Exam 1

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1

What a nurse should look for when a pt has multisystem conditions?

  • observe for slow sudden changes esp. in vital signs, and mental status
  • address dietary restrictions
2

What are the nursing priorities?

A- absolutely now

B- better get this in the first hour

C-can wait a few hours

D-can delegate

3

Multi-system affects of aging

  • Arteries stiffen, pumping rate declines, Blood o2 decreases
  • Brain looses neurons and axons, vision and hearing loss, high pain threshold
  • Max breath capacity decreases, loss of surface area by alveoli, weaker cough reflex
  • bladder capacity decreases, kidneys less efficient in removing waste, changes in lab results, increase to medication toxicity
  • decreased digestion, peristalisis, decreased absorption
  • abdominal body fat, loss of muscle mass
4

What age related changes would indicate a fall risk

  1. Absorption
  2. Polypharmacy
  3. Distribution
  4. Metabolism
  5. Elimination
5

COPD is a multisystem Disease

causes cachexia, peptic ulcers, muscle wasting, cardiovascular disease, anxiety and depression, pulmonary HTN, anemia, osteoporosis, DM

6

What are complications of Diabetes Mellitus

stroke, TIA, blindness, angina/heart attack., kidney disease, high blood pressure, erectile dysfunction. loss of legs/feet, nerve disease ( peripheral nephropathy)

7

Complications of Hypertension

Stroke, Blindness, Heat failure, heart attack, Kidney failure, arteriosclerosis

8

Pathophysiology of Diabetes

Multisystem disease, inadequate glucose metabolism leading to hyperglycemia

-impaired use of insulin

-abnormal production of insulin

9

List preventative Immunizations

Pneumococcal, Influenza, Herpes Zoster, Td/Tdap, Hepatitis

10

Geriatric Syndrome

  1. Urinary Incontinence
  2. Injurious falls
  3. Persistent Pain from arthritis
  4. Neuropathic pain
11

Understanding Metformin

  • initial pharmacologic management
  • anti-hyperglycemic lowers basal and postprandial glucose
  • inhibits hepatic glucose production and intestinal absorption of glucose
  • increases peripheral insulin uptake and utilization
12

What is produced in the body that burns fat for energy

Ketones

13

List two complications that are from hyperglycemia

HHS and DKA

14

Pt has peripheral nephropathy, what position should the pt put her feet when standing from a seated position? What are the priority nursing actions?

Plant feet on ground first before standing

Fall precautions

15

List three skin changes with Diabetes

Foot ulcers, gangrene, atrophic ( thinning, dry, inflamed)

16

HHS= Hyperosmolar Hyperglycemic Syndrome

Infection/stressor/illness/gradual onset

  • extreme dehydration, Hypotension, AMS
  • BG over 800
  • 3 ps, tachycardia, Altered consciousness
17

Nursing interventions for HHS

IV saline to correct fluid and E imbalance

Insulin

-be cared watch for FVE, can cause Heart failure, cardiac dys

replace K+

18

Labs for HHS

ECGS, BUN and Creat will be elevated

19

DKA-diabetic ketoacidosis ( type 1)

Sudden onset due to infection, stress, not enough food,

  • increased BG (greater than 300)
  • BUN greater than 20
  • Creatinine greater than 1.5
20

DKA assessment

  • 3ps
  • kussmals
  • nausea and abd pain
  • dry skin
21

Nursing intervention for DKA

Rapid IV 0.9 or .45%,

-add dextrose when BG reaches 250-300

-Bolus 5-10 units of short acting (IV)

acidosis, moitor for ICP, may need to replace k+

22

Metformin/Glycophage (peak 12 hours)

decrease glucose production and intestinal absorption, increase sensitivity to glucose

  • GI upset, hypoglycemia, heartburn, anorexia, diarrhea
  • monitor BG, withold for 48 for imagining studies
  • low carb high protein diet
23

Glyburide ( sulfonyureas)

long acting ( 24 hrs)

  • increase appetite, N&V, dyspepsia
  • Contraindicated in Type 1, DKA
  • monitor CBC, BG, AST, LDH, BUN, Creatinine