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Adult Health I Test II > Class Day II > Flashcards

Class Day II Flashcards

1
Q

explain type 1 diabetes

A
  • inadequate production of insulin
  • Autoimmune dysfunction involving destruction of beta cells which produce insulin in islets of langerhans of pancreas
  • Can be triggered by genetic tissue types or viral infections
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2
Q

explain type II diabetes

A
  • inability of body’s cells to respond to insulin
  • Progressive condition due to inc inability of cells to respond to insulin (insulin resistance) and dec production of insulin by beta cells
  • Linked to obesity, sedentary lifestyle, heredity
  • Metabolic syndrome often precedes it
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3
Q

what is diabetes a contributing factor to?

A

development of CV disease, HTN, kidney dz, neuropathy, retinopathy, peripheral vascular dz, stroke

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4
Q

in which populations in diabetes more prevalent?

A
  • More prevalent in African Americans, American Indians, and Hispanic populations
  • More common in men than women
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5
Q

risk factors for diabetes

A
  • obesity,
  • HTN,
  • sedentary lifestyle,
  • hyperlipidemia,
  • cigarette smoking,
  • genetic history,
  • ethnic group,
  • women with PCOS or delivered infants over 9 lbs
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6
Q

which people should you screen for diabetes?

A

Screen those greater than 25 BMI and age greater than 45 yo, or if child overweight with other risk factors

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7
Q

client education for dz prevention of diabetes

A
  • Exercise and good nutrition are necessary for preventing/controlling DM
    • Carbs: 45% daily
    • Protein: 15-20% daily
    • Unsaturated and polyunsaturated fats: 20-35% daily
  • Consistency in amount of food consumed and regularity in meal times promotes blood glucose control
  • Encourage diet low in saturated fats to dec LDL, assist with weight loss for secondary prevention of diabetes, and reduce risk of heart dz
  • Modify client’s diet to include omega 3 fatty acids and fiber to lower cholesterol, improve blood glucose, for secondary prevention of diabetes, and to reduce risk of heart dz
  • Encourage physical activity at least 3x per week
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8
Q

explain metabolic syndrome as a risk factor for DM

A
  • collection of manifestations that predispose an individual to DM
  • Includes: abdominal obesity, insulin resistance, sedentary lifestyle, HTN, and elevated lipid and triglyceride levels
  • Associated risk of CV dz
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9
Q

explain insulin resistance as a risk factor for DM

A
  • impaired fasting glucose levels 100-125; impaired glucose tolerance 140-199; or A1C level 5.5-6.0%
  • Pancreatitis and Cushing’s syndrome are secondary causes of diabetes
  • Vision and hearing deficits can interfere w/ the understanding of teaching, reading of materials, and preparing meds
  • Tissue deterioration secondary to aging can affect the client’s ability to prepare food, care for self, perform ADLs
  • Fixed income can mean there are limited funds for meds and supplies
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10
Q

S/S of diabetes

A
  • Hyperglycemia: blood glucose greater than 250
  • Polyuria: excess urine production and frequency from osmotic diuresis
  • Polydipsia: excessive thirst from dehydration
  • Polyphagia: excessive hunger and eating caused from inability of cells to receive glucose (b/c of lack of insulin or insulin resistance) and the body’s use of protein and fat for energy
  • acetone/fruity breath odor (from accumulation of ketones)
  • HA
  • n/v
  • Abdominal pain
  • Inability to concentrate
  • Fatigue
  • Weakness
  • Vision changes
  • Slow healing of wounds
  • Dec LOC
  • Seizures
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11
Q

what are signs of polydipsia that occurs with DM?

A
  • Loss of skin turgor, skin warm and dry
  • Dry mucous membranes
  • Weakness and malaise
  • Rapid weak pulse and hypoTN
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12
Q

polyphagia with DM

A
  • excessive hunger and eating caused from inability of cells to receive glucose (b/c of lack of insulin or insulin resistance) and the body’s use of protein and fat for energy
    • Client may have weight loss
    • Ketones accumulate in blood due to breakdown of fatty acids when insulin is not available–>metabolic acidosis
      • Kussmaul respirations: inc RR and depth in attempt to excrete CO2 and acid from metabolic acidosis
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13
Q

how to diagnose DM?

A
  • you must have 2 findings (on separate days) of at least 2 of the following:
    • Manifestation of DM puls casual glucose conc greater than 200
    • Fasting blood glucose greater than 126
    • 2 hour glucose greater than 200 w/ oral glucose tolerance test
    • A1C greater than 6.5%
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14
Q

fasting blood glucose

A
  • Nursing actions: postpone administration of anti DM meds until after level is drawn
  • Client edu: fast for 8 hour prior to test
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15
Q

oral glucose tolerance test

A
  • Can be used to diagnose gestational DM
  • Not generally used for routine diagnosis
  • Draw fasting blood glucose at start of test, then client is instructed to consume specified amount of glucose
    • Blood glucose levels are obtained every 30 min for 2 hour
    • Clients are assessed for hypoglycemia throughout procedure
  • Client edu:
    • Instruct client to consume balanced diet for 3 days prior to test, then fast for 10-12 hour prior to test
    • Only water may be taken during testing period
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16
Q

HgbA1c

A
  • Expected reference range is 4-6%, but an acceptable reference range for clients who have DM is 6.5-8%, w/ a target goal of less than 7%
  • Best indicator of average blood glucose level for past 120 days
    • Assists in evaluating tx effectiveness and compliance
  • Client edu:
    • Instruct client that test evaluates tx effectiveness and compliance
    • Recommended quarterly or twice yearly depending on glycemic levels
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17
Q

urine ketones

A

High ketones in urine assoc with hyperglycemia (excess 300) is medical emergency

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18
Q

self monitored blood glucose test (SMBG)

A
  • Nursing action: ensure client follows procedure for blood sample collection and use of glucose meter
    • Supplemental short acting insulin may be prescribed for elevated pre meal glucose levels
  • Client edu:
    • Instruct client to check accuracy of the strips w/ control soln
    • Instruct client to use correct code number in meter to match strip bottle number
    • Instruct client to store strips in closed container in dry location
    • Instruct client to obtain adequate amount of blood when performing test
    • Encourage hand hygiene
    • Encourage use of fresh lancets and avoid sharing glucose monitoring equipment
    • Advise client to keep record of SMBG that include time, date, serum glucose level, insulin dose, food intake, and other events that can alter glucose metabolism
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19
Q

insulin for DM1

A
  • Insulin regimens are established for clients who have DM1
  • More than 1 type of insulin: rapid-, short-, intermediate-, and long-acting
  • Given 1 or more times a day based on blood glucose
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20
Q

insulin for DM2

A
  • Insulin can be required by some clients who have DM2 or gestational DM if glycemic control is not obtained with diet, exercise, and oral hypoglycemic agents
  • can use oral hypoglycemics along with diet and exercise to control blood glucose
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21
Q

insulin pump

A
  • Continuous infusion of insulin can be accomplished using a small pump worn externally
    • Pump programmed to deliver insulin through a needle in subQ tissue
      • Needle should be changed at least Q2-3 days
    • Complications of pump: accidental cessation of insulin administration, obstruction of needle, pump failure, infection
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22
Q

insulin pens

A
  • prefilled cartridges of 150-300 units of insulin w/ disposable needles
    • Used if only one insulin given at a time
    • Convenient for travel
    • Used for clients w/ vision impairment of problems with dexterity
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23
Q

rapid acting insulin

A
  • insulin lispro, insulin aspart, insulin glulisine
  • Administer before meals to control postprandial rise in glucose
  • Onset is 10-40 min
  • Administer in conjunction w/ intermediate or long acting insulin to provide glycemic control w/ meals and at night
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24
Q

short acting insulin

A
  • regular insulin
  • Administer 30-60 min before meals to control postprandial hyperglycemia
  • Regular insulin available in 2 conc:
    • U-500 is reserved for client with insulin resistance (never give IV)
    • U-100 prescribed for most clients, can be given IV
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25
Q

intermediate acting insulin

A
  • NPH insulin
  • Administered for glycemic control b/w meals and at night
  • Not administered before meals
  • Contains protamine which causes delay in insulin absorption or onset and extends duration of action
  • Administer subQ only and as only insulin to mix with short acting
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26
Q

