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Health Care Participant Nursing: N1220 > Endocrine System (Exam Two) > Flashcards

Endocrine System (Exam Two) Flashcards

1
Q

How does Adrenocorticotropic Hormone (ACTH) work?

A
  • Stimulates the adrenal cortex to release glucocorticoids (cortisol)
  • Acts on the adrenal gland
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2
Q

The Adrenal Medulla releases what hormones?

HINT: MEN

A

Epinephrine and Norepinephrine

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3
Q

What effect do Epinephrine and Norepinephrine have on the body?

A
  • Act on alpha one, beta one and beta two receptors
  • Increase the heart rate, increase the force of cardiac contraction, bronchodilation, vasoconstriction of peripheral arteries, vasodilates skeletal muscle arterioles, tells the liver to convert glycogen to glucose for energy (increased blood sugar)
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4
Q

When are Epinephrine and Norepinephrine released?

A

Released during stressful times (flight or fight) to manage stress response and keep body safe

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5
Q

The Adrenal Cortex releases what hormones?

A

It releases corticosteroids, which include:

  • Glucocorticoids (Cortisol)
  • Mineralocorticoids (Aldosterone)
  • Gonadocorticoids (Androgens)
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6
Q

What two hormones secreted by the adrenal cortex are essential for life?

A
  • Glucocorticoids (Cortisol)

- Mineralocorticoids (Aldosterone)

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7
Q

What tropic hormone is released to promote the release of Cortisol from the Adrenal Cortex?

A

Adrenocorticotropic Hormone (ACTH)

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8
Q

What is the target organ of Mineralocorticoids (Aldosterone)?

A

Kidneys

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9
Q

What body systems are affected by Glucocorticoids (Cortisol)?

A

All of them

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10
Q

What does Glucocorticoids (Cortisol) do for the body?

A

Provides energy sources to the body during stress (because it tells the liver to convert glycogen to glucose)

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11
Q

What organ is both an endocrine and exocrine gland?

A

Pancreas

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12
Q

What hormones does the Pancreas synthesize and release?

A
  • Insulin

- Glucagon

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13
Q

Where do beta and alpha cells live within the Pancreas?

A

Islet of Langerhans

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14
Q

What are the three causes of endocrine disorders?

A
  • Overproduction of hormones
  • Underproduction of hormones
  • Side effects of certain drugs
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15
Q

What is a primary endocrine disorder?

A

Something is wrong with the actual gland

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16
Q

What is a secondary endocrine disorder?

A
  • Problems outside of the gland

- Something is wrong with a different gland or organ

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17
Q

What does Mineralocorticoids (Aldosterone) do for the body?

A

-Regulates sodium and potassium balance

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18
Q

What is Cushing Syndrome?

A
  • Hypersecretion of cortisol levels in the blood

- Can affect aldosterone and androgens

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19
Q

What causes Cushing Syndrome?

A
  • Chronic exposure to excess corticosteroids

- Exogenous corticosteroid administration

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20
Q

What is Cushing Disease?

A
  • Specific type of Cushing Syndrome

- Hypersecretion of cortisol throughout the day regardless of time/event

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21
Q

What are the two types of Cushing Disease? What causes them?

A
  • Pituitary Cushing Disease is caused by hypersecretion of ACTH in pituitary gland causing adrenal gland to secret too much cortisol
  • Adrenal Cushing Disease is caused by problem in the adrenal cortex (only involves one adrenal gland)
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22
Q

Is Cushing Syndrome or Cushing Disease more prevalent?

A

Cushing Syndrome

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23
Q

What are the signs and symptoms of Cushing Syndrome?

A
  • Weight gain
  • Truncal/generalized obesity
  • Thin arms and legs
  • Moon face
  • Buffalo Hump
  • Muscle wasting/weakness
  • Hyperglycemia
  • Type II Diabetes
  • Osteoporosis
  • Loss of collagen (i.e. striae, wrinkles)
  • Immunosuppression
  • Increased risk for infection
  • Irritability, anxiety, euphoria, psychosis
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24
Q

What causes a moon face and buffalo hump in patients with Cushing Syndrome?

A

Excess deposit of adipose tissue

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25
Q

What are the signs and symptoms of mineralocorticoid (aldosterone) excess in relation to Cushing Syndrome?

