year 2 second semester exam study
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year 2 second semester exam study - Leaderboard
year 2 second semester exam study - Details
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| What are some symptoms of hypokalemia? | Muscle weakness and ileus (lack of peristalsis), serious cardiac arrhythmias such as ventricular tachycardia |
| What is the function of the thyroid gland? | *secrete thyroid hormones - regulate the rate at which calories are burned *regulates basal metabolic rate - hormones *secretes calcitonin |
| Risk factors for thyroid function? | *The incidence of thyroid dysfunction increases with age *Those with other autoimmune disease, e.g. type 1 diabetes, Addison’s disease, coeliac disease *A family history of thyroid dysfunction *more common in woman |
| What is hypothyroidism? | Deficient levels of thyroid hormones (low basal metabolic rate) |
| What does primary, secondary and tertiary hypothyroidism indicate? | Primary means the problem is with the thyroid gland itself. Secondary means it is a result of a disorder of the anterior pituitary gland where TSH is produced. Tertiary is when the hypothalamus ceases to make enough TRH |
| Common causes of hypothyroidism? | *hashimotos thyroidistis - most common (autoimmune disease of the thyroid) *Previous treatment for hyperthyroidism ie: Loss of thyroid tissue - thyroidectomy, radioiodine treatment, anti thyroid medication Iodine deficiency *Drug induced hypothyroidism such as from Lithium *Congenital Hypothyroidism (Guthrie Test) can retard growth and mental development |
| Symptoms of hypothyroidism? low BMI | *intolerance to cold *constipation *weight gain *fatigue *muscle weakness |
| What is hashimotos thyroiditis? | Is an Autoimmune Disease and is the most common cause of hypothyroidism Characterized by the destruction of thyroid cells through auto immune-mediated destruction leading to progressive fibrosis |
| Diagnostics tests for hashimotos ? | *Thyroid stimulating hormone (TSH) test: A high TSH level most commonly means the thyroid gland is not producing enough T4 hormone. *Free T4 test: A low T4 level suggests that the person has hypothyroidism. *Antithyroid antibody test: Presence of antibodies indicates a higher risk of developing Hashimoto’s hypothyroidism. |
| What is the treatment for hypothyroidism? | Levothyroxine - synthetic form of thyroxine (T4) is converted by the liver to the active form of T3 |
| Nursing considerations for hypothhyroidism? | *promote activity - give rest periods *thermal regulation - blankets, heaters etc *altered body image - think about phycological support *educate on Decreased metabolism means medications such as opioid and anesthetics will be in the body longer, therefore more chance of increased effects/overdose. *decreased cardiac output - risk of atherosclerosis |
| What is myxedema coma? | Life threatening severe untreated hypothyroidism leading to decreased mental status, hypothermia, and other symptoms related to slowing of function in multiple organs. |
| What is hyperthyroidism? (high basal metabolic rate) | Excess thyroid hormones than the body needs |
| Risk factors for hyperthyroidism? | * female, aged over 60 *Have been pregnant or had a baby within the past 6 months *Hx of thyroid surgery or goitre *Have a family history of thyroid disease *Have another autoimmune disease such as type 1 diabetes or primary adrenal insufficiency. *Increased iodine ie ingesting to much iodine from food or using iodine-containing medicines or supplements |
| Causes of hyperthyroidism? | *Grave's disease, which is an autoimmune disorder in which the immune system attacks your thyroid which results in the thyroid making too much hormone. This is the most common cause of hyperthyroidism *Thyroid nodules, which are basically growths (normally benign) on the thyroid. They nodules may become overactive and in turn produce too much thyroid hormone. *Thyroiditis, is as the name suggests inflammation of the thyroid. It causes stored thyroid hormone to leak out of the thyroid gland. *Too much iodine. Iodine is found in some medicines, cough syrups, seaweed and seaweed-based supplements. *Medication induced hyperthyroidism can occur when people who take thyroid hormone medicine for hypothyroidism take too much of it perhaps due to not having the correct blood tests . |
| Symptoms of hyperthyroidism? | Sensitivity to heat weight loss tremors diarrhea enlarged thyroid bulging eyes |
