Med. Surge 3 - exam

Question 1

which describes HHS in DM type 2?

Answer 1

a blood glucose of >600-1000; the patient is going through total dehydration because water is leaving the cells to thin the blood of glucose; No ketones because insulin is still being produced

Question 2

What is a fasting plasma glucose?

Answer 2

-to help diagnose diabetes
-this is a BG >126

Question 3

Which describes non-pharmacologic treatment of type 1 diabetes?

Answer 3

-diet “my plate” guidelines; a protein, carb and veggie - this will slow absorption + the glycemic response
-stop/no smoking
-exercise

Question 4

What is causing an arrhythmia in a uncontrolled diabetic patient?

Answer 4

high blood sugar

Question 5

which of these describes A Fib?

Answer 5

missing P waves and irregular QRS complexes

Question 6

What cardiac arrhythmias result from uncontrolled diabetes?

Answer 6

-A Fib
- A Flutter
-V Tach
-V Fib

Question 7

Which describes V Fib?

Answer 7

(crazy) multiple QRS’s

Question 8

If your patient is in V Tach or V Fib, what are you doing about it?

Answer 8

-CPR/ code cart
-Lidocaine + Amiodarone

Question 9

When your diabetic patient is having an arrhythmia due to high blood sugar, what are we doing to help this patient?

Answer 9

-check their blood sugar
-hang normal saline - this is going to thin the blood to “get rid” of the excess sugar
-then give insulin, because you don’t want their sugar to drop too quickly
(all with dr.’s orders)

Question 10

What are you going to do for a patient that is experiencing SVT?

Answer 10

-have the patient bare down to vagal themselves
-bag of ice to “put them into shock” and bring HR down
-ADENOSINE

Question 11

What should be taught to your diabetic patient about their blood glucose related to stress?

Answer 11

-their blood sugar may increase
-physical activity and exercise are very important

Question 12

What medication would you give to patient in sinus bradycardia?

Answer 12

ATROPINE
-this is a HR <60

Question 13

What are you going to give your type 1 diabetic patient who is currently hypoglycemic?

Answer 13

-glucagon
-dextrose in water (this will also rehydrate them)

Question 14

Why does a diabetic patient develop microalbuminuria? (protein in the urine)

Answer 14

this is caused by blood vessel damage in the kidneys; if their blood glucose isn’t brought down this may facilitate a need for dialysis

Question 15

which describes peripheral neuropathy?

Answer 15

tingling and numbness

Question 16

What are some s+s of DKA?

Answer 16

-kussmal respirations
-ketones present in the urine
-fruity breath
-blurred vision
-altered mental status

Question 17

which of these describes kussmal respirations?

Answer 17

deep and labored

Question 18

describe the SOMOGYI effect.

Answer 18

elevated blood sugar in the morning; when blood sugar is low the body releases glucagon (from its stores) + epinephrine, the liver turns that glucagon into glucose.

-this process is trying to counter regulate and bring the blood sugar up, but it can result in a period of high blood sugar following this

Question 19

How can a patient try to avoid the SOMOGYI effect in the morning?

Answer 19

by having a snack at bedtime w/ their insulin

Question 20

describe the dawn phenomenon.

Answer 20

this is when hormones, (cortisol + growth hormone) that your body is naturally producing, causing an increase in your blood sugar in the morning, and your body isn’t producing enough insulin to control the glucose level.

Question 21

how can a patient try to avoid the dawn phenomenon in the morning?

Answer 21

-changing their insulin dose and adding a carbohydrate into their bedtime routine

Question 22

what are some things we need to educate diabetic patients about when they’re leaving the hospital?

Answer 22

-diet + exercise
-proper foot care etc.

Question 23

What describes a continuous glucose monitor (CGM)?

Answer 23

this is continuously monitoring the patients glucose levels, make sure to monitor for hypo and hyperglycemia

Question 24

which describes PVD wounds?

Answer 24

they are irregular shaped wounds

Question 25

Why do patients with PVD have swelling and edema?

Answer 25

this is because there is obstructed blood flow + blood begins to pool and extra fluid begins to accumulate in the tissue

Question 26

which describes PAD wounds?

Answer 26

they are round wounds (they look like little beauty PADs)