General Care Flashcards
0
Q
Calculation of age-adjusted heart rate
A
220 - client’s age = estimated age-adjusted heart rate
1
Q
Exercise intensity should be ____% of client’s age adjusted heart rate.
A
60-85%
2
Q
Rating of Perceived Exertion
A
Used to assess exercise intensity, rated 0-10.
2 to 5 recommended
3
Q
SMART goals
A
Specific Measurable Achievable Realistic Time bound
4
Q
Steps of educational process
A
Assess
Plan
Implement
Evaluate
5
Q
7 client centered areas of self care
A
Healthy eating Physical activity Monitor BG and health markers Take meds Problem solve Healthy coping Reduce risk
6
Q
DPP showed that ___ minutes of exercise per week, along with healthy choices, reduced the risk for type 2.
A
150
7
Q
What is the best immunologic predictor for development of type 1?
A
High titer of Glutamic Acid Decarboxylase (GAD), which is an islet cell antibody that will attack beta cells of the Islet.
8
Q
What is Pattern Management?
A
Analyze 3-5 days of blood glucose readings and identify patterns of high/low, then adjust made on trend rather than a single reading
9
Q
Example tools for evaluating quality of life in diabetics
A
DQOL Diabetes Quality of Life Measure
Diabetes Treatment Satisfaction Questionnaire
DSQOLS Diabetes-Specific Quality of Life Scale
10
Q
DCCT
A
Diabetes Control and Complications Trial
11
Q
What did DCCT show related to A1C?
A
Elevated levels are related to long-term complications of Diabetes.
12
Q
What is the gold standard for measuring glucose control in people with diabetes?
A
A1C, or glycated hemoglobin A1C
13
Q
Diagnosis of diabetes by A1C is a level of _____ or higher.
A
6.5%
14
Q
People with diabetes have risk for CV disease that is _ - _ times that of non-diabetic population.
A
2 to 4
15
Q
How often should lipids be tested if diabetic patient is low risk?
A
Annually or every 2 years with complete lipid panel
16
Q
Two things to consider when involving the family in care
A
- Cultural context
2. Functional health/stability of family dynamics
17
Q
Which medications require education about driving?
A
Sulfonylureas and insulin due to hypoglycemia risk
18
Q
At what blood glucose levels should someone not be driving?
A
70 mg/dl
19
Q
Common skin problems for diabetics
A
Anhidrosis
Diabetic dermopathy
20
Q
Anhidrosis definition
A
Autonomic neuropathic condition, with little perspiration in feet/legs, leading to severely dry/cracked skin
21
Q
Diabetic dermopathy definition
A
Pigmented spots on shins, usually asymptomatic, but can be painful if they ulcerate. Usually due to poor perfusion
22
Q
Common skin infections in diabetics
A
Staph, fungal, and Candida
23
Q
In 2002, how many cases of diabetes were the primary source of disability (according to Social Security Disability Insurance)?
A
122,000
24
What are ketones and which type of diabetics have them?
Byproducts of fat metabolism, which cause acidosis in excess amounts.
Type 1 are prone to this; Type 2 are usually ketone-resistant.
25
When should someone with Type 2 consider testing for ketones?
During acute illness or following trauma.
26
When should someone with Type 1 test for ketones?
When blood glucose consistently >300 mg/dl or when ill.
27
In what situation should ketone testing be considered in anyone with diabetes?
When trying to lose weight by calorie restriction
28
What is MNT?
Medical Nutrition Therapy, used in diabetics to manage glycemic control, maintain lipid profile, achieve blood pressure goal, among other goals for those with diabetes.
29
What is the recommended fiber intake?
14 grams/1000 kcal, with 1/2 of grain coming from whole grains
30
Ideal calories for weight maintenance?
11 kcal/pound ideal body weight
31
Ideal carbohydrate intake?
130 grams/day minimum, 45-65% of total calories
32
Ideal protein intake?
15-20% of daily caloric intake. There are 7 grams of protein per ounce.
33
Ideal fat intake?
25-30% of daily calories, less than 7% should be saturated fat. For individual foods, make sure saturated fat is <1 gram saturated fat per 100 calories. NO trans fat at all.
34
Should fructose be eliminated from diet of diabetics?
Not necessary if those are only 3-4% of total calories.
35
When counting carbohydrates of food containing sugar alcohols, how much should be subtracted from the total carbs?
Subtract half of the sugar alcohol grams from total carbs
36
What are the approved non-nutritive sweeteners?
acesulfame potassium, aspartame, neotame, saccharin, and sucralose.
37
What is the daily limit of cholesterol intake?
200 mg/day
38
Does consuming protein with carbohydrate slow the blood glucose response to carbohydrate or influence peak activity?
No.
39
Does consuming protein prior to bedtime prevent nocturnal hypoglycemia?
No, the current recommendation for insulin users is to reduce insulin dose or consume a snack, either carb alone or with protein, prior to bedtime.
40
Recommended daily protein intake as % of calories
20%
41
Dietary protein intake for Americans
1.2 - 1.4 g/kg of body weight (15-20% of daily energy)
42
How much should protein be reduced in microalbuminuria?
Reduce to 0.8 - 1 g/kg body weight per day for renal function
43
How much should protein be reduced in clinical nephropathy?
Reduce to 0.8 g/kg of body weight per day to improve renal function
44
Excess waist circumference associated with risk factor for diabetes, CV disease, Hypertension, and dyslipidemia:
>40 inches in men and >35 inches in women
45
BMI Classifications
```
18.5-24.9 Ideal
25-29.9 Overweight
30-34.9 Obese, high risk
35-39.9 Very high risk
>40 Extremely high risk
```
46
Hypocaloric diets in obese women with gestational diabetes can result in ___________.
Ketosis
47
Daily carb allowance during pregnancy is ____ grams in ___ small meals and ______ snacks
175 grams in 3 small meals and 2-4 snacks
48
ADA recommends clinical consideration of stress test before starting exercise in diabetics:
Previously sedentary with moderate/high risk for CV disease
Concurrent autonomic neuropathy, peripheral vascular disease, or microvascular disease
Type 2 diabetes >10 years
Type 1 longer than 15 years if 35 years or older
49
Hyperglycemia and ketosis can worsen if a person with Type 1 initiates exercise while blood glucose is greater than ____ and ______ is present.
250 mg/dl and ketones are present
50
If Type 1 experiences a rise in blood glucose after intense exercise, should additional insulin be administered?
No, because its action will coincide with increased insulin sensitivity that follows exercise.
51
If ketones are negative, is insulin deficiency present?
No
52
Difference between Grade 1 and Grade 5 evidence?
Grade 1 is highly controlled, randomized design, whereas Grade 5 is expert opinion or descriptive study.
53
DCCT demonstrated a ____% reduction of microvascular complications in intensively treated people with Type 1.
60%.
| Those with intensive treatment had A1C of 7% compared to 9% in standard treatment group
54
UKPDS outcomes
In those with Type 2 for 10 years, with intensive control and median A1C of 7%:
1. Risk for microvascular complications was significantly reduced.
2. Suggested reduced risk of heart attack and stroke
55
ACCORD study had one arm of the study terminated early. Why?
Intensive control group (<6%) had an increased mortality of participants.
Other study arms continue
56
Possible causes of blood glucose high after meals:
too much carbs at meal
not enough pre-meal insulin
inadequate oral meds (except metformin)
not enough exercise in preceeding days
57
When fasting blood glucose is high, possible causes are:
not enough basal insulin
| inadequate oral med in evening or bedtime
58
When blood glucose high most of the time, may be due to:
```
insufficient med dose
patient needs combination therapy
med needs more time to work
not enough exercise
too much carbs overall
excess stress
```
59
Erratic blood glucose is due to:
inconsistent meal times
irregular insulin technique
insulin lost potency
excess stress
60
ADA Educator 7 Self Care behaviors
```
Healthy eating
Physically active
Monitor blood glucose and health markers
Take meds
Problem solve
Healthy coping
Reducing risk
```
61
ADA standard of care for testing when on intensive insulin:
Monitor blood glucose minimum of 3 times a day
62
ADA standard of care in performing A1C test:
2 times per year
63
When should bariatric surgery be considered for diabetic?
BMI >35
64
Treatment for hypoglycemia
15-20 grams of glucose or glucagon in emergency.
65
Pneumococcal vaccine recommendation
Any diabetic > 2 years old. Revaccinate for those over 64 if vaccine was over 5 years ago.
66
Aspirin for CV protection is considered for most men over _______ and women over _________ with one risk factor.
Men at 50 and women at 60
67
Aspirin dose for primary prevention
75-162 mg/day
68
Meds recommended with known CVD diabetics
ACE inhibitor, aspirin, and statin. Also a beta blocker for 2 years following a CV event.
69
How often should urine albumin and serum creatinine be tested?
At least annually. Treatment with ACE or ARB (if not pregnant)
70
Frequency of dilated eye exam for retinopathy
At Type 2 diagnosis and 5 years after Type 1 diagnosis. Repeat annually or more often if progresses. Those controlled may have every 2-3 years if they have more than 1 normal exam.
71
Hypertension in children should be treated with what agents?
ACE inhibitors are first line
72
Blood pressure goal in kids with diabetes
130/80 or below the 90th percentile, whichever is lower
73
BP above the _____ percentile for age, sex, and height in diabetic children should be treated with lifestyle modification for 3-6 months, then consider meds if not at goal.
90th
74
Children with LDL >160 mg/dl and over 10 years of age should be treated with _______.
Statin
75
Children with CV risk factors should be treated with statin if LDL is ________
>130 mg/dl
76
Do patients need to use alcohol wipes to disinfect skin prior to testing blood glucose?
No, good handwashing is typically adequate.
77
Does the ADA forbid reusing needles/lancets?
No, but manufacturers don't recommend. Do not reuse if poor hygiene, illness, or compromised immunity.
78
What is CQI?
Continuous Quality Improvement, a methodology for supporting service excellence and customer satisfaction.
79
Celiac disease prevalence rate in Type 1 diabetics
4-6%
80
What is celiac disease?
autoimmune disorder of small intestine, most common in European descent. Triggered by viral immune response in those with genetic predisposition. A gluten-free diet improves health.
81
Appropriate grains for celiac disease
Corn, Rice, Potatoes, and soy
82
What thyroid dysfunction is most common?
Hypothyroid, which in diabetics can affect glucose control and response to meds. Metabolism may slow and meds may be prolonged, which increase hypoglycemia risk
83
What should be done with med doses when hypothyroidism presents with diabetes?
reduce doses to prevent hypoglycemia
84
Hyperthyroidism causes worsening glucose control and _____________ need for insulin.
Increased
85
Symptoms of hyperthyroidism
Pounding heartbeat
Sweating
Tremors
(which can mimic hypoglycemia)
86
What is offloading for diabetic foot ulcer?
No weight on the affected foot.
87
What is needed in diabetic foot ulcer treatment?
Debridement and meticulous documentation
88
What should be monitored for low-carb diets?
Renal function and lipid profiles. Also, monitor protein if the patient has neuropathy
89
Daily allowance for carbs
130 grams/day
90
How long is the insulin-sensitizing effect of exercise?
24-72 hours, depending on the duration and intensity
91
What is the maximum time recommended between exercise sessions to maximize the insulin sensitizing effects?
No more than 2 days between sessions
92
Both aerobic and resistance training affect insulin sensitivity the same, but which may last longer?
Resistance
93
How many hours per week of moderate to vigorous exercise correlates to people who are able to maintain a larger weight loss?
7 hours
94
True or false: aerobic exercises has shown to improve A1C regardless of weight loss
True
95
How many minutes of weekly exercise is recommended for diabetics?
150 minutes moderate or 90 minutes of vigorous (over 3 days per week, and no more than 2 consecutive days should lapse between exercise sessions
96
Current recommendations for resistance exercise per week for those with Type 2
3 times per week (3 sets of 8-10 reps)
97
ADA recommendations for cardiac stress test before starting exercise include clinical judgement, with consideration for some patients such as:
Previously sedentary
Concurrent autonomic neuropathy, PVD, or microvascular disease
Type 2 > 10 years
Type 1 for longer than 15 years if over 35 years
98
At what glucose level should exercise be avoided when ketones are present?
250 mg/dL
99
If Type 1 has blood glucose of 250-300 mg/dL but ketones are negative, is exercise safe?
Yes, no ketones means not insulin deficient and risk for ketosis is small.
100
If Type 1 has blood glucose over 300 mg/dL but ketones are not present, should exercise be avoided?
Yes, it is prudent to delay.
101
If a Type 1 has an acute rise in blood glucose after exercise, should insulin be administered?
No, because it's action will coincide with increased insulin sensitivity that follows exercise.
102
Do Type 2 diabetics need to delay exercise if hyperglycemia and ketones?
Typically not necessary
103
True or false: If Type 2 has blood glucose of over 300, they don't need to abstain from exercise, especially if in postprandial state.
True, as long as not insulin deficient, increased activity should decease blood glucose. If no ketones, then no insulin deficiency is present.
104
When should strenuous exercise be avoided in a hyperglycemic with Type 2?
When ketones are present.
105
What is the calorie expenditure for minimum health conditioning and what yields the maximum?
700 calories minimum and 2000 calories maximum.
106
What should be done for exercise in patients with retinopathy?
Avoid vigorous or resistance to prevent vitreous hemorrhage and retinal detachment.
107
Why should those with autonomic neuropathy have cardiac stress testing?
Risk of deceased cardiac response, postural hypotension, silent angina, and impaired thirst sensation.
108
Does presence of microalbuminuria limit exercise?
No, but do consider Cardiovascular status because microalbuminuria and nephropathy are associated with increased CV risk.
109
Walking with intermittent claudication is ok, except when_______.
Yes, except if person has pain at rest or during the night (then the degree of PVD is severe and walking is contraindicated).
110
When should blood glucose be monitored before exercise and carbohydrates consumed (for blood glucose < 100 mg/dL)?
When patient uses insulin or insulin secretagogues.
111
When does ADA indicate supplemental carbs are NOT needed prior to exercise, even if blood glucose is less than 100 mg/dL?
When treating by lifestyle alone
OR
Using metformin, alpha-glucosidase inhibitors, or TZDs WITHOUT insulin or secretagogues
112
What is PEL?
Post-exercise late-onset hypoglycemia, which is exercise induced low blood glucose 4 hours after exercise
113
What is PEL the result of?
Exercise related increases in glucose utilization and insulin sensitivity and replenishment of glycogen stores post exercise
114
Who is at risk for PEL hypoglycemia?
Anyone with Type 1, or anyone using insulin or insulin secretagogues.
They should be educated and might need to increase carbs after exercise, and not to exercise right before bed to prevent nocturnal hypoglycemia.
115
What happens if insulin is injected into muscle with exercise?
Muscle contractions can hasten absorption and increase risk for exercise induced hypoglycemia
116
Should Injecting insulin into the part of body to be exercised be avoided?
Not any longer. It isn't found to decrease the risk for exercise-induced hypoglycemia.
117
If a person doesn't use insulin or an insulin secretagogue, is carb replacement required?
Not generally
118
For moderate exercise of 30-60 minutes, ___ extra grams of carbs is needed. For more than an hour, ____ extra gram may be needed for each hour.
15 grams for 30-60 and then 30-50 grams for every additional hour
