part 10 Flashcards
1
Q
Nursing Assessment Subjective Data: past health history
What should you ask?
A
- viral infections
- trauma
- infection
- stress
- pregnancy
- chronic pancreatitis
- Cushing syndrome
- acromegaly
- family history of diabetes
2
Q
Nursing Assessment Subjective Data: Medications
What should you ask?
A
- corticosteroids
- diuretics
- phenytoin (antiseizure med)
3
Q
What objective data should you get from a pt with DM?
A
- eye health
- integumentary health
- respiratory: Kussmaul respirations
- cardiovascular: hypotension, weak, rapid pulse
- GI: dry mouth, vomiting, fruity breath
- Neuro: restless, confusion
- Musculoskeletal: muscle wasting
4
Q
What are some labs you might find in a pt with DM?
A
- electrolyte abnormalities
- fasting BG of 126 or higher
- oral glucose tolerance test greater than 200
- leukocytosis (high WBC)
- increased BUN, creatinine
- increased triglycerides, cholesterol, LDL, VLDL
- low HDL
- A1C greater than 6.0%
- glycosuria, ketonuria, albuminuria, acidosis
5
Q
Why can acute illness, injury, and surgery result in hyperglycemia and what should we do about it?
A
- hyperglycemia in stressful situations can result due to counterregulatory hormone responses
- we need to or pt’s need to check blood glucose Q4H during times of illness/stress
6
Q
When should a pt test urine for ketones?
A
if glucose is over 240
7
Q
Nutritionally what should a pt with DM do when they are sick/stressed?
A
- attempt to maintain normal diet
- increase noncaloric fluids
- continue antidiabetic meds
- if a normal diet is not possible supplement with CHO containing fluids while continuing meds
8
Q
How will an intraoperative DM pt be cared for?
A
- IV fluids and insulin
- frequent monitoring of blood glucose
9
Q
- too much insulin in proportion to glucose in the blood
- neuroendocrine hormones are released
- autonomic nervous system activated
A
hypoglycemia
10
Q
What number constitutes hypoglycemia?
A
<70
11
Q
What are some common manifestations of hypoglycemia?
A
shakiness palpitations nervousness diaphoresis anxiety hunger pallor altered mental functioning: difficulty speaking, visual disturbances, stupor, confusion, coma
12
Q
What can untreated hypoglycemia progress to?
A
- loss of consciousness
- seizures
- coma
- death
