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vanessa endocrine ppnp > nursing practice > Flashcards

nursing practice Flashcards

1
Q

what is the goal setting for diabetic patient?

A
  1. achieve and maintain premeal glucose in (4-7 range) within3 days
  2. target Hba1c below 7%
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2
Q

what is the flow of diabetes check if after 2 test cannot cfm
(not sure of this medthod)

A

first do fasting : if more than 6 (high)
do oral gtt
impaired fasting glucose : less then or equal to 7.8
impaired glucose tolerance : 7.8-11
diabetes melletus : more than or equal to 11

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3
Q

what are the things to take note for oral GTT

A
  1. fast patient 8-14 hours overnight
  2. performed in the morn after at least 3 days of restricted diet (greater than 150g of carb daily), normal physical activities
  3. collect 3ml of blood
  4. administer 75g anhydrous glucose orally over 5 mins
  5. collect blood sample again after 2 hours
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4
Q

what to do if Hba1c less than 7% (mild)

A

medical nutrition, therapy exercise and patient education

metformin (monotherapy)is an option

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5
Q

what to do if Hba1c 7-9%

A

metformin 1st line of drug

alternative therapy

  1. sulfonylurea + DPP 4 inhibitor
  2. Sulfonylurea + Thiazoldinedione
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6
Q

what to do if Hba1c more than 9%

A

metformin plus 2nd agent

alternative : start insulin therapy

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7
Q

for all hba1c high patient what do you need to do?

A
  1. reevaluate in a timely manner

2. lifestyle modification

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8
Q

when should urine and blood ketone monitoring be done?

A

during sustained hyperglycemia ( blood glucose more than 14 ) in patients with type 1 diabetes especially during acute illness

blood»> urine

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9
Q

when is self monitoring of blood glucose needed?

A
  1. type 1 or 2 diabetes who are using insulin
  2. type 2 diabetes who are not treated with insulin but are at risk of developing hypoglycemia, pregnant, acute illness, failed to achieve glycemic goals, undergoing fasting
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10
Q

when is hba1c monitoring needed?

A
  1. routinely in all patients with diabetes at initial assessment
  2. 3-4 monthly in patients with unstable glycemic control , failure to meet treatment goals, recent adjustment in therapy or intensive insulin therapy
  3. 6monthly with stable glycemic control and who are meeting treatment goals
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11
Q

what to do when patient is diagnosed with dka ? all situations

A

start IV fluid 1liter of 0.9% Nacl per hour

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12
Q

what to do when there is severe hypovolemia ? in dka patient

A

administer 0.9% Nacl (1 liter per hour)

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13
Q

what to do when there is mild hypovolemia? in dka patient

A

determine the serum NA level in the body

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14
Q

what to do when there is high - normal Na level? in dka patient

A

0.45 % Na cl (250-500ml per hour)

when serum glucose reaches 200mg/dl (11.1) change to
5% dextrose with 0.45% Nacl at 15-250ml/hour

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15
Q

what to do when serum Na level is low ? in dka patient

A

administer 0.9% Nacl (250-500ml per hour)

when serum glucose reaches 200mg/dl (4.4) change to
5% dextrose with 0.45% Nacl at 15-250ml/hour

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16
Q

what to do for cardiogenic shock? in dka patient

A

hemodynamic monitoring / pressor

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17
Q

what to do if potassium level is less than 3.3 LOW ? (dka patient)

A

hold insulin and give 20-40 K per hour until K is more than 3.3

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18
Q

what to do if potassium level is 3.3-5.3 medium ? (dka patient)

A

give 20-30 of K in eacg liter of IV fluid to keep serum K between 4-5

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19
Q

what to do if potassium level is more than 5.3 ? (dka patient)

A

do not give K but check serum K every 2 hours

20
Q

what to do if patient Ph is less than 6.9 ?

A 
dilute NaHCO3 (100mol) in 400ml H20 with 20KCL 
infuse over 2 hours

repeat NaHCO3 administration every 2 hours until PH more than 7

Monitor serum K every 2 hours

21
Q

what is preoperative care ?

A

begins with the decision to perform surgery and continue until the client has reached the operating table

22
Q

what is intraoperative care?

A

entire duration of the surgical procedure until transfer of patient to recovery area

23
Q

what is post operative care?

A

begins with admission to recovery area and continues until the client receives follow up evaluation at home or is discharged to rehabilitation unit

24
Q

what is involved in preoperative care ?

A
  1. informed consent
  2. pre operative checklist
  3. nil by mouth
  4. pre operative teaching
25
Q

what to take note for the signing of form?

A
  1. all amendments on the form must have a initial and stamp of the person making the amendments
  2. witness should have their full name and designation
  3. all the dates need to reflect the same day
  4. nature of surgery must be complete
26
Q

what is the reason behind not being able to eat or drink before surgery?

A
  1. risk of aspiration
  2. risk of infection and surgery complications
  3. bowel prep interference
  4. risk of nausea and vomitting
27
Q

for surgeries in the morn, what are the instructions to take ?

A

12- 6am

  • water is allowed
  • high bp med allowed
  • no food and drinks
  • no diabetic medication

after 6am

  • no water
  • everything else is same
28
Q

for surgeries after 1pm what are the instructions to take ?

A

12-6am

  • water and 2 slices of plain bread allowed
  • high bp med allowed
  • no food n drinks
  • no diabetic medication

6am -10am
- everything same except no bread

after 10am
- everything same plus no high blood med

29
Q

what to do during pre operative training?

A
  1. what to expect during the day of surgery
  2. what to expect post operative
  3. post operative exercise
30
Q

what are the post operative exercise ?

A
  1. coughing (splinting)
    - instruct the patient to take a deep breath and hold it for 1-2 second
    - cough 2-3 times in a row
    - cough from belly and not throat
    - support incision site with towel during the cough
  2. deep breathing exercise
    - incentive spirometry
31
Q

what is the presenting problem of hemorrhage for post op?

bleeding from a damaged blood vessel

A

low blood pressure

tachycardia

32
Q

what are the preventive measure for hemorrhage ?

A
  1. doctor to review medication such as anti platelet agents and anticoagulant
  2. anemia is best corrected before planned surgery and preoperative transfusion should occur at least 48-72 hours
  3. avoid preoperative dehydration with use of maintenance IV fluid
33
Q

what are the presenting symptom of surgical site infection?

A

at surgical site
- pain , swelling, heat , prulent wound discharge or dehiscence (separation of wound)

general:
- pyrexia(fever) , tachycardia and malaise (discomfort)

usually after 3 day

34
Q

what are the preventive measures for surgical site infection?

A
  1. control hyperglycemic
  2. treat exisitinf bacterial colonisaton (mrsa screening)
  3. optimise nutrition
  4. in operating theatre, for hair removal use clipping and avoid shaving ,aseptic technique , and avoid hypothermia by using patient warming device)
  5. regular wound inspection
35
Q

what are the two different venous thromboembolism ?

A

pulmonary embolism

deep vein thrombosis

36
Q

what are the signs of pulmonary embolism ?

A
  1. tachypnoea and decreased oxygen saturations
  2. tachycardia
  3. pleuritic type chest pain (sudden intense stabbing or burning pain in the chest when inhaling and exhaling or coughing and sneezing)

usually after 3 day

37
Q

what are the signs of deep vein thrombosis ?

A

unilateral calf swelling and tenderness
dilation of superficial veins
erythema (skin rash)
mild pyrexia (fever)

38
Q

what are the preventive measures for venous thromboembolism?

A
  1. ensure adequate hydration
  2. promote early mobilization
  3. use stockings
39
Q

what are the signs of post operative pain?

A

pain can result in

  • tachycardia and hypertension
  • respiratory compromise (diaphragmatic splinting , atelectasis collapse of lung , sputum retention, infection)
  • paralytic ileus
  • urinary retention
  • immobility and low mood
40
Q

what are the ways to prevent post operative pain?

A

pre emptive analgesia ( painkiller)

41
Q

what are the signs of respiratory complication?

A

basal atelectasis :
most common cause of fever and low oxygen saturations in the first 12-24 hour after surgery

tachypnoea (rapid breathing) or productive cough , low o2 saturation

42
Q

what are the preventive measures for respiratory complication?

A

preoperative and post operative physiotherapy
deep breathing exercises as well as techniques for expectoration secretion
bronchodilator nebulizer and incentive spirometry

43
Q

when there is productive cough and fever and decreased O2 saturation what is the possible complication ?

A

basal atelectasis

44
Q

when there is intense sharp pain in chest with decreased O2 saturation?

A

pulmonary embolism

45
Q

when there is low blood pressure and tachycardia what is the possible complication?

A

haemorrhage , escape of blood from blood vessel

vanessa endocrine ppnp (8 decks)

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