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Adult 1 Quiz 2
Acid Base, Diabetes, Upper and lower Resp and Diag Tests
37
Nursing
Undergraduate 3
08/14/2012

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Term
Diabetes Mellitus
Definition
Multi-system disease related to abnormal insulin production, impaired insulin utilization or both
Term
DM and Ethnicity
Definition
Native Americans, Hispanics and AA highest
Term
DM can cause
Definition
cause of heart disease, cerebral vascular accidents, renal failure, blindness, and non traumatic limb amputation
Term
Normal Blood Glucose Range
Definition
70-100
Term
Insulin
Definition
is released from the pancreatic Beta cells.
promotes transport of glucose from the bloodstream across the cell. membrane to the cytoplasm of the cell.
Impacted by Incretin hormone
Term
Rise in Insulin after a meal
Definition
Stimulates storage of glucose as glycogen in the liver and muscle (glycogenesis)
Inhibits conversion of proteins to glucose (gluconeogenesis)
Enhances fat cells to store triglycerides
Increases protein synthesis
Term
Incretin Hormone
Definition
Produced in intestines
Secreted in response to the presence of food
Increases insulin, decreases glucagon, slows the rate of gastric emptying
Term
Secondary Diabetes
Definition
Chemical: caused by meds/steroids
D
Term
Type I Diabetes
Definition
Failure of pancreas.
Genetic/recessive.
Can be caused by virus.
Under age of 40.
Peak age at 20 y/o.
Progressive destruction of pancreatic B cells.
Requires continuous insulin.
Diabetic Ketoacidosis
Term
Type I diabetes 3 P's (Acute Onset)
Definition
Polydipsia-excessive thirst

Polyphagia-excessive hunger

Polyuria-increased frequency of urination
Term
Prediabetes; Impaired Glucose Tolerance (IGT) or Impaired Fasting Glucose (IFG)
Definition
Beta cells become fatigued from overproduction

Beta cell dysfunction is mild – with slight increase in glucose

Patients with IGT are increased risk for DM II usually within 10 years
Term
Pre-Diabetes
Definition
Fasting BS greater than 100.

prevent or delay the development of type 2 diabetes through changes to their lifestyle that include modest weight loss and regular exercise.
Term
Type II
Definition
Correlated with obesity

Over the age of 35

Genetics – dominant and multifactorial (

Insulin resistance

Pancreas usually continues to form some insulin

Insulin amount is usually insufficient to meet needs of body AND/OR is poorly utilized by tissues

Results in HHNK
Term
Metabolic Syndrome
Definition
cluster of abnormalities working synergistically to greatly ↑ risk for CV disease and diabetes.

