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TT3 Diabetes
NHCC TT3 Diabetes
| Question | Answer |
|---|---|
| What is Diabetes? | Diabetes is a disorder of carbohydrate, protein, and fat metabolism resulting from an imbalance between insulin availability & insulin need. |
| How does Normal Insulin Metabolism work? | Insulin unlocks the cell wall to get glucose in. Also helps produce stores of insulin (reason why many diabetics gain weight). Insulin is continually released. Counter regulatory hormones are produced (ex. Glucagons) that keep insulin within normal ran |
| What two hormones produced in the pancreas maintain a constant blood-glucose level? | insulin and glucagon. |
| Where is insulin made and secreted by? | the beta cells of the pancreatic islets, small islands of endocrine cells in the pancreas |
| What does insulin do for the liver? | Stimulates it to store glucose in glycogen, make proteins from amino acids, |
| What does insulin do for the muscle cells? | same as the liver it Stimulates it to store glucose in glycogen, make proteins from amino acids, |
| What does insulin do for the fat cells? | to form fats from fatty acids and glycerol |
| Where is the protein hormone Glucagon made and secreted from? | the alpha cells of the pancreatic islets |
| What does glucagon do for the liver and muscles cells? | • Stimulates the liver and muscles to break down stored glycogen (glycogenolysis) and release the glucose |
| What hormone • Stimulates gluconeogenesis in the liver and kidneys? | Glucagon |
| What hormone inhibits the liver and kidney cells from making glucose from intermediate compounds of metabolic pathways (gluconeogenesis)? | Insulin |
| What is Type 1 diabetes? | Absolute lack of insulin (pancreas doesn’t produce any) |
| What is Type 2 diabetes? | Absolute lack of insulin (pancreas doesn’t produce any) |
| What is the Prevalence of Type 1 diabetes? | 5 - 10% of people diagnosed |
| What is the Prevalence of Type 2 diabetes? | 90% of people diagnosed |
| What is the age of onset for Type 1 diabetes? | Usually, but not always, childhood or early adulthood (can be 20s, 30s, even 40s) |
| What is the age of onset for Type 2 diabetes? | Frequently over age 35,, Frequency increases with age, Incidence is increasing in children |
| What is the Type of onset for Type 1 diabetes? | Abrupt (but disease process may be present for several years), Genetic, Viral, Abnormal immune responses, Often have islet cell antibodies, |
| What is the Type of onset for Type 2 diabetes? | Insidious, Generally gradual, Genetic, Obesity, No islet cell antibodies |
| What are the nursing interventions for a fasting blood sugar test? | NPO 4-8 hours before, morning blood draw, monitor results, teaching as necessary |
| What is the Glycosylated Hgb (HbA1c) test for? | Used to monitor diabetes control over a period of time. Glucose attaches to Hgb. Blood cell lives 3-4 months. So you can tell overall control. Over a period of time, sugar is hanging around |
| What are the nursing interventions for an oral glucose tolerance test? | High carb diet 3 days prior. No alcoholFast 12 hrs before, no more than 16No vigorous exercise during test period |
| What does an increased value mean in an oral glucose tolerance test? | decreased glucose tolerance |
| What does an decreased value mean in an oral glucose tolerance test? | increased glucose tolerance |
| What does ketones in urine indicate? | indicates no glucose available for energy & using FFA. Starvation type of thing. Type I is more likely to experience ketoacidosis |
| What does glucose in urine indicate? | indicates that the glucose has exceeded the renal threshold |
| What are the nursing interventions in performing urine glucose - ketones test? | Discard first morning urine. Use second specimen. Don’t drink between first & second specimen. (or else it will dilute glucose |
| What is the purpose of ketone - glucose test? | used to be how they monitored control. Only tells 3-5 hrs previous, not big picture. |
| · Ineffective management of therapeutic regimen r/t ? | lack of knowledge (diet, exercise, weight control, medications, glucose monitoring) AEB continued hyperglycemia, inaccurate statements regarding diabetes and its management, and self-professed confusion regarding the patho. of diabetes and its treatment |
| Risk for infection r/t ? | depressed immune system, inadequate circulation, and environmental pathogens. |
| Fatigue r/t ? | nutritional deficits secondary to mismanaged diabetes AEB inability to perform ADLs secondary to malaise, desire for frequent naps during the daytime, and lethargy that is unrelieved by sleep |
| Powerlessness r/t? | sudden change in lifestyle and restrictions placed on normal eating habits secondary to diagnosis of diabetes AEB anger and statements alluding to lack of control over the situation. |
| Serving sizes of Bread? | cassette tape |
| Serving sizes of Pasta? | tennis ball |
| Serving sizes of Potato? | small fist |
| Serving sizes of Salad? | baseball |
| Serving sizes of Fresh fruit? | small fist |
| What are the goals of an ADA diet? | Maintain BG, Optimal lipid levels, adequate calories, Prevent complications, Improve overall health |
| Type I How much of total calories should Carbohydrates consist of? | 45 – 55% |
| Type I Simple carbs should not be more than how much of total calories? | 25% |
| Type I how much Fiber per day? | 20 – 30 g |
| Type I what type of proteins should be eaten? | good proteins, steer away from animal fats |
| Type I how much of total calories should be proteins? | 10 – 20% |
| Type I what type of fats? | low saturated, no trans fats, more polyunsaturated (canola, sunflower oils) |
| Type I how much of total calories should be fats? | 30 – 35% |
| What does a Type II diet consist of? | Essentially the same as Type I, but more attention to “good” food choices & less fat, very individualized |
| Goals of type II diet? | Achieve weight loss to achieve lower cholesterol, lower BP, and lower glucose, Try to keep glucose fairly constant |
| What are total calorie considerations for type I? | Increase calorie intake possibly necessary to achieve desirable body weight and restore body tissues |
| What are total calorie considerations for type II? | Reduction in caloric intake desirable for overweight or obese patient |
| What is the Effect of diet on type I? | Diet and insulin necessary for glucose control |
| What is the Effect of diet on type II? | Diet alone possibly sufficient for glucose control |
| What does Consistency in daily intake achieve in type I? | Necessary for glucose control |
| What does Consistency in daily intake achieve in type II? | Desirable for weight reduction and moderation of blood glucose levels |
| Does Uniform timing of meals affect type I? | Crucial for NPH/lente insulin programs; flexibility with multidose rapid-acting insulin |
| Does Uniform timing of meals affect type II? | Desirable but not essential |
| Should Intermeal & Bedtime snacks be consumed with type I? | Frequently necessary |
| Should Intermeal & Bedtime snacks be consumed with type II? | Not usually recommended |
| Are Nutritional supplement for exercise programs with type I? | CHO 20 g/hr for moderate physical activities |
| Are Nutritional supplement for exercise programs with type II? | May be necessary if patient controlled on sulfonylurea or insulin |
| What are The effects of exercise for a diabetic person? | Keeps BP and Blood sugar under control, Keeps vessels and muscles healthy, Weight management, Glucose uptake into exercising muscle, Longer exercise is assoc with fat burn, Improved cardio and vessel condition |
| when does fat burn occur suring exercise? | after 30 – 40 minutes, |
| What does · Too much or too vigorous of exercise do to blood sugar? | Increases it |
| How shou;d a diabetic be consistent with exercise? | follow same regimen, same amt per day, level of activity, same time |
| Where is Insulin is taken up faster ? | exercising muscles |
| Why is it Important to know when insulin peaks ? | That is when blood sugar will be the lowest |
| How long after exercis can post exercise hypoglycemia occur? | 24 – 48 hours |
| What is the overall goal of treatment for diabetes? | maintain near-normal blood glucose control. |
| Diabetes treatment consists of what? | Insulin (or OHA), monitoring, diet, exercise, education |
| What are the goals for care of a diabetic client? | Aimed at achieving a balance between diet, activity, and medication |
| What is the criteria for contol of diabetes? | Client’s weight is within recommended limits, Client enjoys good health, Glycosylated Hgb is WNL, Blood sugar near normal, Experience minimal or no episodes of hyper or hypo glycemia, Adjust lifestyle, Delay or prevent complications (very difficult!) |
| Interventions for Ineffective management of therapeutic regimen - Assess the patient’s current level of knowledge related to specific disease process to | determine the scope and extent of required teaching. |
| Interventions for Ineffective management of therapeutic regimen- Describe the disease process and treatment recommendations to | enable patient to better understand rationale behind treatment regimen and lifestyle changes |
| Interventions for Ineffective management of therapeutic regimen - Discuss lifestyle changes that may be required to | Discuss lifestyle changes that may be required to control the disease process to encourage patient to actively participate in determining changes that will be acceptable. |
| Interventions for Ineffective management of therapeutic regimen -Describe possible chronic complications to | increase awareness of the long-term effects of inadequate control of disease process |
| Interventions for Ineffective management of therapeutic regimen - Plan individualized exercise program with patient because | because exercise is an integral part of diabetes management |
| Interventions for Ineffective management of therapeutic regimen - Review steps to prevent hyper and hypoglycemia because | activity changes can cause changes in insulin needs |
| nterventions for Ineffective management of therapeutic regimen - Review insulin administration (if used); have patient give return demonstration of insulin injection to | ensure proper technique |
| nterventions for Risk for infection · Observe extremities for | color, warmth, swelling, pulses, texture, edema, and ulcerations to detect early signs and symptoms of infection and decreased circulation |
| Interventions for Risk for infection ·Monitor skin for | prevent conditions that favor skin breakdown |
| Interventions for Risk for infection ·Promote sufficient nutritional intake to | prevent illness and encourage wound healing |
| Interventions for Risk for infection - Encourage fluid intake to | maintain adequate hydration and blood viscosity |
| Interventions for Risk for infection - Encourage rest periods to | allow the body to rejuvenate itself and decrease stress |
| Interventions for Risk for infection - Encourage increased mobility and exercise to | promote and increase circulation to prevent the formation of pressure ulcers and to improve the efficiency of the body’s use of insulin |
| Interventions for Risk for infection - Teach patient and family about signs and symptoms of infection | (and ask for return demonstration) and when to report them to health care provider to promote early detection |
| What are the signs and symptoms of hyperglycemia? | polyuria, polydipsia, polyphagia, weakness, lethargy, malaise, blurring of vision, or headache |
| · Restrict exercise when blood glucose levels are >250 mg/dl to | decrease the body’s requirement for already unavailable glucose |
| Precipitating factors of hypoglycemia are? | Fasting, exercise, taking more OHA (oral hypoglycemic agent) |
| Precipitating factors of hyperglycemia for are? | Stress, infection, trauma, decreased exercise |
| Onset of hypoglycemia symptoms are? | Rapid |
| Onset of hyperglycemia symptoms are? | gradual |
| Signs and symptoms of hypoglycemia are? | Irritability, pass out/black out, altered consciousness, anxious, shaking, diaphoresis, and headache. Most of the symptoms of hypoglycemia are cerebral. More profound in Type I |
| What is the treatment for hyperglycemia? | Meds - insulin or OHA, increased exercise, more calculated diet |
| What is the treatment for hypoglycemia? | CHO, simple sugars, OJ, (Good idea to give a protein as well to help for later – otherwise once the simple sugar goes through system, they could be in trouble again) |
Created by:
2007Nurse
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