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Adult Health 1 Review > T2 - Diabetes (Josh) > Flashcards

T2 - Diabetes (Josh) Flashcards

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1
Q

Where is Proinsuline secreted and strored?

Where is it converted into Insulin?

A

Pancreas (Islets of Langerhans)

Liver

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2
Q

Pancreatic Cells:

— cells make glucagon

— cells secrete insulin

A

Alpha

Beta

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3
Q

Glucagon:

What is it used for?

A

released by pancreatic alpha cells

goes to liver and releases glucose from storage sites in liver

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4
Q

DM:

Why treat Type 1 with insulin?

A

because they don’t produce insulin

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5
Q

— is the converting of simple substance into more complex compounds

— is breaking them down again to be used for energy

A

Anabolism

Catabolism

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6
Q

— is the formation of glucose from non-carbohydrate sources (fat, protein)

A

Gluconeogenesis

***occurs in liver

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7
Q

— is the formation of glycogen from glucose to be stored in liver

A

Glycogenesis

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8
Q

— is the conversion of glycogen into glucose to be used for energy.

A

Glycogenolysis

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9
Q

Hyperglycemia:

3 Cardinal Signs

A

Polyuria

Polydipsia

Polyphagia

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10
Q

Hyperglycemia:

Why would you pee alot?

A

glucose has a high level of osmolality

***leads to dehydration

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11
Q

Hyperglycemia:

What happens to K+?

A

levels are all over the map

**constantly monitor potassium

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12
Q

Hyperglycemia:

What does HCT look like?

A

high

blood is highly concentrated and viscous due to dehydration (polyuria)

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13
Q

Hyperglycemia:

What type of respirations?

A

Kussmaul Respirations due to acidotic state

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14
Q

DM:

Risk factors

A

AA, Hispanic, American Indians

BMI over 24

45 years or older

Overweight child

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15
Q

DM:

Which type is an autoimmune disorder?

A

Type 1

***beta cell destruction leading to absolute insulin deficiency

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16
Q

DM:

Symptoms of Type 1

A

Abrupt onset

Thirst

Hunger

Weight loss (usually not obese)

Polyuria

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17
Q

DM:

With —, the beta cells are destroyed.

With —, the beta cells are dysfunctional.

A

Type 1

Type 2

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18
Q

DM:

Symptoms of Type 2

A

NOT ALWAYS PRESENT

Thirst

Fatigue

Blurred Vision

Vascular or Neural Complications

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19
Q

DM:

Diagnostic criteria for Type 2

A

A1c = 6.5%

Fasting plasma glucose greater than 126 mg/dL

2 hr Glucose greater than 200

Casual Glucose greater than 200

***must be at least one of these

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20
Q

What is metabolic syndrome?

A

simultaneous presence of different metabolic factors known to increase risk for developing Type 2 and Cardiovascular Disease

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21
Q

Metabolic Syndrome:

What are teh factors that predispose for developing Type 2?

A

Abdominal Obesity

Hyperglycemia

HTN

Hyperlipidemia

***need to be all at same time

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22
Q

Metabolic Syndrome:

What Abdominal Obesity measure are we looking for?

A

Men: waist greater than 40 in

Women: waist greater than 35 in

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23
Q

Metabolic Syndrome:

What Hyperglycemia levels are we looking for?

A

Fasting BS of 100 mg/dL or greater or on treatment for elevated glucose

Abnormal A1c (between 5.5% and 6.0%)

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24
Q

Metabolic Syndrome:

What HTN levels are we looking out for?

