DM Nursing Care (NUR 324) Created by Diana Hallis Flashcards
1
Q
Autoimmune destruction of beta cells in our pancreas
A
Type 1 diabetes
2
Q
Step 1 in diabetes type 1 development
A
Autoantigens form on insulin-producing beta cells and circulate in the blood and lymphatics
3
Q
Step 2 in diabetes type 1 development
A
Activation of cellular immunity and humoral immunity towards beta cells
4
Q
Step 3 in diabetes type 1 development
A
Destruction of beta cells with decreased insulin secretion
5
Q
Macrophages and T cytotoxic cells are part of __ immunity.
A
Cellular immunity
6
Q
Autoantibodies are part of __ immunity
A
humoral
7
Q
Beta cells overworked and cells become immune or resistant to insulin
A
type 2 diabetes
8
Q
Type 1 more common in…
A
younger adults
9
Q
Signs and symptoms are more abrupt in __ diabetes
A
type 1
10
Q
Type 1 diabetes represents __ - __ % of all diabetes
A
5-10%
11
Q
Type 1 diabetes have no __ insulin production
A
endogenous
12
Q
Type 1 diabetes must have insulin __.
A
replacement
13
Q
3 P’s for diabetes
A
Polyuria, polydipsia, polyphagia
14
Q
Type 2 diabetes more common in adults and can go…
A
undiagnosed for years
15
Q
Type 2 diabetes: Doctors most often screen based on
A
risk factors, not signs and symptoms
16
Q
Diabetic type 2 patients are insulin __
A
RESISTANT
17
Q
Some type 2 diabetes can need insulin __
A
replacement
18
Q
Type 2 diabetes often treated with __ or __
A
oral or subcut medications
19
Q
Excessive thirst
A
polydipsia
20
Q
Excessive urination
A
polyuria
21
Q
Excessive hunger
A
polyphagia
22
Q
Normal fasting blood glucose
A
less than 126 mg/dL
23
Q
To test for a fasting blood glucose the patient will have not had any food or drink in…
A
8 hours
24
Q
Casual blood glucose normal level
A
less than 200 mg/dL
25
High urine ketones is associated with
Hyperglycemia
26
What level of urine ketones is associated with a medical emergency
Over 300 mg/dL
27
__ and __ may be elevated in patients with diabetes (lipids)
LDL and triglycerides
28
Diabetics may have low lipid __ levels
HDL
29
OGTT
Oral glucose tolerance test
30
Oral glucose tolerance test is commonly used to diagnose
gestational diabetes
31
To test for a oral glucose tolerance test, you must draw a
fasting glucose prior to testing
32
After the patient consumes oral glucose in a GTT, the patient's glucose levels are obtained every...
30 minutes until 2 hours post consumption
33
Fasting glucose in an OB patient prior to GTT should be
less than 110 mg/dL
34
At one hour after oral glucose consumption for the GTT, an OB patient's blood glucose should be
less than 180 mg/dL
35
At two hours after oral glucose consumption for the GTT, an OB patient's blood glucose should be
less than 140 mg/dL
36
HbA1C
Glycosylated Hemoglobin
37
HbA1C is the indicator for AVERAGE glucose level over the...
past 120 days (3 months)
38
HgA1C is most commonly used for
diagnosis of diabetes and intervention evaluation
39
Normal A1C
4-6%
40
A1C diabetic level
6.5% or greater
41
For those diagnosed with diabetes, what is the acceptable reference A1C level?
6-8%
42
What is the target A1C level for those diagnosed with diabetes?
7%
43
A1C normal level
About 5
44
A1C pre diabetic level
5.7-6.4
45
A1C diabetic range
6.5 or greater
46
Fasting plasma glucose normal range
Less than 100
47
Fasting plasma glucose pre diabetic range
100-125
48
Fasting plasma glucose diabetic range
126 or higher
49
Oral GTT normal range
139 or below
50
Oral GTT pre diabetic range
140-199
51
Oral GTT diabetic range
200 or above
52
If in the pre diabetic range for A1C, GTT, or fasting glucose this is indicative of
the possible development of diabetes
53
To be diagnosed with diabetes you must have at least ONE of the following:
1) A1C 6.5 or higher, 2) Fasting blood glucose of 126 mg/dL or higher, 3) GTT 12 hr level of 200 mg/dL, 4) Classic symptoms of hyperglycemia, random GTT greater than 200, or hyperglycemic crisis
54
Classic signs of hyperglycemia
3 P's or unexplained weight loss
55
If someone has labs indicative of diabetes you would
repeat labs before diagnosing
56
Lab diagnostic criteria are more common to diagnose
Type 2 diabetes
57
To diagnose type 1 diabetes...
