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med surg Diabetes Flashcards

1
Q

what is the pathologic cause of type 1 DM?

A

destruction of beta cells

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2
Q

what organ releases glucagon?

A

liver

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3
Q

what does beta cells do?

A

secretes insulin

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4
Q

what pH disorder is associated with DKA?

A

metabolic acidosis

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5
Q

what is breaking down in metabolic acidosis

A

fat

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6
Q

what is the pathologic cause of type 2 DM

A

insulin resistance
impaired insulin secretion
overworked beta cells

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7
Q

what 2 physical characteristics are of a type 2 DM patient that is not a characteristic of type 1 DM

A

obesity and age

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8
Q

which type of diabetes is genetic

A

both

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9
Q

t/f weight loss can cure diabetes

A

false

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10
Q

a patients lab on a routine exam revealed a fasting blood sugar = 140. whats an appropriate intervention for this patient?

A

consider repeating FBS, order HgbA1c, start SBGM, education about diabetes

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11
Q

what serum lab provides the most accurate representation of blood sugar control?

A

HgbA1c

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12
Q

what urinalysis finding is an indicator that blood sugar is not well controlled?

A

ketonuria

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13
Q

what are normal blood sugar values for fasting, postprandial, and HgbA1c?

A

FBG < 126
postprandial BG < 200
HgbA1c <6.5%

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14
Q

a newly diagnosed type 2 DM tells the nurse he doesn’t want to buy insulin he can just use his wife’s because she is diabetic. What 2 things indicate he needs education?

A

he is type 2 and needs oral most likely
don’t use meds not prescribed to you

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15
Q

when teaching a patient about injecting insulin what site should he avoid if he exercises daily?

A

arms/ legs bc with exercise, certain parts of the body may absorb insulin more quickly

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16
Q

if BS is < 80 prior to exercise, what should you teach a patient to do?

A

eat a snack before exercise

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17
Q

name a statement that indicates the patient understands the importance of foot care

A

” i need to check my feet every day for a cut and/or infection”

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18
Q

what is the ADA recommendation for % of fat/pro/carb per meal?

A

pro 10-20% (4 cal/g)
fat 20-30% (9 cal/g)
carb 50-60% (4 cal/g)

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19
Q

when educating patient about type 2 diabetes what should you discuss? (4 things to teach)

A

BS monitoring
medication therapy
diet/exercise
complications

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20
Q

what is important to tell patients when taking Alpha-Glucosidase inhibitors

A

must take with first bite of meal

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21
Q

what class of oral anti-diabetic agents is contraindicated with ETOH use and CKI (chronic kidney insufficiency)?

A

biguanides

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22
Q

what is basal insulin dosing mean and what is its peak?

A

its a 24 hour dose with no peak

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23
Q

a patient has been ordered 15 u NPH insulin in addition to 10 u Novolog R insulin to be given with meals. Which should you draw up first?

A

Novolog R - clear to cloudy

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24
Q

what type of insulin should be used with the sliding scale formula and what is the formula

A

short acting insulin
(BG-100)/30

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25
a type 2 DM has been changed from Metformin (biguanide) to litaglutide glucagon-like peptide 1 agonist (or GLP-1). what is important to tell the patient about his new medication regimen?
this new med is a daily injection and not an oral med
26
name 4 organs that can be affected by DM
heart eyes kidneys feet
27
what ocular pathological condition occurs with DM
diabetic retinopathy
28
what are the macrovascular complications associated with uncontrolled diabetes
CAD (coronary artery disease) CVA PVD
29
what are the microvascular complications associated with uncontrolled diabetes
retinopathy nephropathy
30
t/f - greater than 50% of amputations are performed on DM patients
true
31
name all the things a diabetic must do
take insulin (t1) or oral (t2) cholesterol med baby aspirin ACE or ARB HgbA1c test every 3 mo podiatrist every 3 mo check feet everyday ophthalmologist every year EKG every year Neurologist every year
32
t/f - physiologic stress frequently causes hypoglycemia
false
33
When managing hyperglycemic episodes of patients during their hospitalization, the nurse needs to identify the factors that contribute to this. Name 3 of these causes
Routine mealtimes, portions, choice Aggressive Tx of hypoglycemia Mismatched timing of meals & med therapy IV fluid therapy with dextran Certain prescribed meds Procedural NPO status
34
A 70 yo with long standing diabetes presents to hospital with fevers, RLE erythema, edema, and 1 inch wound with drainage right medial aspect of heel. She reports she had a pedicure 5 days prior to admission. What is her diagnosis?
cellulitis
35
what complication is most likely related to the ladys cellulitis that had the pedicure?
peripheral neuropathy
36
t/f - eating lots of sugar will cause type 2 DM
false
37
name at least 4 clinical manifestations (s/s) of diabetes
polyuria polydypsia polyphagia fatigue poor wound healing (infections)
38
what serum lab test is most accurate representation of blood sugar control?
glycated hemoglobin
39
what does microalbuminuria indicate in diabetics?
kidney disease or early stage diabetic nephropathy
40
what condition occurs when nerve conduction is affected by diabetes?
neuropathy
41
when should you repeat blood sugar after treating hypoglycemia?
15 minutes
42
what class of medications are used to protect kidney function in diabetics?
ACE and ARBs
43
what organ's function or lack there of causes diabetes
pancreas
44
what hormone is secreted that affects blood sugar
insulin
45
what type of hormone is insulin
anabolic (storage hormone)
46
what type of cell secretes insulin and where is it located
beta cells in islets of langerhans
47
what action affects insulin secretion
eating
48
when insulin increases it moves glucose where
into muscle, liver, and fat cells
49
t/f - the pancreas secretes insulin during fasting periods
true
50
t/f - glucagon is released when blood sugar increases
false (decreases)
51
t/f - glucagon is a hormone
true
52
t/f - insulin and glucagon together maintain a constant level of glucose
true
53
t/f - the liver releases glucagon
false (alpha cells in the pancreas release glucagon)
54
t/f - the pancreas has stored glucose and is released in response to insulin secretion
true
55
t/f - after 12 hours without food, the liver forms glucose through gluconeogenesis
true
56
t/f - gluconeogenesis occurs from the rapid breakdown of carbohydrates
false (noncarbohydrated substances like amino acids)
57
t/f glycogen is a glucose that can be stored by our muscles and liver
true
58
what is the BS level for HHS?
>600
59
what is the BS level for DKA?
300-600
60
if a patient comes in with fruity breath, what do they have?
DKA
61
what 5 things do DKA, HHS, and Hypoglycemia have in common?
altered LOC possible seizures treat immediately (emergency) give them more DM education can be caused by dehydration
62
what is it called when you have a loss if fatty tissue?
lipoatrophy
63
DM is the leading cause of what 3 things
amputations blindness ESRD
64
what are the s/s of a type 1 diabetic
young weight loss abdominal pain fatigue polyuria polydipsia polyphagia
65
what are the characteristics of a type 2 diabetic
older weight gain slow onset blurred vision 3P's
66
at what BS should a DM avoid exercise
BG>250 BG<80
67
if a pt is hot and dry..
their sugar is high (hyperglycemic)
68
what are hypoglycemic s/s (mild to severe)
cold clammy blurred vision difficulty speaking weakness coordination issues numb lips and tongue seizures LOC Coma
69
how do you treat a severe hypoglycemic pt
give 1mg glucagon IV or IM or give 50% dextrose IV once able to swallow, give food
70
give examples of carbs for the 15-15 rule
1/2 cup juice glucose tablets 1/2 soft drink hard candies 4 sugar cubes 3 graham crackers
71
muscle cramps after DKA episode can be from what
loss of salt hyponatremic
72
whats the treatment for HHS & DKA
fluid replacement with NS correct electrolyte balance by giving dextrose 5% when BS =300 insulin administration (short acting)
73
what is the serum osmolarity in an HHS pt
>350mOsm/L
74
what is the plasma bicarbonate level in DKA pt
<15mEq/L
75
what is the common lab levels for DKA and HHS
BUN/ Creatinine are both elevated
76
what is the common treatment for micro and macrovascular complications
control BP control BG control Lipids
77
what are the s/s for peripheral neuropathy
paresthesia burning numbness Charcot's joint
78
what meds do you take to prevent peripheral neuropathy
cymbalta neurontin (gabapentin) lyrica tegretol mexitil

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