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| Nursing diagnosis for Diabetes Insipadus 1 2 3 |
fluid vol deficit
Decreased cardiac output
impaired tissue perfusion |
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sue524 Sat, 04 Feb 2012 13:40:33 GMT |
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| medication for diabetes insipidus is |
Desmopressin DDAVP a nasal spray causes increased water resabsorption |
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sue524 Sat, 04 Feb 2012 13:40:33 GMT |
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diabetes insipidus
1. deficit of
2. Unable to replace water pt becomes
3 the specific gravity is |
1. ADH
2 dehydrated and hyPERnatremic
3. Low |
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sue524 Sat, 04 Feb 2012 13:40:33 GMT |
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| this type of diabetes insipidus is from renal tubules are not sensitive to ADH. this is familar in renal failure |
nephrogenic diabetes insipidus |
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sue524 Sat, 04 Feb 2012 13:40:33 GMT |
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| this type of diabetes insipidus is a result from either disruption of the hypothalmus and pitutary glands from trauma irrdiation or cranial surgery or idiopathic |
Neurogenic dibetes insipidus |
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sue524 Sat, 04 Feb 2012 13:33:53 GMT |
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| Two types of Diabetes insipidus are |
Neurogenic and Nephrogenic |
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sue524 Sat, 04 Feb 2012 13:33:53 GMT |
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Nursing Diagnosis for SAIDH are
1 2 3 4 |
Fluid vol. excess
increased cardiact out put
fluid vol. overload
fall risk |
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sue524 Sat, 04 Feb 2012 13:33:53 GMT |
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HyPERfunction of anterior pitutary gland GH during Adulthood causes
GH before puberty |
Acromegaly
Gigantism |
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sue524 Sat, 04 Feb 2012 13:33:53 GMT |
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HyPOpitutarism of anterior pituitary gland cause
1. GH
2 PRL
3ACTH
3TSH |
1 Growth retardation
2. PRL failure to lactate
3. Addisons
4. Hypothyroidism |
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sue524 Sat, 04 Feb 2012 13:28:47 GMT |
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| Drugs used for SIADS are |
Demeclycycline (tetracycline) |
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sue524 Sat, 04 Feb 2012 13:28:47 GMT |
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| Treatment and nursing practices of SIADS is |
keep pt safe, restrict fluids to 1 L a day for 3 - 10 days Demecloycycline a(tetracycline) antibiotic , correct underlying cause |
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sue524 Sat, 04 Feb 2012 13:28:46 GMT |
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signs and symptoms
brain cells, causing neurologic symptoms including headache, changes in mental status or personalit, lethargy and irriatability, weight gain from retention of fludea with no edema |
SIADA |
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sue524 Sat, 04 Feb 2012 13:28:46 GMT |
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| Manifestation of SIADH are usually nonspecific but are related to ___ and __ __ |
hyponatremia and water intoxication |
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sue524 Sat, 04 Feb 2012 13:19:07 GMT |
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SIADH occurs as a result of water ?
2. Blood volumne ___ but plasma is ___
3. what is suppressed as a reslult of renal excretions of sodium increases |
1. retention, hyponatremia and serum hyPO osmolality
2. expands diluted
3. Aldosterone |
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sue524 Sat, 04 Feb 2012 13:19:07 GMT |
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SIADH is most often caused by
Other causes may be |
ectopic production of ADH by maligant tumor oat cell carcinoma of lung, pancreatic carcinoma, leukemia and Hodgkins.
