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NURS 306 > Diabetes Mellitus > Flashcards

Diabetes Mellitus Flashcards

1
Q

Diabetes Mellitus (DM)

A
  • multisystem disease related to: defect in insulin production or action, or both
  • always results in hyperglycemia no matter the cause.
  • 7th leading cause of death in the US
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2
Q

What is the leading cause of chronic diseases?

A

diabetes mellitus

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3
Q

Types of Diabetes Mellitus

A
  1. Type 2 Diabetes Mellitus

2. Type 1 Diabetes Mellitus

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4
Q

Type 2 Diabetes Mellitus

A
  • Most common
  • 90-95% of patients have Type 2
  • Affects adults and children
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5
Q

Pathogenesis: Type 2 Diabetes Mellitus

A

Caused by relative INSULIN DEFICIENCY (reduced insulin secretion by pancreas) and insulin produced is either insufficient or poorly utilized by the tissues (INSULIN RESISTANCE) due to defective insulin receptors –> hyperglycemia

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6
Q

Insulin Resistance

A
  • tissues do not respond to insulin (reduced number and sensitivity of insulin receptors)
  • resistance to the actions of insulin in muscle, fat and liver
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7
Q

Impaired fasting glucose

A

mild alteration in Beta cell function

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8
Q

Impaired glucose tolerance

A
  • progression impaired from fasting glucose approx. 10-25% will convert to DM Type 2 within 10 years
  • many are obese
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9
Q

Metabolic Syndrome

A

also known as insulin resistance syndrome, Metabolic X.

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10
Q

Metabolic Syndrome: Collection of comorbidities that are associated with type 2 diabetes

A
  1. Coronary artery disease
  2. Central obesity
  3. Dyslipidemia
  4. HTN
  5. Microalbuminuria (spilling of protein into urine), and increase risk for thrombotic events.
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11
Q

Goal BP for Type 2 Diabetes

A

130/80

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12
Q

Prediabetes Screenings

A

categories of increased risk for diabetes including:

  • hemoglobin A1C of 5.7% - 6.4%
  • Fasting plasma glucose (FPG) levels higher than or equal to 100 mg/dL but less than 126 mg/dL.
  • impaired glucose tolerance test (oral glucose exchange)
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13
Q

Diabetes screening is recommended every

A

3 years for all patients 45 years of age or older.

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14
Q

Type 2 Diabetes Diagnostics

A
  • Fasting plasma glucose level > or = 126 mg/dL
  • Random Plasma glucose > or = 200 mg/dL plus symptoms
  • HgbA1C > or = 6.5%
  • Two-hour plasma glucose > or = 200 mg/dL during oral glucose tolerance test
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15
Q

Clinical Manifestations of Type 2 Diabetes

A
  • asymptomatic at early onset
  • weight loss
  • 3 P’s: Polydipsia, Polyuria, Polyphagia
  • May have other symptoms
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16
Q

Possible Physical Findings in Patients with Type 2 Diabetes Mellitus

A
  • Obesity, particularly central
  • Hypertension
  • Eye-hemorrhages, exudates, neovascularization
  • Skin-acanthosis nigricans (particularly in dark skinned ethnic and racial groups); candida infections
  • Neurologic: decreased or absent light touch, temp sensation and proprioception; loss of deep tendon reflexes in ankles
  • fleet-dry, muscle atrophy, claw toes, ulcers
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17
Q

What are causes of Hyperosmolar nonketotic syndrome (HNKS) ?

A
  • illness, infection, severe pain
  • uncontrolled blood glucose, high carb diet, medications (i.e steroids)
  • can result in metabolic acidosis -> coma, if untreated.
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18
Q

Hyperosmolar nonketotic syndrome (HNKS) signs/symptoms

A

LIFE THREATENING

  • polyuria, polydipsia
  • dehydration, anorexia
  • lethargy, confusion, tachypnea, electrolyte disturbances, N/V
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19
Q

Hyperosmolar nonketotic syndrome (HNKS)

A
  • severe dehydration and electrolyte imbalance
  • less ketones when compared to DKA
  • blood glucose >600 mg/dL
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20
Q

Hyperosmolar nonketotic syndrome (HNKS) treatment

A
  • Normal Saline IV (administer 1st for fluid loss)
  • Regular Insulin (for hyperglycemia)
  • Potassium (to treat potassium/electrolyte loss)
  • Acid-base balance
  • Treat underlying cause (i.e infection, pain, illness.)
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21
Q

Type 1 Diabetes Mellitus

A
  • mostly in children and young adults but can occur at any age
  • < 10% of individuals with DM have Type 1
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22
Q

Pathogenesis: Type 1 Diabetes Mellitus

A
  • Destruction of pancreatic beta cells (caused by autoantibodies, genetic predisposition & RT human leukocyte antigens (HLAs) or exposure to a virus)
  • lack of insulin production
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23
Q

Clinical Manifestations of Type 1 Diabetes Mellitus

A
  • 3 P’s: Polydipsia, Polyuria, Polyphagia

- Other symptoms: fatigue, generalized weakness, visual changes, frequent infections, rapid weight loss

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24
Q

Diabetic Ketoacidosis (DKA)

A
  • when no insulin is present to allow glucose to be used for energy production, the body resorts to breaking down fatty acids for fuel which produces ketones as a by-product.
  • uncontrolled diabetes, LIFE THREATENING
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25
Q

