Complex Concepts Exam 2 Review
Erectile Dysfunction (1-3 questions)
 Management of Care
o Medical management of ED begins with a medical and sexual history to
determine the degree of the problem and to reveal disease, lifestyle habits, or
med use that may be contributing to ED
o Nocturnal penile tumescence and rigidity monitoring helps differentiate
between psychogenic and organic causes
 Physically healthy men have involuntary erections in sleep
o Mechanical Device—Vacuum Constriction Device
 Draws blood into the penis w/ a vacuum and traps it there with a
constricting band at the base of the penis
o Surgery involves either revascularization procedures or implantation of
prosthetic devices
o Nurses should:
 Maintain a professional affect when discussing ED
 Promote self-esteem
 Provide info about treatment options
 Teach patient and partner how to use penile implant
 Health Promotion
o Treatment of ED usually starts with lifestyle changes: quitting smoking,
reducing alcohol intake, losing weight, increasing exercise
 Pharmacological Interventions
o Oral Meds: -FIL (sildenafil, vardenafil, etc.)
 Enhance erections only when sexual stimulation is present
 Acts within 30-60min
 Facilitate relaxation of smooth muscle in penis to increase blood flow
 Don't take more than once a day
 Don't take with nitrate-based drugs or alpha-blockers
 Complications
o Can cause relationship issues with significant other
o Priapism—erection lasting longer than 4hrs
 May be a side effect of ED medications
BPH (1-3 questions)
 BPH is when the enlargement of the prostate gland starts to cause urinary
dysfunction
o Can impair the outflow of urine from bladder, causing retention and infection
(of urinary tract or kidneys)
 Management of Care
o Typical S/S: urinary frequency/urgency/hesitance/incontinence, dribbling
post-voiding, diminished force of urinary stream, straining with urination
o Nursing Care (Education):
Frequent ejaculation helps decrease size of prostate
Avoid drinking large amounts of fluids at one time
Urinate when urge is first felt
Avoid bladder stimulants (alcohol, caffeine)
Avoid meds that cause decreased bladder tone (anticholinergics,
decongestants, antihistamines)
o Transurethral Resection of the Prostate (TURP)
 Most common surgical procedure
 Resectoscope inserted through urethra trims away excess prostatic
tissue
 Post-op: placement of indwelling 3-way catheter
 Drains urine and allows continuous irrigation
o Keep irrigation return pink or lighter by adjusting rate
 Avoid heavy lifting, strenuous exercise, straining, sexual intercourse
for 2-6 weeks
 Drink lots of fluids (12+ 8oz glasses)
 Pharmacological Interventions
o Goal is to re-establish uninhibited urine flow
o Finasteride—decreases production of testosterone in prostate, causing a
decrease in size
 Can take 6-12mos for therapeutic effects
 Impotence and decreased libido are possible
 Teratogenic to male fetus!! Preggo women should avoid contact with
broken tablets/semen of client on this med
o Tamsulosin (alpha blocker—no –FIL!!!!)
 Causes relaxation of bladder and prostate and decrease pressure on
urethra, re-establishing a stronger flow
 Ortho hypo can occur
Menopause (1-3 questions)
 Menopause is the cessation of menses. Complete when no menses have occurred for
12 months.
 Health Promotion
o This is a normal process!!
