Review for Fundamentals & Med. Surg.
Chapter 41: Oxygenation
Clubbing: swelling of fingers and toes nails from low oxygen
Hypoxia: Low level of oxygenation in the body
Angina:
Chest pain that is aching, sharp, tingling, or burning or that feels like pressure. Typically chest pain
is left sided or substernal and often radiates to the left or both arms, jaw, neck, and back. It is usually
relieved with rest and coronary vasodilators, the most common being a nitroglycerin preparation.
MI:
Men: Chest pain associated with MI in men is usually described as crushing, squeezing, or stabbing.
The pain is often in the left chest and sternal area; may be felt in the back; and radiates down the
left arm to the neck, jaws, teeth, epigastric area, and back. It occurs at rest or exertion and lasts
more than 20 minutes. Rest, position change, or sublingual nitroglycerin administration does not
relieve the pain.
Women: There is a significant difference between men and women in relation to coronary artery
disease. Women’s symptoms differ from those of men. The most common initial symptom in
women is angina, but they also present with atypical symptoms such as fatigue, indigestion,
shortness of breath, and back or jaw pain. Women have twice the risk of dying within the first year
after a heart attack than men.
Heart sounds:
Valve closure causes the first heart sound (S1), often described as “lub.”
At normal rates S1 occurs after the long diastolic pause and before the short systolic pause. S1 is
high pitched, dull in quality, and heard best at the apex.
If a murmur occurs between S1 and S2, it is a systolic murmur.
If it occurs between S2 and the next S1, it is a diastolic murmur.
Left-sided Heart Failure:
Decreased functioning of the (L) ventricle
S/SX: Fatigue, Breathlessness, Dizziness, and Confusion as result of Tissue Hypoxia from
diminished cardiac output, Crackles in the lungs
Right-sided Heart Failure:
Impaired functioning of the (R) ventricle.
More commonly result from pulmonary dx.
S/SX: Weight gain, distended neck veins, hepatomegaly, peipheal edema
Atelectasis:
Collapse of alveoli that prevents normal exchange of oxygen and carbon dioxide.
Insentive Spirometer: prevention and/ or treatment.
Pneumonia:
Wheezing
Prevent by using an incentive spirometer, deep breathing and coughing, move every 2 hours
The 45-degree semi-Fowler’s is the most effective position for promoting lung expansion and
reducing pressure from the abdomen on the diaphragm.
A hemothorax is an accumulation of blood and fluid in the pleural cavity between the parietal and
visceral pleura, usually as a result of trauma. It produces a counter pressure and prevents the lung
from full expansion. A rupture of small blood vessels from inflammatory processes such as
pneumonia or TB can cause a hemothorax.
Hypertension:
The afterload increases, making cardiac workload also increase.
Coumadin for A-Fib:
Whooshing:
Leaking or regurgitating
Hemoptysis:
Blood in sputum
Hemothorax:
Blood in lining of thorax
Tidal Volume:
The amount of air you breath out.
Residual Volume:
Air in alveoli after expiration.
Blood is oxygenated through:
Ventilation, Perfusion and Transfusion.
Cerebral Cortex:
Controls respirations in brain stem
Frank Starling law of the heart:
As the myocardium stretches, the strength of the subsequent contraction increases.
In the diseased heart (cardiomyopathy or myocardial infarction [MI]), Starling’s law does not
apply because the increased stretch of the myocardium is beyond the physiological limits of the
heart. The subsequent contractile response results in insufficient stroke volume, and blood begins
to “back up” in the pulmonary (left heart failure) or systemic (right heart failure) circulation.
The arteries of the systemic circulation deliver nutrients and oxygen to tissues, and the veins remove
waste from tissues. Oxygenated blood flows from the left ventricle through the aorta and into large
systemic arteries. These arteries branch into smaller arteries, then arterioles, and finally the smallest
vessels, the capillaries. Exchange of respiratory gases occurs at the capillary level, where the tissues are
oxygenated. Waste products exit the capillary network through venules that join to form veins. These
veins become larger and form the vena cava, which carries deoxygenated blood to the right side of the
heart, from which it then returns to the pulmonary circulation.
Cardiac Output:
Amount of blood from the left ventricle each minute. (LV/MIN)
Stroke Volume:
amount of blood from the left ventricle each contraction
Ventircles Fill:
Diastole
Ventricles Empty:
Systole
Preload:
Ends diastolic pressure
Afterload:
Resistance to LV contraction.
Normal Cardiac Output:
4-6L/ min
Increased preload count causes:
fluid volume overload- means there is still blood in the ventricle after the contraction.
Hyperventilation occurs:
as the body tries to compensate for the metabolic acidosis.
Cherry Red Mucosa:
Carbon monoxide combines with hemoglobin causing hypoxia
Capnography:
end CO2 Monitoring- measured at the end of exhalation.
Heart Attack Labs:
CPK, TRIP
Brain Peptides:
CHF
Copd:
Anxious and restless because you cant breath- o2 sats are dropping- co2 is building up.
Copd- no more than 3 liters o2
Copd- 88 is normal for patients
Pursed lip breathing
Aireway Maintenance:
Increase Fluids, Humidification, Nebulization
Clubbing:
From reduced amount of oxygen in the blood.
(Kussmaul Respiration):
Deep and labored breathing pattern often associated with severe metabolic acidosis, particularly
diabetic ketoacidosis (DKA) but also kidney failure.
Why do you have a barrel chest?
Occurs because the lungs are chronically over-inflated with air, so the rib cage stays partially
expanded all the time.
Chapter 43: Sleep
Sleep provides physiological and psychological restoration.
Circadian Rythym:
Influences temperature, blood pressure, mood, snsory and hormones
Sleep Diary:
What time do you go to bed
How many times do you wake up
How many hours
Take anything to sleep
Stage 1 NREM: *NREM promotes protein synthesis for skin, bones and gastric restoration*
-Last a few minutes
-includes lightest level of sleep
- fall of vital signs and metabolism
- noise easily arouse person
Stage 2 NREM:
-stage last about 10-20 mins
-body functions continue to slow
-arousal remains relatively easy
Stage 3 of NREM:
stage last about 15-30 mins
- it involves initial stages of deep sleep
-muscles are completely relaxed
-vital signs decline but remain regular
-sleeper is difficult to arouse
Stage 4 NREM
- stage lasts aprox. 15-30 mins
-deepest stage of sleep
- sleep loss has occured, sleeper spends considerable portion of night in this stage
-vitals signs are significantly lower then waking hours
-sleepwalking and enuresis (bed wetting) sometimes occur
- it is very difficult to arouse sleep
REM Stage: *restores brain tissue for cognitive function and memory*
-stage usually begins about 90 ins after sleep has begun
-duration increase with each sleep cycle and averages 20 mins
- vivid full color dreaming occurs, less vivid dreaming occurs in other stages
- stage is typified by rapidly moving eyes, fluctuating heart and respiratory rates, increased or
fluctuating blood pressure, loss of skeletal muscle tone, and increase of gastric secretions
- it is very difficult to arouse sleeper.
Estrogen decreases REM stage
Sleep Issues:
Disruptions in sleep can often be caused by lifestyle, stress and/ or alcohol consumption.
Nocturiaurination during the night, which disrupts the sleep cycle
Insomniachronic difficult falling asleep,most common sleep complaint, signaling an underlying physical or
psychological disorder
Narcolepsyfalls asleep uncontrollably, dysfunction of mechanisms that regulate the sleep and wake states
(excessive daytime sleepiness EDS)
Parasomniassleep problems: sleep walking, bed wetting, night terrors, and bruxism (more common in
children, an example is sudden infant death syndrome (SIDS)
Sleep Apneacharacterized by the lack of airflow through the nose and mouth for 10 second or longer during
sleep
Tx: BiPap, CPap
Sleep Deprivationproblem patients experience as a result of dyssomnia
-irritability, hyperactivity, decreased motivation, alters judgement, decreased ability to
concentrate, weight gain
Management:
>20 min. Day naps,exercise, good sleep habits, light meals
Avoid:
Factors that increase drowsiness (e.g., alcohol; heavy meals; exhausting activities; long-distance
driving; and long periods of sitting in hot, stuffy rooms).
Chapter 49: Sensory
Nurses Role: detect, educate and referral
Normal Sensory Alterations with age:
Vision: 40-50 years old
Hearing: 30 years old
Gust/ Olf: 50 years old
Proprioceptive: 60 years old
Vision deficits:
Presbyopia (decreased ability of lenses to accommodate on close objects)
glaucoma (pressure) 40-50 y/o
macular degeneration (central vision)
cataracts (cloudy- not normal)
diabetic retinopathy (decreased vision or vision loss)
Hearing deficits:
Presbycusis: Most common type of Sensorineural Hearing Loss caused by the natural aging of the
auditory system. It occurs gradually and initially affects the ability to hear higher pitched (higher
frequency) sounds.
