FINAL EXAM Study Guide Version Part 1 Flashcards

Question

**CAUTION** algorithm for warning signs of cancer

Answer 1

**C:** change in bowel or bladder habits (color, hematuria #1 sign) **A:** a sore that does not heal **U:** unusual bleeding or discharge **T:** thickening or lump in breast or elsewhere **I:** indigestion or difficulty in swallowing **O:** obvious change in mole or wart **N:** nagging cough or hoarseness **S:** sudden and unexplained weight loss

Answer 2

* *T-** the extent of the tumor * *N-** the absence or presence and extent of lymph node metastasis. * *M-** the absence or presence of metastasis

Answer 3

**Epinephrine** 1:1,000 dilution injection * SubQ in upper arm or thigh **Antihistamine** * Benadryl (Diphenhydramine) 25-50 mg IV push **Corticosteroid** * Solucortef or solumedrol 150 mg IV push **H2 Receptor blocker** * Pepcid, etc.

Answer 4

* -Pruritus * -Rhinitis * -Rash * -Redness * -Fever * -Urticaria

Answer 5

**SYSTEMIC RESPONSE: WORSE TYPE OF REACTION- MAY BE FATAL IF NOT TREATED QUICKLY!!!** * Massive vasodilation: causes sudden drop in BP * Increased capillary permeability * Smooth muscle contraction: gastrointestinal and uterine spasm * Laryngeal stridor and edema: bronchospasm * Angioedema

Answer 6

* *Mild-** peripheral tingling, sensation of warmth, fullness in mouth and throat, nasal congestion, peri-orbital swelling, pruritus, sneezing. **Symptoms begin within 2 hours of exposure.** * *Moderate-** flushing, warmth, anxiety, itching, cough, wheezing, bronchospasm, and any or all of the above mild symptoms. **Onset begins within 1 hour of exposure.** * *Severe-** **abrupt onset of symptoms** beginning with mild and moderate and quickly progressing to laryngeal edema, cyanosis, severe dyspnea, and hypotension. Dysphagia, vomiting, diarrhea, and seizures may also occur followed by cardiac arrest and coma.

Answer 7

* Sexual Contact; unprotected sex = Primary transmission * Person receiving semen is more likely to have HIV transmitted to them * Blood, needle sharing, drug paraphernalia = 2nd route of transmission * Birth, in utero, breast milk * (HIV that is undetectable , is untransmissable)

Answer 8

4 drug regimen → Combination therapy Dosages are fixed in combination drugs 2 NNRTI’s, Integrase inhibitor, and Protease inhibitor Goals of drug therapy: * Decrease the viral load * Maintain or increase CD4+ T cell counts * Prevent HIV related opportunistic diseases * Delay disease progression * Prevent HIV transmission

Answer 9

**Musculoskeletal:** 90% joint involvement, similar to RA but no RF and no joint destruction **Integumentary**: rashes, “butterfly” rash on nose, cheeks; alopecia, sun sensitivity, mucous membrane lesions **Cardiovascular:** pericarditis, ischemic heart disease **Pulmonary:** pleural effusion, pneumonitis, PE **Renal:** glomerulonephritis, nephrotic syndrome **Neurological:** 30-75%; vasculitis leads to CVA, seizures, depression, psychiatric complications **Hematopoietic:** hemolytic anemia, leukopenia, lymphopenia, thrombocytopenia, lymphadenopathy with lesions on head, scalp, neck.

Answer 10

* -Joint pain, redness and warmth with swollen effusions * -Lack of joint mobility and function **bilaterally** * -Joint instability, contractures * -Deformities of the hands and feet * -Fatigue, malaise, anorexia * -Elevated body temperature * -Subcutaneous nodules on joints * -Limited ROM, paresthesias of hands/feet * -Morning stiffness and crepitus * -Pericarditis, Leukopenia * -Splenomegaly, Enlarged lymph nodes * -Anemia * -Lymph node enlargement * -Peripheral Neuropathy * -Raynaud’s phenomenon- cold and stress induced vasospasm of the hands and feet giving them a cyanotic (bluish) appearance. * -Ulnar drift * -Boutonniere deformity * -Hallux Valgus * -Swan-neck deformity

