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272 Cards in this Set
- Front
- Back
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Pathophysiology of diabetes
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A disorder of glucose metabolism related to insufficient insulin.
Results from progressive destruction of pancreatic Beta cells due to an autoimmune process |
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___ to ____% of the ____cells of the pancreas are destroyed before there are any manifestations of diabetes
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80-90%
islet |
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Diabetes Type 1 generally occurs in ppl ......
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Generally occurs in people under 30, peak onset between 11 and 13. Incidence higher in whites than non whites and males over females
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A hormone produced by the beta cells of the islets of Langerhans of the pancreas
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insulin
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Required hormone for glucose utilization
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insulin
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Continuously released in the blood stream with periods of increased release in response to food ingestion
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insulin
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Average insulin released is __to __ U or ___ of body weight
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40-50
0.6 U/kg |
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Insulin maintains the glucose level between __ and ___mg/dl
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70- 110
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5 functions of insulin:
(promote, promote, inhibit, enhance, increase) |
Promotes glucose transport from the bloodstream into the cell.
Promotes storage of glucose as glycogen in the liver and muscle Inhibits gluconeogenesis Enhances fat deposition in adipose tissue Increases protein synthesis |
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These hormones-oppose insulin
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Glucagon
Cortisol Epinephrine Growth hormone by increasing the blood sugar through stimulating glucose production and output by the liver and decreasing movement of glucose into cells. |
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What are the 3 P's and what do they point to?
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Three P’s
Polyuria Polydipsia Polyphagia Diabetes Type 1 onset |
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What are the manifestations of diabetes?
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Usually rapid once pancreas no longer functioning, slow onset otherwise
Recent, sudden weight loss Three P’s Polyuria Polydipsia Polyphagia |
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increased thirst
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Polydipsia
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Polyphagia
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increased appetite
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Also known as:
DKA |
Ketoacidosis
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Also known as Diabetic Acidosis
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Ketoacidosis
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Also known as Diabetic Coma
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Ketoacidosis
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Ketoacidosis Caused by what? And what does it cause?
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lack of insulin
Hyperglycemia Ketosis Acidosis Dehydration |
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What precipitates Ketoacidosis?
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Undiagnosed diabetes
Infection Illness Inadequate insulin dosage Poor compliance Change in diet or exercise regimen |
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What are the steps to ketoacidosis
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Insulin is not present so…
Glucos cant b used for energy fat break down for energy metabolism of fat > ketones Ketones are acidic alters PH of the blood causing Metabolic Acidosis High sugar content causes severe dehydration |
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Insulin deficiency impairs ___ synthesis and causes protein to breakdown which results in ____ loss from tissues
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Insulin deficiency impairs protein synthesis
This causes proteins to break down The break down of proteins results in nitrogen loss from tissue |
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Insulin deficiency Stimulates the production
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of glucose (from the proteins) which further increases blood sugar
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Insulin deficiency causes glucose levels to rise which leads to
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osmotic diuresis
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Insulin deficiency untreated may cause ___ imbalance which can lead to what?
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Untreated.. leads to fluid and electrolyte imbalance
Renal failure may occur from the decreased fluid volume (hypovolemic shock). |
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What are the early Manifestations of Ketoacidosis?
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Early-
Lethargy and weakness Dehydration Poor skin turgor Dry mucous membranes Tachycardia Orthostatic hypotension Thirst Dry mouth |
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s/s of Ketoacidosis
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Severe dehydration
Sunken eyeballs Dry , loose skin Abdominal pain with or without anorexia and vomiting Kussmaul respirations Acetone breath Glucose >250 mg/dl, pH <7.35, serum bicarbonate<15 mEq/L Fever Urinary frequency |
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Ketoacidosis
Glucose ____mg/dl, pH ____, serum bicarbonate_____ |
>250
<7.35 <15 mEq/L |
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Interventions for Ketoacidosis
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Large bore IV for IV fluids
.9% NS per MD order Insulin therapy- IV drip- per MD order Assess skin and mucous membranes Monitor I & O Monitor labs: serum glucose, acetone serum and urine specific gravity, ABG’s, Na+ and K+- as ordered by MD Monitor VS and LOC- neurological check Cardiac monitor- maybe hemodynamic monitoring O2 per NC per MD order |
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Rapid acting Insulin
Names, onset, peak, duration |
Humalog(lispro)
Aspart (Novolog) 10 min, 1 hour, 3 hours |
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Short acting Insulin
Names, onset, peak, duration |
Regular (Humulin R, Novolin R)
1/2 -1 hr, 2-3, 4-6 |
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Intermeadiate acting Insulin
Names, onset, peak, duration |
NPH (humulin N, novolin N)&Lente
3-4, 4-12, 16-20 |
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Very long acting Insulin
Names, onset, peak, duration |
Glargine (Lantus)
1 hour, no true peak, duration 24 hours |
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Long acting insulin
names, onset peak duration |
Ultra Lente
6-8,12-16, 16-30 |
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Lantus (lente), how and when is it given?
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given at same time each day DO NOT MIX
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Current trends in diabetes treatment
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Byetta (type 2 only)
Insulin pump Jet injectors Nasal insulin (Exubera-type 2 only) Skin patch Oral insulin with enzyme control Oral spray |
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How do you mix insulin?
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NRRN
NPH, Reg, Reg, NPH 1st inject air in NPH then reg, then pull insulin from reg then NPH, clear to cloudy |
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Trends- Byetta incretin mimetics, pancreas, liver, appetite, stomach
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Byetta signals the pancreas to make the right amount of insulin after you eat, it sops the liver frmo making too much glucose, may also reduce your appetie, helps to slow how quickly food and glucose leave the stomach.
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Do I take my Insulin if I am sick??
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yes
Take insulin or oral agent as usual Test blood glucose and urine for ketones every 3-4 hours Report glucose >300 mg/dl to doctor or as otherwise directed If unable to tolerate regular meal, substitute soft foods (custard, eggs, broth) 6-8 x/day If V/D- ½ cup broth 1 cup Gatorade every ½-1 hour and report to health care provider |
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Teaching Plan for diabetes
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What is diabetes
What are the symptoms of high/low sugar Medication Diet (Refer to dietician) Exercise Management when ill Foot care Eye care Dental care Technique for injection Method, frequency of glucose monitoring Complications Routine follow up care |
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DCCT
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(Diabetes Control and Complications Trial)
3-4 injections per day to achieve control Goal: maintaining blood glucose levels to as close to normal as possible prevents or slows prevention of long term complications Allows patients to change insulin dose day to day in accordance to eating and activity pattern |
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DCCT, who are candidates who can't have tight control>
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Persons with autonomic neuropathy (disease of autonomic nerve that causes them to have hypoglycemic unawareness) they do not experience symptoms of hypoglycemia and can be severe hypoglycemic
Persons with recurring severe hypoglycemia, target goals for glucose levels should be raised in interest of safety Persons with permanent irreversible complications of diabetes (blindness from retinopathy or CRF) requiring dialysis as risks with intensive treatment outweigh benefits Patients with cerebral vascular or cardiovascular complications severe hypoglycemia may trigger CVA or cardiovascular event Patients who don’t take full responsibility for their care |
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Most prevalent of the diabetes, accounts for over 90% of patients with diabetes.
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Type II
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Usually occurs in people over 40 years old and 80-90% are overweight at the time of diagnosis.
