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MED SURG COLLAB > DM Nursing Care (NUR 324) Created by Diana Hallis > Flashcards

DM Nursing Care (NUR 324) Created by Diana Hallis Flashcards

1
Q

Autoimmune destruction of beta cells in our pancreas

A

Type 1 diabetes

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2
Q

Step 1 in diabetes type 1 development

A

Autoantigens form on insulin-producing beta cells and circulate in the blood and lymphatics

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3
Q

Step 2 in diabetes type 1 development

A

Activation of cellular immunity and humoral immunity towards beta cells

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4
Q

Step 3 in diabetes type 1 development

A

Destruction of beta cells with decreased insulin secretion

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5
Q

Macrophages and T cytotoxic cells are part of __ immunity.

A

Cellular immunity

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6
Q

Autoantibodies are part of __ immunity

A

humoral

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7
Q

Beta cells overworked and cells become immune or resistant to insulin

A

type 2 diabetes

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8
Q

Type 1 more common in…

A

younger adults

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9
Q

Signs and symptoms are more abrupt in __ diabetes

A

type 1

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10
Q

Type 1 diabetes represents __ - __ % of all diabetes

A

5-10%

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11
Q

Type 1 diabetes have no __ insulin production

A

endogenous

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12
Q

Type 1 diabetes must have insulin __.

A

replacement

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13
Q

3 P’s for diabetes

A

Polyuria, polydipsia, polyphagia

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14
Q

Type 2 diabetes more common in adults and can go…

A

undiagnosed for years

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15
Q

Type 2 diabetes: Doctors most often screen based on

A

risk factors, not signs and symptoms

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16
Q

Diabetic type 2 patients are insulin __

A

RESISTANT

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17
Q

Some type 2 diabetes can need insulin __

A

replacement

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18
Q

Type 2 diabetes often treated with __ or __

A

oral or subcut medications

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19
Q

Excessive thirst

A

polydipsia

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20
Q

Excessive urination

A

polyuria

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21
Q

Excessive hunger

A

polyphagia

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22
Q

Normal fasting blood glucose

A

less than 126 mg/dL

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23
Q

To test for a fasting blood glucose the patient will have not had any food or drink in…

A

8 hours

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24
Q

Casual blood glucose normal level

A

less than 200 mg/dL

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25
Q

High urine ketones is associated with

A

Hyperglycemia

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26
Q

What level of urine ketones is associated with a medical emergency

A

Over 300 mg/dL

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27
Q

__ and __ may be elevated in patients with diabetes (lipids)

A

LDL and triglycerides

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28
Q

Diabetics may have low lipid __ levels

A

HDL

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29
Q

OGTT

A

Oral glucose tolerance test

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30
Q

Oral glucose tolerance test is commonly used to diagnose

A

gestational diabetes

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31
Q

To test for a oral glucose tolerance test, you must draw a

A

fasting glucose prior to testing

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32
Q

After the patient consumes oral glucose in a GTT, the patient’s glucose levels are obtained every…

A

30 minutes until 2 hours post consumption

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33
Q

Fasting glucose in an OB patient prior to GTT should be

A

less than 110 mg/dL

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34
Q

At one hour after oral glucose consumption for the GTT, an OB patient’s blood glucose should be

A

less than 180 mg/dL

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35
Q

At two hours after oral glucose consumption for the GTT, an OB patient’s blood glucose should be

A

less than 140 mg/dL

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36
Q

HbA1C

A

Glycosylated Hemoglobin

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37
Q

HbA1C is the indicator for AVERAGE glucose level over the…

A

past 120 days (3 months)

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38
Q

HgA1C is most commonly used for

A

diagnosis of diabetes and intervention evaluation

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39
Q

Normal A1C

A

4-6%

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40
Q

A1C diabetic level

A

6.5% or greater

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41
Q

For those diagnosed with diabetes, what is the acceptable reference A1C level?

A

6-8%

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42
Q

What is the target A1C level for those diagnosed with diabetes?

A

7%

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43
Q

A1C normal level

A

About 5

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44
Q

A1C pre diabetic level

A

5.7-6.4

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45
Q

A1C diabetic range

A

6.5 or greater

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46
Q

Fasting plasma glucose normal range

A

Less than 100

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47
Q

Fasting plasma glucose pre diabetic range

A

100-125

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48
Q

Fasting plasma glucose diabetic range

A

126 or higher

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49
Q

Oral GTT normal range

A

139 or below

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50
Q

Oral GTT pre diabetic range

A

140-199

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51
Q

Oral GTT diabetic range

A

200 or above

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52
Q

If in the pre diabetic range for A1C, GTT, or fasting glucose this is indicative of

A

the possible development of diabetes

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53
Q

To be diagnosed with diabetes you must have at least ONE of the following:

A

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

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54
Q

Classic signs of hyperglycemia

A

3 P’s or unexplained weight loss

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55
Q

If someone has labs indicative of diabetes you would

A

repeat labs before diagnosing

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56
Q

Lab diagnostic criteria are more common to diagnose

A

Type 2 diabetes

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57
Q

To diagnose type 1 diabetes…

A

Islet cell autoantibody testing

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58
Q

How to evaluate the effectiveness of treatment for type 1 diabetics

A

A1C

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59
Q

Impaired GTT, impaired fasting-glucose, or both

A

Pre-diabetes

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60
Q

There are typically no symptoms associated with pre-diabetes however,

A

long-term damage can already by occurring

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61
Q

What can we do for a patient who is pre-diabetic?

A

TEACH! Lifestyle modifications, blood glucose and A1C monitoring, symptom monitoring

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62
Q

Symptoms of diabetes

A

Fatigue, slow wound healing, getting sick frequently

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63
Q

Diet modifications for the pre-diabetic

A

Avoiding sugary foods and monitoring carbohydrate intake

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64
Q

Oral medications are started at a low dose and increased gradually based on

A

A1C levels and fasting glucose levels (usually AM)

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65
Q

Oral medications are most frequently used in

A

type 2 diabetics

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66
Q

Oral diabetes medications work in 3 main ways

A

Reverse insulin resistance, increase insulin production, or increase hepatic glucose production

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67
Q

In hospitalized patients taking oral diabetes medications…

A

Oral medications are stopped and they are put on insulin while acutely ill

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68
Q

Putting patients on insulin while in the hospital can cause

A

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

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69
Q

You may need to hold metformin before

A

certain procedures

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70
Q

When a diabetic patient is actually ill they will often be started on

A

Oral or IV steroids

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71
Q

What do steroids do to blood sugar?

A

Increase it, dramatically

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72
Q

If a patient is prescribed steroids they may need to… (3)

A

1) Alter insulin regimen at home, 2) Adjust basal dosage, 3) increase scheduled doses

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73
Q

Illness naturally causes body

A

Stress

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74
Q

Stress on the body to release more hormones which causes the body to release more

A

Glucose

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75
Q

If a diabetic patient is ill, they may need to

A

Check blood glucose more often and adjust insulin regimen

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76
Q

Diabetic patients are more prone to go into __ or __ when sick

A

DKA or HHNS

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77
Q

If a diabetic patient has a stomach illness, they may not be eating or drinking. As a nurse you should…

A

Tell them to check their blood sugar more often and treat as necessary

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78
Q

Diabetics still need to do what when they are sick to their stomach

A

Take their oral medications

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79
Q

Nursing teaching point: Tell diabetic patients to do what when they are sick

A

Notify their HCP

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80
Q

Nursing teaching point: Tell diabetic patients to monitor their blood glucose more frequently when sick, maybe every

A

2-4 hours

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81
Q

Nursing teaching point: Diabetics when sick need to continue to __ & __

A

Take medications and stay hydrated

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82
Q

Nursing teaching point: When diabetics become ill, they need to maintain their

A

Carbohydrate needs, either through oral food or liquid such as gatorade or pedialyte

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83
Q

Nursing teaching point: When diabetics are sick they need to…

A

REST!

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84
Q

Tell diabetics to call HCP if urine positive for…

A

Ketones

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85
Q

Tell diabetics to call HCP is their blood sugar is greater than…

A

250 mg/dL

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86
Q

Tell diabetics to call HCP is fever greater than __ and not responding to __

A

Fever greater than 101.5 and not responding to Tylenol

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87
Q

Tell diabetics to call HCP if they are feeling…

A

confused, disoriented, or have rapid breathing

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88
Q

Tell diabetics to call HCP is they are consistently having these GI symptoms

A

nausea, vomiting, diarrhea

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89
Q

Tell diabetes to call HCP is they are unable to tolerate

A

liquids

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90
Q

Tell diabetics to call HCP is their illness lasts longer than

A

2 days

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91
Q

Critical part of diabetes management

A

the patient’s self-monitoring of blood glucose

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92
Q

Frequently of blood sugar checks depends on these factors (5)

A

1) glycemic goals, 2) type of diabetes, 3) medication regimen, 4) access to supplies and equipment, 5) patient’s willingness

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93
Q

If a patient is newly diagnosed and/or only on oral medications for diabetes, they should check their blood sugar

A

Once in the morning and once before they go to bed

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94
Q

Patients who are on insulin should check their blood sugar

A

Multiple times per day

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95
Q

Continuous glucose monitoring is more commonly used in…

A

Type 1 diabetes

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96
Q

However, continuous glucose monitoring can be very

A

expensive

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97
Q

With continuous glucose monitoring, the patient can use

A

An insulin pump, or respond to readings with medications

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98
Q

In healthcare, we do our best to mimic the body’s

A

normal insulin production

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99
Q

How do we best mimic normal body insulin production?

A

Combine basal insulin with mealtime insulin

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100
Q

Combining basal insulin with mealtime insulin is called a

A

“basal-bolus” regimen

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101
Q

What type of insulin is used for bolus

A

Rapid or short acting insulin

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102
Q

What type of insulin is given once a day, typically in the morning

A

Basal

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103
Q

Typical basal-bolus insulin regimen

A

4x, basal at bedtime, and bolus before each meal

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104
Q

Basal insulin

A

Glargine

105
Q

Bolus insulin

A

NovoLog or Regular

106
Q

Rapid acting insulin

A

lispro, aspart, glulisine

107
Q

lispro

A

Humalog

108
Q

aspart

A

NovoLog

109
Q

glulisine

A

Apidra

110
Q

Short acting insulin

A

Regular

111
Q

Regular insulin types

A

Humulin R or Novolin R

112
Q

Intermediate acting insulin

A

NPH, or Humulin N or Novocain N

113
Q

Long acting insulin

A

glargine, detemir, degludec

114
Q

glargine

A

Lantus

115
Q

detemir

A

Levemir

116
Q

degludec

A

Tresiba

117
Q

Inhaled insulin

A

Afrezza

118
Q

Onset of rapid acting insulin

A

10-30 minutes

119
Q

Peak of rapid acting insulin

A

30 min - 3 hrs

120
Q

Duration of rapid acting insulin

A

3-5 hrs

121
Q

Onset of short acting insulin

A

30 mins - 1 hr

122
Q

Peak of short acting insulin

A

2-5 hrs

123
Q

Duration of short acting insulin

A

5-8 hrs

124
Q

Onset of intermediate acting insulin

A

1.5-4 hrs

125
Q

Peak of intermediate acting insulin

A

4-12 hrs

126
Q

Duration of intermediate acting insulin

A

12-18 hrs

127
Q

Onset of long acting insulin

A

0.8-4 hrs

128
Q

Peak of long acting insulin

A

less defined or no pronounced peak

129
Q

Duration of long acting insulin

A

16-24 hrs

130
Q

Onset of inhaled insulin

A

12-15 mins

131
Q

Peak of inhaled insulin

A

60 mins

132
Q

Duration of inhaled insulin

A

2.5-3 hrs

133
Q

Most commonly used rapid acting insulin type

A

lispro (Novolog)

