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NURS 1245 > DM > Flashcards

DM Flashcards

1
Q

ADPIE DM

Assessment

A

Health History
( OLD CARTS, Patients medical history, Family history, Lifestyle)

Symptom Assessment
(Polyuria, polydipsia, polyphagia, fatigue, weight loss)

Physical examination:
(Vital signs, BMI, focused Assessment “Cardiovascular, neurological, integumentry”)

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2
Q

Common Symptoms of DM

A

Polyuria, polydipsia, polyphagia, fatigue, weight loss

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3
Q

ADPIE DM

Diagnosis

A

Imbalanced nutrition: More than Body requirements

Risk for Unstable Blood Glucose Level

Deficient knowledge related to diabetes self-management

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4
Q

ADPIE

Planning

A

SMART

Have 110 blood glucose for 1 month during every reading

Weight 220 lbs by the 1st of July

Incorporate 2 standard servings of vegetables in every dinner.

(Develop CARE PLAN to meet: nutrition, medication management, exercise, and education)

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5
Q

ADPIE DM

Implementation

A

Patient education: insulin administration, oral meds, diet, exercise, monitoring of blood glucose

Medication Administration: proper Route, Dosage, Time

Dietary Management

Promote Physical Activity

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6
Q

ADPIE

Evaluation

A

Monitoring changes in blood glucose

Weight Management

Revising Care Plan

Continued Education

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7
Q

5 rights of medication

A

Patient
Medication
Dose
Route
Time

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8
Q

SBAR

Situation

Include which information

A

Nurses Name
Patients Name (Age)/ Room Number
Reason for admission (brief, e.g. uncontrolled glucose levels)

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9
Q

SBAR

Background

A

Patients Name

Medication (Name, Dose, Amount, Route)

Glucose Monitoring (Frequency)

Value of last Glucose Reading

(Recent changes or interventions “Adjustments in Insulin Dosage/ Dietary Modifications)

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10
Q

SBAR DM

Assessment

A

Patients Name

Stable / Unstable

Vital signs, mental status, Symptoms of DM (Polyuria / Polydipsia)

Patients Complaints (Symptoms)

Plan of care ( medications, restrictions diet, monitoring)

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11
Q

SBAR

Recommendation

A

Specific

Continue with current insulin regimen and monitor glucose

Notify provider if significant change occurs

Patient recieves education on DM adheres to prescribed diet

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12
Q

Glucose can only enter cells that contain

A

Beta cells and insulin

(Lock & Key)

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13
Q

Glucose is converted into ATP by cellular respiration in a process called

A

Glycolysis

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14
Q

Glycogenesis is…

A

Glucose converted to glycogen

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15
Q

Glycogen is….

A

the stored form of glucose that’s made up of many connected glucose molecules.

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16
Q

_______ role in the body is toprevent blood glucose levels dropping too low. To do this, it acts on the liver in several ways: It stimulates the conversion of stored glycogen (stored in the liver) to glucose, which can be released into the bloodstream. This process is called glycogenolysis.

A

Glucagon’s

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17
Q

Glucagon’s role in the body is to ___________To do this, it acts on the liver in several ways: It stimulates the conversion of stored glycogen (stored in the liver) to glucose, which can be released into the bloodstream. This process is called glycogenolysis.

A

prevent blood glucose levels dropping too low.

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18
Q

Glucagon’s role in the body is to prevent blood glucose levels dropping too low. To do this, it acts on the liver in several ways: It stimulates the conversion of stored _______ (stored in the liver) to glucose, which can be released into the bloodstream. This process is called glycogenolysis.

A

glycogen

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19
Q

Glucagon’s role in the body is to prevent blood glucose levels dropping too low. To do this, it acts on the liver in several ways: It stimulates the conversion of stored glycogen (stored in the liver) to glucose, which can be released into the bloodstream. This process is called _______.

A

glycogenolysis

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20
Q

What does Glucagon do to blood sugar levels

A

Raises them

Conversion of Glycogen to Glucose

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21
Q

When Glucose levels rise give Insulin to reduce blood sugar

            True or False
A

True

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22
Q

Insulin decides what (glycogen / glucose) sugar is used for energy and which to store (glycogen/ glucose)

A

Glucose/ glycogen

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23
Q

Biphasic pattern
(Name)
low - level
Around the clock

(Name)
Bursting, rising-release
Meals

A

Basal
(Low - level )
Around the clock

Postprandial
(Bursting, rising-releas)
Meals

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24
Q

Types of diabetes

Insulin resistance and impaired insulin secretion

Destruction of pancreatic beta cells

A

TPYE II
Insulin resistance and impaired insulin secretion

TYPE I
Destruction of pancreatic beta cells

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25
Q

Monogenic diabetes are rare and come from

A

Mutation in the genes

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26
Q

Type 1 diabetes

Autoimmune disorder in which ______ (insulin secreting) destruction occurs in the (this organ) _____ in a genetically susceptible person

