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ECU NURS 4510 Captsone exam 3 (Diabetes, Endocrine, management, respiratory, integumentary, immune)
Terms in this set (219)
List the endocrine glands
What hormones are released form the hypothalamus?
Growth hormone-inhibiting hormone
Growth hormone-releaseing hormone
what hormones does the anterior pituitary glad produce?
follicle stimulating hormone
somatotrophic growth-stimulating hormone
Thryroid stimulating hormone
what hormones does the posterior pituitary glad produce?
Oxytocin and ADH
condition of diminished hormone secretion from the anterior pituitary gland
the excess secretion of growth hormone that causes acromegaly and gigantism
Tx for hyperpituitarism
Pituitary adenectomy, sublabial transsphenoidal pituitary surgery
minimally invasive endoscopic surgery that removes pituitary tumors through the nasal cavity via the sphenoid sinus (transsphenoidal) without affecting brain
transsphenoidal hypophysectomy complications
cerebrospinal fluid leak
What is a main consideration following a transsphenoidal hypophysectomy?
Monitoring for a postnasal drip/clear nasal drainage. This might indicate a cerebrospinal fluid leak, in which the clear drainage should be checked for glucose
Hyposecretion of antidiuretic hormone , or the kidney is resistant to its effect causing excessive urinary output
Central Diabetes Insipidus
ADH deficiency due to hypothalamic or psoterior pituitary pathology (tumor, trauma, infection, inflammation)
nephrogenic diabetes insipidus
Impaired renal response to ADH
Syndrome of Inappropriate Antidiuretic Hormone
overproduction of the antidiuretic hormone ADH, leading to bloating, water retention, and electrolyte imbalance
Hyposecretion of adrenal cortex hormones (insufficiency of cortisol, aldosterone, and androgens)
a condition caused by prolonged exposure to high levels of cortisol
Cushing's disease symptoms
hypertension, hyperglycemia, fatty hump between shoulders, upperbody obesity, rounded face, for women, hair on face, chest, abdomen, thighs
Addison's Disease Manifestations
weight loss, salt craving, hyperpigmentation, weakness, fatigue, N/V, dizziness, ortho hyptension, dehydration, hyponatremia, hyperkalemia, hypoglycemia, hypercalcemia
precipitated by physical or emotional stress, sudden withdrawal of hormone.
Addisonian crisis manifestations
sudden profound weakness; severe abdominal, back, and leg pain; hyperpyrexia followed by hypothermia; peripheral vascular collapse; coma; and renal failure.
condition of hyposecretion of the thyroid gland causing low thyroid levels in the blood that result in sluggishness, slow pulse, and often obesity
Fatigue, lethargy. Modest weight gain with anorexia. Dry, coarse skin and cold intolerance. Swelling of face, hands, and legs. Constipation. Weakness, muscle cramps, arthralgias, paresthesias, impaired memory and hearing.
excessive activity of the thyroid gland
Nervousness, weight loss despite increased appetite, excessive sweating and heat intolerance, palpitations, frequent bowel movements, muscular weakness of the proximal type and tremor
a relatively rare, life-threatening condition caused by exaggerated hyperthyroidism
deficient production of parathyroid hormone
circumoral tingling, tetany, muscle cramps, irritability
+chvostek's sign, +trousseau's test
increases blood calcium levels
arm/carpal spasm associated with hypocalcemia
Hypocalcemia (facial muscle spasm upon tapping)
**hypercalcemia, anorexia, n/v, constipation, fatigue, weakness, confusion, polyuria, polydipsia, bone pain, kidney stones
insulin is not secreted adequately or tissues are resistant to its effects
Diabetes mellitus type 1
insulin is functionally absent due to destruction of beta cells of pancreas; where insulin would normally be produced. starts in children ages 4 or older, adolescense. symptoms include polyuria, polydipsia, polyphagia, nausea, weight loss, fatigue, blurred vision, and dehydration
Diabetes mellitus type 2
Reduced insulin receptor function, occurs when tissues do not respond to insulin (insulin resistance); usually associated with obesity, most common form of diabetes mellitus
Early morning glucose elevation produced by the release of growth hormone, which decreases peripheral uptake of glucose resulting in elevated morning glucose levels. Admin of insulin at a later time in day will coordinate insulin peak with the hormone release.
