question

Diabetes Mellitus

answer

Disorder of pancreas where beta cells of islets of langerhans fail to produce adquate amount of insulin -Disease in which high blood glucose results from defective insulin secretiono r action * Juvenile or insulin dependent (adult onset can be non-insulin dependent)

question

endogenous

answer

derived or originating internally

question

gastroparesis

answer

delayed gastric emptying

question

glycosuria

answer

the presence of abnormally high levels of sugar in the urine

question

hyperglycemia

answer

abnormally high blood sugar usually associated with diabetes

question

hypoglycemia

answer

abnormally low blood sugar usually resulting from excessive insulin or a poor diet

question

ketoacidosis

answer

acidosis with an accumulation of ketone bodies *Patient will have a sweet taste in the back of the mouth.

question

Kussmaul's respirations

answer

increased rate and depth with panting and long grunting exhalation

question

nephropathy

answer

a disease affecting the kidneys

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neuropathy

answer

any pathology of the peripheral nerves

question

nocturia

answer

excessive urination at night

question

polydipsia

answer

excessive thirst (as in cases of diabetes or kidney dysfunction)

question

polyphagia

answer

excessive hunger

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polyuria

answer

renal disorder characterized by the production of large volumes of pale dilute urine

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postprandial

answer

following a meal (especially dinner)

question

preprandial

answer

preceding a meal (especially dinner)

question

retinopathy

answer

disease of the retina

question

What should be included in the teaching for a 40 yr old with type 2-diabetes mellitus to prevent long term complications?

answer

1. Have regular eye examinations 2. Maintain good oral hygiene and make regular visits to the dentist 3. Wash, dry and inspect feet daily 4. Take daily aspirin as prescribed 5. See a podiatrist or other health care professional to monitor neuropathy

question

Diabetes is diagnosed when the fasting plasma glucose drawn 8 hours without eating is?

answer

126 mg/dL or higher

question

Which type of diabetes is most common?

answer

Type 2 Diabetes

question

The nurse is caring for a patient with Type 1 diabetes mellitus being treated for pneumonia. Which lab value should the nurse monitor most closely to identify potential complications early?

answer

Urine Ketones

question

A person with type 2 diabetes mellitus is scheduled for hip surgery and is upset because an infusion of glucose and insulin is being started; this is a change from the patients usual oral hypoglycemic therapy. What should the appropriate response from the nurse be?

answer

Surgery is a stressor that can alter blood glucose control and the IV medications are likely only temporary.

question

The nurse is caring for a patient with Type 2 diabetes mellitus who started oral hypoglycemic medication 2 months ago for fasting blood glucose level of 160 mg/dl. What would be a good indicator that the treatment was working?

answer

HbA1c 5%

question

What acute high blood glucose complication can occur as a result of uncontrolled type 2 DM?

answer

Hyperosmolar Hyperglycemia

question

The nurse working on the endocrine unit is reviewing preprandial glucose results. Which results indicate the patients DM is well controlled?

answer

51yr old female with glucose = 115 mg/dL 29yr old male with glucose = 84 mg/dL

question

The nurse is caring for a patient with type 2-DM who has taken an oral hypoglycemic agent who is now experiencing hunger, sweating, headache and agitation. which action should a nurse take first?

answer

Give 4oz of OJ

question

The nurse is assisting with community education fair on risks for diabetes and heart disease. What are criteria for metabolic syndrome and should be included in instruction?

answer

Fasting plasma glucose = 100 mg/dL BP = 130/85 mm/Hg HDL cholesterol is <40 mg/dL for men and ,<50 mg/dL for woman

question

What is a major cause of Type 1 diabetes?

answer

Destruction of beta cells in the Islets of Langerhans in the Pancreas

question

Symptoms of uncontrolled DM

answer

Polydipsia, polyuria, polyphagia, glycosuria, nocturia, fatigue, blurred vision, abdominal pain, headache

question

Treatment options for DM

answer

Nutrition, exercise, insulin or oral hypoglycemic agents, blood glucose monitoring, education

question

Symptoms of Hypoglycemia

answer

Hunger sweating, tremor, blurred vision, headache and irritability; If not treated, confusion, seizures and coma

question

Symptoms of diabetic neuropathy

answer

Numbness and pain in extremities, sexual dysfunction, gastroparesis

question

Pathophysiology of type 2 DM

answer

Pancreas does not produce enough insulin or tissues are resistant to insulin, causing elevated blood glucose. heredity and obesity are major factors

question

Criteria for metabolic or cardiometabolic syndrome

answer

Abdominal obesity, elevated triglycerides, decreased HDLs, BP >130/85 mm Hg, fasting plasma glucose (FPG) >110 mg/dL

question

Acute, life threatening complication of uncontrolled type 2 diabetes

answer

Hyperosmolar hyperglycemia

question

Nursing interventions to prevent amputation in DM

answer

Wash and dry feet daily in warm water, Apply non-alcohol-based lotion, Inspect for lesions daily, Wear cotton socks and leather shoes, Avoid crossing legs and wearing constricting clothing, Use care when cutting toenails, Have feet checked regularly by a health professional

question

Causes of hypoglycemic episodes in diabetes

answer

Under-eating, skipping a meal, too much medication, too much exercise, poor timing of medication, food, exercise

question

Steps for mixing insulins; Remember "clear to cloudy":

answer

-Assemble equipment -Check orders to conform type/dose of regular (clear) and intermediate acting (cloudy) insulins -Roll bottle of cloudy insulin -wipe tops of both bottles with alcohol -Draw up amount of air equal to dose of cloudy insulin 1. Inject air into cloudy vial, -Draw up amount of air equal to dose of clear insulin 2. Inject air into clear vial, 3. draw up clear insulin, have nurse double check 4. then draw up cloudy insulin, have nurse double check *If too much insulin drawn into syringe, discard and start over *Remember, never to mix insulin glargine (Lantus) *If the clear is drawn up last, the vial may be contaminated by the cloudy insulin, altering the action of the clear insulin *If the cloudy insulin is unknowingly contaminated by clear insulin, the clear will become cloudy and its effect will be diminished

question

Mrs. Brown is a 52-year-old cook in a fast-food restaurant. She is 5'2" tall and weighs 190lbs. She says she is "shaped like a pumpkin" because her arms and legs are relatively thin compared to her middle. Because she tends to eat her meals at work, she has a high-fat, high-sodium diet that is low in fresh fruits and vegetables. She drinks diet soda all day long and spends long periods on her feet. Mrs Brown's sister has DM, but Mrs. Brown's blood glucose levels have always been normal whenever she has been tested.

answer

1. What factors place Mrs. Brown at risk for diabetes? Heredity Obesity Body shape Age 2. What actions can Mrs. Brown take to reduce her risk of developing diabetes? Lose weight Exercise regularly 3. Mrs. Brown tries to lose weight butis unsuccessful and, at age 57, is diagnosed with type 2 diabetes. Diabetes is diagnosed when the fasting plasma glucose is __________ mg/dL or greater? 126 mg/dL or greater for fasting plasma 200 mg/dL or greater for casual plasma with symptoms of diabetes are diagnostic for diabetes. 4. Mrs. brown develops a small blister on he bottom of her right heel. Which actions are important for her to take to make sure her heel heals? Gently wash, dry and inspect the area daily Use crutches to avoid bearing weight on the blister See podiatrist if it is not healed in 2-3 days *Wear shoes and socks for support *Never open blisters/wounds 5. Mrs. Brown is very disciplined. her foot heals, and she loses 50 lbs. Her physician tells her to stop her metformin (Glucophage) and return to the office for follow-up in 3 months. What blood test can the physician order that will reflect her blood glucose control over 3 months? Glycohemoglobin or HbA1c test reflects 2-3 months. Normal is 45-65. The American Diabetic Association recommends less than 7% as a goal for people with diabetes.

question

Endogenous hormone

answer

Is made by the body and does not need to be ingested or injected

question

Glycosuria results when...

answer

the kidneys are unable to reabsorb all the glucose in the renal tubules

question

Diabetic ketoacidosis or ketoacidosis is an acute complication risk for persons with type 1 DM if...

answer

Blood glucose is uncontrolled and insulin is deficient

question

Kussmaul's respirations are used to ....

answer

Eliminate excess acidity in patients with diabetic ketoacidosis

question

Nephropathy

answer

Diabetic kidney disease

question

Postprandial blood glucose tests are recommended to....

answer

Determine the response of blood glucose to a meal

question

Retinopathy

answer

A microvascular disease caused by complication of DM

question

4% - 6% is the normal level of...

answer

glycohemoglobin

question

Believed to be caused by an auto immune response, what percentage of diabetic patients have Type 1 diabetes?

answer

5% - 10%

question

Difference between Type 1 and Type 2 diabetes is...

answer

Type 1-Must have insulin because body is not producing it Type 2- Body not producing enough and body needs the glucose for energy

question

Goal in management of DM is...

answer

To maintain sugar levels in the 70 -125 mg/dL range

question

Prediabetes

answer

Diagnosed when fasting glucose levels are higher than normal (100 mg/dL) but lower than 126 mg/dL; Or when Glucose Tolerance Test is higher than normal (140 mg/dL) but lower than 199 mg/dL; Or when HbA1c levels are higher than normal (6.0%) but lower than 6.5% People with prediabetes usually develop type II diabetes within 10 years; Treat with weight loss and exercise to prevent onset of type II diabetes

question

Tests for Diabetes are...

answer

Fasting Blood Glucose Glucose Tolerance Test HbA1c

question

Diabetes can be diagnosed when...

answer

fasting glucose levels are 126 mg/dL or higher; Or when Glucose Tolerance Test is200 mg/dL or higher; Or when HbA1c levels are 6.5% or higher

question

Type 1 Diabetes

answer

ONSET - Rapid AGE AT ONSET - Usually younger than 40 RISK FACTORS - Virus, autoimmune response, heredity USUAL BODY TYPE - Lean HIGH BLOOD GLUCOSE COMPLICATION - Ketoacidosis TREATMENT - Diet, exercise; Must have insulin to survive

question

Type 2 Diabetes

answer

ONSET - Slow AGE AT ONSET - Usually older than 40 RISK FACTORS - heredity, obesity USUAL BODY TYPE - Obese HIGH BLOOD GLUCOSE COMPLICATION - Hyperosmolar hyperglycemia; may develop ketoacidosis TREATMENT - Diet, exercise; May need oral hypoglycemics or insulin to control blood glucose level

question

Diabetes Goals and recommendations:

answer

-Capillary plasma glucose should be measured at least three times a day for patients using multiple insulin injections -BP measured every office visit -Serum creatnine and Urine microalbumin should be assessed yearly Target levels are: -HbA1c s/b <7% -preprandial capillary glucose s/b 70-130 mg/dL -Peak postprandial capillary glucose s/b < 180 mg/dL **(Blood glucose can be different in hospitalized patients) -BP s/b <130/80 mm Hg -LDLs s/b <100 mg/dL or < 70 mg/dL inpatients with cardiovascular disease -Triglycerides s/b 40 mg/dL in men >50 mg/dL in women

question

More Diabetes Goals and recommendations:

answer

*Yearly flu vaccine for all patients 6mos and older *1 lifetime pneumococcal vaccine for patients older than 2, re-vaccination for patients older than 64 if first vaccine was more than 5 years earlier *Aspirin therapy 75-162 mg/day if older than 30 years *Statin therapy if history of CVD or if older than 40 with CVD risk factors *Smoking cessation counseling *Yearly comprehensive foot exam *Dilated comprehensive eye exam within onset of Type 1 diabetes, or at diagnosis of Type 2 diabetes, and annually thereafter

question

Onset, Peak and Duration of VERY SHORT ACTING Insulins

answer

EXAMPLE- Insulin lispro BRAND NAME- Humalog ONSET- 5-15 min PEAK- 30-90 min DURATION- 5 hrs or less EXAMPLE- Insulin aspart BRAND NAME- Novolog ONSET- 10-20 min PEAK- 1-3 hrs DURATION- 3-5 hrs EXAMPLE- Insulin glulisine BRAND NAME- Apidra ONSET- 15-20 min PEAK- 30-90 min DURATION- 6 hrs

question

Onset, Peak and Duration of SHORT ACTING Insulins

answer

EXAMPLE- Regular BRAND NAME- Humulin R, Novolin R ONSET- 30 min PEAK- 2-5 hrs DURATION- 5-8 hrs **Remember Rule of Odds 1-3-5

question

INTERMEDIATE ACTING Insulins

answer

EXAMPLE- NPH BRAND NAME- Humulin N, Novolin N ONSET- 1-2 hrs PEAK- 6-12 hrs DURATION- 18-26 hrs **Remember Rule of evens 2-12-24 hrs

question

Onset, Peak and Duration of BASAL Insulins

answer

EXAMPLE- Insulin glargine BRAND NAME- Lantus AE ONSET- 1-2 hrs PEAK- No Peak DURATION- Up to 24 hrs

question

Onset, Peak and Duration of BASAL Insulins

answer

EXAMPLE- Insulin detemir BRAND NAME- Levemir ONSET- 1hr PEAK- No Peak DURATION- Up to 24 hrs

question

What insulins can not be mixed with other insulins?

answer

glargine (Lantus) detemir (Levemir)

question

Oral hypoglycemic agents ABSORPTION DELAYERS

answer

ALPHA-GLUCOSIDASE INHIBITORS (AGIs)-Lower postprandial glucose by reducing rate of carb digestion and absorption EXAMPLES- acarbose (Precose) miglitol (Glyset) S/E- Flatulance, Bloating NURSING IMPLICATIONS: -Give at start of each meal -No weight gain or hypoglycemia risk -Multiple dosing less convenient -If used in combination with another drug and hypoglycemia occurs, treat with milk or glucose tablets, not table sugar

question

Oral hypoglycemic agents ABSORPTION DELAYERS

answer

DPP-4 INHIBITOR - Inhibits DPP-4, an enzyme that breaks incretins (hormones secreted by GI in response to food), they reduce glucogon secretion and increase insulin synthesis and release EXAMPLES- sitagliptin (Januvia) S/E- Upper respiratory infection, headache; hypoglycemia when administered in combination with a sulfonylurea NURSING IMPLICATIONS: -Administer one a day -Only works when blood glucose is high, so does not cause hypoglycemia when used alone -Watch for allergic reactions

question

Oral hypoglycemic agents INSULIN SENSITIZERS

answer

BIGUANIDE- Decreases glucose production by liver; Increases glucose uptake by muscle EXAMPLES- metformin (Glocophage, Fortamet, Riomet, Glumetza) S/E- Nausea, diarrhea, decreased appetite, less likely to cause hypoglycemia than other agents NURSING IMPLICATIONS: -Give with meals -May enhance weight loss -Withhold if patient is having test with contrast dye -Contraindicated in renal and hepatic disease and heart failure -Monitor serum creatnine level -Notify physician of early symptoms of lactic acidosis; hyperventilation, myalgia, malaise

question

Oral hypoglycemic agents INSULIN SENSITIZERS

answer

THIAZOLIDINEDIONES (glitazones)- reduce insulin resistancein muscles, Improve blood lipids, may lower blood pressure and improve cardiovascular risk EXAMPLES- pioglitazone (Actos) rosiglitizone (Avandia) S/E- Nausea, weight gain, fluid retention NURSING IMPLICATIONS: -Give with meals -Work well with obese patients -Avoid with liver disease; monitor liver enzymes -Monitor for heart failure -May alter effectiveness of some birth control pills.

question

Oral hypoglycemic agents INSULIN STIMULATORS

answer

SULFONYUREAS- Stimulate insulin secretion by pancreas, increase insulin receptor sensitivity EXAMPLES- glipizide (Glucotrol) glimepride (Amaryl) glyburide (Micronase, Diabeta) S/E- Hypoglycemia, weight gain, possible increased risk of cardiovascular disease NURSING IMPLICATIONS: -Monitor patient for hypoglycemia -Teach patient to avoid alcohol

question

Subjective data collection for patient with DM

answer

-Age and symptoms at onset -Understanding of Diabetes (1 & 2) and self care -Current treatment plan (medication, nutrition therapy, exercise) and adherence to plan -Frequency of blood glucose monitoring and pattern of BG levels (check diary) -History of diabetes related complications -Involvement of family or other support systems

question

Objective data collection for patient with DM

answer

-Vital signs -Height, Weight, Body Mass Index -Skin, Integrity Turgor, condition of injection sites -Feet; pulses, color, temp, skin integrity, pressure points, sensation -Lab results: blood glucose, HbA1c, creatnine, lipid profile, albuminuria, urine and serum ketones

question

One of the risk factors for type 2 diabetes is...

answer

Obesity

question

Which symptom is commonly associated with hyperglycemia?

answer

Polyuria

question

Protein in the urine is a sign of which long-term complication of diabetes?

answer

Nephropathy

question

What is the best way for patients to avoid long-term complications of diabetes?

answer

Maintain pre-meal blood glucose levels under 1.30 mg/dL

question

What is a breakfast menu must appropriate for a patient with diabetes?

answer

One slice whole grain toast with peanut butter, skim milk, orange juice

question

Correct sequential order for mixing insulin

answer

1. Roll cloudy vial 2. Clean vial tops with alcohol 3. Inject air into cloudy insulin 4. Inject air into clear insulin 5. Draw up clear insulin 6. Draw up cloudy insulin

question

A patient who is preparing for surgery asks the nurse why his physician took him off his oral hypoglycemic and placed him on sliding-scale insulin. Which response by the nurse is best?

answer

"It helps us to maintain better control of your blood glucose during surgery. you will most likely be back on pills before you go home."

