altered health states exam B

Which skin layers are affected in a deep partial-thickness burn?

Epidermis and dermis

What causes hypovolaemia during the emergent phase of burn injury?

Increased capillary permeability

What occurs during the emergent phase of a burn injury?

Massive fluid shift out of blood vessels

How does full-thickness burn skin appear?

Dry, leathery, and hard

What happens in the acute phase of burn recovery?

Diuresis and fluid mobilisation

What is a key sign that oedema is resolving in burns?

Increased urine output

During burn injury, why does fluid leave the bloodstream?

Increased capillary permeability

What phase follows the emergent phase of burns?

Acute phase

What is the major complication of fluid shift in burns?

Hypovolaemia

What is a hallmark of severe burns in early stages?

Fluid loss and shock risk

What causes polydipsia in diabetes?

Fluid loss due to osmotic diuresis

What causes polyphagia in diabetes?

Cellular starvation

What is glycosuria?

Glucose in urine

Which hormone is released when blood glucose falls?

Glucagon

What is a major contributing factor to type 2 diabetes?

Obesity

What is microangiopathy?

Damage to small blood vessels

What is an example of a microvascular complication?

Neuropathy

What causes diabetic ketoacidosis (DKA)?

Fat metabolism producing ketones

How does metformin work?

Decreases hepatic glucose production

What prevents microvascular and macrovascular complications?

Tight glucose control

What best describes cancer?

Cell growth that escapes normal control

What serum marker is used for prostate cancer screening?

PSA

Which cancer is associated with HPV?

Cervical cancer

What is the leading cause of cancer death in NZ?

Lung cancer

Which is an early warning sign of cancer?

A sore that doesn’t heal

Which is another common early cancer sign?

Unusual bleeding or discharge

What is the highest key risk factor for cancer?

smoking

Which country has high melanoma rates?

New Zealand and Australia

Malignant tumours are characterised by:

Ability to metastasise

What differentiates malignant from benign tumours?

Invasion and spread

What stage of bone healing occurs at 3 weeks?

Callus formation

What indicates fracture healing for cast removal?

Ossification

What is the surgical treatment for compartment syndrome?

Fasciotomy

What is an early sign of compartment syndrome?

Progressive pain unrelieved by analgesia

What fracture type is diagonal?

Oblique

What condition is most indicated by petechiae after fracture?

Fat embolism

What are the 6 P’s used to assess?

Neurovascular status

Osteoarthritis primarily involves:

Cartilage degeneration

Rheumatoid arthritis is:

Autoimmune disease

What defines an open fracture?

Bone communicates with external environment

What is the primary function of bile in digestion?

Fat emulsification

What occurs when gallstones obstruct bile flow to the duodenum?

Impaired fat digestion

Why does steatorrhea occur in cholelithiasis?

Lack of bile salts prevents fat digestion

What happens to fats when bile is unable to reach the duodenum?

Remain undigested and excreted

What is the cause of bleeding tendencies in biliary obstruction?

Reduced absorption of fat-soluble vitamin K

Why is vitamin K deficiency seen in biliary obstruction?

Lack of bile prevents fat-soluble vitamin absorption

What are the two main types of gallstones?

Pigment and cholesterol

Which system is directly affected when bile flow is obstructed?

Digestive system

What type of nutrients are most affected by biliary obstruction?

Fats

What is the underlying problem in cholelithiasis leading to symptoms?

Obstruction of bile flow

What layers of the skin would a deep partial thickness burn affect?

epidermis and dermis

  Describe the pathophysiological changes that occur during the 'emergent phase' of a burn injury.

massive shift of fluids out of blood vessels as a result of increased capillary permeability

how would you describe a full-thickness burn injury during the emergent phase? 

leathery, dry, hard skin

What serum levels are assessed as part of early screening for the detection of prostate cancer?

serum PSA levels

Other than hepatitis A which other viral hepatis is transmitted via faecal-oral route?

Hepatitis E

How is hepatitis B and C transmitted

Via bodily fluids e.g. blood, semen, or another body fluid from a person infected with the virus. This can happen through sexual contact; sharing needles, syringes or from mother to baby at birth

Which type of cancer is a person at increased risk of developing if infected with Human Papilloma Virus (HPV)?

cervical

Describe osteoarthritis degenerative changes.

degenerative changes in the cartilage and bones of joints may cause symptoms of pain and loss of function in some people as they age

Describe rheumatoid arthritis

a chronic, systemic autoimmune disease characterized by inflammation of connective tissue in the diarthrodial (synovial) joints

What is the leading cause of cancer death in both men and women in New Zealand?

lung cancer

Describe the cause of polydipsia in diabetes mellitus

Thirst caused by the fluid shift resulting from the osmotic diuresis effect of hyperglycaemia

Describe the cause of polyphagia in diabetes mellitus.

Cellular starvation

What is the term used specific to diabetes to describe damage that affects mainly the capillary membranes of the eyes, kidneys and skin?

Microangiopathy

What is an example of microvascular complication from diabetes?

Neuropathy

What is a specific and significant contributing factor to type 2 diabetes mellitus?

obesity

What is the term used to describe the creation of new glucose being produced from amino acids?

gluconeogenesis

What term is used to describe microvascular changes that develop and damage the eyes in diabetes mellitus?

retinopathy

When blood glucose levels fall this stimulates the pancreas to secrete which hormone?

glucagon

Which 2 types of viral hepatitis are mostly to result from eating contaminated shellfish and drinking faecal contaminated water?

hepatitis A and E

Name 3 clinical manifestations for advanced liver disease?

ascites

  jaundice

  portal hypertension

The nurse explains to a patient with a distal tibial fracture returning for a 3-week check-up that healing is indicated by what stage of the bone/fracture healing process?

callus formation

What is the primary surgical treatment for compartment syndrome?

fasciotomy

What specific group of oral hypoglycaemic drugs does 'Gliclazide' belong to?

Sulfonylureas

Joints that are primarily damaged by cartilage destruction is part of a condition known by what name?

Osteoarthritis

Describe the five stages of bone healing

A: fracture haematoma B: Granulation tissue C: Callus formation D: Ossification E: Remodelling

Describe the pathophysiological events that would cause someone with cholelithiasis (gallstones) to experience the clinical manifestation of steatorrhea

·       Gallstones obstructing bile flow getting to duodenum

·       Fat is unable to be emulsified as no bile salts and therefore

·       cannot be digested Fat remains in stool and passed

Name 4 modifiable risk factors that can cause pancreatitis

·       Excessive alcohol consu mption. Research shows that heavy alcohol users (people who consume four to five drinks a day) are at increased risk of pancreatitis.

·       Cigarette smoking. Smokers are on average three times more likely to develop chronic pancreatitis, compared with nonsmokers. The good news is quitting smoking decreases your risk by about half.

·       Obesity. You're more likely to get pancreatitis if you're obese.

·       Diabetes. Having diabetes increases your risk of pancreatitis.

Describe six early warning signs/clinical manifestations of cancer.

 

·       Change in bowel or bladder habits

·       A sore that doesn't heal

·       Unusual bleeding or discharge

·       Thickening or lump in breast or elsewhere

·       Indigestion or difficulty with swallowing

·       Obvious change in a mole or wart

·       Nagging cough or hoarseness

1 What is it that occurs to allow hypovolaemia to develop during the emergent phase of a severe burn injury?

increased capillary permeability.

Describe the pathophysiological changes that occur during the 'acute phase' of a burn injury.

diuresis from fluid mobilization occurs, and the patient is no longer grossly oedematous

When describing Cancer as a large group of diseases, what characteristics would simply describe its initial cellular growth?

cell growth that escapes normal control

Hepatitis A can be transmitted via which route?

a faecal-oral transmission

Which viral hepatitis does a person require to already have to have hepatitis D

hepatitis B

Which two countries the highest rates of melanoma in the world

New Zealand and Australia

Describe how type 2 diabetes mellitus differs from type 1 diabetes mellitus

Type 1 has no endogenous insulin while type 2 may have decreased insulin secretion and/or cellular resistance to insulin that is produced.

 

Describe the cause of polyuria in diabetes mellitus

fluid shifts resulting from the osmotic diuresis effect of hyperglycaemia

How does the biguanide drug metformin work?

By decreasing the rate of hepatic glucose production and improving glucose uptake by the tissues

What is the term used specific to diabetes to describe damage that causes organ damage resulting from changes in large and medium-sized blood vessels?

Macroangiopathy

What is the main way that both macro and microangiopathy can be prevented by someone with diabetes mellitus?

Tight glucose control -keeping it within normal parameters (BSL)

How would you describe the cause type 1 diabetes mellitus?

involves the immune system attacking and killing pancreas cells that make insulin.

What is the serious condition that can result when someone with type 1 diabetes with a lack of insulin, metabolizes fat stores instead, which produce large amounts of acidic ketones?

DKA Diabetic ketoacidosis

What term describes filtered glucose that the kidney cannot absorb and so it spills over into the urine to be excreted?

Glycosuria

Describe glycogenolysis.

When glycogen in the liver breaks down into glucose through the action of glucagon

What is an early sign that would alert the nurse that the patient is developing compartment syndrome?

progressive pain unrelieved by usual analgesics

What is the tissue damage in pancreatitis caused by?

Premature activation of pancreatic proenzymes

Petechiae around the neck and upper chest in a patient with a fracture is a possible clinical indication of what specific condition

a fat embolism

Emergency management of an open fracture requires the nurse assess the neurovascular status distal to the injury. What are the 6 P’s that can be used to guide this?

Pain: not relieved by analgesia

Pressure: increases in the compartment

Paresthesia: numbness & tingling

Pallor: loss of normal colour of the extremity

Paralysis: loss of function

Pulselessness: diminished or absent peripheral pulse

PLUS an extra one of Polar: the affected extremity is cool to touch

At what stage of fracture healing is cast removal and limited movement allowed?

ossification

A fracture line which is diagonal to the bone is known as what kind of fracture?

oblique fracture

Name 6 specific risk factors for developing cancer. 

·      Genetic predisposition

·      Dietary fat intake and obesity

·      Cigarette smoking

·      Alcohol consumption

·      Physical inactivity

·      Sun exposure

·      Poor diet