NURS 623 exam 2 Cary review-updated.
EXAM 2 Cary Review Adult 2
1.
It is important to consider that certain drugs, including glucocorticoids, furosemide (Lasix), thiazide
diuretics, estrogen-containing products, beta blockers, and nicotinic acid, can produce hyperglycemia. If
the random plasma glucose level is elevated in the clinic, the urine should be tested for ketones and
additional blood plasma glucose testing should be done
2. Diabetes Type 1
lack of insulin (pancreas does not produce any insulin) - always on insulin, beta cells are
destroyed that are the ones responsible for secretion of insulin. Autoimmune. The exact cause
of type 1 diabetes is unknown. Usually, the body's own immune system — which normally
fights harmful bacteria and viruses — mistakenly destroys the insulin-producing (islet, or islets
of Langerhans) cells in the pancreas. Other possible causes: Genetics and exposure to viruses
and other environmental factors
S/S: classic symptoms
Polyuria
Polyphagia
Polydypsia
Anorexia
Wht loss
Bed-wetting in children who previously didn't wet the bed during the night
Irritability and other mood changes
Fatigue and weakness
Blurred vision
Impaired immunity-repeat infections, decreased wound healing
Diabetic foot ulcer: decreased circulation, decreased immunity, infection, peripheral neuopathy
A1c goal for diabetics- Below 7%
,NURS 623 exam 2 Cary review-updated.
-Red blood cell life is 90 days and glucose is carried on the RBC, so we can
measure glucose over a 90 day RBC life rather than just a fasting glucose
DKA:
Signs begin with anorexia, increased thirst, N/V, abd cramping, polyuria, alterations in
breathing patterns, requires immediate medical attention, BG >359, plasma ketone >5
Hyperosmolar Hyperglycemic syndrome
BS>600
More common in Type 2 DM
Polyuria, polydipsia, weakness, lethargy, confusion
How often are the feet examined? Every doctor visit! Should come in at least every 3 months for
diabetes check.
a. If they happen to have a foot problem – refer to Podiatry, always. And they need to wear good
fitting shoes!
b. Also, they must get eyes checked annually- no matter what.
c. Come into the office, feeling clammy, or dizzy, took Insulin, didn’t eat- first thing to do? CHECK
THE BLOOD SUGAR.
d. Most patients with type I will never have weight gain- ever. Polydipsia, Polyuria, Polyphagia,
Ketones in urine. HBGA1C- > 6.5-7 (goal for DM patients), DM, if they are in the 10-14 % for
A1C- please treat NOW!
is >120 and HgbA1C is > than 7.0, keep diet, exercise and weight loss then add meds.
Management/when to initiate medication therapy:
usually presents in crisis. Usually in hospital and endo follows not PCP until management is
stable. Figure out cause such as medication non-adherence or underlying infection - most
common cause of DKA)
Intensive insulin regimens may be necessary with the goal of plasma glucose levels:
80 to 120 mg/dL before meals
100 to 140 mg/dL at bedtime
<180 mg/dl postprandial
A1C below 7%.
Treatment team: PCP, endocrinologist on occasional, diabetic education, family
Goal: normalize blood glucose levels
Optimal monitoring is 3-4 times a day, before meals and at bedtime
Hypoglycemia-treated best with 15g ingestion of carbohydrates, check BG 15 min later
Nutrition: Protein 10-20%, Fat 10-20%, Carbs 60-70% of caloric intake
Exercise: screen for micro and macrovascular damage, exercise may exercise may aggravate
these, check BS every 30-60 in during and after exercise, avoid if fasting glucose if >250 ketosis
present, or if BS alone is >300, if glucose <100 take additional carb prior
Monitor urine ketones if ill, monitor BG every 2 hours when ill, if blood sugar is >240 urine
ketones should be checked Q4hrs.
3. Diabetes Type II- too little insulin or not using insulin effectively (used to be called adult onset- but
changing as kids can have type 2) due to insulin resistance
, NURS 623 exam 2 Cary review-updated.
happens over time -due to lifestyle and genetics - pancreas can compensate for a while and make
more insulin to combat the increased BS. But then it can’t keep compensating and diabetes may
not be noticed until something happens (CAD, MI, etc…). same symptoms as type 1
diagnosed when the A1C is over 6.5 percent.
A1c gives us an idea of the average blood sugar reading over the past 3 months.
increased thirst, increased urination, sweating, hunger, fatigue, blurred vision
Education- it is important to exercise because: helps lower cholesterol, lower postprandial blood
sugar, help decrease triglycerides.
Checking BS is good for control, routine establishing, and essential for preventing further disease.
Good control prevents further problems.
When do you take Metformin, Glipizide- If daily, before breakfast, if BID, then before breakfast and
Dinner.
Exercise can lower blood sugar, have snack ready.
Exercise is important for prevention because it improves insulin sensitivity, insulin secretion, helps
lower blood glucose, improves glycemic control, leads to weight loss, improves high cholesterol and
postprandial blood glucose levels, reduces cardiovascular risks.
Metformin is not for everyone- not anyone with liver disease (alcoholics) = can cause severe lactic
acidosis. hypoglycemia, kidney injury (poorly controlled, ketoacidosis type patient’s) - can cause
diarrhea with new dose or increased dose
ACE is good for preventing Neuropathy, and also Albuminuria, also protects kidneys, small dosing is
good for all DM II patients.
Ischemic heart failure is leading cause of death, so earlier tight control, use an ACE, the better.
Triglycerides may be elevated in a diabetic
Screen at age 45, if normal Q3 years
1st line therapy for DMII: Metformin- a biguanide that works by suppressing excessive hepatic
glucose production and by increasing glucose utilization in peripheral tissues. Natural effect on
weight loss, can lower triglycerides and LDL levels, increases HDL
-common side effects: N/V/D
- Can also be used with sulfonylureas and insulin and remain hyperglycemic despite treatment,
as well as in patients who are obese, because it has a neutral effect on weight.
-Dose - 500mg QD with breakfast, then increase to 500mg bid up to 1000 mg BID
Sulfonylureas stimulate pancreatic insulin secretion. Few side effects and drug interactions, not for
pregnancy
Alpha glucosidase inhibitors slow down breakdown of carbohydrates, potential for hypoglycemia if
used with sulfonylureas or insulin
contraindications: Contraindicated in renal disease. Must have adequate renal function (SrCR 1.4
or CCL >50mL/mn). Should not be used in liver impairment, alcoholic or pt’s that can develop
hypoxia due to cardiopulmonary insufficiency: Can develop fatal lactic acidosis and kidneys are
needed to maintain balance. CT’s with contrast increase the load placed on the kidneys, so if lactic
acidosis were to develop, the kidneys could not support the increased need.
Management/1st intervention and when to implement medication therapy: When dietary
modification and exercise do not result in blood glucose control. Oral medication is initiated when
3 months of nutritional therapy and exercise have not achieved and maintained fasting plasma
glucose levels less than 120mg/dL and an A1C of less than 7%
EXAM 2 Cary Review Adult 2
1.
It is important to consider that certain drugs, including glucocorticoids, furosemide (Lasix), thiazide
diuretics, estrogen-containing products, beta blockers, and nicotinic acid, can produce hyperglycemia. If
the random plasma glucose level is elevated in the clinic, the urine should be tested for ketones and
additional blood plasma glucose testing should be done
2. Diabetes Type 1
lack of insulin (pancreas does not produce any insulin) - always on insulin, beta cells are
destroyed that are the ones responsible for secretion of insulin. Autoimmune. The exact cause
of type 1 diabetes is unknown. Usually, the body's own immune system — which normally
fights harmful bacteria and viruses — mistakenly destroys the insulin-producing (islet, or islets
of Langerhans) cells in the pancreas. Other possible causes: Genetics and exposure to viruses
and other environmental factors
S/S: classic symptoms
Polyuria
Polyphagia
Polydypsia
Anorexia
Wht loss
Bed-wetting in children who previously didn't wet the bed during the night
Irritability and other mood changes
Fatigue and weakness
Blurred vision
Impaired immunity-repeat infections, decreased wound healing
Diabetic foot ulcer: decreased circulation, decreased immunity, infection, peripheral neuopathy
A1c goal for diabetics- Below 7%
,NURS 623 exam 2 Cary review-updated.
-Red blood cell life is 90 days and glucose is carried on the RBC, so we can
measure glucose over a 90 day RBC life rather than just a fasting glucose
DKA:
Signs begin with anorexia, increased thirst, N/V, abd cramping, polyuria, alterations in
breathing patterns, requires immediate medical attention, BG >359, plasma ketone >5
Hyperosmolar Hyperglycemic syndrome
BS>600
More common in Type 2 DM
Polyuria, polydipsia, weakness, lethargy, confusion
How often are the feet examined? Every doctor visit! Should come in at least every 3 months for
diabetes check.
a. If they happen to have a foot problem – refer to Podiatry, always. And they need to wear good
fitting shoes!
b. Also, they must get eyes checked annually- no matter what.
c. Come into the office, feeling clammy, or dizzy, took Insulin, didn’t eat- first thing to do? CHECK
THE BLOOD SUGAR.
d. Most patients with type I will never have weight gain- ever. Polydipsia, Polyuria, Polyphagia,
Ketones in urine. HBGA1C- > 6.5-7 (goal for DM patients), DM, if they are in the 10-14 % for
A1C- please treat NOW!
is >120 and HgbA1C is > than 7.0, keep diet, exercise and weight loss then add meds.
Management/when to initiate medication therapy:
usually presents in crisis. Usually in hospital and endo follows not PCP until management is
stable. Figure out cause such as medication non-adherence or underlying infection - most
common cause of DKA)
Intensive insulin regimens may be necessary with the goal of plasma glucose levels:
80 to 120 mg/dL before meals
100 to 140 mg/dL at bedtime
<180 mg/dl postprandial
A1C below 7%.
Treatment team: PCP, endocrinologist on occasional, diabetic education, family
Goal: normalize blood glucose levels
Optimal monitoring is 3-4 times a day, before meals and at bedtime
Hypoglycemia-treated best with 15g ingestion of carbohydrates, check BG 15 min later
Nutrition: Protein 10-20%, Fat 10-20%, Carbs 60-70% of caloric intake
Exercise: screen for micro and macrovascular damage, exercise may exercise may aggravate
these, check BS every 30-60 in during and after exercise, avoid if fasting glucose if >250 ketosis
present, or if BS alone is >300, if glucose <100 take additional carb prior
Monitor urine ketones if ill, monitor BG every 2 hours when ill, if blood sugar is >240 urine
ketones should be checked Q4hrs.
3. Diabetes Type II- too little insulin or not using insulin effectively (used to be called adult onset- but
changing as kids can have type 2) due to insulin resistance
, NURS 623 exam 2 Cary review-updated.
happens over time -due to lifestyle and genetics - pancreas can compensate for a while and make
more insulin to combat the increased BS. But then it can’t keep compensating and diabetes may
not be noticed until something happens (CAD, MI, etc…). same symptoms as type 1
diagnosed when the A1C is over 6.5 percent.
A1c gives us an idea of the average blood sugar reading over the past 3 months.
increased thirst, increased urination, sweating, hunger, fatigue, blurred vision
Education- it is important to exercise because: helps lower cholesterol, lower postprandial blood
sugar, help decrease triglycerides.
Checking BS is good for control, routine establishing, and essential for preventing further disease.
Good control prevents further problems.
When do you take Metformin, Glipizide- If daily, before breakfast, if BID, then before breakfast and
Dinner.
Exercise can lower blood sugar, have snack ready.
Exercise is important for prevention because it improves insulin sensitivity, insulin secretion, helps
lower blood glucose, improves glycemic control, leads to weight loss, improves high cholesterol and
postprandial blood glucose levels, reduces cardiovascular risks.
Metformin is not for everyone- not anyone with liver disease (alcoholics) = can cause severe lactic
acidosis. hypoglycemia, kidney injury (poorly controlled, ketoacidosis type patient’s) - can cause
diarrhea with new dose or increased dose
ACE is good for preventing Neuropathy, and also Albuminuria, also protects kidneys, small dosing is
good for all DM II patients.
Ischemic heart failure is leading cause of death, so earlier tight control, use an ACE, the better.
Triglycerides may be elevated in a diabetic
Screen at age 45, if normal Q3 years
1st line therapy for DMII: Metformin- a biguanide that works by suppressing excessive hepatic
glucose production and by increasing glucose utilization in peripheral tissues. Natural effect on
weight loss, can lower triglycerides and LDL levels, increases HDL
-common side effects: N/V/D
- Can also be used with sulfonylureas and insulin and remain hyperglycemic despite treatment,
as well as in patients who are obese, because it has a neutral effect on weight.
-Dose - 500mg QD with breakfast, then increase to 500mg bid up to 1000 mg BID
Sulfonylureas stimulate pancreatic insulin secretion. Few side effects and drug interactions, not for
pregnancy
Alpha glucosidase inhibitors slow down breakdown of carbohydrates, potential for hypoglycemia if
used with sulfonylureas or insulin
contraindications: Contraindicated in renal disease. Must have adequate renal function (SrCR 1.4
or CCL >50mL/mn). Should not be used in liver impairment, alcoholic or pt’s that can develop
hypoxia due to cardiopulmonary insufficiency: Can develop fatal lactic acidosis and kidneys are
needed to maintain balance. CT’s with contrast increase the load placed on the kidneys, so if lactic
acidosis were to develop, the kidneys could not support the increased need.
Management/1st intervention and when to implement medication therapy: When dietary
modification and exercise do not result in blood glucose control. Oral medication is initiated when
3 months of nutritional therapy and exercise have not achieved and maintained fasting plasma
glucose levels less than 120mg/dL and an A1C of less than 7%
