Help
Options
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't Know
Remaining cards (0)
Know
retry
shuffle
restart
0:00
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
medsurg
diabetes part 1
| Question | Answer |
|---|---|
| diabetes | life-long, chronic, progressive disease... but manageable. most people with diabetes can lead a normal life with appropriate diabetes therapy and self management. |
| goal: | to optimize glycemic control and minimize complications |
| diabetes incidence | 40.1 million people in the US 12% of US population 27.6 % of adults are undiagnosed |
| diabetes is the... | 7th leading cause of death causes end-organ damage, inc HR and inc stroke risk |
| diabetes increases risks: | rate of heart attack 1.8 times higher rate of stroke 1.5 times higher #1 cause of kidney failure and non traumatic lower-limb amputations |
| diabetes by race/ethnicity | 13.6% of american/indians/alaskan native adults 12.1% of non-hispanic black adults 11.7% of hispanic adults 9.1% of asian american adults 6.9% of non-hispanic white adults |
| diabetes is directly correlated to | obesity |
| glucose control is a... | balancing act insulin and exercise decrease BGL food and stress hormones increase BGL |
| insulin is produced by | pancreatic beta cells |
| glucagon is produced by | pancreatic alpha cells |
| chronic multisystem diabetes is due to | defects in insulin production defects in insulin action or both |
| 4 classification of DM | type 1 DM type 2 DM iatrogenic (from meds) gestational diabetes (pregnancy) |
| diagnostic criteria for DM | fasting blood glucose >126mg/dL OR random serum glucose >200 mg/dL OR glucose tolerance test > 200 mg/dL OR HbA1C > 6.5% (shows last 3 months) *on 2 occasions* |
| hemoglobin A1C | Shows how well pt is maintaining blood sugar over period of time It accumulates in RBCs over last 150 days |
| calculation for hemoglobin A1C | estimation: eAG = (HbA1C-2)x30 |
| Type 1 diabetes | insulin dependent DM 5-10% cell mediated autoimmune destruction of beta cells, beta cells DON'T make any insulin. risk factors: autoimmune, viral, environmental |
| T1DM CMs | fatigue, frequent urination, always hungry, blurry vision, weight loss, numb or tingling in hands or feet, wounds wont heal, always thirsty, sexual problems, vaginal infection |
| T1DM - the 3 P's | polydipsia, polyuria, polyphagia |
| polyuria | excessive urination GI draws water into urine by osmolarity |
| polydipsia | excessive thirst due to cellular dehydration |
| polyphagia | excessive hunger cellular starvation |
| Tx of diabetes | insulin without insulin... DKA will occur which i life-threatening |
| Type 2 Diabetes | gradual onset impaired insulin release, suppressed glucose production, and decreased glucose uptake. less effective bc cells fail to respond weight gain |
| T2DM | >90% older >45, seeing it earlier now RF: family Hx, ethnicity, physical activity Tx: lifestyle modifications, oral agents, insulin |
| central adiposity | INC free fatty acid regulators of glucose metabolism cause an INC risk of T2DM. INC stomach fat = INC risk of T2DM |
| natural course of T2DM | progressive: insulin resistance and deficiency 6 years after Dx: >50% will require insulin Bc-ell failure: 50% at disease onset |
| pre diabetes | FPG: 100-125 2 hr PG 140-199 A1C 5.7%-6.4% associated with Cardiometabolic factors: obesity, HTN, INC trg, DEC HDLs |
| diabetes screening | overweight (BMI >25) and/or having other RF > test yearly normal weight and no RF > every 3 years starting at 45 |
| diabetes risk factors | inactive 1rst degree relative w DM high risk ethnic group delivered baby >9lbs HTN HDL <35 and or TRG >250 A1C >5.7% CVD insulin resistance |
| macrovascular complications | disease of large and medium sized blood vessels CAD, CVD |
| primary prevention of macrovascular complications | BP <130/80 LDL <100 TRG <150 HDL >40 (M) >50 (W) daily aspirin >45yo keep glucose controlled |
| microvascular complications | disease of small sized blood vessels |
