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NUR3220 ADULT HEALTH I > Exam 1 Study Guide > Flashcards

Exam 1 Study Guide Flashcards

1
Q

You know that nursing care in PACU is multifaceted and involves which of the following?

A
  • Monitoring the pt’s physiological status
  • Intervening to ensure uneventful recovery from anesthesia & surgery
  • Providing a safe environment for the pt experiencing limitations in physical, mental, & emotional function
  • Preventing or promptly treating complications in the immediate post-anesthesia period
  • Upholding the pt’s rights to dignity, privacy, & confidentiality
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2
Q

PostOp Verbal Report

A
  • Height & weight
  • Name of surgical procedure
  • Relevant health hx
  • Anesthetic agents & drugs administered
  • Estimated blood loss
  • Fluid status & IV therapy
    (done to ensure pt SAFETY)
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3
Q

High Priority Assessments PostOp

A
  • Airway
  • Pulse (circulation)
  • Blood pressure
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4
Q

Why is it important to measure SpO2 in PACU?

A

Levels indicate how much oxygen is available for use by tissues

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5
Q

Shivering is a physiological effort to:

A

Generate heat

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6
Q

The opiate antagonist ________ should be readily available in PACU should reversal of respiratory depression be necessary

A

Naloxone hydrochloride (Narcan)

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7
Q

You assist a pt to a sitting position on the side of the PACU bed and allow pt to dangle feet for 10 minutes. This will help prevent ___________ when pt stands

A

Orthostatic Hypotension

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8
Q

Discharge Info/Instructions

A
  • Report elevated temp
  • Monitor & protect operative site
  • Avoid strenuous activity
  • Continue deep breathing activities
  • Someone else drive home
  • Continue ice/heat at home
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9
Q

Preoperative prophylactic antibiotic administration according to Surgical Care Improvement Project (SCIP) guidelines

A

Antibiotic administration within 1 hour before surgical incision

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10
Q

Common lab tests preop

A
  • Urinalysis
  • Electrolyte levels (low = risk for cardiac dysthymias)
  • Clotting studies
  • Serum creatinine
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11
Q

Nursing actions after administering preoperative medications

A
  • Raise side rails
  • Place call light within reach
  • Instruct pt not to get out of bed
  • Place bed in lowest position
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12
Q

Informed Consent

A
  • Surgeon is responsible for consent form signed before sedation & before surgery is performed
  • Nurse is responsible for witnessing consent form being signed, not that the pt is informed
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13
Q

Moderate sedation expected outcome

A

Decreased LOC, yet able to respond to verbal commands

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14
Q

What medical condition increases a pt’s risk for surgical wound infection

A

Diabetes mellitus

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15
Q

“Time-Out” Procedure

A
  • Procedure completed in OR suite prior to start of operation
  • Pt’s identity, correct site, correct pt position, and proposed procedure are verified
  • Involves the participation of all members of surgical team
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16
Q

What is the best indicator that peristaltic activity has resumed?

A

Passing of flatus or stool

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17
Q

What is the priority nursing assessment when a patient is admitted to the PACU

A

Airway & gas exchange

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18
Q

Which are nursing interventions for med-surg nurse to use in preventing hypoxemia for postop patient?

A
  • Monitor the pt’s oxygen saturation
  • Encourage cough & deep breathing
  • Ambulate as soon as possible
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19
Q

Identify the number-one priority for all personnel during the perioperative period and primary roles of the nurse

A

Patient Safety!

