176 final exam Flashcards
What are the 6 elemants necessary for infections?
- infector agent (pathogen)
- reservoir (where pathogen grows)
- portal of exit (exit route from reservoir; entry route)
- mode of transportation (method of transportation)
- portal of entry (entrance through skin; entry route)
- Host
When would you want a patient with herpes zoster to take acyclovir?
Take within 72 hrs
14-28 days the symptoms would get better but not cure it
antihistamine - PO
Used for allergy symptoms & motion sickness
Side effects:
* Retention
Adverse reaction:
* Thrombocytopenia, hemolytic anemia
Diphenhydramine (Benadryl)
How do you know Vancomycin is working?
if diarrhea decreases
Antiretrovirals - PO/IV
Uses: genital herpes, shingles, HIV
adverse reaction:
* seizure
* hematuria
* AKF, SJS
Precautions: administer with food, increase fluid intake, and begin therapy with first onset of symptoms
Acyclovir (Zovirax)
Antifungal - PO/IV
Used for yeast infection
adverse reaction:
* seizure
* prolonged QT interval
Fluconazole (Diflucan)
Vasopressor - IM, SubQ, IV
used for acute asthmatic attacks, hemostasis, bronchospasm, anaphylaxis
side effects:
* tremors
* anxiety, tachycardia
* dizziness
adverse reaction:
* Dysrhythmias
* increased T wave
Epinephrine (adrenaline)
immunosuppressant - IV, IM PO
tx: RA, lupus and psoriasis
reactions:
- bone marrow suppression
- increased risk for infection
- DVT, AKI, liver failure
- decreased RBC
- leukocytopenia
- seizure, hepatotoxic
education:
- avoid large groups, people with infections
- receive inactivated vaccines (flu and pneumococcal)
Methotrexate (Rheumatrex)
NSAID used to treat mod- severe pain, inflammation, or arthritis
- RA, OA, tendonitis
- given PO, IV and recally
works if inflammation decreases
reactions:
- abnormal bleeding (hematuria)
- HF, AKI, HTN, MI, CVA
- liver failure, nephrotoxicity
- peripheral edema, cardiac changes
- N/V/D/C/A
BBW: CVA, MI & GI bleed risk
Indomethacin (Indocin)
Bronchodilator - PO
causes bronchodilation by action on B2 pulmonary receptors
- used for asthma
side effects:
- tremors
- anxiety, restlessness
albuterol
Antibiotic - PO/IV
Used against gram-positive, C-diff, streptococci, MRSA & staphylococci, & stomach infections
Nursing interventions:
* vital signs, check allergies
* monitor BUN/Cr levels (elevated levels not good)
Side effects:
* ototoxicity (check pt for hearing loss before given it, hearing aid)
* nephrotoxicity, n/v
Sever reaction: red man syndrome
Vancomycin (Vancocin)
What does ABCDE mean for melanoma?
A - asymmetry:
- one half not like the other/ uneven shape
B - border:
- irregular or poorly circumcised
- look for edges that are burned, notched, or ragged
C - color:
- varies from one area to another
- pigmentation is not uniform
- white/ blue are bad
D - diameter:
- larger than 6mm as a rule
- greater than the size of a typical pencil eraser
E - evolving:
- mole changes size, shape, color
- begins to bleed or scab points to danger
Most serious form of skin cancer
- deadly
cancerous neoplasm in which pigment cells invade the epidermis, dermis, and subq tissue
- can metastasize to any organ
characterized by black or dark brown patches on the skin that may appear uneven in texture, jagged, or raised
malignant melanoma
skin cancer that begin in the flat cells in the upper outer part of the epidermis but may grow into deeper tissue
- prone to metastasize
A firm nodular lesion topped w/ crust or a central area of ulceration
most common places:
- head, neck, and lower lip
- sites of chronic irritation & injury
squamous cell carcinoma (SCC)
You have a patient with a nut allergy . What would you educate this patient?
avoid peanuts in baked goods/ avoid all nuts in general
check food labels for nuts
wear medical bracelets
carry epi-pen
you are teaching a patient about safety precautions regarding cancer. what safety precautions would you suggest?
wear sunscreen
- no direct sunlight
self examinations and check moles frequently
wear sunglasses
Why do we use an EpiPen?
to help make RBC
- given subq
use for severe allergies
Tx for scabies - Topical
paralyzes and kills scabies and their eggs
side effects:
- itching
- mild rash
- headache
adverse reaction:
- severe burning
- stinging
- redness
Permethrin cream
A patient with AIDS has dark purplish brown lesions on the mucus membranes of the mouth. As the nurse you know these lesions correlate with what type of opportunistic disease?
A. Epstein-Barr Virus
B. Herpes Simplex Virus
C. Cytomegalovirus
D. Kaposi’s Sarcoma
D. Kaposi’s Sarcoma
Which HIV test can give the earliest test results?
A. Nucleic Acid Test (NAT)
B. Antibody HIV Test
C. Combination HIV antigen/antibody test
D. CD4 count
A. Nucleic Acid Test (NAT)
Human Immunodeficiency Virus (HIV) can NOT be spread in what type of fluid below? Select all that apply:
A. Breastmilk
B. Blood
C. Tears
D. Semen
E. Vaginal Fluid
F. Sweat
C. Tears
F. Sweat
What is the hallmark symptom of systemic lupus?
butterfly rash on face and chest
What do we do for a mom who has herpes and is going to deliver a baby?
c-section
T/F - Patients with herpes zoster are at risk for secondary infections
True
What would you do for a patient who is an IV drug user, prostitute, and has gonorrhea?
give her medication for gonorrhea and teach safe sex practices
You have a patient who is getting a blood transfusion and they are complaining about itching. what would be your priority?
stop the infusion
report to the HCP
You have a patient who is refusing a blood transfusion. What would your nursing priority be?
explain why they need the transfusion
assess why they are refusing
A patient has redness, swelling and warmth in the lower extremities. What would that indicate?
Cellulitis
- treat w/ antibiotics (penicillin)
You have a patient who is 6 months pregnant and has HIV, what would you teach this patient?
She cannot breast feed
- the baby can get the virus through the breast milk
You have a patient who is 5 years old and they have a bee sting. What symptoms would you anticipate seeing with a bee sting?
Swelling and hives
use epinephrine (epi-pen) or antihistamine
you are assessing a patient suspected of having scabies, what would you anticipate that looking like?
brown crust
Itchy lines on skin
You have a 5 year old patient and you are looking at the scalp. You notice nits in the hair. What would you anticipate the nits being?
lice
You have a patient who is having surgery and is allergic to latex. What information would you gather from the patient before surgery?
ask what type or reaction they have and notify the surgical team
You have a patient with HIV and you are educating them on multidrug therapy that is needed. What would you include in the education?
