Exam 1 Flashcards
Providing education at health fairs about diet, exercise, or environmental hazards is an example of what?
primary prevention
Providing both education and health screenings at health fairs for such health issues as early diagnosis and treatment of diabetes and hypercholesterolemia in order to shorten the duration and severity of the disease. This is an example of what?
secondary prevention
Providing education in rehabilitation centers to teach individuals who have been in an accident that left them with either an amputation or some paralysis ways to increase their functioning. This is an example of what?
tertiary prevention
A systematic, sequential, logical, scientifically based process with a planned course of action. It consists of two major interdependent operations: teaching and learning.
education
Client education includes what 3 things?
promotion of health and illness prevention, restoration and maintenance of health, and coping with impaired functioning.
An active process in which one person shares information with others to provide them with the information to make behavioral changes: promotes learning.
teaching
The process of assimilating information with a resultant change in behavior: acquisition of knowledge, skills, attitudes.
learning
A planned interaction that promotes behavioral change that is not a result of maturation or coincidence.
teaching-learning process
This domain of learning includes all intellectual behaviors and requires thinking: includes memory, recognition, understanding, reasoning, application, and problem solving
cognitive domain (thinking)
This domain of learning deals with expression of feeling and acceptance of attitudes, opinions, or values: nurse’s attitudes and values may differ from the client’s
affective domain (feeling)
This domain of learning involves acquiring skills that require integration of mental and muscular activity: skills require some degree of neuromuscular coordination; requirements include necessary ability, sensory image, opportunity to practice
psychomotor domain (skills)
This basic learning principle addresses the client’s desire and willingness to learn, it is moving in the direction of meeting a need or toward reaching a goal. It will promote a client’s compliance.
motivation to learn
This basic learning principle depends on physical and cognitive abilities, developmental level, physical wellness, and thought processes.
ability to learn
This basic learning principle allows a person to attend to instruction. It can create, promote, or detract from a state of learning receptivity.
learning environment
Gaps in knowledge that exist between a desired level of performance and the actual level of performance: active learning is most effective
learning needs
Low literacy, lack of motivation to learn information and make needed behavioral changes, the stress of acute and chronic illness, anxiety, and sensory deficits, as well as the negative influences of the environment are all examples of what?
barrier to learning
The basic science of public health. A multidisciplinary enterprise that recognizes the complex interrelationships of factors that influence disease and health at both the individual level and the community level.
epidemiology
Name the three components of the epidemiologic triangle.
environment, agent, host
This field studies the social distribution and social determinants of health and disease. It focuses on the roles and mechanisms of specific social phenomena.
social epidemiology
Testing of groups of individuals who are at risk for a certain condition but are as of yet asymptomatic. Not a diagnostic test and is key to many secondary prevention interventions.
screening
The systematic collection, analysis, and interpretation of data related to the occurrence of disease and the health status of a given population. It can be through active or passive systems.
surveillance
This is based on the assumption that a population’s overall mortality rate is a function of the age distribution of the population and the age-specific mortality rates.
age adjustment
This type of epidemiology looks at person, place, and temporal patterns such as secular trends, point epidemic, cyclical patterns, and event related clusters.
descriptive epidemiology
This type of epidemiology looks at cohort studies, case-control studies, cross-sectional studies, and ecological studies.
analytic epidemiology
A group of metabolic diseases that cause high blood glucose (sugar), either because the pancreas does not produce enough insulin, or because cells do not respond to the insulin that is produced.
diabetes mellitus
Rank these ethnicities from the highest percentage of diabetes to the lowest: Asian Americans, Whites, Hispanics, Blacks, American Indians/Alaskan Natives.
American Indians/Alaskans, Blacks, Hispanics, Asian Americans, Whites
What are some lifestyle/environmental triggers of diabetes?
animal based high protein/high fat diet, lack of physical activity, obesity.
What are some other factors that influence the disease process of diabetes?
genetics, autoimmune, and viral factors
What type of diabetes is most common and what percentage of cases belong to this type?
Type 2, and 90%
Besides type 1 and 2 diabetes, name 3 other types of diabetes.
gestational, pre-diabetes, and secondary
What is one way to prevent type 1 diabetes?
breastfeeding for at least 3 months has a preventative effect
Name a couple of ways to prevent type 2 diabetes.
a diet of plant based foods that avoids animal based foods, and moderate physical activity of at least 150 minutes.
Sudden, a younger age of onset, a thin to normal body habitus, common ketoacidosis, the presence of autoantibodies, low or absent endogenous insulin, and a 50% concordance rate in identical twins are characteristics of what pathology?
type 1 diabetes
A gradual onset, being found mostly in adults, seen often in obese body habitus, with rare ketoacidosis and no autoantibodies, possessing normal, decreased, or increased amounts of endogenous insulin, and a 90% concordance rate with identical twins are characteristics of what patholog?
type 2 diabetes
What are 4 causes of high blood sugar in type 2 diabetes?
too little glucose uptake by muscle and fat cells, too much glucose from the liver, pancreatic burn out, and decreased intestinal hormone release.
