Exam 2: Diabetes Mellitus Flashcards
Why do patients experience polydipsia in Type 1 diabetes?
Polydipsia (excessive thirst) occurs due to elevated sugar levels drawing large amounts of water from the cells in the body
What is the major difference between type 1 and type 2 diabetes?
There is a decreased secretion and or cellular resistance to insulin that is being produced
What are major clinical manifestations of type 2 diabetes? (4)
- poor wound healing
- visual changes (retinopathy)
- candidal infections
- recurrent yeast infections
What is the best indicator of sugar control for a diabetic?
A1C of 6.5% (realistically 7%): a glycosylated hemoglobin level tracking over 2-3 months
In a patient with hyperglycemia, a random plasma glucose will show?
Glucose level greater than or equal to 200
What is one way to ensure patient understands teaching?
Using the teach-back method before discharge for glucose monitoring and insulin self-injections
What are the most important factors of insulin medications?
Its onset and peak
Which insulin does not have a peak? Examples?
Long-acting insulin (ex: Levemir, Lantus)
A bolus insulin must have? What is an example?
Bolus insulin must be taken with food present (Novolog) due to the onset initiating in 15 mins of injection of pen
What is the onset and peak of rapid acting insulin? When should it be injected? Examples? (3)
Onset: 15 mins
Peak: 1-3 hrs
Should be injected within 15 mins of mealtime
Ex) Humalog, Novolog, Apidra
Short-acting insulin has an onset of? When should it be injected?
Onset: 30-60 mins
Inject 30-45 mins BEFORE a meal to ensure the onset coincides with the absorption of the meal
What happens if the patient only eats half of their food?
Must contact the HCP before administering the insulin injection in case the dosage must be changed
Intermediate-acting insulin is also used as what type of insulin? Duration of action? Peak? Can result in?
NPH (cloudy):
- duration: 12-18 hrs
- peak: 4-12 hrs
- can result in hypoglycemia
How should insulin vials and pens be stored?
Vials and pens currently in use may be left at room temperature for up to 4 weeks, after this it must be discarded
What type of insulin can be given through IV only?
Regular insulin
**What are good places for insulin injections? (2)
- back of the arm
- abdomen
Patients with type 2 can take?
Can take oral medications instead of insulin but can still experience serious complications from the disease process
What is the most common form of biguanides used in the hospital?
Metformin
What is the primary action of metformin? (3)
- Reduce glucose production by the liver
- Enhances insulin sensitivity at the tissue level
- Improves glucose transport into the cells
What is a nursing consideration for metformin?
Should be discontinued before surgery or any radiologic procedure that involves the use of contrast medium
If a patient cannot stop taking metformin, or stops taking it too late before procedure, what should be done?
Give lots of fluids to flush the dye out
What do sulfonylureas do?
Stimulates insulin release from the pancreas and increases sensitivity to insulin at receptor sites
What do meglitinides do?
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
Glucosidase inhibitors work by? When should it be taken?
Slowing the absorption of carbohydrates in the small intestine. Should be taken with the very first bite of the meal
What do thiazolidinediones do?
Improves insulin sensitivity, transport, and the utilization at target tissues
What do dipeptidyl peptidase inhibitors do?
Stimulate the release of insulin from pancreatic B-cells
When should blood sugar be monitored when exercising?
Before, during, and after exercise to determine the need for additional insulin during times of activity
How often should blood glucose levels be checked during times of illness?
At 4 hr intervals
Which behavior indicates that the nurse should implement additional teaching?
Patient increases their daily exercise after finding ketones in the urine
Nursing diagnosis for diabetes?
Non-compliance related to diet and medication
Nursing intervention for diabetes?
Have patient should proper way to administer insulin and check blood sugar before hand
What is a goal for diabetes?
Have an A1C level lower than 7%
Routine care for patients with diabetes include? (6)
- regular bathing
- emphasis on foot care
- inspection of feet daily
- avoid going barefoot
- wear appropriate shoes
- be supportive
What vital sign should be checked for patients with diabetes?
Skin turgor, due to polydipsia, patient can be chronically dehydrated
How can compliance to patient teaching be checked?
Using A1C levels (shows how well blood sugar has been controlled over 3 months)
S/S of diabetic ketoacidosis. (4) What type of diabetes is it most associated with?
- dehydration (causes poor skin turgor), dry mucous membranes, tachycardia, orthostatic hypotension
- type 1 diabetes
What type of breathing would the patient be showing during DKA?
Kussmaul respirations (rapid deep breathing associated with dyspnea)
DKA causes what type of acidosis. How can it be treated?
- metabolic acidosis: overproduction of ketones alters pH balance
- give normal saline to hydrate patient, will present dehydration
What assessment should be done for DKA?
Neuro status assessment because glucose excites the brain which can lead to seizures
Nursing intervention for hyperosmolar hyperglycemic syndrome?
Administer IV normal saline fluids to help with dehydration
Glucose levels of HHS?
Greater than 600
S/S of hypoglycemia? (7)
- shakiness
- palpitations
- nervousness
- diaphoresis
- anxiety
- hunger
- pallor
What causes hypoglycemia?
Low blood glucose occurs when there is too much insulin or not enough food in proportion to available glucose in the blood
What should be done if a patient with hypoglycemia is found unconscious?
Check blood sugar immediately and administer drugs and D50 fluids through IV if levels are severely low
What fluids can be administered to patients with hypoglycemia? (3)
D50, D10, D5 through IV
What is the Somogyi effect?
A hormonal effect which overall increases blood sugar in the mornings
What cardiovascular disease is commonly associated with diabetes?
Silent ischemia
What questions should be asked for patient with autonomic neuropathy vs sensory neuropathy?
Autonomic: do you feel full or bloated after just a small amount of food
Sensory: how well is the sensation in your feet
Why are diabetic patients at a higher risk for infections?
There is a defect in the mobilization of white blood cells and an impaired phagocytosis by neutrophils and monocytes
Why should insulin be decreased before surgeries?
The higher the insulin level, the greater the chances for infection because it provides a growth medium for bacteria
T/F insulin vials should be disposed of after 4 weeks?
True
What is the most effective way to track compliance for type 2 diabetes mellitus?
A1C testing
