Exam 2 Study Guide
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This 19 page Study Guide was uploaded by Katelyn Paccione on Wednesday February 18, 2015. The Study Guide belongs to Nur 221 at Purdue University taught by Davis and Hannigan in Winter2015. Since its upload, it has received 250 views.
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Date Created: 02/18/15
Exam 2 Study Guide Lecture 1 Blood Suoar and Diabetes Mellitus Endocrine function of the pancreas Islet of Langerhans 0 Alpha Cells function secrete glucagon Increases blood sugar hyperglycemic effect Promotes the liver to break down glycogen 0 Beta Cells function secrete insulin Decreases blood sugar hypoglycemic effect Promotion of storage of glycogen in the liver 0 De nition of Diabetes Mellitus o Lehne 702 quotdisorder of carbohydrate metabolismquot quotdeficiency in insulincellular resistance to insulin39s actionsquot 0 Etiology of DM Lehne 703 Genetic Some studies suggest that heredity is a factor Autoimmune Attack the cells of the pancreas Mostly the cause of Type I diabetes Environmental fx Sedentary lifestyle 0 Not being active increases the risk for obesity increases the risk for diabetes Stressful lifestyle Obesity Increased longevity increases with age 0 We see this a lot in the elderly that have Type II diabetes 0 Type 1 AKAJuvenileonset or insulindependent DM Etiology of Type 1 Autoimmune destruction of beta cells Signs and Symptoms Hyperglycemia increase in blood glucose Polydipsia increased thirst Polyuria excessive urination Polyphagia increased hunger Glucosuria sugar in the urine Weight loss 0 Only have fat and muscle do not have the simple carbs Fatigue Diagnostic Criteria for DM 0 Explain Hemoglobin A1c 65 or higher 0 The attachment of glucose to a hemoglobin molecule red blood cell o What is a fasting Blood Sugar and what number represents suggests DM 0 Greater than 126 0 FBS means that they had nothing to eat within the last 8 hours 0 What is a random Blood Sugar or casual BS and what number represents DM 0 200 0 Random is also called casual meaning the blood sugar that is taken within any given time throughout the day after eating 0 Treatment for Type 1 INSULIN Goal of Treatment Lehne 706 Prevent long term complications 0 What is meant by the words quotTight controlquot and quotPost Prandialquot Tight control Maintaining glucose levels within a normal range aroundtheclock Post Prandial During or relating to the period after dinner or lunch Complications of Type 1 0 Chronic heart disease 0 due to fat build up in the arteries atherosclerosis stroke kidney disease nephropathy blindness diabetic retinopathy nerve damage neuropathy loss in sensation but causes pain impaired circulation can result in amputation toenails note we do not cut the toenails of the elderly why 0 They cannot feel what is going on with their feet Risk for cutting the skin infection 0 Acute Insulin Shock rapid onset or aka Hypoglycemia 55 in result to stimulation of the sympathetic nervous system think what happenshow do you feel when you have not ate anything in a long period of time Pallor Tremor Anxiety Tachycardia Palpitations Diaphoresis Heart attack 0 Fatigue 0 Diagnostic BS Numbers for adults 5560 0 Diagnostic BS Numbers for newborn lt30 0 Diabetic Ketoacidosis DKA describe what causes acidosis Slow onset Cells are unable to access the sugars which makes ketoacids wasteful and decrease the pH 0 BS gt250 Stress is a predisposing factor 0 Describe Hyperglycemic Nonketoic Syndrome AKA Hyperglycemic hyperosmolar Syndrome Lehne 729 Uncommon Diagnostic BS Numbers gt600 Severe dehydration and loss of electrolytes Hypoglycemia quotCold and Clammy need some candyquot 0 Treat with giving glucose wither through IV or fooddrink Hyperglycemia quotHot and Dry sugar highquot 0 Type 2 AKA ageonset or maturityonset Insulin resistance Etiology of Type 2 Obesity inactivity Dyslipidemia Signs and