Causes of Diabetic Ketoacidosis

A
  • illness, infection, severe pain
  • extreme anxiety, stress
  • vigorous exercise, omission of meds/insulin
26
Q

Signs and Symptoms of Diabetic Ketoacidosis

A
  • extreme hyperglycemia (BLOOD GLUCOSE OF 300 OR MORE) and PRESENCE OF KETONES in serum
  • METABOLIC ACIDOSIS, dehydration and electrolyte imbalances
  • nausea, vomiting, confusion, lethargy
  • polydipsia, polyuria, polyphagia, tachypnea
27
Q

Treatment for Diabetic Ketoacidosis

A
  • Normal Saline IV (0.9-0.45%: for fluid loss)
  • Regular Insulin (for hyperglycemia)
  • Potassium (for potassium/electrolyte loss)
  • Acid-base balance
  • Treat underlying issue
28
Q

Without treatment for Diabetic Ketoacidosis, it could lead to

A

coma and death

29
Q

DKA is most common in

A

patients with type 1 but can be seen in patients with type 2.

30
Q

Gestational Diabetes

A
  • Hyperglycemia that develops during pregnancy.

- Pancreas can be overwhelmed due to glucose needed for the woman AND the fetus.

31
Q

Gestational Diabetes occurs in what percentage of pregnancies and is detected after how long?

A
  • 2-10% of pregnancies.

- is detected at 24-28 weeks of gestation

32
Q

Gestational Diabetes effects

A
  • increases pregnancy complications, mortality and fetal abnormalities if left untreated
  • usually subsides after delivery, but 30% of pts may develop type 2 diabetes within 10-15 years
33
Q

Gestational Diabetes Treatments

A
  • Diet and Medications (meds if necessary)
  • Insulin (to prevent birth defects)
  • Glyburide or Metformin (concern for long-term adverse effects from these meds)
34
Q

Secondary Diabetes

35
Q

Diagnostics for Secondary Diabetes?…

A
  • Fasting plasma/serum glucose level > 126 mg/dl
  • Random plasma/serum glucose >200 mg/dl measurement plus symptoms
  • IFG 100-125 mg/dL
36
Q

HgbA1C

A

hemoglobin A1C or glycosylated hemoglobin A1C.

**most comprehensive evaluation of glucose control

37
Q

A1C goal

A

less than 7

38
Q

Hypoglycemia

A

abnormally low blood glucose level

<50 mg/dL

39
Q

Clinical Manifestations of Hypoglycemia

40
Q

Treatment of Hypoglycemia

A
  • orange juice
  • buccal tablets
  • semisolid gel
  • 50% dextrose in water (D50W)
  • glucagon
41
Q

Chronic Complications of Diabetes Mellitus

A
  • PVS, coronary artery disease, cerebrovascular accident (stroke)
  • Retinopathy, nephropathy, dermopathy (microvascular/capillary damage)
  • Neuropathy
  • Infection
42
Q

Goals of DM Management

A
  • reduce symptoms
  • promote well-being
  • prevent acute complications
  • delay onset and progression of long-term complications
43
Q

Treatment Plan for DM

A
  • patient teaching
  • lifestyle changes (diet, regular exercise)
  • drug therapy
  • self-monitoring of blood glucose
  • regular follow up with HCP
44
Q

Preventative Measures of Diabetes Mellitus

A
  • reducing alcohol intake

- regular exercise

45
Q

Complete Pathogenesis of Type 1 Diabetes

A
  • Transition between preclinical and onset of type 1 is triggered by acute illness, major emotional stress or an unidentified viral infection.
  • These triggers involve the release of cortisol and epinephrine which cause more glucose to be released, which triggers the final autoimmune reaction that destroys the insulin-producing beta cells.
46
Q

Macrovascular complications from DM

A

secondary to large vessel damage caused by deposition of atherosclerotic plaque
-CAD, cardiomyopathy, HTN, cerebrovascular disease, peripheral vascular disease.

47
Q

Microvascular complications from DM

A

complications secondary to damage to capillary vessels (impairs peripheral circulation and damages eyes and kidneys)
-retinopathy, nephropathy, neuropathy

48
Q

Glucose homeostasis is regulated by

A

insulin (beta cells) and glucagon (alpha cells)

49
Q

Glucose

A

primary source of energy for cells in the body

50
Q

Optimal blood glucose levels

A

70-100 mg/dL

51
Q

Hemoglobin A1C tests normal

A

<5.5%

RBC life span around 2-3 months

52
Q

Insulin

A

-uptake of glucose in skeletal, cardiac and adipose tissue.

causes liver to store glucose as glycogen

53
Q

Without insulin

A

blood glucose levels rise

54
Q

Polyphagia

A

excessive eating due to being hungry all the time

55
Q

Polyuria

A

increased urine output

56
Q

polydipsia

A

increased water intake due to being thirsty

57
Q

Importance of screening

58
Q

Risk factors for DM

59
Q

Significance of DM

60
Q

Nonpharmacological management of DM

61
Q

Nursing Process and Patient Centered Care: Patient Teaching

A

pg 514-521

62
Q

Most common S&S of diabetes mellitus

A
  • elevated blood glucose levels
  • polyuria
  • polydipsia
  • polyphagia
  • glycosuria
  • weight loss
  • blurred vision
  • fatigue

NURS 306 (26 decks)

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