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Geriatrics > Diabetes/Healthcare/Dying > Flashcards

Diabetes/Healthcare/Dying Flashcards

1
Q

What is the result of diabetes?

A

glucose dysregulation leading to hyperglycemia

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2
Q

Type 2 DM is also known as _________. Type 1 DM is also known as ________.

A

Type 2 - non-insulin dependent or adult-onset (NIDDM)

Type 1 - absolute insulin deficiency (IDDM)

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3
Q

Prediabetes and Diabetes fasting glucose

- non-diabetic

A

prediabetes - 100-125 mg/dl

diabetes - >/= 126 mg/dl

non-diabetic - = 99

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4
Q

Prediabetes and Diabetes 2 hour glucose following ingestion of 75g glucose load

A

prediabetes - 140-199 mg/dl

diabetes - >/= 200 mg/dl

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5
Q

Prediabetes and Diabetes HbA1c

- non-diabetic

A

prediabetes - 5.7% - 6.4%

diabetes - >/= 6.5%

non-diabetic - <5.7%

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6
Q

What is the target HbA1c and what number is unacceptable?

A

target - < 7%

unacceptable - > 8%

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7
Q

normal fasting capillary blood glucose and post-prandial (after eating) blood glucose

A

normal fasting - 110 mg/dl

post-prandial - 180 mg/dl

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8
Q

glucose monitoring is mandatory for which patients

A
  • patients using insulin

- patients taking sulfonylurea drugs

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9
Q

symptoms of hypoglycemia

A
  • pale skin, sweaty (clammy)
  • shakiness, anxiety
  • hunger
  • irritability
  • fatigue
  • tachycardia
  • confusion
  • blurred vision
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10
Q

symptoms of hyperglycemia

A
  • thirst
  • headache
  • polyuria
  • poor concentration/confusion
  • fatigue
  • blurred vision
  • nausea
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11
Q

treatment for hypoglycemia

A

sugary snack like OJ, soda, etc.

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12
Q

treatment for hyperglycemia

A

check and see if they took their insulin/medical emergency due to potential ketoacidosis – if blood glucose is high then exercise, body will produce more glucose because it is not getting enough glucose in cells which is required for exercise

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13
Q

What is glycemic index? What foods are lower?

A
  • rating of how much glucose is needed to breakdown

- fat and dairy are typically lower than grains and starches

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14
Q

What is glycemic load?

A

compares index to load
- measure that takes into account the amount of carbohydrate in a portion of food together with how quickly it raises blood glucose levels.

(GI/100) x grams of carbs=GL

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15
Q

What is the leading risk for T2DM?

A

obesity - Adipose tissue affects metabolism by secreting hormones

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16
Q

What are common adverse effects of metformin?

A

GI issues

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17
Q

Bolus vs basal insulin

A

Bolus – taken right before the meal (bowl of food)

Basal – slow constant release all day – to help control and keep steady control of glucose

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18
Q

adverse effects of insulin

A

hypoglycemia and weight gain

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19
Q

What is a significant predictory of diabetes?

A

HTN

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20
Q

Goal BP, at what systolic should you proceed w/ caution and when should you send patient to ED?

A

goal - < 130/80
proceed w/ caution - systolic > 160
ED - >/= 180/120

21
Q

What can autonomic neuropathy cause?

A

may cause silent agina that can lead to MI

- Use Borg and modified Borg to monitor

22
Q

Lowering what in Type 1 and 2 DM shows significant health benefits

A

Type 1: lowering A1c shows significant health benefits

Type 2: lowering BP shows significant health benefits

23
Q

signs and symptoms of diabetic ketoacidosis. What type of diabetes is this more common in? What is treatment?

A
  • fruity breath
  • vomiting
  • respiratory failure
  • LOC/coma
  • death

more common in type 1 diabetes

may require hospitalization (ICU) and IV fluids

24
Q

What is hyperglycemic hyperosmolar state (HHS)? Which type of diabetes is it more common in?

