range e3

Fasting Glucose range

70-100

Hypoglycemia

<70

Hyperglycemia

>130 fasting

HHS

>600

DKA

>250

A1C

<5.7%

Prediabetic A1C

5.7-6.4%

Diabetic A1C

> or equal to 6.5%

Goal range for diabetics

< or equal to 7%

BNP normal range

<100

BNP HF indication?

>400

Albumin normal range?

3.5-5

PAD S1

Asymptomatic

PAD S2

Claudation-Difficulty walking

PAD S3

Rest pain

Worse when elevated and relieved when legs are dangling

Numbness burning tingling

PAD S4

Necrosis

High risk for amputation

A nurse with acute arterial occlusion should monitor for what?

Compartment syndrome

Arterial embolus

A clot within the arteries

Osteomyelitis

A serious bone infection, usually caused by Staphylococcus aureus.

What is the best Dx of osteomyelitis?

MRI

Bone Biopsy

Or ESR/CRP

Tx Of Osteomylitis

IV antibiotics for 4–6 weeks

Surgical debridement if needed

Control blood sugar (diabetes ↑ risk)

Osteoporosis

Chronic progressive loss of bone density, making bones weak and fragile.

Osteoporosis Sx are often silent until?

A bone fracture

What cause Kyphosis or dowagers hump?

Osteoporosis

What are the Dx of osteoporosis?

DEXA scan

What are normal DEXA scan level

+1 to -1

DEXA scan osteopenia level

-1 to -2.5

DEXA scan osteoporosis levels?

< or equal to -2.5

What are the 6 P’s

Pain

Pallor

Pulselesness

Parastesia

Paralysis

Poikilothermia

Why shouldn’t you elevate a limb suspected of compartment syndrome?

Worsens ischemia

What is the Urgent treatment to compartment syndrome?

IV Heparin

Thromboectomy or embolectomy

Possibly TPA

A client on heparin for arterial embolus requires which lab monitoring?

aPTT

Osteoporosis vs Osteopenia

Penia=mild bone density loss

Porosis= severe bone density loss

Osteomalacia

Bones soften due to mineralization issues

Vit D deficiency

A hotspot under a patients cast is an indication of?

A cast infection

In skeletal traction the nurse must ensure?

The weights hang freely

Skin Traction vs Skeletal Traction

Skin traction:

With boot or foam

Light:5-10 lbs

Short term

Skin breakdown is a risk

Mild Pull

Skeletal traction:

Bone with pins and wires

Heavy: 15-30lbs

Long term

Pin infection is a risk

Strong constant pull

Skin traction is used for?

Femur

Hip

Or cervical fractures

What should you clean the pins with daily?

Chlorexhidine or sterile saline

How often should you perform CMS(circular motion checks) with skin traction?

Q1-2h

What is the priority risk of skin traction?

compartment syndrome

Bucks Traction is what type of traction?

Skin Traction

Sx of fat embolism include?

Petechiae

Fat embolism

Fat enters the BS lodging itself in the brain and lungs.

What is the triad of fat embolism?

Petechiae-Most telling indicator

Respiratory distress

Neurological Changes

osteoarthritis typically includes?

Pain worse with activity

Med for acute gout?

Colchicine

Med for chronic gout

Allopurinol

A client with a below the knee amputation must?

Lie prone every 20-30 mins

Prevent hip flexion contractures

A nurse evaluates a client with T2 DM on glipizide. What is the priority monitoring?

Hyooglycemia

Glipizide is an oral Dx med used for T2 pts

GLP - 1 agonists require monitoring for?

Pancreatitis

A diabetic with fruity breath likely has ?

DKA

DKA Causes:

Usually T1

Can occur late stage T2(rare)

BG:<250

infection

Missing insulin doses

When the body is burning fat for energy instead of BG ketones are produced

Ketones are produced when?

The body burns fat for energy as an alternative or lack of BG

Sx Of DKA

Kussmaul Respiration

Ketones in blood or urine

Metabolic acidosis

Fruity breath

Polaris dehydration

Abdominal pain

What are the complications regarding K and DKA

When DKA occurs K is high

After insulin dose the K drops fast-hypokalemia risk

DKA Tx

IV Fluids (.9NS) 1st

IV insulin 2nd

K replacement only if the pt is <5 and urinating

Treat the cause- usually infection based

HHS- Hyperglycemic State Cause

T2

BG>600

Older adult with T2

Illness infection

Dehydration

HHS key features:

No Ketones

No acidosis

No kussmaul

Severe dehydration( worse than DKA)

Nuero changes

Slow onset

K either normal or low

Monitor heavily with any cardiac issues

HHS Tx

Iv fluids 1st

Iv insulin

Correct electrolytes

Treat underlying cause

Statins require monitoring of?

Liver enzymes

A client in biphosponstes should ?

Sit upright for 30 mins

What does biphosphonate do?

Stop osteoclasts which prevent bone breakdown

Increasing bone density

Biohosphonate important teachings?

Sit upright for 30 mins

On an empty stomach

First thing in the A.M

With a full glass of water

When should you hold biphosphonates?

Issues with swallowing, standing, sitting, or hypocalcemia

What is the biggest SE of biphosphonates

Esophagitis

GI upset

Jaw bone necrosis

Atypical demure fractures

If a patient that has just started taking an ACE inhibitor is experiencing a dry cough what should you do?

Notify the provider

What is the action of metformin

Decrease BG production

Increase insulin sensitivity

T2

Metformin Important notes

Hold 48hrs before and after contrast dye

Don’t give if GFR<30

Kidney issues: MON BUN, CREAT,GFR