NUR 257 Chronic Aging Exam 3 Study Guide
Unit 6
Chapter 20 Metabolic Disorders
A1C greater than 6.5% is a diagnosis of DM Notes from key
concepts:
Type 1 vs Type 2
Type 1: Is an autoimmune disorder. Usually diagnosed in younger than 30. Classic signs: 3 P’s.
Sudden weight loss, delayed wound healing.
Type 2: Insulin resistance, this is a progressive disorder. Often subtle or absent. Blurred vision,
cardiovascular and neurological complications. Most older people don’t get this diagnosis until
there is serve organ damage.
A1C is the average over 90 days prior
Signs of End-Organ damage in diabetes: decreased visual acuity, paresthia, neuropathy, heart
disease, stroke and periodontal disease.
Notes from the textbook boxes:
• Box 20.1: Symptoms of hypothyroidism: Differences in older adults compared with
younger adults Less common: Fatigue, weakness, depression, dry skin, constipation
• Box 20.2: Appropriate Administration of Levothyroxine: Levothyroxine should be taken
early in the morning, on empty stomach and at least 30 minutes before a meal with a
full glass of water.
• Box 20.5: Factors contributing to increase incidence of Hypoglycemia in older adults:
Multiple comobidities, presence of geriatric syndromes, frequency of frailty,
polypharmacy, long duration of illness, and prevalence of rank and hepatic disease
• Box 20.6 Risk factors for Diabetes Mellitus:
o Non-modifiable: High-risk population, more than 45 years old, first degree
relative with DM, Baby over 9lbs, Hx of cardiovascular disease, taking atypical
antipsychotics or glucocorticoids
o Modifiable: Blood pressure >140/90, Prediabetes, Overweight
BMI >25, Undesirable lipid levels, inactivity
, Box 20.11 Minimizing cardiovascular risks in persons with diabetes: Eat a healthy
diet, Renault exercise (at least 150 minutes/week), keep blood pressure <140/90,
stop smoking, A1C <7% , and acceptable lipid levels.
• Box 20.12 Complications of DM more common in older adults: dry eyes, dry mouth,
confusion, incontinence, weight loss, anorexia, dehydration, delirium, nausea and
delayed wound healing.
• Any time a person shows signs of depression, a-fib, dementia or confusion a thyroid
disturbance should be considered.
Notes from Test-bank:
• True statements about DM: Diabetes is diagnosed after two fasting plasma glucose
readings over 125 mg/dl. Type 2 diabetes is present when insulin is produced but does
not lower the blood glucose level.
• To reduce the risk for diabetes and heart disease the serum triglycerides value should be
under 250mg/dl. Fasting glucose should be under 125mg/dl.
• While taking anti diabetic drugs the patient should eat the same amount and quality of
food every day, should eat meals and snacks at the same time every day is important.
The patient should consult with a dietician for meal planing.
• If a patient with newly diagnosed type 2 DM still has questions about their diet and
exercise the nurse should contact the PCP regarding the most recent orders.
• Exercise is good for patient who has DM. A decrease in exercise is going to greatly
impact the body’s hormone response.
• Stress increase insulin resistance, and exercise is going to decrease insulin resistance.
• A delay in diagnosis is the older adult population of DM2 is related to the fact that there
are usually few, if any, symptoms until severe organ damage has been done.
• Care plan for a patient with type 2 DM should include the following interventions: Teach
to prevent hypoglycemia, emphasis the role of physical exercise review the
manifestations of complications and instruct in self-monitoring of blood glucose levels.
• A patient with type 2 DM needs to prevent hyperglycemia, which will help delay the
onset of micr vascular complications. These are diabetic retinopathy, nephropathy,
neuropathy.
Teaching plan for foot care for a patient with type 2 DM.: make sure footwear fits
properly and has even patterns. Check their feet daily, ask family yo help them or use a
mirror that is not shatter-able
• If a patient who has type 2
• DM is acutely ill with a cold or other illness, they can not follow sick day rules, the first
action is for them to call the PCP
Unit 6
Chapter 20 Metabolic Disorders
A1C greater than 6.5% is a diagnosis of DM Notes from key
concepts:
Type 1 vs Type 2
Type 1: Is an autoimmune disorder. Usually diagnosed in younger than 30. Classic signs: 3 P’s.
Sudden weight loss, delayed wound healing.
Type 2: Insulin resistance, this is a progressive disorder. Often subtle or absent. Blurred vision,
cardiovascular and neurological complications. Most older people don’t get this diagnosis until
there is serve organ damage.
A1C is the average over 90 days prior
Signs of End-Organ damage in diabetes: decreased visual acuity, paresthia, neuropathy, heart
disease, stroke and periodontal disease.
Notes from the textbook boxes:
• Box 20.1: Symptoms of hypothyroidism: Differences in older adults compared with
younger adults Less common: Fatigue, weakness, depression, dry skin, constipation
• Box 20.2: Appropriate Administration of Levothyroxine: Levothyroxine should be taken
early in the morning, on empty stomach and at least 30 minutes before a meal with a
full glass of water.
• Box 20.5: Factors contributing to increase incidence of Hypoglycemia in older adults:
Multiple comobidities, presence of geriatric syndromes, frequency of frailty,
polypharmacy, long duration of illness, and prevalence of rank and hepatic disease
• Box 20.6 Risk factors for Diabetes Mellitus:
o Non-modifiable: High-risk population, more than 45 years old, first degree
relative with DM, Baby over 9lbs, Hx of cardiovascular disease, taking atypical
antipsychotics or glucocorticoids
o Modifiable: Blood pressure >140/90, Prediabetes, Overweight
BMI >25, Undesirable lipid levels, inactivity
, Box 20.11 Minimizing cardiovascular risks in persons with diabetes: Eat a healthy
diet, Renault exercise (at least 150 minutes/week), keep blood pressure <140/90,
stop smoking, A1C <7% , and acceptable lipid levels.
• Box 20.12 Complications of DM more common in older adults: dry eyes, dry mouth,
confusion, incontinence, weight loss, anorexia, dehydration, delirium, nausea and
delayed wound healing.
• Any time a person shows signs of depression, a-fib, dementia or confusion a thyroid
disturbance should be considered.
Notes from Test-bank:
• True statements about DM: Diabetes is diagnosed after two fasting plasma glucose
readings over 125 mg/dl. Type 2 diabetes is present when insulin is produced but does
not lower the blood glucose level.
• To reduce the risk for diabetes and heart disease the serum triglycerides value should be
under 250mg/dl. Fasting glucose should be under 125mg/dl.
• While taking anti diabetic drugs the patient should eat the same amount and quality of
food every day, should eat meals and snacks at the same time every day is important.
The patient should consult with a dietician for meal planing.
• If a patient with newly diagnosed type 2 DM still has questions about their diet and
exercise the nurse should contact the PCP regarding the most recent orders.
• Exercise is good for patient who has DM. A decrease in exercise is going to greatly
impact the body’s hormone response.
• Stress increase insulin resistance, and exercise is going to decrease insulin resistance.
• A delay in diagnosis is the older adult population of DM2 is related to the fact that there
are usually few, if any, symptoms until severe organ damage has been done.
• Care plan for a patient with type 2 DM should include the following interventions: Teach
to prevent hypoglycemia, emphasis the role of physical exercise review the
manifestations of complications and instruct in self-monitoring of blood glucose levels.
• A patient with type 2 DM needs to prevent hyperglycemia, which will help delay the
onset of micr vascular complications. These are diabetic retinopathy, nephropathy,
neuropathy.
Teaching plan for foot care for a patient with type 2 DM.: make sure footwear fits
properly and has even patterns. Check their feet daily, ask family yo help them or use a
mirror that is not shatter-able
• If a patient who has type 2
• DM is acutely ill with a cold or other illness, they can not follow sick day rules, the first
action is for them to call the PCP
