325 e 2 Flashcards
process of regulating the ECF volume, body fluid osmolality, and plasma concentrations of electrolytes
fluid and electrolyte balance
keeps the volume, osmolality, and electrolyte concentrations of fluids in body fluid areas within the normal range
optimal fluid and electrolyte balance
intake and absorption of F and E matches the output of fluid
optimal balance
major ECF cation
sodium
135 to 145
sodium range
present in most body fluids or secretions
sodium
major role in maintaining the concentration and volume of ECF
sodium
essential for maintence of acid base and fluid
sodium
maintenance of active and passive transport mechanisms, and irritability and conduction of nerve and muscle tissue
sodium
3.5 to 5
POTASSIUM
vital role in cell metabolism and transmission of nerve impulses
potassium
helps with functioning of cardiac, lung and muscle tissues and acid base balance
potassium
reciprocal action with sodium
potassium
major ICF cation and major factor in resting membrane potential of nerve and muscle cells
potassium
cause clinical problems
potassium changes
moves fluid into cell
hypotonic
moves fluid out of cell
hypertonic
equal balance…dont effect cell fluid shifts
isotonic
infants and old people
RF for imbalances
impaired ability to conserve water(less lean muscle mass); blunted thirst sensation; decreased renal reserve(less able to respond to ADH)
older population and imbalances
immature kidneys and large surface area of skin and lungs
infants and imbalances
high metabolic rate and large exchange ratio making RR increase
infants and imbalances
vomiting, diarrhea, malabsoprtion, fever, inadequate or excessive intake of F or E
RF for fluid and electrolyte distrubances(conditions)
diurtetics, laxatives, antacids, corticosteroids, IV fluid infusion, blood transfusion
RF for fluid and electrolyte disturbances(ADR)
hemorrhage, burns, crush and head injury, pancreatitis, kidney injury
RF for fluid and electrolyte disurbances(acute med conditions, injury or trauma)
heart failure, DM, cancer, oliguria renal disease, liver disease, alcoholism, eating disorders(anorexia nervosa, bulimia)
RF for fluid and electrolyte disturbances(chronic med conditions)
old(reduced kidney function and over dose of fluids (oral, enteral, IV))
hypervolemia RF
provides energy for cell metabolism, tissue maintence and repair
nutrition
give energy for organ function, growth and development, and exercise
nutrition
water is the most basic _____
nutrition
water
needed for all body fluids and cell functions
water
science of optimal cellular metabolism and impact on health and disease
nutrition
sum of processes where one takes in and uses nutrients
nutrition
SES and race
nutrition RF
very young and very old
nutrition RF
pregnancy, young, old, preemie, institutionalized old ppl
nutrition RF (age)
vit D DEFICIENT in hispanic and AA
nutrition RF(race)
type 2 DM in hispanic, NA and AA
nutrition RF(race)
IN WHITES…TYPE 1 DM, CELIAC DISEASE, MS, HUNNINGTONS DISEASE
NUTRITION RF(RACE)
low SES for malnutrition bc of food insecurity/availability)
nutrition RF(poor and underserved)
low SES bc of lack of access, insufficient funds, distance to markets, limited food prep options, high prices, and cheap prices
nutrition RF(poor and underserved)
genes, lifestyle, inconsistent eating patterns, poor food choices
nutrition RF
IMPAIRED ORAL INTAKE, IMPAIRED DIGESTION AND ABSOORPTION, AND INCREASED METABOLIC DEMAND
nutrition RF
starvation RT, chronic diseases RT, acute disease RT
3 causes of malnutrition
common sequence of illness, surgery, and hospitalization
malnutrition
NUTRITIONAL INTAKE IS PART OF
A HISTORY TO SEE IF SOMEONE IS HAVING INADEQUATE NUTRITION
DIET RESTRICTIONS ARE PART OF
A HISTORY TO SEE IF SOMEONE IS HAVING INADEQUATE NUTRITION
CHANGES IN APEPTITE AND INTAKE ARE PART OF
A HISTORY TO SEE IF SOMEONE IS HAVING INADEQUATE NUTRITION
CHANGES IN WEIGHT ARE PART OF
A HISTORY TO SEE IF SOMEONE IS HAVING INADEQUATE NUTRITION
MED HISTORY IS PART OF
A HISTORY TO SEE IF SOMEONE IS HAVING INADEQUATE NUTRITION
CURRENT MED CONDITIONS ARE PART OF
A HISTORY TO SEE IF SOMEONE IS HAVING INADEQUATE NUTRITION
CURRENTS MEDS AND TREATMENTS ARE PART OF
A HISTORY TO SEE IF SOMEONE IS HAVING INADEQUATE NUTRITION
ALLERGIES ARE PART OF
A HISTORY TO SEE IF SOMEONE IS HAVING INADEQUATE NUTRITION
FAMILY HISTORY ARE PART OF
A HISTORY TO SEE IF SOMEONE IS HAVING INADEQUATE NUTRITION
SOCIAL HISTORY are part of
A HISTORY TO SEE IF SOMEONE IS HAVING INADEQUATE NUTRITION
chief complaint/presenting symptoms are
exam findings TO SEE IF SOMEONE IS HAVING INADEQUATE NUTRITION
general observations are
exam findings TO SEE IF SOMEONE IS HAVING INADEQUATE NUTRITION
anthropomorphic measurements are
exam findings TO SEE IF SOMEONE IS HAVING INADEQUATE NUTRITION
nausea, vomit, diarrhea are
expected findings TO SEE IF SOMEONE IS HAVING INADEQUATE NUTRITION
constipation, flaccid muscles, and mental status changes are
expected findings TO SEE IF SOMEONE IS HAVING INADEQUATE NUTRITION
loss of appetite, change in bowel patterns, and poor dental health are
expected findings TO SEE IF SOMEONE IS HAVING INADEQUATE NUTRITION
change in bowel patterns and spleen/liver enlargement are
expected findings TO SEE IF SOMEONE IS HAVING INADEQUATE NUTRITION
DRY, BRITTLE HAIR AND NAILS ARE
expected findings TO SEE IF SOMEONE IS HAVING INADEQUATE NUTRITION
LOSS OF SUBQ FAT IS
expected findings TO SEE IF SOMEONE IS HAVING INADEQUATE NUTRITION
DRY, SCALY SKIN AND INFLAMMATION OF GUMS ARE
expected findings TO SEE IF SOMEONE IS HAVING INADEQUATE NUTRITION
dry, dull eyes and enlarged thyroid are
expected findings TO SEE IF SOMEONE IS HAVING INADEQUATE NUTRITION
prominent protrusions in bony prominences are
expected findings TO SEE IF SOMEONE IS HAVING INADEQUATE NUTRITION
weakness and fatigue are
expected findings TO SEE IF SOMEONE IS HAVING INADEQUATE NUTRITION
changes in weight and poor posture are
expected findings TO SEE IF SOMEONE IS HAVING INADEQUATE NUTRITION
anorexia nervosa, binge eating disorder, and bulimia nervosa are
expected findings TO SEE IF SOMEONE IS HAVING INADEQUATE NUTRITION
LBW and fears being fat is
anorexia nervosa
sees self as fat and restricts food and not gain weight is
anorexia nervosa
repeated episodes of eating and when overweight/obese are signs of
binge eating disorder
episodes from 1-14+ times in a week are signs of
binge eating disorder
doesnt use purging and feels a loss of control when eating then has guilt, shame, or depression are signs of
binge eating disorder
cycle of binge eating then purging and lack of control during binges are
bulimia nervosa
avg of at least one cycle of binge eating and purging per week for at least 3 months
bulimia nervosa
inadequate intake and impaired nutrient absorption are
insufficient nutrition
ineffective nutrient utilization is
insufficient nutrition
insufficient nutrition leads to
malnutrition
