Exam 1 Flashcards by Jeralyn Wiggins

A nurse is teaching a client who has type 1 DM about the use of an insulin pump. Which of the following information should the nurse include in the teaching?

The risk for developing DKA can be increased with the use of an insulin pump

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What number indicated a fasting blood glucose measurement that is outside the expected reference range?

118 mg/dL

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What are assessment findings for hypokalemia?

• May have no symptoms if loss is gradual
• Dramatic function changes if loss is rapid

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What are assessments findings of hyperkalemia?

• Palpitations
• Skipped heartbeats
• Muscle twitching
• Leg weakness
• Tingling
• Numbness
• Diarrhea

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What are assessment findings for hypocalcemia?

• Frequent, painful muscle spasms in calf or foot
• Paresthesia
• Cardiac, intestinal or skeletal changes

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What are assessment findings for hypercalcemia?

• Severe muscle weakness
• Decreased deep tendon reflexes
• Decreased peristalsis

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What are assessment findings for hypomagnesemia?

• Inhibited nerve impulse transmission
• GI symptoms

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What are some assessment findings for hypermagnesemia?

• Depressed nerve impulse transmission
• Respiratory insufficiency
• Could lead to coma

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What are interventions for hypokalemia?

• Increase serum potassium
• Give potassium (IV or SQ)

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What are some interventions for hyperkalemia?

• Reduce serum potassium
• Cardiac monitoring
• Restore potassium balance through excretion and movement of potassium

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What are some interventions for hypocalcemia?

• Direct calcium replacement (oral or IV)
• Vitamin D
• Calcium rich foods

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What are some interventions for hypercalcemia?

• Stop IV solutions and oral drugs containing calcium
• Stop vitamin D
• Give fluid volume replacement (normal saline)
• Diuretics that help excrete calcium
• Cardiac monitoring

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What are some interventions for hypomagnesemia?

• Drugs promoting magnesium loss should be d/c
• Magnesium sulfate

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What are some interventions for hypermagnesemia?

• Reduce serum level
• Oral and parenteral magnesium should be d/c
• Magnesium (free IV fluids)
• Loop diuretics

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pH normal value

7.35-7.45

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PaCO2 normal value

35-45

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HCO3 normal value

21-28

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What causes metabolic acidosis?

Overproduction of hydrogen ions

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What causes metabolic alkalosis?

Caused by either an increase of bases or decrease of acids

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What causes respiratory acidosis?

It is the retention of CO2, causing increased production of free hydrogen ions

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What causes respiratory alkalosis?

Caused by excessive loss of CO2 through hyperventilation

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What are assessment findings of metabolic acidosis?

 Pt takes long breaths
 Severe diarrhea
 Weakness
 Lethargy
 Confusion
 Stupor
 Coma or death

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What are some assessment findings for metabolic alkalosis?

 Irritability
 Disorientation
 Lethargy
 Muscle twitching
 Numbness and tingling

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What are some assessments findings for respiratory acidosis?

 Increasingly difficult breathing
 Dyspnea
 Weakness
 Dizziness
 Sleepiness
 Change in alertness

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What are some assessment findings for respiratory alkalosis?

 Deep, rapid breathing  Tingling of fingers  Pallor around mouth  Dizziness  Muscle spasms of hands

What are interventions for metabolic acidosis?

 Identify and treat the underlying cause  Insulin  Dialysis  IV bicarb and lactate

What are interventions for metabolic alkalosis?

 IVF’s  Electrolyte replacement

What are interventions for respiratory acidosis?

 Establish & maintain airway  Oxygen  Deep breathing exercises  Bronchodilators  Antibiotics

What are interventions for respiratory alkalosis?

Breathing through re-breather mask or paper bag

S/S of phlebitis

 Pain at sight  Skin = red, inflamed and potentially hard

Interventions for phlebitis

 Remove site, if possible  Heat and elevate extremity

S/s of infiltration

 Skin = cool, tight and tender  Fluid leaking from puncture site  Severely swollen

Interventions for infiltration

 Stop infusion, remove sire  Elevate extremity  Cold/warm compress

S/s of extravasation

 Skin = cool, tight and tender  Fluid leaking from puncture site  Severely swollen  Blistering/tissue sloughing

Interventions for extravasation

 Stop infusion  Surgical intervention may be necessary

S/s of thrombosis

 Swollen extremity  Tenderness/redness  Slowed/stopped infusion

Interventions for thrombosis

 Stop infusion, apply cold compress  Elevate extremity  Potential need for surgical intervention

S/s of site infections

 Site = red, swollen and warm  Potential purulent or odoris exudate

Interventions for site infection

 Clean exit site, remove catheter, send for culture, cover with dry sterile dressing

