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Nursing of Adults I > Chapter 53: Diabetes > Flashcards

Chapter 53: Diabetes Flashcards

1
Q

long acting insulin onset, peak, and duration

A

onset: 0.8-4 hr
peak: no pronounced peak
duration: 24+ hr

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2
Q

environmental factors include obesity and lack of exercise

A

type 2 diabetes

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3
Q

primary defect is absent or minimal insulin production

A

type 1 diabetes

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4
Q

involves BG over 600 mg/dL and increased serum osmolality

A

hyperosmolar hyperglycemic syndrome (HHS)

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5
Q

these diabetes medications do not cause hypoglycemia when used alone and are good for insulin resistance

A

thiazolidinediones: pioglitazone (Actos), rosiglitazone (Avandia)

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6
Q

hypoglycemia is defined by a BG level less than ____

A

70 mg/dL

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7
Q

pathogenesis of foot complications from diabetes

A

sensory neuropathy–> loss of protective sensation–> unawareness of injury

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8
Q

neurogenic bladder can cause ______________, to treat, empty frequently, using _____________; also use _____________ and _____________

A

urinary retention, Credé’s maneuver, medications, self-catheterization

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9
Q

manifestations include dehydration; lethargy and weakness early; skin dry and loose; eyes soft and sunken; abdominal pain; anorexia; nausea/vomiting; Kussmaul respirations; sweet, fruity breath odor

A

diabetic ketoacidosis (DKA)

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10
Q

can affect nearly all body systems, such as gastroparesis, cardiovascular abnormalities, sexual function, and neurogenic bladder

A

autonomic neuropathy

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11
Q

islet cell antibodies are often present at onset

A

type 1 diabetes

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12
Q

most common cause of new cases of adult blindness

A

diabetic retinopathy

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13
Q

cardiovascular abnormalities of autonomic neuropathy (3)

A

postural hypotension, resting tachycardia, and painless MI

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14
Q

examples of 15 g quick-acting carbohydrate snacks (5)

A
  1. 4-6 oz of regular soda, orange juice
  2. 5-8 lifesavers
  3. 1 tbsp syrup or honey
  4. 4 tsp jelly
  5. commercial dextrose products
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15
Q

Somogyi effect is treated with _____________

A

a bedtime snack

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16
Q

Microvascular and macrovascular diseases increase risk for injury and infection of _______

A

feet

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17
Q

two drugs that can delay progression of diabetic nephropathy with albuminuria present

A

ACE inhibitors
Angiotensin II receptor agonists

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18
Q

Neurontin (gabapentin)

A

treats sensory neuropathy

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19
Q

symptoms: often none but include fatigue, recurrent infections, may have polyuria, polydipsia, polyphagia

A

type 2 diabetes

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20
Q

laser destroys ischemic areas of retina

A

laser photocoagulation

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21
Q

characterized by red-yellow lesions

A

necrobiosis lipoidica diabeticorum

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22
Q

diagnosis of diabetes involves these four criteria

A
  1. A1C 6.5% or higher
  2. fasting plasma glucose level: 126 mg/dL or higher
  3. 2-hour plasma glucose level of 200 mg/dL or greater during OGTT using glucose load of 75 g
  4. In a patient with classic symptoms and random plasma glucose level of 200 mg/dL or greater (repeat testing not needed)
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23
Q

life-threatening syndrome that occurs with type 2 diabetes

A

hyperosmolar hyperglycemic syndrome (HHS)

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24
Q

vascular/neurological complications frequent

A

type 1 diabetes, type 2 diabetes

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25
Q

ketosis not present except during infection or stress

A

type 2 diabetes

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26
Q

when taking metformin, cannot have _____________ with a CT scan (must be off for __________)
increases risk for _______________, which can worsen lactic acidosis

A

contrast dye that contains iodine (48 hours before and after)
contrast-induced nephropathy (CIN)

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27
Q

bone and joint changes that occur secondary to loss of sensation

A

neuropathic arthropathy (Charcot’s foot)

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28
Q

microvascular damage to retina

A

diabetic retinopathy

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29
Q

delay exercise if BG is less than ________ after eating ________ and rechecking after _____________

A

100, 15 g snack, 15-30 minutes

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30
Q

defect in mobilization of inflammatory cells and impaired phagocytosis can cause this diabetes complication

