Diabetes Crisis 2 BSN3

1,2,4,5

A client has been diagnosed with hyperthyroidism. The nurse monitors for which signs and symptoms indicating a complication of this disorder? Select all that apply. 1. Fever 2. Nausea 3. Lethargy 4. Tremors 5. Confusion 6. Bradycardia

3

A client has just been admitted to the nursing unit following thyroidectomy. Which assessment is the priority for this client? 1. Hypoglycemia 2. Level of hoarseness 3. Respiratory distress 4. Edema at the surgical site

3

A client is admitted to a hospital with a diagnosis of diabetic ketoacidosis (DKA). The initial blood glucose level is 950 mg/dL (54.2 mmol/L). A continuous intravenous (IV) infusion of short-acting insulin is initiated, along with IV rehydration with normal saline. The serum glucose level is now decreased to 240 mg/dL (13.7 mmol/L). The nurse would next prepare to administer which medication? 1. An ampule of 50% dextrose 2. NPH insulin subcutaneously 3. IV fluids containing dextrose 4. Phenytoin for the prevention of seizures

2

A client is admitted to an emergency department, and a diagnosis of myxedema coma is made. Which action should the nurse prepare to carry out initially? 1. Warm the client. 2. Maintain a patent airway. 3. Administer thyroid hormone. 4. Administer fluid replacement.

3

A client is brought to the emergency department in an unresponsive state, and a diagnosis of hyperosmolar hyperglycemic syndrome 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

1,3

A client is taking Humulin NPH insulin and regular insulin every morning. The nurse should provide which instructions to the client? Select all that apply. 1. Hypoglycemia may be experienced before dinnertime. 2. The insulin dose should be decreased if illness occurs. 3. The insulin should be administered at room temperature. 4. The insulin vial needs to be shaken vigorously to break up the precipitates. 5. The NPH insulin should be drawn into the syringe first, then the regular insulin.

1,3

A client with a diagnosis of addisonian crisis is being admitted to the intensive care unit. Which findings will the interprofessional health care team focus on? Select all that apply. 1. Hypotension 2. Leukocytosis 3. Hyperkalemia 4. Hypercalcemia 5. Hypernatremia

2,3,5

A client with a diagnosis of diabetic ketoacidosis (DKA) 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

A client with diabetes mellitus demonstrates acute anxiety when admitted to the hospital for the treatment of hyperglycemia. What is the appropriate intervention to decrease the client's anxiety? 1. Administer a sedative. 2. Convey empathy, trust, and respect toward the client. 3. Ignore the signs and symptoms of anxiety, anticipating that they will soon disappear. 4. Make sure that the client is familiar with the correct medical terms to promote understanding of what is happening.

1

A client with diabetes mellitus visits a health care clinic. The client's diabetes mellitus previously had been well controlled with glyburide daily, but recently the fasting blood glucose level has been 180 to 200 mg/dL (10.2 to 11.4 mmol/L). Which medication, if added to the client's regimen, may have contributed to the hyperglycemia? 1. Prednisone 2. Atenolol 3. Phenelzine 4. Allopurinol

1,3,4

A client with hyperthyroidism has been given methimazole. Which nursing considerations are associated with this medication? Select all that apply. 1. Administer methimazole with food. 2. Place the client on a low-calorie, low-protein diet. 3. Assess the client for unexplained bruising or bleeding. 4. Instruct the client to report side and adverse effects such as sore throat, fever, or headaches. 5. Use special radioactive precautions when handling the client's urine for the first 24 hours following initial administration.

2

A client with type 1 diabetes mellitus calls the nurse to report recurrent episodes of hypoglycemia with exercising. Which statement by the client indicates an adequate understanding of the peak action of NPH insulin and exercise? 1. "I should not exercise since I am taking insulin." 2. "The best time for me to exercise is after breakfast." 3. "The best time for me to exercise is mid- to late afternoon." 4. "NPH is a basal insulin, so I should exercise in the evening."

3

A daily dose of prednisone is prescribed for a client. The nurse provides instructions to the client regarding administration of the medication and should instruct the client that which time is best to take this medication? 1. At noon 2. At bedtime 3. Early morning 4. Any time, at the same time, each day

D

A nurse in a clinic is caring for a client who is to receive an immunization. The client asks about contraindications to immunizations. Which of the following is an appropriate response by the nurse? A. "The use of insulin is a contraindication." B. "An anaphylactic reaction is a contraindication for administration of any type of immunization." C. "The common cold is a contraindication for receiving an immunization." D. "Your provider will weigh the risks if you have experienced any adverse effects."

C

A nurse is caring for a client who has blood glucose of 52 mg/dL. The client is lethargic but arousable. Which of the following actions should the nurse perform first? A. Recheck blood glucose in 15 min. B. Provide carbohydrate and protein food. C. Provide 4 oz grape juice. D. Report findings to the provider.

B

A nurse is preparing to administer a morning dose of aspart insulin (Novolog) to a client who has type 1 diabetes mellitus. Which of the following is an appropriate action by the nurse? 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.

C

A nurse is preparing to administer a varicella immunization to a client. Which of the following questions by the nurse is appropriate? A. "Are you allergic to eggs?" B. "Are you allergic to baker's yeast?" C. "Are you pregnant?" D. "Do you have a history of Guillain-Barre syndrome?"

C

A nurse is preparing to administer an IM injection of immune globulin to a client who has been exposed to hepatitis A. Which of the following statements by the nurse is appropriate? A. "This medication offers permanent immunity to Hepatitis A." B. "This medication involves three injections over several months." C. "This medication provides you with an immune response more quickly than your body can produce it." D. "This medication contains an attenuated virus to help your body create antibodies."

C

A nurse is preparing to administer the morning doses of glargine (Lantus) insulin and regular (Humulin R) insulin to a client who has a blood glucose of 278 mg/dL. Which of the following is an appropriate nursing action? 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.

B,C,D

A nurse is preparing to document administration of a meningococcal vaccine to a client. Which of the following information should the nurse include in the documentation? (Select all that apply.) A. Age of client receiving the vaccine B. Name of vaccine manufacturer C. Vaccine expiration date D. Date of administration E. Serial number of the vaccine

A,B,C,E

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.

B,C,D

A nurse is reviewing strategies to promote comfort with a client who received an immunization. Which of the following information should the nurse include? (Select all that apply.) A. Massage the injection site B. Apply a cool compress to the injection site C. Take acetaminophen or ibuprofen D. Use the affected extremity E. Apply an antimicrobial ointment to the injection site

C,D,E

A nurse is teaching foot care to a client 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 closed-toe shoes

C

A patient with diabetes has a serum glucose level of 824 mg/dL (45.7 mmol/L) and is unresponsive. After assessing the patient, the nurse suspects diabetic ketoacidosis rather than hyperosmolar hyperglycemic syndrome based on the finding of a. polyuria. b. severe dehydration. c. rapid, deep respirations. d. decreased serum potassium.

4

An external insulin pump is prescribed for a client with diabetes mellitus. When 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 either 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. This releases insulin into the bloodstream. 4. It administers a small continuous dose of short-duration insulin subcutaneously. The client can self-administer an additional bolus dose from the pump before each meal.

A

Analyze the following diagnostic findings for your patient with type 2 diabetes. Which result will need further assessment? a. A1C 9% b. BP 126/80 mm Hg c. FBG 130 mg/dL (7.2 mmol/L) d. LDL cholesterol 100 mg/dL (2.6 mmol/L

1. blood vessels 2. diabetes-related 3. glucose levels

Angiopathy is damage to _____1_____ secondary to chronic hyperglycemia; Leading cause of _______2_______ death; Macrovascular and microvascular; Tight _______3_______ can prevent or minimize complications

1. inflammatory 2. persistent 3. vigorously 4. Flu and pneumonia

Another chronic complication of diabetes is infection, Defect in mobilization of _____1_____ cells and impaired phagocytosis; Recurring or _____2_____ infections- big indicator if patient has not been diagnosed with diabetes; Treat promptly and ______3_____; Patient teaching for prevention includes Hand hygiene and ______4_____vaccine

End stage organ disease

Chronic Complications of diabetes are associated with what?

