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HONDROS - MED SURG II - QUIZ #4

Terms in this set (53)

ETIOLOGY: Systemic metabolic disorder that involves improper metabolism of carbs, fats, and proteins. Insulin deficiency.
RISK FACTORS: Heredity, environment and lifestyle, viruses, malignancy or surgery of pancreas.
TYPES: Type 1 - insulin dependent (IDDM), and Type 2 - non insulin dependent (NIDDM)
S/S: Type 1 and 2: 3 P's (polyuria, polydipsia, polyphagia)
S/S: Type 1: sudden onset, weight loss, hyperglycemia, under 40 years old.
S/S: Type 2: slow onset, may go undetected for years, the 3 P's are usually mild. If untreated, may have skin infections and arteriosclerotic conditions. Average years - 50 years old. Fasting blood sugar more than 126. Increased BP, fatigued, decreased energy, obese.
DIAGNOSTIC TESTS: Fasting blood glucose (FBG), Oral glucose tolerance test (OGTT), 2 hour postprandial blood sugar, patient self monitoring of blood glucose (SMBG), glycosylated hemoglobin (HbA), C-peptide test.
DIET: balanced diet should include proteins, carbs, and fats. Type 2 may be controlled by diet alone. Type 1 diet is calculated and then insulin is required to metabolize if needed. American Diabetes Association recommends 7 exchanges and a quantitative diet. 3 regular meals with snacks between meals and at bedtime to maintain constant glucose levels.
EXERCISE: promotes movement of glucose into the cell, lowers blood glucose, lowers insulin needs.
STRESS OF ACUTE ILLNESS AND SURGERY: extra insulin may be required, increased risk of ketoacidosis (hyperglycemia), glucose must be monitored closely.
MEDICATIONS: Insulin. Classified by action: Regular (Lente), and NPH (Ultralente). Classified by type: beef (Humulin), pork (Novolin), injection site should be rotated to prevent scar tissue formation. Use sliding scale. Oral hypoglycemic agents - stimulate islet cells to secrete more insulin, only for Type 2.
PATIENT TEACHING: good skin care, report any skin abnormalities to doctor, special foot care is crucial (do not trim toenails - see podiatrist, no hot water bottles or heating pads), assess for symptoms of hypoglycemia.
ACUTE COMPLICATIONS: Coma: diabetic ketoacidosis, hyperglycemic hyperosmolar nonketotic, hypoglycemic reaction. Infection.
LONG TERM COMPLICATIONS: diabetic retinopathy, cardiovascular problems, renal failure.
Therapeutic management focus
Monitoring HIV disease progression and immune function.
Preventing the development of opportunistic diseases.
Initiating and monitoring antiretroviral therapy.
Detecting and treating opportunistic diseases.
Managing symptoms.
Preventing complications of treatment.
Pharmacological management
Most common opportunistic diseases associated with HIV - Pneumocystis carinii pneumonia (PCP). Most common infection - S/S: fever, night sweats, productive cough, short of breath. TREATMENT: Bactrim or Septra, pentamidine, steroids. Wear gown, mask, and gloves during patient care.
Kaposi's sarcoma - Most common neoplasm found in HIV infected patients. S/S: reddish purple spots on the skin. TREATMENT: Radiation and chemotherapy.
Cytomegalovirus (CMV). S/S: stomatitis and colitis. TREATMENT: Gancyclovir and Foscarnet.
Cryptococcal meningitis - S/S: fever and headache. TREATMENT: Amphotericin B and Fluconazole.
Toxoplasma encephalitis - S/S: fever, headache, seizures, and mental changes. TREATMENT: Pyrimethamine and folic acid, Sulfadiazine, Clindamycin.
Mycobacterium (avium complex and tuberculosis) - S/S: fever, chills, sweats, abdominal pain, bone pain, fatigue, diarrhea, nausea, weight loss. TREATMENT: Rifampin, INH, ciprofloxacin.
Antiretroviral therapy - Combination therapy prevents development of resistance. Must be given around the clock. Usually initiated when CD4+ count is below 350 or when viral load is greater than 30,000 copies/ml.
Alternative and complimentary therapies - Massage, acupuncture, acupressure, biofeedback, nutritional supplements, herbal remedies.
Adherence - Adhering to a prescribed regimen is of paramount importance to survival and the success of treatment.
Palliative care - The active, total care of patients whose disease is not responsive to curative treatment.
Psychosocial issues - Uncertainty, isolation, fear, depression, and limited financial resources.
Assisting with coping - Educate about HIV, encourage patients to participate in their own care, encourage patients to face life a day at a time, live each day to the fullest, listen to them, maintain sources of psychological support.
Reducing anxiety - Clarification and education about HIV and AIDS, include patient and support person in planning care, encourage talking about feelings or relaxation and meditation, assess for suicidal ideation, support groups.
Minimize social isolation - Social stigma (associated with homosexuality, drug use, and sexual transmission), sharing diagnosis with others (need to choose carefully), support groups (for patients and significant others).
Assisting with grieving - Listening. Explore feelings, fears, and treatment options. Significant others and family members that may experience fear, anger, embarrassment, and shame.
Confidentiality - Diagnosis should be carefully protected. Need to know basis. Not every health care worker needs to know diagnosis. Universal precautions should be used with every patient.
Duty to treat - Health care professionals may not pick and choose their patients. Rehabilitation Act of 1973 prohibits discrimination against the handicapped and the disabled (HIV and AIDS are included).