314 Final Flashcards
What cells in the pancreas secrete glucagon and which ones secrete insulin
Alpha =glucagon
Beta = insulin
Where is glycogen broken down into glucose?
Liver
What is the key to the cell that lets in glucose and potassium
Insulin
What is a leading cause of blindness, ESRD, and amputations
Diabetes mellitus
What would the fasting glucose of 115 be considered
Pre diabetes
If you have gestational diabetes what are the risks
High risk of c section
Increase risk for neonatal complications
63% chance of developing type 2 diabetes within 16 years
Signs of hyperglycemia poly =more
Polyphagia
Polyuria
Polydipsia
Dry skin
Blurred vision
Delayed wound heal
Weak
What are signs of hypoglycemia remember TIRED
Tachycardia
Irritable
Restless
Excess hunger
Dizziness
Sleepy
Pallor/clammy
In general, would we rather have patients be high or low blood sugar?
High.
Hypoglycemia management rule of 15
Glucose <70 PO 15g fast acting sugar
Recheck in 15 min
If still low, treat again with 15g carbs and recheck 15 min later
Still low 2-3 times; contact physician
If a glucose is <40 what might be ordered
IV dextrose
(1 ampule of D50)
For inpatient settings at what level is hyperglycemia management usually started AND what is it
At 150. Insulin: short acting insulin (homologous/novolog)
Adjust basal-bolus regimen
(Basal =long acting insulin, bolus = short acting)
Why are clients generally taken off oral antidiabetic medications in an inpatient setting?
Because metformin doesn’t play well with contrast imaging and if they need to get that done and are on metformin, it will cause an issue/delay
If a patient is on an insulin pump upon admission, what do you do?
You do not use the pump if unfamiliar with it. Most patients with pumps are taken off pumps on admit and put on sliding scale insulin
What is Dawn Phenomenon
Blood sugar slowly rises throughout the night due to peaks of growth hormone = morning fasting hyperglycemia
What is somogyi effect?
Too much insulin Given or Insulin peaking at night which creates hypoglycemia = body over responding during the night to compensate resulting in hyperglycemia in early morning
If a patient is experiencing a Dawn phenomenon would they maybe need a little more or less insulin given at night
More
Patients with DKA are experiencing severe dehydration
Life threatening
Yep
Kussmauls respiration is a deep rapid respiration and associated with what
DKA
Compensation for metabolic acidosis
What’s treatment for DKA
Fluid replacement (usually includes K+)
IV insulin (always regular)
Hourly blood sugar checks
Monitor potassium levels (may have false elevated serum potassium)
Possible sodium bicarbonate to correct acidosis.
When treating DKA, what glucose measure would be appropriate to switch from IV insulin to SQ
About 200
Upper GI disorders affect what
Stomach and above. (Esophageal)
Explain GERD
Painful irritation and inflammation of esophagus from HCL acid and pepsin secretions leaking from a dysfunctional (relaxed sphincter between the stomach and intestines )
Acid reflux is due to a relaxed sphincter between where
Esophagus and stomach
S/s of GERD
Heartburn
Dyspepsia
Regurgitation
Chest pain (might feel like a heart attack)
Hoarseness and sore throat
Complications of GERD
Esophagitis —- long term can cause cancer (Barrett’s esophagus precancerous)
Dental erosion
Respiratory complications
How is GERD diagnosed
Barium swallow
Endoscopy
What drugs would be administered with Acid Reflux
PPI, histamine blocker,
GERD treatment
Lifestyle modification
PPI or H2 inhibitors (short term)
Cytoprotective= sulcrafate (coats stomach and protect it from the acid PO)
Prokinetics: promotes gastric emptying =metoclopramide
Antacids (short term)
Surgery- Nissan fundoplication
What is a hiatal hernia
Stomach protrudes into esophagus or through an opening in diaphragm
Complications of hiatal hernia
Lower esophageal Sphincter stenosis
Ulcerations
Strangulations of hernia.
Gastritis (very common inflammation of gastric mucosa) can be caused by what?
Acute: (NABS); nsaids, acid/alkali ingestion, bacteria [salmonella].
Chronic: autoimmune, H.Pylori
Complications of gastritis
Pernicious anemia due to absorb cobalamin r/t loss of intrinsic factor.
Erosive ulcers: due to extensive gastric mucosal wall damage.
Treating gastritis
Hydration (Iv if unable to tolerate PO fluid)
Antiemetics
Eliminate cause.
-——
NPO diet, advance as tolerated
H2 antagonists (-tiding), PPI (prazole), antacids, prostaglandins.
PUD causes
H. Pylori
NSAIDs, Aspirin(ASA)
Stress
Ulcers are identified based on location. What differentiates gastric from duodenal
Gastric= pain 30-60 min after meal, malnourished,hematemesis (bright red blood or coffee grounds blood in vomit)
Duodenal= pain 1.5- 3hr post meal, awakening at night with pain, well-nourished, melena (dark tarry stools).
H. Pylori treatment meds
PPI
Amoxicillin
Clarithromycin.
Complications of PUD
Pernicious anemia
Hemorrhage
Perforation
Gastric outlet obstruction (inflammation of tissues blocking food getting out of stomach)
Tx for PUD
No NSAID
Medications to reduce acids (similar to GERD)
Antibiotics for h pylori
Surgery if severe- gastrectomy.
What are pre and post procedure guidelines for EGD (endoscopy)
Pre:
NPO for 6-8 hrs
No red dyes.