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20
Q

Focused Assessment IN PACU

A
  • History
  • Initial assessment data
    > LOC & awareness
    > Resp assessment is most critical to
    perform after surgery for any pt who has undergone general anesthesia, moderate sedation, has received sedative, or opioid drugs; (assess for patent airway and adequate gas exchange)
  • Temperature, pulse, respiration, blood pressure
  • Oxygen saturation
  • Examine the surgical area for bleeding and drainage
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21
Q

Discharge FROM PACU

A
  • Hlth care team determines the pt’s readiness for discharge
  • Recovery rating score may vary from facility to facility
  • Other criteria for discharge:
    > Stable vital signs
    > Normal body temp
    > No overt bleeding
    > Return of gag, cough, and swallow reflexes
    > Ability to take liquids
    > Adequate urine output
    > May be discharged to a hospital unit (ICU, telemetry, med-surg) or home
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22
Q

Potential Respiratory Complications of Surgery

A
  • Atelectasis (collapse of whole or part of lung)
  • Pneumonia
  • Pulmonary Embolism (PE)
  • Laryngeal Edema
  • Ventilator dependence
  • Pulmonary Edema
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23
Q

Potential Cardiovascular Complications of Surgery

A
  • HTN
  • Hypotension
  • Hypovolemic Shock
  • Dysrhythmias
  • Venous Thromboembolism (VTE), especially DVT
  • Heart Failure
  • Sepsis
  • Disseminated Intravascular Coagulation (DIC)
  • Anemia
  • Anaphylaxis
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24
Q

Potential Skin Complications of Surgery

A
  • Pressure ulcers
  • Wound infection
  • Wound dehiscence
  • Wound evisceration
  • Skin rashes or contact allergies
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25
Q

Potential Gastrointestinal Complications of Surgery

A
  • Paralytic ileus
  • Gastrointestinal ulcers & bleeding
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26
Q

Potential Neuromuscular Complications of Surgery

A
  • Hypothermia
  • Hyperthermia
  • Nerve damage & paralysis
  • Joint contractures
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27
Q

Potential Kidney/Urinary Complications of Surgery

A
  • Urinary tract infection (UTI)
  • Acute urinary retention
  • Electrolyte imbalances
  • Acute Kidney Injury (AKI)
  • Stone formation
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28
Q

Focused Assessment on Med-Surg AFTER Discharge from PACU

A
  • Airway (patent?)
  • Breathing (quality, pattern, rate, depth, accessory muscle use, oxygen, pulse oximetry, lung sounds)
  • Mental status (LOC & awareness)
  • Surgical incision site (dressing, amnt of drainage, bleeding, drains)
  • T, P, BP (baseline, diff from PACU?)
  • IV fluids (type, how much infused, rate, monitor intake)
  • Other tubes (foley, NG, monitor output)
  • Pain assessment & management
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29
Q

Preventing Hypoxemia After Surgery

A
  • Related to the effects of anesthesia, pain, opioid analgesics, & immobility:
    > Maintain airway
    > Monitor O2 sat, pulse oximetry
    > Positioning
    > O2 therapy, if indicated
    > Breathing exercises: splint incision, cough, deep breathe, use IS
    > Movement/mobility: encourage early ambulation, reposition q2hr, breathing & leg exercises, antiembolism stockings, pneumatic compression devices
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30
Q

Preventing Would Infection & Delayed Healing After Surgery

A
  • Related to wound location, dcrd mobility, drains & drainage, tubes:
    > Dressing change (surgeon will change 1st dressing)
    > Assess wound for infection: warmth, swelling, tenderness, pain, type & amount of drainage
    > Assess drains: patency, amnt, color, & type of drainage
    > Drug therapy (antibiotics)
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31
Q

Acute Pain After Surgery

A

Related to the surgical incision, positioning during surgery, & endotracheal (ET) tube irritation

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32
Q

Dehiscence

A
  • Partial or complete separation of the outer wound layers, sometimes described as a “splitting open of the wound”
    > apply a sterile nonadherent (telfa) or saline dressing to wound
    > notify surgeon
    > instruct pt to lie supine, bend knees, avoid coughing
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33
Q

Evisceration

A
  • Total separation of all wound layers & protrusion of internal organs through the open wound
    > surgical emergency-prepare for surgery
    > notify surgeon
    > apply sterile saline soaked gauze
    > instruct pt to lie supine, bend knees, avoid coughing
    > review emergency care of pt & surgical wound evisceration
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34
Q

