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| Inject appropriate amount of air into slow acting insulin first (NPH, Novolin N, etc.) à this is your Cloudy insulin. Inject air into regular insulin, this is the fast acting insulin, and draw up appropriate amount of R insulin à this is your Clear insulin Then draw up the slower acting insulin last. CLEAR to CLOUDAY, slower acting insulin closer to the needle…faster acting insulin is closer to the plunger. NOTE: R (regular) is the only insulin given IV. |
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Bolus tube feedings Entire can is given at one time over 5 – 10 minutes. It is given through a syringe. Flush the line, bolus, and flush the line. |
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| Gastrointestinal Tubes- Nasogastric tube- Levin tube - Salem Sump Tube – bigger, allows atmospheric air in to prevent reflux – suction goes to the wall; used after surgery to pull air off abdomen; can connect to tube feedings |
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| Intestinal Tubes- Duotube – goes to duodenum; mercury weight on end to pull it to intestines; used to rest belly; must confirm by x-ray; used for feedings- Miller Abbott – double lumen; one tubes get mercury for weight; other lumen used for suction; used for small bowel obstructions- Cantor tube – put in by surgeon; single lumen with balloon on the end; mercury is injected for weight; used for suction - Dennis tube – triple lumen; one for suctioning, one for mercury weight, and one for irrigation and venting Intestinal tubes MUST have a X-ray are used for suctioning |
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3a. Values and Functions of Sodium |
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Definition
Na:135-145 mEq/l, principal cation in ECF responsible for fluid volume imbalance regulate fluid volume, osmolarity, conduction of neuromuscular impulses, atract fluids, combine w/Cl+HCO3 regulate acid base. increase Na=> increase thirst=> ADH=>H2O increase decrease Na=>decrease thrirst=> decrease ADH=> H2O HypoNatremia=>neurologic problems, seizure, coma, ALOC restrict K, bcz if Na low=>K high HyperNatremia: cerebral edema water follows sodium, kidney excrete or conserve sodium for raise or drop BP by: - stimulate renin-angitensin -aldosterone system - regulates ADH SECRETION - modulate gomerular filtration rate - control atrial natriuretic peptide release |
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3b. Values and Functions of Potasium |
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Definition
K 3.5-5.0, intracelular vital role in heart function, regulate protein, and neuromusculator fct. kidney eliminate K from body under regulation of aldosterone: increase H2O+Na=>decrease K hypoK: -bcz diuretics:Lasix, hyperaldosteronism, DM, GI tract(vomiting, gastric suction, diarrhea, ileostomy drainage), wach bcz potentiate digitalis toxicity - not K intake, alcoholism - kidney dialysis, NG tube monitor K - NEVER GIVE K IV PUSH ONLY IV INFUSION - if give Kayexelate make pup=> K loose in stool HyperK: - renal failure, adrenal insuficiency, salt substitues, meds impair K excretion, ACIDOSIS, tissue trauma SS: decrease HR, diarrhea, colic pain, tremor, paralysis |
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3c. Values and Functions of Calcium |
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Definition
Ca 9-11 mEq/l found in the bones, from diet, regulate muscle contraction, relaxation, respiratory muscle, enzyme activation, maintain cardiac fct, act in bl clotting, Ca increase => Ph decrease HypoCa: Lasix, Phenytoin, Dilantin, tranfusion bl=>Ca loss Tetany, pos Chvostek's sign(face spasm)+ trousseau's sign(carpal spasm), SS:bradycardia, cardiac arrest HyperCa: bcz hyperparathyroidism, cancers, imobility, thiazide diurectics, lithium SS: neuro irritability, weakness, confusion, anorexia, polyuria, thirst incr. |
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3d. Values and Functions of Clorium |
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Cl 95-108 mEq/l, anion, combine w/salts like Na+K, maintain balance btw ECF+ICF, control osmotic pressure, maintain acid base balance, e-lytes, enzyme activator, combine+H=>acid gastric, assist in liver clearing waste, found in sweat. |
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4. AP chest diameter related to respiratory disruptions (acid-base imbalance) |
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5. Acidosis and patients at risk |
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starvation, malnutrition, chronic diarrhea, renal failure,heperthyroidism, trauma, shock, infections, exercise, fever DKA |
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6/7. 2 Interpret ABG (know if partially and fully compensated |
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8/9. 2 After interpretation you must pick treatment |
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10. COPD and acid-base imbalance |
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| Most important concern is teratogenic effects. Pregnancy test is required before therapy and strict birth control measures must be used during therapy. There must be two forms of birth control. Other side effects include: elevated liver function test results; dry, chapped skin; and depression in some clients. |
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| if you have green, yellow, bumps, blisters, or some other weird thing it is probably a STD |
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13. Laboratory data cirrhosis |
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| Diagnostic tests for cirrhosis include elevations in liver enzymes, decreased total protein, fat metabolism abnormalities, and liver biopsy |
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| N dx: Impaired urinary eliminationNot sure what to put here refer to power point slides page 254 |
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| functional unit of kidney |
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| Preventive measures for UTI:Emptying the bladder regularly and completelyEvacuating the bowel regularlyWiping perinea area from front to back after urination and defecationDrinking adequate amounts of fluid each day |
