DM and MS Flashcards
Impaired Fasting Glucose
FPG 100-125
Impaired Glucose Tolerance
Based on result of 2h OGTT
140-199
Hba1c Prediabetes Range
5.7-6.4%
Hba1c level diagnostic for DM
6.5% or greater
Goal Hba1c for a diabetic pt (ADA)
less than 7%
In US, DM is leading cause of (3)
non-traumatic amputations
blindness
end stage renal disease
Preferred diagnostic test for DM
Fasting Plasma Glucose (after 8 hour fast) venous or cap stick
Diagnostic Criteria for DM
Classic s/s hyperglycemia plus random BG 200+
Hba1c 6.5% or higher
FPG 126 or higher
2 hour OGTT of 200 or higher
who is recommended to do SMBG
all insulin-treated DM pts
pts on sulfonylureas
pts not achieving glycemic control goals.
Type 1 pts should SMBG
3-4x/day
type 1 pts should test urine ketones when
during acute illness
when BG consistently elevated
s/s DKA are present
DM pt should not exercise when
BG 250
ketones positive
Type 1 pt should eat before exercise
15g CHO before moderate activity
more food for more activity
who should carry a readily-absorbable CHO on person
Type 1
pts on sulfonylureas or meglinitides
ADA recommended BG for DM pts before and after meals
before: 90-130
after: less than 180
drugs that can antagonize (oppose) hypoglycemic effects of insulin
corticosteroids
thiazide/loop diuretics
sympathomimetics
thyroid hormone
drugs than can increase hypoglycemic effects of insulin
alcohol
anabolic steroids
MAOIs
salicylates
can mask tachycardia from hypoglycemia
nonselective beta blockers
Peak action of rapid-acting insulin
1 hour
Duration of action of rapid-acting insulin
3-4 hours
Three types of rapid-acting insulin
Apidra (glulisine)
Humalog (lispro)
Novolog (aspart)
Onset of short-acting (regular) insulin
30 min-1 hour
Peak of action of short-acting (regular) insulin
2-4 hours
Duration of action of short-acting (regular) insulin
6-8 hours
Types of short-acting (regular) insulin
Novolin R
Humulin R
Onset of Intermediate-Acting (NPH) insulin
1-3 hours
Peak of Action of Intermediate-Acting (NPH) insulin
6-8 hours
Duration of action of Intermediate-Acting (NPH) insulin
12-16 hours
Types of Intermediate-Acting (NPH) insulin
Novolin N
Humulin N
Onset of Action of Long-Acting insulin
2-6 hours
Peak of Action of Long-Acting insulin
none
Duration of Action of Long-Acting insulin
12- 24 hours
DCCT
Diabetes Control and Complications Trial
Demonstrated intensive glucose control dramatically reduced the development and progression of complications; also increased risk of hypoglycemia
UKPDS-UK Prospective Study
demonstrated a decrease in complications in patients who had Type 2 DM
alcohol consumption is dangerous in DM pts (especially those on insulin) because
alcohol inhibits gluconeogenesis and can cause hypoglycemia
May also impair ability to recognize and treat HoG
swan neck deformity
affects most distal joint of finger, occurs in RA
ulnar deviation, drift
all fingers angle toward ulnar side, occurs in arthritis
Valgus deformities
distal arm of joint points away from midline (brings joints closer)
Bunion
Hallux valgus deformity of big toe
Genu valgum
Valgus deformity of knees (together)
Talipes valgus
Eversion of feet (walk on instep)
Varus deformities
distal arm of joint points toward midline (moves joints apart)
Talipes varus
inversion of feet
Genu varum
bow legs
Lordosis
exaggerated curvature of lumbar spine; “sway back”; often in pregnant women
Scoliosis
lateral curvature of spine, increased when bending forward
Kyphosis
increased curvature of thoracic spine; often in elderly with OA
Pes planus
flat foot
Pes cavus
high instep
isometric exercise
contraction of muscle but no joint or extremity movement–Kegels, Quad sets
isotonic exercise
muscle contraction resulting in movement
clonus
rhythmic contraction of muscle
fasciculations
involuntary muscle twitches
most significant RF of OA
age-still not part of normal aging process
finger nodules caused by OA
Herberden’s and Bouchard’s nodules
Total Hip Dislocation Precautions
Keep legs abducted
No internal rotation
No flexion 60-90 degrees
No adduction (wedge pillow, pillow bt legs)
Hereditary metabolic disturbance of purine metabolism leading to excess uric acid crystals that are deposited in body tissues and joints.
Gout
Ankylosing Spondylitis
Type of RA
systemic inflammatory condition of vertebral column and sacroiliac joints
Strain vs. Sprain
Strain: stretching of the muscle and its fascial sheath
Sprain: injury to ligaments surrounding a joint caused by twisting motion
Compression of median nerve at wrist; entrapment neuropathy
Carpel Tunnel Syndrome
3 ways to reduce a fracture
Closed reduction
Open reduction
Traction
fat embolism presentation
confusion, respiratory distress, petechiae along chest, axilla, and neck
s/s of compartment syndrome (6Ps)
Pain Pallor Pulselessness Paresthesia Paralysis Pressure
goal of skin traction
control muscle spasms and immobilize before surgery for short periods Ex. Buck’s extension traction
Skeletal traction is used when
a joint needs rest; usually large trauma or infected TJR needs to be removed.
