THEORY EXAM III
Hypoglycemia
low blood sugar
Intermediate acting insulin
onset: 1,5 hr-4 hr peak- 4-12 hr duration- 12-18 hr NPH (Humulin N, Novolin N)
inhaled insulin
onset: 12-15 minute peak: 60 minute duration: 2.5-3 hour should be taken 20 mins after meal and is rapid acting long term insulin should be used conconurrently no for emergency treatment or those with copd/asthma types: Afrezza
What is petechiae/purpura :
petechiae : Small dot like pinpoint hemorrhages on the skin. purpura: A rash of purple spots due to small blood vessels leaking blood into the skin, joints, intestines, or organs.
insulin pump
portable, battery-powered device that delivers insulin through the abdominal wall in measured amounts. Delivers a continuous, SQ infusion through a pump of rapid acting insulin. They adminster this insulin in 24 hours a day calculated at a basal rate. the dose can be temp. adjusted based on carb intake, activity or illness. different rates are needed for different times of the day. the most severe side effect of insulin pump admin is hypoglycemia.
Hyperosmolar Hyperglycemic State (HHS)
rare but deadly metabolic state is more common in the elderly with type 2 DM. HHS is characterized by hyperglycemia and severe dehydration without ketoacidosis.
What is a zosteriform lesion?
vesicular lesions of the skin could be due to either herpes zoster (caused by varicella zoster virus) or zosteriform herpes simplex (caused by herpes simplex virus).
Short acting insulin
- Regular (Humulin R, Novolin R) - Onset 30 min-1 hr - peak 2-5 hr - duration 5-8 hr
Islet Cell Antibodies (ICA)
-Antibodies frequently found in type I diabetes that suggests an autoimmune etiology -Can help distinguish between TYPE 1 AND TYPE 2 DM
MCH normal range
27-34 pg
type 1 diabetes mellitus
-Beta cells in the inslet of langerhorns (pancreas) don't work, destroyed. There is NO more insulin. -Must use insulin treatment -Not related to lifestyle, genetic, auto-immune (virus) -Patients are thin, young and happens suddenly, ketones in urine
Hypoglycemia
-Occurs when there is too much insulin in the blood in proportion to available glucose. -Drops below 70 mg/dL (3.9 mmol/L) -Epinephrine is a counterregulatory hormone that is released and can caused shakiness, palpitations, sweating, anxiety and hunger -The brain's main fuel source is glucose, so as levels drops low, neurological symptons can be seen: confusion, difficultly speaking, visual changes, eventually coma -Can mimic alcohol toxicity -Some can have hypoglycemia unawareness: where glucose is low but no warning signs or symptoms
basophil normal range
0-2% Basophils play an important role helping your body respond to allergic reactions. Basophils destroy foreign organisms by surrounding and ingesting them (phagocytosis) Having an increased number of basophil cells (basophilia) may be an indication of an underlying medical condition. Basopenia could be the result of your basophils working overtime to attack an allergen or treat an infection that is taking longer than normal to heal. It could also be the result of your thyroid gland producing too much thyroid hormone.
eosinophils normal range
0-4% An absolute eosinophil count is a blood test that measures the number of one type of white blood cells called eosinophils. Eosinophils become active when you have certain allergic diseases, infections, and other medical conditions. Blood is comprised of red blood cells, platelets, and various white blood cells.
platelets normal range (plt)
150,000 - 400,000/ uL Thrombocytopenia: Low platelet count can lead to bruising and excessive bleeding. Thrombocytosis: High platelet count can lead to abnormal blood clotting.
Lymphocytes normal range
20-40% High levels of lymphocytes in your blood are called lymphocytosis. Lymphocytosis is usually due to an infection or illness Low levels of lymphocytes in your blood are called lymphocytopenia (or lymphopenia). The flu or other mild infections can cause lymphocytopenia, but it could also be caused by a more serious disease or condition, including: aids/hiv , tb, lupus
MCHC normal range
32-37%
WBC normal range
4,000-11,000 high wbc: infection or inflammation in your body. A low wbc count almost always is related to a decrease in a type of infection-fighting white blood cell called neutrophils. When you have a low level of neutrophils, the condition is known as neutropenia. There are many causes of neutropenia, and some medications can lead to this problem
monocytes normal range
4-8% Monocytes call on other white blood cells to help treat injury and prevent infection Monocytosis occurs when your monocyte count is too high. It's most often linked to a chronic infection or disease that your body is fighting. cancer, autoimmune disease, infection, cardiovascular issue Monocytopenia occurs when your monocyte count is too low. This is the result of decreases in your white blood cell count. Causes of monocytopenia include: Aplastic anemia. Blood infection. Burn injuries. HIV. Reaction to chemotherapy.
Neutrophil normal range
50-70% bands go up= immature neutrophils= severe (usually acute) infection = shift to the left segs go up= mature neutrophils = chronic infection = shift to the right They help the body fight infection. An absolute neutrophil count may be used to check for infection, inflammation, leukemia, and other conditions. The lower a person's absolute neutrophil count is, the higher the risk is of getting an infection.
MCV normal range
80-100 fL
What does a CBC detect?
A CBC blood test can help your provider diagnose a wide range of conditions, disorders, diseases and infections, including: Anemia (when there aren't enough red blood cells to carry oxygen through the body). Bone marrow disorders, such as myelodysplastic syndromes. Disorders such as agranulocytosis and thalassemias and sickle cell anemia. Infections or other problems that cause abnormally low white blood cell count or high white blood cell count. Several types of cancer, including leukemia and lymphoma. Side effects of chemotherapy and some prescription medications. Vitamin and mineral deficiencies.
fructosamine test
A blood test that measures average glucose levels over the past 3 weeks. - Can assess glucose levels in the previous 1-3 weeks -May show a change in glucose levels before an A1C does -Used in patients with hemoglobionpathies, or short term measuresments
Ringworm
A highly contagious, fungal infection of the skin or scalp. annular (circular, begins in center and spreads)
What is jaundice?
A yellowing of the skin and eyes
Which patient risk factor would thenurse assign as thepriority focus of patient teaching? a. Multiple dysplastic nevi b. Light-skinned with blue eyes c. Using a tanning booth weekly d. Mother died of malignant melanoma
Because theonly risk factor that thepatient can change is theuse of a tanning booth, thenurse should focus teaching about melanoma prevention on this factor. theother factors contribute to increased risk for melanoma but can't be changed through health behaviors
What is confluent?
CONFLUENT - Joining or running together. CRESCENTIC - Shaped like a crescent moon (the moon in its first quarter)
Treatment for hypoglycemia
Can be quickly reversed. -Check glucose first, the follow the rule of 15 -Have pt eat/drink 15-20 grams of quick acting carbohydrate (regular soda, syrup,honey,jelly, orange juice, dextrose) -Wait 15 minute then check glucose again -If still below 70 mg/dL have pt eat another 15-20 gram of fast acting carb. -Once stable, give patient additional food -Emergency if no improvement after 2-3 doses For emergency/unconscious pt: - 1 mg glucagon SQ or IM -Alternativeley, IV admin of 20-50 ml of 50% glucose -TURN PATIENT on side to prevent asipration
type 2 diabetes mellitus
Cause: cells (primary muscle, fat,liver) are resistant to the actions of insulin and or your pancreas stops producing enough insulin. Impacts: Your body is resistant to the actions of insulin Prevention: Most cases, can be prevented, delayed by changing lifestyle, losing weight, better diet, increase exercise Diagnose: Can develop any age, but usually diagnosed in middle ages adults Management: decrease excess body fat/ make life changes, along with taking insulin or other medications as needed
DKA s/s
D-ehydration K-etones in urine/blood, Kussmauls and K+ A-cidosis, Acetone breath, Anorexia d/t nausea
DKA = HYPERGLYCEMIA
DKA IS considered an emergent form of hyperglycemia Diabetic ketoacidosis. High blood sugar level High ketone levels in urine
what is discrete?
