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Flashcards in Med Surg III - Diabetes Deck (102):
1

What is DKA?

Diabetic Ketoacidosis
- deficiency of insulin
- hyperglycemia
- ketosis
- acidosis
- dehydration
- BS >250

2

DKA: What are some precipitating factors?

Illness
Infection
Inadequate insulin dosage
Undiagnosed Type I diabetes
Poor self-management
Neglect

3

DKA: Pathophysiology?

- Circulating insulin is insufficient, elevation of counter-regulatory hormones (glucagon, cortisol, and growth hormone)
- Glucose is not used, so the body breaks down fat for energy
- Ketones (acid by-product of fat metabolism) removed in urine (Ketonuria)
- Ketosis alters pH balance
- Metabolic acidosis develops
- Electrolytes depleted - body attempting electrical neutrality, caused by polyuria (Na, K, Cl, Mg, Ph), hypovolemia
- Insulin def. impairs protein synthesis, degradation. Nitrogen losses.
- Insulin def. stimulates glucose production which leads to further hyperglycemia.

4

Signs of dehydration:

Poor skin turgor (if older, check chest, forehead for tenting)
Dry mucous membranes
Tachycardia
Orthostatic hypotension
Sunken eyeballs
Lethargy

5

What is orthostatic hypotension:

Decreased bp when standing (may take up to 3 minutes to appear)

6

What are some clinical manifestations of DKA?

Dehydration
Abdominal pain
N/V
Kussmaul respirations
Blood glucose >250
pH <7.35
Ketones in blood and urine

7

What are Kussmaul respirations:

Body's attempt to reverse metabolic acidosis.
Deep and rapid.

8

How to treat DKA?

- IV insertion ... hydrate!
- Fluids - NS or 1/2 NS to quickly increase vol.
- K+ for hypokalemia
- at risk for vtac, vfib, place pt. on cardiac monitor
- Insulin bolus/insulin infusion
- Pt. becomes anxious/nervous/sweaty
- Get glucose reading hourly

9

What is HHNS:

Hyperosmolar Hyperglycemic Nonketotic Syndrome

10

Describe HHNS?

The pt. is able to produce enough insulin to prevent DKA, but not enough to prevent severe hyperglycemia, osmotic diuresis, and extracellular fluid depletion.

11

Some signs of HHNS?

No ketosis
Hypovolemic
Usually occurs in older adults with Type 2
Hospital admission - insert large bore IV cath for large volumes of IV fluids

12

How to care for a patient with HHNS?

IV fluids, NS or 1/2 NS
Regular insulin - bolus then infusion
Monitor lytes - polyuria
Requires more fluid than DKA - pt. severely dehydrated, blood sugar severely high
Cardiac monitoring

13

What is hypoglycemia?

Too much insulin
Symptoms mimic alcohol withdrawal
Blood glucose <70 mg/dl
Confusion, irritability, diaphoresis, tremors, hunger, weakness, visual disturbances

14

Treatment for hypoglycemia?

Check glucose
Give 1/2 c. juice, pop, etc.
Follow with complex carbohydrate and protein to prevent sugar crash
Vital signs
Document!!

15

Some complications of hypo/hyperglycemia?

Angiopathy
- macrovascular
- microvascular
- retinopathy
Nephropathy
Neuropathy
Infection

16

What is Angiopathy?

blood vessel disease

17

What is macrovascular angiopathy?

vascular cardio and PVD blood vessel disease. First indication of angiopathy.

18

What is microvascular angiopathy?

eyes, kidneys, and skin. Can take years to see evidence.

19

What is retinopathy?

microanurisms in capillary walls of eye, leaks out into eye, microvascular damage to eye.

20

What is nephropathy?

damage to the kidney treated with aggressive management with ACE inhibitors (prils)

21

What is neuropathy/sensory neuropathy?

nerve damage
Sensory - lops (loss of protective sensation)
-avoid high heels
-wash feet, dry, no soaking
-avoid heating pads, commercial callus and corn remover
-see specialist

22

Long-term complications of diabetes?

Neuropathy
Pressure ulcers
Blindness
Stroke
Amputation
Dementia

23

What is autonomic neuropathy?

controls involuntary body functions.

24

What are signs of autonomic neuropathy?

Hypoglycemia unawareness
Bowel incontinence
Diarrhea
Urinary retention
Gastroparesis
Cardiovascular abnormalities
Sexual dysfunction

25

Why is infection a complication of hypo/hyperglycemia?

There is a defect in the mobilization of inflammatory cells which causes impairment of phagocytosis by neutrophils and monocytes.
Glycosuria predisposes to bladder infections because bugs like sugar!

26

Hemoglobin A1c Test

Glycosalated Hgb
- 4-6% normal
- 7-9% elevated
- 7% and less for diabetics
Gives average blood glucose over 90 days.

27

What is the carbohydrate count for 1800 ADA diet?

4 breakfast
4 lunch
5 dinner
2 snack
15 total

28

What is carbohydrate count for 2000 ADA diet?

4 breakfast
5 lunch
5 dinner
3 snack
17 total

29

What education should nurse give to diabetic pt?

S&S
Feet
Monitor BS
Survival Skills
Med instructions
Sick Day management

30

What are possible poor outcomes as a result of hypo/hyperglycemia?

Loss of consciousness
Seizures
Death

31

What is the Rule of 15:

Give 15 g. carbs, check blood glucose in 15 minutes.

32

What is considered to be a carbohydrate?

Bread
Grains
Cereal
Fruit
Vegetables
Milk
Any sweetened items

33

For what diagnostic testing should Glucophage (Metformin) be held for?

All diagnostic tests using contrast media (when taken together, kidneys may not be able to properly elim. Glucophage from blood). Restart 3 days later.

34

What item is important to have in pt.'s room prior to giving insulin?

Food tray!

35

What should nurse do when DKA patient's glucose is below 250?

decrease the insulin infusion rate and add IV solution containing dextrose

36

treatment for neuropathy

control glucose
Creams - capsaicin (dangerous for lower extremities)
tricyclic antidepressants
anti-seizure meds

37

ways to decrease complications of diabetes

educate patient on tight glucose control, lower their weight, exercise, stop smoking, dialysis

38

when should you look for symptoms of hypoglycemia

at peak times (oral hyperglycemics last longer)

39

what is ulcerative colitis

chronic, recurrent inflammation of intestinal tract (cause unknown)

40

where does ulcerative colitis begin

in the rectum, spreads up colon

41

what age group is most affected by ulcerative colitis

15 - 25, and 60 - 80

42

S & S of ulcerative colitis

bloody stools, abdominal pain/cramping, fever, anorexia, and rebound tenderness (report rebound tend. immediately)

43

complications of ulcerative colitis

increased risk of colorectal cancer, hemorrhage, malabsorption, liver disease, osteoporosis, colon can become paralyzed and not function

44

what diagnostic results would ulcerative colitis have

decrease sodium, dehydration, increase hematocrit, iron deficiency, and blood, mucus, or pus in stool

45

treatment for ulcerative colitis

rest the bowel (NPO), control inflammation, combat infection, correct malnutrition (TPN), alleviate stress, drug Sulfasalazine (must be taken with meals)

46

diet for ulcerative colitis (after acute phase of NPO)

high calorie, high protein, low fiber, vitamin and iron supplements, avoid cold foods and stop smoking

47

what should patient do if they are having more than 10 stools per day

go to the ER

48

what is Crohn's disease

inflammatory bowel disorder (usually small intestine) on any part of the GI tract. it is lifelong with unpredictable periods of remissions and recurrences

49

clinical manifestations of Chron's

insidious (creeps up on them), diarrhea, fatigue, abdominal pain, weight loss, fever, non-bloody diarrhea

50

complications of Chron's

strictures, obstructions, fistulas, impaired absorption, arthritis, liver disease, kidney stones

51

how is Chron's diagnosed

History (bowel movements) & physical (abdominal tenderness). Cobblestone pattern shown on barium study, increase in WBC, decrease in Albumin

52

Treatment for Chron's

75% need surgery (does not cure), corticosteroids to reduce inflammation, immunosuppressive agents, Flagyl (topical) if perianal area affected, Remicade (prevents activity of TNF)

53

Diet for pt with Chron's

high calorie, high protein, low fat, low fiber, Vitamin B12

54

what is Celiac Sprue

malabsorption disorder, intolerance to dietary wheat proteins, gluten, barley, oats

55

How does Celiac Sprue present

weight loss and diarrhea containing fat deposits

56

what is diverticulitis

inflammation of diverticulum (out-pouch of mucosa of the intestinal wall

57

treatment for diverticulitis Acute

NPO, parenteral fluids, NG tube to drain bile...assess for pain and observe for peritonitis

58

diet for pt with diverticulitis

high fiber, avoid nuts, seeds, raspberries, strawberries

59

Common for all hepatitis pt's

use standard precautions

60

what does elevation in T3 or T4 signify

hyperthyroidism

61

what do low T3 or T4 values signify

hypothyroidism

62

treatment for hypothyroidism

monitor vitals, admin thyroid replacement drugs, provide roughage and fluids for constipation, warm environment, avoid sedatives & opioids, monitor for OD of meds (start low and go slow), meds are increased over weeks

63

treatment for hyperthyroidism

provide rest, admin sedatives, cool and quiet environment, daily weight, high calorie diet, admin anti-thyroid meds (PTU, iodine), admin propanolol for tachycardia

64

treatment for myxedema coma

#1 is maintain patent airway, aspiration precautions, meds, take hourly temperature, keep warm

65

HBsAG

hepatitis B surface antigen, if present indicates hep B infection

66

IgM

indicates acute hepatitis A

67

IgG

indicates past hepatitis A infection

68

Hepatitis A

fecal-oral, can go away

69

Hepatitis B

blood or body secretions, adequate rest and nutrition are most important treatments (no cure)...contact precautions

70

Hepatitis B teaching

no alcohol for one year, watch meds metabolized in liver, family members should be tested, use condoms

71

once jaundice is gone, are Hep B patients fully recovered

NO

72

who should be tested for Hep C

everyone with history of IV drug use

73

how is Hep C transmitted

percutaneously (IV drug use, transfusions, sex, tattoos, body piercing, organ transplant).

74

treatment for Hep C

interferon and ribaviron

75

what is needed for Hep D to infect body

Hep B, same route of transmission

76

Hep E usually comes from what

contaminated water or poor sanitation (fecal-oral)

77

preicteric phase of Hep

initially may be asymptomatic, 1 - 21 days, GI symptoms, anorexia, malaise, HA, right upper quadrant pain

78

Icteric phase of Hep

jaundice (seen in sclera, palms, soles, skin, hard palate)

79

posticteric phase of Hep

malaise and fatigue, hepatomegaly...jaundice may be gone

80

Lab value associated with Hepatitis

increased biliruben > 1.5 (also clay colored stools may be present)

81

complications of hepatitis

liver failure, cirrhosis, hepatocellular carcinoma

82

clinical manifestations of cirrhosis

GI complaints, enlarged liver, jaundice, spider angiomas, portal hypertension, pruritus, esophageal varices, ascites

83

highest priority for patient with esophageal varices

maintaining airway (they may rupture). Can do banding to correct them

84

what should patient do before a paracentesis

empty their bladder

85

how can ascites be treated

paracentesis (drain the fluid)

86

what can lead to encephalopathy

increase in ammonia levels

87

why monitor albumin level in cirrhosis patients

the low pressure caused by hypoalbuminemia is the reason for ascites and edema

88

hepatic encephalopathy treatment

use lactalose to trap ammonia in the gut, do not d/c for diarrhea because it improves neural function

89

meds that can be use for cirrhosis

histamine blockers and beta blockers

90

asterixis

flapping tremors (have patient extend arms) cirrhosis complication

91

fetor hepaticus

musty sweet odor of breath (poopy mouth) cirrhosis complication

92

treatment for liver cancer

palliative, or transplant

93

acute pancreatitis manifestations

pain severe and unrelenting, may be epigastric pain, abdominal pain in LUQ that radiates to back, N/V, BS absent or decreased, fever, leukocytosis, tachycardia, jaundice

94

highest priority for acute pancreatitis

respiratory failure

95

lab values associated with acute pancreatitis

elevated glucose, amylase, and lipase, risk for hypocalcemia

96

Trousseau's

carpal spasm when blood pressure cuff is inflated, sign of hypocalcemia

97

Chvostek's

contraction of facial muscle when you tap on face, sign of hypocalcemia

98

treatment for acute pancreatitis

pain relief (morphine), prevent shock (fluid replacement), reduce secretions (NPO, NG suction, Tagament, Prilosec), and treat the infection causing it

99

chronic pancreatitis manifestations

lot of pain, weight loss, jaundice, steatorrhea (fatty stools), diabetes

100

treatment for chronic pancreatitis

pain relief, can not tolerate fatty foods, control diabetes, bland, low fat, high CHO diet

101

whipple

surgery involving resection of the pancreas, duodenum, distal portion of stomach, and common bile duct

102

risk factors for pancreatic cancer

smoking, diabetes, high fat diet