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Exam 1 Study Guide Latest Updates, Exams of Nursing

Liberty University (LU)Nursing

Exam 1 Study Guide Latest Updates

Typology: Exams

2023/2024

Available from 06/09/2024

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Exam 1 Study Guide Latest Updates
Diabetes Mellitus Concept Map
•Type 1- Insulin dependent (born with it)
•Type 2 – Insulin Resistant (can be reversible)
•Risk Factors: increased BMI, poor diet, HTN, decreased perfusion
•Assessment: Polyuria, polydipsia, polyphagia, weight loss, fatigue
•Complications: retinopathy, nephropathy (urine =30ml/hr, BUN,
creatinine), neuropathy, CVD—stroke, Slow wound healing (skin, wbc,
temp)
•Nursing Diagnosis: ineffective tissue perfusion, risk for ineffective wound
healing
•Medications: insulin, oral meds
•Labs and Diagnostic: FBS, A1C, urine,
oFasting BG: 70-110 <126
oPostprandial BG (2hr) <200
oRandom BG: <200
oHA1C: < 6.5 – gives 8-12 week average
o2 hr plasma glucose: give pt sugar and check blood 60 min-2 hrs
later to make sure it’s getting insulin and being used correctly
•Nursing Interventions: monitor diet [stay away from simple carbs],
exercise, specialists (eye doc), walking
oWhen exercising make sure to check BG before, during and after,
especially when starting a new regimen
oMonitor skin integrity, especially feet
oNo lotion between toes
Make sure you know the different types of Insulin
•Know Onset, peak, duration
•Rapid Acting: lispro, aspart, glulsine
oOnset: 10-30min
oPeak: 30min-3hr
oDuration 3-5 hr
•Short Acting: Regular Humulin R, Novolin
oOnset: 30min-1hr
oPeak: 2-5 hr
oDuration: 5-8 hr
•Intermediate: NPH Humulin R, Novalin
oOnset: 1.5-4hr
oPeak 4-12 hr
oDuration 12-18 hr
•Long Acting: glargine, determir
oOnset: 0.8-4hr
oPeak: no pronounced peak
oDuration: 24+ hr
Hypoglycemia: Cold, Clammy, changes in
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Exam 1 Study Guide Latest Updates

Diabetes Mellitus Concept Map

  • Type 1- Insulin dependent (born with it)
  • Type 2 – Insulin Resistant (can be reversible)
  • Risk Factors: increased BMI, poor diet, HTN, decreased perfusion
  • Assessment: Polyuria, polydipsia, polyphagia, weight loss, fatigue
  • Complications: retinopathy, nephropathy (urine =30ml/hr, BUN, creatinine), neuropathy, CVD—stroke, Slow wound healing (skin, wbc, temp)
  • Nursing Diagnosis: ineffective tissue perfusion, risk for ineffective wound healing
  • Medications: insulin, oral meds
  • Labs and Diagnostic: FBS, A1C, urine, o Fasting BG: 70-110 < o Postprandial BG (2hr) < o Random BG: < o HA1C: < 6.5 – gives 8-12 week average o 2 hr plasma glucose: give pt sugar and check blood 60 min-2 hrs later to make sure it’s getting insulin and being used correctly
  • Nursing Interventions: monitor diet [stay away from simple carbs], exercise, specialists (eye doc), walking o When exercising make sure to check BG before, during and after, especially when starting a new regimen o Monitor skin integrity, especially feet o No lotion between toes Make sure you know the different types of Insulin - Know Onset, peak, duration
    • Rapid Acting: lispro, aspart, glulsine o Onset: 10-30min o Peak: 30min-3hr o Duration 3-5 hr
    • Short Acting: Regular Humulin R, Novolin o Onset: 30min-1hr o Peak: 2-5 hr o Duration: 5-8 hr
    • Intermediate: NPH Humulin R, Novalin o Onset: 1.5-4hr o Peak 4-12 hr o Duration 12-18 hr
    • Long Acting: glargine, determir o Onset: 0.8-4hr o Peak: no pronounced peak o Duration: 24+ hr Hypoglycemia: Cold, Clammy, changes in

LOC

▪ A good test question would be what would be a good fluid to give to someone who has HHS?

  • NO D5 given!!! Typically 0.9% normal saline o Know difference between blood glucose of DKA and HHS ▪ DKA is ketones HHS is not. You do not go into metabolic acidosis with HHS o HHS can happen due to any reason, can be caused by lots of different things;
  • Hypoglycemia: Cold, clammy, changes in LOC o Assessment: diaphoresis, pallor, tremors, loss of consciousness, seizures, coma o Management: glucose administration, safety ▪ > 70mg/dL: look for other causes ▪ < 70mg/dL: begin treatment for hypoglycemia
  • 15g fast-acting carb (pb and crackers), recheck in 15 minutes and if still low give 15g more (2- doses) o If patient is unconscious do not give them anything, use other means to treat o Avoid milk and orange juice in renal patients- it increases potassium levels ▪ Orange juice with added sugar is not appropriate when managing low blood sugar ▪ For renal patients – substitute cranberry juice, ginger ale, graham crackers, skin milk
  • dextrose IVP
  • glucagon IM or SQ
  • Hyperglycemia o Assessment: tachycardia, decresed LOC, palpatations, nervousness, lightheadedness, tremors, cold-clammy skin, glucose <

o

  • Hyperthyroidism (Grave’s Disease)—everything elevated o Assessment: HTN, tachycardia, tachypnea, increased appetite, weight loss, warm skin, diaphoresis, hair loss, tremors, exophthalmos, goiter ▪ TSH, free thyroxine (free t4) - KNOW TSH LEVELS o Complications: thyrotoxicosis [thyroid storm, everything is elevated, medical emergency] o Nursing Care: cardiac monitoring, O2, IV fluid, rest, cool room, quiet area, ROM, eye comfort, elevate HOB, meds, high calorie foods [ frequent meals that are high in calories], no caffeine ▪ Post op care: VS, respirations, bleeding, semi-fowler’s, pain management, hypocalcemia Ca levels, trousseau’s and chvostek’s sign o Treatment: remove thyroid gland (monitor ABC’s) o KNOW DIFFERENCE BETWEEN HYPERTHYROIDISM AND HYPOTHYROIDISM

o

- Hypothyroidism everything is slow o Assessment: fatigue, cold and dry skin, hair loss, slowed speech, constipation, depression, weight gain, decreased cardiac output, anemia, myxedema [swelling in face and eyes] ▪ TSH, free thyroxine (fre t4) o Complications: myxedema coma, cardiovascular collapse o Nursing Care: meds, low calorie diet, VS, cardiac assessment, warm environment, skin care ▪ No heating pad or heating blanket because they can’t sense that, they are at risk for burns

o

- Addison’s Disease o Assessment: weight loss, N/V, bronze-colored skin , hyponatremia (brain), hyperkalemia(heart), hypoglycemia ▪ Know normal ranges for Na and K o Complications: Addisonian crisis o Nursing Care: hormone therapy, VS, weight, monitor glucose, NA, K, quiet environment fluids, I&O, LOC o Good snack foods: turkey and cheese sandwich. Addison’s pts need a diet high in protein, carbs, and sodium

o RENAL CHAPTERS UTI

  • e.coli most common cause of UTI
  • Can have lower tract infection or upper tract infection
  • Lower Tract o Lower: Cystitis –inflammation of bladder o Dysuria, frequency, urgency, hematuria, confusion ▪ Confusion is seen mainly in the elderly (check for LOC) - Safety is a big concern with this! - If elderly patient is confused, expect a UTI o Treatment: antibiotics, antispasmodic, fluids, preventative ▪ You will first do a urinalysis to check for UTI, but to guarantee that they have a UTI, you must do a urine culture sensitivity test ▪ ALWAYS do culture first!!! Then do antibiotics and whatever else is ordered ▪ Antispasmodic-pyridium (turns urine orange, normal side effect)
  • Upper Tract o Upper: Pyelonephritis o Fever, chills, flank pain (CVA tenderness ), n/v

Nephrotic Syndrome

  • Assessment: peripheral edema, massive proteinuria, HTN, hypoalbuminemia, hyperlipidemia, cola -colored urine o Diabetic patients more likely to get this o Massive protein loss
  • Nursing Care: corticosteroids, anti-hypertensive, diuretics, NSAIDS, low- sodium and moderate-protein diet, small and frequent meals, assess edema o Monitor glucose levels due to corticosteroids o Typically given ACE inhibitors o Check circumference of abdomen or legs in order to monitor edema
  • BIGGEST take away: lost of protein lost and a lot of edema (typically in legs)
  • Nursing DX: excessive fluid volume, fluid volume overload

Polycystic Kidney Disease

  • Assessment: asymptomatic, hypertension, hematuria, palpable, enlarged kidneys
  • Cause is genetic
  • Assessment: enlarged kidneys
  • Nursing Care: prevent infection, dialysis, kidney transplant o Genetic counseling for those who want to have kids o NO bubble baths, void after sex o Typically have renal failure, so discuss dialysis o Discuss ways to monitor pain o The cystic push against the blood vessels and cut off the blood supply. o No treatment only treat the symptoms.

