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AH1 > unit4 diabetes/endocrine 12q > Flashcards

unit4 diabetes/endocrine 12q Flashcards

1
Q

Type 1-

A

○ Autoimmine disorder
○ Beta cells of the pancreas are destroyed by antibodies
○ Onset usually <30 y/o
○ Abrupt onset
○ Polydipsia, polyuria, polyphagia, and weight loss
○ Requires insulin
○ Could be viral in etiology

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2
Q

Type 2-

A

Reduction of cells to respond to insulin (insulin resistance) and decreased
secretion of insulin from beta cella
○ Predisposing facors are obesity, physical inactivity, and genetics
○ Onset usually >50 y/o
○ Could have no symptom or polydipsia, fatigue, blurred vision, vascular and neural
complications
○ Accounts for 90% of diabetic patients

● Gestational- Glucose intolerance during pregnancy

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3
Q

Explain acute and chronic complications of DM
● Microvascular Chronic Problems-

A

○ Retinopathy- Caused by damage to retinal vessels causing leaking and retinal
hypoxia

○ Neuropathy- Progressive deterioration of nerves; loss in sensation or muscle
weakness

○ Nephropathy- Chronic high BG causes damage to blood vessels in kidneys
causing leaking and hypoxia; kidneys allow filtration of larger particles which
damage the kidneys further

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4
Q

Explain acute and chronic complications of DM
● Microvascular Chronic Problems

Caused by damage to retinal vessels causing leaking and retinal
hypoxia

A

Retinopathy

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5
Q

Explain acute and chronic complications of DM
● Microvascular Chronic Problems-

Progressive deterioration of nerves; loss in sensation or muscle
weakness

A

Neuropathy

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6
Q

Explain acute and chronic complications of DM
● Microvascular Chronic Problems-

Chronic high BG causes damage to blood vessels in kidneys
causing leaking and hypoxia; kidneys allow filtration of larger particles which
damage the kidneys further

A

Nephropathy

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7
Q

Explain acute and chronic complications of DM
● Macrovascular Chronic Problems-

A

○ CV disease
○ Stroke
○ Peripheral vascular disease

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8
Q

Analyze lab values associated with DM and the significance of abnormal values
● Fasting blood glucose-

70-100

> 100 but <126 indicate impaired fasting glucose

> 126 on at least 2 occasions are diagnostic of diabetes

A

○ Normal is 70-100
○ Levels >100 but <126 indicate impaired fasting glucose
○ Levels >126 on at least 2 occasions are diagnostic of diabetes

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9
Q

Analyze lab values associated with DM and the significance of abnormal values

● Hemoglobin A1C- tells the average BG over the past 3 months

● Hemoglobin A1C- tells the average BG over the past 3 months

○ 4-6%
○ >6.5% are diagnostic for the diagnosis of DM
○ >8% indicate poor diabetic control

A

● Hemoglobin A1C- tells the average BG over the past 3 months

○ Normal is 4-6%
○ Levels >6.5% are diagnostic for the diagnosis of DM
○ Levels >8% indicate poor diabetic control

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10
Q

Analyze lab values associated with DM and the significance of abnormal values

● Glucose tolerance test-
<140
>140 or <200 indicate impaired glucose tolerance; levels >200 indicate
provisional diagnosis

A

● Glucose tolerance test-
○ Normal is <140
○ Levels >140 or <200 indicate impaired glucose tolerance; levels >200 indicate
provisional diagnosis

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11
Q

Examine medical and surgical interventions for patients with DM

A

● Transplantation of the pancreas- cadaver donor
● Iselet cell transplantation- considered experimental
● Yearly eye exams
● Adaptive devices for administering insulin
● Specialized adaptive equipment for blood glucose monitoring
● Control BP
● Eat a healthy diet and exercise
● Smoking cessation
● Drug therapy for nephropathy
● Wear proper fitting shoes and avoid walking barefoot
● Wear clean socks daily and trim toe nails properly
● Report non-healing breaks in the skin of the feet to HCP
● Gabapentin (Neurotin) is a common medication for management of neuropathic pain

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12
Q

Compare and contrast the four types of insulin therapy
Rapid Acting-
a. Onset-
b. Peak-
c. Duration-

A

Rapid Acting- Aspart and Lispro
a. Onset- 15 minutes
b. Peak- 1-2 hours
c. Duration- 3-5 hours

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13
Q

Compare and contrast the four types of insulin therapy

Short-Acting (Regular)
a. Onset-
b. Peak-
c. Duration-

A

Short-Acting (Regular)

a. Onset- 30-60 minutes
b. Peak- 2-3 hours
c. Duration- 6-10 hours

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14
Q

Compare and contrast the four types of insulin therapy

Long-Acting (Glargine)
a. Onset- Gradual
b. Peak- None
c. Duration- Up to 24 hours

A

Long-Acting (Glargine)

a. Onset-
b. Peak-
c. Duration-

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15
Q

Compare and contrast the four types of insulin therapy

Intermediate Acting
a. Onset-
b. Peak-
c. Duration-

A

Intermediate Acting

a. Onset- 15-2 hours
b. Peak- 1-12 hours
c. Duration- 12-24 hours

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16
Q

It is important for the RN to know the onset, peak, and duration of insulin to be able to identify if
the patient is experiencing hypoglycemia, and when that could occur (peak action time)

A

Remember

17
Q

Explain the factors influencing insulin absorption

● Injection site-
● Absorption rate-
● Injection depth-
● Timing of injection
● Mixing insuli

A

● Injection site-
○ Absorption fastest in abdomen
○ Teach to rotate around a site but not to another site

● Absorption rate-
○ Affected by the type of insulin, local heat, massage, exercise, or scarring

● Injection depth-
○ 90 degree angle usually (thinner patients is 45)

● Timing of injection

● Mixing insulin
○ Response to mixed insulin may differ from response to same insulins given
separately

18
Q

Use patient education strategies for patients with DM

A

● Refrigerate insulin not in use
● Insulin in use may be kept at room temperature for up to
● Discard unused insulin after 28 days
● Prefilled syringes are stable up to 30 days when refrigerated- store upright
● Have a spare bottle of each type of insulin used on hand
● Inspect the insulin before each use
● Use disposable needles one time
● Follow infection control measures

19
Q

Apply nursing interventions to prevent chronic complications of DM

A

● Adequate, healthy nutrition
● Exercise
● Blood glucose monitoring
● Medications

20
Q

Differentiate the features of hypoglycemia and hyperglycemia-

A

● Hypoglycemia CM- Weakness, difficulty thinking, confusion, clammy, diaphoresis,
coolness, pale skin

○ “Cool and clammy, need some candy”
○ Causes- Deficient intake, excessive insulin, exercise, alcohol, decreased gastric
emptying

● Hyperglycemia CM- Warm, moist skin, possibly fruity breath
○ “Hot and dry, sugar high

21
Q

Apply nursing interventions to treat and/or prevent hypoglycemia

A

● Give insulin when the patient has food in front of them versus before the food arrives
● Educate the patient the importance of eating soon after recieving insulin
● After short acting insulin is given, RN should check on the patient within 20 minutes of
administration

22
Q

Differentiate the onset, precipitating factors, manifestations, and lab values of DKA and HHS

A

● DKA- Uncontrolled hyperglycemia, metabolic acidosis, and increased production of
ketones
○ Causes- Infection, stress, inadequate insulin
○ Sudden onset
○ Ketones present
○ Dehydration and electrolyte loss; 3 P’s
○ Acidosis
○ BG >300
○ Give insulin first then IV fluids

23
Q

Differentiate the onset, precipitating factors, manifestations, and lab values of DKA and HHS

A

● HHS- Increased blood osmolarity caused by hyperglycemia and dehydration
○ Gradual onset
○ Altered CNS with neurological symptoms
○ Severe dehydration and electrolyte loss
○ BG >600
○ Tx- Give IV fluids first, then give insulin

24
Q

Prioritize nursing interventions for patients with DKA and HHS

A

● DKA- Immediately would be to give regular insulin and then put the patient on IV fluids to
prevent hypovolemic shock

25
Q

Prioritize nursing interventions for patients with DKA and HHS

A

● HHS- Fluids first, and then insulin

26
Q

Endocrine Assessment

Endocrine Changes with Aging-

A

● Decreased glucose tolerance-
○ Weight becomes greater than ideal
○ Elevated fasting and random blood glucose levels
○ Slow wound healing
○ Frequent yeast infections
○ Polydipsia
○ Polyuria

● Decreased general metabolism-
○ Less tolerant of cold
○ Decreased appetite
○ Decreased HR and BP

● Decreased ADH production-
○ Urine more dilute and may not concentrate when fluid intake is low
○ Patient is at greater risk for dehydration

● Decreased ovarian production of estrogen-
○ Bone density decreases
○ Skin is thinner, drier, and at greater risk for injury
○ Perineal and vaginal tissues become drier, and the risk of cystitis increases

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