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Which insulin do you draw up first?
regular (clear) or NPH (cloudy)
hint: R . N.
Hypoglycemia episode after insulin administration may mean...
- blood sugar too low & no glucose available in body... it's used up...
- SO ALWAYS CK THE BLOOD GLUCOSE B4 ADMINISTRATION
- maximum effect
- *(low blood sugar)* HYPOGLYCEMIC
Which insulin does not PEAK?
- Long acting...
- ie.: glargine (Lantus) & detemir (Levemir) never...ever MIX them
Which insulin should never be MIXED?
- LONG acting..
- ie.: glargine (Lantus) & detemir (Levemir) no PEAK
ONLY one (1) insulin can be given via IV, which one?
REGULAR (ie.: Humulin R)
Rx used to treat emergency HYPOGLYCEMIC reactions...
- via sub-q, im, iv
Which oral anti-diabetic Rx must be stopped 24-48 hrs b4 & after CT scans or procedures w dyes?
Type 1 diabetes is ? ? ?
always insulin dependent, cannot produce enuf
Type 2 diabetes
adult onset or developed
Genetic or Drug induced diabetes
w certain genetic diseases or drug induced; chemicals
DO: Every 5ml/dl over 150 finger stick give 1 unit of REG. insulin... Pt finger stick (203). How much do you administer?
- 10.6 = 10u administered
- **NEVER ROUND INSULIN..EVER**
Can you round insulin?
NO NO NO never ! ! !
How are STEROID's (cortisone) related to DIABETES?
Cause blood sugars to INCREASE monitor closely!
Rapid acting insulin types
clear - regular... ie.: lispro (Humalog), aspart (Novolog), glulisine (Apidra).
... 10 - 20 mins
- PEAK... 1 - 3 hrs.
- DURATION... 3 - 5 hrs.
Short acting insulin types
regular...clear (Humulin R) & (Novolin R) ONLY insulins given via IV or sub-Q
ONSET... 30 - 60 mins.
PEAK... 1 - 5 hrs.
DURATION... 5 - 10 hrs.
Intermediate acting insulin types
isophane (NPH) Humulin N & Novolin N, it's reg. insulin & protamine (binding agent) combo.
ONSET... 1 - 2 hrs.
PEAK... 4 - 12 hrs.
DURATION... 16 - 28 hrs.
Long acting insulin types
- glargine (Lantus)
- detemir (Levemir)
- no PEAK
... 1 hr.
DURATION... 24 hrs.
Can you freeze insulin?
How do you store insulin prefilled syringes?
Needle up in a jar of the refrigerator...re: medication will settle to the needle and clog up if store any oth way...
How do you mix & warm insulins?
Roll in hand...DO NOT SHAKE!!!
Name 3 ORAL diabetic Rx?
metformin (Glucophage) - biguanide
glimepiride (Amaryl) - sulfonylurea hypo-use, sulfur agents added
glucagon -emergency use only for hypo-use
metformin (Glucophage) - biguanide
DO NOT INITIATE DURING ...
abnorm. creatine (kidney) levels
What life threatening complication can occur w metformin (Glucophage)?
- Lactic acidosis
- also causes n&v
What are some complications or DO NOT USE IN situations w Sulfonylurea Oral Rx's?
- DO NOT USE IN PT ALLERGIC TO sulfur drugs
- Pt can become hypoglycemic
glucagon assessments b4 administration
- -used in EMERGENCY situations usually
- -if responsive give pt something sweet to eat or drink instead
- -routes: IV, IM, SUB-Q
When taking Steroids/Prednisone (CORTISONE) aka corticosteroids what should be done to minimize stomach upset?
prophylactically take antacids to minimize gastric symptoms.
intranasal corticosteroids help by...
reducing inflammation of nasal passages to allow easier breathing
Corticosteroid Therapy and Potassium what are the issues?
corticosteroid enhances the loss of potassium monitor hbp pt carefully w use
Important anti-inflammatory effect in certain medical situation...
usually given in allergic reaction, rashes, break outs, poison ivy situations
Baseline assessments in CORTICOSTEROIDS
wt, bp, electrolyte/glucose tests, I&O
Glucocorticoids use is...
anti-inflammatory & antiallergenic in nature
immunosuppression, ie.: cancer pt, organ transplantation, etc.
Therapeutic use of GLUCOCORTICOIDS...
- reduce pain and inflammation
- reduce chemotherapy n&v
GLUCOCORTICOID common & adverse side effects...
eletrolyte imbalance, behavior changes, hyperglycemia, delayed wound healing, osteoporosis
Corticosteroids and Immunocompromised pts
certain cancers, organ trnsplantation, autoimmune diseases (ie.: lupus, rheumatoid arthritis)
Does a pt have to be weaned off of Corticosteroid therapy?
Yes, abrupt discontinuation may result in adrenal insufficiency.
Should or is it alright for HYPERTENSIVE pts to take Corticosteroids?
be monitored closely, due to the possible electrolyte imbalance in potassium.
Best way to prevent RHINITIS MEDICAMENTOSA...
prevention... careful administration
What is RHINITIS MEDICAMENTOSA?
REBOUND effect by OVER use of topical (nasal) decongestants
What does a person that works outside a lot w itchy-watery eyes need to take?
