Med-Surgical Test 1

Are they kidneys a high pressure system or low pressure system?

-Nephrons are damaged because kidneys' are a *low pressure system*, and when you have constant high pressure flowing through the kidneys you'll have some problems.

Short term access device for central infusion:

-Non-tunneled percutaneous - Sublavian vein most common site - Can be single, double, triple lumen

What are the advantages of using dextrose solutions?

-Nutrition -Vehicle for drug administration -Provide free water to body -Treat dehydration, hyperkalemia

Peritoneal Dialysis

-Peritoneal access is obtained by inserting a catheter through the anterior wall -Technique for catheter placement varies -Usually done via surgery -After catheter inserted, skin is cleaned with antiseptic solution and sterile dressing applied -Connected to sterile tubing system -Secured to abdomen with tape -Catheter irrigated immediately -Waiting period of 7 to 14 days preferable -2 to 4 weeks after implantation, exit site should be clean, dry, and free of redness/tenderness -Once site healed patient may shower and pat dry

Two methods of dialysis available:

-Peritoneal dialysis (PD) -Hemodialysis (HD) *Table 47-13-Comparison*

CKD causes clinical manifestation with psychologic changes, what are they?

-Personality and behavioral changes - Labile emotions - Withdrawal - Depression

Inflow (p dialysis)

-Prescribed amount of solution infused through established catheter over about 10 minutes -After solution infused, inflow clamp closed to prevent air from entering tubing

What is the function of platelets (thrombocytes)?

-Primary function is initiation of clotting process -Works with clotting factors in blood to stabilize site of bleeding -Have important role in shrinkage and retraction of blood clot

In a patient with critical limb ischemia, what special precautions should they take and what is the best way to treat it?

-Protect from trauma -Decrease vasospasm -Prevent/control infection -Maximize arterial perfusion

Why do we use dextrose solutions?

-Provide calories -Reduce protein catabolism -Prevent negative nitrogen balance

If a Hematoma develops during peripheral IV therapy, what is the treatment?

-Remove catheter if needed -Apply pressure with 2x2 -Elevate extremity -Cold compresses

What nursing interventions will you perform with a patient having respiratory alkalosis?

-Resolve underlying problem -Assist with breathing -Monitor for fatigue Medications

What should a nurse frequently monitor after a surgical procedure involving peripheral arterial bypass*, *Endarterectomy*, *Patch graft angioplasty*, *Amputation*

-Skin color and temperature -Capillary refill -Presence of peripheral pulses distal to the operative site -Sensation and movement of extremity -Knee-flexed positions should be avoided except for exercise -Turn and position frequently -Monitor ABI

Hemodialysis Procedure

-Two needles placed in fistula or graft -Needle closer to fistula or red catheter lumen pulls blood from patient and sends to dialyzer -Blood returned from dialyzer to patient through second needle or blue catheter

Transfusing Blood Products:Intra-procedure

-Use normal saline to prime IV tubing -Take vital signs before starting blood and according to institution protocol -Start slowly;remain with pt. first 15-30 minutes -Monitor vital signs, infusion rate, breath sounds, neck veins -Complete transfusion in 2-4 hrs.

Transfusing Blood Products:Post-procedure

-Vital signs upon completion -dispose of blood administration set -Check lab values (RBCs, Hgb, Hct) Hgb should rise by approx. 1 g/dL with each unit transfused -Complete paper work or electronic documentation -Document patient response

Metabolic disturbances (a clinical manifestation of CKD)

-Waste product accumulation -Normal BUN: 5-20mg/dl -Normal Serum Creatinine: 0.5-1.5mg/dl -As GFR ↓, BUN ↑ and serum creatinine levels ↑ *Serum creatinine clearance, and GFR are more accurate indicators of kidney function than BUN*

Ultrafiltration

-Water and fluid removal -Results when there is an osmotic/pressure gradient across the membrane

What factors should you indicate to the lab with a patient's arterial blood gas sample? Why?

-You should notify the lab if a patient is on supplemental 02 or if they have a fever. *Why? Because fever and supplemental oxygen can change the outcome of the blood gas readings

What are the objectives of of blood transfusion therapy?

-increase circulating blood volume -increase number of RBCs, maintain Hgb levels -provide selected cellular components

What CKD clinical manifestations occur with the

-kussmaul respiration (deep rapid) d/t metabolic acidosis -Dyspnea d/t fluid volume overload -Pulmonary edema d/t fluid volume overload *What would you do with this patients? ASSESS them...listen to thei rlungs, they coul dbe crackles! If you don't' hear anything, it could be total fluid over load. You may have to give them lassix!*

Rh factor

-positive vs. negative -*most people are positive* -Type and Rh faactor determined with a simple blood draw

What is the normal Magnesium level in the body?

(N= 1.5-2.5 mEq/l)

What foods are rick in phosphate and should be restricted with patients with CKD?

.The main food sources of PO4 are the protein-rich food groups, including dairy products, meat, and fish *Although it is found in most foods*

What are some examples of hypotonic solutions?

0.45% NaCl & D 2.5% W

What is the *ONLY* acceptable IV fluid when giving blood products?

0.9 normal saline

A patient's blood glucose level was found to be 65 mg/dL during a follow-up visit to learn about management of hypoglycemia. Which action of the patient might be responsible for this? 1 including whole milk in the diet 2 Including more fruits and juices in the diet Incorrect 3 Performing moderate amounts of exercise 4 Including large quantities of rapid-acting carbohydrates in the diet

*1. including whole milk in the diet* _ Whole milk contains a high fat content and will reduce glucose absorption, and it may cause hypoglycemia.

The nurse is caring for a patient diagnosed with diabetes mellitus (DM) who has developed insulin resistance. Which class of glucose-lowering agents can reduce insulin resistance? 1. DPP-IV inhibitors 2 Dopamine agonists 3. Thiazolidinediones 4. α-glucosidase inhibitors

*3 Thiazolidinediones* are often referred to as "insulin sensitizers." These agents improve insulin sensitivity, transport, and utilization at target tissues. Because they do not increase insulin production, thiazolidinediones do not cause hypoglycemia when used alone. Examples of thiazolidinediones include rosiglitazone and pioglitazone

The urinalysis of a patient with diabetes mellitus that has a blood glucose level of 680 mg/dL reveals a minimal ketone level. Which other finding can the nurse observe in the reports? 1. Decreased blood pH 2. Increased potassium 3. Increased serum osmolality 4. Decreased serum bicarbonate

*3. Increased serum osmolality* Blood glucose of 680 mg/dL and a minimal amount of ketones in the urine indicate that the patient has hyperosmolar hyperglycemic syndrome; the patient will also have increased serum osmolality. Decreased blood pH is associated with diabetic ketoacidosis. Patients with hyperosmolar hyperglycemic syndrome may have milder potassium deficits (hypokalemia) due to fluid losses. Decreased serum bicarbonate is observed with diabetic ketoacidosis.

Ramipril (Altacel)

*ACE inhibitors* ↓ Cardiovascular morbidity ↓ Mortality ↑ Peripheral blood flow ↑ABI ↑ Walking distance

There are six types of "problems" that a nurse needs to prioritize when it comes to patient care. What are those two types of problems?

*Actual problem* and *potential problem* ALSO, is it a *systematic problem* or a *local problem* Finally, is it an *acute problem* or a *chronic problem*

What types of drug therapy is given to patient with PAD after surgery?

*Antiplatelet agents:* after surgery for graft patency, inhibit platelet activity, adhesion *aspirin* *clopidogrel (Plavix):* more effective than aspirin

What is *step three* when assessing a patient's arterial blood gasses?

*Assess HCO3 * N=22-26 mEq/l If the pH and the HCO3 are moving in the SAME direction = Metabolic

What is *step four* when assessing a patient's arterial blood gasses?

*Assess pO2-oxygenation status* N= 80-100 mmHg

What are the risk factors for PAD?

*Cigarette Smoking!!!!* *Number 1 cause* -Hyperlipidemia -HTN -Diabetes Mellitus -C-Reactive Protein *Others:* -Obesity -Hypertriglyceridemia -Family history -Sedentary lifestyle -Stress

Polyuria

*Clinical Manifestations* -Results from inability of kidneys to concentrate urine -Occurs most often at night -Specific gravity: N= 1.005 - 1.030 Inability to concentrate urine Fixed around 1.010

CKD-MBD

*Cronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD)* -Skeletal Complications -Result of alterations in calcium and phosphate metabolism -Weaken bones, increase fracture risk: INJURY! -Vascular/soft tissue complications: Excess Phos binds with Ca++, deposits in soft tissue and blood vessel walls= CV disease, interfere with conduction, cardiac arrest

A patient may develop diabetes as a result of another medical condition. Which condition can be linked to diabetes?

*Cushing syndrome* is treated with corticosteroids, which can then cause diabetes. SIADH and hypothyroidism will not. *Celiac disease* is another autoimmune disease that a patient with diabetes is at a greater risk of developing.

What is DM?

*Diabetes Mellitus* - A chronic, multi system disease - Altered metabolism of carbohydrates, fats, and proteins occurs

What nursing interventions will you perform with a patient with metabolic alkalosis?

*Difficult to treat* - Monitor VS - Monitor LOC - Monitor I & O - Lytes

NPH

*Duration*: Intermediate acting, 18-24 hours *Route*: Subcutaneous

Glargine (Lantus) & Detemir (Levemir)

*Duration*: Long acting, 10-24 hours *Route*: Subcutaneous

Lispro (Humalog)

*Duration*: Rapid acting, 3-4 hours *Route*: Subcutaneous or SQ infusion(pump)

Aspart (NovoLog)

*Duration*: Rapid acting, 3-5 hours *Route* Subcutaneous SQ infusion(pump)

Regular (Humulin R, Novolin R)

*Duration*: short acting, 5-7 hours (slower than Lispro or Aspart) *Route*: SubcutaneousSQ infusion(pump), IV (Only one!) - *Insulin action.* Insulin is a medicine that lowers blood glucose (sugar). ... *Onset* refers to when the insulin starts to work. *Peak* refers to when the insulin works hardest. *Duration* refers to how long the insulin works.

DKA may effect the production of erythropoietin, causing anemia. What drugs are used to stumulate the production of erythropoietin?

*Epoetin alfa (Epogen, Procrit)* *Darbepoetin (Aranesp)-longer acting* - Administered IV or SQ - Increased hemoglobin and hematocrit in 2 to 3 weeks Side effect: Hypertension

After admitting a patient with diabetic ketoacidosis (DKA) to the emergency department, which nursing intervention is a priority? 1. Administer insulin 2. Administer oxygen 3. Insert a Foley catheter 4. Establish an intravenous (IV) access

*Establish an intravenous (IV) access* DKA is severely dehydrated, which can be life-threatening

DKA: Diagnostic criteria

*Hyperglycemia* blood glucose > 250 mg/dL *Low bicarbonate* plasma bicarbonate < 16 mEq/L *Low arterial pH* plasma pH < 7.30 *Ketones* blood and/or urine positive for ketones(moderate to large)

HHS: DIAGNOSTIC CRITERIA:

*Hyperglycemia* blood glucose > 600 mg/dL *Arterial pH* GREATER than 7.35 *Ketones* absent or small in blood and urine *Osmolarity* serum osmolarity > 320 mOsm/L *Alterations in electrolytes* K+, Na+, Cl-

What is the pathophysiology with HHS?

