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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
What does the presence of ketones in urine mean?
Diabetic control is deteriorating & body is breaking down fat reserves
26
What is the normal A1c percent?
~ 5%
27
What is the A1c percentage range of a prediabetic patient?
5.7-6.4%
28
What is the expected A1c precentage of a diabetic?
>6.5%
29
How often is A1c checked?
q 3 months
30
Increased BGL predispose patients to neuropathic, microvascular, and macrovascular complications.
True
31
Renal complications are more common in _________
Type I Diabetes
32
Cardiovascualr complications are more common in _________
Type II Diabetes
33
What are examples of macrovascular disease?
Coronary Artery Disease (CAD) Cerebrovascular Disease (CVD) Peripheral Vascular Disease (PVD)
34
What does CAD affect?
Vessels of the heart
35
What does CVD affect?
Vessels of the brain
36
What does PVD affect?
Vessels of the lower extremities
37
How would you manage macrovascular disease?
``` Modify diet Cease smoking Increase activity Antihypertensives Antilipidemics Anticoagulants ```
38
Why are diabteics more suseptible to silent MI's?
Blood vessels thicken and become occluded by plaque silencing ischemic symptoms
39
What are microvascular complications?
Characterized by thickening of the basement membrane surrounding
40
What are areas that are affected by microvascular complications?
Retina | Kidneys
41
What are the clinical manifestations of diabetic retinopathy?
Painless Floaters Sudden visual changes
42
What causes diabetic retinopathy?
Changes in the small blood vessels of the retina
43
How would you manage diabetic retinopathy?
``` Control BGL Control BP Cease smoking Patient education Encourage routine opthalmic exams ```
44
What are the clinical manifestations of diabetic nephropathy?
Albuminuria Hypertension Renal insufficiency
45
How would you manage diabetic nephropathy?
``` Control hypertension Monitor albumin in urine Avoid nephrotoxic agents Low sodium & protein diet Antihypertenives Dialysis / kidney transplantation ```
46
What is diabetic neuropathy?
Group of diseases that affect peripheral and autonomic nerves Disruption in blood supply to nerves
47
What are the clinical manifestations of peripheral neuropathy?
Paresthesia Burning sensation Decrease proprioception Joint deformities
48
How would you manage peripheral neuropathy?
Control BGL Non-opiod analgesics Antidepressants Antiseizure medications
49
What are clinical manifestations of autonomic neuropathies?
``` Resting tachycardia Orthostatic hypertension MI N/V Diarrhea Constipation Delayes gastric emptying Decreased sensation of bladder fullness Sexual dysfunction ```
50
How would you manage autonomic neuropathies?
Depends on symptoms | Delayed gastric emptying
51
What are the clinical manifestations of complications to the lower extremities?
Thermal Chemical Traumatic
52
How would you manage complications of the lower extremities?
``` Patient education BGL control Regular exams Podiatrist referral Family teaching Monofilament test ```
53
What causes hyperglycemia in surgical patients?
Physiologic stress
54
What causes hypoglycemia in surgical patients?
Delayed surgery
55
What are the nursing interventions for hospitalized patients with diabetes?
Proper IVF Proper skin care Inform & Educate pt
56
What tasks can you delegate to UAP?
Accuchecks Vitals Communication/reinforcement Simple assessment
57
What are ways to manage diabetes with nutrition?
Maintain a reasonable body weight | Prevent wide fluctuations in BGL
58
What percentage of a diabetic's diet should be carbohydrates?
50-60% complex carbs
59
What percentage of a diabetic's diet should be fats?
> 30%
60
What percentage of a diabetic's diet should be protein?
10-20% Lean protein
61
Diabetic women can have 2 alcoholic drinks/day.
False. Women can have 1
62
Moderate-vigorous exercise is necessary to lower BGL
True
63
A 15g snack is suggested prior to exercise, after exercise, and at bedtime to prevent _________
Hypoglycemia
64
Management of diabetes is paramount to prevent future complications.
True
65
What would you make sure a newly diagnosed DM patient knows?
Self monitoring and interpretation of results Ability to perform self testing Cost of BG monitoring Test when BGL high / low
66
When preparing to teach a newly diagnosed DM patient, what would you want to assess?
Readiness to learn | Knowledge and adherence to plan of care
67
What things would you recommend to a newly diagnosed DM patient?
Encourage health promotion activities and regular health screenings
68
What is the treatment goal of managing diabetes?
To normalize BGL to reduce the risk of diabetes related complications
69
What is hypoglycemia?
Deprivation of brain cells fuel for functioning | BGL 50-60
70
How would you treat a conscious hypoglycemic patient?
15g snack of simple carb | Check BGL in 155 minutes
71
How would you treat an unconscious hypoglycemic patient?
Glucagon 1mg IM or subcu | Followed by a snack
72
How would you treat a hypoglycemic hospitalized patient?
D50W 25-50mL IVP at 10mL/min
73
What is diabetic ketoacidosis?
Absence or inadequate amounts of insulin with subsequent rise in BGL
74
What are the clinical features of DKA?
``` Hyperglycemia Ketosis Dehydration *** Electrolyte loss Acidosis ```
75
You should not start DKA interventions until after you recheck BGL and lab results.
False. DKA is a medical emergency and should be treated immediately
76
What are the precipitating factors of DKA?
Missed/insufficient dose of insulin Physical/emotional stress Illness/infection
77
What are the clinical manifestations of DKA?
``` Polyuria Polydipsia Nausea/vomiting Orthostatic hypotension Kussmaul respirations Fruity breath Altered mental status ```
78
What is the expected BGL of a patient in DKA?
> 250
79
What is the expected serum pH level of a patient in DKA?
6.8-7.3
80
A patient in DKA would have urine and serum ketones.
True
81
What IVF would you use to rehydrate a patient in DKA?
0.9% NS 1/2-1L/hour If BGL < 250: use D5NS or D5 1/2
82
Which electrolyte imbalance would you be concerned about for a patient in DKA?
Potassium
83
What is Hyperglycemic Hyperosmolar NonKetotic Syndrome?
Osmolality > 340 BGL > 600 Ketosis is minimal or absent
84
How would you manage a patient with HHNKS?
``` IVF 0.9%NS Cardiac monitoring Continuous insulin infusion Monitor vitals & fluid status Accurate I & O ```
85
What are the causes of morning hyperglycemia?
Dawn phenomenon or Somogyi effect
86
What is the dawn phenomenon?
Insufficient insulin coverage at night causes BGL to increase overnight
87
How do you treat dawn phenomenon?
Change the time of NPH from dinner to bedtime
88
What is the somogyi effect?
A rebound phenomenon of BGL rising rapidly after dropping due regulatory hormones from too much insulin coverage
89
How do you treat the somogyi effect?
Decrease pm insulin dose or give bedtime snack
90
What patient is best suited from oral antidiabetic agents?
Type II DM who cannot be treated by diet control and excercise alone
91
What are the nursing interventions for oral antidiabetic agents?
Monitor BGL Assess for hypoglycemia Assess for other side effects
92
How does insulin work?
Reduces BGL by increasing glucose transport across cell membranes
93
Insulin enhances the conversion of glucose to glycogen.
True
94
________ is a hormone that stimulates insulin secretion in response to meals.
Incretion
95
Insulin signals the liver to continue releasing glucose.
False | Insulin signals the liver to STOP releasing glucose
96
What is insulin lipohypertrophy?
Fibrofatty masses at injection sites
97
Coexisting conditions can complicate diabetes management.
True
98
Diagnosis of diabetes may be difficult due to age related changes
True
99
Age related health problems increase the risk of diabetes related complications..
True

NUR123 Exam 1 (5 decks)

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