2630 collaborative case study

kassmaul's

regular, rapid, deep

cheyne-stokes

regular with increase then decrease in rate and depth, followed by apnea

tactile fremitus

hands over chest, patient says "99", chronic condition = less vibration

crepitus

escaped air under skin, feels like rice crispies

wheezes

high pitched, inspiration, narrow airways

rhonchi

low pitched wheezes, continuous, bubbling, secretions from inflammation, large airways

rales / fine crackles

brief, end of inspiration, popping/crackling, fluid in alveoli, coarse = longer and louder

stridor

trachea, life threatening, high pitched, loud

pleural friction rub

inflammation of pleura, rubbing sound, pain

bloodwork for respiratory distress

hemoglobin, hematocrit, blood gases

hemoglobin levels in males

140-180 g/L

hemoglobin levels in females

120-160 g/L

hematocrit levels in males

0.42-0.52

hematocrit levels in females

0.37-0.47

pH levels

7.35-7.45

PaO2 levels

80-100 mmHg

PaCO2 levels

35-45 mmHg

HCO3- levels

22-26 mEq/L

uncompensated

pH abnormal, one measure normal, one measure abnormal

partially compensated

pH abnormal, other measures abnormal + opposite (only one value matches pH)

fully compensated

pH normal, other measures abnormal + opposite

nasal prongs flow rate

up to 6L / min (4% / L)

high flow nasal cannuli

additional attachment on nasal prongs so they stay on better

simple face mask oxygen level

up to 60% (moderate)

non-rebreather oxygen level

60-80% (high flow)

cons of non-rebreather

short term only, suffocation risk

venturi mask oxygen level

up to 50% (high flow, precise)

oxygen flow rate changes

5%-10%, 1-2L increments

rhinorrhea

runny nose

myalgia

muscle pain

complication of influenza

secondary bacterial pneumonia

symptoms of secondary bacterial infection

temperature above 38, purulent nasal exudate, tender and swollen glands, sore and red throat

4 types of pneumonia

1. community acquired

2. hospital acquired

3. aspiration pneumonia

4. opportunistic pneumonia (compromised immune system)

pneumonia s&s in elderly

stupor, CONFUSION, hypothermia, diaphoresis, fatigue, poor appetite, no fever

status asmathticus

can't make asthma stop

relievers

B2 adrenergic agonists, ease symptoms, open airways

controllers

corticosteroids, daily maintenance

saba

short acting

laba

long acting

candidiasis

yeast infection in mouth caused by controllers

main 2 types of copd

emphysema, chronic bronchitis

emphysema

destruction of elastin in connective lung tissues, breakdown of alveolar walls and ineffective gas exchange

chronic bronchitis

constant bronchial irritation and inflammation, narrowing of airway and too much mucus

primary cause of copd

exposure to tobacco smoke

sounds with empysema

rhonchi

secondary polycythemia

from progressed copd, not enough oxygen so body makes too many RBCs to try to fix it

physical signs of copd (2)

clubbing from chronic hypoxia, barrel chest from emphysema

cor pulmonale

hypertrophy of right side of heart and heart failure, complication of copd

ABG signs of COPD

respiratory acidosis

blood test signs of COPD

polycythemia, maybe elevated WBC, possible electrolyte levels altered by acidosis

chest xray signs of COPD

hyperinflation of lungs (air stuck in and can't get out)

SpO2 for COPD

88-94%

O2 delivery for COPD

1-2 L/min via nasal prongs

what happens if a diabetic is ill

counter regulatory hormones increase, leading to increase in blood glucose

counter regulatory hormones

glucagon, epinephrine, growth hormone, cortisol

type 1 diabetes symptoms

polyuria, polyphagia, polydipsia, fatigue, weight loss

type 2 diabetes symptoms

none, fatigue, recurrent infections

diabetes manifestations

blurred vision, breath smells like acetone, kussmaul breathing

fasting blood glucose test diagnosis results

2 results of > 7 mmol/L

glucose tolerance test diagnosis results

11.1 mmol/L

glycosylated hemoglobin (HbA1c) diagnosis results (glucose attached to Hgb)

>6.5%

in diabetic patients, aim for blood glucose

under 6.5%

glycemic index (gi)

increase in blood glucose after eating carbs (different carbs have different gis)

capillary BG

finger prick

continuous BG

sensor with 5 min updates

flash glucose monitoring

sensor with reader / cell phone

BG monitoring for type 1

3 times / day pre and post meal

BG monitoring for type 2

with insulin / oral agents, at least 1 time / day

BG monitoring if ill

q4h

rapid insulin onset

10-15 mins, bolus

regular insulin onset

30-60 mins, bolus

intermediate insulin onset

1.5-4 hours, basal, morning and bedtime

long-acting insulin onset

1-2 hours, basal

somogyi effect

rebound morning hyperglycemia d/t release of counter regulatory hormones from decrease in BG overnight

prevention: bedtime snacks, lower insulin dose

dawn phenomenon

hyperglycemia on awakening d/t increased secretion of GH and cortisol overnight

prevention: increase insulin dose, adjust admin timing

oral hypoglycemics

increase insulin production or insulin sensitivity

metformin

most common, decreases glucose production and reduces insulin resistance

DON'T GET DEHYDRATED

glyburide

stimulates release of insulin from beta cells

microvascular complications of diabetes

retinopathy, dermopathy, nephropathy, gastroparesis, peripheral neuropathy, neurogenic bladder, erectile dysfunction, infections

how much juice is 15g of carbs

175mL

how much juice is 20g of carbs

250mL

glucose levels of severe hypoglycemia

< 2.8 mmol/L

severe hypoglycemia IV

push 20-50 mL dextrose 50% in water over 1-3 mins

severe hypoglycemia if no IV access

SC/IM glucagon 1 mg or glucagon 3mg intranasal