*Hyperglycemia* occurs due to increased insulin resistance, excessive carbohydrate intake, *hyperosmolarity* is caused by extremely high BG levels and dehydration is profound-water will move out of the cells as the high BG leader to diuresis

What is the drug therapy for hyperkalemia

*IV insulin* Potassium moves from the extracellular to intracellular space IV glucose given concurrently to manage hypoglycemia *Sodium polystyrene* sulfonate (Kayexalate) Cation-exchange resin Resin in bowel exchanges K+ for Na+ Evacuates potassium-rich stool from body Educate patient that diarrhea may occur due to laxative effect Given orally or rectally

Are IV solutions colloid or crystalloid solutions?

*IV solutions are crystalloid solutions:* or water mixed with electrolytes. The particles are small enough to make their ways out of the IVS. *Examples of COLLOID solutions would be blood products, with particles such as albumin that cannot make their way out of the IV space.

What clinical manifestations can occur during hypoglycemia?

*Impaired Cerebral Function* - headache - slurred speech - change in emotional behavior - impaired motor function - seizures coma, death *Autonomic Nervous System Response* - hunger - anxiety - tachycardia - diaphoresis - constriction of superficial blood vessels

Defective carbohydrate metabolism,a metabolic disturba nce with CKD, is caused by what?

*It is caused by impaired glucose use* -From cellular insensitivity to the normal action of insulin -Results in hyperinsulinemia hepatic production of triglycerides -Triglyceride levels increase *Risk for: atherosclerosis*

What are some APPROACHES TO CARE for DM?

*Medications* - Oral Agents - Insulin - Non insulin injectable agents *Nutrition* - Type 1 vs. Type 2 - Plate method *Glucose Monitoring* - Frequency, tracking *Exercise* Many benefits

Microangiopathy is also known as....

*Microvascular disease*. or small vessel disease is an angiopathy (i.e. disease of blood vessels) affecting small blood vessels in the body.

Hyperkalemia,a clinical disturbance with CKD, is...

*Most serious electrolyte disorder in kidney disease* - Causes fatal dysrhythmias - Results from decreased excretion by kidneys and tendency for metabolic acidosis

CKD causes clinical manifestation to the integumentary system, what are they?

*Most visible change* - Yellow-gray discoloration of the skin D/T absorption/retention of urinary pigments -Pruritus: bleeding, infection -Uremic frost-rare -Dry, pale skin -Dry, brittle hair -Thin nails

Duplex imaging

*PAD diagnostic test that...* -Bidirectional, color Doppler -Maps blood flow

Angiogram

*PAD diagnostic test that...* -Location and extend of disease -Inflow/outflow vessels

Magnetic resonance angiography (MRA)

*PAD diagnostic test that...* -MRI w/ angiography capability

Doppler ultrasound

*PAD diagnostic test that...* -Segmental blood pressures -Sound waves test velocity of blood -Can dx arterial or venous occlusion

Name 4 surgical PAD interventions

*Peripheral Arterial Bypass:* autogenous vein or synthetic graft material, bypass blood around the lesion *Endarterectomy*: Open artery, remove plaque -*Patch graft angioplasty* -*Amputation*

Autologous donations can occcur...

*Preoperative*: Prior to procedure *Intraoperative Blood Salvage*: During early part of procedure *Postoperative Blood Salvage*: Blood from surgical field given back to patient

Electrolyte/acid-base imbalances re a clinical manifestation of CKD, what is involvned with electrolyte/acid-base imblances?

*Sodium (N=135-145mEq/L)* -May be elevated, normal, or low Because of impaired excretion, sodium is retained -Water is retained -Edema -Hypertension -HF

Dyslipidemia may occur as a result of DKA. What types of drugs are used to control dyslipidemia?

*Statins* -HMG-CoA reductase inhibitors-Statins -Most effective for lowering LDL *Lipitor* Monitor LFTs

What class of drugs are known as "insulin sensitizers" (from AQ)?

*Thiazolidinediones*: This class of drugs improves insulin sensitivity, transport, and utilization at target tissues.

HHS: COLLABORATIVE CARE

*Treatment similar to DKA* - IV fluids- 0.9 NS or 0.45 NS; rate depends on cardiac status - Regular insulin IVP as bolus then continuous infusion -Change IV fluids to one containing glucose when blood level falls to 250 mg/dl

Long term access catheters

*Tunnelled catheters* - Single or multiple lumen - Can stay in place months to years - Cuff anchors catheter OR *implanted port*

What is *step one* when assessing a patient's arterial blood gasses?

*assess pH* N= 7.35-7.45 Above 7.45= alkalotic Below 7.35= acidotic

What is *step two* when assessing a patient's arterial blood gasses?

*determine primary cause, respiratory or metabolic* - Assess pCO2 - N=35-45 mmHg

Platelets have what blood components?

*have a vital role in homeostasis* - Live approximatly 12 days in the blood - Normal value of platelts - Can be obtaiend from single or multiple donors!

In *metabolic acidosis*, the PH is ?, the PCO2 is ?, and the HCO3 is ?

*pH:* DOWN *PCO2:* NORMAL *HCO3:* DOWN

In *respiratory acidosis*, the PH is ?, the PCO2 is ?, and the HCO3 is ?

*pH:* DOWN *PCO2:* UP *HCO3:* Normal

In *respiratory alkalosis*, the PH is ?, the PCO2 is ?, and the HCO3 is ?

*pH:* UP *PCO2:* DOWN *HCO3:* Normal

In *metabolic alkalosis*, the PH is ?, the PCO2 is ?, and the HCO3 is ?

*pH:* UP *PCO2:* NORMAL *HCO3:* UP

PICC:

- A type of short term central infusion access catheter that is inserted peripherally and runs through the superior vena cava - Single or double lumen most common - Can use UP TO 1 yr

What does DM involve in regards to insulin?

- Abnormal insulin productivity - Impaired insulin utilization - BOTH of the above

What nursing interventions will you perform with a patient with respiratory acidosis?

- Administer O2 - Mechanical ventilation - Elevate HOB - Remove cause *Remove pain* *Pneumothorax* *Treat OD*

Who needs a central infusion device?

- Any type of long term infusion therapy - Can be weeks to years - There are two categories: short term and long term

How do you prevent a hematoma from occurring during peripheral IV therapy?

- Apply tourniquet just before venipuncture - Use indirect method for venipuncture - Use BP cuff if skin very thin

How often should you flush an IV site?

- At least once a shift - Before and after every IV medication is administered - In between IV medications

What are some Nsg.Interventions/ClientEducation with *thizaolidinediones*?

- Baseline/periodic - LFT's and Lipidprofile - Monitor for s/s heart failure, edema, weight gain

What is documented as part of maintaining an IV site?

- Condition of site - Site care provided - Any dressing changes - Any site changes - Tubing and solution changes - Any teaching provided and patient's understanding of teaching

The site for venipuncture and the size of the catheter used are determined based on what several factors:

- Condition of the vein - Type of fluid or medication to be delivered - Duration of therapy - Patient's age and size - Whether the patient is right or left handed - Patient's medical history and current health status - Skill of person performing the venipuncture

What are three major microvasular complications related to DM complications?

- Diabetic retinopathy *proliferative, nonproliferative (most common) - Nephropathy *Multiple factors contribute, ESRD results* - Neuropathy *Sensory & Autonomic*

What 3 ways are IV medications given?

- Direct injection (IVP) - Intermittent infusion - Continuous infusion

*Macrovascular* is a chronic complication of DM. What is *macrovascular?*

- Disease of large and medium blood vessels - Heart, brain and peripheral vascular system are target organs *Complications associated with Chronic Hyperglycemia*

What types of anit-hypertensive drugs are given to CKD patients who suffer from hypertension?

- Diuretics - β-Adrenergic blockers - Calcium channel blockers - Angiotensin-converting enzyme - - (ACE) inhibitors - Angiotensin receptor blocker agents

With *metabolic alkalosis* a patient may have renal failure, a patient may have excess base, loss of acid. When assessing this patient, what symptoms are you looking for?

- Dizziness - Lethargy - Seizures - Coma - Muscle weakness - Twitching - N/V

With Respiratory Acidosis: a patient may have respiratory depression, CNS depression. What will you assess for?

- Drowsiness - Disorientation - HA - Decreased BP - Restlessness - Cyanosis - Dyspnea

What are the signs and symptoms (localized) of a hematoma during peripheral IV therapy?

- Ecchymoses - Site swelling/pain - Inability to advance catheter - Resistance to flushing

What are certain thing you should think about when prioritization the need for your patient

- Emergency first: ABCD - Respond to trends vs. isolated findings - Actual before potential - Systemic before local - Acute before chronic - Maslow's Hierarchy - Time Management - Infection control issues - Nursing Process

Why do we flush an IV site?

- Ensures patency of the site - Cost less than having IV fluid infusing continuously - Helps prevent mixing of incompatible substances - Allows the patient more mobility in between infusions - Reduces the risk for fluid overload in susceptible patients - Is normally performed on a schedule.

What are the disadvantages to lactated ringers?

- Excess sodium if too much given - Cannot be given if lactated metabolism is impaired

What are classical manifestations of DKA?

- GI distress - Fruity odor on breath - CNS depression - Dehydration - Kassmaul's respiration

In an unconscious hypoglycemic patient, what typically occurs during collaborative care?

- Give Glucagon 1mg subcutaneously or intramuscular (Can teach family to do this) - Glucose 50% intravenously (Trained personnel only) *When using 50% glucose, make sure you use a large enough needle*

Leuokocytes are compries of what two major types of white blood cells?

- Granulocytes (include neutrophils, basophils, eosinophils - Agranulocytes (include lymphocytes, monocytes)

Whole blood products have what components?

- Has ALL cellular components - Major use is autologous transfusion - Increases RBC mass - Increases O2 carrying capacity

What are some of the advantages of lactated ringers?

- Has a precursor to bicarbonate - MOST like body's ECF

When conservative therapy is no longer effective-Renal Replacement Therapy is necessary, what does that involve?

- Hemodialysis - Peritoneal Dialysis -Transplantation

How is the glomerulus in the kidney's damaged as a result of the microvascular complication of nephropathy?

- Hyperglycemia - High renal blood flow - High pressure within glomerulus *This results in progressive decreas in glomerular blood flow* *damage to the glomulus occurs as the permeability changes and albumin/protein spills into the urine*

What is considered intake?

- IV fluid - Naso gastric fluid - Any thing liquid at room temperature - IV flush

What are the precipitating factors of DKA?

- Illness, infection - Inadequate insulin dosage - Undiagnosed type 1 diabetes - Poor self management

What responsibility do nurses have when a patient is undergoing IV therapy?

- Initiate, maintain therapy - Monitory response - Discontinuing therapy

Time, or time factors, are important when priortizing care. What questions should you ask yourself relating to time?

- Is it an immediate problem or can it wait til the end of your shift? - What takes the least amount of time to complete?

What are the purposes of the IV route?

- Keeps vein open - Administration of fluids - Administration of meds - blood sampling - access to venous tree

What should you assess during replacement IV fluid therapy?

- Kidney function - Creatinine , BUN - Crackles in the lungs - Heart rate

With *metabolic acidosis* a patient may have renal failure, DKA, anaerobic metabolism, starvation, and salicylate poising. When assessing this patient, what symptoms are you looking for?

- Kussmaul's respiration - Diarrhea - Drowsiness - LOC - HA - Stupor - Coma - N/V

With *Respiratory Alkalosis:* a patient may have hyperventilation, increased metabolic demands, medication, CNS lesions. When assessing this patient, what are you symptoms are you looking for?

- Lethargy - Lightheaded - Confusion - Numbness - Tingling - Dysrhythmias - Palpitations

What nursing interventions will you perform with a patient with metabolic acidosis?

- Look for hypoxia - Restore tissue perfusion - Monitor lytes - I & O - IV fluids - Na Bicarb, if necessary

Over-the-needle catheter

- MOST widely used - Catheter is flexible - Needle is guide for insertion - Clear chamber permits visualization of blood return - Color coded!!

Scalp Vein Needle

- Made with stainless steel - have wings made of rubber and plastic - Tubing extends off of needle - NOT flexable - NOT typically used anymore

5 main functions of the kidney:

- Maintain fluid, acid-base and electrolyte balance - Detoxify blood and eliminate wastes - Regulate blood pressure - Assist in red blood cell production - Regulate vitamin D and calcium formation

As CKD progresses, patients are *no longer able to*:

- Maintain fluid, acid-base and electrolyte balance - Detoxify blood and eliminate wastes - Regulate blood pressure - Assist in red blood cell production - Regulate vitamin D and calcium formation

What are the 3 types of IV therapy?

- Maintenance - Replacement - Restoration

18 catheter gauge is used for:

- Major trauma, blood administration (green color)

What should you make sure ask when a patient reveals that have DM?

- Make sure you take a good history - Ask what age they were when they were diagnosed and what medication worked for them

Name some precipitation factors of HHS:

- Medications - Infection - Acute or chronic - - illness - Invasive procedure

What type of urine and blood test should a DM patient undergo each year?

- Microalbuminuria - Serume creatine - GFR

20 catheter gauge is used for:

- Minor trauma, surgery, blood (pink color, probably the most popular)

During hemodialysis,what should you assess and monitor?

- Monitor for signs of fluid volume changes Assess access site: - Auscultate for BRUIT - Palpate for THRILL *NEVER use the access arm for BPs or blood draws! Can destroy or clot the access.* - Monitor weight: Pre-dialysis Post-dialysis

14-16 catheter gauge is used for:

- Multiple trauma, heart surgery (gray color)

What are some characteristics of an implanted port?

- No external parts - In place for years - Safe, reliable access - RN must be trained to access

What are the advantages of dextrose solutions?

- Nutrition - Vehicle for drug administration - Provide free water to the body - Treat dehydration, *hyperkalemia*

Blood components products include:

- Packed red blood cells (PRBCs) - Plasma - Albumin - Clotting factors - Platelets - Prothrombin complex - Cryoprecipitate

Genitourinary function can also have compolications due to DM and autonomic neuropthay. What complications of the genitournary systems can occur?

- Paralytic bladder (or even an atonic bladder) - incomplete voiding - impotence

What is part of the routine assessment of ANY and EVERY intravenous site?

- Patency - Any signs of local tissue irritation or inflammation

What is the best way for a patient to prevent deeper complications related to DM?

- Patient teaching is vital! - *The patient must take an active role in controlling disease and improving health status* - Maintaining blood glucose levels in normal range is essential - Regular checks/screenings by health care provider

Red Blood Cells (RBCs) products have what components?

- Plasma removed from whole blood - Remainder is RBC or PRBCs - Same RBC mass as whole blood - Volume less than a unit of whole blood

Dual lumen peripheral catheter:

- Possess 2 separate channels for infusion - Administer 2 solutions simultaneously

Another miscrovascular complication often resulting from DM is vasomotor compolications. Name two vasomotor complications that results from autonomic neuropathy

- Postural hypotension - resting tachycardia

What is the function of erythrocytes?

- Primary function is transport of gases, O2 and CO2 - Also assist in maintaining acid-base balance - Has a flexible shape for ease in movement through capillaries

What are some of the advantages of using sodium chloride?

- Provides replacement for ECF - Compatible with blood products

What types of patients do we typically administer leuokocyte reduced RBCs?

- Pts who recieve multiple transfusions - Pts who require a transplant

What are the goals of care for DM?

- Reduce symptoms -Delay or prevent onset of complications *promote well being* *prevent acute complications of hyperglycemia* *Prevent/delay onset/progression of long term complications

What is the localized treatment of a hematoma during peripheral IV therapy?

- Remove catheter if needed - Apply pressure with 2x2 - Elevate extremity - Cold compresses

What are major acid-base imbalances?

- Respiratory Acidosis - Respiratory Alkalosis - Metabolic Acidosis - Metabolic Alkalosis

Microvascular is a chronic complication of DM. What is Microvascular?

- Result from thickening of vessel membranes in capillaries and artioles - Specific to diabetes - Eyes, kidneys, skin most affected *Complications associated with Chronic Hyperglycemia*

Name the types of peripheral IV catheters:

- Scalp vein needle - over the needle catheter - single lumen catheter - dual lumen catheter - midline catheter

What are some Nsg.Interventions/ClientEducation with *Sulfonylureas*?

- Teach s/s (signs and symptoms) of hypoglycemia - Have glucose handy - Exercise/Diet

What are some Nsg.Interventions/ClientEducation with *Meglitinides*?

- Teach s/s of hypoglycemia - Have glucose handy - Eat within 30 minutes of taking

Aside from checking your orders, what else should you check with an IV bag?

- That it's 100% clear, NOT CLOUDY - Expiration date

What is the goal of needless IV systems and why do we use them?

- The goal is to prevent needle stick injuries - We use them to connect IV devices, administer fluids and medications and to take blood samples.

What are the uses of dextrose solutions?

- They provide calories - They reduce protein catabolism - Prevent negative nitrogen balance

What are the uses of lactated ringers?

- To treat all types of dehydration - Restore fluid volume deficits

Why do we use sodium chloride solutions?

- To treat many alterations - To treat hyponatremia, hypercalcemia

Peripheral Vascular Disease (Arterial) is more diffuse (widespread) in DM patients. What major compolications related to PVD and DM can occur in DM patients?

- Ulcers - Gangrene - Amputations *High morbidity and mortality*

CKD results in retaining what substances?

- Urea - Creatinine - Phenols - Hormones - Electrolytes - Water - Other substances

What are some of the basic causes of dehydration?

- Vomiting - Diarrhea - Diuretics - Anorexia

Dehydration is a classical manifestation of DKA, what signs will a patient show if they are dehydrated?

- Warm, dry skin - Dry mucous membranes - Tachycardia, weak pulse - Acute weight loss

Coronary Artery disease is a macrovascular complication DM. How does DM contribute to coronary artery disease progression?

- atherosclerosis is accelerated with DM - Risk greater with hyperlipidemia, HTN & smoking - *Cause of death up to 75% of diabetics*

What often precipitates a hypoglycemic event?

- decreased intake, - - increased exercise, - decrease in insulin need, - medications - change in site for insulin injection

What kind of neurologic alterations can you expect with someone suffereing from HHS?

- decreased level of consciousness - impaired sensory, motor function - lethargy, coma, seizures

GI function also is a effected by the microvasular comolication of autonomic neuropathy. What common GI compolications results from autonomic neuropathy?

- gastroparesis - diarrhea/constpation

What are the six rights of medication administration?

- patient - time - route - medication - dose - documentation

Before transfusing blood products, following protocol, what should you confirm?

- patient's identity,- - blood compatibility -expiration date -blood component to be delivered

22-24 catheter gauge is used for:

- small veins, pediatric pt. (22 is blue, 24 is yellow)

What three major functions does blood have?

- transport of oxygen, nutrients, wastes - regulation of fluid, electrolyte, acid-base balance - protective role: ability to clot and combat infection *blood is a connective tissue*

What are they key elements in paraenteral solutions?

- water - carbs - amino acids - vitamins - electrolytes - Ph

What are some clinical manifestations PAD?

-*Paresthesia:* numbness, tingling toes, feet>>>nerve ischemia - Thin, shiny, and taut skin - Loss of hair on the lower legs - Diminished/absent pedal, popliteal, or femoral pulses - Reactive hyperemia (dependent rubor) Pallor w/ elevation *Rest pain*

What should you do if an acute reaction occurs?

-*STOP TRANSFUSION IMMEDIATELY* -Initiate infusion with 0.9 normal saline -Assess patient -Save blood bag and tubing for testing -Notify provider to inform and receive further orders

What are the overall goals of the treatment and relief of PAD?

-Adequate tissue perfusion -Relief of pain -Increased exercise tolerance -Intact, healthy skin on extremities -Protect from trauma -Prevent/treat infection

Glomerular Function Rate (GFR) is based on:

-Age -Gender -Race -Muscle mass *Not everyone is created equal!* SO, SAME CREATINE, different degrees of kidney function!

Deglycerolized RBCs

-Allows long term storage of RBCs -Useful with rare blood types

How do we prevent a hematoma from developing?

-Apply tourniquet just before venipuncture -Use indirect method for venipuncture -Use BP cuff if skin very thin

What types of vascular accesses to we use with peritoneal dialysis?

-Arteriovenous fistulas (AVF) -Arteriovenous grafts (AVG) -Temporary vascular access (1-3 weeks)

What are complications of PAD?

-Atrophy of the skin and underlying muscles -Delayed healing -Wound infection -Tissue necrosis -Arterial ulcers -Amputation

What are the dialysis solutions that are used?

-Available in 1- or 2-L plastic bags with glucose concentrations of 1.5%, 2.5%, and 4.25% -Electrolyte composition similar to plasma -Solution warmed to body temperature which Increases peritoneal clearance, prevent hypothermia, enhance comfort

When does a patient begin diaylsis?

-Begun when patient's uremia can no longer be adequately managed conservatively -Initiated when GFR (or creatinine clearance) <15 ml/min (ESKD), or when patient is symptomatic of kidney failure

What should you obtain during the pre-procedure blood transfusion?

-Blood for type and crossmatch *Always verify order*

What are ambulatory and home care nursing interventions with patients with PAD?

-Comfortable shoes with rounded toes and soft insoles -Shoes lightly laced -Frequent inspection of the feet -Management of risk factors -Importance of meticulous foot care -Clean, light-colored, all-cotton or all-wool socks

Conservative therapy

-Correction of extracellular fluid volume overload or deficit -Nutritional therapy -Erythropoietin therapy -Calcium supplementation, phosphate binders -Antihypertensive therapy -Measures to lower potassium -Adjustment of drug dosages to degree of renal function

What is the leading cause of CKD?

-Diabetes -Hypertension

Hemodialysis Procedure

-Dialyzer/blood lines primed with saline solution to eliminate air - Heparin added to blood as it flows to dialyzer - Terminated by flushing dialyzer with saline to remove all blood - Needles removed and firm pressure applied

Dwell (p dialysis)

-Diffusion and osmosis occur between patient's blood and peritoneal membrane into the dialysate -Duration of time varies depending on method In CAPD, this is usually several hours

Directed or Designated blood donor collection

-Donation of blood from friends/family -Same screenings as homologous blood -Unit MUST be compatible with recipient's

Irradiated Blood Products

-Done on whole blood, RBCs, platelets -Useful for pts. who are immune compromised

What is a complete list of what to consider during prioritizing nursing care?

-Emergency first: ABCD -Respond to trends vs. isolated findings -Actual before potential -Systemic before local -Acute before chronic -Maslow's Hierarchy -Time Management -Infection control issues -Nursing Process

What are the clinical manifestations of the gastrointestinal system with CKD patients?

-Every part of GI tract is affected - *D/T excessive urea* Mucosal ulcerations/Stomatitis Uremic fetor (urinous odor of the breath) Metallic taste in mouth Anorexia N/V Constipation

Diagnostic studies of CKD are?

-History and physical examination - Laboratory tests Urinalysis BUN, Serum creatinine Estimated GFR Creatinine clearance Serum electrolytes (K+, Ca++, PO4, Mg, Na) Urine culture RBC/Hemoglobin/Hematocrit -Renal US, Renal Scan, Biopsy

Hemodialysis complications

-Hypotension - Muscle cramps - Loss of blood - Hepatitis - Sepsis - Disequilibrium Syndrome: fluid shift into brain, cerebral edema

What are some *nursing diagnosis* you may use for a patient with PAD?

-Ineffective tissue perfusion (peripheral) -Impaired skin integrity -Acute pain -Activity intolerance I-neffective therapeutic regimen management

CKD causes clinical manifestation to the reproductive system, what are they?

-Infertility Experienced by both sexes - Decreased libido - Low sperm counts - Sexual dysfunction

Interventional Radiologic Procedures are used in severe cases of PAD. What are some of these severe cases in witch this collaborative care is used?

-Intermittent claudication symptoms become incapacitating -Pain at rest -Ulceration or gangrene severe enough to threaten viability of the limb

What are some of the classic symptoms of PAD?

-Ischemic muscle ache or pain that is precipitated by a constant level of exercise -Resolves within 10 minutes or less with rest -Reproducible -Anaerobic metabolism-lactic acid

Explain the pathophysiology of DKA.

-Ketosis is the break down in fats, which increases keotones bodies, which lowers PH, which draws water out of the cells, which increases urination. *Greater than 250 mg/dL, DKA begins

Hemodialysis Dialyzers

-Long plastic cartridge that contains thousands of parallel hollow tubes or fibers - Fibers are the semipermeable membrane

In a patient who has type 1 DM who is hypoglycemic, what clinical manifestations can you expect? a.) shakiness b.) urinary frequency c.) dry mucous membranes d.) excess thirst

a.) Shakiness *all the other symptoms are typical of hyperglycemia

A nurse is caring for a client who is postoperative following a parathyroidectomy to treat hyperparathyroidism. Which of the following laboratory values should the nurse expect to decrease as a therapeutic effect of the procedure? a.) calcium b.) sodium c.) potassium d.) phosphorous

a.) calcium

A nurse is checking laboratory values to determine if a client who has diabetes mellitus is adhering to the treatment plan. Which of the following test should the nurse use to make this determination? a.) glycosylated hemoglobin levels b.) urine sugar and acetone c.) glucose tolerance test d.) fasting serum glucose

a.) glycosylated hemoglobin levels * checking glycosylated hemoglobin levels, or HbA1c, is an accurate method to determine if the client is routinely complaint

Below 7.35 is...

acidotic

Above 7.45 pH is...

alkalotic

*Percutaneous Transluminal Angioplasty (PTA)*

an *Interventional Radiological procedure* that: -Involves the insertion of a catheter through the femoral artery -Catheter contains a cylindric balloon -Balloon is inflated dilating the vessel by cracking the confining atherosclerotic intimal shell -May also place stent

Hypoxemia

an abnormally low concentration of oxygen in the blood

In a DKA diagnosis, ketones in the blood and urine....

are present in moderate to large numbers

What is the leading cause of PAD?

atherosclerosis

A pregnant woman reports headaches and shortness of breath to the nurse. The nurse auscultates crackles and a bounding pulse. What is the appropriate nursing action? a.) Applying hot and cold compresses b.) Restricting the intake of dietary sodium c.) Asking the patient to sit and then stand d.) Providing ice chips to hydrate the patient

b.) Restricting the intake of dietary sodium

What is the goal of drug therapy regarding the appropriate triglyceride level?

below 200 mg/dl

what does inter mean?

between

What is a common skin manifestation with a client with Addison's disease?

bronze pigmentation of skin

If the aortoiliac is blocked, you were have symptoms of intermittent claudication in...

buttocks, thighs

To prevent a recurrence of hypocalcemia, the nurse should encourage the patient to increase intake of which of foods? a.) Fish b.) Lean meat c.) Dairy products d.) Potatoes and starches

c.) Dairy products *Dairy products, including milk, cheese, and yogurt, are rich in calcium and can help correct hypocalcemia. Lean meat, potatoes, and fish may have calcium; however, dairy products have the highest content of calcium of the foods listed.*

A nurse is caring for a client whose blood glucose is 49 mg/dL. The client is lethargic but arousable. Which of the following is the priority nursing action? a.) Re-check blood glucose in 15 minutes b.) Give 7 grams of protein c.) Give 15-20 grams of carbohydrates d.) Report findings to the health care provider

c.) Give 15-20 grams of carbohydrates....and then check their BG in 15 minutes!

What are the following clinical findings should a nurse expect to find with a client who has Graves' disease? a.) constipation b.) cold intolerance c.) difficulty sleeping d.) anorexia

c.) difficulty sleeping * an overproduction of thyroid hormone causes anxiety which can disturb sleep.

A nurse is monitoring a client who has syndrome of inappropriate anti-diuretic hormone secretion (SIADH). Which of the following findings should the nurse expect? a.) polyuria b.) dehydration c.) hyponatremia d.) hyperthermia

c.) hypnatremia *a client who has SIADH wil have hyponatremia caused by excessive release of antidiuretic hormone (ADH). As a reslt of the excess ADH, the client retains water that causes dilutional hyponatremia

A nurse is providing teaching to a client who has Addison's disease about health snack foods. Which of the following food choices by the client indicated an understand of the teaching? a.) sliced bananas b.) baked potato c.) turkey and cheese sandwich d.) plain yogurt with peaches

c.) turkey and cheese sandwich * A client who has Addison's disease requires a diet low in potassium and high in sodium, carbohydrates, and protein

If the femoral-popliteal is blocked, you were have symptoms of intermittent claudication in...

calf

Vasomotor

causing or relating to the constriction or dilatation of blood vessels.

What is contained in the plasma?

contains water, proteins (albumin), nutrients, gases, waste

When a diabetic is sick or under stress, what is released and what does this release result in?

counter-regulatory hormones are released *resulting in increased blood glucose values*

When assessing a patient admitted with nausea and vomiting, which finding supports a determination of deficient fluid volume? a.) Polyuria b.) Decreased pulse c.) Difficulty breathing d.) General restlessness

d.) General restlessness *Restlessness is an early cerebral sign that dehydration has progressed to the point where an intracellular fluid shift is occurring. If the dehydration is left untreated, cerebral signs could progress to confusion and later coma. Polyuria, decreased pulse, and difficulty breathing do not support a determination of deficient fluid volume.*

The nurse identifies that a patient with chronic kidney disease is at risk for which electrolyte disturbance? a.) Hypokalemia b.) Hyponatremia c.) Hypercalcemia d.) Hyperphosphatemia

d.) Hyperphosphatemia

The nurse is preparing a patient for peritoneal dialysis. What nursing action is appropriate at this time? a.) Inducing vomiting in the patient b.) Recording the patient's blood pressure c.) Measuring patient's blood glucose levels d.) Have the patient empty the bladder and bowel

d.) The nurse should ensure that the patient's bladder and bowels are empty before inserting a catheter to prevent an accidental puncture and mixing of the dialysate with bowel contents *Side note:Induction of vomiting is not predialysis care. The nurse does not need to record the patient's blood pressure and blood glucose levels immediately prior to peritoneal dialysis.*

A nurse is reviewing the laboratory values of a client who has diabetic ketoacidosis. The nurse should understand that which of the following values is consistent with diabetic ketoacidosis? a.) Blood glucose 30 mg/dl b.) negative urine ketones c.) Blood pH 7.38 d.) bicarbonate level 12 meq/L

d.) bicarbonate level 12 meq/L * a client who has DK should have a bicarbonate level less than 15 meq/L. This is caused by the increased production of counter-regulatory hormones that lead to metabolic acidosis

What does most maintenance IV therapy contain?

dextrose: 2.5% - 10% * Once you get past 10% you start to think about a central line

What are you looking for when a patient has unbalanced potassium?

dysrhythmia

Anuria

failure of the kidneys to produce urine *Urine output <100 ml per 24 hours* -Normal minimum urine output per hour: 30ml/hr

What is lost during dehydration?

fluid and electrolytes

Which factor may lead to coexistence of hyperinsulinemia and hyperglycemia?

he insulin receptors do not respond to the insulin and the production of insulin increases

Will water travel to a lower or higher concentration of a solute?

higher concentration of a solute, which means it will have a lower concentration of water, and it will keep moving until both sides level off.