A
  • Salt and water retention
  • Hypokalemia
  • Hypertension
  • Bounding pulses
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26
Q

What are the signs and symptoms of adrenal androgen excess in relation to Cushing Syndrome?

A
  • Acne
  • Amenorrhea (loss of period)
  • Virilization in women (manly facial hair)
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27
Q

What should the nurse initially assess in a patient with Cushing Syndrome?

A
  • History and physical exam
  • Vital signs
  • Mental status examination
  • Laboratory tests
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28
Q

What are the treatment options for patients with Cushing Syndrome?

A
  • Surgery or radiation

- Reducing, tapering dose of steroids

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29
Q

What nursing management do you want to provide for a patient with non-surgical Cushing Syndrome?

A
  • Fluid overload!
  • Assess skin
  • Hand washing
  • Safety
  • Drug therapy
  • Education
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30
Q

What nursing management do you want to provide for a patient with surgical Cushing Syndrome?

A
  • Pre-op care
  • Post-op care
  • Assess for shock
  • Monitor I&O’s, weight, electrolytes
  • Monitor for Acute Adrenal Insufficiency
  • Education on hormone replacement therapy
  • Avoid extreme temperatures, infection, stress
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31
Q

What must a patient, undergoing an adrenalectomy, be treated with before, during, and after surgery?

A

IV steroids (i.e. hydrocortisone)

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32
Q

What is Addison’s Disease?

A
  • Insufficient productions of the hormones of the adrenal cortex
  • Typically a deficiency in cortisol
  • Can also be deficiency in aldosterone or androgens
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33
Q

What are the primary causes of Addison’s Disease?

A
  • Autoimmune

- Bilateral adrenalectomy

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34
Q

What are the secondary causes of Addison’s disease?

A
  • Pituitary or hypothalamus problems

- Abrupt discontinuance of long-term steroids

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35
Q

What are the signs and symptoms of Addison’s Disease?

HINT: Opposite of Cushing’s Syndrome

A
  • Hypotension
  • Dizziness
  • Progressive weakness
  • Fatigue, weakness, confusion
  • Weight loss
  • Anorexia
  • Nausea, vomiting, diarrhea
  • Skin changes (hyperpigmentation)
  • Hypovolemia
  • Hypoglycemia
  • Hyponatremia
  • Hyperkalemia
  • Irritability
  • Depression
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36
Q

What causes hyperpigmentation in patients with Addison’s disease?

A

Increase in Adrenocorticotropic Hormone (ACTH)

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37
Q

What are the treatment options for patients with Addison’s disease? What patient education must you provide?

A
  • Lifelong hormone therapy (i.e. hydrocortisone or prednisone)
  • Need to take steroids at the same time each day
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38
Q

What nursing interventions should you provide for a patient with Addison’s disease?

A
  • Correct fluid and electrolyte imbalance
  • Daily weights
  • Administer corticosteroids
  • Cardiac monitor
  • Assess for s/sx of Addisonain Crisis or Cushing’s Syndrome
  • Provide patient education regarding diet, stress management, heat, and important of taking medication at the same time
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39
Q

What education should you provide to a patient with Addison’s disease?

A
  • High Sodium/ Low Potassium diet
  • Stress management
  • Heat (sweating=losing sodium)
  • Need to take medication at the same time each day
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40
Q

What is an Addisonian Crisis (Acute Adrenal Insufficiency)? What causes it?

A
  • Life-threatening, EMERGENCY!
  • Insufficient levels of cortisol and aldosterone
  • Caused by a stressful event or sudden, sharp decrease in hormones (i.e. adrenalectomy)
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41
Q

What are the signs and symptoms of an Addisonian Crisis?

HINT: Think Addisons Disease s/sx to a severe state

A
  • Fluid volume deficit
  • Hypoglycemia, hyponatremia, hyperkalemia
  • Shock
  • Lethargy
  • Coma
  • Death
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42
Q

What is the highest priority nursing intervention with an Addisonian Crisis?

A

-High-dose of IV hydrocortisone replacement (highest priority!)

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43
Q

Why would a patient be prescribed corticosteroid therapy?

A
  • Relieve signs and symptoms of chronic conditions

- Decreased endogenous cortisol production /secretion

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44
Q

True or False: Treatment benefits must outweigh the risks of taking a corticosteroid

A

True

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45
Q

Patients on corticosteroid therapy are at an increased risk for what?

A
  • Infection
  • Osteoporosis
  • GI ulcerations
  • Fluid/electrolyte imbalances
  • Cushing’s Syndrome
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46
Q

Corticosteroid therapy should not be…

A
  • Used long-term

- Stopped abruptly

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47
Q

Hyperaldosteronism is also known as what?

A

Conn’s Syndrome

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48
Q

What is hyperaldosteronism?

A

-Rare hypersecretion of aldosterone

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49
Q

What are signs and symptoms of hyperaldosteronism?

A
  • Hypernatremia
  • Hypokalemia
  • Metabolic alkalosis
  • Increased fluid volume
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50
Q

What are the treatment options for hyperaldosteronism?

A
  • Surgery

- Spironolactone therapy

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51
Q

What is pheochromocytoma? What does it cause?

A
  • Rare condition caused by a tumor in adrenal medulla

- Causes an excess production of catecholamines (epinephrine and norepinephrine)

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52
Q

What is the priority nursing concern for a patient with pheochromocytoma?

A

Severe episodic hypertension accompanied by severe pounding headache, tachycardia with palpitations, severe sweating, and unexplainable abdominal or chest pain
-Can last minutes or hours

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53
Q

What are the signs and symptoms of pheochromocytoma?

A
  • Severe episodic hypertension
  • Palpitations
  • Tremors
  • Diaphoresis
  • Anxiety
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54
Q

What diagnostic tests are associated with pheochromocytoma?

A
  • CT/MRI

- 24 Hour urine

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55
Q

What are the treatment options for patients with a pheochromocytoma?

A
  • Surgery/Tumor removal

- Medical management

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56
Q

What specific cells secrete insulin?

A

Beta cells

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57
Q

What specific cells secrete glucagon?

A

Alpha cells

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58
Q

What specific cells secrete somatostatin?

A

Delta cells

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59
Q

When ____ cells are destroyed, insulin cannot be synthesized

A

Beta

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60
Q

When is insulin released by the Pancreas?

A

When glucose levels are elevated (hyperglycemia)

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61
Q

How does insulin work within the body?

A
  • It opens the cells and allows glucose to travel inside of the cells
  • The cells can then use glucose for energy
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62
Q

Without insulin, what happens to the cells?

A
  • They starve

- Glucose cannot get inside of the cells and the cells do not have glucose to use as energy

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63
Q

When is glucagon released by the Pancreas?

A

When glucose levels are decreased (hypoglycemia)

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64
Q

How does glucagon work within the body?

A
  • Glucagon stimulates the liver to convert glycogen to glucose
  • Glucose is the usable form of energy for the cells
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65
Q

What type of disease is Type One Diabetes Mellitus classified as?

A
  • Autoimmune disease
  • Body attacks beta cells (that live within the Islet of Langerhans in the Pancreas)
  • When beta cells are all killed off, insulin can not be synthesized any longer
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66
Q

What are the two possible reasons the body is intolerant to glucose?

A
  • Pancreas has developed faulty production of insulin

- Tissues have become insensitive to the insulin

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67
Q

What does a Type One Diabetic patient need to survive?

A
  • Exogenous insulin administration daily for life

- Have to have insulin!!!

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68
Q

What is the most prevalent form of Diabetes Mellitus?

A

Type Two

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69
Q

Explain what happens within the body in Type Two Diabetes Mellitus

A
  • Still capable of insulin synthesis, BUT insulin secretion is impaired
  • Beta cells are decreased
  • Beta cells aren’t as responsive when glucose levels are elevated, therefore they will not release as much insulin as quickly
  • The tissues within the body become resistant to insulin
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70
Q

What is diabetes mellitus?

A

-Disorder of carbohydrate (glucose) metabolism

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71
Q

What is ketoacidosis (DKA)? What are the signs and symptoms?

A
  • Body breaks down fat for energy (because there is no insulin) creating ketones, which leads to metabolic acidosis
  • Primarily occurs in Type One Diabetes Mellitus
  • Fruity breath
  • Kussmaul respirations
  • Polyuria
  • Polydipsia
  • Nausea/Vomiting
  • Coma
  • Death
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72
Q

What are the risk factors for Diabetes Mellitus Type Two? How can Type Two Diabetes Mellitus be controlled?

