Diabetes Flashcards

Question

Patient's might present with the following:

Answer 1

Urine: positive for glucose and negative for protein Wet preparation of smear from rash: consistent with Candida albicans ECG: evidence of early ventricular hypertrophy

Answer 2

Diet, exercise, medications

Answer 3

``` Patient teaching Nutritional therapy Drug therapy Exercise Self-monitoring of blood glucose ``` Foot care (amputations are primarily caused by pts with infections due to neuropathy, encourage to always wear sturdy shoes, no open toes) Inspect feet! Do not put a lot of lotions or wet ointments on feet because that can be a breeding ground for bacteria. KEY: Diet, exercise, and weight loss may be sufficient for patients with type 2 diabetes All patients with type 1 require insulin

Answer 4

attain an optimal level of blood glucose control. However, for the majority, drug therapy is necessary.

Answer 5

Rapid acting Peak: 30 minutes Short acting (taken before meals) - Peak 2-5 hrs. Intermediate acting- Peak 4-12 hour Long acting - no pronounced peak (athletes or activities that require a lot of caloric expenditure)

Answer 6

Basal-bolus regimen Most closely mimics endogenous insulin production Rapid- or short-acting (bolus) insulin before meals Intermediate- or long-acting (basal) background insulin once or twice a day Less intense regimens can also be used (commonly mixed with short or rapid)

Answer 7

The kidneys can be damaged. Clinical manifestation for chronic DM is proteinuria (too much protein in urine.) Also, the left ventricle of the heart can become enlarged ( lack of perfusion in coronary arteries due to CHF, other cardio)

Answer 8

Because as a nurse we want to know when the patient is most likely to be HYPOGLYCEMIC! low blood sugar <70 Monitor patient within 10-

Answer 9

Monitor patient within 10-30 minutes up to 3 hours for S/S of hypoglycemia.

Answer 10

Remember that our brain needs oxygen and glucose and this needs to be addressed right away. Only 5 minutes to react.

Answer 11

No It means that it is not going to throw the patient into a hypoglycemic state at all.

Answer 12

``` Confusion Diaphoresis Extreme hunger Irritability Seizure!! if very deprived of glucose ```

Answer 13

lispro (humaLOG) aspart (NovoLOG) glulisine (Apidra) Onset 10-30 minutes Peak: 30 min -3 hr Duration: 3-5 hr Typically taken before meals

Answer 14

Humulin R, and Novolin R Onset 30 minutes Peak: 32-5 hr Duration: 5-8 hr

Answer 15

Onset 1.5-4 hour Peak: 4-12 hr Duration: 12-18hr

Answer 16

Yes. Patients who typically are on a basal bolus regimen take metformin

Answer 17

Inject air into NPH, then Air into Regular that's clear, Draw up Regular then draw NPH So we don't accidentally mix regular with NPH.

Answer 18

Storage of insulin Do not heat/freeze In-use vials may be left at room temperature up to 4 weeks Extra insulin should be refrigerated Avoid exposure to direct sunlight, extreme heat or cold Store prefilled syringes upright for 1 week if two insulin types; 30 days for one

Answer 19

Intermediate-acting insulin (NPH) is also used as a basal insulin. Its action has a duration of 12 to 18 hours. The disadvantage of NPH is that its peak of action ranges from 4 to 12 hours, which can result in hypoglycemia. NPH is the only basal insulin that can be mixed with short- and rapid-acting insulins. NPH is a cloudy insulin that must be gently agitated before administration.

Answer 20

Can mix short- or rapid-acting insulin with intermediate-acting insulin in same syringe Provides mealtime and basal coverage in one injection Commercially premixed or self-mix For patients who want to use only one or two injections per day, a short- or rapid-acting insulin is mixed with intermediate-acting insulin in the same syringe. This allows patients to have both mealtime and basal coverage without having to administer two separate injections. Although this may be more appealing to the patient, most patients achieve better control with basal-bolus therapy.

Answer 21

Absorption is fastest from abdomen, followed by arm, thigh, and buttock Abdomen is preferred site Do not inject in site to be exercised Rotate injections within one particular site

Answer 22

An insulin pen is a compact portable device loaded with an insulin cartridge that serves the same function as a needle and syringe. Pen needles are available in various lengths and sizes. Many patients prefer using insulin pens because of greater convenience and flexibility. They are portable and compact, their use is more discreet than using a vial and syringe, and they provide consistent and accurate dosing. For patients with poor vision, the pen is a better option as they can hear the clicks of the pen as the dose is selected. Insulin pens come packaged with printed instructions including pictures of the steps to take when using the pen. These instructions are helpful to use in teaching new users and in reviewing technique with current users of a pen.

Answer 23

Continuous subcutaneous infusion Battery-operated device Connected to a catheter inserted into subcutaneous tissue in abdominal wall

Answer 24

Problems and complications of insulin pump therapy are infection at the insertion site, an increased risk for DKA if the insulin infusion is disrupted by a problem at the infusion site, and the increased cost of the pump and supplies. Kinks -

Answer 25

Hypoglycemia Problems with insulin therapy Hypoglycemia Allergic reaction Lipodystrophy

Answer 26

Somogyi effect Rebound effect in which an overdose of insulin causes hypoglycemia Release of counterregulatory hormones causes rebound hyperglycemia

Answer 27

Hyperglycemia in the morning may be due to the Somogyi effect. A high dose of insulin produces a decline in blood glucose levels during the night. As a result, counterregulatory hormones (e.g., glucagon, epinephrine, growth hormone, cortisol) are released, stimulating lipolysis, gluconeogenesis, and glycogenolysis, which in turn produce rebound hyperglycemia. The danger of this effect is that when blood glucose levels are measured in the morning, hyperglycemia is apparent and the patient (or the health care professional) may increase the insulin dose. If a patient is experiencing morning hyperglycemia, checking blood glucose levels between 2:00 AM and 4:00 AM for hypoglycemia will help determine if the cause is the Somogyi effect. The patient may report headaches on awakening and may recall having night sweats or nightmares. A bedtime snack, a reduction in the dose of insulin, or both can help to prevent the Somogyi effect.

Answer 28

If the Somogyi effect is causing the patient’s increased morning glucose level, the patient will experience hypoglycemia between 2:00 and 4:00 AM. The patient should be instructed to check their blood sugars then. The dose of insulin will be reduced..

Answer 29

Dawn phenomenon Morning hyperglycemia present on awakening Due to release of counterregulatory hormones in predawn hours

Answer 30

If the predawn levels are less than 60 mg/dL (3.3 mmol/L) and signs and symptoms of hypoglycemia are present, the insulin dosage should be reduced. If the 2:00 to 4:00 AM blood glucose level is high, the insulin dosage should be increased. In addition, counsel the patient on appropriate bedtime snacks.

Answer 31

First line med that pts are typically put on with diabetes. Work on three defects of type 2 diabetes Insulin resistance Decreased insulin production Increased hepatic glucose production (med will decrease this) Can be used in combination

Answer 32

Metformin (Glucophage) Reduce glucose production by liver Enhance insulin sensitivity Improve glucose transport May cause weight loss Used in prevention of type 2 diabetes Withhold if contrast medium is used

Answer 33

Withhold if patient is undergoing surgery or radiologic procedure with contrast medium Day or two before and at least 48 hours after! Monitor serum creatinine Contraindications Renal, liver, cardiac disease Excessive alcohol intake

