Nsg: Diabetes

Question 1

Acute Complications of DM

Answer 1

• Hyperglycemia: HHNS, DKA.

- Hypoglycemia

Question 2

Long term Complications of DM

Answer 2

Microvascular:

• Neuropathy,
• Retinopathy,
• Nephropathy

Macrovascular:
-Peripheral Arterial disease (from Atherosclerosis)

Erectile Dysfunction (ED): Tigh glycemic control delays onset. 
Tx: with viagra and referral to an ED specialist

Question 3

Tx of Hyperglycemia

Answer 3

Inuslin
Meformin
Exercise
Diet of low CHO and sugar

Question 4

Tx of Hypoglycemia

Answer 4

Mild: 15g CHO, 175ml OJ or soda

Wait 15min, check BG, repeat if t awake to swallow.

Question 5

What is Peripheral Vascular Disease?

Answer 5

Narrowing and degeneration of the arteries: Neck, abdomen, and extremeties.

Question 6

Tx for Peripheral Arterial Disease

Answer 6

Sx:

• Angiogram
• Angioplasty
• Bypassgraft
• Amputation (last resort)

Increase exercise to increase collatoral circulation, walk till point of discomfort and rest to let circulation continue then restart. Antiplatelets, pain managment when sleeping, HOB elevated when sleeping, reduce dietary cholesterol, fats, calories prn, and use meds to reduce cholesterol (all to prevent blockage of arteries). quit smoking. revascularization by sx.

Question 7

S/s of Peripheal Arterial Disease

Answer 7

-Loss of hair on legs
-Tight and shiny skin
-Pallor of extremeties
-Slow cap refill
-Decrease arterial supply to distal tissues when pt exercises, leading to pain (buildup of Lactic Acid)
“Intermitten Claudication”
Tx: Pain is relieved by rest.
-“Resting claudication” Pain in periphery while at rest.
Tx: Pain is relieved if pt dangles legs.

Blood flow/oxygen to the periphery becomes so decreased that peripheral cells die b/c of lack of oxygen.

Question 8

What is Ketoacidosis (DKA)?

Answer 8

For Type 1 Diabetics. Sometimes type 2.
Metabolic complication when fats are metabolised when insulin is absent. pH is very acidic b/c of the amount of BG and acid ketones (byproduct of fat breakdown)

Question 9

S/s of Ketoacidosis (DKA)

Answer 9

Hyperglycemia BG>14mmol/L and pH <7.34

• polyuria and polydipsia
• dehydration: dec.
• skin turgor,
• tachycardia,
• orthostatic hypotension,
• lethargy,
• weakness,
• dry and loose skin,
• N/V b/c of acidosis (result=dehydration),
• KUSSMAUL RESPIRATIONS: deep and rapids breaths to rid of CO2.
• Osmotic Diuresis: to rid of excess ketone and glucose
• Low BP: D/t osmotic diuresis.

Question 10

Tx of Ketoacidosis (DKA)

Answer 10

• 0.45% or 0.9% NaCl to restore U/O to 30-60ml/hr and incr. BP from Osmotic Diuresis
• When BG is < 14mmol/L, 5% Dextrose is added to the fluid to prevent HYPOGLYCEMIA.
• Fluid/Electrolyte Tx to replace lost electrolytes b/c of Osmotic Diuresis.
• Potassium replacement b/c of hypokalemia d/t lost electrolytes.
• Monitor K balance once Insulin Tx is started so it doesn’t decrease.
• IV insulin Tx to correct hyperglycemia and hyperketonemia. Start insulin tx once fluid replacement is restored b/c insulin also draws water into the cells along with glucose.
• Administer IV sodium bicarbonate is sever acidosis pH <7.0

Question 11

What is Hyperosmolar Hyperglycemic Nonketotic Syndrome? ( HHNS)

Answer 11

With Type 2 Diabetics.
Life threatening syndrome.
Can produce enough insulin to prevent DKA, but not prevent hyperglycemia.

