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what percentage of the united states has diabetes?

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1

what percentage of the united states has diabetes?

10.5%

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2

what percentage of diabetics in the united states didn’t know they had diabetes?

21.4%

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3

what percentage of diabetics in the united states are over 65?

36.8%

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4

what is the normal process of glucose control?

when blood sugar is low, glucagon is released from pancreatic alpha cells & triggers liver to release stored glycogen into glucose

glucose is transported to target cells

when blood sugar is high, insulin is released from pancreatic beta cels & drives glucose into the cells, therefore lowering blood sugar

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5

what is the pathophysiology of type 1 diabetes?

autoimmune process caused by genetic & environmental factors that causes a lack of insulin production

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6

what is the pathophysiology of type 2 diabetes?

insulin resistance, defects at cell membrane, & beta cell failure cause insulin production to decrease

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7

what are the clinical manifestations of diabetes? (include specific ones for type 1 & 2)

polyuria, polydipsia, polyphagia, fatigue

type 1 - weight loss

type 2 - poor wound healing, cardiovascular disease, renal insufficiency, recurring infection

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8

how is diabetes diagnosed?

ha1c (average BG over 6 to 8 weeks) - greater than 6.5

fasting plasma glucose (BG after no caloric intake for 8 hours) - greater than 126

2 hour postprandial glucose - greater than 200

random plasma glucose - greater than 200

**can be elevated with recent carb restrictions, illness, medications, & bed rest

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9

what are some rapid-acting insulins?

humalog, lispro, novolog, & aspart

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10

what is the onset, peak, & duration of rapid-acting insulins?

onset - 10 to 30 min

peak - 30 to 90 min

duration - 3 to 5 hr

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11

what are some short-acting insulins?

regular humulin, novolin

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12

what is the onset, peak, & duration of short-acting insulins?

onset - 30 to 60 min

peak - 2 to 5 hr

duration - 5 to 8 hr

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13

what are some intermediate-acting insulins?

nph

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14

what is the onset, peak, & duration of intermediate-acting insulins?

onset - 1 to 2 hr

peak - 4 to 12 hr

duration - 18 to 24 hr

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15

what are some long-acting insulins?

lantus, glargine, levemir

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16

what is the onset, peak, & duration of long-acting insulins?

onset - 1 to 2 hr

peak - none

duration - 20 to 24 hr

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17

what are some treatments for hypoglycemia?

oral - 15 to 20 g glucose (juice, soda, bread, crackers)

IV - 25 to 50 mL D50

IM - 1 mg glucagon

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18

what are some complications of type 1 diabetes?

hypoglycemia (BG less than 65), which causes SNS & CNS compensation

DKA (body gets energy from fat & releases glucagon & cortisol, which lowers pH & causes electrolyte imbalances)

dawn phenomenon (increased BG in the morning due to growth hormone, glucagon, & cortisol release)

somogyi effect (increased BG in the morning due to excessive insulin at bedtime)

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19

what are some complications of type 2 diabetes?

metabolic syndrome (increased triglycerides & LDLs & HTN)

decreased immune response

vascular disease

neuropathy

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20

how do you manage type 1 diabetes?

treatment - insulin, isotonic fluids

considerations - vitals, i/o, BG, potassium

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21

how do you manage type 2 diabetes?

treatment - oral medications (increase insulin, lower insulin resistance, & slow reabsorption of carbs)

considerations - BG, diet, exercise, weight loss, carb intake, alcohol restriction

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22

what are some self-care strategies for diabetes?

infection control - hygiene, dental visits, foot care

weight loss - diet, exercise, medications

travel - carry snacks & medical id, walk every 2 hours to prevent DVT

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23

what are some complications of gastric bypass surgery?

short term - DVT, pressure ulcer, infections

long term - band slippage, obstruction, hernia, vitamin deficiency, anemia, dumping syndrome

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24

what are some risk factors for metabolic syndrome?

