Hyperglycemia Flashcards

(41 cards)

1
Q

Define Diabetes

A

A chronic multisystem disease related to
* Abnormal insulin production
* Impaired insulin utilization
* Or both

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2
Q

Diabetes is the leading cause of

A
  • End-stage renal disease
  • Adult blindness
  • Nontraumatic lower limb amputation
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3
Q

Diabetes is a major contributing factor to

A
  • Heart disease
  • Stroke
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4
Q

Indigenous communities have a rate ______ general population

A

3-5x higher rate

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5
Q

How can personal health practices and coping affect a diabetes diagnosis

A

If diagnosed, progression can be delayed with good habits

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6
Q

How does sex play a role in the incidence of diabetes?

A

CAD risk amongst type 2 diabetics impact female > male

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7
Q

Etiology of diabetes

A
  • Genetic
  • Autoimmune
  • Viral
  • Environmental
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8
Q

Types of Diabetes

A

Two most common types
* Type 1
* Type 2
Other types
* Gestational
* Prediabetes
* Secondary diabetes

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9
Q

What produces insulin

A
  • Produced by the  cells - Islets of Langerhans
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10
Q

Explain the release of insulin

A

Released continuously into bloodstream in small increments with larger amounts released after food

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11
Q

What range does insulin normally stabilize blood glucose to?

A

4 to 6 mmol/L

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12
Q

What does insulin promote?

A

glucose transport from bloodstream across cell membrane to cytoplasm of cell

Decreases glucose in the bloodstream

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13
Q

What A1C test is diagnostic of diabetes

A

> 6.5

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14
Q

Why can A1C test show glucose levels over the last 3 months?

A

Shows the amount of glucose attached to hemoglobin molecules over RBC life span which is
approximately 120 days

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15
Q

8 Clinical Manifestations of Diabetes

A
  1. polyuria
  2. polydipsia
  3. polyphagia
  4. elevated BG
  5. blurred vision
  6. weight loss
  7. weakness/fatigue
  8. abdominal cramping
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16
Q

Treatment of hyperglycemia (5)

A
  1. assessment and reassessment of if this is an existing or new diagnosis
  2. insulin reassessment of dose (SC/IV)
  3. fluids oral or IV
  4. BG monitoring
  5. monitor for acute complications
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17
Q

What causes DKA

A

profound insulin deficiency

18
Q

What type of diabetes usually sees DKA

19
Q

What 4 things characterize DKA?

A
  1. hyperglycemia
  2. ketosis
  3. acidosis
  4. dehydration
20
Q

Why does hyperglycemia and ketosis characterize DKA

A

(r/t impaired secretion of insulin, glucose sits in vessels, body must break down fat leading to ketosis)

21
Q

Why does acidosis characterize DKA

A

high ketones which drive down patient’s pH, leading to metabolic acidosis

22
Q

Why does dehydration characterize DKA

A

Body attempting to correct a-b balance

23
Q

Precipitating Factors of DKA (7)

A
  • Illness
  • Infection
  • Inadequate insulin dosage; patients rationing doses
  • Undiagnosed type 1; come in with extreme sugars
  • Poor self-management/neglect
  • Change in diet, insulin or exercise regimen
  • Stress
24
Q

Early signs and symptoms of DKA are associated with

A

Lack of perfusion r/t lack of circulating volume (dehydration)

25
Signs and Symptoms of DKA
- lethargy/weakness - BG > 11.1 - dehydration - poor skin turgor - dry mucous membranes - tachycardia - orthostatic hypotension - sunken eyes
26
Lab pH expectation of DKA patient
< 7.35 (acidic)
27
Urinalysis expectation DKA
Ketone spill
28
Electrolyte expectation for DKA labs
Hyperkalemia early Hypokalemia can occur with insulin therapy Remainder of electrolytes can be depleted with dehydration
29
What are kussmauls respirations and why are they seen in DKA
* Rapid deep breathing – body is trying to get rid of acid by blowing off CO2 to increase pH * Attempt to reverse metabolic acidosis * Sweet fruity odour
30
Why is abdominal pain seen in DKA
Gastroparesis associated with ischemia to mesentry
31
ABC PRIORITY assessments for DKA
1. airway and O2 admin r/t kussmauls 2. LOC + VS 3. hydration status + IV access 4. electrolytes + BG monitoring
32
Fluid resuscitation for DKA - solution and purpose
IV infusion 0.45% or 0.9% NaCl * Restore urine output * Raise blood pressure
33
How does fluid therapy change when BG levels approach 13.8 in DKA patients?
* 5% dextrose added to regimen * To prevent hypoglycemia- avoid rapid drop in blood sugar levels
34
Why can IV potassium replacement be necessary in DKA patients?
* Insulin drives potassium into the cells which can cause … * Potential hypokalemia – why don’t we like this? * Differentiation in potassium levels can cause arrhythmias
35
When is IV insulin administration started?
only AFTER fluid resuscitation
36
Describe IV insulin administration
1. after fluid resuscitation 2. slow careful continuous infusion 3. hourly BG or more often 4. SC insulin when patient is taking oral fluids and ketone spill in urine stops
37
Nursing Management of DKA patient
1. Monitoring during administration 2. subjective assessment 3. objective assessment
38
What will be administered to DKA patient that nurse will have to monitor/manage?
* IV fluids * Insulin therapy * Electrolytes
39
What subjective information is key in management of DKA patient?
* History or DM * Nutrition/pharma hx
40
What objective information is key in management of DKA patient?
* Renal status (output) * Full Cardio/Resp assessment * Breath sounds * Cardiac rhythm (monitor) * Level of consciousness (r/t glucose impairment) * Other systems? * N/V – abdominal * Hydration status
41
4 Points of Evaluation for DKA patient
* Pt will achieve glucose control * Avoid common complications from diabetes * Remain free from foot lesions, infections and deformities * Have decreased episodes of DKA