MARK KLIMEK NCLEX STUDY GUIDE NOTES 2025 Nursing Review Comp

● Acid base gasses ○ ABG interpretation ■ Rule of the B’’s ● If the pH and the Bicarb (HCO3) are both in the same direction then it is metabolic ● Decrease in pH = acidosis ● Increase in pH = alkaline ○ Values ■ Normal pH = 7.35-7.45 ■ Normal Bicarb = 22-26 ■ PaO2 = 80-100 mmHg ■ PaCO2 = 35-45 mmHg ■ SaO2 = 95-100% ○ Signs and symptoms of Acid-Base imbalances ■ As the pH goes, so goes the patient except for potassium (because it will try to compensate) ■ pH UP K+ DOWN (alkalosis) ● Tachycardia ● Tachypnea ● Diarrhea ● Tremors ● Seizure ● Hyperreflexia ● Agitated ● Borborygmi (increased bowel sounds) ● Hypertension ● Palpitations ● Tetany ● anxiety/panic ● Die due to seizure ■ pH DOWN K+ UP (Acidosis) ● Bradycardia ● Bradypnea ● Hypotension ● Decreased lucidity ● Anorexia ● Coma ● Lethargy ● Cardiac arrest ● Suppressed, decreased, falling ● Die due to respiratory arrest ○ Kussmaul (MacKussmaul) ■ Rapid and deep respirations ■ Only seen in metabolic acidosis lOMoAR cPSD| ■ This is a compensatory mechanism ○ Causes of acid-base imbalance ■ First ask “it is lung?’ ● Yes - then it is respiratory ■ Then ask yourself ● Are they over ventilating or under ventilating? ○ If over ventilating - pick alkalosis ○ If under ventilating - pick acidosis ○ Rate has nothing to do with ventilation (high rate and low SaO2 = under ventilating) ○ Low rate and high SaO2 is over ventilating ■ If not lung, then it’s metabolic ● If the patient has prolonged gastric vomiting or suction, pick metabolic alkalosis ● For everything else that isn’t lung pick metabolic acidosis ○ Also, if you don’t know what to pick choose metabolic acidosis ● Alcoholism/any form of abuse ○ Note: remember in psych question if you are asked to prioritize DO NOT forget Maslow! Use the following priorities: ■ Physiological ■ Safety ■ Comfort ■ Psychological ■ Social ■ Spiritual ○ Also, all psych patients start as med surg patient… rule out all feasible med answers before picking psych answers ○ Pain is not the priority, pain falls under the “comfort” ■ We don’t give pain medication until we know what is happening ○ Psychodynamics of Alcoholism ■ The #1 psychological problem in abuse is DENIAL ● Definition: refusal to accept the reality of their problem ● Treatment: ○ Confront it by pointing out to the person the difference between what they say and what they do ○ In contrast, support the denial of loss and grief (BC the use of denial is serving a functioning process) ■ dependency/Codependency ● Dependency: when the abuser gets the significant other to do things for them ● Codependency: when the significant other derives positive self-esteem from doing other things for or making decisions for the abuser ● Treatment: lOMoAR cPSD| ○ Set boundaries (limits) and enforce them. Agree in advance on what requests are allowed then enforce the agreement ○ Work on the self-esteem of the codependent person ■ Manipulation ● Definition: when the abuser gets the significant other to do things for him/her that are not in the best interest of the significant other. The nature of the act is dangerous or harmful to the significant other ● Treatment: ○ Set limits and enforce ○ It's easier to treat than dependency/codependency because nobody likes to be manipulated ○ Wernicke’s (Korsakoff’s) Syndrome- only seen in alcoholism ■ Psychosis induced by Vitamin B1 (Thiamine) deficiency ● Thiamine is necessary for the metabolism of alcohol to occur ■ Primary symptom: amnesia with confabulation (making up stories to fill in memory loss– believe as true) ■ Characteristics: ● Preventable: by giving B1 vitamins ● Arrestable: can stop from getting worse- not imply better ● Irreversible: dementia symptoms don’t get better– only worse ■ Psychotic doesn’t know when they are confabulating and the truth ■ Our goal with dementia is maintenance/slowing