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Type II
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Tendency to run in families and has a genetic basis
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Type II
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Native Americans 3 x and African Americans 1.7 x more likely to have Type ___ diabetes as non-Hispanic whites.
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2
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More than half diagnosed after age 55**Used to be called adult onset but no longer as diabetes is growing in numbers among children and adolescence
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type 2
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In Type II, the major pathophysiologic difference between type 1 and type 2.
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The pancreas continues to produce some insulin
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Insulin produced is insufficient for the needs of the body and/or is poorly utilized by the body.
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type 2
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Pathophysiology Three Major Metabolic Abnormalities in Type II diabetes
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1. Insulin resistance develops-insulin receptors are not responsive to the action of insulin or there are not enough receptors. This impairs the entry of glucose into the cell.
2. A marked decrease in the pancreas ability to produce insulin as the Beta cells become fatigued from trying to compensate for the elevated sugar levels. 3. Inappropriate glucose production by the liver. Instead of regulating release of glucose in response to blood levels, the liver releases glucose haphazardly without response to body’s needs. |
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Risk Factors- Type 11
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certain meds
inactivity HTN, high chol pregnacy race, stress obsiety age +65 family history |
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Diabetes Type 2 Manifestations
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Not as apparent usually as Type 1
Fatigue Recurrent infections (bacterial, vaginal yeast) Prolonged wound healing Visual changes Acanthosis Nigricans |
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Glucose Tolerance
Test |
Fasting sugar obtained, patient given 50-100g glucose, blood sugar drawn at intervals. Peak should be ½-1 hours with return to normal in 3 hours). Level of 200 mg/dl after 2 hours is diagnostic. Between 140 and 200mg is considered impaired fasting glucose and a risk factor
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Fasting Glucose (FBG)
TEST |
Exceeding 126 diagnostic for diabetes. Between 110 and 126 indicated impaired glucose tolerance (IGT)
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Non-fasting glucose
TEST |
Random greater than 200 with accompanying symptoms (polyuria) diagnostic for diabetes
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Glycosylated hemoglobin (HgbA1C)
TEST |
Used to determine glucose levels over time (3-4 months). Shows amount of glucose that attaches to hgb over the lifespan. Ideal for diabetic is <7%. Non diabetic 2-5%.
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Diabetes Type II diet based on pyramid
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Protein 10-20% of total daily calories
Fat less than 20-30% of daily calories (<10%saturated) Cholesterol less than 300 mg/day Carbohydrate should constitute the remaining 50-60% Sodium less than 2400 mg/day Fiber 25 to 30 gm/day Added fiber in diet improves glucose tolerance due to delayed absorption. Same effect occurs with type I diabetics :will thus decrease insulin need (if required) Alcohol sparingly. Absorbed before other nutrients. Insulin not required for absorption Hypoglycemia risk. Be careful of interactions – diabinese causes antabuse effect. Metformin- may cause lactic acidosis |
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Plate method for diatetes type 2 diet
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Helps visualize the amounts- 9 inch plate
Lunch and dinner one half of plate filled with nonstarchy vegetables one fourth is filled with a starch and one fourth with 2-3 oz of lean meat. A glass of skim milk and small piece of fresh fruit. Breakfast plate filled half way with starch, one fourth an optional protein. Skim milk and a small fruit. |
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Meds that decrease hepatic glucose output
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Biguanides Metformin (Glucphage).
Thiaxolidinediones Pioglitazone (Actos) and Rosiglitazone (Avandia) |
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meds that decrease glucose absorption also known as starch blockers
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Alpha Glucosidase Inhibitors- Action : slows the absorption of carbohydrates in the small intestine.Taken with first bite of meal.
Acarbose (Precose) and Miglitol (Glyset) |
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meds that increase peripheral glucose uptake
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Biguanides Metformin (Glucphage).
Thiaxolidinediones Pioglitazone (Actos) and Rosiglitazone (Avandia) |
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meds that increase insulin secretion
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Sulfonylureas- Action is to increase insulin production from the pancreas. Generally more effective early in course.
Examples: 2nd generation Glipizide (glucotrol), glyburide (Micronase, DiaBeta, Glynase), Glimepiride (Amaryl) Meglitinides-Action also to increase insulin production from the pancreas. However action is more rapid. When taken just before a meal increase pancreatic secretion of insulin mimicking the normal response. Examples: Nateglinide (Starlix) and Repaglinide (Prandin) |
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What meds have an Action that increases insulin production from the pancreas. Generally more effective early in course.
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Sulfonylureas
Glipizide (glucotrol), glyburide (Micronase, DiaBeta, Glynase), Glimepiride (Amaryl) |
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Action to increase insulin production from the pancreas. However action is more rapid. When taken just before a meal increase pancreatic secretion of insulin mimicking the normal response.
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Meglitinides
Nateglinide (Starlix) and Repaglinide (Prandin) |
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These medications action is to reduce glucose production by the liver. It also enhances insulin sensitivity at the tissue level and improves glucose transport into the cell.
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Biguanides
Metformin (Glucphage). |
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These medications action is to improve insulin sensitivity, transport and utilization. Will not cause hypoglycemia as they do not increase insulin production.
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Thiaxolidinediones
Pioglitazone (Actos) and Rosiglitazone (Avandia) |
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What medication is also known as starch blockers. Action : slows the absorption of carbohydrates in the small intestine.Taken with first bite of meal.
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Alpha Glucosidase Inhibitors-
Acarbose (Precose) and Miglitol (Glyset) |
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What medications may mask the symptoms of hypoglycemia and prolong the hypoglycemia effects of insulin
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beta blockers, Metropolol, Toprol, Atenolol, Inderal
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What medications can cause hyperglycemia because of the potassium loss. (Remember, K+ helps bring glucose into the cell)
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Thiazide and loop diuretics (Lasix, HCTZ)
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What is the effect of exercise on Type II?
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Regular consistent (time, amount) exercise
Increases insulin sensitivity and has a direct effect on lowering glucose levels. Promotes weight loss and insulin resistance. Improves circulation and muscle tone. Raises HDL, lowers LDL Weight loss may be the only treatment required for type II Glucose lowering effects can last up to 48 hours after activity Schedule 1 hour after a meal or have snack 10-15 g cho before Monitor glucose levels before, during and after ALSO: strenous exercise may increase glucose levels |
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Foot care cont'd
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Do not wear new shoes longer than 2 hours
Bath daily, watching skin folds Foot care as discussed, notify health care provider if wounds present Dental cleaning every 6 months, daily brushing and flossing. Inform dentist of condition. |
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Causes of hypeglycemia
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Causes: Too much food
Too little or no diabetic medication Inactivity Emotional, physical stress Poor absorption of insulin |
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Symptoms of hypeglycemia
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3 P's, dry skin, b.urred vision, nausea, drowsiness
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Causes of hypoglycemia
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Alcohol without food –reduces gluconeogenesis
Too little food- delayed or omitted Too much diabetic medication Too much exercise without compensation Diabetes med or food taken at wrong time Loss of weight without change in medication or diet Use of beta blockers masking symptoms |
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Symptoms of hypoglycemia
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shaking, fast HR, sweating, hunger, impaired vision,
dizziness, anxious |
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Chronic complications of Type 2 diabetes
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stroke, eye damage, heart attack, kidney damage, impotancey, numbness
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A complication Specific to diabetes
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Microvascular- (capillaries and arterioles)
Generally occur 10-20 years Diabetic retinopathy (other eye changes: cataracts, lens changes, visual disturbances, extraocular muscle palsy, glaucoma) Nephropathy Neuropathy |
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complications for diabetes type 2, large and small
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Macrovascular- (large and medium blood vessels)
Macrovascular- (large and medium blood vessels) |
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Prevent macro vascular complications by
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Quitting smoking
Tight glycemic control Maintaining normal lipid values Low fat diet, medications Weight loss Control of hypertension Exercise |
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15 years nearly all type 1 and 80% type II will have. Most common cause of blindness in 20-74 y/o
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Retinopathy
Occurs as a result of micro hemorrhage, leaking. Treatment- prevent blindness with regular eye exams (dilated) as there are no symptoms until blindness Treat vessels with cryotherapy, biectomy, photocoagulation with laser |
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Risks same for type I and II
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Leading cause of End Stage Renal Disease (ESRD) in the US
Risk factors HTN, smoking, genetic predisposition and hyperglycemia Occurs as a result of damage to the small blood vessels that supply the glomeruli of the kidney. |
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Nephropathy occurs because
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Occurs as a result of damage to the small blood vessels that supply the glomeruli of the kidney
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Treatment to prevent-
Nephropathy |
ACE inhibitors (Lisinopril, Enalapril) or ARB (Cozaar, Hyzar) due to its kidney protective effect. 1st choice for patients with HTN, given even in patients without hypertension
Yearly screening for microalbumin in urine> If present 24 hour urine for protein, creatinine clearance |
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a problem in peripheral nerve function (any part of the nervous system except the brain and spinal cord) that causes pain, numbness, tingling, swelling, and muscle weakness in various parts of the body. ...
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Neuropathy
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Nerve damage that occurs possibly as a result built up _____and ____
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sorbitol and fructose.
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(the most common) type of Neuropathy
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Sensory neuropathy
Effects the hands and feet causing paresthesias (pain, burning, numbness, tingling, itching, sometimes hyperesthesia- skin very sensitive**Story Time:Amy) Treatment- Control of blood sugar. May use meds to control the pain Antiseizure:gabapentin- (neurontin), Lyrica Tricyclic antidepressants: amitriptyline (Elavil)-Inhibits neurotransmitters serotonin and norepinephrine- transmit pain Capsaicin (Zostrix)- depletes accumulating pain mediating chemicals |
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Can affect nearly all body systems and lead to hypoglycemic unawareness, bowel incontinence, urinary retention, delayed gastric emptying, erectile dysfunction
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Autonomic neuropathy-
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Hyperglycemic Hyperosmolar Nonketotic Syndrome (HHNS)
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Life threatening syndrome that can occur in the patient with diabetes that is still able to produce some insulin. Because some insulin is released, DKA does not occur but there is not enough insulin to prevent hypergylcemia leading to osmotic diuresis and extracellular fluid volume depletion (celluar dehydration)
Usually precipitated by illness, physiological stress, some medications (thiazides) Glucose of >600 mg/dL |
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Glucose metabolism in pregnant diabetic
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Insulin requirements increase
Placenta produces human placental lactogen (HPL)an insulin antagonist. Placental enzyme insulinase accelerates breakdown of insulin Rate of glucose in kidney is increased which reduces the renal threshold for glucose |
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______ amniotic fluid greater than normal.Occurs 10X more in diabetic pregnancies. Causes premature rupture of membranes, pre-term labor
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Hydramnios (polyhydramnious)
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Most often occurs in 2nd or 3rd trimester often caused by maternal infection or illness
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Ketoacidosis
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Fetal/Neonatal risks and complications of the infant
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Macrosomia- Infant > 4000 g. 25-42% of pregnancies
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Increases in maternal serum and urine after 2 months of pregnancy and continues at high levels until term.
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Estriol levels-
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Gestational diabetes
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Develops during pregnancy
Usually detected 24-28 weeks of gestation Normal glucose levels within 6 weeks postpartum Risk of developing type II diabetes in 5-10 years is increased Diet is generally the treatment,may need insulin |
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Pre-gestational diabetic
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Not related to pregnancy
Glucose levels do not return to normal post partum without treatment Hereditary |
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Effects of surgery on blood glucose and resultant insulin therapy
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Stress may increase the glucose
Monitor blood glucose |
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Tests prior to C-Section
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Type and cross match or auto transfusion??
Ultrasound Blood sugar Cover BS with SSI |
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Too much insulin to available glucose =
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hypglycemia
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BS < 50mg/dL
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hypoglycemia
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Too much glucose to insulin in the blood
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hyperglycemia
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who has the highest risk factor for type I diabetes
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white males
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osmotic diuresis has what manifestations
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3 P's
poly: uria dipsia phagia |
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Which of the following statements about Type I diabetes vs. Type II diabetes is not true?
The Type I diabetic will require insulin for control The onset of Type I diabetes is generally more rapid Obesity is more often a predisposing factor in Type II diabetes Type II diabetics are more prone to develop ketoacidosis |
Type II diabetics are more prone to develop ketoacidosis
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Select the false statement(s) about the pathophysiological basis of the symptoms of diabetes:
Answer Polyphagia and weight loss occur because insulin deficiency impairs metabolism of protein and fats Polyuria occurs because the thirsty diabetic increases fluid intake Hyperglycemia produces diuresis All are false |
All are false
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Select the true statements about diabetic ketoacidosis:
Answer It may be caused either by overeating or by forgetting to take insulin Blood glucose is elevated Symptoms include fruit-smelling breath All of the above |
ALL
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Which nursing measures would be inappropriate for the client in diabetic/ketoacidosis?
Answer Starting an IV as prescribed Observing vital signs and level of consciousness frequently Injecting Glucagon IM All are inappropriate |
Injecting Glucagon IM
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During treatment of diabetic ketoacidosis:
Answer The aim of fluid and electrolyte therapy is to replace water and correct electrolyte deficits. Insulin drives K+ from the blood back into the cells Both of the above |
both
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The diagnosis of diabetes mellitus may be confirmed by this sensitive diagnostic test:
Answer Glucose tolerance test Fasting blood sugar Two-hour postprandial blood sugar Urine test for glucose and acetone |
glucose tolerance test
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The client who is scheduled for a fasting blood sugar should be told that he:
Answer Must have nothing by mouth except water for 16 hours before a blood sample is drawn Will be asked to drink a concentrated glucose solution Should void when the test starts and again when it ends None of the above |
none of the above
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client is given NPH insulin at 7 AM each day before breakfast. The peak of its effect is likely to occur:
Answer At 8:00 a.m. Late in the afternoon After midnight Before breakfast the next day |
late in afternoon
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Select the FALSE statement(s) about oral antidiabetic agents of the Sulfonylurea type:
Answer They stimulate the beta cells of the pancreas to secrete insulin Insulin dependent diabetics can easily switch to these drugs Side effects include hypoglycemia All of the above are false |
Insulin dependent diabetics can easily switch to these drugs
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Which statement would be inappropriate to include in a teaching plan for the client who is taking an oral hypoglycemic agent of the sulfonylurea group?
