diabetes
The home health nurse visits a client with a diagnosis of type 1 diabetes mellitus. The client reports 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? "I need to stop my insulin." "I need to increase my fluid intake." "I need to monitor my blood glucose every 3 to 4 hours." "I need to call my primary health care provider (PHCP) because of these symptoms."
"I need to stop my insulin." When a client with diabetes mellitus is unable to eat normally because of illness, the client still should take the prescribed insulin or oral medication. The client should consume additional fluids and should notify the PHCP. The client should monitor the blood glucose level every 3 to 4 hours. The client should also monitor the urine for ketones during illness.
A client with a history of diabetes mellitus has a fingerstick blood glucose level of 460 mg/dL (25.6 mmol/L). The home care nurse anticipates that which additional finding would be present with further testing if the client is experiencing diabetic ketoacidosis (DKA)? Hyponatremia Rise in serum pH Presence of ketone bodies Elevated serum bicarbonate level
Presence of ketone bodies DKA is marked by the presence of excessive ketone bodies. As a result of the acidosis, the pH and serum bicarbonate level would decrease. Hyponatremia is not related to DKA.
The primary health care provider (PHCP) prescribes exenatide for a client with type 1 diabetes mellitus who takes insulin. The nurse should plan to take which most appropriate intervention? Withhold the medication and call the PHCP, questioning the prescription for the client. Teach the client about the signs and symptoms of hypoglycemia and hyperglycemia. Monitor the client for gastrointestinal side effects after administering the medication. Withdraw the insulin from the prefilled pen into an insulin syringe to prepare for administration.
Withhold the medication and call the PHCP, questioning the prescription for the client. Exenatide is an incretin mimetic used for type 2 diabetes mellitus only. It is not recommended for clients taking insulin. Hence the nurse should withhold the medication and question the PHCP regarding this prescription. Although options 2 and 3 are correct statements about the medication, in this situation the medication should not be administered. The medication is packaged in prefilled pens ready for injection without the need for drawing it up into another syringe.
A client with diabetes mellitus who takes insulin is seen in the health care clinic. The client tells the clinic nurse that after the insulin injection, the insulin seems to leak through the skin. The nurse would appropriately determine the problem by asking the client which question? "Are you rotating the injection site?" "Are you aspirating before you inject the insulin?" "Are you using a 1-inch needle to give the injection?" "Are you placing an air bubble in the syringe before injection?"
"Are you rotating the injection site?" The client should be instructed that insulin injection sites should be rotated within 1 anatomical area before moving on to another area. This rotation process promotes uniform absorption of insulin and reduces the chances of irritation. The remaining options are not associated with the condition (skin leakage of insulin) presented in the question.
The nurse teaches a client newly diagnosed with type 1 diabetes about storing Humulin N insulin. Which statement indicates to the nurse that the client understood the discharge teaching? "I should keep the insulin in the cabinet during the day only." "I know I have to keep my insulin in the refrigerator at all times." "I can store the open insulin bottle in the kitchen cabinet for 1 month." "The best place for my insulin is on the windowsill, but in the cupboard is just as good."
"I can store the open insulin bottle in the kitchen cabinet for 1 month." An insulin vial in current use can be kept at room temperature for 1 month without significant loss of activity. Direct sunlight and heat must be avoided. Therefore, options 1, 2, and 4 are incorrect.
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? "I will stop taking my insulin if I'm too sick to eat." "I will decrease my insulin dose during times of illness." "I will adjust my insulin dose according to the level of glucose in my urine." "I will notify my primary health care provider (PHCP) if my blood glucose level is higher than 250 mmol/L."
"I will notify my primary health care provider (PHCP) if my blood glucose level is higher than 250 mmol/L." During illness, the client with type 1 diabetes mellitus is at increased risk of diabetic ketoacidosis, due to hyperglycemia associated with the stress response and due to a typically decreased caloric intake. As part of sick day management, the client with diabetes should monitor blood glucose levels and should notify the PHCP if the level is higher than 250 mg/dL (13.9 mmol/L). Insulin should never be stopped. In fact, insulin may need to be increased during times of illness. Doses should not be adjusted without the PHCP's advice and are usually adjusted on the basis of blood glucose levels, not urinary glucose readings.
A client newly diagnosed with diabetes mellitus is instructed by the primary health care provider to obtain glucagon for emergency home use. The client asks a home care nurse about the purpose of the medication. What is the nurse's bestresponse to the client's question? "It will boost the cells in your pancreas if you have insufficient insulin." "It will help promote insulin absorption when your glucose levels are high." "It is for the times when your blood glucose is too low from too much insulin." "It will help prevent lipoatrophy from the multiple insulin injections over the years."
"It is for the times when your blood glucose is too low from too much insulin." Glucagon is used to treat hypoglycemia resulting from insulin overdose. The family of the client is instructed in how to administer the medication. In an unconscious client, arousal usually occurs within 20 minutes of glucagon injection. When consciousness has been regained, oral carbohydrates should be given. Lipoatrophy and lipohypertrophy result from insulin injections.
A client with type 1 diabetes mellitus who takes NPH daily in the morning 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? "I should not exercise since I am taking insulin." "The best time for me to exercise is after breakfast." "The best time for me to exercise is mid- to late-afternoon." "NPH is a basal insulin, so I should exercise in the evening."
"The best time for me to exercise is after breakfast." Exercise is an important part of diabetes management. It promotes weight loss, decreases insulin resistance, and helps control blood glucose levels. A hypoglycemic reaction may occur in response to increased exercise, so clients should exercise either an hour after mealtime or after consuming a 10- to 15-g carbohydrate snack, and they should check their blood glucose level before exercising. Option 1 is incorrect because clients with diabetes should exercise, though they should check with their primary health care provider before starting a new exercise program. Option 3 in incorrect; clients should avoid exercise during the peak time of insulin. NPH insulin peaks at 4 to 12 hours; therefore, afternoon exercise takes place during the peak of the medication. Option 4 is incorrect; NPH insulin is an intermediate-acting insulin, not a basal insulin.
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? Correct the acidosis. Administer 5% dextrose intravenously. Apply a monitor for an electrocardiogram. Administer short-duration insulin intravenously.
Administer short-duration insulin intravenously. Lack of insulin (absolute or relative) is the primary cause of DKA. Treatment consists of insulin administration (short- or rapid-acting), intravenous fluid administration (normal saline initially, not 5% dextrose), and potassium replacement, followed by correcting acidosis. Cardiac monitoring is important due to alterations in potassium levels associated with DKA and its treatment, but applying an electrocardiogram monitor is not the priority action.
The emergency department nurse is reviewing the laboratory test results for a client suspected of having diabetic ketoacidosis (DKA). Which laboratory result should the nurse expect to note in this disorder? Serum pH of 9.0 Absent ketones in the urine Serum bicarbonate of 22 mEq/L (22 mmol/L) Blood glucose level of 500 mg/dL (28.5 mmol/L)
Blood glucose level of 500 mg/dL (28.5 mmol/L) n the client with DKA, the nurse should expect to note blood glucose levels between 350 and 1500 mg/dL (20 and 85.7 mmol/L), ketonuria, serum pH less than 7.35, and serum bicarbonate less than 15 mEq/L (15 mmol/L).
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. Increase in pH Comatose state Deep, rapid breathing Decreased urine output Elevated blood glucose level
Comatose state Deep, rapid breathing Elevated blood glucose level Because of the profound deficiency of insulin associated with DKA, glucose cannot be used for energy and the body breaks down fat as a secondary source of energy. Ketones, which are acid by-products of fat metabolism, build up, and the client experiences a metabolic ketoacidosis. High serum glucose contributes to an osmotic diuresis and the client becomes severely dehydrated. If untreated, the client will become comatose due to severe dehydration, acidosis, and electrolyte imbalance. Kussmaul's respirations, the deep rapid breathing associated with DKA, is a compensatory mechanism by the body. The body attempts to correct the acidotic state by blowing off carbon dioxide (CO2), which is an acid. In the absence of insulin, the client will experience severe hyperglycemia. Option 1 is incorrect, because in acidosis the pH would be low. Option 4 is incorrect because a high serum glucose will result in an osmotic diuresis and the client will experience polyuria.
The nurse is providing instructions regarding home care measures to a client with diabetes mellitus and instructs the client about the causes of hypoglycemia. The nurse determines that additional instruction is needed if the client identifies which as a cause of hypoglycemia? Omitted meals Increased intensity of activity Decreased daily insulin dosage Inadequate amount of fluid intake
Decreased daily insulin dosage Decreasing the dose of insulin will lead to hyperglycemia. Causes for hypoglycemic reactions include delayed consumption of meals and lack of necessary amounts of food. Other causes include the administration of excessive insulin or oral hypoglycemic medications, vomiting associated with illness, and strenuous exercise, which may potentiate the action of insulin.
