A 53-year-old male with poorly controlled diabetes presents with elevated HbA1c, lipid abnormalities, microalbuminuria, and non-proliferative diabetic retinopathy. Which intervention should the nurse prioritize to address the patient's risk of microvascular complications?

C) Recommend starting a GLP-1 receptor agonist to improve glycemic control.

A) Initiate a statin medication to reduce LDL cholesterol levels.

B) Educate the patient on proper foot care to prevent neuropathic ulcers.

C) Recommend starting a GLP-1 receptor agonist to improve glycemic control.

D) Refer the patient for an ophthalmologic follow-up to monitor retinopathy.

A 53-year-old male with a history of type 2 diabetes presents with elevated HbA1c, hyperlipidemia, microalbuminuria, and non-proliferative diabetic retinopathy. Given these findings, which nursing intervention is most important to prevent further microvascular complications?

A) Encourage the patient to monitor blood glucose levels daily and report any significant changes.

B) Advise the patient to reduce sodium intake to manage potential hypertension.

C) Recommend the patient see an ophthalmologist annually for ongoing eye assessment.

D) Educate the patient on the importance of foot care to prevent peripheral neuropathy complications.

A 58-year-old male patient with type 2 diabetes mellitus has been started on a GLP-1 receptor agonist and reports some improvement in his blood glucose levels. However, his fasting blood glucose remains elevated, and his blood pressure is 150/95 mmHg. He also experiences numbness and tingling in his feet, now with a mild burning sensation. Which nursing intervention is most appropriate to address the patient's current symptoms and prevent further complications?

C) Instruct the patient on the importance of daily foot inspection and proper foot care.

A) Encourage the patient to increase daily physical activity to at least 60 minutes.

B) Advise the patient to monitor blood glucose before and after meals only.

C) Instruct the patient on the importance of daily foot inspection and proper foot care.

D) Recommend the patient to take over-the-counter pain medication for neuropathy symptoms.

A patient with type 2 diabetes mellitus is experiencing persistent numbness, tingling, and a mild burning sensation in his feet, along with elevated fasting blood glucose levels and hypertension. The healthcare team is considering pharmacological interventions and lifestyle modifications. Which of the following should be prioritized to address the patient's current symptoms and prevent further complications?

C) Refer the patient to a neurologist for further evaluation of peripheral neuropathy.

A) Increase the dosage of the GLP-1 receptor agonist to achieve better glycemic control.

B) Initiate an ACE inhibitor to protect renal function and manage hypertension.

C) Refer the patient to a neurologist for further evaluation of peripheral neuropathy.

D) Emphasize strict dietary changes and exercise to improve overall health.

A patient with diabetes has a hemoglobin A1c of 8.3%, elevated LDL cholesterol, and mild peripheral arterial disease with an ABI of 0.85. Based on these findings, which nursing intervention is most appropriate to prioritize for this patient?

B) Encourage daily foot inspections to detect changes in skin condition or circulation.

A) Recommend increasing dietary fiber intake to manage cholesterol levels.

B) Encourage daily foot inspections to detect changes in skin condition or circulation.

C) Suggest the patient engage in high-intensity interval training to improve cardiovascular health.

D) Advise reducing insulin dosage to prevent further decrease in ABI values.

A patient with diabetes has a hemoglobin A1c of 8.3% and an ankle-brachial index (ABI) of 0.85. Which nursing intervention is most appropriate to address the patient's current condition and prevent further complications?

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

A) Encourage the patient to increase their intake of carbohydrates to manage energy levels.

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

C) Advise the patient to limit physical activity to reduce strain on the lower extremities.

D) Recommend the patient to reduce fluid intake to decrease ankle and foot swelling.

A patient with diabetes and newly diagnosed moderate peripheral arterial disease (PAD) reports experiencing intermittent claudication. The healthcare team notes an elevated blood pressure and a slight increase in serum creatinine. Which intervention should the nurse prioritize to address the patient's condition holistically?

B) Suggest adjusting the antihypertensive medication to better control blood pressure.

A) Recommend the patient increase their daily walking to improve circulation and alleviate symptoms.

B) Suggest adjusting the antihypertensive medication to better control blood pressure.

C) Advise the patient to reduce protein intake to manage renal function.

D) Encourage the patient to maintain strict glycemic control to prevent further complications.

A patient with diabetes and newly diagnosed moderate peripheral arterial disease (PAD) presents with intermittent claudication and a slight increase in serum creatinine. Which nursing intervention is most appropriate to address the patient's current symptoms and potential complications?

B) Educate the patient on the importance of medication adherence, particularly for antihypertensive and statin medications.

A) Encourage the patient to increase high-impact exercises to improve circulation.

B) Educate the patient on the importance of medication adherence, particularly for antihypertensive and statin medications.

C) Suggest the patient follow a high-protein diet to support renal function.

D) Advise the patient to limit fluid intake to prevent further increase in serum creatinine.

A patient with a history of hypertension and diabetes is experiencing dizziness and fatigue after starting a calcium channel blocker. The healthcare team is considering switching to an ACE inhibitor. What is the primary reason for choosing an ACE inhibitor in this scenario?

