NSG 6420_QUIZ 2 REVIEW NOTES. LATEST FALL. Best to study the NOTES before the exam.

NSG 6420_QUIZ 2 REVIEW NOTES CAD major risk factors HTN, smoking, obesity, physical inactivity, dyslipidemia, diabetes, Microalbuminuria, GFR 55men, >65 women), Fam hx of premature cardiac dx Etiology of AS Conge ...

NSG 6420_QUIZ 2 REVIEW NOTES CAD major risk factors HTN, smoking, obesity, physical inactivity, dyslipidemia, diabetes, Microalbuminuria, GFR <60, age (>55men, >65 women), Fam hx of premature cardiac dx Etiology of AS Congenital and senile calcifications AR etiologies HTN, aortic dissection, syphilis, collagen vascular disorders MR etiologies rupture chordae tendinae, CAD, MVP, infectious endocarditis AS characteristics *increased with pt leaning forward *crescendo-decrescendo/diamond shaped murmur *radiates to neck *Early systolic "click" Most common cause of AS? calcification of a normal trileaflet or congenital bicuspid valve MR characteristics Radiates to chest and axilla *high pitch with blowing quality *pansystolic regurg murmur with thrill Standing will decrease murmur, squeezing both hands will increase murmur MR complications afib - affects approx 75% with MR systolic embolization bacterial endocarditis Most common cause of MR? MVP Prophy antibiotics? invasive procedures and dental cleaning if MR and MVP CHF s/sx Cough at first nonproductive at night, progressing to frequent cough productive of pink frothy sputum orthopnea What is diabetes equitable to? Heart disease -assumed the patient with DM already has microvascular dx processes in place HDL, Triglyceride levels >40 in males, >50 in females Trigs <150 Secondary hyperlipidemia causes? identifiable diseases or conditions: DM, metabolic syndrome- reversible with control or eradication Primary hyperlipidemia causes? Hereditary or sporadic genetic disorder of lipoprotein metabolism Not modifiable hyperlipidemia causes? genetic predisposition, fam hx of atherosclerotic dx, male sex, and age (men >45, women>55) LDL goal for highest risk patients Known CVD, DM, CVA, PVD, AAA /6.5% FPG >/126 (at least 8 hours NPO) 2 hour PP glucose >/ 200 Random plasma glucose >/200 with classic symptoms DM cholesterol guidelines LDL <100 HDL men >40 women>50 TG <150 MOA of Biguanides METFORMIN (glocophage) -reduces glucose production by liver -enhances insulin sensitivity at tissues MOA of alpha glucosidase inhibitors PRECOSE -slows down absorption of carbs in small intestine MOA of Thiazolidinediones Pioglitazone (ACTOS) -Improves insulin sensitivity, transport and utilization at target issues DPP4 inhibitor MOA JANUVIA, JANUMET enzyme that destroys hormone incretin *Meds block that action Sx and labs of DKA Hyperglycemia, ketosis, acidosis, dehydration -lethargy/weakness, dehydration (dry MM, tachy, orthostatic hypotension), abd pain (N/V), Kussmaul respirations Labs: BG >300, PH <7.3, bicarb < 15, ketones in blood and urine HHS sx and labs BG >400 absent/minimal ketone bodies Fewer sx in earlier stages h/o inadequate fluid intake, increasing mental depression, polyuria PUD causes and risk factors causes: H.pylori, NSAIDs, ETOH, steroids Risk factors: ETOH, smoking, male, >40, fam hx Duodenal ulcer causes h.pylori associated with 95% of duodenal ulcers Hep C diagnosis Neg anti hcv eia and hcv rna= not infected +EIA and - RNA=resolved infection -EIA and +RNA=early acute infection or chronic infection in immune compromised person ++= acute or chronic infection What indicates a dx of pancreatitis? elevated amylase and lipase What is elevated in acute cholecystitis? alkaline phosphatase and bili High WBC acute appendicitis pain begin in periumbilical and then localize to rt lower quad Perforated duodenal ulcer pain epigastrium initially, then migrates to the lower quadrants Biguanides MOA Metformin (Glucophage) -Decreases amount of glucose released from liver Sulfonylureas MOA Glimepiride, Glyburide, Glipizide -Stimulated pancreas to release more insulin, right after a meal and then over several hours Thiazolidinediones MOA Actos -makes the body more sensitive to the effects of insulin -Keeps the liver from overproducing glucose DPP-4 inhibitors MOA Januvia -Improves insulin level after a meal and lowers amount of glucose made by your body Meglitinides MOA Prandin, Starlix -non-sulfonylurea -resembles sulfonylureas in MOA