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Term 3 Stanbridge > Endocrine Exam 2 > Flashcards

Endocrine Exam 2 Flashcards

1
Q

what is metabolic syndrome

SYNDROME X

A

risk factors: obesity, HTN, high BG, and abnormal cholesterol, all cluster together

–> leads to the chance of developing heart disease, STROKE, and diabetes

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2
Q

glyburide (Micronase, DiaBeta, Glynase)

A

Action-
• Stimulates insulin release from pancreas, causing a decrease in blood sugar levels
• Increases tissue sensitivity to insulin
Pt teaching-
• Administer 30 min before meals
• Monitor for hypoglycemia and report frequent episodes to the provider
• Instruct client to avoid alcohol due to disulfiram effect

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3
Q

hyperglycemia

A

too much sugar

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4
Q

intermediate acting insulin

A

Onset- 1-2 hour
Peak- 6-14 hour
Duration- 16-24 hour
Administered for glycemic control between meals and at night

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5
Q

hypoglycemia S/S

A 
o	Mild shakiness
o	Mental confusion
o	Palpitations
o	Sweating
o	Headache
o	Lack of coordination
o	Blurred vison
o	Seizures
o	Coma
o	“Cold and Clammy, Need some Candy”
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6
Q

HHS treatment

A
  1. Administer IV fluids (0.9% sodium chloride followed by 0.45% sodium chloride to treat dehydration
  2. When BG reaches 250-300 mg/dL, switch to dextrose 5%W.
  3. Administer IV insulin to reverse hyperglycemia and potassium to treat hypokalemia
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7
Q

Metformin (Glucophage)

A

Action-
• Reduces the production of glucose by the liver (gluconeogenesis)
• Increases tissue sensitivity to insulin
Pt teaching-

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8
Q

what is DKA

A

rapid onset

breakdown of body fat for energy and an accumulation of ketones in the blood and urine.

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9
Q

diabetic retinopathy

A

chronic complication

impaired vision and blindness

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10
Q

HHS labs

A 
o	SERUM GLUCOSE - >600mg/dL
o	SERUM SODIUM - increased
o	SERUM POTASSIUM - initially decreased
o	BUN - >30mg/dL
o	CREATININE - >1.5 mg/dL
o	KETONES – Absent in serum and urine
o	OSMOLARITY - > 320 mOsm/L
o	SERUM pH ABG – Absence of acidosis. pH > 7.4
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11
Q

DM type 1 treatment

A

consistant management of BG levels

administer insulin

exercise

eat healthy

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12
Q

DM type 2 nursing considerations

A 
BG levels
I and O/ weight
skin integ
sensory alterations
visual alterations
SMBG sk
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13
Q

DKA S/S

A 
FRUITY BREATH
•	Polydipsia
•	Polyphagia
•	Weight loss
•	N/V
•	Abdominal pain
•	Blurred vision
•	Headache
•	Weakness
•	Orthostatic hypotension
•	Fruity odor of breath
•	Kussmaul respirations
•	Metabolic acidosis
•	Mental status changes
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14
Q

normal serum glucose level

A

70 - 110

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15
Q

diabetic nephropathy

A

chronic complication

Renal disease that increases the risk for CAD and mortality from MI.

earliest manifestation is:
MICROALBUMINURIA

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16
Q

Glipizide (Glucotrol)

A

• Stimulates insulin release from pancreas, causing a decrease in blood sugar levels
• Increases tissue sensitivity to insulin
Pt teaching-
• Administer 30 min before meals
• Monitor for hypoglycemia and report frequent episodes to the provider
• Instruct client to avoid alcohol due to disulfiram effect

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17
Q

diabetic diet

A

exercise and good nutrition

smoking cessation

limit calories and decrease fat 30%

diet low in sat fat

include omega 3 from fish

should include carbs from fruit, veggies, who grains, legumes, and low fat milk

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18
Q

DM type 2 treatment

A

consistent management of BG levels

Lifelong commitment to:
oral anti diabetics
exercise regularly
eat healthy

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19
Q

hypoglycemia

A

low blood sugar

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20
Q

what are names of intermediate active insulin

A

NPH insulin (Humulin N

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21
Q

HHS education

A

encourage medical bracelet

take measures to decrease dehydration

monitor BG q4h

consume liquids with carbs

22
Q

symptom x treatment

A

weight loss through diet/exercise

antihypertensive drugs

cholesterol lowering drugs

anti diabetic drugs

23
Q

hallmark risk factors of DM type 2

A

OBESITY, PHYSICAL INACTIVITY, HIGH TRIGLYCERIDES, AND HTN.

