[Exam 4] Chapter 51 - Diabetes Flashcards
Diabetes: What is this?
Group of metabolic diseases characterized by increased levels of glucose in blood
Diabetes: What can cause this to occur?
Defects in insulin secretion, insulin is not as effective anymore, or combination of both.
Diabetes: What are the different types?
Type 1 and Type 2
Diabetes: What does Type 1 involve?
Beta Cells in the pancreas are destroyed.
Diabetes: What can cause Type 1 DM?
Can be genetic or autoimmune related.
Diabetes: What happens when beta cells are desroyed?
Insulin production is reduced
Diabetes: What are Type 1 Diabetics treated with?
Insulin
Diabetes: What does insulin bind to?
REceptors on the cells and see an increase amount of glucose in the blood
Diabetes: What is basically occuring in Type 1 DM?
Body is not producing enough insulin to do its job
Diabetes: What is Type 2 DM?
Pancreas produces enough insulin, but cells aren’t responsive to insulin
Diabetes: What effect does insulin have on cells?
Is the key to cells. Opens it up so glucose can go from the blood into the cells; that is the energy.
Diabetes: insulin is secreted by what?
Beta cells in the pancreas
Diabetes: What is the purpose of glucose?
It gives energy to the muscle, liver, fat cells
Diabetes: What are some of the different actions of insulin?
Transport and metabolizes glucose for energy, stimulates storage of glucose in liver and muscle.
Tells liver to stop releasing glucose
Enhances storage of dietary fat and adipose tissue
Accelerates transport of amino acids into cells
Diabetes: Glucose is stored in the liver as what
Glycogen.
Diabetes: Insulin inhibits the breakdown of what
Stored glucose, protein, and fat. Important to know when body cannot get energy from glucose, it will start to break this down
Diabetes: What happens if the liver needs to release glycogen from liver?
Will go through glycogenolysis to become glucose. Amino acids can also be converted during this step to become glucose
Diabetes: Where does energy come from when someone is in DKA and body doesn’t have enough energy?
It’ll start breaking down fatty acids and goes through ketogenesis. Releases ketone bodies to be used for body, heart, and brain.
Diabetes: Insulin is basically what?
The key that opens up the pathway , opens the door for glucose to enter the cell.
Diabetes: Risk factors for diabetes?
Family Hx
Obesity
Hypertension
Elevated Triglyceride Levels
Diabetes: Diabetes is the leading cause of what?
Non-traumatic amputations
Blindness
ESRD
Diabetes: What is the difference between Type 1DM and Type 2 DM?
Type 1: Pancreas fails to produce insulin
Type 2: Cells fail to respond to insulin correctly
Diabetes: What is having Type 1 DM bad?
Since pancreas isn’t producing insulin, you have glucose floating around in bloodstream. Can’t get into cells
DKA: This only occurs with who?
Those with Type 1 DM
DKA: What occurs in DKA?
There is not enough insulin this results in hyperglycemia, dehydration, and electrolyte loss along with acidosis
DKA: What do kidneys do here?
they try to excrete the excess glucose , and that is why there is dehydration and electrolyte imbalance
DKA: Why does the body go into acidosis?
Because the body is trying to break down fats for energy causing ketone bodies which leads to acidosis.
DKA: Important for Diabetics to follow Sick Day Rules, which include what?
Take insulin as usual
Test glucose/ketones every 3-4 hours
Report elevated glucose
Take supplemental glucose ever 3-4 hours as needed
Sub soft foods if needed
Take liquids every 30- 1 hour to prevent dehydration
DKA: What are the three main causes of this?
Either decreased or missed doses of insulin
Illness/infection
Undiagnosed/untreated diabetes.
DKA: What happens when patients are sick and they don’t eat enough food?
It could throw them into DKA
DKA: How do you prevent this when sick?
Continue to take insulin
Check glucose levels/ketones every 3-4 hours
Be in contact with provider.
Sub foods for soft foods. Stick to meal plan.
DKA - CMs: What are the first three main ones we may see?
Polyuri, Polydipsia, Fatigue
DKA - CMs: What are some other signs that they may have?
Hypotension due to volume depletion
Acidotic
Fruity Breath
DKA - CMs: What GI symptoms may they have?
Anorexia, N/V, abdominal pain
DKA - CMs: What is the hallmark sign of this?
Fruity breath due to buildup of ketones
DKA - CMs: How will their respiration’s be?
Kussmaul Respirations (deep, rapid breathing). they are in metabolic acidosis and are trying to breathe off the CO2.
DKA - CMs: Mental status can vary how?
Some can be in coma, or some can be alert.
DKA - CMs: Assessment will focus on what?
The clinical manifestations. Assessing for dehydration, blood pressure, gi status, fruity breath, kuzzmal breathing.
DKA - Diagnostics: What will their glucose level be at?
300-800.
DKA - Diagnostics: How will their abg levels be?
In metabolic acidosis
Will have decreased bicarb. pH will be less than 7.35.
Respiratory system may try to compensate for this
DKA - Diagnostics: Urine test will reveal what?
Ketones present in the urine
DKA - Diagnostics: Albumin and creatinine will be what?
Will both be increased
DKA - Mx: What is the number one management way?
Rehydration. First start with normal saline.
DKA - Mx: What will first be given for dehydration?
A bolus on normal saline, around 0.5 - 1L / hr over 2/3 hours.
DKA - Mx: After the normal saline is given, what will then be given?
1/2 NS at 200-300 mL / hr. Have to keep an eye on glucose
DKA - Mx: Why do you have to keep an eye on glucose as you rehydrate an individual?
BEcause as the glucose continues to be brought down, the glucose level will need to be switched once below 300
DKA - Rehydration Mx: Once BS < 300, what will be given?
Will be switched to D5W and actually given a little bit of dextrose as well.
DKA - Rehydration Mx: What electrolyte will be a big concern?
Potassium. Will usually see elevated potassium and will start to go down because patient is receiving a lot of fluids and insulin. Shifts potassium into cell.
DKA - Rehydration Mx: What is a treatment of hyperkalemia?
Insulin
DKA - Rehydration Mx: So while potassium is being corrected, what else is being corrected?
Metabolic Acidosis through insulin
DKA - Mx: To ensure they are recovering, what must you do?
Get labs every 2-4 hours.
EKGs done more frequently.
Frequent monitoring.
DKA - Mx: Why is the patient acidotic?
Because of the ketone bodies that have accumulated related to fat breakdown for energy.
DKA - Mx: How will the patients acidosis be fixed?
Through Insulin IV drip. Will be getting glucose every hour.
DKA - Mx: We wont give bicarb to correct acidosis to DKA patients why?
Because it will eventually correct itself normally
DKA - Mx: When giving insulin, what must we keep in mind when we are hanging?
We must flush insulin because it tends to stick to the tubing. Make sure 50 mL are flushed through IV set because it will stick to tubing.
Nickname for Hyperglycemic Hyperosmolar Syndrome?
HHS
HHS: What is the official name of this?
Hyperglycemic Hyperosmolar Syndrome
HHS: Sometimes referred to as HH NKS, which is what?
Non-Ketonic Syndrome
HHS: This will typically affect what patient?
Those with Type 2 DM and older
HHS: This is usually initiated by what?
Illness that raises the demand for insulin
HHS: Why don’t you see acidosis with this?
Because there is not the ketosis that is going on. They still have insulin in circulation so they don’t develop acidosis.
HHS: They will have an increase in what?
blood sugar, which causes the kidneys to try to get rid of all this extra sugar/glucose and see osmotic diuresis
HHS: How long does this take to progress
This can progress over days to weeks
HHS - CMs: What changes will start to occur?
Decreased blood pressure (hypotension)
Dehydration (bc of diuresis)
Tachycardia
Mental status varies (seizures)
HHS - CMs: Decreased blood pressure and dehydration is coming from what
osmotic diuresis that happens because body is trying to get rid of excess glucose.
HHS - Assessments: You will be looking at what glucose level?
Looking at glucose level of 600 - 1200
HHS - Assessments: What will patient be assessed for?
Signs they are experiences so blood pressure and dehydration that matches with high glucose levels.
Elevated BUN / Creatinine.
HHS - Mx: What three things cna be done to manage this?
Fluid replacement
Electrolyte correction
Insulin
HHS - Mx: How long will this take to correct?
Usually 3-5 days, especially if theyre having AMS.
HHS - Mx: Why will insulin be given?
To help get their blood sugar down
Nursing Process - DKA and HHS: Assessment for both will focus on what?
Vital signs
Electrolytes
ABGs (DKA)
Mental status
Nursing Process - DKA and HHS: Nursing Diagnosis will be what?
