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PNC 104 lecture > Chapter 40: nursing care of patients with disorders of the endocrine pancreas > Flashcards

Chapter 40: nursing care of patients with disorders of the endocrine pancreas Flashcards

1
Q

pathophysiology of diabetes mellitus

A
  • glucose intolerance: faulty production of insulin OR tissue insensitivity to insulin
  • altered carbohydrate, fat, protein metabolism
  • long term complications
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2
Q

CDC statistics for diabetes mellitus

A
  • more than 30 million people in the US have diabetes
  • 84 million people have prediabetes
  • cost $245 billion per year in the US
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3
Q

Type 1 diabetes (former names: insulin dependent diabetes mellitus, juvenile diabetes)

A
  • 5% of diabetes cases
  • some genetic component (10%)
  • autoimmune response to virus
  • destruction of beta cells
  • pancreas secretes no insulin
  • more common in young, thin patients
  • prone to ketosis
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4
Q

type 2 diabetes (former names: non insulin dependent diabetes mellitus, adult onset)

A
  • 95% of diabetes cases
  • large genetic component (90%)
  • reduced number of beta cells
  • reduced tissue sensitivity to insulin
  • largest risk factor is obesity
  • not usually ketosis prone
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5
Q

type 2 diabetes in youth

A
  • more obesity in children
  • type 2 epidemic
  • a nursing challenge
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6
Q

other types of diabetes

A

gestational
prediabetes
secondary diabetes

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7
Q

gestational diabetes

A

pregnancy

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8
Q

prediabetes

A

glucose intolerance

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9
Q

secondary diabetes

A

drugs
pancreatic trauma

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10
Q

metabolic syndrome

A
  • elevated waist circumference
  • elevated triglycerides
  • low high density lipoprotein cholesterol
  • elevated blood pressure
  • elevated fasting plasma glucose
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11
Q

signs and symptoms of metabolic syndrome

A
  • 3 p’s: polydipsia, polyuria, polyphagia
  • fatigue
  • blurred vision
  • infection prone
  • abdominal pain
  • headache
  • ketosis/acidosis
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12
Q

diagnosing diabetes

A
  • fasting blood glucose test > 126 mg per deciliter
  • random blood glucose test >200mg per deciliter
  • oral glucose tolerance test >200mg per deciliter after 2 hours
  • hemoglobin a1c(Hba1C)>6.5%
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13
Q

additional tests

A
  • lipid profile
  • serum creatinine
  • urine microalbumin
  • urinalysis
  • electrocardiogram
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14
Q

prevention of type 2 diabetes

A
  • 7% body weight loss
  • moderate physical activity: 150 minutes per week
  • metformin in some patients
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15
Q

goals of treatment

A
  • preprandial glucose 80-130 mg per deciliter
  • peak postprandial glcose <180 mg per deciliter
  • blood pressure >140/90 millimeters of mercury
  • glycohemoglobin <7%
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16
Q

therapeutic interventions

A
  • nutrition therapy
  • exercise
  • medication
  • monitoring
  • education
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17
Q

nutrition theapy

A
  • carbohydrate counting
  • glycemic index/load
  • create your plate
  • remember cultural dietary needs***
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18
Q

general principles with type 1 diabetes

A
  • avoid wide swings in blood glucose
  • regular eating schedule
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19
Q

general principles with type 2 diabetes: control

A
  • blood pressure
  • weight
  • lipids
  • regular eating schedule
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20
Q

carbohydrate counting

A
  • 15 gram carbohydrate = 1 exchange
  • 30 gram carbohydrate = 2 exchanges
  • 45 gram carbohydrate = 3 exchanges
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21
Q

exercise

A
  • lowers glucose up to 48 hours
  • lowers blood lipids
  • exercise 150 minutes per week, over 3 days
  • refer to hcp or exercise physiologist
  • avoid exercise during ketosis
  • eat snack priori f blood glucose <100 mg per deciliter
  • carry fast sugar
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22
Q

medication

A
  • insulin for type 1 or 2
  • oral hypoglycemics for type 2
  • other injectables
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23
Q

insulin

A
  • action
  • routes: subcutaneous, IV
  • insulin pump
  • site rotation
  • timing
  • regimens
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24
Q

timing with insulin

A
  • onset
  • peak
  • duration
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25
Q

regimens with insulin

A
  • basal bolus
  • sliding scale
26
Q

oral hypoglycemics

A
  • are NOT insulin
  • action depends on medication
  • stimulate pancreas
  • increase tissue sensitivity to insulin
  • slow carbohydrate digestion and absoprtion
  • reduce glucose reabsorption by kidneys
27
Q

injectable agents

A
  • amylin analog
  • incretin mimetics
28
Q

amylin analog

A
  • type 1 diabetes
  • pramlintide (symlin)
29
Q

incretin mimetics

A
  • type 2 diabetes
  • exenatide (byetta, bydureon)
  • liraglutide (victoza)
30
Q

