NUR2571 Exam 3 Study Guide Professional Nursing II / PN 2.

1 NUR2571 Exam 3 Study Guide Professional Nursing II / PN 2.

N2 Exam 3

❖ Type 1 Diabetes – an autoimmune dysfunction involving the destruction of beta cells, which produce insulin in the islets of Langerhans of the pancreas.

❖ Type 1 is an absolute lack of insulin secretion

• Absence of insulin production; patient is dependent on insulin to

prevent ketoacidosis and maintain life

• Onset is frequently in childhood; usually ages 10-15
• This is forever
• First sign is often Diabetic Ketoacidosis

❖ Type 2 is a combination of insulin resistance and inadequate insulin secretion to compensate

• Often linked to obesity, sedentary lifestyle, and heredity
• Onset is predominately in adulthood, generally after the age of 35
• Usually controlled with diet, exercise and oral hypoglycemics
• Usually found by accident; the patient keeps coming back for a wound

that won’t heal or repeated vaginal infections

❖ Signs and Symptoms:

• Both Type 1 and Type 2: 3 Ps: polyuria, polydipsia, and polyphagia
• Fatigue
• Increased frequency of infections

❖ Type 1:

• Weight loss
• Bed-wetting, blurred vision
• Enuresis (involuntary urination, especially in children at night) in

children, nocturia in adults

• Abdominal pain
• Rapid onset

❖ Type 2:

• Weight gain, visual disturbances
• Slow onset; usually around 40 years old
• Fatigue and malaise
• Recurrent vaginal yeast

❖ Diagnostics:

PN2 EXAM 3 STUDY GUIDE

2

• The criteria for diagnosis must include two findings on separate days

– must also be the test plus a random glucose greater than 200 mg/dL

• Fasting blood glucose level above 126 mg/dL

o Oral glucose tolerance test: 2- hour glucose values greater than 200

mg/dL

• Glycosylated hemoglobin (A1C) greater than 6.5%

❖ Medications:

❖ Insulin:

o Rapid-acting insulin: lispro, aspart, glulisine

▪ Given before meals

▪ Onset: 5-15 minutes

▪ Peak: 30-90 minutes

▪ Duration: les than 5 hours

▪ Given subcutaneously ▪ Given in conjunction with intermediate- or long-acting insulin to provide control between meals and at night ▪ Because of quick onset, patient must eat immediately

o Short-Acting Insulin: regular

▪ Given approximately 30-60 minutes before meals

▪ Onset: 30 minutes – 1 hour

▪ Peak: 2-3 hours

▪ Duration: 5-8 hours

▪ This is our clear insulin ▪ Given alone or in combination with longer-acting insulin ▪ Given for sliding scale coverage ▪ Can be given subcutaneously, IV, or IM ***only insulin that can be given IV • U-500 is for patient who is insulin resistant, never given IV • U-100 is for most patients and can be given IV

o Intermediate-Acting insulin: NPH, Novolin N

▪ Hypoglycemia tends to occur in mid to late afternoon

▪ Onset: 2-4 hours

▪ Peak: 4-10 hours

▪ Duration: 10-16 hours

▪ This is our cloudy insulin ▪ Given for control between meals and at night

3 ▪ Contains protamine (a protein), which causes a delay in the insulin absorption or onset and extends the duration of action of the insulin ▪ Give NPH insulin subQ only – can be mixed with short-acting or rapid-acting

o Long-Acting Insulin: glargine (Lantus), detemir (Levemir)

▪ CANNOT be diluted or mixed with any other insulin ▪ Usually given at bedtime

▪ Onset: 2-4 hours

▪ No peak

▪ Duration: 24 hours

▪ Detemir may be given twice a day, dependent on dose ▪ Only given subQ

❖ Insulin starting dose is 0.4 – 1 unit/kg/day, the dose is adjusted until the blood sugar is normal and there is no glucose or ketones in the urine

❖ Basal/bolus dosing is the most common method of daily dosing; it is a combination of long-acting insulin and rapid-acting insulin

❖ Insulin pumps are an alternative to daily insulin injections

• Pump is programmed to deliver insulin through a needle in the subQ

tissue. The needle needs to be changed at least every 2-3 days to prevent infection

• Only rapid-acting insulin is used in infusion pump

o Complications: accidental cessation of insulin administration,

obstruction of the tubing/needle, pump failure, and infection

❖ Insulin Pens are prefilled with 150-300 units of insulin

• Convenient for travel
• Used for patients who have vision impairment or problems with

dexterity

❖ Insulin sites should be rotated to prevent lipodystrophy or lipohypertrophy – lumps under the skin from an accumulation of extra fat at the site of many subQ injections

❖ Oral Medications:

❖ Sulfonylureas – glipizide, glimepiride, glyburide

• Stimulates insulin release from the pancreas causing a decrease in

blood sugar levels and increases tissue sensitivity to insulin

• Monitor for hypoglycemia - biggest side effect of this medication

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• Given 30 mutes before meals
• Avoid alcohol due to disulfiram effect

❖ Thiazolinediones – avandia (Rosiglitazone), and actos (Pioglitazone)

• Reduces the production of glucose by the liver (gluconeogenesis)
• Increases tissue sensitivity to insulin – does not increase insulin

production

• Reverse insulin resistance by acting on muscle, fat, and to a lesser

extent the liver to increase glucose utilization and diminish glucose production

• Monitor for fluid retention, especially in clients who have a history of

HF

• Monitor for elevation of ALT, LDH, and triglyceride levels
• Patient should report rapid weight gain, shortness of breath or

decreased exercise tolerance

• Use additional birth control because this medication increases

pregnancy risk

❖ Biguanides – metformin

• Decreases sugar production by the liver (gluconeogensis) and helps

the muscles use insulin to break down sugar

• Increases tissue sensitivity to insulin
• Slows carbohydrate absorption in the intestines
• Monitor for lactic acidosis – especially in patients who have kidney

disorders or liver dysfunction

• STOP for 48 hours before any type of elective radiographic test with

iodine contrast dye and restart 48 hours after test

• Take with food – causes GI discomfort (diarrhea), this does stop
• This medication lowers lipids and triglycerides

❖ Treatment is insulin for Type 1 diabetes

❖ Treatment for Type 2 diabetes – first diet and exercise, then oral hypoglycemics, then insulin

❖ Diet: calories should be complex carbohydrates, then fats, and lastly protein ***protein should be limited 10-20?cause most diabetics have renal disease

• Patient should get a high fiber diet because fiber slows the glucose

absorption in the intestines

❖ Exercise should not be started until after the blood sugar normalizes