NSRG QUIZ 8

pulse

P

after

p (with a vertical line above it)

after meals

pc

premature atrial contraction

PAC

post anesthesia care unit

PACU

peripheral artery disease

PAD

patient-controlled analgesia or patient care assistant

PCA

pulmonary embolism

PE

pupils equal, round and reactive to light and accomodation

PERRLA

percutaneous endoscopic gastrostomy

PEG

peripherally inserted central catheter

PICC

pelvic inflammatory disease

PID

peripheral intravenous

PIV

pulmonary function tests

PFT

platelet

PLT

past medical history

PMH

point of maximal impulse

PMI

paroxysmal nocturnal dyspnea

PND

by mouth (per os)

PO

point of care

POC

post-op day

POD

positive

pos/+

posterior

Post.

packs per day

ppd

purified protein derivative (TB skin test) or percussion and postural drainage

PPD

partial/peripheral parenteral nutrition

PPN

Pneumococcal polysaccharide vaccine

PPV

per rectum

PR

when necessary

PRN/prn

passive range of motion

PROM

prostate-specific antigen

PSA

prothrombin time or physical therapy

PT

prior to admission

PTA

partial thromboplastin time

PTT

peptic ulcer disease

PUD

peripheral vascular resistance

PVR

partial weight bearing

PWB

used to express acidity and alkalinity

pH

Dawn phenomenon

• periodic episodes of hyperglycemia experienced by patients with diabetes in the early morning hours.

  • In the early morning — between approximately 3 a.m. and 8 a.m. — your body releases a surge of hormones, including cortisol and growth hormone.

  • your pancreas either doesn’t make any or enough insulin to respond to the rise in blood sugar, resulting in high blood sugar.

  • Insulin resistance can also contribute to this phenomenon.

• This clinical entity differs from the Somogyi effect in that it is not preceded by an episode of hypoglycemia.

• only affects people with diabetes

• Symptoms include: Increased thirst (polydipsia). Increased hunger. Frequent urination (peeing). Headache. Irritability. Blurred vision.

• The most effective way to diagnose or detect is with continuous glucose monitoring (CGM)

• The main complication of untreated high blood sugar is an increase in A1C levels

Diabetes mellitus (DM)

• a metabolic disease, involving inappropriately elevated blood glucose levels

  • It develops when your pancreas doesn’t make enough insulin or any at all, or when your body isn’t responding to the effects of insulin properly.

• affects people of all ages and is common

• Symptoms

  • Increased thirst (polydipsia) and dry mouth. Frequent urination. Fatigue. Blurred vision. Unexplained weight loss. Numbness or tingling in your hands or feet. Slow-healing sores or cuts. Frequent skin and/or vaginal yeast infections.

• Causes

  • Insulin resistance, Autoimmune disease, Hormonal imbalance, Pancreatic damage, Genetic mutations

• Complications

  • hyperosmolar hyperglycemic state

  • Diabetes-related ketoacidosis

  • Hypoglycemia

• Long term complications

  • Coronary artery disease. Heart attack. Stroke. Atherosclerosis

• Types

  • Type 1 - an autoimmune disease in which your immune system attacks and destroys insulin-producing cells in your pancreas for unknown reasons

  • Pre - stage before Type 2 diabetes.

    • Your blood glucose levels are higher than normal but not high enough to be officially diagnosed with Type 2 diabetes.

  • Type 2 - your body doesn’t make enough insulin and/or your body’s cells don’t respond normally to the insulin (insulin resistance).

    • This is the most common type of diabetes

  • Gestational - develops in some people during pregnancy

    • Goes away after pregnancy but does leave risk of type 2

• Testing

  • Fasting blood glucose test

    • Normal - < 100 mg/dL, Diabetic - > 126 mg/dL

  • Random glucose blood test

    • Diabetic - > 200 mg/dL

  • A1c

    • Normal - < 5.7%, Diabetic - >6.5%

Diabetic ketoacidosis (DKA)

• when your body doesn’t have enough insulin to allow blood sugar into your cells for use as energy.

• Common among type 1, can also happen in type 2

• Serious and can be life-threatening

• Early symptoms

  • Increased thirst and urinary frequency

• Later, severe symptoms

  • Fast, deep breathing. Dry skin and mouth. Flushed face. Fruity-smelling breath. Headache. Muscle stiffness or aches. Being very tired. Nausea and vomiting. Stomach pain.

• Causes

  • Illness, missed insulin shots, heart attack/stroke, physical injury, alcohol/drug use, medications (diuretics and corticosteroids)

• Signs

  • Blood sugar stays at 300 mg/dL or above, Fruity breath, Vomiting and can't keep food or drinks down, Trouble breathing.

• Test for by measuring ketones

  • Elevated ketones signal DKA

Diabetic peripheral neuropathy

• nerve damage due to high blood sugar (hyperglycemia) that lasts a long time

  • Over time, high blood sugar can injure nerves throughout the body

• most often damages nerves in the legs and feet.

• symptoms may include pain and numbness in the legs, feet and hands, Slow healing leg or foot sores, pins and needles sensation

• can cause problems with the digestive system, urinary tract, blood vessels and heart

• Range from mild to painful and disabling

• Types

  • Peripheral - affects any nerves outside spinal cord

    • Most common

    • often affects your feet and legs and sometimes your hands.

  • Autonomic - damage to autonomic nerves, which control your involuntary body processes

  • Proximal - affects nerves in your hip, thigh or buttock

    • Usually only one side of body

• Risk Factors

  • poor blood sugar control, diabetic history, kidney disease, obesity, smoking, high BP and cholesterol

• Complications

  • Hypoglycemia unawareness, loss of toe/foot/leg, urinary retention, UTIs, incontinence, sharp BP drop, digestive issues, erectile dysfunction, excessive sweating Skin breakdown. Infection. Ulceration. Charcot foot. Difficulty with mobility. Increased risk of falls and bone fractures. Amputation.

• Testing

  • Hemoglobin A1C test, Diabetes foot exam, NCS (nerve conduction studies), EMG (Electromyography)

Gestational diabetes mellitus (GDM)

• diabetes that's first diagnosed during pregnancy

• causes high blood sugar that can affect a pregnancy and a baby's health.

• blood sugar goes back to its usual level soon after a baby is born

  • You have a higher risk of getting type 2 diabetes.

  • That means you'll need to be tested for changes in blood sugar more often.

• Being thirsty and urinating more often are possible symptoms.

• during pregnancy, hormone levels change, including insulin

• Risk factors

  • Obesity, physical inactivity, prediabetes, history of this condition, polycystic ovary syndrome, genetics, baby is 9 lb or more, race/ethnicity (black, hispanic american, Indian, Asian)

• Complications

  • high birth weight, early birth, trouble breathing, hypoglycemia, Stillbirth, high BP, preeclampsia, require surgical delivery, future diabetes

Glucosuria

• when there’s more sugar (glucose) in your pee than there should be

  • > 0.25 mg/mL

• a symptom of hyperglycemia (high blood sugar).

  • But it can also happen in people with normal or low blood sugar levels

• you can get glycosuria if your kidneys don’t filter waste properly.

• Symptoms (if untreated)

  • Extreme thirst or hunger. Dehydration. Peeing more than usual.

• If a symptom of type 2, symptoms include:

  • Fatigue. Unexplained weight loss. Vision Discoloration where skin touches skin (like your armpits, inner elbows and folds of your neck). Slow healing whenever you get a cut or scrape.

• Main causes

  • Your body doesn’t make or use insulin like it should.

  • There’s more sugar in your system than your body can process at once.

  • You have a kidney disorder.

• Linked conditions

  • Type 1 and 2 diabetes, Gestational diabetes, Fanconi diabetes, Renal glycosuria

• Tests

  • urinalysis, Blood glucose test, A1C test

Hemoglobin A1c (Hg A1c)

• a blood test that measures glucose (sugar) in your blood over a 3-month period.

• It is used to check your blood sugar control.

• Suggested for 45 and older

• shows average blood sugar levels over the past 90 days, expressed as a percentage.

• In addition, it can be used to diagnose diabetes mellitus.

• When sugar enters the bloodstream, it attaches to hemoglobin — the protein in red blood cells that carries oxygen.

  • The A1C test measures the percentage of the hemoglobin that is coated with sugar

• A normal A1C level is at or below 5.6 %. 

  • A level of 5.7% to 6.4% indicates prediabetes, and a level of 6.5% or more indicates diabetes.

• High levels linked to:

  • linked to diabetes complications including vision troubles or blindness, kidney problems and failure, heart attacks and circulation problems, and nerve problems including numbness of the toes and feet

• Factors causing false readings

  • 1) kidney and liver disease as well as severe anemia, 2) certain medications, including opioids and some HIV medications, 3) blood loss or blood transfusion, and 4) early or late pregnancy.

• Risk factors

  • a parent or sibling with diabetes, being physically inactive, having high blood pressure, having high triglycerides or a low HDL, and having a history of heart disease.

Hyperglycemia

• too much sugar (glucose) in your blood

  • body has too little insulin (a hormone) or if your body can’t use insulin properly (insulin resistance).

  • greater than 180 mg/dL one to two hours after eating (can vary though)

    • Symptoms usually occur at 250 mg/dL or more

• can happen due to insulin resistance and/or issues with your pancreas — the organ that makes insulin.

  • Excess cortisol (the “stress hormone”) or growth hormone, for example, can lead to high blood sugar

• Indication of diabetes

• If untreated, can damage your nerves, blood vessels, tissues and organs.

• can also lead to an acute (sudden and severe) life-threatening complication called diabetes-related ketoacidosis (DKA)

• Early symptoms

  • Increased thirst (polydipsia) and/or hunger. Frequent urination (peeing). Headache. Blurred vision.

• Long term symptoms

  • Fatigue. Weight loss. Vaginal yeast infections. Skin infections. Slow-healing cuts and sores.

• Complications

  • Retinopathy. Nephropathy. Neuropathy. Gastroparesis. Heart disease. Stroke.

• Testing/detection

  • Fasting glucose tests. Glucose tolerance tests. A1c test. Glucose meter, continuous glucose monitoring

Hypoglycemia

• the level of sugar (glucose) in your blood drops below the range that’s healthy for you.

  • blood sugar level is below 70 milligrams per deciliter (mg/dL) or 3.9 millimoles per liter (mmol/L) for diabetics

  • below 55 mg/dL or 3.1 mmol/L for normal ppl

• common in people with diabetes, especially Type 1 diabetes.

• Severe cases can be life-threatening and requires treatment with emergency glucagon and/or medical intervention.

• Causes

  • Too much insulin, wrong type/site for insulin, bad insulin timing, too much diabetic medications, increased activity, alcohol with no food, later or skipping meals, unbalanced meals

• Early symptoms

  • Shaking or trembling. Weakness. Sweating and chills. Extreme hunger (polyphagia). Faster heart rate. Dizziness or lightheadedness. Confusion or trouble concentrating. Anxiety or irritability. Color draining from your skin (pallor). Tingling or numbness in your lips, tongue or cheeks.

• Severe symptoms

  • Blurred or double vision. Slurred speech. Clumsiness or difficulty with coordination. Being disoriented. Seizures. Loss of consciousness.

• symptoms often begin for people with diabetes when their blood glucose is around 70 mg/dL or lower.

• If sugar levels chronically low, may not even be noticed

• Can also have negative effects on sleep

• Complications

  • Multiple organ failure. Cardiac arrhythmias. Cardiac arrest. Permanent brain damage. Coma. Death.

• The only way to know if you have hypoglycemia is to check your blood sugar with a blood glucose meter (glucometer)

Hypoglycemic unawareness

• inability to recognize early symptoms of low blood sugar until they become severe

• urgent treatment is needed to prevent further progression and life-threatening health problems, such as a seizure or stroke.

• Symptoms

  • confusion, slurred speech, unsteadiness when standing or walking, muscle twitching, and personality changes

• Frequent and severe low blood sugar episodes are likely to evolve into this

• The longer a person has had diabetes, the more likely it is that they will develop this

• Once it occurs, more are likely to occur

Hyperosmolar hyperglycemic syndrome (HHS)

• when your blood glucose (sugar) levels are too high for a long period, leading to severe dehydration and confusion.

  • a life-threatening complication of diabetes — mainly Type 2 diabetes

  • when very high blood sugar leads to severe dehydration and highly concentrated blood (high osmolality), which are life-threatening.

• A blood sugar level over 600 mg/dL (33 mmol/L) with low ketone levels points to a diagnosis of HHS.

• also involves a lack of insulin, but the person usually still produces enough insulin to prevent the production of ketones.

• In addition, there’s usually an underlying condition, such as an infection, that’s also contributing to the high blood sugar.

• Symptoms

  • hyperglycemia. Confusion, delirium or experiencing hallucinations. Loss of consciousness. Dry mouth and extreme thirst (polydipsia). Frequent urination. Blurred vision or loss of vision. Weakness or paralysis

• Causes

  • Infections (Pneumonia, UTI, sepsis), Stopping diabetic medication, medications (Corticosteroids, thaizaide diuretics), Cardiovascular issues (Stroke, pulmonary embolism, heart attack

• Risk factors

  • Having poorly managed diabetes. Being 65 or older. Having other health issues, such as an infection, illness or a heart condition.

• Complications

  • Seizures. Coma. Organ failure. Death.

• Tested via comprehensive metabolic panel

Polyphagia

• an abnormally strong, incessant sensation of hunger or desire to eat often leading to overeating.

• AKA hyperphagia

• does not subside after eating and often leads to rapid intake of excessive quantities of food.

• may or may not lead to weight gain depending on the underlying cause.

  • In some cases, it’s associated with unexplained weight loss.

• a symptom indicating an underlying medical condition.

  • frequently a result of abnormal blood glucose levels

• one of the "3 Ps" commonly associated with uncontrolled diabetes mellitus

• Cuases

  • Undiagnosed/Underdiagnosed diabetes

  • Malnutrition

  • associated with hyperthyroidism and endocrine diseases, e.g., Graves' disease, and it has also been noted in Prader–Willi syndrome and other genetic conditions caused by chromosomal anomalies.

  • Depression, Stress, Anxiety

• Not as apparent in type 2 as type 1

• In type 1 diabetes, it probably results from cellular starvation and the depletion of cellular stores of carbohydrates, fats, and proteins

Somogi effect

• when a low blood sugar (hypoglycemia) episode overnight leads to high blood sugar (hyperglycemia) in the morning due to a surge of hormones

• Happens to diabetics taking insulin

• Symptoms

  • Increased thirst (polydipsia). Increased hunger. Frequent urination (peeing). Headache. Irritability.

• Body releases hormones in response to low insulin detection at night

  • Adrenaline. Corticosteroids. Growth hormone. Glucagon.

• Complications

  • Consistently high blood sugar.

    • Retinopathy. Nephropathy. Neuropathy. Heart disease.

  • Overnight low blood sugar episodes. (70 mg/dL or below)

    • Shaking or trembling. Intense hunger (polyphagia). Sweating and chills. Dizziness or lightheadedness. Faster heart rate.

• The most effective way to test this is with continuous glucose monitoring (CGM).