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
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)
3
Q
High Priority Assessments PostOp
A
- Airway
- Pulse (circulation)
- Blood pressure
4
Q
Why is it important to measure SpO2 in PACU?
A
Levels indicate how much oxygen is available for use by tissues
5
Q
Shivering is a physiological effort to:
A
Generate heat
6
Q
The opiate antagonist ________ should be readily available in PACU should reversal of respiratory depression be necessary
A
Naloxone hydrochloride (Narcan)
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
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
9
Q
Preoperative prophylactic antibiotic administration according to Surgical Care Improvement Project (SCIP) guidelines
A
Antibiotic administration within 1 hour before surgical incision
10
Q
Common lab tests preop
A
- Urinalysis
- Electrolyte levels (low = risk for cardiac dysthymias)
- Clotting studies
- Serum creatinine
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
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
13
Q
Moderate sedation expected outcome
A
Decreased LOC, yet able to respond to verbal commands
14
Q
What medical condition increases a pt’s risk for surgical wound infection
A
Diabetes mellitus
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
16
Q
What is the best indicator that peristaltic activity has resumed?
A
Passing of flatus or stool
17
Q
What is the priority nursing assessment when a patient is admitted to the PACU
A
Airway & gas exchange
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
19
Q
Identify the number-one priority for all personnel during the perioperative period and primary roles of the nurse
A
Patient Safety!
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
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
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
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
24
Q
Potential Skin Complications of Surgery
A
- Pressure ulcers
- Wound infection
- Wound dehiscence
- Wound evisceration
- Skin rashes or contact allergies
25
Potential Gastrointestinal Complications of Surgery
- Paralytic ileus
- Gastrointestinal ulcers & bleeding
26
Potential Neuromuscular Complications of Surgery
- Hypothermia
- Hyperthermia
- Nerve damage & paralysis
- Joint contractures
27
Potential Kidney/Urinary Complications of Surgery
- Urinary tract infection (UTI)
- Acute urinary retention
- Electrolyte imbalances
- Acute Kidney Injury (AKI)
- Stone formation
28
Focused Assessment on Med-Surg AFTER Discharge from PACU
- 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
29
Preventing Hypoxemia After Surgery
- 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
30
Preventing Would Infection & Delayed Healing After Surgery
- 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)
31
Acute Pain After Surgery
Related to the surgical incision, positioning during surgery, & endotracheal (ET) tube irritation
32
Dehiscence
- 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
33
Evisceration
- 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
34
Managing Pain
- 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
35
Commonly Used Medications
- Morphine Sulfate
- Hydromorphone (Dilaudid)
- Ketorolac (Toradol)
- Codiene
- Butorphanol (Stadol)
- Oxycodone w/ Aspirin (Percodan)
- Oxycodone w/ Acetaminophen (Tylox, Percocet)
36
Patient Teaching on Discharge
- 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
37
Resp Changes in Older Adults - Alveoli
- Alveolar surface area dcrs
- Diffusion capacity dcrs
- Elastic recoil dcrs
- Bronchioles & alveolar ducts dilate
- Ability to cough dcrs
- Airways close early
38
Resp Changes in Older Adults - Lungs
- Residual vol incrs
- Vital capacity dcrs
- Efficiency of oxygen & carbon dioxide exchange dcrs
- Elasticity dcrs
39
Resp Changes in Older Adults - Pharynx & Larynx
- Muscles atrophy
- Vocal cords become slack
- Laryngeal muscles lose elasticity
- Airways lose cartilage
40
Resp Changes in Older Adults - Pulmonary Vasculature
- Vascular resistance to blood flow through pulmonary vascular syst incr
- Pulm capillary blood vol dcrs
- Risk for hypoxia incrs
41
Resp Changes in Older Adults - Exercise Tolerance
Body's response to hypoxia & hypercarbia dcrs
42
Resp Changes in Older Adults - Muscle Strength
Respiratory muscle strength, especially the diaphragm and the intercostals dcrs
43
Resp Changes in Older Adults - Susceptibility to Infection
- Effectiveness of the cilia dcrs
- Immunoglobulin A dcrs
- Alveolar macrophages are latered
44
Resp Changes in Older Adults - Chest Wall
- 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
Pt Hx of Resp Assessment
- 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
Assessment of Respiratory Syst
- 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
Respiratory Laboratory & Imaging Assessment
- 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
Pulse Oximetry
- 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
Other Noninvasive Diagnostic Assessments (resp)
- 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
Laryngoscopy (endoscopic exam)
- 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
Mediatinoscopy (endoscopic exam)
- 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
Bronchoscopy (endoscopic exam)
- 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
Thoracentesis
- 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
