CH 44: DIABETES MELLITUS + HYPEROSMOLAR HYPERGLYCEMIC STATE

CH 44: diabetes mellitus NOTE: these are only the zoom review topics. i will create another one, where the final study guide contents are present as an "NGN REVIEW"

(12) An older patient with type 1 diabetes mellitus has poor oral intake. What should be considered to ensure adequate blood glucose control?

1) Hold all prandial doses

2) Consider increasing longer-acting insulin

3) Increase the frequency of correctional doses

4) Administer prandial and correctional insulin together

ANS: 4

patients with poor food intake (4) takes their prandial and correctional together, after ensuring the carb intake.

→ prandial insulin: meal time insuline

→ correctional insulin: rapid-acting when gljucose is high

→ both the meds are taken after (EVEN IF PRANDIAL IS USUALLY GIVEN BEFORE), because the nurse will not be able to gauge how much the patinet will eat. t

→ administering prandial before: risk of hypoglycemia due to too much insulin, if patient ate less than what the nurse expected

Rapid acting insuling (Humalog): should be given when food is ready

(17) A patient with type 1 diabetes mellitus is preparing to play tennis. What should be done first before engaging in this physical activity?

1) Drink 1 liter of fluid

2) Measure blood glucose level

3) Eat one serving of carbohydrate

4) Take a dose of prescribed medication

ANS: 2

when a type I diabetes patient is going to tdo exercise it is approprioate to (2) measure blood glucose level first. the patient does need some supplemental glucose to evade hypoglycemia, but the BG needs to measure first before hyperglycewmia can then occur due to too much sugar.

exercise + potential hypoglycemia — check blood glucose before activity

(18) A patient with type 2 diabetes mellitus is being evaluated for hyperosmolar hyperglycemic state (HHS). Which finding would be consistent with this medical diagnosis?

1) pH 7.31

2) Abdominal pain

3) Blood glucose 250 mg/dL

4) Serum bicarbonate 28 mEq/L

ANS: 4

a patient with HHS will have a (4) high serum bicarbonate (higher than 15)

• alkaline pH (higher than 7.4) (1)

• extremely high blood glucose (higher than 600) (3)

• NO abdominal pain
  
  → HHS: a serious complicaiton of type 2 diabetes mellitus that is composed of

• extremely high blood glucose

• high blood osmolality (thick, concentrated blood)

• altered mental status

HHS manifestsations: dehydration, thirst, dry skin ,glycosuria

HHS lab findings: pH > 7.4 and bicarbonate > 15

(25) A medication regimen is being planned for a patient newly diagnosed with type 1 diabetes mellitus. For which reasons should the nurse instruct the patient to self-administer doses of insulin? Select all that apply.

1) Basal

2) Prandial

3) Deficient

4) Excessive

5) Correctional

ANS: 1,2,5

lantus = long-acting insulin