A patient with poorly controlled Type 2 diabetes has a hemoglobin A1c of 9.2%, elevated triglycerides, LDL cholesterol, and microalbuminuria. The healthcare team plans to add a GLP-1 receptor agonist to her regimen. What is the primary benefit of this medication addition in the context of her current condition?

C) It addresses both glucose control and supports weight management.

A) It directly reduces serum creatinine levels and improves kidney function.

B) It primarily lowers LDL cholesterol, reducing cardiovascular risk.

C) It addresses both glucose control and supports weight management.

D) It replaces the need for lifestyle modifications such as diet and exercise.

A patient with Type 2 diabetes has been found to have a hemoglobin A1c level of 9.2%, elevated triglycerides, and LDL cholesterol. She has been started on a GLP-1 receptor agonist and advised on lifestyle modifications. Which of the following nursing interventions is most important to prioritize to prevent further progression of diabetic complications?

C) Monitoring the patient’s blood pressure and reinforcing adherence to antihypertensive medication

A) Educating the patient on the importance of glucose self-monitoring and adjusting insulin doses based on results

B) Encouraging the patient to increase dietary fiber intake to improve lipid levels

C) Monitoring the patient’s blood pressure and reinforcing adherence to antihypertensive medication

D) Scheduling regular foot examinations to prevent neuropathy-related injuries

A patient with diabetes has returned for a follow-up appointment reporting occasional tingling and numbness in her feet. Her recent lab results show improved hemoglobin A1c and fasting blood glucose levels but persistent microalbuminuria and a slight increase in serum creatinine. Which nursing intervention is most appropriate to address the risk of diabetic nephropathy progression?

A) Educate the patient on maintaining a low-sodium diet to help manage blood pressure.

B) Recommend increasing the daily intake of protein to support renal function.

C) Advise the patient to reduce physical activity to prevent further renal damage.

D) Encourage the patient to discontinue the low-carbohydrate diet to improve renal health.

A patient with type 2 diabetes presents with improved energy levels and weight loss after lifestyle modifications, but reports tingling and numbness in the feet. Lab results show an improved hemoglobin A1c of 8.4%, fasting blood glucose of 160 mg/dL, and a slight increase in serum creatinine to 1.4 mg/dL. Which nursing intervention is most appropriate to address the patient's current health concerns?

B) Educate the patient on foot care to prevent complications from neuropathy and suggest wearing diabetic socks.

A) Encourage continued adherence to the low-carbohydrate diet and monitor blood glucose levels daily.

B) Educate the patient on foot care to prevent complications from neuropathy and suggest wearing diabetic socks.

C) Advise the patient to increase physical activity to further enhance weight loss and glycemic control.

D) Discuss the importance of regular eye exams to detect early signs of diabetic retinopathy.

A patient with type 2 diabetes is concerned about increasing episodes of tingling and numbness in her feet. Her hemoglobin A1c is 7.9%, fasting blood glucose is 150 mg/dL, and serum creatinine is 1.5 mg/dL. Which intervention should the nurse prioritize to address the patient’s concerns about neuropathy?

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

A) Encourage continued adherence to a low-carbohydrate diet and physical activity.

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

C) Discuss the potential benefits and side effects of starting an SGLT2 inhibitor.

D) Advise the patient to increase her fluid intake to manage renal function.

A patient with type 2 diabetes reports more frequent episodes of tingling and numbness in her feet, which now occasionally disturb her sleep. Her current medications include metformin and an SGLT2 inhibitor. Which nursing intervention is most appropriate to address her symptoms of diabetic neuropathy?

A) Educate the patient on incorporating foot exercises to improve circulation.

B) Recommend increasing carbohydrate intake to improve energy levels.

C) Advise the patient to wear compression stockings to reduce swelling.

D) Suggest the use of over-the-counter analgesics to manage pain.

A patient with type 2 diabetes mellitus presents with a hemoglobin A1c of 7.5%, occasional dizziness upon standing, and a serum creatinine of 1.6 mg/dL. Which nursing intervention should be prioritized to address her current symptoms and prevent further complications?

