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medsurg > Exam 2: Diabetes Mellitus > Flashcards

Exam 2: Diabetes Mellitus Flashcards

1
Q

Why do patients experience polydipsia in Type 1 diabetes?

A

Polydipsia (excessive thirst) occurs due to elevated sugar levels drawing large amounts of water from the cells in the body

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2
Q

What is the major difference between type 1 and type 2 diabetes?

A

There is a decreased secretion and or cellular resistance to insulin that is being produced

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3
Q

What are major clinical manifestations of type 2 diabetes? (4)

A
  • poor wound healing
  • visual changes (retinopathy)
  • candidal infections
  • recurrent yeast infections
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4
Q

What is the best indicator of sugar control for a diabetic?

A

A1C of 6.5% (realistically 7%): a glycosylated hemoglobin level tracking over 2-3 months

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5
Q

In a patient with hyperglycemia, a random plasma glucose will show?

A

Glucose level greater than or equal to 200

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6
Q

What is one way to ensure patient understands teaching?

A

Using the teach-back method before discharge for glucose monitoring and insulin self-injections

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7
Q

What are the most important factors of insulin medications?

A

Its onset and peak

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8
Q

Which insulin does not have a peak? Examples?

A

Long-acting insulin (ex: Levemir, Lantus)

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9
Q

A bolus insulin must have? What is an example?

A

Bolus insulin must be taken with food present (Novolog) due to the onset initiating in 15 mins of injection of pen

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10
Q

What is the onset and peak of rapid acting insulin? When should it be injected? Examples? (3)

A

Onset: 15 mins
Peak: 1-3 hrs
Should be injected within 15 mins of mealtime
Ex) Humalog, Novolog, Apidra

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11
Q

Short-acting insulin has an onset of? When should it be injected?

A

Onset: 30-60 mins

Inject 30-45 mins BEFORE a meal to ensure the onset coincides with the absorption of the meal

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12
Q

What happens if the patient only eats half of their food?

A

Must contact the HCP before administering the insulin injection in case the dosage must be changed

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13
Q

Intermediate-acting insulin is also used as what type of insulin? Duration of action? Peak? Can result in?

A

NPH (cloudy):

  • duration: 12-18 hrs
  • peak: 4-12 hrs
  • can result in hypoglycemia
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14
Q

How should insulin vials and pens be stored?

A

Vials and pens currently in use may be left at room temperature for up to 4 weeks, after this it must be discarded

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15
Q

What type of insulin can be given through IV only?

A

Regular insulin

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16
Q

**What are good places for insulin injections? (2)

A
  • back of the arm

- abdomen

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17
Q

Patients with type 2 can take?

A

Can take oral medications instead of insulin but can still experience serious complications from the disease process

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18
Q

What is the most common form of biguanides used in the hospital?

A

Metformin

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19
Q

What is the primary action of metformin? (3)

A
  • Reduce glucose production by the liver
  • Enhances insulin sensitivity at the tissue level
  • Improves glucose transport into the cells
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20
Q

What is a nursing consideration for metformin?

A

Should be discontinued before surgery or any radiologic procedure that involves the use of contrast medium

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21
Q

If a patient cannot stop taking metformin, or stops taking it too late before procedure, what should be done?

A

Give lots of fluids to flush the dye out

22
Q

What do sulfonylureas do?

A

Stimulates insulin release from the pancreas and increases sensitivity to insulin at receptor sites

23
Q

What do meglitinides do?

A

When it is taken before a meal, it mimics the normal response to eating by increasing pancreatic production of insulin during and after the meal

24
Q

Glucosidase inhibitors work by? When should it be taken?

A

Slowing the absorption of carbohydrates in the small intestine. Should be taken with the very first bite of the meal

25
Q

What do thiazolidinediones do?

A

Improves insulin sensitivity, transport, and the utilization at target tissues

26
Q

What do dipeptidyl peptidase inhibitors do?

A

Stimulate the release of insulin from pancreatic B-cells

27
Q

When should blood sugar be monitored when exercising?

A

Before, during, and after exercise to determine the need for additional insulin during times of activity

28
Q

How often should blood glucose levels be checked during times of illness?

A

At 4 hr intervals

29
Q

Which behavior indicates that the nurse should implement additional teaching?

A

Patient increases their daily exercise after finding ketones in the urine

30
Q

Nursing diagnosis for diabetes?

A

Non-compliance related to diet and medication

31
Q

Nursing intervention for diabetes?

A

Have patient should proper way to administer insulin and check blood sugar before hand

32
Q

What is a goal for diabetes?

A

Have an A1C level lower than 7%

33
Q

Routine care for patients with diabetes include? (6)

A
  • regular bathing
  • emphasis on foot care
  • inspection of feet daily
  • avoid going barefoot
  • wear appropriate shoes
  • be supportive
34
Q

What vital sign should be checked for patients with diabetes?

A

Skin turgor, due to polydipsia, patient can be chronically dehydrated

35
Q

How can compliance to patient teaching be checked?

A

Using A1C levels (shows how well blood sugar has been controlled over 3 months)

36
Q

S/S of diabetic ketoacidosis. (4) What type of diabetes is it most associated with?

A
  • dehydration (causes poor skin turgor), dry mucous membranes, tachycardia, orthostatic hypotension
  • type 1 diabetes
37
Q

What type of breathing would the patient be showing during DKA?

A

Kussmaul respirations (rapid deep breathing associated with dyspnea)

38
Q

DKA causes what type of acidosis. How can it be treated?

A
  • metabolic acidosis: overproduction of ketones alters pH balance
  • give normal saline to hydrate patient, will present dehydration
39
Q

What assessment should be done for DKA?

A

Neuro status assessment because glucose excites the brain which can lead to seizures

40
Q

Nursing intervention for hyperosmolar hyperglycemic syndrome?

A

Administer IV normal saline fluids to help with dehydration

41
Q

Glucose levels of HHS?

A

Greater than 600

42
Q

S/S of hypoglycemia? (7)

A
  • shakiness
  • palpitations
  • nervousness
  • diaphoresis
  • anxiety
  • hunger
  • pallor
43
Q

What causes hypoglycemia?

A

Low blood glucose occurs when there is too much insulin or not enough food in proportion to available glucose in the blood

44
Q

What should be done if a patient with hypoglycemia is found unconscious?

A

Check blood sugar immediately and administer drugs and D50 fluids through IV if levels are severely low

45
Q

What fluids can be administered to patients with hypoglycemia? (3)

A

D50, D10, D5 through IV

46
Q

What is the Somogyi effect?

A

A hormonal effect which overall increases blood sugar in the mornings

47
Q

What cardiovascular disease is commonly associated with diabetes?

A

Silent ischemia

48
Q

What questions should be asked for patient with autonomic neuropathy vs sensory neuropathy?

A

Autonomic: do you feel full or bloated after just a small amount of food
Sensory: how well is the sensation in your feet

49
Q

Why are diabetic patients at a higher risk for infections?

A

There is a defect in the mobilization of white blood cells and an impaired phagocytosis by neutrophils and monocytes

50
Q

Why should insulin be decreased before surgeries?

A

The higher the insulin level, the greater the chances for infection because it provides a growth medium for bacteria

51
Q

T/F insulin vials should be disposed of after 4 weeks?

A

True

52
Q

What is the most effective way to track compliance for type 2 diabetes mellitus?

A

A1C testing

medsurg (16 decks)

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