NUR 112 TEST 2 (diabetes)
Which symptoms indicate autonomic neuropathy? Select all that apply.
Atonic bladder Dried, cracked skin Orthostatic hypotension
Which hormones raise blood glucose levels? Select all that apply.
Cortisol Glucagon Epinephrine Growth hormone
The patient with diabetes is at risk for eye and vision complications. What is the distinguishing characteristic of proliferative diabetic retinopathy?
Formation of new retinal blood vessels
Which of the following is the process of converting proteins to glucose?
Gluconeogenesis
which complications of diabetes are considered acute complications that require emergency treatment.
Hypoglycemia Diabetic ketoacidosis Hyperglycemic-hyperosmolar state
What can slow the progression of diabetic neuropathies?
Normal blood glucose levels Keeping blood glucose levels in the normal range can slow the development and progression of diabetic neuropathies. Daily exercise, avoiding high-fat foods, and controlling blood pressure are not identified as directly slowing the progression of diabetic neuropathies.
A patient with type 2 diabetes mellitus is experiencing an eye hemorrhage and vision changes. What should the nurse suspect is occurring with this patient?
Proliferative diabetic retinopathy Proliferative diabetic retinopathy is the growth of new retinal blood vessels. The new vessels are thin, fragile, and bleed easily, leading to eye hemorrhage and vision loss.
What is an important feature of the glycosylated hemoglobin A 1c (HbA 1c) test?
The results are not altered by eating habits 24 hours before the test Glucose binds to hemoglobin through a process called glycosylation. The glycosylated hemoglobin A 1c (HbA 1c) test is a good indicator of the average blood glucose level during the previous 120 days—the life span of red blood cells.
What best describes the etiology of type 1 diabetes mellitus?
autoimmune disorder
basal entrance insulin
long acting , have it eating or not
lipotraphy lipohypertrophy down phenonmenon smoggy phenomenon
complications of insulin therapy
A1c ?
over 6.5 is a indicator
leading cause of blindness leading cause of foot or leg amputations leading cause of ESRD requiring dialysis
diabetes * overall goal is to promote the patients health and well being
is used to describe a group of disorders characterized by chronic hyperglycemia and disturbances in carbohydrate, protein, and fat metabolism.
diabetes mellitus
is an acute event that results from insulin deficiency and is sometimes the presenting symptom of type 1 diabetes.
diabetic ketoacidosis The combination of hyperglycemia, ketosis, and acidosis leads to dehydration, and fluid resuscitation and insulin therapy are needed to correct this state. Other symptoms include abdominal pain, vomiting, poor skin turgor, tachycardia, and hypotension. Stress is a frequent trigger for DKA.
insulin sensitizer (feeds your cells by letting glucose in cells) almost everyone with type 2 gets this. affects GI system (gives bad gas) hold this 48 hours after CT scan
glucaphage (metformin) patients needs to move/ walk so sugar goes where it needs to go in the cells to make it work
3 P's?
polyuria, polydipsia, polyphagia
When obtaining a health history from a client recently diagnosed with type 1 diabetes, the nurse expects the client to report what clinical manifestations?
polyuria, polydypsea, polyphasia Excessive thirst (polydipsia), excessive hunger (polyphagia), and frequent urination (polyuria) are caused by the body's inability to metabolize glucose adequately. Although polydipsia and polyuria occur with type 1 diabetes,
Headache sweaty hot shaky irritable
s/s : hypoglycemia
"rule of 15" 15 grams of carbohydrate see if there feeling better in 15 minutes and recheck if needed
treatment of hypoglycemia *can they participate in there treatment?
most common form of diabetes
type 2
is characterized by the features of insulin resistance paired with β cell failure resulting in hyperglycemia.
type 2 diabetes melittus
Which of the following would be included in the assessment of a patient with diabetes mellitus who is experiencing a hypoglycemic reaction? (Select all that apply.) 1 Tremors 2 Nervousness 3 Extreme thirst 4 Flushed skin 5 Profuse perspiration 6 Constricted pupils
1,2,5 When hypoglycemia occurs, blood glucose levels fall, resulting in sympathetic nervous system responses such as tremors, nervousness, and profuse perspiration. Dilated pupils would also occur, not constricted pupils. Extreme thirst, flushed skin, and constricted pupils are consistent with hyperglycemia.
A nurse is caring for a client who is receiving total parenteral nutrition. Which responses indicate that the client is experiencing hyperglycemia? Select all that apply. 1 Polyuria 2 Polydipsia Paralytic ileus 4 Respiratory rate of 24 breaths/min Serum glucose of 105 mg/dL (5.8 mmol/L)
1,2,4 Glucose that is being filtered in the kidney acts as an osmotic diuretic; glycosuria promotes polyuria. Polydipsia (excessive thirst) and fluid intake are the responses to excess fluid loss related to osmotic diuresis. With hyperglycemia, there may be hyperventilation in an attempt to blow off carbon dioxide if ketones are produced; 24 breaths/min is characteristic of hyperventilation.
What is the nurses best response about developing diabetes to the patient whose father has type 1 diabetes mellitus? 1 You have a greater susceptibility for development of the disease because of your family history. 2 Your risk is the same as the general population, because there is no genetic risk for development of type 1 diabetes. 3 Type 1 diabetes is inherited in an autosomal dominant pattern. Therefore the risk for becoming diabetic is 50%. 4 Because you are a woman and your father is the parent with diabetes, your risk is not increased for eventual development of the disease. However, your brothers will become diabetic.
1 Even though type 1 diabetes does not follow a specific genetic pattern of inheritance, those with one parent with type 1 diabetes are at an increased risk for development of the disease.
The nurse recognizes which patient as having the greatest risk for undiagnosed diabetes mellitus? 1 Young white man 2 Middle-aged African-American man 3 Young African-American woman 4 Middle-aged Native American woman
4 The highest incidence of diabetes in the United States occurs in Native Americans. With age, the incidence of diabetes increases in all races and ethnic groups.
When a diabetic patient asks about maintaining adequate blood glucose levels, which of the following statements by the nurse relates most directly to the necessity of maintaining blood glucose levels no lower than about 74 mg/dl? 1 Glucose is the only type of fuel used by body cells to produce the energy needed for physiologic activity. 2 The central nervous system cannot store glucose and needs a continuous supply of glucose for fuel. 3 Without a minimum level of glucose circulating in the blood, erythrocytes cannot produce ATP. 4 The presence of glucose in the blood counteracts the formation of lactic acid and prevents acidosis.
2 The brain cannot synthesize or store significant amounts of glucose; thus a continuous supply from the bodys circulation is needed to meet the fuel demands of the central nervous system.
Which nursing intervention is the priority when a client is first admitted with hyperglycemic hyperosmolar nonketotic syndrome (HHNS)? provide oxygen Encouraging carbohydrates Administering fluid replacement Teaching facts about dietary principles
3 As a result of osmotic pressures created by an increased serum glucose level, the cells become dehydrated; the client must receive fluid and then insulin. Oxygen therapy is not necessarily indicated.
A diabetic patient is brought into the emergency department unresponsive. The arterial pH is 7.28. Besides the blood pH, which clinical manifestation is seen in uncontrolled diabetes mellitus and ketoacidosis? 1 Oral temperature of 38.9 Celsius 2 Severe orthostatic hypotension 3 Increased rate and depth of respiration 4 Extremity tremors followed by seizure activity
3 Ketoacidosis decreases the pH of the blood, stimulating the respiratory control area of the brain to buffer the effects of the increasing acidosis. The rate and depth of respirations are increased (Kussmauls respirations) to excrete more acids by exhalation.
When obtaining the history of a client recently diagnosed with type 1 diabetes, what will the nurse expect to discover? Edema Anorexia Weight loss Hypoglycemic episodes
3 Protein and lipid catabolism occur because carbohydrates cannot be used by the cells; this results in weight loss and muscle wasting. Dehydration, not edema, is more likely to occur because of the polyuria associated with hyperglycemia. Polyphagia, not anorexia, occurs with diabetes as the client attempts to meet metabolic needs. Hyperglycemia, not hypoglycemia, is present in both type 1 and type 2 diabetes.
The nurse associates which assessment finding in the diabetic patient with decreasing renal function? 1 Ketone bodies in the urine during acidosis 2 Glucose in the urine during hyperglycemia. 3 Protein in the urine during a random urinalysis 4 White blood cells in the urine during a random urinalysis
3 Urine should not contain protein. Proteinuria in a diabetic heralds the beginning of renal insufficiency or diabetic nephropathy with subsequent progression to end stage renal disease. Chronic elevated blood glucose levels can cause renal hypertension and excess kidney perfusion with leakage from the renal vasculature. This leaking allows protein to be filtered into the urine.
Normal blood glucose (BG) levels range between?
70 and 99 mg/dL in the fasting state
A nurse is planning to teach facts about hyperglycemia to a client with diabetes. What information should the nurse include in the discussion about what causes diabetic acidosis?
