Medical-Surgical Nursing Exam 2 Practice Flashcards

Diabetes Mellitus

• Hemoglobin A1C (Glycated Hemoglobin): This diagnostic test measures the average blood glucose levels over the preceding $3$ months.

• Hypoglycemia Management: Patients with diabetes should always maintain a supply of simple carbohydrates to treat acute hypoglycemic episodes.

• Hyperglycemia (High Blood Sugar):     * Clinical Presentation: Patients may present with a sweet or metallic taste in the mouth, delayed or slow wound healing, polydipsia (excessive thirst), and polyuria (excessive or frequent urination).

• Hypoglycemia (Low Blood Sugar):     * Clinical Presentation: Patients may exhibit sweating (diaphoresis), shakiness or tremors, bradycardia (slow heart rate), confusion, and dizziness.

Thyroid Disorders

• Hypothyroidism:     * Pathophysiology: Characterized by low levels of thyroid hormones ($T3$ and $T4$).     * Pharmacological Treatment: Treated with levothyroxine, which must be administered on an empty stomach.     * Systemic Symptoms: weight gain, sensitivity to cold (feeling cold), bradycardia, and increased thirst/urination.     * Safety Precautions: Patients are advised to wear a medical alert device (e.g., a bracelet) to notify emergency responders of their condition and specific medication requirements.     * Diagnosis: The condition is formally confirmed through laboratory tests measuring levels of $T3$ and $T4$.

• Hyperthyroidism:     * Pathophysiology: Characterized by high levels of thyroid hormones ($T3$ and $T4$).     * Systemic Symptoms: These are generally the opposite of hypothyroidism and include weight loss, heat intolerance, and tachycardia (rapid heart rate).

Parathyroid Disorders

• Gland Function: The parathyroid gland is responsible for the regulation of calcium and phosphorus levels within the body.

• Hypoparathyroidism:     * Etiology: frequently occurs as a complication following the surgical removal of the thyroid gland.     * Consequences: Results in systemic calcium deficiency.     * Treatment: necessitates supplementation with Vitamin C and Vitamin D.     * Clinical Symptoms:         * Numbness and tingling (specifically circumoral, around the mouth, and in the extremities).         * Extreme fatigue and "brain fog."         * Muscle spasms.         * Cardiac arrhythmias.     * Calcium-Phosphorus Relationship: There is an inverse relationship between these minerals:         * $\text{Calcium} \uparrow \implies \text{Phosphorus} \downarrow$         * $\text{Calcium} \downarrow \implies \text{Phosphorus} \uparrow$

Metabolic Acid-Base Imbalances

• Metabolic Acidosis (Excess H+ or deficient Bicarbonate):     * Biochemical Thresholds: pH < 7.35 and HCO_3 < 22\,mEq/L.     * Etiology (Causes): Diabetic ketoacidosis (DKA), renal failure, increased production of hydrogen ions (e.g., due to dehydration or liver dysfunction), decreased elimination of hydrogen ions, decreased production of bicarbonate ($HCO_3$), or increased bicarbonate elimination.     * Clinical Symptoms:         * Neurological: Headache.         * Electrolytes: Hyperkalemia ($K^+ \uparrow$).         * Neuromuscular: Muscle twitching and decreased muscle tone and reflexes.         * Integumentary/Vascular: Warm, flushed skin caused by vasodilation.         * Cardiovascular: Decreased blood pressure.         * Gastrointestinal: Nausea and vomiting.         * Respiratory: Kussmaul respirations (characterized by deep, rapid breathing as a compensatory mechanism to blow off $CO_2$).

• Metabolic Alkalosis (Excess Base or deficient Acid):     * Biochemical Thresholds: pH > 7.45 and HCO_3 > 26\,mEq/L.     * Etiology (Causes): Severe vomiting, excessive gastrointestinal (GI) suctioning, diuretic use, and excessive administration of sodium bicarbonate ($NaHCO_3$).     * Clinical Symptoms:         * Neurological: Confusion (decreased level of consciousness/LOC, dizziness, irritability), which can progress to restlessness and then lethargy.         * Gastrointestinal: Nausea, vomiting, and diarrhea.         * Musculoskeletal: Tremors, muscle cramps, and tingling of the fingers and toes.         * Cardiovascular: Dysrhythmias, tachycardia, and hypokalemia ($K^+ \downarrow$).         * Respiratory: Compensatory hypoventilation (characterized by slow, shallow breaths to retain $CO_2$).

Respiratory Disorders

• Emphysema and COPD (Chronic Obstructive Pulmonary Disease):     * Pathophysiology: Characterized by chronic $CO_2$ retention and insufficient exhalation of $CO_2$. It is primarily associated with smoking.     * Physical Findings:         * Barrel chest (increased anteroposterior diameter).         * Clubbed fingers (nail bed clubbing) resulting from chronic hypoxia.     * Oxygenation: A normal $SpO_2$ for a COPD patient is approximately $88\%$.     * Intervention: Pursed-Lip Breathing: Instruct the patient to inhale slowly and exhale for a duration twice as long as the inhalation.     * Oxygen Delivery: Venturi Mask: Oxygen delivery device that is color-coded and provides high-flow oxygen at precise concentrations; it covers both the mouth and nose and is secured by a strap behind the head.

• Pneumonia:     * Risk Factors: The highest risk is observed in patients who aspirate (inhalation of gastric or oral contents into the lungs).     * Findings: Sputum produced is typically clear in color.     * Management: focusing on patient hydration and promoting expectoration of secretions.

• Sinusitis:     * Management Strategies: Includes nasal irrigation, elevation of the head, and increased intake of fluids.

• Sleep Apnea:     * Risk Factors: Obesity is the primary risk factor ($1$).     * Nursing Care: When patients use breathing machines (e.g., CPAP or BiPAP), always verify the patency of the tubing.

Respiratory Acid-Base Imbalances

• Respiratory Acidosis (Excess CO2 via Hypoventilation):     * Biochemical Thresholds: pH < 7.35 and pCO_2 > 45\,mm\,Hg.     * Etiology (Causes): COPD, pneumonia, atelectasis, anesthesia, and drug overdose (which decreases respiratory stimuli).     * Clinical Symptoms:         * Respiratory: Rapid, shallow respirations and dyspnea. Patients may state: "I can’t catch my breath."         * Neurological: Headache, drowsiness, dizziness, and disorientation.         * Cardiovascular: Decreased blood pressure due to vasodilation, hyperkalemia ($K^+ \uparrow$), and dysrhythmias.         * Neuromuscular: Muscle weakness and hyperreflexia.

• Respiratory Alkalosis (Loss of CO2 via Hyperventilation):     * Biochemical Thresholds: pH > 7.45 and pCO_2 < 35\,mm\,Hg.     * Etiology (Causes): Anxiety, pulmonary embolism, fear, and mechanical ventilation (excessive rate or tidal volume).     * Clinical Symptoms:         * Neurological: Seizures, lethargy, confusion, and lightheadedness.         * Respiratory: Deep, rapid breathing (hyperventilation).         * Cardiovascular: Tachycardia, and either normal or low blood pressure.         * Electrolytes/Sensation: Hypokalemia ($K^+ \downarrow$) and numbness or tingling of the extremities.         * Gastrointestinal: Nausea and vomiting.

Renal and Genitourinary Disorders

• Chronic Kidney Disease (CKD): Characterized by incomplete renal function.

• Hemodialysis:     * Process: Blood is filtered through a port, typically performed $3$ times per week.     * Dietary Restrictions: Patients must avoid foods high in potassium.     * Assessment of AV Fistula:         * Normal findings: Warm skin color, palpable thrill (vibration).         * Abnormal findings: Pale skin (indicates poor circulation and possible obstruction).

• Peritoneal Dialysis:     * Process: Performed daily using a dialysis bag; patients must be weighed before and after the procedure.

• Post-Dialysis Electrolytes: After dialysis, electrolyte levels are typically low because waste and excess minerals are flushed out during the process.

• Distended Bladder Management:     * First Step: Perform a bladder scan to confirm volume.     * Intervention: Encourage the patient to attempt voiding naturally before proceeding to catheterization.

Male Reproductive Conditions

• Priapism: An erection lasting longer than $3$ hours. It occurs commonly after the use of sildenafil (Viagra) and is a medical emergency requiring immediate intervention.

• Retrograde Ejaculation: A condition where sperm enters the bladder rather than exiting through the urethra; this results in the patient experiencing a "dry orgasm."

• Peyronie’s Disease: Characterized by an upward curvature of the penis caused by the buildup of scar tissue inside the shaft.

Immunological and Miscellaneous Conditions

• Immunocompromised Precautions (Neutropenic/Reverse Precautions):     * Protective Measures: Staff and visitors must wear masks to protect the patient from external pathogens.     * Common Population: Cancer patients and transplant recipients are routinely placed on these precautions.

• Anaphylaxis:     * First-line Treatment: Epinephrine auto-injector (EpiPen). It can be administered through clothing if necessary.     * Emergency Actions: Immediately check the airway and call $911$.

• Fibrosis: This refers to the excessive buildup of scarring in tissues, leading to a permanent loss of organ function (e.g., pulmonary fibrosis or liver cirrhosis).

Geriatric Considerations

• Senile Purpura: Benign red or purple spots appearing on the skin of elderly patients caused by fragile blood vessels; while clinically insignificant, they may cause concern for the patient.

• Jung’s Theory of Aging: Suggests that elderly individuals seek purpose and meaning in their lives, similar to a midlife crisis but occurring in later years.

• Sandwich Generation: Refers to adults who are simultaneously responsible for caring for their own children and their aging parents.