Test 3 - study guide

Etiology of Diabetes Mellitus

Hyperglycemia due to absent/insufficient insulin and/or poor utilization of insulin, influenced by genetic, autoimmune, and environmental factors.

your body increases blood glucose with

• glucagon

• epinephrine

• growth hormone

• cortisol

Glucose and Insulin Metabolism

Insulin facilitates glucose transport into cells for energy production, with skeletal muscle and adipose tissue being insulin-dependent tissues.

Counterregulatory Hormones

Glucagon, epinephrine, growth hormone, and cortisol oppose insulin effects by increasing blood glucose levels and decreasing glucose movement into cells.

Classes of Diabetes Mellitus

Include Type 1 (insulin-dependent), Type 2 (non-insulin-dependent), Gestational, and other specific types, each with distinct characteristics and risk factors.

Diagnosing Diabetes Mellitus

Diagnosis based on criteria like Hemoglobin A1C levels, fasting plasma glucose levels, two-hour plasma glucose levels during OGTT, and classic symptoms of hyperglycemia.

2 hr plasma glucose level during OGTT

200mg with 75 g

Prediabetes

Characterized by elevated but not diabetic levels of blood glucose, with a focus on screening, managing risk factors, and lifestyle modifications to prevent progression to type 2 diabetes. LABS OF 5.7-6.4

Inhaled Insulin/ afrezza

Rapid-acting insulin administered at the beginning of each meal or within 20 minutes after starting a meal, not a substitute for long-acting insulin.

Oral Agents

Medications addressing 3 defects of type 2 diabetes - insulin resistance, decreased insulin production, increased hepatic glucose production, can be used in combination.

Biguanides

e.g., Metformin (Glucophage), reduce glucose production by the liver, enhance insulin sensitivity, improve glucose transport, may cause weight loss, used in preventing type 2 diabetes. Take with food to avoid GI, monitor serum creatinine

Sulfonylureas

Medications that increase insulin production from the pancreas, major side effect is hypoglycemia, examples include Glipizide (Glucotrol), Glyburide (Glynase), Glimepiride (Amaryl).

Meglitinides

Medications increasing insulin production from the pancreas, rapid absorption and elimination, taken before each meal, e.g., Repaglinide (Prandin), Nateglinide (Starlix).

Diabetic Ketoacidosis (DKA)

Acute complication of diabetes characterized by hyperglycemia, ketosis, acidosis, and dehydration, most likely in type 1 DM, treated with fluid resuscitation, insulin, and electrolyte replacement.

HHS

• ketones absent or minimal in blood and urine

• profound dehydration

• TYPE 2 DIABETES

DKA

• acetone breath

• ketones in urine

• Kusmals respiration

• TYPE 1 DIABETES

The nurse is caring for a patient hospitalozed with DM would look for which lab test to obtain info on the pts past glucose control

a. prealbumin level

b. urine ketone level

c. fasting glucose

d. glycoselated hemoglobin level

Answer D

Cerebral Edema

To avoid this, prevent rapid drops in serum glucose.

Insulin Effects

Insulin allows water, potassium, and glucose into cells, leading to vascular volume depletion and hypokalemia.

Hyperosmolar Hyperglycemic Syndrome (HHS)

Life-threatening syndrome in type 2 diabetes with factors like UTIs, pneumonia, and sepsis.

HHS Manifestations

Fewer symptoms, higher glucose levels, severe neurologic manifestations, and absence of ketones.

HHS Treatment

Medical emergency with high mortality, similar to DKA therapy, IV insulin, fluid replacement, and potassium monitoring.

Hypoglycemia

Low blood glucose level (

Causes of Hypoglycemia

Include excess insulin, delayed eating, too much exercise, and rapid glucose level drops.

Hypoglycemia Treatment

Rule of 15 - consume 15g of simple carbohydrate, recheck glucose, repeat if needed, avoid fat, and give complex carbs after recovery.

Acute Hypoglycemia Treatment

In acute care settings, use 50% dextrose IV push or glucagon IM/subcutaneously if patient is unable to swallow.

Explore Reasons for Hypoglycemia

Investigate why hypoglycemia occurred to prevent future episodes and provide additional patient education.

Macrovascular complications in diabetes

Risk factors such as obesity, smoking, hypertension, high fat intake, and sedentary lifestyle can increase the risk of blood vessel and cardiovascular disease in diabetic patients.

Hypertension management in diabetes

Controlling blood pressure is crucial for preventing cardiovascular and renal diseases in diabetic individuals, with a target BP of less than 140/90 mm Hg recommended.

Diabetic retinopathy screening

Regular eye examinations are essential for early detection and treatment of diabetic retinopathy, with recommended schedules varying for type 1 and type 2 diabetes patients.

Nephropathy management in diabetes

Annual screening for albuminuria and serum creatinine, along with the use of ACE inhibitors or angiotensin II receptor antagonists, is crucial for delaying the progression of nephropathy in diabetic patients.

