Nclex Ch04 U02-01: Alterations In Glucose Metabolsim

Front 1

ALTERATIONS IN GLUCOSE METABOLISM

Back 1

ALTERATIONS IN GLUCOSE METABOLSM

Front 2

Assessment of alteration in glucose metabolism (4)

Back 2

1. polyuria
2. polydipsia
3. polyphagia
4. weight change

Front 3

How is DM characterized?

Back 3

by glucose intolerance

Front 4

Onset of DM-1?

Back 4

before age 30

Front 5

Physiology of DM-1?

Back 5

pancreatic beta cells destroyed by autoimmune process

Front 6

Give insulin to DM-1?

Back 6

yes

Front 7

What are people w/ uncontrolled DM-1 prone to?

Back 7

ketosis

Front 8

Onset of DM-2?

Back 8

older than 30 & obese

Front 9

physiology of DM-2?

Back 9

1. insulin resistance

OR

2. decreased insulin production

Front 10

What is insulin resistance?

Back 10

decreased sensitivity to insulin

Front 11

Does ketosis occur w/ DM-2?

Back 11

no, rare

Front 12

Give insulin for DM-2?

Back 12

NO:

tx w:
1. diet & exercise
2. oral hypoglycemic agents

Front 13

Onset of gestational DM?

Back 13

during pregnancy (2nd or 3rd trimester)

Front 14

A mom w/ GDM is considered to have __

Back 14

a high risk pregnancy

Front 15

What is impaired fasting glucose? Why is it significant?

Back 15

above 110 mg/dl and below 126 mg/dl

risk factor for future DM devo

Front 16

DM-2 Risk Factors (8)

Back 16

1. parents & sibs w/ DM
2. obesity (20%+ above ideal BW)
3. AA, hispanic, Native Am., Asian
4. 45+
5. previously impaired fasting glucose
6. HTN
7. HDL <35 mg/dL, TG>250 mg/dl
8. hx of GDM or baby 9+lb

Front 17

3 tests to help detect DM

Back 17

1. blood glucose monitoring
2. urine ketones
3. glycosylated hgb (HbA1c)

Front 18

Normal range in FASTING BLOOD GLUCOSE

Back 18

60-110 mg/dL

Front 19

Presence of sugar in the urine is a sigh of DM, calls for an immediate __

Back 19

blood glucose test

Front 20

What does the presence of urine ketones indicate?

Back 20

DM control has deteriorated & the body has started to break down stored fat for energy

Front 21

What is a HbA1c?

Back 21

a blood sample that can be taken WITHOUT fasting

Front 22

Normal values for HbA1c?

Back 22

4-6%

Front 23

Special considerations that might impact testing for DM? (3)

Back 23

1. meds
2. illness
3. stress

Front 24

4 goals for nutrition management in a pt w/ DM

Back 24

1. provide all essential food constituents (low lipids if elevated)
2. ideal BW
3. meet energy needs
4. achieve normal-range glucose levels

Front 25

4 methods for nutrition management in a pt w/ DM

Back 25

1. Food exchange
2. Carb counting
3. Food guide pyramid
4. Glycemic index

Front 26

What is a food exchange?

Back 26

foods on list in specified AMOUNTS contain equal number of calories, and G of fat, protein, carbs

Front 27

How does insulin work?

Back 27

lowers BG by facilitating uptake and the use of glucose by muscle & fat skills

Front 28

How does the presence of insulin impact the release of glucose from the liver?

Back 28

decreases its release

Front 29

When you mix insulins, which should you draw up first?

Back 29

REGULAR FIRST

Front 30

Sites of insulin injections?

Back 30

1. abdomen
2. posterior arms
3. anterior thighs,
4. hips

Front 31

What special consideration should you consider for insulin injections?

Back 31

ROTATE SITES

Front 32

How many times should one use a self injection syringe?

Back 32

use a disposable syringe 1x and discard into a hard plastic container w/ a tight-fitting top

Front 33

"Sick day rules": how should you take DM meds?

Back 33

take insulin or oral agent as ordered

Front 34

"Sick day rules": how often should you check blood glucose & urine ketones?

Back 34

q3-4 hr

*report altered levels to MD

Front 35

"Sick day rules": what should you do if the pt can't follow a normal meal plan?

Back 35

sub soft foods (soup, custard, gelatin) 6-8x/day

Front 36

"Sick day rules": if V, D, or fever?

Back 36

1. report to MD
2. take liquids (cola, broth, Gatorade) every 0.5-1 hour

Front 37

2 possible actions of oral hypoglycemic agents?

Back 37

oral hypoglycemic agents:
improve both tissue responsiveness to insulin and/or the ability of the pancreatic cells to secrete insulin

Front 38

SMBG?

Back 38

self monitoring of blood glucose

Front 39

What must we check to assure that it is safe for one to self-monitor their BG?

Back 39

eyesight to make sure the pt can see directions and read results

Front 40

If taking insulin, how often should you check the pt's BG?

Back 40

2-4x/day

Front 41

If not taking insulin, how often should you check the pt's BG?

Back 41

2-3x/week

Front 42

What is the goal time for testing to be performed?

Back 42

at the peak action time of medication

Front 43

4 guidelines for skin and foot-care in pt w/ DM?

Back 43

1. inspect feed DAILY (use mirror if pt is old/has decreased mobility)
2. wear well-fitting shoes
(break in new shoes slowly by wearing 1-2 hr initially w/ gradual increase in time)
3. don't walk barefoot or use a heating pad on feet
4. cut toenails STRAIGHT across w/o rounding corners

Front 44

When should a pt w/ DM NOT exercise?

Back 44

1. extreme temperatures
2. when control of DM is poor

Front 45

6 common complications a/w DM?

Back 45

1. hypoglycemia (insulin reaction)
2. hyperglycemia (DKA)
3. HHNKS (hyperglycemic hyperosmolar nonketotic syndrome)
4. diabetic retinopathy
5. coronary artery dz
6. cerebrovascular dz

Front 46

BG of a pt/ w/ hypoglycemia (insulin rxn)

Back 46

BG: <50-60 mg/DL

Front 47

S&S of hypoglycemia?

Back 47

1. CNS: irritability, confusion, tremors, coma, seizures
2. blurring of vision
3. hypOtension
4. tachycardia
5. skin: cool, clammy, diaphoretic

Front 48

If hypoglycemic pt is conscious, what should you give?

Back 48

liquids containing sugar,

SKIM MILK is ideal if tolerated

Front 49

If hypoglycemic pt is UNconscious, what should you give?

Back 49

Dextrose 50% IV & glucagon 1 mg IM or SQ

Front 50

After giving a hypoglycemic pt appropriate liquids, what should you give 15 min later?

Back 50

additional carb

Front 51

3 main causes for hypoglycemia?

Back 51

1. too much insulin/oral hypoglycemia agent
2. inadequate food
3. excess exercise

Front 52

BS of a pt w/ hyperglycemia (DKA)?

Back 52

BS 300-800 mg/dL

Front 53

S&S of hyperglycemia (DKA)?

Back 53

1. CNS: headache, drowsy, weak, stupor, coma
2. hypOtension
3. tachycardia
4. elevated T
5. polyuria-->oliguria-->polydipsia-->polyphagia
6. *fruity odor to breath

Front 54

What type of breathing does aperson w/ hyperglycemia (DKA) undergo?

Back 54

KUSSMAUL RESPIRATIONS (rapid & deep)

Front 55

How does a pt w/ hyperglycemia (DKA)'s skin appear/feel?

Back 55

skin is warm & dry

w/ dry mucus membranes

Front 56

What is a major complication a/w hyperglycemia (DKA)?

Back 56

fluid volume DEFICIT

Front 57

3 infusions that a hyperglycemic (DKA) pt will receive?

Back 57

1. first 2-3 hr: 1 L of NS/hr
then, 200-500 ml/hr 1/2NS
then, D5W or D51/2NS
2. REGULAR IV insulin 5 units/hr
3. K replacement

Front 58

In a hyperglycemic (DKA) pt, what are 2 areas that you should assess q2-4 hr?

Back 58

q2-4hr:

1. EKG
2. K

Front 59

If a patient is hyperglycemic (DKA), what are 4 areas that you should check HOURLY?

Back 59

HOURLY:
1. level of consciousness
2. UO
3. T
4. blood glucose levels

Front 60

If a pt is hyperglycemic (DKA), how often should you check the VS?

Back 60

VS: q15min until stable

Front 61

If a pt is hyperglycemic (DKA), how often should you assess the CVP?

Back 61

CVP: q30 min

Front 62

3 major causes of hyperglycemia (DKA)?

Back 62

hyperglycemia (DKA)

1. decreased/missed insulin
2. illness/infection
3. untx DM

Front 63

BS level of a pt/ w/ HHNKS?

Back 63

BG >800 mg/dL

Front 64

In which age group does HHNKS typically manifest?

Back 64

>50 y/o

Front 65

Which type of DM is a/w HHNKS?

Back 65

DM-2

Front 66

Does ketosis and acidosis occur w/ DM-2 or HHNKS?

Back 66

NO

Front 67

S&S of HHNKS?

Back 67

1. hypOtension
2. DRY mucus membranes
3. poor skin turgor
4. tachycardia
5. CNS: alteration in sense of awareness, seizures, hemiparesis

Front 68

Replacement therapy for HHNKS (3)?

Back 68

1. NS or 1/2NS
2. REGUlAR insulin
3. K

Front 69

Before replacing a pt w/ K, what must you first assess?

Back 69

**make sure the UO is satisfactory

Front 70

3 main causes of HHNKS?

Back 70

1. acute illness
2. meds (ie thiazides)
3. treatments (dialysis)