Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Nur 333 fundamentals 2 > Wk 3: Caring for a Diabetic Pt/ Nutrition > Flashcards

Wk 3: Caring for a Diabetic Pt/ Nutrition Flashcards

(88 cards)

Start Studying
1
Q

Type 1 DM

A

autoimmune destruction of Beta cells in our pancreas
-S/sx more abrupt
-common in youth
-NO ENDOGENOUS insulin production
-MUST have insulin replacement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

type 2 DM

A

Beta cells in pancreas wear out and body becomes immune or resistant to insulin/body cells do not respond to insulin
-common in adults
-can go undiagnosed for long time
-some need insulin with PO meds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what are the 3 P’s of type 1 DM?

A

polyphagia -> excessive hunger
polydipsia -> excessive thirst
polyuria -> frequent urination

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Common Symptoms of Diabetes

A

three P’s
fatigue
recurrent infections
slow healing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Non-modifiable risk factors for type 2 DM

A

family Hx
over 45 y/o
race/ethnicity
history of gestational diabetes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Modifiable risk factors for type 2 DM

A

Physical inactivity
High body fat/overweight
HTN
HLD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What labs are involved in monitoring diabetes ?

A

-Fasting BG (no food/drink for 8 hours)
Nml <126
-Casual BG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What labs are involved in monitoring diabetes ?

A

-Fasting BG (no food/drink for 8 hours)
Nml <126
-Orala Glucose Tolerance Test (to Dx gestational diabetes)
-Glycosylated Hemoglobin (HbA1C)
-Casual BG
Nml <200
-urine ketones
-lipid profile
low HDL, high LDL, high triglycerides

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

HbA1C test

A

-Average BG over 3 months
-used to Dx and evaluate effectiveness of interventions
-nml is 4-6%
> 6.5% is considered diabetic
acceptable range for diabetics is 6-8%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How do you take an Oral Glucose Tolerance Test

A

-consume oral glucose
-glucose taken every 30 minutes until 2 hours have passed
-fasting should be <110
- at 1 hour should be <180
-at 2 hours should be <140

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

A1C levels for
-Diabetics
-Pre-diabetes
-Normal

A

-diabetic: 6.5 or above
-Pre-diabetes: 5.7 - 6.4
-Normal: ~5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Fasting Plasma Glucose levels for
-diabetes
-pre-diabetes
-normal

A

-diabetes: 126 or above
-pre-diabetes: 100-125
-normal: 99 or below

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

oral glucose tolerance test for
-diabetes
-pre-diabetes
-normal

A

-diabetes: 200 or above
-pre-diabetes: 140-199
-normal: 139 or below

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the criteria for a DM diagnosis

A

at least one of the following:
-A1C of 6.5% or higher
-fasting BG >126
-OGTT 2Hr level of 200
-Sx of hyperglycemia, a random BG >200, or hyperglycemia treatment

*usually a repeat lab is done before official diagnosis
*for Type 1 DM would beed an islet cell autoantibody test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What can you do for a pre-diabetic pateint?

A

-teach
-lifestyle modifications
-encourage close monitoring of BG and A1C
-monitor for: fatigue, slow healing, frequently being sick
-diet modification

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are some pharmacological considerations for a diabetic patient (specifically type 2 DM) when they are sick or hospitalized

A

-oral meds may be stopped when in the hospital
-might be put on insulin when in hospital, even if they do not normally take it
-BG can rise when sick
-hold metformin prior to surgeries
-Pt may be more prone to DKA or HHNS
-PO intake may be less, may need to alter insulin dose
-steroids make BG rise

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

When a patient with DM is sick, when should (you or) they call their provider

A

-urine ketones
BG >250
Temp >101.5 w/o response from Tylenol
Confusion/Disoriented/ Rapid Breathing
N/V/D
Fluid intolerance
sick >2 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Frequency of BG checks depends on what

A

glycemic goals
type of diabetes
medication regimen
access to supplies and equipment
patients willingness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

When would rapid or short acting insulin be given?

A

before each meal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

When would lantus or long acting insulin be given?

A

at bedtime

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Since Insulin is a high alert drug, what should you be checking/ know prior to administering it?

A

-current BG level
-check current diet order
-onset/peak/duration of insulin
-S/Sx of hypoglycemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What do you do if your diabetic patient is NPO?

A

may need medication dosage change

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What should you always do with a patient with a new diagnosis of DM?

A

-Make sure to educate properly about side effects, when to time insulin doses, and S/sx for hypoglycemia
-always observe new patients self-administer insulin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Hypoglycemia criteria and treatment

A

BG <70

Trx:
-FSBG
-rule of 15

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What is the rule of 15?
if Pt is hypoglycemic but still able to swallow give 15g of simple carbohydrates -FSBG in 15 minutes then eat regular meal -if still <70 then repeat steps (15g CHO should increase BG by 50) Simple CHO include: 4Oz juice, regular soda, 3 glucose tabs
26
What can you give a patient that is hypoglycemic if they are unable to swallow or are unconscious?
IM Glucagon IV D50
27
What are some symptoms of hypoglycemia?
diaphoresis, blurred vision, dizziness, anxiety, hunger, irritability, shakiness, fast heart beat, headache, weakness, fatigue
28
What are some causes of hyperglycemia? what are some manifestations of it?
causes: illness, infection, self-management issues, stress manifestations: weakness, fatigue, blurry vision, headache, N/V/D
29
Insulin Pumps
-SQ continuous infusions of rapid acting insulin -be aware of: infections at pump site and increased risk of DKA if pump malfunctions
30
Macrovascular Complications of DM
damage to large vessels like: -coronary arteries -peripheral vascular -cerebral vascular *much higher risk for CVD
31
Microvascular Complications for DM
damage to capillaries: -retinopathies -nephropathies -neuropathies
32
Loss of Protective Sensation (LOPS)
prevents patients from being aware that injury has occurred -related to neuropathy
33
Diabetic foot care steps
1. wash feet daily 2. pat dry 3. inspect feet daily 4. use lanolin to prevent dryness 5. mild foot powder for sweat 6.no commercial remedies 7. clean cuts with mild soap (NOT iodine/alcohol/adhesives) 8. report skin infections 9. trim nails 10. separate overlapping toes with cotton 11. do not go barefoot 12. clean/ absorbent socks 13. no hot water bottles
34
Nutritional considerations for diabetics
high fiber low fat low cholesterol carb counting (especially with T1) whole grains sugar free alternatives work well limit alcohol intake **NEVER tell a patient to not eat a certain food group
35
Integumentary Concerns d/t DM
1. Diabetic Dermopathy: reddish-brown spots 2. Acanthosis Nigricans: brown/black thickening of skin 3. Necrobiosis lipoidica diabeticorum: red patches around blood vessels *all can improve when DM is being treated/controlled properly
36
What is the difference between Enteral and parenteral nutrition?
Parenteral -> providing nutrition outside of the GI tract, through IV nutrition/ TNP Enteral -> preferred way of getting nutrition, through the GI tract
37
what are the three main functions of the GI tract?
transportation digestion absorption
38
what is the flow if the GI tract from mouth to anus?
through the mouth down the esophagus esophageal sphincter stomach pyloric sphincter small intestine (duodenum, jejunum, ileum) large intestine (colon/sigmoid) (water reabsorption) rectum anus
39
complications with malnutrition
-malnutrition leads to higher readmission rates -dysrhythmias -skin breakdown -sepsis -hemorrhage -increased length of stay -delayed surgical healing
40
What is malnutrition?
-lack of nutritional intake -can be be present in underweight or obese Pt
41
What are the importances of good nutrition?
-reach/ maintain healthy weight -reduce risk of chronic Dz -promote overall health
42
dietary guidelines
1. follow healthy eating pattern 2. variety of nutrient dense foods 3. limit added sugars/sat. fats/ sodium intake 4. shift to healthier foods support healthy eating patterns
43
what influences a persons nutrition intake?
appetite negative experiences disease, illness medications environmental factors (income/education) developmental needs alternative food patterns(religion/culture)
44
Nutritional Considerations for Older Adults
chronic illness medications GI changes decreased metabolic rate cognitive impairment available transportation functional ability fixed income usually need calcium supplements
45
What are the five steps to the assessment of nutritional status?
screening anthropometry laboratory and biochemical tests diet and health history physical examination
46
Nutritional assessment: screening
-subjective: what they report -objective: height/weight -identifying risk factors of malnutrition: weight loss Sx -using standardized tools: SGA/MNA/MST
47
Nutritional assessment: anthropometry
-study of measurement and proportions of human body -measure size/ makeup of body -BMI -skin fold measures -fat percentage -registered dietitians can assist
48
BMI calculations
BMI = 703 x [lb/in(^2)} BMI= kg/m(^2)
49
nutritional assessment: Laboratory
*no single lab test to determine nutrition* Factors that affect lab results: fluid balance liver and kidney function presence of Dz Common labs: Total protein, albumin, prealbumin, hemoglobin
50
Total Protein
combination of albumin and globulin constitute Nml range: 6.4-8.3
51
Albumin
indicator for CHRONIC illness synthesized in the liver half life of 21 days Nml: 3.5-5.0
52
Prealbumin
indicator for ACUTE conditions half life of 2 days Nml range: 15-36
53
Hemoglobin
protein responsible for transferring O2 if low should eat iron rich foods Nml Range for males: 14-18 Nml range for females: 12-16
54
Nutritional assessment: nutritional history
diet history healthy history other history: age, socioeconomic status, culture, religion
55
Nutritional assessment: physical examination What does a person with a healthy nutritional assessment present with?
alert & erect appearance BMI WNL neuro intact w/ EMV of 15 VS WNL no GI complaints no musculoskeletal abnormalities shiny hair no facial/ neck swelling lips are pink, free of lesions or swelling pink tongue teeth are clean and white MMM that are red colored with no lesions
56
Nutritional assessment: physical examination What does a person with malnutrition present with during their examiantion?
