2Nd Part Of 2Nd Med/surg Exam

Front 1

Humulin N/NPH, Humulin L/Lente, or pre-mixed Novolin 70/30

Back 1

*Intermediate acting insulin
*controls postprandial hyperglycemia
*Give with meals

Front 2

Timing of intermediate insulin

Back 2

*With meals

Front 3

Onset of Humulin N/NPH, Humulin L/Lente, or premixed Novolin 70/30

Back 3

*2-4 hours

Front 4

Peak of Humulin N/NPH, Humulin L/Lente, or premixed Novolin 70/30

Back 4

*4-10 hours

Front 5

Duration of Humulin N/NPH, Humulin L/Lente, or premixec Novolin 70/30

Back 5

*14 hours

Front 6

Considerations for intermediate acting insulins

Back 6

*Cloudy mixture
*Agitate vial really well

Front 7

What insulin is cloudy?

Back 7

*Intermediate

Front 8

When you have a premixed insulin which number is the short acting insulin?

Back 8

*The 2nd/smaller number

Front 9

Humulin U/Ultralente, Lantus, & Levemir

Back 9

*Long acting insulin
*Do not mix with any other insulin
*Are CLEAR

Front 10

*Considerations with Humulin U/Ultralente, Lantus & Levemir

Back 10

*Lantus and Levemir are both clear but are long acting!
*Shorter experiation date (14 days vs 30)
*Do not mix with any other insulin

Front 11

Time of administration of Humulin U/Ultralente, Lantus, & Levemir

Back 11

*usually at night

Front 12

Onset, peak, and duration of Humulin U/Ultralente, Lantus, & Levemir

Back 12

*last 24 hours.
*Peak and onset are unknown

Front 13

What is insulin concentration?

Back 13

*100units per 100 ml in the US

Front 14

How do we store insulin?

Back 14

*At home it is stored at room temp but in the hospital is is stored in the refrigerator
*keep away from direct sunlight

Front 15

How do we decrease pain of insulin injection for pt in the hospital

Back 15

*set insulin out at room temp for a few minutes
*also this will increase absorbtion

Front 16

What type of syringe do we use to give insulin?

Back 16

*Low does syringe

Front 17

Things to consider when choosing an injection site for insulin

Back 17

*rotate sites
*Avoid muscles that are going to be exercised soon
*We use ETOH but the needle is so small we prolly don't have to--pt may not at home
*Avoid muscle areas
*Don't aspirate
*90 degree angle

Front 18

Can an insulin syringe be reused?

Back 18

*In the hospital no
*Pt may reuse them at home for 2 injections

Front 19

Why shouldn't you give an insulin injection in an area that will be used for exercise?

Back 19

*Because if it gets into a muscle and the pt exercises it it will increase the absorbtion and cause hypoglycemia

Front 20

What type of surgical managment is available for diabetics?

Back 20

*Pacreas-Kidney transplants for type 1 DM

Front 21

Why is the pts pancreas left in with a pancreas transplant?

Back 21

*Because the new pancreas must be placed in the groin area so the old one must be left so that it can still be used for its exocrine function

Front 22

What is the exocrine function of the pancreas?

Back 22

*Secreting digestive enzymes

Front 23

Where is the new pancreas placed with a pancreas transplant?

Back 23

*In the iliac artery in the groin with anastamosis (connection)

Front 24

What happens to the insulin that the pancreas secretes with a pancreas transplant?

Back 24

*It goes into systemic circulation

Front 25

Where do the digestive enzymes from a new pancreas go with a pancreas transplant?

Back 25

*Drains from pancreatic duct into the bladder

Front 26

Why does a pt that recieves a pancreas transplant need a kidney transplant as well?

Back 26

*Because pts with DM have kidney issues
*Pt that recieves a transplant will have to be on antirejection meds
*Antirejection meds are filtered in the kidneys

Front 27

What does hyperglycemia result from?

Back 27

*Insulin defiency
*Decreased glucose utilization

Front 28

What do pts with DM have an increased need for energy?

Back 28

*Increased fat mobilization
*Increased protein utilization

Front 29

What type diabetics have an increased need for energy?

