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Adult Health 1 > Endocrine/Diabetes > Flashcards

Endocrine/Diabetes Flashcards

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1
Q

What are the four endocrine changes associated with aging?

A

decreased glucose tolerance, decrease general metabolism, decreased antidiuretic hormone production, decrease ovarian production of estrogen.

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2
Q

Effects of decreased glucose tolerance

A

weight becomes greater than ideal
elevated fasting and random blood glucose levels
slow wound healing
frequent yeast infections
polydipsia
polyuria

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3
Q

Effects of decreased general metabolism

A

less tolerant of cold
decrease appetite
decreased HR and BP

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4
Q

effects of decreased ADH production

A

urine is more dilute and may not concentrate fluid intake is low (Dehydration Risk because the body cant regulate this)
patient is at greater risk for dehydration

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5
Q

effects of decreased ovarian production of estrogen

A

bone density decreases
skin is thinner, drier, and at greater risk for injury
perineal and vaginal tissues become drier, and the risk of cystitis increases.

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6
Q

diabetes definition

A

chronic metabolic disease resulting from either a deficiency in insulin secretion, resistance of insulin action at the cellular level or both
resulting in hyperglycemia and inability to regulate blood glucose.

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7
Q

what happens in the absence of insulin?

A

body breaks down other sources for energy (fats and proteins)
counter-regulatory hormone levels are increased (glucagon, epinephrine, GH, and cortisol)

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8
Q

why is insulin important?

A

key that moves glucose into cells
a decrease can cause hyperglycemia
the cells don’t get the glucose they need

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9
Q

symptoms of DM

A

polyuria, polydipsia, polyphagia, metabolic acidosis, Kussmaul respirations, dehydration and electrolyte imbalance

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10
Q

polyuria

A

frequent and excessive urination
caused by osmotic diuresis secondary to excess glucose

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11
Q

polydipsia

A

excessive thirst
caused by dehydration

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12
Q

polyphagia

A

excessive eating
cause by cell starvation

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13
Q

Kussmaul respirations

A

increased rate and depth of breathing- respiratory system trying to fix acidosis.
acitone bodies are the fruity smell in breath

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14
Q

dehydration and electrolyte imbalance

A

caused by excessive diuresis

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15
Q

types of diabetes

A

type 1, type 2, gestational

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16
Q

type 1 diabetes

A

no insulin is produces
autoimmune disorder
beta cells of the pancreas are destroyed by antibodies
onset usually occurs less than 30 yo
abrupt onset
weight loss
requires insulin
could be viral in etiology

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17
Q

Type 2 diabetes

A

reduction of the cells to respond to insulin and decreased secretion of insulin from beta cells
onset usually occurs greater than 50 yo
could have no symptoms or polydipsia, fatigue, blurred vision, vascular and neural comlications

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18
Q

gestational diabetes

A

glucose intolerance during pregnancy

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19
Q

Acute complications of DM

A

Diabetic Ketoacidosis
Hyperglycemic- Hyperosmolar state
Hypoglycemia
all considered medical emergencies

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20
Q

DKA

A

insulin deficiency and acidosis

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21
Q

HHS

A

insulin deficiency and severe dehydration

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22
Q

hypoglycemia

A

too much insulin or too little glucose

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23
Q

What are chronic complications of DM caused by

A

changes in blood vessels in tissue and organs (poor tissue perfusion, cell damage and death)
vascular changes result from:
hyperglycemia thickening basement membranes and causing organ damage.
hyperglycemia affects cell integrity

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24
Q

What are the two types of chronic complications in DM

Study These Flashcards
A

macro vascular
microvascular

25
Macrovascular examples
cardiovascular disease- MI cerebral vascular disease- stroke peripheral vascular disease- PAD/PVD pulmonary embolism- PE
26
risk factors for macrovascular diseases
HTN obesity dyslipidemia sedentary lifestyle
27
nursing implication for DM
decreasing modifiable risk factors
28
microvascular examples
retinopathy neuropathy nephropathy
29
retinopathy
caused by damage to the retinal vessels causing leaking and retinal hypoxia
30
neuropathy
progressive deterioration of nerves loss in sensation or muscle weakness blood vessel changes that lead to nerve hypoxia can affect multiple body systems (extremities, GI, cardiac, urinary)
31
nephropathy
change in kidney that decreases function and causes kidney failure chronic high blood glucose: causes leaking and hypoxia of nephrotic vessels increase in filtration of large particles, damaging kidneys further
32
Fasting blood glucose range
70-100 above 126 on at least 2 occasions is diagnostic for DM
33
Glucose tolerance test
less than 140
34
Hemoglobin A1C
4-6% levels greater than 6.5% are diagnostic for DM
35
Planning and Priorities for DM
injury related to hyperglycemia impaired wound healing injury related to diabetic neuropathy acute and chronic pain related to diabetic neuropathy injury related to retinopathy (reduced vision) potential for kidney disease potential l hypoglycemia potential DKA potential HHS
36
expected outcome for DM
maintaining blood glucose in expected range and preventing acute and chronic complications of DM are the primary outcomes
37
interventions for DM
proper nutrition- decrease alcohol, carb counting, watch saturated fats and cholesterol exercise- watch for injury blood glucose monitoring- accurate samples, clean technique, adequate supplies medications- DM T1 will require insulin, DM T2 may require medication
38
rapid acting insulin
onset is 15 min
39
short acting insulin
onset is 30-90 min
40
intermediate acting insulin
onset 15-90 min`
41
long acting insulin
onset is 1-4 hours
42
factors affecting insulin absorption
injection site, absorption rate, injection depth, timing of injection, mixing insulin
43
patient education for insulin
refridgerate unopened insulin insulin in use can be in room temp for 28 days Discard unused insulin after 28 days prefilled syringes are stable up to 30 days when refridgerated keep spare bottles inspect insulin before each use
44
ways to reduce risk for peripheral neuropathy by proper footcare
cleanse and inspect feet daily wear properly fitting shoes avoid walking with bare feet wear clean, dry socks daily trim toenails properly report non healing breaks in the skin of the feet
45
s/s of neuropathy
tingling/numbness burning muscle cramps piercing or stabbing pain metatarsalgia (walking on marbles) allodynia (pain from normal non-painful stimuli) hyperalgesia (exaggerated pain response)
46
reducing injury from impaired vision
regular eye exams appropriate eyewear reading aids adaptive devices for insulin administration/ BG monitoring
47
reducing injury for diabetic nephropathy
control HTN control hyperlipidemia assess kidney function annually smoking cessation
48
hypoglycemia features
skin is cool and clammy absent dehydration no change in respirations anxious, nervous, irritable mental status seizure and coma weakness, double vision, blurred vision, hunger tachycardia, palpitations glucose is less than 70 negative ketones
49
hyperglycemia features
Skin is warm and moist Dehydration is present Kussmaul respirations- fruit odor Mental status varies No specific symptoms- acidosis and dehydration Glucose greater than 250 Positive ketones
50
Laboratory findings for DKA
glucose greater than 300 variable osmolarity positive serum ketones pH less than 7.35 HCO3 less than 15 variable serum Na BUN greater than 30 Creatinine greater than 1.5 positive urine ketones
51
Laboratory findings for HHS
glucose greater than 600 osmolarity greater than 320 negative serum ketones pH greater than 7.4 HCO3 greater than 20 normal or low serum Na elevated BUN and creatinine negative urine ketones
52
60 yo woman is one day post op from a knee replacement; she is a type 2 diabetic on a new insulin regimen; the nurse gave took her BG and gave her short acting insulin knowing she ordered her lunch; one hour later she is pale, confused, and clammy; her lunch tray is on her table and appears totally untouched. Is her condition consistent with hyperglycemia or hypoglycemia? Explain why...
Hypoglycemia especially because she received her insulin about an hour ago and has not replenished her glucose supply.
53
60 yo woman is one day post op from a knee replacement; she is a type 2 diabetic on a new insulin regimen; the nurse gave took her BG and gave her short acting insulin knowing she ordered her lunch; one hour later she is pale, confused, and clammy; her lunch tray is on her table and appears totally untouched. What is your first action? Explain why...
Check her blood glucose level immediately because the methods to increase her blood glucose level are dependent on how the current level is.
54
60 yo woman is one day post op from a knee replacement; she is a type 2 diabetic on a new insulin regimen; the nurse gave took her BG and gave her short acting insulin knowing she ordered her lunch; one hour later she is pale, confused, and clammy; her lunch tray is on her table and appears totally untouched. What is the most likely cause leading to this problem?
Clearly, there was a delay in eating after receiving the insulin. Moreover, it is possible because of her recent change to insulin, she was not aware of the necessity of eating soon after receiving insulin.
55
60 yo woman is one day post op from a knee replacement; she is a type 2 diabetic on a new insulin regimen; the nurse gave took her BG and gave her short acting insulin knowing she ordered her lunch; one hour later she is pale, confused, and clammy; her lunch tray is on her table and appears totally untouched. What should happen to prevent this from happening again in the future?
More education to the patient about the relationship between insulin and eating. The nurse should also evaluate the patient 20 min after administering short acting insulin.
56
21 yo college student brought to the ED by his roommate. ABD pain, polyuria for the last 2 days, vomiting and extreme thirst. He is flushed, lips and mucus membranes are dry and cracked, skin turgor is poor. Rapid respirations, fruity odor, and may have skipped a few doses of insulin. He is alert but struggling to answer questions. O2 sat is 99, BP 110/60, pulse is 110/min, Resp. are 32/min, glucose 485 mg/dL . Should you apply oxygen at this time? Why or why not?
No. Applying oxygen would serve no useful purpose. His respiratory symptoms are a result of compensation for the metabolic acidosis.
57
21 yo college student brought to the ED by his roommate. ABD pain, polyuria for the last 2 days, vomiting and extreme thirst. He is flushed, lips and mucus membranes are dry and cracked, skin turgor is poor. Rapid respirations, fruity odor, and may have skipped a few doses of insulin. He is alert but struggling to answer questions. What is going on with this patient?
DKA
58
21 yo college student brought to the ED by his roommate. ABD pain, polyuria for the last 2 days, vomiting and extreme thirst. He is flushed, lips and mucus membranes are dry and cracked, skin turgor is poor. Rapid respirations, fruity odor, and may have skipped a few doses of insulin. He is alert but struggling to answer questions. What is the immediate intervention the Dr. would prescribe?
IV drip because SQ wont absorb fast enough and is inappropriate for emergency situations. patient could also get IV fluids to correct fluid deficit.
59
21 yo college student brought to the ED by his roommate. ABD pain, polyuria for the last 2 days, vomiting and extreme thirst. He is flushed, lips and mucus membranes are dry and cracked, skin turgor is poor. Rapid respirations, fruity odor, and may have skipped a few doses of insulin. He is alert but struggling to answer questions. What is another acute complication of DM resulting from elevated glucose?
HHS

Adult Health 1 (16 decks)

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