o Weight-bearing exercises reduce chance of osteoporosis
 Clinical Manifestations
o Hot flashes
o Decreased vaginal secretions/vaginal dryness
o Mood swings/changes in sleep patterns
o Decreased bone density
o Decreased HDL/Increased LDL
o Decreased skin elasticity
o Breast tissue changes
 Complications





o Embolic complications—risk increased by concurrent smoking
 MI, stroke, thrombophlebitis
o Cancer—long term use of HT can increase risk for breast cancer
 Teaching
o American Cancer Society recommends periodic cancer-related checkups
o Increase Ca intake and do weight-bearing exercises
o Yearly mammograms, clinical breast exams, and pap tests until age 65
 Management of Care
o Increased FSH level is considered menopausal
o HRT was common until the AHA advised against it to protect heart
o Promote effective sexuality pattern—vaginal dryness can interfere with
sexual expression/satisfaction
o Promote self-esteem
o Promote a healthy body image
Sexually Transmitted Infections (4-6 questions)
 Gonorrhea, Syphilis, Chlamydia, Genital Herpes, HPV
 Prevention
o Most effective way to prevent STIs is to avoid sexual intercourse with an
infected partner
o Use latex condoms
o Don’t exchange sex for money or drugs
 Clinical Manifestations
o Gonorrhea
 Men: dysuria; serous, milky, purulent penile discharge
 Women: dysuria, urinary frequency, abnormal menses, increased
vaginal discharge, dyspareunia
 20% of men and 80% of women are asymptomatic until disease is
advanced
o Syphilis—Four Stages
 Primary: chancre at site of inoculation, regional enlargement of lymph
nodes; HIGHLY CONTAGIOUS AT THIS STAGE
 Secondary—systemic; 6 weeks later; skin rash (on palms of hands or
soles of feet), mucous patches in oral cavity, sore throat, condyloma
lata (flat, broad based papules)
 Latent—no symptoms; may last 1yr to a lifetime
 Tertiary—infiltrating tumors in skin/bones/liver; inflammatory
response involving nervous and cardiovascular system—RARE (only if
untreated)
o Chlamydia
 Incubation period is 1-3 weeks; can be asymptomatic for months
 Target cervix and male urethra
 Dysuria, urinary frequency, discharge (like gonorrhea)
o Genital Herpes
Within 2-14 days: painful, small vesicles in genital area (shaft of penis
or labia/vagina/cervix)
 When blisters break—highly infectious virus creates patches of
painful ulcers that last 10-20 days
 First outbreak—flu-like symptoms
 Dysuria, urinary retention, vaginal/urethral (male) discharge
o HPV—most common STI in US
 Some have no symptoms
 Others exhibit genital warts
 In females—may be in vagina or on cervix and only apparent
during pap smear
Pharmacological Interventions
o Gonorrhea
 Ceftriaxone IM
o Syphilis
 Treatment of choice: penicillin G IM
 If allergic, oral doxycycline or tetracycline
o Chlamydia
 For men and non-pregnant women: azithromycin, doxycycline,
levofloxacin
o Genital Herpes (VIRAL!!!)
 No cure—Acyclovir help reduce length and severity of each outbreak
 For HSV resistant to acyclovir—foscarnet is used
o HPV (VIRAL!!!)
 No drugs available
 Warts may need to be removed
Teaching/Management of Care
o Gonorrhea
 Diagnosed via cultures from infected membranes
 Condom use is needed to prevent future infections
o Syphilis
 If untreated, can lead to blindness, paralysis, mental illness,
cardiovascular damage, and death
 Hard to diagnose—mimics other diseases
o Chlamydia
 Can be passed through the birth canal to neonate
 Most commonly reported bacterial STI in US
 Leading cause of preventable infertility/ectopic pregnancy
o Genital Herpes
 No cure!! Treatment focuses on relieving symptoms/preventing
spread
o HPV
 Women are at greater risk



 Regular pap smears!
 Can lead to cervical cancer
 Vaccine available
Disorders of Female Reproductive Tissue (1-3 questions)
 Fibrocystic Breast Disease—noncancerous breast condition thought to occur due
to cyclic hormonal changes
o Breast pain; tender lumps commonly in upper, outer quadrant
 Cystocele—protrusion of posterior bladder through anterior vaginal wall
o Polyuria, stress incontinence, history of frequent UTI, back/pelvic pain
 Rectocele—protrusion of anterior rectal wall through posterior vaginal wall
o Constipation, pelvic/rectal pressure or pain, fecal incontinence, hemorrhoids
 Health Promotion
o Cystocele/rectocele
 Lose weight if obese
 Eat high-fiber diets and drink adequate fluids to prevent constipation
 Nutrition
o For rectocele specifically, eat high-fiber diet and drink fluids to prevent
constipation (which is a risk factor)
o Fibrocystic breast condition: reduce intake of salt before menses
 Pharmacological Intervention
o Fibrocystic Breast Condition
 OTC analgesics
 Oral contraceptives or hormonal medication therapy if manifestations
are severe enough to suppress estrogen/progesterone secretion
 Diuretics to decrease breast engorgement
o Cystocele/rectocele
 Intravaginal estrogen used to prevent atrophy of the pelvic muscles in
postmenopausal women
 Teaching
o Bladder training helps urinary incontinence
o Vaginal pessary—removable latex device inserted into vagina to provide
support and block protrusion of other organs into vagina—teach how to
insert/remove/clean
o Kegel exercises—strengthen pelvic floor muscles that prevent organ prolapse
and stress urinary incontinence
o Notify provider about signs of infection
o Avoid straining at defecation; sneezing; coughing; lifting; sitting, walking,
standing for long periods of time following surgery
o Post-op restrictions: avoid strenuous activity, lifting anything greater than
5lbs, and sexual intercourse for 6 weeks
o Fibrocystic breast condition DOES NOT INCREASE RISK OF BREAST
CANCER!!
