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NURS3313 Adult Health > Chapter 46 Management of Patients w/ Diabetes > Flashcards

Chapter 46 Management of Patients w/ Diabetes Flashcards

1
Q

Diabetes

A

A group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both

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2
Q

Criteria for Diabetes Diagnosis

A

1)Symptoms of diabetes: Polyuria, polydipsia, polyphagia, unexplained weight loss (Type I)

2) Fasting blood glucose ≥ 126 mg/dL (no caloric intake for 8 hrs)

3) Random blood glucose ≥ to 200

4) HgbA1C ≥ to 6.5%

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3
Q

Glycated Hemoglobin (A1C or HgbA1C)

A

A measure of glucose control that is a result of glucose molecule attaching to hemoglobin for the life of the red blood cell (120 days: 3 months)

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4
Q

Hyperglycemia

A

Excess glucose in the blood

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5
Q

The 3 Ps

A

Polyuria, polydipsia, & polyphagia

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6
Q

Polyuria

A

Excess urination

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7
Q

Polydipsia

A

Increased thirst

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8
Q

Polyphagia

A

Increased appetite

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9
Q

When does glycosuria occur?

A

It occurs when the renal threshold for sugar exceeds 180mg/dL

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10
Q

What condition can glycosuria lead to?

A

It can lead to osmotic diuresis (excess loss of water & electrolytes)

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11
Q

Fasting Plasma Glucose

A

Blood glucose determination obtained in the lab after fasting for at least 8 hrs

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12
Q

Prediabetes

A

Impaired glucose metabolism in which blood glucose concen fall btwn norm levels and those considered diagnostic for diabetes

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13
Q

Type 1 Diabetes

A

A metabolic disorder characterized by an absence of insulin production & secretion from autoimmune destruction of the beta cells of the islets of Langerhans in the pancreas

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14
Q

Type 2 Diabetes

A

A metabolic disorder characterized by the relative deficiency of insulin production & a decreased insulin action & increased insulin resistance

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15
Q

Gestational Diabetes

A

Diabetes that develops during pregnancy ( usually in 2nd/3rd trimester due to hormone secretion that inhibit insulin)

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16
Q

What can lead to the development of gestational diabetes?

A

Secretion of certain placental hormones that cause insulin resistance

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17
Q

Patients that are at an elevated risk for developing gestational diabetes

A

Women w/marked obesity, strong personal/family hx of gestational diabetes, & glycosuria

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18
Q

Diabetes Risk Factors

A

Age
-Type 1: <30 years old
-Type 2: >30 years old

High-density lipoprotein (HDL) level ≤35 mg/dL (0.90 mmol/L) and/or triglyceride level ≥250 mg/dL (2.8 mmol/L)

History of gestational diabetes or delivery of a baby over 9 lbs

HTN

Family hx of diabetes

Obesity

Previously identified impaired fasting glucose/impaired glucose tolerance

Ethnicity Groups: African Americans, Hispanic Americans, Native Americans, Asian Americans, Pacific Islanders

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19
Q

Insulin

A

A protein anabolic hormone secreted by beta cells, in the pancreas

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20
Q

Functions of Insulin

A

Transports and metabolizes glucose for energy

Stim storage of glucose in the liver and muscle (via glycogen)

Signals the liver to stop the rel of glucose

Enhances storage of dietary fat in adipose tiss

Accelerates transport of amino acids (derived from dietary protein) into cells

Inhibits the breakdown of stored glucose, protein, and fat

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21
Q

Since insulin is an anabolic hormone, what expected side effect can you see in patients?

A

Weight gain

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22
Q

Glucagon

A

A protein hormone secreted by the alpha cells in the pancreas

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23
Q

Function of Glucagon

A

Increases blood glucose levels

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24
Q

Clinical Manifestations of Type 1 Diabetes

A

Symptoms sudden in onset

May have sudden weight loss

Polyuria

Polydipsia

Polyphagia

Ketoacidosis

Glycosuria

Fatigue

Weakness

Vision changes DKA

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25
Q

What happens if beta cell destruction occurs?

