N444: Test 4

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N444: Test 4 by Mind Map: N444: Test 4

1. Surgery

1.1. Pre-Operative Phase

1.1.1. Various types of surgeries

1.1.1.1. Purposes

1.1.1.2. Urgency

1.1.1.3. Degree of risk

1.1.1.4. Extent

1.1.1.5. Place

1.1.2. Pre-admission testing

1.1.2.1. Initial pre-op assessment begins

1.1.2.1.1. Nutritional and fluid status

1.1.2.1.2. Dentition

1.1.2.1.3. Substance use

1.1.2.1.4. All medication use

1.1.2.1.5. Psychosocial factors

1.1.2.1.6. Review of systems

1.1.2.1.7. Special considerations

1.1.2.1.8. Health history

1.1.2.2. Involves family in interview

1.1.2.3. Verifies completion of diagnostics

1.1.2.3.1. CBC, chems

1.1.2.3.2. Urinalysis, pregnancy test

1.1.2.3.3. PTT, PT/INR

1.1.2.3.4. Blood glucose

1.1.2.3.5. Type/screen vs. Type/cross-match

1.1.2.3.6. EKG

1.1.2.3.7. Chest x-ray

1.1.2.4. Verifies understanding of pre-op orders

1.1.3. Informed consent

1.1.3.1. Voluntary, in writing

1.1.3.2. Must be obtained by the surgeon

1.1.3.3. Adequate disclosure

1.1.3.3.1. Procedure

1.1.3.3.2. Risks, benefits, alternatives

1.1.3.3.3. Unusual procedure disclosure

1.1.3.4. Nurse's role

1.1.3.4.1. Obtained before psychoactive medication

1.1.3.4.2. Verify patient's understanding

1.1.3.4.3. Obtain and witness signature

1.1.3.5. Can't be given by incompetent patients

1.1.3.5.1. Not autonomous

1.1.3.5.2. Cannot give or withhold

1.1.4. Patient education

1.1.4.1. Deep breathing

1.1.4.2. Coughing

1.1.4.3. Incentive spirometry

1.1.4.4. Mobility

1.1.4.5. Pain management

1.1.4.6. Cognitive coping strategies

1.1.4.7. Ambulatory instructions

1.1.4.8. Day-of-surgery instructions

1.1.4.8.1. Where/when to report

1.1.4.8.2. NPO status (except some medications)

1.1.4.8.3. No substance use for 24 hours prior

1.1.4.8.4. No makeup, jewelry, valuables

1.1.4.8.5. Loose clothing

1.1.5. Nursing interventions

1.1.5.1. General

1.1.5.1.1. Psychosocial

1.1.5.1.2. Safety

1.1.5.1.3. Nutrition, fluids

1.1.5.1.4. Bowel and skin preparation

1.1.5.2. Immediate

1.1.5.2.1. Pre-anesthetic medication

1.1.5.2.2. Pre-op record

1.1.5.2.3. Transport

1.1.5.2.4. Family needs

1.1.5.3. Preventative

1.1.5.3.1. Diaphragmatic breathing

1.1.5.3.2. Coughing

1.1.5.3.3. Leg exercises

1.1.5.3.4. Turning to side

1.1.5.3.5. Getting out of bed

1.1.5.4. Post-surgical

1.1.5.4.1. Pain management

1.1.5.4.2. Respiratory interventions

1.1.5.4.3. Positioning

1.1.5.4.4. Early ambulation

1.1.5.4.5. Dietary restrictions

1.1.5.4.6. Equipment

1.1.5.4.7. Expected length of stay

1.1.5.4.8. Outpatient surgery*

1.1.6. Transferring to the OR

1.1.6.1. Verification process

1.1.6.1.1. ID and allergy bands

1.1.6.1.2. NPO status

1.1.6.1.3. Completed bowel and skin preparation

1.1.6.1.4. H&P and labs in chart

1.1.6.1.5. Required forms complete

1.1.6.2. Baseline VS and PA

1.1.6.3. Valuables

1.1.6.4. Voiding before surgery

1.1.6.5. Pre-operative medications

1.1.6.6. Final check with transport

1.2. Intra-Operative Phase

1.2.1. Surgical nursing

1.2.1.1. Circulating nurse

1.2.1.1.1. Set up the OR

1.2.1.1.2. Ensures surgical team

1.2.1.1.3. Maintains asepsis

1.2.1.1.4. Communicates & documents

1.2.1.2. "Scrub" nurse or tech

1.2.1.2.1. Sets up field and tables

1.2.1.2.2. Prepares equipment

1.2.1.2.3. Assists surgeon and circulator (count)

1.2.1.2.4. Labels specimens >> circulator >> lab

1.2.1.3. Perioperative nurse

1.2.2. Surgical asepsis

1.2.2.1. Three OR zones

1.2.2.1.1. Unrestricted

1.2.2.1.2. Semi-restricted

1.2.2.1.3. Restricted

1.2.2.2. Basics

1.2.2.2.1. Only sterile touches wound or field

1.2.2.2.2. Gown is sterile at level of field

1.2.2.2.3. Top of draped tables only!

1.2.2.2.4. Sterile >> sterile (or unsterile >> unsterile)

1.2.2.2.5. Cannot contaminate field while moving around

1.2.2.2.6. Prepare the field as close to time of surgery as possible

1.2.2.3. Site prep

1.2.2.3.1. At home

1.2.2.3.2. Before the surgery

1.2.3. Health hazards

1.2.3.1. Faulty or improper use of equipment

1.2.3.2. Exposure to toxins

1.2.3.3. Lasers

1.2.3.3.1. Warning signs

1.2.3.3.2. Goggles to prevent inhalation

1.2.3.3.3. Smoke evacuators

1.2.3.4. Blood and body fluids

1.2.3.4.1. Sharps

1.2.3.4.2. Bony fragments

1.2.3.4.3. Special gear required

1.2.4. Adverse effects

1.2.4.1. Allergic reactions

1.2.4.2. Drug toxicity

1.2.4.3. System alterations

1.2.4.3.1. Dysrhythmias

1.2.4.3.2. CNS changes

1.2.4.3.3. hTN

1.2.4.3.4. Thrombosis

1.2.4.4. Trauma

1.2.4.4.1. Larynx

1.2.4.4.2. Mouth

1.2.4.4.3. Nerves

1.2.4.4.4. Skin

1.2.5. Anesthesia

1.2.5.1. Selection criteria

1.2.5.1.1. Medical history

1.2.5.1.2. Type and duration of surgery

1.2.5.1.3. Safety issues (airway)

1.2.5.1.4. Emergency*

1.2.5.1.5. Pain management

1.2.5.1.6. Client's position

1.2.5.2. Types

1.2.5.2.1. General

1.2.5.2.2. Regional

1.2.5.2.3. Moderate

1.2.5.2.4. MAC

1.2.5.2.5. Local

1.2.6. Complications

1.2.6.1. N/V

1.2.6.1.1. Should pre-medicate

1.2.6.1.2. Suctioning

1.2.6.2. Anaphylaxis

1.2.6.2.1. Medications, latex, etc.

1.2.6.2.2. Can be fatal

1.2.6.3. Hypoxia

1.2.6.3.1. Variable causes

1.2.6.3.2. Brain damage risk

1.2.6.4. Hypothermia

1.2.6.4.1. >98.0 (36.6)

1.2.6.4.2. Many causes

1.2.6.4.3. Lots of monitoring

1.2.6.5. Malignant hyperthermia

1.2.6.5.1. Pathophysiology

1.2.6.5.2. Common cause: succinylcholine + INH

1.2.6.5.3. Management

1.2.6.5.4. Goals

1.2.6.5.5. Manifestations

1.2.6.6. Gerontological considerations

1.2.6.6.1. Increased risk of complications

1.2.6.6.2. Risk factors

1.2.7. Nursing interventions

1.2.7.1. Anxiety

1.2.7.2. Latex exposure

1.2.7.3. Positioning injuries

1.2.7.3.1. Patient's risk factors

1.2.7.3.2. Common systems affected

1.2.7.3.3. Long procedure

1.2.7.3.4. Staff's knowledge

1.2.7.3.5. Complications

1.2.7.3.6. Prevention

1.2.7.3.7. Interventions

1.2.7.4. Protecting from injury

1.2.7.4.1. ID bands

1.2.7.4.2. Informed consent

1.2.7.4.3. Verification of records

1.2.7.4.4. Diagnostics

1.2.7.4.5. Allergies

1.2.7.4.6. Environmental monitoring

1.2.7.4.7. Safety measures

1.2.7.4.8. Blood products

1.2.7.4.9. "Time-out" verification

1.2.7.5. Advocacy

1.2.7.6. Complications

1.2.8. Nursing responsibilities

1.2.8.1. Transport to the OR

1.2.8.2. Assisting anesthetist

1.2.8.2.1. Monitoring devices

1.2.9. Skin closures

1.2.9.1. Hold wound edges together

1.2.9.1.1. For healing

1.2.9.1.2. Occludes blood vessels

1.2.9.1.3. Prevents contaminatin

1.2.9.2. Various types

1.2.9.2.1. Sutures/staples

1.2.9.2.2. Tape or steri-strips

1.2.9.2.3. Glue (dermabond)

1.3. Post-Operative Phase

1.3.1. Begins with PACU admission

1.3.1.1. Recovery area

1.3.1.2. Care in surgical unit

1.3.1.3. Home

1.3.1.4. Clinic follow-up

1.3.2. PACU nursing

1.3.2.1. Care until patient has recovered from anesthesia

1.3.2.1.1. Motor, sensory function

1.3.2.1.2. Oriented

1.3.2.1.3. Stable VS

1.3.2.1.4. No signs of hemorrhage or complications

1.3.2.2. Requires frequent skilled assessment

1.3.2.3. Three phases

1.3.2.4. Responsibilities

1.3.2.4.1. Review of data prior to admission

1.3.2.4.2. Focused assessment

1.3.2.4.3. Proper positioning

1.3.2.4.4. Airway maintenance

1.3.2.4.5. Monitor for complications

1.3.2.4.6. Targeted assessment for complications

1.3.3. Surgical dressings

1.3.3.1. Purposes

1.3.3.1.1. Healing

1.3.3.1.2. Absorption

1.3.3.1.3. Splint/immobilization

1.3.3.1.4. Protection

1.3.3.1.5. Homeostasis

1.3.3.1.6. Comfort

1.3.3.2. Management

1.3.3.2.1. DOS >> POD #1

1.3.3.2.2. 1st dressing change

1.3.4. Collaborative problems

1.3.4.1. Pulmonary infection

1.3.4.2. Hypoxia

1.3.4.3. DVT

1.3.4.4. Hematoma/hemorrhage

1.3.4.5. Pulmonary embolism

1.3.4.6. Wound dehisence

1.3.4.6.1. Apply sterile or NS dressing

1.3.4.6.2. Call the surgeon

1.3.4.7. Wound evisceration

1.3.4.7.1. Open with protrusion

1.3.4.7.2. Immediate surgery!

1.3.5. Wound complications

1.3.5.1. Impaired healing

1.3.5.1.1. Chronic disease

1.3.5.1.2. Elderly

1.3.5.2. Increased sepsis

1.3.5.2.1. Malnourished

1.3.5.2.2. Immunosuppressed

1.3.5.2.3. Prolonged stay

1.3.5.3. Fluid accumulation

1.3.5.3.1. Impaired healing

1.3.5.3.2. Increased risk of infection

1.3.5.4. Gerontological considerations

1.3.5.4.1. Greater risk for complications

1.3.5.4.2. Careful, frequent monitoring

1.3.5.4.3. Confusion, delirium likely

1.3.5.4.4. Watch drug dosages

1.3.5.4.5. Hydration status

1.3.5.4.6. Reorient PRN

1.3.6. Discharge for PACU

1.3.6.1. Occurs when criteria met

