Final Exam: SG Material 2 Flashcards
Intermediate Insulin
- brand name
- peak
- duration
- onset
- what other insulin can it be administered with?
- NPH
- peak: 4-12 hrs
- duration: 18-24 hrs
- onset: 1-2 hrs
- regular or rapid acting
Long-acting insulin
- brand name
- peak
- duration
- onset
- when to administer subcutaneous injection?
- Glargine
- NO peak
- duration: 24 hrs
- onset: 1-2 hrs
- administered at bedtime or early in the morning
Rapid-acting insulin
- brand name
- peak
- duration
- onset
- when to have a meal?
- Lispro
- peak: 1-2 hrs
- duration: 4-6 hrs
- onset: 5-15 mins
- should have food within 5-15 mins after administration
Short-acting insulin
- brand name
- peak
- duration
- onset
- when to have a meal?
- Regular
- peak: 1.5 hrs
- duration: 6-8 hrs
- onset: 30 mins - 1 hr
- should have a meal within 1 hr
What test is used to test adherence in diabetic patients?
Hemoglobin A1C (ideal: less than 7%)
S/S of hypoglycemia (4) “DISH”
diaphoresis, irritability, shakiness, hunger
DKA occurs in? Indicated by?
DM1; indicated by ketones in the urine
Hyperosmolar hypoglycemic (HHS) requires similar treatment to DKA including? (4)
- normal saline
- insulin drip
- electrolyte monitor
- check mental status
Types of angina? (2)
stable: stopping activity and rest can alleviate pain
unstable: cannot be relieved with nitroglycerin, has a possibility of turning into an MI (happens spontaneously)
Patient teaching for nitroglycerin (3)
- vasodilator: take while sitting or standing to prevent dizziness (orthostatic hypotension)
- max of 3 doses, one every 5 mins if pain does not subside after 3rd dose, call 911
- take under the tongue, do not chew or swallow
Patient teaching for hypertension (2)
- sodium restriction (2 g/day)
- teach the patient to self-record BP
Hypertension and diabetes are associated with what disease process?
Chronic kidney disease
Preventions for DVT? (4)
- SCD device on AT ALL TIMES
- compression stockings
- ambulation
- prophylactic blood thinners
Lab monitoring for warfarin/coumadin (anticoagulant) (2)
- PT (normal = 10-13 seconds)
- INR (normal = 2-3)
Lab monitoring for heparin?
aPTT
If a patient’s control is 30 and their aPTT result is 45, is their dose within therapeutic levels? What does it mean if they are below range?
(find the range by x 1.5 and 2 to the control)
range = 45-60 = within therapeutic range
below range = subtherapeutic
DVT is most common in which patients?
Periop patients
RSHF systemic s/s? (4)
- JVD
- hepatomegaly
- splenomegaly
- peripheral edema
LSHF respiratory s/s (4)
- dyspnea
- SOB
- crackles in lungs
- feelings “drowning” at night (unable to breath when lying down flat)
Medication treatment for CHF? (2)
- Lasix
- Digoxin
Patient teaching for digoxin (2)
- assess apical pulse, hold if less than 60
- s/s of digitalis toxicity: visual halos, nausea, vomiting, diarrhea, headaches
Patient teaching for Lasix (2)
- assess electrolytes (esp potassium; normal = 3.5-5)
- assess BP (hold if hypotensive)
Congestive heart failure can cause?
LOC changes due to oxygenation and perfusion deficiency
Diet for patients with kidney failure?
- low sodium and low potassium renal diet
End-stage renal disease can cause issues in?
mental status / changes in LOC
Which dietary selection should lead the nurse to conclude that the dietary teaching is successful for a patient on a low-sodium diet?
Baked chicken, white rice, apple juice
When should we anticipate the HCP ordering an anticoagulant?
To decrease or prevent clotting (eg: DVT)
If a clot breaks in the left leg, where is it most likely to travel to?
To the lungs
If a clot forms in the atrium from atrial defibrillation, it is most likely to travel to which organ?
The brain
Antiplatelet vs anticoagulant
Antiplatelet: keeps platelets from sticking together (eg: aspirin, clopidogrel)
Anticoagulant: works on the coagulation cascade (eg: warfarin, heparin)
Common side effect of aspirin?
GI bleed
What is the onset of warfarin?
3-4 days (risk for DVT enlargement)
What are the two types of heparin?
Unfractionated and LMW
Low-molecular-weight: Lovenox, can be used as a preventative measure for patients who are immobile for long periods of time; has a FASTER onset
Heparin is measured in?
units
A nursing student who is preparing to care for a postop patient with DVT asks the nurse why the patient must take heparin rather than warfarin. Which response by the nurse is correct?
Warfarin has a delayed 3-4 day onset
A 50 yr old female patient asks the nurse about taking aspirin to prevent heart disease. The patient does not have a hx of MI. Her cholesterol and BP are normal and she does not smoke. What will the nurse tell the patient?
There is most likely no protective benefit for patients of her age
A patient who is taking clopidogrel (Plavix) calls the nurse to report black, tarry stools and coffee-ground emesis. the nurse will tell the patient to?
Continue taking the clopidogrel until talking to the provider
A patient is admitted to the hospital with unstable angina and will undergo a percutaneous coronary intervention. Which drug regimen will the nurse expect to administer to prevent thrombosis in this patient?
Anticoagulants (eg: heparin, abciximab (ReoPro); antiplatelets would not be strong enough
A postop patient reports pain in the left lower extremity. The nurse notes swelling in the lower leg, which feels warm to the touch. The nurse will anticipate giving which medication?
Warmth to the touch, swelling are indications of DVT. Will anticipate administering an anticoagulant like enoxaparin (lovenox)
A patient who is taking warfarin (coumadin) has just vomited blood. The nurse notifies the provider who orders lab work revealing a PT of 42 seconds and an INR of 3.5. The nurse will expect to administer?
Vitamin K (antidote for warfarin)
A patient is receiving heparin post-op to prevent DVT. The nurse notes that the patient has a BP of 90/50, HR of 98. The patient’s most recent aPTT is greater than 90 seconds. The nurse reports lumbar pain. What should the nurse request to put an order for?
Protamine sulfate (antidote for heparin)
normal aPTT = 60-80 seconds
Which vital sign should be taken for a patient with a gastroesophageal balloon in place?
Respiratory rate
Aldosterone regulates? (2)
- fluid volume
- sodium
RAAS
renin aldosterone angiotensin system
Describe the steps of RAAS in response to low BP (5)
- low BP is sensed by baroreceptors
- kidneys release renin
- renin secretes aldosterone
- aldosterone secretes angiotensin 1
- angiotensin-converting enzyme converts angiotensin 1 to 2 (potent vasodilator, culprit for increasing BP)
ACE inhibitors end in? Effects?
-pril; decreases BP
Patient teaching for ACE inhibitor medications? (3)
- change positions slowly when sitting to standing (orthostatic hypotension)
- should take the first dose when sitting down (can have first dose hypotension)
- ACE non-prod cough can cause patient to stop adherence to medication
