Ch 49: Nursing Management: Diabetes Mellitus

In addition to promoting the transport of glucose from the blood into the cell, what does insulin do?
accelerates the transport of amino acids into cells and their synthesis into protein
Which tissues require insulin to enable movement of glucose into the tissue cells
adipose and skeletal muscle
Why are hormones cortisol, glucagon, epinephrine, and growth hormone referred to as a counter regulatory hormones?
stimulate glucose output by the liver
What characterizes type 2 Diabetes?
Beta Cell exhaustion, insulin resistance, genetic predisposition, altered production of adipokines, inherited defect in insulin receptors, inappropriate glucose production by the liver
Which lab results would indicate that the patient has pre diabetes?
Fasting blood glucose result of 120 mg/dL
The nurse is teaching the patient with pre diabetes ways to prevent or delay the development of type 2 diabetes. What info should be included?
maintain a healthy weight and monitor for polyuria, polyphagia and polydipsia
*polyuria: excessive urine
*polyphagia: excessive hunger/ increased appetite
*polydipsia: abnormally great thirst
In type 1 diabetes there is an osmotic effect of glucose when insulin deficiency prevents the use of glucose for energy. Which class symptom is caused by the osmotic effect of glucose?
Polydipsia: abnormally great thirst as a symptom of disease.
Which patient should the nurse plan to teach how to prevent or delay the development of diabetes?
a 34 year old woman whose parents both have type 2 diabetes
When caring for a patient with metabolic syndrome, what should the nurse give the highest priority to teaching the patient about?
Achieving a normal weight

Metabolic syndrom is cluster of biochemical and physiological abnormalities associated with CVD, T2D

During routine health screening, a patient is found to have fasting plasma glucose (FPG) of 132 mg/dL. At a follow up visit, a diagnosis of diabetes would be made based on which lab results?
A1C of 7.5% and FPG > or equal to 126 mg/dL
The nurse determines that a patient with a 2 hr OGTT (oral glucose tolerance test) of 152 mg/dL has
impaired glucose tolerance
When teaching the patient with diabetes about insulin administration, the nurse should include which instruction for the patient?
consistently use the same size of insulin syringe to avoid dosing errors
A patient with type 1 diabetes uses 20 U of 70/30 neutral protamine Hagedorn (NPH/regular) in the morning and at 6pm. 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
Lispro insulin (Humalog) with NPG 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
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 when the patient does what?
withdraws the NPH dose into the syringe first
The following interventions are planned for a diabetic patient. Which intervention can the nurse delegate to unlicensed assistive personnel (UAP)?
check that the bath water is not too hot
The home care nurse should intervene to correct patient whose insulin administration includes
mixing an evening dose of regular insulin with insulin glargine in one syringe for admin.
When teaching a patient with type 1 diabetes, what should the nurse emphasize as major advantage of using an insulin pump?
tight glycemic control can be maintained
a patient taking insulin has recorded fasting glucose levels above 200 mg/dL on awakening for the last 5 mornings. What should the nurse advise patient to do first?
monitor glucose level at bedtime, between 2-4am and on arising
which class of oral glucose lowering agents is most commonly used for people with type 2 diabetes bc it reduces hepatic glucose production and enhances tissue uptake of glucose?
biguanide
the patient with type 2 diabetes is being put on acarbose (Precose) and wants to know why she is taking it. What should nurse include in this patients teaching?
take it with first bite of each meal
effectiveness is measured by 2 hour postprandial glucose
it delays glucose absorption from the GI tract
the nurse is assessing a NEWLY admitted diabetic patient. which observation should be addressed as the priority by the nurse?
rapid respirations with deep inspiration
individualized nutrition therapy for patients using conventional, fixed insulin regimens should include teaching the patient to
eat regular meals at regular times
what should the goals of nutrition therapy for patient with type 2 diabetes include?
normal serum glucose and lipid levels
to prevent hyperglycemia or hypoglycemia related to exercise, what should the nurse teach patient using glucose-lowering agents about best time for exercise?
about 1 hour after eating when blood glucose levels are rising
the nurse accesses the diabetic patient technique for self monitoring of blood glucose (SMBG) 3 months after initial instruction. which error in performance of SMBG noted by nurse requires intervention?
cleaning the puncture site with alcohol before the puncture
a nurse working in an outpatient clinic plans a screening program for diabetes. what recommendations for screening should be included?
FPG for all individuals at age 45 and then every 3 years
a patient with diabetes calls the clinic bc she is experiencing nausea and flu like symptoms. which advice from the nurse will be best for patient?
administer usual insulin dosage
the nurse should observe the patient for symptoms of ketoacidosis when:
an insulin deficit causes body to metabolize large amounts of fatty acids rather than glucose for energy

ketoacidosis: body produces excess blood acids (ketones)

what are manifestations of diabetic ketoacidosis (DKA?
thirst, ketonuria, dehydration, metabolic acidosis, kussmaul respirations, sweet/fruity breath odor
what describes the primary difference in treatment for diabetic ketoacidsos (DKA) and hyperosmolar hyperglycemic syndrome (HHS)?
HHS requires greater fluid replacement to correct the dehydration
the patient with newly diagnosed diabetes is displaying shakiness, confusion, irritability, and slurred speech. what should nurse suspect is happening?
hypoglycemia
the patient with diabetes has a blood glucose level of 248 mg/dL. Which 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
a diabetic patient is found unconscious at home and a family member calls clinic. after determining that a glucometer is not available, what should the nurse advise family member to do?
administer glucagon 1 mg intramuscularly (IM) or subcutaneously
the patient with diabetes is brought to the emergency dept by his family members, who say that he is not acting like himself and he is more tired than usually. Number the nursing actions in the order of priority for this patient.
1. ensure patent airway
2. check blood glucose
3. establish IV access
4. administer 0.9% NaCl solution at 1L/hr
5. begin continuous regular insulin drop
6. establish time of last food and medication(s).
two days following a self managed hypoglycemic episode at home, the patient tells the nurse that his blood glucose levels since the episode have been between 80-90 mg/dL. Which is the best response by nurse?
“that is a good range for your glucose levels”
which statement best describes atherosclerotic disease affecting the cerebrovascular, cardiovascular, and peripheral vascular systems in patients with diabetes?
it occurs with higher frequency and earlier onset than in the non diabetic population
what disorders and diseases are related to macrovascular complications of diabetes?
coronary artery disease
ulceration and amputation of lower extremities
the patient with diabetes has been diagnosed with autonomic neuropathy. What problems should the nurse expect to find this patient?
erectile dysfunction
vomiting undigested food
painless myocardial infarction
following the teaching of foot care to a diabetic patient, the nurse determines that additional instruction is needed when patient makes which statement?
“Ill know if I have sores or lesions on my feet because the will be painful”
a 72 year old woman is diagnosed with diabetes. What does the nurse recognize about the management of diabetes in older adult?
it is more difficult to achieve strict glucose control than in younger patients