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Adult II Quiz 2

by: Emily Sun

Adult II Quiz 2 Nurs 305-002

Emily Sun

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About this Document

These notes will cover whats going to be on the quiz and on the final.
Adult II
Professor Fasolka
Study Guide
Nursing, adult, Endocrine, immune, Urinary
50 ?




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This 8 page Study Guide was uploaded by Emily Sun on Wednesday August 10, 2016. The Study Guide belongs to Nurs 305-002 at Drexel University taught by Professor Fasolka in Summer 2016. Since its upload, it has received 14 views. For similar materials see Adult II in NURSING at Drexel University.

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Date Created: 08/10/16
Endocrine Part 2  Adrenal cortex (makes corticosteroids) and Adrenal Medulla (makes epinephrine)  ­ Corticosteroids:  ­ Glucocorticoids­ catabolic (​Cortisol)  ­ Regulate metabolism  ­ Increase hunger, keep blood sugar up, stress response  ­ Suppresses Inflammatory response  ­ Suppresses Immune system  ­ Mineralocorticoids­ ​aldosterone  ­ Regulate fluid & electrolytes  ­ Aldosterone­ kidney retains Na and H20 and causes release of K+  ­ Androgens­ E ​ strogen, Testosterone, Androsterone   ­ Growth & development in both  ­ Sexual activity in women  ­ Disorders:  ­ Cushing’s Syndrome  ­ Too much esp. Glucocorticoids   ­ How do they get this?­   ­ 1) Most common: we give them too much corticosteroids (exogenous)  ­ 2) ACTH secreting pituitary tumor   ­ 3) ACTH secreting tumor (from outside  cancer)  ­ What do they look like?­  ­ Cardiac​: ​edema from holding on extra fluid +  HTN (from extra fluid)  ­ Skin​: Moon face, skin is thinner in  extremities, acne and stretch marks, truncal  obesity  ­ Impaired skin healing  ­ Immobility in bed  ­ Musculoskeletal: ​catabolic results from  glucocorticoids make the extremity skin  ­ GI: i​ ncreased hunger, increased blood sugar  (increased risk for ketones in urine)  ­ Neurological: d ​ epressed + labile moods  ­ How do they diagnose Cushings?  ­ 24 hour urine test → locating cortisol levels  ­ Plasma cortisol levels (not a good indicator because when stressed = inc.  cortisol)  ­ Plasma ACTH  ­ CT/MRI to locate adrenal and pituitary glands  ​ ­ Electrolyte Studies: Na+ and K+   ­ Nursing Care of Cushing’s Syndrome:  ­ Treatment depends on where it’s located:  ­ Pituitary Adenoma  ­ Transsphenoidal hypophysectomy­ ​HOB elevated, no  coughing/straining, watch for meningitis, CSF leakage, don’t  brush teeth, prone to infections  ­ Ectopic ACTH­ treat the neoplasm  ­ Adrenal Tumor  ­ Adrenalectomy­ ​will be on a lifelong supply of corticosteroids,  may get high doses of steroids (remember to taper them down)  ­ Patients are at a high risk for infection  ­ Release of hormones into circulation → orthostatic  hypotension (m ​ ake sure patients wear medical alert)  ­ Remember patients are at a risk for infection (from high cortisol suppresses  immune system), self image, skin integrity, imbalanced fluid volume  ­ Monitor HR and BP­ Cardiac  ­ Monitor Blood Sugar­ from cortisol  ­ Signs of Infection­ sore throat, HR, mental status, not feeling well  ­ Addison’s Syndrome:  ­ What it is: primary (autoimmune) and secondary (lack of ACTH or not taking medicines)  ­ What it looks like:  ­ Slow and gradual  ­ Weight loss, decreased appetite, hypotension, hyperkalemia, hyponatremia,  irritable