long acting insulin

A
  • insulin glargine, insulin detemir
  • Administered once daily, always at same time each day
  • Glargine forms microprecipitates that dissolve slowly over 24 hour and maintains a steady blood glucose level w/ no peaks or troughs
  • Detemir has an added fatty acid chain that delays absorption
    • No peak, but duration is dose dependent (either Q12 or Q24)
  • Administer subQ ONLY, never IV
27
Q

long acting insulin nursing considerations

A
  • Observe client perform self administration
  • Monitor for hypoglycemic rxns: sweating, weakness, dizziness, confusion, HA, tachycardia, slurred speech
  • Dosage adjusted for procedures that require pt to fast
28
Q

long acting insulin client education

A
  • Provide info regarding self administration:
    • Rotate injection sites to prevent lipohypertrophy w/in 1 anatomic site
    • Inject at 90 deg (45 deg if pt is thin)
    • When mixing a rapid or short acting insulin w/ longer acting insulin, draw up shorter acting into syringe first then longer acting (cloudy, clear, clear, cloudy)
  • Advise client to eat at regular intervals, avoid alcohol, adjust insulin to exercise and diet
  • Encourage client to wear medical ID band
29
Q

biguanides

A
  • Metformin
    • Reduces production of glucose by the liver (so stops gluconeogenesis)
    • Inc tissue sensitivity to insulin
    • Slows carb absorption in the intestines
30
Q

biguanides: nursing considerations

A
  • Monitor GI effects: flatulence, anorexia, n/v
  • Monitor for lactic acidosis, especially in clients who have kidney disorders or liver dysfunction
  • Stop medication for 48 hours before any type of elective radiographic test w/ contrast dye and restart 48 hour after (can cause lactic acidosis due to acute kidney injury)
31
Q

biguanides: client edu

A
  • Take with food
  • Take with vit B12 and folic acid
  • Contact the provider if manifestations of lactic acidosis occur (myalgia, sluggishness, somnolence, hyperventilation)
  • May be taken during pregnancy for GDM
  • Never crush or chew
32
Q

second generation sulfonylreas

A
  • glipizide, glimepiride, glyburide
    • Stimulates insulin release from the pancreas causing a dec in blood sugar levels
    • Inc tissue sensitivity
33
Q

second gen sulfonylreas: nursing considerations and client edu

A
  • Nursing considerations:
    • Monitor for hypoglycemia
    • Beta blockers can mask tachycardia typically seen during hypoglycemia
  • Client edu:
    • Administer 30 min before meals
    • Monitor for hypoglycemia and report frequent episodes to provider
    • Instruct client to avoid alcohol
34
Q

meglitinides

A
  • repaglinide, nateglinide
    • Stimulates insulin release from pancreas
    • Administered for post meal hyperglycemia
35
Q

meglitinides: nursing considerations and client edu

A
  • Nursing considerations:
    • Monitor for hypoglycemia
    • Monitor HbA1C every 3 mos
  • Client edu:
    • Administer 15-30 min before meals
    • Must eat w/in 30 min of administration
    • Omit dose if skipped meal to prevent hypoglycemic crisis
36
Q

what should be monitor for a client with DM?

A
  • Blood glucose levels and factors affecting levels
  • I&O and weight
  • Skin integrity and healing status of any wounds for presence of recurrent infection
  • Sensory alterations (tingling, numbness)
  • Visual alterations
  • Dietary practices
  • Exercise patterns
  • Self medication administration proficiency
37
Q

client education for a patient with DM

A
  • Teach the client appropriate techniques for SMBG, including obtaining blood samples, recording results, and handling supplies
  • Provide info regarding self administration of insulin
  • Rotate injection sites to prevent lipohypertrophy or lipoatrophy w/in 1 anatomic site
38
Q

foot care for a client with DM

A
  • Inspect feet daily and wash daily w/ mild soap and warm water
  • Pat feet dry gently
  • Use foot powder
  • Perform nail care after a bath or shower
  • Separate overlapping toes
  • Avoid open toe, open heel shoes
    • Leather shoes are preferred ot plastic
    • Do not go barefoot
  • Wear clean, absorbent socks
  • Avoid prolonged sitting, standing, crossing legs
39
Q

nutritional guidelines for a client with DM

A
  • Consult w/ dietician
  • Plan meals to achieve appropriate timing of food intake, activity, onset, and peak of insulin
    • Calories and food composition should be similar each day
    • Eat at regular intervals
  • Count grams of carbs
  • Restrict calories and inc physical activity
  • Include fiber in diet
40
Q

what is important for a client with DM to do when sick?

