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
2
Q
what does the endocrine system do within the body?
A
facilitate fluid and electrolyte imbalances, regulate glucose levels
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
4
Q
where is the hypothalamus located?
A
at the base of the brain, near the pituitary gland
5
Q
what is the hypothalamus called?
A
neuro-endocrine gland
6
Q
which gland is called the master gland?
A
pituitary gland
7
Q
how does the hypothalamus function?
A
receives signals from nerves and funnels those signals into the pituitary gland
8
Q
what hormones do the hypothalamus produce?
A
ADH and oxytocin
9
Q
what does ADH control?
A
vasopressin, fluid regulation and volume
10
Q
what does oxytocin do?
A
stimulates uterus to contract during pregnancy
11
Q
where is the pituitary gland located?
A
below the hypothalamus
12
Q
how does the pituitary gland function?
A
takes signals from the hypothalamus and directs it to ALL other endocrine glands
13
Q
the posterior pituitary gland is divided into…?
A
anterior and posterior sections
14
Q
what hormones are secreted in the anterior pituitary gland?
A
TSH, ACTH, Lutenizing hormone, FSH, Prolactin, Growth Hormone
15
Q
what outside/ environmental factors stimulates TSH?
A
stress or cold
16
Q
what hormones are secreted in the posterior pituitary gland?
A
ADH , oxytocin
17
Q
where is the thyroid gland located?
A
around the trachea
18
Q
what does the thyroid regulate?
A
metabolism
19
Q
what hormones regulate metabolism?
A
T3, T4
20
Q
An increase in metabolism causes an increase in what?
A
oxygen usage and heat production of our tissues
21
Q
The thyroid can also affect?
A
heart rate and contractility, RBC production, respiration rate
22
Q
where is the parathyroid hormone located?
A
4 spots on the back of the thyroid
23
Q
what does the parathyroid regulate?
A
Ca2+ levels
24
Q
what hormone regulates calcium?
A
PTH (parathyroid hormone)
25
what are some functions of calcium?
muscle contraction, bone growth
26
where are the adrenal glands located?
on top of the kidneys
27
how many parts are the adrenal glands divided into?
2
28
what are the 2 adrenal glands?
adrenal cortex, medulla
29
what part of the adrenal gland is the adrenal cortex?
outer part
30
what part of the adrenal gland is the medulla?
inner part
31
where are corticosteroids made? (cortisol)
adrenal cortex
32
where are catecholamines made?
medulla
33
what part of the brain is where the fight or flight response is activated?
medulla
34
what hormones are classified as catecholamine?
epinephrine and norepinephrine
35
what does cortisol do to the body?
increase blood sugar during stress to increase energy
anti-inflammatory functions
36
what other hormone does the adrenal cortex regulate?
aldosterone
37
where are secondary sex characteristics, puberty, and menopaus developed?
gonads
38
what hormones do the ovaries produce?
estrogen and progesterone
39
what hormone do the testes produce?
testosterone
40
what does estrogen do in the body?
affects the reproductive tract, the urinary tract, the heart and blood vessels, bones, breasts, skin, hair, mucous membranes, pelvic muscles, and the brain.
41
what does progesterone do in the body?
prepare the endometrium (lining of your uterus) for a fertilized egg to implant and grow
42
what does testosterone do in the body?
affects height, hair and pubic growth, enlargement of testes, penis and prostate gland, increase in libido
43
where is the pancreas located?
upper part of the abdomen
44
what hormones do the pancreas control?
insulin and glucagon
45
how does the insulin negative feedback loop work?
blood glucose increases
insulin is secreted
insulin turns cells on and tells them to increase glucose uptake into the cells
blood glucose levels decreases
46
how does the cortisol negative feedback loop work?
