The Sweet Stuff
This is the gland that produces hormones to maintain balanced serum glucose
Pancreas
You complete a physical assessment of a patient and notice the following: thinning hair, moon-face shape, bruises all over, striae of skin, increased facial hair, hypertension. What do you think is the patient's condition?
Cushing's Syndrome (Adrenal HYPERfunction)
Nursing interventions and patient teaching for diabetic patients are usually aimed at modifiable risk factors. Name these modifiable risk factors.
Diet education, exercise education, and medication knowledge & compliance: dosage, type, route
What are the type of oral hypoglycemic agents that improve insulin production and increase insulin sensitivity?
Sulfonylureas, Meglitinide, and thiazolidinediones (Glucotrol, Diabeta, Amaryl, Avandia, Actos)
What is gestational diabetes and how can it be prevented?
A pregnant woman's intolerance of glucose during pregnancy. Risk for woman to develop diabetes later in life (50% within 5 years). Treatment and nursing interventions focus on nutrition and carbohydrate monitoring and limitations. Insulin is prescribed if there's no success with temporary interventions.
What drug class of cardiac medications are contraindicated for COPD patients?
Non-selective beta blockers (e.g. propranolol). Use cautiously with patients who have co-existing asthma or chronic obstructive pulmonary disease (COPD) because of the effects on Beta-2 receptors that could potentially cause bronchoconstriction!
These pancreatic islet cells produce two hormones. What hormone does each islet cell produce?
Alpha and Beta cells. Alpha cells secrete glucagon. Beta cells secrete insulin.
You interview a patient and they complain of the following: fatigue, weight loss for a month, menstrual changes (irregular), postural hypotension, bronzed-looking skin. What do you think is the condition they have?
Addison's Disease (Adrenal HYPOfunction)
Why is it important to rotate injection sites and allow 1 inch between insulin injection sites?
To prevent lipohypertrophy
If you need to administer NPH and Regular insulin, what is the process for drawing up the insulin?
Draw up the clear (Regular) first before the cloudy (NPH)
What are the risk factors of Gestational Diabetes?
Maternal age >25yo, obesity, family hx of DM, previous pregnancy/delivery of an infant who was large or stillborn
Name some of the hallmark symptoms of a patient with acute asthma excacerbation.
Wheezing, chest tightness, and dyspnea after exposure to stimuli such as allergens, environmental irritants, viral infections, exercise, and cold air
Essentially, diabetes is one of two problems. Name these two problems.
There is either a subnormal amount of insulin being produced by the beta cells due to autoimmune disorder (Type 1). In people with type 1 diabetes, the immune system mistakes the body’s own healthy cells for foreign invaders. The immune system attacks and destroys the insulin-producing beta cells in the pancreas. After these beta cells are destroyed, the body is unable to produce insulin. In type 2, the body still produces insulin, but it’s unable to use it effectively. Several lifestyle factors may contribute, including being inactive and carrying excess weight. Other genetic and environmental factors may also play a role. When you develop type 2 diabetes, your pancreas will try to compensate by producing more insulin. Pancreas eventually get "exhausted." Because your body is unable to effectively use insulin, glucose accumulates in your bloodstream.
Essentially, an endocrine disorder is caused by one of three things. Explain.
Endocrine conditions can be due to three main causes: 1) Underproduction of a certain hormone; 2) Overproduction of a certain hormone; 3) A malfunction in the production line of a hormone or in its ability to function correctly.
What areas are appropriate for injecting insulin?
Upper, outer arms. Abdomen. Buttocks. Upper, outer thighs.
What oral hypoglycemic agent decrease hepatic glucose production and increase insulin sensitivity
Metformin
How do you screen pregnant moms for gestational DM?
UA (glycosuria), oral glucose test
What are the goals of therapy for asthma?
Reduce Impairment: 1) prevent chronic and troublesome symptoms (e.g., coughing or breathlessness at night, in the early morning, or after exertion), 2) require infrequent use (less than twice a week) of inhaled short-acting beta2 agonists for relief of symptoms (not including use for exercise-induced bronchoconstriction [EIB]). 3) Maintain (near) normal pulmonary function. 4) Maintain (near) normal activity levels. 5) Meet patients’ and families’ expectations of and satisfaction with asthma care.
Reduce Risk: 1) Prevent recurrent exacerbations of asthma and minimize the need for emergency department visits or hospitalizations. 2) Prevent loss of lung function; for children, prevent reduced lung growth. 3) Provide optimal pharmacotherapy with minimal or no adverse effects.
What are the s/s of Type 1 Diabetes?
