N120 Test 2
Where do most diverticula occur?
colon
is GERD a disease or syndrome?
*SYNDROME *any significant symptomatic condition or histopathological alteration secondary to reflux of gastric contents into lower esoph *most common GI problem *Heartburn, dyspepsia, hypersalivation, noncardiac chest pain, regurgitation, esophagitis, Barrett's esphagus, dental erosion
What instruction should the nurse emphasize when teaching the diabetic client about how to alter diabetes management during a period of illness that includes nausea and vomiting.
"Monitor your blood glucose levels at least every 4 hours." Treatment decisions and alterations will be made on the basis of blood glucose levels and the presence of ketone bodies in the urine.
in what position should the nurse place the pt to prevent aspiration i the unconscious pt is vomiting?
*30 degrees, side lying
chronic complications of DM
*Angiopathy (damage to blood vessels secondary to chronic hyperglycemia, 65% deaths) *Macrovascular (cv, cva, pvd, disease of med-large blood vessels) *Microvascular (thickening capillaries and arterioles d/t chronic hyperglycemia-retinopathy, nephropathy, dermopathy) *Infection (impairment phagocytosis, unable to feel) *neuropathy(nerve damage due to metabolic derrange)
describe the role of nutrition in management of DM
*Carbs and mono-unsaturated fats should provide 45-65% of total-energy intake *low carb diets are NOT recommended *carbs include sugar, starch, and fiber. carbs from whole grains, fruits, vegetables, and low-fat milk should be included in meal plan *protein should contribute less than 10% of energy consumed *alcohol promotes hypertriglyceridemia. Can cause hypoglycemia in pts using insulin or oral hypoglycemic meds. DM pts should only drink with food, use sugar-free mixes,drink dry-white win. No more than 1 drink / day for women and 2 for men *ADA goal is to help diabetics make healthy nutritional choices to: -maintain blood glucose levels to near normal to prevent complications of DM -achieve lipid profiles and bp levels that reduce CVD risk -improve health through healthy food choices and physical activity -modify lifestyle as appropriate for the prevention and treatment of obesity, dyslipidemia, CVD, and nephropathy -address individual nutritional needs while taking personal and cultural preferences and respect willingness to change
what is the cause of respiratory complications of GERD?
*Cough, bronchospasm, laryngospasm, cricopharyngeal spasm *d/t irritation of upper airway by gastric secretions *potential for asthma, chronic bronchitis, pneumonia as a result of aspiration of gastric contents into respiratory system
how are HHS and DKA different?
*DKA occurs with type 1, HHS usualy occurs with type 2 *DKA occurs with with people who's circulating insulin is insufficient, HHS there is enough insulin so that ketoacidosis doesn't occur *person with DKA has polyuria, HHS there is reduction of renal perfusion so there is oliguria and possible absence of urine *DKA shows ketones in urine, HHS doesn't have ketones b/c there's still insulin so not protein or fat breakdown is necessary *HHS requires greater fluid replacement *hypoglycemia is not as significant in HHS as DKA, but fluid losses may result in potassium deficits
acute complications of DM
*Hypoglycemia(BG<70, cold clammy, rapid HR, slurred, vision change) -can result from too much insulin or excessive dose of oral agent -treat by giving pt 15-20 g simple carbs (fruit juice) -dont treat with sweet foods that also contain fats *Diabetic Ketoacidosis (diabetic coma) *Hyperosmolar hyperglycemic syndome
what type of insulin can be given IV?
*Regular (short acting) *Aspart (rapid acting) can be given via IV infusion
differentiate between regurgitation and projectile vomiting
*Regurgitation: partially digested food is slowly brought up from the stomach. Vomiting seldom precedes it *projectile vomiting: forceful expulsion of stomach contents w/o nausea, characteristic of CNS tumor
what is the relationship between an incompetent lower esophageal sphincter (LES) and GERD?
