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diabetes test3
test 3
| Question | Answer |
|---|---|
| Type 1 diabetes (formerly insulin dependent diabetes mellitus) | Sudden severe insulin deficiency requiring insulin therapy to prevent ketoacidosis, coma, and death. 5-10% of all cases. Onset is juvenile. immune mediated: destruction of beta cells of pancreas. idiopathic |
| beta cells of pancreas | make insulin |
| Type 2 diabetes (formerly non-insulin-dependent diabetes mellitus) | insulin resistance, obesity with inadequate insulin production. 90-95% of all cases. usually after age 40. "running out" of insulin |
| type 2 diabetes | now in epidemic proportions in younger populations (obesity) |
| gestational diabetes | carbohydrate intolerance of varying severity with onset of 1st recognition of pregnancy. 2-5% of all pregnancies. 30-40% of women are likely to develop type 2 within 10 years. |
| Prediabetes | have IFG or IGT >100. increased risk of heart disease with development of type 2. lifestyle changes can reduce rate of progression. slowed but not completely gone. |
| genetics | Obesity increases chance of developing diabetesFamily history—may have gene mutations and may inherit insulin resistance not related to obesity |
| genetics | T1DM: autoimmune attack associated with heredity and viral infectionsT2DM: associated with insulin resistance and obesity, hypertension, hyperlipidemia, hyperuricemia, and sedentary lifestyle |
| type 1 symptoms | polydipsia, polyuria, polyphagia, weight loss (burning fat & muscle, fruity breath (DKA), fatigue or weakness, hyperosmolar, inc fluid, dehydrated, sugar needed. |
| type 2 symptoms | Poor wound healing or recurrent infections, Blurred vision,Skin irritation or infection, Recurrent gum or bladder infections,Patients may also be asymptomatic |
| metabolic pattern of diabetes | Overall Energy Balance--Metabolic disorder resulting in lack of insulin affecting each basic energy nutrient Especially related to metabolism of carbohydrates and fat |
| metabolic pattern of diabetes | Normal Blood Glucose Control-70 to 120 mg/dl vital to normal overall fuel metabolism and other metabolic functionsSources of Blood Glucose-Diet, energy in foodGlycogen, backup source from constant turnover of “stored” liver glycogen |
| hormone function | InsulinFacilitates transport of glucose through cell membranes by way of insulin receptorsEnhances conversion of glucose to glycogenStimulates conversion of glucose to fat |
| hormone function cont. | InsulinInhibits fat and protein breakdownPromotes uptake of protein in skeletal muscleInfluences glucose oxidation through main glycolytic pathway |
| glucagon | Balancing antagonist to insulin,Increases blood glucose levels to protect brain and other tissues,Helps maintain normal blood glucose levels during sleep. |
| glucagon | Produced in pancreas in response to low BS Causes liver to convert glycogen to glucose and release into circulationRaises BS levels, preventing hypoglycemiaSide effect: Stimulates insulin |
| somastatin | Inhibits interaction between glucagon, insulinMany GI effects, inhibits other hormones(GH, gastrinEffects on the Pancreas Cells within Pancreatic Islet cells secrete insulin, glucogon and somatostain Inhibits secretion of both insulin and glucagon |
| meabolic changes in diabetes | Blood glucose cannot be oxidized through main glycolytic pathway, builds up in bloodFat breakdown increases, formation of excess ketonesTissue protein is broken down to secure energy |
| General Management of Diabetes | Maintain optimal nutrition (required for health, growth and development, desirable body weight), Prevent hypoglycemia and hyperglycemia |
| General Management of Diabetes | Prevent hypoglycemia and hyperglycemia, Prevent complications, Retinopathy, nerve damage, kidney damage, coronary artery disease, peripheral vascular disease |
| HgbA1c | To explain what an A1c is, think in simple terms. Sugar sticks, and when it's around for a long time, it's harder to get it off. In the body, sugar sticks too, particularly to proteins. Hgb is a protein within the RBC: |