Managing Pain

A
  • Alternative therapies for relaxation
  • Pain reduction
  • Distraction: positioning, massage, diversion
  • Drug Therapy:
    > opioid analgesics 1st 24-48hrs postop
    > around-the-clock or pt-controlled analgesia (PCA)
    > assess the type, location, & intensity of pain b4 & after giving meds
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35
Q

Commonly Used Medications

A
  • Morphine Sulfate
  • Hydromorphone (Dilaudid)
  • Ketorolac (Toradol)
  • Codiene
  • Butorphanol (Stadol)
  • Oxycodone w/ Aspirin (Percodan)
  • Oxycodone w/ Acetaminophen (Tylox, Percocet)
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36
Q

Patient Teaching on Discharge

A
  • Prevention of infection
  • Care & assessment of surgical wound
  • Management of drains & catheters
  • Nutrition therapy
  • Pain management
  • Drug therapy
  • Progressive incr in activity
  • Appropriate referrals, if needed
  • Follow-up w/ surgeon
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37
Q

Resp Changes in Older Adults - Alveoli

A
  • Alveolar surface area dcrs
  • Diffusion capacity dcrs
  • Elastic recoil dcrs
  • Bronchioles & alveolar ducts dilate
  • Ability to cough dcrs
  • Airways close early
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38
Q

Resp Changes in Older Adults - Lungs

A
  • Residual vol incrs
  • Vital capacity dcrs
  • Efficiency of oxygen & carbon dioxide exchange dcrs
  • Elasticity dcrs
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39
Q

Resp Changes in Older Adults - Pharynx & Larynx

A
  • Muscles atrophy
  • Vocal cords become slack
  • Laryngeal muscles lose elasticity
  • Airways lose cartilage
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40
Q

Resp Changes in Older Adults - Pulmonary Vasculature

A
  • Vascular resistance to blood flow through pulmonary vascular syst incr
  • Pulm capillary blood vol dcrs
  • Risk for hypoxia incrs
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41
Q

Resp Changes in Older Adults - Exercise Tolerance

A

Body’s response to hypoxia & hypercarbia dcrs

42
Q

Resp Changes in Older Adults - Muscle Strength

A

Respiratory muscle strength, especially the diaphragm and the intercostals dcrs

43
Q

Resp Changes in Older Adults - Susceptibility to Infection

A
  • Effectiveness of the cilia dcrs
  • Immunoglobulin A dcrs
  • Alveolar macrophages are latered
44
Q

Resp Changes in Older Adults - Chest Wall

A
  • Anteroposterior diameter incrs
  • Thorax becomes shorter
  • Progressive kyphoscoliosis occurs
  • Chest wall compliance (elasticity) dcrs
  • Mobility of chest wall may dcr
  • Osteoporosis is possible, leading to chest wall deformities
45
Q

Pt Hx of Resp Assessment

A
  • Family & personal data
  • Smoking
  • Drug use (prescribed & rec)
  • Allergies
  • Travel, geographic area of residence
  • Nutritional status
  • Current hlth problems
    > is the current hlth problem acute or chronic
    > cough: productive or nonproductive? sputum? how much?
    > chest pain
    > dyspnea
46
Q

Assessment of Respiratory Syst

A
  • Physical assessment via inspection & auscultation of lungs
  • Skin & Mucous Memb changes (pallor, cyanosis)
    > assess nail beds & mucous membs of oral cavity
    > examine fingers for clubbing (indicates long-term hypoxia)
  • General Appearance
    > long-term resp probs lead to weight loss & a loss of general muscle mass
    > arms & legs may appear thin or poorly muscled
    > neck & chest muscles may be hypertrophied
  • Endurance
    > dcrs when gas exchange is inadequate
    > observe how easily pt moves & whether the SOB is at rest or exertion
    > note how often pt pauses for breath btwn words when talking
47
Q

Respiratory Laboratory & Imaging Assessment

A
  • Red Blood Cell count (RBC)
    > data act transport of oxygen
  • Hemoglobin
    > transports oxygen to tissues
    > deficiency could cause hypoxemia
  • White Blood Cell count (WBC) w/ Diff
    > indication of infection
  • Arterial Blood Gases (ABG)
    > data on oxygenation as well as acid base balance
  • Sputum
    > culture & sensitivity
    > cytology
  • Chest X-Rays
    > very common diagnostic tool
    > typically one of 1st tools
  • CT Chest (computerized tomography)
    > w/ or w/out contrast
48
Q

Pulse Oximetry

A
  • Identifies hemoglobin saturated w/ oxygen
  • Readings recorded as SpO2, SaO2, or O2 sat
  • Normal: 95%-100%
  • Below 91%
    > requires immediate assessment & treatment
  • Below 85%
    > body tissues have a difficult time becoming oxygenated
  • Able to detect desaturation b4 other manifestations occur (dusky skin, pale mucosa, pale or blue nail beds)
49
Q

Other Noninvasive Diagnostic Assessments (resp)

A
  • Capnometry & Capnography
  • Pulmonary func tests (PFTs)
    > Forced Vital Capacity (FVC): vol of air exhaled from full inhalation to full exhalation
    > Forced Expiratory Vol (FEV1): vol of air blown out as hard & fast as possible during 1st second of most forceful exhalation after greatest inhalation
    > Peak Expiratory Flow (PEF): fastest airflow rate reached at any time during exhalation
  • Exercise testing
  • Skin tests
    > allergy testing
    > tuberculin skin testing
50
Q

Laryngoscopy (endoscopic exam)

A
  • Scope inserted into larynx to assess the func of the vocal cords
  • Uses:
    > remove foreign bodies caught in larynx
    > obtain tissue samples for biopsy or culture
  • Pts receive sedation
51
Q

Mediatinoscopy (endoscopic exam)

A
  • Insertion of a flexible tube thru the chest wall just above sternum into area btwn lungs
  • Uses:
    > examine for tumors
    > obtain tissue samples for biopsy or culture
  • Performed under general anesthsia
52
Q

Bronchoscopy (endoscopic exam)

A
  • Insertion of a tube in the airways, usually as far as the secondary bronchi
  • Uses:
    > view airway structures
    > obtain tissue samples for biopsy or culture
    > remove excessive secretions or foreign bodies
    > assist w/ placing or changing endotracheal tube
  • Rigid bronchoscopy requires general anesthesia in the OR
  • Flexible bronchoscopy can be performed at bedside
  • Nursing Interventions Post Procedure:
    > monitor VS, O2 sat, & breath sounds every 15 min for 2 hrs
    > monitor for return of gag reflex
    > assess for possible complications of bleeding, infection, or hypoxemia
53
Q

Thoracentesis

A
  • Needle aspiration of pleural fluid or air from the pleural space for diagnostic or management purposes
    > often performed at bedside
    > local anesthetic agent to numb area
    > help to position pt
    > stress importance not to move, cough, or deep breath during procedure
  • Nursing Interventions Post Procedure:
    > CXR to rule out possible pneumothorax (can occur w/in 24hrs)
    > monitor VS, lung sounds, bleeding at puncture site
54
Q

Lung Biopsy

A
  • Performed to obtain tissue for histologic analysis, culture, cytologic examination
  • May be performed:
    > in the radiology depart w/ help of fluoroscopy or CT
    > in OR if an open biopsy is required under general anesthesia
    > Thru a bronchoscopy
  • Nursing Interventions Post Procedure:
    > CT or CXR to rule out pneumothorax
    > Follow up: assess VS, breath sounds at least q4hrs for 24hrs, assess for resp distress, report reduced/absent breath sounds immediately, monitor for hemoptysis
55
Q

