NR 601 Final Exam Guide Final EXAM Guide 601 to pass your NR 601 Exam

NR 601 Final Exam Guide
Final EXAM Guide 601 to
pass your NR 601 Exam
Glucose Metabolism Disorders
Type 1 Diabetes
2 types
1. Immune mediated (type 1A) 90% of cases
• Caused by autoimmune destruction of insulin-producing pancreatic beta islet cells
• The triggering factor in the development of type 1 DM is thought to be an infection or toxic insult in persons
with a genetic predisposition.
• The most commonly identified infectious agents are congenital rubella, othersinclude; Coxsackie B4 virus,
cytomegalovirus, adenovirus, and mumps virus.
• Associated with an increased incidence of other autoimmune disorders, including thyroid, adrenal, and
gonadal insufficiency
• Progressive beta cell destruction remainsthe hallmark of type 1 DM, with hyperglycemia typically developing
once 80% to 90% of a patient’s beta cells have been destroyed
2. Idiopathic (type 1B)
Clinical Presentation
• The majority of patientsseek medical attention due to symptoms related to hyperglycemia, with the initial
diagnosisin children often being made when patients present in frank diabetic ketoacidosis (DKA)
o Signs of severe ketosis known as diabetic ketoacidosis (DKA) include extreme fatigue, abnormal
cramping, and alterations in breathing pattern. In addition, a telltale sign of ketosis is halitosis, which
smells like a combination of nail polish (acetone) and rotting fruit. In contrast, hyperosmolar
hyperglycemic state (HHS) is a serious form of nonketotic acidosis resulting from prolonged
hyperglycemia that is less common than DKA but has a higher mortality rate. HHS is seen most
frequently in adults who have a restriction in fluid intake forsome reason,such as a concurrent illness,
impaired physical function, or reduced cognition.
• The classic symptoms of type 1 DM are polyuria (increased urination), polydipsia (increased fluid intake due to
excessive thirst), nocturnal enuresis, polyphagia with paradoxical weight loss (due to reduced glucose
metabolism, despite increased consumption), visual changes (especially blurred vision), and eventual fatigue,
weakness, and anorexia.
Screening:
• The American Diabetes Association (ADA) does not recommend screening for type 1 DM in apparently healthy
individuals who have no risk factors for this disorder. However, if suspected, point-of-care testing can be
accomplished by utilizing a portable blood glucose monitor to determine capillary blood glucose level as a
random plasma glucose measurement taken without regard to the timing of a patient’s last meal. If elevated, the
patient’s urine should be tested for ketones and additional plasma glucose testing should be initiated.
Diagnostic criteria:
• Glycosylated hemoglobin (A1C) of 6.5% or higher
• Symptoms of diabetes(e.g., polyuria, polydipsia, weight loss) plus a random plasma glucose level of 200
mg/dL or higher
• Fasting plasma glucose level of 126 mg/dL or higher (following 8 hours of no caloric intake)