41.3.27: Chapter 28
Unfolding Case Study
1.
c.
Due to the client’s age, gradual onset of symptoms and sedentary lifestyle, she will most likely be diagnosed with type 2 diabetes mellitus. This client’s symptoms of fatigue, polyuria, thirst, and blurred vision are consistent with this diagnosis.
2.
d.
Glycosylated hemoglobin measures the average blood glucose level of an individual for the past 90 days. A reading of 6.5% or higher indicates diabetes.
3.
a.
Extended-release glipizide should be taken with the first meal of the day, not with dinner.
4.
a.
The client’s glycosylated hemoglobin has dropped from 7.8% to 6.9%, below the goal of less than 7% for a person with diabetes. She has also lost 15 pounds in 6 months. The health care provider would not recommend changes in the treatment plan at this time.
Review Questions
1.
d.
A glycosylated hemoglobin greater than 6.5% represents diabetes.
2.
b.
Clients with diabetes should be taught to recognize signs of hypoglycemia to prevent a hypoglycemic reaction and serious complications.
3.
a.
The onset of regular insulin is 30 minutes. Breakfast should be given by 7 a.m. to prevent hypoglycemia.
4.
b.
Insulin glargine is a long-acting insulin.
5.
c.
Insulin isophane NPH peaks in 4–12 hours. The client is at risk for hypoglycemia during this time and should eat a snack to prevent hypoglycemia.
6.
d.
Glucagon is used to treat severe hypoglycemia when the client is semiconscious, unconscious, or unable to consume carbohydrates/sugar.
7.
c.
The nurse should combine the regular insulin and the NPH in the same syringe so a total of 38 units should be prepared, with regular insulin being drawn up first.
8.
c.
Only rapid-acting insulins should be administered via an insulin pump. Insulin aspart is a rapid-acting insulin.
9.
a.
Metformin should be held 24 hours prior to and 48 hours after contrast dye administration in clients with renal impairment.
10.
a.
(desired dose)
(supply on hand)