Nursing 119 Application Activity Diabetes Resources: Lewis

Nursing 119 Application Activity Diabetes Resources: Lewis et al. (10th ed) and Giddens (2nd ed), Lilley pharm text, Mosby’s Nursing Drug Reference, and Potter et al DK is an 18-year-old high school student who began to experience weight loss despite a ravenous appetite and resulting in increased dietary intake. She has to make frequent trips to the bathroom to urinate and has difficulty concentrating on her work because of fatigue. She drinks large volumes of coffee to help with a constant dry mouth and to combat her fatigue. At a clinic appointment, it was noted that DK’s weight has dropped from 140 pounds to 128 pounds. She is 5 feet 7 inches tall. Her urine specimen shows glycosuria and ketonuria. A chemstick blood glucose level is 412 mg/dl. DK had eaten breakfast 3 hours before the chemstick blood test. Subjective Very Tired Feeling weak Abdominal pain Vomiting Objective Kussmaul Respirations Pulse 90 Lab Data Serum Osmolarity 372 Glucose Level 412 mg/dl Regular Insulin 6 Units AC PH7.1 Physician Orders Check Blood Sugars AC and Hs (6:30AM, 11:30AM, 4:30PM, and 9:30PM) Glucagon 1mg sc for blood sugar <50 Metformin 500mg BID Assignment: Answer the following critical thinking questions. Diabetes of any type can be characterized by hyperglycemia or hypoglycemia. What are the three clinical manifestations that are often associated with Diabetes? Hypoglycemia Hyperglycemia Considering DK's presenting history and physical data, what form of diabetes mellitus is indicated? Hyperosmolar Coma vs. Diabetic Ketoacidosis, describe what is the difference. Why is a diabetic patient having the following signs and symptoms: polydipsia, polyuria, and polyphagia? What immediate and long-term therapy will DK need to manage her disorder? 6. DK will have to frequently monitor her own glucose levels to evaluate her diabetic control. What range of blood glucose and AIC range should she be advised to aim for? 7. DK needs to understand the signs and symptoms of hypoglycemia so that she can quickly intervene to prevent life-threatening complications. How can she recognize hypoglycemia and what should she do when it occurs? 8. DK should be aware of the potential acute and long-term complications of diabetes mellitus. What are they? A. How does one distinguish between type 1 diabetes and type 2 diabetes? B. In patients who have type 1 diabetes with evidence of insulin resistance, what treatment options are available? Answer options: Decreased level of consciousness due to osmotic cell shriveling Insulin is low Ketoacids Decreased level of consciousness due to decreased pH Blood glucose > 600 mg/dL Insulin is absent Blood glucose 300-600 mg/dL No ketoacids Diabetic Ketoacidosis Hyperosmolar Coma SCIENCE HEALTH SCIENCE NURSING NSG 119

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