Med Surg CH 51

In the US, diabetes is the leading cause of ____, ____, and ____

Nontraumatic amputation, blindness, end-stage kidney disease

When educating a patients with diabetes about increasing fiber intake, what risks should be discussed?

One risk involved in suddenly increasing fiber intake is that it may require adjusting the dosage of insulin or oral agents to prevent hypoglycemia. Other problems may include abdominal fullness, nausea, diarrhea, increased flatulence, and constipation if fluid intake in inadequate.

When excess glucose is excreted in the urine, it is accomplished by excessive loss of fluids and electrolytes, which is called ____.

Osmotic diuresis

Classic clinical manifestations of diabetes include the "three Ps": ____, ____, and ____.

Polyuria, polydipsia, polyphagia

Type 2 diabetes is the ____ leading cause of death and affects approximately __% of older adults.

Seventh, 20

How do sulfonylureas act for patients with type 2 diabetes?

Sulfonylureas act by directly stimulating the beta cells of the pancreas to secrete insulin (connot be used in patients with type 1 diabetes).

Insulin resistance refers to a ____ tissue sensitivity to insulin.

Decreased

A finding of ____ is the basic criterion for the diagnosis of diabetes.

Elevated blood glucose levels

Because insulin normally inhibits ____ and ____, therse processes occur in an unrestrained fashion in people with insulin deficiency and contribute further to hyperglycemia.

Glycogenolysis, gluconeogenesis

Why does hyperglycemia develop during pregnancy?

Hyperglycemia develops during pregnancy because of the secretion of placental hormones, which causes insulin resistance.

___, ____, and ____ are the three metabolic derangements that occur in diabetic ketoacidosis.

Hyperglycemia, ketosis, metabolic acidosis

List the clinical manifestations characteristic of hyperglycemia hypersmolar syndrome.

Answer should include: hypotension, profound dehydration, tachycardia, and variable neurologic signs (seizures, hemiparesis, alteration of sensorium).

Match: 1. Gluconeogenesis 2. Glycosuria. 3. Glycogenolysis. 4. Nephropathy. 5. Retinopathy. a. Filtered glucose that the kidney cannot absorb spills over into urine. b. Glycogen breaks down in the liver through the action of glucagon. c. New glucose is produced from amino acids. d. Microvascular changes develop in the eyes. e. Small vessel disease affects the kidneys.

1. c 2. a 3. b 4. e 5. d

Goals for blood glucose levels during pregnancy are ____ or less before meals and ____ or less 2 hours after meals.

105 mg/dL, 130 mg/dL

Gestational diabetes occurs in as many as __% of pregnant women and increases their risk for hypertensive disorders during pregnancy.

18%

A woman at average risk for the development of hyperglycemia during pregnancy should be tested at ____ weeks of gestation.

24 to 28

It is estimated that more than ____ million people in the US have diabetes, although almost one third of these cases are undiagnosed.

25.8

Why does the economic cost of diabetes continue to increase?

Because of increasing health care costs and an older adults.

The major classifications of diabetes are: ____, ____, ____, and diabetes associated with other conditions or syndromes.

Type I diabetes, type II diabetes, gestational.

A female patient with diabetes who weighs 130 lb has an ideal body weight of 116 lb. For weight reduction of 2 lb/wk, approximately what should her daily caloric intake be? a. 1000 calories. b. 1200 calories. c. 1500 calories. d. 1800 calories.

a. 1000 calories.

An older adult patient is in the hospital being treated for sepsis related to a urinary tract infection. The patient has started to have an altered sense of awareness, profound dehydration, and hypotension. What condition does the nurse suspect the patient is experiencing? a. Systemic inflammatory response syndrome. b. Hyperglycemic hypersmolar syndrome. c. Multiple-organ dysfunction syndrome. d. Diabetic ketoacidosis.

b. Hyperglycemic hypersmolar syndrome.

The nurse is administering an insulin drip to a patient in ketoacidosis. What insulin does the nurse know is the only one that can be used intravenously? a. NPH. b. Regular. c. Lispro. d. Lantus.

b. Regular.

The nurse is preparing to adiminster IV fluids for a patient with ketoacidosis who has a history of hypertension and congestive heart failure. What order for fluids would the nurse anticipate infusing for this patient? a. D5W. b. 0.9% normal saline. c. 0.45% normal saline. d. D5 normal saline.

c. 0.45% normal saline.

