Final Exam

 DIABETES
o from- heart disease, stroke, hypertension
o insulin
 produced by b cells
o normal glucose- 70-120
o glucagon
 produced by a cells
 increases blood glucose
o type 1
 insulin is absent or minimal
 wt loss, polydipsia (thirsty), polyuria (lot of urine), polyphagia (eat a lot)
o type 2
 insulin production is decreased or tissues are resistant
o metabolic syndrome
 3 out of 5 things
 elevated glucose levels, abdominal obesity, hypertension, high
triglyceride levels, low HDL
o two-hour OGTT: >200
o Hgb A1C: >6.5
o fasting glucose: >126
o random glucose test: >200
o common complications of DM
 retinopathy
 nephropathy
 neuropathy
 cardiac involvement
o hyperglycemia
 blood sugar over 120
 wt loss, polyuria, polydipsia, polyphagia, fatigue, infection, prolonged
wound healing, visual changes
o hypoglycemia
 blood sugar under 70
 shaky, diaphoretic, confused, pallor, cool,
 treatment: 15g simple carb recheck in 15 mins
o DKA
 hyperglycemia, ketosis, acidosis, dehydration
  S over 250, PH under 7.30, HCO3 under 16, kussmaul breathing,
sweet fruity breath, tachycardia, hypotension, low Na Cl Mg and
phosphate, moderate to large amount of ketones
o treatment: HI..E (hydration, Iv insulin, electrolyte
management)
o HHS
 hyperglycemia, dehydration
 BS over 600, increased osmolality, resemble stroke, K Na Phos
changes, absent of minimal ketones, hypovolemic
o treatment Hi…E (hydration, iv insulin, electrolyte
management)
o oral meds
 biguanides
 metformin: decrease hepatic glucose production, increase glucose
uptake, withhold 48 pre and post iv contrast
 sulfonylureas
 Amaryl: increase insulin production from pancreas
o injection insulin
 Rapid: lispro
 onset: 5-15 min
 peak: 30-90 min
 duration: 3-5 hour
 short: regular
 onset: 30-60 min
 peak: 2-3 hour
 duration: 5-8 hour
 intermediate: NPH
 onset: 2-4 hour
 peak: 4-10 hour
 duration: 10-16 hour
 long: Lantus
 onset: 2-4 hour
 peak: none
 duration: 24+ hours
o complications:
 local reactions
 lipodystrophy
  dawn phenomenon
 BS high in the morning: need more insulin
 somogyi’s
 BS high in the morning, 2-4 am Bs is low: give a snack at night
 THYROID
o TSH: most common lab to test
 high: hypothyroid
 low: hyperthyroid
o RAIU: to test for graves disease
o hyperthyroid
 large goiter (air way obstruction)
 Tiger
 HTN, tachycardia, palpations, wt. loss, diarrhea, hot, nervous,
exophthalmos
 graves disease
 may cause total destruction of thyroid
 causes:
o lack of iodine, infection, stress, smoking
 thyroid storm
 tachycardia, heart failure, shock, hyperthermia, delirium
 treatment:
 antithyroid drug (tapazole)
 beta blockers (lower bp and pulse)
 iodine (inhibits T3 and T4)
 surgical
 5000-6000 calorie intake
o hypothyroid
 caused by destruction of thyroid or caused by pituitary gland
 Eeyore
 decrease body metabolism, bradycardia, cold, wt. gain,
constipation, lethargy, forgetfulness, coarse dry hair
 decreased cardiac output, SOB, anemia, myxedema
 myxedema coma
 hypoventilation, hyponatremia, hypoglycemia, lactic acidosis
 Synthroid, low calorie diet
 FLUID AND ELECTROLYTES
o fluid spacing
 first: homeostasis
  second: abnormal interstitial fluid: edema
 third: fluid accumulates portion of body: stomach and lungs
o osmolarity
 determined by Na and glucose in body
 normal plasma: 275-295
 >295: water deficit
 <275: water excess
o fluid volume deficit
 vein to interstitial: decrease in intravascular
 wt. loss, poor turgor, < 30 mL output, flat neck veins, increased BUN and
Na, weak rapid pulse, postural hypotension
o fluid volume excess
 interstitial to vein: increase in fluid in the intravascular
 wt. gain, edema, polyuria, JVD, decreased BUN and Na, full bounding
pulse, hypertension
o sodium
 normal: 135-145
 transmission of nerve impulses, muscle contractility,
 hypernatremia
 over 145
 thirst, lethargic, agitation, seizures, coma
 treatment: isotonic or hypotonic, limit Na
 hyponatremia
 under 135
 confusion, irritability, headache, seizures, coma
 treatment: hypertonic, limit fluids, block ADH
o potassium
 normal 3.5-5
 muscle contraction, transmission ion nerve impulses, regulation of
heartbeat
 hyperkalemia
 over 5
 leg cramping, weak muscles, abdominal cramping, diarrhea,
dysrhythmias
 peak T, flat P and wide QRS
 K sparing drugs, beta blockers, ACE inhibitor may cause
 hypokalemia
 under 3.5
  muscle weakness, decreased GI, hyperglycemia, dysrhythmias
 flat T, peak P and UA present
o calcium
 normal: 8.5-10-.5
 formation of teeth and bones, blood clotting, transmission of nerve
impulses, myocardial contractions, muscle contractions
 milk, yogurt, broccoli, sardines
 hypercalcemia
 over 10.5
 moans, groans, bones and stones
 treatment: isotonic, bisphosphates, fluids 3-4L
 hypocalcemia
 under 8.5
 positive trousseaus sign (BP pronation), positive Chvostek’s sign
(mandible- smile), laryngeal stridor, dysphagia, tingling,
dysrhythmias
 treatment: rebreathe in paper bag
o phosphate
 normal: 2.5-4.5
 maintain bones and teeth, neuromuscular cation, CHO metabolism
 hyperphosphatemia
 over 4.5
 NM irritability, tetany, calcifications
 chemo, overuse of fleets enema, renal failure
 hypophosphatemia
 under 2.5
 CNS depression, muscle weakness, dysrhythmias
o magnesium
 normal 1.5-2.5
 metabolism of PRO and CHO, nucleic acid and protein synthesis, maintain
Ca and K balance, need for Na-K pump
 hypermagnesemia
 over 2.5
 lethargic, N/V, impaired reflexes, somnolence, respiratory failure,
cardiac arrest
 no MOM
 hypomagnesemia
  under 1.5
 hyperactive DTR’s, muscle cramps, seizures, dysrhythmias
o chloride
 normal: 95-108
 enzyme-activator, forms hydrochloric acid
o bicarbonate
 normal: 22-26
o isotonic
 cell stays the same
 for: surgery, dehydration, vomiting, diarrhea
 Ex: 0.9% NS, LR
 SE: watch renal and HF pts.
o hypotonic
 cell get bigger (ECF to ICF)
 for: DKA, diabetes, dehydration, high Na
 Ex: ½ NS, 1/3 NS
 SE: hypovolemia, decrease BP, increase HR
 no burns, trauma or ICP pts.
o hypertonic
 cell gets smaller (ICF to ECF)
 for high Na, cerebral edema
 Ex: 3% NS, D10, D50 and D51
 SE; fluid overload, pulm edema
o Lasix after transfusion and between transfusions
 HYPERTENSION
o drop of blood
 SVC, R atrium, tricuspid, R ventricle, pulm artery, lungs, pulm vein, L
atrium, mitral, L ventricle, aorta, system
o sympathetic nervous system
 increase HR, BP, contractility, conduction of AV nodes, causes
vasoconstriction
o parasympathetic nervous system
 decrease BP, HR, conduction of AV nodes
o BP
 systolic: peak pressure
 diastolic: residual pressure
 arterial: pressure against walls of arterial system
 normal: 120/80
  prehypertension: 120-139/80-89
 HTN 1: 140-159/90-99
 HTN 2: 160 and up/100 and up
o crisis: 180 and up/ 110 and up
o regulation of BP
 sympathetic nervous system, vascular endothelium, prostaglandins,
endocrine, RAAS
o RAAS
 lowers BP or Na
 liver (releases angiotensinogen), kidney (release renin)= angiotensin 1 ,
lungs (release ACE)= angiotensin 2, adrenal gland, aldosterone= high Na,
high BP, lower K
o patho of HTN
 increased Na intake= water retention
 high renin activity= vasoconstriction
 increased SNS activity= vasoconstriction
 hyperinsulinemia= stimulates SNS, impairs vasodilation
 endothelium dysfunction= reduced vasodilation, prolonged
vasoconstriction
o medications
 check BP and pulse before giving
 diuretics: inhibit NaCl reabsorption, Lasix, watch Vit K
 adrenergic blockers: reduce SNS, vasodilate, catapress
 alpha blocker: peripheral vasodilation, Cardura and Minipress,
 beta blocker: decrease CO, blocks vasoconstriction, decreases renin, end
in olol
 SE: orthostatic hypotension, bronchospasm
 vasodilator, vasodilate, nitro press
 ACE inhibitor, prevent vasoconstriction, end in pril
 change position slowly, cough if so take ARB
 ARB, prevent vasoconstriction, end in sartan
 CCB, vasodilate, Procardia, Norvasc
o hypertensive crisis
 hypertensive encephalopathy, HF, pulmonary edema, renal insufficiency,
diaphoresis
 CAD
o atherosclerosis- fatty deposits within the artery
o collateral circulation- tiny blood vessels around occlusion
 o medications
 statins
 inhibit cholesterol, decreases LDL, increase HDL
 joint pain take off drug
 monitor liver damage and myopathy (rhabdomyolsis) LFT every 6
months
 niacin
 lower LDL and triglycerides increases HDL
 SE: flushing, pruritis, GI side effects, orthostatic hypotension
 fibric acid derivatives
 decreases triglycerides, increase HDL
 SE: GI upset
 bile acid sequestrants
 increase conversion of cholesterol to bile acid
 SE: GI upset and bind with other drugs (warfarin, thyroid
hormones, beta blockers)
 Zetia
 decrease absorption of dietary and biliary cholesterol
 antiplatelet
 ASA, Plavix
 check platelets
 CHRONIC STABLE ANGINA
o chest pain, occurs intermittently over time, same pattern and place, lasts 5-15
min
o Prinzmetals: relived by exercise
o microvascular: brought on by exercise
o medication
 short-acting nitrates
 decrease systemic SVR, increase preload, decrease o2 demand
 sit feet flat when taking
 1 pill every 5 mins then after 3 call 911
 ACE
