Random Flashcards
Statin drugs used
To treat hyperlipidemia (high cholesterol)
What meds are used for HTN and renal insufficiency?
Ace inhibitors
Calcium channel blockers
Angiotensin ii receptor blockers
What meds are not recommended for T2DM?
Beta blockers (-olol) but are used for HTN and decrease CVD
Stop using ace inhibitors if
Dry hacking cough
Diuretics are used for
Fluid overload and HTN control (Furosemide!)
Metformin
Lowers BG and improves glucose tolerance
May cause weight loss
MUST be held 48 hrs prior to and after use of dye
Sulfinylureas
Side effects: hypoglycemia and weight gain
Alcohol use can potentiate hypoglycemic effects
Increase insulin production from pancreas
Diabetic retinopathy
Microvascular damage to retina
Diabetic retinopathy increases risk for
Other eye diseases
-glaucoma
-blindness
-cataracts
Nonproliferative diabetic retinopathy
Partial occlusion of small blood vessels in retina causes micro aneurysms
Proliferative diabetic retinopathy
New blood vessels formed (neovascularization)
Can cause retinal detachment (blindness)
Nephropathy
Leading cause of ESRD
Need to control HTN and tight BG control
Labs for Nephropathy
UA — should be free of albumin, protein, glucose, nitrites, bacteria, etc.
BUN/Creatinine — BUN: 8-20; creatinine: 0.6-1.2
GFR — >60
Cues for Nephropathy
Edema of face, hands, feet
UTI symptoms
Symptoms of renal failure: anorexia, nausea, fatigue, difficulty concentrating
Sensory neuropathy
Loss of protective sensation in limbs
Anti-seizure medications
Gabapentin is the gold standard
Used for sensory neuropathy
Autonomic neuropathy
Gastroparesis — delayed gastric emptying
Cardiovascular abnormalities
Hypoglycemic unawareness
Hypoglycemia unawareness is related to
Autonomic neuropathy and lack of counterregulatory hormones
Autonomic neuropathy chronic complications
Sexual function
Neurogenic bladder (urinary retention) bethanochol!!!
Self catheterization is the last option
Cholesterol should be
Less than 200
LDL should be
Less than 100
Triglycerides should be
Less than 150
HDL should be
Women — more than 50
Men — more than 40
Glycemic index
Refers to the response to 50 grams of glucose or white bread in a normal person without diabetes
Foods with a high glycemic index do what?
Raise glucose levels faster and higher than foods with a low glycemic index
Diabetes exercise
Exercise 1 hour after a meal, don’t want to exercise when meds peak
Do not exercise if BG >300 and if ketones are present in urine
Ketones
Break down fat rapidly
Patients who use _______ are at an increased risk for ________
Insulin, meglitinides, and Sulfinylureas are at an increased risk for hypoglycemia
Hydration
8 oz fluid per hr
Every 3rd hour, consume 8oz of sodium rich choice like bullion
SMBG
Every 2-4 hours while BG is elevated or until symptoms subside
Ketones (Sick)
Every 4 hours or until negative
(For type 2, determined for individual)
Medication adjustments
Continue as able
Adjust insulin doses to correct hyperglycemia
(For type 2, hold metformin during serious illness)
Food and beverage selections
Guide patients to consume 150-20g CHO daily in divided doses
Switch to soft or liquids as tolerated
Food and beverage selections
Guide patients to consume 150-20g CHO daily in divided doses
Switch to soft or liquids as tolerated
Informed consent
Adequate disclosure
Patient must have clear understanding
Consent must be given freely
Adequate disclosure
Patient needs to know purpose of case
Risk of non treatment
Are there other treatments available
Risk of procedure
Probability of success
NPO before surgery, why?
Risk for aspiration and pneumonia
Universal protocol
Surgical timeout- all members of the surgical team stop what they are doing before the procedure starts to verify:
Patient ID
Procedure
Surgical site (surgeon should mark procedure site)
Ileostomy
Right side
Small bowel —> loose, watery stool
Colostomy
Left side
Large intestine —> more formed stool
If stoma is purple
Blood is not reaching
Medical emergency
Should be red or pink
Always protect skin around stomach bag
Teach pt/fam
Dont want bag to get so full that it starts to pull away from skin
JP drain
If compressed, doing its job
If not compressed, it is full. Empty, collect, measure
If blood clot, milk the drain to create suction to remove blood clot
Drainage should be serous/Sanguineous (pinkish clear)
