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Exam 3 > Diabetes > Flashcards

Diabetes Flashcards

1
Q

What is diabetes usually caused from?

A

Obesity- bad diet and no exercise

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2
Q

What is diabetes characterized by?

A

Hyperglycemia

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3
Q

What defects is diabetes caused by?

A

Defects in:

Insulin secretion, insulin action or both

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4
Q

What portion of diabetes cases are undiagnosed?

A

one third

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5
Q

In terms of diabetes:

Minority populations and older adults are…

A

Disproportionately affected

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6
Q

In patients with diabetes:

What needs to happen to the patients insulin and glucagon levels?

A

Insulin levels need to be increased and glucagon levels need to be decreased.

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7
Q

What does insulin (beta) mainly do?

A

Moves glucose from blood into cells

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8
Q

What does insulin inhibit?

A

It inhibits the breakdown of stored glucose, protein and fat

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9
Q

What does insulin accelerate?

A

It accelerates transport of amino acids into cells

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10
Q

What does insulin enhance?

A

It enhances storage of dietary fat in adipose tissue

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11
Q

What does insulin stimulate?

A

It stimulates storage of glucose in the liver and muscle as glycogen

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12
Q

What does insulin transport and metabolize?

A

It transports and metabolizes glucose for energy

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13
Q

When is glucagon (alpha) released?

A

When serum glucose decreases

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14
Q

Glucagon stimulates what?

A

It stimulates glycogenolysis in the liver

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15
Q

Glucagon increases what?

A

Increases formation by liver of glucose from noncarbohydrate sources

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16
Q

Gluconeogenesis is described as?

A

The formation of glucose from noncarbohydrate sources

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17
Q

Type 2 diabetes affects what percentage of patients diagnosed with diabetes?

A

90 to 95%

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18
Q

Type 1 diabetes affects what percentage of patients diagnosed with diabetes?

A

5-10%

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19
Q

Gestational Diabetes affects what percentage of pregnancies?

A

2-5%

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20
Q

What happens to a patient’s risk of diabetes if they come down with gestational diabetes?

A

it increases

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21
Q

What are the two things that occurs in a patient if they are diagnosed with type 2 diabetes?

A

A decreased sensitivity to insulin and impaired secretion of insulin

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22
Q

What secondary diagnosis does a patient frequently have if they have type 2 diabetes?

A

Hypertension

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23
Q

What is type 2 diabetes initially treated with?

A

Diet and exercise

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24
Q

What type of medication is a patient with type two diabetes initially put on?

A

A pill form of hypoglycemic agents.

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25
Q

If the pill form of hypoglycemic agents doesn’t work then a patient with type two diabetes will likely be put on?

A

Insulin

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26
Q

What age group is type two diabetes increasing in?

A

Children

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27
Q

Impaired insulin secretion from the pancreas and increased basal hepatic glucose production leads to what?

A

Hyperglycemia

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28
Q

Gastrointestinal absorption of glucose and decreased insulin-stimulated glucose uptake in the muscle leads to what?

A

Hyperglycemia

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29
Q

Patients who are thirty years of age or older are at a higher risk for what?

A

Type 2 diabetes

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30
Q

What BMI are patients of the Asian American decent at a higher risk for type 2 diabetes?

A

greater than 23

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31
Q

What races have an increased risk of type two diabetes?

A

African Americans, Hispanics, Native Americans, and Alaskan Natives

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32
Q

Metabolic syndrome is a risk factor for what?

A

Type 2 diabetes

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33
Q

Hypertension, elevated triglyceride, and decreased HDL are risk factors for what?

A

Type 2 diabetes

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34
Q

What disease is a patient at risk for if they have polycystic ovary syndrome?

A

Type 2 diabetes

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35
Q

What are the two things a patient typically goes to the doctor for and end up being diagnosed with type 2 diabetes?

A

An eye issue or a wound that won’t heal

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36
Q

What does polydipsia mean?

A

Increased thirst

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37
Q

What does polyphagia mean?

A

Increased hunger

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38
Q

Does type 2 diabetes have a slow or fast onset of clinical manifestations?

A

Slow

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39
Q

Skin infections, blurred vision, fatigue, paresthesias, polydipsia and polyuria are all clinical manifestations of what?

A

Type 2 diabetes

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40
Q

History of Hypertension and obesity could potentially lead to what?

A

Type 2 diabetes

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41
Q

What do you need to include when taking vital signs in a patient suspected of having type two diabetes?

A

Orthostatic blood pressure

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42
Q

In a patient who has type two diabetes what happens when taking orthostatic blood pressure?

A

It takes 10-15 minutes for brain to regulate so their BP will be different each time.

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43
Q

During a physical exam:

What would be happening to the skin that would suggest the patient has type 2 diabetes?

A

The back of their neck turns dark and looks dirty. Due to a fungal infection.

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44
Q

When doing an eye exam on a patient suspected to have type 2 diabetes what must you make sure you use?

A

A fundoscope

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45
Q

When doing a physical exam on a patient who is suspected to have type 2 diabetes: what should you make sure you do when checking out their feet?

A

Check their pedal pulses and reflexes.
Check for sensation in their feet to rule out neuropathy.
Check for any wounds that aren’t healing.

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46
Q

When checking the patients hemoglobin A1C- what levels would diagnose them with diabetes?

A

Greater than or equal to 6.5%

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47
Q

What is a bench mark diagnostic test for a patient with diabetes?

A

Hemoglobin A1C

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48
Q

During an oral glucose tolerance test: what would diagnose a patient with diabetes?

A

If their two hour plasma glucose was anything over 200

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49
Q

If a patient has a fasting glucose of this they are a diabetic.

A

126 or greater

50
Q

What does FPG stand for?

A

Fasting Plasma Glucose

51
Q

What is a normal FPG?

A

Less than 100

52
Q

What is an impaired FPG?

A

Greater than 100 but less than 126

53
Q

If a patient has an impaired FPG what would they be classified as?

A

Prediabetic

54
Q

What is a microalbuminuria?

A

A urine test for albumin

55
Q

If a patient has a positive microalnuminuria what does that mean and what will the doctor ask for?

A

It means they are dumping albumin in their urine and a doctor will likely ask for a 24 hour urine test.

56
Q

The first treatment for type 2 diabetes is what?

A

Life style modifications of their diet, exercise, and weight control.

57
Q

If a patient cannot control their type 2 diabetes through life style modifications what is the next step?

A

Pharmaceuticals

58
Q

If a patient is able to lose just this percentage of their original weight it will have a BIG effect on their diabetes.

A

10%

59
Q

One of the dietary management goals for type 2 diabetes is to pace food intake throughout the day. What does that mean?

A

Small meals to maintain blood sugar. Typically 3 meals with 3 small snacks.

60
Q

Why is it so important for a patient with type two diabetes to maintain their blood pressure in a normal range?

A

Anything abnormal going on in the body increases stress which will increase the body’s blood sugar.

61
Q

What is the best way for a patient to assess their diet history and make sure they meet caloric requirements throughout the day?

A

By keeping a diet journal.

62
Q

How many grams of fiber should a patient with diabetes have per day?

A

25 g

63
Q

What percentage of fat can a patient with diabetes have?

A

20-30%

64
Q

A patient with diabetes should have less than what percentage of saturated fat per day??

A

Less than 10%

65
Q

What percentage of protein should a patient with diabetes have per day?

A

10-20%

66
Q

How many milligrams of cholesterol a day should a patient with diabetes have?

A

Less than 300 mg

67
Q

A patient with diabetes should have what percentage of carbohydrates a day?

A

50-60%

68
Q

What type of carbohydrates should a patient focus on consuming throughout the day?

A

Whole grains

69
Q

What food groups should you combine to slow absorption and glycemic response?

A

Starchy foods with protein and fats

70
Q

What types of foods tend to lower glycemic index?

A

raw or whole foods

71
Q

Why should you eat whole fruits rather than juices if you have diabetes?

A

Whole fruits decrease glycemic response because of their fiber-slowing absorption.

72
Q

Consuming ETOH on an empty stomach causes what?

A

Hyperglycemia

73
Q

If a patient sticks to a ROUTINE exercise regimen what can happen with their blood sugar?

A

It can help maintain it.

74
Q

Where is the best spot to administer insulin when giving it to a patient in the hospital?

A

The back of the arm due to the patient not being able to reach it.

75
Q

If you have diabetes what are you four more times likely to die from?

A

Cardiovascular complications.

76
Q

What do hypoglycemic agents do?

A
  • Stimulate or increase insulin secretion
  • Prevent breakdown of glycogen to glucose
  • Make cells less resistant to insulin
77
Q

What are the two acute complications with diabetes?

A
  • Hypoglycemia

- Hyperglycemic hyperosmolar syndrome (HHS)

78
Q

If a diabetes patient experiences nausea, vomiting, or diarrhea what could happen to their blood sugar?

A

They could become hypoglycemic.

79
Q

Hypoglycemia is characterized by?

A

Abnormally low blood glucose levels

-below 50-60.

80
Q

What are the adrenergic symptoms of hypoglycemia?

A
  • Sweating
  • Tremors
  • Tachycardia
  • Palpitations
  • Nervousness
  • Hunger
81
Q

What are the central nervous system symptoms of hypoglycemia?

A
  • Inability to concentrate
  • Headache
  • Confusion
  • Memory Lapses
  • Slurred speech
  • Drowsiness
82
Q

Severe hypoglycemia has symptoms of:

A
  • Disorientation
  • Seizures
  • Loss of consciousness
  • Death
83
Q

If a patient can swallow:

What would you give them if they are having a hypoglycemic episode?

A

15 g of rapid acting sugar

-half of a cup of juice, 8 oz of skim milk, 3 glucose tabs

84
Q

If a patient cannot swallow:

What two things would you give them if they are having a hypoglycemic episode?

A

50 ml of 50% D50 solution.
-10 ml per minute IVP
Glucagon

85
Q

How long should a patient be monitored after having a hypoglycemic episode?

A

24 hours

86
Q

What is the 15/15 rule?

A

If a patient is having a hypoglycemic episode:

Give 15 g of rapid-acting sugar then check blood sugar after 15 minutes. If still low repeat the process.

