Interventions to prevent diabetes
Maintain healthy weight, diet and exercise
Signs of type 1 diabetes
3 polys, blurred vision, cold feet,
... [Show More] numbness, shiny thin skin w/ no hair, age 30 and under, sudden onset, underweight,
Signs of type 2 diabetes
No symptoms at first , later develop the 3 polys, obesity, Nigricans (black line on back of neck) skin tags
S/S of hypoglycemia
Fatigue, weakness, irritability, reduce cognition, tremors, seizures, diaphoresis( sweating)
S/S of hyperglycemia
3 polys, fruity breath
S/S of diabetic ketoacidosis and treatment
High BS, high HR, restlessness, weight loss, fruity breath, kussmaul(fast deep RR) -- treatments; IV regular insulin
First intervention if a pt. Presents with s/s of hypo/hyperglycemia
Check blood sugar
Prevention of long term complications of diabetes
Takes meds, daily feet care, yearly renal test, eye exams every 6 months, LDL less than 150
Dietary teaching for a diabetic patient
Meals at the same time every day, decrease saturated fats, increase exercise , refer pt. To MyPlate learning tool,
Diabetic Pt. should never increase carbs unless...
Sugar is low before exercising
Discharge teaching for diabetic pt.
Know hypo/hyperglycemia s/s, know that stress and illness increase BS , see a diabetic educator, know what the effect of Exercise can have on Bs
Diabetic foot care
Clean w/ soap and warm water, clean socks everyday, cut toe nails straight across, keep feet dry, no powder or lotion b/t toes , wear shoes , inspect feet daily, no gardners
Lipid analysis
LDL-less than 100 HDL- more than 40 Triglycerides- more than 150
What are low and high levels of HDL indicative of
High- insulin resistance, low- insulin sensitivity
What insulins can not be mixed?
Levemir and Lantus ( detemir and glargine )
How to mix insulin
Short acting to long acting, regular to NPH, Clear to cloudy
Should a nurse hold a patients insulin before consulting a dr?
No
No insulin, beta cells are destroyed is a result of ?
Diabetes type 1
Beta cells exhaustion , insulin resistance is a result of ?
Diabetes type 2
Rapid acting insulin
Lispro(Humalog) aspart(Novolog) glulisine(Apidra)
Onset, peak and duration of Novolog and Apidra
Onset-15-30, Peak-1-3hr, duration-3-5hr
onset, peak and duration of humalog
Onset-15-30, Peak-1-2hr, duration-3-4hr
Short acting insulin( regular)
Humulin R, Novolin R, ReliOn R, Onset-30-60 , Peak-2-4hr, duration-6-8hr
Intermediate insulin (NPH)
Humulin N, Novolin N, ReliOn N, Onset-1-4hr Peak-4-12hr, duration-12-16hr
Long acting insulin
Lantus and levemir Onset-1-2hr, Peak- none, duration-24hr
Which insulin is the only one that can be given through IV ?
Regular
What is glucagon used for?
Makes glucose. Received if BS is low
If a pt. Is lethargic, what form of glucose should be administered?
Glucagon gel in cheek
What is Lipohypotrophy and the prevention ?
Lump under subcut tissue due to repeated injections at the same site. Rotate sites
S/s of brain tumor
Vision changes, confusion and headache
S/S of traumatic brain injury
Blurred vision, personality changes, altered level of consciousness, slurred speech, confusion, headache, uncoordinated, weakness / numbness of legs and arms
If someone hit their head, which test should be completed?
CT scan to make sure there's no head bleeding
Early signs of IICP
Altered levels of consciousness
Nursing interventions for mannitol & lasix
Monitor I&O and electrolytes
Nursing interventions for prednisone
Monitor blood glucose and daily weight
Glasgow coma scale measures ..
Eye opening, verbal and motor response. A score less than 8 is considered in a coma
S/S of Ischemic strokes
80% have these, trouble talking, Face droop? Arm drift, Slurred speech
S/S of hemorrhagic stroke
Serve headache, aneurysm rupture from hypertension , *never administer TPA for these strokes
What is Aphasia
Trouble speaking, expressive, receptive and global
Dysphagia precautions
No straws , thicken liquids,
Steps before administering TPA
Do CT scan to verify Ischemic stroke, neurological assessment, make sure they aren't on blood thinners, history of blood disorders
Side effects of Lovenox (enoxaparin)
Bruising at injection site, dark loose stools , GI bleeding
Is Delirium a disease of the CNS ?
