1
Exam 3:
Diabetes
1. List the common risk factors for Type 2 diabetes. (1307)
a. obesity, physical inactivity, hypertension
b. first degree relative with diabetes, bad cholesterol levels, polysistic ovary syndrome,
history of vascular disease.
2. List the signs and symptoms of both hyperglycemia and hypoglycemia. (1330)
a. Hypoglycemia: weakness, fatigue, difficulty thinking, confusion, behavior changes,
emotional instability, seizures, loss of consciousness, brain damage, death, shaky, heart
pounding, anxious, sweaty, hungry, tingling.
b. Hyperglycemia: warm, moist skin, dehydration, rapid deep breathing, fruity breath,
mental status varies, abdominal cramps, n/v, orthostatic hypotension, turgor, ketones
positive.
3. What is the diagnostic criteria for diabetes? (1308)
a. A1C: >6.5%
b. Fasting blood glucose >126mg/dl
c. 2 hour blood glucose equal to or greater 200mg/dl
d. Patient with manifestations hyperglycemia, random blood glucose >200mg/dL.
e. Classic symptoms diabetes= polyuria, polydipsia, unexplained weight loss.
4. A patient is being prescribed insulin for the first time. What key teaching items need to be
included? (1313-1319)
a. Insulin types, injection technique, site of injection, and patient response all affect
abdorption, onset, degree, and duration of insulin activity.
b. Changing insulins can affect blood glucose levels.
c. How to adjust insulin doses, understand nutrition therapy and monitor blood glucose
levels accurately. Must adhere to insulin schedule.
d. Don’t mix any other insulin with premixed insulin.
e. Refrigerate insulin not in use to maintain potency, prevent exposure to sunlight, and
inhibit bacterial growth. Always have a spare bottle of each insulin. Insulin is bad after 30
days. Store prefilled syringes upwards to prevent needles clogging. Roll don’t shake
prefilled syringes.
f. Subcutaneous Insulin Administration
i. Wash your hands.
ii. Inspect the bottle for the type of insulin and the expiration date.
iii. Gently roll the bottle of intermediate-acting in the palms of your hands to mix
the insulin.
iv. Clean the rubber stopper with an alcohol swab.
v. Remove the needle cover, and pull back the plunger to draw air into the syringe.
The amount of air should be equal to the insulin dose. Push the needle through
the rubber stopper, and inject the air into the insulin bottle.
vi. Turn the bottle upside down, and draw the insulin dose into the syringe.
vii. Remove air bubbles in the syringe by tapping on the syringe or injecting air back
into the bottle. Redraw the correct amount.
viii. Make certain the tip of the plunger is on the line for your dose of insulin.
Magnifiers are available to assist in measuring accurate doses of insulin.
,2
ix. Remove the needle from the bottle. Recap the needle if the insulin is not given
immediately.
x. Select a site within your injection area that has not been used in the past month.
xi. Clean your skin with an alcohol swab. Lightly grasp an area of skin, and insert the
needle at a 90-degree angle.
xii. Push the plunger all the way down. This will push the insulin into your body.
Release the pinched skin.
xiii. Pull the needle straight out quickly. Do not rub the place where you gave the
shot.
xiv. Dispose of the syringe and needle without recapping in a puncture proof
container.
g. NURSING SAFTEY PRIORITY!
i. Albiglutide (Tanzeum) is only administered once per week, not daily like other
incretin mimetics.
ii. All four DPP-4 inhibitors and the incretin mimetics liraglutide are associated with
an increased risk for pancreatitis. Warn patients taking these drugs to
immediately report these manifestations to the HCP: Jaundice; sudden onset of
intense abdominal pain that radiates to the back, left flank, or left shoulder; or
gray-blue discoloration of the abdomen or periumbilical area.
iii. Do not mix pramlintide and insulin in the same syringe because the PH of the
two drugs is not compatible.
iv. Do not mix any other insulin type with insulin glargine, with insulin detemir, or
with any other of the premixed insulin formulations, such as Humalog Mix
75/25.
v. Prevent hypoglycemia by ensuring that appropriate blood glucose testing
products are used for patients receiving parenteral maltose, parenteral
galactose, and oral xylose products.
vi. Teach patient with history of hypoglycemic unawareness NOT to test at
alternative sites.
5. What does a diabetic patient need to know before exercising? (1321-1322)
a. Wear appropriate footwear, examine feet regularly.
b. Stay hydrated, don’t exercise in extreme temps
c. Don’t exercise within 1 hour of insulin ejection or near peak time of insulin
d. Don’t exercise unless blood glucose is atleast 80 and less than 250
i. Have a carb snack before exercising if 1 hour has passed since last meal
ii. Carry simple sugar to eat during exercise if hypoglycemia happens
iii. Carry identification that you have diabetes
e. Check glucose levels more frequently on days of exercise , extra carbs and less insulin
may be needed during 24 hours after extensive exercise.
6. What are the “sick day” rules for diabetic patients? (1335)
a. Notify MD if your ill
b. Monitor glucose every 4 hours; test urine for ketones when glucose above 240
c. Continue to take insulin, drink 8 to 12 oz sugar free liquids every hour awake
d. Eat meals at regular times, if can’t do solid foods eat more easily tolerated foods with
the same amount of carbs
e. Call DR if:
, 3
i. Nausea/vomiting, moderate or large ketones, glucose elevation after 2
supplemental insulin doses, high temp/fever over 24hours (101.5)
7. What does a diabetic patient need to know about foot care? (1325-1327)
a. Foot injury most common complication of diabetes leading to hospitalization.
Assessment
o Assess the patient for risk for diabetic foot problems:
History of previous ulcer
History of previous amputation
Assess the foot for abnormal skin and nail conditions:
Dry, cracked, fissured skin
Ulcers
Toenails: thickened, long nails; ingrown nails
Tinea pedis; onychomycosis (mycotic nails)
o Assess the foot for status of circulation:
Manifestations of circulation
Presence or absence of dorsalis pedis or posterior tibial pulse
Prolonged cap refill time (greater than 25 seconds)
Presence or absence of hair on the top of the foot
o Assess the foot for evidence of deformity:
Calluses, corns
Prominent metatarsal heads (easily felt under the skin)
Toe contractures: clawed toes, hammertoes
Hallux valgus or bunions
Charcot foot (“rocker bottom”)
o Assess the foot for loss of strength:
Limited ankle joint ROM
Limited motion of great toe
o Assess the foot for loss of protective sensation:
Numbness, burning, tingling
Semmes-Weinstein monofilament testing at 10 points on each foot
Foot Risk Categories
Risk Categories Management Categories
Risk Category: 0 Management Category: 0
Has protective sensation Comprehensive foot examination once a
No evidence of PVD year
No evidence of foot deformity Patient education to include advice on
appropriate footwear
Risk Category: 1 Management Category: 1
Does not have protective sensation Evaluation every 3-6 months
May have evidence of foot deformity Consider referral to a specialist to assess
need for specialized treatment and
follow-up
Patient education
Risk Category: 2 Management Category: 2 &3
Does not have protective sensation Evaluation every 1-3 months
Evidence of PVD Referral to a specialist
Exam 3:
Diabetes
1. List the common risk factors for Type 2 diabetes. (1307)
a. obesity, physical inactivity, hypertension
b. first degree relative with diabetes, bad cholesterol levels, polysistic ovary syndrome,
history of vascular disease.
2. List the signs and symptoms of both hyperglycemia and hypoglycemia. (1330)
a. Hypoglycemia: weakness, fatigue, difficulty thinking, confusion, behavior changes,
emotional instability, seizures, loss of consciousness, brain damage, death, shaky, heart
pounding, anxious, sweaty, hungry, tingling.
b. Hyperglycemia: warm, moist skin, dehydration, rapid deep breathing, fruity breath,
mental status varies, abdominal cramps, n/v, orthostatic hypotension, turgor, ketones
positive.
3. What is the diagnostic criteria for diabetes? (1308)
a. A1C: >6.5%
b. Fasting blood glucose >126mg/dl
c. 2 hour blood glucose equal to or greater 200mg/dl
d. Patient with manifestations hyperglycemia, random blood glucose >200mg/dL.
e. Classic symptoms diabetes= polyuria, polydipsia, unexplained weight loss.
4. A patient is being prescribed insulin for the first time. What key teaching items need to be
included? (1313-1319)
a. Insulin types, injection technique, site of injection, and patient response all affect
abdorption, onset, degree, and duration of insulin activity.
b. Changing insulins can affect blood glucose levels.
c. How to adjust insulin doses, understand nutrition therapy and monitor blood glucose
levels accurately. Must adhere to insulin schedule.
d. Don’t mix any other insulin with premixed insulin.
e. Refrigerate insulin not in use to maintain potency, prevent exposure to sunlight, and
inhibit bacterial growth. Always have a spare bottle of each insulin. Insulin is bad after 30
days. Store prefilled syringes upwards to prevent needles clogging. Roll don’t shake
prefilled syringes.
f. Subcutaneous Insulin Administration
i. Wash your hands.
ii. Inspect the bottle for the type of insulin and the expiration date.
iii. Gently roll the bottle of intermediate-acting in the palms of your hands to mix
the insulin.
iv. Clean the rubber stopper with an alcohol swab.
v. Remove the needle cover, and pull back the plunger to draw air into the syringe.