Answer They are contraindicated during pregnancy They may interact adversely with alcohol It is no longer necessary to adhere to a diabetic diet |
it is no longer necessary for diabetic diet
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Which statement is true about nutrition for a diabetic::
Answer The American Diabetes Association endorces a specific meal plan The goal is healthy eating The diabetic diet is very different than two the diet of a nondiabetic diet |
healthy eating
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Which statement is true?
Answer Diet and insulin is necessary for glucose control for a type 2 diabetic Bedtime snack is not usually necessary for a type 1 diabetic Consistency in daily intake is necessary for glucose control for a type 1 diabetic |
Consistency in daily intake is necessary for glucose control for a type 1 diabetic
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Macrovascular complications are thought to be a basis for which long-term complications of diabetes:
Answer Cerebrovascular disease Cardiovascular disease Peripheral vascular disease All of the above |
all of the above
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The diabetic should know that, on days when he is sick, he should:
Answer Omit daily insulin dosage Reduce usual daily insulin dosage by half Test blood glucose every 4 hours to detect need for additional insulin |
Test blood glucose every 4 hours to detect need for additional insulin
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Babies of diabetic mothers tend to be:
Answer Low birth weight, hyperglycemic Prone to respiratory distress, low birth weight, immature Excessively large, prone to respiratory distress, hypoglycemic Excessively large, postmature, diabetic |
Excessively large, prone to respiratory distress, hypoglycemic
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When a diabetic undergoes surgery, which problem may occur:
Answer Stress may raise the blood sugar and increase the need for insulin Infection or fever may lower the blood sugar and decrease the need for insulin Impaired circulation may lead to increased wound healing |
stress may increase BS
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Factors involved in insulin deficiency in the diabetic include:
Answer Impaired production of pancreatic insulin Insufficient insulin secretion in proportion to blood glucose levels Insulin resistance All of the above |
all
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Which of the following statements about Type I diabetes vs. Type II diabetes is true?
Answer Type I diabetes usually can be controlled with oral hypoglycemic drugs Most Type I diabetics have rather stable blood glucose levels Type II diabetics usually have some functioning islets of Langerhans Type II diabetes is usually diagnosed in the twenties |
Type II diabetics usually have some functioning islets of Langerhans
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Select the false statement about insulin reaction:
Answer It may be caused by skipping a meal There is too much insulin in the blood in relation to the amount of available glucose Occurs midmorning |
midmorning
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During treatment of diabetic ketoacidosis:
Answer The aim of fluid and electrolyte therapy is to replace water and correct electrolyte deficits Insulin drives K+ from the blood back into the cells Both of the above |
both
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In evaluating the results of an oral glucose tolerance test, you should know that, in the nondiabetic individual, the blood glucose level will:
Answer Elevate and then return to less than 140 mg/dl in 2 hours Elevate and then return to fasting level in four hours Show very little change from fasting level Drop noticeably and then gradually rise over two hours |
Elevate and then return to less than 140 mg/dl in 2 hours
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The usual procedure for a glucose tolerance test includes:
Answer High carbohydrate diet for several days before the test Drinking a concentrated carbohydrate solution after the fasting blood sample is taken Obtaining a blood specimen fasting and at one, two, and three hour intervals after the test starts All of the above |
all of the above
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Select the FALSE statement about oral antidiabetic agents:
Answer They can produce hypoglycemic reactions Are effective for selected diabetics They are a form of insulin which can be taken orally |
form of oral insulin
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Microvascular complications include:
Answer nephropathy (kidneys) retinopathy (eyes) dermopathy (skin) All of the above |
all
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The diabetes control and complications trial of 1993 validated:
Answer All diabetic clients benefit from tight control of blood glucose Importance of urine testing for glucose level information No effect with control of blood glucose during pregnancy Importance of goal of maintaining a lower glycosated hemoglobin level |
Importance of goal of maintaining a lower glycosated hemoglobin level
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When testing the blood with a blood glucose monitor, the nurse should be aware that:
Answer A small drop of blood covering 1/4 the pad is adequate the results are often inaccurate Blood samples should be taken p.c. None of the above |
none
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In regard to rest and exercise, the diabetic should be taught that:
Answer Physical exercise should be minimized because it interferes with glucose utilization Insulin dosage must be increased on heavy exercise days A regular pattern of rest and exercise should be followed as much as possible each day |
regular rest and exercise
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Select the true statement about diabetes and pregnancy:
Answer Most diabetic women are infertile or abort early on in pregnancy Diabetics are more likely than nondiabetics to suffer from toxemia and hydramnios Women with gestational diabetes will have serious visual and renal impairment as a result of pregnancy A cesarean section is recommended at 30 weeks for early delivery of a diabetic mother's baby |
Diabetics are more likely than nondiabetics to suffer from toxemia and hydramnios
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When the insulin-dependent diabetic undergoes surgery, you would anticipate that he would post operatively receive:
Answer Regular insulin subcutaneous according to a sliding scale NPH insulin subcutaneous in usual dose NPH insulin IV mixed in a bottle of 5% D/W No insulin while NPO |
regualr sliding scale
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Largest gland in the body
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liver
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Functions of the Liver
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Glucose metabolism
Ammonia conversion- to urea- kidneys remove Protein metabolism Clotting- Synthesizes clotting factors Albumin-Synthesizes plasma proteins Fat metabolism Cholesterol synthesis Vitamin and iron storage Bile formation Bilirubin excretion |
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Symptoms of Liver Dysfunction
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Jaundice
Fatigue Pruritus Abdominal pain Fever Anorexia Vitamin deficiencies Weight gain/Edema Increasing abdominal girth Hematemesis Melena Easy bruising/bleeding Sleep disturbance |
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Hepatitis A is caused by what
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Fecal-Oral
has vaccine crowded, contaminated food |
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hep B etiology, transmission, prevention
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from exposure tobody fluids, saliva
vaccine can overcome |
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Hep C
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IV drug use most common, body fluids chronic liver disease Increased cancer
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The edema causes RUQ pain and the liver is enlarged, what disease is it?
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hepatitis
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Diagnostic Evaluation for hepatitis.
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Bleeding times (PT/PTT) high
Serum and urine bilirubin Total serum protein-Decreased Serum albumin- Decreased - ALK Pho high AST high ALT high Ammonia high antigen antibody test |
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Why is a pt susceptible to hemorrhage with hepatitis?
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PT is increased. Liver responsible for the manufacture of clotting factors and the liver is not in proper working order
Nursing care to include: Good skin care, careful mouth care, small bore needles (minimize IM), check for bleeding gums |
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Why is a pt susceptible to pruiti with hepatitis?
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Pruritis develops as a result of increased bile salts in the blood.
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Diet, type? Rationale? Problems, with hepatitis
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High protein- For liver cell regeneration. Protein may be restricted when liver function is decreased due to decreased ability of liver to metabolize protein byproducts
High carbohydrates-Restore glycogen stores Low fat- Bile salts released in effort to break down fat Increase calorie- To counteract weight loss Small, frequent meals- Early satiety due to RUQ fullness Fluid intake of 2500-3000 mL per day Carbonated beverages and avoidance of very hot or cold foods may help anorexia |
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interventions for heptatits pt
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bedrest during icteric phase to increase liver cell regeneration and reduce meabolic demands, drugs entiemetics, NO COMPAZINE
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drug treatment for hepatitis
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reverse transcripatse inhibitors Epvie or Hepsera, treats chronis HBV, alpha interferon 3x/wk for 6months, remission
antiviral agent- ribaviran |
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Type B hep recovery is
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3-4 months or longer, 10% can die or develop chronic hep
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Phsychological stress of hep
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icterus-body image, isolation from others
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prevent hep
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No alcohol or raw shellfish?
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Functions of the Gallbladder
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Storage deposit for bile
Between meals with sphincter of Oddi closed, bile produced by the liver, enters the gallbladder. During storage, a large amount of water in the bile is absorbed through the wall so the bile is 5-10x more concentrated. When food enters the duodenum, the gallbladder contracts, sphincter of Oddi relaxes and bile enters the intestine. Capacity of gallbladder is 30-50 mL |
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Two types of gall bladder stones
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Pigment stones 25%,
Cholesterol stones (most common)- Cholesterol is the normal constituent of bile and is insoluable in water. 75% of time. . In gallstone prone clients there is a decrease in bile acids, and increase in cholesterol synthesis, resulting in bile supersaturated with cholesterol resulting in stone formation and inflammation due to irritation |
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Risk factors for Gallstones
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5 F's
fat female family history forty flatulent |
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Gallstones obstruct the bile duct causing
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jaundice, nausea and vomiting, RUQ pain radiating to the back, right shoulder and scapula. Clay colored stools due to lack of bile pigments. Urine dark from excretion of bile pigments
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Gallstone Symptoms occur
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primarily after a meal high in fat/fried foods when bile is trying to be released to break down the fat
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Symptoms of chronic cholecystitis include
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a history of fat intolerance, dyspepsia, heartburn and flatulence, vitamin deficiency
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Acalulous Cholecystitis thought to be caused from what?
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Inflammation unrelated to obstruction by stone. May occur after major surgery, trauma. Believed to be caused by change in fluid/electrolytes and bile stasis.
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Labs for gallstones
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high WBC, ALT, AST, Alk Phos,
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Objective assessment for gallstones
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-Fever, restless, jaundice, icteric sclera, diaphoresis, tachypnea, splinting during respirations, tachycardia, abdominal gaurding and distention. May have elevated liver enzymes, bilirubin (serum and urine), elevated WBC, abnormal GB ultrasound
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Non surgical procedures to treat cholelithiasis
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Nutritional and supportive therapy- IV, NG, pain med, antibiotics. Low fat liquid diet. Surgical tx held off until acute symptoms subside if possible.
ERCP- to remove stones |
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Medications that dissolve cholesterol stones
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(Ursodeoxycholic acid (UDCA) and chendeoxycholic acid (chenodiol or CDCA)
Cholesterol solvents methyl tertiary terbutyl (MTBE)- through catheter or during ERCP |
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Laproscopic cholelithiais nursing interventions post op
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Pain
Place in left Sims position to help move gas pocket away from diaphragm (causing irritation of phrenic nerve) PC: Bleeding R/L decreased Prothrombin production Risk for ineffective breathing pattern R/T pain Encourage deep breathing Encourage early ambulation and movement Knowledge deficit Common to have referred pain to shoulder- from CO2 |
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what is a Choledochostomy-
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Incision in common bile duct for removal of stones. Tube inserted in duct for drainage of bile until edema subsides
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what is a Cholecystostomy
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Cholecystostomy-Gallbladder is opened, stones, bile and pus are removed. T-Tube is inserted to ensure ductal patency. Trauma to the common bile duct stimulates inflammation which can impede bile flow and contribute to bile stasis.
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Thyroid hormones affect many vital body functions what are they
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HR, RR,
rate for calorie burn, skin maintenance heat production, fertility digestion |
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What is the second most common disease after diabetes?
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hypethyroidism
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Produces and stores 3 hormones:
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Thyroxine (T4)
Triiodothyroinine (T3) Calcitonin (lowers plasma calcium level by increasing deposition in bone) |
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What is essential to the thyroid for production of the 3 hormones
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iodine
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Secretion of T3 and T4 occur in response to
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TSH levels
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DIscharge teaching for hypothyroid patient in regard to medications
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Medication- Levothyroxine (synthroid) must take on empty stomach at same time daily
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Grave disease also known as
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hyperthyroidism
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manifestations of hyperthyroid, or thyrotoxicsosi
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Nervousness
Hyperexcitability Irritable, apprehensive Palpitations, increased HR Poor toleration of heat Flushed skin Warm, soft, moist skin Fine tremor Exophthalmos |
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Cirrhosis is a chronic disease characterized by
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replacement of normal liver tissue with diffuse fibrosis that disrupts the structure and function of the liver.
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Functions of the Liver- REMEMBER
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Glucose metabolism
Ammonia conversion- to urea- kidneys remove Protein metabolism Clotting- Synthesizes clotting factors Albumin-Synthesizes plasma proteins Fat metabolism Cholesterol synthesis Vitamin and iron storage Bile formation Bilirubin excretion |
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Manifestations late of cirrhosis
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Late-Result from liver failure and portal hypertension
Jaundice and pruritis- Skin lesions (spider angiomas) Hematologic problems –increased clotting times/vitamin K def Gastrointestinal varicies from increased pressure (portal hypertension) Malnutrion-lack of vitamin storage Edema- lack of albumin Ascites- Protein rich fluid accumulates in peritoneal cavity further worsened by hyperaldosterone leading to sodium and water retention and potassium loss Endocrine problems due to inability to metabolize hormones (Men- gynecomastia, loss of axillary and pubic hair, testicular atropy and impotence. Women-menstrual changes) Infection and peritonitis Mental deterioration- rising ammonia levels |
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Laboratory tests for cirrhosis
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AST- Elevated with liver cell damage
ALT-Elevated with liver cell damage LDH (lactate dehydrogenase) LDH 4 and 5 more specific to liver damage Bilirubin Elevated (direct (conjugated-soluble)and indirect (unconjugated-protein bound) Ammonia level –Elevated Byproduct of protein metabolism- converted to urea in the liver (normally functioning liver) Prothrombin time- Prolonged in liver disease Total protein (albumin decreased and globulins-increased) Albumin-Decreased Electrolytes-High sodium, low potassium |
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Medications for liver cirrohisis
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Aldactone (Spirolactone)-aldosterone blocking agent, helps prevent K+ loss and promote diuresis
Vitamin K 10 mg IM- Deficient absorption of vitamin K from GI tract, prevent hemorrhage as liver cells have problem making prothrombin Thiamine 40 mg daily- common vitamin deficiency causing polyneuritis, beriberi, Wernicke-korsakoff psychoses Multivitamin- 1 tablet- inadequate storage of A,D,E,K Lactulose (Cephulac) 5 mL po- reduce blood ammonia levels, promotes excretion of ammonia in stool. Side effect diarrhea **sometimes used for therapeutic effect of diarrhea |
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Assessment -Cirrhosis
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Alcohol intake, other drugs
Skin and eye color- jaundiced from increase in bilirubin Bleeding- check stools, urine, skin Mentation- Check for hepatic encephalopathy Diet history Level of comfort- pruritis, abdominal pain, edema Fluid and electrolyte –Weight/abd girth |
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Complications of liver problems
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Portal hypertension
Ascites Esophageal varices Hepatic encephalopathy and coma Asterixis Fector hepaticus Bleeding Hepatorenal Syndrome (HRS) Portal hypertension along with liver decompensation results in systemic vasodilation and decreased arterial blood volume Vitamin deficiency Metabolic abnormalities Pruritus and skin changes |
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Ascites – WHY?