Under 80-100 mmHg p02 reading indicates...

hypoxemia

If the internal iliac: is blocked, you were have symptoms of intermittent claudication in...

impotence

diuresis

increased excretion of urine

Pentoxifylline (Trental):

increases erythrocyte flexibility, reduces blood viscosity, improves oxygenation to ischemic muscle *Intermittent Claudication*

Cilostazol (Pletal):

inhibits platelet aggregation, increases vasodilation, inhibits smooth muscle cell production -Phosphodiesterase inhibitor -Intermittent claudication -Increases pain-free walk distance

What does a Microalbumin test check?

is a check for small amounts of protein in the urine. The results will tell you how well your kidneys function.

Hyperosmolar hyperglycemic state (HHS)

is a complication of diabetes mellitus in which high blood sugar results in high osmolarity without significant ketoacidosis. ... The main risk factor is a history of diabetes mellitus type 2

Gastroparesis

is a condition that affects the normal spontaneous movement of the muscles (motility) in your stomach.

Kussmaul's respiration are a compensatory mechanism with a clinical manifestation of DKA. What are *kassmaul's respiration*?

is a deep and labored breathing pattern often associated with severe metabolic acidosis, particularly diabetic ketoacidosis (DKA) but also kidney failure.

What function does Magnesium provide to the body?

is a nutrient that the body needs to stay healthy. Magnesium is important for many processes in the body, including regulating muscle and nerve function, blood sugar levels, and blood pressure and making protein, bone, and

Critical limb ischemia (CLI)

is a severe blockage in the arteries of the lower extremities, which markedly reduces blood-flow

Prioritization

is the organization of activities according to the order in which they should be done.

RBC aggregation

is the reversible clumping of red blood cells (RBCs) under low shear forces or at stasis.

Allen's Test

is when you occlude the radial and ulnar artery and then wait for the hand to turn pale, and then release to watch refill.

What is Addison's disease?

it is a hormone deficiency caused by damage to the outer layer of the adrenal gland (adrenal cortex). Addison's disease occurs when the adrenal gland to not produce enough of the hormone cortisol and, in some cases, the hormone aldosterone.

What is glycosylated hemoglobin?

it is glucose that is attached to a hemoglobin molecule The amount is expressed in %

What was DM type 1 once called?

juvenile diabetes

What two medications are known for reducing potassium levels?

k ebislate? and potassium

As part of the pre-procedure, what labs should you check?

labs: RBCs, Hgb, Hct

In a hypotonic solution, is the osmolarity more or less than the serum?

less than

The plasma bicarbonate level must be less than what number for a diagnosis of DKA?

less than 16 mEq/L

With nutrition therapy in a person with PAD, where should they keep their dietary cholesterol?

less than 200 mg/day

intracellular

located or occurring within a cell or cells

Percutaneous

made, done, or effected through the skin.

Phosphatemia is aggravated by consumption of what foods?

meat and dairy products in patients with CKD.

What is an electrolyte?

minerals in your body that have an electric charge. They are in your blood, urine and body fluids. They are essential components (nutrients and/ or chemicals) that help stimulate nerves throughout the body - from regulating your heartbeat to allowing your muscles to contract so you can move. Also, they balance fluid levels, an electrolyte imbalance can cause a variety of serious negative symptoms, including some that are potentially deadly.

Microangiopathy

occurs in diabetes mellitus. When it affects the eyes, it is called *diabetic retinopathy.* When the kidneys are affected, the patient has *nephropathy.* When the skin is affected, it can lead to diabetic foot ulcers. Macroangiopathy can occur in either type 1 or type 2 diabetes and contributes to cerebrovascular, cardiovascular, and peripheral vascular disease. Sexual impotence and slowed gastric emptying result from microangiopathy and neuropathy.

What type of medication is typically used first in managing DM?

oral agents

What is pC02?

pCO2 (Partial Pressure of Carbon Dioxide)

With a DKA diagnosis, there is a low arterial pH. What level does the plasma pH have to fall below for a DKA diagnosis

pH < 7.30

what does p02 mean?

partial pressure of Oxygen

Is osmosis active or passive transport?

passive, active requires energy.

What are very common symptoms of diabetes insipidus?

polyuria or polydipsia *a client with DI will excrete large quantities of urine with a very low specific gravity

Baked beans, sweet potatoes, canned mushrooms, and chocolates are rich in what type of electrolyte?

potassium

Genitourinary

relating to the genital and urinary organs

HHS, or Hyperosmolar hyperglycemic state, is an acute complications characterized by:

severe hyperglycemia, severe dehydration, extracellular fluid depletion, osmotic diuresis *with an insidious onset*

"Lewis" definition of ELECTROLYTE

substances whose molecules dissociate, or split, into ions when placed in water. Ions are electrically charged particles.

GFR test

tands for glomerular (glow-MAIR-you-lure) filtration rate. A blood test checks your GFR, which tells how well your kidneys are filtering. A GFR of 60 or higher is in the normal range. *A GFR below 60 may mean you have kidney disease.*

Remember, the small the number catheter gauge....

the LARGER size gauge of the catheter

etiology

the cause, set of causes, or manner of causation of a disease or condition.

Osmotality

the concentration of a solution expressed as the total number of solute particles per kilogram

What is morbidity?

the condition of being diseased.

ketonuria

the excretion of abnormally large amounts of ketone bodies in the urine, characteristic of diabetes mellitus, starvation, or other medical conditions.

Sodium

the main cation of ECF, plays a major role in maintaining the concentration and volume of ECF and influencing water distribution between ECF and ICF.

Leukocyte Reduced RBCs is a blood product that has:

the number of WBCs in unit reduced drastically

extracellular fluid (ECF)

the portion of the body fluid comprising the interstitial fluid and blood plasma.

Oliguria

the production of abnormally small amounts of urine. *Occurs as CKD worsens*

The lower the ABI....

the worse the disease

When a patient reaches stage 5, what are they considered?

they are considered End-Stage Renal Disease (ESRD and require renal replacement therapy: Dialysis or transplant in order to survive.

Getting your feet checked is also an important part of DM care. What very important test is administered during a foot test for a diabetic patient?

to see whether you can feel the vibration of a tuning fork or the light touch of a thin wire called a monofilament.

When should self-monitoring of blood glucose occur?

• Prior to meals and snacks • Occasionally postprandially • At bedtime • Prior to exercise • When low blood glucose is suspected • After treating low blood glucose until normoglycemic • Prior to critical tasks (i.e., driving)

How long is fresh frozen plasma given over?

1-2 hours

What is normal specific gravity?

1.005-1.030

Magnesium

1.5 - 2.3

What type of syringe must you use in a PICC line?

10 ml syringe

How much medication is available to the patient via IV?

100%

What is the maximum amount of K you can delivery via IV therapy in a 24 hour period?

125 ml

Sodium normal range

135-145

Drain (p dialysis)

15 to 30 minutes May be facilitated changing position

What is the normal value of platets?

150,000-300,000

What size IV assess guage should you use for a blood transufsion?

18, 20 guage *initiate a large bore IV assess*

How many nurses does it take to follow protocol and confirm the patients identity, blood compatibility, expiration date, and blood components to be delivered?

2

Potassium restriction

2 to 3 g / day, correlate with lab values High-potassium foods should be avoided, table 47-11

How often does a DM patient take long intermediate insulin?

2 x a day

A patient with type 2 diabetes mellitus (DM) receives a prescription for metformin. The nurse identifies that which statement is characteristic of this medication? 1. It causes weight gain. 2. It decreases hepatic glucose production. 3. It should not be given with sulfonylureas. 4. It is inappropriate for initial management of type 2 DM

2. It decreases hepatic glucose production. *The primary action of metformin is to reduce glucose production by the liver. Metformin often causes weight loss instead of weight gain. Metformin can be administered in conjunction with sulfonylureas. Metformin is preferred for the initial management of type 2 diabetes. *

What size gauge is most commonly used for IV catheters?

20 and 22 gauge

In order to diagnose DM, to hour OGTT level > or = to:

200 mg/dl after glucose load of 75g

What is the normal range of bicarbonate?

22-26 meq per biocarbonate is normal

The patient with diabetes should consume fiber as part of a healthy diet. The current recommendation for persons with diabetes is

25 to 30 g/day

How many majors types of DM are there?

2: Type 1 and Type 2 DM

Phosphorus normal range

3.0-4.5 mg/1.8-2.6 meg)

Potassium normal range

3.5 - 5 *Most common electrolyte imbalance*

When should you administer Regular insulin (Humulin R, Novolin R) and when is the onset?

30-60 minutes before a meal, Novolin- 20 minutes before a meal with a onset of 30-60 minutes *Peak 2-5 hours*

What is normal minimum urine output per hour?

30ml/hr

What is the normal range of pCO2?

35-45 mmHg

African American are how much more likely to have PAD?

3X greater

Hemodialysis is usually done...

3x/week for about 4 hours per treatment *Some patients may do home hemodialysis, which can also be done as daily nocturnal dialysis. This method is more gentle to the system, and patients and their family members are trained how to do the dialysis. *

What is the normal range of glycoslyalted hemoglobin (Hg A1C)?

4-6% *HgA1c is expressed in %*

Which diagnostic test is the most appropriate to assess the risk of diabetes in a patient who reports polyuria and a family history of diabetes? 1. Hematocrit test 2. Serum creatinine test 3. Postprandial blood test 4. Glycosylated hemoglobin test

4. Glycosylated hemoglobin test *Glycosylated hemoglobin is a form of hemoglobin that is measured primarily to identify the average plasma glucose concentration over prolonged periods*

How long should you apply pressure to a puntured site after taking a blood sample from the radial artery?

5 minutes...but longer if anticoaglulated.

When should you administer Aspart (NovoLog) and when is the onset?

5-10 minutes before a meal with a *rapid onset* of 10-30 minutes *Peak: 1-3 hours*

When should you administer Lispro (Humalog) and when is the onset?

5-10 minutes before a meal with a *rapid onset* of 10-30 minutes. *Peak: 0.5- 3 hour*

What percentage of the population who have DM are diagnosed with Type 1 DM?

5-10% *Generally affect people less than 40 years old*

In order to diagnose DM, Hg A1C ( or glycated hemoglobin) must be:

6.5% or greater

Typically, what % of the artery need to be block in order for symptoms to begin to appear?

60-75%

What is the common age for people with PAD?

60-80 years old, earlier with DM

Short term access device for central infusion are in place for how long?

7 to 10 days

Normal pH

7.35-7.45 *Outside this range affects cellular functioning

What is the normal range of glucose concentration in the blood?

70-99 mg/dl%

What is the recommended daily allowance for phosphorus?

700 mg/d in healthy adults, or 1 about gm/day *Note: Most foods high in phosphate are also high in calcium*

What percentage of people with CPD have CKD?

75% *other factors include aging population and obesity*

What is the normal p02

80-100 mmHg

At what levels is BG considered critically high?

800 or 900

Calcium

9-11 mg

What percentage of patients in acute care settings undergo IV therapy?

90%

Hg A1c (Hemoglobin A1C) measures control of blood sugar over a period of:

90-120 days

What % of the population with DM are Type 2?

