Diabetes & DKA

Hypoglycemia: Treatment "Rule of ( )" -If alert enough to swallow --Give 15-20 g of simple carb (juice followed by bread/crackers/peanut butter) --Recheck blood sugar 15 minutes after treatment --Repeat until blood sugar >( ) mg/dL. --Patient should eat regularly scheduled meal/snack to prevent rebound hypoglycemia --Check blood sugar again 45 minutes after treatment

15 70

The nurse is caring for a patient with type 1 diabetes mellitus who is admitted for diabetic ketoacidosis. The nurse would expect which laboratory test result? A. Hypokalemia B. Fluid overload C. Hypoglycemia D. Hyperphosphatemia - this would be low or normal (if you are having profound diuresis, you would be excreting phosphorus?)

A Electrolytes are depleted in diabetic ketoacidosis. Osmotic diuresis occurs with depletion of sodium, potassium, chloride, magnesium, and phosphate levels.

HHS diagnosis: Blood glucose > ( )mg/dL And Increase is serum ( ) ( ) are absent or minimal in blood serum and urine.

600 osmolality ketones

A patient screened for diabetes at a clinic has a fasting plasma glucose level of 120 mg/dL (6.7 mmoL/L). Which statement by the nurse is best? A. "You will develop type 2 diabetes within 5 years." B. "You are at increased risk for developing diabetes." C. "The test is normal, and diabetes is not a problem." D. "The laboratory test result is positive for type 2 diabetes."

B

A patient with type 1 diabetes calls the clinic with complaints of nausea, vomiting, and diarrhea. It is most important that the nurse advise the patient to A. Withhold the regular dose of insulin. B. Drink cool fluids with high glucose content. C. Check the blood glucose level every 2 to 4 hours. D. Use a less strenuous form of exercise than usual until the illness resolves.

C If a person with type 1 diabetes mellitus is ill, he or she should test blood glucose levels at least at 2- to 4-hour intervals to determine the effects of this stressor on the blood glucose level.

Nurse must closely monitor: Patient closely monitored -Administration --IV fluids --Insulin therapy --Electrolytes ---( ) imbalance (milder imbalance)- may be low? Assessment Typically older patients with multiple co-morbidities ( ) ( ) status ( ) status Cardiopulmonary status Cardiac monitoring Level of consciousness Vital signs

K fluid volume renal

HHS caused by: Caused by: -(U), pneumonia, (s), ( ) illness, newly diagnosed type 2 -Few symptoms resulting in elevated BS without knowing it -High blood glucose can result in (s), hemiparesis, (a)

UTI, sepsis, acute illness seizures, aphasia

administration of insulin: Fastest absorption from ( ), followed by arm, thigh, and buttock ( ) is the preferred site ( ) injections

abdomen abdomen rotate

gestational diabetes: Develops during pregnancy (4.6-9.2%) Screened at first prenatal visit Detected at 24 to 28 weeks of gestation (OGTT) Risk factors: Obese ( ) maternal age Family history Usually normal glucose levels at 6 weeks post partum Increased risk for cesarean delivery, perinatal death, and neonatal complications Increased risk for developing type 2 within 16 years Therapy: First ( ), second ( )

advanced nutritional insulin

HHS treatment: -Similar to DKA -Manage ( ) -Correct ( )/( ) imbalance --Establish IV access --IV infusion 0.45% or 0.9% NaCl ( ) ---Restore ( ) output ---Raise ( ) When blood glucose levels approach ( ) mg/dL add ( )-( )% ( ) added to regimen to prevent ( ) -Insulin infusion therapy Started ( ) fluids have been started Usually begin with a bolus of insulin followed by insulin drip Monitor blood glucose ( )

airway fluid/electrolyte SLOWLY urine BP 250 5-10% dextrose, hypoglycemia AFTER hourly

DKA treatment: Manage ( ) Correct fluid/electrolyte imbalance IV infusion 0.45% or 0.9% NaCl Restore ( ) output Raise blood pressure When blood glucose levels approach 250 mg/dL --( )% ( ) added to regimen --Prevent ( ) ( ) replacement (know K level before starting insulin gtt) -could cuase lethal dysrythmias Sodium bicarbonate - to protect kidneys and reverse acidosis

airway urine 5% dextrose hypoglycemia potassium

Chronic complications: ( ) disease (P ) Diabetic ( ) -Must have annual dilated eye examinations for type 1 diabetes Diabetic ( ) -( ) cause of end-stage renal disease -Yearly screening --Serum creatinine -Diabetic ( ) --Foot injury and ulcerations can occur without the patient having pain. -Infection --Diabetic individuals more susceptible to infection --Must Have Toe Nails Cut By A Podiatrist (b/c very susceptible to infection)

cardiovascular PAD retinopathy nephropathy leading neuropathy

Prediabetes: Long-term ( ) already occurring Heart, blood vessels Usually present with no ( ) Teach diet, exercise, weight loss, and patient to watch for diabetes symptoms: Polyuria, Polyphagia, Polydipsia

damage symptoms

Nurse must closely monitor patient: Patient closely monitored -Administration --IV ( ) --Insulin therapy --Electrolytes ---( ) imbalance Assessment -( ) status -Cardiopulmonary status --( ) monitoring -Level of consciousness -Vital signs

fluids K renal cardiac

DKA treatment.. Insulin therapy: -Started AFTER ( ) have been started -Usually begin with a ( ) of insulin followed by insulin ( )

fluids bolus drip

Gerontologic considerations: -Increased prevalence and mortality -( ) control challenging --Increased ( ) unawareness --Functional limitations --( ) insufficiency Meal planning and exercise Patient teaching must be adapted to needs

glycemic hypoglycemic renal

Diabetes Mellitus: Leading cause of-- End-stage renal disease Adult blindness Nontraumatic lower limb amputations Major contributing factor to: ( ) disease (2-4x higher) ( ) (risk is 2-4x higer) (because it increases risk for ( )

heart stroke

Stress of acute illness and surgery: -Acute illness, injury and surgery can cause a counterregulatory ( ) response -Interventions for patients at home --Check blood glucose every ( ) ( ) --Report to MD if glucose is greater than ( )mg/dL x( ) Continue to ( ), increase non-( ) fluids (diet soda) If unable to eat increase ( ) containing fluids (regular soda or juice) Continue to take insulin or oral medications Notify MD if unable to keep food/fluids down interventions for hospitalized patient: -IVF -IV insulin -Frequent blood glucose monitoring -If patient is unconscious monitor for ( ), tachycardia, ( )

hormone 4 hours 300 x 2 eat, caloric, carb sweating, tremors

Acute complications: Diabetic Ketoacidosis and Diabetic Coma Profound deficiency of insulin Characterized by -( )glycemia -Ketosis -Acidosis -( ) Mostly occurs in type ( )

hyper dehydration 1

complications from insulin therapy: Hypoglycemia Allergic reaction Infection at insertion site ( )-atrophy of sub q tissue Somogyi effect-( ) during sleep 02-04am -May sleep through it -Provide HS ( ), ( ) insulin dose -But wake up with ( ) blood glucose b/c body is trying to counteract hypoglycemia Dawn phenomenon-( ) upon awakening -Have headache, night sweats, nightmares -Assess HS BS and BS at 02-04am -( ) insulin dose or adjust times in order to figure out what is happening, need to take blood sugar...

lipodystrophy hypoglycemia snack, decrease high hyperglycemia -increase in middle of night

treatment: type 1: -( )-necessity type 2: -d -e -weight loss -oral meds -i

insulin diet exercise insulin

Hyperosmolar Hyperglycemic syndrome (HHS) -Life threatening --Severe hyperglycemia-but has enough ( ) production to prevent ( ) -Less common than DKA -Occurs in pts >65 with Type ( )

insulin DKA 2

Rapid onset of symptoms- Classic symptoms: Polyuria (frequent urination) Polydipsia (excessive thirst) Polyphagia (excessive hunger) Weight ( ) Weakness Fatigue

loss

type 1: Insulin -( ) High risk Diabetic ketoacidosis ( ) life threatening-leads to: ( ) ( )

required DKA metabolic acidosis

Type 2 DM: Pancreas continues to produce ( ) endogenous insulin Major difference between type 1 & 2 Insulin produced is ( ) or is poorly utilized by tissues Obesity-most powerful risk factor

some insufficient

complications of hyperglycemia: Increased ( ) Increased appetite followed by lack of appetite Weakness, fatigue ( ) vision Headache N/V -May progress to ( )

urination blurred DKA

Type 2 DM: Nonspecific symptoms (May have classic symptoms of type 1) Fatigue Recurrent infection Recurrent vaginal ( ) or monilia infection Prolonged wound healing ( ) changes

yeast vision