Cerumen accumulation: Buildup of earwax in the external auditory canal.
Sensory deficits:
Cognitive:
Reduced capacity to learn
Inability to think or problem solve
Poor task performance
Disorientation/confusion
Bizarre thinking
Increased need for socialization, altered mechanisms of attention
Affective:
Boredom
Restlessness
Increased anxiety
Emotional lability
Panic
Increased need for physical stimulation
Perceptual:
Changes in visual/motor coordination
Reduced color perception
Less tactile accuracy
Changes in ability to perceive size and shape
Changes in spatial and time judgment
Cognitive function in the mini mental state exam:
The Mini-Mental State Exam (MMSE) is a widely used test of cognitive function among the
elderly; it includes tests of orientation, attention, memory, language and visual-spatial skills. 1.
Alert Level: In general participant scoring below education-adjusted cut-off scores* on the MMSE
may be cognitively impaired.
Why does glaucoma create a risk for falls?
Increased risk of falling may be associated with changes in gait that accompany the visual
manifestations of glaucoma.
How do we prevent blindness:
Four recommended interventions are: (1) screening for rubella, syphilis, chlamydia, and gonorrhea
in women who are considering pregnancy; (2) advocating adequate prenatal care to prevent premature birth
(with the danger of exposure of the infant to excessive oxygen); (3) administering eye prophylaxis in the
form of erythromycin ointment approximately 1 hour after an infant's birth; and (4) periodic screening of
all children, especially newborns through preschoolers, for congenital blindness and visual impairment
caused by refractive errors and strabismus.
Expressive/ Receptive/ Global:
Expressive- can understand but not communicate.
Receptive can communicate but not understand.
Global is the inablity to do either.
Chapter 44: Pain
Somatosensory cortex identifies where there is pain.
Types of Pain
Visceral Pain resulting from stimulation of internal organs.
Ex: Crushing sensation, like angina. Burning sensation like gastric ulcer
Somatic painPain that originates from Skeletal muscles, ligaments, or joints.
Cancer Pain Acute / Chronic
Administer Opioids
Idiopathic Pain Chronic pain without identifiable physcal of psychological cause
Neuropathic PainPain from damage to neurons of either peripheal or CNS
Administer NSAIDS
PCA Pump-:
The patient is the only person who should press the PCA button to administer the pain
medication. Monitor the patient for signs and symptoms of over sedation and respiratory
depression. And for potential side effects of opioid analgesics. Administer Narcan if needed.
Opioid tolerance Over time, increased doses needed to obtain analgesic effect
Withdrawal SyndromeRapid or sudden cessation or marked dose reduction may cause rhinitis, chills, pupil dilatation,
diarrhea, "gooseflesh"
Narcan - standing order
Pain & Gate Theory:
According to this theory, gating mechanisms located along the CNS regulate/block pain impulses.
Pain impulses pass through when a gate is open and are blocked when a gate is closed. Closing the
gate is the basis for NPI’s.
Culture and PainMeaning of pain: affects the experience of pain and how one adapts to it; associated with a
person's cultural background, including age, ethnicity, education, race, and familial factors.
Ethnicity:
Cultural beliefs and values affect how individuals cope with pain. Individuals learn what is
expected and accepted by their culture, including how to react to pain.
Different meanings and attitudes are associated with pain across various cultural groups.
Older population and opioids:
narcan and laxative and/ or stool softener
How to get someone to move after surgery:
give them pain meds 30 minutes prior
Nurses job for an epidural:
label that it is an epidural. Make sure to use a catheter for this patient since they will not be able
to urinate on their own. Monitor every fifteen minutes.
Chapter 48: Skin Integrity
Pressure ulcers, staging and healing:
1- intensity 2- duration and 3- tolerance
Risk factors:
Impaired sensory perception- impaired mobility- altered LOC (mini mental), shear, friction &
moisture (neuropathy not specific to DM)
Shear:
is the force exerted parallel to skin.
Friction:
is the force exerted against the skin.
Stage 1:
Intact skin presents with nonblanchable redness of a localized area, usually over a bony
prominence.
Stage 2:
Partial thickness loss of dermis presents as a shallow, open ulcer with a red-pink wound bed
without slough.
Stage 3:
Full-Thickness Skin Loss loss subcutaneous fat may be visible; but bone, tendon, and muscle are
not exposed
Stage 4:
Full-Thickness Tissue Loss exposed bone, tendon, or muscle, subcutaneous fat may be visible;
but bone, tendon, and muscle are not exposed. Slough or eschar may be present.