obesity, HTN, smoking, hypercholesterolemia

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25

how do you manage metabolic syndrome?

reduce cholesterol, smoking cessation, lower BP, reduce BG

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26

how do you manage obesity?

diet - reduction of 500 to 1000 calories/day, loss of 1 to 2 lb/week

exercise - 30 min/day of moderate intensity

behavioral therapy - food logs, social support

medication - phentermine, lorcaserin, orlistat (Xenical)

surgery - gastric bypass, gastric banding, sleeve gastrectomy

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27

what are some dietary considerations for a patient with a cardiac disorder?

decreased saturated fats & cholesterol

increased complex carbs

fat intake as 25-35% of total calories

increase omega 3s

high fiber

DASH - grains, veggies, fruits, nuts, dried fruit, lean meats, dairies

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28

what is included in the history assessment of the GI system?

dietary practices, nutrition, preventative health, weight changes, appetite changes, stool changes, pain

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29

what is included in the physical assessment of the GI system?

inspection - hernia (bulging masses), aneurysm (pulsatile masses), jaundice, cullen’s sign, hemorrhoids

auscultation - bowel sounds

percussion - tympany (gas), dullness (fluid, constipation)

palpation - peritonitis (rigid, pain, guarding), mass

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30

what do hypoactive bowel sounds indicate?

ileus, constipation

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31

what do hyperactive bowel sounds indicate?

ileus, diarrhea, IBD

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32

what do bruits indicate in the GI system?

arterial obstruction

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33

what are some diagnostic studies for the GI system & what do they correlate to?

h/h - blood loss

cbc - blood loss, infection

cmp - liver, electrolytes, creatinine

pt/inr - clotting

ua - kidney infection

occult blood - GI bleed

amylase/lipase - pancreatitis

gastric analysis - pH, h. pylori, GI bleed

LFTs (AST/ALT) - increased with alcohol, statins, & Tylenol

KUB x-ray

ultrasound

endoscopy

barium study (**contraindicated if perforation is suspected)

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34

what are some age-related changes of the GI system?

slowing function, dysphagia, loss of appetite, constipation, incontinence

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35

what is stomatitis?

painful inflammation of the oral mucosa

primary - ulcer, canker sore, herpes

secondary - decreased immune response from chemo & radiation

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36

what are the clinical manifestations of stomatitis?

dry, red, cracked mucosa; mouth ulcers; open/bleeding sores; pain

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37

how do you manage stomatitis?

salt rinses q4, topical analgesics, moisturizers, antifungals (for thrush), antivirals, lidocaine

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38

what are some complications of stomatitis?

dysphagia, xerostomia

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39

what is a hiatal hernia?

portion of the stomach protruding through LES into the esophagus

sliding - due to trauma, genetics, or anatomy

rolling - due to anatomical deficit

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40

what are the clinical manifestations of a hiatal hernia?

sliding - heartburn, regurgitation, chest pain, dysphagia, belching

rolling - fullness & breathlessness after eating, suffocation, angina worsened with laying down

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41

what are some complications of a hiatal hernia?

sliding - GERD

rolling - obstruction, incarcerations, volvulus, iron deficiency anemia

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42

how is a hiatal hernia diagnosed?

upper abdominal x-ray, endoscopy, barium swallow, EGD

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43

how do you manage a hiatal hernia?

smaller, frequent meals, elevate HOB after eating, weight loss

medication - antacids, PPIs, H2 blockers

surgery - nissen fundoplication (**gold standard)

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44

what is gastroesophageal reflux disease (GERD)?

acid reflux from the stomach into the esophagus, causing inflammation

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45

how is GERD diagnosed?

pH monitoring, esophageal motility testing, EGD, barium swallow

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46

what are the clinical manifestations of GERD?

heartburn, wheezing, coughing, dyspnea, sore throat, lump in throat, choking, regurgitation

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47

what are some complications of GERD?

airway spasms, bronchitis, pneumonia, esophagitis (ulceration/scar tissue), esophageal stricture, barrett’s esophagus (metaplasia)

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48

how do you manage GERD?

antacids, PPIs, H2 blockers, prokinetics

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49

what is the difference between lefort 1, 2, & 3 with oral trauma?

1 - mandible

2 - mandible, orbital

3 - mandible, orbital, temporal

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50

how do you diagnose oral trauma?

blood cell count, serum chemistry analysis, ABG, x-ray, CT/MRI

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51

what are the clinical manifestations of oral trauma?

increased RR, stridor, SOB, decreased O2, tachycardia, changes in LOC, bleeding, swelling, edema, loss of teeth, pain

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52

what are some complications of oral trauma?

short term - airway compromise, aspiration of teeth, infection, inadequate nutrition, cerebrospinal leak (meningitis)

long term - pain, TMJ, disfigurement

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53

how do you manage oral trauma?

establish & maintain airway, control bleeding, prophylactic antibiotic

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54

how is esophageal cancer classified?

squamous cell carcinoma - upper 2/3 of esophagus

adenocarcinoma - lower 1/3 of esophagus

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55

how do you diagnose esophageal cancer?

barium swallow, CT, PET, endoscopic ultrasonography, thoracoscopy, laparoscopy

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56

what are the clinical manifestations of esophageal cancer?

progressive dysphagia, inability to eat, unintentional weight loss

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57

how do you manage esophageal cancer?

yoga, meditation, spirituality, religion, nutrition

surgery - esophagectomy (interventions: parenteral fluids, NG, high calorie/protein, upright position, observe for leakage, IS, infection prevention)

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58

how do you diagnose gastritis?

x-ray, endoscopy, histological exam, fecal occult blood test, biopsy, CBC, B12

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59

what are the clinical manifestations of gastritis?

epigastric pain, weight loss, decreased appetite, blood in stool or emesis, dehydration, hypovolemic shock

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60

how do you manage gastritis?

fluid replacement, smoking cessation, pain management, removal of cause, vitals, i/o, cbc, cmp, monitor for blood, decrease use of NSAIDs

medication - H2 blockers, PPIs, antacids, sucralfate, antibiotics, B12

surgery - vagotomy, gastrectomy, pyloroplasty

diet - NPO to clear liquids; bland foods; no caffeine; small, frequent meals

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61

what does epigastric pain indicate?

gastritis, duodenal ulcer

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62

what are the clinical manifestations of gastroenteritis?

anorexia, distention, dehydration, electrolyte imbalance, hyperactive bowels, hypotension, dry mucus membranes

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63

how do you diagnose gastroenteritis?

history, stool culture, PCR

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64

how do you manage gastroenteritis?

fluid replacement, antidiarrheals, pepto-bismol, antiemetics, antibiotics

diet - NPO to clear liquids; bland foods; no caffeine or milk; small, frequent sips of fluid

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65

what is peptic ulcer disease?

erosion & ulceration of GI mucosa from hydrochloric acid & pepsin

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66

for what condition is it common to have no symptoms?

peptic ulcer disease (due to lack of sensory fibers; silent ulcers are common in elderly & with NSAIDs)

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67

what are the clinical manifestations of peptic ulcer disease?

gastric ulcer - burning, gassy, worse after meals, not relieved by antacids

duodenal ulcer - burning, epigastric pain, worse when fasting, relieved by antacids

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68

what are some complications of peptic ulcer disease?

hemorrhage, penetration, perforation, adenocarcinoma, obstruction

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69

how do you diagnose peptic ulcer disease?

biopsy (H. pylori), endoscopy, barium swallow, CBC, liver enzymes, serum amylase, stool examination

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70

how do you manage peptic ulcer disease?

rest, smoking cessation, fluid/blood replacement, pain management

medication - antacids, PPIs, H2 blockers, sucralfate, misoprostol (**not in pregnancy)

surgery - endoscopy, vagotomy (to reduce acid production), pyloroplasty (widening of stomach opening), gastrectomy

diet - bland food; avoid eating within 2 hr of bedtime; avoid spicy food, caffeine, & alcohol

