Term | Definition |
Manifestations of Hypoglycemia | *Reduced cognition
*Tremors
*Diaphoresis
*Weakness
*hunger
*headache
*irritability
*Seizure
*tachycardia
*Restlessness
*Depression |
Manifestations of Hyperglycemia | *polyuria
*polydipsia
*dehydration
*fatigue
*fruity odor to breath
*Kussmaul breathing
*Weight loss
*hunger
*dry skin
*blurry vision
*infections heal more slowly than usual |
Treatment of hypoglycemia | 15 grams of carbohydrates, protein, fat, glucose tabs |
Treatment of hyperglycemia | Insulin (glargine, lispro, metformin, regular) |
Glargine | long acting insulin (no peak) |
Lispro | short acting insulin |
Metformin | most common PO diabetes med |
Regular | short acting insulin ordered IV; a prescription and very cheap |
Labs & Diagnostics for Hypo/hyperglycemia:
Random Blood Glucose | not fasting; below 140-150 |
Labs & Diagnostics for Hypo/hyperglycemia
Fasting Blood Glucose | no food 6-8 hours before testing; 70-100 |
Labs & Diagnostics for Hypo/Hyperglycemia
Post-Prandial Glucose | 2 hours after a meal; 70-100 |
Labs & Diagnostics for Hypo/Hyperglycemia
Oral Glucose Tolerance Test | before high carb meal and 30 mins to hour after, then 30 mins to hour after, etc |
Labs & Diagnostics for Hypo/Hyperglycemia
Hemoglobin A1C | shows how BS has been over 3 months; an average |
Foot Care Do's (Diabetics) | *mild soap and water, pat dry
*Nail care following bath or shower
*Cotton wool separate overlapping toes
*powder with cornstarch
*socks are clean and absorbent
*shoes need to be correct fit and leather
*shake out shoes before putting on |
Foot Care Don'ts (Diabetics) | *use commercial remedies for removing calluses or corns
*wear open-toe or open heel shoes
*go barefoot
*wear plastic shoes
*heating pads/hot water bottles
*stand or sit long periods of time or cross legs |
Sick Days for Diabetics | *Sports drinks, soups, fluids that replace electrolytes (high in carbs)
*call Dr if unable to eat and replaced 4-5 meals with liquids
*check glucose q 4-5 hours and urine for keystones
*don’t be alone and get rest
*no skipping meals |
When do you go to the ER if you're Diabetic and Sick? | *Decreased LOC
*sick for more than 2 days
*temp over 102 and doesn’t respond to meds or lasts more than 12 hrs
*high resp rate
*can’t tolerate fluids
*glucose more than 240 |
How do you manage Type 1 Diabetes? | *balance carbs with insulin doses
*Encourage patient to eat moderately and experiment with diets to see what works best for them |
How do you manage Type 2 Diabetes? | *fewer, but healthier carbs
*Encourage patient to eat moderately and experiment with diets to see what works best for them |
What necessary/lifesaving skill should you teach a new Diabetic patient? | How to check blood sugars |
Manifestations of Pancreatitis (Acute) | *Severe Pain (starts suddenly and becomes more severe with eating)
*Nausea
*Bloated
*Distended
*fever
*increased HR
*elevated BP
*Cullen’s Sign
*Grey Turner’s sign
*low blood pressure
*hypoxia
*Pleural effusion/hypoxemia
*steatorrhea |
Manifestations of Pancreatitis (Chronic) | *Severe Pain (in LUQ and is often constant)
*nausea
*bloated
*Distended
*fever
*increased HR
*elevated BP
*Cullen’s Sign
*Grey Turner’s sign
*low blood pressure
*hypoxia
*Pleural effusion/hypoxemia
*steatorrhea
*Oily stools
*Weight Loss |
Interventions of Pancreatitis | *NPO (TPN feeding)
*Position for comfort
*NG tube w/ suction for N/V (watch for metabolic acidosis & hypokalemia)
*IV fluids |
Treatment of Pancreatitis | *Antibiotics
*Morphine/hydromorphone
*PPIs/H2 blockers (pantoprazole/famotidine IV)
*Monitor stools; number and consistency
*Electrolyte managment
*nutritional support and electrolyte managment |
