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JM Diabetes
Diabetes
| Question | Answer |
|---|---|
| What are two aspects of insulin injections besides technique and diet, that the RN should teach? | rotate injection sites (within one site at a time), draw regular insulin into syringe FIRST when mixing insulins. |
| Discuss diet for DM pt. | Carbs-55%-60%,12-15% protein,30%orless of fats. Complex carbs preferred (high fiber low fat),alcoholic beverages if proper exchanges are made,bedtime snack (can prevent insulin reactions to long-acting insulin). |
| How should DM pts handle sick days? | Keep taking insulin, monitor glucose more frequently,watch for signs of hyperglycemia. |
| What is the body’s response to illness and stress? | Body’s response is to produce glucose-therefore any illness results in hyperglycemia. |
| What should Rn teach DM pt about exercise? | exercise decreases sugal levels, get reg nonstrenous exercise, after mealtime, with someone or let someone know where for safety,snack may be needed before or during,monitor blood glucose before,during,and after when beginning a new regimen. |
| What is the basic item RN should teach about DM? | S/S of hyperglycemia or hypoglycemia. |
| What labs are indicated for DM? | Serum glucose,electrolytes,creatinine, BUN,ABGs as indicated. Glycosylated Hgb A1c:indicates glucose control over previous 120 days, valuable measurement of diabetes control. |
| What is the body’s response to illness and stress? | Production of glucose. |
| How should DM pt manage sick days? | Keep taking insulin,monitor glucose more frequently,watch for signs of hyperglycemia. |
| What is diabetes mellitus? | A metabolic disorder where there is an absence or insufficient production of insulin. |
| What does diabetes mellitus affect? | The metabolism of protein, carbs, and fats. |
| What is the fasting glucose level indicating DM? | >126mg/dl. |
| Name the two major classifications of diabetes? | Type 1:insulin-dependent DM (IDDM) and Type 2 :non-insulin-dependent DM(NIDDM). |
| What is a major factor in type 2 diabetes? | Obesity |
| What is the diagnostic parameter for fasting glucose level for DM? | >126 mg/dl. |
| What affects the complications of DM? | Blood glucose level control. |
| What are some clinical characteristics of IDDM? | Pt becomes hyperglycemic relatively easily, risk of KETOACIDOSIS,serum glucose >350,lg amts ketonunria,venous pH of 6.8-7.2. Serum bicarb<15mEq/dl |
| Discuss treatment for IDDM. | Usually isotonic IV fluids,slow IV infusion by IV pump w/regular insulin,with IM or SC bolus as needed with careful blood glucose monitoring,careful replacement of K+ based on labs. |
| Discuss clinical characteristics of NIDDM. | Rare ketoacidosis,risk of nonketotic hyperosmolar hyperglycemia w/extreme hyperglycemia,hyperglycemia,plasma hyperosmolality, dehydration,changed mental status |
| What are the usual treatments for NIDDM? | Isotonic IV fluid replacement&careful monitoring ofK+ and glucose levels,IV insulin. |
| What skin nursing assements should be evaluated for? | Breaks in skin, infectionson skin, diabetic dermopathy (skin spots),unhealed injection sites. |
| What oral assessments need to be done for DM? | Cavities,gum disease,candidiasis |
| Nursing assements for eye complications with DM? | Cataracts,retinal problems |
| Nursing assessments for the cardiopulmonary system with DM? | Angina, dyspnea |
| What are some assessments for DM in the periphery? | Hair loss on extremities, indicating poor perfusion,cool,shiny,thin skin,WEAK OR ABSENT PERIPHERAL PULSES,ulceration on extremities,pallor,thick nails with ridges. |
| Nursing assessments of DM with the kidneys? | edema of face,hands,and feet, UTI (fatigue,pallor, and weakness),urinary RETENTION. |
| Nursing assessments with neuromusculature with DM. | Atrophy of hands and feet,neuropathies (numbness,tingling,pain, burning). |
| GI nursing assessments with GI with DM pts? | Nighttime diarrhea, emesis falling into a patter (e.g., vomits qnight 1 hr after dinner),gastroparesis (faulty absorption. |
| Reproductive assessments with DM. | Impotence, vaginal dryness, frequent vaginal infections, menstrual irregularities. |
| What test indicates glucose control and what are the goal values? | Hgb A1c indicates glucose control over previous 120 days/values between 4-6%-less than 7% for diabetics |
| Name some nursing diagnoses for DM. | Deficient knowledge r/t, ineffective coping r/t, risk for injury r/t |
| What injection technique should the RN teach for DM pts? | lift skin, use 90-degree angle |
| How should insulin be stored? | unopened insulin in fridge, may be kept at room temp for 29 days, should be given at room temp |
| What are two aspects of insulin injections besides technique and diet, that the RN should teach? | rotate injection sites (within one site at a time), draw regular insulin into syringe FIRST when mixing insulins. |
| Discuss diet for DM pt. | Carbs-55%-60%,12-15% protein,30%orless of fats. Complex carbs preferred (high fiber low fat),alcoholic beverages if proper exchanges are made,bedtime snack (can prevent insulin reactions to long-acting insulin). |
| How should DM pts handle sick days? | Keep taking insulin, monitor glucose more frequently,watch for signs of hyperglycemia. |
| What is the body’s response to illness and stress? | Body’s response is to produce glucose-therefore any illness results in hyperglycemia. |
| What should Rn teach DM pt about exercise? | exercise decreases sugal levels, get reg nonstrenous exercise, after mealtime, with someone or let someone know where for safety,snack may be needed before or during,monitor blood glucose before,during,and after when beginning a new regimen. |
| What is the basic item RN should teach about DM? | S/S of hyperglycemia or hypoglycemia. |
| What labs are indicated for DM? | Serum glucose,electrolytes,creatinine, BUN,ABGs as indicated. Glycosylated Hgb A1c:indicates glucose control over previous 120 days, valuable measurement of diabetes control. |
| What is the body’s response to illness and stress? | Production of glucose. |
| How should DM pt manage sick days? | Keep taking insulin,monitor glucose more frequently,watch for signs of hyperglycemia. |
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