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
47
1 hormone
selective pituitaryism
48
2+ hormones
panhypopituitarinism
49
what is the most common cause of hypopituitarism
tumors
50
what are some other causes of hypopituitarism?
malnutrition
shock
hypotension
trauma
surgery
radiation
51
what are some s/s of hypopituitarism related to GH? (children)
short in stature
52
what are some s/s of hypopituitarism related to GH? (adults)
decreased bone density, deceased muscle strength, fractures
53
what are some s/s of hypopituitarism related to TSH?
cold intolerance, lethargy, weight gain, slow cognition
54
hydrocortisone or prednisone treats...?
hypopituitarism related to adrenal (ACTH)
55
levothyroxine or Synthroid treats...?
hypopituitarism related to thyroid (TSH)
56
somatropin treats...?
hypopituitarism related to GH
57
Hyperpituitarism
over secretion of the hormone
58
when can hyperpituitarism occur?
tissue hyperplasia or an anterior pituitary tumor (pituitary adenoma)
59
acromegaly
excess of GH
60
Physical signs of acromegaly in adults?
large face, hands, feet
61
Physical signs of acromegaly is children
gigantism
62
What are some other signs and symptoms of hyperpituitarism (Acromegaly) ?
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
63
What symptoms of acromegaly can be permanent?
hypertrophy of the soft tissue
64
What kind of growth is acromegaly?
slow
65
What critical visceral organs become enlarged?
heart, lungs, liver
66
Some complications of Acromegaly include...?
Increased ICP, Enlarged (benign) tumor, increased blood sugar
67
Diagnostics for hyperpituitarism include?
increased (somatropin) GH
X-rays, MRI, physical changes, Oral glucose challenge tests
68
What is another name for the oral glucose challenge test?
Growth hormone suppression test
69
What do the x-rays and MRI look at related to Hyperpituitarism
X-rays look at skeletal changes
MRIs look at the gland
70
You need to be NPO for 6-8 hours before what diagnostic procedure?
Growth Hormone suppression test
71
How does the oral glucose challenge test work?
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
72
Medication therapy for Hyperpituitarism include?
Dopamine Agonists
Somastatin analogs
GH receptor blockers
73
What do Dopamine Agonists do?
inhibit GH
74
What medications are classified as Dopamine Agonists?
bronocriptine mestlate, cabergoline
75
What are some adverse reactions of Dopamine agonists?
dizziness, watery drainage (indicates CFS leak), chest pain
76
What do Somastatin analogs do?
inhibits GH
77
What medications are classified as Somastatin analogs?
ocreotide, lanreotide
78
What medications are part of GH receptors blockers?
pegvisomant
79
What invasive procedure can also treat hyperpituitarism?
hypophysectomy
80
What is a hypophysectomy?
removal of the tumor that secretes GH
81
What kind of dressing is used for hypophysectomy?
mustache dressing
82
The patient will receive a nasal packing after a hypophysectomy for how many days?
2-3
83
Should hypophysectomy patients bend forward?
NO, increases ICP and can cause a CSF leak
84
Can hypophysectomy patients brush their teeth or cough to clear secretions?
NO , instead they can use dental floss and mouth wash and breath through their mouth
85
How often should a nurse complete neuro checks on a post op hypophysectomy patient?
hourly for the first 24 hours, then at least every 4 hours
86
The nurse should document and assess what changes?
vision, mental status, LOC, and extremity strength
87
What should the nurse monitor on a post op hypophysectomy patient?
I&O for diabetes insipidus (output greater than input, means a decrease in ADH)
88
The nurse should monitor for s/s of this infection on a post op hypophysectomy patient?
meningitis
89
What are the s/s of diabetes insipidous?
| Jordan called me the n word on this card
polyuria, polyphagia, polydipsia
90
What are the s/s of meningitis?
neck stiffness, fever, confusion or altered mental status, headaches, nausea and vomiting
91
What nursing intervention should be performed for a post op hypophysectomy patient?
elevate HOB
92
What kind of treatment will a patient receive if the entire pituitary gland was removed?
lifelong hormone supplementation
93
what are some patient teaching points for a hypophysectomy patient?
report post nasal dripping , increase swallowing, severe headache
94
A patient post op hypophysectomy has a decrease sense of smell, is this normal?
Yes, they will have a decreased sense of smell for 3-4 months
95
What treatment do you use for a CSF leak?
bedrest
96
How do you tell if leakage is CSF fluid?
light yellow color ring at the edge of clear drainage with glucose present
97
What foods are needed to make thyroid hormones?
Protein and iodine
98
If glucose tolerance is decreased, this means the patient will have ...?
Hyperglycemia
99
Hyperthryoidism does what to the body systems?
speeds everything up (increases metabolism)
100
how does hyperthyroidism occur?
too much thyroid hormones from the thyroid gland
101
Primary hyperthyroidism
issue with the thyroid gland itself, causing too much thyroid hormones to be produced
102
Secondary hyperthyroidism
excess in thyroid hormones due to increased TSH from the pituitary or hypothalamus
103
Graves disease occurs due to..?
thyroid inflammation where autoantibodies attach to TSH receptors on the thyroid gland, increasing thyroid hormone production, mimicking TSH
104
What symptoms are specific to Graves disease?
exopthlamos
pretibial myxedema
105
Graves disease can also be caused by..?
toxic multi nodular goiter
106
What is toxic multi nodular goiter?
multiple thyroid nodules
107
What are signs and symptoms of thyroid storm?
pyrexia, tachycardia, delirium
108
What is thyroid storm?
Acute presentation of hyperthyroidism
109
How do you treat thyroid storm patients?
More supportive care, IV fluids, beta blockers
110
Symptoms of hyperthyroidism
dysrhythmias
HTN
palpitations
tachycardia
diarrhea
fatgiue
heat intolerance
anxiety
diaphoresis
insomnia
tremors
goiter
wide eye stare (exopthlamos , Graves disease only)
finger clubbing
111
What will labs look like in a patient with hyperthyroidism?
T3 T4 increase
TSH high
112
What will the TSH levels looks like in a patient with Graves disease?
Low
113
Diagnostics for hyperthyroidism include..?
thyroid scan, radioactive iodine , thyroid ultrasound, EKG
114
Non surgical treatment for hyperthyroidism
monitor pulse, BP, temp.
reduce stimulation
115
What does an increasing temp in a patient with hyperthyroidism mean?
Worsening condition, thyroid storm event
116
Is an increase of just one degree in Fahrenheit indicate concern?
YES
117
What does reducing stimulation do for a hyperthyroidism patient?
reduce symptoms
118
What does reduce stimulation mean?
quiet, calm environment, limiting visitor
119
What medications do you use as initial treatment for hyperthyroidism?
Thianomides
120
What is a secondary medication used to treat hyperthyroidism
PTU, not used as often due to toxic liver effects
121
Patient teaching for thionimines and PTU
avoid crowds due to reduce immune system, monitor for s/s of hypothyroidism
122
What do PTU patients need to report?
darkening of the urine (liver toxicity)
123
What is the preferred drug of thianomides?
Methimazole
124
How does methimazole work?
inhibits production of thyroid hormone by preventing iodine from binding with or in the thyroid gland
125
What pregnancy category is Methimazole?
Cat D
126
What is supportive medication therapy for hyperthyroidism?
Beta Blocker, relieves diaphoresis, anxiety, tachycardia
127
What is Lugol's solution?
short term hyperthyroidism therapy prior to surgery by reducing blood flow to thyroid gland, reducing production of thyroid hormones.
128
How long does it take Lugol's solution to see an improvement of symptoms?
2 weeks
129
Radioactive iodine does what?
destroys thyroid cells
130
Safety precautions for radioactive iodine
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
Thyroidectomy
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
If the thyroid is completely removed, the patient will need to do what?
Take lifelong supplemental therapy
133
Pre-op teaching/ MANAGEMENT
Cough and deep breath
May have a drain and a dressing after surgery
Keep tachycardia and high BP under control
134
Post-op nursing interventions
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
when is hemorrhage most likely?
