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Third Semester > Adult Care 1 Exam 2 > Flashcards

Adult Care 1 Exam 2 Flashcards

Endocrine and Diabetes

1
Q

what is the function of the endocrine system?

A

secrete hormones into the blood streams that contribute to the maintenance of homeostasis in the body

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2
Q

what does the endocrine system do within the body?

A

facilitate fluid and electrolyte imbalances, regulate glucose levels

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3
Q

issues of the glands are related to?

A

excess of a hormone,
deficiency of a hormone,
poor interaction @ receptor site cells that do not respond or are resistant

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4
Q

where is the hypothalamus located?

A

at the base of the brain, near the pituitary gland

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5
Q

what is the hypothalamus called?

A

neuro-endocrine gland

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6
Q

which gland is called the master gland?

A

pituitary gland

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7
Q

how does the hypothalamus function?

A

receives signals from nerves and funnels those signals into the pituitary gland

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8
Q

what hormones do the hypothalamus produce?

A

ADH and oxytocin

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9
Q

what does ADH control?

A

vasopressin, fluid regulation and volume

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10
Q

what does oxytocin do?

A

stimulates uterus to contract during pregnancy

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11
Q

where is the pituitary gland located?

A

below the hypothalamus

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12
Q

how does the pituitary gland function?

A

takes signals from the hypothalamus and directs it to ALL other endocrine glands

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13
Q

the posterior pituitary gland is divided into…?

A

anterior and posterior sections

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14
Q

what hormones are secreted in the anterior pituitary gland?

A

TSH, ACTH, Lutenizing hormone, FSH, Prolactin, Growth Hormone

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15
Q

what outside/ environmental factors stimulates TSH?

A

stress or cold

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16
Q

what hormones are secreted in the posterior pituitary gland?

A

ADH , oxytocin

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17
Q

where is the thyroid gland located?

A

around the trachea

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18
Q

what does the thyroid regulate?

A

metabolism

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19
Q

what hormones regulate metabolism?

A

T3, T4

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20
Q

An increase in metabolism causes an increase in what?

A

oxygen usage and heat production of our tissues

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21
Q

The thyroid can also affect?

A

heart rate and contractility, RBC production, respiration rate

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22
Q

where is the parathyroid hormone located?

A

4 spots on the back of the thyroid

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23
Q

what does the parathyroid regulate?

A

Ca2+ levels

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24
Q

what hormone regulates calcium?

A

PTH (parathyroid hormone)

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25
Q

what are some functions of calcium?

A

muscle contraction, bone growth

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26
Q

where are the adrenal glands located?

A

on top of the kidneys

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27
Q

how many parts are the adrenal glands divided into?

A

2

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28
Q

what are the 2 adrenal glands?

A

adrenal cortex, medulla

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29
Q

what part of the adrenal gland is the adrenal cortex?

A

outer part

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30
Q

what part of the adrenal gland is the medulla?

A

inner part

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31
Q

where are corticosteroids made? (cortisol)

A

adrenal cortex

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32
Q

where are catecholamines made?

A

medulla

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33
Q

what part of the brain is where the fight or flight response is activated?

A

medulla

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34
Q

what hormones are classified as catecholamine?

A

epinephrine and norepinephrine

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35
Q

what does cortisol do to the body?

A

increase blood sugar during stress to increase energy
anti-inflammatory functions

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36
Q

what other hormone does the adrenal cortex regulate?

A

aldosterone

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37
Q

where are secondary sex characteristics, puberty, and menopaus developed?

A

gonads

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38
Q

what hormones do the ovaries produce?

A

estrogen and progesterone

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39
Q

what hormone do the testes produce?

A

testosterone

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40
Q

what does estrogen do in the body?

A

affects the reproductive tract, the urinary tract, the heart and blood vessels, bones, breasts, skin, hair, mucous membranes, pelvic muscles, and the brain.

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41
Q

what does progesterone do in the body?

A

prepare the endometrium (lining of your uterus) for a fertilized egg to implant and grow

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42
Q

what does testosterone do in the body?

A

affects height, hair and pubic growth, enlargement of testes, penis and prostate gland, increase in libido

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43
Q

where is the pancreas located?

A

upper part of the abdomen

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44
Q

what hormones do the pancreas control?

A

insulin and glucagon

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45
Q

how does the insulin negative feedback loop work?

A

blood glucose increases
insulin is secreted
insulin turns cells on and tells them to increase glucose uptake into the cells
blood glucose levels decreases

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46
Q

how does the cortisol negative feedback loop work?