Bone growth outside the skeleton–bony fragments in soft tissue
Heterotopic ossification
s/s Hip fracture
leg shortened and externally rotated
severe pain
muscle spasms
sometimes ecchymotic
when to amputate stump post op
Elevate 1st 24h to reduce edema
Don’t elevate past 24h or leave flexed, can cause contracture
First sign of osteoporosis
Back pain
fracture
skeletal disorderof abnormally rapid bone turnover that results in excess localized overgrowth of bone
Paget’s disease
malignant tumor of plasma cells in bone marrow
multiple myeloma
pyogenic infection of bone and surrounding tissue
osteomyelitis
most commonly Staph
once insulin is started in treating DKA, monitor for these two complications
hypokalemia and hypoglycemia
immediately given to treat DKA
isotonic or hypotonic fluids to rehydrate
ng tube given to DKA pt because
to relieve n/v and prevent aspiration
HHNC treatment
hypotonic saline
insulin ( bolus or drip)
KCl
elevated BUN seen in
DKA and HHNC
on a sick day a diabetic should test for ketones if BG is below? how often?
240; q4h
on a sick day a diabetic should call MD if BG is
over 300 two times
on a sick day a diabetic should test BG
every 4 hours, use more insulin if needed.
stenosing tenosynovitis
trigger finger
tennis elbow
epicondylitis-pain radiates down dorsal forearm
Osteoporosis treatments
No cure–goal is to manage pain and prevent fracture
WB exercise
Ca in diet
Biphosphates
osteomalacia treatment
increase Ca Vitamin D, and light exposure
tumor may be chondrogenic or osteogenic
osteosarcoma
s/s of multiple myeloma
back pain
anemia
thrombocytopenia
bleeding tendencies
osteomyelitis can complicate into
sepsis
Most Type 2 diabetics can control BG through weight loss because
weight loss increases the number and sensitivity of insulin receptor sites
First step tx for newly diagnosed prediabetic
attain ideal weight; 10-15 lbs. may increase glycemic control
insulin action
Anabolic, storage hormone
moves glucose from blood into muscle, liver, and fat cells
stimulates glycogen storage in liver and muscle; inhibits glycogenolysis
glucagon action
released when BG decreases
stimulates glycogenolysis–glycogen breakdown and glucose release from liver
glucose cannot be stored in the liver without
insulin
osmotic diuresis leading to electrolyte and fluid loss in diabetics results from
excess glucose in urine pulling water with it
DM especially prevalent inthese groups
elderly
Blacks, hispanics, native americans
timing of adult DM screening
begin at age 45, repeat every three years is normal, more often if pt has risk factors
(BMI >25, other rfs)
cause and treatment of somogyi phenomenon
gradual excessive admin of insulin; decrease insulin or give bedtime snack
cause and treatment of dawn phenomenon
surge in cortisol or GH; change time of evening insulin
once proteinuria starts in dm nephropathy (middle stage) treat with
diuretics
low salt diet, protein modifications
final stage of nephropathy treatment
dialysis or transplant
the early/asymptomatic stage of nephropathy goal is
prevention
prompt treatment of anything that impairs kidney function: UTIs, HTN
can decrease proteinuria even in non-HTN DM nephropathy patients
ACE inhibitors
to prevent nephropathy
HTN management
low protein diet
Kyphosis is associated with
OA
gangrene-amputation triad
Neuropathy +
Vascular disease (large vessel insufficiency+autonomic neuropathy leading to dry cracked skin, decreased sweating) +
infection
Risk of spinal HA
Myelogram
Exam of action potentials made by skeletal muscle contractions to differentiate muscle and nerve disease
Electromyogram (EMG)
Radioisotope scan Nsg
Dose of ri 2hours prior
Empty bladder
Increase fluids after
Degree of uptake on RI bone scan indicates
Degree of blood flow
Increased-osteoporosis, osteomyelitis, ca, fx
Decreased-AVN
After arthrocentesis
Compression dsg, observe for leakage or bleeding
The longer a dislocated joint remains in reduced. The greater the risk of
AVN
Impingement syndrome can progress to
RCT
A pt with a rotator cuff injury can’t
Flex and abduct shoulder
Stages of fracture healing
Hematoma
Granulation Tissue
Because irreversible tissue damage from compartment syndrome can happen in only 4-6 hours
Neurovascular checks must be done on time
Pain from compartment syndrome
Unrelenting, greater than expected, and worse on passive ROM
S/S Hip Fx
Leg shortened and externally rotated
Severe pain and muscle spasms
If delayed going to OR with a hip fx
Apply Buck’s traction to immobilize hip
Increase fluids in a pt with a cast due to increased risk of
Constipation and renal calculi
Surgeries to repair hip fracture
Hemiarthroplasty (treat with total hop dislocation precautions)
Or
ORIF (nothing to dislocate)
onset of rapid acting insulin
15 min
