NUR 335 Exam 2 Study Questions and 100% Correct Answers
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NUR 335
The principle sign of diabetes Hyperglycemia
s/s of diabetes -Polyuria -Polydipsia -Ketonuria -Weight loss
Type 1 DM onset -Accounts for 5% of DM cases -As a rule, develops during childhood/adolescence; can develop during adulthood
Primary defect in DM1 -Destruction of pancreatic beta cells d/t ...
NUR 335 Exam 2 Study Questions and
100% Correct Answers
The principle sign of diabetes ✅Hyperglycemia
s/s of diabetes ✅-Polyuria
-Polydipsia
-Ketonuria
-Weight loss
Type 1 DM onset ✅-Accounts for 5% of DM cases
-As a rule, develops during childhood/adolescence; can develop during adulthood
Primary defect in DM1 ✅-Destruction of pancreatic beta cells d/t autoimmune
response
-Trigger for response is unknown, but genetic, environmental, and infectious factors
likely have a part
What are beta cells ✅Cells responsible for insulin synthesis and release into the
bloodstream
Type 2 DM ✅-Most common for; 90-95% of all DM cases; ~22 million Americans
-Commonly begins in middle age, then progresses
-Little risk of ketoacidosis compared to DM1; but same long term complications
-Characterized by insulin resistance and impaired insulin secretion
-Strong familial association; genetic role
-Linked to weight gain and obesity
Hyperinsulinemia ✅-the presence of excess insulin in the blood
-early characteristic of DM2
3 causes of insulin resistance in the body ✅-reduced binding of insulin to its receptor
-reduced receptor numbers
-reduced receptor responsiveness
Short term DM complications ✅Hyperglycemia
Hypoglycemia
Ketoacidosis: rare in type 2, common in type 1
Long term complications of DM ✅-Most occur secondary to blood flow disruption;
micro/macro-vascular damage
-Amputation secondary to infection
-Erectile disfunction
,Limiting long term complications of DM ✅-Strong control of BG can reduce
microvascular damage, and good control may also reduce macrovascular injury
-Other factors besides BG control (exercise, diet, BP and lipid ctrl) may be even more
important
Macrovascular complications r/t DM ✅CVD is the leading cause of death in people
with DM
Inc. risk for:
- Heart disease
-Stroke
-HTN
*much of this pathology is d/t atherosclerosis
*Macrovascular complications result from a combination of hyperglycemia and altered
lipid metabolism
3 common microvascular complications ✅-Nephropathy
-Retinopathy
-Neuropathy
*directly related to the degree and duration of hyperglycemia
Retinopathy and DM ✅-DM is the major cause of blindness in the US
-DM damages retinal capillaries; microaneurysms may occur, followed by scarring;
overgrowth of new retinal capillaries reduces visual acuity
-Accelerated by hyperglycemia, HTN, and smoking
-All diabetics need a comprehensive eye exam every 1 or 2 years
Diabetic Nephropathy ✅-Characterized by albuminuria, reduced glomerular filtrartion,
and increased BP
-Most common cause of end-stage renal disease; primary cause of kidney failure
-Kidney damaged screened for with microalbuminuria
Albuminuria ✅Spilling of protein into the urine
Microalbuminuria ✅-early sign of renal disease involving the presence of albumin in
the urine in amounts greater than expected but too low to be detected by dipstick testing
-When the kidney is healthy, urine contains no albumin
-When glomerulus is damaged, some albumin gets into urine
-If renal functions continues to decline, large amounts of albumin will enter urine,
resulting in macroalbuminuria, and eventually renal failure
,Control of nephropathy in DM ✅-Tight glucose control
-ACEi/ARBs: slow progression that is already present; not effective for primary
prevention
Sensory and motor neuropathy r/y DM ✅-Nerve degeneration often begins early, but
symptoms take years to show
-Damage to nerves is directly related to sustained hyperglycemia
-Finger and toe paresthesias
-Increased pain or decreased ability to feel pain
-Reflex suppression
-Loss of other sensations, especially vibratory
-Reduce these symptoms with metoclopramide (Reglan)
*Autonomic nephropathy can blunt a patients ability to sense hypoglycemia
Amputations r/t DM ✅-Secondary to infections
-DM is responsible for 60% of amputations in the US
-Amputation is only solution if infection become gangrenous; foot inspections are
important
3 reasons infections occur in DM ✅1: hyperglycemia provides a glucose rich
environment for bacteria to grow
2: DM can suppress immune function and thereby compromise hosts defense against
infection
3: DM nephropathy can prevent the patient from feeling discomfit and other sensation
that would signal an infection is developing
Erectile dysfunction and DM ✅-Result of blood vessel injury and neuropathy
-Prevalent in 35-75% of DM cases
3 complications of DM r/t pregnancy ✅-Placenta produces a hormone that antagonizes
insulin
, -Cortisol production, which promotes hyperglycemia, increases 3x over in pregnancy
* Both of these factors inc. bodies need for insulin
-Glucose can pass freely between mother and baby; resulting in hyperinsulinism in the
fetus and have multiple adverse effects
Gestational diabetes ✅-Diabetes that occurs during pregnancy, subsides after delivery
-If diabetes continues after the mother gives birth, it i no longer considered gestational
diabetes
-Recommended to discontinue oral DM meds during pregnancy, but insulin is safe;
continue oral meds after birth
Methods of Diagnosing DM ✅*Tests based on blood levels of glucose
-Fasting plasma glucose
-Oral glucose tolerance test
-Random plasma glucose test
-Hgb A1C
Fasting plasma glucose test ✅-Blood drawn 8hrs after last meal
-Normal is <100mg/dL
-100-125 mg/dL is prediabetes
-DM is indicated if 126 or higher
Oral glucose tolerance test ✅-Often used when DM is suspected, but could not be
diagned using FPG or A1C
-Give oral glucose load of 75mg
-Measure glucose level 2 hours later
-Normal is below 140 mg/dL
-Prediabetes is 140-199 mg/dl
-200 or higher is an indication of DM
-Test is more expensive and time consuming compared to other tests
Random plasma glucose test ✅-Taken at any time, without regard to meals
-Finger stick
-200 mg/dL or high is indication of DM; to make definitive diagnosis the patient must
also have s/s of DM (polyuria, polydipsia, rapid weight loss, ketouria is present if
glucose level is very high)
Hemoglobin A1C ✅-Average glucose levels over 2-3 months
-6.5% or high is diagnostic of DM
-5.7%-6.4% is prediabetes
-Not necessarily accurate for all patients
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