134
Q

Most commonly used regular or short acting insulin type

A

human regular (Novalin R/Humalin R)

135
Q

Most commonly used intermediate acting insulin type used

A

NPH (Humalin N)

136
Q

Most commonly used long acting insulin type

A

glargine (Lantus)

137
Q

Typically providers use a combination of

A

rapid, regular and long acting insulin regimens

138
Q

Insulin is a…

A

high alert medication

139
Q

First, before you ever give an insulin injection you need to know

A

the patient’s current glucose

140
Q

Second, you must check the.. (2)

A

1) diet order, 2) patient’s oral intake tolerance

141
Q

If a patient is on a scheduled insulin regimen but the patient isn’t eating…

A

You may need to hold the insulin and contact the provider

142
Q

What do you do if your patient is NPO but is scheduled for insulin?

A

Hospital policy whether you give 50% or hold

143
Q

When giving insulin it’s very important to know these three things

A

Hospital policy, patient’s blood sugar, and if patient has been eating

144
Q

If you give insulin and your patient throws up, what may happen?

A

They may become hypoglycemic

145
Q

What is the MOST important point for patients on insulin?

A

Teaching!

146
Q

Many times, diabetics understand their bodies…

A

better than we do, listen to them!

147
Q

For newly diagnosed patients you should…

A

Observe their self-administration of insulin

148
Q

What is crucial for insulin injections?

A

TIMING! Understand when it is administered, when it will take effect, and when you might see adverse reactions such as hypoglycemia

149
Q

Hypoglycemia can…

A

Kill people

150
Q

Hypoglycemia can cause __ if it is not treated

A

seizures

151
Q

Blood sugar less than 70

A

Hypoglycemia

152
Q

If blood sugar is greater than 70, especially in an uncontrolled diabetic

A

they can still have symptoms of hypoglycemia

153
Q

Symptoms of hypoglycemia (10)

A

Sweating, blurry vision, dizziness, anxiety, irritability, hunger, shakiness, tachycardia, headache, fatigue

154
Q

After checking airway and circulation, if a patient is unresponsive you should check

A

blood sugar!

155
Q

Hypoglycemic patients can feel like they are going to…

A

die

156
Q

To treat hypoglycemia, first thing you do is

A

confirm they are hypoglycemic based off blood glucose

157
Q

Follow rule of 15 for hypoglycemia

A

If sugar is low, give them 15 grams of carbohydrates

158
Q

Carbohydrates sources to give a diabetic experiencing hypoglycemia

A

15g of simple sugars such as 4 oz juice or regular soda, or 3 glucose tabs

159
Q

You should avoid simple sugars that are paired with

A

Fat because it delays absorption (such as a candy bar)

160
Q

If the patient is unresponsive they will not be able to swallow so…

A

the rule of 15 is not appropriate

161
Q

15 grams of simple carbohydrates will increase the blood sugar by

A

50 mg/dL in about 15 minutes

162
Q

Also equivalent to 15 grams of simple sugars

A

1 tbs of honey or 5-8 lifesavers

163
Q

Once their blood sugar has risen after following the rule of 15, then you encourage

A

the patient to eat a regular meal

164
Q

If after 15 minutes the patient’s blood sugar is still less than 70…

A

Repeat the rule of 15 process

165
Q

If patient is unresponsive and cannot swallow you can give…

A

IM glucagon or D50 (25-50ml) IV

166
Q

At home a diabetic can use __ if unable to swallow

A

a jelly SL that will absorb even if unable to swallow

167
Q

Other complication that can occur with insulin administration

A

hyperglycemia

168
Q

Hyperglycemia is typically due to…

A

illness, infection, self-management issues, stress

169
Q

What does a patient look like who is extremely hyperglycemic?

A

Weakness, fatigue, blurry vision, headache, nausea, vomiting, diarrhea

170
Q

A patient with hyperglycemia will have a blood sugar of

A

250, even greater than 300

171
Q

For hyperglycemia, check urine for

A

ketones!

