Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Ivy Tech Nursing > Med Surg III - Diabetes > Flashcards

Med Surg III - Diabetes Flashcards

You may prefer our related Brainscape-certified flashcards:
Nursing Pharmacology flashcards NCLEX-RN® flashcards Nursing Mental Health flashcards Nursing Fundamentals flashcards Nursing Safety & Infection flashcards Nursing Adult Health flashcards NCLEX-PN® flashcards Nursing Management of Care flashcards Nursing Pediatrics flashcards Nursing Maternity flashcards
1
Q

What is DKA?

A

Diabetic Ketoacidosis

  • deficiency of insulin
  • hyperglycemia
  • ketosis
  • acidosis
  • dehydration
  • BS >250
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

DKA: What are some precipitating factors?

A 
Illness
Infection
Inadequate insulin dosage
Undiagnosed Type I diabetes
Poor self-management
Neglect
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

DKA: Pathophysiology?

A
  • Circulating insulin is insufficient, elevation of counter-regulatory hormones (glucagon, cortisol, and growth hormone)
  • Glucose is not used, so the body breaks down fat for energy
  • Ketones (acid by-product of fat metabolism) removed in urine (Ketonuria)
  • Ketosis alters pH balance
  • Metabolic acidosis develops
  • Electrolytes depleted - body attempting electrical neutrality, caused by polyuria (Na, K, Cl, Mg, Ph), hypovolemia
  • Insulin def. impairs protein synthesis, degradation. Nitrogen losses.
  • Insulin def. stimulates glucose production which leads to further hyperglycemia.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Signs of dehydration:

A 
Poor skin turgor (if older, check chest, forehead for tenting)
Dry mucous membranes
Tachycardia
Orthostatic hypotension
Sunken eyeballs
Lethargy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is orthostatic hypotension:

A

Decreased bp when standing (may take up to 3 minutes to appear)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are some clinical manifestations of DKA?

A 
Dehydration
Abdominal pain
N/V
Kussmaul respirations
Blood glucose >250
pH <7.35
Ketones in blood and urine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are Kussmaul respirations:

A

Body’s attempt to reverse metabolic acidosis.

Deep and rapid.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How to treat DKA?

A
  • IV insertion … hydrate!
  • Fluids - NS or 1/2 NS to quickly increase vol.
  • K+ for hypokalemia
    • at risk for vtac, vfib, place pt. on cardiac monitor
  • Insulin bolus/insulin infusion
    • Pt. becomes anxious/nervous/sweaty
    • Get glucose reading hourly
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is HHNS:

A

Hyperosmolar Hyperglycemic Nonketotic Syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Describe HHNS?

A

The pt. is able to produce enough insulin to prevent DKA, but not enough to prevent severe hyperglycemia, osmotic diuresis, and extracellular fluid depletion.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Some signs of HHNS?

A

No ketosis
Hypovolemic
Usually occurs in older adults with Type 2
Hospital admission - insert large bore IV cath for large volumes of IV fluids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How to care for a patient with HHNS?

A 
IV fluids, NS or 1/2 NS
Regular insulin - bolus then infusion
Monitor lytes - polyuria
Requires more fluid than DKA - pt. severely dehydrated, blood sugar severely high
Cardiac monitoring
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is hypoglycemia?

A

Too much insulin
Symptoms mimic alcohol withdrawal
Blood glucose <70 mg/dl
Confusion, irritability, diaphoresis, tremors, hunger, weakness, visual disturbances

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Treatment for hypoglycemia?

A 
Check glucose
Give 1/2 c. juice, pop, etc.
Follow with complex carbohydrate and protein to prevent sugar crash
Vital signs
Document!!
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Some complications of hypo/hyperglycemia?

A 
Angiopathy
- macrovascular
- microvascular
- retinopathy
Nephropathy
Neuropathy
Infection
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is Angiopathy?

A

blood vessel disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is macrovascular angiopathy?

A

vascular cardio and PVD blood vessel disease. First indication of angiopathy.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is microvascular angiopathy?

A

eyes, kidneys, and skin. Can take years to see evidence.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is retinopathy?

A

microanurisms in capillary walls of eye, leaks out into eye, microvascular damage to eye.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is nephropathy?

A

damage to the kidney treated with aggressive management with ACE inhibitors (prils)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is neuropathy/sensory neuropathy?

A

nerve damage
Sensory - lops (loss of protective sensation)
-avoid high heels
-wash feet, dry, no soaking
-avoid heating pads, commercial callus and corn remover
-see specialist

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Long-term complications of diabetes?

A 
Neuropathy
Pressure ulcers
Blindness
Stroke
Amputation
Dementia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is autonomic neuropathy?

A

controls involuntary body functions.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are signs of autonomic neuropathy?

A 
Hypoglycemia unawareness
Bowel incontinence
Diarrhea
Urinary retention
Gastroparesis
Cardiovascular abnormalities
Sexual dysfunction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Why is infection a complication of hypo/hyperglycemia?

A

There is a defect in the mobilization of inflammatory cells which causes impairment of phagocytosis by neutrophils and monocytes.
Glycosuria predisposes to bladder infections because bugs like sugar!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Hemoglobin A1c Test

A 
Glycosalated Hgb
- 4-6% normal
- 7-9% elevated
- 7% and less for diabetics
Gives average blood glucose over 90 days.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What is the carbohydrate count for 1800 ADA diet?

A 
4 breakfast
4 lunch
5 dinner
2 snack
15 total
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What is carbohydrate count for 2000 ADA diet?

A 
4 breakfast
5 lunch
5 dinner
3 snack
17 total
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What education should nurse give to diabetic pt?

A 
S&S
Feet
Monitor BS
Survival Skills
Med instructions
Sick Day management
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What are possible poor outcomes as a result of hypo/hyperglycemia?

A

Loss of consciousness
Seizures
Death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What is the Rule of 15:

A

Give 15 g. carbs, check blood glucose in 15 minutes.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What is considered to be a carbohydrate?

A 
Bread
Grains
Cereal
Fruit
Vegetables
Milk
Any sweetened items
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

For what diagnostic testing should Glucophage (Metformin) be held for?

A

All diagnostic tests using contrast media (when taken together, kidneys may not be able to properly elim. Glucophage from blood). Restart 3 days later.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What item is important to have in pt.’s room prior to giving insulin?

A

Food tray!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What should nurse do when DKA patient’s glucose is below 250?

A

decrease the insulin infusion rate and add IV solution containing dextrose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

treatment for neuropathy

A

control glucose
Creams - capsaicin (dangerous for lower extremities)
tricyclic antidepressants
anti-seizure meds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

ways to decrease complications of diabetes

A

educate patient on tight glucose control, lower their weight, exercise, stop smoking, dialysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

when should you look for symptoms of hypoglycemia

A

at peak times (oral hyperglycemics last longer)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

what is ulcerative colitis

A

chronic, recurrent inflammation of intestinal tract (cause unknown)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

where does ulcerative colitis begin

A

in the rectum, spreads up colon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

what age group is most affected by ulcerative colitis

A

15 - 25, and 60 - 80

42
Q

S & S of ulcerative colitis

A

bloody stools, abdominal pain/cramping, fever, anorexia, and rebound tenderness (report rebound tend. immediately)

43
Q

complications of ulcerative colitis

A

increased risk of colorectal cancer, hemorrhage, malabsorption, liver disease, osteoporosis, colon can become paralyzed and not function

44
Q

what diagnostic results would ulcerative colitis have

A

decrease sodium, dehydration, increase hematocrit, iron deficiency, and blood, mucus, or pus in stool

45
Q

treatment for ulcerative colitis

A

rest the bowel (NPO), control inflammation, combat infection, correct malnutrition (TPN), alleviate stress, drug Sulfasalazine (must be taken with meals)

46
Q

diet for ulcerative colitis (after acute phase of NPO)

A

high calorie, high protein, low fiber, vitamin and iron supplements, avoid cold foods and stop smoking

47
Q

what should patient do if they are having more than 10 stools per day

A

go to the ER

48
Q

what is Crohn’s disease

A

inflammatory bowel disorder (usually small intestine) on any part of the GI tract. it is lifelong with unpredictable periods of remissions and recurrences

49
Q

clinical manifestations of Chron’s

A

insidious (creeps up on them), diarrhea, fatigue, abdominal pain, weight loss, fever, non-bloody diarrhea

50
Q

complications of Chron’s

A

strictures, obstructions, fistulas, impaired absorption, arthritis, liver disease, kidney stones

51
Q

how is Chron’s diagnosed

A

History (bowel movements) & physical (abdominal tenderness). Cobblestone pattern shown on barium study, increase in WBC, decrease in Albumin

52
Q

Treatment for Chron’s

A

75% need surgery (does not cure), corticosteroids to reduce inflammation, immunosuppressive agents, Flagyl (topical) if perianal area affected, Remicade (prevents activity of TNF)

53
Q

Diet for pt with Chron’s

A

high calorie, high protein, low fat, low fiber, Vitamin B12

54
Q

what is Celiac Sprue

A

malabsorption disorder, intolerance to dietary wheat proteins, gluten, barley, oats

55
Q

How does Celiac Sprue present

A

weight loss and diarrhea containing fat deposits

56
Q

what is diverticulitis

A

inflammation of diverticulum (out-pouch of mucosa of the intestinal wall

57
Q

treatment for diverticulitis Acute

A

NPO, parenteral fluids, NG tube to drain bile…assess for pain and observe for peritonitis

58
Q

diet for pt with diverticulitis

A

high fiber, avoid nuts, seeds, raspberries, strawberries

59
Q

Common for all hepatitis pt’s

A

use standard precautions

60
Q

what does elevation in T3 or T4 signify

A

hyperthyroidism

61
Q

what do low T3 or T4 values signify

A

hypothyroidism

62
Q

treatment for hypothyroidism

A

monitor vitals, admin thyroid replacement drugs, provide roughage and fluids for constipation, warm environment, avoid sedatives & opioids, monitor for OD of meds (start low and go slow), meds are increased over weeks

63
Q

treatment for hyperthyroidism

A

provide rest, admin sedatives, cool and quiet environment, daily weight, high calorie diet, admin anti-thyroid meds (PTU, iodine), admin propanolol for tachycardia

64
Q

treatment for myxedema coma

A

1 is maintain patent airway, aspiration precautions, meds, take hourly temperature, keep warm

65
Q

HBsAG

A

hepatitis B surface antigen, if present indicates hep B infection

66
Q

IgM

A

indicates acute hepatitis A

67
Q

IgG

A

indicates past hepatitis A infection

68
Q

Hepatitis A

A

fecal-oral, can go away

69
Q

Hepatitis B

A

blood or body secretions, adequate rest and nutrition are most important treatments (no cure)…contact precautions

70
Q

Hepatitis B teaching

A

no alcohol for one year, watch meds metabolized in liver, family members should be tested, use condoms

71
Q

once jaundice is gone, are Hep B patients fully recovered

A

NO

72
Q

who should be tested for Hep C

A

everyone with history of IV drug use

73
Q

how is Hep C transmitted

A

percutaneously (IV drug use, transfusions, sex, tattoos, body piercing, organ transplant).

74
Q

treatment for Hep C

A

interferon and ribaviron

75
Q

what is needed for Hep D to infect body

A

Hep B, same route of transmission

76
Q

Hep E usually comes from what

A

contaminated water or poor sanitation (fecal-oral)

77
Q

preicteric phase of Hep

A

initially may be asymptomatic, 1 - 21 days, GI symptoms, anorexia, malaise, HA, right upper quadrant pain

78
Q

Icteric phase of Hep

A

jaundice (seen in sclera, palms, soles, skin, hard palate)

79
Q

posticteric phase of Hep

A

malaise and fatigue, hepatomegaly…jaundice may be gone

80
Q

Lab value associated with Hepatitis

A

increased biliruben > 1.5 (also clay colored stools may be present)

81
Q

complications of hepatitis

A

liver failure, cirrhosis, hepatocellular carcinoma

82
Q

clinical manifestations of cirrhosis

A

GI complaints, enlarged liver, jaundice, spider angiomas, portal hypertension, pruritus, esophageal varices, ascites

83
Q

highest priority for patient with esophageal varices

A

maintaining airway (they may rupture). Can do banding to correct them

84
Q

what should patient do before a paracentesis

A

empty their bladder

85
Q

how can ascites be treated

A

paracentesis (drain the fluid)

86
Q

what can lead to encephalopathy

A

increase in ammonia levels

87
Q

why monitor albumin level in cirrhosis patients

A

the low pressure caused by hypoalbuminemia is the reason for ascites and edema

88
Q

hepatic encephalopathy treatment

A

use lactalose to trap ammonia in the gut, do not d/c for diarrhea because it improves neural function

89
Q

meds that can be use for cirrhosis

A

histamine blockers and beta blockers

90
Q

asterixis

A

flapping tremors (have patient extend arms) cirrhosis complication

91
Q

fetor hepaticus

A

musty sweet odor of breath (poopy mouth) cirrhosis complication

92
Q

treatment for liver cancer

A

palliative, or transplant

93
Q

acute pancreatitis manifestations

A

pain severe and unrelenting, may be epigastric pain, abdominal pain in LUQ that radiates to back, N/V, BS absent or decreased, fever, leukocytosis, tachycardia, jaundice

94
Q

highest priority for acute pancreatitis

A

respiratory failure

95
Q

lab values associated with acute pancreatitis

A

elevated glucose, amylase, and lipase, risk for hypocalcemia

96
Q

Trousseau’s

A

carpal spasm when blood pressure cuff is inflated, sign of hypocalcemia

97
Q

Chvostek’s

A

contraction of facial muscle when you tap on face, sign of hypocalcemia

98
Q

treatment for acute pancreatitis

A

pain relief (morphine), prevent shock (fluid replacement), reduce secretions (NPO, NG suction, Tagament, Prilosec), and treat the infection causing it

99
Q

chronic pancreatitis manifestations

A

lot of pain, weight loss, jaundice, steatorrhea (fatty stools), diabetes

100
Q

treatment for chronic pancreatitis

A

pain relief, can not tolerate fatty foods, control diabetes, bland, low fat, high CHO diet

101
Q

whipple

A

surgery involving resection of the pancreas, duodenum, distal portion of stomach, and common bile duct

102
Q

risk factors for pancreatic cancer

A

smoking, diabetes, high fat diet

Ivy Tech Nursing (21 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions