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NUR123 Exam 1 > Unit 4: Altered Glucose Metabolism > Flashcards

Unit 4: Altered Glucose Metabolism Flashcards

1
Q

What is Diabetes Mellitus?

A

A group of metabolic diseased characterized by hyperglycemia resulting from:
Defects in insulin secretion
Defects in insulin action
Or both

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2
Q

The chronic hyperglycemia of diabetes is associated with long-term damage, dysfunction, and failure of different organs.

A

True

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3
Q

What is insulin?

A

A hormone secreted by Beta cells in the Islets of Langerhans

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4
Q

What does insulin do?

A

Controls blood glucose levels by regulating the production, use, and storage of glucose

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5
Q

What happens to insulin release during fasting, between meals, and overnight?

A

Body continuously releases small amounts of insulin

Basal insulin

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6
Q

What is Type I Diabetes?

A

An autoimmune disease that causes the destruction of pancreatic beta cells

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7
Q

What is the job of Beta cells?

A

They produce insulin

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8
Q

What factors can contribute to beta cell destruction?

A

Genetic
Immunologic
Environmental

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9
Q

How to Type I and Type II DM differ?

A

Type I has ZERO insulin production

where Type II either has depleted production or resistance

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10
Q

What does beta cell destruction result in?

A

Decreased insulin production
Unchecked Glucose by liver
Fasting hyperglycemia
Postprandial hyperglycemia

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11
Q

If glycogen and protein breakdown, leading to ketoacidosis, can muscles use glucose despite low insulin?

A

NO

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12
Q

Polyuria, Polydipsia, and polyphagia are signs of _______

A

Diabetes Mellitus, both Type I and II

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13
Q

Why is polyphagia a symptom of DM?

A

Cells are not getting sugar; so body senses hunger to “feed cells”

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14
Q

What are the two types of Type II DM?

A

Insulin resistance

Impaired insulin secretion

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15
Q

How does insulin resistance affect BGL?

A

Insulin becomes less effective in stimulating glucose uptake by the cells and regulating glucose release by the liver

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16
Q

What is Type II DM associated with?

A

Overweight (high BMI)
Advanced age
High lipid diet
Hypertension

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17
Q

Muscles are still able to use glucose despite insulin resistance.

A

False

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18
Q

What are non-controllable risk factors of Type II DM?

A

Advanced age
Gestational Diabetes
1st degree relative with diabetes
High risk ethnicity

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19
Q

What are controllable risk factors for Type II DM?

A

Weight
Activity level
Hypertension
Hypercholesterolemia

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20
Q

What fasting glucose range is indicative of prediabetes?

A

100-125 mg/dL

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21
Q

What fasting glucose range is indicative of a diabetic?

A

> 126 mg/dL

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22
Q

What is the normal fasting glucose ranger?

A

80-90 mg/dL

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23
Q

What random glucose test result would indicate a pt is diabetic?

A

> 200 mg/dL on more than one occasion

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24
Q

What do urine dip tests assess?

A

Presence of sugar &/or presence of ketones in urine

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25
Q

What does the presence of ketones in urine mean?

A

Diabetic control is deteriorating & body is breaking down fat reserves

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26
Q

What is the normal A1c percent?

A

~ 5%

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27
Q

What is the A1c percentage range of a prediabetic patient?

A

5.7-6.4%

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28
Q

What is the expected A1c precentage of a diabetic?

A

> 6.5%

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29
Q

How often is A1c checked?

A

q 3 months

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30
Q

Increased BGL predispose patients to neuropathic, microvascular, and macrovascular complications.

A

True

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31
Q

Renal complications are more common in _________

A

Type I Diabetes

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32
Q

Cardiovascualr complications are more common in _________

A

Type II Diabetes

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33
Q

What are examples of macrovascular disease?

A

Coronary Artery Disease (CAD)
Cerebrovascular Disease (CVD)
Peripheral Vascular Disease (PVD)

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34
Q

What does CAD affect?

