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70 Cards in this Set
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- Back
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___: A genetically and clinically heterogeneous group of disorders of metabolism which is manifested ultimately by loss of carb tolerance
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Diabetes
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Type of diabetes that is characterized by beta cell destruction usually resulting in absolute insulin deficiency
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Type 1
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Type of diabetes characterized by insulin resistance and relative rather than absolute insulin deficiency?
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Type 2
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Which type of diabetes has abrupt onset typically in the young & requires insulin therapy for survival?
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Type 1
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Which type of diabetes has a slower onset, assoc w obesity, usually in older people, & insulin therapy may or may not be necessary?
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Type 2
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Type 2 Diabetes is also called what?
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Insulin resistance syndrome
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Type 2 Diabetes is characterized by (4)
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Hyperlipidemia
Insulin resistance Obesity Hypertension |
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Cardinal s/s of Diabetes? (5)
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Polyuria
Polydipsia Weight loss Polyphagia (^ appetite) Asthenia (Weakness, numbness) |
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5 M's of balancing Diabetes?
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Meds
Meals Motion Monitoring Management |
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What are the most important ways of managing diabetes (2)
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Diet and exercise
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When giving oral metformin (glucophage) what should the nurse be cautious about?
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risk of lactic acidosis
held when IV contrast dye is used. |
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When should oral sulfonylureas & meglintides be taken?
"ides" |
within 30 mins of meals
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There is a risk of ___ when taking sulfonylureas?
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Hypoglycemia
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Oral acarbose (Precose) & miglitol (Glyset) should be taken when?
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with first bite of food
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What caution should nurse take when administering oral gilitazone, Thiazolidenediones, pioglitazone (Actos), rosiglitazone (Avandia)
one's |
Monitor BUN & Creatinine for liver function
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sitagliptin (Januvia), vildagliptin (Galvus) are DPP-4 inhibitors which act how?
gliptins |
decrease possibility of hypoglycemia without weight gain side effects
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exenatide (Byetta) a Incretin memetic ___ the effect of insulin & are given ____
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prolong
SQ |
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Rapid acting insulin onset?
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15 mins
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Short acting onset?
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1/2 - 1 hour
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Intermediate acting onset?
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2-4 hours
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Long-acting onset?
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1-2 hours
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3 types of rapid acting insulins?
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lispro (Humalog)
aspart (Novolog) glulisine (Apidra) |
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3 types of short acting insulins?
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Regular (Humulin R, Novolin R, ReliOn R)
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3 types of intermediate acting insulins?
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NPH (Humulin N, Novolin N, ReliOn N)
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2 types of long acting insulins?
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glargine (Lantus)
detemir (Levemir) |
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What insulins should not be mixed?
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Long acting
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What type(s) of insulin can be given IV?
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ONLY REGULAR
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What is more important, hypoglycemia going down or going up?
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down
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What should nurse do when her pts sugar is <60 & not able to talk?
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Give 20cc of D50 IV push
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Which type of diabetes pt should receive a snack with night meds?
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type 1
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What should the nurse teach the pt as general rules for exercise? (5)
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1. Physical activity is encouraged
2. *Consult physician for a plan* 3. *Have glucose under control before beginning exercise program* 4. Exercise 1-3 hours after meal 5. Eat a CHO snack before moderate exertion (type 1) |
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How often should diabetes pt exercise
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3 times a week
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What precautions should diabetic pt take when exercising? (2)
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1. Carry a CHO in case of hypoglycemia.
2. Monitor blood glucose for several hours after exercising to watch for exercise induced hypoglycemia |
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What is the test we use to monitor how pt is managing diabetes & to possibly diagnose?
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HbA1C
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What is the goal of the HbA1c?
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<7% which is an average glucose level of 150
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___:condition of rapid onset low blood sugar
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hypoglycemia
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s/s of hypoglycemia (4)
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anxiety
agitation cold & clammy diaphoresis |
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Treatment of hypoglycemia in awake pt?
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Rapid absorbing CHO
Check blood glucose after 15 mins & repeat if needed After s/s improve-give slower digested CHO & PROT snack (milk) |
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Treatment of hypoglycemia pt if unconscious?
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IV access-50ml of 50% Dextrose
No IV access-glucagon injection or commercial gel/paste between cheek & gums Once LOC improves-CHO & PROT snack |
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NI for hypoglycemia (5)
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1. Know s/s most likely time for hypoglycemia to occur
2. Teach family causes, s/s, prevention, & treatment 3. Instruct client on adherence to meal times 4. Caution about alcohol intake 5. Instruct client to wear id bracelet |
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__: condition that results from prolonged & uncontrolled hyperglycemia
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Diabetic Ketoacidosis
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What type of diabetes does Diabetic Ketoacidosis typically occur in?
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Type 1
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What would the nurse expect the lab data to look like in Diabetic Ketoacidosis?
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Blood glucose > 250
Serum/urine ketones high (large) ^ anion gap |
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What instructions would the nurse give for "Sick Day Rules"
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Continue to take insulin
Continue meal plan Increase fluid intake Check glucose q4h |
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s/s of Ketoacidosis? (12)
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Polyuria
Polydispsia Dehydration Weight loss Hypotension & weak rapid pulse N&V, abdominal pain Weakness & paresthesias Kussmaul's respirations Acetone breath Shock Oliguria (lots pee) -> anuria (none) Depressed sensorium -> coma |
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___: condition of ^ blood sugar w insidious gradual onset
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Hyperosmolar Hyperglycemic Nonketotic Syndrome (HHNS)
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Which type of diabetes is HHNS typically seen in?
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Type 2
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What lab data would the nurse expect to see in HHNS?
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Blood glucose > 400
Serum/urine ketones negative (small) Serum osmolality increased (Conc urine) |
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What are the 2 significant differences in HHNS from Diabetic Ketoacidosis?
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Hyperglycemia is more severe (leads to more severe dehydration & neuro s/s)
NO ACIDOSIS b/c some insulin is available to prevent breakdown of fats & PROT |
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Hot and dry, ___ ____
Cool & clammy, ________ |
sugars high
give some candy |
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Decreased sugar is more significant in HHNS (T or F)
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False, increased
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DKA: tx to correct fluid?
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Isotonic, then hypotonic. 1 liter/hr. Rate decreased when BP returns to normal
Dextrose added after glucose decreases to approx 250 |
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HHNS: tx to correct fluid?
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10-20 liters over 1st 24-48 hours. Rate monitored carefully to prevent cerebral edema.
Dextrose added after glucose decreases to approx 250 |
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DKA: insulin tx?
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Loading dose of 5-10 units regular insulin, then IV of only few units/hr
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HHNS: insulin tx?
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low dose of IV regular insulin; repeated only if glucose levels are still high
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DKA: electrolyte imbalance tx?
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Na+ & Cl replacement-give saline IV
K+ monitored. K+ only added to IV after adequate urinary output is established Bicarbonate only when ph < 7 Phosphates-after adequate urinary output |
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HHNS: electrolyte imbalance tx?
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Na+ & Cl replacement-give saline IV
K+ monitored. K+ only added to IV after adequate urinary output is established Bicarbonate only if ph is < 7 Phosphates-after adequate urinary output |
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DKA: treat precipitating causes?
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culture & treat infections
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HHNS: treat precipitating causes?
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Culture & treat infections
Prevent condition by giving water w continuous tube feedings & by monitoring rate of TPN closely |
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DKA: Client teaching?
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Teach how to prevent future occurrences of ketoacidosis
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HHNS: Client teaching?
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Teach about:
disease process which precipitated condition (undiagnosed diabetes, MI, etc) medication therapy for chronic conditions (diuretics, steroids) |
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DKA: Miscellaneous treatments? (6)
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Airway for unconscious pts
Foley-monitor output monitor vitals Freq blood glucose Close assessment of fluid status ABG monitoring |
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HHNS: Miscellaneous treatments? (6)
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Airway for unconscious pts
Foley-monitor output monitor vitals Freq blood glucose Close assessment of fluid status ABG monitoring if shock & lactic acidosis occur |
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___: disease of the large & medium sized blood vessels that leads to development of atherosclerosis-> CAD, HTN, Angina, MI, cerebrovascular disease, & PVD.
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Macroangiopathy
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___: condition that results from thickening of the basement membrane of capillaries. (specific to diabetes)
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Microangiopathy
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Tx of Macroangiopathy (4)
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1. Manage DM to keep blood sugar under control
2. Reduce risk factors of CV disease: no smoking, dec BP, diet, exercise 3. Foot care to prevent ulcers 4. Tx of foot ulcers |
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Tx of Microangiopathy? (6)
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1. Maintain glucose levels
2. Control BP; Ace inhibitors-prevent progression of neuropathy 3. Regular opthamologist appts 4. Surgery for retinopathy 5. Treats/s nephrpathy 6. Protect skin from injury & infection |
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___: procedure where client fasts overnight. Venous blood sample drawn before client eats
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Serum glucose test (FBS)
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___: procedure where client is given a routine meal consisting of 75-100 gm of carbs. Blood sample is drawn 2 hours after meal.
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2 hour Post-Prandial Glucose Test
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___: procedure wher for 3 days prior to the test, a ^ carb diet (300 gm/day). The client fasts the night before test. On the morning of the test, fasting blood & urine samples taken.
Client then given 75-100 gm of glucose that pt must drink within 5 mins Blood & urine samples collected 30 mins after glucose is ingested, then hourly up to 4 hours |
Glucose Tolerance Test
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