Week 10 Diabetes
Gluconeogenesis: Creation of glucose from sources
OTHER THAN CARBS, i.e., proteins, glycerol or lactate
Glycogenesis: Creation of glycogen; carb that is easily
transformed into simple glucose
Glycolysis: Breakdown of glucose in an individual cell to
release energy in the form of ATP
Glycogenolysis: Breakdown of glycogen to simple
glucose
Glucagon: Made in alpha cells, When glucose is GONE,
get GLUCAGON! it stimulates the release of glucose into
your blood, stored in the liver and it increases
glycogenolysis.
Insulin: Promotes glucose uptake by target cells and
provides for glucose storage as glycogen; prevents fat
breakdown (lipolysis) and glycogen breakdown
(glycogenolysis); inhibits gluconeogenesis and increases
protein synthesis.
Diabetes: ↓insulin secretion and insensitivity to insulin;
characterized by hyperglycemia.
NORMAL GLUCOSE VALUE: <7.8mmol/L
Type 1: Complete loss of insulin production, usually
before age between 6 months to 25 years, 5‐10% of all
diabetics. Type 1A is an autoimmune disorder while
Type 1B is idiopathic. ALWAYS REQUIRES INSULIN
Type 2: Insulin resistance by body cells (increase in
production to compensate for peripheral tissue
resistance), usually >25yrs but more fat kids = more kids
with diabetes. EVENTUALLY REQUIRES INSULIN
Gestational DM: Placenta produces hormones which
resist insulin action – mother’s body tries to ↑insulin
production – pancreas cannot keep up; occurs in 5‐10%
of pregnancies; begins during pregnancies.
Polyuria: Excessive piss Polydipsia: Excessive thirst:
Excessive Polyphagia hunger
DKA: Characterized by hyperglycemia, ketosis and
metabolic acidosis, primarily affects Type 1, lack of
insulin = rapid breakdown of energy from muscle and
fat, leads to increased movement of amino and fat to be
converted to glucose and ketones. ↑HR, ↓BP and ↑RR,
fruity smell on breath.
Hypoglycemia: ↑insulin in blood = ↓blood glucose;
Manifestations: Altered brain function (headache,
seizures, confusion), hunger, anxiety, sweating,
cool/clammy skin; MOST EFFECTIVE TREATMENT: 15‐
20g of glucose in a simple carbohydrate source.
Diabetic Nephropathy: Lesions that occur in the
diabetic kidney, leading cause of CKD. First
manifestation is albumin excretion (microalbuminuria).
Diabetic Retinopathy: Acquired blindness from DM
Week 11 Renal
ATN: Acute tubular necrosis; 3 stages: Onset,
Creatinine (blood): By‐product of muscle metabolism.
Maintenance, Recovery phase.
↑retained = ↓GFR
Acute Renal Failure vs CKD: ARF is sudden, early sign is
BUN (blood): Urea level in the blood; indicates
oliguria. CKD is slow, early sign is polyuria with dilute
retention of nitrogenous products
urine and anemia/fatigue w/ HTN.
Oliguria: ↓urine output Polyuria: Excessive urine
Chvostek’s sign: Hypocalcaemia; twitching of the lip on
volume
Uremia: Waste products build up in the blood, affects
the corner of the mouth
the whole body.
Trousseau’s sign: Hypocalcaemia; involuntary
Azotemia: “Gold standard” manifestation; accumulation
contraction of the muscles in the hand/wrist
of urea, nitrogen, uric acid and creatinine in the blood;
↓GFR
1. What assessment findings would the health care provider consider as MOST indicative of acute renal failure?
a. Increased nitrogenous waste levels; decreased glomerular filtration rate (GFR)
2. Which teaching points about acute tubular necrosis (ATN) should the renal nurse educator include in the
orientation session of new nurses?
a. “Trauma, burns and major surgery are common precursors to ATN”
3. Which clients scheduled for an interventional radiology procedure requiring administration of radiocontrast dye
would be considered high risk for nephrotoxicity?
a. Young adult with a history of glomerular nephritis who is reporting severe flank pain.
b. Middle‐aged adult with diabetes undergoing testing for new‐onset proteinuria.
