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;
86 Cards in this Set
- Front
- Back
|
3 P's for DM
|
*Polyuria-Happens to get rid of sugar, but F/E go out with water. BODY'S NATURAL WAY OF GETTING RID OF SUGAR, however this may cause dehydration.
*Polydipsia-Increased thirst due to loss of fluids. Thirsty b/c it is the body's response to dehydration. *Polyphagia-Increased hunger b/c the body thinks that it is hungry when it is really eating at itself. |
|
|
What do P's of DM indicate?
|
High blood sugar
|
|
|
Polyuria & polydipsia always happen....
|
...during hyperglycemic episodes, but Polyphagia may not b/c a person with a 800-1000 BG level may be too sick to eat.
|
|
|
A patient comes into ER with DKA, how do you know they are getting better?
|
DKA is diabetic ketacidosis meaning High sugar
Vital signs in DKA are..low BP, increased heart rate, incrased respirations, BG increased. You KNOW they are getting better when...BP decreases and HR, RR, and BG decreases. |
|
|
What is the first thing you do in ER with DKA patient (with DR order)?
|
1st thing you do is IV fluids with some IV insulin.
IV insulin b/c it is faster, SQ would take too long to work. Start putting sugar on board (DSW) with the fluids when BG gets between 250-300, b/c you don't want them to get too hypoglycemic.(start w/ NS or .45 NS) Nee sugar b/c if you get them from 800-300 in 2 hrs, you need a little sugar on board so they don't get too low. |
|
|
If a patient is polyphagic during hyperglycemic episodes it is because...?
|
The body thinks it is in stress.
|
|
|
The body treats hyperglycemic episodes as if the person was...
|
running from a bear and needed more and more sugar to have the energy to keep going.
|
|
|
If the patient is polyphagic most the the time they feel so bad...
|
that they do not experience polyphagia
|
|
|
What kills the DKA and HHNS (hyperglycemic hperosmolar nonketotic syndrome.) patients?
|
Dehydration
|
|
|
What are the BIG side effects of PO meds?
|
Mainly Hypoglycemia
Hyperglycemia with some other meds, so always aske them what they are taking Liver GI Lactic acidoses Derm |
|
|
When do PO meds peak?
|
They don't peak
|
|
|
How to PO meds work?
|
Stimulate pancreas to release insulin
Facilitate insulin action on peripheral receptor sites Delays glucose absorption in the gut Or a combination of the the 3 actions. |
|
|
Why would I want to eat a snack at 4:00 p if I was taking Humulin N at 8:00 a?
|
B/C that is when Humulin N peaks (4-12 hours), 8 hrs is the magic number!
|
|
|
Peaks and Onsets of Insulins
Rapid |
Onset (10-15 Min), peak (1-2 hrs) remember have tray in the room.
|
|
|
Peaks and Onsets of Insulins
Short |
Onset (30 min-1 hr)
Peak (2-3 hrs) |
|
|
Peaks and Onsets of Insulins
Intermediate |
Onset (3-4 hrs)
Peak (4-12 hrs, 8 hrs is the magic number) |
|
|
Peaks and Onsets of Insulins
Long |
Onset (6-8 hrs)
Peak (12-16 hrs) Watch for HS hypoglycemia |
|
|
Peaks and Onsets of Insulins
Continuous |
Onset (1 hr)
Peak (none, contnuous basal dose throughout the day) Watch for hypoglycemia all day long with Continuous Insulin |
|
|
Peaks and Onsets of Insulins
Watch other insulin patients for Hypoglycemia during... |
Their particular insulins peak, doesn't apply to Continuous insulin because it has not peak, have to watch them all day.
|
|
|
What are Microvascular changes unique to DM patients?
|
Diabetic retinopathy
Diabetic nephropathy |
|
|
What Macrovascular changes can happen with DM?
|
Coronary artery desease (CAD)
Cerebrovascular disease (CVA and TIA) Peripheral vascular disease (PVD) |
|
|
What brings sugar up?
|
Illnes
Stress Foods (CHOs and proteins) CHOs bring sugar up the Fastests! (milk, peanut butter, cheese) |
|
|
What brings sugar down?
|
Fiber (but watch for GI side effects)
Exercise Alcohol Oral meds Insulin |
|
|
Patients should exercise when?
|
After meals b/c that is when sugar is the highest.
|
|
|
How do you treat a pregnant diabetic?
|
First try and treat them with controlled diet and exercise before insulin
Only have them on insulin, no PO antidiabetic meds. |
|
|
Patient going to have gallbladder removed in the AM. Should they be on PO antidiabetic meds or insulin and why?
|
They should be on insulin b/c you don't know when the oral med will peak, but you do know when the insulin will peak
If you have a high sugar with no order, call md and tell them patient usually takes PO meds, their BG is 400, and ask which insulin to give them before surgery. |
|
|
Patient comes into ER w/ 650 blood sugar. What will you hook them up to?
