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MCAI-FINALS--4
Diabetes Mellitus
| Question | Answer |
|---|---|
| how many americans with DM disease | approx. 23.6 |
| what is the 5th cause of death in US | Diabetes |
| what are the major complications of diabetes | renal disease, adult blindness, lower limb amputations, stroke, heart disease |
| what is insulin? | hormone produced by the Bcell in the islets of langerhans of pancreas |
| where is insulin produce? | islets of langerhans of pancreas |
| what does it do? | lowers blood glucose |
| normal range of blood glucose | 70 to 110 mg/dL |
| what hormones stimulate glucose production? | glucagon, epinephrine, growth hormone, and cortisol. |
| how glucose is stored? | glucose stores in liver and muscle in the form of glycogen |
| what is type 1 diabetes | juvenile or insullin-dependent, abrup onset,may also cause by virus /toxics attacking pancreas, production of insulin stop. |
| what are the s/s of type I Diabetes | weight loss, thirst, polyuria, polyphagia, fatigue |
| what is type II diabetes | chronic disease, usually > 35 yo, obesesity, lack of exercise, poor diet, sedentary |
| what are the s/s of type II Diabetes | none or mild. |
| what are the types of diabetes | type I, type II, gestational diabetes, and secondary diabetes |
| type II work of pancrease | overworked producing insulin. |
| what is secondary diabetes | increase of glucose due to other problems: pancreatitis, chusing's disease, hyperthyroid, taking prednisone or corticosteroids, or dilantin (anti-siezures) |
| what are the 3 type II dm abnormalities | insulin resistance, inability of pancrease to produce insulin, inappropriate glucose production. |
| what is pre-diabetes | can develop type II DM w/I 10 years, b cell mild impaired, |
| what are the rn dx for pre-diabetes | impaired fasting glucose, impaired glucose tolerance. |
| what are metabolic syndrome | insulin resistance, hyperinsulinermia, inc TG, inc LDL, dec HDL, HTN |
| what are the insulin resistance syndrome risk factors? | obesity, sedentary, polycystic ovarian disease, urbanization, ethnicity, family hx. |
| normal blood FBG | <100 |
| normal OGTT | <140 |
| Prediabetic FBG | >=100 <126 |
| prediabetic OGTT | >=140 <200 |
| prediabetic Hbg AiC | 5.7% - 6.4% |
| Diabetes FBG | >=126 |
| Diabetes OGTT | >=200 |
| Diabetes HgbA1c | >=6.5% |
| what are the goals care of pt with Diabetes? | reduce symptoms, promote well-being, prevent complications of hyperglycemia, delay the onset of long-term complications. |
| why is it easire to treat hyperglycemia than hypoglycemia | hypoglycemia complication (pt could die) onset very fast rather than hyperglycemia. |
| what are the collaborative care of pt with Diabetes? | pt teaching, nutritional teaching, exercise, drug therapy, self glucose monitory. |
| what are diabetic pt teaching | participation, dietary restriction, exercise, medications, inspections of body areas, medical alert bracelet, travel planning with meds, stress mgmt, family support |
| what are the things to consider diabetic pt dietary goals: | consider financial, socio, culture, cognitive, dietician, achive caloric, glucos, lipid, and BP goals. |
| how does exercise help for pt with diabetes | improve body use of insulin, decrease tissue resistance to insulin |
| What are the six classess of DM oral agents? | sulfonylureas, meglitinides, biguanides, alpha-glucosidase inhibitors, thiazolidinediones, dipeptidyl peptidase -4(DDP-4) inhibitors |
| what is sulfonylureas? | it stimulate insulin production, more effective in earlier states of DM, |
| what are first generation of sulfonylureas? | orinase, tolinase, diabinese |
| what are the second generation of sulfonylureas? | glipizide, (Glucotrol), Glyburide (Micronase, DiaBeta, Glynase), Glimepiride (Amaryl) |