A
  • Monitor glucose Q3-4 hours
  • Continue to take insulin or oral hypoglycemic agents
  • Consume 4 oz of sugar free, non caffeinated liquid every 30 min
  • Meet carb needs thru soft food 6-8 times per day
  • Test urine for ketones
  • Rest
41
Q

when should a client with DM call the doctor if they are sick?

A
  • Blood glucose greater than 240
  • Fever greater than 38.6 deg C, does not respond to APAP, or lasts more than 24 hours
  • Feeling disoriented
  • Vomiting more than once, diarrhea more than 5 times
  • Inability to tolerate liquids
  • ketones in urine for more than 24 hours
42
Q

what are complications of DM?

A
  • cardiovascular and cerebrovascular dz: HTN, MI stroke
  • diabetic retinopathy
  • diabetic neuropathy
  • diabetic nephropathy
43
Q

explain cardiovascular/cerebrovascular dz as a complication of DM

A
  • HTN, MI, stroke
  • Monitor blood glucose
  • Client edu:
    • Encourage checks of cholesterol and monitor BP and A1c
    • Encourage regular activity
    • Encourage diet of low fat meals and high in fruits, veggies, whole grains
    • Teach client to report SOB, HA, numbness in extremities, swelling of feet, infrequent urination, changes in vision
44
Q

explain diabetic retinopathy as a complication of DM

A
  • Impaired vision and blindness
  • Client edu:
    • Yearly eye exams
    • Management of blood glucose
45
Q

explain diabetic neuropathy as a complication of DM

A
  • Caused from damage to sensory nerve fibers resulting in numbness and pain
  • Is progressive, can affect every aspect of the body, and can lead to ischemia and infection
  • Nursing actions:
    • Monitor glucose
    • Provide foot care
  • Client edu:
    • Encourage annual exams by podiatrist
    • Encourage regular follow up with provider to assess and tx neuropathy
46
Q

explain diabetic nephropathy as a complication of DM

A
  • Damage to kidneys from prolonged elevated blood glucose levels and dehydration
  • Nursing actions:
    • Monitor hydration and kidney function (I&O, serum creatinine)
    • Report an hourly output of less than 30 mL/hour
    • Monitor BP
  • Client edu:
    • Encourage yearly urine analysis, BUN, microalbumin, and serum creatinine
    • Avoid soda, alcohol, and toxic levels of acetaminophen or NSAIDs
    • Teach the client to consume 2-3 L/day fluid
    • Report dec in output to provider
47
Q

what is DKA?

A
  • acute, life threatening condition characterized by uncontrolled hyperglycemia (greater than 300) resulting in breakdown of body fat for energy, dehydration, metabolic acidosis, and an accumulation of ketones in the blood and urine
48
Q

what is HHS?

A
  • Hyperglycemic, hyperosmolar state (HHS):
    • Acute, life threatening condition characterized by profound hyperglycemia (greater than 600), hyperosmolarity that leads to dehydration, and absence of ketosis
    • Onset generally occurs gradually over several days
    • Can lead to coma and death
49
Q

DKA: risk factors

A
  • Lack of sufficient insulin related to undiagnosed or untreated DM1 or nonadherence to a diabetic regimen
  • Reduced or missed dose of insulin
  • Any condition that increases carb metabolism, such as physical or emotional stress, illness, infection (#1 CAUSE OF DKA), surgery, or trauma that requires inc need for insulin
  • Inc hormone production (cortisol, glucagon, epi) stimulates liver to produce glucose and dec effect of insulin
50
Q

