Term
| What is the typical age of onset for Type 1 diabetes vs. Type 2 diabetes? |
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Definition
Type 1 = juvenile diabetes, age of onset is usually less then 30/Insulin dependent diabetes
Type 2 = mature onset diabetes, usually peaks around 50 & may occur later/non insulin dependent diabetes. |
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Term
| What are some symptoms of Type 1 diabetes? What are the pathological mechanisms of Type 1? |
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Definition
| symptoms are abrupt with thirst and wt loss, patient is usually not obese. There is primary beta cell destruction happening leading to an absolute insulin deficiency. Type 1 diabetics are insulin dependent. |
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Term
| What are some symptoms of type 2 diabetes? What's the pathological mechanism of type 2 diabetes? |
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Definition
| There are frequently no symptoms, but may be some thirst, fatigue, visual blurring. Patient is usually obese. There is insulin resistance and dysfunctional beta cells. There might be a secretory deficit. Both reasons have type 2 diabetics having an insulin deficiency. |
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Term
| Who is at risk for type 2 diabetes? |
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Definition
| Obesity, heredity, low exercise, HTN, syndrome X, high cholesterol levels, BMI greater than 25 have gestational diabetes, have PCOS or history of vascular disease. |
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Term
| Explain insulin pathophysiology and the effects on carbs, protein and fat metabolism. |
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Definition
| First, preproinsulin is produced. It is a precursor molecule that's inactive and must be made smaller before becoming insulin. Then it is cut into c peptide and proinsulin. Insulin allows glucose in the blood to move into cells to make energy. Insulin binds to insulin receptors on the cell membrane, it is a key to open a cell membrane to glucose. The liver is the first organ reached by insulin. The liver promotes the production and storage of glycogen (glycogenesis). Insulin increases protein & lipid synthesis, inhibits tissue breakdown. In muscle insulin promotes protein and glycogen synthesis. In fat cells insulin promotes triglyceride storage. Insulin keeps blood glucose levels from becoming too high and helps to keep blood lipid levels at a normal range. |
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Term
| Does insulin promote glycogenolysis, ketogenesis and gluconeogenesis? |
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Definition
| No, insulin inhibits all 3. Glycogenolysis (glycogen breakdown into glucose), ketogenesis (conversion of fats to acids) and gluconeogenesis (conversion of proteins to glucose) are all inhibited by insulin. Insulin ONLY PROMOTES GLYCOGENESIS: the production and storage of glycogen. |
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Term
| Chronic total body disease of metabolism is ___________ ___________. |
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Definition
|
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Term
| What happens if the body is low on sugar? |
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Definition
| There is brain changes and LOC changes. |
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Term
| Diabetes Mellitus is a chronic and progressive disease. It is known as the "silent ______." |
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Definition
|
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Term
| What does DM result from? |
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Definition
| defects of insulin secretion, insulin action or both. |
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Term
| What other effects can diabetes lead to in the body? |
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Definition
| Blindness, amputations, End Stage Renal Disease requiring dialysis, increases the risk for Coronary Artery Disease & Cerebral Vascular Accident. |
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Term
| Are there more cases of Type 1 or Type 2 diabetics? |
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Definition
| Type 2 by far! Type 2 diabetes is 85-90% of cases. Type 1 accounts for only 5-10% of cases. |
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Term
| Type 1 diabetes is an ___________ disorder from ____-cell destruction. |
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Definition
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Term
| Type 1 diabetics have 2 strong factors influencing them getting the disease, what are they? |
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Definition
| 1. Genetics 2. Environmental factors (viruses, illnesses, toxins) |
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Term
| There is a strong ___________ influence to Type 1 diabetes. Meaning you have a 45% chance if your identical twin has it, a 5-10% chance if your sibling has it, a 4-6% chance if father does and a 2-3% chance if your mother does. |
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Definition
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Term
| There is an association between Type 1 diabetics and _________ leukocyte antigens (HLAs) |
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Definition
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Term
| What's the only treatment for Type 1? |
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Definition
| injectable insulin. They're insulin dependent. |
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Term
| What is the major risk factor for Type 2 diabetes? |
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Definition
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Term
| There is an even stronger ________ influence in Type 2 diabetics have almost a 100% chance if their identical twin has it, offspring have a 15-45% risk when both parents are affected. |
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Definition
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Term
| Type 2 diabetes is associated with: |
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Definition
| HTN, lipid abnormalities and insulin resistance. |
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Term
| Type 2 diabetes _________ with age. |
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Definition
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Term
| What ethnic groups are at risk for type 2? |
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Definition
| Increased risk in non-hispanic whites (8.7%), blacks (13.3) and hispanics/latinos are 1.7 times as likely to get type 2 diabetes as non-hispanic whites. |
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Term
| Does type 1 develop in all individuals with genetic predisposition? |
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Definition
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Term
| Type 1 diabetes is a slow, progressive insult to ____ cells and insulin molecules. |
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Definition
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Term
| Type 1 diabetes have an _________ insulin deficiency. THere is a production of excess ______________. |
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Definition
| absolute. They get an accumulation of glucose in the plasma (hyperglycemia) and there is NO intracellular glucose to be used as energy or CHO metabolism (cellular starvation). There is a production of EXCESS GLUCAGON. |
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Term
| Type 2 diabetics have the disease because of 2 reasons. #1 - there is a desensitization, explain... |
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Definition
| Desensitization is a limitation of beta-cells to respond to hyperglycemia. Beta cells are chronically exposed to hyperglycemia and become less efficient, which furthers glucose elevations. |
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Term
| Type 2 diabetics have the disease because of 2 reasons. #2 is insulin _________. |
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Definition
| resistance! The insulin resistance causes continued hepatic glucose production. THere is an inability of muscle and fat tissues to increase glucose uptake. |
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Term
| Key Points about Insulin we have to know are: |
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Definition
| Insulin UNLOCKS the CELLS of the body. Insulin ALLOWS GLUCOSE to ENTER. Insulin results in FUEL for the BODY WHERE NEEDED. Insulin is one of the MAJOR REGULATORS of LIPID METABOLISM. |
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Term
| What 3 metabolic problems happen WITHOUT insulin?? |
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Definition
| 1. DECREASED GLUCOSE UTILIZATION: skeletal & cardiac muscles & adipose tissue are NOT getting enough glucose. 2. INCREASED FAT MOBILIZATION-THIS LEADS TO FORMATION OF BREAKDOWN PRODUCTS: this is KETONES! 3. DECREASED PROTEIN UTILIZATION - there is PROTEIN WASTING. Type 1 diabetics appear thin and emaciated. |
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Term
| What are the cardinal manifestations of Type 1 diabetics? What other manifestations are there? |
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Definition
| 3 cardinal signs of type 1: Polyuria (lots of urine), Polydipsia (more thirst), Polyphagia (even hungrier. There is also Weight Loss, Ketonuria (ketones in urine), Complications such as Ketoacidosis, Weakness, Fatigue, Dizziness. |
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Term
| What are the clinical manifestations of Type 2 diabetes? |