A

Vessels of the heart

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35
Q

What does CVD affect?

A

Vessels of the brain

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36
Q

What does PVD affect?

A

Vessels of the lower extremities

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37
Q

How would you manage macrovascular disease?

A 
Modify diet
Cease smoking
Increase activity
Antihypertensives
Antilipidemics
Anticoagulants
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38
Q

Why are diabteics more suseptible to silent MI’s?

A

Blood vessels thicken and become occluded by plaque silencing ischemic symptoms

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39
Q

What are microvascular complications?

A

Characterized by thickening of the basement membrane surrounding

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40
Q

What are areas that are affected by microvascular complications?

A

Retina

Kidneys

41
Q

What are the clinical manifestations of diabetic retinopathy?

A

Painless
Floaters
Sudden visual changes

42
Q

What causes diabetic retinopathy?

A

Changes in the small blood vessels of the retina

43
Q

How would you manage diabetic retinopathy?

A 
Control BGL
Control BP
Cease smoking
Patient education
Encourage routine opthalmic exams
44
Q

What are the clinical manifestations of diabetic nephropathy?

A

Albuminuria
Hypertension
Renal insufficiency

45
Q

How would you manage diabetic nephropathy?

A 
Control hypertension
Monitor albumin in urine
Avoid nephrotoxic agents
Low sodium & protein diet
Antihypertenives
Dialysis / kidney transplantation
46
Q

What is diabetic neuropathy?

A

Group of diseases that affect peripheral and autonomic nerves
Disruption in blood supply to nerves

47
Q

What are the clinical manifestations of peripheral neuropathy?

A

Paresthesia
Burning sensation
Decrease proprioception
Joint deformities

48
Q

How would you manage peripheral neuropathy?

A

Control BGL
Non-opiod analgesics
Antidepressants
Antiseizure medications

49
Q

What are clinical manifestations of autonomic neuropathies?

A 
Resting tachycardia
Orthostatic hypertension
MI
N/V
Diarrhea
Constipation
Delayes gastric emptying
Decreased sensation of bladder fullness
Sexual dysfunction
50
Q

How would you manage autonomic neuropathies?

A

Depends on symptoms

Delayed gastric emptying

51
Q

What are the clinical manifestations of complications to the lower extremities?

A

Thermal
Chemical
Traumatic

52
Q

How would you manage complications of the lower extremities?

A 
Patient education
BGL control
Regular exams
Podiatrist referral
Family teaching
Monofilament test
53
Q

What causes hyperglycemia in surgical patients?

A

Physiologic stress

54
Q

What causes hypoglycemia in surgical patients?

A

Delayed surgery

55
Q

What are the nursing interventions for hospitalized patients with diabetes?

A

Proper IVF
Proper skin care
Inform & Educate pt

56
Q

What tasks can you delegate to UAP?

A

Accuchecks
Vitals
Communication/reinforcement
Simple assessment

57
Q

What are ways to manage diabetes with nutrition?

A

Maintain a reasonable body weight

Prevent wide fluctuations in BGL

58
Q

What percentage of a diabetic’s diet should be carbohydrates?

A

50-60% complex carbs

59
Q

What percentage of a diabetic’s diet should be fats?

A

> 30%

60
Q

What percentage of a diabetic’s diet should be protein?

A

10-20% Lean protein

61
Q

Diabetic women can have 2 alcoholic drinks/day.

A

False. Women can have 1

62
Q

Moderate-vigorous exercise is necessary to lower BGL

A

True

63
Q

A 15g snack is suggested prior to exercise, after exercise, and at bedtime to prevent _________

A

Hypoglycemia

64
Q

Management of diabetes is paramount to prevent future complications.

A

True

65
Q

What would you make sure a newly diagnosed DM patient knows?

A

Self monitoring and interpretation of results
Ability to perform self testing
Cost of BG monitoring
Test when BGL high / low

66
Q

When preparing to teach a newly diagnosed DM patient, what would you want to assess?

