Kidney Disease
Asthma/COPD
Meds - respiratory
Diabetes
Treatment - Diabetes
100
The patient is due for dialysis in 15 minutes and they have morning meds due right now, including blood pressure medication and an antibiotic. What do you do?
What is...
Hold the medication until after dialysis.
100
How is COPD diagnosed?
What is...
pulmonary function tests (PFT)
? What else does this test help with?
? How is this test performed?
100
A patient with asthma is prescribed to take inhaled Salmeterol and Fluticasone for long-term management of asthma. You observe the patient taking these medications. Which order should this patient take the medications?
What is...
The patient inhales the Salmeterol first and then waits 5 minutes before inhaling the Fluticasone.
100
What are the three classic clinical manifestations of hyperglycemia? (3 Ps)
What is....
Polyphagia, polyuria, polydipsia
100
How would you instruct your patient to self-administer insulin injections at home?
(i.e., what angle and sites to you inject the needle, risks associated with insulin administration)
- 45-90 degree angle, depends on weight of patient - - Anterior thigh; triceps, posterior arm; abdomen, - Don't use same site more than once in 2-3 weeks; avoid inserting in an arm that will be used immediately following for exercise (increase absorption). Use same sites around same time of day, sites absorb differently. - risk -> hypoglycemia
200
What is normal/expected urine output and at what point would you report to the provider for low output?
What is....
Report urine less than 30mL/hr to the provider.
0.5mL/kg/hr
200
With COPD, the goal is to maintain their SaO2 at what? (hint: it is NOT equal to or greater than 94%)
What is
Greater or equal to 90%
200
You assist your patient with using their inhaler. The inhaler contains the medication Budesonide (inhaled corticosteroid). Before administering the inhaler, you will want to connect what device_____ to the inhaler to help decrease the patient from developing ________?
What is...
Spacer, thrush
200
Ketones are the by product of what?
What is....
The break down of fat and muscle by the liver to get energy.
Happens due to inadequate insulin* Occurs in DM1*
200
Patient's blood sugar is 190 and they want to eat breakfast. When do you administer their SC short acting (Regular) insulin?
What is
a) 15-30min before tray arrives because that is the onset
300
What are nursing considerations when taking care of a patient with a fistula? (safety?)
What is...
- Listen for bruit, feel for thrill
- Restrict extremity - no blood pressure or blood draws in that arm
- No tight clothing over the fistula
300
What nursing interventions can you implement to help patient achieve airway clearance?
What is...
Chest PT, postural drainage, education on controlled coughing
300
The nurse provides care for a client who is diagnosed with chronic obstructive pulmonary disease (COPD) and prescribed long-term glucocorticoid pharmacotherapy. Which diagnostic test should the nurse anticipate for this client based on the current clinical data?
What is...
Eye exams (cataracts)
Dexa bone scan (osteoporosis)
HbA1c (hyperglycemia)
300
What are the 3 pathys that result from uncontrolled diabetes?
What is...
Nephropathy
Neuropathy
Retinopathy
300
What are the different classes of insulin (subcutaneous)?
What is....
Rapid acting, Short acting (regular), NPH, Long acting
ONSET, PEAK, DURATION
400
How is PD performed? How often?
What is...
Either over night while patient sleeps or 3-5 exchanges during the day.
Using the peritoneal cavity.
400
What teaching can you do with your patient to improving their breathing patterns?
What is...
Pursed lip breathing (prolonged exhalation and increasing airway pressure on expiration 0 this reducing air trapping)
Diaphragmatic breathing (Strengthens the diaphragm)
Both slow down and control respiratory patterns
400
The nurse provides care for a client who is admitted to the urgent care clinic for the treatment of an asthma exacerbation. The client reports feeling shaky and has a heart rate of 124 beats per minute. Laboratory data reveals a serum potassium level of 3.1 mEq/L. Which prescribed medication does the nurse suspect as being responsible for the client’s current symptoms?
Guaifenesin, Albuterol, Montelukast, or Diphenhydrine (Benadryl)?
What is...
Guaifenesin - mucolytic
Albuterol - Can lower serum potassium, cause tachycardia, and tremors/shakiness
Montelukast - leukotriene modifier
Diphenhydrine - anti-histamine
400
What are the differences between Type 1 and Type 2 diabetes?
What is...
Type 1 - quick onset; causes tend to be autoimmune; usually occurs early in life <30years, is unpreventable. Pancreas cells are destroyed and can't produce insulin.
Type 2 - progressive; causes tend to be more linked to lifestyle and weight, occurs later in life >30years, is usually preventable. Pancreas cells don't produce enough insulin or can no longer utilize insulin.
400
What are the different modes of insulin delivery and when would you use one of the other?
What is...
insulin pump, insulin pen,insluin needle, oral anti-diabetic, inhalation powder
insurance, literacy, impairment (vision, mobility with hands)
500
What are complications of PD?
What is...
peritonitis (look for CLOUDY effluent)
Weight gain (glucose is used in the dialysate to increase gradient to help with osmosis, this is added glucose from their normal diet = increased calories)
Hernia
Inadequate dialysis
500
What medication should your client with asthma use at home if they have an asthma attack?
What is...
Albuterol (rescue inhaler, aka short-acting beta adrenergic agonist [SABA])
500
What are nursing considerations when giving theophylline?
What is...
Toxicity - Very narrow therapeutic rangs (10-20mcg/mL)...frequent serum level checks
Tonic-clonic seizures - #1 sign for severe toxicity
Tachycardia and dysrhythmias - avoid caffeine but also avoid beta blockers because it negates the medication
500
What are the 3 criteria for diagnosing diabetes? (4)
Chart 46-2 in text, pp 1492
What is...
HbA1C > 6.5%
2hr postload glucose equal to or greater than 200mg/DL
Fasting plasma glucose equal to or greater than 126mg/dL
Symptoms (3 Ps) plus casual blood glucose of equal to or greater than 200mg/dL
500
What oral antidiabetic agent inhibits the production of glucose by the liver?
What is...
Metformin
600
What are complications can occur with HD?
What is...
Hypotension
Fluid overload
Bleeding from access points
Clot within access point
Infection
Hyperkalemia
600
What diagnostic test is used to diagnose COPD?
What is...
Pulmonary Function Tests (PFT)
600
What medications should be avoided
What is...
Naproxen and Beta blockers
600
What is a normal HgbA1C value for a non-diabetic?
For a diabetic?
What is this test?
What is....
Normal is 4-6%
Target range for a diabetic is less than 7%
It measures the average glucose in the past 3 months for your patient - it tells us how well controlled their glucose levels are
600
When a patient is hypoglycemic, what is the rule of 15?
What is...
After checking your blood glucose level with your meter and seeing that your level is under 70 mg/dl, consume 15 grams of carbohydrate, wait about 15 minutes, then recheck your blood glucose level.
700
How is chronic kidney disease staged?
What is...
based on the glomerular filtration rate (GFR)
Stage 1 --- GFR = ≥90 mL/min/1.73 m2
Stage 2 --- GFR = 60–89 mL/min/1.73 m2
Stage 3 --- GFR = 30–59 mL/min/1.73 m2
Stage 4 --- GFR = 15–29 mL/min/1.73 m2
ESRD -- Stage 5 --- GFR <15 mL/min/1.73 m2
700
What is a bronchospasm and what do you expect to find on assessment?
What is...
Contractions of the airway that limits oxygen from getting to the lung parenchyma (muscles that line your bronchi tighten and cause your airways to narrow).
Respiratory distress, crackles or absent sounds over site of bronchospasm.
700
What order should be used when administering the following respiratory medications?
Steroids, Albuterol, Ipratropium
What is...
AIM
Albuterol, Ipratropium, Methylprednisone
700
Why is exercise good for glucose management?
What is...
It makes your cells more sensitive to insulin so it helps your body control blood glucose levels better (by responding better to insulin)
700
What are the first lines of treatment for patients diagnosed with Type 2 diabetes?
What is....
Lifestyle modifications like weight management and diet. Also, they may take an oral antidiabetic agent along with these lifestyle modifications.
800
What are the phases of AKI?
What is...
Initiation
Oliguria
Diuresis
Recovery
800
What is an incentive spirometer and peak flow meter?
What is...
Incentive spirometry - device used to exercise the lungs to prevent pna or atelectasis.
Peak flow meter - measures expiratory volume on forced expiration (forced vital capacity). Good to monitor treatment/disease porogression for COPD/asthma
800
What are the side effects of anticholinergics?
What is...
dry eyes, xerostomia, constipation, urinary retention
800
What daily percent of carbohydrates is recommended for a patient with diabetes?
What is 50-60%
800
Your patient's blood glucose is 149 and their lunch tray is arriving to the unit. What do you do? See the sliding scale order below:
What is....
Give the patient their lunch tray, do not administer insulin per order. You do NOT need to contact the provider, you just follow the sliding scale order.