Stephanie Talbot
Diabetic Ketoacidosis- caused by lack of insulin in body causing
severe hyperglycemiaAcute Complications: s/s: 1. Dehydration 2.
Kussmals bx 3. Acetone breath 4. Glucose, ketones, protein in urine
5. Tachycardia ,hypotension 6. Weight loss and anorexia 7.
Glucose>300mg/dL, pH1.5 8. Hyperkalemia 9. Abdominal pain 10.
N& V
Hyperglycemia increases serum osmolalitypolyuria
Treatment: 1. Maintain patent airway 2. O2 therapy 3. IV bolus
insulin, then cont infusion 4. Fluid resuscitation 0.9% NaCl
infusion 1L/hr until BP stable and blood glucose approaches 250
mg/dL 5% dextrose added to prevent hypogylcemia 5. Regular insulin
via bolus then drip 0.1U/Kg/hr 6. Monitor K+- cause initially high
but as add insulin, pushes K+ into cells resulting in vascular
depletion K+
Hyperosmolar Hyperglycemic Syndromecharacterized by
hyperglycemia, osmolar diuresis, and dehydration Acute
Complications: S/S: 1. Dehydration 2. Tachycardia, hypotension 3.
Hemiparesis 4. Somulance, decreased LOC 5. Hypernatremia &
hypokalemia 6. Blood glucose>600mg/dL 7. Osmolality >330mOsm
8. Lactic acidosis, Azetemia (kidney), Lack ketones 9. Aplasia 10.
E-lytes- hypernatremia, hypokalemia, hypochloremia, increased BUN,
creatinine HCT & HgB
Treatment: -treat cause- infection,stress, surgery, TPN, tube
feeds or conditions like MI, sepsis, pancreatitis, stroke, drugs,
like diuretics, glucocorticoids, Ca2+ channel blockers,
propanolol
Maintain patent airway O2 therapy IV access Immediate Fluid
resucitation 0.9%/.45% NaCl infusion 1L/hr until BP stable 5.
Regular insulin via bolus, then by infusion 0.1U/Kg/hr. When
glucose 250mg/dL dextrose added 6. Monitor VS, I/O, heart and
elytes1. 2. 3. 4.
EO 1.1: Define The Following Terms
Bradycardia:
Originates SA node Rate 900mOsm/Kg, post-renal =N, intra-renal
failure 3.4ng/mL 3. Icnrease serum acid phosphtase 4. Transrectal
ultrasound (TRUS) of prostate 5. Prostate tissue biopsy 6. Lymph
node biopsy 7. CT & MRI
INT: 1. Watchful waitin w/ PSA & DREs to monitor progress 2.
Surgery for those w/ stage AB: radical prostectomy- TURP to promote
urination, bilateral orchiectomy(removal testicles) to slow spread
cancer by removing source testosterone, laparoscopic radical
prostatectomy (LRP) for those w/ PSA500mg/mL HF probable
s/s: 1. HTN 2. Paroxysmal nocturnal dyspnea, dyspnea on
exertion, orthopnea 3. Wheezing & crackles 4. hypoxia, resp.
Acidosis 5. Cough w/ pink frothy sputum, pulmonary edema 6. S3/4
heart sounds 7. Palpitations 8. Dysrhythmias
right sided HF leads to core pulmonaleCause: 1. Athlerosclerosis
2. L. Sided HF 3. Lung dx- core pulmonale, r. Ventriculare dilation
& hypertrophy due to pulmonary dx ABS: 1. CXR-congestion,
cardiomegaly 2. Echo- cardiomegaly, decreased fxn 3. EKG: L. &
R Ventricular hypertrophy
s/s: Weakness, fatigue, synchope Hepatomegaly, splenomegaly
Ascites depedent pitting edema Jugular vein distention
Hepatojugular reflex Oligura Dysrhythmias Elevate central
venous/right atrial pressure 10. Nausia, vomiting, anorexia,
abdominal distension 11. Weight gain1. 2. 3. 4. 5. 6. 7. 8. 9.
R.L sided HF interventions1. 2. 3. 4. 5. 6. 7. 8.
9.
Diet therapy O2, bed rest, semifowlers
Assessemntscardiovascular, VS Foley catheter Morphine Diuretics:
Lasix Cardiac glycosieds: Digoxin Cardiac stimulants: dopamine
(Intropin), dobutamine (Dobutrex) Nitrates vasodilators
10. 11. 12. 13. 14. 15. 16. 17. 18. 19.
Fluid restriction Diet theapy teaching Daily weights Medication
administration, teaching Measure abdominal girths Assess peripheral
edema Cardiovasculare assessments CVP readings Rest periods Monitor
e-lytes, I/O Skin care
R.L sided HF interventionsDischarge planning: 1. Stop smoking 2.
Maintain ideal body weight 3. Activity restrictions/care 4.
rehab
Digitalis preparations- not used new MIAction: increase force
contraction, slows HR, kkpromotes diuresis, decreases heart size
Tx: CHF, atrial fibrilation or other tachyarhythmias NSG: monitor
client response, check apical pulse: do not give
