NR 601 Final Exam Guide

NR 601 Final Exam Guide NR 601 Final Exam Guide Final EXAM Guide 601 to pass your NR 601 Exam lOMoAR cPSD| FINAL EXAM GUIDE Glucose Metabolism Disorders Type 1 Diabetes 2 types 1. Immune mediated (type 1A) 90% of cases • Caused by autoimmune destruction of insulin-producing pancreatic beta islet cells • The triggering factor in the development of type 1 DM is thought to be an infection or toxic insult in persons with a genetic predisposition. • The most commonly identified infectious agents are congenital rubella, others include; Coxsackie B4 virus, cytomegalovirus, adenovirus, and mumps virus. • Associated with an increased incidence of other autoimmune disorders, including thyroid, adrenal, and gonadal insufficiency • Progressive beta cell destruction remains the hallmark of type 1 DM, with hyperglycemia typically developing once 80% to 90% of a patient’s beta cells have been destroyed 2. Idiopathic (type 1B) Clinical Presentation • The majority of patientsseek medical attention due to symptoms related to hyperglycemia, with the initial diagnosis in children often being made when patients present in frank diabetic ketoacidosis (DKA) o Signs of severe ketosis known as diabetic ketoacidosis (DKA) include extreme fatigue, abnormal cramping, and alterations in breathing pattern. In addition, a telltale sign of ketosis is halitosis, which smells like a combination of nail polish (acetone) and rotting fruit. In contrast, hyperosmolar hyperglycemic state (HHS) is a serious form of nonketotic acidosis resulting from prolonged hyperglycemia that is less common than DKA but has a higher mortality rate. HHS is seen most frequently in adults who have a restriction in fluid intake for some reason, such as a concurrent illness, impaired physical function, or reduced cognition. • The classic symptoms of type 1 DM are polyuria (increased urination), polydipsia (increased fluid intake due to excessive thirst), nocturnal enuresis, polyphagia with paradoxical weight loss (due to reduced glucose metabolism, despite increased consumption), visual changes (especially blurred vision), and eventual fatigue, weakness, and anorexia. Screening: • The American Diabetes Association (ADA) does not recommend screening for type 1 DM in apparently healthy individuals who have no risk factors for this disorder. However, if suspected, point-of-care testing can be accomplished by utilizing a portable blood glucose monitor to determine capillary blood glucose level as a random plasma glucose measurement taken without regard to the timing of a patient’s last meal. If elevated, the patient’s urine should be tested for ketones and additional plasma glucose testing should be initiated. Diagnostic criteria: • Glycosylated hemoglobin (A1C) of 6.5% or higher • Symptoms of diabetes (e.g., polyuria, polydipsia, weight loss) plus a random plasma glucose level of 200 mg/dL or higher • Fasting plasma glucose level of 126 mg/dL or higher (following 8 hours of no caloric intake) lOMoAR cPSD| • Two-hour plasma glucose level of 200 mg/dL or higher during an oral glucose tolerance test (OGTT) with a 75-g glucose load *The first three criteria listed above should be confirmed by repeat testing (preferably with the same test) without delay, except in the setting of unequivocal hyperglycemia with acute metabolic decompensation Patients with borderline glucose intolerance at risk for developing type 1 DM or those with suspected LADA can be tested for antibodies against GAD, insulin, tyrosine phosphatases (e.g., IA-2), or zinc transporters (e.g., ZnT8), as these autoantibodies help differentiate (latent autoimmune diabetes in adults (LADA) from type 2 DM. If two or more of these antibody classes are positive in the setting of diagnostic hyperglycemia, then the diagnosis of type 1 DM is confirmed. However, such antibodies are not a diagnostic requirement for type 1 DM. Treatment: Patient with type 1A NEED exogenousinsulin to survive. • The initial goal of treatment for type 1 DM is to normalize the elevated blood glucose level. This is best accomplished by intensive insulin regimens to achieve the following goals: o Plasma glucose levels of 80 to 130 mg/dL before meals o Peak postprandial (1–2 hours after the beginning of a meal) glucose levels of lessthan 180 mg/dL o A1C below 7% for adults with type 1 DM