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Med Surg 1 > Care of Pt. with diabetes > Flashcards

Care of Pt. with diabetes Flashcards

1
Q

Glucose

where is it stored

A
  • “Sugar”
  • Fuels the cells of our body
  • Stored mainly in liver in form of glycogen
  • Needs help of Insulin to enter the cells
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2
Q

Insulin

A
  • Hormone which regulates amount of glucose in blood
  • Helps body use glucose by allowing it to enter the cell
  • Secreted by Beta Cells
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3
Q

Glucagon

A
  • Secreted by Alpha Cells

- Hormone that helps the liver turn stored glucose (glycogen) into glucose

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4
Q

a&p of Increased blood sugar

A
  • Pancreas releases Insulin → Glucose enters cells to be used or saved for later to lower blood sugar
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5
Q

Decreased blood sugar

A

Pancreas releases Glucagon → Liver releases glycogen (stored glucose) to increase blood sugar

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6
Q

what is diabetes Mellitus

A
  • common, chronic, complex disorder
  • results from inability to produce insulin and the bodys resistance to insulin
  • results in hyperglycemia
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7
Q

type 1 dm

A
  • autoimmune- destruction of beta cells
  • known as juvenille onset or insluin dependdent diabetes mellitus
  • onset before 30
  • management: dependent on insulin, diet, and exercise
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8
Q

type 2 dm

A
  • progressive disorder: initial resistance to insulin, progresses to decrease secretion
  • known as adult onset diabetes or non insulin dependent mellitus
  • onset is any age
  • Management: diet, exercise, oral hypoglycemics, 20-30% require insulin
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9
Q

3 initial symtoms of dm

A
  • polyuria
  • polydipisa- thirst
  • polyphagia
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10
Q

polyuria

A
  • increased urination

- Kidneys attempt to filter high blood glucose → Excreted from body in urine

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11
Q

polydipsia

A
  • increased thirst/ drinking

- Increased water consumption to make up from water loss by frequent urination

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12
Q

polyphagia

A
  • increased hunger

- Cells are starved of glucose leads to increased huger/eating

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13
Q

hyperglycemia causes and symptoms

A
  • BG > 115 mg/dL

Causes

  • Stress
  • Skipped Insulin
  • Steroids

Symptoms

  • Warm/Dry
  • Tachycardia
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14
Q

hypoglycemia causes and symptoms

A

BG < 70 mg/dL

Causes

  • Lack of eating
  • Intense exercise
  • Too Much Insulin

Symptoms

  • Sweating
  • Cool/Clammy
  • Irritable/Anxious
  • Hunger
  • Double Vision
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15
Q

Diabetic Ketoacidosis (DKA)

A
  • More Common in Type 1 Diabetics

- Insulin deficiency → Cellular Starvation → Breakdown of Fats → Ketones → Acidotic State

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16
Q

Diabetic Ketoacidosis (DKA) Signs/Symptoms

A
  • Nausea/Vomiting
  • Excessive Thirst
  • Kussmaul’s Respirations
  • Fruity Breath
  • Changes in LOC
  • Metabolic Acidosis
  • BG > 300 mg/dL
17
Q

Hyperglycemic Hyperosmolar Syndrome (HHS)

A
  • More Common in Type 2 Diabetics

- Insulin deficiency combined with profound dehydration → Blood Glucose Elevation

18
Q

Hyperglycemic Hyperosmolar Syndrome (HHS) s/s

A
  • Blurred Vision
  • Headache
  • Changes in Mental - Status
  • Seizures
  • BG > 600 mg/dL
19
Q

diagnostic testing for dm

A

Glycosylated hemoglobin (A1C)

  • Identifies average blood glucose over time
  • Previous 120 days
  • Reference Range 4 – 6%
  • Diabetics: 6.5 – 8%
  • Preference 7% or less

Fasting Blood Glucose (FBG)
- Two separate results >126 mg/dL

20
Q

Long term cardio/cerebrovascular disease complications

A

HTN, MI, Stroke

Nursing
- BP Control, smoking cessation, lipid-lowering medications and ASA

Education
- Cholesterol checks, regular activity, low-fat diet

21
Q

long term diabetic rentiopathy complications

A

Impaired Vision, Blindness

Education
- Yearly Eye Exam, report vision changes

22
Q

long term diabetic neuropathy complications

A

Peripheral Neuropathy: change in sensation- cant feel
- Most commonly affects feet/lower extremities

