Exam 3 Study Materials
1. What does a HgbA1C tell us?
It measures our average glucose over a 3 month period and shows good glycemic control
<7 for diabetic patients
<6 for non diabetics
2. How long does NPH take to peak?
4-12 hours
3. In a diabetic patient, there are a lot of things that require follow-up
Hypoglycemia is important to report in diabetic patients, PRIORITY
Hypoglycemia S/S: Sweating, clammy, irritable, shaky (PRIORITY ISSUE)
Fix low blood sugar before anything else
4. Sick day teaching.
S (Sugar): Check blood sugar every 4 hours
I (Insulin): Give Insulin on time, every time; continue taking insulin/diabetic meds
C (Carbs): Strick usual meal plan times, increase fluid intake and rest. Report vomiting, fruity odor on breath
(ketoacidosis), kussmal respiration (deep/rapid breaths), decreased LOC, or persistent hyperglycemia
K ( Ketones): Check urine ketones at each void or if glucose is >240
5. Know how to mix regular and NPH (In order)
-Inject air into NPH (cloudy)
-Inject air into Regular (clear)
-Draw up Regular (clear)
-Draw up NPH (cloudy)
6. What does elevated creatinine levels show?
Kidneys aren’t functioning properly
7. Diabetic foot care
Nothing between the toes, no petroleum jelly, clip nails straight across
Don’t wear same shoes 2 days in a row, will rub in same spot and create a sore
Check feet everyday
Shoes should be soft like leather and well fitting, not too tight, NO SANDALS
Wash feet in luke warm water, but don’t soak feet
8. Know how to prime an insulin pen
(Prime the needle with a drop of insulin)
Take off inner cap
Turn dose knob to 2
Hold pen straight up
Tap insulin window (checking for air bubbles)
(If there are air bubbles, they will move to top)
Press knob on bottom and hold until you see insulin coming out of needle
If you don’t see insulin coming out, then repeat priming steps again
9. If someone who has diabetes is at home and becomes unconscious, what would you give them?
Glucagon (Given IM or SQ), then call 911
10. When administering insulin on sliding scale, would you give in addition to other insulin or by itself?
In addition to other insulin
11. Somogyi effect (Rebound effect)
(Normal blood sugar at bedtime, low blood sugar overnight, high blood sugar in the morning)
Make sure to have a snack before bedtime
Rebound hyperglycemia due to a drop in glucose levels overnight because of evening insulin administration.
As a result – glucagon is released by the pancreas, the liver releases glucose, thus, causing hyperglycemia in the
morning.
Treat by decreasing the evening insulin dose and/or provide the patient with a bedtime snack of complex carbs. Calm
pt = complex
12. If you have had (femoral) surgery, what is important regarding assessment?
Distal pulse checks (checks for perfusion), increase pain, temperature of skin
, Exam 3 Study Materials
13. Signs/symptoms of Left sided Heart Failure
*Any issues with the lungs*
Confusion (low oxygen), altered mental status
Paroxysmal Nocturnal Dyspnea (sensation of SOB that awakens the patient after 1-2hrs of sleep)
Orthopnea (discomfort when breathing while lying down flat)
Tachycardia
Weakness
Fatigue
Dizziness
Acute Confusion (indicates low oxygen)
Breathlessness
Oliguria (abnormally small amounts of urine)
S3 Ascites
Crackles
14. Signs/symptoms of Peripheral Artery Disease
Stage 1: Asymptomatic, poss. Decreased pedal pulses
Stage 2: Intermittent claudication (ischemia/lack of blood flow) with exercise, relieved with rest
Stage 3: Ischemic pain at rest. Gets worse with elevation of leg
Stage 4: Necrosis/gangrene. Ulcers may blacken with odor
Cool or cold foot
Bad wound healing
Edema
Poor perfusion, Decreased or absent pulses
Atrophy of skin
Hair loss
Pallor with elevation
Dependent Rubor- red colored skin
Pain, numbness
15. Know what v-fib looks like and what to do
CHECK PULSE FIRST, then De-fib
16. Know how to identify symptomatic bradycardia.
Measure the HR and give Atropine
17. Know how to measure heart rate and rhythm
Always count the rate first, and then the rhythm
Count QRS complexes in a 6 second strip and multiply by 10 to get the HR
HR <60 = Sinus Bradycardia
HR 60-100 = Normal Sinus Rhythm
>100 = Sinus Tachycardia
PR interval = 0.12-0.20 (Atrial depolarization)
QRS interval = 0.08-0.12 (Ventricular depolarization)
T wave = Ventricular repolarization
18. Know Furosemide (Look in Davis drug guide, know what is in RED)
1. What does a HgbA1C tell us?
It measures our average glucose over a 3 month period and shows good glycemic control
<7 for diabetic patients
<6 for non diabetics
2. How long does NPH take to peak?
4-12 hours
3. In a diabetic patient, there are a lot of things that require follow-up
Hypoglycemia is important to report in diabetic patients, PRIORITY
Hypoglycemia S/S: Sweating, clammy, irritable, shaky (PRIORITY ISSUE)
Fix low blood sugar before anything else
4. Sick day teaching.
S (Sugar): Check blood sugar every 4 hours
I (Insulin): Give Insulin on time, every time; continue taking insulin/diabetic meds
C (Carbs): Strick usual meal plan times, increase fluid intake and rest. Report vomiting, fruity odor on breath
(ketoacidosis), kussmal respiration (deep/rapid breaths), decreased LOC, or persistent hyperglycemia
K ( Ketones): Check urine ketones at each void or if glucose is >240
5. Know how to mix regular and NPH (In order)
-Inject air into NPH (cloudy)
-Inject air into Regular (clear)
-Draw up Regular (clear)
-Draw up NPH (cloudy)
6. What does elevated creatinine levels show?
Kidneys aren’t functioning properly
7. Diabetic foot care
Nothing between the toes, no petroleum jelly, clip nails straight across
Don’t wear same shoes 2 days in a row, will rub in same spot and create a sore
Check feet everyday
Shoes should be soft like leather and well fitting, not too tight, NO SANDALS
Wash feet in luke warm water, but don’t soak feet
8. Know how to prime an insulin pen
(Prime the needle with a drop of insulin)
Take off inner cap
Turn dose knob to 2
Hold pen straight up
Tap insulin window (checking for air bubbles)
(If there are air bubbles, they will move to top)
Press knob on bottom and hold until you see insulin coming out of needle
If you don’t see insulin coming out, then repeat priming steps again
9. If someone who has diabetes is at home and becomes unconscious, what would you give them?
Glucagon (Given IM or SQ), then call 911
10. When administering insulin on sliding scale, would you give in addition to other insulin or by itself?
In addition to other insulin
11. Somogyi effect (Rebound effect)
(Normal blood sugar at bedtime, low blood sugar overnight, high blood sugar in the morning)
Make sure to have a snack before bedtime
Rebound hyperglycemia due to a drop in glucose levels overnight because of evening insulin administration.
As a result – glucagon is released by the pancreas, the liver releases glucose, thus, causing hyperglycemia in the
morning.
Treat by decreasing the evening insulin dose and/or provide the patient with a bedtime snack of complex carbs. Calm
pt = complex
12. If you have had (femoral) surgery, what is important regarding assessment?
Distal pulse checks (checks for perfusion), increase pain, temperature of skin
, Exam 3 Study Materials
13. Signs/symptoms of Left sided Heart Failure
*Any issues with the lungs*
Confusion (low oxygen), altered mental status
Paroxysmal Nocturnal Dyspnea (sensation of SOB that awakens the patient after 1-2hrs of sleep)
Orthopnea (discomfort when breathing while lying down flat)
Tachycardia
Weakness
Fatigue
Dizziness
Acute Confusion (indicates low oxygen)
Breathlessness
Oliguria (abnormally small amounts of urine)
S3 Ascites
Crackles
14. Signs/symptoms of Peripheral Artery Disease
Stage 1: Asymptomatic, poss. Decreased pedal pulses
Stage 2: Intermittent claudication (ischemia/lack of blood flow) with exercise, relieved with rest
Stage 3: Ischemic pain at rest. Gets worse with elevation of leg
Stage 4: Necrosis/gangrene. Ulcers may blacken with odor
Cool or cold foot
Bad wound healing
Edema
Poor perfusion, Decreased or absent pulses
Atrophy of skin
Hair loss
Pallor with elevation
Dependent Rubor- red colored skin
Pain, numbness
15. Know what v-fib looks like and what to do
CHECK PULSE FIRST, then De-fib
16. Know how to identify symptomatic bradycardia.
Measure the HR and give Atropine
17. Know how to measure heart rate and rhythm
Always count the rate first, and then the rhythm
Count QRS complexes in a 6 second strip and multiply by 10 to get the HR
HR <60 = Sinus Bradycardia
HR 60-100 = Normal Sinus Rhythm
>100 = Sinus Tachycardia
PR interval = 0.12-0.20 (Atrial depolarization)
QRS interval = 0.08-0.12 (Ventricular depolarization)
T wave = Ventricular repolarization
18. Know Furosemide (Look in Davis drug guide, know what is in RED)