A

low cortisol levels (adrenal cortex)
stimulates secretions of corticotropin releasing hormone (CRH, hypothalamus)
stimulates anterier pituitary gland to secrete andriocorticotropic hormone (ACTH)
cortisol levels increase, inhibiting the initial corticotropin releasing hormone from the thalamus

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47
Q

1 hormone

A

selective pituitaryism

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48
Q

2+ hormones

A

panhypopituitarinism

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49
Q

what is the most common cause of hypopituitarism

A

tumors

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50
Q

what are some other causes of hypopituitarism?

A

malnutrition
shock
hypotension
trauma
surgery
radiation

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51
Q

what are some s/s of hypopituitarism related to GH? (children)

A

short in stature

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52
Q

what are some s/s of hypopituitarism related to GH? (adults)

A

decreased bone density, deceased muscle strength, fractures

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53
Q

what are some s/s of hypopituitarism related to TSH?

A

cold intolerance, lethargy, weight gain, slow cognition

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54
Q

hydrocortisone or prednisone treats…?

A

hypopituitarism related to adrenal (ACTH)

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55
Q

levothyroxine or Synthroid treats…?

A

hypopituitarism related to thyroid (TSH)

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56
Q

somatropin treats…?

A

hypopituitarism related to GH

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57
Q

Hyperpituitarism

A

over secretion of the hormone

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58
Q

when can hyperpituitarism occur?

A

tissue hyperplasia or an anterior pituitary tumor (pituitary adenoma)

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59
Q

acromegaly

A

excess of GH

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60
Q

Physical signs of acromegaly in adults?

A

large face, hands, feet

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61
Q

Physical signs of acromegaly is children

A

gigantism

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62
Q

What are some other signs and symptoms of hyperpituitarism (Acromegaly) ?

A

vision changes, headache, increased ICP, joint pain, voice changes, protruding jaw, hypertrophy of soft tissue (tongue, skin, visceral organs) and enlargement of small bones in hands and feet

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63
Q

What symptoms of acromegaly can be permanent?

A

hypertrophy of the soft tissue

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64
Q

What kind of growth is acromegaly?

A

slow

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65
Q

What critical visceral organs become enlarged?

A

heart, lungs, liver

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66
Q

Some complications of Acromegaly include…?

A

Increased ICP, Enlarged (benign) tumor, increased blood sugar

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67
Q

Diagnostics for hyperpituitarism include?

A

increased (somatropin) GH
X-rays, MRI, physical changes, Oral glucose challenge tests

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68
Q

What is another name for the oral glucose challenge test?

A

Growth hormone suppression test

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69
Q

What do the x-rays and MRI look at related to Hyperpituitarism

A

X-rays look at skeletal changes
MRIs look at the gland

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70
Q

You need to be NPO for 6-8 hours before what diagnostic procedure?

A

Growth Hormone suppression test

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71
Q

How does the oral glucose challenge test work?

A

when you administer glucose, growth hormone SHOULD be suppressed So they administer high levels of glucose and measure GH levels at an interval of time (10,60,120min) and an abnormal result indicates Acromegaly

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72
Q

Medication therapy for Hyperpituitarism include?

A

Dopamine Agonists
Somastatin analogs
GH receptor blockers

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73
Q

What do Dopamine Agonists do?

A

inhibit GH

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74
Q

What medications are classified as Dopamine Agonists?

A

bronocriptine mestlate, cabergoline

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75
Q

What are some adverse reactions of Dopamine agonists?

A

dizziness, watery drainage (indicates CFS leak), chest pain

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76
Q

What do Somastatin analogs do?

A

inhibits GH

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77
Q

What medications are classified as Somastatin analogs?

A

ocreotide, lanreotide

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78
Q

What medications are part of GH receptors blockers?

A

pegvisomant

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79
Q

What invasive procedure can also treat hyperpituitarism?

A

hypophysectomy

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80
Q

What is a hypophysectomy?

A

removal of the tumor that secretes GH

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81
Q

What kind of dressing is used for hypophysectomy?

A

mustache dressing

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82
Q

The patient will receive a nasal packing after a hypophysectomy for how many days?

A

2-3

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83
Q

Should hypophysectomy patients bend forward?

A

NO, increases ICP and can cause a CSF leak

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84
Q

Can hypophysectomy patients brush their teeth or cough to clear secretions?

A

NO , instead they can use dental floss and mouth wash and breath through their mouth

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85
Q

How often should a nurse complete neuro checks on a post op hypophysectomy patient?

