Diabetes
Name 3 lifestyle changes we can teach our patients with prediabetes
exercise, lose weight, diet changes, reduce sugar intake
What is the medication given for hypothyroidism and what would you teach in regards to this medication?
levothyroxine; it is lifelong and take 30 minutes before food
Name 3 signs and symptoms/clinical manifestations of Cushings disease
“moon face”, “bufflohump,” hyperglycemia, weight gain in trunk, thin extremities, masculine features, edema, HTN, heart failure symptoms, hypokalemia, hypernatremia, osteoporosis, weakness, sleep disturbances, purplish/red striae
In our patients with stress incontinence, what treatment/exercise do we tell them to do?
Kegel exercises
When do you give rapid acting insulin?
0-15 minutes before meal, or after you see what they eat
What are differences between diabetic ketoacidosis & Hyperosmolar Hyperglycemic Syndrome?
DKA: ketones, metabolic acidosis, more Type I, blood glucose >300
HHS: no metabolic acidosis, no ketones, more Type II, blood glucose >600
You have a patient who has not been taking their levothyroxine for multiple weeks due to not being able to afford their medications. They not present with a coma in the ED. Which medical emergency would you expect?
Myxedema Coma
Addison's is a deficiency of what?
Cortisol and aldosterone
The patient has a pressure ulcer that is a blister on their sacrum. No slough or eschar is present. What stage would you expect?
Stage II --> blisters count as 'breaking the skin'
What is a special nursing consideration for metformin?
To hold for 24-48 hours before IV contrast, and 48 hours after IV contrast or else there can be severe kidney damage
You have a patient presenting with Kussmauls respirations, extreme dehydration, and there are ketones present in the urine. What are 3 nursing interventions you would do at this time?
Check blood glucose, hang fluids, ensure patent airway
What are nursing interventions and important patient teaching for a thyroidectomy (pre and post op)?
WILL HAVE LIFELONG THYROID REPLACEMENT
Pre-op goals: reduce stress, educate on diet, teach about lifelong replacement, head & neck support post-op
Post op
Support head and neck; Assess for hematoma formation; AIRWAY IMPAIRMENT; have tracheostomy kit @ bedside; Pain; Semi-fowlers position; Assess voice & discourage talking; Assess for hypocalcemia (Trousseau and Chvostek)
Name 3 nursing diagnoses for Cushings disease?
risk for infection, disturbed body image, hyperglycemia risk, fluid volume excess, risk for impaired skin integrity
You have a patient who has been diagnosed with C.diff.
A.) What type of isolation do we need?
B.) What hand hygiene do we need?
C.) What do we need to clean the room with?
A) Contact (gloves & gown)
B) soap and water (NO HAND SANITIZER)
C) Bleach
Onset: 10-30 minutes
Peak: 30 minutes-3 hours
Duration: 3-6 hours
What insulin is this?
rapid acting; lispro, aspart, glulisine
You have a patient who is cool, clammy, shaky, and vision changes.
A.) What complication would you expect?
B.) What all would you do at this time?
B) CHECK BLOOD GLUCOSE FIRST; based off of that, administer 15 g of carbs and then continue with rule of 15
The patient has low T3 and T4 and high TSH. What signs and symptoms would you expect?
They have hypothyroidism; Cold intolerance, weight gain, husky voice, constipation, low cardiac output (bradycardia), hoarseness, brittle nails, hair loss, mental slowing
A nurse is teaching a client with Addison’s disease about dietary needs. Which instruction is appropriate?
A. “Restrict your salt intake.”
B. “Increase sodium intake in your diet.”
C. “Avoid high-carbohydrate foods.”
D. “Limit your fluid intake.”
B; a s/s of Addison's is HYPOnatremia, so we would want them to increase sodium in their diet
The patient presents with a pressure ulcer that is covered by slough and eschar, and you are unable to see how deep it goes. What stage is this?
Unstageable; you would expect a stage III or IV after debridement
The patient has a sudden urge to pee, and then is unable to make it to the bathroom.
A.) what type of incontinence is this?
B.) what medication would you expect to give this patient?
B.) oxybutynin
There are 3 common microvascular complications for diabetes.
A.)What are they?
B.) what system does it affect?
C.) What is the BIGGEST prevention measure for these?
A.) retinopathy, nephropathy, neuropathy
B.) eyes, kidneys, nerves
C.) TIGHT BLOOD GLUCOSE CONTROL (try to keep blood glucose between 70-100)
You have a patient presenting with a fever of 103, heart rate of 140, is very warm to the touch and is lethargic. You identify this as thyrotoxicosis, or a thyroid storm. What nursing interventions would you implement at this time?
Hypothermia blankets, Ice packs, Oxygen, IV fluids, PTU/methimazole (In IV), Iodine, propranolol
It is important to taper off steroids- meaning not stopping them completely.
These patients are at a higher risk of hyperglycemia, or higher blood glucose.
These patients are at a higher infection risk due to the high blood glucose.
If you take steroids too long, they are at risk of Cushing's disease, which is when the patient has excess cortisol. But if you don't taper and cut them off, they are at risk of Addison's disease, or not enough cortisol.
hypokalemia
A patient who has hyperthyroidism, asthma, and HF. Which medication would you question?
A.) fluticasone
B.) PTU
C.) propranolol
D.) albuterol
C, propranolol; this is a beta blocker, and one of the side effects is bronchospasm. This would be contraindicated for asthma. Other side effects of beta blockers is hypotension and bradycardia (3 B's)