of symptoms ○ antabuse/Revia ■ Disulfiram (drugs used for alcoholism) ■ Aversion therapy ● You get a patient to associate something that you want them to stop doing with a very negative experience ■ Onset and duration of effectiveness: 2 weeks ● Take drugs 2 weeks and builds up in blood to a level that when drinking alcohols will become horribly sick; if off for two weeks, will be able to drink without sickness again ■ Patient teaching: avoid ALL forms of alcohol to avoid nausea, vomiting, and possibly death including: ● Mouthwash, aftershave, perfumes/cologne, insect repellant, vinaigrettes (salad dressing), vanilla extract, elixirs (contains alcohol-OTC med), alcohol prep pad, alcohol sanitizers ○ Overdose vs Withdrawal ■ Uppers: MEMORIZE ● Names: ○ Caffeine ○ Cocaine ○ PCP/LSD (psychedelic hallucinogens) ○ Methamphetamines ○ ADHD- adderall/Ritalin lOMoAR cPSD| ○ Bath salts (Cath-Kath) ● signs/symptoms: ○ Tachycardia ○ Hypertension ○ Diarrhea ○ Agitation ○ Tremors ○ Clonus ○ Belligerent ■ Increase in the symptomatology on the violence scale ○ Seizures ○ Exaggerated, shrill, high pitched cry ○ Difficult to console ■ Downers ● Names: everything else ● Signs/Symptoms: ○ Bradycardia ○ Hypotension ○ Constipation ○ Constricted pupils ○ Flaccidity ○ Respiratory arrest ○ Decreased core body temperature ■ Then ask yourself, “Are they talking about overdose or withdrawal?” ● overdose/intoxication ○ “I have too much” ○ Too much upper: everything is UP ○ Too much downer: everything is DOWN ● Withdrawal ○ “I don’t have enough” ○ Too little upper: everything is DOWN ○ Too little downer: everything is UP ○ Drug addiction in the newborn ■ Always assume intoxication (first 24 hours after birth), then after this time assume withdrawal ○ Alcohol Withdrawal Syndrome vs Delirium Tremens ■ Differences: ● Every alcoholic goes through alcohol withdrawal syndrome (AWS) (after 24 hours) ● Only a minority get delirium tremens (DT) ● AWS is not life threatening. DT’s can kill you ● Patients with AWS are not dangerous to themselves or others. Patients with DTS are dangerous to self and others ■ AWS lOMoAR cPSD| ● Semi-private-anywhere ● Regular diet ● Up Ad Lib (no activity restrain) ● Do not restrain ■ DT’s ● Private-near nurses station ● Clear liquids or NPO ● Restricted bedrest (no bathroom privileges) ● Should be restrained (2 point leather restraints) 2 extremity restricted-arm on one side and leg on one, one upper extremity and one opposite lower extremity ■ Both ● Anti-hypertensives ● Tranquilizer ● B1 multi-vitamin (to prevent dementia) ○ Aminoglycosides ■ Think “a mean old mycin” ■ Power antibiotics- to treat severe, life-threatening, resistant infections ● VRE, Gram-negative infections, septic shock, C.diff ■ All aminoglycosides end in ‘mycin’, but not all drugs that end in mycin are aminoglycosides. For example… ● Azithromycin, clarithromycin, erythromycin, thromycin - NOT ● Wanna be mycins have “thro” in them ■ Examples of aminoglycosides: Streptomycin, Cleomycin, Tobramycin, Gentamicin, Vancomycin, Clindamycin ■ Toxic effects: ● The most famous feature of the world's most famous mouse (ears) ○ Toxic effect: ototoxicity ○ Must monitor hearing, balance, tinnitus ● The human ear is shaped like a kidney ○ Toxic effect: nephrotoxicity ○ Monitor: creatinine ■ Best indicator of kidney function ■ 0.6-1.2 mg/dL ○ The number 8 draws inside the ear reminds you of: ■ Cranial nerve 8 (drug toxic to) ■ Frequency of administration: every 8 hours ■ Route of administration ● Give IM or IV ● Do not give PO (not absorbed) except in these two cases: ○ Hepatic encephalopathy ■ Also called liver coma, ammonia-induced encephalopathy ■ When want a sterile bowel lOMoAR cPSD| ■ Due to a high ammonia level ○ Pre-op bowel surgery ■ REMEMBER the military sound off: ● NEOmycin ● KANamycin ● WHO CAN STERILIZE MY BOWEL? NEO KAN ● PO2 bowel sterilizers ○ C.diff ■ Vancomycin ■ Peaks and troughs on these medications ● Reason for drawing TAP levels: narrow therapeutic range (drug is very toxic) ● Time table: ○ Sublingual ■ Trough (lowest): 30 min before next dose ■ Peak (highest): 5-10 minutes after drug dissolve ○ IV ○ IM ○ SQ ○ PO ■ Trough: 30 min before next dose ■ Peak: 15-30 min after drug finished ■ Trough: 30 min before next dose ■ Peak: 30-60 min after drug given ■ Trough: 30 min before next dose ■ Peak: see diabetes lecture ■ Trough: 30 min before next dose ■ Peak: forget about it Calcium Channel Blockers + Chest Tubes ● Calcium channel blockers are like valium for your heart. What does that mean? ○ It relaxes the heart ○ Given when you want to rest the heart ● Calcium Channel Blockers are negative inotropic, chronotropic, dromotropic ○ Relax the heart, calms it down ○ Inotropic = strength of heart ○ Positive inotropic: strong heartbeat ○ Negative inotropic: weak heartbeat ○ Chronotropic: rate of heart beat ○ Positive chronotropic: fast heartbeat ● “AAA”- Antihypertensives, Antianginals, Anti Atrial Arrhythmia ○ Relax the heart and blood vessels decreases BP lOMoAR cPSD| ○ Antianginal drugs- relax the heart and therefore uses less oxygen which removes the agina ○ Anti Atrial Arrhythmia- will treat Atrial flutter, Atrial fibrillation, Premature Atrial contractions, Atrial bigeminy, Supraventricular Tachycardia (SVT) ● Side effects of Calcium Channel Blockers ○ “HNH” ■ Headache and Hypotension ● Names of CCB can be remembered by saying… ○ I sop zem dipine in the Calcium Channel (“zem”, “dipine”, “verapamil/isoptin”) ○ Amlodipine, Nifedipine, Verapamil, Cardizem ■ Cardizem can be given continuous IV drip ● Measure BP before giving CCB ○ Parameters: hold the CCB if the systolic is under 100 ● Cardiac arrhythmia ○ “QRS depolarization” always refers to Ventricular (not atrial, junctional or nodal) ○ “P wave” refers to atrial ○ Asystole means a lack of QRS depolarization (flat line) ○ Atrial flutter: rapid P-wave depolarization in a saw-tooth pattern (flutter) ○ Atrial fibrillation: chaotic P-wave depolarizations ○ V fib- chaotic squiggly line (wide blizzard QRS’s) ○ Premature Ventricular Contractions (PVC) ■ Periodic, wide, bizarre QRS’s ○ Ventricular tachycardia: wide bizarre QRS’s ○ Chaotic always describes fibrillation ○ Bizarre is for tachycardia ● If there are more than 6 PVCs in a minute or in a row or if the PVC falls on the T-wave of the previous beat then you elevate the priority of the PVC patient to “moderate” ● What are the lethal arrhythmias? Asystole and ventricular fibrillation ○ Both of these have no cardiac output which means no brain perfusion ● What are the potentially life-threatening arrhythmias? ○ V-tach ○ A-fib ○ A-flutter ● When dealing with an IV push drug if you don’t know go slow except adenocard ● What is the treatment for V Tach? ○ Lidocaine and Amiodarone ● What is the treatment for PVCs? ○ Lidocaine and Amiodarone ○ For ventricular use lidocaine ● What are the treatments for supraventricular arrhythmias (Atrial)? ○ ABCD ○ Adenocard/adenosine- push in less than 8 seconds ■ Can go into asystole when you push it but they will come out of it ○ Betablocker (end in lol) lOMoAR cPSD| ○ Calcium Channel Blocker ■ Better for people with asthma than Beta Blocker ○ Digitalis/Digoxin (Lanoxin) ● What is the treatment for V-fib ○ You defib ● What is the treatment for AsystolE? ○ Give Epi first then Atropine Chest Tubes ● The purpose for chest tubes is to re-establish negative pressure in the pleural space ● In the pneumothorax, the chest tube removes air ● In the hemothorax, the chest tube removes blood ● In the pneumohemothorax the chest tube removes air and blood ● Report to doctor/RN for a hemothorax: ○ Chest tube is not bubbling- report if it was a pneumothorax ○ Chest tube drained 800 mL in the first 10 hours- report if it was a pneumothorax ○ Chest tube