Coronary Artery Disease (4-6 questions)




Most common type of heart disease caused by impaired blood flow to the
myocardium
o Accumulation of atherosclerotic plaque in the coronary arteries is the usual
cause
Risk Factors
o Non-modifiable
 Age (men >45, women >55)
 Gender
 Family history of CAD
 Race
o Modifiable
 Hyperlipidemia (elevated LDL, reduced HDL)
 High blood pressure
 Diabetes mellitus
 Stress
 Kidney disease
 Smoking
 Obesity
 Physical inactivity
 Use of oral contraceptives/HRT (females only)
Clinical Manifestations
o Fatigue
o Dyspnea
o Palpitations
o Anxiety
o Cough
o Chest pain
o Syncope and fainting w/ activity
o Hypertension
o S/S of heart failure (see below)
o **Symptoms occur when coronary artery is blocked enough that the blood
supply to the muscle is inadequate
 Many patients are asymptomatic until they have a coronary event
o Manifestations of ANGINA
 Usually precipitated by physical exertion
 Chest pain (may radiate to jaw, neck, shoulder, or arm), dyspnea,
pallor, tachycardia, anxiety
 Women: indigestion, nausea, vomiting, fatigue, upper back pain
o Manifestations of ACUTE MI
 Onset of chest pain is sudden and usually not associated with activity
 Pain lasts 15-20min and not relieved by rest or nitro
Health Promotion/Teaching
o Reduce modifiable risk factors!
Decrease BP, smoking cessation, decrease lipids, weight loss, decrease
diabetes
o Physical activity with approval from provider
o Stress management
o No more than 2 drinks a day for men and 1 drink a day for women
 1 drink is 5oz wine, 12oz beer, 1.5oz whiskey
o If MI is expected, bed rest for first 12hrs is prescribed to reduce cardiac
workload
 Nutrition
o Low calorie, low cholesterol, low fat diet
o Avoid trans fat and saturated fat
o Increase fiber—helps transport cholesterol out
 Whole grains, whole fruits, vegetables, oats, beans, flaxseed
o Switch from animal fats to healthy fats: fish, flaxseed, soybeans, canola, nuts,
seeds, olives (OMEGA 3s!)
o Conservative use of RED WINE can reduce risk of developing CAD
 Pharmacological Interventions
o Lipid Lowering Drugs (-STATIN)
 Watch for myopathy (muscle pain)
 Monitor liver function
 Report rash
o Antiplatelets
 Clopidogrel, abciximab
 Decreases platelet aggregation
 Prophylactic low dose aspirin 81mg
o Anti-hypertensives
 Beta blockers
 ACE inhibitors
 ARBs
o Nitrates
 For angina
 Sublingual nitroglycerin—acts fast
 Sit before taking, then put one tab under tongue
 If pain still there after 5 minutes, take another tab and call 911
 5min later, can take 3rd and final tablet
 Can quickly cause hypotension!