Answer 34

``` ↑ Insulin production from pancreas Major side effect: hypoglycemia diaphoresis, confusion, hungry, irritable. Examples Glipizide (Glucotrol) Glyburide (Micronase, ``` DiaBeta, Glynase) Glimepiride (Amaryl)

Answer 35

No. Why? Because it doesn't increase insulin it only reduces amount of glucose that the liver makes. Can irritate stomach nausea, take with food

Answer 36

Onset 10-30 minutes Peak: 30 min -3 hr Duration: 3-5 hr Typically taken before meals

Answer 37

Emphasis on achieving glucose, lipid, and blood pressure goals Weight loss Nutritionally adequate meal plan with ↓ fat and CHO Spacing meals Regular exercise Carbohydrate counting Serving size is 15 g of CHO Typically 45 to 60 g per meal Insulin dose based on number of CHOs consumed Patient teaching essential

Answer 38

Cardiovascular disease, can have MI

Answer 39

``` Type/amount Minimum 150 minutes/week aerobic Resistance training three times/week Benefits ↓ Insulin resistance and blood glucose Weight loss ↓ Triglycerides and LDL , ↑ HDL Improve BP and circulation ``` Monitor blood glucose Glucose-lowering effect up to 48 hours after exercise Exercise 1 hour after a meal Snack to prevent hypoglycemia Do not exercise if blood glucose level exceeds 300 mg/dL and if ketones are present in urine

Answer 40

Enables decisions regarding diet, exercise, and medication Accurate record of glucose fluctuations Helps identify hyperglycemia and hypoglycemia Helps maintain glycemic goals A must for insulin users Frequency of testing varies

Answer 41

The MiniMed Paradigm insulin pump (A) delivers insulin into a cannula (B) that sits under the skin. Continuous glucose monitoring occurs through a tiny sensor (C) inserted under the skin. Sensor data are sent continuously to the insulin pump transmitter (D). The transmitter sends data to the insulin pump through wireless technology.

Answer 42

``` Patient teaching How to use, calibrate When to test Before meals Two hours after meals When hypoglycemia is suspected During illness Before, during, and after exercise ```

Answer 43

``` kidney transplant Eliminates need for exogenous insulin, SMBG, dietary restrictions Can also eliminate acute complications Long-term complications may persist Lifelong immunosuppression Islet cell transplantation experimental ```

Answer 44

When the patient is hyperglycemic >300

Answer 45

Ketones occur in the urine, when the body starts burning fat for energy. When there is no more glucose to go into the cell.

Answer 46

Kidney and pancreas transplantations are often performed together, or a pancreas may be transplanted after kidney transplantation. Pancreas transplantation alone is rare. If renal failure is not present, the ADA recommends that pancreas transplantation be considered only for patients who exhibit the following three criteria: (1) a history of frequent, acute, and severe metabolic complications (e.g., hypoglycemia, hyperglycemia, ketoacidosis) necessitating medical attention; (2) clinical and emotional problems with exogenous insulin therapy that are so severe as to be incapacitating; and (3) consistent failure of insulin-based management to prevent acute complications.

Answer 47

From 9 range to 7.1%. Progression of disease, improving! Diabetics get a higher value that is considered normal (A1C)

Answer 48

BC Isles of langerhans could be damaged and affect insulin excretion

Answer 49

History: Trauma, infection, stress, pregnancy, chronic pancreatitis, Cushing syndrome, acromegaly, family history of diabetes, baby > 9 lbs Medications: Insulin, OAs, corticosteroids-these can increase blood sugar) , diuretics, phenytoin (can impact blood sugar as well) this is an (anticonvulsant/antiarrhythmics) Recent surgery Malaise Obesity, weight loss or gain Thirst, hunger, nausea/vomiting Poor healing

Answer 50

``` Constipation/diarrhea Frequent urination, bladder infections Nocturia, urinary incontinence Muscle weakness, fatigue Abdominal pain, headache, blurred vision Numbness/tingling, pruritus Impotence, frequent vaginal infections Decreased libido Depression, irritability, apathy Commitment to lifestyle changes ```

Answer 51

``` DEHYDRATION: Sunken eyeballs vitreal hemorrhages cataracts Dry, warm, inelastic skin Pigmented skin lesions ``` ``` ulcers, loss of hair on toes, acanthosis nigricans Kussmaul respirations Hypotension Weak, rapid pulse Dry mouth Vomiting Fruity breath Altered reflexes, restlessness Confusion, stupor, coma Muscle wasting ```

Answer 52

When there is an acid base imbalance and patient have DKA the blood sugar is so HIGH and the patient has NO INSULIN, in order to compensate the respiratory system kicks in first, pretty quickly resulting in Kussmaul respirations which are very deep respirations, and fast. In an effort to blow off CO2. Fruity breath.

