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NURS 3512 - Class 1-6 > Week 1 - Diabetes > Flashcards

Week 1 - Diabetes Flashcards

1
Q

what is diabetes (3)

A
  • disease related to abnormal insulin production
  • impaired insulin utilization
  • or both
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2
Q

what is the cause of type 1 DM

A
  • progressive destruction of the beta cells –> no release of insulin
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3
Q

describe the onset of type 1 DM (2)

A
  • sudden onset of symptoms

- typically in people under 30

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4
Q

what is the cause of type 2 DM

A
  • the pancreas is still producing insulin, but the insulin is either insufficient, poorly used by the tissues (insulin resistance), or both
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5
Q

decsribe the onset of type 2 DM (2)

A
  • gradual onset of symptoms –> often goes undetected until complications
  • typically in people older than 35
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6
Q

what are the 3 P’s ph type 1 DM / hyperglycemia

A
  • polyuria
  • polydipsia
  • polyphagia
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7
Q

what are other symptoms of type 1 DM (5)

A
  • weight loss ( due to the body burning fat)
  • glucosuria
  • weakness & fatigue (body lacks energy bc cant get sugar)
  • vision changes
  • vaginal yeast infections in women
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8
Q

when is type 1 DM often discovered?

A
  • in the ER when they get DKa
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9
Q

what type of symptoms are common in type 2 DM

A
  • nonspecific

- may have symptoms similar to type 1

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10
Q

list symptoms in type 2 DM (5)

A
  • fatigue
  • recurrent infections
  • delayed wound healing
  • visual acuity changes
  • painful peripheral neuropathy
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11
Q

what are the 4 methods to diagnose DM

A
  • hemoglobin A1C
  • fasting plasma glucose lvl
  • random or casual plasma glucose lvl
  • two hour oral glucose tolerance test (OGTT) lvl
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12
Q

what is hemoglobin A1C

A
  • test that shows how much glucose is attached to hemoglobin molecules over RBC lifespan
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13
Q

what is the benefit of hemoglobin A1C (2)

A
  • greater convenience (no fasting required)

- determines glycemic control over time –> over 90-120 days

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14
Q

what is normal A1C? what A1C lvl indicates DM

A
  • normal = < 6.5%

- DM = > 6.5%

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15
Q

pts with DM should have regular assessments of A1C every how often?

A

3-6 mo.

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16
Q

what are the benefits of people w DM who have near-normal A1C lvls (3)

A

reduced risks for the development of:

  • retinopathy
  • nephropathy
  • neuropathy
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17
Q

what is fasting plasma glucose (FPG)

A
  • test that measures BG after fasting (no caloric intake) for at least 8 hrs
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18
Q

what FPG lvl indicates DM

A

> 7.5 mmol/L

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19
Q

what random/casual plasma glucose measurement indicates DM

A

> 11.1 mmol/L

- plus classic symptoms (polyuria, polydipsia, weight loss, polyphagia)

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20
Q

what is a OGTT lvl

A
  • test that gives the pt a 75 g glucose load, then measures glucose lvls 2 hr later
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21
Q

what OGTT lvl indicates DM

A

> 11.1 mmol/L

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22
Q

what are the goals of DM management (4)

A
  • promote well-being
  • reduce symptoms
  • prevent acute complication of hypo/hyperglycemia
  • prevent long-term complications
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23
Q

what are important aspects of management of DM (5)

A
  • nutrition
  • exercise
  • drug therapy
  • self-monitoring of BG
  • BP control
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24
Q

what is the cornerstone of therapy for DM

A
  • nutrition
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25
Q

what other interprofessional members should be involved in nutrition therapy for DM (2)

A
  • dietician

- diabetes nurse education

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26
Q

what should be considered when creating nutrition plans for someone w diabetes (8)

A
  • keep food routine as regular as possible

individualize to:

  • behavioral
  • cognitive
  • socioeconomic
  • cultural
  • spiritual aspects
  • age
  • needs
  • preferences
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27
Q

describe the meal plan for a pt with type 1 DM (4)

A
  • base on usual food intake balanced w insulin & exercise patterns
  • insulin regimen is managed day to day
  • intermeal and bedtime snacks are often necessary (especially w NPH)
  • carb counting strategies
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28
Q

why are bedtime snacks often required for a pt with type 1 DM

A
  • the insulin often peaks during the night = risk of hypoglycemia
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29
Q

what is the emphasis of nutritional therapy for a pt with type 2 DM (4)

