NUR 504 Exam 5 Practice Questions and Correct Answers
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Course
NUR 504
Institution
NUR 504
Diabetes: a metabolic disorder affecting insulin production and insulin resistance
Type I DM: -an autoimmune disease with an acute onset -most prominent in children, teens, and adults <30 -*beta cells in the pancreas are destroyed*, causing an inability to produce a sufficient amount of insulin...
NUR 504 Exam 5 Practice Questions and
Correct Answers
Diabetes: ✅a metabolic disorder affecting insulin production and insulin resistance
Type I DM: ✅-an autoimmune disease with an acute onset
-most prominent in children, teens, and adults <30
-*beta cells in the pancreas are destroyed*, causing an inability to produce a sufficient
amount of insulin or none at all
-cannot be prevented or cured
-requires insulin injections for life
Type II DM: ✅-has a gradual onset
-NOT autoimmune
-*insulin resistance* and beta cell dysfunction occurs preventing cellular uptake of
glucose (it takes more insulin to reach the tissues d/t the resistance barrier)
-most prominent in adults > 30, but can develop at any age
-can be prevented through lifestyle modifications
-may require insulin but oral glycemics are usually tried first
risk factors for type I DM: ✅-family hx
-autoimmune dz
risk factors for type II DM: ✅-family hx
-obesity
-more prevalent in African American, Hispanic, and Native Americans
-sedentary lifestyle
-Hx of gestational DM
Labs for diabetes: ✅Fasting Blood Sugar (FBS) --> representative of the bodies
baseline rate
-w/ out diabetes --> 70-90
-w/ diabetes --> 80-130
Random Blood Sugar:
-gives a view of how the body is responding to food
HBA1C: measures BG over the past 3 months (the lifecycle of RBCs)
-normal non diabetic: <6
-prediabetes: 5.7-6.4
-diabetes: >7 (we don't want them to be super low because that means they are
frequently hypoglycemic)
,Oral Glucose Tolerance Test (GTT):
-blood is checked at 1,2, & 3 hours to see how insulin production is responding to
carbohydrate and glucose intake
DX testing for diabetes: ✅Ongoing monitoring for complications of the disease
Eye exam:
-they are at risk for diabetic retinopathy (sugar damages the vasculature in the eye and
is irreversible)
Cardiovascular health:
-CAD is the biggest risk for diabetic patients which can lead to MU
-we use an EKG to monitor baseline cardiac function
Foot care:
-they will have neuropathy
S/S of diabetes: ✅*new onset of diabetes will always present with symptoms
consistent with high blood sugar or hyperglycemia*
-polyphagia, polyuria, polydipsia
-always hungry
-always tired
-dizziness
-frequent urination (good red flag is children who have been potty trained wetting the
bed or adults waking up in the middle of the night with urgency)
-sexual problems
-blurry vision
-tingling in hands or feet
-always thirsty
-unexplained weight gain in type II --> type I there will be weight loss m
-wounds that wont heal
Bolus insulin: ✅*Carb coverage*
-patients do not need this coverage if they don't eat
-extra amounts of insulin in the pancreas would naturally make in response to glucose
consumption through meals
-the amount of bolus insulin given depends on the size of the meal
-Humalog
-Novolog
-Regular
Basal Insulin: ✅Insulin given at any time regardless of meals or not
-given for the insulin that is normally supplied by the pancreas and is present 24 hrs/day
whether or not the patient eats
Lantus or Levemir: doesn't have a set peak
,-within 24 hrs the way its secreted 1 unit will be secreted each hr for 24 hrs
-1 unit/hr x 24 hrs
Humalog or Novolog via insulin pump
Rapid acting insulin: ✅Lispro (Humalog) & Aspart (Novolog)::
-Route: subcut
-Onset: within 15 min
-Peak: 1-2 hrs
-Duration: 3-4 hrs
-highest risk for hypoglycemia: 1-2 hrs
Short acting/ regular insulin: ✅regular (Humulin R or Novolin R):
-Route: subcut
-Onset: 30-60 min
-Peak: 2-4 hrs
-Duration 5-7 hrs
-High risk for hypoglycemia: 2-4 hrs
-Route: IV
-Onset: 10-30 min
-Peak: 15-30 min
-Duration: 30-60
-High risk for hypoglycemia: ALL THE TIME
Long Acting Insulin: ✅Glargine (lantus):
-Route: subcut
-Onset: 3-4 hrs
-Peak: No peak
-Duration: 24 hrs
-High risk for hypoglycemia: 3-24 hrs
Detemir (levemir):
-Route: subcut
-Onset: 3-4 hrs n
-Peak: 3-4 hrs
-Duration: up to 24 hrs
-High risk for hypoglycemia: 3-14 hrs
, Blood glucose monitoring and insulin injections: ✅-only fast acting insulin is used in
insulin pumps
-work with the client to develop compliance
-we need to know their level of activity
-PATIENT PREFERENCE
Insulin Delivery: ✅target BG is individualized and typically between 100-130
Sliding Scale:
-*reactive* approach
-we intervene once BG is already elevated --> does not prevent it from getting high
-roller coaster effect --> letting the BG go high and then rapidly down many times
-given B4 meals based upon ac BG
Fixed method:
-patients are given the same insulin dosage everyday
-doesnt account for variations in meal carbs or time of eating
Basal Bolus Correction:
-*proactive* approach
-Requires insulin and good carb coverage
-mimics natural insulin delivery
-can be given via insulin syringe/ insulin pump
-insulin carb ratio --> I:C (helps does how much rapid acting insulin they'll need to
"cover" the carbohydrate they'll at with a meal or snack)
-correction factor/ sensitivity factor: used to calculate the amount of insulin you need to
bring your BG into target range
-requires complex carb counting and frequent BG monitoring to determine dosage of
insulin
S/S hypoglycemia: ✅Can result from too much insulin or not enough carb intake
-BG <70
-cool, clammy skin
-diaphoretic
-shakiness/ mild tremors, dizziness
-anxious/ confusion
-seizures
-weakness
-double vision
-blurred vision
-hunger
-tachycardia
-palpations
-*negative for urine ketones*
Treatment for hypoglycemia: ✅Safety!
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