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
WVC IGGY 1492 DM
WVC part 2 Diabetes pg 1492 to end
| Question | Answer |
|---|---|
| Hepatitis B virus can survive in a dried state for at least 1 week. Advise patients to | never reuse or share lancets or needles. |
| What would the accuracy teaching be for SMBG (self monitoring blood glucose) | always calibrate machine and recheck if you have a abnormal BG. |
| What is the most accurate type of test | lab blood test, A1c |
| The American Diabetes As sociation (ADA) recommends that patients with type 1 diabetes aim for hemoglobin A1c (HbA1c) values | less than 7%, premeal glucose levels of 90 to 130 mg/dL (5.0 to 7.2 mmol/L), and postmeal glucose levels less than 180 mg/dL (10.0 mmol/L) |
| Continuous BG monitoring provides | blood glucose readings every 1 to 10 minutes for up to 72 hours |
| Continuous glucose monitoring is meant to | supplement, not replace, finger-stick tests. Insulin should be given only after confirming the results of any of the continuous glucose monitoring systems. |
| Meal plans that consider the patient's | cultural background, financial status, and lifestyle are more likely to be successful. |
| The nutritionist develops a meal plan based on the | patient's usual food intake, weight-management goals, and lipid and blood glucose patterns |
| Dietary fat and cholesterol, especially saturated fatty acids and trans fatty acids are | restricted to reduce the risk for cardiovascular disease. |
| Fiber improves | carbohydrate metabolism and lowers cholesterol levels |
| Dietary sucrose does not | increase blood glucose more than equal amounts of other starches. they don’t need to restrict their intake more than other forms of sugar. |
| Many patients with type 2 diabetes are | overweight and insulin resistant. |
| Older patients are at increased risk for | malnutrition, hypoglycemia, and especially dehydration, a factor in the development of hyperglycemic-hyperosmolar state (HHS). |
| Vigorous aerobic or resistance exercise may be | contraindicated in the presence of proliferative diabetic retinopathy (PDR) or severe non-PDR (NPDR) |
| Teach the patient with PDR or NPDR to avoid the | Valsalva maneuver (breath holding while bearing down) and activities that increase blood pressure. |
| Consideration for PDR and NPDR, heavy lifting, rapid head motion, or jarring activities can cause | vitreous hemorrhage or retinal detachment |
| Teach the patient with peripheral neuropathy to engage in | non–weight-bearing activities such as swimming, bicycling, or arm exercises. |
| Those with autonomic neuropathy are at increased risk for | exercise-induced injury from impaired temperature control, postural hypotension, and impaired thirst with risk for dehydration. Physical activity also can increase urine protein excretion. |
| High risk is defined by the ADA (for exercise injury) as: | Age>35•Age>25 years and type 2 diabetes of more than 10 year's duration•Age older than 25 years and type 1 diabetes of more than 15 year's duration• coronary artery disease• microvascular disease •peripheral vascular disease •Autonomic neuropathy |
| Guidelines for exercise are based on | blood glucose levels and urine ketone levels |
| Patients with type 1 diabetes should perform vigorous exercise only if blood glucose levels are | 80 to 250 mg/dL (4.4 to 13.8 mmol/L) and no ketones are present in the urine. |
| When urine ketones are present, the patient should | not exercise. Ketones indicate that current insulin levels are not adequate and that exercise would elevate blood glucose levels. |
| The American Diabetes Association's Recommendations for Exercise | 150 min/wk of moderate-intensity aerobic physical activity and/or at least 90 min/wk of vigorous aerobic. ( days a week) |
| ADA states that as little as _________ hours per week, help to reduce cardiovascular risks associated with DM | 4 |
| ADA states: for long-term maintenance of major weight loss (more than 13.6 kg/30 lb), larger volumes of exercise ____________ hrs/week, of moderate or vigorous aerobic physical activity may be helpful. | 7 hr/week |
| ADA states: resistance exercise: In the absence of contraindications, patients with type 2 diabetes are urged to perform resistance exercise __________ times per week, targeting all major muscle groups. | 3 |
| Teach patients not to exercise within ______ hour n of insulin injection or at the peak time of insulin action | 1 hour |
| Why shouldn’t you exercise w/i 1 hour of injection or peak time | it can increase absorption of insulin from the injection site, increasing blood insulin levels. The risk for hypoglycemia increases when insulin is injected into an area that is exercised. |
| How often should a patient monitor BG if exercising | before and after |
