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NUR 333 Fund Adult Nursing Care 2 > Week 3 Diabetes > Flashcards

Week 3 Diabetes Flashcards

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1
Q

How does T1D work?

A
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2
Q

How does T2D work?

A
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3
Q

T1D facts

A
  • More common in younger people
  • S/S normally more abrupt
  • NO endogenous insulin production -> must have insulin replacement
  • 3 Ps most common: polyphagia, polydipsia, polyuria
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4
Q

T2D Facts

A
  • More common in adults (w/ risk factors)
  • Can go undiagnosed for years
  • Drs just screen for risk factors, not s/s
  • Pts are INSULIN RESISTANT —> treat w/ oral/SQ meds, may need insulin replacement
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5
Q

Symptoms of T2D

A

Fatigue, recurrent infections (decreased immune system), slow wound healing

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6
Q

What are the 3 Ps associated with T1DM?

A

Polydipsia, polyuria, polyphagia

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7
Q

Non-modifiable risk factors for T2D

A
  • Family hx of diabetes
  • > 45 years old
  • Race/Ethnicity
  • Hx of gestational diabetes
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8
Q

Modifiable risk factors for T2D

A
  • Physical inactivity
  • High body fat or body weight
  • High BP
  • High cholesterol
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9
Q

Labs involved in diabetes:

Fasting
Casual
Urine ketones
Lipid profile

A

Fasting - No food/drink in 8 hours <126 mg/dL
Casual - <200 mg/dL
Urine ketones - high = hyperglycemia >300
HDL >50 LDL <130 Total <200

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10
Q

Oral Glucose Tolerance Test & Lab Values

A
  • Gestational Diabetes
  • Fasting, oral glucose, levels obtained every 30 min until 2 hours post consumption
  • Fasting <110 mg/dL
  • 1 hour - <180 mg/dL
  • 2 hours - <140 mg/dL
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11
Q

HbA1C

A

Indicated for AVG glucose level over past 120 days (3 mos)

Used commonly for diagnosis and to evaluate effectiveness of interventions (meds/lifestyle)

Normal 4-6% Diabetic >6.5%

*Acceptable reference range for those w/ diagnoses DM, 6-8% range -> w/ target of 7%.

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12
Q

Blood Test Levels for Diagnosis: A1C

A

Normal: 4-6%
Pre-Diabetes: 5.7 - 6.4%
Diabetes: >6.5%

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13
Q

Blood Test Levels for Diagnosis: Fasting

A

Normal: 99 or below
Pre-Diabetes: 100 - 125
Diabetes: 126 or above

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14
Q

Blood Test Levels for Diagnosis: Oral Glucose Tolerance Test

A

Normal: 139 or below
Pre-Diabetes: 140 - 199
Diabetes: 200 or above

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15
Q

Diagnostic Criteria for T1D and T2D

A

T1D: islet cell antibody test

T2D: 
At least one of the following: 
- A1C 6.5 or higher
- Fasting >126
- OGTT 200 mg
- 3 Ps 
- Random glucose test of >200
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16
Q

Care for Pre-Diabetic Patient

A

Defined as impaired glucose tolerance, impaired fasting-glucose, or both.

No symptoms although long-term damage may already be occurring

Diagnostic criteria:

  • A1C: 5.7 - 6.4
  • Fasting: 100 - 125
  • OGTT: 140 - 199

What can we do for these pts?

  • Teach
  • Lifestyle modification
  • Close monitoring of A1C
  • Monitor for s/s: fatigue, slow wound healing, getting sick
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17
Q

What medications are used more frequently in T2D patients?

A

Oral medications

Try to:

  • Reverse insulin resistance
  • Decrease insulin production
  • Increase hepatic glucose production
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18
Q

What happens to hospitalized pts that are previously on oral diabetic meds?

A

They are put on insulin while acutely ill.

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19
Q

What do steroids do to your blood sugar?

A

Make it rise

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20
Q

Patients are more prone to what when they are sick?
T1D?
T2D?

A

T1D -> DKA - diabetic ketoacidosis

T2D -> HHNS - hyperosmolar hyperglycemic syndrome

21
Q

What happens when a pt w/ DM gets sick w/ a virus?

A
  • May not be eating or drinking.
  • Must check blood sugar often and treat as necessary
  • Still need to take oral meds if sick, if possible
22
Q

What are some teaching points for pts when they are sick and have DM?

A
  • Notify HCP
  • Monitor BS more frequently (q2-4h)
  • Cont. to take meds
  • Prevent dehydration
  • Meet carb needs -> either via food or liquid
  • Rest
23
Q

When should the pt call their HCP when they are sick and have DM?

A
  • Ketones in urine
  • BS >250
  • Fever >101.5 & is not responding to Tylenol
  • Confused/disoriented/rapid breathing
  • Persistent N/V/D
  • Unable to tolerate liquids
  • Illness lasting longer than 2 days
24
Q

Basal insulin vs bolus

A

Basal - Long-time insulin

Bolus - “Mealtime” insulin -> rapid and short acting

25
Q

Why do we give basal-bolus combos for insulin?

A

To mimic the body’s normal insulin production

26
Q

Rapid-Acting Insulin

A

Lispro (NovoLOG)

Onset: 15 min
Peak: 1 hour
Duration: 2-4 hours

27
Q

Regular/Short Acting Insulin

A

Human regular (Novalin R/Humalin R)

Onset: 30-60 min
Peak: 2-6 hours
Duration: 3-8 hours

28
Q

Intermediate Insulin

A

NPH (Humalin N)

Onset: 2-4 hours
Peak: 4-10 hours
Duration: 10-20 hours

29
Q

Long Acting Insulin

A

Glargine (Lantus)

Onset: 70 min
Peak: None
Duration: 24 hours

30
Q

Is Insulin a high alert medication?

A

Yes!

31
Q

What do you do before giving insulin?

A

1st - Check current glucose levels
2nd - Check diet order & pts oral intake tolerance

Know onset, peak, duration of insulin and the type you’re giving

Monitor for hypoglycemia

32
Q

What BG levels are for hypoglycemia?

A

<70

Can show symptoms if greater than 70 depending on if the diabetes is uncontrolled

33
Q

How do you treat hypoglycemia?

A
  1. Check FSBG levels
  2. The rule of 15 (if conscious and able to swallow)
  3. Recheck FSBG levels in 15 min, then eat regular meal w/ protein
  4. If still >70, repeat. When glucose stable, give additional food.
34
Q

What is the “Rule of 15”?

A
  • 15 simple CHO (4 oz juice, regular soda, 3 glucose tabs, 1 tbsp honey, 5-8 lifesavers)
  • Avoid sugars w/ fat (candy bar) because it delays absorption

*15g of CHO should raise BG levels by 50!!

35
Q

What do you do if the pt is hypoglycemic and unconscious?

A

IM glucagon

IV D50

36
Q

What are the levels for hyperglycemia?

A

> 250 - 300

37
Q

What causes Hyperglycemia?

A

Illness, infection, self-management issues, stress

38
Q

What are s/s of Hyperglycemia?

A

Weakness, fatigue, blurry vision, headache, N/V/D

39
Q

What is the treatment for hyperglycemia?

A
  • Check for ketones in urine
  • Insulin
  • Drink fluids, prevent dehydration
  • Education on prevention
40
Q

Insulin pumps

A
  • T1D
  • Rapid acting insulin
  • Pts receive continuous basal infusion
  • Required to check BS 4TID
  • Deactivated in hospital and switched to sliding scale
  • Cost $$$$$$
41
Q

Chronic complications of Diabetes:
Macrovascular
Microvascular

A

Macrovascular

  • Damage to lg vessels
    • coronary arteries
    • peripheral vascular
    • cerebral vascular

Microvascular

  • Damage to capillaries
    • Retinopathies
    • Nephropathies
    • Neuropathies
42
Q

Macrovascular disease facts

A
  • Women w/ DM have 4-6x more risk of CVD
  • Men have 2-3x risk of CVD

Educate!

  • PREVENTION
  • Stop smoking, control BP, modify high fat diet
43
Q

Microvascular disease complications

A

Retinopathy
- Damage to retina

Nephropathy

  • Damage to small blood vessels in kidneys
  • Leading cause of end stage renal dz.

Neuropathy

  • Nerve damage due to metabolic imbalances
  • 60-70% of patients have
44
Q

What are the highest risks for neuropathy in DM pts?

A
  • Lower extremities and feet

- Foot ulcers and lower amputations common

45
Q

Diabetic foot care

A
  • Wash feet daily
  • Pat feet dry, esp between toes
  • Inspect feet daily for cuts, swelling, blisters, red areas
  • Lanolin to prevent dry skin and cracking, but not between toes
  • Mild foot powder on sweaty feet
  • Do not use commercial remedies to remove calluses or corns
  • Clean cuts w/ mild soap
  • Report skin infections or no healing sores
  • Trim nails after shower or bath and round corners
  • Separate overlapping toes w/ cotton
  • Do not go barefoot, wear open-toes, or plastic shoes. Shake soles before wearing regular shoes.
  • Clean, absorbent socks
  • No hot water bottles
46
Q

Nutritional Concerns for Diabetes

A
  • Balanced, high fiber, low fat, low cholesterol diet
  • Encourage clients to consume grains/fruits/legumes/milk
  • Limit simple carbs -> pasta and bread
  • CHO: 45-65% of intake
  • Fats: low in sat fat and trans fat; polyunsaturated fats best (fish)
  • Fiber: Promote fiber intake (beans, veggies, oats, whole grains)
  • Protein: Promote intake from meats, eggs, fish, nuts, and beans; 15-20% intake
  • Alcohol: limit intake; 1 daily for women, 2 for men
47
Q

Exercise for DM patients

A
  • Exercise can LOWER blood sugar
    • Do not exercise if glucose is >250 OR <80
    • Best to exercise after meals
  • If more than 1 hour has passed since eating, eat CHO snack prior
  • Wear a medical alert bracelet
  • Proper fitting footwear
48
Q

Nursing considerations for the hospitalized diabetic patient

A
  • Stress/surgery can increase blood glucose levels
  • Common to be controlled at home but uncontrolled at the hospital
  • Wound healing is impaired in pts w/ DM
  • High risk of infection
49
Q

Integumentary Concerns r/t DM

A

Diabetic dermopathy: reddish brown spots, shins

Acanthosis nigricans: brown/black thickening of skin, skin folds

Necrobiosis lipoidica diabeticorum: Red patches around blood vessels

NUR 333 Fund Adult Nursing Care 2 (4 decks)

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