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Chapter 32: Lee CC
Lee College Nursing Program Exam 5 CHP 32: endocrine system
| Question | Answer |
|---|---|
| what are the 2 types of diabetes? | type 1 and type 2 |
| What are the signs and symptoms of diabetes mellitus? | *elevated fasting glucose (higher than 126mg/dL *polyuria *polydipsia *polyphagia *glycosuria *unexplained weight loss *Hyperglycemia |
| What is polyuria? | a condition usually defined as excessive or abnormally large production and/or passage of urine (at least 2.5 or 3 L over 24 hours in adults). i.e. peeing a lot |
| What is polydipsia? | excessive thirst |
| What is polyphagia? | over eating |
| What is Glycosuria? | the excretion of glucose into the urine |
| People with type 1 diabetes need ____ because the pancreas produces ____ _____. | exogenous insulin little to no insulin |
| ___% of people with diabetes have type 1 diabetes | 10 |
| Complications with type 1 diabetes______and_____. | diabetic ketoacidosis (DKA) hyperosmolar nonketotic syndrome |
| Type 2 diabetes occurs in ____% of all cases | 90 |
| what causes type 2 diabetes? | insulin deficiency and insulin resistance |
| With type 2 diabetes, many tissues are resistant to insulin because ______ and ______ | reduced number of insulin receptors and insulin receptors are less responsive |
| Name the six co-morbid conditions that usually accompany type 2 diabetes usually referred to as "syndrome x" or "metabolic syndrome" or "insulin-resistant syndrome" | 1.obesity 2. coronary heart disease 3. dyslipidemia 4. Hypertension 5. Micro-albuminemia (protein in the urine) 6. increased risk for thrombotic events |
| what is gestational diabetes? | a type of diabetes that occurs only during pregnancy |
| Why must insulin be given to a woman with gestational diabetes? | to prevent birth defects in her unborn child |
| Gestational diabetes usually subsides after____ but may come back within ____years in 30% of patients. | the delivery of the child 10-15 |
| the pancreas must produce some insulin in order for patients with type 2 diabetes to _____ dosage form | oral |
| Fasting plasma glucose levels between 110mg/dL and 126 mg/dL indicates what? | Patient may be "pre-diabetic" |
| Diabetes testing is recommended every ____ years for patients over 45 years of age | 3 |
| What are the 2 preferred treatments for people with type 1 diabetes? | 1. insulin therapy 2. lifestyle change |
| what are the 2-3 treatments for people with type 2 diabetes? | 1. lifestyle change 2. oral drug therapy 3. ***insulin if the above no longer provide glycemic control |
| When is insulin given to patients with type 2 diabetes? | When oral form and lifestyle changes no longer work |
| what are the 2 types of anti-diabetic drugs? | insulin oral hypoglycemia drugs |
| What is the purpose of anti-diabetic drugs? | they aim to produce normal blood glucose states |
| The effects if anti-diabetic drugs are the same as the body's natural insulin, therefore they restore the patients ability to________,_______, and_______. | *metabolize carbs, fats, and proteins *store glucose in the liver *convert glycogen to fat stores |
| If your patient is in a coma and requires a rapid acting drug never use _____ insulins | intermediate or long acting |
| How to you mix a insulin vial? | Roll in hands. Never shake because that will cause unwanted bubbles |
| Which insulin can never be diluted or mixed with other insulin/ solutions? | insulin glargine (Lantus) |
| When mixing 2 insulins in 1 needle always draw ____ first | regular insulin |
| If insulin is administered IV you can only use what type of insulin? | regular |
| 3 common adverse effects of Metaformin | metallic taste, nausea&vomiting, abdominal discomfort |
| What is diabetic ketoacidosis? (DKA) | A severe metabolic complication of uncontrolled diabetes that, if untreated, leads to diabetic coma or death |
| what is glucagon? | a hormone produced by the alpha cells in the islets of Langerhans that stimulates the conversion of glycogen to glucose in the liver |
| what does the A1C measure? | measure of average daily blood glucose levels in the monitoring of diabetes |
| what is Hypoglycemia? | a blood glucose level less than 50mg/dL |
| ketones are what? | organic chemical compounds produced through the oxidation of secondary alcohols (fat molecules) including dietary carbohydrates |
| what is the normal blood glucose range for a normal person? | 70-100 mg/dL |
| 3 Major long term macro-vascular (atherosclerosis plaque) complications from both types of diabetes? | coronary arteries--Heart attack cerebral arteries--stroke peripheral vessels--peripheral vascular disease(foot ulcers and possible amputations) |
| 3 Major long term microvascular complications (capillary damage) of both types of diabetes | *Retinopathy(retinal damage)--partial or complete blindness *Neuropathy--autonomic and somatic nerve damage *Nephropathy--kidney damage/chronic renal failure |
| in type 1 diabetes how much insulin does the patient's pancreas produce? | little to none |
| in type 2 diabetes how much insulin does the patient's pancreas produce? | normal levels are produced |
| What is the etiology (cause or origin) of type 1 diabetes? | autoimmune destruction of beta cells in the pancreas |
| what is the etiology (cause or origin)of type 2 diabetes? | multifunctional genetic defects: strong association with obesity and insulin resistance resulting from a reduction in the number or activity of insulin receptors |
| What % of people with type 2 diabetes are obese? | 80 |
| Type ___ almost always requires insulin therapy, but type___ only needs insulin in stressful situations, or if other therapy in not effective. | 1 2 |
| Regular insulin can be mixed with ___insulin except ____ | all, glargine |
| Never mix ___types of insulins | premixed EX:(Humulin 70/30) |
| Contraindication for the use of insulin | drug allergy or hypoglycemic patient |
| The 2 most serious adverse effects of excessive insulin dosing include: | shock, death |
| The 3 less severe adverse effects of insulin include: | weight gain, allergic reaction, and lipodystrophy at the site of repeated injection |
| What 5 drugs can interact with insulin and cause elevated blood glucose levels? | corticosteroids, niacin, thiazide & loop diuretics, sympathomimetic drugs, and thyroid hormones |
| What are the 6 substances/drugs that interact with insulin and cause blood sugar to drop? | alcohol, anabolic steroids,sulfa drugs,clofibrate, MAOIs,salicylates |
| All currently available oral and injectable anti-diabetic drugs are classified as pregnancy category ___ or ___ | B, C |
| _______ therapy is the only currently recommended drug therapy for pregnant women with diabetes. | Insulin |
| Rapid-acting insulin has an onset of action in __to__ minutes | 5-15 |
| When must patient eat when taking a rapid acting insulin? | right after injection |
| What is the rapid acting insulin on our exam 5 drug list? | lol we don't have one--gotta keep you on your toes :D |
| Rapid acting insulin may be given how? | Subcutaneous or subcutaneous infusion, but NEVER IV |
| Short actin insulins have an onset of action in ___ to ___minutes. | 30-60 |
| What is the short acting insulin on our exam 5 drug list? | Humulin R (regular insulin) |
| What is the only insulin that can be given IV bolus, IV infusion, and even IM | regular insulin |
| what color should regular insulin be? | clear |
| Why do we need insulin in the first place? | to break down glucose, and glucose is needed for energy |
| At what angle are SC injection given? | ~45 degrees |
| What is the appearance of intermediate-acting insulin? | cloudy |
| What is the intermediate-acting insulin on our exam 5 drug list? | Humulin N |
| what are the pros and cons of intermediate-acting insulin? | Pro: more prolonged duration than endogenous insulin Cons: slower in onset of action |
| What is the Long-acting insulin on our exam 5 drug list? | glargine/ Lantus |
| What is the apperance of Lantus? | clear and colorless |
| According to the sliding scale dosing chart, when do you not give insulin? | when the blood glucose level is below 140mg/dL |
| According to the sliding scale dosing chart, when do you give 2 units of insulin? | blood glucose level between 141-199mg/dL |
| According to the sliding scale dosing chart, when do you give 4 units of insulin. | blood glucose level between 200-249 mg/dL |
| According to the sliding scale dosing chart, when do you give 6 units of insulin? | blood glucose levels between 250-299 mg/dL |
| According to the sliding scale dosing chart, when do you give 8 units of insulin? | blood glucose levels over/or at 300 |
| What types of insulin are given in the sliding scale insulin dosing? | rapid acting or regular insulin |
| What is the disadvantage to using the sliding scale dosing method? | delays administration of insulin until hyperglycemia has occurred resulting in large swings in glucose control |
| When is the sliding scale typically used? | hospitalized diabetic patients or those on TPN or enternal tube feeding |
| how does the sliding scale work? | Subcutaneous insulin is ordered in an amount that increases as the blood glucose increases |
| what are the lifestyle modifications suggested for the treatment of type 2 diabetes? | diet, exercise, smoking cessation, weight loss |
| How does metaformin work? (its mechanism of action) | decreases production of glucose by the liver, decreases intestinal absorption of glucose, increases the uptake of glucose by the tissues, and does not increase insulin secretions from the pancreas (does not cause hypoglycemia) |
| How does glipizide work? | stimulates insulin secretions from the beta cells in the pancreas, thus increasing insulin levels ***Remember that with this drug beta cell function must be present for the drug to work***This drug does cause blood glucose to drop |
| Adverse effects of metaformin on the GI tract: | abdominal bloating, nausea, cramping,diarrhea, feeling of fullness |
| _____is rare with metaformin , but lethal if it occurs | lactic acidosis |
| _______ does NOT cause hypoglycemia | Metaformin |
| If a patient is on Metaformin and they need to have a CT scan with contrast, you must hold the metaformin for how long prior to the scan? | metaformin therapy should be discontinued the day of the test and for at least 48 hours after the patient undergoes any radiological study that requires the use of contrast media |
| Adverse effects of sulfonylureas? | hypoglycemia, hematologic effects, nausea, epigastric fullness, heartburn |
| Which antidiabetic drug may interact with alcohol causing a disulfiram-type reaction? | sulfonylureas |
| What are the early symptoms of hypoglycemia? | Confusion, irritability, tremor, sweating |
| What are the late symptoms of hypoglycemia? | hypothermia, seizures, coma and even death if left untreated |
| What are the 2 oral forms of concentrated glucose | buccal tablets, semisolid gels |
| Ideally, doctors would like the A1c level to be ___ or below | 5.5-6.0 |
| Before giving drugs to a patient that alter glucose levels always remember to: | assess patients ability to consume food, assess for nausea or vomiting |
| What 4 things that will affect the amount of anti-diabetic drugs a patient will receive? | stress, infection, illness or trauma, pregnancy/lactating mother |
| With anti-diabetic drugs, through patient education is essential regarding what____ | disease process,diet and exercise recommendations, self-administration, and potential complications |
| when insulin is ordered ensure its the correct _____,______,_____, and ______ | route, type of insulin, time of dosage, dosage |
| insulin orders and dosages are always ____ with a second nurse | double checked |
| Can you freeze insulin> | NO |
| can you store unopened insulin in the fridge? | yes |
| Can you keep opened insulin on the kitchen counter? | yes, if the home is kept at room temperature 64-73 degrees |
| Nursing Implications: 5 things to remember when administering insulin | 1.check blood glucose before giving insulin 2.roll vial in hand (NO SHAKING VIAL) 3.ensure correct storage of vials 4.only use insulin syringes, calibrated in units to measure and give insulin 5.ensure correct timing of insulin with meals |
| with oral antidiabetic drugs always: | check blood glucose before giving oral medication |
| Usually give oral antidiabetics ___ minutes before meals | 30 |
| _______is taken with meals to reduce GI upset | Metaformin |
| If hypoglycemia occurs and the patient is conscience then give him/her: | glucose tablet/gel, corn syrup, honey, fruit juice, or non diet soda or a small snack |
| If hypoglycemia occurs, and the patient is unconscious give: | D50W or glucagon intravenously |
| _____ should not be used in women while they breast feed | Lantus |
| Intermediate acting insulin is often mixed with regular insulin, why? | to reduce the number of insulin injections per day |
| what is the first line drug used in in type 2 diabetes? | metaformin |
| does metaformin cause weight gain? | no, actually it can cause moderate weight loss |
| can metaformin be combined with insulin therapy? | yes |
| Metaformin is contraindicated in patients with _____ or _____ | renal disease or renal dysfunction |
| Other contraindications for metaformin (3) | alcoholism, hepatic disease, heart failure |
| ______ is a second step drug used when metaformin does not work | Glipizide |
| Glipizide should not be used in patients with ____ | Patients with advanced diabetes depending on insulin |
| Contraindications for use of glipizide? | hypoglycemia,or conditions that predispose the patient to hypoglycemia such as reduced calorie intake, ethanol intake, or advantage age |
| Adverse effects of glipizide | weight gain, skin rash, nausea, epigastric fullness, and heartburn |
| Primarily a higher intake of ____and a lower intake of ____ is recommended to prevent a rebound postprandial hypoglycemic effects | protein, carbohydrates |
| Which is faster table sugar or buccal tablets in the relief of hypoglycemia? | buccal tablets |
| how can you identify a insulin syringe? | orange cap, calibrated in units, 29 gauge, and 1/2 inch in length |
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