A

hourly for the first 24 hours, then at least every 4 hours

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86
Q

The nurse should document and assess what changes?

A

vision, mental status, LOC, and extremity strength

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87
Q

What should the nurse monitor on a post op hypophysectomy patient?

A

I&O for diabetes insipidus (output greater than input, means a decrease in ADH)

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88
Q

The nurse should monitor for s/s of this infection on a post op hypophysectomy patient?

A

meningitis

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89
Q

What are the s/s of diabetes insipidous?

Jordan called me the n word on this card

A

polyuria, polyphagia, polydipsia

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90
Q

What are the s/s of meningitis?

A

neck stiffness, fever, confusion or altered mental status, headaches, nausea and vomiting

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91
Q

What nursing intervention should be performed for a post op hypophysectomy patient?

A

elevate HOB

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92
Q

What kind of treatment will a patient receive if the entire pituitary gland was removed?

A

lifelong hormone supplementation

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93
Q

what are some patient teaching points for a hypophysectomy patient?

A

report post nasal dripping , increase swallowing, severe headache

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94
Q

A patient post op hypophysectomy has a decrease sense of smell, is this normal?

A

Yes, they will have a decreased sense of smell for 3-4 months

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95
Q

What treatment do you use for a CSF leak?

A

bedrest

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96
Q

How do you tell if leakage is CSF fluid?

A

light yellow color ring at the edge of clear drainage with glucose present

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97
Q

What foods are needed to make thyroid hormones?

A

Protein and iodine

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98
Q

If glucose tolerance is decreased, this means the patient will have …?

A

Hyperglycemia

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99
Q

Hyperthryoidism does what to the body systems?

A

speeds everything up (increases metabolism)

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100
Q

how does hyperthyroidism occur?

A

too much thyroid hormones from the thyroid gland

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101
Q

Primary hyperthyroidism

A

issue with the thyroid gland itself, causing too much thyroid hormones to be produced

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102
Q

Secondary hyperthyroidism

A

excess in thyroid hormones due to increased TSH from the pituitary or hypothalamus

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103
Q

Graves disease occurs due to..?

A

thyroid inflammation where autoantibodies attach to TSH receptors on the thyroid gland, increasing thyroid hormone production, mimicking TSH

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104
Q

What symptoms are specific to Graves disease?

A

exopthlamos
pretibial myxedema

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105
Q

Graves disease can also be caused by..?

A

toxic multi nodular goiter

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106
Q

What is toxic multi nodular goiter?

A

multiple thyroid nodules

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107
Q

What are signs and symptoms of thyroid storm?

A

pyrexia, tachycardia, delirium

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108
Q

What is thyroid storm?

A

Acute presentation of hyperthyroidism

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109
Q

How do you treat thyroid storm patients?

A

More supportive care, IV fluids, beta blockers

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110
Q

Symptoms of hyperthyroidism

A

dysrhythmias
HTN
palpitations
tachycardia
diarrhea
fatgiue
heat intolerance
anxiety
diaphoresis
insomnia
tremors
goiter
wide eye stare (exopthlamos , Graves disease only)
finger clubbing

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111
Q

What will labs look like in a patient with hyperthyroidism?

A

T3 T4 increase
TSH high

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112
Q

What will the TSH levels looks like in a patient with Graves disease?

A

Low

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113
Q

Diagnostics for hyperthyroidism include..?

A

thyroid scan, radioactive iodine , thyroid ultrasound, EKG

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114
Q

Non surgical treatment for hyperthyroidism

A

monitor pulse, BP, temp.
reduce stimulation

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115
Q

What does an increasing temp in a patient with hyperthyroidism mean?

A

Worsening condition, thyroid storm event

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116
Q

Is an increase of just one degree in Fahrenheit indicate concern?

A

YES

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117
Q

What does reducing stimulation do for a hyperthyroidism patient?

A

reduce symptoms

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118
Q

What does reduce stimulation mean?

A

quiet, calm environment, limiting visitor

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119
Q

What medications do you use as initial treatment for hyperthyroidism?

A

Thianomides

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120
Q

What is a secondary medication used to treat hyperthyroidism

A

PTU, not used as often due to toxic liver effects

121
Q

Patient teaching for thionimines and PTU

A

avoid crowds due to reduce immune system, monitor for s/s of hypothyroidism

122
Q

What do PTU patients need to report?

A

darkening of the urine (liver toxicity)

123
Q

What is the preferred drug of thianomides?

A

Methimazole

124
Q

How does methimazole work?

