UTA NURS 3561 Med-Surg Exam 1
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| Anti-HTN periop concerns | may predispose pt to shock from combined effect of the drug and vasodilator effect of some anesthetic agents
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| Tranquilizer periop concerns | potentiate effect of opioids and barbiturates
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| Insulin or oral hypoglycemic agents periop concerns | may require dose or agent adjustments during the perioperative period because of increased body metabolism, decreased caloric intake, stress, and anesthesia. (Lewis 112010, p. 337)
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| Aspirin, clopidogrel (Plavix), and NSAIDs periop concerns | inhibit platelet aggregation and may contribute to postoperative bleeding complications. (Lewis 112010, p. 337)
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| Anticoagulant, such as warfarin (Coumadin) periop concerns | excessive postoperative bleeding
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| Echinacea periop concerns | May cause inflammation of the liver if used with certain medications
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| Feverfew periop concerns | May inhibit platelet activity and increase bleeding
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| Garlic periop concerns | May increase bleeding, especially in patients taking anticoagulants
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| Ginger periop concerns | May increase bleeding, especially in patients taking anticoagulants
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| Ginkgo biloba periop concerns | May increase bleeding, especially in patients taking anticoagulants
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| Ginseng periop concerns | May increase bleeding, especially in patients taking anticoagulants; may cause increased heart rate or elevated blood pressure (BP)
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| Goldenseal periop concerns | May cause increased BP; may increase swelling
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| Kava periop concerns | May prolong the effects of certain anesthetics or antiseizure medications; may cause liver injury
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| Licorice periop concerns | Certain preparations may cause elevated BP, swelling, or electrolyte imbalance
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| Saw palmetto periop concerns | May have additive effects with other hormone therapies
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| St. John's wort periop concerns | May prolong the effects of anesthetic agents
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| Valerian periop concerns | May prolong the effects of certain anesthetics or antiseizure medications; may cause liver injury
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| Vitamin E periop concerns | May increase bleeding, especially in patients taking anticoagulants; may affect thyroid gland function; in high doses may cause increased BP in patients who already have high BP (Lewis 112010, p. 338)
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| Role of nurse in consent | witnessing patient's signature; verifying patient understands information on consent, implications of consent, and that consent is voluntary and can be withdrawn anytime.
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| Risk factors for poor wound healing | Renal dysfunction, Diabetes, Impaired immune system, and Nutritional deficiences (especially protein, vitamins A, C, & B complex)
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| Risk factors for respiratory complications | Smoking, Asthma, and COPD
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| Preop teaching | All patients: deep breathing, coughing, and early ambulation; Individualized teaching: incentive spirometers, PCA pumps, pain rating & management, surgery specific information
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| Hyperglycemia manifestations | increased urination, increased appetite followed by lack of appetite, weakness/fatigue, blurred vision, headache, glycosuria, n/v, abdominal cramps, progression to DKA or HHS
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| Hypoglycemia manifestations | cold/clammy skin, numbness of fingers/toes/mouth, rapid heartbeat, emotional changes, headache, nervousness/tremors, faintness/dizziness, unsteady gait/slurred speech, hunger, changes in vision, seizures/coma
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| Hyperglycemia treatment | diabetes meds, monitor blood glucose and urine ketones, drink fluids hourly
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| Hypoglycemia treatment | immediately ingest 15-20 g of simple carbs, repeat every 15 min, contact provider if no relief, discuss med dosage with provider
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| Diabetic ketoacidosis | an acute metabolic complication of diabetes occurring when fats are metabolized in the absence of insulin resulting in formation of acid by-products, such as ketones (Lewis 112010, p. G-3)
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| DKA manifestations | dehydration (poor skin turgor, dry moucous membranes, tachycardia, orthostatic hypotension), lethargy/weakness, abdominal pain, anorexia, vomiting, Kussmaul respirations, fruity breath.