4. An ultramarathon runner is admitted following a day long, 50‐mile race because his urine volume is drastically
decreased, and the urine is dark red. What is the likely cause of the red urine?
a. Myoglobinuria
5. Following the diagnosis of acute renal failure, the nurse knows that one of the earliest manifestations of tubular
damage is which lab/diagnostic result?
19. The nurse is planning the care for a client with acute kidney injury (AKI). What should the nurse PRIORITIZE in
the client’s plan of care?
a. Assessing fluid balance
b. Monitoring electrolyte levels
c. Promoting infection control (Secondary infections are a major cause of death in people with AKI).
20. The nurse is caring for a group of 4 male clients with CKD and coronary artery disease. The nurse will prioritize
which client as being at greatest risk for angina?
a. The client with a hemoglobin level of 8.0 g/dl (Rationale: A hemoglobin level of 8.0 g/dL is significantly
lower than the lower limit for males of 14 g/dL.)
21. A 5‐year‐old child who has been receiving dialysis treatments has undergone renal transplant and will now be
taking prednisone. The parents are hopeful the child’s development and overall health will normalize. The nurse
should inform the parents that taking prednisone can result in similar adverse effects as CKD. Which effects
should the nurse include?
a. Fluid retention
b. Increased risk for infection
c. Delayed growth
d. Weakened bone structure
22. The nurse is caring for an older adult client with acute glomerulonephritis who develops sudden‐onset dyspnea.
The client’s vital signs are: BP of 175/96, HR 98, RR 22, O2 Sat 88% on room air. What is the nurse’s priority
assessment?
a. Breath sounds (Rationale: dyspnea and low O2 sat levels could be evidence of pulmonary edema).
23. The nurse is monitoring a group of clients being treated for various chronic illnesses. Which clients should the
nurse prioritize as most at risk for hyperkalemia?
a. 76‐year‐old with type 2 diabetes controlled with insulin and taking an ACE inhibitor
b. 25‐year‐old with acute kidney injuring taking penicillin
24. A client is in cardiogenic shock following a massive myocardial infarction. The client’s family asks the nurse “Why
are the health care providers recommending dialysis since its the heart that is sick?” Which response by the
nurse is most appropriate?
a. “When a person has a large heart attack and goes into shock due to heart failure, there is a decrease in
renal perfusion which allows toxins to increase in the blood.”
25. A nurse is caring for a group of clients are reviewing the recent lab values and medical charts. What adult client
is exhibiting early manifestations of prerenal AKI, which should be reported to the HCP?
a. Urine output has dropped from 1200mL/24 hours to current 300mL/24 hours.
b. BUN to creatinine ratio has gone from 10:1 to 21:1.
26. A client in the ICU is receiving a blood transfusion. The client immediately developed a reddish‐color urine
flowing into the Foley bag. What is the cause of this red urine and what priority intervention should the nurse
implement?
a. Hemoglobinuria indicating an acute hemolytic reaction; the transfusion must be stopped immediately.
(Rationale: Myoglobinuria causes urine color change that is associated with muscle destruction, usually
brown in colour. Trauma with insertion of a catheter would cause bleed at the time of insertion and not
be associated with a blood transfusion. Kidney infections can cause bleeding, but this is evident before
hanging/infusing the blood)
Week 12 Ortho
Osteomyelitis: Infection within the bone, can be
acquired directly (through trauma/surgery
EXOGENOUS) or indirectly (via blood stream i.e.,
hematogenous ENDOGENOUS). Most common bacteria:
Staph. Aureus. Poor blood supply at risk. DIRECT: Bone
devitalizes, leads to bacteria proliferation. INDIRECT:
Bacteria under periosteum via bloodstream, bacterial
growth cuts off blood supply leading to necrosis; hard to
treat w/ antibiotics.