What are the three P’s that are symptoms of diabetes in general, but especially type 1?
polyuria, polydipsia, and polyphagia
What is the A1C value for a person with diabetes?
6.5 or above
What is the A1C value for a person with prediabetes?
5.7 to 6.4
What is the A1C value for a normal person?
about 5
What is the fasting plasma glucose level ( in mg/dL) of a person with diabetes?
126 or above
What is the fasting plasma glucose level ( in mg/dL) of a person with prediabetes?
100-125
What is the fasting plasma glucose level ( in mg/dL) of a normal person?
99 or lower
What is the oral glucose tolerance test score (mg/dL) of a person with diabetes?
200 or above
What is the oral glucose tolerance test score (mg/dL) of a person with prediabetes?
140-199
What is the oral glucose tolerance test score (mg/dL) of a normal person?
139 or below
This shows the amount of glucose attached to hemoglobin molecules over RBC life span (approximately 120 days). A normal value reduces the risks of retinopathy, nephropathy, and neuropathy.
Hemoglobin A1C
Name some medical conditions from which secondary diabetes can stem.
cushing syndrome, hyperthyroidism, pancreatitis, cystic fibrosis, hemochromatosis
Name some medical treatments from which secondary diabetes can stem.
corticosteroids (prednisone), thiazides, phenytoin, atypical antipsychotics (clozapine), parenteral nutrition
If a patient has high blood sugar in the morning due strictly to the rise of counter regulatory hormones they are experiencing what?
the dawn effect
If a patient has high blood sugar in the morning due to hypoclycemia during the early morning either due to too much insulin, an insulin peak at night, or too little food, they are experiencing what?
the somogyi effect
How does one know if a patient is experiencing the dawn effect or the somogyi effect?
assess blood sugar at 0200-0300, if its high then its dawn effect, if its low then its the somogyi.
Name 5 things that play a part in treating diabetes mellitus.
diet, physical activity, medication, monitoring blood glucose level, and diabetes education
What are the blood glucose goals for the management of diabetes mellitus?
BS of 70-130 before meals, less than 180 1 to 2 hours after meals, and an A1C of less than 7
What are some long term complications of diabetes?
kidney disease, adult blindness, lower limb amputations due to neuropathy, also contributes to heart disease and stroke risk.
This condition is caused by a profound deficiency of insulin and is characterized by hyperglycemia, ketosis, acidosis, and dehydration. It is more likely to occur in type 1 diabetes.
diabetic ketoacidosis
The pathophysiology of this condition is that when the supply of insulin is insufficient glucose cannot be properly used for energy. The body breaks down fat stores instead. Ketones are byproducts of fat metabolism and alter pH balance causing metabolic acidosis. Ketone bodies are excreted in the urine and electrolytes, particularly potassium become depleted.
diabetic ketoacidosis
Kussmaul respirations, thirst, dehydration, tachycardia, hypotension, acidosis, high blood sugar, polyuria, hyperkalemia, and breath that smells fruity are all symptoms of what condition?
diabetic ketoacidosis
What three things are important for treating somebody with diabetic ketoacidosis?
hydration, insulin, and electrolyte replacement
This complication of diabetes is life threatening and less common than DKA. It often occurs in clients older than 60 years with type 2 diabetes. The client has enough circulating insulin to prevent DKA and produces fewer symptoms, but neurologic manifestations occur because of increased serum osmolality.
Hyperosmolar hyperglycemic syndrome (HHS)
In this condition the patient usually has a history of inadequate fluid intake, increasing mental depression, and polyuria. Laboratory values include a blood glucose >400 mg/dL, increased serum osmolality, and absent or minimal ketone bodies. It is a medical emergency with a high mortality rate.
hyperosmolar hyperglycemic syndrome (HHS)
Name some nursing management actions for DKA and HHS.
monitor the patient closely for signs of potassium imbalance, cardiac monitoring, vital signs. Administer IV fluids, insulin, electrolytes (esp. K+), assess renal status, cardiopulmonary status, and level of consciousness.
This condition results when blood glucose is
hypoglycemia
Confusion, irritability, diaphoresis, tremors, hunger, weakness, and visual disturbances are all manifestations of what condition? If untreated a loss of consciousness, seizures, coma and death may occur.
hypoglycemia
Name two situations where a person will not experience the warning signs/symptoms of hypoglycemia and thus increasing the risk that it will occur.
This could occur related to autonomic neuropathy, or in patients taking beta blockers.
What rule is utilized in treating a patient with hypoglycemia that is alert enough to swallow?
the 15/15 rule - give 15-20 grams of simple carbs (avoid foods with fat that will slow absorption) and recheck blood sugar 15 minutes later. Repeat until >70 mg/dL. Give them a protein/carn combined snack when above 70 mg/dL to prevent rebound hypoglycemia and check again after 45 minutes.