What are some adverse effects for a pt taking Digoxin?

o Fatigue o Bradycardia o Anorexia o N/V o Dysrhythmias o CNS effects o GI effects

What are some adverse effects due to talking Lasix?

o Hypokalemia o Hypotension o hyponatremia o dehydration

S/s of left sided heart failure

o Weakness o Fatigue o Cough o Chest pain/palpitations o Small amounts of urine o Dyspnea o Arm heaviness

S/s of right sided heart failure

o Distended jugular veins o Abdomen girth o Edema in upper and lower extremities o Hepatomegaly o Hepatojugular reflux o Ascites

Diet for pt's with heart failure:

 Low sodium  Fruits and veggies  Low fat

What are some adverse effects of Warfarin?

 Red/brown urine  Abdominal pain  Black tarry stool  Vomiting/coughing up blood  Hepatitis  Hypotension  Syncope

Interactions for warfarin

 Anticoagulants  Oral contraceptives  Herb supplements

Contraindications for warfarin

 Diverticulitis  Uncontrolled high BP  Severe hepatic or renal disease

Meds for PVD include:

- Anticoagulants - Antiplatelets - Thrombolytics

Example of antiplatelet meds

ASA and Plavix

What are some assessment findings for PAD

o Rubor (redness) of extremity o Thick toenails o Dry, scaled, mottled skin o Decreased/non-palpable pulses

How can you prevent dislodgment of VTE

o Do NOT massage the affected limb o Encourage ambulation after anticoagulation therapy initiated o Warm moist compress

Treatment for varicose veins include:

o Exercise o Elevation o Elastic compression hose

What is the priority intervention for chest pain?

A cardiac assessment

What is some pt education on foot care for DM?

o Do NOT soak feet o Inspect feet daily o Wear breathable shoes o Wear socks to keep your feet warm o Do not go barefooted or sandals with open toes/straps between the toes

S/s of hypoglycemia

o Cool, clammy, sweaty o Anxious o Nervous o Mental confusion o Seizures o Coma o Weakness o Double vision o Blurred vision o Hunger o Tachycardia o Palpitations o Irritable

Diet for pt's with diabetes include:

o Fruits and veggies o Whole grains o Low fat/sodium o Carbs (complex carbs)

When should you take lispro insulin?

Before or with meals

When should you take long acting insulin?

Once a day

Type 1 diabetes is...

insulin dependent - juvenile-onset diabetes

Type 2 diabetes is...

non-insluin dependent - adult-onset

Priority assessments for someone with heart failure include...

- cardio (edema) - resp (listen for crackles/wheezing in the lungs) - vitals - neuro (disorientation/confusion)

Meds for right sided heart failure include...

- diuretics - inotropics - nitrates

Normal potassium level

3.5 - 5.0

Normal calcium level

8.5 - 10.5

Normal magnesium leve

1.8 - 3.0

Normal sodium level

135 - 145

What does a pt do when they have respiratory alkalosis?

over ventilation

What does a pt do when they have respiratory acidosis?

Underventilation

What does a pt experience when they have metabolic alkalosis?

prolonged vomiting and suction

During your morning assessment of a patient with heart failure, the patient complains of sudden vision changes that include seeing yellowish-green halos around the lights. What medication do you suspect is causing this issue?

Digoxin

A patient is taking Digoxin. Prior to administration you check the patient's apical pulse and find it to be 61 bpm. Morning lab values are the following: K+ 3.3 and Digoxin level of 5 ng/mL. What is the correct nursing action?

Hold the dose and notify the physician of the digoxin level

What is a common side effect of Spironolactone?

Hyperkalemia

What type of heart failure does this statement describe? The ventricle is unable to properly fill with blood because it is too stiff. Therefore, blood backs up into the lungs causing the patient to experience shortness of breath.

Left ventricular diastolic dysfunction

A patient reports during a routine check-up that he is experiencing chest pain and shortness of breath while performing activities. He states the pain goes away when he rests. This is known as:

Stable angina

A patient calls the cardiac clinic you are working at and reports that they have taken 3 sublingual doses of Nitroglycerin as prescribed for chest pain, but the chest pain is not relieved. What do you educate the patient to do next?

Call 911 immediately

A patient who has diabetes will be started on Metoprolol for medical management of coronary artery disease. What will you include in your discharge teaching about this medication?

Check your glucose regularly because this medication can mask the typical signs and symptoms of hypoglycemia

What do you want to do with pts legs if they have PVD?

Elevate them

What do you want to do with pts legs if they have PAD?

"Hang" them

What can you not drink with a statin?

Grapefruit juice

What labs do you look at with a pt with HF?

- K+ - BUN - Creatinine - BNP - Troponin's