Diabetic neuropathy

Nerve damage due to metabolic derangements in diabetes, affecting 60-70% of patients, leading to sensory and autonomic symptoms, such as loss of protective sensation, pain, and autonomic dysfunctions.

Sensory neuropathy treatment

Managing blood glucose levels and using drug therapy like topical creams, tricyclic antidepressants, selective serotonin and norepinephrine reuptake inhibitors, and antiseizure medications can help alleviate neuropathic symptoms.

Autonomic neuropathy in diabetes

Affects various body systems, leading to complications like gastroparesis, cardiovascular abnormalities, and sexual dysfunction, necessitating careful management and patient education.

Preventing foot complications in diabetes

Proper foot care, including daily checks, wearing appropriate footwear, avoiding foot injuries, and prompt treatment of ulcers, is crucial to prevent neuropathic foot complications like ulcers and Charcot's foot.

Skin problems in diabetes

Skin conditions like diabetic dermopathy, acanthosis nigricans, and necrobiosis lipoidica diabeticorum are common in individuals with diabetes, requiring attention and management to prevent complications.

Diabetic Ketoacidosis (DKA) Laboratory Test:

In a patient with type 1 diabetes admitted for DKA, the nurse would expect hypokalemia as a laboratory test result due to electrolyte depletion.

Glucose Control Assessment in Diabetes:

To assess past glucose control in a patient with diabetes, obtaining the glycosylated hemoglobin (HbA1c) level is essential.

Hyperthyroidism and Graves' Disease:

Hyperthyroidism, particularly Graves' disease, involves excess thyroid hormone secretion and autoimmune factors. Clinical manifestations include goiter, ophthalmopathy, and cardiovascular symptoms.

Diagnostic Studies for Hyperthyroidism:

Diagnostic tests for hyperthyroidism include decreased TSH levels, increased free T4 levels, and radioactive iodine uptake to differentiate Graves' disease from other thyroid conditions.

Radioactive Iodine Therapy (RAI)

Treatment of choice in nonpregnant adults, damages or destroys thyroid tissue, has a delayed response of up to 3 months.

Hypothyroidism

"Low and slow" metabolic rate, more common in American women, can be primary or secondary, often caused by atrophy of the thyroid gland.

Thyroid Disorders

Beta-blockers: provide symptomatic relief

Synthroid (levothyroxine)

treatment for hypothyriooiddeism- monitor for apical pulse, take before meals, take at same time each day, monitor apical pulse

Cushings syndrome :

ACTH secreting pituitary eadenoma- more physcial changes resolve after surgery or treatmetn and horomone levels return to normal

SIADH

results in reabsorption of water, S&S urine specifity very low

Myxedema Coma

A medical emergency in severe hypothyroidism, characterized by impaired consciousness, subnormal temperature, hypotension, hypoventilation, and cardiovascular collapse.

Levothyroxine (Synthroid)

Drug for hypothyroidism, restores euthyroid state, lifelong therapy, monitor for cardiovascular side effects and adjust dose gradually.

Cushing Syndrome

High cortisol levels causing weight gain, muscle wasting, osteoporosis, and other symptoms, diagnosed through tests like salivary cortisol and dexamethasone suppression test.

Addison's Disease

Adrenocortical insufficiency, primary or secondary, often autoimmune, symptoms include fatigue, weight loss, low blood pressure, and joint pain.

Corticosteroid Therapy

Effective but with side effects like potassium and calcium decrease, glucose and BP increase, delayed healing, susceptibility to infection, and mood changes.

Acute Adrenal Crisis Risk

Risk of adrenal crisis if corticosteroid therapy is abruptly stopped, leading to severe consequences.

Corticosteroid Therapy Patient Teaching

Education for patients on corticosteroid therapy regarding dietary needs, rest, exercise, sodium restriction, monitoring for hyperglycemia, and notifying healthcare providers about symptoms.

SIADH

Syndrome of Inappropriate Antidiuretic Hormone characterized by overproduction of ADH, fluid retention, dilutional hyponatremia, and concentrated urine.

Diabetes Insipidus

Posterior pituitary disorder resulting in increased urine output, high plasma osmolality, hypernatremia, and symptoms like polydipsia and polyuria.

Respiratory System Structures

Upper respiratory tract includes nose, mouth, pharynx, larynx, trachea; lower respiratory tract includes bronchi, bronchioles, alveolar ducts, and alveoli.

Oxygenation

Process of obtaining oxygen from the atmosphere and making it available to organs and tissues, assessed by PaO2 and SaO2.

Control of Respiration

Chemoreceptors respond to changes in PaCO2 and pH, while mechanical receptors respond to various physiologic factors influencing respiration.

Respiratory Defense Mechanisms

Include filtration of air, mucociliary clearance system, cough reflex, reflex bronchoconstriction, and alveolar macrophages.

