NUR 239 Final Exam UPDATED ACTUAL Questions and
CORRECT Answers
What is the pathophysiology of type 1 diabetes? -Beta cell destruction usually leading to absolute insulin deficiency.
-Type IA: immune system destroys beta cells
-Type IB: genetic cause
What are the signs and symptoms of type 1 diabetes? -Polyuria: increased urination
-Polydipsia: increased thirst
-Polyphagia: increase hunger
-Weight loss
-Fatigue
-Increased frequency of infections
-Rapid onset
-Insulin dependent
-Familial tendency
-Peak incidence from 10-15 years
What is the pathophysiology of type 2 diabetes? -May range from predominantly insulin resistance with relative insulin
deficiency to a predominantly secretory defect with insulin resistance.
-Result of beta-cell exhaustion due to long-standing insulin resistance.
-Genetics and family history put you at an increased risk
1. Stomach converts food to glucose
2. Glucose enters bloodstream
3. Pancreas produces sufficient insulin but it is resistant to effective use
4. Glucose unable to enter body effectively
5. Glucose levels increase
What are risks factors for type 2 diabetes? -Sedentary lifestyle
-Familial tendency
-Average age 50 years
-Hx of increased BP
-Fatigue and decreased energy
-Obese
-Recurrent infections
-Polyuria
-Polydipsia
-FBS > 126 mg/dl
What are the metabolic abnormalities? -Insulin resistance -failure of target cells to respond to insulin. Often predated
by compensatory beta cell hyperfunction and hyperinsulinemia
-Increased glucose production in liver - overproduction of glucose despite
fasting hyperinsulinemia
-Impaired secretion of insulin by pancreatic beta cells - may be result of
decrease in beta cell mass, increased apoptosis, decrease regeneration of beta
cells, beta cell exhaustion due to long standing insulin resistance
,What are the characteristics of hyperglycemia -BG > 600 mg/dL
hyperosmolar state? -High plasma osmolarity (pulls fluid out of cells and into extracellular fluid)
-Severe dehydration, thirst
-Absence of ketoacidosis (suppressed by insulin available)
-Many neurological symptoms
-Insidious onset
-More common is Type 2 DM
-May also occur with MI, acute pancreatitis, severe infections, oral or parenteral
nutrition solutions
-Treatment similar to DKA, but with larger amounts of IV fluid replacement
What are the characteristics of diabetic ketoacidosis -Hyperglycemia: BG>250mg/dL
and what do they need to treat it? -Begins with polyuria, polydipsia, N, V, fatigue, stupor
-Onset: over 4-10 hours
-Causes: lack of insulin, GI upset, febrile illness
-Symptoms:
^Breath smells like juicy fruit gum
^Kussmaul respirations
^Thirsty, dehydration, dry mouth
^Stomach pain
^Sleepiness
^Increased pulse
^Vomiting
^Flushed face
^Tachycardia
^Hypotension
^Acidosis
^High Blood Sugar (>240mg/dl)
^Hyperkalemia
^Polyuria
-Patient will need hydration, insulin, and electrolyte replacement.
^Regular Insulin IV push and infusion
^K+ replacement
^IV fluids (NS at first, then add Dextrose as BG lowers)
^Frequent BS checks, labs
What diabetes patients are critical care? 140-180mg/dL
, What are the characteristics of hypoglycemia and what -BG < 70
do they need? -Low blood sugar symptoms
-Symptoms:
^Headache
^Shaking
^Hunger
^Weakness
^Feeling tired
^Sweating
^Tachycardia
^Irritability
^Restless
^Excessive hunger
^Diaphoresis
^Depression
^Anxious
^Confusion
^Blurred/Double vision
^Cool, clammy skin
-Onset: Rapid. 1-3 hours.
-Causes: Insufficient food, excess exercise, excess insulin
-Patients need their blood sugar increased with glucose, glucagon, or dextrose
(IV)
What is the somogyi effect? -Rebound hyperglycemia
-Cycle of insulin induced post-hypoglycemic episodes
-Insulin induced hypoglycemia produces compensatory increase in blood
levels of catecholamines, glucagon, cortisol, growth hormone
-Causes blood glucose to become elevated
-Produces some degree of insulin resistance
-Hypoglycemic episode may occur at night
-Requires change in diet and dose or time of insulin
What is the blood sugar mnemonic? -Hot and dry: sugar high
-Cold and clammy: need some candy
What are the chronic complications of diabetes? -Angiopathy
-Peripheral vascular disease
-Retinopathy
-Nephropathy
-Neuropathy
-Infections
-Lesions
What are the chronic diabetic lesions caused by? -Intracellular hyperglycemia
-Excess sorbitol production alters cell function
-Glycoproteins damage vessels
-Elevated DAG and PKC damages vessels
-Macrovascular
^Atherosclerosis, CAD, cerebrovascular disease, peripheral vascular disease,
foot ulcers
^Risk factors- obesity, HTN, hyperglycemia, hyperinsulinemia, hyperlipidemia,
altered platelet function, endothelial dysfunction, systemic inflammation,
elevated fibrinogen
-Microvascular
^Neuropathy, retinopathy, nephropathy
CORRECT Answers
What is the pathophysiology of type 1 diabetes? -Beta cell destruction usually leading to absolute insulin deficiency.
