4.1 Management of Chronic Endocrine Disorder Flashcards
1
Q
Diabetes
A
- Metabolic disease
- Increased glucose in body (hyperglycemia)
- Results from defects in insulin secretion, insulin action or both
- Leading cause of microvascular problems and major contributor to microvascular problems
- Major clinical Manifestation is Hyperglycemia
2
Q
Glucose
A
- Simple sugar that is an energy source for living organisms. Major component of carbohydrates
- Carbohydrates are broken down into glucose in the small intestines
3
Q
Insulin
A
- Secreted by beta cells in the pancreas
- Promotes glucose transport and opens receptors and insulin dependent tissues
- Acts as a key to transfer glucose into cells
- Brain liver and blood cells do not require insulin for glucose transport.
4
Q
Counter Regulatory Hormones of Insulin
A
- Glucagon, Epinephrine, Growth Hormone, Cortisol
- Oppose effects of Insulin
- These increase glucose levels
- Regulation of Insulin secretion is through glucose and other hormones. It is often inhibited by stress.
5
Q
Type 1 Diabetes
A
- Body does not make insulin
- Immune system attacks and destroys cells in pancreas that make insulin
- Insulin dependent
- 5% of all diabetes cases
- Onset under age 40 with about half under age 20
- Rapid onset of ketoacidosis
- Sudden Weight Loss, Dehydration, Hypoglycemia while patient is on insulin therapy
6
Q
Type 2 Diabetes
A
- Onset usually over age 40 (Gradual Onset)
- 95% of diabetes cases
- Body does not produce enough insulin
- Caused by insulin resistance. In these cases it takes more insulin to work
- Higher risk in minorities
- Obesity is the biggest risk
- Risk Factor is Metabolic Syndrome
(Abdominal Obesity, Elevated Lipids, Hypertension, Impaired Fasting Glucose)
7
Q
Risk Factors for Diabetes
A
- Age 45+
- Family history
- Overweight
- Physically Inactive
- ## High blood pressure
8
Q
Insulin Resistance
A
- Fat cells become resistant to insulin.
- When fat cells get too big it changes the insulin shape preventing the cell from absorbing glucose
- This causes pancreatic insulin production to fail due to creating more insulin to try and absorb glucose
- Losing weight reduces size of fat cells causing insulin resistance to reverse
9
Q
What can Diabetes Cause
A
- Heart disease (Hypertension, Coronary Artery Disease)
- Stroke (Brain issues)
- Kidney Disease (Nephropathy/Failure)
- Eye Issues (Cataracts, Glaucoma, Blindness)
- Dental Disease
- Nerve Damage
- Foot Problems
- Peripheral Vascular Disease (Poor healing of wounds and gangrene)
- GI/GU and Sexual Issues
- Angiopathy (damage of blood vessels or lymphatics)
10
Q
Managing Diabetes
A
- Manage blood glucose, blood pressure, cholesterol.
(ABC’s to manage diabetes) - A1C Test shows average blood glucose in last 3 days
- Blood pressure goal is 140/90
- Control Cholesterol
- Stop smoking
11
Q
Blood Levels for Diabetes
A
- Non-fasting glucose levels - Greater than 200
- Fasting glucose greater than or equal to 126 mg/dL
- Two hour post load glucose equal to 200 mg/dL
- Normal Glucose levels is 70-100
12
Q
Glyco-hemoglobin test (A1C)
A
- Measures average blood glucose levels for the past 3 months. (5.7% is normal. Or from 4% - 6%)
- A1C greater than or equal to 6.5% (Diabetes)
- A1C between 5.7% and 6.4% is pre-diabetes
- Normal A1c is less than 5.7%
- Target for people with diabetes is 7%
13
Q
A1C Test
A
Average blood glucose levels in past 2-3 months
- Measures percentage of hemoglobin that is coated with sugar glycated
- A1C greater than or equal to 6.5% (Diabetes)
- A1C between 5.7% and 6.4% is pre-diabetes
- Normal A1c is less than 5.7%
14
Q
Hypoglycemia
A
- If glucose falls to less than 70
- Less than 40 is severe which can mean too much insulin, too little food, or too much exercise
Symptoms - Shaky, Sweaty, Confused, Pale
Treatment - 15 g’s of Carbs x3
- Glucagon 1mg subcutaneous OR Dextrose 50% IV if unconscious
15
Q
Diabetic Ketoacidosis
A
- Insulin deficiency and fat breaks down into ketones (acids)
- Accumulation leads to metabolic acidosis and hyperkalemia
- Blood glucose > 250
- Usually with Type 1 Diabetes
16
Q
Hyperglycemic Hyperosmolar Syndrome (HHS)
A
- Results from insulin deficiency initiated by illness that raises demand for insulin
- Usually occurs in Type 2 Diabetes Mellitus
- Osmotic Diuresis (Kidneys filter too much liquid) which results in loss of water and electrolytes
- Hypovolemia
- Blood Glucose > 600
17
Q
Chronic Conditions of Diabetes
A
Macrovascular - Angiopathy (coronary artery disease), cerebrovascular disease, peripheral vascular disease
Screen and Treat Increased Lipids
Microvascular - Retinopathy (damage to small vessels in the retina), Nephropathy (damage to kidney cells), Neuropathy (dysfunction of one or more peripheral nerves causing numbness or weakness).