| Rationale for Diabetes Nutrition Therapy | Should be individualized,Eating habits, lifestyle factors, Consistency in eating pattern will result in better glycemic control |
| HgbA1c(cont) | RBC’s live how long?When sugar sticks to these cells, it gives us an idea of how much sugar has been around for the preceding three months. |
| Type 1 | Goal to achieve blood glucose levels as close as possible to normal,Reduction of HbA1c from 9% to 7% can reduce complications 50% to 75% |
| Type 2 | Glycemic control and cardiovascular risk reduction reduce rates of macrovascular and microvascular complications,Cardiovascular disease is a major cause of morbidity and mortality in T2DM |
| Gestational diabetes | Risks of fetal abnormalities and mortality increase with hyperglycemia,Insulin does not cross placenta, glucose does,Individualized nutrition therapy (NT) based on maternal height and weight |
| Gestational diabetes | Adequate kcalorie or kcal and nutrient intake to meet needs of pregnancy,Fetal/infant problems,Hyperglycemia in baby |
| Mother risks | inc risk of pre eclampsia,inc risk to develop DM II within 5-10 years,inc, C Section, Birth injuries,inc amniotic fluid |
| Blood Glucose Goals for Pregnancy | Fasting: less than 95 mg/dl, 1 hour postprandial: less than 140 mg/dl,2 hours postprandial: less than 120 mg/dl |
| Blood Glucose Goals for Pregnancy | To support and facilitate individual lifestyle and behavior changes that will lead to improved glycemic control,Maintain blood glucose levels in the normal (or near-normal) range |
| Blood Glucose Goals for Pregnancy | PreImprove health through healthy food choices and physical activity,Address individual nutritional needs taking into consideration personal and cultural preferences |
| Youth With T1DM | Ensure provision of sufficient energy for normal growth and development |
| Youth With T2DM | Facilitate changes in eating and physical activity habits to decrease insulin resistance |
| Pregnant and Lactating Women | Ensure adequate energy and nutrients necessary for optimal pregnancy outcomes |
| Older Adults | Include nutritional and psychosocial needs of the individual in NT goals |
| Individuals Treated With Insulin or Secretagogues | Prevent hypoglycemia, acute illness |
| Individuals at Risk for Diabetes | Encourage physical activity,Encourage food choices that facilitate moderate weight loss or prevention of weight gain,Insulin Therapy,Intensive insulin therapy with different types of insulin is used |
| Rapid-Acting Insulins | Regular Insulins, Humulin R, Novolin R, Onset ½ hour after injection, stay in body for less than 5 hours, peak at 2 hours |
| Very Rapid acting Insulins | Aspart and Lispro: very rapid, 5-10 minutes onset, peaks at 30-60 mins, tapers off in 2 hours, |
| Lantus | Approved for once daily dosing, “Peakless”: slow continuous release, Can be used with oral anti diabetic agents, Not required to be refrigerated, use within 28 days of opening, Never mix with another type of insulin |
| Lantus | Not meant to take the place of short acting,Not tested in children <6, Hypoglycemia most common SE, Not for IV use, Consistent carbohydrate intake needed to identify blood glucose pattern, |
| Sources of Insulin | Beef and pork insulins, immunogenic, not used often anymore |
| Human Insulin | Biosynthesis by recombinant deoxyribonucleic acid (DNA) technology through rapidly reproducing bacteria that have been given the human gene,Chemical substitution of the terminal amino acid of the beta-chain of pork insulin, |
| lantus | After mastering and understanding it, patient can move on to more complex planning and more flexible lifestyle |
| human insulin | Almost completely nonimmunogenic, Insulin and Exercise Balance, Exercise increases insulin receptors on muscle cells, Must be regular exercise to be effective |
| Blood Glucose Goals for Pregnancy | Maintain lipid and lipoprotein profiles that reduce risk for macrovascular diseases, Maintain blood pressure levels that reduce risk for vascular disease, Prevent and treat chronic complications |