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Portal hypertension causes resistance of blood flow through liver
Weeping of protein rich lymph from liver blocks lymph channel Decreased oncotic pressure from lack of albumin Hyperaldosteronism-From decreased renal blood flow causes increase in sodium and water retention Impaired water excretion from decreased renal vascular flow and excessive ADH |
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Nursing Interventions for paracentesis, treatment for ascites
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Pre
Ensure patient has voided (bladder decompression) Obtain sterile equipment Obtain consent During Patient in upright position edge of bed B/P cuff on arm Trocar introduced by MD and fluid drained Observe for vascular collapse (pallor, increased HR, decreased b/p) Post Patient comfortable Record amount, characteristic of fluid and send to lab |
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A nurse develops a plan of care for a client with hyperthyroidism and includes which of the following in the plan?
A. Provide small meals B. Provide extra blankets C. Provide a high-fiber diet D. Provide a restful environment |
restful environment
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A nurse is performing an assessment on a client following a thyroidectomy. The nurse notes that the client has developed hoarseness and a weak voice. Which nursing action is most appropriate?
A. Notify physician immediately B. Reassure the client that this is usually a temporary condition C. Check for signs of bleeding D. Administer calcium gluconate |
normal finding
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A client is admitted to an emergency room, and a diagnosis of myxedema coma is made. Which action would the nurse prepare to carry out initially?
Warm the client Administer fluid replacement Maintain an airway Administer thyroid hormone |
airway
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A client is taking NPH insulin daily every morning. The nurse
Instructs the client that the most likely time for a hypoglycemia reaction to occur is 2 to 4 hours after administration 6 to 14 hours after administration 16 to 18 hours after administration 18 to 24 hours after administration |
6-14
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A nurse is preparing a teaching plan for a client with diabetes mellitus regarding proper foot care. Which instruction is included in the plan?
Soak feet in hot water Apply a moisturizing lotion to dry feet but not between toes Always have a podiatrist cut your toenails; never cut them yourself. Avoid using a mild soap on the feet |
lotion not betweentoes
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A client is brought to the emergency room in an unresponsive state, and a diagnosis of hyperglycemic hyperosmolar nonketotic syndrome is made. The nurse would prepare immediately to initiate which of the following anticipated physician’s orders?
100 units of NPH insulin Endotracheal intubation Intravenous replacement of sodium bicarbonate Infusion of normal saline |
infuse normal saline
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A client with a diagnosis of diabetic ketoacidosis (DKA) is being treated in an emergency room. Which finding would a nurse expect to note as confirming this diagnosis?
Elevated blood glucose level and a low plasma bicarbonate Deceased urine output Increased respirations and an increase in pH Comatose state |
Elevated sugar and low bicarb thus acidosis
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A nurse provides instructions to a client newly diagnosed with type I diabetes mellitus. The nurse recognizes accurate understanding of measures to prevent diabetic ketoacidosis when the client states:
“I will stop taking my insulin if I’m too sick to eat.” “I will decrease my insulin dose during times of illness.” “I will notify my physician if my blood glucose level is greater than 250 mg/dL.” “I will adjust my insulin dose according to the level of glucose in my urine.” |
notify doc
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A client is admitted to a hospital with a diagnosis of diabetic ketoacidosis (DKA). The initial blood glucose level was 950mg/dL. A continuous intravenous infusion of regular insulin is initiated along with intravenous rehydration with normal saline. The serum glucose level is now 240 mg/dL. The nurse would next prepare to administer which of the following?
Intravenous fluids containing 5% dextrose NPH insulin subcutaneously An ampule of 50% dextrose Phyentyoin (Dilantin) for the prevention of seizures |
During treatment of DKA, when the blood glucose falls below 250 to 300 mg/dL, the infusion rate is reduced and 5% dextrose is added to maintain a blood glucose of about 250mg/dL or until the patient recovers from ketosis.
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A physician prescribes levothyroxine sodium (Synthroid), 0.15 mg PO daily, for a client with hypothyroidism. A nurse will prepare to administer this medication
Three times a day in equal doses of 0.5 mg each to ensure consistent serum drug levels In the morning to prevent sleeplessness Only when the client complains of fatigue and cold intolerance At various times during the day to prevent tolerance from occurring. |
morning
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A nurse is caring for a client admitted to the emergency room with diabetic ketoacidosis (DKA). In the acute phase the priority nursing action is to prepare to
Administer regular insulin intravenously Administer 5% dextrose intravenously Correct acidosis Apply an electrocardiogram monitor |
administer regualr insulin
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A client with type II diabetes mellitus has a blood glucose of greater than 600 mg/dL and is complaining of polydipsia, polyuria, weight loss and weakness. A nurse reviews the physician’s documentation and would expect to note which of the following diagnoses?
Diabetic Ketoacidosis (DKA) Hypoglycemia Hyperglycemic, hyperosmolar nonketotic syndrome (HHNS) Pheochromocytoma |
C HHNS
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A nurse is interviewing a client with type II diabetes mellitus. Which statement by the client indicates an understanding of the treatment for this disorder?
“ I am taking oral insulin instead of shots.” “The medications I’m taking help to release the insulin I already make.” “By taking these medications, I am able to eat more.” “When I become ill, I need to increase the number of pills I take.” |
Sulfonyureas help to stimulate the beta cells to produce insulin
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A nurse is caring for a client with type I diabetes mellitus. Which client complaint would alert the nurse to the presence of possible hypoglycemic reaction?
Hot, dry skin Muscle cramps Anorexia Tremors |
tremors
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A client who is currently taking levothyroxine sodium(Synthroid) complains of cold intolerance, constipation, dry skin, weight gain, and puffy eyes. Based on these findings, the nurse would anticipate which of the following prescriptions?
Increase levothyroxine sodium dosage after checking the T4 level Decrease levothryroxine sodium dosage after checking the T 4 level Discontinue levothyroxine sodium because the client is having an adverse reaction No change in medication as these are common side effects and will diminish with time. |
increase levothyroine
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A client with diabetes mellitus visits a health care clinic. The client’s diabetes mellitus previously had been well controlled with glyburide (DiaBeta), 5 mg PO daily, but recently the fasting blood glucose has been running 180 to 200 mg/dL. Which medication, if added to the client’s regimen, may have contributed to this change?
Prednisone (Deltasone) Atenolol (Tenormin) Phenelzine (Nardil) Allopurinol (Zyloprim) |
prednisone
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A hospitalized patient with type I diabetes mellitus received NPH and regular insulin 2 hours ago (at 7:30 am). The patient calls the nurse and reports that he is feeling hungry, shaky, and weak. The client ate breakfast at 8 am and is due to eat lunch at noon. List in order of priority the actions that the nurse would take, with # 1 being first
___Give the client ½ cup of fruit juice to drink ___Check the client’s blood glucose level ___Take the client’s vital signs ___Give the client a small snack of carbohydrate and protein ___Document the client’s complaints, actions taken and the outcome |
Check glucose level
Administer juice Check vital signs Administer snack Document |
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The nurse is performing an abdominal assessment. The nurse performs which assessment technique first?
Auscultation Inspection Palpation Percussion |
inspec
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The nurse is assessing a client 24 hours following a cholecystectomy. The nurse notes that the T- Tube has drained 750 mL of green-brown drainage. Which nursing intervention is most appropriate?
Notify the physician Document the findings Irrigate the T-Tube Clamp the T-Tube |
Normal finding for output to be 500-1000 first 24 hours
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The nurse is reviewing the record of a client with a diagnosis of cirrhosis and notes that there is documentation of asterixis. To assess for presence of this sign, the nurse would do which of the following?
Ask the client to extend the arms Assess for the presence of Homan’s sign Instruct the client to lean forward Measure the abdominal girth |
extend arms
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The client with ascites is scheduled for a paracentesis. The nurse is assisting the physician in performing the procedure. Which of the following positions will the nurse assist the client to assume for this procedure?
Supine Left side-lying Right side-lying Upright position |
upright with BP cuff on
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The nurse is reviewing the laboratory results in a client with cirrhosis and notes that the ammonia level is elevated. Which of the following diets would the nurse anticipate would most likely be prescribed for this client?
High-carbohydrate Moderate fat High protein Low protein |
low protein
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The client is admitted to the hospital for treatment of acute hepatitis B. Which activity order would the nurse expect to be prescribed?
Bedrest Encourage ambulation Out of bed in a chair No activity restrictions |
br
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The physician has determined that the client with hepatitis has contracted the infection from contaminated food. The nurse understands that this client is most likely experiencing what type of hepatitis?
A. Hepatitis A B. Hepatitis B C. Hepatitis C D. Hepatitis D |
a
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A client is suspected of having hepatitis. Which diagnostic test results will assist in confirming this diagnosis?
Decreased erythrocyte sedimentation rate Elevated serum bilirubin Elevated hemoglobbin Elevated blood urea nitrogen |
Elevated serum bilirubin
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The nurse is evaluating the effect of dietary counseling on the client with cholecystitis. The nurse would evaluate that the client understands the instructions given if the client stated that which of the following food items is acceptable in the diet?
Baked scrod Sauces and gravies Fried chicken Fresh whipped cream |
fish
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The nurse would assess the client experiencing an acute episode of cholecystitis for pain that is located in the right
Upper quadrant and radiates to the left scapula and shoulder Upper quadrant and radiates to the right scapula and shoulder Lower quadrant and radiates to the umbilicus Lower quadrant and radiates to the back |
Right upper quadrant pain radiating to right shoulder and scapula due to phrenic nerve irritation
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The client with cirrhosis is beginning to show signs of hepatic encephalopathy. The nurse would plan a dietary consult to limit the amount of which of the following ingredients in the client’s diet?
Fat Carbohydrate Protein Minerals |
protein
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The client with cirrhosis complicated by ascites is admitted to the hospital. The client has stated a 10 lb weight gain over the last week and a half. The client has edema of the feet and ankles. The abdomen is distended, taut, and shiny with striae. The nurse would select which of the following as the most appropriate nursing diagnosis for this client?
Imbalanced nutrition: more than body requirements Impaired gas exchange Risk for impaired skin integrity Excess fluid volume |
EFV
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The client with hepatitis is scheduled for a liver biopsy. The nurse implements which of the following to assess for the most common symptom of bile peritonitis following the liver biopsy?
Monitoring for bloody diarrhea Assessing for rebound tenderness Assessing for increased flatulence Monitoring for abdominal pain |
ab pain
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The client is admitted to the hospital with viral hepatitis, complaining of “no appetite” and “losing my taste for food.” To provide adequate nutrition, the nurse would instruct the client to
Eat a good supper when anorexia is not as severe Eat less often, preferably only three large meals daily Increase intake of fluids including juices Select foods high in fat |
increase fluids and juice
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A client has developed hepatitis A after eating contaminated oysters. The nurse assesses the client for which of the following?
Dark stools Left upper quadrant discomfort Malaise Weight gain |
malaise
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The nurse is caring for a black client who has a diagnosis of acute viral hepatitis. The nurse assesses for jaundice by checking which specific area?
Flexor surface of the extremities Hard palate of the mouth Nailbeds Skin |
Jaundice occurs in the skin and mucous membranes. In light skinned persons, jaundice is first seen in the sclera of the eyes and later in the skin. In dark-skinned persons, jaundice is observed in the inner canthus of the eyes and hard palate of the mouth. Pallor is detected in nailbeds and flushing from temperature is noted in the flexor surfaces of the extremities.
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The nurse should evaluate results of which of the following laboratory tests for a client who has cirrhosis in order to plan for safe care?
Prothrombin time Urinalysis Serum lipase Serum troponin |
Prothrombin time
Many clotting factors are produced in the liver, including prothrombin |
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The nurse caring for a client with hemolytic jaundice anticipates which of the following findings on the laboratory results?
Elevated serum indirect bilirubin Decreased serum protein Elevated urine bilirubin Decreased urine pH |
Elevated serum indirect bilirubin
Obstruction to portal blood flow causes a rise in portal venous pressure resulting in splenomegaly, ascites, and dilation of collateral venous channels predominantly in the paraumbilical and hemorrhoidal veins, the cardia of the stomach and extending into the esophagus. Bleeding gums would indicate insufficient vitamin K production in the liver. Muscle wasting, commonly accompanies the poor nutritional intake commonly seen in clients with cirrhosis. Hypothermia is an unrelated finding. |
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A client was admitted to the hospital with cholelithiasis the previous day. Which of the following new assessment findings indicates to the nurse that the stone has probably obstructed the common bile duct?
Nausea Elevated cholesterol level Right upper quadrant (RUQ) pain Jaundice |
jaundice
Nausea and RUQ pain occur in cystic duct disease, but obstruction of the common bile duct results in reflux of bile into the liver, which produces jaundice. Alkaline phosphotase increases with biliary obstruction but cholesterol level does not increase. |
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The nurse caring for a client with uncomplicated cholelithiasis anticipates that the client’s laboratory test results will show an elevation in which of the following?
Serum amylase Alkaline phosphatase Mean corpuscular hemoglobin concentration (MCHC) Indirect bilirubin |
Alkaline phosphotase
Obstructive biliary disease causes a significant elevation in alkaline phosphotase. Obstruction in the biliary tract causes an elevation in direct bilirubin, not indirect bilirubin |
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In caring for the client 4 days post-cholecystectomy, the nurse notices that the drainage from the T-tube is 600 mL, in 24 hours. Which is the appropriate action by the nurse?
Clamp the tube q 2hours for 30 minutes Place the patient in a supine position Assess drainage characteristics and notify the physician Encourage an increased fluid intake |
Assess drainage characteristics and notify the physician
The T-tube may drain 500 mL in the first 24 hours and decreases steadily thereafter. If there is excessive drainage, the nurse should further assess the drainage to be able to describe it accurately and notify the physician immediately. |
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The post-cholecystectomy client asks the nurse when the T-tube will be removed. Which of the following responses by the nurse would be appropriate?
“When your stool returns to a normal brown color, the tube can be removed.” “The tube will be removed at the same time as your staples.” “When the tube stops draining, it will be removed.” “The tube is usually removed the day after surgery.” |
A When T tube drainage declines and stool returns to normal brown color, the tube can be clamped 1-2 hours before and after meals in preparation for tube removal. If the client tolerates clamping, the tube can be removed.
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Which of the following assessments made by the nurse could indicate the development of portal hypertension in a client with cirrhosis?
Hemorrhoids Bleeding gums Muscle wasting Hypothermia |
A. Hemorrhoids Obstruction to portal blood flow causes a rise in portal venous pressure resulting in splenomegaly, ascites, and dilation of collateral venous channels predominantly in the paraumbilical and hemorrhoidal veins and others. Bleeding gums would indicate insufficient vitamin K production in the liver. Muscle wasting commonly accompanies the poor nutritional intake commonly seen in clients with cirrhosis.
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The nurse is caring for a client who has ascites, and the health care provider prescribes spirolactone (Aldactone). The client asks why this drug is being used. Which is the best response by the nurse?
“This drug will help increase the level of protein in your blood.” “The drug will cause an increase in the amount of hormone aldosterone your body produces.” “This medication is a diuretic but does not make the kidneys excrete potassium.” “This will help you excrete larger amounts of ammonia.” |
Spirolactone is used in clients with ascites that show no improvement with bedrest and fluid restriction. It inhibits sodium reabsorption in the distal tubule and promotes potassium retention by inhibiting aldosterone.
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When caring for a client who has cirrhosis, the nurse notices flapping tremors of the wrist and fingers. How should the nurse chart this finding?
“Trousseau’s sign noted.” “Caput medusa noted.” “Fector hepaticus noted.” “Asterixis noted.” |
D D Asterixis, also called liver flap, is the flapping tremor of the hands when the arms are extended. A reflects hypocalcemia. B refers to spiderlike abdominal veins that are also commonly found in clients with cirrhosis who have portal hypertension as a complication. Option C is a specific odor noted in liver failure.
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Diagnostic test for TSH
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T# an T4 levels
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what is a symptom of hypertyroidsm
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constipation
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bed rest and antiviral meds would be ordered for the person with Hep __
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A
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a disease associated with hyperthyroidims
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graves disease
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OA, oral antidiabetics that cause decrease glucose production from the liver
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biguanides
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when checking a newborn from a diabetic mother 2-4 hours after birth you'd look for what
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signs of hypoglycemia
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you would test for ketone in the urine when BGL are
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> 240 mg/dL when tested two times
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meds that decrease hepatic glucose output in liver
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Biguanides: glucophage
Thiaxolidinediones- actos and avandia |
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meds that decrease glucose absorption in intestines
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alpah glusodieuse inhibitors
prcose and glset |
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meds that increase peripheral glucose uptake in muscles
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Thiaxolidinediones: actos and avandia,
Biguanides-glucophage |
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meds that increase insulin secretion from pancreas
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sulfonylurea: flipizide, glyburide, limepride
meglitinides: nateglinide, praglinide |
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men who drink 4 or more glassse or beer wine or other drinks each day are high risk for
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cirrhosis
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bed rest and antiviral meds would be ordered for the person with Hep __
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A
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a disease associated with hyperthyroidims
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graves disease
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OA, oral antidiabetics that cause decrease glucose production from the liver
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biguanides
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when checking a newborn from a diabetic mother 2-4 hours after birth you'd look for what
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signs of hypoglycemia
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you would test for ketone in the urine when BGL are
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> 240 mg/dL when tested two times
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meds that decrease hepatic glucose output in liver
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Biguanides: glucophage
Thiaxolidinediones- actos and avandia |
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meds that decrease glucose absorption in intestines
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alpah glusodieuse inhibitors
prcose and glset |
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meds that increase peripheral glucose uptake in muscles
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Thiaxolidinediones: actos and avandia,
Biguanides-glucophage |
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meds that increase insulin secretion from pancreas
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sulfonylurea: flipizide, glyburide, limepride
meglitinides: nateglinide, praglinide |
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men who drink 4 or more glassse or beer wine or other drinks each day are high risk for
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cirrhosis
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hepatocellular jaundice is cause by an obstruction in the bile duct, T or F
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F, it is not in the liver...hepatocellular is
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Vit K is needed for sythesis of
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prothrombin, PT time
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a common symptom of ascitesis
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increase ab girth
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esophogeal varies result from what
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portal hypertension, big veins
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leading cause of acute liver failure is
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tylenol
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high levels of serum ammonia can cause
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hepatic encephalopathy
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Alk Pho and a glutamyltacaisferase are markers for
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cholestasis
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very long acting insulin
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lantus, glargine 1 hour onset duration 24 hours
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metoprolo (toperol XL and Lopressor are what class and used for what
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beta blockers HTN
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Type 2 diabetes is more prevalant that one T or F
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true
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Can an insulin dependent pt have the physiological decrease in ciruclating insulin that normally occurs with exercise?
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NO
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Lassic clinical maifestations of all types of diabetes include the three P's what are they
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polydypsia (thirst)
polypahgia, polyuria |
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what is the term used to describe how much a given food increases the blood glucose level compared with an equivalent amount of glucose
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glycemic index
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a blood test that relfects average blood glucose levels over a period of 2-3 months
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Clycolicated HG aclhg
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what is the most common risk of insulin pump therapy
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ketoacidosis
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what are 3 major acute complications of diabetes related to short term imbalances in blood glucose levels
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hypoglycemia, DKA, hyper....
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The DCC, CTT study
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tight control of glucose to prevent long term complications like renal failure etc.
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Kussamal def
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rapid deep breathing
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when glucsoe levels approach 250mg/dL in ketoacidosis what do you do
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5% dextrose
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Short acting insulins, 2
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Humulin R, Novloin R
generic: Reuglar Human Insulin injection, recombinant DNA origin |
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Humulin R and Novoling R, are what type of insulin and what is onset, peak and duration
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Short Acting
Onset, 30min-1hr, peak 2-3 hours, duration 4-6 hours |
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Rapid Acting Insulin (2)
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Humalog-insulin lispro injection and Novalog- asvarte
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Humalog-insulin lispro injection and Novalog- asvarte are what type of insulin and give onset, peak and duration
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rapid acting
Onset: 5-15 min Peak: 1 hour Duration: 2-4 |
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Intermediate Acting Insulin (2)
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Humulin L-lente human insulin
Humulin N- NPH human insulin Nolvolin N-NPH human insulin |
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Humulin L-lente human insulin
Humulin N- NPH human insulin Nolvolin N-NPH human insulin are what kind of insulin and give onset peak and duration |
Intermediate Acting
Onset: 2-4 hours Peak: 4-12 Duration: 16-20 |
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Long acting insulin (1)
onset peak and duration |
Humulin U-ultralente human insuling,
onset 6-8 hours, peak 12-16 duration: 20-30 hours |
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very long acting insulin (1)
onset, peak and duration |
Lantus- insulin glargine
CAN NOT MIX w/ other insulins onset 1 hour peak: no peak duration 24 hours |
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type one or two?
thirst up bed wetting rapid onset |
type one
also weight decrease |
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type one or two?
eye problems slow onset |
type two also increased weight
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Dx of DM type one or two done by FBG would be what
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FBG >126 mg/dL confirmed by test on another day
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dx of DM type I or II
3 tests with numbers |
FBG > 126 mg/dl on 2 seperate days
casual or random glucose > 200mg/dl + symptoms glucose tolerance test > 200mg/dL |
