Diabetes Part 1 Flashcards
(113 cards)
1
Q
what is the main goal of diabetes management?
A
to normalize insulin and BG levels to reduce the development of vascular and neuropathic complications
2
Q
what 3 complications can result from diabetes?
A
- retinopathy
- nephropathy
- neuropathy
3
Q
what can reduce the chance of developing complications?
A
glucose control
4
Q
what are the 3 major adverse effects for intensive therapy?
A
- hypoglycemia
- coma
- seizure
5
Q
what are the 5 components of diabetes management?
A
- nutrition
- exercise
- monitoring
- pharmacologic therapy
- education
6
Q
what is more important when it comes to diet?
hint: calories
A
control of total caloric intake to attain or maintain a reasonable boy weight and control BG levels
7
Q
what can control of caloric intake successfully lead to?
A
reversal of hyperglycemia in type 2 diabetes
8
Q
what are the 5 goals for nutrition management in a diabetic?
A
- providing all of the essential foods for optimal nutrition
- meeting energy needs
- achieving and maintaining a reasonable weight
- preventing wide fluctuations in glucose levels throughout day
- decreasing serum lipid levels
9
Q
why is consistency of time between meals and snacks important?
A
helps in preventing hypoglycemic reactions and in maintaining overall BG control
10
Q
what are three acute complications of diabetes?
A
- hypoglycemia
- DKA
- HHNS (hyperglycemic hyperosmolar nonketoic coma)
11
Q
what BG is considered hypoglycemia?
A
less than 2.7-3.3 mmol/L
12
Q
what is hypoglycemia caused by? (3)
A
- too much insulin or oral hypoglycemic agents
- too little food
- excessive physical activity
13
Q
when can hypoglycemia happen?
A
anytime in the day or night
- often occurs before meals or when they are delayed
14
Q
what 2 categories are hypoglycemia symptoms separated into?
A
- adrenergic symptoms
- central nervous system (CNS)
15
Q
what are symptoms of mild hypoG?
A
- SNS is stimulated
- resulting in a surge of epinephrine and norepinephrine resulting in: sweating, tremor, tachycardia, palpitations, nervousness, and hunger
16
Q
what are the symptoms of moderate hypoG?
A
- impaired Fx of CNS: inability to concentrate, headache, light-headedness, confusion, memory lapses, numbness of lips
17
Q
what are the symptoms of severe hypoG?
A
CNS so impaired, patient needs help to manage sympt
- disoriented behaviour, seizures, difficulty arousing from sleep, loss of consciousness
18
Q
what is a factor contributing to altered hypoG sympt?
A
dec. hormonal (androgenic) response to hypoG
19
Q
what are some considerations for older adults? (4)
A
- live alone and may not be able to detect hypoG
- dec. renal Fx
- skipping meals
- dec. visual acuity
20
Q
what is the management for mild-moderate hypoG?
A
15g of carbs
- wait 15 mins and retreat if BG less than 3.8-4.0 mmol/L
- after get a snack of protein and starch UNLESS patient has a meal coming
21
Q
what must people receiving insulin carry at all times?
A
simple sugar (eg. tablets, gel)
22
Q
what should one refrain from eating when trying to treat hypoG? why?
A
- high calorie and high-fat desserts
- slow absorption rate of glucose into blood
23
Q
what is the management for a unconscious patient with hypoG?
A
1mg glucagon can be injected
- subcut or IM
24
Q
what is glucagon?
A
a hormone produced by the alpha cells of the pancreas that stimulate the liver to release glucose
25
how long can it take for the hypoG patient to become conscious again after the infection?
up to 20 mins
26
what should be given to the patient once they wake from the hypoG coma?
concentrated carbohydrate
27
what are some macrovascular complications of diabetes?
- CAD (most common)
- PVD
- cerebral vascular disease
28
why could diabetics have a lock of ischemic response?
may be d/t autonomic neuropathy
29
what are S&S of PVD?
- diminished peripheral pulses
- intermittent claudication
- inc. incidence of gangrene and amputation
30
what can have accelerated development in patient's with diabetes?
atherosclerosis
31
what can diabetics do to dec. their chance of developing a CV disease? (7)
- achievement and maintenance of healthy body weight
- healthy diet
- physical activity
- smoking cessation
- optimal glycemic control
- optimal BP control
- additional vascular protective meds
32
when should statins be used?
- age >40 with one of the following:
- diabetes duration >15y and age >30
- microvascular compx
- warrants therapy based on other risk factors
33
when should ACE or ARB be used?
- clinical macro-vascular disease
- age >55 for those with additional risk factors or end organ damage
- age >55 and microvascular complx
34
what drug should be used routinely for primary prevention of CV disease in people with diabetes?