-Type IA: immune system destroys beta cells
-Type IB: genetic cause
What are the signs and symptoms of type 1 diabetes? -Polyuria: increased urination
-Polydipsia: increased thirst
-Polyphagia: increase hunger
-Weight loss
-Fatigue
-Increased frequency of infections
-Rapid onset
-Insulin dependent
-Familial tendency
-Peak incidence from 10-15 years
What is the pathophysiology of type 2 diabetes? -May range from predominantly insulin resistance with relative insulin
deficiency to a predominantly secretory defect with insulin resistance.
-Result of beta-cell exhaustion due to long-standing insulin resistance.
-Genetics and family history put you at an increased risk
1. Stomach converts food to glucose
2. Glucose enters bloodstream
3. Pancreas produces sufficient insulin but it is resistant to effective use
4. Glucose unable to enter body effectively
5. Glucose levels increase
What are risks factors for type 2 diabetes? -Sedentary lifestyle
-Familial tendency
-Average age 50 years
-Hx of increased BP
-Fatigue and decreased energy
-Obese
-Recurrent infections
-Polyuria
-Polydipsia
-FBS > 126 mg/dl
What are the metabolic abnormalities? -Insulin resistance -failure of target cells to respond to insulin. Often predated
by compensatory beta cell hyperfunction and hyperinsulinemia
-Increased glucose production in liver - overproduction of glucose despite
fasting hyperinsulinemia
-Impaired secretion of insulin by pancreatic beta cells - may be result of
decrease in beta cell mass, increased apoptosis, decrease regeneration of beta
cells, beta cell exhaustion due to long standing insulin resistance
,What are the characteristics of hyperglycemia -BG > 600 mg/dL
hyperosmolar state? -High plasma osmolarity (pulls fluid out of cells and into extracellular fluid)
-Severe dehydration, thirst
-Absence of ketoacidosis (suppressed by insulin available)
-Many neurological symptoms
-Insidious onset
-More common is Type 2 DM
-May also occur with MI, acute pancreatitis, severe infections, oral or parenteral
nutrition solutions
-Treatment similar to DKA, but with larger amounts of IV fluid replacement
What are the characteristics of diabetic ketoacidosis -Hyperglycemia: BG>250mg/dL
and what do they need to treat it? -Begins with polyuria, polydipsia, N, V, fatigue, stupor
-Onset: over 4-10 hours
-Causes: lack of insulin, GI upset, febrile illness
-Symptoms:
^Breath smells like juicy fruit gum
^Kussmaul respirations
^Thirsty, dehydration, dry mouth
^Stomach pain
^Sleepiness
^Increased pulse
^Vomiting
^Flushed face
^Tachycardia
^Hypotension
^Acidosis
^High Blood Sugar (>240mg/dl)
^Hyperkalemia
^Polyuria
-Patient will need hydration, insulin, and electrolyte replacement.
^Regular Insulin IV push and infusion
^K+ replacement
^IV fluids (NS at first, then add Dextrose as BG lowers)
^Frequent BS checks, labs
What diabetes patients are critical care? 140-180mg/dL
, What are the characteristics of hypoglycemia and what -BG < 70
do they need? -Low blood sugar symptoms
-Symptoms:
^Headache
^Shaking
^Hunger
^Weakness
^Feeling tired
^Sweating
^Tachycardia
^Irritability
^Restless
^Excessive hunger
^Diaphoresis
^Depression
^Anxious
^Confusion
^Blurred/Double vision
^Cool, clammy skin
-Onset: Rapid. 1-3 hours.
-Causes: Insufficient food, excess exercise, excess insulin
-Patients need their blood sugar increased with glucose, glucagon, or dextrose
(IV)
What is the somogyi effect? -Rebound hyperglycemia
-Cycle of insulin induced post-hypoglycemic episodes
-Insulin induced hypoglycemia produces compensatory increase in blood
levels of catecholamines, glucagon, cortisol, growth hormone
-Causes blood glucose to become elevated
-Produces some degree of insulin resistance
-Hypoglycemic episode may occur at night
-Requires change in diet and dose or time of insulin
What is the blood sugar mnemonic? -Hot and dry: sugar high
-Cold and clammy: need some candy
What are the chronic complications of diabetes? -Angiopathy
-Peripheral vascular disease
-Retinopathy
-Nephropathy
-Neuropathy
-Infections
-Lesions
What are the chronic diabetic lesions caused by? -Intracellular hyperglycemia
-Excess sorbitol production alters cell function
-Glycoproteins damage vessels
-Elevated DAG and PKC damages vessels
-Macrovascular
^Atherosclerosis, CAD, cerebrovascular disease, peripheral vascular disease,
foot ulcers
^Risk factors- obesity, HTN, hyperglycemia, hyperinsulinemia, hyperlipidemia,
altered platelet function, endothelial dysfunction, systemic inflammation,
elevated fibrinogen
-Microvascular
^Neuropathy, retinopathy, nephropathy
