Endocrine/Diabetes Flashcards
What are the four endocrine changes associated with aging?
decreased glucose tolerance, decrease general metabolism, decreased antidiuretic hormone production, decrease ovarian production of estrogen.
Effects of decreased glucose tolerance
weight becomes greater than ideal
elevated fasting and random blood glucose levels
slow wound healing
frequent yeast infections
polydipsia
polyuria
Effects of decreased general metabolism
less tolerant of cold
decrease appetite
decreased HR and BP
effects of decreased ADH production
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
effects of decreased ovarian production of estrogen
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.
diabetes definition
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.
what happens in the absence of insulin?
body breaks down other sources for energy (fats and proteins)
counter-regulatory hormone levels are increased (glucagon, epinephrine, GH, and cortisol)
why is insulin important?
key that moves glucose into cells
a decrease can cause hyperglycemia
the cells don’t get the glucose they need
symptoms of DM
polyuria, polydipsia, polyphagia, metabolic acidosis, Kussmaul respirations, dehydration and electrolyte imbalance
polyuria
frequent and excessive urination
caused by osmotic diuresis secondary to excess glucose
polydipsia
excessive thirst
caused by dehydration
polyphagia
excessive eating
cause by cell starvation
Kussmaul respirations
increased rate and depth of breathing- respiratory system trying to fix acidosis.
acitone bodies are the fruity smell in breath
dehydration and electrolyte imbalance
caused by excessive diuresis
types of diabetes
type 1, type 2, gestational
type 1 diabetes
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
Type 2 diabetes
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
gestational diabetes
glucose intolerance during pregnancy
Acute complications of DM
Diabetic Ketoacidosis
Hyperglycemic- Hyperosmolar state
Hypoglycemia
all considered medical emergencies
DKA
insulin deficiency and acidosis
HHS
insulin deficiency and severe dehydration
hypoglycemia
too much insulin or too little glucose
What are chronic complications of DM caused by
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
What are the two types of chronic complications in DM
macro vascular
microvascular
Macrovascular examples
cardiovascular disease- MI
cerebral vascular disease- stroke
peripheral vascular disease- PAD/PVD
pulmonary embolism- PE
risk factors for macrovascular diseases
HTN
obesity
dyslipidemia
sedentary lifestyle
nursing implication for DM
decreasing modifiable risk factors
microvascular examples
retinopathy
neuropathy
nephropathy
retinopathy
caused by damage to the retinal vessels causing leaking and retinal hypoxia
neuropathy
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)
nephropathy
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
Fasting blood glucose range
70-100
above 126 on at least 2 occasions is diagnostic for DM
Glucose tolerance test
less than 140
Hemoglobin A1C
4-6%
levels greater than 6.5% are diagnostic for DM
Planning and Priorities for DM
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
expected outcome for DM
maintaining blood glucose in expected range and preventing acute and chronic complications of DM are the primary outcomes
interventions for DM
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
rapid acting insulin
onset is 15 min
short acting insulin
onset is 30-90 min
intermediate acting insulin
onset 15-90 min`
long acting insulin
onset is 1-4 hours
factors affecting insulin absorption
injection site, absorption rate, injection depth, timing of injection, mixing insulin
patient education for insulin
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
ways to reduce risk for peripheral neuropathy by proper footcare
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
s/s of neuropathy
tingling/numbness
burning
muscle cramps
piercing or stabbing pain
metatarsalgia (walking on marbles)
allodynia (pain from normal non-painful stimuli)
hyperalgesia (exaggerated pain response)
reducing injury from impaired vision
regular eye exams
appropriate eyewear
reading aids
adaptive devices for insulin administration/ BG monitoring
reducing injury for diabetic nephropathy
control HTN
control hyperlipidemia
assess kidney function annually
smoking cessation
hypoglycemia features
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
hyperglycemia features
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
Laboratory findings for DKA
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
Laboratory findings for HHS
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
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…
Hypoglycemia especially because she received her insulin about an hour ago and has not replenished her glucose supply.
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…
Check her blood glucose level immediately because the methods to increase her blood glucose level are dependent on how the current level is.
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?
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.
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?
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.
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?
No. Applying oxygen would serve no useful purpose. His respiratory symptoms are a result of compensation for the metabolic acidosis.
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?
DKA
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?
IV drip because SQ wont absorb fast enough and is inappropriate for emergency situations.
patient could also get IV fluids to correct fluid deficit.
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?
HHS
