ENDOCRINE: DIABETES NCLEX REVIEW/PRIORITIZATION & DELEGATION Flashcards
Nocturnal Hypoglycemia
The low morning fasting blood glucose level indicates possible nocturnal hypoglycemia. Research indicates that it is important to avoid hypoglycemic episodes in pediatric patients because of the risk for permanent neurologic damage and adverse developmental outcomes. Although a lower hemoglobin A1c might be desirable, the upper limit for hemoglobin A1c levels ranges from 7.5% to 8.5% in pediatric patients. The parents’ questions about diet and the child’s activity level should also be addressed, but the most urgent consideration is education about the need to avoid hypoglycemia.
appropriate tasks for non–health care professional personnel such as teachers, paraprofessionals, and unlicensed health care personnel in emergency situation regarding a child?
National guidelines published by the American Diabetes Association (ADA) indicate that administration of emergency treatment for hypoglycemia, obtaining blood glucose readings, and reminding children are appropriate tasks for non–health care professional personnel such as teachers, paraprofessionals, and unlicensed health care personnel. Assessments and education require more specialized education and scope of practice and should be done by the school nurse.
While performing an admission assessment on a patient with type 2 diabetes, he tells you that he routinely drinks 3 beers a day. What is your priority follow-up question at this time?
What would you monitor for?
Alcohol has the potential for causing alcohol-induced hypoglycemia. It is important to know when the patient drinks alcohol and to teach the patient to ingest it shortly after meals to prevent this complication. The other questions are important, but not urgent. The lipid profile question is important because alcohol can raise plasma triglycerides but is not as urgent as the potential for hypoglycemia.
The UAP reports to you that a patient with type 1 diabetes has a question about exercise. What important points would you be sure to teach this patient?
- Guidelines for exercise are based on blood glucose and urine ketone levels.
- Patients should test blood glucose before, during, and after exercise to be sure that it is safe.
- When ketones are present in urine, the patient should not exercise because they indicate that current insulin levels are not adequate.
- Vigorous exercise is permitted in patients with type 1 diabetes if glucose levels are between 100 and 250 mg/dL.
- Warm-up and cool-down should be included in exercise to gradually increase and decrease the heart rate.
The experienced UAP has been delegated to take vital signs and check fingerstick glucose on a diabetic patient who is postoperative. Which vital sign change would you instruct the UAP to report immediately?
An unexpected rise in blood glucose is associated with increased mortality and morbidity after surgical procedures. Current ADA guidelines recommend insulin protocols to maintain blood glucose levels between 140 and 180 mg/dL. Also, unexpected rises in blood glucose values may indicate wound infection.
You are preceptor for a senior nursing student who will teach a diabetic patient about self-care during sick days. For which statement by the student must you intervene?
Urine ketone testing should be done whenever the patient’s blood glucose is greater than 240 mg/dL. All of the other teaching points are appropriate “sick day rules.” For dehydration, teaching should also include that if the patient’s blood glucose is lower than her target range, she should drink fluids containing sugar.