A

Insulin prod decreases, glucose prod (liver) increases, & fasting hyperglycemia

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26
Q

Osmotic Diuresis

A

When excess glucose is excreted in the urine, it is accompanied by excessive loss of fluids & electrolytes

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27
Q

Ketone bodies

A

A highly acidic substance formed when the liver breaks down free fatty acids in the absence of insulin

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28
Q

Diabetic Ketoacidosis (DKA)

A

An acute complication from insulin deficiency (usually from Type I) where highly acidic ketone bodies are formed, and metabolic acidosis occur

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29
Q

DKA Signs & Symptoms

A

Fruity breath

Kussmaul respirations

Polyuria

Polydipsia

Polyphagia

Marked fatigue

Blurred vision

Weakness

Headache

Orthostatic Bp

Tachycardia

Poor skin turgor

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30
Q

Diabetic Ketoacidosis Management

A

Correct dehydration, electrolyte loss & acidosis BEFORE correcting hyperglycemia w/insulin

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31
Q

Risk Factors for Type II Diabetes

A

Family hx

Obesity: BMI more than or equal to 30

Race/Ethnicity

Age 30 & up

Prev identified impaired fasting glucose/glucose tolerance test

High density lipoprotein (HDL) less than or equal to 30 mg/dL and/or triglyceride lvl 250mg/dL or more

Hx of gestational diabetes

Delivery of a baby > 9lbs

HTN

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32
Q

Type II Diabetes Clinical Manifestations

A

Slow onset

Polyuria

Polydipsia

Polyphagia

Fatigue

Weakness

Vision changes

Neuropathy

Dry skin

Skin lesions/wounds that are slow to heal

Recurrent vaginal yeast infections

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33
Q

True or False (T/F): Type II tends to be undetected for many years due to the slow, progressive nature of the disease.

A

True

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34
Q

What is the main problem related to type II diabetes?

A

The main problems is insulin resistance due to decreased sensitivity of the tissues to the effects of insulin

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35
Q

Most Common Health Complications Associated w/ Type II Diabetes

A

Eye disease, peripheral neuropathy, & peripheral vascular disease (PVD)

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36
Q

Peripheral Neuropathy

A

Result of damage to the nerves located outside of the brain & spinal cord

Often causes weakness, numbness & pain (usually in the hands & feet)

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37
Q

Initial Symptoms of Peripheral Neuropathy

A

Occurs bilaterally:
- Tingling
- Heightened sensation
- Burning

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38
Q

Progressive Symptoms of Peripheral Neuropathy

A

Numbness

Problems w/proprioception

Decreased sensation of light touch

Unsteady gait

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39
Q

Management of Peripheral Neuropathy

A

Daily checks of the feet (infection)

Intensive insulin therapy: control of blood glucose levels

Analgesic agents

Antiseizure meds (also help w/neuropathy)
-Lyrica (pregablin)
- Neurontin (gabapentin)

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40
Q

Macrovascular Complications of Diabetes

A

Medium to large vessels: thicken, scleroses, become occluded w/plaque

3 Main types of Macrovascular Diseases Associated w/ Diabetes:
1) Coronary artery disease
2) Cerebrovascular disease
3) Peripheral vascular disease

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41
Q

Signs of Severe Foot Infections

A

1) Drainage
2) Swelling
3) Cellulitis
4) Gangrene

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42
Q

Cellulitis

A

Deep bacterial skin infection that causes painful inflammation (swelling, redness)

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43
Q

Gangrene

A

Death of body tissue due to lack of blood flow/severe infection

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44
Q

Foot Care Instructions

A

Daily feet checks

Wash feet everyday

Keep skin soft and
smooth

Trim toenails straight
across
-Go to a podiatrist if
unable to trim toenails

Wear shoes and socks at ALL times

Keep the blood flowing to your feet

Do not smoke

Contact PCP right away if a cut, sore or bruise on foot does not begin to heal after 24 hours

