Exam 3 Flashcards
1
Q
Why are disease modifying antiheumatic drugs used to treat RA?
A
Because it is an immuno suppressant that slows progression
2
Q
What drug is given to manage pain for patients with a hip fracture?
A
Morphine
3
Q
What age does type 2 diabetes typically affect?
A
Middle to older adults
4
Q
What is normal range for PT?
A
11-12.5 seconds
5
Q
What is fosamax?
A
A biophosphanate given to patients with osteoporosis as a precaution
6
Q
What is a major complication of left sided heart failure?
A
Pulmonary edema
7
Q
Describe Skeletal traction
A
Done through pins and wires attached to bone coming through skin. It is important to do pin care on these patients.
8
Q
Describe the contraction of the heart muscle.
A
SA Node fires within the top right atria which causes the atria to contract then sending an electrical signal to the AV Node located at the bottom of the atria.
The AV node sends an electoral signal to the Bundle of His which then travels down and breaks into the left and right bundle branch.
The left and right bundle branch then travel to the Purkinje fibers causing them to fire.
The firing of the Purkinje fibers is what causes the ventricles to contract
9
Q
How do you treat symptomatic sinus bradycardia?
A
Atropine, oxygen, treat underlying problem, pacemaker
10
Q
Why are beta-blockers given to HF patients?
A
Beta blockers increase EF over time
11
Q
What part of the body is affected in Buerger’s Disease?
A
Distal extremeties (hands/ feet)
12
Q
Describe arthroplasty.
A
A routine surgery that also involved an open reduction internal fixation (ORIF)
13
Q
What causes Raynaud’s phenomenon?
A
Vasospasms that cut off blood supply
14
Q
Describe ventricular fibrillation
A
A chaotic rhythm.
No P,QRS, and T wave
No BP, No HR, No RR
15
Q
How often should a patient do calf pumps when driving or flying long distances?
A
Once an hour
16
Q
What can cause sinus bradycardia?
A
Valsalva maneuver or rectal stimulation
17
Q
How do you treat v-tach?
A
Check ABCs Call for help Check a pulse Start CPR if needed Use defibrillator if needed
18
Q
Why are NSAIDs a last resort of treatment for osteoarthritis?
A
Because it is so harsh on organs – especially the stomach
19
Q
What are the clinical manifestations of right sided heart failure?
A
SOB Chest pain JVD Increased abdomen girth Dependent edema Hepatomegaly Ascites Edema Weight (most reliable indicator of fluid gain/loss)
20
Q
Which type of arthritis is a degenerative joint disease that progresses over time?
A
Osteoarthritis
21
Q
What is another name for asynchronized shock?
A
Defibrillator shock
22
Q
What type of insulin is Humulin NPH?
A
Intermediate acting insulin.
23
Q
How do you prevent hip dislocations post op?
A
Abduction pillow
Straight alignment
24
Q
What are late symptoms of RA?
A
Joint deformities
Severe pain
Weight loss
25
Why is diabetes type 1 considered an autonomic disorder?
Because patients are born with the disease. The pancreas does not have enough insulin to secrete.
26
What happens to the heart when the EF range is less than 50%?
There is less perfusion because blood pressure is dropping and the heart is not beating hard enough.
27
What are complications of osteoporosis?
Bone fractures
28
When can a diabetic patient not exercise?
When they are positive for ketones, when blood glucose is higher than 250 or lower than 80, with in one hour of peak insulin time or when they develop fruity breath or kussmaul respirations
29
How do you clean skeletal tractions?
Cleanse with NS or 50/50 NS and peroxide. Rinse with NS.
30
What surgery is done for osteoarthritis?
Arthroplasty (joint replacement)
31
What are three things that alter venous flow?
Thrombus
Defective valves
Non-contracting muscles.
32
Why is early treatment so potent for RA?
Because the goal is to prevent deformities
33
What is the treatment for osteomylitis?
Antibiotic therapy for weeks
34
How is type 2 diabetes treated?
First with pills and then insulin if needed.
35
What age group are hip fractures most common in?
Older adults
36
What are the risk factors for type 2 diabetes?
Overweight, no exercise, office workers, smoking, heart disease, age
37
Why does the patient with HF need to do calf pumps?
To help prevent DVT's in legs and helps reduce swelling in ankles
38
Describe Normal Sinus Rhythm
Normal P,QRS, and T wave, Rate is between 60 and 100bpm and no PVCs
39
When a patient is hemodynamically unstable, who do you call for help?
