Final Exam NR 601 Study guide flash cards super duper sheeeeeit

Final Exam NR 601 Study guide flash cards super duper sheeeeeit DM1 definition patho - CORRECT ANSWER-or absence of functioning beta cells Autoimmune disorder Asymptomatic diabetes - CORRECT ANSWER-type II diabetes affects nearly 10% of the population, and due to this high prevalence, potentially severe complications Prediabetes labs - CORRECT ANSWER-1. Prediabetic- fasting glucose consistently elevated above the normal range but less than 100-125. Impaired glucose tolerance (IGT) state of hyperglycemia where 2 hr post glucose load glycemic level is 140-199. RANDOM glucose test cannot be used to diagnose pre-diabetes. Needs to be fasting or two-hour glucose tolerance test. A1c greater than 5.7%. Fasting blood glucose greater than 100 but less than 126. OGTT greater than 140 but less than 200. Diagnostic Criteria of Diabetes - CORRECT ANSWER-However, if the individual is asymptomatic, then a diagnosis of diabetes mellitus requires two positive tests that are separated by at least one week of time. Diagnostic Criteria - CORRECT ANSWER-· AIC of 6.5 or higher=diabetes · Random plasma glucose level of 200 WITH classic symptoms of hyperglycemia or a hyperglycemic crisis · Fasting plasma glucose level of 126 or higher on TWOoccasions(fasting is defined as no caloric intake for at least 8 hrs · 2 hour glucose tolerance test- 2-hour post load plasma glucose level of 200 or higher during an OGTT, following consumption of a glucose load containing the equivalent of 75g of anhydrous glucose dissolved in water (OGTT is also used to screen for diabetes during pregnancy) screening for type 1 and type 2 - CORRECT ANSWER-· You do not screen for type 1 diabetes but you do screen for type 2 if an individual is overweight or obese, regardless of age, and for all adults aged 45 years and older. Tests should be repeated at a minimum of 3 year intervals what is the minimum time interval for screening for Diabetes type 2 - CORRECT ANSWER-3 years treatment for Type 1 and what blood sugar level before meals? - CORRECT ANSWER-Type 1- FIRST LINE: INSULIN. 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: plasma glucose levels of 80 to 130 mg/dL before meals 1 - 2 hours postprandial blood sugar and A1C goal for a type 1 DM? - CORRECT ANSWER-(1-2 hours after the beginning of a meal) glucose levels of less than 180 mg/dL, and an A1C below 7% for adults with type 1 DM. initiation of insulin therapy - CORRECT ANSWER-. INITIATION OF INSULIN THERAPY IN NEWLY DIAGNOSED TYPE 1 DM, SHOULD BE MANAGED BY OR IN CLOSE COLLABORATION WITH AN ENDOCRINOLOGIST. DM 2 Management - CORRECT ANSWER-Type 2-FIRST LINE: LIFESTYLE MANAGEMENT metformin is first line medication management when is a second medication added??? - CORRECT ANSWER-The AACE recommends adding a second agent to lifestyle treatment and metformin if the A1C is more than 7.5% or after 3 months of monotherapy without achievement of the patient's blood glucose goals what A1c is insulin added? when in dual therapy indicated? when is triple line therapy indicated? - CORRECT ANSWER-Immediately upon diagnosis of type 2 DM, begin lifestyle therapy with medically assisted obesity treatment. • If glycemic goals are still not met 3 months later, begin single-agent or dual therapy with oral antidiabetic agents, depending on whether A1C is less than or greater than 7.5%. • If glycemic goals are not met in 3 months, initiate triple therapy. • If after 3 additional months (or at the time of diagnosis) A1C is 9.0% or higher and the patient is symptomatic, add insulin therapy. what indicates strong diabetic control - CORRECT ANSWER-· A1c less than 7% indicate strong control what medication can cause a metalic taste? - CORRECT ANSWER-Metformin can cause: hypoglycemia esp in older adults, adverse reactions such as GI disturbances and metallic taste, and is contraindicated in renal disease so assess renal function prior to prescribing. metformin has a black box warning for what? - CORRECT ANSWER-FDA-approved prescribing information for lactic acidosis, although this side effect is very rare. Metformin should be discontinued 24 to 48 hours before diagnostic and