question

Which meal plan is best for the patient with reactive hypoglycemia?

answer

Small, frequent meals

question

Glucose in urine is called

answer

Glycosuria

question

Too much sugar in the blood is called...

answer

Hyperglycemia

question

Too little sugar in the blood is called...

answer

Hypoglycemia

question

Deep, sighing respiration's from diabetic acidosis are called...

answer

Kussmaul's respirations

question

Excessive hunger is called...

answer

Polyphagia

question

Excessive thirst is called...

answer

Polydipsia

question

The patient who gets up to urinate at night has...

answer

Nocturia

question

The time when insulin is working its hardest after injection is called...

answer

Peak Action Time

question

The length of time insulin works is called its...

answer

Duration

question

The Diabetes Control and Complications Trial (DCCT) found that individuals who maintain _______ control of their diabetes will have fewer long-term complications.

answer

Tight

question

Hypoglycemia symptoms

answer

Tremor Irritability Sweating

question

Hyperglycemia symptoms

answer

Polydipsia Polyuria Lethargy Fruity Breath Abdominal Pain

question

Retinopathy

answer

SYMPTOM- Impaired vision

question

Neuropathy

answer

SYMPTOM- Burning pain in legs and feet

question

Hyperosmolar hyperglycemia

answer

SYMPTOM- Profound hyperglycemia without ketonemia

question

Diabetic Ketoacidosis

answer

SYMPTOM- Ketones in the blood and urine

question

Nephropathy

answer

SYMPTOM- Microalbuminuria

question

Gastroparesis

answer

SYMPTOM- Food intolerance

question

Infection

answer

SYMPTOM- Fever

question

What is an acceptable pre-meal blood sugar range for a patient with diabetes?

answer

70-130 mg/dL

question

Before giving insulin, the nurse always checks which result?

answer

Blood sugar level

question

At what point after injection does the peak action of regular insulin occur?

answer

2-5 hours

question

What is a symptom of hypoglycemia?

answer

Cold sweats and Tremors

question

In addition to stimulating insulin production, glyburide (Micronase) has what effects?

answer

Increases tissue sensitivity to insulin

question

A 26 yr old patient is admitted to the hospital with a new diagnosis of diabetes, a blood glucose of 690 mg/dL, and ketones in the blood and urine. Which type of diabetes should the nurse expect?

answer

Type 1

question

A 45 yr old with diabetes forgot to take a daily dose of glyburide (Micronase). What symptom should the nurse be vigilant about ?

answer

Fatigue, thirst, blurred vision

question

Which routes can Insulin be administered?

answer

Intravenous (IV) Sub Q Intramuscular

question

While providing discharge instructions to a patient newly taking NPH insulin every morning, the nurse recognizes that teaching has been effective if the patient knows to observe for signs and symptoms of low blood sugar level at which of the following times?

answer

6-12 hours after administration of insulin

question

A patient with newly diagnosed diabetes asks the nurse what to take for low blood sugar. What would be appropriate for the nurse to suggest?

answer

Raisins

question

The nurse recognizes that teaching is effective if a patient with diabetes knows to use sub Q glucagon for an emergency episode of which of the following conditions?

answer

Hypoglycemia

question

A patient on an American Diabetes Association diet receives a breakfast tray and does not care for the oatmeal. What is a food can the nurse substitute for a 1/2 cup of oatmeal?

answer

A slice of wheat toast

question

Oral hypoglycemic agents COMBINATION AGENTS

answer

EXAMPLES- metformin and glyburide (Glucovance) metformin and rosiglitazone (Advandamet) glipizide and metformin (Metaglip) S/E- See individual agents NURSING IMPLICATIONS: -See individual agents

question

Diabetes Summary

answer

SIGNS AND SYMPTOMS: Polyuria Polydipsia Polyphagia Fatigue Blurred Vision Headache Abdominal pain DIAGNOSTIC TESTS: Fasting Plasma Glucose HbA1c (glycosylated hemoglobin) Oral glucose tolerance test Additional testing for complications THERAPUTIC MEASURES: Nutrition Therapy Exercise Insulin Oral hypoglycemic medication Self monitoring of blood glucose levels Education COMPLICATIONS: Hypoglycemia Hyperglycemia Diabetic ketoacidosis Hyperosmolar hyperglycemia Long-term complications PRIORITY NURSING DIAGNOSIS: Risk for Unstable Blood Glucose Level

Chapter 40 – Nursing Care of Patients with Disorders of the Endocrine Pancreas – Flashcards

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