CH. 51
Diabeetus
Diabeetus
Which statement by a nurse to a patient newly diagnosed with type 2 diabetes is correct?
a. Insulin is not used to control blood glucose in patients with type 2 diabetes.
b. Complications of type 2 diabetes are less serious than those of type 1 diabetes.
c. Changes in diet and exercise may control blood glucose levels in type 2 diabetes.
d.Type 2 diabetes is usually diagnosed when the patient is admitted with a hyperglycemic coma.
C. Changes in diet and exercise may control blood glucose levels in type 2 diabetes
For some patients with type 2 diabetes, changes in lifestyle are sufficient to achieve blood glucose control. Insulin is frequently used for type 2 diabetes, complications are equally severe as for type 1 diabetes, and type 2 diabetes is usually diagnosed with routine laboratory testing or after a patient develops complications such as frequent yeast infections.
A nurse is aware of the high incidence and prevalence of fluid volume deficit among older adults. What related health education should the nurse provide to an older adult?
A) If possible, try to drink at least 4 liters of fluid daily.
B) Ensure that you avoid replacing water with other beverages.
C) Remember to drink frequently, even if you don’t feel thirsty.
D) Make sure you eat plenty of salt in order to stimulate thirst.
C. Remember to drink frequently, even if you don't feel thirsty
The nurse emphasizes the need to drink throughout the day even if the patient does not feel thirsty, because the thirst stimulation is decreased. Four liters of daily fluid intake is excessive and fluids other than water are acceptable in most cases. Additional salt intake is not recommended as a prompt for increased fluid intake.
A 42-year-old woman comes to the clinic complaining of occasional urinary incontinence when she sneezes. The clinic nurse should recognize what type of incontinence?
A) Stress incontinence
Stress incontinence is the involuntary loss of urine through an intact urethra as a result of sudden increase in intra-abdominal pressure. Reflex incontinence is loss of urine due to hyperreflexia or involuntary urethral relaxation in the absence of normal sensations usually associated with voiding. Overflow incontinence is an involuntary urine loss associated with overdistension of the bladder. Functional incontinence refers to those instances in which the function of the lower urinary tract is intact, but other factors (outside the urinary system) make it difficult or impossible for the patient to reach the toilet in time for voiding.
what technique must you use to help prevent peritonitis during peritoneal dialysis?
aseptic technique
What are symptoms of pyelonephritis? name at least 2
flank pain, high fever, malaise, WBCs & bacteria in urine, urinary symptoms similar to cystitis
A 48-year-old male patient screened for diabetes at a clinic has a fasting plasma glucose level of 120 mg/dL (6.7 mmol/L). The nurse will plan to teach the patient about
a. self-monitoring of blood glucose.
b. using low doses of regular insulin.
c. lifestyle changes to lower blood glucose.
d. effects of oral hypoglycemic medications.
C. life style changes to lower blood glucose
The patient’s impaired fasting glucose indicates prediabetes, and the patient should be counseled about lifestyle changes to prevent the development of type 2 diabetes. The patient with prediabetes does not require insulin or oral hypoglycemics for glucose control and does not need to self-monitor blood glucose.
Results of a patient’s 24-hour urine sample indicate osmolality of 510 mOsm/kg, which is within reference range. What conclusion can the nurse draw from this assessment finding?
A) The patient’s kidneys are capable of maintaining acidbase balance.
B) The patient’s kidneys can produce sufficiently concentrated urine.
C) The patient’s kidneys reabsorb most of the potassium that the patient ingests.
D) The patient’s kidneys are producing sufficient erythropoietin.
B. The patient's kidneys can produce sufficiently concentrated urine
Osmolality is the most accurate measurement of the kidney’s ability to dilute and concentrate urine. Osmolality is not a direct indicator of renal function as it relates to erythropoietin synthesis or maintenance of acidbase balance. It does not indicate the maintenance of healthy levels of potassium, the vast majority of which is excreted.
The nurse is caring for acutely ill patient. What assessment finding should prompt the nurse to inform the physician that the patient may be exhibiting signs of acute kidney injury (AKI)?
A) The patient is complains of an inability to initiate voiding.
B) The patient’s urine is cloudy with a foul odor.
C) The patient complains of acute flank pain.
D) The patient’s average urine output has been 10 mL/hr for several hours.
D) The patient’s average urine output has been 10 mL/hr for several hours.
Oliguria (<500 mL/d of urine) is the most common clinical situation seen in AKI. Flank pain and inability to initiate voiding are not characteristic of AKI. Cloudy, foul-smelling urine is suggestive of a urinary tract infection.
What should you always assess for in someone with an A/V fistula?
bruit and thrills
To prevent the production of kidney stones what nursing education would you provide?
avoid large amounts of protein, lower sodium intake, drink plenty of fluids, prevent dehydration, anti-gout meds
A 55-year-old female patient with type 2 diabetes has a nursing diagnosis of imbalanced nutrition: more than body requirements. Which goal is most important for this patient?
a. The patient will reach a glycosylated hemoglobin level of less than 7%.
b. The patient will follow a diet and exercise plan that results in weight loss.
c. The patient will choose a diet that distributes calories throughout the day.
d. The patient will state the reasons for eliminating simple sugars in the diet.
A. The patient will reach a glycosylated hemoglobin level of less than 7%
The complications of diabetes are related to elevated blood glucose, and the most important patient outcome is the reduction of glucose to near-normal levels. The other outcomes also are appropriate but are not as high in priority.
A nurse is caring for a patient with impaired renal function. A creatinine clearance measurement has been ordered. The nurse should facilitate collection of what samples?
A) A fasting serum potassium level and a random urine sample
B) A 24-hour urine specimen and a serum creatinine level midway through the urine collection process
C) A BUN and serum creatinine level on three consecutive mornings
D) A sterile urine specimen and an electrolyte panel, including sodium, potassium, calcium, and phosphorus values
B) A 24-hour urine specimen and a serum creatinine level midway through the urine collection process
To calculate creatinine clearance, a 24-hour urine specimen is collected. Midway through the collection, the serum creatinine level is measured.
The nurse is caring for a patient suspected of having renal dysfunction. When reviewing laboratory results for this patient, the nurse interprets the presence of which substances in the urine as most suggestive of pathology?
A) Glucose and protein
B) Potassium and sodium
C) Bicarbonate and urea
D) Creatinine and chloride
A) Glucose and protein
The various substances normally filtered by the glomerulus, reabsorbed by the tubules, and excreted in the urine include sodium, chloride, bicarbonate, potassium, glucose, urea, creatinine, and uric acid. Within the tubule, some of these substances are selectively reabsorbed into the blood. Glucose is completely reabsorbed in the tubule and normally does not appear in the urine. However, glucose is found in the urine if the amount of glucose in the blood and glomerular filtrate exceeds the amount that the tubules are able to reabsorb. Protein molecules are also generally not found in the urine because amino acids are also filtered at the level of the glomerulus and reabsorbed so that it is not excreted in the urine.
What are the 3 types of acute kidney injury? and name examples of each.
Prerenal – hypoprofusion of kidneys (before kidney)
Intrarenal – damage to kidney tissue (in kidney)
Postrenal – obstructed urine flow (past kidney)
What education would you provide to a patient in order to help prevent UTIs?
shower, clean from front to back, drink lots of fluids daily, avoid coffee, colas, tea, alcohol, void q2-3 hours, and empty bladder completely
When mixing intermediate and short acting insulin which insulin do you draw up first?
remember clear before cloudy!!!
The nurse is assessing a patient’s bladder by percussion. The nurse elicits dullness after the patient has voided. How should the nurse interpret this assessment finding?
A) The patient’s bladder is not completely empty.
B) The patient has kidney enlargement.
C) The patient has a ureteral obstruction.
D) The patient has a fluid volume deficit.
A) The patient’s bladder is not completely empty.
