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nur 333 fundamentals 2 > Wk 3: Caring for a Diabetic Pt/ Nutrition > Flashcards

Wk 3: Caring for a Diabetic Pt/ Nutrition Flashcards

1
Q

Type 1 DM

A

autoimmune destruction of Beta cells in our pancreas
-S/sx more abrupt
-common in youth
-NO ENDOGENOUS insulin production
-MUST have insulin replacement

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2
Q

type 2 DM

A

Beta cells in pancreas wear out and body becomes immune or resistant to insulin/body cells do not respond to insulin
-common in adults
-can go undiagnosed for long time
-some need insulin with PO meds

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3
Q

what are the 3 P’s of type 1 DM?

A

polyphagia -> excessive hunger
polydipsia -> excessive thirst
polyuria -> frequent urination

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4
Q

Common Symptoms of Diabetes

A

three P’s
fatigue
recurrent infections
slow healing

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5
Q

Non-modifiable risk factors for type 2 DM

A

family Hx
over 45 y/o
race/ethnicity
history of gestational diabetes

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6
Q

Modifiable risk factors for type 2 DM

A

Physical inactivity
High body fat/overweight
HTN
HLD

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7
Q

What labs are involved in monitoring diabetes ?

A

-Fasting BG (no food/drink for 8 hours)
Nml <126
-Casual BG

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8
Q

What labs are involved in monitoring diabetes ?

A

-Fasting BG (no food/drink for 8 hours)
Nml <126
-Orala Glucose Tolerance Test (to Dx gestational diabetes)
-Glycosylated Hemoglobin (HbA1C)
-Casual BG
Nml <200
-urine ketones
-lipid profile
low HDL, high LDL, high triglycerides

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9
Q

HbA1C test

A

-Average BG over 3 months
-used to Dx and evaluate effectiveness of interventions
-nml is 4-6%
> 6.5% is considered diabetic
acceptable range for diabetics is 6-8%

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10
Q

How do you take an Oral Glucose Tolerance Test

A

-consume oral glucose
-glucose taken every 30 minutes until 2 hours have passed
-fasting should be <110
- at 1 hour should be <180
-at 2 hours should be <140

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11
Q

A1C levels for
-Diabetics
-Pre-diabetes
-Normal

A

-diabetic: 6.5 or above
-Pre-diabetes: 5.7 - 6.4
-Normal: ~5

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12
Q

Fasting Plasma Glucose levels for
-diabetes
-pre-diabetes
-normal

A

-diabetes: 126 or above
-pre-diabetes: 100-125
-normal: 99 or below

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13
Q

oral glucose tolerance test for
-diabetes
-pre-diabetes
-normal

A

-diabetes: 200 or above
-pre-diabetes: 140-199
-normal: 139 or below

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14
Q

What is the criteria for a DM diagnosis

A

at least one of the following:
-A1C of 6.5% or higher
-fasting BG >126
-OGTT 2Hr level of 200
-Sx of hyperglycemia, a random BG >200, or hyperglycemia treatment

*usually a repeat lab is done before official diagnosis
*for Type 1 DM would beed an islet cell autoantibody test

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15
Q

What can you do for a pre-diabetic pateint?

A

-teach
-lifestyle modifications
-encourage close monitoring of BG and A1C
-monitor for: fatigue, slow healing, frequently being sick
-diet modification

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16
Q

What are some pharmacological considerations for a diabetic patient (specifically type 2 DM) when they are sick or hospitalized

A

-oral meds may be stopped when in the hospital
-might be put on insulin when in hospital, even if they do not normally take it
-BG can rise when sick
-hold metformin prior to surgeries
-Pt may be more prone to DKA or HHNS
-PO intake may be less, may need to alter insulin dose
-steroids make BG rise

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17
Q

When a patient with DM is sick, when should (you or) they call their provider

A

-urine ketones
BG >250
Temp >101.5 w/o response from Tylenol
Confusion/Disoriented/ Rapid Breathing
N/V/D
Fluid intolerance
sick >2 days

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18
Q

Frequency of BG checks depends on what

A

glycemic goals
type of diabetes
medication regimen
access to supplies and equipment
patients willingness

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19
Q

When would rapid or short acting insulin be given?

A

before each meal

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20
Q

When would lantus or long acting insulin be given?

A

at bedtime

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21
Q

Since Insulin is a high alert drug, what should you be checking/ know prior to administering it?

A

-current BG level
-check current diet order
-onset/peak/duration of insulin
-S/Sx of hypoglycemia

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22
Q

What do you do if your diabetic patient is NPO?

A

may need medication dosage change

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23
Q

What should you always do with a patient with a new diagnosis of DM?

A

-Make sure to educate properly about side effects, when to time insulin doses, and S/sx for hypoglycemia
-always observe new patients self-administer insulin

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24
Q

Hypoglycemia criteria and treatment

A

BG <70

Trx:
-FSBG
-rule of 15

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25
Q

What is the rule of 15?

A

if Pt is hypoglycemic but still able to swallow give 15g of simple carbohydrates
-FSBG in 15 minutes then eat regular meal
-if still <70 then repeat steps

(15g CHO should increase BG by 50)
Simple CHO include: 4Oz juice, regular soda, 3 glucose tabs

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26
Q

What can you give a patient that is hypoglycemic if they are unable to swallow or are unconscious?

A

IM Glucagon
IV D50

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27
Q

What are some symptoms of hypoglycemia?

A

diaphoresis, blurred vision, dizziness, anxiety, hunger, irritability, shakiness, fast heart beat, headache, weakness, fatigue

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28
Q

What are some causes of hyperglycemia?
what are some manifestations of it?

A

causes: illness, infection, self-management issues, stress
manifestations: weakness, fatigue, blurry vision, headache, N/V/D

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29
Q

Insulin Pumps

A

-SQ continuous infusions of rapid acting insulin
-be aware of: infections at pump site and increased risk of DKA if pump malfunctions

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30
Q

Macrovascular Complications of DM

A

damage to large vessels like:
-coronary arteries
-peripheral vascular
-cerebral vascular

*much higher risk for CVD

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31
Q

Microvascular Complications for DM

A

damage to capillaries:
-retinopathies
-nephropathies
-neuropathies

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32
Q

Loss of Protective Sensation (LOPS)

A

prevents patients from being aware that injury has occurred
-related to neuropathy

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33
Q

Diabetic foot care steps

A
  1. wash feet daily
  2. pat dry
  3. inspect feet daily
  4. use lanolin to prevent dryness
  5. mild foot powder for sweat
    6.no commercial remedies
  6. clean cuts with mild soap (NOT iodine/alcohol/adhesives)
  7. report skin infections
  8. trim nails
  9. separate overlapping toes with cotton
  10. do not go barefoot
  11. clean/ absorbent socks
  12. no hot water bottles
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34
Q

Nutritional considerations for diabetics

A

high fiber
low fat
low cholesterol
carb counting (especially with T1)
whole grains
sugar free alternatives work well
limit alcohol intake

**NEVER tell a patient to not eat a certain food group

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35
Q

Integumentary Concerns d/t DM

A
  1. Diabetic Dermopathy: reddish-brown spots
  2. Acanthosis Nigricans: brown/black thickening of skin
  3. Necrobiosis lipoidica diabeticorum: red patches around blood vessels

*all can improve when DM is being treated/controlled properly

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36
Q

What is the difference between Enteral and parenteral nutrition?

A

Parenteral -> providing nutrition outside of the GI tract, through IV nutrition/ TNP
Enteral -> preferred way of getting nutrition, through the GI tract

37
Q

what are the three main functions of the GI tract?

A

transportation
digestion
absorption

38
Q

what is the flow if the GI tract from mouth to anus?

A

through the mouth
down the esophagus
esophageal sphincter
stomach
pyloric sphincter
small intestine (duodenum, jejunum, ileum)
large intestine (colon/sigmoid) (water reabsorption)
rectum
anus

39
Q

complications with malnutrition

A

-malnutrition leads to higher readmission rates
-dysrhythmias
-skin breakdown
-sepsis
-hemorrhage
-increased length of stay
-delayed surgical healing

40
Q

What is malnutrition?

A

-lack of nutritional intake
-can be be present in underweight or obese Pt

41
Q

What are the importances of good nutrition?

A

-reach/ maintain healthy weight
-reduce risk of chronic Dz
-promote overall health

42
Q

dietary guidelines

A
  1. follow healthy eating pattern
  2. variety of nutrient dense foods
  3. limit added sugars/sat. fats/ sodium intake
  4. shift to healthier foods
    support healthy eating patterns
43
Q

what influences a persons nutrition intake?

A

appetite
negative experiences
disease, illness
medications
environmental factors (income/education)
developmental needs
alternative food patterns(religion/culture)

44
Q

Nutritional Considerations for Older Adults

A

chronic illness
medications
GI changes
decreased metabolic rate
cognitive impairment
available transportation
functional ability
fixed income
usually need calcium supplements

45
Q

What are the five steps to the assessment of nutritional status?

A

screening
anthropometry
laboratory and biochemical tests
diet and health history
physical examination

46
Q

Nutritional assessment: screening

A

-subjective: what they report
-objective: height/weight
-identifying risk factors of malnutrition: weight loss Sx
-using standardized tools:
SGA/MNA/MST

47
Q

Nutritional assessment: anthropometry

A

-study of measurement and proportions of human body
-measure size/ makeup of body
-BMI
-skin fold measures
-fat percentage
-registered dietitians can assist

48
Q

BMI calculations

A

BMI = 703 x [lb/in(^2)}
BMI= kg/m(^2)

49
Q

nutritional assessment: Laboratory

A

no single lab test to determine nutrition
Factors that affect lab results:
fluid balance
liver and kidney function
presence of Dz
Common labs:
Total protein, albumin, prealbumin, hemoglobin

50
Q

Total Protein

A

combination of albumin and globulin constitute
Nml range: 6.4-8.3

51
Q

Albumin

A

indicator for CHRONIC illness
synthesized in the liver
half life of 21 days
Nml: 3.5-5.0

52
Q

Prealbumin

A

indicator for ACUTE conditions
half life of 2 days
Nml range: 15-36

53
Q

Hemoglobin

A

protein responsible for transferring O2
if low should eat iron rich foods
Nml Range for males: 14-18
Nml range for females: 12-16

54
Q

Nutritional assessment: nutritional history

A

diet history
healthy history
other history: age, socioeconomic status, culture, religion

55
Q

Nutritional assessment: physical examination
What does a person with a healthy nutritional assessment present with?

A

alert & erect appearance
BMI WNL
neuro intact w/ EMV of 15
VS WNL
no GI complaints
no musculoskeletal abnormalities
shiny hair
no facial/ neck swelling
lips are pink, free of lesions or swelling
pink tongue
teeth are clean and white
MMM that are red colored with no lesions

56
Q

Nutritional assessment: physical examination
What does a person with malnutrition present with during their examiantion?

A

fatigue, apathetic, cachectic, sunken chest, humped back
obesity, overweight or underweight
inattentive, irritable, confused, decreased reflexes
VS WNL
GI: anorexia, indigestion constipation, N/V/D
weak, poor tone, “wasted” appearance, bowlegged, visible ribs
rough/dry/pale skin
brittle nails
face/neck is swollen, dark skin under eyes
pale conjunctivae, dry eyes
gums: spongey, receding, bleeding, inflamed
Tongue: swelling, raw
teeth: missing/ broken
mucus membranes: swollen, oral lesions

57
Q

nursing problems related to nutrition

A

imbalanced nutrition (more or less)
impaired swallowing
risk for aspiration
diarrhea, constipation, nausea
impaired dentition
fatigue
risk for unstable BG

58
Q

What are some nursing implementations you can do regarding a patients nutrition?

A

health promotion
advancing diet
diet selection
care of common nutritional issues
measuring I&O
obtaining height and weight

59
Q

What are the components of selecting a diet for a patient?

A

the amount of calories needed
ability for the patient to eat (teeth? cant chew?)
any alterations to GI tract (bariatric Sx)
any special considerations based on heath status (DM)

60
Q

What are some different kinds of diets?

A

regular PO
liquid diets
modified texture
therapeutic diets modified for nutrients
supplements

61
Q

What are some examples of a modified texture diet?

A

mechanical soft
pureed
minced
ground
chopped

62
Q

what is allowed in a clear liquid diet

A

water
black coffee
tea w/o cream
fat free broth
lemonade
sports drinks
gelatin
popsicles

*anything you can see through that is easily digestable

63
Q

before you enact a fluid diet, what are two considerations you should bring up

A
  1. is the patient on fluid restrictions?
    HF, kidney failure, low serum sodium
  2. do they need a modified consistency of their liquids?
63
Q

before you enact a fluid diet, what are two considerations you should bring up

A
  1. is the patient on fluid restrictions?
    HF, kidney failure, low serum sodium
  2. do they need a modified consistency of their liquids?
    thin vs thick liquids
    dysphagia Pt’s
    risk for aspiration
64
Q

What are the different liquid consistencies ?

A

thin-> water, coffee, tea, soda
nectar-like -> can drip off a spoon
spoon thick -> pudding consistency
Honey like-> honey consistency

65
Q

what are some therapeutic diet orders?

A

consistent carbohydrate
cardiac diet (low Na+, low sat fat, low cholesterol)
low residue (undigested food)
high fiber
gluten free
lactose free
bland

66
Q

what determines a persons diet tolerance?

A

no N/V/D
no abdominal distention
normal bowel sounds

67
Q

What are some common nutritional issues ?

A

anorexia
inability to feed self
dysphagia
nausea and vomiting

68
Q

what are some things the nurse can do to increase a patients appetite

A

treat cause
use creative approaches to stimulate appetite
change environment
smaller / more frequent meals
allow for food preferences
seasoning food
oral hygiene
ensure patient is comfortable
medications for appetite stimulation

69
Q

assisting a patient with oral feedings

A

protect safety/independence/dignity
tray within reach
assess risk of aspiration
does patient need to be supervised?
any visual deficits? plate as a clock
decrease motor skills -> adaptive utensils

70
Q

what are some complications for dysphagia ?

A

aspiration PNA
dehydration
malnutrition
weight loss

71
Q

What does the nurse need to do when the patient is on strict I&O?

A

measure all intake and output
record it in the patients medical record
measure in either mL or amount of occurrences
can be delegated to tech
educate the patient & family on participation
assess and monitor trends

72
Q

What kind of patients would be in strict I&O’s?

A

Critical care patients
unstable patients
Post-op Pt
Pt with h/o HF, liver failure or renal failure
malnourished Pt
NPO pt
Pt on diuretics
changes in weight

73
Q

What counts as intake?

A

oral intake
IV fluids
blood products
tube feedings
flushes

74
Q

what counts as output?

A

urine
BM
emesis
drainage tubes (JP, chest tubes)

75
Q

What is a feeding tube that leads through an artificial external opening into the stomach?

A

PEG tube

76
Q

What is a feeding tube that leads through an artificial external opening into the small intestine?

A

PEJ tube

77
Q

how do you confirm the placement of a PEG or PEJ tube?

A

XR

(also pH test with aspirated secretions and inserting air into tube then auscultating)

78
Q

If the patient has a risk for gastric reflux then what type of tube should be used?

A

jejunum tube

79
Q

What are some indications that the patient may need enteral nutrition?

A

prolonged anorexia
severe protein-energy malnutrition
coma
impaired swallowing
critical illness

80
Q

Benefits of Enteral over Parenteral nutrition

A

reduced chance of sepsis
minimize hyper-metabolic response to trauma
decreased hospital mortality
maintains intestinal structure and function, decreased chance of atrophy

81
Q

S/Sx of tube feeding intolerance

A

high gastric residuals
nausea
cramping
vomiting
diarrhea

82
Q

Bolus vs Pump tube feedings

A

bolus is intermittent
pump is continuous

83
Q

Complications of tube feedings

A

pulmonary aspirations
constipation
abdominal cramping
N/V/D
tube occlusion or displacement
delayed gastric emptying
serum electrolyte imbalance
fluid overload
hyperoslmolar dehydration

84
Q

nursing assessment of feeding tubes

A

abdominal focused exam
check for surrounding skin breakdown
assess nutritional status
assess for intolerance
I&O
monitor labs

85
Q

how often to check gastric residual in stomach

A

check continuous feedings every q 4-6 hrs
check intermittent feedings before giving feeding

86
Q

what does high gastric residual indicate?

A

delayed gastric emptying

> 250 ml hold for 1 hr and recheck
500 ml hold and notify HCP

87
Q

what do do when administering medications through a feeding tube

A

follow 5 rights of med admin
ensure med can be administered through tube
always verify placement
flush with water before and after administration
administer one med at a time

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