A

based on achieving:

  • glucose
  • lipid (fat reduction)
  • BP lvl goals
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30
Q

what is the benefit of weight loss for a pt with type 2 DM (3)

A

improve glycemic control by:

  • increasing insulin sensitivity
  • increasing glucose uptake
  • decreasing hepatic glucose hepatic
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31
Q

describe the diet plan for a pt with type 2 DM (3)

A
  • calorie reduction
  • reduction of total fats (especially sat. fat)
  • increased fibre
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32
Q

for pts with type 2 DM, what interventions might be enough to attain an optimal lvl of BG control

A

lifestyle modifications:

  • healthy eating
  • regular physicial activity
  • maintenance of desirable body weight

many also need oral antihyperglycemics (or insulin)

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33
Q

why is exercise an essential part of DM management (7)

A
  • increases insulin sensitivity
  • lowers BG lvls
  • contributes to weight loss
  • reduce BP
  • improves circulation
  • decreases triglycerides and LDL
  • decreases cholestrol
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34
Q

exercise plans for pts w DM should be started… (2)

A
  • after medical clearance

- slowly w gradual progression toward the goal

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35
Q

when is it best to exericise for a pt w DM

A
  • best done after meals
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36
Q

what effect does exercise have on BG

A
  • causes decreased BG
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37
Q

when should pts w DM avoid exercise

A
  • during peak times of insulin –> risk of hypoglycemia
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38
Q

how long can the glucose lowering effect of exercise last

A

-up to 48 hrs

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39
Q

what steps r/t diet can prevent hypoglycemia when exercising (4)

A
  • exercise about 1 hr after a meal
  • if not doing it after a meal, take a 10-15 g carb snack before exercising
  • have several small carb snacks every 30 min
  • carry fast acting source of carbs w them
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40
Q

what is the importance of self-monitoring of BG

A
  • allows the pt to make self-management decisions regarding diet, exercise, and meds
  • can detect hypo/hyperglycemia
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41
Q

what is the benefit of invasive glucose monitors that use a sensor under the skin to display BG (4)

A
  • displays BG continuously
  • updates values every 1-5 min
  • helps identify trends and patterns
  • pt is alerted during episodes of hypo/hyperglycemia
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42
Q

it is recommended that pts w type 1 DM test their BG at least __ times per day: type 2? when else should it be tested?

A
  • type 1: 3 per day and include post and preprandial testing
  • type 2: at least once per day

and whenever hypoglycemia is suspected

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43
Q

what type of med is required for pts with type 1 DM

A
  • insulin
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44
Q

when is insulin required for pts with type 2 DM

A

if the combo of:

  • nutritional therapy
  • exercise
  • and oral antihyperglycemics cannot maintain BG control
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45
Q

what type of meds do pts with type 2 DM take

A
  • oral antihyperglycemics
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46
Q

when do insulin requirements increase

A
  • periods of stress such as illness or injury
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47
Q

what is the fnxn of oral antihyperglycemics

A
  • improve the mechanisms in which insulin & glucose are produced & used by the body
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48
Q

what is required for oral antihyperglycemics to be effective

A
  • must have some circulating endogenous insulin
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49
Q

what are the 4 categories of insulin

A
  • rapid
  • short (regular)
  • long
  • intermediate
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50
Q

what is a type of rapid acting insulin

A

lispro

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51
Q

what is the onset of rapid acting insulin

A

10-15 mins

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52
Q

what is the peak of rapid acting insulin

A
  • 60-90 min
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53
Q

what is the duration of rapid acting insulin

A

3-5 hr

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54
Q

when should rapid acting insulin be administered

A
  • 0-15 min before meals (w food)

- or up to 15 min after a meal (not preferred)

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55
Q

what is a type of regular /short acting insulin

A
  • humulin R
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56
Q

what is the onset of short acting insulin

A

30-60 min

57
Q

what is the peak of short acting insulin

A

2-4 hr

58
Q

what is the duration of short acting insulin

A
  • 5-8 hr
59
Q

when should short acting insulin be administered

A
  • 30-45 min before meals
60
Q

what is a type of intermediate acting insulin

A

NPH

61
Q

what is the onset of intermediate acting insulin

A
  • 1-3 hr
62
Q

what is the peak of intermediate acting insulin

A
  • 4-8 hr
63
Q

what is the duration of intermediate acting insulin

A

12-16 hr

64
Q

what are 2 types of long acting insulin

A
  • glargine (lantus)

