Term
| What makes the Pancreas an Exocrine Gland? |
|
Definition
| Releases digestive enzymes |
|
|
Term
| What makes the Pancrease an Endocrine Gland? |
|
Definition
| Beta cells in the Islets of Langerhans produce and secrete insulin in response to rise in blood sugar |
|
|
Term
| Does insulin ever go down to zero? |
|
Definition
| No. Insulin responde to blood sugars |
|
|
Term
| Name 3 ways that glucose gets into the blood; |
|
Definition
1. Intestine
2. Liver
3. Protein Catabolism |
|
|
Term
| How does glucose get into blood through Intestine? |
|
Definition
| absorption of simple sugars |
|
|
Term
| How does glucose enter blood through liver? |
|
Definition
| Convert Glycogen-->Glucose |
|
|
Term
|
Definition
| Breakdown glycogen to Glucose |
|
|
Term
| How does Protein catabolism allow glucose to enter blood? |
|
Definition
|
|
Term
|
Definition
| Making glucose from things other than carbohydrates, such as fatty acids and amino acids |
|
|
Term
| What is glucose used for in The Tissues? |
|
Definition
|
|
Term
| What is glucose used for in The Liver? |
|
Definition
Reserve supply as Glycogen in the liver
It is also converted to fat |
|
|
Term
|
Definition
|
|
Term
|
Definition
| Glucose is stored as glycogen |
|
|
Term
| What is Renal Threshhold? What happens during renal threshold? |
|
Definition
When BS>200
Body starts to excrete glucose in urine (called Glucoseria)
This will pull fluids with glucose out of the body |
|
|
Term
|
Definition
1. Transport & metabolizes glucose for E
2. Stimulates storage of glucose in the liver in the form of Glycogen (process called Glycogenesis)
3. Enhances storage of fat in adipose tissue
4. Transports amino acids & glucose into the cells
5. In hibits the breadown of stored glucose, protein, & fat
|
|
|
Term
| What happens during fasting of a non diabetic? |
|
Definition
Pancrease releases a base level of insulin AND Pancrease release Glucagoon (hormone made by Alpha cells-stimulate process of Glycogenolysis-breakdown of glycogen to glucose)
Resulting in constant level of BS |
|
|
Term
| What percentage of diabetics are Type I? |
|
Definition
|
|
Term
What is the Pathophysiology of Type I?
Leading to what? |
|
Definition
1. Destruction of Beta Cells
2. Glucose not stored as glycogen
3. Glycogenolysis & glyconeogenesis occu unrestrained
4. Fat breakdown occurs
LEADING TO HYPERGLYCEMIA |
|
|
Term
| Can TYPE I survive without insulin? |
|
Definition
|
|
Term
| TYPE 2 Diabetes Etiology? |
|
Definition
1. Insulin Resistance
AND/OR
2. Decreased production of Insulin |
|
|
Term
| How is Type 2 usually treated? |
|
Definition
| Lifestyle changes and some oral medication |
|
|
Term
| When is insulin given for a Type 2? |
|
Definition
|
|
Term
| Does Type 2 breakdown fats to form glucose? |
|
Definition
|
|
Term
| What is the third type of Diabetes? |
|
Definition
Gestational Diabetes- pregnant women w. high blood sugar.
Gestational Diabetes is at higher risk of coverting to Type 2 diabetic |
|
|
Term
| What are the 3 major symptoms of Hyperglycemia? |
|
Definition
1. polyurea
2. Polydipsea
3. Polyphasea |
|
|
Term
What causes Polyurea?
Can lead to what? |
|
Definition
| BS>200, renal threshhold is eliminating glucose and pulling fluids-->lead to Fluid Volume Deficit |
|
|
Term
What causes Polydipsea?
This can lead to what? What are physical manifestations? |
|
Definition
Increase glucose-->Increase Osmotic pressure intravascularly-->Pull fluids from intracellular-->Intracellular FVD
Physical manifestations: Poor skin turgor, dry mucous membranes... |
|
|
Term
|
Definition
Glucose is unavailable to cells-->hunger
Because decrease or lack of insulin |
|
|
Term
| What are some other signs and symptoms of Hyperglycemia? |
|
Definition
BS>126, Visual Changes
Late Signs: Hypotensive, Renal Failure, FVD, Cellular Dehydration, Coma & Death |
|
|
Term
| What is the #1 nursing intervention for Hyperglycemia? |
|
Definition
|
|
Term
| How often should you check blood sugar for Type I? |
|
Definition
|
|
Term
| How often check BS for Type II? |
|
Definition
| 2-3/week. 2 hrs postprandial (after meal) |
|
|
Term
What do you do for patients of Type I and Type 2 who are hospitalized?
When given?
When should you call the MD? |
|
Definition
They are on a fractional scale for Insulin Dose.
Give in Morning & Bedtime
Call MD if BS>400 |
|
|
Term
| What are other nursing interventions for Hyperglycemia? |
|
Definition
| 2. Fluids 3. Airway 4. Patient Teaching 5. Diet 6. Activity & Exercise 7. Oral Meds (Type 2 ONLY) 8. Decrease Stress |
|
|
Term
| Oral meds are given to ONLY who? |
|
Definition
|
|
Term
| What kind of oral meds do you give to Type 2 pts? |
|
Definition
1. For Insulin Resistance- Antihyperglycemic Agents
2. For Decrease Insulin Production- Hypoglycemic Agents |
|
|
Term
| What kind of medication is used for Insulin Resistance Type II? |
|
Definition
Antihyperglycemics:
Actos, Glucophage, Glycet, Precose, Avandia
TO DECREASE INSULIN RESISTANCE |
|
|
Term
What is the action of Thiazolidinediones (Actos)?
ADE? |
|
Definition
DECREASE Insulin resistance
ADE: Increase incidence of Angina, MI |
|
|
Term
What are the actions of Biguanide (Glucophage)?
ADE?
What precaution must be taken? |
|
Definition
Action:DECREASE insulin resistance, DECREASE Hepatic Glucose Production
BLACK BOX WARNINING: Lactic acidosis Common: N,V, abd discomfort
Precaution: Stop 24-48 hrs b/f contrast dye |
|
|
Term
What do Alpha-Glucosidase Inhibitors (Glyset, Precose) do?
ADE? |
|
Definition
Delays GI absorption of glucose.
ADE: Abd discomfort, Diarhea, flatulence |
|
|
Term
| Can Antihyperglycemics cause HYPOGLYCEMIA? |
|
Definition
|
|
Term
| What kind of medicaiton is given to Pts with Impaired Insulin Production Type IIs? |
|
Definition
|
|
Term
What are the actions of Sulfonylureas (Glucotrol, Miconase, Diabeta)?
ADE? |
|
Definition
Increase Insulin Production
ADE: Hypoglycemia Common: N, Abd fullness |
|
|
Term
What are the actions of Megitinide?
ADE? |
|
Definition
Increase Insulin Production
ADE: Hypoglycemia |
|
|
Term
Diagnostic Tests for diabetics:
Fasting Glucose Level:
Random Glucose Level:
Hemoglobin A1C: |
|
Definition
Fasting Glucose level> 126
(Normal is 70-100)
Random Glucose Levle > 200 on more than 1 occasion
(Normal is below 200)
Hemonglobin A1C: > 6.5 or 7%
(Normal is 4-5%) |
|
|
Term
Humalog (Lispro) is what kind of an agent?
When is it given? |
|
Definition
| Rapid Acting. Given bf meals |
|
|
Term
What type of drug is Regular Insulin?
When is it given?
How is it administered? |
|
Definition
Short Acting. Given before meals
Given via IV |
|
|
Term
What type of agent is NPH, Lente?
When is this given? |
|
Definition
Intermediate Acting
Given after meals |
|
|
Term
What kind of agent is Ultralente (UL)?
|
|
Definition
|
|
Term
What kind of agent is Glargine (Lantus)?
Precautions? |
|
Definition
Long Acting.
DO NOT MIX with other insulins! |
|
|
Term
| Generally how is insulin administered? |
|
Definition
|
|
Term
| What kind of insulin cover meals immediately AFTER injection? |
|
Definition
|
|
Term
| What kind of insulin covers subsequent meals? |
|
Definition
|
|
Term
| What kind of kind of insulin provides constant level and acts as basal inuslin? |
|
Definition
|
|
Term
| What are 3 precautions for administering Insulin? |
|
Definition
| 1. ONLY regular insulin is given IV 2. Rotate site to prevent Lipoatrophy 3. Mixing ONLY CLEAR TO CLOUDY! |
|
|
Term
|
Definition
GET NPH into REGULAR!!