|
NS or some fluid
IV insulin |
|
|
Type 2 patient comes into the MD's office, but does not know they are Type 2, what will they tell you has been going on with them?
|
Urinate all the time
Drink all the time/thirsty Lost weight Feel weak |
|
|
What is the best thing to give ORAL if the patient is hypoglycemic?
|
Milk, b/c it is a carb which means it will spike your BG up, but it is also a protein, which means it will plateau you out so you don't spike up and then back down.
|
|
|
Why should you have a food tray in the room before you administer rapid acting insulin?
|
Because it begins working in 10-15 min.
|
|
|
How do you know if a patient has Diabetic Retinopathy?
|
MD sees spots in eye upon exam
|
|
|
How do you kow if a patient has Nephropathy?
|
They are throwing albumin in the urine
|
|
|
Type 2 DM patient comes into hospital w/ pneumonia dn MD orders an incrase in insulin the nurse would be:
|
No concerned b/c the body is fighting off an infection meaning the clood sugar will be even higher meaning that the patient will need more insulin to control the BG
Need more insulin sue to stress raising blood sugar levels |
|
|
Type 2 DM patient with pneumonia and MD orders diet from 1800 to 2400 cal per day, the nurse would:
|
Not be concerned b/c the patient needs the extra calories to provide more energy to fight off the infection and healing.
|
|
|
If MD orders decrease in insulin while Type 2 DM patient is in the hospital for pneumonia the nurse would:
|
Question this order b/c with sugars elevated when the patient is not ill would be even more elevated when the patient is ill.
|
|
|
Is it ok for a MD to change insulins on patients while they are in the hospital and why or why not?
|
It is ok because he is trying to adjust to fit their needs (wherever sugars are high and low during the day)
|
|
|
If a person drinks alcohol what happens?
|
Blood sugar drops
|
|
|
Diagnostic magic numbers
|
Fasting BG > 126
Random BG > 200 2 hrs PP> 200 Impaired fasting 110-126 |
|
|
What is the usual body type of Type 2?
|
80% are obese
|
|
|
What are the treatments for DKA and HHNS?
|
IV insulin
IV fluids to rehydrate PO fluids if they can tolerate it |
|
|
Diet Breakdown
|
50-60 % from CHO
< 30% from fats 10-20 % from proteins |
|
|
How do you know if patient has been following diabetic diet?
|
A1C test (measures glucose bound to hemoglobin over the last 3 months)
Glycosolated hemoglobin-avg. BG over last 3 months These tests help to catch things that the patient may or may not be doing correctly. |
|
|
What kind of insulin should be used in Insulin pumps?
|
Rapid acting insulin-Humalog, Apidra or Novolog
|
|
|
What infection rate/risk do you incur with an insulin pump?
|
About the same as you would with regular SQ injections q4d.
|
|
|
What is the goal of an insulin pump?
|
Maintaining sugars thereby reducint total insulin per day
Prevent long term complications Mimics how the healthy pancreas works |
|
|
Patient on Humulin R 30 units. What kind of diabetic is she?
|
You don't know because you have to know the whole picture before deciding which type she is.
|
|
|
Patient on Humulin R 30 units, age 15, 5'4" and 90lbs. What kind of diabetic is she?
|
Type 1
|
|
|
Patient on Humulin R 30 units, age 37, 5' and 450lbs. What kind of diabetic is she?
|
Type 2
|
|
|
What organ creates sugar for us when we don't have it in our bodies?
|
Liver
|
|
|
Why don't we say insulin dependent diabetes and non-insulin dependent diabetes anymore?
|
Because both types of diabetes can now be insulin dependent.
|
|
|
DKA is now present in what type of DM?
|
Type 1 and 2
|
|
|
HHNS is present in what type of DM?
|
Type 2
|
|
|
What percentage of diabetics are Type 2?
|
80% maybe even close to 90%
|
|
|
What is the age of onset for Type 1 DM?
|
Juvenile onset (<30)
|
|
|
What is the age of onset for Type 2 DM?
|
Typically over 30
|
|
|
When might you see a 12 year old with type 2?
|
If they are obese
|
|
|
What are the magic words for Type 1 and Type 2 DM
|
Type 1 is Antibodies
Type 2 is insulin resistant |
|
|
What is the impaired glucose tolerance when fasting?
|
110-126
|
|
|
What does Type 1 DM destroy?
|
Beta cells that produce insulin
|
|
|
How does exercise impact DM?
|
Brings sugar down
Should exercise after eating |
|
|
Do you snack type 2 dm with exercise?
|
No, not unless they are shaking, sweating, get low sugar reading etc.
|
|
|
Can just anyone start walking 3 miles a day?
|
No patients over 30 with 2 or more risk factors such as obese, mokers, HTN patients, etc all need a stress test before beginning exercise.
|
|
|
In a type 2 DM patient, how much weight loss can be significant (impact amount of meds..etc)
|
5-10% of their current body weight can make a significat difference in reducing meds
Major selling point on weight loss, if they lose weight they may not have to take as much medicine |
|
|
Why are urine sugar and ketone tests better than finger stick?
|
More cost efficient
Less invasive because you don't have to stick yourself |
|
|
What is the needle size for insulin?
|
28-31
|
|
|
What kind of insulin has the fastest peak?
|
Rapid acting
|
|
|
What kind of peak does Lantis have?
|
continuous
|
|
|
What do you do for unconscious hypoglycemic patients?
|
At home -Glucagon pen
ER- D50W IV |
|
|
What is "good sugar" when fasting?
|
70-110
|
|
|
Facts about DM
|
Disease of metabolic/endocrine system
50% population > 65 y.o. have some degree of glucose intolerance Higher prevalence in Hispanics, African Americans, Native Americans Leading cause of new blindness in 25–74 y.o. Leading cause of non-traumatic amputations 50% pts beginning dialysis have DM 3rd leading cause of death by disease(Coronary Artery Disease) 2-5 X higher hospitalization in DM pts High economic cost for care of DM |
|
|
What is DM caused by?
|
A Defect in insulin secretion and/or insulin action causing elevated levels of blood glucose (hyperglycemia)
|
|
|
In a diabetic state...
|
cells don’t respond to insulin or
pancreas stops producing insulin |
|
|
Major source of glucose
|
food absorbed in GI tract and
liver forms glucose from ingested food substances |
|
|
What is insulin?
|
hormone produced by pancreas controls level of glucose in blood
|
|
|
What is the goal for DM patients?
|
control BG levels
and prevent acute/chronic complications |
|
|
In pancreas what contains beta cells which produce insulin
|
the islets of Langerhans
|
|
|
What are the types of DM?
|
Type1
Type 2 Gestational DM associate w/other syndromes |
|
|
What are the goals for nutrition as it relates to DM?
|
- Proper diet
-Weight control -Meet energy needs -Prevent wide BG fluctuations -Decrease serum lipid levels -Strive for consistency in amount of calories, amount of CHOs(carbohydrates), and time between meals. This prevents hypoglycemia reactions – controls BG |
|
|
How does obesity impact DM?
|
BMI(Body Mass Index) 25 + or 20% above ideal body weight = obesity
Obesity = ↑ insulin resistance / ↓ insulin sensitivity Type 2 c wt loss #of insulin receptors on cells increase thereby allowing glucose to better enter cell Weight loss may reduce/eliminate need for po/sq meds Loose 5-10% of total weight Encourage, behavior therapy, group support, ongoing nutrition counseling for Long tERM ADHERENCE |
|
|
What are some methods of insulin delivery?
|
1. syringe
2. insulin pen 3. jet injector 4. insulin pump(see appendix) 5. implantable and inhalant insulin-Exubera contraindicated in lung patients, inhaler size of hammer OFF MARKET 6. transplant of pancreas or islet cell |
|
|
What are the goals for nutrition as it relates to DM?
|
- Proper diet
-Weight control -Meet energy needs -Prevent wide BG fluctuations -Decrease serum lipid levels -Strive for consistency in amount of calories, amount of CHOs(carbohydrates), and time between meals. This prevents hypoglycemia reactions – controls BG |
|
|
How does obesity impact DM?
|
BMI(Body Mass Index) 25 + or 20% above ideal body weight = obesity
Obesity = ↑ insulin resistance / ↓ insulin sensitivity Type 2 c wt loss #of insulin receptors on cells increase thereby allowing glucose to better enter cell Weight loss may reduce/eliminate need for po/sq meds Loose 5-10% of total weight Encourage, behavior therapy, group support, ongoing nutrition counseling for Long tERM ADHERENCE |
|
|
What are some methods of insulin delivery?
|
1. syringe
2. insulin pen 3. jet injector 4. insulin pump(see appendix) 5. implantable and inhalant insulin-Exubera contraindicated in lung patients, inhaler size of hammer OFF MARKET 6. transplant of pancreas or islet cell |
|
|
What are the goals for nutrition as it relates to DM?
|
- Proper diet
-Weight control -Meet energy needs -Prevent wide BG fluctuations -Decrease serum lipid levels -Strive for consistency in amount of calories, amount of CHOs(carbohydrates), and time between meals. This prevents hypoglycemia reactions – controls BG |
|
|
How does obesity impact DM?
|
BMI(Body Mass Index) 25 + or 20% above ideal body weight = obesity
Obesity = ↑ insulin resistance / ↓ insulin sensitivity Type 2 c wt loss #of insulin receptors on cells increase thereby allowing glucose to better enter cell Weight loss may reduce/eliminate need for po/sq meds Loose 5-10% of total weight Encourage, behavior therapy, group support, ongoing nutrition counseling for Long tERM ADHERENCE |
|
|
What are some methods of insulin delivery?
|
1. syringe
2. insulin pen 3. jet injector 4. insulin pump(see appendix) 5. implantable and inhalant insulin-Exubera contraindicated in lung patients, inhaler size of hammer OFF MARKET 6. transplant of pancreas or islet cell |
