Week 1 Flashcards
Inflammatory Response
- __________ response to cell injury
-Establishes an environment for healing and repair
-Inflammation is ______________________________ , but infection is not always present with inflammation – (think sprained ankle)
-Sequential response to cell injury
-Establishes an environment for healing and repair
-Inflammation is always present with infection, but infection is not always present with inflammation – (think sprained ankle)
Inflammatory Response
Cellular Response
-Neutrophils & monocytes
- _____________ first to arrive – phagocytize bacteria and other foreign objects
-Dead neutrophils and bacteria are ____
- Monocytes transform into _____________ and clean the area for healing…
-_______________ arrive later – humoral and cell mediated immunity
-Neutrophils & monocytes
- Neutrophils first to arrive – phagocytize bacteria and other foreign objects
-Dead neutrophils and bacteria are pus
- Monocytes transform into macrophages and clean the area for healing…
-Lymphocytes arrive later – humoral and cell mediated immunity
Inflammatory Response
Vascular Response
-Initial vascular ____________ followed by chemical mediated (histamine)
_____________ /capillary permeability (redness, swelling, heat)
-Initial vascular constriction followed by chemical mediated (histamine)
vasodilation/capillary permeability (redness, swelling, heat)
Chemical mediators
- Complement system – ___________ ___________ mediates inflammation
-______________ & Leukotrienes – (think of meds used to treat inflammation – leukotriene inhibitors)
- Complement system – enzyme cascade mediates inflammation
-Prostaglandins & Leukotrienes – (think of meds used to treat inflammation – leukotriene inhibitors)
Clinical manifestations of inflammation
See table 11-3 (Local Manifestations of Inflammation)
-______, redness, ______, swelling, loss of function (due to pain & swelling)
-Increase and “shift to the left” (______)
-Fever!
-Fever may not be present in ___________________ individuals (Cancer or those receiving chemo, HIV/AIDS, transplant recipients on immunosuppressant medications, older adults)
-Even small increases in ______ in compromised individuals should be a “red flag” to investigate and be concerned about
-Heat, redness, pain, swelling, loss of function (due to pain & swelling)
-Increase and “shift to the left” (WBCs)
-Fever!
-Fever may not be present in immunocompromised individuals (Cancer or those receiving chemo, HIV/AIDS, transplant recipients on immunosuppressant medications, older adults)
-Even small increases in temp in compromised individuals should be a “red flag” to investigate and be concerned about
Inflammation treatment
-RICE
_______
_______
____________________________
_____________
-Drug therapy
_________
__________
-RICE
Rest
Ice
Compression & immobilization
Elevation
-Drug therapy
NSAIDS
Tylenol
WOUND HEALING
Regeneration - ___________ of lost cells and tissues with the same type
Repair - Lost cells replaced with _____________________ – scar formation
Primary, secondary, tertiary - intention healing
Regeneration - Replacement of lost cells and tissues with the same type
Repair - Lost cells replaced with connective tissue – scar formation
Primary, secondary, tertiary - intention healing
WOUND HEALING COMPLICATIONS
Review Table: 11-7 (Complications of Wound Healing)
Adhesions
Contractions
Dehiscence
Evisceration
Fistula
Infection
Hemorrhage
Hypertrophic scars
Keloid
Adhesions
Contractions
Dehiscence
Evisceration
Fistula
Infection
Hemorrhage
Hypertrophic scars
Keloid
________________________ is the most common acute hyperglycaemic emergency in people with diabetes mellitus
Diabetic ketoacidosis (DKA)
Diabetic Ketoacidosis (DKA) results from ____________ deficiency, leading to hyperglycemia, metabolic acidosis, and ketosis.
It commonly occurs in uncontrolled type 1 diabetes (T1DM) but can also affect poorly controlled type 2 diabetes (T2DM) under stressful conditions.
insulin
Rights of Delegation:
Right task, circumstance, person, directions and communication, and supervision and evaluation
Why do you ice? (RICE) for inflammation
Causes vasoconstriction
Why do you elevate for inflammation?
Stops pooling/ fluid accumulation
Tylenol does what?
reduces:
fever & pain
NSAIDS like ibuprofen
they reduce:
inflammation, pain, & fever
Inflammation = primary
__________ is a separation of an incision
___________ is protrusion of abdominal viscera through an incision.
Dehiscence is a separation of an incision
Evisceration is protrusion of abdominal viscera through an incision.
Immunity is the body’s ability to:
resist disease.
Immunity serves three functions
- __________ – prevents invasion of microorganisms and infection
- _______________ – damaged cellular substances are digested and removed
- ____________ – mutations continually arise, recognized as foreign
- Defense – prevents invasion of microorganisms and infection
- Homeostasis – damaged cellular substances are digested and removed
- Surveillance – mutations continually arise, recognized as foreign
Antigens are substances that elicit :
an immune response
Antigens are usually __________ , but also large polysaccharides, lipoprotiens, and nucleic acids
proteins
Innate immunity – ___________________ , primary role is against pathogens
-Non-specifi c response – not antigen specific
present at birth
Acquired Immunity - 2 types
Active
Passive
Active acquired immunity
- Results from __________________________ & development of antibodies & sensitized lymphocytes
- Naturally or through _____________
- Takes time to develop but lasts a long time
- Results from invasion of foreign bodies & development of antibodies & sensitized lymphocytes
- Naturally or through vaccinations
- Takes time to develop but lasts a long time
Passive acquired immunity
- Host ___________________ rather than making them
- From mother to fetus
- Injection of gamma globulin (serum antibodies) – think rabies …
- Benefits – ____________ immunity
- Drawback – ____________ immunity
- Host receives antibodies rather than making them
- From mother to fetus
- Injection of gamma globulin (serum antibodies) – think rabies …
- Benefits – immediate immunity
- Drawback – short lived immunity
B Lymphocytes - _____________ !
Antibodies
T Lymphocytes
-Primarily responsible for immunity to ____________________ , tumor cells (Cancer), fungi.
T-helper & T-Cytotoxic
- T-Helper – help identify and activate the cell and humoral mediated immune response
(think HIV and inability to mount immune response)
- T-cytotoxic – have antigen specificity and sensitized by exposure to antigens, release
chemicals to kill cells
intracellular viruses
T-helper & T-Cytotoxic
- T-Helper – help identify and activate the ________________________________ response
(think HIV and inability to mount immune response) - T-cytotoxic – have _____________________ and sensitized by exposure to antigens, release
chemicals to kill cells
- T-Helper – help identify and activate the cell and humoral mediated immune response
(think HIV and inability to mount immune response) - T-cytotoxic – have antigen specificity and sensitized by exposure to antigens, release
chemicals to kill cells
NK (Natural Killer) Cells
- Large ______________ with numerus granules
- No prior sensitization required
- Primarily kill _______________ cells, tumor cells, transplanted graft tissue
- Significant role in immune surveillance for _____________ cells
- Large lymphocytes with numerus granules
- No prior sensitization required
- Primarily kill virus infected cells, tumor cells, transplanted graft tissue
- Significant role in immune surveillance for malignant cells
Cytokines
-Soluble factors secreted by WBCs and other cells
-Immune cell interactions depend/rely on cytokines, which act as ____________
- _____ different known cytokines
-Proinflammatory, antiinflammatory
-Stimulate _______________
-Soluble factors secreted by WBCs and other cells
-Immune cell interactions depend/rely on cytokines, which act as messengers
-100 different known cytokines
-Proinflammatory, antiinflammatory
-Stimulate hematopoiesis
Hypersensitivity Reactions Type-I
_____________________
— Mast cells, basophils, histamine, leukotrienes, prostaglandins
- Immunoglobulin (IgE)
Drug Classes to Treat __________________
- Antihistamines, Sympathomimetic/decongestants, corticosteroids, antipruritic, mast cell-stabilizing, leukotriene receptor antagonists (inhibitors)
Allergic Disorders
Humoral Immunity
- ___cells
- Antibody mediated immunity (Immunoglobulins [IgM, IgG, etc…)
*Primary exposure (IgM) – ______________as the body is first encountering antigen
- B-cells differentiate into plasma cells when exposed to antigens & create/release antibodies
- Some stimulated B-cells remain and are called memory cells
- Memory cells allow for rapid production if antigen is encountered a second time
*Secondary exposure (IgG) – ________________ & more significant response due to previous exposure
- B-cells
- Antibody mediated immunity (Immunoglobulins [IgM, IgG, etc…)
*Primary exposure (IgM) – takes time as the body is first encountering antigen
- B-cells differentiate into plasma cells when exposed to antigens & create/release antibodies
- Some stimulated B-cells remain and are called memory cells
- Memory cells allow for rapid production if antigen is encountered a second time
*Secondary exposure (IgG) – much faster & more significant response due to previous exposure
Cell Mediated Immunity
- ___cells
- Response to specific __________
- Primary importance in: Intracellular antigens (virus), fungi, transplant rejections, tumor/cancer cell
- T-cells
- Response to specific antigens
- Primary importance in: Intracellular antigens (virus), fungi, transplant rejections, tumor/cancer cell
Autoimmunity
- Response against _________
-Immune system unable to recognize _________________
- Human Leukocyte Antigen System (HLA)
- Unique to each person
- Crucial to organ/tissue transplantation
- Goal is to get best match for transplant
- Response against oneself
-Immune system unable to recognize self from other (attacks self) - Human Leukocyte Antigen System (HLA)
- Unique to each person
- Crucial to organ/tissue transplantation
- Goal is to get best match for transplant
Treat autoimmune disorders by:
suppressing the immune system
ORGAN TRANSPLANT
Life saving procedure!
- 123,000 people on organ waiting list!
- Fewer than _______ receive transplants annually
_____________ is required
- HLA compatibility required or best match
- Identical twins only people who will perfect HLA compatibility
Life saving procedure!
- 123,000 people on organ waiting list!
- Fewer than 30,000 receive transplants annually
Tissue typing is required
- HLA compatibility required or best match
- Identical twins only people who will perfect HLA compatibility
Transplant/organ/tissue Rejection
Hyperacute rejection
- Occurs within ______
- ______________ are rapidly destroyed
- Preexisting antibodies to transplanted tissue
- Organ __________ necessary
- Rare – better testing
- Occurs within 24hrs
- Blood vessels are rapidly destroyed
- Preexisting antibodies to transplanted tissue
- Organ removal necessary
- Rare – better testing
Transplant/organ/tissue Rejection
Acute rejection
- occurs when? __________
- ______-mediated immunity
- _____________ with immunosuppressive medication
- Long-term use of immunosuppressive drugs
- Risk for infection!!! – teach patient to take precautions
- First 6-months
- Cell-mediated immunity
- Reversible with immunosuppressive medication
- Long-term use of immunosuppressive drugs
- Risk for infection!!! – teach patient to take precautions
Immunosuppressive therapy - [organ transplant]
- duration _________
- Many immunosuppressive drugs have side-eff ects
- Corticosteroids!
- Biggest complications from immunosuppression – _________________
- Life-long
- Many immunosuppressive drugs have side-eff ects
- Corticosteroids!
- Complications from immunosuppression – risk for infection
Transplant/organ/tissue Rejection
Chronic rejection
- Occurs when? ___________
- Organ is infiltrated with large numbers of __________ cells
- Results in scarring and fibrosis
- No definite therapy, difficult to manage, not associated w/ optimistic prognosis of acute rejection
- Months to years
- Organ is infiltrated with large numbers of T and B cells
- Results in scarring and fibrosis
- No definite therapy, difficult to manage, not associated w/ optimistic prognosis of acute rejection
Graft-versus-host disease
- Most commonly seen in ____________________ transplants
- Graft rejects host _______ days after transplant
- Little can be done – donor T-cells attack host cells
- Immunosuppression
- Most commonly seen in Hematopoietic stem cell transplants
- Graft rejects host (7-30) days after transplant
- Little can be done – donor T-cells attack host cells
- Immunosuppression
Pathogens - microorganism that causes _________
Major pathogens
- _________________________________
Pathogens - microorganism that causes disease
Major pathogens
-Bacteria, viruses, fungi, protozoa, prions
Infections can be:
- Local, disseminated, systemic
- Local, disseminated, systemic
____________ infections include Covid, Ebola
Emerging
Antibiotic _____________
- MRSA = Methicillin Resistant Staph Aureus
- VRE; VRSA = Vancomycin Resistant Enterococci & VR Staph Aureus
- CRE = Carbapenem Resistant enterococci
Resistance
Health care providers contribute to the problem [Abx resistance]
- abx for _______ infections
- prescribing abx unnecessarily
- inadequate drug regimens
- using ________________ abx when not needed
- abx for viral infections
- prescribing abx unnecessarily
- inadequate drug regimens
- using broad spectrum abx when not needed
Patient contribute to the problem [Abx resistance]
1. __________ doses
2. not taking medication for _______________ of treatment
3. saving ________ abx
- skipping doses
- not taking medication for full duration of treatment
- saving unused abx
hospital-acquired infections - HAIs - Acquired through exposure in a healthcare setting
_______
_______
_______
- c-Diff
- VRE
- MRSA
Fluid Compartments
Intracellular
- 2/3 of Decreases as we age
- body water is _____________
Extracellular
- Interstitial fluid – spaces between the cells
- Intravascular (plasma) – blood and vasculature
Intracellular
- 2/3 of Decreases as we age
- body water is INSIDE cells
Extracellular
- Interstitial fluid – spaces between the cells
- Intravascular (plasma) – blood and vasculature
Osmosis-
movement down a pressure gradient (From low to high conc.)