Dullness to percussion of the bladder following voiding indicates incomplete bladder emptying. Enlargement of the kidneys can be attributed to numerous conditions such as polycystic kidney disease or hydronephrosis and is not related to bladder fullness. Dehydration and ureteral obstruction are not related to bladder fullness; in fact, these conditions result in decreased flow of urine to the bladder.
A patient with type 1 diabetes has told the nurse that his most recent urine test for ketones was positive. What is the nurse’s most plausible conclusion based on this assessment finding?
A) The patient should withhold his next scheduled dose of insulin.
B) The patient should promptly eat some protein and carbohydrates.
C) The patient would benefit from a dose of metformin (Glucophage).
D) The patient’s insulin levels are inadequate.
D) The patient’s insulin levels are inadequate.
Ketones in the urine signal that there is a deficiency of insulin and that control of type 1 diabetes is deteriorating. Withholding insulin or eating food would exacerbate the patient’s ketonuria. Metformin will not cause short-term resolution of hyperglycemia.
What is the difference between nephrotic and nephritic syndrome?
Nephritic Syndrome: hematuria, oliguria, azotemia, hypertension
Stress
Urge
Functional
Iatrogenic
Overflow
Mixed
•Stress – involuntary loss of urine thru intact urethra when sneezing, coughing, most often in women s/p vaginal delivery, men – after prostate surgery
•Urge – involuntary loss of urine associate with strong urge to void but cannot reach toilet in time, in pts with neurological dysfunction of bladder
•Functional – lower tract functions but other factors prevent make it difficult or impossible for patient to get to bathroom, dementia or physical impairments
•Iatrogenic – involuntary loss of urine d/t extrinsic medical factors, medications
•Overflow - involuntary loss of urine d/t over distention of bladder
•Mixed urinary - includes more than one type
After change-of-shift report, which patient will the nurse assess first?
a. 19-year-old with type 1 diabetes who was admitted with possible dawn phenomenon
b. 35-year-old with type 1 diabetes whose most recent blood glucose reading was 230 mg/dL
c. 60-year-old with hyperosmolar hyperglycemic syndrome who has poor skin turgor and dry oral mucosa
d. 68-year-old with type 2 diabetes who has severe peripheral neuropathy and complains of burning foot pain
C. 60-year-old with hyperosmolar hyperglycemic syndrome who has poor skin turgor and dry oral mucosa
The patient’s diagnosis of HHS and signs of dehydration indicate that the nurse should rapidly assess for signs of shock and determine whether increased fluid infusion is needed. The other patients also need assessment and intervention but do not have life-threatening complications.
The nurse is preparing to collect an ordered urine sample for urinalysis. The nurse should be aware that this test will include what assessment parameters? Select all that apply.
A) Specific gravity of the patient’s urine
B) Testing for the presence of glucose in the patient’s urine
C) Microscopic examination of urine sediment for RBCs
D) Microscopic examination of urine sediment for casts
E) Testing for BUN and creatinine in the patient’s urine
A, B, C, D
Urine testing includes testing for specific gravity, glucose, RBCs, and casts. BUN and creatinine are components of serum, not urine.
A medical nurse is caring for a patient with type 1 diabetes. The patient’s medication administration record includes the administration of regular insulin three times daily. Knowing that the patient’s lunch tray will arrive at 11:45, when should the nurse administer the patient’s insulin?
A) 10:45
B) 11:15
C) 11:45
D) 11:50
B) 11:15
Regular insulin is usually administered 2030 min before a meal. Earlier administration creates a risk for hypoglycemia; later administration creates a risk for hyperglycemia.
The nurse is caring for a patient postoperative day 4 following a kidney transplant. When assessing for potential signs and symptoms of rejection, what assessment should the nurse prioritize?
A) Assessment of the quantity of the patient’s urine output
B) Assessment of the patient’s incision
C) Assessment of the patient’s abdominal girth
D) Assessment for flank or abdominal pain
A. Assessment of the quantity of the patient's urine output
After kidney transplantation, the nurse should perform all of the listed assessments. However, oliguria is considered to be more suggestive of rejection than changes to the patient’s abdomen or incision.
For urinary incontinence what type of treatments would be done?