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54/64 Unit 2 > DM, DKA, HHNS > Flashcards

DM, DKA, HHNS Flashcards

1
Q

Hormones made by the beta cells of the pancreas

A

insulin and amylin (incretin hormone)

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2
Q

glucagon is made by the _____ cells of the pancreas

A

alpha

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3
Q

Glucagon works opposite of _____ preventing hypoglycemia

A

insulin

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4
Q

Functions of amylin

A

slows gastric emptying, suppresses glucagon secretion, and increases satiety

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5
Q

The liver and muscles store glucose as

A

glycogen

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6
Q

_________ is main fuel for the body

A

glucose

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7
Q

Glucose mainly comes from food, but the _____ can produce glucose also

A

liver

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8
Q

If the liver does not have glycogen, the body will break down ___ and _____ for energy

A

fats; proteins

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9
Q

breakdown of fats

A

lipolysis

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10
Q

Protein breakdown

A

proteolysis

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11
Q

A1c > ___ is diagnosed diabetes

A

6.5%

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12
Q

Fasting plasma glucose > ___ mg/dL is diagnosed diabetes

A

126

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13
Q

Random plasma glucose > ___ mg/dL is diagnosed diabetes

A

200

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14
Q

Examples of medications that can cause hyperglycemia

A

steroids

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15
Q

beta blockers may mask the signs and symptoms of

A

hypoglycemia

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16
Q

micro/macrovascular changes and complications can occur ___-___ years before diagnosis of diabetes

A

5-10

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17
Q

hypoglycemia is classified as blood sugar < ___ mg/dL

A

70

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18
Q

Characteristics of hypoglycemia

A

acute complication, sudden onset, requires immediate treatment, can cause cognitive impairment

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19
Q

Hypoglycemia precipitating factors

A

skipping meals, exercising more than normal, taking too much insulin or oral medications

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20
Q

S/S of hypoglycemia

A

shakiness, dizziness, diaphoresis, tachycardia, blurred vision, changes in mental status

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21
Q

Hypoglycemia nursing care

A

immediate treatment, increase glucose level, monitor CNS changes

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22
Q

Characteristics of DKA

A

sudden onset, life-threatening, most common with Type I diabetics but can occur in Type II diabetics although rare

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23
Q

DKA precipitating factors

A

infection (elevates BS), vomiting, inadequate insulin, undiagnosed diabetes, medications (steroids), not eating

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24
Q

DKA key players

A

glucose, insulin, liver and glucagon, ketones, kidneys

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25
Q

DKA manifestations

A

hyperglycemia, metabolic acidosis, production of ketones, Kussmaul respirations, dehydration (electrolyte imbalances such as hyponatremia/kalemia)

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26
Q

During DKA, respirations increase so the lungs blow off ___ from the body to raise pH

A

CO2

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27
Q

metabolic acidosis

A

low pH, low HCO3, normal or no change in PCO2

28
Q

DKA manifestations

A

electrolyte imbalances (low K+, Na, bicarb), polyuria, polydipsia, fatigue, weight loss

29
Q

glucose associated with DKA

A

> 300 mg/dL

30
Q

Serum and urine ketones will be _________ in DKA

A

positive

31
Q

Serum pH related to DKA

A

< 7.35 (acidosis)

32
Q

Serum bicarb related to DKA

A

< 15 mEq/L

33
Q

BUN related to DKA

A

> 30 mg/dL (elevated)

34
Q

creatinine related to DKA

A

> 1.5 mg/dL (elevated)

34
Q

Anion gap related to DKA

A

> 17

34
Q

normal anion gap

A

5-17

35
Q

Test that measures the acid-base balance and electrolyte balance of blood

A

anion gap

36
Q

Treatment of DKA

A

immediate treatment: 1) hydrate with IV fluids (NS, D5W to balance blood sugars/prevent hypoglycemia), 2) lower blood gluocse with REGULAR insulin drip, monitor potassium level, correct acid-base imbalance

37
Q

Characteristics of Hyperglycemia Hyperosmolar Non-ketonic State (HHNS)

A

gradual onset, more common in type II diabetics

38
Q

HHNS precipitating factors

A

infection, stressors, poor fluid intake (dehydration)

39
Q

HHNS key players

A

glucose, insulin, kidneys

40
Q

Why do type II diabetics not typically enter ketosis?

A

because unlike type I diabetics, there is just enough insulin to get glucose into cells

41
Q

HHNS manifestations

A

altered CNS function, seizures, electrolyte loss, dehydration, severe hyperglycemia

42
Q

HHNS typically occurs in

A

older clients with type II diabetes

43
Q

Glucose related to HHNS

A

> 600 mg/dL

44
Q

Osmolarity related to HHNS

A

> 320 mOsm/kg

45
Q

Serum ketones will be _________ in HHNS

A

negative

46
Q

Serum pH related to HHNS

A

> 7.3

47
Q

Serum bicarb related to HHNS

A

> 20 mEq/L

48
Q

BUN and creatinine will be ________ with HHNS

A

elevated

49
Q

HHNS treatment

A

1) hydrate (fluid therapy to increase blood volume), 2) decrease blood glucose, correct electrolyte imbalance

50
Q

Patient education of prevention of DKA

A

monitor glucose when ill, watch for and report any illness lasting more than 1-2 days, check blood glucose levels every 4-6 hrs if anorexia, N/V is experiences, check urine ketones when BG is greater than 300 mg/dL

51
Q

normal A1c

A

< 5.6%

52
Q

Prediabetes A1c

A

5.7 - 6.4%

53
Q

target A1c after diagnosis of diabetes

A

< 7%

54
Q

Treatment of hypoglycemia

A

immediate treatment; 15 g of simple carb (oral if conscious and able to swallow), if unconscious: IV glucose (D50) or glucagon IM, recheck BG after 20 min, eat a snack/small meal after BG is > 70 mg/dL

55
Q

Patient education of prevention of hypoglycemia

A

do not skip meals, no exercising on empty stomach, check BG before exercise (if < 100, eat a snack before exercise and take a snack with you)

56
Q

Examples of simple carbs for the treatment of hypoglycemia

A

juice, candy (CHEW, do not suck), regular soda, spoonful of sugar if nothing else

57
Q

DKA protocol

A

IV fluids, IV insulin, vital signs, correction of acidosis, administer potassium, administer bicarbonate, administer D5 or D10 per protocol, DKA resolved when labs within normal range according to facility

58
Q

DKA treament

A

follow DKA protocol, fluids, IV insulin (regular), decrease blood glucose GRADUALLY (prevents further electrolyte imbalances and hypoglycemia)

59
Q

HHNS treatment

A

IV fluids, sliding scale insulin protocol, correct electrolyte imbalance

60
Q

Diabetes long-term care

A

4 M’s: monitor, motion (exercise), medication, meal planning

61
Q

Older adult diabetes considerations

A

increased prevalence and mortality, glycemic control challenging, increased hypoglycemic unawareness, functional limitations, renal insufficiency, diet and exercise (main treatment), patient teaching must be adapted to needs, HHS more prevalent in older adults

62
Q

why are older adults more likely to have hypoglycemia?

A

older adults have a decreased metabolism causing medications to stay in system longer

63
Q

Pediatric diabetes considerations

A

medical management is similar to adults, requires parent participation, promotion on health growth and development, DKA more prevalent in younger clients

54/64 Unit 2 (8 decks)

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