Rapid
40
What is damaged in left sided heart failure and where do you exhibit symptoms?
The rest of the body is damaged in left sided heart failure and the symptoms are shown in relation to the lungs (SOB--crackles due to fluid back up in the lungs)
41
What are the four different types of medications that are used to treat diabetes?
Sulfonylurea agents, Biguanides, Insulin Sensitives, and Insulin
42
How are DVT's diagnosed?
Ultrasound of extremity
43
How is atropine administered? What happens if atropine is not administered correctly?
Atropine must be pushed fast. If it is not pushed fast, it has a paradoxical effect -- makes the heart rate even slower
44
What is the purpose of insulin?
to move glucose from blood to the muscles and cells for energy
45
How would you treat a patient who is having a hypoglycemic episode?
Juice or hard candy followed by protein
46
Which type of arthritis is crippling?
RA
47
Describe fem/pop bypass procedure for managing PAD
Dilating a balloon
48
What is normal range for glucose tolerance test?
Less than 140
49
Define afterload
Amount of tension in the left ventricle during systole
50
For the HF patient, how much sodium can they intake in a day?
2-3 grams a day
51
What A1C level is needed to diagnose diabetes?
Greater than 6.5%
52
What are signs and symptoms of sinus tachycardia?
```
Fatigue/ weak
SOB or orthopnea
Decreased pulse ox stat
Hypotension
Chest pain
Dehydration
```
53
What is Humulin 70/30?
a combination of Regular and Isophane insulin.
54
What are some post op nursing considerations for hip replacements?
```
Assess patient for high risk for falls
Assess for confusion
Early ambulation
Prevent skin breakdown
Anticoagulant therapy
```
55
After a cast is placed, what is the nurse responsible for?
Neurovascular check
56
When do you hold beta blockers, calcium channel blockers and digoxin and call the doctor?
When the heart rate is less than 55
57
What medications are given to HF patients?
```
Venous vasodilators
Morphine
Diuretics
ACE/ARBs
Beta blockers
Digoxin
```
58
What is normal HDL levels?
Men: >45
Women: >55
59
Where does the left ventricle get blood from and where does it send blood to?
It gets blood from the lungs and pumps to the body
60
What is the second step when treating hypotension?
Give fluids
61
What is normal triglyceride levels?
Men: 40-160
Women: 35-135
62
What is the therapeutic level of digoxin?
0.5-2
63
Why is osteoporosis referred to as the silent disease?
Because the first signs in most people follow some kind of fracture.
64
Describe the onset of type 2 diabetes.
Slower and progressive
65
How much carbohydrates should a diabetic patient consume?
45% of intake should be carbohydrates
66
What is the priority for a patient who is in v fib?
Defibrillate as soon as possible.
67
If your patient is in v tach and not responsive, what should you do?
Call code blue and start compressions
68
Which type of arthritis is a non inflammatory disease?
Osteoarthritis
69
What type of diabetes is Glipizide used for?
Type 2
70
Where does the right atrium get blood from and where does it send blood to?
It gets blood from the body and sends to the lungs
71
Describe atrial fibrillation
Atria have more electoral contractions. These contractions cause the quivering between the QRS segments seen on an EKG strip.
72
How are flexion contractures treated?
Prone position 2-3 times a days. Gravity will help straighten it out.
73
What are some non surgical ways you can manage peripheral arterial disease?
Exercise and positioning
Promote vasodilation
Antiplatelet agents
74
How do you treat DVTs?
```
Bed rest
Elevate leg
NO SCDs
Do not massage
Give heparin
```
75
What is peripheral venous disease?
When the veins do not operate properly
76
What are the sick day rules?
Notify health care provider
Monitor your blood glucose levels every 4 hours
Test urine for ketones if BS is >240
Continue to take insulin and oral diabetic agents
Drink 8-12 oz of sugar free fluids
Try to eat regularly
Get plenty of rest
Call for help if you have persistent N/V, ketones, or a temp higher then 101.5
77
What causes heart failure?
Hypertension
MI
Valve insufficiency
78
What is the main fuel for the central nervous system?
Glucose
79
What is the formula for calculating heartbeats per minute?
number of QRS segments multiplied by 10 (this works with a 6 second strip)
80
Is NPH clear or cloudy?
