Ch. 56 Flashcards
1
Q
metabolic syndrome is
A
the simultaneous presence of metabolic factors that increase the risk for Type 2 DM
2
Q
metabolic syndrome includes
A
- abdominal obesity
- hyperglycemia
- hypertension
- hyperlipidemia
3
Q
incidence and prevalence of DM
A
- more than 34 million people in the US are living with DM
- 7.3 million in US are undiagnosed
- 86 million in the US with prediabetes
- 2.2 million adults in Canada
4
Q
health promotion and maintenance of DM
A
- control of DM and its complications is the major focus of health promotion activities
- low-calorie diet
- increase acitivity
5
Q
Type 1 DM
A
- beta cell destruction = absolute insulin deficiency
- autoimmune
- idiopathic
- not controlled by diet
- ONLY treated by insulin
6
Q
Type 2 DM
A
- insulin resistance to insulin deficiency
- later onset
- risk factors can be mitigated
- can be treated w/ insulin, diet, exercise, mult. treatment options
7
Q
ethnic disparities in DM in the US
A
African Americans: 12.6%
Hispanics: 11.8%
Asian Americans: 8.4%
Non-Hispanic Whites: 7.1%
American Indians in Southern AZ: 24.1%
8
Q
DM assessment: risk factors
A
- decreased PA
- obesity/high BMI
- poor diet
- genetics/ fam history
9
Q
DM assessment: s/sx
A
- always tired
- frequent urination
- sudden weight loss
- wounds that won’t heal
- sexual problems
- vaginal infections (yeast)
- always thirsty
- numb or tingling hands or feet
- blurry vision
- always hungry
10
Q
DM assessment: labs/screenings
A
- glycosylated hemoglobin (A1c)
- FBG
11
Q
Hgb A1c levels
A
healthy: < 5.3
trending 5.3-5.5
prediabetic: 5.6-6.4
diabetic: > 6.4
lifespan of Hgb: 3 months
12
Q
patient problems related to DM
A
- potential for injury
- potential for poor wound healing
- potential for kidney disease (damage to blood vessels causes kidneys to not function properly)
- potential for complications
13
Q
nursing actions with DM
A
- preventing injury from hyperglycemia
- enhancing surgical recovery
- preventing injury from peripheral neuropathy
- reducing risk for kidney disease
- preventing complications
14
Q
PO medication for DM
A
- sulfonylurea agents: glipizide, glyburide, glimepiride
- meglitinide analogues: repaglinide
- biguanides: metformin
- thiazolidinediones: pioglitazone, rosiglitazone
- DPP-4 inhibitors: sitagliptin (januvia)
15
Q
insulin therapy: types of insulin
A
- rapid: aspart, lispro, humalog
- short: regular, humalin
- intermediate: NPH
- long: glargine/lantus
16
Q
mixing insulin
A
- make sure that they can be mixed/compatible
- regular and NPH: clear before cloudy (R before N)
- inject air into NPH, then inject air in R, draw up R, then draw up NPH
17
Q
factors that influence insulin absorption
A
- fat scarring
- injection site (abdomen is fastest site)
- high temperature (hot shower, bath, water bottle, spa, sauna)
- massaging/vigorously rubbing injection site
**(heat increases, cold decreases absorption)
18
Q
rapid-acting insulin
A
aspart, lispro, humaLOG
- onset: 10-20 min
- peak: 1-3 hours
- duration: 3-5 hours
- take with meals?: want food tray in the room
19
Q
short-acting insulin
A
regular (given IV route only), humaLIN
- onset: 30-60 min
- peak: 1-5 hours
- duration: 6-10 hours
- take with meals?: 30 mins before each meal
20
Q
intermediate-acting insulin
A
NPH
- onset: 60-120 min
- peak: 6-14 hours
- duration: 16-24 hours
- take with meals?: 30-45 mins before meals
21
Q
long-acting insulin
A
glargine (lantus)
- onset: 70 min
- peak: none
- duration: 18-24 hours
- take with meals?: same time every day, usually within 1 hour of breakfast
22
Q
health teaching of DM
A
- normal values
- Hgb A1c
- how to take a glucose finger stick?
- exercise: promotes uptake of glucose without insulin, also to decrease weight
- prevent complications: peripheral neuropathy
23
Q
what do meglitinide analogues do?
A
stimulate insulin release
- actually stimulate the beta cells to make insulin
- CAN cause hypoglycemia
24
Q
what do biguanides do?
A
improves insulin sensitivity, decrease liver glucose production
- makes the liver not make as much sugar/glycogen, makes tissue more sensitive to take in glucose/less resistant to insulin
- will NOT cause hypoglycemia!!
