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;
130 Cards in this Set
- Front
- Back
|
What is the Target Blood Glucose Range?
|
70-110 mg/dL
or 90-130 mg/dL after meals |
|
|
What are the counter regulatory hormones, and what do they do?
|
Glucagon, Epinephrine, growth hormone, and cortisol. They produce the opposite effect of insulin, they increase blood glucose.
|
|
|
What happens in Diabetes Mellitus Type 1?
|
The Beta cells in the pancrease are destoryed, so the body does not make insulin.
|
|
|
What are the three P's of Diabetes Mellitus Type 1?
|
Polydypsia, polyuria, polyphagia
|
|
|
How does the body develop acidosis in DM Tpye 1? What happens if untreated?
|
The body metabolizes fatty acids which creates ketone bodies (acidosis). DKA results if untreated.
|
|
|
How is DM Type II controlled?
|
With diet or oral hypoglycemic agents, and possible insulin.
|
|
|
What are the two P's of DM Type II?
|
Polydypsia and polyuria
|
|
|
If DM Type II goes untreated, what may result?
|
Hyperosmolar non-ketotic coma
|
|
|
How does gestational diabetes develop?
|
Growth hormone from the placenta blocks the action of the mother's insulin
|
|
|
What happens to the baby in a gestationally diabetic mother?
|
The mother's BG is high, so extra glucose gets to the baby and the baby will put on extra weight (baby usually weigh's > 9 pounds)
|
|
|
What is diabetes insipidus?
|
Has nothing to do with insulin. Patient has normal BG, but still has S/S of hypoglycemia caused by an ADH insufficiency to polyuria to dehydration to hypernatremia.
|
|
|
What is the cause of diabetes insipidus?
|
Brain tumors, infection, CVA, pituitary surgery, renal/organ failure
|
|
|
What are drugs that can cause diabetes?
|
Corticosteriods, thiazides, phenyton (dilantin), and atypical antipsychotics (clozapine)
|
|
|
What lab test are used to diagnose DM?
|
Fasting Blood Sugar, Two hour glucose tolerance test, and Glycosylated hemoglobin A1C
|
|
|
What are the possible results of fasting blood sugar anad what do they indicate?
|
Greater than 126X2 = Diabetes
100-125 = Pre-diabetes Less than 110 = Normal |
|
|
What result from the two hour glucose tolerance test would indicate diabetes?
|
Greater than 200
|
|
|
What result from the A1C would indicate diabetes?
|
Greater than 7-9%
|
|
|
When do kidneys start to spill glucose into the urine?
|
When the BG is greater than 180
|
|
|
What sort of testing is recommended for DM Type 1 and 2 during illness?
|
Urine Ketone Testing
|
|
|
How often should a Type 1 diabetic test during the day?
|
3-4 times a day
|
|
|
Are pumps good for noncompliant patients? Why or why not?
|
No, because if they do not eat, they may have a hypoglycemic episode since the insulin is continuosuly being infused.
|
|
|
What is the goal for DM Type 1 Medications?
|
To think like the pancreas
|
|
|
What is the "gold standard" for treatment of DM Type 1?
|
Insulin injections 3-4 times per day
|
|
|
What are you most careful of when a patient is on insulin?
|
Its hypoglycemic effects
|
|
|
What are the rapid acting insulins? Onset, peak, and duration?
|
Lispro, Aspart, and Glulisine
Onset: .25 Hours Peak: 1- 1.5 Hours Duration: 3-5 Hours |
|
|
What are the short acting insulins? Onset, peak, and duration?
|
Regular (Norolin-R and Humulin-R)
Onset: 0.5 Hours Peak: 2-3 Hours Duration: 4-6 Hours |
|
|
What is the intermediate acting insulin? Onset, peak, and duration?
|
NPH
Onset: 2 Hours Peak: 4-6 Hours Duration: 6-8 Hours |
|
|
What is the long acting insulin? Onset, peak, and duration?
|
Lantus
Onset: 2 Hours Peak: 16-20 Hours Duration: 24+ Hours |
|
|
Can you mix Lantus?
|
NO
|
|
|
Which type of insulin is Cloudy?
|
NPH
|
|
|
How do you draw up insulins when you will be mixing them?
|
Draw up clear to cloudy. So always draw up NPH last!
|
|
|
Which area absorbs insulin in the most constant manner?
|
The abdomen
|
|
|
Which insulin can be given IV?
