Focus Review Flashcards
What is difference between Hypothyroidism and Graves’ Disease?
Hypothyroidism: Decrease in T3 & T4, Watch TSH
Graves: Patient is at risk for thyroid storm
** What are the signs and symptoms of hypothyroidism?
Lethargy, Fatigue, Weight Gain, Cold Intolerance, Bradycardia
** Know the signs and symptoms of Graves’ disease
TACHYCARDIA, Heat intolerance (excessive sweating), Tremors, Bulging eyes (Exophthalmos), Decrease Weight, Insomnia, Restlessness, Muscle Weakness
What patient educations would you include when taking Synthroid?
Take in the AM at the same time; 30 minutes Before breakfast
What are the side effects of Synthroid?
Nervousness, Insomnia, Weight loss, Tremors, N/V, Diarrhea, Cramps, TACHYCARDIA, Palpitations, Hypertension, Dysrhythmias, Angina, or Thyroid Crisis
What are the long term side effects of PTU and Tapazole?
Anti-thyroid meds, Treat HYPERthyroidism, Liver damage, Liver failure, Death, Wean off of it, do not abruptly stop, Interact w/anticoagulants (increases), Decreases effects of Antidiabetics
Describe the signs and symptoms of Thyroid storm?
Fever, Tachycardia (Give beta blocker to bring heart rate down), High BP, Visit to ICU
What is the difference between Type I and Type II Diabetes?
Type 1 – Insulin dependent, NO ORAL MEDS Type 2 – Insulin resistance. Can be managed with diet and Oral meds, if that isn’t working you may need to switch to Insulin SubQ
What is the treatment of Type I?
Will look Up
What is the treatment of Type II?
Will look Up
** What is the difference Hypoglycemia and Hyperglycemia
HYPO- tremors, clammy, sweating, faintness, confusion, fast heartbeat
HYPER- blurry vision, THIRST, dry skin, hunger, need to urinate often
Patient and family education when managing Type I or Type II diabetes.
Will look up
What is the Peak, Onset, and duration for Insulin?
Onset (5 to 15 minutes) Peak (30 minutes to 1 hour) Duration (2 to 4 hours)
Patient education regarding Insulin Pumps and Insulin
Keep in fridge, Exp dates, how to administer
Nursing considerations with Insulin administration
Check blood glucose, expiration dates, and fridge, throw away after 30 days
Patient education for the Diabetic patient on Glucophage
Stop 24 – 48 hours before scans with iodine contrast, False positive result Do not give dextrose, if NPO/fluid hanging because of protein
Signs and symptoms of the patient with DKA and management of the patient with DKA
Fruity breath, Blood glucose over 600 confused, extreme thirst, kassmual breathing
Management: IV drip Insulin (Regular) Check blood sugar every hour ICU
Describe possible side effects and patient education regarding the use of steroids
Prednisone, Increase appetite, Steroid induced diabetes, COPD patients
Know the difference between Addison’s Disease and Cushing’s Disease
Addison’s: Low electrolytes & fluid deficits
Cushing’s: Too much/overflow, take away glucocorticoids
What medications are used to treat Addison’s and Cushing’s Disease?
Gluccoroticoids (Florinef): Watch for increase appetite (watch diet), watch mood (agitated or depressed), urinary output, hypertension, take as prescribed
Review Nursing Process for the patient with Addison’s and Cushing’s
Addison’s: Watch HYPOTENSION, Dysrhythmias, Bradycardia, watch electrolytes, if untreated = fatal
What is heart failure & S/S?
Right = peripheral edema (feet, hands) Left = pulmonary edema, fluid in the lungs, congested (rales/crackles), Lung disease, Risk for right sided heart failure
List important patient teaching for patients are Digoxin
Check pulse: less than 60 do not give
Half life = 36 to 48 hours
Antidote = Digamide
Lab: If greater than 2.5 = TOXIC
List signs and symptoms of Digoxin Toxicity
Bradycardia, Nausea, Very confused, Halos (white/green), older adults with renal impairments
Non-pharmacological measure to help the patient with heart failure
Control Sodium intake – 1 Teaspoon a day, proper rest, decrease stress, no extreme weather changes, avoid smoking, relaxation techniques
How to treat the patient with Angina
Nitro – 5 minutes apart – Sublingual times 3, call doctor after
**Which medications are used to treat Stable, Unstable and Variant Angina?
Stable: Excessive stress/strenuous activity Med = betablocker (propranolol) not for asthmatics, lung disease, or COPD
Unstable: Progressive (not related to activity) Med = Nitro or Isosoribide
Variant: Channel Calcium blockers (Cardizem)
Know when Nitro is used
Unstable
Know side effects to monitor for Nitrates
Weak, dizziness, confused, headaches, risk for orthostatic hypotension, lightheadedness
Teach Keep out of sunlight, throw away after 6 months, check expiration dates.
Which medications should be avoided with the patient with Heart block?
Calcium Channel Blockers
Know the management of Hypertension
Decrease sodium, exercise, decrease stress, diet, smoking, Coronary artery disease
Why are diuretics used?
Decrease blood pressure and fluid
Know the difference between Thiazides, Loop, Osmotic, and Potassium sparing
Thiazides (HCTZ): long-term and maintenance, used with antihypertensives, edema, “water pill”
Loop Diuretics: Bumex, Furosemide,“tequila” works fast and hard- AT RISK FOR electrolyte imbalance watch K+ levels
Osmotic: to decrease ICP , Mannitol watch cerebral edema, medication is working if patient becomes alert. Trip to ICU if changes in consciousness, committing, seizure
Potassium Sparing: Watch potassium levels, use with anti-hypertensives
Nursing considerations for patients on thiazides
Watch diabetics because they can go into HYPERglycemia
Know labs to monitor for the patient on thiazides
Glucose, electrolytes
When do we use osmotic diuretics?
Intercranial Pressure
What are nursing considerations for patient on diuretics?
Watch electrolyte imbalance, BP, Kidney Function, Potassium
What are nursing considerations for patients on Antihypertensive?
Check blood pressure, Make sure there is no heart block, coronary heart disease
Dietary restrictions for the patient on ACE inhibitor’s
Watch potassium and salt substitutes, give herbs and natural foods instead
Common side effects of ACE inhibitors
Nagging Cough, Give ARBs, Diavan
When are ARB’s used?
Nagging Cough
Dietary restrictions for patient on Loop diuretics
Bum ex && feurosimide –diuretics
Watch out for potassium levels
Know the management of the patient that we suspect he had a stroke
Will look up
What type of thrombolytic therapy would be used with if a stroke has been confirmed?
Will look up
What lab values should be monitored when on Antiplatelet therapy?
PTT – aPTT (Heparin)
What is Protamine Sulfate used for?
Antidote for Heparin
What is the antidote for Coumadin?
Vitamin K
Know the difference between Cardio selective and non-cardio selective
Cardio selective: Only heart
Non cardio selective: Heart & Lungs, Do not give properolol if they have lung disease
What medication is use for dysrhythmia? How do we know if it has been effective?
Adenosin
If EKG is normal sinus rhythm
Know dietary restrictions for a patient of ACE inhibitors
Use salt substitutes
Know the labs to monitor for patients on Anticoagulant therapy
PT – INR
What lab values are monitored with hyperlipidemia?
HDLs & LDLs
What type of medication is commonly used?
Lipitor “Statins” only take at night to get an reaction
What important education should the nurse provide regarding side effects and adverse reactions to Statins?
Adverse Reaction = Rhabdo (muscle weakness, nerve endings), if leg pain occurs call doctor
What are commonly used Statin’s?
lower cholesterol
When are statin’s usually taken and why?
