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Adult Health Final Review – Key Vocabulary

Finals Blueprint

  • 100 total questions (no NGN)
    • GI – 15
    • Renal – 15
    • Cardiac – 20
    • Endocrine – 15
    • Hematology/Oncology – 15
    • Neuro – 20

Neuro

Seizure Precautions

  • Lower safely to floor; remove hazards; loosen clothing → maintain perfusion & comfort.
  • Left-lateral recovery position to reduce aspiration risk.
  • Never place objects in mouth; suction only post-ictal if secretions.
  • Pad side-rails, protect airway; note onset/duration, type of movements.

Stroke

  • Persistent neuro deficits ≥24 h.
  • Types
    • Ischemic (thrombotic/embolic blockage)
    • Hemorrhagic (vessel rupture) – hallmark = abrupt “worst headache of life”.
  • Shared risk: \text{HTN}, diabetes, sleep-apnea, valvular dz, MI, aneurysm, age > 65 (↓mobility in ≈50 %).
  • Imaging identical to TIA; rule-out bleed before thrombolytics (non-contrast CT ≤ 1 h).

Headache Overview

  • Origins: muscle, meninges, facial structures, vessels, cranial/spinal nerves.
  • Primary vs secondary classification.
  • Etiologic cues
    • Tension – stress, posture, depression.
    • Cluster – stress, allergens, toxins, tobacco/ETOH.
  • Systemic accompaniments: nausea, visual changes, ↑BP, fatigue, GI upset, mood disorders.
Phenotypes
  • Tension-type: mild–moderate, bilateral “band-like”; cervical/shoulder tightness.
  • Cluster: severe unilateral retro-orbital; lacrimation, nasal stuffiness, eyelid edema/ptosis.

Migraine (4 Phases)

  1. Prodrome – hrs-days (mood change, cravings, yawning).
  2. Aura – visual scintillation, smells, paresthesia.
  3. Headache – throbbing ± photo-/phonophobia.
  4. Post-drome – fatigue, cognitive fog.
  • Genetic predisposition + trauma/foods/environment; leading cause of disability in women > 50.
  • Nursing: dark quiet room, safety, med edu, trigger diary.

Parkinson’s Disease

  • Degeneration substantia nigra → ↓dopamine ± ↓norepinephrine.
  • Classic triad: resting tremor, bradykinesia, rigidity; + postural instability.
  • Non-motor: fatigue, orthostatic hypotension, constipation.
  • Lewy bodies = diagnostic hallmark.
  • Stage I (unilateral) → Stage V (wheelchair/bed-bound).
  • Dx: clinical; DAT-SPECT/MRI supportive; genetic testing expanding.

Peripheral Neuropathy

  • Demyelination of peripheral axons → pain, paresthesia, weakness.
  • Causes: diabetes, \text{B}_{12} deficiency, back injury, toxins, autoimmune, hereditary.
  • Wallerian degeneration → foot/ankle weakness.
  • Work-up: med list, EMG, \text{B}_{12} levels, spine CT/MRI.
  • Tx: gabapentin, pregabalin, NSAIDs, \text{B}_{12} shots.

TIA – “Mini-Stroke”

  • Etiology: arterial plaque stenosis or acute clot occlusion.
  • Symptoms resolve fully; 30 % stroke within 1 yr if untreated (highest risk < 48 h).
  • FAST screen; work-up: non-contrast CT ≤ 1 h, MRI, ECG (A-fib), labs.
  • Tx: antiplatelets, RF modification, possible carotid endarterectomy if >50\% stenosis.

Gastrointestinal

GERD

  • Patho: LES relaxes too often/doesn’t close → acid reflux.
  • Risk ↑: obesity, hiatal hernia, smoking, ETOH, meds, DM, asthma.
  • Complications: esophagitis, strictures, Barrett’s → ↑esophageal cancer, chronic cough/laryngitis.
  • Nursing Care
    • Rule-out cardiac cause for chest pain first.
    • Lifestyle: small meals, remain upright, elevate HOB.
    • Meds: PPIs, H2 blockers, antacids; teach adherence.

Ulcerative Colitis (UC)

  • Chronic colonic mucosal inflammation & ulcers.
  • Dx: colonoscopy + biopsy; stool blood, inflammatory markers.
  • Risk: genetics, environment, ?diet.
  • Tx: 5-ASA, steroids, immunosuppressants, biologics; colectomy if severe.
  • Complications: anemia, colorectal Ca, osteoporosis, growth delay (kids).

Colon Cancer Screening

  • Risk: age > 45, FHx, lifestyle.
  • Manifestations: bowel-habit change, rectal bleed, abd pain.
  • Screening 45–75 yr: colonoscopy q10 y, FIT yearly, gFOBT yearly, stool DNA q3 y.

Peptic Ulcer Disease (PUD)

  • Types: gastric, esophageal, duodenal.
  • S/sx: dull/burning epigastric pain, fullness, belching, heartburn; may be silent.
  • Complications: bleeding, perforation (sudden severe pain, fever, shock), gastric outlet obstruction.
  • Tx
    • Meds: PPIs, H2 blockers, abx for H.\ pylori (amoxicillin + clarithro ± metronidazole), bismuth.
    • Lifestyle: avoid alcohol, coffee, spice; quit smoking; stress mgmt.
    • Surgery for perforation, obstruction, massive bleed.

Celiac Disease / Gluten Sensitivity

  • Autoimmune villous atrophy → malabsorption.
  • GI: pain, bloating, diarrhea; extra-GI: anemia, osteoporosis, neuro, rash (dermatitis herpetiformis).
  • Strict gluten-free diet: avoid wheat, rye, barley.
  • Naturally safe: fruits, veggies, meats, rice, corn, quinoa; distilled spirits.

NG Tubes

  • Nasal→stomach; confirm placement (X-ray gold standard).
  • Uses: feed, decompress, meds, lavage.
  • Risks: discomfort, displacement, aspiration, infection.
  • Nursing: verify pH, secure tube, oral care, monitor I/O & electrolytes.

Hiatal Hernia

  • S/sx: heartburn, chest pain, dysphagia.
  • Risk: age, obesity, smoking.
  • Dx: CT, esophagram, endoscopy.
  • Tx similar to GERD; surgery if refractory.

Colostomy Care

  • Stoma: pink-red, moist; clean w/ warm water, pat dry.
  • Empty bag ⅓–½ full; change wafer q3-7 days.
  • Use skin barrier rings/paste; track diet/fluid effect on output.

Oral Cancer

  • RF: tobacco (all forms), alcohol, HPV, prior head/neck Ca.
  • Dx: dental/ENT exam, biopsy.
  • Tx: surgery (radical neck), radiation, chemo.
  • Nursing priorities: airway (trach care), pain, nutrition (NG/PEG), graft/wound care, multidisciplinary referrals.

Abdominal Quadrants (review)

  • RUQ – liver, GB, R kidney
  • LUQ – stomach, spleen, pancreas, L kidney
  • RLQ – appendix, cecum/ascending colon, R ovary/ureter
  • LLQ – sigmoid/descending colon, L ovary/ureter

Renal

Chronic Kidney Disease (CKD)

  • Gradual ↓GFR → fluid, electrolyte, endocrine dysfunction.
  • Stages
    • 1 > 90, 2 60-89, 3 30-59, 4 15-29 (prep dialysis), 5 < 15 (ESRD).
  • Manifestations: edema, HTN, JVD, crackles, S3, lethargy, seizures; uremic frost, anemia, bone disease.
  • Labs: \text{GFR↓}, \text{creatinine↑}, \text{albuminuria}≥30\ mg.
  • Dialysis options: HD, PD, continuous RRT.
  • Access
    • Chronic: AV fistula/graft (thrill/bruit care).
    • Temporary: double-lumen central catheter.

Polycystic Kidney Disease (PKD)

  • Inherited; kidney/liver cysts.
  • S/sx: flank pain, HTN, nocturia, palpable masses, proteinuria.
  • Dx: renal US/CT.
  • Management: BP control (ACE/ARB), pain, tolvaptan slows cyst growth, prep for eventual transplant/dialysis.

Pancreatitis (brief renal tie-in for labs)

  • Severe abd pain, N/V; amylase & lipase ≥3× norm.
  • Causes: ETOH, gallstones.
  • Nursing: NPO, pain control, IV fluids, monitor glucose & Ca++.

Nephrotoxic Medications

  • Aminoglycosides, Amphotericin B, cisplatin, NSAIDs, ACE/ARB, calcineurin inhibitors, PPIs, some antivirals & diuretics.

Hepatitis Review (renal dosing relevance)

  • Transmission & chronicity differences (A fecal-oral, B/C parenteral). Vaccinate A & B.

Kidney Function Labs

  • pH 7.25–7.35; BUN 7–20 mg/dL; Serum Cr < 1.2 mg/dL.
  • GFR ≥ 90 mL/min; UA normal ranges (SG 1.005–1.025, protein neg, etc.).

UTI

  • Pathogen: E.\ coli.
  • S/sx: frequency, dysuria, urgency, cloudy/bloody urine; flank pain if pyelo.
  • Tx: TMP-SMX, nitrofurantoin, fluoroquinolone; phenazopyridine for dysuria.
  • Education: hydrate 2–3 L/day, wipe front→back, void after sex, finish abx.

