Quiz 6 - Insulin/Nutrition Assessment Flashcards
1
Q
list some impacts of malnutrition
A
- inc risk of falls
- infections
- muscle wasting
- inc risk of fx
- dec mobility
- inc risk of hospital admission
- low mood
- low energy
- weight loss
- confusion
2
Q
the patients nutritional status provides information on the pt ability to ___ and resist ____
A
heal and resist infection
3
Q
Thinness/obesity is ____ a reliable methods to determine nutritional status
A
NOT
4
Q
these are 4 categories of lab assessment of nutrition status
A
- biochemical
- dietary records
- clinical data
- anthropometric data
5
Q
3 biochemical lab assessments of nutrition status
A
- serum albumin
- hemoglobin
- lymphocytes
6
Q
4 clinical data lab assessments of nutrition status
A
- skin
- hair
- nails
- mucous membranes
7
Q
3 anthropometric data lab assessments of nutrition status
A
- height
- weight
- BMI
8
Q
BMI formula
A
weight in kg/(height in m)^2
9
Q
in to m
A
multiply by .025
10
Q
underweight BMI =
A
less than 18.5
11
Q
normal BMI =
A
18.5 - 24.9
12
Q
overweight BMI =
A
25 - 29.9
13
Q
obese BMI =
A
30-39.9
14
Q
extremely obese BMI =
A
greater than 40
15
Q
4 examples of patient intake
A
oral, IV, blood, NG
16
Q
estimates of intake are ___
A
inaccurate
17
Q
I/O is done at ___ and over ___
A
shift and 24 hrs
18
Q
NG tubes are placed when
1.
2.
A
- pt can’t eat by mouth/can’t eat enough
2. remove gastric contents (dec air swallowing, drug OD)
19
Q
the large lumen is for
A
suction of gastric contents
20
Q
the small lumen is an
A
air vent
21
Q
the Salem sump NG tube has a
A
dual lumen
22
Q
the Salem sump is for ____ and ____ suctioning
A
continuous and intermittent
23
Q
the Levine tube is ___ lumen and for ____ suction only
A
single lumen and for intermittent suctioning only
24
Q
tube size is measured by the ___ scale
A
French Fr
25
1 Fr =
1 Fr = diameter of 1/3 mm
26
the larger the French the ___ the tube
larger
27
the gold standard for checking NG tube placement is
x ray
28
NG tube placement can be confirmed with what two things
1. aspirate GI secretions (pH between 1-4 of stomach contents)
2. injection of air into NG tube and listening over gastric area
29
you should check gastric residuals ____ and ____
every shift and before admin of feeding or meds
30
___ NG tubes will clog more easily
smaller
31
you should ____ meds completely and mix with ____ before admin through an NG tube
CRUSH meds completely and mix with fluids before admin through an NG tube
32
___ is most effective way to clear NG tubes
water
33
with type 1 diabetes they can't
produce insulin (beta cells destroyed by autoimmune process)
34
__% of the US pop is diabetic (___% of US adults)
7%, 50%
35
__% over 60 have diabetes
21%
36
___% of new diagnoses are children and adolescents
45%
37
type 2 diabetes is a dec in ___ and ___
insulin prod and insulin sensitivity
38
6 signs of diabetes
1. polyuria
2. polyphagia
3. polydipsia
4. fatigue
5. numbness
6. dec healing
39
fasting blood glucose
125 mg/dL (70-130)
40
random blood sugar
200 mg/dL
41
with capillary blood glucose testing the ___ greatly impacts the results
SITE
42
____ are the gold standard for capillary blood glucose testing
fingers
43
name the three rapid acting insulins
1. aspart (novorapid)
2. glulisine (apidra)
3. lispro (homolog)
44
onset, peak, and duration of rapid acting insulin
onset: 10-15 min
peak: 1-1.5 hr
duration: 3-5 hr
45
list the two short acting insulins
regular (humbling R and novolin R)
46
onset, peak, duration of short acting insulins
onset: 30-45 min
peak: 2-3 hr
duration: 6.5 hr
47
name the two intermediate acting insulins
NPH (humulin N and novolinge NPH)
48
onset, peak, and duration of intermediate acting insulin
onset: 1-3 hr
peak: 5-8 hr
duration: 14-18 hr
49
name the two long acting insulins
detemir (levemir) and glargine (lantus)
50
detemir (levemir) onset, peak, and duration
onset: 1-2 hr
peak: 8-10 hr
duration: 12-24 hr
51
glargine (lantus) onset, peak, and duration
onset: 1-2hr
peak: none
duration: 22-24 hr
52
___ and ____ acting insulin are bolus
rapid and short acting
53
___ and ____ acting insulin are basal
intermediate and long acting
54
3 complications of insulin therapy
1. local/systemic allergic rxns
2. insulin lipdystrophy
3. insulin resistance
55
morning hyperglycemia is a ____
dawn phenomenon
56
with morning hyperglycemia you have...
nocturnal surges of GH
57
to treat morning hyperglycemia you should
give insulin at HS, not b4 dinner
58
the somogyi effect is ___
nocturnal hypoglycemia followed by rebound hyperglycemia
59
to treat the somogyi effect you should
dec evening dose of insulin
60
hypoglycemia is a BS of
50-60 or less
61
three causes of hypoglycemia
inc insulin, dec food, inc physical activity
62
7 sx of hypoglycemia
1. epinephrine and norepinephrine surge
2. sweating
3. inc HR
4. palpitations
5. nervousness
6. hunger
7. tremors
63
___ effects are caused by hypoglycemia
CNS (H/A, lightheaded, confused, slurred speech, LOC, seizures)
64
treatment for hypoglycemia
2-3 tsp of sugar/honey, 6-10 hard candies, 4-6oz of juice or soda, 3-4 glucose tablets then recheck BS in 15 min (if same sx repeat) once it is improved following with cheese, crackers, or milk
in extreme situations give glucagon and D50W
65
3 clinical features of DKA
hyperglycemia, dehydration (electrolyte loss), acidosis
66
6 sx of DKA
1. 3 p's
2. orthostatic hypoTN
3. ketosis
4. GI s/s
5. acetone breath
6. HYPERventilation
67
hyperglycemia is a BS of
300-800
68
with hyperglycemia dx you have these 5 things
1. BS 300-800
2. acidosis
3. electrolyte abnormalities
4. inc BUN, CR, HCT
5. dehydration
69
treatment for hyperglycemia/DKA
rehydrate with NS, follow with .45% naCl then D5.45NS.
restore electrolytes, ECG, hourly BS, IV insulin, avoid bicarb (effects K+)
70
an order for insulin will include
the units and volume in mL
71
insulin is given ___ never ___
SQ, NEVER IM
72
insulin syringes are for ___ insulin only
U-100
73
insulin should be ___ temp when administered
room
74
___ is the time period before the insulin starts to DEC the BS
onset
75
___ is the time period where the insulin is most effective
peak
76
____ is the time period where insulin continues to dec BS
duration
77
____ is insulin delivered continuously over 24 hours, to keep BS in range between meals and overnight (can be different rates at different times)
basal
78
____ is doses delivered at mealtimes to provide control for additional food intake
bolus
79
when putting two types of insulin in a syringe you do ___ then ___-
clear then cloudy
80
when putting air into vials of two different insulins you put air in the ___ first
cloudy (intermediate/long acting) first
81
the ____ is drawn first
regular (rapid)
82
if you draw too much ___ you need to start over
intermediate/long acting
83
contact the physician for more than ___ units regular insulin for coverage
15