| Reinforce that snacks containing rapidly absorbable carbohydrate may be eaten | before and during exercise to maintain normal blood glucose levels. |
| After exercising, extra carbohydrate may be needed for up to | 24 hours after exercise to prevent hypoglycemia. |
| What would you teach a patient who plans on exercising regarding insuling | to decrease insulin dosage before planned exercise as directed. |
| _______________is a common complication after major surgery and is associated with increased mortality. | Hyperglycemic-hyperosmolar state (HHS) |
| Diuresis from hyperglycemia can cause severe dehydration and increase the risk for | kidney failure. |
| Two types of surgery for diabetics are | pancreas transplant and islet cell transplant. |
| Anesthesia and surgery cause a stress response with release of counterregulatory hormones that | elevate blood glucose. |
| Complications of diabetes increase the risk for surgical complications. Diabetics are higher risk for | hypertension, ischemic heart disease, cerebrovascular disease, MI, and cardiomyopathy. |
| Metformin (Glucophage) is stopped ___ hours before surgery and restarted only after renal function is normal. | 48 |
| Preoperative blood glucose levels should be less than | 200 mg/dL |
| IV infusion of insulin, glucose, and potassium is standard therapy for | perioperative management of diabetes. |
| What is is common in patients with mild to moderate kidney failure and can lead to cardiac dysrhythmia. | hyperkalemia |
| When a diabetic is post-surgery, what should a nurse monitor for | hyperglycemia, hypoglycemia, hyperkalemia, hypokalemia, cardio changes (can result in MI) and renal changes (resulting in renal failure) |
| The Charcot foot is a type of | diabetic foot deformity. The foot is warm, swollen, and painful. Walking collapses the arch, shortens the foot, and gives the foot a “rocker bottom” shape. |
| Sensory neuropathy may cause | tingling or burning, but more often it produces numbness and reduced sensation. |
| Neuropathy of the feet and legs can be delayed by | keeping blood glucose levels as near normal as possible. |
| Feet should be assessed by a doctor | annually |
| Sensory examination with Semmes-Weinstein monofilaments is | a sensory test to determine the amount of feeling a diabetic has in his feet and legs. It identifies spots that are at risk for injury. |
| Poor blood glucose control, proteinuria, diastolic hypertension, and long duration of diabetes are risk factors for | diabetic retinopathy and vision loss |
| Glomerular filtration rate (GFR) is the best overall measure of | kidney function. |
| Serum creatinine should be measured at least | annually for an estimation of GFR in all patients with diabetes (ADA, 2007c). |
| The earliest evidence of nephropathy is the appearance of | albumin in the urine. An annual test for microalbumin is performed for patients who have had type 1 diabetes for over 5 years and for all patients with type 2 diabetes starting at diagnosis and during pregnancy |
| Radiocontrast dyes can also affect | renal function, especially in patients with preexisting renal insufficiency |
| The brain cannot make glucose and stores only a few minutes' supply as | glycogen. |
| Normally, insulin secretion decreases when blood glucose levels drop to about | 83 mg/dL |
| Counterregulatory hormones are activated at about | 67 mg/dL, a level well above the threshold for symptoms of hypoglycemia. |
| The main counterregulatory hormone is | glucagon. |
| Epinephrine also becomes important in diabetic patients who are deficient in | glucagon. Glucagon, & epinephrine ↑glucose levels by stimulating liver glycogen breakdown and conversion of protein to glucose. |
| Epinephrine limits | insulin secretion. Growth hormone and cortisol also are important during prolonged hypoglycemia. Their effects do not become evident until 4 hours after the onset of hypoglycemia. |
| In DM1, over time, the pancreas loses its ability to secrete | glucagon in response to hypoglycemia. Epinephrine’s response is also decrease→risk for sever hypoglycemia |
| Symptoms of hypoglycemia are | neuroglycopenic or neurologic. |
| Neuroglycopenic symptoms occur when brain glucose | gradually declines to a low level. |
| Neurologic symptoms result from | autonomic nervous activity triggered by a rapid decline in blood glucose |
| In mild hypoglycemia, the patient remains | alert and able to self-manage symptoms. |
| In severe hypoglycemia, | neurologic function is so impaired that he or she needs another person's help to increase blood glucose levels. |
| NEUROGLYCOPENIC SYMPTOMS of severe hypoglycemia | Warmth, Weakness, Fatigue, Difficulty thinking, Confusion, Behavior changes, Emotional liability, Seizures, Loss of consciousness, Brain damage, Death |
| Neurogenic symptoms of hypoglycemia | Shaky/tremulous, Heart pounding, Nervous/anxious, Cholinergic, Sweaty, Hungry, Tingling |
| Planning Outcomes for a DM, The diabetic patient is expected to have decreased episodes of hypoglycemia and remain oriented to person, place, and time, as indicated by a | Glasgow Coma Scale score above 7. |
| According to the ADA, hypoglycemia is defined as | A blood glucose level below 70 mg/dL |
| Sensitivity to insulin is increased with the use of | an insulin sensitizer (metformin and thiazolidinedione agents), late after exercise, or after weight loss. Insulin clearance is decreased in kidney failure. |
| For mild hypoglycemia (hungry, irritable, shaky, weak, headache, fully conscious; blood glucose usually less than 70 mg/dL, treat the symptoms of hypoglycemia with | 10 to 15 g of carbohydrate. |
| Moderate hypoglycemia s/s | cold, clammy skin; pale; rapid pulse; rapid, shallow respirations; marked change in mood; drowsiness |
| Severe hypoglycemia s/s | unable to swallow; unconsciousness or convulsions. Administer glucagon. |
| Classic symptoms of hypoglycemia | profuse perspiration, anxious, nervous, mental confusion, weakness (no ketones) BG<70 |
| Classic symptoms of hyperglycemia | skin: hot/dry, rapid, deep respirations, fruity odor (Kussmaul if severe), ketones present, BG>250 |
| Glucagon converts liver | glycogen to glucose but is not effective in severely starved patients. |
| Teach the patient how to prevent hypoglycemia. Four common causes of hypoglycemia are | (1) excess insulin, (2) deficient intake or absorption of food, (3) exercise, and (4) alcohol intake. |
| Instruct the older diabetic patient and family to check blood glucose values when symptoms such as | unsteadiness/lightheadedness/↓concentration/trembling/sweating. Assess eating to make sure they eat sufficient foods at appropriate times. Encourage a patient with a poor appetite to eat a small snack at bedtime to prevent hypoglycemia during the night. |
| DKA results from | sudden onset, occurs from infection, inadequate insulin or other stressors |
| Manifestations are | fruity breath, Kussmaul breathing, N/V, abd px, dehydration or electrolyte loss: polyuria, polydipsia, weight loss, dry skin, sunken eyes, soft eyeballs, lethargy, coma |
| Lab findings for DKA | BG >300 mg/dL, serum/urine ketones Positive at 1:2 dilutions, pH<7.35, BUN>20 &, creatinine>1.5 dt dehydration. |
| HHS results from | poor fluid intake, infection or other stressors, onset is gradual |
| manifestations of HHS are | Altered central nervous system function with neurologic symptoms. Dehydration or electrolyte loss: same as for DKA |
| Lab findings for HHS | BG >600 (Gayle sd 800), osmolarity >320, no ketones, pH>7.4, loss of Na & K, (especially K) ↑BUN & creatinine |
| Classic symptoms of DKA include | polyuria, polydipsia, polyphagia, weight loss, vomiting, abdominal pain, dehydration, weakness, altered mental status, shock, and coma. |
| Priority assessment for DKA is | First assess the airway, level of consciousness, hydration status, electrolytes, and blood glucose level. |
| Treatment of acidosis, priority nursing care is to monitor for | hypokalemia. Hypokalemia is a common cause of death in the treatment of DKA |
| Exploring the factors leading to DKA helps in planning specific educational efforts. Teach the patient and family to check blood glucose levels every | 4 to 6 hours as long as symptoms such as anorexia, nausea, and vomiting are present and as long as glucose levels exceed 250 mg/dL. Teach him or her to check urine ketone levels when blood glucose levels exceed 300 mg/dL. |
| HHS differs from DKA in that ketone levels | are low or absent and blood glucose levels are much higher. |
| Sick-Day Rules | Monitor your blood glucose at least every 4 hours., test for ketones, continue to take insulin or oral antidiabetics, drink fluids, eat and have a family care plan. Notify HCP if a fever>24 hrs of>101.5 |
| HHS is the end result of a sustained | osmotic diuresis |
| Renal insufficiency in HHS allows for extremely high | blood glucose levels. Glucose impairs the concentrating ability of the kidney. |
| HHS occurs most often in older patients with type | 2 diabetes mellitus, many of whom did not know that they had diabetes |
| Myocardial infarction, sepsis, pancreatitis, stroke, and some drugs (glucocorticoids, diuretics, phenytoin [Dilantin], propranolol [Inderal], and calcium channel blockers) also may cause | HHS. |
| Unlike DKA, patients with HHS may have | seizures, myoclonic jerking, and reversible paralysis. The degree of neurologic impairment is related to serum osmolarity, with coma occurring once serum osmolarity is greater than 350 mOsm/kg |
| In HHS, the patient secretes just enough insulin to prevent | ketosis but not enough to prevent hyperglycemia |
| review travel plans and home teaching objective…they are not included in this study stack |
Created by:
wvc
Popular Nursing sets