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NUR 202 Week 3 > Diabetes Pt 6 - Chronic Complications > Flashcards

Diabetes Pt 6 - Chronic Complications Flashcards

1
Q

?

  • Damage to blood vessels 2° chronic hyperglycemia
  • Leading cause of DM-related death
  • Macro- or microvascular
  • Tight glucose control (in type 1 - DCCT study; type 2 - UKPDS) can prevent or minimize complications
A

Angiopathy

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2
Q

?

Diseases of large & medium-sized blood vessels
- Greater freq & earlier onset in pts w/DM
- cerebrovascular, cardiovascular, & peripheral vascular dz

A

Macrovascular angiopathy

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3
Q
  • Decrease risk factors (yearly screening)
  • Obesity
    ! Smoking (esp injurious to those w/DM & sig inc risk for blood vessel & CVD, CVA, & lower extrem amputation)
  • HTN
  • High fat intake
  • Sedentary lifestyle

A target BP of 130/80 is recommended for all pts w/DM

A
  • Screen for & treat hyperlipidemia
    ADA recommends (target values):
    LDL <100 mg/dL
    TG’s <150 mg/dL
    HDL >40 mg/dL (M) & >50 mg/dL (F)
  • Rx’s (primarily statins) are rec for people who do not reach lipid goals w/lifestyle modifications & for people older than 40 yrs w/other CVD risk factors, regardless of baseline lipid lvls
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4
Q

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Thickening of vessel membranes in capillaries & arterioles

Specific to DM & includes
- Retinopathy
- Nephropathy
- Dermopathy

  • Clinical manifestations usually appear 10-20 years >dx (w/type 2 @ time of dx)
A

Microvascular angiopathy

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5
Q

?

Microvascular damage to the retina as a result of chronic hyperglycemia, presence of nephropathy, & HTN in pts w/DM

  • Most common cause of new cases of adult blindness
  • Nonproliferative: more common
  • Proliferative: more severe
A

Diabetic retinopathy

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6
Q

?

  • Involves retina & vitreous humor
  • New blood vessels formed (neovascularization); very fragile & bleed easily
  • Can cause retinal detachment
A

Proliferative (most severe)

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7
Q

?

Partial occlusion of small blood vessels in retina causes microaneurysms to develop in capillary walls
- Vision may be affected if macula is involved

A

Nonproliferative (most common)

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8
Q

Persons w/DM are also prone to other visual problems

  • Glaucoma occurs as a result of the occlusion of the outflow channels 2° to neovascularization; this type of glaucoma is difficult to treat & often results in blindness
A
  • Cataracts develop @ an earlier stage & progress more rapidly in people w/DM
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9
Q
  • Initially no changes in vision
  • Annual eye exams w/dilation to monitor
  • Maintain glycemic control & manage HTN
A

Treatment

  • Laser photocoagulation
  • Most common
    → to reduce risk of vision loss in pts w/proliferative retinopathy or macular edema & in some cases of nonproliferative retinopathy
  • Laser destroys ischemic areas of retina
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10
Q

> Vitrectomy

  • Aspiration of blood, membrane, & fibers from inside the eye through a small incision behind the cornea
A
  • Drugs to block action of vascular endothelial growth factor (VEGF)
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11
Q

?

Damage to small blood vessels that supply the glomeruli of kidney

Leading cause of ESRD

Risk factors
- HTN
- Genetics
- Smoking
- Chronic hyperglycemia

A

Diabetic nephropathy

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12
Q

> Annual screening
- Check for albuminuria w/measuring albumin-to-creatinine ratio in a random spot urine collection; also serum creatinine as an est of GFR & ° of kidney function

> If albuminuria is present, drugs to delay progression
- ACE inhibitors (e.g., lisinopril [Prinivil, Zestril])
- Angiotensin II receptor antagonists (e.g., losartan [Cozaar])

A
  • Control of HTN & tight BG control imperative
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13
Q

?

Nerve damage d/t metabolic derangements of DM

Of pts w/DM, 60-70% have some ° of ___

  • Reduced nerve conduction & demyelinization
  • Sensory or autonomic
A

Diabetic neuropathy

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14
Q
  • The pathophysiologic processes of diabetic neuropathy are not well understood
  • Several theories exist, including metabolic, vascular, & autoimmune factors
  • Prevailing theory is that persistent hyperglycemia leads to an accumulation of sorbitol & fructose in the nerves that causes damage by an unknown mechanism
  • Result is reduced nerve conduction & demyelinization
A
  • Ischemia in blood vessels damaged by chronic hyperglycemia that supply the peripheral nerves is also implicated in the development of diabetic neuropathy
  • Neuropathy can precede, accompany, or follow the dx of DM
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15
Q

The 2 major categories of diabetic neuropathy are ___ neuropathy, which affects the peripheral nervous system, & ___ neuropathy

  • Each of these types can take several forms
A

sensory; autonomic

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16
Q

___ neuropathy

  • Loss of protective sensation in lower extremities
    ! Major risk for lower limb amputation
A

Sensory

17
Q

___ ___ ___

  • Most common form of sensory neuropathy
  • Affects hands and/or feet bilaterally
  • loss of sensation [complete or partial loss of sensitivity to touch & temp]
  • abn sensations [pt reports walking on pillows or numb feet; sensitive skin to the point of light pressure from bed sheets is intolerable]
  • pain [burning, cramping, crushing, or tearing; worse @ night]
  • paresthesias [tingling, burning, itching sensations]
A

Distal symmetric polyneuropathy (aka stocking-glove neuropathy)

18
Q

Neuropathy: Neurotrophic Ulceration

  • Foot injury & ulcerations can happen w/o pt’s ever having pain
  • Neuropathy can also cause atrophy of the small muscles of the hands & feet, causing deformity & limiting fine movement
A
19
Q

Treatment for sensory neuropathy

  • Tight BG control
  • Drug therapy
  • Topical creams (e.g., capsaicin [Zostrix])
  • Tricyclic antidepressants (e.g., amitriptyline [Elavil])
  • SSRIs, SNRIs (e.g., duloxetine [Cymbalta])
  • Anti-seizure rx’s (e.g., gabapentin [Neurontin], pregabalin [Lyrica])
A
20
Q

?

  • Can affect nearly all body systems & lead to hypoglycemic unawareness, bowel incontinence & diarrhea, & urinary retention
  • Gastroparesis
  • Delayed gastric emptying
    → anorexia, n/v, GERD, & persistent feelings of fullness
    ! can trigger hypoglycemia by delaying food absorption
  • Cardiovascular abnormalities
  • Postural hypotension, resting tachycardia, painless MI
A

Autonomic neuropathy

21
Q

Sexual function
- ED
- Decreased libido
- Vaginal infections

A

Neurogenic bladder → urinary retention
* Empty frequently, use Crede’s maneuver

Rx’s
- Cholinergic agonist rx’s like bethanechol (Urecholine)

  • Self-catheterization
22
Q

Foot Complications

  • Microvascular & macrovascular diseases increases risk for injury & infection
  • Sensory neuropathy & PAD are major risk factors for amputation
A
  • Also clotting abnormalities, impaired immune function, autonomic neuropathy
  • Smoking is deleterious to health of lower extremity blood vessels & increases risk for amputation
23
Q
  • Sensory neuropathy → loss of protective sensation (LOPS) → unawareness of injury
  • Monofilament screening
A
  • Peripheral artery disease
  • ↓ blood flow, ↓ wound healing, ↑ risk for infection

! intermittent claudication, pain @ rest, cold feet, loss of hair, delayed capillary filling, & dependent rubor (redness of skin that happens when extremity is in a dependent position)

24
Q

Patient teaching to prevent foot ulcers
- Proper footwear
- Avoidance of foot injury
- Skin & nail care
- Daily inspection of feet
- Prompt treatment of small problems

  • Diligent wound care for foot ulcers
A
  • Neuropathic arthropathy (Charcot’s foot)
    > Results in ankle & foot changes that ultimately lead to joint dysfunction & footdrop; abn distribution of wt over the foot
25
Q

Skin Problems (up to 2/3 develop)

?

Velvety, light brown to black skin

A

acanthosis nigricans

26
Q

?

Most common
Red-brown, round or oval patches

A

Diabetic dermopathy

27
Q

Necrobiosis lipoidica diabeticorum

  • Red-yellow lesions, w/atrophic skin that becomes shiny & transparent, revealing tiny blood vessels under the surface
  • Uncommon & more in young women
A
28
Q

Infection

  • Defect in mobilization of inflammatory cells & impaired phagocytosis
  • Recurring or persistent infections (e.g., Candida albicans, boils/furuncles; persistent glycosuria may predispose to bladder infections esp in pts w/a neurogenic bladder)
  • Treat promptly & vigorously
  • Patient teaching for prevention
  • Hand hygiene
  • Flu & pneumonia vaccine [q5yr]
A
29
Q

Gerontologic Considerations

  • Increased prevalence (25% in those >65) & mortality
  • Glycemic control challenging
  • Increased hypoglycemic unawareness
  • Functional limitations (greater rate of decline of cognitive function)
  • Renal insufficiency
A
  • Diet & exercise: main treatment
  • Patient teaching must be adapted to needs

NUR 202 Week 3 (7 decks)

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