FINAL COPY EXAM 4

What is happening in the body in type 1 diabetes mellitus?

Type 1 diabetes mellitus is an autoimmune disorder in which the body destroys pancreatic beta cells, resulting in little to no insulin production

What is happening in the body in type 2 diabetes mellitus?

Type 2 diabetes mellitus is a progressive disorder characterized by insulin resistance and decreased insulin production.

What causes type 1 diabetes mellitus?

Type 1 diabetes mellitus is caused by autoimmune destruction of pancreatic beta cells.

What causes type 2 diabetes mellitus?

Type 2 diabetes mellitus is caused by insulin resistance and decreased insulin production associated with obesity, sedentary lifestyle, and heredity.

What is metabolic syndrome and how is it related to type 2 diabetes mellitus?

Metabolic syndrome is a group of conditions including central obesity, hyperglycemia, hypertension, and hyperlipidemia that increase the risk of type 2 diabetes mellitus.

What findings support the diagnosis of type 1 diabetes mellitus?

Findings include polyuria, polydipsia, polyphagia, weight loss, and hyperglycemia.

What findings support the diagnosis of type 2 diabetes mellitus?

Findings include hyperglycemia and gradual onset of symptoms such as polyuria and polydipsia.

What is polyuria in diabetes mellitus?

Polyuria is excessive urination caused by osmotic diuresis from elevated blood glucose levels.

What is polydipsia in diabetes mellitus?

Polydipsia is excessive thirst caused by dehydration from increased urination.

What is polyphagia in diabetes mellitus?

Polyphagia is increased hunger caused by the inability of glucose to enter cells.

What causes weight loss in diabetes mellitus?

Weight loss occurs because the body breaks down fat and protein for energy when glucose cannot enter cells.

Which findings in type 1 diabetes mellitus or type 2 diabetes mellitus require immediate intervention?

Altered level of consciousness, severe hypoglycemia, severe hyperglycemia, dehydration, and Kussmaul respirations require immediate intervention.

What is hypoglycemia in type 1 diabetes mellitus and type 2 diabetes mellitus?

Hypoglycemia is a blood glucose level less than 70 milligrams per deciliter.

What are early signs of hypoglycemia in diabetes mellitus?

Early signs include sweating, tachycardia, palpitations, headache, confusion, and blurred vision.

What severe symptoms occur in hypoglycemia?

Severe symptoms include seizures, coma, and decreased level of consciousness.

What is the first priority nursing action for hypoglycemia in diabetes mellitus?

The nurse should administer 15 to 20 grams of a fast acting carbohydrate.

What are examples of fast acting carbohydrates used to treat hypoglycemia?

Examples include juice, regular soda, glucose tablets, honey, or hard candy.

What should the nurse do after treating hypoglycemia?

The nurse should recheck blood glucose in 15 minutes.

What should the nurse do if hypoglycemia persists?

The nurse should repeat treatment until blood glucose is above 70 milligrams per deciliter.

What should be done after blood glucose stabilizes in diabetes mellitus?

The client should eat a snack containing carbohydrates and protein.

What is the priority intervention for an unconscious client with hypoglycemia?

The nurse should administer glucagon or intravenous dextrose and place the client in a side lying position.

What are manifestations of hyperglycemia in type 1 diabetes mellitus and type 2 diabetes mellitus?

Manifestations include hot dry skin, dehydration, and fruity or acetone breath.

What type of respirations are seen in severe hyperglycemia in type 1 diabetes mellitus?

Kussmaul respirations are seen as the body attempts to correct metabolic acidosis.

What should the nurse do for hyperglycemia in diabetes mellitus?

The nurse should administer insulin and encourage sugar free fluids.

When should ketones be checked in diabetes mellitus?

Ketones should be checked when blood glucose levels are elevated.

What is diabetic ketoacidosis in type 1 diabetes mellitus?

Diabetic ketoacidosis is a life threatening condition caused by lack of insulin leading to hyperglycemia, metabolic acidosis, and ketone production.

What symptoms occur in diabetic ketoacidosis in type 1 diabetes mellitus?

Symptoms include polyuria, polydipsia, nausea, vomiting, abdominal pain, dehydration, and altered mental status.

What type of respirations occur in diabetic ketoacidosis?

Kussmaul respirations occur.

What breath odor is associated with diabetic ketoacidosis?

Fruity or acetone breath

What lab findings are seen in diabetic ketoacidosis?

Findings include blood glucose greater than 300 milligrams per deciliter, metabolic acidosis, and ketones in blood and urine.

What is the first priority treatment for diabetic ketoacidosis?

The first priority is fluid replacement with intravenous isotonic fluids.

What type of fluids are given first in diabetic ketoacidosis?

Zero point nine percent sodium chloride is given first.

What insulin is used in diabetic ketoacidosis?

Regular insulin is administered intravenously.

Why must potassium be monitored during treatment of diabetic ketoacidosis?

Insulin causes potassium to shift into cells, which can lead to hypokalemia.

What is the goal of treatment in diabetic ketoacidosis?

The goal is to correct dehydration, reduce blood glucose, and resolve metabolic acidosis.

How is diabetes mellitus diagnosed?

Diabetes mellitus is diagnosed using fasting blood glucose, random blood glucose, oral glucose tolerance testing, and hemoglobin A1C.

What is the normal fasting blood glucose level?

The normal fasting blood glucose level is 70 to 99 milligrams per deciliter.

What fasting blood glucose level indicates diabetes mellitus?

A fasting blood glucose level of 126 milligrams per deciliter or higher indicates diabetes mellitus.

What random blood glucose level indicates diabetes mellitus?

A random blood glucose level greater than 200 milligrams per deciliter with symptoms indicates diabetes mellitus.

What does hemoglobin A1C measure?

Hemoglobin A1C measures average blood glucose over the past 2 to 3 months.

What hemoglobin A1C level indicates diabetes mellitus?

A hemoglobin A1C level of 6.5 percent or higher indicates diabetes mellitus.

What is the target hemoglobin A1C for clients with diabetes mellitus?

The target hemoglobin A1C is less than 7 percent.

What medication is required for type 1 diabetes mellitus?

Insulin is required for type 1 diabetes mellitus.

What medication is first line for type 2 diabetes mellitus?

Metformin is first line for type 2 diabetes mellitus.

What class of medication is metformin?

Metformin is a biguanide.

How does metformin work in type 2 diabetes mellitus?

Metformin decreases liver glucose production, increases insulin sensitivity, and slows carbohydrate absorption.

What should the nurse monitor in a client taking metformin?

The nurse should monitor for gastrointestinal effects and lactic acidosis.

What should a client avoid while taking metformin?

The client should avoid alcohol.

What should the nurse monitor in diabetes mellitus?

The nurse should monitor blood glucose levels, hydration status, infection, neurological status, and vision changes.

What is the priority nursing action in diabetes mellitus?

The nurse should assess blood glucose levels first.

How does the nurse know treatment is effective in diabetes mellitus?

Treatment is effective when blood glucose levels return to the target range and symptoms improve.

What should a client with type 1 diabetes mellitus understand about insulin?

The client should understand that insulin is required for life and must be taken as prescribed.

What should a client with type 2 diabetes mellitus understand about treatment?

The client should understand that treatment includes diet, exercise, medications, and possibly insulin.

What should a client with diabetes mellitus know about meal timing?

The client should eat meals at consistent times to maintain stable blood glucose levels

What should a client with diabetes mellitus know about carbohydrate intake?

The client should monitor carbohydrate intake and understand that one carbohydrate serving equals 15 grams.

What should a client with diabetes mellitus know about exercise?

The client should exercise regularly but avoid exercise if ketones are present.

What blood glucose range is safe for exercise?

Exercise should occur when blood glucose is between 80 and 250 milligrams per deciliter.

What should a client do when sick with diabetes mellitus?

The client should continue medications, monitor blood glucose frequently, and stay hydrated.

How often should blood glucose be checked during illness?

Blood glucose should be checked every 2 to 4 hours.

When should ketones be checked during illness?

Ketones should be checked when blood glucose exceeds 240 milligrams per deciliter.

When should the provider be notified in diabetes mellitus?

The provider should be notified if blood glucose is greater than 250 milligrams per deciliter or symptoms worsen.

What should a client with diabetes mellitus do for foot care?

The client should inspect feet daily, keep them clean and dry, and wear properly fitting shoes.

What should a client avoid in foot care?

The client should avoid walking barefoot and using over the counter callus removers

What statement by a client with diabetes mellitus shows understanding?

I will monitor my blood glucose regularly and take my medications as prescribed.

What statement indicates a need for further teaching in diabetes mellitus?

I can skip meals after taking insulin.

What complications occur in diabetes mellitus?

Complications include cardiovascular disease, neuropathy, nephropathy, and retinopathy.

What is the first priority nursing action for a client with type 1 diabetes mellitus or type 2 diabetes mellitus who has symptoms of hypo or hyperglycemia?

The nurse should check the client’s blood glucose level.

What is the first priority nursing action for a conscious client with hypoglycemia in type 1 diabetes mellitus or type 2 diabetes mellitus?

The nurse should administer 15 to 20 grams of a fast acting carbohydrate.

What is the first priority nursing action for an unconscious client with hypoglycemia in diabetes mellitus?

The nurse should administer glucagon or intravenous dextrose and place the client in a side lying position.

What is the first priority nursing action for a client with hyperglycemia in type 1 diabetes mellitus or type 2 diabetes mellitus?

The nurse should check the blood glucose level and administer insulin as prescribed.

What is the first priority nursing action for a client with suspected diabetic ketoacidosis in type 1 diabetes mellitus?

The nurse should begin fluid replacement with intravenous isotonic fluids.

What is the priority intervention before administering insulin in a client with suspected hypoglycemia?

The nurse should check the blood glucose level.

What is the first priority when a client with diabetes mellitus has a blood glucose level of 52 milligrams per deciliter and is conscious?

The nurse should immediately give 15 grams of a fast acting carbohydrate.

What is the priority nursing action if a client with diabetes mellitus is NPO and has type 1 diabetes mellitus?

The nurse should continue basal insulin to prevent diabetic ketoacidosis.

What is the first priority nursing action when a client with diabetes mellitus has altered level of consciousness?

The nurse should assess blood glucose level immediately.

What is the priority nursing action for preventing complications in diabetes mellitus?

The nurse should maintain blood glucose levels within the target range.

What is the priority nursing action when administering insulin?

The nurse should monitor for signs of hypoglycemia.

What is the priority nursing action when treating diabetic ketoacidosis after fluids are started?

The nurse should administer intravenous regular insulin.

What is the priority nursing action regarding potassium in diabetic ketoacidosis?

The nurse should monitor potassium levels closely and replace potassium as needed.

What is the first priority when a client with diabetes mellitus reports symptoms of sweating, confusion, and shakiness?

The nurse should assess blood glucose and treat for hypoglycemia

What is the priority nursing action when a client with diabetes mellitus is sick?

The nurse should instruct the client to continue medications and monitor blood glucose frequently.