Mr. L is a 58-year-old man who is recovering in the orthopedic unit of the hospital from a right total knee replacement of two days ago. Mr. L has type 1 diabetes and was diagnosed with the condition at 12 years of age. He has been managing his illness with blood glucose checks 4 times a day: before meals and once at bedtime. He currently takes Humulin-R on a sliding scale based on his glucose results. He weighs 315 lbs. and has developed osteoarthritis in both knees, requiring surgical replacement of the knee joint on the right side.
The nurse caring for Mr.L. enters his room at 8:15 AM for a morning assessment. She finds Mr. L lying in his bed awake, but his mental status is altered and there is a fruity odor to his breath. His vital signs are: HR 100bpm, RR 32/minute, BP 116/78 mm Hg. The nurse notes that his last blood glucose level was 156 mg/dl the previous night before bed and he received 2 units of insulin at that time, but he has not received his morning glucose check or any insulin yet today. A rapid bedside glucose check reveals a blood glucose level of 468 mg/dl. The nurse contacts the physician and upon further examination, Mr. L is diagnosed with diabetic ketoacidosis.
Describe how diabetic ketoacidosis could develop in a patient who has undergone surgery.
Mr. L has an elevated respiratory rate that is classified as Kussmaul respirations. Explain this type of respiratory pattern.
Mr. L complains of feeling very thirsty and that he can’t see very well because his vision is suddenly blurry. The nurse notes he has a large amount of clear urine in his catheter bag. She takes a sample of urine and it tests positive for ketone bodies.
How does the body release ketone bodies into the urine when DKA occurs.
Explain why Mr. L would have increased urinary output, blurred vision, and increased thirst.
The physician has given orders to administer 0.9% Sodium Chloride IV at 500 mL/hour for 1 hour, then 200mL/hour for the next 4 hours. The nurse is to start a drip of Regular insulin at 0>1mg/kg/hour. The physician has also added orders for lab work, including a metabolic profile and arterial blood gases. The metabolic panel results are: Na 135 mEq/L, K 3.2mEq/l, CL 95mmol/L, Ca 8.5mg/dl. The arterial blood gases results are as follows: ph 7.31, pCO2 20 mmHg, pO2 95 mmHg, HCO3 12 mmol/L
What is the rationale for the IV fluids to be given at this rate?
Explain why the patient’s potassium result is at the current level?
Based on the metabolic profile results, what is the next step that the nurse would most likely need to perform?
Explain why DKA would most likely produce these types of blood gas results.
An hour after the insulin was started, the nurse checks Mr. L.’s blood glucose levels and notes it has decreased to 208 mg/dl. He appears more comfortable and his vital signs are: HR 92 bpm, RR 22/ minute, BP 116/70mm Hg, O2 saturation 95% on 2L of oxygen.
What should the nurse do next?

Answers

Answer 1

The nurse should advice the patient to get admitted in the hospital one or two days prior to any operation so that he may be put under surveillance before the surgery.

For such patients, it is advised to wait a few days before their scheduled surgery. When possible, even urgent surgery should be postponed to give patients with diabetic crises time to stabilize. The physiologic stressor known as surgery can cause ketoacidosis. Insulin resistance increases as a result of the postoperative upregulation of regulatory hormones such glucagon, growth hormone, and cortisol.

Increased postoperative morbidity and mortality as well as an increased need for surgical operations are all related to diabetes. Perioperative ketoacidosis or hyperosmolar syndrome can arise from the stress response to surgery and the ensuing hyperglycemia, osmotic diuresis, and hypoinsulinemia.

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Related Questions

A couple is getting a married a few months ago.they are required to attend siminars on family planning and what is healthy policy

Answers

A healthy family planning policy encourages couples to have open and honest discussions about their future family planning goals, to consider potential risks and benefits of their chosen method(s) of contraception, and to be aware of their legal rights and responsibilities around family planning decisions. Couples should also be aware of any medical or financial implications that could arise due to their family planning decisions. Additionally, couples should be aware of the resources available to them for helpful guidance about family planning, such as premarital classes, counseling, and support groups.

Which of the following is a specific example of the Mobile Integrated Healthcare (MIH) model? A. patient transport from an acute clinic
B. paramedic giving a vaccine C. emt responds to a woman complaining of a high fever D. emts assess a patient whose lung disease is acting up

Answers

The paramedic administers a patient's flu vaccination is a specific example of the Mobile Integrated Healthcare (MIH) model. Thus, the correct option is B.

What is Mobile Integrated Healthcare model?

Mobile integrated health care (MIH) is a new model of the community-based health care that uses the community paramedics, who work directly with other health care professionals, to provide the needs-based on-site urgent and nonurgent care for the patients.

Integrated care is the model which contributes to improved access to services, fewer unnecessary hospitalizations, and readmissions, better adherence to patient treatment, increased patient satisfaction, health literacy, and self-care, greater job satisfaction for the healthcare workers, and the overall improved health outcomes of the community. An example of mobile integrated healthcare is the paramedic administers a patient's flu vaccination.

Therefore, the correct option is B.

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radio questions film study what is the name of coach jones school

Answers

The name of the coat Jones is Harold Jones that was known as Radio. This movie is about his story of him as coat of TL Hanna High School.

What is the movie "Radio" about?

The movie 'Radio' is a story based on the life of a real person named Harold Jones who works as a football coach at Hanna High School. In the movie, Harold befriends one of his students who suffered from cognitive illness. This young man was known at school as Radio due to his love for listening to the radio. Throughout the film, the relationship between these two characters becomes more friendly, impacting the lives of other characters.

According to the above, the name of the coach of the football team is Harold Jones.

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What are the most common and easiest exercises for everyone to do every day?

Answers

Jumping jacks, they are the most easy exercises for everyone to do every day.
walking and running.

Why is learning about building a physically active lifestyle important for you now and in the future?

Answers

Maintaining a active lifestyle is important to increase your balance to reduce the likelihood of falling and sustaining injuries.

What is a healthy lifestyle?

By adopting new, healthier habits, you may be able to prevent health conditions like diabetes and obesity that pose a life-threatening hazard. By forming new habits like regular exercise and a healthy diet, you may be able to manage your weight and have more energy. If you keep making these changes, they could gradually start to feel natural to you. Engaging in physical activity helps to postpone or prevent aging-related diseases and chronic illnesses. As a consequence, elderly active people live longer and maintain their independence.

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Gloria McGraw, a patient at Broadmoor Medical Clinic, underwent an arthroscopic surgical procedure of her right knee. Dr. Jones's fee for this procedure was $1400; however, the claim payment from her insurance carrier was reduced to $1100 because of UCR provisions. Ms. McGraw doesn't understand why this occurred and asks you to explain. What do you tell her?

Answers

The claims payment from her insurance carrier was reduced to $1100 because of UCR provisions. UCR decides what amount can be paid by the will be charged, it can be less or equal.

What is UCR?

The amount paid in a geographic area for a medical treatment based on what providers in the area typically charge for the same or similar medical service.

The UCR amount is occasionally used to calculate the permissible amount. Amount commonly charged for or covered for similar medically necessary, doctor-recommended, or treatment-required services and supplies.

Therefore, UCR decides what amount can be paid by the will be charged, it can be less or equal.

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Developing healthy habits is easy for individuals with strong willpower and self-discipline

Answers

Answer:

True!

Explanation:

How does the food pyramid accomplish these goals do you think the Food Guide Pyramid is effective?

Answers

The Food Guide Pyramid accomplishes these goals by encouraging people to eat a variety of foods from the base of the pyramid to the top. The Food Guide Pyramid is effective because it encourages people to make healthier choices and eat a balanced diet.
The Food Pyramid shows how much of what you eat overall should come from each shelf to achieve a healthy, balanced diet. The shape of the Food Pyramid shows the types of foods and drinks people need to eat most for healthy eating.

When administering a skin-fold assessment, which side of the body should all measurements be taken on for body fat?
Left
Front
Right
Back

Answers

Answer:

Right

Explanation:

When administering a skin-fold assessment, measurements should be taken on the right side of the body. These measurements are usually done on the right hand side of the body. This is simple because the heart on the left side will cause more impedance to the flow. To get a more accurate estimation, measure the circumference of the neck and waist. Females should also measure the circumference of the hips. Skinfold measurements are generally taken at specific sites on the right side of the body, with the tester pinching the skin at the location.