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Definition
| Type 2 has an insidious (slow) onset, asymptomatic or mildly asymptomatic, mild manifestations of the hyperglycemia, may have recurrent blurred vision, neuropathic changes (tingling in feet, infections), may have the 3 P's, weakness, fatigue, dizziness. |
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Term
| How does Type 2 differ from Type 1's onset? |
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Definition
| Type 2 differs b/c they have diabetes, but it is a very insidious onset. Usually have for 2 years before it's discovered & the damage is done. |
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Term
| Any blood sugar above ___ is a diagnosis for DM. |
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Definition
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Term
| Any random blood glucose over ____ indicates DM. |
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Definition
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Term
| Did the study in 1993 recommend intensive therapy (3-4 injections daily) or conventional therapy (1-2 injections per day)? |
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Definition
| recommended intensive therapy (3-4 injections daily). This delays onset and slows progression of chronic complications by 35-70%. |
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Term
| What are goals of primary prevention for diabetes? |
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Definition
| Initiating good eating habits (food pyramid), avoiding refined sugars & saturated fats, attaining & maintaining ideal body weight (starting in childhood and after pregnancy), regular exercize. |
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Term
| What are the tertiary preventions & self-mgmt for DM? |
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Definition
| Extensive & Comprehensive Education and the big goal is Glycemic Control. |
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Term
| Glycemic Control is a fasting, bedtime and hemoglobin A1C of what? |
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Definition
| Fasting: 80-120 (normal is less then 110) suggested is 80-140. Bedtime: 100-140 (normal is 120) suggested is 100-160. Hemoglobin A1C: greater then or equal to 6.5% (normal is 4-6%). Suggested is Hb A1C of less then 8%. |
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Term
| Urine Testing is looking for ________. |
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Definition
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Term
| Urine testing also tests renal function. Urine albumin excretion rates of ___ - _____ gms/min = microalbuminuria. Normally it is 0 to trace amts of albumin in urine. This tells if there is damage to the kidneys. If there is, then we want to do a urine test for _____________ clearance to see how much functioning remains. urine testing for ___________. |
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Definition
| 20-200 (tells damage to kidneys), CREATININE clearance (how much functioning remains). urine testing for GLUCOSE. |
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Term
| What is the most expensive part of glucose monitors? |
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Definition
| machines are cheap, but the strips are expensive. So diabetics are reluctant to check their blood sugar as much as they're told to, it's expensive. |
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Term
| There are charts with a Hemoglobin A1C number that corresponds to the average blood sugar. We want a Hgb A1C% of ___ or below. |
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Definition
| 6.5 or 7 and below. Because that corresponds to a blood sugar of 135-150 and below... When it gets over 200 it slows down cells & makes you more prone to infection. |
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Term
| Are there HbA1C monitors? |
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Definition
| meters are now available and are usually used in the primary care setting. |
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Term
| Insulin was introduced in 1955, now there are lots of oral diabetic medications too. Sulfonylurea agents are one of them. How do they work. |
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Definition
| stimulate insulin secretion and enhance the sensitivity of the cell receptor sites. |
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Term
| What is the most common side effect of sulfonylurea agents? |
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Definition
| Hypoglycemia is the most common. Also, nausea and heartburn. |
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Term
| What drugs interact with sulfonylurea agents? |
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Definition
| Need to avoid alcohol and monitor liver + kidney functioning. |
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Term
| Oral diabetic medication Meglitinide Analogs. These have AE similar to ______________. Putting people at risk for... |
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Definition
| Sulfonylureas. also at risk for hypoglycemia with meglitinide analogs. |
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Term
| When should meglitinide analogs be taken? why's this? |
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Definition
| Take just before meals and skip it if you skip a meal. |
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Term
| What kind of onset & duration do meglitinide analogs have? |
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Definition
| a rapid onset, then a short duration. |
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Term
| Meglitinide Analogs are _________ _________ derivatives. |
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Definition
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Term
| Your patient is taking meglitinide analogs (oral diabetic medication). What needs to be avoided and what needs to be monitored? |
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Definition
| avoid alcohol & monitor liver function |
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Term
| Your patient is taking oral diabetic meds, BIGUANIDES (Metformin). You know as the nurse, that they do what to insulin? |
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Definition
| Biguanides does NOT stimulate insulin release! They DECREASE LIVER GLUCOSE and INSULIN RESISTANCE. |
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Term
| What patients should NEVER be given Biguanides (like Metformin)? |
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Definition
| people with renal or liver disease, alcoholics, severe CHF patients or people over 80 years-old. |
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Term
| How do Alpha-Glucosidase Inhibitors work as oral diabetic meds? |
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Definition
| they slow intestinal digestion and absorption of carbohydrates. |
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Term
| When should patients take their oral diabetic meds if it is an Alpha-Glucosidase Inhibitor? |
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Definition
| Take with the first bite of each meal |
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Term
| What can oral diabetic meds Alpha-Glucosidase Inhibitors cause? |
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Definition
| flatulence, diarrhea and abdominal pain |
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Term
| Alpha-Glucosidase Inhibitors will inhibit the absorption of __________, but not glucose or lactose. |
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Definition
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Term
| How do Thiazolindinione agents work? |
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Definition
| they enhance insulin action and glucose utilization in peripheral tissues. |
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Term
| What needs to be monitored before starting on Thiazolindinione agents and also periodically while on? |
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Definition
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Term
| What do Thiazolindinione agents reduce the effectiveness of? |
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Definition
| oral contraceptives (definitely need to patient teach this when you know your patient is on Thiazolindinione agents) |
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Term
| Who are Thiazolindinione agents not recommended in & why? |
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Definition
| CHF patients b/c it can increase plasma volume |
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Term
| Januvia (sitaliptin) is a _______ inhibitor. |
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Definition
| DDP-4 (dipeptidyl peptidase IV) |
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Term
| Is Januiva (sitagliptin) used alone or with other oral medications? |
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Definition
| either, it is done both ways |
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Term
| What dose & how often of Thiazolindinione agents? What about in renal patients? |
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Definition
| 100 mg, once a day. Decrease the dose in renal patients. |
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Term
| How much is the starting dose of Biguanides (Metformin)? |
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Definition
| 15 mg, gradually brought up to 1000 mg twice a day. (sd effects will make them noncompliant if they do not start off on a small dose) |
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Term
| If your patient is on Biguanides (Metformin) and has a contrast dye or anesthesia done, what is VERY, VERY IMPORTANT to know to do. |