90-95% *Age of people are usually over 35 and *obese* * Patients are becoming diagnosed earlier and earlier in age

What is a normal pulse-ox?

95-100%

Chloride

95-105

In order to diagnose DM , the fasting blood glucose must be:

> 126 mg/dl

In order to diagnose DM, the random blood glucose must be

> 200 mg/dl

What pH levels can results in death?

> 7.8 or < 6.8 result in death

Renal Buffer Response

A *compensatory mechanism* that occurs in the *kidneys* - HCO3: retain or excreted - *Slower response:* hours to days

Respiratory Buffer Response

A *compensatory mechanism* that occurs in the *lungs* - C02: is retained or excreted - The response is rapid, 1-3 minutes - Change is respirations

Where are arterial blood gasses collected from?

A blood sample from an *artery!* For example, a radial artery is a optimal site for collection.

Ankle-Brachial Index (ABI)

A diagnostic Test that... *Ankle SBP divided by Highest Brachial SBP* -Normal = .91 -1.3 .-71 - .90 = mild disease .-41 - .70 =moderate disease - >.40 = SEVERE disease

An eye exam is also important for people that have DM. What would a doctor check with a patients eyes?

A doctor should check the blood vessels in your eyes for early warning signs of damage. The eye doctor must put drops in your eyes that dilate your pupils in order to do a thorough exam. Treatment can help slow eye disease if it's found early.

Because fluid loss can occur rapidly with HHS, what devise should doctors/nurses consider to control the output?

A folly catheter

Tunnelled catheter

A tunneled central line is a catheter (a thin tube) that is placed in a vein for long-term use. It is most commonly placed in the neck (internal jugular) but may also be placed in the groin (femoral), liver (transhepatic), chest (subclavian) or back (translumbar). The catheter is tunneled under the skin.

What are the major blood types?

A, B, O, AB

Dyslipidemia

Abnormally elevated cholesterol or fats (lipids) in the blood

As we know, the normal pH of the body is about 7.35 to 7.45, what level of pH do CKD typicall have?

About 7.1

What occurs when the pH falls out of the normal 7.35-7.45 range?

Activation of Compensatory Mechanisms

What does ABCD stand for?

Airway, Breathing, Circulation, and Disability

Acarbose (Precose)and Miglitol (Glyset) are what type of oral hypoglycemics?

Alpha glucosidase Inhibitors

With the microvascular complication of *sensory neuropathy*, what alterations occur?

Alterations in sensation and pain perception occur with sensory neuoropathy

Intermittent claudication

An aching, crampy, tired, and sometimes burning pain in the legs that comes and goes -- it typically occurs with walking and goes away with rest -- due to poor circulation of blood in the arteries of the legs.

Postural hypotension

Another name for Orthostatic hypotension.

peripheral artery disease

Anywhere below the level of disease will be effected by the disease

What arteries can PAD effect?

Aortoiliac artery Femoral artery Popliteal artery Tibial artery Peroneal artery

How many nephrons are there per kidney?

Approximately 1 millions. *These are lost as the disease progresses, if they're not lost, they become larger to compensate (hypertrophy)* -Basically the kidney sub-parts becomes larger, but weaker....EVENTUALLY as they kidney loses nephrons they kidney will actually shrink

When a diabetic is sick or under stress (acutely), how often should they check their BG?

At least every *4 hours*

When doe reset pain most often occur?

At night

What is the average amount of insulin secreted on a daily basis?

Average secreted daily by adult approx 40-50 units

The nurse is monitoring a patient with hyperkalemia. Which conditions should the nurse conclude may cause this condition? Select all that apply. a.) Alkalosis b.) Renal failure c.) Low blood volume d.) Large urine volume e.) Adrenal insufficiency

B.) Renal Failure E.) Adrenal insufficiency

When should you take a patietns vital signs during a blood transfusing procedure?

BEFORE and AFTER administration

What lab findings will show a patient being hypoglycemic?

BG less than 70 mg/dL

What is the BP goal of hypertention

BP <130/80mmHg -Weight loss -Lifestyle changes -Diet recommendations Sodium and fluid restriction DASH Diet

When treating a patient for PAD, where do we want the patient's blood pressure to be maintained at?

BP maintained < 130/80

What types of cell in the pacrease are destroyed with patients with Type 1 DM?

Beta cells

What is a common medication for gastroparesis?

Bethanechol

What is HCO3?

Bicarbonate

Occlusion

Blockage that prevents teh ability to infuse fluids or flush IV side. Due to an accumulation of fibrin, platelets, blood materials, or some crystallization in the lumen of the infusion device or the vein.

What comprises 45% of blood?

Blood cells

Homologous/Allogenic

Blood or blood component donated from another person - *it's a volunteer process that matches a certain criteria for donation, and screening is performed after blood is donated*

Excessive thirst, frequent urination, and unexplained weight loss are clinical symptoms of Type 1 or Type 2 DM (AQ)?

Both Type 1 and Type 2!

Even though a patient may lose sensation with sensory neuropathy, what do they typically feel in an area effected by the compolication?

Burning or electric shock *It can by physicallly and emotionally draining

If a patient reports large keotones, diahrea, changed breathing pattern, confusions, a BG greater than 300, a fever over 102 with vomitting, what should you do?

CALL THE DOCTOR!

CAPD vs. CCPD

CAPD: continuous ambulatory PD. Exchanges done 3-4x/day APD: continuous cycler PD. Exchanges are done at night while patient is sleeping.

What is the best way for a patient to achieve their goals with DM?

CONTROL of blood glucose is the best way to achieve goals! *Patient must be committed to and active in their own care*

How much more common is cerebovascular disease, a macrofascular dm compolication, in a patient with DM?

CVA is 2x more common in diabetics & the survival rates in diabetics is lower *Risk great with HTN, hyperglycemia, hyperlipidemia

What is a Vitamin D supplement used for renal osteodystrophy (CKD-MBD)?

Calcitriol (Rocaltrol)

Calcium and phosphate alterations (inverse)imbalances re a clinical manifestation of CKD, what is involvned with those types electrolyte/acid-base imblances?

Calcium and phosphate alterations (inverse) - Calcium deficit R/T inability of GI tract to absorb calcium d/ DROP in calcitriol Phosphate excess R/T LOWERS excretion and INCREASES PTH

How does the build up of phosphorus in the body effect calcium?

Calcium is reduced because there is a decreased production of calcitriol, the activated form of vitamin D, so the gut cannot absorb it. Calcium also binds with the excess phosphorus, further reducing its levels

How long before a surgery can an autologous donation occur?

Can be done up to *72 hours before surgery*

What are common clinical manifestations of diabetes mellitus type 2?

Candidal infection, recurrent infections, recurrent vaginal yeast, and prolonged wound healing

What's the first thing you do when you open an IV bag?

Check your orders first!

Chronic kidney disease (CKD) patients should be taking what prescribed medication for pain?

Chronic kidney disease (CKD) patients should be taking Tylenol as prescribed for pain. *ibuprofen, and other nonsteroidal antiinflammatory drugs (NSAIDS), will cause further damage to the kidneys.*

In regards to foot care, what should a DM patient wear on their feet?

Cotton socks because they absorb the best...and NEVER go barefeet!

the BUN test is used in conjunction of what other test?

Creatinine

Automated peritoneal dialysis (APD or CCPD)

Cycler delivers the dialysate Times and controls fill, dwell, and drain

What are examples of hypertonic solutions?

D5/0.45NaCl, D5/0.9 NaCl

When blood glucose is greater than 250 mg/dl (hyperglycemia) what diagnostic complication with DM an occur?

DKA

What is DKA and what is it caused by?

DKA stand for *Diabetic ketoacidosis (DKA)*. It is caused by a SEVERE DEFICIENCY of insulin.

When should you administer Glargine (Lantus) & Detemir (Levemir) and when is the onset?

Daily at same time with an onset of 70 minutes *Peak...NO PEAK!*

What is the most comonly used osmotic agent used in peritoneal dialysis?

Dextrose is the most commonly used osmotic agent used in peritoneal dialysis. *Side note: Normal saline solution is not used in peritoneal dialysis.*

What may IV fluid be mixed with during maintenance therapy?

Dextrose or potassium

Sodium restrictions for CKD?

Diets vary from 2 to 4 g / day depending on degree of edema and hypertension Patient should be instructed to avoid high-sodium foods Avoid salt substitutes- contain potassium chloride

What should you think about regarding your most infectious patient?

Do they have... - TB - VRE - Draining Wounds I- Immune-Compromised *Ask yourself, what will I take to the next room!?*

Anemia is a clinical manifestation of chronic kidney failure. What occurs physiologically with anemia caused by CKD?

Due to ↓ production of erythropoietin by kidney ↓ of function renal tubular cells Normally stimulate precursor cells in bone marrow Nutritional deficiencies Dialysis Bleeding Iron deficient

When is replacement fluid used?

During physiological distress * if a patient is not feeling better in 24-48 hours, you need to rethink their health

When is EPO given?

EPO is usually given weekly or bi-weekly if patients are not yet on dialysis. Once on dialysis, they receive it during their dialysis treatment intravenously. IV iron can be given as a series of outpatient infusions, or also during dialysis.

What are the signs/symptoms of a hematoma developing during peripheral IV therapy?

Ecchymoses Site swelling/pain Inability to advance catheter Resistance to flushing

What are the three types of bloods cells?

Erythrocytes (RBCs) Leukocytes (WBCs) Thrombocytes (Platelets)

Three phases of PD cycle

Exchange -Inflow (fill) -Dwell (equilibration) -Drain

What does excercise impove in the legs of patient with PAD?

Exercise improves oxygen extraction in the legs and skeletal metabolism

What are some of the complications with peritoneal dialysis?

Exit site infection *Peritonitis* Abdominal pain Outflow problems Loss of ultrafiltration

What should you always explain to a patient during the pre-procedure blood transufsion?

Explain reason for delivery of blood products!

Phosphate binders should be administered with what?

FOOD! Must be administered with each meal!

What is a precipitating factor?

Factors that causes or triggers the onset of a disorder, illness, accident, or behavioral response.

IV restoration

Find source of fluid loss. NEED I/O

Fingerstick blood glucose testing should be performed before or after meals?

Fingerstick blood glucose testing should be performed before meals. Checking the blood glucose after meals will yield inaccurate results.

What is the initial goal of the treatment plan with a patient who presents with diabetic ketoacidosis (DKA) (from AQ)?

Fluid imbalance is potentially life threatening for patients with DKA. The initial goal of therapy is to establish intravenous (IV) access and begin fluid replacement.

Can fluids be restricted with CKD patients?

Fluid intake can be unrestricted assuming normal urine output

Thrombosis

Formation or presence of a blood clot

What does FFP stand for with a blood product?