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45
Q

Coronary Artery Disease

A

A narrowing/blockage of coronary arteries (supply heart) due to the accumulation of plaque

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46
Q

Cerebrovascular Disease

A

A group of conditions that affect blood flow to the brain

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47
Q

Peripheral Vascular Disease (PVD)

A

A common condition in which narrowed arteries reduce blood flow to the arms or legs

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48
Q

Management of Macrovascular Complications from Diabetes

A

Aggressive reduction of risk factors for atherosclerosis:
-Obesity
-HTN
-Hyperlipidemia

Control blood glucose levels

Smoking cessation

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49
Q

What causes microvascular complications from diabetes?

A

Capillary basement membrane thickening

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50
Q

Retinopathy

A

Damage to small blood vessels that nourish the retina

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51
Q

Clinical Manifestations of Diabetic Retinopathy

A

Painless

Floaters

Cobwebs

Spotty/hazy vision

Complete Loss of Vision

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52
Q

Nephropathy

A

Damage to the kidney cells

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53
Q

How does diabetes cause nephropathy?

A

High glucose levels over long periods of time stresses the kidney’s filtration system-> allows proteins to leak into the urine

Also kidney blood vessel pressure increases

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54
Q

Nephropathy Management

A

Dialysis
-Hemodialysis
-Peritoneal dialysis
-Mortality rates higher for diabetic patients

Kidney Transplant

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55
Q

Insulin Resistance

A

Decreased tissue sensitivity to the effects of insulin

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56
Q

What does the body do in order to compensate for insulin resistance & glucose buildup?

A

Insulin secretion increases to maintain the glucose at a normal/slightly elevated level

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57
Q

Hyperglycemic Hyperosmolar State (HHS)

A

Insulin secretion increases to maintain the glucose at a normal/slightly elevated level

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58
Q

Clinical Manifestations of HHS

A

Hypotension

Profound dehydration,

Tachycardia

Variable neurologic signs caused by cerebral dehydration (alterations of consciousness, seizures, hemiparesis)

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59
Q

Which condition is often associated w/ Type I Diabetes?

A

Diabetic Ketoacidosis (DKA)

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60
Q

Which condition is often associated w/ Type II Diabetes?

A

Hyperglycemic Hyperosmolar State (HHS)

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61
Q

Example of Possible Consequences of Untreated Diabetes

A

Blindness

Limb amputation

Cardiovascular disease

Kidney disease

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62
Q

Intensive Treatment of Diabetes is defined by the ADA as…

A

… 3 or 4 insulin injections/day or an insulin pump & frequent blood glucose monitoring and weekly contacts w/ diabetes educators

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63
Q

5 Components of Diabetes Management

A

1) Nutritional Therapy

2) Exercise

3) Monitoring

4) Pharmacologic therapy

5) Education

64
Q

A1C Monitoring for Diabetes Management

A

Keep below 7%

65
Q

Succeeding in nutritional therapy alone can have what effect on type II diabetes patients?

A

Reversal of Type II Diabetes

66
Q

Diabetes Nutritional & Dietary Management Goals

A

Control of total caloric intake to attain/maintain a reasonable body weight, control of blood glucose levels, & normalization of lipids and BP to prevent heart disease

67
Q

Recommended Caloric Distribution of Carbs for Diabetics

A

50-60%

68
Q

Recommended Caloric Distribution of Fats for Diabetic Patients

A

Total % of Fats: < 30% of total calories

Saturated fats: 10% of total calories

69
Q

Exchange Lists

A

Foods w/in one food group (in the portion amounts specified) contain = numbers of calories & are approx. equal in grams of protein, fat, and carb