The amount of air should be equal to the insulin dose. Push the needle through
the rubber stopper, and inject the air into the insulin bottle.
vi. Turn the bottle upside down, and draw the insulin dose into the syringe.
vii. Remove air bubbles in the syringe by tapping on the syringe or injecting air back
into the bottle. Redraw the correct amount.
viii. Make certain the tip of the plunger is on the line for your dose of insulin.
Magnifiers are available to assist in measuring accurate doses of insulin.
,2
ix. Remove the needle from the bottle. Recap the needle if the insulin is not given
immediately.
x. Select a site within your injection area that has not been used in the past month.
xi. Clean your skin with an alcohol swab. Lightly grasp an area of skin, and insert the
needle at a 90-degree angle.
xii. Push the plunger all the way down. This will push the insulin into your body.
Release the pinched skin.
xiii. Pull the needle straight out quickly. Do not rub the place where you gave the
shot.
xiv. Dispose of the syringe and needle without recapping in a puncture proof
container.
g. NURSING SAFTEY PRIORITY!
i. Albiglutide (Tanzeum) is only administered once per week, not daily like other
incretin mimetics.
ii. All four DPP-4 inhibitors and the incretin mimetics liraglutide are associated with
an increased risk for pancreatitis. Warn patients taking these drugs to
immediately report these manifestations to the HCP: Jaundice; sudden onset of
intense abdominal pain that radiates to the back, left flank, or left shoulder; or
gray-blue discoloration of the abdomen or periumbilical area.
iii. Do not mix pramlintide and insulin in the same syringe because the PH of the
two drugs is not compatible.
iv. Do not mix any other insulin type with insulin glargine, with insulin detemir, or
with any other of the premixed insulin formulations, such as Humalog Mix
75/25.
v. Prevent hypoglycemia by ensuring that appropriate blood glucose testing
products are used for patients receiving parenteral maltose, parenteral
galactose, and oral xylose products.
vi. Teach patient with history of hypoglycemic unawareness NOT to test at
alternative sites.
5. What does a diabetic patient need to know before exercising? (1321-1322)
a. Wear appropriate footwear, examine feet regularly.
b. Stay hydrated, don’t exercise in extreme temps
c. Don’t exercise within 1 hour of insulin ejection or near peak time of insulin
d. Don’t exercise unless blood glucose is atleast 80 and less than 250
i. Have a carb snack before exercising if 1 hour has passed since last meal
ii. Carry simple sugar to eat during exercise if hypoglycemia happens
iii. Carry identification that you have diabetes
e. Check glucose levels more frequently on days of exercise , extra carbs and less insulin
may be needed during 24 hours after extensive exercise.
6. What are the “sick day” rules for diabetic patients? (1335)
a. Notify MD if your ill
b. Monitor glucose every 4 hours; test urine for ketones when glucose above 240
c. Continue to take insulin, drink 8 to 12 oz sugar free liquids every hour awake
d. Eat meals at regular times, if can’t do solid foods eat more easily tolerated foods with
the same amount of carbs
e. Call DR if:
, 3
i. Nausea/vomiting, moderate or large ketones, glucose elevation after 2
supplemental insulin doses, high temp/fever over 24hours (101.5)
7. What does a diabetic patient need to know about foot care? (1325-1327)
a. Foot injury most common complication of diabetes leading to hospitalization.
Assessment
o Assess the patient for risk for diabetic foot problems:
History of previous ulcer
History of previous amputation
Assess the foot for abnormal skin and nail conditions:
Dry, cracked, fissured skin
Ulcers
Toenails: thickened, long nails; ingrown nails
Tinea pedis; onychomycosis (mycotic nails)
o Assess the foot for status of circulation:
Manifestations of circulation
Presence or absence of dorsalis pedis or posterior tibial pulse
Prolonged cap refill time (greater than 25 seconds)
Presence or absence of hair on the top of the foot
o Assess the foot for evidence of deformity:
Calluses, corns
Prominent metatarsal heads (easily felt under the skin)
Toe contractures: clawed toes, hammertoes
Hallux valgus or bunions
Charcot foot (“rocker bottom”)
o Assess the foot for loss of strength:
Limited ankle joint ROM
Limited motion of great toe
o Assess the foot for loss of protective sensation:
Numbness, burning, tingling
Semmes-Weinstein monofilament testing at 10 points on each foot
Foot Risk Categories
Risk Categories Management Categories
Risk Category: 0 Management Category: 0
Has protective sensation Comprehensive foot examination once a
No evidence of PVD year
No evidence of foot deformity Patient education to include advice on
appropriate footwear
Risk Category: 1 Management Category: 1
Does not have protective sensation Evaluation every 3-6 months
May have evidence of foot deformity Consider referral to a specialist to assess
need for specialized treatment and
follow-up
Patient education
Risk Category: 2 Management Category: 2 &3
Does not have protective sensation Evaluation every 1-3 months
Evidence of PVD Referral to a specialist