Breakdown of fat stores for energy In the absence of insulin, which facilitates the transport of glucose into cells, the body breaks down proteins and fats to supply energy; ketones, a by-product of fat metabolism, accumulate, causing metabolic acidosis (pH below 7.35).
3 emergencies
DKA, HHS, hypoglycemia educate people around them so they know what to look for and who to help
What microvascular complications of the blood vessel structure can occur in the patient with diabetes mellitus? Select all that apply.
Retinopathy and nephropathy are microvascular complications that can occur with diabetes mellitus.
retinopathy nephropathy neuropathy Ed (erectile dysfunction)
Microvascular complications (little things) that go wrong with poorly controlled diabetes
Which complications of diabetes are considered chronic complications? Select all that apply.
Neuropathy Retinopathy Nephropathy Neuropathy, retinopathy, and nephropathy are all chronic complications of diabetes.
What measure should the caregiver of a patient with diabetes take to treat moderate hypoglycemia?
Provide 15 g of carbohydrate and cheese
Which is the best referral that the nurse can suggest to a patient who has been newly diagnosed with diabetes?
The American Diabetes Association can provide national and regional support and resources to patients with diabetes and their families. The Centers for Disease Control and Prevention does not focus on diabetes.
Which explanation best assists a patient in differentiating type 1 diabetes from type 2 diabetes?
Those with type 2 diabetes make insulin, but in inadequate amounts. People with type 2 diabetes make some insulin but in inadequate amounts, or they have resistance to existing insulin. Although type 1 diabetes may occur early in life, it may be caused by immune responses.
Which is a feature of metabolic syndrome?
Triglycerides 220 mg/dL One feature of metabolic syndrome is hyperlipidemia or a triglyceride level of 150 mg/dL or greater. In metabolic syndrome, the A1C level is between 5.5% and 6%. An A1C level of 5% is not consistent with metabolic syndrome. In metabolic syndrome the waist circumference for a female would be greater than 35 inches.
The nurse is caring for a patient with diabetes mellitus who is being screened for nephropathy. What laboratory test will the nurse reference as the test used to screen for early nephropathy?
Urine for albumin Early manifestations of nephropathy present with microalbuminuria, albumin in the urine. Serum creatinine, urine for ketones, and blood urea nitrogen are not used to assess for early nephropathy.
makes sugar go up upon waking down phenomenon
corticol
Which hormone is responsible for maintaining blood glucose levels during periods of fasting from food?
glucagon Glucagon is a counterregulatory hormone that prevents hypoglycemia, which can occur during periods of fasting from food by triggering the release of glucose from cell storage sites. Insulin opens locked membranes to glucose, allowing blood glucose to move into cells to generate energy
Goal: reduce the disease
healthy people 2020
occurs as a result of insufficient insulin production or secretion, excessive counterregulatory hormones secretion, or from deficient hormone signaling
hyperglycemia
Hypoglycemia is a state of low glucose levels and typically occurs as a result of insufficient nutritional intake, adverse reaction to medications, excessive exercise, and/or as a consequence of disease states. Often, hypoglycemia occurs due to a combination of these factors.
hypoglycemia Prolonged starvation and malnutrition can eventually lead to life-threatening hypoglycemia
A nurse is caring for a client who had a pancreaticoduodenectomy for cancer of the pancreas. The nurse provides education about hypoinsulinism, a long-term complication related to this type of surgery. The nurse evaluates that the teaching is understood when the client states that he will seek medical supervision if he experiences which symptom?
increased thirst / polydypsia
is produced, stored, and released by pancreatic β cells (located in pancreatic islets).
insulin
refers to a state in which the body cells respond abnormally to the signaling action of insulin; in other words, there is not a problem with insulin supply but, rather, with how the cell responds to insulin signaling due to a reduction of insulin receptors or glucose transporter molecules,1 resulting in sluggish glucose uptake by the cell.
insulin resistance
the whole health goal of diabetes ?
live well with diabetes
you can not mix any insulins with long acting (PH will go off)
long actin insulins are given in a separate site all by themselves
given once a day never in a pump and never mixed with other drugs
long acting
is an autoimmune disorder in which the body's immune system destroys the β cells in the pancreas, resulting in absolute insulin deficiency. These patients require lifelong insulin replacement therapy to maintain normal metabolism and nutrition.
type 1 diabetes mellitus Most individuals with type 1 diabetes are thin or normal weight, and although it is more common in children and adolescents, approximately 13% of all newly diagnosed type 1 diabetes occurs in people ages 30-50 years.
