NURS 5463 UPDATED EVALUATION EXAM
QUESTIONS AND ANSWERS SURE A+
✔✔Systemic Heparin Therapy - ✔✔Used in the hospital as parenteral infusion
- 80 units/kg initial IV bolus then 18units/kg/hr infusion
- Titrate for aPTT 1.5-2.5 times normal (aPTT 60-85 seconds)
- Check aPTT prior to infusion, 6 hours after starting infusion, & 6 hours after any dose
change
- Reversal: protamine sulfate
- Risk for HIT; Monitor platelets at baseline, daily to every other day
- Ok to use in renal failure
- Do not use if platelets < 50,000
✔✔Systemic Enoxaparin Therapy - ✔✔- 1mg/kg subcutaneous injection
- No reversal agent, protamine may help
- Moderate risk for HIT; Do not use if platelets < 50,000
- Contraindicated in creat clearance <30ml/minute
✔✔Systemic Fondaparinux Therapy - ✔✔- Weight based 5-10 mg subcutaneous
injection
- No reversal agent available
- Low risk of HIT; do not use if platelets < 50,000
- Contraindicated in creat clearance <30ml/minute
, ✔✔Somogyi Effect - ✔✔Nocturnal hypoglycemia ( 3AM) followed by morning (7AM)
rebound hyperglycemia to increase counter-regulatory hormones
*Decrease or discontinue HS insulin, or encourage a snack before bedtime*
✔✔Dawn Phenomenon - ✔✔Morning hyperglycemia (no nocturnal hypoglycemia)
*Increase or add HS insulin*
✔✔Hyperglycemia from Inflammation - ✔✔Elevation in:
pro-inflammation cytokines, tumor necrosis factor-alpha, interleukin 1B, 6, 8, lipid
peroxidation markers, plasminogen activator inhibitors 1 and C-reactive protein
✔✔Total Daily Dose (TDD) of SubQ Insulin - ✔✔*0.4 to 0.6 U/Kg/day*
- Use lower parameter for pts who are *not* on insulin prior to admission
- Use higher parameter for pts who are on insulin prior to admission, obese, or on
corticosteroids
✔✔TDD of SubQ Insulin for Elderly/Renal Failure - ✔✔Can start as low as 0.3 U/Kg/day
✔✔DKA - ✔✔Hallmark: Anion gap metabolic acidosis, hyperglycemia, elevated ketones
in urine and blood
- Beta-hydroxybutyrate (BHB) is best diagnostic for ketones
✔✔HHS - ✔✔Hallmark: Little or no ketoacid accumulation, serum BS frequently > 1000
mg/dL, serum osmolality > 320 but may reach 380 osmol/kg, neurologic abnormalities
are frequently present (coma in 25 to 50 percent of cases)
No ketone in UA, Elevated BUN/CR from volume depletion
✔✔DKA vs. HHS - ✔✔DKA:
- Anion Gap Metabolic acidosis
- Serum Osmo is lower
- Mental status changes
- Abdominal pain can be present
- Water deficit @ 6 liters
HHN:
- Blood sugars > 600 or higher
- Acidosis is not present
- Present with Stupor or coma
- Serum Osmole is > 320 mOsm/kg
QUESTIONS AND ANSWERS SURE A+
✔✔Systemic Heparin Therapy - ✔✔Used in the hospital as parenteral infusion
- 80 units/kg initial IV bolus then 18units/kg/hr infusion
- Titrate for aPTT 1.5-2.5 times normal (aPTT 60-85 seconds)
- Check aPTT prior to infusion, 6 hours after starting infusion, & 6 hours after any dose
change
- Reversal: protamine sulfate
- Risk for HIT; Monitor platelets at baseline, daily to every other day
- Ok to use in renal failure
- Do not use if platelets < 50,000
✔✔Systemic Enoxaparin Therapy - ✔✔- 1mg/kg subcutaneous injection
- No reversal agent, protamine may help
- Moderate risk for HIT; Do not use if platelets < 50,000
- Contraindicated in creat clearance <30ml/minute
✔✔Systemic Fondaparinux Therapy - ✔✔- Weight based 5-10 mg subcutaneous
injection
- No reversal agent available
- Low risk of HIT; do not use if platelets < 50,000
- Contraindicated in creat clearance <30ml/minute
, ✔✔Somogyi Effect - ✔✔Nocturnal hypoglycemia ( 3AM) followed by morning (7AM)
rebound hyperglycemia to increase counter-regulatory hormones
*Decrease or discontinue HS insulin, or encourage a snack before bedtime*
✔✔Dawn Phenomenon - ✔✔Morning hyperglycemia (no nocturnal hypoglycemia)
*Increase or add HS insulin*
✔✔Hyperglycemia from Inflammation - ✔✔Elevation in:
pro-inflammation cytokines, tumor necrosis factor-alpha, interleukin 1B, 6, 8, lipid
peroxidation markers, plasminogen activator inhibitors 1 and C-reactive protein
✔✔Total Daily Dose (TDD) of SubQ Insulin - ✔✔*0.4 to 0.6 U/Kg/day*
- Use lower parameter for pts who are *not* on insulin prior to admission
- Use higher parameter for pts who are on insulin prior to admission, obese, or on
corticosteroids
✔✔TDD of SubQ Insulin for Elderly/Renal Failure - ✔✔Can start as low as 0.3 U/Kg/day
✔✔DKA - ✔✔Hallmark: Anion gap metabolic acidosis, hyperglycemia, elevated ketones
in urine and blood
- Beta-hydroxybutyrate (BHB) is best diagnostic for ketones
✔✔HHS - ✔✔Hallmark: Little or no ketoacid accumulation, serum BS frequently > 1000
mg/dL, serum osmolality > 320 but may reach 380 osmol/kg, neurologic abnormalities
are frequently present (coma in 25 to 50 percent of cases)
No ketone in UA, Elevated BUN/CR from volume depletion
✔✔DKA vs. HHS - ✔✔DKA:
- Anion Gap Metabolic acidosis
- Serum Osmo is lower
- Mental status changes
- Abdominal pain can be present
- Water deficit @ 6 liters
HHN:
- Blood sugars > 600 or higher
- Acidosis is not present
- Present with Stupor or coma
- Serum Osmole is > 320 mOsm/kg