A

Beta cells

Pancreas

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27
Q

____ works like a key to let glucose move into the cells

A

Insulin

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28
Q

Type 2 diabetes

Reduction in ability of most cells to respond to insulin ( ______ )
Poor control of liver glucose output
Decreased ______ function eventually leading to beta cell failure

A

Insulin resistance

Beta cell

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29
Q

Check the balance between water and certain chemicals in the blood

A

Serum osmolality

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30
Q

An abnormally high concentration of blood. Blood becomes concentrated, or thickens, when the proportion of cells and other larger elements of the blood increase

A

hemoconcentration

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31
Q

Insulin Absence

Hyperglycemia fluid loss (increases / decreases) Serum Osmolality, resulting in movement of water out of the cells (hemoconcentration)

In effort to (increase/ decrease) glucose levels

A

Increase / decrease

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32
Q

Insulin absence

Hyperglycemia = ________ = ________

A

Hypokalemia = Hyperkalemia

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33
Q

Insulin Absence

Hyperglycemia =Hypokalemia = Hypokalemia

Kidneys will try to save ____ to maintain osmolality (balance between water and chemicals in blood)

A

Sodium Na

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34
Q

Increased amount of glucose excretion, blocks fluid reabsorption in renal tubules resulting in

A

Dehydration

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35
Q

Insulin can cause hypokalemia by

A

Driving Ka+ back into cells

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36
Q

Ketone bodies

Result from ______ when body is absent of insulin

A

Fat break down for energy

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37
Q

Ketone bodies cause an increase in ______ (liver cannot keep up) leading to metabolic acidosis

A

Lactic acid

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38
Q

Metabolic acidosis

Ketone breakdown (FFA) aka (_______)

Affects Ka+ and H+ levels

A

Lipolysis

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39
Q

Which electrolyte cannot be regenerated fast enough to prevent Diabetic Keto Acidosis

A

Bicarbonate (HCO3)

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40
Q

Hyperventilating during Diabetic Keto Acidosis is referred to as

A

Kussmaul respirations

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41
Q

Symptoms of Type I

Onset (Slow / Quick)
Thirst or Hunger
Weight (Loss or Gain)
Urine output (Less / More)
Breath?

A

Abrupt onset
Thrist
Hunger
Weight loss
Increase urine output
Acetone breath

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42
Q

Symptoms of Diabetes

Type II

A

Frequently None
Thirst
Fatigue
Blurred Vision
Microvascular complications

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43
Q

Symptoms that affect both type I & II diabetes

A

Slow healing, Infections, mental status (acute)

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44
Q

Lab assessments

Urine & Blood

For DM

A

Urine:
Ketone bodies
Renal function
Glucose

Blood:
Fasting Blood Glucose
Glycosyated hemoglobin (HgbA1C)

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45
Q

Random Glucose level

Normal

Pre-DM (n/a)

DM

A

Normal
70 - 115

DM
200 +

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46
Q

Fasting Glucose

Normal
Pre-D
DM

A

Normal
<100

Pre-DM
100-125

DM
126+

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47
Q

GTT “Glucose Tolerance Test”
(8 hr fast “Blood Drawn”
Given glucose syrup orally
2hrs later blood drawn again)

Normal

Pre-DM

DM

A

Normal
<140

Pre-DM
140 - 199

DM
200+

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48
Q

HgA1C

Normal

Pre-DM

DM

A

Normal <5.7

Pre-DM 5.7 - 6.4

DM >6.5

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49
Q

A1C

6

Mean Blood Glucose

A

126

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50
Q

A1C

7

Mean Blood Glucose

A

154

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51
Q

A1C

8

Mean Blood Glucose

A

183

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52
Q

A1C

9

Mean Blood Glucose

A

212

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53
Q

A1C

10

Mean Blood Glucose

A

240

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54
Q

A1C

11

Mean Blood Glucose

A

269

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55
Q

A1C

12

Mean Blood Glucose

A

298

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56
Q

Acute complications

Hyperglycemia

A

Hyperglycemic hyperosmolar Nonketotic syndrome

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57
Q

Hyperglycemia

Polyuria

Why?

A

Osmotic diuresis r/t excess glucose in urine

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58
Q

Hyperglycemia

Polydipsia

Why

A

Result of excessive dehydration

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59
Q

Hyperglycemia

Polyphagia

Why?

A

Result of cell starvation (no glucose)

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60
Q

Hyperglycemia

Lipolysis

Why

A

Breakdown for energy

Release fatty acids = ketone bodies = metabolic acidosis

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61
Q

DKA

Diabetic Keto Acidosis

Which type (I or II)
Insulin or not?
Onset (Faster / Slower)
(Younger / Older)
(Harder / Easier) to fix

A

Type 1

Patho: No INsulin, No sugar IN cells.

