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NRSG 202 > Week 3: Diabetes > Flashcards

Week 3: Diabetes Flashcards

1
Q

What are the benefits of SMBG?

A

enables the patient to make their own decisions regarding diet, exercise, and medication management

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2
Q

What is the only CGMS in Canada?

A

The Medtronic MiniMed Paradigm REAL-Time System

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3
Q

What is a CGMS useful for?

A
  • managing insulin therapy
  • alert for hyper/hypoglycemic episodes
  • prompt, immediate and corrective actions
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4
Q

How many times should type 1DM check BG?

A

3 times per day

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5
Q

How many times should type 2DM check BG?

A

once daily

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6
Q

If a diabetic is in critical, how often should their BG be checked?

A

every 2-4 hours

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7
Q

Where is a subcutaneous injection?

A

into the loose connective tissue under the dermis

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8
Q

Why is subcut absorbed much slower?

A

absorbed more slowly than IM injections due to the lack of blood supply

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9
Q

Why may a patient experience discomfort with a subcut injection?

A

because the subcutaneous has pain receptors

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10
Q

Subcut injection angle

A

45-90 degree

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11
Q

Intramuscular injection angle

A

90 degree + wait 10 seconds

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12
Q

Intradermal injection angle

A

5-15 degree

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13
Q

What are the best Subcut sites

A
  • outer posterior aspect of upper arms
  • abdomen
  • anterior thighs
  • upper back
  • upper ventral/dorsal gluteal areas
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14
Q

LMWH

A

Low Molecular Weight Heparin

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15
Q

Special considerations with LMWH (3 things)

A

left or right of the abdomen at least 5cm away from umbilicus
do NOT expel air bubble
pinch skin

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16
Q

Goals of Diabetes Management:

A
  • promote wellbeing
    -reduce symptoms
  • prevent acute complications of hyperglycemia/hypo
  • delay onset of and progression of long term complications
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17
Q

Fasting Blood Glucose (FBG)

A

no intake for at least 8 hours

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18
Q

FBG ranges

A

less than 6 or 6 = NORMAL
between 6.1-6.9 = PRE-DIABETES
7.0 or more = DIABETES

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19
Q

Hemoglobin A1C

A

average BG over 3 months previous

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20
Q

A1C ranges

A

less than 6% = NORMAL
between 6.0-6.4% = PRE-DIABETES
6.5 or greater = DIABETES

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21
Q

Random Plasma Glucose

A

less than 11.1mmol/l (without regard to meals)

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22
Q

NOVA machine ranges

A

3.3-7.0mmol/l

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23
Q

S&S of hypoglycemia

A
  • BG <4
  • cool clammy skin
  • rapid HR
  • HA, faitness, dizziness
  • nervousness, tremors, shaking
  • hunger
  • emotional changes
  • numbness of fingers, toes, mouth
  • unsteady gait, slurred speech
  • vision changes
  • seizures, coma
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24
Q

Causes of hypoglycemia

A
  • inadvertent insulin OD
  • missed/inadequate meal
  • unexpected exercise
  • error in dosing timing
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25
Q

S&S of Hyperglycemia

A
  • elevated BG (>11)
  • 3 P’s
  • weakness/fatigue
  • blurred vision
  • headache
  • N/V
  • abdominal cramps
  • glycosuria
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26
Q

Causes of Hyperglycemia

A
  • inadequate doses
  • infection
  • stress
  • surgery
  • meds
  • nutritional intake variations
  • enteral/parenteral
  • critical illness
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27
Q

Goals of BGM

A
  • to determine or monitor BG levels @ risk of hyper/hypoglycemia
  • promote BG regulation
  • evaluate effectiveness of insulin/OHA
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28
Q

Around what times of meals does insulin have to be administered?

