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NUR 170 Exam 3 Study Guide- Galen College of Nursing
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NUR 170 Exam 3 StudyGuide- Galen College of
Nursing
, EXAM 3 STUDY GUIDE
Diabetes Mellitus
Patho: Type 1: autonomic disorder in which beta cells are destroyed. Onset is
abrupt, generally before the age of 30 (“juvenile diabetes”). Clients are insulin
dependent and very thin/skinny (due to the body using up fats/carbs).
Type 2: malfunctioned beta cells with weak insulin production. Onset is
slower/progressive, older adults with weight gain. Risk factors: BMI >25,
genetic history, older age, ethnicity, HTN + high cholesterol
Other factors that can cause increased blood glucose
• Steroid Therapy
• Atypical Anti-Depressants
• Mood Stabilizers
• Pancreatitis (with type 1)
Labs:
• A1C: above 6.5% is a dx of diabetes mellitus. Normal is 4-6%. Taken over a 3
month (90 day) period.
• Fasting blood glucose: >126 mg/dL. Normal is less than 100mg/dl. No food
for 8 hours, except water.
• Non-fasting glu: >200mg/dL. Normal is less than 140mg/dl.
S/S: Hyperglycemia: above 250mg/dL. “hot and dry, sugars high!”
Polydipsia, Polyurea, Polyphagia. Warm + moist, kussmauls respirations
(metabolic acidosis), fruity breath, abdominal cramps, stupor, ketones in
urine.
Hypoglycemia: below 70mg/dL. “cold and clammy, gimme some candy!”
• cool, clammy, anxiety/nervous, confusion (in older adults), weakness,
blurred vision, tachycardia..
Mild: less than 60mg/DL. hungry, irritable, shaky, weak, headache, fully conscious.
• treat symptoms with 10-15 g of carbohydrates… glucose tablets, 1/2 cup
of fruit juice, 1/2 cup of soft drink, 8 oz skim milk, 6-10 hard candies, 5
cubes of sugar…..
• retest glucose in 15 minutes, repeat if symptoms don’t resolve.
Moderate: less than 40mg/dL.cold, clammy skin, pale, rapid pulse, shallow
respirations, dizzy.
• treat symptoms with 15-30 g of rapidly absorbed carbs.
• retest glucose in 15 minutes, repeat if symptoms don’t resolve.
Severe: less than 20mg/dL. unable to swallow, unconsciousness, convulsions.
,• administer 1mg of glucagon IM/SQ. administer second dose in 10 minutes if
pt remains unconscious. OR dextrose 50 is pt has IV. CALL HCP
IMMEDIATELY!!
, Complications of Diabetes
• Neuropathy: Diabetes type 2 patients lose feeling in their extremities.
Pain/tingling/ numbness in peripheries. High risk of feet injury. Advise patient to
wear shoes at all time of a comfortable texture such as leather. Wear
different shoes every day. Wash feet with soap and water. Wear cotton socks
and change them each day. Inspect feet daily and trim nails across. Lotion
foot, but do not put lotion between toes. Don’t soak feet. NO SMOKING.
• Nephropathy: Kidney disease. Avoid patients to take metformin 48
hours before ingesting and sort of contrast. Push fluids.
• Retinopathy: have patients get annual eye exams (every 12 months).
High risk for cataracts, glaucoma..
• HTN/cardiovascular diseases: promote exercise and healthy diet.
• DKA: sudden onset of glucose over >300mg/dl. Kussmauls respirations,
fruity breath, nausea, abdominal pain, dehydration.
Tx: EXERCISE!! 150 minutes of aerobic exercise a week. Check glucose levels
before, during, and after. Do not exercise if hypo/hyperglycemic. Do not exercise
within 1 hour when your insulin will peak. Don’t take insulin immediately before
an exercise. Eat a snack (carbs) before.
DIET!!!
• healthy carbs: 45% (minimum of 130g/day.. fruits, veggies, whole grains,
legumes, low fat milk),
• fats: 20-35% UNSATURATED or POLYSATURATED,
• fiber: 38g for men, 24g for women,
• protein: 15-20%
• Alcohol: 1 drink for women, 2 drinks for men. To avoid hypoglycemia,
patient should consume alcohol during or after a meal.
•
Teaching: Check your blood glucose levels 3 times a day and before bed.
Infection control: don’t share glucometer….
Sick Day Rules
• Continue taking scheduled insulin and anti-diabetic meds
• Contact HCP
• blood glucose levels to rise due to body on the stress.
• check blood glucose levels more frequently (every 4 hours).
• Asses for ketones in urine in blood glucose is higher than 240mg/dl.
• if patient is vomiting, still take insulin and call HCP.
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