Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

ADULT Health > Diabetes > Flashcards

Diabetes Flashcards

1
Q

Insulin are produce where in the body?? How many units does that organ make per day??

A

Pancreas produces 40-50 units per day!!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What’s the rate of production of insulin when fasting vs when eating???

A
  • Slow & steady when fasting
  • Increased rate when eating
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the 2 functions of Insulin???

A
  1. Keeps blood glucose from being too high
  2. Keeps blood lipids within a normal range
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Which cells require insulin for glucose uptake???

A
  1. Muscle
  2. Fat
  3. Portions of the liver
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Which cells don’t require insulin to be able to attach/accept blood sugar??

A
  1. Brain
  2. RBCs
  3. Cornea
  4. Intestine
  5. Kidneys
  6. Portions of the liver
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the implications of cells that don’t require insulin?????

A

It makes these cells vulnerable to the effects of high blood sugar. You wouldn’t need to have enough Insulin around for elevated blood glucose to really work on the brain in a negative way or do something awful to the Red blood cells.
Like Hemoglobin A1C; glucose can readily bind to hemoglobin without the aid of Insulin whatsoever.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Which type of diabetics may be diagnosed several YEARSSS after onset, after complications have already arisen??? and which will show instantly (several days, months)? WHY??

A
  • Type 2 diabetes progression is more gradual!! IT TAKES YEARS FOR TYPE II TO BE DIAGNOSED!!!!!!
  • Type I will be diagnosed faster because it’s Autoimmune disorder where ur pancreas is failing! So it’s faster!
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Anything in between Normal and Diagnostic for diabetes is known as what??????** What does it mean?

A

Impaired glucose tolerance!!!!!!!!!!!!!
Means that we’re not diagnosed with diabetes yet, but we’re also not normal!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Who’s going to get away with monitoring their blood glucose less frequently???? WHY?

A

Type II diabetics may not need to monitor it as closely because a lot of them are not on insulin or drugs that directly influence insulin production!!!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

T/F? many diabetics gonna deal with hypertension??

A

TRUE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Fat is broken down into what when we need energy/glucose?

A

Ketones!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Whenever u find a diabetic who’s looking down, which is always the safe measurement..? Assuming that they are hypoglycemic or hyperglycemic first??

A

ALWAYS ASSUME THAT THEY ARE HYPOGLYCEMIC!!!!!!!!
BECAUSE even if they are not, we can deal with High blood sugar WAY more effectively than we can deal with Low blood sugar!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the 15-15 rule of hypoglycemia?

A

For giving glucose orally, give 15 grams of glucose then check the Blood glucose in 15 minutes!! Repeat until their BG is within normal range. THEN FOLLOW UP WITH MEAL/SNACK (Complex Carb!!) to prevent secondary hypoglycemia and help liver store glycogen!!!!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What should you do AFTER giving any treatment for hypoglycemia????
What’s the purpose of that?

A

FOLLOW UP WITH A MEAL OR SNACK (COMPLEX CARBS!) To:
Prevent Secondary hypoglycemia and restore liver glycogen!!!!!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the Examples of 15 grams of carbs to treat hypoglycemia???? Including ATI examples!!!

A
  1. 1/2 banana
  2. 1/2 cup of orange juice
  3. 1 tablespoon of sugar/honey
  4. 4-5 Saltine Crackers
  5. 3-4 Glucose Tablets
  6. 1/2 cup of oatmeal
  7. 1 Slice of bread!!
  8. Small piece of fruits!!!
    ——-
    ATI:
  9. 6 saltines
  10. 8 oz or 1 cup of MILK
  11. 6-10 hard candies
  12. 1/3 cup of yogurt
  13. 1/2 cup of Ice cream!!!!
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are teachings to give family and friends when giving Glucagon Injection to someone who’s hypoglycemic????

A
  1. signs of Hypoglycemia
  2. Injection sites: IM and SC
  3. Recovery position (left side!!!)
  4. TACHYCARDIA POSSIBLE
  5. IF UNSURE, CALL 911!!!!
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

The only way to know for sure that BG is low is how??? What should you assume if there’s none of that??

A

By glucose meter or Blood draw!!! In doubt, ALWAYS ASSUME HYPOGLYCEMIA!!!!!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Hypoglycemia can ultimately cause what???

A

Coma or Stroke, then death!!!! ☠️

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What contribute to the manifestations of hypoglycemia and what are the manifestations of it??

A

SNS Activation and Low Blood glucose to CNS (brain)!!!!!!!!!
“SSSS, PP, FDD, Wah!”
1. Shaking
2. Swearing
3. Slurred Speech
4. Sleepiness
—-
5. Palpitations
6. Parathesia (numbness n tingling on ur limbs)
——
7. Fatigue
8. Dizziness
9. Difficulty THINKING
——
10. Weakness/ Loss of coordination!!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What patient EDUCATION WOULD YOU GIVE FOR HYPOGLYCEMIA!????

