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Adult Health Test 3 > TEST 3 - Diabetes > Flashcards

TEST 3 - Diabetes Flashcards

1
Q

Osmotic diuresis

A

Excess glucose is excreted in urine, it is accompanied by excessive loss of fluids and electrolytes (usually occurs around BS: 180 -200)

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2
Q

Initial presentation of DMI

A

weight loss over few months
fatigue
increased rate of infection
rapid onset

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3
Q

S/S DMI (3)

A

polyuria
polydipsia
polyphagia

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4
Q

DMII characteristic fasting blood sugar

A

> 126

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5
Q

4 labs for diabetics

A

Hgb A1C
Serum CR
UA
Fasting lipid profile

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6
Q

Important referrals

A

Podiatrist
Dietician
Ophthalmologist
Diabetic educator

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7
Q

HGB A1C normal range

A

4-6%

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8
Q

Goal of diabetic

A

<7%

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9
Q

Nursing managment (5)

A 
blood glucose monitoring
nutrition
meds
exercise
self-care
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10
Q

Rule of self monitoring DMI

A

2-4 times per day/ usually pre-prandial, post-prandial, and bedtime

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11
Q

Rule of self monitoring DMII

A

2-4 times per week OR 2-3 times per day depending on blood sugar control and meds

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12
Q

Blood glucose therapy goals
AC
PC

A

AC: 70-130
PC: <180

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13
Q

BMI goal (mainly DMII)

A

18.5 - 24.9

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14
Q

BP goal

A

<130/80

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15
Q

What can hyperinsulinemia cause in DMI

A

weight gain

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16
Q

Dietary recommendations by macro

A

Carbs: 130g/day or 45-60g/meal

Fats: < 7% total daily calories

Protein: 15-20% of total calories consumed

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17
Q

Why is alcohol a problem?

A

Inhibits gluconeogenesis by liver (glycogen - > glucose) ->can cause hypoglycemia

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18
Q

When to NOT exercise

A

w/n 1 hour insulin, at insulin peak

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19
Q

General rule for complex carbs and exercise

A

15g carbs + protein snack

  • prior to exercise
  • for every 30-60 min exercise
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20
Q

Types of insulin by onset

A
  1. rapid-acting
  2. short acting
  3. intermediate-acting
  4. basal insulin= very long acting
  5. combination products
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21
Q

Rapid acting insulin examples (4)

A

Insulin lispro
Insulin aspart
Insulin glulisine
Afrezza

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22
Q

Short acting examples (1)