1.3.6.1.1. Stable BP

1.3.6.1.2. Good RR

1.3.6.1.3. Good O2 sat

1.3.6.1.4. Modified Aldrete Score

1.3.6.2. Transfer of care

1.3.6.2.1. PACU >> Unit RN

1.3.6.2.2. Give a good report

1.3.6.3. Direct discharge instructions

1.3.6.3.1. Planning and assessment

1.3.6.3.2. Shorter stays = less teaching time

1.3.6.3.3. Written, verbal instructions

2. Diabetes

2.1. Overview

2.1.1. Characterized by hyperglycemia

2.1.1.1. Insulin secretion defect

2.1.1.2. Insulin action defect

2.1.1.3. BOTH

2.1.2. Demographics

2.1.2.1. 23 million Americans

2.1.2.1.1. 1/3 are undiagnosed

2.1.2.1.2. +1 mil per year

2.1.2.1.3. Increasing

2.1.2.2. Certain populations

2.1.2.2.1. Minorities

2.1.2.2.2. Elderly

2.2. Risk Factors

2.2.1. Obesity

2.2.2. Impaired FG or GT

2.2.2.1. Pre-diabetes

2.2.2.2. Glucose b/w normal and diabetic levels

2.2.3. HTN

2.2.4. Dyslipidemia

2.2.4.1. Low HDL (35 and below)

2.2.4.2. High TG (250 and higher)

2.2.5. Gestational diabetes

2.2.6. High birth weight delivery (>9 lbs)

2.2.7. Metabolic syndrome

2.2.7.1. Picture of patient with Type 2 DM

2.2.7.2. Diagnosed with 3+ criteria

2.2.7.2.1. Insulin resistence

2.2.7.2.2. Central obesity

2.2.7.2.3. Dyslipidemia

2.2.7.2.4. High BP (>130/85)

2.2.7.2.5. Pro-inflammatory state

2.2.7.2.6. Pro-thrombotic state

2.2.8. Personal characteristics

2.2.8.1. Family history (parents or siblings)

2.2.8.2. Race or ethnicity

2.2.8.3. Age 45+ yo

2.2.8.3.1. Age-related glucose elevation

2.3. Diagnostic Criteria

2.3.1. Normal

2.3.1.1. FPG <100 mg/dL

2.3.1.2. 2 hr. PG <140 mg/dL

2.3.2. Pre-diabetes

2.3.2.1. FPG 100-126 m/dL

2.3.2.2. 2 hr. PG 140-199 mg/dL

2.3.3. Diabetes

2.3.3.1. FPG 126+ mg/dL

2.3.3.2. RPG 200+ plus symptoms

2.3.3.3. 2 hr. PG 200+

2.4. Classifications

2.4.1. Type I DM

2.4.1.1. Autoimmune process destroys beta cells

2.4.1.2. Insulin-dependent r/t altered production

2.4.1.3. Acute onset before age 30

2.4.1.4. 5-10% of persons with DM

2.4.2. Type II DM

2.4.2.1. Pathophysiology

2.4.2.1.1. Insulin resistance + impaired beta cell function

2.4.2.1.2. >> Decreased insulin production

2.4.2.1.3. Slow, progressive glucose intolerance

2.4.2.2. 90-95% of DM cases

2.4.2.3. Onset age 30+ and obese

2.4.2.4. Treatment

2.4.2.4.1. Diet and exercise first

2.4.2.4.2. Oral hypoglycemics, insulin

2.4.2.5. Insulin Functions

2.4.2.5.1. Transports and metabolizes glucose >> energy

2.4.2.5.2. Stimulates glucose storage in liver and muscle as glycogen

2.4.2.5.3. Signals liver to stop glucose release

2.4.2.5.4. Enhances storage of fat into adipose tissue

2.4.2.5.5. Accelerates transport of amino acids into cells

2.4.2.5.6. Inhibits breakdown of stored glucose, protein, fat

2.4.2.6. Manifestations

2.4.2.6.1. Polyuria, polydipsia, polyphagia

2.4.2.6.2. Fatigue, weakness

2.4.2.6.3. Vision changes

2.4.2.6.4. Parasthesias

2.4.2.6.5. Dry skin

2.4.2.6.6. Slow healing

2.4.2.6.7. Recurrent infections

2.4.2.7. Diagnostics

2.4.2.7.1. FBG 126 mg/dL +

2.4.2.7.2. RG >200 mg/dL

2.4.3. Gestational

2.4.4. Associational

2.5. Treatment

2.5.1. Goals of treatment

2.5.1.1. Normalize blood levels

2.5.1.1.1. Intensive methods = best outcome

2.5.1.1.2. Fewer vascular, neuropathic complications

2.5.1.2. Dietary management

2.5.1.2.1. Goals