B) Educate the patient on slowly changing positions to prevent orthostatic hypotension.

A) Encourage increased fluid intake to address dehydration and dizziness.

B) Educate the patient on slowly changing positions to prevent orthostatic hypotension.

C) Suggest a reduction in antihypertensive medication dose to manage dizziness.

D) Recommend increasing carbohydrate intake to improve energy levels.

A patient with diabetes mellitus type 2 presents with occasional dizziness upon standing, improved glycemic control, and a slight increase in serum creatinine levels. Which nursing intervention is most appropriate to address the patient's dizziness while considering her renal function?

B) Advise the patient to rise slowly from sitting or lying positions to reduce orthostatic symptoms.

A) Encourage the patient to increase fluid intake to prevent dehydration.

B) Advise the patient to rise slowly from sitting or lying positions to reduce orthostatic symptoms.

C) Suggest reducing the dose of the patient's antihypertensive medication to prevent dizziness.

D) Recommend the patient to increase salt intake to help manage blood pressure fluctuations.

A patient with a history of hypertension and diabetes returns for a follow-up with new symptoms of fatigue, shortness of breath on exertion, and mild lower extremity edema. Her lab results show a slightly elevated BNP and a serum creatinine of 1.8 mg/dL. Considering these findings, what is the most appropriate nursing intervention to prioritize at this time?

B) Educate the patient on low-sodium diet to manage edema.

A) Encourage increased fluid intake to prevent dehydration.

B) Educate the patient on low-sodium diet to manage edema.

C) Instruct the patient to monitor blood glucose levels more frequently.

D) Advise the patient to reduce physical activity to decrease fatigue.

A patient with a history of hypertension and diabetes presents with increased fatigue, occasional shortness of breath during exertion, mild lower extremity edema, and slightly elevated BNP levels. The healthcare team has adjusted her diuretic therapy and is considering adding an ACE inhibitor. Which nursing intervention is most appropriate to prioritize in this situation?

D) Encourage the patient to perform daily weights and report any sudden changes.

A) Educate the patient on dietary sodium restrictions to minimize fluid retention.

B) Advise the patient to increase fluid intake to prevent dehydration from diuretic use.

C) Instruct the patient to monitor blood glucose levels more frequently to detect hypoglycemia.

D) Encourage the patient to perform daily weights and report any sudden changes.

type 2 diabetes - Nursing Case Study

Pathophysiology

• Primary mechanism: Insulin resistance - Body's cells become less responsive to insulin, leading to decreased glucose uptake and increased blood sugar levels. This resistance is often associated with obesity and physical inactivity.

• Secondary mechanism: Beta-cell dysfunction - Pancreatic beta cells fail to secrete adequate insulin in response to elevated blood glucose, further exacerbating hyperglycemia. This dysfunction can progress as the disease advances.

• Key complication: Chronic hyperglycemia - Persistent high blood sugar levels can lead to microvascular and macrovascular complications, such as retinopathy, nephropathy, neuropathy, and cardiovascular disease, emphasizing the importance of early intervention and management.

Patient Profile

Demographics:

58-year-old 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 20 mg daily, Aspirin 81 mg daily

• Allergies: Penicillin

Current Presentation:

• Chief complaint: Increased fatigue and occasional blurred vision

• Key symptoms: Peripheral neuropathy in feet, elevated blood glucose levels, 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, BMI 32 kg/m²

Section 1

As the case progresses, the patient undergoes a series of diagnostic tests to further assess her current condition. Her latest lab results reveal a hemoglobin A1c level of 9.2%, indicating poor long-term glycemic control. Additionally, her fasting blood glucose level is recorded at 180 mg/dL, further confirming suboptimal management of her Type 2 diabetes. A lipid panel shows elevated triglycerides at 250 mg/dL and LDL cholesterol at 160 mg/dL, highlighting an increased risk for cardiovascular complications. Renal function tests reveal a slight increase in serum creatinine to 1.3 mg/dL, suggesting early signs of diabetic nephropathy. Urinalysis uncovers microalbuminuria, which supports the suspicion of kidney involvement.

In response to these findings, the healthcare team considers adjustments to the patient's medication regimen and lifestyle interventions. The addition of a GLP-1 receptor agonist is discussed to address both glucose control and weight management, given its dual benefit in reducing blood sugar levels and promoting weight loss. Furthermore, the patient is encouraged to engage in regular physical activity and adopt a heart-healthy, low-carbohydrate diet to improve insulin sensitivity and lipid profile. The importance of regular follow-up appointments to monitor her progress and adjust treatment as needed is emphasized.

The patient is also educated about the potential complications of uncontrolled diabetes, such as cardiovascular disease and progression of neuropathy and nephropathy. She is advised to monitor her blood pressure closely and adhere to her antihypertensive therapy to minimize the risk of further vascular damage. As she implements these changes, the healthcare team plans to reassess her condition in three months to evaluate the effectiveness of the interventions and make any necessary modifications to her care plan. This proactive approach aims to prevent the progression of diabetes-related complications and improve her overall quality of life.

Section 2

Three months later, the patient returns for a follow-up appointment. During the initial assessment, the healthcare team notes some positive changes but also new concerns that require attention. The patient reports feeling more energetic and less fatigued, attributing these improvements to her adherence to the low-carbohydrate diet and increased physical activity. Her weight has decreased by 6 pounds, which is an encouraging sign of her commitment to lifestyle modifications. However, she mentions occasional tingling and numbness in her feet, a potential indication of diabetic neuropathy progression.

New diagnostic tests provide a mixed picture of her current health status. Her hemoglobin A1c has improved to 8.4%, demonstrating better glycemic control, though it remains above target. Fasting blood glucose has decreased to 160 mg/dL, indicating some progress but still requiring further management. The lipid panel reveals a reduction in triglycerides to 210 mg/dL, while LDL cholesterol has improved to 140 mg/dL, suggesting partial success in reducing cardiovascular risk. Nevertheless, the renal function tests show a slight increase in serum creatinine to 1.4 mg/dL, and microalbuminuria persists, highlighting the need for intensified nephropathy management.

In response to these findings, the healthcare team considers optimizing the patient's medication regimen further. The addition of an SGLT2 inhibitor is contemplated to enhance renal protection and provide additional glucose-lowering effects. The patient continues to be educated on the importance of blood pressure control, with an emphasis on maintaining a systolic target below 130 mmHg to mitigate the risk of further vascular damage. The team plans another follow-up in three months to closely monitor her neuropathic symptoms and evaluate the effectiveness of the updated interventions. This approach aims to address both the metabolic and microvascular complications of her diabetes, striving for improved overall health outcomes.

Section 3

Three months later, the patient returns for another follow-up appointment. During the initial assessment, the healthcare team observes further improvements in her weight, noting an additional loss of 5 pounds, which indicates her sustained commitment to lifestyle changes. She reports maintaining her low-carbohydrate diet and regular physical activity, which have helped her feel more energetic and alert. However, the patient expresses concern about more frequent episodes of tingling and numbness in her feet, which now occasionally disturb her sleep. This symptom escalation suggests a possible progression of diabetic neuropathy, necessitating a closer examination and tailored management strategies.

The new diagnostic results present a mixed picture. Her hemoglobin A1c has improved to 7.9%, showing continued progress in glycemic control, though it remains above the target goal. Fasting blood glucose levels have decreased to 150 mg/dL, reflecting better management but still needing refinement. The lipid panel reveals further reduction in triglycerides to 190 mg/dL and LDL cholesterol to 130 mg/dL, illustrating ongoing improvement in cardiovascular risk factors. However, renal function tests remain a concern, as serum creatinine has increased slightly to 1.5 mg/dL, and microalbuminuria persists, indicating the need for more aggressive nephropathy management.

The healthcare team decides to proceed with adding an SGLT2 inhibitor to the patient's medication regimen to address both glucose control and renal protection. They also intensify education on neuropathy management, including foot care and the potential use of medications to alleviate neuropathic pain. The team emphasizes the importance of maintaining blood pressure within the target range, given the increased renal risk. They schedule another follow-up in three months to assess the patient's response to the new interventions and monitor any changes in her neuropathic symptoms, aiming to prevent further complications and improve her overall quality of life.

Section 4

Three months later, the patient returns for her scheduled follow-up, eager to discuss her progress and any new concerns. Upon initial assessment, the healthcare team notes that she has maintained her weight loss, shedding an additional 3 pounds, a testament to her steadfast adherence to lifestyle modifications. Her blood pressure is recorded at 135/85 mmHg, slightly above the target but improved from previous readings. During the consultation, the patient reports a marked reduction in the frequency of tingling and numbness in her feet, suggesting a positive response to the newly implemented neuropathy management strategies. However, she mentions experiencing occasional dizziness, particularly when standing up quickly, which prompts further evaluation.

The updated diagnostic results provide a clearer picture of her current health status. Her hemoglobin A1c has decreased to 7.5%, a positive trend indicating improved glycemic control but still necessitating continued efforts to reach the target goal. Fasting blood glucose is now at 140 mg/dL, reflecting consistent progress. The lipid panel shows further improvement, with triglycerides at 170 mg/dL and LDL cholesterol at 120 mg/dL, reducing her cardiovascular risk factors. Renal function tests, however, reveal a slight increase in serum creatinine to 1.6 mg/dL, and microalbuminuria remains unchanged. These findings underscore the importance of intensifying renal protection strategies alongside her current regimen.

In response to these findings, the healthcare team considers adjusting the patient's antihypertensive medication to address her occasional dizziness, which may be related to orthostatic hypotension. They reinforce the importance of maintaining adequate hydration and gradual positional changes to mitigate these symptoms. Additionally, the team discusses the potential need for further renal protective measures, such as optimizing the dose of the SGLT2 inhibitor or considering an ACE inhibitor, to better manage her nephropathy. A follow-up appointment is scheduled for three months, with a focus on closely monitoring renal function and ensuring continued improvement in glycemic control and neuropathic symptoms, all aimed at enhancing the patient's quality of life and preventing further complications.

Section 5

Three months later, the patient returns for her follow-up appointment. She reports improved energy levels and continues to adhere to her lifestyle modifications, which have resulted in another 2-pound weight loss. During the initial assessment, her blood pressure is recorded at 130/80 mmHg, an encouraging improvement that suggests effective management of her antihypertensive regimen. However, she now reports a new symptom: increased fatigue and occasional shortness of breath during exertion, especially when climbing stairs. The healthcare team notes that her heart rate is slightly elevated at 92 beats per minute, and her physical exam reveals mild edema in her lower extremities.

The latest diagnostic results reveal her hemoglobin A1c has further decreased to 7.2%, indicating continued progress in managing her blood glucose levels. Her fasting blood glucose is now 130 mg/dL, and her lipid panel shows triglycerides at 160 mg/dL and LDL cholesterol at 115 mg/dL, reflecting ongoing improvement. However, her serum creatinine has increased slightly to 1.8 mg/dL, raising concerns about her renal function. Additionally, her BNP levels are slightly elevated, prompting consideration of possible cardiac involvement, potentially indicating early heart failure or fluid overload.

In response to these developments, the healthcare team decides to adjust her diuretic therapy to address the edema and potential fluid overload, while emphasizing the importance of monitoring her kidney function closely. They discuss the addition of an ACE inhibitor to further protect her kidneys and manage her blood pressure, as well as the possibility of a referral to a cardiologist for further cardiac evaluation. The patient is advised on recognizing signs of worsening heart failure and the need for prompt medical attention if symptoms escalate. A follow-up appointment is scheduled in six weeks to reassess her response to these interventions and ensure comprehensive management of her diabetes and associated complications.