DM
The three P's of hyperglycemia?
Polyuria, polyphagia, polydipsia
A patient with DKA what indicates that the body is attempting to compensate for metabolic acidosis?
Kussmaul respirations (rapid, deep, labored breathing).
True or False: DKA and HHS mainly occur in type 2 diabetics.
FALSE, DKA is mostly in type 1, HHS is mostly in type 2
To prevent recurrence in a female patient with frequent UTIs, what is the best health promotion instruction the nurse should provide?
Wipe from front to back
A client with asthma is restless, using accessory muscles, and can only speak 2–3 words at a time. What is the nurse’s priority intervention?
Administer a short-acting bronchodilator (albuterol).
A patient is prescribed 10 units of Regular insulin and 20 units of NPH. In what order should the nurse draw up the medication?
Insert air into the cloudy, insert air into the clear, draw up the clear, draw up the cloudy
s/s of DKA
Fruity or acetone-scented breath, Presence of ketones in the urine (ketonuria), Abdominal pain, nausea, and vomiting, Blood glucose between 300-600, Positive Anion Gap.
What is the best cue to differentiate HHS from DKA?
Extreme hyperglycemia (often >600mg/dL) and severe dehydration without ketosis or acidosis.
In an older adult patient, name the most important atypical cue the nurse should recognize as a potential sign of a UTI.
Acute confusion or altered mental status.
What increases the risk for obstructive sleep apnea?
& What interventions/patient teaching is important?
Obesity, Large neck circumference, Hypertension
CPAP therapy at night, Weight reduction, Avoid alcohol before sleep, Side-lying sleep position
s/s of hypoglycemia
Diaphoresis (sweating)
Tremors or shakiness
Palpitations/Tachycardia
Irritability or anxiety
The elderly patient with type 2 diabetes mellitus presents to the clinic with a fever and productive cough. The diagnosis of pneumonia is made. You notice tenting skin, deep tongue furrows, and vital signs of 110/80 mm Hg, 120 beats/minute, and 24 breaths/minute. What assessment is important for you to obtain and why?
A. Blood glucose
B. Orthostatic blood pressures
C. Urine ketones
D. Temperature
A. Blood glucose
HHS is typically seen in patients with type 2 diabetes and infection, such as pneumonia.
What fluids are used for treatment of HHS?
Isotonic (0.9% NS) solutions
(5% Dextrose 0.45% NS may be added when the glucose has reached 300 mg/dL)
A patient has a uric acid stone; what is the best dietary recommendation to prevent future stones?
Low-purine diet (avoiding organ meats, sardines, etc.).
A patient with asthma is prescribed Fluticasone. What is the best instruction to prevent complications when taking this medication?
Rinse the mouth with water and spit after each use (to prevent thrush).
A patient is prescribed Glargine (long-acting) and Lispro (rapid-acting) insulin. What is the best instruction regarding administration?
They must be administered in two separate syringes; Glargine cannot be mixed with any other insulin.
A patient is admitted with Diabetic Ketoacidosis. The physician orders intravenous fluids of 0.9% Normal Saline and 10 units of intravenous regular insulin IV bolus. The patient’s labs are the following: pH 7.25, Glucose 455, potassium 2.5. Which of the following is the most appropriate nursing intervention to perform next?
Hold the insulin and notify the prescriber of the potassium level of 2.5
HHNS presents _______ (suddenly/gradually) and the patient will experience early signs such as _______, _______, and EXTREME ____glycemia
GRADUALLY, POLYURIA, POLYDIPSIA, and extreme HYPERglycemia
A patient with a 10mm renal stone has a sudden drop in urine output to 10mL/hr. What is the nurse's priority action?
Notify the prescriber (<30mL/hr)
Bacterial pneumonia assessment findings
Dullness on percussion over affected lobes
Use of accessory muscles for breathing
Pleuritic chest pain (pain on inspiration)
Increased tactile fremitus
A patient is found unconscious and clammy with a history of Type 1 Diabetes. What is the best first-line emergency intervention if no IV access exists?
Administer Glucagon IM or Subcutaneously.
Osmotic diuresis is present in HHNS and DKA due to the kidney's inability to reabsorb the excessive glucose which causes glucose to leak into the urine which in turn causes extra water and electrolytes to be excreted. TRUE OR FALSE
TRUE
A patient undergoing treatment for Hyperglycemic Hyperosmolar Nonketotic Syndrome has a blood glucose of 799 and potassium >3.5. The doctor has ordered IV fluids and IV Regular insulin therapy. What is the nurse concerned about?
Prior to insulin administration for HHNS the potassium level should be >3.5 because insulin causes potassium to enter back to the cell, which will cause further hypokalemia.
A client undergoes a transurethral resection of the prostate (TURP) for BPH. Postoperatively, the nurse notes bright red urine with clots in the continuous bladder irrigation (CBI) drainage bag. What is the priority nursing intervention?
Increase the flow rate of the continuous bladder irrigation.
A patient with community-acquired pneumonia is prescribed intravenous antibiotics. Before administering the first dose, which nursing action is most critical?
Collect the sputum specimen first!!!!! then initiate the antibiotic therapy.