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Pathophysiology CVP 622 > Test 1 content-Glucose management on CPB > Flashcards

Test 1 content-Glucose management on CPB Flashcards

1
Q

Pre-diabetic fasting blood glucose level range

A

within 100-125 mg/dl

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2
Q

A fasting blood glucose level over 126 mg/dl is considered

A

Diabetic

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3
Q

Which type of diabetes is considered “juvenille”?

A

Type 1

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4
Q

Type 1 diabetes is in what percent of the population?

A

5-10%

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5
Q

Complete lack of insulin secretion by the pancreas is which type of diabetes?

A

Type 1

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6
Q

Diabetes type ll occurs in which percent of the population?

A

90-95%

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7
Q

Insulin resistance resulting from multiple etiologies is which type?

A

Type ll

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8
Q

Multiple etiologies associated with type ll diabetes (4)

A
  • Genetic predesposition
  • Unhealthy diet
  • Lack of physical activity
  • Central pattern weight gain
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9
Q

2 ways to measure blood glucose? How?

A

Short term-Glucose monitor or a blood gas analyzer in OR

Long term-Use a hemoglobin A1c test

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10
Q

What does an A1c test measure?

A

Average blood sugar for the last 2-3 months

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11
Q

At higher glucose levels, ________ become inelastic and stenotic

A

Blood vessels

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12
Q

Hemoglobin undergoes slow _____ with average glucose concentration over the 120 day life span of RBC’s

A

Glycosylation

ADA recomments a A1c level below 7%

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13
Q

Glycosylation % is

A

A1c

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14
Q

________ activates pathways for long term inflammation and immune response

A

Hyperglycemia

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15
Q

What are the 2 main functions of the pancreas?

A
  • Exocrine function (Aids in digestion)

* Endocrine function (Regulates blood sugar)

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16
Q

The endocrine component of the pancreas consists of _____ cells

A

Islet cells. (islets of langerhans)

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17
Q

What do islet cells do?

A

*They create and release hormones into the bloodstream

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18
Q

Two main hormones released by islet cells are:

A

Insulin-Which lowers blood sugar (when high)

Glucagon-Which raises blood sugar (when low)

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19
Q

What are the 4 types of cells within the islets that regulate blood glucose levels?

A
  • Alpha cells
  • Beta cells
  • Delta cells
  • Gamma cells (PP cells)
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20
Q

What do alpha cells do?

A

Secrete glucagon-increase glucose in blood

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21
Q

What do beta cells do?

A

Secrete insulin-decrease glucose in blood

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22
Q

What do delta cells do?

A

Secrete somatostatin-regulates/stops alpha and beta cells

23
Q

What do gamma cells (PP cells) do?

A

Secrete pancreatic polypeptide-pancreatic polypeptide regulates both endocrine and exocrine pancreatic secretions

24
Q

Activity of the cells in the islets is affected by the _____

A

ANS-autonomic nervous system

25
Q

T/F-The capillaries of the islets are lined by layers of islet cells

A

True

26
Q

Following statement relate to diabetic or non-diabetic patients? Circulating concentrations of insulin inhibit platelet aggregation and thrombosis by inhibiting tissue factor and inhibiting production of plasminogen activator inhibitor -1 (PAI-1)

A

Non diabetic patients

27
Q

What percent of diabetics have a CABG?

A

Roughly 28%

28
Q

T/F-Following a CABG diabetics will have higher morbidity and mortality, and a greater chance of stroke, renal failure, and sternal wound infections

A

True

44% greater chance of readmission after CABG discharge

29
Q

Following statement relate to diabetic or non-diabetic patients? Insulin resistance promotes increased synthesis of PAl-1 and fibrinogen as well as reduced production of tissue plasminogen activator, these factors collectively result in atherothrombosis

A

Diabetic patients

30
Q

T/F-Most endocrine cells have indirect contact with blood vessels

A

False! Most endocrine cells have direct contact with bv

31
Q

_______ is associated with worse outcomes after acute coronary syndrome, acute MI or coronary artery surgery

A

HYPERglycemia

32
Q

HYPERglycemia may predispose a patient to? (2 things)

A
  • Neurologic damage

* Infection complications

33
Q

What 5 things make HYPERglycemia a byproduct of CPB?

A
  • Hypothermia
  • Stress-hormone releases
  • Pancreatic hypo perfusion (releasing less insulin)
  • Insulin/circuit binding
  • Glucose containing crystalloid solutions
34
Q

As glucose goes up, so does _______

A

Mortality

35
Q

Describe 3 factors associated with Type 1 diabetes

A
  • Insulin dependent
  • Occurs when your body can’t produce insulin
  • Considered autoimmune disease
36
Q

Describe type ll diabetes

A

Body can produce insulin, but it either doesn’t produce enough or it isn’t using it properly

37
Q

What is gestational diabetes?

A

Develops during pregnancy and usually disappears after childbirth

38
Q

What is insulin resistance?

A
  • Also called pre diabetes

* Body produces insulin, but is not utilizing it correctly

39
Q

T/F-You will see hypoglycemia on bypass

A

False, HYPERglycemia

40
Q

Hemoglobin A1c level <7.0% indicates ______ glycemic control

A

Adequate

41
Q

Glycemic control is best achieved with _______

A

Continuous infusions

42
Q

During surgery glucose levels should be measured at least _____ an hour

A

Once

43
Q

Oral hypoglycemics withheld for at least ______ prior to surgery

A

24 hours

44
Q

Insulin dependent diabetics should/should not receive their nutritional insulins once they have started fasting the evening before

A

should NOT

45
Q

It is suggested that all diabetic patients undergoing surgical procedures should receive insulin infusions in the OR and for at least 24 hours post op to maintain what serum glucose levels?

A

Below 180 mg/dl

46
Q

_____ glucose levels during surgery were found to be an independent predictor of mortality in patients with and without diabetes

A

Higher

47
Q

Glycemic control in patients during cardiac surgery has what 4 positive outcomes?

A
  • Reduces mortality and morbidity
  • Lowers incidence of infection rates
  • Reduces length of stay
  • Enhances long term survival
48
Q

3 things that can happen by using a glucose containing prime solution

A
  • Raise osmotic pressure
  • Reduce preoperative fluid requirements
  • Decrease post op fluid retention
49
Q

Glucose in the prime may be advocated in patients where a high osmotic pressure in the prime is important and the use of blood derived colloidal solutions may be restricted. What situation might this happen with?

A

Jehovah’s witness patients.

Can’t increase w/ albumin but they will take glucose so sometimes used b/c of this

50
Q

_____ can be used to lower high K+ levels on bypass

A

Insulin

51
Q

Insulin shifts K+ into cells by stimulating the activity of the Na+-H+ antiporter on the ____1_____, promoting the entry of sodium into cells, which leads to activation of Na+-K+ ATPase, causing an _______2_________

A

(1) Cell membrane,

(2) electrogenic influx of K+

52
Q

IV insulin leads to __________ in serum K+ levels

A

Dose dependent decline

53
Q

Glucose control on CPB suggestions (5)

A
  • Insulin infusion (0.1 U/kg/hour
  • Carefully monitor blood glucose ranges
  • Carefully monitor electrolytes
  • Monitor FiO2 under 300
  • Perioperative blood glucose levels range or 100-150 mg/dl)

(no clearly established universal guidelines for cpb with diabetic patients)

Pathophysiology CVP 622 (5 decks)

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