Test 4

• Prediabetes


  • Impaired fasting glucose (IFG)
  • Fasting glucose of 100 to 125 mg/dL
  • Intermediate stage between normal glucose homeostasis and diabetes
  • Increased risk for developing type 2 diabetes
• Patient teaching for prediabetes

  1. Undergo screening; glucose and A1C

  2. Learn and manage risk factors

  3. Monitor for symptoms of diabetes

  4. Maintain healthy weight, exercise, make healthy food choices
• Type 1 Diabetes


  Autoimmune disorder where body develops antibodies against insulin and/or pancreatic B cells that produce insulin, resulting in not enough insulin to survive
• Type 1 Diabetes


  • Manifestations develop when pancreas can no longer produce insulin—then rapid onset
  • Recent history of sudden weight loss and polydipsia, polyuria, and polyphagia
• Questions to ask a patient with suspected type 1 diabetes

  1. Have you lost weight recently?

  2. Are you experiencing an increase in hunger or thirst or are you urinating more than usual?
• Type 2 Diabetes


  Many risk factors: overweight or obese, advanced age, family history, Increase prevalence in children due to obesity, Pancreas continues to produce some endogenous insulin but not enough is produced and/or body does not use insulin effectively
• Type 2 Diabetes


  • Major distinction from type 1 is that in type 2 there is an absence of endogenous insulin
  • Nonspecific symptoms
  • Classic symptoms of type 1 may manifest (body tries to rid itself of glucose)
  • Fatigue
  • Recurrent infection, recurrent vaginal yeast or candida infection (as bacteria feed on excess glucose)
  • Prolonged wound healing (elevated glucose hinders the healing process)
  • Visual problems
• A1C level

  Glycosylated hemoglobin: reflects glucose levels over past 2 to 3 months<|>Glucose attaches to hemoglobin molecule; higher the glucose level=higher the A1C<|>Used to diagnose, monitor response to therapy and screen patients with prediabetes<|>Goal less than 6.5 to 7% (reduces complications)
• Fasting plasma glucose (FPG) level


  Greater than 126 mg/dL
• Hyperglycemia

  • Causes: Illness, infection, Corticosteroids, Too much food, Too little or no diabetes meds, Inactivity, Emotional or physical stress, Poor absorption of insulin
  • Assessment findings: Elevated blood glucose, Increased urination, Increased appetite followed by lack of appetite, Weakness, fatigue, Blurred vision, Headache, Glycosuria, Nausea and vomiting, Abdominal cramps, Progression to DKA or HHS-will learn about in acute care course, Mood swings
• Culturally Competent Care


  Culture can have a strong influence on dietary preferences and meal preparation<|>High incidence of diabetes in Hispanics, Native Americans, blacks, and Asians and Pacific Islanders<|>Important to consider food preferences with teaching about nutrition
• Exercise

  1. Regular, consistent exercise plan essential

  2. ADA recommends At least 150 minutes/week moderate-intensity aerobic activity

  3. Resistance training 3 times/week

  4. Benefits: Decreases insulin resistance and blood glucose, Weight loss, Reduce need for medications (type 2), Decreases triglycerides and LDL, ↑ HDL, Decreases BP and increases circulation

  5. Glucose-lowering effect of exercise lasts up to 48 hours

  6. Type 1—delay activity if glucose ≥ 250 mg/dL and ketones are present in the urine; makes condition worse

  7. Encourage exercise 1 hour after a meal or have a 10 to 15 g CHO snack and check glucose before exercise; CHO snack to prevent hypoglycemia every 30 minutes while exercising
• Biguanides(diabetes)

  Action: reduces glucose production by liverMetformin (Glucophage) most effective 1st line treatment for type 2<|>Drug alert-contrast Lactic acidosis; Discontinue metformin 2 days before procedure; Resume 48 hours after procedure, if kidney function is normal<|>Weight loss; Take with food to minimize GI side effects
• Sulfonylureas


  Action: increases insulin production from pancreas<|>Major side effect: hypoglycemia<|>Examples: Glipizide (Glucotrol), Glyburide (Glynase), Glimepiride (Amaryl)
• If a patient was scheduled for a CT with contrast and had Metformin on their MAR, what would you do?

  Discontinue metformin 2 days before procedure; Resume 48 hours after procedure, if kidney function is normal
• Insulin

  How to store insulin; Onset/Peak of rapid and short acting in relation to hypoglycemia and food tray availability
• Foot Care(diabetes)


  • Patient teaching: Proper footwear, Avoidance of foot injury, Skin and nail care, Daily inspection of feet, Prompt treatment of small problems, Diligent wound care for foot ulcers
• Problems with insulin therapy


  • Somogyi effect: High dose of insulin causes decrease glucose during the night; Release of counterregulatory hormones cause rebound hyperglycemia
  • Dawn phenomenon: Morning hyperglycemia present on awakening; May be due to release of counterregulatory hormones in predawn hours; More severe in adolescence and young adulthood-peak for growth hormone
• Metabolic Syndrome

  Risk factors: Genetics, age, central/abdominal obesity, DM 2, sleep apnea<|>Criteria for diagnosis: 3/5 - Abdominal obesity >35" female, >40" male, high blood pressure, high blood sugar levels, high triglycerides, low HDL (good)<|>Symptoms: Abdominal obesity >35" female, >40" male, high blood pressure, high blood sugar levels, high triglycerides, low HDL (good)<|>Treatment: Lifestyle changes (health promotion), Medications (BP, DM), Bariatric surgery
• Chronic Neurological Problems