Tx: weight loss and exercise
Term
Type II- nonspecific manifestations
Definition
Can be the 3P’s
Fatigue
Recurrent infections
Visual changes
Prolonged healing times
Term
Fasting Plasma Glucose
Definition
- no caloric intake for at least 8 hrs
- (>100- <126) Impaired Fasting Glucose
- Critical Values <60 mg/dl or >500 mg/dl
Term
Random Glucose
Definition
can be drawn any time;
meals, drugs, stress can cause increase.
>180 mg/dl on two occasions
>200 mg/dl with s/s hyperglycemia
Term
Two hour oral glucose tolerance test (OGTT)
Definition
-multiple blood draws over 2 hrs after a glucose load of 75 g.
-200 mg/dl or more = diabetes->140 and <199 = pre-diabetes
Term
Glycosylated Hemoglobin A1C (HbA1C)
Definition
Glucose attaches to Hgb and remains attached to the RBC for it’s lifespan (90 days)
Indicates overall glucose control for the previous 90 days.
Near-normal levels over time have greatly reduced risk for development of complications.
Normal range = 4 – 7%
Goal: A1C level of 6.5% or less
Conditions that effect red blood cell turnover may alter HbA1C (sickle cell anemia, hemolysis, etc)
Term
Rapid Acting Insulin
Definition
Onset: 15 min
Peak: 60-90 min
Duration: 3-4 Hrs
Term
Short acting regular
Definition
Onset: 30-60min
Peak: 2-3hours
Duration: 3-6 hrs
Term
NPH/Intermediate
Definition
Onset: 2-4 hours
Peak: 4-10 hours
Duration: 10-16 hours
Term
Long acting
Definition
Onset:1-2 hours
NO PEAK
Duration: 24+hrs
Term
Insulin mixture
Definition
Air in NPH
Air in Regular
Draw up Regular
Draw up NPH
Term
Insulin Pump
Definition
Change site every 2 to 3 days.
Check site for redness and s/s of infection.
Term
Insulin Jet
Definition
Delivers insulin in fine pressurized steam through skin without needle
Peak onset etc. occur earlier
Thorough training and monitoring needed
Term
Somogyi Effect
Definition
rebound effect of excessive insulin usually at night
results in ↓ B.S. in middle of night as a response to ↑ insulin
Check B.S. between 2 and 4 AM
- If this AM B.S. is low …then reduce PM dose of insulin OR eat a more substantial bedtime snack
Term
Dawn Effect
Definition
: hyperglycemia noted on awakening in A.M. due to release of hormones in predawn hours.
Growth hormone is possible factor
Affects majority of those with diabetes but most severe in adolescence and young adulthood
Problem: high B.S. usually after 3 AM
Treatment:
- Check B.S. between 2 and 4 AM;
- if high then increase insulin and eat bedtime snack.
- change timing of evening intermediate acting from dinnertime to bedtime
Term
Lipodystrophy
Definition
Hypertrophy or atrophy of s.c. tissue due to frequent use of same injection site or an immune reaction to impurities in insulin
Term
Hypoglycemia Symptoms
Definition
Skin: cool & clammy
Perspiration: profuse
Mental Status: anxious, nervous, irritable, mental confusion, seizures, coma
Misc: weakness, double vision, blurred vision, hunger, tachycardia, palpitations
Glucose: <70 mg/dl (or when high level falls too rapidly)
Ketones: Negative
Term
Hyperglycemia Symptoms
Definition
Skin: Hot, dry
Dehydration: Present
Respiration: Rapid, deep; Kussmaul type; acetone to breath
Mental Status: Varies from alert to stuporous, obtunded, or frank coma
Glucose: > 250 mg/dl
Ketones: Positive
Term
Diabetes Ketoacidosis (DKA)
Definition
Profound deficiency of insulin
Hyperglycemia (BS > 300)
Ketosis, acidosis, dehydration
Fruity odor to breath; Kussmaul respirations
Anorexia, nausea, vomiting
Lethargy, weakness, altered mental status
Lead to coma, electrolyte imbalance, death etc.
Term
Hypergylcemic Hyperosmolar State (HHS)
Hyperosmolar Hyperglycemic Nonketotic State (HHNK
Definition
Produce enough insulin to prevent DKA
Not enough insulin to prevent osmotic diuresis, hyperglycemia or ECF depletion
Increase in serum osmolarity
BS >400mg/dl
Ketones are absent
High BG produces high serum osmolarity thus producing neurological manifestations (coma, seizures etc), strokelike s/s.
*** fewer symptoms seen earlier with HHNS so BS can get quite high
Term
Treatment of DKA and HHS
Definition
Medical emergency
IV administration of NSS or ½ NSS
Regular insulin IV
When glucose falls < 250… add IV glucose (D5 ½)
Electrolyte replacement
Bicarbonate for DKA in pH<7.10
Treat underlying cause and complications
Term
Chronic Complications
Definition
Cataracts
Retinopathy/Blindness
Infections such as Gangrene
Neuropathy
Arteriosclerosis
Myocardial Infarctions
Kidney disease
Valve Disease
Cerebral Vascular Accidents
Erectile dysfunction
Term
Illness causes increased BS
Definition
Eat regular diabetic diet; Increase noncaloric fluids
Continue with oral agents and/or insulin
Monitor BS every 4 hrs. If > 240 check urine for ketones and report + ketones to physician
Term
If Illness leads to decreased PO intake:
Definition
Supplement CHO food intake with CHO-containing fluids while continuing with oral agents and/or insulin
Notify physician immediately if unable to keep any food or fluids down
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