Chapter 29: Nursing Management: Diabetes Mellitus

Chapter 29: Nursing Management: Diabetes Mellitus ScienceMedicineNursing mzimme01781 Save Chapter 29: (Nursing Management: ...38 terms mikayla_walker Preview

Chapter 30: Diabetes Mellitus 1-4

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18 terms aman_virk9Preview Ch 30 C 23 terms Tam A nurse is caring for a client with type 1 diabetes who exhibits confusion, light-headedness, and aberrant behavior. The client is conscious. The

nurse should first administer:

15 to 20 g of a fast-acting carbohydrate such as orange juice.

ex:

This client is experiencing hypoglycemia. Because the client is conscious, the nurse should first administer a fast-acting carbohydrate, such as orange juice, hard candy, or honey. If the client has lost consciousness, the nurse should administer I.M. or subcutaneous glucagon or an I.V.bolus of dextrose 50%. The nurse shouldn't administer insulin to a client who's hypoglycemic; this action will further compromise the client's condition.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 carries glucose into body cells.ex Insulin carries glucose into body cells as their preferred source of energy. Besides, it promotes the liver's storage of glucose as glycogen and inhibits the breakdown of glycogen back into glucose. Insulin does not aid in gluconeogenesis but inhibits the breakdown of glycogen back into glucose. Insulin does not have an effect on the intestinal absorption of glucose.A client with diabetes mellitus has a blood glucose level of 40 mg/dL. Which rapidly absorbed carbohydrate would be most effective?1/2 cup fruit juice or regular soft drink

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In a client with hypoglycemia, the nurse uses the rule of 15: give 15 g of rapidly absorbed carbohydrate, wait 15 minutes, recheck the blood sugar, and administer another 15 g of glucose if the blood sugar is not above 70 mg/dL. One-half cup fruit juice or regular soft drink is equivalent to the recommended 15 g of rapidly absorbed carbohydrate. Eight ounces of skim milk is equivalent to the recommended 15 g of rapidly absorbed carbohydrate. One tablespoon of honey or syrup is equivalent to the recommended 15 g of rapidly absorbed carbohydrate.Six to eight LifeSavers candies is equivalent to the recommended 15 g of rapidly absorbed carbohydrate.

A 16-year-old client newly diagnosed with type 1 diabetes has a very low body weight despite eating regular meals. The client is upset because friends frequently state, “You look anorexic.” Which statement by the nurse would be the best response to help this client understand the cause of weight loss due to this condition?"Your body is using protein and fat for energy instead of glucose."

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Persons with type 1 diabetes, particularly those in poor control of the condition, tend to be thin because when the body cannot effectively utilize glucose for energy (no insulin supply), it begins to break down protein and fat as an alternate energy source. Clients may be underweight at the onset of type 1 diabetes because of rapid weight loss from severe hyperglycemia. The goal initially may be to provide a higher-calorie diet to regain lost weight and blood glucose control.What is the only insulin that can be given intravenously?Regular

ex:

Insulins other than regular are in suspensions that could be harmful if administered IV.A client has been recently diagnosed with type 2 diabetes, and reports continued weight loss despite increased hunger and food consumption.

This condition is called:

polyphagia

ex:

While the needed glucose is being wasted, the body's requirement for fuel continues. The person with diabetes feels hungry and eats more (polyphagia). Despite eating more, they lose weight as the body uses fat and protein to substitute for glucose.A client with diabetes mellitus is receiving an oral antidiabetic agent. When caring for this client, the nurse should observe for signs of: hypoglycemia

ex:

The nurse should observe the client receiving an oral antidiabetic agent for the signs of hypoglycemia. The time when the reaction might occur is not predictable and could be from 30 to 60 minutes to several hours after the drug is ingested.Which clinical characteristic is associated with type 2 diabetes (previously referred to as non-insulin-dependent diabetes mellitus)?Blood glucose can be controlled through diet and exercise

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Oral hypoglycemic agents may improve blood glucose concentrations if dietary modification and exercise are unsuccessful. Individuals with type 2 diabetes are usually obese at diagnosis. Individuals with type 2 diabetes rarely demonstrate ketosis, except with stress or infection.Individuals with type 2 diabetes do not demonstrate islet cell antibodies.Which combination of adverse effects should a nurse monitor for when administering IV insulin to a client with diabetic ketoacidosis?Hypokalemia and hypoglycemia

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Blood glucose needs to be monitored in clients receiving IV insulin because of the risk of hyperglycemia or hypoglycemia. Hypoglycemia might occur if too much insulin is administered. Hypokalemia, not hyperkalemia, might occur because I.V. insulin forces potassium into cells, thereby lowering the plasma level of potassium. Calcium and sodium levels aren't affected by IV insulin administration.

