Diabetes Exam Flashcards
Glucose in the urine is called ___
glycosuria
___ is too much sugar in the blood.
Hyperglycemia
___ is too little sugar in the blood
Hypoglycemia
Deep, sighing respirations from diabetic acidosis are called ___ respirations.
Kussmaul’s
Excessive hunger is called ___ .
polyphagia
Excessive thirst is called ___.
polydipsia
The patient who gets up to urinate at night has ___.
nocturia
The time when insulin is working its hardest after injection is called its ___ action time.
peak
The length of time insulin works is called its ___.
duration
The Diabetes Control and Complications Trial (DCCT) found that individuals who maintain ___ control of the diabetes will have fewer long term complications
tight
organize these symptoms according to if they are hyperglycemia or hypoglycemia tremor polydipsia polyuria lethargy irritability fruity breath sweating abdominal pain
HYPOglycemia:
tremor
irritability
sweating
HYPERglycemia: polydipsia polyuria lethargy fruity breath abdominal pain
A long term complication of diabetes
Ketones in the blood and urine
Diabetic ketoacidosis (DKA)
A long term complication of diabetes
Burning pain in legs and feet
Neuropathy
A long term complication of diabetes
Fever
Infection
A long term complication of diabetes
Profound hyperglycemia without ketonemia
Hyperosmolar hyperglycemia
A long term complication of diabetes
Impaired vision
Retinopathy
A long term complication of diabetes
Food intolerance
Gastroparesis
A long term complication of diabetes
Microalbuminuria
Nephropathy
Which of the following is an acceptable pre-meal blood sugar range for a patient with diabetes?
- 46 to 98 mg/dL
- 70 to 130 mg/dL
- 180 to 250 mg/dL
- 350 to 600 mg/dL
-70 to 130 mg/dL
Before giving insulin, the nurse always checks which test result?
- Recent potassium level
- Blood sugar level
- Urine Ketones
- White blood cell count
-Blood sugar level
At what point after injection does the peak action of regular insulin occur?
- 30 to 60 minutes
- 1 to 2 hours
- 2 to 5 hours
- 8 to 12 hours
-2 to 5 hours
Which of the following are symptoms of hypoglycemia
- nausea and vomiting
- glycosuria
- cold sweat and tremor
- polyuria and polydipsia
-cold sweat and tremor
In addition to stimulating insulin production, glyburide (Micronase) has which of the following effects?
- Stimulates gluconeogenesis
- Promotes fat breakdown
- Increases tissue sensitivity to insulin
- Enhances appetite
-Increases tissue sensitivity to insulin
A 26-year-old patient is admitted to the hospital with a new diagnosis of diabetes, a blood glucose of 680 mg/dL, and ketones in the blood and urine. Which type of diabetes should the nurse suspect?
- Type 1
- Type 2
- Prediabetes
- Gestational
- Type 1
Ketones and DKA usually occur in type 1 diabetes, especially in a newly diagnosed patient.
A 45-year-old with diabetes forgot to take a daily dose of glyburide (Micronase). For which of the following symptoms should the nurse be vigilant?
- Cold, clammy sweat
- Tachycardia, nervousness, hunger
- Chest pain, shortness of breath
- Fatigue, thirst, blurred vision
- Fatigue, thirst, blurred vision
If a patient forgets a prescribed oral hypoglycemic, blod sugar levels will go up.
By which routes can insulin be administered? (select all that apply)
- Oral
- Topical
- Intravenous
- Subcutaneous
- Intramuscular
- Intravenous
- Subcutaneous
- Intramuscular
While providing discharge instructions to a patient newly taking NPH insulin every morning, the nurse recognizes that teaching has been effective if the patient knows to observe for signs and symptoms of low blood sugared level at which of the following times?
- 1 hour after administration of insulin
- 6 to 12 hours after administration of insulin
- 24 to 36 hours after administration of insulin
- NPH insulin does not cause low blood sugar level
- 6 to 12 hours after administration of insulin
A patient with newly diagnosed diabetes ask the nurse what to take for low blood sugar. which of the following would be most appropriate for the nurse to suggest?
- Raisins
- Cheese
- acetaminophen (Tylenol)
- beef jerky
- Raisins
Raisons contain sugar, which will raise the blood glucose level
The nurse recognizes that teaching is effective if a patient with diabetes knows to use subcutaneous glucagon for an emergency episode of which of the following conditions?
- Hyperglycemia
- Ketonuria
- Diabetic ketoacidosis
- Hypoglycemia
- Hypoglycemia
Glucagon stimulates the liver to convert glycogen to glucose, which raises the blood glucose level
A patient on an American Diabetes Association diet receives a breakfast tray and does not care for the oatmeal. Which of the following foods can the nurse substitute for a half cup of oatmeal?
- 4 oz of orange juice
- Two strips of bacon
- 1 oz of cheese
- A slice of wheat toast
- A slice of wheat toast
What is diabetes caused by
absent, inadequate levels of, under-utilization of insulin
or cell resistance to insulin.
___ have the highest rate of diabetes of all ethnic and racial groups
Native Americans
Usual presentation of diabetes is rapid, with classic symptoms of ___ ___ ___ and ___
polydipsia, polyphagia, polyuria, and weight loss
Examples of long term complications from diabetes are:
blindness, kidney failure, heart attacks, and strokes.
The hormone insulin is produced by _______ of the pancreas
beta cells in islets of Langerhans
Etiology of Type 2 Diabetes
Family history: 90% heredity component Ethnicity Age: over 40 most common If > 20% over ideal body wt Diabetes Type II is now showing up in kids.
Defined as carbohydrate intolerance occurring during pregnancy.
Gestational Diabetes Mellitus
refers to blood glucose levels that are above normal, but do not meet the criteria for diagnosing diabetes.
It is usually diagnosed prior to being diagnosed with DM II.
Prediabetes
Develops due to another chronic illness that damages the islet cells such as:
Pancreatitis
Cystic fibrosis
May be the result of medication use
Most commonly steroids
Secondary Diabetes
When a patient has 3 or more of the following metabolic abnormalities. HTN Increased Cholesterol Low HDL (below 40) Increased Triglycerides Obesity Fasting Glucose greater than 100
Metabolic Syndrome or Syndrome X
Why does your body present with classic symptoms of polyuria, polydipsia, and polyphagia
Polyuria: The bodies attempt to excrete the large amount of glucose.
Polydipsia: Due to the large amount of urine lost.
Polyphagia: The cells do not receive glucose and become starved!
Diagnostic test. This is when the blood is checked with no regards to the last meal. It is done randomly. Diabetes is diagnosed if this level is 200 or above and have s/s of diabetes with it.
Casual Plasma Glucose
Oral Glucose Tolerance Test.
What is it.
When is DM diagnosed
what does it evaluate
A loading dose of carbohydrates are given and the blood glucose is measured at intervals afterwards.
DM is diagnosed when measurements are above 200 mg/dl after 2 hours of CHO intake
This test evaluates insulin response to glucose loading.
If diabetic, the patient will have greatly elevated glucose levels for 1-5 hrs after glucose load.
Patient considerations for fasting lab draws
For fasting glucose pt must fast from any caloric intake for at least 8 hours. (overnight), sips of water are allowed.
refrain from smoking before the glucose sampling.
Hold insulin or oral anti-hyperglycemic medications
For postprandial test, advise patient that no food should be eaten during the 2-hour interval.
Check lab results before administering medication or food
Blood glucose attaches itself to hemoglobin & forms ____
glycohemoglobin
HgA1c
this test will indicate the average blood glucose for the last ___ months
2-3
Normal HbA1c is
4%-5%.
HbA1c.
THIS TEST WILL BE INACCURATE WITH THOSE PATIENTS THAT HAVE ___
ANEMIA.
blood glucose is raised by….
Food Acute illness or trauma Emotional stress Obesity Some medications (such as steroids)
blood glucose is lower by…
Insulin Some oral diabetes medications Alcohol Weight loss Some medications (such as pentamidine)
Treatment of Diabetes
Dietary management Weight management Exercise Blood glucose monitoring Oral hypoglycemics or insulin Pancreatic transplant
What is the only cure for Diabetes
pancreatic transplant
benefits of exercise for diabetics
increases uptake of glucose improves insulin usage increases circulation improves cardiovascular status decreases stress assists with weight loss reduced incidence of complications
Insulin can not be taken by mouth as it’s a ___ and would be digested.
protein
define onset of action
once insulin is injected until it begins to lower the blood sugar.
define peak action
occurs when the insulin is working its hardest and the blood glucose is at it’s lowest point.
action of oral hypoglycemics
The action is to either increase the production of insulin, or decreases glucose production by the liver.
Most people that have glucose in their urine have a blood glucose of approximately ___ or more.
180
possible causes of hyperglycemia
To much CHO intake
Stress
(remember stress releases epinephrine, cortisol, growth hormone and GLUCAGON!) These hormones increase blood glucose levels
hypoglycemia is when BS level is below
50
Symptoms of hypoglycemia are caused by activation of the sympathetic nervous system. they are…
Hunger Sweating Pallor Tremor Palpitations Headache Behavior changes Irritability!
if hypoglycemia, give ___ oz of CHO. what are some examples of CHO
4 oz
OJ, hard candy, soda, raisins, glucose tablets
Diabetic ketoacidosis (DKA) is an acute complication of diabetes mellitus characterized by:
Hyperglycemia Ketonuria Acidosis Dehydration Hyperkalemia
pathophysiology of diabetic ketoacidosis
Insulin deficiency prevents glucose from being used for energy, forcing the body to metabolize fat for fuel.
The fat breakdown releases an acid substance called ketones.
As ketones build up in the blood, ketoacidosis occurs.
In DK The body attempts to compensate for ____ by deepening the respirations, thereby blowing off excess CO2. These respirations are called ___ respirations.
acidosis
Kussmaul’s
interventions for DK
- -IV Fluids will be the initial treatment, the patient will be dehydrated.
- -Insulin will be initially be added to the IV fluids.
- -when Blood sugars down to 180, glucose may be added, to prevent hypoglycemia!
- -ABG’s will be monitored in order to observe the acidosis.
- -Monitor glucose levels every hour until stable
- -Monitor specific gravities until patient is more stable with the dehydration problem.
- -I&O
Summarize Hyperosmolar-Hyperlycemia Nonketotic syndrome (HHNK)
Complication of diabetes mellitus TYPE II
It also primarily occurs in the elderly.
Precipitating stressful events (cardiac failure, burn, or chronic illness)
As the blood glucose rises, polyuria causes dehydration producing the hyperosmolar (concentrated) state.
Blood glucose can get as high as 1500
There are little or no ketones.
patient will not feel as ill as the patient with DKA.
S/S: extreme thirst, lethargy and confusion.
Nursing intervention for HHNK
- -Restoring Fluid Balance
- -Assess patient for increasing s/s of dehydration, hyperglycemia, electrolyte imbalance.
- -Monitor those LAB VALUES
- -Institute fluid replacement therapy as ordered
- -Administer insulin as ordered
- -Maintain patent IV line.
macrovascular complications of diabetes
Atherosclerosis Arteriosclerosis HTN Increase of LDL Increase chance of stroke and heart attacks Poor circulation in feet and legs Increase clotting
what is retinopathy
involves damage to tiny blood vessels that supply the eye
Small hemorrhages occur which can cause blindness.