What do you think is the importance of eating healthy foods while doing physical activities how will this help you achieve your fitness goal?

Answers

For optimum health, both exercise and diet are crucial. The key to losing weight is changing your food to create a calorie deficit, and exercise has several advantages that help you keep your results long-term.

What does the term "optimal health" mean?

A state of total physical, mental, & social well-being is referred to as optimal health. By emphasising the holistic approach to reaching your greatest health outcome, promote healthy behaviours. Health for Life and Work.

What kind of health is ideal?

According to one definition, optimum health refers to a person's capacity for maintaining their own physical, emotional, and mental well-being. In other words, it's the health objectives one might reasonably pursue to feel their best.

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What should I eat between breakfast and lunch?

Answers

Between breakfast and lunch, we should consume fruit and cream, a handful of almonds, high-fiber mixed grain toast and cheese, or nut butter.

What are the food sources?

Animals and plants are the primary sources of food for all living beings on Earth. The main staple food is food originating from animals, such as fish, yogurt, meat, poultry, and cheese. Plants create foods for people that are a substantial supply of grain, protein, and carbohydrates.

Why is a lunch break necessary?

Everyone needs to eat lunch every day. It supplies nourishment and energy to keep our heart and brain functioning well throughout the afternoon.

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Messages are impulses are carried from one part of the body to another by​

Answers

Answer: A special cell called a neuron

Please help. 50 Points!!!

Logical thinking is worse than emotional thinking because when we react from emotional thinking we make predictable choices.

True
False

Answers

Answer:

true

Explanation:

In many ways, logic is better than emotion. The more you can think critically and objectively about a decision before you make it, the more likely the decision will be the best for you. The less you are drive only by emotion and instinct, the fewer impulsive or irrational decisions you should make

Answer:

True

Explanation:

cause choices made emotionally can put one in danger if one is not careful and can also make one make predictable choicesas you said.

determining whether or not a program led to changes in health status is an example of ___

Answers

Answer:

Determining whether or not a program led to changes in health status is an example of program evaluation or program assessment.

Explanation:

Determining whether or not a program led to changes in health status is an example of program evaluation or program assessment.

Program evaluation is the systematic collection of information about the activities, characteristics, and outcomes of programs to make judgments about the program, improve program effectiveness, and/or inform decision-making about future program development. Program evaluation typically involves gathering data on program activities and outcomes, analyzing that data, and using the results to make recommendations for program improvement or continuation.

The main goal of program evaluation is to assess the effectiveness and impact of the program. It helps to measure the program outcomes and determine if the program met its objectives and if the program goals were accomplished. Program evaluation can also be used to identify program strengths and weaknesses, as well as identify areas where the program can be improved.

There are many different methods and techniques that can be used to evaluate a program, including surveys, interviews, focus groups, and various statistical techniques. Depending on the program being evaluated, different methods may be more appropriate.

Sporting example of medial rotation

Answers

Movement of the femur in the transverse plane around its longitudinal axis and towards the midline

Which of the following behaviors is most likely to promote formation of dental caries? a) Drinking water immediately before going to bed b) Eating cheese and crackers as a snack c) Having ice cream as a snack d) Slowly sipping fruit juice between meals

Answers

Slowly sipping fruit juice between meals is most likely to promote formation of dental caries.

Dental caries is a common chronic infection caused by cariogenic bacteria that cling to teeth, primarily Streptococcus Mutans. These bacteria break down sugars into acid over time, demineralizing the tooth's structure.

The condition known as caries, or cavities, is tooth deterioration. A specific type of oral bacteria that feeds on sugars and other refined carbohydrates and produces acids as a byproduct causes tooth decay. The enamel, the tooth's tough outer layer, is where the acids initially adhere.

Brush your teeth with a fluoride-containing toothpaste at least twice a day to avoid tooth decay. Brush ideally after every meal and especially before before bed.

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Prompt
Imagine you somehow developed a chronic disease. How would you gather information that would help you cure your illness? How could you tell if the information you had gathered was accurate and credible?

Answers

To gather information on ways to cure a chronic illness, there is need to employ the services of a medical professional and research. The information is credible and accurate when it comes from a licensed professional.

What to do with the emergence of a chronic disease?

Chronic diseases are long-term conditions that can usually be managed but not cured. People suffering from chronic illnesses frequently have to deal with daily symptoms that impair their quality of life, as well as acute health problems and complications that can shorten their life expectancy.

Some chronic diseases when detected early can be treated. To treat chronic illnesses when they arise, information on how to handle them should be collected from reliable sources such as the medical professionals that have treated such cases.

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The risk of dying from extreme obesity is equal to the risk of dying from what?
1 diabetes
2 smoking
3 obesity
4 hypertension

Answers

The risk of dying from extreme obesity equals the risk of dying from the disease called diabetes.

Is obesity a risk factor for type 1 or 2 diabetes?

Obesity is a major risk factor for the development of type 2 diabetes, but it has never been considered a major complication of type 1 diabetes. In type 1 diabetes, the body completely stops insulin production.

How much does obesity increase the risk of death?

Even being moderately overweight (10 to 20 pounds for someone of average height) increases the risk of death, especially in adults ages 30 to 64. Obese individuals (BMI > 30) have a 50-100% increased risk of premature death from all causes, compared with normal weight individuals.

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What are physical activities that you can do in order to increase the level of your health related fitness components?

Answers

Physical activities that you can do in order to increase the level of your health related fitness components are:

Knees to the floor push-upsBody weight or elastic band workouts for strengthSkipping using a jump rope or an ankle rope from Whip 'n SkipRunningParticipating in sports such as gymnastics, basketball, volleyball, and tennis.Walking for fitnessCycling

Any voluntary body movement produced by the skeletal muscles that needs energy expenditure is characterized as physical activity. Physical exercise includes any activities of any intensity, at any time of the day or night. It incorporates both exercise & incidental activities into the everyday routine.

Regular physical activity has been demonstrated to help prevent and treat noncommunicable diseases like heart disease, stroke, diabetes, as well as a variety of cancers. It also aids in the prevention of hypertension, the maintenance of a healthy body weight, and the enhancement of mental health, life quality and well-being. Regular physical exercise, including such walking, cycling, wheeling, sports, or active enjoyment, has considerable health advantages. Some physical exercise is preferable to none.

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A 42 year old male work out for 30 minute on the tationary bike, and ha a HR of 158 a oon a he finihe. One minute later, hi HR i 114, and 2 minute after he topped biking hi HR i 95. What i hi HRR (Heart Rate Recovery)?

Answers

Your age is subtracted from 220. A 30-year-maximal old's heart rate, for instance, is 220-30 = 190. Then, 114 to 152 (60% to 80% of 190) would be his desired heart rate range for cardio-respiratory activity.

What heart rate is ideal for my age?

Based on your age, you may calculate your maximum heart rate. Subtract your age from 220 to get a ballpark idea of your maximal age-related heart rate. For instance, the predicted maximum age-related heart rate for a 50-year-old person would be computed as 220 - 50 years = 170 beats per minute (bpm)

What is a heart rate that is unsafe?

The body's cardiac problems are reflected in abnormal heart rates or heart beats. This can occasionally be lethal if discovered and if untreated. Conditions where the heartbeat exceeds 120–140 beats per minute or drops below 60 beats per minute can be regarded as hazardous, necessitating urgent medical attention.

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What does breakfast consist of?

Answers

Answer:

Protein, dairy, wheat and a fruit

What are the 4 environmental factors to consider during physical activity?

Answers

Environmental elements including accessibility to public recreation areas and infrastructure, availability of sidewalks, violence in the region, and area deprivation have an influence on the physical engagement levels of children.

What exactly does exercise entail?

According to the World Health Organization, physical exercise includes any skeletal muscle-driven motion that involves the use of energy. Movement is referred to as physical activity if it occurs at any time, whether it be while a person is working, traveling, or just having fun.

Set up a regular exercise schedule to?

For all age groups, enhance your memory and mental capacity. safeguard you from a variety of chronic illnesses. support for managing weight better heart health and blood pressure control.

