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Nursing 4 Exam 1
Care of client with diabetes
| Question | Answer |
|---|---|
| what is diabetes mellitus? | metabolic disorder characterized by hyperglycemia due to an absolute or relative lack of insulin or to a cellular resistance to insulin |
| impact on health of american population | sixth leading cause of death due to cardiovascular effects resulting in atherosclerosis, coronary artery disease, and stroke |
| impact on health of american population | leading cause of end stage renal failure, major cause of blindness, and most frequent cause of non-traumatic amputations |
| glucagon | increase BG by stimulating liver and other cells to release stored glucose |
| insulin | helps the body store and use CHO, faats and protein |
| beta cells release | insulin |
| alpha cells release | glucagon |
| what releases glucose into blood? | liver |
| what takes in glucose from the blood? | fat cells |
| Type 1 DM | primary beta-cell destruction & pancreas can't produce insulin |
| triggers of type 1 DM | environmental disorder(diet-cow's milk, viruses) and genetic susceptibility |
| type 2 DM | Insulin resistance, decreased insulin secretion, too much glucose released by the liver |
| DM cardinal signs | polyuria, polydipsia, polyphagia and wt loss(type 1 only) |
| polyuria occurs b/c... | H2O not absorbed from renal tubles b/c of osmotic activity of glucose in tubules |
| polydipsia occurs b/c... | polyuria causes severe dehydration which causes thirst |
| polyphagia occurs b/c... | tissue breakdown and wasting cause a state of starvation that increases hunger |
| wt loss occurs in type 1 DM b/c... | glucose not available to cells, thus body breaks down fat and protein stores for energy |
| DM diagnosing... | fasting plasma glucose(nothing to eat 8hrs prior, >126), casual plasma glucose(random glucose, >200), oral glucose tolerance test(>200, 2hrs post consumption of fluid) |
| DM diagnosing of FBS, Casual plasma glucose and OGTT requirements... | one of the three tests must be positive and must be confirmed on another day with one of the three tests |
| FPG range | <100=normal 100-126 is prediabetic > or = 126 is diabetes |
| OGTT range | <140 is normal 140-200 prediabetic > or = 200 is diabetic |
| normal fasting blood sugar | <100 |
| normal post prandial blood sugar | <140 |
| normal HbA1c | <6% |
| prediabetes | not high enough for diabetes dx, increased risk for developing type 2 diabetes, if no preventive measure taken-usually develop diabetes w/in 10 years |
| DM prevention/delay onset | maintain normal body weight, exercise regularly, eat a well balanced diet, FBG checks as indicated for early diagnosis |
| DM intervention Triad of control | diet, exercise, and medication |
| DM interventions | home glucose monitoring to assess management status and make adjustments |
| DM medications | insulins, sulfonylureas, biguanides, alpha-glucosidase inhibitors, glitazones, meglitinides, glucagon |
| insuline indication | all type 1 and some type 2 diabetics, diabetics enduring stressors, women w/gestational diabetes, some pt's receiving high caloric feedings including tube feedings or parenteral nutrition |
| Types of insulin | rapid, short, intermediate, and long acting |
| rapid acting insulin onset | 15 minutes |
| rapid acting insulin peak | 60-90 minutes |
| rapid acting insulin duration | 3-4 hours |
| rapid acting insulins | humalog, novolog, and apidra |
| short acting insulins | Regular (Humulin R, Nololin R)-clear |
| short acting insulin onset | 30 mins to 1 hr |
| short acting insulin peak | 2-3 hours |
| short acting insulin duration | 3-6 hours |
| intermediate acting insulin | NPH (Humulin N, Novolin N)-cloudy |
| intermediate acting insulin onset | 2-4 hours |
| Intermediate acting peak | 4-10 hours |
| intermediate acting duration | 10-16 |
| long acting insulin | lantus and levemir |
| long acting onset | 1-2 hours |
| long acting peak | no pronounced peak b/c it's a basal insulin |
| long acting duration | 24+ hours |
| onset | the time span after admin when insulin will begin to affect the blood glucose level |
