NUR1211- CH 51 Assessment and Management of Patients with Diabetes

An older adult patient is in the hospital being treated for sepsis related to urinary tract infection. The patient has started to have an altered sense of awareness, profound dehydration, and hypotension. What condition does the nurse expect the patient is experiencing?

Hyperglycemic hyperosmolar syndrome

What laboratory results should the nurse expect to find that may be associated with Christine's condition?

Hyperkalemia

When the nurse is caring for a patient with type 1 diabetes, what clinical manifestations would be a priority to closely monitor?

Hypoglycemia

A patient with diabetic ketoacidosis has had a large volume of fluid infused for rehydration. What potential complication from rehydration should the nurse monitor for?

Hypokalemia

As blood glucose levels approach normal, what electrolyte imbalance should the nurse assess for?

Hypokalemia

List the clinical manifestations characteristic of hyperglycemic hyperosmolar syndrome.

Hypotension, profound dehydration, tachycardia, and variable neurologic signs (seizures, hemiparesis, alteration of sensorium)

Because insulin normally inhibits ______ and ____, these processes occur in an unrestrained fashion in people with insulin deficiency and contribute further to hyperglycemia.

glycogenolysis, gluconeogenesis.

self-monitoring of blood glucose (SMBG)

A method of capillary blood glucose testing

Why does the economic cost of diabetes continue to increase?

Because of increasing healthcare costs and an older adults.

Every morning Albert is given NPH insulin at 7:30 AM. Meals are served at 8:30 AM, 12:30 PM, and 6:30 PM. Between what hours does the nurse expect that the NPH insulin will reach its maximum effect or peak?

Between 11:30 AM and 7:30 PM.

fasting plasma glucose (FPG)

Blood glucose determination obtained in the laboratory after fasting for a least 8 hours

What information can the nurse provide to Betty to help prevent future events of hypoglycemia?

Eating regularly scheduled meals, eating snacks to cover the peak time of insulin, increasing food intake when engaging in increased levels of physical exercise.

A finding of ___________________ is the basic criterion of diagnosis of diabetes.

Elevated blood glucose levels

After Betty is medically stabilized, she is admitted to the clinical area for observation and health teaching. What warning symptoms should the nurse educate Betty about associated with hypoglycemia?

Emotional changes, slurred speech and double vision, staggering gait, weakness, diaphoresis, and lack of coordination.

Glycosuria

Filtered glucose that the kidney cannot absorb spills over into urine.

Glycogenolysis

Glycogen breaks down in the liver through the action of glucagon

Why does hyperglycemia develop during pregnancy?

Hyperglycemia develops during pregnancy because of the secretion of placental hormones, which causes insulin resistance.

_______,______, and ______ are the three metabolic derangements that occur in diabetic aketoacidosis.

Hyperglycemia, ketosis, and metabolic adcidosis

Uncontrolled type 2 diabetes may lead to an acute problem-______

Hyperglycemic hyerosmolar syndrome

The nurses educating a patient about the benefits of fruit versus fruit juice in a diabetic diet. The patient states, "what difference does it make if you drink the juice or eat the fruit? It is all the same." What is the best response by the nurse?

"Eating the fruit instead of drinking juice decreases the glycemic index by slowing absorption"

The nurse is preparing to administer IV fluids for a patient with ketoacidosis who has a history of hypertension and congestive heart failure. What order for fluids with the nurse anticipate infusing for this patient?

0.45% normal saline

What rehydrating intravenous solution does the nurse expect to infuse?

0.9% sodium chloride

A female patient with diabetes weighs 130 lb has an ideal body weight of 116 lb. For weight reduction of 2 pounds per week, approximately what should her daily caloric intake be?

1000 calories

Goals for blood glucose levels during pregnancy are ________mg/dl or less before meals and ________mg/dl or less 2 hours after meals.

105, 130

A bedtime snack is provided for Albert. This is based on the knowledge that intermediate acting insulin's are effective for what duration of time?