Which of the following factors would a nurse identify as a most likely cause of diabetic ketoacidosis (DKA) in a client with diabetes?The client has eaten and has not taken or received insulin.

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If the client has eaten and has not taken or received insulin, DKA is more likely to develop. Hypoglycemia is more likely to develop if the client has not consumed food and continues to take insulin or oral antidiabetic medications, if the client has not consumed sufficient calories, or if client has been exercising more than usual.A client with type 1 diabetes asks the nurse about taking an oral antidiabetic agent. The nurse explains that these medications are effective only if

the client:

has type 2 diabetes.

ex:

Oral antidiabetic agents are effective only in adult clients with type 2 diabetes. Oral antidiabetic agents aren't effective in type 1 diabetes.Pregnant and lactating clients aren't ordered oral antidiabetic agents because the effect on the fetus or breast-fed infant is uncertain.The client with diabetes asks the nurse why shoes and socks are removed at each office visit. The nurse gives which assessment finding as the explanation for the inspection of feet?Sensory neuropathy

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Neuropathy results from poor glucose control and decreased circulation to nerve tissues. Neuropathy involving sensory nerves located in the periphery can lead to lack of sensitivity, which increases the potential for soft tissue injury without client awareness. The client's feet are inspected on each visit to ensure no injury or pressure has occurred. Autonomic neuropathy, retinopathy, and nephropathy affect nerves to organs other than feet.The nurse is preparing to administer intermediate-acting insulin to a client with diabetes. Which insulin will the nurse administer?

NPH

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Intermediate-acting insulins are called NPH insulin (neutral protamine Hagedorn) or Lente insulin. Lispro (Humalog) is rapid acting, Iletin II is short acting, and glargine (Lantus) is very long acting.Which clinical characteristic is associated with type 1 diabetes (previously referred to as insulin-dependent diabetes mellitus)?Presence of islet cell antibodies

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Individuals with type 1 diabetes often have islet cell antibodies and are usually thin or demonstrate recent weight loss at the time of diagnosis.These individuals are prone to experiencing ketosis when insulin is absent and require exogenous insulin to preserve life.Which information should be included in the teaching plan for a client receiving glargine, a "peakless" basal insulin?Do not mix with other insulins.

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Because glargine is in a suspension with a pH of 4, it cannot be mixed with other insulins because this would cause precipitation. When administering glargine insulin, it is very important to read the label carefully and to avoid mistaking Lantus insulin for Lente insulin and vice versa.

A client with diabetes mellitus is receiving an oral antidiabetic agent. The nurse observes for which condition when caring for this client?Hypoglycemia

ex:

The nurse should observe the client receiving an oral antidiabetic agent for signs of hypoglycemia. The time when the reaction might occur is not predictable and could be from 30 to 60 minutes to several hours after the drug is ingested. Polyuria, polydipsia, and blurred vision are symptoms of diabetes mellitus.A nurse is preparing to administer insulin to a child who's just been diagnosed with type 1 diabetes. When the child's parent stops the nurse in the hall, the parent is crying and anxious to talk about their child's condition. The nurse's best response is: "I'm going to give your child some insulin. Then I'll be happy to talk with you."

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Attending to the parent's needs is a critical part of caring for a sick child. In this case however, administering insulin in a prompt manner supersedes the parent's needs. By informing the parent that administering the insulin is the priority and then they will make time to talk, the nurse recognizes the parent's needs as legitimate. The nurse provides a reasonable response while attending to the priority of administering insulin as soon as possible. Telling the parent that they can't talk or telling the parent to wait for the health care provider could increase the parent's fear and anxiety. The nurse shouldn't tell the parent that everything will be fine; the nurse doesn't know that everything will be fine.Which instruction about insulin administration should a nurse give to a client?"Always follow the same order when drawing the different insulins into the syringe."

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The nurse should instruct the client to always follow the same order when drawing the different insulins into the syringe. Insulin should never be shaken because the resulting froth prevents withdrawal of an accurate dose and may damage the insulin protein molecules. Insulin should never be frozen because the insulin protein molecules may be damaged. The client doesn't need to discard intermediate-acting insulin if it's cloudy; this finding is normal.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

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Metformin is a biguanide and, along with the thiazolidinediones (rosiglitazone and pioglitazone), are categorized as insulin sensitizers; they help tissues use available insulin more efficiently. Glyburide and glipizide, which are sulfonylureas, and repaglinide, a meglitinide, are described as being insulin releasers because they stimulate the pancreas to secrete more insulin.Which is a characteristic of type 2 diabetes?insulin resistance The nurse is administering lispro insulin. Based on the onset of action, how long before breakfast should the nurse administer the injection?10 to 15 minutes A diabetic client using insulin reports weight gain. Which response from the nurse explains the most likely cause of the weight increase?Insulin is an anabolic hormone.