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Med/Surg 1 > Diabetes > Flashcards

Diabetes Flashcards

1
Q

List the complications of Diabetes

A
  1. Coronary Artery Disease
  2. Cerebrovascular Disease (CVA)
  3. Peripheral Vascular Disease
  4. Diabetic Retinopathy
  5. Diabetic Neuropathy
  6. Peripheral Neuropathy
  7. Autonomic Neuropathy
  8. Foot Ulcer
  9. Depression
  10. Periodontal disease
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2
Q

Foot Care Patient Education for Diabetics

A
  1. Inspect feet everyday (cuts?temp change? use mirror to check bottom)
  2. Wash feet everyday (do NOT soak, dont check temp with toe, dry feet well)
  3. Always wear shoes
  4. Protect feet from hot/cold
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3
Q

What is Diabetic Neuropathy? How is it managed?

A
  1. Kidney disease due to albumin in urine, hypertension, edema, and renal dysfunction
  2. Mangement:
    • ACE Inhibitor
    • Weight loss
    • low sodium, low protein diet
    • exercise
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4
Q

What are the 3 stages of diabetic retinopathy? State manifestations of each stage

A
  1. Background
    • early stage, asymptomatic, some swelling/distorted vision
  2. Preproliferative
    • destruction of retinal blood vessels
  3. Proliferative
    • abnormal growth of new vessels, ruptured vessels
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5
Q

How is Diabetic Retinopathy managed?

A
  1. Insulin therapy
  2. Hypertension management
  3. Smoking cessation
  4. Annual eye exams
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6
Q

Management of Macrovascular Diabetic Complications

A
  1. Prevent/Treat athersclerososis
  2. Diet/Exercise
  3. Keep BP below 130/80
  4. Keep LDL low and HDL high
  5. Smoking cessation
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7
Q

Sick Day Management

A
  1. Take insulin/oral anti diabetic as usual
  2. Test BS & urine ketones Q3-4H (report if needed)
  3. Take supplemental doses of regular insulin Q3-4H if needed
  4. Substitute soft foods and drink liquids to prevent dehydration
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8
Q

What causes Diabetic Ketoacidosis?

A
  1. Decreased/Missed Insulin
  2. Illness/Infection
  3. Undiagnosed/Untreated Diabetes
  4. Type 1 Diabetes
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9
Q

Clinical Manifestations of DKA

A
  1. Polyuria & Polydyspia
  2. Blurred vision
  3. Fruity Breath
  4. Kussmaul respiration
  5. Change in mental status
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10
Q

What diagnostics would a nurse see in a DKA patient?

A
  1. BS: 300-800
  2. Low Bicarb 0-15
  3. low pH (6.8-7.3)
  4. Ketones in blood/urine
  5. Low Na & K levels
  6. Increased BUN & Creatinine
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11
Q

15-15 Rule for Alert & Oriented Patients

A
  1. Give 15g of carb
  2. Recheck BS in 15 min
  3. Repeat if BS<70
  4. Notify HCP when stable
  5. Check again in an hour
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12
Q

15-14 Rule for Patients Not Alert & Oriented with IV

A
  1. Administer D50 IV push
  2. Recheck in 15
  3. Repeat until BS >70
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13
Q

15-14 Rule for Patients Not Alert & Oriented without IV

A
  1. Administer glucagon 1 mg SQ/IM

2. Start IV D5W @ 100mL/hr

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14
Q

What is the dawn phenomenon

A
  1. Rise in BS between 3-7am
  2. Not related to hypoglycemia
  3. Related to increase in GH
  4. Give intermediate acting insulin at bedtime
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15
Q

What is the Dawn Phenomenon?

A
  1. Rise in BS between 3-7am
  2. Not related to hypoglycemia
  3. Related to increase in GH
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16
Q

What is the Somogyi Effect?

A
  1. Normal/Elevatated at bedtime
  2. Hypoglycemic at 2-3am
  3. Increase in the AM
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17
Q

How would a nurse treat Dawn Phenomemon?

A
  1. Check BS at 3AM

2. 4. Give intermediate acting insulin at bedtime

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18
Q

How would a nurse treat Somigyi Effect

A
  1. Decrease evening dose of Intermediate Acting Insulin
    OR
  2. Increase bedtime snack
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19
Q

What oral anti diabetic is given SubQ?

A

Exenatide

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20
Q

What is Lipodystrophy?

A
  1. Lump/dent in skin due to continuous injection in same site
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21
Q

What is PreMixed Insulin? When is it given?

A
  1. Combo of NPH & rapid acting or short acting insulin

2. Give twice a day before mealtime

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22
Q

What is Long Acting Insulin (Glargine) used for?

A

to control BS overnight, while fasting, and between meals

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23
Q

Screening tools for Diabetes

A
  1. Should show 3 P’s
  2. Casual plasma glucose
  3. Fasting plasma glucose
  4. 2 hour plasma glucose during OGTT
  5. HgA1C
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24
Q

What is a casual plasma glucose? What is diabetic range?

A
  1. BS taken at anytime of day, last meal doesn’t matter

2. BS =/> 200

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25
Q

What is a fasting plasma glucose? What is diabetic range?

A
  1. No food/drink 8h before drawing BS

2. BS=/> 126

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26
Q

What is a 2h plasma glucose during OGTT? What is diabetic range?

A
  1. Given glucose drink then test

2. BS =/> 200

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27
Q

HgA1C diabetic range

A

BS =/> 6.5%

28
Q

Type 1 Diabetes

A
  1. Insulin dependent
  2. 30 and younger
  3. 5%
29
Q

Type 2 Diabetes

A
  1. Adult onset
  2. Most common, 95%
  3. Can be managed with diet and exercise
30
Q

Gestational Diabetes

A
  1. Diagnosed during pregnancy
  2. Increases risk for hypertensive disorder
  3. Screened at 20w
  4. Return to normal after birth, but may get Type 2 later in life

pg 1459

31
Q

LADA

A
  1. Slow beta cell destruction

2. Shares Type 1 & Type 2 symptoms

32
Q

What is the fasting glucose of someone that is prediabetic?

A

100-125

33
Q

What is the OGTT of someone that is prediabetic?

A

140-199

34
Q

What is the normal fasting glucose?

A

70-100

35
Q

Risk Factors for Diabetes

A
  1. Family Hx
  2. Obesity (BMI>30)
  3. Race/Ethnicity
  4. Age
  5. Hypertension
  6. HDL <35 or triglycerides >250
  7. Hx of gestational diabetes or baby delivered over 9 lbs
36
Q

What body tissues/organs require insulin to transfer glucose?

A
  1. SkM
  2. CardiacM
  3. Adipose tissue
37
Q

What body tissues/organs do NOT require insulin to transfer glucose?

A
  1. Brain
  2. Liver
  3. Intestines
  4. Renal tubules
38
Q

S/S of Type 1 Diabetes

A
  1. 3 P’s
  2. Unexplained weight loss
  3. Fasting hyperglycemia (high BS w/o eating anything
  4. Glycosuria
  5. Ketones in uria
39
Q

S/S of Type 2 Diabetes

A
  1. Slow Onset
  2. Polydyspia
  3. Polyuria
  4. Weakness/fatigue
  5. Numbness in peripherals
  6. Blurred vision
  7. Poor wound healing
  8. Vaginal infections
40
Q

Purpose of HgA1C ?

A

determines average blood glucose over 2-3 months

41
Q

What does presence of glucose in urine indicate?

A

Hyperglycemia

42
Q

DKA Nursing Interventions

A
  1. Monitor ECG for dysrhtymias
  2. Monito vitals, ABGs
  3. Ascultate lung sounds
  4. Neuro/LOC checks
  5. Check BS every hour
43
Q

What is Hyperglycemic Hyperosmolar Syndrome?

A

Type 2 Diabetes disorder

Due to insulin deficiency caused by illness/infection

44
Q

Why doesn’t ketosis and acidosis occur in HHS?

A

Insulin is still present

45
Q

What lab values would you expect to see in a HHS patient?

A

BS: 600-1200
Osmolality >320
Increased BUN/Creatine
Decreased sodium & Potassium

46
Q

HHS Clinical Manifestations

A

hypotension
profound dehydration
tachycardia
neurological changes

47
Q

Nursing Interventions for HHS

A
  1. assess vital signs
  2. fluid status – strict intake and output (fluid administration = risk for fluid overload)
  3. continuously monitor labs (BUN/creatinine/potassium/blood glucose)
  4. thorough cardiovascular, pulmonary, and kidney function assessments
48
Q

What are some complications of HHS and why?

A
  1. Fluid overload/Pulmonary edema/Heart failure
    2.Hypokalemia (insulin administration)
  2. Hyperglycemia and Ketoacidosis (treatment isn’t successful or too much insulin & fluids??)
    hypoglycemia (too much insulin)
    cerebral edema
49
Q

What type of insulin is most commonly used in hospital? How does it work?

A

Sliding Scale Insulin

Check BS and treat accordingly after meals

50
Q

Most common side effect of glipizide/glyburide

A

Hypoglycemia (gets worse when patient is NPO)

51
Q

Mechanism of action for Glipizide/Glyburide

A
  1. Stimulate the pancreatic cells to secrete more insulin

2. Increases the sensitivity of peripheral tissues to insulin.

52
Q

Adverse Effects of Glipizide/Glyburide

A

weight gain
GI distress
hepatotoxicity
disulfiram-like reaction with alcohol

53
Q

Which oral antidiabetic medication impairs kidney function?

A

Metformin

54
Q

If a patient is on Metformin but must have CT with contrast, what intervention should the nurse complete?

A

Hold Metformin for 24h

55
Q

Metformin places patient at risk for what disorder?

A

Lactic acidosis

56
Q

Metformin mechanism of action

A
  1. Reduces the FBS

2. Reduces hyperglycemia after meals in Type 2 Diabetes

57
Q

Pioglitazone is contraindicated in what kinds of patients?

A
  1. CHF
  2. pulmonary edema
  3. Impaired liver function
58
Q

What is the purpose of administering pioglitazone?

A
  1. Decrease insulin resistance
59
Q

Common side effects of Pioglitazone

A

fluid retention
headache
weight gain
hypoglycemia (if used with other meds)

60
Q

What medication is administered for prediabetic patients?

A

Acarbose

61
Q

Acarbose Mechanism of Action

A
  1. Slow carbohydrate digestion

2. Delay glucose absorption.

62
Q

If a diabetic patient is NPO, what oral anti diabetic agent should not be administered?

A

repaglinide

63
Q

Most common adverse effect of repaglinide

A

Hypoglycemia

64
Q

What is the mechanism of action for repaglinide?

A

Stimulate insulin release from pancreas

65
Q

Which oral antidiabetic med is the only agent that can be administered SQ?

A

Exenatide

66
Q

How does Exenatide lower blood glucose?

A
  1. Activates GLP 1 receptors
  2. Increasing insulin secretion
  3. Slows glucose absorption
67
Q

How does sitagliptin/saxagliptin lower blood glucose?

A
  1. Inhibits DPP-4 to allow rise in natural incretin

2. Works with other drugs effectively

Med/Surg 1 (3 decks)

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