Chapter 56: Concepts of Care for Patients With Diabetes

Chapter 56: Concepts of Care for Patients With Diabetes

Mellitus chromevrt Save b. "Your brain needs a constant supply of glucose because it cannot store it." Because the brain cannot synthesize or store significant amounts of glucose, a continuous supply from the body's circulation is needed to meet the fuel demands of the central nervous system. The nurse would want to educate the patient to prevent hypoglycemia. The body can use other sources of fuel, including fat and protein, and glucose is not involved in the production of red blood cells. Glucose in the blood will encourage glucose metabolism but is not directly responsible for lactic acid formation.A nurse is teaching a client with diabetes mellitus who asks, "Why is it necessary to maintain my blood glucose levels no lower than about 60 mg/dL (3.3 mmol/L)?" How would the nurse respond?

• "Glucose is the only fuel used by the body to produce the energy that it needs."
• "Your brain needs a constant supply of glucose because it cannot store it."
• "Without a minimum level of glucose, your body does not make red blood cells."
• "Glucose in the blood prevents the formation of lactic acid and prevents acidosis."

• Abdominal obesity

The client at risk for metabolic syndrome typically has hypertension, abdominal obesity, hyperlipidemia, and hyperglycemia.The nurse is assessing a client for risk of developing metabolic syndrome. Which risk factor is associated with this health condition?

• Hypotension
• Hyperthyroidism
• Abdominal obesity
• Hypoglycemia
• "Diabetes can cause blindness, so I should see the ophthalmologist yearly."

Diabetic retinopathy is a leading cause of blindness in North America. All clients with diabetes, regardless of age, should be examined by an ophthalmologist (rather than an optometrist or optician) at diagnosis and at least yearly thereafter.After teaching a young adult client who is newly diagnosed with type 1 diabetes mellitus, the nurse assesses the client's understanding. Which statement made by the client indicates a correct understanding of the need for eye examinations?

• "At my age, I should continue seeing the ophthalmologist as I usually do."
• "I will see the eye doctor when I have a vision problem and yearly after age 40."
• "My vision will change quickly. I should see the ophthalmologist twice a year."
• "Diabetes can cause blindness, so I should see the ophthalmologist yearly."

• Examine the client's feet for signs of injury.

Diabetic neuropathy is common when the disease is of long duration. The client is at great risk for injury in any area with decreased sensation because he or she is less able to feel injurious events. Feet are common locations for neuropathy and injury, so the nurse would inspect them for any signs of injury. After assessment, the nurse would document findings in the client's chart. Testing sensory perception in the hands may or may not be needed. The primary health care provider can be notified after assessment and documentation have been completed.A nurse assesses a client who has a 15-year history of diabetes and notes decreased tactile sensation in both feet. What action would the nurse take first?

• Document the finding in the client's chart.
• Assess tactile sensation in the client's hands.
• Examine the client's feet for signs of injury.
• Notify the primary health care provider.

• "Your risk of diabetes is higher than the general population, but it may not occur."

Risk for type 1 diabetes is determined by inheritance of genes coding for HLA-DR and HLA-DQ tissue types. Clients who have one parent with type 1 diabetes are at increased risk for its development. Diabetes (type 1) seems to require interaction between inherited risk and environmental factors, so not everyone with these genes develops diabetes. The other statements are not accurate.A nurse cares for a client who has a family history of diabetes mellitus. The client states, "My father has type 1 diabetes mellitus. Will I develop this disease as well?" How would the nurse respond?

• "Your risk of diabetes is higher than the general population, but it may not occur."
• "No genetic risk is associated with the development of type 1 diabetes mellitus."
• "The risk for becoming a diabetic is 50% because of how it is inherited."
• "Female children do not inherit diabetes mellitus, but male children will."
• "Maintain tight glycemic control and prevent hyperglycemia."

Hyperglycemia is a critical factor in the pathogenesis of long-term diabetic complications.Maintaining tight glycemic control will help delay the onset of complications. Restricting fluid intake is not part of the treatment plan for patients with diabetes. Preventing hypoglycemia and ketosis, although important, is not as important as maintaining daily glycemic control.A nurse teaches a client who is diagnosed with diabetes mellitus. Which statement would the nurse include in this client's plan of care to delay the onset of microvascular and macrovascular complications?

• "Maintain tight glycemic control and prevent hyperglycemia."
• "Restrict your fluid intake to no more than 2 L a day."
• "Prevent hypoglycemia by eating a bedtime snack."
• "Limit your intake of protein to prevent ketoacidosis."