ASA
35
what thickens in microvascular complications?
the capillary basement membrane
36
what is diabetic retinopathy caused by?
changes in the small BV in the retina, which is the area of the eye which receives images and sends info to the brain
37
what are the three main stages of retinopathy?
non-proliferative, pre-proliferative, and proliferative
38
what are 4 changes to the microvasculature?
- microaneurysms
- intraretinal hemorrhage
- hard exudates
- facial capillary closures
39
do most patients get visual impairments?
NO!
40
what can macular edema lead to?
visual distortion and loss of central vision
41
what is the biggest threat to vision? why?
proliferative retinopathy
| - this is where new BV form, and these are more prone to bleeding
42
what happens when there is bleeding in the vitreous of the eye?
becomes clouded and cannot transmit light, resulting in loss of vision
43
what are clinical manifestations of retinopathy?
- painless process
- blurry vision d/t macular edema
- spotty/hazy vision, complete loss of vision
44
how is retinopathy diagnosed?
direct visualization with an ophthalmoscope or with a technique known as fluorescein angiography (dye injected and goes to capillaries in the eye)
45
what is medical management for retinopathy?
- maintenance of BG
| - argon laser photocoagulation
46
what is argon laser photocoagulation?
destroys leaking vessels and areas of neovascularization
| - stops wide growth of new vessels and hemorrhaging of damaged vessels
47
what are nursing interventions for retinopathy?
- impliment care plans and educating patients
- encouraging regular ophthalmic appointments
- early diagnosis
- helping the patient to use any extra adaptive devices for their vision
48
what is the best way to preserve vision in retinopathy?
frequent eye exams
49
what is nephropathy?
renal disease secondary to diabetic microvascular changes in the kidneys and is a common complx of diabetes
50
when associated with diabetes nephropathy is the leading cause of...
...kidney failure
51
what are the mnfts of diabetic nephropathy?
- similar to those in a non-diabetic
| - catabolism of exogenous and endogenous insulin decreases and frequent hypoG episodes may result
52
what happens if renal fx dec?
patient may have multi-organ failure
53
what is one of the most important proteins that leak into the urine?
albumin
54
if microalbuminuria is present, what are the chances that nephropathy will develop?
85%
55
how might nephropathy be diagnosed?
early detection may be made by testing a random urine sample for the albumin to creatine ratio (ACR) along with the dipstick test to rule out non-diabetic renal disease
56
what is the level of ACR for the diagnosis of nephropathy to be made?
2.0 mmol in 2/3 specs
57
what else may develop with real disease?
| HINT: blood pressure
HTN
58
what are medical managements of nephropathy?
- control of HTN
- prevention and treatment of UTIs
- avoidance of nephrotoxic substances
- low sodium and protein dites
59
what treatment takes place at the end stages of kidney disease?
dialysis or transplantation (relative or cadaver)
60
what are the chances that the transplanted kidney will continue to fx for 5 years?
75-80%
61
what other transplant may also be attempted at the same time as the kidney?
pancreas
62
what are diabetic neuropathies?
groups of diseases that affects all types of nerves (peripheral, autonomic, and spinal)
63
what do the diversities of diabetic neuropathies depend on?
the location of the affected nerve cells
64
what are clinical manifestations of peripheral neuropathy?
- symptoms include parathesias and burning sensations
- feet become numb
- a decrease in proprioception, sensation
- dec. sensation of pain and temp
65
what does dec. sensation of pain and temperature d/t neuropathy put the diabetic at higher risk for?
injury and undetected foot infection
66
what is a management technique for peripheral neuropathy? why?
- intensive insulin therapy and control of BG levels delay the onset and slow the progression of neuropathy
67
how long does pain persist in peripheral neuropathy?
for some 6 months, others for years
68
what systems of the body do autonomic neuropathies affect?
cardiac, GI, and renal systems
69
how does autonomic neuropathy affect the CV system?
- tachycardia
- orthostatic HTN
- silent, painless ischemia
70
how does the autonomic neuropathy affect the GI system?
- delayed gastric emptying, bloating, nausea, vomiting
71
how does the autonomic neuropathy affect the renal system?
urinary retention, a dec sensation of bladder fullness
72
why do patients with autonomic neuropathy often develop UTIs?
are not able to empty bladder fully
73
what is autonomic neuropathy of the adrenal medulla responsible for?
diminished or absent adrenergic signs of hypoG
74
what is sudomotor neuropathy?
decrease or absense of sweating
75
why is sudomotor neuropathy a problem?
dryness of the feet cause cause foot ulcers
76
what kind of sexual disfunction can men face when dealing with autonomic neuropathy?
hard time getting erections, staying erect, and ejaculating
77
what is the Tx for silent MIs?
there is none, and prognosis is poor... :(
78
what are 2 Tx for orthostatic HTN?
high sodium diet and discontinuation of meds that impede the autonomic NS
79
how are some Tx for delayed gastric emptying?
- low fat diet
- frequent small meals
- close blood glucose control
- use of agents that inc. gastric motility
80
what are some Tx of constipation?
- high-fiber diet
- hydration
- laxatives/enemas may be needed
81
how does neuropathy contribute to foot and leg problems in diabetics?
loss of pain/pressure
82
how does PVD contribute to foot and leg problems in diabetics?
poor circulation to lower extremities
83
hows does being immunocompromised contribute to foot and leg problems in diabetics?
hyperglycemia impairs the ability of specialized leukocytes to destroy bacteria
84
what is the typical sequence for the development of a foot ulcer?
soft tissue injury --> pt does not inspect the feet daily so does not notice --> ulcer forms
85
what should diabetics do to dec. the formation of ulcers?
inspect feet daily for drainage, swelling, redness, or gangrene
86
what are some Tx for foot ulcers?
bedrest, Abx, debridement
87
why do foot ulcers on a diabetic have less of a chance to heal?
lack of oxygen, nutrients, and Abx to site (reduced blood flow)
88
what are other risk factors for developing foot and leg problems as a diabetic?
- duration of diabetes >40y
- age older than 40y
- Hx of smoking
- dec. peripheral pulses
- dec. sensation
- anatomic deformities or pressure areas
- history of previous foot ulcers or amputations
89
management for foot ulcers?
- inspect feet
- bathe, moisturize (NOT b/w toes)
- close-toed shoes that fit well
- trimming toe nails straight across
- reducing risk factors
90
what is the accepted glycemic value for perioperative patients with diabetes?
5.0-10.0 mmol/L
91
what is the perioperative period?
from the time the patient goes to the hospital for their procedure until the time they come home
92
is hyperG or hypoG a concern for patients undergoing surgery?
hyperG
93
what is crucial during surgery periods?
frequent capillary glucose monitoring
94
what are the 4 approaches to surgery with a diabetic?
| it's loooooong
- the morning of, all insulin doses are withheld
- one half or two thirds of the patient's usual morning dose of insulin is administered subcut in the morning before the surgery
- daily dose is divided into 4 equal doses
- patient with type 2 who do not usually take insulin may require it during perioperative periods
95
why do you need to monitor for CV complications during the perioperative period?
because inc. prevelence of atherosclerosis in patients with diabetes
96
what do you need to monitor in the integument during perioperative period?
wound infections, skin breakdown
97
what is "pre-prandial"?
done or taken before meals
98
what is an accepted pre-prandial glucose level in the hospital?
5.0-8.0 mmol/L
99
what is an accepted BG for a med/surg patient that is very ill and has a continuous IV of insulin?
between 8-10 mmol/L
100
what are 5 factors that can cause hyperG in the hospital?
- changes in usual treatment regimens
- medications
- IV dextrose
- overly vigorous treatment of hypoG
- mismatched timing of meals and insulin
101
what are 3 factors that lead to hypoG in the hospital?
- overuse of the sliding scale
- lack of dosage change when dietary intake is changed
- overly vigorous treatment of hyperG
102
is one reason patients would be NPO?
- prep for surgery/post surgery
103
do you have to deliver insulin to a type 1 that is NPO?
ABSOLUTELY
104
do you have to administer insulin to a type 2 who is NPO? why?
not necessarily... DKA will not develop in patients with type 2 because they still produce SOME insulin
105
how often should BBGM and insulin be done each day on a type 1 that is NPO for long periods of time?
often, 2-4 times a day
106
what is a clear liquid diet?
some carbs such as juices and gelatin dessert
107
when are diet drinks not appropriate?
when the only source of calories is clear liquids
108
what does enteral tube feedings contain that is more than normal diabetic diet?
more simple carbs and less protein
109
when should insulin be given to one on enteral tube feeds?
regular dosing ties at continous rate
110
what are some barriers to learning for gerontologic patients?
- dec. vision
- hearing loss
- inc. tremors
- depression
- loneliness
111
what should be considered for older adults to test BG at home?
- the choice of a meter should be tailored to the patient's visual and cognitive status and dexterity
112
when is frequent evaluation of self-care skills needed on patients with diabetes?
when vision and memory are deteriorating
113
why is dietary adherence difficult for older adults?
decreased appetite, living alone, etc.