FASTER ONSET
YOUNGER
EASIER TO FIX

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62
Q

DKA

Causes

(S)

A

Sepsis NCLEX TIP
Sickness “stomach virus & Flu (most common)
Stress
Skip insulin

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63
Q

Hyperglycemic Hyperosmolar Non-ketotic Syndrome
(HHNS)

This type ( I or II )

Patho ( None or Few )

Onset (Faster or Slower)
( Easier or Harder) to fix

A

Type 2

Patho: Few INsulin- puts sugar IN cells (NO KETONES)

SLOWER ONSET
HARDER TO FIX

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64
Q

Hyperglycemic Hyperosmolar Non-ketoic Syndrome (Type 2)

Causes

A

Illness & Infections

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65
Q

Chronic Complications

Chronic hyperglycemia (thins / thickens) basement membrane causing organ damage.

Macrovascularity

Disease associated

A

Thickens
Macrovascular involves larger vessels

Coronary heart disease
Cerebrovascular disease
Peripheral Vascular disease

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66
Q

Chronic Complications

Microvascular

These types of diseases

A

Nephropathy

Neuropathy

Retinopathy

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67
Q

Major complications of DM

Microvascular

Eye

A

High BP & Glucose can damage eye blood vessels

Retinopathy, cataracts, glaucoma

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68
Q

Major complications of DM

Microvascular

Kidney

A

High BP damages small blood vessels.

Excess glucose over worksnl kidneys

Nephropathy

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69
Q

Major complications of DM

Microvascular

Neuropathy

A

Damages nerves in peripheral NS

Pain / Numbness

Feet wounds undetected, infection, gangrene

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70
Q

Major complications of DM

Macrovascular

Brain

A

Increased risk stroke and cerebrovascular disease

Transient ischemic attacks

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71
Q

Major complications of DM

Macrovascular

Heart

A

High BP & insulin resistance

Increase risk for Coronary heart disease

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72
Q

Major complications of DM

Macrovascular

Extremities

A

Peripheral vascular disease

Causes lack blood flow in feet

Wounds slow to heal, gangrene

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73
Q

Nutrition

Carbs per meal

Eat foods low on Glycemic Index or balance between high and low

Fat: Mediterranean

Fiber ____ g daily

A

45 - 60 g/meal

25g daily

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74
Q

Exercise

A

30 min / 5 days per week

Strength/ Resistance

2x weekly

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75
Q

Exercise Considerations for DM

Planned exercise ( reduce/ increase) insulin to prevent hypoglycemia

A

Reduce

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76
Q

Exercise Considerations for DM

Unplanned exercise may require additional (insulin / carbohydrate)

A

Carbohydrate

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77
Q

Decrease insulin resistance

Improved measures of glycemia

Reduced dyslipidemia

Reduced BP

Describes

A

Therapeutic Objective for personas with type 2 diabetes

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78
Q

Biguanides

Class of drugs that lowers blood sugar in Type II

name the only example

A

Metformin

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79
Q

Drugs that sensitize the body to insulin and / or control hepatic glucose production

A

Thiazolidinediones

Biguanides

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80
Q

Drugs that stimulate the pancreas to make more insulin

A

Sulfonylureas

Meglitinides

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81
Q

Drugs that slow the absorption of Startch

A

Alpha-glucosidase inhibitor

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82
Q

Metformin, Glucophage (XR)

Are medications that sensitize the body to insulin by decreasing hepatic glucose production

Improve insulin resistance

Increase insulin-mediated peripheral glucos3 uptake

A

Biguanides

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83
Q

Metformin is most used in hospitals to help with DM II

             TRUE OR FALSE
A

False: not available in most hospitals

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84
Q

________ increase endogenous insulin secretion by stimulation of pancreas to make more insulin

A

Sulfonylureas

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85
Q

Chlorpropamide (Diabinese)
Tolazamide
Acetohexamide (Dymelor)
Tolbutamide

Sulfonylureas: increase endogenous insulin secretion by stimulating the pancreas to make more insulin (Only Type II)

1st or 2nd generation

A

First

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86
Q

Glyburide (Micronase, Glynase, and DiaBeta)

Glimepiride (Amaryl)

Glipizide (Glucotrol (Xl)

Sulfonylureas: increase endogenous insulin secretion by stimulating the pancreas to make more insulin (Only Type II)

1st or 2nd generation

A

2nd Safer

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87
Q

Biguanides

Side Effects / Contradictions

A

SE:
Lactic Acidosis (alcohol)
Vitamin B12 (Folic Acid)
Diarrhea

Contradicciones

Impaired renal function eGFR <30

Patients receiving IV contrast dye

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88
Q

Biguanides

Benefits

A

Cheap
No weight gain / loss
No hypoglycemia
Lowe4 CVD risk
Decrease Cholesterol
Pre-diabetes prevetion

89
Q

When is Glyburide (Sulfonylurea) taken?

A

With 1st meal of the day

90
Q

Sulfonylureas

SE

A

Hypoglycemia (alcohol)
Weight gain
Increase CVD risks
Beta cell destruction
Smaller doses in geriatrics
Beta blockers Interaction

91
Q

Hypoglycemia (alcohol)
Weight gain
Increase CVD risks
Beta cell destruction
Smaller doses in geriatrics
Beta blockers Interaction

SE of…

A

Sulfonylureas

92
Q

Sulfonylureas

Benefits

A

Effective monotherapy

Cheap

No Effect on Plasma lipids or BP

93
Q

Benefits of this drug include

Effective monotherapy

Cheap

No Effect on Plasma lipids or BP

A

Sulfonylureas

94
Q

4 types of Synthetic Human Insulin

A

Rapid
Short
Intermediate
Long-acting forms

95
Q

Subcutaneous insulin injection where?

A

the tricep area at the back of the arm, about halfway between the elbow and the shoulder

The belly, at least 2 in. (5.1 cm) from the belly button

96
Q

Action of insulin (3)

A

Moves glucose into cells

Stores glucose in the liver and muscles

Enhances fat storage

97
Q

Type of insulin maybe given in IV

A

Regular

98
Q

Insulin can be used in both DM & non-DM patients to treat

A

Hyperkalemia

99
Q

Rapid-acting insulin analogue

Onset

A

5 - 15 minutes

100
Q

Rapid-acting insulin analogue

Peak

A

30 - 60 min

101
Q

Rapid-acting insulin analogue

Duration

A

2 - 5 hrs

102
Q

Can be injected at the start of a meal

A

Rapid-acting insulin analogue

103
Q

Short-acting (soluble/regular insulin)

Onset

A

30 min

104
Q

Short-acting (soluble/regular insulin)

Peak

A

1 - 3 hrs

105
Q

Short-acting (soluble/regular insulin)

Duration

A

4 - 8 hrs

106
Q

Usually injected 15 - 30 minutes before a meal.

Clear solution

A

Short-acting (soluble/regular insulin)

107
Q

Intermediate or long-acting insulin (isophane(NPH, Lente) or zinc(ultralente) insulin)

Onset

A

NPH, LENTE 1-2 hr

ULTRALENTE 2-3 hr

108
Q

Intermediate-acting insulin (isophane(NPH, Lente) or zinc(ultralente) insulin)

Peak

A

4 - 8 hrs both

109
Q

Intermediate or long-acting insulin (isophane(NPH, Lente) or zinc(ultralente) insulin)

Duration

A

NPH 8-12 hr

Ultralente 8 - 24

110
Q

Used to control glucose between meals. Maybe combined with Short-acting insulin

A

Intermediate or long-acting insulin (isophane(NPH, Lente) or zinc(ultralente) insulin)

111
Q

Long-acting insulin analogue

Onset

A

30 - 60 min

112
Q

Long-acting insulin analogue

Peak

A

No peak

113
Q

Long-acting insulin analogue

Duration

A

16 - 24 hes

114
Q

Usually taken once a day

A

Long-acting insulin analogue

115
Q

Aspartame (Novolog)

Must have food within 5 - 10 min

Uses in Insulin pumps

Part of combinación dose

Uses for sliding scales

A

Rapid acting

116
Q

Humulin R

Within 30 minutes of meal

Provides Baseline coverage

A

Short acting

117
Q

For use between meals

Combined with short acting

Taken AM or PM

A

Intermediate-acting

118
Q

Levemir/ Lantus

Usually once a day. Sometimes BID

A

Long Acting

119
Q

Combination Insulin

Withdraw _____ first

A

Regular or shorter acting

120
Q

Insulin Glargine or Lantus must….

A

Not be mixed with any other types

121
Q

Insulin Pump Therapy

____ acting insulin

Catheter in abdomen

Basal rate and _____ (Continuously)

Coverage is only given by one. (RN or PT)

A

Rapid acting

Bolus

122
Q

Insulin pump therapy

Change needle

A

Q 2-3 days

123
Q

BS <70

Brain will Die

Cool
Pallor
Diaphoretic
Trembling

Causes (besides for Hypoglycemia)

A

Exercise
Alcohol NCLEX TIP
Insulin PEAK time NCLEX TIP

124
Q

Beta blockers can mask rapid heart beat and trembling associated with

A

Hypoglycemia

125
Q

CNS Hypo/Hyperglycemic

Drowsiness progressing to coma, ataxia, headache, blured vision, hyperactive reflexes

A

Hypoglycemia

126
Q

CNS Hypo/Hyperglycemic

Decreased level of consciousness, sluggish progression to coma, hypoactive reflexes

