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PNC 104 lecture > Chapter 40: nursing care of patients with disorders of the endocrine pancreas > Flashcards

Chapter 40: nursing care of patients with disorders of the endocrine pancreas Flashcards

(60 cards)

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1
Q

pathophysiology of diabetes mellitus

A
  • glucose intolerance: faulty production of insulin OR tissue insensitivity to insulin
  • altered carbohydrate, fat, protein metabolism
  • long term complications
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2
Q

CDC statistics for diabetes mellitus

A
  • more than 30 million people in the US have diabetes
  • 84 million people have prediabetes
  • cost $245 billion per year in the US
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3
Q

Type 1 diabetes (former names: insulin dependent diabetes mellitus, juvenile diabetes)

A
  • 5% of diabetes cases
  • some genetic component (10%)
  • autoimmune response to virus
  • destruction of beta cells
  • pancreas secretes no insulin
  • more common in young, thin patients
  • prone to ketosis
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4
Q

type 2 diabetes (former names: non insulin dependent diabetes mellitus, adult onset)

A
  • 95% of diabetes cases
  • large genetic component (90%)
  • reduced number of beta cells
  • reduced tissue sensitivity to insulin
  • largest risk factor is obesity
  • not usually ketosis prone
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5
Q

type 2 diabetes in youth

A
  • more obesity in children
  • type 2 epidemic
  • a nursing challenge
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6
Q

other types of diabetes

A

gestational
prediabetes
secondary diabetes

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7
Q

gestational diabetes

A

pregnancy

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8
Q

prediabetes

A

glucose intolerance

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9
Q

secondary diabetes

A

drugs
pancreatic trauma

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10
Q

metabolic syndrome

A
  • elevated waist circumference
  • elevated triglycerides
  • low high density lipoprotein cholesterol
  • elevated blood pressure
  • elevated fasting plasma glucose
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11
Q

signs and symptoms of metabolic syndrome

A
  • 3 p’s: polydipsia, polyuria, polyphagia
  • fatigue
  • blurred vision
  • infection prone
  • abdominal pain
  • headache
  • ketosis/acidosis
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12
Q

diagnosing diabetes

A
  • fasting blood glucose test > 126 mg per deciliter
  • random blood glucose test >200mg per deciliter
  • oral glucose tolerance test >200mg per deciliter after 2 hours
  • hemoglobin a1c(Hba1C)>6.5%
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13
Q

additional tests

A
  • lipid profile
  • serum creatinine
  • urine microalbumin
  • urinalysis
  • electrocardiogram
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14
Q

prevention of type 2 diabetes

A
  • 7% body weight loss
  • moderate physical activity: 150 minutes per week
  • metformin in some patients
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15
Q

goals of treatment

A
  • preprandial glucose 80-130 mg per deciliter
  • peak postprandial glcose <180 mg per deciliter
  • blood pressure >140/90 millimeters of mercury
  • glycohemoglobin <7%
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16
Q

therapeutic interventions

A
  • nutrition therapy
  • exercise
  • medication
  • monitoring
  • education
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17
Q

nutrition theapy

A
  • carbohydrate counting
  • glycemic index/load
  • create your plate
  • remember cultural dietary needs***
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18
Q

general principles with type 1 diabetes

A
  • avoid wide swings in blood glucose
  • regular eating schedule
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19
Q

general principles with type 2 diabetes: control

A
  • blood pressure
  • weight
  • lipids
  • regular eating schedule
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20
Q

carbohydrate counting

A
  • 15 gram carbohydrate = 1 exchange
  • 30 gram carbohydrate = 2 exchanges
  • 45 gram carbohydrate = 3 exchanges
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21
Q

exercise

A
  • lowers glucose up to 48 hours
  • lowers blood lipids
  • exercise 150 minutes per week, over 3 days
  • refer to hcp or exercise physiologist
  • avoid exercise during ketosis
  • eat snack priori f blood glucose <100 mg per deciliter
  • carry fast sugar
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22
Q

medication

A
  • insulin for type 1 or 2
  • oral hypoglycemics for type 2
  • other injectables
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23
Q

insulin

A
  • action
  • routes: subcutaneous, IV
  • insulin pump
  • site rotation
  • timing
  • regimens
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24
Q

timing with insulin

A
  • onset
  • peak
  • duration
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25
regimens with insulin
- basal bolus - sliding scale
26
oral hypoglycemics
- are NOT insulin - action depends on medication - stimulate pancreas - increase tissue sensitivity to insulin - slow carbohydrate digestion and absoprtion - reduce glucose reabsorption by kidneys
27
injectable agents
- amylin analog - incretin mimetics
28
amylin analog
- type 1 diabetes - pramlintide (symlin)
29
incretin mimetics
- type 2 diabetes - exenatide (byetta, bydureon) - liraglutide (victoza)
30
self monitoring of blood glucose
- test before meals (AC) and at bedtime (HS) or as ordered - record results - analyze meaning of results - know target glucose levels - call provider if out of range
31
urine testing
glucose ketones
32
glucose urine testing
- no longer recommended unless self monitoring of blood glucose (SMBG) is impossible
33
ketones urine testing
- if blood sugar elevated and risk present
34
alterations in blood glucose
- hyperglycemia - hypoglycemia = "insulin reaction"
35
hyperglycemia
- blood glucose >126 mg per deciliter - causes: overeating, stress, illness, not enough medications
36
symptoms of hyperglycemia
- 3 p's: dysphagia, polyuria, polydipsia - blurred vision - fatigue, lethargy - headache - abdominal pain - ketonuria - coma
37
treatment of hyperglycemia
- check blood glucose - use sliding scale insulin - check ketones as needed - determine and treat cause - if blood glucose is >180 for 2 days, call hcp - call hcp if ill or vomiting
38
hypoglycemia
- blood glucose <70 - causes: too much insulin, exercise, not enough food
39
symptom of hypoglycemia
- headache - hunger - fight or flight: shaky, cold sweats, palpitations - neuroglycopenia: irritability, confusion, seizures, coma - caution: autonomic neuropathy = NO symptoms***
40
treatment of hypoglycemia
- check blood glucose - administer 15-20 gram fast acting carbohydrates - recheck in 15 minutes - repeat as needed - snack if longer than 1 hour until meal
41
fast sugars
- 4 oz orange juice - 6 oz regular (not diet) soda - miniature box of raisins - commercial glucose tablets - 6-8 lifesavers
42
acute treatment of hypoglycemia
- IV dextrose 50% - SQ glucagon
43
causes of diabetic ketoacidosis
- high blood glucose: most common in type 1 - stress - illness
44
pathophysiology of diabetic ketoacidosis
- insulin deficiency - cells starving - fat breaks down - byproduct of fat breakdown is ketones - ketones are acidic
45
signs and symptoms of diabetic ketoacidosis
- flu like symptoms - symptoms of hyperglycemia - kussmaul respirations - fruity breath - electrolyte imbalance - dehydration - coma - death
46
therapeutic interventions for diabetic ketoacidosis
- IV fluids - IV insulin drip - frequent glucose monitoring - electrolyte monitoring
47
prevention of diabetic ketoacidosis
- check urine ketones - blood sugar elecated - during stress or illness - good diabetes control
48
causes of hyperosmolar hyperglycemic state
- hyperglycemia in type 2 diabetes - stress - illness - most common in elderly
49
signs and symptoms of hyperosmolar hyperglycemic state
- extreme dehydration - lethargy - blood glucose may be 1000-5000 mg per deciliter - electrolyte imbalance - coma -death
50
therapeutic interventions for hyperosmolar hyperglycemic state
- iV fluids - IV insulin drip - frequent glucose monitoring - electrolyte monitoring
51
prevention of hyperosmolar hyperglycemic state
- SMBG - if glucose rising: drink fluids, lower glucose
52
long term complications: macrovascular changes
- stroke - heart attack - peripheral vascular disease
53
long term complications: microvascular changes
- retinopathy - nephropathy
54
overall long term complications
- neuropathy - infection - foot problems
55
foot care
- inspect feet daily - wash and dry feet daily - wear well fitting shoes - protect feet from injury - avoid crossing legs - use caution w/ nail care - see HCP immediately if lesion develops
56
care of patient undergoing surgery
- frequent glucose monitoring - sliding scale insulin or insulin drip - maintain glucose 140-180 mg per deciliter in critically ill
57
nursing diagnosis
- risk for unstable blood glucose level
58
diabetes self management education
- disease process and treatment - nutrition therapy - exercise - medications - SMBG - acute complications - chronic complications - psychosocial adjustment - health promotion
59
reactive hypoglycemia
- overreaction of pancreas - low glucagon levels - low blood glucose - sympathetic "fight or flight" response
60
therapeutic interventions for reactive hypoglycemia
- frequent small meals - high protein, low carb diet

PNC 104 lecture (3 decks)

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