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Medical-Surgical Nursing, 9th Ed., Ignatavicius & Workman, 2018/
64 - Care of Patients With Diabetes MellitusAce Your Medical-Surgical Nursing, 9th Ed., Ignatavicius & Workman, 2018 Classes and Exams with Picmonic: #1 Visual Mnemonic Study Tool for Registered Nurse (RN) Students
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Medical-Surgical Nursing, 9th Ed., Ignatavicius & Workman, 2018 | Registered Nurse (RN) School Study Aid
Pancreas
- Characteristics
- Acinar Cells Release Digestive Enzymes
- Ductal Epithelial Cells Release Bicarbonate
- Islets of Langerhans
- Beta Cells Release Insulin
- Alpha Cells Release Glucagon
- Delta Cells Release Somatostatin
- Somatostatin Inhibits Alpha and Beta Cells
3 mins
Blood Glucose Lab Value
- 70-100 mg/dL
25 secs
Hyperglycemia
- Mechanism
- Insulin Resistance
- Too Little Insulin/Medication
- Infection/Illness
- Corticosteroids
- Assessment
- Elevated Blood Glucose
- Polyphagia
- Polydipsia
- Polyuria
- Hypotension
- Fatigue/Drowsiness
1 min
Insulin
- Rapid Acting
- Insulin Lispro (Humalog)
- Insulin Aspart (Novolog)
- Insulin Glulisine (Apidra)
- Short Acting
- Regular Insulin (Humulin R)
- Intermediate Acting
- Isophane NPH (Humulin N)
- Long Acting
- Detemir (Levemir)
- Glargine (Lantus)
2 mins
Erectile Dysfunction
- Cause/Mechanism
- Age-Related Changes
- Psychological
- Medical Conditions
- Drug-Induced
- Assessment
- Sexual Dysfunction (Unable to Maintain Erection)
- Interventions
- Phosphodiesterase Type 5 (PDE5) Inhibitors
- Vacuum Constriction Devices
- Intraurethral Devices
- Penile Implants
- Considerations
- Sexual Counseling
2 mins
Blood Pressure Classification (JNC 7)
- Classifications
- Normal
- Systolic (<120)
- Diastolic (< 80)
- Prehypertension
- Systolic +20 (120-139)
- Diastolic +10 (80-89)
- Stage 1 Hypertension
- Systolic +20 (140-159)
- Diastolic +10 (90-99)
- Stage 2 Hypertension
- Systolic + > 20 (160)
- Diastolic + > 10 (100)
- Hypertensive Crisis
- Systolic > 180
- Diastolic > 110
4 mins
Hypertension Assessment
- Mechanism
- Essential Hypertension
- Secondary Hypertension
- Assessment
- Headache
- Vision Changes
- Nosebleed (Epistaxis)
- Chest Pain
- Syncope (Fainting)
- Diagnosis
- Average 2 Sets, 2 Minutes Apart
- After 2 or More Visits (within 1-4 weeks)
- Nursing Considerations
- Take BP Both Arms
- Common in African Americans
2 mins
Hypertension Intervention
- Lifestyle Modifications
- Weight Reduction and Exercise
- Diet Changes
- Relaxation Techniques
- Smoking Cessation
- Medications
- Encourage Self Monitoring
1 min
Metabolic Syndrome
- Assessment
- Dyslipidemia
- Central Obesity
- Insulin Resistance
- Hypertension
- Increased C-Reactive Protein (CRP)
- Increased Fibrinogen
- Considerations
- Increased Risk Cardiovascular Disease
1 min
Diabetes Assessment
- Assessment Type 1
- Juvenile Onset
- Absent Insulin Production
- Ketosis Prone
- Assessment Type 2
- Adult Onset
- Insulin Resistance
- Obesity
- Gestational Diabetes
- Onset During Pregnancy
- Glucose Intolerance
- Complications
- Retinopathy
- Peripheral Vascular Disease
- Nephropathy
- Neuropathy
2 mins
Oral Glucose Tolerance Test (OGTT)
- Used for Diabetes Screening
- Fasting State
- Samples Drawn
- Baseline
- Normal < 100 mg/dL
- 30 and 60 Minutes
- Normal < 200 mg/dL
- 120 Minutes
- Normal < 140 mg/dL
2 mins
Hemoglobin A1c Lab Value
- 4-6%
1 min
Diabetes Interventions
- Early Diagnosis
- Insulin
- Oral Hypoglycemics
- Glucose Monitoring
- Routine Exercise
- Diabetic Diet
- Monitor for Complications
- Insulin Therapy
- Diabetic Ketoacidosis (DKA)
2 mins
Chlorpropamide and Tolbutamide (Orinase) (1st Generation Sulfonylureas)
- Mechanisms
- 1st Generation Sulfonylureas
- Stimulate Release of Insulin
- Indications
- Type 2 Diabetes
- Side Effects
- Hypoglycemia
- Possible Cardiovascular Toxicity
- Weight Gain
- Considerations
- Exacerbated Hypoglycemia with Beta-blockers
- Avoid During Pregnancy and Breast Feeding
- Avoid Alcohol
2 mins
Glyburide and Glipizide (2nd Generation Sulfonylureas)
- Mechanisms
- 2nd Generation Sulfonylureas
- Blocks Potassium Channels in Beta Cells
- Stimulate Release of Insulin
- Indications
- Type 2 Diabetes
- Side Effects
- Hypoglycemia
- Considerations
- More Potent
- Beta Blockers Reduce Effects
- Avoid Alcohol
- Avoid Breastfeeding
2 mins
Repaglinide and Nateglinide (Meglitinides)
- Mechanisms
- Meglitinides
- Increased Insulin Release
- Indications
- Type 2 Diabetes
- Side Effect
- Hypoglycemia
- Considerations
- Eat Within 30 Minutes
- Gemfibrozil Increases Risk of Hypoglycemia
- Short Half-Life
2 mins
Metformin (Glucophage)
- Mechanism
- Decrease Glucose Production
- Increase Insulin Sensitivity
- Indications
- Type 2 Diabetes
- Polycystic Ovary Syndrome (PCOS)
- Side Effects
- GI Distress
- Decreased Appetite
- Lactic Acidosis
- Considerations
- IV Contrast
- Limit Alcohol Consumption
2 mins
Pioglitazone (Thiazolidinediones)
- -glitazones Suffix
- Mechanism
- Binds PPAR-Gamma
- Decreases Insulin Resistance
- Indications
- Type 2 Diabetes
- Side Effects
- Weight Gain
- Heart Failure
- Myalgia
- Hypoglycemia
- Upper Respiratory Infection
- Considerations
- Increased Risk of Bladder Cancer
- Increased Fracture Risk in Women
- Monitor Liver Enzymes
2 mins
Acarbose (Precose) and Miglitol (Glyset) (Alpha Glucosidase Inhibitors)
- Mechanisms
- Alpha Glucosidase Inhibitors
- Delays Absorption of Carbohydrates
- Indications
- Type 2 Diabetes
- Side Effects
- Flatulence
- Diarrhea
- Anemia
- Cramps
- Considerations
- Monitor LFTs
- Oral Glucose for Hypoglycemia
2 mins
Exenatide (Byetta)
- Mechanism
- Incretin Mimetic
- GLP-1 Synthetic Analog
- Indications
- Type 2 Diabetes
- Side Effects
- Hypoglycemia
- Nausea and Vomiting
- Diarrhea
- Thyroid Cancer
- Pancreatitis
- Renal Failure
- Considerations
- (Give Exenatide) One Hour After Other Medications
- Adjunct Therapy
3 mins
Sitagliptin (Januvia) and Saxagliptin (Onglyza) (DPP-4 Inhibitors)
- -gliptin Suffix
- Mechanisms
- DPP-4 Inhibitor
- Increases Insulin Release
- Indications
- Type 2 Diabetes
- Side Effects
- Pancreatitis
- Upper Respiratory Infection and Inflammation
- Stevens-Johnson Syndrome
- Considerations
- Used as Add-on Agents
2 mins
Pramlintide (Symlin)
- Mechanism
- Synthetic Amylin Analog
- Indications
- Diabetes Type 1 and 2
- Supplement Mealtime Insulin
- Side Effects
- Nausea
- Skin Reactions at Injection Site
- Considerations
- Hypoglycemia When Combined with Insulin
- Delayed Absorption of Oral Drugs
2 mins
Mixing NPH and Regular Insulin for Injection
- Verify Order
- Roll NPH Insulin
- Alcohol to Multiuse Vials
- Inject Air into NPH Insulin (Cloudy)
- Inject Air into Regular Insulin (Clear)
- Withdraw Regular Insulin Units
- Withdraw NPH Units
- Verify with 2nd Nurse
- Discard if Error
3 mins
Dawn Phenomenon
- Cause/Mechanism
- Increased Hormone Production
- Assessment
- Hyperglycemia Upon Awakening
- Interventions
- Long-Acting Evening Insulin
- Change Administration Times
- Insulin Pump
- Considerations
- Closely Monitor Glucose Levels
- Between 2-6AM
- Limit Carbohydrates Before Bedtime
2 mins
Cyclosporine (Sandimmune) Overview
- Mechanism
- Immunosuppressant
- Inhibits Calcineurin, Decreasing IL-2
- Indications
- Prevent Transplant Rejection
- Psoriasis
- Rheumatoid Arthritis
- Considerations
- Monitor Plasma Levels
- Avoid Grapefruit Juice
- Increased Risk of Lymphoma
2 mins
Cyclosporine (Sandimmune) Side Effects
- Side Effects
- Nephrotoxicity
- Hepatotoxicity
- Infection
- Hypertension
- Hirsutism
- Tremor
- Hyperkalemia
- Hypomagnesemia
- Gingival Hyperplasia
1 min
Tacrolimus (Prograf) Overview
- Mechanisms
- Immunosuppressant
- Inhibits Calcineurin, Decreasing IL-2
- Indications
- Transplant Rejection
- Atopic Dermatitis
- Considerations
- Increased Lymphoma Risk
- Avoid Grapefruit Juice
1 min
Tacrolimus (Prograf) Side Effects
- Nephrotoxicity
- Neurotoxicity
- GI Distress
- Infection
- Hypertension
- Hyperkalemia
- Hyperglycemia
1 min
Pressure Ulcers
- Risk Factors
- Prolonged Immobilization
- Neurologic Disease
- Decreased Level of Consciousness
- Classification
- Stage 1: Intact Skin with Non-blanchable Erythema
- Stage 2: Partial Thickness Skin Loss
- Stage 3: Full-thickness Skin Loss without Fascial Involvement
- Stage 4: Full-thickness Skin Loss with Fascial Involvement
- Management
- Wound Care
- Surgery
- Considerations
- Septicemia
- Osteomyelitis
- Prevention
3 mins
Care for the Visually Impaired
- Assessment
- Decreased Visual Acuity
- Snellen Chart
- Status of Corrective Lenses
- Nursing Considerations
- Sighted-Guide Technique
- Communication
- Safe Environment
- Medications
- Clock Technique for Food
- Activities of Daily Living (ADL)
1 min
Angiotensin-Converting Enzyme (ACE) Inhibitors
- "-pril" Suffix
- Mechanism of Action
- Block Renin Angiotensin-Aldosterone System (RAAS)
- Indications
- Hypertension
- Heart Failure
- Side Effects
- Dry Non-productive Cough
- Hypotension
- Dizziness
- Possible Hyperkalemia
- Angioedema
- Nursing Considerations
- Slowly Change Position
- Do Not Stop Abruptly
2 mins
Hypoglycemia Assessment
- Mechanism
- Too much insulin
- Decreased glucose
- Assessment
- < 70 mg/dL
- Change in LOC
- Lethargic
- Confusion and Irritability
- Tremors
- Diaphoresis
- Tachycardia
- Vision Changes
- Weakness
- Seizures
2 mins
Hypoglycemia Intervention
- Interventions
- Mild to Moderate Hypoglycemia
- Simple Carbohydrate (Oral Dextrose, Fruit Juice, Candies)
- Complex Carbohydrate (Whole Grains, Vegetables)
- Severe Hypoglycemia or Unconscious
- 50% Dextrose
- Glucagon
- Considerations
- Monitor Blood Glucose Q 10-15 Minutes
- Give Small Meal After Intervention
- Patient Education
- Hypoglycemia Prevention
- Encourage Self-Monitoring
3 mins
Glucagon (GlucaGen)
- Mechanism
- Increases Glucose
- Indications
- Hypoglycemic Emergency
- Side Effects
- Nausea and Vomiting
- Considerations
- Reconstitute Powder
- Consume Oral Carbohydrates
- 50% Dextrose IV (If No Effect)
2 mins
Diabetes Education
- Self-Monitoring (Blood Glucose)
- SubQ Injection Technique
- Lifestyle Changes
- Symptoms of Hyperglycemia and Hypoglycemia
- Sick Day Care
- Foot Care
- Exercise Therapy
- Medication
1 min
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