DIABETES

A client who was diagnosed with type 1 diabetes 14 years ago is admitted to the medical-surgical unit with abdominal pain. On admission, the client's blood glucose level is 470 mg/dl. Which finding is most likely to accompany this blood glucose level?

RAPID, thready pulse

A client has just been diagnosed with type 1 diabetes. When teaching the client and family how diet and exercise affect insulin requirements, the nurse should include which guideline?

"You'll need less insulin when you exercise or reduce your food intake."

A nurse explains to a client that she will administer his first insulin dose in his abdomen. How does absorption at the abdominal site compare with absorption at other sites?

Insulin is absorbed more rapidly at abdominal injection sites than at other sites.

A client has type 1 diabetes. Her husband finds her unconscious at home and administers glucagon, 0.5 mg subcutaneously. She awakens in 5 minutes. Why should her husband offer her a complex carbohydrate snack as soon as possible?

To restore liver glycogen and prevent secondary hypoglycemia

A nurse is developing a teaching plan for a client with diabetes mellitus. A client with diabetes mellitus should:

wash and inspect the feet daily

A client's blood glucose level is 45 mg/dl. The nurse should be alert for which signs and symptoms?

Coma, anxiety, confusion, headache, and cool, moist skin

After being sick for 3 days, a client with a history of diabetes mellitus is admitted to the hospital with diabetic ketoacidosis (DKA). The nurse should evaluate which diagnostic test results to prevent dysrhythmias?

Serum potassium level

A client is admitted with hyperosmolar hyperglycemic nonketotic syndrome (HHNS). Which laboratory finding should the nurse expect in this client?

Blood glucose level 1,100 mg/dl

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A nurse is teaching a client about insulin infusion pump use. What intervention should the nurse include to prevent infection at the injection site?

Change the needle every 3 days

When referred to a podiatrist, a client newly diagnosed with diabetes mellitus asks, "Why do you need to check my feet when I'm having a problem with my blood sugar?" The nurse's most helpful response to this statement is:

"Diabetes can affect sensation in your feet and you can hurt yourself without realizing it."

NPH is an example of which type of insulin?

intermediate-acting

Which is a by-product of fat breakdown in the absence of insulin and accumulates in the blood and urine?

ketones

The nurse is describing the action of insulin in the body to a client newly diagnosed with type 1 diabetes. Which of the following would the nurse explain as being the primary action?

It enhances the transport of glucose across the cell membrane

The nurse is reviewing the initial laboratory test results of a client diagnosed with DKA. Which of the following would the nurse expect to find?

Blood pH of 6.9

What is the duration of regular insulin?

4-6 hrs

Which of the following insulins are used for basal dosage?

Glargine (Lantus)

Which of the following is a risk factor for the development of diabetes mellitus? Select all that apply.

* Hypertension
* Obesity
* Family history
* Age greater of 45 years or older
* History of gestational diabetes

What is the only insulin that can be given intravenously?

regular

A client with a history of type 1 diabetes is demonstrating fast, deep, labored breathing and has fruity odored breath. What could be the cause of the client's current serious condition?

ketoacidosis

The nurse is preparing a presentation for a group of adults at a local community center about diabetes. Which characteristic would the nurse inform the group is associated with type 2 diabetes?

Insulin resistance or insufficient insulin production

A client with diabetes is receiving an oral anti diabetic agent that acts to help the tissues use available insulin more efficiently. Which of the following agents would the nurse expect to administer?

metformin

A client is admitted to the unit with diabetic ketoacidosis (DKA). Which insulin would the nurse expect to administer intravenously?

regular

The client who is managing diabetes through diet and insulin control asks the nurse why exercise is important. Which is the best response by the nurse to support adding exercise to the daily routine?

Increases ability for glucose to get into the cell and lowers blood sugar

A nurse is preparing to discharge a client with coronary artery disease and hypertension who is at risk for type 2 diabetes. Which information is important to include in the discharge teaching?

How to control blood glucose through lifestyle modification with diet and exercise

The nurse is administering lispro insulin. Based on the onset of action, how long before breakfast should the nurse administer the injection?

10-15 mins

A client is admitted with diabetic ketoacidosis (DKA). Which order from the physician should the nurse implement **first**?

Infuse 0.9% normal saline solution 1 L/hr for 2 hours.

A client receives a daily injection of glargine insulin at 7:00 a.m. When should the nurse monitor this client for a hypoglycemic reaction?

This insulin has no peak action and does not cause a hypoglycemic reaction.

The nurse is teaching a client about self-administration of insulin and about mixing regular and neutral protamine Hagedorn (NPH) insulin. Which information is important to include in the teaching plan?

When mixing insulin, the regular insulin is drawn up into the syringe first.

A client presents to the clinic reporting symptoms that suggest diabetes. What criteria would support checking blood levels for the diagnosis of diabetes?

Fasting plasma glucose greater than or equal to 126 mg/dL (7.0 mmol/L)

A nurse is providing health education to a teenage client newly diagnosed with type 1 diabetes mellitus, as well as the client’s family. The nurse teaches the client and family nonpharmacologic measures that will decrease the body's need for insulin. What measure provides the **greatest** impact on glucose reduction

exercise

The nurse is discussing macrovascular complications of diabetes with a client. The nurse would address what topic during this dialogue?

The fact that clients with diabetes have an elevated risk of myocardial infarction

A teenage client is brought to the emergency department with symptoms of hyperglycemia. Based on the fact that the pancreatic beta cells are being destroyed, the client would be diagnosed with what type of diabetes?

type 2 diabetes

A nurse is caring for a client with type 1 diabetes who is being discharged home tomorrow. What is the best way to assess the client's ability to prepare and self-administer insulin?

Observe the client drawing up and administering the insulin.

A client has been brought to the emergency department by paramedics after being found unconscious. The client's MedicAlert bracelet indicates that the client has type 1 diabetes and the client's blood glucose is 22 mg/dL (1.2 mmol/L). The nurse should anticipate what intervention?

IV administration of 50% dextrose in water

A child is brought into the emergency department with vomiting, drowsiness, and blowing respirations. The child's parent reports that the symptoms have been progressing throughout the day. The nurse suspects diabetic ketoacidosis (DKA). Which action should the nurse take first in the management of DKA?

Begin fluid replacements.

An older adult patient that has type 2 diabetes comes to the emergency department with second-degree burns to the bottom of both feet and states, "I didn't feel too hot but my feet must have been too close to the heater." What does the nurse understand is most likely the reason for the decrease in temperature sensation?

Peripheral neuropathy

A patient with diabetic ketoacidosis (DKA) has had a large volume of fluid infused for rehydration. What potential complication from rehydration should the nurse monitor for?

hypokalemia

A nurse knows to assess a patient with type 1 diabetes for postprandial hyperglycemia. The nurse knows that glycosuria is present when the serum glucose level exceeds:

180 mg/dL

A nurse is assigned to care for a patient who is suspected of having type 2 diabetes. Select all the clinical manifestations that the nurse knows could be consistent with this diagnosis.

* Blurred or deteriorating vision
* Fatigue and irritability
* Polyuria and polydipsia
* Wounds that heal slowly or respond poorly to treatment

A client is brought to the emergency department. The client is a type 2 diabetic and is experiencing hyperglycemic hyperosmolar syndrome (HHS). The nurse should identify what components of HHS? Select all that apply.

* Glycosuria
* Dehydration
* Hyperglycemia

This client's abnormally high blood glucose level indicates hyperglycemia, which typically causes the three P’s:

polyuria, polyphagia, and polydipsia

Because polyuria leads to fluid loss, the nurse should expect to assess signs of:

deficient fluid volume, such as a rapid, thready pulse; decreased blood pressure; and rapid respirations

Cool, moist skin and arm and leg trembling are associated with ___ Rapid respirations — not slow, shallow ones — are associated with hyperglycemia

hypoglycemia

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The nurse should advise the client that exercise, reduced food intake, hypothyroidism, and certain medications *insulin requirements.* Growth, pregnancy, greater food intake, stress, surgery, infection, illness, __ insulin antibodies, and certain medications increase insulin requirements.

decrease; increase

What patient education should a patient give a pt dx with type 2 diabetes regarding foot care?

* wear nonconstructive shoes
* corns should be treated by a podiatrist
* nails should be **filed** (not trimmed) straight across
* never walk barefoot

Signs and symptoms of hypoglycemia (indicated by a blood glucose level of 45 mg/dl) include:

anxiety

restlessness

headache

irritability

confusion

diaphoresis

cool skin

tremors

coma

seizures.

A patient diagnosed with DKA needs the potassium levels evaluated frequently because during periods of acidosis, potassium leaves the cell, causing ___.

hyperkalemia

Arterial pH and plasma bicarbonate levels typically remain within normal limits in ___, making it different from a DKA where ph will be decrease with an increase in bicarb.

hyperosmolar hyperglycemic nonketotic syndrome (HHNS)

A patient experiencing hyperosmolar hyperglycemic nonketotic syndrome (HHNS) will have an increase in what?

the client produces large quantities of urine to attempt to rid the excess glucose. *(if fluid intake isn't increased at this time, the client becomes dehydrated)*

A patient in. DKA is also know as ____.

metabolic acidosis

The **duration** of Lantus insulin (long-acting) is ___.

24 hours

The **duration** of NPH insulin (intermediate) is ___.

12-16 hours

___ is the **duration** for rapid-acting insulin such as NovoLOG, HumaLOG.

3-5 hours

What type of respirations will a patient in DKA experience?

Kussmaul respirations (fast, deep, labored breathing)

What medications are described as insulin releasers because they stimulate the pancreas to secrete more insulin?

sulfonylureas:

Glyburide and glipizide &

repaglinide, a meglitinide

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In addition to treating hyperglycemia, management of DKA is aimed at correcting __,__, & __ before correcting the hyperglycemia with insulin.

dehydration, electrolyte loss, and acidosis

normal blood sugar level:

70-100 mg/dL

Myocardial infarction and stroke are considered ___complications of diabetes, while the effects on vision and kidney function are considered to be __.

macrovascular; microvascular

If a patient becomes UNCONCIOUS, what form of glucose needs to be given?

IV since patient cannot swallow

In HHS, persistent hyperglycemia causes ___, which results in losses of water and electrolytes

osmotic diuresis

DKA is a prolonged decrease or absence of insulin that usually occurs in type 1 diabetics. The body can no longer use glucose without the insulin, so the body resorts to what?

alternative fuels such as protein, fats, making the body highly acidic ketone bodies

What is the difference between HHS & DKA?

DKA has a rapid onset and BG levels vary between 300-800 vs HHS happens over days and BG can be up to 2,000 mg/dL

Insulin is made in the ___, which is why there is no cure for diabetes except for an organ transplant.

pancreas

The 3 major functions of the pancreas:

synthesis & secretion of insulin, glucagon, somatostatin

What does insulin help the body do?

metabolizes glucose for energy

stores glucose in the liver & muscle as glycogen

signals the liver to stop releasing glucose

enhances storage of dietary fat in adipose tissue

The BETA cells secrete how much insulin per day & when are they high vs low?

40-50 units per day; low levels when fasting, high post-prandial

The brain’s only form of food is ___.

glucose (sugar)

The production of glycogen makes blood glucose __ and the breakdown makes blood glucose __.

fall; rise

The key to successful management of DM is ___.

pt’s own knowledge and skills + patient education

What ethnicities are at high risk for DM?

African Americans

Alaskan Natives

American Indians

Hispanics

What is the leading cause of kidney failure, adult-onset blindness, lower limb amputations, heart disease, stroke, high bp, & nerve damage?

diabetes

Why is smoking cessation imperative in diabetic pts?

smoking increases risk & progression of disease due to reduced tissue perfusion

Mrs. Margaret has had three children. All weighed 9 lbs+ at birth. What disease did she most likely develop at pregnancy? What patient teaching in imperative?

gestational diabetes; she should be screen every 3 years for diabetes mellitus

A client presents to the clinic reporting symptoms of diabetes. What **criteria** would support a diagnosis of diabetes?

fasting plasma glucose > or = to 126 mg/dL on two separate occasions

two hour post-glucose load > 200 mg/dL during an oral glucose tolerance test

What symptoms are indicative of diabetes?

the 3 p's:

polyuria-increased urination

polydipsia- increased thirst

polyphagia- increased appetite

A patient with type 1 diabetes will experience __ symptoms as opposed to type 2 diabetics experiencing __ symptoms.

GI symptoms (n/v + abdominal pain, weight loss) & lethargy with Kussumal respirations

vs.

nerve damage symptoms (tingling/numbness, blurred vision), recurrent infection, & slow wound healing

type 1 diabetes can be categorized as the destruction of __ cells, __, & lack of __ by the pancreas. The patient will have weight loss and ketoacidosis.

beta cells, autoimmune with genetic predisposition, & lack of insulin

The only tx for type 1 diabetics patients is___.

replacement on insulin (IM injection in adipose or fatty tissue)

type 2 diabetes can be categorized as __ & __. Patients may be non-insulin dependent initially but may become insulin dependent.

cellular insulin resistance & impaired insulin secretion

A patient with type 2 diabetes asks the nurse about non-modifiable risk factors. What does the nurse respond?

“Non-modifiable risk factors are not able to be prevented. Some examples include age over 45, family hx of DM, personal hx of GDM, hx of stroke/heart disease, PCOS, ethnicity and depression.”

A patient with type 2 diabetes asks the nurse about modifiable risk factors. What does the nurse respond?

“The modifiable risk factors include exercising daily to reduce obesity, high bp, high cholesterol and even stress.”

A physical finding that is indicative of type 2 diabetes, or insulin resistance, is ___.

acanthosis nigricans (dark, thick, velvety skin around body folds & creases)

Glucagon is a catabolic hormone that is secreted by what cells? What is its action?

Alpha cells; respond to low glucose levels to then increase BS by stimulating gluconeogenesis

Define gluconeogenesis.

the glycogen in the liver is then turned into glucose by glucagon

___ is NEVER normal. This is defined as what? what can it cause?

glucose; glycosuria which will have diluted due to osmotic diuresis

A nurse knows to assess a pt with type 1 diabetes for what?

postprandial hyperglycemia

If a patient were to test positive for glycosuria, the nurse knows the patient’s serum blood glucose is __.

greater than 180 mg/dL

A patient with diabetes has been ordered to have PBS. The nurse knows the assess the BS to the following times: 7am, 11am, 4 pm, & 9 pm. What is the purpose of this schedule?

to know the BG before meals and before bedtime

What is the best indicator of a diabetics blood glucose control?

glycosylated hemoglobin A1C

The normal HbA1c is ___. This is measures the % of RBS coated with sugar over a period of how many months?

4-6%; 2-3 months (90-120 days)

What % is the goal for a HbA1c for a diabetic patient?

less than 7% (170 mg/dL)

Hypoglycemia is when the blood sugar drops to ___ mg/dL. Causes include too little food, too much exercise, or too much insulin/oral agent (usually at peak), tumors or alcohol.

50-70 mg/dL

A patient with hypoglycemia experiences s/s from the adrenergic response. What are these symptoms?

**cold n clammy, need some candy*\*

diaphoresis

palpitations

tachycardia

tremors

hunger

A nurse knows that if a patient is at risk for hypoglycemia, ___ medications may mask symptoms.

beta blockers

What CNS symptoms will a patient with hypoglycemia experience?

HA (brain has no food)

confusion

memory loss

drowsy

behavioral changes

poor coordination

double vision

slurred speech

numb lips/tongue

coma (unresponsive)

death

The nurse just obtained a serum blood glucose of 70 mg/dL. The nurse knows this is indicative of hypoglycemia but the patient is not exhibiting any symptoms. What is the priority nursing intervention?

double-check the glucose level to ensure it’s correct

The first nursing intervention a nurse will carry out if a patient is experiencing hypoglycemia and is conscious is ___.

giving a fast-acting carb PO (10-15 grams) then follow up with protein if next meal more than an hour away (cheese & crackers)

Fast acting carbs/sugar include:

3-4 glucose tablets = 15 grams

4-6 oz of fruit juice or skim milk

6 saltines or 3 graham crackers

2-3 tsp of honey

5 lifesaver candies

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The best prevention for hypoglycemia is:

consistent eating schedule

administering insulin

exercise

Mr. Smith’s blood serum glucose was between 20-50 mg/dL at 700 am. You know that insulin was administered at that time. What does the nurse need to assess for?

insulin shocks, nurse needs to assess LOC