What is the diet of pancreatitis? | when diet is resumed, avoid alcohol, caffeine, spicy foods, fatty foods and eat: bland, low fat/high protein food, high carbs (unless glucose issues) |
Teaching about Pancreatitis | *Small, frequent meals
*No smoking
*don't chew pancreatic enzymes
*Referral to Alcoholics Anonymous if needed |
Manifestations of Bacterial Skin infection (non-necrotizing cellulitis) | *Erythema
*Warmth
*localized pain
*Edema
*Exudate that contains pus/odor |
Manifestations of Bacterial Skin infection (necrotizing soft tissue infections) | *Fever
*Tachycardia
*Pain disproportionate to clinical findings
*Disorientation
*Lethargy
*hypotension
*firmness
*ischemia
*tissue necrosis
*sepsis |
Treatments of Bacterial Skin infections | *Surgical Debridement
*Bactoban ointment (if MRSA)
*Antibiotic
*Debridement
*Decolonization strategies
*Appropriate dressing |
Labs/Diagnosis of Bacterial Skin infections | *blood culture/sensitivity
*CBC with differential
*serum electrolytes
*C-reactive protein
*Wound tissue biopsy
*identification of gas in subcutaneous tissues by CT scan |
Teaching about Bacterial Skin infections | *Hand washing
*How to care for their wound
*Manifestations of infection |
Manifestations of Superficial Surgical Site infection | *Purulent drainage
*Organisms isolated from sterile culture from wound
*pain and tenderness
*localized swelling
*erythema
*Heat |
Treatment of Superficial Surgical site infection | *antibiotics
*adequate nutrition status |
Interventions of Superficial Surgical site infection | *Ensure sterile technique
*Report S/S of infection or dehiscence immediately
*Frequently assess wound site
*Sterile dressing change
*prevent hypothermia during surgery
*Know risk factors of infection
*Record output and characteristics of drainage |
Labs/Diagnostics of superficial surgical site infection | *blood culture/sensitivity
*CBC with differential
*serum electrolytes
*C-reactive protein
*identification of gas in SC tissues by CT scan
*Wound tissue biopsy
(All of this is at a Surgical site) |
Teaching about Superficial Surgical Site infection | *Medication schedule and side effects (including pain meds)
*follow up with physician
*wound care instructions
*Drain care instructions
*Recommended activity level
*Diet
*Potential complications
*Call Dr with: excessive bleeding, S/S of infection |
Dehiscenence | Total separation of wound edges, with no bowels/organs showing |
Evisceration | protrusion of intestinal contents |
Treatment of Dehiscenece | Cover with NS soaked pad and notify physician |
Treatment of Eviceration | Cover with NS gauze and prepare them for emergency surgery! (NPO, call surgeon, etc) |
When is dehiscenence and Evisceration likely? | in elderly, obese, malnourished, on steroids, and later in post-op period (days 5-10) |
What should you teach patient to do to prevent dehiscence and evisceration? | When you cough/laugh hold a pillow over the site to stabilize/brace it |
Manifestations of Ischemic Stroke | *headache
*mental changes
*aphasia
*respiration issues
*reduced cough/swallow reflex
*agnosia
*incontinence
*seizures
*hemiparesis/hemiplagia
*emotional liability
*Horner's syndrome
*visual changes
*hypertension
*vomiting
*Apraxia |
Treatments of Ischemic Stroke | Thrombolytic therapy (recombinant tissue plasminogen activator)
Lorazepam/antiepileptics
Calcium channel blockers
stool softeners
analgesics
antianxiety drugs
Surgery (angioplasty with stenting, endarterectomy, extracranial-intracranial bypass) |
Interventions of Ischemic Stroke | *Neural assessment/vitals q 1-2 hrs
*Monitor ICP
*emotional support
*improve mobility
*communication/swallowing
*ECG & cardiac enzymes
*serum electrolyte (na+)
*I&O
*HOB >30 degrees
*aspiration/bleeding precautions
