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Schedule I

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category of drugs with high abuse potential and no medical use (generally unsafe), e.g., heroin, lysergic acid diethylamide (LSD), and marijuana

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Schedule II

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high risk for abuse or physical or psychological dependency but also have safe and accepted uses, e.g., morphine, amphetamines, short-acting barbiturates, cocaine

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Schedule III

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less potential for abuse or addiction than Schedule II, e.g., paregoric, various analgesic compounds containing codeine

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Schedule IV

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medically useful category of drugs with less potential for abuse or addiction than Schedule II drugs, e.g., chloral hydrate, diazepam, meprobamate, phenobarbital

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Schedule V

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lowest potential for abuse of all categories, medically acceptable uses e.g., antidiarrheals and antitussives with opioid derivatives

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tips for pharma naming

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"PRILS" = ACE inhibitors (enalapril, lisinopril) "SARTANS" = angiotensin receptor blockers (losartan, valsartan) "TRIPTANS" = treatment of acute migraine headache "STATINS" = lower LDL cholesterol (simvastatin, rosuvastatin) "DIPINES" = calcium channel blockers (amlodipine, nifedipine) "PRAZOLES" = proton pump inhibitors (omeprazole) "AZOLES" = antifungals (miconazole)

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peak

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point in time after the administration when a medication exerts its strongest therapeutic and adverse effects; a serum blood sample is drawn (about 1 hour) after the drug is administered

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trough

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the lowest drug level that is needed to reach therapeutic range; a serum blood is drawn (about 30 minutes) before medication administration

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0.5-1ml

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max deltoid muscle injection

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depot injection

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intramuscular injection of a drug in an oil suspension that results in a gradual release of the medication over a period of time (from several days to weeks to months)

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isotonic solution

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Concentration of dissolved particles is similar to that of plasma Infused solutions remain in the extracellular space and increase intravascular volume ex. NS, LR, D5W, Ringer's solution

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Hypotonic solution

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Lower tonicity or solute concentration Fluids shift from the intravascular space to both the intracellular and interstitial spaces Hypotonic fluids are used to treat conditions causing intracellular dehydration, including diabetic ketoacidosis & hyperosmolar hyperglycemic state ex. 0.45% nacl, 0.33% nacl, 0.2% nacl 2.5 dextrose in water

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Hypertonic (crystalloid) solution

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Higher tonicity or solute concentration Water is drawn out of the intracellular space, increasing extracellular fluid volume Hypertonic fluids are used as volume expanders for conditions such as severe hyponatremia & cerebral edema Typically administered only in high acuity areas with constant nursing surveillance ex. 3% nacl, 5% nacl, 5% dextrose and 0.45% nacl, 5% dextrose and 0.9% nacl, D5LR, D10W, D20W

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Hypertonic (colloid solutions)

answer

Unlike crystalloids, colloids contain molecules too large to pass through semipermeable membranes; they expand intravasular volume by drawing fluid from the interstitial spaces into the intravascular compartment through their higher oncotic pressure Known as volume expanders or plasma expanders Colloids are indicated for conditions such as hypoproteinemia and malnourished states and for individuals who cannot tolerate large infusions of fluid ex. albumin, dextrans (low-molecular weight dextran [LMWD] & high-molecular weight dextran [HMWD]) hydroxyethylstarches (hetastarch and hespan)

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collection chamber

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- chest tube chamber that collects fluid -monitor and document rate and nature of drainage (initially every 30 minutes in first few hours, then every 1 to 4 hours)

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water seal chamber

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- chest tube chamber that provides a one-way valve so that air leaves and cannot reenter chest - bubbling is normal initial 48 to 72 hours - tidaling (expected to rise with inspiration, fall with exhalation)

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suction control chamber

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- negative pressure transmitted to pleural space is determined by the amount of solution in this chamber, not the setting on the wall suction - expected finding is continuous bubbling in chamber - used to enhance re-expansion of lung quickly

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Buck's traction

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- Simple horizontal traction Unilateral or bilateral limb traction - Used before repair of fractured hip or for lumbosacral muscle spasms - remove every 2 to 4 hours to inspect skin integrity

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Donlop's traction

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- Horizontal Buck's Extension to humerus with vertical Buck's extension to forearm - Used for supracondylar fractures of the humerus

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Bryant's traction

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- Vertical extension with bilateral traction to legs Hips kept at 90-degree flexion Buttocks kept one hand-level off the bed -Used in infants or children weighing less than 35 to 40 pounds for fractured femur or congenital hip dysplasia

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Cotrel traction

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- Head halter and pelvic belt pulling in opposite directions - Preoperative treatment for spinal curvatures

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Pelvic Belt

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- Girdle-type belt that fits around lumbosacral area - Used for low back pain, muscle spasms, and ruptured nucleus pulposus

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Pelvic Sling

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- Hammock-like sling that cradles pelvis - Used for fractured pelvis

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Cervical Halter

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- A strap under the chin - Used for degenerative or arthritic conditions of cervical vertebrae

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Russell's Traction

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- Modified Buck's extension with sling under knees; note risk of impaired circulation in lower leg - Used for fractures of femur, hip, or knee disorders

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Preanesthetic medications

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- sedatives/hypnotics - calming effect - narcotics - to relieve pain, calming effect - anticholinergics - to dry secretions, tranquilizers and antianxiety agents - to decrease nervousness, promote relaxation - H1-receptor antagonists - to prevent nausea and vomiting, e.g., promethazine (Phenergan) - proton pump inhibitors - to decrease acid production in stomach - possibly an antibiotic - to reduce risk of infection

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malignant hyperthermia

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- complication of general anesthesia - a hypermetabolic state - rapid progressive rise in body temperature (may exceed 102 degrees Fahrenheit) - fatal if not treated - s/sx: tachycardia, tachypnea, unstable BP, diaphoresis, muscle rigidity - tx: dantrolene (Dantrium)

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somatic pain

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- the nerves (nociceptors) that detect pain are located in the skin and deep tissues, picking up sensations related to temperature, - tissues such as skin, muscle, joints, bones, and ligaments - "musculoskeletal pain" - sharp and well-localized; tends to be intense - Examples: fibromyalgia, tension headaches, chronic back pain (not caused by nerve damage), arthritis

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visceral pain

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- comes from the internal organs - specific receptors for stretch, inflammation, and oxygen starvation (ischemia) are involved - often poorly localized - vague, deep ache that involves a cramping sensation - referred pain to the back (but it is not in a direct nerve distribution), e.g., gallbladder pain can radiate to the scapula - Examples: irritable bowel syndrome, cystitis, endometriosis pain, prostate pain

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neuropathic pain

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- caused by damage to or dysfunction of the nerves, spinal cord, or brain (the central nervous system) - often coexists with nociceptive pain - follows nerve distribution path - "pinched nerve" - shooting, burning or hypersensitive - numbness, tingling and weakness involved in the area of referred pain - nerve compression, as with a tumor or ruptured intervertebral disk - nerve damage, as occurs in metabolic disorders such as diabetes mellitus - abnormal or disrupted processing of pain signals by the brain and spinal cord - Examples: diabetic neuropathy, trigeminal neuralgia, postherpetic zoster pain, thalamic pain syndrome, sciatica, phantom limb pain

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sympathetic pain

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- due to possible over-active sympathetic nervous system and central/peripheral - extreme hypersensitivity in the skin and around the injury and also peripherally in the limb - the limb is usually so painful that the client will refuse to use it, which can cause secondary problems like muscle wasting and joint contractures - occurs more commonly after a fracture and soft tissue injuries of the arms and legs, and these injuries may lead to Complex Regional Pain Syndrome (CPRS), which is also called Reflex Sympathtic Dystrophy (RSD) - Examples: neuropathy, neuralgia, neuritis

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paralytic ileus

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- severely diminished or absent peristalsis - caused by stress response to surgery and anesthesia, trauma or manipulation of abdominal contents, electrolyte imbalance such as low potassium, anesthetics and pain medications, wound infections and immobility - occurs to some degree after all abdominal surgeries - bowel sounds should return gradually within 48 to 72 hours after the surgery - s/sx: decreased or absent bowel sounds; abdominal distention with tight, tense abdomen; feeling of fullness, pain of abdomen with activity

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syngeneic

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- donor and recipient are identical twins

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autologous

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- client receives own bone marrow cells, harvested before high-dose chemotherapy or radiation

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allogeneic

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- donor is not genetically identical to recipient

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Basic metabolic panel

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- is a group of 8 specific tests used to determine the status of the kidneys, blood sugar, electrolyte and acid/base balance. - This commonly-ordered test includes: glucose, calcium, sodium, potassium, CO2, chloride, BUN and creatinine.

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Schick test

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- a test that detects the presence of diphtheria toxin.

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laparoscopy

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- involves injecting (carbon dioxide or nitrous oxide) gas into the abdominal cavity to expand the area for better viewing. Many people experience shoulder pain for a few days after the procedure because the gas irritates the diaphragm, which shares some of the same nerves as the shoulder.

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Fluoroscopy

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- is a type of medical imaging that shows a continuous x-ray image on a monitor. It is used to diagnose or treat clients by displaying the movement of a body part or of an instrument or dye (contrast agent) through the body.

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intravenous cholangiogram (IVC)

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- is an iodine-based contrast study designed to visually study the function of the bile ducts.

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Pacemakers

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- uses low-energy electrical pulses to speed up a slow heart rhythm, help control abnormal or fast rhythms, and coordinate electrical signaling between the chambers of the heart

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Implantable cardioverter defibrillators (ICD)

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- uses both low-energy and high-energy electrical pulses (these high-energy pulses treat the life-threatening arrhythmias).

