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NRSG 110: Med Surg 2 > [Exam 3] Chapter 51: Assessment and Management of Patients with Diabetes ( Page 1456 - 1483, 1496-1500 ) > Flashcards

[Exam 3] Chapter 51: Assessment and Management of Patients with Diabetes ( Page 1456 - 1483, 1496-1500 ) Flashcards

1
Q

What is diabetes?

A

A group of diseases characterized by hyperglycemia (high blood sugar) caused by defects in insulin secretion, insulin action, or both.

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2
Q

What does diabetes alter?

A

Alters CHO, Protein, and Fat Metabolism.

Increases risk of CVD.

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3
Q

What is Type 1 Diabetes?

A

Considered autoimmune disease, occuring after a virus. Insulin-producing beta cells in the pancreas are destroyed by an autoimmune process

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4
Q

Why does Type 1 Diabetes require insulin?

A

Because little or no insulin is produced. Onset is acute and usually before 30.

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5
Q

Type 1 Diabetes accounts for how much of the population?

A

5-10%, with it being genetic.

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6
Q

What does Insulin do?

A

Insulin secretion increases and moves glucose from the blodo into muscle, liver, and fat cells

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7
Q

What happens to Insulin in Type 2 Diabetes?

A

Islets of Langerhans in the Pancreas stops producing insulin

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8
Q

General description of Type 2 Diabetes?

A

Produce insulin, but have decreased sensitivity to insulin (insulin resistance) and impaired beta cell function result in decreased insulin production

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9
Q

Population % that has Type 2 Diabetes?

A

90-95% of people with diabetes, onset over age of 30, increasing in children, obesity,

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10
Q

Type 2 Diabetes is a slow, progressive what?

A

glucose intolerance

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11
Q

Type 2 Treated initially with

A

diet and exercise

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12
Q

Why would Oral Hypoglycemic agents be used with Type 2 Diabetes?

A

Initially may need to convert insulin or use both

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13
Q

Number one cause of Type 2 Diabetes?

A

Obesity

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14
Q

Type 1 Diabetes: What is the range of glucose in the blood that should not exceed?

A

180-200 mg/dL

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15
Q

What type of Diabetes is referred to as Pre Diabetic?

A

Type 2

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16
Q

What does Type 1 require for treatment?

A

Insulin Injection, and is a lifelong condition.

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17
Q

Type 2 Diabetes and Islets of Langerhans in Pancreas produce how much Insulin?

A

Still produce, but in a lesseer amount

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18
Q

Treatment for Type 2 Diabetes?

A

Exercise and Diet

Oral Hypoglycemic

Insulin if nothing else works

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19
Q

Type 2: Insulin resistance may lead to what symptoms?

A

Hypertension, hypercholesterolemia, abdominal obesity, and other abnormities

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20
Q

Functions of Insulin (6)

A

Transports and metabolizes glucose for energy

Stimulates storage of glucose in liver and muscle as glycogen

Signals the liver to stop release of glucose

Enhances storage of fat in adipose tissue

Accelerates transport of amino acids into cells

Inhibits the breakdown of stored glucose, protein, and fat

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21
Q

Unhooking your insulin pump means what for fat?

A

Cannot store fat, meaning you will be skinny

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22
Q

What are the risk factors for getting Type 1 Diabetes?

A

Early Onset, Familial, Genetic Predisposition, Possible immunologic or environmental (viral or toxins) factors

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23
Q

What are the risk factors for getting Type 2 Diabetes?

A

Obesity, age, previous identified impaired fasting glucose or impaired glucose tolerance.

Hypertension > 140/90 , HDL < 35, Triglycerides >250

History of Gestational Diabetes or babies over 9 lbs

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24
Q

Diabetes Signs and Symptoms: What are the “Three Ps”?

A

Polyuria (Urinate A lot), Polydipsia (Increase in thirst due to high suger in body, increasing osmolality in blood), Polyphagia (excessive hunger or increased appetite)

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25
Q

Diabetes Signs and Symptoms: What are signs and symptoms seen here?

A

Fatigue, weakness, vision changes, tingling, or numbness in hands or feet, dry feet, skin lesions or wounds slow to heal, recurrent infections

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26
Q

Diabetes Signs and Symptoms: Why is there an increased risk of slow wound healing and recurrent infections?