A

regular

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23
Q

Intermediate acting examples

A

NPH

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24
Q

Basal insulin examples

A

Insulin glargine/lantus

Insulin Detemir

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25
Lispro O,P,D
O: 10-15 min P: 1 hour D: 2-4 hours
26
Aspart O,P,D
O: 5 -15 min P: 40 – 50 min D: 2 – 4 hours
27
Glulisine O,P,D
O: 5 – 15 min P: 30 – 60 min D: 2 hours
28
Regular O,P,D
O: 30 – 60 min P: 2 – 3 hours D: 4 – 6 hours
29
NPH O,P,D
O: 2 – 4 hours P: 4 – 12 hours D: 16 – 20 hours
30
Glargine/Lantus O,P,D
O: 1 hour P: no peak D: 24 hours
31
Afrezza O,P,D
O: <15 min P: ~50 min D: 2-3 hours
32
"contraindications" for intensive regimen (4)
Recurring severe hypoglycemia ESRD Ineffective self-care skills Nervous system disorder
33
Drawing up insulin
cloudy clear clear cloudy
34
Insulin admin considerations
NO shaking, rolling check dose with other nurse admin 5-15 minutes from prep
35
Thighs O,D
O: fast D: long
36
Arm O,D
O: fast D: short
37
Abomen O,D
O:very fast D: very short
38
Butt O,D
O: very slow D: very long
39
Insulin options for pump
Lispro | Aspart
40
Pump MOA
Continuous insulin infusion, basal rate + Bolus dose of insulin is administered based on total carbs consumed
41
units per grams of carbs for pump
1 unit/15g
42
Complications of insulin therapy (4)
systemic allergic rxn insulin lipodystrophy insulin resistance morning hyperglycemia
43
3 examples of morning hyperglycemia
dawn phenomenon Somogyi effect insulin waning
44
Dawn phenomenon
normal until 3am, then rises as a result of nocturnal surges in growth hormone
45
Somogy effect
Nocturnal hypoglycemia followed by rebound hyperglycemia
46
Inulin waning | cause
progressive increase in BG from bedtime to morning | seen when NPH is given before dinner -- give it after!
47
5 medication classes
1. insulin secretagogues 2. insulin sensitizers 3. Intestinal enzyme inhibitors 4. incretins 5. glucose offloading
48
2 types of insulin secretagoues
1. Sulfonylureas | 2. Non-sulfonylurea insulin secretagogues
49
Sulfonylureas (examples)
Glipizide Glyburide Glimepiride
50
Non-Sulfonylurea insulin secretagogues (examples)
Nateglinide | Repaglinide
51
Insulin Sensitizers (classes)
1. Biguanides | 2. Thiazolidinediones (TZDs)
52
Biguanide example
Metformin
53
Thaizolidinediones examples
Pioglitazone | Rosiglitazone
54
Intestinal enzyme inhbitors
Alpha-glucosidase inhibitors
55
Alphaglucosidase inhibitor examples
Miglitol | Acarbose
56
Incretins (2 classes)
1. DPP-4 inhibitors | 2. GLP-1 agonists
57
DPP-4 inhibitor examples
sitaglipitin linagliptin saxagliptin alogliptin
58
GLP-1 agonist examples
exenatide | pramlintide
59
Glucose offloading class
SGLT-2 inhibitors
60
SGLT-2 inhibitor example
Canagliflozin
61
Meds that INCREASE BG as a SE
``` estrogens corticosteroids lithium salts niacin potassium depleting diuretics caffeine nicotine/weed CCBs ```
62
Meds that DECREASE BG as a se
``` Salicylates Beta-blockers Acetaminophen NSAIDs Potassium ETOH ```
63
Hyperglycemic Hyperosmolar syndrome
``` Type II complication hyperglycemia osmotic diuresis hypernatremia profound dehydration ```
64
hyperglycemia s/s
3 Ps blurred vision weakness headache
65
DKA labs
``` BG (high) bicarbonate (low) pH (low) PCO2 (low) serum keton bodies (high) UA (ketones present) Electrolytes Creat, HCT, BUN ```
66
Late stage HHS
altered sensorium seizures hemiparesis
67
hypoglycemia nursing intervention (conscious)
1. Immediately give a 15-20g carb replacement per physician order or standing protocol 2. Check blood glucose with monitor/call lab for confirmatory serum level 3. Retest in 15 minutes and repeat dose of glucose if BG<70
68
Nursing Interventions (unconscious)
1. Administer glucagon 1 mg IM or SQ or IV 50% dextrose in water 25-50mL slowly as needed 2. Maintain patent airway 3. Maintain IV access 4. Protect from injury 5. Review events leading up to event to ascertain probable cause 6. Pt and family edu re s/s/risk factors/prevention/tx 7. Instruct pt to wear medic-alert bracelet
69
Microvascular complications
1. Diabetic Retinopathy 2. Diabetic Nephropathy 3. Diabetic Neuropathy
70
Microvascular complication categories (2)
1. Non-proliferative | 2. Proliferative
71
Neuropathy meds (3 classe)
SNRIs (duloxetine) TCAs (amitriptyline) Anti-seizure meds (gabapentin, pregabalin)
72
Nephropathy s/s
``` Weakness Fatigue Dry flaky gray-bronze skin HTN Pitting edema Crackles, tenacious sputum Ammonia odor to breath Anemia, thrombocytopenia ```
73
Treatment of microalbuminuria
ACE Inhibitor (lower BP to prevent leaking of albumin – also protects kidneys)
74
NPO considerations
- half dose of usual intermediate acting insulin OR holding of usual intermediate acting insulin (consult provider!) - more frequent blood glucose monitoring
75
Enteral tube feedings
-contain less protein and fat than the ADA diet and more simple CHOs
76
TPN considerations
- regular insulin via IV/TPN solution - short/intermediate acting insulin to fill in between - If TPN is intermittent – SQ insulin should be given so peak action coincides with TPN infusion

Adult Health Test 3 (3 decks)

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