NSG 260 Endocrine, AIDS, Chronic Renal Failure, & Chronic Liver Failure

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NSG 260 Endocrine, AIDS, Chronic Renal Failure, & Chronic Liver Failure
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2010-09-18 13:52:42
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WCCC Nursing Endocrine AIDS Chronic Renal Failure Chronic Liver Failure
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Study Guide for Ms. G's NSG 260 Endocrine, AIDS, Chronic Renal Failure, & Chronic Liver Failure test set to notecards
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  1. Describe: Hypothalamic pituitary target gland axis
    • Stimuli (envoronmental/sensory input) triggers the release of hormones from the hypothalamus
    • Hormones (Releasing factors and Inhibiting factors) from the hypothalamus are sent to the anterior pituitary gland
    • Inhibiting factors instruct the pituitary to stop releasing hormones
    • Releasing factors trigger the release of tropic hormones from the pituitary to a target organ
    • Target organs release hormones that are then read by either the pituitary or the hypothalamus as a negative feeback mechanism, resulting in the stop of hormone flow to that organ
  2. List: where antidiuretic hormone (ADH) is made, stored, ad released from
    • Made: in the hypothalamus
    • Stored: in the posterior pituitary
    • Released: from the posterior pituitary
  3. Describe: the function of Antidiuretic Hormone (ADH)
    • Controls water balance by increasin water absorption
    • "Stop peeing hormone"
    • Stimulates the contraction of smooth muscle in intestines and blood vessels
    • Vasoconstricts arterioles
  4. How does the pituitary gland regulate the release of glucocorticoids?
  5. Describe: the function of cortisol
  6. Describe: the function of mineralcorticoids
    Promotes retention of sodium and elimination of potassium
  7. Describe: the function of androgens
    Promotes preadolescent growth spurts
  8. Side effects of: Glucocorticoids
  9. What patient teaching is needed for a patient on steriods?
    • Teaching: 12S's
    • Most critical issue: must wean off steriods, could induce adrenal crisis
  10. Etiology: Syndrome of Inappropriate Antidiuretic Hormone Syndrome (SIADH)
    • Paraneoplastic disease
    • Lung disease, small cell/oat cell lung cancer
    • Duodenal cancer
    • CNS disorders
    • Trauma
    • Increased ICP
    • Medications: Diabinese, Thiazides, Tegretol, Nicotene, Morphine, anesthetics
  11. Symptoms: Syndrome of Inappropriate Antidiuretic Hormone Syndrome (SIADH)
    • Dilutional hyponaterimia (< 130meQ)
    • Serum hypo-osmolarity
    • Poor urinary output
    • High urine specific gravity (>1.030)
    • Decreased BUN, H&H, etc. due to hemodilution
    • Weight gain
    • Hypertension
    • Confusion
    • Lethargy
    • Convulsions
  12. Medical Treatment: Syndrome of Inappropriate Antidiuretic Hormone Syndrome (SIADH)
    • Surgical removal of ADH secreting tissue
    • Restrict fluids (I=O), no more than 800-1000mL/day
    • Lasix (may need potassium supplements)
    • Hypertonic saline if severe
    • Chronic management: declomycin, urea, lithium (all interfere with ADH release or synthesis
  13. Nursing Management: Syndrome of Inappropriate Antidiuretic Hormone Syndrome (SIADH)
    • Dx: Fluid Volume Excess
    • Restrict total fluids , I&O
    • HOB flat or <10 degree elevation (enhances left atrial filling pressure and reduces ADH release)
    • Hourly urine specific gravity measurements
    • Daily weights
    • Vital signs
    • Monitor LOC - convulsions, N/V, muscle cramping, side rails & seizure precautions
    • Monitor cardiopulmonary status - CHF
  14. Etiology: Diabetes Insipidus
    • CNS disorders
    • Tumors
    • Infection
    • Trauma (usually self limiting)
    • Post-op brain surgery (may be permanent)
    • Pituitary tumor
    • S/P hyperphysectomy
  15. Symptoms: Diabetes Insipidus
    • Polyuria (5-20 liters/day)
    • Dilute urine (specific gravity <1.005)
    • Polydipsia
    • Dehydration
    • Orthostatic hypotension
    • Vascular collapse
    • Increased serum osmolarity
    • Hypernatremia
    • Inelastic skin turgor
    • Weight loss + fluid deprivation test
  16. Medical Treatment: Diabetes Insipidus
    • IV therapy
    • Surgery or radiation if tumor is present
    • Drug therapy: Thiazides, Tegretol, Diabenese to induce an SIADH reaction
    • ADH hormone replacement - DDAVP (desmopressin) nasal spray, Vasopressin SQ/IM, Pitressin in oil
  17. Nursing Management: Diabetes Insipidus
    • Dx: Fluid Volume Deficit
    • Monitor IV flow rate
    • I&O - hourly measurements of urine specific gravity
    • Daily weights
    • Vital signs

    • Dx: Altered urinary elimination - perineal care
    • Dx: Sleep disturbance - Adjust DDAVP
    • Dx: Medication Knowledge deficit (DDAVP) - monitor output, reduce nocturia
    • S/E - nasal irritation (hyponatremia, headache & nausea may indicate overdosage)
  18. Etiology: Cushing's Syndrome
    • Adrenal tumor
    • Hyperplasia or cancer of the adrenal gland
    • Paraneoplastic disease
    • Secondary: pituitary dysfunction
    • Iatrogenic: steroid dependency
  19. Symptoms: Cushing's Syndrome
    • Hyper glycemia, hypernatremia & hypokalemia
    • Hypertension & edema
    • Cetripedal obesity, Moon face, buffalo hump
    • Hirsuitism, gynemastia, amenorrhea
    • Bruisability & thin skin
    • Depressed immunity, risk for infections
    • Gastric ulcers, osteoporosis, cataract
    • Increase WBCs and platelets, decrease lymph
  20. Medical Treatment: Cushing's Syndrome
    • Radiation/surgery for pituitary tumor
    • Cortisol cytotoxics: stop production of cortisol (give with food)
    • Miotane - lysodren
    • Metyrapone (S/E - N/V, GI bleed, rash)
    • Aminoglutethiamide - cytadren
    • Ketoconazole - nizoril (block cortisol production)
    • Steroid weaning
    • Aldactone - spirolactone
    • Adrenalectomy
  21. Nursing Management: Cushing's Syndrome
    • High risk for infection (assess WBCs, hand washing, private room)
    • High risk for injury (prevent falls, appropriate weight bearing, nutrition)
    • Altered nutrition (increase calcium and protein, decrease calories and fat)
    • Skin integrity (assess skin, gentle handling)
    • Monitor vital signs, I&O, glucose
  22. Etiology: Addison's Disease / Adrenocortical Insufficiency
    • Primary: autoimmune destruction of adrenal gland (infection, hemorrhage)
    • Secondary: pituitary adenoma or hemorrhage
    • Iatrogenic: sudden withdrawl of steriods
    • TB, AIDS, metastatic cancer, chemotherapy
  23. Symptoms: Addison's Disease / Adrenocortical Insufficiency
    • Cortisol deficiency: hypoglycemia, intolerance to stress, weight loss, vasomotor collapse, increased pigmentation (include mucous membrane) decreased serum cortisol
    • Aldosterone deficiency: hypotension, hyponatremia, hyperkalemia
  24. Medical Treatment: Addison's Disease / Adrenocortical Insufficiency
    • Replacement of glucocorticoids: cortisone (2/3 in AM, 1/3 in PM)
    • Replacement of mineralcorticoid: florinef
  25. Nursing Management: Addison's Disease / Adrenocortical Insufficiency
    • Dx: Activity intolerance r/t weak hypotension
    • Altered nutrition: increase sodium
  26. Addisonian Crisis
    • Signs:Profound asthenia, severe pain (abdomen, lower back, legs), peripheral vascular collapse, weak rapid pulse, renal shutdown with azotemia (kidney failure). Body temp may be low, severe fever often occurs, especially in acute infection. Shock and fever may be the only signs
