Adult Health Exam 2- Diabetes

A client with type 1 diabetes mellitus in the emergency department is diagnosed with diabetic ketoacidosis (DKA). Which interventions would the nurse anticipate being prescribed initially? Select all that apply. 1. Monitoring urine for ketones 2. Intravenous potassium replacement 3. Administration of intravenous insulin 4. A bolus of 5% dextrose intravenously 5. Administration of a liter of 0.9% NaCl intravenously

1. Monitoring urine for ketones 2. Intravenous potassium replacement 3. Administration of intravenous insulin 5. Administration of a liter of 0.9% NaCl intravenously DKA is caused by a profound deficiency of insulin and is characterized by hyperglycemia (blood glucose level greater than or equal to 250 mg/dL [13.9 mmol/L]), ketosis (ketones in urine or serum), metabolic acidosis, dehydration, and hypokalemia. Therefore, the correct options are 1, 2, 3, and 5. Option 4 is incorrect, as clients with DKA have a profound deficiency of insulin and an elevated blood glucose; therefore, dextrose would not be administered as an initial intervention.

The nurse is caring for a client with a diagnosis of diabetic ketoacidosis (DKA). Which assessment findings are consistent with this diagnosis? Select all that apply. 1. Polyuria 2 Polydipsia 3 Polyphagia 4 Dry mouth 5 Flushed, dry skin 6 Moist mucous membranes

1. Polyuria 2 Polydipsia 3 Polyphagia 4 Dry mouth 5 Flushed, dry skin

A nurse caring for a 23-year-old client newly diagnosed with type 1 diabetes mellitus teaches the client insulin administration. Which statement by the client indicates a need for further teaching? 1. "It is not necessary for me to aspirate before injecting my insulin." 2 "I will rotate my insulin injection between my arms, thighs, and abdomen on a daily basis." 3 "I will perform a capillary blood glucose measurement before I administer my insulin regimen." 4 "My glargine insulin is long acting and should be administered once a day, but insulin lispro is given just before I eat."

2 "I will rotate my insulin injection between my arms, thighs, and abdomen on a daily basis." Insulin should be rotated within an anatomical site during one day and sites should be rotated daily

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? 1. Omitted meals 2 Increased intensity of activity 3 Decreased daily insulin dosage 4 Inadequate amount of fluid intake

3 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. An inadequate amount of fluid intake is not a cause of hypoglycemia but can lead to dehydration.

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? 1. Increased use of glucose 2. Overproduction of insulin 3. Increased production of glucose 4. Increased osmotic movement of water

3. Increased production of glucose

what counts as 15 grams of a complex carb?

4 oz soda 4 oz juice 1 tsp of sugar or hone 8oz skim milk

A newly admitted client with a diagnosis of type 1 diabetes asks the nurse what caused their diabetes. When the nurse is explaining to the client the etiology of type 1 diabetes, what process should the nurse describe?

Destruction of special cells in the pancreas causes a decrease in insulin production. Glucose levels rise because insulin normally breaks it down, Type 1 diabetes is characterized by the destruction of pancreatic beta cells, resulting in decreased insulin production, unchecked glucose production by the liver, and fasting hyperglycemia. Also, glucose derived from food cannot be stored in the liver and remains circulating in the blood, which leads to postprandial hyperglycemia. Type 2 diabetes involves insulin resistance and impaired insulin secretion. The body does not "make" glucose.

Features of metabolic syndrome

Features of metabolic syndrome include abdominal obesity: waist circumference of greater than 35 inches (female) and 40 inches (male); hyperglycemia: fasting blood glucose level of 110 mg/dL (6 mmol/L) or more or on medication treatment for elevated glucose; abnormal hemoglobin A1C: >6.0%; hypertension: systolic blood pressure of 130 mm Hg or more or diastolic blood pressure of 85 mm Hg or more or on medication treatment for hypertension; hyperlipidemia: triglyceride level of 160 mg/dL or more or on medication treatment for elevated triglycerides (normal triglyceride level is 40 to 160 mg/dL (0.45 to 1.81 mmol/L); high-density lipoprotein cholesterol less than 40 mg/dL: normal is >40 mg/dL (>1.55 mmol/L). The client's risk factors include elevated triglyceride level, elevated hemoglobin A1C, and elevated fasting blood glucose levels.

