NR 325 Exam 1 Study Guide

NR 325 Exam 1 Study Guide

Latest 2023 / 2024

Endocrine:

• Diabetes Mellitus:

• Impaired glucose regulation
• Hyperglycemia form abnormal insulin production or impaired

insulin use

• 7

th leading cause of death in US

• Affects function of all cells and tissues
• Managed by – diet, exercise, medication
• Either not producing insulin well, or you have an inability to use

insulin properly

• Affects every part of the body and body system

• Pathophysiology:

• Beta and Alpha cells are made by the Islet of Langerhans’s
• Beta cells

▪ Insulin and amylin ▪ Insulin • allows the uptake of glucose into the cells – give insulin for treatment, cells will no longer be starving and will have energy • hormone made by the beta cells in the pancreas • key to let glucose get into the cell ▪ Liver and brain – do not use insulin to import glucose ▪ Two phase release of insulin • Basal rate – normally released into the blood in small amounts • With meals – pancreas increased release when food is ingested ▪ Normal levels – 70-100

• Alpha cells

▪ Release glucagon • Glucagon – release of glucose from the liver and skeletal muscle

• Opposite of insulin, it increases blood sugar
• Work against insulin 1 / 3

• Increase blood glucose by stimulating glucose

production and release and decreasing movement of glucose into the cell ▪ Glucose – broken down for energy inside the cell ▪ Excess is stored in the liver and muscle cells as glycogen

• Classifications:

o Pre-Diabetes:

▪ Can lead to Diabetes if lifestyle changes do not occur ▪ 2 hour GTT of 140-199mg/dL ▪ FBS of 100-125mg/dL ▪ A1C of 5.7% - 6.4% ▪ Monitor and educate S/S that they are now diabetic ▪ Usually asymptomatic ▪ May/may not require medications

▪ Treatment:

• Lose 5-10% of body weight • Exercise 30 mins a day • Diet – low fat protein, lots of veggies, plenty of fiber

• Limit portion size, calories, sugar and carbs
• Carb counting
• Eat Omega 3 fatty acids

• Medications:

• Metformin – does not increase insulin

production ▪ Decreases liver glucose production ▪ Decrease intestinal production ▪ Decreases intestinal absorption of glucose ▪ Improve insulin sensitivity ▪ Why it needs to be withheld for surgical patients and those receiving contrast dye

o Type 1 DM:

▪ Idiopathic ▪ Beta cell destruction – no insulin at all ▪ Autoimmune – body develops antibodies against beta cells • Destruction of beta cells ▪ Often diagnosed when in ketoacidosis

▪ S/S

• Polyuria – increase urination

• Since there is excess sugar in the blood, the

body is trying to compensate by peeing it out ▪ Osmotic diuresis 2 / 3

▪ Large amounts of dilute urine are voided • Polydipsia – increase thirst

• Patient is very dehydrated from peeing so often

that the body tries to compensate by increasing thirst to help get fluid back into the body • Polyphagia – increase hunger

• Cells are starving because glucose cannot get

into them, body compensates by eating more to try to get more energy • *Hallmark* - Weight loss, fatigue, increase in frequency of infections (sugary blood attracts bacteria and bugs), slow healing wounds

• More prone to UTI, yeast infections, etc.

▪ Peak incidence is 10-15 years, familial tendency, rapid onset ▪ Will require lifelong insulin therapy – needed to sustain life ▪ 3-12 months after diagnosis – honeymoon period occurs ▪ Nutrition • Carb counting to determine insulin – pump

• *hallmark* 1 unit of rapid acting insulin for

15g of a carb

• Take glucose before meals and 2 hours after

▪ Exercise • Need insulin for physical activity

• if no insulin, body will use fats for energy and

go into ketosis

• glucose levels need to be >100mg/dL

• best time to exercise – 30 mins to 1 hour after meals

▪ drugs:

• insulin replacement therapy – check sugar levels at peak

• types

▪ Lispro – 15-30 min • Peaks in 30 mins to 2.5 hours • Check at 1-1.5 hours ▪ Regular – 30-60 min • Peak in 1-5 hours ▪ NPH – 60-120 min • Peak in 6-14 hours

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