is not draining ○ Chest tube is intermittently bubbling ● When the chest tube is apical (high) for air aka apex ○ 300 ml/hour = bad ○ Not bubbling = bad ● When the chest tube is Basilar (low) for blood aka base (bottom of lung) ○ Not bubbling = fine ○ 200 ml/hour = fine ● How many chest tubes and where for unilateral pneumohemothorax? ○ 2: apical and basilar on side of pneumo ● How many chest tubes and where for bilateral pneumothorax? ○ 2: apical for both ● Unless stated, assume all chest trauma is unilateral ● Do not use chest tubes for pneumonectomy ● In routine, NEVER clamp the chest tube. In emergency CLAMP the chest tube ● What do you do if you kick over the collection bottle? ○ Set it back up (not an emergency) ● What do you do if the water seal breaks? ○ First: clamp it, cut tube away from device ○ Best: submerge the tube under water, then unclamp ● What do you do if the chest tube comes out? ○ First- cover up with a gloved hand ○ Best- cover the hole with vaseline gauze, put a dry sterile dressing on top, tape on 3 sides ● In the best question you only get to do one thing, in a first question you do both, it’s just about determining steps ● If there’s bubbling in the water seal intermittently it is… good ● If there’s bubbling in the water seal and it’s continuous it is… bad (this is a leak) lOMoAR cPSD| ● If there’s bubbling in the suction control chamber intermittently it is… bad (suction is not high enough) ● If there’s bubbling in the suction control chamber continuously it is… good ● Straight catheter is to a foley catheter as a thoracentesis is to a chest tube ● Rules for clamping the tube: ○ Never clamp longer than 15 seconds without Doctor's order use rubber tipped double clamps ● Every congenital heart defect is either TRouBLe or No TRouBLe ○ Causes a lot of problems or it is not big deal at all- there is no in-between ○ TRouBLe ■ If it’s trouble you need surgery now in order to live ■ No trouble you don’t need surgery but may have surgery years later ○ Trouble defect is right to left for blood ■ Also blue ○ No trouble defect is left to right ■ Not blue so they are pink ○ R-L: right to left shunt ○ B: blue ○ All congenital heart defects that start with a “T” are trouble ○ Ex: Truncus arteriosus, Transposition of great vessels, Tetralogy of Fallot, Tricuspid stenosis, TAPZ, Left Ventricular hypoplastic syndrome ● All CHD kids will have 2 things, whether TRouBLe or No TRouBLe.. ○ Murmurs ○ Echocardiogram ● Four defects present in Tetralogy of Fallot are.. ○ VarieD ○ PictureS ○ Of A ○ RancH ○ Ventricular Defect ○ Pulmonary Stenosis ○ Overriding Aorta ○ Right Hypertrophy Infectious Disease and Precautions ● What are CONTACT precautions used for? ○ Herpes, Enteric (Rotavirus, Shigellosis), Staph (MRSA), RSV (transmitted via droplet but contact because kids put mouths on everything), C.diff, Hepatitis A, Cholera, Dysentery ○ Used for anything enteric (can be caught from intestine- fecal oral) ○ CONTACT PRECAUTIONS: private room (is preferred), gloves, gown, handwashing, disposable supplies (BP cuff), stethoscope can be taken from room to room as long as sterilized after use ● Standard, Universal, Contact, Droplet, and Airborne lOMoAR cPSD| ● What is droplet prevention used for? ○ Influenza (H1N1), Meningitis, Diphtheria, Pertussis, Mumps ○ DROPLET PRECAUTIONS: private room, mask (most important), gloves, handwashing, pt wear mask when leaving room, disposable supplies ● What are airborne precautions used for? ○ Measles, TB (spread via droplet), Chicken Pox (Varicella), SARS ○ AIRBORNE PRECAUTIONS: private room (door closed), mask, gloves, gown (more for contact), handwashing, special filter mask (for TB only), pt wear mask when leaving room, disposable supplies, negative air flow, everyone that enters the room must wear a mask ● Unless otherwise specified, assume that PPE includes: gloves, gowns, goggles, and