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71

what are the clinical manifestations of gastric cancer?

heartburn, abdominal pain, feeling full, back pain, anorexia

advanced - iron deficiency anemia, palpable mass, enlarged lymph nodes, weakness, fatigue, weight loss, metastasis

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72

what does back pain indicate?

gastric cancer

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73

how do you diagnose gastric cancer?

upper GI endoscopy, barium swallow, biopsy, CT, CBC

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74

how do you manage gastric cancer?

chemo, radiation, surgery, antiemetics, opioids, vitamins, NG

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75

what is a hernia?

protrusion of abdominal contents due to weakened abdominal wall

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76

what are some risk factors for hernias?

obesity, smoking, malnutrition, pregnancy, wound tension, medications, heavy lifting, abdominal surgery, straining

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77

how do you diagnose a hernia?

physical exam, herniography with contrast, CT/MRI

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78

what are the clinical manifestations of a hernia?

strangulation, pain, vomiting, distention, fever, tachycardia

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79

how do you manage a hernia?

surgery - herniorrhaphy (to fix hernia), hernioplasty (to fix hernia & add mesh), temporary colostomy, binder

**surgery is immediately required to prevent gangrene

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80

what is a hemorrhoid?

swollen vein in anorectal area that can be internal or external

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81

how do you diagnose a hemorrhoid?

external - inspection

internal - digital exam, anoscope, sigmoidoscopy

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82

what are the clinical manifestations of a hemorrhoid?

pain, pruritis, bleeding, prolapse

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83

what are some complications of hemorrhoids?

infection, pain, urinary retention, impaction, sphincter damage, bleeding, abscess

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84

how do you manage a hemorrhoid?

surgery - ligation, bipolar/infrared/laser coagulation, sclerotherapy, cryosurgery, hemorrhoidectomy

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85

what are the clinical manifestations of irritable bowel syndrome?

pain improved with defecation; loose, frequent stools; distention; mucus; sensation of incomplete evacuation; fatigue; headache; sleep disturbances

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86

what are some complications of IBS?

psychosocial effects, isolation, malabsorption

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87

how do you manage IBS?

nutrition diary, high fiber, stress reduction, ginger, antidiarrheals, imodium, avoid trigger foods, smoking cessation

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88

what is irritable bowel disease a combination of?

crohn’s & ulcerative colitis

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89

what are some triggers of IBD?

infection, medication, smoking

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90

what does crohn’s disease affect?

mouth to anus

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91

what does ulcerative colitis affect?

large intestines & mucosa

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92

what are the clinical manifestations of IBD?

diarrhea, cramps, fever, weight loss, fluid/nutrition imbalance, anemia, delayed growth, mouth ulcers, rectal bleeding, skin/joint/eye irritation

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93

how do you diagnose IBD?

CBC, CRP

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94

how do you manage IBD?

rest; perianal care; small, frequent meals; alleviate stress

diet - avoid chocolate, milk, caffeine, citrus, & alcohol

medication - antimicrobials (Cipro), glucocorticoids (dexamethasone, budesonide), antidiarrheals (Lomotil, Imodium)

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95

what is narcotic bowel sydrome?

narcotic-induced constipation

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96

what are the clinical manifestations of narcotic bowel syndrome?

chronic, intermittent cramping; abdominal pain

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97

how do you manage narcotic bowel syndrome?

wean off narcotics, antidepressants, fluids, treat withdrawal

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98

what is short bowel syndrome?

100 cm or more is removed in a bowel resection, affecting absorption

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99

what are the clinical manifestations of short bowel syndrome?

diarrhea, steatorrhea

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100

how do you manage short bowel syndrome?

fluid/electrolytes, nutrition, PPIs, opioids, antidiarrheals

diet - high carb, low fat, fiber, small meals, TPN

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