Endocrine & Metabolic 2 Flashcards
insulin injection sites
- give all morning in one site and all evening in another (ie/ legs) d/t differing rates of absorption from sites
- space injections about 1/2 in apart
- arms (upper), abdomen (lower), thighs, gluteal
describe omnipod system
- aka omnipod DASH
- small, waterproof pod provides up to 72 hrs of insulin delivery
- simple, hand held device
advantages of continuous infusion of insulin
- helps maintain blood glucose control between meals
- improves glycemic control
- improves growth in children
- allows child to eat with less adherence to a schedule and have a more flexible lifestyle
- reduces incidences of DKA
what are continuous infusion of insulin devices
-matches basal rate needed plus an insulin bolus at mealtime to move closely stimulate normal pancreatic function
disadvantages of continuous infusion devices
- cost
- increased risk of infection at insertion site
- pump size and visibility
- requires willingness
- requires constant vigilance and adherence (frequent BS testing, carb counting, dose calculation)
exercise for type 1
- encourage sports and activity
- avoid exercise during insulin peak or spilling urine ketones
- add an extra 15 g carbs snack for each 30 min of exercise
type 1 nursing care
- teaching and support
- patho of insulin insufficiency
- glucose monitoring
- insulin injection
- diet modification
- complication prevention and response
things to remember when self monitoring BG
- GOAL: 70-140 mg/dL before meals
- record BG in diary or log
- observe for patterns of hypo/hyperglycemia and make an insulin dosage adjustment
medical nutrition therapy for insulin pump
counting carbs for all meals/snacks and calculating bolus dose using an insulin to carb ration
medical nutrition therapy for multiple injections
- meals and snacks are balanced with insulin action
- adherence to a daily schedule that maintains a consistent food by counting carbs with consistent insulin injections aids in achieving metabolic control
type 1 patho
insulin deficiency - hyperglycemia - polyuria, cell starvation - ketones cannot nourish cells d/t no insulin - ketoacidosis
type 1 outcomes
- achieve BGgoals, monitor hemoglobin A1C
- target A1C below 7.5% in children with diabetes (aiming near normal BS level is risky as it poses a greater risk for hypoglycemia)
- no complications
potential type 1 complications
- acute: hypoglycemia
- chronic: microvascular changes.. neuropathy, retinopathy, nephropathy
neuropathy
decreased sensation in hands and feet
retinopathy
decreased vision to blindness
nephropathy
impaired renal function
s/s of DKA
- polyuria, polydipsis
- wt loss, abdominal pain
- N/V
- tachycardia, s/s of dehydration
- glycosuria, ketonuria
- Kussmaul resp
- acetone breath
- altered LOC
- hypotension
- flushed ears and cheeks
- hyperglycemia (BG >250)
describe DKA
- potentially life threatening
- primarily occurs in type 1
- often present with new onset diabetes
- occur d/t incorrect/missed insulin, illness, trauma, surgery
- associated with severe metabolic, electrolyte, and fluid imbalance
if DKA is untreated what will it lead to
-electrolyte disturbances, arrhythmias, altered consciousness, shock and death
what is the most common cause of DKA related DEATH
cerebral edema
only _______ insulin can be administered intravenously and when is it given
REGULAR
used for treatment of hyperglycemia and DKA
nursing care of DKA pt
- monitor VS, resp status, perfusion and mental status cont
- assess for changes in neuro status, resp pattern, BP and HR
- assess for dehydration
- monitor BG levels hourly
- strict I + Os hourly