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| Kussmaul respirations | rapid, deep breathing associated with dyspnea; body's attempt to reverse metabolic acidoses (such as in DKA)
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| Hyperosmolar hyperglycemic syndrome (HHS) | life-threatening syndrome that can occur in the patient with diabetes who is able to produce enough insulin to prevent diabetic ketoacidosis but not enough to prevent severe hyperglycemia, osmotic diuresis, and extracellular fluid depletion
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| Rapid-acting insulins | lispro (Humalog), aspart (NovoLog), glulisine (Apidra)
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| Short-acting insulins | regular (Humulin R, Novolin R, ReliOn R)
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| Intermediate-acting insulins | NPH (Humulin N, Novolin N, ReliOn N)
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| Long-acting insulins | glargine (Lantus), detemir (Levemir)
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| Rapid-acting insulin Onset, Peak, & Duration | Onset: 15 min, Peak: 60-90 min, Duration: 3-4 hr
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| Short-acting insulin Onset, Peak, & Duration | Onset: 1/2-1 hr, Peak: 2-3 hr, Duration: 3-6 hr
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| Intermediate-acting insulin Onset, Peak, & Duration | Onset: 2-4 hr, Peak: 4-10 hr, Duration: 10-16 hr
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| Long-acting insulin Onset, Peak, & Duration | Onset: 1-2 hr, Peak: none, Duration: 24+ hr
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| Primary hypertension | an elevated systemic arterial pressure for which no cause can be found and which is often the only significant clinical finding (Lewis 112010, p. G-7)
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| Secondary hypertension | elevated blood pressure associated with any of several primary diseases, such as renal, pulmonary, endocrine, and vascular diseases (Lewis 112010, p. G-8)
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| Anti-HTN drug categories | Diuretics, Adrenergic Inhibitors, Direct Vasodilators, Ganlionic Blockers, Angiotensin inhibitors, Renin Inhibitors, Calcium Channel Blockers
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| Diuretic considerations | Monitor for orthostatatic hypotension & electrolyte abnormalities (Lewis et al., 2010, p. 748)
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| Adrenergic Inhibitors considerations | Monitor for orthostatic hypotension & advise that sudden d/c may cause withdrawal syndrome (Lewis et al., 2010, p. 748)
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| Direct Vasodilator considerations | Used for hypertensive crisis & monitor for tachycardia
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| Ganglionic Blockers considerations | Admin by IV infusion & monitor for visual disturbances (Lewis et al., 2010, p. 748)
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| Angiotensin Inhibitors considerations | Aspirin & NSAIDs may reduce drug effectiveness & don’t use with potassium-sparing diuretics
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| Renin Inhibitors considerations | May cause angioedema & don’t use when pregnant (Lewis et al., 2010, p. 748)
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| Calcium Channel Blockers considerations | Can cause Bradycardia, use with caution in HF pts (Lewis et al., 2010, p. 748)
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| Diabetes Type 1 | absolute deficiency of insulin
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| Diabetes Type 2 | relative deficiency of insulin
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| Diabetes Type 3 | gestational
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| Diabetes Type 4 | diabetes secondary to another condition
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| Sulfonylureas Problems | Weight gain, hypoglycemia
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| Meglitinides Problems | Weight gain, hypoglycemia
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| Biguanide Problems | Diarrhea, lactic acidosis
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| α-Glucosidase Inhibitors Problems | Gas, abdominal pain, diarrhea
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| Thiazolidinediones Problems | Weight gain, edema [and] Increased risk for cardiovascular events such as myocardial infarction and stroke
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| Dipeptidyl Peptidase-4 (DPP-4) Inhibitors Problems | Upper respiratory tract infection, sore throat, headache, urinary tract infection, diarrhea
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| Diabetes | 2 A1C ≥6.5%; 2 fasting blood glucose levels ≥126 mg/dL; 2 glucose tolerance tests >200 mg/dL; or a random glucose ≥200 mg/dL
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| Diabetic Retinopathy | the process of microvascular damage to the retina as a result of chronic hyperglycemia, presence of nephropathy, and hypertension in patients with diabetes. (Lewis 112010, p. 1248)
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| Diabetic nephropathy | a microvascular complication associated with damage to the small blood vessels that supply the glomeruli of the kidney. (Lewis 112010, p. 1249)
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| Diabetic neuropathy | nerve damage that occurs because of the metabolic derangements associated with diabetes mellitus (Lewis 112010, p. 1249)
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| Acanthosis nigricans | a dark, coarse, thickened skin predominantly seen in flexures and on the neck (Lewis 112010, p. 1251)
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| Diabetic dermatopathy | red-brown flat-topped papules (Lewis 112010, p. 1251)
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| Necrobiosis lipoidica diabeticorum | associated with type 1 diabetes, usually appears as red-yellow lesions, with atrophic skin that becomes shiny and transparent revealing tiny blood vessels under the surface (Lewis 112010, p. 1251)
