Term
|
Definition
| Saline, Administer medication, Saline |
|
|
Term
|
Definition
| Saline, Administer medication, Saline, Heparin flush |
|
|
Term
|
Definition
Peripheral
Central Venous Catheters
Implanted Catheters |
|
|
Term
|
Definition
<3 inches
Inserted in superficial veins |
|
|
Term
| Central Venous Catheters (CVC) |
|
Definition
-Subclavian/Jugular
-Peripherally Inserted Central Catheters (PICC)
-Tip of catheter is typically located in large vessel such as inferior or superior vena cava
-Subclavian (inserted in subclavian vein)
FYI:1 CVC costs about the same as 3 peripheral catheters |
|
|
Term
|
Definition
Under the skin, usually located in the chest
Tip of catheter is in a large vessel
Typically used in long term IV therapy i.e. chemotherapy |
|
|
Term
|
Definition
Lactated Ringers (LR)
0.9% Sodium Chloride (NS)
Dextrose 5% in Water (D5W)
Albumin |
|
|
Term
| Nursing Management of Isotonic IVF's |
|
Definition
-Expands intravascular compartment
-Monitor s/s fluid overload (HF, HTN)
Don't give LR if pt's pH > 7.5 (lactate is converted to bicarb)
-Avoid D5W in patients at risk for increased ICP because it acts like a hypotonic solution (dextrose is quickly metabolized leaving only water- a hypotonic fluid) |
|
|
Term
| Kinds of Hypotonic IV Solutions |
|
Definition
0.45% sodium chloride (1/2 NS)
Dextrose 5% in water (D5W) |
|
|
Term
| Nursing Management for Hypotonic IV Solutions |
|
Definition
Hypotonic fluids cause a fluid shift from blood vessels into the cells
Don't give to pt's at risk for increased ICP from stroke or head trauma |
|
|
Term
| Types of Hypertonic IV Solutions |
|
Definition
D5 1/2 NS (D5 0.45% NS)
D5 NS, (D5 0.9% NS)
3.0% Saline |
|
|
Term
| Nursing Management of Hypertonic IV Solutions |
|
Definition
-Expands intravascular space
-Monitor for overload
-Don't give in diabetic ketoacidosis (DKA)
-Cautiously give in impaired renal or heart functions |
|
|
Term
| Assessment of client with Peripheral IV therapy |
|
Definition
Physical assessment
-hydration status
Insertion site assessment
-any signs of complications?
-s/s infiltration, phlebitis, leaking, patent |
|
|
Term
| Complications of Peripheral IV Therapy- Infiltration |
|
Definition
S/S
Pallor, cool, pain due to edema, edematous, tightness, leaking at site
Interventions and Rationale
-D/c IV- prevents further infiltration
-elevate and apply warm compress |
|
|
Term
|
Definition
0-no symptoms
1-skin blanched, edema, <1 inch in any direction, cool to touch, c or w/out pain
2-skin blanched, edema 1-6 inches in any direction, cool to touch, with or without pain
3- skin blanched, transluscent, gross edema >6 inches in any direction, cool to touch, mild-moderate pain, possible numbness
4- skin blanched, transluscent, skin tight, leaking, skin discolored, bruised, swollen, gross edema >6 inches in any direction, deep pitting tissue edema, circulatory impairment, moderate to severe pain, infiltration of any amount of blood product, irritant, or vesicant |
|
|
Term
| Complications of Peripheral IV therapy - EXTRAVASATION |
|
Definition
-The leaking of vesicant drugs into surrounding tissue. Can result in local tissue damage which can lead to delayed healing, infection, tissue necrosis, disfigurement, loss of function, and even amputation
-s/s - blanching, burning, discomfort, coolness, edema
-Interventions- STOP the infusion, catheter is not needed to administer antidote remove catheter, estimate amount of med given, call physician, instill antidote, elevate extremity |
|
|
Term
|
Definition
| inflammation of the intimal layer of the vein |
|
|
Term
|
Definition
*Bacterial
*Chemical
-irritation from IV fluids with high osmolarity
*Mechanical-tip of catheter moving inside lumen of vein |
|
|
Term
|
Definition
| Erythemia, may be painful, edematous, warm |
|
|
Term
| Intervention and Rational of phlebitis |
|
Definition
| d/c IV- prevents further infiltration, elevate and apply warm compresses |
|
|
Term
|
Definition
0-no symptoms
1-erythema at access site with or without pain
2-pain at access site with erythema and/or edema
3-pain at access site with erythema and/or edema, streak formation
4-pain at access site with erythema and/or edema, streak formation, palpable venous cord >1 inch in length, purulent drainage |
|
|
Term
|
Definition
| redness at the site, discharge at the site, temperature |
|
|
Term
| Interventions for INFECTION |
|
Definition
| stop the infusion, notify physician, remove the device, possible culture of the site and device, possible antibiotic therapy, monitor client |
|
|
Term
THROMBUS
(s/s, intervention and rationale) |
|
Definition
Assess patency every shift (8hrs) and flush (blood return)
S/S- reddened, edematous, tightness
Intervention and Rationale-
Prevention
-anticoagulant therapy
-activity to discourage venous stasis
If IV difficult to irrigate DO NOT continue to attempt irrigation- can dislodge thrombus
-d/c IV
-notify Physician |
|
|
Term
|
Definition
-Assess the IV site for signs of infiltration or phlebitis
-Aspirate the IV line prior to administering IVP, IVPB medications or initiating IVF's
-If blood return proceed with injection of medications
-If no blood return and visual inspection of site is clear then proceed with saline flush and observe site for swelling
0 Do not force an IV to flush. May produce an embolism |
|
|
Term
| Complications- DRUG INCOMPATIBILITY |
|
Definition
-Fluids and medications cause unintended effects when mixed- may crystallize or become cloudy
-pH of the infusing solution is the major cause of drug incompatibilities
-Side effect of drug incompatibility may include the medication acting beyond the targeted effect i.e. decrease BP more than anticipated
Intervention: Drug guide text: use tables to assess for compatibility and look up all IV medications in Gahart
Evaluation: continued assessment of client for side effects |
|
|
Term
| Upper respiratory tract includes |
|
Definition
| nose, pharynx, adenoids, tonsils, epiglottis, larynx, trachea |
|
|
Term
| Lower respiratory tract includes |
|
Definition
| bronchi, bronchioles, alveolar ducts, alveoli. |
|
|
Term
|
Definition
| the projections inside the nose that increase the surface area of the nasal mucosa, which warms and moistens air as it enters then nose |
|
|
Term
| Aspiration is more likely to occur in the left or right lung? |
|
Definition
| Right, the right mainstem bronchus is shorter, wider, and straighter than the left mainstem bronchus |
|
|
Term
| In adults, a normal tidal volume (Vt), or volume of air exchanged with each breath, is?? |
|
Definition
|
|
Term
|
Definition
| Normally, each person takes a slightly larger breath, termed a sigh, after every 5-6 breaths, which stretches the alveoli and promotes surfactant secretion |
|
|
Term
| When not enough surfactant is present... what happens? |
|
Definition
|
|
Term
| Lungs have two different types of circulation |
|
Definition
| Pulmonary circulation and bronchial circulation |
|
|
Term
| What is pulmonary circulation? |
|
Definition
| provides lungs with blood for gas exchange. |
|
|
Term
| What is bronchial circulation? |
|
Definition
| starts with bronchial arteries, which arise from the thoracic aorta. Provides oxygen to the bronchi and other pulmonary tissues. |
|
|
Term
|
Definition
| Purulent pleural fluid with bacterial infection |
|
|
Term
| What two methods are used to assess the efficiency of gas transfer in the lung? |
|
Definition
| analysis of arterial blood gases (ABGs) and oximetry |
|
|
Term
|
Definition
| are meausred to determine oxygenation status and acid-base balance. ABG analysis includes measurement of the PaO2, PaCO2, acidity (pH), and bicarbonate in arterial blood |
|
|
Term
| ABG gas values at sea level |
|
Definition
| pH: 7.35-7.45, PaO2: 80-100 mmHg, SaO2: >95%, PaCo2: 32-48 mmHg, HCO3: 22-26 mEq/L (mmmol/L) |
|
|
Term
| Gas exchange takes place in the ? |
|
Definition
|
|
Term
|
Definition
| a lipoprotein that helps to keep the alveoli open |
|
|
Term
|
Definition
| an active process, involving muscle contraction |
|
|
Term
|
Definition
| a passive process, when elastic recoil is reduced, expiration becomes a more active, labored process |
|
|
Term
| Where can a pulse ox be placed? |
|
Definition
| finger, toe, ear, or bridge of nose |
|
|
Term
| Difference between chemoreceptors and mechanical receptors |
|
Definition
Chemoreceptor- responds to change in chemical composition and the fluid around it
Mechanical receptor- stimulated by a variety of physiologic factors such as irritants, muscle stretching, and alveolar wall distortion |
|
|
Term
|
Definition
| regular, rapid, and deep inspirations for metabolic acidosis, and aids body in CO2 excretion |
|
|
Term
|
