lOMoARcPSD|22896205
Lomoarcpsd|22896205
EXAM 3 170 STUDY GUIDECONCEPTS OF
MEDICAL–SURGICAL NURSING (GALEN
COLLEGE OF NURSING) EXAM 3 STUDY
GUIDE
Diabetes Mellitus
Patho: Type 1: autonomic disorder in which beta cells are destroyed. Onset is abrupt,
generally before the age of 30 ( juvenile diabetes ). Clients are insulin dependent and very
thin/skinny (due to the body using up fats/carbs).
Type 2: malfunctioned beta cells with weak insulin production. Onset is slower/progressive,
older adults with weight gain. Risk factors: BMI >25, genetic history, older age, ethnicity,
HTN + high cholesterol
Other factors that can cause increased blood glucose
¥ Steroid Therapy
¥ Atypical Anti-Depressants
¥ Mood Stabilizers ¥
Pancreatitis (with type 1)
Labs:
¥ A1C: above 6.5% is a dx of diabetes mellitus. Normal is 4-6%. Taken over a 3 month (90
day) period.
¥ Fasting blood glucose: >126 mg/dl. Normal is less than 100mg/dl. No food for 8 hours,
except water.
¥ Non-fasting glu: >200mg/dl. Normal is less than 140mg/dl.
S/S: Hyperglycemia: above 250mg/dl. Hot and dry, sugars high!
Polydipsia, Polyurea, Polyphagia. Warm + moist, kussmauls respirations (metabolic
acidosis), fruity breath, abdominal cramps, stupor, ketones in urine.
Hypoglycemia: below 70mg/dl. Cold and clammy, gimme some candy!
¥ cool, clammy, anxiety/nervous, confusion (in older adults), weakness, blurred vision,
tachycardia..
Mild: less than 60mg/DL. Hungry, irritable, shaky, weak, headache, fully conscious.
¥ treat symptoms with 10-15 g of carbohydrates glucose tablets, 1/2 cup of fruit juice,
1/2 cup of soft drink, 8 oz skim milk, 6-10 hard candies, 5 cubes of sugar ..
, lOMoARcPSD|22896205
¥ retest glucose in 15 minutes, repeat if symptoms don t resolve.
Moderate: less than 40mg/dl.cold, clammy skin, pale, rapid pulse, shallow respirations,
dizzy.
¥ treat symptoms with 15-30 g of rapidly absorbed carbs.
¥ retest glucose in 15 minutes, repeat if symptoms don t resolve.
Severe: less than 20mg/dl. Unable to swallow, unconsciousness, convulsions.
¥ administer 1mg of glucagon IM/SQ. Administer second dose in 10 minutes if pt remains
unconscious. OR dextrose 50 is pt has IV. CALL HCP IMMEDIATELY!!
Complications of Diabetes
¥ Neuropathy: Diabetes type 2 patients lose feeling in their extremities. Pain/tingling/
numbness in peripheries. High risk of feet injury. Advise patient to wear shoes at all time
of a comfortable texture such as leather. Wear different shoes every day. Wash feet with
soap and water. Wear cotton socks and change them each day. Inspect feet daily and
trim nails across. Lotion foot, but do not put lotion between toes. Don t soak feet. NO
SMOKING.
¥ Nephropathy: Kidney disease. Avoid patients to take metformin 48 hours before
ingesting and sort of contrast. Push fluids.
¥ Retinopathy: have patients get annual eye exams (every 12 months). High risk for
cataracts, glaucoma..
¥ HTN/cardiovascular diseases: promote exercise and healthy diet.
¥ DKA: sudden onset of glucose over >300mg/dl. Kussmauls respirations, fruity breath,
nausea, abdominal pain, dehydration.
Tx: EXERCISE!! 150 minutes of aerobic exercise a week. Check glucose levels before,
during, and after. Do not exercise if hypo/hyperglycemic. Do not exercise within 1 hour when
your insulin will peak. Don t take insulin immediately before an exercise. Eat a snack (carbs)
before.
DIET!!!
¥ healthy carbs: 45% (minimum of 130g/day.. Fruits, veggies, whole grains, legumes, low fat
milk),
¥ fats: 20-35% UNSATURATED or POLYSATURATED,
¥ fiber: 38g for men, 24g for women,
¥ protein: 15-20%
¥ Alcohol: 1 drink for women, 2 drinks for men. To avoid hypoglycemia, patient should
consume alcohol during or after a meal.
¥
Teaching: Check your blood glucose levels 3 times a day and before bed. Infection
control: don t share glucometer .
Sick Day Rules
, lOMoARcPSD|22896205
¥ Continue taking scheduled insulin and anti-diabetic meds
¥ Contact HCP
¥ blood glucose levels to rise due to body on the stress.
¥ check blood glucose levels more frequently (every 4 hours).
¥ Asses for ketones in urine in blood glucose is higher than 240mg/dl.
¥ if patient is vomiting, still take insulin and call HCP.
Dawn s phenomenon: Patient wakes up hyperglycemic, elevates around 5-6am. Tx:
Provide more insulin for overnight period. Give patient evening dose of intermediate-acting
insulin at 10pm, or long acting Levemir
Somogyi effect: Patient becomes hypoglycemia around 3-4am, then body tries to correct
this and patient wakes up hyperglycemic: Tx: Provide evening snack, or lower dose of
insulin overnight so patient doesn t bottom out.
INSULIN PO
Biguanides: Glucophage (Metformin): No IV contrast within 48 hours. Nephrotoxic. Weight
loss. Can cause lactic acidosis in patients with renal insuffiency.
Sulfonylureas: Glipizide, Glyburide, Glimepiride: Given 30 minutes before meals to
prevent hypoglycemia. NEVER give if patient is NPO.
TZDS: Pioglitazone, Rosiglitazone. Contraindicated in patients with heart failure due to
causing more edema.
INSULIN INJECTIONS ***KNOW ENTIRE CHART***
Insulin Onset Peak Duration
Rapid Acting: Lispro, 10-15minutes 30 minutes 3 hours
Aspart, Glusiline,
LOGS.
Given with 10 minutes
of meal. Can be stored
at room temperature
for 28 days.
Short Acting: Regular 30 minutes 8 hours 16 hours
Humulin; LINS
Given with 30 minutes
of meals. Can be
mixed with
intermediate acting
NPH. Stored at room
temp for 28 days.
Lomoarcpsd|22896205
EXAM 3 170 STUDY GUIDECONCEPTS OF
MEDICAL–SURGICAL NURSING (GALEN
COLLEGE OF NURSING) EXAM 3 STUDY
GUIDE
Diabetes Mellitus
Patho: Type 1: autonomic disorder in which beta cells are destroyed. Onset is abrupt,
generally before the age of 30 ( juvenile diabetes ). Clients are insulin dependent and very
thin/skinny (due to the body using up fats/carbs).
Type 2: malfunctioned beta cells with weak insulin production. Onset is slower/progressive,
older adults with weight gain. Risk factors: BMI >25, genetic history, older age, ethnicity,
HTN + high cholesterol
Other factors that can cause increased blood glucose
¥ Steroid Therapy
¥ Atypical Anti-Depressants
¥ Mood Stabilizers ¥
Pancreatitis (with type 1)
Labs:
¥ A1C: above 6.5% is a dx of diabetes mellitus. Normal is 4-6%. Taken over a 3 month (90
day) period.
¥ Fasting blood glucose: >126 mg/dl. Normal is less than 100mg/dl. No food for 8 hours,
except water.
¥ Non-fasting glu: >200mg/dl. Normal is less than 140mg/dl.
S/S: Hyperglycemia: above 250mg/dl. Hot and dry, sugars high!
Polydipsia, Polyurea, Polyphagia. Warm + moist, kussmauls respirations (metabolic
acidosis), fruity breath, abdominal cramps, stupor, ketones in urine.
Hypoglycemia: below 70mg/dl. Cold and clammy, gimme some candy!
¥ cool, clammy, anxiety/nervous, confusion (in older adults), weakness, blurred vision,
tachycardia..
Mild: less than 60mg/DL. Hungry, irritable, shaky, weak, headache, fully conscious.
¥ treat symptoms with 10-15 g of carbohydrates glucose tablets, 1/2 cup of fruit juice,
1/2 cup of soft drink, 8 oz skim milk, 6-10 hard candies, 5 cubes of sugar ..
, lOMoARcPSD|22896205
¥ retest glucose in 15 minutes, repeat if symptoms don t resolve.
Moderate: less than 40mg/dl.cold, clammy skin, pale, rapid pulse, shallow respirations,
dizzy.
¥ treat symptoms with 15-30 g of rapidly absorbed carbs.
¥ retest glucose in 15 minutes, repeat if symptoms don t resolve.
Severe: less than 20mg/dl. Unable to swallow, unconsciousness, convulsions.
¥ administer 1mg of glucagon IM/SQ. Administer second dose in 10 minutes if pt remains
unconscious. OR dextrose 50 is pt has IV. CALL HCP IMMEDIATELY!!
Complications of Diabetes
¥ Neuropathy: Diabetes type 2 patients lose feeling in their extremities. Pain/tingling/
numbness in peripheries. High risk of feet injury. Advise patient to wear shoes at all time
of a comfortable texture such as leather. Wear different shoes every day. Wash feet with
soap and water. Wear cotton socks and change them each day. Inspect feet daily and
trim nails across. Lotion foot, but do not put lotion between toes. Don t soak feet. NO
SMOKING.
¥ Nephropathy: Kidney disease. Avoid patients to take metformin 48 hours before
ingesting and sort of contrast. Push fluids.
¥ Retinopathy: have patients get annual eye exams (every 12 months). High risk for
cataracts, glaucoma..
¥ HTN/cardiovascular diseases: promote exercise and healthy diet.
¥ DKA: sudden onset of glucose over >300mg/dl. Kussmauls respirations, fruity breath,
nausea, abdominal pain, dehydration.
Tx: EXERCISE!! 150 minutes of aerobic exercise a week. Check glucose levels before,
during, and after. Do not exercise if hypo/hyperglycemic. Do not exercise within 1 hour when
your insulin will peak. Don t take insulin immediately before an exercise. Eat a snack (carbs)
before.
DIET!!!
¥ healthy carbs: 45% (minimum of 130g/day.. Fruits, veggies, whole grains, legumes, low fat
milk),
¥ fats: 20-35% UNSATURATED or POLYSATURATED,
¥ fiber: 38g for men, 24g for women,
¥ protein: 15-20%
¥ Alcohol: 1 drink for women, 2 drinks for men. To avoid hypoglycemia, patient should
consume alcohol during or after a meal.
¥
Teaching: Check your blood glucose levels 3 times a day and before bed. Infection
control: don t share glucometer .
Sick Day Rules
, lOMoARcPSD|22896205
¥ Continue taking scheduled insulin and anti-diabetic meds
¥ Contact HCP
¥ blood glucose levels to rise due to body on the stress.
¥ check blood glucose levels more frequently (every 4 hours).
¥ Asses for ketones in urine in blood glucose is higher than 240mg/dl.
¥ if patient is vomiting, still take insulin and call HCP.
Dawn s phenomenon: Patient wakes up hyperglycemic, elevates around 5-6am. Tx:
Provide more insulin for overnight period. Give patient evening dose of intermediate-acting
insulin at 10pm, or long acting Levemir
Somogyi effect: Patient becomes hypoglycemia around 3-4am, then body tries to correct
this and patient wakes up hyperglycemic: Tx: Provide evening snack, or lower dose of
insulin overnight so patient doesn t bottom out.
INSULIN PO
Biguanides: Glucophage (Metformin): No IV contrast within 48 hours. Nephrotoxic. Weight
loss. Can cause lactic acidosis in patients with renal insuffiency.
Sulfonylureas: Glipizide, Glyburide, Glimepiride: Given 30 minutes before meals to
prevent hypoglycemia. NEVER give if patient is NPO.
TZDS: Pioglitazone, Rosiglitazone. Contraindicated in patients with heart failure due to
causing more edema.
INSULIN INJECTIONS ***KNOW ENTIRE CHART***
Insulin Onset Peak Duration
Rapid Acting: Lispro, 10-15minutes 30 minutes 3 hours
Aspart, Glusiline,
LOGS.
Given with 10 minutes
of meal. Can be stored
at room temperature
for 28 days.
Short Acting: Regular 30 minutes 8 hours 16 hours
Humulin; LINS
Given with 30 minutes
of meals. Can be
mixed with
intermediate acting
NPH. Stored at room
temp for 28 days.