o Calcium Channel Blockers (for HTN)
 Verapamil, diltizaem—watch for heart probs
o Fibrinolytics—dissolve and break up clots
 Streptokinase, apsac, alteplase
Deep Vein Thrombosis (1-3 questions)







A condition in which a blood clot forms on the wall of a vein and is accompanied by
inflammation and some degree of obstructed venous blood flow—DVT occurs when
thrombosis is in a deep vein of the body
Risk Factors
o Orthopedic procedures: total hip replacement, hip fracture, total knee
replacement
o Atrial fibrillation: thrombi form within the atria
o Acute MI
o Ischemic stroke and paralyzed lower extremities
o Women of childbearing age
 Oral contraceptives
 Pregnancy
Clinical Manifestations
o Calf pain (esp. upon walking)
o Tenderness, swelling, warmth, erythema along vein
o Cyanosis and edema of affected extremity
Complications
o Pulmonary embolism
 Clot travels into the right side of the heart and enters the pulmonary
circulation
Pharmacologic Interventions
o Anticoagulants: prevent clots
 Heparin—monitor aPTT
 LMW Heparin (enoxaparin)—to prevent and treat venous thrombosis
 Do not require close laboratory monitoring
 Oral Warfarin—can overlap with heparin for a few days
 Full effect of warfarin takes a few days
 Watch INR (should be 2-3)
o Fibrinolytic drugs: clot lysis
 Streptokinase, alterplase
 Used in clients who have serious complications and low risk of
bleeding
 Use within a short time after diagnosis
Teaching
o DVT prophylaxis
 Enoxaparin is a standard prophylactic medication
 Ambulate often
 Change positions q 2hr
o Elevate extremity above level of heart
o Warm moist compresses
o No massagemay dislodge clot
o Antiembolic stockings, no compressions socks or SCDs
o Don’t put pillow under knee (decreases circulation)
o Don't cross legs
Heart Failure (4-6 questions)
 Heart failure occurs when the heart muscle is unable to pump effectively
 Right and Left
o Left-sided heart failure results in inadequate left ventricle output and
inadequate tissue perfusion—LHF=LUNG PROBLEMS
o Right sided heart failure results in inadequate right ventricle output and
systemic venous congestion—RHF=BODY PROBLEMS
 Risk Factors
o LHF
 Hypertension, CAD, angina, MI, valvular disease
o RHF
 LHF, right ventricular MI, COPD, pulmonary fibrosis
 Clinical Manifestations
o LHF
 Dyspnea, orthopnea, fatigue, displaced apical pulse (hypertrophy), S3
sounds, pulmonary congestion, pink frothy sputum
o RHF
 JVD, dependent edema, fatigue, polyuria at rest, hepatomegaly, weight
gain
 Diagnostics
o hBNP—elevated levels indicate heart failure
 <100 is normal
o Hemodynamic monitoring
o Ultrasound (echocardiogram)—measures systolic and diastolic functioning of
the heart
o Transesophageal echocardiography—transducer placed in esophagus behind
heart to obtain detailed view of cardiac structures
o Chest x-ray—can show cardiomegaly, pleural effusions
 Management of Care
o Monitor daily weight and I&O
o Assess for SOB and dyspnea on exertion
o Put patient in high-Fowler’s
o Encourage energy conservation by helping with ADLs
o Maintain dietary restrictions as prescribed
 Teaching
o Report weight gain of 2lb in 24hr or 5lb in 1 week
o Exercise should be gradual
o Administer prescribed O2
o Encourage bed rest until the patient is stable
 Nutrition
o Diet low in Na (1.5-2g per day), along with fluid restrictions
o Increase protein intake
o Teach how to read labels
o Serve small meals with rest periods before and after (dyspnea)
 Pharmacological Interventions
o Diuretics—used to decrease preload
 Loops: furosemide
 Thiazide: hydrochlorothiazide
 Potassium-sparing: spironolactone
o Afterload-reducing agents
 ACE inhibitors: -PRIL
 1st line drug for heart failure
 Angioedema, dry cough
 ARBs: -SARTAN
 CCBs: diltiazem, -DIPINE
o Inotropic agents—increase contractility (positive inotrope)
 Digoxin
 Take apical heart rate; don't give if HR <60bpm
 Regularly have digoxin and potassium levels checked
 Dopamine
 Dobutamine
o Beta Blockers: -OLOL
o Vasodilators: nitroglycerin, isosorbide
 Reduce preload and afterload, decreasing myocardial O2 demand
o hBNPs: nesiritide