associated with insufficient calorie intake(weight loss and not enough nutrients)
malnutrition
anorexia nervosa correlates to ___ malnutrition
starvation RT
burn injury or trauma correlates to _____
acute disease RT malnutrition
sarcopenic obesity or pancreatic cancer correlates to ______
chronic disease RT malnutrition
assist in advancing the diet as prescribed is a
nursing interventions for optimizing nutrition
instruct cts about the app diet regimen is a
nursing interventions for optimizing nutrition
provide interventions to promote appetite(good oral hygeine, fav foods, minimal odors) is a
nursing interventions for optimizing nutrition
edu cts abt meds that affect nutritional intake is a
nursing interventions for optimizing nutrition
assisting cts with feeding to promote optimal independence is a
nursing interventions for optimizing nutrition
individualize menu plans according to cts preferences is a
nursing interventions for optimizing nutrition
assisting with aspiration is a
nursing interventions for optimizing nutrition
position in fowlers position and support upper back/neck/head are
ways to prevent aspiration
avoid straw use and cts tuck chin are
ways to prevent aspiration
observing for indications of dysphagia is a
way to prevent aspiration
coughing, choking, gagging, and food drooling
dysphagia
keep the cts in semi fowlers 1 hour after a meal is
a way to prevent aspiration
providing oral hygiene after meals and snacks is
a way to prevent aspiration
provide therapeutic diets is a
nursing intervention to optimize nutrition
administering and monitoring enteral feedings by NG, gastrostomy, or jejeunostomy tubes are a
intervention to optimize nutrition
administering and monitoring parenteral nutrition to cts who are unable to use their GI tract to eat is a
intervention to optimize nutrition
lipids, electrolytes, minerals, vitamins, dextrose, and amino acids are
parenteral nutrients
maintaining a fluid balance is a
intervention to optimize nutrition
administering IV fluids and restricting oral intake and encourage oral intake of fluids are
way to maintain fluid balance
removing water pitcher from bedside is
restricting oral intake
informing the dietary staff of the amt of fluid to serve with each meal tray is
restricting oral intake
inform the staff of each shift of the amt of fluid cts may have in addition to what they get at meals is
restricting oral intake
RECORD ALL ORAL INTAKE AND INFORM THE FAMILY OF RESTRICTION IS
restricting oral intake
provide fresh drinking water is
a way to encourage intake of fluids
remind and encourage a consistent fluid intake is
a way to encourage intake of fluids
ask about beverage preferences is
a way to encourage intake of fluids
HEALTHY EATING AND PHYSICAL ACTIVITY ARE
PRIMARY PREVENTION TO OPTIMIZE NUTRITION
SCREENING FOR DISEASE AND NUTRITIONAL STATUS ARE
SECONDARY PREVENTION TO OPTIMIZE NUTRITION
LIPID AND BLOOD GLUCOSE SCREENING ARE
SECONDARY PREVENTION TO OPTIMIZE NUTRITION
CHECK BMI IS A
SECONDARY PREVENTION TO OPTIMIZE NUTRITION
DOING LABS OF ALBUMIN, PREALBUMIN AND C REACTIVE PROTEIN ARE
SECONDARY PREVENTION TO OPTIMIZE NUTRITION IF POOR STATUS EXISTS
DOING LABS FOR HBA1C AND BLOOD GLUCOSE AND ELECTROLUTES ARE
SECONDARY PREVENTION TO OPTIMIZE NUTRITION IF POOR STATUS ALREADY
DOING LABS FOR HB AND HEMATOCRIT AND LIPID PROFILE IS
SECONDARY PREVENTION TO OPTIMIZE NUTRITION IF POOR STATUS ALREADY
GLUCOSE LEVELS, FINDING METABOLIC DISORDERS, AND LOOKING FOR CONGENTITAL FACTORS ARE
think infants and prevention
SECONDARY PREVENTION TO OPTIMIZE NUTRITION IN INFANTS
DIETARY INTERVENTIONS, PAHARMACOLOGICAL AGENTS, AND SURGICAL INTERVENTIONS ARE ALL
COLLABORATIVE INTEREVENTIONS TO OPTIMIZE HEALTH
MEDICAL NUTRITION THERAPY ADN DIETARY SUPPLEMENTS ARE
DIETARY INTERVENTIONS
BASIC THERAPEUITIC DIETS AND TUBE FEEDING/ENTERAL NUTIRITION ARE
DIETARY INTERVENTIONS
PERENTERAL NUTRITION IS A
DIETARY INTERVENTION
LOW SALT AND LOW FAT ARE
BASIC THERAPEUTIC DIETS
CALORIES REDUCTION AND FIBER SONCUMPTION ARE
BASIC THERAPEUTIC DIETS
WEIGHT LOSS MEDS ARE
PAHARMACOLOGICAL AGENTS
ANTILIPID AGENTS ARE
PAHARMACOLOGICAL AGENTS
MICRONUTRIENT SUPPLEMENTS ARE
PAHARMACOLOGICAL AGENTS
parenteral nutrition is a
PAHARMACOLOGICAL AGENT
bariatric surgery and common complications are
surgical interventions
bariatric surgery can be
nonmalabsorptive or malabsoprtive procedures
surgical complications and nutrient deficiencies are
common complications
assessment, feeding dependent pt assistance, and seeing red flags are
nursing skills RT nutrition
refer to a ____ when you see red flags
RDN
pressure ulcers and weight loss are
red flag ass with nutrition
inadequate oral intake or appetite changes are
red flag ass with nutrition
NPO or nausea are
red flag ass with nutrition
needs to happen within 24 hours of admission
nutrition screening
body composition changes like weight loss and strength loss are signs of
malnutrition
serum protein an electrolyte levels are used in conjunction with a physcial exam when diagnosing _______
malnutrition
achieve an ideal body weight, consume a number of calories, and have no adverse consequences are
goals for pt with malnutrition
impaired nutritional status and fluid balance are
how to care for pt with imbalanced nutrition
risk for impaired tissue integrity and impaired nutritional intake are
how to care for pt with imbalanced nutrition
no added salt or 1 to 2 g sodium
low sodium diet
liquids that leave little residue(clear fruit juice, gelatin, broth)
clear liquid diet
clear liquids plus liquid dairy products, all juices. some facilities incl. purred veggies
full liquid diet
a nurse is caring for a ct who is at high risk for aspiration. what should the nurse do?
instruct the ct to tuck their chin when swallowing
what gives the most energy to the body?
carbs
a pt is on a low residue diet…they will eat what?
vanilla custard not veggies
older pts nutritional needs and considerations are what?
older adults are more prone to dehydration
older pts nutritional needs and considerations are what?
many need calcium supplements
older pts nutritional needs and considerations are what?
older adults need the same amount of vitamins and minerals as young people
directly delivered into the GI tract, bypassing the oral cavity is an
enteral feeding indications
not able to swallow but has an intact GI tract is an
enteral feeding indication
=
kilocalories and the roles in nutrition/mal
fats, vitamins and carbs are
kilocalories
proteins, minerals and water are
kcal
what is critical for cell function and replaces fluids the body loses?
water
what helps complete essential biochemical reactions in the body (K, Na, Fe, Ca)?
minerals
what is neccessary for metabolism and fat/water soluble?
vitamins
what is necessary for metabolism and fat/water soluble?
vitamins
what are the fat soluble vitamins?
A,D,E,K
contribute to growth, maintenance, and repair of body tissues.
proteins
each gram produces 4 kcal
proteins
sources of complete ____ are beef, whole milk, poultry
proteins
provide energy and vitamins
fats
no more than 35% of calories
fat
produces 9kcal per gram
fat
olive oil, salmon, egg yolk
fat sources
most of the body’s energy and fiber
carbs
produces 4kcal per gram
carbs
provide glucose
carbs
whole grain bread, baked potatoes, brown rice, plant foods
carb sources
burns completely and efficiently without prodtucts to excrete
glucose
anorexia, bulimia, and fat malabsorption syndrome
conditions ass with insufficient nutrition
protein calorie malnutrition, vit deficiencies, and zinc deficiency
conditions ass with insufficient nutrition
these are the kcal energy containing nutrients(carbs, fat, proteins)
macronutrients
cant support or maintain body functions and not a macronutrient
alcohol
in ____, an anadequate intake of protein and kcal(marasmus) impairs growth and fevelopment, stunts height and brain development
kids
primary source of fuel and energy
carbs
facilitates growth and repair of tissues; energy source
protein
source of fatty acid, needed for growth and development; energy
fat
a, d, e, k
fat soluble vitamins
c, b, thiamin, riboflavin
water soluble vitamins
niacin, pyridoxine, pantothenic, biotin
water soluble vitamins
folate and cobalamin
water soluble vitamins
ca, phosphorus, Mg, Na, K, Cl
major minerals
lack of adherance to diet and guidelines
bariatric surgery RF
limited knowledge of actual needs
bariatric surgery RF
weight gain if noncompliant to calorie intake
bariatric surgery RF
insulin lowers blood glucose and stabilizes glucose range
glucose regulation
euglycemia, hyper and hypoglycemia are
cat of glucose regulation
process of maintaining optimal blood glucose levels
glucose regulation
cell use of glucose for energy (ATP synthesis)
end result of glucose metabolism
age and pregnancy
glucose regulation RF
race and genes and lifestyle are
glucose regulation RF
fam history and certain meds
glucose regulation RF
virus and toxins are
glucose regulation RF for type one DM
islet cell autoantibodies for beta cell destruction
glucose regulation RF for type one DM
pancreas can not make enough insulin to maintain normal glucose
glucose regulation RF for type one DM
lack of exercise and overweight are
glucose regulation RF for type two DM
being older and family history are
glucose regulation RF for type two DM
insulin resistance is type __ of DM
2
more prevelant in AA, asians, hispanics, native hawaiins, NA
type 2 DM
marked decreased in the ability of the pancreas to make insulin is
type 2 DM
inappropriate glucose production by the liver is
type 2 DM
altered production of hormones and cytokines by adipose tissue relates to
type 2 DM
brain, kidneys, and gut have roles in development of
type 2 DM
state of insufficient or low blood glucose levels and below 70
hypoglycemia
state of elevated blood glucose levels and more than 100 in fasting and more than 140 in nonfasting
hyperglycemia
lispro(humalog) is a ____ acting insuline
rapid
regular/humulin R is a ___ acting insulin
short
NPH / Humulin N is a ___ acting insulin
intermediate
reduced cognition and tremors are signs of
hypoglycemia
diaphoresis and seizure are signs of
hypoglycemia
irritability and headache are signs of
hypoglycemia
weakness and hunger are signs of
hypoglycemia
diaphoresis is a sign of
hypoglycemia
polyuuria ad polydispia are signs of
hyperglycemia
dehydration and fatigue are signs of
hyperglycemia
fruity smelling breath and kussmal breathing are signs of
hyperglycemia
weight loss and hunger are signs of
hyperglycemia
poor wound healing is a sign of
hyperglycemia
70-140 is the range for
euglycemia
LT 70 is the range for
hypoglycemia
severe hypoglycemia is LT __
50
severe hyperglycemia is GT
180
4-6 or 6.5 to 8.5 with a target goal of LT 7%
A1C reference range
fasting plasma glucose level is
GT 126 mg/dL
casual plasma glucose levels are
GT 200 mg/DL
casual glucose levels are often ass with
polyuria, polydispia, and sudden weight loss
the range for the oral glucose tolerance test is
GT 200mg/dL
with the oral glucose tolerance test, you give ____
75 g of oral glucose and then check BG after 2 hr
A1C is diagnosed at GT ___
6.5%
the blood glucose target for preprandial plasma glucose is
70-130 mg/dL
the blood glucose target for postprandial plasma glucose is
the blood glucose target for bedtime plasma glucose is
100-140
the blood glucose target for HBA1C is
nervousness and muscle tremors are
consequences of hypoglycemia
normal hydration and irritability are
consequences of hypoglycemia
no ketones and blurred vision are
consequences of hypoglycemia
diaphoresis and hunger are
consequences of hypoglycemia
anxiety and palpitations are
consequences of hypoglycemia
weakness and dizziness are
consequences of hypoglycemia
headache and tachycardia are
consequences of hypoglycemia
no RR change and seizures are
consequences of hypoglycemia
neurological changes are
consequences of hypoglycemia
shaking and coma are
consequences of hypoglycemia
confusion and clamminess are
consequences of hypoglycemia
difficulty concentrating and unconsiousness are
consequences of hypoglycemia
death and being cool are
consequences of hypoglycemia
dehydration is a a
short term consequences of hypoglycemia
end organ disease due to microvascular damage is a y
long term consequences of hypoglycemia
macrovasucular angiopathy is a
long term consequences of hypoglycemia
peripheral neuropathy is a
End-organ disease due to microvascular damage
retinopathy is a
■ End-organ disease due to microvascular damage
nephropathy is a
■ End-organ disease due to microvascular damage
hypertension is a
■ Macrovascular angiopathy
cardiovascular and peripheral vascular disease are examples of
■ Macrovascular angiopathy
symptoms ass with dehydration or acidosis are
consequences of hyperglycemia
mental status is a
consequences of hyperglycemia
skin being warm and moist are
consequences of hyperglycemia
alert to confused and coma, esp. in untreated in ketoacidosis is
mental status
nausea and vomit are
■ Symptoms ass with dehydration or acidosis
ab cramps and fatigue are
■ Symptoms ass with dehydration or acidosis
excessive thirst(polydispia) and polyuria are
■ Symptoms ass with dehydration or acidosis
ketones and excessive hunger (polyphagia) are
■ Symptoms ass with dehydration or acidosis
wash and dry hands completely. not needed to clean the site with ETOH…will interfere and increase results
glucose regulation ct teaching
hard to get blood? warm hands and let arms dangle to get blood
glucose regulation ct teaching
lance the side of finger(fewer nerves)
glucose regulation ct teaching
record results and compare to personal blood glucose goals
glucose regulation ct teaching
brisk walking can do glucose reducing effects you need
glucose regulation ct teaching (exercise)
choose exercise that is enjoyable
glucose regulation ct teaching (exercise)
use proper fitting footwear to avoid rubbing or injury
glucose regulation ct teaching (exercise)
exercise session should have a cool down period
glucose regulation ct teaching (exercise)
start the exercise program gradually and increase slowly
glucose regulation ct teaching (exercise)
exercise is best donw after meals
glucose regulation ct teaching (exercise)
monitor blood glucose levels bf, during and after exercise to see the effect on BG level
glucose regulation ct teaching (exercise)
bf exercise, if LT/<100, eat a carb snack then check BG level after 15 min. delay exercise if <100
glucose regulation ct teaching (exercise)
bf exercise, if BG is GT/>250 in a type one person and ketones are present. delay activity until ketones are gone. drink fluid
glucose regulation ct teaching (exercise)
MAY GET EXERCISE INDUCED HYPOGLYCEMIA SEVERAL HOURS AFTER
glucose regulation ct teaching (exercise)
COMPENSATE FOR ACTIVITY BY MONITORING BLOOD GLUCOSE LEVELS AND MAKING INSULIN ADJUSTMENTS AND FOOD INTAKE ADJUSTMENTS
glucose regulation ct teaching (exercise)
for diet…use myplate ad guidelines
glucose regulation ct teaching
for exercise…150 min a week or 30 min a day 5 times a week
glucose regulation ct teaching
when preventing type 2 DM, weight loss and diet and exercise
glucose regulation ct teaching
eat carbs regularly with good timing due to drug onset and duration
collaborative interventions to optimize glucose regulation (Non-Pharmacological) for hypoglycemia
exercise and limit carb intake
collaborative interventions to optimize glucose regulation (Non-Pharmacological) for hyperglycemia
educate on self management, monitor and manage blood glucose
collaborative interventions to optimize glucose regulation (Non-Pharmacological) for type 2 DM
do nutrition therapy as a
collaborative interventions to optimize glucose regulation (Non-Pharmacological) for type 2 DM
control glucose by diet, exercise and weight control as a
collaborative interventions to optimize glucose regulation (Non-Pharmacological)
expected range of what test is 4-6/6.5-8 but must be LT 7 as a target goal?
Hemoglobin A1C lab
what lab is the best indicator of the avg BG level for the past 120 days?
Hemoglobin A1C lab
what lab assists in evaluating treatment effectiveness and compleiance?
Hemoglobin A1C lab
what lab is recommended quarterly or twice a year depending on glycemic level?