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| Granuloma annulare | associated mainly with type 1 diabetes, is probably autoimmune in nature and forms partial rings of papules, often on the dorsal surface of hands and feet (Lewis 112010, p. 1251)
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| Macrovascular complications | diseases of the large and medium-size blood vessels that occur with greater frequency and with an earlier onset in people with diabetes (Lewis 112010, p. 1247)
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| Microvascular complications | result from thickening of the vessel membranes in the capillaries and arterioles in response to conditions of chronic hyperglycemia. (Lewis 112010, p. 1248)
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| Hemoglobin normal | Male: 13.2-17.3; Female: 11.7-16.0; possible etiology if decreased: hemorrhage
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| Hematocrit normal | Male: 39-50%; Female: 35-47%; possible etiology if decreased: hemorrhage
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| WBC normal | 4.0-11.0 × 103/μL; possible etiology if increased: infection
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| Cholesterol normal | <200 mg/dL; possible etiology if elevated: uncontrolled diabetes
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| Creatinine normal | 0.2-1.0 mg/dL; possible etiology if decreased: DM
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| Glucose (fasting) normal | 70-99 mg/dL; possible etiology if elevated: DM
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| Insulin (fasting) normal | 4-24 μU/mL; possible etiology if elevated: untreated mild type 2 diabetes; possible etiology if decreased: inadequately treated type 1 diabetes
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| Osmolality normal | 275-295 mOsm/kg; possible etiology if elevated: DM
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| Phosphorus normal | 2.4-4.4 mg/dL; possible etiology if decreased: DM
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| Triglycerides normal | <150 mg/dL; possible etiology if elevated: DM
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| Hemoglobin, glycosylated normal | 4.0%-6.0%; possible etiology if elevated: poorly controlled DM
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| Urine Acetone normal | negative; possible etiology if elevated: DM
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| Urine Creatinine normal | <100 mg/day; possible etiology if elevated: DM
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| Urine Glucose normal | negative; possible etiology if elevated: DM
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| Urine Ketone bodies normal | 20-50 mg/day; possible etiology if elevated: DM
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| Urine specific gravity normal | 1.003-1.030
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| Potassium normal | 3.5-5.0 mEq/L; possible etiology if elevated: DKA, diuretics
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| Sodium normal | 135-145 mEq/L; possible etiology if decreased: DKA; possible etiology if decreased: diuretic therapy
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| b-Type natriuretic peptide (BNP) normal | <100 mcg/L; possibly etiology if elevated: HF
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| Pulmonary edema manifestations | decreased O2 sat, crackles, infiltrates on chest x-ray
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| Dopamine (Intropin) Drug Alert | Extravasations (tissue necrosis and sloughing can occur); Ventricular dysrhythmias (with high dosages)
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| Doxazosin (Cardura) Drug Alert | Syncope (sudden loss of consciousness) occasionally occurs 30 to 90 minutes following initial dose, a too-rapid increase in dose, or addition of another antihypertensive agent to therapy. (Lewis 112010, p. 752)
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| Labetalol (Normodyne) Drug Alert | Instruct patient not to discontinue drug abruptly as this may precipitate angina and/or heart failure. (Lewis 112010, p. 757)
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| Clonidine (Catapres) Drug Alert | Orthostatic hypotension, drowsiness, rebound HTN if discontinued abruptly
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| Biguanides Drug Alert | Do not use in patients with kidney disease, liver disease, or heart failure, or in people who drink excessive amounts of alcohol. (Lewis 112010, p. 1230)
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| Rosiglitazone (Avandia) Drug Alert | Increased risk of MI & stroke; not for use in pts with HF
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| metformin (Glucophage) | Class: Biguanide; Action: ↓ Rate of hepatic glucose production; augments glucose uptake by tissues, especially muscles; Side Effects: Diarrhea, lactic acidosis
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| Exenatide (Byetta) Drug Alert | Acute pancreatitis and kidney problems have been associated with its use. (Lewis 112010, p. 1230)
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| Pramlintide (Symlin) Drug Alert | Can cause severe hypoglycemia when used with insulin. (Lewis 112010, p. 1230)
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| Nitropursside (Nipride) Drug Alert | Assess BP before and during admin; too rapid IV admin can reduce BP too quickly; can cause headache, nausea, dizziness, dyspnea, blurred vision, sweating, and restlessness
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| Captopril (Capoten) Drug Alert | Excessive hypotension and hyperkalemia may occur; monitor for first-dose hyptension (syncope); skipping doses or d/c'ing can result in rebound HTN; angioedema can develop suddenly and be life threatening
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| Spironolactone (Aldactone) Drug Alert | Monitor potassium; may reduce effects of digoxin; avoid foods high in potassium; Gynecomastia is a common side effect of long-term use
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| Carvedilol (Coreg) Drug Alert | OD produces bradycardia, hypotension, bronchospasm, and cardiogenic shock; obtain standing BP 1 hr after admin; abrupt withdrawl results in sweating, palpitations, and headaches
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