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NURS 6531 Final exam Study guide
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NURS 6531 Final exam Study guide
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NURS 6531 Final exam Study guideAddison Disease
✓ ~~~ Adrenal destruction, once predominantly caused by TB. Addrenal insufficiency
associated with autoimmune or significant physiological stress. caused by
destruction of adrenal glands.
Cushing syndrome
✓ ~~~ Overproduction of cortisol, symptoms caused by pituitary caused symptoms.
Glucocorticoids can cause iatrogenic cushings. Excess ACTH can also be caused by
pituitary tumors or adrenal gland hyperproduction.
Pheochromocytoma
✓ ~~~ catacholemine secreting tumor of chomaffin cells. Most are found in the adrenal
medulla. usually unilaeral.
Hypothalamus
✓ ~~~ Creates corticotropin-rleasing hormon that rgulates ACTH. ACTH regulates
cortisol.
Addisons symptoms
✓ ~~~ fatigue, malaise, dizziness, nausea, chronic abd pain, muscle cramps,
hyperpigmentation, weight loss, and salt craving. pts appear chronically ill, weight
loss, dehdyration,
Cushing symtpos
, ✓ ~~~ chronic changes. rapid weight gain, menses chagnes, decreased libido,
weakness, and bruising are possible. hypertension, glucose intolerance, and
insomnia are common. memory and metnal health disturbances are common in
50%. Peds symtpoms is often excess weight gain and depressed linear growth.
Central obesity, moon face, buffalo hump, kmuscle weakness and wasting,
hirsutism, red-purple abd striae. emotional lability and "senile" purpura on the hands.
Pheochromocytoma symtpoms
✓ ~~~ episodic, include headache, diaphoresis, and palpitations. May occure
frequently or infrequently. Symptoms may last 15-30 minutes, and may be
precipitated by activities such as position chagnes. PE shows new onset of moderate
to severe hypertension, with systolic pressures above 170. arrhythmia, sinus tachy,
or bracy may be present.
addisons diagnostics
✓ ~~~ Classically ahve an elevated serum ACTH concentration and suppressed levels
of cortisol. hyponatremia, hyperkalemia related to concurrent lost aldosterone
production. adrenal antibody studies to identify autoimmune disorders, screening for
underlying TB, glucocortioid levels will be low with secondary insufficiency resulting
from HPA axis issues and will have intact aldosterone levels.
chusing syndrome diagnostics
✓ ~~~ classically diagnosed by measurement of more than 100 mcg of cortisol in the
urine during a 24-hour period.
pheochromocytoma diagnostics
✓ ~~~ elevated levels of fractionated metanephrines in a urine or plasma sample
confirm diagnosis. Collection of sample must occur during a flare. abnormal tests
should trigger imaging to confirm.
addisons management
, ✓ ~~~ crisis best managed in hospital with iv corticosterioids and shock management.
chronic can be managed in OP setting using hydrocortisone in dividided doses daily,
(20-30 mg). Mineralcorticoid replacement and salt intake increase to supplement.
cushings management
✓ ~~~ tumor resection, daily ketoconozole to manage P-450 cytochrome competition.
Bone density studies should be done especially with concurrent conditions such as
menopause and thyroid replacement therapy.
Pheochromocytoma treatment
✓ ~~~ definitive treatment is surgical removal. presurgical antihypertensive therapy is
focused on a adrenergic blockage and attention to maintenance of adequate
hydration. B or calcium channel blockers can be added if tachycardia or coronary
artery vasospasm issues arise.
Corticosterioid use in cushings
✓ ~~~ cannot withdraw suddenly, doubling of hydrocortisone dose is required with
fever and illness.
diabetes diagnosis
✓ ~~~ * Glucose Challenge Test (GCT) : <140, 140-199, >200, Fasting glucose: <100,
100-125, >126, random glucose >200 diagnosic for diabetes. HgbA1c <5.7, 5.7-6.4,
>6.5
labs to distinguish type 2 dm from type 1 dm
✓ ~~~ typical DB labs, TSH. to distinguish: C-peptide level, GAD-65 autoantibodies,
insulin autoantibodies, and islet cell autoantibodies.
hirsutism
, ✓ ~~~ excessive hair growth in a female patient.Most common cause is PCOS. PE
includes the Ferriman-Gallwey scoring system. adult postpubertal women may be
tested for hirsutism by the mFG scale.
Hirsutism diagnostics
✓ ~~~ test for androgen levels,
Osteoarthritis
✓ ~~~
McMurray's test
✓ ~~~ Knee exam: shows painful click as the knee is brought from flexion to extension
with either internal or external rotation. Indicates: signal a tear of either the medial or
lateral meniscus when knee is brought from flexion to extension.
Lachmans test
✓ ~~~ Indicates: ACL tear
Exam: bend knee, stablize the femur, pull tibia towards and back. Should feel firm
stopping point, test is postiive with no firm stopping point.
Pivot Shift test
✓ ~~~ test for ACL injury or insufficiency. Exam:
Posterior Drawer test
✓ ~~~ Tests for PCL injury
Exam: laxity posteriorily with lachmans test
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