Cloudy
81
What are some post op considerations for arthroplasty on the knee?
CMP machine, PT, OT, CMS checks
82
Describe a stasis ulcer
Never circular, deep all the way down, looks like and even crater
83
Where should unused insulin be stored?
in the refrigerator
84
Describe Sinus bradycardia
Normal P,QRS, and T wave
| Rate is less than 60 bpm
85
How many days is a bottle of insulin good for after opening?
28 days
86
What is the level needed to diagnose diabetes for fasting blood glucose?
greater than 126
87
When is it appropriate to administer 1 mg of glucagon?
When a patient is severely hypoglycemic (<20 blood glucose)
88
What is the number 1 goal for patients with osteoporosis?
Prevent broken bones and promote patient safety
89
Short acting insulin onset?
30-90 minues
90
What type of insulin is Lispro?
Rapid acting insulin (regular)
91
What is the downside to using disease modifying antiheumatic drugs to treat RA?
It increases the risk for infection.
92
What is malignant hypertension?
Hypertension that occurs during sleep time and the patient does not know that is is extremely high.
93
Short acting insulin peak?
2-5 hours
94
Which type of arthritis affects bilateral joints?
RA
95
What are some side effects associated with Pioglitazone?
Increased risk of heart failure, bone fracture, macular edema, liver impairment and bladder cancer.
96
What are the two types of heart failure
Left sided and right sided
97
Define preload
Amount of stretch in the ventricle just before systole (contraction)
98
Rapid acting insulin onset?
15-20 minutes
99
What can cause PVC's to occur?
Hypokalemia, stress, hypoxia, irritability
100
Why do HF patients need to have their electrolytes tested?
because many HF patients are on diuretics and will need replacement of mainly potassium if not others.
101
What glucose level is considered severe hypoglycemia?
Less than 20
102
How would you treat a patient who is having a hyperglycemic episode?
Water and insulin
103
How long are pre filled insulin syringes good for?
30 days
104
What are the risk factors associated with RA?
Females
Possible genetics
Smoking
Other immune disease diagnosis
105
What is neuropathy?
Damage to the nerves
106
If a patient is on potassium, what do they also have to be on?
Telemetry
107
When do you administer a small dose of heparin?
When you a preventing a patient from getting a DVT
108
For the HF patient, what are restrictions to weight gain?
Do not gain more than 2 lbs in a day or 3 lbs in a week
109
What are signs and symptoms to hypertension
Headaches
Facial flushing
Dizziness
Fainting
110
Describe Skin (Bucks traction)
A weight system with a sling on the patient.Weights are suspended in the air to cause traction on the joint through the use of wraps pulling the joint in the desired direction.
111
What is normal range for PTT for a patient who is on heparin?
1.5 -2.5 times the normal control
112
What tests are done to diagnose Osteoarthritis?
X Rays and MRIs because they show the inflammation (blood work is only done to rule out other problems)
113
What is the mode of action of Biguanides?
Increases insulin sensitivity
114
What are triggers of Raynaud's phenomenon?
Cold and stress
115
How do you treat v fib?
If there is no pulse, still check patient!
Call for help
Do CPR
Defibrillate!
116
```
Cool and clammy
Anxious/ nervous
Mental confusion
Weakness
Blurred vision
Tachycardia
Seizures
Coma
Hunger
Palpitations
Glucose <70
```
are signs and symptoms of what?
Hypoglycemia
117
What insulin can be mixed?
All insulins can be mixed using the clear to cloudy method except Lantus. Lantus cannot be mixed with anything.
118
What are the proper steps for doing an accucheck?
```
Wipe area with alcohol
Wait for area to dry (do not blow on it)
Get rid of first drop of blood
Wipe with clean gauze
Fill strip completely
Leave mete on flat surface while it reads
```
119
What are some side effects of glipizide?
hypoglycemia, weight gain (also interacts with many other medications)
120
True/False: An opened insulin bottle must be kept refrigerated.
FALSE
121
What kind of diet should a patient with osteoporosis be on?
A healthy diet in calcium and vitamin D
122
Intermediate acting insulin duration?
16-24+ hours
123
Why do patients with peripheral arterial disease lose hair in the legs?
Because their is poor circulation so the nutrients needed for the hair follicle to survive are never delivered which causes the hair to fall out.
124
Long acting insulin onset?
2-4 hours
125
What can neuropathy lead to if not taken care of?
