Med Surg Ch 44 Coordinating Care for Patients with Diabetes

Med Surg Ch 44 Coordinating Care for Patients with Diabetes Mellitus ScienceMedicine ccrosariol Save The nurse understands that type 1 DM is caused by which of the following conditions?(Select all that apply.)

• Gestational diabetes
• A history of mumps or rubella
• Family history of autoimmune disorders
• Autoimmune destruction of the beta cells of the pancreas
• Obesity

Answer: B and D

Rationale: Type I DM is caused by an autoimmune process in which the insulin-producing beta cells of the pancreas are destroyed. Triggers are not fully understood, but a history of mumps or rubella are sometimes implicated.

The nurse monitors for which clinical manifestations in the patient newly diagnosed with type

• DM? (Select all that apply.)
• Polyuria
• Fatigue
• Weight loss
• Polyphagia

E Decreased appetite

Answer: A, B, C, and D

Rationale: Fatigue, polyuria, weight loss, and polypha- gia are all clinical manifestations.Glucose is typically totally reabsorbed in the renal tubules. Hyperglycemia results in glucose excretion in the urine, which creates an osmotic effect that effectively reduces water reab- sorption into the renal tubules, leading to excessive volume loss through the kidneys.Hyperglycemia also causes hyperosmolarity in the blood, which causes a shift of fluid from the intracellular space to the vascu- lar space. The loss of intracellular water combined with the volume loss through the kidneys creates excessive thirst in the patient, or polydipsia. The lack of insulin necessary to move glucose into the cells leads to the breakdown of proteins and fat as a source of energy. This starvation of the cells leads to polyphagia, increased appetite. Despite an increased appetite lead- ing to consumption of large amounts of food, the continual breakdown of fats and proteins leads to weight loss and fatigue.The nurse correlates which laboratory value with the diagnosis of DM?

• Fasting blood glucose greater than 140 mg/dL
• Hemoglobin A1c, 5.8%
• Random blood glucose, 150 mg/dL
• OGTT, 155 mg/dL

Answer: A

Rationale: A fasting blood glucose greater than 140 mg/dL indicates DM. The other values are indicative of prediabetes.

The charge nurse is reviewing orders for a newly admitted patient with type 1 DM. It is a priority for the charge nurse to follow up with the provider about which order?

• NovoLog insulin subcutaneous at bedtime
• NovoLog insulin subcutaneous 15 minutes prior to meals
• Basal insulin subcutaneous at bedtime
• Correctional and nutritional insulin administered immediately after the meal

Answer: A

Rationale: NovoLog is a fast acting insulin reserved for correctional or prandial insulin— administration at bedtime without adequate nutritional intake may result in hypoglycemia.The nurse correlates which laboratory values as a diagnostic for DKA? (Select all that apply.)

• Serum bicarbonate of 15 mEq/L
• Negative anion gap
• Serum glucose of 350 mg/dL
• Positive anion gap
• Arterial pH of 7.36

Answer: A, C, and D

Rationale: In diabetes ketoacidosis, there is inadequate insulin for cells to obtain adequate glucose for normal metabolism. The body attempts to obtain energy by the rapid breakdown of fat stores, releasing fatty acids from adipose tissues. The liver converts the fatty acids into ketone bodies, which can serve as an energy source in the absence of glucose. The ketone bodies, however, have a low pH, resulting in a metabolic acidosis, a low serum bicarbonate, and a positive anion gap. The absence of insulin also results in an increased release of hormones such as glucagon and cortisol in response to inadequate glucose transport into the cells. This leads to gluconeogenesis and glycogenolysis, resulting in severe hyperglycemia.

The nurse should intervene immediately if a patient has which blood glucose level?

• 200 mg/dL B. 152 mg/dL
• 80 mg/dL D. 40 mg/dL

Answer: D

Rationale: As the brain can only use glucose for

its metabolic functions, a glucose of 40 requires immediate treatment to avoid potential irreversible CNS dysfunction.The nurse recognizes that blood glucose monitoring before meals and at bedtime is done to achieve which outcome? (Select all that apply.)

• Maintain glycemic control.
• Prevent complications of long-term hyperglycemia.
• Facilitate insulin administration that mimics the healthy pancreas.
• Provide frequent practice with the finger stick technique.
• Prevent acute complications of type 1 diabetes.

Answer: A, B, and C

Rationale: Blood glucose monitoring before meals and at bedtime facilitates insulin administration that mim- ics the healthy pancreas which helps maintain glycemic control and prevents complications of long-term hyper- glycemia. The goal is not frequent practice.Acute com- plications can occur independent of glucose monitoring such as infection or stress which increase glucose needs.The nurse is screening patients for the risk of developing type 2 DM. The nurse should consider which patients at risk? (Select all that apply.)

• Women with a history of gestational diabetes
• Women with a history of multiple births
• Men with a history of pancreatic cancer D. Men who are overweight or obese
• Men and women with cardiovascular disease

Answer: A, D, and E

Rationale: Multiple births or a history of pancreatic cancer do not increase the risk of type 2 DM. Pancre- atic cancer may result in surgically induced type

• DM.