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myelogram

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- uses a special dye (oil-based, water-soluble and even air-contrast) and an x-ray (fluoroscopy) to make pictures of the bones and the subarachnoid space between the bones in the spine.

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electromyogram (EMG)

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- Electrical activity in muscles is measured ; this is a painful test.

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cisternography

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- is a radioisotope scan of CSF in one of the cisterna within the skull or subarachnoid spaces.

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ileal conduit

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- is a urinary diversion, bypassing the urinary bladder. The ureters are connected to the small intestine and the part of the small intestine is then brought out (looped) through the skin (this is the ileal conduit), which is used to create a stoma through which urine will drain.

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pilocarpine test

answer

- also known as a sweat test. It is used for diagnosing cystic fibrosis. - measures sodium and chloride excretion from sweat glands.

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esophageal manometry

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- thin, pressure-sensitive tube is passed into the esophagus. As the client swallows, the tube measures the pressure of the muscle contractions. This test is used to determine the cause of dysphagia, to evaluate for signs of GERD, or when there is chest pain that may be coming from the esophagus.

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urinary bladder ultrasound

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The client must drink 32 ounces of water and be finished drinking 60 minutes prior to the start of the exam. The client cannot void until after the exam.

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QRS complex

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- in ECG represents the time it takes for depolarization of the ventricles. The duration of the QRS complex is normally 0.06 to 0.1 seconds.

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MRI

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- uses a powerful, magnetic fields and radiofrequency energy to create clear pictures of internal body structures. Because of these magnetic fields, clients must remove all metal objects or risk injury. Clients with shrapnel, a pacemaker, or any surgically implanted joints may not be able to have this test.

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non-rebreather mask

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- delivers the highest percentage of oxygen of any of the high flow systems; near 100%. It should be used only in medical emergencies, for a relatively short time (6 to 8 hours); any longer and the client risks pulmonary oxygen toxicity.

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SA (sinoatrial) node

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- referred to as the pacemaker of the heart; located in the right atrium (intrinsic rate of 100 impulses per minute)

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atrioventricular node or AV node

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- "junctional tissue" (intrinsic rate of 40 - 60 impulses per minute)

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bundle branch/Purkinje system

answer

- the electrical system located in the septum and into cardiac tissues intrinsic rate 20-40 impulses per minute

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Leukocytes increase with

answer

Neutrophil- Bacteria or fungus Lymphocyte- Viral or tumor Eosinophil & Basophil- Allergies Monocyte- nonspecific infection

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Platelets

answer

- Small fragments of cells - Life span eight to ten days - Essential to blood clotting/coagulation - Forms the Initial "plug" at the site of injury

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Dextrocardia

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- may be due to a congenital defect, or caused by disease or surgery. There are no symptoms of dextrocardia if the heart is normal, so no treatment is required.

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Pericarditis

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- inflammation of the pericardial sac - s/sx: sharp chest pain often relieved by sitting upright and leaning forward and worsened with coughing and lying in supine position; pericardial friction rub; dyspnea ever, sweating, chills (with infectious causes); dysrhythmias, pulsus paradoxus (fall in systolic BP with inspiration > 10 mm Hg) ;client cannot lie flat without severe chest pain or dyspnea

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Dressler's syndrome

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- "post myocardial infarction syndrome" - a combination of pericarditis, pericardial effusion and constrictive pericarditis; etiology is unclear - occurs several weeks to months after a myocardial infarction

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Myocarditis

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- an inflammatory condition of the myocardium - s/sx: fatigue and dyspnea, palpitations, occasional precordial discomfort manifested as a mild chest soreness and persistent fever ; history of recent upper respiratory infection with fever, viral pharyngitis, or tonsillitis; fatigue and dyspnea; possible signs of congestive heart failure: peripheral edema, weight gain, crackles in lungs; abnormal heart sounds: murmur, S3 or gallop or friction rub; tachycardia disproportionate to the degree of fever; joint pain or swelling

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digitalis toxicity

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- anorexia, nausea, vomiting, blurred vision, cardiac arrhythmias

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Endocarditis

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- an infection of the endocardium, heart valves, or heart valve prosthesis resulting from bacterial or fungal invasion - s/sx: cardiac murmurs in 85% to 90% of clients usually a murmur that changes suddenly, or a new murmur that develops in the presence of a fever; fever, chills, nightsweats with no identifiable source of infection "fever of unknown origin"; pericardial friction rub malaise, fatigue, anorexia, petechiae of the skin, splinter hemorrhage under the nails signs of infarction related to embolization

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rheumatic endocarditis

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- damage to the heart, particularly the valves, resulting in valve leakage (regurgitation) and/or stenosis; to compensate, the heart's chambers enlarge (dilate) - s/sx: history of streptococcal pharyngitis (sudden sore throat, often with tonsillar exudate; swollen, tender lymph nodes at angle of jaw; headache; fever to 104° Fahrenheit); polyarthritis manifested by numerous warm and swollen joints (usually elbows, wrists, knees and ankles); high fever with chills, malaise; chorea (emotional instability, muscle weakness with quick, uncoordinated jerky movements usually in the face, feet, and hands); rash- erythema marginatum (ring-like or snake-shaped rash on trunk and extremities); subcutaneous nodules; heart problems including shortness of breath and chest pain; heart murmurs pericardial friction rub and pericardial rub

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Mitral Stenosis

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- mitral valve thickens and gets narrower, blocking blood flow from the left atrium to left ventricle - s/sx: mild - asymptomatic heart murmur; moderate to severe stenosis: symptoms of left-sided heart failure due to blood backing up into lungs and poor cardiac output (heart murmur, dyspnea on exertion, orthopnea (dyspnea when supine), recent history of propping up with pillows to sleep or sleeping in recliner); paroxysmal nocturnal dyspnea (PND, sudden waking due to shortness of breath); crackles to severe congestion in the lungs; weakness, fatigue, palpitations; mild weight gain

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Mitral Insufficiency

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- a damaged mitral valve allows blood from the left ventricle to flow back into the left atrium during ventricular systole; to handle the backflow, the atrium enlarges (as does the left ventricle, in order to make up for its lower cardiac output) - s/sx: client may be asymptomatic; orthopnea, dyspnea, fatigue, weakness,weight loss; chest pain and palpitations; systolic murmur at the apex; high pitched, blowing murmur; may radiate to axilla; jugular vein distention, peripheral edema, hepatomegaly

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DO-ABLE mnemonic for heart failure interventions

answer

- Diuretics - to relieve pulmonary congestion, fluid overload & return to baseline weight - Oxygen - to correct hypoxia - ACE inhibitors - to reduce preload and afterload, counteracting compensatory hormones - Beta-blockers - to prevent arrhythmias and reduce heart workload - Low sodium diet - to prevent fluid retention - Exercise as tolerated - to monitor response to therapy and return to baseline functional status

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CARDIAc LeVeLS mnemonic for cardiac assessment

answer

Chest discomfort Activity tolerance Response to drug therapy Depression & anxiety Increased weight Arrhythmias c... Lightheadedness e... Vital sign changes e... Level of consciousness decreased Shortness of breath

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Self-care instructions for heart failure: R-E-A-L keys

answer

- Report findings of heart failure to provider - weight gain, worsening dyspnea, orthopnea, fatigue - Exercise is important - start low & go slow to increase functional capacity, attending to symptoms - Adherence to cardiac medications is essential to staying healthy - Lowsodium diet - 2000 grams per day

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Tricuspid Stenosis

answer

- narrowing of the blood flow through the tricuspid valve between the right atrium and right ventricle - s/sx: right heart failure and poor cardiac output when severe; dyspnea, fatigue, weakness, syncope; peripheral edema, ascites. pulmonary edema unlikely as blood is backing up from right side of heart into venous system; distended jugular veins

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Tricuspid insufficiency

answer

- tricuspid valve does not close properly during ventricular systole, allowing blood to leak from the right ventricle back into the right atrium - s/sx: right heart failure and poor cardiac output when severe; asymptomatic in early stages; dyspnea, fatigue, weakness and syncope; distended jugular veins; peripheral edema, ascites. pulmonary edema unlikely as blood is backing up from right side of heart into venous system

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Pulmonic Stenosis

answer

- narrowing of pulmonic valve between right ventricle and pulmonary artery obstructs right ventricular outflow leading to right ventricular hypertrophy and right heart failure - s/sx: cyanosis dyspnea, fatigue, syncope, findings of right heart failure; cyanosis, failure to thrive

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Pulmonic insufficiency

answer

- pulmonary valve fails to close, so that blood flows back into the right ventricle during ventricular diastole - s/sx: dyspnea, fatigue, chest pain and syncope; peripheral edema may cause discomfort; if advanced:jaundice with ascites and peripheral edema; possible malnourished appearance

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Treatment for pulmonary edema: M DOG

answer

M = Morphine D = Diuretics (furosemide) O = Oxygen G = Gases (blood gasses)

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Aortic Stenosis

answer

- aortic valve becomes narrowed, causing poor cardiac output and increasing left heart pressures. - s/sx: classic triad = dyspnea (especially with exertion), syncope, angina (see assessing clients with cardiovascular disorders); fatigue, palpitations, left-sided heart failure may occur with orthopnea, paroxysmal nocturnal dyspnea and crackles in the lungs; systolic murmur that radiates into carotid arteries and the apex of the heart; EKG - findings of left ventricular hypertrophy

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Aortic Insufficiency

answer

- blood flows back into the left ventricle during ventricular diastole overloading the ventricle and causing it to hypertrophy extra blood - s/sx: uncomfortable awareness of heartbeat palpitations along with a pounding head; dyspnea with exertion; orthopnea, paroxysmal nocturnal dyspnea, cough; fatigue and syncope with exertion or emotion; anginal chest pain unrelieved by sublingual nitroglycerin; heartbeat that seems to jar the client's entire body; client's nailbeds may appear to be pulsating when fingertip is pressed (Quincke's sign); if right ventricle fails, client may show signs of right heart failure with peripheral edema, jugular vein distention and ascites; high pitched diastolic murmur at third or fourth intercostal space - left sternal border; pulsus bisferiens: a double-beat pulse (palpated over the carotid or brachial arteries); widened pulse pressure

