fast med

Question 1

why is metformin stopped 48 hrs before and after a ct or mri

Answer 1

these investigations often use contrast medium. in patients with renal failure, renal clearance of metformin is decreased and the retention of the drug can result in lactic acidosis. therefore metformin is stopped to allow the kidney a period of time to filter blood of the contrast first.

Question 2

in which patients are metformin and contrast medium contraindicated. which lab results indicate this contraindication.

Answer 2

patients with renal failure. this is often indicated by a serum creatinine of less than 150 which indicates eGFR of 30 - 59 mL/min

Question 3

what is TOC, what does it entail and when is it successful

Answer 3

toc is trial off catheter. it involves removing the catheter, encouraging fluid intake. success of toc is often indicated by a PVRU of less than 100 ml or void of more than 150

Question 4

what is contrast medium

Answer 4

a medium which increases the contrast of structures and fluids

Question 5

on an iv line, what is the difference in the purpose of the roller clamp and the side clamp

Answer 5

the roller clamp controls the infusion rate, while the side clamp allows for clamping completely for a moment without having to readjust the infusion rate

Question 6

why do patients on warfarin need consistent K

Answer 6

wafarin is an anticoagulant which interferes with the hepatic synthesis of vitamin K–dependent coagulation factor. therefore warfarin rncrease INR and vit K decrease INR, essentially they work against each other. so it is important to keep consistent K, so that INR monitoring will be accurate.

Question 7

what is the duration of a pvru and why

Answer 7

immediately or up to 10 mins, as more than 10 mins can lead to clinically significant overestimation of PVRU
or
some suggest up to 30 minutes post void

Question 8

what are the protocols for a pvru of more than 200mls

Answer 8

200 - 300 mls (CICx1 a day)
301-400 mls (CICx2 a day)
401 - 500 mls (CICx3 a day)
more than 500 mls (IDC)

Question 9

upon glucose POCT, a patient is found to have a BSL of less than 4mmol/L, still alert and on orals feeds. what are your interventions

Answer 9

1. give sugar water (15g dextrose power in 50mls of water)
2. inform doctor and after 15 minutes do a second POCT
3. after doctor has reviewed pre meal dm medications do serve next meal if within 30 minutes and if not within 30 minutes to give 3 crackers or 1/2 can isocal
4. supplement any meals of less than 1/2 share with
   - 1/2 share glucerna (if on fluid restict - 1/2 share nepro)
   or
   - 2 slices of bread
   or
   - 3 crackers and 1 cup milo
5. repeat third POCT 1 hours later

Question 10

what are the consequence of leaving hypoglycemic states untreated

Answer 10

coma or death

Question 11

a patient is said to be in a mild hypoglycemic state

1) What would the BSL range be?
2) What are some s/s
3) What is the pathophysiology of these s/s

Answer 11

1) 3 - 3.9 mmol/L
2) sweating, palpitations, tremors, anxiety, hunger,
3) these are manifestations of a nutritionally deprived brain which stimulates the sympathetic nervous system to increase blood sugar levels

Question 12

why is the occurrence of hyperglycemic states higher in hospitals

Answer 12

hyperglycemia is a natural response to injury and illness as the adrenal glands release cortisol to raise glucose levels to ensure that there is enough glucose readily available

Question 13

a patient is said to be in a hyperglycemic state

1) What would the BSL range be?
2) What are some s/s

Answer 13

1) more than 24mmol/l

2) polydipsia, polyuria (increase sugar, has an osmotic effect, eventually peed out), dry mouth, blurred vision