The nurse is providing dietary instructions to help with diabetes control for a client newly diagnosed with diabetes mellitus who will be taking insulin. The nurse should provide the client with which best instruction? Eat meals at approximately the same time each day. Adjust mealtimes depending on blood glucose levels. Vary mealtimes if insulin is not administered at the same time every day. Avoid being concerned about the time of meals as long as snacks are taken on time.
Eat meals at approximately the same time each day. Mealtimes must be approximately the same each day to maintain a stable blood glucose level. The client should not be instructed that mealtimes can be varied depending on blood glucose levels, insulin administration, or consumption of snacks
A client with type 2 diabetes mellitus has a blood glucose level greater than 600 mg/dL (34.3 mmol/L) and is complaining of polydipsia, polyuria, weight loss, and weakness. The nurse reviews the primary health care provider's documentation and expects to note which diagnosis? Hypoglycemia Pheochromocytoma Diabetic ketoacidosis (DKA) Hyperosmolar hyperglycemic syndrome (HHS)
Hyperosmolar hyperglycemic syndrome (HHS) HHS is seen primarily in clients with type 2 diabetes mellitus, who experience a relative deficiency of insulin. The onset of signs and symptoms may be gradual. Manifestations may include polyuria, polydipsia, dehydration, mental status alterations, weight loss, and weakness. The clinical manifestations noted in the question are not signs of hypoglycemia. Pheochromocytoma is not related to these clinical manifestations. DKA typically occurs in type 1 diabetes mellitus.
A client is admitted to a hospital with a diagnosis of diabetic ketoacidosis (DKA). The initial blood glucose level is 950 mg/dL (52.9 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 (13.3 mmol/L). The nurse would next prepare to administer which medication? An ampule of 50% dextrose NPH insulin subcutaneously IV fluids containing dextrose Phenytoin for the prevention of seizures
IV fluids containing dextrose Emergency management of DKA focuses on correcting fluid and electrolyte imbalances and normalizing the serum glucose level. If the corrections occur too quickly, serious consequences, including hypoglycemia and cerebral edema, can occur. During management of DKA, when the blood glucose level falls to 250 to 300 mg/dL (13.9 to 16.7 mmol/L), the IV infusion rate is reduced and a dextrose solution is added to maintain a blood glucose level of about 250 mg/dL (13.9 mmol/L), or until the client recovers from ketosis. Fifty percent dextrose is used to treat hypoglycemia. NPH insulin is not used to treat DKA. Phenytoin is not a usual treatment measure for DKA.
The emergency department nurse is preparing a plan for initial care of a client with a diagnosis of hyperosmolar hyperglycemic syndrome (HHS). The nurse recognizes that the hyperglycemia associated with this disorder results from which occurrence? Increased use of glucose Overproduction of insulin Increased production of glucose Increased osmotic movement of water
Increased production of glucose Hyperglycemia results from decreased use and increased production of glucose. Increased use of glucose and overproduction of insulin would most likely cause hypoglycemia. Option 4 is incorrect.
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 prescription? Endotracheal intubation 100 units of NPH insulin Intravenous infusion of normal saline Intravenous infusion of sodium bicarbonate
Intravenous infusion of normal saline The primary goal of treatment in hyperosmolar hyperglycemic syndrome (HHS) is to rehydrate the client to restore fluid volume and to correct electrolyte deficiency. Intravenous (IV) fluid replacement is similar to that administered in diabetic ketoacidosis (DKA) and begins with IV infusion of normal saline. Regular insulin, not NPH insulin, would be administered. The use of sodium bicarbonate to correct acidosis is avoided because it can precipitate a further drop in serum potassium levels. Intubation and mechanical ventilation are not required to treat HHS.
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 primary health care provider's prescription? Endotracheal intubation 100 units of NPH insulin Intravenous infusion of normal saline Intravenous infusion of sodium bicarbonate
Intravenous infusion of normal saline The primary goal of treatment in hyperosmolar hyperglycemic syndrome (HHS) is to rehydrate the client to restore fluid volume and to correct electrolyte deficiency. Intravenous (IV) fluid replacement is similar to that administered in diabetic ketoacidosis (DKA) and begins with IV infusion of normal saline. Regular insulin, not NPH insulin, would be administered. The use of sodium bicarbonate to correct acidosis is avoided because it can precipitate a further drop in serum potassium levels. Intubation and mechanical ventilation are not required to treat HHS.
A client admitted to the hospital with chest pain and a history of type 2 diabetes mellitus is scheduled for cardiac catheterization. Which medication would need to be withheld for 24 hours before the procedure and for 48 hours after the procedure? Glipizide Metformin Repaglinide Regular insulin
Metformin Metformin needs to be withheld 24 hours before and for 48 hours after cardiac catheterization because of the injection of a contrast medium during the procedure. If the contrast medium affects kidney function, with metformin in the system the client would be at increased risk for lactic acidosis. The medications in the remaining options do not need to be withheld 24 hours before and 48 hours after cardiac catheterization.
A test to measure long-term control of diabetes mellitus has been prescribed for a client. In instructing the client about the test, the nurse explains that long-term control can be measured because chronic high blood glucose levels lead to irreversible glucose binding onto what? Platelets Muscle tissue Adipose tissue Red blood cells (RBCs)
Red blood cells (RBCs) With chronic high circulating blood glucose levels, some glucose binds irreversibly onto RBCs and remains there for the life of the cell. The average life span of an RBC is 120 days. The measurement of glycosylated hemoglobin A (HbA1c), which detects glucose binding on the RBC membrane, is expressed as a percentage. Glucose does not bind onto platelets in diabetes mellitus. One of the problems in diabetes is that muscle and adipose cells may be unable to transport glucose across cell membranes.
A client arrives in the hospital emergency department complaining of severe thirst and polyuria. The client tells the nurse that she has a history of diabetes mellitus. A blood glucose level is drawn, and the result is 685 mg/dL (39.1 mmol/L). Which intervention should the nurse anticipate to be prescribed initially for the client? Glyburide via the oral route Glucagon via the subcutaneous route Insulin aspart via the subcutaneous route Regular insulin via the intravenous (IV) route
Regular insulin via the intravenous (IV) route The client is most likely in diabetic ketoacidosis (DKA). Regular insulin via the IV route is the preferred treatment for DKA. Regular insulin is a short-acting insulin and can be given intravenously; it is titrated to the client's high blood glucose levels. Glucagon is used to treat hypoglycemia, and glyburide is an oral hypoglycemic agent used to treat type 2 diabetes mellitus. Insulin aspart is a short-acting insulin and is not appropriate for the emergency treatment of DKA.
The nurse is caring for a client with diabetic ketoacidosis and documents that the client is experiencing Kussmaul's respirations. Which patterns did the nurse observe? Select all that apply. Respirations that are shallow Respirations that are increased in rate Respirations that are abnormally slow Respirations that are abnormally deep Respirations that cease for several seconds
Respirations that are increased in rate Respirations that are abnormally deep Kussmaul's respirations are abnormally deep and increased in rate. These occur as a result of the compensatory action by the lungs. In bradypnea, respirations are regular but abnormally slow. Apnea is described as respirations that cease for several seconds.
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 symptoms develop? Select all that apply. Polyuria Shakiness Palpitations Blurred vision Lightheadedness Fruity breath odor
Shakiness Palpitations Lightheadedness Shakiness, palpitations, and lightheadedness are signs/symptoms of hypoglycemia and would indicate the need for food or glucose. Polyuria, blurred vision, and a fruity breath odor are manifestations of hyperglycemia.
A client with diabetes mellitus is being discharged following treatment for hyperosmolar hyperglycemic syndrome (HHS) precipitated by acute illness. The client tells the nurse, "I will call the primary health care provider (PHCP) the next time I can't eat for more than a day or so." Which statement reflects the most appropriate analysis of this client's level of knowledge? The client needs immediate education before discharge. The client requires follow-up teaching regarding the administration of oral antidiabetics. The client's statement is inaccurate, and he or she should be scheduled for outpatient diabetic counseling. The client's statement is inaccurate, and he or she should be scheduled for educational home health visits.
The client needs immediate education before discharge. If the client becomes ill and cannot retain fluids or food for a period of 4 hours, the PHCP should be notified. The client's statement indicates a need for immediate education to prevent hyperosmolar hyperglycemic syndrome (HHS), a life-threatening emergency. Although all of the other options may be true, the most appropriate analysis is that the client requires immediate education.