Inflammation
What are the 5 key signs of inflammation?
Redness
Heat
Swelling
Pain
Loss of function
What is the gold standard for opioids pain management?
What is the antidote?
Morphine
Antidote is Naloxone
What is the first management for anaphylaxis treatment?
Always epinephrine first.
What is a normal blood sugar?
70-110
If a patient has a sudden change in neuro status, what is the first couse of action?
Check blood sugar.
How should potassium be given?
Slow infusion, never bolus!
What is the primary acid and base in our body?
Acid - CO2.
Base - bicarbonate.
What is the precursor to all chemicals responsible for inflammation?
Arachidonic acid.
What patient population should not receive aspirin and why?
Not for children or pregnant women, can cause Reye's Syndrome.
What precautions should be used for tuberculosis?
What does this include?
N-95, negative pressure room, private room.
What is the only type of insulin that can be given IV?
Regular insulin.
Hypoglycemia, the brain is not getting enough energy and nutrients to function properly. No fat storage in the brain!
What is the most accurate way to measure fluid status?
Daily weights - same time in the morning, same scale and same clothing.
What are the normal values for pH, CO2, and bicarb?
pH - 7.35 to 7.45
CO2 - 35 to 45
Bicarb - 22 to 26
What is the first cell to respond during an inflammatory response?
Neutrophils
What are the differences in properties between Aspirin, Ibuprofen and Acetaminophen?
Aspirin - analgesic, antipyretic, anti-inflammatory, and anticoagulant.
Ibuprofen - analgesic, antipyretic, and anti-inflammatory.
Acetaminophen - analgesic and antipyretic.
Briefly explain the role of the 5 immunoglobulins (IgA, IgD, IgE, IgG, and IgM).
IgA - found in saliva, fights bacteria, viral and fungal specimens.
IgD - activates B cells.
IgE - allergic reactions
IgG - most common.
IgM - storage version of IgG
What is the only way to medically manage type 1 diabetes?
Insulin.
If a patient is conscious and their blood sugar is less than 70, what nursing intervention should you perform?
15 by 15 rule - 15 grams of carbs, recheck blood sugar in 15 minutes.
Example of 15 grams - 4 oz of juice or soda, 8 oz of skim milk, 5 to 6 hard candies, 3 glucose tablets.
Give small meal or protein rich snack once resolved!
What are the normal lab values for the following:
Sodium
Potassium
Calcium
Magnesium
Phosphate
Sodium - 135 to 145
Potassium 3.5 to 5
Calcium 9 to 10.5
Magnesium - 1.2 to 2
Phosphate - 3 to 4.5
What is the mnemonic to remember acid base?
Respiratory
Opposite
Metabolic
Equal
What are 3 examples of local vs systemic inflammation symptoms?
Local:
Redness, swelling, pain, heat, loss of function, exudate.
Systemic:
fever, malaise, nausea, vomiting, increase HR and respiratory rate, elevated WBCs.
With a PCA for pain management, what is important to educate the patient about?
Only the patient presses the button!
When a patient is receiving brachytherapy, what should be at the patients bedside?
Tongs.
What's the difference between gluconeogenesis and glycogenolysis?
Gluconeogenesis - creation of glucose from non-sugar molecules.
Glycogenolysis - breakdown of glycogen into glucose.
What should you do if a patient is unconscious and their blood sugar is less than 70?
IM glucagon - turn on side, high risk of vomiting.
IV dextrose - push half then recheck blood sugar. Very thick.
Which electrolytes are sedating and which are irritating when increased?
Sedating - potassium, calcium and magnesium.
Irritating - sodium and phosphate.
Interpret the following ABG:
pH - 7.31
CO2 - 53
Bicarb - 26
Respiratory acidosis.
What are the 5 chemical mediators of inflammation and what do they do?
Leukotrienes - WBC.
Kinins - pain.
Histamine - vasodilation.
Prostaglandins - pain.
Thromboxane - blood clotting.
How do we assess pain?
Provoking factors (what makes it worse, what makes it better)
Quality (what does it feel like)
Region/radiation (where is it, does it radiate)
Severity
Time (how long has the pain been present, when did it start).
U You (how does it affect the patient)
If giving Vancomycin, what do we need to watch for?
What is the treatment?
Red man syndrome.
Slow the infusion and administer an antihistamine.
What are the 5 factors of metabolic syndrome?
When is one considered to have metabolic syndrome?
BP greater than 130/85.
Triglycerides greater than 150.
Waistline greater than 40.
Low HDL less than 40
Fasting blood sugar greater than 110.
Explain the SICK day rules of diabetes management.
Sugar - check blood sugar every 2 to 3 hours.
Insulin - continue to take insulin as scheduled.
Carbs - drink and eat regularly.
Ketones - assess for ketones and take rapid insulin if present.
What is the difference between hypotonic, hypertonic and Isotonic dehydration?
How do we manage the different type of dehydration?
Hypotonic - electrolyte loss is greater than water loss --> treat with hypertonic or isotonic fluids.
Hypertonic - water loss is more than electrolyte loss --> treat with hypotonic or isotonic fluids.
Isotonic - salt loss and water loss are equal --> treat with isotonic fluids.
When giving a blood transfusion:
What type of fluid should run/flush blood with?
What size IV do we need?
When should vitals be checked?
Normal saline only
20 G IV or larger
Check VS at baseline before transfusion then every 15 minutes (x2), then every 30 minutes until complete.