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Cardiovascular Disorders

answer

1. Pericarditis 2. Myocarditis 3. Endocarditis 4. Rheumatic Endocarditis 5. Mitral Stenosis 6. Mitral Insufficiency 7. Tricuspid Stenosis 8. Tricuspid Insufficiency 9. Pulmonic Stenosis 10. Pulmonic Insufficiency 11. Aortic Stenosis 12. Aortic Insufficiency 13. Myocardial Infarction 14. Heart Failure 15. Cardiac Tamponade

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Myocardial Infarction

answer

- nsufficient oxygen supply kills (causes necrosis) myocardial tissue; may be sudden or gradual and total event may take 3 to 6 hours - persistent, crushing substernal chest discomfort - s/sx: pain may radiate to the left arm, jaw, neck and shoulder blades, with a feeling of impending doom (pain may persist for 12 hours or more, some clients report no pain or call it mild indigestion); fatigue, nausea, vomiting and shortness of breath sudden death; within the first hour clients may experience hypertension; others may experience hypotension with signs of shock, especially with large anterior-lateral ST elevation on EKG ("tombstone" appearance)- poor prognosis- risk of sudden death and complications- EMERGENCY revascularization needed!

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Therapeutic treatment for Myocardial infarction: "O BATMAN!"

answer

O =Oxygen B =Beta blocker A =ASA (aspirin) T =Thrombolytics (heparin) M =Morphine A =ACE (especially for those with heart failure or a lower ejection fraction) N =Nitroglycerin

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THE CARDIO-CARE SIX: ABCDEF

answer

A- ADLs, help clients w/ adls--stresses heart less B- Bed rest, maintain bed rest to reduce O2 demand C- Commode, stresses heart less than using bedpan. D- Diversions, offer diversionary activities that don't stress the heart. E- Elevate head of head, to increase chest expansion and improve ventilation F- Feelings, listen to client's concerns and provide emotional support to reduce anxiety.

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Heart Failure

answer

- damaged fails to pump enough blood to support the body's functions, leading to poor cardiac output and fluid overload

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Cardiac Tamponade

answer

- fluid quickly fills pericardial sac and minimizes cardiac output, requiring emergency care to avoid cardiac arrest - s/sx: hypotension with muffled heart sounds with marked jugular vein distention if no hypovolemia; pulsus paradoxus, narrowed pulse pressure, tachypnea, tachycardia, restlessness, lightheadedness or decreased level of consciousness

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Pregnancy Induced Hypertension (PIH)

answer

-high blood pressure present before week 20 of gestation

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Accelerated Hypertension

answer

- a hypertensive crisis when blood pressure rises very rapidly, threatening the brain

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acute hypertensive crisis

answer

- findings reflect the effects of sudden blood pressure elevation on organs brain: hypertensive encephalopathy (often first sign) severe headache, nausea, vomiting, seizures, confusion, coma, or stroke-like symptoms eyes: papilledema heart: rapid development of angina or myocardial infarction, pulmonary edema. kidneys: new renal insufficiency or renal failure

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Coronary Artery Disease

answer

- fatty deposits in coronary arteries (atheroma or plaque) narrow the artery (by 75% or more) reducing flow of blood and oxygen to the heart muscle - s/sx: early stages- asymptomatic anginal chest discomfort or cardiac symptoms when blockage significantly reduces cardiac blood flow (> 70% narrowing)

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DISORDERS OF THE CIRCULATORY SYSTEM

answer

1. Hypertension 2. Coronary Artery Disease (CAD) 3

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Hyperlipidemia

answer

- an elevation of lipids (fats) in the bloodstream, e.g., cholesterol, cholesterol esters (compounds), phospholipids, triglycerides

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Management of atrial fibrillation: ABCD

answer

A =Anticoagulant B =Beta blocker to control rate C =Cardioversion (if beta blocker ineffective or calcium channel blocker to control rate) D =Digoxin

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Aneurysm

answer

- dilation of an artery due to a weakness in the arterial wall - s/sx: - usually asymptomatic vague abdominal or back pain- if severe, this may be a sign of active dissection, requiring emergent care tenderness & pulsation felt on palpation hypotension diminished pulses in lower extremities most common site: just below renal arteries and above iliac arteries

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Arterial Occlusive Disease

answer

-insufficient blood supply in the arteries (usually in legs); may be acute or chronic

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6 P's of acute arterial occlusion:

answer

P allor (or mottling) P ain P aresthesia (numbness or tingling) P allor (cool or cold skin) P ulselessness (distal to the blockage) P aralysis (or weakness or muscle spasm)

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Acute Arterial Occlusive Disease

answer

- - s/sx: pain in affected limb, especially with activity or walking cyanosis in affected limb paresthesia in affected limb if untreated, gangrene

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Chronic Arterial Occlusive Disease

answer

- intermittent claudication (predictable pain with walking relieved with rest, also called "angina of the legs") - indicates mild to moderate obstruction pain at rest indicates severe arterial obstruction affected limb will show skin: waxy, hairless, cool, pale, cyanotic weak or absent pulses paresthesia non-healing wounds in men, impotence

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Raynaud's Phenomenon

answer

- episodic vasospasm of the small cutaneous arteries that results in intermittent pallor or cyanosis of the skin - usually affects the fingers bilaterally, but occasionally affects the toes, nose, or tongue that result in intermittent pallor or cyanosis of the skin the process involves a severe constriction of cutaneous vessels followed by vessel dilation and then a reactive hyperemia (blue, white, red). can lead to tissue necrosis when severe.

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Thromboangiitis obliterans (Buerger's disease)

answer

- inflammatory disease of the arteries (vasculitis), usually affecting the legs and feet, but sometimes the hands - s/sx: pain, including intermittent claudication numbness and tingling of toes weak or absent peripheral pulses - remember the 6 P's! ischemic ulcerations may occur can lead to gangrene and amputation

question

Varicose veins

answer

- dilation of superficial veins of the legs and feet - s/sx: pain after period of standing foot and ankle swelling at end of day distended leg veins

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Thrombophlebitis

answer

- a thrombus (clot) accompanied by the inflammation of the wall of a superficial blood vessel - s/sx: swelling tenderness warmth complication: thromboembolism - dislodgement and migration of a thrombus

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Deep venous thrombosis

answer

- clot formation in a deep vein (upper or lower extremity) - s/sx: unilateral edema of an extremity, with warmth, tenderness and redness at site

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Venous stasis ulcers

answer

- hronic skin and subcutaneous ulcers usually found on legs, ankles or feet (often is a chronic symptom for clients with chronic venous insufficiency) - s/sx: open skin lesion with irregular border skin around ulcer usually brown and leathery pain in affected area

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Sickle cell anemia

answer

- one of a group of diseases in which normal adult hemoglobin A (HbA) is partly or completely replaced by abnormal sickle hemoglobin (HbS)

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Types of crises in Sickle cell anemia

answer

vaso-occlusive - painful distal ischemic usually hands and feet sequestration crisis - pooling of blood in liver and spleen aplastic crisis - diminished RBC production hyperhemolytic crisis increased destruction of RBC

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B- Thalassemia " Cooley's anemia"

answer

- inherited blood disorder characterized by deficiencies in rate of production of specific globin chains in hemoglobin - s/sx: severe anemia, pallor microcytic RBCs impaired growth splenomegaly

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Von Willebrand's disease

answer

- the clotting protein is deficient or defective, affecting both males and females, the most common congenital (autosomal dominant) bleeding disorder - s/sx: easy bruising, nosebleeds, heavy menstrual periods, prolonged bleeding times, epistaxis (nosebleed), blood in stool or urine

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Aplastic anemia

answer

- a rare condition that occurs when the body stops producing enough new blood cells - s/sx: petechiae, bruising, pallor, fatigue, myelosuppression

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Hemophilia

answer

- group of bleeding disorders in which there is a deficiency of one of the factors necessary for coagulation of blood - s/sx: mild-severe prolonged bleeding; most often in muscles and joints (hemathrosis) long-term loss of range of motion of affected joints

question

desmopressin acetate (DDAVP)

answer

- antidiuretic that aids blood clotting

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Disseminated Intravascular Coagulation (DIC)

answer

- disorder of coagulation characterized by clotting followed by bleeding - s/sx: bleeding, bruising, petechiae altered serum levels of clotting-related factors (increased PT, PTT, TT, decreased platelets, degraded fibrinogen) clotting, hypoxemia, intracranial hemorrhage, progressive organ failure

question

Rhinitis

answer

- Definition: inflammation of the mucous membrane of the nose marked especially by rhinorrhea, nasal congestion and itching, and sneezing - s/sx: excessive nasal drainage and congestion, postnasal drip with sore throat, allergic causes: nasal itchiness and sneezing, watery eyes, viral causes (common cold): sore throat, general malaise, fever, chills, headache, bacterial causes: purulent nasal discharge, fever.

