DM (type 1 & 2) / DKA / HHS
In type 1 diabetes, the body's own _____ cells are attacked and destroyed.
Pancreatic beta (ß)
Which clinical manifestations may be seen in a client experiencing a hypoglycemic (insulin) reaction? (Select all that apply.) a. headache b. nervousness c. tremor d. excessive perspiration e. tachycardia f. abdominal pain
a, b, c, d, e
A nurse ho is teaching a client how to recognize symptoms of hypoglycemia should include which symptoms in the teaching? (Select all that apply.) a. Headache b. Nervousness c. Bradycardia d. Sweating e. Thirst f. Sweet breath odor
a, b, d
Antidiabetic drugs are designed to control signs and symptoms of diabetes mellitus. The nurse primarily expects a decrease in which? a. Blood glucose b. Fat metabolism c. Glycogen storage d. Protein mobilization
a
In maturity-onset, or type 2, diabetes, the oral antidiabetic (hypoglycemic) drug group that stimulates beta cells to secrete more insulin is sulfonylureas. For juvenile-onset, or type 1, diabetes, oral hypoglycemics (ARE/ARE NOT) prescribe.
ARE NOT
A type II diabetic presents to the clinic for a follow up appointment after working with a dietitian for two months. Which of the following tests would indicate improvement of blood sugar over a two to three month period? a. SMBG b. Fasting Blood Glucose level c. HgA1C d. Urine Ketone
a
Which statement by the patient with type 2 diabetes is accurate? a. "I am supposed to have a meal or snack if I drink alcohol." b. "I am not allowed to eat any sweets because of my diabetes." c. "I do not need to watch what I eat because my diabetes is not the bad kind." d. "The amount of fat in my diet is not important; it is just the carbohydrates that raise my blood sugar."
a
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. Hypoglycemia prevention, symptoms, and treatment
a & d
Which drugs may cause hyperglycemia? (Select all that apply.) a. prednisone b. epinephrine c. levothyroxine d. hydrochlorothiazide
a, b, d
Which clinical manifestations may be seen in a client experiencing diabetic ketoacidosis (hyperglycemia)? (Select all that apply.) a. thirst b. polyuria c. bradycardia d. Kussmaul's sign e. dry mucous membranes f. fruity breath odor
a, b, d, e, f
In nutritional management of all types of diabetes, it is important for the patient to a. eat regular meals at regular times. b. restrict calories to promote moderate weight loss. c. eliminate sucrose and other simple sugars from the diet. d. limit saturated fat intake to 30% of dietary intake.
a. The body requires food at regularly spaced intervals throughout the day, and omission or delay of meals can result in hypoglycemia, especially for the patient taking insulin or oral hypoglycemic agents. Weight loss may be recommended in type 2 diabetes if the individual is overweight, but many patients with type 1 diabetes are thin and require an increase in caloric intake. Fewer than 7% of total calories should be from saturated fats, and simple sugars should be limited, but moderate amounts can used if counted as a part of total carbohydrate intake.
A client is to receive insulin before breakfast, and the time of breakfast tray delivery is variable. The nurse knows that which insulin should not be administered until the breakfast tray has arrived and the client is ready to eat? a. Humulin N b. lispro (Humalog) c. glargine (Lantus) d. Humulin R
b
Analyze the following diagnostic findings for your patient with type 2 diabetes. Which result will need further assessment? a. BP 126/80 mm Hg b. A1C 9% c. FBG 130mg/dL (7.2 mmol/L) d. LDL cholesterol 100 mg/dL (2.6 mmol/L)
b
List five signs and symptoms that are present in DKA that are not seen in HHS
a. Kussmaul's respirations b. ketonuria c. sweet, fruity odor to breath d. decreased arterial pH (acidosis) e. ketonemia
When the client is prescribed glipizide (Glucotrol), the nurse knows that which side effects/adverse effects may be expected? (Select all that apply.) a. Tachypnea b. Tachycardia c. Increase alertness d. Increased weight gain e. Visual disturbances f. Hunger
b, e, f
The nurse enters the room of a client who was administered insulin with breakfast. The nurse finds the sitting up in the chair with cool, pale and sweaty skin. What is the first thing the nurse should do? a. Administer insulin immediately. b. Check the client's blood glucose c. Report the symptoms to the physician d. Treat the symptoms with simple carbohydrates
b
The time is 0710 and the nurse is caring for a type 1 diabetic that has glargine (Lantus) and lispro (Humalog) ordered to be given at 0700. The client's blood glucose is 134 mg/dL. Which of the following is correct? a. Administer both insulins in the same syringe. b. Administer glargine (Lantus) now and lispro (Humalog) once the breakfast arrives. c. Call the physician and question why the type I diabetic client needs two insulins. d. Administer both insulins now.
b
Goals of nutritional therapy for the patient with type 2 diabetes include maintenance of a. ideal body weight. b. normal serum glucose and lipid levels. c. a special diet using diabetic foods. d. five small meals per day with a bedtime snack.
b Maintenance of as near-normal blood glucose levels as possible and a achievement of optimal serum lipid levels with dietary modification are believed to be the most important factors in preventing both short- and long-term complications of diabetes. There is no specific "diabetic diet," and use of dietetic foods is not necessary for diabetes control. Most diabetics eat three meals a day, and some require a bedtime snack for control of nighttime hypoglycemia. A reasonable weight, which may or may not be an ideal body weight, is also a goal of nutritional therapy.
A diabetic patient has a serum glucose level of 824 mg/dL (45.7 mmol/L) and is unresponsive. Following assessment of the patient, the nurse suspects diabetic ketoacidosis rather than hyperosmolar hyperglycemic syndrome based on the findings of a. polyuria. b. severe dehydration. c. rapid, deep respirations. d. decreased serum potassium.
c
A type II diabetic client presents to the clinic with the fever and states, "I don't know why my blood glucose has been running in the 300s." Which of the following is the best explanation that the nurse should teach the client? a. "Influenza can lead to very high blood sugars and less insulin will be needed." b. "Illness tends to stress you out and lead to high blood sugars." c. "Illness can cause hyperglycemia because hormones produced to combat the illness cause the blood sugar to rise which may require more insulin intake." d. "Illness causes the beta cells to temporarily stop functioning and causes the blood glucose to trigger glucagon storage and will require more insulin."
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 patients blood glucose level. d. Assess for other neurologic symptoms.
c
The nurse determines that a patient with a 2-hour OGTT of 152mg/dL has a. diabetes. b. impaired fasting glucose. c. impaired glucose tolerance. d. elevated glycosylated hemoglobin (Hb)
c Impaired glucose tolerance exists when a 2-hour plasma glucose level is higher than normal but lower than the level diagnostic for diabetes (i.e., 140-199mg/dL). Impaired fasting glucose exists when fasting glucose levels are greater than the normal of 100mg/dL but less than the 126mg/dL diagnostic of diabetes. Both conditions represent a condition known as pre diabetes.
First drug generally prescribed in type 2 diabetes. a. Glucosamine b. Diet pills for weight loss c. Glucophage d. Insulin
c metformin (Glucophage)
The nurse teaches an obese client that which of the following may prevent diagnosis of type 2 diabetes? a. Oral medication b. Use of Homeopathic remedies c. Life style changes d. South Beach diet
c
A 7-yr-old girl with type I diabetes begins to experience low blood sugar on the bus ride home. Her friend alerts the school bus driver. Which of the following should the bus driver give the girl to treat her symptoms? a. Chocolate Milk b. Crackers c. Peanut M&Ms d. Apple Juice
d
What is the only type of insulin that may be administered IV? a. NPH b. Detemir c. Lantus d. Regular
d
What is the rationale for rotation of insulin injection sites? a. prevents polyuria b. prevents rejection of insulin c. prevents an allergic reaction d. prevents lipodystrophy
d
When comparing the pathophysiology of type 1 and type 2 diabetes, 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 the development of ketoacidosis. b. The patient has islet cell antibodies that have destroyed the ability of the pancreas 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 secretion to prevent ketosis but is at risk for development of hyperosmolar hyperglycemic syndrome.
d
A diabetic patient is found unconscious at home, and a family member calls the clinic. After determining that no glucometer is available, the nurse advise the family member to a. try to around the patient to drink some orange juice. b administer 10 U or regular insulin subcutaneously. c. call for an ambulance to transport the patient to a medical facility. d. administer glucagon 1mg intramuscularly (IM) or subcutaneously.
d. If a diabetic patient is unconscious, immediate treatment for hypoglycemia must be given to prevent brain damage, and IM or subcutaneous administration of 1mg of glucagon should be done. If that unconsciousness has another cause, such as ketosis, the rise in glucose cause by the glucagon is not as dangerous as the low glucose level. Following administration of the glucagon, the patient should be transported to a medical facility for further treatment and evaluation. Insulin is contraindicated without knowledge of the patient's glucose level, and oral carbohydrate cannot be given when patients are unconscious.
The home care nurse should intervene to correct a patient whose insulin administration includes a. warming a pre filled refrigerated syringe in the hands before administration. b. storing syringes pre filled with NPH and regular insulin needle-up in the refrigerator. c. placing the insulin bottle currently in use in a small container on the bathroom countertop. d. mixing an evening dose of regular insulin with insulin glargine in one syringe for administration.
d. Insulin glargine (Lantus), a long-acting insulin that is continuously released with no peak of action, cannot be diluted or mixed with any other insulin or solution. Mixed insulins should be stored needle-up in the refrigerator and warmed before administration. Currently used bottles of insulin can be kept at room temperature.
Which of the following patients would a nurse plan to teach how to prevent or delay the development of diabetes? a. A 62 year-old obese white woman. b. An obese 50 year-old Hispanic woman. c. A child whose father has type 1 diabetes. d. A 34 year-old woman whose parents both have type 2 diabetes.
d. Type 2 diabetes has a strong genetic influence, and offspring of parents who both have type 2 diabetes have an increased chance of developing it. Whereas type 1 diabetes is associated with genetic susceptibility related to human leukocyte antigens (HLAs), offspring of parents who both have type 1 diabetes have only a 6% to 10% chance of developing the disease. Lower risk factors for type 2 diabetes include obesity; being a Native American, Hispanic, or African-American; and being 55 years or older.
Tissues that require insulin for glucose transport are _____ and _____ tissue.
skeletal muscle; adipose
Following the teaching of foot care to a diabetic patient, the nurse determines that additional instruction is needed when the patient says, a. "I should wash my feet daily with soap and warm water." b. "I should always wear shoes to protect my feet from injury." c. "If my feet are cold, I should wear socks instead of using a heating pad." d. "I'll know if I have sores or lesions on my feet because they will be painful."
d. Complete or partial loss of sensitivity of the feet is common with peripheral neuropathy of diabetes, and diabetics may suffer foot injury and ulceration without ever having pain. Feet must be inspected during daily care for any cuts, blisters, swelling, or reddened areas.
In addition to promoting the transport of glucose from the blood into the cell, insulin also a. enhances the breakdown of adipose tissue for energy. b. stimulates hepatic glycogenolysis and gluconeogenesis. c. prevents the transport of triglycerides into adipose tissue. d. accelerates the transport of amino acids into cells and their synthesis into protein.
d. Insulin is an anabolic hormone, responsible for growth, repair, and storage, and it facilitates movement of amino acids into cells, synthesis of protein, storage of glucose as glycogen, and deposition of triglycerides and lipids as fat into adipose tissue. Glucagon is responsible for hepatic glycogenolysis and gluconeogenesis, and fat is used for energy when glucose levels are depleted.
Lispro insulin (Humalog) with NPH insulin is ordered for a patient with newly diagnosed type 1 diabetes. The nurse knows that when lispro insulin is used, it should be administered a. only once a day b. 1 hour before meals c. 30-45 minutes before meals d. at mealtime or within 15 minutes of meals
d. Lispro is a rapid-acting insulin that has an onset of action of 5 to 15 minutes and should be injected at the time of the meal to within 15 minutes of eating. Regular insulin is short acting with an onset of action in 30 to 60 minutes following administration and should be given 30 to 45 minutes before meals.
What are the major symptoms that characterize diabetes? (Select all that apply.) a. polyuria b. polyphagia c. polyposia d. polydipsia e. polyrrhea
a, b, d
Which are appropriate therapies for patients with diabetes mellitus (select all that apply)? a. Use of statins to treat dyslipidemia b. Use of diuretics to treat nephropathy c. Use of ACE inhibitors to treat nephropathy d. Use of laser photocoagulation to treat retinopathy
a, c, d
A client is newly diagnosed with type 1 diabetes mellitus and requires daily insulin injections. Which instruction should the nurse include in the teaching of insulin administration? a. Teach the family members to administer glucagon by injection if the client has a hyperglycemic reaction. b. Instruct the client about the necessity for compliance with prescribed insulin therapy. c. Teach the client that hypoglycemic reactions more likely to occur at the onset of action time. d. Instruct the client in the care of insulin container and syringe handling.
b
Polydipsia and polyuria related to diabetes mellitus are primarly 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 RBC's resulting from attachment of excessive glucose to hemoglobin.
b
The diabetic educator is teaching a newly diagnosed client about monitoring blood glucose at home. Which of the following would the diabetic educator teach the patient to do at home? a. HgA1c b. SMBG c. Dipstick to check for ketones d. Glucose Tolerance Test
b
A client is diagnosed with type 2 diabetes mellitus. The nurse is aware that which statement is true? a. Client is most likely a teenager. b. Client is most likely a child younger than 10 years. c. Heredity is a major causative factor. d. Viral infections contribute most to disease development.
c
A client is receiving a daily dose of Humulin N insulin at 7:30 am. The nurse expects the peak effect of this drug to occur at which time? a. 8:15 am b. 10:30 am c. 5:00 pm d. 11:00 pm
c
Four hormones released that are counter-regulatory to insulin are _____, _____, _____, and _____.
cortisol; epinephrine; glucagon; growth hormone
A newly diagnosed type I diabetic asks the nurse why she can't just take a pill like her friend to treat her diabetes. How should the nurse reply? a. "Oral agents are only used in type 2 diabetics." b. "You should discuss changing to oral agents instead of insulin with your doctor." c. "Your friend's insurance probably doesn't cover insulin so she takes the oral agents instead." d. "Oral agents make the beta cells function in type I diabetics."
a
Which information should be included in health teaching for clients taking insulin? (Select all that apply.) a. Recognize signs of hypoglycemic reaction. b. Adhere to the prescribed diet. c. Take insulin as prescribed. d. Monitor blood glucose level. e. Be sure to exercise. f. Keep appointments with health care provider. g. Alter insulin dose based on how you're feeling.
a, b, c, d
Two days following a self-managed hypoglycemic episode at home, the patient tells the nurse that his blood glucose levels since the episode have been between 80 and 90mg/dL. The best response by the nurse is, a. "That is a good range for your glucose levels." b. "You should call your health care provider because you need to have your insulin increased." c. "That level is too low in view of your recent hypoglycemia, and you should increase your food intake." d. "You should only take half your insulin dosage for the next few days to get your glucose level back to normal."
a. Blood glucose levels of 80 to 90mg/dL (4.5-5 mmol/L) are within the normal range and are desired in the patient with diabetes, even following a recent hypoglycemic episode. Hypoglycemia is often caused by a single event, such as skipping a meal or taking too much insulin or vigorous exercise; once corrected, normal control should be maintained.