A

1) How to AVOID hypoglycemia:
1. Exercise carefully
2. Regular meals
3. Monitor BG before Meds!!!
2) Wear Medic Alert BRACELET!!
3) Signs and symptoms of hypoglycemia
4) Watch for signs of hypoglycemia when blood glucose is >65-70 mg/dL (consider their normal values)
5) Hypoglycemic Unawareness:**
1. SNS Impairment!!!! Can be due to BETA BLOCKER!!!
2. May contribute to:
- Frequent episodes of hypoglycemia
- Long term diabetes
- Strict control diabetes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the Hypoglycemic Unawareness due to???***

A
  1. SNS Impairment!!!! Can be due to BETA BLOCKER!!!
  2. May contribute to:
    - Frequent episodes of hypoglycemia
    • Long term diabetes
    • Strict control diabetes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Which insulin is the cloudy insulin?????**

A

INTERMEDIATE!!!!!!!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

which background insulin can we mix rapid and short acting insulin with?????***

A

INTERMEDIATE is the ONLY CLOUDY insulin!!! Meaning that we can only mix a rapid or short with an intermediate!!!! (NEVER with long acting)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Which type of insulin can you give in IV form?????***

A

ONLY REGULAR INSULIN (Short acting insulin)!!!!!!!!!!!!!
NEVER INTERMEDIATE OR LONG!!!!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Why would you ever give IV insulin???

A
  1. When pt is in diabetic Ketoacidosis or HHS, to give constant insulin
  2. When they have BURN all over their body and sticking insulin would be hard
  3. When they have GENERALIZED EDEMA
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What are the examples of Intermediate insulin??

A

(The ones that end with an ‘N’)
NPH, Humulin N, Novolin N

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What are the examples of Long insulin??

A

Determir (Levemir), Glargine (Lantus)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What are the examples of Rapid insulin??

A

(“Huma has a Lisp” and Nova is an Ass”)
Lispart (Humalog) and Aspart (Novalog)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What are examples of Short Insulin???

A

(The Regular’s)
Humulin Regular, Novolin Regular

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What are the 2 types of Background Insulin?? What do you need to know about them?

A

1) Intermediate Insulin:
1. Dose only 2x a day because they only work 1/2 a day
2. THE ONLY CLOUDY INSULIN!!!!!!!! (meaning that you can only mix rapid or short with intermediate!!)
2) Long acting Insulin:
1. NO PEAKS. Gives a 24 hr STEADY coverage!!!
2. DON’T MIX LONG ACTING WITH ANYTHING ELSE IN THE SAME SYRINGE!!!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What are The Mealtime/Breakthrough Insulin?? What do you need to know about them?

A
  1. Rapid acting: Work almost immediately (faster than short), DON’T GIVE until FOOD IS READY!
  2. Short acting: Work immediately, but little later after rapid, DON’T GIVE until FOOD IS READY!
    BOTH:
    - MONITOR FOR HYPOGLYCEMIA FOR EITHER RAPID OR SHORT IN THE MORNING!!
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What do you need a monitor after giving someone a rapid or short insulin?????

A

MONITOR FOR HYPOGLYCEMIA!!!!!!!!!!!!!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What is the initial non-insulin therapy for Type 2 Diabetes???? How does it work?? What are the 3 side effects?? patient teachings??

A

Glucophage (Metformin), a biguanide.
1. Decrease liver production of glucose
2. Increase cell sensitivity to insulin
3. Decrease CHOLESTEROL
4. WEIGHT LOSS
—-
Side effects:
1. GI UPSET
2. LACTIC ACIDOSIS
3. NOT FOR PATIENT WITH KIDNEY DISEASE!!!
—
1. Withold 48 hours BEFORE and AFTER surgery for any test where CONTRAST is used!!!!!!!! WHY? Because interaction can lead to increase risk for kidney dysfunction & lactic acidosis
2. SIGNS OF LACTIC ACIDOSIS: “MMARS”
- Malaise
- Muscle pain
- Abdominal distress
- Respiratory distress
- Somnolence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What are examples of Sulfonylureas and Meglitinides???? How do they work and What are major side effects/teaching????

A

Sulfonylureas: Glipizide (Glucotrol), Glyburide (Diabeta)
Meglitinides: Repaglinide (Prandin), Netaglinide (Starlix)

How they work?
1. Stimulate betta cell production of Insulin
2. **Decrease Liver production of glucose!!
–
Side effects:
1. Weight gain
2. Hypoglycemia
3. Plan to eat! Monitor BG
4. Shouldn’t be used in pt with kidney dysfunction
5. SULFA ALLERGY (Due to Sulfonylureas ONLY): IS OKAY FOR PATIENT WITH SULFA SENSITIVITY TO TAKE!!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What are examples of Thiazolidinediones???? How do they work and What are major side effects/teaching????