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Definition
| The dosage needs to be held for the biguanide (Metformin) for 48 hrs or it can send the person into renal failure. |
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Term
| Januvia (sitagliptin) does not cause weight _____. It is not usually a first line treatment, but given when others are not working well. |
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Definition
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|
Term
| What happened to diabetics before insulin was discovered? |
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Definition
| diabetes was a death sentence prior to the discovery of insulin (the first pt's were being given 5-10 mL IM!) there were beginning problems with abcess' and allergies, but once they saw it might work, it got a lot of research. |
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Term
| Insulin was originally from where? Now it is gnetically engineered. |
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Definition
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Term
| What temp should insulin be kept at? Inject at what temp? |
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Definition
| Want to keep insulin away from heat. It's good to refrigerate it & then take it out 24 hrs before giving the injection b/c cold insulin can be irritating. |
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Term
| What are the different pharmacokinetics of insulin? (these ALL effect the absorption...) |
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Definition
| The injection site (how well vascularized it is), absorption rate, injection depth, time of injection, mixing insulins. |
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Term
| Explain the dawn phenomenon. What causes it? What is blood glucose like in the morning, high or low? How do we treat it. |
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Definition
| Dawn Phenomenon is the term used to describe an abnormal early-morning increase in blood sugar (glucose) — usually between 4 a.m. and 8 a.m. — in people with diabetes. Some people believe it is d/t the night time release of GH. It could also have to do with insufficient insulin the night before or eating a carbohydrate snack late at night. We treat by giving NPH (intermediate acting) later at night. |
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Term
| Dawn phenomenon is characterized by morning ____glycemia. |
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Definition
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Term
| Why is the Somogyi Effect often called the rebound effect? |
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Definition
| It's the bodies reaction to extremely low blood sugar (hypoglycemia) that happens in the night. The body overcompensates and causes a resulting high blood sugar in the morning. THe body "rebounds" & Somogyi is the man who researched it. |
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Term
| What is the best insulin combination? |
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Definition
| Best one is personally fit by the doctor & patient. Gotta work it out for each person. |
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Term
| What are some exercise instructions for diabetics? |
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Definition
| check their blood sugar before starting, check ketones if bs > 250, do low intensity aerobic exercise, walk briskly, weak good shows, have an emergency stash. |
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Term
| What insulin can NEVER be mixed with any other? |
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Definition
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Term
| How can we help treat Somogyi effect? |
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Definition
| treat with a late night snack (helps to prevent the middle of the night hypoglycemia). |
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Term
| Some info on site injection on insulin: |
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Definition
| The site of injection affects the speed of insulin absorption. Rotation WITHIN one anatomic site is preferred to rotation from one site to another to prevent day-to-day changes in absorption. The abdomen is the preferred site b/c it provides the most rapid insulin absorption. |
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Term
| What is the injection depth of insulin? |
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Definition
| It's a subcutaneous injection. It is injected at a 90 degree angle. (A thin person may need to do 45 degree so not to give it IM) |
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Term
| Your patient tells you that they are reusing their needles to save money. What should you encourage as the nurse? |
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Definition
| Encourage patients NOT to reuse their needles. It really puts them at risk for infection & needle fragments left in their skin. Discard after one use. |
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Term
| Common in Europe is the insulin pen... what are some of its advantages? |
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Definition
| It's a small, lightweight, pre-filled insulin cartridges that do not need to be refrigerated. They can be disposable or can have refillable cartridges. They're portable & discreet. Help people who have therapy where they're giving themselves injections often. The cost is more, but the convenience is great. |
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Term
| What are some advantages & disadvantages to insulin pumps? |
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Definition
| THey can achieve nearly normal blood sugar. They're a small computerized device that can deliver both basal rate insulin & boluses. Insulin pumps require intensive education. The injection site must be cleansed and change the spot on the abd every 3 days. Can give rapid or short acting too... allows for supplements in meals. Don't have to carry it with you. Have to be able to check BG multiple times a day. Can cause wt gain. |
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Term
| What about inhaled insulin? |
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Definition
| It's currently under development. it's out there, but it's not being used b/c not sure about long-term effects. It's a powder form of recombinant human insulin. It's short acting - usually taken with meals. IT's not currently available. |
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Term
| WHat is Symlin (pramlintide acetate)? |
|
Definition
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|
Term
| How does Symlin (pramlintide acetate) work? |
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Definition
| it slows gastric emptying and promotes satiety. It works by INHIBITING THE SECRETION OF GLUCAGON. Therefore, reducing the total insulin demand. |
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Term
| What is Byetta (exenatide) Incretin Mimetic? |
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Definition
| Byetta enhances glucose-dependent insulin secretion by the pancreatic beta-cell, suppresses inappropriately elevated glucagon secretion and slows gastric emptying. It breaks down rapidly (only injectable available b/c of this). Originally found in the saliva of gila monsters. It helps regulate the glycogen release. |
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Term
| A diabetic diet is individualized depending on the persons body size & activity level. All diabetics could benefit from meeting with a registered dietitian. What are some common goals? |
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Definition
| Want to keep blood sugars within normal limits, want optimum lipid levels, want a BO less then 130/80, want enough calories to meet the metabolic needs. |
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Term
| Surgical interventions for diabetes mellitus include transplantation of all or part of the _____________. |
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Definition
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|
Term
| 80% of pancreas transplants include a _________ transplant. |
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Definition
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Term
| chronic loss of pancreatic secretions can cause exocrine secretions to drain into the __________ |
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Definition
| urinary bladder, where they're not absorbed & cause irritation. |
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Term
| This is important. what are the s/s of Hypoglycemia? |
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Definition
| Diaphoresis, Trembling, Dizziness/Irritable, Headache/Confusion, Drowsiness/Fatigue, Slurred Speech, LOC/Seizures/Coma |
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Term
| What are some common causes of Hypoglycemia? |
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Definition
| Excess Insulin, Deficient Food intake or absorption, Exercise, Alcohol Intake |
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Term
| What are some treatments for Hypoglycemia if they are alert & able? |
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Definition
| oral therapy of SIMPLE carbohydrates. |
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Term
| What are some treatments for Hypoglycemia if they are unable to swallow? |
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Definition
| IV glucose, Glucagon IM/SubQ, Maintain the airway & protect from injury. |
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Term
| What are the manifestations of mild hypoglycemia (less then 60) & moderate hypoglycemia (less the 40)? What about severe (less then 20)? |