At night because cholesterol is highest
Know non pharmacological ways to manage the patient with Nausea and Vomiting
Banannas Rice Apple Toast
Flat sodas/weak teas
Gatorade = vomiting
Know the management of patient with Diarrhea
Lomotil: has atropine = dry up, if working it will decrease diarrhea
Know the management of the patient with Constipation
Typically seen with pain management patients
Commonly used antiemetic for patient’s on chemotherapy and when is it administered
30 minutes before treatment - Zofran
Know the treatment for H. Pylori
Flagyll, Pepto Bismo, Amoxicillin, Prilosec
Patient teaching for Laxative use and Antidiarrheal medications
Dependency - people abuse them.
Know how to determine if medications for GI disorders are effective
Will look up
Commonly used medication with liver disease know how to determine its effectiveness
Lactolose - mental status goes back to normal & is alert, decrease in ammonia levels
Know important patient education regard the use of Carafate
30 minutes before meals 3 times a day & once before bed
Disease resulting from deficient glucose metabolism
Diabetes Mellitus
Protein secreted from the beta cells of the pancreas
Insulin
Reaction to low blood sugar
Hypoglycemic reaction
Type of diabetes with no beta cell function
Type 1 Diabetes
Diabetic Acidosis
Ketoacidosis
Tissue Atrophy
Lipodystrophy
Increased thirst
Polydipsia
Increased Hunger
Polyphagia
Increased Urine Output
Polyuria
Hyperglycemia on Awakening
Dawn Phenomenon
Intermediate-acting insulin
NPH insulin
Tissue Atrophy (What drug)
Lipoatrophy
Oral hypoglycemia drug group
Sulfonylureas
Hyperglycemic hormone that stimulates glycogenolysis
Glucagon
Rapid-acting insulin
Lispro Insulin
Nursing Intervention: Monitor blood glucose levels (What is the Rationale?)
Prevents incidences of hyper and hypoglycemia
Nursing Intervention: Instruct the patient to report signs and symptoms of “insulin shock” (Hypoglycemic reaction) (What is the Rationale?)
Signs and symptoms include nervousness, tremors, cold and clammy skin, and slurred speech.
Nursing Intervention: Inform the patient to have orange juice or a sugar-containing drink available if hypoglycemic reaction occurs(What is the Rationale?)
Orange juice or a sweetened beverage adds sugar to the body for insulin utilization
Nursing Intervention: Instruct the patient to check the blood sugar daily (What is the Rationale?)
Done to make sure it is within normal levels
Nursing Intervention: Instruct the patient to adhere to the prescribed diet (What is the rationale?)
Diet is prescribed according to amount of insulin given per day
Nursing Intervention: Instruct family members on how to administer glucagon by injection for a hypoglycemic reaction (What is the rationale?)
Patient may be unable to swallow orange juice
Advise the patient to obtain a Medic-Alert card or tag (What is the Rationale?)
Needed in case of a severe hypoglycemic reaction where the patient ma be unconscious
What is/are the major symptoms that characterize diabetes?
Polydipsia, Polyphagia, and Polyuria
Which drugs may cause hyperglycemia?
Epinephrine, Hydrochlorothiazide, and Prednisone
What is the rationale for rotation of insulin injection sites?
It prevents lipodystrophy
What is the only type of insulin that may be administered IV?
Regular.. DKA patients, Type 1 patients
Which clinical manifestations may be seen in a patient experiencing a hypoglycemic (insulin) reaction?
Headache, excessive perspiration, nervousness, tremor, and vomiting.
Which clinical manifestations ay be seen in a patient experiencing diabetic ketoacidosis (Hyperglycemia)?
Dry mucous membranes, Fruity breath odor, Kussmaul’s respirations, polyuria, and thirst.
The patient has Type 1 diabetes. Which medication should the patient not use to control his diabetes?
Tolazamide (Tolinase) – Type 1: insulin dependent
Which information should be included in health teaching for patient taking insulin?