masks ● The proper place for donning PPE is outside the room and doffing PPE is inside the room ● The proper order for donning PPE is: ○ Gown ○ Mask ○ Goggles ○ Gloves ● The proper removing PPE is: ○ Gloves ○ Goggles ○ Gown ○ Mask Crutches, Canes, Walkers and Psychiatry ● Crutches, Canes, Walkers ○ One of the major human function is locomotion; pt teaching for use of crutches, canes, and walkers is important ○ For unstable gaits whose muscles are weak and who require a reduction in the load on weight-bearing structures ● Crutches ○ How to measure the length of crutches? ■ It’s important for risk reduction to avoid nerve damage during ambulation ■ Measured by: ● Holding it vertically and placing the tip on the ground ● Having 2 to 3 fingers widths between the pad and the anterior axillary fold (underarm) ● The tip is located to a point lateral (6 inch) and slightly in front of foot (6 inches) ■ Rule out landmarks on foot or axilla ○ Hand grip measurement ■ The angle of elbow flexion is 30 degrees ■ The wrists should be at the level of the handgrip ○ How to teach crutch gaits? ■ 2 point gait lOMoAR cPSD| ● Move a crutch and opposite foot together, then the other foot together ● Together (right leg + left crutch) - together (left leg + right crutch) ● For mild bilateral leg weakness ■ 3 point gait ● Move 2 crutches and bad leg together, followed by unaffected leg ● The gait goes 3-1, 3-1, 3-1 ● The affected (bad) leg is not on the ground ● The unaffected (good) leg is on the ground ● When one leg is affected ■ 4 point gait ● Move all 4 separately ● Move one crutch - move opposite foot - followed by other crutch - followed by opposite foot ● Right crutch - left foot - left crutch - right foot ● 4-point gait is very slow but very stable, for severe bilateral leg problems ■ Swing through ● Similar to 3 point gait ● The unaffected foot gets pass the tip of both crutches ● The person may be an amputee or does not bear weight on the leg at all ● Can move really fast ● For non-weight bearing (amputee) ■ Tips ● Use even-point gait for even, odd-point gait for odd ● Even-point gait when weakness is evenly/bilaterally distributed; 2 for mild 4 for severe ● Odd-point fait when one leg is affected; 3 for one leg ● Swing-through for non-weight bearing/amputation ■ Questions: ● Early stages of rheumatoid arthritis? 2-point ● Left ATK amputation post op day 2? Swing through ● Post op day 1, right knee, partial weight bearing allowed? 3-point ● Advanced stages of ALS? 4-point ● Left hip replacement, post op day 2, non-weight bearing? Swing through ● Bilateral total knee replacement, post op day 1, weight bearing allowed? 4-point ● Bilateral total knee replacement, post op 3 weeks? 2-point ■ Stairs with crutches ● “UP with the GOOD, DOWN with the BAD” ● When you go up the stairs, the good foot move up first ● When you go down the stairs, the bad foot move down first ● No matter what, BOTH crutches always move with the BAD leg ○ Cane ■ Hold cane on the unaffected (good) side ■ Advance cane with the opposite side for a wide base of support lOMoAR cPSD| ■ Handgrip should be at the level of wrist ○ Walker ■ Walker should be on the side of the pt ■ “Pt picks it up, sets it down, walks to it” ■ “Hold onto chair, stand up, then grab walker” ■ Don’t tie belongings to the front of the walker, tie them to either side so it won’t tip over ● Psychiatry ○ First thing to ask in psych question: Is the patient psychotic or nonpsychotic ○ Non-psychotic: has insight and is reality-based ■ Technique to use for non-psychotic: good therapeutic communication (look at them as med/surg pts) ■ E.g., “that must be very overwhelming for you”, “how are you feeling?”, “tell me about your current feeling” ■ Look for “reflection, clarification, amplification, restatement” ○ Psychotic: has NO insight and is NOT reality-based ■ They don’t think they are sick but everyone else has problem ■ Psychotic symptoms: delusions, hallucination, illusions ● Delusions: a false, fixed belief/idea/thought with NO sensory component (it’s just a thought) ○ Paranoid: “people are out to kill me” ○ Grandiose: “I’m the president” “I’m the smartest person in the world” ○ Somatic: “I have x-ray vision” “there are worms in my arm”- part of body delusion ● Hallucination: a sensory experience without a referent (nothing is actually there) ○ Auditory (#1), Visual, Tactile, Gustatory, Olfactory ● Illusion: misinterpretation of sensory reality with a referent in reality ○ E.g., “listen, I hear demon voices” while nurses talk and laugh at the nursing station: there is referent - illusions ○ How do you deal with these psychotic patients? ■ FIRST, you should know what TYPE of psychosis they have ■ There are three types of psychosis: functional, dementia, delirium ● Functional psychosis: ○ They can function in everyday life ○ 90% of psychosis falls under this category ○ Schizophrenia, Schizoaffective, major depression (not depression), mania (bipolar pts have depression and mania and they are psychotic in acute mania) ○ Chemical imbalances in the brain ○ They have potential to learn reality (no brain damage) ○ Nurse should teach reality lOMoAR cPSD| ○ 1. Acknowledge feeling, 2. Present reality, 3. Set limits, 4. Enforce these limits ● Psychosis of dementia: actual brain destruction/damage ○ Due to Alzheimer, stroke, organic brain syndrome ○ Anything that says senile/dementia falls in this category ○ They cannot learn reality so don’t present the reality ○ 1. Acknowledge feeling, 2. Redirect them- give them something they can do ○ Do not confuse reality orientation (person, place, time) with presenting reality ● Psychosis of delirium: temporary, sudden, dramatic, episodic secondary to something else (underlying cause should be treated) ○ Loss of reality due to underlying cause (e.g., chemical imbalance) ○ Causes: UTI, thyroid imbalance, adrenal crisis, electrolyte, medications/drugs ○ 1. Acknowledge feeling 2. Reassure about safety and temporariness of their condition ■ Psychotic symptoms ● Flight of ideas: rapid flow of thought ● Word salad: throw words together and toss it out (sicker than flight of ideas) ● Neologisms: make up new words ● Narrow self-concept: refuses to change their clothes or refuses to leave their room - it’s functional, don’t make a psychotic do something they don’t want to; leave them alone! ● Idea of reference: you think everyone is talking about you ■ Dementia hallmark: memory loss, inability to learn ● Acknowledge their feelings first ● Then, reassure, redirect the reality Diabetes ● Diabetes Mellitus: an error of glucose metabolism ● Diabetes insipidus: polyurethane, polydipsia, leading to dehydration due to low ADH ○ Just the fluid part of diabetes mellitus, not the glucose part ● Type I Diabetes Mellitus: ○ Insulin dependent (not producing insulin) ○ Juvenile onset ○ Ketosis prone ● Type II Diabetes Mellitus: ○ Non insulin dependent (body resisting insulin) ○ Adult onset ○ Non ketosis prone ● Signs and symptoms of diabetes mellitus: lOMoAR cPSD| ○ Polyuria (pee a lot) ○ Polydipsia (drink a lot) ○ Polyphagia (eat/swallow a lot) ● Treatment for Type I DM ○ Diet (calories from carbs) ○ Insulin ○ Exercise ● Treatment for Type II DM ○ Diet ○ Oral hypoglycemics ○ Activity ● Diet of Diabetics ○ Calorie (carbs) restriction ○ Need to eat 6x per day - smaller more frequent meals ● Insulin acts to lower blood sugar ● Insulin type: R ○ R = regular, rapid, run (IV) ○ Onset: 1 hour ○ Peak: 2 hour ○ Duration: 4 hour ● Insulin Type: N ○ N = NPH, not in the bag, not so fast, not clear (cloudy) ○ Suspension, not a solution as suspension are cloudy ○ Cannot be given IV drip as you will overdose them ○ Onset: 6 hour ○ Peak: 8-10 hour ○ Duration: 12 hour ● Insulin type: Humalog ○ Insulin lispro ○ Fastest ○ Onset: 15 minutes ○ Peak: 30 minutes ○ Duration: 3 hours ○ Give with meals ● Insulin type: Lantus (Glargine) ○ Long acting ○ Slow absorption ○ No peak- low risk of hypoglycemia so you can safely give at bedtime ○ Duration: 12-24 hours ● With insulin remember: ○ Check expiration date ○ Refrigerate but once open no refrigeration ● Exercise potentiates insulin: if more exercise, you need less insulin. If less exercise, need more insulin lOMoAR cPSD| ● Sick day rules for insulin ○ Take insulin ○ Take sips of water ○ Stay active as possible ● Low blood sugar in Type I DM (insulin shock) is caused by: ○ Not enough food ○ Too much insulin ○ Too much exercise ● Why is low blood sugar in Type 1 DM dangerous? ○ Permanent brain damage ● S&S of low blood sugar in Type 1 DM: ○ Cerebral impairment, vasomotor collapse, cold, clammy, slow reaction time, *drunk in shock* ■ Low BP, tachycardia, labile, tachypnea, ● Treatment for low blood sugar in T1DM: ○ Administer rapidly metabolizable carbohydrate (candy, honey, pop) ○ Ideal combination: sugar and protein ■ Crackers and juice is good ■ Skim milk is good ■ Bottle of coke and candy is bad ● Only want one sugar ○ If unconscious IV D50 IM glucagon ● High blood sugar in T1DM/DKA/Diabetic Coma is caused by: ○ Too much food ○ Not enough insulin ○ Not enough exercise ○ #1 cause is acute viral upper respiratory infection within the last 10 days ● Signs and symptoms of high blood sugar in T1DM/DKA/Diabetic Coma ○ Dehydration ○ Ketones, Kussmaul Breathing, high K+ ○ Acidosis, Acetone breath, Anorexia ● Treatment for High blood sugar in T1DM/DKA/Diabetic Coma ○ Insulin IV R ○ IV rate flow 200 mg/hr ● Treatment for low blood sugar in T2DM ○ Administer rapidly metabolized carbohydrate (candy, honey) ○ Ideal combination: sugar and protein ○ If unconscious IV D50 IM glucagon ● High Blood Sugar in T2DM ○ Called HHNK or HHNC- hyperosmolar, hyperglycemic, non-ketotic coma ○ This is severe dehydration ● S&S of high blood sugar in T2DM ○ Hot, dry, increased HR, decreased skin turgor ● Treatment for high blood sugar in T2DM lOMoAR cPSD| ○ Rehydration ● Long term complications of HHNC are related to: ○ Poor tissue perfusion ○ Peripheral neuropathy ● Which lab test is the best indicator of long-term blood glucose control (compliance/effectiveness/adherence)? ○ Ha1c (average blood glucose over last 90 days) ■ 8 and higher means out of control ■ 6 and lower is good ■ 7 means that they are on the border ● Cold and clammy- get some candy ● Hot and dry- sugar’s high Drug Toxicity/Electrolytes ● What is the therapeutic and toxic levels for Lithium ○ Therapeutic level: 0.6-1.2 ○ Toxic level: greater than or equal to 2 ● What are the therapeutic and toxic levels for Lanoxin (Digoxin)? ○ Therapeutic level: 1-2 ○ Toxic level: 2 ● What is the therapeutic and toxic level for Aminophylline (bronchodilator)? ○ Therapeutic level: 10-20 ○ Toxic level: greater than or equal to 20 ● What is the therapeutic and toxic level for Bilirubin? ○ Therapeutic level (elevated level): 10-20 ○ Toxic level: 20 ● Dilantin (Phenytoin- anticonvulsant) ○ Therapeutic level: 10-20 ○ Toxic level: greater than or equal to 20 ● Kernicterus: bilirubin in the CSF ● Opisthotonos: position of slight extension in neck seen in patients with Kernicterus (bad sign) ○ Happens around a level of 20 ● Dumping Syndrome: post-op gastric surgery complication in which gastric contents dump too quickly into the duodenum ○ Right direction, wrong rate ○ S&S: “drunk”- staggering gait, slurred speech, reaction time delayed, emotionally labile, signs of shock (pale, cold clammy, tachycardic), plus acute abdominal distress (cramping, pain, guarding, protecting, hyperactive bowel sounds (borborygmi), diarrhea) ● Hiatal Hernia: regurgitation of acid into esophagus because upper stomach herniates upward through the diaphragm ○ Wrong direction, correct rate ○ S&S: GERD