Diabetes
*****A nurse is teaching about disease management for a client who has type 1 diabetes mellitus. Which statement made by the client indicates an understanding of the teaching? "I am to take my blood sugar reading after meals." "Insulin allows me to eat ice cream at bedtime." "A weight reduction program will make me hypoglycemic." "I give the insulin injections in my abdominal area."
"I give the insulin injections in my abdominal area." The client should give insulin injections in one anatomic area for consistent day-to-day absorption. The abdomen is the area for fastest absorption.
***************A nurse is teaching about self-monitoring to a client who has type 1 diabetes mellitus. Which of the following statements by the client indicates an understanding of the teaching? "I will check my urine once a day for ketones." "I will notify my provider if pre-meal glucose is 120 mg/dL." "I will check my blood glucose every 4 hours when I am sick." "I will check blood glucose every 5 minutes when lightheaded."
"I will check my blood glucose every 4 hours when I am sick." The client should follow specific guidelines when sick. The nurse should instruct the client to monitor blood glucose every 3 to 4 hr and continue to take insulin or oral antidiabetic agents. The client should consume 4 oz of sugar-free, noncaffeinated liquid every 30 min to prevent dehydration and eet carbohydrate needs through soft food if possible. If not, the client should consume liquids equal to usual carbohydrate content. The nurse should also instruct the client to test urine for ketones and report to provider if they are abnormal (the level should be negative to small).
*****A nurse is teaching a client who has diabetes mellitus about the manifestations of hypoglycemia. Which of the following statements by the client indicates an understanding of the teaching? "I will feel shaky." "I will be more thirsty than usual." "My skin will be warm and moist." "My appetite will be decreased."
"I will feel shaky" Manifestations of hypoglycemia include feeling shaky and nervous.
****A nurse is teaching a client who has type 1 diabetes mellitus about foot care. Which of the following statements by the client indicates an understanding of the teaching? "I'll wear sandals in warm weather." "I'll put lotion between my toes after drying my feet." "I'll soak my feet in cool water every night before I go to bed."
"I'll check my feet every day for sores and bruises." The client should check his feet daily to monitor for any problems and observe any other changes before they become serious. He can use a hand mirror to examine areas that are difficult for him to see.
************A nurse is teaching an older adult client who has diabetes mellitus about preventing the long-term complications of retinopathy and nephropathy. Which of the following instructions should the nurse include? "Have an eye examination once per year." "Examine your feet carefully every day." "Wear compression stockings daily." "Maintain stable blood glucose levels."
"Maintain stable blood glucose levels." Keeping blood glucose under control is the client's best protection against long-term complications of diabetes, since increased blood sugar contributes to neuropathic disease, and microvascular complications such as retinopathy and nephropathy, as well as to macrovascular complications.
****A client who has Type 2 diabetes mellitus asks the nurse, "Why did I develop diabetes?" Which of the following responses should the nurse make? "Your body is destroying the cells that secrete insulin." "Your body has insulin resistance and decreased insulin secretion." "An infection in your pancreas destroyed the cells that make insulin." "Your kidneys are not able to reabsorb water which leads to Type 2 diabetes mellitus."
"Your body has insulin resistance and decreased insulin secretion." A client genetically susceptible can develop Type 2 diabetes mellitus when obesity and physical inactivity lead to insulin resistance at cells as well as decreased secretion of insulin by pancreatic beta-cells.
What are the S/S of Hyperglycemia?
-3 P's *polyphagia *Polydipsia *Polyuria -type 1 see all ps -type 2 see polydipsia, polyuria
What is T1DM?
-Beta cells dont work, have been destroyed, body doesn't release -Tx: must use insulin -Risk Factors: Genetic, autoimmune (virus), -Pt look young, thin -Happens suddenly within 6 months -ketones will be present in the urine, due to fat metabolization, acetone smelling breath
What is T2DM
-Cell don't respond to insulin, causing insulin resistance -Tx: diet and excersice, 2nd resort oral medications, may need insulin during stress, surgery, or infection -Risk factors: Life style, obesity, sedentary, poor diet, stress, genetics, gestational diabetes, baby over 9lbs -Pt look overweight, adult aged -Happens overtime, rare to have ketones
What is DKA?