Adhere to the prescribed diet, Be sure to exercise, Monitor blood glucose level, Recognize signs of hypoglycemic reaction, take insulin as prescribed
Which information should be included in health teaching for patients taking oral anti diabetic (hypoglycemic) drugs?
Adhere to prescribed diet, monitor blood glucose levels, monitor weight, and participate in regular exercise.
Lipoatrophy is a complication that occurs when insulin is injected repeatedly in one site. What is the physiologic effect that occurs?
Raised lump or knot on the skin surface
Where should the patient who takes insulin daily be taught to store the opened insulin?
In a cool place
How should the nurse or patient prepare insulin prior to administration?
Roll the bottle in the hands
The nurse is preparing to give a patient his daily insulin. The patient receives both NPH and regular insulin. What is the best action by the nurse?
Prepare one injection; draw up regular insulin first.
Which type of syringe should be used to administer a patient’s daily insulin dose of 6 units of U100 regular and 14 units of U100 NPH?
Prepare one injection; draw up regular insulin first.
The patient needs to develop a “site rotation pattern” for insulin injections. The American Diabetes Association suggests which actions?
Choose an injection site for a week, Inject insulin each day at the injection site at 1 1/2 inches apart. With two daily injection times, use the right side in the morning and the left side in the evening.
When should the nurse expect that the patient may experience a hypoglycemic reaction to regular insulin if administration occurs at 0700 and the patient does not eat?
0800-0900
How long after NHP administration would the nurse expect the patient’s insulin peak?
6-12 hours
Lantus is a long-acting insulin. Which statements best describes Lantus?
It is given in the evening, it is available in a 3-mL cartridge insulin pen, and some patients complain of pain at the injection site.
What is a method to determine if the patient has developed an allergy to insulin?
Skin test with different insulin preparations
The insulin pump, though expensive, has become popular in the management of insulin. What does the nurse know about this method of insulin delivery?
It is more effective in decreasing the number of hypoglycemic reactions
What is an action of an oral hypoglycemic agent?
It increases the number of insulin cell receptors
The patient asks if Prandin is oral insulin. What is the nurse’s best response?
No, it is not the same as insulin. Prandin can be used only when there is some beta cell function.
Which effect is/are representative of econd-generation sulfonylureas?
Effective doses are less than with first generation sulfonylureas. They have less displacement from protein-binding sites by other highly protein-bound drugs.
The nonsulfonylureas are used to control serum glucose levels after a meal. What best describes their action?
They decrease hepatic production of glucose from store glycogen.
A patient newly diagnosed with type 2 diabetes has been prescribed acarbose (Precose), and he asks the nurse how the medication works if it is not insulin. What is the nurse’s best response?
It works through inhibiting digestive enzymes in the small intestine, which releases glucose from the complex carbohydrates in the diet (less sugar is available).
The patient has Type 2 diabetes and has just not been prescribed pioglitazone HCI (Actos). This medication is in the thiazolidinedione of nonsulfonylureas. How does this group of oral antidiabetics work?
They increase insulin sensitivity for improving blood glucose levels.
In 2007 the FDA added a warning to rosiglitazone (Avandia). What was the warning regarding?
Increased risk of heart attack.
Patients taking thiazolidinedione drugs such as pioglitazone (Actos) and rosiglitazone (Avandia) should have which laboratory test monitored?
Liver enzymes
Herb-drug interaction must be assessed in patients taking herbs and antidiabetic agents. How do ginseng and garlic affect insulin or oral antidiabetic drugs?
They can lower the blood glucose level, thus causing a hypoglycemic effect.
What is/are the recommended guidelines for use of oral antidiabetics in patients with diabetes?
Fating blood sugar
***Which drugs or categories of drugs will interact with sulfonylurea?
Anticoagulants, Anticonvulsants, Aspirin, and Sulfonamides.
What is/are contraindications for the use of oral antidiabetic drugs?
Breastfeeding, pregnancy, renal dysfunction, and severe infection.
