Med Surg Diabetes Final Exam guide
Type I Diabetes
-Age at Onset: More common in young people but can occur at any age.
- Type of Onset: Signs and
... [Show More] symptoms usually abrupt, but disease process may be present for several years.
- Prevalence: Accounts for 5-10% of all cases
-Primary Defect: Absent or minimal insulin production.
-Islet cell antibodies: Often present at onset
-Endogenous insulin: Absent
-Nutritional status: thin, normal, or obese
-Symptoms: Polydipsia, polyuria, polyphagia, fatigue, weight loss without trying.
-Insulin: required for all
Type II Diabetes
-Age at Onset: More common in adults but can occur at any age.
-Type of onset: Insidious, may go undiagnosed for years.
-Primary Defect: Insulin resistance, decreased insulin production over time, and alteration in production of adipokines.
-Islet cell antibodies: Absent
Prevalence: Accounts for 90-95% of cases.
-Endogenous insulin: initially increased in response to insulin resistance. secretion diminishes over time.
-Nutritional status: Frequently overweight or obese. May be normal.
-Symptoms: Frequently none. Fatigue, recurrent infections. May also experience polyuria, polyphagia, and polydipsia.
-Insulin: Required for some. Disease is progressive and insulin treatment may need to be added to treatment regimen.
A1C
6.5% or higher
Fasting plasma glucose (FPG)
Greater than or equal to 126mg/dL
Two-hour plasma glucose
Greater than or equal to 200 mg/dL, when using a glucose load of 75g.
In a patient with classic symptoms of hyperglycemia or hyperglycemic crisis, a random plasma glucose
Greater than or equal to 200 mg/dL
A1C measures what?
Measures the amount of glycosylated hemoglobin as a percent of total hemoglobin.
Risk Factors for Type 1 Diabetes
-Predisposition to this is related to human leukocyte antigens (HLAs)
Risk Factors for Type II Diabetes:
Overweight or obese, being older, and having a family history of type 2 diabetes.
-This is more prevalent in some ethnic populations. African Americans, Asian Americans, Hispanics, Native Hawaiians or other Pacific Islanders, and Native Americans have a higher rate of this than whites.
Prediabetes
-A diagnosis of IGT with the 2-hour oral glucose tolerance test values of 140-199 mg/dL.
-A diagnosis of IFG when blood glucose levels are 100-125 mg/dL
Rapid Acting Insuling
Lispro (Humalog)
Aspart (NovoLog)
Glulisine (Apidra)
-Onset: 10-30 minutes
-Peak: 30 min-3hr
-Duration: 3-5hr
-Often preferred by those taking insulin with their meals.
Short Acting Insulin
Regular (Humulin R, Novolin R)
-Onset: 30min-1hr
-Peak: 2.5hr
-Duration: 5-8hr
-More likely to cause hypoglycemia because of a longer duration of action.
-Should be injected 30-45 minutes before a meal to ensure that the onset of action coincides with meal absorption.
Intermediate Acting Insulin
NPH (Humulin N, Novolin N)
-Onset: 1.5-4hr
-Peak: 4-12hr
-Duration: 12-18hr
-Disadvantage is that it has a peak ranging from 4-12hrs, which can result in hypoglycemia.
-Can be mixed with short and rapid-acting insulins.
-should never be given IV
Long Acting Insulin
Glargine (Lantus)
Detemir (Levemir)
Degludec (Tresiba)
-Onset: 0.8-4hr
-Peak: Less defined or no pronounced peak.
-Duration: 16-24hrs
-Because they lack peak action time, the risk for hypoglycemia from this type of insulin is greatly reduced.
Inhaled Insulin
Afrezza
-Onset: 12-15min
-Peak: 60min
-Duration: 2.5-3hr
What are some problems with insulin Therapy?
-Allergic Reactions
-Lipdystrophy
-Somogyi Effect
-Dawn Phenomenon
Lipdystrophy
-Atrophy or hypertrophy of SubQ tissue.
