Download Endocrine and Renal System Exam Cram: Review Notes for NU 189 and more Assignments Biology in PDF only on Docsity!
2027 ) Medical-Surgical Nursing II
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A client is admitted for removal of a goiter. Which nursing intervention should receive priority during the postoperative period? *Exam Cram Endocrine Assessing the Clients Airway A client is admitted for treatment of hypoparathyroidism. Based on the client's diagnosis, the nurse would anticipate an order for? *Exam Cram Endocrine Calcium A client with Addison's Disease will most likely exhibit which symptom? *Exam Cram Endocrine Bronze Pigmentation A client w/ Cushing's Syndrome should be instructed to? *Exam Cram Endocrine Limit the Sodium in her DIet The client w/ a suspected pituitary tumor will most likely exhibit symptoms of? *Exam Cram Endocrine
2027 ) Medical-Surgical Nursing II
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Galen
Alteration in Visual Acuity A diabetic client has been maintained on GLucophage (Metformin) for regulation of his blood glucose levels. Which teaching should be included in the plan of care? *Exam Cram Endocrine Report changes in Urinary Pattern A client w/ diabetes experiences Somogyi's effect. To prevent this complication, the nurse should instruct the client to? *Exam Cram Endocrine Eat a protein and carbohydrate snack at bedtime Which item should be kept at the bedside of a client who has just returned from having a thyroidectomy? *Exam Cram Endocrine A tracheostomy set Which vitamin is directly involved in the metabolism of the hormones secreted by the parathyroid? *Exam Cram Endocrine Vitamin D
2027 ) Medical-Surgical Nursing II
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The physician has prescribed hydralazine (Apresoline) for a client with acute glomerulonephritis. Which finding indicates that the drug is having the desired effect? *Exam Cram Renal The clients bp has decreased A client with acute glomerulonephritis requests a snack. Which snack is suitable given the client's dietary restrictions? *Exam Cram Renal Applesauce The physician has ordered Prednisone 50 mg daily to promote diuresis in a client with nephrotic syndrome. The nurse should administer the medication... Exam Cram Renal With a snack or glass of milk A client receiving Gentamicin (Garamycin) IVPB has a morning peak level of 12 micrograms/mL. The nurse should...Exam Cram Renal Notify the physician because the level is too high
2027 ) Medical-Surgical Nursing II
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Galen
The nurse is teaching the client with an ileal conduit regarding skin care to prevent excoriation. In addition to applying a well-fitted collection bag the client should be told to empty the collection bag... *Exam Cram Renal When it is one third full A client with end stage renal disease has been managed by peritoneal dialysis. Which finding should be reported to the doctor immediately? *Exam Cram Renal The client complains of abdominal pain and nausea The nurse notes dark red blood and a few clots in the catheter of a client two days after transurethral prostatectomy (TURP). The nurse should first... *Exam Cram Renal Apply traction to the urethral catheter A client is admitted with a tentative diagnosis of bladder cancer. Which finding most likely contributed to the development of bladder cancer? *Exam Cram Renal Two PPD cigarette use for 25 years The nurse is providing dietary instructions to a client with oxalate renal calculi. The nurse should tell the client to avoid which of the following snacks... *Exam Cram Renal Strawberries
2027 ) Medical-Surgical Nursing II
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Side Effects: Abdl Fullness, Gas, Diarrhea, & NV Considerations: Take w/ Meal Interactions: Contrast Iodine Dye can lead to acute renal failure. Hold 48 hrs before iodine test. Alcohol raises risk of lactic acidosis Alpha-Glucosidase (Precose/Acarbose) *Endocrine Action Site: Small Intestine Action: Delays carbohydrate digestion & absorption Side Effects: Abd Fullness, Gas, Diarrhea Considerations: Take w/ Meal. Treat low blood sugar w/ glucose tabs or milk Interactions: Less effective with other drugs that affect digestion for example metamucil Thiazolidinediones TZD's (Actos/Pioglitazone and Avandia/Rosiglitazone) *Endocrine Action Site: Liver, Muscle, Fat Action: Less liver glucose production. More insulin sensitivity. Lowers Triglycerides. Side Effects: Headache, NV, Edema Considerations: Take w/ Meal. Onset-4 weeks, Avoid w/ Severe CAF. Increases Liver Enzymes Interactions: Less effective when taken w/ oral contraceptives
