Diabetes

A nurse is teaching a client who has diabetes mellitus about the manifestations of hypoglycemia. Which of the following statements by the client indicates an understanding of the teaching? "I will feel shaky." "I will be more thirsty than usual." "My skin will be warm and moist." "My appetite will be decreased."

"I will feel shaky" Manifestations of hypoglycemia include feeling shaky and nervous.

What is HHS?

-Happens in type 2 diabetes -present hyperglycemia w/o ketone breakdown, there is no acidosis/ketosis, because there is enough insulin present in the body to prevent the break down of fats -S/S: Very dehydrated, thirsty, hyperglycemic, mental status changes, 3 ps: Polyuria, ploydipsia, polyphagia

Alpha-glucose inhibitors

-Instruct Pt to take with first bite of meal -liver function test once a year - adverse effects: Cramps, gas, distention

What is Glucagon?

-deals with low blood sugar level -hormone that causes the live to turn glycogen into glucose -also secreted by pancreas

What are risk factors for type 2 diabetes?

-family Hx -obesity especially abd -BMI over 27 -race/ethnicity -GDM or baby over 9lbs -HTN 140/90 -Triglycerides over 200 -HDL below 35 -HX of impaired glucose tolerance

Sulfonylureas?

-ides, rides mides -avoid alchol -can cause extreme hypoglycemia 2nd gen: glypized are stronger and less effect then 1 st gen. -increase hypoglycemia, contraindicated with heart pt

Prediabetes test?

-individual at risk for TD2 -impaired glucose intolerance test (2 hrs oral glucose tolerance test): NPO 8hrs, avoid nicotine, and sternous physical activity: prediabetic 140 to 199 -impaired fasting glucose (fasting glucose level): NPO 8 hrs, 100 to 125

Diabetic diets: Cholesterol

-limit to 200 mg/day

Where is glucose stored and what is it converted to?

-mainly liver -stored as glycogen

A nurse is teaching a client who has type 1 diabetes mellitus about exercise. Which of the following instructions should the nurse include? Perform vigorous exercise when blood glucose is less than 100 mg/dL. Do not exercise if ketones are present in your urine. Avoid eating for 2 hr before exercise. Examine your feet weekly.

Do not exercise if ketones are present in your urine. The nurse should instruct the client not exercise if ketones are present in her urine because this is an indication of inadequate insulin and increases the risk for hyperglycemia.

What helps glucose enter the cell?

Insulin

What are the different types of insulin?

Ready, set, inject, Love -Ready (rapid) -Set (short)(regular) -Inject (intermediate) -Love (long)

What is the normal range for glucose in the blood?

70-100 mg/dl

A nurse is assessing a client who has diabetes insipidus. Which of the following findings should the nurse expect? Dehydration Polyphagia Hyperglycemia Bradycardia

Dehydration Diabetes insipidus causes excessive excretion of dilute urine, resulting in dehydration.

A nurse is preparing to administer lispro insulin to a client who has type 1 diabetes mellitus. Which of the following actions should the nurse take? Assess for hypoglycemia 4 hr after the insulin injection. Monitor for polyuria. Administer with short-acting insulin.

Inject the insulin 15 min before a meal. The nurse should administer lispro insulin 15 min before a meal, because lispro insulin is rapid-acting insulin that has an onset within 15 to 30 min. The client may develop hypoglycemia quickly if they do not eat.

How is the pancrease involved in DM?

Release insulin and glucagon

A nurse administers desmopressin to a client who has a diagnosis of diabetes insipidus. The nurse recognizes that which the following laboratory findings indicate a therapeutic effect of the medication? Serum sodium 146 mEq/L Blood glucose 80 mg/dL Blood urea nitrogen (BUN) 15 mg/dL

Urine specific gravity 1.015 A therapeutic effect of the medication would be urine specific gravity within the expected reference range, which is 1.010-1.025.

A nurse is teaching about disease management for a client who has type 1 diabetes mellitus. Which statement made by the client indicates an understanding of the teaching? "I am to take my blood sugar reading after meals." "Insulin allows me to eat ice cream at bedtime." "A weight reduction program will make me hypoglycemic." "I give the insulin injections in my abdominal area."

"I give the insulin injections in my abdominal area." The client should give insulin injections in one anatomic area for consistent day-to-day absorption. The abdomen is the area for fastest absorption.

