Exam (elaborations)

NUR 445 - Final Exam Questions and Correct Answers

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NUR 445

Institution
NUR 445

Hyperglycemia (2) -happens in both diabetic & non-diabetic pts -BG >200 mg/dL What contributes to hyperglycemia in critically ill pt? (8) -stress response (hormones) -meds (glucocorticoid therapy) -overfeeding (too many calories) -IV dextrose & TPN -immobility -increased insulin resistance -def...

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Contains Questions & answers

hyperglycemia 2 happens in both diabetic non
what contributes to hyperglycemia in critically il
why is hyperglycemia an issue in pts 4 impair

Institution NUR 445
Course NUR 445

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NUR 445 - Final Exam Questions and
Correct Answers
Hyperglycemia (2) ✅-happens in both diabetic & non-diabetic pts
-BG >200 mg/dL

What contributes to hyperglycemia in critically ill pt? (8) ✅-stress response (hormones)
-meds (glucocorticoid therapy)
-overfeeding (too many calories)
-IV dextrose & TPN
-immobility
-increased insulin resistance
-deficient insulin secretion
-surgery

Why is hyperglycemia an issue in pts? (4) ✅-impairs wound healing
-poor immune response
-inflammation
-endothelial dysfunction (inner lining of blood vessels)

Hyperglycemia Guidelines (5) ✅-tx w/IV insulin until controlled
-target BG: < 180 mg/dL
-must receive glucose calorie source
-BG monitoring q1-2h until stable, then q4h
-confirm hypoglycemia from finger stick

Diabetes Insipidus (DI) - Clinical Manifestations (3) ✅-polydipsia & polyuria
(inadequate ADH secretion OR decreased renal response)
-enormous quantities of extremely dilute/water-like urine (>3L/24hr)
-drinks 2-20L per day (craves cold H2O)

DI - Labs (8) ✅-UO = increased (normal: 1-1.5 L/day)
-urine specific gravity = decreased, 1.001-1.005 (normal: 1.005-1.030)
-urine osmolality = decreased (normal: 300-1400)
-urine Na = decreased (normal: 40-220)
-serum ADH = decreased (normal: 1-5)
-serum osmolality = increased (normal: 280-300)
-serum Na = increased (normal: 135-145)
-fluid volume status = hypovolemia

Neurogenic Shock (3) ✅-injury above T6
-prohibits SNS impulse from passing

,-loss of vasoconstriction = dilated vessels

Why does neurogenic shock look like hypovolemia? (2) ✅-b/c the vessels are dilated
causing blood to pool in periphery
-decreased = venous return, CO, & perfusion

Neurogenic Shock - Triad s/sx (3) ✅-hypotension
-bradycardia
-hypothermia

What does no SNS innervation in neurogenic shock cause? (3) ✅-decreased BP
-decreased HR (very bradycardic)
-decreased temp (skin is still warm)

SIADH - Classic Profile (2) ✅-small amount of concentrated urine (< 400 ml/day)
-decrease in serum Na

What causes the s/sx of SIADH? ✅H2O retention (over secretion of ADH)

What is the severity of the s/sx of SIADH r/t? ✅onset & severity of hyponatremia

What s/sx of SIADH are r/t onset & severity of hyponatremia? (6) ✅-weakness
-confusion
-HA
-seizures
-coma
-fluid overload

Normal ABG Values - Acid-Base (4) ✅-pH = 7.35-7.45
-PaCO2 = 35-45 mmHg
-HCO3 = 22-26 mEq/L
-BE = (-2)-(+2) mEq/L

Normal ABG Values - Oxygenation Status (3) ✅-PaO2 = 80-100 mmHg
-SaO2/SpO2 = ≥95%
-Hgb = 12-18 g/dL

Respiratory Acidosis (3) ✅pH: < 7.35
PaCO2: >45 mmHg
HCO3: normal

Respiratory Alkalosis (3) ✅pH: >7.45
PaCO2: < 35 mmHg
HCO3: Normal

, Metabolic Acidosis (4) ✅pH: < 7.35
PaCO2: normal
HCO3: < 22 mEq/L
BE: < -2 mEq/L

Metabolic Alkalosis (4) ✅pH: >7.45
PaCO2: normal
HCO3: > 26 mEq/L
BE: >+2 mEq/L

ABG Compensation ✅-uncompensated = either the CO2 or the HCO3 is normal (only
one abnormal)
-partially compensated = nothing is normal
-fully compensated = pH is normal

Stroke - Modifiable Risk Factors (4) ✅-BP > 140/95 mmHg
-cardiac disease 2x more likely than those w/o
-DM & dyslipidemia (associated w/conditions that are risk factors)
-smoking

Stroke - Non-Modifiable Risk Factors (4) ✅-age
-gender
-race/ethnicity (african-americans higher risk)
-genetics

Age & Strokes (2) ✅-for each successive decade after 55 y/o stroke rate doubles
-prevalence in >75 is even higher

Gender & Strokes (3) ✅-men at > risk before women until 75 y/o when it equals
-women >84 y/o are at higher risk
-marriage = protective factor

Ischemic-Thrombotic Stroke - Risk Factors (5) ✅-HTN
-smoking
-high cholesterol
-DM
-atherosclerosis

Ischemic-Embolic Stroke - Risk Factors (5) ✅-cardiac abnormalities
-*a.fib*
-valvular heart disease
-carotid plaque
-thrombosis

Hemorrhagic-Subarachnoid Stroke - Risk Factors (3) ✅-ruptured aneurysm

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