Summary
Summary NRSG 3320 Exam 2 Study Guide
- Course
- NRSG 3320
- Institution
- Northeastern University
This is a comprehensive and detailed study guide on Exam 2 for NRSG 3320. ***An Essential Study Resource!! All for YOU!!
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2 La t
e nta utoimmunedi abeteso fadul ts(LADA)-s ubtypeo fdi
abetesin
wh ichp rogressiono fau t
oimmu neb etac el
ld estr
uctioninthep ancre
a si
s
slowe rthani nt ypes1a nd2d iabetes(wi l
lno ttes
tu sont h
is)
No tinsulindepe ndenti ntheini t
ial6mo nthsofdiseaseonset.
Cl inicalma nif
es t
ationo fLADAs h a
rest hefeat
u r
eso ftypes1a nd2
diabetes
Eme rgings ubtypeh asl edso met opro posethed i
abetesclass
ific at
ion
schemes houldb erev is
edt ore fle ctc hangesintheb et
ac el
lsinthe
pancreas
Ge stat
io naldiabe t
es
Di ab etesa ss
o ciat
e dwitho therc onditi
o nsors yndrome s
o Functi
onso fI nsulin:
Tr an sportsan dme t
abolizesg lucosefo renergy
St imu latesstorageo fgluc oseint heliverandmu scleasglycog e
n
Si gn al
st helivert ostopth ereleaseo fglucose
En hanc esstorageo fdietaryf atinad i
p oseti
ssu e
Ac celeratestranspo r
to fami noa ci
d sintoc e
lls
I nhibitstheb reak downo fs t
or edgluc ose,protein
, andfat
o Po
ss i
blecau seso fh yperglycemia:
I mpa iredi nsuli
ns ecret
ion
Ga str
o intest
inala bsor
p ti
ono fglucose
I ncreas edb asalhe pa
ticg l
u cosep r
od uction
De creasedi nsulin-st
imu l
a t
edg l
ucoseu pt
ake
o Cl
inicalMa ni
festati
o ns(De pen d
so nt helev elofh yperglycemia)
:
Th r
e ePs :
Po lyuria r esu l
tsfro me xcesslosso fflu idassoci
a t
edwi t
ho smoti
c
diuresis
Po lydipsia r esu l
tsf r
ome xcesslosso fflu i
da ssocia
tedwi t
ho s
mo t
ic
diuresis
Po lyph agia r esult
sf romt hec atabolicstat
eindu c
edb yinsulin
defic iencya ndt heb reakdowno fproteinsandfa t
s
Fa ti
g ue
We a kness
Vi sionc hanges
Ti ng l
in gan dn umb ness
Dr ys ki n
Ski nl esion s
Re c urrentinfe ct
ions
Sl owt oh ealwo und s
Ty pe1 :Sudde nWe ightl oss
o Di
ag nosti
cfin d i
ngs( on eofthe se
):
Fa stingb loodg l
u cos
e1 26mg /
dLormo re(fastforatleast8h ours
)
Ca sual glucosee xceeding2 00mg /dLp l
ussy mp t
oms
Po st-loadg luco s
e>2 00mg /dL
,3
A1 C>6 .
5%( f
ord iagn osis)
o Medi
calma nageme ntofd iabetes:
Ma i
ng oalistono rma lizei nsulina cti
v it
ya ndbl oo dgluco s
el evelstoreduc
e
th
ed evelopme nto fco mp lications.
Th eADAn o wr ecomme n dsHg bA1cl essthan7 %( forma nage men t
)
Di abetesma nage me ntha sfiv eco mp onents:
Nu tri
tiona lt
he rapy
Ex erci
se
Mo nit
oring
Ph arma cologict hera p
y
Ed ucation
o Nu
tri
ti
on:
Di etar
yMa nage me ntGo als:
Co ntrolo ftotalc alori
ci ntaketoa ttai
no rma intai
nar ea sonablebody
weight
Co ntrolo fbloo dgl uco s
el evels
No rma li
z at
iono flipidsa ndbl oodp ress
uret opreventh eartdiseas
e
Ro leo ftheNu rse:
Bek nowl edgeab lea boutme dicalandd ie
taryma nageme nt
Co mmu nicateimp o rt
antinfo r
ma tiontoth ed i
eti
ciano ro t
he r
mana geme ntsp ecialist
s
Re infor
c ep at
ien tun derstanding
Su pportd iet
arya ndl i
festylec hanges
Me alplanni
n g:
Co nsiderf oodp refe re
n ces,l
ifestyl
e ,usualeatin
gt i
me s,a ndc u
ltur
al
ande t
hn i
cb ack gro und
Re viewdi ethisto rya ndn eedf orwe ightloss,gain,orma i
n t
enance
Ca lori
cr equireme ntsa ndca lor
ied is
tri
b ut
iont hr
o ughou ttheday;
exch
a ngel i
sts
o Ca r
boh yd rates:50%t o6 0%c a
rboh ydrat
es;emp hasi
zewh ole
g rains
o Fa t:30%,l imitings atur
a t
edf at
sto10 %a nd<3 0 0mg
c holesterol
o No nanima ls ou r
ceso fp rot
e i
n(e.g.,l
e gumes, wh olegrains
)and
inc re
a sefib er(2 5g d oneg r
ad uall
y)
Gl ycemi ainde x–h owmu chc arboh ydrat
es ugarisi nthefood swee a
tthat
wil
la ffe c
tb l
o ods uga rle vel
s
Ke epsitl ow:
o Co mbinin gs tarchyfo odswi thprotei
na ndf atslowsa bsorpt
ion
a ndg l
y ce mi crespons e
o Ra wo rwh o l
ef oodst en
dt oh avelowe rresponsest hanc o
oked,
c hoppe d,o rp ureedfoo ds
o Ea twh ol ef rui
tsrathe rthanju i
ces;thisdecreasesg lycemic
re sponseb ecau s
eo ffib er(sl
owi nga bs
o r
p t
ion)
,4
o Ad din gfoo dwi ths u
g arsma yp roducelowe rres
ponseifeat
en
wit
hf o odsthat aremo reslowlya bsorbe
d
Ot h
erdiet
aryc oncerns:
Al coho l
o Ca ns ti
llen j
oy,b uth ypo gl
y ce
mi acano ccur
o To omu ch a lsoc anno trecognizehypog l
ycemia
Nu trit
ivean dno nn ut
riti
v eswe eteners
o Su crosea ffe ctsthemo s
t
Mi sleadingfo odla bel
s
o Ex
erc
ise
:
Be nefits:
Lo we rsbloods u gar
Ai dsinwe i
gh tloss,easings tress,andma i
ntai
ningaf eel
ingofwell
-
bei
ng
Lo we rscardiovascularr i
sk
Re fertoCha rt5 1-4
o Ex ercise3t ime se ac
hwe e
kwi thn omo rethan2c onsecut
iv
e
dayswi thoutex ercis
e
o Pe rf
o rmr esis
tan cetrainingtwi ceawe ek( t
ype2di abet
es)
o Ex ercisea tsamet imeo fd ayands amed urati
on
o Us ep rope rfootwe ar
o Av oidt raumat ol owe rex t
remities
o Av oide xercisesinh otorc ol
o Av oide xercised uringp eri
o dsofp oorme tabol
iccontr
ol
Precaut
ions
:
Ex erciseelevatesb l
oo ds ugarlev e
ls;insuli
nmu s
tb eadjus
ted
o Li v erinc r
easesg lucoser eleasedu r
ingexercis
e
I ns
ulinn orma ll
yd e
crease swi t
he x e
rcise;pati
entsone xog
e no
usinsul
in
shoulde a
ta1 5-gc ar
b ohy dr
ates nackb eforemo derat
eexercis
eto
prev
e nthypo glycemia
Po tent
ialpo stex e
rciseh ypog l
y cemia:refertoCha r
t5 1-
5
o Ea tas na c
ka ftere xer
c i
sea ndb eforebed
o Mo nitorglucosemo ref requentl
y
Ne edt omo ni t
orb loodg lucos elevels
Ge rontologicc onsiderati
o ns
o Ma yl ea dto:
I mpr ovedg lycemi cc ont
rol
De creasedr i
skf orc hr
o ni
cv ascul
ardisease
I mpr ovedq ualityo fli
fe
Le
ctur
e2
I
nsu
linTh
erapy:
o Bloodgluco
semoni
tor
ing(mustk
nowi
fme
asu
rin
gwh
oleb
loo
dorp
las
mar
esu
lts
p l
asmais10
-15
%h ighe
r):
, 5
Corner
stoneo fdiabet
esma n
agement
Be foreme als
Be forebedtime
Int hemi ddleofthenig
ht(so
met
ime
s)
Wh ens y
mp tomati
c
Se l
f-monit
oringo fbloodgluc
ose(SMBG)l
eve
lsh
asd
rama
tic
all
yal
te
red
di
abete
sc ar
e
Te c
h ni
ques houldberevie
we deve
ry6mont
hs
o Ca
teg
orie
so fi
ns u
lin:refe
rtoTa b
le51-3
Ra pidacti
ng
Sh orta
cting:regulari
nsuli
n
Intermediat
ea ct
ing:NPHi nsul
in
Ve rylongacting:“Peakl
ess”
Typ
e Age
nts Onse
t Pe
ak Dura
ti
on In
dic
ati
on
Rapi
dac
ti
ng Li
spr
o 10
-15mi
n 1hour 2-
4h our
s Rapi
dreduc
ti
oni
n
bl
oodsuga
r
Sh
orta
cti
ng Re
gul
ar 3
0-6
0mi
n 2
-3h
our
s 4
-6h
our
s Pr
epr
and
ial
I
nte
rme
dia
te NPH 2
-4h
our
s 4
-12 1
6-2
0ho
urs Af
terf
ood
ho
urs
Longacti
ng Gl
arg
ine 1h
our n
one 24hou
rs Ba
salr
ate
(u
suall
ygive
nat De
temir 6h
our
s 2
4 -
36hou
rs
bedt
ime)
Quali
tyands afet
ya l
ert- whena d
mi ni
ster
inginsuli
n,itisver
yimp ort
a nttor
eadt
he
l
abelcar
efullytoma kes ur
ey ouhavethec or
recttypeofinsuli
n
I
nsuli
nRe gime n:
o Va ri
e sfrom 1t o4i nj
e c
ti
onsp erday
o Co mb inati
ono fas hort
-ac
ti
ngin sul
inandal onger-
acti
nginsuli
n
o Ta b le5 1-
4d es
c r
ibesseverali
nsuli
nreg i
men sandtheadvantagesa n
d
d
isadv ant
age sofe ach
o T wog enerala pproachestoinsul
intherapy:
Co nv entional:si
mp l
e,we l
lma nagedpatient
s,cons
iste
ncy
Ex ample:1long-act
inginsul
inp erday
I nte nsive:comp l
ex,fr
eq u
ent,poorl
yma n age
dp at
ients
Compli
cati
on so finsulintherapy:
o Lo cala l
ler
g icreacti
on s
o Sy ste micallergicreacti
ons
Tr e
a tme nt
:d e
sensit
iza
ti
ont her
a p
y
o I nsul inli
po dy st
rophy–f atdeposit
so rsca
rt i
ssueatinj
ect
ions i
te wh ywe
r
otates i
tes
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