Mark K Lectures 4-6 Flashcards
When would a patient use 2 point crutches?
Both legs are mildly bad
When would a pt use 3 point crutches?
One leg is bad, but can bear weight
When would a pt use 4 point crutches?
Both legs are very bad
How would a pt go up and down the stairs with crutches?
Up with good leg first
Down with bad leg first
Which side does a pt hold a cane?
On the strong side
What does it mean if a pt has neurosis?
They are not psychotic
They still have good insight and are reality based
What is a delusion?
False belief but cant be sensed
What is a hallucination?
Sensing something that isnt there
What is an illusion?
Misinterpretation of reality (sensory)
Which types of psychosis are functional?
Scitzophrenia
Scitzo-effective disorder
Major depression
Manic
How should you treat functional psychosis types?
They have the potential to learn reality so you teach them reality:
1st acknowledge their feeling
2nd present reality
3rd set limit (ex: that topic is off limits)
4th enforce limit (end convo if they don’t stop)
How should you treat a pt with dimensia?
Cannot learn reality so
1st acknowledge feeling
2nd redirect them (to something they can do)
But can do reality orientation (person, place, time)
What is delirium?
Temporary, sudden, dramatic, secondary loss of reality (usually due to chemical imbalance)
How should you treat a pt with delirium?
The focus is on removing the cause and keeping the pt safe
Communication:
1st acknowledge feeling
2nd reassure
What is flight of ideas?
Phrases don’t make sense together
What is neoglism?
Made up words
What is a narrowed self concept?
Functional psychotic won’t leave room or change clothes because it terrifies them (they don’t know who they are anymore)
What is ideas of reference?
They think everyone is talking about them
Main concepts about T2DM diet
Calorie restriction
6 small meals
When should you check glucose levels?
At the insulin’s peak
Which insulin can be given IV?
Regular insulin
Onset, peak, duration of regular insulin
Onset 1 hr
Peak 2 hr
Duration 4 hr
What type of insulin is regular insulin?
Short rapid acting
What type of insulin is NPH insulin?
Intermediate
(N = Not so fast & No IV)
Onset, peak, duration of NPH insulin
Onset 6 hr
Peak 8-10 hr
Duration 12 hr
What type of insulin is Lispro?
Fastest acting
Onset, peak, and duration of lispro insulin
Onset 15 min
Peak 30 min
Duration 3 hr
When should Lispro be given?
Give WITH meals (Not AC = before meal)
What type of insulin is Glargine?
Long acting
Onset, peak, and duration of Glargine
Onset 2 hr
No peak
Duration 12-24 hr
When should glargine be given?
No risk of hypoglycemia so can safely give at bedtime
Pt teaching for insulin
Need to check expiration date - ok for 30 days after opened
Refrigeration of insulin in hospital not necessary, but pt should refrigerate at home
Exercise acts as extra insulin shot
Sick days: keep taking insulin as usually (glucose raises due to stress of illness)
S/s of hypoglycemia
Pt acts drunk and in shock
(Staggering, emotionally liable, slurred speech, slowed judgement, low BP, tachycardia, tachypnea, cold and clammy)
Treatment for hypoglycemia
If conscious: sugar/rapid carb AND starch or protein
If unconscious: glucagon IM or IV Dextrose (D10 or D50)
Does DKA occur with T1 or T2 DM?
T1DM
What is the number one cause of DKA?
Acute viral upper respiratory infection in last 2 weeks
S/s of DKA
D = dehydrated
K = ketones (in blood), Kussmauls, high K (potassium)
A = acidosis, acetone breath (fruity), anorexia (r/t nausea)
Treatment of DKA
IV fluids with regular insulin in it very rapidly
Can T1 or T2 DM get HHNK/HHS
Only T2DM
How should you treat HHNK?
Treat as dehydration
(2nd priority but more people die)
A1C ranges
< or = to 6 is in control
> or = to 8 is out of control
7 is on the border so check for infection, tell to diet and exercise
What is lithium used for?
Bipolar mania
Therapeutic and toxic levels of lithium
Therapeutic: 0.6-1.2
Toxic: > or = 2
What is digoxin used for?
Treats Afib and CHF
Therapeutic and toxic levels for digoxin
Therapeutic: 1-2
Toxic: > or = 2
What is Aminophylline used for?
Airway antispasmodic
Therapeutic and toxic levels of Aminophylline
Therapeutic: 10-20
Toxic: > or = 20
What is phenytoin used for?
Seizures
Therapeutic and toxic levels of phenytoin
Therapeutic: 10-20
Toxic: > or = 20
What is bilirubin?
Waste product from breakdown of RBCs (only worry about this level for newborns)
Newborn elevated and toxic levels for bilirubin
Elevated range: 10-20
Toxic: > or = 20
What is Kernicterus?
Bilirubin in brain (level around 20 is deadly)
What is opisthotonic?
Hyperextension of body due to Kernicterus
Emergency
What should you do for a pt who is opisthotonic?
Put pt on side
Difference between pathologic and physiologic jaundice
Pathologic: baby born with jaundice = bad
Physiologic: not present at birth = normal
What occurs with a hiatal hernia?
Regurgitation into esophagus because stomach is herniated into esophagus
(Stomach contents move in wrong direction at normal speed)
What occurs with dumping syndrome?
Usually occurs after gastric surgery (gastric contents move in correct direction too quickly)
S/s of hiatal hernia
GERD that occurs when lying down after eating ONLY
Treatment of hiatal hernia
HOB high
Liquid with meals
High carb content
S/s of dumping syndrome
Drunk symptoms (due to decreased blood flow to brain)
Shock symptoms
Acute abdominal distress (cramping, gurgling, diarrhea, borborigmy, etc.)
Treatment of dumping syndrome
HOB flat (head to side)
Liquid between meals only
Low carb content
What happens to the body with a potassium imbalance?
Kalemias do the same as the prefix except for HR and urine output
If symptoms are other than skeletal and muscular, pick kalemia
What happens to the body with a calcium imbalance?
Calcemias do the opposite of the prefix
With more skeletal/muscular symptoms
What happens in the body when magnesium imbalances?
Magnesium as do the opposite of the prefix
What is a Trosseau sign and when does it occur?
Hand spasm with BP cuff
Low calcium
What is chevostek sign and when does it occur?
Cheek spasm
Low calcium
Symptoms of hypernatremia
Dehydration
Symptoms of hyponatremia
Overload
1st s/s of electrolyte imbalance
Paresthesia (esp. circumoral paresthesia)
What is one symptom all electrolyte imbalances have?
Paresis (muscle weakness)
Things to remember when treating hypokalemia
Never push IV
Never > 40 of potassium
Treatment for hyperkalemia
Give D5W with regular insulin (to drive K into cell)
Polystyrene sulfonate (Kayexalate)
*both are given at the same time
