Exam 2 Diabetes Flashcards
1
Q
Absence of insulin
A
Without insulin, the body breaks down fat and protein as a source of energy. Glucose levels build up in the blood stream and glucose is not available to organs and tissue
2
Q
Type 1 diabetes
A
- Autoimmune disorder
(Beta cell destruction)
(Absolute insulin deficiency)
-Usually non-obese
3
Q
Type 1 diabetes criteria
A
- Idiopathic
- Etiology can be viral infection
- ICAs present
Islet cell autoantibodies - C-peptide levels low or absent
4
Q
Type 1 diabetes symptoms
A
- Abrupt onset
- Thirst
- Hunger
- Weight loss
- Polyuria
5
Q
Type 2 diabetes
A
- Progressive disorder
- Insulin resistance
(Relative insulin deficiency to secretory deficit w/ insulin resistance) - Dysfunctional pancreatic beta cells
- Obesity common
6
Q
Type 2 diabetes symptoms
A
- Not always present
- Thirst
- Fatigue
- Blurred vision
- Vascular or neural complications
7
Q
Type 2 Diabetes criteria
A
- A1c 6.5%
- or fasting plasma glucose > 126 mg/dL
- or 2hr glucose tolerance test > 200 mg/dL
- or casual blood glucose > 200 mg dL
8
Q
Macrovascular complications of diabetes and preventions
A
- Cardiovascular disease
Control HTN
Control cholesterol levels - Cerebrovascular disease
Control HTN
9
Q
MIcrovascular complication of diabetes and preventions
A
- Eye and vision complications
Annual eye exams, protect eyes - Diabetic neuropathy
(gabapentin; pregabalin; duloxetine)
(Foot care, foot care, foot care) - Diabetic nephropathy
(Annual U/A, BUN/CR)
(Drink 2-3 liter per day, avoid soda or alcohol)
(Avoid acetaminophen, NSAIDs)
-Male erectile dysfunction
10
Q
Meds- Biguanides for diabetes: Metformin HCL
A
- Treats type 2 diabetes
- increases your body’s response to insulin, a natural substance that controls the amount of glucose in the blood
11
Q
Meds- Sulfonylureas, 2nd generation: Glipizide, glimepiride, glyburide
A
- Treats type 2 diabetes
- Stimulates the pancreas to release insulin
12
Q
Meds- Meglitinides: Repaglinide
A
- Treats type 2 diabetes
- Control high blood sugar
13
Q
Meds- Thiazolidinediones: Pioglitazone
A
- Treats type 2 diabetes
- Helps body use insulin better
14
Q
Meds- Alpha-glucosidase: acarbose
A
- Treats type 2 diabetes
- works in your intestines to slow the breakdown and absorption of carbohydrates from foods that you eat.
15
Q
Meds- Dipeptidyl peptidase-4 inhibitors: Sitagliptin
A
- Treats type 2 diabetes
- increases levels of natural substances called incretins.
- Incretins help to control blood sugar by increasing insulin release, especially after a meal.
- They also decrease the amount of sugar your liver makes.
16
Q
Meds- Incretin mimetic: Exenatide (subq)
A
- Treats type 2 diabetes
- increases insulin release (especially after a meal) and decreasing the amount of sugar your liver makes.
- Decreases amount of sugar absorbed by food
17
Q
Meds- Amylin mimetic: Pramlintide (subq)
A
- Treats type 1 and 2 diabetes
- Acts like a certain natural substance called amyrin, which lowers blood sugar.
- Slows the movement of food through your stomach
- Decreases your appetite and the amount of sugar your liver makes.
