Nursing Review Lecture Flashcards

Hormones Related to Appetite Regulation

  • Leptin

    • Definition: A hormone produced by fat cells (adipocytes) that signals the hypothalamus regarding sufficient energy stores in the body.

    • Function: Reduces appetite and promotes the sensation of fullness.

  • Ghrelin

    • Definition: Known as the "hunger hormone".

    • Function: Stimulates appetite and food intake.

Assessment of Obesity Risk in Clients

  • BMI (Body Mass Index) Criteria

    • A BMI of 32 is classified as obesity.

    • A BMI of 26 is not classified as obesity.

    • Nursing Assessment:

    • Waist circumference of 36 inches is considered obesity.

    • Waist circumference of 42 inches in a male is considered obesity.

    • Clients with a BMI of 32, waist circumference of 36 inches, and waist circumference of 42 inches should be prioritized for teaching due to increased health risks associated with obesity.

Evidence-Based Therapies for Weight Reduction

  • Mainstay Treatments:

    • Diet and Exercise: Fundamental to weight loss.

    • Medications:

    • Important to monitor for malabsorption of calories which can affect the absorption of fat-soluble vitamins (A, D, E, and K).

    • Risks include bleeding and fracture risks due to deficiencies in these vitamins.

    • Surgical Options:

    • Types include:

      • Restrictive, malabsorptive, or combined procedures.

    • Gold standard treatment is both malabsorptive and restrictive.

    • Lifestyle Integration: Patients must engage in diet, exercise, and possibly medication or surgery to sustain weight loss.

Understanding Status Asthmaticus

  • Definition: Asthma that does not respond to standard medication (e.g., albuterol).

  • Treatment:

    • Administer Magnesium sulfate, a smooth muscle relaxer that can be effective when other treatments fail.

Correct Use of Metered-Dose Inhalers

  • Steps for effective administration:

    • Shake the inhaler and exhale fully before use.

    • Form a tight seal around the mouthpiece and inhale deeply while activating the inhaler to deliver the medication into the lungs.

    • Hold breath for 5-10 seconds post-inhalation to allow drug absorption.

    • Wait 1-2 minutes between puffs if multiple doses are prescribed.

Cardiac Tamponade

  • Definition: Accumulation of fluid in the pericardial sac that restricts heart function.

  • Key Symptoms (Beck's Triad):

    • Jugular vein distension.

    • Muffled heart sounds.

    • Hypotension.

  • Etiology of Symptoms:

    • Distension due to blood backing up in the jugular veins.

    • Hypotension from impaired filling and reduced cardiac output.

    • Muffled heart sounds caused by fluid interference with sound transmission.

Peripheral Vascular Disease vs. Peripheral Arterial Disease

  • Peripheral Arterial Disease (PAD):

    • Symptoms: Characterized by decreased or absent pulses, pale or cool extremities, and wounds that are dry and well defined.

    • Nursing Actions:

    • Position: Dangling the legs to enhance blood flow due to gravity.

  • Peripheral Venous Disease (PVD):

    • Symptoms: Swelling, redness, and drainage from ulcers, which are moist and weepy.

    • Nursing Actions:

    • Position: Elevate legs to facilitate venous return.

    • Use compression stockings as needed.

Assessing DVT (Deep Vein Thrombosis)

  • Signs:

    • Redness, warmth, and unilateral edema.

Pericarditis Overview

  • Symptoms:

    • Increased pain with inspiration and a pericardial friction rub.

    • Pain relief is usually found in a sitting position leaning forward.

  • Treatment:

    • High-dose NSAIDs or aspirin.

Endocarditis Overview

  • Definition: Infection of the endocardium (inner lining of the heart).

  • Signs/Symptoms:

    • Fever, flu-like symptoms, splinter hemorrhages, Janeway lesions, and fatigue.

  • Diagnosis:

    • Cultures may be drawn followed by the initiation of broad-spectrum antibiotics pending culture results.