Islet cell autoantibody testing
58
How to evaluate the effectiveness of treatment for type 1 diabetics
A1C
59
Impaired GTT, impaired fasting-glucose, or both
Pre-diabetes
60
There are typically no symptoms associated with pre-diabetes however,
long-term damage can already by occurring
61
What can we do for a patient who is pre-diabetic?
TEACH! Lifestyle modifications, blood glucose and A1C monitoring, symptom monitoring
62
Symptoms of diabetes
Fatigue, slow wound healing, getting sick frequently
63
Diet modifications for the pre-diabetic
Avoiding sugary foods and monitoring carbohydrate intake
64
Oral medications are started at a low dose and increased gradually based on
A1C levels and fasting glucose levels (usually AM)
65
Oral medications are most frequently used in
type 2 diabetics
66
Oral diabetes medications work in 3 main ways
Reverse insulin resistance, increase insulin production, or increase hepatic glucose production
67
In hospitalized patients taking oral diabetes medications...
Oral medications are stopped and they are put on insulin while acutely ill
68
Putting patients on insulin while in the hospital can cause
Increased anxiety, so you must explain to the patient why you are using the insulin and that they will resume their medication when going back home
69
You may need to hold metformin before
certain procedures
70
When a diabetic patient is actually ill they will often be started on
Oral or IV steroids
71
What do steroids do to blood sugar?
Increase it, dramatically
72
If a patient is prescribed steroids they may need to... (3)
1) Alter insulin regimen at home, 2) Adjust basal dosage, 3) increase scheduled doses
73
Illness naturally causes body
Stress
74
Stress on the body to release more hormones which causes the body to release more
Glucose
75
If a diabetic patient is ill, they may need to
Check blood glucose more often and adjust insulin regimen
76
Diabetic patients are more prone to go into __ or __ when sick
DKA or HHNS
77
If a diabetic patient has a stomach illness, they may not be eating or drinking. As a nurse you should...
Tell them to check their blood sugar more often and treat as necessary
78
Diabetics still need to do what when they are sick to their stomach
Take their oral medications
79
Nursing teaching point: Tell diabetic patients to do what when they are sick
Notify their HCP
80
Nursing teaching point: Tell diabetic patients to monitor their blood glucose more frequently when sick, maybe every
2-4 hours
81
Nursing teaching point: Diabetics when sick need to continue to __ & __
Take medications and stay hydrated
82
Nursing teaching point: When diabetics become ill, they need to maintain their
Carbohydrate needs, either through oral food or liquid such as gatorade or pedialyte
83
Nursing teaching point: When diabetics are sick they need to...
REST!
84
Tell diabetics to call HCP if urine positive for...
Ketones
85
Tell diabetics to call HCP is their blood sugar is greater than...
250 mg/dL
86
Tell diabetics to call HCP is fever greater than __ and not responding to __
Fever greater than 101.5 and not responding to Tylenol
87
Tell diabetics to call HCP if they are feeling...
confused, disoriented, or have rapid breathing
88
Tell diabetics to call HCP is they are consistently having these GI symptoms
nausea, vomiting, diarrhea
89
Tell diabetes to call HCP is they are unable to tolerate
liquids
90
Tell diabetics to call HCP is their illness lasts longer than
2 days
91
Critical part of diabetes management
the patient's self-monitoring of blood glucose
92
Frequently of blood sugar checks depends on these factors (5)
1) glycemic goals, 2) type of diabetes, 3) medication regimen, 4) access to supplies and equipment, 5) patient's willingness
93
If a patient is newly diagnosed and/or only on oral medications for diabetes, they should check their blood sugar
Once in the morning and once before they go to bed
94
Patients who are on insulin should check their blood sugar
Multiple times per day
95
Continuous glucose monitoring is more commonly used in...