Normal PaO2 Values

A

80-100 mmHg

56
Q

Normal pH Values

A
  • 7.35-7.45
  • Low = acidic
  • High = alkalosis
57
Q

Normal PaCO2 Values

A
  • 35-45 mmHg
  • Respiratory component
  • Partial pressure of carbon dioxide
58
Q

Normal HCO3 Values

A
  • 22-26 mEq/L
  • Metabolic component
  • Bicarbonate
59
Q

Infectious Respiratory Diseases (pneumonia) Risk Factors

A
  • Older adult
  • Not received flu or pneumococcal vaccine
  • Chronic hlth probs (esp. chronic lung disease)
  • Recent exposure to resp viral of flu infections
  • Limited mobility
  • Uses tobacco or alcohol
  • Presence of gram-neg colonization of mouth, throat, or stomach
  • Altered LOC
  • Aspiration
  • Presence of endotracheal, tracheostomy, NG tube
  • Poor nutritional status
  • Has immunocompd status
  • Mechanical vent (vent-associated pneum)
60
Q

Infectious Respiratory Disease (pneum) Prevention

A
  • Avoid risk factors
  • Annual flu vaccine
  • Avoid crowded public areas during flu & holiday seasons
  • Handwashing
  • If limited mobility, cough, turn, move as much as possible, & perform deep breathing exercises
  • Clean resp equipment
  • Avoid indoor pollutants
  • Stop smoking
  • Rest & eat healthy, balanced diet
  • Drink 3L of fluid/day (unless fluid restriction)
61
Q

Infectious Respiratory Disease (pneum) Laboratory Assessment Findings

A
  • Sputum by Gram stain, culture & sensitivity testing
    > determine type of organism
  • CBC to assess an elevated WBC count
  • Blood cultures
    > determine infection in blood
  • ABGs
    > determine need for oxygen & baseline O2 & CO2 lvls
  • Serum lactate lvls
    > used for prognosis & effectiveness of treatment
  • Procalcitonin
    > used to determine antibiotic use & clinical improvement
  • BUN & electrolytes
    > determine fluid status
62
Q

Infectious Respiratory Disease (pneum) Imaging Assessment Findings

A
  • Chest X-Ray
    > most common diagnostic test for pneum
    > may not show changes until 2+ days after manis are present
    > essential for early diagnosis in older adult
  • Pulse oximetry
  • Invasive tests
    > Transtracheal aspiration
    > Bronchoscopy
    > Direct needle aspiration of lung
63
Q

Infectious Respiratory Disease (pneum) Priority Nursing Diagnoses & Problems

A
  • Impaired gas exchange related to dcrd diffusion at the alveolar-capillary membrane
  • Potential for airway obstruction related to excessive tracheobronchial secretions, fatigue, chest discomfort, & muscle weakness
  • Potential for sepsis related to the presence of microorganism in a very vascular area
64
Q

Infectious Respiratory Disease (pneum) Nursing Interventions

A
  • Oxygen therapy
  • Monitor pulse ox
    > 95% or greater
  • Cough & deep breath q2hrs
  • Incentive spirometry
    > 5-10 breaths per session q1hr while awake
  • Adequate hydrations
    > helps thin secretions
  • Assess fluid status
    > monitor I/O
    > assess oral mucous membranes & skin turgor
  • Drug therapy
    > anti-infective: priority when there is a bacterial infection (CORE measure), determined by type & severity of infection
    > bronchodilators
    > steroids (IV or inhaled)
    > expectorants
65
Q

Obstructive Sleep Apnea Assessment/Diagnostic

A
  • Epworth Sleepiness Scale
  • Polysomnography (full “sleep study”)
    > monitor EEG, ECG, pulse ox, & EMG
    > monitors type of sleep, depth & rate of breathing, oxygen sat, & muscle movement
  • Overnight strip oximetry
    > monitors for oxygen desat during sleep
    > only a preliminary test
66
Q