70
Q

Examples of “free items” from Exchange Lists

A

Diet soda, unsweetened ice tea, & ice water w/lemon

71
Q

Special Considerations for Diabetes & Alcohol Consumption

A

Since alcohol may decrease the normal physiologic reactions in the body that produce glucose, there is an increased risk for pts who consume alcohol on an empty stomach to develop hypoglycemia

72
Q

Medical Nutrition Therapy

A

Nutritional therapy prescribed for management of diabetes usually given by a registered dietitian

73
Q

To promote a 1- to 2-lb weight loss per week…

A

…500-1,000 calories are subtracted from the daily total

74
Q

Glycemic Index

A

Amount a given food increases the blood glucose level compared w/ equivalent amount of glucose

75
Q

Nutritive Sweeteners

A

Sweeteners that contain calories & cause less elevation in blood sugar levels than sucrose

76
Q

Examples of Nutritive Sweeteners

A

Fructose, sorbitol, & xylitol

77
Q

Non-nutritive Sweeteners

A

Sweeteners that contain min/no calories & produce min/ no elevation in blood glucose levels

78
Q

Examples of Non-nutritive Sweeteners

A

Sucralose (Splenda)

79
Q

General Exercise Considerations for Diabetic Patients

A

Exercise at the same time of day (preferably when blood glucose levels are at their peak) & for the same duration each session.

Use proper footwear and, if appropriate, other protective equipment (i.e., helmets for cycling)

Avoid trauma to the lower extremities (especially if you have numbness due to peripheral neuropathy)

Inspect feet daily after exercise

Avoid exercise in extreme heat or cold

Avoid exercise during periods of poor metabolic control

Stretch for 10-15 mins before exercising

80
Q

How often should a pt with diabetes exercise for (days per week)?

A

3X a week w/no more than 2 consecutive days w/out exercise

81
Q

What type of exercise should people w/Type II diabetes perform & how often?

A

People w/type II should perform resistance training twice a week

82
Q

What effect does exercise have on blood glucose levels?

A

Exercise lowers blood glucose levels by increasing the uptake of glucose via body muscles & by improving insulin utilization

83
Q

Exercise Precautions for Patients who have blood glucose levels exceeding 250 mg/dL (14 mmol/L) and who have ketones in their urine

A

They should not begin exercising until the urine test results are negative for ketones & the blood glucose level is closer to normal

84
Q

What can a patient do to avoid post-exercise hypoglycemia?

A

Eat a snack at the end of the exercise session & at bedtime and monitor the blood glucose level more frequently

85
Q

Self-Monitoring of Blood Glucose (SMBG)

A

A method of capillary blood glucose testing in which the patient pricks their finger & applies a drop of blood to a test strip that is read by a meter

86
Q

Candidates for Self-Monitoring of Blood Glucose

A

Unstable diabetes (Severe swings from very high -> very low blood glucose levels w/in 24 hr day)

Tendency to develop severe ketosis/ hypoglycemia

Hypoglycemia w/out warning signs

87
Q

How often should a patient monitor their SMBG levels?

A

2-4 times daily (usually before meals & at bedtime)

88
Q

Biguanide Primary Drug Action

A

Inhibit liver prod of glucose

89
Q

Example of Biguanide

A

Metformin

90
Q

Which drug classes are considered insulin sensitizers?

A

Biguanides & thiazolidinediones (rosiglitazone and pioglitazone)

91
Q

What is the action of insulin sensitizers?

A

Help tissues use available insulin more efficiently

92
Q

Which drug classes are insulin releasers?

A

Sulfonylureas (Glyburide and glipizide) & meglitinides (Repaglinide)

93
Q

What is the action os insulin releasers?