24 hours after procedure
136
How often do you monitor vital signs after a thyroidectomy?
every 15 min until patient is stable and every 30 min there after
137
Laryngeal striata indicates?
Acute respiratory obstruction
138
What will laryngeal striata sound like?
high pitched, harsh respiratory sound
139
What can occur if the thyroid glands are destroyed or damaged?
Muscle twitching, paresthesia (Hypocalcemia)
140
Laryngeal nerve damage can occur during a thyroidectomy, what should you do as a nurse to monitor?
assess vocal cords every 2 hours
141
During an assessment for a hyperthyroidism patient with a noticeable goiter, do you palpate the goiter?
No, can release excess amounts of thyroid hormones, triggering thyroid storm
142
Why does exopthlamos occur?
edema to the extra ocular muscles and increased fatty tissues behind the eyes
143
What is hypothyroidism?
Decrease or absent thyroid hormones
144
What is the main manifestation of hypothyroidism?
decreased metabolism
145
What causes hypothyroidism?
Autoimmune diseases, atrophy of the thyroid gland, thyroid surgery, radioactive iodine, iodine deficiency, amnioterone lithium
146
What is a specific autoimmune disease that causes hypothyroidism?
Hashimoto's thyroiditis
147
What is the pathology of Hashimoto's thyroiditis?
body produces antibodies that attack thyroid tissues, resulting in inflammation and tissue destruction which decreases thyroid hormones secretion (potentially causing goiter)
148
What does amnioterone lithium interfere with that causes hypothyroidism?
thyroid hormone production
149
What are the signs and symptoms of hypothyroidism?
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
What labs are diagnostics for hypothyroidism?
T3 and T4 decreased, TSH increased
151
What is the medication of choice to treat hypothyroidism?
Levothyroxine
152
What are some patient teaching points for Levothyroxine?
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
What is myexedema coma?
A complication of poorly treated hypothyroidism, results in cardiopulmonary and neurological function, pt may experience chest pain
154
What to do if the patient is having more fatigue or constipation?
increase meds
155
What to do if the patient is having more diarrhea and difficulty sleeping?
decrease meds
156
Iodine is needed for what?
the thyroid to make thyroxine
157
Decrease metabolism causes what within the body?
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
What manifestation of hypothyroidism is a medical emergency?
myxedema coma
159
What are some risk factors for myxedema coma?
acute illness, recent surgery, chemotherapy, not taking a thyroid replacement, sedative or opioid use,
160
What are complications of myxedema coma?
reduced LOC and cognition, hypertension, hypothermia, bradycardia, hypoglycemia, respiratory failure, hyponatremia
161
What are some nursing interventions for myxedema coma?
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
What is your priority if your patient goes into myxedema coma?
AIRWAY
163
What does the parathyroid gland regulate?
Calcium and phosphate balances in the body
164
What hormone does the parathyroid gland secrete?
Parathyroid hormone
165
What does the parathyroid hormone act on?
Bone, kidneys, GI tract
166
If Calcium levels are low, parathyroid hormones secrete more to increase calcium and do so in the
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
Where do we get vitamin D?
The response to sunlight, and food
168
Parathyroid hormone does what to vitamin D?
turns it into an active form, raising blood calcium levels
169
Deficiency in vitamin D can lead to
deficiency in calcium
170
Hypoparathyroidism labs and diagnostics
Increased Phsophrous
Decreased PTH, calcium, magnesium
24 hour urine test to measure amount of calcium, vitamin D levels
171
Hypoparathyroidism causes include
Removal of parathyroid gland or glands
Autoimmune condition
172
S/S of hypoparathyroidism
muscle cramps, spasms, seizures, mental status changes, tingling (paresthesia) of hands and mouth, positive Trousseaus or Chovesteks sign
173
Positive Trousseas sign
involuntary contraction of the hand and wrists are compression from a blood pressure cuff
174
Positive Chvosteks sign
stimulation of cranial nerve 7 by tapping in front of the ear and facial twitching occurring
175
Nonsurgical treatment for hypercalcemia
correcting the calcium level and preventing kidney stones
176
What do you give to patients who present with acute and severe hypocalcemia?
