Chart Flashcards
2nd Generation Sulfonylureas Examples
Glipizide (Glucotrol)
Glyburide (Glynase)
Glimepiride (Amaryl)
2nd Generation Sulfonylureas Action
Works to increase output of insulin by beta cells in pancreas
2nd Generation Sulfonylureas Nursing Implications
- Best taken 30 min prior to meal
- Main potential side effects: hypoglycemia with delayed or skipped meals or alcohol
- Use cautiously in elderly
Metformin Classification
Biguanide
Insulin Nursing Implications
- Monitor blood sugar level
- When mixing, draw rapid acting first (clear before cloudy)
Very Rapid Acting Insulin (examples & nursing implication)
Lispro (Humalog)
Aspart (Novalog)
-Clear solution
-Give 15 before meal
Very rapid acting insulin onset, peak, duration
- Onset: 10 min
- Peak: 1 hr
- Lasts: 3-4 hrs
Short (rapid) acting insulin (example & nursing imp)
Regular (R) insulin
- Clear solution
- Give 30 min before meal
Short (rapid) acting insulin onset, peak, duration
- Onset: 30 min
- Peak: 3-5 hr
- Lasts: 6-10 hrs
Intermediate acting insulin (examples and nursing imp)
NPH insulin
Lente
-Cloudy solution
-Rotate prior to use
Glargine (Lantus)
- LONG ACTING
- Clear solution
- Do NOT mix with others
- Onset: 1 hr
- NO peak
- Lasts: 24 hrs
Detemir (Levemir)
- LONG ACTING
- Clear solution
- Do NOT mix with others
- Onset: 3-4 hrs
- NO peak
- Lasts: 24 hrs
Metformin (Glucophage) Action
- Decrease liver output of sugar
- Increase peripheral insulin sensitivity
Metformin (Glucophage) Nursing Imp.
- Kidney surveillance testing required (monitor creat)
- Contraindications: CHF, alcohol abuse, metabolic acidosis, liver or kidney disease, or > 80 yrs old
- Side effects: GI distress, diarrhea, lactic acidosis
- Take WITH food
- Discontinue after OR, dye (contrast) studies for 48 hrs or until kidney function normal
Anytime Plasma Glucose Level
- Screen for diabetes
- Normal: < 200 mg/dL
Anytime Plasma Glucose Level (interpretation)
- Increased in: diabetes, acute stress reaction, severe liver disease, pancreatitis, severe renal disease
- Decreased in: hypoglycemia, excessive insulin, cancer, malnutrition, alcohol use, liver disease
Anytime Plasma Glucose Level (nursing imp)
- Assess nutritional status
- Encourage proper body weight
- Monitor blood glucose
Fasting plasma glucose level
- Screen for diabetes
- Normal: 70-100 mg/dL
Fasting Plasma Glucose Level (interpretation)
100-126 mg/dL indicates prediabetes
> 126 mg/dL indicates diabetes
Oral glucose test
-Screen for diabetes
-Normal: < 200 mg/dL
> 200 mg/dL indicates diabetes
Glycosylated hemoglobin A1c (HbA1c)
- Assess long-term glucose control (2-3 months)
- Normal: < 6.0% (decreasing)
- Increased in poorly controlled or uncontrolled diabetes
Liver Function Tests
- ALT, AST, ALP, bilirubin
- Assess liver function and damage
- Increased in hepatitis, liver disease, cancers, CHF
Hepatitis A antibody, Hepatitis B antigen & antibody, Hepatitis C antibody, Hepatitis D antibody
- Assess for Hepatitis A, B, C, D
- Positive results indicates hepatitis infection
Thyroid antibodies lab (indications & interpretation)
- Assist in diagnosis of Grave’s disease
- Increased in chronic thyroiditis, Grave’s disease, pernicious anemia, RA
Thyroid hormones: T3 and T4 (Indication)
- Evaluate hypo or hyper-thyroidism
- Monitor response to therapy
Thyroid hormones: T3 and T4 (interpretation)
- Increased in hyperthyroidism, thyrotoxicosis, excessive intake of iodine, hepatitis
- Decreased in hypothyroidism
Thyroid stimulating hormone (TSH) indication
-Diagnosis of hypo- or hyper-thyroidism
TSH interpretation
- Increased in: primary hypothyroidism, thyroid hormone resistance, thyroiditis
- Decreased in: excessive thyroid hormone replacement, Grave’s disease, primary hyperthyroidism, secondary hypothyroidism
Radioactive Iodine (RAI) Uptake Test (indication)
- Evaluate hyper- or hypo-thyroidism
- Evaluate thyroiditis, goiter, or pituitary failure
- Monitor response to therapy for thyroid disease
RAI Uptake Test (interpretation)
- Abnormal findings in decreased iodine intake or increased iodine excretion, Grave’s disease, iodine-deficient goiter
- Increased uptake in hyperthyroidism
- Decrease uptake in hypothyroidism
Albumin Lab (indication)
- Assess nutritional status
- Evaluate chronic illness
- Evaluate liver disease
Albumin (normal)
3.4-4.8 g/dL
Albumin (interpretation)
- Increased in dehydration
- Decreased in: malnutrition, liver disease, inflammation, increased blood volume, increased loss (burns, hemorrhage)
Albumin Lab (nursing imp)
- Assess nutritional status
- Monitor for edema when levels are low
- Assess tissue integrity and prevent skin breakdown
- Encourage protein intake
Prealbumin Lab (indication)
- Evaluate nutritional status
- Monitor parenteral nutrition
Prealbumin (normal)
12-42 mg/dL
Prealbumin (interpretation)
- Increased in: alcoholism, chronic renal failure, pts receiving steroids
- Decreased in: malnutrition, tissue necrosis, liver disease, acute phase inflammatory responses, chronic illness
Antithyroid Agent
Methimazol (Tapazole)
Methimazol (Tapazole) Action
-Antithyroid agent: inhibits synthesis or thyroid hormones
Methimazol (Tapazole) nursing imp.
- Monitor thyroid function and hepatic function
- Take with meals
Thyroid supplement
Levothyroixine (Synthroid)
Levothyroxine (Synthroid) Action
Synthetic thyroid hormone
Levothyroxine (nursing imp)
- Give on EMPTY stomach, 1/2-1 hr before breakfast
- Monitor thyroid function
Liver function tests (nursing imp)
- Encourage proper diet
- Encourage vaccination as appropriate
Hepatitis Labs (nursing imp)
- Encourage prevention of transmission
- Eliminate alcohol ingestion