A

-Genetics, obesity, sedentary lifestyle

  • Through proper diet and exercise (weight loss)
  • Oral medications
  • Insulin
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73
Q

What is glucose? What happens to the body without glucose?

A
  • Primary energy source for body cells
  • ONLY energy source for brain and nervous system

-Brain and nervous system will shut down!

74
Q

What is required for cells to absorb glucose and use it as energy?

75
Q

When are glucose levels low?

A

In a fasting state

76
Q

When are glucose levels high?

A

After eating a meal

77
Q

What tests are used to diagnose diabetes?

A
  • Fasting Plasma Glucose Test (FPGT)
  • Oral Glucose Tolerance Test (OGTT)
  • Random Plasma Glucose Test
78
Q

Explain the Fasting Plasma Glucose Test (FPGT).

A
  • Glucose tested after fasting for 8 hours
  • Glucose <100 = Good!
  • Glucose 100-125 = Pre-diabetic
  • Glucose >126 = Diabetic
79
Q

When is glucose considered critically low?

A

< 40 mg/dL

80
Q

When is glucose considered critically high?

A

> 450 mg/dL

81
Q

What is a normal Hemoglobin A1C (Hgb A1C)?

82
Q

If the glucose results higher than normal, the first thing the nurse should do is…

A

Assess the patient!

83
Q

If the glucose results higher than normal, the second thing the nurse should do is…

A

After assessing the patient, inquire about the patient’s dietary habits for the day. Have they eaten recently?

84
Q

What will kill the patient first, a critically high or critically low glucose?

A
  • Critically low!
  • Brain requires glucose for energy. Without glucose, the brain will shut down and the body will go into a coma (life threatening!)
85
Q

If a provider wants to see how well the glucose has been controlled over the past two to three months, what lab will be ordered?

A

Hemoglobin A1C

86
Q

A Hemoglobin A1C less than what number is ideal for a patient with Diabetes Mellitus?

87
Q

If a Hemoglobin A1C is > 9 %, what does the provider know?

A

The blood glucose has been very poorly controlled over the past two to three months

88
Q

If a patient has a glucose level of 80 mg/dL but a Hemoglobin A1C of 14%, will they have s/s of hyperglycemia?

A
  • No

- Glucose level is within range so s/s should not be present

89
Q

A Hemoglobin A1C of _____% or higher is indicative of diabetes.

90
Q

A Hemoglobin A1C of _____% is indicative of pre-diabetes.

A

5.7 - 6.4%

91
Q

If a patient is diagnosed with pre-diabetes, how will they manage the disease?

A
  • Diet, exercise, weight loss

- When done properly, they can avoid the diagnosis of Diabetes Mellitus

92
Q

What is pre-diabetes?

A
  • Condition in which blood glucose levels are higher than normal, but not high enough for a diagnosis of diabetes
  • DMII is developed within 10 years without preventative measures
93
Q

What is gestational diabetes?

A
  • Diabetes developed during pregnancy
  • Will usually return to normal glucose levels within six weeks postpartum
  • Increased risk for developing Type Two Diabetes
94
Q

What are acute complications of Diabetes Mellitus? What is most concerning?

A
  • Hypoglycemia
  • Hyperglycemia
  • Ketoacidosis

-Hypoglycemia is the most concerning, it can kill a patient first

95
Q

What increases insulin sensitivity and is an essential part of diabetes management?

96
Q

Nutritional therapy and education should be _____?

A

Individualized

97
Q

What should the nurse include in their nutritional therapy and education?

A
  • Patient should not eat whatever they want and use insulin to “cover the calories”
  • Everything in moderation
98
Q

List the benefits of exercise.

A
  • Lowers insulin resistance and blood glucose
  • Weight loss
  • Lowers triglycerides and LDL
  • Increases HDL
  • Improves blood pressure and circulation
99
Q

What education should the nurse provide in regards to diabetes and exercise?

A
  • Exercise 150 minutes/week
  • Eat before exercising
  • Do not exercise if hyperglycemic and ketones are present in the urine
  • Hypoglycemia can occur up to 48 hours after exercising
  • Bring a snack to prevent hypoglycemia
  • Caution patient about injecting insulin into a site that is to be exercised
100
Q

Why should a patient not inject insulin into a site that is to be exercised?

