NUR 325 Exam #2 Flashcards
What is glucose regulation?
the process of maintaining optimal blood glucose
euglycemia (definition & levels)
normal blood sugar levels
70-140 mg/dL
hyperglycemia (definition & levels)
high blood sugar levels
> 100 mg/dL fasting
140 mg/dL regular
180 mg/dL severe
hypoglycemia (definition & levels)
low blood sugar levels
< 70 mg/dL regular
< 50 mg/dL severe
S/S of hypoglycemia
-reduced cognition
-tremors
-diaphoresis
-weakness
-hunger
-headache
-irritability
-seizures
S/S of hyperglycemia
-polyuria (overproduction of urine)
-polydipsia (excessive thirst)
-dehydration
-fatigue
-fruity odor to breath
-kussmaul breathing (rapid, deep breathing)
-weight loss
-hunger
-poor wound healing
polyuria
overproduction of urine
polydipsia
excessive thirst
possible causes of hypoglycemia
-result of insufficient nutritional intake
-adverse reaction to medications
-excess exercise
-underlying disease
possible causes of hyperglycemia
-result of insufficient insulin production/secretion
-excessive counter regulatory hormone secretion
-deficient hormone signaling
hypoglycemia mental status
anxious, irritability, confusion, seizures, unconsciousness, coma
hyperglycemia mental status
can range from alert to confused and coma
hypogylcemia skin
diaphoresis, cool, clammy
hyperglycemia skin
warm, moist
hypoglycemia respiratory
no change in respirations
hyperglycemia respiratory
deep, rapid respirations
fruity, acetone scent to breath
hypoglycemia cardiac
tachycardia
hyperglycemia cardiac
tachycardia if dehydrated
are ketones present in hypo or hyperglycemia?
hyperglycemia
What is the A1C (aka HbA1c) test?
blood test that measures the average blood sugar levels over the past 3 months
What does a higher A1C mean?
greater risk for developing type 2 diabetes
A1C values
-Normal A1C: below 5.7%
-Pre-diabetes: 5.7% - 6.4%
-Diabetes: > 6.5%
long-term consequences of hypoglycemia
-repeated hypoglycemic episodes lowers the threshold that stimulated counter regulatory hormone
-death
long-term consequences of hyperglycemia
-organ disease due to microvascular damage
-retinopathy
-neuropathy
-macrovascular angiopathy
-hypertension
retinopathy
damage to blood vessels in retina
causes blindness and blurred vision
neuropathy
peripheral nerve damage to the brain and spinal cord
causes weakness, numbness, pain in hands and feet
macrovascular angiopathy
macrovascular = large vessels like arteries and veins
angiopathy = disease of the blood vessels
glucose regulation- diet
-low in saturated fats
-consistency in amount of food consumed
-regular meal times
-include omega 3 and fiber in diet to lower cholesterol
glucose regulation- exercise
physical activity lat least 3x a week = 150 minutes
Prevention/early recognition of type 2 DM
-screen pts with BMI over 25
-A1C test
pt & nursing interventions for hypoglycemia
-glucose tabs
-glucagon for unconscious patients
-eat full meals
-15/15 rule
what is the 15/15 rule?
eat 15g of carbs then check BG after 15 minutes
pt & nursing interventions for hyperglycemia
-oral hypoglycemic agents
-insulin
-change in lifestyle
-change in diet
-weight control
-education for self management
what are electrolytes?
minerals in the body that conduct electricity
What are the 4 minerals in the body?
potassium, sodium, calcium, magnesium
electrolyte function
-balancing water in the body
-balancing pH level
-moving waste out of body cells
-moving nutrients into body cells
-helping muscle/heart/nerve/brain function
what 2 groups are at high risk for impaired fluid and electrolyte balance?
infants and elderly
why are infants at the highest risk for fluid and electrolyte imbalance?
-high metabolic rate
-immature kidneys
-more rapid RR
-proportionately greater body surface area
why are elderly at risk for impaired fluid and electrolyte balance?
-thirst sensation blunt
-kidneys less able to respond to ADH
-impaired ability to conserve
Risk factors for fluid and electrolyte imbalance
-vomiting
-diarrhea
-organ failure (liver, kidney, heart)
-unexplained nausea
-fatigue
-dizziness
-shortness of breath
-muscle cramping
-edema
-sudden changes in weight
primary prevention - fluid and electrolyte imbalance
-pt teaching
-dietary measures
-fluid management
secondary prevention - fluid and electrolyte imbalance
-screening for imbalances
-water replacement therapy
-electrolyte supplements
-pharmacology (diuretics, insulin, vasopressin- ADH)
-daily weight
-monitoring I/Os
diffusion
-movement of solutes (electrolytes) from an area of high concentration to low concentration
-passive
osmosis
-movement of water across a semi-permeable membrane from an area of low concentration to an area of high concentration
-active
oral hypoglycemics vs insulin administration
-oral hypoglycemics are administered when pt DOES have function pancreas
-insulin is administered when client DOES NOT have functioning pancreas
why are oral anti-diabetics not used for type 1 diabetes?
-oral anti-diabetic meds require a functioning pancreas, which type 1 diabetics do not have
Why should patients with kidney failure, alcoholism, heart failure, or COPD not take metformin?
it can cause lactic acidosis in blood which can cause sepsis
When should regular insulin be administered? Why?
It should be administered 30 minutes before mealtime to ensure the client will ingest some carbs for insulin to act on –> reduces risk of hypoglycemia
How should the nurse administer insulins?
-alternate injection sites
-regular insulin before NPH
-second nurse check
-understand sliding scales
_____ insulin before ____ insulin
regular before NPH
When insulin reaches it’s ____ is when pt is most at risk for ________
peak, hypoglycemia
insulin pumps are for which kind of insulin?
short acting
What electrolyte imbalance may be caused/corrected by insulin? why?
hypokalemia, due to uptake of potassium from blood glucose
Lispro insulin info
-Onset: 15-30 minutes
-Peak: 30 min - 3 hours
-Duration: 3-5 hours
-“meal-time” insulin
-subQ
What kind of insulin is lispro?
rapid acting
Humulin R (_____) insulin
regular
What type of insulin is Humulin R?
short acting
Humulin R info
-Onset: 30 minutes- 1 hour
-Peak: 1-5 hours
-Duration: 6-10 hours
-SubQ
NPH Insulin aka ____ ____
Humulin N
What type of insulin is NPH Insulin?
intermediate acting
NPH insulin info
-Onset: 1-2 hours
-Peak: 4-14 hours
-Duration: 14-24 hours
-SubQ
Glargine Insulin brand name
Lantus
What type of insulin is glargine insulin?
long acting
Lantus generic name
glargine insulin
glargine insulin info
-onset: 1-4hr
-peak: none/steady
-duration: 24hrs
-SubQ injection
hypertonic solution
-higher osmolality than blood
-draws water OUT of cells into ECF, cell = shrinks
What should you monitor when giving a hypertonic solution?
BP, lung sounds, sodium levels
Examples of hypertonic solutions
-3% saline
-D10W (10% dextrose in water)
-D5NS (5% dextrose in normal saline, 0.9%)
-D51/2NS (5% dextrose in half normal saline, 0.45% NS)
hypotonic solution
-lower osmolality than blood
-moves water from ECF to ICF
what should you monitor when giving hypotonic fluids?
changes in mentation
examples of hypotonic fluids
-0.45% saline
-0.33% saline
-0.225% saline
-D5W (starts as isotonic but becomes hypotonic in body due to body metabolizing dextrose)
isotonic fluids
-no movement between ECF and ICF
examples of isotonic fluids
-NS, 0.9% saline
-LR (Lactated ringers)
-D5W, starts isotonic but becomes hypotonic in body)
What’s in lactated ringers?
sodium, potassium, chloride, calcium, lactate
what do lactated ringers do?
-expands ECF
-treats burns and GI losses
-contraindicated with liver dysfunction, hyperkalemia, and hypovolemia
(isotonic)
Intracellular fluid (ICF)
fluid within cells, 2/3
extracellular fluid (ECF)
fluid outside of cells, 1/3
contains interstitial fluid and intravascular fluid
interstitial fluid
fluid around the cells
sodium function
-supports the function of nerves and muscles
-helps maintain BP
-regulates body’s fluid balance
potassium function
-helps with nerve and muscle cell function, especially muscles in the HEART
What category does the medication Glipizide fall under?
sulfonylurea
What category does the medication Repaglinide fall under?
meglitinide
What category does the medication metformin fall under?
biguanide
What category does the medication prioglitazone fall under?
thiazolidinedoines
hypovolemia
too little fluid (ECV deficit)
causes of hypovolemia
-polyuria
-prolonged vomiting
-prolonged diarrhea
-sweating
-dehydration
symptoms of hypovolemia
-sudden weight loss
-skin tenting
-dry mucous membranes
-vascular underload –> rapid thready pulse, postural BP drop, HR increase, lightheadedness, flat neck veins when supine, syncope (fainting), shock
what is the best treatment for hypovolemia?
isotonic fluids
hypervolemia
too much fluid, ECV excess
hypervolemia symptoms
-sudden weight gain
-edema
-vascular overload –> bounding pulse, distended neck when upright, dyspnea (difficulty breathing), pulmonary edema
hypervolemia pt teaching
-reduce salt in diet
-monitor weight
-monitor fluids
interventions for hypervolemia
-diuretic
-reduce fluid intake
-reduce salt in diet
-dialysis if severe