Question 12

S/s of HHNS

Answer 12

Hyperglycemic s/s: inc. Urination, weakness, fatigue, headache, N/V, abd pain.
BG lvls can quickly elevate before it is noticed.

Question 13

Tx of HHNS

Answer 13

Monitor:
BG lvls,
U/O (from osmotic diuresis),
IV fluid balance (to replace what was voided), Electrolytes (to replace what was lost),
Insulin therapy for the high BG lvls,
LOC,
Potassium balance from (too much insulin, and too little insulin causing and incr in urinaion and decr. potassium)
Assess renal status
Assess cardiopulmonary status r/t hydration and electrolyte levels (movement of K can alter cardiac function).

Question 14

What can insulin do to potassium?

Answer 14

Insulin can make the cells take up potassium resulting in low potassium levels in the blood causing potential cardiac issues.

Question 15

S/s hyperglycemia

Answer 15

BG >7mmol/L
Polyuria, Polydipsia, polyphagia
Can lead to: DKA, HHNS

Question 16

S/s hypoglycemia

Answer 16

BG < 2.8mmol/L
Tachycardia
shakiness/tremor
hunger/nausea
pallor
headache
dizziness
drowsiness
Dec. LOC
irrational behaviour.

Question 17

What is an Angiogram?

Answer 17

A test that provides a picture of vessels, enters through major artery (femoral) and a contrast is injected for visualisation.

Pre test: allergies to seafood/iodine?

Post test: assess peripheral circulation, assess cap refill, assess CWSM, best rest up to 8hrs ( don’t wanna distrupt clot formarion and create bleeding), assess pedal pulses.

Question 18

What is an Angioplasty?

Answer 18

A procedure to open blocked/narrows arteries in the heart withouth major sx.

Pre-test: NPO after midnight, may need to stop anticoagulants, allergy to seafood/iodine?, stop smoking

Post test: assess peripheral circulation, assess cap refill, assess CWSM, best rest up to 8hrs ( don’t wanna distrupt clot formarion and create bleeding), assess pedal pulses.

Question 19

Tx of Neuropathy, Retinopathy, Nephropathy.

Answer 19

Neuropathy: (decreased sensation to pain of foot)

• TIght glycemic control
• Foot care

Retinopathy:

• Eye exams
• Laser therapy
• Tight glycemic conrtrol helps delay onset

Nephropathy:

• TIght glycemic control
• Annual creatinine and microalbumin in urine sceening
• Use ACE inhibitors and referral to a nephrologist.

Question 20

Peripheral Arterial Disease Assessment

Answer 20

1) Comfort: Intermittent/rest claudication
2) Activity: Exercise tolerance dec. with time.
3) Safety: High risk skin breakdown (wound infection)
4) Rest and Sleep: Rest pain may disrupt sleep
5) Nutrition: Dyslipidemia and obesity may increase risk for PAD
6) Oxygenation: Signs of reduced perfusion to skin.

Question 21

What is a Bypassgraft?

Answer 21

A Bypassgraft is a surgery creates new routes around narrowed and blocked arteries, allowing sufficient blood flow to deliver oxygen and nutrients to the heart muscle. Leaving the diseased artery in place.

Post-op:
Care is similar to general post-op. Assess peripheral circulation, and infection day 3) No prolonged sitting or legs dependant.

Question 22

What is an Amputation?

Answer 22

Surgical removal of part of a limp.

• Last resort.
• For gangrenous limb.
• High enough to obtain adequate circulation and remove all infected/ischemic tissue, but low enough to preserve as much limb as possible.

Post op:

• similar to gen. post op.
• Pay attention to wound healing + infection.
• May have prosthesis.
• Stump drsg or stump shaping stocking
• Positioning: danger for contracture, no elevtaing limb, place on abdomen several times a day.
• Rehab: to learn prosthesis.
• Phantom Leg Sensation: Pain felt in area that’s been amputated b/c peripheral nerves are still connected to the brain. Pain usually subsides as healing progresses. Body image change.