A 57-year-old female patient with a history of poorly controlled diabetes presents with decreased sensation in her feet, signs of diabetic retinopathy, and elevated blood pressure and LDL cholesterol levels despite being on medication. Which nursing intervention should be prioritized to address her current health concerns?

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

A) Initiate a referral to a dietitian for dietary modifications.

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

C) Recommend immediate intensive insulin therapy to lower HbA1c levels.

D) Schedule an ophthalmology consult to evaluate diabetic retinopathy.

A 57-year-old female patient with diabetes exhibits decreased sensation in her feet, signs of diabetic retinopathy, and has an HbA1c level of 9.2%. Her blood pressure is 150/95 mmHg, and her LDL cholesterol is 145 mg/dL. Which of the following nursing interventions is the priority to address the potential complications of her condition?

C) Collaborate with the healthcare provider to adjust her antihypertensive medications.

A) Educate the patient on the importance of foot care and regular foot inspections.

B) Discuss with the patient the need for consistent medication adherence.

C) Collaborate with the healthcare provider to adjust her antihypertensive medications.

D) Develop a personalized exercise regimen to enhance cardiovascular health.

A patient with type 2 diabetes is experiencing elevated blood pressure and increased albuminuria despite being on a GLP-1 receptor agonist and a calcium channel blocker. Which nursing intervention is most appropriate to address the patient's condition and prevent progression of diabetic nephropathy?

C) Request the addition of an ACE inhibitor to the treatment regimen.

A) Increase the dose of the GLP-1 receptor agonist.

B) Encourage adherence to a low-sodium diet and regular physical activity.

C) Request the addition of an ACE inhibitor to the treatment regimen.

D) Increase the dose of the calcium channel blocker.

A patient with type 2 diabetes is undergoing treatment for glycemic control and hypertension management. Despite improvements in blood glucose levels and slight blood pressure reduction, recent tests indicate an increase in albuminuria and LDL cholesterol still above target. As a nurse, what is the most appropriate initial intervention to address the patient's current condition?

B) Suggest the addition of an ACE inhibitor to the patient's regimen to address albuminuria.

A) Educate the patient on the importance of medication adherence and regular follow-up appointments.

B) Suggest the addition of an ACE inhibitor to the patient's regimen to address albuminuria.

C) Recommend increasing the dosage of atorvastatin to better manage LDL cholesterol levels.

D) Encourage the patient to begin a regular exercise routine to improve overall cardiovascular health.

A patient with hypertension, nephropathy, and dyslipidemia reports persistent fatigue and occasional dizziness. Vital signs show a blood pressure of 142/90 mmHg, heart rate of 98 bpm, and mild peripheral edema. Lab results indicate increased microalbumin levels and elevated LDL cholesterol. Considering the patient's current condition, which action should the nurse prioritize to address the patient's symptoms and prevent further complications?

C) Discuss with the healthcare provider about adjusting the antihypertensive medication to an ACE inhibitor.

A) Educate the patient on dietary sodium restriction to reduce blood pressure and edema.

B) Suggest the patient increase physical activity to improve cardiovascular health.

C) Discuss with the healthcare provider about adjusting the antihypertensive medication to an ACE inhibitor.

D) Recommend the patient to increase fluid intake to alleviate dizziness.

A patient with a history of hypertension and nephropathy presents with persistent fatigue and occasional dizziness. Given the current findings of inadequately controlled blood pressure, mild peripheral edema, and elevated microalbumin levels, which intervention should the nurse anticipate as a priority to address both cardiovascular and renal complications?

B) Switch to an ACE inhibitor to improve blood pressure and renal protection

A) Initiate a diuretic to manage peripheral edema

B) Switch to an ACE inhibitor to improve blood pressure and renal protection

C) Increase the dosage of the current antihypertensive medication

D) Recommend a high-protein diet to counteract fatigue

A patient with hypertension, diabetes, and hyperlipidemia is being managed with an ACE inhibitor, dietary sodium restriction, and statin therapy. Recent follow-up shows improved blood pressure and renal function, but persistent elevated LDL cholesterol and stable HbA1c. Which intervention should the nurse prioritize to further reduce the patient's cardiovascular risk?

