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Diabetes
N/A
44
Nursing
Undergraduate 2
10/25/2009

Additional Nursing Flashcards

 


 

Cards

Term
Where is insulin produced?
Definition
Beta Cells of Pancreas
Term
Functions of insulin
Definition
  • Controls level of blood glucose
  • Controls storage of glucose as glycogen in liver
  • Moves glocose into muscles, liver, & fat cells
Term
Action of insulin inside of cell
Definition
  • Metablolizes glucose for energy
  • Stimulates storage of glucose in liver & muscle
  • Stops release of glucose by liver
  • Enhanses storage of dietary fat (adipose)
  • Encourages transport of amino acids (proteins) into the cells
Term
Risk factors of diabetes
Definition
  • Family History
  • Obesity
  • Minority Race
  • Over 45 years old
  • Previously abnormal fasting glucose or glucose tolerance test
  • Hypertension
  • Low HDL, High Triglyceride levels
  • History of gestational diabetes
  • Giving birth to baby weighing over 9lbs
Term
Type 1 diabetes
Definition
  • Insulin producing beta cells of pancreas destroyed
  • Little to no insulin produced by pancreas
  • Uncontrolled glucose production by liver
  • Acute onset, but process may be ongoing for years before
  • Usually occurs before age 30
Term
Cause of type 1 diabetes
Definition
  • Unknown
  • Body's own T-cells attack and destroy pancreatic beta cells
  • May be due to combine genetic, immunologic, and viral factors
Term
Treatment for type 1 diabetes
Definition
  • Requires insulin injections for life
Term
Type 2 diabetes
Definition
  • Often due to development of resistance to endogenous insulin
  • Frequently occurs in individuals with family disposition who are obese and over age of 40.
Term
What are the hallmark risk factors for the development of insulin resistance?
Definition
  • Obesity
  • Physical inactivity
  • High Triglycerides >250mg/dl
  • Hypertension
Term
Secondary causes of insulin resisance
Definition
  • Pancreatitis
  • Cushing's syndrome
Term
Iatrogenic (r/t therapy) causes of insulin resistance
Definition
  • glucocorticoid usage
Term
Diagnostic criteria for diabetes mellitus
Definition
  • Two finding (on seperate days) of one of the following:
    • Symptoms of diabetes plus casual plasma glucose concentration of greater than 200mg/dl (without regard to time since last meal)
    • Fasting blood glucose greater than 126mg/dl (8hrs fasting)
    • Two-hour glucose greater than 200mg/dl with an oral glucose tolerance test (10 to 12 hr fasting)
Term
Fasting blood glucose
Definition
  • Ensure that client has fasted (no food or drink other than water) for the 8hrs prior to the blood draw.
  • Antibiabetic medications should be postponed until after the level is drawn.
Term
Oral Glucose Tolerance Test
Definition
  • Instruct client to consume a balance diet for the 3 days prior to the test.
  • Instruct client to fast for the 10 to 12 hrs prior to the test.
  • A fasting blood glucose level is drawn at the start of the test.
  • The client is then instructed to consume a specified amount of glucouse.
  • Blood levels are drawn every 30min for 2hrs.
  • Clients must be assessed for hypoglycemia throughout the procedure.
Term

Glycosylated Hemoglobin

(HbA1c)

Definition
  • The target is 4 - 6%
  • HbA1c is the best indicator of average blood glucose level for the past 120 days. 
  • Assists in evaluating treatment effectiveness and compliance.
Term
Pre-meal glucose
Definition
  • The target is 90 - 130mg/dl.
  • Follow or ensure that the client follows the proper procedure for blood sample collection and use of glucose meter.
  • Supplemental short-acting insulin may be prescribed for elevated pre-meal glucose levels.
Term
Signs & Symptom of Type 1 diabetes
Definition
  • Polyuria, jpolydipsia, polyphagia
  • Weight Loss
  • Fatigue
  • Increased frequence of infections
  • Rapid onset
  • Controlled by exogenous insulin
Term
Sings & Symptoms of Type 2 Diabetes
Definition
  • Polyuria, Polydipsia, polyphagia
  • Obesity
  • Fatigue
  • Increased frequency of infections
  • Grandual onset
  • Controlled by oral antidiabetic medications and insulin
Term
Signs & Symptoms of Hypoglycemia
Definition
  • Cool, clammy skin
  • Diaphoresis
  • Anxiety, irritability, confusion, blurred vision
  • Hunger
  • General weakness, seizures (severe hypoglycemia)
Term
Signs & Symptoms of Hyperglycemia
Definition
  • Hot, dry skin
  • Absense of diaphoresis
  • Alert to coma (varies)
  • N/V, abdominal pain (w/ketoacidosis)
  • Rapid deep respirations (acetone/fruity oder due to ketones)
Term
Foot care
Definition
  • Inspect feet daily.  Wash with mild soap & warm water
  • Pat dry gently, especially between the toes
  • Use mild foot powder (w/cornstarch) on sweaty feet
  • Do not use commercial remedies to remove calluses or corns
  • Consult podiatrist
  • Cut toenails even with rounded contours. Do not cut down corners.
  • Best time to cut nail is after bath/shower
  • Separate overlapping toes with cotton or lamb's wool
  • Avoid open-toe, open-heel shoes.
  • Leather shoes preferred over plastic.
  • Wear slippers w/soles.
  • Do not go barefoot.
  • Shake out shoes before putting them on.
  • Wear clean, absorbant (cotton or wool) socks or stockings that have not been mended.
  • Do not use hot water bottles or heating pads to warm feet.
  • Wear socks for warmth.
  • Avoid prolonged sitting, standing, and crossing of legs.
Term
1 unit of insulin = ? grams of carbs
Definition
15g
Term
When sick:
Definition
  • Monitor glucose every 4hrs
  • Continue to take insulin or oral antidiabetic agents
  • Consume 8oz of sugar-free non-caffeinated liquid every hour to prevent dehydration.
  • Meet carbs needed through solid food (if possible), or consume liquids equal to usual carb content.
  • Test urine for keones and report if abnormal (should be neg to small.)
  • Rest.

 

Term
When sick, should call doctor when:
Definition
  • Glucose > 250mg/dl
  • Ketones are moderate or large
  • Fever
    • > 102
    • does not respond to tylenol
    • lasts more than 12 hours
  • Feeling groggy or confused
  • Experiencing rapid breathing
  • Vomited more than once
  • Diarrhea occurs more than five times or for longer than 24hrs
  • Unable to keep down liquids
  • Illness lasts longer than 2 days
Term
Guidlines for hypoglycemia
Definition
  • Check blood glucose
  • Threat with 15g of carbs
  • Recheck glucose in 15min
  • If still, low give 15g more of carbs
  • Recheck in 15min
  • If blood glucose is normal, take 7g protein (if next meal is >1hr)
Term
15g of carbs =
Definition
  • 4oz orange juice
  • 2oz grape juice
  • 8oz milk
Term
Response to hyperglycemia
Definition
  • Encourage oral fluid intake
  • Administer insulin as prescribed
  • Restrict excercise when blood sugar >250mg/dl
  • Test urine for ketones and report if abnormal
Term
When mixing rapid or short acting insulin with a longer acting insulin:
Definition
Draw up the shorter acting insulin into the syringe first and then the longer acting insulin.
Term
Leading cause of death with diabetes
Definition
Heart Disease
Term
Treatment for Type 2 diabetes
Definition
  • Diet & Excercise first
  • Single oral medication second
  • Mulitple oral medications third
  • Injections later
  • May require injections only during periods of acute stress
Term
For treatment of hypoglycemia avoid:
Definition
high fat foods

(Fat prevents absortion of glucose)
Term
If hypoglycemic and cannot swallow:
Definition
  • Inject glucagon 1mg SQ or IM
  • 50% Glucose in H2O IV given in ER or hospital
Term
Glucagon
Definition
  • Stimulates liver to release glucose
  • Person should awake withing 20min
  • May cause nausea
  • Follow with concentrated CHO
Term
Assessment of ketoacidosis (DKA)
Definition
  • Blood sugar 300 - 800+
  • Low bicarbonate
  • Low pH
  • Ketones in blood & urine
  • Electrolyte abnormalities
Term
What electrolyte to watch for with hyperglycemia
Definition
  • Potassium
  • Insulin causes K to move into cells
  • If kidneys are impaired, cannot excrete K
Term
Hyperglycemic-hyperosmolar nonketotic syndrome

(HHNS)
Definition
  • An acute, life-threatening condition characterized by profound hyperglycemia > 600 mg/dl, dehydration, and an absense of ketosis.
Term
Priority interventions for both DKA & HHNS are:
Definition
  • Administration of fluids
  • Administration of insulin
Term
DKA is more common with
Definition
type 1 diabetics
Term
HHNS is more common in
Definition
  • Older adults
  • untreated or undiagnosed type 2
Term
Differences between DKA & HHNS
Definition
  • glucose levels:   DKA = >300      HHNS = > 600
  • Potassium:        May increase due to acidosis in DKA
  • Ketone levels:    DKA:  Present    HHNS:  Absent
  • Serum OmA:     DKA:  High        HHNS:  Very High
  • Serum pH:         DKA: Metabolic Acidosis      HHNS:no acidosis
Term
What happens to electrolytes with DKA & HHNS
Definition
  • DKA:
    • Na increases due to water loss
    • K initially low due to diuresis
    • K may increase due to acidosis
  • HHNS
    • Na increases due to water loss
    • K low due to diuresis
Term
What happens with serum renal studies with DKA & HHNS
Definition
  • Both Increased secondary to dehydration
Term
What happens to potassium with insulin therapy?
Definition
  • Potassium will shift into the cells with insulin therapy. 
  • The client will need to be monitored for hypoglycemia
  • Make sure urinary output is adequate before administering potassium.
Term
What is treatment for severe acidosis (pH < 7.0)
Definition
  • Admisistration of sodium bicarbonate by slow IV infusion
  • Need to monitor K levels because too quick of correction of acidosis can lead to hypokalemia.
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