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Med/Surg > Long term Complications of Diabetes > Flashcards

Long term Complications of Diabetes Flashcards

1
Q

Long term complications of diabetes usually does not occur until

A

10 years after diagnosis

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2
Q

Hyperglycemia causes changes to

A

the medium layer of large vessels

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3
Q

Blood vessels thicken and

A

sclerosis plaque adheres to walls

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4
Q

This accelerated atherosclerosis causes

A

diminished blood flow

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5
Q

These atherosclerosis changes happen more often in

A

diabetics and at earlier age

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6
Q

Diabetics have twice the risk of disease and death than

A

non-diabetics

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7
Q

Recovery from stroke can be impaired in

A

Cerebrovascular Disease causing neuropathy

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8
Q

S&S of Cerebrovascular Disease can
mimic

A

hypoglycemia and looks like a stroke

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9
Q

The typical S&S of Coronary Artery Disease
may

A

not be present = silent MI’s

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10
Q

Blockage or narrowing of an artery in the legs (or rarely the arms), usually due to atherosclerosis and resulting in decreased blood flow.

A

Occlusive peripheral arterial disease

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11
Q

Causes a greater incidence of gangrene, amputation in diabetics

A

Peripheral Vascular Disease

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12
Q

Management of macrovascular complications

A

Aggressive modification of risk factors such as smoking, hypertension, diet, exercise

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13
Q

Microvascular complications

A

Increased blood glucose causes thickening of capillary basement membrane

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14
Q

Microvascular complications affect

A

Eyes
Kidneys
Nerves

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15
Q

Almost all patients with type 1 diabetes and majority of pts with type 2 have some degree of

A

retinopathy after 20 years.

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16
Q

Small vessels in the retina are affected in

A

diabetic retinopathy

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17
Q

Three phases of diabetic retinopathy:

A

non-proliferative, pre-proliferative, and pro-liferative

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18
Q

Phases of diabetic retinopathy:

Early stage. Asymptomatic. Micro aneurysms, fluid leak

A

Non-proliferative

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19
Q

Macular edema (10% of pt’s) can lead to

A

visual changes and loss of central vision

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20
Q

Edema around the retina

A

Macular edema

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21
Q

Phases of diabetic retinopathy:

Increased destruction of retinal blood vessels
Possible vision changes from macular edema

A

Pre-proliferative

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22
Q

Phases of diabetic retinopathy:

Abnormal growth of new blood vessels growing from retina into the vitreous
New vessels rupture, vitreous becomes cloudy block light – loss of vision
Scar tissue forms in vitreous – pulls retina, retina detachment

A

Proliferative

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23
Q

vitreous means

A

becomes cloudy

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24
Q

Is retinopathy painful?

A

No

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25
Q

Diabetic retinopathy is the ___ leading cause of blindness

A

3rd

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26
Q

Early stages of diabetic retinopathy

A

lesions and macular edema causes blurry vision

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27
Q

Later stages of diabetic retinopathy

A

Hemorrhage S&S: floaters, cobwebs, sudden hazy vision, could lead to compete vision loss

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28
Q

Diagnostic Tests for diabetic retinopathy:

Ophthalmoscopic exam of

A

dilated pupils to exam retina

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29
Q

Diagnostic Tests for diabetic retinopathy:

Rare exam where dye is injected into arm vein travels to vessels of retina

A

Fluorescein angiography

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30
Q

Management of diabetic retinopathy

A

Prevention
Keep blood glucose at near normal levels
Yearly eye exams
Control HTN, smoking cessation
Advanced cases – Photocoagulation
Major hemorrhage: vitrectomy

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31
Q

Surgery where bloody water is removed from the eye and replaced with NS

A

vitrectomy

32
Q

Lazer eye surgery used to treat retinopathy

A

Photocoagulation

33
Q

Maintaining blood glucose to normal or near normal level with intensive insulin therapy and pt education has decreased risk of retinopathy by

34
Q

Protein in urine is the 1st sign of

A

problems with kidneys

35
Q

Kidney disease from thickened capillary basement membrane from hyperglycemia

A

nephropathy

36
Q

Kidney’s filtration mechanism is stressed, allowing blood proteins to leak into urine

A

nephropathy

37
Q

As it progresses, breakdown of insulin decreases causing episodes of hypoglycemia