No
S/S of early stage dementia
Gradual onset of memory loss, difficulty focusing attention, depression
Main goal for dementia patients
Maintain self care abilities and prevent injuries
Nursing interventions for dementia patients
Large clock and calendar, decreased distractions during meals, decreased stimuli, monitor weight
How many pain assess menus are done for pt with dementia?
2
Interventions for an agitated dementia pt.
Move pt. To a calm environment
Reality orientation for dementia pts
Be honest, call by preferred name, eye contact, set a routine , simple tasks and directions, familiar objects
Safety interventions in the Alzheimer's pt.
Calm environment, encourage supervision, allow social and physical activity
Med for multiple sclerosis
Copaxone
Generalized tonic-clonic seizures (grand mal)
Most common, stiffening of body for 10-20 sec. then jerking extremities for another 30-40 secs
Absence seizures ( petit mal)
Occurs during childhood, stares off with little to no tonic-clonic movement
Psychomotor (partial seizures)
Occurs at any age, pt. Behaves in a drunk manner, doesn't remember
Jacksonian-focal seizures ( local or partial)
Occur in pts. With structural brain disease, starts in the hands or feet, can turn into tonic-clonic
Myoclonic seizures
Sudden jerking of body
Akinetic seizures
Not common, falls in flaccid state, unconscious for 1 or 2 minutes
What med will a pt get with new onset seizures?
Broad spectrum anti-seizure med
Pt education related to seizures
Keep long and recorded time and duration, any drowsiness , nausea and vomiting.
Discharge education for a pt taking Dilantin
Mouth care, avoid alcohol, no driving, use soft tooth brush
Seizure disorder interventions
Stay with them while they seize, lower them to floor, observe and record, keep them safe, don't force mouth open , turn on side if excessive sputum accumulates
What should be determined when assessing meningitis?
Viral or bacterial, the specific organism that caused it
Bacterial meningitis labs
Increase protein, increase WBC , decrease glucose
Isolation for meningitis
Respiratory droplet, 24 hour isolation after first treatment
Age of onset for type 1 diabetes
30 years or younger
Age of onset for type 2 diabetes
35 years or older but increasing in children
Hyperglycemia Blood glucose levels
Higher than 100-140mg/dl
Hypoglycemia blood glucose levels
Less than 70mg/dl
Euglycemia blood glucose level ( normal)
70-100mg/dl
Level of Consciousness oriented to
1. Person 2. Person and Place 3. Person Place and Time. 4. Person Place Time and Purpose
S/S Intracranial Pressure
Increase in systolic b/p widening pulse pressure, bradycardia, irregular breathing pattern page 302 (cooper)
Insulin
Peptide hormone commonly absorb into patients blood stream. Given subcutaneously. (Also IV mixed with NS)
When giving Insulin be careful to only inject into
Subcutaneous tissue (between fat and muscle layer) page 1758 (cooper)
Intractable
Pain that is described as unbearable and does not respond to treatment.
Diplopia
Double vision
NIHSS
Stroke scale
Characteristics of Parkinson's Disease
Blank facial expression, Forward tilt to posture, slow monotonous slurred speech, tremor, short shuffle gait
Ischemic Stroke
Deficient blood flow to the brain from a partial or complete occlusion of an artery. Either thrombotic or embolic account for 90% of all strokes (cooper 1938)
Postictal Period
Rest period of a seizures varies in length
Epilepsy
Chronic two or more unprovoked seizures
Seizure
A disorder in which nerve cell activity in the brain is disturbed, causing seizures.
What is the action of glucagon?
Increases blood sugar (blood glucose)
What does the nurse record after a seizure?
Duration and time, degree of drowsiness afterward, SE of N/V
Can we restrain a pt having a seizure?
No
Can we place something in a pt's mouth to protect their airway?
No
Phenytoin and pt teaching?
Avoid alcohol, good oral hygiene, may have driving restrictions, pt needs to take meds even when seizures stop
Why is it important to find pathogen that caused Meningitis?
So it can be treated properly
meningitis
Inflammation of brain and spinal cord membranes, typically caused by an infection.
What test is usually done to determine the type of organism in Meningitis?
Lumbar puncture
Pt teaching about Meningitis?
Vaccinations are important; bacterial treated with antibiotics, viral treated with comfort measures
If there is suspected bacterial meningitis?
Respiratory isolation (droplet) until antibiotic runs for 24 hours
Alzheimer's pt and safety
Offer social or physical activity as distraction, encourage family and staff supervision, do Not restrain - physically or chemically, maintain calm environment
Dementia pt and reality orientation
Wall clock and calendar, do not overstimulate, decrees distraction during meals, do NOT put up rails as restraints, monitor weight for changes
What do we monitor while pt on Mannitol (osmitrol)?
I/O electrolytes [Show Less]