| peak | the time span afer dmin when insulin will have the greatest effect on the blood glucose level |
| duration | the time span after admin when insulin will continue to affect the blood glucose level |
| long-acting insulin(basal) | injected once a day at HS or in the am, released steadily and continuously, no peak action, cannot be mixed w/any other insulin or solution |
| mixing insulins technique | roll bottle of cloudy mix, inject air in cloudy(intermediate), inject air in R or Humalog, withdraw clear insulin, withdraw cloudy without contaminating contents of the clear |
| insulin is stored at what temp? | room temp for 30 days |
| what will allow insulin to have a longer life | being refrigerated |
| in extreme heat what should you do with your insulin? | keep cool and do not freeze |
| Insulin pump is... | continuous subQ infusion and battery operated |
| how is the insulin pump connected | via plastic tubing to a catheter inserted into subQ tissue in the abd wall |
| insulin pump gives a potention for... | tight glucose control |
| oral hypoglycemic agents are used to treat... | DM type 2 |
| what may affect the blood glucose levels while on a hypoglycemic agent | specific drugs |
| oral agents | sulfonylureas, meglitinides, biguanides, a-Glucosidase inhibitors, thiazolidinedionesl |
| sulfonyureas action | stimulates pancreatic cells t secrete more insulin & increases sensitivity of periphral tissues to insulin |
| examples of sulfonylureas | glyburide, glipizide, glimepiride |
| meglitinides action | increase insulin production from pancreas |
| when are meglitinides taken | 30 minutes before each meal up to time of meal, should not be takenn if meal is skipped |
| examples of meglitinides | Prandin (repaglinide) & Starlix (nateglinide) |
| biguanides action | reduce glucose production by liver, enhance insulin sensitivity at tissues, improve glucose transport in cells, does not promote wt gain |
| example of biguanides | metformin (glucophage) |
| when should biguanides never be given? | before surgery |
| when should you stop taking glucophage when your having surgery | the night before surgery |
| when should you start taking glucophage again after surgery | not until kidney are checked and you are eating normally |
| when should you stop taking glucophage when having a prcedure w/injectable iodinated dye | the day of the test or the night before |
| when should you start taking glucophage again after a procedure w/injectable iodinated dye | at least 48 hrs after or until your kidneys are checked |
| what can the glucophage cause if you don't stop taking it before a surgery or procedure with injectable iodine dyes? | renal failure |
| a-Glucosidase inhibitors are | "starch blockers" they slow down absorption of carbs in small intestine |
| example of a-Glucosidase | Acarbose (Precose) |
| s/e of a-Glucosidase inhibitors | causes huge amt of gas and stomach cramping |
| thiazolidinediones is the most effective with those with | insulin resistance |
| Thiazolidinediones improves | insulin sensitivity, transport and utilization at target tisues |
| examples of thiazolidinediones | Actos and Avandia |
| when is pancreas transplantation used | for patients with type 1 diabetes who also have end-stage renal dx or had, or plan to have, a kidney transplant |
| what is usually transplanted withthe pancreas transplant | kidney |
| why is the pancreas transplanted? | eliminates need for exogenous insulin and can also eliminate hypoglycemia and hyperglycemia |
| HbA1c is? | glycosolated hemoglobin which measures average BS for last 3 months |
| DM management? | HbA1c, urine ketones & protein, decrease smoking, lipid profile, foot and eye exams, BP & BS readings, liver studies if indicated |
| normal A1C reduces risk of? | retinopathy, nephropathy and neuropathy |
| acute complications of DM? | DKA, HHNK, and hypoglycemia (insulin shock) |
| long term complications of DM? | vascular changes, peripheral neuropathy, visual changes, and infections |
| surgial car for diabetics preop include: | euglycemia for several weeks before if possible, NPO & hold insulin, check BS vefore goeing to OR, verify otherr antidiabetic drugs if short procedure |
| surgical care of diabetics intra operatively? | no insulin or glucose if short procedure and will regulate with 5 or 10% IV glucose & insulin drip if necessary |
| surgical care of diabetics post op? | eat as soon as possible, IV drip will remain until BG are stable & pt is eating, may wean from the drip while resuming subQ insulin, may be controlled by insulin even if not on it at home but prob wont go home on |
| in children with diabetes it is very important to? | monitor and change tx with activity and growth |
| hypoglycemia is... | a s/e of the tx of diabetes. it is an abnormally low level of glucose in the blood |
| hypoglycemic level... | <70 mg/dL |
| complications of hypoglycemia arise when... | an imbalance of glucose intake (or production) and glucose utilization is present |
| hypoglycemia onset is... | rapid |
| causes of hypoglycemia.. | too much insulin, exercise, alcohol intake, skipping meals |
| What happens when sugar levels drop? | glucagon is made(stimulating glycogenolysis & gluconeogenesis) and epinephrine is produced by adrenal glands (suppresses insulin release and inhibits cells responsiveness to insulin) |
| what is also released by the adrenal glands besides epinephrine? | cortisol, which slowly raises BG levels through stimulating gluconeogenesis and suppresses cells respnsiveness to insulin |
| What is released by the pituitary gland when sugar drop? | growth hormone which slowly raises BG levels and causes the cells to respnd less efficiently to insulin |
| why is hypoglycemia so dangerous? | reduced levels of glucose in the brain, may sustain permanent damage, and coma & death |
| Beta blocker block effects of? | epinhephrine |
| CV symptons of hypoglycemia? | r/t the release of epinephrine, rapid HR, sweating, tremors, anxiety, hunger, nausea |
| CNS symptoms of hypoglycemia? | Brain is directly affected due to lack of glucose; light-headedness, confusion, lethargy, h/a, loss of consciousness, seizures, delayed reflexes, slurred speech, coma |
| treatment of pt with hypoglycemia who is CONSCIOUS? | confirm glucose level, admin 15g of rapid acting carb, recheck glucose level in 15 mins, repeat admin of 15g of carb if necessary |
| What are some kind of 15g carbs to give a pt with hypoglycemia? | 1/2 cup OJ, 1 cup milk, 1/3 cup apple juice or reg soda, 1/2 box raisins, 10 jelly beans, 3 tsp honey, 3 glucose tabs, 8 lifesavers, 8 small sugar cubes, 4 tsp sugar, 2 small tube frosting, 1 small tube glucose gel |
| What is the treatment of a SEMI-CONSCIOUS pt with hypoglycemia? | assistance is needed, confirm BG, admin glucagon, if no improvement after 20 mins repeat glucagon, once pt can swallow give 20g of carbs PO, if pt doesn't repsond call 911 |
| Glucagon? | raises BS by stimulating the release of glucose from the liver |
| how is glucagon given? | IV, subQ or IM(kit) |
| when can glucagon be given again if no improvement? | 20 mins |
| if no response of glucagon subQ or IM what must be given? | IV glucose & give supplemental CHO when pt responds |
| What is the treatment for a UNCONSCIOUS pt with hypoglycemia? | confirm BG, admin 50% dextrose 20 to 50 ml IV, a continuous infusion of D5W OR D10W |
| warning signs of hypoglycemia events? | 1st sign apparent-confusion |
| hypoglycemic unawareness causes... | the body to adapts to the hypoglycemia so that it takes a lower and lower BG to cause a release of epinephrine and the associated warning signs |
| nursing diagnosis for hypoglycemic pt's? | altered nutrition: less than body requirements, r/t decreased intake or altered metabolism of glucose and knowledge defecit r/t disease process and self care |
| nursing interventions for a pt with hypoglycemia? | supply O2 (semi conscious & conscious), monitor VS, determine BG, give oral glucose(if gag reflex is present) admin 50% dextrose or glucagon (unconscious or no gag reflex), monitor mental status, educate pt and sig others, instruct pt s/s |
| definition of DKA? | metabolic disturbance in which BG levels rise too high resulting in dehydration and excessive fat metabolism |
| why does fat breakdown occur in DKA? | occurs in the liver in an attempt to feed teh starving cells |
| ketones that are released into the urine during DKA causes... | acidosis |
| protein breakdown in DKA occurs and releasing... | urea into the serum |
| what is the leading cause of death in type 1 diabetics? | DKA |
| Factors that put a pt at risk for DKA? | elevated BS's, stress, infection, new onset diabetics, inadequate insulin on board, certain meds(steroids) |
| What occurs in DKA? | the body attempts to rid itself of glucose; osmotic diuresis & water loss occurs |
| what does the patient lose during DKA? | large amounts of extra and intracellular fluid, electrolytes including:K+, Na, Cl, Mag, Phospate |
| hallmark signs of DKA? | blood glucose level above 250, arterial blood Ph below 7.35, serum bicarb less than 15, presence of ketones in the blood and urine |
| bicarb (CO2) normal level? | 22-26 |
| PO2 normal level? | 35-45 |
| pH normal level? | 7.35-7.45 |
| s/s of DKA are related to? | severe hyperglycemia, dehydration, and metabolic acidosis |
| neurological s/s of DKA? | lethargy, confusion, coma, and hyperthermia |
| pulmonary s/s of DKA? | kussmaul respirations, fruity acetone breath(indicates worsening of ketoacidosis) |
| cardiovascular s/s of DKA? | tachycarida, hypotension, dysrhthmias |
| integumentary s/s of DKA? | flushed skin, dry mucous membranes, poor skin turgor(tenting) |
| renal s/s of DKA? | polyuria, ketonuria, glucosuria |
| GI s/s of DKA? | N/V, abd cramps, ileus(intestinal obstruction) |
| what thing should you do first in a pt with DKA? | IV fluids(0.9% NS push), Insulin therapy(hourly glucometers, insulin drip-IV), potassium replacement(insulin drives K+ into cell), bicarbonate replacement(b/c acidotic) |
| possible complications of DKA? | fluid volume overload, hypo/hyperglycemia, hypo/hyperkalemia(can occur in the 1st 4hrs), hyponatremia, cerebral edema, risk for infection |
| normal K+ level? | 3.6-5 |
| Normal Na level? | 135-145 |
| nursing diagnosis for DKA? | decreased c/o r/t alterations in preload, fluid volume deficit r/t absolute loss, risk for infection, ineffective individual coping r/t situational crisis, knowledge defecit |
| HHNS? | Hyperglycemic Hyperosmolar Nonketotic State |
| Definition of HHNS? | a metabolic disturbance resulting from extremely high blood glucose level resulting in hyperosmolarity and severe dehydrations w/out the production of ketones |
| patients that are most likely to get HHNS? | type 2 diabetics, usually over the age of 65yrs, pts with TPN and pancreatitis |
| The main difference between DKA and HHNS is that... | the pt has SOME insulin in HHNS. This is why ketosis does not occur. |
| In HHNS blood sugars can rise as much as? | 600-2000 mg/dL |
| a HHNS pt loses large amounts of extra and intracellular fluid, electrolytes including: | potassium, sodium, chloride, magnesium, phosphate |
| plasma glucose in HHNS? | >600 mg/dL |
| arterial pH in HHNS? | >7.35 |
| serum bicarb in HHNS? | >15 |
| steroids make our blood sugars... | go high |
| causes of HHNS (same as DKA) | insufficient insulin, increased endogenous glucose intake(stressed/meds), increased exogenous glucose |
| neuro s/s of HHNS? | confusion, lethargy, seizures, coma |
| pulmonary s/s of HHNS? | shallow or normal respirations |
| renal s/s of HHNS? | polyuria and glucosuria |
| cardiovascular s/s of HHNS? | tachycardia, elevated T waves, and dysrhthmias(sign of K+ imbalance) |
| GI s/s of HHNS? | mild abd discomfort, N/V |
| what do you do for a pt with HHNS? | corret fluid deficit(0.9% NS), insulin therapy, potassium replacement, monitor pt's response to therapy, provide comfort & emotional support, watch for complications |
| when the BS gets to this level you should switch the 0.9% NS to D5% NS? | 250 |
| complications of HHNS? | dehydration, fluid volume overload, hypo/hyperglycemia, hyper/hypokalemia, seizures |
| hot & dry... | sugar high |
| cold & clammy... | need some candy |
Created by:
jbittner
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