Answer 11

- ESR: blood test to determine rate at which RBC’s reside to the bottom of the test tube over the course of an hour. Faster rate is indicative of infection.**Notice I said infection and not just lupus, this test does not 100 percent verify diagnosis of lupus but elevated ESR is present in the case of lupus.** - ANA: test for presence of antibodies (+) - Urinalysis: to detect blood or proteins in the urine

Answer 12

* Serum rheumatoid factor is present in 80 % * Elevated erythrocyte sedimentation rate (ESR) indicates inflammation * C-reactive protein is positive (CRP) indicates inflammation * RBC’s decreased * C4 complement is decreased * Serum Antinuclear antibody (ANA) is positive

Answer 13

**MEDICAL MANAGEMENT** * **Corticosteroids are the single most important medication used for treatment.** * **Prednisone**: Used in low oral doses for remissions and in high doses (IV if needed) for exacerbations. Must NEVER be stopped abruptly!! Always a tapered reduction of dose. * **Anti-malarial medications, alkylating agents and purine analogs** are used for serious forms that do not respond to conservative therapies. **NURSING MANAGEMENT** * Decreasing fatigue * Promoting restorative sleep * Providing protection for impaired skin integrity * Sun and ultraviolet light exposure can increase disease activity or cause exacerbation- * Facilitating self-care * Improving body-image and coping * Monitoring and managing potential complications- cardiac and renal involvement

Answer 14

**MEDICAL MANAGEMENT** * -NSAIDs, anti-Rheumatics, corticosteroids, immunosuppressants * -NSAIDs, splints, thermal heat, relaxation * -Exercise programs and muscle strengthening * -Adaptive devices * -Provide and reinforce patient teaching * -Emphasize therapeutic regimen and lifestyle **NURSING MANAGEMENT** * -Achieve adequate pain control * -Decrease fatigue * -Promote restorative sleep * -Increase mobility * -Facilitate and encourage self-care * -Improve body-image and coping * -Monitor and manage potential complications * -Promote home and community-based care/ resources * -Balancing periods of activity with rest * -Exercise to maintain joint function and mobility * -Patient support related to chronic illness * -Assistive devices for joint protection * -Support groups and other information

Answer 15

**Type 1** * No insulin secretion at all / beta cells destroyed * MUST be given insulin * Signs: **3 P’s** * **Polyuria** * **Polyphagia** * **Polydipsia** * Weight loss * Fatigue **Type 2** * Some insulin secretion but not enough / receptors not sensitive to insulin. Happens over time. * Initially treat with diet/exercise but if not controlled use insulin as well like metformin * Don’t get v high BG levels around 800-900 like type 1 does * **Signs:** * Fatigue * Poor wound healing * Recurrent infections (ex: yeast) * Vision changes * Paresthesia

Answer 16

Skin and muscle: profuse sweating, tremors, **Cardiovascular:** tachycardia, palpitations **Head region:** numbness of lips and tongue, slurred speech, double vision **Neuro:** nervousness, inability to concentrate, headache, confusion, memory lapses, irrational or combative behavior, drowsiness **Stomach:** hunger! **Severe hypoglycemia may cause disorientation, seizures, and loss of consciousness, DEATH**

Answer 17

**Cardiovascular**: hypotension, tachycardia **Head region:** profound dehydration so really thirsty, blurred vision **Neuro:** headache, confusion, memory lapses, irrational or combative behavior, drowsiness

Answer 18

**Macro-vascular changes** * Heart (CAD), brain (cerebrovascular disease), peripheral vascular system (accelerated atherosclerosis), neuropathies (paresthesia, foot ulcers) **Micro-Vascular changes** * Eyes (retinopathy), kidneys (nephropathy so monitor kidney)

Answer 19

* Hyperglycemia of Type 1 * Breaking down fat for energy causes release of ketones which are acidic * Severe dehydration, metabolic acidosis, fruity breath, hyperventilation with Kussmaul respirations, abdominal pain, n/v, sudden weight loss, polyuria, polydipsia * Tx: 1st thing to do = FLUID REPLACEMENT 0.9% NS (if pollute, want to dilute), 2nd O2 because metabolic acidosis, 3rd regular insulin IV push

Answer 20

* Hyperglycemia of Type 2 * More serious than DKA * No ketones in urine * Hypotension (bc dehydrated), tachycardia, altered LOC * Tx: rehydration, insulin administration

Answer 21

* TSH \> 4.0 * Myxedema (non-pitting edema), confusion, can progress to stupor, coma, death * Slow metabolism manifestations * Fatigue, hair, skin, nail dryness, paresthesia, hypothermia, bradycardia, weight gain, slow speech

Answer 22

* TSH \< 1.0 * Poor heat tolerance, tachycardia, exophthalmos (bulging eyes), increased appetite but weight loss, high BP * Increases chance for A.Fib.

Answer 23

**PRERENAL:** Azotemia caused by **hypo-perfusion** of the kidney. Sudden severe drop in BP (shock) or interruption of blood flow to the kidneys from severe injury or illness. **VOLUME DEPLETION AS A RESULT OF:** * Hemorrhage * Renal losses: diuretics, osmotic diuresis * GI losses: vomiting, diarrhea, nasogastric suctioning I**MPAIRED CARDIAC FUNCTION DUE TO:** * Myocardial infarction, heart failure, dysrhythmias, shock **VASODILATION RESULTING FROM:** * Sepsis, anaphylaxis, vasodilatory medications- antihypertensives

Answer 24

**INTRARENAL:** The renal parenchyma or nephron is damaged. Damage to renal tubules or glomeruli occurs. Direct damage to the kidneys by inflammation, toxins, drugs, infection, or reduced blood supply. **PROLONGED RENAL ISCHEMIA:** * Most common cause is ATN (acute tubular necrosis) * Pigment nephropathy (breakdown of blood cells containing pigments that occlude kidney structures) **Myoglobinuria** (trauma, crush injuries, burns) **Hemoglobinuria** (transfusion reaction, hemolytic anemia) **Rhabdomyolysis**-colored urine due to muscle breakdown **Infectious processes:** Pyelonephritis, Glomerulonephritis **Nephrotoxic agents such as:** * Aminoglycoside antibiotics- Gentamicin, Tobramycin, Vancomycin * Radiopaque contrast agents used in CAT scans and Angiograms * Heavy metals- lead, mercury * Arsenic poisoning * NSAID’s, ACE inhibitors

Answer 25

**POSTRENAL:** urine outflow is obstructed. Sudden obstruction of urine flow due to enlarged prostate, kidney stones, bladder tumor, or injury. **URINARY TRACT OBSTRUCTION:** * Calculi- renal stones * Tumors * Benign Prostatic Hyperplasia (BPH) * Flomax! or TURF (transurethral resection of the prostate gland) * Urethral strictures * Obstructive blood clots

Answer 26

HYPERTENSION & DM * HTN and DM * Think about it, HTN causes perfusion issues to kidneys, and diabetes messes up pretty much everything

Answer 27

**Peritoneal: uses a peritoneal membrane** * Can be done by patient independently at home. Patient can maintain a fairly normal lifestyle. PD can be done at night while sleeping or the patient can do cycles during the day (about every 4 hours) * 2 types: automated and continuous * Catheter is surgically implanted in abdomen * Peritoneal membrane is used as semipermeable membrane * 2L of dextrose: 1.5%, 2.5%, or 4.5% are infused into the abdominal cavity. Called fill cycle à dwells in cavity. Called dwell cycle à fluid is then drained and weighed to make the same amount is drained as was filled. Called drain cycle à abdomen filled with dialysate * Complications: peritonitis, infection caused by staph aureus or staph epidermidis

Answer 28

**Hemodialysis: uses cellulose or synthetic material as semipermeable membrane** * Done at a center or in hospital and is done three days a week and takes about 4 hours for each session * Two 14-16 gauge needles are inserted into fistula or graft for access à attached via tubing to dialysis lines using sterile technique à one needle pulls blood into dialyzer machine and other is to return clean blood to patients * A thrill can be felt by palpating the anastomosis and a bruit can be heard with a stethoscope * Strict following of dietary restrictions necessary for optimal management