A

inhibits production of thyroid hormone by preventing iodine from binding with or in the thyroid gland

125
Q

What pregnancy category is Methimazole?

A

Cat D

126
Q

What is supportive medication therapy for hyperthyroidism?

A

Beta Blocker, relieves diaphoresis, anxiety, tachycardia

127
Q

What is Lugol’s solution?

A

short term hyperthyroidism therapy prior to surgery by reducing blood flow to thyroid gland, reducing production of thyroid hormones.

128
Q

How long does it take Lugol’s solution to see an improvement of symptoms?

A

2 weeks

129
Q

Radioactive iodine does what?

A

destroys thyroid cells

130
Q

Safety precautions for radioactive iodine

A

Sit to pee, flush 2-3 times with lid closed, avoid close contact with pregnant women, infants and children 1 week after admnistration, avoid sleeping in same bed, do not share toothbrushes, utensils, or beverages

131
Q

Thyroidectomy

A

Removes all or part of the thyroid gland to manage hyperthyroidism or graves disease in a patient who hasn’t responded to nonsurgical management, or large goiter that causes tracheal or esophageal compression

132
Q

If the thyroid is completely removed, the patient will need to do what?

A

Take lifelong supplemental therapy

133
Q

Pre-op teaching/ MANAGEMENT

A

Cough and deep breath
May have a drain and a dressing after surgery
Keep tachycardia and high BP under control

134
Q

Post-op nursing interventions

A

admin pain meds, use pillows to support head and neck, semi fowlers position, avoid any neck extension position, can cause respiratory distress with reduced gastric exchange, hemorrhage,parathyroid damage, r/f thyroid storms, monitor V/S

135
Q

when is hemorrhage most likely?

A

24 hours after procedure

136
Q

How often do you monitor vital signs after a thyroidectomy?

A

every 15 min until patient is stable and every 30 min there after

137
Q

Laryngeal striata indicates?

A

Acute respiratory obstruction

138
Q

What will laryngeal striata sound like?

A

high pitched, harsh respiratory sound

139
Q

What can occur if the thyroid glands are destroyed or damaged?

A

Muscle twitching, paresthesia (Hypocalcemia)

140
Q

Laryngeal nerve damage can occur during a thyroidectomy, what should you do as a nurse to monitor?

A

assess vocal cords every 2 hours

141
Q

During an assessment for a hyperthyroidism patient with a noticeable goiter, do you palpate the goiter?

A

No, can release excess amounts of thyroid hormones, triggering thyroid storm

142
Q

Why does exopthlamos occur?

A

edema to the extra ocular muscles and increased fatty tissues behind the eyes

143
Q

What is hypothyroidism?

A

Decrease or absent thyroid hormones

144
Q

What is the main manifestation of hypothyroidism?

A

decreased metabolism

145
Q

What causes hypothyroidism?

A

Autoimmune diseases, atrophy of the thyroid gland, thyroid surgery, radioactive iodine, iodine deficiency, amnioterone lithium

146
Q

What is a specific autoimmune disease that causes hypothyroidism?

A

Hashimoto’s thyroiditis

147
Q

What is the pathology of Hashimoto’s thyroiditis?

A

body produces antibodies that attack thyroid tissues, resulting in inflammation and tissue destruction which decreases thyroid hormones secretion (potentially causing goiter)

148
Q

What does amnioterone lithium interfere with that causes hypothyroidism?

A

thyroid hormone production

149
Q

What are the signs and symptoms of hypothyroidism?

A

bradycardia
SOB
constipation
decreased basal metabolic rate
decreased activity tolerance
cold intolerance
cool, pale, ashy, gray, coarse skin
dry brittle hair
confusion
poor wound healing

150
Q

What labs are diagnostics for hypothyroidism?

A

T3 and T4 decreased, TSH increased

151
Q

What is the medication of choice to treat hypothyroidism?

A

Levothyroxine

152
Q

What are some patient teaching points for Levothyroxine?

A

Take 30-60 min before a meal in the morning
Monitor for hypotension and bradycardia
Assess LOC and mental status
Monitor for myexedema coma

153
Q

What is myexedema coma?

A

A complication of poorly treated hypothyroidism, results in cardiopulmonary and neurological function, pt may experience chest pain

154
Q

What to do if the patient is having more fatigue or constipation?

A

increase meds

155
Q

What to do if the patient is having more diarrhea and difficulty sleeping?

A

decrease meds

156
Q

Iodine is needed for what?

A

the thyroid to make thyroxine

157
Q

Decrease metabolism causes what within the body?

