DSM: Type II DM
The nurse is assisting a patient with type 2 diabetes mellitus with meal planning. Which general rules should the nurse include in the plan?
Intake of 45-65% of carbs. 15-20% protein & 10% fat.
The nurse reviewing a monthly blood glucose diary of a patient with type 2 diet-controlled diabetes mellitus finds the levels are elevated at bedtime. Which information should the nurse obtain to determine why this is occurring?
Amount and type of food eaten at dinner
The parents of a child with type 2 diabetes mellitus call the urgent care center because the child's skin is clammy and diaphoretic. Which question should the nurse first ask the parents?
"Have you checked your child's blood sugar?"
The diabetes nurse educator is teaching a patient the cause of type 2 DM. Which patient statement indicates an understanding of the instruction given?
"T2DM is caused by inadequate insulin production." T2DM is associated c reduction in insulin production by pancreatic beta cells along c cellular resistance to insulin. pancreas produces some insulin, enough to keep body from breaking down fats into ketones, but not enough to keep PT's blood glucose level in normal limits. T1DM is from an autoimmune process that destroys all pancreatic beta cells, these PTs will start to break down free fatty acids & produce ketones if they do not receive insulin injections. Pathophys of T2DM: lack of endogenous insulin; insulin resistance; nonketotic form of DM; insufficient insulin to lower glucose
The nurse is teaching a group of parents about ways to prevent type 2 diabetes mellitus in children. Which parent statement indicates a need for further teaching
"I should decrease the amount of sugared beverages in my child's daily diet." A preventive measure to decrease the risk of developing type 2 DM during childhood is to completely eliminate, not just decrease, sugared beverages. this statement, it indicates a need for further teaching. monitoring carb intake, 30 min of activity per day, & limiting TV time are correct
The nurse is teaching an overweight pregnant patient with type 2 diabetes mellitus about discontinuing their oral hypoglycemic medication and beginning insulin administration. Which patient statement indicates an understanding of the instruction given?
"I should stop taking and replace my medication with insulin because it can hurt the baby."
The nurse is assessing the feet of a patient with type 2 diabetes mellitus and notes a sore on the left great toe. Which patient statement indicates a need for further teaching on diabetic foot care?
"I stubbed my toe the other day walking around the house in bare feet."
The parents of a pediatric patient call the nurse to report that the child's blood glucose levels have not decreased after a week of taking metformin (Glucophage).Which response by the nurse is best?
"It can take up to 3 months to see the full benefit of metformin."
The nurse is caring for four patients. Which patient is at highest risk for the development of type 2 diabetes mellitus?
50 YO wheelchair-bound woman who is obese. Two major risk factors for type 2 DM are obesity & inactivity. patient with the autoimmune disease and the patient who is thin and athletic may be at higher risk for type 1 DM. Etiology of T2DM: obesity, inactivity, age, illnesses, meds
The nurse is caring for a child with a suspected diagnosis of type 2 diabetes mellitus. Which assessment finding specifically supports the diagnosis of type 2 diabetes mellitus versus type 1 diabetes mellitus?
Acanthosis nigricans
The nurse is planning care for a school-age child diagnosed with type 2 diabetes mellitus who will be seen every 3 months. Which task is a priority for the nurse to include in the plan of care every 12 months?
Administer an influenza vaccine.On a yearly basis the nurse should plan to administer an influenza vaccine for a child with type 2 DM. The nurse would draw labs to establish hDb A1C and administer a psychosocial assessment during the initial visit after diagnosis.
A 12-year-old child with type 2 diabetes mellitus states, "I don't like outdoor activities, but I like to to play video games." Which suggestion should the nurse make to the parents to help increase the child's activity level?
Advise interactive video games that involve movement.
A morbidly obese adult pt c type 2 DM has tried dietary modifications, oral hypoglycemic meds, & exercise, but has not seen any significant decrease in the hbg A1C. Which intervention should the nurse recommend that the pt explore to prevent long-term complications of type 2 DM?
Bariatric surgery. Pts who are morbidly obese and have uncontrolled type 2 DM may benefit from bariatric surgery. This surgery allows the patient to lose weight and diminish or eliminate diabetes. Alternative medicine approaches to managing type 2 DM: Laparoscopic adjustable gastric banding (LAGB). Roux-en-Y gastric bypass surgery.
A patient with type 2 DM states, "I have increased hunger at the evening meal and know I'm eating more than I shsould. "Which blood glucose level would be impacted by overeating at the evening meal?
Bedtime. If the PT is consuming a larger evening dinner, blood sugars would increase at bedtime.
The nurse is caring for a patient admitted with pneumonia who is receiving corticosteroids to decrease inflammation. Which laboratory value best validates hyperglycemia?
Blood glucose level of 150 mg/dL
An overweight patient with type 2 DM who takes an oral hypoglycemic medication just discovered that she is pregnant. Which collaborative treatment should the nurse expect?
Discontinue the oral hypoglycemic med and prescribe insulin. The pt has type 2 DM & is taking an oral hypoglycemic, which is often not safe during pregnancy. Therefore, the nurse anticipates the hcp to discontinue this med & prescribe the use of insulin.
A pediatric patient with new-onset type 2 diabetes mellitus has been prescribed metformin (Glucophage). Which information should the nurse provide the parents regarding the use of this drug?
Drug effectiveness may take several weeks.
The nurse is providing teaching for an obese patient with a new diagnosis of type 2 diabetes mellitus. Which information should the nurse include that could eliminate the disease?
Follow a low-fat, low-calorie diet. T2D can be eliminated in obese patients by following a low-fat, low-calorie diet and incorporating exercise into the patient's lifestyle.
The nurse is teaching a group of young adults about the risk factors for type 2 DM. In relation to metabolic syndrome, which factor should the nurse include?
HTN. Metabolic syndrome is a constellation of risk factors that can put the pt at risk for type 2 DM & CAD. risk factors include abd obesity, HTN, triglyceridemia, hypercholesterolemia, & physical inactivity. Risk factors for T2DM:Family hx;Physical inactivity;Obesity;metabolic syndrome;Polycystic ovarian syndrome; Gestational DM;Hypercholesterolemia;Hypertriglyceridemia
The nurse notes that a patient with no history of diabetes has a blood glucose level of 215 mg/dL. Which test should the nurse expect the healthcare provider to prescribe?
Hemoglobin A1C
The nurse is reviewing laboratory tests for a patient being seen in the clinic. Which result would indicate to the nurse a need for further testing?
Hemoglobin A1C of 9.0% (>6.5% = DM). when T2DM suspected the hcp will prescribe a hgb A1C to determine overall blood glucose levels for the past 3 M. Normal is <6%. Fasting blood glucose levels less than 100 mg/dL and a random blood glucose level under 140 mg/dL are normal and do not indicate a need for further testing.
The nurse notes that a patient with no history of diabetes has a blood glucose level of 215 mg/dL. Which test should the nurse expect the healthcare provider to prescribe
Hemoglobin A1C. A hemoglobin A1C in conjunction with symptoms is used to diagnose type 2 DM. Other testing would include fasting blood glucose levels.
A pt c a history of HTN is admitted c an infected, poorly healing wound on the HTN ankle. Other reported symptoms include fatigue, blurred vision, polyuria, & polydipsia for the past month. The pt has a blood glucose level of 225 mg/dL & urine is negative for ketones. Which condition should the nurse suspect in this patient?
Hyperglycemia. The pt's risk factors of HTN & elevated blood glucose, as well as symptoms of fatigue, blurred vision, polyuria, & polydipsia are all consistent c hyperglycemia & more than likely type 2 diabetes. Complications of type 2 DM include: Hyperosmolar hyperglycemic state (Blood sugar level of 1000-2000 mg/dL.Altered level of consciousness), Wound infections.Impaired vision.Nephropathy.Peripheral neuropathy.
The nurse is caring for an older adult patient with type 2 who is recovering from a colon resection for cancer. The pt is febrile, has increased urine output, and has a fasting blood glucose level of 650. Which complication of type 2 DM should the nurse suspect is occurring?
Hyperosmolar hyperglycemic state (HHS). This pt with type 2 DM is under stress related to surgery and now presents with a fever, increased urinary output, and elevated blood sugars. These symptoms indicate the onset of HHS. Complications type 2 DM: Hyperosmolar hyperglycemic state.microalbuminuria;Cardiovascular disease. Neuropathies.Periodontal disease.
A child with a new diagnosis of type 2 DM is started on an oral hypoglycemic medication. Which med should the nurse expect the HCP to prescribe?
Metformin (Glucophage). Metformin is the ONLY oral hypoglycemic that is safe to use in children.
A 10-year-old child is diagnosed with type 2 diabetes mellitus. Which nursing intervention should the nurse refrain from performing during outpatient office visits?
Performing blood glucose monitoring & insulin injections. nurse would not perform blood glucose monitoring nor would they admin insulin during outpatient visits. Instead, they would teach pt how to perform these tasks. Checking HbA1C levels to determine average blood glucose over past 3 months, emphasizing the importance of annual evaluations to monitor for potential complications & assessing height, weight & BMI, & plotting them on an appropriate growth curve for age & gender would be appropriate interventions. advise to exercise 150 min a wk.
Which nursing assessment finding of a patient with type 2 diabetes mellitus may indicate the onset of microvascular complications?
Prolonged capillary refill. a prolonged cap refill indicates poor peripheral circulation & likely micro-vascular complications. Microalbuminuria results from protein spilling into the urine from uncontrolled DM.
The nurse is teaching a patient with a new diagnosis of type 2 DM about appropriate foot care to prevent diabetic foot ulcers from forming. Which info should the nurse include in the teaching to prevent skin breakdown?
Refrain from walking barefoot. Diabetic PTs must perform meticulous foot care to prevent skin breakdown. Educate to wear shoes at all times, including slippers, no using heat pads, prevent sunburn, do not sit c legs crossed, no open toed shoes, cotton or wool socks. Toenails trimmed straight across. OTC chemical preps should not be used to remove corns or callouses, this should only be performed by a podiatrist. Shoes should have 0.5 - 0.75 in. of toe room left.
The nurse is caring for a 14YO pt c a dx of type 2 DM whose hemoglobin A1C has not decreased. The pt reports difficulty following the diet at school.Which factor should the nurse investigate as a possible barrier to health maintenance?
The child is embarrassed about food restrictions among peers. Adolescents have difficulty following dietary restrictions and making good food choices because of how it appears to their friends and peers. The child reports noncompliance c proper food choices at school, which therefore implies an understanding of the diet.
The nurse is reviewing the laboratory results for a patient who was diagnosed with type 2 diabetes mellitus 6 months prior and notices the patient has a hemoglobin A1C of 10%. Which inference should the nurse draw from the patient's results?
The patient is most likely not compliant with the diabetic diet and medication.
The nurse is developing a plan of care for a patient with new-onset type 2 diabetes mellitus and determines the patient has a nursing diagnosis of Deficit Knowledge related to new disease process. Which clinical finding indicates that the patient's goals have been met?
The pt demonstrates accurate blood glucose monitoring. The nurse develops a care plan for a diagnosis of Deficit Knowledge related to new disease process. When the pt demonstrates independent and accurate blood glucose monitoring, this indicates that the goals are met. Expected outcomes for patients with type 2 DM:Accurate blood glucose monitoring.Verbal understanding of medications.Remains free of infection. Skin integrity remains intact. Compliance c plan of care.
The nurse is assessing a patient with uncontrolled blood sugar and notices acanthosis nigricans on the back of the patient's neck. Which medical dx should the nurse expect to find in the medical record?
Type 2 DM. The presence of acanthosis nigricans is found in patients with type 2 DM. Manifestations of T2DM: Acanthosis nigricans; fatigue; extreme thirst; frequent urination; extreme hunger; weight loss; blurry vision; slow wound healing; infection
