Nur 155 Final Exam Review: Key Concepts on Diabetes and Perfusion Midlands Technical College Midlands Tech Questions And Answers With Verified Study Solutions Rated A+

Test 1 materials Cellular Regulation Diabetes (~9) Normal Glucose lvls: 70-110 mg/dl Maintain HgA1c: 7.0 Fasting (no caloric intake for at least 8hrs) • Normal: 60- 99 mg/dl • Pre-diabetes: 100-125 mg/dl • Diabetes: 125 • Random: 200 mg/dl or greater • Urine ketone test: 0.6 or lower= normal • What is Diabetes? o Metabolic Dx characterized by elevated glucose levels ● Diabetic patient (type 1 & 2): signs & symptoms; treatments; labs; complications ○ Type 1 ■ Autoimmune, born w/ it, beta cells destroyed don’t make insulin at all. ■ Age: mainly Juvenile, younger population, children, young adult ■ Rapid onset once pancreas doesn’t make enough insulin survival – DKA usually seen here- Requires exogenous insulin ● S/S: polyuria, polydipsia, polyphagia, weight los (Hx of and sudden) ■ PT TEACHING FOR Toaded_by ● Nutrition therapy: base meal plan on food intake, insulin, and exercise patterns (day to day consistency in timing makes it easier for managing BG lvls)oaded_by ● Small frequent meals w/ red. Amt of carbs ○ Type 2 (lifestyle) ■ Combination of inadequate insulation insulin secretion and insulin resistance (body tissues don’t respond to the action of insulin b/c insulin receptors are unresponsive , insufficient in #, or both) ■ Gradual onset – cells fail to utilize insulin properly- pancreas may be secreting enough insulin but the body is unable to use it to move glucose out of the blood and into the cells – presence of endogenous insulin is major distinction b/w T1&2 ■ Pple w/ metabolic syndrome has an increased risk of developing T2 diabetes( increased glucose, abodominal obesity, high BP, high level of triglycerates, low HDL — 3/5= Metabolic syndrome ■ Pt teaching for T2 ● Diet and exercise (30 min, 5 days/week of mod intensity ● resistance training recom. 3x/week unless contra. Emphasize achieving glucose, lipid, and BP ● Treat HTN, nephropathy, retinopathy, neuropathy, and dislipsedema ● Tight glycemic control is not appropriate ○ 1. Weight management (5-7% body fat) mod. Decrease in caloric intake ○ 2. OA ○ 3. Insulin therapy (order) ○ Nutrition therapy: reduce sat and trans fat, low carbs, spacing meals, spread nutrient intake t/o the day ■ Risk factors of developing T2 diabetes ● Age b/w 35 -64 (40 yrs old) ● Metabolic syndrome ● Ooaded_by ● High BMI (30 or above) ● Physical inactivity ● Poor diet ● Family HX of T2 diabetes ● Gestational diabetes during pregnancy ● Ethnic status: NA, African Americans, and hispanics. Americans are twice as likely to develop T2 diabetes compared to caucasian or asian americans ● A medical dx of prediabetes ■ S/S ● Fatigue, polyuria, polydipsia, polyphagia, vaginal infections or candida infections, blurred vision (if glucose levels are very high), skin wounds that el poorly (prolonged) - vascular or neural complications ○ Hyperglycemia (Manifestations) ■ Elevated blood glucose ■ Increase in urination , increase appetite followed by ack of appetiteweakness ■ Fatigue ■ Blurred vision, headache, glycouia, NV ■ Abdominal cramps ■ Progression of DKA (diabetic ketoacidosis) or HHS (mood swings) ○ Hypoglycemia (manifestations) ■ Cold, clammy skin ■ NEED HARD candies (5) ■ Blood glucose 70mg/dl ■ Poaded_by ■ Numbness of fingers, toes, and mouth ■ Tachycardia, diaphoresis ■ Emotional changes ■ Headache, nervousness, tremors, palpitations, faintness, dizziness ■ Unsteady gait, slurred speech ■ Hungers; changes in speech and vision, seizures, coma, confusion ○ Complications ■ Sick Day Rules for the diabetic ● Always continue take normal doses insulin and pills even if iyou cannot eat- NEVER STOP TAKING unless HCP says ● Test BG and urine ketones q3-4 hr (more often than usual) ● Known blood sugar target range ● Report elevations to provider (300 mg/dL) ● Consume 4 ozone fluid q30 min ● Maintain carb and fluid intake ● Eat small frequent meals, try to eat same amt of carbs as you normally do and follow normal meal plan closely ( if challenging: consume yogurts, applesauce , crackers , soup) — juice frown fruit bars, broth, regular soda ● Drink plenty of fluids ● Call DOCTOR if: ○ can’t keep fluids down more than 4 hrs ○ vomit of diarrhea more than 6 hrs ○ BGC: stays over 300 or below 70 ○ Cant stay awake ○ Haven’t eaten over oaded_by ● Diabetic foot are ○ Inspect feet daily ○ Avoid going barefoot ○ Clip toenails straight across ○ Inspect feet regularly ○ Wear comfy and supportive shoes ○ If burns, cuts, scrapes occur, monitor and treat promptly ■ Wash area and apply a non-abrasive or no irritating antiseptic ointment ● Cover w/ dry sterile pad ● Notify HCP if injury doesn’t begin to occur w/n 24 hrs or if signs of infection develop ● Avoid heat or cold directly to the feet ● Keep skin moisturized by aspplying cream to surfaces of the feet but not in b/w the toes ○ Carb counting (75g cap off() ■ One slice of bread ■ ½ cup starch ( pasta, rice, potatoes, beans, etc ■ 4 oz of juice ■ 5 oz cola ■ Small fruit *apples, pears, etc ○ Fast 5 (hyperglycemic episode) ■ Simple carbs: hard candies, honey, crackers/graham crackers 4 oz fruit juice, 8 oz skim milk ● Insulin & oral medication therapy & oaded_by ○ Rapid: Onset: 15 min, Peak 1 hr, Duration 3hrs ■ Lispro (Humolog) – NPH, clear ■ Aspart (nova log) – NPH, clear ■ Glulisine (Apidra) – NPH, clear ○ Short: Onset 30 min, Peak 2hr, Duration 8hr ■ Insulin IV (Regular) insulin only , clear ■ Insulin injection SQ: Novolin R (Humulin R U-500, Humalin R -NPH, clear ○ Intermediate: Onset 2 hr, Peak 8hr, Duration 16r ■ : NPH (Novolin NPH, Humuli N)- regular, hum alog, novolog, apidracloudy ○ Long : Onset 2 hrs, Peak NONE, Duration 24hrs ■ Detemir (levemir)- ONCE DAILY W/ EVENING MEAL OR BEDTIME- CLEAR ■ Glargine (lantus)- MUST NOT BE MIXED W/ ANY OTHER INSULIN OR SOLUTION – GIVEN ONCE DAILY AT THE SAME-TIME EVERYDAY ○ Rapid -acting insulins and Regular can be mixed with longer acing NPH insulin ■ Glargine cannot be mixed w/any other insulin ● Administering ○ Rotate sites: do not use the same site more than once in a 2-3 week period this PREVENTS ○ LIPODYSTROPHY (pitting of subq fat) ○ – Sites include: abdomen, arms, and thighs ○ • When mixing insulin (clear to cloudy) cle/aQ ○ • Don’t massage site after administration /increase hypoglycemia due to absorptionp