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Sinusitis

answer

- nflammation of one or more of the paranasal sinuses - frontal headache tenderness over the affected sinus(es), especially when palpated or percussed purulent nasal drainage and congestion nasal obstruction fever malaise tooth pain

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Pharyngitis

answer

- inflammation of mucous membranes of pharynx - scratchy throat throat pain, often severe, worsened by swallowing pharynx can appear red and edematous with or without patchy white or yellow exudates

question

Tonsillitis and Adenoiditis

answer

- inflammation and infection of the tonsils and especially the palatine tonsils - sore throat - may be recurrent fever difficulty swallowing enlarged tonsils and adenoids - may be "kissing tonsils" where they are touching foul smelling breath (halitosis) noisy respirations - snoring loudly during sleep if enlarged adenoids recurrent ear infections

question

Periotonsillar abscess

answer

- complication of acute tonsillitis or pharyngitis with spread of tonsillar infection into the surrounding tissue - s/sx: inability to swallow saliva with drooling marked tonsillar enlargement, possibly threatening airway "hot potato" or muffled voice high fever and chills increased white blood cell count facial swelling

question

Laryngitis

answer

- inflammation of vocal cords and surrounding mucous membranes - s/sx: hoarse voice swollen lymph nodes in neck (cervical lymphadenopathy) fever larynx blocked by edema, spasm or both

question

Vocal cord paralysis

answer

- damage to both laryngeal nerves may lead to airway obstruction - emergency treatment needed! - s/sx: hoarse voice, difficulty swallowing

question

emphysema

answer

- walls of alveoli enlarge and lose elasticity, trapping air and decreasing capacity for vital gas exchange

question

chronic bronchitis

answer

- chronic inflammatory response in the bronchioles of the lung

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Asthma

answer

- a chronic lung disorder marked by recurrent episodes of bronchospasm-related airway obstruction triggered by hyperreactivity to various stimuli, producing airway narrowing and tenacious, thick, excess, mucous - s/sx: (expiratory) wheezing, often audible - wheezing may decease or stop with worsening bronchoconstriction as airflow becomes severely limited Listen shortness of breath cough with sputum production normal or low oxygen saturation chest tightness tachycardia use of accessory respiratory muscles with respiratory distress high normal PaCO2 and low normal PaO2

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Interstitial lung disorders

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- irritants, e.g., toxic drugs, radiation, and industrial substances, cause damaging inflammation of the alveoli and interstitial tissue of the lungs; as a result, the lungs become scarred, stiff, and non-compliant - s/sx: difficulty inhaling evidences of hypoxia (chronic) cough hemoptysis fatigue anorexia weight loss

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pleural effusion:

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- fluid (transudate or exudate) in the pleural space; treated with thoracentesis or chest tube

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empyema:

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- purulent drainage in pleural space; usually a complication of pneumonia, treated with chest tube and antibiotics

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chylothorax:

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- milky white lymphatic fluid in pleural space, treated with thoracentesis or chest tube, pleurodesis or surgery

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Guillain Barre Syndrome (GBS)

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- a group of autoimmune peripheral neuropathies resulting in symmetric and ascending motor paralysis; an acute condition; potentially fatal if respiratory muscles are affected - s/sx: typically begins with weakness accompanied by tingling sensation in the extremities ascending paralysis begins in the lower extremities and may affect the entire body autonomic nervous system involvement may include fluctuations in blood pressure and dysrhythmias, usually with severe disease pain - hyperesthesias, paresthesias, muscle aches and cramps when the weakness/paralysis reaches the respiratory muscles the client is unable to maintain an adequate respiratory effort

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Myasthenia Gravis

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-autoimmune disorder with fluctuating weakness of skeletal muscle - s/sx: skeletal muscle weakness with a pattern of fluctuation, and improved strength after rest muscles most commonly involved are facial muscles including those responsible for chewing and swallowing and speech - risk for aspiration proximal muscle weakness in neck, shoulders and hips exacerbations can be caused by stress, temperature extremes, pregnancy, certain drugs myasthenic crisis can cause respiratory failure and need for emergent care

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anticholinesterase (Tensilon) test

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- in myasthenia gravis, improved muscle contractility following administration (note: atropine should be available for emergency use during this test)

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Poliomyelitis

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- viral infection that can affect nerves and can lead to partial or full paralysis - subclinical infection (95% of cases): ranging from no findings to malaise, headache, red throat, slight fever, vomiting nonparalytic: back pain, diarrhea, fatigue, headache, irritability, leg pain, moderate fever, muscle stiffness, neck pain and stiffness, rash paralytic: fever; abnormal sensations; bloated feeling in abdomen; difficulty breathing, constipation; muscle pain, contraction or spasms; sensitivity to touch; stiff neck and back post-polio syndrome: a complication that develops in some people, usually 30 or more years after initial infection complications may include aspiration pneumonia, cor pulmonale, kidney stones, urinary tract infections, shock

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Amyotrophic lateral sclerosis (ALS; also called Lou Gehrig's Disease)

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- a disease of the nerve cells in the brain and spinal cord that control voluntary muscle movement - s/sx: usually begins in upper extremities progressive neuromuscular weakness, spasticity, inability to communicate or move voluntarily, loss of involuntary reflexes such as blinking and gag reflex autonomic, sensory and mental function unchanged leads to respiratory failure and death within 2 to 6 years

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Pneumonia

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- a lung disease characterized by inflammation and consolidation of lung tissue followed by resolution - s/sx: fever, chills, malaise shortness of breath with decreased oxygen saturation productive cough with purulent sputum pleuritic chest pain crackles in affected lobe(s), egophony, whispered pectoriloquy (indicating consolidation)

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Whispered pectoriloquy

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- Sounds: sound of increased voice resonance heard through the chest wall when a client whispers a word or a number (usually the number '99') Respiratory tract involvement: heard over cavities that communicate with a bronchus Causes, exacerbations/remittance often a sign of lung consolidation whispered sounds are not normally heard through the chest wall

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Wheeze

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-Sounds :high-pitched whistling sounds sibilant: high-pitched sounds, with a shrill or squeaking quality typically occur when airways are narrowed, e.g., during an acute asthmatic attack sonorous: lower-pitched sounds, with a snoring or moaning quality; secretions in large airways (due to bronchitis) produce these sounds; may clear somewhat with coughing; expected to be expiratory with COPD Respiratory tract involvement usually the problem originates in the bronchial tubes but it may be due to blockage in larger airways usually heard on expiration but may occur during inspiration, expiration, or both Causes, exacerbations/remittance: caused by air moving through airways narrowed by constriction, swelling of airway, or partial airway obstruction (due to secretions) Associated health conditions asthma COPD

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Stridor

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Sounds intense, continuous, monophonic wheeze-like sound usually high-pitched, musical sound often heard without the aid of a stethoscope Respiratory tract involvement upper airway, including the larynx and/or trachea heard loudest over extrathoracic airway accentuated during inspiration, but may be inspiratory, expiratory or both Causes, exacerbations/remittance partial upper airway obstruction, often from a spasm may be a medical emergency Associated health conditions tonsillar abscess airway injury allergic reaction croup inhalation of a foreign object

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Rhonchi

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Sounds essentially the same as a wheeze, but sound is lower-pitched, coarse, rumbling may have a snoring or rattle-like quality Respiratory tract involvement large airways more commonly heard during expiration, but may occur in either during inspiration or expiration Causes, exacerbations/remittance caused by air moving past secretions in larger airways passages may disappear after coughing Associated health condition: pneumonia

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Pleural friction rub

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Sounds different from all other adventitious sounds continuous high-pitched, grating, or squeaking sound Respiratory tract involvement: heard more on inspiration, but can be heard on both inspiration and expiration Causes, exacerbations/remittance occurs when inflamed pleural surfaces (parietal and visceral layers of an inflamed pleura) rub together during respiration not affected by coughing to differentiate between this and a pericardial friction rub, ask the client to hold his breath briefly and if the rubbing sound continues, it is a pericardial friction rub; a pleural rub stops when breathing stops Associated health conditions pleuritis pleurisy

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Crackles (also called Rales)

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Sounds fine crackles - the sound is similar to rolling a strand of hair between your fingers near your ear or by moistening your thumb and index finger and separating them near your ear - soft, high-pitched, very brief medium crackles coarse crackles - often described as the sound of opening a Velcro fastener louder, lower in pitch, and last longer than fine crackles; may sound wet Respiratory tract involvement small bronchi, bronchioles, alveoli (distal parts of the airway) tend to occur at the end of inspiration but can be heard on either inspiration or expiration Causes, exacerbations/remittance often associated with inflammation or infection; caused by fluid build up in the small airways or due to atelectasis "popping" or bubbly sounds produced are created when air is forced through respiratory passages that are narrowed by fluid, mucus, or pus exaggerated with a deep breath if crackles don't clear after a cough may indicate pulmonary edema or fluid in the alveoli due to heart failure or adult respiratory distress syndrome (ARDS) Associated health conditions CHF atelectasis pneumonia interstitial fibrosis

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Pulmonary Tuberculosis

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- a chronic infection caused by an acid-fast bacillus, generally transmitted by inhalation or ingestion of infected droplets - s/sx: early weakness, fatigue anorexia, weight loss chest pain - pleurisy late productive cough with purulent sputum night sweats

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Mantoux skin test

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- positive if > 10 mm induration in healthy persons (or positive if > 5 mm induration in clients who are immunosuppressed) - additional tests are needed false-negative responses - common in people who are immunosuppressed; two-step Mantoux is used for this population (and health care providers) false positives - may occur for those who have received the BCG vaccine (commonly administered outside the U.S.)

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Severe Acute Respiratory Syndrome (SARS)

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respiratory illness caused by the coronavirus (called SARS-associated coronavirus) - s/sx: syndrome begins with a fever, overall feeling of discomfort, body aches, and mild respiratory symptoms; dry cough and dyspnea may develop later last pandemic occurred in 2003

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Pulmonary Embolism

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- blood clot prevents blood from perfusing the "bed" of arteries that feed the lung, resulting in pulmonary infarction and decreased cardiac output; emboli can also be composed of air or fat - types of embolus blood clot - has usually traveled from deep veins in the leg or pelvis fat - from fractured femur, hip amniotic fluid - postdelivery air- from injection of large air bolus through IV or arterial line - s/sx: abrupt onset of dyspnea - classic finding anxiety, apprehension - feeling of "impending doom" cough - productive or nonproductive tachycardia, tachypnea, low oxygen saturation diaphoresis cyanosis

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Acute Respiratory Distress Sydnrome (ARDS) or Acute Lung Injury (ALI)

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- associated with pulmonary injury and characterized by noncardiogenic pulmonary hypoxemia, and severe respiratory distress - s/sx: restlessness, anxiety- ill appearance dyspnea, progressing to respiratory distress and failure requiring emergency care! tachycardia cyanosis intercostal retractions, accessory muscle use refractory hypoxemia - does not respond to oxygen therapy lung sounds are clear early, later crackles heard throughout Listen interstitial fibrosis develops in some patients who survive ARDS

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Cor Pulmonale

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- right heart failure that developes due to sustained lung resistance in chronic lung disease (i.e. COPD) - s/sx: fatigue, tachypnea, exertional dyspnea, and cough anginal chest pain - due to right ventricular ischemia or pulmonary artery stretching hemoptysis

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Respiratory Failure

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- lungs cannot maintain arterial oxygen levels or eliminate carbon dioxide - s/sx: PaCO2 > 50 mm Hg PaO2 < 60 mm Hg clients with chronic lung disease precautions look for drop from baseline function clients are always hypoxemic and hypercarbic classic presentation: the three "H's" or hypoventilation, hypoxemia, hypercapnia

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frontal lobe

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- brain lobe, higher intellectual functions, social behavior, personality; Broca's area, voluntary movement; memory retention

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parietal lobe

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- brain lobe, interprets sensory input (touch, pain, temperature)

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temporal lobe

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- brain lobe, hearing, taste, and smell; Wernicke's area; emotional response

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occipital lobe

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- brain lobe for vision

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31 segments of spinal cord

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- 8 cervical - neck and upper extremities 12 thoracic - thoracic and abdomen 5 lumbar - lower extremities 5 - lower extremities, urine and bowel control 1 coccygeal

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Sensory nervous system

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- sends muliinformation to the CNS from internal organs or from external stimuli

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Motor nervous system

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The figure shows the peripheral nervous system including the central nervous system, brain, spinal cord and the peripheral nerve. - carries information from the CNS to organs, muscles, and glands

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somatic nervous system

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- controls skeletal muscle and external sensory organs

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autonomic nervous system

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- controls involuntary muscles, such as smooth and cardiac muscle

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sympathetic nervous system

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- controls activities that increase energy expenditures (speeds up heart rate, dilate pupils, and relax the bladder) - involved in "fight or flight response"

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parasympathetic nervous system

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- controls activities that conserve energy expenditures (inhibiting heart rate, constricting pupils, contracting the bladder, maintain GI peristalsis)

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Parkinson's disease

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- degenerative disorder of the dopamine - producing neurons - s/sx: pper extremity resting tremor: pill-rolling; unintentional tremors; both are absent during sleep bradykinesia / akinesia fatigue stiffness and rigidity of muscles - cogwheel rigidity signs are initially unilateral, then bilateral mask-like facial expression, drooling slow, shuffling walk; gradually more difficult difficulty rising from sitting position, postural instability ultimately confined to a wheelchair mind usually stays intact

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Classical Findings of Parkinson's: TRAP

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T-R-A-P T = tremors R = rigidity A = akinesia/bradykinesia P = postural instability

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Huntington's disease

answer

- progressive atrophy of basal ganglia and some parts of cerebral cortex - increased involuntary movements, progressive decline in cognition, decline in speech - findings usually occur in middle age motor chorea dystonic posture client gradually becomes bedridden impaired chewing and swallowing cognitive: less able to organize, plan and sequence behavior mental: personality changes, depression, even psychosis

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Dementia

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- a loss of brain function that occurs with certain diseases, affecting memory, thinking, language, judgment, and behavior - s/sx: usually first appears as forgetfulness difficulty with many areas of mental function language memory perception emotional behavior or personality higher levels of cognitive function, e.g., ability to think abstractly, perform calculation

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Alzheimer's disease

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-a type of dementia in which there is memory impairment, as well as problems with language, decision-making ability, judgment, and personality - s/sx: cognitive deficits with memory impairment one or more of the following: difficulty naming objects (agnosia) language disturbance (aphasia) problems with organization and abstract thinking difficulty with motor activities (apraxia) noticeable decline in level of functioning cognitive difficulties are not related to other conditions altered sensory perception-illusions hallucinations behaviorial findings-wandering - persistent aimless walking verbal or physical abuse resisting care socially inappropriate behavior sundown syndrome (also called sundowning)

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Meningitis

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- acute or chronic inflammation of the meninges average length of illness - 4 month - s/sx: severe headache fever nuchal rigidity (stiff neck) altered LOC - lethargy, drowsiness, irritability, photophobia, hypersensitivity

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Parameningeal infections

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- localized collection of exudate in brain or spinal cord - s/sx: similar to meningitis headache, fever, stiff neck, altered consciousness

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Encephalitis

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- acute inflammatory viral disease of brain tissue; death range is up to 70%; most common pathogen is herpes simplex - s/sx: adult sudden fever severe headache altered level of consciousness, progressing to stupor then coma with seizure activity nuchal rigidity change in personality mild flu-like complaints infant vomiting body stiffness constant crying that worsens when child picked up constant full or bulging anterior fontanelle

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Botulism

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- acute flaccid paralysis - s/sx: CNS findings usually appear within 12 to 36 hours blurred vision, diplopia, lethargy, vomiting and dysphagia, weakness, difficulty speaking, life threatening progressive respiratory paralysis

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Nipah & Hendra Viruses

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- a paramyxovirus that causes encephalitis in humans and is transmitted from animals - Hendra virus: the cause of a highly fatal respiratory virus disease of horses Nipah virus: transmitted from bats and is zoonotic, causing a highly fatal infection in humans - s/sx: human infections range from asymptomatic to fatal encephalitis initially influenza-like symptoms, e.g., fever, headache, myalgia, vomiting and sore throat some people experience atypical pneumonia and severe respiratory problems encephalitis and seizures occur in severe cases, progressing to coma within 24 to 48 hours

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Multiple Sclerosis

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- demyelination of white matter throughout brain and spinal cord -s/sx: cranial nerve: blurred vision, dysphagia, diplopia, facial weakness and/or numbness motor: weakness, paralysis, spasticity, gait disturbances sensory: paresthesias, decreased proprioception cerebellar: dysarthria, tremor, incoordination, ataxia, vertigo cognitive: decreased short-term memory, difficulty with new information, word-finding difficulty, short attention span urinary retention or incontinence loss of bowel control sexual dysfunction fatigue

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Myasthenia Gravis

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- antibodies destroy acetylcholine receptors where nerves join muscles - s/sx: atigue of voluntary muscles, but not muscular atrophy facial, ptosis (drooping eyelid) and reduced eye closure, weak smile, diplopia, blurred vision, speech and swallowing disorders, weakness of facial muscles signs of restrictive lung disease sensation remains intact

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Myasthenic crisis in MG

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- myasthenic crisis usually follows stressor, i.e., infection - edrophonium (Tensilon)= positive

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Cholinergic crisis in MG

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- may follow over dosage of medication during periods of medication adjustments - edrophonium (Tensilon) test= negative; treat with atropine

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Status epilepticus

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- condition where motor, sensory, or psychic seizures follow one another with no intervening periods of consciousness medical emergency failure to treat results in severe hypoxia, hyperthermia, hypoglycemia, acidosis, and death

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Contusion:

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- bruising on the surface of the brain

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Intracerebral:

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-bleeding directly in the brain tissue; secondary to invasive skull trauma/open fracture or hemorrhagic CVA

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Epidural hematoma

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- lacerated blood vessels (arteries) in the space between the skull and dura mater; often the middle meningeal artery is involved secondary to a skull fracture or contusion arterial bleeding, the risk of death is greatest client commonly looses consciousness after injury then is lucid; then LOC drops quickly within the next 24 hours

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Subdural hematoma

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-lacerated the blood vessels (veins) crossing the subdural space secondary to closed head injury acute: findings surface in 24 to 72 hours after injury with rapid neurologic deterioration subacute: findings surface 72 hours to 2 weeks after injury with a slower progression of deterioration chronic: gradual clot formation over time, possibly months with minimal deterioration

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Syndrome of inappropriate antidiuretic hormone secretion (SIADH)

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- cerebral edema presses on hypothalamus, which produces excess ADH to skew the body's sodium and water balance urinary output decreases, BP increases, high urine specific gravity

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Diabetes Insipidus (DI)

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- DI results when ADH drops and body excretes too much fluid low urine specific gravity with significant increases in urinary output (up to 10 liters of urine in 24 hours)

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Trigeminal neuralgia (tic douloureux, facial neuralgia)

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- syndrome of paroxysmal facial pain - s/sx: intense facial pain lasting about 1 to 2 minutes pain follows branches of nerve facial sensitivity

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Facial nerve paralysis (Bell's palsy)

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- disorder of cranial nerve VII (facial nerve) , (Smoothing out of forehead, eyebrow droop, drooping of corner of mouth), involves one side only, may be related to increased periods of stress - s/sx: ptosis with excess tearing cannot close or blink eye flat nasolabial fold impaired taste lower face paralysis with difficulty eating - impaired swallowing or tongue movement

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Spinal Cord Injuries

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- conditions that can affect the spinal cord are usually due to trauma, but may also be from diseases of the musculoskeletal system (arthritis) or congenital abnormalities (spina bifida)

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Anterior cord syndrome:

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damage to anterior spinal artery, resulting in hyperflexion paralysis, loss of pain and/or temperature sensation

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Posterior cord syndrome:

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vertebral dislocation, herniated disc, compression weakness in certain muscles groups resulting in tingling, pain, abnormal reflexes, and bowel and bladder dysfunction

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Brown-Séquard syndrome:

answer

penetrating trauma with ipsilateral loss of proprioception and motor function and contralateral loss of pain and temperature sensation

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Central cord syndrome:

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cord transection from a hyperextension injury, resulting in partial flaccid paralysis of upper extremities with spastic paralysis of the lower extremities; varying degrees of bowel, bladder and sexual dysfunction

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Cauda equina syndrome:

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injury to the lumbosacral nerve roots secondary to central lumbar disk herniation, resulting in areflexia of affected limbs, areflexia of bowel and/or bladder and varying degrees of motor and sensory loss

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Conus medullaris syndrome:

answer

sacral cord injury resulting in areflexia of the bladder, bowel, and less prominently in the lower limbs, resulting in varying degrees of motor and sensory loss in the lower limbs

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Spinal shock

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- Is a temporary loss of reflex function below the level of the injury Occurs after complete transection of the cord, and to varying degrees with partial transection, contusions, compressions and ischemia of the spinal cord Begins in the first hour following the injury and lasts for minutes to months, depending on the degree of injury - s/sx: Flaccid paralysis below level of injury Areflexia below level of injury Loss of sensation (pain, touch, temperature, pressure) below the level of injury Absence of visceral and somatic sensations below the level of the injury (absent bowel sounds) Bowel and bladder dysfunction (bladder distention) Loss of the ability to perspire below the level of the injury

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Neurogenic shock

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- results in an imbalance in the autonomic nervous system (sympathetic and parasympathetic systems) The parasympathetic system causes massive vasodilatation, a drop in the systemic vascular resistance, and pooling of blood in the venous system, which leads to significant hypotension - s/sx: hypotension bradycardia - until compensatory mechanisms begin bounding pulse progressing to weak and thready pulse warm, dry, and pink skin progressing to pale and cool skin mental status - restless, progressing to lethargy and coma oliguria progressing to anuria lower than normal body temperature

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Cluster headache

answer

- The pain comes on suddenly and usually subsides quickly, before even over-the-counter pain relievers such as ibuprofen or acetaminophen can start working. Triptans can provide effective acute treatment.

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Delirium

answer

- acute confusional state, is not a disease but a transient and potentially reversible disorder of cognition. It is often mistaken for dementia or even an acute schizophrenic reaction.

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Myopia (near-sightedness):

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blurred distance vision, but clear close vision

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Hyperopia (far-sightedness):

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blurred close vision, but clear distant vision

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Presbyopia:

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in middle age, lens loses elasticity with results of hyperopia

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Astigmatism:

answer

lens refracts light rays to focus on two different points of retina

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Chronic Open-angle glaucoma

answer

- hereditary link aqueous humor does not drain adequately, causing intraocular pressure (IOP) to increase this pressure on optic nerve causes; destruction of nerve fibers in retina, with results of vision loss; most common type - s/sx: most clients are symptom-free until loss of vision peripheral vision is affected first three classic findings elevated intraocular pressure visual field loss cupping of optic disk

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Electroretinography (ERG)

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- Detects diseases of the rods and the cones of the retina Evaluates the electrical potential between the retina and the cornea Uses: to evaluate disorders of the retina to determine if retinal surgery or cataract extraction is needed

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Tonometry

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- Indirect measurement of intraocular pressure (IOP) using a "puff" of air -Used to detect glaucoma

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Intravenous fluorescein angiography

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- Records the appearance of blood vessels within the eye Used to evaluate for retinopathy and tumors - postop: (yellowish) skin color from the dye red after-image from the photoflash discoloration of the urine

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Ocular ultrasonography

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- Use of high frequency sound waves to evaluate eye structures Useful in evaluating ocular tumors, as well as the retina when they are obscured by cataracts or hemorrhage

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Acute closed-angle (shallow, narrow-angle, primary, or congested glaucoma)

answer

- iris bulges and blocks trabecular network - a medical emergency, may result in permanent blindness iris lies near drainage channel (canal of Schlemm) and bulges forward against cornea, blocking the trabecular network and increasing IOP affects more women; usually after age 45 - s/sx: sudden onset of blurred vision, halos or colored rings around white lights, frontal headache, severe eye pain followed by progression of findings as pressure increases: profuse lacrimation; mildly dilated, nonreactive pupil, and nausea/vomiting, cornea appears hazy findings may come and go, and resolve with rest or sleep

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Cataract

answer

- clouding of lens - may be unilateral or bilateral; one of the most common eye disorders,

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hyphema

answer

-blood in anterior chamber of the eye - may require bed rest, patching, special positioning observe for increased intraocular pressure - severe eye pain may prescribe miotics or cycloplegics

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vitreous prolapse

answer

- allows vitreous humor to fall forward into wound may result in pupil block may lead to retinal detachment vitrectomy may be performed

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retinal detachment

answer

- holes or breaks (tears) in the retina - s/sx: a rapid separation gives the sense of a "curtain being pulled over the eye" so that clients have partial vision in affected eye a slow separation may be asymptomatic the ophthalmic exam reveals the detached area as gray bulge, ripple or fold

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Visual impairment and blindness

answer

legal blindness is a maximum visual acuity of 20/200 (with optimum correction) and/or a visual field that is reduced to a range of 20 degrees (normal range=180 degrees)

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Color blindness

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- an abnormal condition characterized by the inability to clearly distinguish different colors of the spectrum - red-green - most common type blue-yellow (which are seen as white or gray): rare achromatopsia: total inability to distinguish any color

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otitis externa "swimmer's ear"

answer

- an infection of the external auditory canal - history of progressive ear pain pruritus within ear canal purulent discharge feeling of fullness or pressure in ear

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Otitis media

answer

- infection or inflammation of the middle ear - may be acute (AOM) or chronic - s/sx: otalgia (ear pain) otorrhea (discharge from the ear) fever irritability headache concurrent (or recent) URI

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Otosclerosis

answer

- a hereditary degenerative disorder that results in conduction deafness - s/sx: (gradual) hearing loss tinnitus

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Ménière's disease

answer

- an inner ear disorder where the endolymphatic system dilates and the volume of endolymph expands - s/sx: attacks intermittent three recurrent and progressive findings vertigo with prostrating nausea and vomiting - ** avoid a high triglyceride diet tinnitus hearing loss on involved side persists and progresses

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Hearing loss

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- an inability to perceive the normal range of sounds audible to an individual with normal hearing - s/sx: decreased hearing tinnitus vertigo

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Pernicious anemia

answer

- mucosa and parietal cells of stomach atrophy; stomach fails to produce intrinsic factor, thus vitamin B12 cannot be properly absorbed - s/sx: anemia - findings depend on severity tissue hypoxia - producing fatigue, weakness, dyspnea, pallor, palpitations GI symptoms - sore tongue, anorexia, nausea, vomiting, abdominal pain neurological symptoms - paresthesia in hands and feet, weakness, impaired coordination, changes in level of consciousness (LOC) complications: GI findings are reversible, but neurological changes are not

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Schilling test

answer

determines whether the body absorbs vitamin B12 normally

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Gastric ulcer

answer

- an ulceration of the mucous membrane of the esophagus, stomach, or duodenum, due to action of the acid gastric juice - s/sx: pain, burning, or gas that worsens with ingestion of food pain in left upper epigastric area nausea/vomiting bleeding; hematemesis

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Duodenal ulcers

answer

- an ulcer of the duodenum - s/sx: pain, heartburn occur during night or when stomach is empty pain typically relieved by food intake melena (tarry stool; black with digested blood)

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dumping syndrome

answer

- post op complication of peptic ulcer surgery. - from rapid emptying of the stomach - tachycardia, palpitations, syncope, diaphoresis, diarrhea, nausea, abdominal distention more common with Billroth II subsides after several months decreases with slow eating, low-carbohydrate, high-protein and fat diet avoid liquids with meals if possible, lie down on left side for one to two hours after eating

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PUD treatment "Please Make Tummy Better"

answer

P = Proton pump inhibitor M = Metronidazole T = Tetracycline B = Bismuth subsalicylate

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Gastroesophageal Reflux Disease (GERD)

answer

- a condition in which the gastric contents leak backwards from the stomach into the esophagus - s/sx: heartburn or burning pain the chest, increased by bending, stooping, lying down, eating; relieved by antacids nausea after eating pediatric vomiting or spitting up with meals failure to thrive irritable pallor or cyanosis

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scintigraphy

answer

- test to assess gastric emptying

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Ulcerative Collitis

answer

- an inflammatory bowel disease that causes swelling, ulcerations, and loss of function of the large intestine - s/sx: bloody diarrhea that ranges from two-three per day to 10 to 20 per day stools may also contain pus and mucus abdominal pain - tenderness and cramping fever, weight loss, anemia, tachycardia, dehydration impaired absorption of fat-soluble vitamins A, D, E, and K loss of potassium, protein and base or bicarbonate systemic manifestations skin lesions - erythema nodosum joint inflammation inflammation of the eyes - uveitis liver disease - ** high calorie and high protein diet

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Crohn's disease

answer

- a type of inflammatory bowel disease resulting in swelling and dysfunction of the intestinal tract, especially the small intestine; ulceration, fissures, fistula, and abscess formation; bowel wall thickens and narrows, producing strictures; slowly progressive; 15 to 30 years old - s/sx: diarrhea with steatorrhea abdominal pain - right lower quadrant fatigue, weight loss, dehydration, fever systemic manifestations arthritis, clubbing of fingers skin inflammations nephrolithiasis complications obstruction from strictures fistula formation bowel may perforate and infect: peritonitis - **diet high in calories and protein, low in roughage and fat

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Diverticular disease

answer

-outpouching of the intestinal mucosa - s/sx: frequently asymptomatic crampy, lower, left abdominal pain alternating constipation and diarrhea low grade fever, chills, anorexia, nausea leukocytosis - diverticulosis- high fiber diet - diverticulitis- rest bowel= low fiber diet in acute phase

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Bowel obstruction

answer

- a partial or complete blockage of the bowel that results in the failure of the intestinal contents to pass through - s/sx: abdominal pain distention (more with large bowel obstruction) nausea and vomiting (more with small bowel obstruction) - vomitus will be bile-stained (yellowish brown) which indicates fluid from small intestine hypoxia metabolic acidosis bowel necrosis from impaired circulation

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Hepatitis A

answer

- •transmitted from infected food, water, milk, shellfish •fecal-oral route of infection common in areas of poor sanitation and overcrowding •higher incidence in fall and winter •vaccine: Havrix - do not cause chronic hepatitis

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Hepatitis B

answer

•transmitted percutaneously or sexually via contact with infected blood •clients may become carriers •vaccine: Recombivax, Engerix - can produce both an acute and chronic infection - s/sx: jaundice if liver fails to conjugate bilirubin or excrete it clay-colored stools from lack of urobilinogen urine is dark, tea colored, from urobilinogen excreted in urine rather than stool urine foams when shaken pruritus from bile salts excreted through skin right upper quadrant pain from edema and inflammation of liver anorexia, nausea, vomiting, malaise, weight loss prolonged bleeding from impaired absorption of vitamin K anemia from decreased RBC lifespan - ** high carbohydrates and proteins; lowfat diet

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Hepatitis C

answer

•transmitted parenterally (post-transfusion hepatitis) •clients may become carriers •CDC recommends testing for all "baby boomers" •usually no symptoms for years until cirrhosis develops or liver cancer is detected - can produce both an acute and chronic infection - s/sx: often asymptomatic in acute phase often recognized long after exposure often develops into chronic active hepatitis, cirrhosis, and often liver cancer

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Hepatitis D

answer

•transmitted percutaneously or sexually via contact with infected blood •coexists with hepatitis B •No effective antiviral therapy for treatment -can produce both an acute and chronic infection - coexists with hepatitis B (needs hepatitis B to replicate) - treatment and recovery of hepatitis B results in recovery

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Hepatitis E

answer

•transmitted via the oral-fecal route, usually by contaminated water •more common in young adults in developing countries in Africa, Asia •vertical transmission from pregnant woman to fetus •no vaccine; prevention is the most effective approach - do not cause chronic hepatitis

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Cirrhosis

answer

- irreversible, chronic, progressive degeneration of the liver, with fibrosis and areas of nodular regeneration - s/sx: weakness, fatigue, weight loss, hepatomegaly right upper quadrant pain jaundice, pruritus, steatorrhea (decreased absorption of fat and fat-soluble vitamins - A, D, E, K) clay-colored stools increased bilirubin in urine, producing dark tea-colored urine impaired aldosterone metabolism results in edema - ascites impaired estrogen metabolism: gynecomastia, menstrual changes, changes in distribution of body hair, vascular changes - spider angiomas, palmar erythema impaired metabolism of protein, carbohydrate, and fat produces less plasma protein, resulting in edema and ascites produces less of proteins needed for clotting (fibrinogen and prothrombin) absorbs less vitamin K, results in prolonged bleeding liver fails to convert glycogen to glucose, resulting in hypoglycemia and fatigue

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Portal Hypertension

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- increased pressure in the portal veins - s/sx: prominent abdominal-wall veins (caput medusa) hemorrhoids enlarged spleen anemia from increased destruction of RBCs esophageal varices with bleeding - medical emergency

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Ascites

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- accumulation of fluid in the peritoneum - s/sx: abdominal distention, protruding umbilicus, dull sound on percussion of abdomen, fluid wave on abdomen bulging flank dyspnea - ** low sodium diet

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Hepatic Encephalopathy

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- CNS dysfunction associated with severe liver disease or failure - s/sx: changes in level of consciousness from confusion to coma changes to an increased sleep pattern memory loss asterixis - flapping hands tremor impaired handwriting hyperventilation with respiratory alkalosis fetor hepaticus - musty, sweet odor to breath - ** low protein diet

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Acute Pancreatitis

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- inflammation of the pancreas - s/sx: severe left upper quadrant abdominal pain, classic "feels like a knife is going through my body" pain worsens after eating and when lying flat nausea, vomiting fever, agitation, confusion hypovolemia and shock hemorrhage into retroperitoneal space may produce ecchymosis in flank or around umbilicus tachypnea, pulmonary infiltrates, atelectasis from circulating enzymes complications respiratory problems - atelectasis , pneumonia from the immobility imposed by pain tetany from decreased calcium levels abscess or pseudocyst - ** high in proteins and carbohydrates and low in fat

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Cholecystitis

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- Inflammation of the gallbladder - s/sx: colicky pain in right upper quadrant with possible radiation to right shoulder and high back area indigestion after eating fatty foods nausea, vomiting jaundice (if the liver is involved or inflamed or the common duct obstructed), low grade fever - **low-fat diet

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The 6 'F' s for gallbladder disease:

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F air (skin and hair) F at F orty (and older) F ertile (lots of children) F emale F latulent

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Pancreatic cancer

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is an insidious disease that often goes undetected until its later stages; it is the fourth leading cause of cancer deaths among both men and women.

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Benign Prostate Hyperplasia (BPH)

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- enlargement of the prostate gland - s/sx: recurrent urinary tract infections (UTIs) early stages often asymptomatic as enlargement occurs changes in micturition - frequency, dribbling difficulty starting or stopping urinary stream

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Cystocele

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- bladder herniates into vagina - s/sx: in early stages, asymptomatic pelvic pressure changes in urination - frequency, urgency, stress incontinence, inability to empty bladder complications infection urinary incontinence

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Pelvic Inflammatory Disease (PID)

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- infection of the cervix ascending to the fallopian tubes and broad ligaments - s/sx: pelvic pain, sometimes with cervical discharge, may be foul smelling fever cervical motion tenderness irregular bleeding nausea, vomiting, acute abdomen dysuria, frequency chlamydia, gonorrhea, or other STD's

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Endometriosis

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-endometrium tissue grows in cysts at various sites throughout the pelvis and/or abdominal wall (**25-45 white women, estrogen increases it/progestin decreases it) - s/sx: may be asymptomatic may be present with pelvic pain dyspareunia painful defecation abnormal uterine bleeding persistent infertility hematuria, dysuria and flank pain if bladder is involved complication: infertility dysmenorrhea

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Urinary Tract Infection (UTI)

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- infections, by various agents, of parts of the urinary system - s/sx: spike in temperature to 101° Fahrenheit or higher dysuria, frequency, urgency, nocturia suprapubic pain hematuria complications pyelonephritis sepsis

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Renal calculi

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- small, hard deposits (made of mineral and acid salts) that form inside the kidneys - s/sx: pain - site dependent on location of obstruction; can be severe, ncreased hydrostatic pressure renal colic urethral colic findings can mimic cystitis with obstruction: when stones (calculi) block urine flow, client will show findings of UTI with fever and chills gastrointestinal findings nausea, vomiting diarrhea abdominal discomfort

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Acute renal failure

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- the abrupt loss of kidney function resulting in the retention of urea and other nitrogenous waste products and in the dysregulation of extracellular volume and electrolytes - s/sx: prerenal- Hypotension, hypoperfusion, reduced urine output, shriveled skin, dry mucous membranes; intrarenal- History of glomerulonephritis; edema; rash; changes in kidney function (both output and chemistry); postrenal- History of urinary obstruction; difficulty voiding; changes in micturition

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Chronic renal failure

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- a progressive, irreversible deterioration in renal function; body cannot balance metabolism and fluid or electrolytes, resulting in uremia - s/sx: (Respiratory) Pulmonary edema, pleural effusions, pleural rub (Cardiovascular) Hypertension, hyperkalemia with subsequent EKG changes, pericardial effusion, tamponade (Neuromuscular) Sleep disorders, headache, lethargy, peripheral neuropathies, seizures, coma (Metabolic-endocrine) Hyperlipidemia, decreased libido, impotence, amenorrhea, glucose intolerance (Acid-base) Water retention, metabolic acidosis, hyperkalemia, hypocalcemia, hypermagnesemia, hyperphosphatemia (Gastrointestinal) Anorexia, nausea, vomiting, gastric, ulcerations and/or hemorrhage (Blood) Anemia from decreased or no erythropoietin production, increased bleeding, platelet defects (Skeletal) Renal osteodystrophy, osteomalacia from decreased serum calcium levels (Skin) Pruritus, uremic frost, hyperpigmentation, ecchymosis, pallor (Psychosocial) Changes in cognition, behavior, personality

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Chlamydia

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- the most common sexually transmitted disease in the U.S., caused by the bacteria Chlamydia trachomatis - s/sx: often called the "silent epidemic" because most people do not know they are infected women: usually asymptomatic; may experience lower abdominal pain, burning pain with urination, vaginal discharge men: usually no symptoms; may have discharge from penis, pain or burning with urination, inflammation or infection of a duct in the testicles

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Gonorrhea

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- one of the most common and oldest known STD; caused by gonococcal bacteria - s/sx: findings women: usually asymptomatic; may cause itching and burning of the vagina, usually with a thick yellow-green discharge; bleeding between menstrual periods; need to urinate often; sore throat; rectal pain and discharge men: pain or burning during urination; thick, yellow penile discharge, inflammation or infection of a duct in the testicles, inflammation or infection of the prostate gland; sore throat; rectal pain and discharge newborns: irritation of the mucous membranes in the eye

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Syphillis

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- a chronic STD caused by the spirochete Treponema pallidum; sometimes called "the great impostor" because it has a variety of findings that can mimic many other infections - s/sx: a chronic STD caused by the spirochete Treponema pallidum; sometimes called "the great impostor" because it has a variety of findings that can mimic many other infections; atent (dormant) phase: occurs 1 year or more after first chancre with occasional relapses back to previous symptoms tertiary syphilis: 4-20 years after primary phase, may have lesions, cardiovascular findings, neurological findings

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Genital herpes

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- an STD usually caused by the herpes simplex viruses type 2 (HSV-2) - s/sx: clustered painful vesicles and ulcers on or around the genitals or rectum mild lymphadenopathy can be reactivated as a result of stress, infection, pregnancy, sunburn

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Genital warts

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- a highly contagious and most common sexually-transmitted disease caused by a virus (the human papillomavirus [HPV]) - s/sx: flesh-colored or gray growths found on or around the genitals or rectum most people report painless bumps, itching and discharge there may be a history of previous or concurrent STDs

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HIV

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- can range from a brief acute retroviral syndrome to a multiyear chronic and clinically latent illness that eventually progresses to a symptomatic, life-threatening immunodeficiency disease known as AIDS - s/sx: lack of energy weight loss frequent fevers and sweats persistent skin rashes or flaky skin short-term memory loss mouth, genital, or anal sores (from herpes infections) - ** high in calories and protein, low in residue diet

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AIDS

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- cough and shortness of breath seizures and lack of coordination difficult or painful swallowing mental symptoms such as confusion and forgetfulness nausea, abdominal cramps, vomiting, severe and persistent diarrhea severe headaches with neck stiffness Kaposi's sarcoma malignant tumor of the endothelium lining the heart, blood vessels, lymphatic system, and serous cavities most benign form limited to the skin (particularly the lower extremities) characterized by diffuse cutaneous lesions

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Adrenal gland (cortex) hormones - SSS

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S =Sugar (glucocorticoids) S =Salt (mineralocorticoids) S =Sex (androgens)

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Endocrine glands "Herman Probably Pasted The Paper To a Pot of Tea"

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H =Hypothalamus P =Pituitary P =Pineal T =Thyroid P =Parathyroid T =Thymus A =Adrenal P =Pancreas O =Ovaries T =Testes

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Hypopituitarism

answer

- diminished secretion of pituitary hormones due to under-activity of the anterior pituitary gland - s/sx: female) hypogonadism amenorrhea infertility decreased libido breast and uterine atrophy loss of axillary and pubic hair vaginal dryness delayed physical growth premature aging decreased intellectual development increased intracranial pressure (male) hypogonadism decreased libido erectile dysfunction small, soft testicles loss of axillary and pubic hair decreased growth hormone - results in dwarfism (when developed in childhood) hypothyroidism - occurs because pituitary regulates thyroid glands via thyroid stimulating hormone (TSH) hypoadrenalism - occurs because pituitary regulates adrenal glands though production of adrenocorticotropic hormone (ACTH) syndrome of inappropriate antidiuretic hormone (SIADH): fluid overload and dilutional hyponatremia related to increased antidiuretic hormone (ADH) levels

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Hyperpituitarism

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- anterior pituitary secretes too much growth hormone and/or ACTH acromegaly - when growth plates are closed giantism - when growth plates are still open - s/sx: excess prolactin: typically includes headache, visual disturbances, growth failure; pubertal arrest (with menstrual abnormalities in girls) during puberty excess adrenocorticotropic hormone: weight gain with concurrent growth failure excess growth hormone mild-to-moderate obesity gigantism in a child with longitudinal growth acceleration macrocephaly coarse facial features cardiovascular disease, i.e., hypertrophy, hypertension tumors endocrinopathies, i.e., diabetes, hypogonadism

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Diabetes Insipidus

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- Posterior pituitary gland makes too little antidiuretic hormone (ADH). Body loses too much water in the urine; plasma osmolality and sodium levels increase. - s/sx: excessive thirst (polydipsia) polyuria - as much as 20 liters per day with specific gravity below 1.006 nocturia signs of dehydration constipation

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Syndrome of inappropriate antidiuretic hormone secretion (SIADH)

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- continuous secretion of ADH with water intoxication - s/sx changes in level of consciousness changes in mental status tachycardia hyponatremia weight gain urine specific gravity - will be greater than 1.030 hypertension

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Hypothyroidism (Hashimoto's disease)

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- a condition in which the thyroid gland does not make enough thyroid hormone; an underactive thyroid - s/sx: early constipation increased sensitivity to cold fatigue heavier menstrual periods joint or muscle pain paleness or dry skin sadness or depression thin, brittle hair or fingernails weight gain late - if left untreated decreased taste and smell hoarseness puffy face, hands, feet slow speech thickening of skin thinning of eyebrows - ** give thyroid replacement in the morning on an empty stomach

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myxedema crisis/coma:

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- a loss of brain function as a result of severe, longstanding hypothyroidism; usually precipitated by a secondary insult (hypothermia, infection, or another systemic condition, or drug therapy) - tx: mechanical ventilation treatment of associated infection correct hypothermia with passive rewarming IV thyroid hormone replacement

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Hyperthyroidism (Graves Disease)

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- overactive thyroid makes too much thyroid hormone - ** diet high in calories, protein, carbohydrates - s/sx: difficulty concentrating fatigue hyperphagia, weight loss, diarrhea goiter or thyroid nodules heat intolerance exophthalmos tachycardia palpitations restlessness thin, brittle hair, pliable nails ("plummer's" nails) irregular menstrual periods in women insomnia

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thyrotoxic crisis (thyroid storm):

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- rare but potentially fatal complication of hyperthyroidism; precipitated by factors such as stress, infection, pregnancy -

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Hypoparathyroidism

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- parathyroid produces too little parathormone (paraphyroid hormone), resulting in hypocalcemia - s/sx: neuromuscular irritability personality changes muscular weakness or cramping numbness of fingers tetany carpopedal spasms laryngospasm seizures dry, scaly skin hair loss abdominal cramping

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Hyperparathyroidism

answer

- parathyroid secretes too much parathyroid hormone (PTH); results in increased serum calcium (hypercalcemia) -s/sx: gastrointestinal: constipation, nausea, vomiting, anorexia skeletal: bone pain, demineralization, deformities, pathological fractures kidney stones - due to increased calcium levels blurred vision (due to cataracts) muscle weakness and fatigue depression

question

"moans, groans, stones, and bones... with psychic overtones".

answer

Symptoms of hyperparathyroidism

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heochromocytoma

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- (rare tumor of the adrenal gland causing the gland to make too much epinephrine & norepinephrine)

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Addison's disease

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-adrenal cortex secretes too little adrenocorticotropic hormone (ACTH) decreases secretion of other adrenal products: mineralocorticoid, glucocorticoids, and sex hormones - s/sx: acute adrenal insufficiency (Addisonian crisis) severe headache or back pain severe generalized muscle weakness diarrhea or constipation confusion lethargy severe hypotension circulatory collapse adrenal insufficiency vague complaints or findings fatigue muscle weakness vague abdominal complaints: anorexia, nausea, vomiting personality changes skin pigmentation darkens - ** diet high in protein, carbohydrates, and sodium

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Cushing's syndrome

answer

- adrenal cortex secretes too much glucocorticoid (cortisol) -s/sx: upper body obesity with thin arms and legs round, red, full face (moon face) slow growth rate in children skin changes - acne, striae (purple marks) on skin of abdomen, thighs, breasts, easy bruising muscle/bone changes - backache, bone pain or tenderness, buffalo hump, rib/spine fractures women with have excess hair growth on face, neck, chest, abdomen, thighs men may be impotent, decreased libido other - personality/behavior changes, fatigue

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Pheochromocytoma

answer

- adrenal medulla secretes too much epinephrine and norepinephrine (catecholamines), causing excessive stimulation of the sympathetic nervous system - s/sx: abdominal pain, chest pain irritability, nervousness severe stress response pallor palpitations tachycardia severe headache diaphoresis weight loss other: hand tremor, hypertension, difficulty sleeping - ** phentolamine (Regitine) for hypertensive crisis

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Diabetes mellitus (DM)

answer

- a condition in which the pancreas produces too little insulin, or cells stop responding to insulin; results in hyperglycemia - s/sx: hyperglycemia the 3 "polys" of diabetes mellitus polydipsia (increased thirst) polyuria (increased urine production) polyphagia (increased hunger) fatigue weight loss (in type 1 diabetes mellitus only) blurred vision vaginal infections slow wound healing

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diabetic ketoacidosis (DKA)

answer

- an acute complication of DM - type 1 - s/sx: blood sugar levels greater than 350 mg/dL elevated ketone levels - cause sweet odor to breath (may also have odor of someone drinking alcohol) metabolic acidosis - Kussmaul's respirations, flushed appearance thirst polyuria drowsiness anorexia, vomiting may lead to shock and coma usual causes: undiagnosed diabetes mellitus inadequacy of prescribed therapy for diabetes mellitus; missed dose of insulin physical stress such as surgery, illness, or trauma in person with diabetes mellitus caused by increased gluconeogenesis from amino acids and glycogenolysis in the liver

question

hyperosmolar hyperglycemic state (formerly called: hyperglycemic hyperosmolar nonketotic coma [HHNC])

answer

- rare, but with a high mortality rate - gradual onset - type 2 - s/sx: severe hyperglycemia; usually > 600 mg/dL pH usually > 7.4 ketones - negative (profound) dehydration altered level of consciousness

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