What is the primary reason for performing regular foot inspections in diabetic patients?

B) To prevent the development of foot ulcers

A) To monitor for changes in skin color

B) To prevent the development of foot ulcers

C) To assess for changes in foot size

D) To reduce the risk of heart disease

Which of the following is a primary reason for conducting regular foot inspections in a patient with diabetes?

A) To assess for early signs of infection

B) To evaluate the patient's gait

C) To monitor changes in blood pressure

D) To ensure compliance with dietary recommendations

What is the primary goal of the nurse's dietary recommendations for the patient with an HbA1c level of 7.2%?

B) To reduce the patient's carbohydrate intake

A) To decrease the patient's protein intake

B) To reduce the patient's carbohydrate intake

C) To increase the patient's sodium intake

D) To eliminate all sugars from the patient's diet

A patient with type 2 diabetes has an HbA1c level of 7.2%. Which nursing intervention is most appropriate to help the patient improve blood glucose control?

C) Recommend the patient engage in at least 150 minutes of moderate exercise per week

A) Encourage the patient to drink 8-10 glasses of water daily

B) Suggest the patient increase dietary protein intake

C) Recommend the patient engage in at least 150 minutes of moderate exercise per week

D) Advise the patient to increase sodium intake to manage blood sugar levels

What is the primary purpose of ordering an HbA1c test for the patient in this scenario?

B) To assess long-term blood glucose control

A) To measure immediate blood glucose levels

B) To assess long-term blood glucose control

What is the primary reason for ordering an HbA1c test for this patient at the follow-up appointment?

B) To evaluate long-term blood glucose control

A) To assess short-term blood glucose control

B) To evaluate long-term blood glucose control

C) To measure current insulin levels

D) To check for electrolyte imbalances

Which intervention is most important for the nurse to emphasize to the patient to prevent complications due to tingling in the feet?

B) Schedule regular foot examinations

A) Increase strength training to three times per week

B) Schedule regular foot examinations

C) Reduce physical activity to prevent further discomfort

D) Limit carbohydrate intake further to control blood glucose

Which intervention would most likely help in addressing the patient's reported tingling sensation in the feet?

B) Encouraging regular movement and activity breaks

A) Increasing the frequency of foot massages

B) Encouraging regular movement and activity breaks

C) Applying warm compresses to the feet daily

D) Reducing carbohydrate intake further

diabetes - Nursing Case Study

Pathophysiology

• Primary mechanism: In type 1 diabetes, the immune system mistakenly attacks and destroys insulin-producing beta cells in the pancreas, leading to an absolute insulin deficiency. In type 2 diabetes, the body becomes resistant to insulin, causing the pancreas to produce more insulin until it can't keep up, resulting in relative insulin deficiency.

• Secondary mechanism: With insufficient insulin, glucose cannot enter the cells and remains in the bloodstream, leading to elevated blood sugar levels. Over time, high blood sugar can damage blood vessels and nerves.

• Key complication: Persistent high blood sugar can lead to minor complications such as delayed wound healing and frequent infections due to impaired immune response, emphasizing the importance of blood sugar management in diabetes care.

Patient Profile

Demographics:

55-year-old male, office manager

History:

• Key past medical history: Diagnosed with type 2 diabetes 2 years ago

• Current medications: Metformin 500 mg twice daily

• Allergies: None

Current Presentation:

• Chief complaint: Routine follow-up for diabetes management

• Key symptoms: Mild fatigue, occasional increased thirst

• Vital signs: Blood pressure 125/80 mmHg, heart rate 72 bpm, respiratory rate 16 breaths per minute, temperature 98.6°F, BMI 27

Section 1

Initial Assessment Findings:

During the routine follow-up appointment, the nurse conducts an initial assessment to evaluate the patient's current diabetic management. The patient, a 55-year-old male office manager, reports mild fatigue and occasional increased thirst, symptoms he attributes to his busy work schedule. Despite these mild symptoms, he maintains an active lifestyle and adheres to a diet plan recommended by his healthcare provider. On examination, his vital signs are stable, with a blood pressure of 125/80 mmHg, a heart rate of 72 bpm, and a respiratory rate of 16 breaths per minute. His temperature is normal at 98.6°F, and he has a BMI of 27, indicating that he is slightly overweight.

The nurse performs a focused assessment on the patient's feet, a common area for complications in diabetic patients. There are no visible wounds or signs of infection, but the patient reports some numbness and tingling in his toes, which he has occasionally noticed over the past few months. This finding prompts the nurse to consider the possibility of peripheral neuropathy, a minor complication of diabetes. The nurse educates the patient about the importance of regular foot inspections and proper foot care to prevent complications such as ulcers or infections. Additionally, the nurse schedules the patient for a comprehensive metabolic panel and HbA1c test to further assess his blood sugar control and kidney function.

These assessment findings provide a basis for the healthcare team to evaluate the effectiveness of the current treatment plan and consider any necessary adjustments. The detection of early signs of neuropathy highlights the importance of ongoing monitoring and patient education in managing diabetes effectively. The nurse plans to review the upcoming lab results with the patient to discuss potential adjustments to his medication or lifestyle modifications that could improve his symptoms and overall quality of life.

Section 2

A week later, the nurse receives the patient's lab results, which reveal an HbA1c level of 7.2%, indicating that the patient's blood sugar levels have been slightly above the target range over the past few months. The comprehensive metabolic panel shows normal kidney function, with creatinine and blood urea nitrogen (BUN) levels within the normal range. However, a slight elevation in fasting blood glucose is noted, measuring 135 mg/dL. These results suggest that while the patient's diabetes management is generally on track, there is room for improvement in maintaining optimal blood sugar control.

During a follow-up appointment to discuss the lab results, the nurse talks with the patient about potential modifications to his current management plan. The nurse emphasizes the importance of closely monitoring his blood sugar levels and suggests slight dietary adjustments to help reduce carbohydrate intake. Additionally, the nurse encourages the patient to increase his physical activity, suggesting moderate exercises such as brisk walking or cycling for at least 150 minutes per week, to help improve insulin sensitivity and promote weight loss.

The patient expresses understanding of the recommendations and agrees to incorporate these changes into his routine. The nurse also discusses the potential need for medication adjustment if lifestyle modifications do not sufficiently lower his HbA1c levels. The patient is scheduled for a follow-up appointment in three months to reassess his progress and make any necessary adjustments to his treatment plan. This ongoing monitoring and support aim to prevent further complications and enhance the patient's overall well-being.

Section 3

Three months later, the patient returns for his follow-up appointment. During the visit, the nurse conducts a thorough assessment to evaluate the patient's progress. The patient reports feeling more energetic and notes a slight weight loss of 5 pounds since the last visit. He has been diligently following the recommended dietary changes and engaging in brisk walking for 30 minutes, five days a week. His commitment to these lifestyle modifications is evident in his improved energy levels and overall mood.

The nurse checks the patient's vital signs and finds them to be stable: blood pressure is 128/78 mmHg, heart rate is 72 beats per minute, and respiratory rate is 16 breaths per minute. The nurse also reviews the patient's self-monitored blood glucose log, which shows a consistent decrease in fasting blood glucose levels, averaging around 110 mg/dL over the past month. This improvement indicates that the lifestyle changes are positively impacting his blood sugar control.

The nurse discusses these encouraging findings with the patient and reinforces the importance of continuing his current regimen. An HbA1c test is ordered to obtain updated data on his long-term blood glucose control. The nurse also addresses any concerns the patient may have and ensures he is comfortable with maintaining these lifestyle habits. The follow-up plan includes another appointment in three months to reassess the HbA1c level and make any necessary adjustments to his treatment plan. The focus remains on preventing complications and maintaining the patient's improved health status.

Section 4

Three months later, the patient returns for his scheduled follow-up appointment. The nurse notes that the patient appears more confident and reports feeling consistently energized. He has continued with his dietary modifications and physical activity, now incorporating light strength training twice a week. His weight has stabilized, with an additional loss of 2 pounds, bringing his total weight loss to 7 pounds since the initial intervention. Vital signs remain within normal ranges: blood pressure is 126/76 mmHg, heart rate is 70 beats per minute, and respiratory rate is 16 breaths per minute. These findings suggest that the patient is effectively managing his condition through lifestyle changes.

The nurse reviews the patient's HbA1c test results, which show a decrease from the initial 7.2% to 6.8%. This improvement demonstrates better long-term blood glucose control, aligning with the patient's efforts and self-reported adherence to his management plan. The nurse praises the patient for his dedication and reiterates the importance of maintaining these healthy habits. Additionally, the patient mentions a minor issue with occasional tingling in his feet, particularly after prolonged periods of inactivity, prompting the nurse to perform a more focused assessment on peripheral sensation and circulation.

The nurse educates the patient on the importance of foot care and monitoring for any changes that could indicate complications, such as neuropathy. The patient is advised to schedule regular foot examinations and to continue monitoring his blood glucose levels closely. The nurse and patient collaboratively set goals for the next three months, focusing on further weight management, enhancing physical activity, and maintaining blood glucose levels within the target range. Another follow-up appointment is planned to reassess his HbA1c and address the tingling sensation, ensuring comprehensive care and preventing potential complications.

Section 5

Three months later, the patient returns for another follow-up appointment. During the initial assessment, the nurse notes that the patient appears well and is enthusiastic about his progress. He reports feeling more energetic and maintains his routine of dietary modifications, regular physical activity, and strength training. The patient's weight remains stable, with no further loss, which is appropriate given his current BMI. Vital signs continue to be within normal ranges: blood pressure is 124/74 mmHg, heart rate is 68 beats per minute, and respiratory rate is 15 breaths per minute, indicating that his cardiovascular health remains stable.

The nurse reviews the latest HbA1c test results, which show a further decrease to 6.5%, reflecting continued improvement in long-term blood glucose management. The patient mentions that the tingling sensation in his feet has become less frequent and less intense since he has been more conscious about taking breaks to move around during prolonged periods of inactivity. The nurse performs a focused assessment of peripheral sensation and circulation, noting that sensation in the feet is intact, and capillary refill is brisk, suggesting that the patient is successfully managing early signs of neuropathy through lifestyle adjustments.

The nurse reinforces the importance of ongoing foot care and regular monitoring of blood glucose levels. Together, they set new goals for the next three months, emphasizing the need to maintain current habits and explore strategies for further reducing the tingling sensation. The patient is encouraged to continue his regimen and is advised to schedule regular check-ups to monitor any changes. Another follow-up appointment is planned to reassess his HbA1c and peripheral sensation, ensuring that any potential complications are addressed promptly. This proactive approach is integral to the patient's ongoing diabetes management and overall well-being.