A nurse is providing teaching about foot care for a client who has type 2 diabetes mellitus. Which of the following statements by the client indicates an understanding of the teaching? "I should soak my feet before trimming my nails." "I should buy new shoes late in the day." "I should wear a clean pair of nylon socks every day." "I should use a heating pad at night when my feet feel cold."

"I should buy new shoes late in the day." The client's feet are larger later in the day. Therefore, this is the best time to buy new shoes.

A nurse is teaching a client who has type 1 diabetes mellitus about foot care. Which of the following statements by the client indicates an understanding of the teaching? "I'll wear sandals in warm weather." "I'll put lotion between my toes after drying my feet." "I'll soak my feet in cool water every night before I go to bed."

"I'll check my feet every day for sores and bruises." The client should check his feet daily to monitor for any problems and observe any other changes before they become serious. He can use a hand mirror to examine areas that are difficult for him to see.

A nurse is teaching an older adult client who has diabetes mellitus about preventing the long-term complications of retinopathy and nephropathy. Which of the following instructions should the nurse include? "Have an eye examination once per year." "Examine your feet carefully every day." "Wear compression stockings daily." "Maintain stable blood glucose levels."

"Maintain stable blood glucose levels." Keeping blood glucose under control is the client's best protection against long-term complications of diabetes, since increased blood sugar contributes to neuropathic disease, and microvascular complications such as retinopathy and nephropathy, as well as to macrovascular complications.

a pt screened for DM at a clinic has a fasting glucose level of 120. which statement by the nurse is best?

"you are at increased risk for diabetes" prediabetes. >126 is considered diabetic

Diabetic diets: Proteins?

-15-20 -meats, chicken, turkey, fish, plant based beans, peas, low fat cheese, egg whites -not high protein diets especially with renal patients

Diabetic diets: Fiber

-25-30g/day -limit refined grains and sugars

What are the S/S of Hyperglycemia?

-3 P's *polyphagia *Polydipsia *Polyuria -type 1 see all ps -type 2 see polydipsia, polyuria

Diabetic diets: Fats

-<7% of total calories -Limited saturated, trans, cholesterol -give mono and polyunsaturated, avocados, olives, peanuts, nuts, fish

Diabetic diets: carbs

-ADA, American Diabetic Association -Carbs: 45-60%, 130g/day -grains, veggies, starches, potatoes, sweets, cookies, soada, dried beans, milk, legumes

What kind of excersice would you recommend for a diabetic patients?

-Aerobic, helps the body use insulin -ex. cardio running, walking, swimming

What do you want to make sure you do and teach a diabetic patient to do before they exercise?

-always check BG before exercise , if lower then 100 eat a small carb snack, and carry a simple carb with you while excercising Simple carb: hard candy, honey, crackers/grahm, fruits juice -If work out if long check BG before, during, and after -If BG is higher then 250 with ketones present in urine prior to exercise don't proceed and wait until glucose and ketones stabilize

What medication cause hypoglycemia?

-beta blockers: mask symptoms of it -Etoh, ASA, Sulfonylureas , and MAO inhibitors , Bactrium

What is insulin?

-deals with high blood glucose -hormone that helps regulate the amount of glucose in the blood -help insulin enter the cell -secreted by the BETA cells

A nurse is providing teaching to a client who has a diabetes mellitus about carbohydrate intake needs when exercising. Which of the following foods should the nurse include as containing a 15 g serving of carbohydrates?

1 cup milk The nurse should instruct the client that 1 cup of milk contains 15 g of carbohydrates.

Step approach to treatment of type 2 diabetes?

1. diet and exercise 3-6 months 2. lifestyel change pluse metformin 3. lifestyle change, metformin, second drug 4. lifestyle changes, metformine, and insulin therapy

what is the 15 in 15 rule?

15 complex carbs initially when BG is low

A nurse is reviewing the laboratory results of a client who is at risk for developing diabetes mellitus. The nurse should recognize that which of the following results indicates the client meets the criteria for diagnosis of diabetes mellitus? HbA1c 5.5% 2 hr blood glucose 170 mg/dL Fasting blood glucose 155 mg/dL Casual blood glucose 180 mg/dL

Fasting blood glucose 155 mg/dL A fasting blood glucose above 126 mg/dL meets the criteria for a diagnosis of diabetes mellitus.

A nurse is assessing a client who has type 1 diabetes mellitus and finds the client lying in bed, sweating, and reporting feeling anxious. Which of the following complications should the nurse suspect? Hypoglycemia Nephropathy Hyperglycemia Ketoacidosis

Hypoglycemia Manifestations of hypoglycemia include sweating, tachycardia, tremors, palpitations, hunger, and anxiety.

A nurse is providing teaching to a client who has a new diagnosis of type 2 diabetes mellitus. The nurse should recognize that the client understands the teaching when he identifies which of the following as manifestations of hypoglycemia? (Select all that apply.) Polyuria Blurred vision Polydipsia Tachycardia Moist, clammy skin

Polyuria is incorrect. Manifestations of hyperglycemia include polyuria (excessive urination). Blurred vision is correct. Manifestations of hypoglycemia include blurred vision. Polydipsia is incorrect. Manifestations of hyperglycemia include polydipsia (excessive thirst). Tachycardia is correct. Manifestations of hypoglycemia include tachycardia. Moist, clammy skin is correct. Manifestations of hypoglycemia include moist, clammy skin.

A nurse is caring for an adolescent client who has a long history of diabetes mellitus and is being admitted to the emergency department confused, flushed, and with an acetone odor on the breath. Diabetic ketoacidosis is suspected. The nurse should anticipate using which of the following types of insulin to treat this client? NPH insulin Insulin glargine Insulin detemir Regular insulin

Regular insulin Regular insulin is classified as a short-acting insulin. It can be given intravenously with an onset of action of less than 30 min. This is the insulin that is most appropriate in emergency situations of severe hyperglycemia or diabetic ketoacidosis.

a patient with diabetes calls the clinis with complaints of N/V/D. it is more important that the nurse advise the patient to... withhold insulin drink fluids with high glucose content check BG levels every 2-4 hours use less strenuous form of exercise that usual

check BG every 2-4 hours

what do you not want to happen with DKA?

do not want it to drop more than 100mg/dl per hour

the nurse plans a class for pts who have newly diagnosed T2DM which goal is most appropriate

enable the patient to become active participants in the management of their own disease the patient needs to take ownership

a nurse is caring for a pt with T1DM who has DKA. the nurse would expect which lab result

hyperglycemia, high serum osmorality

somogyi effect

it is a rebounding high blood sugar that is a response to low blood sugar. check BG between 2 and 4 am because that is when pt will bottom out

A nurse is teaching a client who is taking metformin XR for type II diabetes mellitus. Which of the following instructions should the nurse include in the teaching? "Take the medication with a meal." "You may crush or chew the medication." "This medication may cause an increase in perspiration." "This medication may turn your urine orange."

"Take the medication with a meal." The client should take metformin with a meal to avoid hypoglycemia and GI upset, and to provide the most absorption of the medication.

A client who has Type 2 diabetes mellitus asks the nurse, "Why did I develop diabetes?" Which of the following responses should the nurse make? "Your body is destroying the cells that secrete insulin." "Your body has insulin resistance and decreased insulin secretion." "An infection in your pancreas destroyed the cells that make insulin." "Your kidneys are not able to reabsorb water which leads to Type 2 diabetes mellitus."

"Your body has insulin resistance and decreased insulin secretion." A client genetically susceptible can develop Type 2 diabetes mellitus when obesity and physical inactivity lead to insulin resistance at cells as well as decreased secretion of insulin by pancreatic beta-cells.

What is T1DM?

-Beta cells dont work, have been destroyed, body doesn't release -Tx: must use insulin -Risk Factors: Genetic, autoimmune (virus), -Pt look young, thin -Happens suddenly within 6 months -ketones will be present in the urine, due to fat metabolization, acetone smelling breath

What is T2DM

-Cell don't respond to insulin, causing insulin resistance -Tx: diet and excersice, 2nd resort oral medications, may need insulin during stress, surgery, or infection -Risk factors: Life style, obesity, sedentary, poor diet, stress, genetics, gestational diabetes, baby over 9lbs -Pt look overweight, adult aged -Happens overtime, rare to have ketones

What are the S/S of Hypoglycemia?

-Im sweaty, cold, and clammy, give me some candy -sweaty -clammy -confusion -Light headedness -double vision -tremors

Short- acting Insulin

-regular -Humiln R, novlin R -Onset: 30 mins- 1 hr -Peak: 2-5 hrs -Clear -may be used IV

For diabetics how do you manage risk factors?

-teach them to have a healthy life style -watch their weight -regular exercise q other day for 30 mins -balanced diet

What medication cause hyperglycemia?

-thiazide diuretics -clucocoricoids -estrogen therapy -insulin

A nurse is caring for a client with diabetes mellitus who is prescribed regular insulin via a sliding scale. After administering the correct dose at 0715, the nurse should ensure the client receives breakfast at which of the following times? 0720 0730 0815

0745 Regular insulin should be given 20 to 30 minutes before eating because the onset of action is 30 minutes. There are circumstances when this lag time guide can be adjusted.

what BG level will the patient begin to see ketones in their urine and will start showing signs of ketoacidosis??

>240

A nurse is caring for a client who has uncontrolled type 1 diabetes mellitus. Which of the following findings should the nurse expect? Hypertension Hematuria Weight loss Bradycardia

Weight loss- is an expected finding for a client who has uncontrolled diabetes.

A nurse is teaching a client who has a new diagnosis of Type 1 diabetes mellitus about self-administration of insulin. Which of the following instructions should the nurse include? "Pull back on the plunger after injecting the insulin." "Massage the injection site after removing the needle." "Store the current bottle of insulin at room temperature." "Use each syringe up to six times."

"Store the current bottle of insulin at room temperature." The nurse should instruct the client to keep the bottle of insulin she is currently using at room temperature to minimize painful injections. The client should refrigerate unused bottles of insulin to protect the quality of the medication.

What are complication of DM?

-Hypoglycemia: less than 60 mg/dl -organ problems: atherosclerotic make vessels hard from glucose, cause poor circulation, eye troubles, infection -DKA: type 1, body burns fat for energy since it cant get to -HHS

Thiazolidinedione

-glitazone -decrease insulin resistance -watch liver function and heart function increase risk of MIs -adverse effects: URI, HA, cyanitis, myalgia, fluid retention -caution with mild and severe HF pt

Biguanides?

-metformine: first line drug for prediabetics -adverse effect: decrease app, N/D, Lactic acidosis (S/S weakness, fatigue) -contradicted: for renal/liver patients, no alcohol (increase lacticacidosis) -stop med 48 Hrs Post/pre procedure (heart cath): contrast medium iodine, drink water to flush

A nurse is caring for a client with type 1 diabetes mellitus who reports feeling shaky and having palpitations. When the nurse finds the client's blood glucose to be 48 mg/dL on the glucometer, he should give the client which of the following? Graham crackers 1 tsp sugar 4 oz diet soda 4 oz skim milk

Graham crackers After establishing that the client has hypoglycemia, the nurse should give the client about 15 g of a rapid-acting, concentrated carbohydrate, such as 4 oz of fruit juice, 8 oz of skim milk, 3 tsp of sugar or honey, 3 graham crackers, or commercially prepared glucose tablets. The nurse should recheck the client's blood glucose level in 15 minutes.

A nurse is caring for a client who has type 1 diabetes mellitus. The nurse misread the client's morning blood glucose level as 210 mg/dL instead of 120 mg/dL and administered the insulin dose appropriate for a reading over 200 mg/dL before the client's breakfast. Which of the following actions is the nurse's priority? Give the client 15 to 20 g of carbohydrate. Monitor the client for hypoglycemia. Complete an incident report. Notify the nurse manager.

Monitor the client for hypoglycemia The first action the nurse should take using the nursing process is to assess or collect data from the client. The nurse should immediately check the client's blood glucose level, expecting it to be low because of the excessive dose of insulin. If it is within the expected reference range, the nurse should continue to monitor the client for signs of hypoglycemia.

What is DKA?

-Happens in type 1 diabetes -no insulin, so body starts to burn fats for energy since it cant get to the glucose -due to this ketones, which are acids, start to enter into the body and this causes life threatening situation, such as acid/base imbalance -S/S: N/V, excessive thirst, hyperglycemia, Kussmals breathing(fast/ deep)

Intermediate acting Insulin

-Nph -Humlin N, Novlin N -Onset: 1.5-4hrs -Peak 4-12 hrs -cloudy insulin

Hyperglycemia assessment?

-Polyuria -Polydipsia -Polyphagia *Remeber SUGAR -S: Slow wound healing -U: blUrry vision -G: Glycosuria -A: Acetone smell of breath -R: Rashes on ski Dry and itch, repeated vaginal infections

Oral medications?

-Sulfoylureas -Meglitinides -Biguanides -Alpha-glucoside inhibitors -Thiazolinedione

What happens in DM?

-The body is unable to use glucose due to either the absence of insling or the bodys resistance to use insulin. -the patient becomes hypoglycemic (glucose hangs in blood can cause organ damage) -The body starts to metabolize fats for energy (type 1) -Or carbs cannot be used (T2DM)

A nurse observes mild hand tremors in a client who has diabetes mellitus. Which of the following actions should the nurse take after obtaining a glucose meter reading of 60 mg/dL? Administer 15 g of carbohydrates. Retest the blood glucose level. Administer 1 mg of glucagon IM. Administer IV dextrose.

Administer 15 g of carbohydrates. The first step in preventing the client's blood glucose level from dropping further is to administer 15 to 20 g of carbohydrates. A client who is awake and can swallow can consume carbohydrates, such as glucose tablets or glucose gel, 120 mL (4 oz) of orange juice, 240 mL (8 oz) of skim milk, 6 saltine crackers, 3 graham crackers, or 6 to 10 hard candies.

A nurse is teaching about self-monitoring to a client who has type 1 diabetes mellitus. Which of the following statements by the client indicates an understanding of the teaching? "I will check my urine once a day for ketones." "I will notify my provider if pre-meal glucose is 120 mg/dL." "I will check my blood glucose every 4 hours when I am sick." "I will check blood glucose every 5 minutes when lightheaded."

"I will check my blood glucose every 4 hours when I am sick." The client should follow specific guidelines when sick. The nurse should instruct the client to monitor blood glucose every 3 to 4 hr and continue to take insulin or oral antidiabetic agents. The client should consume 4 oz of sugar-free, noncaffeinated liquid every 30 min to prevent dehydration and eet carbohydrate needs through soft food if possible. If not, the client should consume liquids equal to usual carbohydrate content. The nurse should also instruct the client to test urine for ketones and report to provider if they are abnormal (the level should be negative to small).

How is the liver involved in DM?

-Turns glycogen into glucose when the pancreas secretes glucagon

Rapid Acting insulin

-fastest -onset: 10-30 min -peak 30-3 hrs -Lipro, aspart, glulisine -Clear

Long acting Insulin

-glargine, detemir -onset: 0.8-4 hrs -no peak -can not be mixed with anything else

Medlitinides

-glinide -instruct patient to take 30mins before meal -cause hypoglycemia in pt with impaired liver

A nurse working for a home health agency is teaching a client who has diabetes mellitus about disease management. Which of the following glycosylated hemoglobin (HbA1c) values should the nurse include in the teaching as an indicator that the client is appropriately controlling his glucose levels? 6.3% 10% 8.5% 7.8%

6.3% The client who has diabetes mellitus needs to manage activity and diet while monitoring blood glucose levels. High levels of blood glucose cause damage to the macro and microcirculation, affecting such things as eyesight and kidney function. The goal for a client who has diabetes mellitus is to keep the HbA1c values at 6.5% or less.

A nurse is preparing a teaching session about reducing the risk of complications of diabetes mellitus. Which of the following information should the nurse plan to include in the teaching? (Select all that apply.) Reduce cholesterol and saturated fat intake. Increase physical activity and daily exercise. Enroll in a smoking-cessation program. Sustain hyperglycemia to reduce deterioration of nerve cells. Maintain optimal blood pressure to prevent kidney damage.

Reduce cholesterol and saturated fat intake is correct. Diabetes mellitus is associated with cardiovascular disease (CVD). Most clients die from a myocardial infarction or heart failure. Clients who have diabetes often have additional risk factors for cardiovascular disease, such as obesity, hypertension, dyslipidemia, and a sedentary lifestyle. The American Diabetes Association recommends that low-density lipoprotein (LDL) remain below 100 mg/dL. Diets high in saturated fat raise total cholesterol and LDL levels, which increase the risk for coronary artery disease. Increase physical activity and daily exercise is correct. If the client is overweight, weight loss is indicated. Weight loss and increased physical activity are recommended to improve the lipid profile and to decrease the risk for heart disease. Renal tissue perfusion will be enhanced with exercise as well. Enroll in a smoking-cessation program is correct. Cigarette smoking can cause vasoconstriction of vessels. Clients who have diabetes have increased risk for coronary artery disease. Vasoconstriction causes further narrowing of vessels and increases blood pressure. Vasoconstriction increases risk for myocardial infarction and stroke. Maintain optimal blood pressure to prevent kidney damage is correct. Nephropathy is a pathologic change in the kidney that reduces kidney function and leads to kidney failure. Diabetes is the leading cause of end-stage kidney disease. Risk factors for nephropathy include a 10 to 15 year history of diabetes mellitus, poor glucose control, and uncontrolled hypertension. Both systolic and diastolic hypertension speed the progression of diabetic nephropathy.