2.5.1.2.2. Role of the nurse

2.5.1.2.3. Meal planning

2.5.1.2.4. Glycemic index

2.5.1.2.5. Other concerns

2.5.1.3. Exercise regimen

2.5.1.3.1. Lowers glucose, weight, CV risk

2.5.1.3.2. Certain precautions apply

2.5.1.3.3. Need regular daily exercise

2.5.1.3.4. Recommended stress test

2.5.1.3.5. Gerontological considerations

2.5.2. Aspects of treatment

2.5.2.1. Oral agents

2.5.2.1.1. Supplemental for Type 2 DM

2.5.2.1.2. May combine agents

2.5.2.1.3. Most CSE: Hypoglycemia

2.5.2.1.4. Patient education

2.5.2.1.5. Process

2.5.2.2. Insulin therapy

2.5.2.2.1. Requires blood glucose monitoring

2.5.2.2.2. Various categories and durations

2.5.2.2.3. Usually injected, but may be inhaled

2.5.2.3. Sick day management

2.5.2.3.1. Use meds as prescribed

2.5.2.3.2. Test blood, urine q3-4 hours

2.5.2.3.3. Report elevations to HCP

2.5.2.3.4. Supplemental insulin

2.5.2.3.5. Substitute soft meals PRN

2.6. Complications

2.6.1. Acute events

2.6.1.1. Hypoglycemia

2.6.1.1.1. Very low glucose (<60 mg/dL)

2.6.1.1.2. Causes

2.6.1.1.3. Manifestations

2.6.1.1.4. Assessment

2.6.1.1.5. Management

2.6.1.2. DKA (Type 1)

2.6.1.3. HHNS

2.6.1.3.1. The initialism

2.6.1.3.2. Lack of effective insulin causes hyper- states

2.6.1.3.3. Minimal to no ketosis

2.6.1.3.4. Results of hyperglycemia

2.6.1.3.5. Manifestations

2.6.1.3.6. Treatment

2.6.1.3.7. Prevention

2.6.2. Chronic problems

2.6.2.1. Macrovascular

2.6.2.1.1. Advanced atherosclerosis

2.6.2.1.2. CAD, CVD, PVD

2.6.2.2. Microvascular

2.6.2.2.1. Retinopathy

2.6.2.2.2. Nephropathy

2.6.2.3. Neuropathic

2.6.2.3.1. Peripheral neuropathy

2.6.2.3.2. Autonomic neuropathy

2.6.2.3.3. Hypoglycemic unawareness

2.6.2.3.4. Neuropathy

2.6.2.3.5. Sexual dysfunction

2.7. Nursing Process

2.7.1. Assessment

2.7.1.1. Presenting problem

2.7.1.2. Related needs

2.7.1.3. Patient knowledge

2.7.1.4. Blood glucose

2.7.1.5. Skin

2.7.1.6. Preventative measures

2.7.2. Diagnoses

2.7.2.1. Deficient knowledge

2.7.2.2. Anxiety

2.7.2.3. Fluid/electrolyte imbalance

2.7.2.4. Fluid volume deficit

2.7.3. Collaboration

2.7.4. Planning, goals

2.7.5. Interventions

2.7.6. Evaluation

2.7.6.1. Fluid-electrolyte balance

2.7.6.2. Knowledge re: HHNS

2.7.6.3. No complications

3. HIV

3.1. CDC Statistics

3.1.1. 1.14 million HIV cases in 2009

3.1.1.1. US statistics

3.1.1.2. 18% are undiagnosed

3.1.2. 57, 000 new cases in 2006

3.1.3. Concentrated in urban areas

3.1.4. Highest levels in the South

3.2. Transmission

3.2.1. HIV or infected CD4 lymphocytes

3.2.2. Non-casual contact

3.2.3. Increased risk with broken skin

3.2.4. Fewer blood transfusions infected

3.2.4.1. Since 1985 screening

3.2.4.2. Still possible during "window period"

3.3. Risk Factors

3.3.1. Risk factors

3.3.1.1. Sharing used needles

3.3.1.2. Sexual contact

3.3.1.3. Blood products before 1985

3.3.1.4. Congenital factors

3.3.2. Gerontology

3.3.2.1. Lack of condom use

3.3.2.2. Not viewed as high-risk

3.3.2.3. IV drug users

3.3.2.4. Transfusions before 1985

3.3.2.5. Reduced immunity

3.4. Prevention

3.4.1. Safe sex practices

3.4.2. Clean needles

3.4.3. Blood screening

3.4.4. Education for childbearing women

3.5. HCP Information

3.5.1. Standard precautions apply

3.5.2. Post-exposure protocol per institution