Renal Calculi

  • Assessment: severe pain, dysuria, chills, fever
  • Nursing Care: analgesics, anti-spasmodics, hydration, dietary restrictions, strain urine, post-lithotripsy care, education o Treat pain first because they are in excruciating pain o Drink lots and lots of fluids! Stay Hydrated!!! About 3000ml a day
  • Suprapubic catheter o Most risk at infection for UTI o Monitor for skin breakdown Urinary Diversion Types
  • Nephrostomy: drains urine from kidney
  • Ileal conduit: uses small intestine
  • Cutaneous ureterostomy: ureters detached, stoma formed Renal Failure
  • Diabetic patients most at risk for renal failure along with patients who have HTN
  • Types of Acute Renal Failure o Prerenal: reduced perfusion to the kidneys, blood loss, sepsis, hypovolemia/ dehydration, reduced cardiac output ▪ Can be caused by uncontrolled HTN o Intrarenal: damage to renal paranchyma ▪ Caused by medication toxicity -like gentamycin/streptomycin ▪ Caused by infection or nephrotoxic meds, aspirin/ibuprofen ▪ Ace inhibitors ▪ Contrast dye o Postrenal: sudden blockage that stops urine form flowing out the kidneys ▪ Tumor ▪ Kidney stones ▪ Injury ▪ Enlarged prostate gland

o

  • Stages of Acute Renal Failure o What would you expect to see in the oliguric phase ▪ Decreased urine output, <400ml/day ▪ Decrease in glomerular filtration rate (know normal level— 90- 120ml/min ) ▪ Occurs within 1 to 7 days of precipitating event ▪ Duration: 10 to 14 days, but can last months ▪ The longer the phase, the poorer the prognosis of regaining renal function o What would you expect to see in the diuretic phase ▪ Loosing a lot of urine, may loose up to 5L/day ▪ Urine production occurs ▪ Osmotic diuresis from high urea levels and kidneys inability to concentrate urine ▪ Initial urine output of 1-3 L/day and may increase to 3-5L/day ▪ Duration 1 to 3 weeks ▪ Kidneys stop working, so everything just floods through it o What would you expect to see in the Recovery phase ▪ Labs normalize (BUN and creatinine) ▪ Glomerular filtration rate starts to go up ▪ Can take up to a year, most recover, if they don’t then it develops to CKD ▪ Some patients never reach this phase and progress to chronic renal failure o Nursing interventions

o GI—Anorexia, N/V, metallic taste in mouth, gastritis, constipation, uremic colitis, stomatitis o Skin—pruritus, dry [keep nails short, and try not to scratch skin], ecchymosis, purpura, yellow-gray pallor, decreased skin turgor, soft- tissue calcifications, uremic frost o Musculoskeletal—pain, weakness [monitor safety] o Hematologic—anemia [know rbc, H&H levels] o Reproductive—menses o Urinary—polyuria (early), nocturia(early), oliguria(late), anuria(late), proteinuria, hematuria, diluted , straw like appearance

  • Dialysis o Movement of fluid/molecules across a semipermeable membrane from one compartment to another o Corrects fluid/electrolyte imbalances and removes waste products in renal failure o Begun when patient’s uremia can no longer be adequately managed conservatively o Diet: control K, P, Na, and liquid in the diet, o Two methods: ▪ Peritoneal dialysis (PD)—goes into the abdomen, access is obtained by inserting a catheter through the anterior wall
  • Complications—lower back problems, protein loss, pulmonary complications, bleeding, dialysate retention, infection, may not come out [make sure tube isn’t blocked off, no kinks, turn and reposition patient]
  • Effective & Adaptation—can be done at home, idependence, ease of traveling, fewer dietary restrications more convenient than HD, short training program ▪ Hemodialysis (HD)
  • Procedure: Two needles placed in fistula or graft, needle closer
  • Nursing Care o Before: complete assessment of fluid status [daily weight], condition of access (bruits and thrill), educate patient [length of time 2- hrs], temperature, and skin condition o During: Monitor VS every 30 to 60 min. [pulse, bp], loss of blood, muscle cramps, hepatitis, monitor changes in condition o After: monitor changes in condition (VS, bleeding), No BP or venipuncture in affected arm, skin care, diet [monitor K, phosphors, Na, fluid

o Do not give beta blockers before procedure but can give antihypertensive drugs. Kidney Transplant Nursing Care

  • Postop care of recipient o Fluid and electrolyte balance o Urine output [1100ml/hr normal] o Catheter patency—check for kinks or blockage if output decreases o Immunosuppression medications o Complications—rejection, infection, reoccurrence of kidney disease [elevated BUN or creatinine]