Post:
Monitor VS and airway
Sore throat, hoarseness to be expected.
What is a barium swallow used for
Diagnose hiatal hernia, strictures or structural abnormalities.
What can be a complication of a barium swallow that is reduced by administration of post procedure stool softener and laxatives
Failure to eliminate barium places client at risk for fecal impaction
Crohn’s disease is an inflammation of any segment of GI tract from mouth to anus but usually in the bowels
Yep
S/s of crohns
Diarrhea, cramping, weight loss.
Tx for Crohns
Meds: anti inflammatory, corticosteroids, immunosuppressants (potential high risk for infection with these)
-most require surgery: colectomy, repairing fistula, strictures (narrowing of irritated bowel)
Explain Ulcerative colitis
Inflammation and ulceration of colon and rectum. Affects mucosa and submucosal layers
Ulcerative colitis complications
Can lead to bowel obstruction
Mucosal changes can lead to colon cancer, pernicious anemia
Ulcerative colitis symptoms
Bloody diarrhea and pain
Mucus in diarrhea sometimes
Medications for ulcerative colitis
Anti inflammatories, corticosteroids, immunosuppressants (puts them at higher risk for infection)
Diverticulitis develops from what.
Diverticulosis.
Tx for diverticulitis
Antibiotics
Diet is low fiber during and after it is resolved high fiber.
Avoid inflammatory foods
Hydrate!!
Possible surgery: colon resection with or without osteomyelitis placement.
What is a risk that you should be aware could happen to patients with diverticulitis
Ruptured diverticula= contents emptying into peritenium (abdominal cavity)
Manifestation of celiacs
Steatorrhea -fatty stool?
Foul smelling diarrhea
Flatulence, abdominal distention, malnutrition
Dermatitis herpetiformis- itchy vesicular rash
Peritonitis is what and caused by what
Medical emergency
Life threatening inflammation of the peritoneum and lining of the abdominal cavity often due to bowel perforation
Can also be caused by
Peritoneal dialysis
Perforated diverticula
Ruptured appendix
surgery
Rigid abdomen, sudden severe upper abdominal pain that spreads and radiates to the back could be a sign of what
Bowel perforation
Rigid board like abdomen, abdominal distention, rebound tenderness, tachycardia, fever, nausea and vomiting can signify what condition
Peritonitis.
Interventions for peritonitis
Semifowlers
NPO
Ensure O2 take vitals
Admin antibiotics, fluids and electrolytes if ordered
Prepare for surgery.
What is a Cullens sign?
bruising around belly button
Sign of internal bleeding
What is grey turners sign
Bruising of flank. Sign of internal bleeding
Small bowel obstruction can present as what kind of acid base imbalance
Metabolic alkalosis
A patient has an intestinal obstruction, what are the nursing interventions
Bowel rest: NPO, NG placement to LIS(low intermittent suction)
Fluid and electrolytes
Surgery may be necessary
Encourage ambulation
Gold standard for NG tube placement confirmation
X-ray
After PO medication administration through an NG tube, what is next step
Clamp NG tube 30-45 minutes so you don’t suction meds right out.
A patient with toxic megacolon is at an increased risk for what
Bowel perforation
Colonoscopy should be done at what age and how often
45, every 10 years
What is pre and post procedure guidelines for colonoscopy
Pre:
Bowel prep night before
NPO after prep is complete
post:
Monitor for rectal bleeding
Resume normal diet, encourage fluids
C diff is what precaution
Contact isolation and bleach wipes.
When treating c diff , what beside antibiotics is given
Lactobacillus
If stool is formed, it is most likely not c diff
Yep
Dumping syndrome is what
Rapid movement of food through digestive tract.
Early manifestations of dumping syndrome
Within 30 minutes of eating
S/s - nausea, sweating, dizziness, tachycardia, palpitations.
Diarrhea—- malnutrition
Dumping syndrome interventions
Low Fowler after eating for 30 minutes to delay gastric emptying
Avoid triggers( high sugar high carb foods)
Consume small frequent meals
Monitor fluid and electrolyte balance
Patients with an Ileostomy are at a higher risk for dehydration why
Most liquid is absorbed in the large intestine and the ileum is in the small
When do you empty the ostomy bag
1/4-1/2 full.
Patient education for ostomies
Diet modification depending on where the stoma is.
Burp bag
Support group
Stoma specific products being used.
Pyloric stenosis risk factors
Male
White
Family history
3-6 weeks old
Pyloric stenosis signs
Forceful Projectile vomiting of infant
Intussusception is when the bowel folds on itself and what hallmark signs
Red currant jelly stool
Abdominal distention
Abdominal pain intermittent
In school age children
Treatment of intussusception
Enema
Hirschsprungs disease aka congenital megacolon might be a concern if what is observed
No bowel movement within first 48 hrs of life.
Infant reflux does not require medications
True.
Smaller frequent feed
Upright during and after feeds
Loose diapers
Acid reducers are not helpful for infants.
Pathological jaundice might be suspected if what signs are present besides normal expected elevated serum bilirubin that is indicative of physiological jaundice
Signs of bleeding
Weight loss
Dehydration
Lethargy
Abnormal tone and seizures ( indicating brain damage)
Hepatosplenomegaly
Priority intervention for dumping syndrome?
Monitor blood glucose levels
Priority Actions to take for a patient with a small bowel obstruction who is vomiting
NG tube insertion
Ondansetron