    • Treatment: Replace cortisol in times of stress (surgery, trauma, dental work, flu), have 100mg Cortisol pen, wear medicalert bracelet
  27. Pre/post-op care: transphenoidal hypophysectomy
    • Pre:
    • Post: HOB (30 degrees) to decrease ICP and possible CSF leak (signs - postnasal drip, halo signs, clear fluid test positive for glucose)
    • Wound care - no tooth brushing (10 days), soft toothettes, rinse with saline or baking soda
    • Anorexia r/t decreased olfactory sense (increase fluids after nausea)
    • Assess for complications - meningitis (h/a, fever, nuchal rigidity), diabetes insipidus (excess urination, vasopressin needed), increased ICP (avoid coughing, sneezing, nose blowing, bending over, straining), may need hormone replacement
  28. Etiology: Pheochromocytoma
    Catecholamine producing tumor of adrenal gland
  29. Symptoms: Pheochromocytoma
    • Hypertension (350/200)
    • Hyperglycemia
    • Hypermetabolism
    • Throbbing headache, sweating, tachycardia
    • Increased serum catecholamines
    • Increased VMA and metaphrines in urine
  30. Medical Treatment: Pheochromocytoma
    • Alpha and Beta blockers
    • Inderal
    • Clonidine
    • Regitine
    • Nipride
    • Removal of tumor (adrenalectomy)
  31. Nursing Management: Pheochromocytoma
    • Monitor hypotension post-op
    • Monitor pulse, respiration, blood sugars
  32. Pre/post op care: adrenalectomy
    • Pre:
    • Post:
  33. HIV screening tests
    • Rapid HIV test: results in 20 minutes
    • EIA or ELISA: enzyme linked immunosorbent assay (1% error)
    • Western Blot: along with ELISA's (0.005% error)
    • RIPA: radioimmunoprecipitation assaym looks at HIV protein instead of antibodies
    • IFA: immunoflourescent assay
    • CD4 cell count: normal 800-1600/mm3, relatively healthy until they drop below 500
    • CBC: decrease in lymphs, neutrophils, & platelets
    • Viral lode: measures HIV RNA viral particles
  34. List: limitations of HIV screening
  35. How long does it take for a person to seroconvert?
  36. List: modes of transmission of HIV
    Body fluid contact: blood, semen, vaginal secretions, breast milk, cerebral spinal fluid, synovial fluid, pleural fluid, peritoneal fluid, amniotic fluid, pericardial fluid
  37. Patient teaching: safe sex (HIV focused)
  38. Define: HAART
    • Highly Aggressive/Active Antiretroviral Therapy
    • Combination therapy requiring 100% compliance/adherence
    • Take medication on time 100% to prevent HIV from developing drug resistance (may be taking 12-20 pills/day)
    • HAART has decreased the death rate by 66%
    • Treat when CD4 cells are 200 or below
    • Higher risk of cardiac disease, diabetes and liver disease with meds
  39. Nucleoside Reverse Transcriptase Inhibitor (NRTI): How do they work?
    Becomes part of HIV DNA and disrupts its building process, virus can't control the cell
  40. Nucleoside Reverse Transcriptase Inhibitor (NRTI): AZT, ZDV (Zidovudine)
    S/E: anemia, neutropenia
  41. Nucleoside Reverse Transcriptase Inhibitor (NRTI):Epivir (Lamivudine), 3TC
    S/E: lactic acidosis, peripheral neuropathy, pancreatitis, liver dysfunction, bone marrow suppression
  42. Protease Inhibitors: how do they work?
    Prevent protease enzyme from cutting HIV viral proteins (viron), can't infect new lymphocytes
  43. Protease Inhibitors: Frotovase (saquinavir)
    S/E: hemolytic anemia, parathesia, kidney stones, altered taste, diabetes
  44. Protease Inhibitors: Crixivan (indivir)
    • S/E: Kidney stones, fat redistribution
    • Note: No St. John's Wort
  45. Protease Inhibitors: Viracept (nelfinavir)
    S/E: Kidney stones, fat redistribution
  46. Protease Inhibitors: Norvir (ritonavir)
    S/E: Kidney stones, fat redistribution
  47. Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTI): how do they work?