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Definition
| mild: hungry, irritable, shaky, weak, headache, fully conscious. moderate: cold, clammy skin, pale, rapid pulse, rapid, shallow respirations, marked change in mood, drowsiness. severe: unable to swallow, unconscious or convulsions. |
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Term
| WHat is Diabetic Ketoacidosis? |
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Definition
| A state of relative or absolute insulin aggravated by ensuing: hyperglycemia (glucose > 300), dehydration - polydipsia/polyuria, acidosis-pH<7.35. |
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|
Term
| What usually happens before Diabetic Ketoacidosis? |
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Definition
| It is usually precipitated by infection, stressors or inadequate insulin. |
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|
Term
| In diabetic ketoacidosis: _____ is metabolized to produce ketones in the blood and urine. |
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Definition
|
|
Term
| What do the labs of Diabetic Ketoacidosis look like? |
|
Definition
| Serum bicarb falls/decreases. BUN + creatinine increase. |
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|
Term
| What are some manifestations of diabetic ketoacidosis? |
|
Definition
| Kussmaul Respirations (deep, rapid, labored breathing), fruity breath & odor to the room, nausea & abdominal pain, dehydration & electrolyte loss. |
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Term
| How do we treat Diabetic Ketoacidosis? |
|
Definition
| Fluid Replacement of 1 Liter of NS over 30-60 minutes, then 0.45% NS. Give insulin IV infusion. Monitor: airway, vitals, LOC, glucose, electrolytes, urine output, and heart rhythm. (look at the flow chart on pg. 1545) |
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Term
| What is the blood sugar like in HHNS? (hyperglycemic hyperosmolar non ketotic syndrome) |
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Definition
| There is VERY high blood sugars... blood glucose levels can exceed 800. The blood osmolality is also very high & may exceed 350. HHNS differs from Diabetic Ketoacidosis b/c of the absence of ketosis (and the much higher blood glucose & blood osmolality). |
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Term
| In HHNS (hyperglycemic hyperosmolality non ketotic syndrome), the client secretes just enough insulin to prevent ketosis, but not enough to prevent hyperglycemia. The hyperglycemia of HHNS is more severe than that of DKA, greatly increasing the blood osmolality and causing profound diuresis. What occurs b/c of this diuresis in HHNS? |
|
Definition
| severe dehydration & electrolyte loss occurs with HHNS. The client may lose 15-25% of their body fluids. Fluid deficit in the adult may be 10 liters or more. |
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Term
| Since fluid loss is so huge in HHNS (hyperglycemic hyperosmolar non ketotic syndrome) what is the FIRST intervention? |
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Definition
| FIRST: half of the estimated water lost is replaced in the first 12 hours. So first step to HHNS is you replace the fluid deficit within 12 hours. Then continuing therapy is IV insulin given at 10 units/hr is often needed to reduce blood glucose levels. |
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Term
| The goal is obviously to prevent diabetic ketoacidosis. Does the same plan work for everyone? |
|
Definition
| No, everybody has different functioning & NEED AN INDIVIDUALIZED PLAN OF CARE! |
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Term
| When a patient becomes sick, it is really important they know to monitor their blood glucose carefully. How often though? |
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Definition
| BG is often elevated. It needs to be monitored every 2-4 hrs AROUND THE CLOCK. |
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Term
| If pre-meal blood glucose is more then 250 mg/dL, then what needs to be done? |
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Definition
| test for ketones & call a HC provider. Should monitor for ketones in the urine every 2-4 hrs also. |
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Term
| What should a patient do about their insulin when they become sick? |
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Definition
| Do NOT stop taking insulin or oral antidiabetic agents! The usual amount of insulin should be enough. They may need to increase dose, even though their appetite is poor. |
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Term
| WHen someone gets sick & they're diabetic.. NUTRITION & FLUIDS ARE ESSENTIAL! WHat should be given if they are able to tolerate foods? |
|
Definition
| 8 oz of fluid per hour (calorie free) and soft, bland foods (no milk products) |
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|
Term
| If the sick diabetic is unable to tolerate foods & their blood glucose is less then 240, what should be given? |
|
Definition
| replacement carbohydrate of 15 g every hour. A small quantity (30 mL) of fluid every 15-30 minutes. |
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Term
| Diabetic patients need to notify their HC providers for complications: |
|
Definition
| if the illness persists longer then 24 hours, if severe abd pain, if fever is higher then 100, having persistent diarrhea, if they're vomiting & can't take fluids for longer then 4 hours, their BG levels have been difficult to control, there is moderate to large ketones in the urine, shortness of air or chest pain, acute visual loss. |
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|
Term
| To prevent foot problems in diabetics, what is necessary? |
|
Definition
| foot inspections daily, footwear needs to be custom fitted, once problems develop a podiatrist is essential, should call the HC provider for any problems (what seems small may rapidly become life threatening). |
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|
Term
| As a nurse, you should be assessing your patients to identify the diabetics at risk for foot problems. THen it is really important to teach: |
|
Definition
| to maintain good foot care! They need to recognize & treat wounds promtly, should NEVER go barefoot, NEVER use hot soaks or heating pads, assess their vascular status & encourage to stop smoking (impaired blood flow to the foot limits wound healing). |
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|
Term
| If a diabetic gets a wound on their foot, what should they do? |
|
Definition
| see a wound specialist to debride the area, administer antibiotics (when indicated), promote off weighting (eliminate pressure on the wound), check arterial circulation & prevent edema. |
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|
Term
| What is Charcot Foot Deformity? |
|
Definition
| It's when the bones in the foot collapse. Onset is an EMERGENCY! Unfortunately, this is often mistaken for an infection/ulceration when they arrive. |
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Term
| What is the proper intervention for Charcot foot deformity? The foot here is usually lacking sensation. |
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Definition
| Proper treatment is just like a fracture to prevent further deformity. Need immediate off weighting, cannot walk on it at all & should put it in a cast |
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|
Term
| What are patients following a Charcot Foot Deformity at risk for? |
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Definition
| These patients are set for a lifelong problem of ulceration with possible amputation. They really need proper protective footwear & follow-up. |
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Term
| Poor blood glucose control, diastolic HTN, and long duration of diabetes are risk factors for what effects on the eyes? |
|
Definition
| diabetic retinopathy & vision loss. |
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|
Term
| WHat needs to be done to help diabetics avoid retinopathy, cataracts & other ocular disorders? |
|
Definition
| control blood glucose, avoid isometric contractions (static contractions), control HTN. |
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|
Term
| How often should a diabetic visit their ophthalmologist for funduscopic exams? |
|
Definition
|
|
Term
| A diabetic patient who has NONPROLIFERATIVE DIABETES in their eye vessels might display what in the eye exam? |
|
Definition
| microaneurysms in their eye, dot & blot hemorrhages & hard (intra retinal) exudates |
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|
Term
| SIgns & Symptoms of diabetic retinopathy: |
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Definition
Diabetic retinopathy often has no early warning signs. Even macular edema, which may cause vision loss more rapidly, may not have any warning signs for some time. In general, however, a person with macular edema is likely to have blurred vision, making it hard to do things like read or drive. In some cases, the vision will get better or worse during the day.
As new blood vessels form at the back of the eye as a part of proliferative diabetic retinopathy (PDR), they can bleed (hemorrhage) and blur vision. The first time this happens, it may not be very severe. In most cases, it will leave just a few specks of blood, or spots, floating in a person's visual field, though the spots often go away after a few hours.
These spots are often followed within a few days or weeks by a much greater leakage of blood, which blurs vision. It may take the blood anywhere from a few days to months or even years to clear from the inside of the eye, and in some cases the blood will not clear. These types of large hemorrhages tend to happen more than once, often during sleep.
On fundoscopic exam, a doctor will see cotton-wool spots and dot-blot hemorrhages. |
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Term
| WHat's happening in nonproliferative diabetic retinopathy? |
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Definition
| Small blood vessels – such as those in the eye – are especially vulnerable to poor blood sugar (blood glucose) control. An overaccumulation of glucose and/or fructose damages the tiny blood vessels in the retina. During the initial stage, called nonproliferative diabetic retinopathy (NPDR), most people do not notice any change in their vision. s the disease progresses, severe nonproliferative diabetic retinopathy enters an advanced, or proliferative, stage. The lack of oxygen in the retina causes fragile, new, blood vessels to grow along the retina and in the clear, gel-like vitreous humour that fills the inside of the eye. Without timely treatment, these new blood vessels can bleed, cloud vision, and destroy the retina. The new blood vessels can also cause tractional retinal detachment. |
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Term
| With proliferative Diabetic retinopathy an ophthalmic hemorrhage could be: |
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Definition
| neovascularization of the retina, optic disc or iris. Fibrous tissue adheres to the vitreous face of the retina. Retinal detachment. Vitreous hemorrhage. Pre retinal hemorrhage. |
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Term
| MICROangiopathy is affecting the small blood vessels of the body & causes _____________. |
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Definition
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Term
| What are the risk factors leading to nephropathy? |
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Definition
| poor glycemic control, duration of the disease, HTN |
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Term
| How is nephropathy prevented? (Remember, it is damage to your kidney an results from microangiopathy, small blood vessels, not getting enough blood and are damaged... happens from long term DM in the retina (diabetic retinopathy) and the kidneys (diabetic nephropathy). |
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Definition
| Avoid nephrotoxic drugs & contrast dyes, have an annual UA with microalbumnuria & creatinine clearance, check microalbumin levels in urine at home. |
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Term
| Macrovascular disease is any disease of the large blood vessels of the body. This occurs when a person has had diabetes for a long-time. Three common macrovascular diseases are coronary artery disease (in the heart), cerebrovascular accident (in the brain), and peripheral vascular disease (in the limbs). What is coronary artery disease like? |
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Definition
| CAD is often silent and atypical. It leads to myocardial infarction and congestive heart failure, shock, arrhythmias. |
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Term
| What are transient ischemic attacks (TIAs) and cerebral vascular accidents (CVAs) like for macro vascular events? |
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Definition
| TIAs & CVAs are more serious with higher mortality rates. |
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Term
| How are Macrovascular Evens prevented/treated? (like CAD, TIAs & CVAs) |
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Definition
| they're treated with platelet aggregation inhibitors (aspirin?) |
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Term
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Definition
| Gastro means stomach. Paresis means weakness. Gastroparesis is a weak stomach. This condition is very common. It can be the cause of a number of abdominal complaints. |
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Term
| What are the symptoms of gastroparesis? |
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Definition
| early satiety, N/V, bloating, abdominal distention following a meal, constipation, diarrhea (nocturnal), inability to maintain glycemic control.. |
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Term
| How is gastroparesis treated? |
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Definition
| With DIET (needs to be LOW FAT & LOW RESIDUE), possibly a GASTRIC PACEMAKER & MEDS (INSULIN & METOCLOPRAMIDE (REGLAN). |
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Term
| What genitourinary problems happen because of uncontrolled DM? |
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Definition
| Incomplete emptying of the bladder. |
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Term
| What sexual problems happen b/c of uncontrolled DM? What treatments are given? |
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Definition
| Impotence/Erectile Dysfunction, Retrograde Ejaculation. Treatments = Viagra, Ditropan, Penile Implants |
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Term
| What Vasomotor dysfunctions happen b/c of uncontrolled DM? (vasomotor = nerves + muscles that cause the blood vessels to constrict & dialate) |
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Definition
| Symptoms: poor BP control, dizziness, postural hypotension, loss of pupillary response to light. Need to assess: BP, VS every visit & do routine eye exams. |
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Term
| What extra stresses does a diabetic undergoing surgery have? |
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Definition
| interruption of their therapeutic regimen, their diet is changed, dosage of insulin/oral hypoglycemic agent changed, elevated serum glucose levels, more prone to infection, surgical incision, slow wound healing. |
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Term
| Pre-op lab tests for a diabetic include: |
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Definition
| BG levels of course, also HgA1c which is commonly used to determine how well diabetes has been controlled in recent (2-3) months. Lab ELECTROLYTES, BUN, CREATININE. CBC (COMPLETE BLOOD COUNT). |
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Term
| What other pre-op care is done for diabetics? |
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Definition
| Monitor with EKG, surgery should be scheduled early in the morning, they are NPO, Insulin administration is IV drip with glucose administered (5%). Do BG level 1 hr pre-op. |
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Term
| What about post-op care for a diabetic? |
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Definition
| Do IV infusions & regular insulin until able to take PO. Should offer FLUIDS THAT CONTAIN CALORIES (so not just water). BG levels need to be done 4-6 times daily following surgery. We prevent infections with diabetic patients post-op by: AVOIDING URINARY CATHETERS, DOING METICULOUS STERILE DRESSING CHANGES AND SKIN CARE. |
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Term
| Often when people receive a diagnosis of diabetes they need time to have some adjustments. Some feelings they might have are: |
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Definition
| shock or denial, sadness, fear & anxiety, anger & resentment, guilt. |
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Term
| WHen a person starts to adjust to "living with diabetes" it is important to assess: |
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Definition
| attitudes & beliefs, balancing superviion with independence, the impact on the family, financial concerns, and educate yourself. |
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Term
| Diabetic patients need to be taught to give themselves special care & have special directions. What needs to be taught? |
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Definition
| Inspection is important. Need to avoid dry skin & attend cuts with care. Must have routine oral hygiene & dental visits. Routine eye exams. Foot care & footwear are very important. Call the HC provider for problems. |
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Term
| The future of diabetes includes what new ideas? |
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Definition
| Pancreatic transplants, Islet-cell transplants, creating new islet cells through genetic engineering. |
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Term
| What are examples of rapid acting insulins? how fast is the onset then? when do you really need to check the pt for hypoglycemia? |
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Definition
| novolog & humalog. onset is w/in 15 minutes. Check for hypoglycemia during their peak action, 1-3 hours. |
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Term
| What are examples of short acting insulins? how fast will they start working? what's their peak action? duration? |
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Definition
| humulin & novolin. (Regular) onset=w/in 30 minutes. peak=2-4 hours (check for hypoglycemia) duration=6-8 hours |
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Term
| What is the intermediate acting insulin? onset time? peak? duration? |
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Definition
| NPH. onset=1.5 hrs peak=4-12 hrs duration=24 hrs |
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Term
| what is our long acting insulin? Gives a 24 hour basal level... What is the time of onset? peak? duration? |
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Definition
| glargine (Lantus) gives the 24 hr basal level. onset=24 hrs peak=none duration=24 hrs |
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Term
| fixed combination insulin is what? onset? peak? duration? |
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Definition
| 70/30. onset=w/in 30 minutes, peak=2-12 hrs, duration=24 hrs |
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Term
| SO what insulins are clear & what are cloudy? |
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Definition
| The only one that is cloudy is NPH (our intermediate acting). The rest are clear (rapid, short & long acting). So, draw up all the others FIRST & NPH will always come second! Clear THEN CLOUDY! |
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Term
| What is the leading cause of death in diabetics? |
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Definition
| Coronary artery disease (heart disease & strokes... things like that) |
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Term
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Definition
| progressive degeneration & loss of cartilage in one or more joints. |
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Term
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Definition
| old & young can have it. Most of the population is 65 & older. Primarily in knees & hips. Some in shoulders & hands... osteoarthritis is mostly in the lower joints b/c of weight. |
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Term
| What are the manifestations of osteoarthritis? |
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Definition
| pain, crepitus, can be debilitating (decrease in ADLs). There is NO REDNESS OR SWELLING WITH OSTEOARTHRITIS! Osteoarthritis is asymmetrical (on one sd of the body) unlike RA. |
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Term
| Does osteoarthritis get better when the pt sits & puts their feet up? |
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Definition
| Yes, the pain & discomfort is relieved when they put their feet up in osteoarthritis. (RA it is not relived when resting) |
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Term
| How is osteoarthritis diagnosed? |
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Definition
| Self reports of pain & discomfort, crepitus, creaking.... Then x-rays, MRIs, scans are done to show pictures. might see fragments & cartilage broken down in these. |
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Term
| What nursing interventions can be done to help osteoarthritis patients? |
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Definition
| Tell them to REST, use hot & cold packs, different positions to relieve pain, medications (NSAIDS - aspirin & Ibuprofen). ASPIRIN IS THE FIRST LINE DRUG OF CHOICE FOR OSTEOARTHRITIS.) GLUCOSAMINE (injections or oral use. adds viscosity & gluidity in joint. hasn't been proven to work, it's an alternative though), CORTISONE INFLAMMATION (inflammation isn't in the joint tho, but the bone. helps temporarily, but not long-term). THere is also TOPICAL (Bengay, Biofreeze, Icy Hot, etc... if it works for you, great.) SYNVISC (something else injected in joint like Glucosamine). We use: REST, POSITIONING, HOT & COLD, LOSE WEIGHT, EXERCISE! |
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Term
| What kind of exercise is recommended for osteoarthritis patients? didn't we tell them to rest their joints? |
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Definition
| Yes, you rest them & get off them, but they need to exercise them to keep them mobile. Encourage low impact exercises: water, swimming, bicycling, walking. Do not encourage jogging or running. Patient needs to have their weight reduced. Need to lose weight AND exercise (they really need to be doing both!) |
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Term
| Some complementary & alternative therapies for osteoarthritis: |
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Definition
| TENS (trancutaneous electrical nerve stimulation): to INTERRUPT the nerve pathways, Acupuncture, music therapy.. anything along those lines is ok if it works! |
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Term
| If nothing seems to help the osteoarthritis, then they may need to have reconstructive therapy (replacing hip/s or knee/s are common with OA). What are the contraindications to total joint replacement? |
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Definition
| INFECTION. Infection is absolutely a contraindication before surgery & especially bone surgery. You'll get osteomyelitis. |
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Term
| What is given pre-op to a pt with OA going got a total joint replacement? |
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Definition
| autologous BLOOD donation is given pre-op. When they first show up, the nurse needs to do an ASSESSMENT. Pre-op may be given iron supplements, get a CBC baseline, give blood to receive back during surgery, want lab work, EKGs. During the assessment: find out what other problems they're having in life, what's going on w/ them, explain hospital routines, find out what they're here for, find out if they understand why they're here. |
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Term
| What are some things the patient might have on post-op joint replacement? |
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Definition
| May have an IV, a urinary catheter, the SCD boots, often hooked up to dinamaps (monitor vitals), PCA pump (pt controlled analgesia), on the joint there is a dressing, on the non affected leg there is TED hose. If it's a hip, there is usually a wedge or pillow between their legs. There are DRAINS in hips & knees. |
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Term
| Why is there a pillow/wedge between the legs after hip surgery? |
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Definition
| Reminds them not to bring the leg past the MIDLINE. it is NOT to restrain or keep them still, just to keep from going past the midline. It's called an ABDUCTION PILLOW for the hips. Need this b/c there is nothing to keep it there & prevent dislocation. There is NO CROSSING LEGS or SQUATTING DOWN for atleast the first month. |
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Term
| Do we need an abduction pillow for the knees? No! There is a dressing, but not a device. There is a DRAIN in the knee (and also the hip). The nurse needs to monitor the output. How many cc's an hour is okay? |
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Definition
| generally, less then 50 cc's an hour is okay. |
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Term
| Can knees turn side to side? |
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Definition
| Yes, knees can turn side to side. get in a position of comfort! Hips can roll on incision side, but it's not comfortable so it's usually on the other side. |
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Term
| What do we need to look for & prevent besides dislocation? |
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Definition
| Look for & monitor bleeding at incision site. Look for circulation below the site. If it's in knee, check the pedal pulses on both sides. Monitor for INFECTION (with temperature, inflammation) take vital signs frequently - atleast every 4 hours. Look at movement, sensation, warmth, color.. |
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Term
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Definition
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Term
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Definition
| Enoxaparin (Lovenox) to help stop formation of blood clots, given in abdomen sub-q fat, do NOT rub site afterwards or will get bruise. Sd effects of Lovenox: might see bleeding at epidural site, incision site, IV site, etc... |
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Term
| What is the BEST prevention of DVT? |
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Definition
| exercise is best solution to DVT there is! encourage pt to do leg exercises: quad sets, try to push back of knee into bed & that will set the knee in the front. We ARE GOING TO GET THEM WALKING! want them moving the night or day after surgery. Knees are up within 24 hrs. Hips? They sit up in 24 hrs. They will need LOTS of pt education to get them moving: tell them they will go home quicker, clot prevention & they'll breathe better (no pneumonia). |
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Term
| Post-op total joint replacement... Patients will have a PCA pump for the first 24-48 hrs, they they'll have something by mouth for the pain. Get them up out of bed the day of surgery. How far of a flexion can total hips have? |
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Definition
| NO MORE THEN 90 DEGREE FLEXION. They can not prop their feet up when sitting up. They'll use raised toilet seats (b/c they can't stoop down), whether it is weight bearing is up to the physician & prosthesis (some are full weight, some partial & some are non weight bearing) |
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Term
| Knees are going to use a machine to continually move the joint, what is it? |
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Definition
| CONTINUOUS PASSIVE MOTION machine. In certain hospitals, doctors do not use them at all though. Knees are weight bearing & they will get up, walk & move on the same day. |
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Term
| Terry had a total knee surgery, on a CPM machine. The post-op intervention that the nurse should expect is to: |
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Definition
| empty drainage & record. (Read your questions really carefully! the other option had a cast, you would not have that for a joint replacement) |
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Term
| Nurse performs a neurovascular assessment of Terry's feet after a total knee surgery every 2 hours. What assessment finding should be reported to the HC providers? |
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Definition
| Presence of paresthesia bilaterally |
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Term
| Terry notifies the nurse of pain in both knees even with the PCA pump... Pain is an 8 on a 0-10 scale. Which intervention should be implemented FIRST? |
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Definition
| ASSESS IS always first! So the answer is: ASSESS Terry & rule out any possible complications. |
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Term
| Evening of 2nd post-op day, the PCT tells the nurse that Terry is having extreme fatigue. She wants more blankets & is very cold. What should the nurse do FIRST? |
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Definition
| ASSESS the vital signs. ASSESS is always first! |
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Term
| Pt has a temperature, a pulse of 132, respirations of 18 and a B of 102/56. Then nurse notifies the surgeon of the changes. What intervention will the nurse be ready to implement? |
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Definition
| The nurse will likely "obtain wound & blood cultures" to look for possible sepsis or infection in the blood. It would be wrong to administer packed RBC's b/c she is not bleeding. She's showing signs of infection. |
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Term
| What labs do we look at to diagnose musculoskeletal problems? |
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Definition
| CALCIUM & PHOSPHORUS (the 2 have an inverse relationship) We also look at vitamin D. (not going to ask specific values) |
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Term
| Low calcium can be indicative of many things... Do we usually look at their labs to find out about diseases? |
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Definition
| Usually know b/c they will have a fracture & then we run lab results. The pt will low calcium = osteoporosis. vitamin d deficiency = rickets. |
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Term
| We can use radiological exams to x-ray the bones too. CT (computerized tomography) scans give us slices of the body & we're able to diagnose with them too. Though CT scans are NON-INVASIVE, what do CT scans require from the patient? What is always checked? |
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Definition
| CT scans require a patient to drink an iodine dye. Must check to see if patient is allergic to iodine. |
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Term
| CT scans are also known as CAT scans. They are an x-ray that circles around the body. Since it is a highly technological tube, what may the patient feel? |
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Definition
| CT/CAT scans can cause claustraphobia. |
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Term
| What is electromyography? |
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Definition
| A needle is inserted in to the muscle to monitor electric activity of an individual muscle. |
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Term
| What are the risks & contraindications to electromyography (EMG)? |
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Definition
| There is very little risk, a small potential for infection. ANTICOAGULANTS are contraindicated before electromyography though b/c you don't want to be sticking these patients with needles! |
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Term
| What does an arthroscopy allow ability to do? what should the pt watch for after this procedure? |
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Definition
| Used for LOOKING INSIDE A JOINT and CLEAN IT OUT. Tell the patient to look for: pain & infection in the joint when they're leaving (increased temperature, warmth, pain...) |
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Term
| What is administered prior to a Bone Scan? |
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Definition
| an isotope of Gallium is administered via IV which is taken up well & helps to visualize the bone. Then wait a few days for the bone to absorb & then can scan multiple days in a row to see how the bone takes it up. Very helpful for tumors (bone scans are not for arm/leg fractures). Usually can't do other things when a bone scan is going on. Gotta wait until the next day to do another test. |
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Term
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Definition
| Magnetic Resonance Imaging. It's like a HUGE MAGNET that helps us see inside the body. |
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Term
| What cannot be worn for an MRI? |
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Definition
| Don't wear anything ferrous (made with iron or metal base). An artificial hip socket is going to be find - it's titanium. It's not going to pull fillings out of people's teeth either! The magnet can pull a pin out of a pocket & throw it across the room though. Claustraphobia can occur with this too, if pt is 300 lbs+ then they will not fit in, Patients must take nicotine patches off prior to an MRI! |
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Term
| What's the difference between osteoporosis & osteopenia? |
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Definition
| osteoporosis is a disease that breaks down the bone & makes them fragile + likely to break. Osteopenia is a low bone density & is not described as a disease. Osteopenia is something leading up to osteoporosis. Both can lead to fractures & in the last 20 years we have really begun to focus on osteoporosis. |
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Term
| What is a Dowager's Hump? |
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Definition
| It's KYPHOSIS. It is from compression fractures in the vertebrae. |
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Term
| Who's kyphosis common in & what do we tell people to do to prevent it? |
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Definition
| Mostly it's a woman's disease. Girls in their teens need to be told to do WEIGHT BEARING EXERCISES and take in ADEQUATE CALCIUM + VIT D FOR STRONG BONES. We actually have fortified foods now so there will likely be less osteoporosis in future generations. Though it is mostly in women, MEN CAN DEFINITELY GET OSTEOPOROSIS. |
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Term
| What are the main risk factors for osteoporosis? |
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Definition
| Female, Advanced Age, Caucasian, Fair Skin, Thin frames, Family History of the disease, post-Menopause, abnormal absence of menstrual cycles, anorexia or bulimia. |
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Term
| What foods need to be recommended to get adequate calcium? |
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Definition
| milk & other dairy products like yogurt, cheese. Eat fortified cereals, DARK LEAFY VEGETABLES (kale, spinach, broccoli), OMEGA 3 OILY FISH are great! Like Salmon, Sardines... Think about what examples you should choose. (something like a cup of cottage cheese, some grapes & a cracker is NOT enough ca++ each day) |
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Term
| People who are on __________ for a long-time LOSE BONE MASS. What is the main drug to know that will long-term lower the patients bone mass??? |
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Definition
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Term
| Lack of exercise definitely lowers bone mass/density also. What needs to be recommended? |
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Definition
| weight bearing exercises (like running or walking) |
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Term
| Can smoking & alcohol cause osteoporosis?? |
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Definition
| YES! Smoking causes a decrease in calcium & alcohol IN EXCESS can cause it. |
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Term
| How is osteoporosis commonly diagnosed? |
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Definition
| Often after a fall fracture or severe pains in the back. Often it is the lady who consistently visits the HC provider & is losing height. They get fractures, kyphosis & curvature of the spine. |
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Term
| What radiographic test is currently the most widely used to measure bone density? It measures in the hips, wrists & vertebra. It's non-invasive. The machine can really put out results on osteopenia & osteoporosis. |
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Definition
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Term
| What do we do for patients once they have osteoporosis? |
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Definition
| Calcium supplements, Boneva, hormonal replacement therapy, fosomax (phosphates) <--not something we give lightly b/c they inhibit bone resorption. |
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Term
| The main sd effect for Fosomax (phosphates) & Boneva given for osteoporosis is: |
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Definition
| OSOPHAGITIS. They must be able to sit up for 30 minutes after taking & drink a full glass of water after too. It's very irritating to the esophagus if any stays in there at all. |
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Term
| Since osteoporitic bones are very easily broken. what do HC workers need to take huge care in? |
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Definition
| Don't hold their arms too tight or pull on them b/c HC workers can easily break their bones. USE PULL SHEETS INSTEAD to avoid fractures. |
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Term
| How do you know patients are having esophagitis? |
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Definition
| the patient will likely alert you that they can't swallow, they're having burning in their throat when on Boneva. Need to call the Dr & tell them to put them on something else. |
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Term
| Osteoporosis patients are often on ________ replacement therapy. |
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Definition
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Term
| Calcitonin is given for patients with osteoporosis. What route is this drug given in? What are the benefits? |
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Definition
| intranasally. It inhibits osteoclasts (what resorbs the bone) & helps decrease the bone loss in the bone. |
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Term
| The most commonly given for osteoporosis is _________ supplements. |
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Definition
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Term
| How much calcium supplement is needed? What is important to pt teach? |
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Definition
| 1-1.5 Grams. Recommended to take it in divided doses. Best on an empty stomach. Should pt teach to DRINK A LOT OF WATER. large amounts of calcium can form calcium type kidney stones. |
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Term
| After taking calcium supplements, it is important to monitor for what F & E imbalance? What are its signs? |
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Definition
| Hypercalcemia. It's not real likely, but watch for bounding pulses, disorientation, muscle weakness & tachycardia. |
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Term
| OSteoporosis patients need fall prevention. What is done in this area? |
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Definition
| non-skid socks, LOWER THE BED, have bed alarms, hip protectors/pads. Very frequent reason for falls: a high bed with the rails up: fall risk-they will climb over! |
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Term
| What are some very low technology + effective ways to prevent falls? |
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Definition
| put their glasses on, education, call lights and ATTENTION! Tell someone you'll be back in a certain time & then you come back... really helps. Frequent toileting, assistance and education are the easiest! Use life sheets & slider boards so you're not pulling on them. |
