Upgrade to remove ads
Med. Surg Exam 4
Terms in this set (61)
A chronic disorder of impaired glucose intolerance and carbohydrate, protein and lipid metabolism because of deficiency of insulin.
4. cerebrovascular disease
What types of illness can a person with DM have? (7)
What does the fasting blood sugar need to be under to be considered not diabetes?
Type 1 Diabetes
Destruction of pancreatic beta cels. Combined genetic, immunologic, and environmental factors contribute to beta cell destruction.
1. Usually abrupt in onset
2. Occurs primarily in childhood or adolescence but can occur at any age.
What two characteristics about the onset and when DM Type 1 occurs?
What type of treatment does Type 1 DM require?
Body will start to consume fat, which will lead to consumption of muscles- muscle wasting
If the body cannot find energy from insulin what will happen?
Type 2 DM
-insulin resistance and impaired insulin secretion
-Insulin resistance: decreased tissue sensitivity to insulin
-Impaired insulin secretion
1. Generally slow in onset
2. Onset after the age of 30
When does Type 2 DM start and is it a slow or fast onset?
In type 2 DM was is released with stress?
Medication: pills ( work on pancreas to decrease insulin amounts, GI decrease absorption)
What type of medication management is used in type 2 DM?
What is the biggest factor of cause in Type 2 DM?
cells are resisting insulin, they will not take it
What happens to the cells and insulin in Type 2 DM?
glucose starts accumulating in the blood
What starts happening to glucose in the blood in Type 2 DM?
2. lack of exercise
3. diet- too much sugar (panaceas cannot keep up)
What are the environmental factors in Type 2 DM? (3)
What is the key to treating Type 2 DM?
1 portion should include a protein and the rest vegetables
What should a balanced diet look like in Type 2 DM?
Fasting Plasma Glucose > 126 mg/d
Random Plasma Glucose > 200 mg/dL
2-hour Postload Glucose > 200 mg/dL
What are the levels for Fasting, Random, and 2 hour postload glucose to be considered DM?
Random Plasma Glucose
Greater than 200
Regardless last time they ate
2-hour posload glucose
Greater than 200
Drink 75 grams of sugar diluted with water
An hour later, take urine and blood samples
Increased levels indicates diabetes
Glycoasted Hemoglobin- HgbA1c
-Reflects average blood glucose levels over 2-3 months (120 days)
-Measures blood sugar attachment on RBCs (if high lots of attachment)
- Not diagnostic
How long to RBCs live for?
-Used for diabetics to show compliance and medication management
What are HgbA1c Tests used for?
What are the three classic symptoms of DM?
What is the first symptom in DM?
-Occurs because it starts precipitating on kidney tulles
-Starts attracting fluid from blood and excretes through kidney
-Patient is thirsty
-Happens because cells are loosing fluids, become "thirsty"
-Patient is hungry
-Cells are hungry from lack of fluids
- leads to uncontrollable hunger
1. hypoglycemia (insulin reaction)
3. Diabetic Ketoacidosis (DKA)
4. Hyperglycemic Hyperosmolar Nonketotic Syndrome (HHNS)
What are the diagnostic findings of DM? (4)
When blood sugar is low, you:
1. give 15 grams of sugar (6-8ox of OJ)
2. Wait 15 minutes and follow-up
3. Re-check blood sugar
Can do up to two times, if second time does not work, third time you give d50
What is the "15 minute" rule?
Complex sugar (milk)
What do you give to prevent further drop in sugar?
Microvascular Complications and Diabetic Retinopathy
- Leading cause of blindness between 20-74 years old
- Most diabetics have some degree after 20 years (especially Type 1 diabetics)
-decrease blood supply because of thickening membranes of capillary cells
Deterioration of small blood vessels that nourish the retina
Opacity of the lens of the eye; occurs at an earlier age in diabetics
1. decrease any intraocular pressure
2. decrease heavy lifting
3. no driving
4. no sneezing
5. no coughing
What is the goal after cataract surgery? (5)
Results from occlusion of the outflow channels by new blood vessels. May occur with slightly higher frequency in the diabetic population
-20-30 percept of people with Type 1 and 2 develop it
-kidney disease or damage that can occur in people with diabetes.
Watch kidney function, decreased urine output
What do you watch in patients with nephropathy?
1. urine dipstick test is positive for significant amounts of albumin
2. Check serum creatinine and BUN
What are two diagnostic findings of nephropathy?
1. Control of hypertension
2. prevention of vigorous treatment of UTI
3. avoidance of nephrotoxic substances
4. Adjustment of medications as renal function changes
5. low sodium and low protein diet.
What is the medical management for nephropathy?
1. paresthesias and burning sensations
2. decreased pain and temperature sensation
3. foot deformities
4. decreased blood supply to lower extremities
What are the sings and symptoms for peripheral diabetic neuropathy?
a result of nerve damage, often causes numbness and pain in your hands and feet
1. intensive insulin therapy and good blood glucose control delays in onset and slow progression
2. pain management
What is the management for peripheral neuropathy?
- Autonomic neuropathy of the adrenal medulla is responsible for diminished symptoms of hypoglycemia
2. Peripheral Vascular Disease
What are the foot and legs problems in DM? (3)
Peripheral Vascular Disease
Poor circulation of the lower extremities contributes to poor wound healing/gangrene
Impaired ability of leukocytes to destroy bacteria
1. File and trim nails
2. Soak nails in water
3. Inspect feed daily for cuts/ulcers
4. Wash feed with mild soap and water, pat to dry
5. Moisturize feet, make sure not dry
6. Check in between toes- fungus
7. Must wear very well fitted shoes with clean socks
What do you do in-regards to foot care for DM patients? (7)
3. Weight control
What are the foundations of diabetes management? (3)
Every 6 hours
When does blood sugar need to be checked?
small frequent meals
What type of meals should DM patients eat?
Schedule snack 1 hour before exercise and snack at bed time to prevent dawns and s. phenomenon
When should snacks be scheduled?
-Agent - Lispro (Humalog)
- Aspart (Novolog)
-Onset - 10-15min
- Peak - 1 hour
- 40-50min (Aspart)
- Duration - 3 hours
- 4-6 hours (Aspart)
-Agent - Regular (Humalog R, Novolin R)
-Onset - ½ - 1 hour
- Peak - 2-3 hours
-Duration - 4-6 hours
- Agent - NPH-Humulin N, Novolin N
-Onset - 3-4 hours
-Peak - 6-12 hours
-Duration - 16-20 hours
Agent - Ultralente
Onset - 6-8 hours
Peak - 12-16 hours
Duration - 20-30 hour
Agent - Lantus
Onset - 1 hour
Peak - Continuous
Duration - 24 hours
Indications - Used primarily to control fasting glucose level
Sulfonylureas (Glucatrol, Micronase)
-Directly stimulate the pancreas beta cells to secrete insulin
-Side effects - GI symptoms and dermatologic reactions
- Inhibits production of glucose by liver
- Increases body sensitivity to insulin
- Side effects- GI symptoms
Thiazolidinediones/glitazones (Actose, Avandia)
-Enhance cells sensitivity to insulin action at the receptor site
- Stimulates insulin receptors to lower glucose and improve action of insulin
- May affect liver function
-S.E. Hypoglycemia, wt gain, edema, anemia
Alpha-glucosidase inhibitors (Precose or Glyset)
- Must take immediately before meal
- Delays the absorption of glucose in the intestine
- HemA1C levels decline
- Principal side effect is hypoglycemia. Patient must take glucose tablets. Sucrose absorption will be blocked
- S.E. diarrhea and flatulence
THIS SET IS OFTEN IN FOLDERS WITH...
Management of Patients with GI Disorders
Endocrine System Disorder
YOU MIGHT ALSO LIKE...
Disorders of Endocrine Pancreas
OTHER SETS BY THIS CREATOR
Mental Health Review
OTHER QUIZLET SETS
SPAA 100 Exam 3
ECON 105: Supply
English 292 1st Midterm Terms/Concepts
Pharm Final Exam