Answer 53

Answer: c Rationale: The goal of diabetes education is to enable the patient to become the most active participant in his or her own care.

Answer 54

``` Serum electrolyte abnormalities Fasting blood glucose level of 126 mg/dL or higher Oral glucose tolerance test and/or random glucose level exceeding 200 mg/dL Leukocytosis ↑ Blood urea nitrogen >20, creatinine >1.3 ↑ Triglycerides, cholesterol, LDL, VLDL ↓ HDL Hemoglobin A1C value higher than 6.5% Glycosuria Ketonuria Albuminuria (due to kidney damage) Acidosis ↑ Triglycerides, cholesterol, LDL, VLDL ↓ HDL Hemoglobin A1C value higher than 6.5% Glycosuria Ketonuria Albuminuria (due to kidney damage) Acidosis Possible diagnostic findings: Serum electrolyte abnormalities; fasting blood glucose level of126 mg/dL or higher; oral glucose tolerance test result exceeding 200 mg/dL; random glucose test result of 200 mg/dL or higher; leukocytosis; ↑ blood urea nitrogen, creatinine levels ```

Answer 55

``` Ambulatory and home care Frequent oral care Foot care Inspect daily Avoid going barefoot Proper footwear closed toe, leather, comfortable How to treat cuts ```

Answer 56

Diabetic ketoacidosis (DKA) Hyperosmolar hyperglycemic syndrome (HHS) Hypoglycemia

Answer 57

``` Caused by profound deficiency of insulin Characterized by Hyperglycemia Ketosis Acidosis Dehydration Most likely to occur in type 1 diabetes ```

Answer 58

``` Precipitating factors Illness Infection Inadequate insulin dosage Undiagnosed type 1 diabetes Poor self-management Neglect Clinical manifestations Dehydration Lethargy and weakness early Skin dry and loose; eyes soft and sunken Abdominal pain, anorexia, nausea/vomiting Kussmaul respirations Sweet, fruity breath odor Blood glucose level of 250 mg/dL or higher Blood pH lower than 7.30 Serum bicarbonate level lower than 16 mEq/L Moderate to high ketone levels in urine or serum ```

Answer 59

When the circulating supply of insulin is insufficient, glucose cannot be properly used for energy. The body compensates by breaking down fat stores as a secondary source of fuel. Ketones are acidic by-products of fat metabolism that can cause serious problems when they become excessive in the blood. Ketosis alters the pH balance, causing metabolic acidosis to develop. Ketonuria is a process that occurs when ketone bodies are excreted in the urine. During this process, electrolytes become depleted as cations are eliminated along with the anionic ketones in an attempt to maintain electrical neutrality. Insulin deficiency impairs protein synthesis and causes excessive protein degradation. This results in nitrogen losses from the tissues. Insulin deficiency also stimulates the production of glucose from amino acids (from proteins) in the liver and leads to further hyperglycemia. Because there is a deficiency of insulin, the additional glucose cannot be used and the blood glucose level rises further, adding to the osmotic diuresis. If not treated, the patient will develop severe depletion of sodium, potassium, chloride, magnesium, and phosphate. Vomiting caused by the acidosis results in more fluid and electrolyte losses. Eventually, hypovolemia will ensue and be followed by shock. Renal failure, which may eventually occur from hypovolemic shock, causes the retention of ketones and glucose, and the acidosis progresses. Untreated, the patient becomes comatose as a result of dehydration, electrolyte imbalance, and acidosis. If the condition is not treated, death is inevitable.