Type 1 diabetes
96
However, continuous glucose monitoring can be very
expensive
97
With continuous glucose monitoring, the patient can use
An insulin pump, or respond to readings with medications
98
In healthcare, we do our best to mimic the body's
normal insulin production
99
How do we best mimic normal body insulin production?
Combine basal insulin with mealtime insulin
100
Combining basal insulin with mealtime insulin is called a
"basal-bolus" regimen
101
What type of insulin is used for bolus
Rapid or short acting insulin
102
What type of insulin is given once a day, typically in the morning
Basal
103
Typical basal-bolus insulin regimen
4x, basal at bedtime, and bolus before each meal
104
Basal insulin
Glargine
105
Bolus insulin
NovoLog or Regular
106
Rapid acting insulin
lispro, aspart, glulisine
107
lispro
Humalog
108
aspart
NovoLog
109
glulisine
Apidra
110
Short acting insulin
Regular
111
Regular insulin types
Humulin R or Novolin R
112
Intermediate acting insulin
NPH, or Humulin N or Novocain N
113
Long acting insulin
glargine, detemir, degludec
114
glargine
Lantus
115
detemir
Levemir
116
degludec
Tresiba
117
Inhaled insulin
Afrezza
118
Onset of rapid acting insulin
10-30 minutes
119
Peak of rapid acting insulin
30 min - 3 hrs
120
Duration of rapid acting insulin
3-5 hrs
121
Onset of short acting insulin
30 mins - 1 hr
122
Peak of short acting insulin
2-5 hrs
123
Duration of short acting insulin
5-8 hrs
124
Onset of intermediate acting insulin
1.5-4 hrs
125
Peak of intermediate acting insulin
4-12 hrs
126
Duration of intermediate acting insulin
12-18 hrs
127
Onset of long acting insulin
0.8-4 hrs
128
Peak of long acting insulin
less defined or no pronounced peak
129
Duration of long acting insulin
16-24 hrs
130
Onset of inhaled insulin
12-15 mins
131
Peak of inhaled insulin
60 mins
132
Duration of inhaled insulin
2.5-3 hrs
133
Most commonly used rapid acting insulin type
lispro (Novolog)
134
Most commonly used regular or short acting insulin type
human regular (Novalin R/Humalin R)
135
Most commonly used intermediate acting insulin type used
NPH (Humalin N)
136
Most commonly used long acting insulin type
glargine (Lantus)
137
Typically providers use a combination of
rapid, regular and long acting insulin regimens
138
Insulin is a...
high alert medication
139
First, before you ever give an insulin injection you need to know
the patient's current glucose
140
Second, you must check the.. (2)
1) diet order, 2) patient's oral intake tolerance
141
If a patient is on a scheduled insulin regimen but the patient isn't eating...
You may need to hold the insulin and contact the provider
142
What do you do if your patient is NPO but is scheduled for insulin?
Hospital policy whether you give 50% or hold
143
When giving insulin it's very important to know these three things
Hospital policy, patient's blood sugar, and if patient has been eating
144
If you give insulin and your patient throws up, what may happen?
They may become hypoglycemic
145
What is the MOST important point for patients on insulin?
Teaching!
146
Many times, diabetics understand their bodies...
better than we do, listen to them!
147
For newly diagnosed patients you should...
Observe their self-administration of insulin
148
What is crucial for insulin injections?
TIMING! Understand when it is administered, when it will take effect, and when you might see adverse reactions such as hypoglycemia
149
Hypoglycemia can...
Kill people
150
Hypoglycemia can cause __ if it is not treated
seizures
151
Blood sugar less than 70
Hypoglycemia
152
If blood sugar is greater than 70, especially in an uncontrolled diabetic
they can still have symptoms of hypoglycemia
153
Symptoms of hypoglycemia (10)
Sweating, blurry vision, dizziness, anxiety, irritability, hunger, shakiness, tachycardia, headache, fatigue
154
After checking airway and circulation, if a patient is unresponsive you should check
blood sugar!