Discrete—lesions are distinctly separate from each other with identifiable borders.
RBC normal count
FEMALE: 3.8- 5.1 X 10 (6)/ uL MALE: 4.3- 5.7 X 10 (6) uL million cells per microliter (cells/mcL) low amount of rbc = indicate a vitamin B6, B12 or folate deficiency. It may also signify internal bleeding, kidney disease or malnutrition (where a person's diet does not contain enough nutrients to meet their body's needs). / Anemia A high rbc count can be a sign of: Dehydration. Heart disease. Polycythemia vera, a bone marrow disease that causes too many red blood cells to be made
DKA treatment
High IV flow rate (150-200hr) with insulin R in prescribed mixture (Rehydrate and push K back into cell, Oxygenate)
Three P's of diabetes
Polyuria (excessive urination) frequent urination Polydipsia (excessive thirst) a rise in appetite Polyphagia (excessive hunger) an increase in thirst
Common skin lesions
Primary contact dermatitis Allergic drug reaction Tinea corporis (ringworm of the body) Tinea pedis (ringworm of the foot) Psoriasis Tinea versicolor Labial herpes simplex (cold sores) Herpes zoster (shingles) Erythema migrans of Lyme disease
Type 2 Diabetes signs and symptoms
Signs and symptoms of type 2 diabetes often develop slowly. In fact, you can be living with type 2 diabetes for years and not know it. Increased thirst Frequent urination Increased hunger Unintended weight loss Fatigue Blurred vision Slow-healing sores Frequent infections Numbness or tingling in the hands or feet Areas of darkened skin, usually in the armpits and neck
type 1 diabetes mellitus signs and symptoms
Type 1 diabetes symptoms can appear suddenly and may include: Feeling more thirsty than usual Urinating a lot Bed-wetting in children who have never wet the bed during the night Feeling very hungry Losing weight without trying Feeling irritable or having other mood changes Feeling tired and weak Having blurry vision
What is cyonosis?
a bluish discoloration of the skin resulting from poor circulation or inadequate oxygenation of the blood.
What is ecchymosis?
a discoloration of the skin resulting from bleeding underneath, typically caused by bruising.
Which activities can the nurse working in the outpatient clinic delegate to a licensed practical/vocational nurse (LPN/VN)? (Select all that apply.) a. Administer patch testing to a patient with allergic dermatitis. b. Interview a new patient about chronic health problems and allergies. c. Apply a sterile dressing after the health care provider excises a mole. d. Explain potassium hydroxide testing to a patient with a skin infection. e. Teach a patient about site care after a punch biopsy of an upper arm lesion.
a. Administer patch testing to a patient with allergic dermatitis. c. Apply a sterile dressing after the health care provider excises a mole. Skills such as administration of patch testing and sterile dressing technique are included in LPN/VN education and scope of practice. Obtaining a health history and patient education require registered nurse (RN) level education and scope of practice
A patient in the dermatology clinic has a thin, scaly erythematous plaque on the right cheek. Which action would the nurse take? a. Prepare the patient for a skin biopsy. b. Teach the use of corticosteroid cream. c. Explain how to apply tretinoin to the face. d. Discuss the need for topical application of antibiotics
a. Prepare thepatient for a skin biopsy. Because the appearance of the lesion is suggestive of actinic keratosis or possible squamous cell carcinoma, theappropriate treatment would be excision and biopsy. Over-the-counter corticosteroids, topical antibiotics, and Retin-A would not be used for this lesion.
Which information would thenurse include when teaching a patient who has just received a prescription for ciprofloxacin (Cipro) to treat a urinary tract infection? a. Use a sunscreen with a high SPF when exposed to the sun. b. Sun exposure may decrease theeffectiveness of themedication. c. Photosensitivity may result in an artificial-looking tan appearance. d. Wear sunglasses to avoid eye damage while taking this medication.
a. Use a sunscreen with a high SPF when exposed to the sun Ciprofloxacin (Cipro) causes photosensitivity, so he patient should stay out of thesun. If that is not possible, teach the patient to wear sunscreen when taking medications that can cause photosensitivity.