16 to 20 hours.

Gestational diabetes occurs in as many as _____% of pregnant woman and increases their risk for hypertensive disorders during pregnancy.

18%

A woman at average risk for the development of hyperglycemia during pregnancy should be tested at ___________ weeks of gestation.

24-28

It is estimated that more than ____ million people in the United States have diabetes, although almost one third of these cases are undiagnosed.

25.8

The nurse expects that a patient with type 1 diabetes maybe receive what percentage of the usual morning dose of insulin preoperatively?

50 to 60%

Diabetes

A group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both

glycated hemoglobin (glycosylated hemoglobin, HgbA1C, A1C)

A measure of glucose control that is a result of glucose molecule attaching to hemoglobin for the life of the red blood cell (120 days)

Diabetic ketoacidosis DKA

A metabolic derangement in type 1 diabetes that results from a deficiency of insulin; highly acidic ketone bodies are formed, resulting in acidosis

latent autoimmune diabetes of adults (LADA)

A subtype of diabetes

A patient is diagnosed with type one diabetes. What clinical characteristics does the nurse expect to see in this patient? (select all that apply) A. Ketosis prone B. Little endogenous insulin C. Obesity a diagnosis D. Younger than 30 years of age E. Older than 65 years of age

A, B, D

A nurse is caring for a patient with diabetes and has a diagnosis of nephropathy. What would the nurse expect the urinalysis report indicate?

Albumin

Describe how insulin regulation is altered in diabetes state.

Insulin regulates the production and storage of glucose. In diabetes, either the pancreas stops producing insulin or the cells stop responding to insulin. Hyperglycemia results and can lead to acute metabolic complications such as diabetic ketoacidosis and hyperglycemic hyperosmolar syndrome. Long-term complications can contribute to macrovascular or microvascular complications.

What are two main problems related to insulin type 2 diabetes?

Insulin resistance and impaired insulin secretion

_________ is the most common risk of insulin pump therapy.

Ketoacidosis

The nurse is assessing a patient with non-proliferative background retinopathy. When examining the retina, what should the nurse expect to assess? Select all that apply

Leakage of fluid or serum-exudates, microaneurysms, focal capillary single closure

The nurse is caring for a patient with an abnormally low glucose concentration. What glucose level will the nurse observe when assessing laboratory results?

Lower than 50 to 60 mg/dL

The nurse is educating the patient with diabetes about the importance of increasing dietary fiber. What should the nurse explain is the rationale for the increase? Select all that apply

May improve blood glucose levels, decrease the need for exogenous insulin, help reduce cholesterol levels

Retinopathy

Microvascular changes develop in the eyes.

What priority action should the nurse take in caring for Christine?

Monitoring urinary output by means of an indwelling catheter, evaluating serum electrolytes, testing for glycosuria and acetonuria, blood glucose testing, and vital signs.

The nurse is preparing to administer intermediate-acting insulin to a patient with diabetes. Which insulin will the nurse administer?

NPH

Gluconeogenesis

New glucose is produced from amino acids

In the Unites States, diabetes is the leading cause of _____, ____, _____.

Non Traumatic amputation, blindness, end-stage kidney disease.

When education a patient with diabetes about increasing fiber intake, what risks should be discussed?

One risk involved in suddenly increasing fiber intake is that it may require adjusting the dosage of the insulin or oral agents to prevent hypoglycemia. Other problems may include abdominal fullness, nausea, diarrhea, increased flatulence and constipation if fluid intake is inadequate.

When excess glucose is excreted in the urine, it is accompanied by excessive loss of fluids and elcotrolytes, which is called

Osmotic diuresis

An older adult patient that has diabetes type 2 comes to the emergency department with second-degree burns to the bottom of both feet and states, "I didn't feel too hot but my feet must have been too close to the heater." What does the nurse understand is most likely the reason for the decrease in temperature sensation?

Peripheral neuropathy

Classic clinical manifistations of diabetes include the "three P's":____,____,_____

Polyuria, polydipsia, polypgagia

The patient is administering an insulin drip to a patient in ketoacidosis. What insulin does the nursing know is the only one that can be used intravenously?

Regular

A patient has been newly diagnosed with type 2 diabetes, and the nurse is assisting with the development of a meal plan. What steps should be taken into consideration prior to making the meal plan?

Review the patient diet history to identify eating habits, and lifestyle and cultural eating patterns

Albert refuses his bedtime snack. What is a priority for the nurse to assess due to his refusal of a snack?

Signs of hypoglycemia earlier than expected.

Nephropathy

Small vessel disease affects the kidney.

What factors may have contributed to the development of buddies hypoglycemia?

Stress due to the break up, lack of dietary intake.

How do sulfonylureas act for patients with type II diabetes?

Sulfonylureas act by directly stimulating the beta cells of the pancreas to secrete insulin (cannot be used in patients with type 1 diabetes)

Betty is given 1 mg of glucagon hydrochloride, subcutaneously, in the emergency department what latent symptoms should the nurse monitor for related to the action of the glucagon

Symptoms of rebound hypoglycemia.

The major classifications of diabetes are: ______,_______,_______, and diabetes associated with other conditions or syndromes.

Type I diabetes, Type II diabetes, gestational

The healthcare provider orders an insulin drip to be started at 5 units/hour. When hanging the drip, what should the nurse do prior to connecting the drip to the patient?

When hanging the insulin drip, the nurse must flush the insulin solution through the entire IV infusion site and discard the first 50 mL's of fluid. Insulin molecules adhere to the inner surface of plastic IV infusion sets;there for the initial fluid may contain a decreased concentration of insulin.

retinopathy

a complication of diabetes in which the small blood vessels that nourish the retina in the eye are damaged

insulin pump

a continuous subcutaneous insulin infusion device that delivers insulin on a 24-hour basis.

ketone

a highly acidic substance formed when the liver breaks down free fatty acids in the absence of insulin.

insulin

a hormone secreted by the beta cells of the islets of langerhans of the pancreas that is necessary for the metabolism of carbohydrates, proteins, and fats; a deficiency of insulin results in diabetes.

nephropathy

a long-term complication of diabetes in which the kidney cells are damaged ; characterized by microalbuminuria in early stages and progressing to end-stage kidney disease.

type 1 diabetes

a metabolic disorder characterized by an absence of insulin production and secretion from autoimmune destruction of the beta cells of the islets of Langerhans in the pancreas; formerly called insulin-dependent diabetes or juvenile diabetes.

type 2 diabetes

a metabolic disorder characterized by the relative deficiency of insulin production and decreased insulin action and increased insulin resistance; formerly called non-insulin dependent diabetes, or adult -onset diabetes.

hyperglycemic hyperosmolar syndrome (HHS)

a metabolic disorder of type 2 diabetes resulting from a relative insulin deficiency initiated by an illness that raises the demand for insulin.

impaired fasting glucose (IFG) or impaired glucose tolerance

a metabolic stage intermediate between normal glucose homeostasis and diabetes; referred to as prediabetes.

gestational diabetes

any degree of glucose intolerance with its onset during pregnancy

Insulin resistance refers to a ______ tissue sensitivity to insulin.

decreased

hyperglycemia

elevated blood glucose level

prediabetes

impaired glucose metabolism in which blood glucose concentrations fall between normal levels and those considered diagnostic for diabetes; includes impaired fasting glucose and impaired glucose tolerance, not clinical entities in their own right but risk factors or future diabetes and cardiovascular disease.

Hypoglycemia

low blood glucose level

medical nutrition therapy (MNT)

nutritional therapy prescribed for management of diabetes that usually is given by a registered dietician.

Type 2 diabetes is the __________ leading cause of death and affects approximately _______% of older adults

seventh, 20%

glycemic index

the amount a given food increases the blood glucose level compares with an equivalent amount of glucose.