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Acute Care Final > Diabetes mellitus > Flashcards

Diabetes mellitus Flashcards

1
Q

alpha cells produce what

A

glucagon

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2
Q

beta cells produce what

A

insulin

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3
Q

Insulin promotes:

A
  • glucose production, use, and storage
  • hypoglycemia (and moves K+ back in cells) and glucagon promotes hyperglycemia
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4
Q

what type of agent is glucose and what is the action

A

osmotic
diuresis and fluid and F&E loss

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5
Q

what is diabetes and what are the types

A
  • Chronic multisystem disease characterized by hyperglycemia from abnormal insulin
    production, no insulin
    production, impaired insulin use, or all.
  • Without insulin, glucose builds up in the blood causing
    hyperglycemia
  • Type 1, Type 2, gestational, and secondary
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6
Q

clinical manifestations of DM

A
  • Polyuria - osmotic agent - diuresis
  • Polydipsia - excreted fluid - now thirsty
  • Polyphagia - no energy from glucose so need energy from food
  • Dehydration, weight loss, fatigue,
    weakness, vision changes,
    tingling/numbness if hands/feet, dry
    skin, lesions that are slow to heal,
    and recurrent infections
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7
Q

medical management of DM

A
  • Nutrition
  • Exercise
  • Glucose Monitoring
  • Medication
  • Education
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8
Q

Acute Complications of Diabetes Mellitus

A
  • Arise from events associated with
    hyperglycemia (DKA and HHS) and
    hypoglycemia (also referred to as
    insulin reaction).
  • Hypoglycemia worsens rapidly and
    constitutes a serious threat if action is
    not immediately taken.
  • All require emergency treatment and
    can be fatal!!!
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9
Q

glucose levels for hypoglycemia

A

Blood glucose falls below range of 50-60 mg/dL

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10
Q

treatment to increase blood glucose

A

Epi and glucagon
(using the autonomic nervous system) by stimulating liver

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11
Q

causes of hypoglycemia

A

overdose of diabetes medication (peak),
inadequate food intake,
increased exercise without food,
improper administration of insulin,
decreased food intake/missed meals,
increased insulin sensitivity,
decrease glucose production with alcohol consumption,
rapid hypoglycemia (in treatment of DKA & HHS),
nocturnal hypoglycemia,

can happen anytime
***More deadly than the other complications of DM

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12
Q

Hypoglycemia clinical manifestations

A
  • Diaphoresis
  • Tremor
  • Hunger
  • Tachycardia
  • Palpitation
  • Anxiety
  • Cool, clammy skin
  • CNS:
    – Headache
    – Confusion
    – Memory lapses
    – Numbness of lip and mouth
    – Slurred speech
    – Impaired coordination
    – Emotional changes
    – Irrational/combative behavior
    – Diplopia
    – Drowsiness
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13
Q

complications/severe s/s of hypoglycemia

A

disoriented behavior, seizures, difficulty arousing
from sleep, loss of consciousness
* Symptoms can occur suddenly and vary

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14
Q

relative hypoglycemia

A

The client seemingly has a glucose WNL, but is lower than their usual high numbers
The client frequently has a blood glucose level in low range of normal and are symptomatic when it falls below 50

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15
Q

hypoglycemic unawareness

A

Normal compensatory response fails to cause symptoms; hypoglycemia without warning

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16
Q

hypoglycemia treatment

A

Can be quickly reversed
Treatment depends on LOC, ability to eat, setting, & glucose level
Immediately check glucose upon symptom onset
“Rule of 15” ONLY IF ALERT!!!
* Give 15-20 g simple carb
– 3-4 glucose tablets
– 4-6 oz of fruit juice or reg soda
– 6-10 hard candies
– 2-3 teaspoons of sugar/honey
* Recheck in 15 min
* If still low, repeat procedure
* Notify MD after 2-3 failed tries
* Once glucose WNL, provide a snack or meal to prevent recurrent hypoglycemia
* explore causes
* prevention education

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17
Q

hypoglycemic treatment for unresponsive patient

A
  • 20-50 mL IV 50% Dextrose at rate of 10 mL/min (instant results)
  • No IV, not alert, & can’t swallow?  glucagon IM or SQ
  • Turn on side for risk of aspiration
  • Teach family/friends/coworkers how to use
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18
Q

what is diabetic ketoacidosis

A

Absence or markedly inadequate amount of insulin
* Characterized by uncontrolled hyperglycemia from profound insulin deficiency
* Just because they are hyperglycemic, doesn’t mean they are in DKA!
* Commonly occurs in type 1 DM
Untreated, the patient becomes comatose as a result of dehydration, electrolyte imbalance, and acidosis. If the condition is not treated, death is inevitable.