Diagnostics Related to Vascular Diseases

  • Doppler Ultrasound:

    • Used to assess blood flow and pulse in vessels.

  • Transesophageal Echocardiogram (TEE):

    • Invasive; requires NPO status before the procedure.

  • Bubble Study:

    • Evaluates for hole in the heart (e.g., PFO) if bubbles pass through.

Hypertension and Its Complications

  • Complications:

    • Macrovascular changes leading to increased risk of stroke and myocardial infarction.

    • Microvascular changes that can affect organ function over time.

  • Management Empirical Strategies:

    • Low-sodium diet and regular exercise.

    • Pharmacological approaches include using a DASH diet.

Hyperlipidemia Management

  • Statins:

    • Mechanism: HMG-CoA reductase inhibitors.

    • Importance: Routine liver function tests (AST, ALT) should be monitored.

    • Major Complications:

    • Myopathy and rhabdomyolysis possibly leading to kidney damage.

Respiratory Considerations

  • Open Pneumothorax Treatment:

    • Immediate treatment: Cover with sterile occlusive dressing on three sides to allow air to escape but not enter.

  • Chest Tube Management:

    • Intermittent bubbling in the water seal chamber is normal; continuous bubbling may indicate a leak.

    • Never milking or clamping the tubes as it increases intrathoracic pressure.

  • Tension Pneumothorax:

    • Needle decompression can be a temporary measure if a chest tube cannot be immediately placed.

Tracheostomy Care

  • Purpose:

    • Provides an alternate airway.

  • Suctioning:

    • Should be done sterilely and only as needed.

  • Emergency Management:

    • Use an obturator at the bedside for re-insertion if tracheostomy tube is displaced.

Tuberculosis Screening

  • Mantoux Test (Skin Test):

    • Procedure: Intradermal injection followed by assessment at 24-48 hours for induration (not just redness).

    • Follow-Up Assessment: Any positive result should be confirmed with AFB or chest X-ray to determine active vs. latent TB.

Recognizing Bacterial vs. Viral Infections

  • Bacterial Infections:

    • Symptoms include a fever (often over 102°F), prolonged duration (more than 7 days), and increased pain.

  • Viral Infections:

    • May lead to rebound congestion with treatment using nasal steroids.

Oxygen Delivery Devices

  • Nasal Cannula:

    • Simple and often used in stable COPD patients.

  • Non-Rebreather Mask:

    • Requires inflation prior to application to ensure the bag is filled for patient use.

Diabetes Management

  • Insulin Types:

    • Rapid-acting Insulin:

    • Onset: ~15 mins, Peak: 1 hour, Duration: ~3 hours.

    • Short-acting Insulin:

    • Onset: 30 mins, Peak: 2 hours, Duration: ~8 hours.

    • Intermediate-acting Insulin:

    • Onset: 2 hours, Peak: 8 hours, Duration: ~16 hours.

    • Long-acting Insulin:

    • Onset: 2 hours, No peak, Duration: 24 hours.

  • Obesity Classifications:

    • Primary obesity: Excess caloric intake without expenditure.

    • Secondary obesity: Caused by underlying health issues (e.g., endocrine disorders).

Key Takeaways on Obesity and Metabolic Syndrome

  • Metabolic Syndrome Diagnostic Criteria:

    • Assessment may include abdominal obesity (apple vs. pear shape), hypertension, dyslipidemia, and insulin resistance.

  • Patient Education & Sensitivity:

    • Understand personal biases to avoid projecting onto patients dealing with obesity or sensitive health topics.

Additional Considerations for Bariatric Surgery

  • Criteria for Considering Surgery:

    • BMI > 40 or BMI > 35 with comorbid conditions.

  • Post-Surgical Risks:

    • Awareness of dumping syndrome and managing dietary changes following surgery.

Final Notes

  • Encourage active recall, practice scenarios, and continuous review for effective learning in the clinical setting.