and depressed  ­ Nausea and Vomiting/Diarrhea → Crisis is about to Occur (Addisonian  Crisis)  ­ Addisonian Crisis:  ­ Rapid decrease in corticosteroids  ­ More profound symptoms + sepsis and shock (not perfusing  blood to organs)  ­ Nursing:  ­ Manage shock   ­ High Dose IV Hydrocortisone  ­ Bolus of IV Fluids­ NSS 0.9% and D5%  ­ Nursing Care:  ­ Corticosteroid Replacement Therapy:  ­ Hydrocortisone  ­ Florinef­ mineralocorticoids → increase Na in heat  ­ Glucocorticoids ⅔ morning ⅓ night; Mineralocorticoids­ once daily  morning  ­ Patient compliance with taking medicine  ­ Increase dose in times of stress  ­ Manage cardiac, shock, fluid and electrolytes­ ​Na, K+, Blood Sugar, I/O and daily  weights  ­ Reduce stress on body  ­ Patient Education:  ­ S/S of decrease + BP monitoring  ­ IM hydrocortisone­ emergency­ how to give it  ­ Pheochromocytoma  ­ What it is: release of catecholamines­ epinephrine & norepinephrine   ­ Can be from opioids, anti­HTN, TCAs  ­ Adrenal medulla tumor  ­ Can increase workload of heart → leading to death if untreated  ­ What it looks like?  ­ Shaky, palpitations, diaphoresis, tachycardia (too much epinephrine)  ­ Diagnosing it:  ­ Clients that do not respond to anti­HTN  ­ Plasma catecholamines  ­ CT/MRI  ­ Treatment:  ­ Open/Laparoscopic (similar nursing care to post adrenalectomy)  ­ Pre­Op  ­ Manage HTN  ­ Alpha and beta blockers­ slow HR, increase  contractility, vasodilation  ­ Monitor BS, Avoid Smoking/Caffiene  ­ Don’t palpate­ could secrete more  ­ Nursing Care:  ­ HTN should be resolved  ­ Metyrosine  ­ Last resort but can lead to orthostatic hypotension  Renal/Urinary  Lab Values:  ­ BUN 7­20   ­ Cr 0.6­1.2  ­ BUN:Cr 12:1­20:1  ­ Specific Gravity: 1.003­1.030 (Low= Dilute; High= Concentrated)  ­ Na: 135­145; K: 3.5­5.0; Ca: 8.6­10.1; Phos 2.4­4.4; Bicarb 22­26  Disorders:  ­ Polycystic Kidney Disease (PKD)  ­ Cysts filled with pus in the nephron  ­ Symptoms: Nocturia, HTN, flank pain/heaviness, HTN, hematuria (​first manisfestations is UTI or  stone)  ­ Diagnosis: CT, Ultrasound, urinalysis for proteins, Cr, BUN,   ­ Nursing: control the infection (urinary tract infections), diet, fluid restrictions and antiHTN  ­ Treatment: nephrectomy and transplant  ­ Urinary Tract Infections (UTI)  ­ Upper­ affects kidney and ureter  ­ Acute Pyelonephritis (lower UTI that wasn’t treated properly)  ­ begins in the renal medulla and spreads to the cortex  ­ begins with infection in the lower tract  ­ Chronic Pyelonephritis  ­ kidney becomes small, atrophied, loss of function because of scarring  ­ Symptoms: ​flank pain, nausea/vomiting, chills/fever  ­ Lower­ affects bladder/urethra  ­ Urethritis­ inflammation of the urethra or Trichomonas, monilial infection, chlamydia,  gonorrhea  ­ Cystitis­ Inflammation of bladder  ­ Symptoms: ​dysuria, urgency, polyuria, pressure, cloudy, hematuria   ­ Uncomplicated (typical UTI) vs Complicated (can lead to systemic effects)  ­ Diagnosing:  ­ Costovertebral Angle Tenderness  ­ Urine Culture: Bacteria, CBC, CT, IVP  ­ Nursing Care:  ­ Pyridium *** patient education that urine may turn orange ***­ can be used for LUTI  ­ TMP/SMZ  ­ Fluoroquinolones  ­ Acute Attacks:  ­ Fluids, Heat, Avoiding Spicy Food/Chocolate/Caffiene, monitor for changes  ­ Patient Teaching­ ​Cranberry Juice can keep the bacteria from sticking to the walls + water  + hygiene  ­ Acute/Chronic Glomerulonephritis  ­ Both kidneys; ​increases BUN and Cr  ­ Acute poststreptococcal glomerulonephritis  ­ From a sore throat 5­21 days   ­ Symptoms: ​rusty colored urine, HTN, oliguria, flank pain, abdominal pain  ­ Treatment: Antibiotics  ­ Nephrotic Syndrome  ­ Glomerulus is permeable to plasma proteins → ​proteinuria, low albumin, edema (because they  cannot draw fluid back)  ­ Treatment:  ­ Edema: ​lasix/diuretics, low Na Diet, Fluid Restrictions, Daily Weights  ­ Thromboembolism: ​Anticoagulants (coumadin) to prevent blood clots  ­ Cholesterol­ S ​ tatins, Dietary restrictions  ­ Nephrolithiasis/Urolithiasis­ “Stones”  ­ Increased urine calcium, uric acid, low fluid intakes, diet tea, proteins, juices  ­ Symptoms: f​ lank pain, abdominal pain, n/v, fever and chills  ­ Diagnosis: cystoscopy, IVP, CT,  urine culture, BUN and Cr  ­ Treat:  ­ The pain  ­ The source  ­ Surgery?  ­ Patient Education/Nursing Interventions  ­ Dietary Modifications­ avoiding tea, cola, juices, high Na foods,   ­ Purine: sardines, beef, chicken, pork, kidney, liver...  ­ Oxalate: spinach, cabbage, asparagus, beets…  ­ Hydration!  ­ Ureteral Strictures (urine → kidneys to the bladder)  ­ Symptoms: colic and decreased urine output  ­ Diagnose: IVP  ­ Treatment: stent, tube, reanastomosis of the ureter  ­ Urethral Strictures­ inflammation of urethral  ­ Symptoms: diminished force of stream, straining, dribbling, incomplete bladder emptying  ­ Diagnose: RUG, cystourethrography  ­ Treatment: stent and dilation   ­ May learn how to self catheterize  ­ Nephrosclerosis: small arteries and arterioles of kidneys  ­ From HTN = sclerosis (treat the HTN)  ­ Diabetic Neuropathy:   ­ From HTN, smoking, chronic hyperglycemia  ­ Treatment/Patient Education: Control Blood Glucose (diet/exercise/medications), control HTN­ Ace  Inhibitors  ­ Renal Trauma  ­ Renal Cancer:  ­ Risk Factors­ cigarette smoking, familial, obesity, hypertension, exposure to chemicals, end stage  renal disease  ­ Symptoms – incidental findings, hematuria, flank pain, mass, hypertension, weight loss,  anemia  ­ Diagnostic Studies – IVP, ultrasound, CT, MRI  ­ Treatment –radical nephrectomy (removing cancer tumor on kidney), radiation therapy,  chemotherapy  ­ Bladder Cancer:  ­ Risk Factors – cigarette smoking, exposure to dyes (rubber),  radiation for cervical cancer  ­ Symptoms – dysuria, frequency, urgency, hematuria  ­ Diagnostic Studies – urine for cytology, IVP, ultrasound, CT, MRI  ­ Treatment – Surgery, Radiation, Chemotherapy, Intravesical therapy  Urinary Diversions:  ​ ­ Indwelling Catheter: M ​ ake sure it is patent, sterile technique,   ­ Nephrostomy Tube: ​make sure its patent so it doesn’t back up into the kidney  ­ Kidney could swell and can cause acute renal injury  ­ Monitor tube site + I/O  ­ Suprapubic Tube: drainage directly into bladder  ­ Patent  ­ Ileal Conduit: abdominal stoma, ureter is in ileum  ­ Urine will be mucousy as well  ­ Continent Urinary Diversion­ new intra abdominal urinary reservoir   ­ Routinely scheduled catheterization (self)  ­ People don’t know that their bladder is full  ­ Orthotopic Bladder Reconstruction­ new bladder from bowel   ­ Routine toileting schedule­ won’t feel when bladder is full  ­ Reconstruction surgery­ using pelvic muscles  ­ Nursing Interventions for Renal Surgery:  ­ Frequent Vital Signs q 15 mins  ­ Urine Output  ­ 1 to 2 hours  ­ dressings/daily weights  ­ Respiratory­ prone to pneumonia  ­ Incentive spirometer  ­ Ambulation  ­ Alleviate pain so cough and deep breathe  ­ Postoperative  ­ Stoma (beefy red, moist, how to use a pouch), bowel sounds,  ­ Urine (mucus urine)­ ileal conduit  ­ Continent Diversions­ self cath  ­ Infection  ­ Thrombophlebitis­ Blood Clots  ­ calves, legs, PE (altered breath sounds, sudden dyspnea, anxiety, impending doom)  ­ Prevention: Ambulation + Anticoagulants + Compression Devices  Acute Kidney Injury!  ­ rise in Cr and decrease in urine output  ­ Suddenly decreases function  ­ BUN and Cr rise and ratio is constant… (normally it is 12:1 or 20:1)  ­ Reversible i​ f treated properly  ­ Azotemia­​ build up of waste products  ­ High urea and ammonia levels  ­ Neurologic changes occur  Prerenal­ hypovolemia,  Intrarenal­ injury to the kidney  Post Renal­ rare  hemorrhage, burns  ­ Prerenal that wasn’t  ­ tumors, nephrostomy  ­ Source of injury prior to  treated enough  tube, stones, BPH  the kidney  ­ Antibiotics  ­ Affects urine outflow  ­ Decreased  ­ IV Contrast  ­ Urine can back up into  perfusion/blood flow to  the kidney  kidney    Low urine output + concentrated  (still good kidney)­ BUN is high;  Cr is normal ← rise is not in a  constant = dehydration      Initiating Phase:  Oliguric Phase:  Diuretic Phase:  Recovery phase:  decreased urine output  Filtration starts up again  Kidneys regain normal  <30­60 mL/hr  and everything is  function  Risk for fluid  getting filtered out  overload­ bounding  Increased urine  pulses, edema,  output – gets rid of  increased BP, weight  gain, respiratory  urea and waste  (distress, frothy  products  Risk for dehydration,  sputum, crackles),  electrolyte imbalance  electrolyte imbalance –  (K+)­ hyperkalemia,  k+ and na, low BP,  H+­ metabolic  hypokalemia,  acidosis (deep  hyponatremia  breaths), neurologic    changes  GFR rate is low    ­ Lab Values: BUN, Cr, Urine specific gravity, Electrolytes (Na, K, Ca and Mg)  ­ Treatment:  ­ Metabolic Acidosis­ too much H+ ion  ­ Dialysis of patient  ­ Hyperkalemia  ­ Kayexalate­ slow removal of K+  ­ Insulin + Dextrose­ K+ follows insulin into the cell – temporary shift  ­ Protect the heart­ Calcium Gluconate  ­ Hypervolemia­ fluid overload  ­ Dialysis  ­ Restrict fluid intake­ 600 mL + urine output from day before, restricting Na and K+  ­ Nutrition: Sodium and potassium restrictions + fluid  ­ Prevention:  ­ Prevent infection  ­ Watch for nephrotoxic drugs   ­ Monitor Fluid Status  ­ Recurrent kidney disease/infections  Chronic Kidney Disease  ​ ­ Blood Los  ­ Hemolysis, air embolism  ­ Nursing Care For HD  ­ Make sure patient is hemodynamically stable  ­ Check labs­ monitor Na+ Fluid intake  ­ Prevent complications  ­ Hold morning HTN meds and Diuretics (2­3 hours post dialysis of BP and pulse are stable)  ­ Should not gain more than 1­2 kg a week (​patients may take phosphorus binder)  Peritoneal Dialysis  ­ Using the peritoneum as a semipermeable membrane  ­ Will have a surgically implanted catheter that exits through umbilicus  ­ 3 phases:  ­ Fill (run dialysis fluid into peritoneum)  ­ Dwell­ letting the fluid sit in there for a while  ­ Drain­ drain the fluid into the drain bag­ fluid that they put in + waste products (extra electrolytes)  ­ Complications:  ­ Peritonitis (most common)  ­ Will have a pain, rigid abdomen  ­ Infection  ­ Hernias  ­ Low back problems  ­ Pulmonary­ filling it up with fluid  ­ Protein loss­ ​increase protein because the peritoneum isn’t that semipermeable to proteins  ­ Portable, home based  Continuous Renal Replacement Therapy (CRRT)  ­ Critical care RN 1:1 patient ratio  ­ ICU setting­ may need a central access device  ­ For hemodynamically unstable patients­ patients who are hypervolemic and edematous not responding to  diuretics, multiple organ failure   ­ Contraindicated if patient has life threatening uremia (hyperkalemia, pericarditis) that requires RAPID  dialysis  ­ Complications  ­ Decreased filtration rate  ­ Clotting of filter  ­ Hypotension  ­ Fluid + electrolytes  ­ Bleeding  ­ Dislodgement or infection  ­ Nursing Care:  ­ Hemodynamic (central venous pressure, pulmonary artery pressure, mean arterial pressure,  cardiac output)­ I/O q1h  ­ Vital Signs q1h  ­ Filtration rate a1h  ­ Clotting, kinks, warm blood tubing  Altered Immune Response  ­ Neutrophils are the first response to infections­ however they are not specific to antigens  ­ Active vs Passive  ­ Active­​  when your body makes it (immunization­ artificial)  ­ Natural­ let your body get sick and get immunized it to it  ­ Long term effects→ memory cells →  subsequent exposure you can get a quick response  to keep you from getting sick  ­ Passive​­ you did not make the response but someone  else made it + giving you benefits  ­ Immunoglobulins­ Hep A and Hep B  ­ Getting exposed  ­ Breast milk    Allergic Reactions  ­ Hypersensitivity  ­ Triggers excite the mast cells which release histamine  ­ *Type I­ Anaphylactic  ­ Systemic:   ­ S/S  ­ Airway, hoareness, stridor, bronchial constriction, weak pulse, tachycardia,  hypotension, itching, rashes, hives, angioedema, impending doom, N/V/D  ­ Diagnostic:  ­ Radioallergosorbent Test (RAST)  ­ What they commonly do  ­ Skin Test: ​chance of reaction when they do the test: redness, swelling, itching  ­ Acute Anaphylaxis  ­ Clinical Manifestations: difficulty breathing, wheezing, N/V, tachycardia, drop in BP,  rash, hives, swelling of airway (angioedema)  ­ Nursing:  ­ First give: Epinephrine­ opens up airway­ bronchodilation, increase heart rate  (vasoconstriction),  ­ Can also get IV/IM Benadryl (preferably IV), corticosteroids (take a long time  to work­ suppress them until allergen gets out of system)  ­ Airway: may intubate patient (keep airway open)  ­ Tourniquet­ like if you got a bee sting on the wrist (not focused)  ­ Lifestyle Changes:  ­ Epipen, allergy bracelet, relaxation techniques  ­ Antihistamines  ­ Corticosteroids  ­ Sympathomimetic/Decongestants (like afrin)  ­ Type II­ Cytotoxic  ­ Example: hemolytic transfusion reaction (work blood)  ­ Type III­ Immune Complex Reactions  ­ Example: systemic lupus erythematosus (SLE) (immunocompromised)  ­ *Type IV­Delayed Hypersensitivity Reactions  ­ Examples: Contact dermatitis (Poison Ivy/Oak), tuberculosis skin test  ­ Clinical issue­ delayed response  Immunotherapy:  ­ If nothing else is working  ­ Chance they can have reaction when receiving therapy  Autoimmunity:  ­ Cluster­ at a risk for other autoimmune disease if they have one  ­ Genetic  ­ Can also get ​plasmapheresis­ ​plasma exchange  ­ Pulling out plasma and removing abnormal antibodies and replacing it with donor plasma  ­ I.e Systemic Lupus, RA, Addison’s, Type I Diabtes, Ulcerative Colitis, Crohns  Immunodeficiency Disorders:  ­ Primary:   ­ Secondary (most common) → underactive can lead to infection and malignancies  ­ Drug induced, age, malnutrition, AIDS, Diabetes, Cushings, Burns, CKD, Stress…   


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