*When this sphincter doesnt work, it allows gastric juices and contents to escape from the stomach to escape into esphagus, causing irritation and inflammation. *acidity leads to esophageal erosion and bleeding/infections. *caffeine, chocolate, and alcohol make it worse *LES results in decrease in pressure in distal esophagus, as a result gastric contents move from high pressure(stomach) to low pressure(esophagus).
what is metformin?
*a biguinide glucose lowering agent *used alone or w/ sulfonylureas (which increase insulin productionin pancreas), or other OAs, or insulin to treat type 2 DM *primary action is to REDUCTION GLUCOSE PRODUCTION BY LIVER *also ENHANCES INSULIN SENSITIVITY at tissue level and IMPROVES GLUCOSE TRANSPORT *doesn't cause weight gain *used to prevent DM in prediabetic
Reglan
*antiemetic *treatment of postsurgical and diabetic stasis *mgmt of gastroesophageal reflux *therapeutic effects: -decreases N/V -decreases gastric stasis *releases acetylcholine resulting in increased gastric empyting *used for N/V r/t cancer or post-op
Vistaril
*antihistamine *AKA hydroxyzine *prevents N/V
Phenergan
*antihistamine *prevents N/V *AKA promethazine *anticholinergic effect to control N/V *can't see, can't pee, can't spit, can't ****
What are the characteristics of type 1 DM?
*autoimmune disease, body's T-cells attack and destroy pacreatic b-cells, causing inability to produce insulin *due to genetic predisposition (African/Asian decent) or exposure to virus *antibodies present months ->years before symptoms appear *accounts for 5-10% of all diabetes *islet cell antibodies often present at onset *nutritional status = thin,catabolic state *presenting symptoms are polydypsia, polyphagia, polyuria, fatigue, weight loss *ketosis prone at onset or during insulin defieciency *will require exogenous insulin
why are symptoms more acute in type 1 diabetes?
*before and manifestations occur, 80-90% of the b cells have already been destroyed. the pancreas can no longer produce insulin, so the onset is rapid and acute *ketoacidosis is usually the presenting symptoms, with the 3 p's
what is the clinical significance of melena?
*black tarry feces associated with GI hemorrhage *black d/t oxidation of iron in the Hgb as it passes thru the colon. *Gastric bleed can be significant source of blood loss, 50-75 ml from upper GI is req'd for stools to be black. *common causes: peptic ulcers, gastritis, esophagitis, diverticuli, hemorrhoids, neoplasia. *most common sites for bleeding are esophagus, stomach, duodenum
What are the characteristics of type 2 DM?
*body usually continues to produce insulin, but cells may become resistant *development associated with obesity *usually adult onset, but more children are seen with it *accounts for 90% of all diabetes *individuals with metabolic syndrome have increased risk for DM (increased insulin, increased triglycerides, LDLs, deacreased HDLs, hypertension) *ketosis resistant during infection or stress *gradual onset, may go years with hyperglycemia *symptoms, same as type 1, + recurrent infections, prolonged wound healing, visual changes
how are HHS and DKA similar?
*both occur b/c of hyperglycemia *treatment is similar, includes IV admin
what is glucophage?
*brand name of metformin
whats important to remember when mixing insulins?
*clear before cloudy *you don't want to contaminate the faster-acting insulins with the longer acting ones b/c it may interfere with subsequent use and efficacy
what is the rationale for the increasing incidence of peptic ulcer disease in pts over 60?
*d/t increased used of NSAIDS *first signs may be frank gastric bleeding (hematemesis or melena), or decrease in hematocrit *morbidity and mortality in PUD are higher in older adults because of health problems and decreased ability to withstand hypovolemia *usually treated with antisecretory agents PPI's or H2R blockers
what are 3 problems associated with N&V?
*dehydration: water and electrolyte loss *metabolic alkalosis: results from loss of gastric HCL *threat of pulmonary aspiration
Explain the glycemic index
*describe the rise in blood glucose after a person has consume a carb-containing food. *a GI of 100 refers to the response of 50 g of glucose, or a white bread in a person w/o DM *all other food is measured against this standard (apple is 52, regular milk is 27, baked potato is 93)
how does stress effect blood glucose?