A

Hyperglycemia

127
Q

Neuromuscular hypo/Hyperglycemia

Paresthesia, weakness, muscle spasms, twitching to seizures

A

Hypoglycemia

128
Q

Neurovascular Hypo/Hyperglycemia

Weaknesses, lethargy

A

Hyperglycemia

129
Q

CV hypo/Hyperglycemia

Tachycardia, palpitations, Normal to high BP

A

Hypoglycemia

130
Q

CV hypo/Hyperglycemia

Tachycardia, hypotension

A

Hyperglycemia

131
Q

Respitory Hypo/Hyperglycemia

Rapid, shallow Respition

A

Hypoglycemia

132
Q

Respitory Hypo/Hyperglycemia

Rapid, Deep respiration (Kussmaul), acetone / fruity breath

A

Hyperglycemia

133
Q

GI Hypo/Hyperglycemia

Hunger, nausea

A

Hypoglycemia

134
Q

GI Hypo/Hyperglycemia

Nausea, Vomiting, thirst

A

Hyperglycemia

135
Q

Misc. Effects Hypo/Hyperglycemia

Diaphoresis, cool & clammy skin, Nirmal eyeballs

A

Hypoglycemia

136
Q

Misc. Effects Hypo/Hyperglycemia

Dry, Warm, flushed skin, soft eyes

A

Hyperglycemia

137
Q

Effects of Onset Hypo/Hyperglycemia

Sudden, patient appears anxious,
drunk associated with overdose of insulin, missing a meal, increased stress.

A

Hypoglycemia

138
Q

Treatment for hypoglycemia

A

15:15

15 grams of carbs
15 minutes after, check bp

139
Q

Glucose elevating drug

Glucagon can be given if glucose is <45

Given via these 2 routes

A

Orally or IM

140
Q

Glucose Elevating Drugs

50% dextrose (D5)

Given via this route

A

IV

141
Q

Give what in conjunction with Insulin to treat Hyperkalemia

A

Glucagon

142
Q

Sick Day Management

Continue insulin
Notify provider if glucose over ____ continues after 2 doses

Follow same meal plan

Check glucose atleast every ___ hr

Notify provider if urine ketones are elevated for over __ hrs

A

> 240

4hrs

24hrs

143
Q

NCLEX KEY WORDS

Inspection (Daily or Weekly)
(Shoes or Sandals)
Socks (Cotton or Nylon)
Nails cut (Straight or Angle)
Remove callous (Yes or No)
Is rubbing feet vigorously good for circulation
Baths (Hot or Warm)

A

Daily
Shoes
Cotton
Straight
No
No
Warm

144
Q

Pioglitazone & Rosiglitazone

Decrease insulin resistance by making the muscle and adipose cells more sensitive to insulin.

Suppress hepatic glucose production

A

Thiazolidinediones

145
Q

Thiazolidinediones

Pioglitazone & Rosiglitazone

A

Decrease insulin resistance by making muscle amd adipose cells more sensitive to insulin.

Supress hepatic glucose production

146
Q

SE

Weight gain
Edema
Hypoglycemia (if taken with other agents)
Mixed effects on Plasma lipids
Increase in ALT levels
Liver Toxicity (Troglitazone)
Unintended pregnancy

A

Thiazolidinediones

147
Q

Concerns in those with:

Heart Failure (Black Box)
Liver abnormalities
Fluid retention
Bladder Cancer (Pioglitazone)
Fractures
Anemia

Associated with this type of medication

A

Thiazolidinediones

148
Q

Repaglinide (Prandin)

Nateglinide (Starlix)

A

Meglitinides

149
Q

Binds to beta cell receptors to stimulate insulin secretion (rapidly and for a short duration) in the presence of glucose (after meals)

A

Meglitinides

150
Q

SE

Hypoglycemia (take w/ meals)
Weight gain
Gemfibrozil (Lopid) “used to lower triglycerides can inhibit the metabolism of this medication causing HYPOGLYCEMIA

Concerns: Patients w/ Liver Dysfunction

A

Meglitinides

Prandin repaglinida

151
Q

Alpha-glucosidase inhibitor

Acarbose (precose)
Miglitol (glyset)

Action

A

Block the enzyme that digest scratches in the small intestine

152
Q

Block the enzyme that digest scratches in the small intestine

A

Alpha-glucosidase inhibitor

Acabose (precose)
Miglitol (glyset)

153
Q

SE

Flatulence/ abdominal discomfort

NO weight gain, BP, Lipids

Contradicted in patients with inflammatory bowel disease or corrhosis

A

Alpha-glucosidase inhibitor

154
Q

Dulaglutide (Trulicity)
Exenatide (Byetta)
Extended-release exenatide (Bydureon BCise)
Liraglutide (Victoza)
Lixisenatide (Adlyxin)
Semaglutide (Ozempic, Rybelsus)

A

Glucagon-like peptide-1 receptor agonists

155
Q

GLP-1

Pancreas

Insulin (Up / Down)
Glucagon (Up / Down)

A

Insulin Up
Glucagon Down

156
Q

What do GLP-1 do to the following systems

Body weight
Blood pressure
Plasma glucose
Plasma lipids

A

Lowers

157
Q

This type of Biphasic pattern release of Insulin is “Low-level / Around the clock”

While this type of Insulin release is “Burst, Rising-Release”

A

Basal Low Level, Around the clock

Postprandial Bursting, Rising Release

158
Q

Ketones result from fat breakdown for energy.