Causes/Contributing Factors of OSA

A
  • Most common cause is upper airway obstruction by sift palate or tongue
  • Can have a neurological cause
  • Contributing factors:
    > obesity
    > large uvula
    > short neck
    > smoking
    > enlarged tonsils or adenoids
    > oropharyngeal edema
67
Q

Pneumonia Clinical Manifestations in Older Adults

A
  • Acute confusion from hypoxia (rather than a fever or cough)
  • Confusion, weakness, fatigue, lethargy, poor appetite, hypotension (secondary to dehydration)
68
Q

Cause of Cor Pulmonale (noninfectious lower resp)

A
  • Right sided heart failure caused by pulmonary disease (ex: emphysema or pulmonary HTN)
    > Incrd vascular resistance in lung causes the nightside of heart to work harder against the incrd pressure
    > the right side of the heart enlarges and can cause a back flow of blood into venous system
69
Q

Causes of Lung Cancer (noninfectious lower resp)

A
  • Exposure ti inhaled irritants over time: smoke, asbestos, coal, air pollution (cigarettes most common)
  • Cancer cells arise from bronchial epithelium secondary to irritation/inflamm
  • Genetic predisposition
70
Q

Cor Pulmonale Symptoms/Assessment

A
  • Hypoxemia
  • Dyspnea
  • Cyanosis
  • Vein distention
  • System edema
  • Acidosis
  • Fatigue
  • Enlarged liver
  • Chest pain
71
Q

Cor Pulmonale Diagnostic Testing

A
  • ABGs: asses for hypoxia
  • Brain Natriuretic Peptide: assess the function of the heart; incrd lvls w/ incrd work of heart
  • Echocardiogram: assess for heart function
  • Right Heart Catherization: assess for pulmonary artery pressures
  • Ventilation Perfusion scan (V/Q scan)
72
Q

Cor Pulmonale Treatment/Nursing Care

A
  • Medications
    > Endothelia receptor antagonist
    > Prostaglandin agents
    > Calcium channel blockers
    > Diuretics
    > Anticoagulants
  • Oxygen therapy
  • Heart/lung transplant
73
Q

Lung Cancer Symptoms/Assessment

A
  • Dyspnea
  • Persistent cough or change in cough
  • Hemoptysis/rust colored sputum
  • Hoarseness
  • Pain (chest, back, shoulder, pleuritic)
  • Dcrd lung sounds where mass is located & dullness when percussed; wheezing if obstructed
  • Recurrent pleural effusion: collection of fluid in pleural space
  • Late Signs: weight loss, fatigue, dysphagia, anorexia
74
Q

Lung Cancer Diagnostics

A
  • Chest x-ray
  • Chest Computed Tomography (CT)
  • Bronchoscopy w/ biopsy
  • CT guided biopsy
  • Open lung biopsy
  • Positron emission tomography (PET) scan: check for metastasis
  • Thoracentesis: drainage & testing of pleural fluid
75
Q

Lung Cancer Treatment/Nursing Care

A
  • Surgical intervention: best option for NSCLC: tumor emission, lobectomy, pneumonectomy, wedge resection
  • Chemotherapy: best option for SCLC
    > supportive care related to side effects
    > educate regarding immunosuppression
  • Radiation therapy: used in conjunction w/ other treatments
    > oral & skin care a priority
    > nutrition support
76
Q

Lung Cancer Palliative Treatment

A
  • Goal: comfort & symptom relief
  • Oxygen: assest in dyspnea management
  • Medications: pain management; opioids, dyspnea management; opioids, anxiety managemen; benzodiazepines
  • Radiation: palliative to dcr size of tumor & relieve pain & dyspnea
  • Thoracentesis: assist in dyspnea management
77
Q

Emergencies in Lower Resp

A
  • Tracheal deviation
  • Sudden onset or incrd intensity of dyspnea
  • Oxygen sat less than 90%
  • Drainage greater than 70 L/hr
  • Visible eyelets on chest tube
  • Chest tube falls out of pt’s chest
  • Chest tube disconnects from drainage system
  • Drainage in tube stops (in first 24hrs)
78
Q