-May occur if the same injection sites are used frequently.
Somogyi Effect
-A high dose of insulin produces a decline in blood glucose levels during the night. As a result, counterregulatory hormones (Glucagon, Epi, GH, and cortisol) are released, stimulating lipolysis, gluconeogenesis, and glycogenolysis, which in turn produces rebound hyperglycemia.
-Danger is that patient may increase insulin dose due to hyperglycemic symptoms which can be too much insulin.
-A bedtime snack, a reduction in the dose of insulin, or both can prevent this.
-Checking BG between 2-4 AM for hyperglycemia can help determine this diagnosis.
Dawn Phenomenon
-Characterized by hyperglycemia that is present on awakening.
-Two counterregulatory hormones (GH and Cortisol), which are excreted in increased amounts in the early morning may be cause of this.
-Increased BG is caused by the body producing more glucose due to levels being low and since insulin dose may not be large enough the body can produce glucose to try and compensate for the lack of glucose which can result in Hyperglycemia.
-Treatment is increase insulin.
-
Biguanides
(Metformin)
-MOA: Decreases rate of hepatic glucose production. Augments glucose uptake by tissues, especially muscles.
-Side Effects: Diarrhea, lactic acidosis. Must be held 1-2 days before IV contrast media given and for 48 hrs after.
-DRUG ALERT:
-Do not use in patients with kidney disease, liver disease, or heart failure. Lactic acidosis is a rare complication.
-IV contrast media that contain iodine pose a risk of acute kidney injury which could exacerbate lactic acidosis.
-Do no use in people who drink excessive amounts of alcohol
-Take with food to minimize Gi side effects.
Sulfonylureas:
Glipizide
Glyburide
Glimepiride
-MOA: Stimulates release of insulin from pancreatic islets. Decrease glycogenolysis and gluconeogenesis. Enhance Cellular sensitivity to insulin.
Side Effects: Weight gain and hypoglycemia.
Meglitinides:
Nateglinide
Repaglinide
-MOA: Stimulates a rapid and short-lived release of insulin from the pancreas.
-Side Effects: Weight gain and hypoglycemia
a-Glucosidase inhibitors:
acarbose
miglitol
-MOA: Delay absorption of complex carbohydrates from Gi tract.
-Side Effects: Gas, abdominal pain, diarrhea
Thiazolidinediones:
pioglitazone
rosiglitazone
-MOA: Increase glucose uptake in muscle. Decrease endogenous glucose production.
-Side Effects: Weight Gain, edema
-Pioglitazone: may increase risk for bladder cancer and exacerbate heart failure
-Rosiglitazone: May increase risk for cardiovascular events (MI, Stroke)
Dipeptidy Peptidase-4 Inhibitors
-linagliptin
saxagliptin
sitagliptin
alogliptin
-MOA: Enhance activity of incretins. Stimulate release of insulin form pancreatic B-cells. Decrease hepatic glucose production.
-Side Effects: Pancreatitis, allergic reactions
Dopamine Receptor Agonists
-Bromocriptine
-MOA: Activates dopamine receptors in CNS. Unknown how it improves glycemic levels.
-SIde Effects: Orthostatic Hypotension
Sodium-Glucose Co-transporter 2 inhibitors
-MOA: Decreases renal glucose reabsorption and increases urinary glucose excretion.
-Side Effects: Increased risk of genital and UTIs. Hypoglycemia.
Glucagon-like peptide-1 Receptor Agonists
-MOA: Stimulate release of insulin, decrease glucagon secretion, and slow gastric emptying. Increase satiety.
-Side Effects: Nausea, vomiting, hypoglycemia, diarrhea, headache
Amylin Analogs
-MOA: slow gastric emptying, decrease glucagon secretion and endogenous glucose output from liver.
-Side Effect: Hypoglycemia, nausea, vomiting, decreased appetite, headache.
Nutritional Therapy for Type I
-Base their meal planning on usual food intake and preferences balanced with insulin and exercise patterns. The patient coordinates insulin dosing with eating habits and activity pattern in mind. Day to day consistency in timing and amount of food eaten makes it much easier to manage BG levels. Especially for those individuals using conventional, fixed insulin regimens.
Nutritional Therapy for Type II
-Emphasizes achieving glucose, lipid, and BP goals. Modest weight loss has been associated with improved insulin resistance. Therefor weight loss is recommended for all individuals with diabetes who are overweight or obese.
Importance of Exercise
Regular, consistent exercise is an essential part of diabetes and prediabetes management. The ADA recommends that people with diabetes engage in at least 150 min/wk of a moderate intensity aerobic physical activity.
-The ADA also encourages people with type 2 diabetes to perform resistance training three times a week in the absence of contraindications.
-Exercise decreases insulin resistance and can have a direct effect on lowering BG levels. It also contributes to weight loss, which further decreases insulin resistance.
-The therapeutic benefits of regular physical activity may result in a decreased need for diabetes medications to reach target BG goals in people with type 2 diabetes. Regular exercise may also help reduce triglyceride and low density lipoprotein (LDL) cholesterol levels, increase HDLs, reduce BP, and improve circulation.
Outline how you would teach a newly diagnosed patient with diabetes to use a self monitoring machine
1. Wash hands in warm water. Finger should be dry before puncturing. Alcohol swab should not be used.
2. If it is difficult to obtain an adequate drop of blood for testing. Warm hands in warm water or let harms hang for a few minutes.
3. A lancing device is usually used. Place Lancet in the device and use side of finger pad to puncture instead of center of the finger.
4. Set lancing device to make a puncture just deep enough to obtain a sufficiently large drop of blood.
5. Follow instructions on monitor for checking the blood.
6. Record results. Compare with personal target BG goals.
Why is it important for patients with diabetes to do SMBG
-It provides a current BG reading. SMBG enables the patient to make decisions regarding food intake, activity patterns, and medication dosages. It also produces accurate records of daily glucose fluctuations and trends, and it alerts the patient to acute episodes of hyperglycemia and hypoglycemia.
-it provides patients with a tool for achieving and maintaining specific glycemic goals.
Criteria Patients must meet for a Pancreas Transplant
1. history of frequent, acute , and severe metabolic complications (hypoglycemia, hyperglycemia, ketoacidosis) requiring medical attention.
2. Clinical and emotional problems with the use of exogenous insulin therapy that are so severe as to be incapacitating.
3. Consistent failure of insulin-based management to prevent acute complications.
Why is a pancreas transplant a good alternative for many diabetics.
Improve quality of life for people with diabetes, eliminating the need for exogenous insulin, frequent blood glucose measurements, and the risk involved with hyper- and hypoglycemia, eliminate acute complications with type 1s.
What are some nursing interventions you might do R/T Insulin Therapy
-proper administration, assessment of the pt response to insulin therapy, and teaching the pt about administration, storage, and side effects of insulin.;
- new user to understand the interaction of insulim, food, and activity, and to recognize and treat the symptoms of hypoglycemia; explore the patients underlying fears before beginning the teaching.