Diabetic Nephropathy

Damage to small blood vessels that supply the glomeruli of the kidney; Leading cause of end-stage renal disease (20-40% of people with diabetes)

Gastroparesis

Delayed gastric emptying; can produce GURD, n/v/d, feeling of fullness

2,3,5

Glimepiride is prescribed for a client with diabetes mellitus. The nurse instructs the client that which food items are most acceptable to consume while taking this medication? Select all that apply. 1. Alcohol 2. Red meats 3. Whole-grain cereals 4. Low-calorie desserts 5. Carbonated beverages

1. Life-threatening 2. two

Hyperosmolar Hyperglycemic Syndrome (HHS) is a ____1_____ syndrome; Occurs with type ___2____ diabetes

-ACE inhibitors -Angiotensin II receptor antagonists

If albuminuria present, drugs to delay progression are what?

Proliferative Diabetic Retinopathy

Involves retina and vitreous humor; New blood vessels formed (neovascularization): very fragile and bleed easily; Can cause retinal detachment

1. large and medium 2. diabetes

Macrovascular Angiopathy is Diseases of ________1________-sized blood vessels; Greater frequency and earlier onset in patients with _____2_____

-Cerebrovascular disease -Cardiovascular disease -Peripheral vascular disease

Macrovascular Angiopathy is associated with what diseases?

-Retinopathy (eyes) -Nephropathy (kidneys) -Dermopathy (skin)

Microvascular Angiopathy is Specific to diabetes and includes what?

Diabetic Retinopathy

Microvascular damage to retina; Most common cause of new cases of adult blindness; Nonproliferative: more common; Proliferative: more severe

Diabetic Neuropathy

Nerve damage due to metabolic derangements of diabetes; 60% to 70% of patients with diabetes have some degree of this; Reduced nerve conduction and demyelinization; Sensory or autonomic; Can be the reason why people come in and find out they have diabetes

Nonproliferative Diabetic Retinopathy (most common)

Partial occlusion of small blood vessels in retina causes microaneurysms-once start to leak, causes edema in retina, can cause vision loss

B

Polydipsia and polyuria related to diabetes mellitus are primarily due to a. the release of ketones from cells during fat metabolism. b. fluid shifts resulting from the osmotic effect of hyperglycemia. c. damage to the kidneys from exposure to high levels of glucose. d. changes in RBCs resulting from attachment of excessive glucose to hemoglobin.

3,4

The client with hyperparathyroidism is taking alendronate. Which statements by the client indicate understanding of the proper way to take this medication? Select all that apply. 1. "I should take this medication with food." 2. "I should take this medication at bedtime." 3. "I should sit up for at least 30 minutes after taking this medication." 4. "I should take this medication first thing in the morning on an empty stomach." 5. "I can pick a time to take this medication that best fits my lifestyle as long as I take it at the same time each day."

1

The health care provider (HCP) prescribes exenatide for a client with type 1 diabetes mellitus who takes insulin. The nurse should plan to take which most appropriate intervention? 1. Withhold the medication and call the HCP, questioning the prescription for the client. 2. Administer the medication within 60 minutes before the morning and evening meal. 3. Monitor the client for gastrointestinal side effects after administering the medication. 4. Withdraw the insulin from the prefilled pen into an insulin syringe to prepare for administration.

2

The home care nurse visits a client recently diagnosed with diabetes mellitus who is taking Humulin NPH insulin daily. The client asks the nurse how to store the unopened vials of insulin. The nurse should tell the client to take which action? 1. Freeze the insulin. 2. Refrigerate the insulin. 3. Store the insulin in a dark, dry place. 4. Keep the insulin at room temperature.

1,2,3,4

The home health care nurse is visiting a client who was recently diagnosed with type 2 diabetes mellitus. The client is prescribed repaglinide and metformin. The nurse should provide which instructions to the client? Select all that apply. 1. Diarrhea may occur secondary to the metformin. 2. The repaglinide is not taken if a meal is skipped. 3. The repaglinide is taken 30 minutes before eating. 4. A simple sugar food item is carried and used to treat mild hypoglycemia episodes. 5. Muscle pain is an expected effect of metformin and may be treated with acetaminophen. 6. Metformin increases hepatic glucose production to prevent hypoglycemia associated with repaglinide.

