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N232 > Diabetes Part 1 > Flashcards

Diabetes Part 1 Flashcards

1
Q

what is the main goal of diabetes management?

A

to normalize insulin and BG levels to reduce the development of vascular and neuropathic complications

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2
Q

what 3 complications can result from diabetes?

A
  • retinopathy
  • nephropathy
  • neuropathy
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3
Q

what can reduce the chance of developing complications?

A

glucose control

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4
Q

what are the 3 major adverse effects for intensive therapy?

A
  • hypoglycemia
  • coma
  • seizure
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5
Q

what are the 5 components of diabetes management?

A
  • nutrition
  • exercise
  • monitoring
  • pharmacologic therapy
  • education
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6
Q

what is more important when it comes to diet?

hint: calories

A

control of total caloric intake to attain or maintain a reasonable boy weight and control BG levels

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7
Q

what can control of caloric intake successfully lead to?

A

reversal of hyperglycemia in type 2 diabetes

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8
Q

what are the 5 goals for nutrition management in a diabetic?

A
  • providing all of the essential foods for optimal nutrition
  • meeting energy needs
  • achieving and maintaining a reasonable weight
  • preventing wide fluctuations in glucose levels throughout day
  • decreasing serum lipid levels
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9
Q

why is consistency of time between meals and snacks important?

A

helps in preventing hypoglycemic reactions and in maintaining overall BG control

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10
Q

what are three acute complications of diabetes?

A
  • hypoglycemia
  • DKA
  • HHNS (hyperglycemic hyperosmolar nonketoic coma)
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11
Q

what BG is considered hypoglycemia?

A

less than 2.7-3.3 mmol/L

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12
Q

what is hypoglycemia caused by? (3)

A
  • too much insulin or oral hypoglycemic agents
  • too little food
  • excessive physical activity
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13
Q

when can hypoglycemia happen?

A

anytime in the day or night

- often occurs before meals or when they are delayed

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14
Q

what 2 categories are hypoglycemia symptoms separated into?

A
  • adrenergic symptoms

- central nervous system (CNS)

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15
Q

what are symptoms of mild hypoG?

A
  • SNS is stimulated
  • resulting in a surge of epinephrine and norepinephrine resulting in: sweating, tremor, tachycardia, palpitations, nervousness, and hunger
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16
Q

what are the symptoms of moderate hypoG?

A
  • impaired Fx of CNS: inability to concentrate, headache, light-headedness, confusion, memory lapses, numbness of lips
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17
Q

what are the symptoms of severe hypoG?

A

CNS so impaired, patient needs help to manage sympt

- disoriented behaviour, seizures, difficulty arousing from sleep, loss of consciousness

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18
Q

what is a factor contributing to altered hypoG sympt?

A

dec. hormonal (androgenic) response to hypoG

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19
Q

what are some considerations for older adults? (4)

A
  • live alone and may not be able to detect hypoG
  • dec. renal Fx
  • skipping meals
  • dec. visual acuity
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20
Q

what is the management for mild-moderate hypoG?

A

15g of carbs

  • wait 15 mins and retreat if BG less than 3.8-4.0 mmol/L
  • after get a snack of protein and starch UNLESS patient has a meal coming
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21
Q

what must people receiving insulin carry at all times?

A

simple sugar (eg. tablets, gel)

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22
Q

what should one refrain from eating when trying to treat hypoG? why?

A
  • high calorie and high-fat desserts

- slow absorption rate of glucose into blood

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23
Q

what is the management for a unconscious patient with hypoG?

A

1mg glucagon can be injected

- subcut or IM

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24
Q

what is glucagon?

A

a hormone produced by the alpha cells of the pancreas that stimulate the liver to release glucose

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25
Q

how long can it take for the hypoG patient to become conscious again after the infection?

A

up to 20 mins

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26
Q

what should be given to the patient once they wake from the hypoG coma?