  • Multiple Sclerosis
  • Parkinson's Disease
  • Myasthenia Gravis
• Multiple Sclerosis (MS)


  Chronic, progressive, degenerative disorder of the CNS<|>Onset usually ages 20 to 50 years<|>Characterized by disseminated demyelination of nerve fibers of brain and spinal cord<|>Myelin can still regenerate<|>When it does patient is in remission<|>As inflammation continues, myelin loses ability to regenerate<|>Nerve impulse transmission is disrupted<|>Nerve function lost permanently
• Clinical Manifestations MS


  1. No definitive diagnostic test for MS

  2. Based primarily on history, clinical manifestations, and results of certain diagnostic tests

  3. MRI of brain and spinal cord may show plaques, inflammation, atrophy, and tissue breakdown and destruction

  4. For a diagnosis of MS, evidence of at least two inflammatory demyelinating lesions in at least two different locations within CNS

  5. Damage or an attack occurring at different times (usually greater than 1 month apart)

  6. All other possible diagnoses must ruled out
• Interprofessional Care Drug Therapy

  No cure for MS<|>Interprofessional care is aimed at treating the disease process and providing symptomatic relief
• Drug Therapy

  1. Muscle Relaxers

  2. Bacolofen

  3. B-Interferon

  4. Corticosteroids (methylprednisolone, prednisone)

  5. Helpful in treating acute exacerbations, reduce edema and acute inflammation at the site of demyelination

  6. Therapeutic plasma exchange and IV immunoglobulin G
• Treatment plan

  1. Medication management

  2. Interprofessional Care

  3. Exercise (decreases spasticity, increases coordination, retrains unaffected muscles)

  4. Avoid fatigue, extremes of hot and cold, exposure to infection

  5. Teach patient good balance of exercise and rest, minimize caffeine intake, high fiber diet to relieve constipation, nutritious, well-balanced meals
• Parkinson's Disease (PD)


  Chronic, progressive neurodegenerative disorder characterized by bradykinesia, slowness of movements, rigidity, tremor at rest, gait changes
• Clinical Manifestations Parkinson's disease

  1. Onset is gradual and insidious with ongoing progression

  2. TRAP: Tremor (often first sign, aggravated by emotional stress, increased concentration), Rigidity (sustained muscle contraction, feeling tired and achy), Akinesia (absence or loss of voluntary muscle movements), Postural instability
• Drug TherapyParkinson's disease

  1. Aimed at correcting imbalance of neurotransmitters within the CNS

  2. Antiparkinsonian drugs either enhance or release supply of DA (dopaminergic) or block the effects of overactive cholinergic neurons in the striatum (anticholinergic)

  3. Levodopa with carbidopa (Sinemet) is the primary treatment
• Nutritional therapy

  1. Malnutrition and constipation can be serious consequences

  2. Patients with dysphagia and bradykinesia need appetizing foods that are easy to chew and swallow

  3. Adequate fiber and fruit

  4. Eating 6 small meals a day is less tiring than eating 3 large meals each day
• Parkinsons disease Nursing Implementation

  1. Problems secondary to bradykinesia can be alleviated by consciously thinking about stepping over an imaginary object on the floor, walking to a beat, one step back and two steps forward

  2. Work to promote independence, get out of a chair by using arms and placing the back legs on small blocks, remove rugs and excess furniture, simplify clothing from buttons and hooks, use elevated toilet seats, use an ottoman to elevate legs
• Myasthenia Gravis (MG)


  Autoimmune disease affecting skeletal muscles<|>Symptoms: Ptosis, Diplopia, Difficulty chewing, swallowing, speaking, Breathing
• Drug Therapy


  1. Anticholinesterase agents to improve impulse transmission (pyridostigmine (Mestinon))

  2. Corticosteroids to suppress immune system (prednisone)

  3. Plasmapheresis to improve symptoms
• Nursing Management

  1. Adherence to treatment plan, schedule dose of meds to peak with mealtime, help with ADLs in the morning, balanced diet, chew and swallow (semisoft foods)

  2. Myasthenic Crisis: Acute exacerbation of muscle weakness, airway can be compromised, prepare for intubation
• Headaches


  If no systemic disease is the cause, the type of headache guides therapy
• Therapies used for headaches

  • Symptomatic
  • Preventive
  • Drugs
  • Yoga
  • Biofeedback
  • Cognitive-behavioral therapy
  • Relaxation therapy
• Drug Therapy: Tension-type headache


  1. Symptomatic: Mild-moderate headache treated with aspirin, acetaminophen, or an NSAID alone or in combination with caffeine, a sedative, or muscle relaxant

  2. Preventive: Antidepressants

  3. Antiseizure medications
• Drug therapy: Migraine headache


  1. Goal is to stop or decrease symptoms

  2. Symptomatic: Mild to moderate headache can obtain relief with NSAID, aspirin, or caffeine-containing analgesics

  3. For moderate to severe headaches, triptans (sumatriptan) are first line of therapy

  4. Affect selected serotonin receptors

  5. Reduce neurogenic inflammation of cerebral blood vessels

  6. Produce vasoconstriction-safety alert
• Drug therapy: Cluster headache

  Symptomatic: Triptans
• Assessment: Health history


  • Seizures
  • Cancer
  • Stroke
  • Trauma
  • Asthma or allergies
  • Mental illness
  • Stress
  • Menstruation
  • Exercise
  • Food
  • Bright lights
  • Noxious stimuli
• Assessment: Objective data

  • Anxiety or apprehension
  • Diaphoresis
  • Pallor
  • Unilateral flushing with cheek edema
  • Conjunctivitis