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54/64 Unit 2 > DM, DKA, HHNS > Flashcards

DM, DKA, HHNS Flashcards

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1
Q

Hormones made by the beta cells of the pancreas

A

insulin and amylin (incretin hormone)

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2
Q

glucagon is made by the _____ cells of the pancreas

A

alpha

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3
Q

Glucagon works opposite of _____ preventing hypoglycemia

A

insulin

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4
Q

Functions of amylin

A

slows gastric emptying, suppresses glucagon secretion, and increases satiety

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5
Q

The liver and muscles store glucose as

A

glycogen

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6
Q

_________ is main fuel for the body

A

glucose

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7
Q

Glucose mainly comes from food, but the _____ can produce glucose also

A

liver

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8
Q

If the liver does not have glycogen, the body will break down ___ and _____ for energy

A

fats; proteins

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9
Q

breakdown of fats

A

lipolysis

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10
Q

Protein breakdown

A

proteolysis

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11
Q

A1c > ___ is diagnosed diabetes

A

6.5%

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12
Q

Fasting plasma glucose > ___ mg/dL is diagnosed diabetes

A

126

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13
Q

Random plasma glucose > ___ mg/dL is diagnosed diabetes

A

200

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14
Q

Examples of medications that can cause hyperglycemia

A

steroids

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15
Q

beta blockers may mask the signs and symptoms of

A

hypoglycemia

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16
Q

micro/macrovascular changes and complications can occur ___-___ years before diagnosis of diabetes

A

5-10

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17
Q

hypoglycemia is classified as blood sugar < ___ mg/dL

A

70

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18
Q

Characteristics of hypoglycemia

A

acute complication, sudden onset, requires immediate treatment, can cause cognitive impairment

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19
Q

Hypoglycemia precipitating factors

A

skipping meals, exercising more than normal, taking too much insulin or oral medications

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20
Q

S/S of hypoglycemia

A

shakiness, dizziness, diaphoresis, tachycardia, blurred vision, changes in mental status

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21
Q

Hypoglycemia nursing care

A

immediate treatment, increase glucose level, monitor CNS changes

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22
Q

Characteristics of DKA

A

sudden onset, life-threatening, most common with Type I diabetics but can occur in Type II diabetics although rare

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23
Q

DKA precipitating factors

A

infection (elevates BS), vomiting, inadequate insulin, undiagnosed diabetes, medications (steroids), not eating

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24
Q

DKA key players

A

glucose, insulin, liver and glucagon, ketones, kidneys

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25
DKA manifestations
hyperglycemia, metabolic acidosis, production of ketones, Kussmaul respirations, dehydration (electrolyte imbalances such as hyponatremia/kalemia)
26
During DKA, respirations increase so the lungs blow off ___ from the body to raise pH
CO2
27
metabolic acidosis
low pH, low HCO3, normal or no change in PCO2
28
DKA manifestations
electrolyte imbalances (low K+, Na, bicarb), polyuria, polydipsia, fatigue, weight loss
29
glucose associated with DKA
>300 mg/dL
30
Serum and urine ketones will be _________ in DKA
positive
31
Serum pH related to DKA
< 7.35 (acidosis)
32
Serum bicarb related to DKA
< 15 mEq/L
33
BUN related to DKA
> 30 mg/dL (elevated)
34
creatinine related to DKA
> 1.5 mg/dL (elevated)
34
Anion gap related to DKA
> 17
34
normal anion gap
5-17
35
Test that measures the acid-base balance and electrolyte balance of blood
anion gap
36
Treatment of DKA
immediate treatment: 1) hydrate with IV fluids (NS, D5W to balance blood sugars/prevent hypoglycemia), 2) lower blood gluocse with REGULAR insulin drip, monitor potassium level, correct acid-base imbalance
37
Characteristics of Hyperglycemia Hyperosmolar Non-ketonic State (HHNS)
gradual onset, more common in type II diabetics
38
HHNS precipitating factors
infection, stressors, poor fluid intake (dehydration)
39
HHNS key players
glucose, insulin, kidneys
40
Why do type II diabetics not typically enter ketosis?
because unlike type I diabetics, there is just enough insulin to get glucose into cells
41
HHNS manifestations
altered CNS function, seizures, electrolyte loss, dehydration, severe hyperglycemia
42
HHNS typically occurs in
older clients with type II diabetes
43
Glucose related to HHNS
>600 mg/dL
44
Osmolarity related to HHNS
>320 mOsm/kg
45
Serum ketones will be _________ in HHNS
negative
46
Serum pH related to HHNS
> 7.3
47
Serum bicarb related to HHNS
> 20 mEq/L
48
BUN and creatinine will be ________ with HHNS
elevated
49
HHNS treatment
1) hydrate (fluid therapy to increase blood volume), 2) decrease blood glucose, correct electrolyte imbalance
50
Patient education of prevention of DKA
monitor glucose when ill, watch for and report any illness lasting more than 1-2 days, check blood glucose levels every 4-6 hrs if anorexia, N/V is experiences, check urine ketones when BG is greater than 300 mg/dL
51
normal A1c
< 5.6%
52
Prediabetes A1c
5.7 - 6.4%
53
target A1c after diagnosis of diabetes
< 7%
54
Treatment of hypoglycemia
immediate treatment; 15 g of simple carb (oral if conscious and able to swallow), if unconscious: IV glucose (D50) or glucagon IM, recheck BG after 20 min, eat a snack/small meal after BG is > 70 mg/dL
55
Patient education of prevention of hypoglycemia
do not skip meals, no exercising on empty stomach, check BG before exercise (if < 100, eat a snack before exercise and take a snack with you)
56
Examples of simple carbs for the treatment of hypoglycemia
juice, candy (CHEW, do not suck), regular soda, spoonful of sugar if nothing else
57
DKA protocol
IV fluids, IV insulin, vital signs, correction of acidosis, administer potassium, administer bicarbonate, administer D5 or D10 per protocol, DKA resolved when labs within normal range according to facility
58
DKA treament
follow DKA protocol, fluids, IV insulin (regular), decrease blood glucose GRADUALLY (prevents further electrolyte imbalances and hypoglycemia)
59
HHNS treatment
IV fluids, sliding scale insulin protocol, correct electrolyte imbalance
60
Diabetes long-term care
4 M's: monitor, motion (exercise), medication, meal planning
61
Older adult diabetes considerations
increased prevalence and mortality, glycemic control challenging, increased hypoglycemic unawareness, functional limitations, renal insufficiency, diet and exercise (main treatment), patient teaching must be adapted to needs, HHS more prevalent in older adults
62
why are older adults more likely to have hypoglycemia?
older adults have a decreased metabolism causing medications to stay in system longer
63
Pediatric diabetes considerations
medical management is similar to adults, requires parent participation, promotion on health growth and development, DKA more prevalent in younger clients

54/64 Unit 2 (8 decks)

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