Question

R.H. is a 62-year-old woman who comes to the clinic for a routine physical examination.

She works as a banking executive and gets little exercise.

She says she is “just tired.”

She has gained 18 pounds over the past year and eats a high-fat diet.

Her blood pressure is 162/98, heart rate is 92, and respiration rate is 20

R.H. complains of some weakness in her right foot that began about a month ago.

She says it also feels a little numb.

A sensory examination reveals diminished sensations of light touch, proprioception, and vibration in both feet.

R.H. also complains of increased thirst and frequent nighttime urination.

She denies any other weakness, numbness, or changes in vision

A physical examination reveals an erythematous scaling rash in both inguinal areas and in axillae.

R.H. states the rash has been there on and off for several years and is worse in the warm weather.

Question 1

What risk factors for diabetes does R.H. have? Which type of diabetes is R.H. at highest risk for developing?

Questio n2

What clinical manifestations of diabetes is she displaying?   

What diagnostic tests for diabetes would you expect the health care provider to order?

Question 3. R.H.’s diagnostic testing results

Random glucose test: 253 mg/dL

Hb A1C: 9.1%

Urine: positive for glucose and negative for protein

Wet preparation of smear from rash: consistent with Candida albicans

ECG: evidence of early ventricular hypertrophy. What goals of diabetes management for her?

R.H. receives a diagnosis of type 2 diabetes mellitus.

What three treatment modalities will you expect to teach R.H about? Type of insulin Goal of insulin Insulin therapy problems

Questio 4

R.H.’s health care provider orders metformin (Glucophage) 500 mg PO bid.

What is the mechanism of action of metformin?

What would you teach R.H. about metformin?

Question 5 Points: What would you teach R.H. about her dietary needs in relation to her type 2 diabetes

Questio n6

R.H. realizes that she needs to start exercising in order to gain her health back.

She asks you what she should be doing.

How would you respond?

Question 7 What would you teach R.H. about hyperglycemia associated with type 2 diabetes?

  

Questio n8 Despite intense patient teaching, R.H. presents to the ED with hyperglycemic hyperosmolar syndrome.

She has been ill with the flu and has not taken her metformin as prescribed.

R.H.’s admitting blood glucose level is 832 mg/dL.

She is admitted to the ICU for IV hydration and insulin therapy.

What will be your priority nursing assessments/interventions for R.H.?

Question 9 As you administer IV insulin to R.H., for which clinical manifestations of hypoglycemia

will you assess R.H.?

Questio 10

Several days after being admitted for hyperglycemia, R.H.’s blood glucose level drops to 56 mg/dL.R.H. remains alert and oriented.

What are your priority nursing interventions?

Question 11

What are acute and chronic complications of diabetes Mellitus?

How can the nurse educate the patient on how to avoid these?

  

Questio n 12

The nurse plans a class for patients who have newly diagnosed type 2 diabetes mellitus. Which goals is most appropriate?

Answer 1

1. Risk factors for type 2 diabetis mellitus in R.H

• Age- 62 year old
• High fat diet
• No physical exercise
• Weight gain of 18 pounds in last year.

Type 1 diabetis mellitus is juvenile diabetis.after 40 years and if it is due to lifestyle , it is type 2 diabetis.

2.

Clinical manifestations showing,

• Numbness on right foot without sensation of light touch , proprioception and vibration on both feet.
• Frequent night time urination,
• Increased thirst.

She may be reffered to check fasting blood sugar , HbA1c, oral glucose tolerance test and urine sugar test.

3. Goal of diabetic management.

Weight. Loss

Dietary management to control blood sugar level

Physical exercise like walking to maintain blood sugar in normal level.

To control blood pressure.

Treatment modalities are:

• Diabetic diet rich in fibre
• Oral medication
• Insulin therapy
• Monitoring blood glucose.