Renal Calculi

  • Stone = mineral salt precipitate; pH > 7.2 favors calcium phosphate/oxalate.
  • S/sx: acute flank pain, hematuria, N/V.
  • Dx: CT abd/pelvis (gold); US if pregnant; KUB x-ray for large stones.
  • Tx: hydration, tamsulosin, analgesia; ESWL, ureteroscopy, stent, PCNL for large/obstructive stones.

Cardiac

Basic EKG Rhythms (recognition)

  • NSR: 60–100 bpm, P before every QRS, upright T.
  • Brady < 60, tachy > 100 (sinus origin).
  • PAC vs PVC extra beats (atrial vs ventricular focus).
  • Heart Blocks: 1° (PR > 0.20), 2° Mobitz I (Wenckebach) vs II, 3° AV dissociation.
  • A-fib: “irregularly irregular”, no discernible P.
  • A-flutter: sawtooth, constant F waves.
  • SVT: narrow QRS > 150 bpm (AVNRT).
  • V-tach: wide regular > 120 bpm; V-fib: chaotic baseline.

Dysrhythmia Management (high-yield)

  • Sinus Brady symptomatic: atropine 1\ mg IV q3-5 min (max 3); TCP → PPM.
  • Sinus Tachy: treat cause; beta-blocker, adenosine if AVNRT.
  • A-fib/A-flutter/SVT: vagal, adenosine (6 → 12 mg), diltiazem, cardiovert if unstable; anticoagulate.
  • V-tach w/ pulse: amiodarone; pulseless VT/VF: defibrillate.

Heart Failure (HF)

  • Left vs Right presentations (pulmonary vs systemic congestion).
  • Diagnostics: BNP↑, echo EF, cath.
  • NYHA functional classes I–IV; Framingham criteria.
  • Core Tx: lifestyle (↓Na, weight, exercise), ACE/ARB/ARNI, beta-blocker, MRA, diuretics; devices – ICD, Bi-V pacer.

Murmurs

  • “Whoosh” d/t valve stenosis/regurg; grade, timing (systolic vs diastolic) critical.

Myocardial Infarction (MI)

  • STEMI vs NSTEMI vs unstable angina.
  • S/sx: crushing chest pain radiating jaw/arm, SOB; women – atypical (nausea, back pain).
  • Labs: Troponin I/T detectable in 4 h, peak 24–48 h; CK-MB similar timeline.
  • Risk factors: modifiable lifestyle + age/sex & genetics.

Hyperlipidemia

  • RF: diet (sat/trans-fat), obesity, inactivity, DM, CKD, hypothyroid, smoking, genetics.
  • Lifestyle cornerstone; meds: statins, PCSK9i, bempedoic acid, BAS, fibrates, niacin.

Chest Pain Treatment Algorithm

  • Rule-out ACS: ECG, troponin; MONA basics (morphine, O₂, nitro, ASA).
  • Angina: nitrates, beta-blockers, CCBs; consider PCI/CABG.
  • Non-cardiac pain: treat GERD, anxiety, musculoskeletal accordingly.

Pericarditis

  • Causes: infection, autoimmune, cancer.
  • S/sx: sharp chest pain ↓ when leaning forward; pericardial friction rub.
  • ECG: PR depression, diffuse ST elevation.
  • Tx: NSAID + colchicine 2–4 wks; steroids if refractory; PPI gastric prophylaxis.

Peripheral Artery Disease (PAD)

  • Atherosclerotic lower-extremity ischemia.
  • RF: HTN, DM, obesity, smoking, hyperlipid, >30 BMI.
  • S/sx: intermittent claudication, ↓hair, slow nails, absent pulses; 6 Ps acute ischemia.
  • Dx: ABI < 0.9, duplex US, CTA/MRA, angiogram.
  • Tx: exercise, cilostazol, statins, antiplatelets; angioplasty/bypass for severe.

Cardiac Catheterization Post-Care

  • Groin: lay flat ≈6 h, monitor site for bleed; radial: fewer restrictions.
  • Check distal pulses, VS, monitor for back pain (retroperitoneal bleed).

Endocrine

Diabetes Mellitus

Type 1
  • Autoimmune β-cell destruction → absolute insulin deficiency.
  • 3 Ps, weight loss, DKA.
  • Dx: random ≥ 200 mg/dL, fasting ≥ 126, A1C ≥ 6.5\% (two occasions).
  • DKA: glucose > 250–800, ketones+, pH < 7.3, HCO₃ ≤ 15.
  • Tx: basal-bolus insulin, monitor A1C goal <7\%, eye/foot care.
Type 2
  • Insulin resistance ± ↓secretion.
  • RF: obesity, diet, inactivity, smoking, stress, sleep, aging, FHx.
  • Gradual onset: fatigue, blurred vision, infections, neuropathy.
  • First-line: lifestyle; then oral agents (metformin, GLP-1 RA, SGLT2i) ± insulin.

Thyroid Disorders

Hypothyroidism
  • ↓T3/T4, ↑TSH.
  • S/sx: fatigue, cold intolerance, weight gain, bradycardia, constipation, myxedema coma (emergency → IV levothyroxine).
  • Tx: levothyroxine daily AM empty stomach; monitor for hyperthyroid s/sx.
Hyperthyroidism / Graves’
  • ↑T3/T4, ↓TSH; autoimmune TSI antibodies.
  • S/sx: weight loss, heat intolerance, tachy, tremor, exophthalmos; thyroid storm (fever, HTN, tachy, seizures).
  • Meds: methimazole, propylthiouracil (PTU); beta-blockers for symptom control.
  • Radioactive iodine therapy: follow SAFE precautions.
  • Surgery: total thyroidectomy → monitor airway, bleeding, laryngeal nerve, hypocalcemia (tetany).

Addison’s Disease (Adrenal Insufficiency)

  • Lifelong glucocorticoid replacement.
  • Labs: hyponatremia, hyperkalemia, hypoglycemia, hypercalcemia.
  • Crisis: profound hypotension, arrhythmias; treat with high-dose hydrocortisone, fluids.

Cushing’s Syndrome

  • Excess cortisol (endogenous or chronic steroids).
  • S/sx: moon face, central obesity, buffalo hump, muscle wasting, hirsutism, HTN, hyperglycemia, osteoporosis.
  • Dx: overnight dexamethasone suppression test.

Hematology / Oncology

Deep-Vein Thrombosis (DVT)

  • Unilateral pain, swelling, warmth below knee.
  • D-dimer ↑ then leg Doppler; CT for central clots.
  • Tx: anticoagulation (LMWH → warfarin/DOAC); thrombolysis for massive; IVC filter if anticoag contraindicated.
  • Bridging: stop warfarin pre-op, use LMWH/UFH until INR therapeutic post-op.

Anemias (Quick Grid)

  • Iron deficiency: brittle nails, pallor; labs ↓ferritin, ↑TIBC → oral iron + vit C, stool softener.
  • B12 deficiency: neuro paresthesia; B12 < 200 pg/mL → IM cobalamin.
  • Sickle Cell: autosomal-recessive; VOC pain, organ ischemia; hydrate, opioids, hydroxyurea, transfuse.

Blood Transfusion Reactions

  • Acute hemolytic: immediate chills, back pain; STOP, flush NS, return blood.
  • Febrile non-hemolytic: within 2 h, fever/chills; leukocyte-reduced units.
  • Allergic: urticaria → anaphylaxis; stop, give antihistamine.
  • Bacterial sepsis: wheeze, cyanosis; culture bag, broad abx.

Radiation Therapy Side Effects

  • Short-term: fatigue, skin erythema, hair loss (field only), N/V, mucositis, diarrhea.
  • Long-term: fibrosis, lymphedema, bowel/bladder issues, cognitive deficits, infertility, secondary malignancy.

Tamoxifen (SERM)

  • Uses: ER+ breast Ca treatment & prevention.
  • Common SE: hot flashes, vaginal discharge, mood swings.
  • Serious: DVT/PE, endometrial Ca, cataracts, hepatotoxicity.
  • Nursing: teach thrombus signs, ensure pelvic & eye exams, encourage Ca++/Vit D.

Cancer Screening Guidelines

  • Mammogram: women 40–74 q1–2 y (earlier if high-risk).
  • Colon Ca: adults 45–75; colonoscopy q10 y, FIT yearly, etc.
  • PSA: men 50–69 (45 if high-risk); shared decision q1–2 y.
  • Low-dose CT lung: 50–80 yr, ≥20 pack-year, current or quit ≤15 yr; annually.

Formulas / References

  • ABI =\dfrac{\text{Ankle SBP}}{\text{Brachial SBP}} (normal ≥ 0.9).
  • MAP =\dfrac{\text{SBP}+2(\text{DBP})}{3} (goal ≥ 65 mmHg in shock).
  • eGFR (CKD-EPI simplified) requires serum creatinine, age, sex, race (auto-calculate in EHR).

Study Tip: Connect disease risk factors across systems (e.g., HTN, diabetes contribute to stroke, CKD, CAD, PAD). Prioritize ABCs in emergencies, then treat underlying pathophysiology.