Diabetes
This test measures glucose over the past 3 months.
What is: HgbA1c (or) A1c (or) glycated hemoglobin.
BONUS! What is the normal value range (nondiabetic)
The Body Mass Index (BMI) classification range of 25-29.9
What is: overweight (or) pre-obese
Class 1 Obesity (30-34.49), Class II Obesity (35-39.9), Class III (40 or higher)
Your patient has eaten 1/3 of their tray. This is the percent of food consumed.
What is approximately 33%
1/3 (or) 1 divided by 3 = 33%
Additional Practice: 3/4 (or) 3 divided by 4 = 75%
This is a slow (gradual) onset, progressive neurologic movement disorder that eventually leads to disability. Cardinal signs include bradykinesia (slowing of movement) rigidity, and tremor.
What is Parkinson Disease (PD)
*Clinical manifestations can be found on page 2123.
Type 1 diabetes is characterized by the destruction of what cells?
What are pancreatic beta cells.
For more context, please see page chapter 46 (Page 1490)
Patients with type 2 diabetes that drink alcohol and are insulin dependent are at risk for what complication (hint: level of glucose)
What is HYPOglycemia (low glucose)
All diabetics: Alcohol can be used in moderation (without excess), but they need to be aware of side effects!
DKA (Diabetic Ketoacidosis is type 1)
You have a patient with a BMI of 36 that would like guidance on how to increase physical activity to promote weight loss. What is your initial action? (first step) think ADPIE.
-Identify their goals for activity, assess their current level of activity, find out what they have done in the past.
*Be mindful that it relates to what they want to do (increase physical activity)
This common diabetic medication is nephrotoxic (toxic to the kidneys), and you will want to assess kidney function through labs.
What is Metformin.
This is an autoimmune, chronic, degenerative, progressive disease of the central nervous system where demyelination occurs in the brain and spinal cord.
What is Multiple Sclerosis (MS)
De-myelination-destruction of myelin (material around nerve fibers in the brain and spinal cord)
Clinical Manifestations: Fatigue, pain, muscle tension. Review page 2095 clinical manifestations and how to care for your patient.
You know that you typically give regular insulin ___ minutes before a meal
What is: 15 minutes.
Categories of Insulin - Page 1499-1500 (46-3)
This is the dietary recommendation levels for caloric intake for carbohydrates according to the American Dietetic Association (ADA).
Carbs 50-60%, Fat 20-30%, Protein 10-20%.
This is a surgical procedure that often involves multiple consults to dieticians and psychologists in addition to beginning lifestyle changes beforehand.
What is bariatric surgery.
YES! It takes time to meet the requirements for surgery.
What are 2 emergency medications that can be given in patients with low glucose levels?
(1) Glucagon (sub q or IM) - prescribed and can be given outside of the hospital
(2) Dextrose 50% (D50W) in water IV - in hospital or emergency department
What condition involves demyelination of the nerves, but in this condition the Schwann cell is spared allowing for remyelination in the recovery phase of the disease.
What is Guillain-Barre syndrome (or) GBS
Acute rapid demyelination of peripheral nerves producing ASCENDING weakness with dyskinesia (inability to move) Typically caused by a virus (see page 2103)
This is a risk that a patient that has had peripheral neuropathy for years would experience.
Injury (or) Falls - Those injuries can lead to infection
Peripheral neuropathy can begin with tingling or burning sensations. As it progresses, it can lead to numbness, an unsteady gait and decrease in feeling pain and temperature
(Starts on page 1523)
For diagnosis of diabetes - a fasting blood glucose of what (number) suggests diabetes
126 mg/dl
(See chart 46-2) The chart gives you other diagnostic criteria for diabetes.
*Be cautious of words like "casual" or "random" glucose. These are not fasting labs.
A patient has come to you because their sibling said that their obesity is caused from their diet. You educate them on the potential contributing factors of obesity.
What are: activity levels, excess caloric intake, family history/genetics, endocrine factors (hormonal changes), and microbiota (health of the gut) which is affected by what you consume.
Page 1344-1345
(RX) 150mg fluconazole (Diflucan) IV over 60 minutes
(Pharmacy) 150mg in 250ml
What rate will the nurse set the pump to?
What is 250ml/hr.
An autoimmune disorder affecting the myoneural junction characterized by weakness in voluntary muscles. Antibodies impair impulses making fewer receptors available for use, leading to muscle weakness.
Myasthenia Gravis
May involve eyes, face, throat, limbs, respirations, dysphonia (voice), and dysphagia (swallowing).
With an impairment of these things-how would you anticipate their needs?
The long-term (over 5-10 years) use of this medication can cause dyskinesia (abnormal involuntary movements), which includes facial grimacing, rhythmic jerking movements, head bobbing, and chewing.
Sinemet, which contains levodopa and carbidopa.
Please review page 2124.
In the metabolic disorder, hyperglycemic hyperosmolar syndrome (HHS), you would expect to see what clinical manifestations?
Hypotension, dehydration, electrolyte imbalance, tachycardia, neurologic signs (high glucose over 600)
(Page 1516) - HHS. Table 46-6 has a great comparison chart between DKA and HHS.
When educating a patient on dietary guidelines, what would you explain is the recommended amount of protein intake?
Protein intake is 10-20%.
Patient weight 198lbs.
(RX) Order for streptomycin 5mg/kg IM every 12 hours
How many milligrams will the patient receive in 24 hours?
What is 900mg
198 / 2.2 = 90kg
90kg x 5mg = 450 (BUT WAIT THERES MORE!)
450 x 2 (twice in 24 hours) = 900mg
This is a disorder with a loss of motor neurons in the spinal cord and motor nuclei of the lower brain stem. You may anticipate seeing a patient with this disorder having muscle weakness, cramps, lack of coordination, difficulty talking/swallowing and ultimately breathing.
Amyotrophic Lateral Sclerosis (ALS) aka Lou Gehrig Disease.
Page 2131-2132
This medication would be used to treat myasthenia gravis, and the intended action would be to improve muscle strength and control fatigue.
pyridostigmine bromide (Page 2101)
Myasthenia gravis - weak muscles so the medication should increase muscle strength.
(pyrido-stigmine) pyro (fire) you need muscle strength to run from a fire, and you will be tired!