A

infection

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31
Q

how many criteria required for diagnosis of diabetes

A

2 criteria from first 3; 4th criteria alone

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32
Q

intermediate acting insulin onset, peak, and duration

A

onset: 1.5-4 hrs
peak: 4-12 hrs
duration: 12-18 hrs

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33
Q

rapid acting insulin onset, peak, and duration

A

onset: 10-30 min
peak: 30 min-3 hrs
duration: 3-5 hrs

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34
Q

hyperglycemia is present upon awakening from GH and cortisol; BG levels between 0200 and 0400 are normal

A

Dawn phenomenon

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35
Q

do not use this medication in people who drink excess amounts of alcohol

A

metformin

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36
Q

do not use this diabetes medication in patients with a personal or family history of medullary thyroid cancer

A

dulaglutide (Trulicity)

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37
Q

hyperglycemia rebounds in the morning after period of hypoglycemia between 0200 and 0400

A

Somogyi effect

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38
Q

may be thin, normal, or obese

A

type 1 diabetes

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39
Q

damage to small blood vessels that supply glomeruli of kidney

A

diabetic nephropathy

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40
Q

most widely used oral agent for diabetes

A

metformin

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41
Q

nursing management of diabetic ketoacidosis (DKA)

A
  1. ensure patent airway; administer O2
  2. establish IV access; begin fluid resuscitation
  3. continuous regular insulin drip, 0.1 units/kg/hr
  4. potassium replacement as needed
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42
Q

more common in young but can occur at any age

A

type 1 diabetes

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43
Q

manifestations of hypoglycemia (8)

A

shakiness, palpitations, nervousness, diaphoresis, anxiety, hunger, pallor, altered mental functioning (difficulty speaking, visual disturbances, stupor, confusion, coma)

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44
Q

do not use metformin in patients with _________ disease, ________ disease, or ______________

A

liver, kidney, heart failure

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45
Q

insulin injections in thigh may increase __________, especially in athletes such as ________

A

metabolism, bikers

46
Q

glucose lowering from exercise can last up to ____ hours and increases risk of ___________

A

48, hypoglycemia

47
Q

important to rotate insulin injection sites to prevent _________________ and ______________

A

lipodystrophy, hypertrophy

48
Q

drug therapy for sensory neuropathy (4)

A
  1. topical creams
  2. tricyclic antidepressants (TCAs)
  3. selective serotonin and norepinephrine reuptake inhibitors (SSNRIs)
  4. antiseizure medications
49
Q

those with type ___ diabetes should not exercise if BG is over _____ with ketones present in urine

50
Q

nutrition therapy is essential

A

type 1 diabetes, type 2 diabetes

51
Q

precipitated by UTIs, pneumonia, sepsis, acute illness, newly diagnosed type 2 diabetes, impaired thirst sensation and/or inability to replace fluids

A

hyperosmolar hyperglycemic syndrome (HHS)

52
Q

environmental factors include viruses and toxins

A

type 1 diabetes

53
Q

used to test for nerve damage

A

monofilament screening

54
Q

leading cause of end-stage kidney disease

A

diabetic nephropathy

55
Q

exercise recommendations for diabetes are ________ per day at least ____ times a week

A

30 minutes, 5

56
Q

rare complication of metformin accumulation

A

lactic acidosis

57
Q

90-95% of diabetes

A

type 2 diabetes

58
Q

causes of hypoglycemia (4)

A
  1. too much insulin or oral hypoglycemic agents
  2. too little food
  3. delayed time of eating
  4. too much exercise
59
Q

insulin therapy required from some; disease is progressive and insulin treatment may need to be added

A

type 2 diabetes

60
Q

onset is gradual and may go unnoticed for years

A

type 2 diabetes

61
Q

characterized by red-brown, round, or oval patches

A

diabetic dermopathy

62
Q

three ways autonomic neuropathy can affect sexual function (manifestations)

A

erectile dysfunction, decreased libido, and vaginal infections

63
Q

acute pancreatitis may occur with this medication

A

dulaglutide (Trulicity)

64
Q

patient teaching to prevent foot ulcers (5)

A
  1. proper footwear
  2. avoidance of foot injury
  3. skin and nail care
  4. daily inspection of feet
  5. prompt treatment of small problems
65
Q

intermediate stage between normal homeostasis and diabetes in which BG levels are elevated but not high enough to meet diagnostic criteria for diabetes

A

prediabetes

66
Q

strenuous exercise can be perceived as _______ by the body and can cause _______________

A

stress, hyperglycemia

67
Q

how peripheral artery disease increases risk of foot complications from diabetes (3)

A

decreased blood flow, decreased wound healing, increased risk for infection

68
Q

hypoglycemia is a major side effect of this diabetes medication

69
Q

affects hands and/or feet bilaterally (specific type) with loss of sensation, abnormal sensations, pain, and paresthesias

A

distal symmetric polyneuropathy

70
Q

reduced nerve conduction and demyelinization

A

diabetic neuropathy

71
Q

Dawn phenomenon is treated by _____________

A

increasing or adjusting insulin schedule

72
Q

in treating DKA, decrease BG slowly by ________ to prevent ______________

A

36-54 mg/dL/hr, cerebral edema

73
Q

only type of insulin that can be given IV

A

regular/rapid

74
Q

most common treatment for diabetic retinopathy

A

laser photocoagulation

75
Q

characterized by velvety light brown to black skin

A

acanthosis nigricans

76
Q

loss of protective sensation in lower extremities with major risk for amputation (specific type)

A

sensory neuropathy

77
Q

characterized by hyperglycemia, ketosis, acidosis, dehydration

A

diabetic ketoacidosis (DKA)

78
Q

drugs to treat hypoglycemia in unconscious patient (2)

A
  1. 1 mg glucagon IM or SUBQ
  2. 50% dextrose, 20-50 mL IVP
79
Q

moderate to high ketones with urine are present with this condition

A

diabetic ketoacidosis (DKA)

80
Q

5-10% of all diabetes

A

type 1 diabetes

81
Q

complication more likely to occur in type 1 diabetes

A

diabetic ketoacidosis (DKA)

82
Q

most common form of diabetic neuropathy

A

distal symmetric polyneuropathy

83
Q

islet cell antibodies absent

A

type 2 diabetes

84
Q

diabetic neuropathy occurs in ____% of patients with diabetes (to some degree)

85
Q

endogenous insulin initially increased in response to insulin resistance; secretion decreases over time

A

type 2 diabetes

86
Q

this condition is typically asymptomatic but damage to heart and vessels may already be occurring

A

prediabetes

87
Q

major risk factors for amputation with foot complications (2)
other risk factors for amputation with foot complications (4)

A

major: sensory neuropathy, peripheral artery disease (PAD)
other: clotting abnormalities, impaired immune function, autonomic neuropathy, smoking

88
Q

leading cause of diabetes-related death

A

angiopathy

89
Q

short acting insulin onset, peak, and duration

A

onset: 30 min-1 hr
peak: 2-5 hr
duration: 5-8 hr

90
Q

fluids for management of DKA

A

0.45% or 0.9% NS
Add 5-10% dextrose when BG approaches 250 mg/dL

91
Q

normal fasting BG level

A

74-106 mg/dL

92
Q

insulin therapy required

A

type 1 diabetes

93
Q

more common in adults but can occur at any age (incidence is increasing in children)

A

type 2 diabetes

94
Q

endogenous insulin absent

A

type 1 diabetes

95
Q

Dawn phenomenon occurs most likely in __________

96
Q

drugs for diabetic retinopathy block the action of ______________

A

vascular endothelial growth factor (VEFG)

97
Q

symptoms usually abrupt but disease may be present for several years

A

type 1 diabetes

98
Q

most common skin problem from diabetes

A

diabetic dermopathy

99
Q

primary defect is insulin resistance, decreased insulin production over time, changes in adipokinase production

A

type 2 diabetes

100
Q

nerve damage due to metabolic derangements of diabetes

A

diabetic neuropathy

101
Q

symptoms include polydipsia, polyuria, polyphagia, fatigue, weight loss without trying

A

type 1 diabetes

102
Q

inhaled insulin should not be used in these people

A

children
people with asthma, COPD, bronchospasms

103
Q

ketosis present at onset

A

type 1 diabetes

104
Q

treatment that involves aspiration of blood, membrane, and fibers inside eye

A

vitrectomy

105
Q

therapy for hyperosmolar hyperglycemic syndrome (HHS) (4)

A
  1. IV insulin and NaCl infusions
  2. more fluid replacement needed
  3. monitor serum potassium and replace as needed
  4. correct underlying precipitating cause
106
Q

damage to blood vessels secondary to chronic hyperglycemia

A

angiopathy

107
Q

prediabetes is defined as impaired glucose tolerance (IGT) __ hour OGTT __________ mg/dL, impaired fasting glucose (IFT) with fasting BG _________ mg/dL, or both

A

2, 140-199, 100-125

108
Q

injectable drug taken once a week with diet and exercise for diabetes

A

semaglutide (Ozempic)

109
Q

complication caused by profound deficiency of insulin

A

diabetic ketoacidosis (DKA)

110
Q

nutrition: often overweight or obese

A

type 2 diabetes

Nursing of Adults I (21 decks)

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