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N151 > Diabetes > Flashcards

Diabetes Flashcards

1
Q

Name at least four common causes of hypoglycemia:

A
  • Excess insulin
  • Deficient food intake or absorption of food
  • Exercise when insulin action is peaking
  • Excessive alcohol intake
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2
Q

Give three descriptive statements of Diabetes II:

A
  • Related sedentary lifestyle; obesity
  • Not dependent on insulin (body still makes insulin) NIDDM
  • Ranges from insulin resistance with relative insulin deficiency to secretory deficit with insulin resistance
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3
Q

What do the cells use insulin for?

A

Glucose regulation

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4
Q

What are the three P’s of diabetes (mainly in type 1DM)?

A

Polyuria (↑ urination)
Polydipsia (↑ thirst)
Polyphagia (↑ hunger)

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5
Q

Name the emergency complications of DM, differences and treatment?

A
  • Diabetic ketoacidosis (DKA): causes absence of insulin and generation of ketoacids (type 1 DM)
    o Treatment: Give fluids (0.9% NS), electrolytes, and insulin
  • Hyperglycemia-hyperosmolar state (HHS): cause by insulin deficiency and profound dehydration (Type 2)
    o Treatment: Give fluids (0.9% NS), electrolytes, and insulin
  • Hypoglycemia: too much insulin or too little glucose
    o Treatment: Give fluids (0.9% NS), electrolytes, and insulin
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6
Q

What type of insulin is given IV in those emergent situations such as DKA and HHS?

A

Regular insulin (only insulin able to give IV)

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7
Q

What is the respiratory pattern displayed by patients with hyperglycemia?

A

Kussmaul respiration: A rapid and deep respiratory pattern with an aromatic smell (fruity odor) that attempts to “blow off” carbon dioxide and acid (acetone).
-Used to correct metabolic acidosis

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8
Q

Your nursing assessment will show what likely signs/symptoms in the hypoglycemia patient?

A

-Neurogenic symptoms: results from autonomic nervous activity triggered by a rapid decline in blood glucose
o Adrenergic: shaky/tremulous, heart pounding/tachy, nervous/anxious
o Cholinergic: sweaty, hungry, tingling
- Neuroglycopenic symptoms: occur when brain glucose gradually declines to a low level
o Weakness, fatigue, difficulty thinking, confusion, behavior changes, emotional instability, seizures, loss of consciousness, brain damage, death
- Sweat, cold, and clammy give me some candy

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9
Q

Which anti-diabetic (oral) medication is contraindicated in patients with kidney impairment?

A

Hold metformin for a minimum of 48 hours before patient has imaging test that includes dye

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10
Q

An insulin injection in this area is absorbed at a faster rate than any other site.

A

Abdomen is the fastest and preferred injection site except for a 2 inch radius around the navel

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11
Q

Give an example of a medication that raises the glucose level

A
  • STEROIDS
  • IM glucagon
  • 50% IV dextrose
  • diazoxide (Proglycem)
  • octreotide (Sandostatin)
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12
Q

Name 3 insulin’s that have rapid onset action:

A
  • Insulin lispro
  • Insulin aspart
  • Insulin glulisine
  • Note: Given 10 min before mealtime when blood glucose is in the target range.
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13
Q

Name 3 diabetic complications of diabetic peripheral neuropathy

A
  • Injuries that lead to diabetic ulcers
  • Damage to sensory nerve fibers results in pain followed by loss of sensation
  • Damage to motor nerve fibers results in muscle muscle weakness
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14
Q

What is the main indicator of Nephropathy?

A

Protein in the urine (albuminuria)

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15
Q

What is the recommended reduction in calories in the obese DM patient?

A

250-500 calories less daily

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16
Q

What is the recommended advice regarding exercise if the urine has ketones?

A

When urine ketones are present, the patient should not exercise

-Ketones indicate that insulins levels are low and exercise would elevate blood glucose levels

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17
Q

Which insulin is always drawn first when mixing and is given 30 minutes before meals?

A

Regular insulin

o Regular insulin first then NPH

18
Q

What is your action as a nurse to the diabetic patient who is schedules for surgery, is NPO, and is scheduled for a morning dose of insulin?

A
  • Test blood glucose level first!!!
  • Then follow up with endocrinologist or HCP to make sure it is okay to hold insulin or get alternative orders
  • If there is a need for a basal insulin, it should be administered when the pt is NPO because it controls baseline glucose levels.
  • Do not administer insulin mixtures, rapid-acting, or short-acting insulin since it could lead to hypoglycemia
19
Q

Which laboratory value is elevated in DM II patients?

A
  • BUN and Creatine due to dehydration
  • HGB A1C
  • Triglycerides less than 150
20
Q

In meal planning for the diabetic patient, name at least five considerations to meet goals.

A
  • Religious preferences
  • Budgeting for meals
  • Family involvement with cooking
  • Limit bad foods but don’t completely eliminate
  • Include input from pt
21
Q

State the three macrovascular complications associated with uncontrolled diabetes.

A
  • Coronary heart disease
  • Cerebrovascular disease
  • Peripheral vascular disease
22
Q

State the five microvascular complications associated with uncontrolled diabetes.

A
  • Diabetic nephropathy
  • Diabetic neuropathy
  • Retinopathy
  • Sexual disfunction
  • Cognitive dysfunction
23
Q

Describe significance of blood tests and results (normal ranges) for Fasting plasma glucose:

A
  • Used to dx DM in non-pregnant adults

- Normal range: <100 mg/dL

24
Q

Describe significance of blood tests and results (normal ranges) for oral glucose tolerance:

A
  • Used to dx gestational DM during pregnancy

- Normal range: <140 mg/dL

25
Q

Describe significance of blood tests and results (normal ranges) for Hb A1C tests:

A
  • Used to show average blood glucose over 120 days and assess pt’s compliance with tx
  • Normal range: 4%-6%
26
Q

Name the 3 oral antidiabetic medication therapies:

A
  • Insulin stimulators
  • Biguanides
  • Insulin Sensitizers
27
Q 
Insulin stimulators
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Method of action:
Nursing consideration: 
Patient education:
A
  • Method of action: Lower BG by triggering release of preformed insulin from beta cells
  • Nursing consider/ education: Teach pt S/S of hypoglycemia, take before or with meals
28
Q 
Biguanides
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Method of action:
Nursing consideration: 
Patient education:
A
  • Method of action: Lowers BG by inhibiting liver glucose production, decreasing intestinal absorption of glucose, and increasing insulin sensitivity
  • Nursing consider: Metformin not to be used in patients w/ kidney disease. Hold Met before/after using IV contrast or when getting surgery that requires anesthesia
  • Education: Avoid alcohol, remind pt of metformin rule
29
Q 
Insulin Sensitizers
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Method of action:
Nursing consideration: 
Patient education:
A
  • Method of action: Lowers BG by decreasing liver glucose production and improving sensitivity of insulin receptors
  • Nursing consider: Don’t confuse Actos with Actonel
  • Education: Teach pts with CV disease to weigh themselves daily, report vision changes immediately, warm women about increased risk of bone Fx
30
Q

What type of syringe do you use to draw up insulin?

A

1-mL (100-U)
½ mL (50-U)
3/10 mL (30-U)

31
Q

Why do you have to roll cloudy insulin before drawing up?

A

To mix medications, do not shake because it causes air bubbles, which can lead to inaccurate dosing.

32
Q

Explain insulin sliding scale dosing?

A

Corrective insulin given premeal based on BS

33
Q

What is the “timed activity” of rapid-acting insulin?
Onset:
Peak:
Duration:

A 
Insulin lispro (Humalog)
Insulin aspart (Novolog)
o Onset: 15 minutes to 30 minutes
o Peak: 1-3 hours
o Duration: 3-5 hours
34
Q

What is the “timed activity” of short-acting insulin?
Onset:
Peak:
Duration:

A

Regular insulin (Humulin R, Novolin R)
o Onset: 30 minutes- 1 hour
o Peak: 2-5 hours
o Duration: 5-8 hours

35
Q

What is the “timed activity” of intermediate insulin?
Onset:
Peak:
Duration:

A

NPH injection Isophane insulin (Humulin N, Novolin N)
o Onset: 1-2 hours
o Peak: 4-12 hours
o Duration: 16-24 hours

36
Q

What is the “timed activity” of long-acting insulin?
Onset:
Peak:
Duration:

A

Insulin glargine (Lantus)
o Onset: 3-4 hours
o Peak: No peak
o Duration: 24 hours

37
Q

Patient education: Insulin preparation, storage, blood glucose equipment and infection control measures.

A
  • Refrigerate insulin that is not in use.
  • Insulin in use can be kept at room temp. for up to 28 days.
  • Avoid exposing insulin to temps below 36° and above 86°
  • Protect from direct heat and light
  • Do not freeze
38
Q

Proper foot care and maintenance in the diabetic patient includes:

A
  • Inspect feet daily especially between toes
  • Dry between toes
  • Do not apply any moisturizer between the toes
  • No soaking feet
  • No bare foot
  • No sandals
  • Visit Podiatrist at least once a year
  • No heating pads
  • Change shoes midday
  • Use clean and absorbent
  • Do not treat corns, blisters, bunions, calluses, or ingrown toenails yourself
  • Do not cross legs
39
Q

The _____ ______ secrete insulin which are located in the _______.

A

Beta cells, pancreas

40
Q

Insulin therapy in a patient with DKA is to be started only:

A

If the patient’s potassium level is 3.3 or greater

N151 (4 decks)

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