Complications of Insulin Therapy
allergic reactions- can occur at injection sites, include redness/self limiting itchiness lipodystrophy: changes in SQ fatty tissue where wasting of SQ tissue occurs. usually due to oversude of an injection site somogyi effect: is characterized by wide differences in the blood sugar in the morning (hyperglycemia) and during the night (hypoglycemia). It is associated with undetected episodes of hypoglycemia during sleep dawn phenomenon: occurs with an increased level of blood sugar during the early morning hours. It is not associated with hypoglycemia during the night.
A patient who reports chronic itching of the ankles continuously scratches the area. Which assessment finding would the nurse expect? a. Hypertrophied scars on both ankles b. Thickening of the skin around the ankles c. Yellowish-brown skin around both ankles d. Complete absence of melanin in both ankles
b. Thickening of the skin around the ankles Lichenification is likely to occur in areas where thepatient scratches theskin often. It results in thickening of theskin with accentuated normal skin markings. Vitiligo is thecomplete absence of melanin in theskin. Keloids are hypertrophied scars. Yellowish-brown skin indicates jaundice. Vitiligo, keloids, and jaundice do not usually occur because of scratching theskin.
When assessing an African American patient, the nurse notes ashen color of the nail beds. What should the nurse do next? a. Palpate for rashes on the legs. b. Assess for jaundice in the sclera of the eye. c. Assess the mucous membranes for cyanosis. d. Assess for pallor of the skin on the buttocks
c. Assess the mucous membranes for cyanosis. In dark-skinned individuals, cyanosis is seen as ashen nail beds, conjunctiva, or mucous membranes. Vital signs, lung sounds, and cardiorespiratory history would be assessed after verifying cyanosis of mucous membranes. Palpating for rashes and assessing for jaundice and pallor would not be related to this patient's potential cyanosis.
Hemoglobin normal range - Hgb
female: 11.7- 15.5 g/dL male: 13.2- 17.3 g/dL
Which observation about the skin of an older patient is the priority for the nurse to discuss with the health care provider? a. Dry, scaly patches on the face b. Numerous varicosities on both legs c. Petechiae on the chest and abdomen d. Small dilated blood vessels on the face
c. Petechiae on the chest and abdomen Petechiae are caused by pinpoint hemorrhages and are associated with a variety of serious disorders such as meningitis and coagulopathies. the nurse would contact the patient's health care provider about this finding for further diagnostic follow-up. the other skin changes are associated with aging. Although the other changes will also require ongoing monitoring or intervention by the nurse, they do not indicate a need for urgent action.
The home health nurse notices irregular patterns of bruising at different stages of healing on an older patient 's body. Which action would the nurse take first? a. Ensure the patient wears shoes with nonslip soles. b. Discourage using throw rugs throughout the house. c. Talk with the patient alone and ask about the bruising. d. Suggest that the health care provider prescribe radiograph
c. Talk with the patient alone and ask about the bruising. The nurse would note irregular patterns of bruising, especially in theshapes of hands or fingers, in different stages of resolution. These may be indications of other health problems or abuse and would be further investigated. It is important that thenurse interview thepatient alone because, if mistreatment is occurring, thepatient may not disclose it in thepresence of theperson who may be theabuser. Throw rugs and shoes with slippery surfaces may contribute to falls. Radiographs may be needed if thepatient has fallen recently and reports pain or decreased mobility. However, thenurse's first nursing action is to further assess thepatient's safety.
what is grouped?
cluster of lesions
During assessment of the patient's skin, the nurse observes a similar pattern of discrete, small, raised lesions on the left and right upper back areas. Which term would the nurse use to document the distribution of these lesions? a. Confluent b. Symmetric c. Zosteriform d. Generalized
c. Zosteriform The description of the lesions indicates that they are grouped in a bilateral distribution. the other terms are inconsistent with the description of the lesions
What is leukopenia?
A low level of white blood cells in the blood, which can interfere with the ability to fight infection. Anything below 4,000 is typically considered to be a low white blood cell count. causes: autoimmune conditions, such as rheumatoid arthritis, lupus, and Sjögren's cancers, such as Hodgkin lymphoma, leukemia, and myelofibrosis infection, such as influenza, HIV, and hepatitis inflammatory bowel disease (IBD) Treatment for leukopenia depends on which type of WBC is low and what's causing it to be so. Growth factorstions that cause leukopenia -Antimicrobials -Growth factors
type 1 diabetes mellitus
diabetes in which no beta-cell production of insulin occurs and the patient is dependent on insulin for survival. -Auto immune disease -Usually occurs under age of 40 -The body creates antibodies against beta cells or insulin and destroys these cells -Many ppl go months to years before acute onset of symptoms and diagnose as their bells cells are deplenished -Type 1 REQUIRES insulin from an outside source to survive.
What is a hemotoma?
A pool of mostly clotted blood that forms in an organ, tissue, or body space. A hematoma is usually caused by a broken blood vessel that was damaged by surgery or an injury. It can occur anywhere in the body, including the brain.
angiopathy
disease of blood vessels leading cause of death in diabetic patients. damage to the blood vessels is caused by chronic hyperglycemia macrovasuclar: disease of large/med blood vessels microvasucar: results from thickening of the vessels membranes in the capillaries and arterioles
A patient has a urinary tract infection. The nurse knows that which class of drugs is especially useful for such infections? a. Macrolides b. Carbapenems c. Sulfonamides d. Tetracyclines
ANS: C . Sulfonamides Sulfonamides achieve very high concentrations in the kidneys, through which they are eliminated. Therefore, they are often used in the treatment of urinary tract infections
type 1 diabetes mellitus
Cause: immune system attacks and destroy cells in the pancreas that produce insulin. Impact: Your body does not make insulin Prevention: cannot be prevented at this time Diagnose: Can develop at any age, but its most common in children/young adults Management: Daily insulin/ healthy lifestyle
Type 2 Diabetes
Cells quit responding to insulin. Insulin Resistant -Accounts for 90-95 DM cases. -Usually attributed to being overweight, age, and some genetic predisposition -The body either does not make enough insulin, or does not not use it effectively (resistance) -Can sometimes be treated with insulin alternatively therapies that increase effectiveness of use of insulin -More severe cases requires insulin therapy
What is contact dermatitis?
Contact dermatitis happens when the skin becomes irritated or inflamed after coming in contact with a substance that triggers an allergic reaction. It bears some of the same symptoms as the six other types of eczema. But unlike atopic dermatitis — the most common and difficult-to-treat form of eczema
Clinical Manifestations of DKA
Dehydration - poor skin turgor, dry mucus membranes, tachycardia, orthostatic hypotension, skin is dry and loose, eyes become soft and sunken Sweet Breath from acetone. Early symptoms- Lethargy and weakness Abdominal pain/ anorexia, nausea, vomiting Kussmaul Respirations (rapid, deep breathing associated with dyspnea)- body's attempt to eliminate CO2 (an acid) to lower acidosis Acetone breath (result of fatty acid break down)( sweet fruity odor) Labs: Blood glucose 250+ Blood pH- <7.3 Bicarbonate level- <16mEq/L Large to moderate ketones in urine or serum
type 2 diabetes
Diabetes of a form that develops especially in adults and most often obese individuals and that is characterized by high blood glucose resulting from impaired insulin utilization coupled with the body's inability to compensate with increased insulin production.
Metabolic syndrome is Having three out of the five following conditions
Elevated waist circumference elevated triglyceride levels decrease HDL cholesterol levels, elevated blood pressure, elevated fasting blood glucose
C-peptide testing
Measure of endogenous insulin production Can show how much insulin in the body is endogenous (made by the body) vs injected Mechanism: Preinsulin is cleaves to insulin and C peptide in the golgi which are then released in a 1:1 ratio and can be measured Absence of C peptide in serum leads to Type I Diabetes diagnosis
Metabolic syndrome
Metabolic syndrome is a collection of risk factors that increase an individuals chance of developing cardiovascular disease and diabetes
What is neutropenia?