A
  1. Increased RF Atherosclerosis because cannot metabolize fat and decreases blood flow to peripheries.
  2. Bacteria doesn’t die because it has good nutrient source
  3. Low protein = low wound healing.
  4. Wound site releases signal to WBC. Chemical not released here, and not concentrated at the wound bed to heal
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27
Q

Diabetes Signs and Symptoms: Specific signs for Type 1 Diabetes

A

Sudden weight loss, N/V, Abdominal Pain if DKA developed

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28
Q

Type 1: What is Diabeetic Ketoacidosis?

A

Since theres no insulin to carry food , and to carry the glucose across the membrane. It starts to breakdown muscle and fat as a means of energy,, resulting in ketone bodies being formed causing patient to become acidotic.

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29
Q

Diabetes: Fasting blood glucose is what?

A

126 mg/dL or more

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30
Q

Diabetes: Random glucose exceeding what?

A

200 mg/dL

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31
Q

Diabetes: A1-C (gluco-sided hemoglobin, blood test done every 3-4 months) greater than 7% tells what?

A

How well glucose was controlled over last 3-4 months

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32
Q

Diabetes: Urine glucose and ketone levels (don’t want to see high amount of ketone)- monitor for

A

DKA

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33
Q

Diabetes: Uriene tests monitor what?

A

Kidney Function

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34
Q

Diabetes: Serum Cholesterol monitored due to

A

the effect on lipid metabolism can cause hyperlipidemia increasing cardiovascular risks

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35
Q

Diabetes: Serum electrolytes monitored because

A

serum osmolality in the blood can be changed

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36
Q

Diabees Mellitus - Assessment: One of the major roles of nurses in diabetic management is

A

education of the diabetic patient

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37
Q

Diabees Mellitus - Assessment: Nursing care and educational plans for the diabetic patient need to be individualized based on…

A

Type of Diabetes

Length since diagnosis and prior knowledge

Patients individual health and socioeconomic circumstances

Are they able to recognize hyper and hypoglycemia

DO they have symptoms of complications

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38
Q

Type 1 Diabetes: What is the Dawn Phenomenon?

A

Wake up with high blood sugars without a preceding low. Not enough insulin on board to tell liver to not release glucose.

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39
Q

Type 1 Diabetes: What is the Somogyi Effect?

A

Blood sugar drops low in night due to too much bedtime insulin or to small of bedtime snack and the body responds with an increase in glucose release cauing high morning blood sugar

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40
Q

Type 1 Diabetes: Dawn Phenomenon is treated how?

A

With Insulin

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41
Q

Type 1 Diabetes: How is Somogyi Effect treated?

A

Giving them a bedtime snack so they don’t have that low.

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42
Q

Type 1 Diabetes: How to determine whether individual has Dawn Phenomenon or Somogyi Effect?

A

Have them set an alarm in the middle of the night to check their glucose. If low at 1am, it means its Somogyi.

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43
Q

Diagnosis of patients with Diabetes

A

Imbalanced Nutrition (Cannot carry glucose across cell and metabolize it)

Risk of Impaired Skin Integrity (Wounds don’t heal/ increased blood osmolality)

Deficient Knowledge (Don’t know how to care for it/ A1-C)

Risk for Infection (WBC cannot concentrate)

Risk for Injury

Sexual Dysfunction

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44
Q

Main treatment goal of those with diabetes?

A

Maintain normal blood glucose levels (Hgb A1C <7%)

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45
Q

Diabetes Treatment Goal: What is Intensive Control?

A

3-4 Insulin injections per day, or continuous subcutaneous insulin infusion via insulin pump therapy plus frequent blood glucose monitoring, weeakly contacts with diabetic educations,

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46
Q

Diabetes Treatment Goal: Intensive Control causes there to be a decreased development and progression of complications such as

A

retinopathy (damage to small blood vessels that nourish the retina), nephropathy (damage to kidney cells) and neuropathy (damage to nerve cells)

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47
Q

Diabetes Treatment Goal: What do you want to prevent?