24
Q

fast blood glucose level

A

<100mg/dL

25
Q

sick guidelines

A
  • Monitor blood glucose every 3-4 hours
  • Continue to take insulin or oral antidiabetic med
  • Consume 4 oz of sugar free, non-caffeinated liquid every 30 minutes to prevent dehydration
  • Meet carbohydrate needs through soft food (custard, cream, soup, gelatin, graham crackers) 6-8 times per day if possible. If not, consume liquids equal to usual carbohydrate content.
  • Test urine for ketones and report to provider if they are outside than expected reference range (-ve to small).
  • Rest
26
Q

DM type 1 nursing considerations

A 
BG levels
I and O/ weight
skin integ
sensory alterations
visual alterations
SMBG skills
27
Q

diabetic retinopathy education

A

encourage yearly eye exams

manage BG levels

28
Q

hypoglycemia teaching

A

o Avoid excess insulin, exercise, and alcohol on empty stomach
o Check blood glucose level
o If glucose is 70mg/dL or less, take 15-20 grams of absorbable carbs
♣ 4-6 oz fruit juice, 3-4 glucose tabs, 8-10 hard candies
♣ recheck blood sugar in 15 minutes
o repeat administration of carbs if not WNL, and recheck in another 15

29
Q

diabetic nephropathy

nursing considerations

A

monitor I and O and kidney fx tests

report hourly output of less than 30mg/dL

monitor bp

30
Q

what are names of rapid-acting insulin

A 
Lispro (humalog)
aspart insulin (novolog)
glulisine insulin (apidra)
31
Q

DKA treatment

A

treat for dehydration

  • Initially administer 0.9% NaCl at a rapid rate to rehydrate the client to replace lost sodium.
  • After 2 to 3 hours, switch the IV to 0.45% NaCl to prevent hypernatremia. Maintain the rate relatively high.
  • Once the glucose is level is 250-300mg/dL, switch to D5W.
  • Administer regular insulin, to reverse ketoacidosis.
  • Monitor IV potassium
32
Q

HbA1c

A

o The best indicator of the average blood glucose level over the last 120 days, which is the average lifespan of a red blood cell.

o Expected range is 4%-6%. Target less than 7%.

33
Q

what are names of short-acting insulin

A

regular insulin (humulin R, Novolin R)

34
Q

diabetic neuropathy nursing actions

A

monitor BG levels and keep WNR

provide foot care

encourage podiatrist annually

35
Q

rapid acting insulin

A

Onset- 15-30 min
Peak- 0,5-2.5 hour
Duration- 3-6 hours
Administer before meals to control postprandial rise in blood glucose

36
Q

diabetic neuropathy

A

chronic complication

Caused from damage to sensory nerve fibers resulting in numbness and pain. Can affect every aspect of the body and can lead to ischemia and infection.

37
Q

hyperglycemia education

A

oral intake of sugar free foods

administer insulin as prescribed

restrict exercise when BG levels are under 250

test for ketones

38
Q

hyperglycemia S/S

A

hot, dry skin
fruity breath
“hot and dry, sugar is high”

39
Q

what is DM type 1

A

total insulin dependence

results from destruction of pancreatic beta cells.

usually young age

40
Q

acarbose (Precose)

A
  • Slows carbohydrate absorption from the intestinal tract
  • Reduces postmeal hyperglycemia

Nursing actions-
• Alert the client that GI discomfort (abd. Distention, cramps, excessive gas, diarrhea) is common with these meds
• Monitor LFTs every 3 months
• Treat hypoglycemia with dextrose, not table sugar (prevents table sugar from breaking down)

