About Insulin
• In the pancreas's islets of Langerhans, beta cells secrete insulin-the islet-cell hormone of major
physiological importance;
• Without sufficient insulin, the body develops diabetes mellitus.
• Exploration of a number of new delivery systems for insulin is ongoing.
• Implanted insulin delivery systems, in combination with a glucose sensor may create an "artificial
pancreas."
• Exercise increases the body's metabolic rate to result in a decrease in blood sugar and an increase in insulin
sensitivity. Signs of hypoglycemia often occur.
• Illness can disrupt metabolic control and raise blood sugar, which results in an increased need for insulin.
• Insulin-dependent clients should be well controlled for at least one week prior to any surgery.
• Special care for any client with either type of diabetes mellitus should be taken to monitor blood glucose
during and after surgery and adjust insulin accordingly.
• After hip replacements, pulmonary embolism may occur even without thrombosis in foot or leg.
• Clients should sit in a straight, high chair; use a raised toilet seat; and never cross their legs.
• In hip or knee replacement, clients will need assistive devices for walking until muscle tone strengthens and
they can walk without pain.
• After an amputation, the home must be assessed for any modifications needed to ensure safety.
• Some clients will need transportation to continue rehabilitation.
• Amputee support groups can help clients and family.
• After arthroscopy, outpatient rehab may be prescribed depending on procedure; health care provider may
prescribe knee immobilizer.
• External Fixator - If possible, prepare the client preoperatively to reduce anxiety. Device looks clumsy, but
patient should be reassured that discomfort is minimal.
• After a hip pinning or femoral-head prosthesis, caution client not to force hip into more than 90 degree of
flexion, into adduction or internal rotation which will cause dislocation and severe pain and this would be a
nursing emergency.
• Caution clients with a new prosthesis not to use any substances such as lotions, powders etc. unless
prescribed by the health care provider.
• Osteoporosis cannot be detected by conventional X-ray until more that 30% of bone calcium is lost.
• Foods high in calcium include milk, cheeses, yogurt, turnip greens, cottage cheese, sardines, and spinach.
• When performing a musculoskeletal assessment on a client with Paget's disease, note the size and shape of
the skull. The skulls of these clients will be soft, thick and enlarged.
• Clients at high risk for acute osteomyelitis are: elderly, diabetics, and clients with peripheral vascular
disease.
• When clients receive corticosteroids long-term, evaluate them continually for side effects.
• Immunosuppressed clients should avoid contact with persons who have infections.
• Steroids may mask the signs of infections, so client should promptly report slightest change in temperature
or other complaints.
• Photosensitive clients should avoid the sun, limit outdoor activities during peak sun hours and wear sun
block.
I.Cardiac Arrest
B.Early defibrillation
3.In adults, the arrhythmia most correctable is ventricular fibrillation if treated promptly
4.Before starting CPR for ventricular fibrillation, call for help
B.
Airway with simultaneous cervical spine immobilization
6.Must use jaw thrust
7.Do not use head-tilt chin-lift: it could injure neck
C.Breathing
8.Look, listen and feel for respirations
9.Follow CPR procedure
D.Circulation
10.Assess pulses
l.carotid pulse: BP at least 60
m.femoral pulse: BP at least 70
n.radial pulse: BP at least 80
11.Stop any active, visible bleeding
II.Trauma Care
CPR
• Early defibrillation is the key to successful resuscitation for many adults.
• Continually reassess during CPR to see if the client regains a pulse or begins breathing. Reassess to see that
the chest moves and pulses are palpable during CPR.
SHOCK
• In shock, the first hour of treatment is most critical. Early detection is key.
• There are different ways to categorize shock. Basically, shock presents three potential problems:
1.Not enough fluid in the blood vessels (hypovolemia) OR
2.Fluid has moved outside the vessels, so cannot be pumped to the organs (distributive) OR
3.Heart cannot pump fluid that is present (cardiogenic)