Amputation
126
How is digoxin excreted?
It binds to potassium and leaves the body through urine
127
How is fosamax given to patients?
Pts must be sitting upright during and 30 - 60 minutes after to reduce the risk of gerd and aspiration. It must also be given with a full glass of water
128
What labs should be monitored when a patient is on metformin?
BUN/ creatine
129
What is the recommended time a diabetic patient should spend exercising?
150 minutes a week for moderate exercise or 75 minutes a week for vigorous exercise
130
What are the risk factors associated with Osteoarthritis?
```
Age
Female
Smoking
Obesity
Repetitive motion
Joint injuries
Wear and tear
```
131
How do you treat asymptomatic PVCs?
Just monitor the patient.
132
Besides nitrates, what is another vasodilator?
Isorbide Dinitrate
133
Describe aortoiliac or aortofemoral bypass procedure for managing PAD
Rerouting blood flow to different area. You reroute it to bypass the plaque.
134
If the patient complains that the potassium is burning, what can the nurse do?
Slow down the rate or call pharmacy and ask them to dilute it with lidocaine
135
What is another name for typical venous disease?
Peripheral venous disease.
136
Why is B-type natriuretic peptide (BNP) tested for patients suspected of HF?
Because BNP is an enzyme that is released by the heart muscles when they are under preload. This enzyme is a degree of HF the patient is in.
137
Is type 1 or type 2 diabetes more rare?
Type 1 is more rare.
138
Why do patients who are hypoglycemic exhibit mental confusion?
Because there is a lack of glucose getting to the brain.
139
Long acting insulin duration?
24 hours
140
What shows depolarization on an EKG?
The p wave and the QRS complex
141
What is normal range for INR?
0.9-1.2 seconds
142
What is normal range for A1C?
4-6%
143
What is type 1 diabetes treated with?
Insulin only
144
What is the mode of action of sulfonylureas?
Releases insulin
145
Which diabetic medications is extremely harsh on the patient's kidneys?
Metformin (glucophage)
146
What is a normal level for BNP?
less than 100
147
What part of the body usually experiences signs and symptoms of neuropathy first?
The toes
148
What are the two types of arthritis?
Osteoarthritis and Rheumatoid Arthritis
149
How much fiber should a diabetic patient consume?
25g for women
| 38g for men
150
What is the purpose of an urinalysis to diagnose a patient with HF?
To get the specific gravity level. It will show the concentration of urine. The specific gravity will increase in patients with HF due to the lack of urine that is being produced.
151
Intermediate acting insulin onset?
1.5 hr-4 hours
152
Describe prefilled syringes
Insulins that are within pens that are prefilled with a certain amount of insulin.
153
Which type of arthritis is an autoimmune disease where the patient's body destroys the joints?
RA
154
How do you treat asymptomatic sinus bradycardia?
Do nothing!!
155
What tests are done to diagnose RA?
```
RA factor
ANA
ESR (sed rate)
X Rays
Bone scans/ CT Scans
```
156
Why do you elevate the leg when a patient has a DVT?
To allow blood flow to go back
157
Why is tylenol used for treating Osteoarthritis?
Because it blocks pain
158
How is RA treated?
Anti-inflammatories
Analgesic
Disease modifying antiheumatic drugs
159
What are the assessments done for a neurovascular check?
```
Color/ cap refill
Movement
Sensation
Temperature
Pulse
```
160
What type of disorder is type 2 diabetes?
Progressive
161
True/False: A diabetic patient can exercise vigorously on a routinely basis.
FALSE
162
Describe an incomplete facture.
Bone only broken part way through
163
How do you treat asymptomatic sinus tachycardia?
Do nothing!
164
What is another name for capillary blood glucose?
Accuchecks!
165
What are signs and symptoms of severe arterial disease?
Cold and cyanotic
Pallor may occur with extremity elevation
Dependent rubor with dangling
166
What are signs and symptoms of dig toxicity?
Bradycardia, halos, visual disturbances, excessive night time urinating
167
Which insulin is the only insulin type that can be given IV?
Regular!
168
What are the risk factors associated with osteoporosis?
```
Age
Family history
Low body weight
Chronic low calcium and vitamin D
Lack of exercise
```
169
How can a diabetic patient prevent nephropathy?