Back 29

*Type 1
*Type 2 if body is over stressed it will increase the need for insulin

Front 30

What happens when ketones accumulate in the systemic circulation?

Back 30

*They go to the kidneys resulting in decrease in pH which leads to acidosis

Front 31

What is the blood sugar range for someone in DKA?

Back 31

*300-1500

Front 32

What are the ABG values of someone in DKA?

Back 32

*Low pH
*Metabolic Acidosis
*Low bicarb
*High CO2 at first but them with kussmal respirations it will become low

Front 33

Causes of DKA

Back 33

*Skipped insulin
*To low of a dose of insulin
*Illness
*comiting
*Polyuria

Front 34

What is the most serious problem for a type 1 diabetic?

Back 34

*DKA

Front 35

Clinical manifestations of DKA

Back 35

*Dehydration r/t osmotic diuresis--Polydipsia, polyuria, N/V
*Intracellular K depletion

Front 36

Normal potassium level

Back 36

*3.5-4.5

Front 37

Potassiom levels in pts with DKA

Back 37

*above 4.5 in the beginning

Front 38

Managment of DKA

Back 38

*Rehydration
*correction of electrolyte and acid/base imbalance
*return to a state of CHO catabolism

Front 39

What causes the K to leave the cells in DKA?

Back 39

*The H+

Front 40

What is the problem if there is to much K in the blood?

Back 40

*Heart problems

Front 41

Clinical manifestations of DKA

Back 41

*Metabolic acidosis ABG
*Hyperglycemia
*Fruit odor on breath
*Kussmaul respirations
*Ketonuria
*Decreased LOC
*Warm, dry skin

Front 42

Why do pts in DKA have a fruity smelling breath?

Back 42

*Breathing off ketones

Front 43

*Why do pts in DKA have warm, dry skin?

Back 43

*Dehydration

Front 44

DKA managment

Back 44

*Hydration with NS
*NG tube
*Reverse shock
*Restore K balance

Front 45

How do we rehydrate a pt in DKA?

Back 45

*Isotonic solution (NS) at first
*3-8 liters in first 24 hours
*15-20ml/kg/hour
*If pt has CV or renal dz it will be adjusted

Front 46

Why do pts in DKA need an NG tube?

Back 46

*Decrease LOC increases the risk of aspiration

Front 47

Signs and symptoms of shock

Back 47

*Hypotension
*Tachycardia

Front 48

Why would hydration potentiall cause hypokalemia in the DKA pt?

Back 48

*May move to much K back into the cells and now we dont have enough in the blood
*Will have to use potassium supplements

Front 49

*Why can pt not recieve potassium supplements until they have adequate urine output?

Back 49

*If pt not making urine the potassium will build up and we will be back at hyperkalcemia

Front 50

How often should we monitor K levels with supplements?

Back 50

*Q2 hours at first

Front 51

How soon do we start potassium supplements in the DKA pt?

Back 51

*usually 1-2 hours after we begin fluids
*not until pt has adequate urine output

Front 52

Rules for IV potassium

Back 52

*Can give in a peripheral IV but it will be very painful
*10 MEQ over 1 hour in 100ml NS is usually the order
*NEVER PUSH POTASSIUM-it WILL cause death
*Must recheck K level hourly (or MD order) with KCL drip
*slow it down if you have to give it through a peripheral
*Normally given through a central line or PICC

Front 53

How do we give insulin in the DKA pt?

Back 53

*Through an IV

Front 54

What type of insulin can be given IV?

Back 54

*Short acting

Front 55

How is insulin given IV?

Back 55

*Always with a pump
*IV bolus 0.15 u/kg in ER
*Insulin infusion of 5-10 units/hour (0.1 u/kg/hr)

Front 56

How often do you monitor blood sugar on a pt on an insulin drip?

Back 56

*Q30 minutes at first

Front 57

When blood sugar nears 250 in the pt with DKA what do we decrease the insulin and add D5W?

Back 57

*BS can decrease to fast and cause everything to go back to where it began

Front 58

WHy do we keep the BS around 250 for first 12-24 hours in the pt with DKA?

Back 58

*If we rehydrate to fast the cells will swell and cause cellular edema and cause cerebral edema r/t everything rapidly going into the cell.