Symptoms same as Type 1 0 Diagnostic Criteria same as 0 Treatment 0 Diet 0 Exercise 0 Oral hypoglycemic 0 Start this when diet and exercise are not ef cient alone Complications of Type 2 Similar to Type 1 o Gestational diabetes What is this Drugs to know for Diabetes Regular insulin Humulin R Novolin R Lehne pg 713 O O O 0 Short Duration Short Acting often used three times a day before meals Routes subQ injection abdominal site more readily absorbs preferred subQ infusion can be given IV IM injection rarely used and oral inhalation not currently used Rotate sites Clear solution Two concentrations 0 U100 100 units per mL 0 U 500 500 units per mL Who uses this concentration Reserved for patients with insulin resistance Never give lV Make sure the patient has food available 30 minutes after administration and is not hypoglycemic Adverse effect hypoglycemia Peak of 24 hours Insulin glargine Lantus O O O 0 Long Duration used once daily at the same time each day May not be mixed with any other insulins Clear solution No peak Intermediate 0 Cloudy appearance Oral hypoglycemics 1 Biguanides Metformin 1st line of intervention of Type 2 DM MOA Lehne 720 1 Inhibits glucose production in the liver primary 2 Reduces glucose absorption in the gut 3 Sensitizes insulin receptors in target tissues Poses little risk of hypoglycemia or weight gain Contraindicated with radiographic dyes renal failure 2 Sufonyureas used only for Type 2 MOA stimulate more insulin from the pancreas Risks associated with sulfonylureas hypoglycemia 3 Gitazones MOA decrease insulin resistance at cellular level thereby increasing uptake of glucose Usually added to Metformin in a combo therapy Adverse effects Heart failure secondary to uid retention 4 Megitinides MOA stimulate more insulin from the pancreas Adverse effects risk of hypoglycemia 5 Alpha Glucosidase Inhibitors MOA delays the absorption of carbohydrates reducing the rise in blood glucose Adverse effects GI 6 Giptins MOA stimulate the release of insulin by signaling the pancreas and suppress post prandial release of glucagon by signaling the liver Lehne pages 733735 Summary of Major Nursing Implications o lnsulin Goal maintain blood glucose levels within a normal range High risk patients taking medications that can lower or raise blood glucose levels 0 Metformin Type 2 DM High risk patients renal or liver failure heart failure alcohol consumption Adverse Lactic Acidosis Early signs 0 Hyperventilation myalgia malaise Lecture 2 The Thvroid amp Adrenal Glands Location and Function of the Thyroid Gland 0 Action and regulation of thyroid hormones T3 triiodothyronine and T4 tetraiodothyronine Lehne pages 738739 Slide 5 Stimulate energy use Stimulate the heart Promote growth and development lodine essential for synthesis Controled by the hypothalamus via the anterior pituitary Hypothalamus secretes TRH to the anterior pituitary that secretes TSH to the thalamus secretes T3 and T4 If there is not enough T3 or T4 the anterior pituitary is stimulated to release more TSH to be delivered to the thalamus o Hypothyroidism Lehne 740 Signs and symptoms General weakness and muscle cramps Dry skin Slurred speech everything slows down Bradycardia Weight gain 0 The basal metabolic rate is slowed Decreased sense of taste and smell Intolerance to cold temperature lncrease in TSH however a decrease in T3 and T4 0 In relation to the thyroid being the target organ autoimmune disease Causes Primary poorly functioning thyroid Low secretion of TSH Destruction of thyroid rt autoimmune disease Hashimoto s thyroidHS Surgical removal TherapyTreatment Levothyroxine Lehne 742 Adv Hig Synthetic T4 Route PO Dosage 100400 mcgday o Administer in the morning at the same time each day After taking this drug wait 30 minutes to eat se what is seen in HYPERthyroidism Weight loss Heart attack Tremors Heat intolerance Insomnia Menstrual irregularities Dysrhythmias risk patients cardiac problems Start the patient on the lowest dose possible and alquot D39IOIOIO OIOIOIO 390 go from there Are levothyroxine preparations interchangeable NO 0 Risk of maternal hypothyroidism in 1St trimester of pregnancy Neuropsychological effects to the fetus Pregnant woman require 3050 more of Ievothyroxine Risk of hypothyroidism in newborns Cretinism 0 Mental retardation and alterations in growth and development 0 Hyperthyroidism Lehne 741 Signs and symptoms Weight loss 0 Increase in BMR Tachycardia Heat intolerance Heart attack Tremor Increased body temperature Anxiety Insomnia Menstrual irregularities Causes Graves Disease Lehne 741 o Autoimmune disorder 0 Clinical presentation exophthalmos bulging eyes Tumor of the thyroid or pituitary o Toxic Nodular Goiter dt thyroid adenoma ss match Graves except NO exophthalmos treatment surgery and radiation Pregnancy Thera pyTreatment surgical removal of thyroid tissue destruction of thyroid tissue with radioactive iodine preferred for adults suppression of thyroid hormone synthesis with antithyroid drug preferred for child 0 Methimazole aka Tapazole MOA suppress thyroid hormone synthesis Use PTU propylthiouracil Route PO Dosage 510 mgday Contraindicated in pregnancy 0 Category D Thyrotoxic Crisis Thyroid Storm Lifethreatening o This is hyperthyroidism and an adverse event trauma surgery 0Signs and symptoms 0 High fever 0 Cardiac events Tachycardia HF Angina Ml oCNS events Agitation Restlessness Delirium which can excel into a coma 0Treatment antithyroid drug 0 Diagnostic test related to thyroid function TSH Serum T4 Serum T3 0 These three lab results will help to differentiate the cause of hyperthyroidism if it is primary or not Meaning that TSH is high and T3 and T4 are low This means the thyroid itself is not working Or it can be secondary cause meaning the pituitary is not functioning properly T3 T4 and TSH are all low 0 Lehne 747749 Summary of Nursing Implications Levothyroxine 0 Use for hypothyroidism 0 Take P0 in the morning on an empty stomach with a full glass of water 30 minutes before eating 0Adverse o Thyrotoxicosis Notify medical help when presenting with signs and symptoms 0Nursing Implications 0 Separate the administration of levothyroxine 4 hours from other drugs Methimazole 0 Goal reduce TH in Graves hyperthyroidism until radiation may be used thyrotoxic crisis 0 Avoid in pregnancy and breast feeding o Dosage Take once a day every day at the same time everyday o Adverse agranulocytosis Radioactive Iodine 0 Use Graves suppress the TH 0 do not use in breast feeding or pregnancy 0 response to treatment can take a couple months 0Location and Function of the Adrenals 0 Small gland located on top of each kidney 0 Medulla produces Adrenaine epinephrine and norepinephrine oSympathetic nervous system 0 Cortex produces Corticosteroids 0Gonadocorticoidsandrogens 0 Function secondary sexual hair distribution and libido in women oMineralcorticoidsaldosterone 0 Function controls plasma volume Promotes sodium reabsorption and potassium excretion When plasma volume decreases aldosterone will kick in Why would I need to alter plasma volume 0 To compensate for uids lost diarrhea vomiting etc 0Glucocorticoids cortisone 0 Function suppress in ammation and immune responses 0 effect on the lungs bronchodilation 0 effect on the CNS changes in mood o insulin is inhibited to increase blood glucose levels promotes the synthesis of carbohydrates for lipids and proteins gluconeogenesis o Adrenalcortico insuf ciency dysfunction of the gland Slide 25 Low plasma cortisol with high plasma ACTH is diagnostic o The hypothalamus secretes CRH that feeds to the anterior pituitary that secretes ACTH that feeds to the adrenal cortex where cortisol is secreted Signs and symptoms of adrenalcortico insufficiency o Decrease in plasma cortisol and increase in plasma ACTH o Hypoglycemia 0 Fatigue 0 Hypotension 0 Increased skin pigmentation