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adult health > FINALS Obesity and Diabetes > Flashcards

FINALS Obesity and Diabetes Flashcards

1
Q

What are the risk factors of obesity??

A

1) genes
2) Obesogenic environment
3) Medications (KNOW THESE)
4) Secondary causes:
- Cushing syndrome
- Insulinoma
- Hypothyroidism
- Polycystic ovarian syndrome
- Hypogonadism
- Pregnancy
- Growth hormone deficiency

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2
Q

What are “Obesogenic Medications” that cause obesity???

A
  1. Meds for Diabetes: Insulin, Sulfonylurenes, Thiazolidinediones)
  2. Anti-hypertensive drugs (Alpha & Beta blockers)
  3. ## Corticosteroids & Estrogen(“4 Anti’s”):
  4. Antihistamines
  5. Anticonvulsants
  6. Antipsychotics
  7. Antidepressants
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3
Q

What is the Body Mass Index (BMI) for adults?????

A
  • Underweight <18.5
  • Normal weight 18.5 - 24.9
  • Overweight 25-29.9
  • Obesity (Class 1) 30-34.99
  • Obesity (Class 2) 35-39.9
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4
Q

What is the waist circumference for men and women to classify if they have CENTRAL OBESITY???

A

(Central Obesity is the apple shape body = abdominal fat = NOT GOOD!)
* Measure with arms straight down, measure at elbow joint!—————————-
- MEN: >40 INCHES
- WOMEN: >35 INCHES
THIS IS CONSIDERED CENTRAL OBESITY!!!!!!!!!

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5
Q
  • Which cells REQUIRE insulin for glucose uptake?
  • Which cells that DON’T require insulin?
A

Cells that REQUIRE:
1. Muscle
2. Fat
3. Portions of the LIVER
———————
Cells that DON’T Require :
1. Brain
2. RBCs
3. Cornea
4. Intestine
5. Kidneys
6. Portions of the liver

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6
Q

What are 3 main things insulin does its job??

A
  1. FUEL PROVISION (glucose into cells that require insulin: such as muscles, fat, and portions of the liver)
  2. STORAGE FACILITATION (Insulin stores some of extra glucose in fat cells by converting it into triglycerides and stored in the liver in the form of glycogen!)
  3. BREAK DOWN INHIBITION (when we get a big load of glucose, insulin tells parts of the body that we don’t need to convert/break more sugar)
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7
Q

What is normal blood glucose???

A

70-100 mg/dL

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8
Q

What are the actions of Insulin??? (THE GO’S AND STOP’S)

A

GO:
1. Glucose uptake in MUSCLE and FAT cells
2. GLYCOLYSIS (glucose is broken down in the cells to produce energy)
3. GLYCOGEN SYNTHESIS (storing glucose in the liver in the form of glycogen)
4. PROTEIN SYNTHESIS**
5. UPTAKE OF IONS (SODIUM AND POTASSIUM)*** (SHIFT potassium from serum INTO THE CELLS)

STOP:
1. GLUCONEOGENESIS (taking protein to convert it into glucose)
2. GLUCOGENOLYSIS (breaking down of stored glucose, glycogen)
3. LIPOLYSIS (breaking down of fat)
4. KETOGENESIS (converting fat into ketones)
5. PROTEOLYSIS (breaking down of proteins used for gluconeogenesis to produce glucose)

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9
Q

What is TYPE 1 Diabetes????
(What do these patients depend on??)

A
  1. AUTOIMMUNE DISORDER!!!! Meaning that the body attacks itself and destroys its own beta cells! (So, they have LOW insulin or no insulin at all)
  2. Viral infection can trigger the autoimmune cascade!
  3. PATIENTS WITH TYPE I DIABETES ARE DEPENDENT ON *EXOGENOUS INSULIN!!!!!!
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10
Q

What is TYPE II Diabetes???

A
  1. PROGRESSIVE disorder, characterized by REDUCED ABILITY OF CELLS NOT RESPONDING TO INSULIN (Insulin Resistance), which CAUSES POOR CONTROL OF LIVER GLUCOSE PRODUCTION and DECREASED BETA CELL FUNCTION OVER TIME LEADING TO BETA CELL FAILURE!!!!
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11
Q

What are the Modifiable VS Non-modifiable RISK FACTORS for Diabetes???