Osteoporosis: Decrease in bone mass, more porous,
↑fracture risk. Most common in elderly. “Silent till
fracture”
Fractures: Bone break. Avulsed fracture: Muscle pulls
and chips bone; Comminuted: Fragments; Greenstick:
Bone bends and cracks.
Osteoclasts: Break down bone Osteoblasts: Build up
bone
4 stages of bone healing: Hematoma formation; Soft
Tissue Callus; Ossification; Remodeling
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a. Inability to concentrate urine (rationale: BUN, creatinine and GFR do not manifest for 1‐2 days after the
acute renal failure has begun)
A healthcare provider for an obese male who has a history of diabetes and hypertension reports that the client’s
GFR is 51ml/min with elevated serum creatinine levels. Which statement by the HCP will answer the client’s
question about the result?
a. “Your chronic kidney disease has likely been caused by your diabetes and high blood pressure.”
A nurse is collecting a urine specimen prior to measuring the albumin level in a client’s urine. A colleague states,
“I thought albumin was related to liver function, not the kidney.” How can the nurse best respond to this
statement?
a. “Urine albumin levels are useful for diagnosing diabetic kidney disease”
Which clinical manifestations would lead the nurse to suspect that a client with renal failure is developing
uremia?
a. Weakness and fatigue
b. Lethargy and confusion
c. Extreme itching
Which diagnostic bloodwork is MOST suggestive of chronic kidney disease?
a. A client with low vitamin D, low calcitriol, and high parathyroid hormone (PTH) levels. (Rationale: CKD =
low vit D/ calcitriol which = high PTH)
Which medication would the nurse anticipate being prescribed for the client with renal failure who has
hyperphosphatemia?
a. Calcium carbonate
To maintain hematocrit levels in clients with kidney failure, the nurse should be prepared to perform which
intervention?
a. Administer a subcutaneous injection of recombinant human erythropoietin (rhEPO).
A nurse is performing client education with an adult recently diagnosed with chronic kidney disease. Which
statement by the client would the nurse want to correct or clarify?
a. “My kidney problems increase my chance of developing high blood pressure or diabetes.” (Diabetes is
not normally a result of existing CKD; persons with renal failure are prone to anemia, increased HR,
decreased blood viscosity and coagulopathies)
The nurse assesses a client with renal failure for encephalopathy caused by uremia. Which clinical manifestation
will the nurse find?
a. Loss of recent memory and inattention. (Rationale: Joint pain is not associated with uremia, jaundice is
associated with liver dysfunction, chest pain and friction rub occur with uremia‐related pericarditis).
Which phenomenon contributes to the difficulties with absorption, distribution and elimination of drugs that are
associated with kidney disease
a. Reductions in plasma proteins increase the number of free drugs and decrease the number of protein‐
bound drugs.
An adult diagnosed with renal failure secondary to diabetes mellitus is scheduled to begin dialysis soon. Which
statement by the client reflects an accurate understanding of the process of hemodialysis?
a. “I will not be able to go about my normal routine during treatment.”
Which clinical finding among older adults is MOST likely to be viewed as a normal part of age‐related changes?
a. 78‐year‐old whose GFR has been steadily declining over several years. (Rationale: Sudden change in
BUN, dipstick or creatinine would warrant a follow up)
A client with hypertension, arthritis and early CKD has developed viral gastroenteritis and is unable to consume
adequate fluids. Which medications should the nurse caution the client about taking due to the increased risk
for prerenal AKI?
a. Ramipril (ACE inhibitor, decreased blood flow, vasoconstriction)
b. Ibuprofen (NSAID, reduced renal blood flow)
c. Hydrochlorothiazide (diuretic, promotes dehydration and reduced renal blood flow)
A client is admitted to the hospital with acute kidney injury (AKI). Which diagnostic test will the nurse assess to
best determine the cause of the AKI?
a. BUN to creatinine or urea to creatinine ratio (Rationale: creatinine, BUN and GFR may all be abnormal in
AKI)
Involucrum: layer of new bone growth outside existing
bone
Kyphosis: Hump near neck, in middle age with
osteoporosis.
Rheumatoid Arthritis: Chronic Autoimmune disorder,
immune response leads to synovial inflammation which
leads to joint destruction. Symptoms worsen quickly
after onset; flare ups last days or weeks. Systemic and
affects the whole body
Osteoarthritis: Degenerative joint disease; mechanical
injury of chondrocyte leads to cytokine release.
Symptoms worsen slowly with time; improve with
activity. Regional to knees, finger/thumb joints and
asymmetric
1. Following a progressive onset of fatigue, aching and joint stiffness over the last 2 years, a 69‐year‐old male has
recently been diagnosed with rheumatoid arthritis. Which teaching point should his doctor include during the
office visit?
a. “Steroids and anti‐inflammatory drugs that I’ll prescribe will likely bring some relief to your symptoms.”
2. The doctor is considering prescribing an anti tumor necrosis factor (TNF) like infliximab for a client with
rheumatoid arthritis (RA). Which statement is accurate about the advantages of using a TNF inhibitor?
a. TNF inhibitors help slow the disease progression and improve your ability to perform routine ADL.
3. A doctor is attempting a differential diagnosis of a 30‐year‐old female who is suspected of having systemic lupus
erythematosus (SLE). Which assessment and history findings correlate with SLE?
a. “Butterfly rash” on her nose and cheeks.
b. Complaints of intermittent joint pai.
c. Hospitalization twice for pleural effusions.
d. Blood work indicates low RBCs, WBCs and platelets.
4. Which individual is MOST likely to develop a form of reactive arthritis?
a. A 24‐year‐old male who completed treatment for a chlamydia infection 1 year ago.
5. Due to her progressing osteoarthritis, an 80‐year‐old woman is no longer able to perform her ADL without
assistance. Which phenomenon underlies the woman’s situation?
a. Loss of articular cartilage and synovitis has resulted from inflammation caused when joint cartilage
attempted to repair itself.
6. A 64‐year‐old man was diagnosed 19 months ago with bilateral osteoarthritis in his knees and has come to the
family physician for a check up. The client and his physician are discussing the effects of his health problem in
the measures the man has taken to accommodate and treat his OA in his daily routines. Which statement by the
client would necessitate further teaching?
a. “I’ve been avoiding painkillers because I know they can mask damage that I might be inflicting on my
knees.”
7. While reviewing the following diagnostic findings on a group of clients who joined complaints, which finding
would be a priority for further investigation possible medical intervention?
a. Synovial fluid aspiration indicates the presence of monosodium urate crystals.
8. The nurse is creating a teaching plan on self management for a client with moderate rheumatoid arthritis. What
should the nurse include in the teaching plan?
a. Use of heat or cold on joints.
b. Techniques to reduce joint use.
c. Use of assistive devices.
9. An 8‐year‐old child has been diagnosed with juvenile idiopathic arthritis (JIA). the parents asked the nurse about
the prognosis for this condition. What is the nurse’s best response?
a. the prognosis is dependent on the type of JIA which your child has been diagnosed with.
10. While speaking to a senior citizen club about osteoarthritis, which facts are accurate to share?
a. Obesity in women has been correlated to having OA in the knees.
Week 14 Burns
First degree: Superficial, partial thickness, involves the
outer layer of the epidermis. Pink dry and painful no
blister formation. Second degree: partial thickness,
involves dermis and epidermis. Painful red moist and
blistered, heal in one to two weeks. Third degree: full
thickness extend into a subcutaneous tissue and may
involve muscle and bone, vary in colour from waxy
white to brown, deep red or black