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Term
| ______ management is really important for osteoporitic fractures. |
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Definition
| Pain (they really hurt & pain mgmt is REALLY important). Use the whole slew for pain mgmt. Also alternative methods we talked about like braces/corsets to hold their spine straight. |
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Term
| ________________ is a medical procedure where bone cement is percutaneously injected into a fractured vertebra in order to stabilize it. The procedure is typically used for a spine fracture caused by osteoporosis, a disease that causes weakening of the bones and can lead to fractures |
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Definition
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Term
| _________ is the general term for the softening of the bones due to defective bone mineralization. ___________ in children is known as rickets, and because of this, osteomalacia is often restricted to the milder, adult form of the disease. |
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Definition
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Term
| What are the signs of osteomalacia? What is it caused by? |
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Definition
| diffuse body pains, muscle weakness, and fragility of the bones. A common cause is a deficiency of Vitamin D. |
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Term
| ___________ is a bone infection, way into the rich blood vessels. |
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Definition
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Term
| What is done to get rid of osteomyelitis once they have it? |
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Definition
| It is very hard to cure, give them IV antibiotics, may take weeks or months to get rid of it. |
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Term
| What is the very best thing to patient teach to PREVENT getting osteomyelitis? |
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Definition
| GOOD HAND WASHING!!! Can't be emphasized enough. Good education to teach them to wash their hands more! |
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Term
| __________ ____________ Syndrome is a compression of the media nerve in wrist. Most common repetitive strain injury. Who's at risk to getting it? |
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Definition
| Carpal Tunnel. Computer operators, hair dressers... get muscle weakness, clumsiness in hand, difficulty with fine motor movements, cramping. |
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Term
| What is used to prevent carpal tunnels? |
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Definition
| ergonomic aids, fatter handles on hair brushes to PREVENT |
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Term
| Once a patient is diagnosed with carpal tunnel, what are they told to do? |
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Definition
| REST that arm. Stop the computer work, stop the hair dressing, it can really impact their life... |
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Term
| If rest doesn't help the carpal tunnel syndrome they may need surgery to unpinch the nerve. What will be done post-op for this surgery? |
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Definition
| elevate the hand above the heart, decrease swelling with ICE. Dressing changes, all the things you do post-op... teach them prior to know what to expect. |
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Term
| If a patient has a fracture, what is put on to bring bones back in line? What about when it needs to be re-aligned. |
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Definition
| casts, braces, splints. Traction helps re-align. |
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Term
| ________ __________ Syndrome happens when the pressure within gets too high (from too much swelling or bleeding after surgery or injury). The muscle groups are covered by a tough membrane (fascia) which does not readily expand. The lack of oxygen to the tissue can damage blood vessels, nerve and muscle cells. There is lots of pain & numbness. |
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Definition
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Term
| Explain why we do not put on a cast immediately anymore... |
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Definition
| Casts do not allow for an increase in swelling. Today we usually splint, wrap with an ACE bandage. Casts are too inflexible. If we cast immediately there is an increased risk for ACS & neurovascular compromise. |
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Term
| What's the hallmark symptom of ACS? |
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Definition
| Unrelieved pain that has been treated. They've gone home with a cast & then the pain is unrelieved. Not stopped with typical narcotic pills. Pain is really severe & outside what should normally be happening. Also have numbness, tingling, etc... |
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Term
| What assessments need to be checked vascular status following a musculoskeletal injury? |
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Definition
| SKIN COLOR DISTAL TO THE INJURY (should be pigmented same as the rest of the body), SKIN TEMP DISTAL TO INJURY (should be warm), MOVEMENT OF EXTREMITY DISTAL TO INJURY (should move w/o discomfort, No numbness or tingling is what is normal, no differences in sensation when poked between toes with paperclip comparatively, pulses are strong & equal comparatively to the unaffected limb, capillary refill test (blood returns in 3 sec), PAIN IS NORMALLY LOCALIZED & OFTEN DESCRIBED AS STABBING OR THROBBING. (pain out of proportion to the injury is unrelieved by analgesics... may indicate compartment syndrome. |
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Term
| ACS (acute compartment syndrome) can be caused by internal & external causes. What are the interventions for both? |
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Definition
| internal = physician may perform a fasciotomy (slice fascia to allow expansion of relief) external = if it's a cast, take it off! |
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Term
| Your patient is admitted following breaking his femur. 2 days later he is showing signs of altered mental status. He is tachycardic, tachypnea (SOB), and has little red hemorrhage dots on his chest & upper arms (Petechiae). Being the great nurse that you are, you think these are signs of what? What do you do? |
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Definition
| Fat emobolism syndrome. You will want to CALL THE MD IMMEDIATELY. Do NOT just chart this! |
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Term
| What is fat embolism syndrome? |
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Definition
| when fat globules are released in the blood stream, from the bone marrow. They actually become an embolism. Generally, from the femur in the leg. Happens 48-7 hrs later. Not a lot of prevention, but very important to recognize the signs. Earliest sign is: ALTERED MENTAL STATUS! also tachycardia, tachypnea, petechiae. |
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Term
| What are the 2 kinds of casts? |
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Definition
| Plaster=old fashioned, inexpensive, cheap, but if they get wet they are mush. Fiberglass=is synthetic, used a lot on kids, can get a little wet and they won't fall apart. |
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Term
| Since plaster casts take a really long time to dry (like 48 to 72 hours), what do HC personnel always remember to use & not do and teach about? (synthetic too, but they only take 30 minutes so it's less likely) |
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Definition
| DO NOT GRIP THE CAST, always USE THE PALM OF YOUR HANDS. Everywhere your fingers, it makes indentions on the inside. This can cause erosion, sores, infection... big problems actually & it's hidden underneath this hard cast. Must be real careful with plaster casts. |
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Term
| We really need patient education about what happens when underneath their cast itches... what should you tell them? |
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Definition
| do not put ANYTHING down the cast even though they will want to! |
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Term
| Tractions, pulleys, weights are used to get bones to heal. If you're working with a traction patient, you know to NEVER... |
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Definition
| take the weights loose without a physicians order. |
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Term
| What kinds of things need to be watched for with an amputation patient? |
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Definition
| hemorrhage, drainage, infection, phantom limb... |
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Term
| You have a patient who complains of severe pain in his foot, but it was amputated. What are you thinking & what do you do? |
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Definition
| Phantom limb pain, it is very real, take it seriously & you DO treat it! Doesn't matter if there is a limb there, it is still hurting them. Nerves are trying to reconnect. This pain will likely decrease in time from amputation occurence. |
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Term
| If you're working with a BKA patient who is a couple days post-op, what do you need to patient teach him about always keeping it elevated with a pillow? Why is that BAD idea? |
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Definition
| That may be okay for a day, but not past that b/c of FLEXION. If pillows are elevating it, then it will get stiff. Have them move that knee, bend it & flex it. Need to remove the elevation of support under that leg. |
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Term
| How do BKA patients need to be turned? Why? |
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Definition
| Need to turn these people on their tummies for an hour or so - to get extension of their quadriceps. If they just stay on their back, then the quadricep muscle in front is shortening. Hamstring extends, but quadricep shortens. The PT will do this, but the nurse does too. Nurses are with them 24 hrs. |
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