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ABSN > Peds exam 3a - Endo (major) > Flashcards

Peds exam 3a - Endo (major) Flashcards

1
Q

T1DM dx

A

-FPG: >126
-PG: >200 2hr post glucose test
-CBG: >200 w/ the 3 P’s

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2
Q

Pre DM

A

-impaired FG: 100-125
-impaired GT: 140-199 2hr post glucose test

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3
Q

do children w/ T1DM need to restrict their carbs

A

no -> for whatever carbs they take in they just have to dose themselves

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4
Q

nutritional mgt of T1DM

A

-balanced diet
-increased exercise = increased intake needs
-high sugar foods in moderation

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5
Q

rapid acting insulin

A

aspart (novolog), lispro (humalog)
-right after they eat
-onset:15 mins
-peak: 1hr
-duration: 3-4hr

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6
Q

short acting insulin

A

regular insulin
-onset:30 mins
-peak: 3hrs
-duration: 6-8hrs

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7
Q

intermediate acting

A

NPH/lente
-onset:1-2 hrs
-peak: 6-8hrs
-duration: 12-18hrs

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8
Q

long acting insulin

A

glargine (lantus), detemir (levemir)
-onset:4-6hrs
-peak: 8-20hrs
-duration: 24hrs

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9
Q

when to check urine ketones

A

-anytime BG levels are >240 on two separate reads
-during illness
-BG levels >240 one time on a pump

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10
Q

if you have positive urine ketones, what are you at risk for

A

going into DKA contact doctor or just come into emergency room before DKA occurs

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11
Q

Insulin dosing

A

will be on exam, sig & final
-ratio: 1 unit for every 18g carbs
-correction: 1 unit for every 50 above BG of 150
example) BS 227, 48 carbs consumed -> 227-150 = 77/50 -> 1.54 units & 48/18 = 2.66 units
total insulin needed = 1.54 + 2.66 = 4.2 units

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12
Q

development issues w/ DM mgt for a toddler

A

-parents need to differentiate misbehavior from hypogly
-encourage child to report “feeling funny”
-expect food jags
-give choices of mgt

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13
Q

development issues w/ DM mgt for a preschooler

A

-reassure child who views dm mgt as punishment
-encourage child to participate in simple dm tasks
-teach child to report “lows” to an adult
-teach child what to eat when “low”

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14
Q

development issues w/ DM mgt for a school ager

A

-educate school personnel
-encourage age appropriate independence
-all activities DM must be supervised
-encourage extra curricular activities & participation in social groups
-11 to 12 yr old are able to perform an occasional injection

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15
Q

development issues w/ DM mgt for an adolescent

A

-more capable of performing self care activities
-know which foods fit into meal plan & how to adjust
-more willing to perform multiple injections
-risk takers/invincible-> “i can sleep until 1pm and not need to take insulin” “I can’t drink alcohol and be fine”
-needs continued parental involvement & support

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16
Q

what to do when you are a T1DM and drink alcohol

A

they need to dose for it (from clinical) and they need to have a snack (from lecture)

17
Q

sick day mgt for DM

A

-use same dosing and give insulin as scheduled (stress can increase BS)
-check blood sugar more frequently
-monitor urine for ketones
~hydrate

18
Q

normal fasting glucose

A

80-120

19
Q

what food is 15grams of carbs

A

-small pack of skittles
-8oz of white milk no chocolate milk
-4oz of orange or apple juice
~frosting, starbursts
-glucose tabs
honey if over 1yr

20
Q

if a child is extremely hypoglycemic, what do you do

A

rule of 15 wont work bc unable to swallow
1mg glucagon -> subQ or IM then place pt in recovery position to prevent aspiration and then feed after they awake

21
Q

nursing consideration of glucagon

A

has an expiration date

22
Q

causes of hyperglycemia

A

-too much food (carbs)
-too little activity
-too little insulin
-illness/infection

23
Q

S/s of hypergly

A

-high BG
-high levels of glucose in urine
-frequent urination
-increased thirst

24
Q

hypergly treatment

A

-check urine ketones, if increased call HCP
-increase caffeine free fluids
do not increase activity

25
Q

the anion gap

A

tells us the state of acidosis the body is in
-Gap = (Na+K) - (Cl + HCO3)
-a high gap indicates metabolic acidosis & DKA

26
Q

acidosis

A

-ketones build up in the blood, making it acidic
-pH below 7.35
-S/s: deep rapid breathing, confusion/lethargy, abdominal pain

27
Q

ketosis

A

cells aren’t getting glucose so your body starts to burn fat as energy producing ketones (an acidic substances), when excess ketones (0.3-0.7) are present you get ketosis

28
Q

ketoacidosis

A

-severe form of ketosis
-deflects levels of 7.0mmol/L or higher
-lower pH to 7.3 or less

29
Q

DKA

A

hypergly + ketosis + acidosis
-BS >300
-S/s: deep rapid breathing (kussmaul breathinng,breathing off CO2), very dry mouth, fruity breath, N/V, lethargy/drowsiness, osmotic dyuresis
life threatening & needs immediate treatment

30
Q

what is the biggest problem while treating DKA

A

cerebral edema (60-90% of DKA mortality)
usually treatment of DKA is very successful & our protocols are based around preventing C. edema

31
Q

goals of DKA treatment

A

-correct dehydration
-correct acidosis & reverse ketosis
-restore normal glucose levels
-avoid complications in therapy

32
Q

DKA treatment

A

1)fluid replacement w/ 10mL/kg 0.9% NS IV priority- 1st hr
2)lyte replacement over 48hr (0.9% NS + 20 mEq/L KPhos + 20 mEq/L KCl) 2nd hr
3)insulin therapy 0.1u/kg/hr drip 2nd hr (do not give bolus)
-begin dextrose infusion when BG reaches 250-300 (D5 0.45% NS + 20 mEq/L KPhos + 20 mEq/L KCl)
4)careful monitoring, D/c fluids when pt tolerates oral fluids & then give SubQ insulin and stop the drip

33
Q

what is our goal w/ low dose insulin therapy & when do we stop the drip during DKA therapy

A

-decrease BG by 100mg/dL/hr
-drip should be continued until pH is greater than 7.3 and/or HCO is greater than 15 + serum ketones have cleared
do not stop just based on BG levels

34
Q

when should bicarb therapy be considered during DKA treatment

A

-severe acidemia
-life threatening hyperK

35
Q

what part of DKA treatment prevents cerebral edema

A

adding the dextrose to the IV fluids so we don’t drop the BG too fast

35
Q

hourly rounds for pt in DKA

A

-VS
-neuro checks
-accurate I&Os
-point of care testing BG level
-K+ levels
notify HCP immediately if change in labs

36
Q

q2 hour rounding for pt in DKA

A

-urine ketones
-Serum B-OH
-lytes, hematocrit, ABGs, BUN, serum glucose
-cardiac monitoring (continuous)
-amount of administered insulin
insulin rate and dose checked by 2 nurses

37
Q

extra measures for DKA pt

A

-oxygen
-peripheral IV catheter
-if altered mental status: secure airway, NG suction, bladder cath

ABSN (161 decks)

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