 cause natriueresis (loss of Na and vasodilation)
o Anticoagulants: warfarin
Hypertension (4-6 questions)
 Systolic BP >140/Diastolic BP >90 for two or more assessments of BP
 Clinical Manifestations
o Few or no manifestations:
 Headaches, facial flushing, dizziness, fainting, visual changes, nocturia
o PreHTN: 120-139/80-89
o Stage 1 HTN: 140-159/90-99
o Stage 2 HTN: >160/>100
 Risk Factors
o Family history
o Excessive Na intake
o Physical inactivity
o Obesity
o High alcohol consumption
o Smoking
o Hyperlipidemia
o Stress
 Management of Care



Pharmacological Interventions
o Thiazide Diuretics—first line is hydrochlorothiazide
 Inhibit water and Na reabsorption and increase K excretion
o Loop Diuretics—furosemide
 Decrease Na reabsorption and increase K excretion
o Potassium-Sparing Diuretics—spironolactone
 Prevent reabsorption of sodium in exchange for K
o CCBs—verapamil, diltaizem, -DIPINE
 May cause constipation, hypotension
 Avoid grapefruit juice
o ACE inhibitors: -PRIL
 Prevent conversion of angiotensin I to angiotensin II which prevents
vasoconstriction
 Report cough, angioedema, edema
o ARBs: -SARTAN
 Alternative to ACE
 Report findings of angioedema/heart failure
o Aldosterone-receptor antagonists: eplerenone
 Block aldosterone action promoting retention of K and excretion of
Na/H2O
o Beta blockers: -OLOL
 Decrease CO and block release of renin, decreasing vasoconstriction
 Can cause fatigue, weakness, depression, sexual dysfunction
 Mask tachycardia symptom of hypoglycemia
o Central-alpha2 agonists: clonidine
 Inhibit reuptake of norepi
 Not for first-line management
o Alpha-adrenergic antagonists
Health Promotion
o Maintain BMI less than 30
o Maintain glucose control
o Limit caffeine and alcohol
o Use stress mgmt. techniques
o Stop smoking
o Exercise 3x/week
o Limit sodium and fat intake
Teaching
o Report manifestations of electrolyte imbalance
o Adhere to med regimen
o Teach how to monitor BP at home
o Lose weight
o Stop smoking
o Reduce stress
Nutrition
o Monitor for hyperkalemia with salt substitute use
o Consume less than 2.3g/day of Na, eventually less than 1.5g/day
 Foods high in Na: canned soups, potato chips, pretzels, smoked meats,
seasonings, processed foods
o Diet low in fat, saturated fat, cholesterol
o Limit alcohol—2 servings/day for men, 1 serving/day for women
o DASH diet—low-sodium, high-potassium, high-calcium diet
 High in fruits, vegetables and low-fat dairy foods
o Avoid foods high in sodium and trans/saturated fat
o Consume foods rich in Ca and Mg
Life Threatening Dysrhythmias (4-6 questions)
 To find rate: 1500/# of boxes between Rs
 Sinus bradycardia
o Slow rate (less than 60bpm), normal P wave followed by QRS complex and
equal R-R interval
o Interventions:
 Assess LOC—usually first altered symptom
 Look for stable vs. unstable
 Stable BP ok, RR normal
 Unstabledecreased BP, decreased LOC
o Medications—if patient is symptomatic
 Atropine (0.5-1mg): speeds up HR
 Sinus tachycardia
o Fast rate (greater than 100bpm), normal P wave followed by QRS complex
and equal R-R interval
o Interventions: Assess!
 Look for instability: diaphoresis, decreased BP
 Need to find out why! Does not just happen
 Exercise, anxiety, caffeine, fever, pain
o Medications
 If unstable: Beta blockers, adenosinewill cause moment of asystole
 Atrial fibrillation
o No P wave or QRS complex; never a full contraction
 Problem in right atriumquivering instead of contracting
o To find rate: take pulse for 1 full minute
o Can live with this, so ask pt. about onset
o Complications:
 Worried about perfusion, oxygenation, decreased cardiac output
 CAN CAUSE CLOTS because blood is pooling
o Interventions
 Determine if unstable: decreased LOC, decreased BP

Will shock out of rhythm, but first make sure there are no clots (can be
dislodged)—TEE, TTE
o Medications
 If onset is sudden, give amiodarone to stabilize
 Blood thinnerswarfarin, heparin, enoxaparin
 Monitor for bleeding, platelets, PTT, PT/INR
 Atrial flutter
o Flutter waves are saw-toothed!!
o Lots of P waves, no QRS following, regular R-R interval
 Don't need to count rate—too fast!
o Manifestations:
 Decreased CO, decreased BP, decreased filling time
o Don’t usually stay in a. flutter for a long period of time
o Treat like a fib: give amiodarone
 Asystole
o Flatline—DO NOT SHOCK!
o Assess monitor first—make sure its attached!
o Assess for a pulse
 Check carotid pulse for 5sec
 If they have a pulse, check airway
o If no pulse, start CPR unless pt is DNR
o Medications
 Epinephrine
 Interpretation, Clinical Manifestations, Management of Care, Complications,
Pharmacological Interventions
Peripheral Vascular Disease (1-3 questions)
 Venous
o Peripheral venous disorders are problems with the veins that interfere with
adequate return of blood flow from the extremities
 Venous thromboembolism (VTE)—blood clot formed as a result of
venous stasis, endothelial injury, or hypercoagulability
 Venous insufficiency—occurs secondary to incompetent valves in
deep veins of lower extremities; allows pooling of blood and dilation
of the veins
 Varicose veins—enlarged, twisted and superficial veins
 Arterial
o Results from atherosclerosis that usually occurs in the arteries of the lower
extremities and is characterized by inadequate flow of blood
 Clinical Manifestations
o PAD
 Burning, cramping, pain in legs during exercise (intermittent
claudication)
 Numbness/burning pain in feet in bed










o PVD




Pain that is relieved by placing legs in dependent position
Decreased cap refill of toes (>3sec)
Decreased/nonpalpable pulses
Loss of hair on lower calf, ankle, foot
Dry, scaly, mottled skin
Thick toenails
Cold and cyanotic extremity
Pallor of extremity with elevation
Dependent rubor
Limb pain
DVT/Thrombophlebitis
 Can be asymptomatic
 Calf/groin pain, warmth/edema/induration over involved
blood vessel
 Changes in circumference of right and left calf
 Venous insufficiency
 Stasis dermatitis—brown discoloration along ankles
 Edema, stasis ulcers
 Varicose veins
 Distended, superficial veins
 Muscle cramping and aches, pruritus
Health Promotion
o PAD
 Risk factors: hypertension, hyperlipidemia, diabetes, smoking, obesity,
sedentary lifestyle
 Avoid stress, caffeine, and nicotine
o PVD
 Risk factors include immobility, sitting or standing in one position for
a long time, obesity
 Reduce these
Teaching
o PAD
 Encourage client to exercise to build up collateral circulation
 Promote vasodilation—warm environment, insulated socks
 Don't cross legs
 Don't wear restrictive garments
 Elevate legs to reduce swelling, but don’t elevate them above the heart
(will slow arterial blood flow to feet)
o DVT/Thrombophlebitis
 Elevate extremity above level of heart
 Warm moist compresses
 Do not massage
 Antiembolism stockings
o Venous insufficiency
 Elevate legs
 Avoid crossing legs and wearing constrictive clothing or stockings
 Wear elastic compression stockings and apply them after legs have
been elevated and when swelling is at a minimum
Diabetes (6-8 questions)
 Type I
o An autoimmune dysfunction involving the destruction of beta cells, which
produce insulin
 Type II
o Progressive condition due to increasing inability of cells to respond to insulin
(insulin resistance) and decreased production of insulin by beta cells
 Clinical Manifestations
o Hyperglycemia (blood glucose level usually >250mg/dL)
 Hot, dry skin; fruity breath
o Hypoglycemia
 Mild shakiness, mental confusion, sweating, palpitations, headache,
lack of coordination, blurred vision, seizures, coma
o Polyuria
o Polydipsia: excessive thirst, loss of skin turgor, dry mucous membranes,
weakness, rapid weak pulse
o Polyphagia: excessive hunger b/c of inability of cells to receive glucose and
body’s use of protein and fat for energy
 Can have weight loss