A

-Increase the rate of absorption and speed the onset of insulin action

101
Q

What education should the nurse provide in regards to diabetes and illness?

A
  • Blood sugar can rise even if they do not eat or drink anythin
  • Continue to take insulin and diabetes pills as usual
  • Test blood sugar more frequently
  • Drink plenty of fluids
102
Q

What is the drug class for Metformin (Glucophage, Fortamet)?

103
Q

Name a medication that falls under the drug class Biguanide.

A

Metformin (Glucophage, Fortamet)

104
Q

What are trade names for Metformin?

A
  • Glucophage

- Fortamet

105
Q

What is the generic name for Glucophage or Fortamet?

106
Q

How does Metformin (Glucophage, Fortamet) work?

A
  • It decreases the glucose produced by the liver

- It increases the amount of glucose uptake by the muscles

107
Q

Does Metformin (Glucophage, Fortamet) directly decrease blood sugar? Is there a direct risk for hypoglycemia?

A
  • No it does not
  • It does not increase insulin production or release
  • No direct risk for hypoglycemia
108
Q

How is Metformin (Glucophage, Fortamet) administered? When is it given?

A
  • PO

- Daily or multiple times a day

109
Q

What is one reason Metformin (Glucophage, Fortamet) is given?

A

-To help control blood sugar and Hgb A1C levels in the patient with Diabetes Mellitus Type Two

110
Q

Can a patient with Diabetes Mellitus Type One take Metformin (Glucophage, Fortamet) for blood sugar control? Why or why not?

A
  • No

- The patient with Diabetes Mellitus Type One must take exogenous insulin to survive.

111
Q

What organ can Metformin (Glucophage, Fortamet) damage? What labs need to be monitored?

A
  • It can damage the kidneys
  • Monitor BUN, Crt, eGFR

-Must assess these labs prior to starting the medication and while taking it

112
Q

If the patient has a diagnostic imaging test with IV contrast scheduled, what must the nurse do regarding scheduled Metformin (Glucophage, Fortamet) to be given?

A
  • Contact physician
  • Do not give Metformin (Glucophage, Fortamet)
  • It will damage the kidneys
113
Q

Name medications that fall under the drug class Sulfonylureas.

A
  • Glipizide (Glucotrol)
  • Glimeperide (Amaryl)
  • Glyburide (Micronase)
114
Q

The medications Glipizide (Glucotrol), Glimeperide (Amaryl), Glyburide (Micronase) fall under what drug class?

A

Sulfonylurea

115
Q

How does a Sulfonylurea work?

A
  • It stimulates the pancreas to secrete insulin

- It increases insulin receptor sensitivity within the tissues/cells

116
Q

How and when is a Sulfonylurea given?

A
  • PO

- Daily or multiple times a day

117
Q

Can a patient with Diabetes Mellitus Type One take a Sulfonylurea for blood sugar control? Why or why not?

A
  • No
  • There is no insulin within the pancreas so the Sulfonylurea will not work
  • The Type One diabetic must take exogenous insulin for survival
118
Q

What is one reason a Sulfonylurea is given?

A

To control glucose levels in the patient with Diabetes Mellitus Type Two

119
Q

Does a Sulfonylurea directly decrease blood sugar? Is there a direct risk for hypoglycemia?

A
  • It can decrease blood sugar due to its alteration of insulin release
  • The patient can become hypoglycemic
120
Q

What is onset?

A

How long it takes for insulin to begin working and lowering glucose

121
Q

What is peak?

A

When the insulin is working its hardest to lower glucose levels

122
Q

What is duration?

A

How long the insulin continues to work until it is completely used up

123
Q

How is insulin classified?

A

By time course

124
Q

Where can sub-q insulin be administered? Which is the fastest route of absorption?

A
  • Back of arm
  • Abdomen (Fastest)
  • Anterior thigh
  • Buttock
125
Q

Name medications that fall under the drug class Rapid-Acting Insulin

HINT: Logs roll rapidly down the hill

A
  • Insulin Lispro (Humalog)

- Insulin Aspart (Novolog)

126
Q

The medications Insulin Lispro (Humalog) and Insulin Aspart (Novolog) fall under what drug class?

A

Rapid Acting Insulins

127
Q

How does exogenous insulin work?

A

It is given to control and lower blood glucose throughout the day

128
Q

What is the onset of Rapid Acting Insulin?

