Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
90 Cards in this Set
- Front
- Back
|
how prevalent is type 2
|
90% type 2
|
|
|
Old name
|
EDDM = juvinile or type 1
NIDDM= or type 2 |
|
|
New name for diabetes is
|
Type 1
Type 2 |
|
|
What kinds of diabetes are there
|
Type 1
Type 2 Gestational Loss of pancreas due to trauma LADD= latent onset diabetes |
|
|
What is Diabetes Type 1 and 2
|
Type 1, Disorder of metabolism
Type 2, Chronic multisystem dz related to abnomal insulin production, impaired insulin utilization or both |
|
|
How do we get type one
|
Certain genes affect immune response can play a role
|
|
|
How do we bget type Two
|
Genes affecting insulin factor
|
|
|
When does type 2 occure and who can get it
|
people over 35
and even children Prevalence in african Am,Asian AM, Hispanics, Native adn alaskan AM, |
|
|
what nationality gets type 1
|
White people
|
|
|
Secondary diabetes
|
Occurs due to another medical condition.
Things like pancreatitis and medications like steroids (resolved when underlying conditions is treated) |
|
|
Gestational diabetes
|
Developes late in pregnancy in about 4% of patients
Caused by hormones of pregnancy or shortage of insulin. Clears up after birth |
|
|
What is special about agent orange herbacide
|
increase in vets with type 2 diabetes
|
|
|
Pancreas islet Beta cells are destroyed, this causes what
|
Type 1 diabetes
|
|
|
What causes the Beta cells to be destroyed
|
immune response caused by a trigger response. like infections or allergy. This could be genetic
|
|
|
Is the genetic component stronger in type 1 or type 2
|
Type 2 the rate for both twins getting this is 80 to 90%
Type 1 is a rate of 50 to 60% |
|
|
Who gets type 1 diagetes
|
more common in whites
M or F same Finland and sweden have highest incidence 5 to 10% of Americans are type 1 average age for diagnosis is 13 |
|
|
Classic type one symptoms
|
Polyuria increased urine
Polydipsia thirst Polyphagia Hungry -Weight loss -Fatigue -Infections |
|
|
8 hour fasting BGL
Random BG anytime OGTT |
>126 mg/dl
>200 >200 mg/dl in 2 hour sample |
|
|
Hamaglobin A1c for nondiabetic
What is acceptable for children |
4 to 6%
-7.5 |
|
|
OGTT is what
|
oral glucose tolerance test use about 75 grams they need to fast for 8 to 12 hours
|
|
|
PCP
FP NP CNS |
Primary care physician
|
|
|
Podiatrist
|
fot care
|
|
|
Ophthalmologist
|
eye Dr
|
|
|
Management of diabetes
|
-Insulin must be balanced with food and daily activities
-Blood glucose monitoring -Diabetic must take responsibility for their day-to-day care - Must monitor for hyper and hypoglycemia |
|
|
Hot and dry for
|
sugar high
|
|
|
Cold and clammy
|
need some candy
|
|
|
Hypoglycemia
|
Onset is rapid due to
-insufficient food -Excess exercise -Excess insulin Causes -Anxious -Sweaty -Hungry -Confused, blurred or double vision,shaky,irritable -cool clammy skin |
|
|
Mild reaction and Nocturnal
Moderate reaction Severe reaction |
10 to 15g simple cho followed by a protien snack
Moderate Reacton 10 to 15g of simple CHO repeat in 10 to 15 min if symptoms pesist follow with larger snack. Severe reaction, Glucagon if unresponsive follow with meal when able to eat |
|
|
Problems for Adolescents
|
they have most difficult tiem adjusting
them having DM is being different Fluctuating hormones wreak havoc seek independence from parents Daily compliance and structured schedule Girls but boys too- eating disorders |
|
|
Nursing Diagnosis
|
Risk for injury related to dibetes
|
|
|
Know wong
|
743
|
|
|
Diabetes is a leading cause or what
|
-End stage renal disease
-Adult blindness -Lower limb amputations -heart disease -Stroke -73% have hypertension |
|
|
What is prediabetes
|
-Known as IGT impaired glucose tolerance, greater than 100 but less than 126
-IFG, impaired fasting glucose 2 hour plasma glucose higher than normal between 140and199 |
|
|
What is the average daily secretion of insulin
|
0.6 units/kg
|
|
|
What does insulin do after a meal
|
• Stimulates storage of glucose as glycogen in liver and muscle
• Enhances fat deposition • ↑ Protein synthesis • Skeletal muscle & adipose tissue-are directly insulin-dependent tissues. • Other tissues such as brain, liver & blood cells do not directly depend on insulin for glucose transport |
|
|
Counterregulatory hormones
|
Oppose effects of insulin
Increase blood glucose levels Provide a regulated release of glucose for energy Help maintain normal blood glucose levels Examples • Glucagon, epinephrine, growth hormone, cortisol |
|
|
Type 2 Diabetes
|
Most prevalent type of diabetes