Neutropenia involves having lower-than-normal levels of neutrophils (a type of white blood cell) in your blood. It's especially common among people receiving cancer treatments, like chemotherapy. Neutrophils help fight infections. If you have neutropenia, it's important to take extra precautions to avoid germs that may make you sick. Mild neutropenia: 1,000 - 1,500. Moderate neutropenia: 500 - 1,000. Severe neutropenia: Less than 500. causes: HIV, hepatitis, tuberculosis, sepsis, and Lyme disease, among other infections. Cancer: treatment: Antibiotics Corticosteroids Granulocyte colony-stimulating factor (G-CSF)
Rapid acting insulin
ONSET: 10-30 MINUTE PEAK: 30 MIN- 3 HRS DURATION: 3-5 HOURS Types: Lispro (Humalog) Aspart (Novolog, Flasp) Glulisine (Apidra)
Long acting insulin
Onset: 0.8 -4 hour peak: less defined/no peak duration: 16-24 hour glargine (Lantus) detemir (Levemir)
Pathophysiology of metabolic syndrome
Over time causes target organ damage through multiple mechanisms individual diseases produce adverse clinical consequences
COMPONENTS OF Complete blood count (CBC)
RBC: Red blood cells, which carry oxygen. WBC: White blood cells, which fight infection. HGB: Hemoglobin, the oxygen-carrying protein in red blood cells. HCT: Hematocrit, the amount of red blood cells in the blood. Platelets, which help blood to clot.
DKA treatment
Serious condition and must be treated rapidly If fluid and electrolyte imbalance are not severe/life threatening some DKA can be treated at home -Fluid imbalances can be severe in patients with DKA and need to be treated/assessed Insulin adminstere to correct hypergecemia
DKA (diabetic ketoacidosis)
Shortage of insulin resulting in hyperglycemia and production of ketones
What is thrombocytopenia?
Thrombocytopenia is a condition in which you have a low blood platelet count. Platelets (thrombocytes) are colorless blood cells that help blood clot. Platelets stop bleeding by clumping and forming plugs in blood vessel injuries People with severe thrombocytopenia may have an increased risk of developing the following conditions: Severe internal bleeding: Thrombocytopenia may cause gastrointestinal bleeding or bleeding in your brain. Bleeding into your brain is a life-threatening issue. Heart attack: Thrombocytopenia may decrease the amount of blood flow to your heart. causes: bone marrow doesnt make enough platelets (blood cancers like leukemia or lymphoma) Your spleen traps platelets so they can't circulate through your bloodstream. Normally, your spleen stores about one-third of your platelet supply. Cancer treatments,treatment: Infections:, Alcohol use disorder:, Toxic chemicals, antibiotics treatment: Steroids: These medications may boost your platelet production. Blood transfusion: If your platelet level is very low, your healthcare provider may use blood transfusions to temporarily increase your platelet levels. Transfusions may boost levels for about three days. Splenectomy: This is surgery to remove your spleen. Your surgeon may do this if tests show your spleen is trapping large numbers of platelets. People who have splenectomies have an increased risk of developing infections. They may receive vaccinations to prevent infections.
When performing a skin assessment for an older adult, the nurse notes angiomas on the chest. Which action would the nurse take next? a. Suggest an appointment with a dermatologist. b. Assess the patient for evidence of liver disease. c. Teach thepatient about skin changes with aging. d. Discuss theuse of sunscreen to prevent skin cancers.
b. Assess the patient for evidence of liver disease Angiomas are a common occurrence as patients get older, but they may occur with systemic problems such as liver disease. thepatient may want to see a dermatologist to have theangiomas removed, but this is not theinitial action by thenurse. thenurse may need to teach thepatient about theeffects of aging on theskin and about theeffects of sun exposure, but thefirst action would be further assessment
An active athletic person calls the clinic and describes her feet as having linear breaks through the skin. What is the best documentation of this skin problem? a. Scales b. Fissure c. Pustule d. Comedo (acne lesion)
b. Fissure Fissures are linear cracks, such as athlete's foot. Scales are excess dead epidermal cells. A pustule is a circumscribed collection of leukocytes and free fluid. Comedo is associated with acne vulgaris.