Take all medications that are prescribed and take at all times throughout the day
What kind of reaction is contact dermatitis?
skin reaction
new products cause this
- laundry detergent, dye and material
you have a patient who has a virtual infection. what medication would you anticipate giving?
Acyclovir
What kind of things are you concerned with regarding the skin during a physical assessment?
raised irregular edge moles
sore that healed
moles that are itchy
moles that is red w/ a black border
Dangerous infection of the blood
- caused by widespread infection
S/s:
- bounding pulse, tachycardia
- hypotension
- increases RR
- increased WBC’s & C-reactive protein (CRP)
Tx:
- treat cause
- fluid replacement
- vasopressors (norepinephrine & dopamine)
Sepsis
Most common and least severe type of skin cancer
often found on face and upper trunk
- might not be noticed by the patient
arise in the Basal cell layer of the epidermis
- scaly appearance
- pearly papule w/ central crate and waxy, pearly border
Tx: removal of area
- 40-50% recurrence
basal cell carcinoma
systemic/ chronic autoimmune disease in which the joints and some organs of the body systems are attacked
- wrists, knees, knuckles, fingers
- flares occur d/t stress
- causes chronic inflammation of synovial membrane
Balance exercise w/ rest
can affect anyone, but mostly women ages 30-60
believed to be caused by bacteria and viruses
- Ex: labor, infections
S/s:
- stiffness (in morning)
- joint pain, muscle weakness
- fatigue
- subq nodules
Rheumatoid arthritis (RA)
Body has adverse response to a blood transfusion
- allergic, febrile, hemolytic
- hypersensitivity disorder
can be mild, moderate, or severe
Stop the infusion and keep vein open (KVO)
follow protocol and ensure proper crossmatching and typing
store blood properly and administer w/in 4 hrs of removal from fridge
Transfusion reactions
Reaction to certain proteins in latex rubber
clients can develop an allergy to foods
- bananas, kiwis, and avocados
Latex allergy
Severe, acute, life-threatening response to an allergen in which the symptoms develop quickly
- fatal hypersensitivity
- usually given epinephrine
severe, sudden vasodilation from mast cells
three most important aspects:
- anaphylactic reaction
- antibody dependent
- delayed hypersensitivity
Tx:
- Epi (IV)
- Antihistamines
- Oxygen
- Resuscitation
Anaphylaxis
Why is it important to monitor the CD4 cell count?
The more significant the loss, the more severe the immunosuppression becomes
The end stage or terminal phase of HIV
CD4 < 200
acquired immune deficiency syndrome (AIDS)
The earliest infection phases of HIV is often referred to as…..
asymptomatic phase
Why is HIV/AIDS considered an immune system disorder?
immune system attacks the body making the body more susceptible to the disease infection
STD that attacks many parts of the body and is caused by a small bacterium called a spirochete
- bacterial infection that appears 2-14 days after exposure
S/s:
- ulcer
- spores
- discharge rash
can attack the brain, heart, eyes, liver, vessels and bones in a fetus
Syphilis
a sexually transmitted infection caused by herpes simplex virus 2
S/s:
- pain
- sores
- skin rash
genital herpes
A client is being admitted for the treatment of acute cellulitis of the thigh. The client asks the admitting nurse to explain what cellulitis means. The nurse bases the response on the understanding that the characteristics of cellulitis include:
A) An epidermal and lymphatic infection caused by Staphylococcus
B) An inflammation of the epidermis only
C) A skin infection into the subcutaneous tissue and dermis
D) An acute superficial infection of the lymphatics and dermis
D) An acute superficial infection of the lymphatics and dermis
A male client visits the physician’s office for treatment of a skin disorder. As a primary treatment, the nurse expects the physician to prescribed:
A) An IV corticosteroids
B) An IV antibiotic
C) An oral antibiotics
D) A topical agent
D) A topical agent
A female client with herpes zoster is prescribed acyclovir (Zovirax) 200mg PO q4h while awake. The nurse should inform the client that this drug may cause:
A) Palpitations
B) Dizziness
C) Diarrhea
D) Metallic taste
C) Diarrhea
How would you manage fungal infections?
Topical/ oral antifungals
antifungal soap
treatment lasts 2-6 weeks
superficial infection of skin & mucous membrane d/t fungus
- can spread by direct contact or inanimate objects
takes advantage of trauma in moist, warm tissue
risk factors:
- diabetes
- immunosuppressed
- pt taking antibiotics
3 types:
- tinea pedis (athletes foot)
- tinea corpon (ringworm)
- candidiasis (skin, mouth, vag, yeast infection)
Fungal infections
infection of the skin, mouth, or vagina caused by the yeast-type fungus Candida albicans
AKA “thrush”
Tx:
- Swish and swallow
Candidasis
fungal infection of the foot
- AKA “athlete’s foot”
- most common
S/s:
- skin maceration
- fissures and vesicles around/ below toes
- discoloration of infected area
Interventions:
- teach about foot care
- pay attention to areas surrounding the toes
- proper footwear to decrease swelling
- warm socks
- meds
tinea pedis
Ringworm of the body
S/s:
- flat lesions that are clear in the center with reddened borders & look like a raised circle
- round patches with elevated red borders of pustules
- papules / vesicles that affect the non hairy skin of the body
interventions:
- proper hand washing & body hygiene
- no sharing clothes
- wash sports equipment
tinea corporis
A fungal infection (ringworm) of the scalp
characterized by red papules, or spots, at the opening of the hair follicles
tinea capitis
Nurse Tamara discovers scabies when assessing a client who just has been transferred to the med-surgery unit from the day surgery unit. To prevent scabies infection from traveling to other clients, the nurse should:
A) Wash hands, apply a pediculicide to the clients scalp, and remove any observable mites
B) Isolated the clients bed linens until the client is no longer infectious
C) Notify the nurse in the day surgery unit of potential scabies outbreak
D) Place the client on enteric precautions
B) Isolated the clients bed linens until the client is no longer infectious
What population is at risk of getting Scabies?
overcrowded living conditions
poverty
world travel
anyone
Contagious skin disease transmitted by the human itch mite
- contact precaution
penetrates the skin and makes a burrow
- lays eggs that mature and rise to skin surface
- wrist, fingers, ect
transmitted by contact with the infected person
S/s:
- wavy, brown, threadlike lines (hands, genitals, body folds)
- Severe itching (can lead to infection d/t scratching; More common at night)
Scabies
What are some nursing interventions for pediculosis?
apply medication to rid the patient of lice
assess, identify, and treat everyone involved
encourage to clean furniture, carpet, linens, stuffed animals, ect
What are some ways you could treat pediculosis (lice)?