*frequent repositioning |
Labs/Diagnostics of Ischemic Stroke | *CT scan
*MRI
*Dopplar Ultrasound of cartoid arteries
*cerebral angiography
*echocardiography (TEE and TTE)
*Hypercoagubility (lupus anticoagulant, anticardiolipin antibodies, protein C activity, protein S activity, and factor V Leiden mutation) |
Teaching about Ischemic Stroke | how to be involved in care/what diagnosis means
What to look for/when to activate EMS
patient-specific/family risks for stroke
Smoking cessation
Medications for secondary prevention of stroke (reduce BP/hypercholestrolemia, prevent blood clotting) |
Simple Partial Seizure manifestations | Consciousness not impaired, labored speech/inability to speak, symptoms are subjective and vary greatly. This can lead to generalized seizure |
Complex partial seizure manifestations | Always a loss of consciousness, lip smacking and drooling, chewing, precipitated by aura during which patient is unaware of environment and can't respond to stimuli |
Absence Seizure | brief loss of consciousness that lasts 5-10 seconds, minimal to no alteration of muscle tone, no recall of incident |
Myoclonic Seizure | No postictal phase, brief contraction of muscle, one side of the body or can be both sides |
Tonic-clonic seizure | rigidity, rhythmic jerking of extremities, incontinent of urine/stool, lasts 1-2 minutes, postictal phase lasts several hours |
Atonic Seizures | head drop to severe fall to the ground with brief loss of consciousness, may require a helmet (high risk for falling/injury) |
Treatments of Seizures | *give medications consistently to maintain therapeutic levels
*Keppra or Klonopin for prevention
*DON'T administer warfarin with phenytoin
*Vagal nerve stimulation
*anterior lobe resection
*partial corpus callostomy |
Interventions of Seizures | *Seizure precautions (airway, oxygen mask, suction equipment, IV access, side rails up and padded, get rid of clutter)
*LEFT side during & after seizure
*Check for patient airway
*Calm/Dark environment
*Patient safety highest priority!
*Low carb diet |
What are the interventions for status epilepticus? | Airway, breathing, circulation. ABGs monitored. Give benzos first |
Diagostics/Labs for seizures | *CT
*MRI
*Electroencephalogram (EEG)
*sleep test
*CBC
*BMP (infection)
*Cortisol (stress levels could cause it) |
Teaching for Seizures | Social service resources for medication
evaluation of employee safety
Vocational rehabilitation may be subsidized
Can't drive until 6 month after last seizure & physician & driving department both have to clear you
medication management
medical alert |
Relapsing-remitting Multiple Sclerosis | new symptoms appear and old ones worsen/relapse |
Secondary progressive Multiple Sclerosis | initially relapsing-remitting, now has gradual worsening of the disease |
Progressive relapsing Multiple sclerosis | progressive with gradual onset of symptoms from the onset, relapses may or may not recover |
Primary progressive Multiple Sclerosis | gradual progression with no remissions, may have temporary plateaus |
Manifestations of Multiple Sclerosis | *Blurred vision (diplopia)
*numbness or weakness in one or more limbs
*tingling or pain
*electric shock with head movement
*dizziness
*muscle tremors/spasticity
*lack of coordination
*unsteady gait
*fatigue |
Treatment of Multiple Sclerosis | *NO CURE; manage symptoms
*NSAIDs
*steroids
*opioids
*stool softeners
*Gabapentin (nerve pain)
*bronchodialators
*neurotin (nerve pain)
*physical therapy (water therapy)
*manage anxiety |
Interventions of Multiple Sclerosis | rest periods
balance exercise/rest/nutrition
provide easy to swallow food
free clutter
family support
facilitate communication
Assess neuromuscular function
Assess vision/eye movement
assess skin integrity
assess ADLs/bowel/bladder
walker/cane |
Labs/diagnostics of Multiple Sclerosis | *Diagnosis of exclusion
*repeated MRIs looking for lesions
*CSF analysis
*Genetics/Hx
*nerve conduction studies |
Teaching about Multiple Sclerosis | *Avoid stress
*avoid overheating
*medication adherence
*promote independence
*S/S of exacerbation
*disease process and prognosis |
Cardinal Symptoms of Parkinson's Disease | *bradykinesia
*resting tremors
*rigidity
*postural instablility |
Manifestations of Parkinson's Disease | *stooping posture
*slow, shuffling gait
*pill rolling
*dysphagia
*drooling
*depression
*mask-like face
*hypophonia
*rapid mood swings |
Treatment of Parkinson's Disease | *Drug therapy (anticholinergics, dopamine-receptor agonists, dopamine precursors)
*Thalamotomy (surgery)
*Drug holidays for patients on long term drug therapy when drug tolerance is reached
*Deep brain stimulation |
Interventions of Parkinson's Disease | *Fall precautions
*Consults with PT/OT, speech, psychosocial, dietary
*allow extra time for interventions
*bowel/bladder regimen
*assessment q 4 hrs (prn for anxiety/depression/sleepiness)
*monitor for pressure ulcers |
Labs/Diagnostics of Parkinson's Disease | *No specific diagnostics; we try to rule out other things
*progressive decline in motor ability
*2 or more cardinal symptoms in abscence of other causes
CT/MRI
PT/OT assessments
CSF for dopamine levels
PTET or SPECT scans (due to other health probs) |
Teaching about Parkinson's Disease | *Family support/coping
*keep room/house free of clutter
*focus on patient's strengths
*exercises to strengthen muscles
*teach to use cane or walker if needed
*facilitate independence
*restrict caffeine |
Manefestations of BPH | *difficulty starting flow of urine
*weak stream
*dribbling/interruptions during urination
*bed-wetting
*bladder infection/stones
*increased pressure in kidney
*incontinence
*feeling that bladder not emptied
*urinary retention |
Treatments/interventions of BPH | *watchful waiting
*Meds: 5 aplpha reductase inhibitors and alpha-adrenergic blockers
*Herbal: Saw Palmetto, African Plumb, Cernilton, South African star grass
*Surgeries |
Surgeries to treat BPH | *Transurethral Resection of Prostate (TURP)
*Continuous Bladder irrigation
*Prosectomy
*Laser surgery
*Transurethral Needle Ablation (TUNA)
*Prostatic stents
*Water-induced Thermotherapy and transurethral Ethanol Ablation |
Labs/Diagnosis of BPH | *Digital rectal examination
*prostate-specific antigen (PSA) level |
Teaching about BPH | *Avoid excess fluids in the evening
*avoid tranquilzers and over-the-counter meds that contain decongestants
*explain "watchful waiting"
*drug therapy education
*importance of follow-up
*care of surgical/invasive treatment sites |
Manifestations of Colorectal Cancer | *unexplained weight loss
*change in bowel habits
*rectal bleeding/blood in stools
*persistant abdominal discomfort
*feeling bowel doesn't empty completely
*weakness
*bowel obstruction |
Treatments/Interventions of Colorectal Cancer | *chemotherapy
*radiation therapy
*colectomy/hemicoloectomy
*abdominoperineal resection
*Colostomy
*Screening |
Labs/Diagnostics of Colorectal Cancer | *EARLY DETECTION IS KEY
*Colonoscopy (gold standard)/virtual colonoscopy
*Biopsies taken/polyps removed
*Fecal occult blood test
*Lower GI series
*Double-contrast barium enema
*Sigmoidoscopy
*Fecal DNA testing
*Wireless capsule endoscopy |
Teaching about Colorectal Cancer | Lifestyle factors/risk factors that contribute to risk of colorectal cancer
preoperative teaching r/t ostomy care
Bowel prep
Pain/pain management
prevent post-op complications |