A client with diabetes mellitus is receiving an oral antidiabetic agent. The nurse observes for which condition when caring for this client?

Hypoglycemia

Which combination of adverse effects should a nurse monitor for when administering IV insulin to a client with diabetic ketoacidosis?

Hypokalemia and hypoglycemia

A diabetic client using insulin reports weight gain. Which response from the nurse explains the most likely cause of the weight increase?

Insulin is an anabolic hormone that is known to cause weight gain. Insulin does lower blood glucose levels by allowing for active transport of glucose into the cells. Faulty fat and protein metabolism will cease once glucose provides the needed the fuel for energy. The restoration of normal metabolism is not the primary cause for weight gain in a client prescribed insulin. Fluid retention is not indicated in this client.

diabetic ketoacidosis is associated with

Type 1 diabetes

A pt diagnosed with type two diabetes is admitted to the hospital. While the nurse is doing their rounds they notice that their patient is confused, does not know where they are, cool to the touch, and sweating. What should the nurse do FIRST? a. check vital signs b. get a fingerstick c. implement seizure precautions d. call the provider

b. get a fingerstick

Hypoglycemia symptoms

confusion drowsiness irritability (hangry) cool skin clammy (sweating) paleness tachycardia headache

Name causes for hypoglycemic reactions

delayed meal consumption excessive insulin use excessive oral hypoglycemic medications vomiting/ illness strenuous exercise

Sick day diabetic rules

drink 8oz-12oz non sugary drinks (unless blood sugar is low than gatorade is perfect) monitor blood glucose every 4 hours keep taking same amounts of insulin call doctor if patient cannot eat or keep anything down in 4-6 hours hyperglycemia is common with infection

what hormones do alpha cells produce?

epinephrine, norepinephrine and glycogen

Glycogen

hormone produced by the pancreas that is turned into glucose

what nursing intervention should a nurse provide to a patient experiencing dawn phenomen?

increase insulin at night and perform glucose monitoring

what do the beta cells produce?

insulin and amylin

what does glucose do to the body?

it help raises blood sugar to make sure that the body remains even

what does insulin do to the body?

it lowers the blood glucose to help maintain homeostasis

Type 2 cause

lack of exercise, poor nutrition, obesity,

lip atrophic dystrophy

loss of fat near or distant to injection sites, caused by insulin reaction, inject insulin at edge of area (atrophy- fat atrophies)

Somogyi effect

morning hyperglycemia, due to too much glucagon being released due to a hypoglycemic episode from too much insulin

a nurse suspects that their diabetic patient is experiencing Dawn Phenomenon. What signs or symptoms would a nurse expect to see in this condition?

normal blood sugar levels at night, however elevate around 2-3 am and stay high at 5 or 6 am

hyperglycemia

polyuria polyphagia polydipsia hot skin dry skin headache muscle cramps blurred vision nausea (glucose in the urine)

what does amylin do in the body?

prevents secretion of glucose, and delays gastric emptying and helps maintain the peaks in between meals

what does insulin help with?

protein synthesis

what nursing intervention should a nurse provide for a patient who they suspect is experiencing the somogi effect?

provide a snack at bed time, and glucose monitoring throughout the night

delta cells produce

somatostatin

Hypertrophic lipodystrophy

spongy swelling (fat pockets due to scar tissue) at injection site due to repeated site use, rotate sites to prevent this (hypertrphic- fat grows)

what nursing assessment should the nurse provide for a patient that they expect is hyperglycemic?

take vitals, get a finger stick, collect urine to test for ketones, and glucose in the urine

what is glycogen representative of?

the break down of lipids and fatty acids in the liver

The diabetic patient has a glucose of 45 and is slurring their words, what should the nurse do?

the nurse should administer glucagon IM or Sub-q, or administer 50% dextrose through the IV

hypoglycemia range

(technically below 70, but 50 is when its bad, and 40 is when it is really bad)

Type 1 Diabetes

-positive antibodies (GAD, ICA, IAA) -more risk of hyperglycemia -destruction of beta cells -unable to produce insulin -require insulin to be made -can have a pump that has continuous basal rate of insulin - more likely leads to DKA - typically diagnosed in adolescence - sudden onset - weight loss - genetic/ viral/ infection

Type 2 diabetes

-reversible -beta cells produce some insulin but not enough - requires oral agents to stimulate the production -gradual onset -negative for antibodies - associated risk with HSS - increased risk of amputation -

The nurse caring for a client newly admitted to the hospital who is at risk for diabetes mellitus suspects that the client has metabolic syndrome if which characteristics have been identified in this client? Select all that apply. 1. Hemoglobin A1C of 6.5% 2 Waist circumference of 30 inches 3 Triglycerides 160 mg/dL (1.81 mmol/L) 4 Consistent systolic blood pressures <130 mm Hg 5 Serial fasting glucose levels of 120 mg/dL (6.85 mmol/L), 132 mg/dL (7.54 mmol/L), and 128 mg/dL (7.31 mmol/L)

1. Hemoglobin A1C of 6.5% 3 Triglycerides 160 mg/dL (1.81 mmol/L) 5 Serial fasting glucose levels of 120 mg/dL (6.85 mmol/L), 132 mg/dL (7.54 mmol/L), and 128 mg/dL (7.31 mmol/L)

Normal fasting blood glucose

The normal fasting blood glucose is 70 to 99 mg/dL (4 to 5.65 mmol/L) in the adult client. The results in the remaining options indicate elevated fasting serum glucose levels.

what is considered hyperglycemia?

above 125 when fasting above 180 after a meal

what cells produce glycogen?

alpha cells

Decreased blood glucose levels trigger

autonomic nervous system signs and symptoms

Name some causes for hyperglycemic reactions

decreased insulin use

The diabetic patient has a blood glucose of 45, what should be done next?

the nurse should assess whether the patient can swallow properly. If the patient is alert and oriented, then they can be given 15 grams of a carb and have their glucose checked every 15 minutes until it is back to normal, then the nurse should give a snack to prevent rebound hypotension

What causes the dawn phenomenon?

the release of growth hormone, remember it as dawn p(GH)enomenon

what does the nurse need to do for a patient who is hypoglycemic?

the rule of 15: recheck blood sugar every 15 minutes after giving 15 grams of carbs

how do you know is a patient is experiencing somogyi's effect?

they have low blood glucose at 2 or 3 am

where should a patient administer their insulin?

they should be changing between the thighs, arm and stomach daily, and rotating between each site in one day

someone who has increased amylin may appear?

thin, due to weight loss and increase satiety after meals

Type 1 diabetes cause

viral/ infection/ genetic

A client with status asthmaticus requires endotracheal intubation and mechanical ventilation. Twenty-four hours after intubation, the client is started on the insulin infusion protocol. The nurse must monitor the client's blood glucose levels hourly and watch for which early signs and symptoms associated with hypoglycemia?

Sweating, tremors, and tachycardia

What is a way to remember the differences between dawn phenomenon and the somogy's affect?

Think of dawn phenomenon as the sun rising (blood sugar continuously rises due to growth hormone)- increase insulin at night while the somogyi's think of as a yo-yo that needs a snack (blood sugar crashes around 2-3 am then rises around 6-7)- decrease insulin and provide complex carb at night

somatostatin purpose

delays gastric emptying and delays the absorption of glucose