Why does this happen with DM

A

Lack of Insulin won’t allow body to use carbs as energy

Must break down fat

159
Q

Formula for finding correlation between A1C & Mean Blood Sugar

A

Starting at:

6 double, add a zero, and Plus the number 1 time

126

Then

7 double, add zero, and Plus the number 2 times

154

8 double, add zero, Plus 3 times the number (8)

184

160
Q

Diabetic Keto Acidosis us caused by

Hypo/Hyperglycemia

A

Hyperglycemia

161
Q

Which of the following leads to Type II diabetes

  1. Obesity
  2. Unhealthy Lifestyle
  3. Over consumption of Insulin
  4. Eating too many sweets
A

Obesity
Unhealthy Lifestyle

162
Q

Where is glucose absorbed

A

Small intestine

163
Q

Glycagon stimulates which process to raise blood sugar

A

Glucogenesis

164
Q

Ketone bodies a product of fat metabolism - Do they provide energy?

A

Yes

165
Q

HbA1c greater than ___ is considered diabetic

A

7

166
Q

My plate

50%
25%
25%

A

50 non startchy version
25 carbs
25 protein

167
Q

Correct

Hyperglycemia causes these two Acute complications

A

DKA

HHS

168
Q

Dehydration
Rapid, Deep, Respirations aka Kussmaul Respiration
Coma
Fruity breath from ketone break down

Are associated with

A

Hyperglycemia

169
Q

Detemir (Levemir)

Is which type of insulin

Basal or prandial

A

Long lasting

Basal

170
Q

Decreased consciousness / Coma
Weakness
Vomiting/ Thirst
Dry Warm, Flushed skin, soft eyeballs
Gradual onset Slow and sluggish

A

Hyperglycemia

Fruit breath / Kussmaul

171
Q

Headache, blurred visin, Ataxia, drowsy/ coma
Paresthesia, muscle spasms, twitching
Rapid, Shallow breaths
Hunger
Diaphoresis, cool clamy skin
Sudden, Anxious, drunk,

A

Hypoglycemia

172
Q

Which number of BS should someone not exercise

A

> 240

173
Q

Which of the following decreases the amount of glucose produced by the liver

A. Alpha-glucosidase inhibitor
B. Biguanides
C. Meglitinides
D. Sulfonylureas

A

Biguanides (metformin)
Reduce blood glucose by Reducing the amount of glucose produced by the liver, decrease intestine absorption, increase insulin sensitivity.

Meglitinides & Sulfonylureas both increase production of insulin

174
Q

39 year old presents with shakiness, anxiety, sweating, palpations and tells nurse has type 1 diabetes.

Which should the nurse do first

Inject 1 mg of Glucagon SQ
Admin 50 mL of 50% glucose IV
Give 4 to 6 oz of orange juice
Admin 4 to 6 glucose tabs

A

Since client is awake and complaining of symptoms

15:15 rules applies

175
Q

______ is a complicated metabolic syndrome related to underlying illness and characterized by muscle mass loss with or without fat mass loss that is often associated with anorexia, an inflammatory process, insulin resistance, and increased protein turnover

A

Cachexia

176
Q

Sarcopenia

A

is the loss of muscle and strength that can happen when someone gets older and does less physical activity

177
Q

Which insulin can be administered through IV

A

Short (regular) NovolinR

178
Q

Lipodystrophy is …..

Congenital or Aquired

A

a group of rare syndromes that cause a person to lose fat from some parts of the body, while gaining it in others, including on organs like the liver.

A person can be born with lipodystrophy or develop it later in life.

179
Q

Which medication would cause a further decrease in blood glucose

Hydorclorothiazide (Microzide)
Levothyroxine (Synthroid)
Carvedilol (Coreg)
Hydrocortisone (SoluCortef)

A

Carvedilol (Coreg) beta-blocker

Thiazide (antihypertensive) drugs are often prescribed to people with diabetes. Promote hyperglycemia and can contribute to new onset Diabetes

Levothyroxine (Synthroid) Glucose levels stabilize but when Thyroid Function is normal Glucose maybe high

180
Q

Patients BS at 3 AM is Hypoglycemic but at 7 AM is Hyperglycemic Why?