surgical procedures due to the risk of decreased kidney function, and its administration should not be resumed for at least 6 hours after these procedures or until the patient is adequately hydrated side effects of metformin - CORRECT ANSWER-Common adverse reactions include diarrhea, nausea, anorexia, and abdominal discomfort, which usually resolve with a gradual increase of dosage. Metformin has been shown to cause decreased vitamin B12 absorption metformin can cause what vitamin deficiency? - CORRECT ANSWER-B-12 Treatment goals for older adults (Kennedy table 14-2). Healthy - CORRECT ANSWER-· Healthy (few chronic illnesses) A1C 7.5, Fasting glucose 90-130, Bedtime 90-150, BP 140/90, for lipids use statin unless contraindicated or not tolerated Treatment goals for older adults (Kennedy table 14-2). Complex Patient - CORRECT ANSWER-Complex (multiple chronic illnesses, ADL impairment, cognitive impairment) A1C8.0%, fasting 90-150, bedtime 100-180, BP same as above, for lipids use statin unless contraindicated or not tolerated Treatment goals for older adults (Kennedy table 14-2). Very Complex - CORRECT ANSWER-Very complex (LTC or end stage illnesses) A1C 8.5%, fasting 100-180, bedtime 110-200, BP150/90, consider likelihood of benefit with statin (secondary prevention more so than primary) Pregnancy A1C goals - CORRECT ANSWER-- Maintaining an A1C of less than 6.0% during pregnancy is recommended to prevent adverse fetal outcomes, although this goal increases the risk of hypoglycemia DM risk Factors - CORRECT ANSWER-Dm Type 1 · Autoimmune, · Genetics (chromosome 6p) · 1-5% of monogenic forms DM 2 risk factors - CORRECT ANSWER-Diabetes Mellitus Type 2 - Family history (first-degree relative) - Body mass index 25 kg/m2 (lower for Asian Americans) - Age 45 years - Impaired fasting glucose or A1C 5.7% - History of gestational diabetes - Hypertension ( 140/90 mm Hg or on antihypertensive therapy) - Hyperlipidemia (high-density lipoprotein 35 mg/dL, triglycerides 250 mg/dL) - Women with polycystic ovarian syndrome DM 2 complications - CORRECT ANSWER-· Type 2 DM is the leading cause of acquired blindness in adults aged 20-74 and up to 25% of newly diagnosed patient may present with retinopathy at the time of diagnosis. Hyperlipidemia treatment - CORRECT ANSWER-Hyperlipidemia: use of statins as antihyperlipidemia therapy is indicated with these patients with nutritional treatment (diet modification) initiated as first line therapy. (hyperlipidemia: LDL greater than 100 Macrovascular complications of diabetes - CORRECT ANSWER-Macrovascular complications from diabetes substantially increase the risk of morbidity and death from coronary artery disease, stroke, and peripheral vascular disease. Microvascular complications of diabetes - CORRECT ANSWER-retinopathy, nephropathy, neuropathy diabetic referals - CORRECT ANSWER-· Initial diagnosis: referral to dietician and a certified diabetes educator · DM patient should have annual exam of feet and eyes (funcuscopy) · Endocrinologist · Annual eye and oral examination · Podiatry, microphilament sensation of test as well BMI 18.5 or less - CORRECT ANSWER-underweight BMI 18.5-24.9 - CORRECT ANSWER-normal weight BMI 25-29.9 - CORRECT ANSWER-overweight BMI 30.0-34.9 - CORRECT ANSWER-class 1 obesity BMI 35-39.9 - CORRECT ANSWER-obesity class II BMI 40 - CORRECT ANSWER-class 3 obesity Comorbidity r/t obesity - CORRECT ANSWER-· Comorbidities related to obesityObesity is considered a risk factor for the development of a number of illnesses or diseases. Being overweight or obese explains almost 50% of cardiovascular outcomes (ie coronary heart disease, stroke) and contributes of blood pressure, dyslipidemia, and glucose concentration. diseases related to having obesity - CORRECT ANSWER-· The obese patient is more likely to develop coronary artery disease, hypertension, and hyperlipidemia.There is an increased risk of developing type 2 diabetes mellitus, cerebrovascular disease, and CKD.The obese patient is more likely to develop physical disability, sexual dysfunction, lower UTIs, and impaired cognitive function and dementia. Certain types of cancer such as colon, breast, endometrium, liver, kidney, esophagus, gastric, pancreatic, gallbladder, and leukemia are also associated with obesity. Obese patients are also more likely to developobstructive sleep apnea, gallbladder disease, fatty liver disease, and osteoarthritis. They will often have symptomatic varicose veins or GERD. When do UTI's become chronic? - CORRECT ANSWER-UTIs become chronic because of obstructions, antibiotic-resistant bacteria, or the presence of multiple strains of bacteria that are not susceptible to the antibiotic therapy prescribed how many days is bactrim used for in a uncomplicated UTI? - CORRECT ANSWER-3 days behavior to reduce UTIs - CORRECT ANSWER-Void AFTER INTER COURSE Adueqate fluid intake No Douching Use a condom for gay boiz Wipe from front to back you sick cuntz When do you treat Asymptomatic Bacteruria? - CORRECT ANSWER-Pregnant women, before urologic surgeries, after catheter removal Don't treat asymptomatic bacteria in urine for who? - CORRECT ANSWER-DON'T Treat if Asymptomatic in Men Spinal Cord injury pathietns with urinary catheters Non pregnant women Eldery Diabetic person complications of UTI - CORRECT ANSWER-Pyelonephritis, Sepsi, Shock, Death Risk factors of UTI - CORRECT ANSWER-Predisposing factors to the development of cystitis in older adults include indwelling catheters,urethral or condom catheters, incontinence (urinary andfecal), cognitive impairment, neurological conditions thatimpair bladder emptying, and diabetes (high pH=more alkaline), which can lead toneurogenic bladder.Poor hygiene, unprotected anal intercourse, sexual intercourse, immunosuppression, functional disability, sickle cell disease, prior antibiotic therapy, genetic predisposition, and functional or structural genitourinary tract abnormalities (including urethral strictures, uterine or bladder prolapse, ureteral weakness, and vesicoureteral reflux or renal calculi) How do men become at risk for a UTI - CORRECT ANSWER-§ UTI rarely occurs in men younger than 50yo unless caused by urinary caths, anatomical abnormalities, of urinary tract, unprotected anal intercourse, or vaginal intercourse with a woman who has a bacterial infection. most common UTI bacteria - CORRECT ANSWER-· The most common organism in adults of all ages is E. coli, which transcends across community dwelling and long-term care residing older adults. In women, approx. 80-90% of cases of uncomplicated UTI are a result of E.Coli. 2nd most common UTI bacteria - CORRECT ANSWER-· The second most common cause (5-20%) of uncomplicated bacterial infections=Staphylococcus saprophyticus diagnosis of a UTI - CORRECT ANSWER-· Diagnosis of lower UTI is made based on the subjective complaints of the patient and a clean-catch midstream urine sample showing the presence of bacteria, especially if more than 100,000 organisms/mL of the same morphology are present in a sample from a female patient. gold standard of a Lab confirmation of a UTI - CORRECT ANSWER-· Although urine culture is considered the gold standard with the greatest sensitivity for lab confirmation of URI, urinalysis with microscopy is also helpful and provides rapid results. UA typically indicates pyuria (10 neutrophils per hpf on microscopic exam) and often the presence of RBC. Hematuria is common in UTI but not with urethritis or vaginitis, however blood in the urine is not a marker of complicated infection. Hematuria is common in ________ but not with ______________ or ____________, - CORRECT ANSWER-Hematuria is common in UTI but not with urethritis or vaginitis, what amount is a significant bacteriuria? - CORRECT ANSWER-· The presence of greater than 10^ 5 colony-forming units/mL of a single bacterium in a culture of freshly voided urine is generally considered to be a significant bacteriuria what drugs are an option for a sulfa allergy? - CORRECT ANSWER-· And Fosfomycin given in a 3 g one-time dose in previous antibiotic use in past 3 months or a sulfa allergy use? - CORRECT ANSWER-In pts with sulfa allergy or previous abx use in last 3 months, use nitrofurantoin (Macrobid) · Uncomplicated treatment of UTI in the adult male can be treated empirically - CORRECT ANSWER-empirically for 7 days with a fluoroquinolone or sulfamethoxazoletrimethoprim DS.