Unstagable:
Tissue Loss- DEPTH UNKNOWN in which actual depth of an ulcer is completely obscured by
slough and/or eschar
Assessment includes:
locations, depth (staging), type and approximate percentage of tissue in wound bed, wound
dimensions (tunneling if present), exudate description (if odor) and condition of surrounding
skin- pain
3 components for healing:
inflammatory response, epithelial proliferation and migrations, and reestablishment of the
epidermal layers.
Moisture:
Reduces the skin’s resistance and can lead to more pressure ulcers
Slough and eschar:
MUST be removed before wound can heal
Granulation:
- Growth of small vessels and connective tissue to fill full-thickness wound
-Red, moist, shiny, viable tissue (velvet-like appearance)
-Indicates healing
Primary Intention:
-Skin edges approximate or are close together
-Risk of infection slight
-Clean surgical incision (little or no tissue loss)
Secondary Intention:
Wound healing process:
-Edges are not approximated
-Increased risk for infection and loss of tissue function
--ex) Laceration or a chronic wound such as a pressure ulcer
Tertiary intention:
Wound healing process:
-Wound is kept open for several days
-The superficial wound edges are then approximated, and the center of the wound heals by
granulation tissue formation
Exudate:
Serous (Clear and watery), Sanguineous (Bright red), Serosanguineous (Pink and watery)
Purulent (Pus,thick, opaque; yellow/green/brown <- infection = fever , ele. WBC)
Dehiscence:
Is the partial or total separation of wound layers.
Who’s more at risk?
Obese pts., anything putting a strain (coughing, vomming, standing), pt. reports feeling of “given
away”, increase of serosan. Exudate be alert for potential dehiscence.
EviscerationProtrusion of visceral organs through a wound opening (surgical emergency) Immediately place
damp sterile gauze over the site, contact the surgical team, do not allow the patient anything by
mouth (NPO), observe for signs and symptoms of shock, and prepare the patient for emergency
surgery.
Blanching:
does not not occur in dark skin colored patients (absent normal red tones)
Braden scale:
moisture, activity, mobility, nutrition, sensory perception and friction/ shear- education, nutrition
3 major factors of intervention:
skin care and management of incontinence, mechanical loading and support device which
includes proper positioning and the use of therapeutic surfaces and education.
Wound irrigation provides debridement of necrotic tissue with pressure without damaging healthy tissue.
A moist environment supports the movement of epithelial cells and facilitates wound closure.
Always clean from the inside out- least contaminated to most contaminated.
The skin near the site is more contaminated that the site itself. So clean at the wound and move away.
(Opposite of vagina)
Chapter 21: Managing Patient Care
Care Models of Nursing
Team care:
Team is led by a leader, usually RN. This leader is responsible for assessing, analyzing, planning,
evaluating and assigning duties.
Primary care:
(aka: Relationship Based Nursing) This type of nursing is involved with managing and
coordingating care.
Total patient care:
(aka: Client Focused) The Nurse has total responsibility for this patient.
Case management:
Cordination of care management
Autonomy:
Refers to individual decision making in nursing practice: the freedom to assess and provide actions
appropriate for patient care and to establish standards, set goals, monitor practice, and measure
outcomes.
Accountability:
Accepting responsibility for actions.
Staff education:
A professional nursing staff needs to always grow in knowledge. It is impossible to remain
knowledgeable about current medical and nursing practice trends without ongoing education. A
nurse manager is responsible for making learning opportunities available so staff members remain
competent in their practice and empowered in their decision making. This involves planning inservice programs, sending staff to continuing education classes and professional conferences, and
having staff present case studies or evidence-based practice issues during staff meetings. Staff
members are responsible for pursuing educational opportunities for relicensure/recertification and
changing information regarding their patient population.
Patient Advocate:
Speaking up for the patient’s best interest.
Responsibility:
Being held accountable for your actions.
Deontanality:
Right and wrong.
Values:
Can differ between the nurse and the patient. It is important to know that you can not put your
values on your patient.
Utilitarianism:
Value is determined by usefulness
Feminist ethics:
Inequality between people
Ethics of care:
Understand relationships as they are revealed in personal narratives
Casuistry:
Case-based reasoning
How to prioritize care:
ABC’S, Maslow’s Heirarchy, ADPIE, Acuity of other patients.
5 Rights of Delegation:
Right Task
Right Circumstance
Right Person
Right Direction
Right Supervision
Chapter 22: Ethics
What is an ethical dilema and what to do about it:
When you disagree with at least two of the ethical principles. Utilize the seven steps.