A

Complications, hypo and hyperglycemic episodes

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48
Q

Major Goals for Diabetes include

A

improved nutritional status, maintenance of skin integrity (foot care because furthest from heart and with neuropathy because they don’t notice wounds. ), ability to perform basic diabetes self-care skills, as well as preventive care for the avoidance of chronic complications of diabetes

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49
Q

Planning the Care of the patient with diabetes: What should the patient focus on doing?

A

Good glucose control

Weight management

Skin Care

Foot Care

Preventing Complications (lowering lipids, taking an statin every day)

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50
Q

Planning the Care of the patient with diabetes: What is a useful way to check their feet in the morning?

A

Place a mirror under the bed to check underneath

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51
Q

Planning the Care of the patient with diabetes: If buying new shoes, when should they buy them?

A

Late in teh day, because the shoes are already swollen

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52
Q

What are all the difference categories that can be used to treat blood glucose?

A

Nutrition Therapy

Exercise

Monitoring (Check blood glucose, check eyes, if ketones are present)

Pharmacologic Therapy

Education

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53
Q

Self Monitoring of Blood Glucose: Test blood when?

A

AC and HS

AC = Before meals and HS = At bedtime,

Meaning four checks will occur and record the results

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54
Q

Self Monitoring of Blood Glucose: Analyzing the Results includes what?

A

Am i running high in the morning?

Am i running low before bed?

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55
Q

Self Monitoring of Blood Glucose: If blood glucose looks good before bed but running a high A1c, physicians can order

A

P. Blood Sugars which will take blood sugar 2 hours after they eat to see if they have enough insulin to cover teh carbohydrates that they eat

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56
Q

Self Monitoring of Blood Glucose: WHat is the target glucose level that should be monitored?

A

80-120

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57
Q

Self Monitoring of Blood Glucose: Physician should be called when?

A

When readings are out of range

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58
Q

Self Monitoring of Blood Glucose: When would Urine Testing for DKA happen?

A

When blood sugar is over 240 do a ketone stick to see if ketones or glucose is in the urine.

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59
Q

Self Monitoring of Blood Glucose: Urine testing and ketones with blood sugar greater than 240 means what?

A

Patient does not have enough insulin in their body

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60
Q

Nutritional Goals: what is the first thing that should be focused on here?

A

Maintain the pleasure of eating, include personal and cultural preferences

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61
Q

NutritionalGoals: Promotion of what should occur?

A

Exercise and Activity

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62
Q

NutritionalGoals: Achieve and maintain a BMI of

A

<25

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63
Q

NutritionalGoals: Should try to prevent and decrease what?

A

Wide fluctuations of blood glucose levels and decrease serum lipids if elevated

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64
Q

NutritionalGoals: How many calories should be had?

A

1800 calorie American Diabetes Association diet (Right carbohydrate, protein, fat ratio, and avoiding concentrated sweets)

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65
Q

NutritionalGoals: Glycemic Index should be taught because it teaches

A

how quickly a food increases the glucose level after you’ve eaten it. Want to eat low glycemic foods (those without refined sugars) because blood sugar does not spike

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66
Q

NutritionalGoals: What decreases the rise of glucose?

A

Fiber and protein decrease the rise of blodo sugars

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67
Q

Nutritional Goals & Meal Planning: Understand that their diet needs to have what?

A

High fiber, low fat, and no concentrated sweets

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68
Q

Nutritional Goals & Meal Planning: Can they have alcohol?

A

Make sure they consume light beer to help with lipid levels and stay away from sweetened drinks

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69
Q

Nutritional Goals & Meal Planning: Is it okay to have artifical sweeteners

A

Beware that some are very hard on the kidney and can have some side effects

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70
Q

Nutritional Goals & Meal Planning: Sugar free products can cause what side effects

A

Diarrhea , and increased gas production

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71
Q

Nutritional Goals & Meal Planning: Diabetic population is taught to do what in order to determine how much insulin to give?

A

Count carbohydrates eaten in a meal.

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72
Q

Nutritional Goals & Glycemic Index: What slows absoprtion and glycemic response?

A

Combining starchy foods with protein and fat

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73
Q

Nutritional Goals & Glycemic Index: What tends to have a lower response than cooked, chopped, or pureed foods?

A

Raw or whole foods

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74
Q

Nutritional Goals & Glycemic Index: Eat whole foods rather than juices because it does what?