```
Control blood sugar
Control hypertension
Stop smoking
Prevent UTI's
Avoid contrast dyes
Avoid Nephrotoxic drugs
```
170
Describe ventricular tachycardia
No visible P,QRS, and T waves
| Rate is usually 130-150 bpm (sometimes without a pulse)
171
What can atherosclerosis lead to?
Coronary artery disease
172
What specific electrolyte needs to be monitored for patients that are on digoxin?
Potassium
173
Why is it important to control blood pressure (especially for diabetics?)
Because kidneys help regulate blood pressure so controlling blood pressure will help kidneys out.
174
What would give off a positive result for orthostats?
If there is a 20 mmHg drop in systolic and/ or a 10 mmHg drop in diastolic
175
Describe an open reduction.
Done in a surgical setting where a surgeon realigns the bone and places rods, pins and screws if necessary.
176
What are the signs/ symptoms of neuropathy?
Pain, tingling, numbness in extremeties
177
Intermediate acting insulin peak?
4-12 hours
178
Describe and Open/ Compound fracture.
Bone protruding through the skin
179
How much potassium can be administered through a central line?
20 mEq/ hr
180
What is the level needed to diagnose diabetes for glucose tolerance test?
greater than 200
181
Short acting insulin duration?
5-8 hours
182
How much protein should a diabetic patient consume?
15-20% of intake should be protein
183
What are symptoms of Osteoarthritis?
Inflammation
Joint pain and tenderness
Stiffness (usually in the morning)
Crepitus of the joint (cracking of the cartilage)
Stiffness in the morning that gets better as the day goes on
184
Polyuria, polydipsia, polyphagia, vomiting, abdominal pain, dehydration, weakness, confusion, shock and coma are all classic manifestations of what?
DKA
185
What are the clinical manifestations of phlebitis?
Area is reddened and warm
186
Describe osteoporosis.
a chronic metabolic disease in which bone loss causes decreased bone density and increases the risk of fractures.
187
What are the two classifications of fractures?
Open/ Compound or
| Closed/ Simple
188
How much sugar should a diabetic patient consume?
NO SUGAR!!
189
What are symptoms of phelbitis?
Painful, radiating up arm
190
What are some side effects of metformin?
abdominal discomfort, lactic acidosis, interacts with contrast dye and can cause kidney failure.
191
What is normal range for APTT
30-40 seconds
192
What type of exercising should a patient with osteoporosis consider?
Weight bearing and muscle strengthing
193
What is normal range for APTT for a patient who is on heparin?
1.5 -2.5 times the normal control
194
What is the greatest concern for VTE?
Thrombus
| Embolism
195
What should a diabetic patient eat before exercising?
Carbs
196
What must be checked before giving insulin?
Glucose
197
Why can't older patients receive demerol?
Because it causes confusion and confusion is also a sign on infection
198
How do you treat compartment syndrome?
Treatment is to slice the skin open and release the pressure.
199
What are signs and symptoms of v-tach?
Palpitations, SOB, dizziness, chest pain
200
How can diabetic patients prevent neuropathy?
Control blood sugar
201
How do you administer prefilled syringes?
Dial the chamber to the units that are desired for administration
202
Describe phlebitis.
Inflammation of superficial veins
203
What are some complications of fractures?
Fat embolisms and compartment syndrome
204
What is normal range for blood sugar?
70-110
205
Can type 1 diabetics receive PO medication for treatment?
No, they are treated with insulin only!
206
What shows repolarization on an EKG?
The PR interval and the T wave
207
What is the age of onset for type 1 diabetes?
Usually less than 30 years old
208
What are some health promotion topics related to DVTs?
```
Oral contraceptives
No smoking
Drinking fluids
Doing leg exercises
Walking
Wearing SCD's
Calf pumps
Phlebitis from IV sites
```
209
What is another name for typical arterial disease?
Peripheral arterial disease.
210
Why is an echocardiogram performed on a patient with HF?
Because it is the only definitive way of seeing the patients EF without invasive procedures
211
Describe Buerger's Disease
Occlusion of vasculature caused by an allergic reaction to smoking
212
How is osteoporosis diagnosed?
Dual x ray absorptionmetry -- DXA
213
What are some invasive interventions to help manage peripheral arterial disease?
Percutaneous translumal angioplasty
Atherectomy
Fem/Pop bypass
Aortoiliac or aortofemoral bypass
214
What is osteomylitis?
Infection of the bone
215
What drug class is Nitrates?