| What is graves disease? | Autoimmune disease of the thyroid gland causing thyroid to hypersecrete thyroid hormone - most common cause of hyperthyroidism Caused by thyroid antibodies that activate the TSH-receptors Stimulates thyroid hormone synthesis and secretion and thyroid cell growth |
| What are the treatments for hyperthyroidism? | The primary treatment goals are to inhibit production of thyroid hormones and lessen the severity of symptoms *Medication: Anti-thyroid Drugs (Thionamides) Carbimazole Propylthiouracil (PTU) *Non-selective Beta Blockers as an adjunct Propanolol *Radioiodine Therapy: Involves drinking a solution containing radioactive iodine that over time destroys the thyroid cells *Surgery: Partial or full thyroidectomy |
| Carbimazole & Propylthiouracil are a class of antithyroid drugs (Thionamides) to treat hyperthyroidism, what is their mode of action? | Metabolised to its active metabolite thiamazole (methimazole). It interferes with the synthesis of thyroid hormones by inhibiting thyroid peroxidase. |
| Why would a non-selective betablocker (propanolol) be used for hyperthyroidism? | Provides rapid symptomatic relief of adrenergic symptoms: Tachycardia Tremor Heat intolerance Anxiety |
| Why would a thyroidectomy be the first line of treatment for hyperthyroidism? | If there is Allergy to Iodine Pregnancy Large Goitre – enlarged thyroid |
| What medications are associated with thyroid dysfunction? | Lithium - hypothyroidism - Monitor patients on Lithium, TSH and T4 are tested at baseline, then TSH at three months and annually thereafter. amiodarone - both hypo and hyper - High iodine content with direct toxic effect on the thyroid gland. TSH at baseline and then six monthly for patients taking amiodarone |
| Functions of cortisol in the body? | Regulates protein metabolism Increases blood glucose Regulates the action of cellular sodium-potassium pump Helps regulate pH Stimulates sympathetic response Reduces immune response Cause memory impairment Chronic levels of high stress disrupt the feedback mechanism |
| What is Addison's disease? | Autoimmune disorder (immune system attacks adrenal glands) insufficient levels of cortisol |
| Primary adrenal insufficiency is caused by Addison's disease. what is secondary adrenal insufficiency caused by? (involved pituitary gland) | Occurs when the pituitary gland doesn't make enough of the hormone ACTH. Stoppage of Corticosteroid Medication Surgical Removal of Pituitary Tumours - ACTH-producing tumours of the pituitary gland that cause Cushing’s syndrome Tumours (most commonly adenoma), infection in the pituitary Loss of blood flow to the pituitary (eg. post partum haemorrhage |
| What are the symptoms of addisons disease? | Lack of energy or motivation (fatigue) muscle weakness. low mood. loss of appetite and unintentional weight loss. increased thirst. |
| What is adrenal crisis? | Acute medical emergency caused by a lack of cortisol during physical stress such as infection, dehydration, trauma, or surgery |
| Symptoms of adrenal crisis? | Hypotension Hyperkalemia Hyponatremia Hypoglycaemia Confusion/Loss of Consciousness |
| Treatment of adrenal crisis? | Administration of glucocorticoid - Dexamethasone is the initial drug of choice Fluid and electrolyte replacement are essential A short ACTH stimulation test may be performed during resuscitation Followed by hydrocortisone 100 mg IV every 6 hours is the preferred treatment to provide mineralocorticoid support Fludrocortisone- a mineralocorticoid |
| What is cushings disease? | Exclusively describes excessive cortisol production arising from a pituitary tumour secreting the hormone ACTH |
| What is cushings syndrome? | Excessive levels of cortisol in the blood Tumours of the adrenal glands producing cortisol |
| Causes of cushings syndrome? | Most common cause - taking medications that have cortisol, including: hydrocortisone, prednisone, topical skin ointments, asthma inhalers and joint steroid injections |
| What is the symptoms of cushings syndrome/disease? | Buffalo face/moon face weight gain slow healing - reduced immune response Headaches Tiredness/fatigue Depression/irritability/anxiety stretch marks - striae |
| What are some health impacts of diabetes? | Increased risk of heart attacks and strokes Cardiovascular complications and neuropathy increase incidence of: risk of: foot ulcers Infection limb amputation kidney disease |
| What is the pathophysiology of diabetes type 1? | Autoimmune disease - destruction of insulin-secreting beta cells of the islets of Langerhans in the pancreas - Results in an absolute deficiency of insulin - glucose cannot be moved out of bloodstream and into cells |
| What are some risk factors for developing type 2 diabetes? | HX of cardiovascular disease BMI more than 30 HX of gestational diabetes long term steroid use Lifestyle: obesity, diet ,activity smoking |
| What is metabolic syndrome? | Closely linked to obesity characterized by Central/abdominal obesity - BMI > 30 ; waist circumference 102cm men / 88cm women Hypertension Dyslipidaemia – characterised by raised triglycerides and low HDL – increase Insulin resistance/pre-diabetes These factors individual;ly or in combination are associated withincreased risk of cardiovascular disease and diabetes (if not already diagnosed) |
| What is the pathophysiology of diabetes type 2? | Develops when the receptor sites of cells becomes resistant to the effects of insulin (glucose cant enter cells) and/or when the pancreas stops producing enough insulin |
| What are the four main symptoms of diabetes? | Polyuria - frequent urination polyphagia - excessive hunger polydipsia - excessive thirst weight loss - body starts to break down fat |
| What is diabetic ketoacidosis? | Acute metabolic complication of diabetes - mostly common with type 1 Insulin deficiency causes the liver to metabolize triglycerides and amino acids (fats) instead of glucose for energy which produces ketones |
| What are the symptoms of DKA? | Fatigue Thirst, weight loss Nausea, vomiting fruity smelling breath metabolic acidosis |
| What are some causes of DKA? | Infection intoxication not taking insulin heart disease |
| What are the diagnostics of DKA? | ABG's Urinalysis – glucose levels/keytones Serum ketones |
| Treatment of DKA? | IV fluid replacement and insulin – type 1 Bicarbonate may be given if marked acidosis (pH < 7) persists after 1 h of therapy Insulin may be withheld until serum potassium is ≥ above 3.3 mmol/L |
| What is Hyperosmolar hyperglycaemic state? | More common in type two - characterized by severe hyperglycaemia extreme dehydration due to osmotic diuresis resulting in tachy and hypotension absence of significant ketoacidosis – no ketones as beta cells still producing some insulin altered consciousness |
| What are the causes of hypoglycaemia? | Insulin , sulfonylureas – taking medication and not eating – too much insulin Lower than normal food intake Higher than normal energy expenditure Post partum in type I diabetes – woman has used up all stored glucose during labour |
| What is the compensation for hypoglycemia? | Glucagon stimulates liver to release stored glucose and adrenaline increase in response to acute hypoglycaemia and research shows this is the body’s first line of defence |
| What is the treatment for hypoglycemia? | Eat/drink 15-20 grams of glucose for example- glucose tablets gel tube, 2 tablespoons of raisins, 1/2 cup of juice, tablespoon sugar or honey, 4-6 hard candies, jellybeans Follow with some complex carbohydrates for example a sandwich or a scone Recheck blood glucose Glucagon - to release stored glucose Injectable glucagon is important if unconscious |
| What are the complications of diabetes? | Retinopathy - retinal ischemia due to blood vessel changes – microvascular – more prone in type 2. ;largest cause of blindness Nephropathy – most common cause of end stage renal disease -30% type I (onset begins 10yrs post diagnosis) – 40% type II develop this (onset begins 5-8yrs post diagnosis Neuropathy - may lead to amputation Cardiovascular Disease: Coronary Artery Disease (CAD) – linked to duration of disease – most common cause of death type II diabetes Stroke twice as common in people who have diabetes (ischemic) Peripheral Artery Disease (PAD) Peripheral vascular disease (PVD) more common in type 2 diabetes leading cause of amputation – neuropathy – where ppl don’t experience pain – non healing wunds |
| What is the pathophys of diabetic retinopathy? | Microaneurysms – occurring in blood vessels, membrane can become damaged intraretinal haemorrhage Exudates – vhange in permability - leakage macular oedema, ischemia – immune process vitreous haemorrhage – increase pressure |
| What is the treatment for diabetic retinopathy? | Achieving target levels: BGL, HbA1C, BP, lipid levels – managing ranges - below 50 retinal laser photocoagulation - ;Laser of new blood vessels |
| What are the causes of nephropathy? | By the metabolic and hemodynamic changes of diabetes glomerular sclerosis and fibrosis – capilires changing permeability – loose nephrons progressive albuminuria hypertension and renal insufficiency – as kidneys deteriote contribute to hypertension – RAAS system is effected – spiraling downfall – effects oter systems |
| Diabetic neuropathy is the result of? | Nerve ischemia due to microvascular disease direct effects of hyperglycaemia on neurons intracellular metabolic changes that impair nerve function – nerve impulse is lost – sensation is lost . Messages are getting lost |
| What are the complications of peripheral neuropathy? | Paraesthesia - pins and needles Painless loss of sense of touch, vibration or temperature In the lower extremities Symptoms can lead to blunted perception of foot trauma e.g. due to ill-fitting shoes and abnormal weight bearing Foot ulceration and infection Fractures and dislocation – painless Destruction of normal foot architecture (Charcot joint) Necrosis, gangrene Amputation |
| What are some complications for autonomic neuropathy? | Orthostatic hypotension urinary retention/incontinence resting tachycardia Dysphagia |
| What does a limb assessment for diabetics involve? | Need to assess for neuropathy check pulse dorsalis pedis and prosterior tibial artery monofilament - check sensation |
| How does diabetes exacerbate atherosclerosis? | Hyperglycaemia Hypertension Dyslipidemia – lipids, adds to growth of plaques And in type two diabetes – hyperinsulinemia – high insulin Damage to endothelial lining causes an inflammatory response - swelling, edema, inflammatory mediators |
| In coronary artery disease, what are the proinflammatory & prothrombotic effects of hyperglycaemia & hyperinsulinemia? | Cause an inflammatory response Increase vascular permeability Cause endothelial dysfunction Contributes to hypertension Contributes to dyslipidaemia |
| What does HBA1C refer to? | Glycated hemoglobin. measures the proportion of hemoglobin molecules in the blood that have become chemically bonded with glucose over the last three months |
| The target HbA1c in most patients with diabetes is? | < 53 mmol/mol |
| What does an annual diabetes review involve? | Blood pressure Examine feet (including skin, nails, deformity) monofliament Review HbA1c, eGFR, creatanine, BUN, lipid profile, LFTs, TSH(more prone to developing fatty liver disease) Urinalysis |
| What else would you check? | Retinal photoscreening up to date CVD risk Smoking status, alcohol intake and recreational drug use bgl diary |
| What is the step wise treatment approach for diabetes type 2? | Step 1: Lifestyle interventions Add metformin - first line treatment Step 2: Add a second oral hypoglycaemic agent: empagliflozin, dulaglutide, vildagliptin, a sulfonylurea or pioglitazone (can be taken with metformin) stimulate beta cells to produce more insulin A third can be added instead of stepping up to insulin Step 3: Add insulin start on 2 units and gradually build up |
| What are the three ways metformin works to treat hyperglycemia ? | Decreases glucose formation in the liver Increases peripheral utilisation of glucose by increasing sensitivity to insulin at insulin receptors on cell membranes Decreases glucose absorption in the intestine |
| What is the major defence against urinary tract infection? | Complete emptying of the bladder during urination |
| What is Pyelonephritis? | Kidney infection due to a UTI |
| Why is UTI more common in females? | Bacteria ascend the urethra to the bladder therefore the risk is higher in females |
| Risk factors of UTI? | Female Abnormality of the urinary tract that obstructs the flow of urine Diabetes – glucose in urine promotes bacterial growth Immunocompromised sex |
| Signs and symptoms of UTI? | Dysuria Frequency Urgency Burning sensation Pressure in lower pelvic area Only small amounts of urine passed |
| What is an uncomplicated UTI? | Any UTI occurring in an adult female who is not pregnant and has a normal genitourinary tract and a routine presentation of symptoms |
| What is a complicated UTI? | Woman who are pregnant children abnormal gentiurinary tract patients with a catheter renal impairment |
| What is the first line treatment for a UTI? | Nitrofurantoin/macrobid - antibiotic |
