CAT 3 Remediation Flashcards
Biguanides: Metformin Adverse effects
Dizziness
Nausea
Vomitting
Diarrhea
Abdominal discomfort
Lactic acidosis
Biguanides: Metformin Nursing care
- Do not give with kidney or liver impairment
- Monitor glucose, ketones
- Take with food
- Swallow extended release tablet whole
- Avoid alcohol
Sulfonylureas (1st gen) are…
rarely used for diabetes
Sulfonylureas (1st gen): Chlorpropamide adverse (DM II)
- Increased risk of cardiac death
- Epigastric distress
- Aplastic anemia
- prolonged hypoglycemia
- Dilutional hyponatremia
Sulfonylureas (2nd gen): Glimepiride (Adverse) (DMII)
- Dizziness
- Leukopenia
- Agranulocytosis
- thrombocytopenia
- aplastic anemia
- Hypoglycemia
- Dil. Hyponatremia
Sulfonylureas (2nd gen): Glimepiride Nursing care
- May be used with insulin
- Monitor for hypoglycemia
Sulfonylureas (2nd gen): Glimepiride Client EDU
- Take with first meal of day
- Medical identification
- Signs of hypoglycemia
- Discuss OTC meds with HCP
- Avoid alcohol
Glipizide: Action
- Stimulates release of insulin from pancreas
- increases insulin sensitivity at receptor sites
Glipizide: Adverse
- Photosensitivity
- Rashes
- Hypoglycemia
Glipizide: Nursing care
- Assess for allergy to sulfonamides
- Use caution with:
- Diuretics
- Steroids
- Oral contraceptives
- Thyroid preparation
- Isoniazid
- Combined use may decrease glipizide action
Glipizide: PT EDU
- Signs of hypoglyc
- take 30 min before meals
Glyburide: Action
- Stimulates pancreas to secrete insulin
- Increases insulin sensitivity at receptor sites
- Decreases blood and hepatic glucose production
Glyburide: Adverse
Hypoglycemia
Aplastic anemia
Constipation
Diarrhea
Dizziness
HA
Hypo Na
Pancytopenia
Weakness
Drowsiness
Cramps
Hepatitis
Photosensitivity
Rash
Hemolytic anemia
Agranulocytosis
Nausea
Vomiting
Increased appetite
Glyburide: Nursing care
Beta blockers may cause hypoglycemia
Glyburide: PT EDU
- Symptoms of and treatment for hypoglycemia or hyper
- Medical identification
- Avoid stress, alc
- Take with breakfast
- Avoid activities requiring mental alertness
- Discuss all meds with HCP
- Discuss pregnancy with HCP
- Do not use oral contraceptives
- Sun protection
- Carry 15 gram carb to treat hypoglyc.
Thiazolidinediones: Rosiglitazone and Pioglitazone –> Action of these two meds
- Augments cell insulin sensitivity at receptor sites
- Improves glucose utilization
Thiazolidinediones: Rosiglitazone and Pioglitazone –> Adverse
Liver failure
Heart failure
Elevated liver enzymes
Fractures
Bladder cancer
Anemia
Macular edema
Rhabdomyolysis
Edema
Thiazolidinediones: Rosiglitazone and Pioglitazone –> PT EDU
Self blood glucose monitoring
Discuss al meds and preg. with HCP
Alpha-Glucasidase inhibitors: EX: Acarbose, Voglibose, Miglitol –> Action
- Inhibit the absorption of carbohydrates from the small intestine
- Competitively inhibit enzymes that convert complex non-absorbable carbs into simple absorbable carbs
Alpha-Glucasidase inhibitors: EX: Acarbose, Voglibose, Miglitol –> Adverse
Abdominal pain
Diarrhea
Flatulence
Hypocalcemia
Alpha-Glucasidase inhibitors: EX: Acarbose, Voglibose, Miglitol –> Nursing care
Monitor levels of: Calcium, HGB, HCT
Observe for hypoglycemia
Insulin may be needed if surgery or infection
Take with first bite of 3 main meals
Amputation: Pathophysiology
- an acute injury may result in partial or full amputation
- All or part of extremity may be surgically re-attached to body
- In chronic condition such as PVD, blood flow to the tissues of the extremities is interrupted, resulting in venous pooling and edema
- Edema further reduces blood flow and causes skin damage, often resulting in ulceration and infection
- Progressive infection leads to further tissue damage and ultimately causes tissue death
- Extremity will have to be removed to prevent tissue death to other body parts
Most common amputations…
are of the lower extremities due to tissue damage from PVD
Closed amputations:
- Suturing a flap of skin over the amputation site
- Compression dressings used to reduced edema and facilitate use of prosthetic device
Expected outcomes for limb amputation:
- Once swelling subsides, client is prepared to immediately wrap the residual limb or slip on a custom fitted elastic residual limb shrinker
- client inspects the residual limb carefully each day using a mirror
- Rub the res. limb with alc daily to toughen the skin looking for any irritated skin
- Massage the res. limb toward the suture line to mobilize scar and prevent its adherence to bone
- Avoid exposing the skin around the res. limb to excessive perspiration, and be aware of possible need to change bandages/elastic socks
- Prevent contractures
- Prep res. limb for prosthesis
Amputation: Before surgery
- Reinforce HCP’s explanation of procedure
- Answer Q’s
- Provide support as client comes to grips with emotions surrounding limb loss
Amputation: Following surgery
- Give pain meds etc.
- Splint and support the affected area, elevating to reduce edema
- Be prepared to care for the cast or elastic wrap that the HCP applies around the residual limb
- Assess wound and report excessive bleeding or infection
- Turn and reposition frequently and provide ROM exercises
Amputation: following surgery teach pt:
- What to do if cast slips off
- To report drainage through cast, warmth, tenderness, or foul smell
- Anxiety and pain reduction: Relaxation, visualization, deep breathing
- To care for skin
- Use elastic wraps
- Massage site after wound heals
- Prevent hip contracture by performing ROM
- Active listening to support pt
Adrenergic Agonist: What it is and action
- Adrenergic agonists bind to adrenergic receptors throughout the body
- Mimics the function of the sympathetic nervous system
- Norepinephrine and phenylephrine
- These vasoconstrict peripheral blood vessels. And Activates receptors in arterioles of:
- Skin
- Viscera
- Mucous membranes
Norepinephrine: Action
- Increases blood pressure and cardiac output
Norepinephrine: Use
- Cardiogenic, septic, and anaphylactic shock
- Cardiac arrest
- Anaphylaxis
Norepinephrine: Adverse
- HA
- Palpitations
- Nervousness
- Epigastric
Norepinephrine: Nursing care
- Reflex bradycardia with rise in BP
- Constant attendance
- Monitor BP and UO
- Should not be used in shock d/t low blood volume
- Infuse with dextrose solution, not saline
- Tissue extravasation if given IV
- Monitor IV site. Infusions should be in large blood vessel only.
- Protect med from light