A

Piolitazone (Actos) and Rosiglitazone (Avandia)

How they work?
1. Increase cellular sensitivity to Insulin
–
Side effects/ teaching:
1. Weight gain
2. Edema
3. Heart failure . OTHER cardiovascular risk: Fluid retention, Increase LDL
–
4. liver Enzyme elevate
5. OKAY IN PATIENT WITH RENAL DYSFUNCTION
–
6. Contraceptive needed
7. Anovulatory women may resume ovulation. Birth control

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Wherever glucose goes, what follows it??

A

Water follows!!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Osmotic diuresis (Volume loss and elyte loss) As well as Polyphagia in Hyperglycemia can lead to what????**

A

WEIGHT LOSS!!!!! Because of water loss (with osmotic diuretic) and breakdown of fat and protein (polyphagia)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Hyperglycemia** can cause what 3 P’s??

A

Polydipsia (excessive thirst), Polyuria, and Polyphagia!!!!!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What electrolytes do you lose along with osmotic diuresis???

A

Sodium, potassium, Chloride, and water

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Why do patients with hyperglycemic tend to lose weight????

A

Because they are losing water from osmotic diuresis (dehydrated) and also due to the liver breaking down fat and protein because of polyphagia; cells that aren’t getting the glucose, bc either insulin is not produced or cells not responding to insulin, will send the message to the body saying that they are HUNGRY and so body will tell the liver to start breaking down fat (into ketones) and protein causing WEIGHT LOSS!!!!!!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What are other potential manifestations in the Newly diagnosed TYPE I diabetics??????***

A
  1. Bedwetting in Kids
  2. ## Irritability and mood changes
  3. Blurred vision
  4. Fatigue, weakness, sleepiness!!!
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What does it mean when Type II diabetes may present with evidence of complications???

A
  • Many of them will present for the FIRST time because of their complications. They may have type 2 diabetes for many years without realising it and often diagnosed when they are presented with other complication such as they aren’t able to see well so they went to see the doctor and turns out they have Type II diabetes!!!
  • Since with Type II diabetes they progress more GRADUALLY, by the time TYPE II has been diagnosed, the blood sugar has destructed the body from head to toe
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What are the 3 major classifications of POTENTIAL COMPLICATIONS of diabetes mellitus????!!!**

A

3 major classifications!!!!

  1. Things that can kill you OVER THE COURSE of their lifetime (long-term): Cardiovascular disease, Renal failure, Neuropathy, wound healing delay, and Eye changes!!!!!!!
  2. Things that can kill you in SEVERAL WEEKS TO DAYS because of infection, illness, or stress: DKA & HHS
  3. Things that can kill you RIGHT NOW: HYPOGLYCEMIA!!!!!!!!!!!!!!
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

What does Hyperglycemia do to blood vessels?? Serum Lipids????***

A
  1. Vessel wall thickening
  2. Tendency toward vasoconstriction
  3. Serum lipids not stored appropriately
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

What are the most VULNERABLE PARTS of the body in the diabetics??????**

A
  1. Blood vessels
  2. Nerve roots
  3. ## WBC
  4. Eyes
  5. Cardiovascular issues, including cerebrovascular, so Stroke risk. Remember: THE LEADING KILLER OF DIABETICS IS HEART DISEASE & HEART ATTACK!!!!!
  6. Atherosclerosis
  7. Feet
  8. Kidneys
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

What does hyperglycemia do to the ability of RBC’s to carry and deliver oxygen???? (talk about Hemoglobin A1C and also Pulse ox!!!!!!)

A
  1. RBCs become saturated with glucose (GLYCOSYLATION)!!!!
  2. ## Glucose binds to Hgb where oxygen should!!!!!!!
    • Hemoglobin A1C: glucose is going to bind with RBCs since they don’t need Insulin to attach to glucose! They’ll bind to where oxygen is supposed to bind with RBC. Now, since glucose has occupied that binding site, it’s going to bind for the lifespan of that RBCs!!! Then, OXYGEN WON’T BE ABLE TO BIND W/ RBC, WHICH DECREASES THE ABILITY FOR OXYGEN TO BE CARRIED EFFECTIVELY THROUGHOUT THE BODY!!!!
    • Pulse Oximeter does NOT accurately reflect this!! It’s only telling us how saturated our blood cells are, NOT what it’s saturated with!!!!!!!!!!!!!!!!!!!!!
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

What does GLYCOSYLATION mean????

A

When RBCs become saturated with glucose!!!!!!!!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

How does hyperglycemia impact the nerve cells??????***

A
  1. Cell damaging SORBITOL is formed (Polyol pathway)
  2. Cellular swelling, damage, and dysfunction
    3, Nerves, retina, and kidneys are impacted!!!
49
Q

What is formed bc of hyperglycemia that can impact nerve cells???

A

Cell damaging *SORBITOL is formed (Polyol pathway) !!!!!!!!!!!!!

50
Q

How does hyperglycemia impact immune function?????

A
  1. *Decreased WBC FUNCTION!
  2. *Chronic Inflammation
  3. *Glucose DEPOSITION in tissue
51
Q

What are some of the more common infections in the diabetic patients??????

A
  1. Bladder/ Kidney
  2. Mouth
  3. Vagina
  4. Wound
  5. Foot
52
Q

What are the acute complications for diabetes?????**

A

DKA and HHS!!!!

53
Q

What is the LEADING KILLER of diabetics patient???***

A

HEART DISEASE AND HEART ATTACK!!!!!

54
Q

What are additional Cardiovascular risk factors?????

A

“OH, DiSeCt FuK!!!!”

  1. Obesity
  2. Hypertension
  3. Dyslipidemia
  4. Sedentary lifestyle
  5. Cigarrete Smoking
  6. Fam hx
  7. Kidney disease!!!!!!!!!
55
Q

What are additional potential VASCULAR issues with diabetics????*****

A
  1. Peripheral vascular disease –> Diabetes is the LEADING cause of AMPUTATION FOR NON-traumatic reason!!!!
  2. Cerebrovascular disease –> Diabetes is a LEADING risk factor for STROKE!!
  3. Retinopathy –> Cotton Wool Spots in the eyes!!!!
  4. Periodontal disease –> oral cavity
56
Q

Leading cause of kidney disease (Nephropathy) is what????

A

DIBATES!!!

57
Q

Diabetes mellitus is the leading cause of what type of renal disease in the UNITED STATES?????

A

End Stage Renal Disease (ESRD)!!!!!!!!!!!!!!!!!!!!!

58
Q

What are the factors that increase risk for kidney disease?????

A

“PURG, 10-15 yrs hx of diabetes”

  1. Poor GLUCOSE control*
  2. Uncontrolled HYPERTENSION*
  3. Retinopathy*
  4. GENETIC Predisposition**
  5. 10-15 yrs hx of diabetes!!!!**
59
Q

What is the EARLIEST clinical SIGN of NEPHROPATHY??????*** How Often should the testing be for this in Type I Diabetes vs in Type II???*

A

MICROALBUMINURIA!!!!!!!
- Annual (yearly) testing for Type II and Type I AFTER 5 years from you got it!!!!!!

60
Q

What are the additional lab alterations in Kidney Disease (Nephropathy)??????

A
  1. Serum
  2. BUN/ Creatinine
  3. GFR
  4. 24hr Creatinine Clearance!!
61
Q

What are the Potential Assessment alteration with Renal dysfunction??????

A

“LDR? PPoor Female!!”
1. Lack of energy/weakness
2. Difficulty SLEEPING
3. Reduced ability to CONCENTRATE
—–
4. Poor APPETITE & Nausea
5. PRURITIS (itching)
6. Fluid volume OVERLOAD!!!

62
Q

What are the Patient Care Concerns for the patient with Vascular and Renal risk?????

A

(The 3’s managements and BPS)
1. WEIGHT management
2. CHOLESTEROL management
3. STRESS management
—
4. Blood pressure control
5. Physical Activity
6. SMOKING CESSATION!!!

63
Q

For diabetic implication of Nerve cell damage (Neuropathy), what are the Peripheral and Autonomic neuropathy???????**

A

Peripheral Neuropathy:
- Sensory concerns: Numbness, tingling, pain
- Motor: DEFORMITIES –> Charcot Foot*
——
Autonomic Neuropathy:
1. ORTHOSTATIC HYPOTENSION
2. ERECTILE DYSFUNCTION
3. URINARY PROBLEMS
4. GASTROPARESIS* –> *Bezoars–balls of partially digested stuff in the stomach

64
Q

What are the Gastroparesis Assessment Alterations????

A
  1. Reflux and Bloating
  2. Nausea & Vomiting
  3. SPASMS of the stomach
  4. EARLY SATIETY AND LACK OF APPETITE
  5. *WEIGHT LOSS
  6. *ERRATIC BLOOD GLUCOSE LEVEL –> Think about patients who take insulin! imagine if they take their insulin @7am & we have them eating just a few minutes after that. This patient will have food that’ll just be sitting in their stomach, not making down in the small bowel where it gets absorbed that helps to elevate the blood glucose. It’s going to make their BLOOD SUGAR SUPER LOW!!!
65
Q

What are the patient care and teaching for Gastroparesis??????*******

A
  1. Frequent BG checks!!!
  2. Altered Insulin regimen
  3. Medication: METOCLOPRAMIDE (REGLAN) = can cause Tardive Dyskinesia too! (stop the med & report if it happens)!!!
  4. Smaller meals, Eat SLOWLY, UPRIGHT after meals, Take a WALK!!!!
  5. Diet changes:
    1) 5-6 Small meals, chew well
    2) Calories – nutrient dense
    3) HYDRATION!!
    4) FAT CONCERNS
    ——
    5) Well Cooked, NON-Fibrous fruits/veggies
    6) Soups, pureed foods
    7) AVOID Carbonation, Alcohol, and SMOKING
66
Q

WHAT MEDICATION WOULD YOU GIVE TO SOMEONE WHO HAS GASTROPARESIS???????? What concern can this medication bring?????

A

METOCLOPRAMIDE (Reglan)!!! Can cause Tardive Dyskinesia!!!
- Be aware of abnormal uncontrollable movements: lip smoking, tongue thrusting, and tilting of head. STOP med & REPORT if it happens!!

67
Q

What are the diet changes for patients who have Gastroparesis??

A

1) 5-6 Small meals, chew well
2) Calories – nutrient dense
3) HYDRATION!!
4) FAT CONCERNS
————————
5) Well Cooked, NON-Fibrous fruits/veggies
6) Soups, pureed foods
7) AVOID Carbonation, Alcohol, and SMOKING

68
Q

What are the Interventions for Neuropathy in diabetics/ How do we take care of diabetic feet?????

A
  1. Foot checks
  2. WASH & INSPECT DAILY
  3. Control blood glucose
  4. USE A BATH THERMOMETER
  5. ## Proper Shoe Fit!!!!
  6. FIBER SOCKS like Cotton!!!
  7. MOISTURIZING CREAMS BUT NOT BETWEEN TOES***
  8. Gentle treatment of Corns & Calluses with PUMICE STONE!!!!!
  9. TRIM NAILS STRAIGHT ACROSS!!
  10. ## Professional Care of Nails & Feet
  11. DO NOT GO BAREFOOT!!!!!!!
69
Q

TO Prevent/slow the progression of complications from diabetes, what should patients do….?

A

Glucose Control!!
Glucose Control!!
Glucose Control!!

70
Q

What are the Modifiable risk for Diabetes????***

A
  1. BMI ≥ 25 kg/m2. Increased risk for ≥ 30
  2. **Physical inactivity
  3. **Low HDL cholesterol of ≤ 35 AND/OR Triglyceride level of ≥ 250
  4. **METABOLIC SYNDROME!!!!
71
Q

What are the Non-modifiable risk for diabetes????!!!

A
  1. Being: African American, Latino, Native American, Asian American, and Pacific Islander
  2. First Degree relative with diabetes
  3. Hypertension
  4. Women who delivered baby weighting ≥ 90lbs or who were diagnosed with gestational diabetes
  5. ## Women with Polycystic Ovarian Syndrome
  6. Hgb A1C ≥ 5.7%
  7. History of Cardiovascular Disease!!!!
72
Q

What is the primary stress hormone in the counter-regulatory hormone?? How about primary hormone of Fight or Flight??? What is Growth hormone for and When is it the Highest???

A
  1. Cortisol
  2. Epinephrine and Norepinephrine
  3. Healing and tissue repair!! and Growth Development!! Highest AT NIGHT!!!!
73
Q

What are the factors of Metabolic Syndrome (X Syndrome)???

A
  1. Visceral Obesity: APPLE SHAPED
  2. INSULIN RESISTANCE (THE KEY OF METABOLIC SYNDROME)!!!!!!!
  3. Hypertension ≥ 130/85
  4. Fasting BG ≥ 100 – impaired glucose tolerance
    - Normal:70-100
    - Between 100-126 means impaired glucose tolerance
    - Diagnose diabetes ≥ 126
  5. *High triglyceride ≥ 150 mg/dL
    • LOW HDL ≤ 40 mg/dL in men and ≤ 50 mg/dL in women
74
Q

How do we Diagnose diabetes with the different blood tests??????

A
  1. Random blood glucose (≥ 200 mg/dL) - Any time of day, regardless meal schedule, no fasting
  2. ## Fasting blood glucose (≥ 126 mg/dL) - fasting for 8 hours before (WATER IS OK)
  3. Oral Glucose Tolerance Test (≥ 200 mg/dL) :
    - Eat balanced diet for 3 days before and then fast 10-12 hours
    - Come in the clinic in the AM (MORNING) to do fasting blood glucose
    - THEN, They give drink FULL OF GLUCOSE!! They will monitor BG every 30 mins for 2 HOURS!!!!!!!!!!!!!
    - If pancreas is working right, it should be producing insulin and those insulins are working right too.
    —————-
  4. HgbA1C (≥ 6.5):
    - Average blood glucose for past 2-3 months!
    - Any time of day, regardless of meal schedule, no fasting!!!!
75
Q

Should you repeat any diagnostic test of blood glucose? WHY? When is the exception??

A

*ANY diagnostic test should be repeated to confirm the diagnosis and rule out lab error UNLESS classic manifestations of diabetes are present!!!!

76
Q

What is the normal HgbA1C????? What is the value for pre-diabetes and for when we diagnose diabetes???
HOW OFTEN Should we do HgbA1C for patients w/ stable and unstable blood glucose??????

A
  • Normal: 4- 6%
  • Pre-Diabetes: 5.7- 6.4
  • ## Diabetes: ≥ 6.5
  • Twice a year for patient with STABLE glucose!!!
  • 3-4 Times a year for patient with UNSTABLE glucose!!!
77
Q

Nutrition therapy should be what to each patient?? should patient satisfaction be considered???

A
  1. Tailored to each patient
  2. Realistic
  3. Flexible
  4. Include family!!!
    YES!! PATIENT SATISFACTION SHOULD ALWAYS BE CONSIDERED!!!!!!!!!!
78
Q

What are the Principle of Nutrition for Nutrition therapy in diabetics???

A
  1. Major Groups:
    - Complex carbs
    - Lean protein - nuts, fish, legumes
    - Healthy fats - nuts, olives, avocados
  2. FIBER RICH FOODS:
    - Decrease cholesterol absorption
    - Regulate glucose uptake
    - CAUTION WITH GASTROPARESIS
  3. *DASH DIET !!!!!!!!!!
  4. Sweeteners:
    - Dietary Sucrose is OK if covered by increased insulin!!! But not do it every durr
    - FDA approved non-nutritive sweeteners: Sucralose & Aspartame!!
    - STEVIA (plant source sweetener)
  5. ALCOHOL use:
    - SMALL AMOUNT AND ALWAYS WITH FOOD !!!!!!!
79
Q

What are the 3 meal planning strategies for diabetics??

A
  1. Carb counting
  2. Glycemic Index
  3. “Create your Plate”
80
Q
  • Is dietary sucrose okay for diabetics?? for ex is it okay for patient to eat a cake when they’re attending a friends’ bday party???????
  • Is alcohol okay to intake???
A
  1. Dietary sucrose is OK if covered by Insulin!!!!!!
  2. Alcohol is Okay as long as: SMALL AMOUNT & ALWAYS WITH FOOD!!!
81
Q

FDA approved non-nutiritive sweeteners recommended are what???

A

Sucralose and Aspartame!!!

82
Q

WHAT are the 5 benefits of Physical Activity?????*** (EXAM)

A
  1. BETTER REGULATION of BG and DECREASED INSULIN requirements!!!!!!!
  2. INCREASED cell SENSITIVITY to Insulin = Increased uptake of insulin!!!
  3. ## WEIGHT LOSS and HEALTHY WEIGHT management!!!!!
  4. ❤️ CARDIOVASCULAR Benefits: Decreases BP and lipids, Increases HDL!!!!!!
  5. Manage DEPRESSION 😞 AND Improve SLEEP!!! 💤😴 🛌
83
Q

What is the Exercise guidelines/concerns for diabetics???? What happens if BG is low before exercising? what about elevated (and What’s the BG level for when should you stop) ??

A
  1. CONSULT with MD Before starting an exercise!!!!!!!
  2. Be Aware of blood glucose Before, During, and After Exercise!!!
    - When BG is low? Eat a SNACK before exercising!!
    - When BG is HIGH??
    —> When BG is high it means they don’t have enough insulin onboard, right?? So when ur exercising, ur activating the SNS, a counter-regulatory hormone. So when ur BG is already high, and then you activate the SNS, that’s going to make it even more elevated!! So, when BG >240, TAKE A BREAK, DIPSTICK URINE for ketones, Take INSULIN. WAIT, RECHECK BS, THEN CONTINUE WHEN IT’S @ REASONABLE RANGE (lil higher than normal so we don’t want hypoglycemia).
    ————
  3. Take snacks and water w/ you AND wear Medic Alert bracelet!
  4. DO NOT inject insulin into “exercised” extremity AND DO NOT exercise at “PEAK” insulin OR WITHIN ONE HOUR AFTER INJECTION bc of hypoglycemia!!!
  5. GOAL: At least exercise THREE TIMES a week~~!!!!
84
Q

What are 3 ways to monitor for glucose/ test glucose???

A
  1. Finger stick
  2. Continuous monitoring like insulin pump (SHOULD NOT REPLACE FINGER STICK!!!!!!!!!!!!!!!) ***
  3. Blood Draw (BG is part of BMP)!!!!!!!!***
85
Q

Blood glucose is part of what blood culture???

A

BMP!!!!

86
Q

In under what circumstances should you INCREASE FREQUENCY of monitoring blood glucose????

A
  1. Beginning OR adjustment of therapy (when new drugs are adjusted or added)
  2. ACUTE or Ongoing ILLNESS!!!
  3. Sx of HYPO or HYPERglycemia!!!
  4. ## Hypohlycemic Unawareness!!!!!!
  5. Blood glucose NOT CONSISTENT with A1C!!!
  6. Before and After exercise!!!!
  7. PREGNANCY (even if they’re not diabetic)
  8. GASTROPARESIS!!!!
87
Q

Why does Dawn Phenomenon happen??? What is the Nursing care for this????????****

A
  • Night-time release of Growth hormone
  • Nursing care: More PM Insulin (INTERMEDIATE ACTING)!!!!!!!!
88
Q

Which TYPE of insulin do you give to someone who has Dawn Phenomenon?????

A

INTERMEDIATE ACTING!!!!!!!!

89
Q

Why does Somogyi Phenomenon happen??? What is the Nursing care for this????????****

A
  • Counter-regulatory hormone RESPONSE to PM Hypoglycemia!!!!
  • Nursing Care:
    1. HS SNACKS!!!
    2. Insulin regimen Adjustment!!!
    3. NO LATE DAY EXERCISE!!!!!!
90
Q

How do we figure out to know whether the patient need a snack or more insulin/ or whether they are having Dawn Phenomenon or Somogyi Phenomenon???????**

A

THE 2 AM BLOOD SUGAR!!!!!!!!!!
Keep in mind that both patients have high sugar first thing in the morning!!! If they’re already climbing out of the normal range by 2 AM, that means they’re having Dawn Syndrome! If their blood sugar is trending down when you take the 2 AM blood glucose, that means it’s the SOMOGYI PHENOMENON!!!!!!

91
Q

For mixing insulin, an intermediate with a rapid or short, which one do you need to pull out of the vial first??? WHY??***

A

RAPID OR SHORT FIRST, THEN, Intermediate!!! BECAUSE OF CROSS-CONTAMINATION.. When you pull contaminated rapid or short insulin into the intermediate, you can just watch for Hypoglycemia for half of the day. But, if it was the other way around, and it contaminated another nurse who was only getting a rapid/short insulin, then the effects of insulin will be beyond what was expected.

92
Q

What does U-100 or U-500 mean??

A

It’s the Insulin Concentration.
It means that there’s 100 Units of Insulin in 1mL!!
500 units of insulin in 1 mL!!!

93
Q

Do we rotate injection sites for insulin injection?? WHY??

A

ROTATE INJECTION SITES TO PREVENT LIPOHYPERTHERAPY!!!!!!!

94
Q

Where do you administer INSULIN?????

A

subcutaneously!!!
STOMACH, BACK OF THE ARM, OR UR BUTTOCKS!!!

95
Q

What drugs increase the production of Insulin?????

A

SULFONYLUREAS and MIGLITINIDE!!!!

96
Q

What is the protocol for giving 50% Dextrose IV for someone who’s hypoglycemic????***

A

Even if you can’t get a hold of HCP or have an order for it, STILL GIVE IT ANYWAY!!!!!!!!!

97
Q

FOR GLUCAGON INJECTION FOR HYPOGLYCEMIA, How long after patient regain consciousness should you be checking their blood glucose???**

A

FOR 3 TO 4 hours AFTER patient regains consciousness, BS SHOULD BE CHECK HOURLY!!!!!!!!

98
Q

Example of amylin analog drug is what???

A

PRAMLITIDE (SMYLIN)

99
Q

Where should you keep ur BG PRE-OP before surgery or procedures that require NPO???

A

KEEP BG 120-200 mg/dL PRE-OP

100
Q

Patient in NPO should still be in what?????

A

Should still continue their Basal Insulin!!!!!!!!

101
Q

What should you do during Sick Days???????????** In what condition should you contact HCP??????

A
  1. Monitor BG Q4 hrs!!!!!
  2. Stay hydrated and Rest!!
  3. Eat
  4. TAKE MEDS!!
  5. CONTACT HCP IF:
    1) Persistent N/V and DIARRHEA
    2) MODERATE TO HIGH KETONES!!!
    3) BG UP AFTER MEDS!!!
    4) SIGNS OF DEHYDRATION***!!!!
    5) PERSISTENT FEVER!!!!!!!!
102
Q

During Sick Days, when should you check ur ketones??????

A

CHECK KETONES EVERY 4-6 HOURS!! ALSO WHEN BLOOD GLUCOSE >240 mg/dL, AND WHEN THEY HAVE SYMPTOMS OF DKA!!!!

103
Q

Acidosis cause an increase risk for what???

A

HYPERKALEMIA!!!!!!!!
BECAUSE OF THE KETOA

104
Q

Is it HHS or DKA that take longer time to be recognized/ gradual onset???

A

HHS!!!
Just think that HHS is for Type II diabetics right and Type II take years to be diagnosed as well. So, they both connect.

105
Q

Which ACUTE complication of diabetes experience more PROFOUND volume depletion and thus more profound Neuro manifestations???? What’s the consequence of this???

A

HHS!!!!!!!!! SO, THEY ARE MORE LIKELY THAN DKA TO EXPERIENCE COMATOSE AND DEATH!!!!

106
Q

What are the 5 EARLY WARNING SIGNS OF DKA AND HHS???

A
  1. Weakness & fatigue
  2. Increased thirst & Dry mouth
  3. Increased urination
  4. HIGH BLOOD GLUCOSE
  5. High level of Ketones IN DKA ONLY!!!
107
Q

Why is HHS take longer to be recognized??

A

Because there’s no cellular starvation = no ketones to check for it!!

108
Q

What would happen if DKA or HHS is left UNTREATED/WITHOUT INTERVENTIONS?? (Include skin changes in hyper and hypo patients)

A

Dehydration/Volume depletion signs:
1. Skin changes: Non-elastic & Dry
- Hyperglycemic patients: HOT AND DRY!!!!!
- Hypo patients: DIAPHORETIC AND PALE!!!!!!!
2. Mental status: Confusion, lethargy, comatose (HIGHER in HHS)
3. Breathing Pattern: KUSSMAUL breathing in both DKA & HHS!!!
4. Vital Signs: BP decrease, HR increase to compensate, RR increase with Kussmaul, O2 sat Decrease, and Temp INCREASE

Ketosis Signs (WITH DKA)
1. “Fruity” Breath (Acetone)
2. Abdominal pain & Nausea in DKA and HHS because of POOR PERFUSION OF THE GUT!!!!!!

109
Q

What patient care measures should you prioritize for DKA and HHS?? LIST IN ORDER!!!

A
  1. Fluid Replacement/Dehydration
  2. Insulin
  3. Potassium Replacement and other e-lytes
  4. Acidosis Management (Bicarb)
  5. Managing the cause!!! – usually will correct with other tx (insulin & fluids)
110
Q

FIRST nursing action should you do for someone with DKA or HHS?????? what is the initial fluid therapy for DKA???? WHY?

A

FLUID REPLACEMENT!!!!!!!!!!!!!!!! NORMAL SALINE (ISOTONIC) because isotonic help restore Vascular volume and get patient perfused!

111
Q

What are the fluid replacements you would give to treat DKA or HHS, IN ORDER from HIGHEST priority?? Explain each!!
AND THEN WHAT IS THE INITIAL AMOUNT OF INFUSION

A
  1. NS Saline (ISOTONIC) – Restore Vascular volume and get patient perfused
  2. 0.45% Saline (Hypotonic) - Help hydrate cell
  3. ## D5 1/2 NS - Lastly, Add dextrose to the fluids when BS < 250 to prevent hypoglycemia BECAUSE AFTER THIS WE’RE GOING TO GIVE THEM INSULIN DRIP!
    • Initially 2-3 liters RAPID INFUSION!!!!!!
112
Q

FIRST indicator after giving fluid replacement for DKA and HHS would be what?? What is the BEST indicator???

A
  1. FIRST indicator is that their BP WILL GO UP!!!!!!!!!!!
  2. BEST indicator is that they will REGAIN CONSCIOUS AND THEIR NEURO STATUS IS RESTORE slow and steady!!!!!!!
113
Q
  • What is the SECOND nursing action (after fluid replacement) for DKA and HHS????
  • TO WHAT RANGE PER HOUR SHOULD WE REDUCE IT TO ????
  • WHY IS GRADUAL reduction so important???
A
  • Blood glucose management/ INSULIN!!!!!!!!!
  • Reduce Blood glucose to 75-100 mg/dL per hour!!!!!!!!!
  • Gradual is important because:
    1) If you give them TOO much INSULIN, massive POTASSIUM will go into the cell, lowering their K+ too low and BP will drop too quickly!! THIS CAN LEAD TO CARDIAL ARRYTHMIAS!!!!!!!!! PUT THEM ON HEART MONITOR!!!!!
    2) Since BS keeps osmotic really high (if we reduce BS, osmo comes down and fluids are going to go back into the cells), IF we drop OSMO too QUICKLY, Theres going to be RAPID fluid movement back into the cell CAUSING CEREBRAL EDEMA & DEATH!!!!!!!!!!!!!!!!!!!!
114
Q

With what system AND what type of INSULIN should we give someone in DKA or HHS with??? How is it mixed???? IS IT GIVEN BY GRAVITY OR ON A PUMP??? HOW OFTEN SHOULD YOU CHECK BLOOD GLUCOSE WITH IV INSULIN ??

A

REGULAR Insulin IV drip!!!!
- 1:1 Ratio (1 unit = 1 mL)
- ON A PUMP!!!!
- HOURLY CHECKS!!!!!!!!

115
Q

WHICH TYPE OF INSULIN IS THE ONLY ONE THAT’S ALLOWED GIVEN WITH INTRAVENOUSLY/IV DRIP????

A

REGULAR!!!!!!!!

116
Q

OW OFTEN SHOULD YOU CHECK patient’s BLOOD GLUCOSE when they’re on IV INSULIN ??

A

Check hourly!!!!!!

117
Q

How many blood glucose should we REDUCE patient’s BG PER HOUR for in patients w/ DKA or HHS??

A

75-100 mg/dL PER HOUR!!!!!!!!!

118
Q

When giving someone Potassium Management for their KDA or HHS, what should you know about administering potassium????????????*****

A
  1. ONLY when patient is VOIDING AT LEAST 30 ml/hr!!!
  2. IV Potassium (PUMP!!!!!!!!), diluted NS
  3. Replace gradually – remember that Insulin will help shift potassium back into the cell
  4. Too low or too high can cause CARDIAC Arrhythmia!!!! PUT ON HEART MONITOR
119
Q

Which type of insulin can you give in IV form?????***

A

ONLY REGULAR INSULIN (Short acting insulin)!!!!!!!!!!!!!
NEVER INTERMEDIATE OR LONG!!!!

ADULT Health (24 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions