AACN AGACNP Review Study Guide 2024, Exams of Nursing

Download AACN AGACNP Review Study Guide 2024 and more Exams Nursing in PDF only on Docsity! AACN AGACNP Review Study Guide 2024 Cushing's Syndrome/Disease ✔ cortisol excess typically caused by pituitary adenoma 60-70% of cases. Central obesity w/ extremity wasting. dorsocervical fat pad. rounded facies. spontaneous bruising. purple striae hyperpigmentation poor wound healing/ skin infections. Dexamethasone suppression test. 1mg dexamethasone at 2300 hours and measure serum cortisol at 0800. Remove sources of excess and manage consequences ( HTN, hypokalemia, hyperglycemia.) Addison's disease ✔ Primary Caused by damage to the adrenal cortex (autoimmune, TB, metastatic disease, deposition diseases, and drug induced) leading to a decrease in cortisol production. Secondary Caused by pituitary failure to release ACTH (in any hypopituitary disorder) causing a decrease in cortisol production. Sudden withdrawal of systemic corticosteroids leading to a decrease in cortisol production from induced corticosteroid suppression. diabetes insipidus (DI) ✔ Insufficient ADH or decreased sensitivity to ADH Nephron cannot conserve water. Commonly caused by damage to the pituitary gland or hypothalamus (surgery, tumor, meningitis, head injury). Can be nephrogenic where the kidney in unable to respond to ADH. Serum: Hypernatremia and hyperosmolarity. Urine: Hyponatremia and hypoosmolality. Replaced ADH and supportive fluid replacement. Syndrome of Inapropriate Antidiuretic Hormone (SIADH) ✔ Excess ADH production. Nephron conserves excess water. Caused by head injury and lung cancers. Serum: Hyponatremia and hypoosmolality. Urine: Hypernatremia and hyperosmolarity. Fluid overload. Treat with: Free water restriction Loop diuretic and NS IN extremes 3% saline Transudate pleural effusion ✔ CHF Constrictive pericarditis Cirrhosis SG <1.015 Protein <3 g/dl LDH < 200 Fluid-serum protein ratio <0.5 Fluid -serum LDH ratio <0.5 Exudate pleural effusion ✔ Lung parenchymal infection Malignancy PE SG >1.015 Protein >3 g/dl LDH >200 Fluid-serum protein ratio >0.5 Fluid-serum LDH ratio >0.5 Fibrinolysis Contraindications ✔ Absolute Hx of cerebrovascular event (ICH, intracranial neoplasm, aneurysm, AVM) Non-hemorrhagic stroke or head trauma <3 months ago. Cranial or spinal trauma <2 months ago. Dizziness and syncope are an ominous sign pointing to severely decreased cardiac output. Aortic sclerosis ✔ Grade 2-3/6 systolic ejection murmur best heard at RICS. Carotid upstroke full, not delayed, no S4, absence of symptoms. Benign thickening of the aortic valve leaflets. No change in valve pressure gradient. 50 over 50 (found in 50% of those over 50) Aortic regurgitation ✔ Grade 1-3/4 high pitched blowing diastolic murmur heard best at 3rd LICS. May be enhanced by forced expiration, leaning forward. Usually S3, wide pulse pressure, sustained thrusting apical impulses. More common in men usually from rheumatic heart disease and occasionally due to tertiary Syphilis. Mitral Stenosis Murmur ✔ Grade 1-3/4 low pitched late diastolic murmur best heard at the apex. Short crescendo-decrescendo rumble like a bowling ball rolling down an alley or distant thunder. Often with an opening snap, accentuated S1 in the mitral area. ENHANCED by LEFT LATERAL DECUBITUS POSITION, squat, cough, immediately post Valsalva. Nearly all rheumatic in origin. Protracted latency period then gradual decrease in exercise tolerance leading to a rapid downhill course due to low cardiac output. AF common. Atrial Septal Defect ASD ✔ Grade 1-3/6 systolic ejection murmur in the pulmonic area. Widely split S2, right ventricular heave. Typically without symptoms and then middle aged HF. Persistent ostium secundium in mid septum. Will resolve with ASD correction. Pulmonary Hypertension ✔ Narrow splitting S2, murmur of tricuspid regurgitation. SOB nearly universal. Seen RVH, RAH as identified on EKG/echo. Secondary PH may be a consequence of Redux "Phen/fen" use Mitral Regurgitation ✔ Grade 1-4/6 high pitched blowing systolic murmur, often extending beyond S2. Sounds like a long "haaaa, hooo". Heard best at RLSB. Radiates to axilla, often with laterally displaced PMI. Decreased with standing, Valsalva maneuver. Increased by squat, hand grip. Found in ischemic heart disease, endocarditis, RHD. Mitral Valve Prolapse ✔ Grade 1-3/6 late systolic crescendo murmur with honking quality heard best at apex. Murmur follows midsystolic click. Valsalva or standing moves click forward into earlier systole, resulting in a longer sounding murmur. Hard grasp or squat click moves back resulting in a shorter murmur. Often seen with minor thoracic deformities such as pectus excavatum, straight back, and shallow AP diameter. There is sometimes chest pain. McMurray Test ✔ Meniscal tear Talar Tilt Test ✔ Ankle Instability Tinel's sign ✔ carpal tunnel syndrome Lachman Test ✔ ACL tear Straight Leg Raise Test ✔ Lumbar nerve root compression Spurling Test ✔ Cervical nerve root compression Drop Arm Test ✔ Rotator cuff evaluation Finkelstein Test ✔ De Quervain's Tenosynovitis Osgood-Schlatter disease ✔ inflammation or irritation of the tibia at its point of attachment with the patellar tendon Osteoarthritis (OA) ✔ Joint space narrowing Heberden's nodes ✔ Closest to the tip of the finger. Bouchard's nodes ✔ Middle Joint of finger.