Venous vasodilators
216
What does a patient need to check before taking their calcium channel blocker or beta blocker medication?
Heart rate and blood pressure
217
What is the range for fasting blood glucose that is considered pre-diabetic?
100-126
218
What is normal LDL levels?
60-180
219
What is the first step for trying to treat hypotension?
Lay flat
220
When should the needle be changed on a CSII pump to reduce skin irritation and infection?
Every 2 to 3 days
221
What is the purpose of CMP machine?
it is used to flex and extend the knee joint
222
Which type of arthritis is an inflammatory disease?
RA
223
Describe a Closed/ Simple fracture.
Bone kept within the skin layers
224
Which patient will be attended to first? Hyperglycemic or hypoglycemic?
Hypoglycemic
225
Describe Asystole
No electrical firing of the heart
226
What types of fat must be avoided for diabetic patients?
Saturated fats like butter and shortening oil
227
Define ejection fraction
The percentage of blood ejected from the heart during systole.
228
What types of food should a patient with atherosclerosis stick to?
```
Fruits
Vegetables
Whole grains
Fat-Free and Low fat dairy
Lean meats
```
229
What can happen if malignant hypertension is left untreated?
It can lead to renal failure and puts the patient at a high risk for strokes
230
What is the mode of action of insulin sensitizes?
Decreases glucose production
231
What are the nursing interventions for heart failure patients?
```
Minimal fluids or saline lock
Monitor I's & O's
Low sodium diet
Rest
SCD's
Oxygen
Bedside commode or bedpan
Fluid restriction
Don't overexert
```
232
What are complication of hypertension?
Stroke, coronary artery disease, valve disease, headaches, fatigue, activity intolerance
233
What is atherosclerosis?
Plaque buildup in the arteries
234
Describe how you would mix insulin
Administer air of units into cloudy
Administer air of units into clear
Draw clear into syringe of desired units
Draw cloudy insulin into syringe of desired units.
235
Describe premature ventricular contractions (PVC'S)?
the ventricle prematurely contracts when they are supposed to be at rest.
236
What are basic leg exercises that the HF patient cant do?
Calf pumps
237
What are signs and symptoms of DVT's?
Calf or groin pain
Unilateral swelling
Redness and warmth
Painful
238
What is the main symptom of malignant hypertension?
Headaches in the morning and blurred vision
239
Rapid acting insulin duration?
3-5 hours
240
Why is it important for the HF patient to ambulate slowly?
to reduce tiredness
241
Rapid acting insulin peak?
1-3 hours
242
What drug class is Pioglitazone?
Insulin sensitizes
243
When should a diabetic patient test their glucose when exercising?
Before, during and after.
244
What class of medication is glipizide?
Sulfonylurea
245
What is the importance of early treatment for RA?
To prevent deformities
246
Describe a complete fracture.
Bone severed all the way through
247
Is hyperglycemia type 1 or type 2 diabetes?
type 1
248
What is the range for pre-diabetic A1C level?
6.01-6.5%
249
What kind of disorder is type 1 diabetes?
Autonomic
250
What are indications of worsening or recurrent R/L sided heart failure?
```
Rapid weight gain
Decrease in exercise tolerance
Excessive awakening at night to urinate
Development of dyspnea/ angina at rest
Increased edema in feet, ankles, hands
```
251
Describe supine position
Laying flat
252
Besides fosamax, what are two other medications given to patients with osteoporosis?
Boniva and actonel
253
What does the T wave represent?
Repolarization of the ventricle.
254
Why are bone scans and CT scans done to diagnose RA?
because you can see the joints twisting
255
What are early symptoms of RA?
Inflammation
Joint pain and tenderness
Fatigue
Anorexia
256
What are the three different types of treatments for fractures?
Casts and Immobilizations
Open/ Closed reductions
Traction
257
Describe how you would take orthostatic vitals
Blood pressure is taken in three positions.
First lying down, then sitting up with feet dangling and then standing up. There would be a 2-5 minutes break in between each reading.
258
What are the two types of traction used for fractures?
Skin (Bucks traction)
| Skeletal
259
Describe Kussmaul respirations
deep and rapid respirations
260
What are co morbidities and what are some associated with diabetes?
Another disease process on top of what they already have. Hypertension, hyperlipidemia, metabolic syndrome
261
What does a CXR test for?
Fluid in the lungs caused by HF
262
What is the normal range for fasting blood glucose?
less than 100
263
When are fat embolisms seen?
In a long bone break like the femur a fat embolism will form at the break.
264
What is nephropathy?
Damage to the kidneys
265
What can diabetic patients do to prevent injury to feet?
Wear shoes at all times, inspect feet daily, trim nails straight across, don't soak feet
266
Describe compartment syndrome.
Tissues become necrotic due to increased pressure against the fascia.
267
How are flexion contractures prevented?
Range of motion
268
Describe closed reduction.
Done in an ER or office setting. Bone is realigned with the help of force. The patient is sedated and through pulling of the limb (joing) in different directions by medical personal, the joint is put back into alignment.
269
What happens if a patient does not know what triggered their acutre hf?
Change their medications
270
What is the range for glucose tolerance test that is considered pre-diabetic?
141-200
271
How much alcohol can a diabetic patient consume?
1 glass for women and 2 glasses for men
272
What does peripheral vascular disease do to the body?
It alters natural flow of blood flow through arteries and veins of the peripheral circulation
273
What are signs and symptoms of Buerger's Disease?
red, painful sore
274
What does the QRS complex represent?
Ventricle contraction
275
What is normal range for ejection fraction?
50-70%
276
```
Warm and moist
Kussmaul Respirations
Obtunded/ stupor
Abdominal cramps
N/V
Ketones in urine
Metabolic acidosis
Glucose >250
```
are signs and symptoms of what?
Hyperglycemia
277
What type of drug class is Methotrexate?
Disease modifying antirheumatic drug
278
What supplements need to be given with a diuretic for a HF patient?
electrolyte supplements
279
When a patient is experiencing sinus bradycardia and having chest pain, who do you call for help?
Rapid
280
What are the characteristics associated with metabolic syndrome, a co-morbidity of diabetes?
Abdominal syndrome, hyperglycemia, A1C 5.5-6.0, hypertension, hyperlipidemia
281
Is low preload and low afterload good or bad?
Good!
282
What drug therapies are used for treating osteoarthritis?
```
Tylenol
Topical lidoderm
NSAIDs
COX-2 Inhibitors
Cortisone injections
Muscle relaxants
```
283
Which type of diabetes destroys beta cells?
Type 1
284
What are the life threatening rhythms?
V tach, V fib, Asystole
285
What glucose level is considered mild hypoglycemia?
Less than 60
286
What are signs of sinus bradycardia?
Syncope, dizziness, confusion, hypotension, SOB, check pain
287
True/False: Calcium treats and prevents osteoporosis from worsening.
False. Calcium just helps prevent from worsening
288
What type of drug class is celebrex?
COX-2 inhibitors
289
How are nerovascular checks is regards to cast placement?
They are done proximal and distal to break
290
What are the benefits to exercise?
Because it decreases hypertention, body weight, insulin resistance, glucose tolerance, cardiovascular disease.
291
How is osteoarthritis treated?
Start with least invasive and lowest drug treatment plan.
1. Thermal Modalities
2. Drug therapies
3. Surgery
292
Why is digoxin considered a last resort medication for patients?
Because of a small therapeutic window.
293
Describe external insulin pumps.
Continuous subcutaneous infusion which normally has rapid acting insulin that is connected to the patient by an infusion set
294
What is Humilin 70/30 used for?
To treat uncontrolled diabetes
295
What is the normal blood glucose level?
70-110
296
What does an EKG show?
The rate and rhythm that the patient's heart is in.
297
Why is hypertension often referred to as the silent killer?
Because there are many times where there are no signs and symptoms but the problem is still very much there and very dangerous.
298
What does the lab test ESR measure?
Inflammation
299
How do you treat symptomatic sinus tachycardia?
ABC's (rapid response team) oxygen, correct underling problem, Calcium channel blockers, beta blockers
300
What are the clinical manifestations of left sided heart failure?
```
Pink frothy sputum
Weakness
Fatigue
Dizziness
Pulmonary congestion
SOB
Oligura (100-400 m:/24 hr of urine)
```
301
What are some lifestyle changes that can be made to control hypertension?
```
Sodium restriction
Weight reduction
Reduce alcohol intake
Exercise
Decrease stress levels
Stop smoking
```
302
Why do hip fractures have a high mortality rate?
Because of the complications
303
What does morphine do to the heart for it to be a treatment for acute HF?
