Exam 3 Review PowerPoint Flashcards
What should the nurse assess for in a patient who has bradycardia?
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HYPOXIA
What is a potential cause of premature ventricular contractions (PVCs)?
Hyperkalemia (↑ potassium)
Type 1 Diabetes
* What is the cause?
* What should the A1C of a patient with T1DM be?
* What are potential complications of T1DM?
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Cause: destruction & loss of beta cells (genetic)
A1C: less than 7%
Potential Complications:
* DKA
* Nephropathy - ↑ protein in urine
* Retinopathy - blindness
* Coronary Artery Disease (CAD)
* Stroke
* Peripheral Artery Disease (PAD)
List the actions of insulin
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- Promotes glucose uptake
- Glucose is stored as glycogen
- Prevents fat & glycogen breakdown
- Inhibits gluconeogenesis
- ↑ protein synthesis
List the onset, peak , & duration of Humulin R (regular) insulin.
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- Onset: 30 - 60 minutes
- Peak: 2-4 hours
- Duration: 6-8 hours
List the onset, peak , & duration of Novalog (insulin aspart).
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- Onset: 5-15 minutes
- Peak: 1-2 hours
- Duration: 4-6 hours
List the onset, peak , & duration of Lantus.
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- Onset: 2-4 hours
- Peak: flat
- Duration: 20-26 hours
List the onset, peak , & duration of NPH insulin.
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- Onset: 2-4 hours
- Peak: 4-10 hours
- Duration: 10-16 hours
Signs & Symptoms of Hypoglycemia
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- Hunger
- Anxiety
- **Tachycardia **(↑ HR)
- Headache
- Lightheadedness
- Confusion
Treatment for hypoglycemia
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- Pt is awake & alert: 1/2 cup juice, then startch & protein
- Pt is unconscious: 1 amp of D50
Signs & Symptoms of DKA vs. HHS
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DKA:
* pH under 7.3 (pH < 7.3)
* ↑ potassium
* glucose > 250 mg/dL
HHS:
* pH > 7.3
* serum osmo > 320 mOsm / kg
* glucose > 600 mg/dL
Which electrolyte should be closely monitored with Syndrome of Inappropriate Antidiuretic Hormone (SIADH) and Diabetes Insipidus (DI)?
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Sodium
What is the difference in syndrome of inappropriate antidiuretic hormone (SIADH) & diabetes insipidus (DI)?
SIADH: too much ADH (↑ ADH)
DI: lack of ADH (↓ ADH)
What is SIADH? What happens to sodium & urine osmol? What is the treatment??
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SIADH = too much ADH
- ↑ ADH
- ↓ Na+
- ↑ urine osmol (concentrated urine)
Treatment: sodium replacement (hypertonic saline 3%)
What is DI? What happens to sodium & urine osmol? What is the treatment??
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DI: lacking ADH
- ↓ ADH
- ↑ Na+
- ↓ urine osmol (diluted urine)
Treatment: fluid replacement (volume restoration) & Demopressin
Signs & Symptoms of Cardiac (pericardial) Tamponade
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BECK’S TRIAD:
* + JVD
* Muffled heart sounds
* Pulsus paradoxus
- Dyspnea
- ↓ Diastolic filling
- ↓ stroke volume
- ↓ cardiac output
S/S of tension pneumothorax
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- Trachea deviates to the OPPOSITE side
- hyperresonance is heard on the same side
Pneumothorax = collapsed lung
Signs & Symptoms of Hemothorax
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- dyspnea (which can lead to tachypnea)
- Chest pain
- low BP (signs of shock)
- ↓ or absent breath sounds on injured side
- dullness to percussion on injured side
Compartment Syndrome
* What is the hallmark sign?
* What is the treatment?
* What are the 5 P’s?
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- Hallmark sign = Unrelenting pain (pain out of proportion to injury)
- Tx = fasciotomy
5 P’s
* Pallor
* Paresthesia
* Proprioception
* Pain
* Pulse
What is the earliest & most reliable symptom indicative of increased intracranial pressure (↑ ICP)?
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Change in LOC or mental status
Symptoms & Treatment of Acute Renal Injury (ARI/AKI)
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S/S
* Oliguria (↓ urine output)
* hypocalcemia (& hyperkalemia due to ↓ GFR)
* ↑ BUN & Creatinine
Tx = ↓ sodium, potassium, & phosphorus intake(also ↓ protein intake)
Which type of kidney injury causes acute tubular necrosis?
Intrinsic kidney injury
Stages of Acute Tubular Necrosis
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Onset or Initiating Phase: hours to days; from precipitating event until tubular injury occurs
Oliguric / Anuric Phase: 5-16 days; necrotic tissue blocks urine & damages tubular wall
Diuretic Phase: 7-14 days; ↑ GFR & polyuria
* monitor for dehydration
Recovery / Convalescent Phase: renal tissue repair occurs, BUN & Creatinine return to normal
What is the treatment for portal HTN & cirrhosis?
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TIPS procedure
* Transjugular Intrahepatic Portosystemic Shunt
What are signs & symptoms of Fulminant Hepatic Failure (FHF)? What is the treatment?
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- Jaundice
- Ascites
- Confusion
- N/V
- Bleeding (↑ PT, aPTT, & INR; ↓ platelets)
Signs & Symptoms of Fat Embolism Syndrome (FES).
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- Respiratory Failure
- Cerebral Dysfunction
- Skin petechiae (does not blanch)
- Symptoms occur within a few hours to 3-4 days
- Common after a long-bone fracture
Primary vs. Secondary Multisystem Organ Dysfunction (MODS)
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Primary: Occurs as a result of an injury or diease that leads directly to organ dysfunction
Secondary: consequence of wisespread sustained systemic inflammation that indirectly leads to organ dysfunction
Which IV solution most closely resembles the composition of plasma in the body?
Lactated Ringers