Answer 29

* Be a blood type match * BUT, ESRD (End stage renal disease), When that good old GFR is less than 15 (Also known as stage 5 Kidney Failure)

Answer 30

**SIGNS OF REJECTION** * Elevated BUN and creatinine * Fever * Weight gain * Decreased urine output-oliguria * Increased blood pressure * Tenderness or swelling over the transplanted kidney * Elevated white blood cell count * Rejection is confirmed by renal biopsy SO, what can a patient monitor themself for? * DECREASED URINE!! * Fever, weight gain, tenderness over kidney. Basically, any thing you can detect without fancy machines. Hence my rule (Love’s) , if you feel like crap, you probably are in some kind of crap. So go get checked out.

Answer 31

* Clouding of the lens in one or both eyes (cataracts) * High blood sugar, which can trigger or worsen diabetes * Increased risk of infections * Thinning bones (osteoporosis) and fractures * Suppressed adrenal gland hormone production * Thin skin, bruising and slower wound healing * (MAKE SURE, always wean off steroid use or you will have the addisionian crisis)

Answer 32

* extreme weakness * mental confusion * dizziness * nausea or abdominal pain * vomiting * fever * a sudden pain in the lower back or legs * a loss of appetite * extremely low blood pressure * chills * skin rashes * sweating * a high heart rate * loss of consciousness

Answer 33

* Drink some water - obviously * So simple, less water in the system. So less pee you piss out, and low bp cause there’s barely any water :( * Hypotension * Decreased Urine Output, That sewer water colored pee (Dark urine) * Dizziness * Tachycardia * Skin turgor goes down * Strict Vital’s wise: BP down, Heart rate up, Respirations up

Answer 34

Ototoxic drugs also nephrotoxic Lasix/loop diuretics, aminoglycosides (vancomycin, gentamycin)

Answer 35

* Ummm the patient looks like a simpsons character (Jaundice, check Sclera of the eyes first, and then skin manifestations) * Bilirubin Elevation * Albumin Down * Liver function tests go up (ALT up, AST up) * Here’s a cool way I remember it :) * ALcoholics Test (A.L.T) * AlcoholicS Test (A.S.T) * Portal hypertension, ascites, and esophageal varices * Hepatic encephalopathy, or Coma (Happens cause of ammonia)

Answer 36

* If the patient has liver failure / cirrhosis * IV glucose (Prevent protein catabolism) * Lactulose (Its a pooping med lol. But you don’t use it for the poops, but to remove ammonia :D) don’t stop using it, just cause your patient shitted 5 times today, look for LOC changes.

Answer 37

**IF YOU HAVE THESE, boy I hope you live. Greater than 60% chance to die.** * Age \> 55 years * WBC \> 16,000/Ul * Blood glucose \> 200 mg/dl * Serum LDH \> 350 IU/L * AST \> 250 IU/L * Hct dropping \> 10 % * BUN increase 5 mg/dl, U/O decreasing * Pa02 \< 60 mm Hg * Serum Ca+ \< 8 mg/dl

Answer 38

* Give that yum yum pepto * 1 PPI, 2 Antibiotics, and……. PEPTOOOOOOOO

Answer 39

Darn Kidney stones …. (Renal Calculi) Treatments: **IV Fluids**, plus meds (Flomax and Hytrin) **Surgery** * Nephrolithotomy * Pyelolithotomy * Ureterolithotomy * Cystotomy

Answer 40

**Inflammation of renal parenchyma and collecting system** **Treatment:** Uncomplicated: Treat with antibiotics 3 days Complicated: 7 to 10 days

Answer 41

**Inflammation of the kidney (Specifically the glomerulus)** Treatment: **DEPENDS ON CAUSE** (and treat underlying cause) Always remember to treat cause, so that will help you with Tx. Strep (Antibiotics) Lupus (Steroids) Goodpasture (Plasmapheresis)

FINAL EXAM Study Guide Version Part 1 Flashcards

(66 cards)