Definition
| chronic hypoxemia, cystic fibrosis, lung cancer, bronchiectasis |
|
|
Term
|
Definition
| continuous high-pitched squeaking or musical sound caused by rapid vibration of bronchial walls. Occurs in bronchospasm, airway obstruction, COPD |
|
|
Term
|
Definition
Amount of hemoglobin available for combination with oxygen
Male: 14-18
Female: 12-16 |
|
|
Term
|
Definition
Test reflects ratio of red blood cells to plasma. Increased hematocrit found in chronic hypoxemia.
Male: 39-50%
Female: 35-47% |
|
|
Term
| 2nd generation antihistamine |
|
Definition
|
|
Term
| what to avoid for allergic rhinitis |
|
Definition
| house dust,houe dust mites, pet allergens, mold spores, pollen, smoke |
|
|
Term
| Exaple of a leukotriene receptor antagonist (LTRAs) |
|
Definition
| montelukast (Singulair). inhibits leukotriene activity, thereby inhibiting airway edema and bronchoconstriction, and decreasing inflammatory process |
|
|
Term
| Rules with White blood cells |
|
Definition
| Hang with 0.9% NS only, Blood can only hang for 4 hours, Infuse the first 25-50 ml slowly over 15 minutes, Stay with the client the first 15 minutes, Infuse time 2hours to 4 hours (>4hours risk of bacterial growth), Infusion rate based on clients blood volume, cardiac status, etc. |
|
|
Term
|
Definition
| Control bleeding, prevent bleeding r/t deficiencies in platelet number or function, 1 unit increases platelet count by 5,000 platelets/microliter,not prophylactically related to heparin (massive transfusions), 4 hour filter , no ABO matching, age matters (Children rH factor important) |
|
|
Term
| Rules with Fresh Frozen Plasma (FFP) |
|
Definition
Normal components of plasma, clotting factors, and fibrinogen
*bleeding clients with clotting deficiencies, congenital deficiency,liver disease, anticoagulation with warfarin, massive transfusion with RBC and crystalloid/colloid solutions
*1 unit increase clotting factor by 2-3%
*Isotonic- Volume expander (assess s/s overload)
*ABO compatible, w/in 6 hours, filter
*Use w/in 2 hours of thawing |
|
|
Term
| Appearance of RBC, FFP, and platelets |
|
Definition
| RBC- not murky, FFP- clear, Platelets- clear to yellow straw to light strawberry color |
|
|
Term
|
Definition
| air in the pleural cavity resulting from lung collapse |
|
|
Term
|
Definition
| Ruptured BLEB (COPD), Thoracentesis, Trauma, Secondary infection |
|
|
Term
| Treatments of pneumothorax |
|
Definition
|
|
Term
|
Definition
| dyspnea, anxiety, tachycardia, pleural pain, asymmetrical chest wall expansion, diminished breath sounds |
|
|
Term
| Pneumothorax is diagnosed by |
|
Definition
|
|
Term
|
Definition
| Hypersensitivity, URI, Excercise, Air pollutants, respiratory infections, GERD, mold, dust, smoke, pets, chemical odors, cockroaches, grass and weeds |
|
|
Term
| S/s of asthma (reactive airway disease) |
|
Definition
| cough, increased mucus, shortness of breath, wheezing and prolonged expiration, increased CO2 retention, chest tightness, retractions |
|
|
Term
| Complications with giving blood: Circulatory Overload |
|
Definition
Fluids administered to fast, HF, Renal failure
*s/s: cough, dyspnea, coarse crackles, pulmonary edema, HA, HTN, tachycardia, JVD
Tx: Increase HOB, w/feet independent position, administer diuretic, O2, morphine, slow infusion rate |
|
|
Term
| Complications with giving blood: Acute hemolytic |
|
Definition
ABO incompatible
Tx: stop infusion, bl |
|
|
Term
| How long do short acting inhalers (relievers) last? |
|
Definition
|
|
Term
| How long do long lasting inhalers last? |
|
Definition
|
|
Term
| What is the purpose of bronchodilators? |
|
Definition
| Increase diameter of bronchioles to allow air to flow (muscle layer) |
|
|
Term
| What is kussmaul breathing? |
|
Definition
| Fruity, acetone breating, indicates DM (Diabetes Mellitus) |
|
|
Term
|
Definition
| Irregular breathing pattern, present in patients with head trauma, ventilator needed. |
|
|
Term
| What is pneumocystic pneumonia? |
|
Definition
|
|
Term
| When should asthma patient seek emergency care? |
|
Definition
| When signs/symptoms do not respond to treatment within 30 minutes |
|
|
Term
| What are the 6 p's of dyspnea? |
|
Definition
| Pulmonary bronchile constriction, possible foreign body, PE, Pneumonia, Pump failure (heart), Pneumothorax |
|
|
Term
| Where does oxygenation of lung occur? |
|