Seven Steps of Ethical Dilemas:
1- ask if there is a problem
2- gather information
3- clarify values
4- verbalize the problem
5- identify possible courses of action
6- negotiate the outcome
7- evaluate the outcome
Common Ethical Issues in Healthcare:
Quality of life
Diasbilities
Care at the end of live
Heathcare reform
Chapter 23: Legal Implications
Organ donations:
A person 18 years or older can make an organ donation
This is an end of life issue; it can be made in advance
A client must be legally dead to donate organs
Client must have no brain waves, no spontaneous breathing and no superficial or deep reflexes
Good Sam law:
“A person licensed under this chapter who in good faith renders emergency care at the scene of an
emergency which occurs outside both the place and the course of that person’s employment shall
not be liable for any civil damages as the result of acts or omissions by that person in rendering the
emergency care. “
Malpractice insurance:
-A contract between the nurse and the insurance company
-provides a defense when a nurse is in a lawsuit involving negligence or malpractice insurance
-nurses covered by institution's insurance while working
What is a DNR:
Do Not Resuscitate
What is a POA:
Power of Attorney
Who does a living will:
Living wills represent written documents that direct treatment in accordance with a patient’s wishes
in the event of a terminal illness or condition.
Who signs a consent form?
A patient’s signed consent form is necessary for admission to a health care agency, invasive
procedures such as intravenous central line insertion, surgery, some treatment programs such as
chemotherapy, and participation in research studies.
As a nurse, are you a witness or explain the procedure?
Witness
Chapter 38: Stress
Ptsd:
Posttraumatic stress disorder (PTSD) begins when a person experiences, witnesses, or is confronted
with a traumatic event and responds with intense fear or helplessness.
Anxiety associated with PTSD is sometimes manifested by nightmares and emotional detachment.
Some people with PTSD experience flashbacks, or recurrent and intrusive recollections of the
event.
Depression and PTSD commonly occur together.
Acute stress disorder (ASD) is a similar diagnosis that differs from PTSD in duration of symptoms.
Stress:
Stress is a physical, emotional, or psychological demand that can lead to personal growth or
overwhelm a person and lead to illness or worsening of existing acute or chronic illnesses.
Coping:
Coping is the person’s cognitive and behavioral efforts to manage a stressor.
Coping is important to physical and psychological health, because stress is associated with a range
of psychological and health outcomes.
Denial:
Nursing diagnosis for stress.
Epinepherine/ Norepinepherine:
During the alarm stage the central nervous system is aroused and the body’s defenses are mobilized;
this is the flight-or-fight reaction.
Rising hormone levels result in increased blood volume, blood glucose levels, epinephrine and
norepinephrine amounts, heart rate, blood flow to muscles, oxygen intake, and mental alertness.
If the stressor poses an extreme threat to life or remains for a long time, the person progresses to
the second stage, resistance.
Resistance Stage:
The resistance stage also contributes to the flight-or-fight response and the body stabilizes and
responds in an attempt to compensate for the changes induced by the alarm stage.
Hormone levels, heart rate, blood pressure, and cardiac output should return to normal, and the
body tries to repair any damage that occurred.
Anxiety:
The term stress is used in many ways. Most commonly, it is a term describing a process beginning
with an event that evokes a degree of tension or anxiety. Such events are referred to as stressors.
Stressors are tension-producing stimuli operating within or on any system.
Stress Reduction:
Pursue a relaxing activity for adults; children need comforting and night lights
- giving patients control over their health care minimizes uncertainty and anxiety; back rubs;
cautious use of sedatives.
Diabetes:
Hemoglobin H1C:
Prediabetes- fasting glucose between 120-125
Diabetes- >126
H1C- 4-5.6 normal
H1C- 5.7-6.4 prediabetes
HIC- >6.5 diabetes
Fructosamine:
Reflects 1-3 weeks glycemia antibodies
S/S of diabetes and hypoglycemia:
S/S of Diabetes:
Ploydisia
Polyuria
Polyphagia
Fatigue
Recurrent infection
Yeast infections
Different types of insuline and their actions?