 Ketones accumulate in blood when insulin isn’t available, resulting in
metabolic acidosis
o Fruity breath, headache, nausea, vomiting, abdominal pain, inability to
concentrate, vision changes, slow wound healing, decreased LOC, seizures,
coma
 Management of Care
o Monitor:
 Blood glucose levels
 I&O, daily weights
 Skin integrity
 Sensory alterations
 Visual alterations
 Dietary practices
 Exercise patterns
 SMBG skill proficiency
 Health Promotion
o Determine risk factors



o Screenings of clients with BMI >25 and age >45, or children who are
overweight
o Exercise and good nutrition (see below) are necessary for
preventing/controlling diabetes
Teaching
o Teach how to self-admin insulin
o Rotate injection sites within one anatomic site to prevent lipohypertrophy
o Inspect feet daily
o Test water temp. with hands before washing feet
o Avoid lotion between toes
o Wear shoes that fit correctly
o Wear clean, absorbent socks that are cotton or wool
o Don’t use heating pads or hot water bottles to warm feet
o If sick:
 Monitor blood glucose every 3-4hr
 Consume 4oz of sugar-free liquid every 30min to prevent dehydration
 Test urine for ketones and report if they are high
 Call provider if:
 Glucose >240, fever >101.5, confusion, rapid breathing,
vomiting more than once, diarrhea more than 5 times, ill longer
than 2 days
Nutrition
o Caloric breakdown:
 Carbs: 45% of total daily intake
 Protein: 15%-20% of total daily intake
 Unsaturated/Polyunsaturated fats: 20%-35% of total daily intake
o Diet low in saturated fats to decreased LDL
o Include omega-3 fatty acids and fiber
o Plan meals to coordinate with timing of insulin
o Use artificial sweeteners
o Hypoglycemia:
 10-20g of readily absorbable carbs
 2-3 glucose tabs
 6-10 hard candies
 4oz juice
Pharmacological Interventions
o Insulin—Type 1 Diabetics
 Rapid-acting: lispro, aspart, glulisine
 Admin before meals
 Onset is rapid (10-30min)
 Short-acting: regular insulin
 Admin 30-60min before meals
 Only type of insulin that can be given IV
Intermediate-acting: NPH insulin
 Given for glycemic control between meals and at night
 Not given before meals to control postprandial rise
 Only insulin to mix with short-acting insulin
 Long-acting: glargine, detemir
 Given once daily at same time everyday
 Does not have a peak, duration 12-24hrs
o Oral hypoglycemics—Type 2 Diabetes
 Metformin—reduces production of glucose by liver
 GI effects, lactic acidosis (myalgia, sluggishness, somnolence,
hyperventilation), stop 48hr before procedure using iodinated
contrast dye
 Glipizide—stimulates insulin release from pancreas
 Give 30min before meals, monitor for hypoglycemia, avoid
alcohol (disulfiram effect)
 Repaglinide—stimulates insulin release from pancreas
 Administered for post-meal hyperglycemia
 Must eat within 30min of administration
 Pioglitazone—reduces production of glucose by liver
 Watch for fluid retention, watch liver function
 Acarbose—slows carbohydrate absorption
 Reduces post-meal hyperglycemia
 Take with the first bite of each meal
 -LIPTIN—promote release of insulin and decrease secretion of
glucagon
 Exenatide, liraglutide—decreases glucagon secretion
 give 60min before morning and evening meal
 Pramlintide—suppresses glucagon secretion
 Give SQ immediately before each major meal
 Chronic Complications
o Cardiovascular and cerebrovascular disease
o Diabetic retinopathy—impaired vision and blindness
o Diabetic neuropathy—damage to sensory nerve fibers resulting in numbness
and pain; can lead to ischemia and infection
o Diabetic nephropathy—damage to kidneys from prolonged elevated blood
glucose
Obesity (1-3 questions)
 Health Promotion (???)