A

Decreases glycemic response because of fiber (slowing absorption)

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75
Q

Nutritional Goals & Glycemic Index: Adding foods with sugar may produce what response?

A

Lower response if eaten with foods that are more slowly absobred

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76
Q

Nutritional Goals & Glycemic Index: What slows the absorption of glucose the most?

A

Fiber

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77
Q

Benefits of Exercise and Diabetes?

A

Lowers Blood Sugar (By using glucose)

Aids in weight loss (helps those who are type 2)

Lowers cardiovascular risk

Reduces insulin resistance (Cell membranes are resistant to insulin, but exercise makes it easier for insulin to carry glucose across the cell membrane)

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78
Q

Exercise Precautions: Do not exercise when?

A

Blood sugars elevated above 250 mg/dL and ketones present in urine

If ketones present, it means that body is already broken down fat and protein to accomdate for energy needs

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79
Q

Exercise Precautions: If exercising to control or reduce weight, what must be done?

A

Insulin must be adjusted

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80
Q

Exercise Precautions: Insulin normally decreases with exercise, meaning patietns on a exogenous insulin should eat how many carbs and when?

A

15 g carb snack before moderate exercise to prevent hypoglycemia

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81
Q

Exercise Precautions: There is a risk for potential postexercise

A

hypoglycemia . They’ve burned off all of their glucose.

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82
Q

Exercise Precautions: Need to continue to monitor…

A

blood glucose levels

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83
Q

Insulin Therapy: Categories of Insulin?

A

Rapid Acting (3 mins)

Short Acting (5-10 mins)

Intermediate Acting

Very Long Acting

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84
Q

Insulin Therapy: Insulin pumps only use what type of insulin?

A

Rapid Acting

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85
Q

Insulin Therapy: Sliding scales means that

A

physician will look at their glucose level and then that will determine how much they will recieve.

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86
Q

Insulin Therapy: Make sure you store insulin in a location that does not ave

A

a lot of heat, because its protein based and will break down insulin

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87
Q

Insulin Therapy: Insulin stored long term should be kept where

A

Refridgerator

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88
Q

Insulin Therapy: Mixing insulin, clear to cloudy meaning what is pulled first?

A

Fast accting first and then intermediate acting.

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89
Q

Insulin Therapy: If at a restaurant, when should they give their insulin?

A

Giv rapid acting right when the food appears in front of them

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90
Q

Insulin Therapy: Make sure rotating sites because

A

to prevent the buildup of scar tissue which decreases absorption.

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91
Q

Rapid Acting Drugs?

A

Lispro, Aspart (NovoLog) and Glulisine (Apidra)

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92
Q

Rapid Acting, Lispro: Onset?

A

0.25 hours

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93
Q

Rapid Acting, Lispro:Peak?

A

1-1.5 hours

94
Q

Rapid Acting, Lispro: Duration?

A

3-4 hours

95
Q

Rapid Acting, Aspart (NovoLog): Onset?

A

0.25 hours

96
Q

Rapid Acting, Aspart (NovoLog): Peak?

A

40-50 minutes

97
Q

Rapid Acting, Aspart (NovoLog): Duration?

A

3-5 hours

98
Q

Rapid Acting, Glulisine (Apidra): Onset?

A

0.25 hours

99
Q

Rapid Acting, Glulisine (Apidra): Peak?

A

1-1.5 hours

100
Q

Rapid Acting, Glulisine (Apidra): Duration?

A

3-5 hours

101
Q

Short Acting Drugs?

A

Regular (Novolin-R, Humulin-R)

102
Q

Short Acting, Regular (Novolin-R, Humulin-R): Onset

A

0.5-1 hour

103
Q

Short Acting, Regular (Novolin-R, Humulin-R): Peak?

A

2-3 hours

104
Q

Short Acting, Regular (Novolin-R, Humulin-R): Duration?

A

4-6 hours

105
Q

Intermediate Acting Drugs?

A

NPH (Humulin (N) NPH), Detemir (Levemir)

106
Q

Intermediate Acting, NPH (Humulin (N) NPH): Onset?

A

2 Hours

107
Q

Intermediate Acting, NPH (Humulin (N) NPH): Peak?

A

6-8 hours

108
Q

Intermediate Acting, NPH (Humulin (N) NPH): Duration?

A

12-16 hours

109
Q

Intermediate Acting, Detemir (Levemir): Onset?

A

Not defined

110
Q

Intermediate Acting, Detemir (Levemir): Peak?

A

Not defined

111
Q

Intermediate Acting, Detemir (Levemir): Duration?

A

17-24 hours

112
Q

Long Acting Drugs?

A

Glargine (Lantus)

113
Q

Long Acting, Glargine (Lantus): Onset?

A

Not dfined

114
Q

Long Acting, Glargine (Lantus): Peak?

A

Not defined

115
Q

Duration?

A

24 hours

116
Q

Combination Drugs

A

Humulin 50/50

Humulin 70/30

Novolin 70/30

117
Q

Combination, Humulin 50/50: Onset?

A

0.5 hours

118
Q

Combination, Humulin 50/50: Peak?

A

3 hours

119
Q

Combination, Humulin 50/50: Duration?

A

22-24 hours

120
Q

Combination, Humulin 70/30: Onset?

A

0.5 hours

121
Q

Combination, Humulin 70/30: Peak?

A

4-8 hours

122
Q

Combination, Humulin 70/30: Duration?

A

24 hours

123
Q

Combination, Novolin 70/30: Onset?

A

0.5 hours

124
Q

Combination, Novolin 70/30: Peak?

A

4-8 hours

125
Q

Combination, Novolin 70/30: Duration?

A

24 hours

126
Q

When is Oral Antidiaetic Agents used??

A

For patients with type 2 diabetes who require more than diet and exercise alone.

some stimulate pancrease to produce more insulin, cause liver to release les glucose, or make it easier to move glucose.

127
Q

Oral Antidiabetic Agents: Combination of what may be used?

A

Oral drugs

128
Q

Oral Antidiabetic Agents: Major side effect?

A

Hypoglycemia

129
Q

Oral Antidiabetic Agents: Nursing intervention?

A

Monitor blood glucose for hypoglycemia and other potential side effects

130
Q

Oral Antidiabetic Agents: Need to follow what sort of plan?

A

Weight loss plan

131
Q

Sick Day Management: What is required here in terms of insulin?

A

Increased need for insulin or at minimum continue same regimen even if food intake is less

132
Q

Sick Day Management: Hyperglycemia can occur from

A

stress or illness

133
Q

Sick Day Management: Call the doctor if

A

ketones present, unable to eat for 24 hours, or vomiting or diarrhea for 6 hours

134
Q

Acute Complications of Hyperglycemia Diabetes?

A

DKA and HHS (When no ketones present, but hyperosmolality present)

135
Q

Chronic Complications of Hyperglycemia Diabetes?

A

Neuropathy (Neurological damage, pain in feet and hands or numbness here.)

Vascular in a macro or micro sense. (Peripheral damage or kidney damage or blindness)

Result of endothelial inflammation and thickening

136
Q

Hypoglycemia: What is htis?

A

Abnormally low blood glucose levels (below 50-60). Means too much insulin or oral hypoglycemic agents, excessive physical activity, or not enough food

137
Q

Hypoglycemia: Adrenergic Symptoms?

A

Sweating, tremors, tachycardia, palpitations, nervousness, hunger

138
Q

Hypoglycemia: Central Nervous System Symptoms?

A

Inability to concentrate, headache, confusion, memory lapses, slurred speech, drowsiness, change in personality

139
Q

Hypoglycemia: Severe Hypoglycemia signs are

A

Disorientation, Seizures, Loss of Consciousness, Death

140
Q

Hypoglycemia & Assessment: Onset occurs how quickly?

A

Abrupt and may be unexpected

141
Q

Hypoglycemia & Assessment: Symptoms in people?

A

Vary from person to person

142
Q

Hypoglycemia & Assessment: Symptoms may be related to what?

A

Rapid decrease in blodo glucose and usual blood glucose range

143
Q

Hypoglycemia & Assessment: Decreased adrenergic response may affect symptoms in persons who have had

A

diabetes for many years probably related to autonomic neuropathy

144
Q

Hypoglycemia and Treatment: What should be done first?

A

Give 15 g of fast-acting, concentrated cabohydrate.