| What is Biguanides? | reduce glucose production by the liver, enhances insulin sensitivity, improves glucose xport to cell, does not promote weight gain, beneficial lipids, |
| Biguanides drugs? | metformin (Glucophage) |
| what is meglitinides? | incrase insulin production, more rapidly absorbed and excreted, less risk of hypoglycemia, should be taken 30 mins before or up to the meal. |
| meglitinides drugs? | repaglinide (Prandin), nateglinide (Starlix) |
| what is alpha-Glucosidase inhibitors? | "starch - blockers" slows downthe absorption of glucose in the GI tract, most effective in lowering postprandial glucose, not effective for treating fasting hyperglycemia |
| alpha-glucosidase inhibitors? | acarbase(Precose), Miglitol (Glyset) |
| what is thiazolidinediones? | increase glucose updake in muscle , decrease endogenous glucose production, wont' cuase hypoglycemia if used alone, may have benefits for HTN and HLD |
| thiazolidinediones drugs? | Ploglitazone (Actos), Rosiglitazone (Avandia) |
| What is Dipeptidyl Peptidase - 4 (DDP -4) Inhibitors? | newest antiglycemic medications, increase and prolong incretin levels (dec hepatic glucose prod, incretins regulate insulin production and syn), released by intestines, increase with meal. Reduce hypoglycemia, |
| What is incretin mimetics ? | Byetta , enhances insuline secretion from b cell , decrease glucagon secretion, reduce postprandial glucose levels, slows gastric empting, promotes satiety, major side effect:nausea |
| what are adjunct to oral agents drugs? | incretin mimetics (byetta) and amylin analog (pramlintide (Symlin) do not mix with insulin) |
| what are reactions to insulin | allergic, lipodystrophy, somogyi effect, down phenomenon |
| type of insulin reaction when pt become hyglycemic throughout the night | dawn phenomenon |
| type of insulin reaction when pt become hyglycemic from 2 to 4 am. | somogyi effect |
| what will happen to Blood sugar of pt if they are ill? | surgar rise, very high |
| how often ill patient has to test glucose? | every 4 hr during illness |
| what happen will happen to osmolarity for pt with high sugar? | pt will become dehydrated, |
| what is ketoacidosis | sever deficiency of insulin, hyperglycemia, presence of ketones, metabolic acidosis, cel dehydration, most common in type I DM. |
| what is ketosis? | acidic by-products of fat metabolism, problematic when excessive, alters pH balance, presence of ketonuria, depletes electrolytes |
| what will happen if pt is deficient with insulin?' | impaires protein synthesis, excessive protein degradation, tissuues lose nitrogen, stimulates glucosneogenesis, and osmotic diuresis. |
| what will happen to untreated insulin deficiency? | hypovolemic shock, renal failure, retention of ketones and glucose , worsens acidosis, dehydration worsens, cuasing coma and death. |
| what are the manifestation of untreated insulin deficiency | dehydration sign,low bp sign, weakness, vomitting, pain, kussmaul respirations, fruity breath, acetone (PCO2 <35, hco3<22) |
| Diabetic Ketoacidosis lab values | BG >250; ABGPh <7.3; Serum Bicarbonate <15; presense of ketones in blood and urine |
| what is the colaborative care for pt with DKA? | IV fluid, K replacement, Insulin therapy, dextrose water added. |
| what is Hyperosmolar hyperglycemic Syndrome(HHS) | life-threatening, insulin production doesn't meet demains, sever hyperglycemia, increase serum osmolality , no/minimal ketones, prone elderly |
| what are the clinical manisfestation? | same as DKA, and neurological -somnolence, coma, seizures, hemiparesis, aphasia. |
| What are HHS lab values? | BG > 600, Serum osmolality > 295, ketones absent |
| what is the colaborative care for pt with HHS? | IV fluid, more than DKA, insulin, electrolytes, monitor serum osmolality, system assessment |
| What are HHS nursing mgmt? | assess: CV, Renal, Neurologic, Hydration effectiveness, Lab values, BG monitoring. |
