CAT 3 Remediation

Question 1

Biguanides: Metformin Adverse effects

Answer 1

Dizziness
Nausea
Vomitting
Diarrhea
Abdominal discomfort
Lactic acidosis

Question 2

Biguanides: Metformin Nursing care

Answer 2

• Do not give with kidney or liver impairment
• Monitor glucose, ketones
• Take with food
• Swallow extended release tablet whole
• Avoid alcohol

Question 3

Sulfonylureas (1st gen) are…

Answer 3

rarely used for diabetes

Question 4

Sulfonylureas (1st gen): Chlorpropamide adverse (DM II)

Answer 4

• Increased risk of cardiac death
• Epigastric distress
• Aplastic anemia
• prolonged hypoglycemia
• Dilutional hyponatremia

Question 5

Sulfonylureas (2nd gen): Glimepiride (Adverse) (DMII)

Answer 5

• Dizziness
• Leukopenia
• Agranulocytosis
• thrombocytopenia
• aplastic anemia
• Hypoglycemia
• Dil. Hyponatremia

Question 6

Sulfonylureas (2nd gen): Glimepiride Nursing care

Answer 6

• May be used with insulin
• Monitor for hypoglycemia

Question 7

Sulfonylureas (2nd gen): Glimepiride Client EDU

Answer 7

• Take with first meal of day
• Medical identification
• Signs of hypoglycemia
• Discuss OTC meds with HCP
• Avoid alcohol

Question 8

Glipizide: Action

Answer 8

• Stimulates release of insulin from pancreas
• increases insulin sensitivity at receptor sites

Question 9

Glipizide: Adverse

Answer 9

• Photosensitivity
• Rashes
• Hypoglycemia

Question 10

Glipizide: Nursing care

Answer 10

• Assess for allergy to sulfonamides
• Use caution with:
• Diuretics
• Steroids
• Oral contraceptives
• Thyroid preparation
• Isoniazid
• Combined use may decrease glipizide action

Question 11

Glipizide: PT EDU

Answer 11

• Signs of hypoglyc
• take 30 min before meals

Question 12

Glyburide: Action

Answer 12

• Stimulates pancreas to secrete insulin
• Increases insulin sensitivity at receptor sites
• Decreases blood and hepatic glucose production

Question 13

Glyburide: Adverse

Answer 13

Hypoglycemia
Aplastic anemia
Constipation
Diarrhea
Dizziness
HA
Hypo Na
Pancytopenia
Weakness
Drowsiness
Cramps
Hepatitis
Photosensitivity
Rash
Hemolytic anemia
Agranulocytosis
Nausea
Vomiting
Increased appetite

Question 14

Glyburide: Nursing care

Answer 14

Beta blockers may cause hypoglycemia

Question 15

Glyburide: PT EDU

Answer 15

• Symptoms of and treatment for hypoglycemia or hyper
• Medical identification
• Avoid stress, alc
• Take with breakfast
• Avoid activities requiring mental alertness
• Discuss all meds with HCP
• Discuss pregnancy with HCP
• Do not use oral contraceptives
• Sun protection
• Carry 15 gram carb to treat hypoglyc.

Question 16

Thiazolidinediones: Rosiglitazone and Pioglitazone –> Action of these two meds

Answer 16

• Augments cell insulin sensitivity at receptor sites
• Improves glucose utilization

Question 17

Thiazolidinediones: Rosiglitazone and Pioglitazone –> Adverse

Answer 17

Liver failure
Heart failure
Elevated liver enzymes
Fractures
Bladder cancer
Anemia
Macular edema
Rhabdomyolysis
Edema

Question 18

Thiazolidinediones: Rosiglitazone and Pioglitazone –> PT EDU

Answer 18

Self blood glucose monitoring
Discuss al meds and preg. with HCP

Question 19

Alpha-Glucasidase inhibitors: EX: Acarbose, Voglibose, Miglitol –> Action

Answer 19

• Inhibit the absorption of carbohydrates from the small intestine
• Competitively inhibit enzymes that convert complex non-absorbable carbs into simple absorbable carbs