Pt teaching-
• Instruct the client to have LFTs performed every 3 months
• Take the med with the first bite of each meal in order for the med to be effective
• Have available dextrose paste to treat hypoglycemia.
Lab values-
AST- 5-40

41
Q

what is DM type 2

A

insulin reststance

42
Q

HHS S/S

A 
o	Polyuria
o	Polydipsia
o	Blurred vision
o	Headache
o	Weakness
o	Orthostatic hypotension
o	Mental status changes
o	Seizures, myoclonic jerking
o	Reversible paralysis
43
Q

what is HHS

A

Formerly called hyperglycemic hyperosmolar non-ketotic syndrome

acute complication of diabetes characterized by hyperglycemia (600g/dL)

slow onset

44
Q

exenatide (Byetta)

A

Incretin mimetic exenatide (Byetta)- oral hypoglycemic

Action-
• Mimics the function of intestinal incretin hormone by decreasing glucagon secretion and gastric emptying;
• Decreases insulin demand by reducing fasting and postprandial hyperglycemia

Nursing actions-
• Administer subQ 60 min before morning and evening meal
• Monitor for GI distress

Pt. teaching-
• Do no administer after meal
• Oral antibiotic, oral contraceptive or acetaminophen should never be given within 1 hr of oral exenatide or 2 hrs after injection of exenatide
• Can have decreased appetite and weight loss
• Wait for next dose if you miss a dose

45
Q

short acting insulin

A

Onset- 0.5-1 hour
Peak- 1-5 hour
Duration- 6-10 hour
Administer 30-60 min before meals

46
Q

diabetic foot care

A

inspect daily

wash with mild soap and warm water

always dry completely

apply mild foot powder on sweaty feet

nail care after showers

no hot water bottles or heating pads

47
Q

DM type 1 S/S

A 
o	THE THREE P’s
♣	Polyuria (excessive urine)
♣	Polydipsia (excessive thirst)
♣	Polyphagia (excessive hunger)
o	Fatigue/Weakness/Malaise/Lethargy
o	Smell of acetone
o	Kussmaul respirations
o	Blurred vision
o	Mood changes
o	Numbness in tingling in extremities
o	Dry skin, and mucous membranes
o	Infections (UTI, Vaginal yeast infections)
o	Weight loss (most often in Type 1)
o	Muscle wasting
o	Ketonuria (ketones – acids – in urine from breakdown of proteins and fats. High ketone levels can lead to DKA)
48
Q

long acting insulin

Lantus

A

Onset- 70 min
Peak- None
Duration- 24 hour
Offer snacks at peak to prevent hypoglycemia

49
Q

oral glucose tolerance test

A

o A fasting BG is drawn at the start of the test
o Client is instructed to consume a specified amount of glucose
o Glucose levels are obtained q30 minutes for 2 hours
o Must be checked for hypoglycemia throughout the procedure
• Client Education
o Instruct to consume a balanced diet for 3 days prior to test
o Instruct patient to fast for 10-12 hours prior to the test

50
Q

DM type 2 S/S

A 
o	THE THREE P’s
♣	Polyuria (excessive urine)
♣	Polydipsia (excessive thirst)
♣	Polyphagia (excessive hunger)
o	Fatigue/Weakness/Malaise/Lethargy
o	Blurred vision
o	Mood changes
o	Numbness in tingling in extremities
o	Dry skin, and mucous membranes
o	Infections (UTI, Vaginal yeast infections)
o	Weight grain
o	Muscle wasting
o	Increased serum osmolality
51
Q

diabetic nephropathy education

A

o Encourage yearly urine analysis, BUN, and serum creatinine
o Encourage client to avoid soda, alcohol, and toxic levels of acetaminophen or NSAIDS
o Consume 2-3L of fluid per day form food and beverage sources
o Drink adequate water
Report decrease of output to provider

52
Q

syndrome x S/S

A 
o	Abdominal obesity
o	Darkening of the skin on neck or under arms
o	Irregular or absent menses
o	Acne
o	Hirsutism, alopecia

Term 3 Stanbridge (9 decks)

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