Rewriting Ellie's Notes

Unit 1

S/S of hypoglycemia (cold and clammy, need some candy)

  • Sweating

  • Tremors

  • Cold/clammy

  • Lethargy

  • Anxiety

  • Blood sugar less than 70

S/S of hyperglycemia (hot and dry, sugar high)

  • Polyuria

  • Polyphagia

  • Polydipsia

  • Dry mouth

  • Weight loss

  • Tiredness

  • Blurred vision

  • Frequent UTIs

  • Slow healing wound

  • Nocturia

  • Abdominal pain

  • Headaches

Types of Insulins

  • Very short acting: (Humalog, Novolog, Apidra, Afrezza)

  • Short acting: Regular insulin (Humulin R, Novolin R)

  • Intermediate acting: (NPH, Humulin N, Novolin N)

  • Long acting: (Lantus, Levemir)

How to mix insulins:

  • Clear to cloudy

  • Air in the NPH

  • Air in the regular

  • Pull up the regular insulin

  • Pull up the NPH

Signs of a DKA:

  • Fruity smelling breath

  • Kussmaul breathing

  • Increased ketones

  • Headache

  • Fatigue

  • Shortness of breath

  • Increased blood sugar

  • Thirst (Polydipsia)

  • Polyuria

  • Weakness

  • Dry, flushed skin

  • Abdominal pain

  • N/V

Most common diabetes

  • Type 2: typically over the age of 40

  • Type 1: typically in kids

How do you diagnose diabetes:

  • Check A1C (average blood sugar over the past 3 months)

S/S of hypothyroidism

  • Cold

  • Sleepy

  • Lethargy

  • Low metabolism

  • Weight gain

  • Goiter (neck)

S/S of hyperthyroidism

  • Low weight

  • Restlessness

  • Insomnia

  • Nervousness

  • Increased sweating

  • Graves’ disease (eyes)

Labs associated with hypothyroidism

  • High TSH

  • Low T3

  • Low T4

Labs associated with hyperthyroidism

  • Low TSH

  • High T3

  • High T4

Caring for a patient with post thyroidectomy:

  • Sit in semi-fowlers with pillows to support the head and neck

  • Vitals every 30 minutes

  • Monitor for hemorrhage

  • Reassess every 2 hours

  • Assess airway

  • Assess and monitor dressing

  • Monitor for tingling of mouth and toes (calcium deficiency)

S/S of Cushing’s

  • Moon face

  • Buffalo hump

  • High cortisol

  • Hyperglycemia

  • Increased weight: small legs, big girth

S/S of Addison’s

  • Anorexia

  • Hypoglycemia

  • Weight loss

  • Weakness

  • Orthostatic hypertension

  • Confusion

  • Bronze color

  • Steroid insufficiency

Care of injuries/fractures

  • Compound = open skin

  • Spiral = can be a sign of abuse

  • RICE: rest, ice, compression, and elevate

  • Walk with cane on unaffected side

  • With a walker, walk into it slower

Rheumatoid Arthritis? S/S? Care?

  • Autoimmune

  • Hands swollen due to the joints

  • Causes pain and stiffness that can limit mobility and daily activities

Osteoarthritis? S/S? Care?

  • Normal with aging

  • Bone swelling

Multiple Sclerosis?

  • Neurologic that can become a disability

  • Degenerative progressive

  • Do as you can

  • More rest breaks

  • Keep them moving

  • Remind them to take it slow and do as you can

  • Add a cane if they need it

  • Encourage stretching exercises to prevent stiffness and maintain mobility.

  • Provide frequent reminders about staying hydrated throughout the day.

Hip Fractures:

  • Abduction pillow

  • Cannot cross legs

  • Turn, cough, deep breath

  • Prevent DVTs: do not let the patient lay around

  • Do not bend the hip

  • Check the dressing

  • Assess the pain

  • Get moving with PT

S/S of GERD:

  • Gastroesophageal reflux disease

  • Weird symptoms is a coughing, clearing throat, hoarseness due to the acid and reflux

Obesity

  • BMI greater than 30

  • Formula to calculate BMI: weight/height² x 703

Peptic Ulcer Disease?