A

SBP of 130 or greater

DBP of 85 or greater

Or on drug treatment for HTN

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25
Metabolic Syndrome: What Hyperlipidemia levels are we looking for?
Triglycerides greater than 150 HDL less than 40 for men HDL less than 50 for women
26
What needs regular checkups and can be an early sign of microvascular complications from DM?
Eye exams
27
DM: What should a DM patient check every day?
Foot care, Foot care, Foot care ***they should look at their feet every day b/c they may feel fewer sensations and may not notice a sore and not care for it properly
28
DM: To deal with Diabetic Neuropathy, what should they drink?
Drink 2-3 liters per day Avoid Soda Avoid ETOH (excess)
29
DM: What meds should be avoided due to kidney probs?
Acetaminophen NSAIDs
30
DM: What is the Dawn Phenomenon?
phenomenon occuring in most people where blood sugar levels increase from about 4am to 8 am (preparing the body to wake up)
31
DM: What is the Somogyi Effect?
Rebound Effect: Drop of blood sugar from about midnight to 4 am ***they may need a midnight snack to prevent the precipitous drop in glucose
32
DM: What education can we give regarding exercise?
Take a complex carb beforehand to prevent hypoglycemia during exercise Have a routine with same amount of exercise everyday
33
DM: What should we teach about foot care?
Inspect feet daily Pat feet dry gently (avoid lotions between toes to decrease excess moisture) Avoid open-toed, open-heeled shoes Don't warm with hot water bottles or heating pads
34
DM: What should we do about sweaty feet?
use mild foot power (with cornstarch)
35
DM: When is the best time to do toenail care?
after a bath/shower when they are softer and pliable
36
DM: How should they deal with a cut to foot?
cleans with warm water and mild soap gently dry apply a dry dressing
37
DM: How long can insulin last outside fridge?
around 1 month ***store prefilled syringes with needle up
38
DM: How many carbs in 1 CHO Exchange?
15 g carbs = 1 Carb Exchange
39
Metformin: What are the nursing actions?
Monitor for GI effects (farts, anorexia, n/v) Monitor for lactic acidosis Stop 48 hrs before any procedure requiring a dye
40
Metformin: What should we teach client?
Take with food to decrease GI effects Take Vit B12 and Folic Acid supplements Never crush or chew Can take during pregnancy
41
Sulfonyurea (Glip, Glim, Glyb): Nursing Considerations
Have a higher incidence of hypoglycemia Beta Blockers may mask tachycardia typically seen during hypoglycemia
42
Sulfonyurea (Glip, Glim, Glyb): What should we teach client?
Take 30 mins before meals Watch for hypoglycemia Avoid ETOH due to disulfirum effect
43
Meglatinides (Repaglinide): Nursing Considerations
Monitor for hypoglycemia Monitor A1c every 3 months to determine effectiveness
44
Meglatinides (Repaglinide): What should we teach client?
Administer 15-30 mins before meal Omit dose if skipped a meal
45
Thiazolidinediones (Pioglitazone): Nursing Considerations
Monitor for fluid retention (can precipitate HF) Monitor for elevation of client's LDL and Triglycerides
46
Thiazolidinediones (Pioglitazone): What should we teach client?
Report rapid weight gain, SOB, and decreased exercise tolerance (HF) Use additional contraceptives Have liver function tests every 2 months during first year
47
Alpha Glucosidase (Acarbose): Nursing Considerations
Monitor liver function q 3 months Treat hypoglycemia with dextrose, not table sugar (prevents table sugar from breaking down)
48
Alpha Glucosidase (Acarbose): What should we teach client?
Alert that GI discomfort is common Take with first bite of each meal Have dextrose paste available if hypoglycemic
49
DP-4 Inhibitors (Sitagliptan): Nursing Considerations
Few side effects URI (nasal and throat inflammaiton) may happen GI discomforts
50
DP-4 Inhibitors (Sitagliptan): What should we teach client?
Report persistent URI Med only works when glucose is rising
51
Incretin Mimetic (Exenatide): Nursing Considerations