follow a head injury, pituitary surgery or use of medications such as barbiturates, anesthetics or diuretics |
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sue524 Sat, 04 Feb 2012 13:19:07 GMT |
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| this is characterized by High levels of ADH in the Absense of Serum hyPO-osmolality |
Syndrome of Inappropriate ADH Secretion SIADH |
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sue524 Sat, 04 Feb 2012 13:19:07 GMT |
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| Treatment of addisonian crisis is |
rapid fluid and glucorcorticoids replacement |
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sue524 Fri, 03 Feb 2012 19:13:59 GMT |
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| Regular symptoms of addison disease + high fever, severe pain in the abdomen, lower back pain, legs, severe vomitting, diarrhea, circulatory collapse, shock, coma this is |
Addisonian crisis |
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sue524 Fri, 03 Feb 2012 19:13:59 GMT |
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| Aldostion is degraded by the ___ and excreated in the ___ |
liver in urine |
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sue524 Fri, 03 Feb 2012 19:05:24 GMT |
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| ADH is released by increase of ___ ___ or low __ __ |
plasma osmolarity low blood pressure |
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sue524 Fri, 03 Feb 2012 19:05:24 GMT |
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Medication for acromegaly is called ?
It suppresses the anterior pituitary gland and decreases the?
Side effects of the medication are |
1. Octreotide Sandostatin
2 GH levesl
3 GI first few weeks and 25% pt develop cholesterol gallstones in a year |
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sue524 Fri, 03 Feb 2012 19:05:24 GMT |
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acromegaly is treated by surgical removal or irradiation of the ?
the two types of surgery are called |
1 pituitary tumor
2 transspheonidal or transfrontal |
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sue524 Fri, 03 Feb 2012 19:05:24 GMT |
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The patient is admitted to the critical care unit because of uncontrolled chest pain , radiating to the shoulder.
Think about what interventions will be carried on ?
What medications will be administered and why ?
What laboratory tests will be done and why?
What is the nurses/ yours higest priority ?
What nursing diagnosis will be the highest priority ? |
Medication administration (ASA, nitroglycerin, morphine), O2 supplementation initially. Fibrinolysis or Percutaneous Coronary Intervention via balloon angiography and stent deployment may be indicated.
In the acute phase…
ASA: to inhibit platelet activity, and thus clot formation.
Nitroglycerin: a vasodilator, to possibly reduce chest pain and determine whether the episode is an actual MI or just angina.
Morphine sulfate: for pain relief if nitro is contraindicated or ineffective. Also, relief of anxiety.
Fibrinolytics: to dissolve clots. Patients have to qualify. Recent history of bleeding is one important exclusion criteria.
Glycoprotein IIb/IIIa Antagonists: often used in conjunction with PCI to inhibit platelet aggregation.
Long-term…
Beta blockers: to decrease incidence of ventricular arrythmias, recurrent ischemia and infarction, size of infarct, and short-term mortality.
Heparin: until the ruptured plaque has resolved.
Warfarin: in certain cases only (e.g. atrial fibrillation) to reduce recurrence. Pradaxa is a newer “replacement” for Warfarin.
ACE inhibitors: decreases afterload through vasodilation.
Statins: reduces serum cholesterol to decrease progress of atherosclerosis
CBC: RBCs, H&H could be down due to hypoxia. WBC could be up due to infection.
CK/CK-MB: indicator of myocardial injury.
Troponins: most specific indicator for myocardial damage.
Myoglobin: indicator of any muscle injury, including cardiac.
Electrolytes: could be off due to MI
Immediately, relief of pain would be the highest priority.
Acute pain |
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sue524 Thu, 02 Feb 2012 18:23:38 GMT |
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The patient is brain death. how would you explain this to the family .
Who should you call ?
Who is responsible fordirecting care and asking for organs ?
What company in Pennsylvania is well known for organ donation services ?
Take a look at your book as well . |
explanation of brain death to the family: total and irreversible loss of brain function, heart and lung function. pt would stay on assistive device and not regain conscientiousness.
Organ Donation Organization for that particular state.
PA: CORE
Organization would approach the family with regard to organ donation. |
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sue524 Thu, 02 Feb 2012 18:20:56 GMT |
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| Sodium polystyrene sulfonate also known as Kayexalate is medication . Let's review our adrenal gland disorders , when can you see this medication on the patient's profile ? |
Sodium polystyrene sulfonate is used to treat increased amounts of potassium in the body.
