Comprehensive Study Notes on Fluids, Metabolism, Stress, and Coping in Nursing

What is the gold-standard diagnostic imaging test for osteoporosis?

Dual-Energy X-Ray Absorptiometry (DXA), measuring bone mineral density in the lumbar spine and hips to determine T-scores.

What is the pathophysiological mechanism of osteoporosis?

Osteoclastic bone resorption outpaces osteoblastic bone formation, causing severe bone mineral density loss and microarchitectural deterioration.

Which type of osteoporosis is most common and what is linked to it?

Primary osteoporosis (most common, linked to postmenopausal estrogen decline or age-related androgen reduction in older men).

How does osteoporosis differ from osteomalacia on serum labs?

Normal bone calcification with low bone mass; serum labs (calcium, phosphate, PTH, ALP) are within reference ranges.

What is osteomalacia?

Defective bone mineralization (soft bones) caused specifically by Vitamin D deficiency, with elevated ALP and possible pseudofractures (Looser's zones).

What is thoracic kyphosis called when caused by osteoporosis?

Dowager's hump, caused by anterior wedge compression fractures.

How should alendronate (a bisphosphonate) be administered?

Take first thing in the morning with a full 8 oz glass of plain water on an empty stomach, 30-60 minutes before food or other medications, and remain upright for 30-60 minutes afterward.

What is the critical safety mandate for assessing an enlarged thyroid (goiter)?

Never palpate or massage an enlarged thyroid gland aggressively; it can trigger a life-threatening thyrotoxic crisis (thyroid storm).

What is the recommended daily intake of calcium and vitamin D for osteoporosis prevention?

1000-1200 mg/day calcium and 800-1000 IU/day vitamin D.

What are the consequences of hyperparathyroidism?

Hyperparathyroidism causes continuous bone breakdown, leading to secondary osteoporosis, hypercalcemia, and nephrolithiasis.

What is hypoparathyroidism and its common cause?

Inadequate PTH causing acute hypocalcemia and hyperphosphatemia, often a surgical complication after thyroidectomy.

What is Chvostek's sign?

Chvostek's sign: tapping the facial nerve triggers unilateral facial spasm.

What is Trousseau's sign?

Trousseau's sign: inflating a BP cuff above systolic pressure for 3 minutes induces carpopedal spasm.

What are the emergency interventions for hyperkalemia?

Hyperkalemia: IV regular insulin plus D50W, oral/rectal sodium polystyrene sulfonate (Kayexalate), and IV calcium gluconate.

What are the safe peripheral IV potassium delivery limits?

Peripheral IV potassium must never exceed 40 mEq/L concentration and must infuse no faster than 10-20 mEq/hr via infusion pump; never give IV push, bolus, or IM.

What are the signs and treatment of hypomagnesemia?

Hypomagnesemia (<1.3 mEq/L) manifests with neuromuscular hyperirritability, tremors, hyperactive DTRs, and Torsades de Pointes; treat with magnesium sulfate.

How is hypermagnesemia treated?

Hypermagnesemia: loss of deep tendon reflexes, flushing, hypotension, bradycardia, and respiratory depression; emergency treatment is IV calcium gluconate.

How is hypercalcemia treated?

Hypercalcemia (>11.0 mg/dL) manifests with hyporeflexia, lethargy, bone pain, constipation, polyuria, nephrolithiasis, and shortened QT; treat with IV 0.9% NaCl and furosemide.

What are the ECG findings of hypokalemia?

Hypokalemia ECG findings: flat or inverted T waves, ST depression, and prominent U waves.

What are the ECG findings of hyperkalemia?

Hyperkalemia ECG findings: tall, tented, peaked T waves, prolonged PR interval, flattened P waves, and wide QRS complexes.

What is the legal definition of death under the Uniform Determination of Death Act (1981)?

Uniform Determination of Death Act (1981): irreversible cessation of circulatory and respiratory functions OR irreversible cessation of all functions of the entire brain, including the brainstem.

How do palliative care and hospice care differ?

Palliative care is offered at any stage of serious illness concurrently with curative therapy; hospice care is exclusively for terminally ill clients (prognosis 6 months or less) who have discontinued curative treatments.

What are Kübler-Ross's five stages of grieving?

Denial, Anger, Bargaining, Depression, Acceptance (DABDA), which are non-linear.

What is the Dual Process Model of grief?

Stroebe and Schut's model, in which grieving oscillates between loss-oriented coping (crying, yearning) and restoration-oriented coping (new routines, distraction).

What are Therese Rando's Six R processes of grief?

Therese Rando's six R processes: Recognize the loss, React to separation, Recollect memories, Relinquish old attachments, Readjust to new environment, Reinvest in life.

What is disenfranchised grief?

Grief that is not socially recognized, supported, or acknowledged by communal rites (e.g., death of an ex-spouse, elective abortion).

What is masked grief?

Grieving through altered, destructive behaviors such as promiscuity or heavy drinking following a loss.

What are the three stages of Selye's General Adaptation Syndrome?

Selye's GAS: Alarm (fight-or-flight), Resistance (adaptation), and Exhaustion or Recovery.

What is the ego defense mechanism of displacement?

Redirecting anger or frustration from a threatening source to a safer target.

What is the ego defense mechanism of conversion?

Unconsciously transforming emotional anxiety into physical symptoms, such as nausea before an exam.

How do somatoform disorders differ from malingering?

Malingering is conscious, intentional simulation of symptoms for external secondary gain; somatoform disorder involves genuine, involuntary physical symptoms driven by unconscious psychological anxiety.

What does the HOPE spiritual assessment mnemonic stand for?

HOPE: Sources of Hope, Organized religion, Personal spirituality/practices, Effects on medical care and end-of-life decisions.

What does the ANA Code of Ethics require of nurses regarding Medical Aid in Dying?

Nurses must provide nonjudgmental care but are strictly prohibited from administering MAiD medications.

What is the standard Desired Over Have dose formula?

Dose to Administer = (Desired Dose / Have) x Vehicle (tablet or mL).

What is the formula for IV flow rate in mL/hr?

Flow Rate (mL/hr) = Total Volume to Infuse (mL) / Total Time of Infusion (hours).

What is the formula for IV drip rate in gtt/min?

Drop Rate (gtt/min) = (Total Volume (mL) x Drop Factor (gtt/mL)) / Time (minutes).

How do you convert pounds to kilograms?

Client Weight in kg = Weight in lbs / 2.2 lbs/kg.

What is the safe 24-hour intake and output balance rule?

In older or compromised clients, total 24-hour intake must remain within 100 mL of total 24-hour output.