145
Q

Hypoglycemia and Treatment: Examples of fast-acting, concentrated carbohydrates include…

A

3-4 glucose tablets

4-6 oz of juice or regular soda

6-10 candies(skittles)

2-3 tsp of honey

146
Q

Hypoglycemia and Treatment: Retest blood glucose after how long of a wait?

A

15 minutes , and retreat if <70 or if symptoms persistent more than 10-15 mins and testing not possible

147
Q

Hypoglycemia and Treatment: Provide a snack with protein and cabohydrate unlesss patient plans to

A

eat a meal within 30-60 minutes

148
Q

Hypoglycemia and Emergency Measures: If patient cannot swallow or is unconscious.. what is given?

A

Subcutaneous or intramuscular glucagon (1mg) , should be carried as emergency medication

25-50 mL of 50% dextrose solution IV; very viscious and hard to push, used in hospitals.

Cake icing placed on cheek can be absorbed and raise the blood sugar.

149
Q

Long-Term Complcations of Diabetes: Macrovascular Effects?

A

Accelerated Atherosclerotic Changes, Coronary Artery Disease, Cerebrovascular Disease and Peripheral Vascular Disease

150
Q

Long-Term Complcations of Diabetes: Microvascular Effects?

A

Diabetic Retinopathy and Nephropathy

151
Q

Long-Term Complcations of Diabetes: Neuropathic Effects?

A

Peripheral Neuropathy, Autonomic Neuropathies, Hypoglycemic Unawareness, Neuropathy, Sexual Dysfunction

152
Q

What is Self-Monitoring of Blood Glucose?

A

A method of capillary blood glucose testing in which the patient pricks their finger and applies a drop of blood to a test strip that is read by a meter

153
Q

Insulin Pens: How much do these hold?

A

150-300 units

154
Q

Insulin Pens: These are most useful for which type of patient?

A

Patients who need to inject only one type of insulin at a time. Those who also administer right before eating

155
Q

Insulin Pens: What are Jet Injectors?

A

Delivers insulin through the skin under pressure in an extremly fine stream

156
Q

Insulin Pumps: Patient inserts needle where?

A

Needle or catheter into subcutaneous tissue and secures it with tape or transparent dressing

157
Q

Insulin Pumps: Insulin delievered at a basal rate of what?

A

0.025 - 2 units per hour

158
Q

Insulin Pumps: When patient eats a meal, they calculate what?

A

They count the number of carbohydrates for the meal using a predetermined insulin -to - carbohydrate ratio

159
Q

Insulin Pumps: You use 1 unit of insulin for how much carbohydrates?

A

15 grams

160
Q

Selecting Syringes: 1 mL syringe holds how much?

A

100 unit capacity

161
Q

Selecting Syringes: 0.5 mL syringe holds how much insulin?

A

50 unit capacity

162
Q

Selecting Syringes: 0.3 mL syringe holds how much insulin?

A

30 unit

163
Q

Mixing Insulins: Special thing to do with long actinb insulin?

A

It must be mixed throughly before drawing into the syringe

164
Q

Injecting Insulins: Speed of insulin is absorbed fastest in what site?

A

Greatest in abdomen

165
Q

Type 1: General description of this?

A

Acute onset, occurs in patients genetically susceptible to type 1 diabetes , a triggering event such as a viral infection.

166
Q

Type 1: A viral infection causes production of autoantibodies which does what?

A

Kills the beta cells in the pancreas. Leading to decline in and ultimate lack of insulin secretion

167
Q

Type 1: What is Insulin Deficiency, and leads to what?

A

When more than 90% of the beta cells have been destroyed and lead to hyperglycemia, enhanced lipolysis, and protein catabolism

168
Q

Type 2: General description of this?

A

Slow progressive onset, chronic disease caused by one or more factors

169
Q

Type 2: What factors can cause this?

A

Impaired insulin production, inappropriate hepatic glucose production, or peripheral insulin receptor insensitivity

170
Q

Complications of Diabetes come from ?

A

Endothelial inflammation caused by increase in glucose levels and result in thickening of the enothelial lining of vascular and neuropathic structures

171
Q

Both Type 1 and 2 alters what?

A

CHO, Protein, and Fat Metabolism

172
Q

Functions of Insulin?

