What is the primary purpose of Metformin in the management of type 2 diabetes?

B) To decrease insulin resistance and lower blood glucose levels

A) To increase insulin secretion from the pancreas

B) To decrease insulin resistance and lower blood glucose levels

C) To stimulate the release of insulin in response to meals

D) To replace insulin therapy in patients with type 1 diabetes

Which lifestyle modification would the nurse most likely recommend to a patient with a recent diagnosis of type 2 diabetes to help manage blood glucose levels?

C) Incorporate regular physical activity

A) Increase dietary carbohydrate intake

B) Maintain a sedentary lifestyle

C) Incorporate regular physical activity

D) Skip meals to lower calorie consumption

What is the primary purpose of Metformin in the management of type 2 diabetes?

B) To enhance the body’s sensitivity to insulin

A) To increase insulin production by the pancreas

B) To enhance the body’s sensitivity to insulin

C) To decrease the absorption of glucose in the kidneys

D) To rapidly reduce blood glucose levels during hypoglycemic episodes

Which of the following lifestyle changes made by the patient is most likely to contribute to improved blood glucose control?

C) Reducing carbohydrate intake

A) Attending a diabetes education program

B) Incorporating 30 minutes of moderate exercise daily

C) Reducing carbohydrate intake

D) Monitoring blood glucose levels more consistently

Which of the following strategies is most effective for a patient with diabetes experiencing difficulty adhering to meal plans due to a busy schedule?

B) Batch cooking meals for the week

C) Eating fast food as a quick option

D) Consuming only protein shakes

What is the primary reason for monitoring HbA1c levels in a patient with diabetes?

B) To evaluate long-term glucose control

A) To assess daily glucose fluctuations

B) To evaluate long-term glucose control

C) To determine insulin sensitivity

D) To check for acute complications of diabetes

A patient with type 2 diabetes mellitus has shown improvement in her lab results, including a decrease in fasting blood glucose and HbA1c levels. Which intervention is most important for the nurse to emphasize during her follow-up visit to support continued progress?

B) Maintain consistency in dietary habits

A) Increase physical activity to 60 minutes daily

B) Maintain consistency in dietary habits

C) Schedule weekly check-ins with a dietitian

D) Begin a new medication regimen

What is an appropriate nursing intervention for a patient experiencing early signs of diabetic neuropathy, such as tingling in the feet?

A) Encourage the patient to perform daily foot inspections.

B) Advise the patient to reduce their physical activity.

C) Suggest the patient increase their sugar intake.

D) Recommend the use of tight-fitting shoes to support the feet.

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 little or no insulin production. Without insulin, glucose cannot enter cells and remains in the bloodstream, causing high blood sugar levels.

• Secondary mechanism: In Type 2 diabetes, the body becomes resistant to insulin, meaning cells do not respond effectively to insulin's signal to take in glucose. Over time, the pancreas cannot produce enough insulin to overcome this resistance, resulting in elevated blood glucose levels.

• Key complication: Chronic high blood sugar can cause damage to blood vessels and nerves, leading to complications such as cardiovascular disease, neuropathy, and kidney damage. Nurses play a crucial role in patient education and monitoring to prevent and manage these complications effectively.

Patient Profile

Demographics:

45-year-old female, office manager

History:

• Key past medical history: Recently diagnosed with type 2 diabetes, family history of diabetes

• Current medications: Metformin 500 mg once daily

• Allergies: None

Current Presentation:

• Chief complaint: Routine check-up following diabetes diagnosis

• Key symptoms: Mild fatigue, increased thirst

• Vital signs: Blood pressure 120/80 mmHg, heart rate 76 bpm, respiratory rate 16 breaths per minute, temperature 98.6°F, BMI 28

Section 1

Initial Assessment Findings:

During the routine check-up, the nurse conducts a thorough assessment of the patient, focusing on her recent diabetes diagnosis. The patient reports mild fatigue and increased thirst, which are common symptoms associated with elevated blood glucose levels. Upon review of the patient's lifestyle, it is noted that she leads a sedentary lifestyle due to her office job and has not yet made significant dietary changes following her diagnosis. The patient mentions that her diet is high in carbohydrates and she often skips meals, which can contribute to poor blood sugar control.

The nurse performs a physical examination and notes that the patient has a BMI of 28, indicating that she is overweight, which is a known risk factor for the progression of type 2 diabetes. The nurse also checks the patient’s recent lab results, which show a fasting blood glucose level of 140 mg/dL and an HbA1c of 7.2%, suggesting that her blood sugar levels are not yet adequately controlled. The nurse takes the opportunity to reinforce the importance of lifestyle modifications including regular physical activity and a balanced diet to help manage her blood sugar levels and prevent complications.

Based on these findings, the nurse discusses with the patient the importance of adhering to her prescribed Metformin regimen. The nurse also provides basic education on monitoring blood glucose levels at home and recognizing signs of hypo- and hyperglycemia. The patient is encouraged to attend a diabetes education program to learn more about managing her condition effectively. This approach aims to empower the patient with knowledge and practical skills to take active control of her diabetes management and reduce the risk of future complications.

Section 2

Response to Interventions:

Following the initial consultation, the patient diligently begins implementing the recommended lifestyle changes. She gradually incorporates 30 minutes of moderate exercise into her daily routine, choosing to take brisk walks during her lunch breaks. Additionally, she starts attending a diabetes education program, which provides her with valuable insight into meal planning and carbohydrate counting. Over the next few weeks, the patient makes a conscious effort to reduce her carbohydrate intake and ensures she eats regular, balanced meals to maintain stable blood sugar levels.

At her follow-up appointment, the nurse conducts a thorough assessment to evaluate the patient's response to the interventions. The patient's energy levels have improved, and she reports feeling less fatigued. Her weight has decreased slightly, with her BMI now at 27.5, indicating progress towards a healthier weight. The patient has been adhering to her Metformin regimen and has become more consistent with her blood glucose monitoring. Recent lab results show a fasting blood glucose level of 125 mg/dL and an HbA1c of 6.8%, demonstrating a positive trend towards better glucose control.

The nurse commends the patient for her efforts and encourages her to continue with her current regimen. They discuss the importance of maintaining momentum and setting new, achievable goals, such as incorporating more varied physical activities and further refining her diet. The nurse also emphasizes the ongoing need for regular monitoring and follow-ups to track progress and promptly address any emerging issues. This positive response to initial interventions sets a strong foundation for the patient's continued journey in managing her diabetes effectively.

Section 3

A few months later, during a routine follow-up, the patient returns for a new assessment. She reports continuing with her exercise regimen and attending regular sessions of the diabetes education program. However, she mentions occasional difficulty in adhering to her meal plans due to her busy work schedule. The nurse conducts a comprehensive assessment, noting that the patient's weight has stabilized, with her BMI now at 27.0. Vital signs are within normal limits, with a blood pressure of 120/78 mmHg and a heart rate of 72 beats per minute.

The lab results indicate a slight improvement in her glucose levels, with a fasting blood glucose of 120 mg/dL and an HbA1c of 6.5%. These figures suggest that the patient is making steady progress, though there is room for further improvement in her dietary habits. The nurse discusses these findings with the patient, highlighting the importance of meal prep and planning to prevent unexpected deviations from her dietary goals. Together, they set a new target for her HbA1c to be below 6.5% by the next visit.

To address the challenges of meal planning, the nurse suggests exploring time-efficient strategies such as batch cooking or using meal delivery services specializing in diabetic-friendly options. The patient feels motivated by the positive feedback and expresses a renewed commitment to refining her diet. The nurse schedules a follow-up appointment in three months to reassess her progress and reiterates the importance of regular check-ins to ensure continued success in managing her diabetes. This ongoing support will help the patient maintain her momentum and prevent potential complications, setting her on a path toward long-term health and stability.

Section 4

Three months later, the patient returns for her scheduled follow-up appointment. Upon arrival, she reports feeling more energetic and mentions that she has been successfully incorporating meal prep into her weekly routine. She expresses satisfaction with the convenience this has brought to her busy lifestyle. The nurse conducts a comprehensive assessment and notes that the patient's weight has decreased slightly, with her BMI now at 26.5, indicating a positive trend. Vital signs remain stable with a blood pressure of 118/76 mmHg and a heart rate of 70 beats per minute.

The latest lab results show further improvement. Her fasting blood glucose level has decreased to 115 mg/dL, and her HbA1c has dropped to 6.3%. These figures reflect the patient's dedication to her dietary and exercise regimen, and the nurse commends her for the progress made. However, the nurse reminds the patient that while these improvements are encouraging, maintaining consistency is crucial in diabetes management. The patient agrees and expresses a desire to continue refining her approach to nutrition.

To support ongoing success, the nurse suggests a few additional strategies, such as exploring mobile apps for meal planning and tracking nutritional intake. Together, they set a new goal for the patient's HbA1c to be below 6.0% by the next visit. The nurse schedules another follow-up in three months and emphasizes the importance of staying engaged in diabetes education programs. This plan aims to ensure that the patient continues to build on her progress, minimizing the risk of complications and empowering her to achieve long-term health stability.

Section 5

Three months later, the patient returns for her scheduled follow-up appointment. Upon arrival, she is in good spirits and reports feeling even more energetic than before. She has continued her meal prep routine and has also started using a mobile app to track her nutritional intake, as suggested by the nurse. This has helped her make more informed choices about her diet. During the comprehensive assessment, the nurse notes that the patient's weight has decreased further, with her BMI now at 25.8, indicating continued progress toward a healthier weight.

Vital signs show a slight improvement, with a blood pressure of 116/74 mmHg and a heart rate of 68 beats per minute, both within normal ranges. The latest lab results reveal that her fasting blood glucose level is now 110 mg/dL, and her HbA1c has decreased to 6.0%, meeting the goal set during her last visit. The nurse congratulates the patient on her achievements, emphasizing how her commitment to lifestyle changes has positively impacted her health.

However, the nurse also informs the patient about a minor complication noted during the visit. The patient mentions experiencing occasional tingling in her feet, particularly at night. The nurse explains that this could be an early sign of diabetic neuropathy, a common complication of diabetes. To address this, the nurse suggests incorporating simple foot care practices and monitoring the symptoms closely. They discuss the importance of maintaining blood sugar control to prevent further nerve damage. The patient agrees to this approach and remains optimistic, committed to continuing her journey toward improved health. The nurse schedules another follow-up in three months and reiterates the importance of regular check-ups and ongoing diabetes education.