Adult Health Exam 3

insulin

The only hormone that lowers blood glucose; produced by pancreatic beta cells to move glucose into cells for energy

glucagon

Hormone from pancreatic alpha cells; raises blood glucose by signaling the liver to break down stored glycogen (glycogenolysis)

cortisol

Adrenal cortex hormone released during stress/illness; raises glucose by promoting gluconeogenesis and decreasing cell uptake

epinephrine

A "fight or flight" hormone from the adrenal medulla that causes a rapid spike in blood glucose

growth hormone

An anterior pituitary hormone that opposes insulin to maintain circulating glucose for repair and growth

type 1 DM

Autoimmune destruction of beta cells leading to a total absence of insulin; abrupt onset, high risk for DKA

type 2 DM

A progressive disorder characterized by insulin resistance and declining insulin secretion; often lifestyle-related

polyuria

Increased urination caused by osmotic diuresis as the body tries to dump excess glucose Progressive disorder where cells have insulin resistance and the pancreas eventually produces less insulin; gradual onset linked to obesity

polydipsia

Excessive thirst resulting from fluid loss via polyuria

polyphagia

Excessive hunger because cells are starving for energy despite high circulating glucose

A1C

A test showing average blood glucose over 2-3 months; diagnostic for DM if ≥ 6.5%; goal for management is < 7.0%

fasting blood glucose

A level of ≥ 126 mg/dL on two separate tests confirms diabete

hypoglycemia

Blood glucose < 70 mg/dL; symptoms include shakiness, sweating, confusion, and irritability ("Cold and clammy, need some candy")

15-15 rule

Treatment for hypoglycemia: Give 15g fast carbs, recheck in 15 minutes; repeat if still < 70 mg/dL

glucagon

Treatment for hypoglycemia given via nasal spray or injection if the patient is unconscious or cannot swallow

hyperglycemia

Blood glucose > 180 mg/dL; symptoms include increased thirst, frequent urination, and blurred vision ("Hot and dry, sugar high")

DKA

Acute complication in Type 1; BG > 250 mg/dL with positive ketones; a medical emergency

hyperosmosic hyperglycemic state

Acute complication in Type 2; BG > 600 mg/dL; severe dehydration with no ketones

regular

The only type of insulin that can be administered intravenously

cloudy

NPH insulin

metformin

First-line oral DM med; must be held for 48 hours before and after procedures using contrast dye to protect kidneys

alcohol

can cause delayed hypoglycemia; rule is to always consume with food

osteoblasts

Bone-building cells

Osteoclasts

Bone-resorbing cells that break down bone tissue, playing a crucial role in bone remodeling.

compound fracture

A break where the bone pierces the skin; carries a high risk for infection

compartment synrome

Surgical emergency; swelling cuts off blood flow; hallmark is severe pain not relieved by medication

fat embolism syndrome

Emergency 12-48 hours after a long-bone fracture; signs include dyspnea, confusion, and red-brown petechiae on the neck/chest

alpha cells

Cells in the pancreas that produce glucagon, a hormone that raises blood glucose levels.

beta cells

Cells in the pancreas that produce insulin, a hormone that lowers blood glucose levels.

operative

Roll the patient onto the _____ side to keep the legs from accidentally adducting/crossing

sequestrum

Dead bone that has separated from the blood supply in chronic osteomyelitis; acts as a reservoir for bacteria that antibiotics cannot reach

glycogenolysis

The process of breaking down glycogen into glucose, primarily occurring in the liver, to maintain blood glucose levels during fasting.

bisphosphonates

work by inhibiting osteoclasts and decreasing bone resorption. So we're preventing that breakdown of bone and helping it reabsorb. Must take on an empty stomach, with full water, and stay upright for 30–60 minutes to prevent esophagitis

Alendronate, Risedronate, Zoledronic acid

70-99

Fasting Blood Glucose (Normal Range)

>126

Fasting Blood Glucose (Diabetes Diagnosis)

100-125

Fasting Blood Glucose (Prediabetes)

> 6.5

Hemoglobin A1C (Diabetes Diagnosis)

5.7-6.4

Hemoglobin A1C (Prediabetes)

< 7.0

Hemoglobin A1C (Management Goal)

> 200

Oral Glucose Tolerance Test (OGTT) or Random Glucose for diabetes

>250

Diabetic Ketoacidosis (DKA) Glucose Finding Definition: Blood glucose _____mg/dL with the presence of ketones in the urine or blood.