  • Gnawing pain

  • Treatment: proton pump inhibitors to reduce stomach acid, antibiotics for H. pylori infections, and lifestyle changes such as dietary modifications and stress management.

Difference in HIV and AIDS

  • HIV is autoimmune, can develop into AIDS, best to test 3 months after exposure

  • AIDS is from HIV - increased risk for the flu, increased risk of pneumonia, look for increased fever (possible infection), shortness of breath (PE), cough.

Post-op gastric bypass care:

  • N/V

  • Cannot eat as much

  • Turn, cough, deep breathe (prevent DVT)

  • Dumping syndrome

  • Movement - SCD

  • Monitor diet

Unit 2

How do you care for calculi in the kidneys?

  • Also known as a kidney stone

  • Lithotripsy (stone buster)

  • Hydrate

  • Strain the urine

  • Prevent blockage (at least 30 mL of urine out an hour)

TURP?

  • Continuous irrigation of the bladder

  • Shave the prostate

  • 3 way foley

  • Gets rid of the clot

  • The clot can obstruct and prevent urination

  • #1 job is to prevent a clot

  • Call the doctor if it was getting clear and it is now rebleeding

  • Complications: hemorrhage and bleeding (clots in the first 24 hours), assess pain, monitor for post-op bleeding, monitor for infection

BPH?

  • Enlarged prostate

  • Squeeze on the ureters

  • Not able to pee

Meds to avoid with erectile dysfunction

  • Avoid nitro with ED meds

  • Blood pressure medications can cause ED

  • Recreational drugs can cause ED

  • Stress can cause ED

  • Trauma can cause ED

Ways to treat erectile dysfunction:

  • Viagra/ED meds

  • Lifestyle changes

Most common cancer for women:

  • Breast

Most common cancer for men:

  • Prostate

Most common deadly cancer:

  • Lung

Pneumonic for cancer

  • C = Change in bowel habits

  • A = A sore that does not heal

  • U = Unusual bleeding

  • T = Thickening or lump

  • I = Indigestion

  • O = Obvious change in mole

  • N = Nagging cough/hoarseness

Most common sign of colon cancer:

  • Change in bowel habits

Most definitive way to diagnose cancer:

  • Biopsy

Respiratory Alkalosis

  • pH above 7.45

  • Hyperventilation

  • Basic

Respiratory Acidosis

  • pH below 7.35

  • Hypoventilation

  • Retain too much CO2

Metabolic Alkalosis

  • pH is below 7.35

Metabolic Acidosis

  • pH is above 7.45

What IV fluids are hypotonic, hypertonic, and isotonic?

  • Isotonic = Perfect and normal saline to rehydrate

  • Hypotonic = Half normal saline/D5W

  • Hypertonic = D5% ½ normal saline

S/S of Aplastic Anemia? Care?

  • Bone marrow becomes fatty and does not produce cells like it needs to.

  • Aplastic anemia can become fatal

  • Anemia individuals look pale, fatigue, cold, crave, ice, bruise easily, shortness of breath.

  • If someone has a bleeding disorder, soft bristle brushes and electric razors to avoid injury and bleeding.

  • Most common anemia is iron deficiency

What are possible blood transfusions? How do you care for a patient experiencing a reaction to a blood transfusion?

  • First 20 minutes is the time for a reaction

  • Expires after 4 hours

  • Signs of a reaction = fever, chills, chest pain, hives, shortness of breath

  • Stop the blood, start a bag of fluids to wash the blood out of the line, and call the doctor

  • 18 or 20 gauge needle because blood is thicker than water

Concerns during seizure? Care?