Thickening of Capillaries or Small Vessels
Foot ulcers. Patient doesn’t feel pain leading to developing an ulcer which could lead to gangrene or amputation.
18
Q
Nursing Management of Diabetes
A
- Insulin administration
- Meal planning
- Self-Monitoring
- Recognition and treatment of acute complications
- Educate how to self-administer Insulin
- Systematic rotation of injection sites to prevent lipodystrophy (localized change in fatty tissue)
- Educate to call provider when blood sugar is high or low
19
Q
Nursing Management of Insulin
A
- Should be refrigerated.
- Do not allow insulin to freeze or kept in sunlight
- Insulin vial should be used at room temperature
20
Q
Signs/Symptoms of Hyperglycemia
A
- Polyuria (Excess urine output due to osmotic diaresis)
- Polydipsia (Excess Thirst)
- Polyphagia (Excess appetite due to being hypermetabolic)
- Weight Loss
- Fatigue
- Weakness
- Paresthesia (Numbness/Tingling in Hands/Feet)
- Poor Healing in Wounds
- Recurrent Infections
21
Q
Latent Auto-Immune Diabetes of Adults (LADA)
A
- Not common but is emerging
- Destruction of Beta Cells
- Not insulin dependent initially for the first 6 months
- Shares features of both type 1 and type 2 diabetes
22
Q
Gestational Diabetes
A
- Diabetes that develops when women are pregnant. Usually goes away once baby is born but women who get it are at higher risk for Type 2 Diabetes later in life
- Increased risk for C-Section Complications
Risk Factors
- Pregnancy in advanced maternal age
- Obese, Overweight, Family History of Diabetes
- Usually screened earlier if they exhibit high risk factors but usually is checked 24-26 weeks into gestation by Oral Glucose Tolerance Test
23
Q
Pre-Diabetes
A
- No Symptoms but long term damage occurring
- Risk of type 2 diabetes
- Fasting Glucose 100-125 mg/dL
- Education during this time is very important
- Plan to manage risk factors and monitor for symptoms.
- Weight, exercise plan, diet, nutrition, education, screening.
24
Q
Diabetic Retinopathy/Nephropathy
A
- Retinopathy most common cause of blindness in adults
- Ensure patients are getting annual eye exams with dilation
- Nephropathy is leading cause of kidney disease
- Annual screenings for kidney function such as creatinine and glomerular filtration rate (GFR)
- Monitor Albumin in Urine. May need ACE inhibitors or ARB to delay progression. Controlling hypertension and glucose levels is imperative
25
Diabetes and Foot Complications
- Can be devastating and lead to amputation risk
- Foot education is vital as decreased sensation leads to decreased pain. There is also decreased blood flow.
- Patient must know to wear proper footwear to avoid foot injury
- Daily inspection of feet with proper skin and nail care
- If they notice anything abnormal even a small blister, there should be prompt treatment so it doesn't grow
26
Charcot Foot
- Weakening of bone that resulted from a fracture
- It can change the shape of the foot
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Primary Goals of Diabetes
- Normalize Insulin especially in Type 2
- Normalize blood glucose levels
- Keep A1C under 7%
- Reduce development of complications
- Prevent hypoglycemia episodes as well (blood sugar less than 70) related to too much insulin or not enough food.
28
Signs and Symptoms of Hypoglycemia
- Altered Mental State
- Visual disturbances, confused, stuporous, coma
- Older adults can be unaware of hypoglycemia until critically low. When at risk for this, blood sugar should be kept a little higher.
- Untreated hypoglycemia can end with unconscious, seizures, coma, and even death.
- If unsure because nothing to measure blood glucose, it is safer to start treatment anyways
29
Treatment of Hypoglycemia
- If patient is awake and alert they can consume 15 grams of a simple sugar then re-check blood glucose
- If it is still low administer another 15 grams of simple sugar
- Give complex carb's once a patient has recovered
30
5 Components of Diabetes Management
- Nutrition
- Exercise
- Self Monitoring (SMBG)
- Pharmacology
- Education
31
Self Monitoring of Blood Glucose (SMBG)
- Helps make decisions needed for diet, exercise, medication, identify hypo/hyperglycemia
- THIS IS A MUST for Type 1 Diabetics
32
Education of Insulin
- Insulin is usually available in 100 units per mL
- Patient needs to rotate injection sites to prevent lipodystrophy (fatty hard pads that don't absorb medication well)
- Injection angle is typically 90 degrees
33
Education of Diet
- Usually covered by dietician within acute care setting
- Assist in maintaining proper weight
- Meal Planning
- 50-60% should come from carbs, 30% from fats, 7-10% or less from saturated fats. Non-animal proteins such as beans or whole grains is a positive
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34
Glycemic Index
- Rated from 0-100
| - Relates to blood glucose rise in 2 hours after eating
35
Education of Exercise
- 30 Minutes a day for 5 days aerobic exercises
- 2-3 times a week of strict training
- This helps with decreased weight, lipids, blood pressure, improved circulation, decreases insulin resistance.
- Increases uptake of glucose by body muscle which lowers it in the blood
- Patient should be monitored for hypoglycemia after moderate exercise or have a carbohydrate snack before exercising.
36
Challenges of Elderly and Diabetes
- Hypoglycemia unawareness (severe hypoglycemia without warning signs)
- Renal insufficiency (diet and exercise is main treatment)
- Increased mortality in elderly diabetes
