diabetes nurse 2
The nurse expects that a type 1 diabetic patient may receive what percentage of his or her usual morning dose of insulin preoperatively?
50% to 60% One half to two thirds of the patient's usual morning dose of insulin (either intermediate-acting insulin alone or both short- and intermediate-acting insulins) is administered subcutaneously in the morning before surgery. The remainder is then administered after surgery.
A diabetes nurse educator is presenting the American Diabetes Association (ADA) recommendations for levels of caloric intake. What do the ADA's recommendations include?
50% to 60% of calories from carbohydrates, 20% to 30% from fat, and the remaining 10% to 20% from protein
A patient is taking chlorpropamide. The nurse warns the patient about the possibility of hypoglycemia within approximately which time frame after taking the drug?
peaks 3-4 hours so thats the time frame for hypoglycemia
DM1 are at high risk for
post activity delayed onset hypoglycemia takes up to 48 hours to replenish glycogen stores so exercise with caution BG >300 NO KETONES OR BG >250 WITH KETONES
Insulins waning
progresive rise in BG from bed time to moring
Biguanides
stop liver from making sugar when its not needed take metformin with meals
Exenatide is administered by
subcutaneous injection within 60 minutes before morning and evening meals
Oral hypoglycemic classes
-Sulfonylureas -Biguanides -Alpha Glucosidase INhibitors -Thiazolidinediones -Meglitinides
Alpha-glucosidase inhibitors work by
Alpha-glucosidase inhibitors work by delaying digestion of carbohydrates.
the nurse is providing discharge instructions to a client who has just been diagnosed with type 1 diabetes. What instructions are most important for the client to follow related to diet? (Select all that apply.)
Avoid drinking beer, wine, or liquor. Use artificial sweeteners instead of sugar in tea and coffee. Read food labels carefully to look for hidden sources of sugar.
A client is receiving glipizide as treatment for his type 2 diabetes. The nurse understands that this drug acts by:
Binding to potassium channels on pancreatic beta cells Glipizide is a second-generation sulfonylurea that binds to potassium channels on the pancreatic beta cells to improve insulin binding to insulin receptors and increase the number of insulin receptors.
A nurse is assigned to care for a patient who is suspected of having type 2 diabetes. Select all the clinical manifestations that the nurse knows could be consistent with this diagnosi
Blurred or deteriorating vision Fatigue and irritability Polyuria and polydipsia Wounds that heal slowly or respond poorly to treatment
Sulfonylureas
Chlorpropamide Glyburide Glimepiride Glipizide Stimulate insulin release from pancreas. Causes weight gain so dont give to obese patients or allergies to sulfa drugs. Given with cuation to sulfa drugs
The nurse is administering an antidiabetic agent by subcutaneous injection within 60 minutes of the client's breakfast. Which agent would the nurse most likely be administering?
Exenatide
Long acting insulin
Glargine Lantus Detemir Levemir Peakless Duration 24 hours not to be mixed with other insulin used as basal insulin NEVER MIXED WITH OTHER INSULINS******
Exercise lowers blood glucose levels. Which of the following are the physiologic reasons that explain this statement. Select all that apply.
Increases lean muscle mass Increases resting metabolic rate as muscle size increases Decreases total cholesterol Increases glucose uptake by body muscles
A nurse must recognize the duration of insulin as to not cause harm to the client with administration of the improper type of insulin. Which insulins are long-acting insulin? (Select all that apply.)
Insulin glargine (Lantus) Insulin detemir (Levemir)
A client with a diagnosis of diabetes is prescribed pramlintide. How will this drug assist in controlling the client's blood sugar?
It slows gastric emptying. Pramlintide slows gastric emptying, helping to regulate the postprandial rise in blood sugar. Pramlintide does not block the absorption of food. Pramlintide is not absorbed by insulin nor does it increase the release of insulin.
Rapid acting insulin
Lispro (Humalog) Aspart (Novolog) Glulisine (Apidra) Clear, Colorless, given within 15 mins of meal time. Onset 5-15 mins, peak 30-90 mins, duration 5 hours
intermediate insulin
NPH Humalin N, Novolin N, NPH insulin Onset 2 hours Peaks at 6-8 hours Duration 12-16 hours Used as a basal insulin
Which of the following factors should the nurse take into consideration when planning meals and selecting the type and dosage of insulin or oral hypoglycemic agent for an elderly patient with diabetes mellitus?