fatigue, apathetic, cachectic, sunken chest, humped back obesity, overweight or underweight inattentive, irritable, confused, decreased reflexes VS WNL GI: anorexia, indigestion constipation, N/V/D weak, poor tone, "wasted" appearance, bowlegged, visible ribs rough/dry/pale skin brittle nails face/neck is swollen, dark skin under eyes pale conjunctivae, dry eyes gums: spongey, receding, bleeding, inflamed Tongue: swelling, raw teeth: missing/ broken mucus membranes: swollen, oral lesions
57
nursing problems related to nutrition
imbalanced nutrition (more or less) impaired swallowing risk for aspiration diarrhea, constipation, nausea impaired dentition fatigue risk for unstable BG
58
What are some nursing implementations you can do regarding a patients nutrition?
health promotion advancing diet diet selection care of common nutritional issues measuring I&O obtaining height and weight
59
What are the components of selecting a diet for a patient?
the amount of calories needed ability for the patient to eat (teeth? cant chew?) any alterations to GI tract (bariatric Sx) any special considerations based on heath status (DM)
60
What are some different kinds of diets?
regular PO liquid diets modified texture therapeutic diets modified for nutrients supplements
61
What are some examples of a modified texture diet?
mechanical soft pureed minced ground chopped
62
what is allowed in a clear liquid diet
water black coffee tea w/o cream fat free broth lemonade sports drinks gelatin popsicles *anything you can see through that is easily digestable
63
before you enact a fluid diet, what are two considerations you should bring up
1. is the patient on fluid restrictions? HF, kidney failure, low serum sodium 2. do they need a modified consistency of their liquids?
63
before you enact a fluid diet, what are two considerations you should bring up
1. is the patient on fluid restrictions? HF, kidney failure, low serum sodium 2. do they need a modified consistency of their liquids? thin vs thick liquids dysphagia Pt's risk for aspiration
64
What are the different liquid consistencies ?
thin-> water, coffee, tea, soda nectar-like -> can drip off a spoon spoon thick -> pudding consistency Honey like-> honey consistency
65
what are some therapeutic diet orders?
consistent carbohydrate cardiac diet (low Na+, low sat fat, low cholesterol) low residue (undigested food) high fiber gluten free lactose free bland
66
what determines a persons diet tolerance?
no N/V/D no abdominal distention normal bowel sounds
67
What are some common nutritional issues ?
anorexia inability to feed self dysphagia nausea and vomiting
68
what are some things the nurse can do to increase a patients appetite
treat cause use creative approaches to stimulate appetite change environment smaller / more frequent meals allow for food preferences seasoning food oral hygiene ensure patient is comfortable medications for appetite stimulation
69
assisting a patient with oral feedings
protect safety/independence/dignity tray within reach assess risk of aspiration does patient need to be supervised? any visual deficits? plate as a clock decrease motor skills -> adaptive utensils
70
what are some complications for dysphagia ?
aspiration PNA dehydration malnutrition weight loss
71
What does the nurse need to do when the patient is on strict I&O?
measure all intake and output record it in the patients medical record measure in either mL or amount of occurrences can be delegated to tech educate the patient & family on participation assess and monitor trends
72
What kind of patients would be in strict I&O's?
Critical care patients unstable patients Post-op Pt Pt with h/o HF, liver failure or renal failure malnourished Pt NPO pt Pt on diuretics changes in weight
73
What counts as intake?
oral intake IV fluids blood products tube feedings flushes
74
what counts as output?
urine BM emesis drainage tubes (JP, chest tubes)
75
What is a feeding tube that leads through an artificial external opening into the stomach?
PEG tube
76
What is a feeding tube that leads through an artificial external opening into the small intestine?
PEJ tube
77
how do you confirm the placement of a PEG or PEJ tube?
XR (also pH test with aspirated secretions and inserting air into tube then auscultating)
78
If the patient has a risk for gastric reflux then what type of tube should be used?
jejunum tube
79
What are some indications that the patient may need enteral nutrition?
prolonged anorexia severe protein-energy malnutrition coma impaired swallowing critical illness
80
Benefits of Enteral over Parenteral nutrition
reduced chance of sepsis minimize hyper-metabolic response to trauma decreased hospital mortality maintains intestinal structure and function, decreased chance of atrophy
81
S/Sx of tube feeding intolerance
high gastric residuals nausea cramping vomiting diarrhea
82
Bolus vs Pump tube feedings
bolus is intermittent pump is continuous
83
Complications of tube feedings
pulmonary aspirations constipation abdominal cramping N/V/D tube occlusion or displacement delayed gastric emptying serum electrolyte imbalance fluid overload hyperoslmolar dehydration
84
nursing assessment of feeding tubes
abdominal focused exam check for surrounding skin breakdown assess nutritional status assess for intolerance I&O monitor labs
85
how often to check gastric residual in stomach
check continuous feedings every q 4-6 hrs check intermittent feedings before giving feeding
86
what does high gastric residual indicate?
delayed gastric emptying >250 ml hold for 1 hr and recheck >500 ml hold and notify HCP
87
what do do when administering medications through a feeding tube
follow 5 rights of med admin ensure med can be administered through tube always verify placement flush with water before and after administration administer one med at a time

Nur 333 fundamentals 2 (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions