The endocrine system is responsible for:

As we age we have an increase in adrenalgland hormones, decrease in thyroid
stimulating hormone (basal metabolic rate),
decreased production of lipase (reduced fat
absorption), insulin resistance

Alterations to metabolism include:

Common alteration of metabolism:

Less common alterations of metabolism include:

What is the CAGE questionnaire used to identify in liver disease?

What does CAGE questionnaire stand for?

Metabolism and Endocrine gland functions assessed with:

What are some good health history questions to ask in your nursing assessment for alterations to metabolism?

What is shown above?

What could the following picture be caused by?

Your patient presents with a rounded, puffiness of the face as shown above. You know this is known as ______ and is caused by hypothyroidism.

Your patient presents with darker patches of skin around their eyes and on their face. You know that this is called ________ and is a common result of hyperthyroidism.

Your patient is admitted with the following symptoms. You know that your patient has a history of hypothyroidism. What condition is your patient most likely experiencing?

Nails and hair tend to become fine and brittle with ________,

and dry and course with _________.

Your patient is admitted and this following symptom is charted. You know that this is known as ______ and is a result of Grave's disease or hyperthyroidism.

_______ a medical condition characterized by involuntary muscle spasms and nerve hyperexcitability, most often caused by hypocalcemia (low calcium) or sometimes magnesium deficiency.

________ _____ is a clinical sign characterized by twitching of facial muscles when the facial nerve is tapped, and it is often associated with hypoparathyroidism.

________ ____ a medical indication of hypoparathyroidism, identified by a carpopedal spasm—a hand and wrist contraction—that occurs when the brachial artery is compressed by a blood pressure cuff inflated for 3 minutes.

The following is characterized by Lack or dysfunction of growth hormone (GH) from the pituitary gland.

During your musculoskeletal assessment of your patient, you notice they have abnormal growth in various parts of their body. They have an enlarged facial structure, overgrowth of hands and feet, and an increase in body size and height after adulthood. You know that this can be described as _________ and is an excessive production of the growth hormone by the pituitary gland.

Your patient has an abnormally round and protruded stomach as presented in the image above. You know that this is most likely ______ which is an accumulation of fluid in the abdominal cavity.

What is most commonly the cause of ascites? (Notice: all of the following are potential causes of ascites but there is one that is most common when dealing with ascites)

What diagnostic test is completed when assessing for gestational diabetes?

What does the process of an oral glucose tolerance test consist of?

When completing diagnostic testing for a patient with thyroid issues, we rule out this type of medication, as it is known to affect thyroid function:

When working with patients that have problems with metabolism, you may collaborate with these other health professionals to help the patient:

The following pharmacologic therapy is used to help treat what metabolic disorder?

-Calcium regulation agents, Selective estrogen-receptor modulators, Synthetic parathyroid hormone, Bisphosphonates

Insulin is a pharmacologic therapy that is used to treat which metabolic disorder?

Oral hypoglycemics are a pharmacologic therapy used to treat which metabolic disorder?

Type 1 is the most common type of diabetes.

The following risk factors are associated with which type of diabetes?

-hereditary

-tissue types HLA-DR or HLA-DQ

-Exposure to environmental triggers: certain drugs, pollutants, dietary considerations, stress, infections, and gut flora

The following risk factors are associated with which type of diabetes?

-obesity

-family history

-increasing age

-race/ethnicity

-smoking

-sedentary lifestyle

-medications

-metabolic syndrome

The following risk factors are associated with which type of diabetes?

-age >25

-previous baby >9lbs

-family history of type II

-overweight

-race/ethnicity

-polycystic ovary syndrome

Blood requires constant supply of glucose.

Not all tissues require insulin (liver, brain, and red blood cells) but the rest do need insulin

Normal blood glucose in healthy clients is regulated by:

Which of the following describes the pathophysiology of Type 1 diabetes?

In type 1 diabetes, fat begins to breakdown, so _______ form as a result of fat breakdown.

In type 1 diabetes, the accumulation of ketones leads to....

Which of the following describes type 2 diabetes pathophysiology?

The three P's indicating type 1 diabetes include:

Which of the following are symptoms of type 1 diabetes?

The following characteristics describe what?

-High blood glucose levels in mother

-Brings extra glucose to baby

-Causes baby to put on extra weight

Fasting plasma glucose- <100mg/dL (70-100mg/dL)

Casual plasma glucose <140mg/dL

Hemoglobin A1C <5.6%

Fasting plasma glucose 100-125mg/dL

Hemoglobin A1C 5.7-6.4%

Fasting plasma glucose >126 mg/dL

Hemoglobin A1C >6.5%

Which type of diabetes usually ends up in the hospital at first following their diagnosis?

Three main ways to manage diabetes:

Though exercise is helpful with diabetes, it cannot help insulin to work better or decrease the need for insulin.