NEVER MIX LANTUS & GLARGINE with ANYTHING! |
|
|
Term
What are considered conventional Insulin Regimes?
This is to keep BS at what level? |
|
Definition
1 injection or 2 injections / Day
Keep BS at around 140 |
|
|
Term
| When is 1 injection/day administered? |
|
Definition
| Short acting (lispro) & Intermediate acting (NPH) before breakfeast |
|
|
Term
| When is 2 injections/day administered? |
|
Definition
| Before Breakfeast (Lispro & NPH) and Before Dinner (Lispro & NPH) |
|
|
Term
How many injections are given for Intensive Insulin Regimes?
Goal is to keep BS at what level? |
|
Definition
3-4 Injections/Day
Keep BS at 100 |
|
|
Term
| Who is at risk for Intensive Insulin Regimes? |
|
Definition
| Risk for Hypoglycemia. CAD & Elderly patients need to be careful |
|
|
Term
| What 2 insulins CAN NOT BE MIXED WITH ANYTHING! |
|
Definition
|
|
Term
When is Insulin pumps often used?
Do you still need to do testing? |
|
Definition
For pediatric patients.
Still need to do testing! |
|
|
Term
What causes Hypoglycemia?
Progression? |
|
Definition
1. Too little food 2. Too much insulin or diabetes medicine
Onset is SUDDEN |
|
|
Term
| What cells are very sensitive to drop in BS? |
|
Definition
|
|
Term
| What are symptoms of Hypoglycemia? |
|
Definition
1. BS< 60
2. Nervousness, trembling
3. Increase SNS
4. Moist & clammy skin
5. Dizziness, anxious, hunger
6. Impaired vison
7. Weakness, fatigue
8. Confusion, irritable, restless
9. Convulsions w BS<40
Coma-->death |
|
|
Term
| What are Nursing Interventions for Hypoglycemia? |
|
Definition
| Give sugar, Glucagon IV, Check VS, Monitor BS, Comatose-maintain airway, Patient Education |
|
|
Term
|
Definition
Cold & clammy, you need som candy
Hot & Dry, your sugar is too high |
|
|
Term
| What are complications with Insulin Therapy? |
|
Definition
|
|
Term
What are the symptoms of Diabetic Ketoacidosis?
|
|
Definition
| 1. Hyperglycemia 2. FVD 3. Acidosis |
|
|
Term
| What is the BS of Ketoacidosis? |
|
Definition
|
|
Term
| What is BS of Hyperglycemia caused by Ketoacidosis? |
|
Definition
|
|
Term
Acidosis has what PH?
What kind of acidosis is it normally? |
|
Definition
| PH< 7.2, Metabolic Acidosis |
|
|
Term
| What are the nursing assessments for Ketoacidosis? |
|
Definition
| Bs 300-800, Resp: rapid & depp, Acidosis, Ketones in urine & blood, FVD & electrolyte Loss |
|
|
Term
| What are the medical managements of DKA |
|
Definition
| 1. Insulin 2. Hydration (NS or .45 NS), Electrolyte K, Acidosis |
|
|
Term
| What are the Sick Day Rules for Type 1 & 2? |
|
Definition
| 1. Take insulin/oral meds as usual 2. Test BS every 3-4 hrs (if Type I BS>200, test for ketones) 3. Report BS>300 4. Small, freq meals 5. V or D: 1/2 cola, juice, or broth every 1/2 hr 6. Report N/V/D to MD |
|
|
Term
| What are symptoms of HHNS? |
|
Definition
| 1. Hyperglycemia 2. FVD 3. Tachy 4. Alteration in concioiusness |
|
|
Term
| What are the nursing assessments for HHNS? |
|
Definition
| 1. Type 2 2. BS>1000 3. RR:WNL 4. Ph WNL 5. Ketones |
|
|
Term
|
Definition
|
|
Term
| Compare and Contrast DKA & HHNK |
|
Definition
|
|
