NR 325 EXAM 1 NR 325 EXAM 1 REVIEW

NR 325 Exam 1 Material:

Endocrine:
 Diabetes Mellitus:
o Impaired glucose regulation
o Hyperglycemia form abnormal insulin production or impaired
insulin use
o 7th leading cause of death in US
o Affects function of all cells and tissues
o Managed by – diet, exercise, medication
o Either not producing insulin well, or you have an inability to use
insulin properly
o Affects every part of the body and body system
 Pathophysiology:
o Beta and Alpha cells are made by the Islet of Langerhans’s
o Beta cells
 Insulin and amylin
 Insulin
 allows the uptake of glucose into the cells – give
insulin for treatment, cells will no longer be starving
and will have energy
 hormone made by the beta cells in the pancreas
 key to let glucose get into the cell
 Liver and brain – do not use insulin to import glucose
 Two phase release of insulin
 Basal rate – normally released into the blood in small
amounts
 With meals – pancreas increased release when food
is ingested
 Normal levels – 70-100
o Alpha cells
 Release glucagon
 Glucagon – release of glucose from the liver and
skeletal muscle
o Opposite of insulin, it increases blood sugar
o Work against insulin
o Increase blood glucose by stimulating glucose
production and release and decreasing
movement of glucose into the cell

,  Glucose – broken down for energy inside the cell
 Excess is stored in the liver and muscle cells as glycogen
 Classifications:
o Pre-Diabetes:
 Can lead to Diabetes if lifestyle changes do not occur
 2 hour GTT of 140-199mg/dL
 FBS of 100-125mg/dL
 A1C of 5.7% - 6.4%
 Monitor and educate S/S that they are now diabetic
 Usually asymptomatic
 May/may not require medications
 Treatment:
 Lose 5-10% of body weight
 Exercise 30 mins a day
 Diet – low fat protein, lots of veggies, plenty of fiber
o Limit portion size, calories, sugar and carbs
o Carb counting
o Eat Omega 3 fatty acids
 Medications:
o Metformin – does not increase insulin
production
 Decreases liver glucose production
 Decrease intestinal production
 Decreases intestinal absorption of
glucose
 Improve insulin sensitivity
 Why it needs to be withheld for surgical
patients and those receiving contrast dye
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o Type 1 DM:
 Idiopathic
 Beta cell destruction – no insulin at all
 Autoimmune – body develops antibodies against beta cells
 Destruction of beta cells
 Often diagnosed when in ketoacidosis
 S/S
 Polyuria – increase urination
o Since there is excess sugar in the blood, the
body is trying to compensate by peeing it out
 Osmotic diuresis

,  Large amounts of dilute urine are voided
 Polydipsia – increase thirst
o Patient is very dehydrated from peeing so often
that the body tries to compensate by
increasing thirst to help get fluid back into the
body
 Polyphagia – increase hunger
o Cells are starving because glucose cannot get
into them, body compensates by eating more
to try to get more energy
 *Hallmark* - Weight loss, fatigue, increase in
frequency of infections (sugary blood attracts
bacteria and bugs), slow healing wounds
o More prone to UTI, yeast infections, etc.
 Peak incidence is 10-15 years, familial tendency, rapid
onset
 Will require lifelong insulin therapy – needed to sustain life
 3-12 months after diagnosis – honeymoon period occurs
 Nutrition
 Carb counting to determine insulin – pump
o *hallmark* 1 unit of rapid acting insulin for
15g of a carb
o Take glucose before meals and 2 hours after
 Exercise
 Need insulin for physical activity
o if no insulin, body will use fats for energy and
go into ketosis
o glucose levels need to be >100mg/dL
 best time to exercise – 30 mins to 1 hour after meals
 drugs:
 insulin replacement therapy – check sugar levels at
peak
o types
 Lispro – 15-30 min
 Peaks in 30 mins to 2.5 hours
 Check at 1-1.5 hours
 Regular – 30-60 min
 Peak in 1-5 hours
 NPH – 60-120 min
 Peak in 6-14 hours