A

heart muscle becomes flabby, chamber size increases and cardiac output decreases with a decreased tissue perfusion and gas exchange in the brain and other vital organs, causing organ failure

158
Q

What manifestation of hypothyroidism is a medical emergency?

A

myxedema coma

159
Q

What are some risk factors for myxedema coma?

A

acute illness, recent surgery, chemotherapy, not taking a thyroid replacement, sedative or opioid use,

160
Q

What are complications of myxedema coma?

A

reduced LOC and cognition, hypertension, hypothermia, bradycardia, hypoglycemia, respiratory failure, hyponatremia

161
Q

What are some nursing interventions for myxedema coma?

A

assess q8hr to monitor, maintain airway, replace fluids, replace T3 and T4, give IV glucose, glucocorticosteroids, get temperature and BP hourly, cover pt with warm blanket, monitor for changes in mental status, turn pt every 2 hours, aspiration precautions

162
Q

What is your priority if your patient goes into myxedema coma?

A

AIRWAY

163
Q

What does the parathyroid gland regulate?

A

Calcium and phosphate balances in the body

164
Q

What hormone does the parathyroid gland secrete?

A

Parathyroid hormone

165
Q

What does the parathyroid hormone act on?

A

Bone, kidneys, GI tract

166
Q

If Calcium levels are low, parathyroid hormones secrete more to increase calcium and do so in the

A

GI tract by increasing absorption of calcium in the intestines, increasing the reabsorption of calcium in the kidneys thus reducing the amount secreted in the urine. Also increases osteoclastic activity in the bone, breaking it down and releasing calcium into the blood stream

167
Q

Where do we get vitamin D?

A

The response to sunlight, and food

168
Q

Parathyroid hormone does what to vitamin D?

A

turns it into an active form, raising blood calcium levels

169
Q

Deficiency in vitamin D can lead to

A

deficiency in calcium

170
Q

Hypoparathyroidism labs and diagnostics

A

Increased Phsophrous
Decreased PTH, calcium, magnesium
24 hour urine test to measure amount of calcium, vitamin D levels

171
Q

Hypoparathyroidism causes include

A

Removal of parathyroid gland or glands
Autoimmune condition

172
Q

S/S of hypoparathyroidism

A

muscle cramps, spasms, seizures, mental status changes, tingling (paresthesia) of hands and mouth, positive Trousseaus or Chovesteks sign

173
Q

Positive Trousseas sign

A

involuntary contraction of the hand and wrists are compression from a blood pressure cuff

174
Q

Positive Chvosteks sign

A

stimulation of cranial nerve 7 by tapping in front of the ear and facial twitching occurring

175
Q

Nonsurgical treatment for hypercalcemia

A

correcting the calcium level and preventing kidney stones

176
Q

What do you give to patients who present with acute and severe hypocalcemia?

A

IV calcium gluconate

177
Q

What other supplemental therapy can be given to patients with hypocalcemia (hypoparathyroidism) depending on the severity of presentation?

A

oral calcitrol, calcium carbonate

178
Q

Nursing management for hypoparathyroidism

A

Teach about medications
Increase intake of vitamin D (milk, yogurt, ice cream)
Wear a medic alert bracelet

179
Q

Hyperparathyroidism labs and diagnostics

A

PTH, Calcium, Magnesium Increased
Phosphorus decreased
X-rays , bone density tests

180
Q

What is the pathophysiology behind hyperparathyroidism?

A

Excessive PTH levels increase, increasing bone reabsorption by decreasing osteoblastic activity and increasing osteoclastic activity. This releases calcium and phosphorus into the blood and reduces bone density

181
Q

What is the primary cause of hyperparathyroidism?

A

tumor , leads to increased absorption of calcium

182
Q

What are secondary causes of hyperparathyroidism?

A

vitamin D deficiency, CKD (leads to decreased absorption of calcium in the blood which in turn leads to hypocalcemia) ???

CKD dysfunction –> causes decreased calcium absoprtion –> hypocalcemia –> parathyroid gland tries to compensate by releasing PTH –> increased PTH = hyperparathyroidism

Decreased Vitamin D –> decreased calcium reabsoption –> parathyroid gland attempts to compensate by releasing PTH = hyperparathyroidism

183
Q

Some signs and symptoms of hyperparathyroidism include..?

A

bone fractures, weight loss, kidney stones

184
Q

Treatment for hyperparathyroidism includes…?

A

Surgical management or drug therapy

185
Q

Parathyroid drug therapies mechanism of action

A

Calcium medic drug, when taken orally it binds to calcium receptors on the parathyroid tissue, reducing parathyroid hormone production and release, which leads to decrease serum calcium levels

186
Q

Surgical management for hyperparathyroidism

A

Parathryoidectomy, would be curative of the problem

187
Q

Pre and post op nursing interventions and patient teaching for a parathyroidectomy is?

A

Same as thyroidectomy

188
Q

What is glycemic control?

A

Glucose regulation, the process of maintaining optimal glucose control

189
Q

where is the pancreas located?

A

behind the stomach, next to the small intestine

190
Q

Islets of lagerhans are located where?

A

scattered throughout the pancreas

191
Q

What are the 2 types of islet of Langerhan cells?

A

alpha cells and beta cells

192
Q

What do alpha cells do?

A

secrete glucagon

193
Q

What do beta cells ddo?

A

secrete insulin

194
Q

Insulin does what in relation to glucose?

A

prevents hyperglycemia by allowing the body to take up and use glucose by taking it out of the blood and moving it into the cells

195
Q

Glucagon does what in relation to glucose?

A

raises blood glucose by preventing hypoglycemia by triggering the release of glucose from storage sites

196
Q

Where are the glucose storage sites?

A

skeletal muscle and liver

197
Q

S/S of diabetes

A

P, P , P

198
Q

What occurs inside the body when there is an insulin deficiency?

A

the body breaks down stored fats and releases free fatty acids, when the fat is used for energy it produces ketone bodies

199
Q

The pathophysiology for Type 1 and Type 2 differ by…?

A

Type 1 is beta cell DESTRUCTION
Type 2 is beta cell DYSFUNCTION, or insulin resistance

200
Q

Which type of diabetes is an autoimmune diorder or a viral infection?

A

Type 1

201
Q

Which type of diabetes is not autoimmune, but the patients are genetically predisposed?

A

Type 2

202
Q

Type 1 diabetes patients are insulin

A

DEPENDENT

203
Q

What percentage of Type 2 diabetics require insulin?

A

20-30%

204
Q

Onset for Type 1 diabetes is

A

before 30 years of age

205
Q

Onset for Type 2 diabetes is

A

at any age, nobody is safe
mainly in older adults but fattys like jordan eat mcdoanlds

206
Q

Symptoms for Type 1 diabetes include

A

an abrupt onset, polydipsia, polyuria, polyphagia, increased weight loss

207
Q

Symptoms for Type 2 diabetes include

A

frequently none but can be thirst, fatigue, blurred vision, vascular/ neural complications

208
Q

Nutritional status for Type 1 diabetics include

A

same obesity rate as the general adult population

209
Q

Nutritional status for Type 2 diabetics include

A

Metabolic syndrome, 60-80 % are obese

210
Q

What are risk factors for Type 2 diabetes?

A

Family hx
PCOS (polycystic ovarian syndrome)
AA, hispanic, Pacific Islanders
Increased birth weight, gestational diabetes

211
Q

A patient is displaying abdominal obesity, hyperglycemia, and hyperlipidemia. What syndrome do they have?

A

Metabolic Syndrome

212
Q

What are the 4 signs of metabolic syndrome?

A

Abdominal obesity (Women 35 inches in circumference, Men 40 inches)
Hyper glycemic (fasting glucose 100)
HTN (140/90+)
Hyperlipidemia (150+ triglycerides)

213
Q

A patient must display 3/4 signs to qualify for

A

Metabolic syndrome

214
Q

Metabolic syndrome increases a patients risk for?

A

Type 2 diabetes, cardiovascular disease and stroke

215
Q

Normal HgA1C values
Prediabetes
Diabetes

A

4-5.7%
5.7-6.4%
>6.5%

216
Q

Normal fasting glucose values
Prediabetes
Diabetes

A

74-100mg/dL
100-125mg/dL
>126mg/dL

217
Q

Normal glucose tolerance values
Prediabetes
Diabetes

A

<140mg/dL
140-199mg/dL
>200mg/dL

218
Q

Which type of diabetes can’t be prevented and which can be?

A

Type 1 can’t
Type 2 risk can be reduce by nutrition, exercise, medication

219
Q

Examples of healthy carbohydrates include…?

A

fruits, vegetables, whole grains
NOT sugary drinks
teach patient to read food label

220
Q

Examples of healthy fiber include…?

A

legumes, whole grains, fruits, veggies (increase fluids with increase in fiber to avoid constipation)

221
Q

Examples of healthy fats/cholesterols include…?

A

avocados, nuts, seeds

222
Q

A man should have how many alcoholic bevs?

A

2

223
Q

A (diabetic) woman should have how many alcoholic bev?

A

1

224
Q

1 drink is

A

12 oz beer
5 oz wine
1 oz of fruity lil drinks

225
Q

A diabetic patient has a blood glucose of 260 and wants to go exercise. Is the patient allowed?

A

NO, patients can only exercise if their blood glucose is between 100-250

can cause r/f diabetic retinopathy d/t detachment

226
Q

How does exercise cause hypoglycemia?

A

increases the muscle glucose uptake and inhibits glucose release from the liver

227
Q

Will a patient need less or more insulin if they are exercising?

A

less

228
Q

Vigorous exercise should be avoided in patients who have…?

A

uncontrolled hypertension, neuropathy, foot lesions, neuropathy,severe hypoglycemia

229
Q

A patient who has neuropathy they may have decreased sensation of the foot, so what teaching will be needed if they do rigorous exercise?

A

wear proper footwear, inspect feet daily,

230
Q

Initial therapy for diabetic patients includes…?

A

diet, physical therapy, stress management

231
Q

Rapid acting insulin

A
232
Q

Regular acting insulin

A
233
Q

Long acting insulin

A
234
Q

Metformin

A

Antidiabetic medicine, 1st choice of medication

235
Q

How does Metformin work?

A

slows carb absorpiton and production of glucose by increasing insulin sensitivity

236
Q

side/adverse effects of Metformin

A

N/V, flatulence, monitor for lactic acidosis

237
Q

What medication do you stop 24-48 hours before a procedure that requires a contrast dye due to the risk of developing lactic acidosis?

A

Metformin

238
Q

What anti-diabetic medication do you take with food, vitamin B12 and folic acid to reduce GI effects?

A

Metformin

239
Q

Do not drink on this medication

A

Metformin

240
Q

When do you give rapid acting insulin?

A

Before meals, so make sure the patient eats 10 min within administration

241
Q

What is the onset of rapid acting insulin?

A

10-30 minutes

242
Q

What is the onset of short acting insulin?

A

30-60 minutes

243
Q

When do you give shorting acting insulin?

A

Within 30 minutes of the patient eating

244
Q

U500 can be given through IV

A

FALSE

245
Q

U500 is given to which patients?

A

Severely insulin resistant

246
Q

U500 is what type of insulin?

A

Short acting

247
Q

U100 can be given through IV

A

TRUE, its the only insulin that can

248
Q

What insulin is the most commonly prescribed insulin?

A

U100

249
Q

U100 is what type of insulin?

A

Short acting

250
Q

Intermediate acting insulin (NPH) onset is when?

A

60-120 minutes

251
Q

When is NPH given?

A

not at meals thats for sure

252
Q

When does NPH peak?

A

6-14 hours

bitch

253
Q

Long acting insulins are given when?

A

Same time every day

254
Q

Long acting insulins are effective between

A

12-18-24 hours

255
Q

When is the long acting insulins peak?

A

Doesn’t have one

trick question mwahaha

256
Q

Names of long acting insulins are

A

detemir, glargine

257
Q

What should you do with injection sites?

A

rotate, give at a 90 degree angle

258
Q

In what patients does DKA typically occur?

A

Type 1 Diabetics

259
Q

What symptoms are characterized by DKA?

A

high blood sugar, metabolic acidosis, increased production of ketones, fruity breath, abd. pain, dehydration, neuro symptoms, 3 P’s

260
Q

What state is your body in when in DKA?

A

state of stress, unable to keep up with energy demands

261
Q

A lack of insulin in the body means that

A

the body can’t unlock or open up cells to take in glucose, so the body thinks its starving

262
Q

In response to the body believing its starved, the body will

A

releases stored glucose, producing ketones in the liver (from broken down proteins) and glycerol (from broken down fatty acids) and then glycogenesis occurs

glycogenesis occurs but not correctly

263
Q

A byproduct of glucogensis is

A

acetyl coA

264
Q

Acetylcoa is used to make?

A

ketones

265
Q

DKA patients are

A

SICK SICK SICK

266
Q

The biggest complaints of patients who have DKA are?

A

N/V, abdominal pain, cool and clammy skin (due to severe dehydration)

267
Q

N/D during DKA is due to what cellular process in the body?

A

the process of breaking down fat to use it as energy releases inflammatory cytokines

268
Q

Glucose builds up in the blood during DKA because?

A

The body keeps producing since it doesn’t detect any glucose, causing glucose to spill from the blood

269
Q

What is osmotic diuresis?

A

As glucose starts to spill out into the urine, water goes with it and that leads to electrolyte loss and dehydration which then leads to altered mental status

270
Q

What are ketones?

A

acids that lower pH of the blood which leads to acidosis, and it is a metabolic acidosis

271
Q

Metabolic acidosis causes Kussmals respirations, which are?

A

deep and rapid breathing which attempts to correct the metabolic acidosis

272
Q

What do nurses asses in DKA patients?

A

airway, LOC, hydration status and electrolyte levels, glucose levels q15, acute weight loss, thirst, dry mucous membranes, weak or rapid pulse (signs of dehydration and HTN), hyperkalemia

273
Q

First line of treatment for DKA patients are…?

A

IV fluids to restore blood volume (fast infusion for the first hour and then at a reduce rate), regular insulin by IV, may give initial bolus dose and follow up with continuous basal doses

274
Q

How do you know if DKA is resolved?

A

blood glucose below 200

275
Q

What lab can insulin affect?

A

Potassium, monitor for s/s of hyper/hypokalemia

276
Q

Hyperosmolar or Hyperglycemic state is with which type of diabetes?

A

Type 2

277
Q

R/f for HHS include?

A

dehydration, stress, sepsis

278
Q

What’s the difference between HHS and DKA?

A

HHS doesn’t produce ketones

279
Q

Blood glucose levels can be seen around what number with HHS?

A

600

280
Q

HHS occurs when…?

A

blood sugar is high and as blood sugar starts to rise, we have glucose spilling out into the urine and water follows, leading to dehydration state a

281
Q

Type 2 diabetics make enough insulin to prevent DKA but not enough to prevent…?

A

HHS

282
Q

What are the differing levels of pH and HCO3 between DKA and HHS

A

DKA
pH < 7.35
HCO3. < 15
HHS
pH >7.4
HOC3 > 20

283
Q

What is the onset for HHS?

A

gradual

284
Q

What are the symptoms like for HHS?

A

dehydration, neuro

285
Q

Hypoglycemia s/s

A

cool, clammy, sweaty, nervous, irritable, confusion, decreased LOC, weak, blurred vision, tachycardia , palpitations, blood glucose <70mg/dL

286
Q

Hyperglycemia s/s

A

warm, dry skin, dehydration, mental status stuporous, obtunded, coma, blood glucose above > 180 mg/dL, ketones are positive with DKA

287
Q

What causes hypoglycemia?

A

Too much insulin or insulin not at the right time, not enough food intake, decrease gastric emptying (gastroparesis), alcohol, decreased insulin clearance due to kidney failure

288
Q

How many grams of carbohydrates do you give to your patient if they have a blood sugar below 70mg/dL?

A

15g

289
Q

Your patients blood sugar comes back to be below 50mg/dL, what nursing intervention should you perform?

A

administer 30g of carbohydrates

290
Q

What food/ drinks contain 15g CHO?

A

glucose tab/gel
half cup (120mL) of fruit juice or regular soft drink
5 hard glucose candies
4 cubes of sugar or 4tsp of sugar
1 tbsp (15mL) of honey or sugar

291
Q

What happens if your patient is unable to swallow but under hypoglycemia protocol?

A

give glucagon IV or IV dextrose

292
Q

If you give glucagon IV, what do you need to do next as the nurse?

A

Turn patient on their side, glucagon causes vomiting

293
Q

Macrovascular chronic complications of diabetes

A

Cardiovascular disease, Cerebrovascular diseases
(HTN, MI, stroke)

294
Q

Microvascular chronic complications of diabetes

A

neuropathy
retinopathy
nephropathy

295
Q

Risk of stroke is how much higher as a type 2 diabetic?

A

2-4x

296
Q

Shoes should have an extra 1/2 inch in their shoes for diabetic patients, T or F?

A

TRUE

297
Q

Diabetes is the cause of what life threatening disease?

A

end stage kidney disease

298
Q

Patients need to do what for foot care as a diabetic?

A

inspect all surfaces of feet daily, wash feet with lukewarm water, dont use moisturizer between the toes, cut tonenails straight across, dont wear sandals that have open toes or straps between the toes, dont go barefooted

299
Q

In diabetic nephropathy, patient can slow the progression of end stage kidney failure by…?

A

Control BP by using ACE/ARBS
Control blood glucose
Regular monitoring

Third Semester (5 decks)

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