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N353: Practice of Nursing II > MedSurg Mod 5: Diabetes > Flashcards

MedSurg Mod 5: Diabetes Flashcards

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1
Q

What is happening with diabetes prevalence

A

it is increasing among all gender and race groups

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2
Q

What sort of minority groups are disproportionately affected by diabetes

A

African Americans

Hispanic Americans

Pacific Islanders

Native Americans

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3
Q

Different Classifications of Diabetes

A

Type 1

Type 2

Gestational

LADA and MODY

Diabetes Associated with other conditions

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4
Q

MODY

A

Maturity onset diabetes of the young

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5
Q

LADA

A

latent autoimmune diabetes in the adult

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6
Q

Except in Type 1 Diabetes, what can people do with diabetes categories

A

move from one to another

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7
Q

If someone says a steroid caused them to have diabetes, what does that mean?

A

If a person had a lung disease and got steroids to decrease inflammation, the steroids will increase glucose levels and they may rise to a diabetic level

This did not cause diabetes directly but pushed the levels beyond tolerance and the person was probably close to diabetes as well

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8
Q

Why can Cystic Fibrosis cause Diabetes

A

clogged ducts lead to pancreatic damage which damages beta cells meaning there is no insulin made

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9
Q

S/S of Diabetes

A

fatigue

thirst (polydipsia)

hunger (polyphagia)

increased urinary output (polyuria)

vision changes

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10
Q

Why does vision change with diabetes?

A

2 reasons:

  1. Fluid changes in the eye from dehydration
  2. Circulating glucose is damaging the retina and structures of the eye
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11
Q

Diagnosis of diabetes involves what?

A

Symptoms AND any of the following:

  1. RANDOM blood glc > or equal to 200 mg/dL
  2. FASTING glc > or equal to 126 mg/dL
  3. 2 Hour Post Prandial glc > or equal to 200 mg/dL
  4. HgA1c levels >or equal to 6.5-7%
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12
Q

Why does random blood glucose not usually diagnose diabetes

A

it has no regard to the time of the day or meals recently eaten among other considerations

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13
Q

Which of the 4 possible diagnostic tests is the classic measure for diagnosing diabetes

A

Fasting Glucose

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14
Q

HgA1c

A

it is glucose stuck to hgb/RBC

it is being used more and more nowadays

it is a measure of how much glucose our RBC is exposed to over 3 months and we want that to be below 7%

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15
Q

Can an A1C be drawn at any time with no preparation or fasting unlike a Fasting Glucose?

A

yes

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16
Q

What level of HgA1c is concerning for diabetes

A

above 6.5-7%

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17
Q

What level of Fasting glc is concerning for diabetes

A

> or equal to 126

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18
Q

What are the important topics to educate the diabetic patient about

A
  1. Self Care
  2. Disease Process
  3. Consequences and Complications
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19
Q

What things need to be included for education on Self care for a diabetic

A
  1. SMBG - self monitoring blood glucose
  2. foot care
  3. the 3 F’s
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20
Q

What are the 3 F’s

A

Food
Fitness
Fixes (in illness)

teach these to a diabetic

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21
Q

What are some major consequences and complications that arise from diabetes

A

Cardiovascular Disease (the big one)

Nephropathy

Neuropathy

Retinopathy

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22
Q

Blood glucose over the limit regardless by how much…

A

it over the limit and can still cause damage - so it is important to teach people that

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23
Q

What are some options for administering insulin at home

A

Needle and syringe

insulin pens

jet injectors

insulin pumps

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24
Q

Jet Injectors

A

Puts insulin in SQ region without a needle

It is not painful but there is a sensation of jet pressured injection

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25
Q

Insulin Pump

A

It is not an IV, it is put in SQ tissue and insulin is given AND blood glucose levels are monitored

It attempts to mimic normal body changes and can be automatic or decided by you

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26
Q

Why is self monitoring so important in diabetes

A
  1. Useful tool as part of diabetes management
  2. Helps to detect hypoglycemia
  3. helps to adjust insulin dosing
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27
Q

Freestyle Libre

A

one continuous glc monitoring system (like another - Dexcom G6) that uses a thin filament to measure glucose every minute - a glucose monitoring innovation

it has a sensor on the back of the arm and a handheld scanner that reads results

It requires a fingerstick for confirmation of problems though

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28
Q

What is important education to teach the diabetic patient regarding being sick or having GI illness

A
  1. do NOT eliminate insulin doses even with N/V
  2. Person should attempt small frequent portions of carbohydrates
  3. Drink fluids every hour
  4. Assess blood glucose every 3-4 hours
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29
Q

Why should insulin not be eliminated when sick?

A

because during times of stress blood glucose levels will rise even if you are not eating

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30
Q

What are the main areas of focus for diabetic foot care

A
  1. Daily inspection and bathing of feet
  2. Properly fitting shoes / podiatry (no bare feet d/t infection and wound risk)
  3. toenail management (by a podiatrist)
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31
Q

Generally if you hear type 1 Diabetes what are the most common consequences seen

A
  1. Blindness
  2. Kidney Disease (50% of new ESRD pts are diabetic)
  3. Peripheral Neuropathies
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32
Q

Generally if you hear type 2 diabetes what are the most common consequences seen

A
  1. Heart Disease
  2. HTN
  3. Stroke
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33
Q

What is important to note about the common consequences of type 1 and 2 diabetes

A

they can be seen in either type of diabetes, we just generally see certain consequences more commonly in one type or another due to age of diagnosis

for example the cardiovascular issues of type 2 often coincide with a later life diagnosis where the vessel related changes are added on top of it to speed up vessel damage

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34
Q

What are the 4 most important complications of Diabetes

A

Hypoglycemia

Hyperglycemia

DKA

HHS or HHNKS

35
Q

Hypoglycemia is an ___

A

emergency

36
Q

Medical Management for Hypoglycemia Initially

A

First grab 15 g of oral carbohydrates

If an emergency where not awake: 1 amp of D50W IV can be used

Maintenance of IV solution occurs as well

37
Q

Why is D50W IV important for emergency hypoglycemia

A

it contains 25 gm of dextrose - simple

1 gram will increase blood glucose about 4 mg

and it is metabolized fast in 30 minutes

38
Q

What is the first line of action: 15 g oral carbohydrate or 1 amp of D50W IV for hypoglycemia?

A

15 g oral carb

39
Q

1 gram of the 25 grams of dextrose will increase blood glucose levels by ___ mg

A

4 mg (approx)

40
Q

Nursing Interventions for Hypoglycemia

A

monitor IV site

I&O

monitor labs: glc and lytes

monitor IV fluid, rate, site

education on s/s of hypoglycemia and prevention - such as having a simple carb available at home

41
Q

Medical management for Hyperglycemia initially

A

IV REGULAR INSULIN infusion w/ frequent glucose checking

IV Fluids since water is also being pulled out of the body

42
Q

What kind of insulin is given to hyperglycemics

A

Regular Insulin via IV

43
Q

Nursing Interventions for Hyperglycemia

A

Monitor IV concentrations and rate

I&O

monitor labs like glucose and lytes

education on s/s and prevention

44
Q

Insulin Drip

A

a nursing intervention of regular insulin given IV

it is diluted in normal saline and it is regular NOT fast acting

there is a specific technique and procedure to giving this as insulin can adhere to the sides of tubing

always given via a pump, never manually

45
Q

What are the specific flushing and priming procedures for insulin drip

A

In patient treatment only

Always use an IV pump not manual

Typically it is computer guided

46
Q

What are the 6 S’s or 6 Common Causes for DKA

A

Sepsis (infection)

Skipped insulin dose

Stress (mostly physiological but emot/psych as well)

Sugar

Surgery

Substance abuse

47
Q

What is the human response (s/s) of DKA

A

thirst or very dry mouth

frequent urination

fatigue

dry or flushed skin (from dehydration)

N/V or abdominal pain (Abdominal pain is a HUGE one)

SOB (maybe yes maybe no)

difficulty concentrating

48
Q

Diagnostic Lab Tests for DKA

A

Blood glc levels >250

Ketones in urine

blood gases: pH <7.3 and Bicarb <18 mEq/L

Creatinine increased

Sodium, Potassium, Phosphate nL or Increased

49
Q

How can you remember the human response to DKA via D.K.A.,?

A

D - Diuresis, Dehydration, Delirium, Dizziness

K - Kussmaul breathing, Ketotic breath

A - Abdominal Pain!!!

50
Q

Kussmaul breathing

A

breathing faster to blow off Co2 in DKA

51
Q

Medical Goals of DKA

A

Rehydration

Restore Electrolytes

Reverse Acidosis

52
Q

If the goal is rehydration, what must the nurse do for the DKA patient

A

VS

Monitor I&O

Monitor IV: Solution, Rate, Site

Monitor Lungs and Extremities: Edema

Monitor Mental Status

53
Q

If the goal is restoring electrolytes, what must the nurse do for the DKA patient

A

Monitor Labs: Glucose level, Potassium Level!!!, Bicarbonate Level, CO2 level

Maintain telemetry

Replace electrolytes as ordered

Monitor neurological status

54
Q

Why is potassium to critical to think about with DKA

A

because K will shift into cells with insulin via DIK

55
Q

Telemetry

A

monitoring heart rhythm

56
Q

Neurologic status will improve from DKA as…

A

glucose levels improve

57
Q

If the goal is reversing acidosis what must the nurse do for the DKA patient

A

Administer IV insulin and bicarbonate as ordered (may see bicarb but insulin is always given)

Monitor ABGs

58
Q

Hyperglycemia Hyperosmolar NonKetotic Syndrome (HHS or HHNKS)

A

INADEQUATE INSULIN

> Not enough to prevent hyperglycemia BUT enough to prevent lipolysis

more common in Type 2

*so no fats break down but hyperglycemia is not prevented - also it is no acidotic

59
Q

Common Causes for HHNKS

A

Acute Illness (most common reason)

Medications that exacerbate hyperglycemia like contraceptives, thiazides, and steroids

Dialysis

60
Q

Human Response (S/S) of HHNKS

A

Persistent osmotic diuresis (d/t hyperglycemia) (greater than DKA)

Profound dehydration - dry mucous membranes, poor skin turgor, tachycardia, variable neurological signs like altered mental status, seizures and hemiparesis

Hypotension

61
Q

Diagnostic Lab Tests for HHNKS

A

Increased blood glucose 600-1200 mg/dL

Electrolytes

CBC

increased BUN

increased Serum Osmolality exceeding 350 mOsm/kg

ABGs have a normal bicarbonate (non acidotic)

62
Q

What may be worse in HHNKS compared to DKA

A
  1. Fluid Loss is greater
  2. Blood glucose may be higher and worse

*but there is no acidosis so it isnt as deadly as quickly as DKA

63
Q

What is the big symptom that sets HHNKS apart from DKA

A

Neurological Findings

The neurological status can be so affected that they appear to be having a stroke

64
Q

Medical Goals of HHNKS

A
  1. Rehydration
  2. Restore Electrolytes
  3. IV Insulin Administration
65
Q

If the goal is rehydration, what must the nurse do for the HHNKS patient

A

VS

Monitor I&O

Monitor IV solution rate and site

Monitor lungs/extremities for edema

Monitor mental status

66
Q

If the goal is restoring electrolytes what must the nurse do for the HHNKS patient

A

Monitor labs - glucose level, potassium level, bicarbonate level, CO2

Maintain telemetry

replace electrolytes as ordered

monitor neurological status

67
Q

If the goal is IV insulin administration what must the nurse do for the HHNKS patient

A

administer insulin as ordered

monitor ABGs

68
Q

Which condition has potassium as a more serious concern: DKA or HHNKS

A

DKA due to Hydrogen potassium ion shifting

69
Q

Which condition has a larger need for fluids: DKA or HHNKS

A

HHNKS

70
Q

What is an important thing to consider regarding diabetes and hospitalization

A

Often diabetes is not the primary diagnosis or the reason for hospitalization - if anything it would be DKA or HHNKS causing the admission

71
Q

Why do glucose control needs change with hospitalization for the diabetic patient

A

it means when someone has a physiological stressor like an infection or MI, the glucose levels will rise so they will need to change their usual medications to keep these levels under control

it must be kept in mind as people around you will forget

stress increases everyone’s glucose, but usually beta cells take care of it but that is not possible for diabetics

72
Q

What are some major self care issues for Diabetics in the hospital

A
  1. Conflict with Hospital Routine - they may do well with their diabetes at home but the changes of the hospital routine can alter their glucose levels
  2. Monitor for educational opportunities as now is the time to augment their knowledge
73
Q

Nursing Interventions for the Hospitalized Diabetic

A

Assess patient home routine and communicate to appropriate departments

Assess patient reaction to any previous hypoglycemic episodes

Know insulin actions and peaks

Arrange for snacks if meals are delayed

74
Q

What to do Pre operatively for a diabetic going into surgery

A

monitor for s/s of hypo and hyperglycemia as stress will elevate blood glucose and prolonged NPO status can decrease it

Monitor labs

only give about half the amount of medicine as it is ordered that way prior to entering surgery

75
Q

What to do for post operative care for a diabetic coming out of surgery

A

Routine post op care AND:

monitor for s/s of hypo and hyperglycemia

monitor labs

monitor for cardiovascular complications

monitor for skin breakdown

maintain adequate nutrition and hydration

not very different except for particular attention to skin and glycemia

76
Q

Diabetics are more prone to ___ since their wound healing is impaired

A

dehiscence

77
Q

Insulin is a __ __ medication

A

high risk

78
Q

What must be done for giving insulin?

A
  1. Verify order and insulin vial with another nurse and know hospital policy for high risk medications
  2. Check patients blood glucose BEFORE administering
  3. Know how to mix insulin in one syringe or even if they can be mixed as most cannot
79
Q

Most insulin cannot __ together

A

mix

80
Q

What 2 kinds of insulin NEVER mix with any other kinds of insulin

A

Long Acting Insulin

Extra Long Lasting Insulin

81
Q

You can only mix ___ and ___ insulin

A

Regular and NPH (Intermediate)

82
Q

How to draw up regular and NPH insulin to mix when OK

A

Step 1. Draw up the clear (Regular and fast acting)

Step 2. Draw up the cloudy (NPH intermediate acting)

83
Q

Why is NPH referred to as long acting insulin when it is an intermediate acting insulin

A

it used to be a long acting but is now intermediate

N353: Practice of Nursing II (14 decks)

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