Hemoglobin A1C lab
a 2nd generation sulfonylurea
glipizide/Glucotrol
oral hypoglycemic
glipizide/Glucotrol
insulin release from the pancreas
glipizide/Glucotrol
can increase tissue sensitivity to insulin over time
glipizide/Glucotrol
notify the provider if there is a recurrant problem
glipizide/Glucotrol
lower glucose levels
glipizide/Glucotrol
high risk of hypoglycemia
glipizide/Glucotrol
pregnancy cat c risk
glipizide/Glucotrol
less effective over time
glipizide/Glucotrol
more potent with fewer drug interactions than 1st generation
glipizide/Glucotrol
for type 2 DM
glipizide/Glucotrol(TU)
blocks ATP-sensitive K channels, allowing influx of Ca
glipizide/Glucotrol(MOA)
Ca influx stimulates insulin release by pancreatic beta cells
glipizide/Glucotrol(MOA)
insulin release diminishes as glucose declines
glipizide/Glucotrol(MOA)
insulin sensitivity may increase with prolonged use
glipizide/Glucotrol(MOA)
hypoglycemia and nausea are
glipizide/Glucotrol(ADR)
epigastric fullness and heartburn are
glipizide/Glucotrol(ADR)
photosensitivity(sulfa) and diarrhea are
glipizide/Glucotrol(ADR)
possible sudden cardiac death is a
glipizide/Glucotrol(ADR)
monitor for signs of hypoglycemia is a
glipizide/Glucotrol(interventions)
diaphoresis and tachycardia are
signs of hypoglycemia
fatigue and tremors are
signs of hypoglycemia
excessive hunger is a
sign of hypoglycemia
if conscious, give glucose orally in pill form , 2-3 tsp of sugar, OJ, honey, or corn syrup dissolved in water
glipizide/Glucotrol(interventions)
if unconscious, give IV glucose; give parenteral glucagon if IV not available
glipizide/Glucotrol(interventions)
Check the client’s blood glucose every 15–20 minutes
glipizide/Glucotrol(interventions)
continue treatment until BG has returned to expected refence range and ct no longer symptomatic
glipizide/Glucotrol(interventions)
monitor for persistent nausea, vomiting, or diarrhea
glipizide/Glucotrol(interventions)
monitor CBC levels
glipizide/Glucotrol(interventions)
give orally 30 min bf selected meal
glipizide/Glucotrol(administration)
make sure cts swallow the SR form whole and dont crush or chew it
glipizide/Glucotrol(administration)
best taken 30 min bf breakfast. withhold dose if ct will not be able to eat…sometimes split dose BID
glipizide/Glucotrol(administration)
wear a medical alert bracelet
glipizide/Glucotrol(CI)
watch for and reportsymptoms of hypoglycemia
glipizide/Glucotrol(CI)
test BG to confirm
glipizide/Glucotrol(CI)
consume a snack of carbs
glipizide/Glucotrol(CI)
retest in 15 to 20 min and repeat if still low
glipizide/Glucotrol(CI)
carry a carb snack at all times
glipizide/Glucotrol(CI)
pregnancy and lactation(neonatal/infant hypoglycemia) are
glipizide/Glucotrol(Contraindications)
DKA
glipizide/Glucotrol(Contraindications)
sulfa allergy and hepatic/renal impairment(drug acculumation)
glipizide/Glucotrol(Contraindications)
insulin is _____ in pregnancy
recommended
renal and hepatic dysfunction
glipizide/Glucotrol(precautions)
adrenal or pituitary insufficiency are
glipizide/Glucotrol(precautions)
ETOH poses a risk for a disulfiram like reaction and increases hypoglycemia effects
glipizide/Glucotrol(interactions)
nausea and palpitations and flushing are
antabuse/disulfiram like reaction
Sulfonamide antibiotics, NSAIDs, oral anticoagulants, salicylates, monoamine oxidase inhibitors, and cimetidine (Tagamet) increase hypoglycemic effects are
glipizide/Glucotrol(interactions)
thiazides counteract hypoglycemic effects
glipizide/Glucotrol(interactions)
beta blockers mask manifestions of hypoglycemic
glipizide/Glucotrol(interactions)
hypoglycemia (acute ETOH ingestion, antidiabetic, NSAIDs, sulfonamide antibiotic, Tagamet/cimetidine)
glipizide/Glucotrol(interactions)
disulfiram like reaction with alcohol(flushing, palpitations, nausea)
glipizide/Glucotrol(interactions)
beta blockers suppress insulin release, inhibit breakdown of glycogen to glucose, and masks hypoglycemic symptoms
glipizide/Glucotrol(interactions)
use of alcohol can result in disulfiram like reaction(intense nausea, vomiting, flushing, palpitations)
glipizide/Glucotrol(interactions)
NSAIDs, sulfonamide antibiotics, ranitidine, and cimetidine have additive hypoglycemic effect(the nurse will monitor glucose levels when these other agent are used concurrently)
glipizide/Glucotrol(interactions)
tachycardia, tremors, palpitations, and disphoresis are
signs of hypoglycemia
beta blockers decrease effectiveness by inhibiting insulin release(mon glucose levels)
glipizide/Glucotrol(interactions)
a meglitinide
Repaglinide
Repaglinide is an
oral hypoglycemic
insulin release from the pancreas and lower glucose levels are actions of
Repaglinide
Repaglinide is in pregnancy cat ___ risk
C
type two DM are the TU of
Repaglinide
increase pancreatic insulin production during and after meals(shorter acting than sulfonylureas) is the MOA of
Repaglinide
hypoglycemia, nausea and vomiting are ADR of
Repaglinide
mon for signs of hypoglycemia as in intervention for
Repaglinide
diaphoresis, tachycardia, and fatigue are signs of
hypoglycemia
excessive hunger and tremors are signs of
hypoglycemia
if conscious, give glucose orally in either pill form, OJ, 2-3 tsp of sugar, honey or corn syrup dissolved in water are interventions for
Repaglinide
if unconscious, give IV glucose; give parenteral glucagon if IV not available are interventions for
Repaglinide
check the cts BG Q 15-20 min is an intervention for
Repaglinide
continue treatment until the BG has returned to the expected range and the ct is no longer symptomatic is an intervention for
Repaglinide
monitor for persistent nausea, vomiting, or diarrhea and CBC levels is an intervention for
Repaglinide
give orally 30 min or less bf meals, usually 3 xs a day
Repaglinide(administration)
tell cts to skip a dose if they skip a meal and to add a dose if they add a meal
Repaglinide(administration)
dont exceed more than 4 doses a day
Repaglinide(administration)
instruct cts to take the med within 30 min of meal time, 3xs per day
Repaglinide(administration)
notify provider if any recurrant problems
Repaglinide(CI)
wear a med alert bracelet
Repaglinide(CI)
watch for and report symptoms of hypoglycemia
Repaglinide(CI)
test blood glucose to confirm
Repaglinide(CI)
if hypoglycemia occurs, tell pt to take OJ, or 2-3 tsp of sugar, honey, or corn syrup dissolved in water
Repaglinide(CI)
retest in 15 to 20 min and repeat treatment if still low
Repaglinide(CI)
carry a carb snack at all times
Repaglinide(CI)
low down when nauseated
Repaglinide(CI)
consume adequate carbs
Repaglinide(CI)
liver or renal impairment and DKA are
Repaglinide(contraindications)
liver, kidney or endocrine disorders are
Repaglinide(Contraindications)
renal or hepatic dysfunction is a
Repaglinide(precaution)
systemic infection and older adults are
Repaglinide(precaution)
use of ETOH, NSAIDs, warfarin, loop diuretics, and anabolic steroids are
Repaglinide(precaution)
gemfibrozil/Lopid inhibits metabolism and causes hypoglycemia is an
Repaglinide(interaction)
Lopid , erythromycin, and chloramphenicol increase hypoglycemic effects are a
Repaglinide(interaction)
alcohol, corticosteroids, and rifampin decrease hypoglycemic effects are
Repaglinide(interaction)
concurrent use of Lopid results in inhibitition of repaglinide metabolism, which leads to increased hypoglycemic risk are
Repaglinide(interaction)
with ____, you need to avoid concurrent use of pioglitazone and gemfibrozil
Repaglinide
with _________, you want to closely mon for manifestations of hypoglycemia
Repaglinid
an oral hypoglycemic
hint (M)
Metformin
Metformin is a
biguanide
Metformin is pregnancy cat ____
B
Metformin modulates a _____ in postprandial glucose level
rise
what drug reduces the production of glucose within the liver thru suppression of gluconeogenesis?
Metformin
what drug increases glucose intake and use in fat and skeletal muscles?
Metformin
what drug decreases glucose absorption in the GI tract?
Metformin
what drug is the first choice med for most type 2 DM?
Metformin
anorexia and nausea are GI effects of
Metformin
diarrhea and weight loss(6.6-8.8lbs/3-4 kg) are GI effects of
Metformin
with Metformin, you see vitamin ___ and folic acid deficiency bc of altered absorption
B12
hyperventilation and myaglia are
signs of lactic acidosis
sluggishness and somnolence are
sign of lactic acidosis
there is GI effects and lactic acidosis ass with what drug?
Metformin
there is a 50% mortality rate with lactic acidosis ass with what drug?
Metformin
type 2 DM is the TU for
hint (M)
Metformin
lower basal and postprandial blood sugar is a TU of what drug?
Metformin
decrease androgen levels of PCOS is a TU of what drug?(M)
Metformin
treating prediabetics in young and obese pts is a TU in what drug?
Metformin
the MOA of ___ is to reduce glucose production by liver(this decreases breakdown of glycogen and decreases gluconeogensis
Metformin
the MOA of ____ is to enhance insulin sensitivity and glucose transport into fat and skeletal muscle cells(M)
Metformin
the MOA of ____ is to decrease intestinal glucose absorption(slightly)
Metformin
lactic acidosis with Metformin can be fatal and produce a ___ effect
black box, 50% mortality
lactic acidosis with Metformin can be fatal and produce a ___ effect
hyperventilation and myglia
lactic acidosis with Metformin can be fatal and produce a ___ effect
malaise and unusual somnolence
dehyrdation and lack of appetite are ADR of
Metformin
nausea and diarrhea are ADR of
Metformin
weight loss that is ind of GI distress are ADR of
Metformin
decreased absorption of B12 and folic acid are ADR of
Metformin
mon for signs of lactic acidosis and then stop therapy if symptoms occur are interventions of
Metformin
expect that severe lactic acidosis with Metformin will require ____
hemodialylsis
mon for persistent nausea, vomiting, or diarrhea are interventions for which drug?
Metformin
mon for indications of vit B12 or folic acid deficiency are interventions for what drug?
Metformin
recommend an appropriate supplement for which drug as an intervention?
Metformin
mon renal function upon initial therapy and yearly afterward as in intervention for what drug?
Metformin
instruct cts to take IR tablets 2xs a day or SR tablets once a day when administering
Metformin
what is the best time to give Metformin for slower GI transit and giving better absorption?
daily in the evening meal
Metformin can be given in combo with other drugs. true or false?
true
what drug do you give with food to decrease GI side effects?
Metformin
what drug causes decreased appetite, nausea or diarrhea?
Metformin
avoid drinking alcohol when on what drug?(M)
Metformin
report weakness and fatigue with what drug?(M)
Metformin
report lethargy or hyperventilation with what drug?(M)
Metformin
expect adverse effects to diminish as drug therapy continues with what drug(M)?
Metformin
lie down when nauseated with what drug?(M)
Metformin
maintain adequate carb and fluid intake with what drug?(M)
Metformin
report weakness and fatigue with what drug?(M)
Metformin
report pallor and reddened tongue with what drug?(M)
Metformin
if ADR occur with Metformin…what is the action you do?
withhold med if these findings occur, and inform the provider immediately
DKA and ETOHism are contraindications for what drug?
Metformin
heart failure and shock are cotraindications for what drug?
Metformin
cardiopulmonary, hepatic, or renal insufficiency are contraindications of what drug?
Metformin
severe infection and acute MI are contraindications for what drug?(M)
Metformin
hypoxemia and lactic acid are contrainidications of what drug?(M)
Metformin
kidney and liver impairment are contraindications of what drug?
Metformin
Metformin increases the risk for what?
LACTIC ACIDOSIS
DIARRHEA AND ANEMIA ARE PRECAUTIONS FOR WHAT DRUG?
Metformin
dehydration and pituitary insufficiency are precautions for what drug?
Metformin
gastroparesis and obstruction are precautions of what drug?(M)
Metformin
hyperthyroidism and old pts are precautions of what drug?
Metformin
ETOH and Tagamet increase the risk of lactic acidosis with what drug?
Metformin
any contrast dye increasing acute renal failure and lactic acidosis is ass with what drug?
Metformin
Procardia, Lasix, morphine, Zantac andantifungals increase the hypoglycemic effects with what drug?
Metformin
with Metformin, you want to ____ drug 1-2 days bf procedure adn mon BUN and Cr
stop
with Metformin, mon BUN and Cr 48 hours ___ bf restarting drug
afterwards
hypoglycemia with sulfonylureas, glitazones, Byetta, and insulin interacts with
Metformin
avoid alcohol with Metformin bc _______
hypoglycemia and lactic acidosis
cimetidine interacts with Metformin and increases what
risk of lactic acidosis
brand name is Humalog
Lispro
this is an rapid acting insulin
Lispro
this is an injectable hypoglycemic drug
Lispro
the onset is 15-30 min
Lispro
the peak is 0.5 to 2.5 hours
Lispro
the duration is 3 to 6 hours
Lispro
this promotes cell uptake of glucose(it decreases glucose levels)
insulin
converts glucose into glycogen and promotes energy storage
insulin
moves K into cells(along with glucose)
insulin
this lowers glucose levels and is for all DM types
insulin
this is preg cat b
insulin
for all types of DM and for glycemic control of DM to prevent complications is the TU for
insulin
use insulin when type 2 pt is on….
oral antidiabetic med, diet, and exercise are unable to control BG levels
use insulin when type 2 pt has…
severe renal or liver disease or neuropathy is present
use insulin when type 2 pt is….
undergoing surgery or tests or under infection and trauma
use insulin when type 2 pt is…
undergoing treatment for DKA and HHS or hyperkalemia
hypoglycemia and anaphylaxis are ADR of
insulin
hypokalemia and lipodystrophy and injection site reactions are ADR of
insulin
mon for signs of hypoglycemia with
insulin
tachycardia and palpitations are
abrupt onset of hypoglycemia
diaphoresis and shakiness are
abrupt onset of hypoglycemia
headache, tremors and weakness are
gradual onset of hypoglycemia
check BG level to confirm then give OJ or oral glucose or glucose tablets for hypoglycemia with
think I
insulin use
if unconsious, give glucagon parenterally when using
insulin
monitor skin for subq fat accumulation when on
insulin
mon K levels when on
insulin
mon ECG and hypokalemia signs when on
insulin
give sub Q with insulin syringe or IV (Humulin R) when giving
insulin
when giving insulin, an intradermal needle is too ___
short
when giving insulin, an IM needle is too___
long
if a cloudy insulin, gently _____ the vial between your palms to disperse the particles
rotate
when mixing short acting and long acting insulin, you want to ___
put short acting into syringe first
dont mix glargine or detemir with other insulins true or false
true
keep ____ premixed in syringes for 1-2 weeks in fridge and vertical with needles up
insulins
if the insulin is _____, resuspend the insulin via gentle motion bf giving
premixed
make sure adequate glucose is available at onset and peak insulin times when giving ____
insulin
an ____ pump is SC and short acting only
insulin
an ___ pump is expensive, and may have microdeposits that decrease the amt of drug delivered
insulin
IV ____ is for short acting only and in emergencies
insulin
IV _____ is diluted in NS(1:1) and is started in 0.1 U/kg/hour
insulin
for IV ______, it is 100U in 100mL
insulin
for SC ____, roll NPH insulin to disperse suspension
insulin
for SC ___, draw regular insulin if mixed with NPH insulin and use the abdomen for best____ levels
insulin
for SC insulin, you can use arm nd thigh but they are the _______________ ____
slowest absorption
for SC insulin, you want to rotate sites within the general areato prevent _____
lipohypertrophy
use the same site only once a month for the injection of SC
insulin
when giving SC insulin, keep sites at least ___in apart
1
increase ____, if calorie intake, infection or stress
insulin
increase ____, if growth spurts, and in 2 and 3 trimester
insulin
decrease ___, if exercise or 1 trimester
insulin
why do you mix short acting then long acting together?
This prevents the possibility of accidentally injecting some of the longer-acting insulin into the shorter-acting insulin vial. (This can pose a risk for unexpected insulin effects with subsequent uses of the vial.)
NPH and premixed insulin appear cloudy…if other are cloudy, _____
dont give them!
lispro and regular insulin are given SC, and continuous and ___
IV
give NPH insulin via ____
SC
when giving insulin use a U-100 syringe with ____
U-100 insulin
when teaching pts about enhancing diabetes med therapy, tell them to keep a __ diet and ____ activity
proper; consistent
for unopened vials of ___, keep in fridge until expired
insulin
vials of premixed ___, can be stored for up to 3 months in fridge
insulin
syringes of remixed ___, can be kept in fridge for 1-2 weeks and get resuspended bf giving them
insulin
keep the vial of ____that is in use at room temp and keep away from sunlight and intense heat
insulin
inhaled human ___ is in dry powder form, packed in cartridges and then into an inhaler
insulin
IV ____ can be given to pts who need rapid glucose reduction
insulin
____insulin is the most common type given
regular
The typical concentration is _____ of NaCl (0.9%)(1U/mL)
100U/100mL
Lispro insulin is okay for ___ administration
IV
When giving IV insulin , you want to allow 50 mL of solution to flow thru the IV tubing and _____ Is the safety alert
Waste
The insulin will ___ to the tubing , so the ct will get the right concentration of insulin
Bind
Wear a med alert bracelet if you are on _____
Insulin
Watch for symptoms of hypoglycemia and test BG to confirm, then eat a carb snack and retest in 15 to 20 min and repeat treatment if still low if on
Insulin
Carry a carb snack at all times if on what drug?
Insulin
Report recurrring episodes of hypoglycemia to provider if on what drug?
Insulin
Rotate injection sites systemically and space them one in apart if on what drug?
Insulin
Don’t inject cold ____
Insulin
Report weakness or nausea if on what drug?
Insulin
Report palpitations or paresthesia if on what drug?
Insulin
Hypersentivity to Insulin is a contraindication for what drug?
Insulin
Hypoglycemia and hypokalemia are contraindications for which drug?
Insulin
Anaphylaxis and lipodystrophy are contraindications for which drug?
Insulin
Precautions for which drug are altered nutrition and stress?
Insulin
Fever and older adults are precautions for what drug?
Insulin
Sulfonylureas, meglitinides, beta blockers, salicylates, and alcohol increase hypoglycemic effects are interactions for which drug?
Insulin
Thiazides and loop diuretics are interactions for which drug?
Insulin
Sympathomimetics and thyroid hormones and glucocorticoids are interactions with which drug?
Insulin
Thiazides, loop diuretics, sympathomimetics, thyroid hormones, and glucocorticoids increase BG levels(counteracting hypoglycemic effects) are interactions with what drug?
Insulin
Beta blockers and manifestations of hypoglycemia are interactions of what drug?
Insulin
Tachycardia and tremor are signs of ______
Hypoglycemia
Beta blockers impair the body’s natural ability to breakdown glycogen stores to raise BG levels as an interaction with what drug?
Insulin
Sulfonylureas are ass with _____ when looking at insulin
Hypoglycemia
Alcohol is ass with _____ when looking at insulin
Hypoglycemia
Thiazide diuretics are ass with _____ when looking at insulin
Hyperglycemia
Beta blockers are ass with ____ when taking insulin
Hypoglycemia
Lispro insulin is also called
Humalog
Humalog is short duration and ______ ___
Rapid acting and analog
The onset for humalog is 15 to ____ min
30
The peak for humalog is 30 min to ____ hours
2.5
The duration for humalog is 3 to ____ hours
6
Lispro can be given ___ 5-15 min before meals
SC
Lispro can be dosed after meals…true or false?
True
Lispro can be given IV…true or false?
True
Lispro can be external insulin pumps and sliding scale…true or false?
True
Humbling R(regular) is short duration and _______
Slower acting
Regular insulin’s onset is 30 to ___ min
60
Regular insulin’s peak is 1 to __ hours
5
Regular insulin’s duration is __ to 10 hours
6
Regular insulin can be give SC __ min bf meals
30
Regular insulin can be given IV….true or false?
True
Regular insulin can be used for external insulin pumps and sliding scale….true or false?
True
Regular insulin is ___ given IM
Rarely
NPH insulin is also called ____ __
Humulin N
NPH insulin is an intermediate duration and can be _____
Suspension with protamine
NPH’s duration is 16 to ___ hours
24
NPH’s peak is 6 to __ hours
14
NPH’s onset is 1-___ hours
2
NPH may mix in syringe with short duration insulins(____ and shower acting)
Rapid acting
NPH is the only ____ insulin
Cloudy
NPH insulin usually given SC with ____ insulin bf breakfast and dinner (2x a day)
Regular
____ is also called insulin glargine
Lantus
Lantus is a __ duration insulin and is an analog one
Long
Lantus’ onset is ____
70 min
Lantus’ peak is ____
No peak
Lantus’ duration is ____
18-24 hours
Lantus is given ___ 1-2 xs a day and with regular insulin adjusted for each meal
SC
Lantus insulin does not ___in the same syringe with other insulins
Mix
Pramlintide is an amylin mimetic and _____injectable med
Non insulin
This is a preg cat c drug
Pramlintide
This drug lowers glucose levels and for all types of DM
Pramlintide
This drug indicates the actions of the naturally occuring peptide hormone amylin to decrease gastric emptying and inhibit secretin of glucose
Pramlintide
Pramlintide satiates as well(meaning-____)
Helps decrease caloric intake
Glucagon _____ postprandial glucose levels
Reduces
Pramlintide is ass with nausea and the edu with that is _____
To report manifestations to the provider and they can decrease the dose
The Pramlintide reaction at injection sites are _______
Generally self limiting
The TU with Pramlintide is for ____
Type 1 and 2 DM as an insulin or hypoglycemic drug supplement
The TU for Pramlintide is for a supplemental ____control for CT’s with TYPE 1 and 2 DM and with ineffective glucose control with insulin therapy
Glucose
Pramlintide is used in conjunction with ____ ____
Insulin therapy
The MOA for Pramlintide is an amylin analog which is a ____ hormone released with insulin
Peptide
Pramlintide inhibits postprandial release and ______ gastric emptying
Slows
Slower gastric emptying ____ appetite
Suppresses
Nausea and injection site reactions are ADR of
Pramlintide
Hypoglycemia that is severe when combined with insulin is an ADR of
Pramlintide
With Pramlintide, you want to recommend a ____ insulin dosage when starting therapy
Reduced
With Pramlintide, you want to monitor for signs of hypoglycemia , that tend to occur ____ hours after dosing
3
recommend ____ titration of doses with Pramlintide
gradual
mon for perisitent ___and vomiting(more common with type 1 than 2) with Pramlintide
nausea
dont mix____ with insulin in the same syringe
Pramlintide
give Pramlintide SC in ___ or abdomen
thigh
give ____ prior to meal that have at least 30 g of carbs
Pramlintide
rotate injection sites with ___
Pramlintide
expect the peak action of Pramlintide ___ after dosing
20 min
refridgerate ____ unopened vials until the exp date
Pramlintide
Give ____ SC bf major meals
Pramlintide
Ensure the injection is at least 5cm/2in from the injection site for any ___ given at that time
Insulin
Give oral meds 1 hour bf or 2 hr after Pramlintide injections, to prevent ____ abosorption of the oral med
Delayed
When on what drug do you wear a medical alert bracelet and carry a carb snack at all times?
Pramlintide
With what drug do you watch for hypoglycemia esp. 3 hours after dosing?
Pramlintide
You want to test BG to confirm then take a carb snack if low then test again in 15 to 20 min and repeat if still low with what drug?
Pramlintide
You want to lie down when nauseated with what drug?
Pramlintide
You want to keep unopened vials in the fridge not freezer with what drug?
Pramlintide
Opened vials of __ can be kept cool or at room temp and then discarded after 28 days and you keep the vials out of sunlight
Pramlintide
Don’t mix_____ med with insulin in the same syringe
Pramlintide
A poor insulin regimen adherence is a contraindication to what drug?
Pramlintide
Gastroparesis and drugs that affect GI motility are contraindications for which drug?
Pramlintide
Kidney failure and dialysis are contraindications for which drug?
Pramlintide
Thyroid disease and ETOH use are contraindications for what drug?(P)
Pramlintide
Osteoporosis is a contraindication for what drug?
Pramlintide
Visual or dexterity impairments are precautions with what drug?
Pramlintide
Insulin increases hypoglycemia risk and is a interaction for what drug?
Pramlintide
The absorption of oral drugs slows, the ct should take them one hour bf or ____ after Pramlintide
Two hours
Opioids ______ gastric emptying
Slow
Precose and Glyset ___ food absorption and further slow gastric emptying
Delay
When on Pramlintide and insulin, hypoglycemia risk is increased, so you ________ 50% when on both
Decrease the ct per meal rapid or short acting insulin dose by
Rapid acting insulin’s onset is 15- ___ min
30
Lispro/Humalog are rapid acting insulin’s and have a peak of 30 mi to ____
2.5 hours
The duration for lispro is 3 to_____ hours
6
Short acting insulin is regular insulin and have an onset of
30 min to 1 h
Humulin R has a peak of
1-5 hours
The duration for Humulin R is
6-10 hours
Intermediate acting insulin’s are NPH or Humulin N and has an onset of 1-2
Hours
NPH insulin’s peak is
6-14 hours
NPH’s duration is
16 to 24 hours
Long acting insulins are insulin glargine(Lantus) and has an onset of ____ min
70
There is ____ peak for glargine insulin
No
The duration of lantus is
18-24 hours
Why are sulfonylureas not used for type 1 DM?
High risk of hypoglycemia, they lower glucose levels
Why should pts with kidney failure, alcoholism, heart failure, or COPD not take meta form in?
Contrast dyes increase risk of acute renal failure and lactic acidosis
Why should pts with kidney failure, alcoholism, heart failure, or COPD not take metformin?
Avoid alcohol due to hypoglycemia and lactic acidosis
Why should pts with kidney failure, alcoholism, heart failure, or COPD not take meta form in?
Cimetidine increase risk of lactic acidosis
Why should pts with kidney failure, alcoholism, heart failure, or COPD not take meta form in?
Liver impairment, alcoholism, shock and infection inhibit breakdown of lactic acid
Why should pts with kidney failure, alcoholism, heart failure, or COPD not take meta form in?
Renal impairment and dehydration elevates drug blood levels and increasing lactic acidosis risk
regular Insulin should be administered when?
SubQ 30 min bf meal cuz its short acting due to onset (30m-1h)
The nurse can give insulin in which ways?