C) Educate the patient on increasing physical activity

A) Increase the dose of the ACE inhibitor

B) Reinforce dietary sodium restriction

C) Educate the patient on increasing physical activity

D) Encourage stricter adherence to glycemic control measures

A patient with hypertension and type 2 diabetes has recently been started on an ACE inhibitor and a statin. The patient reports reduced edema, improved blood pressure, and stable heart rate, but persistent fatigue. Lab results show a slight improvement in microalbumin levels and a stable HbA1c. Which nursing intervention is most appropriate to address the patient's persistent fatigue?

B) Encourage the patient to increase daily physical activity gradually.

A) Educate the patient on the importance of adherence to dietary sodium restrictions.

B) Encourage the patient to increase daily physical activity gradually.

C) Suggest the patient take frequent rest periods throughout the day.

D) Increase the frequency of blood glucose monitoring to assess for fluctuations.

A patient with type 2 diabetes is experiencing mild peripheral neuropathy and early signs of nephropathy. The healthcare team has decided to introduce a GLP-1 receptor agonist to improve glycemic control. Which nursing intervention is most important to prioritize in the care plan to address the patient's current condition?

A) Educate the patient on the importance of daily foot inspection and foot care.

B) Advise the patient to decrease dietary protein intake to protect kidney function.

C) Instruct the patient to increase fluid intake to help with kidney filtration.

D) Encourage the patient to engage in daily vigorous exercise to improve circulation.

A patient with diabetes presents with occasional tingling sensations in her feet and decreased sensation in her lower extremities, confirmed by monofilament testing. Her blood pressure is stable at 130/85 mmHg, and her creatinine level has increased to 1.2 mg/dL. Which nursing intervention should be prioritized to address her current symptoms and prevent further complications?

A) Encourage the patient to perform daily foot inspections and maintain proper foot hygiene.

B) Advise the patient to increase her daily physical activity to improve circulation.

C) Suggest the patient increase dietary protein intake to support kidney function.

D) Educate the patient about reducing salt intake to further stabilize blood pressure.

Diabetes mellitus - Nursing Case Study

Pathophysiology

• Primary mechanism: Insulin deficiency or resistance disrupts glucose uptake, leading to elevated blood glucose levels. In Type 1 diabetes, autoimmune destruction of pancreatic beta cells results in insufficient insulin production. In Type 2 diabetes, insulin resistance in peripheral tissues means that even normal levels of insulin cannot effectively facilitate glucose uptake.

• Secondary mechanism: Chronic hyperglycemia causes glycation of proteins and lipids, forming advanced glycation end-products (AGEs) that damage blood vessels and tissues, contributing to complications such as neuropathy and retinopathy.

• Key complication: Persistent high blood glucose can lead to microvascular complications (e.g., diabetic nephropathy) and macrovascular complications (e.g., cardiovascular disease), underscoring the importance of glucose control to prevent long-term damage.

Patient Profile

Demographics:

57 years old, female, school teacher

History:

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

• Current medications: Metformin 1000 mg twice daily, Lisinopril 10 mg daily, Atorvastatin 20 mg nightly, 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 headaches

• Vital signs: Blood pressure 150/95 mmHg, heart rate 88 bpm, respiratory rate 18 breaths per minute, temperature 98.6°F, blood glucose level 215 mg/dL

Section 1

As the healthcare team conducts an initial assessment of the 57-year-old female patient, several concerning findings emerge that signal the potential development of diabetes-related complications. Upon physical examination, the patient exhibits decreased sensation in her distal extremities, particularly in the feet, which is confirmed by monofilament testing. This suggests the presence of peripheral neuropathy, a common microvascular complication of diabetes. Additionally, the patient's fundoscopic examination reveals signs of diabetic retinopathy, characterized by microaneurysms and small retinal hemorrhages. Her current blood pressure reading of 150/95 mmHg, despite being on antihypertensive medication, indicates suboptimal control of her hypertension, which may exacerbate her risk of both microvascular and macrovascular complications.

Laboratory tests further illuminate the patient's condition. Her HbA1c level is found to be 9.2%, indicating poor glycemic control over the past three months. This chronic hyperglycemia contributes to the glycation processes that lead to vascular damage. The lipid panel reveals elevated LDL cholesterol levels at 145 mg/dL, despite being on atorvastatin, suggesting that her hyperlipidemia is not adequately managed, increasing her cardiovascular risk. Her urine microalbumin test is positive, signaling early diabetic nephropathy, which requires prompt intervention to prevent progression to renal impairment.

These findings necessitate a comprehensive review of the patient's current management plan. The healthcare team considers escalating her antihypertensive therapy, possibly adding a calcium channel blocker, and intensifying her lipid-lowering regimen. Furthermore, the patient requires education on lifestyle modifications, including dietary changes and increased physical activity, to improve her overall metabolic control. The potential need for additional antidiabetic medication, such as a GLP-1 receptor agonist or SGLT2 inhibitor, is also considered to achieve better glycemic control and address the multifaceted aspects of her diabetes management. The next steps involve closely monitoring her response to these interventions and re-evaluating her condition to prevent further complications.

Section 2

The healthcare team decides to focus first on intensifying the patient's glycemic control and addressing her hypertension more effectively. Following the initiation of a GLP-1 receptor agonist, the patient begins to experience some positive changes. After four weeks, her fasting blood glucose levels have decreased, averaging around 130 mg/dL, and her postprandial glucose levels show improvement, indicating a gradual enhancement in overall glycemic control. Her blood pressure, however, remains elevated, prompting the addition of a calcium channel blocker to her antihypertensive regimen. Subsequent measurements reveal a slight improvement, with readings averaging 140/88 mmHg, though further adjustments may be necessary.

Despite these initial positive responses, new diagnostic results emerge that warrant attention. A follow-up urine microalbumin test shows a slight increase in albuminuria, suggesting that her diabetic nephropathy might be progressing despite efforts to control her blood pressure and glucose levels. Additionally, her lipid panel, re-evaluated six weeks into the intensified treatment, shows a modest reduction in LDL cholesterol to 130 mg/dL, but this remains above the target for a patient with diabetes and increased cardiovascular risk.

These findings prompt a critical review of the patient's current management plan. The healthcare team considers further intensifying her lipid-lowering therapy by increasing the atorvastatin dosage or adding another agent such as ezetimibe. Concurrently, the team emphasizes the importance of lifestyle modifications and encourages the patient to adhere more strictly to dietary recommendations and to increase her physical activity, which can synergistically enhance the effects of her pharmacotherapy. The team schedules regular follow-ups to closely monitor her renal function, lipid levels, and blood pressure, aiming to adjust her treatment plan dynamically to prevent further complications and optimize her overall health outcomes.

Section 3

As the healthcare team continues to refine the patient’s management plan, an unexpected development occurs. During a routine follow-up, the patient reports experiencing persistent fatigue and occasional dizziness. Concerned about these new symptoms, the team conducts a comprehensive assessment, including a detailed review of her current medications, lifestyle habits, and recent lab results.

Vital signs reveal a blood pressure of 142/90 mmHg, indicating that her hypertension remains inadequately controlled despite recent adjustments. Furthermore, her heart rate is slightly elevated at 98 beats per minute. A physical examination shows mild peripheral edema in her lower extremities. Notably, repeat lab tests indicate a further rise in her microalbumin levels, now at 45 mg/g creatinine, which suggests a worsening of her nephropathy. Her glycated hemoglobin (HbA1c) has improved slightly to 7.3%, but her lipid profile shows an LDL cholesterol level that remains at 130 mg/dL.

