Pathophysiology
Basics
Basics
What hormone is secreted by the β-cells of the pancreas and lowers blood glucose levels?
Insulin
Metformin works by decreasing what two sources of glucose?
Decreases hepatic glucose production and intestinal absorption
What must a patient do after using an inhaled corticosteroid like fluticasone?
Rinse mouth to prevent oral candidiasis (thrush)
A patient’s glucose is 58 mg/dL, and they are alert but shaky. What’s your first action?
Give 15 g of carbohydrate and recheck in 15 minutes (15-15 rule)
When should rapid-acting insulin (e.g., lispro) be administered relative to meals?
Within 15 minutes before eating
In Type 1 Diabetes Mellitus, what happens to the pancreatic β-cells?
Autoimmune destruction → absolute insulin deficiency
What class of drugs stimulates β₂ receptors to produce bronchodilation?
β₂-Adrenergic Agonists (e.g., Albuterol)
What is the therapeutic serum range for theophylline?
5–15 µg/mL (toxicity > 20 µg/mL)
A Type 1 diabetic presents with fruity breath and Kussmaul respirations. What complication is this?
Diabetic Ketoacidosis (DKA)
What position promotes optimal ventilation for patients in respiratory distress?
High-Fowler’s position
What is the key physiologic difference between Type 1 and Type 2 Diabetes?
Type 1 = no insulin production; Type 2 = insulin resistance and decreased secretion
Sulfonylureas lower blood glucose through what mechanism?
Stimulate pancreatic β-cells to release insulin
Which oral diabetic medication should be held before IV contrast due to lactic acidosis risk?
Metformin
A patient with asthma has a Peak Flow of 45% of their personal best. What zone are they in, and what should they do?
Red Zone – Use rescue inhaler and seek medical help immediately
What teaching should be given to a patient taking tiotropium?
Not for acute attacks; rinse mouth after use; take daily
What two processes make up metabolism, and what do they each do?
Catabolism (breakdown for energy) and Anabolism (build-up for growth/repair)
Tiotropium blocks which neurotransmitter to cause bronchodilation?
Acetylcholine (muscarinic blockade)
What life-threatening condition may occur if prednisone is stopped abruptly?
Adrenal insufficiency
Why might a COPD patient’s oxygen saturation goal be lower (88–92%) than normal?
High O₂ may suppress their hypoxic respiratory drive
How does smoking affect theophylline levels?
Increases metabolism → lowers serum levels (reduced effectiveness)
In asthma, what immunoglobulin triggers inflammation and bronchoconstriction?
IgE
Corticosteroids reduce airway inflammation by suppressing what?
Inflammatory mediators (cytokines, histamine, leukotrienes)
Name two common side effects of β₂-agonists like albuterol.
Tachycardia and tremors
A patient on corticosteroids shows increased blood sugar. Explain why.
Corticosteroids increase gluconeogenesis → hyperglycemia
List two priority nursing assessments before administering insulin.
Check blood glucose and assess for symptoms of hypoglycemia