A patient with type 2 diabetes presents with an A1c of 9.2%, blurred vision, fatigue, and numbness in the feet. Based on these findings, which intervention should the nurse prioritize to address both glycemic control and cardiovascular risk?

C) Advocate for the addition of an SGLT2 inhibitor to the medication regimen

A) Initiate insulin therapy to rapidly decrease blood glucose levels

B) Recommend an increase in dietary fiber and reduction in saturated fats

C) Advocate for the addition of an SGLT2 inhibitor to the medication regimen

D) Refer the patient to an ophthalmologist for further evaluation of retinopathy

A patient with poorly controlled diabetes exhibits blurred vision and numbness in the feet. Recent laboratory results show a hemoglobin A1c of 9.2%, elevated LDL cholesterol, and signs of non-proliferative diabetic retinopathy. What is the most appropriate nursing intervention to prioritize in the patient's care plan?

C) Reinforce the need for consistent blood glucose monitoring and medication adherence.

A) Encourage the patient to attend regular follow-up appointments with an ophthalmologist.

B) Educate the patient on the importance of adhering to a prescribed exercise regimen.

C) Reinforce the need for consistent blood glucose monitoring and medication adherence.

D) Suggest the patient increase dietary fiber intake to help manage cholesterol levels.

A patient with type 2 diabetes returns for a follow-up visit after starting an SGLT2 inhibitor. The patient reports improved glycemic control and decreased fatigue, but also mild tingling in the hands. Which intervention should the nurse prioritize to address the current symptoms and promote the patient's overall health?

C) Suggest the patient discuss adjusting medication dosage with their healthcare provider.

A) Encourage the patient to increase daily physical activity to improve circulation.

B) Educate the patient on the importance of foot inspections to prevent ulcers.

C) Suggest the patient discuss adjusting medication dosage with their healthcare provider.

D) Recommend a dietary focus on reducing saturated fats and increasing fiber intake.

A patient with type 2 diabetes has shown improvements in glycemic control and lipid profile after starting an SGLT2 inhibitor. However, they continue to experience diminished sensation in their feet and have begun to notice tingling in their hands. What is the priority nursing intervention for this patient to prevent further complications?

B) Educate the patient on daily foot inspections and proper foot care.

A) Increase the dosage of the SGLT2 inhibitor to improve glycemic control.

B) Educate the patient on daily foot inspections and proper foot care.

C) Refer the patient for an immediate neurological evaluation.

D) Suggest the patient increase dietary fiber intake to manage lipid levels.

A patient with type 2 diabetes is experiencing increased frequency of urination, persistent thirst, and sharp, shooting pains in the feet. The patient's blood pressure has increased, and there is a slight weight gain. Which intervention should the nurse prioritize to address these findings and prevent further complications?

B) Educate the patient on portion control and carbohydrate reduction to manage weight and blood glucose levels.

A) Increase the dosage of the current SGLT2 inhibitor to enhance glycemic control.

B) Educate the patient on portion control and carbohydrate reduction to manage weight and blood glucose levels.

C) Refer the patient to a neurologist for further evaluation of neuropathic symptoms.

D) Initiate a GLP-1 receptor agonist to address weight gain and improve glycemic control.

A patient with type 2 diabetes is experiencing increased thirst, frequent urination, and nighttime foot pain. The healthcare team is considering adding a GLP-1 receptor agonist to the patient's treatment regimen. What is the primary nursing consideration when educating the patient about this new medication?

B) Educate the patient about the potential gastrointestinal side effects, such as nausea and vomiting, which may occur with GLP-1 receptor agonists.

A) Emphasize the importance of monitoring for signs of hypoglycemia, as GLP-1 receptor agonists commonly cause this side effect.

B) Educate the patient about the potential gastrointestinal side effects, such as nausea and vomiting, which may occur with GLP-1 receptor agonists.

C) Instruct the patient to increase carbohydrate intake to prevent hypoglycemic episodes related to GLP-1 receptor agonist use.

D) Advise the patient to discontinue the SGLT2 inhibitor immediately upon starting the GLP-1 receptor agonist to avoid drug interactions.

A patient with type 2 diabetes mellitus is being managed with a GLP-1 receptor agonist and an SGLT2 inhibitor. Despite some improvements in weight and hemoglobin A1c, the patient continues to experience hyperglycemia postprandially and has been diagnosed with diabetic peripheral neuropathy. What nursing intervention should be prioritized to enhance the patient's glycemic control and manage neuropathy?

A) Encourage the patient to adhere to prescribed dietary modifications and increase physical activity.

B) Educate the patient on the proper administration and timing of gabapentin to manage neuropathic pain.

C) Schedule regular follow-up appointments to monitor blood glucose levels and adjust medications as necessary.

D) Advise the patient to increase the frequency of blood glucose monitoring to identify patterns in hyperglycemia.

A 58-year-old patient with type 2 diabetes mellitus is receiving treatment with a GLP-1 receptor agonist and an SGLT2 inhibitor. Despite some improvements in weight and hemoglobin A1c levels, the patient continues to experience neuropathic pain and inconsistent blood glucose control. Which nursing intervention is most critical in optimizing this patient's diabetes management?

B) Focus on reinforcing dietary modifications and consistent meal planning to enhance glycemic control.

A) Recommend an increase in the frequency of blood glucose monitoring to every two hours.

B) Focus on reinforcing dietary modifications and consistent meal planning to enhance glycemic control.

C) Suggest starting insulin therapy to achieve better blood glucose regulation.

D) Advise immediate discontinuation of the SGLT2 inhibitor due to neuropathic pain.

A patient with type 2 diabetes reports persistent fatigue and dizziness when standing. His blood pressure is 128/78 mmHg, and he has known fluctuations in blood glucose levels between 150 and 210 mg/dL. Which nursing intervention should be prioritized to address the patient's symptoms and promote overall health improvement?

B) Educate the patient on rising slowly from a sitting or lying position to prevent dizziness.

A) Increase the dosage of gabapentin to better manage neuropathic pain.

B) Educate the patient on rising slowly from a sitting or lying position to prevent dizziness.

C) Suggest a high-protein diet to help stabilize blood glucose levels.

D) Recommend a decrease in physical activity to conserve energy and reduce fatigue.

A patient with diabetes presents with persistent fatigue and dizziness when standing up quickly. The patient's blood pressure is well-controlled, but blood glucose levels remain inconsistent. His LDL cholesterol levels are elevated, and he reports neuropathic pain in his feet. What is the most appropriate initial nursing intervention to address the patient's symptoms of dizziness?

A) Educate the patient on slowly changing positions to prevent dizziness.

B) Increase the patient's dose of gabapentin to manage neuropathic pain.

C) Suggest the patient drink more fluids to address potential dehydration.

D) Recommend the patient eat small, frequent meals to stabilize blood glucose levels.

diabete - Nursing Case Study

Pathophysiology

• Primary mechanism: Insulin deficiency or resistance leads to impaired glucose uptake by cells, causing elevated blood glucose levels. In type 1 diabetes, autoimmune destruction of pancreatic beta cells results in insufficient insulin production. In type 2 diabetes, cells become resistant to insulin's effects, often exacerbated by obesity.

• Secondary mechanism: Hyperglycemia triggers increased hepatic glucose production due to unregulated gluconeogenesis and glycogenolysis, further elevating blood glucose levels. The lack of insulin or its effectiveness fails to suppress these liver processes.

• Key complication: Chronic hyperglycemia induces vascular damage through glycation of proteins, leading to microvascular complications such as retinopathy, nephropathy, and neuropathy, and macrovascular complications like cardiovascular disease. These complications underscore the importance of maintaining blood glucose control.

Patient Profile

Demographics:

52, female, office manager

History:

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

• Current medications: Metformin 1000 mg twice daily, Lisinopril 20 mg daily, Atorvastatin 40 mg daily

• Allergies: Penicillin

Current Presentation:

• Chief complaint: Increasing fatigue and blurred vision

• Key symptoms: Numbness and tingling in feet, occasional dizziness, frequent urination, unintentional weight loss

• Vital signs: Blood pressure 145/90 mmHg, heart rate 88 bpm, respiratory rate 18 breaths per minute, temperature 98.6°F, fasting blood glucose 178 mg/dL

Section 1

New Diagnostic Results:

Following the initial assessment, the healthcare team decided to conduct a comprehensive diabetic panel and additional diagnostic tests to assess the extent of the patient's diabetic control and potential complications. The laboratory results revealed a hemoglobin A1c level of 9.2%, indicating poor long-term glycemic control. This elevated A1c level correlates with the patient's symptoms of blurred vision, fatigue, and numbness in the feet, suggesting ongoing microvascular complications. Additionally, a lipid panel showed elevated LDL cholesterol at 160 mg/dL and reduced HDL cholesterol at 35 mg/dL, further highlighting the risk for cardiovascular complications.

An ophthalmologic exam was performed due to the complaint of blurred vision, revealing signs of non-proliferative diabetic retinopathy, characterized by microaneurysms and dot hemorrhages in the retina. This finding underlines the importance of addressing the patient's hyperglycemia to prevent progression to more severe retinopathy. A foot examination also uncovered diminished sensation in both feet, consistent with peripheral neuropathy, a common complication of chronic diabetes.

These diagnostic results necessitate a strategic adjustment to the patient's diabetes management plan. The healthcare team considers intensifying the patient's pharmacotherapy, potentially introducing an SGLT2 inhibitor or GLP-1 receptor agonist to improve glycemic control and address cardiovascular risk. Further lifestyle interventions, including dietary modifications and increased physical activity, are also emphasized. These steps are crucial in mitigating the current complications and preventing further deterioration, setting the stage for the next phase of the patient's care journey.

Section 2

Response to Interventions

Three months following the implementation of the revised diabetes management plan, the patient returns for a follow-up visit. The healthcare team notes a marked improvement in the patient’s overall condition. The introduction of an SGLT2 inhibitor has aided in reducing the hemoglobin A1c level to 7.8%, demonstrating better glycemic control, though it remains above the target range. The patient reports a significant decrease in fatigue and a slight improvement in vision, though blurring still occurs intermittently. These subjective improvements are corroborated by the ophthalmologic re-evaluation, which shows stabilization of the non-proliferative diabetic retinopathy.

The lipid panel shows modest improvements: LDL cholesterol decreased to 145 mg/dL, and HDL cholesterol increased to 40 mg/dL. These changes suggest a positive trend in cardiovascular risk reduction. However, the foot examination continues to reveal diminished sensation, indicating persistent peripheral neuropathy. The patient has also begun experiencing mild tingling in the hands, suggesting the possible development of diabetic neuropathy in upper extremities. Vital signs are stable, with a blood pressure reading of 130/85 mmHg and a heart rate of 78 bpm.

Given these findings, the healthcare team decides to reinforce lifestyle interventions while considering an adjustment in medication dosage to further enhance glycemic control and lipid management. They emphasize the importance of regular physical activity and adherence to dietary recommendations, particularly reducing saturated fats and increasing fiber intake. The patient is referred to a podiatrist for ongoing foot care and is educated about the importance of daily foot inspections to prevent ulcers. These strategic steps aim to solidify the initial gains and address residual complications, setting a foundation for further improvements in the patient's diabetic management and overall health status.

Section 3

Three months after the patient’s last follow-up, he returns for another evaluation. Despite previous improvements, new complications have emerged. The patient reports increased frequency of urination and persistent thirst, symptoms that he had previously experienced before the initiation of the SGLT2 inhibitor. Blood glucose monitoring logs show occasional spikes above 200 mg/dL. Furthermore, the patient reports experiencing sharp, shooting pains in his feet at night, which disrupt his sleep.

Upon physical examination, the healthcare team notes a slight increase in blood pressure, now reading at 140/88 mmHg, and a weight gain of 5 pounds since the last visit. The new lipid panel indicates an LDL cholesterol level that has risen to 155 mg/dL, while HDL remains stable at 40 mg/dL. A repeat hemoglobin A1c test shows a slight increase to 8.0%, indicating a regression in glycemic control. The continued presence of diminished sensation in the feet, combined with the development of tingling and pain, suggests a progression of peripheral neuropathy.

