Exam 5 nursing care

Symptoms

Type 1: thirst, frequent urination, hunger, weight loss, irritability, weakness, fatigue, N&V Type 2: 3 Ps, excessive weight gain, family history, poor healing, blurred vison, itching drowsiness, fatigue, tingling or numbness of the feet

Glucagon

Used to increase blood sugar in hypoglycemia. Hormone produced by alpha cells of pancreas. Has opposite effect of insulin.

A nurse is teaching a school aged child how to use an insulin pump. What is most important for the child to understand?

The pump is an attemt to mimic the way a healthy pancreas works.

A nurse caring for a client with an underactive thyroid gland. Which responses should be expected the client to exhibit as a result of decreased levels of t3 and t4?

Weight gain, cold intolerance.

A client with type 2 who is taking an oral hypoglycemic agent is to have a serum glucose test early in the morning. The client asks the nurse, "what do I have to do to prepare for the test?" which state is accurate?

Do not ingest anything before the test.

A nurse is collecting info about a client who has type 1 and is being admitted because of diabetic ketoacidotic coma. Which factors can predispose a client to this condition?

Excessive emotional stress, running a fever with the flu.

A client with type 1 self-administers novolin N insulin every morning at 8am. The nurse evaluated the client understand the action of insulin whent he client says, "i should be alert for signs and symptoms of hypoglycemia between"

2pm and 8pm

Which of the following regimens offers the best blood glucose control for persons with type 1?

3 or 4 injections per day of different insulin types. They cannot be treated with oral drugs.

Glucose

Fuel for body's cell

Low blood glucose

Glucagon released by alpha cells of pancreas Liver released glucose into blood

A client is diagnosed with cushing syndrome. Which clinical manifestation does the nurse expect to increase in a client with cushing syndrome?

Glucose level

Euglycemia

BG: 70-140 mg/dL normal

Examination

BMI Obesity: described as 20% over ideal body weight BMI: 30-30.9 80% of type 2 diabetics are obese Hypertension: high BP, can lead to make worse complications of diabetes, (diabetic eye & kidney disease) Peripheral perfusion Neuropathy: nerve damage, numbness in extremities. Retinopathy: damage to blood vessels of retina due to diabetes 1 and 2.

Ketoacidosis

Body generates ketones in response to absence or insufficient supply of insulin. May be caused by failure to take insulin, illness, overeating, severe stress Symptoms: polysipsia (increased thirst), polyphagia (excessive hunger), N/V, dry membranes, hypotension, coma Goal: restore normal pH of blood and electroyte imbalance, low BG

Glycogenolysis

Breaking down glycogen to increase blood glucose concentration to an optimal level

The nurse is caring for a client with type 1. Which signs/symp of insulin should the nurse particularly be observant?

Headache, diaphoresis.

Client with type 1 is experiencing hypoglycemia. What are the symptoms?

Headache, tachycardia, cool clammy skin.

A client with type 2 diabetes is taking one oral hypoglycemic tablet daily The client asks whether an extra pill should be taken before excercise. The best response by the nurse is:

No, but you should observe for signs of hypoglycemia while exercising.

Hypoglycemia

Condition affecting organs which have beta cells that produce insulin Ex: Diabetes mellitus BG: <70mg/dL Signs/symptoms: reduced cognition, tremors, diaphoresis, weakness, hunger, headache, irritability, seizures Severe comps: seizures, unconsciousness, cell damage/death

A nurse who is monitoring the blood glucose level of the term infat of a diabetic mother identifies a blood glucose level of 48mg/dl. What should the nurse do?

Continue to monitor the blood glucose level per policy.

Some clients self prescribe OTC glucosamine to help relieve joint pain and stiffness. Which condition should the nurse identify as a reason for a client to reconsider taking this medication?

Diabetes mellitus

The risk factors for type 1 diabetes include all of the following except:

Diet. Type 1 is a failure of pancreatic beta cells to produce insulin. Typically affects children and young adults, unrealted to diet.

Insulin

Hormone that lowers elevated blood glucose levels after carbohydrate intake

Counter regulatory hormones

Hormones that facilitate glycogenolysis Increased with physical and emotional stress

A nurse is caring for a client with type 1 who developed ketoacidosis. Which lab value supports the presences of diabetic ketoacidosis?

Increased serum lipids.

Those at risk

Infants who are large for gestational age are at risk for hyperglycemia Premature infants- increased energy needs and insufficient glycogenstores Older adults- reduction in lean muscle mass where most glucose is metabolized African americans: highest racial group at risk

Type 1

Insulin dependent. Beta cells have pancreatic inflammatory response. Beta cell destruction Little or no insulin produced usually diagnosed at young age Renal, cardio, retinal, neurological complications if not kept under control No known way to prevent. Accounts for 5-10% of all cases

What does the nurse expect the size of her newborn to be if the mother had inadequate controlled type 1 diabetes during her pregnancy?

Large for gestational age, near term.

Which problem should the nurse consider is most likely to precipitate acute hypoglycemia in a client?

Liver disease.

Type 2

May develop hyperglycemia, hyperosmolar nonketotic syndrome Mostly over 30 Mostly obese Can be controlled with exercise and diet Makes up 90% of all cases Insulin resistance- when insulin reaction with glucose becomes less efficient Pancreas loses ability to produce insulin

A client is receiving dexamethasone for adrenocortical insufficiency. To monitro for a negative side effect of the medication, the nurse should?

Measure blood glucose levels.

Oral hypoglycemic

Metformin (glucophage)- used in treatment of type 2

Which is an independent nursing action that should be included in the plan or care for a client after an episode of ketoacidosis?

Monitoring for signs of hypoglycemia as a result of treatment

Which response should a nurse expect a client experiencing hypoglycemia to exhibit?

Palpitations, tachycardia, nervousness.

the parents of a 12 y/o with cystic fibrosis ask the nurse why he needs a glucose tolerance test. What information should the nurse consider before replying?

Pancreatic scarring predisposes the child to diabetes.

Hyperglycemia

Post-pranidal BG > 140 Signs/symp: polyura, polydipsia, dehydration, fatigue, fruity odor to breath, weight loss, hunger, poor wound healing Interventions: administer insulin as ordered, contact phys., monitor for ketoacidosis Long term comps: nerve damage, diminished circulation, kidney disease, loss of sensation Short term: dehydration, falls, poor skin, pressure ulcers, constipation, increased risk of clot formation

Gluconeogensis

Process in which nitrogen is split from protein sources, resulting in creation of glucose

What should a nurse anticipate about the insulin requirements of a client with diabetes on her first post partum day?

Sharp, sudden decrease.

Hemoglobin A1C

Should be less than 7% Measures the percentage of hemoglobin that is glycated and determines average blood glucose during 2-3 months prior to testing.

A client newly diagnosed with type 2 diabetes is receiving glyburide and asks the nurse how this drug works. The nurse explain that glyburide:

Stimulates the pancreas to produce insulin

a 12 y/o with type 2 is having an abdominal surgery. Which factors are most important for the nurse to consider during the postoperative period?

The blood glucose level will increase because of stress of surgery/ Diabetic control is usually maintained with insulin after surgery.

A client is learning alternate site testing for glucose monitoring. Which client statement indicates to the nurse that additional teaching is necessary?

The fingertip is preferred for glucose monitoring if hyperglycemia is suspected. Only reccommended if hypoglycemia. Should rub forearm.

Glucose regulation

The process of maintaining optimal blood glucose levels

High blood glucose

insulin released by beta cells of pancreas Fat cells take in glucose from blood

Glucagon

peptide hormone produced by alpha cells of the pancreas Raises concentration of glucose in blood stream Has opposite effect of insulin

Carbohydrates

quick source of energy and easily converted to glucose Metabolized the form of sugar in the body Simple carbs: sucrose, fructose, lactose Complex: breads, pasta, cereal, potatoes, rice Starchs provide a more consistent blood glucose level than simple sugars Rec. Intake: min of 130g/day

Insulin resistance

the body cells resist the action of insulin