- detemir (levemur)

65
Q

what is the onset of long acting insulin

A
  • 1-2 hr
66
Q

what is the peak of long acting insulin

A
  • no peak –> released steadiy and continuously over 24 hr
67
Q

what is a pro and con to long acting insulin

A
  • pro = no peak = less risk of hypoglycemia & does not need to be given w food
  • con = does not cover post prandial BG
68
Q

what is the duration of long acting insulin

A
  • 24 hrs
69
Q

what type of insulin cannot be mixed w others

A
  • long acting
70
Q

what is the only type of insulin that can be given IV

A
  • regular
71
Q

when should intermediate insulin bc given

A
  • early morning or hs to cover in the background
72
Q

what type of insulins are often used in combo?

A
  • short or rapid with NPH
73
Q

describe storage of insulin (4)

A
  • unopened = refridgerate
  • open = room temp
  • avoid prolonged exposure to sun
  • avoid temps higher than 30* or below freezing
74
Q

what are some complications insulin therapy (5)

A
  • hypoglycemia
  • allergic rxns
  • lipodystrophy
  • dawn phenomen
  • somogyi effect
75
Q

what do both the dawn & somogyi effect cause

A
  • hyperglycemia in the morning
76
Q

what is the somogyi effect

A
  • when BGL drops = rebound hyperglycemia in the morning caused by BGL dropping during the night (d/t insulin) , causing CRH to be released
77
Q

what is the danger associated w the somogyi effect (2)

A
  • when BGL are measured in morning, and see hyperglycemia, insulin dosage may be increased
  • also associated w the occurrence of undetected hypoglycemia during sleep
78
Q

what is the treatment for the somogyi effect (2)

A
  • increased bedtie snack

- decrease insulin before bed

79
Q

what is the dawn phenomonon

A
  • hyperglycemia in the morning caused by the normal rise in BGL as the body prepares to wake up (thru hormones) & the body is not produced insulin to control rise in BGL
80
Q

what is the treatment for the dawn phenomonon (2)

A
  • increase in insulin before bed

- adjust the timing of insulin before bed

81
Q

how can we tell the difference between the somogyi effect & the dawn phenomonon

A
  • if BG is low between 2-4 am, suspect the somogyi effect

- if BG is normal or high at 2-4 am, suspect the dawn phenomonon

82
Q

what can caused increased BG (4)? how?

A
  • acute illness
  • surgery
  • corticosteroids (prednisone)
  • emotional and physical stress

thru the release of cortisol

83
Q

what interventions can be done to avoid the rise in BG during times of stress (6)

A
  • monitor BG frequently when sick
  • maintain regular doses of OHAs and insulin
  • if pt is ill and continuing w regular meal plan, increase noncarb containing fluids
  • if vomiting 2x in 24 hrs, and cannot keep BGL in control, go to ER
  • if pre-op doctor will order specific orders
  • if pt is ill and not eating, supplement food intake w carb containing fluids
84
Q

if a pt is on corticosteroids, what may need to be done to maintain control of BG

A
  • may need to increase OHA or insulin
85
Q

what is important to consider if a pt is NPO post-op

A
  • NPO = may have low BG = careful w insulin doses
86
Q

what is an acute complication associated w type 1 DM

A
  • diabetic ketoacidosis
87
Q

what is DKA

A
  • life-threatening complication that occurs when the supply of insulin is insufficient
    = glucose cannot be used for energy
    = body breaks down fat stores instead
88
Q

what does the break down of fat stores cause in DKA (3)

A
  • ketone bodies excreted in urine
  • altered pH –> metabolic acidosis
  • depleted electrolytes
89
Q

what can cause DKA

A
  • missed insulin dosage

- times of stress, trauma, infection in pts w type 1 DM

90
Q

what are signs of DKA (5)

A
  • severe hyperglycemia
  • dehydration (hyperglycemia = polyuria)
  • metabolic acidosis
  • fruity breath
  • kussmaul’s resps
91
Q

what might BGL be during DKA

A

> 14 or may just say “high”

92
Q

what must be done if the BG monitor says “high”

A
  • a serum blood draw needs to be sent for glucose
93
Q

what are signs of severe dehydration (10)

A
  • increased urine output
  • poor skin turgor
  • dry mucous membranes
  • sunken eyes
  • thirst
  • orthostatic hypotension
  • tachycardia
  • abdominal pain
  • restlessness
  • confusion
94
Q

how does DKA cause metabolic acidosis

A
  • due to accumulation of ketone bodies

- get decreased pH

95
Q

what are kussmaul’s resps? why does this occur in DKA?

