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chpt 49 study guide

Diabetes

QuestionAnswer
in addtion to promoting the transport of glucose from the blood into the cell. insulin also does what? accelerates the transport of amino acids into cells & their synthesis into protein
tissues that require insulin for the glucose transport are (2) skeletal muscle, and adipose
during the development of type 1 DM, the B-cell response to hyperglycemia can be identified in the blood and urine by the presence o pro-insulin B-peptides
2 hormones released during physical and emotional stress & are counter-regulatory to insulin are cortisol and epinephrine
the type of diabetes strongly related to HLA- human leukocyte antigen type 1
insulin resistance type 2
B-cell secretory exhaustion type 2
inherited defect in insulin RECEPTORS type 2
production of islet-cell antibodies type 1
genetic susceptibility for antibody production type 1
inappropriate glucose production by the liver type 2
B-cell destruction type 1
impaired glucose tolerance which occurs gradually type 2
compensatory-increased insulin production type 2
describe polyuria high glucose levels caused by loss of glucose in urine w/osmotic diuresis
describe polydipsia thirst caused by fluid loss of polyuria
describe polyphasia CELLULAR STARVATION FROM LACK OF GLUCOSE & USE OF FAT AND PROTEIN FOR ENERGY
when teaching a pt with metabolic syndrome, the nurse gives highest priority to teaching on... maintaining a normal weight
A pt is admitted to the hospital w/a FBS of 512 mg/dl and arterial PH of 7.38 indicating... he has enough endogenous insulin to prevent ketoacidosis w/the hyperglycemia
during a health screening, the pt has a fasting plasma glucose FPG of 132 mg/dl. At a follow up visit, the diagnosis of diabetes is made based on...(select all that apply) A FPG of > 126 mg/dl or a random plasma glucose of 210 md/dl
the nurse determines that the pt w/a 2 hr OGGT of 152 has... impaired glucose tolerance
when teaching a pt who take 2 units of 70/30 NPH in the morning and at 6 pm, the nurse teaches importance of set meal pattern w/ a bedtime snack to prevent hypoglycemia
when teaching a pt about insulin administration consistently using the same size of the appropriate strength of insulin syringe to avoid dosing errors
when Lispro insulin (humalog) for a type 1 diabetes pt, the nurse knows it should be administered... @ mealtime or within 15 min of the meal
A diabetic pt is learning to mix NPH and regular insulin together. More teaching is needed when he... draws up the NPH first (to avoid contaminating the regular w/NPH)
the home care nurse should intervene to correct a pt whose insulin administration includes... mixing an evening dose of regular with insulin glargine (Lantus)in one syringe for administration
which agent decreases endogenous glucose production? TZD
which agent should be taken w/in 30 min of each meal, & causes rapid and short-acting release of insulin from the pancreas? meglitinide
which agent decreases glycogenolysis, is frequently the drug of choice (not), stimulates production of insulin and enhances cellular sensitivity to insulin sulfonureas
which agent delays glucose absorption from the GI tract, is not effective w/fasting hyperglycemia, and is take with the first bite of each meal? alpha glucosidase inhibitors
which agent increases glucose uptake in the muscles, and has a primary effect of decreasing glucose production by the liver? biguanide
in nutritional management of diabetes, it is important for the pt to... eat regular meals at regular times
oal of nutritional therapy for the pt w/type 2 diabetes includes... normal serum glucose and lipid levels
to prevent hyper/hypoglycemia with exercise, the nurse teaches what about exercise? that it should be done about 1 hour after eating, when serum glucose levels are rising
An error in performance of SMBG (self monitoring of blood glucose) may be... cleaning the puncture site with alcohol before the puncture (oops)- interferes w/test result and dries out fingers
Recommendation in an outpt screening clinic for diabetes includes... fasting plasma glucose for all individuals at age 45, then Q3 years
A pt calls in to report feeling flu-like symptoms & nausea, the nurse advises... to take usual dose of insulin
ketoacidosis occurs as a complication when... the body utilizes large amounts of fatty acids, rather than the glucose for energy
explain the process of K+ imbalance in ketoacidosis (8 steps) inc. H+ present(acidic ketones & acetone); K+ from cells moves to blood in exchange for H+; inc serum K+; K+ excreted in urine w/osmotic diuresis; tx w/insulin inc glucose metabolism & dec fat metabolism; dec H+; K+ back into cells; totsl body K+ deficit
5 SYMPTOMS OF DKA NOT PRESENT IN HYPERGLYCEMIC HYPEROSMOLAR SYNDROME 1) Kussmal's respirations 2)ketonuria 3)sweet fruity odor to breath 4)decreased arterial ph [acidosis] 5)ketonemia
difference in tx between DKA and HHS HHS requires more fluid replacement to correct dehydration
the nurse is alerted of possible hypovolemic shock by the presence of... a change from polyuria to oliguria
hypoglygemia s/s includes... slurred speech, too much exercise w/out food, and cold/clammy skin
hyperglycemia s/s include... n/v, increased dietary intake, precipitated by stress
s/s of both hyper/hypoglycemia include... HA, changes in vision
A call is made about a diabetic pt is found unconscious at home, with no glucometer. The nurse advises administering glucagon 1 mg IM or SQ
with diabetes, atherosclerosis dz affecting the major systems occurs... with a higher frequency and earlier onset than the pt w/out DM
more teaching on foot care is needed with the diabetic pt who says... I know I'll have sores on my feet b/c they'll be painful
A 72 year old woman is dx w/diabetes. The nurse knows that... she does not need as tight glucose control as a younger pt
autonomic neuropathy characteristics include... male impotence and delayed gastric emptying
microangioplathy characteristics include... skin spots, basement membrane thickening of capillaries & arteriole, microaneurysm/destruction of retinal cappilaries & diffuse/nodular glomerulosclerosis
macroangiopathy characteristics include... altered lipid metabolism, ulceration/amputation of lower extremities, ischemic heart dz
sensory neuropathy characteristics include... atrophy of the small muscles of the hands, pain and paresthesia of the legs
polydipsia and polyuria d/t diabetes is mainly from what? the fluid shift d/t osmotic from hyperglycemia
A pt w/type 2 DM is admitted to the hospital, the nurse realizes this pt... has enough endogenous insulin to prevent ketosis but is at risk of developing hyperosmolar hyperglycemic nonketotic syndrome
teaching a pt "survival skills for type 1, the nurse... teaches self-monitoring of glucose
which therapy (drug) is not appropriate for the pt w/DM use of diuretics to tx renal problems
A pt has a serum glucose level of 825 mg/dl and is unresponsive, the nurse suspects DKA as opposed to hyperosmolar hyperglycemic syndrome based on... rapid deep respiration (Kussmal's)
Created by: arsho453
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