A

nephropathy

38
Q

Microalbumin found in urine with this disease

A

nephropathy

39
Q

Signs & Symptoms of kidney dysfunction:

A

Persistent albuminuria
Decline in glomerular filtration rate

40
Q

Management of nephropathy

A

Achieving and maintain near normal blood glucose levels
Test urine for proteins, BUN, creatinine
Treat HTN - ACE inhibitors
Avoid nephrotoxic medications
Low sodium/low protein diet

41
Q

If nephropathy progresses to ESKD

A

Dialysis or Transplant is needed

42
Q

Still have diabetes after nephropathy, kidneys can again fail if

A

blood glucose not controlled

43
Q

Types of diabetic neuropathies

A

Peripheral, autonomic, and spinal

44
Q

Capillary basement membrane thickening, and demyelination of the nerves thought to be r/t hyperglycemia

A

Neuropathy

45
Q

Two most common neuropathies:

A

Peripheral and Autonomic Neuropathy

46
Q

Affects the distal portion of the nerves, especially of lower extremities

A

Peripheral Neuropathy

47
Q

½ patients do not have symptoms

A

Peripheral Neuropathy

48
Q

Initial symptoms: paresthesia, burning sensation, eventually numb

A

Peripheral Neuropathy

49
Q

In peripheral neuropathy, a light touch can be

50
Q

peripheral neuropathy can cause numbness with

A

shooting pain

51
Q

awareness of posture and movement of body and weight of objects in relationship to body

A

Proprioception

52
Q

Decrease in proprioception

A

Peripheral Neuropathy

53
Q

Neuropathy related joint changes of foot as a result of abnormal weight distribution from lack of proprioception

A

Charcot joints

54
Q

Decrease in DTR and vibratory – may be only sign

A

Peripheral Neuropathy

55
Q

DTR

A

deep tendon reflex.

56
Q

Those patients with peripheral neuropathy, pain is

A

difficulty to control

57
Q

Those patients with peripheral neuropathy should wear

A

White socks

58
Q

Broad range of dysfunction affecting almost every organ system

A

Autonomic neuropathies

59
Q

Many medications diabetics take for HTN also effect

A

erectile dysfunction

60
Q

Type of autonomic neuropathy:

fixed tachycardia, orthostatic hypotension, silent MI’s

A

Cardiovascular

61
Q

Fixed tachycardia cannot

A

fix itself

62
Q

Type of autonomic neuropathy:

delayed intestinal emptying, diarrhea or constipation

63
Q

Med that can be prescribed for GI neuropathy

64
Q

Hypoglycemic Unawareness:

Diminished adrenergic symptoms of hypoglycemia such as

A

sweating/nervousness, shakiness

65
Q

Absence of sweating of lower extremities, with excessive upper extremities sweating

A

Sudomotor neuropathies

66
Q

Sudomotor neuropathy can leave feet dry and susceptible to

67
Q

Management of autonomic neuropathy

A

Prevention, alleviating symptoms and modify risk factors

68
Q

Nursing care of autonomic neuropathy

A

Tight control of blood glucose, check HgB A1C
Annual eye exams
Test urine for microalbumin once a year to check kidney function
Cardiac evaluation twice a year : BP, cholesterol
Daily skin inspection
Monitor for infection

69
Q

Nursing care of feet

A

Cleaned, dried, lubricated with lotion but not between the toes
Calluses, thick toenails should be treated by podiatrist and nails trimmed

70
Q

DIABETICS WHO ARE UNDERGOING SURGERY - NPO: Blood sugar may often

A

Blood sugar often elevated times of stress (infection, illness, hospitalization)

71
Q

DIABETICS WHO ARE UNDERGOING SURGERY - NPO:

During perioperative period, frequent

A

blood glucose monitoring needed

72
Q

DIABETICS WHO ARE UNDERGOING SURGERY:

Pt is NPO having surgery that day,

A

check am BGM and notify provider

73
Q

DIABETICS WHO ARE UNDERGOING SURGERY:

If BGM elevated (over 200)

A

may order short acting coverage

74
Q

Post – Operative diet

A

Clear liquid diet often ordered…juice, jello, flavored ices ….. HYPERGLYCEMIA

75
Q

SICK day rules for diabetic

A

Sugar
Insulin
Carbs
Ketones

Med/Surg (17 decks)

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