Exam 3 Review
Diabetes
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Fasting blood glucose level
○ Normal: 99 or less → Do nothing
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Prediabetes: 100-125 → Lifestyle changes, diet, exercise
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Diabetes: 126 or higher → Meds
What lab test will evaluate blood glucose level over 3 month → A1C
What does the presence of ketones in diabetes patient’s urine signify?
○ If your cells cant utilize glucose for energy, your body will burn fat for energy instead. This produces
ketones in blood or urine → indication of dehydration, DKA, coma etc.
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S/S → Polyuria, Polydipsia,
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DM1 → Weight loss →
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DM2 → Weight Gain →
Goal for A1C → below 7
Exercise education for DM1
○ How often should they check BS during exercise? Before and after and sometimes during depending on the
exercise (high cardio check during)
○ Keep snacks with them
Review peak times for insulin
If a patient receives glucagon for txt hypoglycemia, what type of snack should you give them when they are
conscious? → High protein, complex carb (peanut crackers)
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○ What is a good snack for initial txt in a hypoglycemic patient? → Fast acting simple carb (juice, candy, etc)
DKA complications and txt
○ Which electrolyte is most problematic? → Potassium
○ Should you give fluids or insulin first? → Fluids
Diabetic sick day rules: Takes insulin and meds even if they aren't eating, check BS more frequently (q2-4h), stay
hydrated
○ Stress of being sick can cause hyperglycemia so they still need to take their meds
Consider dietary education for a diabetic
Urinary
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BPH: proscar has special administration considerations
○ Pregnant women or women of childbearing age → Male fetus prone to birth defects
UTI prevention measures - wiping from front to back, urinating before and after intercourse, cranberry juice, hydration,
not sitting in wet bathing suit, preventing constipation, cotton underwear
Cystoscopy: allows urologist to visualize the bladder and urethra → diagnostic procedure and therapeutic
intervention
UTI s/s in older adults: confusion, vague abdominal pain, � appetite
Lower UTI vs upper UTI
○ Lower: Dysuria, urgency, frequency, low back pain, suprapubic pain, hematuria, malodorous urine
○ Upper: Flank pain, fever, NVD, � WBC, fatigue
○ Which is worse? → Upper
Lithotripsy: A txt typically using US shock waves by which a kidney stones or other calculus is broken into small
particles that can be passed out by the body
○ Complications: bleeding, infection, obstruction by stone fragments
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TURP: Transurethral resection of the prostate → treats BPH
○ Postop complications: hematuria, low UOP
○ How to obtain a urine sample from a catheter? → Port
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CAUTI → prevent by avoiding catheters and dc them asap
Prevention for urinary incontinence: kegels, empty bladder regularly
Kidney stone patient education: urine straining (helps determine stone type), how to prevent future occurrence,
recommend 2-3 L of water
Priority interventions for patient with kidney stone
○ Pain control
○ UOP
○ Hydration
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Pre/Post-Op
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Pre Op assessment: VS, height, weight, BS, consents, make sure concerns are addressed
○ Special considerations: some patients may need clearance from other providers prior to surgery depending on hx
Normal UOP → at least 30mL/hr
If patient has OSA and needs surgery, should they bring their home C-PAP → yes
What meds should be held on the day of surgery? Blood thinners,
Review obtaining consents
○ Need qualified hospital interpreter if they speak diff language
After a patient returns from surgery, what should you assess first? → ABCs
After general anesthesia, how long until the patient can drive? → 24 hrs
If a patient has abdominal surgery and does not have adequate pain control, what complication are they at risk for?
○ Atelectasis: partial lung collapse → risk for pneumonia
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What can we do to help w/ this? → Control their pain, turn cough deep breath q2h, incentive spirometer
Early ambulation to prevent DVT
How is diest advanced after surgery?
■ Ice chips, clear liquid, fulls, etc.
Menopause, Osteoporosis, gender dysphoria
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Hormone replacement therapy for menopause: � risk for blood clots, � risk for osteoporosis
Osteoporosis vs osteopenia
○ Penia → precursor
Findings assc w/ menopause
○ Hot flashes, stop cycle, mood swings
Post hysterectomy: early ambulation
Measures to prevent osteoporosis - Ca + Vit D
○ What foods are high in vitamin D?
■ Milk, spinach, eggs
How should patients take ca supplements? Divided doses to � absorption
○ Examples of weight bearing exercises: walking, running, weights, yoga, sports
■ NOT swimming or stationary bike
○ Risk factors for osteoporosis ( age (postmenopausal), gender (female), ethnicity (white, asian), meds (steroids,
heparin), weight)
○ Diagnostics for osteoporosis: DEXA scan - at what age does screening start? 65 unless they are on steroids →
screen early
Review therapeutic communication techniques and gender dysphoria
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Example: gender identity disorder → patient may believe they were born as the wrong gender
Associated conditions
RF for gender dysphoria
Therapeutic communication
Fractures and Amputations
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Complications of Fx: fat embolism/venous embolism, compartment syndrome, infection, delayed health or malunion
Traction: what is the purpose? Reducing muscle spasm, immobilizes, stabilizes
Patient education during the first 24 hrs after fx or musculoskeletal injury: RICE
Red flags for patient with a cast: unrelieved pain, paresthesia, pallor, pulses, paralysis
○ Remember neurovascular check
○ Compartment syndrome
Plaster cast application: do you use fingers or palm when handling the cast while it is still wet? Palms
○ Fingertips could leave indents in the cast
Intervention for phantom pain post amputation → mirror therapy
Risk factors for amputation
○ trauma, osteomyelitis
Post limb residual s/p amputation: don't use lotions and creams unless prescribed, prevention of contractures, compression
wrapping/limb shrinking - figure 8
Measures to prevent contractures in LE amputations
○ Lay on their stomach for 30 min 3-4x a day