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Nur 333 Fun 2 > Care of the Diabetic Patient (Exam 2) Med Surg (Exam 3) > Flashcards

Care of the Diabetic Patient (Exam 2) Med Surg (Exam 3) Flashcards

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1
Q

Type 1 Diabetes

A

Genetic Predisposition + Environmental Factors

Autoimmune destruction of insulin-producing beta cells and circulate in the bloodstream and lymphatics

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2
Q

Type 2 Diabetes

A

-More common in adults (with risk factors)

-Can go undiagnosed for years

-Insulin resistant (body can not respond correctly)

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3
Q

Type 2 diabetes treatment is often started with

A

Oral medication and progress to insulin replacement of needed

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4
Q

Type 2 diabetes can go undiagnosed for years

A

Doctors often just screen on risk factors, not signs/symptoms

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5
Q

Type 1 diabetes (facts)

A

-More common in younger people

-Normally more abrupt (happen suddenly)

-5/10% of all diabetic cases

-No endogenous insulin production

-3 P’s most common presentation

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6
Q

Type 1 diabetics make

A

No endogenous insulin. Must have insulin replacement

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7
Q

Signs and Symptoms of Type 1 Diabetes

A

-Polydispia

-Polyphagia

-Polyuria

-Fatigue

-Recurrent Infections

-Slow Wound Healing

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8
Q

Risk factors for Type 2 diabetes (modifiable)

A

-Physical activity
-High body fat
-HTN
-High cholesterol

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9
Q

Risk factors for Type 2 diabetes (non-modifiable)

A

-History of gestational diabetes (while pregnant)
-Race (aa-hispanic)
-Over 45
-Family history

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10
Q

Labs involved in diabetes

A

-FBG
-CBG
-Urine Ketones
-Lipid profile
-OGTT
-Glycosylated hemoglobin (HbA1C)

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11
Q

Fasting Blood Glucose (diabetes)

A

No food or drink for 8 hours

Normal< 126 mg/dL

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12
Q

casual blood glucose

A

Normal < 200 mgdL

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13
Q

Urine Ketones

A

High ketones associated with hyperglycemia

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14
Q

Urine ketones over what number is considered medical emergency?

A

> 300 md/dL is considered a medical emergency

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15
Q

Lipid profile

A

HDL, LDL, tri’s

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16
Q

HDL-LDL-Triglycired, how do these present in diabetes?

A

HDL = Lower

LDL = High

Tri = High

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17
Q

Oral Glucose Tolerance Test

A

-commonly used for gestational diabetes (Not 1 or 2)

-Fasting glucose drawn prior, client consumes oral glucose, then glucose levels obtained every 30 min until 2 hours post consumption

-Fasting should be less than 110. at 1 hours less than 180. at 2 hour less than 140

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18
Q

Glycosylated Hemoglobin (HbA1C)

A

-Indicator for average glucose level over the past 120 days (3 months)

-For diagnosis and to evaluate effectiveness of interventions

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19
Q

Normal A1C

A

-Normal is 4-6%

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20
Q

What A1C is considered diabetes?

A

-Greater than 6.5% is considered diabetic

-Acceptable reference range for those with diagnosed diabetes is 6-8 with a target of 7

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21
Q

Pre-diabetes range

A1C
FBG
OGTT

A

A1C = 5.7-6.4

FBG = 100-125

OGTT = 140-199

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22
Q

Diabetes: Diagnostic Criteria

A

-At least 1 of the following
1. A1C of 6.5% or higher
2. FBG level greater than 126 mg/dL
3. OGTT 12-hr levelof200 mg/dL

  1. Classic symptoms of hyperglycemia, random glucose greater than 200 mg/dL, or hyperglycemia crisis

-With criteria 1-3, would do a repeat lab test before official diagnosis. (try interventions for 3 months)

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23
Q

What do you need for diagnosing type 1 diabetes

A

islet cell autoantibody test

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24
Q

Definition of Pre-diabetic patient

A

-Impaired glucose tolerance, impaired fasting-glucose, or both

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25
-Patients with pre-diabetes are at high risk of developing
type 2 diabetes
26
Pre-diabetes symptoms
-Typically none but long term damage could already be done
27
Pre-diabetic diagnostic criteria
-An A1C of 5.7%-6.4% -fasting blood sugar of 100-125 mg/dL -An OGTT 2 hour blood sugar pf 140 mg/dL - 199 mg/dL
28
What can nurses do for pre-diabetic patients
-Teach -Lifestyle modifications -Encourage close monitoring of blood glucose and hemoglobin -Monitor for symptoms: fatigue, slow wound healing, frequently getting sick -Diet modification (avoid sugar / count carbs)
29
DM: Oral Medications are started at a low dose and increased base on?
A1C levels and FBG levels. (More frequent in type 2)
30
When a diabetic patient comes into the hospital what is usually done?
-Often in hospitalized patients oral medications are stopped and put on insulin while acutely ill. (Able to maintain tight glucose control while on insulin)
31
What diabetes drug should be help before procedures?
Metformin
32
What do we do with patients when they have diabetes and are sick?
-Patient Usually Started Steroids (oral/IV) make your blood sugar RISE. -(May need to alter insulin regimen at home, adjust basal dosage, increased scheduled doses)
33
Why is being sick with diabetes a big problem
-sickness causes the body stress, may cause your body to release more glucose, so may have to check blood glucose more often, adjust insulin regiments, etc.
34
When a diabetic patient is sick to their stomach, do they still take their medicaitons?
Yes, they still need to take their oral medications if possible
35
WIth being sick the patient with diabetes is at greater risk of?
Going into DKA
36
What do we do when a patient with DM is sick: Teaching points (6)
-Notify provider when sick -Monitor blood sugar more frequently q2 -Continue to take medications -Prevent dehydration -Meet carb needs -Rest
37
When should a patient with DM who is sick call the provider?
-Urine ketones + -BS greater than 250 mg/dL -Fever over 101.5 -Confused -Persistent NVD -Inability to tolerate liquids -Illness lasting longer than 2 days (This is not for the Nurse to call the provider but for the patient at home)
38
What is a critical part of diabetes managment for the patient?
Monitoring Blood Glucose
39
Continuous Glucose Monitoring is more common with
people with Type 1 diabetes (reads every 1-5 min) Insulin pump or injection medication response
40
Nursing Management of Insulin
-Do our best to mimic the bodies normal insulin production (insulin spike with meals) -Combine Basal (long) insulin with meal time insulin (Bolus) (BASAL BOLUS Regimen) -Uses rapid and short acting (bolus) insulin before meals -Use a background insulin once a day
41
Is bolus insulin rapid or long acting? when is it givin?
Bolus is rapid insulin given right before meals
42
When is basal insulin given?
In the morning or at night for 24 hr coverage
43
Nursing management: 4 injections a day
-Lantus or Levemir at bedtime (basal) -Novolog or Regular before each meal (bolus)
44
Rapid acting Insulin (lipspro, aspart, glulisine) Onset Peak Duration
Onset: 15 min Peak: 1 hour Duration: 2-4 hr
45
Short acting (Regular) Onset Peak Duration
Onset: 30 min-1 hr Peak: 2-6 hr Duration: 3-8 hr
46
Intermediate acting (NPH) Onset Peak Duration
Onset: 2-4hr Peak: 4-10 hr Duration: 10-20 hr
47
Long Lasting (glargine, determir, degludec) Onset Peak Duration
Onset: 70 min Peak: less defined or no peak Duration: 24 hr
48
What is the most important thing we can do for patients on insulin?
Teach them
49
For a newly diagnosed client we should
observe them perform a self-administration
50
What is crucial with insulin?
TIMINING Understanding when it was administered, when it will take effect, and when yo would see adverse reaction
51
Hypoglycemia range
Blood sugar less than 70 can have symptoms even if blood sugar is greater than 70, especially if uncontrolled diabetic
52
Hypoglycemia Manifestation
Sweating Blurry Vision Dizziness Hunger Anxiety Irritability Shakiness Tachycardia Weakness
53
Hypoglycemia: Treatment
1. FSBS 2. the "Rule of 15" (if conscious and able to swallow) 3. FSBS in 15 minutes; then eat regular meal if > 70 4. If still less than 70 give additional 15 grams of carbs and check again in 15 min
54
What is 15 grams of simple carbs?
4 oz of juice Regular soda 3 glucose tabs
55
If patient is unconscious / unable to swallow.. How do we treat hypoglycemia?
IM glucagon or IV D50 (25-50ml)
56
Rule of 15
Only if conscious and able to swallow -15g simple CHO (4 - 6 oz juice, regular soda, 3 glucose tablets, honey, lifesavers) -Avoid sugars w/ fat (delays absorption) (Candy bar) -15 grams should increase blood sugar by 50 mg/dL -If still <70 repeat -When glucose is stable give additional food
57
Hyperglycemia: Causes
Illness Infection Self management issues Stress
58
Hyperglycemia: Manifestation
-Weakness -Fatigue -Blurry vision -Headache -NVD
59
Hyperglycemia: Treatment
-Check for ketones in urine (>300 emergency) -Insulin -Drink fluids, prevent dehydration -Education
60
Hyperglycemia: Crisis situations
-Diabetic Ketoacidosis (DKA) -Hyperglycemic Hyperosmolar Syndrome (HHS) Life threating conditions related to uncontrolled hyperglycemia
61
Very high glucose can cause….
electrolyte abnormalities that can lead to death
62
Insulin Pump
-Continuous release of subcutaneous insulin infusion. (Basal infusion) -Can give bolus based on FSBG -Can be increased/decreased or receive a bolus based on finger stick blood glucose
63
What insulin is used in insulin pump?
Rapid acting insulin
64
Insulin Pump: Patients are required to check how many times per day?
4 Can use a CGM in conjunction with the insulin pump to constantly keep eye on sugar
65
Insulin Pump: In hospital
Usually deactivate and switched to a sliding scale regimen (tighter control)
66
Insulin Pump: Nursing Related Problems
-Infection at insertion site -Increased risk of DKA if pump malfunctions -Cost -Can not swim or take a bath (unless taken off)
67
Diabetes: Macrovascular Issues
Damage to large vessels: CVD -Coronary arteries - -Peripheral vascular - -Cerebral vascular
68
Diabetes: Microvascular Issues
Damage to capillaries: -retinopathies -nephropathies -neuropathies
69
Macrovascular Disease: Risk Factors
Women have 4-6x greater risk of CVD Men have 2-3x risk of CVD
70
Macrovascular disease: Nurse Teaching Points
-stop smoking -control blood pressure -modify high fat diet
71
Nursing Consideration Neuropathy
Highest risk = Lower extremities and feet. (Foot ulcerations and lower extremity amputations common complications Lost of protective sensation (LOPS)
72
Diabetic Retinopathy Teaching
Frequent Eye Exams
73
Diabetic Nephropathy Teaching
Treat HTN as well-- DM+HTN = much more likely to have CKD
74
Diabetic Foot Care: 13 Steps
1. Wash feet daily with mild soap and warm water 2. Pat feet dry (between toes) 3. Inspect feet daily for injury 4. Use lanolin to prevent dry skin and cracking 5. Mild foot powder on sweaty feet 6. Do not use commercial remedies to remove calluses or corns 7. Clean cuts with WATER AND SOAP (no iodine-alcohol-adhesives) 8. Report skin infection or non-healing sores 9. Trim nails after shower or bath and cut evenly with rounded contours 10. Separate overlapping toes with coton 11. Do not go barefoot and shake shoes before wearing 12. Clean absorbent socks 12. NO HOT WATER BOTTLES
75
Nutritional Considerations for Diabetes
Eat a balanced high fiber, low fat, low cholesterol diet Carbs = 50% of total daily caloric intake. (Limit simple carbs) Fats = low saturated and trans fat. (polyunsaturated is best = fish-nuts) Fiber = Promote fiber intake (Can improve metabolism and lower cholesterol) Protein = Promote intake from meats, eggs, fish, nuts and beans. (20% total intake) Alcohol: Limit to 1 (women) or 2 drinks (men)
76
Exercise
-Important encourage because it can lower blood sugar -Wear medical alert bracelet -Proper footwear
77
Exercise: If more than 1 hour has passed since eating and high intensity exercise is planned…
Teach to EAT a carbohydrate snack beforehand Keep Blood Sugar High
78
Do not exercise if glucose levels are
Less than 80 or Higher than 250
79
Nursing Considerations for Hospitalized Diabetic Patient
-Stress/surgery can increase blood glucose levels. -Controlled can become uncontrolled in the hospital -Wound healing is impaired in patients with diabetes -HIGH risk of infection
80
Diabetes Integumentary Concerns: Diabetic Dermopathy
-Reddish-brown spots, usually on shins
81
Diabetes Integumentary Concerns: Acanthosis nigricans
Brown/black thickening of skin, often seen in folds
82
Diabetes Integumentary Concerns: Necrobiosis lipoidica diabeticorum
Red patches around blood vessels

Nur 333 Fun 2 (19 decks)

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