-Asses the pts beliefs and concerns starting insulin. Follow up assessment that includes injection site for signs of lipodystrophy and other reactions
What are some nursing interventions for oral and noninsulin injectable agents
factor the patients mental status, eating habits, home environment, attitude toward diabetes, and medication history all play a significant role in determining the most appropriate drug; teach pts that OAs and noninsulin injectable agents are used in addition to food choices and activity as therapy for diabetes and the important of following their meal and activity plans; do not take extra pills if they overeat
What are some nursing interventions for personal hygiene
encourage daily brushing and flossing in addition to regular visits to the dentist; regular bathing, with particular emphasis on foot are, inspect feet daily, avoid going barefoot, wear shoes that are comfortable and supportive; treat cuts, burns, scrapes—if not heling in 24 hr call HCP
what are some nursing interventions for medication identification and travel
Carry medical identification at all times indicating that he or she has diabetes; wear a medic alert bracelet or necklace
TRAVEL: requires planning; sitting long periods cause rise in glucose levels, get up and walk around every 2 hours to lower risk for DVT; have diabetic supplies when traveling n a plane, train, or bus. Have equitant like syringe, lancing devices, insulin vials or pens, and insulin pumps handy and have professional labels printed to delay checks at security points. Pts on OAs, keep snack items and quick acting carbohydrates source for treating hypoglycemia handy; if out of the country have letter from doctor for airport; plan an appropriate insulin schedule. Key to travel when taking insulin is to know the type of insulin being taken, its onset, anticipated peak, and mealtimes
Hyperglycemia:
Manifestations:
• High blood glucose
• Increased urine
• Increased appetite followed by lack of it
• Weakness, fatigue
• Blurred vision
• Headache
• Glycosuria
• Abdominal cramping
• Progression to DKA or HHS
Causes:
• Illness, infection
• Corticorsteroids
• Too much food
• Too little or no diabetes medication
• Inactvitiy
• Emotional, physical stress
• Poor absorption of insulin
Treatments:
• Get medical care
• Continue diabetes medication as prescribed
• Check blood glucose frequently and check urine for ketones; record results
• Drink fluids at least on hour basis
• Contact HCP
Preventive measures:
• Take prescribed dose of mediation at proper time
• Accurately administer insulin, noninsulin, injectable, OA
• Make healthy food choices
• Follow sick day rules when ill
• Check blood glucose routinely
• Wear identification band
Hypoglycemia:
Manifestations:
• Blood glucose less than 70
• Cold clammy skin
• Numbness of fingers, toes, mouth
• rapid heartrate
• emotional changes
• headache
• nervousness, tremors
• faintness, dizziness
• unsteady gait, slurred speech
• hunger
• changes in vision
• seizures, coma
Causes:
• Alcohol intake without food
• Too littelfood-delayed, omitted, inadequate intake
• Too much diabetes medication
• Too much exercise without adequate food intake
• Wrong time of meds
• Loss of weight without change in medication
• Use of b blockers interfering with recognition of symptoms
Treatments: Follow rule of 15
Preventive Measures:
• Take prescribed dose of mediation at proper time
• Accurately administer insulin, noninsulin, and OAs
• Coordinate eating with medications
• Eat adequate food intake needed for calories for exercise
• Know symptoms to treat immediately
• Carry simple carbs
• Teach fam and caregiver about symptoms
• Wear diabetes identification
Rule of 15
A BG less than 70 mg/dL is treated by ingesting 15 g of a simple fast acting carbohydrate such as 4-6 ounces of fruit juice or a regular soft drink.
-Commercial products such as gels or tablets containing specific amount of glucose are convenient for carrying in a purse or pocket to be used in such situations.
-Recheck BG 15 min later. If the value is still less than 70 mg/dL ingest 15 g more of carbohydrate and recheck the BG in 15 minutes.
-If no improvement after 2-3 administrations contact HCP.
Complications of Diabetes
Stroke, hypertension, dermopathy, atherosclerosis, nephropathy, peripheral neuropathy, neurogenic bladder, erectile dysfunction, retinopathy, cataracts, glaucoma, blindness, coronary artery disease, gastroparesis, islet cell loss, infections, gangrene
Gerontological considerations for diabetes
• Higher rates of premature death, functional disability, and coexisting illness such as hypertension and stroke than those without diabetes
• Progress of aging associated with a reduction in B cell function, decreased insulin sensitivity, and altered carbohydrate metabolism increased the prevalence of diabetes
• Undiagnosed or untreated diabetes is more common because of the normal physiologic changes of aging resemble those of diabetes, such as low energy levels, falls, dizziness, and confusion, and chronic urinary tract infections
• Hypoglycemia unawareness is more common in older patients
• Diabetes increased the rate of decline of cognitive function
• Educated about meal planning and exercise
• Assess renal function and creatine clearance in patients over 80 yrs old taking metformin
• Insulin pens safer for older pts because decreased vision to accurately administer
• Issues with teaching an older adult: altered vision, mobility, cognitive status, and functional ability, try and used slower pace and simple printed or audio materials in patients with limitations
Mr. Steve has been admitted to the hospital with complications from liver failure. After reviewing Mr. Steves chart, the nurse notices he has lost 3 pounds in two days, and is showing signs of ketoacidosis. The nurse knows from this information that--->
A- Mr. Steve treats his diabetes regularly and keeps it under control
B- She should give Mr. Steve Metformin for his diabetes
C- Mr. Steve has poorly treated type 1 diabetes Mellitus
D- She should monitor for recurrent infections, monitor wound healing, and watch for visual changes
Correct Answer- C
Ketoacidosis and weight loss are signs of poorly or untreated type 1 diabetes mellitus
A- (page 1124) showing synptoms of ketoacidosis losing weight shows that his diabetes is poorly treated
B- (page 1130 DRUG ALLERT) the drug metformin should not be used with patients that have kidney disease, liver disease, or heart failure
C- see above* (page 1124)
D- (page 1124) infections, prolonged wound healing, and visual changes are all signs of type 2 diabetes mellitus
A prediabetic patient's Glycosylated Hemoglobin (A1C) test results in a reading of 6.5% during their regular checkup. What would be the best next step in the care of this patient?
a. Begin teaching the patient about a treatment plan for Type II Diabetes Mellitus
b. Initiate testing to obtain a Fasting Plasma Glucose level
c. Repeat the Glycosylated Hemoglobin (A1C) test
d. Obtain the patient's current Plasma Glucose level
e. Document the reading of 6.5% as an expected lab value for this patient
C
**Confirmation of the A1C level is obtained by a repeat test to rule out laboratory errors. It is preferable for the repeat test to be the same test used initially. (p.1124)
The nurse is teaching a pre-diabetic patient how to look for signs of Type 2 diabetes. Which of the following symptoms should the nurse tell the patient to look for? (Select all that apply)
A. slow healing wounds
B. fatigue
C. weight loss
D. polyuria
E. frequent infections
The symptoms for Type 2 diabetes would be A, B, D and E. Slow healing wounds and frequent infections would occur because of the lack of inflammation to wounds. Fatigue is another symptom because of the increased amount of glucose in the blood that cannot get into the cells to create energy due to the resistance of insulin. Polyuria occurs because the kidneys are trying to compensate for the hyperglycemia by eliminating as much glucose as they can through the urine. C would not be an answer because type 2 diabetics tend to gain weight, not lose weight.
Pg. 1122-1123
Which of the following statements shows that a patient newly diagnosed with Diabetes Mellitus has had sufficient teaching about insulin administration?
A.) "I can administer my insulin in the same location because it makes the dose more effective."
B.) "I can administer my insulin even if I am about to exercise that area because there is no effect."
C.) "I should always check the label to make sure I have the proper type, concentration, and expiration date of the insulin, even if I have been taking insulin for a long time."
D.) "The insulin will be absorbed at the same rate regardless of which site I administer it in."
Answer/Rationale:
(C)- The patient should always be reminded of the insulin administration process, regardless of how long they've been on insulin therapy. There is potential that they misunderstood previous guidelines, or have had a decrease in eyesight and may not double check their insulin viles for accurate dosing. The patient should be educated to rotate injection sites to avoid lipodystrophy. Absorption is quickest in the order of abdomen, arm, thigh, then buttock. Insulin should not be administered in a site that is about to be exercised (ex administered in the thigh prior to jogging) because the increase in body heat can cause a faster absorption of the insulin with the potential risk for hypoglycemia. (Pages 1127-1128).
Your patient, who has been newly diagnosed with diabetes, demonstrates that they have proper knowledge of the precautions and self-care that comes with diabetes when they say (select all that apply):
A. I do not need to worry about my foot care.
B. Exercise can help me control my glucose levels.
C. I need to wear properly fitting shoes and avoid going barefoot.
D. I don't need to monitor my insulin as long as I eat less sugar.
E. I cannot eat the same amount of sugar even if I use a sugar substitute.
Answers: B, C, E
A nurse knows a patient understands his/her drug therapy of taking Meglitinides when the patient states the following:
A) "My blood sugar may rise above normal after taking this drug due to its side effects."
B) "I should take this drug 30 minutes prior to eating."
C) "I can take this when I am experiencing hypoglycemia."
D) "I should notify my HCP if I have sudden weight gain."
Answer: C. Meglitinides mimic normal responses to eating by increasing pancreatic insulin production. p. 1130.
A patient comes in with concerns of having diabetes, select all of the responses that a patient who may have Diabetes will present.
1. Hypotension
2. Potruding Eyeballs
3. Second Cousin who has been diagnosed as diabetic
4. Breath that smells Fruity
5.Dry Mouth
6. Nocturia
Answers: 1, 4, 5, 6
Rationale: Table 48-12 on page 1138, and also table 48-13.
What should be included in your teaching for a Type 1 Diabetic? (Select all that apply)
1. Examine feet daily for skin integrity
2. DKA signs and symptoms
3. Make sure to take oral insulin sensitizers daily
4. Prick the middle of the finger to check BG levels
5. Monitor your BG before, during, and after exercise
6. Alcohol should not effect your BG levels
7. Rotate injection sites for insulin injection
8. It is best to eat before exercise
Answer: (1, 2, 5, 7, 8)
A diabetic patient has the following presentation: unresponsive to voice or touch, tachycardia, diaphoresis, and pallor. Which of the following actions by the healthcare provider is the priority?
A. Administer oxygen per nasal cannula
B. Administer the prescribed insulin
C. Administer 50% dextrose IV per protocol
D. Send blood to the laboratory for analysis
Answer: Administer 50% dextrose IV per protocol
Rationale on pg. 1146-1147
Which noninsulin injectable agent slows down absorption of carbohydrate in the small intestine and are taken with each meal?
A. Biguanides
B. Dipeptidyl Peptidase-4 Inhibitors
C. Alpha-Glucosidase Inhibitors
D. Sulfonylureas
The answer is C. because the drugs block absorption of carbohydrates which in turn lowers overall blood glucose.
A 63 year old male who was diagnosed with type II diabetic mellitus 12 years ago is admitted into the ER with metabolic syndrome. Patient is showing signs of diaphoreses, fatigue, confusion, and hyperglycemia. What else might the nurse expect to see prior to therapy? Select all that apply
Increased LDL's
HgbA1C of 3%
Hypotension
Increased Triglycerides
Order to Administer Insulin
Rationale: Diabetic patients have a decrease in HDL's. (pg. 1123) HDL's break down LDL's, so decreased HDL leads to increased LDL.
Patients with hyperglycemia have an increased percentage of glucose to bind to hemoglobin (pg. 1124), so HgbA1C would be elevated and not declined.
Patients with metabolic syndrome have HTN and triglycerides (pg. 1123)
Type II Diabetes is insulin resistant, so initially, insulin is not needed to fix this problem, but table 48-1 states that the primary defects of diabetes mellitus type 2 are "decrease production of insulin" (pg. 1121)
What are some clinical manifestations of DKA? Select all that apply.
A.Hypertension
B. Orthostatic Hypotension
C. dry mucous membranes
D. Pallor
E. tachycardia
Answers: B, C, E
Rationale on pages 1176 and 1177
What is the priority action for the nurse to take if the patient is admitted to the hospital with HHS?
A. Monitor electrolytes
B. Assess vital signs
C. Fluid replacement
D. Give a rapid acting insulin
Answer: C pg. 1145
A 17 year old patient is experiencing nausea, vomiting, and excessive urination with complaints of severe fatigue and and excessive thirst over the course of several days. What might the nurse suspect of this patient?
A) hyperosmolar hyperglycemia
B) metabolic syndrome
C) diabetic ketoacidosis
D) gestational diabetes
C
Rationale: DKA typically develops over several days with symptoms such as polyuria, polydipsia, nausea, vomting, and severe fatigue, progressing to stupor and eventaul coma. Pg 1114.
A patient has just been diagnosed with Type I diabetes mellitus. What response by the patient shows that they need further education about their disease?
A. "I need to take my prescribed insulin on the prescribed schedule."
B. "As long as I take my insulin regularly, I don't need to adjust my diet at all."
C. "Low blood sugar is a possible side effect of my medication."
D. "Exercise is an important aspect in my diabetes treatment."
...
A 48 year old male has been diagnosed with Diabetes Mellitus. Which of the following suggest that he understood his patient teaching?
A. "If I become emotionally or physically stressed, this can result in a higher blood glucose."
B. "I should self-inject myself with insulin at the end of the day with the combined doses for the whole day."
C. "I should let me dentist know I am diabetic next time I go in for an appointment."
D. "It's important for me to inspect my feet daily, avoid going barefoot, and for me to wear supportive and comfortable shoes."
E. "In times of illness I should check my blood glucose at a minimum of once every 4 hours."
Answers: A,C,D,E (Page1139-1140)
A patient recently diagnosed with Type I Diabetes Mellitus is receiving education about self-monitoring of her glucose. Which of the following statements indicates that she has sufficient understanding of her condition?
A. "When I am sick, my glucose level will be lower than normal, so I should plan to eat more often to counteract this."
B. "When I am sick with a major illness, I need to monitor my glucose level more frequently because the stress on my body could increase my need for insulin."
C. "My blood glucose is higher when I am sick with even a minor cold, so I need to check my glucose level more often and call my doctor if it is consistently high."
D. "I am only at risk for diabetic ketoacidosis when I am sick, so monitoring my glucose level at home is only important if I feel ill."
Correct Answer: C
Rationale: P. 1139; blood glucose levels increase in response to stress including physical stress from illness. The patient should alert the provider to consistently high levels when sick, because additional insulin may be needed to counter risk for DKA. Increase in glucose levels occurs even with only minor illness such as a cold, not only in major illnesses.
Mr. Jones, a newly diagnosed Type 1 diabetic, is being released from the hospital. What would indicate he needs more teaching about monitoring his glucose levels?
A. I should check my glucose levels when I'm sick.
B. I should check my glucose levels before or after exercise.
C. I only have to check my glucose levels whenever I suspect hyperglycemia.
D. I should check my glucose levels before I eat.
Rationale: pg. 1136
...
A patient with long-term diabetes mellitus comes to the clinic with which complications? select all that apply
hypotension
peripheral neuropathy
erectile dysfunction
gain in islet cells
stroke
correct answers: peripheral neuropathy, erectile dysfunction, stroke
A 55 year-old female with hypertension and prediabetes is scheduled for a CT scan of her lower GI tract in the morning, and will be given an iodine containing contrast medium. She has been instructed to discontinue use of her prescribed metformin. Which of the following statements indicate the patient requires further teaching. Select all that apply.
A. I will resume taking my metformin 48 hours after the procedure is done after the doctor has checked that my serum albumin levels are normal.
B. I should discontinue my metformin while receiving IV contrast media that contain iodine because it poses a risk to the insulin producing cells of my pancreas.
C. I can take metformin until 12 hours before my procedure.
D. I shouldn't resume taking my metformin if I have decreased kidney function.
E. I should stop taking my metformin because it poses a risk for kidney injury, and can increase my risk for diabetic ketoacidosis.
