NURS 640 EXAMS SCRIPT ALL QUESTIONS AND
ANSWERS SURE A+
✔✔osteomyelitis evaluation - ✔✔•Infection severity
•Medical stability: Can treatment await cultures ?
•Risk of specific organisms (ex: MRSA)
•Complications: Sepsis, Increased local malignancy development risk
✔✔osteomyelitis management - ✔✔Antibiotic therapy
-Based on cultures, when possible
-Initially broad-spectrum empiric therapy
-S. aureus
•Parenteral treatment of MRSA
•Parenteral vs. oral treatment MSSA
-Prolonged therapy (6 weeks or more)
Debridement
Other surgeries:
-Infected hardware removal
-Neurosurgery vertebral stabilization / other interventions
Monitoring adverse events
-Antibiotic related
-Medical comorbidities impacting metabolism
-Bone / tissue destruction (ex: spine)
✔✔Diabetes mellitus type 1 - ✔✔-auto-immune disease
- often diagnosed by early adulthood
- absolute insulin deficiency
✔✔Diabetes mellitus type 2 - ✔✔- insulin resistance
- black, american indian, and hispanic have increased risk
,- risk increases with age/obesity
✔✔Other diabetes types - ✔✔- steroid induced hyper gly: potentially early sign of
developing type 2
- stress induced hypergyl: potentially early sign of type 2
- gestational diabetes: occurs only in prgnancy, increases risk of development of tpe 2
- other: medications
- prediabetes: increased risk of type 2 DM
✔✔DM complications - ✔✔chronic hypergly
- microvascular and microvascular damage to organs: eyes, kidneys, extremities,
coronary/cerebral arteries, skin
acute excessive hypergly
- DKA
-hyperglycemic hyperosmolar state (HHS)
- absolute (T1) or relative (T2)
✔✔DM older adults - ✔✔increased T2 prevalence
higher rates of complication adn comorbid disease
- macrovascular: CVD, PVD
-microvascular: retinopathy, neuropathy, nephropathy
goals of care differ. higher average glucose may be tolerated in older adults
✔✔Hyperglycemia - ✔✔patients often present asymptomatic
- lack of sx, lack of awareness.
- earlier detection through blood glucose screening.
DM sx correlate to hyperglycemia levels and related effects
glycosuris occurs when BG is 160-180
W DKA or HHS, additional findings specific to these disease stated are present.
✔✔hyperglycemia - subjective - ✔✔- 3 Ps: polyuris, polydipsia, polyphagia
- weakness/fatigue: hyperglycemia causes
- blurred vision: eye response to fluctuate
- prolonged hypergly: weight loss, inc infection, delayed wound healing, impotence
✔✔DM - diagnostic testing - ✔✔Fasting plasma / serum glucose
-"spot check"
-Normal < 100 mg / dL
Glycated hemoglobin A1C
-3 month average blood glucose
, -Normal < 5.7 %
Oral glucose tolerance test (OGTT)
-Glucose rise in response to glucose ingestion
Normal < 140 mg / dL 2 hours post glucose
Urine glucose
-Assumes normal renal glucose threshold
-Positive findings possible in non-DM disorders
-Glycosuria with BG > 160-180
Urine / blood ketones
-Used for diagnosis of DKA
-Urine: ketones
-Blood: beta-hydroxybutyrate acid: Beta-hydroxybutyric acid > 3.0 mmol / L require
hospitalization
✔✔DM monitoring tests - ✔✔Glucose control
- blood glucose
- A1C
- urine ketones (T1 or hx DKA)
- urine glucose (elev BG)
Renal func
- urinary albumin
- serum creatinine
✔✔DM PE chronic - ✔✔overweight/obese
long-standing DM/ hypergly:
- eye: retinopathy, macular edema
-peripheral neuropathy
- peripheral vascular disease
- delayed healing
- chronic infection
-hyperpigmented/hyperkeratotic skin on axilla, groin, back of neck
✔✔DM initial diagnosis - ✔✔- fasting blood glucose >126 x2
- A1C >6.5%
- 2 hr OGTT >200
- +/- sx of hypergly
random BG >200 + hypergly sx (3 Ps)
✔✔DM inital dx based on type - ✔✔DMt1 (hyperglycemia):
-Polyuria, polydipsia
ANSWERS SURE A+
✔✔osteomyelitis evaluation - ✔✔•Infection severity
•Medical stability: Can treatment await cultures ?
•Risk of specific organisms (ex: MRSA)
•Complications: Sepsis, Increased local malignancy development risk
✔✔osteomyelitis management - ✔✔Antibiotic therapy
-Based on cultures, when possible
-Initially broad-spectrum empiric therapy
-S. aureus
•Parenteral treatment of MRSA
•Parenteral vs. oral treatment MSSA
-Prolonged therapy (6 weeks or more)
Debridement
Other surgeries:
-Infected hardware removal
-Neurosurgery vertebral stabilization / other interventions
Monitoring adverse events
-Antibiotic related
-Medical comorbidities impacting metabolism
-Bone / tissue destruction (ex: spine)
✔✔Diabetes mellitus type 1 - ✔✔-auto-immune disease
- often diagnosed by early adulthood
- absolute insulin deficiency
✔✔Diabetes mellitus type 2 - ✔✔- insulin resistance
- black, american indian, and hispanic have increased risk
,- risk increases with age/obesity
✔✔Other diabetes types - ✔✔- steroid induced hyper gly: potentially early sign of
developing type 2
- stress induced hypergyl: potentially early sign of type 2
- gestational diabetes: occurs only in prgnancy, increases risk of development of tpe 2
- other: medications
- prediabetes: increased risk of type 2 DM
✔✔DM complications - ✔✔chronic hypergly
- microvascular and microvascular damage to organs: eyes, kidneys, extremities,
coronary/cerebral arteries, skin
acute excessive hypergly
- DKA
-hyperglycemic hyperosmolar state (HHS)
- absolute (T1) or relative (T2)
✔✔DM older adults - ✔✔increased T2 prevalence
higher rates of complication adn comorbid disease
- macrovascular: CVD, PVD
-microvascular: retinopathy, neuropathy, nephropathy
goals of care differ. higher average glucose may be tolerated in older adults
✔✔Hyperglycemia - ✔✔patients often present asymptomatic
- lack of sx, lack of awareness.
- earlier detection through blood glucose screening.
DM sx correlate to hyperglycemia levels and related effects
glycosuris occurs when BG is 160-180
W DKA or HHS, additional findings specific to these disease stated are present.
✔✔hyperglycemia - subjective - ✔✔- 3 Ps: polyuris, polydipsia, polyphagia
- weakness/fatigue: hyperglycemia causes
- blurred vision: eye response to fluctuate
- prolonged hypergly: weight loss, inc infection, delayed wound healing, impotence
✔✔DM - diagnostic testing - ✔✔Fasting plasma / serum glucose
-"spot check"
-Normal < 100 mg / dL
Glycated hemoglobin A1C
-3 month average blood glucose
, -Normal < 5.7 %
Oral glucose tolerance test (OGTT)
-Glucose rise in response to glucose ingestion
Normal < 140 mg / dL 2 hours post glucose
Urine glucose
-Assumes normal renal glucose threshold
-Positive findings possible in non-DM disorders
-Glycosuria with BG > 160-180
Urine / blood ketones
-Used for diagnosis of DKA
-Urine: ketones
-Blood: beta-hydroxybutyrate acid: Beta-hydroxybutyric acid > 3.0 mmol / L require
hospitalization
✔✔DM monitoring tests - ✔✔Glucose control
- blood glucose
- A1C
- urine ketones (T1 or hx DKA)
- urine glucose (elev BG)
Renal func
- urinary albumin
- serum creatinine
✔✔DM PE chronic - ✔✔overweight/obese
long-standing DM/ hypergly:
- eye: retinopathy, macular edema
-peripheral neuropathy
- peripheral vascular disease
- delayed healing
- chronic infection
-hyperpigmented/hyperkeratotic skin on axilla, groin, back of neck
✔✔DM initial diagnosis - ✔✔- fasting blood glucose >126 x2
- A1C >6.5%
- 2 hr OGTT >200
- +/- sx of hypergly
random BG >200 + hypergly sx (3 Ps)
✔✔DM inital dx based on type - ✔✔DMt1 (hyperglycemia):
-Polyuria, polydipsia