Patient's eating and sleeping habits
The nurse walks into the room of a client with type 1 diabetes and finds the client pale and diaphoretic. The client reports a headache and being hungry. Immediately, the client is unable to talk. What is the nurse's immediate intervention for this client?
Place glucose gel between the gums and cheek.
Pramlintide is administered by
Pramlintide is administered by subcutaneous injection BEFORE MAJOR MEALS
Exercise benefits
Promotes weight loss Lower BP improves CV status Lower risk for depression and CA Lowers BG levels
Short acting insulin
Regular (Humulin R, Novolin R) Only one given IV Route ************************ 0.5-1 hour onset 2-4 hours peak 4-6 duration should have their meal within 30 minutes. make sure meal has been ordered prior to preparing. if given at 0730am it will be seen between 930-1130. Assess for hypoglycemia
Which of the following would lead a nurse to suspect that a client is experiencing hypoglycemia?
Slow, bounding pulse A client with hypoglycemia typically exhibits a normal or slow bounding pulse, pale moist skin, normal to rapid shallow respirations, and absent thirst.
A client has type 1 diabetes. Her husband finds her unconscious at home and administers glucagon, 0.5 mg subcutaneously. She awakens in 5 minutes. Why should her husband offer her a complex carbohydrate snack as soon as possible?
To restore liver glycogen and prevent secondary hypoglycemia
Humulin and Novolin
onset 0.5 peak 2-12 duration 24 hours
A client with newly diagnosed type 2 diabetes is admitted to the metabolic unit. The primary goal for this admission is education. Which goal should the nurse incorporate into her teaching plan?
Weight reduction through diet and exercise
The nurse is providing care for several clients who have diabetes. Which client should the nurse monitor most closely for signs and symptoms of hypoglycemia?
a client who received 12 units of Humulin R 45 minutes ago
patho of DM2
abnormla secretion of insulin in response to increase BG postprandial hyperglycemia in intestines IMpaired hepatic conversion of glucose to glycogen; increaesd gluconeogensis impaired glucose uptake in muscle and fat pancreas doesnt make enough insulin
Rosiglitazone would be
administered as a single oral dose. Thiazolidinediones decrease insulin resistance
impaired ________ conversion of glucose to glycogen; increased glucoenogesis
hepatic
______ doesnt make enough insulin
pancreas
lipodystrophy
due to frequent use of same injection site.
Lactiac acidosis
fatigue, weakness, dizziness, brady, muscle pain, discomofrt
A patient with diabetic ketoacidosis (DKA) has had a large volume of fluid infused for rehydration. What potential complication from rehydration should the nurse monitor for?
hypokalemia Because a patient's serum potassium level may drop quickly as a result of rehydration and insulin treatment, potassium replacement must begin once potassium levels drop to normal in the patient with DKA.
Meglitinides stimulate
insulin release and / or reduce the production of glucose by the liver
Miglitol
is given with the first bite of each meal. l inhibit alpha-glucosidase, thereby delaying the absorption of glucose.
Repaglinide
is used orally before meals.
impaired glucose reuptake in
muscles and fat
the Somogyi effect is
the Somogyi effect is nocturnal hypoglycemia followed by rebound hyperglycemia in the morning.
what kind of exercises for DM?
walking and low impact aerobics are recommended drink 8oz every 30 mins of exercise
A nurse is teaching a client about insulin infusion pump use. What intervention should the nurse include to prevent infection at the injection site?
Change the needle every 3 days.
DM1 exercise? DM2 exercise?
4-7 days per week minimum 3 times a week or eery other day
A client has gained 55 lb in the last 3 years and is concerned about developing type 2 diabetes mellitus. Additionally, the client's healthcare provider has diagnosed metabolic syndrome. What are the conditions contributing to the development of metabolic syndrome? Select all that apply
Abdominal obesity Elevated blood glucose levels Hypertension Metabolic syndrome includes obesity, especially in the abdominal area; hypertension; elevated triglyceride, low-density lipoprotein (LDL), and blood glucose levels; and a low high-density lipoprotein (HDL) level.
alpha glucosidase inhibitors
Acarbose Miglitol starch blockers. Bind to the enzymes in small intestine and inhibit the break down. delys absorption of sugars into blood from gut and prevents sudden surges of glucose
A nurse expects to note an elevated serum glucose level in a client with hyperosmolar hyperglycemic nonketotic syndrome (HHNS). Which other laboratory finding should the nurse anticipate?
Below-normal serum potassium level A client with HHNS has an overall body deficit of potassium resulting from diuresis, which occurs secondary to the hyperosmolar, hyperglycemic state caused by the relative insulin deficiency. An elevated serum acetone level and serum ketone bodies are characteristic of diabetic ketoacidosis. Metabolic acidosis, not serum alkalosis, may occur in HHNS.
The nurse is educating a client who is beginning therapy with acarbose and tells the client to take the medication with the first bite of each main meal to help prevent what adverse effect?
Bloating and diarrhea
The nurse is reviewing the initial laboratory test results of a client diagnosed with DKA. Which of the following would the nurse expect to find? Blood glucose level of 250 mg/dL Blood pH of 6.9 Serum bicarbonate of 19 mEq/L PaCO2 of 40 mm Hg
Blood pH of 6.9 With DKA, blood glucose levels are elevated to 300 to 1000 mg/dL or more. Urine contains glucose and ketones. The blood pH ranges from 6.8 to 7.3. The serum bicarbonate level is decreased to levels from 0 to 15 mEq/L. The compensatory breathing pattern can lower the partial pressure of carbon dioxide in arterial blood (PaCO2) to levels of 10 to 30 mm Hg.
signs of hypoglycemia
Blurred or double vision (diplopia), fatigue, trembling, irritability, headache, nausea, numbness, muscle weakness, hunger, tachycardia, sweating, and nervousness are signs of a hypoglycemic reaction
A nurse is caring for a 48-year-old woman who has been hospitalized after injecting the wrong type of insulin. Which sign of hypoglycemia will the nurse be careful to observe for?
Blurred vision
The nurse practitioner worked with a registered dietitian to customize a 1,800-calorie diabetic diet for a 53-year-old man with special dietary needs. Which of the following percent distribution of calories should be provided?
Carbohydrates 50%,-60 fat 25%-30 and protein 20% 10-20
A client with diabetic ketoacidosis was admitted to the intensive care unit 4 hours ago and has these laboratory results: blood glucose level 450 mg/dl, serum potassium level 2.5 mEq/L, serum sodium level 140 mEq/L, and urine specific gravity 1.025. The client has two IV lines in place with normal saline solution infusing through both. Over the past 4 hours, his total urine output has been 50 ml. Which physician order should the nurse question? Infuse 500 ml of normal saline solution over 1 hour. Hold insulin infusion for 30 minutes. Add 40 mEq potassium chloride to an infusion of half normal saline solution and infuse at a rate of 10 mEq/hour. Change the second IV solution to dextrose 5% in water.
Change the second IV solution to dextrose 5% in water. The nurse should question the physician's order to change the second IV solution to dextrose 5% in water. The client should receive normal saline solution through the second IV site until his blood glucose level reaches 250 mg/dl. The client should receive a fluid bolus of 500 ml of normal saline solution. The client's urine output is low and his specific gravity is high, which reveals dehydration. The nurse should expect to hold the insulin infusion for 30 minutes until the potassium replacement has been initiated. Insulin administration causes potassium to enter the cells, which further lowers the serum potassium level. Further lowering the serum potassium level places the client at risk for life-threatening cardiac arrhythmias.
DKA s/s
D-ehydration K-etones in the urine and blood, Kussmaul Resp and K+ A-cidosis, Acetone breath, Anorexia d/t nausea With DKA, blood glucose levels are elevated to 300 to 1000 mg/dL or more. Urine contains glucose and ketones. The blood pH ranges from 6.8 to 7.3. The serum bicarbonate level is decreased to levels from 0 to 15 mEq/L. The compensatory breathing pattern can lower the partial pressure of carbon dioxide in arterial blood (PaCO2) to levels of 10 to 30 mm Hg.
Which age-related change may affect diabetes and its management?
Decreased renal function It takes longer for oral hypoglycemics agent sto be excreted by kidneys and changes in insulin clearance occur with decreased renal function. Aslo would be HTN, decreased bowel motility and decreased thirst
Which is the primary dietary consideration for a client receiving insulin isophane suspension (NPH) at breakfast?
Encourage midday snack. Because NPH is an intermediate-acting insulin that peaks in approximately 4 to 12 hours, a midday snack should be included in daily calorie intake to avoid hypoglycemia. NPH insulin has no immediate effects. Carbohydrates are distributed throughout the meal plan of diabetics to avoid highs and lows. Delaying dinner meal is not indicated with NPH insulin use.
At risk for hypoglycemia what do you eat for exercise? if planning a longer exercise?
Fast acting glucose tabs or hard candy should be PB snacks Monitor before, during, and after exercise
A patient presents to the clinic complaining of symptoms that suggest diabetes. What criteria would support checking blood levels for the diagnosis of diabetes?
Fasting plasma glucose greater than or equal to 126 mg/dL OR plasma glucose greater or equal to 200mg/dL
After teaching a group of students about sulfonylureas, the instructor determines that the teaching was successful when the students identify which agent as a second-generation sulfonylurea? (Select all that apply.)
Glimepiride Glyburide Glimepiride is a second generation sulfonylurea. Glyburide is a second generation sulfonylurea. Tolazamide is a first generation sulfonylurea. Pramlintide is a human amylin agent. Repaglinide is a meglitinide agent.
During ongoing assessment of clients receiving insulin detemir (Levemir), the nurse assesses the client for symptoms of hypoglycemia that include which symptoms? (Select all that apply.)
Headache Confusion Diaphoresis
A type 2 diabetic is ordered metformin (Glucophage) as part of the management regime. Which is the best nursing explanation for the action of this drug in controlling glucose levels?
Helps tissues use insulin more efficiently Glucophage improves the use of insulin in type 2 diabetes.
A client is admitted with diabetic ketoacidosis (DKA). Which order from the physician should the nurse implement first?
Infuse 0.9% normal saline solution 1 L/hr for 2 hours. DKA have elevated acetone level and ketone bodies In addition to treating hyperglycemia, management of DKA is aimed at correcting dehydration, electrolyte loss, and acidosis before correcting the hyperglycemia with insulin. In dehydrated clients, rehydration is important for maintaining tissue perfusion. Initially, 0.9% sodium chloride (normal saline) solution is administered at a rapid rate, usually 0.5 to 1 L/hr for 2 to 3 hours.
A patient is prescribed Glucophage, an oral antidiabetic agent classified as a biguanide. The nurse knows that a primary action of this drug is its ability to:
Inhibit the production of glucose by the liver.
A client is receiving acarbose. What would the nurse incorporate into the teaching plan for this client about the action of the drug?
Inhibits an enzyme to delay glucose absorption
A client with type 1 diabetes is admitted to an acute care facility with diabetic ketoacidosis. To correct this acute diabetic emergency, which measure should the health care team take first?
Initiate fluid replacement therapy.
Thiazolidinediones
Insulin sensitizeres Rosigitazone AVandia
abnormal secretions of insulin in response to increase BG postprandial hyperglycemia
Intestinal
The nurse admitted a 4-year-old child with type 1 diabetes mellitus. The nurse educates the parents that hypoglycemia can occur as an adverse effect of insulin. The nurse helps the parents to understand that in young children, hypoglycemia may manifest as what signs or symptoms? (Select all that apply.)ll that apply.) Irritability Anorexia Impaired mental functioning Hallucinations Lethargy
Irritability Impaired mental functioning Lethargy
A hospitalized, insulin-dependent patient with diabetes has been experiencing morning hyperglycemia. The patient will be awakened once or twice during the night to test blood glucose levels. The health care provider suspects that the cause is related to the Somogyi effect. Which of the following indicators support this diagnosis? Select all that apply.
Normal bedtime blood glucose Increase in blood glucose from 3:00 AM until breakfast Decrease in blood sugar to a hypoglycemic level between 2:00 to 3:00 AM the Somogyi effect is nocturnal hypoglycemia followed by rebound hyperglycemia in the morning.
MEglitinides
Repaglinide Nateglinide
Which produce their glucose lowering effect by decreasing insulin resistance and increasing insulin sensitivity? (Select all that apply.) Rosiglitazone (Avandia) Metformin (Glucophage) Pioglitazone (Actos) Miglitol (Glyset) Acarbose (Precose)
Rosiglitazone (Avandia) Pioglitazone (Actos)
what drug is given caution with sulfa allergy
Sulfonylurea
After taking glipizide (Glucotrol) for 9 months, a client experiences secondary failure. What should the nurse expect the physician to do?
Switch the client to a different oral antidiabetic agent.
Ketones
amount of insulin available in the cells is inadequate for glucose transport
A client with a 30-year history of type 2 diabetes is having an annual physical and blood work. Which test result would the physician be most concerned with when monitoring the client's treatment compliance?
glycosylated hemoglobin
Dawn phenomenon
normal levels until around 3am then they rise
Somogyi phenomenon
normal to elevated BG at bedtime that decrease around 0300 to hypoglycemic levels
