NUR 2571 / NUR2571 Exam 3 Study Guide (Latest 2021 / 2022): Professional Nursing II / PN, Study Guides, Projects, Research of Nursing

Download NUR 2571 / NUR2571 Exam 3 Study Guide (Latest 2021 / 2022): Professional Nursing II / PN and more Study Guides, Projects, Research Nursing in PDF only on Docsity! NUR2571 Exam 3 Study Guide Professional Nursing II / PN 2. N2 Exam 3 Type 1 Diabetes - an autoimmune dysfunction involving the destruction of beta cells, which produce insulin in the islets of Langerhans of the pancreas. Type 1 is an absolute lack of insulin secretion ° ° ° ° Absence of insulin production; patient is dependent on insulin to prevent ketoacidosis and maintain life Onset is frequently in childhood; usually ages 10-15 This is forever First sign is often Diabetic Ketoacidosis Type 2 is a combination of insulin resistance and inadequate insulin secretion to compensate oo00 Often linked to obesity, sedentary lifestyle, and heredity Onset is predominately in adulthood, generally after the age of 35 Usually controlled with diet, exercise and oral hypoglycemics Usually found by accident; the patient keeps coming back for a wound that won't heal or repeated vaginal infections Signs and Symptoms: ° ° ° Both Type 1 and Type 2: 3 Ps: polyuria, polydipsia, and polyphagia Fatigue Increased frequency of infections Type 1: ° ° ° ° ° Weight loss Bed-wetting, blurred vision Enuresis (involuntary urination, especially in children at night) in children, nocturia in adults Abdominal pain Rapid onset Type 2: Oo oo°o Weight gain, visual disturbances Slow onset; usually around 40 years old Fatigue and malaise Recurrent vaginal yeast Diagnostics: o The criteria for diagnosis must include two findings on separate days - must also be the test plus a random glucose greater than 200 mg/dL o Fasting blood glucose level above 126 mg/dL o Oral glucose tolerance test: 2- hour glucose values greater than 200 mg/dL o Glycosylated hemoglobin (A1C) greater than 6.5% “ Medications: ¢ Insulin: o Rapid-acting insulin: lispro, aspart, glulisine - Given before meals - Onset: 5-15 minutes - Peak: 30-90 minutes - Duration: les than 5 hours - Given subcutaneously - Given in conjunction with intermediate- or long-acting insulin to provide control between meals and at night - Because of quick onset, patient must eat immediately o Short-Acting Insulin: regular - Given approximately 30-60 minutes before meals - Onset: 30 minutes - 1 hour - Peak: 2-3 hours - Duration: 5-8 hours + This is our clear insulin = Given alone or in combination with longer-acting insulin - Given for sliding scale coverage - Canbe given subcutaneously, IV, or IM ***only insulin that can be given IV - U-500 is for patient who is insulin resistant, never given IV - U-100 is for most patients and can be given IV o Intermediate-Acting insulin: NPH, Novolin N - Hypoglycemia tends to occur in mid to late afternoon = Onset: 2-4 hours - Peak: 4-10 hours - Duration: 10-16 hours = This is our cloudy insulin - Given for control between meals and at night o Should be done at the same time every day; when the blood sugar is highest; and the patient should eat before exercising * Hypoglycemia - a condition characterized by a decrease in serum glucose level (less than 70 mg/dL), which results in decreased cerebral function o Signs and Symptoms: - Drowsiness = Cool and clammy skin - Shaky = Tachycardia - Shallow respirations - Nausea - Headache = Slurred speech - **Can mimic stroke but should check BS first and/or treat for hypoglycemia and assess patient - Rapid onset - seen in Type 1 and Type 2 diabetes o Treatment: - 15-20 grams of glucose or simple carbs - 4-6 0z of juice or soda (not diet) - 2 tablespoons of raisins - 1 tablespoon of sugar, honey, or corn syrup - 8072 of nonfat or 1% milk o ***Glucose absorption is delayed in foods with a lot of fat so NO cake, cookies, or candy bars = Can give glucagon IV or IM fora patient that cannot swallow or has altered LOC - D50 o Once the blood sugar is up, the patient should eat complex carbs and protein o Toprevent hypoglycemia the patient should eat, take their insulin, check blood sugar regularly, and know signs and symptoms of hypoglycemia * Diabetic Ketoacidosis (DKA) - an extreme increase in the hyperglycemic state; anything that increases blood sugar can throw a client into DKA (illness, infection, skipping insulin) o ***DKA may be the first sign of Type 1 diabetes o Signs and Symptoms: - Abdominal pain, anorexia, nausea, vomiting, diarrhea - Confusion increasing to coma - Warm, dry, flushed skin = Tachycardia with a weak pulse - Kussmaul’s respirations - trying to blow off CO2 to compensate for the metabolic acidosis - Fruity, acetone breath - Polyuria, Polydipsia, and Polyphagia = Glucose will be greater than 300 mg/dL - pH is low (less than 7.3), CO2 is normal, and HCO3 is low - metabolic acidosis - Ketones are high - Hematocrit is high due to dehydration - Hyperkalemia - potassium follows sugar o The onset for this is rapid - think type 1 diabetes “> Hyperosmolar Hyperglycemia Nonketosis (HHNK) or Hyperglycemia Hyperosmolar State (HHS) - these people are making just enough insulin so that they are not breaking down fats - no fat breakdown=no ketones=NO acidosis o ***Think type 2 diabetes o Signs and Symptoms: - More severe altered LOC - Warm, dry, flushed skin = Tachycardia - Tachypnea = Polyuria - Greater than 600 mg/dL blood sugar - NO acidosis - Hematocrit is high due to dehydration o The onset is slow - think type 2 diabetes o Treatment for HHNK and DKA: - Treat the underlying cause (infection) - Regular insulin administered IV - Kayexalate for hyperkalemia - Sodium Bicarb for severe acidosis = Once glucose gets closer to 250 mg/dL add glucose to the IV fluids to prevent cerebral edema and hypoglycemia R * Diabetic Retinopathy - impaired vision and blindness o Encourage yearly eye exams * Diabetic Neuropathy - caused from damage to sensory nerve fibers resulting in numbness and pain; leads to ischemia and infection o Patient may have sexual dysfunction o Neurogenic bladder - can have incontinence or retention (either pee or don’t) o Gastroparesis - delayed gastric emptying that causes regurgitation -— patient is at risk for aspiration o Provide foot care o Encourage annual exams by a podiatrist * Diabetic Nephropathy - damage to the kidneys from prolonged elevated blood glucose levels and dehydration o Monitor hydration and kidney function (serum creatinine) o Report an hourly output of urine less than 30 mL/hour o Monitor blood pressure o Encourage yearly urine analysis, BUN, microalbumin, and serum creatinine Don't shoot heroin and avoid boner pills o Encourage water Oo R “ Geriatric Patients with Diabetes: o Issues to consider: - Balance and gait - Nutritional status - Visual changes - Cognitive level - Functional capacity o Elderly patients should avoid high-intensity exercise that can increase the risk of myocardial ischemia, which can be asymptomatic in diabetes - strength training is best ¢ Immunity and Inflammation Objective Date: TAGE DEFINING CONDITIONS COUNT CD4+ TLYMPHOCYTE PERCENTAGE OF TOTAL LYMPHOCYT! stage 1 » None 500 cells/mm? or more 29 or more stage 2 >» None 200 to 499 cells/mm? 14 to 28 itage 3 >» One or more of the following: Less than 200 cells/mm? _Less than 14 AIDs)* , Candidiasis of the esophagus, bronchi, trachea, or lungs » Herpes simplex — Chronic ulcers (of more than 1 month duration) » HIV-related encephalopathy » Disseminated or extrapulmonary histoplasmosis » Kaposi's sarcoma » Burkitt's lymphoma » Mycobacterium tuberculosis of any site » Pneumocystis jirovecii pneumonia » Recurrent pneumonia » Progressive multifocal leukoencephalopathy » Recurrent Salmonella septicemia » Wastina svndrome attributed to HIV * Less than 200 is full diagnosis of AIDs * Signs and Symptoms: o Kaposi's Sarcoma - caused by an interaction between HIV, a weakened immune system, and the human herpesvirus-8 (HHV-8) - linked to the spread of HIV and HHV-8 through sexual activity = This is a vascular malignancy first noticed on the skin or mucous membranes - can also invade the lungs * Diagnosis: o Positive result from an HIV antibody-screening test (enzyme-linked immunosorbent assay (ELISA)) confirmed by a positive result from a supplemental HIV antibody test (Western blot test or indirect immunofluorescence assay test) - ELISA detects HIV antibodies - Western blot detects antibodies to specific viral proteins - this test is expensive and is used as confirmation of positive ELISA test Positive result or report of a detectable quantity from any of the following HIV virologic (viral load) testing: - RNA quantification (HIV viral load test) - determines viral load before beginning treatment; this test can be repeated to monitor disease progression, identify compliance, and determine medication resistance * Nursing Care: ° ooooo0o0o00 0 Assess risk factors - sexual practices, IV drug use Monitor fluid intake and urinary output Obtain daily weights to monitor weight loss Monitor nutritional intake Monitor electrolytes Assess skin integrity - rashes, open areas, bruising Assess the client’s pain status Monitor vital signs - especially temperature Assess lung sounds/ respiratory status - diminished lung sounds Assess neurological status - confusion, dementia, visual changes “ Medications: ° Highly active antiretroviral therapy (HAART) involves using 3 or 4 medications in combination to reduce medication resistance, adverse effects, and dosages Fusion inhibitors: Enfuvirtide (Fuzeon)- blocks the fusion of HIV with the host cell Entry inhibitors: Maraviroc (Selzentry) Nucleoside reverse transcriptase inhibitors: Zidovudine (Retrovir) - interferes with the virus’s ability to convert RNA into DNA Non-nucleoside reverse transcriptase inhibitors: Delavirdine (Rescriptor) and efavirenz (Sustiva) - inhibit viral replication in cells Protease inhibitors: Raltegravir (Isentress) Antineoplastic medication: Interleukin (Interferon) - immunostimulant that enhances the immune response and reduces the production of cancer cells (commonly used in Kaposi’s sarcoma) Long-term effects of HAART therapy are hypertension, diabetes, osteopenia, and hyperlipidemia R + R + Patient Education: ° ° ° ° Frequent hand hygiene to reduce the risk of infection Avoid crowded areas or traveling to countries with poor sanitation Avoid raw foods (fruits and vegetables) and undercooked meats, fish, or eggs *** Avoid cleaning the pet litter boxes to reduce risk of toxoplasmosis Opportunistic infections: ° Bacterial diseases: tuberculosis, bacterial pneumonia, and septicemia (blood poisoning) HIV-associated malignancies: Kaposi’s sarcoma, lymphoma, and squamous cell carcinoma Viral diseases: cytomegalovirus, herpes simplex, and herpes zoster virus Fungal diseases: pneumocystitis jirovecil pneumonia (PCP - do drugs), candidiasis, crytospoidiosis, and pencilliosis Protozoal diseases: such as PCP, toxoplasmosis, microsporidiosis, crytospoidiosis, isosporiasis, and leishmaniasis * Wasting syndrome: ° ° ° ° ° Maintain nutrition orally or by TPN if indicated Monitor weight, calorie counts, and 1&0 Provide between-meal supplements /snacks Decrease fat content of foods to prevent complications of fat intolerance Six small feedings, high in protein Seizures (HIV encephalopathy): ° ° Maintain safety Implement seizure precautions Systemic Lupus Erythematosus (SLE) SLE is an autoimmune disorder that affects multiple organs - it is characterized by a diffuse production of autoantibodies that attack and cause damage to body organs and tissue In autoimmune disorders, small antigens may bond with healthy tissue. The body then produces antibodies that attack the healthy tissue. This may be triggered by toxins, medications, bacteria, and/or viruses Risk Factors for SLE: ° Females between 20 and 40 = Clients whose SLE is unable to be managed with immunosuppressants and corticosteroids may experience renal failure secondary to glomerulonephritis. This is a major cause of death, and a renal transplant may be necessary. - Nursing Actions - Monitor for periorbital and lower extremity swelling and hypertension. Monitor the client’s renal status (creatinine, BUN). = Client Education - Teach the client the importance of taking immunosuppressants and corticosteroids as prescribed. - Teach the client the importance of avoiding stress and illness. o Pericarditis and myocarditis (instruct the client to report chest pain) - Inflammation of the heart, its vessels, and the surrounding sac can occur secondary to SLE. - Nursing Actions - Monitor for chest pain, fatigue, arrhythmias, and fever. = Client Education - Take immunosuppressants and corticosteroids as prescribed. - Avoid stress and illness. - Report chest pain to the provider. ¢ Rheumatoid Arthritis R + Rheumatoid arthritis (RA) is a chronic, progressive inflammatory disease that can affect tissues and organs but principally attacks the joints producing an inflammatory synovitis. It involves joints bilaterally and symmetrically, and it typically affects several joints at one time. RA typically affects upper joints first. RA is an autoimmune disease that is precipitated by WBCs attacking synovial tissue. The WBCs cause the synovial tissue to become inflamed and thickened. The inflammation can extend to the cartilage, bone, tendons, and ligaments that surround the joint. Joint deformity and bone erosion may result from these changes, decreasing the joint’s range of motion and function. RA is also a systemic disease that can affect any connective tissue in the body. Common structures that are affected are the blood vessels, pleura surrounding the lungs, and pericardium. Iritis and scleritis can also develop in the eyes. Rheumatoid arthritis is most often seen in older adults and usually progresses to systemic stages involving the heart, lungs, and other vital organs. Comorbid diseases complicate symptom management. Older adults often hesitate to exert themselves and frequently delay seeking help because they believe that nothing can be done for them. Fear and anxiety of the possible flare-up episodes and eventual disability outcomes are contributing factors to depression. Risk Factors o Female gender (3:1) Age 20 to 50 years Genetic predisposition Epstein-Barr virus Stress Environmental factors oooo0o$0 Signs and Symptoms: o Subjective Data - Pain at rest and with movement - Morning stiffness = Pleuritic pain (pain upon inspiration) - Xerostomia (dry mouth) - Anorexia/weight loss - Fatigue - Paresthesias - Recent illness/stressor - Joint pain - Lack of function Common early clinical manifestations include diffuse musculoskeletal pain, low-grade fever, possible anorexia, and loss of weight. Later, articular (within the joint) manifestations include synovitis, which is inflammation of the synovial capsule that causes escape of synovial fluid into the synovial capsule. Subsequent hypertrophy and symmetrical joint deformity (particularly wrists, hands, or knees) occur. Pain; muscle spasm; and weakness, because of contractures of muscles, tendons, and ligaments; and muscle and soft tissue damage greatly impact the person’s daily activities. o Objective Data - Clinical findings depend on the area affected by the disease process - Joint swelling and deformity, warmth, and erythema. - Finger, hands, wrists, knees, and foot joints are generally affected. - Finger joints affected are the proximal interphalangeal and metacarpophalangeal joints. - Joints may become deformed merely by completing ADLs. = Ulnar deviation, swan neck, and boutonniere deformities are common in the fingers. o Subcutaneous nodules - Fever (generally low grade) - Muscle weakness/atrophy = Reddened sclera and/or abnormal shape of pupils - Lymph node enlargement * Diagnostics: o Morning stiffness lasting more than one hour Arthritis of three or more joint areas Arthritis of hand joints Symmetrical arthritis Rheumatoid nodules over extensor surfaces or bony prominences Serum rheumatoid factors Radiographic changes oooo0$0 Anti-CCP antibodies - Positive = This test detects antibodies to cyclic citrullinated peptide (anti- CCP). The result is positive in most people who have rheumatoid arthritis, even years before symptoms develop. - The test is more sensitive for RA than rheumatoid factor (RF) antibodies. Oo o RF antibody - Diagnostic level for rheumatoid arthritis is 1:40 to 1:60 (expected reference range 1:20 or less). - High titers correlate with severe disease. - Other autoimmune diseases also can increase RF antibody. o Biologic response modifiers - etanercept (Enbrel), infliximab (Remicade), adalimumab (Humira), and chelator penicillamine (Cuprimine) o Cytotoxic medications - methotrexate (Rheumatrex), leflunomide (Arava), cyclophosphamide (Cytoxan), and azathioprine (Imuran). These medications can cause severe adverse effects. * Complications o Sjogren’s syndrome (triad of symptoms - dry eyes, dry mouth, and dry vagina) o Sjégren’s syndrome is a chronic inflammatory disorder involving the eyes that can be a primary problem or secondary to RA. There is a decrease in lacrimation and salivation due to obstruction of the secretory ducts by the immune complexes. Dry eyes (keratoconjunctivitis sicca) and dry mouth (xerostomia) are hallmarks of the disorder. o Manifestations include swelling of the lacrimal ducts and parotid glands and fatigue. o Nursing Actions: - Provide the client with eye drops and artificial saliva, and recommend vaginal lubricants as needed. - Provide fluids with meals. * Types of hypersensitive Reactions TYPE NAME REACTION Type1 — Anaphylactic Allergic rhinitis, asthma Type 2 Cytotoxic Transfusion reaction Type 3 Immune complex Systemic lupus erythematosus Rheumatoid arthritis Type 4 Delayed Transplant hypersensitive rejection reaction Adapted from Murphy, K.M., Travers, P., & Walport, M. (2007). Janeway’s immunobiology (7th ed.). New York: Garland Science Publishing. “ Contact Dermatitis ° Allergic contact dermatitis (ACD) is an inflammation of the skin caused by direct contact with an allergen. It is a type 4 allergic reaction, or delayed hypersensitivity reaction. The skin inflammation varies from mild irritation and redness to open sores, depending on the type of irritant, the body part affected, and the sensitivity of the individual. Irritants include water, soaps, detergents, solvents, acids, and alkalis. The rash is generally confined to the site of contact but may be transmitted by the fingers to other sites Medications: = Topical steroids - Triamcininolone (Aristocort): Ointment used on dry or cracked skin, creams used on inflamed skin or weeping lesions - Systemic steroids - Prednisone (Deltasone): Severe cases involving more than 20% of total body surface area (TBSA) - Antihistamines - Diphenhydramine (Benadryl) Hydroxyzine HCL (Atarax, Vistaril): Used to relieve pruritus associated with contact dermatitis