NUR 516 Study guide with complete solution 2023

NUR 516 Study guide with complete solution 2023Review the results of the Diabetes Prevention Program Study - correct answer *** Describe the dyslipidemia and metabolic syndrome guidelines set forth by the National Cholesterol Education Program (NCEP) adult Treatment Panel (ATP). - correct answer Dyslipidemia 1. For elevated LDL-C, saturated fats and trans-fatty acids should be limited to <7% of energy requirements. 2. For elevated triglycerides, low HDL-C, and small dense LDL-C, improve glycemic control (consider insulin), modest weight reduction, dietary saturated fat restriction, and increase physical activity. Metabolic syndrome: The NCEP ATP III panel defined metabolic syndrome as the presence of three or more of the following risk determinants: 1) increased waist circumference (>102 cm [>40 in] for men, >88 cm [>35 in] for women); 2) elevated triglycerides (≥150 mg/dl); 3) low HDL cholesterol (<40 mg/dl in men, <50 mg/dl in women); 4) hypertension (≥130/≥85 mmHg); and 5) impaired fasting glucose (≥110 mg/dl) (16). Define the term cardiometabolic risk - correct answer a condition in which the possibilities of developing atherosclerotic cardiovascular (CV) disease and diabetes mellitus are significantly enhanced as a consequence of the presence of insulin resistance and atherogenic dyslipidemia, the latter being characterized by the presence of low high-density lipoprotein (HDL)-cholesterol and high triglyceride levels.1,2 Cardiometabolic risk is diagnosed by the identification of an enhanced waist circumference (above 102cm in males and 88cm in females) accompanied by the alterations in lipid profile quoted above (HDLcholesterol below 40mg/dl in males and 50mg/dl in females, and serum triglycerides above 150mg/dl). Describe the impact of the obesity epidemic on the cardiometabolic risk of the US population. - correct answer One of the main components of metabolic syndrome is abdominal obesity. Increased obesity population = increased risk for metabolic syndrome Enumerate the pathophysiologic changes of insulin resistance as related to cardiometabolic risk - correct answer The common features include obesity, rising blood glucose concentrations, increased blood insulin concentrations, increased blood triglyceride concentrations, increased small dense LDL-C, decreased HDL, HTN, heart enlargement, blood coagulation dysfunction. Discuss the roll of LDL-C as a persistent predictor of coronary artery disease and stroke. - correct answer They are considered unhealthy bc of their potential to cause atherosclerosis. Review common signs and symptoms of: a. Hypoglycemia b. Hyperglycemia c. Insulin Resistance d. Diabetes Mellitus - correct answer a. Hypoglycemia- BG below 70mg/dL; shakiness, dizziness, hunger, sweating, fast heartbeat, confusion, anxiety b. Hyperglycemia- Fasting BG above 130mg/dL, Postprandial 180mg/dL; increased thirst, urination, trouble concentrating, weight loss, DKA, blurred vision c. Insulin resistance- thirst, urination, dry patches, weight gain, HLD, HTN d. thirst, urination, confusion, weight loss, vision changes, numbness, dry skin Differentiate between pre-diabetes, diabetes mellitus, impaired fasting, impaired glucose tolerance, and metabolic syndrome. - correct answer Pre-diabetes: fasting plasma glucose 100-125mg/dL, two-hour oral glucose challenge 140-199, A1C 5.7-6.4 Diabetes Mellitus: Fasting plasma glucose >126, 2-hour oral glucose challenge >200, A1C >6.5 Impaired Fasting Glucose: fasting glucose equal or to 110-126 Impaired glucose tolerance: When the 2-hr glucose results from the oral glucose tolerance test are greater than or equal to 140 but less than 200mg/dL. Review when it is appropriate to obtain a fasting glucose versus a 2-hour oral glucose tolerance test for identification of abdominal glucose homeostasis. - correct answer The oral glucose tolerance test (OGTT) provides 1.2‐ to 3.5‐fold more diagnoses of impaired glucose homeostasis and diabetes, and adequately measures insulin sensitivity, insulin secretion, and β‐cell function. Review guidelines for diagnosis and management of an individual with diabetes mellitus. a. Type 1 b. Type 2 c. GDM d. LADA - correct answer a. Type 1- Diagnosis: Glycated hemoglobin A1C or fasting blood sugar test. Treatment: insulin, diet modification, exercise, BG test, medications b. Type 2- Diagnosis: Glycated hemoglobin A1C, fasting blood sugar test, OGTT. treatment: Check A1C 2-4x/year, weight loss, diet modification, medications, possibly insulin, sugar monitoring, exercise c. GDM: initial glucose challenge test. Treatment: lifestyle changes, NG monitoring, medication if necessary List the etiologies of type 1 versus type 2 diabetes mellitus - correct answer Type 1- once known as juvenile diabetes or insulin-dependent diabetes, is a chronic condition in which the pancreas produces little or no insulin. Type 2- chronic condition that affects the way your body metabolizes sugar (glucose) — an important source of fuel for your body. your body either resists the effects of insulin — a hormone that regulates the movement of sugar into your cells — or doesn't produce enough insulin to maintain normal glucose levels. Differentiate between central and generalized obesity - correct answer Central obesity: Central obesity is an excess accumulation of fat in the abdominal area, particularly due to excess visceral fat. As visceral fat is supplied by the portal blood system, excess fat in this area can lead to the release of fatty deposits into the bloodstream. (waist circumference, weight, height) Generalized obesity: (BMI and body fat percentage) Describe common HLA genotypes responsible for Type 1 DM - correct answer The major genetic determinants fo T1D are polymorphisms of Class II HLA genes encoding DQ and DR and a lesser extent, DP. Alleles of the class I HLA-B gene are strongly associated as well. Review the purpose of using an ACEI or ARB for hypertensive management in a patient with diabetes. - correct answer Angiotensin-converting enzyme (ACE) inhibitors were initially shown to slow the progression of established renal disease in patients with type 1 diabetes. Subsequent trials have demonstrated a similar benefit in patients with type 2 diabetes and with the use of angiotensin II receptor blockers (ARBs). The use of ACE inhibitors to prevent cardiovascular events in patients with established cardiovascular disease but not left ventricular dysfunction was established in two large randomised trials - HOPE and EUROPA. These benefits were maintained within the diabetic subgroups of these trials and appear to be independent of blood pressure lowering. The LIFE trial also provides evidence of the benefits of ARBs in reducing cardiovascular events in a high-risk population of diabetic patients with hypertension and left ventricular hypertrophy. Ideally, therefore, all diabetic patients with renal or cardiovascular disease should be treated with ACE inhibitors or ARBs. List diagnostic and hallmark features of a person with: a. Metabolic Syndrome b. Type 1 c. Type 2 d. LADA - correct answer Metabolic syndrome- abdominal adipose tissue, HTN, decreased HDL-C, elevated triglycerides, elevated BGs, insulin resistance. Type 1- Type 2- LADA- Categorize level of obesity based on BMI. - correct answer BMI 25-29.9: overweight BMI 30-34.9: obese I (low risk) BMI 35-39.9: obese II (mod risk) BMI >40: Obese III (high risk) Define gluconeogenesis - correct answer Pathway used by cells in the liver to create glucose from non-carbohydrate molecules such as amino acids Describe the level of beta cell function at diagnosis of type 1 and type 2 diabetes. - correct answer pg 49 of text Determine when it is appropriate to measure a C-peptide level. - correct answer C-peptide, which is cosecreted with insulin in equimolar concentrations, can be assessed more accurately and with higher reproducibility and greater sensitivity (10-fold) and has been recommended as the appropriate outcome measure for future clinical trials aimed at preserving β-cell function (13). The long half-life of C-peptide, however, makes evaluation of changes in insulin secretion over short time intervals under non-steady-state conditions difficult. There is substantial overlap between C-peptide levels in Type 1 and Type 2 diabetes close to diagnosis and this will be greatest in obese or older patients in whom the clinical differentiation of Type 1 and Type 2 diabetes is most difficult [18,19,67]. In Type 1 diabetes, insulin/C-peptide levels rapidly fall, therefore the utility of C-peptide testing increases from 3 to 5 years post-diagnosis, where the vast majority of patients with Type 1 diabetes will have low C-peptide levels (Figs 2 and and3)3) [23,65].