Nursing

  • Foot care: check every day
  • Gabapentin

Education
- Annual podiatrist apt, daily foot inspection/care, report numbness/tingling

23
Q

long term diabetic nephropathy complications

A

ESRD/ESKD
- #1 cause of ESRD in US

Nursing

  • monitor kidney function, I&Os, report output less than 30ml/hr monitor bp
  • diuretics

education
- consume 2-3l of fluid/day, avoid soda, alochol, acetaminophen, NSAIDS, report decreased output

24
Q

hypoglycemia unconscious

A
  • Place in lateral position – prevents aspiration

Administer

  • Glucagon SQ/IM: tells liver to take out sugar out of cell
  • D50 or IV Dextrose
25
Q

hypogylcemia conscious

A

Provide readily absorbable carb

  • 4-6oz fruit juice or regular soft drink
  • Glucose tablets/gel
  • Hard candies

Recheck 15 Min After Intervention

26
Q

hyperglycemia action type 2 dm

A

Oral Hypoglycemics

  • Reserved for Type 2 patients
  • NOT Insulin

Action:

  • Stimulate Pancreas to Produce more Insulin
  • Increase Tissue Sensitivity to Insulin
  • Slow carbohydrate absorption in intestines
27
Q

examples of oral hypoglcemics

A

Metformin – Most Common
- Stop 24-48 hours before imaging with iodinated contrast dye, resume 48 hours after

Glipizide
- When given with beta-blockers can mask tachycardia

28
Q

insulin
routes
sites
timing

A
  • given for hyperglycemia

Administration Routes

  • SQ
  • IV

Sites

  • Rotate frequently to prevent tissue damage
  • Abdominal tissue provides fastest absorption
  • Do NOT inject within 2-inches of umbilicus

Timing

  • Onset – Time from administration to lowering of BG
  • Peak – When insulin is working the hardest
  • BG is at its lowest
  • Duration – Length of time before all the insulin is used up
29
Q

Rapid

A

lispro (humalog)

onset: 15min
Peak: 1-2 hours
duration: 3-4hr
admin time: before or with meals

30
Q

short

A

regular (humulin-r)

onset: 30-60 min
peak: 2-4hr
duration: 5-7hr
admin time: 30-60 min before meals

31
Q

intermediate

A

NPH (humulin-N)

onset: 2-4hr
peak: 4-10hr
duration: 10-16hr

admin time: between meals or at night

32
Q

long

A

lantus (glargine)

onset: 3-4hr
peak: none
Duration: 24 hours
admin time: once a day

33
Q

non-pharmacological management: nutritonal therapy

A
  • Patient should work with Registered Dietitian/Nutritionist

Carbohydrates

  • Limit Simple Sugars
  • Stick to Complex Carbs
  • Low Fat/Sodium
  • Be Consistent
34
Q

non-pharmacological management: exercise

A

150 Minutes/Week – Evenly spaced every other day

Precautions

  • Check BG before
  • exercising
  • Eat snack if BG <100 mg/dL
  • Carry Fast Snack
  • Do NOT admin insulin in areas being exercised
  • Affects absorption
35
Q

what kind of insulin therapy does type 1dm need while npo

A
  • Type 1 diabetics will need continued insulin administration even while NPO
  • Preventing DKA
36
Q

what kind of insulin therapy does type 2dm need while npo

A
  • Type 2 diabetics may have less insulin requirements when NPO or on a clear liquid diet
  • Preventing hypoglycemia
37
Q

when is short acting insulin often given

A

at the time of clear liquid meals or enteral feedings to prevent hyperglycemia

38
Q

clients on continous feedings get sugars checked when?

A
  • Clients receiving continuous feedings require blood glucose monitoring at evenly spaced intervals
  • Usually every 6 hours
39
Q

pt. teaching

A

Ensure
- Ensure patient demonstrates appropriate technique for obtaining fingerstick blood glucose

Determine
- Determine patients understanding of how to respond to results of blood glucose testing

Validate
- Validate the patient can perform correct self administration of insulin

Remind
- Remind patient metabolic demand changes with illness, insulin requirements may change

Med Surg 1 (25 decks)

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