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N224 Final for Medsurg
Terms in this set (96)
What does the thyroid function do?
It does the following:regulates body metabolism , energy production and fluid and electrolyte balance and controlling tissue of fats, proteins, carbohydrate.
In hypothyroidism you labs will be?
high TSH (anterior pituary stimulates
low T4 (thyroid produces)
serum cholesterol will be high
Hgb, RBC, HCT will be low
Primary Hypothyroidism is also called?
Hashimotos diease and autoimmune diease and the loss of the thyroid gland.
S/S of hypothyroidism?
**Intolerance to cold
**wt gain with increase of caloric intake
joint and muscle pain
slow everything: pulse, hypotension, respiration all down
bradycardia, arrythmias, low bp
Older clients are often undiganosis with hypothyroidism because?
mimic aging process
which can lead to serious adverse affects with: opioids , anestheics and sedatives.
Medications for hypothyrodism ?
For the rest of their lives
Digoxin and insulin are decreased with?
comodin is increased with
With hypothyroid the radioisotope scan will be?
low uptake of iodine preparation
Nursing care for hypothyroidism?
cardiovascular changes (arrythmias, bradycardia, low blood pressure)
frequent rest periods
low calorie /high fiber
promote wt loss
stool softeners/avoid fiber laxatives
Myxedema coma is a ?
life threatening condition that occurs when hypothyroidism is untreated or when a stressor occurs. (infection, stroke, heart failure or surgery or sudden stop of synthroid)
***urinary tract infection
S/S of myxedema are?
decreased cardiac output
Nursing actions for myexedema?
warm the client and monitor temp
synthroid IV bolus
monitor vital signs close for rebound effect
tx hypoglycemia with glucose
Synthroid should be taken on a ?
No. 1 cause of hyerthyroidism is?
In hyperthroidism the labs will be
T 3 elevated
Clinical manifestions of Graves disease?
***exophthalmos (buldging eyes)
nervousness/irratibility/hyperactivity/emotional lability/**decreased attention span/
hyperkinesia (muscle spasms)
Throid storm can occur from?
S/S of thyroid storm are?
*increased clotting factor 8
Tx of thyroid storm will be?
***When patient has thyroid surgery we must monitor what closely because of the close approximation to the parathyroid gland?
*low calcium and tetany
*have artifical airway and calcium gluconate readily available.
Thyroid crisis they can kill the thyroid with radioactive iodine and they will need to take?
synthroid for the rest of their lives because they no thyroid.
Abumin in the diet plays an important role in
T3 and T 4 because they are protein bound
We need iodine in our diet to produce
When giving a new patient synthroid remind them ?
it takes two weeks to obtain a level so thing might get worst before they get better, do not stop taking the drug.
Any patient having thyroid surgery must be?
euthyroid before operation
Diabetes type 1 is ?
destruction of beta cells in the Islets of Langerhan's in the pancreas
Diabetes type II is from?
progressive condition due to insulin resistance to cell and decrease production of insulin by beta cells
*elevated C reactive protein
Always think CAD with
type II diabetes
Type one is the only one to get
Type on is the only one to spill ketones in?
Hypoglycemia signs and symptoms?
cold and clammy need some candy
*headache/blurred vision/tingling and numb lips
Type II diabetes you will see?
*fat around the trunk
*recurrent vaginal infections
*high blood glucose
S/S of hyperglycemia?
hot and dry sugar high
dry mucous membranes
blood sugar >250
DKA is a medical emergency in which the patient is severly
acetone or fruity breath
seizure leading to coma
These pt go to ICU
DKA seen in patient who are diabetics is probable because?
*missed a dose
*couldn't afford insulin
Type one diabetics usually present in the emergency room with?
undiagnosis diabetes as teenagers
Type II diabetes can take oral anti-diabetics like glyberide, and metformin and ?
*encourage to exercise
*low carb diet
***may need insulin if sugar is uncontroled
Type I diabetics must take ?
Rapid acting insulin is ?
onset of rapid insulin is?
peak of rapid inuslin is
duration of rapid insulin is?
Short acting insulin is only one which is?
Humulin R or Novolin R
30min to one hour
Intermediate insulin is NPH, or Humulin N , given between meals and at night never before meals and the onset is
Long acting Insulin are
onset of long term Levemir
3-8 hours with no peak and duration 24 hours
onset of Lantus is
2-4 hour and last 24 hours
Long term insulins
disipate slowly to keep a tight glycemic control
Nph and regular mixture is
clear before cloudy when drawing
onset 30min to one hour
peak is 5-10
duration is 6-8
Metformin must be stopped 48 hours prior to any
diagnostic procedure with iodine or can cause lactic acidosis
Nursing care for diabetic patients?
monitor glucose by accuchecks per policy
skin integrity for healing/infections
neuropathy (tingling , numbness, weakness)
ulcerations on feet
monitor kidney function
Teaching for diabetics is?
Self monitor blood glucose administration
rotation of injection sites/lipoatrophy
foot care/mirror daily/cotton socks/pat dry feet/no lotions between toes/podiatrist for nail cutting/avoid open toed shoes
avoid prolonged sitting, crossing legs, standing
Too low of sugar, hypoglycemia what do we do?
conscious orange juice
unconscious cake frosting inside cheek
always follow with complex carb and protein
monitor blood sugars every 15 min/until stable
A nurse is caring for a patient with a blood glucose of 52 and symptomatic? what should the nurse do first?