A rebound phenomenon that occurs in clients with type 1 diabetes mellitus. Normal or elevated blood glucose levels are present at bedtime; hypoglycemia occurs at about 2 to 3 am. Counterregulatory hormones, produced to prevent further hypoglycemia, result in hyperglycemia (evident in the prebreakfast blood glucose level). Treatment includes decreasing the evening (predinner or bedtime) dose of intermediate acting insulin or increasing the bedtime snack.
S/S of hypoglycemia
shakiness, diaphoresis, anxiety, nervousness, chills, nausea, headache, weakness, confusion
frequent urination, deep rapid labored respirations, thirst, hunger, dry mucous membranes, weakness, malaise, rapid, weak pulse, hypotension, soft eyeballs
acidity of the blood caused by the presence of ketone bodies produced when the body is unable to burn sugar; thus, it must burn fat for energy
S/S of DKA
**Kussmaul Respirations (blowing off CO2), fruity breath, weakness/fatigue, polydipsia, orthostatic hypotension, poor skin turgor
is a global marker of coagulation activation and measures fibrin degradation products produced from fibrinolysis (clot breakdown). The test is used for the diagnosis of DVT when the patient has few clinical signs and stratifies patients into a high-risk category for reoccurrence. Useful as an adjunct to noninvasive testing, a negative D-dimer test can exclude a DVT without an ultrasound.
less than 250
Normal blood pH
Normal CO2 levels
COPD (chronic obstructive pulmonary disease)
A group of lung diseases that block airflow and make it difficult to breathe.
-Manifests severe dyspnea even at rest.
-Barrel chest shape
-Use of accessory muscles to breathe
-Prolongation of the expiratory phase
-Breath sounds are diminished.
-Hyperresonant percussive tone might be heard.
-AP > lateral
chronic bronchitis s/s
copious gray, white or yellow sputum, dyspnea, tachypnea, cyanosis, use of accessory muscles, pedal edema, JVD, wheezing, rhonchi, increased AP chest diameter (barrel chest), pulmonary HTN
T/F you can set ventilator alarms off
A chronic allergic disorder characterized by episodes of severe breathing difficulty, coughing, and wheezing.
air in the pleural cavity caused by a puncture of the lung or chest wall resulting in a loss of negative pressure in the chest cavity
A pneumothorax that occurs when a weak area on the lung ruptures in the absence of major injury, allowing air to leak into the pleural space.
a pneumothorax with rapid accumulation of air in the pleural space causing severely high intrapleural pressures with resultant tension on the heart and great vessels.
High chest tube is removing what?
A low chest tube is removing what?
acute respiratory distress syndrome (ARDS)
a form of the sudden onset of severe lung dysfunction affecting both lungs, making breathing extremely difficult
severe acute respiratory syndrome (SARS)
Potentially life-threatening viral infection that usually starts with flulike symptoms.
An inflammation of lung tissue, wherer the alveoli in the affected areas fill w/fluid
abnormal accumulation of fluid in the pleural space
accumulation of pus in the pleural cavity
Painful inflammation of the pleura
clot or other material lodges in vessels of the lung
s/s of pulmonary embolism
-sudden sharp pain
An infectious disease that may affect almost all tissues of the body, especially the lungs
What precaution is needed for TB
How is TB confirmed?
Positive TB skin test
immunocompromised >/= 5mm
normal people >/= 15mm
-persistent cough >3 weeks
-hemoptysis (coughing up blood)
embolus lodged at division of pulmonary artery -> sudden death due to right heart strain
Reasons for the high pressure alarm of a ventilator to go off
-Excess secretions in airway
-client biting tube
-kinks/obstructions in the tubing
-client coughs or gag on tube
-client is wheezing or bronchospasms
Reasons for the low pressure alarm of a ventilator to go off
-disconnection in leak in ventilator or in clients air way cuff
-client stops breathing
pursed lip breathing promotes
carbon dioxide elimination
what is the maximum time for suctioning in a pt with a trach?
what is the earliest sign of acute respiratory distress?
