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101 Cards in this Set

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  • Back
What is rapid acting insulin?
insulin lispro or aspart
what is the onset, peak and duration for rapid acting insulin?
onset 5-15 min
peak 1-2 hrs.
duration 3-4hrs
what is short acting insulin?
regular insulin
Humulin R, Nonolin R, Letin II R
What is the onset, peak and duration for short acting insulin?
onset 30min-1 hr
peak 1-3hrs
duration 6-8 hrs
What is Intermediate acting insulin?
NPH (Humulin N, Novolin N)

What is Diadetes Mellitus?
it is a metabolis disorder of the Pancreas; carbohydrates, fat, protien metabolism, chronic disorder.
The pancreas houses what?
The islets of Langerhans which is a secreting hormone
What does the islets of langerhans excrete?
Releases insulin, glucagon, somatostatin, and pancreatic polypeptide.
Insulin does what in the pancrease?
It lowers the level of blood glucose when it rises above normal limits
Glucagon does what in the pancrease?
It raises blood sugar levels by stimulating glycogenolysis
What helps to maintain a constant level of blood sugar by inhibiting the release of insulin and glucagon?
Diabetes is characterized by what?
absolute lack of insulin
impaired secretion of insulin
cellular restistance to the action of insulin
chronic systemic disease
what is the cause of diabetes?
cause is UNKNOWN
What are some of the risk factors for Diabetes?
-sedentary life style
-age 40
-gestational diabetes
-Hispanic 30%
-African American33%
Indian- 33-50%
What are some the complications of the diabetes?
Diabetic eye disease
Heart attack
Kidney disease
Peripheral vascular disease
Decreased wound healing
Beta cells does what in the inlets of langerhans?
they manufacture the INSULIN
Alpha cells does what in the inlets of langerhans?
they manufacture GLUCAGON
What is the only source of nutrition for the brain??
is the only source of nutrition for the brain
the glucose is absorbed into where in the body ??and
causing what to happen??
the GLUCOSE is absorbed into the blood stream, causing elevating blood sugar levels.
When blood sugar rises what is responding?
The BETA CELLS and they are secreting insulin
insulin attaches to the ______
and allows the _______ to enter the cells to provide needed energy
People with pre-diabetes have what?
Impaired fasting glucose
(100-125 mg/dL)
Impaired glucose tolerance (140-199 mg/dL after 2hr. glucose tolerance test)
Is Type I or Type II diabetes the worse one to have?
Type I
Type I (IDDM)
What is it?
Pancreas produces NO insulin
Onest is rapid-over a period of wks or months
Treatment Insulin injections, diet and exercise
More prone to hypoglycemia and ketoacidosis
Can Type II (NIDDM) turn into Type I ??
What is Type II??
It is when the pancreas produces SOME insulin but not enough or the cells of the body is not receptive to insulin
Pregancy induced
increases the risk for prenatal complications
increases the risk for developing diabetes later in life
Why does the insulin not enter the cell in Type I (IDDM)?
because the insulin is not available to unlock the door so the glucose keeps circulating in the blood stream
When there is not insulin it causes the liver to ?
Release glycogen which is changed to glucose
The body breaks down fats and proteins when there is not insulin causing what to be releases?
The KETONES are released and excreted in the urine as acetone.
When too many ketones are released what happens?
Ketones accumulate in the body and cause COMA called Diabetic coma or ketoacidosis.
The body takes it's own proteins and breaks it down to use as glucose causing what ??
What are the three P's??
Increased urine output
The high concentration in the blood pulls fluids from the tissues(osmosis)
This leads to freguent urination of large amounts
As blood sugar levels reach 180-200, glucose begins to be excreted in the urine
Increase thirst
The body attempts to replace the fluids lost.(signs of what?)
increased hunger
Body's attempt to take in nurients to replace the depletion of fats and proteins.
The body thinks it is not taking in enough nutrients(glucose) to supply the cells' needs
What are some of the symptoms of DEHYDRATION
-warm, dry, flushed skin
-poor skin turgor
-rapid weak pulse
-low blood pressure
-dry mucus membranes
What are the symptoms due to ketosis??