Definition
|
|
Term
| What causes inflammation to start? |
|
Definition
|
|
Term
|
Definition
| Easily fatigued, Frequent Respiratory Infections, use of accessory muscles to breath, orthopneic (fluid shifts as stand up and sit down), thin in appearance, wheezing, pursed-lip breathing, chronic cough, barrel chest, dyspnea, prolonged expiratory time, bronchitis-increased sputum, digital clubbing (degree of nail bed) |
|
|
Term
| What is there a possibility of when doing a bronchoscopy? |
|
Definition
|
|
Term
| Why is a bronchoscopy needed? |
|
Definition
| To find signs of lesions in the area of the larynx, trachea, bronchi, and specific bronchioles. |
|
|
Term
| What is a mast cell stabilizer? |
|
Definition
| Cromolyn nasal spray. Inhibits degranulation of sensitized mast cells, which prevents release of histamine. Used to treat allergic rhinitis |
|
|
Term
| Example of an anticholinergic |
|
Definition
| Nasal Spray- Ipratroprium Bromide (Atrovent). Reduces rhinorrhea. |
|
|
Term
| What is diabetes mellitus? |
|
Definition
| a chronic multisystem disease related to abnormal insulin production, impaired insulin utilization, or both |
|
|
Term
| What are the 6 long-term complications of DM? |
|
Definition
| Adult blindness, end-stage renal disease, nontraumatic lower limb amputations, heart disease, stroke, hypertension |
|
|
Term
| Regardless of the cause, diabetes is primarily a disorder of glucose metabolism related to? |
|
Definition
| Absent or insufficient insulin supply and/or poor utilization of the insulin that is available |
|
|
Term
| The American Diabetes Assocation (ADA) recognizes 4 types of diabetes: |
|
Definition
| Type1, Type2, gestational diabetes, other specific type of diabetes |
|
|
Term
|
Definition
| A hormone produced by the B cells in the Islets of Langerhans of the pancreas |
|
|
Term
| Explain insulin production under normal conditions |
|
Definition
| Insulin is continuously released into the bloodstream in small pulsatile increments with increased release (bolus) when food is ingested. |
|
|
Term
| What happens to insulin when food is ingested? |
|
Definition
| Insulin concentrations rise rapidly in the blood |
|
|
Term
| What happens to insulin with digestion of food? |
|
Definition
| A fall in insulin level facilitates the release of stored glucose from the liver, protein from the muscle, and fat from adipose tissue |
|
|
Term
| So, ultimately what is the "action" of released insulin? |
|
Definition
| Promotes glucose transport into the cells |
|
|
Term
| What is a normal glucose range? |
|
Definition
|
|
Term
| This normal range is produced by? |
|
Definition
| A strategic game of tug-o-war; with normal blood glucose the middle ground |
|
|
Term
| What other 4 hormones work to oppose the action (counter-regulatory) of insulin? |
|
Definition
| Glucagon, epinephrine, growth hormone, and cortisol |
|
|
Term
| These (counter-regulatory) hormones work to increase blood glucose levels by? |
|
Definition
| Stimulating glucose production, for a "basal" (constant) supply and in times of real need, like fasting. The bodies attempt at maintaining hemodynamic stability. This glucose is released and produced in the liver but there is a virtual blockade at the cell. An abnormal production of any or all of these hormones may be present in diabetes. |
|
|
Term
| How does insulin promote glucose transport from bloodstream to cell? |
|
Definition
| The rise in plasma insulin after a meal stimulates storage of glucose as glycogen in liver and muscle, inhibits gluconeogenesis, enhances fat deposition of adipose tissue, and increases protein synthesis. |
|
|
Term
|
Definition
| The formation of glucose, especially by the liver, from non carbohydrate sources, such as amino acids. |
|
|
Term
| What are the 2 insulin-dependent tissues? |
|
Definition
| Skeletal muscle and adipose tissue |
|
|
Term
| What tissues do not directly depend on insulin for glucose transport but require an adequate glucose supply for normal function? |
|
Definition
| Brain, liver, blood cells |
|
|
Term
| Type 1 diabetes etiology and pathophysiology |
|
Definition
| An immune-mediated disease. The body's own T-cells attack and destroy the Beta cells in the pancreas that supply insulin. The pancreas is a trooper, it has to have a loss of 80-90% of Beta cells before hyperglycemia and other manifestations occur. |