A

Stim the pancreas to secrete more insulin

94
Q

Alpha-glucosidase Inhibitor Drug Action

A

Delay absorption of complex carbohydrates in the intestine and slow entry of glucose into systemic circulation

95
Q

Special Alpha-glucosidase Inhibitor Drug Consideration

A

MUST be taken w/first bite of food to be effective

96
Q

Example of Alpha-glucosidase Inhibitor Drug

A

Acarbose

97
Q

Steps of Insulin Self-Administration

A

1) Stabilize the skin via pinching the area

2) Hold the syringe as if holding a pencil

3) Insert the needle at a 90 degree angle into the skin

4) Push the plunger of the syringe

5) Pull the needle straight out of the skin

6) Press a cotton ball over the injection site

7) Dispose of the syringe into a hard container

98
Q

Which order do you draw up insulin? Clear to cloudy or cloudy (usually NPH) to clear?

A

Clear then cloudy

99
Q

Onset

A

How soon the insulin starts to lower BG after admin

100
Q

Peak

A

The time after insulin admin, the insulin is working its hardest to lower BG

101
Q

Duration of Action

A

How long the insulin lasts-the length of time
from administration, that it keeps lowering
the blood glucose

102
Q

Rapid-Acting Insulin

A

Used for rapid reduction of glucose level, to treat postprandial hyperglycemia, or to prevent nocturnal hypoglycemia

103
Q

Examples of Rapid-Acting Insulin

A

Lispro (Humalog), aspart, glulisine

104
Q

Onset, Peak, & Duration of Lispro (Humalog)

A

Onset: 15-30 mins

Peak: 30 mins-2.5 hrs

Duration: 3-6 hrs

105
Q

Onset, Peak, & Duration of Aspart

A

Onset: 15 min

Peak: 1-3 hrs

Duration: 3-4 hrs

106
Q

Onset, Peak, & Duration of Glulisine

A

Onset: 5-15 min

Peak: 1 hr

Duration: 5 hrs

107
Q

Considerations for Patients Taking Rapid-acting Insulin

A

Eat no more than 5-15 mins after injection

Patients w/ type 1 diabetes & some patients w/ type 2 or gestational diabetes also req a long-acting insulin (basal insulin) to maintain glucose control

-Basal insulin is necessary to maintain blood glucose levels irrespective of meals

108
Q

Short-Acting Insulin

A

Usually given 15 min before a meal (may be taken alone or in combination with longer-acting insulin)

109
Q

Short-Acting Insulin CANNOT be mixed with

A

Lantus (Glargine) and Apria (Glulisine)

110
Q

Example of Short-acting Insulin Agent

A

Regular

111
Q

Onset, Peak and Duration of Short-acting Insulin

A

Onset: 30min-1hr

Peak: 2-3hr

Duration: 4-6hr

112
Q

Dietary Consideration for Intermediate Acting Insulin

A

Food should be taken around the time of onset & peak

113
Q

Example of Intermediate Acting Insulin

A

NPH (neutral protomine Hagedorn)

114
Q

Onset, Peak & Duration of Intermediate-acting Insulin

A

Onset: 60-120 mins

Peak: 6-14 hrs

Duration: 16-24hrs

115
Q

Indication for Long-Acting Insulin Usage

A

Used for basal dose

116
Q

Example of Long-Acting Insulin

A

Glargine detemir

117
Q

Onset, Peak & Duration of Long-acting Insulin

A

Onset: 70 mins

Peak: None

Duration: 18-24 hrs

118
Q

Insulin Administeration: Dosage & KSU Rounding Rules

A

Needs to be WHOLE numbers: you CANNOT admin fractions of a dose

≤0.4 rounds down
Ex) 1.4 U insulin rounds down to 1.0U insulin

≥ 0.5 rounds up
Ex) 1.5 U insulin rounds up to 2.0U insulin

119
Q

Every morning, a client with type 1 diabetes receives 15 units of Humulin 70/30. What does this type of insulin contain?

A

70% NPH insulin & 30% regular insulin

120
Q

The nurse expects that a type 1 diabetic patient may receive what percentage of his or her usual morning dose of insulin preoperatively?