Sodium polystyrene sulfonate comes as a powder and suspension to take by mouth. It may also be used as a rectal enema
Tell Dr. if you are on a low-salt (sodium) diet or you are taking digoxin
Avoid eating or drinking anything that contains the sweetener sorbitol
Check with your doctor before you use a salt substitute or a product that has potassium in it |
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sue524 Thu, 02 Feb 2012 18:20:56 GMT |
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| The patient is just recovering from massive heart attack. You heard him to talk on the phone with his friend how he is missing regular food . He is naming all the unhealthy meals you can imagine. How will you approach the patient and how will you address this situation as his nurse ? |
I would question the patient on what changes he understands he should make and let him know I over heard his phone conversation. If he is reluctant to change his diet I would give him healthier variations of the foods he loves, for example ground turkey for burgers instead of beef, sweet potatoe fries and to just cut back on portions. There are also plenty of website I could give him to start him in the right direction. |
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sue524 Thu, 02 Feb 2012 18:20:56 GMT |
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The nurse working with criticaly ill clients is prone to emotional distress. Is there anything to prevent that ?
The equipment failure is a number one problem at critical care settings , can you explain why ? |
To prevent emotional distress the nurse can do the following:
•Make a commitment to self-care
•Develop strategies for letting go of work
•Develop strategies for acquiring adequate rest and relaxation
•Plan strategies for practicing effective daily stress reduction
Equipment failure is a problem in critical care settings for the following reasons:
•it can increase workload when it fails or is inadequate
•it eliminates human decision making such as use of monitoring equipment, IV pumps for critical care drips, when they fail, the nurse may not know how to calculate drips or perform a function without a monitoring device |
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sue524 Thu, 02 Feb 2012 18:20:56 GMT |
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| Manifestations of this include peripheral nerve damage from entrapment of nerves, headache, hypertension, congestive heart failure, seizures and visual disturbances. impaired glucose tolerance and diebetes many occure. Arthritis |
acromegaly |
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sue524 Thu, 02 Feb 2012 18:12:28 GMT |
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| Large forehead, maxilla lenghtens,tongue enlarges and voice deepens. Overgrowth of bone and soft tissue in the hands and feet. |
Acromegaly |
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sue524 Thu, 02 Feb 2012 18:12:28 GMT |
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| Acromegaly usually begins during |
adulthood |
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sue524 Thu, 02 Feb 2012 18:12:28 GMT |
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| Giantism is most often the result of a |
tumor |
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sue524 Thu, 02 Feb 2012 18:12:28 GMT |
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| This occurs when GH hypersecretion begins before puberty and the closure of the epephyseal plate. Height and body proportions are relatively normal |
Giantism |
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sue524 Thu, 02 Feb 2012 18:08:34 GMT |
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| Nursing diagnosis with addison |
1 fluid vol deficiet
2risk for ineffective theapeutic regimen management
3 Anxiety lack of knowledge |
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sue524 Thu, 02 Feb 2012 18:08:34 GMT |
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potency
prednisolone and predinsone are ___ in potency
dexamethasone decadron is |
equivelent
4 to 5 times more potent |
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sue524 Thu, 02 Feb 2012 18:08:34 GMT |
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| dyhydration may result because of |
increased hematocrit and blood urea nitrogen |
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sue524 Thu, 02 Feb 2012 18:08:34 GMT |
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Medication for addison is
1.coticosteroid called and used for
2. Mineralocorticoids
3 diet is |
1. hydrocortisone (cortef) to replace cortisol
2. fludrocortisone florinef to replace mineralocorticoids
also INcrease Sodium in diet |
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sue524 Thu, 02 Feb 2012 16:00:00 GMT |
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blood and urine test for addisons
1. cortisol
2. BUN
3. sodium
4. Potassum
5. glucose
6 Urine 17-5s |
1. decreased
2. increased
3. decreased
4 increased
5decreased
6 low or absent |
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sue524 Thu, 02 Feb 2012 16:00:00 GMT |
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Manifestation of addisons are
1.Integumentary system
2.Cardiovascular
3. Central nervous system
4. Musculoskeletal
5. Gastronintestinal system
6. reporductive
7. Metabolic effects |
1.Delayed wound healing and Hyperigmentation
2. postural hypotension, arrhythmias and tachycardia
3. Lethargy, tremors, emotional labilty, confusion
4. wweakness, muscle wasting, joint pain, muscle pain
5. anorexia, nausea and vomiting and diarrhea
6. Menstaul changes
7. HyPERKalemia, hyPOnatremia, HyPOglycemia |
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sue524 Thu, 02 Feb 2012 16:00:00 GMT |
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causes of addisons disease are
1. most common cause and can be associated with type 2 of this kind is associated with
2. Pt who are taking
3 Adrenolukodystrophy is an
4. ACTH deficit resluting from
5. pt who withdraw abruptly from |
1. autoimmune destruction of adrenals called PGA polyglandular autoimmune PGA 2 people with hypothyroidism, type 1 diabetes, primary or testicular faulure and pernicious anemia
3. X linked disorder an accumlation of long chanin fo fatty acids in adrenal cortex, testes, brain, and spinal cord
4. pituitary tumors, pituitary surgery or irradiation and use of exogenous steroids
5. steroids
2. anticogulants or have mary trauma or surgery |
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sue524 Thu, 02 Feb 2012 15:48:06 GMT |
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in addison disease results in a chronic deficiency of
accompanied by
age is usually
more common in |
cortisol, aldosterone, and adreanl androgens
skin pigmentations
under 60
women |
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sue524 Thu, 02 Feb 2012 15:44:30 GMT |
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| this is a disorder resulting from destruction or dysfunctino of the adrenal cortex |
addisons disease |
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sue524 Thu, 02 Feb 2012 15:44:30 GMT |
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| Nursing diagnosis and interventions for cushings syndrome is |
Fluid volum excess because of excess cortisol
Risk for injury
Risk for infection
Distrubed body image |
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sue524 Thu, 02 Feb 2012 15:33:51 GMT |
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surgery in cushing syndrome
when cushing is caused by adrenal cortex tumor the surgery is ?
If ACTH producting ectopic tumor is involved what surgery |
adrenalectomy to remove tumor** only one adrenal gland is usually involved
Bilateral adrenalectomy and both adrenal glads are removed. |
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sue524 Thu, 02 Feb 2012 15:33:51 GMT |
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Drugs used for cushing syndrom are
1. used to treat matastic adrenal cancer
2. This is used for ectopic ACTH secreting tumors that cannot be surgicall removed
3. This durgs suppresses ACTH secretions in some clinets |
1. Mitotane suppresses activity of the adrenal cortes
2. Aminogluthemide or Ketoconazole or both they inhibit cortisol synthesis by the adrenal cortex
3. Somatostatin analog Octreotide suppresses ACTH secretion |
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sue524 Thu, 02 Feb 2012 15:33:51 GMT |
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| Cushing syndrom that results from a pituitary tumor is treated by |
medication, as and adjunct to surgery or radiation |
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sue524 Thu, 02 Feb 2012 15:33:51 GMT |
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| In cushing syndrome dynthetic cortisol daxamethasone is given to suppress the production of ACTH and plasma cortislol levels are measure. If extremely high does of cortisol is necessare to suppress ACTH the primary cushing disorder is ? If aCTH is not suppressed with synthetic cortisol what is suspected? |
Adrenal cortex hyperplasia
Adrenal tumor suspected |
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sue524 Thu, 02 Feb 2012 15:22:54 GMT |
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| in secondary cushing sydrome ACTH leves are |
elevated |
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sue524 Thu, 02 Feb 2012 15:22:54 GMT |
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| in primary cushing syndrom ACTH levels are |
Decreased |
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sue524 Thu, 02 Feb 2012 15:22:54 GMT |
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| Diagnositc test for cushing syndrome are |
1. plasma cortisol higher in morning
2. Plasma ACTH
3 24 hour urine test
4serum potassium calcium and glucose
ACTH suppression conducted to identify the cause of the disorder |