Over 90% of patients with diabetes Usually occurs in people over 35 years of age 80% to 90% of patients are overweight Prevalence increases with age Genetic basis Greater in some ethnic populations Pancreas continues to produce some endogenous insulin Insulin produced is either insufficient or poorly utilized by tissues Obesity (abd/visceral) Genetic mutations |
|
|
Type 2 Diabetes
4 Metabolic Abnormalities |
Insulin resistance
Body tissues do not respond to insulin Results in hyperglycemia Pancreas ↓ ability to produce insulin Inappropriate glucose production from liver Alterations in production of hormones |
|
|
Metabolic Syndrome
|
Individuals with metabolic syndrome at increased risk for type 2 diabetes
Cluster of abnormalities that increase risk for cardiovascular disease and diabetes Characterized by insulin resistance |
|
|
Gestational Diabetes
|
Develops during pregnancy
Detected at 24 to 28 weeks of gestation Usually normal glucose levels at 6 weeks postpartum Increased risk for C-section Increased risk for developing type 2 in 5-10 years Therapy: 1. nutritional, 2. insulin |
|
|
Secondary Diabetes
Results from Another medical condition |
• Cushing syndrome
• Hyperthyroidism • Pancreatitis • Parenteral nutrition • Cystic fibrosis • Medications: steriods, dilantin,antipsycotics • Usually resolve when underlying condition treated |
|
|
Clinical Manifestations
Type 2 Diabetes Mellitus |
Nonspecific symptoms
May have classic symptoms of type 1 Fatigue Recurrent infections Recurrent vaginal yeast or monilia infections Prolonged wound healing Visual changes |
|
|
FPG & OGTT Studies
|
Three methods of diagnosis
Fasting plasma glucose level >126 mg/dl Random or casual plasma glucose measurement ≥ 200 mg/dl plus symptoms Two-hour OGTT level ≥ 200 mg/dl using a glucose load of 75 g |
|
|
Hemoglobin A1C
|
Normal reduces risks
• Ideal: ADA <7.0, ACE <6.5 Useful in determining glycemic levels over time Not diagnostic but monitors success of treatment Shows the amount of glucose attached to hemoglobin molecules over RBC life span • 90 to 120 days |
|
|
Goals of Diabetic Management
|
• Decrease symptoms
• Promote well-being • Prevent acute complications • Delay onset and progression of long-term complications |
|
|
Team Approach
|
Patient teaching
Self-monitoring of blood glucose Nutritional therapy Drug therapy Exercise |
|
|
Drug Therapy
Insulin |
Insulin from an outside source
Exogenous insulin Required for type 1 diabetes Prescribed for patient with type 2 diabetes who cannot control blood glucose by other means |
|
|
Types of insulin
|
Human insulin
• Only type used today • Prepared through genetic engineering • Common bacteria (Escherichia coli) • Yeast cells using recombinant DNA technology |
|
|
Types of insulin
|
Insulins differ in regard to onset, peak action, and duration
• Characterized as rapid-acting, short-acting, intermediate-acting, long-acting Different types of insulin may be used for combination therapy |
|
|
Types of insulin
|
Rapid-acting: Lispro (Humalog), Injected 0 -15 min. before a meal. Onset about 15 min.
Short-acting: Regular. Injected 30 – 45 min before meal. Onset about 30 – 60 min Intermediate-acting: NPH. Varies Long-acting: Glargine (Lantus), Injected once daily, am or pm. Released steadily with no peak action. Cannot be mixed with any other insulin solution. |
|
|
Regimen that closely mimics endogenous insulin production is
|
basal-bolus
Long-acting (basal) once a day Rapid/short-acting (bolus) before meals |
|
|
Storage of insulin
|
Do not heat/freeze
In-use vials may be left at room temperature up to 4 weeks • Lantus only for 28 days Extra insulin should be refrigerated Avoid exposure to direct sunlight |
|
|
Administration of insulin
|
Cannot be taken orally
Subcutaneous injection for self-administration IV administration Fastest absorption from abdomen, followed by arm, thigh, buttock - Abdomen • Preferred site Rotate injections within one particular site Do not inject in site to be exercised NO ALCOHOL SWAB NEEDED ON SITE BEFORE INJECTION |
|
|
If you change their meds on the first of Feb would it be effective to check the Ha1c March 1st
|
No you need 3 months, dont waste money
|
|
|
Inhaled insulin
Exubera |
• Rapid-acting, dry powder inhaled through mouth into lungs
• Not recommended for patients with asthma, bronchitis, or emphysema |
|
|
Problems with insulin therapy
|
Hypoglycemia
Allergic reactions Lipodystrophy Somogyi effect Dawn phenomenon |
|
|
Somogyi effect
|
• Rebound effect in which an overdose of insulin causes hypoglycemia
• Usually during hours of sleep • Counterregulatory hormones released • Rebound hyperglycemia and ketosis occur |
|
|
Dawn phenomenon
|
• Characterized by hyperglycemia present on awakening in the morning