What can you do if a client has hypoglycemia and isn’t alert enough to swallow?
Administer 1 mg of glucagon IM or subq.; once they recover have them ingest a complex carbohydrate
In acute care settings what can you do if a client has hypoglycemia and isn’t alert enough to swallow?
Administer 20-50 mL of 50% dextrose IV push.
These are medications that are separate from insulin that work to improve mechanisms by which insulin and glucose are produced and used by the body.
oral agents
Name three defects of type 2 diabetes that oral agents impact.
insulin resistance, decreased insulin production, increased hepatic glucose production
This type of oral agent increases insulin production from the pancreas and decreases the chance of prolonged hypoglycemia. 10% have decreased effectiveness after prolonged use. Examples include glipizide (glucotrol) and glimepiride (amaryl)
sulfonylureas
This type of oral agent increases insulin production from the pancreas and is taken 30 minutes before each meal up to the time of the meal. They shouldn’t be taken if the meal is skipped. Examples include repaglinide (prandin) and nateglinide (starlix).
meglitinides
These oral agents reduce glucose production by the liver, enhance insulin sensitivity at tissues, improve glucose transport into cells, and do not promote weight gain. Metformin (glucophage) is an example.
biguanides
These oral agents are also known as “starch blockers”. They slow down the absorption of carbohydrate in the small intestine. An example is acarbose (precose)
alpha-glucosidase inhibitors
These oral agents are most effective in those with insulin resistance. They improve insulin sensitivity, transport, and utilization at target tissues. Examples include pioglitazone (actos) and rosiglitazone (avandia)
thiazolidinediones
These oral agents slow the inactivation of incretin hormones (a group of GI hormones that cause an increase in the amount of insulin released from beta cells). There is a potential for hypoglycemia with their use. Examples include sitagliptin ( januvia) and saxagliptin (onglyza).
dipeptidyl peptidase-4 (DDP-4)
This “other” drug treatment for diabetes is a hormone that is secreted by the beta cells of the pancreas and is co-secreted with insulin. It is indicated for type 1 and 2 diabetes and is administered subcutaneously in the thigh or abdomen. It slows gastric emptying, reduces postprandial glucagon secretion, and increases satiety. pramlintide (symlin) is an example.
amylin analog
This “other” drug treatment for diabetes is a synthetic peptide that stimulates the release of insulin from beta cells. It is given via subq injection and suppresses glucagon secretion and reduces food intake. It slows gastric emptying and cannot be used with insulin. Examples include byetta and victoza.
incretin mimetic
What are the 5 stages to the socialization to a professional role?
novice, advanced beginner, competent, proficient, and expert
What are some nursing roles?
caregiver, advocate, manager/coordinator of care, collaborator, educator, researcher, communicator, leader
This is the most traditional nursing role. The nurse practices the science of nursing and provides interventions to meet the physical, psychosocial, spiritual, and environmental needs of clients and families. They use the nursing process and critical judgement, as well as skill, empathy, knowledge, and caring.
provider of care - caregiver
This nursing role involves the nurse acting as a person who pleads the cause for client’s rights in order to respect the client’s decision and boost client autonomy.
advocate
This nursing role involves planning and implementing and managing the care of clients. They direct the work of professional and nonprofessional staff in order to achieve expected outcomes of care.
manager/coordinator of care.
A contractual agreement in which authority and responsibility for a task are transferred by a person who is accountable to another person who then becomes accountable.
delegation
When a nurse acts in this role they make sure that all people involved are listened to and that decisions are developed together. They recognize the expertise and experience of other healthcare team members. They work together to achieve high quality outcomes.
collaborator
When a nurse teaches to clients and their families or serves as a preceptor to novice nurses they take on which nursing role?
educator
When a nurse utilizes systematic inquiry designed for the purpose of advancing knowledge and utilizes this information to propagate evidence based practice they are in what role?
researcher
What are the 4 spheres in which nurses can be a part of the policy process?
workplace, government, professional organizations, and community
This type of insulin has its onset within 10-30 minutes and peaks between 30-90 minutes. It has a duration of 3 to 5 hours. Name this type of insulin and 3 drugs that fall in this class.
rapid; Novolog, Humalog, and Apridra
This type of insulin has its onset within 30-60 minutes and peaks between 2-5 hours. It has a duration of 5 to 8 hours. Name this type of insulin and 2 drugs that fall in this class.
short; Humulin R and Novolin R
This type of insulin has its onset after about 1.54 hours and peaks between 4-12 hours. It has a duration of 12 to 18 hours. Name this type of insulin and 2 drugs that fall into this class.
intermediate; Humulin N and Novolin N
This type of insulin has its onset between .8 and 4 hours. It has no pronounced peak and its duration lasts for 20 to 24 hours. Name this type of insulin and two drugs in this class.
long; lantus and levemir
