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Ashland > Diabetic Care (333E2) > Flashcards

Diabetic Care (333E2) Flashcards

1
Q

difference between type 1 and type 2 diabetes

A

due to genetic predisposition + environmental factors, in T1 insulin producing beta cells are destroyed compared to T2 where beta cells wear out and the body becomes resistant to insulin

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2
Q

T1DM

A

-younger people
-abrupt s/s
-5-10% of all cases
-no endogenous insulin production, must have replacement insulin

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3
Q

3 P’s of T1DM

A

polyphagia (hunger), polydipsia (thirst), and polyuria

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4
Q

T2DM

A

-adults
-can go undiagnosed (often found from screenings)
-insulin resistant (treat w/ diabetic pharm and sometime insulin replacement)

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5
Q

non modifiable risk factors for T2DM

A

-fam hx
-age >45
-race/ethnicity
-hx of GDM

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6
Q

modifiable risk factors for T2DM

A

-physical inactivity
-high body fat / wt
-high BP
-high Chol

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7
Q

labs to check for a diabetic pt

A

-FBG (no food or drink in 8hr)
-casual BG (random)
-Urine ketones
-lipid profile
-OGTT
-HbA1c

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8
Q

FBG levels

A

-normal: <99
-pre diabetes: 100-125
-diabetic: 126+

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9
Q

casual BG - normal & emergent

A

<200 mg/dl ; >300 mg/dl

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10
Q

high urine ketones are associated with

A

hyperglycemia

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11
Q

expected finding lipid panel of a diabetic

A

increased LDL & TAGs, lower HDL

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12
Q

what do you diagnose with the OGTT

A

gestational diabetes -> expected results are:
-fasting <110
-1hr <180
-2hr <140

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13
Q

A1c levels

A

-normal: 4-6%
-pre diabetic: 5.7-6.4
-diabetic: >6.5%
-acceptable range for a diabetic: 6-8%, target is 7%

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14
Q

OGTT levels

A

-normal: </139
-pre diabetic: 140-199
-diabetic: 200+ (after 12hr)

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15
Q

what type of test do you need to diagnose T1DM

A

islet cell autoantibody testing

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16
Q

diagnostic criteria for DM

A
  • elevated (diabetic class) of A1c, FBG, & OGTT (diet & exercise for 3 months then re eval)
    -classic symptoms
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17
Q

Pre diabetic definition

A

impaired glucose tolerance, impaired fasting glucose or both (asym but long term damage can be occuring)

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18
Q

pre diabetic education

A

-teach!!
-lifestyle modification
-monitor BG & A1c
-monitor symptoms: fatigue, slow wound healing, frequently getting sick
-diet modification

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19
Q

oral anti diabetic meds initiation

A

start at low dose and then gradually increase based on A1c and FBG (oral is most frequent used for T2DM)

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20
Q

when is oral medications stopped for a T2DM pt

A

when the pt is sick and in the hospital, oral meds will stopped and pt will be put on insulin to maintain tighter glucose control until they are discharged/no longer ill

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21
Q

how do oral anti diabetic medications work pull from patho pharm

A

brown “helps reverse insulin resistance, increases insulin production, decreases hepatic glucose production, helps the body get rid of excess glucose”

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22
Q

important medication concepts from pathopharm

A

-holding metformin before procedures
-understanding what classes are used to treat diabetes (will not ask about side effects)

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23
Q

what to do when a patient with DM is put on steroids for illness

A

steroids (PO/IV) can significantly raise BG so home insulin regimen may need to change by adjusting basal dosage & increasing scheduled doses, check BG more often

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24
Q

why being sick with DM a big problem

A

-physical stress from illness may cause body to release more glucose
-pts are more prone to go into DKA (T1) or HHNS (T2)
-if stomach virus, might not be eating or drinking (still need to take med when sick if possible)

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25
Q

nursing teaching points for when a sick DM pt needs to call HCP

A

-urine ketones
-BG >250
-fever >101.5 & not responding to tylenol
-feeling confused, disoriented, rapid breathing
-persistent N/V/D
-inability to tolerate liquids
-illness lasting longer than 2 days

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26
Q

what does frequency of blood sugar checks depend on

A

-glycemic goals
-type of DM
-medication regimen
-access to supplies & equipment
-pt willingness

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27
Q

nursing mgt of insulin

A

-use rapid and short acting insulin at meal times (bolus regimen)
-use a long acting insulin as a background once a day (balas regimen)
**4 injection a day: lantus or levemir at bedetime (basal), novolog or regualr before each meal (bolus)

28
Q

types of rapid acting insulin & their onset, peak, duration

A

types: lispro (humalog), aspart (novolog), glulisine (apidra)
onset: 10-30min ~15min
peak: 30min-90min ~1hr
duration: 2-4 hr

29
Q

types of short acting insulin & their onset, peak, duration

A

types: regular (humulin R, Novolin R)
onset: 30min-1hr
peak: 2-6hr
duration: 3-8hr

30
Q

types of intermediate acting insulin & their onset, peak, duration

A

types: NPH (humulin N, novolin N)
onset: 2-4 hr
peak: 4-10 hr
duration: 10-20 hr

31
Q

types of long acting insulin & their onset, peak, duration

A

types: glargine (lantus), detemir (levemir), degludec (tresiba)
onset: ~70 mins
peak: no pronounced peak
duration: 16-24 hr

32
Q

insulin is a “” medication so we have to check “” and “” before giving it

A

high alert ; current BG level ; diet order & intake tolerance

33
Q

signs & symptoms of hypoglycemia

A
  • BG <70 (some might feel sooner if living at higher BG levels)
    -sweating, blurred vision, dizziness, anxiety, hunger, irritability, shakiness, fast heartbeat, headache, weakness/fatigue
34
Q

what hospital policies do you need to know before giving insulin to a pt

A

-what to do if your pt develops hypoglycemia (assessment, food, drug)
-if my pt is NPO, what to do with the insulin schedule

35
Q

what is the most important thing we can do for our pt’s on insulin

A

teach (& then teach back/demo method)

36
Q

main teaching points for pt giving themselves insulin

A

-self admin (cleaning, sites, action)
-timing is crucial (onset, peak, duration)
-monitor for signs of hypoglycemia

37
Q

rule of 15 for hypoglycemia

A

if BG drops & pt is conscious and able to swallow then give 15g simple CHO w/ no fat (4oz juice or soda, 3 glucose tabs, 1 tbsp honey, 5 life savors), recheck BG in 15 minutes -> if still below 70 then give another 15g and if it is above 70 then have them eat a regular meal

38
Q

how much should 15g of carbs increase BG

A

50 mg/dl

39
Q

what should you do if you pt cannot swallow and becomes hypoglycemic

A

-IM glucagon
-IV D50 (25-50ml)

40
Q

causes of hyperglycemia

A

illness, infection, self mgt issues, stress

41
Q

treatment of hyperglycemia

A

-insulin
-drink fluids, prevent dehydration
-education on prevention / assess why it happened
-check for ketones in urine

42
Q

DKA and HHS

A

BG > 500
life threatening conditions by electrolyte imbalances related to uncontrolled hyperglycemia

43
Q

what does the insulin pump provide

A

continuous release of subQ insulin infusion (usually rapid acting) ; they can get basal infusions or bolus

44
Q

how often should a diabetic person check their BG

A

at least 4x a day (w/ pump can use CGM)

45
Q

problems to be aware of with an insulin pump

A

-infections at insertion site
-increased risk for DKA if pump malfunctions
-cost
-cannot swim or bathe

46
Q

what are chronic complications of diabetes related to

A

end organ disease from chronic damage to blood vessels (angiopathy) from long term hyperglycemia

47
Q

macro vascular long term DM complications

A

damage to large vessels:
-coronary arteries
-peripheral vascular
-cerebral vascular

48
Q

microvascular long term DM complications

A

damage to capillaries:
-retinopathies (eyes)
-nephropathies (kidneys)
-neuropathies (sensation in extremities)

49
Q

macrovascular disease x DM

A

-women have 4-6x risk of CVD & men 2-3x than those w/o DM

50
Q

education for macrovascular disease

A

stop smoking, control BP, modify high fat diet, keep A1c low

51
Q

what is the leading cause of end stage renal disease

A

diabetes

52
Q

retinopathy

A

damage to the retina related to chronic hyperglycemia

53
Q

nephropathy

A

damage to small blood vessels in the kidneys

54
Q

neuropathy

A

nerve damage due to metabolic imbalances associated with hyperglycemia

55
Q

nursing considerations r/t neuropathy

A

-highest risk is lower extremities (foot ulcers & ampts)
-loss of protective sensation (LOPS) whihc prevents pts from being aware that injury has occurred

56
Q

different type of foot wounds

A

-neuropathic: deep ulcers
-neuroischemic: open shallow wound that doesn’t heal
-ischemic: no blood flow, leads to amputation

57
Q

know the steps of diabetic foot cares

A

steps 1-13

58
Q

nutritional considerations for diabetes

A

balance, high fiber, low fat (poly un is best to consume), low cholesterol, focus on carbs from whole grains, fruits, milk and legumes and then limit simply carbs (pasta, bread, sweets), lean protein/nuts/beans, limit alcohol

59
Q

what can fiber do to help manage BG

A

improve carb metabolism and lower cholesterol

60
Q

alcohol affects on a diabetic

A

can increase their BG but then cause rebound hypoglycemia which can be fatal

61
Q

exercise x dm

A

-properly fitting footwear
-can lower blood sugar so if BG is <80 or >250 don’t exercise until better normalized
-best to do after meals
-eat carb snack if doing a high intensity work out >1hr post meal
-wear medical alert bracelet

62
Q

nursing considerations for DM pts in the hospital

A

-stress/surgery can increase BG levels so can go from controlled to uncontrolled
-would healing is impaired
-high risk for infection

63
Q

diabetic dermopathy

A

reddish - brownish spots, usually on spins

64
Q

acanthosis nigricans

A

brown/black thickening of skin, often seen in the skin folds

65
Q

necrobiosis lipoidica diabeticorum

A

red patches around blood vessels

66
Q

Nursing teaching points for sick DM pt

A

-notify HCP
-monitor BG every 2-4 hr
-continue to take meds
-prevent dehydration
-meet carb needs
-rest

Ashland (157 decks)

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