-Happens in type 1 diabetes -no insulin, so body starts to burn fats for energy since it cant get to the glucose -due to this ketones, which are acids, start to enter into the body and this causes life threatening situation, such as acid/base imbalance -S/S: N/V, excessive thirst, hyperglycemia, Kussmals breathing(fast/ deep)
What is HHS?
-Happens in type 2 diabetes -present hyperglycemia w/o ketone breakdown, there is no acidosis/ketosis, because there is enough insulin present in the body to prevent the break down of fats -S/S: Very dehydrated, thirsty, hyperglycemic, mental status changes, 3 ps: Polyuria, ploydipsia, polyphagia
What are the S/S of Hypoglycemia?
-Im sweaty, cold, and clammy, give me some candy -sweaty -clammy -confusion -Light headedness -double vision -tremors
Intermediate acting Insulin
-Nph -Humlin N, Novlin N -Onset: 1.5-4hrs -Peak 4-12 hrs -cloudy insulin
Hyperglycemia assessment?
-Polyuria -Polydipsia -Polyphagia *Remeber SUGAR -S: Slow wound healing -U: blUrry vision -G: Glycosuria -A: Acetone smell of breath -R: Rashes on ski Dry and itch, repeated vaginal infections
What are risk factors for type 2 diabetes?
-family Hx -obesity especially abd -BMI over 27 -race/ethnicity -GDM or baby over 9lbs -HTN 140/90 -Triglycerides over 200 -HDL below 35 -HX of impaired glucose tolerance
Rapid Acting insulin
-fastest -onset: 10-30 min -peak 30-3 hrs -Lipro, aspart, glulisine -Clear
Long acting Insulin
-glargine, detemir -onset: 0.8-4 hrs -no peak -can not be mixed with anything else
Short- acting Insulin
-regular -Humiln R, novlin R -Onset: 30 mins- 1 hr -Peak: 2-5 hrs -Clear -may be used IV
What is the normal range for glucose in the blood?
70-100 mg/dl
****A nurse observes mild hand tremors in a client who has diabetes mellitus. Which of the following actions should the nurse take after obtaining a glucose meter reading of 60 mg/dL? Administer 15 g of carbohydrates. Retest the blood glucose level. Administer 1 mg of glucagon IM. Administer IV dextrose.
Administer 15 g of carbohydrates. The first step in preventing the client's blood glucose level from dropping further is to administer 15 to 20 g of carbohydrates. A client who is awake and can swallow can consume carbohydrates, such as glucose tablets or glucose gel, 120 mL (4 oz) of orange juice, 240 mL (8 oz) of skim milk, 6 saltine crackers, 3 graham crackers, or 6 to 10 hard candies.
****A nurse is assessing a client who has diabetes insipidus. Which of the following findings should the nurse expect? Dehydration Polyphagia Hyperglycemia Bradycardia
Dehydration Diabetes insipidus causes excessive excretion of dilute urine, resulting in dehydration.
****A nurse is teaching a client who has type 1 diabetes mellitus about exercise. Which of the following instructions should the nurse include? Perform vigorous exercise when blood glucose is less than 100 mg/dL. Do not exercise if ketones are present in your urine. Avoid eating for 2 hr before exercise. Examine your feet weekly.
Do not exercise if ketones are present in your urine. The nurse should instruct the client not exercise if ketones are present in her urine because this is an indication of inadequate insulin and increases the risk for hyperglycemia.
**********************A nurse is reviewing the laboratory results of a client who is at risk for developing diabetes mellitus. The nurse should recognize that which of the following results indicates the client meets the criteria for diagnosis of diabetes mellitus? HbA1c 5.5% 2 hr blood glucose 170 mg/dL Fasting blood glucose 155 mg/dL Casual blood glucose 180 mg/dL
Fasting blood glucose 155 mg/dL A fasting blood glucose above 126 mg/dL meets the criteria for a diagnosis of diabetes mellitus.
*************A nurse is assessing a client who has type 1 diabetes mellitus and finds the client lying in bed, sweating, and reporting feeling anxious. Which of the following complications should the nurse suspect? Hypoglycemia Nephropathy Hyperglycemia Ketoacidosis
Hypoglycemia Manifestations of hypoglycemia include sweating, tachycardia, tremors, palpitations, hunger, and anxiety.
****A nurse is preparing to administer lispro insulin to a client who has type 1 diabetes mellitus. Which of the following actions should the nurse take? Assess for hypoglycemia 4 hr after the insulin injection. Monitor for polyuria. Administer with short-acting insulin.
Inject the insulin 15 min before a meal. The nurse should administer lispro insulin 15 min before a meal, because lispro insulin is rapid-acting insulin that has an onset within 15 to 30 min. The client may develop hypoglycemia quickly if they do not eat.
****A nurse is caring for a client who has type 1 diabetes mellitus. The nurse misread the client's morning blood glucose level as 210 mg/dL instead of 120 mg/dL and administered the insulin dose appropriate for a reading over 200 mg/dL before the client's breakfast. Which of the following actions is the nurse's priority? Give the client 15 to 20 g of carbohydrate. Monitor the client for hypoglycemia. Complete an incident report. Notify the nurse manager.
Monitor the client for hypoglycemia The first action the nurse should take using the nursing process is to assess or collect data from the client. The nurse should immediately check the client's blood glucose level, expecting it to be low because of the excessive dose of insulin. If it is within the expected reference range, the nurse should continue to monitor the client for signs of hypoglycemia.
****A nurse is providing teaching to a client who has a new diagnosis of type 2 diabetes mellitus. The nurse should recognize that the client understands the teaching when he identifies which of the following as manifestations of hypoglycemia? (Select all that apply.) Polyuria Blurred vision Polydipsia Tachycardia Moist, clammy skin
Polyuria is incorrect. Manifestations of hyperglycemia include polyuria (excessive urination). Blurred vision is correct. Manifestations of hypoglycemia include blurred vision. Polydipsia is incorrect. Manifestations of hyperglycemia include polydipsia (excessive thirst). Tachycardia is correct. Manifestations of hypoglycemia include tachycardia. Moist, clammy skin is correct. Manifestations of hypoglycemia include moist, clammy skin.
What are the different types of insulin?
Ready, set, inject, Love -Ready (rapid) -Set (short)(regular) -Inject (intermediate) -Love (long)
***A nurse is caring for an adolescent client who has a long history of diabetes mellitus and is being admitted to the emergency department confused, flushed, and with an acetone odor on the breath. Diabetic ketoacidosis is suspected. The nurse should anticipate using which of the following types of insulin to treat this client? NPH insulin Insulin glargine Insulin detemir Regular insulin
Regular insulin Regular insulin is classified as a short-acting insulin. It can be given intravenously with an onset of action of less than 30 min. This is the insulin that is most appropriate in emergency situations of severe hyperglycemia or diabetic ketoacidosis.
****A nurse administers desmopressin to a client who has a diagnosis of diabetes insipidus. The nurse recognizes that which the following laboratory findings indicate a therapeutic effect of the medication? Serum sodium 146 mEq/L Blood glucose 80 mg/dL Blood urea nitrogen (BUN) 15 mg/dL
Urine specific gravity 1.015 A therapeutic effect of the medication would be urine specific gravity within the expected reference range, which is 1.010-1.025.
A nurse is caring for a client who has uncontrolled type 1 diabetes mellitus. Which of the following findings should the nurse expect? Hypertension Hematuria Weight loss Bradycardia
Weight loss- is an expected finding for a client who has uncontrolled diabetes.
a nurse is caring for a pt with T1DM who has DKA. the nurse would expect which lab result
hyperglycemia, high serum osmorality
