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NR 325 EXAM 1 REVIEW
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Med Surg 2 Exam 1Review
• Diabetes- 15 q’s: what is type 1 (no insulin- need insulin for the rest of their life)
• Type 2- producing little or not enough (what is being produced, is not being used) or no
insulin (95% of all diabetes is type 2) know the distinction
• Diabetes pt- sugar sitting in their blood, (infection) risk factor for developing dm- obesity,
AA, sedentary lifestyle, high BP, high cholesterol, nutrition (can all predispose you to
diabetes)
• Labs to track diabetes- hemoglobin A1C less than 6.5%; fasting blood sugar
• Review all complications for diabetes: hypoglycemia (know all the symptoms), DKA,
neuropathy—has to do with amputation, retinopathy, nephropathy- it will destroy
kidney over time— someone with diabetes you better be checking their labs--know all
labs (BUN, creat, gfr, CBC)
• How to correct hypoglycemia- (rule of 15) 15g carbs, repeat sugar in 15 min, is still low
give another 15 g of carbs ---- if they are non-responsive the medication that you give is
dextrose 50%, or give glucagon injection (only give one of them)
• Control diabetes from the side of weight loss, exercise and nutrition
• You can actually manage type 2 diabetes with weight loss, exercise, nutrition—it is so
essential
• With type 1 diabetes they need insulin
• Type 2 we give them oral hypoglycemic agent—they may also need insulin
• When diabetics are sick you will have to increase their insulin dosage because your body
produces stress hormones (steroids- will also make your blood sugar higher)
• That’s why when pt are sick like (pneumonia, uti and such, their blood sugar will go up
like crazy) - you better anticipate on increasing their insulin dosage
• For type 2 you have to anticipate that you will be giving them insulin even if they are
taking tablet at home
• Steroid will cause diabetes to worsen (will cause sugar to go up)- adenosterone
adrenocortical steroid
• Diabetes cause high BP/cholesterol and damage to blood vessels, poor circulation that’s
why they have a problem with their feet—need to take care of their feet (amputation—
have to check their feet daily) wounds will not heal quickly
• Pts who tend to have complications from diabetes are pts with pregnancy yeast
infection diabetes will cause; poor wound healing/delayed
• Diabetes will cause infections/ yeast infections esp pregnant women
• DKA associated with type 1 : they are diabetic and they are acidotic, fruity breath
because of the ketones (you open the door in their room it will be smelling like nice
flowers)
• DKA treatment: aggressive hydration and regular insulin, IV- sodium bicarb IV—we start
titraing their blood sugar to be coming down when giving regular insulin, once you reach
250, you add dextrose to the IV to titrate –because you don’t want them to develop
hypoglycemia
• When someone had DKA correct with regular insulin, that’s why they have DKA and
ketones- correct the underlying problem, get their blood sugar down for the ketones to
, go away---maintain sugar within normal limits, all those problems and complications will
disappear
• If you don’t regulate the sugar within that tight range, that’s when they start having
complications
• Retinopathy—they have poor vision, they cannot see, because of damage to the retina—
pts should be seeing a optomology yearly
• Diabetics have to check their feet daily
• Review all complications of diabetes
• Review insulin- rapid-acting, fast- acting, long-acting, intermediate- acting—know onset
and peaks
• What happens at the peak of all those insulins? Peak is where you want to monitor your
client for hypoglycemia; onset is when the insulin start working
• Regular insulin, fast acting, rapid acting need to be given with 15 min of when they have
to eat, you cannot give it if someone is NPO you give it around the meal time
• Know the onset of action, peak- is where you want to monitor your client closely for
hypoglycemia
• We give insulin by rotating the site, abdomen is the preferred site because it is closer to
the pancreas; if you keep giving insulin in the same spot, you are going to cause
lipodystrophy, pain, hardness—90-45 degree angle
• Sliding scale, how to mix, regular and NPH, how to give them together in the same
syringe—syringe orange color and calibrated in units
• For type 2 we usual give oral hypoglycemic agents such as metformin, glucophage- do
not give it when? Someone is going for test that require contrast IV media, 2 days before
the test you should hold Glucophage, otherwise they will develop kidney failure ( BUN,
creat levels will go up like crazy) will be very very bad
• We also have injectables for type 2, they are not insulin but are injectables, type 2 get
insulin sometimes, when they are sick you may have to give it to them.
• Complications and lab monitoring, review them VERY WELL
• Thyroid disease- s/s of hyper and hypothyroidism (hyper- everything speeds up and
hypo- everything slows down
• Form of hyperthyroidism is Graves disease
• Thyroid toxicosis (excessive high amount of thyroid hormone)- if not controlled right
away pt will die –they will be burning up, will be hot, their heart rate will be so high,
they will be losing weight, eating like crazy—everything speeds up in their body
• If you don’t correct thyroid toxicosis very quick they will die, they will suffer cardio
pulmonary arrest- HR will be high, everything will be high
• We treat hyperthyroidism with tapozole—medication to slow down or destroy the
production of thyroid hormone
• Digestive system will speed up, they will have crazy diarrhea, they will be so hot, eating,
losing weight, we have meds to correct that
• Hypothyroidism- is can be very low too, mixed edema, will gain weight, moon face,
restless, reatinign lots of fluid
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