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M/S 2 > Exam 4 - DM > Flashcards

Exam 4 - DM Flashcards

1
Q

hypoglycemia is consider < ___

A

70

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2
Q

severe/critical hypoglycemia is considered < ___

A

40

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3
Q

hypoglycemia s/sx

A

confusion
irritability
diaphoresis
tremors
hunger
weakness
visual disturbances
tachycardia
eventual seizures

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4
Q

hypoglycemia can mimic ___ ___

A

alcohol intoxication

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5
Q

rule of 15 is applied when BGL is < ___

A

70

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6
Q

Rule of 15

A

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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7
Q

when to call PCP or 911 during Rule of 15

A

no improvement after 2-3 doses of carb

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8
Q

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

A

protein (peanut butter, bread, cheese/crackers)

45 minutes

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9
Q

which oral DM med class can cause hypoglycemia

A

sulfonylureas

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10
Q

unconscious pt with hypoglycemia should be treated with

A

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

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11
Q

glucagon has a quicker response when administered in which muscle

A

deltoid

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12
Q

pt positioning if unconscious during hypoglycemia

A

on their side to prevent possible aspiration

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13
Q

gerontologic considerations regarding DM

A

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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14
Q

DKA is caused by

A

profound deficiency of insulin

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15
Q

DKA is characterized by

A

hyperglycemia
ketosis (acidosis)
dehydration (osmotic diuresis)

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16
Q

daily and hourly UOP for osmotic diuresis

A

6 L/day
250 mL/hour

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17
Q

DKA is more common in which type of diabetic

A

DM 1

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18
Q

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

A

ketones

muscle/protein/amino acids; glucose

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19
Q

DKA acid base imbalance

A

metabolic acidosis

low pH; low bicarb

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20
Q

daily and hourly UOP for polyuria

A

2-3 L/daily
80 mL/hour

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21
Q

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

A

osmotic diuresis; shock

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22
Q

DKA precipitating factor

A

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

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23
Q

s/sx of DKA

A

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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24
Q

is the severity of DKA r/t BGL

A

No

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25
Q

what electrolyte level must you know before administering insulin

A

K+

insulin can cause hypokalemia

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26
Q

DKA management

A

ensure airway
fluid resuscitation
K+ replacement
regular insulin drip

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27
Q

fluid resuscitation for DKA

A

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

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28
Q

regular insulin drip rate

A

0.1 unit/kg/hour

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29
Q

IV tubing regarding insulin administration

A

discard the first 50 mL

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30
Q

once BGL reaches 300, what is done?

A

DC insulin
administered D5W to prevent hypoglycemia

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31
Q

insulin to NS ratio

A

1:1

100 units in 100 mL
50 units in 50 mL

32
Q

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

A

insulin resistance

33
Q

HHS occurs commonly in which diabetics

A

DM 2
older adults (50-70s)

34
Q

precipitating factors of HHS

A

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

35
Q

does HHS have a high mortality rate?

A

Yes

36
Q

BGL r/t HHS

A

600-1200

37
Q

HHS s/sx

A

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

38
Q

HHS treatment is similar to that of ___

A

DKA

39
Q

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

A

several days

40
Q

osmolality > ___ is risk for coma

A

340

41
Q

3 possible causes of DM complications

A

nerve damage
decreased elasticity in molecules
decreased oxygenation

42
Q

chronic vessel disease d/t hyperglycemia

A

angiopathy

43
Q

leading cause of DM death is r/t

A

CVD, stroke

44
Q

2 categories of DM complications

A

microvascular
macrovascular

45
Q

macrovascular complications

A

MI
CAD
CVA

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

46
Q

microvascular complications

A

damage to small vessels

retinopathy
nephropathy

47
Q

leading cause of blindness for ages 20-74

A

retinopathy

48
Q

non-proliferative micro/retinopathy

A

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

blurred vision, floaters

49
Q

proliferative micro/retinopathy

A

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

50
Q

what must be performed annually on DM pts

A

dilated eye exam by an opthalmologist

51
Q

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

A

nephropathy

leading cause of ESRD in the US

52
Q

3 races with highest risk for dialysis

A

African Americans
Asian Americans
Hispanic Latios

53
Q

nephropathy labs

A

microalbumin annually
serum Crt
24 hour urine

54
Q

nephropathy meds

A

agressive BP management

ACE, ARB (renal protective)

55
Q

most common type of neuropathy

A

peripheral

loss of sensation in lower extremities
increase risk for limb amputation

56
Q

peripheral neuropathy sensation

A

burning, cramping, crushing, tearing

usually worse at night

57
Q

peripheral neuropathy meds

A

antidepressants
anticonvulsants

58
Q

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

A

autonomic

59
Q

GI s/sx of autonomic neuropathy

A

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

60
Q

autonomic neuropathy education

A

small frequent meals
increased hydration
exercise
enema PRN
bulk forming laxative

61
Q

autonomic neuropathy meds

A

metoclopramide
reglan

given to stimulate peristalsis

62
Q

Cardio s/sx of autonomic neuropathy

A

postural hypotension
resting tachycardia
painless MI

63
Q

GU s/sx of autonomic neuropathy

A

neurogenic bladder (no urge to void)

schedule toileting, bladder training recommended

64
Q

Reproductive s/s of autonomic neuropathy

A

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

65
Q

most common cause of hospitalization in diabetics

A

foot, lower extremities ulceration

66
Q

DM foot care

A

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

67
Q

psychosocial burdens of DM

A

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

68
Q

open insulin vials are only good for how long

A

1 month

69
Q

DM target BP

A

140/90

70
Q

HTN BP meds for DM

A

ACE (1st line)
ARB

71
Q

diet for BP/DM

A

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

72
Q

lipid targets for DM

A

cholesterol < 200
triglycerides < 150

73
Q

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

A

3

74
Q

% of carb, protein, and fat intake for DM

A

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

75
Q

beer, wine, and liquor consumption for DM

A

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

M/S 2 (10 decks)

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