|
Regular
|
|
|
When using an insulin drip on a patient who is hyperglycemic, what needs to be started when BG gets down to 250?
|
Dextrose IV
|
|
|
What is the goal for medication use in Type II diabetics?
|
To decrease insulin resistance and to increase insulin sensitization in the cells.
|
|
|
When are oral hypoglycemic taken?
|
Prior to a meal
|
|
|
Examples of sulfonylureas?
|
Glimepiride, glipizide, glyburide, tolazamide, tolbutamide
|
|
|
How do sulfonylureas work?
|
They stimulate the pancreas to secrete more insulin, and they increase sensitivity of peripheral tissues to insulin.
|
|
|
What is important to teach patients about sulfonylureas?
|
Some may interact with ETOH causing HA, flushing, and nausea
|
|
|
Example of meglitinide?
|
Repaglinide (Prandin)
|
|
|
How do meglitinides work?
|
Stimulate pancreas to produce more insulin.
|
|
|
Example of biguanide?
|
Metformin
|
|
|
How do biguanides work?
|
Decrease the overproduction of glucose by the liver
|
|
|
What is important to remember when taking care of the patient on Metformin?
|
To temporarily D/C before and after the use of contrast media
|
|
|
Examples of Alpha-gluoside inhibitors?
|
Acarbose and miglitol
|
|
|
How do alpha-glucoside inhibitors work?
|
The work in the small intestine to delay carbohydrates digestion and glucose absorption
|
|
|
Examples of thiazolidinediones
|
Actos and Avandia
|
|
|
How do thiazolidinediones work?
|
The sensitize peripheral tissues to insulin.
|
|
|
Examples of amino acid derivatives?
|
Starlix and Prandin
|
|
|
How do amino acid derivatives work?
|
The stimulate the pancreas to produce insulin.
|
|
|
Which oral hypoglycemic work by stimulating the pancreas to produce more insulin?
|
Sulfonylureas, meglitinides, and amino acid dereivatives
|
|
|
Which oral hypoglycemic work by sensitizing peripheral tissues to insulin?
|
Sulfonylureas, biguanides, and thiazolinediones
|
|
|
Which may be an indicator that a lipodystrophy is present?
|
Requiring large doses of insulin
|
|
|
What are complications of DM with hyperglycemia?
|
DKA and Hyperosmolar hyperglycemic syndrome (HHS)
|
|
|
How does DKA develop?
|
Glucose is not utilized- fat is metabolized - metabolic acidosis - ketones spill into urine - depleted electrolytes
|
|
|
What are the characteristics of DKA?
|
Hyperglycemia, ketosis, metabolic acidosis, and dehydration
|
|
|
What might you expect to see in early DKA?
|
Lethargy, weakness, poor skin, dry mucous membranes, tachycardia, abd pain
|
|
|
What might you expect to seee in late DKA?
|
Kussmaul's respirations
|
|
|
What lab values might you find in DKA for BG, pH, bicarb, and potassium?
|
BG > 300
pH < 7.30 Bicarb < 15 Potassium low (hypokalemia) |
|
|
What happens in HHS (hyperosmolar hyperglycemia syndrome)?
|
There is not enough insulin to maintain normal BG levels, but there is enough to keep DKA from developing.
|
|
|
What type of patient is most likely to develop HHS?
|
Patient who is > 60 years old with DM Type II
|
|
|
Signs/Symptoms of late stages of HHS?
|
Somnlence, coma, seizures, hemiparesis, aphasia
|
|
|
Treatments to expect in DKA and HHS?
|
IV Fluid and electrolyte replacementm insulin therapy, moniter BG and urine
|
|
|
What blood glucose indicates hypoglycemia?
|
Less than 70
|
|
|
Signs/symptoms of hypoglycemia?
|
Irritability, confusion, tremors, hunger, rapid pulse, sweating, weakness, and anxiety
|
|
|
What is the treatment for an unconscious patient with hypoglycemia?
|
SQ or IM injection of 1 MG glucagon and IV administration of 50% glucose
|
|
|
What might help delay the progression of diabetic nephropathy?
|
ACE inhibitors, weight loss, exercise, and decreased sodium in diet
|
|
|
What is the goal of dietary control for the diabetic patient/
|
Consistent and controlled blodd glucose levels
|
|
|
Carbohydrates should consist of what percentage of total diet?
|
50%
|
|
|
Proteins should consist of what percentage of total diet?
|
30%
|
|
|
When is the best time for a diabetic to exercise?
|
After a meal when the BG is rising.
|
|
|
What would be appropriate treatment for the insulin dependent diabetic before surgery?
|
IV with dextrose and half normal saline dose needed to cover hepatic glucose production during surgery.
|
|
|
What is the GFR?
|
The amount of fluid filtered from the blood into the Bowman's capsule per minute.
|
|
|
What is a normal GFR?
|
120-125 mL/min
|
|
|
Factors that affect GFR?
|
Total surface area available for filtration, permeability of the membrane, net filtration pressure
|
|
|
Bladder capacity?
|
1000 mL
|
|
|
Usual void?
|
+300 mL
|
|
|
What is anuria?
|
Less than or equal to 100 mL of urine in 24 hours
|
|
|
What is oliguria?
|
100-600 mL of urine in 24 hours
|
|
|
Minimum hourly urinary output?
|
30 mL/hour
|
|
|
What needs to be done for an Urine analysis indicated for suspicion of a UTI?
|
Clean catch speciman
|
|
|
How long is a urine specimen good to sit out at room temperature? Why?
|
30 minutes, because RBC's breakdown, casts disintegrate, and bacteria multiply
|
|
|
Normal lab values: specific gravity, urine protein, serum BUN/Cr?
|
Specific Gravity: 1.005-1.030
Urine Protein: 2-8 BUN: 5-25 Cr: 0.5- 1.5 |
|
|
Which is better indicator of kidney malfunction: BUN or Cr?
|
Cr, because BUN can be changed due to so many other causes.
|
|
|
Why might older adults have a decreases Cr?
|
Because of decreased muscle mass
|
|
|
Common drugs for a UTI?
|
Bactrim and Cipro
|
|
|
What needs to be done before a patient has an intravenous pyelogram (IVP)?
|
Patient will need to be NP, have IV assess, have bowel prep, check for shellfish allergy (because of contrast) and D/C metformin.
|
|
|
What should the post void residual volume be?
|
Less than 50 mL
|
|
|
What are cystitis?
|
Inflammation of the bladder wall
|
|
|
What are urethritis?
|
Inflammation of the urethra
|
|
|
What are pyelonephritis?
|
Inflammation of the kidney
|
|
|
What is the most common type of causative agent for a UTI?
|
E. coli- a gram negative bacteria
|
|
|
What does multiple bacteria types of low count in a UA indicate?
|
Contaminated speciman
|
|
|
Where are renal calculi formed primarily?
|
Renal pelvis
|
|
|
What are stones made out of?
|
Most commonly Calcium, struvite, and uric acid
|
|
|
What kinds of diets might the patient with renal calculi be on?
|
Low calcium, low oxalate, or low purine.
|
|
|
What would be important to report after open renal surgery?
|
Urine output less than 1/2 mL/Kg/hour Or lack of any output from any urethral catherter for greater than 15 minutes.
|
|
|
What is finasteride?
|
Blocks conversion of hormone leading to decrease in prosate size.
|
|
|
How does glomerulonephritis affect the kidney?
|
It causes inflammation of the glomerulus, which impedes its ability to filter.
|
|
|
How is glomerulonephritis classifed?
|
Primary: Immune response to a pathogen
Secondary: Related to a secondary disease |
|
|
Signs/Symptoms of acute glomerulonephritis?
|
Hematuria, proteinuria, frothy urine, cola colored urine, fatigue, weakness, N/V, edema (especial facial), fluid retention, increased BUN, oliguria to anuria, and GFR decreased to 50 mL/min
|
|
|
How is acute glomerulonephritis treated?
|
Sodium resistriction, protein resistriction, high carbohydrate diet to prevent protein metabolism for fuel, high calorie diet and bed rest
|
|
|
What does chronic glomerulonephritis usually result in?
|
Chronic renal failure
|
|
|
Signs/symptoms of glomerulonnephritis?
|
Proteinuria, fluid retention and edema, kidney cannot concentrate urine, reduced GFR, high BUN, malaise, weight loss, irritability
|
|
|
Treatment for chronic glomerulonephritis?
|
No known treatment. Teach healthy lifestyle to slow progression
|
|
|
What is nephrotic syndrome characterized by?
|
Massive loss of protein in the urine, and hypoalbuminia in the blood
|
|
|
Signs/symptoms of nephrotic syndrome?
|
Edema from lack of protein in blood, hyperlipidemia, anemia, hypovolemia (intravascular), DVT, increased susceptibility to infection.
|
|
|
Treatment for nephrotic syndrome?
|
Steroids, control symptoms, avoid renal failure.
|
|
|
When do symtoms for polycystic kidney show up?
|
Around 40-50
|
|
|
Signs/symptoms of polycystic kidney?
|
Hematuria, proteinuria, HTN, UTI, and renal insufficiency
|
|
|
What are the three phases of acute kidney failure?
|
Initiation phase: Begins with the inisting event and ends with tubular injury occurs
Maintenance phase: Acute tubular necrosis occurs. Recovery phase: Tubular cell repair and regeneration |
|
|
Signs/symptoms typical of the maintance phase in acute renal failure?
|
Hypernatremia, hyperkalemia, increase water retention (edema) - CHF, pulmonary edema, JVD, tachycardia, low O2 sats, azotemia, metabolic acidosis because of impaired hydrogen ion excretion, and anemia due to decreased erythropoietin production
|
|
|
What population has the highest mortality rate from acute renal failure? Why?
|
Elderly, because of underlying health problems
|
|
|
What are important treatments for acute renal failure?
|
Fluid and waste products need to be controlled (dialysis), Increase renal blood flow (Dopamine, IV fluids), Manage electrolytes (Kayexalte, bicarb for acidosis and K management), Aggressive HTN treatment, relief of obstruction
|
|
|
What are the stages of chronic renal failure?
|
Decreasing renal reserve: GFR at 50% of normal, unaffected nephrons compensate for lost nephrons, patient is asymptomatic
Renal insufficieny: BUN/Cr start to rise, GFR 20-50% of normal, mild anemia, and azotemia. Renal failure: BUN/Cr continue to rise, anemia, azotemia, acidosis, oliguria, GFR at 10-20% or normal End stage Renal disease: GFR < 5% normal, renal replacement therapy needed to sustain llife |
|
|
What are the two 24 hour test used to diagnose renal failure?
|
24-hour creatinine clearance
24-hour urine protein |
|
|
What are important treatments for the patient with chronic renal failure?
|
Fluids, electrolyte control, dietary control (low protein, low sodium, high calorie), erthropoetin stimulating agents and iron (for RBC production), diuretics, anti-hypertensives, dialysis
|
|
|
What are priorities in managing nursing care for the chronic renal failure patient?
|
Drug management, fluid management, electrolyte monitoring, and comfort
|
|
|
What is important to remember in nursing care of the chronic renal failure patient?
|
Their alterations in comfort- they have dry, itchy skin, bone pain; halitosis, muscle cramping (from Na depletion and phosphate accumulation)
|
|
|
What are two ways hemodialysis is accessed in the dialysis patient?
|
AV-fistula and gortex graft
|
|
|
How does the nurse care for the AV-fistula?
|
Palpate and documet (Bruit present); prevent tigh clothing, BP cuff, lab draw, etc.. on that arm
|
|
|
What are the complications of hemodialysis?
|
Disequilibrium syndrome, dialysis encephalopathy, hypotension, and access malfunctions (clotting, bleeding, or infiltration)
|
|
|
What is diaysis encephalopathy?
|
Aluminum toxicity from aluminum found in the water dialysate bath
|
|
|
What nursing measures should be taken for the patient on dialysis?
|
Weight the patient before and after, Frequent Vital signs, measure serum electrolyte before dialysis, determine drugs that are dialysized out and get an order to put them on temporary hold until after dialysis, determine the need to hold HTN meds due to possible hypotension risk
|
|
|
What is the major complication of renal transplantation?
|
The patient has to be on immunosuppressive drugs for the rest of their life.
|
|
|
What is the definition of obesity?
|
Patient is 30% above ideal body weight or has a BMI greater than or equal to 30
|
|
|
What is the definition of morbid obesity?
|
Patient is 100 pounds above ideal body, or has a BMI greater than 40, or has a BMI greater than 35 with two other co-morbidities
|
|
|
How should the obese patient be positioned to listen to their heart sounds?
|
On their left side
|
|
|
What muscle would be the best for giving an obese patient an IM injection?
|
Deltoid
|
|
|
What is the most common presentation of glomerular injury in a child?
|
Nephrotic syndrome
|
