Final Exam Flashcards
Dka prority
A) insulin
B) administer 0.9% sodiumnchloride
B); metabolic acidosis-> risk of hypovolemia and arrhythmias due to hypokalemia
Prioritize fluid resuscitation with isotonic fluid. then IV insulin with potassium (even if normal)** with hourly bs checks
In dka, hyperglycemia, lots of sugar in urine brings fluid with it. Also fat is broken into ketones and there is deep and labored breathing as a result. Initially there in hyperkalemia but later Insulin administration will cause hypovolemia/hypokalemia. Monitor serum potassium while giving it.
DKA vs HHNS
dka is type 1 and acidic; faster onset. Sugar is greater than 300 and kussmaul’s breathing with ketones and abd pain.
Hhs is type 2 and not ketones. Dehydration is more prominent and confusion.
Hhs treatment when bs is 350
Give normal saline 0.9%
Give iv insulin until 300 and then subcutaneously and then manage electrolytes
Reassess blood sugar hourly and rehydration (bp and cap refill, urine 30 ml/hr; specific gravity of 1.005-.030 and warm skin/color)
Monitor for edema, blood sugar, lung sounds, ecg,kidney function, I/O.
Patient has DI, what to do and monitor after giving medication?
Lack of adh-Desmopression and should urinate every 3-4 hours.
Siadh
What are some interventions? -meds/independent actions
What do you watch out?
What is bp?
In SIADH, there is too much absorbtion of water by adh (increased bp) and low urine output. Sodium is low due to lots of water->seizures/confusion. 7s’s
Stop urination
Sticky thick urine (1.03+)/concentrated
Soaked inside (hypoosmolality and natremia)
Sodium low
Seizures
Severely high bp
Stop fluids and give salt (3% saline) with diuretic
Caused by small lung cancer severe brain trauma and sepsis
Daily weights
DI
Die ADH or Dehydrated (low adh)
Diuresis
Diluted urine (low specific gravity less than .005)
Dry (hyperosmolality-thick blood and hypernatremia
Drinking a lot
Dehydrated skin and mucosa
Decreased bp
Desmopressin decrease urine output and can also cause death by seizures
Caused by brain damage (tumors, trauma, surgery)
When caring for a patient with siadh, what does the nurse implement select all:
Iv 0.9 NS
Fluid restriction
Sodium restriction
Seizure precuations
Monitor I/O
Measure weight weekly
Fluid restriction, seizure precautions, I/O,
In a patient with DI and a brain tumor what does nurse expect to find: dark urine with high sepcific geavity
High blood serum osmolality
Weight gain withe edema
Increased thirst
Sodium of 134
Urine output below 30 ml/less
High serum osmo
Increase thirst
Lack of adh
A client is prescribed desmospressin what is wrong teaching:
Frequent headaches are normal
I will make sure to restrict water
This drug is used to decrease frequent urine
I am glad it can treat siadh
I will record output closely while using drug
I will weight myself weekly
Frequent headaches are normal (headaches are sign of hypomatremia causing seizures)
I will restrict water
It will treat siadh
Weekly weight
Hyperthyroidism
What is diet like? Physical manifestations. Bowels? Gi? Monitor for what?
High energy/Nervous/Tremors/Palpitations
and hot or graves disease
High t3/t4
Monitor for thyroid storm (agitation and confusion)
Grape eyes; exothalamus
High bp/hr; weight loss and hungry due to high energy burn
heat intolerance & sweaty
Tx: Beta blockers, Methimazole, PTU, Radiactive 131 (Family planning/take preg test b4; can give hypothyrodism)
Risk of A fib (clots-stroke) & HF (hypertrophy)
-monitor vision changes: liver function, cbc (thyroid storm), and t3/t4
_give sedatives; avoid stimulants; provide rest
High gi (diarrhea)
Need high calories and proteins (frequent meals-6/8 per day)
No fiber, caffeine (soda or tea), or spicy food
Hypothyroidism
Caused by what? Complications/what to monitor? Nails? Excretion?
Weight/fluid? Blood? Hair? Tx? Temp?
Levothyroxine (whatnot to take it with); 4 things to look out for
Low and slow
Priority: myxedema coma (post thuroidectomy or abruptly stopping levothyroxine)
Puffy face/weight gain (low metabolism), Low hb/anemia
Numbness/tingling, high cholestrol-> left ventricle dysf
Low temp and cold intolerance
Low digestion/constipation
Low hair or alopecia not hirutism and brittle nails
Low mental status and energy
Amen no period
Treat: Rest and levothyroxine at 6am without magnesium antiacids; It will decrease the function of anticoagulants and digoxin (monitor for bleeding annd heart)
There is a risk of angina and arrhythmias due to increase o2 demand to myocardium
Caused primary:not enough t3/4
Seondary: thyroidectomy or pituitary not tsh
Hashimoto’s thyroidits is mostly
Copd patient has 85% o2 sat, would increase oxygen up to 3L on norebreather or increase o2 and get abg
increase o2 and get abg to determine effectiveness. Copd patients use nc 2-4 or venturi 40%
Addison’s
What is diet like? What is high? Does it cure? What causes it?
Lack of cortisol and aldosterone
*Low bp, tanned skin and mucosa (especially knuckles and elbows), low glucose, low sodium, high potassium, & Low weight
Causes: Autoimmune or disease (tb) or overuse of corticosteroids (COPD/Lupus)
Watch for Addison’s crisis
Tx: Prevent circulatory shutdown
Monitor orthostatic bp (administer iv fluids with sodium). If severly hypotensive-give vasopressors. Administer IV Dextrose.
Monitor glucose and electrolytes (Na, K, Ca). I/O and daily weights. High protein and carbohydrate diet with salt. Monitor cortisol and acth.
Administer IV Solu-corkf (hydrocortisone).
Avoid stress
Cushing’s
What is bp like? What mark do they have? Hair? Bones? Causes?
Big huge cushion of steroids
Big, round, and heavy
Big bp, glucose/sodium
Big belly/trunchal obesity/moon face/buffalo hump/hirutism
Big purple striae/butterfly mark/rosy cheeks
Slow wound healing/brittle bones
Causes: high steroids (prednisone)
Tumor (pituitary or adrenal)
Small cell lung cancer
Tx: cut causes; tumor or slowly decrease steroids
Steroid precautions
Swollen:report l lb a day or 2-3 lb in few days
Sepsis: report low wbc;low grade fever (100) is srs
Sugar increased; increase insulin for diabetics
Skinny (osteoporosis)
Sight (cataracts)
What is the purpose of pursed lip breathing?
Helps the airway stay open and provides positive pressure and releases trapper air
Patient is obtunded and responding to only painful stimuli. Blood glucose is 38
Protocols/types of _____
Usually less than 70; severe is less than 40;
Mild: sweating and tachycardia, tremors
Moderate: confusion/slurred speech, drowsy
Severe: seizures, loc, death
In this case give IM/sq glucagon or 25-50 ml 50% dextrose
If awake: gice 15 g carb: 4-6 oz juice ir 3-4 glucose tablets
Recheck sugar in 15 if les than 70; if greater than 70 give protein and carb (pb&j unless they plan to eat in 1 hr)
A diabetic comes in with a foot injury what do you assess? Cap refill
Temperature
Sharp/dull
Two point doscrimination
Light touch
Pulses
Reflexes
Rom
Sharp/dull, two point disc…
Cap refill & pulses
Temperature
Educate patient: not to go to salon and to cut nails straight across; shake shoes before wearing; never go barefoot and get annual foot exams; no moisture between toes and inspect foot daily
Lispro onset and duration
15 min; 2-4 hours
Dawn phenomenon vs somoyagi effeect
Dawn phenomenon occurs in all people; sugar spikes at dawn
Somoyagi: in diabetics if they take too much insulin before bed or if they don’t eat before bedtime, they get hypoglycemic and that causes rebound hyperglycemia
How often do you change insulin pump needles? How do you calibrate it? What should u keep on hand ? Where and when should a non insulin user test blood sugar?
Every 3 days; enter the number of carbs eaten per meal; a spare pen; post-prandial or fasting on the pads of their fingers (smbg or cgms)
Hypoglycemia manifeststions
Diaphoresis, palpitations, shaky, dizzy/hungry, confusion