| retinopathy | microvascular damage to retina |
| retinopathy cause | chronic high blood sugar leading cause of blindness |
| Nephropathy | microvascular damage causing thickening of glomeruli basement membrane screen yearly leading cause of CKD and ESRD |
| nephropathy cause | uncontrolled chronic high blood sugar |
| neuropathy | nerve damage by increased blood sugar with no glycemic control 50% of lower amputation occurs with this |
| neuropathy CM | numbness, tingling, pain, worst @ night, muscle jerks, lose sensation in feet |
| foot ulcers | 50% of all lower limp amputations occur mostly associated with diabetic foot neuropathy |
| primary prevention for foot ulcers | daily foot inspection, careful foot and nail care, and annual foot exam by healthcare professionals want to get PT/OT involves |
| monofilament 5.07 | a standard diagnostic tool used to assess for the loss of protective sensation (LOPS) in the feet assess the pts sensation |
| acute complications of diabetes | hypoglycemia: low BGL <70 hyperglycemia |
| acute hyperglycemia can lead to | diabetic ketoacidosis (T1DM) hyperosmolar hyperglycemia state (HHS) (T2DM) aka hyperglycemic hyperosmolar nonketotic syndrome HHNS |
| hypoglycemia | BS <70 caused by not eating or too much insulin abnormally low levels: adrenergic symptoms, central nervous system symptoms, brain cell death |
| hypoglycemia CMs | diaphoresis, confusion, headache can mimic alcohol or stroke death can occur if untreated |
| hypoglycemia adrenergic symptoms | below 70 (sentinal) confusion, sweating, tachy., nervousness, hunger, palpitations, thirst |
| hypoglycemia central nervous system symptoms | below 50 cant concentrate, confusion, memory loss, slurred speech, numbness, irritation, doubled vision, drowsiness, seizures |
| hypoglycemia brain cell death | below 20 seizures, coma, and death |
| hypoglycemia Tx first | rule of 15 give 15 gm of fast acting, concentrated carbs - 3/4 glucose tabs - 4-6 oz juice or soda (not OJ or diet soda) - 6-10 hard candies - 2-3 tsp honey |
| hypoglycemia Tx second | retest BGL in 15 minutes, repeat if <70 or if symptoms persist more than 10-15 minutes and testing is not possible |
| Tx for pts with severe hypoglycemia <70 w decrease LOC | increased aspiration risk! 1 amp D50 IV push ability to maintain airway monitor and check again in 15 |
| Glucagon | Tx for pts w severe hypoglycemia w decrease LOC and aspiration risk with NO IV ACCESS |
| glucagon emergency kit | 1 mg powdered glucagon/ sterile water reconstitute and give IM |
| glucagon emergency kit dose for adults and children | adults and children over 44 lbs (20kg) get full, children under get 1/2 syringe (0.5mL) |
| glucagon half life | short half life 8-18 mins may repeat if no response in 20mins |
| glucagon causes | N/V |
| glucagon emergency kit pt positioning | have pt lie on side to avoid aspiration |
| focused nursing assessment for hyperglycemia DKA or HHS | airway, breathing, and circulation (ABCs) status mental status possible precipitating events (source of infection, MI) volume and electrolyte status |
| diabetic ketoacidosis | aka diabetic coma cause: deficiency of insulin fatal if untreated 25% of new DM present with DKA (T1DM) (asymptomatic unless high or low) |
| causes of diabetic ketoacidosis | hyperglycemia ketogenesis (ketones in urine) metabolic acidosis (+anion gap) dehydration (polyuria) |
| DKA signs and symptoms | may develop in less than 24 hrs plasma glucose >250 3 P's, weakness N/V>50% abd pain >30% coffee-ground emesis 25% fruity breath (acetone) fever, infection dehydration; dry membranes, tachy consciousness ranges from alert to confused to comatose |
| labs in DKA - standard | plasma glucose, electrolytes, BUN, creat, effective serum osmolarity, phosphorus, beta- hydroxybutyrate (serum acetone), urinalysis, ABG or venous pH, CBC and diff., EKG |
| labs in DKA - as indicated | blood/urine/throat cultures (for infection), CXR (pneumonia or HF), Mg (cardiac arrhythmia, alc, diuretics), A1C level - to determine if hyperglycemic episode is acute or chronic |
| lab confirmation of DKA | BG >250mg/dL (usually higher) CO2 <15 anion gap elevated 12 +/- 4 positive serum and urine ketones arterial or venous pH <7.3 B hydroxybuterate >1 mmol/L |
| Hyperosmolar Hyperglycemic State HHS | life- threatening; high mortality rate pt is able to produce enough insulin to prevent DKA severe hyperglycemia >600 (without acidosis or anion gap) osmotic diuresis and ECF depletion |
| HHS usually | occurs in pt >ago 60 with Type 2 usually triggered by a comorbid event Tx is similar to DKA Caution: central pontine myelinolysis if treated too rapidly |
| HHS s/s | 3 P's hypotension, profound dehydration, tachycardia negative urine and serum ketones despite severe hyperglycemia fever (usually >38C) skin is hot but you do not sweat cerebral dehydration w variable symptoms |
| variable symptoms with HHS | H/A, confusion, Hallucinations, inability to speak, solmulence, paralysis, single sided weakness |
| HHS triggers | infection renal disorders MI meds: diuretics, steroids, or beta blockers excessive alcohol intake leading to polyuria and dehydration chronic illness bleeding ulcer too little insulin or oral anti-diabetic agents recent surgery |
| HHS lab values | serum osmolarity >320 plasma glucose >600 intense dehydration shown by elevated serum sodium levels no ketoacidosis arterial pH >7.3 HCO3 >15 |
| Tx of DKA and HHS- immediate care | IV hydration (.9% nacl or .45% nacl) iv insulin infusion cardiopulm support correct electrolyte imbalance test for glucose Q hour until stable serum electrolytes every 1-2 hopurs until pt awake, then Q4-6 venous pH (DKA) Q2-4 hr |
| correcting electrolyte imbalance for DKA or HHS | K replacement sodium bicarb in severe acidosis (pH<7) |
| Tx of DKA and HHS- continued care | monitor (vs, LOC, cardiac rhythm, spO2, I/O: esp from foley) transition from IV to SubQ insulin when stable |
| Euglycemia DKA | insulin resistance due to counterregulatory hormones, INC peripheral glucose, dec intake (N/V) |
| Euglycemia DKA - surgery | peri-operative fasting, GI surgery has increased incidence as fasting is prolonged and/or gut absorption is slow |
| Euglycemia DKA- fasting | decreased glycogen stores, increased risk with SLGT2i and T1DM |
| Euglycemia DKA- alc intake | decreased carb intake, osmotic diuresis, inc ketogenesis due to altered NADH/NAD ratio, inc risk is pt on SGLT2i |
| Euglycemia DKA- acute vascular events (stroke or ACS) | inc counter-regulatory hormones, dec oral intake |
| Euglycemia DKA- trauma | dec oral intake, inc counter-regulatory hormone, blood glucose dilution by large fluid shifts during resuscitation |
| Euglycemia DKA- prolonges immobility | inc counter-regulatory hormones, inc peripheral glucose utilization, dec carb intake |
| prevention of DKA and HHS | diabetic edu sick day management home check of BG and ketones reducing insulin when pt not eating easy digestible liquid diets when sick tell pt when to seek med care supplement short-acting insulin regimens monitoring high risk pts (insulin pump) |
| somogyi phenomenon (effect) | rebound hyperglycemia low blood sugar at night (3-4am) |
| why does somogyi phenomenon result? | results in release of epinephrine, cortisol, glucagon, growth hormone. liver releases glucagon. BGL rebounds resulting in hyperglycemia in AM |
| s/s of somogyi phenomenon | high BGL when waking up low BGL in the middle of the night headache upon waking up night sweats blurred vision confusion fatigue possible weight gain |
| dawn phenomenon (effect) | elevated BGL in morning. due to surge in cortisol, epinephrine, glucagon, growth hormones the body produces in early morning. liver releases glucagon. normal occurrence for anyone |
| dawn phenomenon vs diabetics | people w diabetes do not have normal insulin response to adjust and fasting blood glucose is elevated |
Created by:
ago24