Diabetes

DKA patients will have a blood pH lower than 7.3 while HHNS patients will have a normal blood pH.

What is the difference between blood pH for patients with DKA and HHNS?

DKA patients have a glucose higher than 250 while HHNS patients will have a glucose over 600.

What is the difference between glucose levels for patients with DKA and HHNS?

normalize blood glucose levels without hypoglycemia

What is the main treatment goal for diabetes patients?

sudden weight loss, N/V, abdominal pain

What manifestations are specific to type 1 diabetes? (3)

200 or more

What random glucose level is concerning when testing for diabetes?

ketosis and acidosis do not occur in HHNS, partly due to differences in insulin levels.

Why don't ketone bodies form in HHNS?

decreases glycemic response due to fiber-slowing absorption

Why is eating whole fruits rather than juices better for diabetics?

Metformin may complicate some tests and procedures.

Why might a physician want to hold metformin a day before surgery?

diabetes

a group of diseases characterized by hyperglycemia due to defects in insulin secretion, insulin action, or both.

hypoglycemia

A client newly diagnosed with diabetes arrives at the emergency room complaining of dizziness and weakness. The client's spouse reports that the client has been confused since this morning. The spouse reports that the client administered the morning dose of 10 units of regular insulin and 25 units of NPH insulin with difficulty and did not eat much breakfast. The nurse should understand the most likely cause of the client's signs and symptoms is:

increases the need for carbs and decreases the need for insulin

A client with diabetes asks how exercise will affect insulin and dietary needs. The nurse should respond, "Exercise:

Novolin R insulin

A client with type 1 diabetes is diagnosed with diabetic ketoacidosis and initially treated with intravenous (IV) fluids followed by an IV bolus of regular insulin. The nurse anticipates that the health care provider will prescribe a continuous infusion of:

ketoacidosis

A client with type 1 diabetes is transported via ambulance to the emergency department of the hospital. The client has dry, hot, flushed skin and a fruity odor to the breath and is having Kussmaul respirations. Which complication does the nurse suspect that the client is experiencing?

Dosage can be adjusted to changing needs during recovery from durgery

A client with type 2 diabetes is admitted for elective surgery. The health care provider prescribes regular insulin even though oral antidiabetics were adequate before the client's hospitalization. The nurse concludes that regular insulin is needed because the

Collaborate with the doctor to alter the insulin dose.

A client's problem with ineffective control of type 1 diabetes is pinpointed as a sudden decrease in blood glucose level followed by rebound hyperglycemia. What should the nurse do when this event occurs?

increased serum lipids

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

acetone, Kussmaul

A patient with DKA may have _____ breath and hyperventilation with ________ respirations.

Wait 20 minutes and check BG until it reaches normal, don't change orders for insulin. Call physician once patient is conscious and speaking.

After following protocol for low BG, what 3 things should the nurse do?

never hold insulin unless ordered by physician

After treating a patient for a hypoglycemic attack, should you hold their next dose of insulin?

hypoglycemia, hypoglycemia symptoms are similar to signs of being tipsy or drunk

Alcohol consumption puts the patient with DM type 1 at risk for ______ because why?

does not

Alcohol does/doesn't require insulin for absorption.

alcohol can be consumed, with its calories counted in the diet

An obese client with type 2 diabetes asks about the intake of alcohol or special "dietetic" food in the diet. The nurse teaches the client that

oral hypoglycemic medications may interact with alcohol

How might alcohol consumption affect a type 2 diabetic that takes medication?

10-15 %

How much body weight should type 2 diabetics lose to maintain or achieve positive nutrition management?

reduce amount of insulin before bed

What adjustments can be made to accommodate for the Somogyi effect?

6-6.5, 3 months

What are normal Hgb A1C levels and how far back does it check?

steroid use, DKA, HHNS, change in schedule, over-treat hypoglycemia

What are some causes of hyperglycemia? Name 3 out of 5.

elevated; both have osmotic diuresis which leads to polyuria and profound dehydration.

BUN and Cr is ______ in DKA and HHNS patients because why?

ESRD, HTN

What are some macrocirculatory problems associated with diabetes?

retinopathy, neuropathy, nephropathy

What are some microcirculatory problems associated with diabetes?

metabolic acidosis

DKA can also be known as ______ ________.

insulin, carbohydrates

DKA is caused by and inadequate amount of _______ which results in abnormal metabolism of ______, protein, and fat.

2, older

Diabetes type ___ patients are more likely to experience HHNS. They are also what age group?

1, younger

Diabetes type ___ patients are more likely to experience diabetic ketoacidosis. They are also what age group?

polyuria, polydypsia, polyphagia

What are the 'three Ps' associated with diabetes?

transports and metabolizes glucose for energy, stimulates glucose storage as glycogen, accelerates transport of protein into cells, inhibits breakdown of stored glucose/protein/ fats

What are the four functions of insulin?

HHNS

Does DKA or HHNS have a higher mortality rate?

hypoglycemia

Exercising at a peak insulin action time may lead to what?

hypoglycemic, there is an increased glucose uptake by muscles.

For the patient with Type 1 Diabetes, moderate exercise may have _____ effects because.....

give supplemental doses of regular insulin

Four hours after surgery the blood glucose level of a client who has type 1 diabetes is elevated. The nurse can expect to:

they can damage their kidneys

How do high protein diets affect diabetics?

fatigue, weakness, vision changes, poor circulation, dry skin, skin lesions, poor healing, recurrent infections, muscle wasting

How does diabetes usually manifest? (9)

disorientation, seizures, loss of consciousness

How might a severe hypoglycemic attack manifest? (3)

increases

In the Dawn Phenomenon, growth hormone is released in the morning and _____ glucose levels.

peaks, hypoglycemia, hyperglycemia

In the Somogyi effect, insulin _____ in the middle of the night which causes __________, and ________ upon awakening.

V/S, fluid status, lab values, urine output, heart/lung/renal

What assessments should be made for a patient with HHNS?

describes how much a food increases blood sugar

What does the glycemic index do?

mild hyperglycemia

Intense exercise could cause what?

126 or more

What fasting glucose level is concerning when testing for diabetes?

K+, K+

Rehydration leads to increased plasma volume and decreased _____. Insulin increases the movement of _____ from ECF into the cells.

Give 15 g of fast acting concentrated carbohydrate

What immediate treatment should be given to someone who is hypoglycemic and conscious?

DKA

Sickness and the omission of insulin can precipitate what condition?

HHNS

Sickness in a patient with type 2 diabetes can precipitate what condition?

1 mg glucagon IM or SQ, D50W 25-50 mL via IV

What immediate treatment should be given to someone who is hypoglycemic and unconscious?

Give glucagon IM or SQ.

What is protocol for low BG if the patient does not have IV access?

Give D50W

What is protocol for low BG if the patient has IV access?

Patients with DKA will have a low bicarb level while HHNS patients will remain normal.

What is the difference between bicarb levels for patients with DKA and HHNS?

lipodystrophy

The nurse identifies a 5-cm nodule on the upper arm of a client with type 1 diabetes. The client says to the nurse, "That is where I give myself insulin shots." The nurse concludes that the nodule, which is neither warm nor painful, is a result of:

confusion

The nurse is caring for a client newly diagnosed with diabetes. The nurse should teach the newly diabetic client that which hypoglycemic symptom is one of the most common?

Fingerstick before eating, know S&S of hypoglycemia, know sick day rules

The nurse is educating the client newly diagnosed with type 2 diabetes on oral antidiabetic medications. The nurse should include what in the teaching plan? Select all that apply.

wear shoes and dry between toes

The nurse is providing instructions about foot care for a client with diabetes mellitus. What should the nurse include in the instructions? Select all that apply.

steroids

The use of what drug has been known to increase blood glucose and may result in diabetes?

Type 2

This type of diabetes can be genetic or acquired through lifestyle due to obesity and lack of exercise.

Type 2

This type of diabetes is best treated through lifestyle changes, but may require oral hypoglycemics and maybe some insulin administration.

Type 1

This type of diabetes is caused by a total lack of insulin due to the destruction of beta cells.

Type 1

This type of diabetes is treated best with insulin administration.

Type 2

This type of diabetes occurs in individuals older than 40 who have insufficient insulin secretion.

Type 1

This type of diabetes responds to autoimmune processes, and its diagnosis is usually in childhood.

too much insulin, too much oral hypoglycemic agents, too little food, excessive physical activity

What 4 things might cause hypoglycemia?

IV fluids with dextrose

What IV solution should be given when the blood glucose level changes in patients with HHNS?

change insulin injection from dinnertime to bedtime

What adjustments can be made to accommodate for the Dawn phenomenon?

glycosuria

glucose excreted in urine

stress

increased _____ can increase blood sugar

Ask client to ingest one tube of glucose gel

A nurse is caring for an alert client who has diabetes and is receiving an 1800-calorie American Diabetic Association diet. The client's blood glucose level is 60 mg/dL. The healthcare provider's protocol calls for treatment of hypoglycemia with 15 g of a simple carbohydrate. The nurse should:

Shows baseline of how BG has been running the last 3-4 months

Why are Hgb A1C levels important to the diabetic patient?

urine negative for ketones and hyperglycemia

Which clinical indicator should the nurse identify as expected for a client with type 2 diabetes?

potassium

Which electrolyte is especially important to monitor in a patient with DKA?

lantus (basal insulins)

Which insulin cannot be mixed with any other insulin?

regular

Which is the only insulin that can be given intravenously?

teach the importance of foot care

While hospitalized, a client with diabetes is observed picking at calluses on the feet. The nurse should immediately:

Complications aren't present at time of diagnosis

A nurse is caring for two clients newly diagnosed with diabetes. One client has type 1 diabetes and the other client has type 2 diabetes. The nurse determines that the main difference between newly diagnosed type 1 and type 2 diabetes is that in type 1 diabetes

before, prevention of hypoglycemia

A patient with Type 1 Diabetes has a sugar level of 92 mg/dl before exercising. The patient should eat a snack _____ exercising because why?

Patients with DKA will have ketones in their urine while HHNS patients will not.

What is the difference between serum and urine ketones for patients with DKA and HHNS?

DKA has a rapid onset- less than 24 hours. HHNS happens over several days.

What is the difference between the onset of DKA and the onset of HHNS?

(100- BG) X 0.3 =

What is the formula for determining the amount of D50W to give a patient with low BG when following hospital protocol?

Rehydrate with IV fluid

What is the initial treatment to begin on a patient who comes in with DKA or HHNS?

C/O morning headaches, night sweats, nightmares, ketones in urine

What manifestations would a patient experiencing the Somogyi effect exhibit?(4)

precipitating factors and prevention, medication knowledge, sick day knowledge, dietary concerns, follow-up appointment importance

What patient education should be included for diabetics? (5)

Don't stop taking insulin with N/V, take usual dose, monitor BG levels q2-3 hours, monitor ketones, eat and drink small portions of carbs, call doctor if vomiting, elevated sugar, and ketones persist.

What teaching should be included for a patient regarding sick days?

A slice of bread

When reviewing an appropriate diet for a client with diabetes, the client expresses a dislike for sweet potatoes. What should the nurse suggest is a safe equivalent for sweet potatoes?

Patient should be taken off a drip and given SQ insulin

When the blood glucose reaches 250 for a patient with HHNS, how should the insulin be given?