pharm

short acting insulin

lispro, SubQ, during mealtime

intermediate acting insulin

NPH, detemir

long acting insulin

glargine, one time a day

type 1 DM

body cannot make insulin

type 2 DM

insulin resistant

hypoglycemia symptoms

tachycardia, sweating, headache, blurry vision, trembling, paleness, hunger, dizzy, mood change (can be masked by beta blockers)

hyperglycemia symptoms

polyuria (lots of pee), polydipsia (thirsty), polyphagia (hungry)

corticosteroid symptoms

obesity, moon face, increased osteoporosis, DON’T STOP ABRUPTLY, sodium/water retention, potassium loss, hyperglycemia, thinning of skin/striae, mood changes

addison’s

need MORE cortisol

weight loss, sodium/water loss, potassium retention, hypoglycemia, decrease BP, darkened skin

cushing’s

need LESS cortisol

weight gain, sodium/water retention, potassium loss, r/o infection /osteoporosis, insomnia, irritability, hyperglycemia, increase BP

hyperthyroidism

DECREASED TSH, INCREASED T3/T4

weight loss, increased appetite, heat intolerance/increased heat sensitivity, tachycarida, palpitations, arrhythmias, diarrhea (increased motility), anxiety, nervousness, irritability, insomnia, tremors, increased hair and nail growth, increased sweating, exophthalmos

Graves disease

hyperthyroidism

hypothyroidism

INCREASED TSH, DECREASED T3/T4

weight gain, decreased appetite, cold intolerance/increased cold sensitivity, bradycardia, constipation, fatigue, depression , impaired memory, impaired concentration, mental fog, hair loss, thin nails, dry skin

Hashimoto’s disease

hypothyroidism

diabetes microvascular complications

check eyes (jaundice for poor kidney function)/feet (edema, loss of feeling)

diabetes macrovascular complications

heart disease/MI

what does insulin lower?

blood sugar and potassium

short acting insulin (blue)

lispro

short/slow acting insulin (red)

regular insulin

intermediate/slow acting insulin (green)

detemir

long acting insulin

glargine

metformin

first line oral antidiabetic drug

does NOT decrease glucose, makes tissues more sensitive to insulin

GI upset (start at low dose)

if drink alc, can increase lactic acidosis

contratindicated: alc use, kidney problems

caution: severe renal, liver disease

sulfonylureas (-ide)

decreases blood sugar, eat with meals

if drink alc, can affect hypoglycemia and have malnutrition bc won’t eat

contraindicated: alc use, preg, breastfeeding

caution: severe renal, liver disease

SE: sweating, racing HR, vision change

liver

hepatic

kidney

renal

metabolic acidosis examples

hypoxia (sepsis), renal tubular acidosis, diarrhea, DKA (compensate by hyperventilating), shock

metabolic alkalosis examples

vomiting, MS, Cushing’s, antacid, potassium-wasting diuretic, nasogastric tube suction

respiratory acidosis examples

hypoventilation, respiratory depression (opioids, benzos), COPD (compensation bc too acidic), PE

respiratory alkalosis examples

altitude sickness, hyperventilation (use bag to breathe back CO2), CNS trauma/disease, hepatic failure, anxiety, pregnancy

ischemia

lack of blood supply to body

hypoxia

low oxygen levels in tissue

hypoxemia

low oxygen levels in blood

ketone

chemical from liver that breaks down fat instead of glucose

ketone buildup leads to DKA

glucagon

counteracts actions of insulin, increases blood glucose levels

CBG-without diabetes

hypo:

hemoglobin A1c

average glucose levels over 3-4 months, shows how well DM is controlled

pre DM: >6 or

PaCO2 levels

35-45

HCO3 levels

22-26

pH levels

7\.35-7.45

respiratory alkalosis (pH, CO2, HCO3)

pH: alk, CO2: alk, HCO3: normal

respiratory acidosis (pH, CO2, HCO3)

pH: acid, CO2, acid, HCO3: normal

metabolic alkalosis (pH, CO2, HCO3)

pH: alk, CO2: normal, HCO3: alk

metabolic acidosis (pH, CO2, HCO3)

pH: acid, CO2: normal, HCO3: acid

partial compensation for acid/base

if either CO2 or HCO3 are abnormal and opposite

full compensation for acid/base

pH is normal and HCO3 or CO2 are abnormal and opposite

nasal cannula

1-6 LPM, don’t go past 4 LPM

simple mask

5-10 LPM, can’t eat/talk, increased r/o aspiration

non-rebreather

10-15 LPM, can’t leave pt alone

types of COPD

obstructive: inside the lungs

restrictive: outside the lungs (ex. obesity)

emphysema and bronchitis

poor ventilation (gas exchange)

limited air reaching alveoli, blood can reach alveoli

ex. emphysema, pain, restricted chest wall movement

poor perfusion (gas exchange)

blood can’t reach alveoli, air can reach alveoli

ex. PE, low hemoglobin

chronic bronchitis

cilia doesn’t work anymore- increases mucus production

“smokers cough”

overweight, cyanotic, edematous

auscultation: rhonchi, wheezing

emphysema

overinflation of alveoli- less surface area for air exchange

presentation: thin, older, tripod posture, barrel chest

auscultation: nothing

chronic CO2 retainers

asthma (gas exchange)

inflammatory condition in smaller airways

auscultation: wheezing

can lead to remodeling of lungs

triggers: environmental allergies, cold, exercise, stress

hypoxic drive

keep SpO2 88-92%

don’t do if pt has emphysema (chronic CO2 retainers)

advanced airway examples

endotracheal tube, tracheostomy, ventilator

mobilizing secretions from lungs examples

incentive spirometer, TCDB/ambulation, suction, percussion, postural drainage, prone positioning

corticosteroids (gas exchange)

anti-inflammatory and immunosuppressive

routes: inhaled, PO, IV

can be used for asthma, COPD, PNA

corticosteroid nrs considerations

assess: baseline breathing/respiratory status

CONTRA: preg, sepsis

SE: thrush (oral inhalers only, use antifungal to fix)

adverse effects: moon face, water/sodium retention, potassium loss, hyperglycemia, insomnia, irritability, increase BP

DON’T STOP ABRUPTLY: addison’s sx

pt teaching: don’t stop abruptly- can have rebound lung sx, monitor for hyperglycemia

beta blocker (-olol)

lowers HR and BP

ADH

increases water retention

beta2 agonist

opposite of BB, treats asthma, COPD, PNA

bronchodilator- SABA (albuterol) and LABA (salmeterol)

beta2 agonist nrs considerations

assess: RR, SpO2, respiratory assessment

SE: tachycardia (indicates OD)

pt teaching: if SABA drugs are taken in excess--tachydysrhythmia, angina, seizure

anticholinergics (-tropium)

improve lung function by blocking muscarinic receptors in the bronchi and reduce bronchoconstriction and reduce excess mucus production

used for COPD

SE: dry mouth

don’t stop abruptly

eval: decreased crackles/wheezing

anticoagulant

heparin (IV/SubQ), warfarin (PO)

warfarin considerations

check PT/INR

CONTRA: preg

don’t eat vit K (leafy greens)

thrombolytics/clotbuster

alteplase (tPA)

r/o hemorrhage

CONTRA: recent injuries

sodium levels

135-145

potassium levels

3\.5-5.2

calcium levels

8\.2-10.2

magnesium levels

1\.8-2.6

albumin levels

protein in bloodstream, attracts fluid into vasculature (pulling/osmotic pressure)

3\.4-5.4

low albumin: edema

RBC count

3\.6-5.4

hemoglobin count

12-17.4

hematocrit count

36-48%

first spacing (fluid compartments)

normal; ex. vessels, cells

second spacing (fluid compartments)

edema, interstitial space

third spacing (fluid compartments)

pleural/peritoneal, no fluid should be here

what does calcium do as an electrolyte

muscles, reflexes, bowels, heart; more excited when low, less excited when high

what does magnesium do as an electrolyte

may be given during pregnancy to slow labor, sleep (muscle relaxant), bowels

phosphorus is low in which disease

CKD

ECG reading if hyperkalemic

T wave is more peaked

colloid IVF

RARE; large solutes- pulls fluid into bloodstream

if pt is dehydrated or HTN

ex. albumin

1/2 life: hrs to days

crystalloid IVF

mimics human serum

1/2 life: 30-60min

hypertonic solution

water leaves the cell (ex. cerebral edema)

3% saline

be careful of dehydration or HTN

hypotonic solution

water goes into the cell, restores fluid to tissues (can give edema)

0\.45% NS or D5W

be careful not to give too much- edema, low BP

whole blood

not given as much anymore bc transfusion rxn

PRBC

transports O2 (for anemia or acute blood loss)

given w/ NS

Hgb < or equal to 6

plasma

NO RBC, Plt, WBC

given for coag factors (bleeding d/t coag problem)

Plt

low Plt (ex. chemo, r/o bleeding)

loop diuretic

furosemide (Lasix); potassium wasting

most common

most powerful diuretic

check potassium levels regularly, usually on K+ supplement

HCTZ

potassium wasting

first line med for HTN

block reabsorption of salt

spironolactone

potassium sparing (monitor K+, can be hyperkalemic)

blocks aldosterone in adrenal glands

loop diuretic nrs considerations

assess: BP, HR, daily weight, labs

CONTRA: HYPOkalemia

caution: renal disease, DM, preg

SE: hyponatremia, hypotension, dehydration, hypokalemia, ototoxicity, (rarely hyperglycemia)

pt teaching: if pt is on insulin; med interactions: digoxin, lithium, ASA, NSAIDS, HTN meds, salt substitutes

\
HCTZ nrs considerations

assess: BP, HR, daily weight, labs

CONTRA: HYPOkalemia

caution: renal disease, diabetes, preg

SE: hyponatremia, hypotension, dehydration, hypokalemia, (rarely hyperglycemia)

pt teaching: if pt is on insulin; med interactions: digoxin, lithium, ASA, NSAIDS, HTN meds, salt substitutes

spironolactone nrs considerations

assess: BP, HR, daily weight, labs

CONTRA: HYPERkalemia

caution: meds that raise potassium

SE: hyperkalemia, anti-androgen effects

pt teaching: if pt is on insulin; med interactions: digoxin, lithium, ASA, NSAIDS, HTN meds, salt substitutes

kayexalate (sodium polystyrene sulfonate)

lowers serum potassium levels

traps potassium in the GI tract for excretion

route: PO or PR

SE: diarrhea

watch for arrythmia, tachycardia

other meds that affect potassium

hyperkalemic: sulfonamides (abx), -pril/-sartan (ace/arb)

hypokalemic: amphotericin B (antifungal), digoxin

anuria

failure of kidneys to produce urine

oliguria

small amount of urine