1

The home health nurse visits a client with a diagnosis of type 1 diabetes mellitus. The client relates a history of vomiting and diarrhea and tells the nurse that no food has been consumed for the last 24 hours. Which additional statement by the client indicates a need for further teaching? 1. "I need to stop my insulin." 2. "I need to increase my fluid intake." 3. "I need to monitor my blood glucose every 3 to 4 hours." 4. "I need to call the health care provider (HCP) because of these symptoms."

1,3,5

The nurse is admitting a client who is diagnosed with syndrome of inappropriate antidiuretic hormone secretion (SIADH) and has serum sodium of 118 mEq/L (118 mmol/L). Which health care provider prescriptions should the nurse anticipate receiving? Select all that apply. 1. Initiate an infusion of 3% NaCl. 2. Administer intravenous furosemide. 3. Restrict fluids to 800 mL over 24 hours. 4. Elevate the head of the bed to high Fowler's. 5. Administer a vasopressin antagonist as prescribed.

4

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.

2

The nurse is caring for a client after hypophysectomy and notes clear nasal drainage from the client's nostril. The nurse should take which initial action? 1. Lower the head of the bed. 2. Test the drainage for glucose. 3. Obtain a culture of the drainage. 4. Continue to observe the drainage.

1,3

The nurse is completing an assessment on a client who is being admitted for a diagnostic workup for primary hyperparathyroidism. Which client complaint would be characteristic of this disorder? Select all that apply. 1. Polyuria 2. Headache 3. Bone pain 4. Nervousness 5. Weight gain

2,4,5

The nurse is monitoring a client diagnosed with acromegaly who was treated with transsphenoidal hypophysectomy and is recovering in the intensive care unit. Which findings should alert the nurse to the presence of a possible postoperative complication? Select all that apply. 1. Anxiety 2. Leukocytosis 3. Chvostek's sign 4. Urinary output of 800 mL/hour 5. Clear drainage on nasal dripper pad

1

The nurse is monitoring a client newly diagnosed with diabetes mellitus for signs of complications. Which sign or symptom, if exhibited in the client, indicates that the client is at risk for chronic complications of diabetes if the blood glucose is not adequately managed? 1. Polyuria 2. Diaphoresis 3. Pedal edema 4. Decreased respiratory rate

1,2,5

The nurse is monitoring a client receiving levothyroxine sodium for hypothyroidism. Which findings indicate the presence of a side effect associated with this medication? Select all that apply. 1. Insomnia 2. Weight loss 3. Bradycardia 4. Constipation 5. Mild heat intolerance

1,3,4

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 reaction? Select all that apply. 1. Tremors 2. Anorexia 3. Irritability 4. Nervousness 5. Hot, dry skin 6. Muscle cramps

3

The nurse is performing an assessment on a client with pheochromocytoma. Which assessment data would indicate a potential complication associated with this disorder? 1. A urinary output of 50 mL/hour 2. A coagulation time of 5 minutes 3. A heart rate that is 90 beats/minute and irregular 4. A blood urea nitrogen level of 20 mg/dL (7.1 mmol/L)

3,4,5,6

The nurse is preparing a client with a new diagnosis of hypothyroidism for discharge. The nurse determines that the client understands discharge instructions if the client states that which signs and symptoms are associated with this diagnosis? Select all that apply. 1. Tremors 2. Weight loss 3. Feeling cold 4. Loss of body hair 5. Persistent lethargy 6. Puffiness of the face

2

The nurse is preparing a plan of care for a client with diabetes mellitus who has hyperglycemia. The nurse places priority on which client problem? 1. Lack of knowledge 2. Inadequate fluid volume 3. Compromised family coping 4. Inadequate consumption of nutrients

2

The nurse is providing discharge teaching for a client newly diagnosed with type 2 diabetes mellitus who has been prescribed metformin. Which client statement indicates the need for further teaching? 1. "It is okay if I skip meals now and then." 2. "I need to constantly watch for signs of low blood sugar." 3. "I need to let my health care provider know if I get unusually tired." 4. "I will be sure to not drink alcohol excessively while on this medication."

2

The nurse is providing instructions to the client newly diagnosed with diabetes mellitus who has been prescribed pramlintide. Which instruction should the nurse include in the discharge teaching? 1. "Inject the pramlintide at the same time you take your other medications." 2. "Take your prescribed pills 1 hour before or 2 hours after the injection." 3. "Be sure to take the pramlintide with food so you don't upset your stomach." 4. "Make sure you take your pramlintide immediately after you eat so you don't experience a low blood sugar."

