A patient with diabetes presents with diminished vibratory sensation, reduced ankle reflexes, and a hemoglobin A1c of 8.2%. Which intervention should the nurse prioritize to prevent further complications in this patient?

A) Educate the patient on daily foot care practices to prevent ulceration.

B) Recommend increasing the frequency of blood glucose monitoring.

C) Suggest the addition of a GLP-1 receptor agonist to the patient's regimen.

D) Advise the patient to follow a low-protein diet to protect kidney function.

A diabetic patient with peripheral neuropathy and early signs of nephropathy is being evaluated for potential changes in his management plan. Considering the patient's current condition and laboratory findings, which of the following interventions is most appropriate to address both glycemic control and renal protection?

C) Prescribe an SGLT2 inhibitor to the current medication plan.

A) Initiate insulin therapy to achieve better glycemic control.

B) Add a GLP-1 receptor agonist to the treatment regimen.

C) Prescribe an SGLT2 inhibitor to the current medication plan.

D) Increase the dose of the current oral hypoglycemic agent.

A patient with type 2 diabetes has started on an SGLT2 inhibitor and reports increased urinary frequency and mild genital irritation. Additionally, the patient has developed a superficial foot ulcer with decreased sensation due to peripheral neuropathy. Which nursing intervention is most appropriate to address both the medication side effects and the foot ulcer?

A) Encourage increased fluid intake to manage urinary frequency and educate on proper foot hygiene.

B) Advise the patient to discontinue the SGLT2 inhibitor and consult the physician about alternative medications.

C) Instruct the patient to apply an over-the-counter antifungal cream for genital irritation and monitor the foot ulcer closely.

D) Recommend the use of absorbent pads for urinary frequency and schedule regular foot examinations with a podiatrist.

A patient with type 2 diabetes has started taking an SGLT2 inhibitor and is experiencing increased urinary frequency and mild genital irritation. During a recent follow-up, a superficial ulcer with mild erythema and decreased sensation is noted on the patient's right heel. Considering these developments, what is the most appropriate nursing action to prioritize in this patient's comprehensive care plan?

A) Educate the patient on proper foot care techniques and the importance of daily foot inspections.

B) Advise the patient to increase fluid intake to manage increased urinary frequency.

C) Recommend the patient discontinue the SGLT2 inhibitor due to side effects.

D) Schedule an immediate follow-up appointment with an endocrinologist to adjust diabetes medication.

A patient on an SGLT2 inhibitor presents with increased fatigue, occasional dizziness, and a decrease in blood pressure. Considering these findings, which nursing intervention is the most appropriate to prevent complications?

B) Instruct the patient to stand up slowly from a sitting or lying position.

A) Increase the patient's fluid intake to prevent dehydration.

B) Instruct the patient to stand up slowly from a sitting or lying position.

C) Discontinue the patient's antihypertensive medications immediately.

D) Advise the patient to reduce physical activity to prevent dizziness.

A patient taking an SGLT2 inhibitor presents with increased fatigue and occasional dizziness. The healthcare team notes a blood pressure of 102/68 mmHg and a recent decrease in eGFR from 75 mL/min/1.73m² to 68 mL/min/1.73m². What is the most appropriate nursing action to address the patient's current status?

B) Educate the patient on monitoring blood pressure at home and report readings below 100/70 mmHg.

A) Advise the patient to increase sodium intake to raise blood pressure.

B) Educate the patient on monitoring blood pressure at home and report readings below 100/70 mmHg.

C) Encourage the patient to take antihypertensive medication at night to avoid daytime dizziness.

D) Recommend reducing fluid intake to prevent further decline in renal function.

A 58-year-old patient with a history of hypertension and type 2 diabetes presents with increased thirst, frequent urination, and an elevated blood glucose level. His eGFR has decreased to 64 mL/min/1.73m², and his hemoglobin A1c has increased to 8.2%. Which of the following nursing interventions should be prioritized to address both his glycemic control and renal protection?

B) Discuss the importance of consistent medication adherence, including potential initiation of an ACE inhibitor.

A) Educate the patient about reducing sodium intake to improve blood pressure control.

B) Discuss the importance of consistent medication adherence, including potential initiation of an ACE inhibitor.

C) Instruct the patient on the importance of increasing physical activity to enhance insulin sensitivity.

D) Advise the patient to increase fluid intake to manage his increased thirst and urination.

A patient with a history of hypertension and diabetes presents with new symptoms of increased thirst and frequent urination. Upon assessment, the patient has an elevated blood glucose level of 230 mg/dL and a worsening eGFR of 64 mL/min/1.73m². Considering the current clinical findings, which intervention should the nurse prioritize to address the patient's overall health status?

B) Educate the patient on dietary changes to improve glycemic control and monitor blood glucose levels more frequently.

A) Increase the patient's antihypertensive medication dosage to manage blood pressure more aggressively.

B) Educate the patient on dietary changes to improve glycemic control and monitor blood glucose levels more frequently.

C) Initiate a referral to a nephrologist for further evaluation of declining renal function.

D) Recommend the addition of an ACE inhibitor to the patient's medication regimen to protect renal function.

A patient with type 2 diabetes mellitus is being treated with an ACE inhibitor and presents with mild peripheral edema. Which nursing intervention is most appropriate to address this concern while maintaining effective management of the patient's condition?

B) Encourage the patient to elevate their legs periodically throughout the day.

A) Advise the patient to decrease fluid intake to reduce edema.

B) Encourage the patient to elevate their legs periodically throughout the day.

C) Suggest the patient discontinue the ACE inhibitor immediately.

D) Recommend the patient increase their salt intake to counteract edema.

A patient with type 2 diabetes is being treated with an ACE inhibitor and presents with mild peripheral edema. His blood pressure is stable, and there is a slight improvement in renal function. Considering the patient's current condition, which nursing intervention is most appropriate to address the concern of peripheral edema?

D) Suggest reducing dietary sodium to help decrease fluid retention.

A) Increase the patient's fluid intake to promote diuresis.

B) Educate the patient to elevate his legs when sitting or lying down.

C) Recommend the use of compression stockings to reduce edema.

D) Suggest reducing dietary sodium to help decrease fluid retention.

Diabetes - Nursing Case Study

Pathophysiology

• Primary mechanism: Insulin resistance in peripheral tissues causes impaired glucose uptake, leading to elevated blood glucose levels. This resistance is often due to obesity-related factors and chronic inflammation, which alter insulin receptor function.

• Secondary mechanism: Pancreatic beta-cell dysfunction results in inadequate insulin secretion. Over time, the beta cells become exhausted from compensating for insulin resistance, reducing their ability to produce insulin effectively.

• Key complication: Chronic hyperglycemia contributes to vascular damage, increasing the risk of microvascular complications like retinopathy, nephropathy, and neuropathy, as well as macrovascular complications such as cardiovascular disease.

Patient Profile

Demographics:

56-year-old male, office administrator

History:

• Key past medical history: Type 2 Diabetes diagnosed 8 years ago, hypertension, hyperlipidemia

• Current medications: Metformin, Lisinopril, Atorvastatin, Aspirin

• Allergies: Sulfa drugs

Current Presentation:

• Chief complaint: Increasing fatigue and tingling in feet

• Key symptoms: Polyuria, polydipsia, blurred vision, intermittent numbness in feet

• Vital signs: Blood pressure 148/92 mmHg, heart rate 88 bpm, respiratory rate 20 breaths per minute, temperature 98.6°F, blood glucose level 210 mg/dL

Section 1

As the patient's case unfolds, further assessment is conducted to evaluate the progression of his diabetes-related complications. A comprehensive foot examination reveals diminished vibratory sensation and reduced ankle reflexes, indicating peripheral neuropathy. Additionally, inspection of the feet shows dry skin and a small callus on the right heel. These findings suggest an increased risk for foot ulcers, a common complication in diabetic patients.

Laboratory tests are ordered to assess the patient's overall metabolic control and identify any worsening conditions. The results show a hemoglobin A1c level of 8.2%, indicating poor long-term glucose control. Serum creatinine levels have risen to 1.4 mg/dL from a previous baseline of 1.0 mg/dL, suggesting early signs of diabetic nephropathy. Urinalysis reveals microalbuminuria, reinforcing concerns about kidney function deterioration.

Based on these findings, it is critical to adjust the patient's management plan to prevent further complications. The healthcare team considers intensifying his diabetes regimen by possibly adding a GLP-1 receptor agonist or SGLT2 inhibitor to improve glycemic control and provide renal protection. Nutritional counseling and an exercise program are recommended to enhance lifestyle modifications. The patient is educated on daily foot care practices to prevent ulceration and advised to schedule regular ophthalmology appointments to monitor for retinopathy. These interventions aim to address the current complications while preventing the emergence of new ones, steering the patient back towards optimal health management.

Section 2

As the healthcare team continues to monitor the patient, a follow-up appointment reveals both encouraging and concerning developments. The patient has initiated the use of an SGLT2 inhibitor, resulting in a modest improvement in glycemic control. His recent fasting blood glucose levels have averaged around 130 mg/dL, demonstrating better daily management. However, the patient reports experiencing increased urinary frequency and mild genital irritation, common side effects associated with this class of medication. Despite these manageable side effects, the patient expresses a willingness to continue with the prescribed treatment, acknowledging the potential renal protective benefits.

Further assessment of the patient's foot health shows increased vigilance in daily care, but new concerns arise. The small callus on the right heel has developed into a superficial ulcer with mild erythema surrounding the area. A thorough examination using a monofilament test indicates further decreased sensation, underscoring the progression of his peripheral neuropathy. The healthcare team initiates a wound care protocol, emphasizing the importance of offloading pressure from the ulcerated area and prescribing a topical antibiotic to prevent infection.

These developments necessitate a reassessment of the patient's comprehensive care plan. The healthcare team must consider the balance between optimizing blood glucose levels and managing the adverse effects of treatment. Additionally, the progression of peripheral neuropathy and the emergence of a foot ulcer prompt a more aggressive approach to foot care education and possibly involving a podiatrist for specialized management. These steps are crucial to prevent further deterioration and to maintain the patient's quality of life, highlighting the need for ongoing vigilance and adaptation in managing diabetes-related complications.

Section 3

In a follow-up visit, the healthcare team observes a change in the patient's status, which requires immediate attention and adjustment of the care plan. The patient reports increased fatigue and occasional dizziness, raising concerns about potential orthostatic hypotension, a known side effect of the SGLT2 inhibitor. Vital signs reveal a blood pressure of 102/68 mmHg, lower than his typical readings, with a heart rate of 88 beats per minute. This hypotensive trend suggests the need to reassess his current antihypertensive regimen, considering the additive effect of the SGLT2 inhibitor on reducing blood pressure. The team decides to adjust his antihypertensive medication dosage to prevent further episodes of dizziness and to mitigate the risk of falls.

Laboratory results further reveal that the patient's estimated glomerular filtration rate (eGFR) has decreased slightly from 75 mL/min/1.73m² to 68 mL/min/1.73m². While this decline is within an acceptable range, it necessitates closer monitoring due to the renal implications associated with both diabetes and the use of SGLT2 inhibitors. The patient is educated on maintaining adequate hydration and is encouraged to report any signs of worsening renal function, such as swelling, weight gain, or changes in urinary output.

The patient's superficial foot ulcer shows signs of improvement, with reduced erythema and no signs of infection. However, the healthcare team emphasizes the importance of continued vigilance in foot care. To address the progression of peripheral neuropathy, the patient is referred to a podiatrist for ongoing management and fitted with special footwear to alleviate pressure on vulnerable areas. These interventions aim to prevent further complications and support the patient's ability to maintain mobility and independence. The healthcare team plans a follow-up in two weeks to reassess the patient's response to these adjustments and to ensure comprehensive management of his diabetes and its complications.

Section 4

Two weeks later, the patient returns for a follow-up appointment. During the initial assessment, the healthcare team notes that the patient reports feeling less fatigued and experiences dizziness less frequently since the antihypertensive regimen was adjusted. However, he mentions new symptoms of increased thirst and more frequent urination, which prompt concerns about potential hyperglycemia or worsening glycemic control. A point-of-care glucose test reveals an elevated blood glucose level of 230 mg/dL. This unexpected rise in glucose levels calls for a reevaluation of his current diabetes management plan and potential adjustments in medication or lifestyle interventions.

Laboratory results obtained during this visit show a further reduction in the patient's eGFR to 64 mL/min/1.73m², indicating a continued decline in renal function. Although still within a moderate range, this trend necessitates a more aggressive approach to renal protection. The healthcare team considers the need to introduce an ACE inhibitor, which can have renal-protective benefits, while carefully balancing the risk of exacerbating hypotension. Additionally, his hemoglobin A1c level has increased to 8.2%, suggesting that his overall glucose control has worsened, possibly due to medication side effects, dietary habits, or other underlying factors.

The patient's foot ulcer has completely healed, and he has been adherent to the podiatrist's recommendations, including wearing the prescribed footwear. Despite these positive developments, the new concerns of glycemic instability and renal function decline require a comprehensive review of his care plan. The healthcare team discusses the importance of dietary adjustments, adherence to prescribed medications, and regular monitoring of blood glucose levels. The patient is scheduled for another follow-up in one month, with the plan to adjust his diabetes management strategy based on his response to these interventions and to prevent further complications.

Section 5

At the follow-up appointment one month later, the patient presents with signs of improved glycemic control. His self-monitored blood glucose logs show fewer fluctuations, with pre-meal readings averaging around 150 mg/dL. He reports feeling more energetic and notes a reduction in polyuria and thirst, which suggests that the adjustments to his diabetes management plan are beginning to take effect. However, during the physical examination, the healthcare team observes mild peripheral edema, raising concerns about potential fluid retention related to the introduction of the ACE inhibitor. His blood pressure remains stable at 125/78 mmHg, and he denies any symptoms of dizziness or lightheadedness, indicating that the risk of exacerbating hypotension has been well managed.

Laboratory results from this visit reveal a slight improvement in the patient's renal function, with an eGFR of 68 mL/min/1.73m². This positive trend suggests that the ACE inhibitor is providing renal protection without significant adverse effects. However, his hemoglobin A1c remains elevated at 8.0%, indicating the need for continued vigilance in managing his diabetes. The healthcare team reviews his dietary habits and encourages ongoing adherence to a balanced diet low in refined sugars and high in fiber. They also emphasize the importance of regular physical activity as a means to further improve insulin sensitivity and support weight management.

Despite the overall positive response to the interventions, the patient expresses concern about the peripheral edema and its potential impact on his mobility. The healthcare team decides to closely monitor his fluid status and consider adjusting the dosage of the ACE inhibitor if necessary. They also plan to reassess his medication regimen at the next appointment to ensure that his glycemic control continues to improve without compromising renal function or cardiovascular stability. The patient is scheduled for another follow-up in six weeks, with a focus on refining his treatment plan and preventing further complications.