Answer 60

Ensure patent airway; administer O2 Establish IV access; begin fluid resuscitation NaCl, 0.45% or 0.9% Add 5% to 10% dextrose when blood glucose level approaches 250 mg/dL Continuous regular insulin drip, 0.1 U/kg/hr. Potassium replacement as needed

Answer 61

Life-threatening syndrome Occurs with type 2 diabetes Precipitating factors UTIs, pneumonia, sepsis Acute illness Newly diagnosed type 2 diabetes Impaired thirst sensation and/or inability to replace fluids Enough circulating insulin to prevent ketoacidosis Fewer symptoms lead to higher glucose levels (>600 mg/dL) More severe neurologic manifestations because of ↑ serum osmolality Ketones absent or minimal in blood and urine

Answer 62

``` Medical emergency High mortality rate Therapy similar to that for DKA IV insulin and NaCl infusions More fluid replacement needed Monitor serum potassium and replace as needed Correct underlying precipitating cause ```

Answer 63

``` Monitor IV fluids Insulin therapy Electrolytes Assess Renal status Cardiopulmonary status Level of consciousness ```

Answer 64

The nurse is caring for a patient with type 1 diabetes mellitus who is admitted for diabetic ketoacidosis. The nurse would expect which laboratory test result? Hypokalemia Fluid overload Hypoglycemia Hyperphosphatemia

Answer 65

Too much insulin in proportion to glucose in the blood Blood glucose level less than 70 mg/dL Neuroendocrine hormones released Autonomic nervous system activated

Answer 66

``` Headache Ringing in the ears Trembling Irritability Sweatiness blurry vision Increase heart rate Hunger Feeling anxious ```

Answer 67

``` Altered mental functioning Difficulty speaking Visual disturbances Stupor Confusion Coma Untreated hypoglycemia can progress to loss of consciousness, seizures, coma, and death ```

Answer 68

Because the brain requires a constant supply of glucose in sufficient quantities to function properly, hypoglycemia can affect mental functioning. The manifestations are speaking difficulties, visual disturbances, stupor, confusion, and coma. Manifestations of hypoglycemia can mimic those of alcohol intoxication. Untreated hypoglycemia can progress to loss of consciousness, seizures, coma, and death.

Answer 69

Causes Too much insulin or oral hypoglycemic agents Too little food Delaying time of eating Too much exercise Symptoms can also occur when high glucose level falls too rapidly

Answer 70

``` Treatment: rule of 15 Consume 15 g of a simple carbohydrate Fruit juice or regular soft drink, 4 to 6 oz Recheck glucose level in 15 minutes Repeat if still less than 70 gm/dL Avoid foods with fat Decrease absorption of sugar Avoid overtreatment Give complex CHO after recovery ```

Answer 71

``` Treatment In acute care settings Fifty percent dextrose, 20 to 50 mL, IV push Patient not alert enough to swallow Glucagon, 1 mg, IM or subcutaneously Explore reason why occurred ```

Answer 72

``` Stroke Hypertension Demopathy Neuropathy Gangrene Neutrogenic bladder Retinopathy Cataracts Glaucoma Blindness Atherosclerosis ```

Answer 73

``` Autonomic neuropathy Can affect nearly all body systems Gastroparesis Delayed gastric emptying Cardiovascular abnormalities Postural hypotension, resting tachycardia, painless myocardial infarction Sexual function Erectile dysfunction Decreased libido Vaginal infections Neurogenic bladder → urinary retention Empty frequently, use Credé’s maneuver Medications Self-catheterization ```

Answer 74

Gangrene Amputations Neuropathy

Answer 75

Diabetic dermopathy is most common

Answer 76

``` Increased prevalence and mortality Glycemic control challenging Increased hypoglycemic unawareness Functional limitations Renal insufficiency Diet and exercise: main treatment Patient teaching must be adapted to needs ```

Answer 77

Lower than 7.3

Diabetes Flashcards

(102 cards)