Diabetes Mellitus
When caring for a patient with metabolic syndrome, the nurse should give the highest priority to teaching the patient about which treatment plan?
achieving a normal weight
A patient with diabetes is found unconscious at home and a family member calls the clinic. After determining that a glucometer is not available, what should the nurse advise the family member to do?
administer glucagon 1 mg intramuscularly (IM) or subcutaneously
A patient with diabetes calls the clinic because she is experiencing nausea and flu-like symptoms. What advice from the nurse will be the best for this patient?
administer the usual insulin dosage
The nurse should observe the patient for symptoms of ketoacidosis when
an insulin deficit causes the body to metabolize large amounts of fatty acids rather than glucose for energy
type 1 diabetes mellitus (juvenile-onset diabetes; insulin-dependent DM)
caused by the autoimmune destruction of pancreatic beta cells, resulting in the lack of insulin secretion; signs and symptoms: hyperglycemia, polyuria, polyphagia, polydipsia, glucosuia, weight loss, and fatigue; labs: HbA1C, FPG, OGTT
The nurse assesses the technique of the patient with diabetes for self-monitoring of blood glucose (SMBG) 3 months after initial instruction. Which error in the performance of SMBG noted by the nurse requires intervention? Doing the SMBG before and after exercising, puncturing the finger on the side of the finger pad, cleaning the puncture site with alcohol before the puncture, or holding the hand down for few minutes before the puncture
cleaning the puncture site with alcohol before the puncture
When teaching the patient with diabetes about insulin administration, the nurse should include what instructions for the patient?
consistently use the same size of insulin syringe to avoid dosing errors
The patient with diabetes is brought to the emergency department by his family members, who say that he has had an infection, is not acting like himself, and he is more tired than usual. Number the nursing actions in the order of priority for this patient. a. Establish IV access b. check blood glucose c. ensure patient airway d. begin continuous regular insulin drip e. administer 0.9% NaCl solution at 1 L/hr f. establish time of last food and medication(s)
c. b. a. e. d. f.
insulin
decrease blood glucose levels through absorption
insulin resistance
decreased cellular response to insulin
Individualized nutrition therapy for patients using conventional, fixed insulin regimens should include teaching the patient to
eat regular meals at regular times
hyperinsulinemia
elevated blood levels of insulin
The patient with diabetes has been diagnosed with autonomic neuropathy. What problems should the nurse expect to find in this patient?
erectile dysfunction, vomiting undigested food, painless myocardial infarction
polyuria
excessive urination
impaired fasting glucose
fasting plasma glucose levels of 100 to 125 mg/dL
Prediabetes
fasting plasma glucose of 100 to 126 mg/dL or an oral glucose tolerance test of 140 to 199 mg/dL; glucose levels are normal or slightly elevated to levels below the criteria for diabetes and insulin levels are increased
hyperglycemic effect
glucagon presence causes blood glucose to rise
The patient with diabetes has a blood glucose level of 248 mg/dL. What manifestations in the patient would the nurse understand as being related to this blood glucose level?
headache, abdominal cramps, increase in urination, weakness, and fatigue
diabetic ketoacidosis (DKA)
high levels of ketoacids lower the pH of the blood, causing this to occur
The nurse determines that a patient with a 2-hour OGTT of 152 mg/dL has
impaired glucose tolerence
glucagon
increase blood glucose levels by forcing release
Diabetic ketoacidosis (DKA) is a result of:
increased fat mobilization.
polyphagia
increased hunger
polydipsia
increased thirst
hypoglycemic effect
insulins presence causes glucose to leave the blood and serum glucose to fall
NPH (Humuin N, Novolin N, ReliOn N)
intermediate-acting; Onset: 2-4 hours; Peak: 4-10 hours; Duration: 10-16 hours
The home nurse should intervene to correct a patient whose insulin administration includes: warming a refilled refrigerated syringe in the hands before administration, storing syringes profiled with NPH and regular insulin needle-up in the refrigerated, placing the insulin bottle currently in use in a small container on the bathroom countertop, or mixing an evening dose of regular insulin with insulin glargine in one syringe for administration.
