Chapter 40 Nursing Care of Patients with Disorders of The Endocrine Pancreas

Answers CHAPTER 40 NURSING CARE OF PATIENTS WITH DISORDERS OF THE ENDOCRINE PANCREAS AUDIO CASE STUDY Mr. Flint Has Diabetes 1. Diabetes, poor circulation, and poor sensation (neuropathy). 2. Bearing weight on a wound can squeeze the already compromised blood supply out, increase damage to the wound, and delay healing. 3. 126 mg/dL. 4. Type 2. He is on metformin, needed to lose weight, and had symptoms of diabetes for some time before he was diagnosed. He also has a brother with diabetes. 5.Some possible answers include polyuria, polydipsia, polyphagia, fatigue, and blurred vision. 6. Shaking, sweating, headache, and tremor. VOCABULARY 1. glycosuria 2. Hyperglycemia 3. Hypoglycemia 4. Kussmaul 5. polyphagia 6. polydipsia 7. nocturia 8. peak 9. duration 10. tight HYPOGLYCEMIA AND HYPERGLYCEMIA 1. O 2. R 3. R 4. R 5. O 6. R 7. O 8. R COMPLICATIONS OF DIABETES 1. (5) 2. (2) 3. (4) 4. (1) 5. (7) 6. (6) 7. (3) CRITICAL THINKING 1. Keeping the blood glucose level too low can increase risk of hypoglycemia, especially in a patient who has had diabetes for some time. If autonomic neuropathy is present, symptoms of hypoglycemia may go unnoticed, making hypoglycemia even more risky. Although most people are advised to keep their premeal glucose readings between 70 and 130 mg/dL, the health care provider (HCP) should always be consulted for desired glucose range. 2. Jennie is exhibiting symptoms of hypoglycemia. You should follow hospital policy, which usually directs the nurse to check the blood glucose level and provide a quick source of glucose such as juice or glucose tablets. Notify the registered nurse (RN) according to policy. 3. It appears that the treatment has been effective; 80 mg/dL is probably okay, especially if a meal tray is to be served soon. Check to be sure her meal is on its way, and watch her for further symptoms. Consult with the RN or HCP before administering her supper dose of insulin lispro (Humalog). 4. Common causes of hypoglycemia include skipping or delaying meals, eating less than prescribed at a meal, and more exercise than usual. 5. Because she is receiving regularly scheduled insulin, it is important to eat regularly to prevent periods during which there is insulin but not enough glucose in her blood. 6. Obesity causes insulin resistance. Losing weight has probably decreased Jennie’s insulin resistance, making her insulin dose too effective. She now needs a lower dose, or it is possible that she will no longer need insulin to control her diabetes. 7. Metformin increases tissue sensitivity to insulin and reduces glucose production by the liver. 1 2 Chapter 40 Answers 8. Jennie has type 2 diabetes. If she had type 1 diabetes, she would not be able to take oral hypoglycemics. Obesity is also common in type 2 diabetes. REVIEW QUESTIONS—CONTENT REVIEW The correct answers are in boldface. 1. (2) is correct. 80 to 130 mg/dL is recommended by the American Diabetes Association. (1) is too low. (3, 4) are too high. 2. (2) is correct. Insulin should never be given without first evaluating the blood glucose level. (1, 3, 4) may all be significant for the person with diabetes, but they are not immediately necessary before administering insulin. 3. (1) is correct. Insulin lispro is a rapid-acting insulin. (2, 3, 4) are incorrect. 4. (3) is correct. These are symptoms of hypoglycemia. (1, 2, 4) are not associated with hypoglycemia; in fact, (2, 4) are symptoms of hyperglycemia. 5. (3) is correct. Micronase increases tissue sensitivity to insulin. (1, 2, 4) can all potentially raise blood glucose levels, an undesirable result. REVIEW QUESTIONS—TEST PREPARATION The correct answers are in boldface. 6. (1) is correct. Ketones and diabetic ketoacidosis usually occur in type 1 diabetes, especially in a newly diagnosed patient. (2) is incorrect. Type 2 diabetes in not usually associated with ketones, except late in the disease. (3) is incorrect. A patient with prediabetes would have a blood glucose closer to normal. (4) is incorrect. Gestational diabetes occurs in pregnant women. 7. (4) is correct. If a patient forgets a prescribed oral hypoglycemic, blood sugar levels will go up. Fatigue, thirst, and blurred vision are the only symptoms of hyperglycemia. (1, 2) are symptoms of hypoglycemia. (3) is not related to diabetes. 8. (3, 4, 5) are all correct. Insulin is given subcutaneously most of the time; regular insulin can be given intravenously or intramuscularly in urgent situations. (1, 2) are incorrect. Insulin is never given orally because it would be digested; it is not currently given via a topical route. 9. (2) is correct. Use of contrast dye with metformin can cause lactic acidosis. (1, 3, 4) do not cause complications with dyes. 10. (1) is correct. Raisins contain sugar, which will raise the blood glucose level. (2, 4) are protein foods and will affect the blood glucose level only very slowly. (3) is not a food. 11. (4) is correct. Glucagon stimulates the liver to convert glycogen to glucose, which raises the blood glucose level. (1, 2, 3) are all related to hyperglycemia, which would be worsened by glucagon. 12. (4) is correct. Oatmeal and bread are both carbohydrate exchanges. (1, 2, 3) are not carbohydrates. 13. The eight areas on the body where subcutaneous insulin injections can be administered: upper arm (marked on both anterior and posterior), abdomen, upper thigh, and buttocks.