IV calcium gluconate
177
What other supplemental therapy can be given to patients with hypocalcemia (hypoparathyroidism) depending on the severity of presentation?
oral calcitrol, calcium carbonate
178
Nursing management for hypoparathyroidism
Teach about medications
Increase intake of vitamin D (milk, yogurt, ice cream)
Wear a medic alert bracelet
179
Hyperparathyroidism labs and diagnostics
PTH, Calcium, Magnesium Increased
Phosphorus decreased
X-rays , bone density tests
180
What is the pathophysiology behind hyperparathyroidism?
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
What is the primary cause of hyperparathyroidism?
tumor , leads to increased absorption of calcium
182
What are secondary causes of hyperparathyroidism?
vitamin D deficiency, CKD (leads to decreased absorption of calcium in the blood which in turn leads to hypocalcemia) ???
## Footnote
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
Some signs and symptoms of hyperparathyroidism include..?
bone fractures, weight loss, kidney stones
184
Treatment for hyperparathyroidism includes...?
Surgical management or drug therapy
185
Parathyroid drug therapies mechanism of action
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
Surgical management for hyperparathyroidism
Parathryoidectomy, would be curative of the problem
187
Pre and post op nursing interventions and patient teaching for a parathyroidectomy is?
Same as thyroidectomy
188
What is glycemic control?
Glucose regulation, the process of maintaining optimal glucose control
189
where is the pancreas located?
behind the stomach, next to the small intestine
190
Islets of lagerhans are located where?
scattered throughout the pancreas
191
What are the 2 types of islet of Langerhan cells?
alpha cells and beta cells
192
What do alpha cells do?
secrete glucagon
193
What do beta cells ddo?
secrete insulin
194
Insulin does what in relation to glucose?
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
Glucagon does what in relation to glucose?
raises blood glucose by preventing hypoglycemia by triggering the release of glucose from storage sites
196
Where are the glucose storage sites?
skeletal muscle and liver
197
S/S of diabetes
P, P , P
198
What occurs inside the body when there is an insulin deficiency?
the body breaks down stored fats and releases free fatty acids, when the fat is used for energy it produces ketone bodies
199
The pathophysiology for Type 1 and Type 2 differ by...?
Type 1 is beta cell DESTRUCTION
Type 2 is beta cell DYSFUNCTION, or insulin resistance
200
Which type of diabetes is an autoimmune diorder or a viral infection?
Type 1
201
Which type of diabetes is not autoimmune, but the patients are genetically predisposed?
Type 2
202
Type 1 diabetes patients are insulin
DEPENDENT
203
What percentage of Type 2 diabetics require insulin?
20-30%
204
Onset for Type 1 diabetes is
before 30 years of age
205
Onset for Type 2 diabetes is
at any age, nobody is safe
mainly in older adults but fattys like jordan eat mcdoanlds
206
Symptoms for Type 1 diabetes include
an abrupt onset, polydipsia, polyuria, polyphagia, increased weight loss
207
Symptoms for Type 2 diabetes include
frequently none but can be thirst, fatigue, blurred vision, vascular/ neural complications
208
Nutritional status for Type 1 diabetics include
same obesity rate as the general adult population
209
Nutritional status for Type 2 diabetics include
Metabolic syndrome, 60-80 % are obese
210
What are risk factors for Type 2 diabetes?
Family hx
PCOS (polycystic ovarian syndrome)
AA, hispanic, Pacific Islanders
Increased birth weight, gestational diabetes
211
A patient is displaying abdominal obesity, hyperglycemia, and hyperlipidemia. What syndrome do they have?
Metabolic Syndrome
212
What are the 4 signs of metabolic syndrome?