A

50-60% of the pt’s morning dose of insulin (either intermediate-acting insulin alone or both short- and intermediate-acting insulins) is administered subcutaneously in the morning before surgery

121
Q

What causes precipitation in long acting insulin?

A

If it’s mixed w/other types of insulin, precipitation would form because of its acidic pH

122
Q

Which type of insulin can be given via IV?

A

Short-acting (regular) is the ONLY one that can be given this route

123
Q

Local allergic reactions to insulin therapy

A

A local allergic rxn (redness, swelling, tenderness, and induration or a 2- to 4-cm wheal) may appear at the injection site 1 to 2 hours after the administration of insulin

124
Q

Systemic Allergic Reactions to Insulin Therapy

A

When they do occur, there is an immediate local skin reaction that gradually spreads into generalized urticaria (hives)

125
Q

Treatment for Systemic Allergies to Insulin

A

Small doses of insulin given in gradually increasing amounts using a desensitization kit

126
Q

Insulin Lipoatrophy

A

Loss of fat tissue in areas of repeated injection causing changes in subcutaneous fat

127
Q

Nursing Action for Insulin Lipoatrophy Prevention

A

Instruct pt to rotate injection site 2 in away from belly button

128
Q

Insulin Lipohypertrophy

A

An insulin complication where fibrous fatty masses form at the injection site due to not rotating injection sites

129
Q

Insulin Waning

A

Progressive increase in blood glucose from bedtime to morning

130
Q

Insulin Waning Treatment

A

Increase evening (predinner or bedtime) dose of intermediate- or long-acting insulin, or institute a dose of insulin before the evening meal if one is not already part of the treatment regimen

131
Q

Dawn Phenomenon

A

Relatively normal blood glucose until early morning (3 AM) hours when levels begin to rise

132
Q

Dawn Phenomenon Treatment

A

Changing time of injection of evening intermediate-acting insulin from dinnertime to bedtime

133
Q

Somogyi Effect

A

Normal or elevated blood glucose at bedtime, early morning hypoglycemia, and a subsequent increased blood glucose caused by the production of counter-regulatory hormones

134
Q

Somogyi Effect Treatment

A

Treated by decreasing evening (predinner or bedtime) dose of intermediate-acting insulin, or increasing bedtime snack

135
Q

Hypoglycemia

A

Abnormal decrease of sugar in the blood (<70 mg/dL)

136
Q

Severe Hypoglycemia

A

BG <40 mg/dL

137
Q

Gerontological Considerations for Hypoglycemia

A

Older adults frequently live alone & may not recognize the sympt of hypoglycemia

W/ decreasing kidney function, it takes longer for oral hypoglycemic agents to be excreted by the kidneys

Skipping meals may occur due to decreased appetite/ financial limitations

Decreased visual acuity may lead to errors in insulin administration

138
Q

Mild Hypoglycemia Signs & Symptoms (SNS Stim)

A

Sweating

Tremor

Tachycardia

Palpitation

Nervousness

Hunger

139
Q

Mild Hypoglycemia Blood Glucose

A

54-70 mg/dL

140
Q

Moderate Hypoglycemia Signs & Symptoms

A

Glucose drop deprive brain cells of O2 (CNS)

Inability to concentrate

Headache

Lightheadedness

Confusion

Memory lapses

Numbness of the lips & tongue

Slurred speech

Impaired coordination

Emotional changes

Irrational/combative behavior

Double vision

Drowsiness

141
Q

Moderate Hypoglycemia BG Range

A

41-53 mg/dL

142
Q

Severe Hypoglycemia Signs & Symptoms

A

CNS is so impaired that the pt needs assistance of another person for treatment

Disoriented behavior

Seizures

Difficulty arousing from sleep

Loss of consciousness

143
Q

General Considerations for Hypoglycemia

A

Check the pt’s BG and correlate it w/ the signs and symptoms

144
Q

Treating ALERT Hypoglycemic Patients

A

Supply carbs
- 15-20 g of fast acting concentrated carbs
-> 2-3 glucose tabs
->4 oz of juice/soda
->1 Tb sugar, honey, or corn syrup
->8 oz of nonfat or 1% milk
->3 graham crackers

Then follow with snack: starch and protein
-Recheck BG in 15 minutes and repeat steps if
needed

145
Q

Management of Hypoglycemia: Unconscious Patients at Home

A

Injection of 1 mg of glucagon IM

After injection may take up to 20 mins for pt to regain consciousness
-Follow w/15 g of concentrated carbs & a snack

146
Q

Management of Hypoglycemia: In the hospital or
ER for patients who are unconscious, NPO,
or cannot swallow

A

Administer 25-50 cc of Dextrose 50% – ( D50, D50W)
IV Push
-Effect seen in minutes

147
Q

Which pharmacological treatment for hypoglycemia is used inside the hospital setting?

A

Dextrose 50% (D50, D50W)

148
Q

Which pharmacological treatment for hypoglycemia is used outside the hospital setting?

A

Glucagon

149
Q

Immediate Treatment for Hypoglycemia

A

The usual recomm is for 15-20 g of a fast-acting concentrated source of carbs

150
Q

Emergency Measures for Hypoglycemia

A

For those w/ glucose level <54 mg/dL, unconscious & cannot eat:

Admin 1 mg IM/SQ injection of glucagon

151
Q

Patient Teaching Considerations for Hypoglycemia

A

Hypoglycemia is prevented by:
-A consistent pattern of eating
-A consistent pattern of insulin administration
-Between meal and bedtime snacks
-Eat additional food when physical activity is increased
-Routine blood glucose tests

Wear a bracelet stating they have diabetes

Carry a form of simple sugar at all times

Having family members/friends be able to
recognize symptoms and actions

152
Q

Management of Diabetics in the Hospital

A

Prolong stay: increase infection rates, increase mortality

Stress & Infection increase blood glucose

BG targets: 140-180 mg/dL
Insulin treatment preferred
Protocols for insulin dosing

Appropriate Timing: Blood checks, meal consumption, insulin dose

153
Q

Sick Day Rules

A

During periods of physiologic stress BG levels increase

NEVER eliminate insulin
-Extra short acting insulin

Small portions of carbs

Check blood glucose & ketones: Every 3 to 4 hours
-Report Elevated BG or +ketones to provider

Drink fluids every hour w/ vomiting/diarrhea
-If ketones are present unable to keep down
fluids, hospitalization may be necessary

Want to prevent DKA
and coma in Type 1

154
Q

Nursing Considerations for Diabetics Undergoing Surgery: Pre-Op

A

Requires frequent BG monitoring (every one to
two hours)

For pts taking insulin:
-Morning of surgery all subq
insulin maybe held unless
BG>200 or half the usual
dose of insulin may be
given per provider orders

-If you don’t have orders to
hold insulin: contact the
healthcare provider

Pts taking metformin may be
instructed to discontinue the oral
agent 24-48 hours before surgery

155
Q

Nursing Considerations for Diabetics Undergoing Surgery: During Surgery

A

Blood glucose is controlled via IV infusion of regular insulin & dextrose infusion
-May come back on an insulin infusion

156
Q

Nursing Considerations for Diabetics that are NPO

A

Insulin dosage has been addressed by health care provider

Changes may include:
-Eliminate rapid-acting insulin
-Giving 1/2 usual dose intermediate acting insulin

IV dextrose may be admin to prevent hypoglycemia

To avoid problems these patients should be
scheduled for diagnostic tests and procedures
early in the morning

While NPO, the scheduled time for glucose
testing and insulin administration should still
match mealtimes

157
Q
A

NURS3313 Adult Health (27 decks)

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