*emotional and physical stress can increase blood glucose levels, resulting in hyperglycemia *sometimes extra insulin is required to maintain glycemic goals and avoid hyperglycemia
Nutrition for DM type 2
*emphasis on acheiving glucose, lipid, and bp goals *calorie and fat reduction to decrease obesity *weight loss of 5-7% of body weight improves glycemic control, even if desirable body weight is not acheived
what are the manifestations of hyperglycemia?
*gradual onset *3 P's - polyuria, polyphagia, polydipsia
Manifestations of DM type 2
*gradual onset, persona may blame symptoms on other causes (lack of sleep, age) *fatigue *recurrent infections *visual changes *3Ps
if patient has manifestations of hypoglycemia and monitoring equipment is not available, what action should the nurse take?
*hypoglycemia should be assumed and treatment initiated *15-20 g simple carbs *avoid foods with fat b/c slows absorption *avoid overtreatment to prevent hyperglycemia
how does illness effect blood glucose?
*illness may evoke a counter-regulatory hormone response resulting in hyperglycemia *when DM pts are ill, they should continue their regular meal plan while increasing intake of non-caloric fluids such as broth, water, diet gelatin and decaf beverages. *blood glucose should be checked every 4 hours *health care provider should be notified if pt cant keep down foods or fluids
How does exercise influence blood glucose?
*increases insulin receptor sites in the tissue which can lower blood glucose
How does exercise affect diabetes?
*increases insulin receptor sites in tissue, can directly lower blood glucose levels *contributes to weight loss, decreasing insulin resistance *may reduce triglyceride and LDL cholesterol levels, increase HDL, reduce BP, improve circulation *glucose lowering effects last up to 48hours *pts who use insulin, sulfonylureas or meglitinieds are at increased risk for hypoglycemia with increased physical activity *small carb snacks can be taken during meals to prevent hypoglycemia *strenuous exercise can be percieved as stress, temporarily elevating blood glucose
why does hypersecretion of insulin occur in type 2 diabetes?
*insulin isnt used properly, cells can't take up glucose, so the blood becomes hyperglycemic. *in early stages of DM2, body responds to hyperglycemia by secreting greater amounts of insulin, creating a temporary state of hyperinsulinemia that coexists with hyperglycemia
describe the pathophysiology and clinical manifestations of DM Type 2
*insulin resistance *marked decrease in ability to produce insulin *inappropriate glucose production in liver (release doesn't correspond to the body's needs, or meals) *alteration in the production of hormones and cytokines by the adipose tissue
what blood and urine tests would you expect to be altered, based on the effects of decreased insulin activity?
*ketone urine & blood levels *lood glucose(>300) *arterial blood pH(<7.3) *serum bicarbonate level (14mEq/L)
what is hyperosmolar hyperglycemic syndrome?
*life-threatening syndrome *person is able to produce enough insulin to prevent DKA, but not enought to prevent severe hyperglycemia, osmotic diuresis and extracellular fluid depletion *less common than DKA, occurs in pts over age of 60 with type 2 DM *when type 2 person eats lots of carbs, their insulin resistance increases causing hyperglycemia, leading to osmotic diuresis, leading to hypovolemia, depletion of sodium, potassium, and phosphorus *has fewer symptoms that DKA in early stages, blood glucose climb high before recognized *high blood glucose produce more severe neurological manifestations such as somnolence, coma, seizures, hemiparesis and aphasia *related to impaired thirst sensation or functional inability to replace fluids. History of inadequate fluid intake, increased depression and polyuria *lab values show blood glucose greater than 400 mg/dL, ketones are absent of minimal in blood and urine *HHS is a medical emergency *treat with IV fluids, admin insulin, admin electrolytes, assess renal status,
Nutrition for DM type 1
*meal plans based on person's usual food intake and balanced w/ insulin and exercise *insulin regimen developed with pts eating habits and activity pattern in mind *day-to-day consistency in timing and amount of food eaten is important for those using conventional, fixed insulin regimens *pts using rapid-acting insulin can make adjustments in dosage before meal based on current blood glucose level and carb content of meal *intensified insulin therapy (multiple daily injections, insulin pump) *flexibility in food selection, adjustments in deviations in food/exercise
differentiate between nausea and vomiting
*nausea: feeling of discomfort in epigastrium w/ a conscious desire to vomit (subjective) *vomiting: forceful ejection of partially digested food and secretions (emesis) from upper GI tract (objective) -Requires coordination: clossure of glottis, deep inspiration w/ contraction of diaphragm in inspiratory postition, closure of pylorus, relaxation of stomach and lower esophageal sphincter, contraction of abdominal muscles with increasing intra-abdominal pressure
what is the pathophysiology of gastritis?
*occurs as a result of breakdown in normal gastric mucosal barrier *barrier usually protects stomach tissue from autodigestion from HCL and pepsin. *pepsin and HCL diffuse back into mucosa, results in tissue edema, disruption of capillary walls w/ loss of plasma into gastric lumen, hemorrhage.
why is a person with type 1 diabetes usually thin?
*person with type 1 is thin because the body does not make insulin, so cells can't take up glucose for energy, and the body looks to other energy sources such as protein and fat
Manifestations of DM type 1
*polyuria *polyphagia *polydipsia *polyuria and polydipsia are due to the osmotic effect of glucose *polyphagia is a consequence of cellular malnourishment when insulin deficiency prevents utilization of glucose for energy
what is glucagon? what is potential adverse effects?
*produced by alpha cells in pancreas, stimulates hepatic response to convert glycogen to glucose, making glucose rapidly available *depletion of glycogen stores d/t fast acting effect (patients with low glycogen stores will not respond to glucagon - alcohol related hepatic disease, starvation, adrenal insufficiency) *hypoglycemia d/t depletion of glycogen stores and fast acting nature is potential adverse effect
what is the clinical significance of "coffee ground" emesis?
*related to gastric bleeding, blood changes to dark brown as a result of interaction with HCL. *Common causes: H. pylori, NSAIDS, stress related mucosal disease (SRMD) *occurs in pts with sustained severe trauma, burns, or major surgery *this is why surgery pts take antacids
describe the pathophysiology and clinical manifestations of DM Type I
*results from loss of beta cell function and absolute insulin deficiency *causes are genetic predisposition or exposure to virus *predispositions are thought to be related to HLAs (human leukocyte antigens), when an individual with certain HLA types is exposed to viral infections, the beta cells are destroyed either directly or through autoimmune process
Zofran
*seratonin antagonist *prevents N/V *AKA ondansetron *antagonist to specific seratonin receptors that act centrally and peripherally to prevent N/V
what are two types of hiatal hernia?
*sliding hernia (most common): stomach and esophagus are above hiatus of diaphragm, part of stomach slides thorugh hiatal opening in diaphgram into the thoracic cavity when patient is supine and goes back into the abdomen when patient stands up. *paraesophageal or rolling: esophagastric junction remains in normal position, but the fundus and greater curvature of the stomach roll up through the diaphragm, forming a pocket alongside the esophagus
what are the manifestations of hypoglycemia?
*sudden onset *weakness *diaphoresis *pallor *tremors *nervousness *feeling hungry *diplopia (seeing two images at once) *confusion *aphasia *vertigo *convulsions *hypoglycemia more dangerous than hyperglycemia
describe the effect of hyperglycemia on the osmotic pressure of the blood and the symptoms that result.
*tissues that don't require insulin for glucose transport (kidney, RBCs, blood vessels, eye lens, nerves), use an alternate pathway of glucose metabolism known as the polyal pathyway *with hyperglycemia, glucose is shunted to this pathway and is converted to sorbitol *the accumulation of sorbitol increases intracellular osmotic pressure and attracts water, leading to injuries such as: -retinopathy - swelling and visual changes in the lens of the eyes, cataracts -neuropathy - damage to Schwann cells in nerves, disrupts nerve conduction -swollen RBCs, making them stiff and intefering with perfusion *also, hyperglycemia pulls water from cells into the blood stream, increasing the pressure in the blood vessels
list factors that are linked to development of oral cancer
*tobacco use - smoking, snuff *alcohol use *long term exposure to sun (lip cancer) *irritation from jagged teeth / poor dental care
why is insulin required for people with type 1 diabetes but not necessarily for type 2?
*type 1 requires insulin from outside source (pancreas doesn't produce any), in order to sustain life *without insulin, type 1 can develop diabetic ketoacidosis *type 2 pancreas can still produce endogenous insulin, just may not be enough, or cells may not be sensitive to it so they make take other meds to make cells more sensitive or change diet
what information does hemoglocin A1C give the health professional? What is normal?
*useful in determining glycemic levels over time and monitoring success of treatment *shows amt of glucose attached to hgb molecule over RBC lifespan 90-120 days(goal <7%); *reduces risk of retinopathy, nephropathy and neuropathy *anemias may alter test results due to abnormal glucose attachment to Hgb
what foods can aggravate GERD?
-Fatty foods like hamburgers, pizza, chocolate, coffee, tea, peppermint all decrease LES pressure (Avoid acidic foods, milk before bed)
describe the nurse mgmt of a pt with newly diagnosed DM
-assess ability to manage therapy safely -understand interaction of insulin, diet, activity to recognize hypoglycemia -help them overcome needle fears -explore underlying fears (insulin last ditch effort that they must be in final stages to use insulin) -foot care emphasis -oral care -bracelet ID -travel with appropriate supplies
what is diabetic ketoacidosis?
-d/t profound deficiency of insulin, characterized by hyperglycemia, ketosis, acidosis, dehydration -ketones are acidic by-products of fat metabolism that alter pH of blood, causing acidosis -ketonuria begins when ketone bodies are excreted in urine, electrolytes are depleted as cations are eliminated with anionic ketones in attempt to maintain electrical neutrality -increased glucose also spills into the urine, taking water and solution Na and K, leading to dehydration -renal failure may occur from hypovolemic shock. this causes retention of ketones and glucose, and acidosis worsens. pt can become comatose as result of dehydration, electrolyte imbalance and acidosis. death is inevitable is untreated. -signs and symptoms: dehydration, lethargy and weakness, abdominal pain (N&V), Kussmaul respirations (compensation for metabolic acidosis, gets rid of CO2), sweet fruity odor) -lab values: blood glucose: >300mg/dL, pH: below 7.3, sreum bicarbonate: <15 mEq/L, ketones in blood and urine
what is hypoglycemic protocol?
-if <70mg/dl, begin treatment -if >70mg/dl, investigate for further cause of signs/symptoms -if no monitoring equipment, begin treatment -15-20g carbs, 4-6oz fruit juice, soda -recheck 15 minutes after tx, repeat until blood sugar is ->70mg -recheck again in 45 minutes to ensure there was no rebound hypoglycemia if there's no improvement after 2-3 doses of carb: -administer 1mg glucagon IM/subq, then have pt ingest CHO or in acute care: 20-50ml of 50% dextrose IV push
describe the nurse mgmt of a pt with dm in the
-interact w/pt, family, and team -involve a nurse educator -refer to others who need assistance with self care(poor vision, mobility) -identify support system -teach proper admin of insulin -what it means to the pt to have DM
after an acute bleeding episode, what pt teaching is indicated in order to help prevent future bleeding episodes?
-patients with ulcer, liver, and respiratory disease can result to future bleedings. -stop smoking and alcohol consumption, -avoid OTC (aspirin, NSAID), -treatment of upper gi infection (cough/sneeze can irritate varices=hemorage), -need for long term followup care -identify cause
what is Kussmaul breathing? is oxygen appropriate intervention for Kussmaul breathing? why or why not?
-rapid deep breaths, assoc with dyspnea, body's attempt to reverse metabolic acidosis via exhale CO2 -Yes, to compensate for metabolic acidosis. Ensure patient airway and administer O2 via nasal cannul/non-rebreather mask
what is fasting glucose test?
-taken after haveing o calories 8 hrs -positive =>125, 100-126= Impaired fasting glucose (IFG)
what is post-prandial glucose tolerance test?
-test 2 hrs after 75g load -positive >= 200, 140-199 = impaired glucose tolerance (IGT)
what is a random glucose test?
-test glucose levels any time of the day regardless of last meal *positive = >200mg/dl , PPP
How many clients with diverticulosis will have blood in their stool?
25%
Which patient could benefit from a trial of home care rather than admission?
A patient with a low fever and strong family support system.
Which change in clinical manifestations in a client with long-standing diabetes mellitus alerts the nurse to the possibility of renal dysfunction?
A sustained increase in blood pressure from 130/84 to 150/100 Hypertension is both a cause of renal dysfunction and a result of renal dysfunction.
Which of these are complications of diverticulitis?
Abscesses and fistulas.
The nurse teaches a patient with newly diagnosed peptic ulcer disease to:
Avoid milk and mild products because they stimulate gastric acid production
Blood that has been in the stomach for some time and has reacted with gastric secretions is:
Coffee ground emesis
A patient treated for vomiting is to begin po intake when the symptoms have subsided. To promote rehydration, the nurse plans to administer:
Cool water
Which diagnostic test would confirm peptic ulcer disease?
Esophagogastroduodeno-scopy (EGD) The EGD is an invasive diagnostic test that visualizes the esophagus and stomach to accurately diagnose an ulcer and evaluate effectiveness of treatment
The 45-year-old diabetic client has proliferative retinopathy, nephropathy, and peripheral neuropathy. What should the nurse teach this client about exercise?
Exercise is not contraindicated for this client, although modifications are necessary based on existing pathology to prevent further injury. A person with nephropathy and peripheral neuropathy should avoid jogging or any activity that increases blood pressure or jars kidneys and joints. Swimming, or, if the client does not know how to swim, dancing or doing exercises in water, provides support for joints and muscles, greatly reducing the risk for injury while increasing the uptake of glucose and promoting cardiovascular health.
Symptoms of diverticulitis can include:
Fever and pain in right upper abdomen.
A patient who has been vomiting for several days from an unknown cause is admitted to the hospital. The nurse anticipates collaborative care to include:
IV replacement of fluid and electrolytes The patient with severe or persistent vomiting requires IV replacement of fluids and electrolytes until able to tolerate oral intake to prevent serious dehydration and electrolyte imbalances Oral fluids are not given until vomiting is relieved Parenteral antiemetics often not used until cause of vomiting is determined NG may be indicated but IV is priority
What are the common characteristics of a diverticular hemorrhage?
It is usually painless and often stops by itself.
The nurse expects a patient with an ulcer of the posterior portion of the duodenum to experience:
Mid-epigastric pain that is unrelieved with antacids
NPH
Onset: 1-2 hour Peak: 6-14 hours Duration: 16-24 hours
Lantus
Onset: 1.1 hour Peak: 2-20 hours Duration: 24 hour "peakless"
Lispro (Humalog)
Onset: 15-30 min Peak: 30-90 min Duration: 3-6.5 hrs
Novolin 70/30
Onset: 30 min Peak: 1.5-12 hours Duration: 24+
Regular insulin
Onset: 30 min - 1 hr Peak: 1-5 hr Duration: 6-10 hour
Diverticulosis affects which group of patients most often?
People over 80 years old.
Which of the following does not affect the results of self-monitoring of blood glucose (SMBG)? (Select all that apply.) A. Hypotension B. Quantity of blood C. Peripheral neuropathy D. Altitude and temperature E. Anemia F. Triglyceride level G. Accuracy of BGM monitor H. Storage of test strips
Rationale: The presence of peripheral neuropathy affects sensation; it does not affect the ability of the operator to obtain a sufficient drop of blood for testing.
The nurse teaches the patient with a hiatal hernia or GERD to control symptoms by:
Sleeping with the head of the bed elevated on 4-6 inch blocks
The client on an intensified insulin regimen consistently has a fasting blood glucose between 70 and 80 mg/dL, a postprandial blood glucose level below 200 mg/dL, and a hemoglobin A1c level of 5.5%. What is the nurse's interpretation of these findings?
The client is demonstrating good control of blood glucose. The client is maintaining blood glucose levels within the defined ranges for goals in an intensified regimen (fasting blood glucose 60 to 120 mg/dL; postprandial blood glucose less than 200 mg/dL; hemoglobin A1c 4% to 6%).
During nursing assessment of the patient, which finding by the nurse is consistent with a large bowel obstruction?
abdominal distension. Abdominal distension is seen in lower intestinal obstruction. Metabolic alkalosis is common in high intestinal obstruction because of the loss of HCl acid from vomiting. Referred back pain is not a common clinical manifestation of intestinal obstruction. Bile-colored vomit is associated with higher intestinal obstruction.
Where is the most common location of a fistula caused by diverticulitis of the bowel?
bladder
The nurse explains to the patient that the most reliable diagnostic test for determining the presence and location of a pepcid ulcer is a(n):
endoscopy
What causes the major loss of circulating fluid volume in a patient diagnosed with hypovolemic shock r/t loss of circulating volume as a result of a ruptured appendix?
extracellular fluid shift into the peritoneal cavity. The inflammatory process causes the shift of fluids into the peritoneal space.
which nutritional group should the nurse teach the diabetic client with normal renal function to rigidly control to reduce complications of diabetes?
fats Diabetes causes abnormalities in fat metabolism that lead to hyperlipidemia. The high lipid levels promote atherosclerosis and many pathologic consequences of vascular insufficiency. Although fats are essential and the diet of a person with diabetes needs to contain some fat, total fats should be limited to 15% to 20% of the total daily caloric intake
Which of the following would be an appropriate collaborative problem (potential complication) for the patient hospitalized with severe vomiting and colicky abdominal pain who has an NG to suction?
potential complication: metabolic alkalosis. Metabolic alkalosis is a complication of NG suction resulting from loss of HCl from the stomach.
what is the relationship between insulin and K+?
insulin drives K+ into the cells, causing hypokalemia
The client getting ready to engage in a 30-minute, moderate-intensity exercise program performs a self-assessment. Which data indicate that exercise should be avoided at this time?
ketone bodies The presence of ketone bodies in the urine is a contraindication to exercise because it indicates that the amount of insulin available is inadequate to promote intracellular glucose transport and utilization. Exercise would lead to further elevations in blood glucose levels.
what nutritional problem should the nurse be more alert for in older adult clients with DM?
malnutrition
what is the earliest sign of nephropathy?
microalbuminuria - Rationale: Chronic high blood glucose causes hypertension in the kidney blood vessels and excess kidney perfusion. The blood vessels become leaky, especially in the glomerulus which allows filtration of larger particles (including albumin) which form deposits in the kidney tissue and blood vessels. The vessels narrow, decreasing kidney oxygenation and leading to kidney hypoxia and cell death.
who is at risk of developing type 2 diabetes?
overweight, obese, those with metabolic syndrome
when treating HHS, why is insulin withheld until fluid resuscitation is underway? what effect does this have on potassium blood level?
withholding insulin aids in avoiding hypokalemia, IV replacement allows potassium replacement
Lab findings that the nurse would expect in the patient with persistent vomiting include:
↑ pH, ↓ potassium, ↑ hematocrit The loss of gastric HCL acid cause metabolic alkalosis and an increase in pH, loss of K+, Na+ and Cl- and loss of fluid, which increases hematocrit