o Increase physical activity
o Decrease BMI
o Eat healthy diet
 Complications

o Metabolic Syndrome: increased waist circumference, HTN, elevated
triglycerides/blood glucose, low HDL cholesterol
o Cardiovascular disease
 Hypercholesterolemia
 Coronary heart disease
 Heart failure
 Hypertension
 Stroke
 Venous thrombosis
o Respiratory
 Sleep disorders
 Sleep apnea
o Gastrointestinal
 Gallbladder disease
 Colon cancer
o Musculoskeletal
 Low back pain
 Muscle strains and sprains
 Osteoarthritis
o Endocrine/Reproductive
 Type 2 diabetes mellitus
o Other
 Depression
 Binge-eating disorder
 Postoperative complications
Osteoporosis (1-3 questions)
 Occurs when rate of bone reabsorption exceeds the rate of bone formation
 Risk Factors
o Female gender
o Family history
o Over age 60
o History of low Ca intake
o Diet deficient or excessive in protein
o Smoking or high alcohol intake
o Excess caffeine consumption
o Gastric bypass surgery
o Lack of physical activity or prolonged immobility
o Males w/ low testosterone
o Female with postmenopausal estrogen deficiency or low levels of calcitonin
 Health Promotion/Teaching
o Ensure diet includes adequate amounts of Ca and vitamin D, esp. before age
35
o Encourage client to take Ca supplement with vitamin D
o Limit amount of carbonated beverages (can cause Ca loss)
o Expose areas of skin to sun for 5-30min twice a week
o Engage in weight-bearing exercises—swimming doesn't help
o Prevent falls/injuries
 Pharmacological Interventions
o Calcitonin salmon, calcitonin human
 Inhibits osteoclast activity
o Teriparatide
 Stimulates osteoblasts to increase new bone formation
 Report leg cramps or bone pain
o Estrogen hormone supplements
 Replaces estrogen lost due to menopause or surgical removal of
ovaries
 Can cause breast/endometrial cancers, DVT
o Raloxifene
 Decreases osteoclast activity
 Report calf pain (sign of DVT), acute migraine, insomnia, UTI
o Calcium carbonate, calcium citrate
 Promotes healthy bones, does not slow osteoporosis
 Can cause GI upset, constipation, hypercalcemia
o Vitamin D supplement
 Increases absorption of Ca from intestinal tract
 Toxicity: weakness, fatigue, nausea, constipation
o Aledronate
 Decreases number and action of osteoclasts
 Risk for esophageal ulceration: take first thing in morning; stay
upright for 30min
Thyroid Disease (1-3 questions)
 Hyper/Hypothyroidism
 Clinical Manifestations
o Hyperthyroidism
 Nervousness, irritability, hyperactivity, decreased attention span,
weakness, heat intolerance, weight loss, insomnia, frequent
stools/diarrhea, menstrual irregularities, warm/sweaty/flushed skin,
thinning hair, tremor, exophthalmos, blurred/double vision,
photophobia, pretibial myxedema, goiter, bruit over thyroid gland,
tachycardia, dyspnea, elevated systolic BP
o Hypothyroidism
 Fatigue, lethargy, intolerance to cold, constipation, weight gain,
thick/brittle fingernails, depression, joint/muscle pain, bradycardia,
hypotension, slow thought processes, thickening of skin, thinning of
hair on eyebrows, dry/flaky skin, myxedema, abnormal menstrual
periods
Complications
o HyperthyroidismThyroid storm/crisis
 Sudden surge of large amounts of thyroid hormone into
bloodstreammedical EMERGENCY
 Hyperthermia, hypertension, delirium, vomiting, abdominal
pain, tachydysrhythmias, chest pain, dyspnea, palpitations
o HypothyroidismMyxedema coma
 Life-threatening condition
 Occurs when hypothyroidism is untreated or when a stressor affects a
client w/ hypothyroidism
 Resp. failure, hypotension, hypothermia, bradycardia, hyponatremia,
hypoglycemia, coma
 Management of Care
o Hyperthyroidism
 Minimize client’s energy expenditure
 Promote calm environment
 Assess mental status and decision-making abilities
 Provide increased calories, protein
 Monitor I&O and daily weight
 Provide eye protection if client has exophthalmos
 Reduce room temperature
 Provide cool shower/sponge bath and frequent linen changes
 Report a temp. increase of 1 degree or morethyroid crisis
 Avoid excessive palpation of thyroid gland
o Hypothyroidism
 Monitor for cardio changes (low BP, low HR)
 Monitor weight
 Orient client periodically
 Apply antiembolism stockings
 Monitor respiratory status
 Provide low-calorie, high-bulk diet and encourage fluids and activity
to promote weight loss and prevent constipation
 Avoid fiber laxatives w/ levothyroxine
 Provide meticulous skin care
 Provide extra clothing and blankets, dress in layers, keep room warm
 Caution against use of electric blankets b/c decreased sensation
 Encourage client to verbalize fears and feelings about changing body
image (weight gain, swelling)
Cushing’s Disease (1-3 questions)
 Clinical Manifestations
 Management of Care
 Nutrition
Addison’s Disease (1-3 questions)



Clinical Manifestations
Management of Care