NURS 3320 MED SURG EXAM 2 {2020} – Northeastern University | NURS3320 MED SURG EXAM 2

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NURS 3320 MED SURG EXAM 2 – Northeastern University Med Surg Exam 2 Management with Diabetes Care of Patient with Diabetes Diabetes • About 26 millions people with diabetes in US alone ... o Huge problem in the US • Many undiagnosed o 1/3 undiagnosed: so not treated • Higher risk population include African American, Native Americans and Hispanic population o Develop complications higher risk of mortality o Complications of unmanaged diabetes:  Non-traumatic ambulation  Blindness  Kidney disease  Heart attack and stroke o Hospitalization rate 2.5 x greater than healthy adults and 5x greater for children Risk Factors • Family History • Obesity • Race/Ethnicity • Age o Over 45 years old • Previously impaired fasting glucose or impaired glucose tolerance • Hypertension o Greater than 140/90 • High cholesterol or triglycerides • Gestational diabetes o Delivered a baby larger than 9 pounds Patho Review • Type 1 and type 2 o Gestational and pre-diabetes • Disease of the pancreas o Islet of Langerhans: endocrine islet cells o Beta cell: secrete insulin o Insulin  Takes glucose in blood to area that need it  Tells livers and muscle cells to form glycogen stores  Enhances stores of dietary fat in adipose tissue  Speeds transport of protein in cells  Inhibits breakdown of stored fat Type 1 Diabetes • No insulin • Insulin dependent, juvenile diabetes, childhood onset • Beta cells are destroyed o Alpha cells release glucagon (release stored glucose) • Little to no insulin production o Insulin is usually always released in small basal amounts • Insulin cannot do its job hyperglycemia occurs • In short: o Beta cells destroyed o Little/no insulin production o Insulin cannot do its job o Hyperglycemia • A metabolic disorder marked by NO insulin production or secretion from the destruction of the beta cells in the islet of Langerhans in the pancreas Type 2 Diabetes • Adult onset or non-insulin dependent diabetes • Most common • Obesity is primary risk • Insulin resistance • Impaired insulin secretion • Risk factors: o Obesity o Growing in children due to obesity • Aspects: o Insulin resistance o Impaired insulin resistance • Pancreases: o Secrete insulin but body can’t utilize it glucose in blood  More insulin secreted  Beta cells cannot keep up • A metabolic disorder marked by insulin resistance and impaired insulin secretion Diagnosing Diabetes • Radom plasma glucose levels of >200mg/dL o At anytime of the day • Fasting plasma glucose levels or > 126mg/dL o No calorie intake for 8 hours • 2 hour post-load glucose =200mg/dL o Oral glucose tolerance test 75 g of anhydrase glucose • Diagnosis is a plasma reading: finger stick Assessing patient with Diabetes • History o Blood sugar history o How much insulin: how does the patient respond o Are they alert and oriented times 3 • VS o Orthostatic hypotension o Hypertension • Pt history o Symptoms related to diagnosis o Hyperglycemic o How often does the pt become hypoglycemic:  How do they treat it  Any certain time during the day o Blood sugar monitoring  How often do they check it  What device do they use o Management of diabetes  Any issues (GI PVD o Diet  Low carb?  How well do they follow diet o Exercise  How often do they exercise  What is their exercise routine o Are the able to follow diabetes treatment o Any complications due to diabetes • Physical exam o Height and weight o Skin assessment, lower extremity  Any neuropathy o Pulses o Neuro checks  Any sensory deficits o Oral exam o Hair distribution o Any open areas or signs of infection o Is there sensation in the toes? o GI:  Bowel sounds  Look at bowel patterns • Keep in minds o Insulin hypodystrophy/ hypertrophy  Fatty deposits or hard areas • Due to injection o Teach rotation of injection site • Labs o Blood glucose monitoring  Hypoglycemia protocol • Juice • Rec-check • Administration of glucagon or IV dextrose o Hemoglobin AIC  Overall picture of management of blood glucose o Fasting lipid o Microalbumin o Kidney  BUN  Creatinin o Urine analysis Goal • Normal Blood Sugar o 70- 100 mg/dL o >180 after eating o Hemoglobin:  AIC: below 7% • Keep blood sugar controlled • Goals: depending on assessment o Compliance of diabetic management • Goals: o Compliance of diabetic regimen o Medical management o Exercise Intervention • Monitor blood sugars o Check before meals, 9am , 3pm • Assessment o Include pt compliance and understanding • Administer insulin o Long acting: maintain basal rate o Rapid acting: for prancial spike o Sliding scale: based on glucose readings • Diabetic diet o 50-60% carbs (whole grains) o 20-30% fats o fiber lowers blood glucose o Exercise: helps maintain healthy weight • Monitor other labs • Pt teaching: o Teach about changing habits o Signs and symptoms of hypo/hyper glycaemia o Maintain diabetic diet o How to administer insulin Pt teaching • How does your patient learn o Brochure o Demonstration o Teach back • Diet: o 2 starch, 3 proteins, 1 veg, 1 fruit, 1 fat, “free item” o Encourage steady low carb diet o Encourage them to keep a log  Document eating  Blood sugar  What insulin used o Limit alcohol consumption - - - - - - - - - - - - - - - - - - - -- o Dark urine • Prevention • Management o Treat symptoms and psycho social issues/concerns o Minimize spread o Minimize damage to liver o Administer anti-viral agents o Make sure getting adequate nutrition o Promote bed rest Hepatitis C • Transmitted via blood and body fluids o No vaccine • Health care workers at risk due to needle sticks • The most common chronic blood born infection • Risk factors o Needle sticks o Sharing needles • Before 1992: blood not screened for Hep C o Children born to Hep C mom at risk • Clinical course o 15-160 day incubation o Symptoms  GI symptoms o Increase risk for cirrhosis and liver cancer o Alcohol makes disease progression worse o Medical treatment: anti-virals Hep D • Delta agent • Assicated with and similar to Hep B o Similar risk factors, incubation o Symptoms: flu like  Likely to develop hepatitc failure • Treatment: o Anti-viral o Rate of re-occurrence is high o Minimize risk factors Hep E • Develop Jaundice • Fecal oral route, similar to A o Contaminated water, poor sanitation • Abrupt onset, self limiting o Has to run its course o Limited treatment • No Chronic Form • Incubation: 15-65 days Nonviral Hepatitis • Toxic Hep o Exposure to chemicals, medications, botanical agents, alcohol, pain relievers, herbs and supplements, industrial chemicals o Recovery may be rapid  removal of the toxic agents o Bad enough exposure leads to fulminant hepatic failure • Drug Induced Hep o Acute liver failure o Onset: chills, fever, rash, nausea, anorexia  Symptoms can go away if drugs stop  Tylenol most common caused • Remove drug and hoping damage can be reversed • High dose of corticosteroids • Fulminant Hepatic Failure o Acute liver failure o As a result of non-viral hepatitis o Develops within 8 weeks of jaundice  Hyper acute, sub acute, and acute o Outcome not great  Potentially reversible  20-50% survival rate Care and Management of Patients with Biliary Disorders Gallbladder • Sac like organ on inferior aspect of liver o When you eat bile is secreted o Gallstone= hardened bile o Blockage: pain when eating • Contains bile, H20, and electrolytes • What if there is an obstruction • Cholithiasis: gall stones • Cholicystitis: inflammation Pancreas • Many endocrine and exocrine function • Alpha cells= glucagon • Beta cells= insulin • Delta cells= somatostatin • Digestive enzymes o Amylase: carbs o Trypsin: proteins o Lipase: fats Gallbladder Disease • Cholecystis o Can be acute or cronic o Inflammation of gallbladder o Obstruction causes gallbladder to fill up can rupture • Cholelithiasis o Gallstones o Build up of bile salts and cholesterol • Risk Factors o Obesity o Multiple pregnancy o Native America, south/west Spanish o Weight fluctuation/ rapid weight loss o High dose estrogen treatment o CF o Diabetes • Clinical Manifestation o Pain in right upper quadrant o Jaundice o Change in urine or stool o Vitamin deficiency • Treatment o Focus on pain o Diagnosed with X-ray/ ultrasound o Surgically remove stones or the gallbladder Pancreatitis • Acute of chronic inflammatory disorder • Auto-digestion of the pancreas o Exocrine function of the pancreas o Hyper secretion due to blockage and digests pancreas instead of food o Risk factors  Choliocistics, viral, bacterial, alcoholism, peptic ulcer, hyper lipidemia, hyper calicemia, steroid use • Medical emergency o Can be fatal • Clinical Manifestation o Severe pain in abdomen and back  Can occur after meals o Abdominal distention o Mass abdomen o Decreased bowel sounds o Rigid board like abdomen o Bruising around umbilicus o Fever o Jaundice • Labs o Increase amalyse and lipase o Hypocalcemia o Hyperglycemia o Gluocseria o Increase bilirubin • Medical Management o Treat symptoms o NPO  Don’t stimulate pancreas o Parental nutrition o Manage pain  Morphine o Critical care/ intensive care o Stent to assist biliary drainage Nursing Management • Nursing is aimed at managing comfort • NPO, maybe NGT o NGT: decompression • Hygiene o Good oral hygiene and mouth care • Skin integrity o Skin assessment • Fluids and electrolytes • Vitals as ordered • Preventing complication o Hemorrhage o Shock The Nursing Process • Assessments o Acute pain o Fluid and electrolyte disturbances o Ineffective breathing patterns • Plan Goals • Interventions to meet goals • Evaluate interventions [Show More]

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