    Attach to reverse transcriptase enzyme, preventig the enzyme from converting HIV RNA to DNA
  48. Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTI): Viramune (nevirapine)
    S/E: liver disease, numbness, psychological isues, muscle pain
  49. Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTI): Sustiva (efavirenz)
    S/E: rash
  50. Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTI): Rescriptor (delavirdine)
    • S/E: rash
    • Note: decreases effectiveness of birth control pills
  51. How do the number of viral copies and disease progession relate?
  52. Infection: Candida
    • Clinical signs: cottage cheese drainage or lesions in the mouth, esophagus, mucus membranes, vagina
    • Medications: ketoconazole, amphotericin B, nystatin
  53. Infection: Herpes
    • Clinical signs: Vesicular lesions coalesce and rupture
    • Medications: acyclovir, foscarnet, valtrex
  54. List: 2 early predictors that an HIV infected patient is progressing to full blown AIDS
  55. Pneumocystitis jiroveci pneumonia (PJP, PCP)
    • Symptoms: coughing (initially nonproductive), fever, dyspnea on exertion (DOE), patchy infiltrates on chest x-ray (CXR)
    • Treatment: oxygen, pentamidine (now aresol, will decrease blood sugars and BP), dapsone (also used for leprosy) trimethoprim-sulfamethoxazole (Bactrim, bone marrow depression)
  56. Mycobacterium tuberculosis (TB)
    • Symptoms: productive cough, fever, night sweats, +/- PPD
    • Treatment: isoniasid, rifampin (orange body fluids, will stain contact lenses), ethambutol, streptomycin (for at least 9 months prophylactically for high risk)
  57. Kaposi's sarcoma
    • Symptoms: patches (flat/pink, eventually violet/black), in HIV it occurs in men who have had sex with other men
    • Treatment: interferon, radiation, antivirals
  58. Cytomegalovirus (CMV retinitis)
    • Symptoms: visual acuity lost, floaters, retina looks like cottage cheese and ketchup, 30% will develop blindness
    • Treatment: ganciclovir, foscarnet
  59. List: Serum lab values elevated in renal disease
    • BUN
    • Creatinine
    • Potassium
    • Phosphate
    • Triglycerides
    • Sodium (initally low, but elevate as disease progresses to end stage)
  60. Renal patient assessment: Cardiovascular
    • Hypertension (r/t volume overload)
    • Lipidemia
    • Palpitations
  61. Renal patient assessment: Fluid & electrolytes
    Elevated potassium (normally 3.5-5, 7-8 may be fatal) and phosphate, decreased calcium, sodium levels are initially low but elevate later
  62. Renal patient assessment: musculoskeletal
    Renal osteodystrophy (can't convert vitamin D to active form, calcium can't be absorbed), parathyroid hormone is secreted (takes calcium out of the bones), and blood levels eventually drop
  63. Renal patient assessment: renal
    • Proteinuria (especially albumin)
    • Urine not concentrated (polyuria, nocturia progressing to anuria)
    • Metabolic acidosis (kidneys can't excrete acid load and ammonia)
  64. Renal patient assessment: gastrointestinal
    • N/V/A
    • Hiccups
    • Peptic ulcer disease
    • Constipation
    • Uremic fetor ("pee breath")
    • Metallic taste
    • Halitosis (bad breath)
    • Weight loss
  65. Renal patient assessment: Integumentary
    • Pruritis
    • Dry skin
    • Uremic frost
    • Yellow gray skin tone
    • Nail changes
    • Thinning hair
    • Edema
  66. Renal patient assessment: Hematopoetic
    • Anemia (r/t loss of erythropoetin and iron deficiencies)
    • Folic acid deficiencies (r/t dialysis)
    • Bone marrow fibrosis (r/t over excretion of parathyroid hormone)
  67. Renal failure electrolyte disturbance: Sodium
    • Normal value: 135-145
    • Usually remains normal to low until end stage renal failure
  68. Renal failure electrolyte disturbance: Potassium
    • Normal value: 3.5-5
    • Excreted mainly by kidneys, increased in renal disease
  69. Renal failure electrolyte disturbance: Calcium
    • Normal value: 9-11
    • Decreased in renal disease due to decreased ability of calcium absorption
  70. Renal failure electrolyte disturbance: Phosphate
    • Normal value: 3-4.5
    • Inversely related to calcium, kidney's responsible for excretion
  71. Describe: Renal diet
    • Low protein (may increase when on hemodialysis)
    • Low phosphate (avoid: fish, pork, beef, chicken, nuts, whole grains, cereals, chocolate, pop)
    • Low potassium (avoid: avocado, rasins, meat, cantaloupe, spinach, bananas, fish, oranges, strawberries, mushrooms, carrots, potatoes, tomatoes)
    • Low sodium (avoid: table salt, soy sauce, cured pork, cheese, milk, butter, mustard, bacon, frankfurter, lunch meat, canned meat, processed food, most snack foods)

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