NUR 170
EXAM 3 STUDY GUIDE
Concepts Of Medical–Surgical Nursing
Galen College of Nursing
, lOMoARcPSD|51648332
NUR 170 Exam 3
DIABETES
Insulin: a key that allows glucose into cells
Glucose: the brain needs a constant supply of glucose because it cannot store it (stroke-like
symptoms if no glucose)
Glucagon – raises BS.
Diabetes
Type 1: absolute absence of insulin. Always needs insulin. Occurs in younger than 30.
Cause: autoimmune destruction of beta cells in the pancreas.
Type 2: adult onset
Indications for testing/Risk factors:
Obese, Native American, African American, Hispanic, Pacific Islander.
Female pt with gestational diabetes or had birth to +9ibs baby.
Bp > 140/90
HDL < 35 mg/dL and/or triglyceride >250 mg/dL
A1C > 5.7% or fasting BS > 100
Hx of vascular disease
Veterans exposed to agent orange.
Patho: deficit in insulin secretion or action
Management:
Appropriate diet and exercise and lifestyle changes in combo w/ meds.
Initial Tx: Metformin
S/S of hyperglycemia: Polyuria, Polydipsia, Polyphagia, and weight loss.
Blurred vision
Paresthesia
Yeast infections (balanitis in men)
Severe hyperglycemia:
Elevated serum ketones:
Hypovolemia
Acidosis
Kussmaul Respirations: deep, labored, rapid breathing (tachypnea)
Fruity breath
Electrolyte imbalances: dilutional hyponatremia and hyperkalemia
Assessment:
Weight and weight changes
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, lOMoARcPSD|51648332
Family hx – strongest r/f for type 1
Frequent infections (fungal, UTI, pneumonia)
Delayed healing (poor LE blood flow) – fat sticks in blood vessels
Peripheral neuropathy, gastropathy
3 Ps
Age/Race: type 2 is higher in non-whites and ages> 40
Physical Exam:
Acanthosis Nigricans: darkening of skin folds in the back of the neck, armpits, and groin.
Yeast infection (breasts, groin, skin flaps)
Type 1: may present w/ DKA. – no insulin to (-) ketones
Type 2: obesity and hypertension, may present w/ HHS (rare): extremely high BS w/ no
ketones and dehydration.
Diagnosing:
Blood tests:
o Fasting BG >126
o Random BG > 200
o A1C > = 6.5%
o 75 gm, 2-hour glucose tolerance test w/ plasma glucose >200
Glucometer: steps for BG monitoring (at home)
Wash hands (no alcohol wipes)
Don’t have to wipe the first drop.
Drug Tx:
Metformin: Type 2 monotherapy
Decreases glucose in the liver. Does not cause hypoglycemia.
SE: weight loss, GI distress/diarrhea – SE decrease over time
CONTRAINDICATION: Can cause lactic acidosis in pt with kidney impairment and not be
used in pt with kidney disease.
o Creatinine > 1.5 men, >1.4 women
o GFR < 46
o HIGH creatinine and LOW GFR – AVOID
Contrast study (CTs, Cardiac cath): stop 24 hours before OR time of, hold for 48 hours
after, and restart when renal functions show normal.
Sulfonylureas: stimulate insulin release from Beta cells
Downloaded by Benjamin Luca ()
EXAM 3 STUDY GUIDE
Concepts Of Medical–Surgical Nursing
Galen College of Nursing
, lOMoARcPSD|51648332
NUR 170 Exam 3
DIABETES
Insulin: a key that allows glucose into cells
Glucose: the brain needs a constant supply of glucose because it cannot store it (stroke-like
symptoms if no glucose)
Glucagon – raises BS.
Diabetes
Type 1: absolute absence of insulin. Always needs insulin. Occurs in younger than 30.
Cause: autoimmune destruction of beta cells in the pancreas.
Type 2: adult onset
Indications for testing/Risk factors:
Obese, Native American, African American, Hispanic, Pacific Islander.
Female pt with gestational diabetes or had birth to +9ibs baby.
Bp > 140/90
HDL < 35 mg/dL and/or triglyceride >250 mg/dL
A1C > 5.7% or fasting BS > 100
Hx of vascular disease
Veterans exposed to agent orange.
Patho: deficit in insulin secretion or action
Management:
Appropriate diet and exercise and lifestyle changes in combo w/ meds.
Initial Tx: Metformin
S/S of hyperglycemia: Polyuria, Polydipsia, Polyphagia, and weight loss.
Blurred vision
Paresthesia
Yeast infections (balanitis in men)
Severe hyperglycemia:
Elevated serum ketones:
Hypovolemia
Acidosis
Kussmaul Respirations: deep, labored, rapid breathing (tachypnea)
Fruity breath
Electrolyte imbalances: dilutional hyponatremia and hyperkalemia
Assessment:
Weight and weight changes
Downloaded by Benjamin Luca ()
, lOMoARcPSD|51648332
Family hx – strongest r/f for type 1
Frequent infections (fungal, UTI, pneumonia)
Delayed healing (poor LE blood flow) – fat sticks in blood vessels
Peripheral neuropathy, gastropathy
3 Ps
Age/Race: type 2 is higher in non-whites and ages> 40
Physical Exam:
Acanthosis Nigricans: darkening of skin folds in the back of the neck, armpits, and groin.
Yeast infection (breasts, groin, skin flaps)
Type 1: may present w/ DKA. – no insulin to (-) ketones
Type 2: obesity and hypertension, may present w/ HHS (rare): extremely high BS w/ no
ketones and dehydration.
Diagnosing:
Blood tests:
o Fasting BG >126
o Random BG > 200
o A1C > = 6.5%
o 75 gm, 2-hour glucose tolerance test w/ plasma glucose >200
Glucometer: steps for BG monitoring (at home)
Wash hands (no alcohol wipes)
Don’t have to wipe the first drop.
Drug Tx:
Metformin: Type 2 monotherapy
Decreases glucose in the liver. Does not cause hypoglycemia.
SE: weight loss, GI distress/diarrhea – SE decrease over time
CONTRAINDICATION: Can cause lactic acidosis in pt with kidney impairment and not be
used in pt with kidney disease.
o Creatinine > 1.5 men, >1.4 women
o GFR < 46
o HIGH creatinine and LOW GFR – AVOID
Contrast study (CTs, Cardiac cath): stop 24 hours before OR time of, hold for 48 hours
after, and restart when renal functions show normal.
Sulfonylureas: stimulate insulin release from Beta cells
Downloaded by Benjamin Luca ()
