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ch49diabetes
lewis
| Question | Answer |
|---|---|
| blood vessel disease | angiopathy |
| A multisystem disease related to abnormal insulin production, impaired insulin utilization, or both. | diabetes mellitus |
| an acute metabolic complication of diabetes occuring when fats are metabolized in the absence of insulin, resulting in formation of acid by-products, such as ketones. | diabetic ketoacidosis (DKA) |
| a microvascular complication of diabetes mellitus associated with damage to the small blood vessels that supply the glomeruli of the kidney. | Diabetic nephropathy |
| nerve damage that occurs because of the metabolic derangements associated with dibetes mellitus and characterized by sensory and/or motor disturbances in the peripheral nervous system | diabetic neuropathy |
| the process of microvascular damage to the retina in patients with diabetes | diabetic retinopathy |
| term used to describe the rise in blood glucose levels after a person has consumed a carbohydrate-containing food. | glycemic index |
| a life-threatening syndrome that can occur in the patient with diabetes who is able to produce enough insulin to prevent diabetic ketoacidosis but not enough to prevent severe hyperglycemia, osmotic diuresis, and extracellular fluid depletion | hyperosmolar hyperglycemic nonketotic syndrome |
| a condition in which a person does not experience the warning signs and symptoms of hypoglycemia, increasing his or her risk for dangerously low blood glucose levels. | hypoglycemic unawareness |
| an intermediate stage between normal glucose homeostasis and diabetes where the fasting blood glucose level is greater than 110- mg/dl but less than 125 mg/dl | impaired fasting glucose |
| a small battery-operated device that is programmed to deliver a continuous infusion of short-acting insulin 24 hours per day, known as the "basal rate," through a catheter inserted into the subcutaneous tissue in the abdominal wall | insulin pump |
| a condition in which body tissues do not respond to the action of insulin | insulin resistance |
| multiple daily insulin injections together with frequent self- monitoring of blood glucose, alternative to insulin pump for tight glucose control | intensive insulin therapy |
| hypertrophy or atrophy of subcutaneous tissue; may occur if the same injection sites are used frequently with the use of beef or beef and pork insulin | lipodystrophy |
| impaired glucose tolerance; occurs when the alteration in islets of Langerhans is mild and a 2-hour plasma glucose level is higher than normal but lower than that considered diagnostic for diabetes | prediabetes |
| the use of blood glucose meteres by patients to determine blood glucose levels and promote self-management decisions regarding diet, exercise, and medication | self-monitoring of blood glucose (SMBG) |
| condition where excessive insulin dose causes decline in blood glucose levels during sleep, causing the release of other hormones that increase glucose levels, resulting in high b. glucose levels at A.M. testing; indicates need for reduced insulin dose | Somogyi effect |
| In addition to promoting the transport of glucose from blood into the cells, insulin also? | accelerates the transport of amino acids into cells and their synthesis into protein. |
| What are the two types of tissues that require insulin for glucose transport? | skeletal muscle & adipose tissues |
| During the development of type 1 diabetes, the Beta cells response to the hyperglycemia can be identified in the blood and urine by the presence of ? | proinsulin C peptides |
| Two hormones released during physical and emotional stress that are counter regulatory to insulin are? | cortisol and epinephrine |
| The type of diabetes that is strongly related to human leukocyte antigen (HLA) types is | type 1 diabetes |
| Type 1 or Type 2 - insulin resistance? | type 2 |
| type 1 or type 2 - betal cell secretory exhaustion | type 2 |
| type 1 or type 2 - inherited defect in insulin receptors | type 2 |
| type 1 or type 2 - production of islet-cell antibodies | type 1 |
| type 1 or type 2 - genetic susceptibility for antibody production | type 1 |
| type 1 or type 2 - inappropriate glucose production by liver | type 2 |
| type 1 or type 2 - beta cell destruction | type 1 |
| type 1 or type 2 - impaired glucose tolerance that occurs gradually | type 2 |
| type 1 or type 2 - compensatory increased insulin production | type 2 |
| Describe the process that occurs to cause the following classic symptoms of diabetes - polyuria | high glucose levels cause loss of glucose in urine with osmotic diuresis |
| Describe the process that occurs to cause polydipsia in diabetes | thirst caused by fluid loss of polyuria |
| describe the process that occurs to cause the classic diabetic symptom - polyphagia | cellular starvation from lack of glucose and use of fat and protein for energy |
| Which of the following patients would a nurse plan to teach how to prevent or delay the development of diabetes? | a 34 year old woman whose parents both have type 2 diabetes. |
| When caring for a patient with metabolic syndrome; the nurse gives the highest priority to teaching the patient about? | maintaining a normal body weight |
| A 52 year old patient admiteed to the hospital w/ Vomiting & diarrhea has a FBS of 512 mg/dl and an arterial pH of 7.38. He is diagnosed w/ DM & treated w/ insulin & IV fluids. The nurse recognizes that it is most likely that this patient? | has enough endogenous insulin to prevent diabetic ketoacidosis with the hyperglycemia |
| During routine health screening, a patient is found to have a fasting plasma glucose of 132. At follow-up visit, a diagnosis of diabetes would be made based on (select all that apply) | 1. an FPG of > or = 126 mg/dl 2. a random plasma glucose of 210 mg/dl |
| The nurse determines the patient with a 2-hour OGTT of 152 mg/dl has | impaired glucose tolerance |
| When teaching the patient W/ diabetes about insulin administration, the nurse instructs the patient to | consistently use the same size of the appropriate strength insulin syringe to avoid dosing errors |
| A patient with type 1 diabetes uses 20 units of 70/30 neutral protamine Hagedorn (NPH/regular) in the morning and at 6:00 p.m. When teaching the pt about this regimen, the nurse stresses that | a set meal pattern with a bedtime snack is necessary to prevent hypoglycemia |
| Lispro insulin (Humalog) with NPH insulin is ordered for a patient with newly diagnosed type 1 diabetes. The nurse knows that when Lispro insulin is used, it should be administered? | at mealtime or within 15 minutes of meals |
| A diabetic patient is learning to mix regular insulin and NPH insulin in the same syringe. The nurse determines that additional teaching is needed when the patient | withdraws the NPH dose into the syringe first |
| The home care nurse should intervene to correct a patient whose insulin administration includes | mixing an evening dose of regular insulin with insulin glargine in one syringe for administration |
| The major advantage of using an insulin pump or intensive insulin therapy is that | tight glycemic control can be maintained |
| A patient taking insulin had recorded fasting glucose levels above 200 mg/dl on awakening for the last 5 mornings. The nurse advises the patient to | monitor the glucose level at bedtime, between 2:00 and 4:00 a.m. and on arising |
| Decreases endogenous glucose production | Thiazolidinediones |
| should be taken within 30 minutes of each meal | meglitinide |
| decreases glycogenolysis | sulfonylurea |
| frequently used drug of choice | sulfonylurea |
| Rapid and short acting release of insulin from the pancreas | meglitinide |
| Delays glucose absorption from the GI tract | alpha glucosidase inhibitor |
| stimulates production and release of insulin and enhances cellular sensitivity to insulin | sulfonylurea |
| increase glucose uptake, especially in muscles | Biguanide |
| Primary effect is decreased glucose production by the liver | Biguanide |
| Not effective against fasting hyperglycemia | alpha Glucosidase Inhibitor |
| One of the disadvantages of using oral antidiabetic agents compared with the use of insulin is that | patients may assume that their diabetes is not serious and that dietary modifications and meal scheduling are not important |
| In nutritional management of all types of diabetes, it is important for the patient to | eat regular meals at regular times |
| Goals of nutritional therapy for the patient with type 2 diabetes includes maintenance of | normal serum glucose and lipid levels |
| To prevent hyperglycemia or hypoglycemia with exercise, the nurse teaches the patient using glucose-lowering agents that exercise should be undertaken | about 1 hour after eating, when blood glucose levels are rising |
| The nurse assesses the diabetic patient's technique of self-monitoring of blood glucose 3 months after initial instruction. An error in the performance of SMBG noted by the nurese that requires intervention is | cleaning the puncture site with alcohol before the puncture |
| A nurse working in an outpatient clinic plans a screening program for diabetes. Recommendations for screening would include: | FPG for all individuals at age 45 and then every 3 years |
| A patient with diabetes calls the clinic because she is experiencing nausea and flulike symptoms. The nurse advises the patient to | administer the usual insulin dosage |
| Ketoacidosis occurs as a complication of diabetes when | an insulin deficit causes the body to metabolize large amounts of fatty acids rather than glucose for energy |
| List 5 signs and symptoms that are present in DKA that are not seen in hyperglycemic hyperosmolar syndrome | 1. Kussmaul's respirations 2. keonuria 3. sweet fruity odor to breath 4. decreased arterial pH (Acidosis) 5. ketonemia |
| The treatment for KDA and HHS differ primarily in that | HHS requires greater fluid replacement to correct the dehydration |
| The nurse is alerted to the possibility of hypovolemic shock occuring in the patient with HHS by the presence of | a change from polyuria to oliguria |
| Hypoglycemia, hyperglycemia or both - slurred speech and iritability | hypoglycemia |
| Hypoglycemia, hyperglycemia or both - headache | both |
| Hypoglycemia, hyperglycemia or both - nausea and vomiting | hyperglycemia |
| Hypoglycemia, hyperglycemia or both - too much exercise without food | hypoglycemia |
| Hypoglycemia, hyperglycemia or both - increased dietary intake | hyperglycemia |
| Hypoglycemia, hyperglycemia or both - cold, clammy skin | hypoglycemia |
| Hypoglycemia, hyperglycemia or both - precipitated by stress | hyperglycemia |
| Hypoglycemia, hyperglycemia or both - change in vision | both |
| A diabetic patient is found unconscious at home, and a family member calls the clinic. After determining that no glucometer is available, the nurse advises the family member to | administer glucagon 1 mg intramuscularly or subcutaneously |
| two days following a self-managed hypoglycemic episode at home, the pt tells the nurse that his blood glucose levels since the episode have been between 80 and 90 mg/dl. The best response by the nurse is | that is a good range for your glucose levels |
| In diabetes, atherosclerotic disease affecting the cerebrovascular, cardiovascular, and periopheral vascular systems | occurs with higher frequency and earlier onset than in the nondiabetic population |
| male impotence | autonomic neuropathy |
| diffuse and nodular glomerulosclerosis | microangiopathy |
| related to altered lipid metabolism of diabetes | macroangiopathy |
| microaneurysms and destruction of retinal capillaries | microangiopathy |
| atrophy of small muscles of the hands | sensory neuropathy |
| capillary and arteriole basement membrane thickening specific to diabetes | microangiopathy |
| pain and paresthesia of the legs | sensory neuropathy |
| ulceration and amputation of the lower extremities | macroangiopathy |
| shin spots | microangiopathy |
| delayed gastric emptying | autonomic neuropathy |
| ischemic heart disease | macroangiopathy |
| Following the teaching of foot care to a diabetic patient, the nurse determines that additional instruction is needed when the patient says | I'll know if I have sores or lesions on my feet because they will be painful |
| A 72 year old woman is diagnosed with diabetes. The nurse recognizes that management of diabetes in the older adult | does not require as tight glucose control as in younger diabetics |
Created by:
kellyaem