Exam 1 Flashcards
Humalog; Novolog Insulin- OPD
Onset: 15 minutes
Peak: 30-3
Duration: 3-5
Regular Insulin- OPD
Onset-30-1 hour
Peak- 2-5 hours
Duration- 5-8
Glargline (Lantus), determir (levemir)- O,P,D
Onset- 0.8-4 hours
Peak- no peak
Duration- 16-24 hours
rule of 15
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
DKA
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
HHS
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
dawn phenomenon
- 5 am growth hormone is released
- this stimulates gluconeogenesis
- blood sugar starts rising
- morning glucose is high
treatment- increase insulin the night before
somogyi effect
- 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
diagnostic dawn v phenomenon
- low at 2 am = somogyi
- normal at 2 am = dawn
hemodialysis
- 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
peritoneal dialysis
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
continuous renal replacement therapy
ON NCLEX blueprint
hemodialysis at bedside
24 hours / day
watch electrolytes
disequilibrium syndrome
first degree burn
pain, minimal edema, blanching and erythema
second degree burn (partial thickness)
severe pain, blisters, blanching
third degree burn (full thickness)
no pain, waxy leathery skin, no blanching
rule of nines
face- 4.5 per side arm- 4.5 per side chest- 18 back- 18 leg- 9 per side genitalia- 1
calculating fluid replacement for 24 hours
4 x TBSA x weight in kg
replacing burn victims fluids
first 8 = 1/2
second 8 = 1/4
third 8 hours = 1/4
set the pump by dividing by 8 for the hourly rate
refer to burn center if:
- 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
preload
volume
right sided = CVP
2-6
left sided - 8-12
how do you decrease preload
diuretics
vasodilators
how do you increase preload
give volume- NaCl
how do you measure preload
swan ganz- R/L
PAWP- L
afterload
resistance right sided = PVR left sided = SVR if its high- need a vasodilator if its low = need a vasoconstrictor
contractility
strength of contraction
positive ionotrope- digoxin (hypokalemia potentiates dig)
shock
inadequate perfusion to tissues
hypovolemic shock
lost volume
pale, weal pulses,
low BP, high HR
give NaCl, then blood
cariogenic shock
heart is not an effective pump
too much fluid in heart
give diuretic
give vasodilator to help decrease resistance
distributive shock
extreme dilation of all vessels
give fluids then vasoconstriction
4 stages of shock
1- initial
2- compensatory
3- progressive
4- refractory
hypertensive crisis
sudden
above 180/110
w/ clinical evidence of organ damage
hypertensive meds
ace inhibitors- “pril”
ARB- sartans
Thiazide diuretics
ca channel blockers
acute renal injury
rapid, reversibleurine output <400 / day
AKI phases
oliguric
diuretic
recovery
oliguric phase
urine <400 / day
metabolic acidosis
hyperkalemia / hyponatremia
elevated bun / creatinine (nothing is being excreted out)
diuretic phase
gradual increase in urinary output til 1-3 L / day
hypovolemia due to urine loss
hypotension due to urine loss
BUN / creatinine normalize
recovery phase
when GFR increases
BUN / creatinine plateau
CKI diet (chronic kidney injury)
protein: 20-40 g / day
fluid restricted: 600-1000 mL / day
sodium, potassium, phosphate based on blood work
phlebitis
acute inflammation of the walls of the veins where IV is
pain, tender, warm, red, swelling, palpable cord
remove catheter
apply warm compress
NSAIDS
normal blood glucose
74-106
counter regulatory hormones
glucagon
cortisol
growth hormone
epinephrine
type 1 diabetes
autoimmune
no endogenous insulin
type 2
often overweight
body cannot make enough insulin to keep up with glucose
diabetes diagnostic tests
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
diabetic foot care
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
hypoglycemia
shaky, palpitations, nervousness, diaphoresis, anxiety, hunger, pallor
hyperglycemia
polyuria increased appetite wak / fatigued blurred vision / headaches N,V, ab cramps
