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210 Ch. 41

Diabetes

QuestionAnswer
What is a cholecystectomy? what is cholecystitis? What is CCK-PZ? What is choledocholithiasis 1.removal of gallbladder 2.inflammation of gallbladder 3.digestive enzyme to stimulate contraction of gallbladder 4.stones in common duct
what is difference b/n endocrine and exocrine glands? endocrine r ductless into bloodstream, works with nervous system and exocrine from ducts
what is secretin? what is trypsin? 1.hormone stimulate pancreatic juices 2.pancreatic enzyme for digestion of protein
what is steatorrhea? frothy, foul smelling stool w/ high fat from bad protein/fat digestion cause lack of pancreatic juices
What is a Zollinger-Ellison tumor? hyper secretion of gastric acid to produce peptic ulcers.
What is fx of gallbladder to store 30-50ml of bile. Hormone CCK-PZ causes gallbladder to secrete bile in intestines.
what is the enterohepatic circulation? Pathway from hepatocytes to bile to intestine and back
What is fx of bilirubin in bile. Composed of half of bilirubin(RBCs) converted to urobilinogen. It's excreted in stool or back to portal circ.
What happens to bilirubin if bile is blocked? bilirubin not enter intestine, incr in blood....lead to jaundice, gallbladder issues
What is fx of pancreas? exocrine: secrete pancreatic enzymes in GI endocrine: secrete insulin, glucagon, somatostatin
What does the pancreatic duct join and where? pancreatic duct joins common bile duct and enters duodenum at ampulla of Vater
What is unique about the pancreatic digestive enzymes? alkaline to neutralize gastric acid: amylase(carbs), trypsin, lipase
What is major hormone to trigger these pancreatic digestive enzymes? CCK-PZ, and secretin hormone for incr bicarbonate secretion from pancreas
What cells compose Islet of Lanterhans? 1.Alpha cells: secrete glucagon 2.beta: insulin 3.delta: somatostatin
What is fx of insulin? 1.transport/metabolize glucose for energy 2.store glucose n liver as glycogen 3.signal liver stop release of glucose 4.store fat 5.transport AA into cells 6. inhibits breakdown of stored glucose/protein/fat
What happens to glucose in absence of insulin builds up in blood and excreted in urine.
what blood level signifies DM? random glucose on more than one time at >200, fasting glucose of >126, 2hr glucose loading level of >126
what are risk factors for DM hx, obese, type 2, gestational, high cholesterol, htn, race(af am, hisp)
What are 4 types of DM Type 1: insulin dependent Type 2: insulin resistant Gestational: pregnant Secondary diabetes: r/t Cushings syndrome or use of corticosteroids
What is osmotic diuresis loss of fluids cause of too high glucose level in blood
what are ketone bodies acids from breakdown of fats, can cause DKA
what are s/s of DKA nausea, abd pain, vomiting, hyperventilation, fruity breath odor, altered consciousness, coma, death
What can type 2 diabetes lead to hyperglycemic hyperosmolar nonketotic syndrome...not DKA
what is gestational Diabetes goal levels <105mg/dL before meals <130 after meals
What are three P's classic to diabetes? polyuria- incr urine polyphagia- incr appetite polydipsia - incr thirst
In secondary diabetes, what does solumedol do? corticosteroid and will casue glucose to rise. Give insulin while on it and then after it will stop.
What is main goal for DM regulate insulin and prevent vascular/neuropathic probs
What are 5 goals for diabetic mgmt nutritional mgmt, excercise, monitoring, drug therapy, education
Types of Insulin: What are kinds of rapid acting insulin? Onset? Peak? Duration? Humalog/Novalog: rapid reduction onset: 10-15m peak: 1hr dur: 2-4hr
Kinds of short acting insulin? onset? peak? dur? Regular, Humalog R, Novolin R given 20-30m before meal onset: 1/2 - 1h peak: 2-3h dur: 4-6h
What is important to remember about regular insulin and mixing? Only one that can mix with NPH
Kinds of NPH(intermediate) onset? peak? dur? NPH, Lente, Novolin N taken after food, cloudy onset: 2-4 peak: 4-12 dur: 16-20h
kinds of long acting onset? peak? dur? Ultralente onset: 6-8h peak: 12-16h dur: 20-30h
kinds of very long acting onset? peak? dur? Glargine (Lantus)...clear, can't be mixed...used as base onset: w/in 1hr peak: none, continuous dur: 24hr
how to mix insulins clear to cloudy... put air of total amt in cloudy (regular), draw clear, then draw cloudy
What % of carbs, protein, fat should be in diet? What are 6 exchange food lists? 50-60% carbs, 20-30% fat (10% sat fat), 10-20% protein, fiber(lowers BS) bread/starch, vegetable, milk, meat, fruit, fat
Ways to lower glycemic index combine carbs with protein/fats, raw/whole foods, whole fruit, not juice
How does alcohol affect sugar levels hypoglycemia Moderate intake is 1 beverage for women, 2 for men
How does excercise affect sugar levels lowers BS, but need to excercise at same time with BS at peak. Eat 15g carb(fruit) or with a protein before excercise.
A complication of lipodystrophy means loss of subcutaneous fat, dimpling, caused by repeated use of injection site
complication: Morning Hyperglycemia also known as Dawn phenomenon - elevated insulin at 3a. Change dose from dinner to bedtime. Incr at 7a so give HS dose
Somogyi effect - nocturnal, BS drops at 3a and incr at 7a. Hypoglycemia followed by rebound hyperglycemia: caused by NPH dose given before dinner, move it to bedtime or incr bedtime snack
So what should you do to determine between two morning hyperglycemic effects Do 3a BS test
Oral antidiabetic meds: Sulfonylureas: 1st gen replaced with 2nd gen stimulate beta cells to make more insulin SE: hypoglycemia, wt gain, reacts nsaids
Biguanides Metformin, inhibit prod of glucose by liver, incr tissue sensitivity to insulin SE: lactic acid and renal probs
thiazolidinediones Avandia, enhance insulin, not incr production SE: can incr ovulation, liver damage so test
Alpha glucosidase inhibitors Acarbose, Miglitol, newer, delay absorption of glucose after meal in gut SE: oily stools cause fat not absorbed
Meglitinides Prandin, stimulate pancreas, fast action, short duration SE: short
Pramlintide (Symlin) Exenatide secreted by beta cells and used with insulin Used in combo with metformin, sulfonylueas, enhance insulin absor
How should insulin be stored? What is flocculation? good for 30 days, room temperature or fridge. frosted, whitish coating in bottle from extreme temps
what is normal A1C? 4.4 - 6.4%
where in body is greatest absorption for insulin abd and decr in arm, thigh, hip. Do not inject in arm that is being excercised....absorb too fast
What are three main complications with insulin? hypoglycemia, DKA, hyperglycemic phyerosmoloar non-ketotic syndrome
What is BS level of hypoglycemic <50-60mg/dL
Which insulins should be delayed 5-15 min after eating? lispro, aspart, glulisine, Apidral
the acronym "tie" helps diabetic patients remember what about giving insulin t-test i-inject 2-eat
what are s/s of hypoglycemia shakiness, sweating, nervousness, hunger, weakness, lightheadedness, confusion, numbness of lips/tongue tx: 15g carb, 1/2c juice
what is gluconeogenesis release of glucose by the liver
what is DKA diabetic ketoacidosis: insulin deficiency and gluconeogenesis incr leading to hyperglycemia. Sugar, water, electrolytes(osmotic diuresis). Mainly type 1
what are ketones and how do they affect DKA without insulin, breakdown of fat is incr into fatty acids and glycerol. The fatty acids are converted into ketone bodies by liver which are acids adn accumulate.
what are three main causes of DKA decr/missed dose of insulin, illness/infection, undiagnosed/untreated diabetes
what are "sick day" rules When sick(vomit/nausea), take insulin with normal diet and fluids. If BS is >240 check for ketones
what kind of foods are good for sick days? softer: reg gelatin, cream soup, custard, graham crackers. Drink liquids q1/2 - 1hr
Is the severity of DKA related to the what glucose level? Not related to BS level, but bicarb and low pH levels(6.8-7.3). Kussmaul resp, low CO(10-30)=resp compensation.
Incr levels of BUN, creatinine and hematocrit can signify what with DKA? dehydration?
Incr levels of creatinine can signify loss of what? muscle mass
Mgmt of DKA & HHNS correct dehydration, electrolyte loss, acidosis
What is major electrolyte loss to be concerned about potassium...K will decr as K is released from ICF to ECF and passed in urine. Rehydration: will see drop in K as it re-enter ECF from ICF. Insulin enhances K to be reabsorbed, so continue K tx. Dysrhymias can result from hypokalemia
How is the acidosis managed in DKA insulin stops fat breakdown, stopping acid build up. IV glucose and NS given to not drop BS too low.
Which insulin is approved for IV use? Regular insulin only and infused separate of rehydrating fluids and infused til subq injections can be taken
Which is usually corrected first in rehydrating DKA pt, blood glucose or acidosis? blood glucose corrected before acidosis. IV insulin continues til pt eats and bicarb level reaches 15 - 18. Do not infuse bicarb to correct severe acidosis, insulin IV works.
What is important to remember when giving IV insulin infusions Flush with NS and discard first 50ml of fluid bc insulin sticks to tube and will be lesser dose
What is hyperglycemic hyperosmolar nonketotic syndrome(HHNS)? fluid losses, sensory loss, no ketosis, usually type 2, age 50-70, slow onset from sickness. No ketones.
What is diff in glucose and osmolarity levels with DKA and HHNS? DKA: BS >250, osmolarity 300-350, pH <7.3, bicar <15 HHNS: BS >600, osmol >350, pH norm, bicarb norm
Renal microvascular disease is more common in pt with type 1 or 2 diabetes? Cardiovascular(macrovascular) complications more wtih 1 or 2? microvascular- changes in tissue(eye, kidney,brain) more wtih type 1 Macrovascular(heart) more with type 2. More MI's
What are three main macrovascular complications? coronary artery disease, cerebrovascular disease, peripheral vascular disease
What happens with diabetic retinopathy changes in small blood vessels in retina.
What develops and is signal for renal disease and retinopathy HTN
What insulin is only used during surgery? regular and usually withheld morning of surgery unless >200
What is diabetic enteral formula Glucerna
Normal non-diabetic blood sugar level <100mg/dL
Acute pancreatitis needs what nsg intv? assess for pain, reduce pancreatic/gastric secretions with anticholinergic meds, assess F&E, high carb, low protein/fat diet, assess resp status, assess for shock, assess for ascites
Created by: palmerag