is shed ●Menarche •1st episode menstrual bleeding ●Menses •Menstrual bleeding ●Menopause •Permanent cessation of menstrual cycles •Perimenopause: gradual decline in ovarian function •Atrophic vaginitis, vasomotor instability •Low estrogen, high FSH
Diagnosis of endocrine disorders
●Immunoassays or blood levels of hormones most important ●Urinary hormone levels assessed in some instances ●Urinary collection over 24 hours ●Suppression/stimulation tests ●CT scan/MRI ●Ultrasound
Human Papilloma Virus (HPV)
●Increased risk of infection •Multiple partners, early onset of sexual activity, immunosuppression, smoking, oral contraceptive use more than 5 years ●HPV enters through break in epithelial barrier ●Diagnosis •Lesion biopsy and DNA testing •Pap smear: anal Pap smear on MSM ●HPV infection associated with other STI's, further testing may be required
Treating DM
●Individuals with DM susceptible to hypoglycemia and hyperglycemia •Insulin excess most common cause hypoglycemia ●Strict glycemic control is goal of all treatment for DM ●Better control related to decreased risk for long-term complications ●The clinician uses three major indices to guide and evaluate treatment efficacy: •A1c level •Fasting blood glucose level •Postprandial blood glucose level
Basic Concepts of Male Reproductive Dysfunction—Overview
●Infertility ●Anatomical abnormalities ●Inflammation and infection ●Precocious puberty ●Delayed puberty ●Priapism
Diabetic Ketoacidosis (DKA)
●Insulin lacking •In presence of insulin, DKA does not occur •Insulin prevents the lipolysis that leads to ketone formation •More common in T1DM than T2DM ●Without insulin (or glucose to use for fuel) ketone formation occurs •Ketones ‒Strong acids, alter blood pH, metabolic acidosis Diagnostic criteria •BG (greater than 250 mEq/L) •pH (less than 7.3) •HCO3- (less than 15 mEq/L) •Ketonuria •Ketonemia ●Presentation •Nausea •Vomiting •Dehydration •Tachycardia •Hypotension •Kussmaul's respirations •Ketone body odor
Pathological Mechanism T2DM
●Insulin resistance with increased insulin levels ●Polyuria, polyphagia, polydipsia ●Metabolic syndrome •HTN, dyslipidemia, hyperinsulinism, centralized obesity ●Hyperosmolar hyperglycemia syndrome (HHM) •DKA does not normally occur in T2DM, presence of some insulin prevents ketone formation
Basics of Carbohydrate Metabolism
●Insulin-supported process of facilitated diffusion moves glucose from blood into cells ●Insulin produced by beta cells of islets of Langerhans in pancreas ●After eating: •Synchronous rise and fall of glucose and insulin
Antidiabetic Agents
●Insulinotropic agents •AKA: insulin secretagogues •Subcategories: sulfonylureas, meglitinides ●Biguanides ●Thiazolidinediones ●Alpha-glucosidase inhibitors ●Incretin mimetics ●Amylin mimetics ●DPP-4 inhibitors ●SGLT2 inhibitors Insulinotropic •Stimulate pancreas to secrete insulin •Examples: glipizide (Glucotrol), sulfonylureas (cannot use if allergy to sulfa drugs) ●Biguanides •Reduces BG by increasing cell sensitivity to insulin and lowering hepatic glucose production •Example: metformin (Glucophage) ‒Metformin: decreases TG, LDL, and body weight Thiazolidinediones •Sensitizing skeletal muscle and adipose tissue to insulin, decrease hepatic gluconeogenesis •Examples: Actos, Avandia ●Alpha-glucosidase Inhibitors •Blocks enzyme in intestine, slowing down breakdown of carbohydrate •Decreases postprandial glucose •Example: Acarbose Incretin mimetics (GLP agonist, GIP agonist) •Insulin-stimulating factor in GI tract •Reduce postprandial BG increase •Example: exenatide ‒Glucose-dependent insulin secretion ‒Promotes growth and development of beta cells ●Amylin mimetics •Injectable (Symlin) ‒Synthetic form of human