Diabetes Type 1 – Evolve Case Study
What is the mechanism that results in Kussmaul respirations?
to compensate for metabolic acidosis, the respirations are deep and rapid.
To achieve a goal of restoring fluid volume in ketoacidosis, the nurse would expect to implement which intervention?
maintain an infusion of normal saline solution.
To restore blood glucose to a normal level during ketoacidosis, what should the nurse prepare to administer?
An I.V. infusion containing regular insulin
In addition to monitoring blood glucose level in ketoacidosis, what additional lab values should the nurse monitored carefully?
hemoglobin, calcium, potassium, blood urea nitrogen (BUN)
Classic symptoms of diabetes are:
Polyuria, polyphagia and polydipsia
What type of onset does Type 1 diabetes usually have?
Type 1 diabetes symptoms have an abrupt onset that is often brought on by a viral illness like the flu.
The sliding scale refers to the administration of a dose of regular -short acting insulin base on what?
current blood glucose level
What are the steps for subcutaneous injection?
pinching the skin on the front of the thigh and insert the needle at a 90 degree angle
When a client with Type 1 diabetes shows symptoms of shaky and sweaty, what is the priority nursing action?
Check the client’s blood glucose. Feeling shaky and sweaty are symptoms of hypoglycemia. If the glucose is low, the nurse should provide a snack of milk and graham crackers.
What are the goals of diet therapy for clients with Type 1 diabetes?
consume all essential nutrients, achieve and maintain ideal body weight, and maintain blood glucose levels as near normal as possible.
What should clients with Type 1 diabetes know about alcohol?
Alcohol does contain a lot of empty calories, but it is also likely to cause your blood glucose to DECREASE. Alcohol may include hypoglycemia. Alcohol should be consumed only in moderation and with , or shortly after meals.
Should a client with Type 1 diabetes take extra insulin before exercise?
Extra insulin should not generally be taken before exercise.
What are the symptoms of HYPOglycemia?
disorientation, tremors, palpitations, lightheadedness, confusion, clammy skin, slurred speech, and lethargy
what is the best nursing action for a person who is experiencing these symptoms of HYPOglycemia at home?
ask the person if they have emergency supplies of Glucagon or cake icing
What snack is appropriate after the administration of glucagon or cake icing to help keep the hypoglycemia from returning?
crackers and milk
What is Somogyi’s phenomenon?
rebounding morning hyperglycemia after night-time hypoglycemia. It is often caused by too much insulin or the lack of an adequate bedtime snack.
what should the nurse assess for with Somogyi’s phenomenon?
Monitor blood glucose levels during the night and before breakfast.
What is a glycosylated Hgb?
A diagnostic test reflects average blood glucose levels over a period of approximately 120 days, the life of an average RBC. The longer the glucose in the blood is above normal, the higher the percentage of glycosylated hemoglobin.
What is the normal range for a glycosylated Hgb?
Normal range is 4-6%. Levels over 8% indicate poor glycemic control.
How often is a glycosylated Hgb done?
every 3 months, 120 days
How is the diagnosis of Diabetes determined?
the diagnosis of diabetes is based on two fasting blood glucose levels greater than 126 mg/dl
Should a person with diabetes take their insulin when they are sick?
YES! Illness increases blood sugar. Taking your usual insulin dose is important.
what is the risk of illness for persons with diabetes?
Illness increases the risk for dehydration and hyperglycemia. Continued administration, adequate fluid and carbohydrate intake are critical to prevent ketoacidosis.
When you are diabetic and you are ill, how often should your blood glucose be monitored?
every 4 hours and report persistent hyperglycemia, ketosis, nausea and vomiting or other significant symptoms to the health care provider.
Is there a genetic predisposition for a offspring with Type 1 diabetes to be linked with their mothers gestation (pregnancy) diabetes?
The highest risk for the onset of Type 1 diabetes is linked to the presence of certain antigens, so there seems to be a genetic predisposition combined with an environmental trigger.
Is there a genetic predisposition between Type 2 diabetes and gestational diabetes?
there is no direct correlation between GDM and Type 2 diabetes, but family history is important.
What is hyperglycemic-hyperosmolor nonketotic syndrome (HHNS)?
HHNS is caused by persistent hyperglycemia, but ketosis does not occur. This results in osmotic diuresis, which results in fluid and electrolyte losses. There is not enough insulin to prevent the breakdown of fats which leads to ketosis. Therefore, ketones are not found in the urine.
Is HHNS a serious condition?
HHNS has a high mortality rate, because it most often affects older, Type 2 diabetics who are significantly dehydrated.
What type of diabetes does HHNS occur in?
HHNS primarily affects Type 2 diabetics who are significantly dehydrated, but someone with Type 1 diabetes should be aware of the symptoms and tx of HHNS>
Can a blood glucose be over 1,000 mg/dL?
Which lab value indicates that a person with Diabetes 1 is working to reduce their risk for cardiovascular disease (a complication of diabetes)?
Low-density lipoprotein (LDL) cholesterol of <100 mg/dL
What findings indicate that a person is experiencing complication of diabetes?
Protein in urine (ketosis), a sore on the foot that is having trouble healing, burning sensation in the toes; paresthesia.
What does protein in the urine mean for diabetics?
Once protein is found in the urine, the diabetic will progress to end-stage renal disease and renal failure.
What is the significance of a sore that won’t heal on the foot of a diabetic?
Poor wound healing is a result of long-term hyperglycemia. High levels of blood glucose damage the intima of capillaries, decreasing perfusion to the periphery, which can result in delayed would healing.
What is paresthesia?
paresthesia, such as a burning sensation is an indication of neuropathy- progressive deterioration of the nerves resulting in loss of nerve function.
What kind of problems can neuropathy cause in a diabetic?
neuropathy can cause loss of sensation, muscle weakness, and altered autonomic function.
What is peripheral neuropathy contribute to?
peripheral neuropathy contributes to the onset of diabetic foot ulcers, which may ultimately lead to amputation.