A

rapid breathing to try to decreased acidity

96
Q

what is the treatment for DKA (8)

A 
Fluids
Insulin
Glucose (monitor)
Potassium (insulin pushes K into the cell)
Infection (monitor for)
Chart fluid balance
Ketones (monitor)

+ Airway management (O2, monitor signs of fluid overload)

97
Q

what should you monitor in a pt with DKA (5)

A
  • cardiac monitoring
  • lung sounds
  • LOC
  • potassium
  • bicarb
  • signs of fluid overload
98
Q

what type of fluid is used for DKA

A
  • NS to start
99
Q

when is insulin therapy withheld until for a pt with DKA

A
  • until fluid resuscitation has begun
  • and until K>3.3

(to prevent hypokalemia and depletion of vascular volume)

100
Q

what electrolytes should we administer w treatment for DKA

A
  • potassium IV to prevent hypokalemia

- IV sodium bicarb if pH <7

101
Q

how is insulin administered during DKA

A
  • bolus to start

- then continuous insulin

102
Q

what is an acute complication associated w pts with type 2 DM

A
  • HHS (hyperosmolar hyperglycemia syndrome)
103
Q

who does HHS typically occur in

A
  • older adults w type 2 DM

- pts also often have history of inadequate fluid intake

104
Q

what is HHS

A
  • life threatening complication that occurs in pts with enough insulin to prevent DKA but not enough to prevent severe hyperglycemia
105
Q

what does HHS result in (5)

A
  • polyuria
  • very high hyperglycemia (>34)
  • neuro changes
  • increased serum osmolarity
  • absent/minimal ketone bodies
106
Q

why does increased serum osmolarity occur w HHS

A
  • due to high glucose

- & polyuria

107
Q

why is BG so much higher in HHS than DKA

A
  • HHS produces less symptoms in the early stages = BG rises higher
108
Q

is DKA or HHS more common? which has a higher mortality rate?

A
  • DKA more common

- HHS has higher fataility rate

109
Q

what is the treatment for HHS?

A
  • same as DKA

but requires greater fluid replacement (bc of correction of high osmolarity)

110
Q

what are some differences between HHS and DKA (3)

A
  • HHS has no ketone bodies = no metabolic acidosis, fruity breath, kussmaul breathing, etc.
  • hypokalemia not as significant
  • high osmolarity not as much of an issue in DKA
111
Q

what often precipiattes HHS? why?

A
  • infection/illness

bc contributes to dehydration

112
Q

what can HHS progress to? why?

A
  • HHNC (hyperglycemic, hyperosmolar nonketotic coma)

- the very high BGL cause more severe neuro impairments

113
Q

what is hypoglycemia

A
  • low BG <4
114
Q

what type of symptoms do you see in hypoglycemia

A
  • if BG <4 = adrenergic (SNS) symptoms

- if BG <2.5 = CNS symptoms

115
Q

what type of SNS symptoms are seen in hypoglycemia (9)

A
  • sweating
  • tachycardiac
  • shaking
  • anxiety
  • palpitations
  • hunger
  • pallor
  • nausea
  • cold, clammy skin
116
Q

what type of CNS symptoms are seen in hypoglycemia (13)

A
  • irritability
  • visual disturbances
  • weakness
  • lack of coordination
  • confusion
  • headaches
  • drowsiness
  • dizziness
  • convulsions
  • difficulty speaking
  • stupor
  • loss of consciousness
  • coma

similar to signs of intoxication

117
Q

what can cause hypoglycemia (4)

A
  • exercise
  • alcohol
  • too much insulin
  • insufficient food intake
118
Q

what is very important to prevent hypoglycemia

A
  • self monitoring
119
Q

what is a complication associated hypoglycemia

A
  • hypoglycemia unawareness syndrome
120
Q

what is hypoglycemia unawareness syndrome

A
  • when repeated bouts of hypoglycemia = densensitized to SNS signs of hypoglycemia
    = no warning signs
121
Q

what should be done at first sign of hypoglycemia

A
  • check BG
122
Q

if the BG is below 4 mmol/L what should be done

A
  • treat immediately
123
Q

what is the treatment for mild-mod hypoglycemia & they are conscious/able to swallow (3)