Subq 60 mins before morning and evening meal Monitor GI distress
52
Incretin Mimetic (Exenatide): What should we teach client?
Not after a meal (give an hour before) No antibiotics, contraceptives, or tylenol 1 hr before or 2 hrs after Can have decreased appetite and weight loss If miss, wait for next scheduled dosed
53
Amylin Mimetic (Pramlintide): Nursing Considerations
subq immediately before meal Hold if A1c is greater than 9% Can give with insulin or oral med
54
Amylin Mimetic (Pramlintide): What should we teach client?
Report frequent periods of hypoglycemia Monitor for injection site reactions
55
Insulin: What are the rapid acting agents and how long till onset?
Lispro, Aspart, Glulisine (LAG) 10-30 mins till onset
56
Insulin: What is the short acting agent and how long until onset?
Regular 30 - 60 mins till onset
57
Insulin: Which type cannot be combined with any others and must be given by itself?
Long Acting: - Glargine - Lantus
58
DM: Which lab are we watching closely?
K+
59
Hyperglycemia: What causes the vascular system damage?
WBC exposure to high glucose starts the inflammatory response that damages vessels and inhibits vasodilation
60
S/S of Hypoglycemia
``` Diaphoresis Tremors Weakness Pallor Apprehension Tachycardia Shallow respirations HTN Hunger Headache Visual Disturbances Restlessness, irritability Decreased LOC Coma ```
61
Hypoglycemia Treatment
Stop continous insulin infusion Recheck q 15020 mins Assess LOC and give PO carbs If unconcious, give D50W IV push
62
Hypoglycemia: If they are alert, how many carbs should we give?
Mild (less than 60 mg/dL) = give 10-15 g Moderate (less than 40 mg/dL) = give 15-30 g
63
Hypoglycemia: If they are unconscious and cannot take PO carbs, what can we do?
IV Push 25-50 mL of D50W or Glucagon 1 mg IM or SubQ
64
How much is 15 g of CHO?
4 oz fruit juice of soft drink (non-diet) 8 oz nonfat or 1% milk 3-4 glucose tablets 8-10 hard candies 6 saltines 3 graham crackers 1 T of honey, sugar, or corn syrup ***recheck in 15 mins
65
DKA: What is the most common reason someone goes into DKA?
they get sick (an infection) ***increase insulin checks if a diabetic gets sick
66
DKA: Diagnostic criteria for DKA
Glucose greater than 300 Arterial pH less than 7.3 (acidic) Bicarb less than 15 mEq/L Keonemia or Ketonurea
67
DKA: S/S of DKA
Malaise, HA, Fatigue Polyuria, Polydypsia, Polyphagie N/V Dehydration (flushed dry skin) Tachycardia, Hypotension Weight Loss CNS (LOC decreased) Kussmaul Resp (fruity breath)
68
DKA: Management
Hydration Restore insulin-glucagon ratio Support the circulatory system Restore electrolyte balance
69
DKA: How should we rehydrate?
First hour = 15-20 mL/kg/hr or NS (isotonic) Then: 4-14 mL/kg/hr or 1/2 NS (hypotonic) 5% Dextrose added once glucose reaches 200-250 mg/dl
70
DKA: What do you do first before starting Reg. Insulin drip?
Fluids first Check K+ (don't start insulin if K+ is low, needs to be corrected first)
71
DKA: What is the goal in lowering blood sugar?
50-75 mg/dl/hr
72
HHS: What is the Patho?
Triggered by recent illness Some insulin produced but not enough (Type II) Severely high glucose levels Mild or Absent Ketones (because some insulin produced so little need to break down fat)
73
HHS: Diagnostic Criteria for Hyperglycemic Hyperosmolar Syndrome
Glucose greater than 600 pH normal (not acidic) bicarb greater than 15 (normal, not acidic) serum osmolality greater than 320 mOsm/kg (norm is 280)
74
HHS: Symptoms of Hyperglycemic Hyperosmolar Syndrome
Slow Onset Profound Dehydration CV Integument CNS
75
HHS: Management goals with HHS
Treat underlying cause Rehydrate Restore electrolyte imbalance Restore insulin/glucose ratio
76
HHS: How do we rehydrate?
Isotonic line at 1 L/hr until BP is stable then Hypotonic (1/2 NS) at 100-200 mL/hr ***watch closely for Cerebral Edema
77
HHS: Which electrolyte is the most important to be monitored for HHS?
Serum Na+ ***its a marker for serum osmolarity

Adult Health 1 Review (26 decks)

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