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NUR 101 Assessment #4 > Diabetes > Flashcards

Diabetes Flashcards

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1
Q

What is diabetes?

A

Either course leads to too much glucose in the bloodstream that over time can cause damage to multiple body systems and organs

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2
Q

Is a chronic, long-term condition that occurs either when the body cannot produce enough insulin (as in ___) or it can’t use the insulin it’s making effectively as it should (___)

A

Type 1; Type 2

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3
Q

Pathophysiology - Type 1 Diabetes Mellitus

Autoimmune process (insulin-producing ß cells of pancreas destroyed)

(?) Excess/lack of insulin

Quick onset

Total insulin deficiency develops within 1 year

Requires lifetime exogenous (from external source) insulin

“juvenile” diabetes

Can develop after a pancreatic resection

A

Lack

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4
Q

Pathophysiology - Type 2 Diabetes Mellitus

Defect at the cellular membrane

Insulin resistance; glucose is (?) released into / kept in the bloodstream

More insulin is needed to work effectively

Pancreas cannot keep up with the demand ⇒ leads to ß cell failure & disease progression

“adult onset”; have also seen in children d/t the obesity epidemic

A

Kept

In later stage of type 2, insulin declines & 30% of clients end up needing exogenous insulin

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5
Q

Labs Associated with Diabetes

Fasting Blood Sugar (FBS) or fasting blood glucose (FBG)

<100 mg/dL is normal

>126 mg/dL for a diagnosis of diabetes

120-126 mg/dL ⇒ prediabetes

A

Glucose Tolerance Test (GTT)

Give 75g of oral or IV glucose after FBS is drawn

Check blood glucose levels at specific intervals

At 1 hr, 2 hrs

Normal ⇒ 140 mg/dL or less

140-199 mg/dL ⇒ signifies impaired glucose tolerance or pre-diabetes

200+ mg/dL ⇒ diagnosis of DM in non-pregnant adult

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6
Q

Urine Glucose

Glucosuria

A

Urine Acetone (lower levels)

Ketones can be present in urine from other diseases like dehydration

Ketonuria

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7
Q

?

Glucose attaches to hgb for life of the RBC

↑ glucose = greater # of hgb that’s glycosylated

Reading reflects avg blood glucose levels for past 2-3 mos

Test 2x year if well-controlled & quarterly if poorly controlled

A

Glycosylated Hemoglobin A1C

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8
Q

Glycosylated Hemoglobin A1C

5.7 - 6.4 = ?

>6.4 = ?

A

pre-diabetes

diabetes

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9
Q

Clinical Manifestations (Signs & Symptoms)

? = increased thirst

? = increase in frequency of urination

Blurred vision ⇒ elevated glucose causes lens of eye to swell

Fatigue

Infection ⇒ immune system function decreases

? = increased appetite

More urination overnight, especially with type 1

A

Polydipsia

Polyuria

Polyphagia

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10
Q

Clinical Manifestations (Signs & Symptoms) cont’d

Vaginitis

Bladder infections

Poor wound healing d/t decreased peripheral circulation

Kidney disorders d/t damage from elevated glucose levels; damage vessels in the kidney

Impotence in men (inability to achieve erection or orgasm)

A
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11
Q

Type ___ = obesity; gradual onset of symptoms

Type ___ = weight loss; rapid onset of symptoms

A

2

1

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12
Q

Clinical Manifestations: Hyperglycemia

Polydipsia / polyphagia

Glycosuria / fruity breath (d/t ketone buildup excretion in the lungs)

Kussmaul’s respirations

Dehydration (electrolytes lost through kidneys w/increased urination)

Itchy skin / fatigue/lethargy / irritation

A

If not corrected, can progress to DKA, coma & death

Hot & dry = sugars high

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13
Q

Clinical Manifestations: Hypoglycemia

Headache (migraines) / blurred vision (d/t brain not getting enough energy) / diplopia

Drowsiness / ataxia (loss of muscle control)

Paresthesia / weakness / muscle spasms / tachycardia / palpitations

Tachypnea (rapid breathing) / hunger / nausea / diaphoresis (sweating)

A

Too much insulin

Too little food intake or delayed meal

Excessive exercise

70 mg/dL and lower

Alcohol

Rx’s like oral hypoglycemic agents

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14
Q

Diabetes Self-Management Education (DSME)

Physical activity (150 min/wk) moderate intensity, aerobic

Nutritional changes

Insulin

Oral antidiabetic agents

Self-monitoring blood glucose (SMBG)

Monitoring glycosylated hemoglobin A1C levels

A

* Team approach

* Education by a certified diabetes nurse educator

* Losing 5% of total body weight can reduce effects of diabetes significantly (in context of Type 2)

* Limit alcohol (it can cause delayed hypoglycemia)

* Best time for exercise is 60-90 min following a meal as that is when blood glucose levels will be highest

* Modified exercise programs for Type 1

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15
Q

Avoid processed foods & sugar-sweetened things

Carbs before workout

Protein

Fats (decrease mono-unsaturated; intake omega-3’s)

