pathophysiology
Pathophysiology of type 1 versus type 2 diabetes mellitus.
What is autoimmune destruction of beta cells resulting in minimal or no insulin production and increased insulin resistance?
Nursing considerations when administering rapid-acting insulin (Lispro/Aspart).
What is give with meals, hold if patient is NPO?
A patient with diabetes states they “don’t feel low blood sugars anymore.” Explain what this indicates and why it is dangerous.
What is hypoglycemia unawareness, where repeated low glucose episodes blunt the body’s warning signs? This is dangerous because the patient may not recognize hypoglycemia until severe symptoms like confusion or loss of consciousness occur.
A patient with diabetes walks barefoot at home. Explain why the nurse should intervene.
What is neuropathy reduces sensation, so injuries may go unnoticed? Walking barefoot increases risk of cuts, infections, and ulcers, which can progress to serious complications like amputation.
A patient presents with confusion and is suspected of having either hypoglycemia or stroke. Explain the nurse’s priority action and rationale.
What is the nurse should check blood glucose immediately, because hypoglycemia can mimic stroke and is rapidly reversible? Delaying treatment could result in brain injury.
A patient with long-standing Type 2 Diabetes Mellitus develops peripheral neuropathy. Explain how chronic hyperglycemia leads to nerve damage.
What is chronic hyperglycemia damages blood vessels supplying nerves, causing inflammation and impaired nerve conduction?
A patient is prescribed both a sulfonylurea and insulin. Explain why this combination increases the risk of hypoglycemia.
What is sulfonylureas stimulate pancreatic insulin release, while exogenous insulin adds additional insulin? Together, they can cause excess insulin levels, significantly increasing risk for hypoglycemia.
A patient in DKA is being treated with IV fluids and insulin. Explain why potassium levels must be continuously monitored during treatment.
What is as insulin is administered, potassium shifts back into cells, which can rapidly cause hypokalemia. This can lead to cardiac arrhythmias, so potassium must be monitored and replaced as needed.
A patient with diabetes is advised to pair carbohydrates with protein. Explain how this helps stabilize blood glucose levels.
What is protein slows digestion and glucose absorption, preventing rapid spikes and drops in blood sugar, leading to more stable glucose control.
A patient with suspected DKA has labs pending. Explain why the nurse should not delay fluid resuscitation while waiting for confirmation.
What is DKA causes severe dehydration and hypovolemia? Delaying fluids worsens perfusion and can lead to shock. Early fluid resuscitation is critical even before labs confirm diagnosis.
What is the patient lacks insulin, so glucose cannot enter cells, so the body switches to fat breakdown for energy? This produces ketones, causing metabolic acidosis. Kussmaul respirations occur as a compensatory mechanism (respiratory alkalosis), where the lungs blow off CO₂ (acid) to help raise the pH.
A diabetic patient on a beta-blocker experiences hypoglycemia but does not report palpitations. Explain how the medication alters the presentation of hypoglycemia.
What is beta-blockers suppress the sympathetic nervous system, which normally causes tachycardia during hypoglycemia. This masks early warning signs, making hypoglycemia harder to detect until changes in level of consciousness occur.
A patient on an insulin drip has hourly glucose checks ordered. Explain the rationale for this frequency of monitoring.
IV insulin acts rapidly and can cause quick drops in blood glucose? Frequent monitoring ensures safe titration and prevents complications like severe hypoglycemia.
A diabetic patient becomes dizzy after exercise. Explain why checking blood glucose before exercise is important.
What is exercise increases glucose utilization by muscles, which can lower blood sugar levels? If glucose is already low, exercise can precipitate hypoglycemia. Checking beforehand allows for preventive carbohydrate intake.
A nurse is caring for a patient with hypoglycemia who becomes unresponsive. IV access is present. Explain why IV dextrose is preferred over glucagon in this situation.
What is IV dextrose works immediately by directly increasing blood glucose, whereas glucagon depends on liver glycogen stores and takes longer? With IV access available, dextrose is faster and more reliable.
A patient in hyperglycemic crisis develops hypotension and tachycardia. Explain the pathophysiologic process linking hyperglycemia to these hemodynamic changes.
What is osmotic diuresis, where glucose pulls water into urine and causes massive fluid loss? This leads to hypovolemia, resulting in hypotension and compensatory tachycardia to maintain perfusion.
A patient in DKA has a potassium level of 3.0 mEq/L and is prescribed IV insulin. Explain the nurse's next actions.
What is the RN will question the order because insulin drives potassium into cells, which will further lower serum potassium? Since the patient is already hypokalemic, giving insulin can cause severe hypokalemia, leading to dangerous cardiac arrhythmias. Potassium must be corrected first.
An unconscious patient with hypoglycemia receives IM glucagon. Explain why the nurse should place the patient in a side-lying position immediately after administration.
What is glucagon can cause vomiting? Since the patient is unconscious and lacks a protective gag reflex, placing them on their side prevents aspiration, which could lead to airway obstruction or aspiration pneumonia.
A nurse teaches a patient to rotate insulin injection sites. Explain why this practice is important for glucose control and two common injection sites.
What is repeated injections in the same site can cause lipodystrophy, which alters insulin absorption? This leads to unpredictable glucose control, making blood sugar harder to manage. The two most common injection sites are abdominal tissue and the back of the arm.
The nurse is assessing multiple diabetic patients. One patient has a blood glucose of 42 mg/dL and is confused and diaphoretic. Explain why this patient is the highest priority compared to a patient with severe hyperglycemia.
What is hypoglycemia is more immediately life-threatening because the brain depends on glucose for function? Severe hypoglycemia can rapidly lead to seizures, coma, or death, whereas hyperglycemia typically develops complications more gradually.
A patient with Type 1 Diabetes Mellitus is admitted with DKA. Labs show glucose 520 mg/dL, potassium 5.6 mEq/L, and metabolic acidosis. Explain why the patient is hyperkalemic despite total body potassium depletion.
What is in DKA, lack of insulin and acidosis cause potassium to shift out of cells into the bloodstream, leading to elevated serum potassium? However, due to osmotic diuresis, the body is actually losing potassium in urine, so total body potassium is depleted despite high lab values.
A patient taking metformin is scheduled for a contrast CT scan. Explain why the nurse should hold this medication and what complication is being prevented.
What is metformin is held because it is cleared by the kidneys and contrast can impair kidney function? If metformin accumulates due to decreased renal clearance, it increases the risk of lactic acidosis due to the buildup of lactate in the bloodstream.
A patient in hyperglycemic crisis is treated with IV fluids before insulin. Explain why fluid resuscitation is prioritized over insulin administration.
What is severe hyperglycemia causes osmotic diuresis, leading to profound dehydration? IV fluids will correct hypovolemia and dilute serum glucose.
A diabetic patient on dialysis is scheduled to receive lisinopril before treatment. Explain the nurse's next actions.
What is check blood pressure and hold if too low because dialysis removes fluid, which can lower blood pressure? Giving antihypertensives beforehand increases the risk of hypotension, which can compromise perfusion and cause dizziness or syncope.
A patient in DKA is started on insulin therapy. Shortly after, ECG changes show flattened T waves and U waves. Explain what is happening and why this is a concern.
What is insulin is causing potassium to shift into cells, leading to hypokalemia? This is dangerous because low potassium can cause life-threatening cardiac arrhythmias, as reflected in ECG changes.