Medical-Surgical Nursing Final Flashcards - Quizlet

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Medical-Surgical Nursing Final

Terms in this set (1126)
lispro insulin (humulog) rapid acting insulin
onset of lispro insulin under 15 minutes

(humolog)
peak of lispro insulin 30 min to 1.5 hours

(humulog)
when to administer lispro 0-15 minutes prior to a meal

insulin (humulog)
regular insulin (Humulin R, short acting insulin

Novolin R)
onset of regular insulin 30 min to 60 minutes

(humulin R, Novolin R)
peak of regular insulin 2 to 3 hours

(humulin R, Novolin R)
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30 minutes before a meal

when to administer regular
insulin (humulin R, Novolin R)
lente insulin (humulin L) intermediate acting insulin
onset of lente insulin 1 to 2 hours
when to administer lente does not need to be with a meal

insulin
peak of lente insulin 4 to 12 hours
insulin glargine long acting insulin
insulin glargine cannot be mixed with other

precautions with insulin
insulins!!, the action may be affected in an
glargine (lantus)
unpredictable manner.
onset of insulin glargine 1-1.5 hours
peak of insulin glargine has no peak...lasts 24 hr
insulin vials should be stored in a refrigerator or

they can be kept at room temperature for up to
storage for insulin
28 days. cartridges and pens should be stored at
room temperature and used within 28 days..
a drug used to treat hypoglycemia. raises blood

glucagon
Medical-Surgical Nursing Finalglucose levels
side effects of glucagon n/v, hypotension, hypersensitivity, & hypokalemia
can be given SQ, IM, or IV. then as soon as the

administration of glucagon patient is awake, give the patient some
carbohydrate snack
whenever mixing insulin, the short acting

(regular/humilin R) insulin is drawn up first in order
to prevent contamination. short acting is clear
mixing insulin
insulin and intermediate acting (humilin L/lente) is
cloudy, so it is drawn up clear then cloudy. insulin
glargine cannot be mixed with any kind of insulin.
the most common oral hypoglycemic medication

for pre diabetic patients and non insulin
metformin
dependent type 2 diabetes. is not used to treat
type 1.
taken each day. administer WITH food in order to

administration of metformin prevent GI upset. also take vitamin B12 and folic
acid supplements
GI effects including anorexia, n/v, HA, abdominal

gas/pain, metallic taste, hypoglycemia,
side effects of metformin LACTIC ACIDOSIS!! (unexplained muscle aches,
fatigue, lethargy and hyperventilation)
*ok for pregnancy
needs to be stopped 48 hours before any type of

radiographic test with iodinated contrast dye and
can't be resumed until 48 hours after because this
precautions taking metformin
can cause lactic acidosis or ARF. watch renal
function when taking metformin.
immediately if unexplained hypoxemia,

when to d/c metformin
dehydration, or signs of lactic acidosis
what foods increase risk of celery, coriander, dandelion root, garlic, ginseng
hypoglycemia with oral anti
diabetic drugs
is a systemic, chronic, and progressive metabolic

disease that requires lifelong lifestyle
Diabetes mellitus
modification. people with DM have the inability to
metabolize carbohydrates, proteins, and fats
can be genetic or autoimmune. involves the

destruction of pancreatic beta cells. has no or
Type 1 DM
minimal insulin production.
aka Juvenile onset/ IDDM
can be genetic and environmental. either d/t

desensitization (limited response by beta cells) or
Type 2 DM
insulin resistance (liver and peripheral tissues).
aka Adult onset/ NDDM
Age: <30 but can occur at any age.

Type 1: age of onset, S/sx: abrupt onset, weight loss
symptoms, insulin production, Insulin production: None, no prevention.
BMI, and insulin mgt BMI: usually non-obese
Insulin: dependent
Age: peak at 50 yo
S/sx: slow onset, fatigue
Type 2: age of onset,
Insulin production: low, normal, or high.
symptoms, insulin production,
Preventable.
BMI, and insulin mgt
BMI: 60-80% of type 2 pts are obese
Insulin: 20-30% require
a complication of diabetes.. is a lack of insulin and

diabetic ketoacidosis ketosis.
more common in Type 1
hyperglycemia-hyperosmolar a complication of diabetes... is an insulin