Fluid Volume Deficit
Fluid and Electrolyte Imbalance (Elevated K+ before tx)
Knowledge Deficit
Anxiety
Fear
Nursing Process - DKA and HHS , Goals: You want to maintain what?
Fluid and electrolyte balance and having absence of complications
Self-CAre by decreasing anxiety.
Nursing Process - DKA and HHS , Nursing Interventions: THis will line up with what and be what?
Nursing Diagnosis.
Maintain fluid and electrolyte balance,
Education to manage anxiety and fear.
Nursing Process - DKA and HHS , Nursing Interventions: We should make sure to evaluate what?
Patient outcomes for our goals such as fluid and electrolyte balance and self care.
Long-Term Comps of Diabetes: These can be split into what categories?
Macrovascular
Microvascular
Long-Term Comps of Diabetes: Macrovascular changes include what?
Changes to medium/large blood vessels (Heart, Brain)
Long-Term Comps of Diabetes: What are some diseases that can occur on macrovascular side?
CAD, Peripheral Vascular Disease, Cerebral Vascular Disease.
Long-Term Comps of Diabetes: What is one of the bigest changes we can do for macrovascular changes?
Reduce risk factors , teach patients nutrition, exercise, smoking cessations, control blood pressure.
Long-Term Comps of Diabetes: What event may occur on a macrovascular scale?
May see a stroke occur because large blood vessels were affected
Long-Term Comps of Diabetes: Microvascular refers to what?
More of the capillary basement membrane thickening. Can see it happen with retina and kidney
Long-Term Comps of Diabetes: What diseases occur on a microvascular scale?
Diabetic retinopathy and nephropathy
Long-Term Comps of Diabetes: What occurs in diabetic retinopathy?
You have small blood vessels in the retina that begin to change. Causes vision changes.
Long-Term Comps of Diabetes: What occurs in nephropathy?
Occurs when theres increased glucose levels which causes increased stress in kidney filtration allowing blood protein to leak into urine. Increases pressure and can lead to CKD, ESKD.
Long-Term Comps of Diabetes: Why do those with uncontrolled diabetes end up with kidney problems?
Because of the increased strain that glucose causes on the kidneys
Long-Term Comps of Diabetes - Diabetic Neuropathies: What categories can this include?
Peripheral Neuropathy
Autonomic Neuropathies
Long-Term Comps of Diabetes - Diabetic Neuropathies: What is this?
Group of diseases that affects all types of nerves.
Long-Term Comps of Diabetes - Diabetic Neuropathies: What is the cause of this?
Can be due to increased glucose over years. Specific cause hasn’t been determined.
Long-Term Comps of Diabetes - Diabetic Neuropathies: What is peripheral neuropathy?
Affects the peripheral portion of the nerves in the lower extremity
Long-Term Comps of Diabetes - Diabetic Neuropathies: What will the patient usually describe with peripheral neuropathy?
Tingling, burning sensation
Decreased sensation
Long-Term Comps of Diabetes - Diabetic Neuropathies: These patients are at big risk for what?
Injury
May have a foot injury that may be unnoticed. Can lead to further complications
Long-Term Comps of Diabetes - Diabetic Neuropathies: What is the best management that can be given to these patients?
Educate on how to control glucose levels, pain management
Long-Term Comps of Diabetes - Diabetic Neuropathies: What is often given for pain?
Gabapentins, because of tingling and burning sensatiosn can be unbearable.
Long-Term Comps of Diabetes - Diabetic Neuropathies: What are Autonomic Neuropathies?
DEals with cardiac, GI, Renal systems.
Long-Term Comps of Diabetes - Diabetic Neuropathies: What problems may those with autonomic neuropathies have?
Silent Ischemia -> MI,
GI -> Delayed gastric emptying
Renal - Urinary Retention
Long-Term Comps of Diabetes - Foot/Leg Probs: When you think of these patients, you think they are having what type of problems?
Some type of ulcers on the foot, or they star to have amputations and lose toes. Can start to go farther up the leg.
Long-Term Comps of Diabetes - Foot/Leg Probs: It is important that these patients are taught what?
Foot care tips
Long-Term Comps of Diabetes - Foot/Leg Probs: What foot care tips may be given?
Take care of DM
Inspect/wash feet daily
Keep skin soft/smooth
Smooth corns and calluses gently
Wear shoes and socks at all times
Protect feet from hold/cold
Keep blood flowing to feet (put feet up when sitting)
Consult with primary provider
