diabetes mellitus ch. 40

hyperglycemia=

dry and hot give them a shot

Which food source should the nurse recommend to treat an episode of hypoglycemia?

hard candies

type 1

onset- rapid age at onset- usually younger than 40 risk factors- virus autoimmune response hereditary usual body type- lean high blood glucose complication- ketoacidosis treatment- diet exercise must have insulin to survive

type 2

onset- slow age at onset- usually older than 40 risk factors- hereditary, obesity usual body type- overweight or obese high blood glucose complications- hyperosmolar hyperglycemic state. may develop ketoacidosis later in disease. treatment- diet, exercise may need oral hypoglycemic agents or insulin to control blood glucose level.

DKA

patients die from hypokalemia

HHS (hyperosmolar hyperglycemic syndrome)

patients die from hypovolemia

Hyperglycemia: 3 P's

polyphagia, polydipsia, polyuria

the nurse is assisting with preparing a teaching plan for a client with diabetes melitus regarding proper foot care which instruction would be included in the plan of care ?

apply moisturizing lotion to dry feet but not in between toes

Which action is most important to prevent the development of complications of diabetes?

control blood glucose levels

when the nurse is reinforcing instructions to a client who has been newly diagnosed with type 1 diabetes mellitus which statement by the client would indicate the teaching has been effective?

i will notify my pcp if my blood glucose level is consistently greater than 250

type 2 diabetes mellitus

insufficient insulin production or insulin resistance. some cells get insulin not enough 95% of diabetes cases large genetic component 90% reduced number of beta cells reduced tissue sensitivity to insulin largest risk factor is obesity not usually ketosis prone po and injectable meds

the nurse is reinforcing instructions to a client with dm who is recovering from dka regarding measures to prevent a recurrence which instruction is important for the nurse to emphasize?

monitor bc levels frequently

Onset of Action of Insulin

once its injected a period elapses before it begins to lower BG

short acting insulin regular Humulin r Novolin r

onset- 30min peak-2-3hrs duration- 3-6hrs not more than 30 min before a meal

the nurse is evaluating a client with diabetes ketoacidosis. the nurse would note which respiratory pattern as indicative of complications associated with this condition?

rapid and deep respirations

DKA s/s

dry and high sugars= 250-500+ ketones and Kussmaul resp. deep rapid/regular respirations fruity breath abdominal pain acidosis metabolic less than 7.35 hyperkalemia abnormally high k+

a nurse is urgently called to a homebound neighbors house. the neighbor is found unconscious and has a history of insulin dependent diabetes. after determining there is no functioning glucometer available would should be the nurses next action?

administer 10 units of regular insulin subcutaneously

a client has an order for a glycosylated hemoglobin (A1C) test to be done. the nurse understands that the purpose of the test is?

determine the glucose levels over the past 120 days

The nurse is caring for a patient with type 1 diabetes who is diaphoretic and clammy. The patient complains of hunger but denies pain. The nurse performs a bedside blood glucose check. What should the nurse do next?

give 6oz of orange juice

Long acting insulin

glargine (Lantus) detemir (Levemir) onset- NA peak- NA duration- 12-24hrs

a responsive client in the emergency department has a blood glucose of 40mg/ml. the nurse would anticipate which medication to be ordered?

glucagon

the nurse is caring for a client who is 8hr post thyroidectomy. what are important nursing interventions for this client?

have the client speak every 2 hours to determine increasing level of hoarseness evaluate behind the neck for the presence of blood from the incision maintain the client in a fowler position check the incision for formation of a hematoma

Which diagnostic test is used to evaluate glucose control over the last 2-3 months?

hemoglobin A1c

Hyperosmolar Hyperglycemic Syndrome (HHS) s/s

highest sugar over 600+ higher fluid loss and extreme dehydration head change level of consciousness, confusion neurological manifestations no ketones no acid no fruity breath/ketones slower onset and stable potassium 3.5.-5.0

DKA: Reassessment

hourly blood glucose rehydration signs- bp stable and cap refill 3 sec or less skin color and warm temp 30ml/hr urine output low specific gravity 1.005-1.030 NOT- ap, lung sounds, pupils

hyperosmolar hyperglycemic syndrome (HHS) treatment

hydration 0.9% ns 1st then hypotonic stabilize sugars with insulin Caution- insulin IV = only regular insulin iv bolus iv titration sq injection and iv sq only

the nurse is monitoring a client who has been newly diagnosed with diabetes mellitus for signs of complications which statement by the client would indicate hyperglycemia and warrant pcp notification?

i am urinating alot

the nurse is reinforcing discharge teaching to a client who has cushings syndrome which statement by the client indicates that the instructions related to dietary management were understood?

i can eat foods that contain potassium

the nurse provides dietary instructions to a client with diabetes mellitus regarding the prescribed diabetic diet which statement by the client indicates a need for further teaching?

i need to buy a special dietetic foods

What is diabetes mellitus?

immune disorder attacks beta cells of pancreas lack of insulin or insufficient insulin goes into cells without it glucose goes up.