state deficiency and profound dehydration
a complication of diabetes... is too little insulin,

hypoglycemia
too little glucose
3 p's (polyuria, polydipsia, polyphagia),

unintended weight loss, fatigue & weakness,
irritability & mood changes, blurred vision, slow
s/sx of diabetes
healing sores, acanthuses nigricans, HTN,
hyperlipidemia, liver impairment, frequent
infections
retinopathy, nephropathy, neuropathy, CAD/CVD

complications of DM
risk of stroke, PVD
skin changes with DM2. skin folds around neck

acanthosis nigricans
and armpits
HBA1C pre diabetes 5.7-6.4 %
> 6.5 %
HBA1C diabetes
goal is to be below 7 % for diabetics.
> 126 mg/dl

Fasting plasma glucose (FPG)
would be 8+ hours fasting, taken in the morning
Normal FPG for non diabetics < 90
> 200 mg/dl after 2 hours

Oral Glucose Tolerance Test -have patient drink several surgery drinks and
(OGTT) take the BG and see how its tolerated?
**check ATI
Random serum glucose > 200 mg/dl
CBC infection, anemia
CMP electrolytes, liver, and renal function
Lipid panel to show CVD risk
urine micro albumin to show protein in the urine, indicates renal failure
other labs for DM 1 antigens & antibodies for DM 1
goal is for HBA1c to be < 6

-lifestyle modifications: weight loss of 7 % of
Interventions for Pre-
body weight, exercise 150 min/week
diabetics
-meformin therapy IF BMI > 35
-might have blood glucose monitoring
Goal is for HBA1C to be < 7

-lifestyle modification
Interventions for Type 1 -insulin therapy is LIFELONG
Diabetics -basal insulin (short acting-sliding scale and
intermediate acting)
-blood glucose monitoring
Goal is for HBA1C to be < 7

-lifestyle modifications
Interventions for Type 2
-try oral hypoglycemic agent 1st
Diabetics
-Insulin is possible tmt
-blood glucose monitoring
pts should have medical nutrition therapy initially

after dx every 3 months. monitor eating patterns,
Nutritional interventions for carb counting/quality, dietary fat & protein,
diabetes supplements, decrease alcohol and sodium,
increase fiber, consult with nutritionist.
GOAL = GLYCEMIC CONTROL (dec. HbA1C)
self management, medications, physical activity,

nutrition, hypoglycemia, blood sugar testing,
Education for diabetes follow up appts/HCP, immunizations: flu,
patients pneumonia, shingles, consult with diabetes
education nurse specialist
Treat to goal of SBP < 140.

Best= systolic <130 and diastolic <80
DM & Hypertension 1st try life style medications, then 2nd try
interventions ACE/ARB to start, 3rd: add diuretic.
monitor BP at home and every HCP visit, monitor
electrolytes, BUN, SrCr, and GFR
lifestyle modification, decrease saturated fat and

DM & Dyslipidemia cholesterol in the diet, meds=statin therapy
interventions preventative, CVD risk and Aspirin therapy
(antiplatlet), get lipid panel drawn every 6 months
LDL <100mg/dl; if have CVD LDL <70 (L you want

low)
lipid panel targets for
HDL > 40 mg/dl in men, >50mg/dl in women (H
diabetes
you want high)
Triglycerides: <150 mg/dl
diabetes pt's have a high risk of CVD d/t FH and

DM & Cardiovascular disease lifestyle. start with ACE/ARB, statin therapy, aspirin
interventions therapy, ... if they had a prior MI: use a beta
blocker; smoking cessation, get a yearly EKG
prevention: glucose control

-optimize BP control
DM & Nephropathy
-1st primary prevention: ACE/ARB
interventions
-monitor urine micro albumin yearly...
monitor BUN/SrCr, GFR <60 = CKD

-comprehensive eye exam initially, then yearly
DM & Retinopathy eye exam.. in history, ask them when last eye
interventions exam was.
Complications include: macular edema, retinal
hemorrhage, retinopathy, blindness

monofilament testing every 6 months-yearly
DM & Neuropathy teach them foot care, smoking cessation, they
interventions have high risk of PVD, meds to help with pain
(neurotic), test the ankle brachial index, podiatry
as needed
is in the early stages of dm, usually type 2. pt's

neuropathy
complain of numbers and tingling.
Inspect feet daily. use mild soap and warm water.