Insulin Resistance
Dawn Phenomenon
Insulin lipohypertrophy
Somogyi Phenomenon

A

Somogyi
(Rebound high blood glucose.
Early morning hyperglycemia is due to rebound effect from late-night hypoglycemia)

Dawn Phenomenon is high morning BS as response to declining levels of insulin and nocturnal release of hormones

Insulin Resistance occurs when person receiving insulin develops antibodies that bind to insulin.

Insulin lipohypertrophy = Development of fatty lumps in surface of skin Common side effect of repeated use of an injection site.

181
Q

( Acute / Chronic)
complications include diabetic ketoacidosis, hyperosmolar hyperglycemic nonketotic coma, and hypoglycemia.

(Acute /Chronic) hyperglycemia is central to the pathophysiology of the following

complications such as cardiovascular and peripheral vascular disease, retinopathy, nephropathy, and neuropath

A

Acute / Chronic

182
Q

Which type of diabetes may need higher amounts of Insulin

A

Type II

183
Q

Perfusion issues can cause the chronic illness associated with DM

A

Neuropathy

184
Q

serious diabetes complication where the body produces excess blood acids

This condition occurs when there isn’t enough insulin in the body. It can be triggered by infection or other illness

A

DKA

185
Q

Usually develops slowly. Early symptoms include:

Being very thirsty.
Urinating a lot more than usual.
If untreated, more severe symptoms can appear quickly, such as:

Fast, deep breathing.
Dry skin and mouth.
Flushed face.
Fruity-smelling breath.
Headache.
Muscle stiffness or aches.
Being very tired.
Nausea and vomiting.
Stomach pain.

A

DKA

186
Q

DKA?

Proper management of DKA requires hospitalization for…. (3)

A

aggressive intravenous fluids, insulin therapy, electrolyte replacement

187
Q

Monitor vitals.
Check blood sugars and treat with insulin as ordered.
Start two large-bore IVs.
Administer fluids as recommended.
Check electrolytes as potassium levels will drop with insulin treatment.
Check renal function.
Assess mental status.
Look for signs of infection

Nursing interventions for

A

DKA

188
Q

Relates to long-term dehydration

HHNS or DKA

A

HHNS

189
Q

Before giving insulin (3)

A

What and when did they eat?

Last BS reading

Last time given insulin (type/dose)

190
Q

No standing order for ____ insulin on a sliding scale

This is the type of insulin used on the sliding scale

A

Rapid / Rapid

191
Q

When to check blood sugar

Patient is PO

(2)

A

Before food (AC)

Hour of Sleep (HS)

192
Q

When to check blood sugar

Patient is NPO

A

Timed intervals

q 4 or 6 hrs

193
Q

Can insulin pen needles be reused?

A

The needle must be replaced after each injection

The pen itself can be resued

194
Q

Preoperative the patient is NPO would you with hold insulin?

A

No, because the stress from the surgery will make BS raise

195
Q

With a BS of 50mg/dL what symptoms would you observe

A. Anxiety, paleness, and pulse of 110bpm

B. Lethargic and hot,dry skin with rapid respiration

C. Alter and cooperative with BP 130/80

D. Short of breath, distended neck veins and pulse of 96

A

A.
Hypoglycemia releases epinephrine which causes: confusion, paleness, tachycardia.

196
Q

Which order should a nurse validate with the Dr.

Humalog for sliding scale coverage

Metformin (Glucophage) 1000mg per day divided doses

Admin regular insulin 30 min prior to meals

Lantus 20U BID

A

Lantus 20U BID

Lantus is usually given once a day
Steady 24 hr coverage

197
Q

Can you take Lantus and a rapid acting insulin at the same time?

A

Yes, but you cannot mix the insulin together in the same syringe

198
Q

Which would be abnormal in UA for a DM patient

A. Amount
B. Odor
C. pH
D. Specific Gravity
E. Glucose level
F. Ketone bodies

A

A. Amount
B. Odor
E. Glucose level
F. Ketone bodies

199
Q

Sick day

When sick Glucose (Raises or Falls)

A

Raises

200
Q

Sick day management TEST

Notify provider if glucose is over ____ after 2 doses

Follow same meal plan

Check Glucose every ___ hr

Notify provider if urine ketones are elevated for over ____ hrs

A

240

4hr

24 hrs

201
Q

Teachings for a new diabetic

A

1 Understanding Diabetes:

Explain the basics of diabetes, including the role of insulin and glucose in the body.

Differentiate between Type 1 and Type 2 diabetes if applicable.

  1. Blood Glucose Monitoring:

Demonstrate how to use a glucose meter and explain the target blood glucose levels.

Instruct on the frequency of monitoring and when to check levels (e.g., before meals, after meals).

  1. Medication Management:

If prescribed, educate about insulin or oral medications.