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sue524 Thu, 02 Feb 2012 15:22:54 GMT |
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other changes in cushing syndrome are electrolytes imbalances and they are
1. calcium changes cause
2. potassium is
3.sodium is
4. risk for peptic ulcers
5 cardiovascular system changes
6. Reporductive system |
1. osteoporosis, compression fractures, reanl calculi
2. lost
3. retained
4. increases
5. Hypertension
6 Oligomenorrhea or amenorrhea, impotence and decreased libido |
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sue524 Thu, 02 Feb 2012 15:12:32 GMT |
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| steroid excess inhibitis fibroblast resulting in loss of collagen and connective tissue results are |
thinning of skin, abdominal strie red purple stretch marks, easy bruising, poor wound healing and frequent skin infections |
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sue524 Thu, 02 Feb 2012 15:12:32 GMT |
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| In cushing changes in protein metabolism causes |
muscle weakness and wasting especially in extremities |
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sue524 Thu, 02 Feb 2012 15:12:32 GMT |
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| cushing syndrom obesity and redistribution of body fate is in what regions |
Abdominal region, fat pads under clavical, buffalow hump over upper back and round moon face |
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sue524 Thu, 02 Feb 2012 15:12:32 GMT |
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| this type of cushings is from long term glucocorticoid use |
Iatrogenic Cushing syndrome |
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sue524 Thu, 02 Feb 2012 14:58:29 GMT |
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| this type of cushing is resulting from excessive cortisol secretion by a benign or malignant adrenal tumor. Excess secretation supresses pituitary ACTH production, resulting in atrophy of the uninvolved adrenal cortex. Thirty two percento of cushing disease is due to excessive autonomous secretion of cortisol by adrenal glands |
Adrenal form |
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sue524 Thu, 02 Feb 2012 14:58:29 GMT |
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| type of cushing caused by ACTH secreting tumor such as small cell lung cancer |
Ectopic form of cushing |
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sue524 Thu, 02 Feb 2012 14:58:29 GMT |
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| this form of cushing is is associaqted with ACTH hypersecretation by tumor of pituitary. This si most commonly causecd by a small pitutiary adenoma with persistent but disorderly and random overproduction of ACTH. Forty three persent of cushing is due to hypersecretation of ACTH by pituitary |
Pituitary form |
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sue524 Thu, 02 Feb 2012 14:54:50 GMT |
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| 4 types of cusing syndrome is |
pituitary form, ectopic form adrenal form, and iatrogenic |
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sue524 Thu, 02 Feb 2012 14:54:50 GMT |
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| a chronic disorder in which hyoper function of the adrenal cortex produces excessive amount of circulating cortisol or ACTH |
Cushing syndrom ave age 30 to 50 more women |
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sue524 Thu, 02 Feb 2012 14:54:50 GMT |
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| which is the only endocrine organ that can be palpated during physical assessment |
thyroid gland |
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sue524 Thu, 02 Feb 2012 14:54:50 GMT |
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| When conductring a health history focused on the endocrin system, which of the following questions should be included |
Have you noticed any increased signs of thirst. |
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sue524 Thu, 02 Feb 2012 14:47:44 GMT |
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| excessive amounts of glucocorticods produced by adrenal cortex, results in what pathophysiologic health |
Inhibit immune response. |
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sue524 Thu, 02 Feb 2012 14:47:44 GMT |
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| What assessment might be made to indenify low calcium levels |
Trousseaus and is done by inflating a blood pressure cuff above the antecubital area, higher than the systolic blood pressure, for two to five minutes, A positive test causes carpal spasmn and the fingers and hand will contract on the arm where the blood pressure cuff is inflated |
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sue524 Thu, 02 Feb 2012 14:47:44 GMT |
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| what physiologic response is expected if the pituitary produces and increased amount of ADH |