|
|
Term
| What is the typical onset of Type 1? |
|
Definition
| The islet cell autoantibodies responsible for B-cell destruction are present for months to years before the onset of symptoms |
|
|
Term
| When do signs/symptoms appear for Type 1 diabetes? |
|
Definition
| When the person's pancreas can no longer produce sufficient amounts of insulin to maintain normal glucose. Once this occurs, the onset of symptoms is usually rapid. |
|
|
Term
| When there is no longer sufficient amounts of insulin to maintain normal glucose the onset of symptoms is usually rapid. What are those 4 symptoms? |
|
Definition
| Recent or sudden weight loss, polydipsia, polyuria, polyphagia (excessive hunger) |
|
|
Term
| Why does the individual with Type1 require an exogenous source of insulin? |
|
Definition
| Requires an injection to sustain life, cannot control glucose |
|
|
Term
|
Definition
| A condition where individuals are at increased risk for developing diabetes. Blood glucose levels are high, but not high enough to meet criteria for diabetes. This group has impaired IFG and IGT. |
|
|
Term
|
Definition
| Impaired fasting glucose. When fasting, glucose levels are 100-125 mg/dL |
|
|
Term
|
Definition
| Impaired glucose tolerance. With IGT, the 2-hour oral glucose tolerance test values are 140-199 mg/dL |
|
|
Term
| Prevention is by what 3 actions taken to manage blood glucose? |
|
Definition
| Maintaining a healthy weight, exercising regularly, and eating a healthy diet |
|
|
Term
| Type 2 diabetes usually occurs in people who are? |
|
Definition
| Over the age of 35 and 89-90% of patients are overweight |
|
|
Term
| Prevalence of type 2 increases with? |
|
Definition
| Age! Approximately 1/2 of the individuals being diagnosed were >55. |
|
|
Term
| Prevalence is greater in which ethnic populations? |
|
Definition
| African Americans, Asian Americans, Hispanics, Native Hawaiins, or other Pacific Islanders, and American Indians |
|
|
Term
| Why is the distinction between exogenous and endogenous insulin important? |
|
Definition
| The presence of endogenous insulin is a major pathophysiologic distinction between type 1 and type 2 diabetes |
|
|
Term
| Most powerful risk factor of type 2 diabetes? |
|
Definition
|
|
Term
| Define insulin resistance |
|
Definition
| A condition in which body tissues do not respond to the action of insulin |
|
|
Term
| Insulin resistance is 1 factor in the development of type 2. The other 4 factors are? |
|
Definition
| A marked decrease in the ability of the pancreas to produce insulin, inappropriate glucose production by the liver, and altered production of hormones and cytokines by adipose tissue |
|
|
Term
| The onset of Type 2 diabetes is rapid or gradual? |
|
Definition
| Gradual- it takes a long time to develop a marked and sustained state of hyperglycemia, most cases are identified not by symptoms but by screening |
|
|
Term
| What are other specific types of Diabetes? |
|
Definition
| Cushing syndrome, hyperthyroidism, recurrent pancreatitis, cystic fibrosis, hemochromatosis, and the use of parenteral nutrition |
|
|
Term
| Clinical manifestations of type 1? |
|
Definition
| the onset is rapid, initial manifestations are usually acute |
|
|
Term
| classic s/s of type 1 diabetes are? |
|
Definition
| ketoacidosis is the BIGGEST complication associated with untreated type 1 diabetes |
|
|
Term
|
Definition
| Break up mucus but watch out for dizziness, drowsiness, bronchospasm, NV, rhinorrhea |
|
|
Term
| What does pulmonary function test measure? (PFT) |
|
Definition
|
|
Term
| What are laryngeal polyps caused by? |
|
Definition
| Polyps on the vocal cords as a result of vocal abuse or irritation resulting in voice hoarseness |
|
|
Term
| What, why, and how does the Hgb A1C detect glycemic levels over time? |
|
Definition
| It indicates the amount of glucose that has been attached to hemoglobin molecules over their life span. A1C of 7% means that 7% of the total hemoglobin has glucose attached to it |
|
|
Term
| What is the ideal Hgb A1C? |
|
Definition
| < or = 7.0% (according to the ADA) |
|
|
Term
| Insulin regimens: If only a single dose? |
|
Definition
| Long acting (in morning or at bedtime) or Intermediate/NPH (at bedtime) |
|
|
Term
| Insulin regimens: if twice a day? |
|
Definition
