NSG 170 exam 1 (glucose regulation)
insulin deficiency; autoimmune in nature; destruction of beta cells
Type 1 diabetes mellitus
hyperglycemia
100 mg/dL --->
Which fasting plasma (FPG) level would indicate a client has prediabetes? 70mg/dL 100mg/dl 130mg/dL 160mg/dL
100mg/dl
Fasting plasma glucose is being tested. The nurse identifies that the client is considered to be diabetic if the results are within which range? 40-60 mg/dL 80-99 mg/dL 100-125 mg/dL 126-140 mg/dL
126-140 mg/dL
Clinical manifestation of diabetes (all 3 types)
3 aunt ploys, blurred vision, fatigue, slow wound healing, yeast infections, uti, mood changes
Treatment of DKA/HHS
8-10 L fluid replacement, regular insulin infusion by IV, monitor K+ and cardiac function for complications
Hypoglycemia
<70 mg/dL
how many times should a diabetic monitor their glucose?
Blood glucose should be monitored 3-4 times a day; before meals; AM/PM
Treatment for hypoglycemia (T1D/T2D)
Check glucose, assess LOC (if conscious/alert give 25-50% glucose solution), 15/15 rule, if altered (parenteral D50/D10/D5 via IV or glucagon via IM), hospitalized if BG < 50 mg/dL, coma, seizures, altered behavior
diabetes only during pregnancy; caused by an alteration in placental hormones
gestational diabetes
a hospitalized child with T1D has become pale, diaphoretic, and shaky 2 hours after eating breakfast. Which action should the nurse take? notify HCP administer supplemental insulin obtain current blood glucose level give orange juice with slice of bread
obtain current blood glucose level
Which result would the nurse expect to see on the ECG traging monitor when. a client had DKA and a K+ of 5.4 mEq/L? abnormal P waves and depressed T waves peaked T waves and widened QRS complexes abnormal Q waves and prolonged ST segments peaked P waves and an inc number of T waves
peaked T waves and widened QRS complexes
Which clinical findings are commonly associated with hyperglycemia? polyuria polydipsia polyphagia polyphrasia polydysplasia
polyuria polydipsia polyphagia
Complications of gestational diabetes
preeclampsia, hydraminos, congenital defects, LGA, neonatal hypoglycemia
Which common cause of DKA would consider when caring for a postoperative client with diabetes? emotional stress presence of infection inc insulin dose inadequate food intake
presence of infection
Which are risk factors of diabetes in pregnancy? preterm birth hypertension cesarean birth placenta previa placental abruption
preterm birth hypertension cesarean birth
Which eye problem is the leading cause of blindness in clients with diabetes? cataracts glaucoma retinopathy astigmatism
retinopathy
An increase in which blood component is responsible for the acidosis related to untreated diabetes mellitus? Ketones glucose lactic acid glutamic acid
ketones
Sick Day Rules (Diabetes)
- Never stop taking insulin or oral antidiabetic agents - Measure blood glucose more frequently - Test urine for ketones and glucose (type 1 >250) - Alternatives to solid foods (milk, soup, cereal, ice cream, pudding, fruit juice, or fizzy drinks) and drink plenty of liquids!
Hyperosmolar Hyperglycemic Syndrome (HHS)
A metabolic complication of uncontrolled type 2 diabetes, similar in severity to diabetic ketoacidosis but without ketosis and acidosis.
Diabetic Ketoacidosis (DKA)
Shortage of insulin resulting in hyperglycemia and production of ketones; only occurs in T1D
Which assessment finding is most significant in an infant of a diabetic mother who is large for gestational age? temp less than 98oF HR of 110 BPM blood glucose < 40 mg/dL increasing bilirubin during first 24hrs
blood glucose < 40 mg/dL
Which common complaints of diabetes would the nurse assess for in a client with a long hx of the disease? leg ulcer loss of visual acuity increased creatinine clearance prolonged capillary refill in toes dec sensation in the lower extremities
leg ulcer loss of visual acuity prolonged capillary refill in toes dec sensation in the lower extremities
Target HbA1c
less than 7%; 6.5% or less
T1D prevention
no prevention
Dawn Syndrome
rise in blood glucose levels between 4am and 8am in response to hypoglycemia during the night
prevention for gestational diabetes
screening is standard from 24-28 weeks of pregnancy, pre-pregnancy consultation, diet, exercise, eye exams
Which outcome is the best indication that a client with T1D is successfully managing the disease? reduction in excess body weight stabilization of serum glucose demonstrated knowledge of the diease adherence to the prescription for insulin
stabilization of serum glucose
Acanthosis nigricans
thickening and darkening of skin near axillary region in patients with Diabetes Type II; also a sign of prediabetes
Which is an appropriate teaching goal for a client who is newly dx as T2D? to perform foot care weekly to administer insulin as prescribed to test urine for both sugar and acetone to identify symptoms of hypoglycemia or hyperglycemia
to identify symptoms of hypoglycemia or hyperglycemia
insulin resistance; defect in insulin secretion; obesity/physical inactivity
type 2 diabetes
Which factor may have precipitated ketoacidosis in a client with T1D who has been adhering to a prescribed insulin regimen? increase exercise dec food intake working night shift upper respiratory infection
upper respiratory infection
Which results would be expected when assessing the lab values of a client with T2D? ketones in blood but not in urine glucose in urine but not in blood urine and blood positive for glucose and ketones urine negative for ketones and positive glucose in blood
urine negative for ketones and positive glucose in blood
Which statement is accurate when teaching a client with diabetes about foot care? remove any corns on your feet wear shoes that are a size larger than your feet examine your feet weekly for potential sores wear synthetic fiber socks when exercising
wear synthetic fiber socks when exercising
A T1D receives humulin R insulin in the AM. Shortly before lunch the nurse identifies the client is diaphoretic and trembling. Which intervention is appropriate? administer insulin give the client lunch immediately encourage the client to drink fluids assess the blood glucose level
assess the blood glucose level
Complication of T1D/T2D
diabetic retinopathy, periodontal disease, neuropathy, nephropathy, CV disease, PVD, CAD, inc risk for infections
T2D Prevention
dietary management, medications for people at risk for prediabetes, exercise, monitor BGL, screen for A1C
A client newly diagnosed with T1D asks why it is necessary to exercise on a regular basis. Which response is accurate? exercise dec insulin sensitivity it stimulates glucagon production exercise improves the cellular uptake of glucose it reduces metabolic requirements for glucose
exercise improves the cellular uptake of glucose
Which intervention would the nurse implement for a client who has T1D and has elevated blood glucose? administer oral hypoglycemic institute urine glucose monitoring give supplemental doses of regular insulin dec rate of IV infusion
give supplemental doses of regular insulin
Which hormone causes the blood glucose level to rise? insulin glucagon epinephrine ACTH
glucagon
Which symptoms would be seen in a client with T1D who is experiencing hypoglycemia? vomiting headache tachycardia cool, clammy skin inc respirations
headache tachycardia cool, clammy skin
Which lab value supports the presence of diabetic ketoacidosis in a client with T1D? dec serum glucose dec serum calcium levels inc BUN levels inc serum bicarbonate levels
inc BUN levels (bc of dehydration)
What will happen to insulin needs during pregnancy for a mother with gestational diabetes?
insulin needs my double or quadruple by the end of pregnancy
Somogyi phenomenon
A rebound phenomenon that occurs in clients with type 1 diabetes mellitus. Normal or elevated blood glucose levels are present at bedtime; hypoglycemia occurs at about 2 to 3 am. Counterregulatory hormones, produced to prevent further hypoglycemia, result in hyperglycemia (evident in the prebreakfast blood glucose level).
Which initial intervention would the nurse expect the primary HCP to order for a client admitted to the hospital with a dx of DKA? IV fluids potassium NPH insulin sodium polystyrene sulfonate (kayexalate)
IV fluids
Which nursing intervention is appropriate when a client is FIRST admitted with hyperglycemic hyperosmolar nonketotic syndrome (HHNS)? providing oxygen encouraging carbs administering fluid replacement teaching facts about dietary principles
administering fluid replacement
An obese client with T2D asks about the intake of alcohol or special 'dietetic' food in the diet. Which instruction would be included in the teaching plan? alcohol can be consumed, with its calories counted in the diet unlimited amounts of sugar substitutes can be used as desired alcohol should not be used in cooking because it adds too many calories special dietetic foods are needed because many regular foods cannot be used
alcohol can be consumed, with its calories counted in the diet
What physiological changes would the nurse expect to find in a client with a 20-year hx of T2D? blurry, spotty, hazy vision arthritic changes in hands hyperactive knee and ankle jerk reflexes dependent pallor of the feet and lower legs
blurry, spotty, hazy vision
Which is the primary fluid shift that occurs with diabetes mellitus? intravascular to interstitial because of glycosuria interstitial to extrecellular because of hypoproteinemia intracellular to intravascular because of hyperosmolarity intracellular to intravascular because of inc hydrostatic pressure
intracellular to intravascular because of hyperosmolarity
A client with T1D has hot dry flushed skin; fruity odor to breath; and is having Kussmaul respirations. Which complication does the nurse suspect that the client is experiencing? ketoacidosis somogyi phenomenon hypersomolar nonketotic coma hypoglycemic reaction
ketoacidosis