Which assessment data from an older patient admitted with bacterial pneumonia would be of concern to the nurse? a. Brown macules on hands b. History of allergic rashes c. Skin wrinkled with tenting on both hands d. Longitudinal nail ridges and sparse scalp hai
b. History of allergic rashes Because the patient will be receiving antibiotics to treat the pneumonia, the nurse would be most concerned about her history of allergic rashes. the nurse needs to do further assessment of possible causes of the allergic rashes and whether the patient has ever had allergic reactions to any drugs, especially antibiotics. the assessment data in the other response would be normal for an older patient.
The nurse assesses a circular, flat, reddened lesion about 5 cm in diameter on a middle-aged patient 's ankle. Which action would the nurse take to determine if the lesion is related to intradermal bleeding? a. Elevate the patient 's leg. b. Press firmly on the lesion. c. Check the temperature of the skin around the lesion. d. Palpate the dorsalis pedis and posterior tibial pulses.
b. Press firmly on the lesion. If the lesion is caused by intradermal or subcutaneous bleeding or a nonvascular cause, the discoloration will remain when direct pressure is applied to the lesion. If the lesion is caused by blood vessel dilation, blanching will occur with direct pressure. the other assessments will assess circulation to the leg but will not be helpful in determining the etiology of the lesion.
1. The nurse notes that a new patient at the outpatient clinic has dry, scaly skin; thin hair; and thick, brittle nails. Which action is the most important for the nurse to take? a. Instruct the patient about the importance of nutrition for skin health. b. Make a referral to a podiatrist so that the nails can be safely trimmed. c. Consult with the health care provider about further diagnostic testing. d. Teach the patient about using moisturizing creams to decrease dry skin.
c. Consult with the health care provider about further diagnostic testing. The patient has clinical manifestations that could be caused by systemic problems such as malnutrition or hypothyroidism, so further diagnostic evaluation is indicated. Patient teaching about nutrition, addressing thepatient's dry skin, and referral to a podiatrist may also be needed, but thepriority is to rule out underlying disease that may be causing these manifestations
The nurse prepares to obtain a culture from a patient who has a possible fungal infection on the foot. Which items would the nurse gather for this procedure? a. Sterile gloves b. Patch test instruments c. Cotton-tipped applicators d. Syringe and intradermal needle
c. Cotton-tipped applicators Fungal cultures are obtained by swabbing theaffected area of theskin with cotton-tipped applicators. Sterile gloves are not needed because it is not a sterile procedure. Local injection or aspiration is not involved in theprocedure. thepatch test is done to determine whether a patient is allergic to specific testing material, not for obtaining fungal specimens
A patient in thedermatology clinic is scheduled for removal of a 15-mm multicolored and irregular mole from theupper back. For which type of biopsy would thenurse prepare? a. Shave biopsy b. Punch biopsy c. Incisional biopsy d. Excisional biopsy
c. Incisional biopsy An incisional biopsy would remove theentire mole and thetissue borders. theappearance of themole indicates that it may be cancerous. A shave biopsy would not remove theentire mole. themole is too large to be removed with punch biopsy. Excisional biopsies are done for smaller lesions and where a good cosmetic effect is desired, such as on theface
A patient with dark skin has been admitted to the hospital with acute decompensated heart failure. How would the nurse assess this patient for cyanosis? a. Inspect the skin color of the earlobes. b. Apply pressure to the palms of the hands. c. Look at the lips and oral mucous membranes. d. Measure capillary refill time of the nail beds.
c. Look at the lips and oral mucous membranes. Cyanosis persons with dark skin is more easily seen in theoral mucous membranes. Earlobe color may change in persons with light skin, but this change in skin color is hard to detect on darker skin. Application of pressure to thepalms of thehands and nail bed assessment would check for adequate circulation but not for skin color.