Endocrine Changes w/ Aging - Decreased Glucose Tolerance

A
  • Weight becomes greater than ideal
  • Elevated fasting & random blood glucose lvls
  • Slow wound healing
  • Frequent yeast infections
  • Polydipsia
  • Polyuria
79
Q

Endocrine Changes w/ Aging - Decreased General Metabolism

A
  • Less tolerant of cold
  • Dcrd appetite
  • Dcrd HR & BP
80
Q

Endocrine Changes w/ Aging - Decreased Antidiuretic Hormone (ADH) Production

A
  • Urine is more dilute & may not concentrate when fluid intake is low
  • Pt is at greater risk for dehydration
81
Q

Endocrine Changes w/ Aging - Decreased Ovarian Production of Estrogen

A
  • Bone density dcrs
  • Skin is thinner, drier, and at greater risk for injury
  • Perineal & vaginal tissues become drier, and the risk for cystitis incrs
82
Q

Acute Complications of DM

A
  • Diabetic Ketoacidosis (DKA)
    > insulin deficiency & acidosis
  • Hyperglycemic-Hyperosmolar state (HHS)
    > insulin deficiency & severe dehydration
  • Hypoglycemia
    > too much insulin or too little glucose
    *all considered a medical emergency
83
Q

Chronic Complications of DM

A
  • Caused by chances in blood vessels in tissue & organs
  • Vascular changes result from:
    > hyperglycemia thickens basement membs & causes organ damage
    > hyperglycemia affects cell integrity
  • Changes in blood vessels lead to poor tissue perfusion & cell damage and death
    > macrovascular
    > microvascular
84
Q

Macrovascular (chronic) Complication of DM

A
  • Cardiovascular disease: MI, heart failure
  • Cerebrovascular disease: 2-4 times higher risk for stroke
  • Peripheral vascular disease: peripheral artery disease, leg ulcers
  • Risk for HTN, obesity, dyslipidemia and sedentary lifestyle incr risk of these comps
  • Focus should be on dcring modifiable risk factors
85
Q

Microvascular (chronic) Complication of DM

A
  • Retinopathy: caused by damage to retinal vessels causing leaking & retinal hypoxia
  • Neuropathy
    > progressive deterioration of nerves
    > loss in sensation or muscle weakness
    > caused by blood vessel changes the cause nerve hypoxia
    > can affect all areas of body (extrems, GI, cardiac, urinary)
  • Nephropathy
    > change in kidney the dcrs function & causes kidney failure
    > chronic high BG causes damage to blood vessels in kidneys causing leaking & hypoxia
    > kidneys allow filtration of larger particles which damage the kidneys further
86
Q

Nutrition Intervention for DM

A
  • Dietician should be involved
  • Should be individualized
  • 45-65% carbohydrates “carb counting”
  • 15-20% protein (if norm kidney func)
  • Limit saturated fats & cholesterol
  • Watch alcohol intake (can lead to hypoglycemia)
  • Need to take pt preferences & culture into considerationE
87
Q

Exercise Intervention for DM

A
  • Help regulate BG and incrs insulin sensitivity
  • Important in weight loss for DM2
  • Should monitor BG and watch for injury
88
Q

Blood Glucose Monitoring Intervention for DM

A
  • Very important in self care
  • Target goals are individualized
  • Frequency depends on drug regimen
  • Accuracy is essential: adequate sample, using correct supplies, calibrate machine
  • Ensure proper technique
  • Continuous glucose monitoring
89
Q

Medication Interventions for DM

A
  • All pts w/ T1DM will require insulin
  • Pts w/ T2DM may require medication (antidiabetic drugs or insulin) if they do not achieve BG control w/ diet & exercise
90
Q

Rapid Acting Insulin

A
  • aspart (Novolog), lisper (Humalog)
  • Onset: 0.25hrs
  • Peak: 0.5-3hrs
  • Duration: 3-5hrs
91
Q