18
Q
Rapid acting insulin
A
- 10 to 30 min onset
- Lispro insulin; aspart; glulisine
19
Q
Short acting insulin
A
- 30 to 60 min onset
- Regular
- “clear” when mixing, pull up first
20
Q
Intermediate insulin
A
- NPH, Humulin N
- used to control the blood sugar overnight, while fasting and between meals
- 1 to 2 hour onset
- “cloudy” when mixing with Rapid or regular insulin, so pull up last
21
Q
Long acting insulin
A
- Glargine, Lantus
- No peak action
- used to control the blood sugar overnight, while fasting and between meals
- 1.5 to 2 hour onset
22
Q
Management of hyperglycemia
A
- Intensive Insulin therapy
Hourly blood sugar checks - Vasopressor therapy
Monitor for increase in glucose levels - Corticosteroids
Monitor for increase in glucose levels - 10% Dextrose infusion
Carbohydrate calories
23
Q
Signs and symptoms of hypoglycemia
A
- Diaphoresis
- Tremors
- Weakness
- Pallor
- Apprehension
- Tachycardia
- Shallow respirations
- Hypertension
- Hunger
- Headache
- Visual disturbances
- Restlessness, irritability
- Decreased LOC
- Coma
24
Q
Hypoglycemia treatment
A
- Stop the continuous Insulin Infusion if in use
- RECHECK blood sugar every 15 to 20 minutes
- 10 to 15 g of carbohydrate if <60
- 15 to 30 g of rapidly absorbed carbohydrate if <40
- If unconscious and cannot take oral, then….25 ml to 50 ml of D50W given IV push
- No IV access:
- Glucagon 1 mg IM or SQ
25
Self-treatment of hypoglycemia <70
- Take 15 to 20 g of readily absorbable carbohydrate
```
- 15 g of CHO examples:
4 oz fruit juice or soft drink (non-diet)
8 oz nonfat or 1% milk
3 to 4 glucose tablets
8 to 10 hard candies
1 tbsp. of honey, sugar or corn syrup
```
- Recheck blood glucose in 15 minutes
26
Diabetic Ketoacidosis (DKA) etiology
```
-Ketoacidosis
Untreated hyperglycemia, ketosis, acidemia
Infection
Trauma
Life-style changes
Emotional stress
Insulin pump
```
27
Diabetic Ketoacidosis (DKA) criteria
- Serum glucose > 300 mg/dl
- Arterial pH < 7.3
- Serum bicarbonate < 15 mEq/L
- Ketonemia or Ketonuria
28
DKA/hyperglycemia signs and symptoms
- Malaise, HA, fatigue
- Polyuria, polydipsia, polyphagia
- Nausea, vomiting
- Dehydration
(Flushed dry skin)
(Tachycardia, hypotension)
- Weight loss
- CNS
- LOC decreased, stuporous
- Kussmaul air hunger (fruity breath)
29
Hyperglycemia/DKA rehydrating
```
IVF
- First hour:
15 to 20 mL/kg/hr of 0.9% saline
Then:
- 0.45% saline @ 4 to 14 mL/kg/hr
- 5% dextrose soln added once glucose reaches 200-250 mg/dl
```
30
Nursing intervention for DKA/hypergylcemia
- Neuro checks hourly or more often if needed
- Infection risk
(Oral care, skin care, invasive tube/catheter site care)
- Hourly UOP measurement
- Vital signs
- CVP, PA pressures
- Cardiac rhythm
- Hypo and hyperkalemia
31
Hyperglycemic Hyperosmolar Syndrome (HHS) etiology
- Elderly
- Obese
- Stress
- Underlying medical condition
(MI, CVA, Sepsis)
- Medications
(Glucocorticosteroids, diuretics, phenytoin, propranolol, calcium channel blockers)
- Iatrogenic treatments
32
Hyperglycemic Hyperosmolar Syndrome (HHS) criteria
- Serum glucose > 600 mg/dl
- Arterial PH > 7.4
- Serum bicarbonate > 15 mEq/L
- Serum osmolality > 320 mOsm/kg
- Absent or mild ketonuria
33
Hyperglycemic Hyperosmolar Syndrome (HHS) Nursing interventions
- Correct insulin/glucose imbalance
IV insulin infusion
Hydration will correct this to some extent
Bolus with 0.15 unit/kg IV
then,0.1 unit/kg hourly
Glucose should decrease by 50 to 70 mg/dl per hour
```
- Correct fluid and electrolyte imbalance
Potassium levels
Assure UOP is adequate
Phosphate levels
Replace for level < 1.0 mg/dl
```
34
Hyperglycemic Hyperosmolar Syndrome (HHS) signs and symptoms
- Onset slow
- Profound dehydration
- CV
- Integument
- CNS
35
Hyperglycemic Hyperosmolar Syndrome (HHS) management
- Re-hydrate
- Restore electrolyte balance
- Restore insulin/glucose ratio
36
The student nurse asks why the patient is breathing so rapidly and deeply. What is the nurse’s best response?
A. “His serum pH is high and this is a compensatory mechanism.”
B. “His serum pH is low and this is a compensatory mechanism.”
C. “His serum potassium is high and this is a compensatory mechanism.”
D. “His serum potassium is low and this is a compensatory mechanism.”
B. “His serum pH is low and this is a compensatory mechanism.”
- As ketone levels rise, the buffering capacity of the body is exceeded and the pH of the body decreases, leading to metabolic acidosis. Kussmaul respirations (very deep and rapid) cause respiratory alkalosis in an attempt to correct the acidosis by exhaling carbon dioxide.
37
In the ED, the patient is diagnosed with diabetic ketoacidosis (DKA).
What is the nurse’s first priority for managing this condition?
A. Airway assessment
B. Fluid and electrolyte correction
C. Administration of insulin
D. Administration of IV potassium
A. Airway assessment
- The first priority is airway management, rapidly followed by the administration of fluids, insulin, and correction of any electrolyte imbalances
38
Twenty minutes later, the patient is admitted to the ICU for DKA management. The patient is receiving IV regular insulin with frequent finger sticks to check his glucose level. His potassium level is 2.5 and IV potassium supplements have been ordered.
What assessment must be made before giving the IV potassium?
A. Production of at least 30 mL/hr of urine
B. Level of consciousness and orientation
C. Finger stick glucose of less than 200 mg/dL
D. Respiratory rate of less than 24/min
A. Production of at least 30 mL/hr of urine
- Hypokalemia is a common cause of death in the treatment of DKA. Before giving IV potassium, make sure the patient produces at least 30 mL/hr of urine.
39
Two days later the patient is recovered and is preparing for discharge. His wife asks about what they can do to prevent this from happening again.
What should the nurse teach the patient and his wife? (Select all that apply.)
A. Check blood glucose levels every 4 to 6 hours if anorexia, nausea, or vomiting is experienced.
B. Check urine ketones when blood glucose is greater than 300 mg/dL.
C. Decrease fluid intake when nausea and vomiting occur.
D. Watch for and report any illness lasting more than 1 to 2 days.
E. Monitor glucose whenever the patient is ill.
- A. Check blood glucose levels every 4 to 6 hours if anorexia, nausea, or vomiting is experienced.
- B. Check urine ketones when blood glucose is greater than 300 mg/dL.
- D. Watch for and report any illness lasting more than 1 to 2 days.
- E. Monitor glucose whenever the patient is ill
- It is important to teach the patient to reduce the risk of dehydration by maintaining fluid and food intake. Small amounts of fluid may be tolerated even when vomiting is present. The patient should drink at least 3 L of fluid daily and increase this amount when infection is present
40
What percent of the United States population has diabetes?
A. 3.2%
B. 5.6%
C. 8.3%
D. 10.1%
C. 8.3%
41
Which symptom requires immediate intervention during a hypoglycemic episode?
A. Tachycardia
B. Hunger
C. Headache
D. Confusion
D. Confusion
- Glucose is necessary for brain function. Confusion is a marker of severe hypoglycemia requiring immediate intervention. Irritability/anxiety, hunger, tachycardia, headache, sweating, and seizures are additional signs of hypoglycemia.
42
When should a patient with type 1 diabetes avoid exercise?
A. When serum glucose is less than 150
B. During colder months
C. When ketones are present in the urine
D. When emotional stressors are high for the patient
C. When ketones are present in the urine
- Exercise should be avoided if ketones are present in the urine. Ketones indicate that current insulin levels are not adequate and that exercise would elevate blood glucose levels.
43
Somogyi effect
- occurs when there is a significant hypoglycemic episode during the night, the morning high glucose is the rebound effect from the hypo episode