Discuss proper administration techniques, dosages, and timing.
Emphasize the importance of adhering to the prescribed medication regimen.

  1. Dietary Guidelines:

Provide guidance on a balanced and individualized meal plan.
Emphasize the importance of carbohydrate counting, portion control, and meal timing.
Encourage a diet rich in fruits, vegetables, lean proteins, and whole grains

  1. Physical Activity:
  2. Symptom Recognition:

Teach the patient to recognize symptoms of hyperglycemia (high blood sugar) and hypoglycemia (low blood sugar).

  1. Foot Care:

to prevent complications.
Encourage regular foot inspections, wearing comfortable shoes, and maintaining good hygiene.

202
Q

Jeff suddenly appears drunk
Diaphoresis, cool calmy skin & normal eyeballs

He is Hypo / Hyperglycemia

A

Hypoglycemic

203
Q

Jill symptoms are gradual onset

Lethargy

Hypoactive reflexes

Nausea vomiting thirst

A

Hyperglycemia

204
Q

Hunger is associated with….
Thirst and vomiting associated with….

A

Hunger Hypoglycemia

Thirst & Vomiting Hyperglycemia

205
Q

Headache, blurred vision, ataxia, diplopia, hyperactive reflexes….

Sluggishness, hypoactive reflexes

A

Hypoglycemia
Headache, blurred vision, ataxia, diplopia, hyperactive reflexes

Hyperglycemia
Sluggishness, hypoactive reflexes

206
Q

Paresthesia, muscle spasms, weakness, twitching, progress to seizure

Weakness, lethargy

A

Paresthesia, muscle spasms, weakness, twitching, progress to seizure

Weakness, lethargy

207
Q

Tachycardia; hypotension

Tachycardia, palpations, normal to high BP

A

Hyperglycemia
Tachycardia; hypotension

Hypoglycemia
Tachycardia, palpations, normal to high BP

208
Q

Rapid, deep respirations (Kussmaul) acetone-like or fruity breath

Rapid shallow respiration

A

Hyperglycemia
Rapid, deep respirations (Kussmaul) acetone-like or fruity breath

Hypoglycemia
Rapid shallow respiration

209
Q

Dry, warm, Flushed skin, soft eyeballs

Diaphoresis, cool clammy skin, normal eye balls

A

Hyperglycemia
Dry, warm, Flushed skin, soft eyeballs

Hypoglycemia
Diaphoresis, cool clammy skin, normal eye balls

210
Q

Sudden, drunk appearance, anxious

Gradual, slow and sluggish

A

Hypoglycemia
Sudden, drunk appearance, anxious

Hyperglycemia
Gradual, slow and sluggish

211
Q

Treatment goal of DKA

(3)

A

Prevent dehydration
Electrolyte Loss
Acidosis

212
Q

Metformin (Glucophage) which of the following are true

A. Stimulates the production of more insulin
B. It must be taken with meals
C. Decreases sugar production in the liver
D. Inhibits absorption of carbs
E. Reduces insulin resistance

A

B. It must be taken with meals
C. Decreases sugar production in the liver
E. Reduces insulin resistance

213
Q

Metformin is a biguanide that
Decreases glucose production in liver
Decreases intestinal absorption
Increase _______
Decreases both basal and Postprandial blood glucose

A

Insulin sensitivity

214
Q

Why is insulin given via injection

A. It needs to work quickly
B. Insulin is destroyed by stomach acid
C. It can be taken via pill form

A

It is destroyed by stomach acid

215
Q

During DKA which insulin should be administered

A

Regular/ Short acting

Via IV

216
Q

Symptoms of Hypoglycemia

A. Thirst
B. Palpations
C. Diaphoresis
D. Slurred Speech
E. Hyperventilating
F. Hypoventilating

A

B. Palpations
C. Diaphoresis
D. Slurred Speech
F. Hypoventilating

217
Q

Signs of DKA

A. Fruity breath
B. Deep and labored breath
C. Blurred vision
D. Increase urination
E. Increased thirst
F. Fatigue
G. Blood Glucose level 60mg/dl
H. Dehydration
I. Respitory rate 8
J. Hypernatremia
K. Metabolic acidosis

A

A. Fruity breath
B. Deep and labored breath
C. Blurred vision
D. Increase urination
E. Increased thirst
F. Fatigue
H. Dehydration

218
Q

70 year old with Type 2 DM is admitted with pneumonia. Health is very poor, which is most likely the problem

A. Insulin Resistance
B. Diabetic ketoacidosis
C. Hypoglycemia unawareness
D. Hyperglycemic hyperosmolar Nonketotic syndrome

A

D. Hyperglycemic hyperosmolar Nonketotic syndrome

Illness esp in frail elderly can result
Dehydration & HHNS

NURS 1245 (12 decks)

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