NUR 321 - endocrine part 2
After a patient has gotten their BG above 70 after a hypoglycemic incident, what should
they do? - ANS-1. After they have gotten to 70 or above, eat a snack with complex
carbs
- Ex cheese and crackers or a sandwich
2. Initially you don't want to eat foods with fats and sugar because this isn't a simple
sugar so it won't be absorbed as quickly
3. Initially, we want it to be absorbed quickly so just give them some sugar, but no fat
4. No peanut butter or milk initially
How can insulin impact potassium levels? - ANS-Insulin can put potassium into the cells
and this can result in lower potassium levels in the blood and it can cause hypoactive
bowel sounds if their potassium gets too low
How can we manage macrovascular complications? - ANS-1. Smoking cessation -
smoking causes vasoconstriction and increases this risk
2. Control BG levels
3. Control HTN and hyperlipidemia - aka monitor for metabolic syndrome
How can we manage nephropathy? - ANS-1. Education is key on how to monitor BG
2. ACE inhibitors
3. Prevention/early treatment of UTI
4. Avoid nephrotoxic drugs and contrast dye -
5. Low-sodium diet
6. Low protein diet
How can we prevent hypoglycemia? - ANS-1. Avoid delays in meal timing
2. Eat a meal or snack about every 4-5 hours (while they are awake) - this helps cover
the peaks of their medicines and stuff
3. Do not skip meals
4. Increase food intake before exercise if BG is less than 100
5. Check BG regularly
6. Identify safe modification of insulin doses consistent with management plan
7. Carry a form of fast-acting (simple) sugar at all times - glucose tablets, lifesavers, etc
8. Wear a medical identification bracelet
9. Educate family friends, and coworkers about the s/s of hypoglycemia
10. Have their family, roommates, traveling companions, etc learn how to use the
injectable glucagon for severe hypoglycemic reactions
, How can we treat metabolic syndrome? - ANS-Treatment = aimed at risk factors:
1. Exercise
2. Diet:
a. Carbs should = 45% of total intake
- Carbs break down to sugars that our bodies can use for energy
b. Protein should = 20% of total intake
c. Fats should = 20-35% of total intake
How do we manage hypoglycemia? - ANS-1. Carbohydrates - 15 grams
2. Emergency measures
- Conscious
- Unconscious
3. Patient education - how to prevent hypoglycemia
How do we treat hypoglycemia? - ANS-1. 15 grams of concentrated carbs (such as 2 or
3 glucose tablets),
2. 1 tube of glucose gel,
3. ½ cup of juice
How do you draw up insulin? - ANS-1. Air in cloudy
2. Air in clear
3. Draw up clear
4. Draw up cloudy
Cloudy = NPH and clear = regular
We don't want to contaminate these due to the different pHs - If you pull up cloudy first
this will contaminate the clear
Never mix glargine (Lantus) and regular insulin - due to the low pH of Glargine
How should men and women limit their carbs per meal/snack? - ANS-Women
- 30-60 grams/meal
- 15-30 grams/snack
Men
- 45-75 grams/meal
- 15-30 grams/snack
After a patient has gotten their BG above 70 after a hypoglycemic incident, what should
they do? - ANS-1. After they have gotten to 70 or above, eat a snack with complex
carbs
- Ex cheese and crackers or a sandwich
2. Initially you don't want to eat foods with fats and sugar because this isn't a simple
sugar so it won't be absorbed as quickly
3. Initially, we want it to be absorbed quickly so just give them some sugar, but no fat
4. No peanut butter or milk initially
How can insulin impact potassium levels? - ANS-Insulin can put potassium into the cells
and this can result in lower potassium levels in the blood and it can cause hypoactive
bowel sounds if their potassium gets too low
How can we manage macrovascular complications? - ANS-1. Smoking cessation -
smoking causes vasoconstriction and increases this risk
2. Control BG levels
3. Control HTN and hyperlipidemia - aka monitor for metabolic syndrome
How can we manage nephropathy? - ANS-1. Education is key on how to monitor BG
2. ACE inhibitors
3. Prevention/early treatment of UTI
4. Avoid nephrotoxic drugs and contrast dye -
5. Low-sodium diet
6. Low protein diet
How can we prevent hypoglycemia? - ANS-1. Avoid delays in meal timing
2. Eat a meal or snack about every 4-5 hours (while they are awake) - this helps cover
the peaks of their medicines and stuff
3. Do not skip meals
4. Increase food intake before exercise if BG is less than 100
5. Check BG regularly
6. Identify safe modification of insulin doses consistent with management plan
7. Carry a form of fast-acting (simple) sugar at all times - glucose tablets, lifesavers, etc
8. Wear a medical identification bracelet
9. Educate family friends, and coworkers about the s/s of hypoglycemia
10. Have their family, roommates, traveling companions, etc learn how to use the
injectable glucagon for severe hypoglycemic reactions
, How can we treat metabolic syndrome? - ANS-Treatment = aimed at risk factors:
1. Exercise
2. Diet:
a. Carbs should = 45% of total intake
- Carbs break down to sugars that our bodies can use for energy
b. Protein should = 20% of total intake
c. Fats should = 20-35% of total intake
How do we manage hypoglycemia? - ANS-1. Carbohydrates - 15 grams
2. Emergency measures
- Conscious
- Unconscious
3. Patient education - how to prevent hypoglycemia
How do we treat hypoglycemia? - ANS-1. 15 grams of concentrated carbs (such as 2 or
3 glucose tablets),
2. 1 tube of glucose gel,
3. ½ cup of juice
How do you draw up insulin? - ANS-1. Air in cloudy
2. Air in clear
3. Draw up clear
4. Draw up cloudy
Cloudy = NPH and clear = regular
We don't want to contaminate these due to the different pHs - If you pull up cloudy first
this will contaminate the clear
Never mix glargine (Lantus) and regular insulin - due to the low pH of Glargine
How should men and women limit their carbs per meal/snack? - ANS-Women
- 30-60 grams/meal
- 15-30 grams/snack
Men
- 45-75 grams/meal
- 15-30 grams/snack