GI O O Anorexia vomiting diarrhea Causes Primary chronic Addison39s Disease 0 Autoimmune disorder 0 Rare 0 Treatment lifelong replacement with hydrocortisone ADDison39s more steroids Direct destruction of the adrenals Deficiency in glucocorticoids and O mineralocorticoids Secondary acute o Decreased secretion of ACTH from the pituitary Tertiary o Decreased secretion of CRH from the hypothalamus Acute adrenal insufficiency 0 Cause adrenal failure pituitary failure 0 Or failure to provide patients receiving replacement therapy with adequate doses of corticosteroids 0 Most common presentation been treated with exogenous steroids and have been suddenly discontinued o MUST TAPER OFF DRUGS Treatment Hydrocortisone Lehne 763765 0 Preferred drug adrenalcortical insuf ciency o Adverse few low doses high doses atrophy of the adrenalsadrenal suppression Administer every other day TAPER OFF Adrenal Hormone Excess Cushing39s Syndrome Lehne 762 overexposure to glucocorticoids over longer periods normally due to replacement therapy CUshings Cortisol is Up Signs and symptoms Adrenal atrophy Osteoporosis Hypertension Increased risk of infection Delayed wound healing Acne Obesity MOON FACE and BUFFALO HUMP o Redistribution of fat o Mood and personality changes 0May mask signs of infection and delay antibiotics Causes 0 Hypersecretion of ACTH by the pituitary 0 Ad renal tumors 0 MOST COMMON long term high dose glucocorticoid therapy Treatment Partial removal of the pituitary 0 OR irradiation of the pituitary 0 OR combine surgery and radiation 0 Surgical removal of the adrenal cancer or removal of the adrenal gland 0Tapering the dose of exogenous hormones oAntiadrenal drug Ketoconazole o Adverse liver dysfunction 0 Congenital Adrenal Hyperplasia overgrowth of tissue Rare Reduced ability to make glucocorticoids The pituitary over secretes ACTH that causes the overgrowth of adrenal tissue Linear growth is advanced and androgen levels increase in both sexes causing o Girlsmasculinization 0Boys penile enlargement Lecture 3 Hormones Estrogen 0 Sources Ovaries are the primary source Pacenta is a great source during pregnancy o PhysiologicPharmacologic effects Develop and maintain the female reproductive tract Breast growth Thickening of vaginal epithelium Proliferation of the uterine epithelium Develop secondary sex characteristics Bone remodeling Dense bones Favorable effects towards cholesterol 0 Uses Menopausa hormone therapy Femae hypogonadism Women who did not develop ovaries Acne o Routes of Administration 0 Oral transdermal intravaginal Adverse Hyperpasia and carcinoma UNOPPOSED In postmenopausal women Progesterone is used to balance the estrogen to keep from getting hyperplasia Increase risk of VTE Increase risk of MI gt60 Nausea Conjugated Equine Estrogen CEE Greatly found in horses Progesterone Progestins 0 Sources 0 O O O Ovaries and placenta Supports quotsecretoryquot endometrium Causes the endometrium to thicken and stabilize Supports pregnancy Smooth muscle relaxant relaxes the bony pelvis during labor Balances the effect of estrogen HRT Hormone Replacement Therapy Keeping the uterus in balance and decreasing the risk for uterine cancer Premenstrual Syndrome PMS Neuroendocrine disorder quotIuteal phase defectquot PROGESTERONE SENSITIVITY 0 Treatment 0 0 Lifestyle changes CaIciummagnesium Calcium is concentrated more OCP Oral Contraceptive Pills Birth control SSRI Serotonin Reuptake Inhibitors Example Prozac oHormone Replacement Therapy Bene ts 0 0 Relief od vasomotor symptoms hot ashes Management of urogenital atrophy Urogenita degeneration Prevent osteoporosis and fractures Wound healing skip the remodeling phase Tooth retention bone remodeling Glycemic controI Adverse EndometriaI cancer 0 Only when estrogen is used alone Estrogen increases the rate that the endometrium proliferates Increase risk for breast cancer w EPT Decrease risk of breast cancer w ET alone