Type 1 diabetes

Born with or get as child

Type 2 diabetes

adult onset- can be caused by obesity

Lancet

Poky/sharp device

Automatic lancing device

Device to poke finger

To get good blood flow in finger

-Milk finger

-hold finger in warm water

-hold arm to side

Place used lancet in:

Sharps container

common times/frequency for blood glucose

B-4 all meals and just b-4 bed

Fasting blood sugar level means:

after 8 hours of fasting

normal

Fasting blood sugar in non-diabetic

70-110 mg/dl

Normal fasting blood sugar for a diabetic

Higher than 110 mg/dl & less than 126 mg/dl

What is pulse ox

- uses light beam to measure O2 of arterial blood

SaO2

Saturation of oxygen

Before pulse ox know:

-hemoglobin levels

-measures only % of O2 carried by available hemoglobin

Spring tension sensor

-device attached to earlobe/finger tip

-connected to moniter

-measures O2

Norms of pulse ox

-95% to 100%

- Less than 85% need to report- have take deep breaths

Kinds of Vital Signs

(6)

1. BP
2. TPR(3)
3. Pulse ox
4. Pain

Most facilities check temp.:

Once a shift

Oral Temp. Norm.

98.6°F - 37°C

Axillary temp. Norm.

97.6°F and 36.5°C

Tympanic Temp. Norms

99.2°F to 37.3°C

Thermoregulation

Balance of heat production/loss controlled by :Hypothalamus

Core temp.

-Temp in deep tissue of the body

-remains constant unless exposed to extreme envir.

-Rectal/tempanic routes used for this

Surface Temp.

- Temp of skin

-May very in response to enviro.

-Use Oral/axillary route for this

Hypothalamus Decreases temp. by

-Vasodialation

-sweating

Hypothalamus increases temp by

-shivering-->releases epinephrin-->increases metabolism & vasoconstriction-->eventually causes frostibite

Circadian Rythems

      -Fluctuation in temp

  -Lowest-1am-4am

-Peak-4pm-6pm

Afebrile

Normal body temperature

S&S associated with ↑ Body temp.

• Increased: pulse, resp., persperation, thirst
• Irratability/restlessness
• Headache
• Hot/dry/flushed skin
• anorexia
• Disorientation

Oliguria

Decrease urinary output

Dangers of elevated temp.

-Dehydration

-oliguria

-tachycardia

Nursing actions for Fever reduction

• Why has
• vital signs q. 2 hrs.
• Adm. meds as ordered(anti-piaretics)
• Remove external coverings
• limit phys activity
• increase liquids
• frequent oral hygene(Cool sponge baths)
• cooling blankets/icepacks

Anti-piaretics

• Asprin, tylanol
• will reduce temp of 102°F (Not over)

Death may occur if:

Electric Therm. covers

• Red: Rectal
• blue: oral

Tympanic temperature

• Accuracy questioned-core temp.
• Wait 10 min. if coming from outside
• Adults: pull ear up Kids: pull earlobe down
• Pinnea=outer ear

Oral Temperature

• Wait 15 min be-4/after eat,drink,smoke,chew gum

Rectal Temperature

• Most accurate-->reflects core temp.
• Not in newborns
• Not in those w/acute cardia/heart disease because of vagul nerve stimulation
• Wear gloves/lubricate

Axillary temperature

• Least accurate
• Routine for infants up to 6wks.
• make sure pit dry

Sites of pulse

1. Corotid-neck
2. Apacal-btwn.5th & 8th intercostal space
3. brachial-arm
4. radial-wrist
5. femoral-groin
6. poplateal-behind knee
7. dorsal pedius-top of foot
8. tibial ??ask rest-back of ankle

Normal pulse rate

• 60-100 bpm  80=average
• New born: 120-160bpm
• Rate varies w/age/gender/wieght/phys. condition

Arythmea

dysrhythmea

pulse defeciet

Resp. controlled by:

• Cerebral cortex-controls voluntary control
• Medulla oblongata-(resp. control center)-involuntary control

Normal amount of air inhaled each breath

Norm. amnt. of resp.

-2-20 resp./ min

-nfants/small children breath more rapidly

(???ask on this on)

External respiration

Internal respiration

Pulmonary venilation

Eupnea

Orthopnea

Cheyne stokes

• Abnormal pattern of repirations
• Alternating from apnea to deep/rapid breathing

Cardiac output

• Amnt of blood pumped per min from heart
• stroke volume(Amnt. sent out each beat) x heart rate=cardiac output

BP

• force of blood against arterial wall during cardiac contractions

Systolic pressure

• Top#
• When ventricles contract

Diastolic pressure

• Low #
• When heart rest btwn. beats

Pulse pressure

• Difference btwn systolic and diastolic pressure

Orthostatic Hypotension

• Low bp R/T weakness/dizziness/fainting
• when arise to erect postion

Peripheral resistance

• Resistance caused by arteris remaining in partial state of resistance

White coat hypertension

• Bp ↑ by going to Dr.

Bp norms.

•  110-140/ 60-90
• Optimal= Less than 120/80 (??)
• Change of 20-30 mmHg may be significant

Korotkoff sounds

Osculatory gap

-When sound between 1st and last deminshes

Assessing pain is

1. Circle of assessment
2. Intervention
3. Re-assessment

Pain is:

• All consuming reality to ptnt.
• often low priotity of nurses
• Subjective

Cutaneous pain

• Skin- paper cut/burn
• Deep as sub-q layer

Somatic pain

• Nerve damage
• muscles/tendons/ligaments/bones
• Difuse or scattered

Visceral pain

• Originates in body organs
• Exp. garding: Reflex contraction/muscle spasm of abdomin-~>defense mechanism to further trauma

referred pain

• pain in area distant to original sight

Nociceptive

• comes from pain sensors
• results from trauma/injury/surgery/inflammation

Neuropathic

• Results from injury to or an abnormal functng. of peripheral nerves or central nervous systm.
• exact cause is unknown.

Intractable pain

• resistant to therapy-cannot get rid of

Psychogenic pain

• Phys.cause cant be ID'd.
• Comes from mind
• Have both phys/phsyc. parts

S&S of Pain

• Irratable
• Depressed
• angry
• uncomfortable
• dependency
• anorexia
• hopless

Remission

-disease present w/ no symptoms

Exocerbation

 treatment actions of pain

• Distraction
• Guided imagery
• Relaxation
• Rubbing/massaging
• Heat/cold application
• TENS
• PENS
• Acupuncture
• hypnosis
• biofeedback
• acupressure
• humor

TENS

• Transcutaneous electrical nerve stimulation
• stimulats procuction of endorphins

PENS

• Percutaneous electrical stimulation
• Combines TENS w/ needles in skin

Bio feedback

• Use of machine
• monitors physciological response
• ptnt taght to regulate response by deep breathing/imagry

Acupressure

• Gentle pressure
• Relief of muscle tension
• increase circulation
• decrease pain

Non-opioid analgesic

• Mild to moderate pain(advil/tylanol)
• Side effects:
  • Gastric bleeding
  • work against anti-hypertensive drug
  • retention of Na+

Opioid Analgesic

•  used 4 moderate to sever pain
• side effects:
  • Constipation
  • Decrease resp
  • Addictive
  • 1% become dependent
  • unresponsivness

Adjuvant analgesics

• Relieves mysteriously
• Creatated for one thing but treats another

Breakthrough pain

• Brief flair up of pain
• Treated with PRN dose with opioid on top of current pain meds

Pain management post-op

Ted Hose

• Measusre ptnts leg for right size
• Inspect leg for abnormalities/circulatory changes
• elevate feet for at least 15 min be-4 applying
• keep 2.5-5 cm(1-2inch) below jnt.
• do not apply if circum. > 100 cm(25 inch)

• Teach ptnt. to :
  • alternatly flex/extend knees
  • "         " Dorsiflex/plantar felx foot
  • Rotate ankles in a complete circle

Immediate post-op care

• Begins with Admission to PACU to transfer to room

Ongoing post-op care

PACU

-Post anasthesia care unit

PACU assessment and legth of stay

• q 5-15-head 2 toe/vital signs
• Stays approx. 2 hrs.

Ineffective venitlation

• Restless
• cyanosis
• chest unequal breathing

Most common PACU emergency

• Airway obsruction
• Caused by:
  • secretions
  • toungue
  • laryngial spasm/edema

hypovalemic shock

• Most common
• Interventions:
  • Keep flat w/legs elevated 45°, cover up, keep warm, maintain airway
• Ask??S&S??

S&S of internal hemorrage

• Increasing pain/abdm. girth(?)
• echymosis around around incision
• tachy cardia
• hypotension

Atelectasis

• Incomplete expansion /colapse of  alveoli
• Signs:Dyspnea,cyanosis,rales,restlessness,aprehention,deminished breath sounds
• Interventions: Postural drainage(beating),chest tube,ambulation, pain meds