Polyuria, Polydipsia, Polyphagia, and usually Hyperglycemia to the point of DKA. Type 1 DM patients tend to get hypoglycemic, have weight loss because of the way the body burns fats and protein instead of glucose.
Maintaining a healthy weight. Eating a balanced, healthy diet. Exercising regularly. Managing your stress. Getting enough quality sleep. Managing your chronic health conditions well (if applicable). Quitting smoking or using tobacco products, if you smoke.
Patient is AAO x4 and you just completed his accucheck. Result is 51. What's your immediate intervention?
Replace glucose right away. If patient can swallow, give a box of juice. Then re-check blood sugar in 15 minutes.
What type of oral hypoglycemic agent delay carbohydrate absorption?
Alpha-glucosidase inhibitors (Precose, Glyset)
Explain Cushing's syndrome
Caused by increased corticosteroids, especially glucocorticoids. The body is exposed to high levels of cortisol for a long period of time. It's sometimes called “hypercortisolism”.
Asthma medications are divided into two categories. What are they?
1) Long-term control medications (controller medications) to achieve and maintain control of persistent asthma, and 2) quick-relief rescue medications (reliever medications) to treat acute symptoms and exacerbations (for example SABAs)
What are the s/s of Type 2 Diabetes?
Onset usually happens in adulthood after the pancreas have gotten "exhausted". Usually accompanied by a host of other existing medical problems, such as: 1) Obesity 2) High Cholesterol 3) High Blood Pressure 4) Insulin Resistance. They rarely become hypoglycemic, usually overweight & unhealthy with comorbidities. T2DM can be prevented with diet and exercise modification, medication management and education. T2DM can lead to HHNC (Hyperglycemic Hyperosmolar Nonketotic Coma)
Hypothyroidism, aka underactive thyroid, is when the thyroid gland doesn’t make enough thyroid hormones to meet your body’s needs. Thyroid hormones control the way your body uses energy, so they affect nearly every organ in your body, even the way your heart beats. Without enough thyroid hormones, many of your body’s functions slow down.
Hyperthyroidism, also called overactive thyroid, is when the thyroid gland makes more thyroid hormones than your body needs. With too much thyroid hormone, many of your body’s functions speed up.
Doctor just placed an order for CT with iodine contrast for your diabetic patient. Patient just took his daily Metformin during morning med pass. What should be your highest concern for this patient?
Patient's kidney would be likely compromised and patient could develop lactic acidosis. Check latest creatinine for patient. Notify MD that patient took Metformin and CT is ordered with iodine contrast. (Patients taking metformin who have an estimated glomerular filtration rate (eGFR) of less than 60 mL/min should stop taking metformin at least 48 hours before contrast administration.)
Name the order, from fastest to slowest onset and peak, of insulin injectable types.
Rapid- or short-acting has a short onset and peak of action (Humalog, Novolog, Apridra). Short-acting (Regular) and Intermediate acting generally has an onset of about 30 minutes and a 6-12 hour effect (Humulin N, Novolin N). Long-acting has a long duration (Lantus). (Mixed is a combination of short-acting and long-acting (NPH/regular Mix-70/30)).
What causes the increased corticosteroids for Cushing's Syndrome?
1.Use of oral corticosteroid medication 2. Body makes to much cortisol of its own: Hyperplasia of adrenal tissue due to overstimulation by ACTH, Tumor of the adrenal cortex, ACTH-secreting neoplasms (tumor) outside of the pituitary
Describe the pathophysiology of COPD
COPD is the term commonly used for conditions of chronic airflow limitation that is not fully reversible. The airflow restriction is usually progressive and involves both the airways and lung parenchyma. The primary risk factor is cigarette smoking, although occupational exposure (grain, coal, asbestos) and air pollution are also known factors.
What is the gold standard therapy for asthma?
The gold standard in asthma therapy is still a low-dose ICS as a controller together with an on-demand Short-acting beta-2-agonist (SABA).
Why do we need to be careful with oxygen therapy for COPD patients?
Giving high concentrations of oxygen to hypoxaemic patients with hypercapnia (high CO2) can result in individuals losing their hypoxic drive to breathe, with development of CO2 retention, respiratory acidosis, and even death.
What is the main pharmacological treatment for COPD patients and what are the three types?
Bronchodilators are the mainstay of pharmacological therapy for COPD patients, treating the reversible component of COPD and maximize airflow by relaxing the airway smooth muscle. Three types of bronchodilators are used in COPD management: beta2 agonists, methylxanthines (theophylline), and muscarinic agents.
What is the target O2sat for COPD patients?
88% to 92%