- hard on kidneys!- CT scan, will need to hold metformin
25
what do thiazolidinediones do?
increase cellular use of glucose
- more insulin receptive
26
what do DPP-4 inhibitors do?
reduced liver glucose production, delay gastric emptying
- make less sugar/glycogen
27
dawn phenomenon
nighttime release of adrenal hormones, glucose elevated 5-6AM; give insulin later at night
morning hyperglycemia because insulin did not cover the whole night
28
somogyi effect
morning hyperglycemia, rebound from nighttime hypoglycemia; eat more at night, monitor insulin dose
morning hyperglycemia because too much insulin/not enough glucose at night caused hypoglycemia
29
inhaled insulins*
- comes w/ inhaler
- "afrezza" is an ultra-rapid/short- acting mealtime insulin
30
insulin pumps*
small computerized device that delivers insulin to help people with diabetes manage their blood glucose level
- can deliver in bolus before meals or continuously
- Usually for type 1 diabetics
31
principles of nutrition
- protein (high)
- dietary fat and cholesterol (low)
- fiber (high)
- sweeteners (low)
- alcohol (low)
32
chronic complications of DM can be
- macrovascular
- microvascular
33
macrovascular complications
- stroke
- heart disease or HTN
- peripheral arterial disease
- foot problems*
34
microvascular complications
- diabetic eye disease (retinopathy and cataracts)
- renal disease
- neuropathy
- foot problems*
35
acute complications of DM: hypoglycemia
Low blood sugar
(cold and clammy needs some candy)
- act quickly, more emergency than hyper because sugar is falling while youre talking, time sensative
36
acute complications of DM: DKA
Very very high blood sugar
(hot and dry, sugar high)
- fat is broken down for energy
- have to be acidic to have DKA
- this is an INFECTION
- medical emergency
37
acute complications of DM: HHS
Very high blood sugar
(hot and dry, sugar high)
38
causes of hypoglycemia
rapid onset (1-3 hours)
- insufficient food intake
- excess insulin
- excess exercise
- history
39
s/sx of hypoglycemia
- anxious
- sweaty
- hungry
- confused
- blurred or double vision
- shaky
- irritable
- cool, clammy skin
40
treatment of hypoglycemia
- rule of "15"
- under 70, 15 grams of carbs, recheck in 15 mins
- need BS increased!
eating is ideal treatment if they can eat (awake and alert) NO FOOD to drooling, unconscious- give glucagon
41
DKA patho
- onset over 4-10 hours
- causes: lack of insulin, GI upset, febrile illness, history
- biggest reason: infection
- BG >300
42
s/sx of DKA
- Polyuria (peeing a lot)**
- Polydipsia (thirsty)**
- Polyphagia**
- Fruity Breath (smell ketones on breath)***
- Nausea/Vomiting
- Abdominal Pain
- Dehydration signs
- Weakness
- AMS
- Kussmaul’s respirations***
- Electrolyte Imbalance***
- could come in comatose or walk in flushed
43
management of DKA
- airway
- LOC
- hydration status: start NS, then 1/2NS until BS at 250, then D5 1/2NS (add sugar to balance) *aggressive fluid resuscitation (get IV in asap)
- electrolytes: K+ high (ketones are acidic, acid pushes the K+ out of the cells and into the blood- hyperkalemia = cardiac issue), sodium bicarbonate
- blood glucose level (>300)
- vital signs Q15min until stable
needs: hydration, insulin, electrolyte replacement
44
hyperglycemic-hyperosmolar state (HHS) aka HHNK (broken down)
- old patient (> 65)*
- type 2 DM*
- uncontrolled DM for weeks
- usually absent N/V/abd pain
- dehydration, polyuria, hypotension, CV collapse
- altered mental state*, lethargy, coma, seizures
- underlying precipitants: sepsis, MI, stroke, medication (diuretics, phenytoin, corticosteroids)
- NO ketosis or acidotic breathing
45
s/sx of HHS
- AMS
-Neurological signs
- Dehydration signs
- Polyuria
- Polydispsia
- Polyphagia
46
HHS management
- fluid therapy: NS - 1/2NS
- LOC/AMS
- electrolytes
- blood glucose level
think slow up, slow down
47
diabetic keto-acidosis DKA (broken down)
- young patient (< 65)
- type 1 DM (type 2 under conditions of extreme stress)
- often 1st time dx
- N/V/abd pain
- dehydration, thirst, polyuria, volume depletion
- altered mental state, lethargy, coma
- underlying precipitants: infection, infarction, drugs (cocaine)
- SOB, ketotic/acidotic breathing (Kussmauls)
48
normal BS levels
74-106 mg/dL
49
peripheral neuropathy: teaching points
- shoes always
- inspect feet daily
- bathe daily- test water before with thermometer
- nail clippers- straight across
- dry between toes
50
low glycemic food choices (good choices)
- banana
- F1
- white corn
- peanut
- sweet potato
- apple
- tomato
- green tea
- milk
- brown rice
51
high glycemic food choices (bad choices)
- baguette
- doughnuts
- rice cakes
- white rice
- potato
- noodles
- corn
- cola
- instant noodles
- popcorn
52
relationship between insulin and potassium
insulin will push the K+ back into the cells, causing hypokalemia
*MUST CHECK K+ LEVEL BEFORE GIVING INSULIN
52
really bad complication/ side effect of DKA
cerebral edema
53
HHS patho
- slow onset
- not as aggressive to treat as DKA
- very high concentration in blood, bring down slowly
- **NEURO (to detect improvement)
- BG >600
54
hyperglycemia blood sugar level
> 106