  • Turn them on their side = #1 first thing to prevent aspiration

  • Airway

  • Keep them safe

  • Bite block

  • Protect the head

  • Pad the bed

  • Stay with the patient

  • Keep the rails up so the patient does not roll off the bed

Unit 3

What is happening in the lungs with COPD. What is the #1 symptom? What is the cause of asthma?

  • Everything is constricting

  • Bronchoconstriction

  • Wheezing is the number 1 sound due to narrowing

  • Causes include allergies, irritants, carpet, dander

What is a regular inhaler for asthma? What is a rescue inhaler?

  • Advair is a steroid inhaler for everyday use, and can be used on a long-term basis (swish and spit to prevent thrush).

  • Albuterol is the rescue inhaler - quick and fast needed during an emergency.

What does COPD look like? How do you care for a COPD patient? What is the risk with too much oxygen?

  • Barrel chest, clubbing of the fingers, tripod position (so they can breathe)

  • Number 1 cause of COPD is smoking

  • Over oxygenating = hypercapnia (too much oxygen) = too much CO2 build up in the blood, which can lead to respiratory acidosis and exacerbation of COPD symptoms.

  • Target oxygen = 88-92%

  • Inceptive spirometer to help deep breathing

What is pneumonia? What does it sound like? What is wrong with the alveoli?

  • The alveoli (O2 and CO2 exchange) has too much fluid

  • Sounds like crackles

  • Common causes are hospital-acquired, lack of movement, laying around, aspiration pneumonia, community-acquired, bacterial

  • Nebs

  • Encourage the patient to cough up the sputum to clear the fluid

What are complications from the flu?

  • Pneumonia

  • Bulk of flu deaths = those greater than 65 years old

What are complications from COVID?

  • Headaches

  • Changes in smell and taste

  • Coughing

  • Fatigue

What is hypoxia? What are the types of oxygen masks and oxygen volumes?

  • These people cannot breathe

  • Low oxygen sat

  • Nonrebreather = 10 L or above

  • Venturi mask

  • Humified oxygen = above 6 L

S/S of hypertension? Complications?

  • Hypertension = above 140/90

  • Prehypertension = 130/80

  • Can be a silent killer

  • People may have nose bleeds, headaches, kidney issues

  • Complications of untreated hypertension = kidney damage, stroke, heart attack

  • Meds include beta blockers (-lol), ACE inhibitors (-pril), lasix, ARBs (-sartan), and calcium channel blockers

  • Lifestyle modifications, diet, exercise, low sodium diet

  • Modifiable = weight, lifestyle, smoking

  • Non-modifiable = age, family history

  • Hypertension is more common in those with family history

  • A man may be more noncompliant with BP meds due to erectile dysfunction

  • Watch for orthostatic hypotension

  • Lasix patients are at risk for electrolyte imbalance - monitor potassium

  • Loop diuretics

  • Hypertensive emergency = 180/120

What is PVD?

  • Fatty deposits in the arteries

  • Pain in their legs

  • Cold limbs due to poor circulation

  • Smoking is the #1 thing that can cause PVD

  • Exercise, diet, quit smoking, take cholesterol meds

  • Pain, pallor, pulselessness, paralysis, paresthesia, pilo (hair loss)

DVT? Prevention and care?

  • Blood clot in the legs

  • Can be caused by surgery and not moving around

  • Clotting disorder

  • Can become very serious when it becomes a PE

  • Redness, swelling, warm and red calves

  • Assess fetal pulses

  • Patient’s will be placed on a blood thinner like heparin

  • If traveling, get up and move, wear compression socks

  • Make sure the patient is getting up and moving, SCDs/ICDs, compression socks, Lovenox (lose dose Heparin - platelets must be above 100) which patient can refuse but let the doctor know.

How do you prevent a PE?

  • Can be a complication of a DVT

  • Pulmonary embolism

  • Can be from laying around

  • #1 S/S is sudden shortness of breath

Unit 4

Unit 5

Unit 6