A. recheck in 15 min glucose
B give carb and protien food
c. provide grape juice
d. report findings to providers
c. provide juice
A nurse is preparing to administrating a morning dose of apart insulin for type one diabetes which of the following are appropriate actions of the nurse?
A. blood sugar check after breakfast
B. admin insulin when breakfast arrives
C. hold breakfast for one hour after admin of insulin
D. clarify the prescription because insulin should not be administered at this time.
Your patient has 278 blood sugar how do administer glaragine and regular?
A. draw up regular then glaragine in same syringe
B. draw up glaragine and then regular in the same syringe
C. draw up in seperate syringes and give both
D draw up in seperate syringes and give apart.
***Remember you can only draw up regular insulin and NPH together in the same syringe.
Answer is C
Nutrition habits for a type II diabetic what should nurse include? Select all that apply?
A. eat less meat and processed foods
B. decrease intake of saturated fats
C. increase daily intakes of fiber
D. limit sat fat intake <15%
E. include omega fatty acids in diet
Teaching foot care for the client with DM, which should the nurse include in teaching?
A remove calluses using OTC remedies
B. apply lotion between toes
c. perform nail care after bathing
d. trim toe nails straight across
e. wear closed toes shoes`
A patient is newly diagnosised DM1 and wants to know about how to prevent DKA ?
A. i will stop taking insulin if i am too sick to eat.
B. decrease my insulin dose during times of illness
c. adjust insulin dose according to level of glucose in my urine
d. I will notify my doctor if blood sugar >250
Answer is D
Keep taking insulin when sick and monitor blood sugar. Notify doctor above 250. They may need to increase insulin during illness. Due to high metabolism and ephedrine, and cortisol.
A nurse is taking is providing teaching to a diabetic in regards to differiate between hypoglycemia and DKA. The client understands that a form of glucose should be taken if the following develops?
c. blurred vision
d. fruity breath odor
A client is brought into the ER in DKA in unconscious what does the nurse prepare to initate?
a. endotrachial intubation
b. 100 units NPH insulin
c. NS infusion
d. IV sodium bicarb
c. NS they are too high dehydrated
We would give a low dose of regular IV insulin to avoid cerebral edema.
A client with a diagnosis of DKA is in the ER which finding would the nurse expect in confirming the diagnosis?
A. comatose state
B decrease urine output
C. increase respiration and an increase in ph
D. Elevated blood glucose level and low bicarb level
A1C need to be under
Diabetics get gastroparesis which is?
nerves to stomach are non functioning/everything slows down/chance of ileus/chronic issue
Diabetes in the leading cause of?
If diabetic has kidney issue they need to be on a ?
ace inhibitor to block angio one to angio two and decrease hypertension.
Do all people with HIV have aids?
no , but all people with aids have HIV
Aids dx is when CD4 is under?
When disease occurs the viral load?
grows expotentially especially in the beginning
S/S of HIV is?
Stage one is?
<200 and diagnosised with AID
Aids have one more of the following?
Wasting syndrome the patient has lost more than?
10% of body wt
oral nutrition and TPN
six meals with high protien value
HIV can be transmitted through the exchange of body fluids and takes ?
two to four weeks for infection to manifest
Remember high viral load and decreased
Aids patients will die from not aids but
opportunist infection they have no immune system
Medications for Hiv is
use several medication to decrease resistance
these medication decrease replication of RNA to DNA
Two diagnosic test that diagonis aids are?
Teach these patient to do?
*good hand hygiene
*stay away from crowds
*six small high protein meals/daily
*AIDS support group
*no raw foods
*no raw vegtables
*no cleaning kitty box
*take medication as prescribed
*side effects will suck, but keep taking medication
seroconversion and HIV
first four to eight weeks after exposure to disease and presence is in high quantity in genital fluids.
Encepholopathy and AIDS
opportunistic infection of the CNS attacking the mylin in the brain.
Important vital sign in AIDs is?
Which test confirms HIV?
A. western blot
B. indirect immunofluorescence assay
c CD4 and T lymphocyte count
d Cd4 and percentage of total lymphocytes
A nurse is assessing a client for HIV which are risk factors associated with HIV?
A. perinatal exposure
c. one sex partner
d older adult women
e. occupational exposure
discharge instruction with aids which of the following statements indicates an understanding of the teaching.
a. wear gloves when changing kitty's box
b. rinse raw fruits with water prior to eating
c. wear mask around ill family members
d. cook veggies prior to eating
nuse is caring for a client and dx with Burkitt's lymphoma which stage are the in?
*Aid patients high risk for cancers and pneumonia and fungal infections.
Client with AIDs began therapy with retrovir, AZT, ZVT, and nurse monitor what lab results?
a. blood culture
b. blood glucose
c. blood count
c/leukopenia and anemia are common side effects in the drugs to help sustain life
Post op Turp look for the following electrolyte imbalances?
do to irragation of NS the Foley catheter post op
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