OTC prescription meds
- pyrethrin shampoo (RID)
Occlusive agents
- petroleum jelly
fine nit comb to get rid of eggs
Ages 2 and younger:
- peanut butter, mayo, ect
lice transmitted by close contact with infected individuals leaving eggs (nits) on skin/ hair surfaces
3 types:
- pediculosis capitis - head louse
- pediculosis corporis - body louse
- pediculosis pubis - pubic louse
lice live 1-2 days w/o blood source
pediculosis
The nurse prepared to care for a male client with acute Cellulitis of the lower leg. The nurse anticipates which of the following will be prescribed for the client?
A) Cold compress to affected area
B) Warm compress to affected area
C) intermittent heat lamp treatments 4x/day
D) alternating hot/cold compresses continuously
B) Warm compress to affected area
What are S/s of Cellulitis?
warm to touch
uneven swelling/ edema
redness on extremity
pain
drainage
diffuse, acute infection of the skin marked by local heat, redness, pain, and swelling
caused by a group of streptococci and staphylococcus aureus
- infection of skin cells
- more common in children
- Can become septic
involves the underlying tissue of the skin
- bacteria can spread to other open areas
not contagious
Cellulitis
The nurse manager is planning the clinical assignments for the day. which staff member can be assigned to care for a patient with herpes zoster (shingles)? SELECT ALL THAT APPLY
A) The nurse who never had german measles
B) the nurse who never received the varicella zoster vaccine
C) the nurse who never had mumps
D) the nurse who never had roseola
A) The nurse who never had german measles
C) the nurse who never had mumps
D) the nurse who never had roseola
The nurse is assigned to care for a female client with herpes zoster (shingles). Which of the following characteristics would the nurse expect to note when assessing the lesion of this infection?
A) clustered skin vesicles
B) A generalized body rash
C) small blue-white spots with a red base
D) cutaneous lesions on the hands, feet, and buttocks
A) clustered skin vesicles
How could you diagnose herpes zoster?
physical exam
a culture that isolates the virus
What are S/s of herpes zoster?
pain - precedes outbreak
rash - thoracic, lumbar, cervical regions, and cranial areas
vesicles erupt along the involved nerve tract
typically lasts 7-28 days
What are nursing interventions for Herpes Simplex Virus (HSV)?
Primary focus:
- treat the symptoms and prevent spread
keep lesions dry
loose fitting under clothing (HSV 2 outbreak)
education regarding transmission
produces various types of vesicles that rupture and encrust, causing ulcerations
- initial outbreak most severe
- AKA “Genital Herpes”
flu like symptoms occur 3-4 days after vesicants rupture
most common sites are the cervix and penis
- present for 7-14 days
Herpes Simplex Virus (HSV) - Type 2
Herpes Simplex Virus (HSV) Type 1 usually occurs after…
acute illness
infection
Takes 10-14 days to heal
vesicle at the corner of the mouth, lips, or nose
- typically fluid filled
- AKA “Cold Sore”
S/s:
- fatigue
- pruritus and burning
- pain in mouth
can use OTC topical treatments
Herpes Simplex Virus (HSV) - Type 1
The nurse plays a vital role in screening patients for a possible HIV infection. What questions below could the nurse ask to help identify a patient who is at risk for HIV? Select all that apply:
A. “How often do you use alcohol or drugs?”
B. “Have you recently experienced an abusive relationship?”
C. “If you are sexually active, do you or your partner use protection?”
D. “In the past month, have you felt sad or unable to get out of bed?”
E. “Have you ever been treated for a sexually transmitted infection?”
F. “Do you ever experience intrusive or unwanted thoughts?”
A. “How often do you use alcohol or drugs?”
C. “If you are sexually active, do you or your partner use protection?”
E. “Have you ever been treated for a sexually transmitted infection?”
You’re providing education to a patient with AIDS on how to prevent opportunistic infections. Which statement below requires the nurse to re-educate the patient about this topic?
A. “I’m traveling to Puerto Rico next week and will be sure to pack bottled water.”
B. “I’ve switched to buying raw organic milk.”
C. “Last month I received the Pneumovax.”
D. “My neighbor bought a cat last week.”
B. “I’ve switched to buying raw organic milk.”
Patients with AIDS should AVOID raw, undercooked, and unpasteurized foods and beverages. These items could contain organisms that could cause serious infections to a person with a compromised immune system
disease in which cancer cells are found in the skin or mucous membranes that line the gastrointestinal (GI) tract, from mouth to anus, including the stomach and intestines
- causes lesions to grow in the skin, lymph nodes, internal organs, and mucous membranes lining the mouth, nose, and throat
often affects people with immune deficiencies
- HIV or AIDS
Purple, red, or brown skin blotches are a common sign. Tumors also may develop in other areas of the body.
Treatment may include radiation or chemotherapy. Rarely, surgery may be needed
Kaposi’s Sarcoma
A 48-year-old patient is HIV positive. The patient has no signs and symptoms and has a CD4 count of 400 cells/mm3. In addition, no opportunistic infections or diseases are present. These findings correlate with what stage of HIV?
A. Acute
B. Chronic
C. AIDS
B. Chronic
These findings correlate with the Chronic Stage (also called the Asymptomatic Stage) of HIV. Signs and symptoms may not be experienced, the viral load is lower than the Acute Stage, but the virus is still replicating and destroying the cells. The patient can still transmit the virus to others. In addition, the CD4 count should be more than 200 cells/mm3 to about 500 cells/mm3. In addition, no opportunistic infections or diseases should be present.
What is a normal CD4 count?
A. 200-500 cells/mm3
B. 1500-3500 cells/mm3
C. 500-1500 cells/mm3
D. <200 cells/mm3
C. 500-1500 cells/mm3
Identify the correct statements about the anatomy of the Human Immunodeficiency Virus (HIV). Select all that apply:
A. HIV is a retrovirus.
B. Inside the virus is packaged DNA.
C. The protein projections found on the virus’ surface play a key role in attaching to the receptors on the helper t-cell.
D. The glycoproteins (specifically GP140) are vital for engaging the receptors on the targeted cell.
A. HIV is a retrovirus.
C. The protein projections found on the virus’ surface play a key role in attaching to the receptors on the helper t-cell.