self monitoring of blood glucose

A
  • test before meals (AC) and at bedtime (HS) or as ordered
  • record results
  • analyze meaning of results
  • know target glucose levels
  • call provider if out of range
31
Q

urine testing

A

glucose
ketones

32
Q

glucose urine testing

A
  • no longer recommended unless self monitoring of blood glucose (SMBG) is impossible
33
Q

ketones urine testing

A
  • if blood sugar elevated and risk present
34
Q

alterations in blood glucose

A
  • hyperglycemia
  • hypoglycemia = “insulin reaction”
35
Q

hyperglycemia

A
  • blood glucose >126 mg per deciliter
  • causes: overeating, stress, illness, not enough medications
36
Q

symptoms of hyperglycemia

A
  • 3 p’s: dysphagia, polyuria, polydipsia
  • blurred vision
  • fatigue, lethargy
  • headache
  • abdominal pain
  • ketonuria
  • coma
37
Q

treatment of hyperglycemia

A
  • check blood glucose
  • use sliding scale insulin
  • check ketones as needed
  • determine and treat cause
  • if blood glucose is >180 for 2 days, call hcp
  • call hcp if ill or vomiting
38
Q

hypoglycemia

A
  • blood glucose <70
  • causes: too much insulin, exercise, not enough food
39
Q

symptom of hypoglycemia

A
  • headache
  • hunger
  • fight or flight: shaky, cold sweats, palpitations
  • neuroglycopenia: irritability, confusion, seizures, coma
  • caution: autonomic neuropathy = NO symptoms***
40
Q

treatment of hypoglycemia

A
  • check blood glucose
  • administer 15-20 gram fast acting carbohydrates
  • recheck in 15 minutes
  • repeat as needed
  • snack if longer than 1 hour until meal
41
Q

fast sugars

A
  • 4 oz orange juice
  • 6 oz regular (not diet) soda
  • miniature box of raisins
  • commercial glucose tablets
  • 6-8 lifesavers
42
Q

acute treatment of hypoglycemia

A
  • IV dextrose 50%
  • SQ glucagon
43
Q

causes of diabetic ketoacidosis

A
  • high blood glucose: most common in type 1
  • stress
  • illness
44
Q

pathophysiology of diabetic ketoacidosis

A
  • insulin deficiency
  • cells starving
  • fat breaks down
  • byproduct of fat breakdown is ketones
  • ketones are acidic
45
Q

signs and symptoms of diabetic ketoacidosis

A
  • flu like symptoms
  • symptoms of hyperglycemia
  • kussmaul respirations
  • fruity breath
  • electrolyte imbalance
  • dehydration
  • coma
  • death
46
Q

therapeutic interventions for diabetic ketoacidosis

A
  • IV fluids
  • IV insulin drip
  • frequent glucose monitoring
  • electrolyte monitoring
47
Q

prevention of diabetic ketoacidosis

A
  • check urine ketones
  • blood sugar elecated
  • during stress or illness
  • good diabetes control
48
Q

causes of hyperosmolar hyperglycemic state

A
  • hyperglycemia in type 2 diabetes
  • stress
  • illness
  • most common in elderly
49
Q

signs and symptoms of hyperosmolar hyperglycemic state

A
  • extreme dehydration
  • lethargy
  • blood glucose may be 1000-5000 mg per deciliter
  • electrolyte imbalance
  • coma
    -death
50
Q

therapeutic interventions for hyperosmolar hyperglycemic state

A
  • iV fluids
  • IV insulin drip
  • frequent glucose monitoring
  • electrolyte monitoring
51
Q

prevention of hyperosmolar hyperglycemic state

A
  • SMBG
  • if glucose rising: drink fluids, lower glucose
52
Q

long term complications: macrovascular changes

A
  • stroke
  • heart attack
  • peripheral vascular disease
53
Q

long term complications: microvascular changes

A
  • retinopathy
  • nephropathy
54
Q

overall long term complications

A
  • neuropathy
  • infection
  • foot problems
55
Q

foot care

A
  • inspect feet daily
  • wash and dry feet daily
  • wear well fitting shoes
  • protect feet from injury
  • avoid crossing legs
  • use caution w/ nail care
  • see HCP immediately if lesion develops
56
Q

care of patient undergoing surgery

A
  • frequent glucose monitoring
  • sliding scale insulin or insulin drip
  • maintain glucose 140-180 mg per deciliter in critically ill
57
Q

nursing diagnosis

A
  • risk for unstable blood glucose level
58
Q

diabetes self management education

A
  • disease process and treatment
  • nutrition therapy
  • exercise
  • medications
  • SMBG
  • acute complications
  • chronic complications
  • psychosocial adjustment
  • health promotion
59
Q

reactive hypoglycemia

A
  • overreaction of pancreas
  • low glucagon levels
  • low blood glucose
  • sympathetic “fight or flight” response
60
Q

therapeutic interventions for reactive hypoglycemia

A
  • frequent small meals
  • high protein, low carb diet

PNC 104 lecture (3 decks)

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