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19
Q

causes of DKA

A

insufficient/missed doses of insulin,
physical/emotional stress, illness, infection

20
Q

four key issues of DKA

A

hyperglycemia, ketosis,
metabolic acidosis, and dehydration

21
Q

patho of DKA

A
  • Lack of glucose in the cell causes the body to attempt to obtain energy by rapid breakdown of fat  fat breakdown that  ketones (acidic by-products)
  • Increased ketones leads to ketosis
  • Ketosis alters pH balance  metabolic
    acidosis
  • Glucose is an osmotic agent and blocks the reabsorption of water  osmotic diuresis  dehydration and loss of F&E
  • Severe depletion of sodium, potassium**, chloride
  • Potassium can be increased with metabolic acidosis
22
Q

clinical manifestations of DKA

A
  • Hyperglycemia: polyuria, polyphagia,
    polydipsia
  • Glucose 300-500
  • Dehydration
  • Blurred vision
  • Abdominal pain with anorexia, nausea,
    and vomiting
  • Acetone in breath  sweet, fruity odor
  • Kussmaul respirations to reverse
    acidosis
  • Mental status changes
23
Q

diagnostics for DKA

A
  • Glucose > 250 mg/dL
  • ABG: pH < 7.30, bicarb <16
  • Moderate to large ketones in
    urine and serum
  • Glycosuria
  • Increased anion gap
  • Abnormal K, NA, and chloride
24
Q