| What is the mode of action of nitrofurantoin? | Bactericidal Inactivates protein synthesis Inhibits DNA synthesis Inhibits RNA synthesis Inhibits cell wall synthesis |
| How to prevent UTI? | Increase fluids-six to eight glasses of water daily, 8-ounce glasses a day- keep hydrated Urinate regularly and when the urge arises Urinate shortly after sex Women should wipe from front to back |
| What is pyelitis? | Inflammation of walls of the renal pelvis |
| What is the main complication of an untreated UTI? | Pyelonephritis-bacteria invade renal cortex and medulla |
| What are the symptoms of kidney infection from UTI? | High fever (fever > 38c) Intense pain Loin pain in upper abdo or back and sides Nausea & vomiting - systemic infection |
| What is the treatment of a kidney infection for people who are systemically unwell, high fever, dehydrated, nausea & vomiting or during pregnancy ? | IV infusion ciprofloxacin antibiotic |
| What is urgency incontinnence? | Overactive neurogenic activity - result from loss of neurological control - stroke, ms, spinal cord injury |
| What are the impacts of incontinence? | Depression Feelings of shame Loss of self-confidence Social isolation Sexual dysfunction Financial difficulties (due to the cost of pads, bedding, laundry and reduced ability to work) Loss of sleep |
| What is overflow incontinence? | Obstruction at the bladder neck or an impairment of detrusor contractility - more commonly in males – involuntary release of urine |
| What is Benign Prostatic Hyperplasia ? | Age-associated prostate gland enlargement |
| What are the symptoms of benign prostatic hyperplasia? | Difficulty to start to void Poor flow of urine Stopping and starting/stuttering Need to strain to pass urine Frequency Nocturia |
| How is BPH diagnosed? | International prostate symptom score Urine Dip Test – rule out other complications Digital rectal examination A voiding chart/diary For 24 hours Record frequency; how voiding occurs eg - difficulty starting, stuttering, flow mild amounts of prostate specific antigen |
| What is a Prostate-specific antigen (PSA) test? | PSA is a protein produced by normal and abnormal cells of the prostate gland - test measures level in blood – may indicate cancer |
| What is the lifestyle treatment of benign prostate hyperplasia? | Lifestyle - Avoid liquids for one to two hours before going to bed Avoid smoking tobacco, alcohol and caffeine moderate exercise eg. walking for 30 to 60 minutes a day improve symptoms kegal exercises to strengthen pelvic floor |
| What is the medication to treat BPH? | Finasteride or dutasteride - shrinks prostate - Blocks action of enzyme 5-alpha reductase – this enzyme usually changes testosterone to another hormone (DHT) that causes the prostate to grow alpha blockers - relax bladder muscles – blocks alpha receptors |
| What is a eGFR test used for? | Estimated glomerular filtration rate - measures level of kidney function and filter blood - based of creatinine |
| What is acute kidney injury AKI? | Acute reversible decline in kidney function - can be life threatning |
| What are some pre renal causes of AKI? interference with renal perfusion (hypoperfusion) | - Trauma -Heart failure -Medication – NSAIDs, ACE inhibitors, ARBs (dilate arterioles of the efferent arteriole) -GI bleeding |
| What are some instinct causes of AKI? | Acute tubular necrosis - ischemia to cells due to pre-renal causes or nephrotoxicity Crush injuries - the release of myoglobin a protein released from muscle when injury occurs and haemoglobin to be released into the circulation causing renal toxicity/ischemia (clog up capilliries in glomerulus) Acute glomerulonephritis - from infections transfusion reaction |
| What are some post renal causes of AKI? Interference with the outflow of urine from the kidney | Blockage to the flow of urine resulting in a back pressure to the kidney causing damage to nephrons - obstruction in urinary tract -prostatic enlargement - Pelvic malignancy - kidney stones |
| What are the four phases of AKI? | Onset oliguric diuretic recovery |
| The focus of management of acute kidney injury is to? | Restore renal blood flow treat urinary obstruction |
| What is chronic kidney disease? | Gradual loss of kidney function leading to kidney failure - from long term damage to disease of the kidney |
| What are the symptoms of AKI? | Decreased urinary output, swelling due to fluid retention, nausea, fatigue and shortness of breath |