ch 48 Diabetes

symptoms of hyperglycemia (6)

"I'm hot and dry, must be on a sugar high!" -hot, dry skin (no diaphoresis) -nausea, vomiting, abdominal pain -polyuria, polydipsia, polyphagia -weakness, fatigue -blurred vision -headache

intermediate-acting insulin: onset, peak, duration

(NPH) -onset: 1-2 hr -peak: 4-8 hr -duration: 10-18 hr

long-acting insulin: onset, peak, duration

(glargine, detemir) -onset: 1-2 hr -peak: none -duration: 24 hrs

short-acting insulin: onset, peak, duration

(regular insulin) -onset: 0.5-1 hr -peak: 1-5 hr -duration: 6-10 hr

treatment for DKA and HHS (3)

-IV insulin -fluid replacement (0.9% or 0.45% NaCl) -electrolyte replacement

how to treat hyperglycemia (3)

-IV insulin (to treat hyperglycemia) -IV fluid therapy/0.45-0.9% NaCl (to treat dehydration) -electrolyte replacement (potassium)

DKA symptoms (7)

-fruity breath odor -Kussmaul respirations (deep, rapid breathing) -abdominal pain -nausea and vomiting -tachycardia -orthostatic hypotension -lethargy, coma

Somogyi effect symptoms (3)

-headache when awakening -night sweats -nightmares

onset of symptoms: hyperglycemia vs hypoglycemia

-hyperglycemia = gradual onset of symptoms -hypoglycemia = rapid onset of symptoms

dawn phenomenon: interventions (2)

-increased insulin in the evening -adjustment in administration time

Somogyi effect: interventions (2)

-less insulin in the evening -bedtime snack

rapid-acting insulin: onset, peak, duration

-onset: 15 min -peak: 1-2 hr -duration: 3-5 hr

symptoms of diabetes type 1 and type 2

-polyuria -polydipsia -polyphagia

symptoms of type 2 diabetes (4)

-recurrent infections -slow wound healing -blurred vision -fatigue

complications associated with diabetes (6)

-retinopathy -neuropathy -nephropathy -hypertension -cardiovascular disease -coronary artery disease

other symptoms of hypoglycemia (5)

-slurred speech -confusion -dizziness -tremors/shakiness -headache

type 1 diabetes vs type 2 diabetes (pathophysiology)

-type 1: characterized by a lack of insulin production or by the production of defective insulin, which results in acute hyperglycemia -type 2: characterized by insulin resistance and insulin deficiency, but there is no absolute lack of insulin as in type 1

symptoms of type 1 diabetes (2)

-unusual weight loss -weakness/fatigue

lifestyle modifications for type 2 diabetes (5)

-weight loss -improved dietary habits (less fat and carbs) -smoking cessation -reduced alcohol consumption -regular physical exercise

A client's serum blood glucose level is 48 mg/dL. The nurse would expect to note which as an additional finding when assessing this client? 1. Slurred speech 2. Increased thirst 3. Increased appetite 4. Increased urination

1. Slurred speech NCLEX

The nurse is monitoring a client who was diagnosed with type 1 diabetes mellitus and is being treated with NPH and regular insulin. Which manifestations would alert the nurse to the presence of a possible hypoglycemic crisis? Select all that apply: 1. Tremors 2. Anorexia 3. Irritability 4. Nervousness 5. Hot, dry skin 6. Muscle cramps

1. Tremors 3. Irritability 4. Nervousness NCLEX

The student nurse is teaching a family member the importance of foot care for his or her mother, who has diabetes. Which safety precautions are important for the family member to know to prevent infection? (Select all that apply.) 1. Cut nails frequently. 2. Assess skin for redness, abrasions, and open areas daily. 3. Soak feet in water at least 10 minutes before nail care. 4. Apply lotion to feet daily. 5. Clean between toes after bathing.

2. Assess skin for redness, abrasions, and open areas daily. 4. Apply lotion to feet daily. 5. Clean between toes after bathing. -do not cut nails or soak the feet of a patient with diabetes because this may create skin breakdown and open sores, leading to skin breakdown or infection Fundamentals

A client with a diagnosis of diabetic ketoacidosis is being treated in the emergency department. Which findings support this diagnosis? Select all that apply: 1. Increase in pH 2. Comatose state 3. Deep, rapid breathing 4. Decreased urine output 5. Elevated blood glucose level

2. Comatose state 3. Deep, rapid breathing 5. Elevated blood glucose level NCLEX

A client with type 1 diabetes mellitus is admitted to the emergency department with suspected diabetic ketoacidosis (DKA). Which laboratory result would be expected with this diagnosis? 1. Urine is negative for ketones. 2. Serum potassium is 6.8 mEq/L. 3. Serum osmolality is 260 mOsm/L. 4. Arterial blood gas values are: pH 7.52, Pco2 44 mm Hg, HCO3 30 mEq/L.

2. Serum potassium is 6.8 mEq/L. NCLEX

The nurse teaches a client with diabetes mellitus about differentiating between hypoglycemia and ketoacidosis. The client demonstrates an understanding of the teaching by stating that a form of glucose should be taking if what symptoms develop? Select all that apply: 1. Polyuria 2. Shakiness 3. Palpitations 4. Blurred vision 5. Lightheadedness 6. Fruity breath odor

2. Shakiness 3. Palpitations 5. Lightheadedness NCLEX

A client is brought to the emergency department in an unresponsive state, and a diagnosis of hyperglycemic hyperosmolar state (HHS) is made. The nurse would immediately prepare to initiate which anticipated health care provider's prescription? 1. Endotracheal intubation 2. 100 units of NPH insulin 3. Intravenous infusion of normal saline 4. Intravenous infusion of sodium bicarbonate

3. Intravenous infusion of normal saline (immediate actions include IV insulin and hydration with NaCl) NCLEX

A client with a history of diabetes mellitus has a fingerstick blood glucose level of 460 mg/dL. The home care nurse anticipates that which additional finding would be present with further testing if the client is experiencing diabetic ketoacidosis (DKA)? 1. Hyponatremia 2. Rise in serum pH 3. Presence of ketone bodies 4. Elevated serum bicarbonate level

3. Presence of ketone bodies NCLEX

A client with type 1 diabetes mellitus is to begin an exercise program, and the nurse is providing instructions regarding the program. Which instruction should the nurse include in the teaching plan? 1. Try to exercise before mealtimes. 2. Administer insulin after exercising. 3. Take a blood glucose test before exercising. 4. Exercise is best performed during peak times of insulin.

3. Take a blood glucose test before exercising. (exercise ↓ blood glucose levels) NCLEX

The nurse is caring for a client admitted to the emergency department with diabetic ketoacidosis (DKA). In the acute phase, the nurse plans for which priority intervention? 1. Correct the acidosis. 2. Administer 5% dextrose intravenously. 3. Apply a monitor for an electrocardiogram. 4. Administer short-duration insulin intravenously.

4. Administer short-duration insulin intravenously. NCLEX

A nurse is preparing a teaching plan for a client with diabetes mellitus regarding proper foot care. Which instruction should be included in the plan? 1. Soak the feet in hot water. 2. Avoid using a mild soap on the feet. 3. Always have a podiatrist cut the toenails. 4. Apply a moisturizing lotion to dry feet but not between the toes.

4. Apply a moisturizing lotion to dry feet but not between the toes. NCLEX

An external insulin pump is prescribed for a client with diabetes mellitus and the client asks the nurse about the functioning of the pump. The nurse bases the response on which information about the pump? 1. It is timed to release programmed doses of short-duration or NPH insulin into the bloodstream at specific intervals 2. It continuously infuses small amounts of NPH insulin into the bloodstream while regularly monitoring blood glucose levels 3. It is surgically attached to the pancreas and infuses regular insulin into the pancreas, which in turn releases the insulin into the bloodstream 4. It gives a small continuous dose of short-duration insulin subcutaneously, and the client can self-administer a bolus with an additional bolus dose from the pump before each meal

4. It gives a small continuous dose of short-duration insulin subcutaneously, and the client can self-administer a bolus with an additional bolus dose from the pump before each meal NCLEX

The nurse monitors the client receiving parenteral nutrition for complications of the therapy and should assess the client for which manifestations of hyperglycemia? 1. Fever, weak pulse, and thirst 2. Nausea, vomiting, and oliguria 3. Sweating, chills, and abdominal pain 4. Weakness, thirst, and increased urine output

4. Weakness, thirst, and increased urine output NCLEX ch 12

A client with diabetes mellitus has a glycosylated hemoglobin A1C level of 9%. On the basis of this test result, the nurse plans to teach the client about the need for which measure? 1. avoiding infection 2. taking in adequate fluids 3. preventing and recognizing hypoglycemia 4. preventing and recognizing hyperglycemia

4. preventing and recognizing hyperglycemia (A1C of 9% is high - 7% is the goal for diabetic pts) NCLEX

normal glucose levels

70-110 mg/dL

A nurse is providing discharge teaching to a client who has experienced diabetic ketoacidosis. Which of the following information should the nurse include in the teaching? (Select all that apply.) A. Drink 2 L of fluid daily B. Monitor blood glucose every 4 hrs when ill C. Administer insulin as prescribed when ill D. Notify provider when blood glucose is 200 mg/dL E. Report ketones in the urine after 24 hours of illness

A. Drink 2 L of fluid daily B. Monitor blood glucose every 4 hrs when ill C. Administer insulin as prescribed when ill E. Report ketones in the urine after 24 hours of illness ATI

A nurse is presenting information to a group of clients about nutrition habits that prevent type 2 diabetes. Which of the following should the nurse include in the information? (Select all that apply) A. Eat less meat and processed foods B. Decrease intake of saturated fats C. Increase daily fiber intake D. Limit saturate fat intake to 15% of daily caloric intake E. Include omega-3 fatty acids in the diet.

A. Eat less meat and processed foods B. Decrease intake of saturated fats C. Increase daily fiber intake E. Include omega-3 fatty acids in the diet. ATI

A nurse is reviewing the health record of the client Who has HHS. Which of the following data confirms the diagnosis? (Select all that apply.) A. Evidence of recent myocardial infarction B. BUN 35 mg/dL C. Takes a calcium channel blocker D. Age 77 years E. No insulin production

A. Evidence of recent myocardial infarction B. BUN 35 mg/dL C. Takes a calcium channel blocker D. Age of 77 years ATI

A 28-year-old female patient is found to be responsive to verbal stimuli only. Her roommate states that she was recently diagnosed with type 1 diabetes and has had difficulty controlling her blood sugar level. She further tells you that the patient has been urinating excessively and has progressively worsened over the last 24 to 36 hours. On the basis of this patient's clinical presentation, you should suspect that she: A. is significantly hyperglycemic. B. has a low blood glucose level. C. has a urinary tract infection. D. has overdosed on her insulin

A. is significantly hyperglycemic. (polyuria) EMT textbook

A nurse is preparing to administer a morning dose of insulin aspart to a client who has type 1 diabetes mellitus. Which of the following actions should the nurse implement? A. Check the client's blood glucose immediately after breakfast. B. Administer the insulin when breakfast arrives C. Hold breakfast for 1 hr after insulin administration D. Clarify the prescription because insulin should not be administered at this time.

B. Administer the insulin when breakfast arrives (insulin aspart = rapid-acting) ATI

A nurse is assessing a client who has DKA and ketones in the urine. Which of the following are expected findings? (Select all that apply.) A. Weight gain B. Fruity odor or breath C. Abdominal pain D. Kussmaul respirations E. Metabolic acidosis

B. Fruity odor or breath C. Abdominal pain D. Kussmaul respirations E. Metabolic acidosis ATI

The nurse is reviewing laboratory reports of a client who has hyperglycemic-hyperosmolar state (HHS). Which of the following is an expected finding? A. Serum pH 7.2 B. Serum osmolarity 350 mOsm/L C. Serum potassium 3.8 mg/dL D. Serum creatinine 0.8 mg/dL

B. Serum osmolarity 350 mOsm/L ATI

Classic signs and symptoms of hypoglycemia include: A. warm, dry skin; irritability; bradycardia; and rapid respirations. B. cool, clammy skin; weakness; tachycardia; and rapid respirations. C. warm, dry skin; hunger; abdominal pain; and deep, slow respirations. C. cold, clammy skin; bradycardia; hunger; and deep, rapid respirations.

B. cool, clammy skin; weakness; tachycardia; and rapid respirations. EMT textbook

A nurse is preparing to administer the morning doses of insulin glargine and regular insulin to a client who has a blood glucose of 278 mg/dL. Which of the following actions should the nurse take? A. Draw up the regular insulin and then the glargine insulin in the same syringe. B. Draw up the glargine insulin then the regular insulin in the same syringe. C. Draw up and administer regular and glargine insulin in separate syringes. D. Administer the regular insulin, wait 1 hr, and then administer the glargine insulin.

C. Draw up and administer regular and glargine insulin in separate syringes. ATI

hypoglycemia symptoms: TIRED

Tachycardia Irritability Restlessness Excessive hunger Diaphoresis ("I'm sweaty and clammy, give me some candy.")

hyperglycemia (pathophysiology)

a state involving excessive concentrations of glucose in the blood when the actions of glucagon and insulin fail to maintain glucose homeostasis

When assessing the patient experiencing the onset of symptoms of type I diabetes, which question should the nurse ask? a. "Have you lost any weight lately?" b. "Is your urine unusually dark-colored?" c. "Do you crave fluids containing sugar?" d. "How long have you felt anorexic?"

a. "Have you lost any weight lately?"

A pt with diabetes has a blood glucose level of 248 mg/dL. Which manifestations in the pt would the nurse understand as being related to this blood glucose level? (Select all that apply) a. headache b. unsteady gait c. abdominal cramps d. emotional changes e. increase in urination f. weakness and fatigue

a. headache c. abdominal cramps e. increase in urination f. weakness and fatigue (unsteady gait and emotional changes = hypoglycemia) MS workbook

A patient with type 2 diabetes that is controlled with diet and metformin (Glucophage) also has severe rheumatoid arthritis (RA). During an acute exacerbation of the patient's arthritis, the health care provider prescribes prednisone (Deltasone) to control inflammation. The nurse will anticipate that the patient may: a. require administration of insulin while taking prednisone. b. develop acute hypoglycemia during the RA exacerbation. c. have rashes caused by metformin-prednisone interactions. d. need a diet higher in calories while receiving prednisone.

a. require administration of insulin while taking prednisone. (corticosteroids can cause hyperglycemia)

Which are appropriate therapies for pt with diabetes mellitus? (Select all that apply) a. use of statins to reduce CVD risk b. use of diuretics to treat nephropathy c. use of ACE inhibitors to treat nephropathy d. use of serotonin agonists to decrease appetite e. use of laser photocoagulation to treat retinopathy

a. use of statins to reduce CVD risk c. use of ACE inhibitors to treat nephropathy e. use of laser photocoagulation to treat retinopathy MS

A nurse is obtaining a health history from a patient with a new diagnosis of type 2 diabetes mellitus. What question related to the skin would be most important for the nurse to ask this patient? a. "Is your sleep interrupted by severe episodes of itching at night?" b. "Have you noticed any changes in the way sores or wounds heal?" c. "Do you have any skin lesions that have changed in size or shape?" d. "What changes if any have you noticed in your skin, hair, and nails?"

b. "Have you noticed any changes in the way sores or wounds heal?" MS ch 22

A patient with type 1 diabetes has received diet instruction as part of the treatment plan. The nurse determines a need for additional instruction when the patient says, a. "I will eat meals as scheduled, even if I am not hungry, to prevent hypoglycemia." b. "I may eat whatever I want, as long as I use enough insulin to cover the calories." c. "I may have an occasional snack if I include it in my meal plan." d. "I will need a bedtime snack because I take an evening dose of NPH insulin."

b. "I may eat whatever I want, as long as I use enough insulin to cover the calories." (most pts with type 1 diabetes need to plan diet choices very carefully)

A 62-yr-old Hispanic male patient with diabetes mellitus has been diagnosed with peripheral artery disease (PAD). The patient is a smoker with a history of gout. To prevent complications, which factor is priority in patient teaching? a. Gender b. Smoking c. Ethnicity d. Comorbidities

b. Smoking MS ch 37

A 1200-calorie diet and exercise are prescribed for a patient with newly diagnosed type 2 diabetes. The patient tells the nurse, "I hate to exercise! Can't I just follow the diet to keep my glucose under control?" The nurse teaches the patient that the major purpose of exercise for diabetics is to a. increase energy and sense of well-being, which will help with body image. b. facilitate weight loss, which will decrease peripheral insulin resistance. c. improve cardiovascular endurance, which is important for diabetics. d. set a successful pattern, which will help in making other needed changes.

b. facilitate weight loss, which will decrease peripheral insulin resistance.

A pt with type 2 diabetes has developed hypertension. What is the blood pressure goal for this pt? a. less than 110/80 b. less than 130/80 c. less than 130/84 d. less than 140/90

b. less than 130/80 Pharm workbook ch 22

how often to check blood sugar when exercising

before, during, and after exercising

What describes the primary difference between DKA and HHS? a. DKA requires administration of bicarbonate to correct acidosis b. potassium replacement is not necessary in management of HHS c. HHS requires greater fluid replacement to correct the dehydration d. administration of glucose is withheld in HHS until the blood glucose reaches a normal level

c. HHS requires greater fluid replacement to correct the dehydration -bicarbonate not given for DKA -potassium required for both -glucose administered for both when blood glucose falls below 250 mg/dL MS workbook

Which patient action indicates a good understanding of the nurse's teaching about the use of an insulin pump? a. The patient changes the needle site for insulin infusion every week b. The patient states that diet will be less flexible when using the insulin pump c. The patient programs the pump to deliver an insulin bolus after eating. d. The patient takes the pump off at bedtime and starts it again each morning

c. The patient programs the pump to deliver an insulin bolus after eating.

While monitoring a pt who is receiving insulin therapy, the nurse observes for which signs of hypoglycemia? a. decreased pulse and respiratory rates and flushed skin b. increased pulse rate and fruity, acetone breath odor c. irritability, sweating, and confusion d. increased urine output and edema

c. irritability, sweating, and confusion Pharm workbook

A pt taking insulin has recorded fasting glucose levels above 200 mg/dL on awakening for the last 5 mornings. What should the nurse advise the pt to do first? a. increase the evening insulin dose to prevent the dawn phenomenon b. use a single-dose insulin regimen with an intermediate-acting insulin c. monitor the glucose level at bedtime, between 2:00am and 4:00am, and on arising d. decrease the evening insulin dosage to prevent night hypoglycemia and the Somogyi effect

c. monitor the glucose level at bedtime, between 2:00am and 4:00am, and on arising -hyperglycemia upon awakening could be caused by dawn phenomenon or Somogyi effect - monitoring glucose levels at night will determine which one is the cause -hypoglycemia at 2am = Somogyi -hyperglycemia at 2am = dawn phenomenon MS workbook

A nurse is teaching foot care to a pt who has diabetes. Which of the following information should the nurse include in the teaching? (Select all that apply) a. remove calluses using OTC remedies b. apply lotion between toes c. perform nail care after bathing d. trim toenails straight across e. wear close-toed shoes

c. perform nail care after bathing d. trim toenails straight across e. wear close-toed shoes (a podiatrist should remove calluses; applying lotion between the toes increases moisture, which can lead to infection) ATI

A nurse is caring for a pt who has blood glucose 52 mg/dL. The pt is lethargic but arousable. Which of the following actions should the nurse perform first? a. recheck blood glucose in 15 min b. provide a carbohydrate and protein food c. provide 4 oz grape juice d. report findings to the provider

c. provide 4 oz grape juice (hypoglycemia - rapidly absorbed carbohydrate such as grape juice) ATI

A pt with diabetes has a serum glucose level of 824 mg/dL and is unresponsive. After assessing the pt, the nurse suspects DKA rather than HHS based on the finding of: a. polyuria b. severe dehydration c. rapid, deep respirations d. decreased serum potassium

c. rapid, deep respirations MS

A nurse is preparing to administer IV fluids to a client who has diabetic ketoacidosis. Which of the following actions should the nurse take? a. administer an IV infusion of regular insulin at 0.3 unit/kg/hr b. administer an IV infusion of 0.45% sodium chloride c. rapidly administer an IV infusion of 0.9% sodium chloride d. add glucose to the IV infusion when serum glucose is 350 mg/dL

c. rapidly administer an IV infusion of 0.9% sodium chloride ATI

A patient with newly diagnosed type 2 diabetes mellitus asks the nurse what "type 2" means in relation to diabetes. The nurse explains to the patient that type 2 diabetes differs from type 1 diabetes primarily in that with type 2 diabetes: a. the immune system destroys the pancreatic insulin-producing cells. b. the patient is totally dependent on an outside source of insulin. c. there is decreased insulin secretion and cellular resistance to insulin that is produced. d. the insulin precursor that is secreted by the pancreas is not activated by the liver.

c. there is decreased insulin secretion and cellular resistance to insulin that is produced.

how to determine if morning hyperglycemia is due to Somogyi effect or dawn phenomenon?

check blood glucose levels between 2am-4am -hypoglycemia = Somogyi effect -hyperglycemia = dawn phenomenon

Which A1C level represents the desired level for glycemic control goal for patients with diabetes? a. 10 b. 9 c. 8 d. 7

d. 7 Pharm workbook

Somogyi effect

excessive doses of insulin → hypoglycemia during sleep → rebound hyperglycemia in the morning

polydipsia

excessive thirst

polyphagia

extreme hunger

HHS (hyperosmolar hyperglycemic syndrome)

extreme hyperglycemia and dehydration without ketosis or acidosis

DKA (diabetic ketoacidosis)

extreme hyperglycemia, dehydration, ketosis, acidosis

polyuria

frequent urination

abdominal cramps: hyperglycemia or hypoglycemia?

hyperglycemia

fatigue: hyperglycemia or hypoglycemia?

hyperglycemia

polydipsia: hyperglycemia or hypoglycemia?

hyperglycemia

dawn phenomenon

hyperglycemia upon awakening

hunger: hyperglycemia or hypoglycemia?

hypoglycemia

irritability: hyperglycemia or hypoglycemia?

hypoglycemia

tremors: hyperglycemia or hypoglycemia?

hypoglycemia

sweating: hyperglycemia or hypoglycemia?

hypoglycemia ("I'm cold and clammy, give me some candy.")

Hgb A1C

measurement of average daily blood glucose over the previous 2-3 months, not affected by recent fluctuations in blood glucose levels

most common precipitator of DKA and HHS

physical or emotional stress

how to treat hypoglycemia

sugar/glucose: -3 glucose tablets -1/2 cup of fruit juice -5-6 pieces of hard candy -inject glucagon (if unconscious)

DKA: which type of diabetes?

type 1

HHS: which type of diabetes?

type 2