Download Hondros 212 Exam 3: Obesity, Metabolic Syndrome, and Diabetes Questions and Answers and more Exams Health sciences in PDF only on Docsity!
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Health risk associated with obesity - correct answer ✅Depression, T2DM, metabolic syndrome, polycystic ovary disease, sleep apnea, asthma, pulmonary HTN, menstrual irregularities, infertility, gestational diabetes, huperlipidemia, sudden cardiac death, a fib, HTN, CAD, DVT, right sided HF, NASH, gallstones, GERD, kidney cancer, CKD, esophagus, pancreas, thyroid, colorectal and gallbladder cancer, breast and ovarian cancer Nutritional therapy for obesity - correct answer ✅Restricting dietary intake so that it is below energy requirements- includes all food groups Criteria guidelines for bariatric surgery - correct answer ✅BMI of 40 or more or a BMI of 35 or more with other significant co-morbidities (HTN, T2DM, HF, sleep apnea) Disadvantages of Roux-en-Y gastric bypass - correct answer ✅Leak at site of anastomosis, anemia, calcium deficiency, dumping syndrome, irreversible Dumping syndrome - correct answer ✅Gastric contents empty too rabidly into the small intestine, overwhelming its ability to digest nutrients.
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Symptoms include n/v, weakness, sweating, faintness and sometimes diarrhea. Pt is instructed to avoid sugary foods after surgery Anastomosis leak - correct answer ✅tachycardia, fever, tachypnea, chest and abdominal pain Post operative care for bariatric surgery - correct answer ✅assess for cardiopulmonary complications, thrombus formation, anastomosis leaks and electrolyte imbalances, maintain the head of the bed at a minimum of a 45 degree angle to reduce abdominal pressure and increase lung expansion, pts should not consume fluids with meals Metabolic syndrome definiton - correct answer ✅is a group of metabolic risk factors that increase a person's change of developing CVD, stroke, diabetes. It is a cluster of heath problems, including obesity, HTN, abnormal lipid levels, and high blood glucose
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C peptide in serum and urine - correct answer ✅useful clinical indicator of pancreatic b cell function and insulin levels Signs and symptoms of type 1 diabetes - correct answer ✅polyuria, polydipsia, polyphagia, weight loss may occur, weakness and fatigue signs and symptoms of type 2 diabetes - correct answer ✅poor wound healing, recurrent infections, dry skin, 3 Ps, drowsiness, hunger Diagnosis of diabetes - correct answer ✅A1C of 6.5 or higher, fasting plasma glucose level of 126 or greater, a 2 hour plasma glucose level of 200 or greater during an OGTT using a glucose load of 75g, in a pt with classic symptoms of hyperglycemia (polyuria, polydipsia, unexplained weight loss) or hyperglycemic crisis, a random blood glucose level of 200 or more
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A1C (glycosylated hemoglobin) - correct answer ✅provides a measurement of blood glucose levels over the previous 2 to 3 months Diseases affecting RBCs (anemia) can influence the AIC Goal A1C for pts with diabetes - correct answer ✅less than 7. Fructosamine - correct answer ✅Is another way to assess glucose levels,, reflects glycemia in the previous 1 to 3 weeks Islet cell antoantibody - correct answer ✅testing is primarily done to help distinguish between autoimmune type 1 diabetes and diabetes from other causes Rapid acting insulin (lispro, aspart) - correct answer ✅Onset 10-30 min Peak- 30 min- 3hr
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Duration- 16-24hr DO NOT MIX WITH ANY OTHER INSULIN Lipodystrophy - correct answer ✅loss of subcutaneous tissue may occur if the same injection sites are used Hypertrophy - correct answer ✅is a thickening of subcutaneous tissue. It eventually regresses if the pt does not use the site for at least 6 months. Injecting into a hypertrophied area may result in erratic insulin absorption Somogyi Effect - correct answer ✅Hyperglycemia in the morning, blood sugar drops at night d/t high dose of insulin then counterregulatory hormones are secreted increasing blood glucose levels. If a pt has morning hyperglycemia, check glucose levels between 2 and 4 am for hypoglycemia to see if its d/t to somogyi effect. Pt may report headaches on awakening and recall having
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night sweats and nightmares. Treatment is a bedtime snack, reducing the dose of insulin or both Dawn phenomenon - correct answer ✅Hyperglycemia present on awakening (GH and cortisol are increased in the morning. Treatment is an increase in insulin or an adjustment in administration time. Metformin - correct answer ✅Do not use in pts with kidney disease, liver disease or heart failure. Lactic acidosis is a rare complication of metformin accumulation (n,v, weakness). IV contrast media that contain iodine pose a risk for CIN, which could worsen metformin- induced lactic acidosis. To reduce the risk of CIN, DC metformin 2 days before the procedure. May be resumed 48 hrs after the procedure, assuming kidney function is normal. Do not use in people who drunk excess amounts of alcohol. Take with food to minimize GI upset
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Type 1 diabetes and exercise - correct answer ✅In a person with type 1 diabetes who has hyperglycemia and ketones, exercise can worsen these conditions. Teach pts to delay activity if the glucose is above 250 and ketones are present in the urine Stress and diabetes - correct answer ✅Stress and illness can raise glucose levels. Teach pts with diabetes to check glucose levels q4hrs during tiems of illness Diabetic Ketoacidosis (DKA) definition - correct answer ✅is characterized by hyperglycemia, ketosis, acidosis and dehydration. Precipitating factors of DKA - correct answer ✅Illness Infection Inadequate insulin dosage
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Undiagnosed type 1 diabetes Poor self-management Neglect If DKA is not treated - correct answer ✅pt will develop severe depletion of sodium, potassium, chloride, magnesium and phosphate. Eventually, hypovolemia followed by shock will happen along with renal failure. Untreated, the pt becomes comatose from dehydration, acidosis and electrolyte imbalance Manifestations of DKA - correct answer ✅dehydration, dry mucous membranes, tachycardia and orthostatic hypotension. Early symptoms include lethargy and weakness. As the pt becomes dehydrated he skin becomes dry and loose, and the yes become soft and sunken. abdominal pain be present along with anorexia, n/v, breath like juicy fruit, KUSSMAUL
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able to produce enough insulin to prevent DKA but not enough to prevent severe hyperglycemia, osmotic diuresis, and extracellular fluid depletion. Causes of HHS - correct answer ✅UTIs, pneumonia, sepsis, any acute illness and newly diagnosed T2DM, impaired thirst sensation Risk of HHS - correct answer ✅The higher the glucose level increase serum osmolality and cause more severe neurologic manifestations such as somnolence, coma, SEIZURES, hemiparesis and aphasia Laboratory findings of HHS - correct answer ✅glucose level of 600 or more, increased serum osmolality. Ketone bodies are absent or minimal in both urine and blood Treatment of HHS - correct answer ✅similar to DKA, Immediate IV administration of REGULAR insulin and 0.9. HHS usually requires large
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volumes of fluid replacement. If glucose levels reach 250 give dextrose to prevent hypoglycemia signs and symptoms of hypoglycemia - correct answer ✅Shaking Fast HR Sweating Anxious Dizziness Hunger Impaired vision Weakness, fatigue Headache Irritable
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Prevention of macrovascular complications - correct answer ✅Yearly screening for CVD in pts with diabetes. Decrease risk factors- obesity, smoking, HTN, high fat intake and sedentary lifestyle. Pts need control over glucose levels. Optimizing BP really helps! Treat HTN. Screening for dyslipidemia and starting statin therapy as needed Microvascular complications - correct answer ✅Thickening of the vessel membranes in the capillaries and arterioles in response to conditions of chronic hyperglycemia Diabetes-related retinopathy - correct answer ✅leading cause of blindness. proliferative diabetic retinopathy - correct answer ✅the most common form, partial occlusion of the small blood vessels in the retina causes microaneurysms to develop in the cap walls. Capillary fluids leak out, causing retinal edema and eventually hard exudates and intraretinal hemorrhages.
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Can be mild or severe-- if the center of the retina (macula) is affected, vision loss is severe Proliferative retinopathy - correct answer ✅the most severe form, involves the retina and vitreous. When the retinal capillaries become occluded, the body compensates by forming new blood vessels to supply the retina (neovascularization). The new blood vessels are fragile and hemorrhage. eventually light is prevented from reaching the retina. The pt sees black or red spots or lines. Retinal detachment can occur Care for retinopathy - correct answer ✅dilated eye examination at the time of diagnosis and annually afterwards. T1DM- q 5 years. Prevent by maintaining healthy glucose levels and managing HTN, laser photocoagulation therapy can reduce the risk for vision loss. A pt who develops vitreous hemorrhage and retinal detachment may undergo vitrectomy is he aspiration of blood, membraine and fibers from inside the
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treatment of sensory neuropathy - correct answer ✅Managing DM is the only treatment. Capsacin, gabapentin, Lyrica, Cymbalta Risk associated with autonomic neuropathy - correct answer ✅hypoglycemia unawareness, bowel incontinence and diarrhea and urinary retention. Gastroparesis (delayed gastric emptying)- can cause anorexia, n/v, GERD, can trigger hypoglycemia, cardiovascular complication include postural hypotension, resting tachycardia and painless MI. Erectile dysfunction, vaginal infections in women and neurogenic bladder Hyperthyroidism (Graves's Disease) - correct answer ✅excessive activity of the thyroid gland with sustained increase in synthesis and release of thyroid hormones. Causes include toxic nodular goiter, thyroiditis, excessive iodine intake pituitary tumors and thyroid cancer. Monitor pts getting iodinated contrast media!!
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thyrotoxicosis - correct answer ✅physiologic effects or clinical syndrome of hypermetabolism resulting from excess circulating levels of T4 and T3. Usually occurs with hyperthyroidism Subclinical hyperthyroidism - correct answer ✅Occurs when the pt has a serum TSH level below 0.4 but normal T3 and T4 levels Grave's Disease (hyperthyroidism) - correct answer ✅is an autoimmune disease of unknown cause characterized by diffuse thyroid enlargement and excess thyroid hormone secretion. pt develops antibodies to the TSH receptor. Is characterized by remissions and exacerbations. May result in destruction of thyroid tissue resulting in hypothyroidism. is associated with other autoimmune disorders (RA, lupus celiac disease, addisons)
