By Linda Campbell PhD RN CNS, Marcia A. Gilbert APRN BC CDE, Gary Robert Laustsen PhD ARPN BC
Speed up your mastery of the $64000 wisdom, abilities, and attitudes you must prevail as an RN. You ll locate assurance that encompasses basic suggestions to the most typical demanding situations confronted within the place of work.
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Patients with type 1 DM must take exogenous insulin to survive. If insulin is not given, the patient metabolizes fats for energy, which results in diabetic ketoacidosis (DKA). This type of DM was formerly called insulin-dependent diabetes mellitus (IDDM) or juvenile-onset diabetes mellitus (Fig. 2–10). In type 2 DM the pancreas may still produce insulin but body cells are now resistant to its action. Patients with this type of DM are often obese (particularly in the abdomen), have a strong genetic predisposition to the disorder, and are hypertensive and dyslipidemic.
Figure 2–1 illustrates the cyclical nature of heart failure. Figure 2–2 shows the pathophysiology of heart failure. Improve your understanding of heart failure through visualization of related pathophysiology. Picture the action of myocytes, brain natriuretic peptides (BNPs), and other compensatory mechanisms described in the following paragraphs. O. ↓ SBP ↓ Renal perfusion Myocardial dysfunction and cardiac remodeling F I G U R E 2 - 1 : Cyclical nature of heart failure. O. and ↓ SBP cause activation of baroreceptors at the left ventricle, aortic arch, and carotid sinuses CARDIAC MUSCLE ↑ hypertrophy and dilation ↑ enlarged cells ↓ contractility VASOCONSTRICTION AND FLUID RETENTION ↑ afterload ↑ BP ↑ heart rate (HR).
Press down on the inhaler once. With a spacer, breathe in a few seconds after pressing on the inhaler. Keep breathing in. 3. Hold your breath for 10 seconds or as long as you can. Wait 15–30 seconds, then repeat for a short-acting beta-agonist. ) 4. , albuterol) first, then the inhaled corticosteroid. Always rinse your mouth after taking a steroid inhaler. qxd Table 2–2 8/20/09 10:43 AM Page 33 Drug Classes for the Treatment of Asthma/COPD —cont’d CLASS MOA/INDICATION ADVERSE EFFECTS Hepatic failure Pseudomembranous colitis Smoking Cessation Agents Nicotine (Nicoderm CQ, Nicotrol patch, Nicotrol NS, Nicotrol inhaler) Nicotine polacrilex (Commit lozenge, Nicorette) Asthma, COPD Nicotine replacement therapy Headache, dizziness, palpitations, HTN; local irritation Varenicline (Chantix) Asthma, COPD Nausea, GI upset, sleep disturbance, headache Bupropion (Zyban) Asthma, COPD Dry mouth, insomnia, anxiety, dizziness To maintain evidence-based nursing practice, periodically check clinical guidelines such as the National Heart, Lung, and Blood Institute/ National Asthma Education and Prevention Program (NHLBI/NAEPP) for new drug classes used in the treatment of asthma.