| Split-mixed dose. NPH and regular or rapid (before breakfast and at dinner) |
|
|
Term
| Basal bolus (exogenous insulin most closely related to endogenous insulin production) |
|
Definition
| Uses rapid (or short-acting) insulin before meal (rapid= 15 minutes before meals, short acting=30 minutes before meals)(rapid is preferred since 30-45 minutes is hard to incorporate in peoples lifestyles) and intermediate (or long-lasting) insulin once or twice a day |
|
|
Term
| Oral agents for drug therapy for diabetes |
|
Definition
| Not insulin, but work on insulin resistance, decreased insulin production, and increased hepatic glucose production. Example of these are sulfonylureas, meglitinides, biguanide, alpha glucosidase inhibitors, thiazolidinediones |
|
|
Term
| Achieving nutritional (Nutrition=cornerstone for people with DM) goals requires a coordinated team effort that considers what 5 factors? |
|
Definition
1. Maintain blood glucose levels to or as normal as safely
2. Achieve lipid profiles and bp levels
3. Prevent or slow rate of development of chronic complications by modifying nutrient intake and lifestyle
4. Address individual nutritional needs
5. Maintain pleasure of eating by allowing as many food choices as appropriate |
|
|
Term
| Emphasis for nutritional therapy in part 1? |
|
Definition
| Insulin insulin insulin! Meal planning, timing, and amount of food with regimen patterns |
|
|
Term
| Emphasis for nutritional therapy in type 2? |
|
Definition
| Achieving glucose, lipid, and bp goals. WEIGHT LOSS! Reduction of total fat, especially saturated fats. Monitoring of blood glucose levels. |
|
|
Term
| What improves insulin resistance? (type 2) |
|
Definition
|
|
Term
| How much weight loss does it take to improve glycemic control? |
|
Definition
| 5-7%. Some weight loss is better than none |
|
|
Term
| Weight loss is best attempted by? |
|
Definition
| A moderate decrease in calories and an increase in caloric expenditure. This is a behavior change, a lifestyle adaptation and it takes learning new behaviors and attitudes to facilitate the change. |
|
|
Term
|
Definition
| Carbs include sugars, starches, and fiber. Foods like whole grains, fruits, vegetables, and low-fat milke. |
|
|
Term
| Why should carbs be included as part of a healthy meal plan? |
|
Definition
| They provide important sources of energy, fiber, vitamins, and minerals |
|
|
Term
|
Definition
| Describes the rise in blood glucose levelsl 2 hours after a person has consumed a carbohydrate-containing food |
|
|
Term
|
Definition
| Compares the postprandial response of carbohydrate containing foods |
|
|
Term
| What is an important component for all individuals on healthy meal plans? |
|
Definition
|
|
Term
| What does alcohol inhibit and ultimately cause? |
|
Definition
| Gluconeogensis (breakdown of glycogen to glucose by the liver) Causes hypoglycemia in patients on insulin |
|
|
Term
| Who does Patient Teaching most often? |
|
Definition
|
|
Term
| Carbohydrate Counting: Each serving of carbohydrate is how many grams? |
|
Definition
|
|
Term
| Usually start with how many carbs at a meal? |
|
Definition
|
|
Term
| Plate method of The MyPyramid guide? |
|
Definition
| For each meal 1/2 of plate is filled with nonstarchy veggies, 1/4 is filled with starch, 1/4 is filled with protein. A glass of nonfat milk and a small piece of fresh fruit complete the meal |
|
|
Term
| What kind of exercise is essential? |
|
Definition
| Regular and consistent exercise |
|
|
Term
| How much exercise does the ADA recommend that individuals with diabetes complete? |
|
Definition
| At least 150 minutes per week of moderate-intensity |
|
|
Term
| How much exercise does the Surgeon General recommend for most adults? |
|
Definition
| 30 minutes of moderate intensity on most days |
|
|
Term
| What other training should a type 2 do and how often? |
|
Definition
| Resistance training. Three times a week |
|
|
Term
| What are some potential complications from exercise? |
|
Definition
| Patients who use insulin, sulfonylureas, or meglitinides are increased risk for hypoglycemia when increasing physical activity. Strenuous activity can be perceived by the body as a stress, resulting in temporarily elevating blood glucose. Vigorous activity should be avoided |
|
|
Term
| How long does the glucose lowering effects of exercise last? |
|
Definition
| Up to 48 hours after activity |
