Exam 4 - DM Flashcards by Ashley Burkhalter

hypoglycemia is consider < ___

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severe/critical hypoglycemia is considered < ___

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hypoglycemia s/sx

confusion
irritability
diaphoresis
tremors
hunger
weakness
visual disturbances
tachycardia
eventual seizures

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hypoglycemia can mimic ___ ___

alcohol intoxication

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rule of 15 is applied when BGL is < ___

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Rule of 15

15-20 G of simple carb (4-6oz juice, soda, low fat milk; glucose gel, tablets)
recheck in 15 minutes; if still < 70 give another 15G of simple carb; reassess in 15 minutes

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when to call PCP or 911 during Rule of 15

no improvement after 2-3 doses of carb

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after BGL is above 70, give the pt a meal that contains ___ and recheck glucose in ___ minutes

protein (peanut butter, bread, cheese/crackers)

45 minutes

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which oral DM med class can cause hypoglycemia

sulfonylureas

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unconscious pt with hypoglycemia should be treated with

glucagon 1mg IM or SQ
Dextrose 20-50 mL IVP

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glucagon has a quicker response when administered in which muscle

deltoid

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pt positioning if unconscious during hypoglycemia

on their side to prevent possible aspiration

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gerontologic considerations regarding DM

decrease kidney function (higher risk for hypoglycemia)
inability to prepare foods
poor access to foods
visually impaired
higher glycemic target to prevent hypoglycemia
educate: s/sx; rule of 15

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DKA is caused by

profound deficiency of insulin

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DKA is characterized by

hyperglycemia
ketosis (acidosis)
dehydration (osmotic diuresis)

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daily and hourly UOP for osmotic diuresis

6 L/day
250 mL/hour

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DKA is more common in which type of diabetic

DM 1

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during DKA fat metabolism causes ___ leading to acidic blood; the breakdown of ___ causes excess ____.

ketones

muscle/protein/amino acids; glucose

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DKA acid base imbalance

metabolic acidosis

low pH; low bicarb

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daily and hourly UOP for polyuria

2-3 L/daily
80 mL/hour

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glucose levels rise causes further ___ ___ which can lead to ___

osmotic diuresis; shock

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DKA precipitating factor

illness, infection
inadequate insulin dosage
undx DM 1
poor self management/noncompliance
neglect

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s/sx of DKA

dehydration
lethargy to coma
weakness
abdominal pain, N/V
Kussmaul (rapid, shallow)
acetone breath
serum glucose >300-1000
+ ketones blood, urine
increase Crt, Hct, BUN

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is the severity of DKA r/t BGL

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what electrolyte level must you know before administering insulin

K+ insulin can cause hypokalemia

DKA management

ensure airway fluid resuscitation K+ replacement regular insulin drip

fluid resuscitation for DKA

1L NS/hourly cardiac hx or elderly: 1/2 NS 200-500 bolus

regular insulin drip rate

0.1 unit/kg/hour

IV tubing regarding insulin administration

discard the first 50 mL

once BGL reaches 300, what is done?

DC insulin administered D5W to prevent hypoglycemia

insulin to NS ratio

1:1 100 units in 100 mL 50 units in 50 mL

Hyperosmolar hyperglycemic syndrome (HHS) is d/t ___ ___

insulin resistance

HHS occurs commonly in which diabetics

DM 2 older adults (50-70s)

precipitating factors of HHS

infection: UTI, PNA, sepsis acute illness newly Dx DM2 impaired thirst sensation (dementia, PO intolerance)

does HHS have a high mortality rate?

Yes

BGL r/t HHS

600-1200

HHS s/sx

elevated BGL ketones absent, minimal in blood and urine dehydration hypotension tachycardia neurological manifestions --altered LOC, hallucinations, mimic a stroke, aphasia, mimic stroke s/sx

HHS treatment is similar to that of ___

DKA

how long will it take for HHS neuro changes to be corrected

several days

osmolality > ___ is risk for coma

340

3 possible causes of DM complications

nerve damage decreased elasticity in molecules decreased oxygenation

chronic vessel disease d/t hyperglycemia

angiopathy

leading cause of DM death is r/t

CVD, stroke

2 categories of DM complications

microvascular macrovascular

macrovascular complications

MI CAD CVA men 2x likely for MI; women are 3x more likely

microvascular complications

damage to small vessels retinopathy nephropathy

leading cause of blindness for ages 20-74

retinopathy

non-proliferative micro/retinopathy

partial occlusion micro aneurysms weak walls (retinal damage, hemorrhage) blurred vision, floaters

proliferative micro/retinopathy

most severe retina, vitreous humor neovascularization macular edema, hemorrhage results in blindness

what must be performed annually on DM pts

dilated eye exam by an opthalmologist

damage to the small blood vessels that supply the glomeruli of the kidneys

nephropathy leading cause of ESRD in the US

3 races with highest risk for dialysis

African Americans Asian Americans Hispanic Latios

nephropathy labs

microalbumin annually serum Crt 24 hour urine

nephropathy meds

agressive BP management ACE, ARB (renal protective)

most common type of neuropathy

peripheral loss of sensation in lower extremities increase risk for limb amputation

peripheral neuropathy sensation

burning, cramping, crushing, tearing usually worse at night

peripheral neuropathy meds

antidepressants anticonvulsants

type of neuropathy that affects nearly all body systems and leads to hypoglycemic unawareness, bowel incontinence, diarrhea, and urinary retention

autonomic

GI s/sx of autonomic neuropathy

gastroparesis (delayed gastric emptying) ---this can lead to hypoglycemia d/t delayed food absorption anorexia N/V GERD persistent feeling of fullness

autonomic neuropathy education

small frequent meals increased hydration exercise enema PRN bulk forming laxative

autonomic neuropathy meds

metoclopramide reglan given to stimulate peristalsis

Cardio s/sx of autonomic neuropathy

postural hypotension resting tachycardia painless MI

GU s/sx of autonomic neuropathy

neurogenic bladder (no urge to void) schedule toileting, bladder training recommended

Reproductive s/s of autonomic neuropathy

ED (men, women) nonspecific vaginitis inability to orgasm retrograde ejaculation: semen back flows into the bladder; will urinate out

most common cause of hospitalization in diabetics

foot, lower extremities ulceration

DM foot care

select proper footwear avoid injuries to feet practice diligent skin care inspect daily foot protection keep feet soft; talons trimmed --do not apply lotion between toes

psychosocial burdens of DM

depression anxiety hopelessness communicate: teach, reteach financial eating disorders: bulimia, purge (esp younger type 1 pts)

open insulin vials are only good for how long

1 month

DM target BP

140/90

HTN BP meds for DM

ACE (1st line) ARB

diet for BP/DM

DASH (dietary approach to stopping HTN) low salt, low fat, high fiber

lipid targets for DM

cholesterol < 200 triglycerides < 150

diabetics should participate in physical activity at least ___ times a week

% of carb, protein, and fat intake for DM

carbs: 50-60% protein: 20-30% fats: 10-20%

beer, wine, and liquor consumption for DM

12 oz beer (low carb) 5 oz wine 1 oz liquor (recommend to avoid d/t high sugar) 1/daily for women; 2/daily for men

Exam 4 - DM Flashcards

(75 cards)