DKA = high serum osmolality! ↑ glucose concentration in serum → intracellular dehydration
high serum osmolality! ↑ glucose concentration in serum → intracellular dehydration
Hydrostatic pressure- __________________________________________
-Fluid pushed out through ‘leaky’ capillary blood vessel wall under high pressure
pressure exerted against the walls of the blood vessels/ capillaries
Colloidal oncotic pressure- caused by plasma proteins (mainly albumin)
-Cirrhosis – decreased intravascular oncotic pressure leads to ascites
Colloidal oncotic pressure- caused by plasma proteins (mainly albumin)
-Cirrhosis – decreased intravascular oncotic pressure leads to ascites
Fluid Spacing
Edema – Second spacing (fluid in the ___________ areas)
1+
2+
3+
4+
Third Spacing –______________________ of fluid
-Ascites, abdominal cavity
Edema – Second spacing (fluid in the interstitial areas)
1+
2+
3+
4+
Third Spacing – abnormal accumulation of fluid
-Ascites, abdominal cavity
Fluid volume regulation - Several mechanisms control fl uid volume deficits and excess
-Hypothalamic-Pituitary Regulation – ADH (anti-diuretic hormone)
- Renal/Kidneys – urination
- Adrenal – Cortical Regulation
>RAAS
- Cardiac (BNP) – Heart failure [MCA-2]
- Gastrointestinal (GI) – think Nausea/vomiting
-Hypothalamic-Pituitary Regulation – ADH (anti-diuretic hormone)
- Renal/Kidneys – urination
- Adrenal – Cortical Regulation
>RAAS
- Cardiac (BNP) – Heart failure [MCA-2]
- Gastrointestinal (GI) – think Nausea/vomiting
Fluid volume deficit / excess
-Nursing Actions: ______________
-IVs, PO, nausea, vomiting, excess urination, sweating (fever), weights!
-Monitor Lab values – _____
- Measure BP, tachycardia, CVP
-Nursing Actions: Track I’s & O’s
-IVs, PO, nausea, vomiting, excess urination, sweating (fever), weights!
-Monitor Lab values – BUN
- Measure BP, tachycardia, CVP
ELECTROLYTES
Sodium - Think ______
Potassium - Think ________
Calcium - Think ________
Phosphorus
Magnesium
Sodium - Think neuro
Potassium - Think cardiac
Calcium - Think muscle
Phosphorus
Magnesium
Fluid types
- Hypertonic – _____ NS
- Isotonic – _____ NS
- Hypotonic – _____ NS
- Hypertonic – 3.0% NS
- Isotonic – 0.9% NS
- Hypotonic – 0.45% NS
Electrolyte Replacement
____________________ . Usually best option [bananas]
IV
– Potassium
*NEVER EVER GIVE K+ _________ – CAN CAUSE CARDIAC ___________
*USUALLY THROUGH CENTRAL LINE
*RATE LIMITED
* Can cause peripheral irritation
* RATE LIMITED
PO – diet or supplements. Usually best option [bananas]
IV
– Potassium
*NEVER EVER GIVE K+ IV PUSH – CAN CAUSE CARDIAC ARYTHMIAS
*USUALLY THROUGH CENTRAL LINE
*RATE LIMITED
* Can cause peripheral irritation
* RATE LIMITED
Diabetes mellitus is a problem of:
glucose metabolism
Global cost of diabetes mellitus in 2015:
1.3 trillion
1 in 5 health care dollars is spent caring for people with : _______ in the US
Diabetes Mellitus
Insulin attaches to receptors on target cells, where it promotes ____________________________ through the cell membranes
Insulin attaches to receptors on target cells, where it promotes glucose transport into the cells through the cell membranes
Diabetes type 1
-_____________disease
-B cells ____________________
-Autoimmune disease
-B cells do not secrete insulin
While Type 1 diabetes cause is unknown/autoimmune and often occurs in children, type 2 diabetes:
is more common in adults; associated with lack of exercise/ poor diet
Symptoms in diabetes type 1 vs 2
type 1: quickly develop
type 2: gradual symptoms
Type 1 diabetics treatment:
daily insulin
Type 2 diabetics treatment:
often managed by exercise, healthy diet, or oral medications
If progresses, may be treated with insulin
Symptoms of type 1 + 2 diabetes
Thirst
weight loss
frequent urination
constant hunger
fatigue
blurry vision
Signs of hypoglycemia
headache
sweaty
hungry
shaky
confused
grumpy
Hyperglycemia signs
Tired
vomiting
stomach pain
rapid breathing, increased pulse
dry mouth
flushed face
fruity breath
Long term complications of Diabetes mellitus
- Retinopathy & PVD
- Peripheral neuropathy
- Coronary Artery Disease
- CVA & Nephropathy
Pre-diabetes
-Not high enough for diabetes diagnosis
-ADA criteria: fasting plasma glucose level from __________ mg/dL
-increase risk for developing type 2 diabetes
-Prevent by : __________________________
-Not high enough for diabetes diagnosis
-ADA criteria: fasting plasma glucose level from 100- 125 mg/dL
-increase risk for developing type 2 diabetes
-Prevent by regular exercise and healthy weight
About ___% of DM population has type 1 DM
5
Type 1 DM
Bodies makes ____________ against pancreatic ________ … cause not entirely known
Classic signs and symptoms: weightloss, weakness, fatigue, 3 P’s (__________________________________________)
Bodies makes antibodies against pancreatic β-cells… cause not entirely known
Classic signs and symptoms: weightloss, weakness, fatigue, 3 P’s (polyuria, polydipsia, polyphagia)
Only treatment for T1DM is:
insulin
Treatment/ management of T1 DM
- ____________________
- __________
-Diet and exercise – to control glucose levels and prevent
complications
YOU CANNOT TREAT T1DM WITH DIET & EXERCISE ALONE!! (this is different from T2DM)
-Glucose monitoring - continuous glucose monitoring (CGM)
-Insulin
-Diet and exercise – to control glucose levels and prevent
complications
YOU CANNOT TREAT T1DM WITH DIET & EXERCISE ALONE!! (this is different from T2DM)
Insulin therapy delivery options
-Consider insulin pump
- Injections
Types of insulin
Insulin function
-promotes entry of amino acids into the cell for protein synthesis