What is the recommended protocol for
Type 2 diabetic clients that want to
loose weight?
A. Participate in an aerobic program twice a
week for 20 minutes each session
B. Slowly increase insulin dosage until mild
hypoglycemia occurs
C. Reduce calorie intake moderately and
increase exercise
D. Reduce daily caloric intake to 1000 calories
and monitor for urine ketones

What is the general guideline for eating carbohydrates with diabetes?

Five grams/serving or more fiber can be subtracted from total carbohydrates

How many grams of carbohydrates are in one serving

What is the gold standard when it comes to meal planning strategies with diabetes?

1800 kcals – 225 g CHO (50% of total kcals)
B (7:30) 45 g CHO (3 CHO)
L (noon) 60 g CHO (4 CHO)
Snack (3:00) 30 g CHO (2 CHO)
D (6.00) 60 g CHO (4 CHO)
HS snack (9:30) 30g CHO (2CHO)

What is the total carbohydrates (CHO) consumed and total servings of carbs?

In developing an individualized meal plan for
the diabetic client, which goals are the focus
of the plan? Select all that apply
A. Maintaining blood glucose levels at or as close
to the normal range as possible
B. Patient food preferences
C. Allowing patients to eat as much as they
desire
D. Eliminating fats
E. Eliminating carbohydrates

What statement about dietary
concepts is true?
A. Alcoholic beverage consumption is
unrestricted
B. Carbohydrate counting is emphasized when
adjusting dietary intake of nutrients
C. Artificial sweeteners should be avoided
because of the side effects
D. Fiber should be limited

The following medications describe treatment of which type of diabetes:

-insulin to cover basal needs (given 1-2 times a day)

-sliding scale to cover prandial needs (given 2-4 times a day)

*sliding scale coverage may be combined with basal coverage in one shot

The following medications are treatment for which type of diabetes?

-none, can be diet controlled

-oral antidiabetics (one or more per day)

-insulin

The following medications and treatment is used for which type of diabetes:

-glucose monitoring 4 times per day

-postprandial levels below 140

-insulin if needed

-some oral hypoglycemics *safety of these is important

-comprehensive prenatal care is essential

Basal coverage of insulin means ______ ______

Prandial coverage of insulin means _____ ________

Types of insulin include:

Which type of insulin is described below?

Given subcutaneously and in pumps

-lispro (Humalog)

-Aspart (Novolog, Fiasp)

-Glulisine (Apidra)

Which type of insulin is described below?

Often given on sliding scale or on bolus-correction scale

-regular (Humulin R) (Novolin R) (ReliOn R)

Which type of insulin is described?

Cloudy, can be mixed with rapid or short acting

-NPH (Humulin N, Novolin N)

Which of the following types of insulin is described?

Used for basal needs, over the length of 24 hours

*clear

-glargine (Lantus, Basaglar, Toujeo)

-detemir (Levemir)
-degludec (Tresiba)

Which of the following are considered prandial (bolus) or correction insulins?

Which of the following are considered basal insulin?

When mixing insulins, you mix two clears.

ONSET of insulin is when it ______

PEAK of insulin is when it....

DURATION of insulin is when it ...

The following onset, peak and duration would describe which type of insulin that mimics normal insulin production

Onset: 5-15 minutes

Peak: 1 hour

Duration: 3-5 hours

Insulin is only given through IV during emergencies

With rapid-acting insulin, you need to be eating within __ minutes

Your patient's insulin prescription is below

20u NPH (Humulin N) at 8 am

8u NPH (Humulin N) at 8 pm

Give regular (Humulin R) as follows based on sliding scale below:

< 150 0 units
151-200 2 units
201-250 4 units
251– 300 6 units
301-350 8 units
>350 call MD

Your patient's blood sugar is 224. What insulin will be given at 8 am?

Your patient needs 20u of NPH (Humulin N) and 6u of regular insulin (Humulin R).

Can this be given in one shot or two?

What is an automated insulin delivery system also known as?

Hardening of tissue associated with a complication of insulin therapy?

Loss of tissue which is common in insulin therapy

Which insulins are considered to have
a rapid onset of action?
Select all that apply
A. Glargine (Lantus)
B. Glulisine (Apidra)
C. Humilin N (NPH)
D. Aspart (Novolog)
E. Lispro (Humalog)

The patient will be using an external
insulin pump. What does the nurse tell
the patient about the pump?
A. Monitoring of blood glucose levels with a
glucometer is not necessary
B. The insulin supply must be replaced every 2 to
4 weeks
C. The pump’s battery should be checked on a
regular weekly schedule
D. The needle site must be changed every 1 to 3
days

A diabetic client is prescribed 12 units of NPH
insulin at 7:30 am. At 1 pm the client reports
feeling shaky and is diaphoretic. Which is the
explanation for the probable cause?
A. The NPH insulin’s action is peaking, and there is
an insufficient blood glucose level
B. The regular insulin’s action is peaking, and there
is an insufficient blood glucose level
C. The patient consumed too many calories at
breakfast and now has an elevated blood glucose
level
D. The symptoms are unrelated to the insulin
administered in the early morning or diet taken at
lunch time

A client is ordered to get 20 units of
Novolin 70/30. How many units of
NPH will he get? How many Units of
Regular will he get?

