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Adult Health 1 > Endocrine/Diabetes > Flashcards

Endocrine/Diabetes Flashcards

1
Q

What are the four endocrine changes associated with aging?

A

decreased glucose tolerance, decrease general metabolism, decreased antidiuretic hormone production, decrease ovarian production of estrogen.

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2
Q

Effects of decreased glucose tolerance

A

weight becomes greater than ideal
elevated fasting and random blood glucose levels
slow wound healing
frequent yeast infections
polydipsia
polyuria

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3
Q

Effects of decreased general metabolism

A

less tolerant of cold
decrease appetite
decreased HR and BP

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4
Q

effects of decreased ADH production

A

urine is more dilute and may not concentrate fluid intake is low (Dehydration Risk because the body cant regulate this)
patient is at greater risk for dehydration

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5
Q

effects of decreased ovarian production of estrogen

A

bone density decreases
skin is thinner, drier, and at greater risk for injury
perineal and vaginal tissues become drier, and the risk of cystitis increases.

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6
Q

diabetes definition

A

chronic metabolic disease resulting from either a deficiency in insulin secretion, resistance of insulin action at the cellular level or both
resulting in hyperglycemia and inability to regulate blood glucose.

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7
Q

what happens in the absence of insulin?

A

body breaks down other sources for energy (fats and proteins)
counter-regulatory hormone levels are increased (glucagon, epinephrine, GH, and cortisol)

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8
Q

why is insulin important?

A

key that moves glucose into cells
a decrease can cause hyperglycemia
the cells don’t get the glucose they need

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9
Q

symptoms of DM

A

polyuria, polydipsia, polyphagia, metabolic acidosis, Kussmaul respirations, dehydration and electrolyte imbalance

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10
Q

polyuria

A

frequent and excessive urination
caused by osmotic diuresis secondary to excess glucose

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11
Q

polydipsia

A

excessive thirst
caused by dehydration

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12
Q

polyphagia

A

excessive eating
cause by cell starvation

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13
Q

Kussmaul respirations

A

increased rate and depth of breathing- respiratory system trying to fix acidosis.
acitone bodies are the fruity smell in breath

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14
Q

dehydration and electrolyte imbalance

A

caused by excessive diuresis

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15
Q

types of diabetes

A

type 1, type 2, gestational

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16
Q

type 1 diabetes

A

no insulin is produces
autoimmune disorder
beta cells of the pancreas are destroyed by antibodies
onset usually occurs less than 30 yo
abrupt onset
weight loss
requires insulin
could be viral in etiology

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17
Q

Type 2 diabetes

A

reduction of the cells to respond to insulin and decreased secretion of insulin from beta cells
onset usually occurs greater than 50 yo
could have no symptoms or polydipsia, fatigue, blurred vision, vascular and neural comlications

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18
Q

gestational diabetes

A

glucose intolerance during pregnancy

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19
Q

Acute complications of DM

A

Diabetic Ketoacidosis
Hyperglycemic- Hyperosmolar state
Hypoglycemia
all considered medical emergencies

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20
Q

DKA

A

insulin deficiency and acidosis

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21
Q

HHS

A

insulin deficiency and severe dehydration

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22
Q

hypoglycemia

A

too much insulin or too little glucose

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23
Q

What are chronic complications of DM caused by

A

changes in blood vessels in tissue and organs (poor tissue perfusion, cell damage and death)
vascular changes result from:
hyperglycemia thickening basement membranes and causing organ damage.
hyperglycemia affects cell integrity

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24
Q

What are the two types of chronic complications in DM

A

macro vascular
microvascular

25
Q

Macrovascular examples

A

cardiovascular disease- MI
cerebral vascular disease- stroke
peripheral vascular disease- PAD/PVD
pulmonary embolism- PE

26
Q

risk factors for macrovascular diseases

A

HTN
obesity
dyslipidemia
sedentary lifestyle

27
Q

nursing implication for DM

A

decreasing modifiable risk factors

28
Q

microvascular examples

A

retinopathy
neuropathy
nephropathy

29
Q

retinopathy

A

caused by damage to the retinal vessels causing leaking and retinal hypoxia

30
Q

neuropathy

A

progressive deterioration of nerves
loss in sensation or muscle weakness
blood vessel changes that lead to nerve hypoxia
can affect multiple body systems (extremities, GI, cardiac, urinary)

31
Q

nephropathy

A

change in kidney that decreases function and causes kidney failure
chronic high blood glucose: causes leaking and hypoxia of nephrotic vessels
increase in filtration of large particles, damaging kidneys further

32
Q

Fasting blood glucose range

A

70-100
above 126 on at least 2 occasions is diagnostic for DM

33
Q

Glucose tolerance test

A

less than 140

34
Q

Hemoglobin A1C

A

4-6%
levels greater than 6.5% are diagnostic for DM

35
Q

Planning and Priorities for DM

A

injury related to hyperglycemia
impaired wound healing
injury related to diabetic neuropathy
acute and chronic pain related to diabetic neuropathy
injury related to retinopathy (reduced vision)
potential for kidney disease
potential l hypoglycemia
potential DKA
potential HHS

36
Q

expected outcome for DM

A

maintaining blood glucose in expected range and preventing acute and chronic complications of DM are the primary outcomes

37
Q

interventions for DM

A

proper nutrition- decrease alcohol, carb counting, watch saturated fats and cholesterol
exercise- watch for injury
blood glucose monitoring- accurate samples, clean technique, adequate supplies
medications- DM T1 will require insulin, DM T2 may require medication

38
Q

rapid acting insulin

A

onset is 15 min

39
Q

short acting insulin

A

onset is 30-90 min

40
Q

intermediate acting insulin

A

onset 15-90 min`

41
Q

long acting insulin

A

onset is 1-4 hours

42
Q

factors affecting insulin absorption

A

injection site, absorption rate, injection depth, timing of injection, mixing insulin

43
Q

patient education for insulin

A

refridgerate unopened insulin
insulin in use can be in room temp for 28 days
Discard unused insulin after 28 days
prefilled syringes are stable up to 30 days when refridgerated
keep spare bottles
inspect insulin before each use

44
Q

ways to reduce risk for peripheral neuropathy by proper footcare

A

cleanse and inspect feet daily
wear properly fitting shoes
avoid walking with bare feet
wear clean, dry socks daily
trim toenails properly
report non healing breaks in the skin of the feet

45
Q

s/s of neuropathy

A

tingling/numbness
burning
muscle cramps
piercing or stabbing pain
metatarsalgia (walking on marbles)
allodynia (pain from normal non-painful stimuli)
hyperalgesia (exaggerated pain response)

46
Q

reducing injury from impaired vision

A

regular eye exams
appropriate eyewear
reading aids
adaptive devices for insulin administration/ BG monitoring

47
Q

reducing injury for diabetic nephropathy

A

control HTN
control hyperlipidemia
assess kidney function annually
smoking cessation

48
Q

hypoglycemia features

A

skin is cool and clammy
absent dehydration
no change in respirations
anxious, nervous, irritable mental status
seizure and coma
weakness, double vision, blurred vision, hunger tachycardia, palpitations
glucose is less than 70
negative ketones

49
Q

hyperglycemia features

A

Skin is warm and moist
Dehydration is present
Kussmaul respirations- fruit odor
Mental status varies
No specific symptoms- acidosis and dehydration
Glucose greater than 250
Positive ketones

50
Q

Laboratory findings for DKA

A

glucose greater than 300
variable osmolarity
positive serum ketones
pH less than 7.35
HCO3 less than 15
variable serum Na
BUN greater than 30
Creatinine greater than 1.5
positive urine ketones

51
Q

Laboratory findings for HHS

A

glucose greater than 600
osmolarity greater than 320
negative serum ketones
pH greater than 7.4
HCO3 greater than 20
normal or low serum Na
elevated BUN and creatinine
negative urine ketones

52
Q

60 yo woman is one day post op from a knee replacement; she is a type 2 diabetic on a new insulin regimen; the nurse gave took her BG and gave her short acting insulin knowing she ordered her lunch; one hour later she is pale, confused, and clammy; her lunch tray is on her table and appears totally untouched. Is her condition consistent with hyperglycemia or hypoglycemia? Explain why…

A

Hypoglycemia especially because she received her insulin about an hour ago and has not replenished her glucose supply.

53
Q

60 yo woman is one day post op from a knee replacement; she is a type 2 diabetic on a new insulin regimen; the nurse gave took her BG and gave her short acting insulin knowing she ordered her lunch; one hour later she is pale, confused, and clammy; her lunch tray is on her table and appears totally untouched. What is your first action? Explain why…

A

Check her blood glucose level immediately because the methods to increase her blood glucose level are dependent on how the current level is.

54
Q

60 yo woman is one day post op from a knee replacement; she is a type 2 diabetic on a new insulin regimen; the nurse gave took her BG and gave her short acting insulin knowing she ordered her lunch; one hour later she is pale, confused, and clammy; her lunch tray is on her table and appears totally untouched. What is the most likely cause leading to this problem?

A

Clearly, there was a delay in eating after receiving the insulin. Moreover, it is possible because of her recent change to insulin, she was not aware of the necessity of eating soon after receiving insulin.

55
Q

60 yo woman is one day post op from a knee replacement; she is a type 2 diabetic on a new insulin regimen; the nurse gave took her BG and gave her short acting insulin knowing she ordered her lunch; one hour later she is pale, confused, and clammy; her lunch tray is on her table and appears totally untouched. What should happen to prevent this from happening again in the future?

A

More education to the patient about the relationship between insulin and eating. The nurse should also evaluate the patient 20 min after administering short acting insulin.

56
Q

21 yo college student brought to the ED by his roommate. ABD pain, polyuria for the last 2 days, vomiting and extreme thirst. He is flushed, lips and mucus membranes are dry and cracked, skin turgor is poor. Rapid respirations, fruity odor, and may have skipped a few doses of insulin. He is alert but struggling to answer questions. O2 sat is 99, BP 110/60, pulse is 110/min, Resp. are 32/min, glucose 485 mg/dL . Should you apply oxygen at this time? Why or why not?

A

No. Applying oxygen would serve no useful purpose. His respiratory symptoms are a result of compensation for the metabolic acidosis.

57
Q

21 yo college student brought to the ED by his roommate. ABD pain, polyuria for the last 2 days, vomiting and extreme thirst. He is flushed, lips and mucus membranes are dry and cracked, skin turgor is poor. Rapid respirations, fruity odor, and may have skipped a few doses of insulin. He is alert but struggling to answer questions. What is going on with this patient?

A

DKA

58
Q

21 yo college student brought to the ED by his roommate. ABD pain, polyuria for the last 2 days, vomiting and extreme thirst. He is flushed, lips and mucus membranes are dry and cracked, skin turgor is poor. Rapid respirations, fruity odor, and may have skipped a few doses of insulin. He is alert but struggling to answer questions. What is the immediate intervention the Dr. would prescribe?

A

IV drip because SQ wont absorb fast enough and is inappropriate for emergency situations.
patient could also get IV fluids to correct fluid deficit.

59
Q

21 yo college student brought to the ED by his roommate. ABD pain, polyuria for the last 2 days, vomiting and extreme thirst. He is flushed, lips and mucus membranes are dry and cracked, skin turgor is poor. Rapid respirations, fruity odor, and may have skipped a few doses of insulin. He is alert but struggling to answer questions. What is another acute complication of DM resulting from elevated glucose?

A

HHS

Adult Health 1 (16 decks)

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