AHI – Diabetes Management – Flashcards

Unlock all answers in this set

Unlock answers
question
DM Type I
answer
autoimmune disorder where the body does not produce insulin for glucose metabolism; acute and sudden onset, typically manifests at a young age
question
DM Type 2
answer
a Metabolic Disorder that accounts for 90 to 95 percent of all diabetes cases wherein either the pancreas does not make sufficient insulin or body cells are resistant to its effects (insulin resistance) *usually occurs in older patients, but is seen increasingly in younger pts
question
Three Main Types of Diabetes
answer
1) DM Type I 2) DM Type 2 3) Gestational Diabetes
question
S/S DM Type 1
answer
Polyuria Polydipsia Polyphagia Fatigue Weakness Weight loss Irritability and mood changes
question
Criteria for Diagnosing Diabetes
answer
1) *A1C = ≥6.5%* (Glycated Hemoglobin, Glycosylated Hemoglobin, Hemoglobin A1c, A1C, HbA1c) 2) Fasting plasma glucose (FPG) = *≥126 mg/dL (7.0 mmol/L)* 3) 2-h plasma glucose ≥200 mg/dL (11.1 mmol/L) during an OGTT 4)A random plasma glucose ≥200 mg/dL (11.1 mmol/L)
question
Hemoglobin A1C
answer
% of hemoglobin that is coated with glucose, used for diagnosis of diabetes b/c it is not as susceptible for spikes as blood glucose levels are
question
Prediabetic Criteria
answer
FPG = 100-126 AB1C = 5.7-6.4% OGTT = 140-199
question
Normal Lab Values Relevant to Diabetes
answer
A1C = < 6.5% (5%) FPG = 70-110 (<99) pH = 7.35-7.45
question
Tx for DM Type I
answer
*Insulin therapy* - Most should be treated with multiple dose injections (3-4 per day of basal and prandial insulin) or continuous subcutaneous insulin infusion Education: how to match prandial insulin dose to carbohydrate intake, premeal blood glucose, and anticipated activity
question
Onset, Peak, Duration of Lispro
answer
O = 15 min P = 0 -1.5 hrs D = 3-4 hrs
question
Onset, Peak, Duration of Asparte (Rapid Acting Insulin)
answer
O = immediate P = 45 min - 1.5 hrs D = 3-4 hrs
question
Onset, Peak, Duration of Regular Insulin (Short Acting Insulin)
answer
O = 30 min - 1 hr P = 2-3 hrs D = 3-6 hrs
question
Onset, Peak, Duration of NPH (Intermediate Acting)
answer
O = 2-4 hrs hrs P = 4-10 hrs D = 10-16 hrs
question
Onset, Peak, Duration of Glargine (Long-Acting)
answer
O = 1-2 hrs P = none (plateaus throughout duration) D = 24+ hrs *commonly used as Basal Insulin
question
Administration of Insulin
answer
Before meals Blood glucose testing and administration of insulin should occur within 30 minutes of each other Injection Proper injection sites Gently pinch skin and give at 90° angle (if very thin 45°) Document blood glucose, and insulin administration Be aware of NPO status, impending tests, and when meals are delivered A hypoglycemia management protocol should be adopted and implemented by each health care setting
question
Blood glucose testing should be done within __ minutes of administration.
answer
30
question
Monitoring Blood Glucose
answer
Important for detecting episodic hyperglycemia and hypoglycemia Patient training is crucial Supplies immediate information about blood glucose levels
question
Continuous Glucose Monitor tests glucose in ____ .
answer
interstitial fluid
question
Adrenalin can make blood sugar ___ .
answer
go up
question
Exercise can also have the effect of ____ blood glucose by using the available sugar during activity.
answer
lowering.
question
Order of NI for Diabetic Pt
answer
1) Vital Signs 2) Fingerstick 3) Administer Insulin 4) Complete Bedside Assessment 5) AM Care 6) Education
question
Beta cell dysfxn begins ___ years before presentation of DM Type 2.
answer
10-12
question
Etiology of DM Type 2
answer
The overabundance of free fatty acids contributes to insulin resistance. As the progression to type 2 diabetes continues, pancreatic insulin-producing cells become exhausted from overwork and damage occurs.
question
Non-modifiable Risk Factors for DM Type 2
answer
Increased age Certain ethnicities (Native Americans, African Americans, Hispanic and/or Asian) Genetic factors
question
Modifiable Risk Factors for DM Type 2
answer
Overweight Sedentary lifestyle Dietary components Perinatal factors, nutrition in utero
question
As one's ___ goes up, their risk for Diabetes Type 2 also increases.
answer
BMI
question
Clinical Manifestations of DM Type 2
answer
Feeling tired and weak Passing large volumes of urine, especially during the night Having frequent infections (ex. yeast infections --> high blood sugar) Having blurred eyesight Weight loss Excessive hunger and thirst
question
Factors Affecting BG Levels in Hospital Setting
answer
• Changing IV glucose rates • TPN and enteral feedings • Lack of physical activity • Unusual timing of insulin injections • Use of glucocorticoids • Unpredictable or inconsistent food intake • Fear of hypoglycemia • Cultural acceptance of hyperglycemia
question
Some non-diabetic medications may _____ blood glucose levels in pts.
answer
increase or decrease
question
Nursing Care for Diabetic Pts
answer
• 24-hour coverage by nursing • Nursing often coordinates, and is aware of, the multiple services required by patient - Travel off unit, (eg, physical therapy, X-ray) - Amount of food eaten (carbohydrates) - Patient's day-to-day concerns - Order changes (by various providers)
question
Goals of Care for DM Pts
answer
Maintain steady control of blood glucose Decrease symptoms Promote well-being Prevent acute complications Delay onset and progression of chronic complications
question
Nursing Assessment for DM
answer
Past health history (Table 49-13) Infections Medications Recent surgery Positive health history Obesity Current management strategies - How often they see their PCP - Education level - Nutritional habits
question
Important Education for Pts with DM
answer
Symptoms Diagnosis Prevention Treatment Self-care Foot Care Exercise Nutrition Storage and dose preparation Syringes Blood glucose monitoring Interpretation of results Frequency of testing Blood glucose therapy goals
question
Nursing Diagnosis for DM
answer
Knowledge Deficit: Pathophysiology Normal levels Effect of insulin & exercise Effects of stress, illness & infections Drugs, alcohol Self testing Signs/Symptoms of Hypoglycemia/ Hyperglycemia
question
Oral Drug Therapy for DM
answer
Work to improve mechanisms by which insulin and glucose are produced and used by the body.
question
Sulfonylureas
answer
increase insulin production from the pancreas 1) Glipizide (Glucotrol) 2) Glyburide (Micronase) 3) Glimepiride (Amaryl)
question
Biguanides
answer
reduce glucose production by the liver, enhances insulin sensitivity and improves glucose transport 1) Metformin (Glucophage) - Temporarily discontinue metformin before IV contrast, resume after 48 hours and normal creatinine - Used for weight loss & lowering Cholesterol as well - CI for pts with liver disease or ETOH abuse
question
Nutritional Therapy for DM
answer
+ Protein, - fats and carbohydrates, + fiber, - sweeteners, + replacers Less Alcohol Food labeling Exchange system, carbohydrate counting - ALL ABOUT BALANCE - Loss of 1-2 lbs a week does drastic improvement for HbAC1 %
question
Exercise Therapy for DM
answer
Benefits of exercise (*decreases insulin resistance*) Risks related to exercise Screening before starting exercise program Guidelines for exercise - 30min/day moderate - 150 min/ week Exercise promotion
question
Acute Complications of DM
answer
1) Diabetic ketoacidosis (DKA) 2) Hyperosmolar hyperglycemic syndrome (HHS) 3) Hypoglycemia - Too much insulin - Too little glucose
question
Hypoglycemia
answer
*Blood glucose level < 70 mg/dL* Diet therapy: carbohydrate replacement Drug therapy: glucagon, 50% dextrose Prevention strategies for: - Insulin excess - Deficient food intake - Exercise - Alcohol consumption
question
What can cause hypoglycemia?
answer
Insulin > demand Change in type of insulin Oral hypoglycemia Decreased caloric intake Increase in activity Decreased metabolism Excessive ETOH Adrenal insufficiency
question
Glucagon IM has precautions for ___ .
answer
aspiration, as it can cause emesis (N/V)
question
Hypoglycemia can lead to ....
answer
- LOC - seizures - coma - death
question
Treat hypoglycemia with ___ carbs.
answer
simple -> absorbed faster!
question
After giving glucose re hypoglycemic protocol, recheck after ___ .
answer
20 min
question
S/S Hypoglycemia
answer
mood changes, tremor, pallor, diaphoresis, dizziness, blurred vision, HA, fatigue, hunger
question
Clinical Manifestations of Diabetic Ketoacidosis (DKA)
answer
Dehydration (poor skin turgor, tachycardia, orthostatic hypotension) Lethargy and weakness Abdominal pain with anorexia and vomiting Kussmaul respirations (Body's attempt to reverse metabolic acidosis) Acetone on breath (sweet, fruity odor) *Typically occurs in DM Type 1 that is poorly managed or undiagnosed*
question
DKA Lab Findings
answer
BG > 250mg/dL (super high blood glucose) Arterial blood pH < 7.30 (low pH) Bicarb < 15mEq/L ( low HCO3) Urine +++ketones (keytones + in urine!)
question
Interventions for DKA
answer
Monitoring for clinical manifestations *Assessment of airway, level of consciousness, hydration status, blood glucose level* Management of fluid and electrolytes Drug therapy goal: to lower serum glucose by 75 to 150 mg/dL/hr Management of acidosis Client education and prevention - Severity of s/s will dictate treatment - Pt can end up on NG tube or respirator
question
Hyperosmolar Hyperglycemic Syndrome (HHS)
answer
Severe hyperglycemia w/ serum glucose *>600mg/dL* Plasma osmolarity > 315 mOsm/kg Bicarb > 15 Arterial pH > 7.3 Serum ketones - negative or mildly elevated *HHNS occurs less often than DKA, but has a much higher mortality* - Patients >60, Type 2 DM, infections End result - hyperglycemia and volume depletion through osmotic diuresis. - Total body water losses can reach 8-12 liters
question
BG levels can rise as high as ___ before s/s of HHS begin, because there is enough insulin in the body to combat the glucose levels before ketosis begins.
answer
600-800
question
Typically, with pts who get HHS, an acute illness has impaired their ____.
answer
thirst mechanism
question
Nursing Interventions for HHS
answer
Monitoring for clinical manifestations Fluid therapy: to rehydrate the client and restore normal blood glucose levels within 36 to 72 hr Continuing therapy with IV regular insulin at 10 units/hr often needed to reduce blood glucose levels Client education and prevention
question
DKA vs HHS
answer
- usually < 40 y/o - S/S last under 2 days - Glucose levels 600-800 mg/dL - Sodium = normal or low - Potassium = irrelevant - BiCarb = low - Ketones = present - Serum Osmolality = < 350 mOsm/kg - Prognosis = 3-10% mortality
question
HHS vs DKA
answer
- usually >60 y/o - S/S usually last > 5 days - Glucose levels = > 800 mg/dL - Sodium = normal or high - Potassium = irrelevant - BiCarb = normal - Ketones = not present - Serum Osmolality = > 350 mOsm/kg - Prognosis = 10-20% mortality
question
Chronic Complications of Diabetes
answer
Cardiovascular disease (Primary cause of death in patients with DM) *silent ischemia* Cerebrovascular disease (Diabetic patients have at least twice the risk of CVA) Retinopathy (vision) problems - damage to blood vessels in retina - Leading cause blindness - *Need annual eye exams* Diabetic neuropathy Diabetic nephropathy Male erectile dysfunction due to nerve impairment *Complications for feet and lower extremities* - due to sensory neuropathy - and peripheral arterial disease
question
Primary cause of death for pts with DM
answer
Cardiovascular Disease
question
Diabetic Retinopathy
answer
- starts with "dirty lens" spots, "floaters" - damage to blood vessels in retina - can lead to blindness - annual eye exams necessary
question
Interventions for DM Risk for Delayed Surgical Recovery
answer
Preoperative care - Careful assessment of cardiac risk factors --> EKG - May be relatively asymptomatic Intraoperative care - Glycemic control Postoperative care and monitoring includes care of: - Cardiovascular - Renal - Nutritional
question
Contributing Factors to Risk for Complications of Feet and Lower Extremities in DM
answer
Risk factors Sensory neuropathy Peripheral arterial disease- 2x more common in diabetics Other contributors: *Smoking* Clotting abnormalities. Impaired immune function Autonomic neuropathy
question
1 in __ diabetics will develop a foot ulcer in their lifetime.
answer
4
question
Foot ulcers can become a big problem in DM pts because of ...
answer
delayed healing that can lead to necrosis or amputation
question
It is recommended that DM pts go to ____ annually.
answer
a podiatrist
question
Interventions for Foot Care
answer
•Testing for sensation (monofilament, vibration) •Annual visit with comprehensive foot examination •Every visit if high risk •Appropriate foot wear •Teach patient daily skin assessment, may need mirror •Wash/dry daily •Avoid hot water; dry thoroughly between toes •Lubricate daily (not between toes) •Trim toes properly after bathing •No self-cutting of nails if: •Neuropathy, PAD, poor vision •Report nonhealing breaks in skin or any other concerns
question
Interventions for Nursing Dx for DM: Risk of Injury Related to Disturbed Sensory Perception: Visual
answer
Blood glucose control Environmental management Incandescent lamp Clock method for meals Syringes with magnifiers Large-print reading materials Hand-held magnifiers
question
DM and Infection
answer
Diabetic individuals more susceptible to infection Defect in mobilization of inflammatory cells Impairment of phagocytosis by neutrophils and monocytes Loss of sensation may delay detection. Treatment must be prompt and vigorous. (frequent yeast infections, neuropathy can delay awareness of s/s of infection, impaired wound healing)
question
DM Gero Considerations
answer
Prevalence increases with age Hypoglycemic unawareness more common Presence of delayed psychomotor function could interfere with treating hypoglycemia Strict glycemic control may be difficult to achieve - cognitive dysfxn can interfere with Tx as well
question
Some medications may _____ blood glucose levels.
answer
increase or decrease
Get an explanation on any task
Get unstuck with the help of our AI assistant in seconds
New