-Loss of appetite
-Nausea and vomitting
-Fruity odor to breath (acetone0
-flushed cheeks
-Dry mucus membranes and skin
-Rapid, weak pulse
What is the rate and depth of respiration longer as the body tries to rid itself of the acidosis?? (called)
What imbalance causes the potassium to shift out of the cells causing transient hyperkalemia in the bloodstream leaving the cells decreased.?
Electrolyte Imbalance
What are the causes of ketoacidosis??
-Noncompliance withmedical regimen
-Failure to eat
-anything that causes the cells to need more energy which increases the need for insulin whish the pancreas can't accommodate
What are the GOALs in treating DKA?
-Reduce elevated blood glocose
-Correct fluid and elecrolyte imbalances
-Clear the urine and blood of ketones
In treating DKA insulin drip does what for the body?
Insulin drip makes the glucose available for use by tissues.
IV fluid replacement in treating DKA does what for the body?
It rehydrates cells
Electrolytes replacement to replenish intracellular levels
Insulin causes potassium to move from where? Kidneys are eliminating what?
insuln causes potassium to move from the extracellular fliud to the cells as the same time the kidneys are eliminating the excess potassium in the urine.
When replacing fluids in the body what could happen?
What are the nursiing management in monitoring electrolytes by IV?
-Monitor IV infusions
-watch for hypervolemia
-Monitor blood and urine glucose levles
-Monitor electrolyte levels
Normal Blood sugar level is?
< 70
> 110
Diagnosing diabetic test are?
Venous Blood
Glycoslated hemoglobin
Oral glucose tolerance test
postprandial glucose test
capillary blood
Venous blood is done to ?
It is done to determine high or low blood sugar level.
-may be done routine or may be random or fasting
Glycoslated hemoglobin does what?
gives the average of the glucose level for the past 2-4 months
What testing does the patient remain NPO for 8hrs., fasting blood and urine are taken and a glucose bolus is consumed in determining diabetes?
Oral glucose tolerance test
In a oral glucose tolerance test what is normal, impaired tolerance and provisional diagnosis of diabetes?
Normal- < 140
Impaired torlerance > 140
Provisional diagnosis > 200
Before having the postprandial glucose test the patient must do what?
Patient will eat a meal of about 100 grams of carbohydrates after an overnight fast and 2 hrs. after the meal blood is drawn
The nurse should do what before the patient takes the postprandial glucose test?
And what is considered positive for diabetes?
-Make sure the patient eats at lest 75% of the meal
-Make sure the lab is on time drawing the blood and
> 160 is considered positive for diabetes
Finger Sticks
Allows for self-monitering
Must be used by all diabetics is what type of test?
With the capillary blood test should be done more frequently when?
It allows for what?
When the patient has illness, surgery, stress, increased or decreased activity
It allows for immediate results to prevent hypoglycemic or hyperglycemia reactions.
What are the S/S of HYPERGLYCEMIA?
3 "P"s
Dry skin
Blurred vision
Weight loss
What are the S/S of
Anxious/ nervous
Slurred speech
Impaired judgment / disorentation
What are the S/S SHARED between hyper and hypo glycemia/
vision disturbances
What can you do to treat hypoglycemia?
give complex carbohydrates and a protein such as peanut butter crackers, skim milk.
What should you do if the patient becomes unconsciosness and blood sugar is low?
give the patient subcutaneous, or intramuscular glucagon. or give IV med if doc. order.
Rebound hyperglycemia in response to hypoglycemia is what and happens when the most?
Somogyi phenomenon : the drop in BS causes what to happen in the body?
Dropping blood sugar signals the body to secrete glucagon, epinephrine, growth hormone and cortisol, raising BS to hyperglycemia
Somogye phenomenon is treated how?
Bychecking the BS level between 2 &4 am and again at 7 am and gradually reducing of evening insulin or using an intermediate acting insulin at bedtime
Results from changes in the small blood vessels
occur in both type I or type II
The basement membrane of the capillaries thickens which impairs the absorption of nutrients
Microvascular complications is aggrevated by what?
Eye damage due to diabetes can be avoided by how?
by controlling BS level
Diabetic Retinopathy nursing management is what?
Encourage therapeutic regimen for tight glucose control
Client education:
complications of diabetes
regular ophthalmic examinations
Causes loss of central vision
decrease in renal function
diabetic nephropathy due to microvascular complications
Diabetic nephropathy is caused by?
high levels of glucose in the filtrate damages the capillaries supplying the glomeruli
Diabetic nephropathy can be delayed by teaching what to yur patient?
monitor blood sugar
monitor blood pressure
take meds
no smoking
avoid meds/chemicals that damage the kidneys
What are the s/s of peripheral vascular disease?
decreased petal pulses
claudication (pain in the calf, back, or butocks while walking)
Peripheral vasular disease may lead to what?
Peripheral vascular disease may lead to decrease blood flow to the lower extremites;
cool and pale
skin ulcers
Neuropathic compications is what?
Pathological changes in the nervous tissues.
neuropathic complications are related to what?
poor glucose control
ischemic lesions of the nerves
chemical changes in the nerve cells.
The nerves in the stomach causing loss of muscle tone so that gastric empting is delayed is called what?
S/S of gastroparesis is what?
nausea, vomitting, gastric reflux and bloating after a meal
Peripheral neuropathy assessment findings are what?
disturbing sensations, digestive , urinary, and sexual dysfunction, dizziness, smaller skeletal muscles are signs of peripheral neuropathy.
The medical management peripheral neuropathy
diet exercise pain relief mesures
Why could the patient's foot become damaged?
Because the patient has lost sensation to the foot and has injured the foot and not taken care of feet.
What are the patient's teaching that could be done by the nurse to prevent injury to the foot?
Wash the feet daily with warm water and mild soap
dry well,
apply lotion, but not between the toes
inspect daily for:
calluses, ect.
wear proper shoes
How should the pateint care for the toes?
always cut the toenails after washing,
cut the toenails straight across and smooth edges with an emory board,
if toenails are thick a MD should cut nails
Teach the patient also for feet care:
do not use:
harsh chemicals such as corn removers, iodine hydrogen peroxide ect
heating pads or hot water bottles or ice packs because of decrease sensation in the feet
never go bare footed
never sit with crossed legs
The patient teaching in diet management is what for diabetes?
-meals and snacks should be eaten at regular times each day
-don't skip meals
-avoid foods high in sugar
-avoid foods high in saturated fat & cholestrol
-alcohol brev
-dietetic food is not necessarily good
weight loss is essential if overweight
Patient teaching during exercise
teach patient to add 10 grams of carbohydrates for each hr. of exercise. Prolonged exercise requires a protien and a carbohydrate
During an illness what should the patient do for their diabetes?
-blood sugar must be monitored more frequently
-continue to take insulin or hypoglycemia med
-type II may have to take insulin during illness
If patient with diabeties is unable to eat what should they do?
may drink sweetend drinks to help maintain carbohdrates
MD should be called if unable to eat for more than 24hrs. or vomitting and diarrhea last> 6hrs
What are the origins of
IIetin/ IIetin II
originates from human DNA
originates from human DNA
IIetin/ IIetin II
originates from pig DNA
1 mL contains ______ units of insulin
Storage of insulin is done how?
May be stored at room temp. for one month
Can be stored in the refrig. up to the expiration date closed once opened same 30 day expiration
Warm to room temp before giving
do not freeze
Do not use expired insulin
Which insulin is giving at night to stablize patient's blood sugar?
Insuliin glargine (Lantus)
The causes of hypoglycemia?
Too little food or skip a meal
too much insulin or diabetes pills,
more active than usual
the onset of hypoglycemia is what?
often sudden; may pass out if untreated
Symptoms of hypoglycemia is what?
fast heartbeat
blurry vision
weakness or fatigue
The causes of hyperglycemia is what?
too much food
too little insulin or diabetes pills
What are the symptoms of hyperglycemia?
extreme thirst
need to urinate often
dry skin
blurry vision
slow-healing wounds
Can diabetitics take more than one meds?