Diabetes Mellitus Pharmacology Medications | NCLEX Nursing Lecture on Management Made Easy

hey everyone it's sarah with registerednessrn.com and in this video we're going to be going over diabetes mellitus specifically the nursing management what i'm going to do is i'm going to focus specifically on the things you need to know for the nclex exam and your nursing lecture exam and after this video be sure to go to my website registerednessrn.com and take the free quiz that will test your knowledge on this material a card should be popping up so you can access this now this video is part of a series about an nclex review over the diabetic patient in the previous video we went over the pathophysiology the causes the complications the different types the nursing assessment and things like that so if you haven't watched that video be sure to watch that video after you watch this okay so let's get started first let's begin by talking about the nurse's role when you're taking care of the diabetic patient your role as a nurse is to educate to administer medications to assess and monitor them and the best way to help you learn this and help your patient learn this is to follow the triangle of diabetes management it's a little triangle it's continuous because everything works together you have diet on one side meds on the other exercise and in the middle you have monitor because based on their diet how they're exercising will determine what type of medications they need especially when that type 2 diabetic because a lot of times they don't even need medications if they can manage their diet and exercise and then all through that you're going to monitor exercise they're going to make sure that their glucose is good before they exercise if not they're going to eat a little snack and they're going to monitor their glucose so all that goes together now for nclex what do you need to know specifically because this is what this lecture is all about getting you to know what you need to know for nclex okay as a nurse you need to know diet how you're going to educate the patient based on what they can eat what food specifically really making sure you know what foods they can have exercise what type of exercise they should do how they're going to monitor their glucose taking their insulin therapy things like that drugs specifically really the drugs pharmacological aspect you need to know all about insulin the complications of insulin the different types of insulin like you're rapid you're short your intermediate long and those peak times and a little bit later in the lecture i'm going to give you a mnemonic on how to remember that because it's a little complicated to remember hopefully the mnemonic will help you and the drugs that cause hypo and hyperglycemia and different types of oral medications that your type 2 diabetics will take so first let's start about the diet now diets in diabetic patients are very individualistic it depends on how much how physical physically active they are how they eat things like that so there's not a one-size-fits-all diet they have to do some tweaking generally it's a good guideline to follow the ada diet which is the american diabetic association diet and here's what it says what you want to concentrate on is the foods that are in each category and how much they can have of each um percentage of each category so carbs a diabetic needs to consume at least 45 carbs in their diet throughout the day so this includes like grains those starchy vegetables like potatoes and corn those sweets have hidden carbs in them like cookies and soda and dried beans and milk next are fats this is the one you want to limit the most no more than about 20 percent and they want to limit those saturated trans fats and cholesterol and those are found in foods such as lard gravies whole milk fatty meats like bologna sausage hot dogs and encouraged as an alternative those healthy fats like the mono saturated and the polysaturated which are like avocados olives and nuts so teaching them how to pick healthy fats compared to unhealthy fats and then proteins um they want at least 15 percent to 20 percent of proteins in their diet and also let them know that meats do not increase the glycemic index so that is good and meat they need to eat really try to avoid those red meats they aren't as healthy so you want to concentrate on chicken turkey fish plant-based beans egg whites and low-fat cheese now let's go over the exercise part okay the best type of exercise for a diabetic to do is the aerobic type exercise because this helps the body use insulin so what type of exercise is best great test questions come from this they'll give you an exercise regimen which one's the best for the diabetic this includes like those cardio exercises that require you to run and really get the heart pumping like walking running and swimming okay education pieces that you need to give the diabetic prior to exercising because remember they have issues with managing their glucose and their insulin so prior to exercising they want to check their blood sugar and if their blood sugar is less than 100 it's a good idea to eat a snack because if you're already starting out on the lower end and you're going to exercise because when you exercise you use glucose you're going to bottom out and experience hypoglycemia so tell them to carry some simple carbs with them um remember in the previous video we went in depth about simple carbs and those this is like hard candy fruit juice honey in case they do get that hypoglycemic attack they can just pop that in the mouth and help increase the blood sugar signs of hypoglycemia is they can be sweaty clammy confused lightheaded double vision tremors remember the phrase i'm sweaty cold and clammy please give me some candy so that can help you and your patient remember what to do for hypoglycemia now they plan on exercising for a long period of time it's a good idea to check their blood sugar prior to exercise during and after just to monitor it because you're going to be using a lot of glucose in the body now if they prior to exercising if the glucose is high instead of low usually greater than 250 and there's urine and there's ketones present in their urine they need to avoid exercising because the body is already burning ketones in the system it can't get to the glucose so they don't want to exercise and burn even more ketones cause some acid-base imbalances which they can go into dka and it would not be good so they need to hold off now what are some signs of high blood sugar remember the three p's polyuria polyphasia and polydipsia polyuria is where you have frequent urination polyphagia is where you're extremely hungry and polydipsia is where you have a frequent thirst and just remember the same i'm hot and dry i must be on a sugar high because those symptoms are present in hyperglycemia okay now let's get to the meat and potatoes of the lecture then we're going to go over medications a lot of test questions come from here what we're going to cover we're going to cover our oral medications the medications that cause hyper and hypoglycemia and insulin okay but first let's talk about oral medications oral medications are typically for your type 2 diabetics and they are usually started when the type 2 diabetic can't manage their blood sugar with either diet and exercise diet exercise is the first things we want and then they will be put on medications as a last resort so let's talk about those first one are your sulfonyureas this is um the most common types and these drugs include glyburide glipizide diabetes amarillo and these drugs typically and help you remember in eyes like zy z-i-d-s my m-i-d-e-s or the rides r-i-d-e-s and what these drugs do is they stimulate the beta cells because remember your beta cells secrete insulin to make insulin but one thing you've got to watch out for this drug will cause hypoglycemia and absolutely no alcohol the patient should never ingest alcohol drinks or anything like that that contains alcohol because you can experience extreme hypoglycemia because alcohol already causes low blood sugar levels so does this medication you put those two together and you have a bad case scenario so remember that with this drug no alcohol next drug category are the drugs known as the myglitonides and this is drugs that usually end in the g-l-i-n-i-d-e like repentaglinide and these stimulate the beta cells to produce insulin source similar as your sulfa niurias and these are usually taken with the first bite of food so an education piece whenever a patient's on these type of drugs you want but right before they eat their food they need to take this medication okay next is the baguanides and this is a very popular drug as a nurse i see this drug all the time uh metformin that's a common drug of this category also called glucophage and what this drug does is it decreases the liver stores of glucose and an education piece you want to watch out for this and even as a nurse working on the floor this is usually held about 48 hours prior to surgery or before a heart cath especially with a heart cath because those dyes that they're giving during the heart cath and metformin and those dyes do not go together and they can cause renal failure so you want to watch renal function and this drug can also cause diarrhea next is the alpha glucoside inhibitors this is the drugs known as precose or glycemic and this lowers the blood glucose by breaking down starchy foods in the gut so education piece with this is that you want to take this medication with the first bite of food since it works on the food you are taking in the next drug category is a mouthful it's called the thiazonelidineons and these are also called for short as tzds and these drugs a common one is glytozone and it decreases the glucose production in the liver also um brand names actos and avandia with this drug however you have to watch the liver function and the heart function because um studies have shown that there may be an increased risk of mis in patients who take these drugs now let's look at the drugs that can cause hypoglycemia and hyperglycemia okay your beta blockers those um like metoprol atenolol things that end in olol they can actually mask the symptoms of hypoglycemia and they can cause it alcohol can as well aspirin those sulfonylureas that we talked about with the oral diabetic medications you don't want them to take alcohol as well with those type of medications your moa inhibitors these are the drugs used to treat depression and bactrim which is a popular antibiotic so if your patients on that you want to watch out for that and some drugs that can cause elevated blood sugars are the thiazides that like hctz those are diuretics glucocorticoids like hydrocortisone prednisone and estrogen therapy and watch out for your oral contraceptives as well now let's hit on insulin okay with this what we're going to do is we're going to talk about some key points you need to remember with insulin and then we're going to go over a couple mnemonics on how to remember what drugs of insulin are either rapid short intermediate or long and then give you some mnemonics on how to remember that onset peak and duration time so first let's go over the little side notes you need to know about giving insulin okay whenever you're given insulin it's usually a sub-q injection the only insulin you can give iv is regular insulin remember that it's only one that can go intravenous but whenever you give it you give it sub-q and it goes into the fat subcues fat of the skin and you want to rotate sides you never want to use the same side rule of thumb rotate sides out where you're not using one site more than one time within a two to three week period because they can develop lipodustry dystrophia which is pitting of like fat and they'll get dimples in their skin and it'll mess up their fat layer never after you give insulin subcu don't massage the area or put heat at it because this will increase absorption faster than what the body can handle and you are going to have increased chances of having a hypoglycemic attack so don't do that and whenever you're mixing insulins remember the little phrase clear to cloudy clear represents regular insulin and nph represents cloudy and how you remember that is the initials are in for registered nurse r represents regular n represents nph so clear to cloudy whenever you're mixing those now some things that can happen with diabetics who take insulin these couple phenomenons these phenomenons people get confused one's a phenomenon one's an effect and they both deal with high blood glucose levels but they happen during different times in the night okay so let's talk about the dawn phenomenon let the word help you okay dawn the crack of dawn in the morning this happens during the waking hours the patient's going to have hyperglycemia during the waking hours and this is because the body in preparation of waking up the body shoots you some extra glucose because it knows you're going to need it for those waking hours and this typically happens between five to eight am and but the diabetic can't handle that extra glucose because they are they have issues with insulin remember insulin helps take glucose into the cell so in the morning they're going to have really high glucose levels to help combat that just throwing on maybe a nighttime dose of nph was it which is an intermediate acting insulin can help counteract that hyperglycemia whenever they're waking at the crack of dawn in the mid in those waking hours next is the somji effect i like to remember this psalm g starts with s for the sleeping hours this happens whenever they're asleep typically the hours between 2 a.m to 3 a.m and what's happening is that they're having a drop in blood sugar around these hours and the body says hey we've got to fix this so they release the hormones like cortisol your catecholamines and growth hormone to increase that blood sugar but the diabetic can't cope with all that extra glucose because they have insulin issues so they're so what happens is that they get hyperglycemia but to help counteract that you want to prevent those glucose levels from falling between that two to three hour so eating a bedtime snack can help that or maybe decreasing that bedtime insulin dose okay so now let's go over the different types of insulins okay you have rapid short intermediate and long i like to remember it as ready set inject love because we're injecting into the diabetic and rapid um ready uh short set intermediate inject and l love so i like to remember that now how i like to do this you can just get a piece of paper whenever you're fixing to take your test write out the word insulin and from top to bottom we're going to start at rapid and go to long and we're going to make this correlate with what insulin types are in each category okay so we have rapid remember ready so rapid we're going to use the i and insulin so r a p d next we have short acting for set ready set so the s we have intermediate inject i and we're going to use the u intermediate means middle so the u and the word insulin is in the middle so that's going to represent our in our intermediate drugs and and one type of intermediate insulin acting drug is humalin in so we're going to put humulin in and i'm just going to put a line to help separate that and separate that from that and then l for long that's our last one's long acting so we're going to write l for long okay so now you have your categories you have rapid short intermediate the u's in the middle so we know it's intermediate and long so now let's just add the types of insulins to help us remember okay we're going to use the a okay rapid are your logs humalog and novelog so we have humalog here and then we have novel law novalog over here okay next we're going to go to short water short acting ones all your regular insulins so humulin are novel and are ones that end in r are your regular so we're going to remember regular we're going to use the r in short just put reg for regular and then we're going to go to our intermediate these are our ones that end in n instead of r so humulin in your nphs novel on in so we're going to use the n and just put n ph and then we're going to go to our next drugs which are the long acting and this is the easiest ones even when remembering peak and onset and we know we have levomir and then we have lantus okay so that helps you remember what drugs are what because on exams they like to throw out humalog and you have to know the peak so just write that out before you take your test and have that and what helps you remember this is just re-watching this part of the video and writing it out over and over helps you remember which drugs are which now let's go over the mnemonics on how to remember the specifically the peak and duration and onset of these specific drugs okay now let's look at the different categories of insulins the rapid the short the intermediate and the long and let's look at the onset peak and duration and specifically what you want to know for exams are the peak times because this is when the patient is most at risk for hypoglycemia now with these mnemonics i wanted to make them nursing related because chances are if you're watching this video you're going to be a nurse and helping things that are related to what you're doing help you remember them and each of these mnemonics is going to tell you whether it's rapid short interacting or intermediate or long and each number will correlate in the same order with onset peak and duration so let's see what they say okay rapid these remember are your logs your humalog and novolog and the onset of this the rapids are 15 minutes the peak is one hour and the duration is three hours so how in the world are you going to remember all this because in nursing we have to get a little creative how we can remember stuff so remember this phrase 15 minutes feels like an hour during three rapid responses okay so clue whenever you remember this this deals with the rapid insulins 15 minutes is the onset because it's the first number you see an hour is the peak and the duration and the duration is three okay next let's look at short short acting insulins they're on set are 30 minutes the peak is two hours and the duration is eight hours to help you remember all those numbers remember the phrase short staff nurses went from 30 patients to eight patients so short you know this is a short acting insulin and 30 is the onset two is the peak and the duration is eight next intermediate acting the onset is two hours the peak is eight hours and the duration is 16 hours remember the phrase nurses play hero 2 8 16 year olds nurses play hero these are your mph drugs like humulin in or nph so nurses n p play and h hero and two is your onset your peak is eight and your duration is 16. next long acting your onset this is the easiest one to remember them all because there's only two numbers you have to remember the onset is two hours there is no peak with your long acting insulins like level mir atlantis and the duration is 24 hours so a phrase to help you remember this is the two long nursing shifts never peaked but lasted 24 hours 2 represents the onset long represents its long acting never peak because there's no peak with long acting and lasting 24 hours is your duration so that is the nursing management of diabetes now go take that quiz on my website register nursery.com and test your knowledge and be sure to check out the other videos in this series and thank you so much for watching and please consider subscribing to this youtube channel

Channel: RegisteredNurseRN

Views: 583,120

Keywords: diabetes, diabetes pharmacology, diabetes mellitus pathophysiology for nurses video series, diabetes mellitus made easy, diabetes mellitus medications, diabetes mellitus management, nursing management of diabetes, diabetes medications, diabetes medications made simple, diabetes medications nursing, diabetes sulfonylureas medications, nclex diabetes mellitus, nclex diabetes, diabetes nursing, diabetes nursing lecture, diabetes nursing care, diabetes nursing school

Id: bK82X1KrCgg

Length: 22min 11sec (1331 seconds)

Published: Mon May 23 2016