#why
2 medications/conditions/therapies that may require additional insulin be administered.
Steroids, Phenytoin (Dilantin), TPN, stressful event (surgery)
You are caring for a type 2 DM patient who states they are lightheaded. They last ate 3 hours ago. What intervention is most appropriate?
Check BG via fingerstick, pt could be hypoglycemic
These types of fluids are utilized to rehydrate a patient DKA. Name 1 type of IVF.
Initially an isotonic solution, the change to hypotonic when BG <300mg/dl (0.45% saline)
Why would a client have an elevated BG in the morning even after taking evening insulin?
The Somogyl effect: when the insulin causes a decrease in BG and the release of hormones causes a rebound increase to attempt homeostasis.
5 symptoms of a patient with hypoglycemia.
Agitation, “hangry”, tachycardic, diaphoretic, headache, shakiness, fatigue.
Name 3 symptoms of a patient in DKA.
Confusion, disorientation, thirst, weight loss, tachycardiac, hypotensive, kussmaul’s respirations
What is the major difference between DKA and HHS?
Lack of serum/ketones
Diagnostic tests of HHS
BG >600, serum osmolality >350, CBC, ABG, BUN, electrolytes
Normal fasting glucose level, 3 month indicator of glucose control, and targeted glucose range
<100, HgbA1C (<6.5) and 80-110
Explain the pathophysiology of Type 1 DM
Autoimmune illness, body attacks beta cells within pancrea→ unable to produce insulin
A type 2 DM patient is preparing for surgery. What education will be needed?
Do not take insulin/oral anti-diabetic agents the day of surgery. Maintain NPO status.
3 education points for the patient with neuropathy
Inspect feet daily, wear flat shoes, do not use heating pads, no lotion between toes, cut nails straight across, etc.
Name four ways that a client is screened for type 2 DM
BBOL: BP, BG, Obesity, and Lipids
Patient’s blood glucose level is 68 and they feel lightheaded. What intervention would you provide?
Give juice (orange or apple) and recheck glucose in 15 minutes. If not elevated in 15 min, repeat juice and recheck in 15 min. Once elevated, give complex carb (milk, graham crackers) and evaluate the cause of hypoglycemia.
What ABG findings would a patient with DKA have?
Metabolic acidosis, low PH 7.2, low HCo3 <16, generally low CO2 follows as the respiratory system tries to buffer acidosis in the body.
What is the best way to prevent diabetes associated complications
Meticulous blood glucose control
Name three common causes of HHS
Infection, dialysis, medications (thiazide-diuretics for BP management)
When might a patient need check their glucose levels- name 4 incidence
Prior to administering insulin, prior to meals, if they feel “low”-hypoglycemic, if they feel ‘high’-hyperglycemic, before exercising, before bed
What is a priority intervention for a patient with DKA?
Safety, glucose management, hydration with IVF, potassium management, and hourly BG checks
The Type 1 patient is at home ill with a viral infection. What 3 pieces of nursing education might the clinic nurse provide?
Check bG every 2-4 hours, consume fluids without added sugar, administer ordered insulin, avoid strenuous exercise, monitor for s/s of DKA
How might a patient describe neuropathy? What medications would help to treat this condition?
Tingling, burning, shooting pain, gabapentin (neurontin), pregabalin (lyrica)
The nurse is caring for a client diagnosed with type 1 diabetes mellitus experiencing the Somogyl effect. Which blood glucose results and treatment would the nurse expect?
0300 blood glucose 68 mg/dL and 0700 blood glucose 200 mg/dL. Instruct to decrease amount of evening insulin.
2 QUESTIONS MUST GET BOTH RIGHT!! (MUAHA)
What is relatively normal BG until about 3 am, when the levels begin to rise?
What is the treatment?
Change time of injection of evening intermediate-acting insulin (NPH) from dinner time to bed time
What is the importance of Kussmaul’s respiration’s? (3 things)
Blow off carbon dioxide, correct metabolic acidosis, cause respiratory compensation
What assessment findings are consistent with diabetic ketoacidosis?
Polyuria, polydipsia, polyphagia, dry mouth