Learn about different macronutrients and their distribution

Carbs/fiber-containing carbs (whole grains, fruits, vegetables)

Carb-counting - especially for Type 1

15-20g of carbs; i.e. 4-6 oz fruit juice/glass of milk

A

Non-starchy vegetables (i.e. spinach, cauliflower, lettuce, broccoli, onions, peppers)

Lowfat proteins

Low glycemic index diet or low glucose control

> Low A1C by 5%

> Decreases hypoglycemic events

> Reduces incidence of microvascular complications

> Lowers LDL, increases HDL

> Reduces risk of cardiovascular disease

> Facilitates weight loss

> Oral, IV glucose

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16
Q

Insulin

* Used w/any type of diabetic diagnosis (most common in type 1 treatment)

* Majority of insulin is human insulin - few allergic reactions occur

* Administered subcutaneously or intravenously

* Only regular insulin can be given IV

A
17
Q

?

Insulin dose that is shorter-acting; to cover needs for 1 meal or shorter period of time

A

Bolus

18
Q

?

Insulin that is longer acting; injected 1 or 2x/day

A

Basal

19
Q

___ Insulin

Longer-acting

i.e. NPH / Lantus / Novolog 70/30 / Levemir

A

Basal

20
Q

___ Insulin

Covers 1 meal or 1 short period of time

i.e. Humalog, Novolog, Regular

A

Bolus

21
Q

Oral Hypoglycemic Agents

* Used with Type ___ diabetes only!

Can often be discontinued once weight loss/loss of body fat occurs

Stimulates insulin release from the pancreatic beta-cells (Type ___ diabetics don’t have these), reduces glucose output from the liver, and increases the uptake of glucose in the tissues

Discontinued during acute hospitalizations and resumed after discharge

Common agents: ___, glipizide, glyburide, glimepiride, acarbose, and glitazones

A

2

1

metformin

22
Q

Self-Monitoring Blood Glucose

Allows clients to try to normalize and stabilize blood glucose levels throughout the day

Amount and timing of checks can vary amongst individuals

A
23
Q

Diabetes and Illness

Blood glucose levels can raise during acute illness

Acute illness can lead to diabetic ketoacidosis in Type ___ diabetes, and ___ in Type 2 diabetes

Increased risk for severe complications with vomiting, diarrhea, and fever

> Clients should monitor their blood glucose every 2-4 hrs until sx’s subside

A

1

Hyperglycemic Hyperosmolar Nonketotic Syndrome (HHNS)

24
Q

?

Seen in type 1 diabetes

A life-threatening emergency

Most common causes include a decreased or missed dose of insulin, illness or infection, uncontrolled disease in a previously undiagnosed person

Dehydration ⇒ Acidosis ⇒ Electrolyte Imbalance

Treatment

A

Diabetic ketoacidosis (DKA)

25
Q

Diabetic Ketoacidosis (DKA) - Treatment

Provide supplemental insulin; fluid & electrolyte replacement

Monitored in an intensive care unit setting

Identify precipitating factor(s) & educate client

Which electrolyte is of especial importance to monitor?

A

Potassium (K+)

Hypo- & hyperkalemias can cause dysrhythmias ⇒ which can be fatal

26
Q

Diabetic Ketoacidosis (DKA) - Dehydration ⇒ Acidosis ⇒ Electrolyte Imbalance

d/t fluid loss

Total fluid loss of 15% of total body wt isn’t unusual for DKA

Without insulin, glucose is unable to transfer into the cells

As glucose stays in plasma, it has an osmotic effect

Pulls H2O into intravascular space, causing cellular dehydration

Body then excretes H2O, glucose, & electrolytes in the urine

A

Problem d/t lack of insulin

Releases protein & fat from tissues to be converted into glucose by the liver

Fatty acids present here transition into ketones and this overwhelms the body, leading to ketonemia and ketonuria

27
Q

?

Occurs in type 2 or older adults

Symptoms can be vague

A life threatening emergency

Four Signs:

Blood glucose level of ___ or greater

Absence of or slight ___ - lipolysis doesn’t occur so there’s no presence of ___ here

Plasma ___ (leading to)

Profound ___

A

Hyperglycemic Hyperosmolar Nonketotic Syndrome (HHNS)

600 mg/dL

ketosis; ketones

hyperosmolality

dehydration

28
Q

Other Complications of Diabetes

?

Blurred vision r/t narrowing of vessels in the eyes b/c of increased amount of glucose in the plasma

Encourage frequent eye exams

A

Diabetic retinopathy

29
Q

?

A paralysis of the stomach w/delayed gastric emptying

Alters absorption of food & leads to problems with glycemic control

A

Gastroparesis

30
Q

?

Involves kidneys narrowing of blood vessels d/t overwhelming amount of glucose within the bloodstream

Affects gastric and intestinal motility; erectile dysfunction; bladder-, cardiac-, vascular tone

A

Diabetic nephropathy

31
Q

?

Is a lack of sensation in the extremities (especially lower)

Leads to wounds on the feet

A

Diabetic neuropathy

NUR 101 Assessment #4 (5 decks)

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