ANTI-HISTAMINE...oral administration because there is no REBOUND affect
overuse of nasal/topical decongestants aka rhinitis medicamentosa
An example of a nasal decongestant...
AFRIN...shrinks the tissue
What adverse reaction does sinus Rx/decongestants have on HBP pt's?
increases BP... all decongestants w "D" in their name
What indication tell you that a Rx has a decongestant in it?
"D" included in their name, (ie.: Allegra "D" fexofenadine)
relaxes bronchial tree allowing increased opening of the bronchioles to increase air flow
liqufy mucus by stimulating secretions of natural lubricant fluids
Mucolytic agent actions
- decreases stickiness & viscosity of pulmonary secretions
- ie. Mucomyst (acetylcysteine)
Inhalant Corticosteroid (steroid inhalant)
How does Flovent (fluticasone) steroid inhalant work?
- dialation of the broncho tree
- enhances smooth muscle relaxation
- inhibits inflammatory responses that result from bronchoconstrictions..
- vasoconstriction occurs
- reduces engorged nasal area blood flow
- promotes sinus drainage
- relieves stuffiness/congestion & obstruction
Sympathomimetic Decongestants adverse reactions:
serious effect is hypertension
Most effective cough suppressant
dextromethorphan (as effective as codeine)
Antihistamine aka (Benadryl)-diphenhydramine ...
- counter acts effects of histamine
- does not prevent histamine
- reduces symptoms
Anti-histamines commonly treat...
allergic rhinitis & conjunctivitis
Anti-histamine adverse effects...
- sedative effects
- drying effects
- anticholinergic effects (ie.: dry mouth & skin, blurred vision, constipation, urinary retention)
Corticosteriod Inhalant is
- steroid inhalant
- inhibits inflammatory responses while...
- dilating brono-tree area, allowing steroid to get in effectively
Two medications ordered which one gets administered first... bronchodialator or steroid?
Pt w flu...taking Humibid aka Muccinex (guaifenesin) expectorant 4 therapy of influenza...what instructions are given by the NURSE:
- force fluids to increase/liquefy & loosen mucus secretions
- it has no sedative effect
Antitussive medications act by...
- suppressing cough center in the brain
- loosens bronchial secretions
- ie.: codeine, dextromethorphan
Can a pt w AGINA (chest pain) take Sudafed (pseudoephedrine)?
NO... do not take...NOT SAFE 4 any heart disease/issues
Asthma pt taking Bronchial dialator... GOAL for pt w an appropriate NURSING DX...of activity intolerance.
This pt VITAL SIGNS stay stable w activity
Proventil (albuterol) is a ...
- stimulate smooth muscles in tracheobronchial tree to relax
- opening airway 4 greater vol of air
OTC cold & allergy Rx
- 1st generation antihistamine (alcohol)
- dries runny nose
- helps you sleep
1st GENERATION anti-histamines work by...
- more Rx ingredients to make you sleep
- dries runny nose
??? Calms coughs ???
??? Relieves nasal stuffiness ???
??? Relieves body aches in cold & allergy Rx ???
acetaminophen, occasionally ibuprofen
??? Loosens mucous ???
Some 1st generation oral anti-histamines are:
- diphenhydramine (Benadryl)
- chlorpheniramine (Chlor-Trimeton)
- clemastine (Tavist)
Some 2nd generation oral anti-histamines are:
- loratadine (Claritin)
- cetirizine (Zyrtec)
- reduces inflammation in nasal passages
- decreases nasal stuffiness
- reduces rhinitis, itching, sneezing...
- adverse effect...Nasal burning
NURSING instructions for taking anti-histamines?
- begin taking b4 allergy season begans
- avoid driving/oth. activities w mental alertness needed
- report excessive coughing/lethargy/confusion
Education for pt taking inhalants:
- exhale completely
- hold breath 10 seconds after medication inhaled
- rinse mouth to avoid thrush on tongue
COMMON Lower Respiratory Disease
- COPD - chronic obstructive pulmonary disease
- CALD -chronic airton disease
- Chronic bronchitis
Mucolytic Agents are
- acetylcysteine (Mucomyst)
- loosens, thick viscous bronchial secretion
- mucus becomes thinner
- common adverse reaction: n & v
- serious adverse reaction: bronchospasm
EXPECTORANTS adverse reaction...
ANTI-TUSSIVE adverse reactions:
- dry mouth
Beta-Adrenergic Bronchodilating Agents action:
- stimulate smooth muscle of tracheobronchial tree
- reverse airway constriction
Beta-Adrenergic Bronchodilating Agents serious adverse effects:
- nervousness, anxiety, restlessness
- headache, dizziness, N & V
Anticholinergic Bronchodilating Agents aka (ipratropium bromide) ATROVENT or (tiotropium) SPIRIVA actions are:
- produce bronchodilation
- used w long-term tx of COPD
- common adverse effects: dry mouth, throat irritation
- serious adverse effects: tachycardia, urinary retention, exacerbation of sx
Respiratory Anti-inflammatory Agents act to:
- inhibit inflammatory responses
- use w pt unresponsive to sympathomimetic agents
- prevents sx of asthma
- common adverse effects: hoarseness, dry mouth
- serious adverse effects: thrush (advise pt to rinse mouth out after use)