A

concentrated carbohydrate

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27
Q

what are some macrovascular complications of diabetes?

A
  • CAD (most common)
  • PVD
  • cerebral vascular disease
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28
Q

why could diabetics have a lock of ischemic response?

A

may be d/t autonomic neuropathy

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29
Q

what are S&S of PVD?

A
  • diminished peripheral pulses
  • intermittent claudication
  • inc. incidence of gangrene and amputation
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30
Q

what can have accelerated development in patient’s with diabetes?

A

atherosclerosis

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31
Q

what can diabetics do to dec. their chance of developing a CV disease? (7)

A
  • achievement and maintenance of healthy body weight
  • healthy diet
  • physical activity
  • smoking cessation
  • optimal glycemic control
  • optimal BP control
  • additional vascular protective meds
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32
Q

when should statins be used?

A
  • age >40 with one of the following:
  • diabetes duration >15y and age >30
  • microvascular compx
  • warrants therapy based on other risk factors
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33
Q

when should ACE or ARB be used?

A
  • clinical macro-vascular disease
  • age >55 for those with additional risk factors or end organ damage
  • age >55 and microvascular complx
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34
Q

what drug should be used routinely for primary prevention of CV disease in people with diabetes?

A

ASA

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35
Q

what thickens in microvascular complications?

A

the capillary basement membrane

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36
Q

what is diabetic retinopathy caused by?

A

changes in the small BV in the retina, which is the area of the eye which receives images and sends info to the brain

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37
Q

what are the three main stages of retinopathy?

A

non-proliferative, pre-proliferative, and proliferative

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38
Q

what are 4 changes to the microvasculature?

A
  • microaneurysms
  • intraretinal hemorrhage
  • hard exudates
  • facial capillary closures
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39
Q

do most patients get visual impairments?

A

NO!

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40
Q

what can macular edema lead to?

A

visual distortion and loss of central vision

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41
Q

what is the biggest threat to vision? why?

A

proliferative retinopathy

- this is where new BV form, and these are more prone to bleeding

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42
Q

what happens when there is bleeding in the vitreous of the eye?

A

becomes clouded and cannot transmit light, resulting in loss of vision

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43
Q

what are clinical manifestations of retinopathy?

A
  • painless process
  • blurry vision d/t macular edema
  • spotty/hazy vision, complete loss of vision
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44
Q

how is retinopathy diagnosed?

A

direct visualization with an ophthalmoscope or with a technique known as fluorescein angiography (dye injected and goes to capillaries in the eye)

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45
Q

what is medical management for retinopathy?

A
  • maintenance of BG

- argon laser photocoagulation

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46
Q

what is argon laser photocoagulation?

A

destroys leaking vessels and areas of neovascularization

- stops wide growth of new vessels and hemorrhaging of damaged vessels

47
Q

what are nursing interventions for retinopathy?

A
  • impliment care plans and educating patients
  • encouraging regular ophthalmic appointments
  • early diagnosis
  • helping the patient to use any extra adaptive devices for their vision
48
Q

what is the best way to preserve vision in retinopathy?

A

frequent eye exams

49
Q

what is nephropathy?

A

renal disease secondary to diabetic microvascular changes in the kidneys and is a common complx of diabetes

50
Q

when associated with diabetes nephropathy is the leading cause of…

A

…kidney failure

51
Q

what are the mnfts of diabetic nephropathy?

A
  • similar to those in a non-diabetic

- catabolism of exogenous and endogenous insulin decreases and frequent hypoG episodes may result

52
Q

what happens if renal fx dec?

A

patient may have multi-organ failure

53
Q

what is one of the most important proteins that leak into the urine?

A

albumin

54
Q

if microalbuminuria is present, what are the chances that nephropathy will develop?

A

85%

55
Q

how might nephropathy be diagnosed?

A

early detection may be made by testing a random urine sample for the albumin to creatine ratio (ACR) along with the dipstick test to rule out non-diabetic renal disease

56
Q

what is the level of ACR for the diagnosis of nephropathy to be made?

A

2.0 mmol in 2/3 specs

57
Q

what else may develop with real disease?

HINT: blood pressure

A

HTN

58
Q

what are medical managements of nephropathy?

A
  • control of HTN
  • prevention and treatment of UTIs
  • avoidance of nephrotoxic substances
  • low sodium and protein dites
59
Q

what treatment takes place at the end stages of kidney disease?

A

dialysis or transplantation (relative or cadaver)

60
Q

what are the chances that the transplanted kidney will continue to fx for 5 years?

A

75-80%

61
Q

what other transplant may also be attempted at the same time as the kidney?

A

pancreas

62
Q

what are diabetic neuropathies?

A

groups of diseases that affects all types of nerves (peripheral, autonomic, and spinal)

63
Q

what do the diversities of diabetic neuropathies depend on?

A

the location of the affected nerve cells

64
Q

what are clinical manifestations of peripheral neuropathy?

A
  • symptoms include parathesias and burning sensations
  • feet become numb
  • a decrease in proprioception, sensation
  • dec. sensation of pain and temp
65
Q

what does dec. sensation of pain and temperature d/t neuropathy put the diabetic at higher risk for?

A

injury and undetected foot infection

66
Q

what is a management technique for peripheral neuropathy? why?

A
  • intensive insulin therapy and control of BG levels delay the onset and slow the progression of neuropathy
67
Q

how long does pain persist in peripheral neuropathy?

A

for some 6 months, others for years

68
Q

what systems of the body do autonomic neuropathies affect?

A

cardiac, GI, and renal systems

69
Q

how does autonomic neuropathy affect the CV system?

A
  • tachycardia
  • orthostatic HTN
  • silent, painless ischemia
70
Q

how does the autonomic neuropathy affect the GI system?

A
  • delayed gastric emptying, bloating, nausea, vomiting
71
Q

how does the autonomic neuropathy affect the renal system?

A

urinary retention, a dec sensation of bladder fullness

72
Q

why do patients with autonomic neuropathy often develop UTIs?

A

are not able to empty bladder fully

73
Q

what is autonomic neuropathy of the adrenal medulla responsible for?

A

diminished or absent adrenergic signs of hypoG

74
Q

what is sudomotor neuropathy?

A

decrease or absense of sweating

75
Q

why is sudomotor neuropathy a problem?

A

dryness of the feet cause cause foot ulcers

76
Q

what kind of sexual disfunction can men face when dealing with autonomic neuropathy?

A

hard time getting erections, staying erect, and ejaculating

77
Q

what is the Tx for silent MIs?

A

there is none, and prognosis is poor… :(

78
Q

what are 2 Tx for orthostatic HTN?

A

high sodium diet and discontinuation of meds that impede the autonomic NS

79
Q

how are some Tx for delayed gastric emptying?

A
  • low fat diet
  • frequent small meals
  • close blood glucose control
  • use of agents that inc. gastric motility
80
Q

what are some Tx of constipation?

A
  • high-fiber diet
  • hydration
  • laxatives/enemas may be needed
81
Q

how does neuropathy contribute to foot and leg problems in diabetics?

A

loss of pain/pressure

82
Q

how does PVD contribute to foot and leg problems in diabetics?

A

poor circulation to lower extremities

83
Q

hows does being immunocompromised contribute to foot and leg problems in diabetics?

A

hyperglycemia impairs the ability of specialized leukocytes to destroy bacteria

84
Q

what is the typical sequence for the development of a foot ulcer?

A

soft tissue injury –> pt does not inspect the feet daily so does not notice –> ulcer forms

85
Q

what should diabetics do to dec. the formation of ulcers?

A

inspect feet daily for drainage, swelling, redness, or gangrene

86
Q

what are some Tx for foot ulcers?

