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Chapter 83
Unit 12: Nursing care of clients with endocrine disorders
| Term | Definition |
|---|---|
| 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 |
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