172
Q

To treat hyperglycemia administer

A

Insulin, have patient drink fluids, and educate on prevention

173
Q

Greater than 300 blood sugar

A

Is considered an emergency and patient should go to ER

174
Q

Greater than __ ketones, let the provider know

A

300

175
Q

Crisis situations for hyperglycemia

A

DKA, and HHS (Hyperglycemic hyperosmolar syndrome)

176
Q

DKA and HHS are conditions that are

A

life-threatening due to uncontrolled hyperglycemia

177
Q

Release continuous infusion of subcut insulin

A

Insulin pumps

178
Q

Insulin pumps use __ or __ types of insulin

A

rapid acting or regular

179
Q

With insulin pumps patients are receiving a continuous

A

basal infusion

180
Q

Patients have the ability to alter the basal rate of their inulin pump and also

A

can give themselves a bolus based on finger stick reading

181
Q

With an insulin pump you still need to check your insulin at least

A

4x per day, breakfast, lunch, dinner, and before bedtime

182
Q

Most users of insulin pumps use monitors that are connected to their

A

phones so they can constantly see what their blood sugar is

183
Q

If a patient with a pump is admitted…

A

Their pump is deactivated and they are switched to a sliding scale insulin regimen so we can gain greater control of their levels

184
Q

Problems to be aware of for insulin pumps:

A

Infection at insertion site, increased risk for DKA if pump malfunctions, and high cost

185
Q

You cannot __ or __ with insulin pumps

A

Swim or take a bath, but you can take the pump off and do those activities

186
Q

Chronic complicated of diabetes (long term hyperglycemia) are related to…

A

end-organ disease from chronic damage to blood vessels

187
Q

chronic damage to blood vessels is called

A

angiopathy

188
Q

Angiopathy is typically what causes __ in patients with diabetes

A

death

189
Q

Cardiovascular related death due to angiopathy

A

68%

190
Q

Stroke related death due to angiopathy

A

16%

191
Q

Damage to large vessels such as coronary arteries, peripheral vascular, or cerebral vascular

A

Macrovascular angiopathy

192
Q

Damage to capillaries such as retinopathy, nephropathy, or neuropathy

A

Microvascular angiopathy

193
Q

Women with diabetes have __x the risk of CVD than those without

A

4-6x

194
Q

Men with diabetes have __x the risk of CVD than those without

A

2-3x

195
Q

Nursing teaching points for macrovascular disease (CVD)

A

Stop smoking, control blood pressure, modify high fat diet

196
Q

If a patient has metabolic syndrome, their risk of death is

A

very much increased

197
Q

Damage to the retina related to chronic hyperglycemia

A

Retinopathy

198
Q

Damage to small blood vessels in the kidneys

A

Nephropathy

199
Q

Nerve damage due to metabolic imbalances associated with hyperglycemia

A

Neuropathy

200
Q

Retinopathy, nephropathy, and neuropathy are examples of

A

microvascular complications

201
Q

Diabetes is the leading cause of end-stage

A

renal disease

202
Q

Much more likely to get kidney disease if you have…

A

Hypertension AND diabetes

203
Q

__% of diabetics have some type of neuropathy

A

60-70%

204
Q

Major contributor to amputation

A

diabetic neuropathy

205
Q

Only prevention for diabetic neuropathy

A

Early screening and keeping blood sugar under control

206
Q

Neuropathy is typically in that patient’s

A

feet and lower extremities

207
Q

Common complications of neuropathy

A

Foot ulcerations and lower extremity amputations

208
Q

What causes the complications of neuropathy?

A

Loss of protective sensation, prevents patients from being aware that an injury has occurred

209
Q

Patients with neuropathy can become

A

Neuroischemic and loose bloodflow

210
Q

Because of the loss of blood flow, the patient’s wound will become

A

Ischemic and amputation will be needed

211
Q

Diabetic foot care is the

A

nurse’s job!!

212
Q

Wash feet daily with…

A

mild soap and warm water after testing water with hands

213
Q

Pat feet dry especially…

A

between toes

214
Q

Inspect feet daily for…

A

cuts, swelling, blisters, red areas

215
Q

Use __ to prevent dry skin and cracking

A

lanolin

216
Q

Do not put lanolin

A

between toes

217
Q

You can use __ of sweaty feet

A

mild foot powder

218
Q

Do not use __ __ to removed calluses or corns

A

commercial remedies

219
Q

Clean any cuts with

A

mild soap and water

220
Q

Do not clean cuts with

A

iodine, alcohol, or adhesives

221
Q

Tell patients to report any

A

skin infections or non-healing sores

222
Q

You should trim nails

A

after shower or bath

223
Q

Cut nails evenly with

A

rounded contours

224
Q

Separate overlapping toes with

A

cotton

225
Q

Educate patient to wear shoes with

A

soles and to shake out before wearing

226
Q

Educate patient to never go

A

barefoot, wear open toed or open heeled or plastic shoes

227
Q

Educate patient to wear socks that are

A

clean and absorbent

228
Q

Educate patient not to use

A

hot water bottles

229
Q

What type of diet is best for diabetics

A

Balanced, high fiber, low fat, low cholesterol

230
Q

Encourage patients to each complex carbohydrates such as

A

grains, fruits, vegetables, legumes and milk

231
Q

Carbohydrates still need to be about __ of total caloric intake

A

45-65%

232
Q

Teach patients to limit simple carbohydrates such as

A

pasta and bread

233
Q

Teach diabetic patients to eat a diet low in __ and __ fats

A

saturated and trans

234
Q

Best type of fats to eat

A

polyunsaturated, can be found in fish and nuts

235
Q

Crucial for diabetic patients. Can improve carb metabolism and lower cholesterol

A

Fiber!

236
Q

Good sources of fiber

A

Beans, vegetables, oats, whole grains

237
Q

15-20% of diet

A

Protein, preferably from lean meats

238
Q

Limit alcohol to

A

1 drink daily for women, 2 drinks daily for men

239
Q

Alcohol turns into…

A

Sugar and can increase blood sugar

240
Q

Alcohol can also have intense

A

rebound effects and dramatically lower blood sugar as well

241
Q

Alternative sweeteners are

A

acceptable alternatives to sugar for patients with diabetes

242
Q

Consistent carb diets or

A

CC

243
Q

CC1

A

60g of carbs/meal, 1500 calories

244
Q

CC2

A

75g of carb/meal, 1800 cals

245
Q

CC3

A

90g of carb/meal, 2200 cals

246
Q

Carb counting is common, especially for

A

Type 1 diabetics

247
Q

Exercise will __ blood sugar

A

lower

248
Q

It’s best to exercise after

A

meals

249
Q

Tell patients not to exercise if blood sugar is

A

less than 80 or higher than 250

250
Q

Teach patient to eat a carbohydrate snack

A

prior to a high intensity workout

251
Q

Teach patient while exercising to wear a

A

medical alert bracelet, so if they pass out people around them will know what’s going on

252
Q

Teach patient to always think about their

A

feet! Teach them to wear good fitting shoes

253
Q

Stress such as surgery can

A

increase blood glucose levels

254
Q

Common for a controlled diabetic to become

A

uncontrolled while admitted to the hospital and this can upset them

255
Q

Wound healing is __ in patients with diabetes

A

impaired, can take longer and at higher risk for infection

256
Q

Integumentary concerns associated with uncontrolled hyperglycemia

A

diabetic dermopathy, acenthosis nigricans, necrobiosis lipidica diabeticorum

257
Q

Diabetic dermopathy

A

Reddish-brownish spots, usually not the shins

258
Q

Acanthosis nigricans

A

Brown/black thickening of skin, often seen in skin folds

259
Q

Necrobiosis lipoidica diabeticorum

A

Red patches around the blood vessels

MED SURG COLLAB (75 decks)

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