DIABETES Self Directed Test (12 Hours) Name: Ward/Practice Area: Mailing Address:

Transcription

1 1 DIABETES Self Directed Test (12 Hours) Name: Ward/Practice Area: Mailing Address:

2 2 Learning Outcomes All nurses, regardless of practice setting, are required to work collaboratively with the person with diabetes to address their health needs. At all stages of life, and at several points across the health continuum, people with diabetes will require services from nurses in generalist settings such as general practice, diagnostic services and general medical/surgical services. People with diabetes may also have co-morbidities requiring identification, treatment and monitoring. All nurses need to be capable of applying generic diabetes nursing knowledge and skills to meet the health needs of these individuals. In particular, all nurses should: Work as part of larger health care team, and understand their role in diabetes care as a member of the multidisciplinary team. Practice nursing in a manner that the person with diabetes determines as culturally safe. Role model the application of the Treaty of Waitangi principles in nursing practice. Assist individuals with (or at risk of developing) diabetes to access resources/information. Lead or assist community health professionals with prevention initiatives as appropriate. Provide support to families of individuals living with diabetes. Provide information and education to individuals. Be engaged in quality activities. Assess and interpret clinical indicators of general health status and metabolic control. Complete documentation of clinical assessment, care, recommendations and evaluation of response accurately. Module Assessment 1. Read the associated fundamental diabetes workbook. 2. Complete the self directed learning and questions in the review questions book. 3. Return the completed workbook to the WDHB Nurse Educators for marking 4. A certificate of completion will be sent to you once you have completed the module and answered all the questions correctly.

3 3 Self Directed Learning 1. State the normal blood glucose range 2. Type 1 diabetes: which is true? a) Affects 10% of people with diabetes and usually occurs before age 40 b) is also called brittle diabetes c) is more serious than other types of diabetes d) can be cured with insulin injections 3. Type One Diabetes management involves balancing: a) Food and insulin b) Food, activity and insulin c) Insulin and exercise d) I don t know 4. Describe effect of metformin on blood glucose levels? 5. List the side effects of sulphonureas and metformin

4 4 6. List the maximum dosages of metformin and glipizide, and gliclazide. Metformin: Glipizide: Glicazide: 7. The patient you are looking after has recently started on metformin and on a small dose of glipizide. He complains of diarrheoa and an upset stomach. What could be the possible cause? An inappropriate combination of medication A well known side effect of glipzide tablets A well known side effect of metformin. 8. When should metformin be given? Before meals In between meals Immediately after food With food. 9. Which of the following sulphonylureas is not recommended for use in the elderly because of its prolonged actions? Glibenclamide Gliclazide Glipizide 10. A middle aged woman on Gliclazide and metformin starts having hypos after loosing weight. Which of the following is appropriate? Substitute glipizide for gliclazide Reduce the gliclazide dose Reduce the metformin dose.

5 5 11. Mrs Jones was admitted for gangrenous toe. She has type two diabetes and has a HbA1C 7%(53mmol/mol ). Current medications include metformin 1 gram BD and glycoside 80mg BD. Her blood sugars during admission were generally between 5-7mmol/l with no hypoglycemic episodes. Three days after admission her metformin and gliclaczide was stopped? Her blood glucose levels are now between 8-9mmol/l. What would you do in this situation? 12. Describe the effects of insulin on blood glucose levels including side effects of administration?

6 6 13. What are the important things to note in the preparation and administration of insulin? 14. Why is it important to time doses in relation to meals?

7 7 15. Describe situations where insulin dose or type may need to be altered? 16. List two basal insulin s and two bolus insulin s? 17. Mr Thomas has type one diabetes and is admitted with renal failure. His regular insulin regime is OD lantus am, and novorapid before each meal. He managed well at home with an HBA1c of 7.6. On admission he was charted scale A on the sub cut insulin orders. On the night of his admission he had BGL of 2.9 which was treated appropriately. On morning handover the nurse reported in passing that she was worried about his blood sugars and queried if he should have his regular novorapid. As a consequence his regular novorapid was withheld for the day. His morning fasting BGL was however 7.6. Following this his BGL ranged between 11-15mol/l, he did receive scale A preprandial insulin. What could done differently in the management of this patient?

