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Nursing 202 - Final > Diabetes > Flashcards

Diabetes Flashcards

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1
Q

Long term complications of DM

A
  • Blindness
  • ESRD
  • Non-traumatic lower limb amputation
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2
Q

What is DM a major risk factor for?

A
  • Heart disease
  • Stroke
  • HTN
  • High cholesterol
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3
Q

Functions of insulin

A
  • Transports & metabolizes glucose for energy
  • Stimulates storage of glucose in liver
  • Signals liver to stop release of glycogen
  • Enhances storage of dietary fat & adipose tissue
  • Accelerates transport of amino acids into cells
  • Inhibits breakdown of stored glucose, protein, fat
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4
Q

What causes glycosuria?

A

Concentration of glucose is > 180-200 —> kidneys cannot reabsorb all the glucose & it is excreted in urine

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5
Q

What accompanies glycosuria?

A

Excessive loss of F&E

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6
Q

Osmotic diuresis

A

Loss of glucose in urine —> excessive loss of F&E

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7
Q

Components of metabolic syndrome

A

If pt has 3/5 = metabolic syndrome —> increased risk of heart disease, DM, stroke

  • Elevated glucose
  • Abdominal obesity
  • Elevated BP
  • High triglycerides
  • Decreased HDL
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8
Q

When can DKA occur in type 2?

A

Severe illness or stress when pancreas cannot meet extra demand for insulin

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9
Q

Risk factors for type 2

A
  • Obesity
  • Age
  • Previous impaired fasting glucose or glucose tolerance test
  • HTN
  • HDL < 35
  • Triglycerides > 250
  • HX of gestational DM or baby > 9 lbs
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10
Q

Clinical manifestations

A
  • Polyuria, polydipsia, polyphagia
  • Fatigue, weakness
  • Vision changes
  • Tingling/numbness of hands & feet
  • Dry skin, skin lesions or wounds that won’t heal
  • Recurrent infections
  • Type 1 may have sudden weight loss
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11
Q

Diagnostic criteria

A
  • Fasting glucose 126 or more
  • Casual glucose exceeding 200
  • S/S
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12
Q

3 main causes of DKA

A

Severe deficiency of insulin

  • Decreased or missed dose
  • Illness or infection
  • Undiagnosed or untreated DM
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13
Q

What may be the initial manifestation of type 1?

A

DKA

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14
Q

DKA is commonly preceded by a day or more of…

A
  • Polyuria
  • Polydipsia
  • N/V (S/T acidosis)
  • Fatigue —> eventual stupor & coma if not treated
  • Acetone breath
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15
Q

Clinical features of DKA

A
  • Hyperglycemia
  • Dehydration w/electrolyte loss
  • Acidosis
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16
Q

How much water & electrolytes can be lost due to DKA?

A
  • 6.5 L water

- 400-500 mEq EACH of Na, K, Cl

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17
Q

What is the initial goal of therapy for DKA?

A

Establish IV access and begin F&E replacement

18
Q

What is the cause of metabolic acidosis in DKA?

A

Ketosis alters pH balance —> metabolic acidosis

19
Q

Why does illness & infection cause DKA?

A

The body increases stress hormones (glucagon, Epi, norepinephrine, cortisol, GH) in response to stress —> hormones promote glucose production & interfere with glucose utilization

20
Q

“Sick day” rules

A
  • Take insulin or PO meds as RX’d
  • Test blood glucose & urine ketones Q3-4 hrs
  • Report elevated glucose to PCP
  • Take supplemental doses or regular insulin Q3-4 hrs PRN
  • Substitute soft foods 6-8 times per day if unable to follow normal meal plan
  • Take liquids (cola, OJ, broth, gatorade) Q30 min to prevent dehydration & prevent calories if N/V or fever present
  • Report N/V/D to PCP
  • Be aware if unable to retain fluids —> hospitalization to avoid DKA
21
Q

Clinical manifestations of DKA

A

-Dry mouth
-Thirst, polydipsia
-Polyuria, urinary frequency
-Fatigue, weakness
-Blurred vision
-HA
IF volume depletion: orthostatic hypotension, rapid/weak pulse

22
Q

What symptoms can ketosis & acidosis lead to?

A

GI

  • Anorexia
  • N/V
  • Abdominal pain
  • Acetone breath
  • Kussmaul respirations
  • AMS - gradually increasing restlessness, confusion, lethargy; patient can be alert, lethargic, or comatose
23
Q

Hourly assessment for DKA

A
  • VS
  • Fluid volume status
  • ABGs
  • Breath sounds
  • Mental status, neuro status (cerebral edema)
  • Blood glucose level
  • Continuous ECG for arrhythmias (low K)
24
Q

What causes renal failure in DKA?

A

Hypovolemic shock

25
Q

Treatment of DKA

A
  • REHYDRATION
  • IV of continuous regular insulin
  • Reverse acidosis, restore acid base balance
  • Monitor blood glucose, renal function, UO, ECG, lyte levels, VS, lungs
26
Q

What IVF is used initially in rehydration?

A

NS 0.5-1 L per hr x 2-3 hrs

27
Q

When is half-strength NS given instead of NS?

A
  • HTN
  • Hypernatremia
  • HF
28
Q

What IVF is used for DKA after initial 2-3 hrs?

A

0.45% NS (as long as BP stable & Na is not low) 200-500 mL/hr for another several hrs

29
Q

What IVF is used for DKA when glucose levels reach 300 or less? Why?

A

D5W —> prevents sudden decline in blood glucose level

30
Q

Factors R/T DKA TX that affect K levels

A 
Rehydration 
-Increased plasma vol = decreased K
-Increase urinary excretion of K 
Insulin 
-Enhances movement of K from extracellular fluid into cells
31
Q

When does potassium replacement start in DKA?

A

When potassium levels drop to WNL

32
Q

When is K replacement withheld?

A
  • Hyperkalemia

- Patient not urinating

33
Q

How is acidosis reversed in DKA?

A

Insulin —> inhibits fat breakdown

-Infused at slow, continuous rate —> 5U/hr

34
Q

What can cause cerebral edema in DKA?

A

Too rapid admin of IVF & rapid lowering of serum glucose

35
Q

Why is bicarb infusion not used to reverse acidosis?

A

Can cause sudden decrease in serum K levels

36
Q

Common causes of HHS

A
  • UTI
  • Pneumonia
  • Sepsis
  • Any acute illness
  • Newly DX’d type 2 DM
37
Q

What is HHS often related to?

A

Impaired thirst sensation and/or functional inability to replace fluids

38
Q

Clinical manifestations of HHS

A
  • Hypotension
  • Profound dehydration (dry mucous membranes, poor skin turgor)
  • Tachycardia
  • Variable neuro S/S (AMS, seizures)
39
Q

Assessment & diagnostics for HHS

A
  • Blood glucose - usually B/T 600-1200
  • Electrolytes
  • BUN
  • CBC
  • Serum osmolality
  • ABG
  • Fluid status
40
Q

What is serum osmolality in HHS?

A

Exceeds 320 mOsm/kg —> neuro S/S, postural hypotension due to dehydration

41
Q

Treatment of HHS

A

Similar to DKA

-May need hemodynamic monitoring due to age & comorbidities

42
Q

How long does it take for neuro S/S to resolve after HHS?

A

3-5 days

Nursing 202 - Final (2 decks)

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