increased respiratory rate
TB medication p
sensory perception, moisture, activity, mobility, nutrition, friction and shear
Braden Scale: Sensory Perception
ability to respond meaningfully to pressure-related discomfort
Braden Scale: Moisture
degree to which skin is exposed to moisture
Braden Scale: Activity
degree of physical activity
Braden Scale: Mobility
ability to change and control body position
Braden Scale: Nutrition
usual food intake pattern
Braden Scale: Friction and Shear 1. Problem
- Requires moderate-to-maximum help to move
- Complete lifting without sliding against sheets impossible
- Frequently slides down in bed or chair, requiring frequent repositioning with maximum assistance
- Spasticity, contracture, or agitation leads to almost certain friction
Braden scale: friction and shear. 2 potential problem
- Moves feebly or requires minimum assistance
- During a move skin probably slides to some extent against sheets, chair, restraints, or other devices
- Maintains relatively good position in chair or bed most of the time but occasionally slides down
Braden Scale: Friction and Shear 3. No Apparent Problem
3. No Apparent Problem
- Moves in bed and in chair independently and has sufficient muscle strength to life up completely during move
- Maintains good position in bed or chair at all times
A clear, watery fluid secreted by the cells of a serous membrane.
thin, watery drainage that is blood-tinged
Frank blood from leaking blood vessel
thick green, yellow, or brown drainage
viral disease affecting the peripheral nerves, characterized by painful blisters that spread over the skin following the affected nerves, usually unilateral; also known as shingles
Herpes Type 1
caused recurrent sores on lips, fever blisters or cold sores, primary and recurrent herpes labialis
herpes type 2
genital herpes - outbreaks occur 2-10 days after infection - tingling, itching, and burning during urination
Healing by Intention: Primary Intention
Acute wounds with minimal tissue loss.
Smooth clean edges
Closed with sutures or staples or adhesives
Superficial partial thickness also heal this way
Minimal scarring heal quickly in an uncomplicated orderly progression.
Healing by intention: secondary intention
occurs with injury/wounds with tissue loss. Require gradual filling in the dead space with connective tissue
Healing by Intention: Tertiary Intention
delayed primary closure and are intentionally left open from several days for irrigation/removal of debris and educates
diffuse, acute infection of the skin marked by local heat, redness, pain, and swelling
basal cell carcinoma
Most common and least severe type of skin cancer; often characterized by light or pearly nodules.
squamous cell carcinoma
Type of skin cancer more serious than basal cell carcinoma; often characterized by scaly red papules or nodules.
highly metastatic skin cancer, and fatal is not caught early
ABCD of skin cancer
asymmetry, border, color, diameter
chronic skin condition producing red lesions covered with silvery scales
Mucocutaneous blistering reactions most often caused by a drug reaction. Complications include secondary infections, fluid loss, & electrolyte imbalance. Can be life threatening. Treat with prompt withdrawl of offending agent, burn unit for care, +/- steroids
Stage 1 pressure ulcer
intact skin with nonblanchable redness of a localized area, usually over a bony prominence
stage 2 pressure ulcer
partial thickness skin loss involving epidermis, dermis, or both
stage 3 pressure ulcer
full thickness tissue loss with visible fat, not thru fascia
stage 4 pressure ulcer
Full-thickness tissue loss with exposed bone, muscle, or tendon
unstageable pressure ulcer
base of ulcer covered by slough and/or eschar in the wound bed.
Rule of 9's adult
Head = 9%
Chest (front) = 9%
Abdomen (front) = 9%
Upper/mid/low back and buttocks = 18%
Each arm = 9% (front = 4.5%, back = 4.5%)
Groin = 1%
Each leg = 18% total (front = 9%, back = 9%)
4ml x TBSA (%) x Pts weight (kg)
How much fluid needs to be given with the parkland formula
Half the requirement in the first 8 hours; next have given over 16 hours
1st degree burn
2nd degree burn
-superficial partial thickness
-large blisters may cover the area
3rd degree burn
deep partial-thickness burn
-extends deeper into the skin dermis
4th degree burn
extends below the subcutaneous tissue to reach muscle or bone
An injury to the airway as a result of breathing smoke and toxic chemicals into the lungs and airway.
What is the most reliable and most sensitive/non-invasive assessment for cardiac output and tissue perfusion
What isolation is used for chicken pox
airborne until all vesicles have crusted over
What diet is given to burn pts
carbon monoxide normal level
Carbon monoxide level of 11-20
Decreased visual acuity
decreased visual function
Carbon monoxide level of 21-40
N & V
Tinnitus and vertigo
Confusion and stupor
Pale to reddish-purple skin
decreased blood pressure
increased and irregular heart rate
depressed ST segment
Carbon monoxide level of 41-60
Carbon monixide level of 61-80
an open wound on the lower legs or feet caused by poor arterial blood flow
Resuscitation/Emergent Phase of burns
begins at time of injurt and ends with restoration of normal capillary permeability
The resuscitative phase of burn injury
begins with the initiation of fluids
ends when capillary integrity reterns to near-normal levels and large fluid shifts have decreased
Acute Phase of Burn Injury
Begins about 48-72 hrs after injury; lasts until wound closure is completed
Care directed toward:
-Continued assessment and maintenance of CV, respiratory systems
-Continued assessment and maintenance of GI and nutritional status
-Burn wound care
Normal CD4 count
immune system problems occur when the CD4+ t-cell count is..
negative feedback loop
A feedback loop in which a system responds to a change by returning to its original state, or by decreasing the rate at which the change is occurring.
systemic lupus erythematosus (SLE)
chronic autoimmune inflammatory disease of collagen in skin, joints, and internal organs
a severe response to an allergen in which the symptoms develop quickly, and without help, the patient can die within a few minutes.
humoral immune response
The branch of acquired immunity that involves the activation of B cells and that leads to the production of antibodies, which defend against bacteria and viruses in body fluids.
cell-mediated immune response
The branch of acquired immunity that involves the activation of cytotoxic T cells, which defend against infected cells.
anaphylaxis nursing interventions
-Assess airway and maintain patent
-call HCP or rapid response team
-Start IV fluids
-Prepare to admin epi
AIDS (acquired immune deficiency syndrome)
a life-threatening, sexually transmitted infection caused by the human immunodeficiency virus (HIV). AIDS depletes the immune system, leaving the person vulnerable to infections.
Malignant skin tumor associated with AIDS
The nurse caring for a client with a pneumothorax and who has had a chest tube inserted notes continuous gentle bubbling in the water seal chamber. What action is most appropriate?
Check for an air leak, because the bubbling should be intermittent
Circulation can be compromised when burn injuries girdle a body segment; inelasticity of the eschar can increase the internal pressure within fascia compartments and lead to compartment syndrome.
Hyperosmolar Hyperglycemic Syndrome (HHS)
a life threatening syndrome that can occur in the patient with diabetes who is able to produce enough insulin to prevent DKA but not enough to prevent severe hyperglycemia, osmotic diuresis, and extracellular fluid depletion.
Primary goal/intervention with hyperosmolar hyperglycemic syndrome
rehydrate the client to restore fluid volume and to correct electrolyte deficiency.
Treatment for SIADH
-address dilutional hyponatremia with 3% NaCl
-Admin a vasopressin antagonist as prescribed
severe hypothyroidism leading to decreased mental status, hypothermia, and other symptoms related to slowing of function in multiple organs
what is the primary reason for DKA
lack of insulin
A benign tumor on the adrenal medulla that causes hypersecretion of epi/norepi resulting in persistent HTN, increased HR, hyperglycemia, diaphoresis, tremor, pounding HA
A face mask and reservoir bag device that delivers specific concentrations of oxygen by mixing oxygen with inhaled air.
A clear plastic mask used for oxygen administration that covers the mouth and nose.
An upright position in which the patient leans forward onto two arms stretched forward and thrusts the head and chin forward.
The client with Cushing's syndrome experiences..
hypokalemia, hyperglycemia, an elevated WBC count, and elevated plasma cortisol and adrenocorticotropic hormone levels
S/S of adrenal insufficiency
mental status changes
what should be seen in the water seal chamber of a chest tube?
gentle intermittent bubbling
disease due to silica or glass dust in the lungs; occurs in mining occupations
what is the earliest sign of ARDS
decreased arterial PaO2
the surgical puncture of the chest wall with a needle to obtain fluid from the pleural cavity
A syndrome marked by the presence of usually three or more of a group of factors (as high blood pressure, abdominal obesity, high triglyceride levels, low HDL levels, and high fasting levels of blood sugar) that are linked to increased risk of cardiovascular disease and Type 2 diabetes.
Normal calcium levels
Normal phosphorus levels
Normal serum osmolality
surgical removal of the pituitary gland
an autoimmune disorder that is caused by hyperthyroidism and is characterized by goiter and/or exophthalmos
"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
Rapid acting insulin
Rapid acting insulin onset
Rapid acting insulin peak
Rapid acting insulin duration
Short acting insulin
Short acting onset
short acting peak
short acting duration
intermediate acting insulin
intermediate acting onset
intermediate acting peak
intermediate acting duration
Long acting insulin
long acting onset
long acting peak
long acting duration
Type 1 DM
autoimmune dysfunction involving the destruction of beta cells, which produce insulin in the islets of Langerhans of the pancreas. Immune system cells and antibodies are present in circulation and also can be triggered by certain genetic tissue types of viral infections. Usually occurs at a young age w/ no successful interventions to prevent.
Type 2 DM
progressive condition due to inability of cells to respond to insulin (insulin resistance) and decreased production of insulin by the beta cells. most often occurs later in life due to obesity, inactivity, and heredity.
5 rights of delegation
1. Right task
2. Right circumstance
3. Right person
4. Right direction/communication
5. Right supervision/evaluation
A reaction to conflict that involves ignoring the problem by doing nothing at all, or deemphasizing the disagreement.
Neglect one's own needs, goals, or concerns (unassertive) while trying to satisfy those of others. Better to say you're too busy than to accept and not do it
Usually creates a lot of tension in the workplace.
Competitors pursue their own needs at the expense of others
an agreement or a settlement of a dispute that is reached by each side making concessions.
conflict that occurs between two or more individuals
conflict that occurs within an individual
when an employee confronts the policies and procedures of an organization
Guidelines that define the organization's standpoint on courses of action
based on policy and define methods for tasks
Prescribe a specific course of action for a specific type of client problem
leadership style that involves making managerial decisions without consulting others
a leadership style that promotes the active participation of workers in taking decisions
allows the group to function more or less on its own
Uses a combo of styles based on the current circumstances and events
Situational styles are assumed according to the needs of the group and the tasks to be achieved.
The leader/manager believes that people are more motivated by external forces and relies on organizational policies and procedures for decision making
A nursing care pattern focusing on tasks and jobs; each nursing team member has certain tasks and jobs to do
ventilation-perfusion scan - radioactive test of lung ventilation and blood perfusion throughout the lung capillaries (lung scan)
a series of x-ray photographs taken from different angles and combined by computer into a composite representation of a slice through the body
allows higher levels of oxygen to be added to the air taken in by the patient
CPAP (continuous positive airway pressure)
A method of ventilation used primarily in the treatment of critically ill patients with respiratory distress; can prevent the need for endotracheal intubation.
R: a device that builds to a higher pressure when you inhale and decreases to a lower pressure when you exhale
-acronym, 4 letters
-bilevel positive airway pressure
A condition in which two or more ribs are fractured in two or more places or in association with a fracture of the sternum so that a segment of the chest wall is effectively detached from the rest of the thoracic cage.
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
chronic inflammatory disease in which small nodules (granulomas) develop in lungs, lymph nodes, and other organs
process in which extensions of cytoplasm surround and engulf large particles and take them into the cell
bind to mast cells and basophils and are involved in allergic reactions
causes phagocytosis by WBCs and prevent pathogens from adhering to mucous membranes
first Ab produced in response to infection
Immunoglobulin G (IgG)
the most abundant class of antibodies; found in blood serum and lymph; active against bacteria, fungi, viruses, and foreign particles
inflammation of sebaceous glands on the back, chest and face
Steven Johnson Syndrome (SJS)
-Severe blistering of the skin, with mucous membrane involvement and fever
-Most common med to cause it is Antibiotics (Sulfonamides), antiseizure meds and NSIAD's
Toxic Epidermal Necrolysis
1. secondary to medication, such as sulfa drugs, anticonvulsants, and NSAID 2 a variant of Stevens-Johnson syndrome
Diagnostic sign whereby the superficial epithelium separates easily from the basal layer on exertion of firm, sliding manual pressure with the fingers
Western blot test
a blood test to confirm the diagnosis of HIV
Tick-borne disease caused by the spirochete Borrelia burgdorferi.
lyme disease signs and symptoms
tick bite, red rash in bulls eye appearance, fevers, chills, headaches, fatigue, flu-like symptons.
contracted by deer ticks
group of immune mediated skin diseases characterized by vesicles, bullae, and ulcers
Lupus signs and symptoms
-Erythema/ macular rash on face (butterfly rash)
- fever, weakness, malaise, fatigue, anorexia
-joint pain, palmar redness
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