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202B > 202B Test #2 > Flashcards

202B Test #2 Flashcards

1
Q

what route should not be used when pt is on an anticoagulant

A

IM

you never give heparin IM but also don’t give other meds IM when they are anticoagulants

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2
Q

what should you assess with heparin infusions

A
  • if pt has any bleeding issues
  • compatibility
  • what to teach your pt
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3
Q

what are K-riders usually run at

A

generally run at 10mEq/hr

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4
Q

what is a possibility of a K-rider

A

cardiac dysrhythmias
so pts may need to have cardiac monitors on while recieving infusion
Burning at IV site- which is why it needs to be ran with a primary infusion

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5
Q

what is special about heparin and k rider infusions

A

it needs its own primary pump

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6
Q

what is the pre assessment

A
  • assess potassium levels
  • check IV site
  • any K+ sparing diuretics they are taking
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7
Q

what can you do to help with the burning sensation

A
  • may have to switch to PO
  • decrease IV rate
  • increase the amount of fluid running with K+ (need to ok with dr)
  • Ice/heat
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8
Q

why do we give insulin subQ

A

because the subQ tissue is less vascular and we want the insulin to metabolize slower

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9
Q

when would you use a 45 degree angle on sub Q injections

A

for a child or a thin person to insure you are not entering muscle

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10
Q

what is the usual angle of subQ injections

A

90 degrees

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11
Q

advantage of subQ injections

A
  • slow sustained and complete absorption
  • faster absorption
  • used for meds that are inactivated by the GI tract. allows them to bypass
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12
Q

Disadvantage of SubQ inj

A
  • discomfort

- various absorption rates- larger pt may have slower absorption than a thin person

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13
Q

what are common subQ inj

A

-all types of injections
-heparin and LMWH
-terbutaline
-immunizations
-colony stimulating factors
(epogen, darbepoetin, heupogen, neumega)

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14
Q

what are the subQ inj sites

A
  • abdomen
  • thigh
  • upper arm
  • upper buttocks
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15
Q

rate of absorption in abdomen

A

the fastest route of absorption

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16
Q

what is the slowest absorption for a subQ inj

A

upper buttocks and thigh

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17
Q

why is the upper buttock and thigh preferred for infants <12months

A

because they don’t have much muscle in the legs and buttock

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18
Q

what areas do you want to avoid with subQ inj

A
  • the umbilical region
  • areas of abnormal tissue
  • areas with burns, birthmarks, scars, inflammation
  • bruising
  • lipodystrophy
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19
Q

what is lipodystrophy

A

lipo formation associated with incorrect injection habits

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20
Q

what is the average volume for subQ inj

A

adult- up to 1mL

pediatrics- up to 0.5mL

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21
Q

average needle size for subQ injections

A

25-30guage

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22
Q

size syringe for heparin

A

1-3mL syringe

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23
Q

in addition to syringe with med, what else do you need to bring to the pt room

A

the medication vial to scan

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24
Q

after you remove the needle what do you want to do

A

cover the injection site with a guaze and apply gentle pressure.
Do NOT massage the site.

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25
Q

when giving a subQ injection what do you want to assess prior to giving the injection

A
  • assess the prior injection site
  • inspect selected site(make sure free of scar tissue, bruising, burns, birthmarks, etc)
  • assess pt anxiety
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26
Q

how is insulin measured

A

units only

why we need to use an insulin syringe

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27
Q

when is a sliding scale used

A 
typically AC(before meals)
and HS(at bedtime)
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28
Q

can a diabetic patient be on scheduled insulin and sliding scale

A

yes- most pts are on a long acting insulin daily and short acting doses before meals and at night

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29
Q

what are pre assessments of giving insulin

A
  • blood sugar level
  • where it was last given
  • what are their trends
  • are they going to eat soon
  • short acting or long acting insulin
  • check expiration date
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30
Q

what anticoagulant lab are you going to look at with heparin

A

PTT

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31
Q

how is heparin measured

A

in units but measured out in mLs- no rounding of doses

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32
Q

where should heparin and lovenox be administered

A

in the abdomen

  • it has faster absorption
  • hurst less
  • less chance of hematoma and hitting muscle
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33
Q

how do you assess effectiveness of enoxaparin

A

you want to look for signs and symptoms of bleeding

  • signs and symptoms of things we are trying to prevent such as TIA or DVT
  • you an look at their platelet , and H&H
34
Q

what are the reassessments for administering heparin or enoxaparin

A
  • calculations based on pts weight
  • hx of thromboembolic events
  • signs of bleeding
  • platelet counts
  • PTT for heparin
35
Q

what is a contraindications of heparin or enoxaparin injections

A 
-IM injections
it can cause a hematoma in pt. 
-severe hypertension 
-pregnancy
-hemorrhage
-hx of HIT
36
Q

how is PPN and TPN administered

A

either peripherally through IV pump and line

or centrally through a central line

37
Q

what assessments do you want to check prior to hanging TPN

A
  • monitor I&O
  • daily weight
  • labs-especially electrolytes
  • orders
  • MAR to make sure has correct components &rate
  • compare bag to flowsheet
  • make sure solution is refrigerated
  • inspect solution
38
Q

when should you pull out TPN bag out of fridge

A

30 minutes prior to admin

39
Q

what are you inspecting when looking at the TPN bag

A

for any sediment, cloudiness leaks, etc

40
Q

what are 2 main components you want to assess when hanging TPN

A
  • Assess the IV site for patentcy

- check blood sugars

41
Q

what is the difference between PPN and TPN

A

PPN- given peripherally, the concentration is <10% dextrose and <5% amino acids
<600mOsmol
TPN is more concentrated and is through a central line

42
Q

what does the patient have an increased risk for with PPN

A

-phlebitis

43
Q

what do you want to monitor with PPN and TPN

A

labs- electrolytes

K+, Na+ etc.

44
Q

what do you need to use with TPN and PPN

A

a filter device

45
Q

what is PPN used for

A

to increase volume
used to give them more than what IV fluids would give
it will maintain nutritional status
-used for short term

46
Q

how is TPN administered

A

via central line or PICC d/t the osmolarity (1500-2800mOsml/L)
to prevent phlebitis, infiltration etc.

47
Q

what is TPN used for

A
  • long term
  • for pts with large caloric and nutritional needs
  • someone who had GI sx and can’t use GI system for few days or has GI dysfunction etc.
48
Q

why do you need a filter when administering TPN/PPN

A

to reduce any particulate matter from infusing into the pt.

49
Q

why do we use a dark cover for TPN/PPN bags

A

light breaks down electrolytes in the feeding

50
Q

how are lipids administered

A

peripherally or centrally

51
Q

what is the only thing allowed to go through the TPN line

A

Lipids are the ONLY thing allowed to go through the TPN line (at the y site below the filter closest to the pt)
-if IV medications are needed a new IV site will be required

52
Q

why do you attach lipids to the y site closest to the pt

A

because you do not want the lipids to go through the filter

unless lipids are mixed in the TPN bag

53
Q

what allergies should you assess for when administering lipids

A
  • eggs
  • soy
  • soybean oils
54
Q

what do you want to monitor during TPN

A
  • vital signs-especially temp

- BS-checks, s/s of hyper/hypogclycemia

55
Q

what complications can happen during TPN/PPN admin

A
  • phlebitis w. peripheral sites
  • sepsis-d/t high glucose content
  • fluid overload
  • hyper/hypoglycemia
  • electrolyte imbalance
  • fatty acid deficiency
56
Q

why would hypoglycemia be a concern with TPN/PPN

A

because if feeding is stopped abruptly, the BG can drop (will occur about 30 min after cessation)

57
Q

what would you want to monitor for during TPN to assess for sepsis

A

-lookat site, monitor labs, and temp

58
Q

if your IV infiltrates and must be d/c’d and you have abruptly stopped the infusion what should you do next

A

-start a new IV to begin running infusion again

59
Q

if pt has elevated glucose of 165mg/dl and is on TPN what should you do

A

-check the sliding scale and administer insulin coverage

60
Q

what impact does TPN have on a diabetic pt

A
  • increased blood sugars

- may end up with insulin in the bag

61
Q

what are factors of diabetes

A

genetics
autoimmune
environmental

62
Q

how much insulin is produced per day by the pancreas

A

approx 40- 50 units /day

63
Q

what are triggers for type 1 diabetes

A

a viral or toxin that triggers the autoimmune reaction to stop producing insulin

64
Q

what are the 3Ps of DKA

A

polyphagia, polydipsia, polyuria

65
Q

what are s/s of type 2

A

may be very subtle or vague symptoms such as fatigue or infections and eventually the 3 Ps

66
Q

what ethnicity is more at risk for type 1 diabets

A

caucasians

67
Q

s/s hypoglycemia

A
  • cold/clammy skin
  • diaphoresis
  • pallor
  • rapid heart rate
  • anxiety
  • hunger
  • headache
  • nervousness
  • tremmors
  • slurred speech
  • vision changes
  • changes in LOC
  • Seizures/Coma
68
Q

what can s/s of hypoglycemia mimic

A

stroke or alcohol intoxication

69
Q

what should you do if someone is showing s/s of hypoglycemia

A

give them a snack with sugar and take their Blood glucose

70
Q

what are causes of hypoglycemia

A
  • too little food
  • too much diabetic med
  • too much exercise w/o food
  • alcohol intake w/o food
71
Q

what does alcohol due to blood sugar

A

inhibits glycogenolysis

72
Q

what are treatments for hypoglycemia

A

-give them simple carbs such as glucose or dextrose via PO or IV routes

73
Q

what is the goal of diabetes treatemetn

A

to have tight glucose control and prevent long term complications

74
Q

what labs would you look at in diabetes treatemetn

A
  • blood glucose
  • Hgb A1C,
  • fasting & post parandial glucose
  • renal function
75
Q

what is the #1 trigger of DKA

A

a viral infection/illness/stress

76
Q

what is osmotic diuresis

A

the pt starts to urinate a lot and lose a lot of electrolytes

77
Q

what does osmotic diuresis occur in

A

Diabetic Ketoacidosis

78
Q

what does an accumulation of keytones lead to

A

they accumulate in the blood and urine and lead to metabolic acidosis

79
Q

what are s/s of ketoacidosis

A
  • 3 Ps
  • lethargy
  • dehydration
  • abdominal pain
  • anorexia
  • vomiting
  • tachy
  • hypotension
  • kussmaul respirations
  • sweet fruity breath
80
Q

what is the first priority of diabetic ketoacidosis

A

Fluid Replacement!
then an insulin drip
and potassium replacement
and close glucose monitoring

81
Q

what are symptoms of hyperosmolar-hyperglycemic syndrome

A

-few early symptoms
-dehydration
-hypotension
-tachycardia
-altered LOC
LATE SIGNS
-neurologic impairment
-lethargy
-seizures
-hemiparesis
-aphasia
-coma

82
Q

what is the first priority of hyperosmolar hyperglycemic syndrome

A

Fluid replacement

usually with 0.45 or 0.9% NS to rehydrate

202B (10 decks)

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