AHI Diabetes

What response would a nurse give a pt with T1DM who asks what causes several brown spots on the skin?

"Those brown spots result from small blood vessel damage. The blood contains iron, which leaves a brown spot"

Diabetic patients should check their blood glucose every ___ hours during times of illness

4

Which action would the nurse take after contacting the PCP of a post-surgical pt complaining of nausea, fatigue, and HA during the fourth hour of the infusion of TPN given via central venous infusion who has an hourly output that is twice the amount of the previous hour? a. check serum glucose b. obtain oxygen sat c. elevate head of the bed d. administer prescribed analgesic

A Rapid administration can cause glucose overload, leading to osmotic diuresis and dehydration

A1C Glycosylated hemoglobin: reflects glucose levels over past ________months Goal:

A1C Glycosylated hemoglobin: reflects glucose levels over past 2 to 3 months Goal: Less than 6.5% to 7% (reduces complications)

When should glucose levels be checked

Before meals Two hours after first bite When hypoglycemia is suspected Every 4 hours during illness Before and after exercise

Which information would a nurse provide a client with DM about alcohol consumption

Consume alcohol with or shortly after meal to avoid alcohol-induced delayed hypoglycemia

When a person is unconscious from hypoglycemia due to insulin OD, what can be given? What is a toxic effect to be cautious of?

Glucagon SQ, IM, IV (preferred) **Watch for n/v and hyperglycemia. nausea is a common reaction after glucagon administration; turn pt on the side until they are alert to prevent aspiration. The toxic effect can by HYPOKALEMIA. IV D50 (dextrose) may also be given

Toxic effect of Glucagon

HYPOkalemia watch for n/v, and hyperglycemia **turn pt on the side until they are alert to prevent aspiration

Somogyi effect

High dose of insulin causes ↓ glucose during the night Release of counterregulatory hormones causes rebound hyperglycemia Concern when glucose checked in the morning and ⭡ insulin is given Determine if Somogyi effect by checking glucose between 2 to 4 a.m. Assess patient for headache, night sweats, or nightmares

Insulin Storage

Insulin vials and pens in use may be left at room temperature for up to 4 weeks. The room temperature cannot be higher than 86°F (30°C) or below freezing (<32°F [0°C]). Teach patients to avoid exposing their insulin to direct sunlight. A person who is traveling in hot climates may store insulin in a thermos or cooler to keep it cool (not frozen). Store unopened insulin vials and pens in the refrigerator. People who are traveling or caregivers of patients with impaired vision or who cannot fill their own syringes may prefill insulin syringes. Prefilled syringes with 2 different insulins are stable for up to 1 week when stored in the refrigerator. Syringes with only 1 type of insulin are stable for up to 30 days. Teach patients to store syringes in a vertical position with the needle pointed up to avoid clumping of suspended insulin in the needle. Before injection, gently roll prefilled syringes between the palms 10 to 20 times to warm the insulin and resuspend the particles.

Why is insulin prescribed in clients with acute renal failure

It promotes transfer of potassium into cells to lower serum potassium levels glucose and K enter cell

DKA Care

Monitor and replace potassium before starting insulin therapy; drives K+ into cells leading to hypokalemia; potentially life-threatening IV regular insulin drip 0.1 U/kg/hr to correct hyperglycemia and ketosis 36 to 54 mg/dL/hr drop in serum glucose will avoid complications

Dawn phenomenon

Morning hyperglycemia present on awakening

Signs of hypoglycemia

Nervousness, weakness, confusion, disorientation, diaphoresis, tachycardia (when glucose levels are low, the autonomic nervous system is activated)

Normal glucose range is _______ If glucose is ______, check for glucosuria If glucose remains above ______, check dx for DM If glucose greater than ________ mg/dL, check urine for ketones every 3 to 4 hours Two consecutive glucose levels greater than ________ mg/dL or moderate to high urine ketone levels should be reported to HCP

Normal glucose range is 70-99 If glucose is 180, check for glucosuria If glucose remains above 200, check dx for DM If glucose greater than 240 mg/dL, check urine for ketones every 3 to 4 hours Two consecutive glucose levels greater than 300 mg/dL or moderate to high urine ketone levels should be reported to HCP

which chemical buffers excessive acetoacetic acid

Sodium bicarbonate

What hormone blocks insulin and glucagon

Somatostatin

Which med causes neonatal hypoglycemia

Tolbutamide

Which diagnosis would cause the nurse to assess for hypoglycemia a. liver disease b. hypertension stage 3 c.hyperthyroidism

a

A client has been placing used insulin needles in a container sealed with heavy-duty tape. The client asks where the container can be disposed. How should the nurse respond? a. take it to the local hazardous waste collection site b. place it in the regular household trash c. take it to the local health department for disposal d. mail it to the EPA

a Each state has their own waste management guidelines for proper disposal of sharps containers as well as hazardous waste collection sites. The local health department does not collect sharps containers. Patients cannot place needles in a recycling bin, as sharps are considered medical waste. Sharps containers are not mailed directly to the EPA.

Which type of insulin is compatible with IV solutions a. NPH b. lispro c. detemir d. glargine

b. lispro (rapid)