A

30 mins before (AC)
2 hours after (PC)

29
Q

BG Nursing Assessment

A

determine frequency/type of testing
determine pts understanding
pt response to previous
client record for meds that prolong bleeding (may need up to 5 mins of pressure)
pts self care abilities

30
Q

BGM Equipment

A

blood glucose meter (glucometer)
reagent strips
gauze
warming device
castille toilette
clean gloves
sterile lancette

31
Q

BGM Equipment

A

blood glucose meter (glucometer)
reagent strips
gauze
warming device
castille toilette
clean gloves
sterile lancette

32
Q

Test strip test time:

A

6 seconds

33
Q

Test strip volume of blood needed

A

1.2ul

34
Q

Glucose measurement range

A

10-600mg/dl (0.6 to 33.3mmol)

35
Q

Test strip stability

A

24 months after manufacture or 180 days after opening

36
Q

How often does a QC need to be done?

A

every 24 hours or locks out (must be done with BOTH low and high glucose solutions)

37
Q

QC stability

A

24 months after manufacture and 90 days if opened

38
Q

where can whole blood be obtained from

A

capillary
venous
arterial

39
Q

Normal BG result range

A

3.3-7.0

40
Q

Adult critical low BG range

A

<2.6mmol/l

41
Q

Adult critical high BG range

A

> 25mmol/l

42
Q

Basal insulins

A

NPH (Humulin N)
Glargine (Lantus)
Degludec (Tresiba)

43
Q

Bolus insulins (ALR)

A

Aspart (Novo-rapid)
Lispro (Humalog)
Regular (HumulinR)

44
Q

Premixed insulins (HH)

A

Humalog mix 25 (25% lispro & lispro protamine 75%)
Humulin 70/30 (70 units N and 30 units R)

45
Q

Why is some insulin cloudy

A

added buffers (like zinc) make them work longer but gives the cloudy appearance

46
Q

What insulins are cloudy

A

intermediate acting (NPH)

47
Q

What intermediate acting is NOT cloudy

A

glargine is clear instead of cloudy

48
Q

What order to draw insulin?

A

CLEAR before CLOUDY

49
Q

How many times does long/intermediate acting have to be administered

A

1-2X/day

50
Q

How many times does short acting have to be administered?

A

before meals

51
Q

Nursing responsibilities for OHA

A

assess pts understanding
assess for effectiveness
asess for ADEs
pt education
evaluation of pts ability
pt education
proper administration

52
Q

What does follow up for OHA include?

A

inspect sites
review prep storage, timing, technique
hx of hypoglycemia episodes/how they treat them
review of recorded glucose tests

53
Q

What is Basal insulins indication

A

required to cover rise in BG between meals and throughout the night

54
Q

What are bolus insulins indicated for

A

to cover the rise in BG due to meals

55
Q

What are pre mixed insulins indications

A

only used for type 2

56
Q

Insulin correction dose indications

A

given to correct elevated blood sugars based on patients sensitivity to insulin

57
Q

Insulin Sensitivity Factor (ISF)

A

the blood glucose drop in mmol/L per unit of insulin given (the patients sensitivity to insulin)

58
Q

ISF calculation

A

100 divided baby TDD (eg daily dose 50) = 100/50 =ISF 2

59
Q

what is a subcut injection not recommended for?

A

severe, uncontrolled, or increasing pain due to the slow absorption

60
Q

Subcutaneous needle size ranges

A

from 29 - 32 gauge

61
Q

Subcutaneous needle length range

A

4mm to 12mm (5/32 inch to 1/2 inch)

62
Q

How much volume should be in a subcutaneous injection?

A

0.5 to 1mL of water soluble meds (up to 2 is considered safe)

63
Q

When does the skin need to be pinched in a subcutaneous injection?

A

on a thin person or when it is a long needle

64
Q

fastest absorption site?

A

abdomen

65
Q

advantages of pen vs syringe

A

better glycemic control
increased medication adherence rates
fewer hypoglycaemia events
improved self management education
fewer med errors
cost saving
improved safety for workers
decreased insulin waste

66
Q

What does the flashing green middle light on the nova mean

A

data is transferring

67
Q

What does the amber right light mean on the nova

A

meter is charging

68
Q

what does no lights mean on the nova

A

no power
lights are burnt out
docking station is broken

69
Q

What does the green right light mean on the nova

A

the meter is fully charged

NRSG 202 (8 decks)

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