87
Q

If giving a patient orange juice due to a hypoglycemic episode what should you be careful of?

A

Heart or renal problems.

88
Q

Why would a patient become dehydrated if they are experiencing osmotic diuresis?

A

Because they are getting rid of urine but no sodium becoming severely dehydrated.

89
Q

How is hyperosmolar hyperglycemic syndrome described?

A

Blood glucose levels greater than 600 mg/dL from lack of sufficient insulin.

90
Q

What are the precipitating factors of hyperosmolar hyperglycemic syndrome?

A

Infection or illness

91
Q

What results from hyperosmolar hyperglycemic syndrome?

A

Severe dehydration with increase in serum sodium.

92
Q

True or false:

It is no big deal if a patient has hyperosmolar hyperglycemic syndrome?

A

False:

It is serious and life-threatening.

93
Q

What are the symptoms of hyperosmolar hyperglycemic syndrome?

A
  • Altered level of consciousness
  • Neuro deficits
  • Coma from cerebral dehydration
  • Hypotension
  • Tachycardia
  • Dry skin and mucous membranes
  • Extreme thirst
94
Q

What is the treatment for hyperosmolar hyperglycemic syndrome?

A
  • Correct fluid and electrolyte imbalances

- Lower blood sugar levels with insulin

95
Q

Chronic complications from diabetes alter what system in the body?

A

Cardiovascular

96
Q

What types of macrovascular complications can result from diabetes?

A
  • Earlier onset of atherosclerosis
  • CAD
  • Carotids
  • PAD
97
Q

What types of microvascular complications can result from diabetes?

A
  • Retinopathy

- Nephropathy

98
Q

What is a common comorbidity associated with chronic complications from diabetes?

A

Hypertension

99
Q

If a patient has diabetic retinopathy what are they at an increased risk for?

A

Cataracts

100
Q

How is diabetic retinopathy described?

A

Retinal ischemia and breakdown in blood-retinal barrier that can lead to blindness.

101
Q

How is diabetic nephropathy described?

A

Thickening of basement membrane of glomeruli, impairing renal function.

102
Q

What does diabetic nephropathy allow to happen?

A

It allows protein to be lost in the urine resulting in microalbuminuria

103
Q

What does hypertension do to nephropathy?

A

It accelerates it

104
Q

What class of drugs is used to control hypertension in relation to nephropathy?

A

ACEIs

105
Q

What is the number one education topic for a patient with type 2 diabetes?

A

Proper foot care!

106
Q

When should a patient with diabetes wear closed toed shoes?

A

ALL the time even around the house.

107
Q

When a patient with diabetes is taking care of their feet what should they do?

A
  • Get up and look at them once per day
  • Wash feet daily
  • Wear closed toed shoes at all times
  • Check shoes everyday before putting them on.
108
Q

True or false:

There is only alterations in the peripheral nervous system in a patient with diabetes?

A

False:

A patient can experience alterations in both the peripheral and autonomic nervous systems.

109
Q

Where do peripheral neuropathies due to diabetes normally start at?

A

In the feet

110
Q

What symptoms do patients have when experiencing distal paresthesias due to peripheral neuropathies?

A
  • Pain
  • Cold feet
  • Tingling
  • Numbness
  • Impaired sensations of pain, temperature, light touch, and vibration.
111
Q

What symptoms do patients have who are experiencing autonomic neuropathies?

A
  • Sweating
  • Abnormal pupillary function
  • Cardiac dysfunction
  • GI motility dysfunction
  • GU dysfunction
  • Hypoglycemic unawareness
  • Sexual dysfunction
112
Q

Why are patients with diabetes more likely to have a UTI?

A

Due to urinary retention

113
Q

If a patient with diabetes needs to have what once per year to make sure they don’t have retinopathy or to make sure that it has not progressed.

A

A blood dilated eye exam

114
Q

Why do patients with diabetes have an increased risk for dementia?

A

Due to autonomic neuropathies

115
Q

Why would a patient with diabetes have to go to a dentist more often?

A

Because periodontal disease progresses more rapidly in these patients.

116
Q

What types of alterations in mood could patients with diabetes experience?

A
  • Strains of living with complex self-care
  • Risk of depression and anxiety
  • Increased risk of dementia
117
Q

Patients with diabetes have an increased susceptibility to infection. What types of complications could arise from this?

A
  • Vascular, neurological impairments
  • Nephrosclerosis
  • Urinary retention
  • Bacterial and fungal skin infections
118
Q

What is the most common complication a patient with diabetes will experience?

A

Complications involving feet

119
Q

What are the most common traumas in the feet that a patient with diabetes can experience?

A
  • Cracks of fissures from dry skin
  • Blisters or pressure ulcers
  • Ingrown toenails
120
Q

When a patient with diabetes develops an ulcer- what typically happens?

A

It begins as superficial and extends deeper.

121
Q

What are the nursing diagnoses associated with diabetes?

A
  • Knowledge deficit
  • Risk for infection
  • Risk for injury
  • Risk for impaired skin integrity
  • Ineffective coping

Exam 3 (8 decks)

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