1

The nurse is teaching a client how to mix regular insulin and NPH insulin in the same syringe. Which action, if performed by the client, indicates the need for further teaching? 1. Withdraws the NPH insulin first 2. Withdraws the regular insulin first 3. Injects air into NPH insulin vial first 4. Injects an amount of air equal to the desired dose of insulin into each vial

1

The nurse is teaching a client with hyperparathyroidism how to manage the condition at home. Which response by the client indicates the need for additional teaching? 1. "I should limit my fluids to 1 liter per day." 2. "I should use my treadmill or go for walks daily." 3. "I should follow a moderate-calcium, high-fiber diet." 4. "My alendronate helps to keep calcium from coming out of my bones."

1

The nurse is teaching the client about his prescribed prednisone. Which statement, if made by the client, indicates that further teaching is necessary? 1. "I can take aspirin or my antihistamine if I need it." 2. "I need to take the medication every day at the same time." 3. "I need to avoid coffee, tea, cola, and chocolate in my diet." 4. "If I gain more than 5 pounds (2.25 kg) a week, I will call my health care provider (HCP)."

3

The nurse performs a physical assessment on a client with type 2 diabetes mellitus. Findings include a fasting blood glucose level of 120 mg/dL (6.8 mmol/L), temperature of 101 °F (38.3 °C), pulse of 102 beats/minute, respirations of 22 breaths/minute, and blood pressure of 142/72 mm Hg. Which finding would be the priority concern to the nurse? 1. Pulse 2. Respiration 3. Temperature 4. Blood pressure

4

The nurse provides instructions to a client newly diagnosed with type 1 diabetes mellitus. The nurse recognizes accurate understanding of measures to prevent diabetic ketoacidosis when the client makes which statement? 1. "I will stop taking my insulin if I'm too sick to eat." 2. "I will decrease my insulin dose during times of illness." 3. "I will adjust my insulin dose according to the level of glucose in my urine." 4. "I will notify my health care provider (HCP) if my blood glucose level is higher than 250 mg/dL (14.2 mmol/L)."

3

The nurse provides instructions to a client who is taking levothyroxine. The nurse should tell the client to take the medication in which way? 1. With food 2. At lunchtime 3. On an empty stomach 4. At bedtime with a snack

2

The nurse should tell the client, who is taking levothyroxine, to notify the health care provider (HCP) if which problem occurs? 1. Fatigue 2. Tremors 3. Cold intolerance 4. Excessively dry skin

2,3,5

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 taken if which symptom or symptoms develop? Select all that apply. 1. Polyuria 2. Shakiness 3. Palpitations 4. Blurred vision 5. Lightheadedness 6. Fruity breath odor

2,5

The nurse teaches the client, who is newly diagnosed with diabetes insipidus, about the prescribed intranasal desmopressin. Which statements by the client indicate understanding? Select all that apply. 1. "This medication will turn my urine orange." 2. "I should decrease my oral fluids when I start this medication." 3. "The amount of urine I make should increase if this medicine is working." 4. "I need to follow a low-fat diet to avoid pancreatitis when taking this medicine." 5. "I should report headache and drowsiness to my health care provider since these symptoms could be related to my desmopressin."

Microvascular Angiopathy

Thickening of vessel membranes in capillaries and arterioles; Usually appear 10 to 20 years after diagnosis

Diabetic Ketoacidosis (DKA)

This is caused by profound deficiency of insulin; typically seen in type 1 but can be seen in type 2; can also be seen in situations of stress or illness as well; Characterized by Hyperglycemia, Ketosis, Acidosis, Dehydration

Diabetic dermopathy

This skin problem is Most common; Red-brown, round or oval patches

Necrobiosis lipoidica diabeticorum

This skin problem is red-yellow lesions; Usually pretty shiny and translucent; Pay close attention; skin becomes thin and can be damage really easily

Acanthosis nigricans

This skin problem is usually found in areas that are usually hidden; Manifestation of insulin resistance; Velvety light brown to black skin

hyperlipidemia

To decrease risk factors for Macrovascular Angiopathy what is one thing we should screen and treat?

-Managing blood glucose levels -Drug therapy Topical creams Tricyclic antidepressants Selective serotonin and norepinephrine reuptake inhibitors Antiseizure medications

Treatment for sensory neuropathy includes what?

-Proper footwear (prescription shoes) -Avoidance of foot injury ( do not walk around barefoot) -Skin and nail care -Daily inspection of feet (special mirrors to see all areas of the foot) -Prompt treatment of small problems -Diligent wound care for foot ulcers; dressings, wound vac, chamber

What are some Patient teaching to prevent foot ulcers?

-UTIs, pneumonia, sepsis -Acute illness -Newly diagnosed type 2 diabetes -Impaired thirst sensation and/or inability to replace fluids -History of inadequate fluid intake, depression, or polyuria

What are some Precipitating factors of Hyperosmolar Hyperglycemic Syndrome (HHS)?

-Illness -Infection -Inadequate insulin dosage -Undiagnosed type 1 diabetes -Poor self-management -Neglect

What are some Precipitating factors of Diabetic Ketoacidosis (DKA)?

-High rates of Depression, Anxiety, and Eating disorders -Open communication is critical for early identification - therapeutic communication

What are some Psychologic Considerations with diabetes?

-Diabetic ketoacidosis (DKA) -Hyperosmolar hyperglycemic syndrome (HHS)

What are some acute complications of diabetes?

-Dehydration (Poor skin turgor, Dry mucous membranes, Tachycardia, Orthostatic hypotension) -Lethargy and weakness (early sign) -Skin dry and loose; eyes soft and sunken (late sign) -Abdominal pain, anorexia, nausea/vomiting -Kussmaul respirations -Sweet, fruity breath odor -Blood glucose level of ≥ 250 mg/dL -Blood pH lower than 7.30 (acidoic) -Serum bicarbonate level < 16 mEq/L -Moderate to high ketone levels in urine or serum

What are some clinical manifestations of Diabetic Ketoacidosis (DKA)?

-Microvascular and macrovascular diseases increases risk for injury and infection -Sensory neuropathy and PAD are major risk factors for amputation -Also clotting abnormalities, impaired immune function, autonomic neuropathy -Smoking increases risk (affects the health of blood vessels)

What are some foot complications that may occur with diabetes?

-Hypertension -Genetics -Smoking -Chronic hyperglycemia

What are some risk factors for Diabetic Nephropathy?

-Obesity -Smoking -Hypertension -High fat intake -Sedentary lifestyle

What are some risk factors for Macrovascular Angiopathy?

-Laser photocoagulation (Most common; Laser destroys ischemic areas of retina) -Vitrectomy (Aspiration of blood, membrane, and fibers inside the eye) -Drugs to block action of vascular endothelial growth factor (VEGF)

What are some treatments for Diabetic Retinopathy?

-Glucose Regulation-Process of maintaining optimal blood glucose levels -Optimal glucose regulation: euglycemia -Impaired glucose regulation: high and low

What is Gidden's Concept of diabetes?

done by applying thin thing to many parts of the foot and ask the patient if they feel the sensation when it is applied by the patches

What is the Monofilament screening?

C

What is the priority action for the nurse to take if the patient with type 2 diabetes complains of blurred vision and irritability? a. Call the physician. b. Administer insulin as ordered. c. Check the patient's blood glucose level. d. Assess for other neurologic symptoms.

-similar to that for DKA -IV insulin and NaCl infusions -More fluid replacement needed (slowly and carefully; possiblity for fluid volume overload); add dextrose to avoid hypoglycemia -Monitor serum potassium and replace as needed -Correct underlying precipitating cause -Monitor I/Os, vitals, cardiac monitor

What is the therapy for Hyperosmolar Hyperglycemic Syndrome (HHS)?

Autonomic neuropathy

What type of Diabetic Neuropathy is Can affect nearly all body systems; Gastroparesis and Cardiovascular abnormalities such as Postural hypotension, resting tachycardia, painless myocardial infarction

Distal symmetric polyneuropathy

What type of Diabetic Neuropathy is Most common form; Affects hands and/or feet bilaterally; Loss of sensation, abnormal sensations, pain, and paresthesias; Pain is burning, cramping and can be worse at night; Walking on pillows or numb feet may be reported by the patient

Sensory neuropathy

What type of Diabetic Neuropathy is loss of protective sensation in lower extremities; Major risk for amputation

A,C,E

Which are appropriate therapies for patients 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

Which statement by the patient with type 2 diabetes is accurate? a. "I will limit my alcohol intake to one drink." b. "I am not allowed to eat any sweets because of my diabetes." c. "I cannot exercise because I take a blood glucose-lowering medication." d. "The amount of fat in my diet is not important. Only carbohydrates raise my blood sugar."

