Mark K lecture 5

Question 1

SIADH and urine and serum specific gravity

Answer 1

decrease serum specific gravity (due to retention of water)
* Increase urine specific gravity (due to decrease urine volume)

Question 2

S/Sx of DM

Answer 2

o Polyuria—pee a lot
o Polydipsia—thirsty
o Polyphagia—(eat/swallow a lot)

Question 3

Treatment for DM Type I

Answer 3

• They will “DIE”
• Diet (calories from carbs, least important)
• Insulin (most important)
• Exercise

Question 4

Treatment for Type II DM

Answer 4

• They are “DOA”
• Diet (most important)
• Oral hypoglycemic
• Activity

Question 5

Diet for DM2

Answer 5

• Primary treatment modality is Calorie restriction
• 1200 Cal, 1400 Cal, 1600 Cal
• These pts need to eat 6 small feeding per day—smaller more frequent meals—keeps blood
  sugar more stable

Question 6

What is the best dietary action a DM2 should take?

a. Restrict calories
b. Divide meal into 6 feedings a day

Answer 6

(a) because pt can eat 6 meals but does not limit the Cal with each meal

Question 7

R-Regular insulin

Answer 7

clear solution, Can be given IV drip (HESI-intermediate, Rapid, Run IV)
* Onset: 1 hour
* Peak: 2 hours
* Duration: 4 hours … (Audio says 3 hours, but it is 4 hours)
* Pattern: 1-2-4 (Pay attention to peak)

Question 8

N-NPH

Answer 8

Intermediate insulin—it is cloudy, N = Not So Clear, Fast (Cloudy =
Suspension—it precipitates—can’t give IV drip), N = not so fast, not in the bag
* Onset: 6 hours
* Peak: 8 to 10 hours
* Duration: 12 hours
* Pattern: 6-8-10-12 (Hear the even #s and pay attention to peak)

Question 9

How would the board ask question about peak of insulin? pt was given NPH at 7 a.m.,

Answer 9

Check for hypoglycemia between 3 and 5 p.m.

Question 10

Lispro: (Humalog)

Answer 10

Don’t give it AC (before meal) … Give it with the meal
* Onset: 15 min
* Peak: 30 min
* Duration: 3 hrs
* Pattern: 15-30-3

Question 11

Glargine (Lantus)

Answer 11

• Long-acting insulin
• No Peak
• Duration 12 to 24 hrs
• Little to no risk for hypoglycemia (only one you can safely give at bedtime)

Question 12

What action invalidates the manufactures date

Answer 12

• Opening the package
• Once the package is open, the new expiration date is 30 days after that
• Open package without an opening or expiration date should be thrown out
• Label the package either with
  o “OPEN” and date package is open
  or
  o “EXP” and expiration date
• Once the package is open, refrigeration is optional
  o However, unopened bottle must be kept refrigerated
  o Although it is good practice to teach pt to refrigerate insulin at home

Question 13

Exercise potentiates insulin action

Answer 13

• Exercise is like another shot of insulin
• Therefore, if a student is schedule to play soccer (exercise) this afternoon … It is necessary
  to decrease the dosage of insulin
• In addition, the school nurse must give the student rapidly metabolized carbohydrates—
  snacks or juice

Question 14

Sick Days … Pt has a fever or the flu, and so on

Answer 14

• Serum glucose levels go up
• Need their insulin even though pt is not eating
• Take sips of water because they get dehydrated
• Any sick diabetic pt has 2 problems
  o Hyperglycemia and Dehydration

Question 15

Acute Complications of Diabetes

Answer 15

• Low blood glucose—a.k.a. Hypoglycemia or Hypoglycemic shock or Insulin shock/reaction
• Why are some of the causes
  o Not enough food
  o Too much insulin (#1 cause, can lead to permanent brain damage)
  o Too much exercise

Question 16

What does hypoglycemia look like?

Answer 16

• Think of Drunk pt in Shock
• Drunk
  o Staggering gait
  o Slurred speech
  o Cerebral impairment (labile)
  o Slow reaction time
  o Decrease social inhibition
• Shock—Vasomotor collapse
  o Tachycardia, tachypnea, Low BP
  o Cold/clammy, mottled skin

Question 17

Treatment of hypoglycemia

Answer 17

• Give pt sugars or Rapidly metabolizable carbohydrates such as
  o Juice (any), candy, regular soda, milk (lactose), honey, icing, jelly, jam
• Boards want sugar + starch or protein
  o For example, apple juice + turkey, Milk is sugar/protein—1/2 cup Skim milk
• Bad answer
  o Candy + Soda—1 sugar is good, 2 sugars are bad (give starch or protein, crakers)
• Unconscious pts—pay attention to location
• Glucagon IM if the mother is on the phone
• Dextrose IV (D10, D50) if in the ER

Question 18

DKA causes

Answer 18

• Too much food
• Not enough insulin
• Not enough exercise
• # 1 cause acute viral Upper Respiratory Infection within last 2 weeks

Question 19

S/Sx of DKA is “DKA”

Answer 19

• Dehydration (dry, poor skin elasticity and turgor, warm) … Water is a coolant (you overheat)
• Ketones in serum, Kussmauls, High K+
• Acidosis, Acetone breath, Anorexia due to nausea

Question 20

Treatment of DKA

Answer 20

• Insulin IV (Regular!)
• IV fluid! 200 mL/hr (some of the fastest rate)

Question 21

HHNK or HHS or HHNS

Answer 21

• High blood sugar in a Type 2
• These pts don’t burn ketones, no acid
• Whenever you see HHNK, think dehydration
• Severe Dehydration!
  o Skin is dry, flushed, decreased turgor, increased HR
  o #1 Nursing diagnosis: fluid volume deficit (same as dehydration)
  o #1 Nursing intervention: Rehydration!
  o Outcomes in successful treatment: Increase urine output, Moist mucous membrane, etc.

Question 22

Long-term complications of HHNK or HHS or HHNS

Answer 22

Poor perfusion, Peripheral neuropathy

Question 23

Long-term complications of diabetes

Answer 23

• Related to
  o Poor tissue perfusion
  or
  o Peripheral neuropathy
• Examples of long-term complications: Renal failure, Gangrene, Heart failure, Urinary
  incontinence, Pt can’t feel a burn on the foot
• For instance
  o Renal failure is a cause of poor perfusion
  o Urinary incontinence is a cause of peripheral neuropathy

Question 24

Differences between DKA and HHNK (* Which one is more dependent on insulin?)

Answer 24

o DKA pt is more dependent on insulin
o HHNK pt needs to be rehydrated

Question 25

Which one has a higher mortality rate?

Answer 25

o More pts die HHNK

Question 26

Which is a higher priority?

Answer 26

o DKA is a more acute condition and responds very quickly to insulin
o HHN pts show up late in the emergency room and do not readily respond to treatment

Question 27

Which lab test is the best indicator of long-term blood glucose level?

Answer 27

• Hb A1C, a.k.a. glycosated Hb or glycosylated Hb
  o Average blood sugar over last 90 days
• (Hb = Hemoglobin)
• Hb < 6 is normal
• Hb > 8 is out of control
• Hb 7 Borderline—have pt come in for evaluation