A

MODIFIABLE:
1. BMI greater than 26 kg/m2
2. PHYSICAL INACTIVITY
3. HDL (High-density lipoprotein) cholesterol levels ≤ 35 mg/dL AND/OR triglyceride level ≥ 250 mg/dL
4. METABOLIC SYNDROME!!!!
—————————————-
NON-MODIFIABLE:
1. Being: AFRICAN AMERICAN, LATINO, NATIVE AMERICAN, ASIAN-AMERICAN, & PACIFIC ISLANDER!!!
2. First Degree Relative w/ Diabetes
3. HYPERTENSION
4. *WOMEN WHO DELIVERED BABY WEIGHING ≥ 9lbs OR WHO WHERE DIAGNOSED WITH GESTATION DIABETES!!!
5. Women with Polycystic Ovarian Syndrome!!!!!!!!!!
6. Hgb A1C ≥ 5.7%
7. History of CARDIOVASCULAR DISEASE!!!

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12
Q

What is METABOLIC SYNDROME?? WHAT ARE THE FACTORS???? (What is the KEY feature of this syndrome????)

A

Factors:
1. INSULIN RESISTANCY!!!!!*** (KEY FEATURE)
2. Visceral obesity (Apple-shaped/ Central obesity)
3. Hypertension! Greater than or equal to 130/85!!!!!!!!!!!!
4. HIGH Triglycerides: ≥150 mg/dL
5. LOW HDL-Cholesterol (healthy cholesterol being too low) ≤ 40 mg/dL in MEN and ≤ 50 mg/dL in WOMEN!

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13
Q
  • What happens when there is NOT enough insulin or when the cells aren’t responding to insulin???? (MANIFESTATIONS OF HAVING HIGH BLOOD SUGAR)
  • So, patients with diabetes, type I in particular, often present to the health care provider with reports of what 3 things???? WEIGHT LOSS or WEIGHT GAIN???
A
  1. CELLULAR DYSFUNCTION = CELLULAR DEHYDRATION!!!!
  2. OSMOTIC DIURESIS = Volume loss and electrolyte loss (sodium, potassium, chloride are lost)!!
    - POLYDIPSIA AND POLYURIA
  3. CELLULAR STARVATION = fat and protein breakdown
    - POLYPHAGIA
    ————————————————–
  4. POLYURIA (excessive urination)
  5. POLYDIPSIA (excessive thirst)
  6. POLYDIPSIA (excessive hunger)
    WEIGHT LOSS!!!! (bc of that polyuria and polydipsia)
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14
Q

What does HYPERGLYCEMIA do to Blood Vessels? To serum lipids??

A
  1. Vessel wall thickening
  2. Tendency toward vasoconstriction
  3. Serum lipids not stored appropriately
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15
Q

There are 3 major CLASSIFICATIONS of chronic complications of HYPERGLYCEMIA?????

A
  1. LONG TERM complications: Renal failure, cardiovascular disease, neuropathy, wound healing delays, eye changes.
  2. Things that can kill a diabetic over the course of days-weeks: DKA and HHS!!!
  3. Things that can kill a diabetic QUICKLY: HYPOGLYCEMIA!!!! Because it can cause comatose and death!!
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16
Q

What does hyperglycemia do to the ability of RBCs to carry and deliver oxygen??

A
  1. RBCs become SATURATED with GLUCOSE (glycosylation)
  2. Glucose binds to Hgb where oxygen should bind
17
Q

How does hyperglycemia impact the NERVE cells??

A
  1. Sorbitol is formed (poly pathway)
  2. Cellular swelling, damage, and dysfunction
  3. Nerves, retina, and kidneys are impacted
18
Q

WHAT IS THE EARLIEST CLINICAL SIGN OF NEPHROPATHY??????

A

MICROALBUMINURIA!!!!!! yearly testing for Type I after 5 years, and for

19
Q

For DIAGNOSING Diabetes, what are the values for:
1. Random (casual) blood glucose?
2. Fasting blood glucose?
3. Oral glucose tolerance test?
4. HgbA1C?

A
  1. Random blood glucose: ≥ 200 mg/dL (Any time of day, regardless of meal schedule, no fasting)
  2. Fasting blood glucose: ≥ 126
    (No intake for 8hrs except water)
  3. Oral glucose tolerance test: ≥ 200
    (Balanced diet for 3 days, fast for 10-12 hours, then they get tested in the AM. they’ll be given a cup of full glucose and we’ll look at their final BG after 2 hours. It should be less than 200)
  4. HgbA1c: ≥ 6.5 !!!!!!!!!!!
    - Normal (4-6%)
    - Pre-diabetes (5.7 - 6.4%)
    - Diabetes (6.5 and above)
    - THIS TEST IS THE AVERAGE blood glucose for past 2-3 months!
20
Q

Is it okay for someone with Hyperglycemic to consume Alcohol???

A

Yes. BUT:
- ALWAYS WITH FOOD and SMALL AMOUNT!!!!

21
Q

WHAT IS THE LEADING DEATH IN DIABETICS????

A

CARDIOVASCULAR DISEASE!!!!

22
Q
  1. What is Down Phenomenon? What is the nursing care/teaching??
  2. What is Somogyi phenomenon??
    What is the nursing care/teaching??
A
  • Night-time release of growth hormone! GROWTH HORMONE IS THE HIGHEST @ NIGHT!
  • ## More PM Insulin (intermediate acting)!!!!!!!!!!!!!!!!!
  • Counter-regulatory response to PM HYPOGLYCEMIA
  • HS snack, insulin regimen adjustment, and NO LATE day exercise!
23
Q

Which type of insulin can you give in IV form?????***

A

ONLY REGULAR INSULIN (Short acting insulin)!!!!!!!!!!!!!
NEVER INTERMEDIATE OR LONG!!!!

24
Q

What are the 2 types of Background Insulin?? What do you need to know about them?

A

1) Intermediate Insulin:
1. Dose only 2x a day because they only work 1/2 a day
2. THE ONLY CLOUDY INSULIN!!!!!!!! (meaning that you can only mix rapid or short with intermediate!!)
2) Long acting Insulin:
1. NO PEAKS. Gives a 24 hr STEADY coverage!!!
2. DON’T MIX LONG ACTING WITH ANYTHING ELSE IN THE SAME SYRINGE!!!

25
Q

What are The Mealtime/Breakthrough Insulin?? What do you need to know about them?

A
  1. Rapid acting: Work almost immediately (faster than short), DON’T GIVE until FOOD IS READY!
  2. Short acting: Work immediately, but little later after rapid, DON’T GIVE until FOOD IS READY!
    BOTH:
    - MONITOR FOR HYPOGLYCEMIA FOR EITHER RAPID OR SHORT IN THE MORNING!!
26
Q

HOW do you mix insulins???

A

CLEAR DRAWN UP FIRST, THEN CLOUDY!!
- Shorts= clear
- Intermediate = cloudy
- NEVER MIX LONG ACTING!!!!

27
Q

When giving insulin injections, why do you rotate injection sites??

A

to prevent LIPOHYPERTROPHY!

28
Q

Why do we teach patient about time of peak action for insulin injections???

A

BECAUSE THATS WHEN THEY ARE at HIGHER RISK FOR HYPOGLYCEMIA!!!

29
Q

Which insulin CAN you mix together???

A

Intermediate (CLOUDY) with Rapid or Short acting!!!!!
(CANNOT mix rapid or short acting with long acting insulin!!!!)

30
Q

When mixing insulin, which type of insulin should you DRAW FIRST???? why??

A

Draw RAPID OR SHORT FIRST!!!!! Because of cross-contamination!! If i put rapid/short into my intermediate, u can expect that the pt should have insulin on board for half of the day. They’re expecting to be watched for signs of hypoglycemia for half of the day. BUT, LETS SAY YOU CONTAMINATE THE RAPID OR SHORT acting with INTERMEDIATE and this patient isn’t suppose to get background insulin, then RISK FOR HYPOGLYCEMIA IS GOING TO BE HIGHER SINCE intermediate is HYPOGLYCEMIA!

31
Q
  • Which type of Insulin can be given intravenously??????*****
  • In what situation would you be using this???????
A
  • ONLY REGULAR INSULIN (short-acting)!!!! NEVER INTERMEDIATE OR LONG!!
  • We give this on a PUMP intravenously in patients with KETOACIDOSIS & HHS!!!!!!!!!!!!
32
Q

How do you calculate Insulin DRIP???????*** (EXAM)

A

1:1 drip!!!!!!
(1 mL = 1 unit insulin)
- 100 units = 100 mL
- 200 units = 200 mL

FORMULA:
(Per kg/weight)
weight/2.2, then MULTIPLY by 0.1 units

EXAMPLE: weight is 166 lbs
166 lbs / 2.2 = 75 kg
(75) x (0.1 units) = 7.5 units –> ROUND TO 8 units!!!!! 8 units = 8 mL!!!!!!

33
Q

What would you teach patient during SICK DAYS???!!!!**

A
  1. Check glucose Q4 hourS!!!!!!***
  2. HYDRATE AND REST
  3. Eat!!!
  4. Take meds!!!
  5. CONTACT HCP:
    1) Persistent Nausea, vomiting or diarrhea
    2) Moderate to large amount of KETONES!!!! TEST FOR KETONES WHEN BLOOD GLUCOSE IS HIGH > 240!!!!! CHECK EVERY 4-6 HOURS!!!!
    3) BG is up even after insulin
    4) symptoms of dehydration
    5) Persistent FEVER!!
34
Q

HHS don’t experience what that’s different than DKA??

A

DONT EXPERIENCE CELLULAR STARVING/POLYPHAGIA bc its more common in type 2 and they still have those insulin (unlike in type 1) to keep those cells from being hungry!!
- This means they DON’T experience KETOACIDOSIS!!! (they’re not positive in ketones!)

35
Q

DOES DKA OR HHS experience PROFOUNDLY* Volume depleted???? WHICH HAVE HIGHER MORBIDITY & MORTALITY??

A

HHS!! THEYRE MORE PROFOUNDLY VOLUME DEPLETED Bc they take longer to recognize and by the time it’s recognized, they’re already very volume depleted!! SOOO HHS HAVE HIGHER MORTALITY nc they’re more volume depleted and are closer to comatose/death!!!!

36
Q

Would osmo be elevated in HHS?

A

YES!! VERY & CERTAINLY ELEVATED!!! It’s even in the name!!!

37
Q

What is the blood glucose level in DKA? How about in HHS?

A

DKA = >250
HHS = >600

38
Q

What are the treatment for DKA and HHS?? FROM HIGHEST PRIORITY!!!1

A
  1. FLUIDS!!!!!!! (TOP PRIORITY)
    - NS (isotonic first), then .45 SALINE (Hypotonic), then D5 1/2 Saline (add to prevent hypoglycemia before giving them insulin)!!!!!!
  2. BLOOD GLUCOSE (SECOND)
    - GIVE REGULAR INSULIN!! ONLY ON PUMP!!!!
    - REDUCE blood glucose at 75-100 mg/dL per hour!!!!!!!
    WHY GRADUAL REDUCTION IS IMPORTANT?? 1. BECAUSE too much insulin can cause too much potassium to go into the cell too fast which can cause CARDIAC ARYTHMIA!!!!!    *** 2. Because dropping osmo too quickly cause RAPID FLUID MOVEMENT BACK into the cell causing CEREBRAL EDEMA & DEATH!!!!! (EXAM)
  3. IV POTASSIUM only when patient is voiding AT LEAST 30 Ml/hr
  4. ACIDOSIS Management
39
Q

MONITOR BLOOD GLUCOSE BEFORE/AFTER/DURING EXCERICE! What does it mean when its LOW before exercising?? how about HIGH??

A

LOW:
1. EAT SNACK BEFORE EXCERCISING!!!

HIGH:
1. Means that they don’t have enough insulin on board!
2. Take a break, DIPSTICK THE URINE FOR KETONES!!!, THEN SUPLEMENTAL INSULIN!!!!!

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