A

bedrest, Abx, debridement

87
Q

why do foot ulcers on a diabetic have less of a chance to heal?

A

lack of oxygen, nutrients, and Abx to site (reduced blood flow)

88
Q

what are other risk factors for developing foot and leg problems as a diabetic?

A
  • duration of diabetes >40y
  • age older than 40y
  • Hx of smoking
  • dec. peripheral pulses
  • dec. sensation
  • anatomic deformities or pressure areas
  • history of previous foot ulcers or amputations
89
Q

management for foot ulcers?

A
  • inspect feet
  • bathe, moisturize (NOT b/w toes)
  • close-toed shoes that fit well
  • trimming toe nails straight across
  • reducing risk factors
90
Q

what is the accepted glycemic value for perioperative patients with diabetes?

A

5.0-10.0 mmol/L

91
Q

what is the perioperative period?

A

from the time the patient goes to the hospital for their procedure until the time they come home

92
Q

is hyperG or hypoG a concern for patients undergoing surgery?

A

hyperG

93
Q

what is crucial during surgery periods?

A

frequent capillary glucose monitoring

94
Q

what are the 4 approaches to surgery with a diabetic?

it’s loooooong

A
  • the morning of, all insulin doses are withheld
  • one half or two thirds of the patient’s usual morning dose of insulin is administered subcut in the morning before the surgery
  • daily dose is divided into 4 equal doses
  • patient with type 2 who do not usually take insulin may require it during perioperative periods
95
Q

why do you need to monitor for CV complications during the perioperative period?

A

because inc. prevelence of atherosclerosis in patients with diabetes

96
Q

what do you need to monitor in the integument during perioperative period?

A

wound infections, skin breakdown

97
Q

what is “pre-prandial”?

A

done or taken before meals

98
Q

what is an accepted pre-prandial glucose level in the hospital?

A

5.0-8.0 mmol/L

99
Q

what is an accepted BG for a med/surg patient that is very ill and has a continuous IV of insulin?

A

between 8-10 mmol/L

100
Q

what are 5 factors that can cause hyperG in the hospital?

A
  • changes in usual treatment regimens
  • medications
  • IV dextrose
  • overly vigorous treatment of hypoG
  • mismatched timing of meals and insulin
101
Q

what are 3 factors that lead to hypoG in the hospital?

A
  • overuse of the sliding scale
  • lack of dosage change when dietary intake is changed
  • overly vigorous treatment of hyperG
102
Q

is one reason patients would be NPO?

A
  • prep for surgery/post surgery
103
Q

do you have to deliver insulin to a type 1 that is NPO?

A

ABSOLUTELY

104
Q

do you have to administer insulin to a type 2 who is NPO? why?

A

not necessarily… DKA will not develop in patients with type 2 because they still produce SOME insulin

105
Q

how often should BBGM and insulin be done each day on a type 1 that is NPO for long periods of time?

A

often, 2-4 times a day

106
Q

what is a clear liquid diet?

A

some carbs such as juices and gelatin dessert

107
Q

when are diet drinks not appropriate?

A

when the only source of calories is clear liquids

108
Q

what does enteral tube feedings contain that is more than normal diabetic diet?

A

more simple carbs and less protein

109
Q

when should insulin be given to one on enteral tube feeds?

A

regular dosing ties at continous rate

110
Q

what are some barriers to learning for gerontologic patients?

A
  • dec. vision
  • hearing loss
  • inc. tremors
  • depression
  • loneliness
111
Q

what should be considered for older adults to test BG at home?

A
  • the choice of a meter should be tailored to the patient’s visual and cognitive status and dexterity
112
Q

when is frequent evaluation of self-care skills needed on patients with diabetes?

A

when vision and memory are deteriorating

113
Q

why is dietary adherence difficult for older adults?

A

decreased appetite, living alone, etc.

N232 (9 decks)

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