Abdominal obesity (Women 35 inches in circumference, Men 40 inches)
Hyper glycemic (fasting glucose 100)
HTN (140/90+)
Hyperlipidemia (150+ triglycerides)
213
A patient must display 3/4 signs to qualify for
Metabolic syndrome
214
Metabolic syndrome increases a patients risk for?
Type 2 diabetes, cardiovascular disease and stroke
215
Normal HgA1C values
Prediabetes
Diabetes
4-5.7%
5.7-6.4%
>6.5%
216
Normal fasting glucose values
Prediabetes
Diabetes
74-100mg/dL
100-125mg/dL
>126mg/dL
217
Normal glucose tolerance values
Prediabetes
Diabetes
<140mg/dL
140-199mg/dL
>200mg/dL
218
Which type of diabetes can't be prevented and which can be?
Type 1 can't
Type 2 risk can be reduce by nutrition, exercise, medication
219
Examples of healthy carbohydrates include...?
fruits, vegetables, whole grains
NOT sugary drinks
teach patient to read food label
220
Examples of healthy fiber include...?
legumes, whole grains, fruits, veggies (increase fluids with increase in fiber to avoid constipation)
221
Examples of healthy fats/cholesterols include...?
avocados, nuts, seeds
222
A man should have how many alcoholic bevs?
2
223
A (diabetic) woman should have how many alcoholic bev?
1
224
1 drink is
12 oz beer
5 oz wine
1 oz of fruity lil drinks
225
A diabetic patient has a blood glucose of 260 and wants to go exercise. Is the patient allowed?
NO, patients can only exercise if their blood glucose is between 100-250
## Footnote
can cause r/f diabetic retinopathy d/t detachment
226
How does exercise cause hypoglycemia?
increases the muscle glucose uptake and inhibits glucose release from the liver
227
Will a patient need less or more insulin if they are exercising?
less
228
Vigorous exercise should be avoided in patients who have...?
uncontrolled hypertension, neuropathy, foot lesions, neuropathy,severe hypoglycemia
229
A patient who has neuropathy they may have decreased sensation of the foot, so what teaching will be needed if they do rigorous exercise?
wear proper footwear, inspect feet daily,
230
Initial therapy for diabetic patients includes...?
diet, physical therapy, stress management
231
Rapid acting insulin
232
Regular acting insulin
233
Long acting insulin
234
Metformin
Antidiabetic medicine, 1st choice of medication
235
How does Metformin work?
slows carb absorpiton and production of glucose by increasing insulin sensitivity
236
side/adverse effects of Metformin
N/V, flatulence, monitor for lactic acidosis
237
What medication do you stop 24-48 hours before a procedure that requires a contrast dye due to the risk of developing lactic acidosis?
Metformin
238
What anti-diabetic medication do you take with food, vitamin B12 and folic acid to reduce GI effects?
Metformin
239
Do not drink on this medication
Metformin
240
When do you give rapid acting insulin?
Before meals, so make sure the patient eats 10 min within administration
241
What is the onset of rapid acting insulin?
10-30 minutes
242
What is the onset of short acting insulin?
30-60 minutes
243
When do you give shorting acting insulin?
Within 30 minutes of the patient eating
244
U500 can be given through IV
FALSE
245
U500 is given to which patients?
Severely insulin resistant
246
U500 is what type of insulin?
Short acting
247
U100 can be given through IV
TRUE, its the only insulin that can
248
What insulin is the most commonly prescribed insulin?
U100
249
U100 is what type of insulin?
Short acting
250
Intermediate acting insulin (NPH) onset is when?
60-120 minutes
251
When is NPH given?
not at meals thats for sure
252
When does NPH peak?
6-14 hours
| bitch
253
Long acting insulins are given when?
Same time every day
254
Long acting insulins are effective between
12-18-24 hours
255
When is the long acting insulins peak?
Doesn't have one
| trick question mwahaha
256
Names of long acting insulins are
detemir, glargine
257
What should you do with injection sites?
rotate, give at a 90 degree angle
258
In what patients does DKA typically occur?
Type 1 Diabetics
259
What symptoms are characterized by DKA?
high blood sugar, metabolic acidosis, increased production of ketones, fruity breath, abd. pain, dehydration, neuro symptoms, 3 P's
260
What state is your body in when in DKA?
state of stress, unable to keep up with energy demands
261
A lack of insulin in the body means that
the body can't unlock or open up cells to take in glucose, so the body thinks its starving
262
In response to the body believing its starved, the body will
releases stored glucose, producing ketones in the liver (from broken down proteins) and glycerol (from broken down fatty acids) and then glycogenesis occurs
## Footnote
glycogenesis occurs but not correctly
263
A byproduct of glucogensis is
acetyl coA
264
Acetylcoa is used to make?
ketones
265
DKA patients are
SICK SICK SICK
266
The biggest complaints of patients who have DKA are?
N/V, abdominal pain, cool and clammy skin (due to severe dehydration)
267
N/D during DKA is due to what cellular process in the body?
the process of breaking down fat to use it as energy releases inflammatory cytokines
268
Glucose builds up in the blood during DKA because?
The body keeps producing since it doesn't detect any glucose, causing glucose to spill from the blood
269
What is osmotic diuresis?
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
What are ketones?
acids that lower pH of the blood which leads to acidosis, and it is a metabolic acidosis
271
Metabolic acidosis causes Kussmals respirations, which are?
deep and rapid breathing which attempts to correct the metabolic acidosis
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What do nurses asses in DKA patients?
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
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First line of treatment for DKA patients are...?
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
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How do you know if DKA is resolved?
blood glucose below 200
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What lab can insulin affect?
Potassium, monitor for s/s of hyper/hypokalemia
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Hyperosmolar or Hyperglycemic state is with which type of diabetes?
Type 2
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R/f for HHS include?
dehydration, stress, sepsis
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What's the difference between HHS and DKA?
HHS doesn't produce ketones
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Blood glucose levels can be seen around what number with HHS?
600
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HHS occurs when...?
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
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Type 2 diabetics make enough insulin to prevent DKA but not enough to prevent...?
HHS
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What are the differing levels of pH and HCO3 between DKA and HHS
DKA
pH < 7.35
HCO3. < 15
HHS
pH >7.4
HOC3 > 20
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What is the onset for HHS?
gradual
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What are the symptoms like for HHS?
dehydration, neuro
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Hypoglycemia s/s
cool, clammy, sweaty, nervous, irritable, confusion, decreased LOC, weak, blurred vision, tachycardia , palpitations, blood glucose <70mg/dL
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Hyperglycemia s/s
warm, dry skin, dehydration, mental status stuporous, obtunded, coma, blood glucose above > 180 mg/dL, ketones are positive with DKA
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What causes hypoglycemia?
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
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How many grams of carbohydrates do you give to your patient if they have a blood sugar below 70mg/dL?
15g
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Your patients blood sugar comes back to be below 50mg/dL, what nursing intervention should you perform?
administer 30g of carbohydrates
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What food/ drinks contain 15g CHO?
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
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What happens if your patient is unable to swallow but under hypoglycemia protocol?
give glucagon IV or IV dextrose
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If you give glucagon IV, what do you need to do next as the nurse?
Turn patient on their side, glucagon causes vomiting
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Macrovascular chronic complications of diabetes
Cardiovascular disease, Cerebrovascular diseases
(HTN, MI, stroke)
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Microvascular chronic complications of diabetes
neuropathy
retinopathy
nephropathy
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Risk of stroke is how much higher as a type 2 diabetic?
2-4x
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Shoes should have an extra 1/2 inch in their shoes for diabetic patients, T or F?
TRUE
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Diabetes is the cause of what life threatening disease?
end stage kidney disease
298
Patients need to do what for foot care as a diabetic?
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
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In diabetic nephropathy, patient can slow the progression of end stage kidney failure by...?
Control BP by using ACE/ARBS
Control blood glucose
Regular monitoring
