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Ivy Tech Nursing > Med Surg III - Diabetes > Flashcards

Med Surg III - Diabetes Flashcards

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1
Q

What is DKA?

A

Diabetic Ketoacidosis

  • deficiency of insulin
  • hyperglycemia
  • ketosis
  • acidosis
  • dehydration
  • BS >250
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2
Q

DKA: What are some precipitating factors?

A 
Illness
Infection
Inadequate insulin dosage
Undiagnosed Type I diabetes
Poor self-management
Neglect
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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.
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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
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5
Q

What is orthostatic hypotension:

A

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

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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
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7
Q

What are Kussmaul respirations:

A

Body’s attempt to reverse metabolic acidosis.

Deep and rapid.

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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
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9
Q

What is HHNS:

A

Hyperosmolar Hyperglycemic Nonketotic Syndrome

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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.

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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

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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
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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

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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!!
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15
Q

Some complications of hypo/hyperglycemia?

A 
Angiopathy
- macrovascular
- microvascular
- retinopathy
Nephropathy
Neuropathy
Infection
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16
Q

What is Angiopathy?

A

blood vessel disease

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17
Q

What is macrovascular angiopathy?

A

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

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18
Q

What is microvascular angiopathy?

A

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

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19
Q

What is retinopathy?

A

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

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20
Q

What is nephropathy?

A

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

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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

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22
Q

Long-term complications of diabetes?

A 
Neuropathy
Pressure ulcers
Blindness
Stroke
Amputation
Dementia
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23
Q

What is autonomic neuropathy?

A

controls involuntary body functions.

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24
Q

What are signs of autonomic neuropathy?

A 
Hypoglycemia unawareness
Bowel incontinence
Diarrhea
Urinary retention
Gastroparesis
Cardiovascular abnormalities
Sexual dysfunction
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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!

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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.
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27
Q

What is the carbohydrate count for 1800 ADA diet?

A 
4 breakfast
4 lunch
5 dinner
2 snack
15 total
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28
Q

What is carbohydrate count for 2000 ADA diet?

A 
4 breakfast
5 lunch
5 dinner
3 snack
17 total
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29
Q

What education should nurse give to diabetic pt?

A 
S&S
Feet
Monitor BS
Survival Skills
Med instructions
Sick Day management
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30
Q

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

A

Loss of consciousness
Seizures
Death

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31
Q

What is the Rule of 15:

A

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

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32
Q

What is considered to be a carbohydrate?

A 
Bread
Grains
Cereal
Fruit
Vegetables
Milk
Any sweetened items
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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.

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34
Q

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

A

Food tray!

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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

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36
Q

treatment for neuropathy

A

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

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37
Q

ways to decrease complications of diabetes

A

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

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38
Q

when should you look for symptoms of hypoglycemia

A

at peak times (oral hyperglycemics last longer)

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39
Q

what is ulcerative colitis

A

chronic, recurrent inflammation of intestinal tract (cause unknown)

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40
Q

where does ulcerative colitis begin

A

in the rectum, spreads up colon

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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

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