LM3 - ppt. 1 endocrine -> diabetes + insulin Flashcards
1
Q
what do glands do?
A
secretes hormones
2
Q
what are hormones?
A
are chemical messengers
3
Q
what is a target organ?
A
the organ or structure toward which the effects of a hormone are primarily directed
4
Q
what are the islets of langerhans secretes?
A
- glucagon hormone
-insulin hormone
5
Q
about glucagon hormone (alpha cells)?
A
- stored glucose releases when needed ( liver, fats)
6
Q
about insulin hormone (beta cells)?
A
- when too much glucose, releases to decrease blood glucose
7
Q
normal response to nutrient intake?
A
- eat
- digestion occur
- increase in sugar (glucose) in blood
- triggers release of insulin from pancreas beta cells
- insulin is the key that will open the insulin receptor cells of the cell to allow for sugar (glucose) into the cell to be use for energy
8
Q
about type 1 diabetes?
A
- absolute deficiency in insulin aka insulin-dependent diabetes mellitus (IDDM)
- autoimmune condition, destruction of beta cells of pancreas, lack of insulin production – then stop prod. of insulin
- due to genetics
- insulin dependent (must inject insulin)
- develops mainly is children/adolescents
- presents suddenly
9
Q
about type 2 diabetes?
A
- due to genetic, environmental factors, aging process, and obesity
- insulin resistant rather than insufficient insulin secretion
- known as non-insulin-dependent diabetes (NIDDM) => may later require insulin
- body’s cells become resistant to effects of insulin
common cause: metabolic syndrome (high BP, high blood sugar, high cholesterol, + obesity)
- treatments: lifestyle changes, oral meds and if not controlled may need insulin
10
Q
what is gestational diabetes?
A
- occurs during pregnancy
- potential of future diabetes in mother
- delivery of larger babies
11
Q
what are the mild to moderate symptoms of hypoglycemia?
A
- shaky/jittery
- sweaty
- hungry
- headache
- blurred vision
- sleepy/tired
- dizzy/light-headed/weak
- confused /disoriented
- pale
- uncoordinated
- irritable/nervous
- argumentative or combative
- changed behavior or personality
- trouble concentrating
- fast/irregular HR
12
Q
what are severe symptoms of hypoglycemia?
A
- unable to eat
- seizures/convulsions (jerky movements)
- unconsciousness
13
Q
what does insulin do?
A
acts as a key to insulin receptors on cells in the body to allow glucose in, to be for energy
14
Q
what are the classic 3 P’s of diabetes?
A
1) polyphagia
2) polyuria
3) polydipsia
15
Q
what is polyphagia?
A
- cells not getting glucose, lacks energy requirements and trigger hunger
16
Q
what is polyuria?
A
- glucose >180mg/dL
–> glucose starts to spill over into urine - water follows glucose —> leading to increase in urine output
17
Q
what is polydipsia?
A
- increase fluid volume loss through urination
- fluid depletion causes increased thirst
18
Q
what are the complications of diabetes?
A
- hyperglycemia/ hypoglycemia
- hypertension
- heart disease
- stroke
- retinopathy
- peripheral vascular disease –> amputation
- nephropathy
- neuropathy
- poor wound healing
19
Q
what are the effects of insulin?
A
- insulin is a protein hormone secreted by the beta cells in the pancreas
- avg. adult pancreas secretes about 40-60 units of insulin/day
- insulin binds w/and activates receptors on the cell membranes of about 80% of the body cell’s
20
Q
how is insulin primarily given?
A
- subcutaneous injection
21
Q
why can insulin NOT be given orally?
A
- it is a protein hormone that is destroyed by GI enzymes
22
Q
what is sliding scale insulin?
A
- insulin is given based on the blood sugar specific to the patient
- rapid acting, given right before meals
- order by physician
ex) humalog sliding scale
- BS <160: do NOT give insulin
- BS 160-200: 4 units of insulin
- BS 200-250: 6 units of insulin
- BS >250: call physician
23
Q
when are insulin mixtures used?
A
- for clients who may have trouble drawing up or mixing two insulins
- clients whose insulin dosages remain the same for long periods of time
- NPH 70%/regular 30%, trade name Humalin 70/30 or Novolin 70/30
- NPH 50% or regular 50%, trade name Humulin 50/50
24
Q
in what measurement is insulin drawn up in?
A
- units –> U-100 (usual concentration used) - means 100 units in 1 milliliter of solution
- U-100 or U-500 (only for patients requiring large doses >200U/day)
25
what does all insulin produce?
- a shift in potassium from the extracellular to intracellular space
---> can cause hyperkalemia (resp. paralysis, ventricular arrhythmia and death)
- monitor K+ labs, esp. if diuretics are used
26
what are advantages and disadvantages of insulin pen injectors?
adv.
- available for many types of insulin
- convenience
- compliance
disadv.
- improper sharing - blood-borne pathogens
- high alert med, improper dosing, improper inj. sites
- cost
27
about the insulin pump?
- controlled dose
- bolus dose after meals
- best for patients who are disciplined and have tight control over BS
28
what is insulin therapy?
hypoglycemia treatment
- follow agency protocol
- oral glucose intake (simple - juice then complex carb)
- glucose gel (buccal cheek)
- glucagon (given parenterally - IV, SubQ, IM)
- dextrose IV
29
what are some adverse effects of insulin therapy?
allergic reactions
- local: swelling, erythema, itching
- systemic: confusion, anxiety, dizziness
insulin lipodystrophy
- shrinking of skin in pockets
30
lifespan considerations: insulin therapy for pediatric
- diabetes control is challenging
- parents must learn how to manage disease
31
lifespan considerations: insulin therapy for pregnancy and breastfeeding
- insulin needs change during pregnancy; more difficult to control
- insulin is the preferred drug, safe for breastfeeding
32
lifespan considerations: insulin therapy for older adults
- management: may have problems w/dosing, monitoring blood glucose (self-management abilities)
- higher risk of hypoglycemia, esp. if taking beta blockers (warfarin)
- might be harder to recognize hypoglycemia
- BG may be more difficult to control due to poor eating
33
what to check before and after administering insulin therapy?
check before:
- drug order + calculation w/another nurse
- blood glucose level
- patient must east within 15-30 min. of taking insulin
- correct type of insulin, calibrated syringe
- gently roll vials; no shaking
- give subQ; do not aspirate or massage site
check after:
- monitor hourly for s/s of hypoglycemia
- blood glucose levels
34
what patient teaching should be taught with insulin therapy?
- diabetes and management (all aspects)
- insulin controls, but does not cure
- diet/exercise, help prevent complications
- don't skip meals esp. w/insulin admin.
- always have candy or carbs available for emergencies