| Insulin Delivery Systems | Multiple injections of rapid-acting insulin alone or with intermediate-acting insulin,Regular injections with disposable syringes or with pump,Pump worn on belt with subcutaneous needle in abdomen, |
| Oral Antidiabetic Drugs | Sulfonylurea, biguanide, thiazolidinedione, meglitinide, and alpha-glucasidase inhibitors, Insulin often used as adjunctive therapy when oral agents are not achieving glycemic control |
| Sulfonylureas | First second and third generation,Use in DMII,Examples: Glyburide, Glipizide,SE: Hypoglycemia: more frequent than newer types of oral agents, Pregnancy Category X, Some feel sulfonylureas increase beta cell destruction |
| Biguanide | For DMII and anti malarial class of drugs, For DMII: Metfomin, GI SE: Diarrhea, stomach upset, up to 30%, Actions not well understood:Decrease insulin resistance, Lower fasting levels of insulin, Reduce gluconeogenesis |
| Not on list: Glitizones | rosiglitazone,pioglitazone,increase risk of edema/fluid retention,Improve insulin sensitivity in liver, adipose and skeletal muscle, pioglitazone |
| Thiazolidinedione | Avandia, Actos, Another (Rezulin) removed from market due to drug induced hepatitis, Relatively new: Introduced in 1990’s, Main SE: LFT elevations, edema (5%), Off label use: PCOS, NASH (Non alcoholic steatohepatitis), autism, psoriasis |
| Meglitinide | Prandin and Starlix, Increases insulin release, Similar to sulfonylureas, Take 30 Minutes AC, Hypoglycemia (less than with others), Weight gain, Mild GI |
| Alpha-glucasidase | Precose, glycoset, Prevent digestion of carbohydrates (Polysacchrides) - makes less glucose available, Sugars remain in colon: GI effects diarrhea, flatulence; dose related, start low and increase slowly, Take at start of main meal, For hypoglycemia: simp |
| Adjunctive Therapies | Pramlintide (Simlin) is synthetic amylin, Injectable; AC, Glucose control depends on two hormones, insulin and amylin, both produced in the beta cells of the pancreas. In patients with type 1 diabetes and often with type 2, beta cells have been damaged or |
| Self-Monitoring of Blood Glucose | Small, lightweight, easy-to-use, hand-size meters are available for convenient use, Reagent test strip inserted in meter, drop of blood from finger placed on test strip, digital reading of blood glucose appears on meter |
| Self-Monitoring of Blood Glucose | Glycated Hemoglobin, HbA1c: glucose attaches to red blood cell, Relates to level of blood glucose over longer period of time, Effective tool for evaluating long-term management of diabetes and degree of control, |
| Physical Activity Habits | Detailed personal history of physical activity and exercise should be discussed, Used as a basis for planning a program of regular moderate exercise |
| Gestational Diabetes | Self-monitoring of blood glucose levels provides information on impact of food on blood glucose levels, No energy modifications for first trimester |
| Gestational Diabetes | Increase of 180 kcal/day during second trimester, High-quality protein increase of 25 g/day, 600 µg/day of folic acid to prevent neural tube defects, Minimum of 1700 to 1800 kcal/day of carefully selected foods |
| Impaired Fasting Glucose and Impaired Glucose Tolerance | Risk factors for future diabetes and cardiovascular disease, Intervention should be consistent with current guidelines for overweight and obesity and address cardiovascular risk factors, |
| Counseling Process in Nutrition Therapy for Diabetes | Dietary prescription based on individual nutrition assessment and goals |
| Counseling Process in Nutrition Therapy for Diabetes | Nutrition intervention, Guides client in selecting and using most appropriate meal planning guide based on individual needs, Monitoring and evaluation,Ongoing clinical data, evaluation of goals, make adjustments if necessary |
| Not on list: Glitizones | pioglitazonefor patients taking metformin, sulfonylurea, or a combination of them,From saliva of Gila monsters, increases insulin secretion |
| Insulin Delivery Systems | User pushes buttons to obtain fixed flow of insulin to balance food intake |
| Self-Monitoring of Blood Glucose | Two to eight before- and after-meal tests performed daily |