Fresh Frozen Plasma *it is plasma frozen for later use*

The stages of CKD are determined by what?

GFR! glomerular (glow-MAIR-you-lure) filtration rate!!!!!

What does diabetes mellitus primarily effect?

Glucose metabolism

When treating a patient for PAD, where do we want the patient's glycosylated hemoglobin to be maintained at?

Glycosylated hemoglobin < 7.0% for diabetics, as near to 6.0%

In a hypertonic solution, is the osmolarity greater than or less than the serum?

Greater *It will expand the IVF compartment

In HHS, blood glucose must be greater than what number for a positive diagnosis?

Greater than *600*

In HHS, the arterial pH must be greater than what number for a positive diagnosis?

Greater than *7.35*

In HHS, the *serum osmolarity* must be greater than what number for a positive diagnosis?

Greater than 320 mOsm/L

What is DKA characterized by?

Hyperglycemia, ketosis, acidosis, and dehydration

What CKD clinical manifestations occur with the cardiovascular system?

Hypertension (cause and consequence) Heart failure Left ventricular hypertrophy Peripheral edema Dysrhythmias

Blood Transfusion Therapy

IV administration of whole blood or a blood component

In a normal examine question, what key words should you look for in an indicaiton of the right answer?

If it ever says "take care of the patient first", lean towards that as the correct answer!

What is very important to ask a patient for the pre-procedure blood transfusion?

If they have had any reactions to blood products

Autologous

In blood transfusion and transplantation, a situation in which the donor and recipient are the same person *good option in elective procures*

In what age group do nurses most often see dehydration?

In the elderly and the young

*Rest Pain* also is alinical manifestation of PAD. What part or the body does rest pain tyhpically occur?

In the forefoot or toes and is aggravated by limb elevation *From insufficient blood flow*

Does the heart rate normally increase or decrease during FVE (Fluid volume excess)?

Increase

Does the heart rate normally increase or decrease during dehydration?

Increase

The nurse is reviewing laboratory results for the patient with diabetes and coronary artery disease. Which laboratory result would help predict possible macrovascular disease as a complication of diabetes?

Increased low-density lipoproteins

The build up of what gas can effect the nueorlogical system due to CKD?

Increased nitrogenous waste products

Extravasation

Infiltration of irritating fluids, resulting in damage to surrounding tissues

Peritonitis

Inflammation of the membrane lining the abdominal wall and covering the abdominal organs.

What are examples of thiazolidinediones?

Insulin sensitizers that include *rosiglitazone* and *pioglitazone*

What will be used to control a patients BG who undergoes surgery and is NPO?

Insulin...and sliding scale insulin may be used *In type 2 diabetics, when NPO is lifted oral agents may be returned.*

What does CKD involve?

Involves progressive, irreversible loss of kidney function *It is a progressive disease*

Microalbuminuria

Is a term to describe a moderate increase in the level of urine albumin. It occurs when the kidney leaks small amounts of albumin into the urine, in other words, when there is an abnormally high permeability for albumin in the glomerulus of the kidney.

what do you need to decide in regards to the types of events that are occurring in a patient?

Is it an *isolated*event or is it a *trend*?

0.9%NaCl and lactated ringers are example of what type of solutions?

Isotonics

What happens to Mg in the body with patients with CKD?

It becomes elevated,especially with the intake of antacids.

What role does chloride play in the body?

It helps keep the amount of fluid inside and outside of your cells in balance. It also helps maintain proper blood volume, blood pressure, and pH of your body fluids. Tests for sodium, potassium, and bicarbonate are usually done at the same time as a blood test for chloride.

What is the Plate method of DM care?

It is a simple guide for planning meals. ... Then fill one quarter of your plate with whole grain or starchy foods and the remaining quarter with lean protein foods. The Diabetes Plate Method includes fruit and low-fat dairy on the side, as your meal plan and calorie needs allow. *It focuses on eating more nonstarchy vegetables, which are low in carbohydrate and calories and high in vitamins, minerals, and fiber. It also helps you get enough lean protein.*

When is CKD diagnosed?

It is defined as the presence of kidney damage or a decreased *GFR < 60 ml/min for more than 3 months.*

What is the BUN test used for?

It is primarily used, along with the creatinine test, to evaluate kidney function in a wide range of circumstances, to help diagnose kidney disease, and to monitor people with acute or chronic kidney dysfunction or failure.

What is the most common cause of low blood sugar?

It is when you administer insulin but the patient doesn't eat

What does glycosylated hemoglobin refer to?

It refers to hemoglobin that is connected to glucose. Since the life span of a RBC is 4 months, this value will not be affected by recent changes if the client's diet or medication.

In a hypotonic solution, does the solution expand the ICF?

It will expand the ICF - the osmolarity inside a cell is greater than in a hypotonic solution, therefore the cells will expand with the hypotonic solution until the osmalirty is the same as inside the cell and outside the cell.

Isotonics solutions that are administered to a patient fill what type of space?

It will fill the ECF compartment *No fluid shift occurs because the osmolarity is the same as the intracellular fluid (ICF).

What is osmosis?

It's a type of diffusion that is the movement of WATER (or a solute) across a semi permeable membrane.

That's it!

It's over!

What is carb counting?

It's the balance between the carbohydrates you eat and insulin that determines how much your blood glucose levels rise after you eat. With the right balance of carbohydrates and insulin,your blood glucose level will usually stay in your target range.

What electrolytes are altered in HHS?

K+, Na+, Cl-

What are key symptoms of DM type 1?

Ketoacidosis and abdominal cramping

When aggressively treating PAD, where do we want the patients LDL and and triglycerides to fall under?

LDL < 100 mg/dl, triglycerides < 150mg/dl

What is the goal for a diabetic's HgA1C?

Less than 7% *The goal of diabetes care is normalization of sugar levels*

When should Lispro insulin be administered?

Lispro is a rapid-acting synthetic insulin that has an onset of action of approximately 15 minutes. Lispro should be *administered 15 minutes after mealtime* because its rapid action closely mimics natural insulin secretion in response to a meal.

Hematoma

Localized mass of blood outside the blood vessel usually found in partically clotted state

Continuous ambulatory peritoneal dialysis (CAPD)

Manual exchange

Basic essential fundamental needs are crucial when it comes to the patient, what popular model is used to outline the fundamental, essential needs of a patient?

Maslow's Hierarchy

If the pH and the HCO3 are moving in the SAME direction, is it metabolic or respiratory?

Metabolic

What type of yearly screening should a DM patient undergo for sensory neuropathy?

Microfilament testing

Will HHS require more or less fluid replacement than DKA?

More

Diffusion

Movement of *solutes* from an area of greater concentration to an area of lesser

Osmosis

Movement of fluid from an area of lesser to area of greater concentration of solutes

Dialysis

Movement of fluid/molecules across a semipermeable membrane from one compartment to another. It is used to correct fluid/electrolyte imbalances and to remove waste products in renal failure

Do patients with type 1 DM produce endogenous insulin?

NO!

Can you mix Glargine (Lantus) & Detemir (Levemir)?

NO! Cannot be mixed with other insulins!!

Do we give blood products with dextrose?

NO! Only with sodium chloride

What is the best way to administer oxygen with a patient suffering from respiratory acidosis?

Nasal canola because its' less intrusive and patients will have less claustrophobia

Does Ketoacidosis usually occur in HHS?

No! *HHS does not develop DKA or hetoacidosis

Should a patient skip their doses of insulin when they are sick?

No, it will worsen the condition.

Are ketones present in HHS?

No, they are absent or in very small amounts in the blood and urine.

What is the most commonly used saline for flushing an iV site?

Normal saline (sometimes there is a heparin flush)

Who is responsible for IV therapy?

Nurses

Embolism

Obstruction of a blood vessel by a blood clot formed elsewhere in the circulatory system and carried to the point of obstruction by the blood stream

What is the most difficult problems when starting peritoneal dialysis?

Obtaining vascular access is one of most difficult problems

Can surgery change blood glucose levels in a diabetic?

Of course, so plan for those changes!

What does intra mean?

On the inside or within

How often does a DM patient take long acting insulin?

Once a day at the hour of sleep.

How often should a diabetic check their cholesterol levels?

Once a year

Thizaolidinediones "glitazones" ACTION

Oral hypoglycemics that decrease insulin resistance in tissues and inhibit glucose formation in liver

Biguanides ACTION

Oral hypoglycemics that increases muscle uptake of glucose (tissue sensitizer. Decreased glucose production in liver, lowers triglycerides, LDL.

Meglitinides ACTION

Oral hypoglycemics that promotes insulin release from pancreas

Sulfonylureas ACTION

Oral hypoglycemics that promotes insulin release from pancreas, sensitize receptor cells to use insulin

Alpha glucosidase Inhibitors ACTION

Oral hypoglycemics that slow carbohydrate absorption, digestion

What is the most common peripheral IV catheter?

Over the needle catheter

Phlebitis

Painful inflammation along the venous path in which the cannula is placed

How often should you obtrain vital signs with hemodialysis procedure?

Perform vital signs every 30 to 60 minutes

Phosphate binders are types of drugs used for what CKD complication?

Phosphate binders -Calcium carbonate (Caltrate) and calcium acetate (Phos-Lo) -Bind phosphate in bowel and excreted -Sevelamer hydrochloride (Renagel) Also lowers cholesterol and LDLs Side effect: Constipation

Next to calcium, what is the 2nd most abundant mineral in the body?

Phosphorus

With Maslow's Hierarchy of needs, what takes top priority?

Physiological...essential whatever is on the bottom to the top takes priority

What will be the drug of choice for a patient who has insulin resistance?

Pioglitazone *Is an insulin sensitizer that is very effective when the receptors on the insulin-dependent tissue do not respond to the insulin, resulting in insulin resistance.*

What comprises 55% of the blood?

Plasma

What is blood made of?

Plasma and blood cells

What are ketones?

Poisonous acidic chemicals produced by the body when fat instead of glucose is burned for energy. Breakdown of fat occurs when not enough insulin is present to channel glucose into body cells.

The nurse is caring for a patient with newly diagnosed type 2 diabetes mellitus. Which symptoms indicate that the patient is experiencing hyperglycemia?

Polydipsia, polyuria, and polyphagia

What is the primary function of leukocytes?

Primary function is protection of the body from infection

Infiltration

Process of seepage or diffusion of IV fluid into the surrounding tissue instead of the blood vessel

Peripheral arterial disease

Progressive narrowing and degeneration of arteries

What do anti-platelet agents reduce the risk for in PAD patients?

Reduce risk for MI, Stroke, other CV events

What is the only type of insulin given by IV?

Regular insulin

interstitial

Relating to spaces or interstices in any structure. Interstitial space is outside a cell

What assessment is most important for hypervolemia?

Respiratory assessment

If pH and pCO2 are moving OPPOSITE, what type of problem does this cause, metabolic or respiratory?

Respiratory!

Metabolic acidosis

Results from Inability of kidneys to excrete acid load (primary ammonia) Defective reabsorption/regeneration of bicarbonate

The nurse is educating a diabetic patient about the use of premixed insulin neutral protamine hagedorn /regular 70/30. What should the nurse inform the patient about using this insulin?

Rotate the injection within one anatomic site for a week *It is important to gently roll the insulin bottle between the palms 10 to 20 times to warm the insulin and resuspend the particles. Injections must be administered at a 45- to 90-degree angle, depending on the thickness of the patient's fat pad.*

According to K/DOQI guidelines, in CKD patients stage 1-4, sodium, calcium, potassium and phosphorus should be limited to what amounts?

SODIUM is restricted to *2000 mg/d*, CALCIUM is restricted to *1200 mg/d,* - potassium and phosphorus intakes should be correlated with laboratory values. . *Careful monitoring of laboratory values is necessary.*

Should you take care of the most or least infectious person first?

See the most infectious patient last whenever possible

Do patients experience dehydration with HHS or is that only a clinical manifestation DKA?

Severe dehydration OFTEN occurs! Check for *dry skin and dry mucous membranes* and if your patient has *extreme thirst* Also.....patients may be *hyperthermic!*

Is an IV bag acidic, basic, or neutral?

Slightly acidic

What is the most important risk factor modification for PAD?

Smoking cessation: most important!!! -Vasoconstriction -Increases blood viscosity -Impairs transport of cellular O2

In an interesting way of treating DKA, dextrose may be ordered at some point to help control BG...why is this?

So the sugar, or BG, does not fall too fast. *Inpatient treatment can call for 0.9% NS along with Dextrose when BG is 250 mg/dL (D5/0.45NS) along with a continuous bolus of regular insult IVP* MONITOR I & O!!!!

What is the major determent in ECF osmolality?

Sodium

What important role does sodium play in the body?

Sodium has an important role in the generation and transmission of nerve impulses, muscle contractility, and regulation of acid-base balance.

What is FFP (fresh frozen plasma) comprised of?

Solid components separated from plasma

What is the best product to be used in place of animal protein for a person with PAD?

Soy products *Also, a PAD patient should decrease intake of saturated fat*

Test-Taking Tip:

Start by reading each of the answer options carefully. Usually at least one of them will be clearly wrong. Eliminate this one from consideration. Now you have reduced the number of response choices by one and improved the odds. Continue to analyze the options. If you can eliminate one more choice in a four-option question, you have reduced the odds to 50/50. While you are eliminating the wrong choices, recall often occurs. One of the options may serve as a trigger that causes you to remember what a few seconds ago had seemed completely forgotten.

What are some Nsg.Interventions/ClientEducation with hypoglycemia Alpha glucosidase Inhibitors?

Take drug with first bite of food

What are some Nsg.Interventions/ClientEducation with *Biguanides*?

Take twice a day with breakfast/dinner

What is the site of best absorption of insulin?

The abdominal area

is the pH & keotones levels normal or abnormal in HHS?

The are normal

Where should you obtain the blood products from during the intra-procedure?

The blood bank *ALWAYS inspect them*(

Which factor may lead to coexistence of hyperinsulinemia and hyperglycemia (from AQ)?

The insulin receptors do not respond to the insulin and the production of insulin increases.

What is the main regulator of phosphorus balance?

The kidneys

What does onset mean in regards to pharmacology?

The length of time needed for a medicine to become effective

When GFR goes down, what happens to BUN and creatinine?

The levels go up!

The lower a patient's blood sugar goes, especially related to hypoglycemia, does thee nuerological effects improve or get worse?

The lower the blood sugar level in a hypoglycemic patient, the more it will effect neurological functioning!

Test-Taking Tip:

The most reliable way to ensure that you select the correct response to a multiple choice question is to recall it. Depend on your learning and memory to furnish the answer to the question. To do this, read the stem, and then stop! Do not look at the response options yet. Try to recall what you know and, based on this, what you would give as the answer. After you have taken a few seconds to do this, then look at all of the choices and select the one that most nearly matches the answer you recalled. It is important that you consider all the choices and not just choose the first option that seems to fit the answer you recall. Remember the distractors. The second choice may look okay, but the fourth choice may be worded in a way that makes it a slightly better choice. If you do not weigh all the choices, you are not maximizing your chances of correctly answering each question.

What is the somogyi effect in relation to DM?

The somogyi effect is a swing of high blood glucose level in the morning after extremely low blood glucose during the night caused by a stress hormone released to counter act low blood glucose levels.

What should a syringe have in it when taking an arterial blood sample?

The syringe must have heparin in it, and the sample should stay cold.

What does peak mean in regards to pharmacology?

The time is takes for a drug to reach it's maximum therapeutic response.

How do you treat HHS?

The treatment is the same as with DKA. *HOWEVER, Always make sure you slowly infuse fluid; it akes more conrol of fluid than DKA*

in kidney disease, what happens to phosphorus in the body?

There is a build up. Bone is the normal storage for phosphorus, but the build up causes phosphorus to collect in the soft tissues.

Aside from blood glucose, what else should a patient check if they are sick or under acute stress?

They MAY have to check urine for ketone bodies every 4 hours

Metformin (Glucophage) is what type of oral hypoglycemics?

They are Biguanides

Repaglinide (Prandin) and Nateglinide (Starlix) are what types of oral hypoglycemics?

They are all *Meglitinides*

Glipizide (Glucotrol), Glyburide (Micronase, Diabeta), and Glimepiride (Amaryl) are what types of oral hypoglycemics?

They are all *Sulfonylureas*

Rosiglitazone (Avandia) and Pioglitazone (Actos)

They are names of Thizaolidinediones "glitazones"

Humulin N, Novolin N (insulin NPH) are intermediate and long acting insulin that are clear or cloudy?

They are usually cloudy!!

Platelet abnormalities is a clinical manifestation of chronic kidney failure. What occurs physiologically with the platelets?

They end up with impaired platelet aggregation

-Increatine enhancers

They increase the secretion of insulin. The incretin response is reduced in patients with type 2 diabetes, so drugs acting on incretins may improve glycaemic control. Incretins are metabolised by dipeptidyl peptidase, so selectively inhibiting this enzyme increases the concentration of circulating incretins.

What is the effect of counterregulatory hormones on insulin (AQ)?

They maintain the blood glucose level in the body. *Counterregulatory hormones are antagonist to insulin.*They help in maintaining the blood glucose level by increasing the blood glucose level and decreasing the movement of glucose into the cells. Counterregulatory hormones key up the glucose production

What is unique about sedentary people if they have PAD?

They may never exhibit symptoms because they do not undergo enough exertion

what does the process of the build up of phosphours in the body where it inhibits calcium reduction lead to?

This process ultimately leads to secondary hyperparathyroidism.

If a patient is showing all the classic signs of hypoglycemia, and you are unable to check the BG, what should you do?

Treat is first, THEN worry about the blood sugar. Treating it first is usually the first thing you would do because time is critical. it is important to treat it quickly! If the doctor questions it, just say that the patient was exhibiting all the signs.

When should you administer NPH and when is the onset?

Twice a day at same time with an onset of 1-2 hours *Peak 4-12 hours*

Is DKA most commin in type 1 or type 2 DM?

Type 1

Fatigue and recurrent infections are clinical manifestations of what type of DM?

Type 2

Is HHS common in type 1 or type 2 diabetics?

Type 2 *HHS can mimic a CVA (Cerebrovascular accident)

How does a DM patient become blind or suffer from retinopathy with microvascular complications?

Typically results from hypoxmia, damage to the retinal vessals and RBC aggregation. *According to professor, all we need to know is that those small vessels in teh back of the eye undergo damage. Anyrisms may occur causing bleeding in the back of the eye*

What age will you typically find patients who are having the acute compmlication of HHS?

Typically they are older.

What type of IV administration set shold you use during the intra-procedure?

Use Y type

If a patient falls into hypoglycemia, what is a nursing intervention as far as food/diet

Use simple carbs to bring them back, an example of juice, milk, candy, regular soda...4-6oz of those liquids *-You follow that with some protein and a little bit of fat*

What changes an IV bag yellow?

Vitamins

What is the most effective exercise for individuals with claudication?

Walking -30-40 minutes/day -Walk to the point of pain, rest, walk again

If a patient is hypoglycemic, do they automatically get admitted to the hospital?

When a patient goes to the ER for a low blood sugar episode, they don't need to be admitted necessary and a doctor may say "hold their glucose medication". *it is very important to treat hypoglycemia very quickly!*

Dialysis

Which process involves movement of fluid and molecules across a semipermeable membrane from one compartment to another?

What blood components can b transfused?

Whole blood or components of whole blood can be transfused

Are IV fluids considered a must with a diabetic undergoing surgery?

YES!

Should a diabetic receive a flu shot?

YES!! A diabetic should get a flu shot once a year!

Should a diabetic receive a pneumonia vaccine?

YES!! You should get the pneumonia vaccine at least once. When you turn 65, you should get another pneumonia vaccine, unless you have had one within the past 5 years.

What kind of screening should a DM patient undergo to check for diabetic retinopathy?

Yearly *dilated* fundoscopic exam

Are crystalloids true solutions?

Yes! *Crystalloids can form crystals and cannot be distinguished from the solution

Are eople who have sensory neuorpathy a fall risk?

Yes! Therefore, they are a risk for injury because they have a *diminished perception of vibration, pain and temperature!*

Does fluid shift occur when the IVF is is filled with a hypertonic solution?

Yes! Water moves OUT of ICF and interstitial fluid (intravenous fluid) compartments and INTO intravascular compartment

Does a person with Type 2 have endogenous insulin production?

Yes; * it's either defective/decreased *erratic/uncontrolled glucose production in the liver *Reduced utilization of insulin defective receptors or insulin resistance

YOU'RE AWESOME AND YOU CAN DO THIS! YOU'RE GOING TO GET AN A!

You rock!

Why do you think polyuria occurs more at night?

You'll have polyuria more at night because you're in a relaxed state, on your back, and the kidneys starts too function better.

Ecchymosis

a bruise, a black adnn blue spot on the skin caused by escape of blood from injured vessels.

What is ecchymoses?

a discoloration of the skin resulting from bleeding underneath, typically caused by bruising

intracellular fluid (ICF)

a fluid within cell membranes throughout most of the body, containing dissolved solutes that are essential to electrolytic balance and to healthy metabolism

Metabolic acidosis is

a neurologic clnical manifestation of CKD that ' -Alter mental ability -Decrease ability to concentrate - Causes Lethargy Fatigue Seizures Coma

What is creatinine?

a waste product from the normal breakdown of muscle tissue. As creatinine is produced, it's filtered through the kidneys and excreted in urine. Doctors measure the blood creatinine level as a test of kidney function.