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med surg notes for week 2, Lecture notes of Legal medicine

North-West College - West CovinaLegal medicine

cool notes and very descriptive to help study

Typology: Lecture notes

2023/2024

Uploaded on 12/16/2024

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julissa-moran-1 🇺🇸

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Jam Notes
Rapid: Attention little girls (Aspart, Lispro, Gluglisine)
o5-15 mins onset (ALL OF THEM SAME ONSET)
oAspart: 1-3 hours peak
DOA: 3-5 hours
oLispro and Glulisine 30-90 min peak
oLispro: DOA: 2-5 hours
oGlulisine: DOA 1-2.5
short acting: Reuben (Regular) insulin: 30 min onset
opeak: 2.5-5 hours
oDOA: Regular insulin 6-8 hours
Intermediate NPH: onset 1-2 hours
o6-12 hours peak
oDOA: 18-24
Long acting: (Detemir): 3-4 hours onset
oDOA: 24 hours
o6-8 hours peak
o(Glargine) 1 hr onset all day, no peak 24 hours
Question on test: glulisine, regular, nph, glargine
Type 1 Diabetes Type 2 Diabetes
Insulin dependent
NO insulin, pancreas doesn’t work
Beta cells(in pancreas) are inside
endocrine
Insulin resistant
Pancreas does not produce enough
insulin
Hyperglycemia Hypoglycemia (more dangerous)
3 P’s (Polydipsia, polyuria, polyphagia)
Moist and warm skin
Weight loss
Hungry, headache, cold and clammy,
sweating, blurry vision, confusion
Milk or sandwich
Weak thready pulse
Nausea and vomiting
Tingleness and numbess of hand and
feet
Tachycardia
Moist(coldclammy skin
Sliding Scale
Big dose: first big dose, then lower dose (higher dose (loading), maintenance dose later
Monitor glucose
Insulin Administration (Pt teaching)
Rotate site: to reduce lipodystrophy Hypertrophy (causing scarring)
Liodystrphy: fat accumulating
Practice quizzes 5-6 times
SUBQ
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Jam Notes  Rapid: Attention little girls (Aspart, Lispro, Gluglisine) o 5-15 mins onset (ALL OF THEM SAME ONSET) o Aspart: 1-3 hours peak  DOA: 3-5 hours o Lispro and Glulisine 30-90 min peak o Lispro: DOA: 2-5 hours o Glulisine: DOA 1-2.  short acting: Reuben (Regular) insulin: 30 min onset o peak: 2.5-5 hours o DOA: Regular insulin 6-8 hours  Intermediate NPH: onset 1-2 hours o 6-12 hours peak o DOA: 18-  Long acting: (Detemir): 3-4 hours onset o DOA: 24 hours o 6-8 hours peak o (Glargine) 1 hr onset all day, no peak 24 hours  Question on test: glulisine, regular, nph, glargine Type 1 Diabetes Type 2 Diabetes  Insulin dependent  NO insulin, pancreas doesn’t work  Beta cells(in pancreas) are inside endocrine  Insulin resistant  Pancreas does not produce enough insulin  Hyperglycemia Hypoglycemia (more dangerous)  3 P’s (Polydipsia, polyuria, polyphagia)  Moist and warm skin  Weight loss   Hungry, headache, cold and clammy, sweating, blurry vision, confusion  Milk or sandwich  Weak thready pulse  Nausea and vomiting  Tingleness and numbess of hand and feet  Tachycardia  Moist(coldclammy skin Sliding Scale  Big dose: first big dose, then lower dose (higher dose (loading), maintenance dose later  Monitor glucose Insulin Administration (Pt teaching)  Rotate site: to reduce lipodystrophy Hypertrophy (causing scarring)  Liodystrphy: fat accumulating  Practice quizzes 5-6 times  SUBQ

 Regular: closer to blood, get into effect right away  NPH: 1 to 2 hours Hyperglycemia: Macrovascular  Affect large blood vessels (brain): can cause heart attack/ stroke, CVA  Microvascular: smaller blood vessels: retinopathy, neuropathy  Glargine(Lantus): never mixed with other insulins o Only given once at bedtime  IV: regular insulin only!  Via pump: type 1 DM o 8 oz of juice for patients  Retinopathy o Seeing spots  Type 2: might not need insulin A1C level: less than 7  DKA patients: give them regular! Metformin  Cant take contrast, can cause acute kidney disease  Slows down glucose production of liver GERD  How to Diagnose: If medication alleviate their symptoms (can be same as heart attack) o Chest pain: give them PPI or H2 blockers, antacids, prokinetics o PPI: neutralizes stomach acid -ozale o H2 blockers: lowers acid production -dine  Taken with meals and at bedtime o Prokinetic(Reglan): works in the brain  Increases peristalsis, stops production of acid, stops vomiting o Antacids: raises stomach ph, to neutralize acid  Give them before meals, 30 mins before eating o If given medications: doesn’t help with symptoms, give them an EKG to help them  Impairs B  Manifestation of GERD: o Heart burn, acid reflux, (burping regurgitation), dyspepsia, halitosis  Endoscopy: camera to check for GERD, sedation needed  Varium swallow: capsule into their esophagus  Certain foods to avoid: fatty, greasy, spicy foods avoided, acidotic, caffeine alcohol  Elevated to sleep 4-6 pillows o Can cause aspiration, asthma o Affect dental erosions, acid