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Medical-Surgical Nursing, 10th Ed., Ignatavicius & Workman, 2020 | Registered Nurse (RN) School Study Aid

Pancreas

Acinar Cells Release Digestive Enzymes

Ductal Epithelial Cells Release Bicarbonate

Islets of Langerhans

Beta Cells Release Insulin

Alpha Cells Release Glucagon

Delta Cells Release Somatostatin

Somatostatin Inhibits Alpha and Beta Cells

3 mins

Blood Glucose Lab Value

70-100 mg/dL

25 secs

Hyperglycemia

Insulin Resistance

Too Little Insulin/Medication

Infection/Illness

Corticosteroids

Elevated Blood Glucose

Polyphagia

Polydipsia

Polyuria

Hypotension

Fatigue/Drowsiness

1 min

Insulin

Rapid Acting

Insulin Lispro (Humalog)

Insulin Aspart (Novolog)

Insulin Glulisine (Apidra)

Short Acting

Regular Insulin (Humulin R)

Intermediate Acting

Isophane NPH (Humulin N)

Long Acting

Detemir (Levemir)

Glargine (Lantus)

2 mins

Erectile Dysfunction

Age-Related Changes

Psychological

Medical Conditions

Drug-Induced

Sexual Dysfunction (Unable to Maintain Erection)

Phosphodiesterase Type 5 (PDE5) Inhibitors

Vacuum Constriction Devices

Intraurethral Devices

Penile Implants

Sexual Counseling

2 mins

Blood Pressure Classification (JNC 7)

Normal

Systolic (<120)

Diastolic (< 80)

Prehypertension

Systolic +20 (120-139)

Diastolic +10 (80-89)

Stage 1 Hypertension

Systolic +20 (140-159)

Diastolic +10 (90-99)

Stage 2 Hypertension

Systolic + > 20 (160)

Diastolic + > 10 (100)

Hypertensive Crisis

Systolic > 180

Diastolic > 110

4 mins

Hypertension Assessment

Essential Hypertension

Secondary Hypertension

Headache

Vision Changes

Nosebleed (Epistaxis)

Chest Pain

Syncope (Fainting)

Average 2 Sets, 2 Minutes Apart

After 2 or More Visits (within 1-4 weeks)

Take BP Both Arms

Common in African Americans

2 mins

Hypertension Intervention

Weight Reduction and Exercise

Diet Changes

Relaxation Techniques

Smoking Cessation

Medications

Encourage Self Monitoring

1 min

Metabolic Syndrome

Dyslipidemia

Central Obesity

Insulin Resistance

Hypertension

Increased C-Reactive Protein (CRP)

Increased Fibrinogen

Increased Risk Cardiovascular Disease

1 min

Diabetes Assessment

Juvenile Onset

Absent Insulin Production

Ketosis Prone

Adult Onset

Insulin Resistance

Obesity

Onset During Pregnancy

Glucose Intolerance

Retinopathy

Peripheral Vascular Disease

Nephropathy

Neuropathy

2 mins

Oral Glucose Tolerance Test (OGTT)

Used for Diabetes Screening

Fasting State

Baseline

Normal < 100 mg/dL

30 and 60 Minutes

Normal < 200 mg/dL

120 Minutes

Normal < 140 mg/dL

2 mins

Hemoglobin A1c Lab Value

4-6%

1 min

Diabetes Interventions

Early Diagnosis

Insulin

Oral Hypoglycemics

Glucose Monitoring

Routine Exercise

Diabetic Diet

Monitor for Complications

Insulin Therapy

Diabetic Ketoacidosis (DKA)

2 mins

Chlorpropamide and Tolbutamide (Orinase) (1st Generation Sulfonylureas)

1st Generation Sulfonylureas

Stimulate Release of Insulin

Type 2 Diabetes

Hypoglycemia

Possible Cardiovascular Toxicity

Weight Gain

Exacerbated Hypoglycemia with Beta-blockers

Avoid During Pregnancy and Breast Feeding

Avoid Alcohol

2 mins

Glyburide and Glipizide (2nd Generation Sulfonylureas)

2nd Generation Sulfonylureas

Blocks Potassium Channels in Beta Cells

Stimulate Release of Insulin

Type 2 Diabetes

Hypoglycemia

More Potent

Beta Blockers Reduce Effects

Avoid Alcohol

Avoid Breastfeeding

2 mins

Repaglinide and Nateglinide (Meglitinides)

Meglitinides

Increased Insulin Release

Type 2 Diabetes

Hypoglycemia

Eat Within 30 Minutes

Gemfibrozil Increases Risk of Hypoglycemia

Short Half-Life

2 mins

Metformin (Glucophage)

Decrease Glucose Production

Increase Insulin Sensitivity

Type 2 Diabetes

Polycystic Ovary Syndrome (PCOS)

GI Distress

Decreased Appetite

Lactic Acidosis

IV Contrast

Limit Alcohol Consumption

2 mins

Pioglitazone (Thiazolidinediones)

-glitazones Suffix

Binds PPAR-Gamma

Decreases Insulin Resistance

Type 2 Diabetes

Weight Gain

Heart Failure

Myalgia

Hypoglycemia

Upper Respiratory Infection

Increased Risk of Bladder Cancer

Increased Fracture Risk in Women

Monitor Liver Enzymes

2 mins

Acarbose (Precose) and Miglitol (Glyset) (Alpha Glucosidase Inhibitors)

Alpha Glucosidase Inhibitors

Delays Absorption of Carbohydrates

Type 2 Diabetes

Flatulence

Diarrhea

Anemia

Cramps

Monitor LFTs

Oral Glucose for Hypoglycemia

2 mins

Exenatide (Byetta)

Incretin Mimetic

GLP-1 Synthetic Analog

Type 2 Diabetes

Hypoglycemia

Nausea and Vomiting

Diarrhea

Thyroid Cancer

Pancreatitis

Renal Failure

(Give Exenatide) One Hour After Other Medications

Adjunct Therapy

3 mins

Sitagliptin (Januvia) and Saxagliptin (Onglyza) (DPP-4 Inhibitors)

-gliptin Suffix

DPP-4 Inhibitor

Increases Insulin Release

Type 2 Diabetes

Pancreatitis

Upper Respiratory Infection and Inflammation

Stevens-Johnson Syndrome

Used as Add-on Agents

2 mins

Pramlintide (Symlin)

Synthetic Amylin Analog

Diabetes Type 1 and 2

Supplement Mealtime Insulin

Nausea

Skin Reactions at Injection Site

Hypoglycemia When Combined with Insulin

Delayed Absorption of Oral Drugs

2 mins

Mixing NPH and Regular Insulin for Injection

Verify Order

Roll NPH Insulin

Alcohol to Multiuse Vials

Inject Air into NPH Insulin (Cloudy)

Inject Air into Regular Insulin (Clear)

Withdraw Regular Insulin Units

Withdraw NPH Units

Verify with 2nd Nurse

Discard if Error

3 mins

Dawn Phenomenon

Increased Hormone Production

Hyperglycemia Upon Awakening

Long-Acting Evening Insulin

Change Administration Times

Insulin Pump

Closely Monitor Glucose Levels

Between 2-6AM

Limit Carbohydrates Before Bedtime

2 mins

Cyclosporine (Sandimmune) Overview

Immunosuppressant

Inhibits Calcineurin, Decreasing IL-2

Prevent Transplant Rejection

Psoriasis

Rheumatoid Arthritis

Monitor Plasma Levels

Avoid Grapefruit Juice

Increased Risk of Lymphoma

2 mins

Cyclosporine (Sandimmune) Side Effects

Nephrotoxicity

Hepatotoxicity

Infection

Hypertension

Hirsutism

Tremor

Hyperkalemia

Hypomagnesemia

Gingival Hyperplasia

1 min

Tacrolimus (Prograf) Overview

Immunosuppressant

Inhibits Calcineurin, Decreasing IL-2

Transplant Rejection

Atopic Dermatitis

Increased Lymphoma Risk

Avoid Grapefruit Juice

1 min

Tacrolimus (Prograf) Side Effects

Nephrotoxicity

Neurotoxicity

GI Distress

Infection

Hypertension

Hyperkalemia

Hyperglycemia

1 min

Pressure Ulcers

Prolonged Immobilization

Neurologic Disease

Decreased Level of Consciousness

Stage 1: Intact Skin with Non-blanchable Erythema

Stage 2: Partial Thickness Skin Loss

Stage 3: Full-thickness Skin Loss without Fascial Involvement

Stage 4: Full-thickness Skin Loss with Fascial Involvement

Wound Care

Surgery

Septicemia

Osteomyelitis

Prevention

3 mins

Care for the Visually Impaired

Decreased Visual Acuity

Snellen Chart

Status of Corrective Lenses

Sighted-Guide Technique

Communication

Safe Environment

Medications

Clock Technique for Food

Activities of Daily Living (ADL)

1 min

Angiotensin-Converting Enzyme (ACE) Inhibitors

"-pril" Suffix

Block Renin Angiotensin-Aldosterone System (RAAS)

Hypertension

Heart Failure

Dry Non-productive Cough

Hypotension

Dizziness

Possible Hyperkalemia

Angioedema

Slowly Change Position

Do Not Stop Abruptly

2 mins

Hypoglycemia Assessment

Too much insulin

Decreased glucose

< 70 mg/dL

Change in LOC

Lethargic

Confusion and Irritability

Tremors

Diaphoresis

Tachycardia

Vision Changes

Weakness

Seizures

2 mins

Hypoglycemia Intervention

Mild to Moderate Hypoglycemia

Simple Carbohydrate (Oral Dextrose, Fruit Juice, Candies)

Complex Carbohydrate (Whole Grains, Vegetables)

Severe Hypoglycemia or Unconscious

50% Dextrose

Glucagon

Monitor Blood Glucose Q 10-15 Minutes

Give Small Meal After Intervention

Hypoglycemia Prevention

Encourage Self-Monitoring

3 mins

Glucagon (GlucaGen)

Increases Glucose

Hypoglycemic Emergency

Nausea and Vomiting

Reconstitute Powder

Consume Oral Carbohydrates

50% Dextrose IV (If No Effect)

2 mins

Diabetes Education

Self-Monitoring (Blood Glucose)

SubQ Injection Technique

Lifestyle Changes

Symptoms of Hyperglycemia and Hypoglycemia

Sick Day Care

Foot Care

Exercise Therapy

Medication

1 min

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