Rapid-acting: *give 15 min within meals*
Lispro (Humalog)
Aspart (NovoLog)
Glulsine (Apidra)
Onset: 10-30 min
Peak: 30 min- 3 hours
Duration: 3-5 hours
Short-acting: *give 30 minutes before meal*
Regular (Humulin R, Novolin R)
Onset: 30 min- 1 hour
Peak: 2- 5 hours
Duration: 5- 8 hours
Intermediate-acting:
NPH (Humulin N, Novolin N)
Onset: 1.5- 4 hours
Peak: 4- 12 hours
Duration: 12- 18 hours
Long-acting:
Glargine (Lantus)
Detemir (Levemir)
Degludec (Tresiba)
Onset: 0.8 - 4 hours
Peak: no peak
Duration: 16- 24 hours
Counterregulatory hormones:
Glucagon, epinephrine, growth hormone, cortisol
When will the pt possible experience an hypoglycemia episode?
After the peak time.
DKA: *more dominant in DM1*
Caused by profound deficiency of insulin.
Hyperglycemia
Ketosis
Acidosis
Dehydration: poor skin turgor, dry mucous membranes, tachy, orthostatic hypotension
Kussmaul Respirations
Sweet, fruity breath
BG >250
Blood pH < 7.3
Ketones in blood/ urine
Serum Bicarbonate <16
*Fluid resuscitation- NaCl 0.45 or 0.9% then add 5% to 10% dextrose when BG approackes 250
With a continuous regular insurlin drip and Potassium replacement as needed*
HHS: *more dominant in DM2*
Precipitating Factors: UTIs, pneumonia, sepsis, acute illness, newly diagnosed DM2, impaired
thirst sensation and/ or ability to replace fluids.
Enough circulation insulin to prevent ketoacidosis
Fewer symptoms lead to higher BG levels >600
No ketones in blood or urine
Treatment similar to DKA
Glyburide:
Sulfonyurea
Increases production of insulin from pancreas.
Major side effect: hypoglycema
Metformin and CT scan:
Reduces the production of glucose by the liver, inproves glucose transport and enhances insulin
sensitivity.
Hold medication for CT scan and 48 hours post procedure.
How to take insulin during sick care:
Take it even though you arent eating? Check sugar every four hours.
Chronic issues Neuropathy:
Nerve damage due to metabolic derangements of diabetes.
Reduced nerve conduction and demyelinization.
Loss of preotective sensation, abnormal sensation, pain or paresthesias in lower extremities and a
major risk for amputation.
Treatment: managing BG levels, topical creams, tricyclic antidepressants, antisezure medication
Arteries, veins and kidneys:
Damage to blodd vessels are secondary to chronic hyperglycemia.
Specific to diabetes:
Retinopathy: vascular damage to the retina. Nonproliferative- partial occlusion. Proliferative- new
vessels are formed that bleed easily and are very fragile. This can cause retinal detachment.
Treatment: laser photocoagulation (laser destroys ischemic areas), vitrectomy (aspiration of the
blood, membrane and fibers insude the eye) or drugs blocking the vascular endothelial growth
factor
Nephropathy: damage to the vessels that supply blood to the glomeruli of the kidney. If albuminuria
is present- utilize drugs to pregent progression: ACE inhibitors, ARB’s. Controlling hypertension
and blood glucose levels is imperative.
Skin Issues: Dermopathy: red-brown, round or oval patches. Acanthosis Nigricans: velvety light
brown to black skin. Necrobiosis Lipoidica Diabeticorum: red-yellow lesions.
What do you give a patient with hypoglycemia: BG <70
Concious: Consume 15g of simple carbohydrates: fruit juice or soda 4-6oz. Recheck 15min and
repeat if necessary. Avoid foods with fat due to decreased absorption of sugar. Give complex CHO
after recovery. Acute: 50% dextrose in 20-50ml IV push
Unconcious: 1mg Glucagon IM or subcutaneously
S/S of Hypoglycemia:
Shaky, palpitations, nervousness, diaphoresis, anxiety, hungor, pallor
How to know if diabetes is in control:
Normal glucose- 70-110
Other:
NG Tube Contraindications:
skull fx, nasal defects, peds, anticoagulant use, recent nasal, throat, or esophageal surgery.
Confirm placement by x-ray,ph strips 1-5.5= good. >5.5 call physician and do not administer
anything through tube.
Flu Vaccine:
6 months or older- for flu shot
49 is the cut off for nasal flu vaccine
Do not adminster to those with an egg allergy or history of Guillain-Barre syndrome
Ca- 8.5-10.5
Na- 135-145
K- 3.5-5
Cl- 95-105
CO2- 35-45
HCO3- 22-26
pH- 7.35-7.45
BUN- 8-20
Creatinine- 0.5-1.2
Mg- 1.5-2.5
2300mL is the average daily intake.