| Diabetes Meal-Planning Tools | Must focus on the unique individual,Tailor actions to person’s learning needs and ability, nutrition needs, personal needs, and lifestyle issues |
| Carbohydrate Counting | Helps people with diabetes become more aware of carbohydrate content of foods that they eat,Focus on adjustment of foods, medications, and activity,One carbohydrate serving is equal to 15 g of carbohydrates |
| Planning for Special Needs | Sick Days,When general illness occurs, food and insulin amount are adjusted accordingly,Physical Activity,A client with T1DM must plan ahead for strenuous physical activity |
| Planning for Special Needs | Travel,Self-monitoring and insulin therapy equipment important while traveling,Plan ahead for food choices,Eating Out,Plan ahead for meals eaten at home before going out to keep daily balance,Get the menu ahead of time |
| Planning for Special Needs | Stress,Hormonal responses that act as antagonists to insulin,Client must learn and practice variety of stress-reduction activities |
| Diabetes Education Program Goal: Person-Centered Self-Care | Use term person with diabetes, not diabetic, Use the term adherence, not compliance,Use person with diabetes, not patient, unless hospitalized,Use having difficulty or having a problem with instead of cheating |
| Diabetes Education Program Content Tools for Self-Care | Build self-sufficiency and responsibility within persons with diabetes and their families |
| Diabetes Education Program Areas of Focus | Needs in relationship to the nature of diabetes, Nutrition and basic meal planning,Insulin/oral medication effects and how to regulate them,Monitoring of blood glucose,How to deal with illness,Urine ketones |
| Educational Materials: Person-Centered Standards | Give the intended receiver credit for having some intelligence and wanting new information, Inform persons fully and completely, giving both sides when experts disagree—as they surely do on occasion |
| Educational Materials: Person-Centered Standards | Appeal to various levels of audience, ranging from basic to sophisticated Never be patronizing, dehumanizing, or childish Health Promotion |
| Alcohol and Diabetes: Do They Mix? | Use only in moderationOne drink per day for women, two drinks per day for menCan cause hyperglycemia or hypoglycemiaCan raise blood glucose, especially if mixed with sweet mixersNever drink alcohol on an empty stomach |
| Alcohol and Diabetes: Do They Mix? | Some medications may not mix with alcohol; check with physician or pharmacist Never drink and drive Never drink if pregnant or trying to become pregnant Above all, use common sense |
| Can I Use Fructose in My Diabetic Diet? | Fructose has the same nutritive value as other sugars—4 kcal/g. The quantity must be limited. If used, the maximum amount is 75 g/day.Consumption of fructose in large amounts may have adverse effects on plasma lipids |
| Ideally, the goal of patient diabetes education is to | 3. enable the patient to become the most active participant in the management of the diabetes. |
| A patient screened for diabetes at a clinic has a fasting plasma glucose of 120 mg/dl (6.7 mmol/L). The nurse explains to the patient that this value | 3. indicates a intermediate stage between normal glucose use and diabetes. |
| Cardiac monitoring is initiated for a patient in diabetic ketoacidosis. The nurse recognizes that this measure is important to identify | 3. dysrhythmias resulting from hypokalemia. |
| hormones secreted by the pancreas | insulin, glucagon |
| glycogenolysis | conversion of glycogen to glucose; leads to increase in blood glucose |
| glycogenesis | conversion of excess glucose to glycogen for storage in skeletal muscle and liver; occurs when blood glucose increases |
| diabetes is most important ______ ______ affecting the pancreas | endocrine disease |
| diabetes is a disoder of carbohydrate metabolism that involves | insulin deficiency, insulin resistance, or both |
| type 1 are prone to: | ketosis |
| type 1 require: | exogenous insulin therapy for survival |
