Final Study Guide PDF

QUIZ 1. Involuntary manslaughter most commonly involves a death arising from a: a. nonvehicular incident caused by negligence (such as an accidental fire). b. premeditated attack. c. spontaneous physical altercation between two people. d. motor vehicle accident. 2. A medical assistant owes...

QUIZ 1. Involuntary manslaughter most commonly involves a death arising from a: a. nonvehicular incident caused by negligence (such as an accidental fire). b. premeditated attack. c. spontaneous physical altercation between two people. d. motor vehicle accident. 2. A medical assistant owes the duty of ___________, meaning they must take appropriate steps to check the type and dosage of medication before administering it to the patient and must take appropriate steps to ensure that the paperwork regarding charts and follow-up appointments is completed accurately. a. standard of care b. reasonable care c. standard practice d. scope of practice 3. The law assumes that an unconscious patient would consent to emergency care if the patient were conscious and able to consent a. Expressed Consent b. Informed Consent c. Implied Consent  4. _______________ allows health care providers to treat youth as adults based upon an assessment and documentation of the young person’s maturity; enables the provider to ask questions of the young person in order to determine whether or not the patient can consent for their own treatment. a. Emancipated minor b. Mature minor c. Old Minor d. Smart Minor 5. A private, judicial determination of a dispute and is an alternative to court action (litigation), and generally, just as final and binding is generally referred to as _______________. a. State Law b. Mediation c. Arbitration d. Disposition 6. _____________ is the type of law created by courts, also referred to as common law or precedent law. a. State law b. Case law c. Federal law  d. Local Law 7. ________________ requires any health care provider accepting Medicare or Medicaid to inform the patient of their right to accept or refuse treatment, their rights regarding advance directives, and of any hospital or provider policies regarding withholding or withdrawing life-sustaining equipment. a. Good Samaritan Act b. Living will c. PSDA d. HIPAA Privacy Rule 8. Which of the following are types of insurance in a medical practice? a. medical malpractice b. liability c. personal injury d. all of the responses are correct 9. When the patient directly communicates their consent to the doctor, usually done in writing by signing papers and can also be supported through oral or verbal communication with the doctor is known as ____________. a. Implied Consent b. Informed Consent c. General Consent d. Expressed Consent 10. Which of the following is an intentional tort?  a. baseball hit through a neighbor’s window b. rock flying from a lawn mower and hitting a passerby c. trespass d. automobile collision TEST 1. _______________ is the underlying principle used to establish whether an injured party can collect for damages in a case centered on negligence q. law b. beyond a reasonable doubt c. standard of care d. supremacy clause 2. If the statute of limitations for a particular tort is two years, it means the: a. patient must bring a suit within two years of the injury. b. patient must wait two years after the injury to bring a suit. c. physician has up to two years to respond to the patient’s suit. d. physician can be imprisoned for up to two years if found guilty. 3. The medical assistant’s scope of practice refers to: a. performing delegated clinical and administrative duties and working under a physician’s direct supervision, consistent with your education, training, and experience. b. the otoscope used to look in a patient’s ears. c. using your experience to the best of your ability. d. none of the above 4. Physician self-referral is the practice of a physician referring a patient to a medical facility in which they have a financial interest, be it ownership, investment, or a structured compensation arrangement, which critics claim: a. a. is a conflict of interest. b. is an unsafe activity. c. may result in errors in patient care. d. requires an incident report. 5. An ethical dilemma is: a. where two moral principles are in conflict. b. there is no clear-cut right or wrong. c. when right behavior leads to the wrong outcome. d. all of the responses are correct. 6. The ___ has a comprehensive Code of Medical Ethics that speaks to a wide range of matters arising in the professional conduct of a doctor. a. American Heart Association (AHA) b. American Association of Medical Assistants (AAMA) c. American Medical Association (AMA) d. American Medical Technologists (AMT) 7. The term ____ refers to the values by which an organization conducts its business. a. company policies b. collaborative efforts c. organizational ethics d. corporate morals 8. When a patient explicitly accepts a physician’s offer of treatment, a(n) _____ contract is created. a. implied b. express c. formal d. technical 9. The physician-patient relationship is created when the: a. patient requests care from a physician. b. physician offers care to a patient. c. patient needs care, regardless of whether that care if offered. d. physician offers care to a patient, and the offer is accepted. 10. A provider is required to report the following to the local health department: a. elder and child abuse b. communicable diseases; sexually transmitted diseases (STDs), such as herpes, HIV, and syphilis. c. neglect, exploitation, and wounds of violence d. all of the responses are correct  11. The relationship between doctor and patient is a contract in which the doctor offers care, and the patient accepts it. From that point on, the provider has an affirmative duty to care for the patient to the professional standards associated with a doctor of similar training and experience, which is referred to as: a. an express contract. b. an implied contract. c. an informed consent. d. an expected standard of care. 12. Which of the following are types of insurance in a medical practice? a. medical malpractice b. liability c. personal injury d. all of the responses are correct 13. Who prosecutes a criminal case? a. police b. district attorney c. attorney for the plaintiff d. jury 14. The unlawful taking of money or goods of another from their person or in their immediate presence by force or intimidation is called  a. robbery. b. burglary. c. petty larceny. d. grand larceny. 15. Which of the following best describes a tort a. Can be intentional or unintentional b. A breach of duty c. Covers only intentional acts d. Occupational Health and safety Act 16. If someone breaks into a vending machine to steal money this crime would be classified as a ____________. a. Felony b. Misdemeanor c. Manslaughter d. Tort Chapter 14-immune -​ Table 14-1 ( combining forms for the chapter) Aden/o = Gland Lymph/o = Lymph Lymphaden/o = Lymph nodes Myel/o = Bone Marrow Splen/o = Spleen Thym/o = Thymus -​ Function and structures of the lymphatic system -​ The main function of the immune system is to protect the body against outside invaders. The immune system creates effective immune responses to continually defend the body against antigens. Known as the first line of defense against disease It plays an essential role in the immune functions of the body Lymph- composed of blood plasma that filters out the capillaries, lymphocytes, hormones, and other substances that are the product of cellular activities. -​ Also referred to as intracellular or interstitial fluid -​ Acts as the ¨ bridges¨ between cells and capillaries Lymph vessels- located throughout the body -​ Lymphatic capillaries absorb fluid and other substances from the tissues and return them to the circulatory system. -​ One-way system only Lymph nodes- are small, round, or oval structures located usually in clusters along the lymph vessels at various places in the body. -​ Adenitis In acute infections, they become swollen and tender because of the collection of cells gathered to destroy the invading substances. This condition is known as adenitis. With extensive involvement, the node may break down, and an abscess will form. -​ How do lymph nodes relate to cancer? With malignancy, the cancer cells are abnormal and so are identified by the cells in the lymph node to be removed from the circulating fluid. As more cells accumulate, the node becomes enlarged and is therefore palpable. Early detection of lymph node involvement is critical to the prognosis of patients with cancer, for it is through the lymphatic system that a malignancy often metastasizes (spreads) to other sites. The extent of lymph node involvement is an important indicator of the ultimate prognosis of the patient. -​ Antigens and antibodies difference -​ Antigens are things that the immune system recognizes as nonself and responds to by destroying or rendering them ineffective.  -​ ANTIBODIES are a dual response system involving the actions of specific cells and other immune system components to attack the antigen. Antigens are the harmful molecules or pathogens that trigger an immune response. Antibodies are the immune system's defense agents that specifically target and neutralize these antigens. -​ Where do RBCs mature Erythrocytes (RBCs) develop from erythroid stem cells and mature in the bone marrow. -​ Where do WBCs mature White blood cells (WBCs), which become the granulated eosinophils, neutrophils, and basophils, develop from myeloid stem cells. One type of agranulocyte, the lymphocyte, develops from a lymphocyte stem cell into two major classes: B cells that mature in the bone marrow and T cells that mature in the thymus. -​ T Cells/ B Cells The B cell represents about 20 percent of the lymphocytes. They act upon their targets by producing antibodies in a process called humoral immunity. When B cells are maturing, they go through two stages of development, in the forest begins with the cell inserting numerous molecules of one specific kind of antibody and only one specific antigen can activate it. Helper T Cells - Helper T cells produce proteins called lymphokines that help other lymphocytes and phagocytes perform their functions. They also help B lymphocytes make antibodies. Helper T cells are identifiable by the CD4+ cell marker. The HIV virus affects the function of the helper T cells, and the severity of the disease is measured by the CD4+ blood counts. Killer T Cells - Killer T cells can directly kill infected or malignant cells and those cells carrying a target antigen. They are also known as cytotoxic T cells and carry the CD8+ cell marker. One type of killer T cell can attach tightly to its target and secrete perfin and other chemicals, which make holes in the target cell’s membrane, destroying it before it can reproduce. Unfortunately, killer T cells will also attack the nonself marker cells of transplant tissues and organs, causing rejection. Memory T Cells - Memory T cells have a memory from a previous experience with specific antigens and so are prepared to act immediately upon recontact. Suppressor T Cells - Suppressor T cells stop or turn off the actions of the T cells when the “battle” is under control. -​ Immunoglobulin( Igg. Igm) Table 14-2 IgA- Concentrated in body fluids, such as tears, saliva, and respiratory and gastrointestinal secretions, to guard the entrances of the body IgD- Located on B cell membranes. Believed to regulate B cell activity IgE- Very effective against parasites but also involved in allergic responses, such as hay fever, asthma, and urticaria IgG- The most plentiful antibody, it coats microorganisms in the tissues to speed up the uptake by other immune system cells. It carries out both antibacterial and antiviral activity. It can cross the placental barrier. IgM- Found in the bloodstream and very effective in killing bacteria. It is responsible for initial formation of antibodies once exposed to an antigen. -​ Active and Passive immunity Active immunity: vaccines are given in initial and in “booster” doses to provide memory cells and antibodies for longer periods. The recipients make their own immunity Passive Immunity: given to people who are already exposed to a disease, such as tetanus. Antibodies from another source are injected into the person to provide a temporary immunity to counter the immediate attack of pathogens.The immunity is short lived Disease and disorder : -​ HIV/ Aids (Originate and the in first case in US)( all the test) (early and late sign) Early Signs and Symptoms—Many people who are infected with the virus do not have any symptoms when first infected. Within a month or two after exposure, however, they may have a flu like illness that includes headache, fever, fatigue, and enlarged lymph nodes. The symptoms usually subside within a week. During this flu like period, the HIV virus is present in high concentrations in genital fluids, and infected persons are highly contagious. Later Signs and Symptoms—Severe symptoms of HIV infection may not appear for 10 or more years in adults and two or more years in children. However, during this asymptomatic period, the infected person is still capable of passing on the virus, and the T helper cells are being systematically destroyed. The numbers decline (as measured by the CD4 [T4] counts) and infections and other symptoms begin to occur, such as: -​ Enlarged lymph nodes -​ Fatigue -​ Pelvic inflammatory disease -​ Fever, sweats -​ Weight loss -​ Yeast infections -​ Rashes, dry skin -​ Short-term memory loss -​ P. Carinii pneumonia Pneumocystis carinii pneumonia, is indicated by a fever, cough, and difficulty breathing; by Kaposi's sarcoma, 2 form of cancer appearing as purplish blotches on the skin; by candidiasis, a yeast infection that is sometimes present in the mouth, esophagus, and vagina, and by the usual infections. -​ Kaposi sarcoma -​ Lupus (SLE,DLE / s/sx and Tx) S/Sx of Lupus - Symptoms of lupus are: ​ fever ​ weight loss ​ headache ​ fatigue ​ swollen glands ​ depression ​ loss of appetite ​ nausea and vomiting ​ easy bruising ​ hair loss ​ edema Suggestive signs of lupus include: ​ a rash over cheeks and bridge of nose ​ rashes developing after being in the sun ​ arthritis in two or more joints ​ seizures ​ bald spots ​ discoid lupus lesions ​ ulcers inside mouth ​ pleurisy ​ anemia ​ Raynaud’s phenomenon ​ (fingers turn white or blue in the cold) Diagnosis is made from symptoms and blood tests for evidence of autoantibodies. Urine is checked for protein, RBCs, and WBCs. A specific antibody test called ANA (antinuclear antibody) looks for antibodies to the nuclei of cells. Over 99 percent of people with lupus will have a positive test; however, only 33 percent of people with a positive ANA have SLE. Other : -​ Modes of transmission Transmission can occur through the vagina, vulva,rectum, penis and mouth during sex ​ Sharing drug needles or syringes with a person infected HIV ​ Women with HIV can transmit the virus to their babies during pregnancy, ,Breastfeeding,birth. ​ The risk of getting HIV from blood -​ Test Early HIV infection: Often has no signs or symptoms, detectable only by a blood test, urine test, or saliva test. Blood tests for HIV detection: Detects antigens found on the virus or antibodies made against HIV. ​ Antibodies: May not be detectable for 1 to 4 months, up to 6 months for enough antibodies to be present for a positive test. Types of HIV tests: ​ Antibody tests: Most common, including ELISA, EIA, and Rapid HIV tests.  ​ Western blot: Used to confirm a positive res1ult from antibody tests (to avoid false positives). ​ Antigen tests: Less commonly used, performed on blood samples, detects HIV 1 to 3 weeks after exposure. Fourth-generation algorithm: Combines antibody/antigen immunoassay to identify both HIV-1 and HIV-2, enhancing early detection. Home testing: ​ OraQuick In Home HIV test: Uses oral swab, results in about 20 minutes. ​ Home Access HIV-1 Test System: Blood sample collection, sent to a lab for testing (not a true HIV test kit). HIV viral load monitoring: Used to predict the risk of HIV progressing to AIDS, as higher virus levels correlate with increased risk of progression to AIDS and related infections or death. -​ Difference between benign and malignant tumors Benign tumors are usually slow-growing, do not invade other tissues, and do not spread to other parts of the body. Usually, they do not cause any problems unless they are growing in a confined space, such as in the brain. Malignant tumors are cancerous and differ from benign in several ways: -​ Cancer cells have an altered cell structure that includes an increased nuclear size, irregular chromatin distribution, and prominent nucleoli. -​ Cancer cells lack normal growth-controlling mechanisms; growth is unorganized and disorderly. -​ Cancer cells lack contact inhibition (normal cell growth stops when other cells are contacted). They continue to grow and invade other tissues. -​ Cancer cells do not respond to growth factors that stimulate or inhibit the growth of normal cells. They can grow rapidly with reduced growth factors. -​ Cancer cells frequently escape immune surveillance. -​ Cancer cells are invasive, destroying normal tissue. -​ Cancer cells can metastasize by traveling through the lymphatic or blood vessels implanting into other body sites and creating additional tumors. -​ Cancer cells have an increased metabolic rate.  -​ Classification of cancer Cancer can be classified according to its cellular origin. Cancers arising from epithelial tissues are known as carcinomas, whereas those from connective tissues are called sarcomas. Cancers of blood and blood forming organs are called leukemias, and those from the lymph tissue are lymphomas. Cancers can be classified by their degree of differentiation. This refers to how similar the cancer cell appears to the normal cell from which it was derived. A well-differentiated cancer cell looks similar to a normal cell, and a poorly or undifferentiated cancer cell appears very abnormal. Grading refers to the degree of differentiation of the cancer cell. The grading system goes from Grade 1, which is a well-differentiated cell, to Grade lll or lV, which is undifferentiated. The grading and staging finding predict prognosis. QUIZ 1. The AIDS epidemic is greatest in a. Europe b. United States c. Africa d. Inda 2. __________ are non-T and non-B lymphocytes. They are numerous in the blood stream. They kill cancer cells and cells infected with viruses without using antibodies or having previous exposure to the antigen. a. Killer T Cells b. Vaccines c. Immunoglobulins d. Natural Killer Cells 3. ______________ are things the immune system recognizes as non self. a. Antibodies b. Antigens c. Allergens d. Phagocytes 4. T Lymphocytes mature in the _______________. a. Spleen b. Thymus c. Bone marrow d. Thyroid 5. The lymph tissue in Peyer's Patches is exposed to antigens invading the___________. a. Thyroid b. Spleen c. Adenoids d. Intestine 6. All body cells carry molecules that are encoded by a group of genes known as ______________.. This is like a biochemical "fingerprint" that serves as the 'ID" for cells so that they are marked as "self".  a. Memory T Cells b. Surveilence c. Major Histocompatibility Complex (MHC) d. Immunoglobulins 7. B Lymphocytes represent about 20% of the total lymphocytes. They act upon their targets by producing antibodies in a process called______________ a. Staging b. Humoral Immunity. c. Cell Mediated Immunity d. Leukocyte 8. Which of the following is NOT and Early sign of HIV ​ Headache ​ Weight Loss ​ Fever ​ Fatigue ​ Enlarged Lymph Nodes 9. Which human Immunoglobulin is found in the bloodstream and very effective in killing bacteria. It is responsible for initial on of antibodies once exposed to an antigen. a. IgA b. IgD c. IgE d. IgM 10. Which T Cells produce proteins called lymphokines and also help B Lymphocytes make antibodies  a. Suppressor T Cells b. Helper T Cells c. Killer T Cells d. Memory T Cells TEST 1. B lymphocytes represent about ____ percent of the total lymphocytes. a. 20 b. 40 c. 60 d. 80 2. The release of histamine into the blood vessels does not typically result in localized: a. numbness b. warmth c. redness d. swelling 3. Which type of cancer treatment involves the use of medications to alter cell growth and division? a. radiation therapy  b. biologic response modifiers (BRM) c. chemotherapy d. brachytherapy 4. Which of the following is NOT a late stage of HIV Pelvic Inflammatory Disease Weight Loss Yeast Infection Headache 5. The following are ALL suggestive signs of Lupus EXCEPT a. A rash over cheeks and bridge of nose b. Arthritis in two or more joints c. Bald Spots d. Heart palpitations e. Anemia f.Raynaud's Phenomenon 7. What is the most common cancer treatment? a. radiation therapy b. surgery c. chemotherapy  d. gene therapy 8. The lymph tissue in the ____ intercepts antigens invading the upper respiratory tract. a. spleen and bone marrow b. appendix and small intestine c. tonsils and adenoids d. Peyer’s patches 9. Complex decongestive Physiotherapy (CDP) is the most common treatment for __________. a. Rheumatoid Arthritis b. Lymphedema c. HIV d. LUPUS 10. Which type of antibodies are the most plentiful? a. IgA b. IgD c. IgG d. IgM 11. ______________ uses radioactive isotopes that are placed directly on or very near the tumor a. Chemotherapy b. Gene Therapy  c. Brachytherapy d. Alternative Therapy 12. Which of the following is not used to diagnose HIV infection? a. enzyme-linked immunosorbent assay (ELISA) b. Western blot c. biopsy d. a fourth-generation algorithm 13. The HIV virus affects the function of the a. suppressor T cells b. helper T cells c. killer T cells d. memory T cells 14. Which immunoglobulin is found in the blood stream and very effective in killing bacteria. a. IgA b. Ig E c. IgD d. IgM 15. Benign tumors usually:  a. are slow growing b. invade other tissues c. cause significant health problems d. spread to other parts of the body 16. In the United States, you are least likely to contract HIV through: a. childbirth and breast feeding b. unprotected sex c. sharing drug needles d. a blood transfusion 17. Which type of biopsy involves removing a portion of the tumor for testing? a. sentinel lymph node b. needle c. excisional d. incisional 18. ​Very effective against parasites but also involved in allergic responses, such as hay fever, asthma, and urticaria a. IgA b. IgD c. IgE d. IgG 19. The following are clinical conditions in patients with AIDS EXCEPT a. CHF (Congestive Heart Failure) b. Candidiasis c. Pneumocystis Carinii Pneumonia d. Cytomegalovirus e Herpes Simplex ( Chronic Ulcers greater than one month) 20. Cancer arising from epithelial tissue a. carcinoma b. sarcoma c. leukemia d. lymphoma 21. Cancer of the connective tissue a. carcinoma b. sarcoma c. leukemia d. lymphoma 22. A form of cancer that appears as purplish blotches on the skin a. Leukemia  b. Kaposi Sarcoma c. Lymphoma d. Lupus 23. This disease is confined to the skin and causes a persistent flush of the cheeks...lesions on the face, neck, scalp, and other areas exposed to ultraviolet light. The lesions of the face are referred to as a butterfly rash. a. Systemic lupus erythematosus (SLE) b. Discoid lupus erythematosus c. Rheumatoid Arthritis d. Lymphedema Chapter 15- digestive -​ 4 phase of digestion -​ Ingestion ,Digestion, absorption, Elimination -​ Digestive system organs -​ Liver Vs Gallbladder Liver -​ The liver is the largest gland in the body. It lies below the diaphragm in the upper right quadrant of the abdomen, extending into the upper left quadrant -​ The liver is a vital organ that performs several functions for the body. It secretes bile at a rate of over a pint a day, and the bile is continuously excreted through bile passages to the bile duct. Gallbladder -​ The gallbladder is a small sac attached to the underside of the liver -​ Its sole purpose is the concentration and storage of bile.  -​ When the body needs bile to digest food, the gallbladder releases the concentrated bile to supplement that being currently produced by the liver. -​ Concentrated bile is very bitter and is green-yellow in color.The gallbladder empties its contents via the cystic duct. The cystic duct from the gallbladder and the hepatic duct from the liver combine to form the common bile duct -​ Stomach Structure and Function -​ The stomach is a J-shaped organ approximately 10 inches long, located just beneath the diaphragm. It consists of three layers of strong muscle tissue, allowing it to perform its functions effectively. The inner lining is thick and contains folds known as rugae, which enable the stomach to expand and hold about half a gallon of food and liquid. Opening Mechanism -​ The upper opening of the stomach is regulated by the cardiac sphincter, a circular muscle that dilates to allow food entry as the peristaltic wave approaches. Once food enters, the sphincter closes to prevent backflow. Digestive Process -​ Once food is inside, the stomach's muscular layers contract in a rhythmic motion, breaking down food into smaller particles. This mechanical digestion is complemented by chemical digestion, initiated by the stomach lining's mucous membrane, which secretes mucus and gastric juices. Gastric Glands and Enzymes -​ The stomach contains approximately 35 million gastric glands that secrete hydrochloric acid and various enzymes. Key enzymes include: ​ Rennin: Curds milk. ​ Lipase: Splits certain fats. ​ Pepsin: Digests milk curds formed by rennin. -​ Hydrochloric acid combines with proteins to form compounds that pepsin can further digest. The mucus layer protects the stomach lining from acid damage, but excessive acid can lead to ulcers, particularly gastric or peptic ulcers. Chyme Formation -​ After three to five hours, the stomach transforms partially digested food into a semiliquid substance called chyme. Liquids pass through the stomach quickly, while solid foods are digested in the following order:  1.​ Carbohydrates 2.​ Proteins 3.​ Fats -​ When chyme reaches the appropriate consistency, the pyloric sphincter allows it to enter the small intestine. Vomiting Mechanism -​ The stomach is equipped with two sphincters that hold food until it is ready to exit. However, in cases of nausea, vomiting can occur. This process involves the contraction of abdominal muscles, which forcefully squeezes the stomach while the diaphragm pushes down, creating pressure that expels the stomach's contents through reverse peristaltic waves, resulting in emesis -​ How does carbs affect energy Carbohydrates supply about two-thirds of the energy calories needed each day. -​ Where do we get proteins -​ Proteins are obtained primarily from plants and animal source but not stored by the body -​ Different teeth -​ “Baby” teeth are called deciduous and begin to appear at about six months. They are gradually exchanged for permanent teeth beginning at about six years. -​ Different teeth have specific duties to perform. -​ The incisors bite food with their sharp edges. -​ The canines or cuspids are pointed to puncture and tear. -​ The premolars or bicuspids and the molars are for grinding and crushing -​ Parts of the small intestine The small intestine is a tube about one inch in diameter and about 20 feet in length. It completes the digestive process and absorbs the nutrients from the chyme. The small intestine is divided into three sections. The first is a C-shaped segment, about nine inches long, called the duodenum. Because this area receives the highest concentration of acid from the stomach, it is especially prone to the development of ulcers. An ulcer in this area is called a duodenal ulcer. The next segment, the jejunum, is about 8 feet in length. The last segment, about 12 feet long, is called the ileum. The jejunum and ileum are suspended in the abdominal cavity by the mesentery, a fan-shaped fold of tissue that is attached to the posterior abdominal wall. The ileum is reduced to about half an inch in diameter by the time it joins the large intestine in the right lower quadrant of the abdomen. The junction is marked by a sphincter called the ileocecal valve, which allows the chyme to enter the cecum (first segment of the large intestine) but prohibits anything from returning to the ileum. -​ Types of diagnostic test -​ How do you prep for GI X Ray Radiologic studies of the GI tract are indicated for a wide variety of reasons and concerned on the various position of the system -​ Barium swallow- If the condition or function of the esophagus is in question, the patient may be asked to drink a radiopaque liquid called barium while the action of the esophagus is observed by fluoroscope. This test is known as a barium swallow. It aids in diagnosing conditions such as dysphagia, hiatus hernia, diverticulosis, and varices. It also detects strictures, tumors, ulcers, and functional disorders. The barium swallow is usually included as part of the more complete GI series. -​ Upper Gi series A barium swallow is performed initially to evaluate the esophagus. Barium is consumed as the progress of the medium is observed by fluoroscope. X-ray films are taken at specific periods to permit further evaluation. The stomach is compressed to ensure that the barium coats the entire lining. As the barium enters the small intestine, the radiologist manipulates the abdomen to obtain distribution of the barium throughout the bowel loops. The patient is rotated to several positions to record pertinent areas. Spot films may be taken at 30- to 60-minute intervals until peristalsis carries the barium to the ileocecal valve Preparation: An upper GI series is not painful, but the chalky taste and consistency of barium are unpleasant. Preparation for the test may require a two- to three-day diet of low-residue foods before the examination. All oral intake must stop at least eight hours before it is scheduled. The patient must also refrain from smoking. Both a laxative and a cleansing enema may be ordered the evening before the procedure to be certain the tract is empty. Post op- An upper GI series aids in the diagnosis of gastric ulcers, tumors, strictures of the sphincters, inflammation of the lining, motility irregularities, duodenal ulcers, tumors, filling defects, and the like. Following the exam, another laxative may be ordered to aid in removal of the barium from the intestines. Retained barium may cause constipation, obstruction, or fecal impaction. -​ Colonoscopy- An examination to view the entire large intestine using a flexible fiber-optic scope. It is indicated in patients with complaints of diarrhea, constipation, bleeding, or lower abdominal pain. -​ The American Cancer Society recommends a colonoscopy every 10 years, beginning at age 45, as a screening test for colon cancer. Preparation- Starting 24 hours prior to the examination, the patient is allowed only clear liquids or things that become liquid when eaten, such as gelatin. Patients are not allowed to drink or eat anything red or purple such as grape juice or Jell-O. In addition to the diet, the patient will be instructed to take a variety of laxatives depending on the provider’s preference. Laxatives are repeated until the stool becomes nothing but liquid. Twelve hours before the procedure, nothing can be taken by mouth. During/ post op -The patient is sedated and positioned on the left side, with the scope guided through the large intestine. Air is inserted, abdomen manipulation aids, and repositioning facilitates passage. The scope can obtain tissue samples, cytology studies, and polyps snaring. -​ Cirrhosis of the liver - This chronic disease of the liver causes destruction of the liver cells. The destruction leads to impaired blood and lymph circulation and interferes with the life-preserving functions of the liver. S/sx —Early symptoms include a variety of GI tract signs, such as lack of appetite, indigestion, nausea, vomiting, constipation, and diarrhea. Later, nosebleeds, bleeding gums, edema, mental confusion, and anemia may develop. The liver and spleen become enlarged, jaundice is present, and ascites (collection of fluid) occurs within the abdomen. Because the disease interferes with portal circulation, hypertension occurs in the portal system, causing esophageal varices that eventually rupture and bleed Various blood tests support the diagnosis of cirrhosis, but positive confirmation can be obtained through a liver biopsy. A liver scan will detect abnormal thickening and a mass. Etiology—The most frequent cause of cirrhosis is malnutrition associated with alcoholism. Other causative factors are hepatitis or the suppression of bile flow resulting from a disease of the ducts. Treatment—Treatment consists of taking measures to prevent further damage or complications and dealing with the underlying cause. Dietary changes, supplemental vitamins, rest, and appropriate exercise are indicated. Extra care is required when prescribing drugs because the damaged liver may not be able to process them. Alcohol must be prohibited. It is also important to avoid contact with infections. Mortality is high, with many patients dying within five years of diagnosis. -​ Colorectal cancer- This is a malignancy of the colon or rectum. The American Cancer Society estimated 104,610 new cases of colon cancer and 43,340 new cases of rectal cancer in 2020. It is the third most common cancer in men and women. S/sx —Symptoms can vary in relation to the area involved. With right-side colon involvement, there may be black tarry stools, anemia, abdominal aching, pressure, and dull cramps in the beginning. As the disease progresses, weakness, fatigue, dyspnea, vertigo, and eventually diarrhea, anorexia, weight loss, vomiting, and other signs of intestinal obstruction will occur. There is rectal bleeding, abdominal fullness, cramping, and rectal pressure. Later, there is diarrhea and “ribbon” or pencil-shaped stools. Bright red blood and mucus is in or on the stools. With rectal cancer, the first symptom is a change in bowel habits—often “morning diarrhea” may alternate with obstipation (constipation caused by obstruction). This will be followed by a feeling of incomplete evacuation and later pain and a feeling of rectal fullness. Treatment—The most effective treatment is surgery to remove the tumor, adjacent tissues, and any lymph nodes that may be involved. The type of tumor and extent of involvement determine the surgical procedure. It may involve only the removal of a section of the colon and its supporting structures, to total resectioning of the rectum and the construction of a permanent colostomy. Chemotherapy is indicated with metastasis, residual disease, or a recurring inoperable tumor. Radiation and chemotherapy may be used before surgery to reduce the tumor size and activity and are given following surgery to treat any missed cells. -​ Colostomy ( when does some need a colostomy ) This is an artificial opening of the colon, allowing fecal material to be excreted from the body through the abdominal wall. A colostomy is also indicated when an obstructive growth process, such as a tumor, prohibits the passage of feces. When the growth is close to the end of the rectum, there may not be enough healthy tissue remaining to which a segment of the colon can be attached. There may also be evidence that removal of the affected area, even if possible, would present no advantage. The colostomy patient has a major emotional adjustment in addition to the physical adjustment to make. The alteration in body image may be difficult to accept. The thought of fecal material being expelled into a pouch attached to the abdomen may be very unappealing. Consider also that there is no control over the expulsion of flatus (gas) or stool, and it is easy to understand the new patient’s rejection. -​ Diverticulosis- This is the presence of bulging pouches in the wall of the GI tract where the lining has pushed into the surrounding muscle. The sigmoid colon is the most common site, but diverticuli can occur anywhere from the esophagus to the anus. Signs and Symptoms—Symptoms of diverticulosis (an infected diverticula) include irregular bowel movements, lower left abdominal pain, nausea, flatus, low-grade fever, and an increase in WBCs. Chronic diverticulosis may result in fibrosis and adhesions (tissues growing together) that severely limit or obstruct the lumen. Symptoms progress from constipation to ribbon-like stools, diarrhea, distention (swelling up) of the abdomen, nausea, vomiting, pain, and abdominal rigidity. Treatment—initially consists of preventing constipation and combating infection. A liquid diet, antibiotics, one medication to soften the stool, and another medication to relieve pain and relax muscle spasms are called for. When conservative measures fail, the affected colon section may need to be removed -​ Hepatitis -Hepatitis is an inflammation and infection of the liver that can result in cell destruction and death. Hepatitis B, serum hepatitis, was the first to be identified, over 20 years ago. It is very contagious, with a relatively high mortality rate.. After 15 years, a type C (HCV) was identified. It is the most worrisome form. It usually has a silent beginning but develops into a chronic form that causes the liver to scar. Etiology -Type A is usually transmitted by the fecal-oral route, meaning organisms from sewage, human, or animal wastes get into the food chain. It is usually transmitted through ingestion of food, water, or milk that has been contaminated, and from seafood taken from contaminated water. Type B is usually transmitted parenterally (other than by mouth). Health care workers are especially prone to it because of contact with human secretions and feces. Like AIDS, hepatitis B can also be acquired through sexual intercourse and contaminated needles, including ear piercing and tattooing. It can be passed from mother to newborn during delivery. But it can be spread by more casual contact through cuts in the skin and in saliva. Signs and Symptoms—Hepatitis produces a variety of symptoms, which appear suddenly with type A; type B symptoms are insidious. Clinical features of stage one includes fatigue, malaise, headache, anorexia (lack of appetite), sensitivity to light, sore throat, cough, nausea, vomiting, frequently a fever of 100° to 101°F (37° to 38°C), and possibly liver and lymph node enlargement. These symptoms occur during the preicteric (before jaundice) stage and disappear when jaundice begins. About 6 to 10 percent of adults and 25 to 50 percent of children become chronic carriers. These individuals are infectious and can develop potentially fatal complications because of liver degeneration and cancer. The second, icteric, stage has begun once the urine becomes dark, the stool is clay colored, the sclera and skin is yellow, and a mild weight loss has occurred. The liver remains enlarged and tender, and the spleen and cervical nodes swell. The jaundice may continue for one to two weeks. Then, liver enlargement subsides, but the fatigue, flatulence (intestinal gas), abdominal tenderness, and indigestion continue. The third stage, posticteric, usually lasts for two to six weeks. Full recovery requires six months. Prevention—Vaccines have been developed to prevent hepatitis A and B and are recommended for the following groups of people: ​ Military personnel ​ Persons living in or moving to areas that have a high rate of HAV infection and who are at a high risk of HBV infection ​ Persons engaging in high-risk sexual activity ​ Sexually active gay and bisexual men ​ Persons who use illegal injection drugs ​ Persons at risk through their work, such as laboratory workers who handle live hepatitis A and hepatitis B virus, police, and those who give first aid or medical help, and workers who come in contact with stool or sewage  ​ People who work in child daycare centers and correctional facilities, residents of drug and alcohol treatment centers, and patients and staff in hemodialysis units ​ People who are at increased risk for HBV infection and who are in close contact with patients that have hepatitis A or B ​ Persons with hemophilia ​ Persons with chronic liver disease The main problem with the vaccine is it requires three shots over a six-month period and is relatively expensive in the United States. Tx- Hepatitis B has no cure but has various drug treatments like interferon, lamivudine, and adefovir. Patients should rest, eat small meals, and take medication for nausea and vomiting. Hepatitis is a contagious disease, and healthcare workers should wear gloves and isolate patients. The only approved drug therapies are interferon alpha-2 b and ribavirin, which can destroy the virus to undetectable levels in 40% of patients. However, severe side effects and potential virus recurrence make this treatment only a lifesaving measure. Chapter 16-urinary Table 16-1 Combining Form Combining Form Definition Exampes bacteri/o Bacteria Bacteriuria indicates the presence of bacteria in the urine, usually from a urinary tract infection (UTI). cyst/o Bladder, sac A cystoscopy is viewing the interior of the bladder with a lighted instrument. glomerul/o Glomerulus, Glomerulonephritis is an inflammation of the filtering unit of a glomerulus of the nephrons. nephron hemat/o Blood In some cases of nephrolithiasis, hematuria, or blood in the urine, is present. lith/o Stone, calculus Nephrolithiasis is a condition of having kidney  stones. nephr/o, ren/o Nephron, functional A nephrectomy is the removal of a kidney; the cell of the kidney, renal artery supplies blood to the kidney. kidney noct/o Night Older patients frequently complain of nocturia, a condition of having to get up during the night to void. py/o Pus Pyuria is the presence of pus in the urine. pyel/o Renal pelvis Pyelolithotomy is the surgical removal of kidney stones from the renal pelvis. ur/o, urin/o Urine Pyuria is an abnormal condition of pus in the urine; a urinometer is an antiquated device that was used to measure the specific gravity of urine. ureter/o Ureter A ureteroscopy is the procedure of viewing the ureter(s) with a scope. urethr/o Urethra A voiding cystourethrogram is an examination that is done while a patient is voiding, which allows visualization of the bladder and the urethra. - 3 Main Function of the urinary system The urinary system performs three main functions. The first is excretion, the process of removing waste products and other elements from the blood. The second is secretion, by which urine is produced. The third is elimination, the emptying of the urine from its bladder storage. - Pathway of the urinary system When waste products are not removed from the blood, they build up, producing potentially fatal toxicity. After the kidneys have performed their functions, the waste material, urine, is carried through the ureters, one for each kidney, to temporary storage in the bladder. When an adequate amount has been accumulated, the bladder expels the urine through the urethra, eliminating it from the body. - Urinary Bladder - Medical terms used to describe urinary output Anuria- an absence of urine Dysuria- pain or discomfort assoi - Dialysis (Hemo vs Peritoneal) (AV Fistula vs Synthetic graft) (Permacath) Hemodialysis- a process whereby blood is passed through a thin membrane and exposed to a dialysate solution to remove waste products. Peritoneal dialysis- Instead of an artificial dialyzer to cleanse the blood, the patient’s own peritoneal membrane is used (the peritoneum covers the abdominal organs and lines the abdominal cavity). AV Fistula- is created by a vascular surgeon who joins an artery and a vein together and makes an opening between the two so that blood flows directly from artery to vein, bypassing the capillaries. This rapid flow of blood can be felt over the fistula and is described as a “buzzing” feeling. Listening with a stethoscope at the fistula, you can hear the blood flow sound, which is called a bruit. A fistula requires about four to six weeks to mature before it can be used. Repeated needle insertions require rotation of sites, but eventually the fistula will fail and another will need to be made.​ Synthetic Graft- is similar to a fistula except it is made with either a synthetic material or a treated, sterilized animal vein. The graft is inserted when the patient’s blood vessels do not permit a fistula. It joins the artery and the vein, and matures for use a little quicker than a fistula. Grafts are at risk for narrowing in the vein near where it is sewn, which causes clotting. Since they are a foreign material, infection becomes a risk. Permacath- a large double-lumen (two openings) catheter. It can be surgically inserted into either the jugular or subclavian vein to provide temporary access for hemodialysis treatments.the jugular and the subclavian veins.The tubing from the hemodialysis machine connects with the openings of the catheter. The blood exits from the proximal opening on the catheter and goes to the machine for filtering. After being treated through the machine filters, the blood returns through the distal opening of the catheter to the body. The catheter is inserted to provide immediate use of a dialysis access to permit hemodialysis. It is often used while waiting for a fistula or a graft to mature. - Kidney Transplant The transplantation of body organs is always at risk of recipient rejection; however, the kidney can usually be successfully transplanted, and the survival of the graft has been markedly improved by the use of the drug cyclosporine. Transplantation is indicated in cases of prolonged chronic debilitating disease and renal failure involving both kidneys; unfortunately, transplantation often is not performed until patients have been on dialysis for a significant time because of a lack of organ donors. The demand exceeds the supply for healthy organs. In addition, blood and other cellular structures must “match” to ensure the greatest probability for a functioning transplanted organ. There is an anticipated percentage of success within immediate family members. A twin provides the greatest likelihood, with a brother or sister, parent, or child providing decreasing percentages of success in that order. The surgical procedure itself is well established and presents virtually no concern as far as the success of the transplanted kidney. The patient, however, is almost always in a state of relatively poor physical condition because of the effects of the extended illness. This status and the tendency of the body to reject a “substance” that is foreign and not of the same cellular structure sometimes results in the organ not surviving in its new host. The use of drugs to control the body’s natural defensive mechanism of rejection increases the rate of success. Transplant patients need to take medication every day to protect their new kidney. Most patients require three drugs. The primary one will probably be cyclosporine, tacrolimus, or sirolimus. In addition, some form of steroid and either mycophenolate mofetil, azathioprine, or rapamycin will be taken. These patients require frequent medical examination at the transplant location to ensure the health of the new organ. - Diagnostic Test (Intake-Output): An intake-output measurement involves keeping a record of all fluid, or food that melts to liquid, that is consumed, along with all urine or other fluid loss, be it measured or estimated. For example, emesis would be measured; perspiration estimated as slight, moderate, or profuse; diarrhea indicated as to frequency; and any other loss (such as bleeding, drainage through a stoma, or excessive respiratory activity) evaluated. Hence, intake is compared with output to determine fluid balance within the body. - A routine specimen: preferably the first of the morning, is simply voided into a clean container. - Clean Catch specimen: usually for culture purpose, pregnancy determination, or microscopic examination, involves specific cleaning of the meatal area and catching the specimen midstream in a sterile container. - 24 hr test:collects all urinary output, from a specified hour one day until the same time the next day, in a special container under specific conditions - Chronic Renal Failure vs. acute Renal Failure Acute Renal Failure -​ Description—A critical illness, acute renal failure results in the sudden cessation of kidney function. Effective medical treatment usually can overcome the problem. If not, however, it will progress to uremia and death. -​ Signs and Symptoms—Symptoms initially apparent are oliguria and azotemia (nitrogenous products of protein metabolism in the  blood). Without filtration, the waste products and excess solutes quickly collect in the blood, resulting in severe electrolyte imbalance, acidosis, and uremia, which interfere with the function of the other body systems. A vast number of other symptoms develop, listed here by body system and in ascending order within the system: -​ Gastrointestinal: anorexia, nausea, vomiting, hematemesis (bloody vomitus) -​ Nervous: headache, drowsiness, confusion, convulsion, coma -​ Integumentary: dryness of the skin, pruritus, pallor, uremic frost (powdery white crystals of urea on the skin) -​ Circulatory: hypotension initially, then hypertension, cardiac rhythm irregularities, CHF, edema, anemia, pulmonary edema -​ Respiratory: Kussmaul’s respirations (fast, deep respirations, over 20 per minute and usually sounding labored, resembling sighs) - Fever and chills, indicators of infection, are an expected complication. Diagnosis of renal failure is confirmed by blood test findings of greatly elevated quantities of urea, nitrogen, and creatinine and by urine samples with casts, protein, and altered specific gravity. Additional verification with diagnostic examinations, such as KUB, IVP, ultrasound, and retrograde pyelography, may be indicated. -​ Etiology—Renal failure may be caused by an obstruction, inadequate circulation, or damage to the nephrons. Failure caused by bilateral obstruction is usually associated with calculi, blood clots, tumors, strictures, or an enlarged prostate. Inadequate blood flow results from low blood pressure and low volume in the arteries, which eliminates the force required for the kidney to filter water and solutes from the blood. This can result from shock, embolism, hemorrhage, loss of fluid caused by burns, congestive heart failure, and arrhythmias. Nephron damage, which may cause failure, can result from acute glomerulonephritis, sickle cell anemia, bilateral renal vein thrombosis, acute pyelonephritis, renal myeloma (tumor), or toxic substances, like medications.  -​ Treatment—Treatment consists of a high-calorie diet that is low in protein, sodium, and potassium. Fluids are controlled. Dialysis may be required. Chronic Renal Failure -​ Description—This is an end result of the progressive loss of kidney function. -​ Signs and Symptoms—Symptoms do not develop significantly enough to warrant investigation until almost 75 percent of glomerular function is gone. The remaining normal nephrons gradually deteriorate, causing symptoms of renal failure and other system involvement. Signs and symptoms initially are related to an imbalance of sodium and potassium and an accumulation of nitrogen from protein metabolism; these may include hypotension, dry mouth, listlessness, fatigue, and nausea. Later, the patient will begin experiencing mental dullness and confusion. Symptoms increase as more nephrons fail.Additional system involvement is similar to that described with acute failure, but a few specific differences do occur with the slower progressive course.Infertility and amenorrhea (lack of menses) in women, impotence in men, and impaired carbohydrate metabolism also result from improper endocrine action. The skeletal system develops a mineral imbalance that results in bone pain because of parathyroid hormone imbalance. This in turn allows the minerals to be withdrawn from the bones, causing fractures. Calcifications develop in the brain, eyes, joints, myocardium, and blood vessels. Children with chronic failure show stunted growth patterns because of endocrine abnormalities. -​ Diagnosis is made in the same manner as for acute renal failure. -​ Etiology—Chronic renal failure can be the result of many preexisting conditions, such as chronic glomerular disease; chronic infections; obstructions; stones; and endocrine diseases, such as diabetes, vascular diseases, hypertension, and chronic overdose of toxic agents. -​ Treatment—Treatment is almost exclusively dependent on dialysis to correct the chemical imbalance. Other treatment is required for the complications developed in the other body systems. Long-term dialysis requires specific physical and psychological therapy. Patients must be meticulous in their  personal care. The skin must be clean, and lotions should be applied to combat dryness and itching. Good oral hygiene is a must to alleviate bad breath and counteract excessive dryness and bad taste. Diet is extremely critical and requires individual adjustments in relation to dialysis. Daily records of intake and output will aid in determining fluid status. If urine is not being excreted, fluid builds up within the body’s tissues. Dialysis removes this fluid, causing the patient to express feelings of being “wrung out.” Chapter 17- endocrine Table 17-2 Gland Location Hormone Principal Effects Pituitary Undersurface of the Growth hormone Normal growth of anterior lobe brain in the sella (GH) body tissues turcica of the skull Thyroid-stimulating Stimulates growth hormone (TSH) and activity of (Thyrotropin) thyroid cells to Adrenocorticotropic produce and secrete hormone (ACTH) thyroid hormone Melanocyte-stimulat Stimulates the ing hormone (MSH) cortex of the Follicle-stimulating adrenal gland and hormone (FSH) the secretion of Luteinizing hormone cortisol (LH) Increases skin Prolactin (PR) pigmentation Stimulates the maturity of the graafian follicle to rupture and to produce estrogen in the female. In the male, it stimulates the development of the testes and the production of sperm.  Causes the development of the corpus luteum, which then secretes progesterone in the female. In the male, it stimulates the interstitial cells of the testes to produce testosterone. Develops breast tissue and stimulates secretion of milk from mammary glands Posterior Oxytocin Stimulates Vasopressin or contraction of antidiuretic uterus, especially hormone (ADH) during childbirth; causes ejection of milk from mammary glands Acts on cells of kidney tubules to concentrate urine and conserve fluid in the body; also acts to constrict blood vessels Thyroid Lower portion of the Thyroxine and Increase anterior neck triiodothyronine metabolism; Thyrocalcitonin influence both physical and mental activity; promote normal growth and development Causes calcium to be  stored in bones; reduces blood level of calcium Parathyroid Posterior surface of Parathormone Regulates exchange thyroid gland of calcium between the bones and blood and increases blood calcium Adrenal Superior surface of Adrenaline Increases heart Medulla each kidney (epinephrine) rate, blood Cortex Aldosterone pressure, and flow (mineral corticoid) of blood; decreases Glucocorticoids intestinal activity Sex hormones Controls electrolyte (androgens) balances by regulating the reabsorption of sodium and the excretion of potassium Affect the metabolism of protein, fat, and glucose, thereby increasing blood sugar; also decrease inflammation Govern sex characteristics, especially those that are masculine Pancreas Behind the stomach Insulin Essential to the Glucagon metabolism of carbohydrates; reduces the blood sugar level  Stimulates the liver to release glycogen and convert it to glucose to increase blood sugar levels Thymus Under the sternum Several peptides React on lymphoid tissue to produce T lymphocyte cells to regulate immunity Pineal Body Third ventricle in Melatonin Influences onset of the brain puberty and circadian rhythms Ovaries Female pelvis Estrogen Promotes growth of Progesterone primary and secondary sexual characteristics Develops excretory portion of mammary glands; aids in maintaining pregnancy Testes Male scrotum Testosterone Develops primary and secondary sexual characteristics; stimulates maturation of sperm - Diagnostic Test (FBS, HCG, GTT, A1c) ​ Blood sugar, frequently measured after fasting (fasting blood sugar, FBS)—To assess the function of the pancreas, including insulin effects ​ T3, TSH, and T4—To measure the level of the thyroid hormones  ​ Urine human chorionic gonadotropin (HCG) (pregnancy test)—To measure the presence of a hormone secreted by the placental cells ​ Glucose tolerance—To measure the body’s ability to process a large dose of glucose. Multiple blood samples are taken at specific intervals following ingestion of the glucose mixture. ​ Glycohemoglobin or Hemoglobin A1c (Hgb A1c)—A simple blood test that measures how well the glucose level has been controlled over the previous four to six weeks. The glucose attaches to the hemoglobin of the red blood cells (RBC). A1c is the stable molecule formed when sugar and hemoglobin bind together in the RBC in a process called glycosylation. A1c can be measured. An elevated finding indicates poor glucose control. Measuring A1c reveals a truer picture of blood sugar level control than conventional glucose measurement. If the diabetic patient has not been conforming to diet, except in anticipation of an office visit, the cells will reveal that they have picked up excess sugar. Recently, an Hgb A1c of 6.5 percent or more is a criterion for diagnosis of diabetes. ​ Normal - below 5.7 , Prediabetes- 5.8 to 6.4, Diabetes- 6.4 and higher ​ Fasting blood sugar(FBS)- 70-130 mg/dl - Diabetes Mellitus (Type 1 + Type 2) Description—A chronic disease of insulin deficiency or resistance, diabetes mellitus interferes with the metabolism of carbohydrates, proteins, and fats. Insulin in the blood facilitates the transfer of glucose into the cell to be used for energy or stored as glycogen. It also stimulates the formation of proteins and free fatty acid storage. Without sufficient insulin being secreted by the pancreas, the body’s tissues do not have access to essential nutrients for fuel or storage.Diabetes mellitus affects an estimated 10.5 percent of the U.S. population or 34.2 million people. The prevalence of diabetes has increased greatly in the past decade, and more children and teenagers are being diagnosed with both type 1 (insulin requiring) and type 2 diabetes. The reasons are multifactorial but increasing numbers of obese individuals and inactivity are common risk factors. There are many long-term effects of diabetes. Diabetes is a leading cause of new cases of blindness, end-stage kidney disease, neuropathy, and lower limb amputation in the United States. It develops more often in people who are older than 40 and have a family history of diabetes, or are of African American, Hispanic, or Native American descent. It more than doubles the risk for stroke and heart disease. The disease also interferes with resistance to organisms, which may result in skin and bladder infections. Diabetic retinopathy results from microvascular changes in the retina of the eye, especially in poorly controlled diabetics. In patients who have had diabetes for 20 or more years, 80 percent develop retinopathy. Diabetes Mellitus (Type 1 DM) Etiology—Type 1 diabetes can be considered a genetic disease. It is an autoimmune disorder that attacks the cells of the pancreas known as the islets of Langerhans. Signs and Symptoms—The diagnosis of diabetes in childhood is usually straightforward. The parents report an increased thirst, increased urination, and weight loss. The child will appear to be dehydrated and may have a sweet odor to the breath from the ketones (a by-product of fatty acids). A urinalysis will generally reveal a large amount of ketones and is positive for glucose. Treatment—A child with newly diagnosed type 1 DM will be admitted to the hospital for stabilization and treatment. Insulin injections or intravenous insulin are required for initial management. During hospitalization, the parents, caregivers, and the child (if of appropriate age) are taught to administer the insulin injections. Commonly, several types of insulin (short-acting, intermediate, and long-acting) will be used to control the elevated blood sugar and complications with childhood diabetes. Diabetes Mellitus (Type 2 DM) Etiology—Type 2 DM is the most common form, usually due to insulin resistance. This is a complex problem arising from the reduced effectiveness of insulin to facilitate glucose entering the cell. The blood sugar level rises, and the liver produces more sugar and often releases lipoproteins full of triglycerides that may decrease HDL cholesterol. Insulin resistance can also result from genetics, aging, and some medications, but being overweight and lack of exercise are the main nongenetic factors. About 90 percent of all newly diagnosed diabetics are overweight. Some of the hormones secreted by fat cells—for example, resistin—interfere with insulin action. The role of fat cells is being studied specifically because obesity is so often associated with the disease. In addition to resistance, other factors exist. The pancreas compensates by secreting more insulin. Eventually, the insulin-producing cells can no longer keep up, and glucose increases in the blood. Over time, this high level of sugar damages blood vessels, nerves, and other body tissues. It also causes a vicious cycle of increasing resistance and further exhausts the pancreas. Treatment—Treatment begins with a strict diet, planned to meet the nutritional needs of the individual patient and to control the blood sugar level. Diet can have a significant impact on controlling blood sugar and diabetes. Losing as little as 10 pounds will reduce blood sugar levels. A recent study determined that a high-fiber diet lowered blood sugar levels by 10 percent, a reduction similar to the effect of some medications. Exercise may be the most important intervention. It not only increases glucose metabolism, but it also increases insulin sensitivity, which causes fat and muscle cells to better respond to insulin. Diet and exercise can have a significant effect in preventing diabetes, but as a treatment, they can only go so far. In most people, the problem of insulin production and insulin resistance tend to worsen in time despite weight loss, diet, and exercise. When diet alone is inadequate, insulin injections or the use of oral hypoglycemic drugs are indicated. Injections may be necessary initially once a day, using long-acting insulin; when control is more difficult, short-acting insulin, injected before meals, may be needed. Diabetic patients are taught to evaluate their glucose level by performing a finger stick for blood analysis. The amount of insulin injected is based on the findings. Hypoglycemic drugs are taken orally to aid in the metabolism of sugar. Oral therapy is adequate only for type 2 DM patients. The drugs used today address insulin resistance and secretion to reduce blood sugar levels. Providers are using more drugs and using them more aggressively. Drugs can be categorized according to their actions (see the following). - 17-11 ( Hyperglycemia Vs Hypoglycemia) Diabetic Coma (Hyperglycemia)  -​ Appears to be in stupor or coma -​ High blood glucose levels -​ Face flushed -​ Fruity odor to breath -​ Tongue dry -​ Labored, Prolonged respirations -​ B/P Low -​ Weak and rapid pulse -​ Urine positive for sugar and acetone -​ Skin dry Insulin Shock (Hypoglycemia) -​ Excited, nervous, dizziness, confused, irritable, inappropriate responses. -​ Low blood glucose levels -​ Headache -​ Face Pale -​ Shallow or rapid respirations -​ B/P normal -​ Full and pounding pulse -​ Urine Negative for sugar and acetone -​ Skin moist-excessive perspiration -​ Lack of coordination, trembling. Disease System Involved Pathology present Diabetes Endocrine Insulin deficiency, destruction of  insulin-producing cells of the pancreas Urinary Glycosuria, polyuria, UTI, kidney disease Circulatory Heart disease, stroke, elevated triglycerides Senses Retinopathy, lens changes Integumentary Skin infection, ulcers Nervous Peripheral neuropathy Graves’ Endocrine Thyroid enlargement disease Circulatory Palpitations, tachycardia, cardiomegaly Muscular Weak muscles, fatigue, paralysis Nervous Nervousness, tremors, mood swings, difficulty in concentration Senses Exophthalmos