Which information would the nurse include in the teaching plan for a patient diagnosed with basal cell carcinoma (BCC)? a. Treatment plans include watchful waiting. b. Screening for metastasis will be important. c. Minimizing sun exposure reduces risk for future BCC. d. Low-dose systemic chemotherapy is used to treat BCC.
c. Minimizing sun exposure reduces risk for future BCC. BCC is frequently associated with sun exposure, and preventive measures should be taken to limit future sun exposure. BCC spreads locally and does not metastasize to distant tissues. Because BCC can cause local tissue destruction, treatment rather than waiting is indicated. Local (not systemic) chemotherapy may be used to treat BCC.
1. Which information would the nurse include when teaching patients about decreasing the risk for sun damage to the skin? a. Use a sunscreen with an SPF of at least 10 for adequate protection. b. Water-resistant sunscreens provide good protection when swimming. c. Try to stay out of the direct sun between the hours of 10 AM and 2 PM. d. Increase sun exposure by no more than 10 minutes a day to avoid skin damage.
c. Try to stay out of the direct sun between the hours of 10 AM and 2 PM. The risk for skin damage from thesun is highest with exposure between 10 AM and 2 PM. No sunscreen is completely water resistant. Sunscreens classified as water resistant still need to be reapplied after swimming. Sunscreen with an SPF of at least 15 is recommended for people at normal risk for skin cancer. Although gradually increasing sun exposure may decrease therisk for burning, therisk for skin cancer is not decreased.
The nurse notes darker skin pigmentation in the skinfolds of a middle-aged patient who has a body mass index of 40 kg/m2 . Which action would the nurse take? a. Discuss the use of drying agents to minimize infection risk. b. Instruct the patient about the use of mild soap to clean skinfolds. c. Teach the patient about treating fungal infections in the skinfolds. d. Ask the patient about a personal or family history of type 2 diabetes
d. Ask the patient about a personal or family history of type 2 diabetes The presence of acanthosis nigricans in skinfolds suggests having type 2 diabetes or being at an increased risk. the description of the patient's skin does not indicate fungal infection, poor hygiene, or the need to dry the skin folds better.
The nurse is developing a health promotion plan for an older adult who worked in the landscaping business for 40 years. thenurse will plan to teach the patient how to self-assess for which skin changes? (Select all that apply.) a. Vitiligo b. Alopecia c. Intertrigo d. Erythema e. Actinic keratosis
d. Erythema e. Actinic keratosis A patient who has worked as a landscaper is at risk for skin lesions caused by sun exposure such as erythema and actinic keratosis. Vitiligo, alopecia, and intertrigo are not associated with excessive sun exposure.
Nepthropathy
damage of the small blood vessels in the kidneys. Leading cause of ESRD (END STAGE RENAL DISEASE)
NEUROPATHY
disease of the nerves. 60-70% of DM patients experience this. most common in extremities. Sensory neuropathy: loss of sensation throughout the body - common on distal limbs pts describe as burning, cramping, crushing/tearing -worse at night -managing glucose is the only form of treatment tricycles antidepressants are somewhat effective in treating pain associated with DM neuropathy autonomic neuropathy: when there is damage to the nerves that controls automatic body functions -can affect all the body systems and leads to hypoglecemia unawareness gastroparesis (delay gastic empyting) sexual function ED is common in men incontinence
retinopathy
disease of the retina Leading cause of adult onsent blindness. Nonproliferative: most common form/ small blood vessels in retina experience partial occlusions= microaneyrusms/ moderate to severe vision loss Prolifeative: more/most severe. Without treatement, more than half of the pts will go blind. Similar to microanyerums but the body compenstates by building new vessels to the retina. These vessels are weak/tend to leak/rupture, causing blood to pool in retina. The blood blocks light from entering the eye, causing vision loss. Patients will see black/red spots/lines.
Hypoglycemia symptoms
hunger, fatigue, weakness, sweating, headache, dizziness, low bp, cold or clammy skin, confusion