155
Hypoglycemic patients can feel like they are going to...
die
156
To treat hypoglycemia, first thing you do is
confirm they are hypoglycemic based off blood glucose
157
Follow rule of 15 for hypoglycemia
If sugar is low, give them 15 grams of carbohydrates
158
Carbohydrates sources to give a diabetic experiencing hypoglycemia
15g of simple sugars such as 4 oz juice or regular soda, or 3 glucose tabs
159
You should avoid simple sugars that are paired with
Fat because it delays absorption (such as a candy bar)
160
If the patient is unresponsive they will not be able to swallow so...
the rule of 15 is not appropriate
161
15 grams of simple carbohydrates will increase the blood sugar by
50 mg/dL in about 15 minutes
162
Also equivalent to 15 grams of simple sugars
1 tbs of honey or 5-8 lifesavers
163
Once their blood sugar has risen after following the rule of 15, then you encourage
the patient to eat a regular meal
164
If after 15 minutes the patient's blood sugar is still less than 70...
Repeat the rule of 15 process
165
If patient is unresponsive and cannot swallow you can give...
IM glucagon or D50 (25-50ml) IV
166
At home a diabetic can use __ if unable to swallow
a jelly SL that will absorb even if unable to swallow
167
Other complication that can occur with insulin administration
hyperglycemia
168
Hyperglycemia is typically due to...
illness, infection, self-management issues, stress
169
What does a patient look like who is extremely hyperglycemic?
Weakness, fatigue, blurry vision, headache, nausea, vomiting, diarrhea
170
A patient with hyperglycemia will have a blood sugar of
250, even greater than 300
171
For hyperglycemia, check urine for
ketones!
172
To treat hyperglycemia administer
Insulin, have patient drink fluids, and educate on prevention
173
Greater than 300 blood sugar
Is considered an emergency and patient should go to ER
174
Greater than __ ketones, let the provider know
300
175
Crisis situations for hyperglycemia
DKA, and HHS (Hyperglycemic hyperosmolar syndrome)
176
DKA and HHS are conditions that are
life-threatening due to uncontrolled hyperglycemia
177
Release continuous infusion of subcut insulin
Insulin pumps
178
Insulin pumps use __ or __ types of insulin
rapid acting or regular
179
With insulin pumps patients are receiving a continuous
basal infusion
180
Patients have the ability to alter the basal rate of their inulin pump and also
can give themselves a bolus based on finger stick reading
181
With an insulin pump you still need to check your insulin at least
4x per day, breakfast, lunch, dinner, and before bedtime
182
Most users of insulin pumps use monitors that are connected to their
phones so they can constantly see what their blood sugar is
183
If a patient with a pump is admitted...
Their pump is deactivated and they are switched to a sliding scale insulin regimen so we can gain greater control of their levels
184
Problems to be aware of for insulin pumps:
Infection at insertion site, increased risk for DKA if pump malfunctions, and high cost
185
You cannot __ or __ with insulin pumps
Swim or take a bath, but you can take the pump off and do those activities
186
Chronic complicated of diabetes (long term hyperglycemia) are related to...
end-organ disease from chronic damage to blood vessels
187
chronic damage to blood vessels is called
angiopathy
188
Angiopathy is typically what causes __ in patients with diabetes
death
189
Cardiovascular related death due to angiopathy
68%
190
Stroke related death due to angiopathy
16%
191
Damage to large vessels such as coronary arteries, peripheral vascular, or cerebral vascular
Macrovascular angiopathy
192
Damage to capillaries such as retinopathy, nephropathy, or neuropathy
Microvascular angiopathy
193
Women with diabetes have __x the risk of CVD than those without
4-6x
194
Men with diabetes have __x the risk of CVD than those without
2-3x
195
Nursing teaching points for macrovascular disease (CVD)
Stop smoking, control blood pressure, modify high fat diet
196
If a patient has metabolic syndrome, their risk of death is
very much increased
197
Damage to the retina related to chronic hyperglycemia
Retinopathy
198
Damage to small blood vessels in the kidneys
Nephropathy
199
Nerve damage due to metabolic imbalances associated with hyperglycemia
Neuropathy
200
Retinopathy, nephropathy, and neuropathy are examples of
microvascular complications
201
Diabetes is the leading cause of end-stage
renal disease
202
Much more likely to get kidney disease if you have...