A

5 to 20 minutes

129
Q

What is the peak of Rapid Acting Insulin?

A

30 minutes to 3 hours

130
Q

What is the duration of Rapid Acting Insulin?

A

2 to 5 hours

131
Q

When is the patient most at risk for hypoglycemia after an insulin injection? (onset, peak or duration?)

A

During the peak of the medication/insulin

132
Q

What is the onset of Short Acting Insulin?

A

30 minutes

133
Q

What is the peak of Short Acting Insulin?

A

2 to 5 hours

134
Q

What is the duration of Short Acting Insulin?

A

5 to 8 hours

135
Q

What route is insulin administered?

A

Subcutaneously

136
Q

What information must the nurse know before administering any type of insulin?

A
  • The nurse must know the patients current blood sugar

- The nurse must know what the onset, peak, duration of the insulin is

137
Q

Name medications that fall under the drug class Short-Acting Insulin

A

Regular Insulin (Novolin R or Humulin R)

138
Q

The medication Regular Insulin (Novolin R or Humulin R) falls under what drug class?

A

Short Acting Insulin

139
Q

What is the only insulin drug class/type that can be given intravenously?

A

Drug Class: Short Acting Insulin

Insulin Name: Regular Insulin (Novolin R or Humulin R)

140
Q

When is Rapid Acting Insulin or Short Acting Insulin given? What must the nurse keep in mind before/while administering this medication?

A
  • When the patient is hyperglycemic, usually with a blood sugar greater than 150 mg/dL
  • The nurse should ensure food is present so the patient can avoid becoming hypoglycemic
  • Can be given AC (before meals) and HS (at night/before bed)
  • Can be given q6hours for a patient who needs more aggressive blood glucose control
141
Q

What insulin drug classes fall under “Bolus Insulin” or “Meal Time Insulin”

A
  • Rapid Acting Insulins

- Short Acting Insulins

142
Q

What insulin drug classes fall under “Basal Insulin” or “Daily Control Insulin”.

A
  • Intermediate Acting Insulin

- Long Acting Insulin

143
Q

Why are Intermediate Acting Insulin and Long Acting Insulin given?

A
  • Manage blood glucose levels long-term (i.e. over the span of a day)
  • Keeps blood sugar at a steady level throughout the day
144
Q

Can Intermediate Acting Insulin and Long Acting Insulin be given when blood sugars are within normal limits? When would the nurse hold these medications?

A
  • Yes, they can be given when blood sugars are in normal limits
  • It is important to ensure the patient eats
  • Hold these medications if hypoglycemia is present
145
Q

Name medications that fall under the drug class Intermediate-Acting Insulin.

A

NPH Insulin (Novolin N or Humulin N)

146
Q

The medication NPH Insulin (Novolin N or Humulin N) falls under what drug class?

A

Intermediate Acting Insulin

147
Q

What is the onset of Intermediate Acting Insulin?

A

1 to 2 hours

148
Q

What is the peak of Intermediate Acting Insulin?

A

6 to 12 hours

149
Q

What is the duration of Intermediate Acting Insulin?

A

18 to 26 hours

150
Q

When are Intermediate Acting Insulin and Long Acting Insulin given?

A

Once or twice a day (Usually morning and/or night)

151
Q

Name medications that fall under the drug class Long-Acting Insulin

A

Insulin Glargine (Lantus)

152
Q

The medication Insulin Glargine (Lantus) falls under what drug class?

A

Long Acting Insulin

153
Q

What is the onset of Long Acting Insulin?

A

1 to 2 hours

154
Q

What is the peak of Long Acting Insulin?

155
Q

What is the duration of Long Acting Insulin?

A

Up to 24 hours

156
Q

What are the side effects of insulin?

A
  • Hypoglycemia
  • Allergic reaction
  • Lipodystrophy
  • Somogyi effect
  • Dawn phenomenon
157
Q

What is the Somogyi Effect?

A

Rebound hyperglycemia caused from hypoglycemia occurring in the night

158
Q

What is Dawn Phenomenon?

A

Early morning hyperglycemia resulting from release of counter-regulatory hormones

159
Q

What can cause hyperglycemia?

A
  • Stress
  • Illness
  • Food
  • Not enough medications
  • Not adhering to medication regimen
160
Q

List the signs and symptoms of hyperglycemia

A
  • Polyuria
  • Polyphagia
  • Polydipsia
  • Glycosuria
  • Nocturia
  • Ketouria
  • Blurred Vision
  • Fatigue, Lethargy, Headache
  • Abdominal Pain
  • Eventual Coma
161
Q

How can hyperglycemia be treated?

A
  • Dietary changes
  • Increase physical activity
  • Non-Insulin Oral agents
  • Insulin coverage
162
Q

What is hyperglycemia?

HINT: Hot and dry, sugar’s high

A

Occurs when glucose available exceeds the amount of insulin available

163
Q

What is hypoglycemia?

HINT: Cold and clammy, need some candy

A

Occurs when there is not enough glucose available for the amount of insulin circulating in the blood

164
Q

What can cause hypoglycemia?

A
  • Undereating
  • Skipping meals
  • Too much insulin
  • Exercise
165
Q

What patient population is at increased risk for hypoglycemia?

A
  • Older adults taking beta blockers

- Masked signs of hypoglycemia – this is called Hypoglycemia Unawareness

166
Q

List signs and symptoms of hypoglycemia

A
  • Hunger
  • Shaking
  • Tremulous
  • Sweating
  • Palpitations
  • Headache
  • Irritable
  • Confusion
  • Neuroglycopenia
  • Eventual Seizures, Coma
167
Q

If the nurse suspects a patient is hypoglycemic, what is the first step?

A

-Check the blood sugar!

Always check the blood sugar so a baseline -value is obtained

168
Q

When should the nurse initiate the hypoglycemia protocol?

A

If the blood sugar is less than 70 mg/dL

169
Q

If the patient’s blood sugar is less than 70 mg/dL and the patient is alert and oriented, following commands, what should the nurse do?

A

Administer 15 to 20 g of a fast acting carb: 4-6 ounces of juice or regular soda, 6 to 8 hard candies

170
Q

If the patient’s blood sugar is less than 70 mg/dL and the patient is lethargic, unconscious and/or uncooperative, what should the nurse do?

A 
Administer Glucagon (SubQ or IM)
If there is IV access, give Dextrose
171
Q

What macrovascular damages occur with long term Diabetes Mellitus complications?

A
  • Atherosclerosis
  • Arteriosclerosis
  • HTN
  • Hyperlipidemia
  • Increased risk of having a myocardial infarction or stroke
  • Cardiovascular disease
  • Cerebrovascular disease
172
Q

What microvascular damages occur with long term Diabetes Mellitus complications?

A
  • Retinopathy
  • Nephropathy
  • Male erectile dysfunction
173
Q

What are some long term complications of Diabetes Mellitus?

A
  • Neuropathy (nerve damage)
  • Increased risk for infection
  • Slow/poor wound healing
  • Microvascular complications
  • Macrovascular complications
174
Q

What is diabetic retinopathy?

A

Process of microvascular damage in the retina because of chronic hyperglycemia

175
Q

What is diabetic nephropathy?

A
  • Microvascular complication associated with damage to the small blood vessels that supply the glomeruli of the kidneys
  • Nerve damage that occurs because of nerve damage caused by increased blood sugar
  • Patients should be screened annually for albuminuria
176
Q

What is sensory neuropathy?

A
  • Most common
  • Affects hands and/or feet bilaterally
  • Major risk factor for lower extremity amputation
177
Q

What is autonomic neuropathy?

A

-Occurs when there is damage to the nerves that manage every day body functions such as blood pressure, heart rate, sweating, bowel and bladder emptying and digestion

178
Q

What is one of the most common causes of hospitalization in a person with diabetes?

A

Foot complications

179
Q

What education should the nurse provide to prevent food complications?

A
  • Always wear shoes
  • Keep feet clean
  • Inspect for injuries
  • Be careful when clipping toenails
  • Wear socks to keep feet warm
  • Avoid heating pads
  • Do not soak in warm/hot water
  • Do not use commercial remedies for calluses or corns
  • Wear flat soled shoes, no open toes
180
Q

What are two common medications a patient might be prescribed for sensory neuropathy and foot pain?

A
  • Amitriptyline

- Gabapentin

181
Q

Glucose levels _____ when type two diabetes patients take corticosteroids.

Health Care Participant Nursing: N1220 (5 decks)

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