A,B,C,E
When educating a patient with type 1 diabetes, what should you teach the patient about the signs and symptoms of diabetic ketoacidosis?
A) dry mouth and excessive thirst
B) Rapid weak pulse
C) fast bounding pulse
D) abdominal pain
E) flushed dry skin
answer: ABDE
A nurse is providing education to a group of young adults regarding the development of type 2 diabetes. Which information should be included? Select all that apply.
a. "Follow a vegetarian diet."
b. "Do not eat sugar-containing foods."
c. "Include physical activity in your daily routine."
d. "Try to maintain a healthy diet."
e. "You are not at risk for this disease yet because it is not diagnosed until after age 30."
correct answers: C, D
Rationale: Obesity is a major risk factor for developing type 2 diabetes therefore you should maintain a healthy diet and include physical activity in your daily routine to lower the risk of developing type 2 diabetes.
page number: 1133-1134
Your patient, Mr. Snickers, is a newly diagnosed Type 1 diabetic who will be going home on insulin therapy. Which statements by Mr. Snickers would mean he needed further teaching on insulin therapy? Select all that apply
A. I should use the same injection site each time to limit damage to tissue.
B. I should wash my hands, and make sure site is clean and dry prior to injection.
C. I can reuse my single-use syringe as long as I boil it in water first.
D. My Insulin is still good for up to 4 weeks after the expiration date on bottle.
E. For my intermediate acting (cloudy) insulins I should roll the bottle between my hands to agitate solution instead of shaking.
Answers: A, C, D
Which of the following tasks would the RN caring for a diabetic patient be unable to delegate to an unlicensed person?
A) Check blood glucose levels
B) Monitor vital signs, urine output, or changes in behavior and level of consciousness
C) Administer insulin to patient in a home care setting
D) Assess for chronic complications of diabetes
Correct answer: D) Assess for chronic complications of diabetes. Rational: pg 1152 It is the job of the RN to assess for chronic complications such as cardiovascular disease, retinopathy, nephropathy, neuropathy, and foot complications. UAP may check glucose levels, administer insulin in a home or community setting, and monitor vitals, urine output, and changes in behavior and levels of consciousness.
Ricky Bobby is a 40 year old diabetic who is currently on insulin therapy. He reports having headaches in the morning when he wakes up, morning hyperglycemia, and night sweats. What actions would you recommend to help relieve these symptoms?
A) an increase in insulin dosage in the evenings
B) adjust insulin administration times
C) limit snacking before bed
D) all of the above
E) none of the above
Answer: E. Page 1129. He is experiencing the Somogyi effect. A bedtime snack, reduction in insulin, or both can help prevent this Somogyi effect.
A patient diagnosed with Type 1 diabetes has assured you that they have been administering their insulin (NPH) per the instructions diligently. However, the lab report shows that their A1C level is 6.8%. Which of the following statements by the patient leads you to believe that they may require more teaching?
A. "I rub the injection site for 15 seconds and let it dry completely before I inject the insulin"
B. "after I pull the insulin out of the fridge I immediately begin to draw out the dose"
C. "I inject the insulin at a 90 degree angle"
d. "I take my insulin before breakfast and again 12 hours later"
Correct: B.
Rationale: NPH is a cloudy insulin " because it contains protamine. This substance decreases solubility, and as a result these insulins must be gently agitated before administration"
A patient believes they have developed type 2 diabetes. With what symptoms would they present?
A. insomnia, irritability, nervousness
B. Increased thirst, increased hunger, increased urination
C. Increased hunger, decreased thirst, increased neuromuscular activity
D. Decreased hunger, decreased urination, decreased thirst
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A patient with type 2 diabetes is about to undergo a radiologic procedure that involves using a contrast medium. The doctor orders for the patient to continue to take Metformin. What nursing action should you take? [Show Less]