Short Acting Insulin

A
  • regular U100, regular U500
  • Onset: 0.5-1.5hrs
  • Peak: 2-5hrs (U500: 4-12hrs)
  • Duration: 5-8hrs (U500: 24hrs)
92
Q

Intermediate Acting Insulin

A
  • NPH, 70/30, 50/50
  • Onset: 0.25-1.5hrs
  • Peak: 1-12hrs
  • Duration: 16-24hrs
93
Q

Long Acting Insulin

A
  • glargine (Lantus), determir (Levemir)
  • Onset: 1-4hrs
  • Peak: none-8hrs
  • Duration: 5.7-24hrs
94
Q

Hypoglycemia Treatment

A
  • Avoid:
    > excess insulin
    > deficient intake or absorption of food
    > exercise
    > alcohol intake
  • Treatments:
    > take 15-20g of oral glucose (<70)
    > take 30g of oral glucose (<50)
    > repeat in 15 mins after initial treatment if glucose remains low
    > glucagon SQ or IM
    > 50% Dextrose IV
    > frequent checks of BG following treatment
    > follow protocols of hlth system/hospital
95
Q

Diabetic Ketoacidosis Treatment

A
  • Uncontrolled hyperglycemia, metabolic acidosis, incrd production of ketones
  • Sudden onset
  • Precipitating factor: infection, stress, inadequate insulin intake
  • Treatment:
    > IV fluids
    > regular insulin by continuous IV infusion
    > replace potassium (ensure urine output is at least 30mL/hr)
    > IV Sodium Bicarbonate (used only for sever acidosis)
96
Q

Hyperglycemia-Hyperosmolar State Treatment

A
  • Hyperosmolar (incrd blood osmolarity) state caused by hyperglycemia
  • Gradual onset
  • Precipitating factor: dehydration, infection, poor fluid intake
  • Treatments:
    > IV fluids of NS if shock or severe hypotension, otherwise IV fluids of 1/2 NS
    > Assess for signs of cerebral edema (abrupt changes in mental status, abnormal neurological signs, coma)
    > IV insulin is admind after fluids have been replaced
97
Q

Type 1 Diabetes Mellitus

A
  • No insulin is produced
  • Auto immune disorder
  • Beta cells of pancreas are destroyed by antibodies
  • Onset usually occurs <30yrs of age
  • Abrupt onset
  • Polydipsia, polyuria, polyphagia, and weight loss
  • Require insulin
  • Could be viral in etiology
98
Q

Type 2 Diabetes Mellitus

A
  • Reduction of cells to respond to insulin (insulin resistance) and dcrd secretion of insulin from beta cells
  • Predisposing factors are obesity, physical inactivity, and genetics
  • Onset usually occurs >50yrs of age
  • Could have no symptoms or polydipsia, fatigue, blurred vision, vascular and neural comps
  • Accounts for 90% of diabetic pts
99
Q

Fasting Blood Glucose Test

A

Levels greater than 100 but less than 126 indicate impaired fasting glucose; Levels greater than 126 on at least 2 occasions are diagnostic of diabetes

100
Q

Glucose Tolerance Test

A

Levels greater than 140 or less than 200 indicate impaired glucose tolerance; levels greater than 200 indicate provisional diagnosis

101
Q

Glycosylated hemoglobin (hemoglobin A1C)

A
  • 4-6%; Levels greater than 6.5% are diagnostic for the diagnosis of DM
  • Levels greater than 8% indicate poor diabetic control
102
Q

Factors Affecting Insulin Absorption

A
  • Injection site
    > absorption fastest in abdomen
    > teach to rotate around site
  • Absorption rate
    > affected by type of insulin, local heat, massage, exercise or scarring
  • Injection depth
    > 90 degree angle usually
    > thinner pts need 45 degree
  • Timing of injection
  • Mixing insulin
    > response to mixed insulin may differ from response to same insulins given separately

NUR3220 ADULT HEALTH I (13 decks)

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