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FINAL: Adult Diabetes/Endocrine
ETSU Accelerated BSN Program
Terms in this set (47)
At what glucose level should you NOT exercise?
**High glucose increases levels of glucagon, growth hormone, and catecholamines which cause liver to release more glucose, and leads to even higher hyperglycemia.
If a patient is on insulin, what should they eat before exercise?
15 gram snack
**exercise can cause hypoglycemia
**want blood glucose to be above 100 mg/dL before exercise
What would cause a diabetic NOT to exercise after testing his/her urine?
*ketones indicate that current insulin levels are not adequate and that exercise would elevate blood glucose levels
What should patients be educated about with regards to insulin and exercise?
do not exercise within 1 hr of insulin injection or near the time of peak insulin action
What are general guidelines for sick day management of a diabetic?
-Illness raises blood glucose
-Take medication as usual
-Call MD with reports of blood glucose & urine check for ketones
-May need to supplement with regular insulin
-Oral intake depends on symptoms
-If unable to tolerate solid foods because of nausea, consume more easily tolerated foods or liquids equal to the carb content of your usual meal
What are the 4 criteria's for metabolic syndrome?
What does metabolic syndrome indicate?
-increase risk for Type II DM
-increase risk for Cardiovascular Disease
What are nutrition considerations for Type I diabetics?
-consistency in amounts of food, and time intervals between eating; snacks to prevent hypoglycemia.
-with intensive insulin therapy there is more flexibility in eating.
-for the young patient, enough calories for growth & development needs, & maybe for weight gain.
What are nutrition considerations for Type II diabetics?
-limit calories to decrease weight.
-regular meals more manageable for work of pancreas.
-glucose control, within normal ranges, is the goal.
Rapid Acting Insulin Pharmacokinetics
-ONSET: 5-10 minutes after injection.
-DURATION: 3-5 hours
-PEAK: 1-2 hours
What are two names of rapid acting insulin?
Short Acting "Regular" Insulin Pharmacokinetics
-ONSET: within 30 minutes
-DURATION: 3-6 hours
-PEAK: 2-4 hours
What are two names of short acting "Regular" insulin?
**can be given IV
Intermediate Insulin Pharmacokinetics
-ONSET: 1.5 to 2.5 hours
-DURATION: 18-22 hours
-PEAK: 4 to 12 hours
What are some types of intermediate insulin?
NPH - Humulin N
NPH - Novolin N
Lente - Humulin L
Lente - Novalin L
Long Acting Insulin Pharmacokinetics
-ONSET: 1.5 to 2.5 hours
-DURATION: 18-24 hours
-does NOT peak
What are types of long acting insulin?
-Insulin glargine (Lantus)
-High dose -Ultralente (Humulin U)
**do NOT mix in syringe with other insulins
**given at same time each day, typically at bedtime
**"poor mans pump"
What do premixed insulins mimic?
normal insulin secretion at meal time
Premixed Insulin Pharmacokinetics
Both have a rapid onset and intermediate duration.
What are some nursing considerations with premixed insulin?
-Inject immediately before a meal.
-Do not give IV
-Do not use with a pump.
-Don't mix with other insulin products.
What should be included with insulin teaching?
-Reason to administer insulin, type of insulin, onset, duration & peak time(s).
-Dosage of insulin
-Rotate sites; lipodystrophy
-Care of injection supplies & insulin
-How to draw up insulin, how to inject
-How to properly dispose of needles
What is sensorimotor polyneuropathy?
-Affects distal nerves, especially lower extremities:
*may spread in proximal direction
*prickling, tingling, tickling, burning, pain
*numbness---unsteady gait, undetected injury, joint deformities
How is neuropathy diagnosed?
in absence of reported symptoms...lack of deep tendon reflexes & decreased vibratory sensation
How is neuropathy prevented?
tight blood glucose control
What is retinopathy?
Deterioration of small blood vessels that nourish the retina
How do you prevent retinopathy?
-tight control of blood glucose
-annual eye examination by opthalmologist
-blood pressure control
What is nephropathy?
-Soon after diabetes onset, kidney filtration stressed & leaks proteins; this increased pressure may be cause of disease
-Type I show signs 15-20 yrs. after diagnosis; Type II 10 yrs. after diagnosis
What are the s/s of nephropathy?
-Microalbuminuria (24 hour urine sample; should have annual checks; if elevated 2x ACE inhibitor prescribed (to lower BP & reduce microalbuminuria) and low protein diet)
-Albuminuria--found with urine dipstick
How is diabetic nephropathy managed?
-Avoid nephrotoxic substances
-Adjust insulin as renal function changes
-Low sodium diet; fluid restriction
-Low protein diet
What is lipodystrophy?
-a condition that creates divots in the fat layer, making the area feel lumpy
-occurs when insulin is repeatedly injected into the subcutaneous tissue
-PREVENTION: rotate injection sites
What are s/s of hypoglycemia?
-Adrenergic symptoms (Pallor, Diaphoresis, Tachycardia, Palpitations, Nervousness, Irritability, Sensation of coldness, Weakness, Trembling, Hunger)
-Neuro/CNS symptoms (Headache/lightheadedness, Mental confusion/inability to concentrate, Fatigue, Incoherent speech, Coma, Diplopia, Memory lapses, numbness of lips & tongue, slurred speech, impaired coordination, combative behavior)
-Severe symptoms (disorientation, seizures, loss of consciousness)
What is the treatment for hypoglycemia?
-10-15 Gm. fast-acting simple carbohydrate/glucose paste
-Follow with protein food source
-For unconscious patients, glucagon 1 mg (teach significant other to administer)
-In hospital, 25-50 ml 50% dextrose in water
What are s/s of hyperglycemia?
How is hyperglycemia treated?
-exercise if glucose is not above 240 and are free of ketones
What is Cushing's disease?
hypersecretion of cortisol
What are s/s of Cushing's disease?
-Facial plethora (flushing)
-Supraclavicular fat pad
-Increased body and facial hair
-Proximal muscle wasting
-Hypertension, hypervolemia, edema
How is Cushing's disease managed?
-Prevent injury and infection
-Skin very fragile, watch for bruising, injury, pressure ulcers, altered skin integrity
-Altered body image
-Prevent pathologic fractures
-Watch for bleeding (GI)
What is Addison's Disease?
hyposecretion of cortisol
What are s/s of Addison's Disease?
-Weakness and fatigue
-Weight loss and decreased appetite
-n/v, diarrhea, abdominal pain
-Low BP causing dizziness or fainting
-Darkening of skin
-Loss of body hair due to low aldosterone
-Depression, confusion, psychotic behavior
What is the treatment for Addison's Disease?
-Aldosterone (Mineralocorticoid - take in the morning)
-maintain fluid balance
-if high stress...then add in more steroids
How is Addisonian Crisis treated?
**need to manage hormone replacement, hyperkalemia and hypoglycemia
What is important to teach about Addison's Disease?
-avoid using alcohol and caffeine
-monitor for signs of GI bleeds
-monitor for hypoglycemia
-report s/s of adrenal insufficiency
-increase corticosteroid doses as directed during times of stress (infection, trauma)
-med therapy may be life long
What are s/s of hyperthyroidism?
-palpitations, blurred or double vision, dyspnea, fatigue, weakness, or insomnia
-muscle weakness, tremors, restlessness, irritability, mood swings, decreased attention span, difficulty concentrating.
-negative nitrogen balance
What is the treatment for hyperthyroidism?
-Take apical pulse, B/P, and temperature q4 hours.
-Assess for respiratory distress due to enlarged goiter.
-High fever and severe hypertension may be signs of "thyroid storm"
-Reduce stimulation, decrease room temperature, cool baths or showers, ice water available to drink.
-Artificial tears for patients with exophthalmos.
-antithyroid medications (Propylthiouracil (PTU); Methimazole (Tapazole))
-radioactive iodine therapy
What is post op care after a thyroidectomy?
-monitor respiratory status (trach kit at bedside for emergency)
-monitor for hypocalcemia (tetany)
-position (semi fowlers)
-VS q15-20 for 1st 24 hrs
-O2 with humidification
-monitor for complications
What is hypercalcemic crisis?
When serum Ca >15mg/dl life threatening
How is hypercalcemic crisis treated?
--Rehydrate with IVs
-Diuretics (Furosemide, Uritol) to promote Calcium excretion
-Dialysis, calcitonin, cytotoxic agents
-In emergency, Calcitonin & corticosteroids help move calcium to bone.
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