A

Transport and metabolize glucose for energy

Stimulates sotrage of glucose in the liver and muscles as glycogen

Singals liver to stop release of glucose

Enhances storage of fat in adipose tissue

Accelerates transport of amino acids into cells

Inhibits breakdown of stored glucose, protein, and fat

173
Q

Prevention of Diabetes?

A

Maintain healthy weight

Exercise

MAintain tight glucose control to prevent complications

ASA to prevent cardiovascular risks

174
Q

Type 1 Risk Factors?

A

Genetic disposition

Viral Infection

175
Q

Type 2 Risk Factors?

A

Obesity, Age, Hypertension, Hyperlipidemia, Gestational Diabetes

176
Q

Diabetes Labs and Diagnostics: Fasting glucose would be

A

126 or more

177
Q

Diabetes Labs and Diagnostics: Random glucose would be

A

> 200

178
Q

Diabetes Labs and Diagnostics: What would A1C levels be?

A

> 7% in last 3-4 months of glucose levels

179
Q

Diabetes Labs and Diagnostics: Why is urine glucose and ketone levels monitored?

A

To monitor for DKA

180
Q

Diabetes Labs and Diagnostics: Why are Urine tests conducted?

A

Monitor kidney function

181
Q

Diabetes Labs and Diagnostics: Why is serum cholesterol evaluated?

A

to determine Decreases of lipid metabolism, and risk of cardiovascular disease

182
Q

Complications of Diabetes?

A

Cardiovascular Disease

Nephropathhy

Retinopathy

Neuropathy

Ketoacidosis and Hyperosmolar Coma

Infections

Hypoglycemic Coma

183
Q

Hypoglycemia: Range for this?

A

Below 50-60 mg/dL

184
Q

Hypoglycemia: How does the onset appear?

A

Abrupt and can e unexpected

185
Q

Hypoglycemia: Causes iof this?

A

Too much insulin
Not Enough Food

Excessive physical exercise of stress

186
Q

Hypoglycemia: Signs and Symptoms?

A

Sweating and Cool To Touch

Tremors

Tachycardia and Palpatations

Nervousness and Inability to Concentrate

Hunger

headache and Confsusion

Slurred Speech

Drowsiness

187
Q

Hypoglycemia: Severe hypoglycemia signs and symptoms?

A

Seizures, loss of consciousness, death

188
Q

Hypoglycemia: What would you do to treat this?

A

Give 15 g of fast acting, concentrated carbohydrate

189
Q

Hypoglycemia: What does 15 g of fast acting, concentrated carbohydrate look like?

A

3-4 glucose tabs, 6-10 skittle candies, and 2-3 tsp honey

190
Q

Hypoglycemia: What to do after patient given the 15 g of carbohydrates?

A

Retest BG in 15 minutes, and retreat if less than 70 or if symptoms persist for more than 10-15 minutes after txx.

191
Q

Hypoglycemia: Once glucose is WINL, give what?

A

Give protein snack unless patient is eating a meal within 30-60 minutes

192
Q

Hypoglycemia: What to do if patient is unconscious or cannot swallow?

A

Sq or IM Glucagon (1mg) or 25-50 mL of 50% dextrose IV

193
Q

Diabetes Assessment: What should we figure out from patient?

A

What type of diabetes

When diagnosed and knowledge of care

Socioeconomic status

General health

194
Q

Diabetes Assessment: What should patient recognize as hyperglycemia?

A

hot and dry sugar hgih

195
Q

Diabetes Assessment: What should patient recognize as hypoglycemia?

A

Cold and clammy needs some candy

196
Q

Diabetes Assessment: Three P’s of Diabetes?

A

Polyuria, Polydipsia, and Polyphagia

197
Q

Diabetes Assessment: Signs and Symptoms od Diabetes?

A

Fatigue and Weakness, Vision Changes, Tingling/Numbness/Burning in feet and hands, Dry Skin and Wounds that won’t heal

198
Q

Diabetes Assessment: Signs specific to Type 1 Diabetes?

A

Sudden weight loss, N/V, Abdominal pain/fruity breath with DKA

199
Q

Diabetes Diagnoses: What would these be?