The nurse expects that a patient with type 1 diabetes may receive what percentage of the usual morning dose of insulin preoperatively? a. 10% to 20% b. 25% to 40% c. 50% to 60% d. 85% to 90%

c. 50% to 60%

An older adult patient that has diabetes type 2 comes to the emergency department with second-degree burns to the bottom of both feet and states, "I didn't feel too hot but my feet must have been too close to the heater." What does the nurse understand is most likely the reason for the decrease in temperature sensation? a. A faulty heater. b. Autonomic neuropathy c. Peripheral neuropathy. d. Sudomotor neuropathy.

c. Peripheral neuropathy.

Uncontrolled type 2 diabetes may lead to an acute problem - ____.

Hyperglycemic hyperosmolar syndrome

Describe how insulin regulation is altered in the diabetic state.

Insulin regulates the production and storage of glucose. In diabetes, either the pancreas stops producing insulin or the cells stop responding to insulin. Hyperglycemia results and can lead to acute metabolic complications such as diabetic ketoacidosis and hyperglycemia hyperosmolar nonketotic syndrome. Long-term complications can contribute to macrovascular or microvascular complications.

What are two main problems related to insulin type 2 diabetes?

Insulin resistance and impaired insulin secretion

___ is the most common risk of insulin pump therapy.

Ketoacidosis

A nurse is caring for a patient with diabetes that has a diagnosis of nephropathy. What would the nurse expect the urinalysis report to indicate? a. Albumin. b. Bacteria. c. Red blood cells. d. White blood cells.

a. Albumin.

When the nurse is caring for a patient with type 1 diabetes, what clinical manifestation would be a priority to closely monitor? a. Hypoglycemia. b. Hyponatremia. c. Ketonuria. d. Polyphagia.

a. Hypoglycemia.

A patient with diabetic ketoacidosis has had a large volume of fluid infused for rehydration. What potential complication from rehydration should the nurse monitor for? a. Hypokalemia. b. Hyperkalemia. c. Hyperglycemia. d. Hypenatremia.

a. Hypokalemia.

A patient is diagnosed with type 1 diabetes. What clinical characteristics does the nurse expected to see in this patient? (SATA) a. Ketosis prone. b. Little endogenous insulin. c. Obesity at diagnoses. d. Younger than 30 years of age. e. Older than 65 years of age.

a. Ketosis prone. b. Little endogenous insulin. d. Younger than 30 years of age.

The nurse is assessing a patient with nonproliferative (background) retinopathy. When examining the retina, what would the nurse expect to assess? (SATA) a. Leakage of fluid or serum (exudates) b. Microaneurysms. c. Focal capillary single closure. d. Detachment e. Blurred optic discs.

a. Leakage of fluid or serum (exudates) b. Microaneurysms. c. Focal capillary single closure.

The nurse is caring for a patient with an abnormally low blood glucose concentration. What glucose level will the nurse observe when assessing laboratory results? a. Lower than 50 to 60 mg/dL b. Between 60 and 80 mg/dL c. Between 75 and 90 mg/dL d. 95 mg/dL

a. Lower than 50 to 60 mg/dL

The nurse is educating the patient with diabetes about the importance of increasing dietary fiber. What should the nurse explain is the rationale for the increase? (SATA) a. May improve blood glucose levels. b. Decrease the need for exogenous insulin. c. Help reduce postprandial glucose levels. e. Increase potassium levels.

a. May improve blood glucose levels. b. Decrease the need for exogenous insulin. c. Help reduce postprandial glucose levels.

The nurse is preparing to administer intermiated-acting insulin to a patient with diabetes. Which insulin will the nurse administer? a. NPH. b. Iletin II c. Humalog. d. Glargine.

a. NPH.

The nurse is educating a patient about the benefits of fruit versus fruit juice in the diabetic diet. The patient states, "What difference does it make if you drink the juice or eat the fruit? It is all the same." What is the best response by the nurse? a. "Eating the fruit is more satisfying than drinking the juice. You will get full faster." b. "Eating the fruit will give you more vitamins and minerals than the juice will." c. "The fruit has less sugar than the juice." d. "Eating the fruit instead of drinking juice decreases the glycemic index by slowing absorption."

d. "Eating the fruit instead of drinking juice decreases the glycemic index by slowing absorption."

A patient has been newly diagnosed with type 2 diabetes, and the nurse is assisting with the development of a meal plan. What step should be taken into consideration prior to making the meal plan? a. Make sure that the patient is aware that quantity of foods will be limited. b. Ensure that the patient understands that some favorite foods may not be allowed on the meal plan and substitutes will need to be found. c. Determine whether the patient is on insulin or taking oral antidiabetic medication. d. Review the patient's diet history to identify eating habits, and lifestyle and cultural eating patterns.

d. Review the patient's diet history to identify eating habits, and lifestyle and cultural eating patterns.