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| Creatinine-best indicator of renal failure |
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| dietary management of dumping syndrome includes a high fat, low carb high protein diet Zantac decreases secretion of gastric acid Explain the rationale for a high-protein, low-fat dietEncourage the patient to eat small, frequent meals to prevent gastric distentionExplain the rationale for avoiding alcohol, smoking (causes an almost immediate, marked decrease in LES pressure), and beverages that contain caffeineTeach the patient not to lie down for 2 to 3 hours after eating, wear tight clothing around the waist, or bend over (especially after eating).Avoid eating within 3 hours of bed timeEncourage the patient to sleep with head of bed elevated on 4 to 6 inch blocks (gravity fosters esophageal emptying).Teach information regarding drugs, including rationale for their use and common side effectsDiscuss strategies for weight reduction if appropriate.Encourage patient and family to share concerns about lifestyle changes and living with a chronic problem Lifestyle modificationsTeach to avoid factors that aggravate symptomsParticular attention is given to diet and drugs that may affect the LES, acid secretion, or gastric emptyingPatients who smoke are encouraged to stop. Cigarette smoking has been associated with decreased acid clearance from the lower esophagus Nutritional therapyNo specific diet is necessary, but foods that cause reflux should be avoided. High fatty foods such as chocolate, peppermint, coffee, and tea should be avoided because they predispose to reflux. Milk products should be avoided, especially at bedtime, because milk increases gastric acid secretion. Small frequent meals are advised to prevent over distention of the stomach. The patient should avoid late evening meals and nocturnal snacking. Fluids should be taken between rather than with meals to reduce gastric distention. Certain foods may irritate the acid-sensitive esophagus and may need to be avoided. To reduce intraabdominal pressure, weight reduction is recommended if the patient is over weight |
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21. Nursing Diagnosis peptic ulcer |
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| S/S of gastric ulcer is pain in upper epigastrium, to the left of the midline. Peptic ulcer disease read pg 1014-1026PUD: is a mucosal lesion of the stomach or duodenum as a result of gastric mucosal defenses impaired and no longer able to protect the epithelium from the effects of acid and pepsin. Acid and pepsin and helicobacter pylori infection play an important role in the development of gastric ulcers Complications of ulcers: Hemorrhage- hematemesisPeforation- a surgical emergencyPyloric obstruction- manifested by vomiting caused by stasis and gastric dilation Intractable disease- the client no longer responds to conservative management or recurrences of symptoms interferes with ADL’s Clinical manifestations: Epigastria tenderness usually occurs at the midline between the umbilicus and the xiphoid processDyspepsiaDescribed as sharp, burning or gnawing painSensation of abdominal pressure or of fullness or hunger Ulcer drug regimen itself promotes relief of pain by eradicating H. pylori infection and promoting healing of the gastric mucosa Drug therapy: goals of drug therapy: Provide pain relief, eradicate H. pylori infection, heal ulceration, prevent recurrence See power points for types of drug therapy page 203-205 |
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| · The most common disorder of the biliary system is cholelithiasis (stones in the gallbladder). Cholecystitis (inflammation of the gallbladder) is usually associated with cholelithiasis. |
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| Emphysema is an abnormal permanent enlargement of the airspaces distal to the terminal bronchioles, accompanied by destruction of their walls and without obvious fibrosis. A diagnosis of COPD should be considered in any patient who has symptoms of cough, sputum production, or dyspnea, and/or a history of exposure of risk factors for the disease. An intermittent cough, which is the earliest symptom, usually occurs in the morning with the expectoration of small amounts of sticky mucus resulting from bouts of coughing. |
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| · Acute pharyngitis:o Is an acute inflammation of the pharyngeal walls that may include the tonsils, palate, and uvula.o The goals of nursing management for acute pharyngitis are infection control, symptomatic relief, and prevention of secondary complications. |
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28. Influenza-high risk groups |
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29. pneumonia and pneumococcal vaccine |
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34. Female Reproductive-general |
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| factors for aphthous stomatitis is woman in the luteal phase of the menstrual cycle |
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38. Ischemia/Injury/Infarct |
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39/40/41. 3 ID, Diagnostics and treatments of anemias |
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47. conductive versus sensineural hearing loss |
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48. primary open-angle glaucoma |
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50. Oxygen saturation values –pulse ox versus ABGs |
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101 Important information from your readings (You may see on your final exam) |
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| -functional unit of kidney is the nephron-risk factors for aphthous stomatitis is woman in the luteal phase of the menstrual cycle-dietary management of dumping syndrome includes a high fat, low carb high protein diet-Complication of Bilroth II is afferent loop syndrome-Zollinger-Ellison syndrome is an autosomal dominant disorder-Oral cancer can appear as a red, velvety patch on the buccal mucosa-Zantac decreases secretion of gastric acid-Pepcid inhibits development of stress ulcers-Foods high in uric acid—organ meats, cheese and wine-S/S of gastric ulcer is pain in upper epigastrium, to the left of the midline. |
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