Nurs 171 Exam III (Diabetes)

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Nurs 171 Exam III (Diabetes)
2011-03-16 23:54:29
Nurs Exam III Diabetes

Nurs 171 Exam III (Diabetes)
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  1. leading cause of end stage renal failure, adult blindness, nontraumatic lower limb amputations

    Major contirbuting factor
    -heart disease, stroke
  2. produced by Beta cells; released into bloodstream continu.
    -larger amounts released after food intake
  3. these are insulin dependent tissues
    skeletal muscles and adipose tissue
  4. oppose effects of insulin; ^ blood glucose levels, help maintain levels
    • counterregulatory hormones
    • -glucagon
    • -epinephrine
    • -GH
  5. formally known are juvenile diabetes of insulin dependent diabetes
    -people under 30
    diabetes mellitus type one
  6. with this type of diabetes the pancreas can no longer produce insulin
    type 1
  7. classic symptoms
    -weight loss
    type 1 diabetes
  8. in prediabetes a impaired glucose tolerance (IGT); a fasting glucose level higher then normal would be ____
    >100 mg/dl, <126 mg/dl
  9. in prediabetes a impaired fasting glucose; a 2-hour plasma glucose higher then normal would be___
    btwn 140-199 mg/dl
  10. this is usually present with no symptoms
  11. pancreas continues to produce some insulin but insulin produced is either insufficient or poorly utilized by tissues
    type II diabetes
  12. in type II diabetes the body tissues do not respond to insulin resulting in
  13. individuals with metabolic syndrome are at increased risk for type 2 diabetes....what are the signs of metabolic syndrome
    • -^insulin
    • -^triglycerides
    • -^LDLs
    • -lower HDL
    • -HTN
  14. this type of diabetes has a gradual onset and has various symptoms including, fatigue, recurrent infections, prolonged wound healing, visual changes
    type II diabetes
  15. this results from another medical condition such as cushing syndrome, hyperthyroidism, pancreatitis, TPN, cystic fibrosis
    secondary diabetes
  16. can be caused by Tx of a medical condition that causes abnormal blood glucose levels: corticosteroids, thiazides, dilantin, antipsychotics
    secondary diabetes
  17. what are the three methods to diagnose diabetes
    • -fasting plasma glucose >126 mg/dl
    • -random or casual plasma glucose >200 mg/dl + symptoms
    • -two-hour OGTT level >200 mg/dl
  18. shows the amount of glucose attached to hemoglobin molecules over RBC life span (90-120 days)
    -ideal goal is
    • Hemoblobin A1C test
    • -<7.0%
  19. in a person with diabetes carbs and monounsaturated fats should provide ___ to ___ % of total energy intakes
  20. term used to describe rise in blood glucose levels after consuming carb containing food
    glycemic index
  21. in a diabetic diet fats should be no more then ___ to ___ % of a meal plans total calories
    • 24-30
    • <7% sat fats
  22. protein in a diabetic diet should only contribue <____% of total energy consumed
  23. lowers blood glucose levels, contributes to weight loss, ^ insulin receptor sites, best done after meals
  24. this tx is used for patients with type I diabetes and end stage renal disease
    -usually done with kidneys too
    pancreas transplant
  25. this type of respirations is associated with diabetes
    kussmaul respirations
  26. patients undergoing surgery or radiologic procedures requiring contract medium should hold their metformin day of surgery and ____ hr
  27. occurs in type 1
    -caused by profound deficiency of insulin; characterized by hyperglycemia, ketosis, acidosis, dehyrdration
    diabetic ketoacidosis (DKA)
  28. in diabetic ketoacidosis the body breaks down fat stores which has an affect by altering pH balance and causing
    -ketones excreted in urine
    metabolic acidosis
  29. S/S of this complication are lethargy/weakness(early), dry mucous membranes, tachy, ortho hypo, N/V
    diabetic ketoacidosis
  30. this is deep rapid breathing, the bodies attempt to reverse metabolic acidosis
    kussmaul respirations
  31. lab findings for DKA are a blood glucose > _____mg/dl; pH below 7.30, ketones in blood and urine, and HCO3 <___ mEq
    • 300
    • 15
  32. IV infusions for DKA to restore urine output and raise BP would be _____ or ____
    0.45% or 0.9% NaCl
  33. when glucose levels reach 250 mg/dl in DKA IV treatment this is added to the regimine to prevent hypoglycemia
    5% dextrose
  34. this is a life threatening syndrome often associated with type II diabetes and is less common then DKA
    Hyperosmolar hyperglycemic syndrome (HHS)
  35. the lab values associated with HHS are >____ mg/dl blood glucose, ^ serum ormolarity and absent of minimal ____ bodies
    • 400
    • ketone
  36. blood glucose <70 mg/dl; occurs whenthere is too much insulin in proportion to glusoe in the blood
  37. the S/S of hypoglycemia are
    • -confusion
    • -irritability
    • -diaphoresis
    • -tremors
    • -hunger
    • -visual disturbances
  38. this mimics alcohol intox
  39. Tx of hypoglycemia are ___-____ g of simple carb; recheck blood sugar after ____ min and then again in 45 min
    • 15-20
    • 15
  40. this can be admin 1mg IM of SubQ is simple carbs to not work immediatly with hypoglycemia
  41. diseases of large and medium sized blood vessels; risk factors, obesity, smoking, HTN, ^ fat intake
    macrovascular angiopathy
  42. is specific to diabetes
    -results in thickening of vessel membranes in capillaries and arterioles
    -response to chronic hyperglycemia
    microvascular angriopathy
  43. the most commonly affected areas for microvascualr angiopathy are
    • eyes
    • kidneys
    • skin
  44. microvascular damage to the eye causes development of microaneurysms and vitreous contractions
  45. tx for retinopathy; laser destroys ischemic areas of retina, prevents further visual loss
  46. associated with damage to small blood vessels that supply the glomeruli of the kidney
    -leading cause of end stage renal disease
    diabetic nephropathy
  47. nerve damage due to metabolic derangements of diabetes
    -loss of sensation, abnormal sensations, pain and paresthesias
    diabetic neuropathy
  48. tx for diabetic neuropathy is
    • tight blood glucose control
    • drug therapy(creams, antidepressants, antiseizure meds
  49. insulin from an outside source
    -requires for type I diabetes or type II who can not control levels
    exogenous insulin
  50. rapid acting insulins including Novolog, hunalog, and Apidra are injected ___ - ___ min before a meal; short duration
    • 0-15 min
    • onset:5-15 min
  51. Humulin R and Novolin R:
    short acting insulin is injected ___ to ___ min before a meal and has an onset of ___ to ___ min
    • 30-45 min
    • onset: 30-60
  52. only insulin that can be given IV or IM
    short acting Humulin R and novolin R
  53. this insulin is slower in its onset and more prolonged duration then endogenous insulin
    • intermediated acting insulin (NPH)
    • -humulin N, Novolin N
  54. long acting insulin is injected once a day at bedtime or in the morning, cannot be mixed with others
    • lantus
    • ultralente
    • humulin U
  55. vials of insulin my be left at room temp up to ___ weeks
    lantus for ____ days
    • 4 weekds
    • 28 days
    • AVOID exposure to direct sunlight
  56. 1ml of insulin contains ____ u
  57. rapid acting, dry powder inhaled through mouth into lungs, not for patients with asthma, bronchitis, or emphysema
    • inhaled insulin
    • Exubera
  58. rebound effect in which an overdose of insulin causes hypoglycemia, usually during hours of sleep; rebound to hyperglycemia and ketosis
    somogyi effect
  59. characerized by hyperglycemia present on awakening in the morning due to release of counterregulatory hormones in pre dawn hours
    dawn phenomenon
  60. these work on three defects of type II diabetes: insulin resistance, decreased insulin production, and increased hepatic glucose production
    oral antidiabetics
  61. stimulate insulin secretion from the beta cells of the pancreas, thus increasing insulin levels
    -result lower blood glucose levels
    • sulfonylureas
    • -glipizide
    • -amaryl
  62. increase insulin production from pancreas, taken 30 min before each meal up to time of meal
    -do not take if meal skipped
    • meglitinides-repaglinide
    • -prandine
    • -starlix
  63. decreases production of glucose by the liver; enhance insulin sensitivity at tissues; improve glucose transport into cells
  64. does not increase insulin secretion from the pancreas
    -does not cause hypoglycemia
  65. insulin sensitizing drugs; decrease insulin resistance; increase glucose uptake and use in skeletal muscle
    • thiazolidinediones
    • -actos
    • -avandia
  66. search blockers; slow down absorption of carbs in small intestine
    -must be taken with meals
    • precose
    • glyset
  67. side effects of sulonylureas are
    • -hypoglycemia
    • -nausea
    • -epigastric fullness
    • -heartburn
  68. the side effects of meglitinides
    • headache
    • hypoglycemic effects
    • weight gain
    • joint pain
    • URI
  69. side affects of metformin include
    • GI tract upset
    • abnormal bloating
    • nausea
    • diarrhea
  70. the side effects of thiazolidinediones
    • hepatic toxicity
    • weigh gain
    • edema
  71. the side effects of glucosidase inhibitors
    • abdominal pain
    • flatulance
    • diarrhea
  72. when taking sulfonylureas(glipizide, amaryl) there may be an allergic cross sensitivity with _____ and ____antibiotics
    • loop diuretics
    • sulfonamide antibiotics
  73. mimics the natural hormone amylin-secreated by beta cells of pancrease; cosecreted with insulin
    • amylin analog pramlintide
    • -Symlin
  74. mimics incretin hormones; synthetic peptide which stimulate release of insulin from beta cells
    -suppresses glucagon secretion
    -ONLY type II
    • incretin mimic
    • -Byetta
  75. always withdraw the which insulins first?
    regular or rapid acting insulin