pat gently including in between the toes when
drying feet. perform nail care after a bath/shower,
use cotton or lamb's wool to separate
footcare for diabetes overlapping toes, use a powder with cornstarch if
feet get sweaty, wear socks made of wool or
lamb, wear shoes that fit correctly and are leather
and wear slippers with soles.. ALWAYS wear
Medical-Surgical Nursing Finalshoes!! no flip flops bc risk of injury and infection
shake out shoes before putting on to prevent

injury
other things to remember for know the hospital protocol for nail care. some
footcare allow clippers to trim straight across and file edge
with emery board/nail file, some only allow nail
files straight across.
DO NOT: use commerical remedies for removing

calluses or corns, don't wear open-toe, open-
heal shoes, don't wear plastic shoes for feet
foot care: "DO NOT..."'s
protection, don't go barefoot, don't use heating
pads or hot water bottles, don't stand or sit for
prolonged periods of time or cross legs
if not able to meet the treatment goals of: HbA1c

when medication therapy is
< 7.0 %, pre-meal BS are 80-130 mg/dl
initiated
peak after meal BS are <180 mg/dl
who takes oral diabetes only type 2 diabetics

medications
initiated if not meet tmt goals. there are 4 types:

insulin rapid acting, short acting, intermediate acting,
and long acting
onset 15 minues, duration 3-5 hours

rapid acting (novalog, lispro, glulisine)
when to take: 0-15 minutes before meal
onset is 30 minutes, duration is 8 hours

(regular insulin)
short acting insulin
ONLY type you can give IV!
when to take: 30 min before meal
onset 30-90 minutes, duration 8-24 hours

intermediate acting insulin
(cloudy, NPH)
onset 2-4 hours, duration 24 hours

long acting insulin
(glargine, detemir)
which types of insulin to give rapid and short acting

w/ meal (novalop, lispro, glulisine) & (regular)
intermediate and long acting

which types of insulin to give
(NPH) (glargine, Detemir)
w/o meal
**or else risk of hypoglycemia
basal insulin dose

initial inuslin tmt therapy 0.5-1.0 units/kg/day
dosing intermediate or long action = 1 injection
may be combined w/ oral agent as well
combination of short & intermediate acting insulin

multiple component insulin -basal dose + short acting for meal times
therapy 2/3 of daily dose before breakfast = 1 injection
1/3 of dose in evening=1 injection
intermediate or long acting + short acting

basal dose + sliding scale coverage!!!
BS 1-2 hours after meal and 10 minutes before
intensified regimens for
next meal
insulin therapy
***Pt needs extensive education for self care to:
monitor BS, control nutrition, administer bolus
doses of insulin
check if they're on a standing dose of insulin. give

BOTH (i.e. sliding scale is 150 and BS is 175). similar
sliding scale
insulins can be in same syringe
morning hyperglycemia from the counter

insulin effects: somogi regulatory response to nighttime hypoglycemia.
phenomenon interventions = adequate evening and nighttime
intake of food, evaluate insulin dosage
nighttime release of growth hormone, elevation

insulin effects: dawn
of BS between 3 & 6 AM.
phenomenon
interventions= increase insulin dosage at night
cool & clammy skin, NOT dehydrated, NO change

in RR. Has tachycardia & palpations, anxious,
hypoglycemia s/sx irritable, LOC changes->seizures->coma; glucose
<70, double or blurred vision, extreme hunger,
NEGative for ketones
warm & moist skin, poor skin turgor, ARE

dehydrated, "kussmaul" rapid RR, fruity breath,
orthostatic HTN, tachycardia, N & V, cramping,
hyperglycemia s/sx
LOC varies from alert-to-stuporous-coma,
glucose > 240 mg/dl, metabolic acidosis, POSitive
for ketones
10-15 g of rapidly absorbed carbs (PO

interventions for mild sugar/carbs)
hypoglycemia take BS in 15 minutes after
eat a small meal
15-30 g of rapidly absorbed coarbohydrate. small

interventions for moderate meal in 15-30 minutes, monitor BS...
hypoglycemia pt's might have trouble staying awake
these patients will appear unconscious,

cool/clammy, have extreme lethargy and
confusion.
1st must assess if they're able to swallow or not.
interventions for severe -if able to swallow: juice w/ sugar
hypoglycemia -if unable to swallow: glucagon 1 mg IM or IV
- give 2nd dose in the pt is still unconscious
if resolved: eat a small meal... if unresolved:
transport to ED
CALL HCP
sudden onset, most often in type 1 DM. will have

onset of DKA and
kussmaul respirations (fruity breath), ketosis, and
manifestations
dehydration, metabolic acidosis
inadequate insulin
precipitating factors of DKA infection
stressors
glucose > 300 mg/dl

urine and serum positive (+) for ketones
BUN and SrCr elevated
labs for DKA
pH <7.35
HCO3 <15
*might see hypokalemia (<3.5)
monitor airway/RR, VS's, and LOC every 15

minutes.
1st: Give IV bolus of short acting insulin (reg) at
0.1unit/kg.
interventions for DKA 2nd: Infusion at 0.1units/kg/hour... want to
decrease glucose by 75 mg/dl/hour, monitor for
ketones, give hypotonic fluids, replace F&E if
needed, may self correct, I&O: CVP monitoring
blood glucose < 200, no metabolic acidosis

goals of DKA tmt
shown on ABGs
gradual onset... more likely in Type 2 DM pt that

onset and manifestations of don't yet know they're are diabetic...
HHS manifestations include altered CNS response,
dehydration, and metabolic alkalosis
poor fluid intake!!

precipitating factors of HHS infection
stressors
Glucose > 600

negative (-) for ketones
labs for HHS BUN and SrCr elevated
pH > 7.40
HCO3 > 20
same as DKA for monitoring: RR, VS, and LOC q

15 min
1st: give fluids (1/2 NS at 1 L/hour until BP and UO
stabilized)...this has high risk of hyperkalemia so
interventions for HHS monitor electrolytes
2nd: Insulin after fluids. Bolus at 0.15 units/kg
then infusion: 0.1units/kg/hour
want to decrease glucose by 50-75mg/dl/hour
goal for HHS tmt blood glucose < 250
screen the pts for diabetes (CMP), want pre-meal

glucose to be <140 mg/dl and random blood
interventions for diabetes in
glucose to be < 180mg/dl. Patients should have
the hospital setting
basal insulin + nutrition + regular insulin correction
in the hospital.
high risk for hyperglycemia if: glucocorticoid

in hospital setting what to therapy, are TPN, take immunosuppressive agents,
monitor for? tmt with octreotide.
are at risk for infection and hypoglycemia
tell them to start a walking program build up

eventually to 150 minutes of exercise weekly. start
education for exercise for
slow & increase the time and speed, wear
diabetes pt's
supportive shoes! walk with a friend, CAN swim
but should wear swim shoes
should count # of carbs from food labels. a

nutritionalist will establish the total grams of carbs
education for carb counting per day and then # of grams of carbs is planned
for diabetes pt's for each meal and snack.
coverage of regular insulin is administered for
each 15 grams of carbs eating.
example of carb counting: if divide by 15. so 1st breakfast: 45/15 = 3 units

breakfast is 45 grams of carbs regular insulin
and lunch + snack is 60 grams lunch: 60/15 = 4 units regular insulin.
of carbs... what is the insulin
coverage for each meal
important teaching for oral never double up. either take when u remember or
medication administration wait till next dose!!
nurse will expect the patients to be taking the

polypharmacy following: anti-hypertensive, statin, and an anti
platelet
teach infection control measures like never

patient teaching for blood
sharing BG testing equipment (lancet) / never re-
glucose monitoring
use needles
is SubQ. abdomen is fastest and best absorption

(but can also do arm and thighs)
*nurse should ask patient "where did you have it
insulin administration teaching last or where do you usually have it) and do the
same site but rotate spot
-have extra bottles of insulin available, never
reuse syringe/needles, teach how to store
how to use insulin pen must hold 6-10 seconds after giving
important thing about long CANNOT be mixed with any other insulin!!
acting insulin
schedule of follow up exam & newly diagnosed: 2 weeks-1 months until control
testing w/ is established.
primarycare/endocrinologist if controlled: every 3 months
whats done at follow up evaluate glucose control, assess VS, heart, lungs,
exam w/ primary care or eyes, feet, skin, coping, medication regiment, labs
endocrinologist (CBC, CMP, HbA1c, lipids, urine micro albumin)
2 weeks to 1 month until controlled

then every 3-6 months.
DM education
patients need to work collaboratively with DM
education and health care team
nutrition for diabetes follow initially and then every month until under control
up exam
how often to see yearly for retinal exam

ophthalmologist
yearly to test for renal impairment

how oftne to see
every 3 months if chronic renal failure
nephrologist
might need dialysis
how often to see podiatrist yearly foot screening, also see for wound care
yearly to check for CAD, and procedures or

how often to see cardiologist
surgery
cardinal sign of anemia fatigue

Male: 4.7-6.1
RBC labs
Female: 4.2-5.4
Male: 14-18
Hemoglobin
Female: 12-16
Male: 42-52
Hematocrit
Female: 37-47
80-95: normocytic
MCV (size) <80 microcytic
>95 macrocytic
27-31: normochromic
MCH (color)
<27 hypochromic aka pale
MCHD 32-36%
Serum Ferratin 12-300 ng/mL
d/t blood loss, menarche (periods), surgery,

Acute iron-deficiency anemia
trauma
chronic iron-deficiency d/t nutrition, slow blood loss in GI tract, gastric

anemia bypass surgery
weakness, pale, fatigue, reduced exercise

s/sx of iron-deficiency anemia tolerance, fissures at corners of mouth, nail
changes, intolerance to cold, severe tachycardia
in a CBC: MCV is microcytic (<80) and MCH

Diagnostics/Labs for iron- hypochromic (pale, <27)
Serum Ferratin: <10 ng/mL
deficiency anemia (normal is 12 to 300)
if mild to moderate: iron from food sources, might

interventions for iron- have FeSO4 325 mg daily or twice a day...(can
deficiency anemia cause constipation)
(mild/moderate and severe) if severe: Iron dextran by Z track, might need RBC
transfusion
goal of iron-deficiency raise Fe stores by 2ng/mL in 4 weeks

anemia
liver, lean meats, legumes, red meat , dried fruit

iron food sources
(i.e. raisins), green leafy veggies like spinach
extrinsic: poor nutrition

causes of Vitamin B12
intrinsic: pernicious anemia, lacking the intrinsic
deficiency anemia
factor to absorb B12.
pale, jaundice, glossitis (red beefy smooth

s/sx of Vitamin B12 deficiency
tongue), fatigue, weight loss, tingling of hands
anemia
and feet, poor balance
CBC: MCV- macrocytic (95<)

B12 levels: insufficiency: 150-300 ng/l; deficiency:
Diagnostics/labs for Vitamin
<300 ng/dl
B12 deficiency anemia
Folic acid level: 3-17 ng/ml
shilling test,
nutrition/increase dietary intake of foods rich in

B12, supplements of B12 and folic acid together to
interventions for Vitamin B12 increase absorption, if pt has pernicious anemia
deficiency anemia d/t malabsorption: they will need life long
injections (Weekly then monthly)
goal of Vitamin B12 deficiency restore B12 and folic acid levels
anemia
animal protein/fat, cooked beef liver, baked wild

salmon, cooked grass-fed beef, cooked organic
foods rich in B12
chicken, cooked turkey, dairy: RAW cow's milk,
organic cheese, organic eggs (hard boiled).
commonly occurs with a B12 deficiency. Can be

due to poor nutrition, malabsorption such as
Folic acid deficiency anemia crohn's or alcohol abuse, and certain drugs.
*NOTE: folic acid deficiency does NOT affect
nerve function
drugs that can cause Folic anticonvulsants, oral contraceptives

acid deficiency anemia
s/sx of Folic acid deficiency pale, jaundice, glossitis, fatigue, weight loss, NO
anemia paresthesias
diagnostics/labs for Folic CBC: MCV-Macrocytic (95<)

acid deficiency anemia Folic acid level: 3-17
interventions for Folic acid nutrition, folic acid replacement therapy PO 400
deficiency anemia mg per day
whole wheat sources, dried beans, peas, seeds

