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Chapter 83

Unit 12: Nursing care of clients with endocrine disorders

TermDefinition
Insulin Regimens for type 1 DM: types of insulin Rapid, short, intermediate & long-acting -Given 1 or more x a day based on glucose results
Other ways to administer insulin? Pump (con't), pens
Rapid acting insulin: (Pg. 915) Lispro insulin (Humalog), Aspart insulin (Novolog), Glulisine insulin (Apidra) -Administer before meals -Onset is rapid: 10-30 mins (<15) -Administer in conjunction w intermediate or long-acting insulins = glycemic control between meals & at nights
Short acting insulin: Regular insulin (Humulin R, Novolin R) -Administer 30-60 min before meals
Short-acting insulin is available in 2 concentrations: U-500 U-100 U-500; for complete insulin resistance, NEVER administered IV U-100; for most clients; can be given IV
Intermediate-acting Insulin: NPH insulin (Humulin N), detemir insulin (Levemir) -For glycemic control between meals & at nights NOT administered before meals
Intermediate-acting insulin contains ____ ? Protamine (a protein), causes a delay in the insulin absorption or onset and extends the duration of action of the insulin
How is NPH insulin administered? SUB Q
What is the only insulin that can mix w short-acting insulin? NPH insulin (Humulin N) .. immediate-acting insulin
How is determir insulin (Levemir) administered? SUB Q
Can you mix determir insulin (Levemir) with other insulin? No
Long-acting insulin: Glargine insulin (Lantus) Peak-less, trough-less Administered once daily, anytime during the day but always at same time
How does Lantus work? Microprecipitates; dissolves slowly over 24 hours & maintains a steady blood sugar level
How is lantus administered? SUB q, never IV
At what angle do you inject insulin? 90 degree; 45 if thin
When mixing a rapid or short-acting insulin w a longer-acting insulin which one do you draw up first? Draw up the shorter-acting insulin first (regular) & then the longer-acting insulin -reduces risk of introducing the longer acting insulin into the short-acting vial
S/S of hypoglycemia: Mild shakiness, mental confusion, sweating, palpitations, headache, lack of coordination, blurred vision, seizures & coma
How can you avoid hypoglycemia: Avoid excess insulin, extreme exercise, alcohol on an empty stomach
Hypoglycemia level? 70 or less
What should we give a hypoglycemic client? 15-20g of a readily absorbable carb (4-6oz of fruit juice or regular soft drink, 3-4 glucose tablets, 8-10 hard candies, or 1 tbsp of honey) -recheck glucose in 15 min
If carbs are given and still not in NL? Give 15-20 more and recheck in 15
How much does BG increase over 30 mins following ingestion of 10g of carbs? 40mg/dl
What if hypoglycemic patient is unconscious or unable to swallow? Administer glucagon subq or IM (repeat if 10 minutes) & notify provider -In acute care, nurse gives IV 50% dextrose, conscious in 20
S/S of hyperglycemia? Hot, dry skin, fruity breath
If pt is hyperglycemic? fluids, insulin, BG, urine oral fluid/nonsugary prevent dehydration, administer insulin, restrict exercise w BG >250, test urine for ketones
Oral hypoglycemics: 1. Metformin HCI (Glucophage) action- Reduces production of glucose by the liver (gluconeogenesis) -Increases tissue sensitivity of insulin
S/e of metformin? (Glucophage) -GI effects (gas, anorexia, nausea/vomit), lactic acidosis * stop med for 48hr before radio test w iodinated contrast dye
Education on metformin? food? supplements? pregnancy? crush or chew? Take w food, take vit b & folic acid supplements can take during pregnancy never crush or chew med
What are.. Glipizide (Glucotrol), Glimepiride (Amaryl), Glyburide (Diabeta, glynase prestab) Second-generation sulfonlyureas -Stimulate insulin release from the pancreas = decrease in BG levels -increase tissue sensitivity to insulin
S/e of second generation sulfonylureas (oral anti diabetics) Monitor for hypoglycemia
Education for second generation? Administer 30 mins before a meal -avoid alcohol
What is lipohypertrophy? and lipoatrophy? and how can you prevent it? Increased swelling of fat Loss of fat tissue -Rotate injection sites within one anatomic site; prevents day to day changes in absorption rate
Foot care: -wash feet how often and with what? -how do you dry & what to avoid Daily w mild soap & warm water (test w hands) -Pat dry, especially in-between the toes, avoid lotions between toes
What should you use on sweaty feet? Should you use commercial remedies for callouses & corns? Mild foot powder (w cornstarch) NO
When is the best time to perform nail care? How should you separate overlapping toes? After a bath/shower when toenails are soft & easier to trim w cotton & lamb wool
Avoid what kind of shoes? Open-toe, open-heal, slippers w/o souls, plastic shoes NO barefoot
What kind of stockings? Heating pads okay? Clean, absorbent stockings, cotton/wool (better absorption) NO, wear socks for warmth
Should you avoid prolonged sitting, standing or crossing legs? Yes
Nail cutting recommendations or filing? Straight across
Nutritional guidelines: (Pg.920) Meals should be similar each day; eat at regular intervals, don't skip meals
Why include fiber in the diet? To increase carb metabolism & to help control cholesterol levels
What kind of sweeteners should you use? Keep saturated fats w/in __ % of caloric intake Artificial 7
When sick.. monitor BG q __ hrs Consume what for fluids & how often? What kind of carbs? 3-4 4oz of sugar-free, non caffeinated liquid q30min to prevent dehydration Softer carbs recommended 6-8x/day
Call provider during sick days if; BG >___ ketones Fever >__ 240, test for ketones fever= >101.5 (38.6), doesn't respond to tylenol or lasts >24hrs disoriented, confused, rapid breathing, vomit/diarrhea, illness >2 days
Created by: mary.scott260!