3.6. Stages

3.6.1. Primary infection

3.6.1.1. CDC Category A

3.6.1.2. Acute infection

3.6.1.3. Window period (lack the antibodies)

3.6.1.4. Rapid viral replication & spread

3.6.1.5. Teetering on viral setpoint

3.6.1.6. No symptoms to flu-like symptoms

3.6.2. Asymptomatic

3.6.2.1. CDC Category A

3.6.2.2. Hit viral set point >> chronic stage

3.6.2.3. >500 CD4/mm3

3.6.2.4. Sufficient immunity

3.6.3. Symptomatic

3.6.3.1. CDC category B from that point on

3.6.3.2. 200-499 CD4/mm3

3.6.3.3. Gradual decline in T-cells

3.6.3.4. Develop symptoms r/t non-category C conditions

3.6.4. AIDS

3.6.4.1. CDC category C

3.6.4.2. CD4 <200/mm3

3.6.4.3. Immunity seriously compromised

3.6.4.4. Develop associated conditions

3.7. Management

3.7.1. Assessment

3.7.1.1. Health history (risk factors)

3.7.1.2. S/S immunosuppression

3.7.2. Diagnostics

3.7.2.1. HIV antibody tests (EIA)

3.7.2.1.1. Positive

3.7.2.1.2. Negative

3.7.2.1.3. Testing types

3.7.2.2. Education, counseling

3.7.2.3. Viral load tests

3.7.2.3.1. RT-PCR

3.7.2.3.2. NASBA

3.7.2.3.3. Viral load test

3.7.2.3.4. HIV culture

3.7.3. Treatment

3.7.3.1. Meds determined by T-cell count

3.7.3.1.1. <350 cells/mm3

3.7.3.1.2. Viral load >100K copies per mL

3.7.3.2. Antiviral agents

3.7.3.2.1. NRTIs

3.7.3.2.2. NNRTIs

3.7.3.2.3. Protease inhibitor

3.7.3.2.4. Fusion inhibitor

3.7.3.2.5. Integrase strand transfer inhibitor

3.7.3.2.6. Multiclass combo products

3.7.3.3. Other considerations

3.7.3.3.1. Viral load

3.7.3.3.2. Severity of HIV/AIDS

3.7.3.3.3. Related symptoms

3.7.3.3.4. Adherence

3.7.3.4. Drug resistance

3.7.3.4.1. Monotherapy

3.7.3.4.2. Adherence

3.7.3.4.3. Late initiation

3.7.3.5. Goals

3.7.3.5.1. Suppress viral load

3.7.3.5.2. Preserve immunity

3.7.3.5.3. QOL; prevent M&M

3.8. Associated Diseases

3.8.1. Respiratory

3.8.1.1. Pneumocystis pneumonia

3.8.1.1.1. Most common infection

3.8.1.1.2. Manifestations

3.8.1.1.3. Diagnosed by lung/bronchial secretions

3.8.1.1.4. Treatment

3.8.1.2. Mycobacterium avium complex (MAC)

3.8.1.2.1. Common, opportunistic

3.8.1.2.2. RR, GI, lymph nodes, bone marrow

3.8.1.2.3. Increases mortality rate

3.8.1.2.4. Treatment

3.8.1.3. Tuberculosis (TB)

3.8.1.3.1. Lungs, CNS, bone, pericardium, stomach

3.8.1.3.2. Peritoneum, scrotum

3.8.1.3.3. Depends on adherence to antiretroviral therapy

3.8.2. Oral candidasis

3.8.2.1. Fungal infection

3.8.2.2. Creamy white patches in oral cavity

3.8.2.3. Moves to stomach, esophagus if untreated

3.8.2.4. Impacts nutritional status

3.8.2.4.1. Problems swallowing

3.8.2.4.2. Retrosternal pain

3.8.2.4.3. Oral lesions

3.8.3. Oncologic

3.8.3.1. Kaposi's sarcoma

3.8.3.1.1. Most common related malignancy

3.8.3.1.2. More common in males who are GB

3.8.3.1.3. Manifestations

3.8.3.1.4. Confirmed by biopsy

3.8.3.1.5. Treatment

3.8.3.1.6. Variable prognosis

3.8.3.2. B-cell lymphomas

3.8.3.2.1. 2nd most common malignancy

3.8.3.2.2. Higher grade, aggressive, resistent

3.8.3.2.3. Outside of the lymph nodes

3.8.3.2.4. Multi-organ involvement

3.8.3.2.5. Unsuccesful treatment

3.8.4. Neurologic

3.8.4.1. Distal sensory polyneuropathy

3.8.4.2. Distal symmetric polyneuropathy (DSPN)

3.8.4.2.1. Most common

3.8.4.2.2. Advanced HIV

3.8.4.2.3. Result of process

3.8.4.2.4. Pain, impaired function

3.8.4.3. HIV encephalopathy

3.8.4.3.1. AIDS dementia

3.8.4.3.2. Progressive decline

3.8.4.3.3. Subtle indications

3.8.4.3.4. Tough to confirm

3.8.4.4. Cryptococcus neoformans

3.8.4.4.1. Opportunistic fungal infection

3.8.4.4.2. Diagnosed by CSF

3.8.4.4.3. Manifestations

3.8.4.5. Progressive multifocal leukoencephalopathy

3.8.4.5.1. Demyelinating disorder

3.8.4.5.2. Manifestations

3.8.4.6. Others

3.8.4.6.1. Toxoplasma gondii

3.8.4.6.2. CMV

3.8.4.6.3. Mycobacterium TB

3.8.4.6.4. Vasculas myelopathy

4. Endocrine Disorders

4.1. Overview

4.1.1. Hormones

4.1.1.1. Messengers, regulators

4.1.1.2. Made and released by glands

4.1.1.3. Integrate with nervous system

4.1.2. Functions of endocrine system

4.1.2.1. Differentiation of reproductive and CNS

4.1.2.2. Stimulating growth/development

4.1.2.3. Coordiating male/female reproductive systems

4.1.2.4. Maintaining homeostasis

4.1.2.5. Correction and adaptation

4.1.3. General characteristics

4.1.3.1. Rate and rhythm

4.1.3.2. Within feedback system

4.1.3.3. Act only on specific target cells

4.1.3.4. Constantly made by kidneys or deactivated by liver, etc

4.1.3.5. Released in response to alteration

4.1.3.5.1. Designed to maintain certain levels

4.1.3.5.2. Regulated by several types of factors

4.2. Feedback Systems

4.2.1. To maintain homeostasis

4.2.2. Two types

4.2.2.1. Negative

4.2.2.1.1. Most common

4.2.2.1.2. (Erythropoietin regulates erythropoesis)

4.2.2.1.3. Process

4.2.2.2. Positive

4.2.2.2.1. Social network

4.2.2.2.2. Oxytocin release during labor

4.2.3. Hypothalamus-Pituitary System

4.2.3.1. Hypothalamus hormones

4.2.3.1.1. TRH

4.2.3.1.2. GnRH

4.2.3.1.3. GFR

4.2.3.1.4. CRH

4.2.3.2. Pituitary hormones

4.2.3.2.1. Posterior (oxytocin and ADH)

4.2.3.2.2. Anterior (adenohypophysis)

4.3. Thyroid Disorders

4.3.1. Thyroid hormone functions

4.3.1.1. Metabolic activity controller

4.3.1.1.1. T4 = weak

4.3.1.1.2. T3 = strong gas pedal

4.3.1.2. Brain development

4.3.1.3. Normal growth

4.3.1.4. All organ systems

4.3.2. Specific tests

4.3.2.1. TSH

4.3.2.1.1. Diagnosis, monitoring replacement

4.3.2.1.2. Differentiates b/w thyroid, pituitary, or hypothalamic disorders

4.3.2.2. Serum free T4

4.3.2.2.1. To confirm abnormal TSH

4.3.2.2.2. Measures active T4

4.3.2.3. Serum free T3/T4

4.3.2.3.1. Total of protein-bound levels

4.3.2.3.2. In response to TSH

4.3.2.4. Others

4.3.2.4.1. Thryoid antibodies

4.3.2.4.2. Radioactive iodine uptake

4.3.3. Alterations

4.3.3.1. Hypothyroidism

4.3.3.1.1. Suboptimal TH levels

4.3.3.1.2. Affects all function

4.3.3.1.3. Mild, subclinical forms to myxedema

4.3.3.1.4. Increases with age

4.3.3.1.5. Most common cause: autoimmune thyroiditis (Hashimoto)

4.3.3.1.6. Manifestations

4.3.3.1.7. Treatment

4.3.3.1.8. Care plan

4.3.3.2. Hyperthyroidism

4.3.3.2.1. Graves disease

4.3.3.2.2. Characteristics

4.3.3.2.3. Assessment/diagnosis

4.3.3.2.4. Gerontological considerations

4.3.3.2.5. Thyrotoxic crisis

4.4. Parathyroid Disorders

4.4.1. Produces PTH

4.4.1.1. Most important factor in regulating Ca

4.4.1.2. Increased Ca and decreased P

4.4.1.3. Stimulated by hypocalcemia

4.4.1.3.1. >> PTH >> Kidneys

4.4.1.3.2. >> Increased Ca resabsorption (decreased P)

4.4.1.3.3. >> Rising Ca >> Inhibited PTH

4.4.1.4. Role of active Vitamin D

4.4.1.4.1. Promotes reabsorption of Ca and P in gut

4.4.1.4.2. Increases Ca while decreasing PTH

4.4.1.4.3. Promotes bone mineralization

4.4.2. Alterations

4.4.2.1. Hyperparathyroidism

4.4.2.1.1. Bone decalcification & kidney stones

4.4.2.1.2. Can be secondary to CRF

4.4.2.1.3. Manifestations

4.4.2.1.4. Assessment/diagnostics

4.4.2.1.5. Medical management

4.4.2.1.6. Hypercalcemic crisis

4.4.2.2. Hypoparathyroidism

4.4.2.2.1. Usually caused by decreased PTH post-op

4.4.2.2.2. Progresses to

4.4.2.2.3. Manifestations

4.4.2.2.4. Assessment

4.4.2.2.5. Treatment

4.5. Adrenal Disorders

4.5.1. Parts of the gland

4.5.1.1. Cortex (outer)

4.5.1.1.1. Glomerulosa (aldosterone)

4.5.1.1.2. Fasiculata (GC: CCC)

4.5.1.1.3. Reticularis

4.5.1.2. Medulla (inner)

4.5.1.2.1. Catecholamines

4.5.1.2.2. E and NE

4.5.2. Adrenocortical insufficiency

4.5.2.1. Addison disease

4.5.2.2. Inadequate adrenal function

4.5.2.3. Need corticosteroids

4.5.2.3.1. Daily for 2-4 weeks

4.5.2.3.2. Can suppress function of glands

4.5.2.4. Manifestations

4.5.2.4.1. Weakness, anorexia, GI s/s

4.5.2.4.2. Fatigue, emaciation

4.5.2.4.3. Dark pigmentation on bony prominences

4.5.2.4.4. hTN, low Na and glucose

4.5.2.4.5. High K

4.5.2.4.6. Mental changes

4.5.2.4.7. Dehydration r/t EI

4.5.2.5. Addisonian crisis

4.5.2.5.1. Disease progression and acute hTN

4.5.2.5.2. Cyanosis and shock symptoms

4.5.2.5.3. Diagnostics

4.5.2.5.4. Treatment

4.5.2.5.5. Nursing care

4.5.3. Cushing syndrome

4.5.3.1. Excess activity

4.5.3.2. Often caused by corticosteroids

4.5.3.2.1. Or hyperplasia

4.5.3.2.2. Or malignant bronchogenic carcinoma

4.5.3.3. Ineffective normal feedback

4.5.3.4. Loss of usual diurnal pattern

4.5.3.5. Manifestations

4.5.3.5.1. Too much GC and androgens (+MC)

4.5.3.5.2. Central obesity

4.5.3.5.3. "Buffalo-hump"

4.5.3.5.4. Moon face

4.5.3.5.5. Heavy trunk

4.5.3.5.6. Thin skin

4.5.3.5.7. Weakness

4.5.3.5.8. Muscle wasting, osteoporosis

4.5.3.5.9. HTN r/t Na-water retention

4.5.3.5.10. Slow healing

4.5.3.6. Assessment/diagnosis

4.5.3.6.1. Dextramethasone suppression test

4.5.3.6.2. 24 hour urine free cortisol

4.5.3.6.3. Plasma ACTH; US, MRI, CV (tumors)

4.5.3.7. Medical management

4.5.3.7.1. By cause

4.5.3.7.2. Pituitary tumor

4.5.3.7.3. Adrenal tumor

4.5.3.7.4. Corticosteroids

4.6. Gerontological Concerns

4.6.1. Thyroid gland

4.6.1.1. Atrophies with age

4.6.1.2. Decrease TSH, T3, T4 >> Hypothyroidism

4.6.1.3. Usually maintain adequate function

4.6.2. Parathyroid glands

4.6.2.1. Increased basal PTH + secretion =

4.6.2.2. More Ca resorption, hypercalcemia, hypercalciuria

4.6.3. Adrenal cortex

4.6.3.1. Fibrotic, shrinks

4.6.3.2. Higher cortisol levels

4.6.3.3. Decreased levels of androgens, aldosterone

4.6.3.3.1. Possible decrease response r/t >>

4.6.3.3.2. Na restriction + upright posture