(black eyed peas, chickpeas, lentils, soybeans,
sunflower seeds), fruit juice (orange, grapefruit,
food sources of folic acid pineapple), green leafy veggies, asparagus, okra,
raw spinach, beets, carrots, cauliflower, green
beans, tomatoes
a deficiency of RBC due to failure of the bone

marrow. pancytopenia, could be due to toxic
Aplastic anemia
agents, certain drugs, ionizing radiation, infection,
or autoimmune
pancytopenia includes 3 types of cells: RBC, WBC, platelets
dyspnea, fever, infection, pale, bruising, bleeding,

s/sx of aplastic anemia
palpations, systolic ejection murmur
SEVERE macrocytic anemia. (way above 95)

diagnostics/labs of aplastic
decreased: RBC, WBC, Platelets
anemia
bone marrow aspiration
blood transfusions, stem cell transplantation,

interventions for aplastic immunosuppression
anemia *NOTE: aplastic anemia does NOT have nutritional
interventions unlike all the others
decreased number of RBC. precursors could be :

Anemia of chronic disease autoimmune disease, crohn's, ulcerative colitis,
systemic lupus, and rheumatoid arthritis
s/sx of Anemia of chronic fatigue, headache, pallor, dyspnea, arthralgia,

disease infection, swelling
CBC: MCH: normocytic (80-95)

diagnostics/labs for Anemia
decreased-RBC, Hgb, may have low ferritin and
of chronic disease
iron
interventions for Anemia of correct the underlying problem.

chronic disease erythropoietin injections

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12/10/2021 Medical-Surgical Nursing Final Flashcards | Quizlet

Study sets, textbooks,End

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Medical-Surgical Nursing Final

lispro insulin (humulog) rapid acting insulin

onset of lispro insulin under 15 minutes

peak of lispro insulin 30 min to 1.5 hours

when to administer lispro 0-15 minutes prior to a meal

regular insulin (Humulin R, short acting insulin

onset of regular insulin 30 min to 60 minutes

peak of regular insulin 2 to 3 hours

Medical-Surgical Nursing Final

30 minutes before a meal

lente insulin (humulin L) intermediate acting insulin

onset of lente insulin 1 to 2 hours

when to administer lente does not need to be with a meal

peak of lente insulin 4 to 12 hours

insulin glargine long acting insulin

insulin glargine cannot be mixed with other

onset of insulin glargine 1-1.5 hours

peak of insulin glargine has no peak...lasts 24 hr

insulin vials should be stored in a refrigerator or

a drug used to treat hypoglycemia. raises blood

side effects of glucagon n/v, hypotension, hypersensitivity, & hypokalemia

can be given SQ, IM, or IV. then as soon as the

whenever mixing insulin, the short acting

the most common oral hypoglycemic medication

taken each day. administer WITH food in order to

GI effects including anorexia, n/v, HA, abdominal

Medical-Surgical Nursing Final

needs to be stopped 48 hours before any type of

immediately if unexplained hypoxemia,

is a systemic, chronic, and progressive metabolic

can be genetic or autoimmune. involves the

can be genetic and environmental. either d/t

Medical-Surgical Nursing Final

Age: <30 but can occur at any age.

a complication of diabetes.. is a lack of insulin and

hyperglycemia-hyperosmolar a complication of diabetes... is an insulin

a complication of diabetes... is too little insulin,

3 p's (polyuria, polydipsia, polyphagia),

Medical-Surgical Nursing Final

retinopathy, nephropathy, neuropathy, CAD/CVD

skin changes with DM2. skin folds around neck

HBA1C pre diabetes 5.7-6.4 %

> 126 mg/dl

Normal FPG for non diabetics < 90

> 200 mg/dl after 2 hours

Random serum glucose > 200 mg/dl

CBC infection, anemia

CMP electrolytes, liver, and renal function

Lipid panel to show CVD risk

Medical-Surgical Nursing Final

other labs for DM 1 antigens & antibodies for DM 1

goal is for HBA1c to be < 6

Goal is for HBA1C to be < 7

Goal is for HBA1C to be < 7

pts should have medical nutrition therapy initially

Medical-Surgical Nursing Final

self management, medications, physical activity,

Treat to goal of SBP < 140.

lifestyle modification, decrease saturated fat and