In response to these findings, the healthcare team decides to reassess the patient's medication regimen. They consider adding a GLP-1 receptor agonist to address the weight gain and improve glycemic control, while also reassessing the dosage of the current SGLT2 inhibitor. The team emphasizes the importance of adhering to lifestyle changes, particularly focusing on portion control and reducing carbohydrate intake. The patient is educated on the potential need for more frequent blood glucose monitoring to prevent hyperglycemic episodes. Additionally, the patient is referred to a neurologist for further evaluation of the neuropathic symptoms to develop a comprehensive management plan. These steps aim to mitigate the recent setbacks and focus on preventing further complications, ensuring the patient remains on a stable path toward effective diabetes management.

Section 4

The patient's follow-up appointment occurs six weeks after the initiation of the GLP-1 receptor agonist and the adjustment of the SGLT2 inhibitor dosage. Upon evaluation, the patient reports some improvement in his weight, having lost 3 pounds. However, he continues to experience episodes of sharp, shooting pains in his feet, though the frequency has slightly decreased. His adherence to the recommended dietary modifications has been inconsistent, as revealed through dietary recall. He manages to monitor his blood glucose levels more frequently, but occasional spikes above 200 mg/dL persist, particularly after meals.

New diagnostic results show a modest improvement in his hemoglobin A1c, now at 7.6%, suggesting a positive response to the medication adjustments, albeit not yet optimal. His LDL cholesterol levels have decreased slightly to 145 mg/dL, indicating some progress in lipid management, although his HDL remains unchanged. Blood pressure reads 136/85 mmHg, showing a slight improvement but still above target. The neurologist's evaluation confirms diabetic peripheral neuropathy, and a decision is made to start the patient on gabapentin to help manage neuropathic pain.

The healthcare team acknowledges the progress made but recognizes the need for further patient engagement in lifestyle modifications to enhance outcomes. They reinforce the importance of consistent dietary practices and regular physical activity, emphasizing their role in weight management and overall glycemic control. Additionally, the patient is educated about managing neuropathy, including foot care practices, to prevent further complications. The team plans to reassess the patient's status in another three months, focusing on continuous improvement in glycemic control and symptom management. This ongoing assessment and tailored interventions aim to support the patient's journey toward achieving better diabetes management and reducing the risk of long-term complications.

Section 5

Three months later, the patient returns for his follow-up appointment. His weight has decreased by an additional 5 pounds, which is a positive sign of his increasing commitment to the recommended lifestyle changes. However, he reports persistent fatigue and occasional dizziness, particularly when standing up quickly. Upon examination, his blood pressure is recorded at 128/78 mmHg, reflecting improved control. Despite these improvements, his fasting blood glucose levels remain inconsistent, with readings fluctuating between 150 and 210 mg/dL.

New diagnostic results reveal a slight decline in his hemoglobin A1c to 7.4%, showing continued, albeit slow, progress in glycemic control. However, his LDL cholesterol levels remain at 145 mg/dL, and his HDL has not shown any significant improvement. The patient expresses frustration over the persistent shooting pains in his feet, which have not significantly abated despite the addition of gabapentin. His compliance with the medication regimen is confirmed, suggesting a need for further adjustment or additional therapeutic interventions for neuropathic pain.

Based on these findings, the healthcare team decides to intensify the patient's dietary and physical activity counseling, reinforcing the benefits of a consistent routine to improve both glycemic control and lipid profiles. Consideration is given to optimizing his medication regimen further, potentially exploring additional neuropathy treatment options or adjusting the dosages of his current medications. The team also discusses the importance of monitoring for potential orthostatic hypotension, given his recent symptoms of dizziness. Plans are made for closer follow-up within the next eight weeks to assess the impact of these adjustments and to continue refining the management plan to address both the metabolic and neuropathic aspects of his diabetes.