A 72-year-old woman is diagnosed with diabetes. The nurse recognizes that management of diabetes in the older adult a. does not require as tight glucose control as in younger diabetics. b. is usually not treated unless the patient becomes severely hyperglycemic. c. does not include treatment with insulin because of limited dexterity and vision. d. usually requires that a younger family member be responsible for care of the patient.
a. Because the clinical manifestations of long-term complications of diabetes take 10 to 20 years to develop, and because tight glucose control in the older patient is associated with an increase frequency of hypoglycemia, the goals for glycemic control are not as rigid as in the younger population. Treatment is indicated, and insulin may be used if the patient does not respond to oral agents. The patient's needs, rather than age, determine the responsibility of other in care.
A patient with diabetes calls the clinic because she is experiencing nausea and flulike symptoms. The nurse advises the patient to a. administer the usual insulin dosage. b. hold fluid intake until the nausea subsides. c. come to the clinic immediately for evaluation and treatment. d. monitor the blood glucose every 1 to 2 hours and call if the glucose rises over 150 mg/dL (8.3 mmol/L)
a. During minor illnesses, the patient with diabetes should continue drug therapy and food intake. Insulin is important because counter regulatory hormones may raise blood glucose during the stress of illness, and food or a carbohydrate liquid substitution is important because during illness the body requires extra energy to deal with the stress of the illness. Blood glucose monitoring should be done every 4 hour, and the health care provider should be notified if the level is >240mg/dL (13.9 mmol/L) or if fever, ketonuria, or nausea and vomiting occur.
The major advantage of using an insulin pump is that a. tight glycemic control can be maintained. b. errors in insulin dosing are less likely to happen. c. complications of insulin therapy are prevented. d. frequent blood glucose monitoring is unnecessary.
a. Insulin pumps provide tight glycemic control by continuous subcutaneous insulin infusion based on the patient's basal profile, with bolus doses at mealtime at the patient's discretion. Errors in insulin dosing and complications of insulin therapy are still potential risks with insulin pumps.
Priority Decision: When caring for a patient with metabolic syndrome, the nurse gives the highest priority to teaching the patient about a. maintaining a normal weight. b. performing daily aerobic exercise. c. eliminating red mean from the diet. d. monitoring the blood glucose periodically.
a. Metabolic syndrome is a cluster of abnormalities that include elevated insulin levels, elevated triglycerides and low-density lipoproteins (LDL), and decreased high-density lipoproteins (HDL). These abnormalities greatly increase the risk for cardiovascular disease associated with diabetes that can be prevented or delayed with weight loss. Exercise is also important, but normal weight is most important.
A diabetic patient is learning to mix regular insulin and NPH insulin in the same syringe. The nurse determines that additional teaching is needed when the patient a. withdraws the NPH dose in the syringe first b. injects air equal to the NPH dose into the NPH vial first. c. removes any air bubbles after withdrawing the first insulin. d. adds air equal to the insulin dose into the regular vial and withdraws the dose.
a. When mixing regular with a longer-acting insulin, regular insulin should always be drawn in the syringe first to prevent contamination of the regular insulin vial with longer-acting insulin additives. Air is added in the neutral protamine Hagedorn (NPH) vial; then air is added to the regular vial, and the regular insulin is withdrawn, bubbles are removed, and the dose of NPH is withdrawn.
In diabets, atherosclerotic disease affecting the cerebrovascular, cardiovascular, and peripheral vascular systems a. can be prevent by tight glucose control. b. occurs with a higher frequency and earlier onset than in the nondiabetic population. c. is cause by the hyperinsulinemia related to insulin resistance common in type 2 diabetes. d. cannot be modified by reduction of risk factors such as smoking, obesity, and high fat intake.
b The development of atherosclerotic vessel disease seems to be promoted by the altered lipid metabolism common to diabetes, and although tight glucose control may help delay the process, it does not prevent it completely. Atherosclerosis in diabetic patients does respond somewhat to a reduction in general risk factors, as it does in nondiabetics, and reduction in fat intake, control of hypertension, abstention from smoking, maintenance of normal weight, and regular exercise should be carried out by diabetic patients.