ESR and CRP

inflammatory markers that will be elevated in patients with osteomyelitis.

oral stomatitis

Inflammation disrupts the delicate oral mucosa, breaking down tissue integrity and leading to painful redness, erosions, and ulcerations

gastritis

Inflammation of the gastric mucosa often caused by NSAIDs, which inhibit the prostaglandins that normally maintain the protective barrier, or by H. pylori infection

peptic ulcer disease

Erosion occurs when H. pylori or NSAIDs significantly weaken the mucosal defenses, allowing acid to digest the epithelium down to the muscle layer

IBS triggers

Stress, anxiety, caffeine, carbonated drinks, dairy

Erythroplasia

A red velvety patch in the mouth; it is a high-risk precancerous lesion (50% progress to cancer)

peritonitis

Inflammation of the peritoneum, often from a perforated ulcer; signs include a rigid, board-like abdomen and sudden severe pain

leukemia

lymphoma

sickle cell

autosomal recessive genetic disorder that results in the production of an abnormal form of hemoglobin called Hemoglobin S (HbS) instead of the normal Hemoglobin A (HbA).

Sickling Process: When red blood cells (RBCs) containing HbS are exposed to low oxygen levels (hypoxia), the hemoglobin molecules link together into long chains. This causes the normally flexible, disc-shaped RBCs to become rigid, sticky, and sickle-shaped.

Sickled cells are fragile and have a much shorter lifespan (about 10–20 days) than normal RBCs (120 days). The body cannot replace them fast enough, leading to chronic anemia.

leukemia

This cancer originates in the blood-forming tissues, primarily the bone marrow . It involves the malignant proliferation of abnormal, immature white blood cells (blasts) that crowd out the production of healthy red blood cells, platelets, and functional white blood cells in the marrow

lymphoma

This cancer originates in the lymphatic system, typically starting in the lymph nodes, spleen, or thymus. It involves the malignant transformation and uncontrolled growth of lymphocytes

thrombocytopenia

Easy bruising, nosebleeds, or petechiae (small purple spots) due to low platelet count bleeding risk

anemia

Fatigue, pallor, and shortness of breath due to decreased red blood cell production

lymphoma

The most common sign is painless lymphadenopathy (enlarged, firm lymph nodes in the neck, axilla, or groin). Patients often experience "B-symptoms," which include:

• Drenching night sweats.

• Unexplained fever.

• Significant weight loss

leukemia

Symptoms are often a direct result of "bone marrow failure" as abnormal cells overwhelm the marrow. Patients typically present with:

• Anemia: Fatigue, pallor, and shortness of breath due to decreased red blood cell production.

• Thrombocytopenia: Easy bruising, nosebleeds, or petechiae (small purple spots) due to low platelet counts.

• Infection Risk: Frequent or persistent infections because the proliferating white blood cells are immature and non-functional

14-16

hemoglobin normal range

hemoglobin

measures the oxygen-carrying capacity of the blood

hematocrit

represents the percentage of whole blood made up of RBCs

37-52%

hematocrit normal levels

5,000–10,000

wbc normal range

150,000–400,000

platelet normal range

thrombocytosis

A condition characterized by elevated platelet counts, exceeding 400,000 platelets per microliter of blood. It may increase the risk of thrombosis. clotting risk

vitamin c

what do you pair iron with to enhance absorption

cytosis

means too many cells

penia

means too few cells

iron

take on an empty stomach 1 hr before meals, be careful not to stain teeth, use straw, do not take with milk

angiogenesis

is the process of forming new blood vessels from pre-existing ones, crucial for growth and healing but also allows tumors to build their own blood supply

30

start blood transfusiion within ____ minutes of the blood leaving the bank; never refrigerate on the unit

15

during a blood transfusion nurse must stay at bedside for ___ min

20

blood transfusions must be run through at least a ___ G iv

barretts esophagus

occurs when esophageal cells change to resemble stomach cells to survive acid; this significantly increases esophageal cancer ris

duodenal ulcers

(Most common): Characterized by high acid secretion and rapid gastric emptying

EGD

The gold standard for GERD, PUD, and Gastritis; allows for direct visualization and biopsy

urea breath test

is a non-invasive test used to detect Helicobacter pylori infection by measuring carbon dioxide in the breath after ingestion of urea.

raise glucose

cortisol, epinephrine, and growth hormone

Endoscopy

The gold standard for GERD, PUD, and Gastritis; allows for direct visualization and biopsy

osteomyelitis

Severe bone infection (most commonly Staph aureus)

clear before cloudy

what to remember when drawing up multiple types of insulin

peak

Nursing priority to ensure the patient has a plate of carbohydrates available during an insulin’s _____ time, as this is the window of highest hypoglycemia risk.

240

Monitor glucose every 4 hours; continue taking baseline insulin; stay hydrated; and check for ketones if blood glucose is > ____ mg/dL

IBS

LLQ abdominal pain that improves after a bowel movement; typically no weight loss; and normal laboratory/imaging results

triple therapy

A 10–14 day regimen consisting of a PPI plus two antibiotics (Clarithromycin and Amoxicillin)

treatment of h pylori

quadruple therapy

A regimen consisting of a PPI, two antibiotics, and Bismuth (Pepto-Bismol); warn patients of black tongue/stools.

treatment of h pylori

stridor

A harsh, high-pitched inspiratory sound indicating an acute airway obstruction; a top priority in oral cancer or neck tumor patients. medical emergency

GERD

Elevate the head of the bed 6–12 inches with blocks or wedges and stay upright for at least 1 hour after eating

HOP

sickle cell crisis priorities Hydration (dilute blood), Oxygenation (reverse sickling), and Pain management (aggressive, continuous opioids)

neutropenic Nadir

The period of lowest blood cell counts (highest infection/bleeding risk) occurring 7–10 days after treatment of cancer with chemotherapy

neutropenic

In a _____ patient, any fever ≥ 100.4°F (38°C) is a medical emergency requiring immediate antibiotics

neutropenia

A condition of abnormally low white blood cells (specifically neutrophils) caused by chemotherapy-induced myelosuppression; it leaves the patient severely immunocompromised and unable to fight infections effectively

-2.7

DEXA T score indicates osteoporosis

AML

The most common acute leukemia in adults; characterized by an abrupt, dramatic onset with serious bleeding or infection

CML

A leukemia that often stays stable for years; its diagnostic hallmark is the Philadelphia chromosome

ALL

The most common leukemia found in children

leukostasis

A life-threatening oncologic emergency where the WBC count is > 100,000 cells/µL, making the blood thick and sludgy, which can lead to a stroke or pulmonary embolism.

leukapherisis

An emergency procedure similar to dialysis that physically removes excess white blood cells from the blood to treat leukostasis

reed sternberg cells

The absolute cellular hallmark of Hodgkin Lymphoma; abnormal giant, multi-nucleated cells that look like "owl eyes" under a microscope

hodgkin lymphoma

A highly curable lymphoma (85% cure rate) that spreads in a predictable, orderly fashion along adjacent lymph chains
have REED STERNBERG CELLS

non hodgkin lymphoma

A diverse group of blood cancers that includes all lymphomas except Hodgkin lymphoma. Non-Hodgkin lymphoma can spread in an unpredictable manner and has varying cure rates depending on the specific subtype.