decreased urine out put because adh antiduret hormone helps to concentrate urine, which would decrease urin output. the adh couses the distal tubules in the kidney to reablsorb water which will concentrate the urinie |
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sue524 Thu, 02 Feb 2012 14:47:44 GMT |
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| extreme larg bones may indicate |
acromegaly |
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sue524 Thu, 02 Feb 2012 14:40:19 GMT |
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| ultered sensation may be seen in |
diabetes, hypothyroidism and acromegaly |
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sue524 Thu, 02 Feb 2012 14:40:19 GMT |
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| Variations of the form and structor may may indicate growth abnormalities seen in |
acromegaly |
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sue524 Thu, 02 Feb 2012 14:40:19 GMT |
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| increased pigmentatin of the nails is seen in what disease |
addisons |
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sue524 Thu, 02 Feb 2012 14:40:19 GMT |
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| Purple striae over the abdomen and brusing may be sinn in what syndrome |
cushing syndrome |
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sue524 Thu, 02 Feb 2012 14:32:38 GMT |
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| hyperpigmentatino is seen in what diseases or syndrome |
Addisons or cushings |
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sue524 Thu, 02 Feb 2012 14:32:38 GMT |
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| Catecholamines Epinephrine and norepinephrine have effects on the |
medula adrenal gland |
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sue524 Thu, 02 Feb 2012 14:32:38 GMT |
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| corticosteriods Gl;ucocorticosteroids and minerocorticosteriods have effects on |
Adreal glands the cortex |
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sue524 Thu, 02 Feb 2012 14:32:38 GMT |
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| What gland sposterior gland stimulates retention of water |
ADH |
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sue524 Thu, 02 Feb 2012 14:27:19 GMT |
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| What posterior gland stimulates uterine contractions, milk ejection reflex uin the mammary glands |
Oxytocin |
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sue524 Thu, 02 Feb 2012 14:27:19 GMT |
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| What gland stimulates deveelopment of testes and ovaries |
LH |
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sue524 Thu, 02 Feb 2012 14:27:19 GMT |
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| what gland stimulates mammary gland growth and mild production |
PRL |
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sue524 Thu, 02 Feb 2012 14:27:19 GMT |
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| what gland stimulates adrenal glands to produce hormones |
ACTH |
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sue524 Thu, 02 Feb 2012 14:22:52 GMT |
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| what gland stimulates Thyroid gland to produce hormones |
TSH |
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sue524 Thu, 02 Feb 2012 14:22:52 GMT |
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| gland that stimulates development of follicles |
FSH |
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sue524 Thu, 02 Feb 2012 14:22:52 GMT |
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| what gland stimulates muscle and skeletal growth |
GH |
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sue524 Thu, 02 Feb 2012 14:22:52 GMT |
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| Posterior Pitutary Glands are |
Antidiuretic ADH and Oxytocin |
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sue524 Thu, 02 Feb 2012 14:21:12 GMT |
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| anterior pituuitary glands are |
growth hormone GH, Prolactin PRL, thyroid stimulating hormone TSH, Adrenocortiocotrophic, ACTH, Follicle stimulating hormond FSH and Luteinizing hormone LH |
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sue524 Thu, 02 Feb 2012 14:21:12 GMT |
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| function of endocrine system is |
control chemicals, water balance , growth and metabolism, embryonic development sexual behavior, stimulate growthe and matureation of gonads, |
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sue524 Thu, 02 Feb 2012 14:21:12 GMT |
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| endocrin glands are |
pituitary, adrenal, thyroid and pancreas |
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sue524 Thu, 02 Feb 2012 14:21:12 GMT |
|