Question 20

Alpha-Glucasidase inhibitors: EX: Acarbose, Voglibose, Miglitol –> Adverse

Answer 20

Abdominal pain
Diarrhea
Flatulence
Hypocalcemia

Question 21

Alpha-Glucasidase inhibitors: EX: Acarbose, Voglibose, Miglitol –> Nursing care

Answer 21

Monitor levels of: Calcium, HGB, HCT
Observe for hypoglycemia
Insulin may be needed if surgery or infection
Take with first bite of 3 main meals

Question 22

Amputation: Pathophysiology

Answer 22

• an acute injury may result in partial or full amputation
• All or part of extremity may be surgically re-attached to body
• In chronic condition such as PVD, blood flow to the tissues of the extremities is interrupted, resulting in venous pooling and edema
• Edema further reduces blood flow and causes skin damage, often resulting in ulceration and infection
• Progressive infection leads to further tissue damage and ultimately causes tissue death
• Extremity will have to be removed to prevent tissue death to other body parts

Question 23

Most common amputations…

Answer 23

are of the lower extremities due to tissue damage from PVD

Question 24

Closed amputations:

Answer 24

• Suturing a flap of skin over the amputation site
• Compression dressings used to reduced edema and facilitate use of prosthetic device

Question 25

Expected outcomes for limb amputation:

Answer 25

- Once swelling subsides, client is prepared to immediately wrap the residual limb or slip on a custom fitted elastic residual limb shrinker - client inspects the residual limb carefully each day using a mirror - Rub the res. limb with alc daily to toughen the skin looking for any irritated skin - Massage the res. limb toward the suture line to mobilize scar and prevent its adherence to bone - Avoid exposing the skin around the res. limb to excessive perspiration, and be aware of possible need to change bandages/elastic socks - Prevent contractures - Prep res. limb for prosthesis

Question 26

Amputation: Before surgery

Answer 26

- Reinforce HCP's explanation of procedure - Answer Q's - Provide support as client comes to grips with emotions surrounding limb loss

Question 27

Amputation: Following surgery

Answer 27

- Give pain meds etc. - Splint and support the affected area, elevating to reduce edema - Be prepared to care for the cast or elastic wrap that the HCP applies around the residual limb - Assess wound and report excessive bleeding or infection - Turn and reposition frequently and provide ROM exercises

Question 28

Amputation: following surgery teach pt:

Answer 28

- What to do if cast slips off - To report drainage through cast, warmth, tenderness, or foul smell - Anxiety and pain reduction: Relaxation, visualization, deep breathing - To care for skin - Use elastic wraps - Massage site after wound heals - Prevent hip contracture by performing ROM - Active listening to support pt

Question 29

Adrenergic Agonist: What it is and action

Answer 29

- Adrenergic agonists bind to adrenergic receptors throughout the body - Mimics the function of the sympathetic nervous system - Norepinephrine and phenylephrine - These vasoconstrict peripheral blood vessels. And Activates receptors in arterioles of: - Skin - Viscera - Mucous membranes

Question 30

Norepinephrine: Action

Answer 30

- Increases blood pressure and cardiac output

Question 31

Norepinephrine: Use

Answer 31

- Cardiogenic, septic, and anaphylactic shock - Cardiac arrest - Anaphylaxis

Question 32

Norepinephrine: Adverse

Answer 32

- HA - Palpitations - Nervousness - Epigastric

Question 33

Norepinephrine: Nursing care

Answer 33

- Reflex bradycardia with rise in BP - Constant attendance - Monitor BP and UO - Should not be used in shock d/t low blood volume - Infuse with dextrose solution, not saline - Tissue extravasation if given IV - Monitor IV site. Infusions should be in large blood vessel only. - Protect med from light