amylin (pancreatic hormone, with insulin, helps to control postprandial BG) •Natural amylin ‒Slows gastric emptying and suppresses glucagon secretion •Diabetes ‒Amylin absent or deficient DPP-4 Inhibitors •Inhibit dipeptidyl peptidase-4 (DPP-4) ‒Enzyme that destroys GI incretin hormones ‒Block enzymatic breakdown of GI incretins •Examples: sitagliptin (Januvia) and saxagliptin (Onglyza) ●SGLT2 Inhibitors •SGLT2: protein that enhances glucose reabsorption in nephron •Inhibiting SGLT2 decreases glucose reabsorption and increases glucose excretion •AKA: "glucoretic" medication •Examples: canagliflozin (InvokanaR) and dapagliflozin (FarxigaR)
LGV and Granuloma Inguinale
●LGV: C. trachomatis •3 stages ‒Painless induration at point of entry ‒Inguinal lymphadenopathy (painful) ‒Anogenitorectal syndrome ●Granuloma inguinale: Klebsiella granulomatis •AKA: donovanosis •Begins with painless induration that develops into wide ulcer Diagnosis and Treatment ●Diagnosis •All patients with genital ulcers require serological testing (syphilis), HIV testing, PCR •Culturing ulcers ●Treatment •Antibiotics
Diabetic Retinopathy and Blindness
●Leading cause of blindness in adults ●Retinal circulatory damage due to high BG •Signs: microaneurysms, macular edema, "cotton wool spots" (infarcted regions of retina) ●Proliferative retinopathy •New vessel growth •Vessels are fragile and may rupture leading to retinal detachment ●Regular fundoscopic exam and ophthalmological examinations are critical
Diabetic Nephropathy
●Leads to renal failure ●Damage to glomerular capillary •Microalbuminuria ●Glomerular basement membrane may eventually thicken due to glycosylation end-products ●Activation of RAAS with renal dysfunction compounds problem as BP elevates
Fatal consequences of DKA
●Life threatening causes of DKA •Inadequate insulin •New onset of diabetes •Stress of infection ●Cerebral edema is a severe complication •70% mortality rate if severe cerebral edema present •Do not overhydrate •Early signs: headache, confusion, and lethargy •Papilledema
Hypopituitarism
●One or more of the pituitary hormones •Panhypopituitarism ‒Complete loss of all pituitary hormones ‒Rare ●Causes •Pituitary tumor, brain surgery, radiation of brain tumor, congenital disorder •Trauma, ischemia, and infarction can cause sudden loss of pituitary function ‒Sheehan's syndrome ●Develops after childbirth with severe hemorrhage ●Primary adenoma •Most common cause •Benign neoplasm •With growth can compress pituitary gland in sella turcica ‒Interfere with pituitary function ●Craniopharyngioma •Benign neoplasm close to pituitary gland or pituitary stalk ●Pituitary apoplexy •Sudden destruction of the pituitary tissue due to infarction or hemorrhage into gland •Traumatic brain injury most common cause ●Sheehan's Syndrome •Ischemia or infarction of the pituitary after childbirth because of severe hemorrhage •Degree of necrosis correlates with hemorrhage •Develop deficiency of ACTH, TSH, FSH, LH, ADH, and PRL
Ovarian Torsion
●Ovary twisted •An enlarged ovary is more likely to twist ●Blood flow obstructed ●Sudden, severe unilateral pain ●Nausea and vomiting often present, which may lead to suspected GI issue (i.e., appendicitis) ●Rule out ectopic pregnancy Diagnosis •Ultrasound with color Doppler ●Treatment •Surgical removal
Thyrotoxic Crisis (Thyroid Storm)
●Overwhelming release of thyroid hormones ●Stimulate metabolism •High fever, tachycardia, agitation, psychosis ●Often precipitated by surgery or trauma ●Medical emergency
Surgical Treatment of DM
●Pancreas and islet cell transplantation ●Lifelong immunosuppression needed
Diagnosis for menstrual disorders