what would be noted on the assessment of a client with hyperthyroidism?

increased activity insomnia and weight loss

A client is 45 years old, 40 pounds overweight, has a total serum cholesterol level of 139 mg/dL, and drinks a glass of wine with dinner every night. The client's parents both have diabetes. What advice can the nurse give to help the client delay or prevent the onset of type 2 diabetes?

lose weight

type 1 diabetes mellitus

no insulin production, insulin dependent. glucose in blood stream cells get nothing. 5% of diabetes cases some genetic component 10% autoimmune response to virus more common in thin young patients prone to ketosis needs insulin

fasting blood glucose ranges

normal- less than 100 mg/dl prediabetes 100-125 mg/dl diabetes- 126 mg/dl or higher!

glucose tolerance test

normal- less than 140 mg/dl prediabetes- 140-199 mg/dl diabetes- 200 mg/dl or higher!

metabolic syndrome

occurs in type 2 diabetes (usually) increase risk for diabetes increase triglycerides decrease HDLs increase b/p central obesity sedentary lifestyle fasting blood sugar greater than 126 mg/dl most common 35 years and older

peak action of insulin

occurs when the insulin is working its hardest and BG is at its lowest point during this point patient is at most risk for an episode of low BG

Long acting insulin glargine (lantus) insulin detemir (levemir)

onset- 1-2 hr NO PEAK duration- up to 24hr offer snack when to give same time everyday

very short acting insulin lispro (Humalog) aspart (novolog) glulisine (apidra)

onset- 15 peak- 1-2hr duration- 2-4 hr when to give- not more than 15 min before meal

Intermediate acting insulin insulin neutral protamine Hagedorn humilin novolin

onset- 2-4 hrs peak 4-12 hrs duration- 12-18 hrs not more than 30 min before a meal

a diabetic client comes into the emergency department with a diagnosis of diabetic ketoacidosis. the nurse would anticipate what symptoms with this client?

rapid and deep respirations tachycardia confusion

A diabetic patient has a serum glucose level of 824 mg/dL and is unresponsive. Following assessment of the patient, the nurse suspects diabetic ketoacidosis rather than hyperosmolar hyperglycemic syndrome based on the finding of?

rapid, deep respirations

the nurse is collecting data regarding client after a thyroidectomy and notes the development of a hoarse and weak voice. which nursing action is appropriate?

reassure the client that this is usually a temporary condition

A client with type 1 diabetes mellitus calls the nurse to report recurrent episodes of hypoglycemia. Which statement by the client indicates a correct understanding humulin N insulin and exercise?

"I should not exercise in the late afternoon."

The nurse is discussing insulin administration with an assigned patient. The patient reports that she prefers to use only certain sites for insulin injections and questions the need to rotate sites. What response by the nurse is most appropriate?

"Rotating injection sites helps enhance insulin absorption."

The nurse is providing care for a client who is newly diagnosed with diabetes mellitus. What explanation about exercise is best for the nurse to provide?

'Exercise helps lower your blood sugar by decreasing insulin resistance.'

Metformin 750 mg tablets is prescribed. The client has 500 mg tablets at home. How many tablets should the nurse instruct the client to take? (Assume tablets are scored and may be split in half if necessary.)

1.5 tablets

The patient received regular insulin 10 units subcutaneously at 8:30 PM for a blood glucose level of 253 mg/dL. The nurse plans to monitor this patient for signs of hypoglycemia at which time related to the insulin's peak action?

10:30 PM to 1:30 AM

A client has the following prescriptions: Insulin glargine 54 units subcutaneously daily at bedtime. Insulin glulisine 14 units subcutaneously before meals and at bedtime. Insulin glulisine coverage subcutaneously before meals and at bedtime based on sliding scale. Sliding scale: 0-149: no coverage; Notify provider of blood sugar less than 70 and treat for hypoglycemia 150-199: 2 units 200-2449: 3 units 250-299: 4 units 300-349:5 units 350-399: 6 units 400 or higher: 7 units and notify provider The patient's blood sugar at 1700 hours was 287. How much insulin glulisine will be administered IN ALL? _______units

18 units

which client would be most likely to be able to control their diabetes through diet and exercise?

a 60 year old woman with onset at age 45 years

A home care client takes 4 units of insulin lispro before meals and 7 units at bedtime. How long will a 10ml vial of U-100 insulin lispro (100 units per ml) last? Round DOWN to the nearest number of days. ___________days

52 days

normal range blood glucose normal range A1C

70-100 less than 5.7

A patient in diabetic ketoacidosis has an insulin drip infusing at 8 mL/h. How many units per hour is the patient receiving? _______units per hour You Answered

8 If there are 100 units in 100 ml, the ratio of mg to mls is 1 to 1. Therefore, the flow rate per hour and the units per hour are the sane. The math would be 100 units:100 ml::X units is to 9 ml.

A client presents with diaphoresis, palpitations and tachycardia approximately 4 hours after taking the prescribed dose of insulin. What are the nurses PRIORITY actions?

Check the blood glucose and administer carbohydrates.

treatment for DKA

D- dehydration first! (0.9% normal saline) K- kill the sugar (slowly) prevent low sugar hourly bs checks * over 250 IV regular insulin only (bolus first) below 200 (or ketones resolve) SQ insulin + 1/2 NS with D5W iv A- add potassium k+ if even normal 3.5-5.0 during iv insulin

DKA symptoms

Dry membranes Ketones and kussmaul breathing Acidosis altered Loc Fruity breath

The nurse educator is asking the nursing student to recall the s/s of hypothyroidism. The nurse educator determines that the student understands this disorder of which are included in the students response?

Dry skin Constipation Cold intolerance

Analyze the following diagnostic findings for your patient with type 2 diabetes. Which result will need further assessment?

Hemoglobin A1C 9%

A client recently diagnosed with Type 2 diabetes returns to the clinic for a follow-up visit. Which of the following laboratory tests will give the nurse the best information about the client's adherence to their diet, exercise, and medication regimen?

Hemoglobin A1c

S/S of HHS

High and dry membranes High urine output Splitting headache Dehydrated

Hyperosmolar Hyperglycemic Syndrome (HHS) what is it?

Increase BG and body excretes sugar in urine (glycosuria) Increase glucose Increase glycosuria Increase fluid imbalance Type 2 Greater than 600 Cause- sickness, stress, skipping insulin

Diabetic Ketoacidosis (DKA) what is it

Lack of insulin increase blood glucose Increase ketones Increase acidosis Type 1 Greater than 250 Cause- sickness, stress, skipping insulin

Rapid acting insulin

Lispro (Humalog) Aspart (Novolog) Glulisine (Apidra) onset-15 peak-30 duration-3hrs

Intermediate acting insulin

NPH (Humulin N, Novolin N) onset- 6hrs peak- 8hrs duration- 12hrs

The nurse notes that a client with type 1 diabetes mellitus has lipodystrophy on both upper thighs, which further information would the nurse obtain from the client during data collection?

Plan for injection rotation

Short acting insulin

Regular (Humulin R, Novolin R) onset- 1hr peak- 2hrs duration- 4hrs

A client with type 1 diabetes mellitus has been vomiting and unable to keep anything but fluids down for the past 3 days. The client's blood glucose is 465 mg/dl. What is the most likely cause for the elevated reading?

Stress hormones released in response to illness.

The nurse is assisting with diabetes screening at a local health fair. Which client should be referred to the health care provider (HCP) for further evaluation?

The client who reports increased thirst, eating a lot and urinating frequently

Which of the following causes of HHNS is most common?

Undiagnosed and untreated diabetes mellitus

hypoglycemia=

cold and clammy give them candy

A client is in DKA, secondary to infection. As the condition progresses, which of the following symptoms might the nurse see?

kussmaul's respirations and a fruity odor on the breath

The nurse is reviewing the patient's prescribed insulin regimen. The nurse notes that the physician has ordered a long-lasting insulin. Which medication best meets this criteria?

lantus

hbA1c

normal- less than 5.7% prediabetes- 5.7- 6.4% diabetes- 6.5% or higher!

a client is placed on insulin sliding scale. the nurse would anticipate which medication needing to be administered?

regular insulin

a client who has been newly diagnosed with diabetes mellitus has been stabilized with daily insulin injections. which teaching information would the nurse reinforce upon discharge?

rotate the insulin injection sites systemically

while gathering information on a diabetic client the nurse smells a sweet fruity odor. what would be important for the nurse to check?

serum blood glucose level

the nurse reinforces teaching to a client with diabetes mellitus regarding differentiating between hypoglycemia and ketoacidosis. the client demonstrates an understanding of the teaching by stating that glucose will be taken if which symptom develops?

shakiness

Which factor can cause HYPERglycemia in diabetes mellitus?

stress and illness

The nurse is explaining the underlying pathophysiology of type 1 diabetes to a newly diagnosed patient. Which information accurately explains why the type 1 diabetic does not produce adequate insulin?

the body's immune system destroyed beta cells.

duration of insulin

the length of time the insulin works before its used up

Which activities can cause hypoglycemia? Select all that apply.

too much insulin exercise

the nurse is caring for a client after a thyroidectomy and notes that calcium gluconate is prescribed. the nurse determines that this medication has been prescribed for which reason?

treat hypocalcemic tetany

DKA patho and causes

type 1 faster and younger d comes first in the alphabet sepsis infection sickness stomach virus and flu (most common) stress (surgery) skip insulin

hyperosmolar Hyperglycemic state (HHS) patho and causes

type 2 slower and older H comes 2nd in alphabet illness infection older age harder to fix

A client with diabetes mellitus has peripheral neuropathy. What recommendation should the nurse give the client to prevent related complications?

wash dry and inspect feet daily

a child is nauseous not eating maybe vomiting do you still give insulin?

yes, we give sick day insulin to prevent DKA because glucose is high during times of illness