Endo Exam 2
The nurse is monitoring a client who has been newly diagnosed with diabetes mellitus for signs of complications. Which statement made by the client would indicate hyperglycemia and thus warrant primary health care provider notification?
"I am urinating a lot"
The nurse provides dietary instructions to a client with diabetes mellitus regarding the prescribed diabetic diet. Which statement made by the client indicates the need for further teaching?
"I need to buy special dietetic foods"
A client with type 1 diabetes mellitus calls the nurse to report recurrent episodes of hypoglycemia. Which statement by the client indicates a correct understanding of Humulin N insulin and exercise?
"I should not exercise in the late afternoon."
When the nurse is reinforcing instructions to a client who has been newly diagnosed with type 1 diabetes mellitus, which statement by the client would indicate that teaching has been effective
"I will notify my primary health care provider if my blood glucose level is consistently greater than 250"
The nurse is discussing insulin administration with an assigned patient. The patient reports that she prefers to use only certain sites for insulin injections and questions the need to rotate sites. What response by the nurse is most appropriate?
"Rotating injection sites helps enhance insulin absorption."
The nurse is providing care for a client who is newly diagnosed with diabetes mellitus. What explanation about exercise is best for the nurse to provide?
'Exercise helps lower your blood sugar by decreasing insulin resistance.'
Signs and Symptoms of Diabetes (all types)
- 3 P's: polydipsia (excessive thirst), polyuria (excessive urination), polyphagia (excessive hunger) -Hyperglycemia -Weight loss -Blurred vision -Slow wound healing -Vaginal infections -Weakness and paresthesia -Signs of inadequate circulation to the feet -Signs of accelerated atherosclerosis: renal, cerebral, cardiac, peripheral -Glycosuria (renal tubules cannot reabsorb extra glucose filtered by glomeruli) -Nocturia (nighttime urination)
Simple Carbohydrates to treat hypoglycemia 15-20 gram fast-acting
-4 oz. orange juice (do not add sugar packets) -6 ounce regular soda (not diet) -Miniature box of raisins -Commercial glucose tablets -6-8 life savors -8 oz low fat milk -6 saltine crackers -3 graham crackers -1 tbsp of honey/syrup -1/2 cup of fruit juice
Insulin - Beta cells
-Allows glucose to be used for energy -Lowers glucose levels in blood -Helps body store excess glucose in liver and muscles in form of glycogen
Non-Urgent Signs and Symptoms of Hyperglycemia
-Blurred vision -Headache -Fatigue -Increase thirst -Urinary frequency
Complications of Insulin Therapy: Dawn Phenomenon
-Characterized by hyperglycemia upon morning awakening that results from excessive early morning release of GH and cortisol -Treatment requires increase in patient's insulin dose or change in the time of insulin administration
Hypoglycemia Moderate Symptoms
-Confusion -Double vision -Drowsiness -Emotional change -Headache -Impaired coordination -Inability to concentrate -Irrational/irritable behavior -Light-headedness -Numbness of the lips and tongue -Slurred speech
DM leads to chronic health problems and early death: Macrovascular Complications
-Coronary artery disease {poor circulation} -Cardiomyopathy -HTN -Cerebrovascular disease -Peripheral vascular disease -Inflammation and hyperosmolarity in vessels
Diet in Diabetes
-Day to day consistency in timing and amount of food intake helps control the blood glucose level -DASH diet -Carb counting
Complications of Insulin Therapy: Insulin Lipodystrophy
-Development of fibrous fatty masses at the injection site caused by repeated use of an injection site, use of human insulin helps prevent this -Reinforce instructions to client to avoid injecting insulin into affected sites -Reinforce instructions to the client about the importance of rotating insulin injection sites -Systematic rotation within one anatomical area is recommended to prevent lipodystrophy -Patient instructed not to use same site more than once in a 2 to 3 week period -Injections need to be 1.5 inches (3.8 cm) apart within the anatomical area
Hypoglycemia Severe Symptoms
-Difficulty arousing -Disoriented behavior -Loss of consciousness -Seizure
Emergent Signs and Symptoms of Hyperglycemia
-Fruity breath -Weakness -Decrease in level of consciousness (LOC) -Confusion -Shortness of breath -Nausea -Vomiting
Hypoglycemia Mild Symptoms
-Hunger -Nervousness -Palpitations -Sweating -Tachycardia -Tremor
Illness, infection, and stress
-Increase blood glucose level and need for insulin -Insulin would not be withheld during illness, infection, or stress because hyperglycemia and diabetic ketoacidosis can result
Complications of Insulin Therapy
-Local allergic reactions -Insulin lipodystrophy -Dawn phenomenon -Somogyi phenomenon
Diabetes Mellitus (DM)
-Metabolic disorder in pancreas -Impaired carbohydrate, protein, lipid metabolism -Deficiency of insulin -Glucose can enter the cells only with help of insulin
Complications of Insulin Therapy: Somogyi Phenomenon
-Normal or elevated blood glycose levels are present at bedtime -Hypoglycemia occurs about 2:00 am to 3:00 am, which causes increase in the production of counterregulatory hormones -By 7:00 am in response to the counterregulatory hormones, the blood glucose rebounds significantly to the hyperglycemic range -Treatment includes: decreasing the evening (predinner/bedtime) dose of intermediate acting insulin, increase bedtime snack or both -Clients experiencing may complain of early morning headaches, night sweats, nightmares caused by morning hypoglycemia
Hypoglycemia
-Occurs when blood glucose levels fall below 70 mg/dL or drops rapidly from an elevated level -Caused by too much insulin or oral hypoglycemic agents, too little food, excessive activity
3 P's of Diabetes (all types)
-Polydipsia - excessive thirst -Polyuria - excessive urination -Polyphagia - excessive hunger
A diabetic client comes into the emergency department with a diagnosis of diabetic ketoacidosis. The nurse would anticipate what symptoms with this client?
-Rapid and deep respirations -Tachycardia -Confusion
Complications of Insulin Therapy: Local Allergic Reactions
-Redness, swelling, tenderness, and induration or a wheal at the site of injection may occur 1 to 2 hours after administration -Reactions usually occur during the early stages of insulin therapy -Reinforce instructions to the client to cleans the skin with alcohol before injection
DM leads to chronic health problems and early death: Microvascular Complications
-Retinopathy {Eyes, blurry} -Nephropathy {Kidneys} -Neuropathy {nerve damage "tingling, numbness"}
Glucagon - Alpha cells
-Rises blood glucose (BG) when needed by releasing stored glucose from liver and muscles
Metformin 750 mg tablets is prescribed. The client has 500 mg tablets at home. How many tablets should the nurse instruct the client to take? (Assume tablets are scored and may be split in half if necessary.)
1 1/2 tabs.
Metabolic Syndrome - Syndrome X in order to be diagnosed needs 3 out of 5 criteria
1) Abdominal obesity: measured by waist circumference -men > 40 in. | women > 35 in. 2) Fasting blood triglycerides 150 mg/dL or higher 3) Blood high-density lipoprotein (HDL) cholesterol -men: <40 mg/dL | women < 50 mg/dL 4) Blood pressure 130/85 mm Hg or higher 5) Fasting glucose 100 mg/dL or higher
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
A client has the following prescriptions: Insulin glargine 54 units subcutaneously daily at bedtime. Insulin glulisine 14 units subcutaneously before meals and at bedtime. Insulin glulisine coverage subcutaneously before meals and at bedtime based on sliding scale. Sliding scale: 0-149: no coverage; Notify provider of blood sugar less than 70 and treat for hypoglycemia 150-199: 2 units 200-2449: 3 units 250-299: 4 units 300-349:5 units 350-399: 6 units 400 or higher: 7 units and notify provider The patient's blood sugar at 1700 hours was 287. How much insulin glulisine will be administered IN ALL? _______units
18
A home care client takes 4 units of insulin lispro before meals and 7 units at bedtime. How long will a 10ml vial of U-100 insulin lispro (100 units per ml) last? Round DOWN to the nearest number of days. ___________days
52
A patient in diabetic ketoacidosis has an insulin drip infusing at 8 mL/h. How many units per hour is the patient receiving? _______units per hour
8
Metabolic Syndrome - Syndrome X
A genetic metabolic disorder characterized by diabetes, hypertension, atherosclerosis, centrally distributed obesity, and elevated blood lipids, Type 2 diabetes
A nurse is urgently called to a homebound neighbor's house. The neighbor is found unconscious and has a history of insulin-dependent diabetes. After determining there is no functioning glucometer available, what should the nurse's next action?
Administer 10 units of regular insulin subcutaneously
The nurse is assisting with preparing a teaching plan for the client with diabetes mellitus regarding proper foot care. Which instruction would be included in the plan of care?
Apply moisturizing lotion to dry feet but not between the toes
A client presents with diaphoresis, palpitations and tachycardia approximately 4 hours after taking the prescribed dose of insulin. What are the nurses PRIORITY actions?
Check the blood glucose and administer carbohydrates.
Which action is most important to prevent the development of complications of diabetes?
Control blood glucose levels.
The nurse is caring for a patient with type 1 diabetes who is diaphoretic and clammy. The patient complains of hunger but denies pain. The nurse performs a bedside blood glucose check. What should the nurse do next?
Give 6 ounces of orange juice
A responsive client in the emergency department has a blood glucose of 40 mg/mL. The nurse would anticipate which medication to be ordered?
Glucagon
Which food source should the nurse recommend to treat an episode of hypoglycemia?
Hard candies
Which diagnostic test is used to evaluate glucose control over the last 2-3 months?
Hemoglobin A1C
Analyze the following diagnostic findings for your patient with type 2 diabetes. Which result will need further assessment?
Hemoglobin A1C 9%
A client recently diagnosed with Type 2 diabetes returns to the clinic for a follow-up visit. Which of the following laboratory tests will give the nurse the best information about the client's adherence to their diet, exercise, and medication regimen?
Hemoglobin A1c
A client is in DKA, secondary to infection. As the condition progresses, which of the following symptoms might the nurse see?
Kussmaul's respirations and a fruity odor on the breath
The nurse is reviewing the patient's prescribed insulin regimen. The nurse notes that the physician has ordered a long-lasting insulin. Which medication best meets this criteria?
Lantus
A client is 45 years old, 40 pounds overweight, has a total serum cholesterol level of 139 mg/dL, and drinks a glass of wine with dinner every night. The client's parents both have diabetes. What advice can the nurse give to help the client delay or prevent the onset of type 2 diabetes?
Lose weight.
The nurse is reinforcing instructions to a client with diabetes mellitus who is recovering from diabetic ketoacidosis regarding measures to prevent a recurrence. Which instruction is important for the nurse to to emphasize?
Monitor blood glucose levels frequently
Type 2 Diabetes Mellitus "A" -Can be reversed -Slow onset -Overweight/obese -Adult onset Diabetes/non-insulin-dependent diabetes mellitus (NIDDM)
Patho: Abnormal resistance and secretion of insulin = not enough insulin Causes: Activity decrease | increase BMI Onset: Adults Ketones: Absent Treatment: Activity Increase | Avoid carbs | Antidiabetics (Metformin) and insulin Complication: HHS Hyperosmolar Hyperglycemic Syndrome {Type 2, BG > 600, Ketones Absent, Glycosuira}
Type 1 Diabetes Mellitus "K" -Juvenile Diabetes/Insulin-dependent diabetes mellitus (IDDM) -Cannot be reversed -Rapid -Skinny/Lean
Patho: Kills pancreatic Beta Cells = no insulin Causes: Kin - genetics Onset: Kids Ketones: Ketones Present Treatment: Keep Insulin Nearby Complication: Diabetic Ketoacidosis DKA -Fats are metabolized for energy which results in ketonemia (acidosis) {Type 1, BG >2 50, Ketones Present} -Insulin Dependent (no insulin) | glucose in bloodstream and cells don't get anything | autoimmune response (viral infections, heredity) -Diet and exercise
The nurse notes that a client with type 1 diabetes mellitus has lipodystrophy on both upper thighs. Which further information would the nurse obtain from the client during data collection?
Plan for injection rotation
The nurse is evaluating a client with diabetic ketoacidosis. The nurse would note which respiratory pattern as indicative of complications associated with this condition?
Rapid and deep respirations
A client is placed on insulin sliding scale. The nurse would anticipate which medication needing to be administered?
Regular insulin
A client who has been newly diagnosed with diabetes mellitus has been stabilized with daily insulin injections. Which teaching information would the nurse reinforce upon discharge?
Rotate the insulin injection sites systematically
While gathering information on a diabetic client, the nurse smells a sweet, fruity odor. What would be important for the nurse to check?
Serum blood glucose level
The nurse reinforces teaching to a client with diabetes mellitus regarding differentiating between hypoglycemia and ketoacidosis. The client demonstrates an understanding of the teaching by stating that glucose will be taken if which symptom develops?
Shakiness
A client with type 1 diabetes mellitus has been vomiting and unable to keep anything but fluids down for the past 3 days. The client's blood glucose is 465 mg/dl. What is the most likely cause for the elevated reading?
Stress hormones released in response to illness.
Which factor can cause HYPERglycemia in diabetes mellitus?
Stress or illness
The nurse is explaining the underlying pathophysiology of type 1 diabetes to a newly diagnosed patient. Which information accurately explains why the type 1 diabetic does not produce adequate insulin?
The body's immune system destroyed beta cells.
The nurse is assisting with diabetes screening at a local health fair. Which client should be referred to the health care provider (HCP) for further evaluation?
The client who reports increased thirst, eating a lot and urinating frequently
Which activities can cause hypoglycemia? Select all that apply.
Too much insulin Exercise
Which of the following causes of HHNS is most common?
Undiagnosed and untreated diabetes mellitus
A client with diabetes mellitus has peripheral neuropathy. What recommendation should the nurse give the client to prevent related complications?
Wash, dry, and inspect feet daily.
Instruct the client with diabetes to monitor their glucose levels
before, during, and after exercising
Glucose is produced by
beta cells in islets of Langerhans of pancreas
Without insulin
blood glucose goes up (hyperglycemia)
Regular insulin (U-100 strength) and the short-duration insulins (lispro, aspart, and glulisine)
can be administered via IV infusion
Regular insulin - U-100 Strength
can be administered via IV injection (IV push)
A client has an order for a glycosylated hemoglobin (AC1) test to be done. The nurse understands that the purpose of this test is to
determine the glucose levels over the past 120 days
Oral hypoglycemic medications are prescribed for clients with type 2 diabetes mellitus when
diet and weight control therapy have failed to maintain satisfactory glucose levels
A client with type 1 diabetes whose glucose is greater than 250 mg/dL and urinary ketones are present is instructed not to
exercise until blood glucose is closer to normal and urinary ketones are absent
Insulin
glucose goes into cells
Exercise in diabetic clients
lowers blood glucose level, encourage weight loss, reduces cardiovascular risks, improves circulation and muscle tone, decreased total cholesterol and triglyceride levels, and decreases insulin resistance and glucose intolerance
Carbohydrates provide
most energy used by body
A diabetic patient has a serum glucose level of 824 mg/dL and is unresponsive. Following assessment of the patient, the nurse suspects diabetic ketoacidosis rather than hyperosmolar hyperglycemic syndrome based on the finding of?
rapid, deep respirations
Infection is a concern because of
reduced healing ability
Injection of glucagon is administered
subcutaneously or intramuscularly
