kettering patient assessment Flashcards
K: key principles for ethics
- autonomy
- veracity
- nonmaleficence
- beneficence
- confidentiality
- justice
- role duty
K: What does the priniciple of “justice” in health care ethics stand for?
the fair distribution of health care
K: What does the principle of “role duty” in health care ethics stand for?
that practitioners understand the limits of their role, their scope of practice, and practice within those limits
K: What is the respiratory quotient?
the ratio of CO2 production to oxygen consumption:
VCO2/VO2
K: What is the normal range of the respiratory quotient?
0.67-1.3
K: What controllable patient factor influences the respiratory quotient?
the type of food metabolized
K: What is the respiratory quotient of carbohydrates?
1
K: What is the respiratory quotient of fats?
0.71
K: What is the respiratory quotient of proteins?
0.82
What lab abnormalities could be manifested by adrenal insufficiency?
- hyponatremia
- hyperkalemia
- hypercalcemia (rare)
- azotemia
- anemia
- eosinophilia
(UTD, accessed 20200907)
K: What is azotemia?
an excess of urea or other nitrogenous wastes in the blood as a result of kidney insufficiency
K: Name some clinical manifestations of acute adrenal insufficiency.
- hypotension refractory to fluids or pressors (UpToDate: characterized predominantly by shock d/t collapse of peripheral venous tone)
- weakness
- nausea and vomiting
- abdominal pain (“acute abdomen” UTD)
- tachycardia
- orthostatic hypotension
- fever (unexplained)
what conditions can generate a diabetic emergency?
a relative or absolute lack of insulin plus increased production of-- * glucagon * catecholamines * cortisol * epinephrine
name the diabetic emergencies
DKA
hyperglycemic hyperosmolar state
what are the common clinical manifestations of hyperglycemic hyperosmolar state?
- -Symptom onset progressive over several days
- -Dehydration (decreased skin turgor, dry axillae and mucosal membranes, tachycardia, low JVP, hypotension)
- -Polyuria
- -Polydipsia
- -Weight loss
- -then neurological symptoms as serum osmolality rises above 320-330 mosm/L–lethargy, focal signs (hemiparesis, hemianopia, seizures), obtundation, coma (UTD, accessed 20201106)
what are common clinical manifestations of DKA?
- -Symptoms onset rapid over 24 hours
- -Dehydration (decreased skin turgor, dry axillae and mucosal membranes, tachycardia, low JVP, hypotension)
- -Abdominal pain (associated with acidosis), nausea, vomiting
- -Kussmaul’s breathing
- -Odor of acetone on the breath
- -Neurological symptoms possible–due to acidosis rather than to hyperosmolar state (UTD, accessed 20201106)
hyperglycemic hyperosmolar state can present with (K short version)—
altered mental status
arrhythmias
who gets hyperglycemia?
diabetics
critically ill patients–diabetic or not
when should insulin therapy be initiated for critically ill patients?
persistent hyperglycemia >180 mg/dL
what glucose level should be targeted in critically ill patients?
140-180 mg/dL
what can give you an inverted t-wave?
ischemia
digitalis toxicity
hypokalemia
what ekg changes might accompany ischemia?
depressed T wave
inverted T wave
what ekg change accompanies cardiac injury?
elevated S-T segment
what ekg change signifies infarction?
significant Q waves