Hypertension AND diabetes
203
__% of diabetics have some type of neuropathy
60-70%
204
Major contributor to amputation
diabetic neuropathy
205
Only prevention for diabetic neuropathy
Early screening and keeping blood sugar under control
206
Neuropathy is typically in that patient's
feet and lower extremities
207
Common complications of neuropathy
Foot ulcerations and lower extremity amputations
208
What causes the complications of neuropathy?
Loss of protective sensation, prevents patients from being aware that an injury has occurred
209
Patients with neuropathy can become
Neuroischemic and loose bloodflow
210
Because of the loss of blood flow, the patient's wound will become
Ischemic and amputation will be needed
211
Diabetic foot care is the
nurse's job!!
212
Wash feet daily with...
mild soap and warm water after testing water with hands
213
Pat feet dry especially...
between toes
214
Inspect feet daily for...
cuts, swelling, blisters, red areas
215
Use __ to prevent dry skin and cracking
lanolin
216
Do not put lanolin
between toes
217
You can use __ of sweaty feet
mild foot powder
218
Do not use __ __ to removed calluses or corns
commercial remedies
219
Clean any cuts with
mild soap and water
220
Do not clean cuts with
iodine, alcohol, or adhesives
221
Tell patients to report any
skin infections or non-healing sores
222
You should trim nails
after shower or bath
223
Cut nails evenly with
rounded contours
224
Separate overlapping toes with
cotton
225
Educate patient to wear shoes with
soles and to shake out before wearing
226
Educate patient to never go
barefoot, wear open toed or open heeled or plastic shoes
227
Educate patient to wear socks that are
clean and absorbent
228
Educate patient not to use
hot water bottles
229
What type of diet is best for diabetics
Balanced, high fiber, low fat, low cholesterol
230
Encourage patients to each complex carbohydrates such as
grains, fruits, vegetables, legumes and milk
231
Carbohydrates still need to be about __ of total caloric intake
45-65%
232
Teach patients to limit simple carbohydrates such as
pasta and bread
233
Teach diabetic patients to eat a diet low in __ and __ fats
saturated and trans
234
Best type of fats to eat
polyunsaturated, can be found in fish and nuts
235
Crucial for diabetic patients. Can improve carb metabolism and lower cholesterol
Fiber!
236
Good sources of fiber
Beans, vegetables, oats, whole grains
237
15-20% of diet
Protein, preferably from lean meats
238
Limit alcohol to
1 drink daily for women, 2 drinks daily for men
239
Alcohol turns into...
Sugar and can increase blood sugar
240
Alcohol can also have intense
rebound effects and dramatically lower blood sugar as well
241
Alternative sweeteners are
acceptable alternatives to sugar for patients with diabetes
242
Consistent carb diets or
CC
243
CC1
60g of carbs/meal, 1500 calories
244
CC2
75g of carb/meal, 1800 cals
245
CC3
90g of carb/meal, 2200 cals
246
Carb counting is common, especially for
Type 1 diabetics
247
Exercise will __ blood sugar
lower
248
It's best to exercise after
meals
249
Tell patients not to exercise if blood sugar is
less than 80 or higher than 250
250
Teach patient to eat a carbohydrate snack
prior to a high intensity workout
251
Teach patient while exercising to wear a
medical alert bracelet, so if they pass out people around them will know what's going on
252
Teach patient to always think about their
feet! Teach them to wear good fitting shoes
253
Stress such as surgery can
increase blood glucose levels
254
Common for a controlled diabetic to become
uncontrolled while admitted to the hospital and this can upset them
255
Wound healing is __ in patients with diabetes
impaired, can take longer and at higher risk for infection
256
Integumentary concerns associated with uncontrolled hyperglycemia
diabetic dermopathy, acenthosis nigricans, necrobiosis lipidica diabeticorum
257
Diabetic dermopathy
Reddish-brownish spots, usually not the shins
258
Acanthosis nigricans
Brown/black thickening of skin, often seen in skin folds
259
Necrobiosis lipoidica diabeticorum
Red patches around the blood vessels