Additional treatments used alongside primary diabetes management (insulin/oral medications)

*cannot be mixed in same syringe as insulin

Type of adjunctive therapy used for Type 1 and Type 2 diabetes

-pramlintide acetate (Symlin)

Type of adjunctive therapy that is for type 2 diabetes only.

-exenatide (Byetta)

-liraglutide (Victoza)

-dulaglutide (Trulicity)

-Semaglutide (Ozempic)

Which diabetes medical treatment increases insulin secretion, reduces hepatic glucose production, delays food absorption, improves tissue sensitivity, and inhibits glucose reabsorption

-sulfonylureas, biguanides, meglitinide analogues, thiazolidinediones, alpha-glucosidase inhibitors, incretin-DPP-4 inhibitors, SGLT2 inhibitors

Oral hypoglycemics are typically held in acute care.

Oral hypoglycemics are typically only used by type 1 diabetes patients.

What is the benefit of taking a combination oral anti-diabetic agent

What is the most accurate way to monitor diabetes?

A higher A1C percentage indicates a more unhealthy level of blood sugar.

An A1C percentage of _._ or higher indicates diabetes

Hot and dry=

Cold and clammy=

Life threatening complication resulting from lack of insulin

-medical emergency

-patient develops severe hyperglycemia (>250mg/dL)

Diabetes Ketoacidosis typically only occurs in type 1 diabetes.

Your patient's skin is flush, dry and warm. They are experiencing nausea, abdominal pain, vomiting, are confused, and have a decreasing level of consciousness. They are very weak and reported weight loss in the past month. They also mentioned increased thirst, urination, and hunger over the past few weeks.

Their vitals are 100/64, 110 bpm, and 26 deep breaths per minute

Their labs showed hyperkalemia and ketones in the urine.

All these symptoms indicate...

Diabetic ketoacidosis interventions include:

Life threatening reaction resulting from very high blood sugar levels (>600mg/dL)

-usually caused by infection

Hyperglycemic Hyperosmolar State (HHS) is usually only seen in Type 1 diabetics.

Your patient is in a hyperglycemic hyperosmolar state. Which action most likely is the cause of this state?

Your patient appears confused, experienced weight loss, polyuria, and has a decreasing level of consciousness. They are severely dehydrated and ketones are not in their urine.

Their vitals are: 105/58, 119 bpm, 102.2 F.

What is your patient most likely experiencing

Your patient is in a Hyperglycemic Hyperosmolar State. What interventions will they most likely be completed on the patient?

What acute complication occurs when blood sugar falls below 70 mg/dL?

Other names for hypoglycemia include:

Your patient received their insulin, did not eat any of their lunch, and is now sweaty, shaking, confused, and has blurred vision. What is your patient experiencing?

Which of the following could cause hypoglycemia?

The nurse knows that a blood sugar level of
40mg/dL indicates which condition?
A. ketoacidosis
B. normal serum blood glucose
C. insulin reaction
D. glycosuria

Acute complication in which there is a rise in blood glucose between 4-8 am

-not a response to hypoglycemia

-will need more basal insulin before bed

An acute complication in which there is a combination of hypoglycemia during the night with rebound morning rise to hyperglycemia

-will need snack or decreased basal insulin before bed

Damage to the large blood vessels caused by high blood sugar, leads to problems like Cardiovascular and Peripheral vascular disease (heart disease, stroke, poor circulation)

Damage to small blood vessels caused by high blood sugar, leading to diabetic retinopathy, neuropathy, nephropathy, male erectile dysfunction.

How can chronic complications such as macrovascular and microvascular be prevented?

What is diabetic retinopathy?

When referring to surgical treatment of diabetes, Islet Cell Transplant is more common than Whole Pancreas Transplant.

What nursing intervention should you complete on your patient if their blood sugar is 50-69 mg/dL.

How long do you wait to recheck blood sugar after treatment?

What nursing intervention should you complete on your patient if their blood sugar is <50mg/dL

Your patient's blood sugar is 44mg/dL and they are unconscious. What nursing intervention do you complete?

If a patient is experiencing severe hypoglycemia at home, what is the next best intervention to treat this patient's condition?

Once a patient's blood sugar is back to >70 mg/dL after an unstable blood glucose, what do you do next?

What are good travel rules to educate a diabetic client on?

What is good practice when consuming alcohol while on insulin?

What are some nursing interventions that can be completed to help with peripheral neuropathy?

What is a big focus when dealing with disturbed sensory perception in diabetes?

Your patient has advanced disturbed sensory perception as a result of diabetes. What are some interventions that you will implement into their care?

When should you call the doctor when you are sick with diabetes?