During routine health screening, a patient is found to have a fasting plasma glucose (FPG) of 132 mg/dL (7.33. mmol/L). At a follow-up visit, a diagnostic of diabetes would be made based on (select all that apply) a. glucosuria of 3+. b. an A1C of 7.5%. c. a FPG of ≥126mg/dL (6.9 mmol/L). d. random blood glucose of 126 mg/dL (7.0 mmol/L). e. a 2-hour oral glucose tolerance test (OGTT) of 190 mg/dL (10.5 mmol/L).
b, c The patient has one prior test result that meets criteria for a diagnosis of diabetes, but on a subsequent day must again have results from on of the three tests that meet the criteria for diabetes diagnosis. These criteria include a fasting plasma glucose level of ≥126mg/dL (7.0 mmol/L), or A1C ≥6.5% or a 2 hour OGTT level ≥200mg/dL (11.1 mmol/L). Both the fasting plasma glucose (FPG) and A1C would confirm a diagnosis of diabetes in this patient.
A patient with type 1 diabetes uses 20U of 70/30 neutral protamine Hagedorn (NPH/regular) in the morning and at 6:00pm. When teaching the patient about this regimen, the nurse stresses that a. hypoglycemia is most likely to occur before the noon meal. b. a set meal pattern with a bedtime snack is necessary to prevent hypoglycemia. c. flexibility in food intake is possible because insulin is available 24 hours/day. d. pre-meal glucose checks are required to determine needed changes in daily dosing.
b. A split-mixed dose of insulin requires that the patient adhere to a set meal pattern to provide glucose for the action of the insulins, and a bedtime snack is usually required when patients take a long-acting insulin late in the day to prevent nocturnal hypoglycemia. Hypoglycemia is most likely to occur with this dose late in the afternoon and during the night. When premixed formulas are used, flexible dosing based on glucose levels is not recommended.
Delegation Decision: The following interventions are planned for a diabetic patient. Which intervention can the nurse delegate to nursing assistive personnel (NAP)? a. Discuss complications of diabetes. b. Check that the bath water is not too hot. c. Check the patient's technique for drawing up insulin. d. Teach the patient to use the glucometer for in-home glucose monitoring.
b. Checking the temperature of the bath water is part of assisting with activities of daily living (ADLs) and within the scope of care for the nursing assistive personnel (NAP). Discussion of complications, teaching, and assessing learning are appropriate for RNs.
To prevent hyperglycemia or hypoglycemia with exercise, the nurse teaches the patient using glucose-lowering agents that exercise should be undertaken a. only after a 10- to 15-g carbohydrate snack is eaten. b. about 1 hour after a eating, when blood glucose levels are rising. c. when glucose monitoring reveals that the blood glucose is in the normal range. d. when blood glucose levels are high because exercise always has a hypoglycemic effect.
b. During exercise, a diabetic person needs both adequate glucose to prevent exercise-induced hypoglycemia and adequate insulin because counterregulatory hormones are produced during the stress of exercise and may cause hyperglycemia. Exercise after meals is best, but a 10- to 15-g carbohydrate snack may be taken if exercise is performed before meals or is prolonged. Blood glucose levels should be monitored before, during, and after exercise to determine the effect of exercise on the levels.
A nurse working in an outpatient clinic plans a screening program for diabetes. Recommendations for screening would include a. OGTT fro all minority populations every year. b. FPG for all individuals at age 45 and then every 3 years. c. testing all people under the age of 21 for islet cell antibodies. d. testing for type 2 diabetes only in overweight or obese individuals.
b. The American Diabetes Association recommends that testing for type 2 diabetes with a FPG should be considered for all individuals at the age of 45 and above and, if normal, repeated every 3 years. Testing for immune markers of type 1 diabetes is not recommended. Testing of a younger age or more frequently should be done for members of a high-risk ethnic population, including African Americans, Hispanics, Native Americans, Asians Americans, and Pacific Islanders.
A patient taking insulin has recorded fasting glucose levels above 200mg/dL (11.1 mmol/L) on awakening for the last five mornings. The nurse advises the patient to 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 2:00 and 4:00 am, and on arising. d. decrease the evening insulin dosage to prevent night hypoglycemia and the Somogyi effect.
c. The patient's elevated glucose on arising may be the result of either dawn phenomenon or Somogyi effect, and the best way to determine whether the patient needs more or less insulin is by monitoring the glucose at bedtime, between 2:00 and 4:00 am, and on arising. If predawn levels are below 60mg/dL, the insulin dose should be reduced, but if the 2:00 to 4:00 am blood glucose is high, the insulin should be increased.
When teaching the patient with diabetes about insulin administration, the nurse instructs the patient to a. pull back on the plunger after inserting the needle to check for blood. b. clean the skin at the injection site with an alcohol swab before each injection. c. consistently use the same size of the appropriate strength insulin syringe to avoid dosing errors. d. rotate injection sites from arms to thighs to abdomen with each injection to prevent lipodystrophies.
c. U100 insulin must be used with a U100 syringe, but for those using low doses of insulin, syringes are available that have increments of 1 unit instead of 2 units. Errors can be made in dosing if patients switch back and forth between different sizes of syringes. Aspiration before injection of the insulin is not recommended, nor is the use of alcohol to clean the skin. Because the rate of peak serum concentrations varies with the site selected for injection, injections should be rotated within a particular area, such as the abdomen.
The nurse assesses the diabetic patient's technique of self-monitoring of blood glucose (SMBG) 3 months after initial instruction. An error in the performance of SMBG noted by the nurse that requires intervention is a. doing the SMBG before and after exercising. b. puncturing the finger on the side of the finger pad. c. cleaning the puncture site with alcohol before the puncture. d. holding the hand down for a few minutes before the puncture.
c. Cleaning the puncture site with alcohol is not necessary and may interfere with test results and lead to drying and splitting of the fingertips. Washing the hands with warm water is adequate cleaning and promotes blood flow to the fingers. Blood flow is also increase by holding the hand down. Puncture on the side of the finger pad are less painful. Self-monitored blood glucose (SMBG) should be performed before and after exercise.
Priority Decision: The nurse is assessing a newly admitted diabetic patient. Which of these observations should be addressed as a priority by the nurse? a. Bilateral numbness of both hands b. Stage II pressure ulcer on the right heel c. Rapid respirations with deep inspiration d. Areas of lumps and dents on the abdomen.
c. Rapid deep respirations are symptoms of diabetic ketoacidosis (DKA). Stage II ulcers and bilateral numbness are chronic complications of diabetes. The lumps and dents on the abdomen indicate a need to teach the patient about site rotation.
The treatment for DKA and HHS differs primarily in that a. DKA requires administration of bicarbonate to correct acidosis. b. potassium replacement is not necessary in management of HHS. c. HHS require greater fluid replacement to correct the dehydration. d. administration of glucose is withheld in HHS until the blood glucose reaches a normal level.
c. The management of DKA is similar to that of HHS except HHS requires greater fluid replacement because of the severe hyperosmolar state. Bicarbonate is not usually given in DKA to correct acidosis unless the pH is <7.0 because administration of insulin will reverse the abnormal fat metabolism. Total body potassium deficit is high in both conditions, requiring potassium administration, and, in both conditions, glucose is added to IV fluids when blood glucose levels fall to 250mg/dL (13.9 mmol/L).
Ketoacidosis occurs as a complication of diabetes when a. illnesses causing nausea and vomiting lead to bicarbonate loss with body fluids. b. the glucose level becomes so high that osmotic diuresis promotes fluid and electrolyte loss. c. an insulin deficit causes the body to metabolize large amounts of fatty acids rather than glucose for energy. d. the patient skips meals after taking insulin, leading to rapid metabolism of glucose and breakdown of fats for energy.
c. When insulin is insufficient and glucose cannot be used for cellular energy, the body releasees and breaks down stored fats and protein to meet energy needs. Free fatty acids from stored triglycerides are released and metabolized in the liver in such large quantities that ketones are formed. Ketones are acidic and alter the pH of the blood, causing acidosis. Osmotic diuresis occurs as a result of loss of both glucose and ketones in the urine.
