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A diabetic educator is discussing sick day rules with a newly diagnosed type 1 diabetic. The educator is aware that the patient will require further teaching when the patient states what?
- A. I will not take my insulin on the days when I am sick, but I will certainly check my blood sugar every 2 hours.
- B. If I cannot eat a meal, I will eat a soft food such as soup, gelatin, or pudding six to eight times a day.
- C. I will call the doctor if I am not able to keep liquids in my body due to vomiting or diarrhea.
- D. I will call the doctor if my blood sugar is over 300 mg/dL or if I have ketones in my urine.
Correct Answer: A
Rationale: The nurse must explanation the sick day rules again to the patient who plans to stop taking insulin when sick. The nurse should emphasize that the patient should take insulin agents as usual and test ones blood sugar and urine ketones every 3 to 4 hours. In fact, insulin-requiring patients may need supplemental doses of regular insulin every 3 to 4 hours. The patient should report elevated glucose levels (greater than 300 mg/dL or as otherwise instructed) or urine ketones to the physician. If the patient is not able to eat normally, the patient should be instructed to substitute soft foods such a gelatin, soup, and pudding. If vomiting, diarrhea, or fever persists, the patient should have an intake of liquids every 30 to 60 minutes to prevent dehydration.
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A patient has been brought to the emergency department by paramedics after being found unconscious. The patients Medic Alert bracelet indicates that the patient has type 1 diabetes and the patients blood glucose is 22 mg/dL (1.2 mmol/L). The nurse should anticipate what intervention?
- A. IV administration of 50% dextrose in water
- B. Subcutaneous administration of 10 units of Humalog
- C. Subcutaneous administration of 12 to 15 units of regular insulin
- D. IV bolus of 5% dextrose in 0.45% NaCl
Correct Answer: A
Rationale: In hospitals and emergency departments, for patients who are unconscious or cannot swallow, 25 to 50 mL of 50% dextrose in water (D50W) may be administered IV for the treatment of hypoglycemia. Five percent dextrose would be inadequate and insulin would exacerbate the patients condition.
An elderly patient comes to the clinic with her daughter. The patient is a diabetic and is concerned about foot care. The nurse goes over foot care with the patient and her daughter as the nurse realizes that foot care is extremely important. Why would the nurse feel that foot care is so important to this patient?
- A. An elderly patient with foot ulcers experiences severe foot pain due to the diabetic polyneuropathy.
- B. Avoiding foot ulcers may mean the difference between institutionalization and continued independent living.
- C. Hypoglycemia is linked with a risk for falls; this risk is elevated in older adults with diabetes.
- D. Oral antihyperglycemics have the possible adverse effect of decreased circulation to the lower extremities.
Correct Answer: B
Rationale: The nurse recognizes that providing information on the long-term complications especially foot and eye problems associated with diabetes is important. Avoiding amputation through early detection of foot ulcers may mean the difference between institutionalization and continued independent living for the elderly person with diabetes. While the nurse recognizes that hypoglycemia is a dangerous situation and may lead to falls, hypoglycemia is not directly connected to the importance of foot care. Decrease in circulation is related to vascular changes and is not associated with drugs administered for diabetes.
A newly admitted patient with type 1 diabetes asks the nurse what caused her diabetes. When the nurse is explaining to the patient the etiology of type 1 diabetes, what process should the nurse describe?
- A. The tissues in your body are resistant to the action of insulin, making the glucose levels in your blood increase.
- B. Damage to your pancreas causes an increase in the amount of glucose that it releases, and there is not enough insulin to control it.
- C. The amount of glucose that your body makes overwhelms your pancreas and decreases your production of insulin.
- D. Destruction of special cells in the pancreas causes a decrease in insulin production. Glucose levels rise because insulin normally breaks it down.
Correct Answer: D
Rationale: Type 1 diabetes is characterized by the destruction of pancreatic beta cells, resulting in decreased insulin production, unchecked glucose production by the liver, and fasting hyperglycemia. Also, glucose derived from food cannot be stored in the liver and remains circulating in the blood, which leads to postprandial hyperglycemia. Type 2 diabetes involves insulin resistance and impaired insulin secretion. The body does not make glucose.
A medical nurse is caring for a patient with type 1 diabetes. The patients medication administration record includes the administration of regular insulin three times daily. Knowing that the patients lunch tray will arrive at 11:45, when should the nurse administer the patients insulin?
- A. 10:45
- B. 11:15
- C. 11:45
- D. 11:50
Correct Answer: B
Rationale: Regular insulin is usually administered 20-30 min before a meal. Earlier administration creates a risk for hypoglycemia; later administration creates a risk for hyperglycemia.
Which of the following patients with type 1 diabetes is most likely to experience adequate glucose control?
- A. A patient who skips breakfast when his glucose reading is greater than 220 mg/dL
- B. A patient who never deviates from her prescribed dose of insulin
- C. A patient who adheres closely to a meal plan and meal schedule
- D. A patient who eliminates carbohydrates from his daily intake
Correct Answer: C
Rationale: The therapeutic goal for diabetes management is to achieve normal blood glucose levels without hypoglycemia. Therefore, diabetes management involves constant assessment and modification of the treatment plan by health professionals and daily adjustments in therapy (possibly including insulin) by patients. For patients who require insulin to help control blood glucose levels, maintaining consistency in the amount of calories and carbohydrates ingested at meals is essential. In addition, consistency in the approximate time intervals between meals, and the snacks, help maintain overall glucose control. Skipping meals is never advisable for person with type 1 diabetes.