A

Impaired nutrition

RF Impaired Skin Integrity

Deficient Knowledge

RF Infection

RF Injury

Sexual Dysfunction

200
Q

Goals and Planning for Diabetes?

A

Tight control of blood glucose levels

BMI below 25

Foot and Skin Care

Frequent blood glucose monitoring (fasting, AC, HS)

201
Q

Diabetes Interventions: What does treatment include?

A

Nutrition Therapy - 1800 cal ADA

Exercise

Frequent BG Monitoring

Pharmocologic Therapy

Education

202
Q

Diabetes Interventions: What two specific things do you lok for?

A

Dawn Phenomenon

Somogyi Effect

203
Q

Diabetes Interventions: What is the Dawn Phenomenon?

A

Wake up with high BG without a preceding low

204
Q

Diabetes Interventions: What is the Somogyi Effect?

A

Blood sugar drops low in the night due to too much bedtime insulin or too small of a bedtime snack, causing liver to release more glucose

205
Q

Diabetes Education: What should the patient focus on for home monitoring?

A

Monitor for DKA if BG above 240.

Look at Glucose and Ketones

206
Q

Diabetes Education: What does ketones in urine indicate?

A

Indicates that the patient does not have enough insulin

207
Q

Diabetes Education: How should insulin be stored?

A

Refrigerated if not used within 30 days

208
Q

Diabetes Education: What are some exercise precuations ?

A

DO not exercise if BG above 250 or ketones present

Eat 15 g carb snack before exercise

Monitor for post exercise hypoglycemia

209
Q

Diabetes Education: Sick Day Management includes what?

A

Hyperglycemia can occur from illness or stress -> Increased need for insulin

Increase fluid intake

210
Q

Diabetes Education: WIth sick day management, when should patient call doctor?

A

If ketones presenet, unable to eat for 24 hours, or Vomiting/diarrhea for 6 hours

211
Q

Diabetes Education: How many calories should come from carbohydrates?

A

50-60%

212
Q

Diabetes Education: How many calories should come from fat and protein?

A

Fat: 20-30%

Protein:: 10-20%

213
Q

Diabetes Education: How much fiber should you have daily?

A

25 g

214
Q

Diabetes Education: What is the Glycemic index?

A

How quickly a food elevates BG

215
Q

Diabetes Education: How to lower GI?

A

Combine starchy foods with proteins or fat

Raw or Whole Foods

Eat whole fruits rather than juices

216
Q

Diabetes Education: What does fiber do to glucose?

A

Slows absorption of glucose

217
Q

Medical Management of Diabetes: Ho to treat Type 1?

A

Insulin

218
Q

Medical Management of Diabetes: How to treat Type 2?

A

Inital tx is dietary changes and exercise.

Oral Hypoglycemic agents,

Insulin needed in some cases

219
Q

Medical Management of Diabetes: When is oral antidiabetic agents use?

A

Used for Type 2 diabetes when diet adn exercise were not effective

220
Q

Medical Management of Diabetes: Side effect of oral antidiabetic agents?

A

Hypoglycemia

221
Q

Medical Management of Diabetes: What do Pumps use?

A

Fast acting insulin-novolog or Humalog

222
Q

Medical Management of Diabetes: How often should you rorate insulin pump sites?

A

Every 3 days

223
Q

Medical Management of Diabetes: What are some rapid acting drugs

A

Lispro, Aspart (NovoLog), Glulisine (Apidra)

224
Q

Medical Management of Diabetes: What are short acting drugs?

A

Regular (Novolin-R)

225
Q

Medical Management of Diabetes: What are some intermediate acting drugs?

A

NPH, Detemir

226
Q

Medical Management of Diabetes: What are some long acting drugs?

A

Glargine

227
Q

Medical Management of Diabetes: Why are statins used?

A

To decrease leipid levels to prevent complications

228
Q

Medical Management of Diabetes: Why is ASA used?

A

lower cardiovascular risk

229
Q

When diet adanced to include liquids, patietns with diabetes recieve much more…

A

simple carbohydrate goods, such as juice and gelatin deserts

230
Q

Enteral Tube feeding formulas contain more of what?

A

Simple carbohydrates and less protein and fat than the typical meal plan for diabetes. REsults in increased levels of glucose

NRSG 110: Med Surg 2 (29 decks)

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