Diabetes 🍭
Which of the following symptoms do NOT present in hyperglycemia?
ANS: C
Which of the following insulins can be administered intravenously?
ANS: C
Most common type of glaucoma
Outflow of aqueous humor is decreased in trabecular meshwork
Caused by age, pupil dilation (could be drug induced).
BONUS: clinical manifestations??
Primary Open-Ange Glaucoma
s/s: develops slowly, typically NO symptoms, unnoticed until peripheral vision is severely compromised
tinnitus
A patient is scheduled to take a morning dose of Metformin. The patient is scheduled for surgery tomorrow. Which of the following nursing interventions are correct?
A. Administer the medication as ordered.
B. Hold the dose and notify the doctor for further orders.
C. Administer the medication as ordered but hold the next day's dose.
D. Check the patient’s blood glucose prior to administering the medication.
ANS: B
Metformin (Glucophage) is held 48 hours prior to surgery (however a doctor's order is needed for this). Therefore, you should hold the dose and call the doctor for further orders.
main differences between DKA and HHS??
DKA: ketone production due to lack of insulin, metabolic acidosis, occurs in T1DM, more prevalent in younger adults
HHS: severe hydration, typically seen in T2DM, more prevalent in older adults, profound neurological impairment
which type of insulin has NO peak, but a duration of 24 hours??
long acting - Lantus
Normal IOP
AACG IOP
POAG IOP
normal: 10-21 mmHg
AACG: > 50 mmHg
POAG: 22-32 mmHg
what is the difference between conductive and sensorineural hearing loss?
which one requires cochlear implants?
conductive: sound transmission to inner ear is impaired; pts. actually hear BETTER in NOISY environments! pts. often speak softly
sensorineural: able to HEAR sound, but UNABLE to understand speech (misunderstanding is a big issue)!; hearing aids make sounds louder but NOT clearer; caused by impairment of inner ear, CN VIII damage, noise trauma, aging, Ménière's disease; uses COCHLEAR IMPLANT !
Cataract treatment?
cataract surgery is also called....
Nursing care AFTER surgery??
-No nonsurgical "cure" for cataracts
-visual aids, changing eyewear prescription, reading glasses, magnifiers, and increased lighting
-Phacoemulsification
-post op care: outpatient procedure, antibiotic and corticosteroid eye drops, limiting activities, follow-up visits
True or False: The Somogyi effect causes the patient to experience an increase in their blood glucose during the hours of 2-3 am.
FALSE
The Somogyi effect causes the patient to experience a DECREASE in their blood glucose during the hours of 2-3 am.
A patient receives aspart (NovoLog) insulin at 8:00 AM. At which time would the nurse anticipate the highest risk for hypoglycemia?
a. 10:00 AM
b. 12:00 AM
c. 2:00 PM
d. 4:00 PM
ANS: A
The rapid-acting insulins peak in 1 to 3 hours. The patient is not at a high risk for hypoglycemia at the other listed times, although hypoglycemia may occur.
microvascular damage to the retina, blurred vision, progressive loss of vision. most common with HTN or DM ‼️
retinopathy
nursing management/health promotion for hearing loss
BONUS points: what is the most preventable cause of hearing loss
Environmental noise control! avoidance of continued exposure to noise levels greater than 70 DB is essential!, assistive devices and techniques, sign language/interpreter, lip reading
Speak in a normal tone, slower, not louder!
noise is the most preventable cause of hearing loss. hearing loss caused by noise is NOT reversible!
drugs & treatment for POAG vs. AACG
POAG: prostaglandin analogs and argon laser trabeculoplasty
AACG: Miotics (decreased visual acuity in dim light), carbonic anhydrase inhibitors and hyperosmotic (oral/IV) agents & laser peripheral or surgical iridotomy
A 36-year-old male is newly diagnosed with Type 2 diabetes. What treatments do you expect the patient to be started on initially?
diet and exercise regimen/lifestyle changes
A patient is scheduled to take 10 units of Humulin N at 1100. When is the patient most susceptible for hypoglycemia?
A. 1900
B. 1300
C. 1130
D. 1500
ANS: A
Humulin N is an intermediate-acting insulin. The peak of this medication is 8 hours.
risk factors for retinal detachment??
BONUS points: clinical manifestations??
risk factors: age, AMD, diabetic neuropathy, eye surgery, eye trauma, fam hx. of retinal detachment, severe myopia, thinning of the peripheral retina
s/s: flashes of light, floaters, cobweb/hair net or ring in field of vision
condition of the inner ear caused by the disruption of debris located in semicircular canal.
sudden onset, weeks to years
S/S??
Vertigo
S/S: alterations in balance, dizziness, N/V
treatment/meds for conditions of the middle ear?
ATBs, analgesics, decongestants/antihistamines, heat, & surgery if OM persistent (myringotomy)
After change-of-shift report, which patient will the nurse assess first?
a. A 19-yr-old patient with type 1 diabetes who was admitted with dawn phenomenon
b. A 60-yr-old patient with type 1 diabetes whose most recent glucose reading was
230 mg/dL
c. A 68-yr-old patient with type 2 diabetes who has severe peripheral neuropathy and
reports burning foot pain
d. A 35-yr-old patient with hyperosmolar hyperglycemic syndrome who has poor
skin turgor and dry oral mucosa.
ANS: D
The patient's diagnosis of HHS and signs of dehydration indicate that the nurse should rapidly
assess for signs of shock and determine whether increased fluid infusion is needed. The other
patients also need assessment and intervention but do not have life-threatening complications.
A patient is scheduled to take 5 units of Humulin R and 10 units of NPH. What is the proper way of mixing these insulins?
A. These insulins cannot be mixed, therefore, should be drawn up in different syringes.
B. Draw-up the Humulin R insulin first and then the NPH insulin.
C. Draw-up 2.5 units of NPH, then 10 units of Humulin R, and then finish drawing up 2.5 units of NPH.
D. Draw-up the NPH insulin first and then the Humulin R insulin.
ANS: B
Remember when drawing up regular and intermediate insulins...you draw-up clear (regular insulins) to cloudy (NPH intermediate). Remember the mnemonic R.N.
what is the difference between wet & dry?
BONUS: risk factors & s/s !!
Age-related Macular Degeneration (AMD)
dry (nonexudative): atrophy of macular cells - more common, slow, progressive, PAINless loss of vision
wet (exudative): MORE severe, abnormal vessels develop in or near macula, rapid onset of vision loss
risk factors: fam hx., obesity, HTN, caucasian, & smoking
s/s: blurred or darkened vision, sctomas (blind spots), and metamorphosia (vision distortion), acute vision loss
condition characterized by severe vertigo accompanied with tinnitus and progressive low-frequency sensorineural hearing loss.
Ménière's disease
AMD treatment/interprofessional care
meds, diet, teaching??
Medications injected every 4 to 6
weeks into vitreous cavity to stop new
vessel formation and slow vision loss
• Photodynamic therapy (PDT) uses laser
to activate Verteporfin to create blood
clots that block abnormal blood vessels;
slows central vision loss
• Patients must avoid sunlight and
intense light for 5 days
• Nutrition: vitamin C and E; beta-
carotene, zinc, lutein
• Smoking cessation