SC, IV, and insulin pump(SC)
Giving SC insulin directions
Roll NPH insulin to disperse suspension
Giving SC insulin directions
Draw regualr insulin first if mixing with NPH
Giving SC insulin directions
Think injection site
Abdomen is best for consistent levels, you can use arm and thigh(but its the slowest absorption here)
Giving SC insulin directions
Think preventing lipohypertrophy
Site rotation within the same general area to prevent lipohypertrophy
Giving SC insulin directions
Think how many times you use a site a month
Use the same site only once a month and they should be 1 in apart
Giving IV insulin directions
Think short acting or long acting
Use short acting only
Giving IV insulin directions
Think emergency or every day use
Emergency situations
Giving IV insulin directions
Think amts and diluted or not diluted
Diluted in NS(1:1)
Start at 0.1 U/kg/hour
Giving IV insulin directions
Think amts
100 U in 100 mL
Isotonic solutions ____ cause a shift in cells
Don’t
Giving insulin in pump form(SC) directions
Think short or rapid acting
Short acting insulins only
Giving insulin in pump form(SC) directions
Think cost and microeposits
Expensive and there will be microdeposits that decrease the amt of drug delivered
Fluid and electrolyte balance
The process of regulating the ECF volume
Fluid and electrolyte balance
The process of regulating body fluid osmolality
Fluid and electrolyte balance
Process of regulating the plasma electrolyte concentrations
optimal Fluid and electrolyte balance
Keeps the volume, osmolality and electrolyte fluid concentrations within normal range
To maintain an optimal Fluid and electrolyte balance, output must be ______by intake, and intake must be absorbed
Matched
Sodium’s range is ______
135 to 145
Sodium is the major _____ cation and maintains concentration and volume of ECF
ECF
Sodium is essential for _____ of acid base and fluid balance and active/passive transport mechanisms.
Maintenance
Sodium is essential for ____ and conduction of nerve and muscle tissue
Irritability
K range is
3.5-5/5.5
K plays a vital role in cell metabolism and _____ of nerve impulses
Transmission
K is needed for cardiac, ___ and muscle tissues
Lung
K is needed for _____ base balance
Acid
K has a reciprocal action with ____
Sodium
K is the major _____ cation and when changed in balance causes clinical problems
ICF
K is needed for ______ _____potential of nerve and muscle cells
Resting membrane
Hypotonic moves fluid ____cell and dilute things
Into
Isotonic is an ____ ____ and dont effect the cell fluid shit
Equal balance
Hypertonic solutions move fluid ___ ___ ___
Out of cell
RF for impaired fluid and electrolyte balance populations at risk
Young kids, infants, and old people
Hypervolemia is due to _____failure, kidney disease, and cirrhosis
Heart
Hypervolemia is due to hyperaldosteronism and severe _______
Stress
Hypervolemia is due to long use of corticosteroids and fluid shifts following _____
Burns
Hypovolemia is due to excessive GI loss like _____, ______, ______
Vomit, NG suctioning, diarrhea
Hypovolemia is due to excessive skin loss(diaphoresis without sodium and _______ _____
Water replacement
Hypovolemia is due to excessive renal system losses like _____ _______, kidney disease, adrenal insufficiency
Diuretic therapy
Hypovolemia is due to burns in the ___ _____
Third space
Hypovolemia is due to hemorrhage or ___ loss
Plasma
Hypovolemia is due to altered intake like _____ nervosa and ______swallowing
Anorexia; impaired
Hypovolemia is due to nausea, confusion, and _____(decreased intake of water and Na)
NPO
If fluid and electrolytes are not absorbed, they _____ in the GI tract and leave the body in feces
Remain
If you have a cognitive disorder or a chronic illness you are at greater risk for ____ imbalance
Electrolyte
Hyperkalemia is due to increased body ____
Potassium
Hyperkalemia Is due to IV K administration and _____
Salt
Hyperkalemia is due to blood ______
Transfusion
Hyperkalemia is due to _____insulin and DKA
Insufficient
Hyperkalemia is due to tissue catabolism which involves: sepsis and ____
Burns
Hyperkalemia is due to tissue catabolism which involves: trauma and ____
Surgery
Hyperkalemia is due to tissue catabolism which involves: fever and ____
MI
hyperkalemia is due to uncontrolled diabetes _____
mellitus
hyperkalemia is due to kidney failure and ____ dehydration
severe
hyperkalemia is due to K sparing diuretics, and ___ inhibitors
ACE
hyperkalemia is due to adrenal ____
insufficiency
hypokalemia is due to hyperaldosteronism and ____dietary intake(rare)
inadequate
hypokalemia is due to prolonged administration of non electrolyte containing IV solutions like ____
5% DEXTROSE IN WATER
with age increasing, you see __ kidney function and med conditions due to salt substitutes, CE inhibitors, and L sparing diuretics
decreasing
hypokalemia is due to receiving ____ parenteral nutrition
total
hypokalemia is due to metabolic _____
alkalosis
hypokalemia is due to excessive GI losses like vomit and ____
NG suctioning
hypokalemia is due to excessive GI losses like diarrhea and ___ laxative use
excessive
hypokalemia is due to renal losses like ______ use of K excreting diuretics like furosemide and corticosteroids
excessive
hypokalemia is due to skin losses like diaphoresis and __ losses
wound
hyponatremia is due to deficient ECF volume and excessive GI losses like(___,___,___,____)
vomit, NG suctioning, diarrhea, and tap water enemas
hyponatremia is due to renal losses like(___,____,___,____)
diuretics, kidney disease, adrenal insufficiency, excessive sweating
hyponatremia is due to ____ losses
skin
skin losses ass with hyponatremia
think B and WD
burns and wound drainage
skin losses ass with hyponatremia think GI O, and PE
GI obstruction and peripheral edema
skin losses ass with hyponatremia
think a
ascites
hyponatremia is due to _____ or normal ECF volume
increased
hyponatremia is due to___ water oral intake and SIADH
excessive
hyponatremia is due to edematous _____
states
hyponatremia is due to ____ failure, cirrhosis and nephrotic syndrome
heart
hyponatremia is due to ____IV administration of dextrose 5% in water
excessive
hyponatremia is due to NPO status bc_____
inadequate sodium intake
hyponatremia is due to ____ irrigating solutions
hypotonic
hyponatremia is due to hyper or hypoglycemia
hyperglycemia
old or younger adults are more at risk for hyponatremia due to chronic illnesses, diuretics, and low sodium intake?
older adults
wound drainage(GI) and low aldosterone are RF of _____
hyponatremia
a freshwater submersion accident and kidney disease are RF of ____
hyponatremia
seizure meds, SSRIs, and desmopressin are RF of
hyponatremia
NPO/water deprivation and high sodium intake can lead to
hypernatremia
heat stroke and hypertonic IV fluids can lead to
hypernatremia
hypertonic tube feedings and bicarb intake lead to
hypernatremia
kidney failure and cushing syndrome lead to excessive sodium retention that leads to
hypernatremia
aldosteronism and glucocorticoids lead excessive sodium retention that leads to
hypernatremia
fever and diaphoresis can lead to
hypernatremia
burns and respiratory infection can lead to
hypernatremia
DI and hyperglycemia and watery diarrhea can lead to(hypo or hypernatremia?)
hypernatremia
excessive intake of oral sodium can lead to
hypernatremia
vomit and diarrhea are
causes of fluid and electrolyte balance
organ failure and nausea are
causes of fluid and electrolyte balance
fatigue and dizziness are
causes of fluid and electrolyte balance
shortness of breath and muscle cramping are
causes of fluid and electrolyte balance
edema and weight changes are
causes of fluid and electrolyte balance
output GT intake and absorption is a
cause of fluid and electrolyte balance
output LT intake and absorption are
causes of disrupted fluid and electrolyte balance
altered fluid and electrolyte distribution are
causes of disrupted fluid and electrolyte balance
too little or too much isotonic fluid present ARE
causes of volume imbalances
body fluid becomes hypertonic or hypotonic in
osmolality imbalances
hypernatremia/water deficit and hyponatremia/water excess or intoxification are examples of
osmolality imbalances
decreased output not balanced by decreased intake is a
causes of disrupted fluid and electrolyte balance
output LT excessive or too rapid intake
causes of disrupted fluid and electrolyte balance
increased output not balanced by increased
causes of disrupted fluid and electrolyte balance
normal output but deficient intake or absorption
causes of disrupted fluid and electrolyte balance
normal output but deficient intake or absorption is an example of ____GT intake and absorption
output
increased output not balanced by increasing intake is an example of ____GT intake and absorption
output
output less than excessive or too rapid intake is an example of output ____ intake and absorption
LT
decreased output not balanced by decreasing intake is an example of output LT ___ and absorption
intake
shift of vascular fluid into the interstitial space causes edema is an example of altered fluid and electrolyte ____
distribution
ECV deficit, too high osmolality, and plasma electrolyte deficit are examples of
normal output but deficient intake or absorption
ECV deficit, too high osmolality, and plasma electrolyte deficit are examples of
increased output not balanced by increased intake
ECV excess, osmolality too low, plasma electrolyte excess are examples of
output LT excessive or too rapid intake
ECV excess, osmolality too low, plasma electrolyte excess are examples of
decreased output not balanced by decreased intake
ECV deficit causes are
think NOBDIOSAW
normal output but deficient intake of sodium and water bc of lack of access
ECV deficit causes are
think IONBBIIOSAW
increased output not balanced by increased intake of sodium and water
vomit, diarrhea, and diuretics lead to
increased output not balanced by increased intake of sodium and water
DRAINING GI FISTUAL , GASTRIC SUCTION , AND INTESTINAL DECOMPRESSION LEAD TO
increased output not balanced by increased intake of sodium and water
addison disease and adrenal insufficiency lead to
increased output not balanced by increased intake of sodium and water
hemorrhage or burns lead to
increased output not balanced by increased intake of sodium and water
acute intestinal obstruction and ascites lead to
rapid fluid shift from ECV into a third space
ECV deficit causes are
think RFSFECVIATS
rapid fluid shift from ECV into a third space
ECV excess causes are
think OLTETRIOSAW
output LT excessive or too rapid intake of sodium and water
ECV excess causes are
think DONBBDIOSAW
decreased out not balanced by decreased intake of sodium and water
excessive IV infusion of Na containing isotonic solution(0.9% NaCl, ringer) are causes of
output LT excessive or too rapid intake of sodium and water
isotonic solutions are
0.9% NaCl and ringers
high oral intake of salty foods and water with renal retention of Na and water are causes of
output LT excessive or too rapid intake of sodium and water
oliguria and aldosterone excess and high levels of glucocorticoids are causes of
decreased out not balanced by decreased intake of sodium and water
normal output but deficient intake of water causes
hypernatremia
body fluids are too concentrated and osmolality too high with ___natremia
hyper
increased output not balanced by increased intake of water causes
hypernatremia
no access to water or inability to respond to or communicate thirst like in aphasia, coma, and infancy is an example of
normal output but deficient intake of water
tube feeding without additional water intake causes
normal output but deficient intake of water
vomit and diarrhea with replacement of Na but not enough water can cause
increased output not balanced by increased intake of water causes
DI due to lack of ADH can cause
increased output not balanced by increased intake of water causes
this is when body fluids too dilute and osmolality too low is ____natremia
hypo
output LT excessive or too rapid intake of water can cause
hyponatremia
decreased output not balanced by decreased intake of water can cause
hyponatremia
IV 5% dextrose in water(D5W) infusion with excess rate or amt is an example of
output LT excessive or too rapid intake of water
rapid oral ingestion of massive amts of water (like in child abuse, club initiation, psychiatric disorder) is an example of
output LT excessive or too rapid intake of water
overuse of tap water enemas or hypotonic irrigating solutions is an example of
output LT excessive or too rapid intake of water
massive replacement of water without Na during vomitting or diarrhea is an example of
output LT excessive or too rapid intake of water
excessive ADH is an example of
decreased output not balanced by decreased intake of water
plasma K deficit is
hypokalemia
normal output but deficient K intake can cause
hypokalemia
increased output not balanced by increased K intake can cause
hypokalemia
prolonged anorexia or lack of K-rich foods is an example of
normal output but deficient K intake
no oral intake plus IV solutions not containing K can casue
normal output but deficient K intake
vomit and diarrhea are an example of
increased output not balanced by increased K intake
use of K wasting diuretics or drugs that increase renal K excretion is an example of
increased output not balanced by increased K intake
excessive aldosterone effects like when cirrhosis, heart failure and hyperaldosteronism is an example of
increased output not balanced by increased K intake
high level of glucocorticoids(cushing disease and corticosteroid therapy) is an example of
increased output not balanced by increased K intake
rapid K shift from ECF into cells can cause
hypokalemia
alkalosis and excessive insulin is an example of
rapid K shift from ECF into cells
excessive beta adrenergic stimulation is an example of
rapid K shift from ECF into cells
plasma K excess that is
hyperkalemia
output LT excessive or too rapid K intake can cause
hyperkalemia
decreased output not balanced by decreased K intake can cause
hyperkalemia
rapid K shift from cells into ECF that can cause
hyperkalemia
IV K infusion with excess rate or amt that is an example of
output LT excessive or too rapid K intake
massive transfusion (GT 8 U for adults) of stored blood that is an example of
output LT excessive or too rapid K intake
oliguria and use of K sparing K diuretics, ACE inhibitors and drugs that decrease renal K excretion that is an example of
decreased output not balanced by decreased K intake
lack of aldosterone is an example of
decreased output not balanced by decreased K intake
lack of insulin or acidosis that is an example of
rapid K shift from cells into ECF
massive sudden cell death that is an example of
rapid K shift from cells into ECF
check K level first then put on a pump for that is a
nursing and collaborative interventions to support fluid and electrolyte balance
prevention examples are pt teaching, dietary measures, and fluid management as
nursing and collaborative interventions to support fluid and electrolyte balance
do adequate intake with vomiting or diarrhea as ___ management
fluid
limit intake when prone to edema as ______management
fluid
check skin tugor and VS and I & O’s as primary prevention for
nursing and collaborative interventions to support fluid and electrolyte balance
tenting is a sign of ECV ____
deficit
rapid thredy pulse and postural hypotension are signs of ECV ___
deficit
bounding pulse is a sign of ECF _____
overload
oliguria is a sign of ECF ___
deficit
weight loss is ass with __ deficit
ECF
weight gain is ass with ECF _____
overload
check weight and do a mental health exam and check muscle strength as a primary prevention for
nursing and collaborative interventions to support fluid and electrolyte balance
impaired cerebral function occurs with _____ and hypernatremia
hypo
flaccid muscle occur with ____ and _____
hyper and hypokalemia
this is based on the principle that intake must balance output
nursing and collaborative interventions to support fluid and electrolyte balance
teach pts taking K wasting diuretics to increase K consumption is
nursing and collaborative interventions to support fluid and electrolyte balance
teach pts with oliguria renal disease to decrease intake of Na and K bc their output is decreased is
nursing and collaborative interventions to support fluid and electrolyte balance
nurses must give ____ when intervening and at the right temp
fluids
collab intervention as ordering a med true or false?
true
provide safety and comfort is a
nursing interventions to support fluid and electrolyte balance
facilitate oral intake if needed is a
nursing interventions to support fluid and electrolyte balance
administering collab interventions
nursing interventions to support fluid and electrolyte balance
adjust the fluid I and O is a
nursing interventions to support fluid and electrolyte balance
treat the underlying cause is a
nursing interventions to support fluid and electrolyte balance
monitor for complications of therapy is
nursing interventions to support fluid and electrolyte balance
teach pts how to prevent imbalances or when to seek help is
nursing interventions to support fluid and electrolyte balance
the nurse can do this for pts on fluid restrictions…
keep fluids out of sight, lubricate the lips, do oral hygiene, and swish fluid in mouth bf swallowing
screening for F and EB is not routine for the general population is a
secondary prevention to support fluid and electrolyte balance
mon serum blood levels as part of disease management is a
secondary screening process
focus on intake, and maybe use dialysis or diuretics is
collaborative interventions to support fluid and electrolyte balance
fluid and electrolyte support and med management is
collaborative interventions to support fluid and electrolyte balance
treat underlying condition and pharmacotheray with diuretics, insulin, and vasopressin is
collaborative interventions to support fluid and electrolyte balance
electrolyte supplements(Na, K) and water replacement therapy(oral fluids, IV fluids) are
collaborative interventions to support fluid and electrolyte balance
NS 0.9% and lactated ringer solution are ____solutions
isotonic
D5W and 10% dextrose in 0.225% saline are ____ solutions
isotonic
give hypotonic for a ___ state
hypertonic
0.45% NaCl and 0.33 NS and 0.225 NS are ___ solutions
hypotonic
3% NS and 5% dextrose in .45% saline are
hypertonic fluids
10% dextrose in water is a
hypertonic fluid
130-145 is the range for
Na
3.5 to 5 is the range for
K
9-11 is the range of
Ca
1.5 to 2.5 is the range for
Mg
no dyspnea and no distended neck veins are
EF
no visible edema and moist lips are
EF
alert and attentive is an
EF
dry lips are a sign of ECF _____
deficit
impaired cerebral functions occurs with hypo and hyper____
natremia
edema is a sign of ECF __
overload
distended neck veins are a sign of ECF ____
overload
dyspnea is a sign of ECF ___
overload
osmotic forces are
the amt of pressure required to stop the osmotic flow of water
osmosis is from high concentration to ____concentration
low
osmosis is from a region of low solute to ___solute
high
osmosis is
passive
diffusion is the movement of ____ and water between the ECF
electrolytes
diffusion is passive and __ a concentration gradient
down