A

Readiness to learn

Knowledge and adherence to plan of care

67
Q

What things would you recommend to a newly diagnosed DM patient?

A

Encourage health promotion activities and regular health screenings

68
Q

What is the treatment goal of managing diabetes?

A

To normalize BGL to reduce the risk of diabetes related complications

69
Q

What is hypoglycemia?

A

Deprivation of brain cells fuel for functioning

BGL 50-60

70
Q

How would you treat a conscious hypoglycemic patient?

A

15g snack of simple carb

Check BGL in 155 minutes

71
Q

How would you treat an unconscious hypoglycemic patient?

A

Glucagon 1mg IM or subcu

Followed by a snack

72
Q

How would you treat a hypoglycemic hospitalized patient?

A

D50W 25-50mL IVP at 10mL/min

73
Q

What is diabetic ketoacidosis?

A

Absence or inadequate amounts of insulin with subsequent rise in BGL

74
Q

What are the clinical features of DKA?

A 
Hyperglycemia
Ketosis
Dehydration ***
Electrolyte loss
Acidosis
75
Q

You should not start DKA interventions until after you recheck BGL and lab results.

A

False. DKA is a medical emergency and should be treated immediately

76
Q

What are the precipitating factors of DKA?

A

Missed/insufficient dose of insulin
Physical/emotional stress
Illness/infection

77
Q

What are the clinical manifestations of DKA?

A 
Polyuria
Polydipsia
Nausea/vomiting
Orthostatic hypotension
Kussmaul respirations
Fruity breath
Altered mental status
78
Q

What is the expected BGL of a patient in DKA?

A

> 250

79
Q

What is the expected serum pH level of a patient in DKA?

A

6.8-7.3

80
Q

A patient in DKA would have urine and serum ketones.

A

True

81
Q

What IVF would you use to rehydrate a patient in DKA?

A

0.9% NS 1/2-1L/hour
If BGL < 250:
use D5NS or D5 1/2

82
Q

Which electrolyte imbalance would you be concerned about for a patient in DKA?

A

Potassium

83
Q

What is Hyperglycemic Hyperosmolar NonKetotic Syndrome?

A

Osmolality > 340
BGL > 600
Ketosis is minimal or absent

84
Q

How would you manage a patient with HHNKS?

A 
IVF 0.9%NS
Cardiac monitoring
Continuous insulin infusion
Monitor vitals &amp; fluid status
Accurate I &amp; O
85
Q

What are the causes of morning hyperglycemia?

A

Dawn phenomenon or Somogyi effect

86
Q

What is the dawn phenomenon?

A

Insufficient insulin coverage at night causes BGL to increase overnight

87
Q

How do you treat dawn phenomenon?

A

Change the time of NPH from dinner to bedtime

88
Q

What is the somogyi effect?

A

A rebound phenomenon of BGL rising rapidly after dropping due regulatory hormones from too much insulin coverage

89
Q

How do you treat the somogyi effect?

A

Decrease pm insulin dose or give bedtime snack

90
Q

What patient is best suited from oral antidiabetic agents?

A

Type II DM who cannot be treated by diet control and excercise alone

91
Q

What are the nursing interventions for oral antidiabetic agents?

A

Monitor BGL
Assess for hypoglycemia
Assess for other side effects

92
Q

How does insulin work?

A

Reduces BGL by increasing glucose transport across cell membranes

93
Q

Insulin enhances the conversion of glucose to glycogen.

A

True

94
Q

________ is a hormone that stimulates insulin secretion in response to meals.

A

Incretion

95
Q

Insulin signals the liver to continue releasing glucose.

A

False

Insulin signals the liver to STOP releasing glucose

96
Q

What is insulin lipohypertrophy?

A

Fibrofatty masses at injection sites

97
Q

Coexisting conditions can complicate diabetes management.

A

True

98
Q

Diagnosis of diabetes may be difficult due to age related changes

A

True

99
Q

Age related health problems increase the risk of diabetes related complications..

A

True

NUR123 Exam 1 (5 decks)

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