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NUR 333: > Diabetes > Flashcards

Diabetes Flashcards

1
Q

patho review of type 1

A
  • more common in younger people
  • more abrupt onset
  • 5-10%
  • No endogenous insulin production
  • 3 P’s most common symptoms
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2
Q

patho review of type 2

A
  • more common in adults
  • can go undiagnosed for years
  • insulin resistant
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3
Q

the 3 p’s

A
  • polydipsia: excessive thirst
  • polyphagia: excessive hunger
  • polyuria: frequent urination
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4
Q

other symptoms of diabetes

A
  • fatigue
  • recurrent infections (sick)
  • slow wound healing
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5
Q

risk factors of t2

A

non modifiable
- fam history, over 45, race/ethnicity, had gestational diabetes
modifiable
- physical inactivity, obesity, high bp, high cholesterol

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6
Q

fasting blood glucose

A

normal below 126 mg/dL
- fast for 8 hours before

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7
Q

casual blood glucose

A

normal below 200 mg/dL

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8
Q

urine ketones

A

high ketones associated w hyperglycemia
- medical emergency above 300 mg/dL

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9
Q

lipid profile

A

hdl will be low
triglycerides and ldls will be high

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10
Q

oral glucose tolerance test

A

used to test for gestational diabetes
- fasting glucose drawn prior, then consumes glucose, and obtain new glucose after 30 mins for 2 hrs
- fasting should be less than 120
- 1 hr: less than 180
- 2 hr: less than 140

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11
Q

glycosylated hemoglobin (HbA1C)

A

avg glucose level over 3 mons
- used to diagnosis and evaluate effectiveness of treatment
- normal 4-6%
- greater 6.5% is diabetic, typical goal is 7%

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12
Q

criteria to get diagnosed w diabetes

A

at least one of the following
- A1C 6.5%+
- fasting level greater than 126
- OGTT 12 hr level of 200 mg/dL
- classic symptom of hyperglycemia

repeat labs to verify

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13
Q

care plan for pre diabetic

A

impaired glucose tolerance, fasting glucose, or both
- typically no symptoms
- alc: 5.7-6.4%, fasting blood sugar: 100-125, ogtt: 140-199

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14
Q

what to do to treat pre diabetic

A
  • teach
  • lifestyle modfications
  • monitoring glucose levels, a1c
  • monitor for symptoms
  • diet modifications
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15
Q

pharmo nursing management

A
  • oral meds started on low does then inc
  • oral meds often stopped in hospitals
  • hold metformin before procedures
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16
Q

how to treat sick DM pt

A
  • steroids inc bs
  • inc body stress which can inc glucose
  • inc risk of DKA, HHNS
  • stomach virus can dec glucose, still need to take med
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17
Q

teach points for sick DM pt (yellow)

A
  • notify HCP
  • monitor bs more frequently
  • continue meds
  • hydrate
  • meet carb needs
  • rest
18
Q

teach points for sick DM pt (red)

A
  • urine ketones
  • bs greater than 250
  • fever greater than 101.5, not responding to meds
  • feeling confused, disoriented, rapid breathing
  • persistant nausea, vomit, diarrhea
  • cant tolerate liquids
  • lasts more than 2 days
19
Q

frequency of bs checks depends on

A
  • glycemic goals
  • types of diabetes
  • med regimen
  • access to supplies and equip
  • pt willingness
20
Q

nursing management

A
  • mimic bodies normal production
  • combine basal w meal time (basal bolus regimen)
  • rapid and short acting before meals
  • use background insulin once a day
  • 4 injections a day –> lantus, levemir or novolog, regular
21
Q

types of insulin (more details in patho)

A
  • rapid
  • regular, short
  • intermediate
  • long
22
Q

high alert med, what to do

A

insulin, always check current glucose levels
- check diet order and intake tolerance

23
Q

what to know about meds

A
  • insulin peak
  • duration of insulin
  • signs of hypoglycemia and interventions (assessment, food, drug therapy, etc)
  • NPO–> what do I do to give them insulin
24
Q

teaching points

A
  • teach pt self admin
  • pt knows their body better than we
  • understand timing of insulin
  • understand s/s of hypoglycemia
25
Q

hypoglycemia and s/s

A

bs less then 70
s/s: sweating, blurry vision, dizziness, anxiety, hunger, irritable, shakiness, inc heart beat,

26
Q

treatment for hypoglycemia

A
  • check fsbg
  • rule of 15 –> give 15g of simple carbs
  • fsbg after 15 mins
  • repeat once more if needed, then do further interventions if needed
27
Q

what happens if pt is unconscious and unable to swallow

A

IM glucagon
IV D50 (25-50 ml)

28
Q

hyperglycemia

A

high bs
- can be caused by illness, infection, self-management issues, stress
manifestation
- weakness, fatigue, blurry vision, headache, N/V/D
- often related to uncontrolled hyperglycemia

29
Q

treatment for hyperglycemia

A
  • check ketones
  • insulin
  • drink fluids
  • educate on prevention
30
Q

crisis situation of hyperglycemia

A
  • DKA: diabetic keto acidosis (t1)
  • HHS: hyperglycemic hyperosmolar syndrome
31
Q

insulin pumps

A

continuous release of subcutaneous insulin infusion to receive continuous basal infusions
- can be inc/dec w bolus if needed

32
Q

pt care of insulin pumps

A
  • pt require to check blood glucose at least 4 times a day
  • using deactivated in hospital
33
Q

potential problems of insulin pumps

A
  • infection at insertion site
  • inc risk for DKA
  • cost
34
Q

microvascular damage

A

damage to capillaries
- retinopathies: damage to retina
- nephropathies: damage in kidneys
- neuropathies: due damage due to metabolic imbalances

35
Q

macrovascular damage

A

damage to large vessels
- coronary artery, peripheral vascular, cerebral vascular
- women and men w diabetes are more likely to have CVD

36
Q

nursing consideration for neuropathy

A

pt w diabetes are at high risk in lower extremities, bottom of feet
- loss of protective sensation prevents pt from injury that has occurred

37
Q

diabetic foot care

A
  • wash feet daily
  • pat feet dry, get in between toes
  • inspect daily for cuts (irritations)
  • use lanonlin to prevent dry skin and cracking
  • foot powder on sweaty feet
  • clean cuts w mild soap no iodine, alc, adhesive
  • report infections
  • separate overlapping toes
  • only shoes w soles and closed toe
  • clean absorbant socks
  • no hot water bottles
38
Q

nutritional considerations for diabetes

A

balanced, high fiber, low fat, low cholesterol
- carbs: encourage grains, fruits, legumes, milk
- fats: polyunsaturated like fish
- fiber: oats, veggies, beans, whole grains
- protein: intake from meat, egg, fish, nut, beans
- alchohol: limit intake

39
Q

exercise

A
  • encourage
  • exercise can lower bs so check before exercising (below 80 or above 250 don’t exercise)
  • exercise after meals
  • eat a snack before exercise
  • wear medical alert bracelet
40
Q

what can happen to a diabetic pt in hospital

A
  • stress can inc bs (surgery)
  • wound healing is impaired
  • high risk of infection
    even if bs is controlled at home
41
Q

integumentary concerns

A
  • diabetic dermopathy: reddish, brown usually on shins
  • acanthosis nigricans: brown/black, thickening of skin, often seen in skin folds
  • necrobiosis lipoidica diabeticorum: red patches around blood vessels

NUR 333: (10 decks)

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