HESI Case Study: Diabetes Mellitus

HESI Case Study: Diabetes Mellitus

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HESI Case Study: Diabetes Mellitus

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HESI C

25 terms MsC What is the mechanism that results in Kussmaul respirations?

• To compensate for metabolic acidosis, the respirations are deep and rapid.
• To overcome respiratory acidosis, the respirations are fast and shallow.
• Injury to the brain's respiratory center results in periods of apnea.
• Hypoxemia causes labored, gasping, and irregular respirations.
• To compensate for metabolic acidosis, the respirations are deep and rapid.

Rationale: To compensate for the ketoacidosis (metabolic acidosis), the lungs attempt to remove CO2 through a pattern of deep, rapid respirations referred to as Kussmaul respirations.To achieve the goal of restoring the client's fluid volume, the nurse would expect to implement which intervention?

• Insert a saline lock for PRN diuretic administration.
• Administer an albumin/furosemide continuous infusion.
• Maintain an infusion of normal saline solution.
• Obtain a type and crossmatch for 2 units of packed RBCs.
• Maintain an infusion of normal saline solution.

Rationale: The treatment of hyperglycemia includes fluid replacement to correct dehydration caused by the increased concentration of glucose in the blood. Isotonic fluids, such as normal saline, are used initially to treat the dehydration.

To restore the client's blood glucose to a normal level, what should the nurse prepare to administer?

• An IV infusion containing regular insulin.
• Humulin-N insulin SC before meals.
• 50% dextrose IV push.
• Glucagon subcutaneously PRN per sliding scale.
• An IV infusion containing regular insulin.

Rationale: Continuous IV infusions containing regular insulin are used to reduce the client's blood glucose level. The client's IV solution will be changed to one that contains glucose when her blood glucose level reaches 250 mg/dl.In addition to monitoring the client's blood glucose level, what additional lab values should the nurse monitor carefully? (Select all that apply.One, some, or all options may be correct.)

• Uric acid.
• Hemoglobin.
• Calcium.
• Potassium.
• Blood Urea Nitrogen (BUN).

B, C, D, E.

Rationale: Though blood glucose and potassium are the most critical lab values to assess, hemoglobin levels may be altered related to the state of hydration and should be monitored. Treatment with an IV insulin infusion will cause the potassium to return to the cells and may result in hypokalemia. Lara should be closely monitored for symptoms of hypokalemia. Supplemental potassium may be added to the IV infusion to prevent or correct this. Dehydration that occurs with DKA can lead to an increased BUN and should be monitored for signs of renal insufficiency.

Ethical-Legal Issues: Client Information

The client's blood glucose level stabilizes, and they begin taking oral fluids. IV solutions are switched to dextrose 5% in sodium chloride 0.45% at a keep-open rate, and the insulin infusion is discontinued.While hospitalized, family members and many of the client's college friends call the nursing unit to check on the client's condition.The nurse's decision about what to tell these callers should be based on what primary consideration?

• The instructions of the nursing unit supervisor.
• The nature of the caller's relationship to the client.
• The seriousness of the client's condition at the time of the call.
• The client's right to privacy regarding her health information.
• The client's right to privacy regarding her health information.

Rationale: The Health Information Privacy Protection Act (HIPAA) stipulates that a client has the right to privacy regarding health information and must give permission for the release of that information.

A student nurse is assigned to work with the charge nurse in caring for the client during their acute illness. The student tells the nurse that they plan to present information about the client to fellow students during a post-clinical conference, and asks the charge nurse for permission to copy the client's lab data to take to the conference.Which response is best for the charge nurse to provide?

• Information about the client cannot be removed from the nursing unit.
• The lab values can be copied as long as there is no identifying client data.
• Since this is for educational purposes, you can remove any information you need.
• Your instructor should tell you what information you are allowed to copy.
• The lab values can be copied as long as there is no identifying client data.

