Diabetes/Healthcare/Dying Flashcards
What is the result of diabetes?
glucose dysregulation leading to hyperglycemia
Type 2 DM is also known as _________. Type 1 DM is also known as ________.
Type 2 - non-insulin dependent or adult-onset (NIDDM)
Type 1 - absolute insulin deficiency (IDDM)
Prediabetes and Diabetes fasting glucose
- non-diabetic
prediabetes - 100-125 mg/dl
diabetes - >/= 126 mg/dl
non-diabetic - = 99
Prediabetes and Diabetes 2 hour glucose following ingestion of 75g glucose load
prediabetes - 140-199 mg/dl
diabetes - >/= 200 mg/dl
Prediabetes and Diabetes HbA1c
- non-diabetic
prediabetes - 5.7% - 6.4%
diabetes - >/= 6.5%
non-diabetic - <5.7%
What is the target HbA1c and what number is unacceptable?
target - < 7%
unacceptable - > 8%
normal fasting capillary blood glucose and post-prandial (after eating) blood glucose
normal fasting - 110 mg/dl
post-prandial - 180 mg/dl
glucose monitoring is mandatory for which patients
- patients using insulin
- patients taking sulfonylurea drugs
symptoms of hypoglycemia
- pale skin, sweaty (clammy)
- shakiness, anxiety
- hunger
- irritability
- fatigue
- tachycardia
- confusion
- blurred vision
symptoms of hyperglycemia
- thirst
- headache
- polyuria
- poor concentration/confusion
- fatigue
- blurred vision
- nausea
treatment for hypoglycemia
sugary snack like OJ, soda, etc.
treatment for hyperglycemia
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
What is glycemic index? What foods are lower?
- rating of how much glucose is needed to breakdown
- fat and dairy are typically lower than grains and starches
What is glycemic load?
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
What is the leading risk for T2DM?
obesity - Adipose tissue affects metabolism by secreting hormones
What are common adverse effects of metformin?
GI issues
Bolus vs basal insulin
Bolus – taken right before the meal (bowl of food)
Basal – slow constant release all day – to help control and keep steady control of glucose
adverse effects of insulin
hypoglycemia and weight gain
What is a significant predictory of diabetes?
HTN
Goal BP, at what systolic should you proceed w/ caution and when should you send patient to ED?
goal - < 130/80
proceed w/ caution - systolic > 160
ED - >/= 180/120
What can autonomic neuropathy cause?
may cause silent agina that can lead to MI
- Use Borg and modified Borg to monitor
Lowering what in Type 1 and 2 DM shows significant health benefits
Type 1: lowering A1c shows significant health benefits
Type 2: lowering BP shows significant health benefits
signs and symptoms of diabetic ketoacidosis. What type of diabetes is this more common in? What is treatment?
- fruity breath
- vomiting
- respiratory failure
- LOC/coma
- death
more common in type 1 diabetes
may require hospitalization (ICU) and IV fluids
What is hyperglycemic hyperosmolar state (HHS)? Which type of diabetes is it more common in?
- Severe hyperglycemia but no ketoacidosis
more common in type 2 diabetes
macrovascular complications from diabetes
large systems like Cardiovascular systems
- coronary artery disease
- peripheral artery disease
- stroke
Microvascular complications from diabetes
small individual systems
- diabetic neuropathy - PNS
- nephropathy - kidneys
- retinopathy - eyes
- vestibulopathy – vestibular/balance
Diabetic footwear CPG
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
____________ knee-high device can be used on non-ischemic/non-infected plantar ulcer. What is 2nd choice?
non-removable on non-ischemic/non-infected plantar ulcer
removable is 2nd choice
What diabetic footwear device is used when a knee-high device is not tolerated?
forefoot off-loading device
signs and symptoms of abuse in the patient
- unexplained or untreated injuries
- poor hygiene
- malnutrition and dehydration
- dirty or inappropriate dress
signs and symptoms of abuse in the abuser
- 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
What do restraints require?
MD order and must be discontinued after 24 hours unless well-documented for necessity
- must show failure of “less restrictive devices”
Medicare A basic coverage. Can student DPT treat?
- hospital care - IP hospital, SNF, Hospice, HH
- no premiums
student DPT can treat
Medicare B basic coverage. Can student DPT treat?
OP care, MD visits, preventive services, labs, DME, kidney supplies, wellness visit
- monthly premium and deductible then 20% coinsurance
student DPTs cannot treat
Medicare C basic coverage. Can student DPTs treat?
- All part A and B, usually part D. Can include eye, dental, hearing
- medicare advantage plan w/ monthly premiums
Medicare Part D basic coverage
prescription drugs
Palliative vs hospice care
Hospice – diagnosed w/ terminal illness and expected to die in 6 months or less
Palliative – have life long disease, but may not be terminal
what is rehabilitation light?
provides exercise and functional training at a much reduced intensity and frequency
what is rehabilitation in reverse?
training and education to assist patient and caregiver to transition to less independent mobility
What is skilled maintenance?
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
what is a durable power of attorney for health care (DPAHC)?
living will
what is a MOLST or POLST?
- medical/physician orders for life-sustaining treatment
explicit IDs extent and nature of life-sustaining interventions from comfort care all the way to full resuscitation
What does Patient Self-Determination Act f 1990 state?
pt has right to determine/facilitate treatment, can deny treatment, respect advance directives
Durable vs Springing POA
durable - continues after principle becomes incapacitated
Springing - gives the agent power only when the principal becomes incapacitated
Benefits of restraints
- prevent falls and injuries
- allow medical procedure to proceed w/o patient interference
- maintenance of body alignment
- protects others from physical harm by individual
Risks of restraints
- injury from falls
- strangulation
- skin abrasions and breakdown
- immobilization sequelae
- decline in ADLs
- social/emotional isolation
common requirements for restraint use in NC
- 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
What is respite care?
short-term care to provide respite for caregiver