Gerontologic Considerations in Respiratory System

Structural changes, defense mechanisms, and respiratory control alterations in aging individuals affecting lung function.

Allergic Rhinitis

Inflammatory disorder of upper airway triggered by allergens, leading to symptoms like sneezing, rhinorrhea, pruritus, nasal congestion, and potential complications like conjunctivitis and asthma.

Nasal Antihistamines

Do not reduce nasal congestion, treat histamine response

Prophylactic Use

Most effective when taken regularly to prevent histamine receptor activation

Intranasal Antihistamines

Azelastine and Olopatadine indicated for allergic rhinitis

Adverse Effects

Sedation, somnolence, nosebleeds, anticholinergic effects, unpleasant taste

Sympathomimetics

Reduce nasal congestion by activating alpha1-adrenergic receptors

Rebound Congestion

Common with prolonged use of topical agents

Cough- Antitussives

Suppress cough, opioid (codeine, hydrocodone) and nonopioid (dextromethorphan, diphenhydramine, benzonatate)

Cough- Expectorants

Guaifenesin renders cough more productive by stimulating respiratory secretions

Cough- Mucolytics

Hypertonic saline, acetylcysteine make mucus more watery

Pharyngitis

Antibiotics for bacterial infections, antifungals for fungal pharyngitis

Common Cold

Self-limited viral infection, OTC remedies contain decongestants, antitussives, analgesics, antihistamines

Fluticasone

Most effective for seasonal hay fever treatment

Lower Respiratory Issues

Pneumonia, bronchitis, etiologies, treatments, and medications

Aspiration Pneumonia

Results from abnormal entry of secretions, triggers inflammatory response

Opportunistic pneumonia

Inflammation and infection of the lower respiratory tract in immunocompromised patients caused by microorganisms that do not normally cause disease.

Pathophysiology of Pneumonia

Specific changes in the lungs triggered by inflammatory responses to offending organisms, leading to symptoms like hypoxia and consolidation.

Clinical Manifestations of Pneumonia

Common symptoms include cough, fever, dyspnea, pleuritic chest pain, and sputum changes; may vary in older or debilitated patients.

Complications of Pneumonia

Potential issues like atelectasis, pleurisy, pleural effusion, bacteremia, pneumothorax, acute respiratory failure, and sepsis, more common in older individuals.

Drug Therapy for Pneumonia

Treatment with antibiotics based on likely infecting organism and risk factors, with IV therapy initially and transition to oral therapy upon stability.

Nutritional Therapy for Pneumonia

Importance of hydration, adjusting diet for older adults or those with heart failure, monitoring weight loss, and offering high-calorie meals.

Discharge Teaching for Pneumonia Patients

Emphasizing rest, fluid intake, completing antibiotics, avoiding alcohol/smoking, follow-up care, yearly vaccinations, and recognizing future symptoms.

Pleural Effusion

A condition characterized by diminished breath sounds over the affected area, decreased movement of the chest on the affected side, dullness to percussion, dyspnea, cough, and occasional sharp chest pain that worsens on inhalation.

Asthma

A chronic inflammatory disorder of the airway with characteristic signs and symptoms such as breathlessness, chest tightening, wheezing, dyspnea, and cough, caused by immune-mediated airway inflammation.

Chronic Obstructive Pulmonary Disease (COPD)

A chronic, progressive, largely irreversible disorder characterized by airflow restrictions and inflammation, with symptoms like chronic cough, excessive sputum production, wheezing, dyspnea, and poor exercise tolerance, mainly caused by smoking cigarettes.

Anti-inflammatory Drugs

Medications like glucocorticoids that are the foundation of asthma therapy, taken daily for long-term control to suppress inflammation, decrease bronchial hyperreactivity, and reduce airway mucus production.

Bronchodilators

Medications like beta2 agonists that provide symptomatic relief by relaxing smooth muscle of the bronchi, used in asthma and COPD to alleviate bronchoconstriction and improve lung function.

Waiting time between puffs

Patients should be taught to wait at least 1 minute between puffs of the inhaler.

Extra doses

Patients should not take extra doses of the medication unless prescribed by the healthcare provider.

Oral rinses

Glucocorticoid inhalation requires oral rinses to prevent dysphonia and oropharyngeal candidiasis.

Calcium and vitamin D

Patients should take adequate amounts of calcium and vitamin D with glucocorticoid therapy.

Spacer use

Patients should use a spacer with inhaled glucocorticoids to reduce the incidence of fungal infections.

Weight-bearing activities

Patients taking glucocorticoids should engage in weight-bearing activities to prevent osteoporosis.

Side effects of inhaled glucocorticoids

The principal side effects of inhaled glucocorticoids are oropharyngeal candidiasis and dysphonia.

Serious adverse effects of long-term oral glucocorticoid therapy

Adrenal suppression, osteoporosis, hyperglycemia, peptic ulcer disease, and growth suppression are serious adverse effects of long-term oral glucocorticoid therapy.