Lung Biopsy
- 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
Normal PaO2 Values
80-100 mmHg
56
Normal pH Values
- 7.35-7.45
- Low = acidic
- High = alkalosis
57
Normal PaCO2 Values
- 35-45 mmHg
- Respiratory component
- Partial pressure of carbon dioxide
58
Normal HCO3 Values
- 22-26 mEq/L
- Metabolic component
- Bicarbonate
59
Infectious Respiratory Diseases (pneumonia) Risk Factors
- 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
Infectious Respiratory Disease (pneum) Prevention
- 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
Infectious Respiratory Disease (pneum) Laboratory Assessment Findings
- 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
Infectious Respiratory Disease (pneum) Imaging Assessment Findings
- 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
Infectious Respiratory Disease (pneum) Priority Nursing Diagnoses & Problems
- 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
Infectious Respiratory Disease (pneum) Nursing Interventions
- 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
Obstructive Sleep Apnea Assessment/Diagnostic
- 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
Causes/Contributing Factors of OSA
- 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
Pneumonia Clinical Manifestations in Older Adults
- Acute confusion from hypoxia (rather than a fever or cough)
- Confusion, weakness, fatigue, lethargy, poor appetite, hypotension (secondary to dehydration)
68
Cause of Cor Pulmonale (noninfectious lower resp)
- 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
Causes of Lung Cancer (noninfectious lower resp)
- 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
Cor Pulmonale Symptoms/Assessment
- Hypoxemia
- Dyspnea
- Cyanosis
- Vein distention
- System edema
- Acidosis
- Fatigue
- Enlarged liver
- Chest pain
71
Cor Pulmonale Diagnostic Testing
- 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
Cor Pulmonale Treatment/Nursing Care
- Medications
> Endothelia receptor antagonist
> Prostaglandin agents
> Calcium channel blockers
> Diuretics
> Anticoagulants
- Oxygen therapy
- Heart/lung transplant
73
Lung Cancer Symptoms/Assessment
- 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
Lung Cancer Diagnostics
- 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
Lung Cancer Treatment/Nursing Care
- 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
Lung Cancer Palliative Treatment
- 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
Emergencies in Lower Resp
- 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
Endocrine Changes w/ Aging - Decreased Glucose Tolerance
- Weight becomes greater than ideal
- Elevated fasting & random blood glucose lvls
- Slow wound healing
- Frequent yeast infections
- Polydipsia
- Polyuria
79
Endocrine Changes w/ Aging - Decreased General Metabolism
- Less tolerant of cold
- Dcrd appetite
- Dcrd HR & BP
80
Endocrine Changes w/ Aging - Decreased Antidiuretic Hormone (ADH) Production
- Urine is more dilute & may not concentrate when fluid intake is low
- Pt is at greater risk for dehydration
81
Endocrine Changes w/ Aging - Decreased Ovarian Production of Estrogen
- 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
Acute Complications of DM
- 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
Chronic Complications of DM
- 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
Macrovascular (chronic) Complication of DM
- 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
Microvascular (chronic) Complication of DM
- 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
Nutrition Intervention for DM
- 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
Exercise Intervention for DM
- Help regulate BG and incrs insulin sensitivity
- Important in weight loss for DM2
- Should monitor BG and watch for injury
88
Blood Glucose Monitoring Intervention for DM
- 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
Medication Interventions for DM
- 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
Rapid Acting Insulin
- aspart (Novolog), lisper (Humalog)
- Onset: 0.25hrs
- Peak: 0.5-3hrs
- Duration: 3-5hrs
91
Short Acting Insulin
- regular U100, regular U500
- Onset: 0.5-1.5hrs
- Peak: 2-5hrs (U500: 4-12hrs)
- Duration: 5-8hrs (U500: 24hrs)
92
Intermediate Acting Insulin
- NPH, 70/30, 50/50
- Onset: 0.25-1.5hrs
- Peak: 1-12hrs
- Duration: 16-24hrs
93
Long Acting Insulin
- glargine (Lantus), determir (Levemir)
- Onset: 1-4hrs
- Peak: none-8hrs
- Duration: 5.7-24hrs
94
Hypoglycemia Treatment
- 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
Diabetic Ketoacidosis Treatment
- 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
Hyperglycemia-Hyperosmolar State Treatment
- 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
Type 1 Diabetes Mellitus
- 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
Type 2 Diabetes Mellitus
- 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
Fasting Blood Glucose Test
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
Glucose Tolerance Test
Levels greater than 140 or less than 200 indicate impaired glucose tolerance; levels greater than 200 indicate provisional diagnosis
101
Glycosylated hemoglobin (hemoglobin A1C)
- 4-6%; Levels greater than 6.5% are diagnostic for the diagnosis of DM
- Levels greater than 8% indicate poor diabetic control
102
Factors Affecting Insulin Absorption
- 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