D

Which statement would be correct for a patient with type 2 diabetes who was admitted to the hospital with pneumonia? a. The patient must receive insulin therapy to prevent ketoacidosis. b. The patient has islet cell antibodies that have destroyed the pancreas's ability to produce insulin. c. The patient has minimal or absent endogenous insulin secretion and requires daily insulin injections. d. The patient may have sufficient endogenous insulin to prevent ketosis but is at risk for hyperosmolar hyperglycemic syndrome.

-Erectile dysfunction -Decreased libido -Vaginal infections

With Autonomic neuropathy, it can affect sexual function in the forms of what?

1. urinary retention 2. Credé's maneuver 3. clean

With Autonomic neuropathy, there can be Neurogenic bladder → _______1______ (difficulty voiding); Empty frequently, use ______2_____ (massage of the muscles down by the bladder); Medications; Self-catheterization (do it frequently, use ____3_____ tech. include the family)

-Renal status -Cardiopulmonary status -Level of consciousness

With DKA/HHSNursing Management what should we assess?

-IV fluids -Insulin therapy -Electrolytes

With DKA/HHSNursing Management what should we monitor?

1. airway 2. Isotonic 3. hypertonic 4. 250 5. Potassium

With Diabetic Ketoacidosis (DKA), Ensure patent ____1____; administer O2; Establish IV access; begin fluid resuscitation (____2____ or ______3_______) NaCl 0.45% or 0.9%; Add 5% to 10% dextrose when blood glucose level approaches ____4____ mg/dL (prevent hyoglycemia); Continuous regular insulin drip 0.1 U/kg/hr; ______5_____ replacement as needed

1. outpatient basis 2. electrolyte imbalance 3. communication

With Diabetic Ketoacidosis (DKA), Less severe form may be treated on _______1_______; Hospitalize for severe fluid and _______2______, fever, nausea/vomiting, diarrhea, altered mental state; Also if ______3_______ with health care provider is lacking

albumin in urine

With Diabetic Nephropathy there is annual screening which looks for what?

1. vision 2. dilation 3. hypertension

With Diabetic Retinopathy, Initially no changes in ____1_____; Annual eye examinations with ____2____ to monitor; Maintain healthy blood glucose levels and manage ______3______

1. ketoacidosis 2. 600 3. osmolality 4. Ketones 5. High

With Hyperosmolar Hyperglycemic Syndrome (HHS), Enough circulating insulin to prevent _____1_____; Fewer symptoms lead to higher glucose levels (>___2____ mg/dL); More severe neurologic manifestations because of ↑ serum ____3_____ (changes mental status- coma, seurizes, ect); ___4____ absent or minimal in blood and urine; Medical emergency with ___5___ mortality rate

1. ↓ 2. ↓ 3. ↑

With foot complications that may occur with diabetes, Peripheral artery disease _____1_____ Blood flow, ____2____ wound healing, ___3____ risk for infection; Prevention of risk factors

1. sensation 2. injury

With foot complications that may occur with diabetes, Sensory neuropathy → loss of protective ____1____ → unawareness of ____2_____ (increase chance of amputation); Monofilament screening

A,D,E

You are caring for a patient with newly diagnosed type 1 diabetes. What information is essential to include in your patient teaching before discharge from the hospital (select all that apply)? a. Insulin administration b. Elimination of sugar from diet c. Need to reduce physical activity d. Use of a portable blood glucose monitor e. Hypoglycemia prevention, symptoms, and treatment

Neuropathic arthropathy (Charcot's foot)

ankle and foot dysfunction/ deformities; can have a foot drop; tell PCP right away so they can treat issue right away

Hyperglycemia

not enough insulin working

Kussmaul respirations

rapid deep breathing; bodys attempt to reverse m. actidosis; breath off excess CO2