Endocrine

Question 1

80% of patients with DM will die from

Answer 1

Heart disease or stroke

Question 2

Type 1 is _____% of cases

Answer 2

10

Question 3

Type 2 is _____% of cases

Answer 3

90

Question 4

That global prevalence is odisbetes is

Answer 4

9-10%, more prevalent is urban high income countries

Question 5

Type 1
-Cause
-Onstet
-Risk factors
-Prevalence
-Treatment

Answer 5

-Cause
Absent or minimal insulin production
-Onstet
Often occurs in young but can happen at any age
-Risk factors
Environmental-virus, toxins
-Prevalence
-10% of cases
-Treatment
Insulin required for all

Question 6

Type 2

-Cause
-Onstet
-Risk factors
-Prevalence
-Treatment

Answer 6

-Cause
Insulin resistance or decreased insulin production
-Onstet
Any age
-Risk factors
Obesity, irregular eating patterns, lack of exercise
-Prevalence
90% of cases
-Treatment
Insulin required for some

Question 7

Four methods of diagnosis

Answer 7

-AIC => 6.5%
-Fasting CBG over 7
-Random or casual plasma glucose measurement over 11 + classic symptoms
-Two-hour OGTT level over 11.1 when a glucose load of 75g is used

Question 8

Goals of collaborative care

Answer 8

1. Promote well being
2. Reduce symptoms
3. Prevent acute complications (hyper/hypoglycaemia, DKA)
   -Delay long term complications

Question 9

Accomplish this through

Answer 9

-Optimal glucose control
-Lifestyle modifications (nutritional therapy, exercise)

Question 10

Cornerstones of treatment DM

Answer 10

-Nutritional therapy
-Exercise therapy
-Drug therapy
-Self monitoring glucose
-B/P monitoring
-Patient teaching

Question 11

Nutritional therapy

Answer 11

-Cornerstone of care for person with diabetes
-Most challenging for many people
-Recommended that diabetes nurse educator and registered dietitian with diabetes experience should be members of the team

Question 12

Rapid-acting insulin: Lisopro, aspart (clear) glusline.

Answer 12

Onset: 10-15 min
Peak: 60-90 min
Duration: 3-5hrs

Question 13

Short acting: regular (clear), humulin R, Toronto, novolinge

Answer 13

Onset: 1-1/2 hr
Peak: 2-4hrs
Duration: 5-8hrs

Question 14

Intermediate acting: Humlin N,NPH (cloudy)

Answer 14

Onset: 1-3 hrs
Peak: 6-8hrs
Duration: 12-16 hrs

Question 15

Extended long acting insulin: Lantus, Levemir

Answer 15

Onset: 1-2hrs
Peak: none
Duration: 24+ hrs

Question 16

Mixing insulin always draw up…

Answer 16

CLEAR before CLOUDY (short before long)

Question 17

cloudy insulins should always be…

Answer 17

gently agitated or rolled before drawing up

Question 18

multi dose insulin vials can be stored for up to…

Answer 18

-4 weeks at room temp
-Refrigerate unopened vials (avoid head or freezing)
-Insulin pens should not be refrigerated

Question 19

why not give insulin PO?

Answer 19

it would be inactivated by gastric juices

Question 20

what’s the only insulin that can be given IV?

Answer 20

Humulin R

Question 21

What 2 insulins cannot be mixed with other insulin

Answer 21

-Levemir and Lantus

Question 22

Order of fastest absorption

Answer 22

-abdomen
-arm
-thigh
-buttock

Question 23

Fixed combination insulins

Answer 23

-Humulin 30/70
-Novolin 30/70, 40/60, 50/50
-Novomix 30
-Humalog mix25
-Humalog mix50

Question 24

Sulphonylureas

Answer 24

Weight gain, hypoglycemia

Question 25

Nonsulphonylureas

Answer 25

N/V/D, hyppoglycemis, HA

Question 26

Biguanides

Answer 26

Edema, weight gain, CHF,

Question 27

α-Glucosidase inhibitors

Answer 27

GI upset, risk of lactic acidosis in patients with hepatic and renal impairment,

Question 28

Thiazolidinediones

Answer 28

URTI, sore throat, HA, diarrhea

Question 29

Dipeptidyl Peptidase 4 (DPP-4) Inhibitors

Answer 29

Less weight gain, decreased incidence of hypoglycemia compared to glyburide

Question 30

Incretin mimet ic -injectable (Byetta)

Answer 30

Flatulence, abd. pain, diarrhea

Question 31

Nursing considerations po Antihyperglycemics

Answer 31

Sulphonylureas – caution in persons with renal impairment and older adults 2. Non-sulphonylureas – take 30 minutes before or right at meal time. Do not take if not eating Biguanides – hold at time of procedure with IV dye and 48 hours post procedure α-Glucosidase inhibitors - take with meal for best effect Thiazolidinediones – do not use with insulin Incretin mimetic -injectable (Byetta) – not indicated for use with insulin

Question 32

B blockers can...

Answer 32

mask symptoms of hypoglycemia and prolong hypoglycemic effect of insulin

Question 33

Thiazide and loop diuretics ...

Answer 33

may potentiate hyperglycemia by inducing K loss

Question 34

Monitoring Blood Glucose

Answer 34

Self-monitoring of blood glucose (SMBG) Enables patient to make self-management decisions regarding diet, exercise, and medication Important for detecting episodic hyperglycemia and hypoglycemia Patient training is crucial Supplies immediate information about blood glucose levels

Question 35

What are key patient teaching points for individuals living with DM for RNs to emphasize?

Answer 35

Insulin therapy Teaching proper administration Effects of insulin S and S of hyper/hypoglycemia Self monitoring of glucose Personal hygiene Diligent skin and dental hygiene Foot care/lower extremities Medical ID and travel Medic-alert