B) To provide renal protection and manage blood pressure

A) To improve blood glucose control

B) To provide renal protection and manage blood pressure

C) To decrease the patient's heart rate

D) To prevent the progression of diabetic retinopathy

A patient with type 2 diabetes and hypertension reports dizziness and fatigue after taking a newly prescribed calcium channel blocker. Lab results indicate microalbuminuria, suggesting early diabetic nephropathy. Which adjustment to the patient's medication regimen is most appropriate to address both hypertension and renal protection?

B) Discontinue the calcium channel blocker and start an ACE inhibitor

A) Continue the calcium channel blocker and add a diuretic

B) Discontinue the calcium channel blocker and start an ACE inhibitor

C) Maintain the current regimen and monitor symptoms closely

D) Switch to a beta-blocker to manage blood pressure and symptoms

Diabetes - Nursing Case Study

Pathophysiology

• Primary mechanism: Insulin deficiency or resistance leads to impaired glucose uptake by cells, resulting in elevated blood glucose levels. In Type 1 diabetes, autoimmune destruction of pancreatic beta cells diminishes insulin production. In Type 2 diabetes, insulin resistance occurs, where cells become less responsive to insulin.

• Secondary mechanism: Hyperglycemia triggers increased hepatic glucose production and decreased glycogen synthesis, further exacerbating high blood sugar levels. The lack of insulin action also disrupts lipid and protein metabolism, contributing to ketone production and potential ketoacidosis in Type 1 diabetes.

• Key complication: Persistent hyperglycemia causes microvascular damage, leading to complications such as retinopathy, nephropathy, and neuropathy. These complications arise from chronic high glucose levels causing endothelial damage and impaired blood flow, affecting organs and tissues.

Patient Profile

Demographics:

53-year-old male, 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, Aspirin 81 mg daily

• Allergies: Penicillin

Current Presentation:

• Chief complaint: Increasing fatigue and numbness in feet

• Key symptoms: Blurred vision, frequent urination, tingling sensation in hands and feet, occasional dizziness

• Vital signs: Blood pressure 145/90 mmHg, heart rate 88 bpm, respiratory rate 18 breaths per minute, temperature 98.6°F, blood glucose 180 mg/dL fasting

Section 1

As the clinical team continues to evaluate the 53-year-old male patient, new diagnostic results provide further insight into his current condition and potential complications. A comprehensive metabolic panel reveals an elevated HbA1c level of 9.2%, indicating poor long-term glycemic control. Additionally, a lipid profile shows elevated LDL cholesterol at 160 mg/dL and decreased HDL cholesterol at 35 mg/dL, suggesting that his hyperlipidemia is not optimally managed. Urinalysis results are concerning, with microalbuminuria present, signaling the early stages of diabetic nephropathy. These findings highlight the need for tighter control of both blood glucose and lipid levels to prevent further microvascular damage.

The patient undergoes an ophthalmologic examination due to his complaint of blurred vision, which confirms non-proliferative diabetic retinopathy. This condition is characterized by microaneurysms and retinal hemorrhages, reflecting ongoing microvascular complications. The presence of retinopathy, combined with the patient's reports of numbness and tingling in his extremities, suggests the development of peripheral neuropathy, a common complication in long-standing diabetes. Clinically, these findings emphasize the interconnection between prolonged hyperglycemia and microvascular injury, necessitating a reassessment of the patient's diabetes management plan.

Given the current diagnostic results, the healthcare team considers adjusting the patient's medication regimen to better address his elevated blood glucose and lipid levels. The introduction of a GLP-1 receptor agonist or SGLT2 inhibitor is contemplated to enhance glycemic control and provide cardiovascular benefits. Additionally, a referral to a diabetes educator is planned to reinforce lifestyle modifications, including dietary changes and increased physical activity. These interventions aim not only to manage the patient's current symptoms but also to mitigate the progression of complications, setting the stage for the next steps in his ongoing care and monitoring.

Section 2

As the healthcare team implements the updated management plan for the patient, they closely monitor his response to the interventions. After introducing a GLP-1 receptor agonist to his medication regimen, the patient reports a modest improvement in his blood glucose levels, as reflected in daily self-monitoring records. However, his fasting blood glucose remains elevated, averaging around 180 mg/dL, indicating that further adjustments may be necessary. Additionally, the patient's blood pressure is measured at 150/95 mmHg during a follow-up visit, suggesting suboptimal control that could exacerbate his microvascular complications. This prompts consideration of adding an ACE inhibitor to protect his renal function and address hypertension.

Despite these pharmacological interventions, the patient experiences persistent numbness and tingling in his feet, which are now accompanied by a mild burning sensation, particularly at night. These symptoms suggest a progression of his peripheral neuropathy, warranting a referral to a neurologist for further evaluation and management. The healthcare team emphasizes the importance of regular foot care and monitoring for any signs of ulceration or infection, given the increased risk associated with neuropathy.