A
  • Severe hyperglycemia but no ketoacidosis

more common in type 2 diabetes

25
Q

macrovascular complications from diabetes

A

large systems like Cardiovascular systems

  • coronary artery disease
  • peripheral artery disease
  • stroke
26
Q

Microvascular complications from diabetes

A

small individual systems

  • diabetic neuropathy - PNS
  • nephropathy - kidneys
  • retinopathy - eyes
  • vestibulopathy – vestibular/balance
27
Q

Diabetic footwear CPG

A

start from most stable (cast/prefabricated) to least stable (forefoot off-loading)

  • Casted or prefabricated offloading device
  • Non-removable knee-high device can be used on non-ischemic/non-infected plantar ulcer
  • Removable knee-high device 2nd choice
  • Forefoot off-loading device used when knee-high device not tolerated
28
Q

____________ knee-high device can be used on non-ischemic/non-infected plantar ulcer. What is 2nd choice?

A

non-removable on non-ischemic/non-infected plantar ulcer

removable is 2nd choice

29
Q

What diabetic footwear device is used when a knee-high device is not tolerated?

A

forefoot off-loading device

30
Q

signs and symptoms of abuse in the patient

A
  • unexplained or untreated injuries
  • poor hygiene
  • malnutrition and dehydration
  • dirty or inappropriate dress
31
Q

signs and symptoms of abuse in the abuser

A
  • aggression toward or verbal abuse of the patient
  • speaking for the patient during an exam or treatment
  • disagreeable to instructions or suggestion in patient’s best interest
32
Q

What do restraints require?

A

MD order and must be discontinued after 24 hours unless well-documented for necessity
- must show failure of “less restrictive devices”

33
Q

Medicare A basic coverage. Can student DPT treat?

A
  • hospital care - IP hospital, SNF, Hospice, HH
  • no premiums

student DPT can treat

34
Q

Medicare B basic coverage. Can student DPT treat?

A

OP care, MD visits, preventive services, labs, DME, kidney supplies, wellness visit
- monthly premium and deductible then 20% coinsurance

student DPTs cannot treat

35
Q

Medicare C basic coverage. Can student DPTs treat?

A
  • All part A and B, usually part D. Can include eye, dental, hearing
  • medicare advantage plan w/ monthly premiums
36
Q

Medicare Part D basic coverage

A

prescription drugs

37
Q

Palliative vs hospice care

A

Hospice – diagnosed w/ terminal illness and expected to die in 6 months or less
Palliative – have life long disease, but may not be terminal

38
Q

what is rehabilitation light?

A

provides exercise and functional training at a much reduced intensity and frequency

39
Q

what is rehabilitation in reverse?

A

training and education to assist patient and caregiver to transition to less independent mobility

40
Q

What is skilled maintenance?

A

when a patient needs to perform an activity that requires the skills of a PT – typically 1 visit to show caregiver and pt how to perform specific activity

41
Q

what is a durable power of attorney for health care (DPAHC)?

A

living will

42
Q

what is a MOLST or POLST?

- medical/physician orders for life-sustaining treatment

A

explicit IDs extent and nature of life-sustaining interventions from comfort care all the way to full resuscitation

43
Q

What does Patient Self-Determination Act f 1990 state?

A

pt has right to determine/facilitate treatment, can deny treatment, respect advance directives

44
Q

Durable vs Springing POA

A

durable - continues after principle becomes incapacitated

Springing - gives the agent power only when the principal becomes incapacitated

45
Q

Benefits of restraints

A
  • prevent falls and injuries
  • allow medical procedure to proceed w/o patient interference
  • maintenance of body alignment
  • protects others from physical harm by individual
46
Q

Risks of restraints

A
  • injury from falls
  • strangulation
  • skin abrasions and breakdown
  • immobilization sequelae
  • decline in ADLs
  • social/emotional isolation
47
Q

common requirements for restraint use in NC

A
  • prohibited in prone
  • may be used if necessary to prevent imminent danger or injury
  • Not used for discipline
  • must be ended at earliest possible time
  • may only be used when less restrictive interventions have been determined to be ineffective
  • must be ordered by a physician
48
Q

What is respite care?

A

short-term care to provide respite for caregiver

Geriatrics (7 decks)

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