Reduces preload of the heart
304
What is an important consideration to how you provide pin care?
It must be done using the sterile technique
305
Describe Atherectomy procedure for managing PAD
Scraping the plaque off
306
What class of medication is metformin?
Biguanides
307
What is retinopathy?
Retina atrophy -- blurred vision and can lead to blindness.
308
What types of drugs are prescribed for patients with atherosclerosis?
Statins (zocor)
309
Why are patients with A fib on anticoagulates?
To prevent clots from dislodging
310
Which peripheral vascular disease will exhibit edema?
Venous
311
Describe depolarization
When the atria and ventricle is contracting
312
What will happen if a patient with Buerger's Disease does not stop smoking?
They will lose fingers, toes and possibly legs
313
What signs and symptoms should a patient exhibit if they have a glucose level of less than 20?
Patient will be lethargic, obtunded
314
What are signs and symptoms of peripheral arterial disease
```
Intermittent claudication (early s/s) pain when walking but subsides at rest
Numbness or burning
Hair loss in lower leg
Dry, scaly, mottled skin
Thickened toenails
Weak or absent pulses in extremeties
Stasis ulcers
Pain that occurs even at rest (late s/s)
```
315
What kind of medication can a diabetic patient take to reduce albumin levels in the urine?
ACE and ARB's
316
Long acting insulin peak?
NONE!
317
What position should the patient with HF be in?
High fowlers
318
When is NPH used?
to cover blood sugar increases between meals and during the night
319
Describe sinus tachycardia.
Normal P,QRS, and T wave and rate is greater than 100 bpm
320
What type of medications cannot be given when a patient is receiving morphine for HF?
Diuretics because morphine helps pull fluid out of the heart
321
What are chronic complications of diabetes?
```
Nephropathy
Neuropathy
Retinopathy
Cardiovascular disease
Cerebrovascular
```
322
What labs are used to diagnose R/L sided heart failure?
Electrolytes, BNP, Urinalysis
323
Why is a fat embolism considered a complication of fracture?
Because it can break off and can travel to the lungs causing a P.E.
324
Describe repolarization
when the atria and the ventricle are relaxed
325
What glucose level is considered moderate hypoglycemia?
Less than 40
326
What type of people prefer to be in sinus bradycardia?
Athletes!
327
When do the perkinje fibers kick in?
When the ventrivles stop contracting
328
What is normal range for PTT
60-70 seconds
329
What can prevent DVT's?
Ambulation
330
Which type of arthritis affects single or multiple joints?
Osteoarthritis
331
What happens to finger tips of a patient having Raynaud's phenomenon?
They turn white and sometimes blue if prolonged
332
What system controls blood pressure?
RAS
333
How much fat should a diabetic patient consume?
20-30% of intake should be fat
334
What should a patient do if protein or albumin is present?
Decrease protein intake
335
How do you treat symptomatic PVCs?
Treat the underlying cause
Lidocaine
Amiodarone
336
What is damaged in right sided heart failure and where do you exhibit symptoms?
The damage is done to the lungs because blood is not able to go in that direction while the body (mainly extremeties) will show signs and symptoms (edema from fluid back up)
337
What does the P wave represent?
Atrial contraction
338
What are the ranges for systolic and diastolic associated with malignant hypertension
Systolic >200
| Diastolic >150
339
How much potassium can be administered through a peripheral IV?
10 mEq/ hr
340
True/ False: Type 1 and type 2 diabetes will have the same complications
True
341
Where should pre filled insulin syringes be stored?
in refrigerator
342
Besised labs, what other tests are done to diagnose HF?
ABG's, CXR, Echocardiogram, EKG
343
True/ False: Positive orthostats occur when there is an increase and decrease in numbers.
False, only going down -- not up.
344
What does the PR segment represent?
Repolarization of the Atria
345
How is phlebitis treated?
Move IV site!! It will usually heal on its own but warm and moist soaks will help.
346
If a patient is on lidocaine or amiodarone drip, what must they also be on?
Telemetry
347
How do you assess for osteomylitis?
REEDA
Check fever
Assess pain (patient will be in severe pain)
348
Describe mixed insulin
Insulins that are mixed by pharmaceutical companies and come in certain percentages of certain insulins
349
When do you administer a big dose of heparin?
For a patient that already has a DVT
350
For the HF patient, how much fluid can they intake in a day?
1000-1500 mL a day
