exam part 3
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- Created by: emilymckee05
- Created on: 14-12-22 08:55
what is the therapeutic range for INR?
2.0-3.0. 1.1 or below considered normal
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what does a Prothrombin time test do?
measures the amount of time it takes for a blood sample to clot. INR is a calculation based of a PT test.
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what is a prophylactic treatment?
it intends to prevent disease e.g, apixaban
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What is glycosuria?
glucose in urine
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what are the 3 indicators of DKA?
Hyperglycaemia, metabolic acidosis, large urine output
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what is the criteria for diagnosis for DKA?
blood glucose above 11
ketones above 3/ urine ketones ++ or more
venous pH less than 7.3 and/or bicarb less than 15
ketones above 3/ urine ketones ++ or more
venous pH less than 7.3 and/or bicarb less than 15
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what are normal ketone levels?
0.6 or less
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how does DKA develop?
when your body doesn't have enough insulin to allow sugar into cells for use as energy.
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insulin and glucagon help regulate blood glucose, which gland releases these hormones?
pancreas
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what are normal bicarbonate levels?
22-29
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DKA management?
isotonic saline
glucose containing fluid once bg reduced to 10-15 but no more than 2l in 24hr
bg every 15 mins
monitor/replace electrolytes
sliding scale insulin
glucose containing fluid once bg reduced to 10-15 but no more than 2l in 24hr
bg every 15 mins
monitor/replace electrolytes
sliding scale insulin
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what are the 3 features of Hyperosmolar Hyperglycaemic state (HHS)?
high serum osmolality, hyperglycaemia, dehydration without significant acidosis
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what other factors diagnose hhs?
blood glucose over 33.3
polyuria leading to dehydration and hypovolaemia
polydipsia
electrolyte deficits
vomiting
hyperosmolality with serum reading >320
serum bicarb >15
seizures common
give HYPOTONIC SALINE
polyuria leading to dehydration and hypovolaemia
polydipsia
electrolyte deficits
vomiting
hyperosmolality with serum reading >320
serum bicarb >15
seizures common
give HYPOTONIC SALINE
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what is normal serum osmolality?
275-295
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what 2 diabetic drug groups could result in hypoglycaemia?
insulin
sulfonyurea
sulfonyurea
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signs of hypoglycaemia?
sweating, high hr, confusion, speech difficulty, tremors, nausea, hunger, seizures
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management of hypoglycaemia?
stop any insulins infusions
give 15-20g rapid acting carb, e.g. 5-7 dextrose tabs, 150-200ml fruit juice
read bg levels after 15 mins, if still less than 4 repeat (no more than 3 times)
give 1m of IM glygacon
100ml 20% or 200ml 10% glucose
if above 4 give
give 15-20g rapid acting carb, e.g. 5-7 dextrose tabs, 150-200ml fruit juice
read bg levels after 15 mins, if still less than 4 repeat (no more than 3 times)
give 1m of IM glygacon
100ml 20% or 200ml 10% glucose
if above 4 give
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What is acute kidney injury?
low urine output(oliguria) and rising creatine levels
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name some risk factors for AKI
>60
iodinated contrast media
cardiac/liver disease
diabetes
iodinated contrast media
cardiac/liver disease
diabetes
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what are the 3 causes of AKI
intrinsic (within kidney e.g, sickle cell)
prerenal (decreased renal blood flow)
postrenal (obstruction of urine from kidney)
prerenal (decreased renal blood flow)
postrenal (obstruction of urine from kidney)
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normal potassium?
3.6-5.2, above 5.5= hyperkalaemia
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normal creatine?
55-100
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normal urea?
2.5-6.6
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Management of hyperkalaemia
ABCDE, 12 lead ECG, telemetry if potassium >6.
if severe, potassium >6.5 give IV calcium, insulin, glucose IV, salbutamol nebulised.
if severe, potassium >6.5 give IV calcium, insulin, glucose IV, salbutamol nebulised.
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what does a hyperkalaemia ECG look like?
wide QRS complex, peaked t-waves, diminished p-wave.
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why is calcium, insulin and salbutamol good in hyperkalaemia?
sodium?
sodium?
calcium calms the heart
insulin and salbutamol moves potassium into cells and removes it from blood.
if doesn't work give sodium. moves potassium to intestine for poo x
dialysis last resort
insulin and salbutamol moves potassium into cells and removes it from blood.
if doesn't work give sodium. moves potassium to intestine for poo x
dialysis last resort
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what are the causes of intestinal obstruction?
adhesions
hernia
tumour
volvulus
diverticular
hernia
tumour
volvulus
diverticular
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how do you prevent post-op complications?
meds for blood clots
TED stockings
PCA
Antibiotics
drains
ECG
NEWS
bloods
TED stockings
PCA
Antibiotics
drains
ECG
NEWS
bloods
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pt has pain in lower right region?
appendicitis
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pt has pain in the lower left region?
diverticulitis
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what is sepsis?
bodies extreme response to an infection
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who are at risk of getting sepsis?
old and frail >75
young<1
pregnant
women how have had a termination
patients with catheters, lines
ppl with impaired immune systems
ppl with diabetes
ppl who had surgery/serious illness
young<1
pregnant
women how have had a termination
patients with catheters, lines
ppl with impaired immune systems
ppl with diabetes
ppl who had surgery/serious illness
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where does it mainly come from and what are the 2 most common?
bacterial infections
pneumonia
uti
pneumonia
uti
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what is neutropenic sepsis?
whole body reaction to infection. happens when you have low neutrophils and an infection at the same time
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what is septic shock?
sepsis and persistent hypotension requiring vasopressors to maintain mean arterial pressure greater than or equal to 65, and lactate greater than or equal to 2.
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what is the sepsis 6?
oxygen
blood cultures
IV antibiotics
IV fluid challenge
measure lactate
measure urine output
blood cultures
IV antibiotics
IV fluid challenge
measure lactate
measure urine output
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signs of sepsis
s=slurred speech
e=extreme shivering or muscle pain
p=passing no urine
s=severe breathlessness
I= i feel like im gonna die
s= skin mottled or discoloured
e=extreme shivering or muscle pain
p=passing no urine
s=severe breathlessness
I= i feel like im gonna die
s= skin mottled or discoloured
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what timeframe should the sepsis 6 be delivered in?
1 hour
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what bloods do you take with sepsis?
cultures, u+e, fbc, crp, clotting, glucose, lactate
consider lumbar puncture
consider lumbar puncture
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what are the 3 components of the GCS
eyes verbal motor, 4,5,6
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Other cards in this set
Card 2
Front
what does a Prothrombin time test do?
Back
measures the amount of time it takes for a blood sample to clot. INR is a calculation based of a PT test.
Card 3
Front
what is a prophylactic treatment?
Back
Card 4
Front
What is glycosuria?
Back
Card 5
Front
what are the 3 indicators of DKA?
Back
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