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Medical-Surgical Nursing Critical Thinking in Patient Care Fifth Edition CHAPTER 20 Nursing Care of Medical-Surgical Nursing Critical Thinking in Patient Care Fifth Edition CHAPTER 20 Nursing Care of Patients with Diabetes Mellitus Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition Priscilla Le. Mone • Karen Burke • Gerene Bauldoff Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Directory • NCLEX-RN® REVIEW Test Questions • Lecture Note Presentation Medical-Surgical Nursing: Critical Thinking Directory • NCLEX-RN® REVIEW Test Questions • Lecture Note Presentation Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition Priscilla Le. Mone • Karen Burke • Gerene Bauldoff Copyright © 2011 by Pearson Education, Inc. All rights reserved.

NCLEX-RN® REVIEW Test Questions Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition Priscilla NCLEX-RN® REVIEW Test Questions Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition Priscilla Le. Mone • Karen Burke • Gerene Bauldoff Copyright © 2011 by Pearson Education, Inc. All rights reserved.

NCLEX-RN® REVIEW Test Question 1 1. Increased susceptibility to the development of type 1 NCLEX-RN® REVIEW Test Question 1 1. Increased susceptibility to the development of type 1 DM is indicated by which of the following? 1. 2. 3. 4. genetic markers that determine immune response persistent obesity throughout the adolescent years delivery of a baby that weighs less than 6 lb excessive amounts of plasma glucagon Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition Priscilla Le. Mone • Karen Burke • Gerene Bauldoff Copyright © 2011 by Pearson Education, Inc. All rights reserved.

NCLEX-RN® REVIEW Test Question 1 Response 1. Increased susceptibility to the development of type NCLEX-RN® REVIEW Test Question 1 Response 1. Increased susceptibility to the development of type 1 DM is indicated by which of the following? 1. genetic markers that determine immune response 2. persistent obesity throughout the adolescent years 3. delivery of a baby that weighs less than 6 lb 4. excessive amounts of plasma glucagon Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition Priscilla Le. Mone • Karen Burke • Gerene Bauldoff Copyright © 2011 by Pearson Education, Inc. All rights reserved.

NCLEX-RN® REVIEW Test Question 1 Rationale Ninety-five percent of patients diagnosed with type 1 NCLEX-RN® REVIEW Test Question 1 Rationale Ninety-five percent of patients diagnosed with type 1 DM have genetic markers indicating increased susceptibility for the development of type 1 DM. Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition Priscilla Le. Mone • Karen Burke • Gerene Bauldoff Copyright © 2011 by Pearson Education, Inc. All rights reserved.

NCLEX-RN® REVIEW Test Question 2 2. Diabetic ketoacidosis is the result of which pathologic NCLEX-RN® REVIEW Test Question 2 2. Diabetic ketoacidosis is the result of which pathologic process? 1. An excess amount of insulin drives all glucose into the cells. 2. A decreased amount of glucagon causes low protein levels. 3. A deficit of insulin causes fat stores to be used as an energy source. 4. An increase occurs in the breakdown of glucose molecules with hypoglycemia. Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition Priscilla Le. Mone • Karen Burke • Gerene Bauldoff Copyright © 2011 by Pearson Education, Inc. All rights reserved.

NCLEX-RN® REVIEW Test Question 2 Response 2. Diabetic ketoacidosis is the result of which NCLEX-RN® REVIEW Test Question 2 Response 2. Diabetic ketoacidosis is the result of which pathologic process? 1. An excess amount of insulin drives all glucose into the cells. 2. A decreased amount of glucagon causes low protein levels. 3. A deficit of insulin causes fat stores to be used as an energy source. 4. An increase occurs in the breakdown of glucose molecules with hypoglycemia. Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition Priscilla Le. Mone • Karen Burke • Gerene Bauldoff Copyright © 2011 by Pearson Education, Inc. All rights reserved.

NCLEX-RN® REVIEW Test Question 2 Rationale A deficit of insulin increases the liver’s production NCLEX-RN® REVIEW Test Question 2 Rationale A deficit of insulin increases the liver’s production of ketone bodies and increased release of free fatty acids. Bicarbonate production is decreased and acid buffering is impaired, resulting in metabolic acidosis. Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition Priscilla Le. Mone • Karen Burke • Gerene Bauldoff Copyright © 2011 by Pearson Education, Inc. All rights reserved.

NCLEX-RN® REVIEW Test Question 3 3. Which of the following patients would be most NCLEX-RN® REVIEW Test Question 3 3. Which of the following patients would be most at risk for the development of type 2 DM? 1. young adult who is a professional basketball player 2. middle-aged man who maintains normal weight 3. middle-aged woman who is the sole caretaker of her parents 4. woman over age 70 who is overweight and sedentary Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition Priscilla Le. Mone • Karen Burke • Gerene Bauldoff Copyright © 2011 by Pearson Education, Inc. All rights reserved.

NCLEX-RN® REVIEW Test Question 3 Response 3. Which of the following patients would be NCLEX-RN® REVIEW Test Question 3 Response 3. Which of the following patients would be most at risk for the development of type 2 DM? 1. young adult who is a professional basketball player 2. middle-aged man who maintains normal weight 3. middle-aged woman who is the sole caretaker of her parents 4. woman over age 70 who is overweight and sedentary Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition Priscilla Le. Mone • Karen Burke • Gerene Bauldoff Copyright © 2011 by Pearson Education, Inc. All rights reserved.

NCLEX-RN® REVIEW Test Question 3 Rationale Caloric need decreases with aging; unless dietary intake NCLEX-RN® REVIEW Test Question 3 Rationale Caloric need decreases with aging; unless dietary intake also decreases (and exercise increases), weight gain ensues. Obesity is a risk factor for the development of type 2 DM. Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition Priscilla Le. Mone • Karen Burke • Gerene Bauldoff Copyright © 2011 by Pearson Education, Inc. All rights reserved.

NCLEX-RN® REVIEW Test Question 4 4. A nurse notes that a patient has a NCLEX-RN® REVIEW Test Question 4 4. A nurse notes that a patient has a nursing diagnosis of Peripheral Neurovascular Dysfunction involving both feet. Which of the following assessments would support this diagnosis? 1. 2. 3. 4. normal sensation to touch loss of normal reflexes states “I can’t feel my feet anymore. ” states “I have been having chest pain. ” Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition Priscilla Le. Mone • Karen Burke • Gerene Bauldoff Copyright © 2011 by Pearson Education, Inc. All rights reserved.

NCLEX-RN® REVIEW Test Question 4 Response 4. A nurse notes that a patient has NCLEX-RN® REVIEW Test Question 4 Response 4. A nurse notes that a patient has a nursing diagnosis of Peripheral Neurovascular Dysfunction involving both feet. Which of the following assessments would support this diagnosis? 1. 2. 3. 4. normal sensation to touch loss of normal reflexes states “I can’t feel my feet anymore. ” states “I have been having chest pain. ” Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition Priscilla Le. Mone • Karen Burke • Gerene Bauldoff Copyright © 2011 by Pearson Education, Inc. All rights reserved.

NCLEX-RN® REVIEW Test Question 4 Rationale Changes in sensation, such as numbness or tingling, NCLEX-RN® REVIEW Test Question 4 Rationale Changes in sensation, such as numbness or tingling, support this diagnosis. Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition Priscilla Le. Mone • Karen Burke • Gerene Bauldoff Copyright © 2011 by Pearson Education, Inc. All rights reserved.

NCLEX-RN® REVIEW Test Question 5 5. Which of the following statements would indicate that NCLEX-RN® REVIEW Test Question 5 5. Which of the following statements would indicate that a patient understands teaching about foot care at home? 1. “I will walk barefooted as long as I am in the house. ” 2. “I always buy my shoes as soon as the stores open. ” 3. “I will check my feet for cuts and bruises every night. ” 4. “If I get a blister, I just put alcohol on it and bandage it. ” Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition Priscilla Le. Mone • Karen Burke • Gerene Bauldoff Copyright © 2011 by Pearson Education, Inc. All rights reserved.

NCLEX-RN® REVIEW Test Question 5 Response 5. Which of the following statements would indicate NCLEX-RN® REVIEW Test Question 5 Response 5. Which of the following statements would indicate that a patient understands teaching about foot care at home? 1. “I will walk barefooted as long as I am in the house. ” 2. “I always buy my shoes as soon as the stores open. ” 3. “I will check my feet for cuts and bruises every night. ” 4. “If I get a blister, I just put alcohol on it and bandage it. ” Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition Priscilla Le. Mone • Karen Burke • Gerene Bauldoff Copyright © 2011 by Pearson Education, Inc. All rights reserved.

NCLEX-RN® REVIEW Test Question 5 Rationale Visual inspection of the feet each day is NCLEX-RN® REVIEW Test Question 5 Rationale Visual inspection of the feet each day is important in preventing more serious complications. Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition Priscilla Le. Mone • Karen Burke • Gerene Bauldoff Copyright © 2011 by Pearson Education, Inc. All rights reserved.

NCLEX-RN® REVIEW Test Question 6 6. Lantus and detemir insulin, long-acting insulins, have a NCLEX-RN® REVIEW Test Question 6 6. Lantus and detemir insulin, long-acting insulins, have a unique insulin characteristic that increases the risk for administration error. The nurse understands that which of the following applies to this long-acting insulin? 1. It is combined with glucose to raise energy levels. 2. It is subject to being inactivated by light and must be kept cold. 3. It is a clear solution like regular insulin, unlike other intermediate and long-acting insulins. 4. It is activated by vigorous agitation. Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition Priscilla Le. Mone • Karen Burke • Gerene Bauldoff Copyright © 2011 by Pearson Education, Inc. All rights reserved.

NCLEX-RN® REVIEW Test Question 6 Response 6. Lantus and detemir insulin, long-acting insulins, have NCLEX-RN® REVIEW Test Question 6 Response 6. Lantus and detemir insulin, long-acting insulins, have a unique insulin characteristic that increases the risk for administration error. The nurse understands that which of the following applies to this long-acting insulin? 1. It is combined with glucose to raise energy levels. 2. It is subject to being inactivated by light and must be kept cold. 3. It is a clear solution like regular insulin, unlike other intermediate and long-acting insulins. 4. It is activated by vigorous agitation. Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition Priscilla Le. Mone • Karen Burke • Gerene Bauldoff Copyright © 2011 by Pearson Education, Inc. All rights reserved.

NCLEX-RN® REVIEW Test Question 6 Rationale Since it is clear, Lantus (glargine) could be NCLEX-RN® REVIEW Test Question 6 Rationale Since it is clear, Lantus (glargine) could be confused with regular insulin. Regular insulin is short acting in 4 to 6 hours and Lantus is long acting in 24 to 28 hours. Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition Priscilla Le. Mone • Karen Burke • Gerene Bauldoff Copyright © 2011 by Pearson Education, Inc. All rights reserved.

NCLEX-RN® REVIEW Test Question 7 7. The nurse is preparing an insulin infusion for NCLEX-RN® REVIEW Test Question 7 7. The nurse is preparing an insulin infusion for a patient in diabetic ketoacidosis (DKA). She is careful to select which type of insulin that can be administered intravenously? 1. 2. 3. 4. glargine NPH regular Humalog Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition Priscilla Le. Mone • Karen Burke • Gerene Bauldoff Copyright © 2011 by Pearson Education, Inc. All rights reserved.

NCLEX-RN® REVIEW Test Question 7 Response 7. The nurse is preparing an insulin infusion NCLEX-RN® REVIEW Test Question 7 Response 7. The nurse is preparing an insulin infusion for a patient in diabetic ketoacidosis (DKA). She is careful to select which type of insulin that can be administered intravenously? 1. 2. 3. 4. glargine NPH regular Humalog Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition Priscilla Le. Mone • Karen Burke • Gerene Bauldoff Copyright © 2011 by Pearson Education, Inc. All rights reserved.

NCLEX-RN® REVIEW Test Question 7 Rationale Only regular insulin can safely be administered intravenously NCLEX-RN® REVIEW Test Question 7 Rationale Only regular insulin can safely be administered intravenously for diabetic ketoacidosis. Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition Priscilla Le. Mone • Karen Burke • Gerene Bauldoff Copyright © 2011 by Pearson Education, Inc. All rights reserved.

NCLEX-RN® REVIEW Test Question 8 8. Glycosylated hemoglobin (A 1 C) is useful for NCLEX-RN® REVIEW Test Question 8 8. Glycosylated hemoglobin (A 1 C) is useful for evaluating the degree of blood glucose control the patient with DM has been maintaining for the previous 2 to 3 months. The ADA recommends a diagnosis of DM at what A 1 C level? 1. 2. 3. 4. > 15% > 9% > 6. 5% > 2. 25% Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition Priscilla Le. Mone • Karen Burke • Gerene Bauldoff Copyright © 2011 by Pearson Education, Inc. All rights reserved.

NCLEX-RN® REVIEW Test Question 8 Response 8. Glycosylated hemoglobin (A 1 C) is useful NCLEX-RN® REVIEW Test Question 8 Response 8. Glycosylated hemoglobin (A 1 C) is useful for evaluating the degree of blood glucose control the patient with DM has been maintaining for the previous 2 to 3 months. The ADA recommends a diagnosis of DM at what A 1 C level? 1. 2. 3. 4. > 15% > 9% > 6. 5% > 2. 25% Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition Priscilla Le. Mone • Karen Burke • Gerene Bauldoff Copyright © 2011 by Pearson Education, Inc. All rights reserved.

NCLEX-RN® REVIEW Test Question 8 Rationale Levels of Hgb A 1 C greater than NCLEX-RN® REVIEW Test Question 8 Rationale Levels of Hgb A 1 C greater than 6. 5% demonstrate elevated or erratic glucose control over time and support a diagnosis of DM. Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition Priscilla Le. Mone • Karen Burke • Gerene Bauldoff Copyright © 2011 by Pearson Education, Inc. All rights reserved.

NCLEX-RN® REVIEW Test Question 9 9. A patient with increased ACTH levels and Addison’s NCLEX-RN® REVIEW Test Question 9 9. A patient with increased ACTH levels and Addison’s disease is likely to manifest which of the following? 1. 2. 3. 4. It should be given intravenously. It should be chilled to slow absorption. It should be given with intravenous glucose. It should be combined with long-acting insulin. Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition Priscilla Le. Mone • Karen Burke • Gerene Bauldoff Copyright © 2011 by Pearson Education, Inc. All rights reserved.

NCLEX-RN® REVIEW Test Question 9 Response 9. A patient with increased ACTH levels and NCLEX-RN® REVIEW Test Question 9 Response 9. A patient with increased ACTH levels and Addison’s disease is likely to manifest which of the following? 1. 2. 3. 4. It should be given intravenously. It should be chilled to slow absorption. It should be given with intravenous glucose. It should be combined with long-acting insulin. Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition Priscilla Le. Mone • Karen Burke • Gerene Bauldoff Copyright © 2011 by Pearson Education, Inc. All rights reserved.

NCLEX-RN® REVIEW Test Question 9 Rationale No intermediate- or long-acting insulin is given the NCLEX-RN® REVIEW Test Question 9 Rationale No intermediate- or long-acting insulin is given the day of surgery since dietary intake postoperatively is uncertain. IV glucose (5%) and regular insulin in equally divided doses will compensate for the increase in serum glucose until the patient is eating and drinking normally. Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition Priscilla Le. Mone • Karen Burke • Gerene Bauldoff Copyright © 2011 by Pearson Education, Inc. All rights reserved.

NCLEX-RN® REVIEW Test Question 10 10. Subcutaneous injections of insulin can be made in NCLEX-RN® REVIEW Test Question 10 10. Subcutaneous injections of insulin can be made in several locations in the body. The nurse teaches the patient that the most rapid absorption occurs in which of the following? 1. 2. 3. 4. hip thigh deltoid abdomen Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition Priscilla Le. Mone • Karen Burke • Gerene Bauldoff Copyright © 2011 by Pearson Education, Inc. All rights reserved.

NCLEX-RN® REVIEW Test Question 10 Response 10. Subcutaneous injections of insulin can be made NCLEX-RN® REVIEW Test Question 10 Response 10. Subcutaneous injections of insulin can be made in several locations in the body. The nurse teaches the patient that the most rapid absorption occurs in which of the following? 1. 2. 3. 4. hip thigh deltoid abdomen Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition Priscilla Le. Mone • Karen Burke • Gerene Bauldoff Copyright © 2011 by Pearson Education, Inc. All rights reserved.

NCLEX-RN® REVIEW Test Question 10 Rationale Insulin is absorbed more rapidly when injected subcutaneously NCLEX-RN® REVIEW Test Question 10 Rationale Insulin is absorbed more rapidly when injected subcutaneously in the abdomen. Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition Priscilla Le. Mone • Karen Burke • Gerene Bauldoff Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Lecture Note Presentation Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition Priscilla Le. Lecture Note Presentation Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition Priscilla Le. Mone • Karen Burke • Gerene Bauldoff Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Learning Outcome 1 • Describe the prevalence and incidence of DM. Medical-Surgical Nursing: Critical Learning Outcome 1 • Describe the prevalence and incidence of DM. Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition Priscilla Le. Mone • Karen Burke • Gerene Bauldoff Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Diabetes Mellitus • Diabetes is a group of chronic disorders resulting in hyperglycemia. – Diabetes Mellitus • Diabetes is a group of chronic disorders resulting in hyperglycemia. – Type 1 DM characterized by a total deficit of circulating insulin – Type 2 DM characterized by insulin resistance • One of the major roles of the nurse in diabetes management is education of the diabetic patient. Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition Priscilla Le. Mone • Karen Burke • Gerene Bauldoff Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Diabetes Mellitus • Nursing care and educational plans for the diabetic patient need to Diabetes Mellitus • Nursing care and educational plans for the diabetic patient need to be individualized based on: – Type of diabetes – Length since diagnosis – Prior knowledge – The patient’s individual health and socioeconomic circumstances Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition Priscilla Le. Mone • Karen Burke • Gerene Bauldoff Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Diabetes Mellitus • Prevalence, incidence, and economic impact of DM – DM is widespread, Diabetes Mellitus • Prevalence, incidence, and economic impact of DM – DM is widespread, and is the sixth-leading cause of death in the United States. – Ninety percent of patients with diabetes have type 2 DM. – 10% have type 1 DM. Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition Priscilla Le. Mone • Karen Burke • Gerene Bauldoff Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Diabetes Mellitus • Type 2 diabetes is most common among these populations: – American Diabetes Mellitus • Type 2 diabetes is most common among these populations: – American Indian – Alaska native – Latino • There has been a sharp increase in type 2 diabetes related to rates of obesity in the United States. Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition Priscilla Le. Mone • Karen Burke • Gerene Bauldoff Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Diabetes Mellitus • Complications such as acute myocardial infarction, stroke, renal failure, blindness, and Diabetes Mellitus • Complications such as acute myocardial infarction, stroke, renal failure, blindness, and traumatic amputations are common among diabetics with poor glycemic control. • According to the American Diabetes Association, health care costs related to diabetes exceeded $132 billion per year in 2002. Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition Priscilla Le. Mone • Karen Burke • Gerene Bauldoff Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Learning Outcome 2 • Explain the pathophysiology, risk factors, manifestations, and complications of type Learning Outcome 2 • Explain the pathophysiology, risk factors, manifestations, and complications of type 1 and type 2 DM. Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition Priscilla Le. Mone • Karen Burke • Gerene Bauldoff Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Type 1 and Type 2 DM • All patients with DM experience hyperglycemia. • Type 1 and Type 2 DM • All patients with DM experience hyperglycemia. • The signs and symptoms of hyperglycemia include – Polyuria – Polydipsia – Polyphagia. Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition Priscilla Le. Mone • Karen Burke • Gerene Bauldoff Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Type 1 and Type 2 DM • Type 1 DM – Autoimmune destruction of Type 1 and Type 2 DM • Type 1 DM – Autoimmune destruction of the pancreatic islet cells – No insulin produced – Occurs in childhood/adolescence – Genetic predisposition plus environmental factors such as onset following viral illness – Includes 5– 10% of all patients with DM Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition Priscilla Le. Mone • Karen Burke • Gerene Bauldoff Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Type 1 and Type 2 DM • Type 1 DM – Rapid onset – Type 1 and Type 2 DM • Type 1 DM – Rapid onset – Risk factors Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition Priscilla Le. Mone • Karen Burke • Gerene Bauldoff Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Type 1 and Type 2 DM • Type 2 DM – Results from insulin Type 1 and Type 2 DM • Type 2 DM – Results from insulin resistance – Occurs at any age – Heredity plays an important role, along with obesity – Includes 90– 95% of all patients with DM – Gradual onset – Risk factors Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition Priscilla Le. Mone • Karen Burke • Gerene Bauldoff Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Type 1 and Type 2 DM • Diabetic complications result from chronic hyperglycemia • Type 1 and Type 2 DM • Diabetic complications result from chronic hyperglycemia • Chronic complications: – Result of endothelial inflammation and thickening Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition Priscilla Le. Mone • Karen Burke • Gerene Bauldoff Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Learning Outcome 3 • Provide rationale for the diagnostic tests used for screening, diagnosis, Learning Outcome 3 • Provide rationale for the diagnostic tests used for screening, diagnosis, and monitoring of DM. Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition Priscilla Le. Mone • Karen Burke • Gerene Bauldoff Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Screening Tests for DM • Casual plasma glucose (PG) • Fasting plasma glucose (FPG) Screening Tests for DM • Casual plasma glucose (PG) • Fasting plasma glucose (FPG) • Oral glucose tolerance test (OGTT) Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition Priscilla Le. Mone • Karen Burke • Gerene Bauldoff Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Screening Tests for DM • Screening tests to determine diabetes management – FBG (fasting Screening Tests for DM • Screening tests to determine diabetes management – FBG (fasting blood glucose) – A 1 C (glycosylated hemoglobin (c)) – Urine glucose and ketone levels – Urine tests, serum cholesterol, and serum electrolytes Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition Priscilla Le. Mone • Karen Burke • Gerene Bauldoff Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Learning Outcome 4 • Discuss the nursing implications for insulin and oral hypoglycemic agents Learning Outcome 4 • Discuss the nursing implications for insulin and oral hypoglycemic agents used to treat patients with DM. Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition Priscilla Le. Mone • Karen Burke • Gerene Bauldoff Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Treating DM • The patient with type 1 DM requires exogenous insulin. • The Treating DM • The patient with type 1 DM requires exogenous insulin. • The patient with type 2 DM may take oral medications or may take insulin. Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition Priscilla Le. Mone • Karen Burke • Gerene Bauldoff Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Treating DM • Types of insulins: – Rapid-acting – Short-acting – Intermediate-acting – Long-acting Treating DM • Types of insulins: – Rapid-acting – Short-acting – Intermediate-acting – Long-acting Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition Priscilla Le. Mone • Karen Burke • Gerene Bauldoff Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Treating DM • Teaching the patient to give insulin: – Measurement of blood glucose Treating DM • Teaching the patient to give insulin: – Measurement of blood glucose – Syringe and needle selection – Preparing the injection – Sites of injection – Mixing insulins – Storage of insulin – Food intake with insulin Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition Priscilla Le. Mone • Karen Burke • Gerene Bauldoff Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Treating DM • Nursing considerations for patients taking either insulin or oral agents: – Treating DM • Nursing considerations for patients taking either insulin or oral agents: – Assessment of therapeutic response – Monitoring blood glucose levels – Signs of hypo- or hyperglycemia • Patient Education: – Safe medication practices Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition Priscilla Le. Mone • Karen Burke • Gerene Bauldoff Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Treating DM • Nursing Implications: – Assessing response to medications, especially in first 7 Treating DM • Nursing Implications: – Assessing response to medications, especially in first 7 days – Assess for signs of hypoglycemia – Assess for signs of hyperglycemia Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition Priscilla Le. Mone • Karen Burke • Gerene Bauldoff Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Learning Outcome 5 • Discuss best practices of self-care management of DM related to Learning Outcome 5 • Discuss best practices of self-care management of DM related to diet planning, sick day management, and exercise. Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition Priscilla Le. Mone • Karen Burke • Gerene Bauldoff Copyright © 2011 by Pearson Education, Inc. All rights reserved.

The Goals of Diabetes Treatment • Prevent hypo- and hyperglycemia • Maintain glucose levels The Goals of Diabetes Treatment • Prevent hypo- and hyperglycemia • Maintain glucose levels close to normal Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition Priscilla Le. Mone • Karen Burke • Gerene Bauldoff Copyright © 2011 by Pearson Education, Inc. All rights reserved.

The Goals of Diabetes Treatment • Dietary management of DM – Carbohydrates – Protein The Goals of Diabetes Treatment • Dietary management of DM – Carbohydrates – Protein – Fats – Fiber – Sodium – Sweeteners – Alcohol Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition Priscilla Le. Mone • Karen Burke • Gerene Bauldoff Copyright © 2011 by Pearson Education, Inc. All rights reserved.

The Goals of Diabetes Treatment • Dietary management of DM – Meal Planning – The Goals of Diabetes Treatment • Dietary management of DM – Meal Planning – Diet plan for the older adult • Sick day management: – Increased need for insulin – Hyperglycemia – Continuing medications important – Food intake – Frequent monitoring Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition Priscilla Le. Mone • Karen Burke • Gerene Bauldoff Copyright © 2011 by Pearson Education, Inc. All rights reserved.

The Goals of Diabetes Treatment • Exercise – Exercise is important to maintain glycemic The Goals of Diabetes Treatment • Exercise – Exercise is important to maintain glycemic control. – The person with DM should be assessed for potential health risks prior to beginning an exercise program. – Exercise can cause hypoglycemia as well as hyperglycemia. – Responses to exercise should be monitored carefully and treated as needed. Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition Priscilla Le. Mone • Karen Burke • Gerene Bauldoff Copyright © 2011 by Pearson Education, Inc. All rights reserved.

The Goals of Diabetes Treatment • Exercise – Glycemic control improves with a regular The Goals of Diabetes Treatment • Exercise – Glycemic control improves with a regular exercise program. • Glycemic responses to exercise should be monitored. Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition Priscilla Le. Mone • Karen Burke • Gerene Bauldoff Copyright © 2011 by Pearson Education, Inc. All rights reserved.

The Goals of Diabetes Treatment • Variables: – Type of DM – Intensity of The Goals of Diabetes Treatment • Variables: – Type of DM – Intensity of exercise – Duration of exercise – The time of day Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition Priscilla Le. Mone • Karen Burke • Gerene Bauldoff Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Learning Outcome 6 • Compare and contrast the manifestations of hypoglycemia, diabetic ketoacidosis, and Learning Outcome 6 • Compare and contrast the manifestations of hypoglycemia, diabetic ketoacidosis, and hyperosmolar hyperglycemic state. Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition Priscilla Le. Mone • Karen Burke • Gerene Bauldoff Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Diabetic Ketoacidosis • Diabetic ketoacidosis (DKA) develops when there is an absolute deficiency of Diabetic Ketoacidosis • Diabetic ketoacidosis (DKA) develops when there is an absolute deficiency of circulating insulin Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition Priscilla Le. Mone • Karen Burke • Gerene Bauldoff Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Diabetic Ketoacidosis • Manifestations of diabetic ketoacidosis – Hyperosmolarity (from hyperglycemia) – Metabolic acidosis Diabetic Ketoacidosis • Manifestations of diabetic ketoacidosis – Hyperosmolarity (from hyperglycemia) – Metabolic acidosis from ketoacids and lactic acids – Volume depletion from osmotic diuresis as a result of hyperosmolarity – Electrolyte imbalances from osmotic diuresis Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition Priscilla Le. Mone • Karen Burke • Gerene Bauldoff Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Diabetic Ketoacidosis • Manifestations of Hyperosmolar Hyperglycemic State (HHS) – Hyperosmolarity from hyperglycemia (often Diabetic Ketoacidosis • Manifestations of Hyperosmolar Hyperglycemic State (HHS) – Hyperosmolarity from hyperglycemia (often more severe than in DKA) – Volume depletion from osmotic diuresis as a result of hyperosmolarity – Electrolyte imbalances from osmotic diuresis Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition Priscilla Le. Mone • Karen Burke • Gerene Bauldoff Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Diabetic Ketoacidosis • Hypoglycemia is more common in diabetics who are insulin dependent. • Diabetic Ketoacidosis • Hypoglycemia is more common in diabetics who are insulin dependent. • Signs and symptoms of hypoglycemia result from responses of the autonomic nervous system (release of stress hormones), and from a deficiency of circulating glucose available for normal brain function. Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition Priscilla Le. Mone • Karen Burke • Gerene Bauldoff Copyright © 2011 by Pearson Education, Inc. All rights reserved.