8 8 18. What key messages should you give to a person who is monitoring their own Blood glucose levels? 19. Identify situations where testing for ketones would be appropriate? 20. What is the recommended HBA1c level for a person with type one diabetes? 21. And a person with type two diabetes? 22. Why are they different?

9 9 23. When and how often should a person with type two diabetes test their BGL o Diet and exercise and or metformin o Metformin and sulphonylurea o Premix insulin o Basal/ bolus (rapid acting and intermediate acting insulin? 24. Joan attends clinic complaining of recurrent thrush (candida). She has a strong family history of diabetes. A random capillary BGL is 9 mmols. What further tests are needed for definitive diagnosis of diabetes?

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11 11 Compare these products yourself? 25. In 100mls, how much sugar is in the: Pure Orange Juice? Fizzy Drink? Diet fizzy drink? 26. Does 'no added sugar' mean that there will be no sugar in the product? 27. How much fat is in a serve of the standard ice cream? 28. List three healthy carbohydrate snacks? 29. What are the main principles of healthy eating?

12 When reading labels what are the general recommendations for, ie what is the recommended limits to the amount of fats, sugars and fibre in the food. Fats 100gm Sugar Fibre 31. What level of BMI would indicate? Overweight Obese 32. What are the benefits of physical activity for a person with diabetes? 33. What is the relationship between smoking and long term outcomes for a person with diabetes?

13 What might be some of the barriers to self care for a person with diabetes? 35. When called to see an unconscious diabetes patient how can you differentiate between Hyperglycemia and hypoglycemia (other that by the BG level)? 36. How does diabetic retinopathy cause eye damage?

14 How often should a person with diabetes have a retinopathy test? 38. What other annual examinations are recommended best practice for a person with diabetes? If in an inpatient clinical setting please complete this section (For community nursing please see page 16) 39. A 28 year of man with type one diabetes (for 6 years) phones for advice. He has been unwell with flu like illness for 24 hours. He is on a novorapid units before each meal and lantus at night. His BGL has risen from 9 to 16mmol. What should be done about his diabetes management?

15 How do steroids affect Glycaemic control in diabetes? 41. Case: Ms. X is a 56-year-old obese woman with type 2 diabetes mellitus who is admitted for treatment of an infected diabetes-related foot ulcer. She will be allowed to eat dinner in a couple of hours, but the surgeons have requested that she be kept nil by mouth (NBM) after midnight for surgical debridement in the morning. Her current weight is 100 kg. Her recent glycosylated hemoglobin (HbA1C) measurement was 8.3% (64mmol/mol). Her home medical regimen includes glipizide 10 mg daily, metformin 1000 mg twice daily, and 20 units of isophane insulin BD. How should this patient s blood glucose be managed in the hospital? 42. How is diabetes managed when a patient with type 1 diabetes, is being starved for an investigation or procedure such as a gastroscopy?

16 16 If in a community clinical setting please complete this section 43. Mr M 54 year old gentleman has had type two diabetes for 10 years. He is managed with Metformin 500mg BD and Simvastatin 20mg OD and Accupril 5mg OD. He presented for his annual diabetes check after having bloods and urine tests. His results are as follows: Hba1c 9.2% Total cholesterol 6.0 Triglyceride 2.5 HDL 0.8 LDL 3.0 HDL/chol Ratio 5.0 Urine alb 55 Creatinine Alb/creat ratio How would you approach this consult and what key areas would you focus on?

17 What advice would you give someone if discovered they had early indications of peripheral neuropathy? 46. What are the key features of a foot assessment?

18 Mrs. B is a 45 year old lady with type two diabetes for 15 years, present feeling unwell with persistent thrush, dry mouth, feeling tired and aware of mood swings. Last seen by GP 6 months ago for medication repeats. Medications: metformin 1gram TDS, Gliclazide 80mg BD, and Simvastatin 40mg OD, Accupril 10mg OD. Her latest Hba1c is 10.5%. How would you approach this consult taking into consideration: 1 Assessment 2. Medications 3. Plan of care and advice 4. Follow-up

19 19 Assessment and Feedback Markers Name: Date module received: Date module marked: Complete / Incomplete Comments of Marker: