EMS 202 Final Exam with 100% Correct Answers Latest 2024 (Graded A+)

EMS 202 Final Exam with 100% Correct Answers Latest 2024 (Graded A+) Diabetes Definition - Correct Answer-chronic, progressive disease characterized by the body's inability to digest carbohydrates (CHO), fats, and proteins leading to hyperglycemia Types of Diabetes - Correct Answer--Type 1 -Type 2 -Pre Diabetes--impaired glucose tolerance test (140-199) and impaired fasting glucose (100-125) -Gestational Diabetes--develops in 2-5% of pregnant women -Diabetes Insipidus--brain problem, not a pancreas problem Pathophys of Type 1 DM - Correct Answer--autoimmune process triggered by environmental factors that destroy Beta cells -genetic predisposition (HLA-DR) and environmental factors (viruses) leads to destruction of pancreatic Beta cells (Absolute insulin deficiency) Pathophys of Type 2 DM - Correct Answer--Beta cells become less efficient in responding to chronically high glucose levels -Beta cells are not all completely destroyed, some insulin is available -Beta cell desensitization + peripheral insulin resistance leads to gradual decrease in function of Beta cells What happens in insulin resistance? - Correct Answer--Reduced ability of most cells to respond to insulin -Poor control of liver glucose output -Decreased beta cell function Proinsulin - Correct Answer-It is a precursor to insulin, it's converted in the beta cells into an equal amount of insulin and c-peptide Risk factors for type 2 DM - Correct Answer--heredity, esp. 1st degree relative -ethnic background (African Americans) -Physical inactivity -Having a baby 9 lbs. -High TRG levels -Hx of polycystic ovaries -Taking steroids, glucoagon, or thiazide meds -Syndrome X (Metabolic syndrome) Abdominal Obesity High TRG 150 HTN Hyperglycemia 110 Preventing Type 2 DM - Correct Answer--periodic screening (FBS, TRG) -committed screening if you have a family hx -exercise -avoid concentrated glucose sources in mass quantities Diagnosing DM - Correct Answer-1. FBS or equal to 126 on at least two different occasions 2. Random or casual glucose 200 3. Oral Glucose Tolerance Test (results outlined below) Oral Glucose Tolerance Test Results - Correct Answer-2 hr post prandial BG 140 = normal 2 hr post prandial BG 140-199 = prediabetes 2 hr post prandial BG 200 or greater = Diabetes S&S of Hypoglycemia ( 70) - Correct Answer-nervousness/anxiousness sweating shaking/tremors irritability tachycardia headache confusion/drowsiness slurred speech blurred vision coma seizure death S&S of Hyperglycemia (250) - Correct Answer-Elevated BG Increased appetite followed by lack of appetite N/V Dry/Flushed Skin Kussmaul's Respirations Frequent urination Increased thirst Blurred vision Fatigue Headache Fruity-smelling breath Nausea and vomiting Shortness of breath Dry mouth Weakness Confusion Coma Abdominal pain The Liver and Hyperglycemia - Correct Answer--The liver plays a role in CHO metabolism. This includes storing and releasing glycogen as the body needs it -Glycogen turns into glucose (glycogenolysis) -If liver glucose is not available, fats and proteins will be broken down and used for fuel Ketones - Correct Answer--substance that is produced when fat is used instead of glucose for cellular energy -They collect in the blood and can decrease the pH, leading to metabolic acidosis (Diabetic Ketoacidosis) What happens when insulin is deficient? - Correct Answer--When insulin is deficient, fats break down releasing fatty acids. These acids convert to ketone bodies and provide a backup energy source Protein as Fuel in DM - Correct Answer--Protein from muscle can also be used as fuel -Increased glucose levels lead to protein wasting as the body turns to muscle for energy. Kidney excretion of protein is called, proteinuria How the kidneys respond to high BG - Correct Answer--high blood glucose levels will be excreted via the kidneys in the urine (glycosuria) -kidneys will also excrete ketones in the urine when the BG level reaches about 300. This is called ketonuria Insulin for Type 1 and Type 2 Diabetes - Correct Answer-Type 1-The pt MUST take insulin Type 2-involves lifestyle adjustment (initially), oral meds, and may involve eventual use of insulin or all three at some point in the disease process (DO NOT necessarily need insulin) Insulin - Correct Answer--chemically made by recombinant DNA technology (Human insulin) -various durations of action (rapid, short, intermediate, long acting) Insulin--Rapid Acting - Correct Answer-Humalog (lispro), Novolog (aspart) O: 5 minutes P: 1 hour D: 2-4 hours *Administer immediately before eating 3 P's (Hyperglycemia) - Correct Answer--Polyphagia -Polydipsia -Polyuria Insulin--Short Acting - Correct Answer-Humulin R, Novolin R O: 30 mins to 2 hours P: 4-10 hours D: 10-16 hours *Administer 30 minutes before eating Insulin--Intermediate - Correct Answer-Humulin (NPH), Humulin L (Lente) O: 2-4 hours P: 4-10 hours D: 10-16 hours *2/3 in the morning, 1/3 in the afternoon. Start at 1/2 a unit/kg/day Insulin--Intermediate Mixed - Correct Answer-Humulin 70/30 (70% intermediate, 30% regular) O: 1/2-1 hour P: Dual D: 10-16 *Administer 30 mins before breakfast and dinner Negative Feedback System in DM - Correct Answer--Low glucose tells pancreas to release glucagon from Alpha cells, which stimulates the liver to release glucose High glucose tells beta cells to release insulin, which lowers BG Insulin--Long Acting (Basal) - Correct Answer-Levemir (Detemir), Lantus (Glargine) O: 3-4 hours P: 3-14 hours (Detemir) No peak (Lantus) D: 24 hours *Administer usually once daily at same time, never mix with other insulins! Administration of Insulin - Correct Answer--When mixing insulins, put air in intermediate insulin vial first, then push air into rapid/regular insulin and withdraw rapid/regular first (fast first) *never mix any insulin with Lantus/Levemir *regular insulin can also be given intravenously