NR 601 2023/2024

NR 601 2023/2024 prediabetes -CORRECT ANSWER-impaired fasting glucose: fasting glucose is consistently elevated above normal range but below 100 and 125 mg/dL impaired glucose tolerance: state of hyperglycemia where a 2-hour post glucose load glycemic level is 140-199 mg/dl type 1 diabetes -CORRECT ANSWER-characterized by severe insulin deficiency resulting from beta cell destruction producing hyperglycemia due to altered metabolism of lipids, carbs, and proteins immune mediated DM (type 1A)- 90% of cases; autoimmune destruction of insulin producing pancreatic beta islet cells; triggering factor: infection (rubella, Coxsackie before virus, cytomegalovirus, adenovirus, mumps virus) or toxic insult with genetic predisposition idiopathic DM (type 1B)- inherited; more common in people of Asian, African, or Hispanic origin type 1 diabetes - risk factors -CORRECT ANSWER-* 60% of patients are 18 years old Caucasian of European descent 1.5-2X more common *High birth weight 4,000 g; higher than expected weight gain in first year of life * protein components of cow's milk * intro of gluten and rice containing cereals before 3 months or after 7 months type 1 diabetes - presentation -CORRECT ANSWER-polyuria, polyphagia with paradoxical weight loss, polydipsia, visual changes, fatigue, weakness signs of dehydration such as poor skin turger, and dry mucous membranes signs of severe ketosis (DKA): extreme fatigue, abnormal cramping, alterations and breathing pattern, and telltale sign of halitosis Hg A1C gives insight into glycemic control over what time period? -CORRECT ANSWER-2 to 3 months initial goal of treatment for type 1 diabetes -CORRECT ANSWER-plasma glucose level 80-130 mg/dl before meals, postprandial (1-2hrs after beginning of a meal) glucose level 180 mg/dl, and a1c 7% for adults lab values for DKA -CORRECT ANSWER-hyperglycemia - BG 359 mg/dl ketonemia - plasma ketone 5 mmol/L acidosis - bicarbonate 9 mEq/L goals of glucose management in type 1 diabetes -CORRECT ANSWER-before meals: 80-120 mg/dL postprandial: less than 180 mg/dL bedtime: 100-140 mg/dL management of hypoglycemia -CORRECT ANSWER-1/2 cup of fruit juice 6 oz of regular soda when cup milk glucose tabs recheck blood sugar after 15 minutes and give additional carbs if BG less than 70 number of kilocalories needed to maintain current weight -CORRECT ANSWER-men col on 66 + 13.7(WT in kg) +5(by in cm) -6.8(age) women: 65 + 9.6(at in kg) + 1.7(ht in cm) -4.7 (age) guidelines regarding exercise to regulate glycemic response -CORRECT ANSWERcheck BG before, q30-60 min, and after exercise avoid exercise if fasting BG greater than 250 and ketosis; or if BG greater than 300 consume additional carbs if BG less than 100 and PRN type 2 diabetes -CORRECT ANSWER-characterized by abnormal secretion of insulin, resistance to action of insulin in target tissues, and/or inadequate response to level of insulin receptor diabetes- risk factors -CORRECT ANSWER-95% of people diagnose with DM stronger genetic predisposition than T1DM first degree relatives with T2DM have 5-10 fold higher risk BMI greater than 25 age greater than 45 PCOS hyperlipidemia HYN HX of GDM AA, Latino, NA, Asian Am, Pacific islander type 1 diabetes-diagnostic criteria -CORRECT ANSWER-* glycosylated hemoglobin A1C of 6.5% or higher * symptoms of diabetes plus random plasma glucose level of 200 mg/dl or higher * fasting plasma glucose of 126 mg/dl or higher (following 8 hours NPO) * 2-hour plasma glucose of 200 mg/dl or higher during OGTT with 75 g glucose load type 2 diabetes - diagnostic criteria -CORRECT ANSWER-capillary BG level A result of $200 or greater should be followed up with whole blood sample for lab-based criteria to confirm DM: 1. A1C level greater than or equal to 6.5% 2. random glucose of 200 and presence of classic symptoms 3. 8-hr fasting glucose of 126 or higher on two occasions 4. 2-hour post load glucose level of 200 or higher during OGTT (75 g) type 2 DM-presentation -CORRECT ANSWER-pruritus fatigue neuropathic complaints: numbness or tingling, blurred vision obese HX of dyslipidemia, HTM, CAD abnormal healing, increase occurrence of infection prediabetes - initial treatment recommendations -CORRECT ANSWERtype one diabetes - first line treatment -CORRECT ANSWER-insulin therapy type 2 diabetes - first line treatment -CORRECT ANSWER-lifestyle Management, nutritional therapy, physical activity, medication if weight loss indicated: caloric restriction of 500-700 calories less than average daily intake exercise: 150 minutes per week of moderate-intensive physical effort, 3x per week; flexibility and balance training 2-3X per week for older adults metformin- first line of pharmacological treatment; 500 mg daily with breakfast or dinner for one week, then bid with breakfast and dinner insulin diabetes - HB A1C goals based on complications -CORRECT ANSWER-healthy older adult: fasting of 90-130 and HB A1C target of less than 7.5% intermediate complex: fasting of 90 to 150 and HB A1C less than 8% very complex older adult: fasting of 100-180 and HB A1C Target of less than 8.5% diabetes - goals of treatment -CORRECT ANSWERweight loss recommendations to decrease risks related to diabetes -CORRECT ANSWER-weight loss of 5% can improve glycemic control diabetes- common medication side effects with risk factors -CORRECT ANSWERmetformin -diarrhea, nausea, anorexia, abdominal discomfort CONTRAINDICATED: renal disease sulfonylureas- hypoglycemia, mild GI upset, weight gain, skin rashes; CONTRAINDICATED: impaired liver or kidney function, type 1 DM or DKA Acarbose and miglitol- flatulence and diarrhea; CONTRAINDICATED: DKA, IBS, colonic ulceration, intestinal obstruction, chronic intestinal disease thiazolidinediones, pioglitazone, and rosiglitazone- weight gain, upper respiratory tract infection, edema, fluid retention, anemia, hypoglycemia; CONTRAINDICATED: liver disease, NYHA class III or IV heart failure DPP4-Is and GLP1 analogues- Steven Johnson syndrome, nasopharyngitis, abdominal pain, hypoglycemia when used with sulfonylureas; CONTRAINDICATED: family HX of multiple endocrine neoplasia syndrome, medullary thyroid carcinoma SGLT2s-mycotic urinary and genital infections, renal failure, ketoacidosis, pancreatitis; CONTRAINDICATED: CHF, nephrotoxicity, volume depletion maglitonides - nausea and orthos diabetes is the leading cause of which complication -CORRECT ANSWER-end stage renal disease and acquired blindness complications related to diabetes -CORRECT ANSWER-cardiovascular and peripheral vascular disease, decreased immune system function, renal failure, retinopathy, and nephropathy diabetes- annual evaluations -CORRECT ANSWER-blood pressure, review of home glucose monitoring, review of medications, examination of feet, annual eye exam including dilation, routine urinalysis including eval for albuminuria and albumin:creatinine ratio, serum creatinine levels and eGFR, annual ECG and fasting lipid profile, HB A1C every 3-6 months, eval for neuro complications, self-management education, immunization update including flu and pneumococcal, biannual oral exam diabetes- required follow-up at each visit -CORRECT ANSWER-evaluate every three months for older patients and patients on insulin therapy follow up at one month if sudden change and health status or treatment regimen evaluate response, tolerability to therapy, goal reassessment, and management of acute and chronic complications, home glucose monitoring, and HB a1c treatments for complications- referrals -CORRECT ANSWER-endocrinologist: ketoacidosis, severe hyperglycemia, or hypoglycemia; fasting glucose