Diabetes and Nutrition Nursing 1 Lone Star North Harris

Tolerable Upper Intake Level (UL)

the maximum daily amount of a nutrient that appears safe for most healthy people and beyond which there is an increased risk of adverse health effects

Perfusion

the passage of fluid through the circulatory system or lymphatic system to an organ or a tissue, usually referring to the delivery of blood to a capillary bed in tissue

Anthropometry

the scientific study of the measurements and proportions of the human body.

Hyperviscosity;relationship with polyuria, ketonuria, and polydipsia

thick, concentrated blood;BP increases and as well as HR too much glucose and ketone bodies in the blood along with the blood cells. Cells have water in them and water moves from lower concentration to higher concentration. Now we have water in the bloodstream. Blood is filtered through the kidneys-water gets dumped (polyuria) this leads to polydipsia because the brain is telling the body to increase water intake, along with ketones (ketonuria)

nasointestinal (NI) tube

tube inserted through the nose and into the upper portion of the small intestine

Nasogastric tube (NG tube)

tube inserted through the nose into the stomach

Triglycerides

perdominant form of fat in food and major storage form of fat in the body <150 mg/dL

-prandial

pertaining to a meal. Post prandial is after a meal.

true dawn phenomenon

shows relatively normal blood glucose level until about 3 AM when the levels begin to rise.

nutrient

specific biochemical substance used by the body for growth, development, activity, reproduction, lactation, health maintenance, and recovery from illness or injury

peripheral parenteral nutrition (PPN)

prescribed for patients who require nutrient supplementation through a peripheral vein because they have an inadequate intake of oral feedings

glycosuria

presence of glucose in the urine; by itself, this is not a diagnostics of diabetes

Absorption

process by which drugs are transferred from the site of entry into the body to the bloodstream

Where is the best location to give insulin injection?

Abdomen

hypovolemia

Decreased blood volume capable of causing hypotension, tachycardia, and decreased urine output. This is caused by dehydration

what should every assessment for nutrition begin with?

Dietary History

Exercise guidelines for diabetic fitness/Benefits

F-frequency regular (3x - 4x per wk) I-Intensity 60-80% of heartrate T-Time Aerobic Activity (20-30 min) w/5-10 min warmup Makes muscles more sensitive to insulin Glucose is used at much faster rate

Insulin waning

progressive rise in blood glucose from bedtime to morning. Treated by increasing the nocturnal insulin dose. AKA-Rebound Hypoglycemia

Recommended Dietary Allowance (RDA)

recommendations for average daily amounts of essential nutrients that healthy population groups should consume over time

Nutrition

study of the nutrients and how they are handled by the body, as well as the impact of human behavior and environment on the process of nourishment

Anorexia

the loss of appetite for food

Normal processing of sugar when sleeping

Glucose is stored in the liver as Glycogen-pancreas releases glucagon which goes to the liver and turns the glycogen back into glucose and it is released into the bloodstream-pancreas releases insulin in response to glucose in the bloodstream and glucose is carried to the cells

neuropothy

Nerve dysfunction

Hypoglycemia S/S

reduced cognition, tremors, diaphoresis, weakness, hunger, headache, irritability, seizure, double vision, cool clammy skin Rapid onset Excess insulin or too little glucose

Short acting insulin: Regular (Humulin R, Novolin R)

only insulin that can be given via IV Always clear

Biguanides Nursing Considerations

- Side effects: GI adverse effects - Risk for lactic acidosis, avoid alcohol, hold 2 days before and after IV contrast - Less risk for hypoglycemia

Sulfonylureas Nursing Considerations

- Side effects: hypoglycemia, GI disturbances, rash - Cross sensitivity with sulfa drugs and thiazide drugs - Possible disulfiram like response with alcohol - Hepatotoxicity