|
|
Term
| Important tips for exercise if diabetic |
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Definition
| Does not have to be vigorous to be effective. Properly fitting footwear. Need warm-up and cool-down. Best done after meals (when blood glucose is rising). Self-monitor blood glucose levels before, during, and after exercise |
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Term
| Self-monitoring blood glucose |
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Definition
| SMBG is a big deal in diabetes management. SMBG is recommended for all insulin-treated patients with diabetes, it helps achieve and maintain glycemic goals |
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Term
| The frequency of monitoring depends on? |
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Definition
| The individuals glycemic goal, the type of diabetes, the medication regimen, individuals ability to perform the test independently and their willingness to test |
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Term
| What is another route for monitoring glucose? |
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Definition
| CGM (continuous glucose monitoring) |
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Term
| What is type O considered? |
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Definition
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Term
| What is type AB considered? |
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Definition
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Term
| Why is O universal donor? |
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Definition
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Term
| Why is AB universal recipient? |
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Definition
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Term
| Why can blood only be hung with normal saline? |
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Definition
| Because lactated ringers and dextrose can cause hemolysis |
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Term
| Why does blood have to have special tubing? |
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Definition
| Special tubing has filters for clots |
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Term
| What is infusion rate for normal adult? |
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Definition
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Term
| What is the fastest that you can infuse blood? |
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Definition
| 2 hours. For HF and or edematous patient go slow! |
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Term
| What is a febrile reaction? |
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Definition
| When patient is sensitive to donor products |
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Term
| What are s/s of a febrile reaction? |
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Definition
| Sudden chills, fever, HA, flushing |
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Term
| What two veins are used for PICCs? |
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Definition
| antecubital in arm and femoral in leg |
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Term
| What is an open ended catheter? |
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Definition
| Hickman, has holes along length of catheter but end is closed, prevents clotting, uses neutral pressure, saline used, may single or dual lumen |
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Term
| What size syringe is used on cvad? |
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Definition
| 10 ml or larger (lower psi) |
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Term
| What amount of air can cause an air embolus? |
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Definition
| 10 ml of air (most likely to occur when changing tube) |
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Term
| How often do fluids need changed? |
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Definition
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Term
| How often do primary and secondary continuous admin tubing get changed? |
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Definition
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Term
| Macrovascular complications are? |
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Definition
| Diseases of the large and medium-size blood vessels that occur with greater frequency and with an earlier onset in people with diabetes. Examples: CAD (MI, CHF), PAD (gangrene occurs) |
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Term
| Treatment in this reduces mortality risk by 50% in individuals with DM? |
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Definition
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Term
| How long does it take for clinical manifestations to appear with MICROvascular complications? |
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Definition
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Term
| Examples of microvascular complications |
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Definition
| retinopathy, nephropathy, dermopathy, neuropathy |
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Term
| What is the leading cause of ESRD (end stage renal disease) in the US? |
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Definition
| Nephropathy (a microvascular complication) |
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Term
| Sensory neuropathy most common characteristics are? |
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Definition
| loss of sensation, abnormal sensations, pain, and paresthesias |
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Term
| The pain of neuropathy is described as? |
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Definition
| burning, cramping, crushing, tearing (usually worse at night) |
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Term
| The paraesthesia (nerve pain) is described as? |
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Definition
| tingling, burning, and itching sensations |
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Term
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Definition
| Loss of protective sensation. The biggest issue with sensory neuropathy. Determined with 10 g Semmes-Weinstein microfilament. Needs aggressive teaching on proper footwear, nair care, and inspecting the foot daily |
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Term
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Definition
| intermittent claudication, pain at rest, cold feet, loss of hair, delayed capillary filling, dependent rubor (redness of skin) |
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Term
| What is acanthosis nigricans? |
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Definition
| A dark, coarse, thickened skin predominantly seen in flexures and on the neck |
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Term
| Antihistamines :Examples and S/E |
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Definition
Benadryl, Zyrtec, Vistaril
SE: drowsiness, tachycardia, dry nose and throat, urinary frequency, and hypotension |
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Term
| Bronchodilators : Examples and SE |
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Definition
| Albuterol, Proventil, Ventolin, Serevent SE: Tachycardia, HA, irritability, anginal pain and tremors. WATCH FOR TOXICITY! |
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Term
| What drug can be used for long term management of asthma? |
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Definition
| Pulmicort! (Budesonide) TAPER OFF!! |
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Term
| What are Somogyi Effects? |
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Definition
| Rebound effects in which an overdose of insulin induces hypoglycemia. Effect usually occurs during hours of sleep, effect produces a decline in blood glucose level in response to too much insulin. The individual may report nightmares or night sweats. Check bs between 0200-0400 to determine if hypoglycemia is present |
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Term
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Definition
| hyperglycemia that is present on awakening due to counterregulatory hormones in the predawn hours. Tends to be most severe in adolescence and young adults |
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