Final Flashcards
Anaphylaxis- intraop
- SS: HoTN, tachycardia, bronchospasm, pulmonary edema
- Tx= recognize SS, maintain airway, 100% O2, epinephrine IV, maintain BP with fluids or meds, Benadryl IV
malignant hyperthermia - intraop
-SS early: tachycardia, rising BP, tachypnea, muscle rigidity
-SS late- increased temp, increased metabolic rate, HoTN, muscle rigidity, cyanosis
Tx- stop procedure, 100% O2, cool PT
Med- dantrolene sodium, diuretics, bicarb
metabolic syndrome
- cluster of 5 components:
1. elevated glucose levels
2. abdominal obesity
3. increased triglycerides
4. Decreased HDLs
5. HTN
T1DM 3 Ps
- polydipsia, polyuria, polyphagia (hungry)
3 methods of diagnosis for DM
- fasting plasma glucose level > 126 mg/dl
- random or casual plasma glucose measurement ≥ 200 mg/dl + SS ( 3 Ps or others)
- Two-hour OGTT level≥ 200 mg/dl using glucose load of 75 g
rapid acting insulin
- basal, bolus-
- Lispro , aspart, glulisine
- injected 0 -15 minutes before meal
- onset : 15 min
- Peak: 60-90 min
- Duration- 3-4 hrs
Short-acting bolus insulin
- reg
- injected 30-45 min before meal
- Action: 30-60 min
- 2-3 hrs
- duration: 3-6 hrs
intermediate acting insulin
- NPH or Lente
- injected 1 or 2 X a day
- onset : 2-4 hrs
- peak: 4-10
- duration: 10-16
long-acting basal
- Lantus or Levimir
- injected once a day at bedtime or in morning
- released steadily and continuously
- onset: 1-2 hrs
- no peak action
- duration: 24 + hrs
- cannot be mixes with any other insulin
Storage of insulin
- do not heat/freeze
- in-use vial may be left at room temp up to 4 weeks
- extra insulin should be refridgerated
- avoid exposure to direct sunlight
- prefilled syringes stable for 30 days when refridgerated
sulfonylureas
- T2DM
- increase insulin production in the pancreas
- 10% experience decreased effectiveness after prolonged use
- ex. Glipizide, Glimepiride
Meglitinides
- increase insulin production from pancreas
- taken 30 min before meal , don’t take if meal skipped
- ex. Repaglinide, Nateglinide
Biguanides
- reduce glucose production by liver
- enhance insulin sensitivity at tissues
- improve glucose transport into cells
- do not promote weight gain
- Metformin: hold 24 hrs before/after use of IV contrast
a-glucosidase inhibitors
- starch blockers
- slow down absorption of carbs in sm intestine
- Acarbose, Miglitol
Meds that impact BGM
- B-adrenergic blockers- mask SS of hypoglycemia or prolong effects
- thiazide/loop diuretics- potentiate hyperglycemia by inducing K+
- corticosteroids- can potentiate hyperglycemia
Hypoglycemia
-BGM < 70 CMs: -confusion, irritability, pale and diaphoretic -weakness -tremors -hunger -visual disturbances -unTreated: Loss of C. seizures, coma, death
at first sign of hypoglycemia, the nurse should
- Check BGM
- if <70 start treatment
Hypoglycemia Rule of 15
- 15 g of simple carbs
- recheck BGM 15 min after tx
- repeat 15 g carbs X2 until BGM > 70
- Call EMS if not responding after 3X
- follow up with longer acting carbs to avoid rebound hyperglycemia
- check BGM again after 45 minutes after Tx
thyroid blood levels , hyperthyroidism
decreased TSH + increased T3 and T4
thyroid blood levels, hypothyroidism
increased TSH + increased T3 and T4
hyperthyroidism CM
-graves, goiter
- increased metabolic rate
- weight loss, nervousness, sleep disturbances
- hair loss
-poor intolerance to heat
-excessive perspiration
- exopthalmos
-tachycardia
Tx- antithyroid, iodine, B adrenergic blockers
signs of hypoglycemia
- Chovsteks
- Trousseau’s
hypothyroidism SS
- congenital:cretinism
- acquired: Hashimoto’s-autoimmune
- SS: weight gain, fatigue, lethargy, forgetfulness, irritability, HAs, constipation, menstrual disorders, numbness, tingling in arms & legs, intolerance to cold
hypothyroidism Physical Exam
- swollen eyelids & lips
- dry thick skin
- goiter
- bruising
- thin, coarse hair
- hoarseness
- non-pitting edema
- facial edema/ myexedema
- bradycardia
- dyspnea
- pallor
- anemia
Aldosterone regulates….
Sodium!
Anti diuretic hormone regulates….
Water !
Sickle cell crisis
HOPS Hydration Oxygen Pain management Support
thrombocytopenia
- platelet < 150k
- other labs
- Bone marrow aspiration
- ITP positive antigen
Blood therapy reaction plan
- STOP TRANSFUSION
- IV access
- ABCs
- frequent VS
- Call MD
- Notify blood bank/save bag
- 24 hour urine-why? evaluate hemolysis
SS local inflammation
FIRE Feeling pain Induration Redness Edema
cortisol
- from adrenal gland
- helps body control inflammation
IgG
viruses, bacteria, fungi
IgM
ABO/blood type
IgA
breast milk
IgE
allergic reactions and parasitic
IgD
Assists in differentiation of B-cells
HIV SS
- frequent persistent infections
- fever
- night sweats
- swollen lymph nodes
- fatigue
- weight loss
- peds: lymphadenopathy, hepatosplenomegaly, oral candidiasis, chronic recurrent diarrhea, failure to thrive, developmental delay
stages of cancer developmetn
- initiation- taken over
- promotion-mutated cell proliferating
- Progression- now have SS of disease process (fatigue, anorexia, weight loss)
TNM classification
anatomic extent of disease is based on 3 parameters:
- Tumor size and invasiveness (T)
- Spread to lymph nodes (N)
- Metastasis (M)
7 warning signs of cancer
CAUTION Change in bowel or bladder habits A sore that does not heal Unusual bleeding or discharge from any body orifice Thickening or a lump in the breast or elsewhere Indigestion or difficulty swallowing Obvious change in a wart or mole Nagging cough or hoarseness
TB SS
- cough
- night sweats
- chest pain & tightness
- fatigue
- anorexia
- weight loss
- low-grade fever
TB confirm DG
Sputum culture AFB
