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Complex Human Needs; Exam 1 > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

Humalog; Novolog Insulin- OPD

A

Onset: 15 minutes
Peak: 30-3
Duration: 3-5

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2
Q

Regular Insulin- OPD

A

Onset-30-1 hour
Peak- 2-5 hours
Duration- 5-8

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3
Q

Glargline (Lantus), determir (levemir)- O,P,D

A

Onset- 0.8-4 hours
Peak- no peak
Duration- 16-24 hours

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4
Q

rule of 15

A 
hypoglycemic symptomatic <70
give fast acting 15 g (4-6 oz juice)
check it again in 15 minutes
still low = another dose
call doc after 2 or 3 doses

when stabilized, give complex carb and protein to keep it stable

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5
Q

DKA

A

type 1
> 250
they have no endogenous insulin at all
cell is starving for glucose, but there is no insulin to bring it into the cell, so the brain tells the liver to keep making more glucose
cells now use fat to breakdown for energy
- by product is ketones

fruity breath
metabolic acidosis
compensate by blowing CO2- kussmaul respirations (deep rapid breathing)
dehydrated

treatment
- Fluids (NaCl)
- Insulin IV (Regular)
bring it down slow or you will cause cerebral edema; you will add dextrose once there glucose falls below 200

  • watch electrolytes especially potassium
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6
Q

HHS

A

type 2 diabetic
a little endogenous insulin
just enough to prevent fat breakdown, preventing ketones
cell is still starving, so brain tells liver to keep making more glucose

dehydrated

same treatment

  • fluids
  • regular insulin IV
  • watch electrolytes, especially potassium
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7
Q

dawn phenomenon

A
  • 5 am growth hormone is released
  • this stimulates gluconeogenesis
  • blood sugar starts rising
  • morning glucose is high

treatment- increase insulin the night before

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8
Q

somogyi effect

A
  • insulin is given at 9 pm night before
  • blood sugar will start to fall
  • 2 am blood sugar is really LOW
  • liver produces glucose
  • 6 am: glucose is high

treat- give less insulin or add a nighttime snack

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9
Q

diagnostic dawn v phenomenon

A
  • low at 2 am = somogyi

- normal at 2 am = dawn

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10
Q

hemodialysis

A
  • AV fistula- feel the thrill hear the bruit (this is how you know its patent)
  • in the forearm
  • 3x/week
  • must go to a clinic or hospital
  • circulation distal to the fistula = check cap refill / pulses
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11
Q

peritoneal dialysis

A 
filter = peritoneum 
abdominal catheter that sticks out (risk for infection)
hooks up to diasylate
infuse 
dwells inside
drains by gravity (drain at least the amount that goes in, maybe more)
can be done at home
done daily

peritonitis can occur

dialysate is high in glucose
patient can become hyperglycemic if it dwells too long

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12
Q

continuous renal replacement therapy

ON NCLEX blueprint

A

hemodialysis at bedside
24 hours / day
watch electrolytes
disequilibrium syndrome

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13
Q

first degree burn

A

pain, minimal edema, blanching and erythema

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14
Q

second degree burn (partial thickness)

A

severe pain, blisters, blanching

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15
Q

third degree burn (full thickness)

A

no pain, waxy leathery skin, no blanching

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16
Q

rule of nines

A 
face- 4.5 per side
arm- 4.5 per side
chest- 18
back- 18
leg- 9 per side
genitalia- 1
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17
Q

calculating fluid replacement for 24 hours

A

4 x TBSA x weight in kg

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18
Q

replacing burn victims fluids

A

first 8 = 1/2
second 8 = 1/4
third 8 hours = 1/4

set the pump by dividing by 8 for the hourly rate

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19
Q

refer to burn center if:

A
  • greater than 10%
  • third degree burns
  • face, hands, feet, genitalia, major joints, perineum
  • electrical
  • chemical
  • inhalation
  • children in hospital w/o personnel or equipment
  • patients who need special social, emotional, or rehab intervention
  • preexisting conditions
20
Q

preload

A

volume
right sided = CVP
2-6

left sided - 8-12

21
Q

how do you decrease preload

A

diuretics

vasodilators

22
Q

how do you increase preload

A

give volume- NaCl

23
Q

how do you measure preload

A

swan ganz- R/L

PAWP- L

24
Q

afterload

A 
resistance
right sided = PVR
left sided = SVR
if its high- need a vasodilator
if its low = need a vasoconstrictor
25
Q

contractility

A

strength of contraction

positive ionotrope- digoxin (hypokalemia potentiates dig)

26
Q

shock

A

inadequate perfusion to tissues

27
Q

hypovolemic shock

A

lost volume
pale, weal pulses,
low BP, high HR

give NaCl, then blood

28
Q

cariogenic shock

A

heart is not an effective pump
too much fluid in heart
give diuretic
give vasodilator to help decrease resistance

29
Q

distributive shock

A

extreme dilation of all vessels

give fluids then vasoconstriction

30
Q

4 stages of shock

A

1- initial
2- compensatory
3- progressive
4- refractory

31
Q

hypertensive crisis

A

sudden
above 180/110
w/ clinical evidence of organ damage

32
Q

hypertensive meds

A

ace inhibitors- “pril”
ARB- sartans
Thiazide diuretics
ca channel blockers

33
Q

acute renal injury

A

rapid, reversibleurine output <400 / day

34
Q

AKI phases

A

oliguric
diuretic
recovery

35
Q

oliguric phase

A

urine <400 / day
metabolic acidosis
hyperkalemia / hyponatremia
elevated bun / creatinine (nothing is being excreted out)

36
Q

diuretic phase

A

gradual increase in urinary output til 1-3 L / day
hypovolemia due to urine loss
hypotension due to urine loss
BUN / creatinine normalize

37
Q

recovery phase

A

when GFR increases

BUN / creatinine plateau

38
Q

CKI diet (chronic kidney injury)

A

protein: 20-40 g / day
fluid restricted: 600-1000 mL / day
sodium, potassium, phosphate based on blood work

39
Q

phlebitis

A

acute inflammation of the walls of the veins where IV is
pain, tender, warm, red, swelling, palpable cord

remove catheter
apply warm compress
NSAIDS

40
Q

normal blood glucose

A

74-106

41
Q

counter regulatory hormones

A

glucagon
cortisol
growth hormone
epinephrine

42
Q

type 1 diabetes

A

autoimmune

no endogenous insulin

43
Q

type 2

A

often overweight

body cannot make enough insulin to keep up with glucose

44
Q

diabetes diagnostic tests

A

A1C: < 6.5%
fasting glucose < 126
2 hour < 200

test it twice to ensure no lab errors

patients with: polyuria, polydipsia, unexplained weight loss, or hyperglycemic crisis (>200) = no repeat test

45
Q

diabetic foot care

A 
wash feet daily
examine feet daily
use lanolin to prevent cracking
no iodine, alcohol
cut toenails with rounded corners
avoid open toe, open heel and high heel
do not no hot water or heating pads bc of lack of sensation
46
Q

hypoglycemia

A

shaky, palpitations, nervousness, diaphoresis, anxiety, hunger, pallor

47
Q

hyperglycemia

A 
polyuria
increased appetite
wak / fatigued
blurred vision / headaches
N,V, ab cramps

Complex Human Needs; Exam 1 (1 decks)

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