●Papanicolaou smear (Pap smear) •Cervical cancer cellular changes ●Liquid-based cytology (LBC) •Used in place of Pap smear •Cervical cell changes, HPV (human papilloma virus) ●Colposcopy •Visualize cervix ●Culdoscopy •Visualize uterine tubes and ovaries •Culdoscope inserted into the vagina posterior to the cervix ●Carcinoembryonic antigen 125 (CA-125) •Marker associated with uterine fibroids, endometriosis, ovarian cancer ●Hysteroscopy •Visualize interior of uterus ●Laparoscopy •Small surgical incision, view internal organs ●Mammography •Specialized x-ray to visualize breast tissue ●Proctoscopy •Examine anal canal and rectum ●Ultrasound
hyperpituitarism
●Pituitary adenoma •Most common cause •May produce ACTH, TSH, or GH •Prolactinoma most common form: secretes PRL ‒High PRL has antiestrogenic and antiandrogenic effects ●Large tumors may cause headaches and visual disturbances (because of proximity to optic nerves) ●Children •ACTH-producing adenoma •Corticotropinomas, common before puberty •Cushing-like symptoms ●GH-secretion adenoma •Children ‒Gigantism •Adults ‒Acromegaly ●Diagnosis •Serum hormone levels •Urine hormone levels may also be assessed •Dexamethasone suppression test to assess ACTH response ●Treatment •Depends on elevated hormone •Prolactinoma ‒Bromocriptine •Transsphenoidal surgery •Adrenal enzyme inhibitors •GH inhibitors
Pathophysiological Theories of DM
●Polyol pathway theory •Intracellular hyperglycemia activates aldose reductase •Glucose converted to polyol sorbitol •Intracellular sorbitol causes cellular damage and oxidative stress ●Glycation theory •Advanced glycation end-products (AGE's) •Glucose attaches to proteins •Endothelial cell protein functioning disrupted leading to vascular damage ●Activation of protein kinase C (PKC) •Pathological activation of PKC occurs in hyperglycemia •Activates VEGF (retinal damage) •Vasoconstriction •Inflammation ●Activation of reactive oxygen species (ROS) •Common denominator of all damage •Free radicals caused by oxidation of glucose •Injury activates inflammation leading to atherosclerotic changes
Diabetes Insipidus (DI)
●Posterior pituitary hypopituitarism ●Lack of ADH or response to ADH ●Dilute, large volume urine •Plasma concentration increases ●Categories of disease •Central DI ‒Lack ADH from the posterior pituitary •Nephrogenic DI ‒Kidney fails to respond to ADH ‒Distinguish by administering ADH to see if kidneys can respond, if so, central DI ●Signs and symptoms •Frequent urination, thirst, dehydration, disorientation, seizures •Blood test will show high osmolarity and hypernatremia •Urine osmolarity and specific gravity will be low ●Diabetes insipidus differs from diabetes mellitus (no hyperglycemia in DI) ●Treatment •ADH administration (if central DI)
Herpes Simplex Virus (HSV)
●Prevalence of HSV2 has increased worldwide •HSV2 can be transmitted to neonate at childbirth ●Transmitted by close skin contact, mucosa secretions, or saliva ●Virus reproduces in skin causing blisters and ulceration ●Travels to dorsal ganglion of sensory nerves ●Manifestations •Local tenderness, burning and erythema, followed by eruption of vesicles ●Diagnosis •Culture •PCR ●Treatment •No cure •Antiviral medication, acyclovir, may reduce symptoms
Diagnosis of hypothyroidism
●Primary: high TSH, low free T3, low free T4 ●Secondary: low TSH, low free T3 and T4 ●Hashimoto's thyroiditis antibodies •Antithyroglobulin (anti-Tg) •Antithyroperoxidase (anti-TPO) ●Ultrasound ●Recommended: thyroid test in women at age 35 and every 5 years after
Hyperthyroidism Diagnosis
●Primary: low TSH, high free T3 and T4 ●Secondary: high TSH, high free T3 and T4 ●Antibodies for Graves' disease •Anti-thyroid peroxidase (anti-TPO) •Thyroid stimulating immunoglobulin ●Ultrasound with color-Doppler evaluation ●Radioactive iodine scanning and iodine uptake
Pineal Gland Dysfunction
●Produces melatonin with the phases of the light-dark cycle ●Tumor may place pressure on adjacent brain structures •Blockage of cerebrospinal fluid (CSF) flow ●Symptoms include headache, nausea and vomiting, seizures, memory disturbances, and visual changes
Hypoparathyroidism
●Rare ●Inadvertent damage with thyroid surgery, genetic disorders ●Presentation due to hypocalcemia •Trousseau's sign, Chvostek's sign •Muscle cramps, tetany •Convulsion ●Treatment •Replacement PTH, normalize serum calcium
Viral- Zika Virus
●Related to dengue and West Nile virus ●Transmitted by mosquitos, sexual activity, blood products ●Can be asymptomatic or cause fever, rash, arthritis •In pregnant women, can be transmitted to fetus ‒Brain underdevelopment (microcephaly) ●No cure WHO recommendation •Refrain from unprotected sexual activity for at least 6 months after infection
Treatment of Hypothyroidism
●Replacement hormone: levothyroxine ●Surgical intervention if necessary ●Myxedema coma •Severe hypothyroid condition •Will progress to confusion and coma if untreated
Male reproduction
●Sperm produced in seminiferous tubules, millions daily travel to epididymis ●Epididymis •Sperm gain final maturation ●Vas deferens •Ascends from epididymis •Part of spermatic cord •Vasectomy: vas deference cut to block sperm delivery to penis ●Spermatic cord •Suspends testicles from abdomen into inguinal region Prostate gland •Encircles urethra below urinary bladder •Normally enlarges with age ‒Benign prostatic hyperplasia (BPH) •Secretes alkaline fluid, contributes to semen •Prostate surface antigen (PSA) ‒Used to assess prostate structure and function ●Bulbourethral glands •Located below prostate and lubricating fluid during sexual arousal Penis •Erectile tissue ‒Corpus spongiosum and corpus cavernosa •Erection requires adequate circulation (vasodilation: nitric oxide) and autonomic neurological control ●Fertility •Quantity of sperm, sperm count, motility of sperm, adequate circulation, hormonal regulation
Treatment of Cushing's Syndrome
●Surgery ●Ketoconazole •Suppress cortisol
Treatments Male Reproductive Disorders
●Surgical correction for anatomical abnormalities ●Culture/sensitivity testing for infection ●Prostate •Medications or surgery ●Testicular cancer •Orchiectomy ‒Removal of testicle and radiation are treatment •Infertility may result, freeze sperm before procedure
Benign Prostatic Hyperplasia: Surgery
●Surgical treatment •Transurethral needle ablation (TUNA) •Transurethral resection of the prostate (TURP) •Transurethral incision of prostate (TUIP) ●Goal •Obstructive prostatic tissue is excised •Free flow of urine restored
Pathological Mechanism T1DM
●T-cell mediated attack of beta cells ●Genetic influence ●Presenting sign is often DKA ●Polyuria, polydipsia, polyphagia
Antidiabetic Non-Insulin Agents T2DM
●T2DM is stepwise approach ●Begin with lifestyle modifications ●Metformin: initial medication choice ●If monotherapy unable to control BG, additional medication can be added ●Combinations often effective BG control ●Oral and injectable medication forms
Puberty
●Tanner staging to evaluate puberty stage ●Precocious puberty •Secondary sex characteristics before the age of 9 •Reduced adult height due to early closure of growth plates ●Delayed puberty •Lack of testicular development, pubic hair by age 14 •Can be due to lack of hormonal signal from pituitary
Graves Disease
●Thyroid-stimulating antibodies •Bind to thyrotropin receptors •Gland enlargement •Continual synthesis thyroid hormones ●Nervousness ●Insomnia ●Sensitivity to heat ●Weight loss ●Enlarged thyroid gland ●Atrial fibrillation ●Increased HR ●Increased sympathetic nervous system sensitivity ●Exophthalmos •Wide-eyed stare •Extraocular area filled with mucopolysaccharides •Graves ophthalmopathy ‒Periorbital edema and bulging of the eyes
Congenital Syphilis
●Transmitted by the mother to fetus ●Transmission most likely with early syphilis •Miscarriage or stillbirth •If fetus born alive, specific signs: ‒Hutchinson teeth ‒Saddle nose ‒Various neurological manifestations
Bacterial—Syphilis
●Treponema pallidum ●Transmissible •Sexual contact, transplacentally, blood product transfusion, broken skin in contact with infectious lesion ●"Great imposter" as mimics several diseases ●Infection rates are increasing, particularly MSM (high co-infection with HIV) ●Incidence rate highest in people ages 25 to 29
Four Major Categories of DM
●Type 1 (T1DM) ●Type 2 (T2DM) ●Gestational diabetes (GDM) •Develops only during pregnancy due to hormonal changes decreasing insulin sensitivity •Approximately 4% of U.S. pregnancies ●Other specific types of diabetes •Pancreatitis, cystic fibrosis, neonatal
hyperparathyroidism
●Usually due to parathyroid adenoma ●Primary •Elevated PTH and calcium ●Secondary •Elevated PTH, low to normal calcium •Any disorder that causes hypocalcemia can induce secondary hyperparathyroidism ●Presentation due to excess calcium •Muscle weakness •Poor concentration •Neuropathies •Kidney stones •Osteopenia •Pathological fractures ●Treatment •Surgery •Reduce serum calcium
Pathologies of Female Reproductive Tract
●Uterus •Endometritis •Endometriosis •Endometrial polyps •Leiomyomas •Dysfunctional uterine bleeding •Uterine prolapse •Cystocele, rectocele, enterocele ●Cervix •Cervicitis ●Vagina, external genitalia •Vulvodynia •Vulvar cancer •Vaginitis Ovary •Premature ovarian failure •Benign ovarian cyst •Teratoma •Ovarian torsion •Polycystic ovarian syndrome •Ectopic pregnancy ●Breast •Fibrocystic breast disease •Fibroadenoma •Mastitis •Galactorrhea •Mammary duct ectasia
Uterus—Endometrial Polyps
●Varying size ●Neoplastic growth, unknown origin ●Usually benign ●May be asymptomatic or cause bleeding ●Diagnosis •Hysteroscopy, curettage, and biopsy ●Treatment •Surgical excision
Disorders of Vagina and External Genitalia
●Vulvodynia •Pain of the vulva •Yeast infection, chemical irritants, infection ●Vulvar cancer •Rare •Bleeding, itching, palpable mass may be present ●Vaginitis •Inflammation of vagina •Discharge, burning, itching •Pain with urination, sexual intercourse •Bacterial causes (40%-45%), vaginal candidiasis (20%-25%), trichomoniasis (15%-20%) •Precise identification of organism is crucial to treatment ‒Oral medications ‒Application of medications to vagina Preventive measures ‒Proper hygiene, avoidance of feminine deodorants and douches
Adrenal Insufficiency Symptoms
●Weakness ●Hypotension ●Easy fatigue ●Emotional lability ●Anorexia ●Hypoglycemia ●Electrolyte imbalances •Hyponatremia •Hyperkalemia ●Tanned appearance due to melanocyte-stimulating hormone (MSH) ●ACTH and MSH arise from same precursor molecule ●Women •Loss of pubic and axillary hair •Amenorrhea
Hyperadrenalism Signs and Symptoms
●Weight gain ●Redistribution of body fat to the face, trunk, and abdomen ●Puffy face called "moon facies" ●Extra subcutaneous fat in the cervicothoracic area called "buffalo hump" ●Increase in the waist-to-hip circumference ratio ●Striae ●Easy bruising and poor wound healing ●Women •Hirsutism •Male pattern hair growth
Eating Disorders and Diabetes
●Young women with T1DM at risk for eating disorder ●Insulin purging •Restrict or skip insulin usage to stimulate lipolysis and weight loss ●Suspect eating disorder in patients with recurrent DKA or chronically poor glycemic control
