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NUR 333 > E2 Care of the diabetic patient > Flashcards

E2 Care of the diabetic patient Flashcards

1
Q

When does Type 1 & 2 develop?

A

T1: Younger People
T2: Adults >45

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2
Q

Is T1 or T2 more common?

A

Type 2 more common
Type 1 is only 5-10% of all diabetic cases

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3
Q

What is the main difference between the beta cells of T1 and T2?

A

T1: No endogenous insulin production due to destruction of beta cells in the pancreas

T2: Beta cells wear out, cells become insulin resistant

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4
Q

The 3 P’s of Type 1

A

Polyphagia- Increased hunger
Polydipsia- Excessive thirst
Polyuria- Excessive urination

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5
Q

Significance of S/S for T1 and T2

A

T1: S/S normally more abrupt

T2: S/S can go undiagnosed for years, screen on risk factors

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6
Q

Symptoms of diabetes

A

-Fatigue
-Recurrent infections (sick)
-Slow wound healing

(T1: Polyphagia, Polydipsia, Polyuria)

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7
Q

Non-modifiable risk factors for T2

A

-Family history
-Age over 45
-History of gestational diabetes
-Race/ethnicity (African Americans, hispanics, Pacific Islanders, American Indians)

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8
Q

Modifiable risk factors for T2

A

-Decreased Physical Activity
-High body fat or body weight
-High BP
-High cholesterol

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9
Q

Labs for diabetes

A
  1. Fasting Glucose: Normal <126mg/dL
  2. Casual blood glucose: Normal <200mg/dL
  3. Urine ketones: High amount indicates hyperglycemia
  4. Lipid profile: Elevated HDL, LDL, triglycerides
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10
Q

What casual blood glucose is considered a medical emergency?

A

> 300mg/dL

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11
Q

Oral glucose tolerance test

A

-Used commonly to diagnose gestational diabetes
-Not usually for diagnosing type 1 or 2
-Fasting glucose drawn, client consumes oral glucose, glucose levels obtained every 30 mins for 2 hours
-Fasting should be <110
-At 1 hour <180
-At 2 hours <140

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12
Q

Glycosylated Hemoglobin (HbA1C)

A

-Average glucose level past 3 months
-Used commonly to diagnosis and evaluate effectiveness of interventions
-Normal 4-6%
-Diabetic >6.5%
-Acceptable range for diabetic 6-8% with target 7%

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13
Q

Diabetes diagnostic criteria

A

Atleast 1 of the following:
1. A1C of 6.5% or higher
2. Fasting level >126mg/dL
3. OGTT at 2hr 200mg/dL
4. Classic symptoms of hyperglycemia (3 P’s or unexplained weight loss)

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14
Q

For diagnosis of Type 1 diabetes, would need ________-

A

islet cell autoantibody testing

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15
Q

What is a prediabetic patient?

A

Impaired glucose tolerance, impaired fasting glucose, or both

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16
Q

Patients with pre-diabetes are at HIGH risk for developing

A

type 2 diabetes

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17
Q

What are the S/S of prediabetes?

A

Typically None
But, longterm damage can already be occuring

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18
Q

Diagnostic criteria for pre-diabetes

A

-An A1C of 5.7-6.4
-Fasting blood sugar of 100-125mg/dL
-An OGTT 2 hour blood sugar of 140mg/dL-199mg/dL

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19
Q

What can we do for pre-diabetic patients?

A

-TEACH
-Lifestyle modification
-Encourage close monitoring of blood glucose and HbA1C
-Monitor for S/S: Fatigue, slow wound healing, frequently getting sick
-Diet modification: Monitor carbs and sugar intake

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20
Q

Oral medications are used most frequently in

A

Type 2 diabetics

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21
Q

Often in hospitalized patients oral medications are

A

stopped and put on insulin while acutely ill

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22
Q

What do diabetic oral medications do?

A
  1. Reverse insulin resistance
  2. Increase insulin production
  3. Decrease hepatic glucose production
  4. Help body get rid of excess glucose
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23
Q

When should metformin be held?

A

Before Procedures

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24
Q

Steroids make your blood sugar _____
What should you do?

A

rise

May need to alter insulin regimen at home, adjust basal dosage, increased scheduled doses

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25
Q

Why is being sick a big problem for diabetics?

A
  1. Causes stress which causes body to release more glucose
  2. More prone to DKA, HHNS when sick
  3. Stomach virus may lead to decreased eating and drinking (need to still take oral meds)
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26
Q

What to do when a patient with DM is sick?

A
  1. Notify HCP
  2. Monitor BS more frequently
  3. Continue to take meds
  4. Prevent dehydration
  5. Meet carbohydrate needs: through oral food intake or liquid (gatorade/ pedialyte)
  6. Rest
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27
Q

Call the provider when

A
  1. Urine Ketones
  2. BS >250mg/dL
  3. Fever >101.5, not responding to Tylenol
  4. Feeling confused/ disoriented/ rapid breathing
  5. Persistant N/V/D
  6. Inability to tolerate liquids
  7. Illness lasting longer than 2 days
28
Q

Continuous glucose monitors are most common for

A

Type 1

29
Q

Nursing management of insulin

A
  1. Mimic bodies normal insulin production
  2. Combines “Basal” insulin with “meal time” insulin
  3. Use rapid and short acting (bolus) insulin before meals
  4. Use a background insulin once a day
  5. Typically get 4 injections a day
30
Q

Rapid acting insulin

A

Insulin lispro (Humalog)
Onset: 15 mins
Peak: 1 hr
Duration: 2-4 hrs

Insulin aspart (Novolog)
Insulin glulisine (Apidra)

31
Q

Short acting

A

Human regular (Novalin R/ Humalin R)
Onset: 30-60 mins
Peak: 2-6 hrs
Duration: 3-8 hrs

32
Q

Intermediate acting

A

NPH (Humalin N)
Onset: 2-4 hrs
Peak: 4-10 hrs
Duration: 10-20 hrs

33
Q

Long acting

A

Insulin glargine (lantus)
Onset: 70 mins
Peak: None
Duration: 24hrs

Insulin detemir (Levemir)
Insulin degludec (Tresiba)

34
Q

Insulin is a HIGH ALERT medication, therefore you need to

A
  1. Always check glucose level before given med
  2. Check diet order and patients oral intake tolerance
  3. Know onset/peak/duration
35
Q

Teaching points for diabetics

A
  1. Teaching is the most important point
  2. Observe pt self-administer
  3. Timing is crucial
  4. Monitor for side effects of hypoglycemia
36
Q

S/S of hypoglycemia

A

Sweating
Blurry Vision
Dizziness
Anxiety
Hunger
Irritability
Shakiness
Fast heartbeat
Headache
Weakness/ Fatigue

37
Q

Hypoglycemia is when the blood sugar is

A

<70

Symptoms can occur at higher # if uncontrolled diabetes

38
Q

What is the Rule of 15

A

If conscious and able to swallow give 15g simple carbohydrates (4 oz juice, regular soda, 3 glucose tablets, tablespoon honey)

Avoid sugars w/fats (candy bars)

39
Q

15g of CHO increases BS

A

50mg/dL

40
Q

How often should you recheck FSBS if hypoglycemic?

A

Every 15 minutes until <70, then give food

41
Q

If patient is unconsious/ unable to swallow:

A

IM glucagon or IV D50 (25-50mL)

42
Q

Hyperglycemia BS:

A

250-300

43
Q

Causes of hyperglycemia

A

-Illness
-Infection
-Self-management issues
-Stress

44
Q

S/S of hyperglycemia

A

Weakness
Fatigue
Blurry Vision
Headache
N/V/D

45
Q

Treatment for hyperglycemia

A
  1. Check for ketones in urine
  2. Insulin
  3. Drink fluid, prevent dehydration
  4. Education on prevention
46
Q

Crisis situation of hyperglycemia?

A

500+
Diabetic ketoacidosis (DKA) or Hyperglycemic Syndrome (HHS)

47
Q

Insulin pump:

A
  1. Continuous release of SQ insulin infusion: Uses rapid acting insulin
  2. Pts receive continuous basal infusion
  3. Still required to check 4 times a day
  4. Usually deactivated in hospital and switched to sliding scale regimen
48
Q

Problems to be aware of with insulin pumps

A
  1. Infection at insertion site
  2. Increased risk for DKA if pump malfunctions
  3. Cost
49
Q

What is the goal for diabetes management?

A

Prevent long term damage in organ disease, angiopathy (damage to blood vessels

50
Q

Macrovascular disease

A

Damage to large vessels:
Coronary arteries (CVS)
Peripheral vascular (extremities)
Cerebral vascular (brain)

51
Q

Microvascular

A

Damage to capillaries:
Retinopathies (eye capillaries)
Nephropathies (Kidneys)
Neuropathies (Sensation to extremities)

52
Q

Women with diabetes have a _____ of CVD than those without

A

4-6x risk

53
Q

Men have ______ of CVD

A

2-3x

54
Q

What is body part is at highest risk for Neuropathy

A

Lower extremities & feet
Foot ulcerations and lower extremity amputations common complications

55
Q

What is neuropathy

A

loss of protective sensation (LOPS)- prevents patient from being aware that injury has occured

56
Q

Nutritional considerations for diabetics

A

Balanced, high fiber, low fat, low cholesterol diet is best

57
Q

Example of Carbohydrates

A

grains, fruits, legumes, milk

Limit simple carbs like pasta & bread

Should be 45-65% of total daily caloric intake

58
Q

Example of Fats

A

Polyunsaturated fats such as Fish

59
Q

Example of Fiber

A

beans, veggies, oats, whole grains

60
Q

Example of Protein

A

meats, eggs, fish, nuts, and beans

Should be 15-20% of total caloric intake

61
Q

Alcohol with diabetics

A

limit alcohol intake
1 for women
2 for males

62
Q

Precautions when it comes to exercise with diabetics

A

-Appropriate foot wear
-Do not exercise if BS <80 or >250
-Best to exercise after meals
-If more than 1 hour has passed since eating and plan on high intensity exercise eat a carbohydrate snack prior
-Wear a medical alert bracelet

63
Q

Nursing considerations for the hospitalized diabetic patietns

A
  1. Stress/ surgery can increased blood glucose levels
  2. Wound healing is impaired
  3. High risk of infection
64
Q

Diabetic Dermopathy

A

reddish-brownish spots, usually on shins

Not life threatening but can clue us to uncontrolled diabetes

65
Q

Acanthosis nigricans

A

Brown/Black thickening of skin, often seen in skin folds

Not life threatening but can clue us to uncontrolled diabetes

66
Q

Necrobiosis lipoidica diabeticorum

A

Red patches around blood vessels

Not life threatening but can clue us to uncontrolled diabetes

NUR 333 (15 decks)

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