In an effort to enhance the patient's overall health and prevent further complications, the diabetes educator works closely with him to refine his lifestyle modifications. A personalized exercise plan is developed to incorporate low-impact activities aimed at improving cardiovascular health without exacerbating his neuropathy symptoms. Nutritional counseling focuses on reducing saturated fat intake and increasing fiber to help manage both his blood glucose and lipid levels. The patient's journey underscores the critical need for a multidisciplinary approach and ongoing reassessment to effectively manage diabetes and its associated complications.

Section 3

As the healthcare team continues to monitor the patient's progress, a routine lab review reveals new diagnostic results that further inform his management plan. The patient's hemoglobin A1c, a critical marker of long-term glucose control, is measured at 8.3%, indicating that despite recent interventions, his diabetes remains suboptimally managed. This reinforces the need for additional therapeutic adjustments and more intensive lifestyle modifications. Concurrently, a comprehensive lipid panel shows elevated LDL cholesterol at 140 mg/dL and triglycerides at 210 mg/dL, which raises concerns about his cardiovascular risk. These findings prompt a discussion about possibly adding a statin to his regimen to address dyslipidemia and further protect his cardiovascular health.

On physical examination, the healthcare team notices slight swelling in the patient's ankles and feet, alongside decreased dorsalis pedis pulses bilaterally. These signs, coupled with the patient's persistent neuropathic symptoms, suggest a possible progression of peripheral vascular disease, a common complication of diabetes that necessitates close monitoring. To further evaluate the severity and impact of his peripheral vascular issues, an ankle-brachial index (ABI) test is ordered, which returns a value of 0.85, indicative of mild peripheral arterial disease.

The team discusses these new findings with the patient, emphasizing the importance of adherence to his medication regimen and lifestyle changes to mitigate these risks. They also educate him on recognizing signs of worsening circulation, such as increased swelling or changes in skin color. Each member of the multidisciplinary team plays a crucial role in supporting the patient, from refining his dietary plan to incorporating therapeutic exercises that enhance circulation without straining his lower extremities. These coordinated efforts reflect the ongoing commitment to leveraging clinical reasoning and patient-centered care to address the complexities of his diabetes management.

Section 4

As the weeks progress, the healthcare team closely monitors the patient's response to the newly implemented therapeutic strategies. Despite his adherence to the medication regimen, including the addition of a statin to address his dyslipidemia, the patient begins to exhibit subtle changes in his condition. During a follow-up visit, he reports experiencing intermittent claudication, a condition characterized by pain and cramping in the legs during physical activity, which is relieved by rest. This new symptom suggests a possible exacerbation of his peripheral arterial disease.

The team conducts a thorough reassessment of the patient's cardiovascular and peripheral vascular status. Vital signs indicate a blood pressure of 150/92 mmHg, slightly elevated from previous readings, and a heart rate of 82 beats per minute. A repeat ankle-brachial index (ABI) test is performed, yielding a value of 0.78, showing a decline from the previous result and confirming a progression to moderate peripheral arterial disease. Additionally, laboratory assessments reveal a slight increase in serum creatinine to 1.4 mg/dL from a baseline of 1.1 mg/dL, raising concerns about potential kidney involvement, a common complication of poorly controlled diabetes.

These developments prompt the healthcare team to refine the patient's management plan further. Emphasis is placed on optimizing blood pressure control, possibly requiring adjustments to his antihypertensive therapy. The patient is counseled on the importance of regular, low-impact exercise tailored to his capabilities to improve circulation and manage symptoms. The dietitian collaborates with the patient to ensure his nutrition plan supports cardiovascular health while being mindful of renal function. This comprehensive approach underscores the need for dynamic clinical reasoning and proactive adjustments to address the evolving challenges in the patient's diabetes management journey.

Section 5

As the healthcare team continues to refine the patient's management plan, they closely monitor his response to the interventions targeting his cardiovascular and peripheral vascular health. During a routine follow-up, the patient reports some improvement in his intermittent claudication symptoms with the introduction of a tailored exercise regimen. However, he now notices occasional dizziness and fatigue, particularly after taking his antihypertensive medications. This prompts the care team to reassess his blood pressure management strategy.

A comprehensive review of the patient's current medications reveals that the recent addition of a calcium channel blocker, aimed at enhancing blood pressure control, may be contributing to these symptoms. Upon examination, his blood pressure is recorded at 142/88 mmHg, indicating a slight improvement, though his heart rate remains stable at 80 beats per minute. Laboratory tests show that his serum creatinine is stable at 1.4 mg/dL, but a new finding of microalbuminuria suggests early diabetic nephropathy, a sign of worsening renal function. This finding necessitates a revision in his treatment plan to address renal protection more effectively.

The healthcare team decides to adjust the patient's antihypertensive regimen, considering an ACE inhibitor to manage both blood pressure and renal protection, while discontinuing the calcium channel blocker to alleviate his dizziness and fatigue. Additionally, the patient's statin dosage is re-evaluated to ensure optimal lipid control without renal compromise. These modifications aim to stabilize the patient's condition and prevent further complications, emphasizing the importance of personalized care and dynamic clinical reasoning in managing complex diabetes cases. As the patient embarks on this adjusted therapeutic pathway, the team remains vigilant, ready to adapt the management plan as needed to support his overall health and quality of life.