Which statement below is not true regarding the role of the helper t cell?
A. The helper T cell releases cytokines to help activate other immune system cells.
B. The helper T cell is part of the adaptive immune system.
C. The helper T cell is cytotoxic and kills invaders.
D. The helper T cell has CD4 receptors found on its surface.
C. The helper T cell is cytotoxic and kills invaders.
All the other options are true statements about the helper T cell. Option C is NOT true. Helper T cells are not cytotoxic and kill invaders (this is another type of t cells called cytotoxic t cell). Helper T cells are “helpers” in that they HELP the immune system by releasing cytokines, which help activate other immune system cells
The Human Immunodeficiency Virus (HIV) mainly attacks what type of cells in the human body?
A. Red Blood Cells
B. CD4 positive cells
C. Stem Cells
D. Platelets
B. CD4 positive cells
cardiac glycoside
- therapeutic range: 0.5-2.0
helps heart contract, slows heart rate, increases cardiac output , decreases preload, fluid retention decreased
dont use on patients w/ renal disease
hold if apical pulse < 60 bpm
Digoxin (Lanoxin)
You have a patient with RA. What interventions would you place?
rest between activities
ROM exercises
heating pads
anti-inflammatories, NSAIDS
You have a patient with RA, you want them to go exercise class. What kind of things would you want them to do prior?
suggest warm bath or shower
What would you teach a person who is newly diagnosed with herpes?
Safe sex practices
- can be transmitted through oral sex
stress management
- stress can bring on herpes
can lay dormant in the body for years
What assessment would you do for a patient with an anaphylactic reaction?
maintain airway
administer epinephrine
You are teaching a nurse methotrexate, what would you educate the nurse about this medication?
take blood pressure and pulse
used for ectopic pregnancies, eczema, RA, and crohn’s disease
blood test to detect various antibodies in bloodstream such as HIV antibodies
- considered more precise than ELISA
Western blot test
What is the enzyme-linked immunosorbent assay (ELISA) test used for?
To test the individuals blood for presence of antibodies to the HIV infection
How would you treat malignant melanoma?
Skin graft
subsequent treatment modalities
- chemo
- radiation
nonspecific immunotherapy
Anaphylaxis caused by hypersensitivity reaction is treated with…..
epinephrine, diphenhydramine, and steroids
What medications would be given to a patient dx with lupus?
Methotrexate
NSAIDS
hydroxychloroquine
corticosteroids
What can chlamydia cause?
infertility
What are s/s of ICP?
Decreased level of consciousness:
* LOC
* lethargy to coma
Cushing’s triad:
* Severe hypertension
* Widened pulse pressure
* Bradycardia
Abnormal posturing:
* Decerebrate
* Decorticate
Osmotic Diuretic
- inhibits reabsorption of water and electrolytes
Use: Cerebral edema, TBI, encephalitis
Adverse: Seizure, tachycardia, HF, Circulatory overload
Nursing Considerations:
- Check vitals ( for tachycardia)
- Monitor urine o/p (for dehydration)
- Monitor electrolytes (for electrolyte imbalance)
- BUN/Cr & liver panel
- May cause phlebitis at IV site
- Monitor neuro status
- Administer via a filter
Know it works when LOC, eye opening, urine o/p increase, & speech patterns all improve
Mannitol (Osmitrol)
sudden, progresses rapidly, critical
- Lumbar puncture (consent needed)
Important relationship between BP, pulse, & ICP (cushing’s triad)
S/s:
- Headache, light sensitivity/ pupillary changes (early)
- Change LOC/speech/vision (early)
- Cushing’s triad, change in vitals (late)
- Motor/sensory, Flaccid (unable to move) (late)
Clinical management:
- Semi-fowlers/ 30 degrees, straight alignment, comfortable
- Suction 10 seconds, Ataxic / Biot’s Breathing (unpredictable irregularity)
- increase fluids to increase perfusion
- Mannitol, Decadron (MS)
- avoid flexion of the hips, waist, neck and rotation of the head, enemas and laxatives, and valsalva maneuver
- administer oxygen via NC
Increased Intracranial Pressure (IICP)
What are some Dx tests for IICP?
MRI (tumors), CT (bleeding)
Skull X-ray (fractures, abnorm bone)
EEG (brain waves, seizures)
Brain biopsy (stages tumors)
lumbar puncture/ spinal tap (tests spinal fluid, infection/ diseases)
Steroid - glucocorticoid - long acting
Decrease inflammation
use: Cerebral edema, allergic reaction, MS, meningitis
Side effect: Hypokalemia, hypotension
Adverse: HF, thrombocytopenia, angioedema
Monitor Bs, mood, & s/s of cushing’s syndrome, poor wound healing, liver panel, lipid levels, and cholesterol
Decadron (dexamethasone)
chronic, progressive, degenerative neurological disorder
-cause is unknown (mostly genetic predisposition)
usually affect women ages 20-40
Myelin sheath damaged by immune system and nerve signal is disrupted (demyelination)
S/s:
- Blurred vision/ vision changes
- Tinnitus, decreased hearing
- urinary retention (Neurogenic incontinence, superpubic cath)
- Paralysis, muscle spams, weakness
- Speech/ swallowing issues (peg tube)
Dx based off Hx
- MRI of spinal cord and brain to reveal plaques that characterize
- No Cure
Multiple Sclerosis (MS)
What are nursing interventions for MS?
Encourage mobility (ROM exercises, PT/OT)
increase fiber, fruit/veg, well balanced diet
avoid breakdown, reposition q2h
balance rest/ exercise, stress reduction
Control environment (avoid hot baths & monitor for urine retention)
protect from opportunistic diseases (C-diff, pneumonia)
Copaxone, Flomax, Baclofin
“Brain attack” - medical emergency
- S/s appear suddenly
- occurs more in men
S/s:
- “worst headache ever” (Hemorrhagic)
- stiff neck (Hemorrhagic)
- loss of consciousness (Hemorrhagic)
- seizure (Hemorrhagic)
- depends on area affected (Ischemic)
- one sided weakness (unilateral; Ischemic)
- vision changes (Ischemic)
- confusion (Ischemic)
- headache (Ischemic)
- dysphagia (Ischemic)
2 types:
- Hemorrhagic: shows on CT
- Ischemic: does NOT show on CT
Tx:
- Monitor vitals, neuro assessment, and ask LKW
Stroke (CVA - Cerebrovascular Accident)
What are some diagnostic tests for a stroke?
CT (fastest, determines stroke type)
-w/o contrast
MRI, ECG/EKG
EEG (later)
Cerebral & carotid angiography
Blood studies (lipid, PT/INR)
Deficient blood flow to the brain from a partial or complete occlusion of an artery
Causes:
- Thrombotic (atherosclerosis; coagulation disorder/ chronic hypoxia)
- Embolic (thrombus is endocardial layer of heart; rheumatic heart disease)
treatment:
- Thrombolytics such as tissue plasminogen activator (tPA, alteplase; acute ischemic stroke)
- digests fibrin and fibrinogen and thus lyses the clot
- platelet inhibitors and anticoagulants given if stroke is caused by thrombus or embolus (ischemic stroke) to prevent more clots (must be given after 24hrs if treated with TPA)
Ischemic stroke
Results from bleeding into the brain tissue or subarachnoid space
- the bleed causes damage by destroying and replacing brain tissue
- aneurysm is often the cause
treatment:
- craniotomy: clipping the aneurysm/ removing the clot to prevent re-bleed
hemorrhagic stroke
Administered IV w/in 3hrs from onset stroke symptoms
breaks up clot causing stroke
- stronger than heparin
CT/MRI needed to confirm no hemorrhage exists in the brain
Bleeding precaution
Thrombolytic (t-pa)
What are s/s of left sided brain damage?
slow/cautious behavior
speech problems, aphasia
Difficulty following verbal commands
Apraxia
difficulty performing simple tasks
right sided hemiplegia
What are s/s of right sided brain damage?
Quick and impulsive behavior
Short attention span
Neglects left side
Easily distracted
left sided hemiplegia
Infection of meninges, membrane around the brain and spinal cord, caused by a virus or bacteria
Vaccine given to prevent infection in people “living in crowds”
- travelers, military, dorms, ect
S/s (sudden; early recognition):
- fever, cold hands/feet,
- rash, pale, blotchy skin
- v/, headache, confusion/ changed LOC
- stiff neck (chin tuck), severe muscle pain
- light sensitivity
Dx tests:
- Lumbar puncture (determines is bacterial or viral)
- CT/MRI (brain swelling, shows affect area, assesses for complications)
- Throat culture (detects/ identifies bacteria
Meningitis
What are two positive signs of meningitis?
Kernig’s sign
- resistance of leg while hip flexed 90 degrees then raise foot
Brudzinski sign
- Head to chest w/ knees flexed
Most severe form of meningitis
- medical emergency
Can have seizure or neurological defects
- show s/s of swelling on brain
person to person contacts / contagious
- droplet isolation
- enters through nose & pharynx
Tx:
- Droplet isolation
- prompt recognition
- broad spectrum antibiotics
Bacterial meningitis
Inflammation of the brain
- Usually viral - slower/ gradual onset
- resembles meningitis
- fatal if untreated
May be from HIV, ticks, mosquitoes, measles, pox or mumps
S/s:
- Neuro damage
- N/V/H/Fever
- Seizure, aphasia, paralysis
- stiff neck, muscle weakness
- Abd. pain
- Increased BP/ cushing’s triad
Tx:
- Safety precaution (increase seizure & fall risk)
- meds for comfort
- therapy to increase strength, speech & ADLs
- Monitor vitals & neuro status
Encephalitis
Sudden change in behavior d/t electrical hyperactivity in the brain
can lead to permanent neuro damage d/t depletion of O2 & glucose stored in the brain
Causes:
- Trauma, infection, epilepsy
- reduced cerebral perfusion
- Electrolyte disturbance ( hypoglycemia, acidosis, dehydration, metabolic panel)
- tumors, stress, drugs
- genetic tendencies
Dx:
- Rule out specific problems (aura)
- EEG (detects brain wave activity)
4 types:
- focal, generalized, acute symptomatic seizure, & unprovoked seizure
Anticonvulsant drug therapy
- DONT STOP TAKING MEDS
Seizure
Affects one area of the cortex affected during onset seizure
- most commonly occurs with epilepsy
Retained or impaired awareness
- may appear awake but usually do not respond to instructions or questions
Can tell when seizure is about to begin
- seizure typically lasts < 3 min
- Aura typically precedes the seizure
Focal Seizure
Affects the whole brain
- most common
- Loss of consciousness
tonic clonic
- fall/ slumped, stiffness, jerking, frothing, cyanosis
- post-ictal stage
- injury risk
- about 1 min long
Myoclonic
- brief jerking/ stiffness
Absent
- “staring spells”
- eye blinking, lip smacking
- 5-10 seconds long
Generalized seizure
Medical emergency d/t continuous seizure for over 30 min
- depletes O2 and glucose from the brain resulting in permanent brain damage
IV anticonvulsants, neuromuscular blocks or general anesthetics used to stop/ slow activity
Tx:
- resolve underlying cause
- dose of meds gradually increase until therapeutic level achieved
- Combination of anticonvulsants may be needed to help control activity
- DO NOT STOP TAKING (can lead to severe seizure activity)
- Ask when last seizure was
Management:
- safety precautions (do not leave client)
- padded side rails, side lying position
- move from harmful objects
- Remove loose fitting clothing, don’t restrain
- provide privacy, note time and duration
- provide education on stress, alc/caffeine, and meds (keppra, lorazepam, ect)
- if aura = find safe place
Status epilepticus
Inhibits seizure activity (antiseizure) - IV
- reduces pain
Use: generalized tonic-clonic seizures; status epileptic
Side effects:
- Hypotension
- Slurred speech
- Agranulocytosis
- Skin rash
- N/V/Constipation
adverse reactions:
- V-fib, bradycardia, cardiac arrest
- hepatitis
Interventions:
- Monitor BP & HR (report bradycardia)
- safety precautions (if Ataxic or drowsy)
Dilantin (phenytoin)
Antiseizure/anticonvulsant/mood stabilizer
- slows transmission of impulses in the CNS
- prevents seizure
- reduces pain
Use: tonic-clonic, complex-partial, mixed seizures
Side effects:
-Drowsy/ ataxia (lose muscle control)
- fluctuating BP
- HF, urine retention
- Rash, hepatitis
- Aplastic anemia (body stops producing new blood cells)
- Agranulocytosis
- Increased BUN
Adverse reaction:
- SJS
Interventions:
- Monitor BP
- Avoid Alc. and excessive sunlight
- Report fever, jaundice, bruising/ bleeding
Tegretol (carbamazepine)
antiseizure/ antipsychotic
- PO/IV
used to decreases seizure activity
- simple, complex, absent seizures
Side effects:
- Lethargy/ dizziness
- Ataxia (lose muscle control)
- Thrombocytopenia
- N/V/H, weight gain
- Tumor, Alopecia
Interventions:
- Monitor Blood work
- Safety precaution (if drowsy)
depakote (valproic acid )
Antiseizure/ Anticonvulsant - PO/IV
- stabilise electrical activity in the brain and prevent seizures
- Decreases severity and incidence of seizures
adverse reaction:
- hepatitis, SJS
Interventions:
- Safety precaution (if drowsy)
- Ask when last seizure was
- Interacts w/ other drugs
- No Alc.
- DO NOT STOP TAKING
- May alter RBC, WBC, and liver function
Keppra (levetiracetam)
Antiseizure/ Sedative/ benzodiazepines - PO, IM, IV
- Initial tx of epilepsy
Side effects:
- Resp. depression
- Hypotension
- Phlebitis
adverse reaction:
- ECG changes
- Tachycardia
- Apnea
- Cardiac arrest (IV, rapid)
Interventions:
- Safety precaution (if drowsy)
- Monitor for extravasation
- Monitor BP
Ativan (Lorazepam)
Antiseizure/ Sedative - IV
- can treat anxiety, muscle spasms, MS, CIWA and seizures
Side effects:
- Hypotension
- Blurred vision
Adverse reaction: Resp. depression
Interventions:
- Assess IV site
- Monitor vitals
- May go into alc./drug withdrawal
Diazepam (Valium)
MS agent given subq
action: modifies immune responses responsible for MS by serving as a decoy to local antibodies
Side effects:
- n/v/d
- blurred vision
- tachycardia
adverse reactions:
- laryngospasms
Glatiramer acetate (Copaxone)
Short term confusional state w/ sudden onset (reversible/ transient)
- disturbance in consciousness that impairs awareness of environment
Management:
- Treat cause
- infection give antibiotics, agitation give antipsychotics
- drug interaction = change med
- minimal stimulus
- family objects in room, keep same nursing staff (impaired cognition)
- Watch for electrolyte imbalance
- High BUN & Cr
Goals: Safety, comfort, decrease anxiety
Delirium
What are factors that contribute to delirium?
Infections:
- meningitis, encephalitis, HIV, UTI
- Bacteremia, septicemia
Cardiovascular disease:
- Hypovolemia, CHF
Metabolic conditions:
- Fluid / electrolytes, DM
- Hepatic/renal/pulm, failure
Vascular incidents:
- Stroke, chronic subdural hematoma
Trauma:
- Head injury, burns, hip fracture
The nurse is collecting data from a client, and the client’s spouse reports that the client is taking donepezil hydrochloride (Aricept). Which disorder should the nurse suspect that this client may have based on the use of this medication?
A. Dementia
B. Schizophrenia
C. Seizure disorder
D. Obsessive-compulsive disorder
A. Dementia
Which of these clinical observations should the UAP report to the LPN for a client with a brain tumor who is taking dexamethasone?
(Select all that apply)
A. Weight gain of 3 lbs since yesterday
B. Tremors and diaphoretic skin
C. Blood pressure change from 150/90 to 120/78
D. Complaints of a sore throat
E. Moist cough
A. Weight gain of 3 lbs since yesterday
D. Complaints of a sore throat
E. Moist cough
A student nurse was asked which of the following best describes dementia. Which of the following best describes the condition?
A. Memory loss occurring as part of the natural consequence of aging.
B. Difficulty coping with physical and psychological change.
C. Severe cognitive impairment that occurs rapidly.
D. Loss of cognitive abilities, impairing ability to perform activities of daily living.
D. Loss of cognitive abilities, impairing ability to perform activities of daily living.
WHEN CARING FOR A PATIENT AFTER A HEAD INJURY, THE NURSE WOULD BE MOST CONCERNED WITH ASSESSMENT FINDINGS WHICH INCLUDE RESPIRATORY CHANGES ALONG WITH WHAT OTHER FINDINGS?
A. HYPERTENSION AND TACHYCARDIA
B. HYPOTENSION AND TACHYCARDIA
C. HYPOTENSION AND BRADYCARDIA
D. HYPERTENSION AND BRADYCARDIA
D. HYPERTENSION AND BRADYCARDIA
Impaired ability to remember, think, or make decisions that interferes with doing everyday activities
- Not a part of normal aging
- Not a disease, but a clinical symptom
nursing interventions:
- Allow pt to perform what they can (impaired ADLs)
- High protein foods (inadequate nutrition)
- Keep awake during the day (sleep disturbances)
- Safe environment (potential injury)
- establish toilet schedule, or urinary intervention (urinary incontinence safety)
- Agitation may mean pain, hunger, stress, fear, or toileting
3 types:
- Alzheimer’s Disease (most common)
- Vascular dementia
- Lewy Body Dementia
Dementia
What are some dx associated with dementia?
TBI, subdural hematoma
Brain tumor
Neurosyphilis
AIDS
Treats symptoms of Alzheimer’s disease, seizures, and Afib - PO
- Mild to severe
Helps improve your attention, memory and ability to complete your daily tasks
Contradictions: Does Not prevent/ slow neurodegeneration by AD
Adverse:
- Bradycardia
Nursing considerations:
- Notify HCP if HR < 60bpm
Donepezil (Aricept)
Treats dementia associated w/ Alzheimer’s disease - PO
- Mod to Severe AD
Interventions:
- Monitor Ph of urine
Namenda (memantine)
protein hormone synthesized in the pancreas that regulates blood sugar
Rotate injection site to prevent lipohypertrophy & lipoatrophy
- DO NOT massage
- Heat & exercise increase absorption rate
lowers blood glucose
AKA “beta cells”
- acts as key that allows sugar into the cell
Insulin
Used when Blood sugar drops
AKA “alpha cells”
glucagon
Elevated BS (>100)
- occurs in type 2 DM
Can result from:
- Insufficient insulin production / secretions
- Deficient hormone signaling
- Excessive counterregulatory hormone secretion
S/s: (Think “FLUSHED”)
- F: Flushed skin/ fruit like breath (acetone)
- L: Listless/ lethargic
- U: Unusual thirst, hunger,urine o/p (3 p’s)
- S: Skin warm/ dry, poor wound healing
- H: hyperventilation (kussmaul RR - deep/rapid breathing)
- E: Emesis, increased N/V ( late findings)
- D: Drowsiness, decreased appetite (N/V)
Hyperglycemia
BS less than normal (<70)
- occurs in type 1 & 2
S/s:
- Tremors, tachycardia
- Clammy skin, cold
- Alt consciousness, irritability
- Hunger
- seizure/ stroke like s/s
- diaphoresis
- Apathy (severe lethargy)
Can result from:
- Insufficient intake
- Adverse reaction to meds
- Excessive exercise
Hypoglycemia
What are some diagnostic testing for diabetes?
Glucose screening:
- Fasting, GTT, Glycosylated hemoglobin (HgbA1c; below 7%)
Antibody testing:
-Glutamic acid decarboxylase (GAD- T1), C-peptide
lipid analysis:
- Triglycerides, HDL, LDL
Renal function tests:
- BUN/Cr, albumin in urine,
C-reactive peptide
DM dx test
level > 100 and < 126 is indicative of prediabetes of impaired fasting glucose
A level of 126 or higher on two separate occasions is indicative of diabetes
A random blood glucose measurement > 200 with s/s of diabetes is conclusive
Fasting glucose
DM dx test
Most sensitive measure of glucose metabolism
Can often detect early Diabetes
Glucose Tolerance Test (GTT)
DM dx test
Measures average blood glucose reading and estimates glucose control for the prior 3 months
A reading of 6.5% is indicative of diabetes
An A1c of 70% has been associated w/ reduced risk for complications of diabetes
- recommended goal for glucose control
Glycosylated hemoglobin (HgbA1c)
Most common Antibody test for type 1 DM
Glutamic Acid Decarboxylase (GAD)
Direct measure of insulin levels
CPT & fasting insulin may help determine quality of residual insulin prediction
C-peptide test
Made by body during times of stress/ infection
elevated in people w/ DM and associated w/ the inflammatory of insulin
lab value: < 1.0 mg/L
C- reactive protein (CRP)
List secondary preventions (screenings) used to detect complications in Diabetes:
A1C checked 2x/year
Annual renal function and lipid tests
Annual dental, foot, and eye exams
Used for low blood sugar between 55-69 mg/dL
have 15 grams of carbs and check your blood sugar after 15 minutes
If it’s still below your target range, have another serving
Repeat these steps until it’s in your target range.
15x15x15 rule
Chronic disorder characterized by impaired metabolism & vascular neurologic complications
Increase risk for heart disease, blindness, amputation, renal disease & pregnancy complications
Diet should be mix of carbs, proteins
& fats
Complex carbs prefered:
- Fruit/veg, wheat bread, ect
Check Bs before & after exercise
- DO NOT exercise during insulin peak (increases risk for hypoglycemia)
- Aerobic: Running, walking, swimming, biking
- Anaerobic: Weight lifting, yoga, ect
Diabetes
Insulin produced by own body
Type 2: inadequate endogenous insulin & the bodies inability to use insulin correctly
Endogenous insulin
Insulin obtained from other sources
- brings sugar into the body
Type 1: absence of endogenous insulin
Exogenous Insulin
Autoimmune process possibly triggered by viral infection, destroys beta cells (insulin)
- if sick, check BS q2-3hr, give insulin as scheduled & check urine (BS >200 breaks down ketones)
Affected people need exogenous insulin for life
Goal: Have controlled Bs
- BS 120-140 depending on person
S/s:
- Polyuria (dehydration/ hypovolemic shock)
- Polyphagia (no glucose for cell energy)
- polydipsia (d/t diuretics)
- Weight loss (10lb/week)
- weakness/fatigue
- Hyperglycemia/DKA
Type 1 DM
How do you manage Type 1 DM?
Med therapy:
- IV insulin drip (regular/short)
Nutrition therapy:
- Monitor calories & weight
Check BS before exercise
Manage stress/ acute illness
- increased BS d/t cortisone (counter reg. hormone)
Snack in middle of day and before bed to prevent BS from decreasing at night
Lispro (Humalog)
Aspart (Novolog)
Clear insulin; most common
Given before pt eats
Onset: 10-30 minutes
Peak: 2hrs
Duration 3-5hrs
Rapid insulin
Humulin R
Novolin R
Clear
Only insulin able to be administered by IV
- Takes longer to kick in
Onset: 30min-1hr
Peak: 2-3hrs
Duration: 5-8hrs
Short/ Regular insulin
Humilin N
Novolin N
Cloudy; roll to mix
Onset: 2-4hrs
Peak: 4-12hrs
Duration: 12-16hrs
Intermediate Insulin/ NPH
Glargine (lantus) - give seperatly
Detemir (levemir)
Clear; given in AM/PM
Onset: 1hr
Peak: N/A
Duration: up to 24hrs
Long acting insulin
What is the difference between Lipohypertrophy & Lipoatrophy?
Lipohypertrophy: Lumps/swelling under skin at insulin injection site
Lipoatrophy: Hollow/ pitting of subq tissue at insulin injection site
oral hypoglycemic that reduces hepatic glucose production and lowers fasting blood glucose levels
- initial treatment for T2DM
Does not cause hypoglycemia when used alone but increased risk when used with sulfonylurea d/t increase in insulin
Adverse reaction: Lactic acids
monitor for hypoglycemic reactions, renal studies, & CBC
BLACK BOX WARNING- Do not give w/ radiologic contrast (can lead to kidney failure & Lactic acids)
- HOLD MED 48hrs after contrast
Metformin (Glucophage)
oral hypoglycemic that stimulates the pancreas to secrete insulin lowering blood sugar by causing the release of your body’s natural insulin
- Piggy backed w/ metformin (increases risk of hypoglycemia)
Adverse reaction:
- Hepatotoxicity
- Jaundice
- Hypoglycemia
Assess for hyper/hypoglycemic reactions & monitor vitals
Can increase liver function and kidney function labs
Glipizide (Glucotrol XL)
- Class: sulfonylurea
oral hypoglycemic that assists the body to remove excessive glucose
- Decreases kidneys absorption of glucose, which promotes increase of glucose excretion in urine
Frequent urination, dizziness, or lightheadedness may occur
- get up slowly when rising from a sitting or lying position
Adverse reaction:
- signs of kidney problems
- Hyperkalemia
- increased LDL
- hypoglycemia
Monitor for DKA and Renal impairment
Empagliflozin (jardiance)
- Class: SGLT-2
oral hypoglycemic that works to lower blood sugar, helping the pancreas make more insulin, decreasing the amount of sugar
- Slows gastric emptying
Improves blood sugar levels and lowers the risk of major cardiovascular events for adults with type 2 diabetes with heart disease
- stroke, heart attack or death
Does NOT replace the need for insulin
Adverse reactions:
- pancreatitis/ severe abd pain
- Thyroid cancer
- Renal damage/ Jaundice
- Hypoglycemia
- Allergic reaction
Assess skin, renal studies & Bs
Semaglutide (Ozempic)
oral hypoglycemic that stimulates the pancreas to release insulin
- improves glucose homeostasis
DO NOT take if on insulin
adverse reaction:
- Acute renal failure
- UTI
- Pancreatitis (rare)
- Anaphylaxis
- increased liver enzymes
Sitagliptin (Januvia)
- Class: DPP-4
Individuals w/ impaired fasting glucose (Bs 100-126), impaired GTT or both
need to receive education on weight reduction and increase physical activity
Testing should begin at age 45 or sooner if symptoms appear
Prediabetes
anticoagulant found in blood and tissue cells
- IV
action:
- prevents conversion of fibrinogen to fibrin & prothrombin to thrombin (prevents clots)
use:
- prevention of treatment of DVT, PE,MI, and open heart surgery
adverse reaction: (bleeding)
- hematuria, hemorrhage
Heparin
Anticoagulant (blood thinner)
- PO
- vitamin K antidote
action:
- interferes with blood clotting
adverse effects:
- hematuria and hemorrhage
BBW: monitor for bleeding
Warfarin (Coumadin)
A hospitalized Patient is prescribed steroid medications (Prednisone) to treat their acute illness. This patient is NOT diabetic. Why is the patient prescribed insulin for elevated blood glucose levels?
The steroid raises Bs. The insulin is given to lower the Bs
What is the treatment for a patient who is nonresponsive, cool & clammy to touch, and a blood glucose level of 34?
Glucagon
NCLEX QUESTION
Insulin Glargine, is prescribed for a client with DM. The nurse tells the client that which is the best time to take the insulin?
A.) 1 hr after each meal
B.) Once daily at same time each day
C.) 15 min before breakfast, lunch, and dinner
D.) Before each meal on the basis of the blood glucose level
B.) Once daily at same time each day
Which term is used to describe speech impaired to the point that the person has almost no ability to communicate?
A.) Global aphasia
B.) Expressive aphasia
C.) Receptive aphasia
D.) Nonfluent aphasia
A.) Global aphasia
The nurse educates a client with diabetes on proper use of insulin glargine. The nurse determines further education is needed after which client statement?
A.) “I will rotate injection sites on my abdomen.”
B.) “I will use a sliding scale to determine my dose.”
C.) “I will throw out an opened vial after 28 days.”
D.) “I will keep my opened pen at room temperature.”
B.) “I will use a sliding scale to determine my dose.”
Explanation: Sliding scale doses of insulin are for short- or rapid-acting insulins only.Long-acting insulins like glargine are not dosed using a sliding scale
The nurse triages a client with a history of type 1 diabetes who reports abdominal pain, nausea, weakness, and thirst. Fruity odor on the client’s breath is noted. A bedside glucose check shows the client’s blood sugar is 323 mg/dL (17.9 mmol/L). The nurse prepares for which drug therapy?
A.) Insulin detemir
B.) Insulin degludec
C.) Regular insulin
C.) Regular insulin
The nurse receives a call from a client with type 2 diabetes. The client reports mid-morning blood sugars in the 60s for the last three days. Which oral antidiabetic medication is most likely causing this reaction?
A.) Sitagliptin phosphate, 100 mg, once per day
B.) Metformin, 1,000 mg, twice per day with meals
C.) Glipizide, 10 mg, daily 30 minutes before breakfast
C.) Glipizide, 10 mg, daily 30 minutes before breakfast
Explanation: Glipizide is a sulfonylurea oral antidiabetic medication that works by stimulating insulin release from the pancreas, reducing glucose produced by the liver, and increasing insulin sensitivity
The nurse cares for clients in a major stroke center emergency department. Which client with suspected ischemic stroke is a likely candidate for alteplase?
A.) The client is currently experiencing heavy menstruation
B.) The client presenting to the hospital five hours after symptom onset
C.) The client with a blood pressure reading of 205/112 mm Hg
D.) The client presenting following a serious motor vehicle accident
A.) The client is currently experiencing heavy menstruation
Explanation: There is no contraindication for alteplase therapy in women experiencing menstruation.
A client with diabetes type 1 is admitted to the emergency room with COVID-19-like symptoms. Which symptoms should the nurse report immediately?
Select all that apply.
A.) Blood glucose of 475 mg/dL
B.) Coughing and temperature of 99.8 F
C.) Deep rapid breathing
D.) Abdominal cramping
E.) ABGs with pH of 7.45
A.) Blood glucose of 475 mg/dL
C.) Deep rapid breathing
D.) Abdominal cramping
A patient has impaired glucose tolerance, high serum insulin hypertension elevated triglycerides low high density cholesterol and altered size and density of low density lipoproteins (LDL) cholesterol’s. Which disorder is associated with these characters?
A.) Retinopathy
B.) Neuropathy
C.) metabolic syndrome
D.) macrovascular syndrome
C.) metabolic syndrome
Life threatening emergency caused by insulin deficiency (acute onset: 4-10hrs)
- More common in T1DM but also seen in T2DM
Results in metabolism disorder of carbs, fats, & protein
- pt in state of metabolic acidosis
S/s:
- Kussmaul RR ( deep/rapid breathing)
- “Fruity” breath, polyuria
- Hypotension
- Hyperkalemia
Tx:
- IV fluids (Hydration; isotonic solution first)
- IV insulin drip until metabolic acidosis is corrected (regular/short acting)
- Electrolyte replacement
- Check Anion gap
DKA
How will labs look during DKA?
Blood Glucose: 300-500
Ketone +
Decreased Na, & increased K
Increased Anion gap
Ph: < 7.3 or lower
CO2: decreased
HCO3: < 15 or lower
Bs > 600 w/ no ketones
Occurs in T2DM d/t illness, infection, or being older age
Lack of insulin or inability to use available insulin can cause osmotic diuresis
Development of dehydration & hypernatremia
S/s:
- High sugar
- Increase fluid loss/ extreme dehydration
- Change in LOC, Confusion
- No ketones, no acid
- Slower onset & stable Potassium
Tx:
- Hydrate (isotonic solution then hypotonic)
- Stabilize sugars (IV insulin; short/ rapid)
- IV bolus, titration
- SubQ injection
Hyperosmolar Hyperglycemic Nonketotic Syndrome (HHNS)