level consistently greater than 300 or HP A1C greater than 13% comorbidities related to obesity -CORRECT ANSWER-CHD, hypertension, hyperlipidemia type 2 DM, cerebrovascular disease, CKD physical disability, sexual dysfunction, lower UTI symptoms, impaired cognitive function, and dementia BMI classifications -CORRECT ANSWER-underweight: 18.5 normal: 18.5-24.9 overweight: 25-29.9 class I obesity: 30 - 34.9 class II obesity: 35 - 39.9 class III extreme obesity 40 UTI - risk factors (differences based on gender) -CORRECT ANSWER-20% women / 1% men sexually active, adults, very young children, frail older adults predisposing conditions: suppressed immune system, pregnancy, urinary obstruction, catheter dependency, neurogenic bladder, DM UTI - pathophysiology + common bacterial causes -CORRECT ANSWER-poor perennial hygiene, unprotected sex, shorten urethra in women, use of spermicide that alters microenvironment, immunosuppressed, alkaline urine in DM e coli Gram+ staphylococcus saprophycticus Proteus mirabilis klebsiella enterobacter serriata pseudomonas Candida species UTI-diagnostic criteria + when to treat -CORRECT ANSWER-subjective complaints + clean catch midstream urine sample with presence of bacteria 100,000 organisms/mL UTI-medications -CORRECT ANSWER-uncomplicated: TMP-SMX (bactrim) 3-day course or ampicillin 10 days or a nitrofurantoin (macrobid) 7-day course complicated: bactrim 14 days, or augmentin 10 days UTI- complications of untreated UTI -CORRECT ANSWER-pollinopritus, sepsis, shock, death Incontinence (risk factors) -CORRECT ANSWER-women, long-term care facilities, increased age types of incontinence -CORRECT ANSWER-stress- r/t hypermobility of bladder neck; vag delivery, cough, sneeze urge - r/t UTI, bladder stones, Parkinson's, MS; history of dysuria, frequency, urgency, hematuria, or nocteria overflow -r/t failure to empty bladder/underactive detrusor activity, obstruction, DM; Ajax of hesitancy, dribbling, decreased stream functional- r/t delirium, fecal impaction, lack of dexterity, decrease mobility Causes of hematuria -CORRECT ANSWER-infection, menstruation, vigorous exercise, viral illness, and trauma hematuria - urethral origin -CORRECT ANSWER-urethritis stricture calculus trauma hematuria - prostatic or genitourinary origin -CORRECT ANSWER-infection- prostatitis, epididymitis bph tumor hematuria-renal origin -CORRECT ANSWER-infection-pyelonephritis nephrolithiasis renal cell cancer trauma ischemia hematuria- ureters origin -CORRECT ANSWER-nephrolithiasis, tumor, endometriosis hematuria- bladder -CORRECT ANSWER-infection, calculus, tumor, endometriosis, drugs hematuria-functional origin -CORRECT ANSWER-intense exercise pseudohematuria -CORRECT ANSWER-menstrual contamination, red food dye, beet consumption, quinine, rafampin, phenothiazines hematuria - RBC indices -CORRECT ANSWER-RBC casts usually indicate injury to nephron and our diagnostic to renal origin RBC's with no cash suggest origination in lower urinary tract hematuria with colicky flank pain -CORRECT ANSWER-ureteral stone causes of proteinuria -CORRECT ANSWER-usually indicative of renal pathology, most often glomerular origin acute illness, emotional stress, excessive exercise multiple myeloma - Bence Jones proteins lymphosarcoma, Hodgkin's disease, and leukemia proteinuria - diagnostics -CORRECT ANSWER-24-hour urine 160 milligrams in urine over 24 hours is abnormal 3.5 grams in urine indicative of nephrotic disease Bence-Jones proteinuria -CORRECT ANSWER-elevated plasma concentration multiple myeloma, leukemia, lymphosarcoma, Hodgkin's disease Tamm-Horsfall proteinuria -CORRECT ANSWER-increase tubular cell secretion normal mucoprotein in urine proteinuria- tubulointerstitial area involvement -CORRECT ANSWER-decrease tubular reabsorption of normal filtered protein