-enhances lipogenesis (fat storage)
-Facilitating entry of glucose into cells for energy
-stimulate glycogenesis (glucose > glycogen to be stored in liver / muscle cells)
-inihibts glycogenolysis (glycogen > glucose )
-promotes entry of amino acids into the cell for protein synthesis
-enhances lipogenesis (fat storage)
-Facilitating entry of glucose into cells for energy
-stimulate glycogenesis (glucose > glycogen to be stored in liver / muscle cells)
-inihibts glycogenolysis (glycogen > glucose )
Insulin type
Lantus / detemir is
long-acting
Insulin type
Lispro / Novolog is
rapid acting
Rapid-acting (bolus)
- Lispro (Humalog), Aspart (Novolog)
- Injected ___________ minutes before meal
- Onset of action 15 minutes
Short-acting (bolus)
- Regular (Humulin, Novolin, Velosulin)
- Injected _____________ minutes before meal
- Onset of action 30 to 60 minutes
Rapid-acting (bolus)
- Lispro (Humalog), Aspart (Novolog)
- Injected 0 to 15 minutes before meal
- Onset of action 15 minutes
Short-acting (bolus)
- Regular (Humulin, Novolin, Velosulin)
- Injected 30 to 45 minutes before meal
- Onset of action 30 to 60 minutes
Long-acting (basal) Lantus (glargine)
-Injected _______ at bedtime or in am
-Released steadily and continuously
-Onset ________ hours
-No peak action
-Duration ____________
-Cannot be _________ with any other insulin or solution
-Injected daily at bedtime or in am
-Released steadily and continuously
-Onset 1-1 ½ hours
-No peak action
-Duration 20-24 hours
-Cannot be mixed with any other insulin or solution
Sites for insulin subcutaneous injection
thights
biceps
abdominal
buttocks
Fastest absorption of insulin injections
Abdomen [preferred]
arms
thighs
buttocks
Administration of insulin (cont’d)
-Hand washing with soap adequate
-Do not _____ needle
- _________ degree angle depending on fat thickness of patient
-Insulin pens preloaded with insulin now available
-Hand washing with soap adequate
-Do not recap needle
-45- to 90-degree angle depending on fat thickness of patient
-Insulin pens preloaded with insulin now available
Insulin pump
-___________ ______ infusion
-Battery operated device
-Connected via plastic tubing to a catheter inserted into sub-Q tissue in abdominal wall
-Continuous sub-Q infusion
-Battery operated device
-Connected via plastic tubing to a catheter inserted into sub-Q tissue in abdominal wall
Problems with insulin therapy
-Hypoglycemia
-Allergic reactions
-Lipodystrophy
-Somogyi effect
-Dawn phenomenon
-Hypoglycemia
-Allergic reactions
-Lipodystrophy
-Somogyi effect
-Dawn phenomenon
Mnemonic for hypoglycemia signs
TIRED
Tachycardia
Irritable
Restless
Excessive hunger
Diaphoresis + Depression
HYPOGLYCEMIA
Treatment
- Remain with patient!
- Treat sooner rather than later if hypoglycemia suspected
- Conscious or unconscious?
- PO vs IV/IM – THINK Aspiration, can they swallow??
-Monitor and repeat treatment every 15 minutes until BG > 70 or 80
- Call for help early!
- Consider cause and address it! [Too much insulin, insufficient carbs, etc]
Treatment
- Remain with patient!
- Treat sooner rather than later if hypoglycemia suspected
- Conscious or unconscious?
- PO vs IV/IM – THINK Aspiration, can they swallow??
-Monitor and repeat treatment every 15 minutes until BG > 70 or 80
- Call for help early!
- Consider cause and address it! [Too much insulin, insufficient carbs, etc]
HYPOGLYCEMIA TREATMENT
If alert enough to swallow “Rule of 15” [measure every 15 mins]
(choose 1)
___________
____________
____________
____________
Avoid foods with fat (Decrease absorption of sugar)
-3-4 glucose tabs
-4 to 6 oz fruit juice
-Regular soft drink
-1 c skim milk
PROBLEMS WITH INSULIN THERAPY
Somogyi effect
-Rebound effect in which too much insulin causes ___________
-Usually during hours of sleep (2-3 am)
-Counter-regulatory hormones released causing rebound hyperglycemia and ketosis
-Prevent by giving a protein and carb snack at _________
-Rebound effect in which too much insulin causes hypoglycemia
-Usually during hours of sleep (2-3 am)
-Counter-regulatory hormones released causing rebound hyperglycemia and ketosis
-Prevent by giving a protein and carb snack at bedtime
PROBLEMS WITH INSULIN THERAPY
Dawn phenomenon
-Characterized by _______________ present on awakening in the ________
-Due to release of counter-regulatory hormones in predawn hours (5-9 am)
-Characterized by hyperglycemia present on awakening in the morning
-Due to release of counter-regulatory hormones in predawn hours (5-9 am)
DM T1 - COMPLICATIONS
-Death
- Hypoglycemia (related to excess exogenous insulin injection or insufficient carbohydrate consumption after insulin injection)
- Diabetic Ketoacidosis (DKA)
- Micro & Macrovascular Complications (SAME AS FOR T2DM)
- Angiopathies, Nephropathies, Retinopathies, Nephropathies, Infections, Amputations
-Death
- Hypoglycemia (related to excess exogenous insulin injection or insufficient carbohydrate consumption after insulin injection)
- Diabetic Ketoacidosis (DKA)
- Micro & Macrovascular Complications (SAME AS FOR T2DM)
- Angiopathies, Nephropathies, Retinopathies, Nephropathies, Infections, Amputations
DM T1 - COMPLICATIONS
Psychological – anxiety, depression, body image, others
Integumentary – skin injection site atrophy, infection
Psychological – anxiety, depression, body image, others
Integumentary – skin injection site atrophy, infection
DM T1 - DIABETIC KETOACIDOSIS (DKA)
-Caused by profound deficiency of ___________
Characterized by
- Hyperglycemia > ______ mg/dl
-Ketosis (blood & urine)
-Acidosis
-Dehydration
-Most likely occurs in type 1
-Caused by profound deficiency of insulin
Characterized by
- Hyperglycemia > 300 mg/dl
-Ketosis (blood & urine)
-Acidosis
-Dehydration
-Most likely occurs in type 1
___________________
-Not enough insulin
-High blood glucose
-A major cause of complications
HYPERGLYCEMIA
DM T1 - DIABETIC KETOACIDOSIS (DKA)
Anticipated labs
-POC blood glucose - Glucose ≥ 250
-Electrolytes & Confirmatory serum glucose (>250)
- Expect low K+ ; Potassium! Must be > than 3.3 mEq/L to administer insulin
> THIS ONLY APPLIES TO IV ADMINISTRATION OF INSULIN – THIS IS NOT RELEVANT TO SUB-
Q INJECTIONS
- WBC – anticipate elevated WBC
Anticipated labs
-POC blood glucose - Glucose ≥ 250
-Electrolytes & Confirmatory serum glucose (>250)
- Expect low K+ ; Potassium! Must be > than 3.3 mEq/L to administer insulin
> THIS ONLY APPLIES TO IV ADMINISTRATION OF INSULIN – THIS IS NOT RELEVANT TO SUB-
Q INJECTIONS
- WBC – anticipate elevated WBC
DM T1 - DIABETIC KETOACIDOSIS (DKA)
Anticipated pharmacotherapy
IV Regular Insulin! – required treatment
- Initially IV push insulin, followed by IV insulin infusion (usually only takes place in ED or ICU)
- Antiemetic – to control N/V
- IV Potassium replacement; May need to replace potassium PRIOR to giving iv insulin; Insulin drives potassium into cells – can create hypokalemia!! Must replace potassium first if ≤ 3.3 mEq/L
- Sodium biacarb (NaHCO3 ) IV push if severe acidosis
Anticipated pharmacotherapy
IV Regular Insulin! – required treatment
- Initially IV push insulin, followed by IV insulin infusion (usually only takes place in ED or ICU)
- Antiemetic – to control N/V
- IV Potassium replacement; May need to replace potassium PRIOR to giving iv insulin; Insulin drives potassium into cells – can create hypokalemia!! Must replace potassium first if ≤ 3.3 mEq/L
- Sodium biacarb (NaHCO3 ) IV push if severe acidosis
THE ONLY INSULIN THAT CAN BE GIVE IV IS ____________ INSULIN
REGULAR
Rising ketones means need to _________________ and contact provider!!
increase insulin
Diabetes Mellitus Type 2
-_________ Onset
-Some insulin produced
-Changes in lifestyle may be sufficient
-____% hereditary
-Prevalence increases with age
-Most common type
-Severe Complication: HHS
-Gradual Onset
-Some insulin produced
-Changes in lifestyle may be sufficient
-90% hereditary
-Prevalence increases with age
-Most common type
-Severe Complication: HHS
Which type of Diabetes is most common?
Type 2 DM
Severe complication of type 2 DM
HHS - Hyperosmolar hyperglycemic state
Symptoms of type 2 DM
May have classic symptoms of type 1
-Fatigue
-Recurrent infections
-recurrent vaginal yeast or monilial infections
-Prolonged wound healing
-Visual changes (blurred vision)
DM Type 2- Three methods of diagnosis
-Fasting plasma glucose level > ____ mg/dl
-Random or casual plasma glucose ≥ ____ mg/dl plus symptoms
-Two-hour OGTT (Oral Glucose Tolerance Test)level ≥ 200 mg/dl using a glucose load of 75 g (norm: > 140 and <200)
-Fasting plasma glucose level >126 mg/dl
-Random or casual plasma glucose ≥ 200 mg/dl plus symptoms
-Two-hour OGTT (Oral Glucose Tolerance Test)level ≥ 200 mg/dl using a glucose load of 75 g (norm: > 140 and <200)
Oral meds for DB Type 2 works on 3 defects:
-___________ resistance
-_____________ insulin production
-______________hepatic glucose production
-Insulin resistance
-Decreased insulin production
-Increased hepatic glucose production
DM T2 - ORAL MEDS - BIGUANIDES
-First line of treatment for DM Type 2
-Metformin plus lifestyle changes to decrease weight and increase activity
Biguanides
-Reduce glucose ___________________
-Enhance insulin ____________ at tissues
-Improve glucose ____________ into cells
-Does not promote weight gain
-Reduce glucose production by liver
-Enhance insulin sensitivity at tissues
-Improve glucose transport into cells
-Does not promote weight gain
-First line of treatment for DM Type 2 -
Biguanides/Metformin + life style changes
DM T2 - ORAL MEDS - SULFONYLUREAS
-Glucotrol (Glipizide); Amaryl (Glimepiride)
-Sulfonylureas
-↑ Insulin production from __________
-↓ Chance of prolonged hypoglycemia
-↑ Insulin production from pancreas
-↓ Chance of prolonged hypoglycemia
DM T2 - ORAL MEDS - THIAZOLIDINEDIONE
Avandia (rosiglitazone).
Actos (pioglitazone)
Thiazolidinedione
-Improves insulin _________
-Most effective in those with insulin __________
-Improves insulin sensitivity
-Most effective in those with insulin resistance
DM T2 - ORAL MEDS - MISCELLANEOUS
Byetta (exenatide); Victoza (liraglutide)
-Increases __________ secretion
-Decreases ___________ secretion (decreases BG)
-Incretin mimetic:
–Reduces food intake
–Slows gastric emptying
-Not to be used with insulin
-Increases insulin secretion
-Decreases glucagon secretion (decreases BG)
-Incretin mimetic:
–Reduces food intake
–Slows gastric emptying
-Not to be used with insulin
DM T2 - ORAL HYPOGLYCEMIA
-Monitor serum glucose levels
-Teach patient signs and symptoms of hyper/hypoglycemia
-Altered liver, renal function will affect medication action
-Avoid OTC meds without MD approval
-Assess for GI distress and sensitivity
-Know appropriate time to administer med
-Monitor serum glucose levels
-Teach patient signs and symptoms of hyper/hypoglycemia
-Altered liver, renal function will affect medication action
-Avoid OTC meds without MD approval
-Assess for GI distress and sensitivity
-Know appropriate time to administer med
-Always ___________ the administration of glucose tablets, juice, Glucagon, and D50 in the Medication Record.
-Record in the nursing notes the signs and symptoms displayed, treatment administered, initial and subsequent glucose reading and notifications to the attending physician.
document
DM T2 – COMPLICATIONS HYPEROSMOLAR HYPERGLYCEMIC SYNDROME (HHS)
-Life-threatening syndrome
-Less common than DKA
-Most frequently seen in patients over 60 years with DM type 2
-Two factors that precipitate hyperglycemia leading to HHS
↑ ______ intake
↑ insulin ____________
-Life-threatening syndrome
-Less common than DKA
-Most frequently seen in patients over 60 years with DM type 2
-Two factors that precipitate hyperglycemia leading to HHS
↑ CHO intake
↑ insulin resistance
DM T2 – HYPEROSMOLAR HYPERGLYCEMIC SYNDROME (HHS) - symptoms
-Blood glucose > _____mg/dl
-Hypotension
-Mental changes
-Dehydration
-Hypokalemia
-Hyponatremia
-Blood glucose > 600 mg/dl
-Hypotension
-Mental changes
-Dehydration
-Hypokalemia
-Hyponatremia
The most important patient outcome of DM is the reduction of glucose to near-normal
levels. (A1C < ____ )
7
DM - PATIENT EDUCATION
-Storage and dose preparation
-Syringes
-Blood glucose monitoring
-Interpretation of results
-Frequency of testing
-Blood glucose therapy goals
-Storage and dose preparation
-Syringes
-Blood glucose monitoring
-Interpretation of results
-Frequency of testing
-Blood glucose therapy goals
DM - NUTRITIONAL THERAPY
Alcohol
-High in calories/No nutritive value
-Promotes hypertriglyceridemia
-Detrimental effects on ______
-Moderate use can cause severe hyperglycemia whereas severe alcohol use can lead to hypoglycemia
-High in calories/No nutritive value
-Promotes hypertriglyceridemia
-Detrimental effects on liver
-Moderate use can cause severe hyperglycemia whereas severe alcohol use can lead to hypoglycemia
DM - EXERCISE
-Purpose - reduce the amount of _________ needed
-Should be individualized
-After medical clearance
-Slowly- gradual progression
-Monitor ________________ levels before, during, and after exercise
-If BG >250 caution zone (check urine for ketones)
-Purpose - reduce the amount of insulin needed
-Should be individualized
-After medical clearance
-Slowly- gradual progression
-Monitor blood glucose levels before, during, and after exercise
-If BG >250 caution zone (check urine for ketones)
DM - NURSING DIAGNOSES
-Ineffective therapeutic regimen management
-Risk for injury
-Risk for infection
-Powerlessness
-Imbalanced nutrition: More than body requirements
-Ineffective therapeutic regimen management
-Risk for injury
-Risk for infection
-Powerlessness
-Imbalanced nutrition: More than body requirements
5 Rights of Delegation
- The right task
- Under the right circumstances
- To the right person
- With the right directions and communication; and
- Under the right supervision and evaluation
Steps of the delegation process
_______________ the delegation, based on pt needs & available resources.
____________ directions to the delegate including any unique patient requirements and characteristics as well as clear expectations regarding what to do, what to report, and when to ask for assistance.
__________________________ of the delegation, including the level of supervision needed for the particular situation and the implementation of that supervision, including follow-up to problems or a changing situation.
____________ and feedback to consider the effectiveness of the delegation, including any need to adjust the plan of care.
Assess and plan the delegation, based on pt needs & available resources.
Communicate directions to the delegate including any unique patient requirements and characteristics as well as clear expectations regarding what to do, what to report, and when to ask for assistance.
Surveillance and supervision of the delegation, including the level of supervision needed for the particular situation and the implementation of that supervision, including follow-up to problems or a changing situation.
Evaluation and feedback to consider the effectiveness of the delegation, including any need to adjust the plan of care.
insulin hormone is released by beta cells of the pancreas with each meal
-It’s a hypoglycemic agent that lowers blood sugar levels by aiding the passage of __________ into the _______.
-It enhances ________________ (fat storage) and prevents the breakdown of fats for energy.
-It’s a hypoglycemic agent that lowers blood sugar levels by aiding the passage of glucose into the cells.
-It enhances lipogenesis (fat storage) and prevents the breakdown of fats for energy.
Insulin is produced by:
beta cells in the islets of Langerhans in the pancreas
GLUCAGON
Hormone released by _______________________
alpha cells of the pancreas
GLUCAGON
→ a hyperglycemic agent that increases blood sugar levels by triggering the liver to :
convert glycogen → glucose
type 1 DM may be brought on by:
virus or toxins
with type 1 DM, the body cannot ________ insulin
with type 2 DM, the body cannot _________ insulin
with type 1 DM, the body cannot make insulin
with type 2 DM, the body cannot respond to insulin
Three P’s symptom more common with
type 1 DM
type 2 may also have this, but more mild usually
___________ therapy essential is essential for both type 1 and 2 DM
nutrition
Do not give insulin before _________________ . Insulin is SAFER to take after.
taking BG levels
Peaks + plates.
Give FOOD during ________ since the highest risk for low sugar is during those
PEAKS
Draw up CLEAR (regular, Humulin R) then CLOUDY (NPH, Humulin N) into the syringe.
- “You want clear days before cloudy ones.”
- This prevents contamination of the clear insulin.
- Think R→N or RN like nurse!
Draw up CLEAR (regular, Humulin R) then CLOUDY (NPH, Humulin N) into the syringe.
- “You want clear days before cloudy ones.”
- This prevents contamination of the clear insulin.
- Think R→N or RN like nurse!
- Rotate injection sites within the same area.
[some facilities _________________________]
do not recommend this anymore
Open vials stored _________ at room temperature
unused insulin can be stored in fridge until exp. date.
Open vials stored 1 month at room temperature
unused insulin can be stored in fridge until exp. date.
Biguanides: ______________
- MOA: ↓ glycogenesis, ↑ insulin sensitivity, ↑ glucose uptake
- Side Effects: lactic acidosis, GI upset, anorexia
- Stop 1-2 days before contrast dyes and 48hrs after!
“glucose be gone!”
Sulfonylureas: end in “____”
- MOA: ↑ insulin production in pancreas, ↓ glycogenolysis and gluconeogenesis
- Side Effects: weight gain, hypoglycemia
- Avoid __________!
Sulfonylureas: end in “-ide”
- MOA: ↑ insulin production in pancreas, ↓ glycogenolysis and gluconeogenesis
- Side Effects: weight gain, hypoglycemia
- Avoid alcohol!
SGLT2: end in “-lozin” → you’re________________ in urine, glucose is “flozin” through the kidneys
- MOA: ↓ renal glucose reabsorption, ↑urinary glucose excretion
- Side Effects: risk for UTI’s, hypoglycemia
SGLT2: end in “-lozin” → you’re “lozin” glucose in urine, glucose is “flozin” through the kidneys
- MOA: ↓ renal glucose reabsorption, ↑urinary glucose excretion
- Side Effects: risk for UTI’s, hypoglycemia
GLP1: end in “-tide” → they _________________________
- MOA: stimulate release of insulin, slow gastric emptying, ↑ satiety
- Side Effects: nausea/vomiting, diarrhea, hypoglycemia
- Never give with insulin!
GLP1: end in “-tide” → they “tide” you over = ↓ hunger
- MOA: stimulate release of insulin, slow gastric emptying, ↑ satiety
- Side Effects: nausea/vomiting, diarrhea, hypoglycemia
- Never give with insulin!
DPP-4 Inhibitors: end in “-liptin”
- MOA: ↑ insulin synthesis and release from pancreas
- Side Effects: lower potential for hypoglycemia because it is glucose dependent
DPP-4 Inhibitors: end in “-liptin”
- MOA: ↑ insulin synthesis and release from pancreas
- Side Effects: lower potential for hypoglycemia because it is glucose dependent
TZD/Thiazolidinedione: end in ______
- MOA: ↑ insulin sensitivity, ↑ insulin secretion, block fatty acid release
- Side Effects: severe (anemia, CHF, fracture), rarely used
TZD/Thiazolidinedione: end in “-zone”
- MOA: ↑ insulin sensitivity, ↑ insulin secretion, block fatty acid release
- Side Effects: severe (anemia, CHF, fracture), rarely used
“Shaky, pale, cool, and clammy = time to ____________________!”
give the patient candy
Interventions and Education for DM:
- Yearly dilated eye exams
- Yearly kidney function tests (creatinine, albuminuria)
- Daily foot care and examination
Which statement by a nurse to a patient newly diagnosed with type 2 diabetes is correct?
A Insulin is not used to control blood glucose in patients with type 2 diabetes.
B Complications of type 2 diabetes are less serious than those of type 1 diabetes.
C Changes in diet and exercise may control blood glucose levels in type 2 diabetes.
D Type 2 diabetes is usually diagnosed when the patient is admitted with a hyperglycemic coma.
C Changes in diet and exercise may control blood glucose levels in type 2 diabetes.
After change-of-shift report, which patient should the nurse assess first?
A 19-year-old with type 1 diabetes who has a hemoglobin A1C of 12%
B 23-year-old with type 1 diabetes who has a blood glucose of 40 mg/dL
C 40-year-old who is pregnant and whose oral glucose tolerance test is 202 mg/dL
D 50-year-old who uses exenatide (Byetta) and is complaining of acute abdominal pain
B 23-year-old with type 1 diabetes who has a blood glucose of 40 mg/dL
[Hypoglycemic state >70; can lead to unconsciousness, seizures, death..]
Other pts not priority here
The nurse has administered 4 oz of orange juice to an alert patient ̀hose blood glucose ̀as 62 mg/dL. Fifteen minutes later, the blood glucose is 67 mg/dL. Which action should the nurse take next?
A Give the patient 4 to 6 oz more orange juice.
B Administer the PRN glucagon (Glucagon) 1 mg IM.
C Have the patient eat some peanut butter with crackers.
D Notify the health care provider about the hypoglycemia.
A) Give the patient 4 to 6 oz more orange juice.
A 34-year-old has a new diagnosis of type 2 diabetes. The nurse will discuss the need to schedule a dilated eye exam:
A Every 2 years.
B As soon as possible.
C When the patient is 39 years old.
D Within the first year of diagnosis.
B As soon as possible.
Recommended at time of diagnosis, and then annually
A 54-year-old patient is admitted with diabetic ketoacidosis. Which admission order should the
nurse implement first?
A Infuse 1 liter of normal saline per hour.
B Give sodium bicarbonate 50 mEq IV push.
C Administer regular insulin 10 U by IV push.
D Start a regular insulin infusion at 0.1 units/kg/hr.
A Infuse 1 liter of normal saline per hour.
With DKA, priority is to infuse IV fluids, then other actions after
Which finding indicates a need to contact the health care provider before the nurse
administers metformin (Glucophage)?
A The patient’s blood glucose level is 174 mg/dL.
B The patient has gained 2 lb (0.9 kg) since yesterday.
C The patient is scheduled for a chest x-ray in an hour.
D The patient’s blood urea nitrogen (BUN) level is 52 mg/dL
D The patient’s blood urea nitrogen (BUN) level is 52 mg/dL
[BUN indicates possible renal failure.. metformin should not be given with renal failure]
Which information will the nurse include in teaching a female patient who has peripheral
arterial disease, type 2 diabetes, and sensory neuropathy of the feet and legs?
A Choose flat-soled leather shoes.
B Set heating pads on a low temperature.
C Use callus remover for corns or calluses.
D Soak feet in warm water for an hour each day.
A Choose flat-soled leather shoes.
A 32-year-old patient ̀ith diabetes is starting on intensive insulin therapy. Which type of insulin
̀ill the nurse discuss using for mealtime coverage?
A Lispro (Humalog)
B Glargine (Lantus)
C Detemir (Levemir)
D NPH (Humulin N)
A Lispro (Humalog)
[Rapid/ short acting insulin for meal coverage]
A patient receives aspart (NovoLog) insulin at 8:00 AM. Which time will it be most important for
the nurse to monitor for symptoms of hypoglycemia?
A 1400
B 0000
C 1000
D 1600
C 1000
10 am - it is rapid-acting and peaks in 1-3 hours
A patient with diabetes has a serum glucose level of 824 mg/dL (45.7 mmol/L) and is unresponsive. After assessing the patient, the nurse suspects diabetic ketoacidosis rather than hyperosmolar hyperglycemic syndrome based on the finding of:
A Polyuria.
B Severe dehydration.
C Decreased serum potassium.
D Rapid, deep respirations.
D Rapid, deep respirations.
DKA is associated with Kussmaul breathing
Fluid Volume Deficit - ______________
Hypovolemia
DKA is associated with __________ breathing
Kussmaul
Fluid Volume Excess -______________
Hypervolemia
Inflammation
Heat is due to increased:
metabolism at the inflammatory site
Inflammation
Redness is due to Hyperemia from _____________
vasodilation
Inflammation
Swelling is due to
Fluid shifts to interstitial spaces;
fluid exudate accumulation
__________ Intention: neatly approximated; surgical incision; leaves a fine scar
Primary
____________ Intention: wounds from trauma, injury, infection, irregular margins; leaves a larger scar
Secondary
__________ Intention: occurs with delayed suturing; leaves a deeper scar
Tertiary
NSAIDs: 3 for 1; ibuprofen, aspirin, naproxen → reduces _______________________________________
Tylenol: 2 for 1; reduces _______________________
NSAIDs: 3 for 1; ibuprofen, aspirin, naproxen → reduces inflammation, reduces pain,
and reduces fever
Tylenol: 2 for 1; reduces fever and pain
A permanent tightening of the muscles, tendons, skin, and nearby tissues that causes the joints to shorten and become very stiff:
Contracture
Nurses can NOT delegate
initial assessment
education
The nurse assesses a patient’s surgical wound on the first postoperative day and notes redness and warmth around the incision. Which action by the nurse is appropriate?
a. Obtain wound cultures
b. Document the assessment
c. Notify the HCP
d. Assess the wound every 2 hrs
b. Document the assessment
A young adult patient who is receiving antibiotics for an infected leg wound has a temperature of 101.8° F (38.7° C). The patient reports having no discomfort. What action by the nurse is
appropriate?
a. Apply a cooling blanket
b. Notify the HCP
c. Check the patient’s Temperature again in 4 hrs
d. Give acetaminophen (Tylenol) prescribed PRN for pain
c. Check the patient’s Temperature again in 4 hrs
Mild to moderate temperature elevations (<103° F) do not harm young adult patients
and may benefit host defense mechanisms. The nurse should continue to monitor
the temperature. Antipyretics are not indicated unless the patient is complaining of
fever-related symptoms, and the patient does not require analgesics if not reporting
discomfort. There is no need to notify the patient’s health care provider or to use a
cooling blanket for a moderate temperature elevation
The nurse could delegate care of which patient to a licensed practical/vocational nurse (LPN/LVN)?
a. The patient who reports increased tenderness and swelling around a leg wound
b. The patient who was just admitted after suturing of a full-thickness arm wound
c. The patient who needs teaching about home care for a draining abdominal wound
d. The patient who requires a hydrocolloid dressing change for a stage III sacral ulcer
d. The patient who requires a hydrocolloid dressing change for a stage III sacral ulcer
LPN/LVN education and scope of practice include sterile dressing changes for stable
patients. Initial wound assessments, patient teaching, and evaluation for possible
poor wound healing or infection should be done by the registered nurse (RN).
After receiving a change of shift report, which patient should the nurse assess first?
a. The patient who has multiple leg wounds with eschar to be debrided
b. The patient receiving chemotherapy who has a temperature of 102° F
c. The patient who requires analgesics before a scheduled dressing change
d. The newly admitted patient with a stage IV pressure ulcer on the coccyx
b. The patient receiving chemotherapy who has a temperature of 102° F
Chemotherapy is an immunosuppressant. Even a low fever in an immunosuppressed
patient is a sign of serious infection and should be treated immediately with cultures
and rapid initiation of antibiotic therapy. The nurse should assess the other patients
as soon as possible after assessing and implementing appropriate care for the
immunosuppressed patient.
A patient from a long-term facility is admitted to the hospital with a sacral pressure injury. The base of the wound involves subcutaneous tissue. The nurse assesses impaired skin integrity
in this patient. How will the nurse document this?
a. Stage I
b. Stage II
c. Stage III
d. Stage IV
c. Stage III
Stage III pressure ulcers are defined as full-thickness skin loss involving damage to or
necrosis of subcutaneous tissue that may extend down to, but not through,
underlying fascia. Stage I ulcers have intact skin with nonblanchable redness of a
local area with a change in skin temperature, tissue consistency, or sensation. Stage II
ulcers are partial thickness with a red-pink wound bed. Stage IV ulcers involve
extensive destruction of tissue with exposed bone, tendon, or muscle
The nurse is evaluating the serum laboratory results on four clients. Which laboratory result should the nurse report first?
a. A client with bulimia and a potassium of 3.6 mEq/L
b. A client with osteoporosis and a calcium of 10 mg/dL
c. A client with renal failure and a potassium of 4.0 mEq/L
d. A client with dehydration and a sodium level of 149 mEq/L
d. A client with dehydration and a sodium level of 149 mEq/L
This answer is correct because the normal range for serum sodium is 135 to 145
mEq/L; therefore this client is experiencing hypernatremia. Because dehydration is
likely to cause serum sodium levels to increase further, this is the lab result the nurse
reports first
What statement made by the client prescribed cyclosporine after a kidney transplant indicates the need for further education by the registered nurse (RN)?
a. I will need to take this drug for one year following the kidney transplant
b. It is important that I avoid large crowds and exposure to infection
c. I understand that I do not need to take this drug with grapefruit juice
d. I understand that with this drug there is a chance that my gum tissue might change
a. I will need to take this drug for one year following the kidney transplant
This answer is correct because the statement “I will need to take this drug for one
year following the kidney transplant” requires further education. Cyclosporine is an
immunosuppressant administered to individuals after an organ transplant to prevent
rejection. When administered to prevent organ rejection, the drug is prescribed for
life-long therapy.
Phosphate and calcium always work:
inversely
High>Low < > < >
Hypernatremia-
Hyponatremia-
Hypernatremia- big & bloated; polydipsia, edema [late signs: swollen/dry tongue, N/V, increased muscle tone)
Hyponatremia- Depressed & deflated; seizures/comas, tachycardia, weak pulse, resp. arrest
Hyperkalemia-
Hypokalemia-
Hyperkalemia- heart is tight/contracted, hypotension, bradycardia, diarrhea, paralysis in extremities, muscle weakness
Hypokalemia- Low & slow heart, muscles, and GI; paralyzed intestines
Hypercalcemia-
Hypocalcemia-
Hypercalcemia- Swollen & slow; kidney stones
Hypocalcemia- weak bones, bleeding, cardiac disrhythmia
Hypermagnesia-
Hypomagnesia-
Hypermagnesia- calm & quiet heart & muscles & lungs & GI, bradycardia, hypotension
Hypomagnesia- Buck wild heart, muscles, GI ,eyes; tachycardia
Hyperphosphatemia-
Hypophosphatemia-
Hyperphosphatemia- low calcium; diarrhea
Hypophosphatemia- high calcium; constipation
Tetany is associated with _____________
hypocalcemia