HHS: risk factors

A
  • Lack of sufficient insulin related to undiagnosed DM
  • Inadequate fluid intake or poor kidney fcn
  • Older adults age 50-70 yo
  • Mortality rates in older clients b/w 40-70% given the older clients seek medical attn later and are sicker than the younger clients
  • Medical conditions such as MI, cerebral vascular injury, or sepsis
  • Meds: glucocorticoids, thiazide diuretics, phenytoin, beta blockers, and CCBs
  • Infection or stress
51
Q

DKA: expected findings

A
  • Polyuria
  • Polydipsia
  • Polyphagia
  • Weight loss
  • GI effects: n/v/abdominal pain
  • Blurred vision, HA, weakness
  • Orthostatic hypoTN
  • Fruity odor of breath
  • Kussmaul respirations
  • Metabolic acidosis
  • Mental status change
52
Q

HHS: expected findings

A
  • Polyuria
  • Polydipsia
  • Polyphagia
  • Weight loss
  • GI effects: n/v/abdominal pain
  • Blurred vision, HA, weakness
  • Orthostatic hypoTN
  • Mental status change
  • Seizures, myoclonic jerking
  • Reversible paralysis
53
Q

what are the differences b/w DKA and HHS?

A
  • DKA causes fruity odor on breath, Kussmaul respirations, metabolic acidosis
  • HHS causes seizures, myoclonic jerking, and reversible paralysis
54
Q

serum glucose with DKA and HHS

A
  • DKA: greater than 300
  • HHA: greater than 600
55
Q

serum electrolytes (Na and K) with DKA and HHS

A
  • DKA:
    • Na: low, normal, or high
    • K: initial levels depend on how long DKA existed prior to treatment, then decrease w/ tx
  • HHS:
    • Na: normal or low
    • K: normal to high as a result of dehydration–>must monitor for dec when tx started
56
Q

serum BUN and Cr with DKA and HHS

A
  • DKA:
    • Inc secondary to dehydration
    • BUN >30
    • Cr >1.5
  • HHS:
    • Inc secondary to dehydration
    • BUN >30
    • Cr >1.5
57
Q

ketones in the serum and urine with DKA and HHS

A
  • DKA: present in serum and urine
  • HHS: absent in serum and urine
58
Q

ABGs with DKA and HHS

A
  • DKA: metabolic acidosis with respiratory compensation (Kussmaul’s respirations)
    • pH less than 7.3
  • HHS: absence of acidosis
    • pH greater than 7.4
59
Q

fluids used to tx DKA and HHS

A
  • Provide isotonic fluid replacement
    • Monitor for signs of fluid volume excess due to need for large quantities of fluid
    • Physiological changes in cardiac and pulmonary fcn can place older adult clients at greater risk for fluid overload
  • Follow w/ hypotonic fluid (0.45% NS) to continue to replace losses to total body fluid
  • When glucose approaches 250, add glucose to IV fluids to minimize risk of cerebral edema
60
Q

patient care with DKA and HHS

A
  • Administer regular insulin 0.1-0.15 units/kg as an IV bolus dose and then follow w/ continuous IV infusion of regular insulin at 0.1 units/kg/hour
  • Administer IV rather than subQ to provide immediate tx
    • Monitor glucose hourly
  • Monitor K+ levels
    • K+ will initially be high, but with insulin K+ will shift into cells and need to monitor for hypokalemia
    • Monitor cardiac rhythm and urinary output
  • Administer bicarb by slow IV infusion for severe acidosis
  • Monitor neuro status
61
Q

how to care for older adults with DKA or HHS

A
  • Monitor glucose every 1-4 hours
  • Emphasize importance of not skipping insulin when ill
  • Maintain hydration b/c they have dec thirst sensation
  • Changes in mental status can prevent older clients from seeking tx
62
Q

client edu for those with DKA or HHS

A
  • Wear med alert bracelet
  • Teach clients to take measures to prevent dehydration:
    • Consume 2-3 L/day
  • Monitor glucose Q4 hours when ill
  • Teach clients to check urine for ketones if glucose is greater than 240
  • Tell clients to consume liquids with carbs and electrolytes when can’t eat solid food
63
Q

signs of hypoglycemia

A
  • Sweating
  • Weakness
  • Dizziness
  • Confusion
  • HA
  • Tachycardia
  • Slurred speech

Adult Health I Test II (3 decks)

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