• Due to release of counterregulatory hormones in predawn hours • Growth hormone/cortisol possible factors |
|
|
Oral Agents
Not insulin |
Work to improve mechanisms by which insulin and glucose are produced and used by the body
Work on 3 defects of type 2 diabetes Insulin resistance Decreased insulin production Increased hepatic glucose production Sulfonylureas Meglitinides Biguanides-Metformin most commonly used α-Glucosidase inhibitors Thiazolidinediones |
|
|
Other Agents
Incretin mimetic-Byetta |
Synthetic peptide
Stimulates release of insulin from cells Subcutaneous injection Suppresses glucagon secretion Slows gastric emptying Not to be used with insulin |
|
|
Glycemic index (GI)
|
Term used to describe rise in blood glucose levels after consuming carbohydrate-containing food
Should be considered when formulating a meal plan |
|
|
why is the abdomen the best site to use for insulin injection
|
continous even absorption
|
|
|
Alcohol
|
High in calories
No nutritive value Promotes hypertriglyceridemia Detrimental effects on liver Can cause severe hypoglycemia |
|
|
Mental illness
|
when it interferes with your daily living.
- a disease of the brain - |
|
|
the brain
|
is most complex, imagine if a tiny thing goes wrong
-senses -memory -social cognition -emotion -planning -reality |
|
|
Psychiatric symptoms
|
arise from
misinterpritation and environment |
|
|
Broad psych catagories
|
Affective disorders
anxiety disorders psychotic disorders personality disorders dementias substance abuse |
|
|
Dementia
|
memory impairment
other cognitive impairments |
|
|
substance dependence
|
tolerance
withdrawal impairiment aggression |
|
|
DSM 4 TR
|
Diagnostic and statistic tool rests with observation of symptoms and catagorized
|
|
|
Function of the brain
|
drugs work directly at altering micro communication
over time such alterations in micro commnication affect macro communication Finally it is hoped that it will effect the large physical symptom |
|
|
Wellbutrin
|
stop smoking and a
antidepresant |
|
|
SSRIs
|
prozac
paxil zoloft celexa luvox wellbutrin remeron serzone |
|
|
Benzodiazepines
|
treat anxiety
Diazepam, lorazepam big problems with abuse |
|
|
Mood stabilizers
|
help treat bipolar
(mania and depression) Used for impulsivity and aggression Sometimes used in refreactory schizophrenia Lithium |
|
|
Antipsychotics
|
Used to treat various symptoms of psychosis
Most effective for positive symptoms Newer drugs are probably more effetive than older drugs for negative and cognitive symptoms Used to treat aggression and impulsivity and used to augment antidepressants |
|
|
Treatment of mental illness
|
require long term treatment
-cessation of medication often results in recurrence of illness -Lack of insight is often part of illness, particularly with schizophrenia. |
|
|
Dangerousness
|
Direct, suicide, homicide, aggression
Indirect, poor self care adn failure to care for self |
|
|
Mental illness summary
|
-common brain diseases
-Diagnosis is based on clusters of presenting symptoms -Need to relive symptoms -Persistent symptoms can lead to dangerousness, necessitating hospitalization |
|
|
Stigma
|
means mark
it was put on slaves to mark status |
|
|
why do mental ill people delay treatment
|
fear and discrimination
|
|
|
Explain the process of case management
· Describe the referral process |
Problem solving is the key,
To coordinate and look at what we can do for our patients. |
|
|
Discuss the trends in community-based care
|
-New models of nursing care, case method,one on one etc
Functional nursing,the art of nursing more case managment-Team nursing,more cna help-primary nursing,nurse does everything,, -Patterns of payment are many,communication is a problem in these, they are complex,qualifications are issues. |
|
|
Describe the agencies delivering care in the community
|
HMO-kaiser
PPO-an contracted with certain hospitals Private pay-ins, that allows you to go where you want prefered provide, like blue cross Goverment, the goverment pays fee for service, pay as you go |
|
|
Identify cost containment measures
|
HMO,
Deligation |
|
|
when does discharge planning start
|
with addmission, the goals and planning should start.
|
|
|
Three factors that influence a patients pain experience
|
anxiety
Age Culture |
|
|
major noninvasive pain relief measures
|
electrical stimulaton TENS
breathing message hypnosis Neuro surgical procedure Distraction Hydrotherapy |
|
|
Most prevelent mental illness in the US
|
Substance abuse, 13% of population
|
|
|
Cross addiction
|
combining uppers and downers to boost the high and potentiate the effect.
|
