Final Exam Patho
Final Exam Patho NSG 330
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This 7 page Study Guide was uploaded by Brieanna Phipps on Monday March 28, 2016. The Study Guide belongs to NSG 330 at University of North Carolina - Wilmington taught by Dr. Goff in Spring 2016. Since its upload, it has received 16 views. For similar materials see Maternal Infant in Nursing and Health Sciences at University of North Carolina - Wilmington.
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Date Created: 03/28/16
Study guide Exam 3 NSG 335 Module 7 Renal: Review and be able to describe the disease processes that put kidneys at risk. DM, HTN, virus (strep) Understand the factors that lead to pre-renal, intra-renal and post- renal failure Microalbuminurea is earliest indication of kidney disease Pre renal- before failure; most common acute failure hypoperfusion of the kidneys (most common cause of acute injury) o Sepsis w/ dec BP can cause this Arterial stenosis MAP drops below 65 (dec BP) o Less perfusion/oxygenation Other causes: low blood pressure, shock, anything that dec BP. Intra renal failure- anything inside kidneys; acute tubular necrosis *(most common cause), Glomerulonephritis Untreated Strep (infection) HTN, DIC, sickle cell clots Post renal failure- after the failure (UTI, any type of obstruction, infection that backs up to kidneys) Kidney stone BPH Neurogenic bladder You do not have to identify a specific lab value, but understand what an elevated BUN/Cr indicates or a low GFR. BUN/ Cr INCREASE when kidneys fail o Cr is the critical value, more accurate o High BUN alone can mean dehydration and not kidney issues GFR DECREASES when kidneys fail o Norm GFR is 120- your measure of the perfusion pressure of glomeruli o GFR less than 30 is failure CKD impacts QOL: describe how it impacts life and possible treatments. QOL- can’t do much because they have to tend to get toxins out, usually feel bad most of the time, fatigue bc of electrolyte imbalance Hemodialysis (3 days a week for 3-4 hours)- really hard to travel Peritoneum dialysis (the solution (diasylate) that goes in and is drained- done every day and continuous in the hospital) Rhabdomylosis: what is it, how is it diagnosed (which lab values). Disease that breaks down muscle and glomeruli SS: muscle pain, weakness, brownish colored urine (coke) • Skeletal striated muscle breaks down quickly • Myoglobin harmful to kidneys • Brown discolored urine • Extensive muscle injury-crush injuries, strenuous exercise, medications, drug abuse, infections • Elevated CK (5X normal)- inc BUN/ CR and dec GFR • CK (creatinine clearance) norm 25-100 Module 8 Neuro 1: Review the different types of stroke and treatment options. Ischemic stroke- embolus is blocking the blood flow to the brain o Causes: PE, obesity, smoking, sedentary lifestyle, A fib, dehydration, o *HTN- doesn’t form the clot, yet dislodges it to go somewhere else o Tx: get a CT then start a TPA (start within 24 hours) Hemorrhagic stroke- rupturing of vessels causing bleeding in the brain o Causes: anticoagulants, HTN, aneurysm, smoking (weakens BV) o Tx: depends on location in the brain, let it resolve on own, can help drain fluid amt in brain TIA –transient ischemic stroke (mini stroke) o can be a warning sign o happens and resolves within 24 hours (usually 4-5 hrs) Know where the language center is located, vision etc. Left: language (wernickes (understanding) and brocas(expressing)), right sided weakness Right sided stroke: left sided weakness (droppy) Occiput is vision Diabetes insipidus as related to head injury. Losing lots of fluid through urination, not concentrated- liters a day Dec ADH, very dehydrated Common cause: trauma in the brain, tumors, head injuries Understand progression and goal for Parkinson’s disease include on- off syndrome- medications: levodopa, COMT. Parkinson- dec dopamine SS: drooling, pin rolling, flat affect, shuffling gait, stooped posture Levodopa- reduces the breakdown of dopamine, which inc it in the brain o ADR: GI effects, psychosis, darkened urine, dyskinesia* o Take a drug holiday bc its effects can work and then not work- st taking a break can help it work again (1 thing) * o DDI- B6 (dec effects of levodopa), high protein (dec effects),* o Can switch to carbidopa during the drug holiday (reduces levodopa breakdown which increases the effects) * o Sinimet (levodopa/ carbidopa)- the combo drug COMT: used to treat wearing off SS of levodopa/ carbidopa & dec breakdown of dopamine o ADR: yellow/ orange urine which is normal Understand progression and treatment of ALS. ALS- progressive muscle wasting that starts in the periphery over time o rapid disease progression (3-5 years until death) o no Tx Module 9 Neuro 2: Mechanism of brain injury (concussion-TBI). most common kind is concussion, during injury brain swells, bleeds Symptoms of increased intracranial pressure. (CSF, Brain, meninges) Early sign- change in LOC Late sign- tissue hypoxia, cushing’s triad (widened pulse pressure, Irreg RR, bradycardia) o If this last too long, can form a hernia o Cerebral death- lights on but no one is home o NO CRANIAL NERVES Treatment of IICP-mannitol. Action: osmotic, dec fluid levels by drawing water in neurons and draining it, can cause dehydration Inc pressure squishes the brain and that pressure kills that part of the brain o bacterial/ viral meningitis (abx need to cross BBB but most don’t) Seizures- phenytoin know use, how to give IV, ADR oral and IV, know therapeutic level. Tonic/ clonic seizure- periods of contractions and relaxation Absent seizure- lose awareness/ “zoning out”/ staring/ hard to Dx For acute tx: Ativan, Valium or other benzos Phenytoin/ Dilantin- for maintenance, TONIC CLONIC o Suppresses activities of seizures by blocking Na channels in neurons o Narrow therapeutic range, discontinue slowly, pregnancy category D o When given IV: give with normal saline bc will give crystalize with other fluids o Use filter needle o DDI: decrease effects of warfarin and contraceptives*** o PO ADR: gingival hyperplasia and skin rash o IV ADR: hypotention and arrhythmias o ADR: sedation* (toxic dose), nystagmus, ataxia, diplopia, cognitive impairment o Normal Therapeutic level range: 10- 20 mcg/ ml* (SE is orthostatic hypotension) Depakote know use, ADR, what needs to be monitored. Valporic acid- used for maintenance of seizures, mood stabilizer Suppresses Ca channels Metabolized in the liver (be careful with alcohol, opioids) o Liver Fxn Test: AST would be higher SE: liver toxicity and GI effects ADR: bone marrow suppression Padded rails, turn on side, lower HOB Module 10- GI 1: Nausea- cause, adjunct therapy with Zofran. Medulla oblongata causes nausea, so use Zofran! Cause: meds, infection, surgery ADR: Lengthens QT interval, HA, diarrhea, dizziness Dexamethasone increases the effects ** PUD- explain how if develops- role of bacteria and treatment options. H. pylori and NSAIDs ( dec mucosal lining) Duodenal: young, family hx, male, ulcer causing drugs, upper abdominal pain PAIN WHEN STOMACH IS EMPTY Gastric: older, stress, cancer risk, PAIN WHEN STOMACH IS FULL Risks: Lowered immune system, stress, NSAIDs, smoking Tx: Amoxicillin, Metronazole, Tetracycline; H2 Receptor Blockers: Zantac, Pepsid (blocks acid); PPI (Prilosec or Protonix); Antacids; Mucosal protectant (Karaphate) Role of stress, NSAIDS, food and drink on development of gastric or duodenal ulcers. Stress- inc risk for ulcers NSAIDs- dec the mucosal protectant, which the acid breaks down Food/ drink- fried, acidic foods, spicy foods, citrus food, CAFFEFINE IS OK!!!! Distinguish the difference between Crohn’s and UC which affects nutrition, how are symptoms managed. Crohn’s- illness throughout the GI (bloody diarrhea and malabsorption and results in malnutrition) o Inflammation all throughout digestive tract o Smaller frequent meals o Antispasmotics, bulk forming, antidiarrheal, Cipro, steroids, mehotrexate Ulcerative colitis- illness affects colon and rectum Laxatives: methylcellulose, docusate, lactulose Treat the symptoms Methylcellulose (Metamucil)- laxative, but adds bulk to stool o Forms a gel, treat constipation and diarrhea o Increase consistency of stool o Hydration is key so give lots of fluid/ H20 o May take a few days to work Docusate- Surfactant Laxative o Doesn’t allow water to be reabsorbed from stool in large bowel o Increases amount of water in school o Take with full glass of water o 2-3 days for BM o Avoid in pts with sodium restricted diets Lactulose- sugar compound that reduces ammonia; laxative o Last resort, can cause more gas and cramping o Broken down by bacteria in colon which causes fermentation and increased water to colon. o It is a sugar, but doesn’t raise your blood sugar Module 11- GI 2: Understand liver cirrhosis: what lab values are altered. Cirrhosis: scarring/ hardening of the liver, irreversible o meds like Tylenol, alcohol can cause this, alcohol, hepatitis B, hep C, idiopathic o develops over years o dec albumin level can cause ascites Know the ratio for AST/ALT in different liver failure. AST is higher= alcohol and drugs ALT is higher= viral/ hepatitis C Know normal ammonia level, how it is treated. 9.5-45 If high (greater than 45)- liver failure, high ammonia causes encephalopathy/ cog issues o give lactulose to treat Liver failure means Dec albumin means fluid leakage in the peritoneum, which causes ascites and is treated with peritonesis Pancreatitis acute and chronic, know labs associated with process. Pancreatitis- inflammation of pancreas caused by autodigestion of pancreas. o leakage of pancreatic enzyme in the pancreas due to blockage or something, in result causes autodigestion of pancreas o most common cause is gall stones Acute Pancreatitis o Epigastric, mid-abdominal pain that is constant, can be severe and incapacitating. May radiate to back. o Pain caused by: edema, chemical irritation, obstruction of bile duct, paralytic ileus, fever o Changes in electrolytes, esp calcium o Abdominal distension-fluid in abd cavity o May have transient hyperglycemia (depends on which cells are effected) o Tx: Narcotic, NPO, NG tube, abx Chronic- happens 3 times a month for longer than a 6 months o Caused by alcohol o Weight loss and intermittent abdominal pain o Pancreas had irreversible structural or functional impairment o Cysts form in pancreas (walled off necrotic debris or pancreatic enzymes) o Clinical manifestation: intermittent abdominal pain and weight loss o Risk factor for pancreatic cancer o May replace pancreatic enzymes o Chronic pain Amylase-normal value 23-85 with pancreatitis the value can be 4X normal Lipase normal value 0-160 with pancreatitis the value can be 4X normal Liver: o filter toxins o break down old RBCs
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