mixing an evening dose of regular insulin with insulin glargine in one syringe for administration
What should the goals of nutrition therapy for the patient with type 2 diabetes include?
normal serum glucose and lipid levels
fasting plasma glucose (FPG)
obtained following a fast of at least 8 hours
To prevent hyperglycemia or hypoglycemia related to exercise, what should the nurse teach the patient using glucose-lowering agents about the best time for exercise?
plan activity and food intake related to blood glucose levels
A newly diagnosed diabetic patient will exhibit symptoms of:
polydipsia, polyphagia, and weight loss.
amylin
slows glucose absorption in small intestine; suppresses glucagon secretion
Ketoacidosis
the accumulation of ketone bodies leading to acidosis related to incomplete breakdown of fatty acids from carbohydrate deficiency or inadequate carbohydrate utilization
glycosylated hemoglobin
the permanent attachment of glucose to hemoglobin molecules and reflects the average plasma glucose exposure over the life of a red blood cell (approximately 120 days)
gluconeogenesis
the production of new glucose from noncarbohydrate molecules (protein and lipid)
What are the manifestations of diabetic ketoacidosis (DKA)?
thirst, ketonuria, dehydration, metabolic acidosis, Kussmaul respirations, sweet, fruity breath odor
The client with type 1 diabetes asks if she can have a glass of wine with dinner on the weekends. What is the nurse's best response?
"An occasional glass of wine with dinner will not cause any problems. Be sure to limit yourself to one serving."
The nurse is teaching a patient with type 2 diabetes mellitus how to prevent diabetic nephropathy. What statement made by the patient indicates that teaching has been successful?
"I can help control my blood pressure by avoiding foods high in salt."
The nurse instructs a patient with diabetes mellitus about a healthy eating plan. What statement made by the patient indicates that teaching was successful?
"I may have a hypoglycemic reaction if I drink alcohol on an empty stomach."
The nurse has taught a patient admitted with diabetes principles of foot care. The nurse evaluates that the patient understands the principles of foot care if the patient makes what statement?
"I should look at the condition of my feet every day."
The nurse teaches a patient recently diagnosed with type 1 diabetes mellitus about insulin administration. What statement by the patient requires an intervention by the nurse?
"I will discard any insulin bottle that is cloudy in appearance."
The nurse is teaching a patient with type 2 diabetes mellitus about exercise to help control blood glucose. The nurse knows the patient understands when the patient elicits what exercise plan?
"I will take a brisk 30-minute walk 5 days per week and do resistance training three times a week."
Following the teaching of foot care to a patient with diabetes, the nurse determines that additional instruction is needed when the patient makes what statement?
"I'll know if have sores or lesions on my feet because they will be painful."
Two days following a self-managed hypoglycemia episode at home, the patient tells the nurse that his blood glucose levels since the episode have been between 80 and 90 mg/dL. What is the best response by the nurse?
"That is a good range for your glucose levels."
A patient admitted with type 2 diabetes asks the nurse what "type 2" means. What is the most appropriate response by the nurse?
"With type 2 diabetes, insulin secretion is decreased, and insulin resistance is increased."
What would a patient state if they understand the recommendations regarding carbohydrate intake?
"it is important to consume the correct amount of carbohydrates at each meal and snack."
A patient is admitted with diabetes mellitus, malnutrition cellulitis, and a potassium level of 5.6 mEq/L. The nurse understands that what could be contributing factors for this laboratory result
-The level may be increased as a result of dehydration that accompanies hyperglycemia. -The level may be raised as a result of metabolic ketoacidosis caused by hyperglycemia. -The level is consistent with renal insufficiency that can develop with renal nephropathy.
Risk factors for insulin resistance include:
-obesity. -inactivity. -age. -medications.
Complications experienced by patients with chronic uncontrolled type 2 diabetes are:
-peripheral vascular disease. -orthostatic hypotension. -thickened capillary membranes. -visual difficulties.
It is true that neurogenic diabetes insipidus (DI):
-results from low levels of antidiuretic hormone (ADH). -occurs with organic lesion of the hypothalamus or pituitary. -is caused by low levels of antidiuretic hormone (ADH).
Beta cell dysfunction
1) Decreased beta cell function & size (progressive and still does some insulin) 2) Amylin loss: does not inhibit glucagon, more release glucose *Beta cells are working so hard they blow themselves out
impaired glucose tolerance
2-hour values in the oral glucose tolerance test of 140 to 199 mg/dL
What is the lab result for the random plasma glucose for diabetes?
200 mg/dL or higher
What is the lab result for the two-hour plasma glucose during an OGTT for diabetes?
200 mg/dL or higher using a glucose load of 75 g
What is the lab results for the fasting blood sugar for prediabetes?
100 to 125 mg/dL
The patient received regular insulin 10 units subcutaneously at 8:30 PM for a blood glucose level of 253 mg/dL. The nurse plans to monitor this patient for signs of hypoglycemia at which time related to the insulin's peak action?
10:30 PM to 1:30 AM
what is the lab result for the fasting plasma glucose for diabetes?
126 mg/dL or higher
What is the lab results for the 2-hour oral glucose tolerance test (OGTT) for prediabetes?
140 to 199 mg/dL
What is the lab results for A1C for a patient with prediabetes?
5.7 to 6.4%
What is the lab result for the A1C for type 2 diabetes?
6.5% or higher
The nurse is reviewing laboratory results for the clinic patients to be seen today. What patient meets the diagnostic criteria for diabetes mellitus?
A 48-yr-old woman with a hemoglobin A1C of 8.4%
Which patient with type 1 diabetes mellitus would be at the highest risk for developing hypoglycemic unawareness?
A 73-yr-old patient who takes propranolol (Inderal)
A patient with type 1 diabetes uses 20 U of Novolin 70/30 (NPH/regular) in the morning and at 6:00 p.m. When teaching the patient about this regimen, what should the nurse emphasize?
A set meal pattern with a bedtime snack is necessary to prevent hypoglycemia.
During routine health screening, a patient is found to have fasting plasma glucose (FPG) or 132 mg/dL, A1C of 7.5%, glycosuria of 3+, Random blood glucose of 126 mg/dL, and a 2-hour oral glucose tolerance test (OGTT) of 190 mg/dL. At a follow-up visit, a diagnosis of diabetes would be made based on which laboratory results?
A1C of 7.5% and FPG greater than or equal to 127 mg/dL
What is the priority for preventing diabetes in people who are at high risk?
Achieve moderate weight loss through increased activity and lowered calorie and fat intake
A patient with newly diagnosed type 2 diabetes has been given a prescription to start an oral hypoglycemic medications. The patient tells the nurse she would rather control her blood sugar with herbal therapy. What action should the nurse take?
Advise the patient to discuss using herbal therapy with her HCP before using it
The patient with type 1 diabetes mellitus eats a large meal but does not take his insulin as prescribed. In what order do the following physiologic events occur in the development of a hyperglycemic emergency? (Answer with a letter followed by a comma and a space (e.g. A, B, C, D).) __ a. Fat metabolism leads to ketonemia.b. Insufficient insulin in the blood streamc. Fat is mobilized for energy from the adipose tissue.d. Potassium and water are excreted with H+ and ketones in the urine.e. Organic acid accumulation in the blood causes metabolic acidosis.
B, C, A, E, D
A patient with type 2 diabetes has a urinary tract infection (UTI), is difficult to arouse, and has a blood glucose of 642 mg/dL. When the nurse assesses the urine, there are no ketones present. What nursing action is appropriate at this time?
Cardiac monitoring to detect potassium changes This patient has manifestations of hyperosmolar hyperglycemic syndrome (HHS).
Discuss complications of diabetes, check that the bath water is too not hot, check the patient's technique for drawing up insulin, and teach the patient to use a meter for self-monitoring of blood glucose are planned for a patient with diabetes. Which intervention can the nurse delegate to unlicensed assistive personal (UAP)?
Check that the bath water is not too hot
The nurse is assisting a patient with newly diagnosed type 2 diabetes to learn dietary planning as part of the initial management of diabetes. The nurse would encourage the patient to limit intake of what foods to help reduce the percent of fat in the diet?
Cheese
The nurse has been teaching a patient with diabetes mellitus how to perform self-monitoring of blood glucose (SMBG). During evaluation of the patient's technique, the nurse identifies a need for additional teaching when the patient does what?
Chooses a puncture site in the center of the finger pad
islets of Langerhans
Clusters of cells in the pancreas are responsible for its endocrine function: the secretion of glucagon and insulin.
What disorders and diseases are related to microvascular complications of diabetes?
Coronary artery disease and ulceration and amputation of the lower extremities
type 2 diabetes (non-insulin-dependent diabetes mellitus)
Diabetes of a form that develops especially in adults and most often obese individuals and that is characterized by high blood glucose resulting from impaired insulin utilization coupled with the body's inability to compensate with increased insulin production. Risk factors: age, obesity, hypertension physical activity, and family history
A patient is newly diagnosed with type 1 diabetes and reports a headache, changes in vision, and being anxious but does not have a portable blood glucose monitor present. What action should the nurse advise her to take?
Eat 15 g of simple carbohydrates.
The nurse is evaluating a patient diagnosed with type 2 diabetes mellitus. What symptom reported by the patient correlates with the diagnosis?
Excessive thirst
A nurse working in an outpatient clinic plans a screening program for diabetes. That recommendations for screening should be included?
FPG for all individuals at age 45 and then every 3 years
The nurse is reviewing laboratory results for a patient with a 15-year history of type 2 diabetes. What result reflects the expected pattern accompanying macrovascular disease as a complication of diabetes?
Increased triglyceride levels
In addition to promoting the transport of glucose from the blood into the cell, what does insulin do?
Increases amino acid transport into cells and protein synthesis
A 72-year-old women is diagnosed with diabetes. What does the nurse recognize about the management of diabetes in the older adult?
It is more difficult to achieve strict glucose control than in younger patients.
What statement best describes atherosclerotic disease affecting the cerebrovascular, cardiovascular, and peripheral vascular systems in patients with diabetes?
It occurs with a higher frequency and earlier onset than in the nondiabetic population
A patient, admitted with diabetes mellitus, has a glucose level of 380 mg/dL and a moderate level of ketones in the urine. As the nurse assesses for signs of ketoacidosis, which respiratory pattern would the nurse expect to find?
Kussmaul respirations
When developing a teaching plan for a client who is taking insulin, what foods would the nurse suggest the client carry with him to treat mild hypoglycemia?
Life Savers
Detemir (Levemir)
Long-acting; Onset: 1-2 hours; peak: no pronounced peak; duration: 24+ hours
Glargine (Lantus)
Long-acting; Onset: 1-2 hours; peak: no pronounced peak; duration: 24+ hours
The nurse is teaching a patient with prediabetes ways to prevent or delay the development of type two diabetes. What information should be included it?
Maintain a healthy weight and monitor for polyuria, polyphagia, and polydipsia
The nurse is teaching a patient who has diabetes about vascular complications of diabetes. What information is appropriate for the nurse to include?
Microangiopathy is specific to diabetes and most commonly affects the capillary membranes of the eyes, kidneys, and skin.
A patient with diabetes mellitus is scheduled for a fasting blood glucose level at 8:00 AM. The nurse instructs the patient to only drink water after what time?
Midnight before the test
A patient taking insulin has recorded fasting glucose levels above 200 mg/dL (11.1 mol/L) on awakening for the last five mornings. What should the nurse advise the patient to do first?
Monitor the glucose level at bedtime, between 2:00 a.m. and 4:00 a.m. and on arising.
A patient with diabetes mellitus who has multiple infections every year needs a mitral valve replacement. What is the most important preoperative teaching the nurse should provide to prevent a cardiac infection postoperatively?
Obtain comprehensive dental care.
In type one diabetes there is an osmotic effect of glucose when insulin deficiency prevents the use of glucose for energy. What is the classic symptom that is caused by the osmotic effect of glucose?
Polydipsia
Regular (Humulin R, Novolin R, ReliOn R)
Short-acting; Onset: 1/2-1 hour; peak: 4-10 hours; duration: 10-16 hours
A patient experiences retinopathy due to diabetes. There is venous dilation, microaneurysm formation, and blot hemorrhages. Which stage of retinopathy is this patient experiencing?
Stage I Stage I is characterized by increase in retinal permeability, vein dilation, microaneurysm formation, and superficial and deep blot hemorrhages.
Why are the hormones cortisol, glucagon, epinephrine, and growth hormone referred to as counter regulatory hormones?
Stimulate glucose output by the liver
The best approach for monitoring carbohydrates intake is to use
The approach that best helps the individual control blood glucose levels
When teaching the patient with type 1 diabetes, what should the nurse emphasize as the major advantage of using an insulin pump?
Tight glycemic control can be maintained
Which food groups provide carbohydrates?
Vegetables, fruit, and milk
A patient with diabetes is learning to mix regular insulin and NPH insulin in the same syringe. The nurse determines that additional teaching is needed earn the patient does what?
Withdraws the NPH dose into the syringe first
diabetes mellitus
a chronic heterogeneous disorder characterized by elevated blood glucose levels (hyperglycemia) related to a relative or absolute deficiency of insulin
Oral Glucose Tolerance Test (OGTT)
a loading dose of 75 g of glucose ingested and the plasma glucose level is obtained 2 hours later
How many carbohydrate choices are provided in a serving of food that supplies 19 grams of carbohydrate?
1
Which tissues require insulin to enable movement of glucose into the tissue cells?
Adipose and skeletal muscle
The nurse knows her instructions about label reading have been effective when the client verbalizes that to determine the amount of carbohydrate choices you must
Adjust total carbohydrates for foods that provide more than 5 g of fiber or more than 5 g of sugar alcohols per serving.
Hemoglobin A1C (HbA1C)
As serum glucose increases, more glucose becomes bound to hemoglobin. Provides and average measure of glucose control over the 8 to 12 weeks prior to test.
The nurse is assigned to the care of a patient diagnosed with type 2 diabetes. In formulating a teaching plan that encourages the patient to actively participate in management of the diabetes, what should be the nurse's initial intervention?
Assess patient's perception of what it means to have diabetes.
Lispro insulin (Humalog) with NPH (Humulin N) insulin is ordered for a patient with newly diagnosed type 1 diabetes. The nurse knows that when lispro insulin is used, when should it be administered?
At mealtime or within 15 minutes of meals
The nurse caring for a patient hospitalized with diabetes mellitus would look for which laboratory test result to obtain information on the patient's past glucose control?
Glycosylated hemoglobin level
A patient develops severe dehydration and hyperglycemia in the absence of ketosis. Which of the following conditions does this patient have?
Hyperosmolar hyperglycemic nonketotic syndrome (HHNKS)
The nurse is assessing a newly admitted patient with diabetes. What observation should be addressed as the priority by the nurse: Bilateral numbness of both hands, Stage II pressure ulcer on the right heel, rapid respirations with deep inspiration, or areas of lumps and dents on the abdomen
Rapid respirations with deep inspirations
Aspart (novolog)
Rapid-acting; onset: 15 minute; peak: 60-90 minute; duration: 3-4 hours
Glulisine (Apidra)
Rapid-acting; onset: 15 minute; peak: 60-90 minute; duration: 3-4 hours
Lispro (Humalog)
Rapid-acting; onset: 15 minute; peak: 60-90 minute; duration: 3-4 hours
The newly diagnosed patient with type 2 diabetes has been prescribed metformin. What should the nurse teach the patient to best explain how this medication works?
Reduces glucose production by the liver and enhances insulin sensitivity
What characterizes type 2 diabetes?
beta-cell exhaustion, insulin resistance, genetic predisposition, altered production of adipokines, inherited defect in insulin receptors, and inappropriate glucose production by the liver
