Exam 4 Flashcards
How do we diagnose patients with diabetes?
An A1C level of 6.5% or higher
What are some symptoms of hypoglycemia?
- blood glucose <70
- cold clammy skin
- nervousness, tremors
- changes in vision
- hunger
- unsteady gait, slurred speech
- tachycardia
- faintness, dizziness
- seizures, coma
- emotional changes, headache
What is done for a conscious patient with hypoglycemia?
- give 15g of simple carbs
- wait 15min then check glucose again
- still <70? Repeat 15g of simple carbs
- repeat up to 3x
*if no improvement still? Go to hospital
What do you do with an unconscious patient with hypoglycemia or their hypoglycemia is getting worse?
- use glucagon paste
- in hospital, give IM glucagon OR glucose/dextrose in IV
- Turn patient on side to prevent aspiration
What are some examples of simple carbs?
4-6oz of soda, 5-8 lifesavers, 1tbsp of syrup or honey, 4 tsp of jelly, 4-6oz of orange juice, 2 tbsp of raisins, commercial dextrose products, 4-5 crackers
Symptoms of hyperglycemia include…
- Elevated blood glucose
- blurred vision
- increased urination
- N/V, abdominal cramps
- mood swings
- weakness, fatigue
- increased appetite to lack of appetite
- headache
Target organ damage can be a result of persistent hyperglycemia. What do you see?
- stroke
- hypertension
- kidney damage
- peripheral neuropathy
- peripheral vascular atherosclerosis
- vision changes
Screenings for eyes, kidneys, BP, etc need to be done for patients with hyperglycemia.
True
False
TRUE
- eye exams, creatinine, etc
How many grams of carbs is a diabetic patient supposed to be getting per day?
25g to 30g per day
*better if including dietary fiber
Where can fat intake for diabetic patients come from?
Olives, nuts, avocados, plants
*healthy fats. Minimize trans fat
Cholesterol - <200g per day
Protein intake is individualized per patient. What type of protein is preferred?
Lean protein
How much exercise should a client with diabetes get?
150 minutes/week
*moderate-intensity aerobic activity AND resistance training 3x/week
Type 1 diabetes patients need to delay activity if ….
Need to delay activity if glucose is <250 and ketones present in urine
How should a diabetic patient eat meals and activity?
- exercise 1 hour after meal OR
- have a 10-15g carb snack
- check glucose before exercise
*if long exercise time, carb snack every 30min while exercising
What is the first line treatment med for type 2 diabetes?
Metformin
Can a diabetic patient getting a test done with IV contrast still take their metformin?
NO!!!
*client needs to stop metformin 2 days before and after test
What is a major side effect of sulfonylureas (like glipizide, glyburide, -ide)???
Hypoglycemia
Once insulin is opened, how does it need to be stored?
In refrigerator but NOT a must
Foot care is important patient teaching for diabetic clients. What are some good care methods?
- wear diabetic socks and footwear that fit correctly
- skin and nail care
- daily inspection of feet
- diligent wound care for foot ulcers
*prompt treatment of small problems
Somgoyi effect is a problem with insulin therapy meaning…
High dose of insulin causing a decreased glucose during the night then elevated elevated in the morning
The problem with insulin therapy called the dawn phenomenon means…
Morning hyperglycemia present on awakening
The main risk factor of metabolic syndrome in diabetes is what?
Central/abdominal obesity
What two types of headache are usually caused by stress?
Tension and Cluster headaches
Sumatriptan is a medication for headaches. Clients with what conditions should not take this medication?
Hypertension, PVD, CAD, Stroke
What triggers should patients with headaches avoid??
Chocolate, cheese, hot dogs, gasoline smell, perfume smell
What is status epilepticus?
A seizure lasting five minutes or more OR recurrent seizures without time for recovery between.
Phenytoin, carbamazepine and divalproex are medications used to manage seizures. What is the number one patient teaching of these meds?
Adhere to your drug plan as closely as possible. Same time everyday. Not missing a dose.
*Tell any new provider about seizure meds
What seizure meds require frequent drug level checks?
Phenytoin and divalproex
What are the 10 warning signs of Alzheimer’s disease?
- memory loss that affects job skills
- difficulty performing familiar tasks
- problems with language
- disorientation to time and place
- poor or low judgment
- problems with abstract thinking
- misplacing things
- changes in mood or behavior
- changes in personality
- loss of initiative
Sundowning is a condition seen in Alzheimer’s. What is sundowning?
Sundowning is when a patient is more confused and agitated in the late afternoon or evening.
A priority and least invasive intervention for agitated and restless dementia patients is to….
Reorient or distract
What areas are affected by multiple sclerosis?
Vision, spinal cord, brain, mouth/speech, sense, muscles, urinary system, digestive system
In clients with multiple sclerosis, some patients are on meds to prevent flare ups.
True
False
TRUE
The diagnosis of Parkinson’s is done through the TRAP abbreviation and this stands for….
T - tremor
R - rigidity
A - akinesia
P - postural instability
Carbidopa/Levodopa is a med used in patients with Parkinson’s. How should clients take this med?
Take meds as directed
Symptoms of myasthenia gravis include…
- ptosis
- diplopia
- difficulty chewing, speaking, swallowing
- breathing
What is the onset of rapid acting insulin like lispro, aspart and glulisine?
10-30min
What is the onset of short acting insulin?
30min-1hr
What is the onset of intermediate acting insulin like NPH?
1.5hrs-4hrs
What is the onset of long acting insulin like Glargine, detemir, degludec?
48min-4hr
What is the onset of inhaled insulin like afrezza?
12-15min
What symptoms are common for type 1 diabetes?
Polydipsia
Polyuria
Polyphagia
The main symptom of kidney cancer is….
Painless hematuria
Patient teaching for patients with UTIs include….
- empty bladder regularly and completely
- evacuate bowel regularly
- wipe front to back
- adequate fluid intake
This type of headache can be treated with aspirin, acetaminophen, NSAID alone or combination with caffeine, sedative or muscle relaxant…
Tension headaches
What is the first line of therapy med to treat moderate to severe headaches like in migraines or cluster headaches?
Sumatriptan
Phenazopyridine is a urinary analgesic used in UTIs. What is an adr patients should watch out for?
azo dye stains urine reddish orange
Sodium polystyrene sulfonate and patiromer are used to treat early…..
Hyperkalemia