Given these findings, the team deliberates on the potential causes of her fatigue and dizziness, considering both medication side effects and the progression of her cardiovascular and renal complications. They decide to adjust her antihypertensive regimen further, possibly by switching to an ACE inhibitor, which could address both her blood pressure and renal protection more effectively. Additionally, they consider increasing her statin dosage or adding ezetimibe to better manage her dyslipidemia. The patient is advised on the importance of dietary sodium restriction and is encouraged to maintain regular physical activity tailored to her current health status. Regular monitoring is emphasized, alongside patient education on recognizing signs of potential complications, to ensure early intervention and prevent further deterioration of her condition.

Section 4

As the healthcare team implements the revised management plan, they schedule a follow-up appointment to assess the patient’s response to the new interventions. At the next visit, the patient reports some improvement in her dizziness but admits that the fatigue persists, albeit slightly less severe. Her adherence to the dietary sodium restriction seems to have positively impacted her condition. A physical examination reveals that the peripheral edema has reduced, and her blood pressure has improved to 136/88 mmHg, suggesting that the introduction of the ACE inhibitor is beginning to take effect. Her heart rate has stabilized at 90 beats per minute, a slight improvement from before.

In light of these changes, the team orders further diagnostic tests to assess any additional impact of the altered treatment regimen. The results show a modest decrease in her microalbumin levels to 40 mg/g creatinine, indicating a slight improvement in her renal function. However, the lipid profile remains concerning, with LDL cholesterol slightly reduced to 125 mg/dL, but still above the target level. Her HbA1c remains stable at 7.3%, suggesting that her glycemic control is being maintained.

The team acknowledges the partial success of the interventions but recognizes the need for continued refinement of her management plan. They decide to increase her statin dosage and monitor her lipid levels closely, emphasizing the importance of lipid control in preventing cardiovascular complications. Patient education is reinforced, focusing on recognizing signs of potential complications and ensuring adherence to lifestyle modifications. They plan to monitor her closely over the next few weeks, with the aim of achieving optimal control over her diabetes and associated complications. This ongoing assessment and iterative adjustment of her treatment plan are crucial in preventing the progression of her condition and maintaining her quality of life.

Section 5

A few weeks after the adjustments to her management plan, the patient returns for a follow-up appointment. She reports that her energy levels have improved marginally, but she now experiences occasional tingling sensations in her feet, raising concerns about potential peripheral neuropathy. Her blood pressure has stabilized further, now reading 130/85 mmHg, and her heart rate remains consistent at 88 beats per minute. During the physical examination, the healthcare team notes that while the peripheral edema has not returned, the patient exhibits decreased sensation in her lower extremities upon monofilament testing, a classic sign of diabetic neuropathy.

In light of these new findings, the team orders a comprehensive metabolic panel and a nerve conduction study. The metabolic panel reveals a slight increase in her creatinine level to 1.2 mg/dL, suggesting early signs of nephropathy progression. Her fasting glucose level is 145 mg/dL, slightly elevated and warranting further attention. The nerve conduction study confirms mild peripheral neuropathy, which aligns with her symptoms. These results indicate that while her cardiovascular parameters show improvement, the risk of diabetic neuropathy and nephropathy remains a concern.

Given these developments, the healthcare team decides to intensify their focus on glycemic control, potentially considering the introduction of a GLP-1 receptor agonist to improve her blood sugar levels while also providing cardiovascular benefits. Additionally, they emphasize the need for strict foot care and regular monitoring to prevent further complications. The patient is educated on the importance of promptly reporting any new symptoms, particularly those related to neuropathy, and adhering to the revised medication regimen. The team schedules more frequent follow-ups to closely monitor her condition and adapt the treatment plan as necessary, aiming to prevent further progression of her diabetic complications.