Rationale: Information used for educational purposes may be shared, as long as the data does not permit identification of the client.Manifestations: Once the acute ketoacidosis is controlled, the client is told that they have Type 1 diabetes mellitus. The nurse obtains the client's history. The client states that prior to the flu, they had been healthy. However, the client had noticed that they had been eating more than normal, but had not been gaining any weight. The client also states that they had been drinking a lot of diet colas and that got up at night frequently to go to the bathroom.The nurse identifies that the client has experienced classic symptoms of diabetes, which are:

• Dysuria, dyspepsia, and dysphagia.
• Polyuria, polyphagia, and polydipsia.
• Abnormal diet, drink, and distention.
• Increased metabolism, increased fluid volume, and increased urgency.
• Polyuria, polyphagia, and polydipsia.

Rationale: Increased urinary output (polyuria), increased appetitie (polyphagia), and increased thirst (polydipsia) are the three classic manifestations of diabetes mellitus.The client tells the nurse that they know that diabetes is a chronic condition and realizes that they probably had it for a while. The client asks why didn't they experience any symptoms before now.How should the nurse respond?

• The symptoms were so minor that you just didn't notice them until you got the flu.
• The type of diabetes you have is the acute form of diabetes, rather than the chronic form.
• The onset of symptoms is so gradual that your body adjusts to the changes.
• The symptoms have an abrupt onset that is often brought on by a viral illness, like the flu.
• The symptoms have an abrupt onset that is often brought on by a viral illness, like the flu.

Rationale: Since Type 1 diabetes seems to involve an interaction of genetic predisposition with an environmental trigger, the onset of symptoms is often abrupt, following an illness such as the flu.

Therapeutic Communication: The client states that they wish they hadn't gotten the flu so that the diabetes wouldn't have been discovered, and they could keep having a normal life.What is the best initial response by the nurse?

• What do you mean when you say a normal life?
• It's better to find out now before complications develop.
• Perhaps you would like to speak to someone who has diabetes.
• It must be quite a shock to learn that you have diabetes.
• It must be quite a shock to learn that you have diabetes.

Rationale: This statement acknowledges the client's feelings, and is open-ended, allowing the client to continue to verbalize their feelings if they wish.The client starts to cry and says that the nurse has no idea how awful this is and asks to be left alone.What is the best response by the nurse?

• I'll leave you alone for now, but I will stop back by in 30 minutes.
• I'll notify the diabetes counselor that you need a visit right away.
• You shouldn't be by yourself right now. I'll stay here with you.
• You need to express your feelings. Tell me more about what you are feeling.
• I'll leave you alone for now, but I will stop back by in 30 minutes.

Rationale: This response respects the client's request to be left alone, but the nurse is offering support and physical presence.Insulin: The goal of treatment with hypoglycemic agents is the maintenance of stable blood glucose levels to prevent the acute complications of hypoglycemia and hyperglycemia, and the long-term complications associated with hyperglycemia. The client will initially be taking 70% NPH/30% regular insulin subcutaneously every a.m., a sliding-scale dose of regular insulin subcutaneously before lunch and dinner, and NPH (N) insulin at bedtime.Which statement made by the client indicates that they correctly understands self-administration of insulin?

• My daily dose of 70% NPH/30% regular insulin is based on how much I ate the day before.
• The amount of short-acting insulin I take every day is based on my blood sugar readings.
• I should store my insulin in the refrigerator and remove it 30 minutes before I need it.
• I will alternate my injection sites from leg to abdomen each day to avoid overuse.
• The amount of short-acting insulin I take every day is based on my blood sugar readings.

Rationale: Sliding scale refers to the administration of a dose of regular (short-acting) insulin based on the client's current blood glucose level.The nurse observes the client administer their morning dose of insulin. The client pinches the skin on the front of their thigh and inserts the needle at a 90-degree angle.What action should the nurse implement?

• Advise the client to remove the needle and reinsert it at a 45-degree angle.
• Instruct the client to pull the plunger back slightly before injecting the insulin.
• Tell the client to remove the needle, and draw up a new dose of insulin.
• Encourage the client to inject the insulin with the needle in place, as inserted.
• Encourage the client to inject the insulin with the needle in place, as inserted.

Rationale: The client has performed the steps for subcutaneous injection correctly. Since aspiration is not necessary, the client is ready to inject the insulin.