Diabetes Type 1

-Rapid Onset -No insulin is produced. Either born with it or developed at a young age. -Destruction of the beta cells that are located in the islets of langerhans in the pancreas and produce insulin. -Either immune mediated-results from an autoimmune disease or Idiopathic or viral infection -Patients are non-obese -Signs and Symptoms: Polyuria, Polydipsia, Polyphagia, weight loss, fatigue, increased frequency of infections

Effects of peripheral neuropathy due to DM

-development of diabetic ulcer -Inadequate vascular supply-main cause of poor healing -Damages foot muscles, caused foot deformitites -Reduced tissue integrity -Skin breakdown -Infection -May result in amputation of toes, foot, and leg -Decreased sensation

A client with a PEG tube is NPO and refusing the prescribed tube feeding. She states, "I didn't realize I wasn't ever going to eat again. I can't live like this." Which is the appropriate nursing action? Select all that apply 1) Notify the primary physician 2) Collaborate with the dietitian 3) Consult the chaplain 4) Institute a 24-hour calorie count 5) Explain the purpose of tube feeding

1) Notify the primary physician 2) Collaborate with the dietitian 3) Consult the chaplain 5) Explain the purpose of tube feeding

Which may be included as aspiration precautions? 1) Raise the head of the bed to 90 degrees 2)Provide only clear, thin liquids to drink 3) Instruct the client to take large sips of liquid 4) Encourage private, unassisted feeding

1) Raise the head of the bed to 90 degrees

A client has a low hemoglobin level, which is attributed to nutritional deficiency, and the nurse provides dietary teaching. Which food choices by the client indicate that the nurse's instructions are effective? Select all that apply. 1) Raisins. 2) Margarine. 3) Spinach. 4) Whole milk. 5) Green tea.

1) Raisins. 3) Spinach.

Foot care for diabetics

1. inspect feet daily 2. wash feet daily, dry btwn toes 3. use lotion, but don't get in btwn toes 4. foot powder for sweaty feet 5. don't clip nails if you can 6. avoid open-toe, open-heeled shoes 7. avoid prolonged sitting/standing/crossing of legs 8. don't go barefoot -No shaving calluses -Do not use alcohol, iodine, etc on any skin breaks -Once a year podiatrist visit (ADA) -Inspection of feet by physician at every visit (ADA) -In hospital, daily inspection and documentation of feet by nurse -Assessment of level of knowledge re foot care by nurse

Magnesium lab value (M+)

1.5-2.5

Long acting insulin-5,7/Determier Onset, Peak, Duration

onset: 1 hr peak 6-8 hr duration up to 24 hrs

Long acting insulin-lantus/ultralente Onset, Peak, Duration

onset: 1-2 hr peak none duration up to 24 hrs

Sodium lab value (Na+)

135-145

The nurse is conducting a nutrition class for a group of clients with congestive heart failure (CHF). It would be most important for the nurse to explain the importance of which action? 1) Restricting fluid intake. 2) Choosing fresh vegetables instead of canned ones. 3) Eating a low caloric diet to reduce weight. 4) Recognizing which products are high in cholesterol.

2) Choosing fresh vegetables instead of canned ones.

What is dysphagia? 1) Difficulty speaking 2) Difficulty swallowing 3) Inability to swallow liquids 4) Inability to understand

2) Difficulty swallowing

The mother of a 2-year-old reports her son is a "picky eater" and is concerned because he is so small. The client has remained at the 35th percentile for both height and weight over the past year. Which is an appropriate nursing response? 1)"Since he is so small in size, try offering Pediasure once per day." 2)"It sounds like you're concerned, but your son's growth has been stable." 3)"The growth of toddlers usually slows down from about age 2 to 3." 4)"Have you considered keeping him on whole milk--instead of skim milk?"

2)"It sounds like you're concerned, but your son's growth has been stable."

The nurse is teaching a class about nutrition to a group of adolescents. Taking into consideration the prevalence of overweight teenagers, what is the best recommendation the nurse can make? 1) Join a gym. 2) Drink fewer diet sodas. 3) Decrease fast food intake. 4) Take a multivitamin daily.

3) Decrease fast food intake.

The nurse is offering suggestions to a client wanting to lose weight. Which is an appropriate recommendation? 1) Shop for groceries when you are hungry 2) Eat while reading a book because it will distract you 3) Remember to learn and use appropriate portion sizes 4) Always eat only half of what is on your plate

3) Remember to learn and use appropriate portion sizes

The nurse is planning to teach the client about the health risks of being overweight. Which of the following is NOT associated with being overweight? 1) Hypertension 2) Heart disease 3) Type I diabetes 4) Gallbladder disease

3) Type I diabetes

Potassium lab value (K+)

3.5-5

What is the best time for DM patient to exercise

30-60 mins after meals

1 lb of body fat = ___ calories

3500

The nurse understands that research demonstrates that malnutrition occurs in as many as 50% of hospitalized clients. The nurse should assess a postoperative client with anorexia for what sign of malnutrition? 1) Dependent edema. 2) Spoon-shaped nails. 3) Loose, decayed teeth. 4) Delayed wound healing.

4) Delayed wound healing.

What piece of equipment is most important for the nurse to include when preparing for the administration of total parenteral nutrition (TPN)? 1) A blood pressure dinemap machine. 2) Padded hemostat taped to headboard of the bed. 3) Infusion set that delivers 60 gtts/mL. 4) Infusion pump.

4) Infusion pump.

Discharge teaching for a client with hypercholesterolemia includes nutritional instructions for a diet low in saturated fat. Which items included by the client on a list of foods to avoid supports the nurse's conclusion that teaching has been effective? 1) High-fiber foods. 2) Canned vegetables. 3) Citrus fruits. 4) Whole milk and hard cheeses.

4) Whole milk and hard cheeses.

Intermediate acting insulin: NPH/Lente onset, peak, duration

onset: 1-4 hr peak 6-12 hr duration 10-18 hrs

HgbA1C

6.5 or 140 mg/dL

BG Normal levels

60-120

Calcium lab value (Ca+)

8.5-10.5

BG levels for hypogycemai

< 60 < 50 severe

BG levels for hyperglycemia

> 140 > 180 severe

2 hr glucose tolerance test

> 200 mg/dL

Random or casual plasma glucose

> 200 mg/dL at least twice

fasting blood sugar (FBS)

> or = to 126 mg/dL on 2 occassions

Intermediate acting insulin 70/30 onset, peak, duration

onset: 30 min peak 4-8 hr duration up to 24 hrs

Hemoconcentration

A condition in which the concentration of blood cells is increased in proportion to the plasma. This is caused by dehydration.

Glucagon

A hormone secreted by the pancreatic alpha cells that increases blood glucose concentration. Counterregulatory hormone actions opposite of insulin.

Dietary Reference Intakes (DRIs)

A set of four reference values for the intake of nutrients and food components that can be used for planning and assessing the diets of healthy people in the United States and Canada.

Which items may be given to a client on a full liquid diet? A)Tomato Soup B)Pudding C)Jell-o D)Milk E)Scrambled Eggs

A)Tomato Soup B)Pudding C)Jell-o D)Milk

How far away from umbilical region due you inject insulin?

At least 2 inches

Diabetic Ketoacidosis (DKA)

BG levels >300 Too many ketones from breakdown of fats. Can be fatal Sudden Onset Symptoms:Ketosis= Kussmaul respirations, fruity breath, nausea, abdominal pain. Poyuria, polydipsia, weight loss, dry skin, sunken eyes,soft eyeballs, lethargy, coma due to dehydration or electrolyte loss. Causes: Infection, other stressors, inadequate insulin dose

Hyperglycemic Hyperosmolar State (HHS)

BG levels >600 No Ketones found Caused by insulin deficiency and dehydration Can be Fatal Gradual Onset Symptoms: Altered CNS function with neurologic symptoms. Polyuria, Polydipsia, weight loss, dry skin, sunken eyes, soft eyeballs, lethargy, coma due to dehydration or electrolyte loss. Causes: Infection, other stressors, poor fluid intake

total calories a day calculation

BMR Calculation weight of male x 11 weight of female x 10 Then calculate calories according to activity level 20% Sedentary 30% Light Activity 40% Moderate Activity 50% High Activity For total Calories a day multiply BMR by % associated with activity level

Adequate Intake (AI)

Based on estimates of nutrient intake by healthy individuals.

Glycemic

Blood glucose

Digestion

Breakdown of food substances into simpler forms that can be absorbed and used

What is the purpose of a calorie count? A)Teach client how to follow a prescribed diet B)Examine clients ability to adhere to a diet C)Accurately assess client intake D)Document Clients increase in intake

C)Accurately assess client intake

Metabolism

Chemical reactions involved in maintaining the living state of the cells and organisms

diabetes mellitus (DM)

Chronic endocrine disorder of impaired glucose regulation that affects the function of all cells and tissues. Three types Type 1 Type 2 Gestational

Ketones

Converted from fatty acid breakdown, caused by insulin deficiency

Which food is high in protein? A)Apple B)Cream Soup C)Milk D)Tuna

D)Tuna

Sulfonylureas MOA

Decrease BG levels by triggering the release of preformed insulin from beta cells; increase insulin secretion

Normal processing of Sugar

Grapes-digested-small intestine absorbs glucose-glucose goes into blood stream-pancreas releases insulin in response to glucose in blood stream-glucose in carried to cells for energy

What are the most common biochemical tests for assessing nutritional status?

Hemoglobin RBC indices Serum albumin Prealbumin

insuln

Hormone produced by the beta cells that are located in the islets of Langerhans in the pancreas. Allows transfer of glucose into cells, thereby reducing BG levels. "Key" that opens cell membranes to glucose Keeps blood lipid levels in normal range (promotes triglyceride storage) Prevents inappropriate release of glycogen from liver

hypoperfusion (shock)

Inability of the body to adequately circulate blood to the body's cells to supply them with oxygen and nutrients. Caused by dehydration

megablastic anemia

Inhibition of DNA synthesis during RBC production

What is sliding scale insulin

It provides a dose of insulin based on the patients glucose level and should only be used temporarily. It is given in addition to basal (what the patient already receives) -Long-acting insulin (glargine/detemir or NPH), once or twice a day with short acting insulin (aspart, glulisine, lispro, Regular) before meals and at bedtime -Long-acting insulin (glargine/detemir or NPH), given once a day -Regular and NPH, given twice a day Pre-mixed, -short-acting insulin analogs or Regular and NPH, given twice a day

Insulin MOA

Key to glucose absorption, causes cells in the liver, skeletal muscles and fat tissues to absorb glucose from the blood.

Hypoglycemia

Low blood glucose level <74 mg/dl

Hypoxia

Low oxygen saturation of the body, not enough oxygen in the blood

Hypoxia

Low oxygen saturation of the body, not enough oxygen in the blood. This is caused by dehydration

Biguanides (Metformin) MOA

Lowers BG levels by inhibiting liver glucose production, decreased intestinal absorption of glucose, and increased insulin sensitivity

Types of Biguanides

Metformin

Rapid acting insulin: Lispro (Humalog) Aspart (Novolog)

Must be given with food

Short-Acting Onset, Peak, Duration

Onset: 30-60 minutes Peak: 2-4 hours Duration: 6-10 hours

Rapid Acting: Onset? Peak? Duration?

Onset: 5 - 15 min Peak: 1 - 2 hrs Duration: 4 - 6 hrs

Carbohydrates

Organic compounds (commonly known as sugars and starches) that are composed of carbon, hydrogen, and oxygen; the most abundant and least expensive source of calories in the diet worldwide.

anorexia nervosa

Personality disorder manifested by extreme fear of becoming obese and an aversion to eating, usually occuring in young women and often resulting in life-threatening weight loss, accompanied by a disturbance in body image, hyperactivity, and amenorrhea. Bradycardia;hypotension <85% of expected weight BMI 17.5 Can be fatal

Hyperglycemia S/S

Polyuria, polydipsia, polyphagia,dehydration, fatigue, fruity odor or breath, kussmaul breathing, weight loss, poor wound healing Absence of Insulin or Insulin Resistance Hot and Dry=Sugar High

Reccommended Dietary Allowance (RDA)

Sufficient to meet the nutrient requirement of nearly all healthy individuals for a specific age and gender group.

Insulin Patient Teaching

Switch sites when doing injections, timing with eating is important (depends on type of insulin and if BG is in targe range or not), teach S/S of hypo/hyperglycemia and how to monitor, insulin storage, diet and exercise, do not share equipment, document BG levels before administering insulin.

TIRED(acronym for Hypoglycemia S/S)

Tachycardia Irritability Restless Excessive Hunger Diaphoresis/Depression

Estimated Average Requirement (EAR)

The estimated average daily dietary intake level that meets the nutritional requirements of half the healthy people of a particular age range and gender.

Gluconeogenesis

The formation of glucose from noncarbohydrate sources, such as amino acids.

Anthropometrics

The measurement of the size, proportions, and range of motion of the human body.

Glucose regulation

The process of maintaining optimal blood glucose levels

gastrostomy

opening created into the stomach

Diabetes Type 2

Usually arises out of insulin resistance in which the body fails to use insulin properly combined with relative insulin deficiency. Sedentary lifstyle Average Age 50 Fatigue Decreased Energy Obese 60-80% Recurrent Infections Polyuria Polydipsia 20-30% require insulin HX of high BP

Anemia

a decrease in the oxygen-carrying ability of the blood (RBC's or erythrocytes) insufficient hemoglobin.

acetone breath

a distinctive fruity odor on the breath of a person with ketosis

percutaneous endoscopic gastrostomy (PEG) tube

a feeding tube placed through the abdominal wall into the stomach surgically or laparoscopically

Body Mass Index (BMI)

a measure of body weight relative to height body weight x 703/height ht in inches squared Underweight * <18.5 Normal * 18.5-24.9 Overweight * 25.0-29.9 Obesity, class 1 * 30.0-34.9 Obesity, class 2 * 35.0-39.9 Extreme Obesity * 40.0+

waist circumference

a numerical measurement of the waist, used to assess an individual's abdominal fat and establish ideal body weight

Which physiologic actions result from normal insulin secretion? a) Increased liver storage of glucose as glycogen b) Increased gluconeogenesis c) Increased cellular uptake of blood glucose d) Increased breakdown of lipids (fat) for fuel e) Increased production and release of epinephrine f) Decreased storage of free fatty acids in fat cells g)Decreased blood glucose levels h) Decreased cholesterol levels

a) Increased liver storage of glucose as glycogen b) Increased gluconeogenesis g)Decreased blood glucose levels h) Decreased cholesterol levels

Vitamins

organic substances needed by the body in small amounts to help regulate body processes; are susceptible to oxidation and destruction

enteral nutrition

alternate form of feeding that involves passing a tube into the gastrointestinal tract to allow instillation of the appropriate formula

basal metabolic rate (BMR)

amount of energy/calories required to carry out involuntary activities of the body at rest. Weight of male x 11 Weight of female x 10

Ketosis

an abnormal accumulation of ketone bodies that is frequently associated with acidosis

iron deficiency anemia

anemia resulting when there is not enough iron to build hemoglobin for red blood cells

HS

at bedtime

trans fat

partially hydrogenated liquid oil; trans fat raises serum cholesterol

AC

before meals

fasting blood sugar (FBS)

blood test to measure amount of sugar in bloodstream after a 12-hour fast

Which precaution is MOST important for the nurse to teach a client who has cardiovascular autonomic neuropathy (CAN) from diabetes? a) avoid drinking ice-cold beverages b) be sure to check your BP twice daily c) Change positions slowly when moving from sitting to standing d) check your hands and feet weekly for areas of numbness or sensation change.

c) Change positions slowly when moving from sitting to standing

Hypovolemia

decreased blood volume

S/S of peripheral neuropathy

decreased sensation, impaired sensation (numbness, tingling, intense pain), impaired GI motility, bladder dysfunction, impotence in males.

Hypokalemia

deficient level of potassium in the blood <3.5

dysphagia

difficulty in swallowing or inability to swallow

retinopathy

disease of the retina; eye dysfunction; microvascular

peripheral neuropathy

disorder of the peripheral nerves that carry information to and from the brain and spinal cord

Somogyi effect

early-morning hyperglycemia that occurs as a result of nighttime hypoglycemic episodes. Treatment is decreasing the nocturnal insulin.

hyperlipidemia

excessive amounts of lipids in the blood;common side effect of DM

polyphagia

excessive hunger due to cells receiving no glucose, cell starvation triggers this hunger

polydipsia

excessive thirst due to polyuria and electorolytes excreted in the urine and severe water loss. The dehydration results in polydipsia

polyuria

excessive urination Results from an osmotic diuresis caused by excess glucose in the urine

Where is glucose level tested

extracellular/intravascular (bloodstream)

aplastic anemia

failure of blood cell production in the bone marrow

Cholesterol

fat-like substance found only in animal tissues; it is important for cell membrane structure, a precursor of steroid hormones, and a constituent of bile; high serum cholesterol levels are a risk factor in the development of atherosclerosis

gastric residual

feeding remaining in the stomach

Types of sulfonylureas

glipizide (Glucotrol) glimepiride (Amaryl)

Fasting

going without food for a period of time

Lipid

group name for fatty substances, including fats, oils, waxes, and related compounds HDL >40 mg/dL LDL <100 mg/dL

sickle cell anemia

hereditary disorder of abnormal hemoglobin producing sickle-shaped erythrocytes and hemolysis. Most common in African Americans

Hypertension

high blood pressure

Hyperglycemia

high blood sugar >106mg/dL

Hyperkalemia

high levels of potassium in the blood >5

When should DM patient not exercise

if BG > 250 mg/dL and ketones in urine

Minerals

inorganic compounds needed in relatively small amounts for regulation, growth, and maintenance of body tissues and functions

Calorie

measure of heat, or energy; kilocalorie, commonly referred to as a calorie, defined as the amount of heat required to raise 1 kg of water 1°C

aspiration

misdirection of oropharyngeal secretions or gastric contents into the larynx and lower respiratory tract

euglycemia

normal level of sugar in the blood 60-120 mg/dL

NPO, npo

nothing by mouth

parenteral nutrition

nourishment provided via IV therapy

total parenteral nutrition (TPN)

nutritional therapy that bypasses the gastrointestinal tract for patients who are unable to take food orally; meets the patient's nutritional needs with a highly concentrated, hypertonic nutrient solution administered intravenously through a central vein

Kussmaul respirations

very deep, labored breathing (usually associated with diabetic acidosis and renal failure) attempt to "blow off" carbon dioxide and acid. Acetone is exhaled giving breath a rotten fruity odor. Cause: Increased acid levels in the blood trigger brain to increase rate and depth of respiration

Protein

vital component of every living cell; composed of carbon, hydrogen, oxygen, and nitrogen

Obesity

weight greater than 20% above ideal body weight or BMI of 30 or more. More common in black women, white men, lower socioeconomic status, and less educated