| What is hypoglycemia? | low blood glucose, too much insulin, serum blood glucose < 70 |
| what are the s/s of hypoglycemia? | confusion, irritability, diaphoresis, tremors, hunger, weakness, visual disturbance. |
| what will happen to untreated hypoglycemia pt? | loss of consciousness, seizures, coma, death. |
| what to do if BS < 70? | give juice, IV dextrose, Check every 30 to 45 min. |
| what is the colaborative care for pt with hypoglycemic? | check glucose every 15 mins after tx, repeat tx if glucose < 70, if glucose > 70 provide regular meal or carbohydrate snack, recheck bs 4 min for rebound effect, may receive an order to give glucagon. |
| How does diabetes affect the body? | circulatory system and nervouse system (high risk for CV, stroke, periperal vascular disease, micro vascular (eye- retinopathy, blindness), renal failure |
| stocking glove | lose sensation of peripheral nerve endings. |
| what is the colaborative care for pt with retinopathy? | encourage regular eye exam, tx for retinopathy photocoagulation,cryotherapy, vitrectomy |
| what is the DM complication on the kidney? | nepropathy - damaged small blood vessel that supply the kidney, leading cause of ESRD, risk for DM -Type1 and Type II |
| what is nonproliferative retinopathy? | more common type of retinopathy |
| what is proliferative retinopathy? | a proliferative growth of abnormal new blood vessels. can bleed |
| what are the treatment for retinopathy | photocoagulation,cryotherapy, vitrectomy |
| what is the colaborative care for pt with nephropathy? | ace inhibitors, ARBs , yearly microalbuminuria screening, monitor creatinine levels, may need creatinine clearance. |
| what is sensory neuropathy? | affects the sensory of hands/fee "stocking-glove" |
| what is the colaborative care for pt with sensory neuropathy | BS control, topic creams, tricyclics, antiseizure meds, pain meds. |
| what is autonomic neuropathy? | affects most of the body system, unaware of hypoglycemic event, gastroparesis (anorexia, N&V, GERD, sensation of feeling full), no signal to urinary system to urinate. |
| what is autonomic neuropathy CV Effects? | postural Hypotension, (OT hypotension) , resting tachycardia, painless MI(heart attack) |
| what are the risk factors of foot DM Complications? | wound can't heal, Poor circulation , nerve ending issue, tobaco, autonomic neuropathy, impaired immune system, |
| what are the s/s of peripheral arterial disease (PAD) | pain at rest, intermittent sense of pain, cold feet, loss of hair, delayed cap refill, dependet rubor (lower extremity look bright red) |
| why people at rest feel pain? | indicates more of circulation problem, they can't meet oxygen demand even they are not moving. |
| How to manage foot complications? | to reestablish blood circulation, baypass graft; control risk factors - control HTN, stop smoke, control hypercholesterolemia) |
| what is skin complications? | diabetic dermatopathy and necrobiosis lipoidica diabeticorum and granuloma annulare |
| what is diabetic dematopathy? | microangiopathy, red-brown spots on shins, harmless and painless. |
| what is necrobiosis lipoidica diabeticorum? | breakdwon of collagen, red-yellow lesions, thin, shiny skin |
| what is granuloma annulare | autoimmune, partial rings, of papules, dorsal surface of hands and feet. |
| what is the effects of infections: | diabetics more susceptible, can't fight investion , yeast infection, urinary retention. Et… |
| What are the values of BP, A1C, HDL, TG to watch out for pt with DM? | >130/80 , >6.5%, <40, >250 - these values needs to be noted or reported. |
| What med can cause complication with diabetes drugs? | steroids - affects carbhydrate metbolism |
| What is ACE inhibitor | dilates blood vessel. |
| What is OGTT | Oral glucose tolerance test |
Created by:
rt-study
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