| diabetic ketoacidosis | occurs as a result of altered energy metabolism in the cell from a lack of insulin |
| DKA symptoms | polyuria, GI upset, abdominal pain |
| DKA treatment | agressive rehydration, administration of insulin, electrolyte monitoring |
| insulin | controls the storage and metabolism of carbohydrates, protein, and fat that binds to receptor sites on cellular plasma membranes |
| factors that affect insulin dosages | dietary intake, physical activity, ability to manage the therapeutic regimen, glucose tolerance |
| factors that may require adjustinng insulin dosage | physical growth, illness, stress, development of antiinsulin antibodies, concomitant administration of certain drugs (cortocosteroids), changes in exercise and diet |
| teaching insulin to new patient | function & importance of therapy, name & dosage of insulin, technique of blood or glucose urine monitoring and adjusting insulin accordingly, |
| teaching insulin to new patient (cont) | proper admin technique, need for lifelong dietary and drug management, differences among the forms of insulin, how to calculate dosages correctly, proper storage and handling of insulin, list of drugs and conditions that alter insulin requirements |
| teaching insulin to new patient (cont) | importance of rotating sites to minimize adverse local reactions, s & s of insulin/hypoglycemia reaction and approiate management, establish and maintain a monitoring record of blood or urine glucose and insulin administration, Medical alert ID |
| symptoms of hyperglycemia | drowsiness, red and dry skin, fruity odor on breath, anorexia, abdominal pain, nausea, vomiting, dry mouth, increased urination, rapid/deep breathing, unusual thirst, rapid weight loss |
| symptoms of hypoglycemia | increased anxiety, blurred vision, chilly sensation, cold sweating, pallor, confusion, difficulty concentrating, drowsiness, headache, nausea, increased pulse rate, shakiness, increased weakness, increased appetite |
| drugs used to treat type 2 diabetes | sulfonylureas, biguanides, alpha-glucosidase inhibitors, meglitinides, thiazolidinediones (glitazones), noninsulin polypeptide analogues |
| sulfonylureas (glipizide, glyburide, glimepiride)mechanism of action: | stimulate beta cells release of insulin from pancreatic islet; decrease hepatic glycogenolysis and gluconeogenesis; enhance cellular sensitivity to insulin, orals |
| sulfonylureas side effects: | weight gain, hypoglycemia |
| diabetes leading cause of: | end-stage renal disease, adult blindness, nontraumatic lower limb amputations |
| Diabetes major contributing factor of: | heart disease, stroke |
| megalitinides (repaglinide, nateglinide)Mechanism of onset | Oral, stimulate a rapid and short-lived release of insulin from the pancreas |
| megalitinides side effects: | weight gain, hypoglycemia |
| biguanide (metformin: glucophage)Mechanism of action | oral, decrease rate of hepatic glucose production; augments glucose uptake by tissues, especially muscles |
| biguanides side effects | diarrhea, lactic acidosis, needs to be held for 48 hours after administration of contrast media |
| alpha glucosidase inhibitors (acarbose, miglitol)mechanism of action | oral, delay absorption of glucose from GI tract |
| alpha glucosidase inhibitors side effects | gas, abdominal pain, diarrhea |
| thiazolidinediones or glitazones (pioglitazone, rosiglitazone-avandia) mechanism of action | oral, increase glucose uptake in muscle; decrease endogenous glucose production |
| thiazolidinediones (glitazones) side effects | weight gain, edema, NOT recommended for patients with heart failure |
| dipeptidyl peptidase-4 (DDP-4) inhibitors (sitagliptin-Januvia, vildagliptin) | Oral, enhances the incretin system, stimulates release of insulin from pancreatic beta cells, and decreases hepatic glucose production |
| DDP-4 inhibitors side effects | upper respiratory tract infection, sore throat, headache, diarrhea |
| combination therapies: glucovance | oral, combination of metformin and glyburide |
| combination therapies: avandamet | oral, combination of rosiglitazone and metformin |
| combination therapies: metaglip | oral, combination of metformin and glipizide |
| combination therapies: duetact | oral, combination of pioglitazone and glimepiride |
| combination therapies side effects | nausea, diarrhea, abdminal pain, lactic acidosis, weight gain, hypoglycemia |
| incretin mimetic (exenatide-byetta) | subq, stimulates release of insulin, decrease glucagon secretion, increased satiety, decreased gastric emptying |
| incretin mimetic side effects | Nausea, vomiting,diarrhea, headache, hypoglycemia |
| amylin analog (pramlinitide-symlin) | subq-only abdomen or thigh, dec gastric emptying, dec glucagon secretions, dec endogenous glucose output from liver, inc satiety |
| amylin analog side effects | hypoglycemia, nausea, vomiting, decreased appetite, headache |
| glucose lowering effect | tylenol, allopurinol, alpha glucosidase inhibitors, anabolic steroids, beta-adrenergic blockers, biguanides, chloramphenlcol, clofibrate, insulin, monoamine oxidase inhibitors, phenylbutazone, potassium salts, probenecid, |
| glucose lowering effect (cont) | salicylates in large doses, sulfonylureas, thiazolidinediones, tricyclic antidepressants, urinary acidifiers |
| glucose raising effects | acetazolamide, arginine, asparaginase, caffiene in large doses, barbiturates, calcitonin, calcium channel blockers, cholestyramine, clonidine, corticosteroids, cyclosporine, furosemide, glucagon, glucose, glycerin, glycerol, levadopa, lithium, niacin |
| glucose raising effects (cont) | marajuana, nicotine, nifedipine(procardia), oral contraceptives, phenobarbital, phenothiazines, phentoin(dilantin), rifampin, tacrolimus(prograf), thiazide diuretics, urinary alkalizing agents |
| rapid acting insulin | humalog-clear, novolog-clear, apidra-clearonset 15 mins, peak 60-90 mins, duration 3-4 hours |
| short acting insulin | Humulin R, Novolin R, ReliOn R-clearonset 1/2-1 hour, peak 2-3 hours, duration 3-6 hours |
| intermediate acting insulin | NPH(Humulin N, Novolin N, ReliOn N)-cloudyOnset 2-4 hours, 4-10 hours, duration 10-16 |
| Long acting insulin | glargine(Lantus), detemir(Levemir)-clearonset 1-2hours, no peak, duration 24+hours |
| once a day insulin regimen (in Am or at bedtime) | intermediate(NPH) or long acting, one injection should cover noon and PM meal, hypoglycemia during sleep not a problem, no fasting, breakfast or nighttime coverage of hyperglycemia is available, 1 inj=24 hours, does not caver postprandial BS |
| twice a day, split-mixed dose (before breakfast and at dinner) | 2 injections provide coverage for 24 hours, patient must adhere to a set meal plan |
| 3 times a day, combo of mixed and single dose (before breakfast,before dinner, at bedtime | NPH,regular, rapid. 3 injections provide coverage for 24 hours, paricularly during early AM hours, potential is reduced for 2-3 AM hypoglycemia. |
| 4 times a day, multiple dose (before breakfast, lunch, dinner, at bedtime) | regular, rapid, NPH. more flexibility is allowed at mealtimes and for amount of food intake. Good postprandial control. Premeal BS checks and establishing and following ind algorithms are necessary.type 1 will require basal insulin to cover 24hrs |
| basal-bolus (before breakfast, lunch, dinner, at bedtime) | regular or rapid, long-acting. 4 injections required per day. most physiologic approach, except for pump. |
| Hyperglycemia manifestations | elevated blood glucose, increased urination, increase in appetite followed by lack of appetite,weakness, fatigue, blurred vision, headache, glycosuria, n/v, abdominal cramps, progression to DKA or HHS |
| Hyperglycemia causes | illness, infection, corticosteroids, too much food, too little diabetes or no diabetes medication, inactivity, emotional or physical stress, poor absorpition of insulin |
| hyperglycemia treatment | physcian's attention, continuance of diabetes medication as ordered, check blood glucose frequently, check urine for ketones, record results, hourly drinking of fluids. |
| hyperglycemia preventive measures | taking prescribed dose of med at proper time, accurate admin of insulin/OA, maintenance of diet & good personal hygiene, adherence to sick-day rules when ill, checking of BS, contacting of health care provider regarding ketonuria, wearing diabetic ID |
| Hypoglycemia manifestations | bs<70, cold, clammy skin, numbness of fingers, toes, mouth, rapid heartbeat, emotional changes, headache, nervousness, tremors, faintness, dizziness, unsteady gait, slurred speech, hunger, changes in vision, seizures, coma |
| Hypoglycemia causes | alcohol intake without food, too little food-delayed, omitted, inadequate; too much diabetic meds, too much exercise wo/compensation, diabetes med/food taken at wrong time, weightloss wo/ change in meds, beta blockers interfering w/recog of symptoms |
| hypoglycemia treatment | immediate ingestion of 15-20g of simple carbs, ingestion of another 15-20g of carbs in 15 mins if no relief obtained, contacting dr if no relief, discussion w/dr about med dosages |
| hypoglycemia preventive measures | prescribed dose of meds at proper time, accurate admin of insulin/OA, all recommended foods at proper time, compensation for exercise, ability to recognize and know symptoms and treat them immed, education of fam about symptoms and treatment, check BS, ID |
| DKA | diabetic acidosis, diabetic coma. is caused by a profound deficiency of insulin and is characterized by hyperglycemia, ketosis, acidosis, and dehydration |
| DKA etiology | undiagnosed diabetes mellitus, inadequate treament of existing diabetes mellitus, insulin not taken as prescribed, infection, change in diet, insulin, or exercise regimen |
| DKA assessment finding | dry mouth, thirst, abdominal pain, n/v, graudally inc restlessness, confusion, lethargy; flushed, dry skin; eyes appear sunken, breath odor of ketones, rapid, weak pulse; labored breathing (Kussmaul), fever, urinary frequency,BS>300, glucosuria, ketonuria |
| DKA Initial interventions | ensure pt airway, admin O2 via NC or nonrebreather mask, est IV access w/large-bore catheter, fluid 0.9%NaCL 1L/hr until BP stablized, urine output 30-60 Ml/hr, insulin drip 0.1U/kg/hr, identify history of diabetes, time of last food,time/amt last insulin |
| DKA ongoing interventions | monitor vitals, LOC, cardiac rhythm, O2 sat, urine output, assess breath sounds for fluid overload, monitor BS and K, admin K for hypokalemia, admin HCL if severe acidosis (ph<7.0) |
| Hyperosmolar hyperglycemia syndrome (HHS) | life-threatening syndrome that can occur in the pt with diabetes who is able to produce enough insulin to prevent DKA but not enough to prevent severe hyperglycemia, osmotic diuresis, ECF depletion |
| diabetic retinopathy | process of microvascular damage to the retina as a result of chronic hyperglycemia in pts with diabetes |
| diabetic nephropathy | microvascular complication associated with damage to the small blood vessels that supply the glomeruli of the kidney. leading cause of end stage renal falure. risk factors HTN, genetics, smoking, chronic hperglycemia |
| dabetic neuropathy | nerve damage due to metabolic derangement associated with diabetes. sensory or autonomic |
| diabetic foot care | wash feet daily w/ mild soap and warm H2O, test water temp. pat feet dry gently, esp between toes, examine feet daily for cuts, blisters, swelling, & red, tender areas. do not depend on feeling sores. if cannot see have others inspect. |
| diabetic foot care (cont) | use lanolin to prevent dry and cracking, not between toes. use mild foot powder on sweaty feet, do not use remedies on corns or callus. cleanse cuts w/ warm h2o & mild soap, cover w/ clean drgs. report skin infection or non healing sores. |
| diabetic foot care (cont) | cut toenails evenly, best after shower. separate overlapping toes w/cotton or lamb's wool. no open-toe, open-heel, high heels. use leather shoes, slippers with soles. No barefoot, shake out shoes before putting on. |
| diabetic foot care (cont) | Do not wear clothing that leaves impressions, hinders circulation.don't use hot water bottles or heating pads to warm feet.Wear socks for warmth.guard against frostbite.exercise feet daily by walking or ROM.avoid prolonged sitting, standing, cossing legs |
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