Lifestyle factors that contribute to risk of colorectal cancer | lack of regular exercise, low fruit/vegetable intake, low fiber/high fat diet, being overweight, alcohol consumption, and tobacco use |
Other risks that contribute to risk of colorectal cancer | Personal/family history of colorectal cancer, adenomatous polyps (also a family history of them), inflammatory bowel disease (IBD) for 10 years or more. |
Manifestations of Prostate Cancer | *May not have any symptoms at first
*trouble urinating
*weak stream of urine
*hesitancy
*sensation of incomplete emptying of the bladder
*frequency
*urgency
*urge incontinence
*urinary tract infection |
Treatment/Interventions of Prostate Cancer | *Radiation & Brachytherapy (radioactive seeds/pellets placed in prostate)
*Cryotherapy
*ablative hormone therapy
*Radial prostatectomy |
Diagnostics/Labs of Prostate Cancer | *Prostate Specific Antigen (PSA) test for detection of early prostate cancer
*Digital Rectal Examinations
*Prostatic Biopsy |
Teaching about Prostate Cancer | Education of disease
brachytherapy (absence of sex for 2 weeks after start & use condom)
chemotherapy/radiation
Signs of infection
Prevention: increased foods with selenium
Risk: consumption of calcium/ingestion of greater than 7 multivitamins/week |
Manifestations of Urolithiasis | *Severe pain (colicky pain with nausea and vomiting)
*Bladder distention
* obstruction of urine flow
*hematuria |
Treatments/Interventions of Urolithiasis | Ureteroscopy
percutaneous nephrolithotomy
extracorporeal shock wave lithotripsy
opioids
Antiemetics
Alpha-adrenergic blockers
Strain urine&stone to lab
surgery if causing obstruction/uncontrolled pain
IV fluids
<5mm pass naturally, >10mm=surgery |
Labs/Diagnostics of Urolithiasis | *Noncontrast CT scan (diagnostic of choice)
*Kidney Ureter bladder (KUB) x ray
*Ultrasound (in children and pregnant females because you don’t want to expose them to too much radiation) |
Teaching about Urolithiasis | *Increase fluids to 3L/day
*Diet: limit sodium, increase intake of citrate, avoid foods high in oxalate
*strain urine
*call provider for fever or chills
*Avoid fluids that could cause dehydration |
Manifestations of IBD | persistent diarrhea, abdominal pain or cramps, fever, weight loss, fluid imbalances, malnutrition, mouth ulcers, anemia, blood from rectum, joint/skin/eye irritation, and delayed growth |
Manifestations of Crohn's | RLQ pain, strictures and adhesions are common, can lead to fistula/abcess/peritonitis (large and small intestine); short bowel syndrome. Happens in "patches" in bowel. |
Manifestations of Ulcerative Colitis | large intestine; diarrhea 15 or more/day; blood mucus and pus, LLQ pain; teresmus (bowel urgency) |
Treatment/Intervention of IBD | *rest bowel and control inflammation
*F&E regulation
*medications, surgery, correction of nutritional deficit and psychosocial needs
*aminosalicylates (sulfasalazine)
* immunomodulators (inflizimab, adalimumab)
* steroids |
Manifestations of IBD | *Uveitis, scleosing cholangitis, nephrolithiasis, cholelithiasis, joint disorders, skin disorders, and oral ulcerations
*Malnutrition is very common |
Complications of Crohn's | fistulas and bowel obstruction |
Labs/Diagnosis of IBD | colonoscopy |
Does Crohn's or Ulcerative Colitis have worse diarrhea? | Ulcerative Colitis (15 or more a day) |
Teaching about IBD | *avoid crowds
*get a TB test every year
*importance of regular follow-ups and colonoscopy
*medication teaching
*importance of adequate nutrition |
Obesity Comorbidities | diabetes, hypertension, hyperlipidemia, cardiac disease |
Class 1 BMI | 30.0-34.9 |
Class 2 BMI | 35.0-39.9 |
Extreme BMI | greater than 40 |
Treatment/Interventions of Obesity | *Weight loss therapy
*diet therapy
