640.cardiac,diabetes,renal

Card Set Information

Author:
jsohl
ID:
142113
Filename:
640.cardiac,diabetes,renal
Updated:
2012-03-19 22:59:23
Tags:
640 DM
Folders:

Description:
640 exam 2
Show Answers:

Home > Flashcards > Print Preview

The flashcards below were created by user jsohl on FreezingBlue Flashcards. What would you like to do?


  1. HHS
    • hyperglycemic hyperosmolar syndrome
    • -clinical manifestation of T2DM
  2. hyperglycemic hyperosmolar syndrome
    • -blood glucose > 600 mg/dL
    • -serum osmolality >320 mOsm/kg
    • -absence of ketoacidosis
    • -infection
    • -dehydration
  3. HHS symptoms
    • -pulyuria
    • -polydipsia
    • -polyphagia
    • -weight loss
  4. HHS treatment
    • -slow rehydration
    • -treat underlying conditions
  5. Metabolic Syndrome
    • central obesity
    • insulin resistance
    • dyslipidemia
    • hypertension
  6. medical treatment for T2DM
    • -MNT
    • -physical activity
    • -medications
    • -urine & blood ketone monitoring
    • -self-management
  7. 5 finger rule for NIDDM
    • -monitor glucose levels (FSBS)
    • -maintain/achieve IBW (lower total kcals, total fat, sat. fat)
    • -exercise regularly (ACSM, American College of Sports Medicine guidelines)
    • -consistent timing of mixed high fiber meals
    • -avoid concentrated sweets
  8. 5 finger rule for T1DM
    • -monitor glucose levels
    • -match insulin to intake
    • -maintain weight
    • -exercise
    • -be prepared for hypoglycemia
  9. medications for T2DM
    • 1.alpha-glucosidase inhibitors (AGIs)
    • 2.amylin analogs
    • 3.biguanides
    • 4.incretin mimetics
    • 5.meglitinides
    • 6.sulfonylurea agents
    • 7.thiazolidinediones
  10. oral hypoglycemic agents
    • -help pancreas to make more insulin
    • ex. 1st & 2nd generation sulfonylureas & meglitinide analogs
  11. oral antihyperglycemic agents
    • -targets different organs to help insulin work better
    • ex.biguanides, AGIs, thiazoldinedones
  12. 1st generation sulfonulureas
    • ex. diabinese
    • -oral hypoglycemic agents
    • -targets pancreas to increase insulin secretion
    • -SE=hyperinsulinemia, hypoglycemia, weight gain
    • -avoid alcohol - reactions reported!
    • + inexpensive , once a day
  13. 2nd generation sulfonulureas
    • ex. Glynase
    • -oral hypoglycemic agents
    • -targets pancreas to increase insulin secretion
    • -SE=hyperinsulinemia, hypoglycemia, weight gain
    • -avoid alcohol
    • + inexpensive , once a day
  14. meglintine analogs (secretagogues)
    • ex. Prandin
    • -oral hypoglycemic agents
    • -helps pancreas make more insulin in the presence of glucose
    • -acts for only about 4 hours after taken (fast acting, short acting)
    • -SE=hyperinsulinemia, hypoglycemia, athralgia (joint pain)
    • -more doses, more expensive
    • -avoid alcohol
    • +less hypoglycemia at night
  15. AGIs
    • -alpha-glucosidase inhibitors
    • ex. Glyset
    • -oral antihyperglycemic agent
    • -inhibits enterocyte disaccharidases thereby delaying CH digestion & absorption
    • SE=GI - cramps, flatulence, diarrhea
    • -take w/ first bite of meals 3x day
    • - less efficacy with frequency of dosing
  16. thiazoldinedones
    • ex. Avandia
    • -oral antihyperglycemic agent
    • -reduces hepatic glucose production
    • -stimulates insulin receptors thereby increasing insulin sensitivity in muscle & adipose cells
    • -can use with renal insufficiency
    • -dose 1x/d
    • -least food & drug interactions
    • SE: possible weight gain/edema, but none reported
    • - very expensive
    • -more effective with insulin deficiency
  17. GDM
    gestational diabetes mellitus
  18. GDM risk factors
    • -overweight
    • -physically unfit
    • > 25 years
    • -family history
    • -African American, Hispanic, Native American
  19. Maternal Risks with GDM
    • -HTN (preeclampsia)
    • -polyhydramnios (excess amniotic fluid)
    • -difficult birth
    • -preterm delivery
    • -increased rate of C section
  20. Fetal Risks with GDM
    • overproduction of insulin by fetus
    • macrosomia (>4500 g)
    • birth trauma
    • neonatal respiratory distress
    • neonatal hypoglycemia
    • hypocalcemia
    • hyperbilirubinemia
    • polycethemia (increase in RBCs)
  21. Screening for GDM
    • done between 24-28 weeks
    • 50 g oral glucose challenge test (GCT)
    • plasma glucose > 140 mg/dL 1 hour after
    • 100 g oral glucose tolerance test (OGTT)
    • + if 2 or more result:
    • fasting plasma glucose > 95 (prior to oral load)
    • 1 hour plasma glucose >180
    • 2 hour pm > 155
    • 3 hr pg >140
  22. GTC
    glucose challenge test
  23. OGTT
    oral glucose tolerance test
  24. Why do we focus on consumption of adequate calories in GDM?
    • to promote appropriate weight gain
    • avoid maternal ketosis
  25. What discomforts are we trying to decrease when treating GDM?
    • hypoglycemia
    • nausea
    • vomiting
    • constipation
    • heartburn
  26. SMBG
    self monitoring of blood glucose
  27. What do we use self monitoring of blood glucose records for?
    • (check glucose levels 1 hour after each meal with GDM)
    • assess effectiveness of MNT
    • guide adjustments to intake
    • determine if insulin therapy is needed
  28. How/why do we adjust CHO intake with GDM?
    • -amount & timing
    • -avoid highs & lows
    • -avoid nausea
    • -CHO not well tolerated in a.m. - plan for < 45 g
  29. Euglycemic Diet
    • aka Jovanovic Diet
    • reduce caloric intake to just above ketonuric threshold
    • restrict CHO to <40% of total calories (>40% from fat & 20% from protein)
    • breakfast small & low in CHO to counter effects of high cortisol levels in a.m.
  30. When should insulin therapy be added for GDM?
    • if 1 hour postprandial glucose level is >120 mg/dL more than twice in 2 weeks
    • if FBS is >90 mg/dL
  31. What type of insulin therapy is used with GDM?
    • NPH - intermediate-acting before breakfast & at bedtime
    • Lispro (Humalog) at lunch and dinner

    Don't forget to exercise! This may cure GDM!
  32. DKA
    diabetic ketoacidosis
  33. Why do we encourage clients with IDDM to rotate injection sites every 2 weeks?
    build up of scar tissue surrounding adipose can affect/inhibit absorption (atrophy/hypertrophy)
  34. too much insulin causes
    hypoglycemia
  35. too little insulin causes
    hyperglycemia
  36. IIT
    intensive insulin therapy
  37. MDI
    multiple daily injections
  38. What is involved with intensive insulin therapy?
    • MD, RD and patient work together
    • MD adjusts basal insulin to blood sugar (BS) pattern
    • Patient must keep records of BS, insulin, & intake
    • Bolus insulin bases on FSBS 4 or more times/day
  39. CSII
    continueous subcutaneous insulin infusion
  40. General Diabetic Diet Guidelines
    • kcals to maintain optimal body weight
    • CHO = 55-60% but don't increase if they consume less (as long as they have at least 130 g/d)
    • protein = 10-20% (usually 15-20, but can be 10% if they have nephropathy)
    • fat = 25-30% of total kcalories
    • cholesterol <300 mg/d
    • Na < 3000 mg/d
    • eat carbs with alcohol & be careful
    • Be careful about sugar alcohols.
    • Sugarfree candy is not carb-free
  41. Goals when following diabetic diet guidelines
    • reduce risk of micro & macrovascular disease by addressing lipoprotein profile
    • reduce risk associated with HTN
    • address individual nutritional needs accounting for cultur & lifestyle
    • enhance health
  42. What do we teach patients with IDDM in survival mode?
    • What's a carb?
    • Where is it in your diet?
    • Eat at regular intervals.
  43. When in individualization phase with IDDM, what should we teach?
    • alcohol
    • exercise
    • being sick
    • menstrual cycle
    • eating & exercise pattern
    • morning
    • fiber
    • sugar alcohol
  44. dosing insulin
    1 unit/10-15 g CHO
  45. TAG
    • total available glucose
    • or
    • triacylglycerol
  46. Why do we encourage exercise if someone has DM?
    • will decrease blood glucose unless BG > 250-300 (there is insulin deficiency)
    • exercise can speed the absorption of insulin in the active limb
    • blood lipid control
    • blood pressure control
    • depression
  47. What recommendations should we give to someone with IDDM if fasting glucose is <180?
    • add 15 g CHO if exercising moderately for 1 hour
    • add 30-45 g CHO if 100-180 exercising for 1-2 hours
  48. What are the rules for counting sugar alcohols & fiber for DM?
    if >5 g, subtract half from total carbs
  49. glycosylated hemoglobin
    • HbA1c fraction
    • reflects average glucose level over last 4 mo.
    • 6-7% are normal values for someone with DM
    • 8-9% acceptable
    • 11-13% poor
  50. long term complications of hyperglycemia affect:
    • eyes
    • kidneys
    • nerves
    • macrovascular
  51. long term complications of hyperglycemia on eyes
    • retinopathy
    • cataract
    • glaucoma
    • ...blindness
  52. long term complications of hyperglycemia on kidneys
    • nephropathy
    • microalbuminuria
    • gross albuminuria
    • ...kidney failure
  53. long term complications of hyperglycemia on nerves
    • neuropathy
    • peripheral
    • autonomic
    • ...amputation
  54. long term complications of hyperglycemia & CVD
    • coexistence of HTN & dyslipidemia
    • underlying metabolic syndrome
  55. a
    before
  56. a.c.
    • before meals
    • antecibum
  57. BID
    twice a day
  58. c
    with
  59. ca
    approximately
  60. CC
    chief complaint
  61. C/O
    complains of
  62. CXR
    chest X-ray
  63. D/C
    discontinue
  64. E D
    emergency department
  65. FMH
    family medical history
  66. F/U
    follow up
  67. HEENT
    head, eyes, ears, nose, throat
  68. HPI
    history of present illness
  69. HS
    hour of sleep
  70. H/O
    history of
  71. I&O
    intake and output
  72. NKA
    no know allergies
  73. p.c.
    • after eating
    • post cibum
  74. PH
    past history
  75. po
    past orally
  76. PTA
    prior to admission
  77. q
    • each
    • every
  78. R
    respirations
  79. s
    without
  80. Sx
    symptoms
  81. SH
    social history
  82. T
    temperature
  83. TID
    three times a day
  84. TPR
    temperature, pulse, respirations
  85. WNL
    within normal limits
  86. body's response to low blood pressure
    • renin released from kidney
    • angiotensinogen converted to angiotensin I
    • angiotensin I converted to angiotensin II
    • -decrease of Na+ & H2O excretion
    • -vasoconstriction
    • -increase in aldosterone...increased blood volume
  87. EF
    • ejection fraction
    • end of diastole
    • amount of blood ejected
  88. hypertension
    140/90
  89. possible symptoms of HTN
    • dizziness
    • faintness
    • headaches
    • vision changes
  90. etiology of hypertension
    • 90% of cases are idiopathic - primary or essential
    • secondary - result of another chronic condition
    • lifestyle - smoking, exercise, diet, obesity
    • sodium intake
    • inflammatory response
  91. ATP III
    • adult treatment panel III
    • guidelines used for cholesterol management
  92. hypertension treatments
    weight reduction, PA, nutrition therapy, pharmacological
  93. medication classes for HTN
    • "loop" diuretics
    • thiazides
    • carbonic anhydrase inhibitors
    • potassium sparing diuretics
  94. loop diuretics
    • used for HTN
    • ex. furosemide
    • effective in patients with impaired kidney function
    • inhibit sodium & chloride reabsorption in the ascending loope of henle
    • potassium depleting
  95. thiazides
    • diuretic treatment for HTN
    • ex. hydrochlorothiazide, hydrodiuril
    • inhibits sodium-chloride-potassium reabsorption in distal convoluted tubule leading to a retention of water in the urine
    • decreases calcium lost
    • potassium depleting except for hydrochlorothiazide
  96. carbonic anhydrase inhibitors
    • diuretic treatment for hypertension
    • ex. acetazolamide
    • prevents exchange of hydrogen, sodium, and water by blocking sodium anhydrase
    • inhibit the transport of bicarbonate out of the proximal convoluted tubule, which leads to less sodium reabsorption and therefore greater sodium, bicarbonate and water loss in the urine
    • the weakest of the diuretics and seldom used in CVD
    • main use is in the treatment of glaucoma
    • potassium depleting
  97. potassium sparing diuretics
    Amiloride (Midamor®) Amiloride and Hydrochlorothiazide (Moduretic®) Spironolactone (Aldactone®) Spironolactone and Hydrochlorothiazide (Aldactazide®) Triamterene (Dyrenium®)Triamterene and Hydrochlorothiazide (Dyazide®, Maxzide®)
  98. What is the Dawn Phenomenon?
    • Release of growth hormone, cortisol, glucagon and epinephrine in the early morning causes an increase in blood glucose
    • NOT the same as the Samogyi Effect,thought to be a reaction to earlier hypoglycemia (if it occurs at all)
    • Can distinguish between the Dawn Phenomenon and the Samogyi Effect by checking 2 am sugar.
  99. How does Type 1 Diabetes Mellitus present?
    • Peak onset age 4-6 and 10-14 (bimodal)
    • Weight loss
    • Polydipsia and polyuria
    • Polyphagia, fatigue and weight loss
    • Often with ketoacidosis
  100. To diagnose diabetes: (type 1)
    • Fasting blood glucose >126 mg/dL
    • Random blood glucose >200mg/dL
    • 2 hour oral glucose tolerance test > 200 mg/dL
    • HbA1c 6.5% or higher
  101. IGT
    impaired glucose tolerance
  102. somatostatin
    inhibits secretion of both insulin & glucagon
  103. To confirm Type 1 DM
    • Presence of serum islet-specific pancreatic autoantibodies
    • Note: About 10% are idiopathic (antibodies negative), and some patients with Type 2 diabetes DO have antibodies
  104. Guidelines for being sick with IDDM
    • Continue usual dose of insulin when sick
    • Monitor blood sugar and urine ketones closely to prevent DKA
    • Ingest 45-50 g CHO every 3-4 hours to prevent DKA
    • Drink more fluids than normal
    • Follow insulin adjustments as per MD's recommendations
  105. What is recommended when a person with DM drinks alchohol? Why?
    Consume CHO when consuming alcohol

    • Alcohol -> AcetylCoA(not glucose)
    • Alcohol metabolism requires glucose
    • Insulin and alchohol both lower blood glucose
  106. other drugs for HTN
    • ace inhibitors - angiotensin converting enzyme, restricts body's production of the chemical that makes vessels constrict ex. lotensin, vasotec, accupril, altase, prinivil, zestril
    • beta blockers - reduces HR / lower force with heart s pressure,
    • sympathetic nerve inhibitors - prevent certain nerves from constricting blood vessels
    • vasodilators - relax muscles in walls of arteries allowing blood vessels to widen
    • calcium antagonists - (calcium channel blockers) reduce HR & relax blood vessels, ex. norvasc, vacor, plendil
  107. digitalis
    used for CHF to increase strength of contraction
  108. PTCA
    percutaneous transluminal coronar angioplasty
  109. CABG
    coronary artery bypass graft
  110. CRP
    • C reactive protein
    • indicator of inflammation
    • good predictor of IHD (ischemic heart disease)
  111. syncope
    fainting
  112. RTC
    return to clinic
  113. dietary intake of trans fat should be less than
    2 g
  114. saturated fats
    • 4:0-12:0 - SCFA & MCFA
    • 14:0 - myristic acid (milk fat)
    • 16:0 - palmitic acid (animal fats / palm oil)
    • 18:0 - stearic acid (beef tallow, shortening, coconut oil)
  115. MUF
    • 16:1 - palmitoleic acid (macadamia nuts)
    • 18:1 - oleic acid (oo, canola oil, avocado, almonds, dark chocolate, most common source in American diet - fr. fries, pizza...)

    -does not raise LDL
  116. omega 6 FA
    • 18:2 - linoleic acid - oils in seeds & nuts
    • shoudn't exceed 10% or more of total calories
    • 11-17 g/day
    • polyunsaturated
  117. omega 3 FA
    • a 18:3 - a linonlenic acid (veggies, flax seed)
    • 20:5 - eicosapentaeic acid / EPA (fish oil, salmon, sardines)
    • lower cholesterol & TAGs, inhibit platelet aggregation & reduce risk of sudden death
    • 1.1-1.6 g/d meet needs
    • oxidize easily
  118. How can arachadonic acid be created?
    • LA, linoleic acid, can be desaturated & elongated
    • conversion of 18:2 to 20:4 omega 6
  119. arachadonic acid
    substrate for eicosanoids, some being proinflammatory (ex. prostaglandin E2 & thromboxane A2) and some being antiinflammatory (ex. prostacyclin)
  120. viscous fiber
    • soluble
    • ex. oat bran, dried beans
    • lowers blood lipids

What would you like to do?

Home > Flashcards > Print Preview