diabetes/metabolism
ethnicities more at risk for diabetes
- native americans, african americans, asian americans, latin ameircans, pacific islanders
diagnostic test/ glucose monitoring
--Fasting plasma glucose (FPG) --Glycated hemoglobin (A1C) three months --2-hour PG during an OGTT (oral glucose tolerance test) --Self-monitoring blood glucose (SMGB) --Urine glucose/Ketone levels --Serum cholesterol/triglyceride levels --Urine test
Pt takes Lispro at 7 am. At what time can we expect to see adverse reactions?
8:30 am **peak is 1 to 1.5 hours after taking
Prediabetes
> 6.5 % A1C test elevated fasting blood glucose, oral glucose tolerance test (OGTT) But not yet able to diagnose yet Important to take delayed measures: -encourage regular blood sugar/A1C tests -monitor for S/S -healthy weight/ eating/ exercise
After performing a health history and physical assessment for a client, the nurse suspects type 2 diabetes mellitus. Which assessment finding is consistent with the nurse's suspicion? (Select all that apply.) A. Acanthosis nigricans B. Hyperglycemia C. Extreme thirst D. Decreased urination E. Hypertension
A B C E All but decreased urination - Acanthosis nigricans is skin disorder where the skin can be velvety and brown in color
The nurse is teaching a group of older adults with type 2 diabetes mellitus. Which complication of the disease should the nurse include? (Select all that apply.) A. Cognitive impairment B. Functional disabilities C. Pulmonary disease D. Polypharmacy E. Autoimmune diseases
A, B, D
A client is admitted with hyperosmolar hyperglycemic state (HHS) and a blood glucose level of 550 mg/dL. Which intervention should the nurse expect to include in the plan of care? (Select all that apply.) A. Give normal saline intravenously. B. Obtain blood for hemoglobin A1C. C. Assess level of orientation. D. Provide education about type 2 diabetes mellitus. E. Monitor serum potassium levels.
A, C, E The hyperosmolarity of the blood causes severe dehydration and depletion of electrolytes. Therefore, the priority care for a client with HHS is to provide isotonic or colloid solutions intravenously. Potassium is depleted, so it must not only be monitored, but also replaced. This client is acutely ill, so the hemoglobin A1C should be reviewed, but it is not a priority. Education should wait until the client's blood glucose level is stabilized and the client is alert enough to be receptive to the teaching.
The nurse is preparing a presentation on risk factors for type 2 diabetes mellitus. Which ethnic group should the nurse include as being amongst the highest diagnosed with this disease? A. American Indians B. African Americans C. Asian Americans D Caucasian Americans
A. American Indians
1. A student nurse is providing diabetic education at a public health fair. Which disorders should the student include as a complication of diabetes? Select all that apply. A. Stroke B. Kidney failure C. Blindness D. Respiratory failure E. Cirrhosis
ABC
1. The nurse is instructing a newly diagnosed client with Diabetes Mellitus 2 on the signs and symptoms of hypoglycemia. Which of the following should the nurse include in the instruction? Select all that apply? A. Blurred Vision B. Mood Swings C. Headache D. Excessive thirst E. Weak/Fatigue
ALL OF THEM
complications of diabetes
Alterations in blood glucose levels, alterations in cardiovascular system, neuropathy (diabetic nerve damage), infection, periodontal disease (gums), problems in feet, microalbuminuria (high albumin in urine from damaged kidneys), overt nephropathy (lots of peeing)
The nurse is caring for a child with type 2 diabetes mellitus. Which item in this child's history should the nurse recognize as a risk factor for this disease? (Select all that apply.) A. Sex B. Obesity C. Family history D. Race E. High-fat diet
B C D E all but sex
1. Which of the following chronic complications is associated with diabetes? A. Dizziness, dyspnea on exertion, and cardiac arrhythmia's B. Retinopathy, neuropathy, and coronary artery disease C. Leg ulcers, cerebral ischemic events, and pulmonary infarcts D. Fatigue, nausea, and vomiting
B Retinopathy, neuropathy, coronary artery disease
The nurse preceptor is teaching a new graduate nurse about hypoglycemic agents used to treat type 2 diabetes mellitus. Which information should the preceptor include related to how these medications lower blood sugar? (Select all that apply.) A. Stimulate hormones for hemodilution B. Prevent breakdown of glycogen C. Increase uptake of glucose by cells D. Increase breakdown of insulin E. Increase insulin secretion
B, C, E * prevent breakdown of glycogen in the liver so it doesn't convert to glucose
The nurse is teaching the caregivers of an adolescent with a new diagnosis of type 2 diabetes mellitus what they should do every 3 months to monitor the disease. The adolescent is currently taking metformin (Glucophage). Which information should the nurse include? (Select all that apply.) A. Obtain an eye exam. B. Review blood glucose logs. C. Assess injection sites. D. Discuss alcohol and drug use. E. Monitor hemoglobin A1C.
B, D, E *eye exam does not need to be done every three months
1. A student nurse teaches a client with diabetes mellitus about sick day management. Which statement should the student nurse include in this client's teaching? A. "When ill, avoid eating or drinking to reduce vomiting and diarrhea." B. "Monitor your blood glucose levels at least every 4 hours while sick." C. "If vomiting, do not use insulin or take your oral antidiabetic agent." D. "Try to continue your prescribed exercise regimen even if you are sick."
B. "Monitor your blood glucose levels at least every 4 hours while sick."
1. The nurse receives the following order for insulin IV NPH (Humulin NPH) 10 units. The nurse will perform which action first? A. Administer the dose as ordered. B. Clarify the insulin type and route. C. Give the drug subcutaneously. D. Question the insulin dose.
B. Clarify the insulin type and route
1. The insulin that has the most rapid onset of action would be: A. Lente B. Lispro C. Humulin N D. Levemir
B. Lispro
What cells produce insulin?
Beta cells of the islets of Langerhans in the pancrease
The healthcare provider prescribes metformin (Glucophage) to a client with newly diagnosed type 2 diabetes mellitus. Which information should the nurse provide to the client? A. This medication is used for clients who are unable to inject insulin. B. This medication is unsafe for use by pregnant and lactating women. C. This medication can take up to 3 months to show effectiveness. D. This medication is only used in the adult population due to side effects.
C
Which information should the nurse provide the client with type 2 diabetes mellitus? A. Include 100 minutes per week of activity and exercise. B. Increase carbohydrate consumption in the diet. C. Inspect your feet on a daily basis for open sores. D. Treat hyperglycemia with concentrated sweets.
C *remember, greater to or equal than 150 minutes/week of exercise
The nurse is caring for a client newly diagnosed with type 2 diabetes mellitus. Prior to any teaching about medications, the client informs the nurse, "I cannot give myself any injections." How should the nurse respond? A. "Insulin administration helps with better blood glucose management." B. "It is understandable to be upset about a new medical diagnosis." C. "Type 2 diabetes mellitus can usually be managed with pills, diet, and exercise." D. "Why do you think you will have to give yourself injections?"
C. Type 2 diabetes mellitus can usually be managed with pills, diet, and exercise.
The nurse is evaluating the plan of care for an obese client diagnosed with type 2 diabetes mellitus 6 months prior. Which finding indicates the client is successfully managing the disease? A. New foot wound with purulent drainage B. Hemoglobin A1C of 10.0% C. Fasting blood sugars averaging 150 mg/dL D. Weight loss of 40 pounds
D The normal hemoglobin A1C for a client with diabetes mellitus is 6-6.5%. Fasting blood sugars should be less than 100 mg/dL if the client has good control
The nurse is developing a plan of care for a client with ineffective peripheral tissue perfusion related to microvascular changes. Which assessment finding supports this nursing diagnosis? A. Fasting blood glucose of 100 mg/dL B. Hemoglobin A1C of 6.4% C. Capillary refill of 3 seconds D. Absent pedal pulses
D *remember, perfusion
1. A client asks what Diabetes Mellitus does to the body over time. Which condition should the nurse include in teaching as a common chronic complication of Diabetes Mellitus? A. Hyperglycemia B. Diabetic ketoacidosis C. Hypoglycemia D. Diabetic Retinopathy
D. Diabetic Retinopathy
1. A nurse performs a physical assessment on a client with type 2 DM. Findings include an FBS of 120mg/dl; temperature of 101 F. pulse of 88; Respiration of 22; and a blood pressure of 122/78. Which finding would be of most concern for the nurse? A. Pulse B. Blood Pressure C. Respiration D. Temperature
D. Temperature This could be from an infection
1. The nurse teaches a client with diabetes mellitus who is experiencing numbness and reduced sensation in the lower extremities. Which statement should the nurse include in this client's teaching to prevent injury? A. "Examine your feet using a mirror every day." B. "Rotate your insulin injection sites every week." C. "Check your blood glucose level before each meal." D. "Use a bath thermometer to test the water temperature."
D. Use a bath thermometer to test the water temperature Clients with diminished sensory perception can easily experience a burn injury when bathwater is too hot, instead of checking the temperature of the water by feeling it, they should use a thermometer.
1. The nursing student is completing an assessment interview with an older adult client being seen for a yearly physical examination. Which client statement would indicate a possible diagnosis of diabetes mellitus? A. "I'm slightly winded when I walk up a flight of stairs, but it passes quickly." B. "I feel a bit tired by mid-afternoon and take a 30-minute nap most days." C. "I sometimes have muscle aches in my upper legs at night." D. "I've been experiencing increased thirst during the past several months."
D. increased thirst
1. A client who has been taking a sulfonylurea antidiabetic medication will begin taking Metformin (Glucophage). The student nurse understands that this client is at increased risk for which condition. A. Hypoglycemia B. Hyperglycemia C. Respiratory distress D. Renal failure
D. renal failure Metformin can cause renal failure
Metformin (Glucophage)
Decreases rate of hepatic glucose production & augments glucose uptake by tissue --IV contrast containing iodine can be harmful with metformin- risk of kidney injury/ lactic acidosis --to reduce kidney injury, discontinue meds a day before surgery --can be resumed 48 post op if kidneys are normal --do not with chronic drinkers --take with food
Nursing Evaluation for DM
Expected outcomes --pt has age appropriate understanding of self management --pt's skin integrity stays intact --pt remains free from infection --pt remains free from injury Nonexpected outcomes --assess diet and medication adherence --develop plan of care that addresses nonadherence
Older adult considerations
Falls, polypharmacy, functional disabilities, cognition issues, depression, incontinence, increased risk for hypo/hyperglycemia set goals with older patients
Clinical manifestations of diabetes
Fatigue, extreme thirst, frequent urination, extreme hunger, weight loss, infection, slow wound healing, blurry vision *lose weight because insufficient glucose in cells for energy so body starts burning fat and muscle
Nursing Planning for DM
Goals --teach how to administer meds and side effects --teach meal planning compliant with ADA --teach about foot inspection and care --teach proper monitoring for blood sugar levels --teach about reducing risk for infection
Examples of NURSING diagnosis
Learning Needs, Risk for Impaired Skin integrity, Risk for Infection, Risk for Unstable blood glucose levels, Risk for
Nursing assessment for DM
Outward S/S Medications Review glucose log Diet (especially carbs) Weight gain/loss exercise urine output VS Microvascular/macrovascular complications skin assessment
Lispro (Humalog)
Rapid-acting insulin. Onset: 15 minutes. Peak: 1-1.5 hours Duration: 3-4 hours
microvessel issues
blurred vision, loss of site, nerve damage, kidney disease
Macrovessel issues
cardiovascular issues, heart disease, stroke, poor blood circulation
A1C test
for diabetes by checking sugar on red blood cells to get an average glucose % level over 3 months
diabetes mellitus
inability of islet cells to make insulin or produce enough to control blood glucose levels
hypoglycemic agents caused by
increased insulin secretion liver prevents glycogen to glucose increased uptake of glucose by muscle/fat in arms/legs instead of trunk blocked absorption of carbs in intestines nursing intervention: monitor for reactions administer with meals
NPH (Novolin N)
intermediate acting insulin Onset: 2 hours Peak: 6-8 hours Duration: 12-16 hours
Lantus (glargine)
long acting insulin Onset: 2 hours Peak: 16-20 hours Duration: 24 +
type 2 diabetes mellitus
modifiable weight sedentary lifestyle family history race/ethnicity advancing age metabolic syndrome (HT, increase in triglycerides, etc)
type 1 diabetes mellitus
non modifiable genetic autoimmune environmental factors (virus, illness)
alpha cells
produce glucagon- promotes liver to release glucos
Do NOT give metformin if......
pt has kidney, liver, or heart failure - lactic acidosis is a rare complication
What is the only insulin given IV?
regular insulin
Peripheral neurovascular dsyfunction
risk of disruption in circulation, feeling, or motion in limb - very common with T2D
Regular Novolin R
short acting insulin Onset: 0.5-1 hour Peak: 2-3 hours Duration: 4-6 hours
sick day management
sick/surgery - blood glucose increases even if food decreases -monitor blood glucose every four hours -test urine for ketones -keep taking meds -8-12 oz water each hour -substitute easily digested liquids or foods -Call HCP if unable to eat for 24 hours and diarrhea for more than 6 hours
Nursing Implementation for DM
teach to recognize/seek care for hypERglycemia ex. -extreme hyperglycemia -increased urination -thirst -dehydration -hypotension -seizures -decreased LOC *SMBG by pt not using insulin should help reach glucose goals
hyperosmolar hyperglycemic state (HHS)
your body is trying to rid excess blood sugar to urine include signs of dehydration, weakness, leg cramps, vision problems, and an altered level of consciousness. A client in HHS would have an increase in urinary output due to the hyperosmolarity of the blood