*increased physical activity
*behavior therapy
*bariatric surgery: restrictive procedure, malabsorptive procedure, combination procedure
*Orlistat
*lorcaserin
*phentermine topiramate |
Labs/Diagnostics of Obesity | *BMI
*ECG if they are at risk for cardiac disease
*overnight sleep test if they have apnea
*RUQ ultrasound to identify fatty liver disease
*transvaginal ultrasonography for ovarian cysts |
Teaching about Obesity | *diet teaching
*post op teaching
*medications side effects
*wound care
*S/S to report (SOB, tachycardia, severe abd pain, s/s of infection, rigors)
*dumping syndrome
*Available support groups |
S/S of Dumping Syndrome | nausea, vomiting, diarrhea, diaphoresis, tachycardia, salivation, fatigue, dizziness |
Manifestations of Apendicitis | *peritonitis and gangrene (life-threatening) firm, ridged, board-like abdomen
*abrupt change in pain, BP, HR
*highest occurrence in 10-19 year olds; affects males more than females
*McBurney’s point |
McBurney's Point | where someone has pain with appendicitis during the later stages; it’s a hallmark sign |
Treatments/Interventions of Apendicitis | *appendectomy
*no management for acute
*temp & HR, intake & output post surgery, pain, rebound tenderness, WBC/differential
*position supine w/ HOB at 30-40 degress
*comfort measures
*provide ice to right lower quadrant post surgery |
Labs/Diagnostics of Apendicitis | *Diagnosis by CT scan (gold standard)
*WBC > or = 20,000 indicates perforation
*ultrasound |
Teaching about Apendicitis | *avoid the use of laxatives and enemas
*take full course of antibiotics
*teach wound care
*turn, cough, deep breathe and use of incentive spirometer 10 times every hour
*encourage early ambulation |
Manifestations of Diverticulitis | *perforation (complication)
*abd pain over area
*fever/leukocytosis
*a mass @ involved area
*increased flatus, anorexia, abdominal bloating &distention, diarrhea/constipation
*stools w/mucus and blood
*bleeding near vessels |
Treatment/Interventions of Diverticulitis | *broad spectrum antibiotics for uncomplicated diverticulitis
*pain medications prn
*IV antibiotics, bowel rest, IV fluids, check CBC
*monitor vitals, serum potassium (may be low), pain and mental status
*NG suction/provide oral care
*Low fiber diet |
Labs/Diagnostics of Diverticulitis | *plain flat-plate abdominal x-rays and a CT scan
*WBC monitored for elevations initially related to inflammation and possible infection |
Teaching about Diverticulitis | *avoid laxatives and enemas
*increasing fiber from new fruits and veggies in diet
*avoid straining, bending, and lifting
*weight reduction
*complete antibiotic therapy as prescribed |
Manifestations of Peptic Ulcer Disease | *PAIN is most common
*duodenal ulcers and gastric ulcers
*remissions and exacerbations |
Which type of Peptic Ulcer is aggravated by fasting and improved with food and antacids? | Duodenal Ulcer |
Which type of Peptic Ulcer is worsened with eating and there is no relief from antacids? | Gastric Ulcer |
Treatment/Interventions of Peptic Ulcer Disease | *pain relief, ulcer healing, prevent recurrence, and reduction of complications
*antibiotics and PPI for H. pylori
*acid suppression (antacids and H2 receptor agonist)
*surgical interventions w/ nonhealing and bleeding ulcers |
Lab/Diagnostics of Peptic Ulcer Disease | *serum antibody testing
*urease breath testing
*stool antigen testing
*CBC to rule out ulcer perforation/peritonitis (increased WBC)/anemia (low hematocrit)
*diagnosed during upper endoscopy, lab and radiological testing |
Teaching about Peptic Ulcer Disease | *advise to avoid aspirin/NSAIDs, spicy foods, and beverages with caffeine
*take meds as prescribed
*avoiding eating within two hours of bedtime |