1500 Exam 5 Masterlist PDF

Blue with underline: hyperlinks Pink highlight: key differences Yellow highlight: important characteristics Green highlight: Nicholson Nuggets Metabolism ---------- Diabetes Mellitus A group of metabolic diseases in which defects in insulin secretion or action result in hyperglycemia. It can c...

Blue with underline: hyperlinks Pink highlight: key differences Yellow highlight: important characteristics Green highlight: Nicholson Nuggets Metabolism ---------- Diabetes Mellitus A group of metabolic diseases in which defects in insulin secretion or action result in hyperglycemia. It can cause blindness, kidney failure, heart attack, stroke, & cognitive decline. The leading cause of limb amputation in the United States. The 3 Ps = Polyphagia (excessive hunger), Polydipsia (excessive thirst), and Polyuria (excessive urination). Blood sugar is controlled by the pancreas. Glucagon is burned when we burn through glucose. Islets of Langerhans stores glucagon (a hormone). When glucose is unable to enter body cells = hyperglycemia Type 1 Diabetes (IDDM) ---------------------- Caused by the destruction of beta cells in the islet of Langerhans of the pancreas. When beta cells are destroyed, they are unable to produce insulin. Insulin must be injected from the body to use food for energy. Dx in childhood, but onset can occur in adults. Only abt 5% of people with diabetes have type 1. The pancreas may attack itself following certain viral infections or the admin of certain drugs = autoimmune response. Type 2 Diabetes (NIDDM) ----------------------- Tissues are resistant to insulin. 95% of people with diabetes have type 2. Oral medications can help boost insulin production or decrease tissue resistance. The pancreas eventually wears out, leading to little to no insulin production, leading to the requirement of insulin injections. Gestational Diabetes (GDM) -------------------------- Occurs in up to 1 in 10 pregnancies, especially in women with risk factors for type 2 diabetes. Extra metabolic demands of pregnancy trigger the onset of diabetes. BG usually returns to normal after delivery. Usually, it starts halfway through the pregnancy to abt 20 to 24 weeks. Complications include macrosomic (high birth weight) baby Metabolic Syndrome ------------------ Conditions: +-------------+-------------+-------------+-------------+-------------+ | Condition | Characteris | Causes | NI | Management | | | tics | | | | +=============+=============+=============+=============+=============+ | Type 1 | Rapid | Destruction | Teach to | Diet, | | Diabetes | onset, | of beta | | exercise, | | (juvenile | | cells in | regularly | must have | | diabetes or | Usually | the islets | monitor | insulin to | | insulin-dep | lean, | of | blood | survive | | endent | young, thin | Langerhans | glucose to | | | diabetes | body types, | of the | keep within | | | mellitus | | pancreas | target | | | \[IDDM\]) | Complicatio | | ranges | | | | ns | | | | | | include | | Adjusting | | | | Ketoacidosi | | insulin | | | | s | | doses based | | | | = | | on carb | | | | uncontrolle | | intake, | | | | d | | physical | | | | production | | activity | | | | of ketone | | and blood | | | | bodies that | | glucose | | | | cause | | levels | | | | metabolic | | | | | | acidosis. | | Educate on | | | | Requires | | the risks | | | | immediate | | of DKA & | | | | hospitaliza | | early signs | | | | tion. | | (nausea, | | | | | | abdominal | | | | Autoimmune | | pain, | | | | disorder | | fruity | | | | | | breath) | | | | FBS \> 126 | | | | | | mg/dL | | Educate on | | | | | | insulin | | | | Kussmaul's | | types, | | | | respiration | | injection | | | | s | | techniques, | | | | (rapid | | timing and | | | | resp) | | site | | | | | | rotation to | | | | Peak | | avoid | | | | diagnosis | | lipodystrop | | | | is around | | hy | | | | 10 to 15 | | | | | | years old | | Educate | | | | | | dietary | | | | Untreated | | management: | | | | can lead to | | impact of | | | | coma or | | carbs on | | | | death | | blood | | | | | | glucose and | | | | \- Beta | | portion | | | | Cells in | | control | | | | pancreas | | | | | | aren't | | Encourage | | | | working | | regular | | | | | | physical | | | | \- | | activity to | | | | Polyuria, | | enhance | | | | Polyphagia, | | insulin | | | | Polydipsia | | sensitivity | | | | | | and assist | | | | \- blurred | | with weigh | | | | vision | | control | | | | | | | | | | -Weight | | Inspect | | | | Loss | | feet daily | | | | | | and | | | | | | encourage | | | | | | proper | | | | | | footwear to | | | | | | prevent | | | | | | injury | | +-------------+-------------+-------------+-------------+-------------+ | Type 2 | Slow onset, | Unknown | Teach to | Diet, | | Diabetes | | cause but | | exercise, | | | Usually | lifestyles, | regularly | may need | | (adult-onse | overweight | genetic, | monitor | oral | | t | or obese | and | blood | hypoglycemi | | or | | environment | glucose to | c | | non-insulin | Tissues are | al | keep within | agents or | | dependent | resistant | factors | target | insulin to | | diabetes | to insulin | lead to | ranges | control | | mellitus | | insulin | | blood | | | FBS \> 126 | resistance | Educate | glucose | | \[NIDDM\]) | mg/dL | and | dietary | levels | | | | decreased | management: | | | | Post Viral | insulin | impact of | | | | infection | production | carbs on | | | | | : | blood | | | | Almost | | glucose and | | | | exclusively | Familial Hx | portion | | | | in adults | | control | | | | | Obesity | | | | | Less prone | | Encourage | | | | to acidosis | Sedentary | regular | | | | | lifestyle | physical | | | | Decreased | | activity to | | | | number of | Unhealthy | enhance | | | | beta cells | diet | insulin | | | | | | sensitivity | | | | \- Is | Hypertensio | and assist | | | | reversable | n | with weigh | | | | with | | control | | | | lifestyle | High | | | | | management | Cholesterol | Inspect | | | | | | feet daily | | | | \- | Polycystic | and | | | | Recurrent | Ovary | encourage | | | | infections | Syndrome | proper | | | | | (PCOS) | footwear to | | | | \- | | prevent | | | | Polyuria, | Obese | injury | | | | Polydipsia, | | | | | | Polyphagia | | | | +-------------+-------------+-------------+-------------+-------------+ | Gestational | S&S: | Insulin | Individuali | Giving | | Diabetes | increased | resistance | zed | birth | | | thirst, | | care based | | | | feeling | | on the | | | | hungrier | | subtype of | | | | and eating | | gestational | | | | more than | | diabetes | | | | usual, | | | | | | increased | | Weekly or | | | | urination, | | bi-weekly | | | | fatigue, | | appointment | | | | frequent | | s | | | | infections | | | | | | of the | | Two-step | | | | bladder, | | glucose | | | | vagina, and | | tolerance | | | | skin, | | test (GTT) | | | | blurred | | | | | | vision | | Target BG: | | | | | | | | | | Complicatio | | Awakens/Bef | | | | ns: | | ore | | | | diabetic | | meals = 95 | | | | retinopathy | | mg/dl | | | | , | | | | | | pre-eclamps | | 1hr after | | | | ia | | meal = 140 | | | | & stroke, | | mg/dl | | | | preterm | | | | | | birth, | | 2hr after | | | | birth | | meal = 120 | | | | injuries, | | mg/dl | | | | stillbirth, | | | | | | C-section | | Monitor for | | | | birth, | | diabetic | | | | large-for-g | | ketoacidosi | | | | estational- | | s | | | | age | | (DKA) | | | | (LGA), | | | | | | macrosomia | | | | | | (fetal | | | | | | overgrowth) | | | | +-------------+-------------+-------------+-------------+-------------+ | Secondary | X | Damage, | X | X | | Diabetes | | injury, | | | | | | interferenc | | | | | | e | | | | | | or | | | | | | destruction | | | | | | of pancreas | | | | | | | | | | | | Cushing | | | | | | Syndrome | | | | | | | | | | | | Hyperthyroi | | | | | | dism | | | | | | | | | | | | Recurrent | | | | | | pancreatiti | | | | | | s | | | | | | | | | | | | Use of | | | | | | parenteral | | | | | | nutrition | | | +-------------+-------------+-------------+-------------+-------------+ | Hypoglycemi | Headache, | Too much | Check blood | X | | a | hunger, | insulin | glucose | | | | fight or | | | | | | flight, | Not enough | 15-20 grams | | | | shaky, cold | sugar | of fast | | | | sweat, | | acting | | | | palpations, | Exercise | carbs | | | | irritabilit | | | | | | y, | | Recheck in | | | | confusion, | | 15 mins | | | | seizures, | | | | | | coma, | | Repeat as | | | | tachycardia | | needed | | | | , | | | | | | restlessnes | | Snack if | | | | s | | longer than | | | | | | 1 hr until | | | | | | meal | | +-------------+-------------+-------------+-------------+-------------+ | Diabetic | Flu-like | High blood | 1^st^) | X | | Ketoacidosi | symptoms | glucose | bolus of IV | | | s | | | fluids | | | | Symptoms of | Most | (saline) | | | | hyperglycem | commonly | | | | | ia | type 1 | 2^nd^) | | | | | | bolus of IV | | | | Kussmaul's | Stress | insulin | | | | respiration | | drip | | | | s | Illness | | | | | | | Frequent | | | | Fruity | | glucose | | | | breath | | monitoring | | | | | | | | | | Electrolyte | | Electrolyte | | | | imbalance | | monitoring | | | | | | | | | | Dehydration | | | | | | | | | | | | Coma | | | | | | | | | | | | Death | | | | +-------------+-------------+-------------+-------------+-------------+ | Metabolic | Abdominal | Abdominal | X | X | | Syndrome | obesity & | obesity | | | | | pain | | | | | | | FBS: 150 | | | | | Polydipsia, | md/dl or | | | | | Polyuria, | higher | | | | | Polyphagia | | | | | | | High HDL in | | | | | Glycosuria | blood | | | | | | | | | | | Nocturia | BP od | | | | | | 130/85 or | | | | | Blurred | higher | | | | | vision | | | | | | | Physical | | | | | Ketosis/aci | inactivity, | | | | | dosis | aging, | | | | | | hormonal | | | | | Fatigue | imbalances, | | | | | | genetic | | | | | | predisposit | | | | | | ions | | | +-------------+-------------+-------------+-------------+-------------+ | Diabetic | Microalbumi | Increased | 24 hr | X | | Nephropathy | nuria | osmotic | creatinine | | | | (MA) | pressure | clearance | | | | advancing | from | detection | | | | to | hyperglycem | of protein | | | | proteinuria | ia, | spillage or | | | | | diuresis, | MA | | | | Hypertensio | GFR | | | | | n | | Blood | | | | accelerates | Widespread | glucose and | | | | renal | atheroscler | blood | | | | damage | osis | pressure | | | | | changes in | control | | | | Decreased | blood, | | | | | urine | decreased | Dialysis | | | | output, | blood | | | | | waste | supply to | ACE and | | | | products | kidney | ARBs may | | | | accumulates | | slow GFR | | | | | Commonly | and MA | | | | | develop | | | | | | pyelonephri | | | | | | tis | | | | | | and renal | | | | | | scarring | | | +-------------+-------------+-------------+-------------+-------------+ +-------------+-------------+-------------+-------------+-------------+ | Condition | Characteris | Causes | NI | Management | | | tics | | | | +=============+=============+=============+=============+=============+ | Diabetic | Nerve | Uncontrolle | \- Check | | | Neuropathy | damage due | d | feet every | | | | to high BG, | high blood | day | | | | injuring | sugar | (redness, | | | | nerves | | cuts, | | | | throughout | Uncontrolle | sores, | | | | the body | d | nails, skin | | | | | hypertensio | changes) | | | | Numbness or | n | | | | | reduced | | \- Wash | | | | ability to | Complicatio | feet | | | | feel pain | ns: | everyday | | | | | | (warm | | | | Changed in | -Loss of a | water, do | | | | | toe, foot, | not soak) | | | | Temperature | leg | | | | | | | \- Never go | | | | Stage 1: | \- sharp | barefoot | | | | numbness | drops in BP | (avoiding | | | | and pain | | injury) | | | | | \- | | | | | Stage 2: | hypoglycemi | \- Wear | | | | constant | a | shoes that | | | | pain | unawareness | fit well | | | | | | (not to | | | | Stage 3: | | create | | | | intense | | blisters) | | | | pain | | | | | | | | \- Trim | | | | Stage 4: | | toenails | | | | complete | | straight | | | | numbers/los | | across | | | | s | | | | | | of | | \- Do not | | | | sensation | | remove | | | | | | corns or | | | | Autonomic: | | calluses | | | | internal | | (doctor | | | | organs | | visit) | | | | | | | | | | Peripheral: | | \- See the | | | | peripheral | | podiatrist | | | | limbs | | every year | | | | | | | | | | Proximal: | | \- Keep | | | | one limb | | blood | | | | | | flowing | | | | Focal: | | (feet up | | | | individual | | when | | | | nerve | | sitting, | | | | | | wiggle | | | | | | toes) | | | | | | | | | | | | \- Choose | | | | | | feet-friend | | | | | | ly | | | | | | activities | | | | | | (walking, | | | | | | biking, | | | | | | swimming) | | +-------------+-------------+-------------+-------------+-------------+ | Glomerulosc | Scarring or | HIV | | No cure | | lerosis | hardening | infection | | | | | of the | | | Lifestyle | | | glomeruli | Obesity | | modificatio | | | | | | ns: | | | S&S: | Sickle cell | | low salt | | | swelling in | disease | | diet, | | | hands, | | | exercise, | | | feet, legs, | Birth | | and | | | abdomen, | defects | | vitamins | | | around the | | | | | | eyes, | Heroin | | ACE | | | changes in | | | inhibitors | | | urine, high | Genetic | | | | | blood | | | Steroids | | | pressure, | Diabetes | | (prednisone | | | high | | | ) | | | cholesterol | Lupus | | | | | | | | Statins | | | | | | | | | | | | Anticoagula | | | | | | nts | | | | | | | | | | | | Diuretics | +-------------+-------------+-------------+-------------+-------------+ Tests +-----------------+-----------------+-----------------+-----------------+ | Test | What is it? | Tests for what? | Nursing | | | | | Interventions | +=================+=================+=================+=================+ | 3 hour Glucose | Steps | Tests for | If the patients | | Tolerance Test | | gestational | vomits -- the | | (GTT) | 1. Fasting -- | diabetes in | test if | | | no food or | pregnant | null/void | | | drink other | patients | | | | than H2O | | If the patient | | | | | becomes | | | 2. Draw blood | | hypoglycemic -- | | | | | the test is | | | 3. Drink | | null/void | | | glucose | | | | | (OJ, cola) | | You go to a | | | | | dietitian and | | | 4. Wait 1 hour | | they teach you | | | | | about carb | | | 5. Draw blood | | counting | | | | | | | | 6. Drink | | | | | glucose | | | | | | | | | | 7. Wait 1 hour | | | | | | | | | | 8. Draw blood | | | | | | | | | | 9. Drink | | | | | glucose | | | | | | | | | | 10. Wait 1 hour | | | | | | | | | | 11. Draw blood | | | | | | | | | | 12. DONE | | | | | | | | | | - 24 to 28 | | | | | weeks of | | | | | pregnancy | | | +-----------------+-----------------+-----------------+-----------------+ +-------------+-------------+-------------+-------------+-------------+ | **Action** | **Type** | **Peak | **Length | **Nursing | | | | time** | time** | considerati | | | | | | ons** | +=============+=============+=============+=============+=============+ | **Very | Humalog, | 1. 2 hrs | 2-4 hrs | CLEAR/ | | Short | Novolog | | | admin | | Acting** | | | | before | | | Afrezza | | | meals (not | | | (inhaled) | | | more than | | | | | | 15 mins | | | | | | before | | | | | | meals) & | | | | | | monitor for | | | | | | hypoglycemi | | | | | | a | +-------------+-------------+-------------+-------------+-------------+ | **Regular | Regular ® | 2-3 hrs | 3-6 hrs | CLEAR/ | | (short | | | | admin 30 | | acting)** | Humalin R, | | | mins before | | | Novalin R | | | meals (no | | | | | | more than | | | | | | 30 mins | | | | | | before | | | | | | meals) & | | | | | | monitor for | | | | | | hypoglycemi | | | | | | a | +-------------+-------------+-------------+-------------+-------------+ | **Intermedi | NPH (N) | 4-12hrs | 12-18 hrs | CLOUDY/ | | ate** | | | | admin twice | | | Humalin N. | | | a day | | | Novalin N | | | (morning & | | | | | | evening) & | | | | | | rotate | | | | | | sites (no | | | | | | more than | | | | | | 30 mins | | | | | | before | | | | | | meal) | +-------------+-------------+-------------+-------------+-------------+ | **Long-acti | Lantus, | None | Up to 24hrs | CLEAR/ | | ng** | Levemir | (steady | | usually | | | | release) | | once a day | | | | | | (evening) & | | | | | | don't mix | | | | | | with other | | | | | | insulins | | | | | | (at same | | | | | | time each | | | | | | day usually | | | | | | at bedtime | | | | | | ) | +-------------+-------------+-------------+-------------+-------------+ | Know clear | | | | | | vs cloudy | | | | | | meds! | | | | | | (WRITE IT) | | | | | +-------------+-------------+-------------+-------------+-------------+ | | **Use / | **Side | **Dose mg / | **Nursing | | | action** | effects** | frequency** | considerati | | | | | | ons** | +-------------+-------------+-------------+-------------+-------------+ | **Metformin | Lowers | GI upset, | 500-1000 mg | +--------+ | | (glucophage | blood | lactic | | | Monito | | | )** | glucose by | acidosis | 1-2 | | r | | | | decreasing | | times/day | | kidney | | | | liver | | | | functi | | | | glucose | | | | on | | | | production | | | | (GFR) | | | | and | | | | | | | | increasing | | | | Hold | | | | insulin | | | | before | | | | sensitivity | | | | contra | | | | | | | | st | | | | | | | | studie | | | | | | | | s | | | | | | | | | | | | | | | | Take | | | | | | | | with | | | | | | | | food | | | | | | | | | | | | | | | | Monito | | | | | | | | r | | | | | | | | serum | | | | | | | | creati | | | | | | | | nine | | | | | | | | | | | | | | | | Report | | | | | | | | sympto | | | | | | | | ms | | | | | | | | of | | | | | | | | lactic | | | | | | | | acidos | | | | | | | | is | | | | | | | | (hyper | | | | | | | | ventil | | | | | | | | ation, | | | | | | | | myalgi | | | | | | | | a, | | | | | | | | malais | | | | | | | | e) | | | | | | | | | | | | | | | | Contra | | | | | | | | indica | | | | | | | | ted | | | | | | | | in | | | | | | | | renal | | | | | | | | & | | | | | | | | heart | | | | | | | | failur | | | | | | | | e | | | | | | | +--------+ | | | | | | | | | | | | -- | | | | | | -- | +-------------+-------------+-------------+-------------+-------------+ | **Diabeta | Stimulates | Hypoglycemi | 2.5-5 mg | +--------+ | | (glyburide) | the | a, | daily | | Monito | | | ** | pancreas to | weight | | | r | | | | release | gain, | | | for | | | | more | dizziness | | | hypogl | | | | insulin | | | | ycemia | | | | | | | | , | | | | | | | | especi | | | | | | | | ally | | | | | | | | in | | | | | | | | elderl | | | | | | | | y | | | | | | | | patien | | | | | | | | ts. | | | | | | | | | | | | | | | | Teach | | | | | | | | to | | | | | | | | avoid | | | | | | | | alcoho | | | | | | | | l | | | | | | | +--------+ | | | | | | | | | | | | -- | | | | | | -- | +-------------+-------------+-------------+-------------+-------------+ | **Glucotrol | Stimulates | Hypoglycemi | 2.5-20 mg | +--------+ | | (glipizide) | insulin | a, | daily | | Monito | | | ** | release | nausea, | | | r | | | | from the | weight gain | | | for | | | | pancreas | | | | hypogl | | | | | | | | ycemia | | | | | | | | , | | | | | | | | take | | | | | | | | 30 | | | | | | | | minute | | | | | | | | s | | | | | | | | before | | | | | | | | meals. | | | | | | | | | | | | | | | | Teach | | | | | | | | to | | | | | | | | avoid | | | | | | | | alcoho | | | | | | | | l | | | | | | | +--------+ | | | | | | | | | | | | -- | | | | | | -- | +-------------+-------------+-------------+-------------+-------------+ | **Ozempic | GLP-1 | GI upset, | 0.25-1mg | +--------+ | | (semaglutid | receptor | pancreatiti | weekly | | Monito | | | e)** | agonist | s, | | | r | | | | that | weight loss | | | for GI | | | | increases | | | | sympto | | | | insulin | | | | ms | | | | secretion, | | | | | | | | decreases | | | | Assess | | | | glucagon | | | | for | | | | release, | | | | signs | | | | and slows | | | | of | | | | gastric | | | | pancre | | | | emptying | | | | atitis | | | | | | | | | | | | | | | | Instru | | | | | | | | ct | | | | | | | | on | | | | | | | | weekly | | | | | | | | inject | | | | | | | | ions | | | | | | | | | | | | | | | | Educat | | | | | | | | e | | | | | | | | on | | | | | | | | proper | | | | | | | | inject | | | | | | | | ion | | | | | | | | | | | | | | | | Educat | | | | | | | | e | | | | | | | | that | | | | | | | | is | | | | | | | | slows | | | | | | | | gastri | | | | | | | | c | | | | | | | | emptyi | | | | | | | | ng | | | | | | | | so may | | | | | | | | alter | | | | | | | | absorp | | | | | | | | tion | | | | | | | | of | | | | | | | | oral | | | | | | | | meds | | | | | | | | | | | | | | | | May | | | | | | | | promot | | | | | | | | e | | | | | | | | weight | | | | | | | | loss | | | | | | | +--------+ | | | | | | | | | | | | -- | | | | | | -- | +-------------+-------------+-------------+-------------+-------------+ | **Januvia | DPP-4 | Upper | 100 mg | Monitor | | (sitaglipti | inhibitor | respiratory | daily | renal | | n)** | that | infections, | | function | | | increases | headaches | | | | | insulin | | | Assess for | | | release and | | | signs of | | | decreases | | | pancreatiti | | | glucagon | | | s | | | release | | | | | | | | | Take once | | | | | | daily | | | | | | | | | | | | Only works | | | | | | when | | | | | | glucose is | | | | | | high so it | | | | | | doesn't | | | | | | cause | | | | | | hypoglycemi | | | | | | a | | | | | | | | | | | | Assess for | | | | | | allergic | | | | | | reactions | +-------------+-------------+-------------+-------------+-------------+ **Insulin Type** **Example** **Onset** **Peak** **Duration** **When to Give** ------------------------- ----------------------------------------------------------------- ------------ ------------ -------------- -------------------------------------- Very short-acting/Rapid Insulin lispro 5--20 min 30--90 min 2- 5 hr Not more than 15 minutes before meal (Humalog) Insulin aspart 10--20 min 1--3 hr 3--5 hr (NovoLog) Insulin glulisine (Apidra) 15 min 60 min 2--4 hr Inhaled insulin (Afrezza) 15 min 30 min 2--3 hr Short-acting Insulin regular (Humulin R, Novolin R) 30 min 2--5 hr 5--8 hr Not more than 30 minutes before meal Intermediate-acting Insulin neutral protamine Hagedorn (NPH) (Humulin N, Novolin N) 1--2 hr 6--12 hr 18-26 hr Not more than 30 minutes before meal Basal/Long-acting Insulin glargine (Lantus AE) 1--2 hr No peak Up to 24 hr The same time each day Insulin detemir (Levemir) \*\*\* Extra Information / Nicholson Nuggets ------------------------------------- PPG = Post Prandial Glucose (after a meal) AC = before meals HS = at bedtime Ketosis = burns fat and makes ketones Non-diabetic A1C = below 6.5 Diabetes A1C = 6.5 or above Diabetes fasting glucose = 126 or above Diabetes GTT = 200 or above Big swings in BG cause people to feel crabby and hangry and can cause damage to other organs Exercise 150 mins per week, over 3 days a week. This is about 30 minutes per day. Sliding scale:  defined as a set of instructions for administering **insulin** dosages based on specific blood glucose readings.  Basal Bolus = Long-acting insulin Injection sights: Into fatty/adipose tissue of the arms, butt, abdomen, thigh Microalbuminuria = early signs of vascular issues. Too little albumin in the body, too much is coming out in the urine. Diabetic Fitness: F = frequency (3x to 4x per week) I = intensity (60-80% of maximal heart rate) T = time (30 mins) Hot and dry: sugar high. ------------------------ Cold and clammy: need some candy -------------------------------- Nuggets: - Difference between type 1 and type 2 diabetes - What is Gestational Diabetes? signs and symptoms? Testing? What happens to babies whose mothers have uncontrolled gestational diabetes when they come out? - What insulins are what? peak, onset, and duration times - What do glomerulosclerosis and HTN do to kidneys & what does that do to patients and how to treat it? - DKA protocols, what it looks like and how it presents / what are their lab values (metabolic acidosis, blood more acidic) Kussmaul's respirations, dehydrated - Metformin is not an insulin / it increases the sensitivity to insulin / first line of defense for type 2 - Hemoglobin A1C normal vs abnormal - Interpret sliding scale - Don't give long-acting insulin during the day, usually during nite - AC & HS - Rotating injections to increase absorption and prevent lipodystrophy - Insulin is given subq and measured in units Quiz Time!! ----------- 1\) What is the priority assessment for a newborn who is macrosomic? 2\) Which factors increase the risk of having a macrosomic baby? Select all that apply. 3\) What complication is a macrosomic newborn at high risk for? 4\) A nurse is caring for a mother and her macrosomic newborn. Which complications should the nurse monitor for in the newborn? Select all that apply. 5\) A nurse is educating a client with newly diagnosed Type 2 diabetes on lifestyle modifications. Which statement by the client indicates understanding? 6\) A nurse is preparing discharge instructions for a client with gestational diabetes. Which teaching points should be included? Select all that apply. 7\) Which of the following is the best intervention for a client with metabolic syndrome to reduce their risk of cardiovascular complications? 8\) A nurse is reviewing nursing interventions for managing Type 1 diabetes in a school-age child. Which interventions should be included? Select all that apply. 9\) In which client is metabolic syndrome most likely to be identified? 10\) The nurse is caring for a client with Type 2 diabetes. Which interventions should be included to improve glycemic control? Select all that apply. 11\) A client with gestational diabetes asks why she needs to monitor her blood sugar after giving birth. What is the nurse's best response? 12\) A nurse is educating a client newly diagnosed with metabolic syndrome. Which lifestyle changes should the nurse recommend? Select all that apply. Top of Form Bottom of Form Answers 1. B 2. A, B, D 3. A 4. A, B, C, E 5. B 6. A, C, D 7. B 8. A, B, C, E 9. B 10. A, C, E 11. A 12. A, B, D 1)The nurse is preparing to administer insulin lispro (Humalog) to a client with Type 1 diabetes. Which instruction is most appropriate for this type of insulin?\ A. \"Administer it 30 minutes before meals.\"\ B. \"It should be given at bedtime.\"\ C. \"Ensure it is given no more than 15 minutes before meals.\"\ D. \"Shake the vial thoroughly before administration.\" 2\) A nurse is teaching a client about administering NPH insulin. Which statement by the client indicates the need for further teaching?\ A. "I will rotate injection sites to avoid lipodystrophy."\ B. "I will inject the insulin at least 30 minutes before eating."\ C. "I should shake the vial before drawing up the insulin."\ D. "This insulin is cloudy, which is normal." 3\) A client receives insulin glargine (Lantus) once daily at bedtime. The nurse knows which statement is accurate regarding this medication?\ A. \"It should be administered 15 minutes before meals.\"\ B. \"It has a peak effect 4 hours after injection.\"\ C. \"It cannot be mixed with other insulins in the same syringe.\"\ D. \"It is given twice daily to maintain blood glucose control.\" 4\) A client taking metformin (Glucophage) is scheduled for a CT scan with contrast dye. Which nursing action is most appropriate?\ A. Administer metformin as scheduled.\ B. Hold the metformin on the day of the procedure and restart 48 hours later.\ C. Increase the dose of metformin before the procedure.\ D. Administer the contrast dye with food to reduce GI upset. 5\) A client is prescribed glipizide (Glucotrol) for Type 2 diabetes. Which client teaching should the nurse prioritize?\ A. \"Take this medication at bedtime.\"\ B. \"Avoid alcohol while taking this medication.\"\ C. \"You may experience weight loss as a side effect.\"\ D. \"This medication should be taken without regard to meals.\" 6\) A client taking sitagliptin (Januvia) reports severe abdominal pain and nausea. What is the nurse's priority action?\ A. Assess for signs of pancreatitis.\ B. Encourage the client to increase fluid intake.\ C. Administer an antiemetic as prescribed.\ D. Reassure the client that GI upset is expected. 7\) A nurse is caring for a client receiving rapid-acting insulin before meals and glargine insulin at bedtime. The client asks why two types of insulin are necessary. What is the nurse's best response?\ A. \"The rapid-acting insulin controls blood sugar between meals.\"\ B. \"The glargine insulin provides a steady level of insulin throughout the day and night.\"\ C. \"Using two types of insulin prevents the risk of hypoglycemia.\"\ D. \"Both insulins work together to lower your blood sugar quickly after eating.\" 8\) Which client is most at risk for lactic acidosis while taking metformin?\ A. A client with hypertension taking lisinopril.\ B. A client with renal insufficiency and a GFR of 30 mL/min.\ C. A client with a BMI of 32 on a calorie-restricted diet.\ D. A client is taking metformin with glipizide. Answers 1. C 2. C 3. C 4. B 5. B 6. A 7. B 8. B