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what does TCS food
mean?
O Time Control for Sanitizing
Temperature Control for Sanitiation
O Time/Temperature Control for Safety
O/TimeTemperature Control for Salmonella

Answers

Answer: TCS means Time/Temperature Control for Safety

Explanation:

Time/Temperature Control for Safety (TCS) is one guidance to prevent foodborne illness. There are many foods that easily become unsafe to consume. TCS use time and temperature as control units to limit the growth of hazardous bacteria.

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Advertiement are conidered to promote product and improve the income and profit of the trading houe. Create an advertiement (print or multimedia) that will promote and increae the income of your tore

Answers

Advertising may boost sales by informing current as well as potential customers about company's new product launches, exclusive deals, and enhancements.

Advertising could assist you in developing or strengthen your company's distinctive brand in addition to reminding existing customers about it.

It is far more informative and more focused on a single product that a company may provide. It focuses more on the characteristics and qualities of the product and how they affect the choice to choose one brand more than another. Institutional advertisements are more branded and support concepts or the brand in its entirety.

Consumer education about the benefits of your goods or services and the values of your brand are aided by advertising. Ad campaigns can help you establish your brand and create a better understanding of it, from the company's objective to the importance of the products you sell.

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In the event of a needle stick/sharps injury, what should you do?

A. Remove gloves and cleanse area, return to duties without gloves which caused the injury

B. Cover with band-aid and carry on with duties; report to supervisor if any continued bleeding

C. Wash the area at the next opportunity; report if it becomes infected

D. Wash needle stick and cuts with soap and water; report it to the supervisor; complete the Employee Incident packet and send to HR

Answers

D! I had to answer this question

A nurse is teaching a patient who has taken glucocorticoids for over a year about glucocorticoid withdrawal. Which statement by the patient indicates a need for further teaching?
a."I should reduce the dose by half each day until I stop taking the drug."
b."I will need to have cortisol levels monitored during the withdrawal process."
c."The withdrawal schedule may take several months."
d."If I have surgery, I may need to take the drug for a while, even after I have stopped."

Answers

The patient indicates a need for further teaching by stating "I should reduce the dose by half each day until I stop taking the drug."

Corticosteroids, which are steroid hormones, are a subclass of glucocorticoids. Glucocorticoids are corticosteroids that bind to the glucocorticoid receptor, which is found in nearly every cell of a vertebrate mammal. Cortisol is the most significant human glucocorticoid (or hydrocortisone). Prednisone, prednisolone, triamcinolone, methylprednisolone, dexamethasone, and other glucocorticoids are routinely utilised. To improve their anti-inflammatory properties, the chemical structures of the cortisone (hydrocortisone) backbone are changed.

Fatigue, lack of energy, nausea, vomiting, loss of appetite, weight loss, myalgia, and stomach discomfort are all possible symptoms. A rapid discontinuation of medicine might produce a significant drop in blood pressure and impact blood sugar levels.

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What are the appropriate procedures for holding hot foods?

Answers

Answer:

have something under and around too not burn hangs or make sure it is at a reasonable temperature

Explanation:

What is the 10 good lifestyle?

Answers

Ten good lifestyles are : healthy balanced diet, drinking lots of water, exercising regularly, plenty of sleep, not smoking, reducing alcohol consumption, keeping a check on mental and physical health, eat plenty of vegetables and some fruits every day, time management and do not skip breakfast.

What is a good lifestyle?

A good lifestyle refers to a positive attitude and means focusing on the good aspects of life and not worrying about the negative things in life. To attain a positive lifestyle, one must improve his/her approach towards life and the people they meet.

It is important to choose a diet that's low in saturated fat and cholesterol, and moderate in sugar, salt and fat.

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What is the hot holding temperature for vegetables?

Answers

Answer: The hot holding temperature for vegetables is 60°C

Explanation:

Vegetables are one of perishable foods. After cooking, all hot holding food must be kept/maintained at 135°F or above (57°C or above).

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Making sure your friends know you are tobacco free and sticking that decision in the face of pressures and influences require_____________________skills.

Answers

Answer:

refusal skills

Explanation:

making sure your friends know you are tobacco free and sticking to that decision in the face of pressure and influences require refusal skills

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