ch 37 questions and topics Flashcards
the nurse identifies a need for additional teaching when the patient who is self monitoring blood glucose levels…
chooses a puncture site in the center of the finger pad
a type 2 diabetic is ordered metformin (glucophage) as part of the management regimen. which is the best nursing explanation for the action of this drug in controlling glucose levels?
helps tissues use insulin more efficiently
a diabetic client maintains glucose control with the use of long acting and short acting insulin. which nursing instruction would be considered a priority teaching issue with this client?
if using Lantus or Levemir give in separate syringes
which is the primary reason for encouraging injection site rotation in an insulin dependent diabetic?
to promote absorption and prevent lipohypertrophy
a client with untreated type 1 diabetes mellitus may lapse into a coma because of acidosis. Which component in the blood is a direct cause of this type of acidosis?
ketones
a 27 y/o patient admitted with diabetic ketoacidosis has a serum glucose level of 732 and a serum potassium level of 3.1. Which action prescribed by the healthcare provider should the nurse take first?
place the patient on a cardiac monitor
an unresponsive patient with type 2 diabetes is brought to the emergency department and diagnosed with hyperosmolar hyperglycemic syndrome (HHS). the nurse will anticipate the need to?
insert an IV catheter
which is the best nursing explanation for the symptom of polyuria in the client with diabetes mellitus?
high sugar pulls fluid into the bloodstream, which results in more urine production
different types of diabetes (4)
- type 1: insulin dependent; little or no insulin is produced. can develop KETOACIDOSIS. controlled with insulin
- type 2: insulin resistant; body can not efficiently use the insulin it produces. can develop HHS. controlled mainly with oral drugs and lifestyle but also can be controlled with insulin.
- LADA (latent autoimmune diabetes in adults): slow onset of type 1 diabetes; eventually islet antibodies destroy the beta cells. often misdiagnosed as type 2 diabetes. dx criteria onset after age 30, islet antibodies present in the blood, insulin is not required sooner than 6 months after dx. Rapid failure of ORAL diabetic drugs indicates LADA
- gestational: occurs only with pregnancy; after pregnancy there is a 35-60% chance of developing diabetes within 5-10 years
what is most important when caring for a patient with ketoacidosis?
- treating hypovolemia and maintaining tissue perfusion
- giving insulin, IV fluid, correcting electrolyte imbalances
what type of medication, specifically insulin, would you give for a diabetic ketoacidosis patient?
IV regular insulin
what is the best nursing interpretation of a patient that is taking oral medication for control of sugar problems? what are they trying to control?
type 2 diabetes mellitus
a patient who has type 2 diabetes is being prepared for an elective coronary angiogram. which information would the nurse anticipate might lead to rescheduling the test?
the patient took their prescribed metformin today
a patient who was admitted with diabetic ketoacidosis secondary to a UTI has been weaned off an insulin drip 30 minutes ago. the patient reports feeling lightheaded and sweaty. which action should the nurse take first?
obtain a glucose reading using a finger stick
to monitor for complications in a patient with type 2 diabetes, which tests will the nurse in the diabetic clinic schedule at least annually?
- blood pressure
- serum creatinine
- urine for microalbuminuria
- monofilament testing of the foot
a female patient is scheduled for an oral glucose tolerance test. which information from the patient’s health history is most important for the nurse to communicate to the healthcare provider?
patient uses oral contraceptives
- can alter the results of the test
the nurse is providing information about foot care to a patient with diabetes. which of the following would the nurse include?
“be sure to apply a moisturizer to feet daily.”
-the patient should also inspect their feet at least once a day using a mirror or having someone else check
what could cause blood sugar to elevate?
stress, diet choices, improper insulin/oral medication administration
factors that influence the development of diabetes (4)
- genetic
- metabolic
- microbiological
- immunologic
what is glycosylated hemoglobin?
reflects the amount of glucose stored in hemoglobin over past several months
(usually 3 months, also called an HbA1c)
proper levels for A1c
(as stated in the textbook)
- lowering level to 6.5% decreases risks for kidney, eye, and nerve diseases
- if patient is very old, frail, or the life expectancy is short, less than 8-8.5%
an elderly patient needs to draw up insulin, what do you need to help them verify that they are drawing up the correct dosage?
a syringe magnifier
Hemoglobin A1c measures what?
that blood glucose has stayed within normal limits from one testing period to the next
if a diabetic patient has an injury to the foot that they are unaware of, how is that explained to the patient?
high blood sugar levels decreases blood circulation to nerves
neuropathy can be painful and also decrease sensation to extremities, especially the feet