A
  1. give 15-20 g of a simple, fasting acting carb (juice box, lifesavers, juice, etc.)
  2. retest BG 15 min later
  3. give a protein and starch or a meal once over 4mmol
  4. check BG again ~45 min after treatment
124
Q

what do you do if BG is still below 4 when you retest 15 min after giving a fast acting carb

A
  • give another load of 15-20 g of fast acting carbs

- if no improvement after 2-3 doses of 15-20 g of carbs, give 1 mg of glucagon

125
Q

what is an example of a good protein & starch to give a pt after hypoglycemia

A
  • pb and crackers

- cheese and crackers

126
Q

what is the treatment for hypoglycemia if the pt is unconscious or unable to swallow (2)

A
  • 1 mg glucagon IM or SC

- IV admin of 25-50 mL of dextrose 50% in ater over 1-3 min –> “1 AMP of D50” (most common in hospital)

127
Q

what are the 2 categories of chronic complications of DM

A
  • macrovascular

- microvascular

128
Q

what are some microvascular complications of DM (4)

A
  • retinopathy
  • nephropathy
  • neuropathy
  • dermopathy
129
Q

what are some macrovascular complications of DM (3)

A
  • peripheral vascular disease
  • cardiovascular disease
  • cerebrovascular disease
130
Q

what are 2 other chronic complications of DM

A
  • infections

- foot ulcers

131
Q

a nursing diagnosis r/t diabetes is ineffective health management. what teaching about the disease process can be done (10)

A
  • appraise the pts current lvl of knowledge
  • describe disease process and therapy/treatment
  • instruct pt on measures to prevent or minimize symptoms
  • discuss lifestyle changes required
  • describe possible chronic comp
  • plan individualized exercise program
  • review steps to prevent hypo/hyperglycemia
  • instruct pt on which S&S to report to HCP
  • review insulin admin
  • review OHA regimen
  • refer pt to local community agencies or support groups
132
Q

what teaching r/t diet can be done for a pt with diabetes (3)

A
  • determine pt & caregivers feelings and attitudes towards prescribed diet and the expected degree of dietary compliance
  • assist the pt to accommodate food preferences in the prescribed diet
  • refer pt to dietician or nutritionist
133
Q

what teaching can be given to the pt regarding activity & exercise (3)

A
  • inform pt the purpose & benefits
  • instruct pt how to monitor tolerance of the activity and exercise to prevent injury
  • assist the pt to incorporate an activity & exercise regimen into their daily lifestyle
134
Q

what nursing interventions r/t hyperglycemia management can be done (4)

A
  • monitor S&S of hyperglycemia
  • anticipate situations in which insulin requirements will increase
  • facilitate adherence to diet and exercise regimen
  • restrict exercise when BG are >14, especially when ketones present to decrease body’s requirements for already unavailable glucose
135
Q

what teaching regarding foot care can be given (5)

A
  • perform comprehensive foot assessment for neuropathy
  • provide info regarding the relationship between neuropathy, injury, and vascular disease & the risk for ulceration and lower extremitity amputation
  • caution abt potential sources of injury to the feet
  • instruct pt to inspect inside of shoes daily for foreign objects, nail points, torn lining, and rough areas to avoid injury by factors that are not felt
  • recommend specialist care for thick fungal or ingrown toenails, calluses
136
Q

what are some potential sources of injury to the foot (10)

A
  • heat
  • cold
  • callouses
  • chemicals
  • use of strong antiseptics or astringents
  • use of adhesive tape
  • going barefoot
  • wearing sandals
  • open-toed shoes
  • ill fitting shoes
137
Q

what nursing interventions can be done regarding hypoglycemia mngmt (4)

A
  • monitor for S&S
  • determine pts recognition of hypoglycemia S&S
  • instruct pt to have simple carb available at all times
  • instruct pt to obtain and carry approp emergency ID
138
Q

a nursing diagnosis r/t diabetes is risk for peripheral neurovascular dysfunction. what nursing interventions can be done for circulatory care & arterial insufficiency (7)

A
  • perform appraisal of peripheral circulation for baseline
  • inspect skin for arterial ulcers or tissue breakdown
  • protect extremitity from injury
  • maintain adequate hydration
  • encourage pt to obtain exercise as tolerates
  • instruct pt on factors that interfere w circulation
  • instruct pt on proper foot care & foot wear
139
Q

what are some factors that interfere w circulation (4)

A
  • smoking
  • restrictive clothing
  • exposure to cold temp
  • crossing of legs

NURS 3512 - Class 1-6 (47 decks)

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