Mark K Lectures 4-6 Flashcards by Katy Peterson

When would a patient use 2 point crutches?

Both legs are mildly bad

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When would a pt use 3 point crutches?

One leg is bad, but can bear weight

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When would a pt use 4 point crutches?

Both legs are very bad

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How would a pt go up and down the stairs with crutches?

Up with good leg first
Down with bad leg first

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Which side does a pt hold a cane?

On the strong side

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What does it mean if a pt has neurosis?

They are not psychotic
They still have good insight and are reality based

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What is a delusion?

False belief but cant be sensed

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What is a hallucination?

Sensing something that isnt there

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What is an illusion?

Misinterpretation of reality (sensory)

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Which types of psychosis are functional?

Scitzophrenia
Scitzo-effective disorder
Major depression
Manic

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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)

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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)

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What is delirium?

Temporary, sudden, dramatic, secondary loss of reality (usually due to chemical imbalance)

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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

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What is flight of ideas?

Phrases don’t make sense together

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What is neoglism?

Made up words

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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)

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What is ideas of reference?

They think everyone is talking about them

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Main concepts about T2DM diet

Calorie restriction
6 small meals

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When should you check glucose levels?

At the insulin’s peak

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Which insulin can be given IV?

Regular insulin

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Onset, peak, duration of regular insulin

Onset 1 hr
Peak 2 hr
Duration 4 hr

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What type of insulin is regular insulin?

Short rapid acting

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What type of insulin is NPH insulin?

Intermediate
(N = Not so fast & No IV)

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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