Mr. Thompson is experiencing declining renal function and peripheral neuropathy as complications of his diabetes. Which of the following nursing interventions is most appropriate to address these complications and prevent further deterioration?

A) Educate Mr. Thompson on the importance of daily foot inspections and proper foot care.

B) Encourage Mr. Thompson to increase his protein intake to support kidney function.

C) Suggest Mr. Thompson limit fluid intake to prevent fluid overload.

D) Advise Mr. Thompson to engage in high-intensity exercise to improve circulation.

Mr. Thompson has been diagnosed with early-stage diabetic nephropathy and peripheral neuropathy. As his nurse, which intervention should you prioritize to address his current health issues and prevent further complications?

A) Educate Mr. Thompson on the importance of regular foot inspections and proper footwear to prevent injuries.

B) Advise Mr. Thompson to increase his dietary protein intake to support kidney function.

C) Encourage Mr. Thompson to limit fluid intake to reduce the workload on his kidneys.

D) Recommend Mr. Thompson discontinue his statin therapy to allow for better kidney function.

Mr. Thompson, a diabetic patient, presents with increased urination frequency and a burning sensation during micturition after starting on empagliflozin, an SGLT2 inhibitor. Which nursing intervention should be prioritized to address his current condition while considering his overall management plan?

A) Encourage increased fluid intake to flush out the infection

B) Educate Mr. Thompson on the importance of adhering to a low-sodium diet

C) Suggest discontinuing the SGLT2 inhibitor immediately to prevent further genitourinary infections

D) Initiate a referral to a nephrologist to assess renal function

During a follow-up visit, Mr. Thompson, who is on an SGLT2 inhibitor, reports increased urination and a burning sensation during micturition. Which nursing intervention is most appropriate to address the new concern while considering his ongoing diabetes management?

A) Instruct Mr. Thompson to increase fluid intake to dilute urine and flush out bacteria.

B) Advise Mr. Thompson to stop the SGLT2 inhibitor immediately to prevent further complications.

C) Educate Mr. Thompson on performing proper perineal hygiene and apply a topical antimicrobial cream.

D) Suggest reducing carbohydrate intake to decrease glucose excretion into the urine.

Mr. Thompson is a diabetic patient currently on empagliflozin therapy. Given his recent lab results and the interdisciplinary team's decision to continue the medication, which nursing intervention is most important to minimize the risk of complications from empagliflozin therapy?

B) Educate Mr. Thompson on the importance of reporting symptoms of urinary tract infections promptly.

A) Encourage Mr. Thompson to increase his dietary intake of carbohydrates.

B) Educate Mr. Thompson on the importance of reporting symptoms of urinary tract infections promptly.

C) Advise Mr. Thompson to reduce his fluid intake to prevent fluid overload.

D) Monitor Mr. Thompson's blood pressure daily to detect any signs of hypertension.

Mr. Thompson's healthcare team has decided to continue empagliflozin therapy despite his recent urinary tract infection and the presence of ketones in his urine. Which nursing intervention is most critical to implement to minimize potential complications associated with empagliflozin in this scenario?

A) Educate Mr. Thompson on the importance of reporting any signs of recurrent infections promptly.

B) Advise Mr. Thompson to increase his daily protein intake to support renal function.

C) Recommend Mr. Thompson decrease fluid intake to prevent urinary symptoms.

D) Instruct Mr. Thompson to take empagliflozin with meals to improve glycemic control.

During Mr. Thompson's follow-up appointment, the nurse notes an increase in nocturnal urination and mild lower extremity edema, along with a decline in his eGFR. Considering these findings, which nursing intervention is most appropriate to prioritize at this time?

B) Educate Mr. Thompson on the signs and symptoms of fluid overload and when to seek medical attention.

A) Encourage Mr. Thompson to increase his fluid intake to at least 3 liters per day.

B) Educate Mr. Thompson on the signs and symptoms of fluid overload and when to seek medical attention.

C) Advise Mr. Thompson to limit his protein intake to reduce renal stress.

D) Suggest Mr. Thompson start a daily exercise regimen to improve fluid balance.

A nurse is reviewing the care plan for Mr. Thompson, who has shown signs of fluid retention and renal impairment. Based on the changes in his condition, which of the following interventions should be prioritized to support Mr. Thompson's renal function while managing his fluid status?

C) Implement a hydration protocol while monitoring for signs of fluid overload.

A) Increase the dose of empagliflozin to enhance glucose excretion.

B) Encourage fluid restriction to prevent further edema and fluid retention.

C) Implement a hydration protocol while monitoring for signs of fluid overload.

D) Discontinue all medications affecting renal function to prevent further decline.

In assessing Mr. Thompson's current condition and the interventions implemented by the healthcare team, which of the following nursing actions is the most critical to monitor for potential complications related to the new ACE inhibitor therapy?

B) Assess Mr. Thompson's potassium levels for signs of hyperkalemia.

A) Monitor Mr. Thompson's blood glucose levels for signs of hypoglycemia.

B) Assess Mr. Thompson's potassium levels for signs of hyperkalemia.

C) Evaluate Mr. Thompson's blood pressure for signs of hypotension.

D) Check Mr. Thompson's weight daily for signs of fluid retention.

A nurse is reviewing the care plan for Mr. Thompson, who has shown signs of worsening renal function. Which of the following interventions should the nurse prioritize to address the risk of further renal deterioration?

B) Encourage Mr. Thompson to monitor his blood pressure daily and report any significant changes.

A) Increase Mr. Thompson's protein intake to support muscle mass.

B) Encourage Mr. Thompson to monitor his blood pressure daily and report any significant changes.

C) Advise Mr. Thompson to reduce fluid intake drastically to prevent edema.

D) Recommend that Mr. Thompson continue his current lifestyle without changes, as his condition is stable.

type 2 diabetes - Nursing Case Study

Pathophysiology

• Primary mechanism: Insulin resistance - Body cells, especially in liver, muscle, and fat tissues, become less sensitive to insulin, leading to impaired glucose uptake and increased blood sugar levels.

• Secondary mechanism: Beta-cell dysfunction - Pancreatic beta-cells fail to secrete enough insulin to compensate for increased insulin resistance, further exacerbating hyperglycemia.

• Key complication: Chronic hyperglycemia - Persistently high blood sugar levels can lead to vascular damage, increasing risk for cardiovascular disease, neuropathy, and renal impairment.

Patient Profile

Demographics:

62-year-old male, retired school teacher

History:

• Key past medical history: Diagnosed with type 2 diabetes 10 years ago, hypertension, hyperlipidemia

• Current medications: Metformin, Lisinopril, Atorvastatin, Aspirin

• Allergies: Penicillin

Current Presentation:

• Chief complaint: Increasing fatigue and blurred vision

• Key symptoms: Numbness in feet, frequent urination, occasional dizziness

• Vital signs: Blood pressure 145/90 mmHg, heart rate 92 bpm, respiratory rate 18 breaths per minute, temperature 98.7°F, HbA1c 8.2%

Section 1

As the patient, Mr. Thompson, undergoes further evaluation, new diagnostic results reveal concerning developments. A comprehensive metabolic panel indicates elevated creatinine levels at 1.6 mg/dL, suggesting declining renal function, likely due to diabetic nephropathy. Additionally, a urine microalbumin test shows increased albuminuria at 35 mg/g creatinine, further supporting the suspicion of early-stage kidney damage. His lipid profile remains suboptimal, with LDL cholesterol at 140 mg/dL and triglycerides at 180 mg/dL, necessitating a re-evaluation of his current statin therapy and lifestyle modifications.

In parallel, a thorough physical examination highlights decreased sensation in Mr. Thompson's feet, confirming the presence of peripheral neuropathy. This sensory loss could be contributing to his complaints of numbness and warrants a more intensive focus on foot care to prevent ulcers or injuries. Given his blurred vision, an ophthalmology referral is made to assess for diabetic retinopathy, a potential complication from chronic hyperglycemia.

These findings prompt the healthcare team to consider adjustments in Mr. Thompson's management plan. Emphasis is placed on tighter glycemic control to slow the progression of microvascular complications, potentially involving the introduction of additional antihyperglycemic agents such as an SGLT2 inhibitor or GLP-1 receptor agonist. The results underscore the necessity for an interdisciplinary approach, involving nutrition, nephrology, and endocrinology, to address the interconnected challenges of Mr. Thompson's diabetes management, ultimately aiming to mitigate further complications and maintain quality of life.

Section 2

As Mr. Thompson's management plan is adjusted to address his diabetic complications, the healthcare team closely monitors his response to the new interventions. Within a few weeks, Mr. Thompson is started on an SGLT2 inhibitor, empagliflozin, to aid in better glycemic control and provide renal protection. Alongside this, his statin therapy is intensified to target an LDL cholesterol level below 100 mg/dL, and he is advised to adhere to a cardiac-friendly diet rich in omega-3 fatty acids and fiber to address his dyslipidemia. Regular follow-ups are scheduled to evaluate the effectiveness of these interventions.

After a month of adherence to the revised management plan, Mr. Thompson presents for a follow-up appointment. His fasting blood glucose readings have improved, averaging around 110 mg/dL, indicating better glycemic control. However, despite these positive changes, a new concern arises. Mr. Thompson reports increased frequency of urination and a burning sensation during micturition. A urinalysis reveals the presence of ketones and a mild urinary tract infection, suggesting a possible side effect of the SGLT2 inhibitor therapy, which can increase the risk of genitourinary infections.

In response to these new findings, the healthcare team initiates a course of antibiotics to address the urinary tract infection and educates Mr. Thompson on maintaining good hydration and personal hygiene to prevent future infections. The team discusses the risks and benefits of continuing the SGLT2 inhibitor, considering its renal and glycemic benefits against the new complication. An interdisciplinary meeting is planned to re-evaluate Mr. Thompson's comprehensive care plan, ensuring all aspects of his health are addressed while minimizing adverse effects. The focus remains on a balanced approach to managing his diabetes, aiming to prevent further complications and maintain his overall quality of life.

Section 3

As the interdisciplinary team reconvenes to discuss Mr. Thompson's case, they focus on his response to the interventions and the emergence of new complications. Mr. Thompson's vital signs are stable, with a blood pressure reading of 128/78 mmHg and a heart rate of 72 beats per minute. His most recent lab results show an HbA1c reduction to 7.2%, reflecting improved long-term glycemic control. However, the presence of ketones in his urine and the recent urinary tract infection necessitate further consideration of his current medication regimen. The team deliberates whether the benefits of empagliflozin, particularly its renal protective effects and ability to lower cardiovascular risk, outweigh the risk of recurrent infections.

Further diagnostic results reveal a slight decline in Mr. Thompson's estimated glomerular filtration rate (eGFR) from 65 mL/min/1.73m² to 60 mL/min/1.73m², suggesting a need for cautious monitoring of his renal function. This decline, although mild, prompts the team to consider potential adjustments in his medication plan or additional renal protective strategies. Meanwhile, his lipid profile shows progress, with an LDL cholesterol level now at 95 mg/dL, indicating that the intensified statin therapy and dietary modifications are effectively managing his dyslipidemia.

Faced with these findings, the healthcare team decides to continue empagliflozin therapy with close monitoring of renal function and urinary symptoms. They emphasize the importance of Mr. Thompson's adherence to lifestyle modifications, particularly hydration and dietary measures, to support his overall health and minimize the risk of future complications. The team schedules more frequent follow-up appointments to reassess his renal function and monitor for any signs of recurrent infections. This proactive approach aims to ensure that Mr. Thompson's diabetes management remains comprehensive and responsive to his evolving clinical picture.

Section 4

Two weeks after the interdisciplinary team’s last meeting, Mr. Thompson returns for his scheduled follow-up appointment. During the initial assessment, the nurse notes that Mr. Thompson appears slightly fatigued and reports increased nocturnal urination and mild lower extremity edema. His vital signs reveal a blood pressure of 130/82 mmHg and a heart rate of 76 beats per minute, which are stable but slightly elevated from previous readings. Mr. Thompson's weight has increased by two pounds since the last visit, prompting the team to consider fluid retention as a potential concern.

The team reviews new lab results, which show a further decline in Mr. Thompson’s eGFR to 58 mL/min/1.73m², raising concerns about the progression of renal impairment. Additionally, his urine analysis reveals persistent ketonuria and traces of protein, suggesting ongoing challenges in metabolic management and possible renal stress. In response to these findings, the team deliberates on the need to adjust his pharmacological regimen. They discuss whether to reduce the dose of empagliflozin or consider alternative medications that may be more suitable given his renal status.

Given these changes, the healthcare team enhances the focus on Mr. Thompson's renal health and decides to implement a more rigorous hydration protocol to help mitigate ketonuria and support renal function. They also discuss the potential introduction of an ACE inhibitor to provide additional renal protection, balancing this against his current medication profile. Mr. Thompson is counseled on the importance of promptly reporting any new symptoms, such as increased swelling or difficulty breathing, that might indicate worsening fluid retention. The team schedules another follow-up in two weeks to closely monitor these adjustments and evaluate their impact on Mr. Thompson's condition, ensuring that his care plan remains dynamic and responsive to his evolving clinical needs.

Section 5

Two weeks later, Mr. Thompson returns for his follow-up appointment. The nurse conducting the initial assessment notes that Mr. Thompson appears more fatigued than on his previous visit. He reports experiencing increased nocturnal urination and has started noticing puffiness around his eyes in the morning. His blood pressure has risen slightly to 138/86 mmHg, and his heart rate is now 80 beats per minute. His weight has increased by an additional three pounds, indicating possible worsening fluid retention. The nurse also observes mild bilateral ankle edema, which is more pronounced than during the last assessment.

New laboratory results show a further decline in Mr. Thompson’s eGFR to 54 mL/min/1.73m², suggesting ongoing renal impairment. The urine analysis reveals persistent ketonuria and an increase in proteinuria, indicating that his kidneys are under significant stress. Blood tests show an elevated blood urea nitrogen (BUN) level of 28 mg/dL and a creatinine level of 1.5 mg/dL, both higher than previous readings. These findings raise concerns about the progression of renal complications and signal a need for immediate intervention to prevent further deterioration.

In response to these developments, the healthcare team decides to intensify Mr. Thompson's renal protection measures. They initiate a low-protein diet to reduce renal stress and adjust his medication regimen by starting a low-dose ACE inhibitor, while carefully monitoring for potential side effects such as hyperkalemia. The team emphasizes the importance of adherence to the new hydration protocol and instructs Mr. Thompson to monitor his weight and report any sudden changes. They also recommend a consultation with a nephrologist to provide specialized guidance. A follow-up appointment is scheduled for one week later to closely monitor Mr. Thompson’s response to these interventions and ensure his treatment plan is adjusted as needed.