2027 ) Medical-Surgical Nursing II
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Meglitinides (Prandin/Repaglinide) *Endocrine Action Site: Pancreas Action: More Insulin Production Side Effects: Low Blood Sugar Considerations: Take before each meal. Do not take if meal is skipped Interactions: N/A Rapid Acting: Humalog (Lispro) Novolog (Aspart) Apidra (Glulisine) *Endocrine Onset: 15-30 minutes Peak: 30-90 minutes Duration: 3-4 hours Short Acting: Novolin Regular *Endocrine Onset: 30-60 minutes
2027 ) Medical-Surgical Nursing II
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Regular Insulin Who would Long Acting Insulin be good for? *Endocrine Sedentary Lifestyle, Type 2, Elderly What are the six kinds of diabetic medications in pill form? *Endocrine sulfonylureas, metformin, thiazolidinediones, alpha-glucosidase inhibitors, repaglinide and nateglinide. Sick Day Guidelines for Diabetics, Call your HCP or go to ER if any of the following occur... *Endocrine
- You feel to sick to eat normally and are unable to keep down any food for more than 6 hours
- Severe Diarrhea
- Lose 5 lbs or More
- Temperature over 101 degrees F
- Blood Glucose is lower than 60 mg/dl or remains over 300 mg/dl
- Moderate to Large Amounts of Ketones in the Urine Trouble breathing
- Sleepy or Cannot Think Clearly
2027 ) Medical-Surgical Nursing II
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Hypoglycemia *Endocrine Low Blood Glucose
- Causes: Too little food, too much insulin or diabetes medicine, or extra activity
- Onset: Sudden, may progress to insulin shock
- S/S: Shaking, Fast Heartbeat, Sweating, Dizziness, Anxious, Hunger, Impaired Vision, Weakness/Fatigue, Headache, Irritable
- What can you do? Drink half of a glass of juice, soft drink, or 1 glass of milk. Eat some soft candies (No Chocolate).After 30 mins check blood glucose.Then eat a light snack, 1/2 peanut butter or meat sandwich and 1/2 glass of milk Hyperglycemia *Endocrine High Blood Glucose
- Causes: Too much food, too little insulin or diabetic medicine, or illness and stress
- Onset: Gradual, may progress to diabetic coma
- S/S:
2027 ) Medical-Surgical Nursing II
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Calcium & Phosphate in Urine=Increased Neuromuscular irritability=Decreased Hypoparathyroidism *Endocrine Serum Calcium Levels= Decreased Serum Phosphate Levels= Increased Bone Resorption= Decreased Calcium & Phosphate in Urine= Decreased Neuromuscular irritability= Increased (May Progress to Tetany) Pheochromocytoma *Endocrine
- Rare tumor of adrenals that secrete catecholamines (epinephrine & norepinephrine)
- Extreme hypertension and tachycardia that may be persistent or intermittent Adrenocorticoid Insufficiency *Endocrine Addisons Adrenocorticoid Excess *Endocrine
2027 ) Medical-Surgical Nursing II
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Cushings Addison's Disease *Endocrine
- Deficiency of all 3 hormones produced by adrenals
- Major problems from mineralocorticoid and glucocorticoid—fluid and electrolyte problems and hypoglycemia and GI problems
- Lifelong hormone replacement
- Regular feedings throughout the day and energy conservation (mornings better)
- Mnemonic: Needs 3 s- sugar, salt, and steroid Addison - Crisis: Critical Care Taking Care of Your Vascular Access for Hemodialysis *Renal A vascular access is an opening made in your skin and blood vessel during a short operation. When you have dialysis, your blood flows out of the access into the dialyzer machine. After your blood is filtered in the dialyzer, it flows back through the access into your body. What are the 3 Main Types of Vascular Accesses for Hemodialysis. * Renal Fistula, Graft, and Central Venous Catheter Fistula *Renal
2027 ) Medical-Surgical Nursing II
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When You First Leave the Hospital, Taking care of the dressing (bandage): *Renal
- If you have a graft or fistula, keep the dressing dry for the first 2 days. You can bathe or shower as usual after the dressing is removed.
- If you have a central venous catheter, you must keep the dressing dry at all times. Cover it with plastic when you shower.
- DO NOT take baths, go swimming, or soak in a hot tub. - DO NOT let anyone draw blood from your catheter. Problems to Watch For w/ Vascular Access for Hemodialysis *Renal
- Grafts and catheters are more likely than fistulas to become infected. Signs of infection are redness, swelling, soreness, pain, warmth, pus around the site, and fever.
- Blood clots may form and block the flow of blood through the access site. Grafts and catheters are more likely than fistulas to clot.
- The blood vessels in your graft or fistula can become narrow and slow down the flow of blood through the access. This is called stenosis. Following these guidelines will help you avoid infection, blood clots, and other problems with your vascular access. *Renal
- Always wash your hands with soap and warm water before and after touching your access. Clean the area around the access with antibacterial soap or rubbing alcohol before your dialysis treatments.
2027 ) Medical-Surgical Nursing II
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- Check the pulse (also called thrill) in your access every day. Your healthcare provider will show you how.
- Change where the needle goes into your fistula or graft for each dialysis treatment.
- DO NOT let anyone take your blood pressure, start an IV (intravenous line), or draw blood from your access arm.
- DO NOT let anyone draw blood from your tunneled central venous catheter.
- DO NOT sleep on your access arm.
- DO NOT carry more than 10 lb with your access arm.
- DO NOT wear a watch, jewelry, or tight clothes over your access site.
- Be careful not to bump or cut your access.
- Use your access only for dialysis. Call your provider right away if you notice any of these problems w/ your Vascular Access *Renal
- Bleeding from your vascular access site
- Signs of infection, such as redness, swelling, soreness, pain, warmth, or pus around the site
- A fever 100.3°F (38.0°C) or higher
- The pulse (thrill) in your graft or fistula slows down or you do not feel it at all
- The arm where your catheter is placed swells and the hand on that side feels cold
- Your hand gets cold, numb or weak
2027 ) Medical-Surgical Nursing II
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- Anxiety, agitation, and irritability
- Tremors
- Increase of BP, P,R, T •Can progress to hallucinations, seizures •Life threatening Physical Examination for Pt w/ Alcohol *Renal •Malnourished •Poor self care •Evidence of Physical Trauma: Falls, Abrasions, or Fights •Diagnosed or symptoms of liver impairment •Diagnosed or symptoms of pancreatic involvement •Hypertension is a critical sign •Behavioral indicators (agitation, irritability) Treatment for Alcohol Abuse *Renal Detoxification
- inpatient
- Frequent Vital signs
2027 ) Medical-Surgical Nursing II
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- Rest and nutrition are emphasized
- Anxiolytics (benzodiazepine) are most often used, but also hypnotics (phenobarbital, chloral hydrate)
- IV magnesium sulfate is used to prevent seizures in rare cases
- Fluids encouraged to combat dehydration, and vitamin replacement therapy is instituted Narcotic Withdrawal *Renal
- Indicators: "needle tracks"
- Symptoms
- Early symptoms of withdrawal include: Agitation, anxiety, insomnia, muscle aches, tearing, runny nose, sweating, Abdominal cramping, Diarrhea, N&V
- Uncomfortable but not life threatening.
- Symptoms usually start within 12 hours of last heroin usage and within 30 hours of last methadone exposure. Chronic Renal Failure *Renal
- Diminished Renal Reserve
- Glomerular Filtration Rate Greater than or equal to 90 ml/min
- Observation and Control of BP
- 24 hr Urine for Creatinine Clearance to detect loss of Renal Reserve
- Kidney Damage w/ Normal or Increased GFR