Light increased risk for ovarian cancer Increase risk from dying from NSCLC lung cancer Increase risk of gallbladder disease 0 There needs to be further study of dementia 0 Give the lowest dose for the shortest amount of time needed Testosterone o Anterior pituitary secretes FSH and LH FSH spermatogenesis LH testosterone production 0 Uses Male hypogonadism No testicular development Treatment 0 Hormone replacement Giving more than needed will not give appropriate therapeutic effects Lack of sufficient testosterone Primary testicles 0 Removal tissue damage that can be caused by torsion Secondary pituitary lmpact muscle mass body composition blood production Symptoms o Diminished secondary sexual characteristics 0 Libido oErectie dysfunction 0 Depression 0 Ana bolicE rtyth ropoietic Effects Promotion of growth of skeletal muscles Promotes synthesis of erythropoietin lncreasing red blood cell production Testosterone is an anabolic steroid Build muscle mass and strength 0 Adverse lncreased LDLs and decreased HDLs Low sperm count Testicular atrophygynecomastia Menstrual disturbancevirilization Epiphyseal closure In children this closes prematurely Taken orally can be hepatotoxic Aggression and psychological dependence Example road rage o Routes of admin Oral is not preferred due to an increased risk of hepatotoxicity Transdermal patch Buccal tablet lmpantabe pellets IV is neither preferred dt non smooth or constant delivery Erectile Dysfunction o 70 physiologic causes Age Atherosclerosis Diabetes Stroke Hypertension Nerve damage Lifestye drinking and smoking 0 Low testosterone o Drugs for Tx medications that cause vasodilation Diuretics SSRI Tricyclic antidepressants Antihypertensive Silena l Viagra Lehne 835 MOA enhances arterial dilation and venous occlusion Use erectile dysfunction Side effects 0 Vasodilation o Nasal congestion o Facial ushing Headache Dizziness Fall in BP se Hypotension Priapism prolonged erection Optic neuropathy Sudden hearing loss ing implications Patients taking blood pressure medications should D Adv Nur low not take this drug since it can decrease BP o Halflife 36 hours 0 space the medications 4 hours apart Benign Prostatic Hyperplasia BPH 0 Not cancerous o Enlargement of the prostate o Obstructs the urethra causing change in frequency of urination leakage and possible nocturia 0 Treatment Excision of tissue Watchful waiting Pharmaceutical therapy o This condition increases in prevalence as the men increase in age 5AlphaReductase Inhibitors Finasteride Proscar Lehne 840 o MOA blocks the conversion of testosterone Dihydrotestosterone which promotes regression of prostate tissue 0 Risks and Bene ts Risk lncreased risk of high grade prostate cancer Benefit Decreased risk of low grade prostate cancer 0 Adverse decreased libido and decreased ejaculate vmume Can cause ED problems because we are shrinking the prostate Alpha 1 Adrenergic Antagonist Bladder contracts and the sphincter relaxes Nonselective medications can lower the BP 0 Caution in patients taking BP meds o Lower in BP can cause Dizziness Sleepiness Nasa congestions Tamsulosin Flomax Lehne 841 0 Works more quickly o Taken 30 minutes after the same meal each day 0 Selective So little effects on BP 0 Adverse Minimal on vascular smooth muscle Lecture 4 Contraception amp Reproductive Hormones Hypothalamus pituitary ovaries in the female reproductive system 0 Hypothalamus secretes GnRH to the anterior pituitary the anterior pituitary secretes FSH and LH LH stimulates androgen production which stimulates estrogen production Also promotes ovulation and nal oocyte maturation Androgenic effects lncrease in SHBG reduces free testosterone Reduced acne Reduced oily skin Reduced hirsutism Reduce libido SLIDE 6 o Follicular Phase usually 1017 days 0 Luteal Phase usually 14 days 0 Menstrual Phase normal blood loss 2080 ml duration 46 days Menstrual cycle Fertility awareness as a method of contraception o Utilizes Basal body temperature Low temperatures could indicate that you are not ovulating Pregnant women have slightly higher body temperatures o Lasting more than 20 days o Increase in progesterone Temperature charts 0 Biphasic chart ovulation has taken place 0 Monophasic chart absence of ovulation Cervical mucus production determines ovulation status Preovulatory relatively infertile phase 0 Low in volume o Thick and cloudy o No ferning o Maximal cellularity Low elasticity The ertile phase High in volume Thin and clear Ferning Minimal cellularity High elasticity Spinnbarkeit Postovulatory completely infertile phase o Low in volume o Thick and cloudy No ferning Maximal cellularity Low elasticity Panningpreventing conception Barrier methods of contraception o Condoms E Diaphragm o Cervical cap with spermicide o Lea39s shield o Sponge 390 h OIOIO o Spermicidal foam lm suppository 0 Oral Contraceptive Pills OCPs What are the primary two ingredients Estrogen and Progesterone Benefits Dysmenorrhea painful periods Hypermenorrhea prolonged periods 0 This can make the woman anemic Metrorrhagia irregular but frequent periods Decrease in PMS Decrease in acne Decrease in ovarian and endometrial cancer Menstrual regulation Higher HDLs and lower LDLs Mechanism by which exogenous estrogen and progesterone prevent conceonn 0 Combined MOA provide negative feedback to the pituitary to inhibit the Adverse effects Abnormal bleeding during periods Amenorrhea and hypermenorrhea secretion of LH and FSH o Estrogen This means that the ovarian follicle cannot mature and ovulation is prevented 0 Low progesterone Hypertension Thromboembolic disorders Nausea Edema Breast tenderness Depression MOA alteration in endometrial secretions and cellular structures CORPUS LUTEUM o Progesterone MOA thickening of the cervical mucus ciia activity is reduced inhibiting ovulation endometrium becomes weak and that impairs implantation Depo Provera injectable One injection every 3 months Side effects 0 Weight gain 0 Decreased libido o Acne No estrogen so no estrogen side effects No drug interactions Better choice for smokers Disadvantages o tapper off 0 must have a visit every 3 months HDL IeveIs drop Decline in bone densityBLACK BOX WARNING Increased appetite weight gain Fatigue Acne Hirsutism Micronor quotmini pillquot IUD Less effective than combined Take the same time everyday No estrogen adverse effects lrregular bleeding Can be used with breastfeeding MOA prevent fertilization Adverse o Menstrual irregularities Spotting ncrease in menstrual ow 0 Increased cramping o Painful insertion and removal 0 Infection risk Risk and bene ts of exogenous hormones for contraception 0 Bene ts no pregnancy leads to most of these bene ts Reduces C section Reduces miscarriages Reduces ectopic pregnancy Reduces ovarian cysts Decreases bleeding therefore decreasing anemia Caution with OCP 0 Does not protect you from contracting STDs 0 Lack protection for the heart Risk of cardiovascular disease 0 Must take the pills daily 0 Early pill danger signals Abdominal pain Chest pain Headache Eye probIems Severe leg pain Additiona modes of delivery of contraception o NuvaRing Black Box Warning May expose to more estrogen and that creates a greater risk for blood clots o lmplanon Flexible plastic rod that is placed under the skin in the arm One can last for 3 years Most cost effective long acting contraceptive When you should not use OCP 0 History of blood clots or heart problems 0 Diabetes with adverse event neuropathy nephropathy retinopathy 0 Breast cancer Breast feeding for less than 6 weeks Smoking heavy for more than 20 days Liver problems Major surgery trauma Hypertension Medications SLIDE 32 St John39s Wort Antibiotics Seizure medication Barbiturates Nursing Implication 0 Teach the patient about 55 of DVT and to report if any symptoms are present
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