anion gap for DKA

A
  • Difference between the measured serum cations (Na) and anions (Cl and HC03) in ECF (p. 87)
    Helps determine source of acidosis and remaining anions in blood
  • Normal: 8-12 mmol/L
  • Increases in metabolic acidosis with acid gain (DKA, lactic acidosis)
  • Elevations in the amount of anions changes the pH of the. blood/serum, decreases pH, & creates a more acidic
    environment
  • May alert the HCP to the presence of a metabolic acidosis that might not be apparent on first glance of the arterial blood gas values.
25
organ involved in diabetes
pancreas
26
rehydration in dka
* 0.9% NS IV initially 1-1.5L bolus in first hour * Subsequent IV fluid replacement depends on Na, vitals, assessment, and U/O * When glucose <250 mg/dL, add 5-10% dextrose to prevent sudden hypoglycemia (from insulin admin) that can cause cerebral edema (from drastic changes in blood osmolarity) * Mindful of hydration to prevent overload * Monitor for s/s of FVO and fluid status (especially with older adults)
27
restoring electrolytes in dka
* Potassium may be low or high * If high, hold K replacement; insulin will help to reduce K * K must be replaced before starting insulin (some require K to be 3.3); do ECG prior to and monitor U/O * Monitor for s/s of too high or too low K * If K is low, provide replacement in IVF (check labs)
28
reversing acidosis in dka
* Regular insulin IV added to a saline solution and infused IV over rate of 0.1 unit/kg/hr (only regular insulin IV) * Assess hourly blood glucose * Goal: decrease glucose by 50-100 mg/dL/hr to prevent cerebral edema * IV insulin given until SQ can resume. * IV continues until bicarb level improves to 15 and anion gap is <12 * Administer sodium bicarb
29
Hyperglycemic Hyperosmolar Syndrome AKA Hyperglycemic Hyperosmolar Nonketotic Syndrome
Client produces enough insulin to prevent fat breakdown (leading to DKA), but not enough to prevent severe hyperglycemia, osmotic diuresis, and extracellular fluid depletion * Glucose levels climb high before it is recognized * Increased glucose  increased serum osmolality * NO ACIDOSIS!!
30
causes of HHNS
infection, acute/chronic illness, meds causing hyperglycemia, therapeutic procedures (HD or surgery); occurs more commonly with older adults
31
Type 1 diabetes patho
Autoimmune disorder where beta cells are destroyed because body attacks insulin secreting cells; also due to diseases of the pancreas
32
Type 2 diabetes patho
Person has a combo of insulin resistance and decreased beta-cell secretion of insulin
33
clinical manifestations and assessment of HHNS
* Hypotension (and postural) * Profound dehydration (dry membranes, poor skin turgor) * Tachycardia * Alteration in sensorium, seizures, hemiparesis * Diagnostics * 600-1200 mg/dL glucose * High serum osmo (>350 mOsm/kg) * BUN and electrolytes indicating dehydration
34
medical management of HHNS
* Goals: replace fluids (priority), correct electrolyte imbalances, administration of insulin * Close monitoring of fluid status, vitals, and labs and prevent FVO, HF, and dysrhythmias * Fluid treatment * 0.9% NS or 0.45% NS * K added with adequate U/O * When blood glucose 250-300 mg/dL, give IVF with dextrose * Insulin (regular) * Administered at a continuous rate * Requires large volumes of fluid replacement * Slowly and carefully * Hypokalemia not as severe, but still should be monitored and treated * Fall Precautions * Detect and correct underlying cause
35
surgery for diabetes
If hyperglycemia not controlled  dehydration and loss of F&E Hypoglycemia can occur Interventions * Frequently monitor glucose in the periop period * Post-op monitor for cardiovascular complications, wound infection, and skin breakdown
36
diabetes and hospitalization
Self-care issues * Must relinquish control and is hard to do * Acknowledge concerns and involve client in plan of care * If client disagrees/refuses, inform provider and healthcare team Hyperglycemia during hospitalization * Causes Hypoglycemia during hospitalization * Causes Assess glucose patterns, check glucose 3-4 hours, arrange snacks Assisting with Hygiene * Oral and skin care * Keep skin dry especially in folds * Prevention of pressure injuries * Feet should be cleaned, dried, lubricated with lotion and inspected frequently * Elevate heels on pillow Managing Stress * Encourage to follow DM plan * Stress and coping mechanisms
37
Patient and Family Education on Prevention
Be aware beta blockers can mask hypoglycemia manifestations Teach how to monitor glucose and provide return demonstration Wear a medical alert bracelet Teach not to delay a meal Teach family/friends how to administer glucagon Do not prolong exercise regimen Each 5 g of carbs raises blood glucose by 20 mg/dL Take 20-30 g of carbs if glucose <50; take 10-15 if glucose 51-70 Ingest alcohol after eating with carbs; avoid alcohol at night Prevent possible causes and have a plan to prevent Don’t delay a meal
38
examples of food to give for hypoglycemia
Glucose tablets or gel ½ cup of fruit juice ½ cup of regular soft drink (non diet) 8 oz of skim milk 6-10 hard candies 4 cubes of sugar 4 teaspoons of sugar 6 saltines 3 graham crackers 1 tablespoon of honey/syrup
39
what are ketones
acidic by-products of fat metabolism that can cause serious problems when they become excessive in the blood. Ketosis alters the pH balance, causing metabolic acidosis to develop
40
what is ketonuria
process that occurs when ketone bodies are excreted in the urine. During this process, electrolytes become depleted as cations are eliminated along with the anionic ketones in an attempt to maintain electrical neutrality
41
sick day rules
- take insulin - test glucose and urine for ketones - report elevated glucoses or ketones - may need to supplement regular insulin - substitute soft foods - Vomiting - take fluids - report symptoms - may require hospitalization
42
rapid acting insulin and peak
Lispro - Humalog Aspart - Novolog Glulisine - Apidra 30-90 min
43
short acting insulin
Regular Humulin R Novolin R 2-4 hrs
44
Intermediate insulin
NPH Humulin N Novolin N 4-12 hrs
45
long acting insulin
Glargine - lantus Detemir - Levemir None

Acute Care Final (5 decks)

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