A 58-year-old patient with type 2 diabetes presents with an HbA1c level of 9.2%, microalbuminuria, and signs of non-proliferative diabetic retinopathy. The nurse is developing a care plan to address the patient's complications. Which of the following interventions should be prioritized to prevent further progression of diabetic nephropathy?

B) Educate the patient on the importance of strict blood glucose control.

A) Increase the dose of atorvastatin to further reduce LDL cholesterol levels.

B) Educate the patient on the importance of strict blood glucose control.

C) Initiate a low-protein diet to reduce kidney workload.

D) Recommend an annual comprehensive eye examination.

A patient with diabetes presents with an elevated HbA1c of 9.2%, microalbuminuria, and non-proliferative diabetic retinopathy. Which nursing intervention is most critical to address the patient's glycemic control and prevent further complications?

B) Collaborate with the dietitian to develop a personalized meal plan.

A) Encourage the patient to monitor blood sugar levels once a day.

B) Collaborate with the dietitian to develop a personalized meal plan.

C) Advise the patient to increase fluid intake to manage microalbuminuria.

D) Schedule regular ophthalmology appointments to monitor retinopathy.

A patient with a history of hypertension and diabetes presents with increased fatigue, lower extremity swelling, elevated blood pressure, worsening proteinuria, and elevated fasting blood glucose levels. The healthcare team has adjusted the patient's antihypertensive and diabetic medication regimen. Which nursing intervention is most critical to prioritize for this patient’s care plan to address the current changes in their condition?

D) Reinforcing the need for consistent self-monitoring of blood pressure and blood glucose at home

A) Educating the patient on the importance of adhering to a low-sodium diet

B) Scheduling regular physical activity sessions to improve cardiovascular health

C) Monitoring for signs of hypoglycemia due to the addition of an SGLT2 inhibitor

D) Reinforcing the need for consistent self-monitoring of blood pressure and blood glucose at home

A patient with a history of hypertension and diabetes presents with increased fatigue, mild lower extremity swelling, elevated blood pressure, worsening proteinuria, and elevated fasting blood glucose levels. The healthcare team has decided to adjust the treatment plan. As a nurse, what is the most important initial action to take in response to these changes in the patient's status?

C) Review with the patient how to properly perform self-monitoring of blood glucose and blood pressure.

A) Educate the patient about the importance of adhering to the new medication regimen.

B) Schedule an appointment for the patient with a dietitian to discuss sodium restriction.

C) Review with the patient how to properly perform self-monitoring of blood glucose and blood pressure.

D) Assess the patient's understanding of the signs and symptoms of worsening nephropathy and retinopathy.

A patient with hypertension and diabetes mellitus has shown improvements in blood pressure, glycemic control, and reduction in proteinuria after adhering to an enhanced management plan. However, they report occasional dizziness and increased thirst. Which nursing intervention is most appropriate to address these symptoms while continuing to monitor and support the patient's progress?

D) Instruct the patient to rise slowly from sitting or lying positions to prevent dizziness.

A) Advise the patient to increase fluid intake and observe for changes.

B) Educate the patient on recognizing signs of hypoglycemia and adjust diet accordingly.

C) Recommend the patient to slightly reduce medication dosage to alleviate symptoms.

D) Instruct the patient to rise slowly from sitting or lying positions to prevent dizziness.

A patient with a history of hypertension and diabetes is on an SGLT2 inhibitor and reports occasional dizziness and increased thirst. Based on these symptoms, which nursing intervention is most appropriate to prioritize in the care plan?

C) Suggest the patient monitor blood glucose levels more frequently.

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

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

C) Suggest the patient monitor blood glucose levels more frequently.

D) Instruct the patient to rest in a supine position during dizziness episodes.

A patient on SGLT2 inhibitors presents with dizziness, polydipsia, and mild hyponatremia. Considering these symptoms and the prescribed medication, which nursing intervention is most appropriate to address the patient's condition?

D) Recommend the patient to monitor and record daily weights to assess fluid status.

A) Encourage the patient to increase their sodium intake through diet.

B) Advise the patient to limit fluid intake to prevent further electrolyte imbalance.

C) Educate the patient on the importance of consistent medication adherence to maintain glycemic control.

D) Recommend the patient to monitor and record daily weights to assess fluid status.

A patient taking an SGLT2 inhibitor reports increased dizziness and thirst, has a heart rate of 98 bpm, mild skin turgor decrease, and lab results showing serum sodium of 130 mmol/L and potassium of 3.4 mmol/L. Which nursing intervention is most appropriate to address the patient's current condition?

A) Encourage the patient to increase their daily water intake to maintain hydration.

B) Educate the patient on decreasing their fluid intake to prevent further electrolyte imbalance.

C) Advise the patient to take a daily potassium supplement to correct hypokalemia.

D) Suggest the patient discontinue the SGLT2 inhibitor immediately and consult their healthcare provider.

A patient on SGLT2 inhibitors presents with mild muscle cramps and occasional fatigue. Recent lab results show a serum sodium level of 133 mmol/L, serum potassium level of 3.6 mmol/L, and creatinine level of 1.3 mg/dL. Which nursing intervention is most appropriate to address the patient's current condition?

B) Instruct the patient to increase potassium-rich foods and continue monitoring renal function.

A) Encourage the patient to increase intake of sodium-rich foods to address hyponatremia.

B) Instruct the patient to increase potassium-rich foods and continue monitoring renal function.

C) Recommend reducing fluid intake to prevent further dilution of electrolytes.

D) Advise stopping the SGLT2 inhibitor to prevent renal function deterioration.

A patient on SGLT2 inhibitors presents with mild muscle cramps and occasional fatigue. Recent lab results show serum sodium at 133 mmol/L, serum potassium at 3.6 mmol/L, and creatinine at 1.3 mg/dL. Which nursing intervention is most appropriate to address the patient's current condition?

C) Administer a potassium supplement and educate the patient on potassium-rich foods.

A) Increase the SGLT2 inhibitor dosage to enhance glucose control.

B) Encourage the patient to increase their fluid intake to improve hydration.

C) Administer a potassium supplement and educate the patient on potassium-rich foods.

D) Discontinue the SGLT2 inhibitor to prevent further renal impairment.

diabetes - Nursing Case Study

Pathophysiology

• Primary mechanism: Insulin deficiency or resistance leads to impaired glucose uptake by cells, resulting in elevated blood glucose levels. This occurs when the pancreas produces insufficient insulin (Type 1) or when cells become less responsive to insulin (Type 2).

• Secondary mechanism: Chronic hyperglycemia causes damage to blood vessels and nerves, leading to complications such as neuropathy, retinopathy, and nephropathy. This damage is due to the accumulation of advanced glycation end-products (AGEs) and oxidative stress.

• Key complication: Persistent high blood sugar levels can lead to cardiovascular diseases, which are a leading cause of morbidity and mortality in diabetic patients, highlighting the importance of blood sugar control to prevent long-term damage.

Patient Profile

Demographics:

58-year-old male, office manager

History:

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

• Current medications: Metformin, Lisinopril, Atorvastatin, Aspirin

• Allergies: Penicillin

Current Presentation:

• Chief complaint: Increasing fatigue and numbness in feet

• Key symptoms: Blurred vision, frequent urination, increased thirst, tingling sensation in hands and feet

• Vital signs: Blood pressure 145/92 mmHg, heart rate 88 bpm, respiratory rate 20 breaths/min, temperature 98.6°F, blood glucose 210 mg/dL

Section 1

New Diagnostic Results:

Following the initial presentation, further diagnostic testing was conducted to assess the extent of the patient's diabetes-related complications. The lab results revealed an elevated HbA1c level of 9.2%, indicating poor long-term glycemic control. Additionally, a comprehensive metabolic panel showed slightly elevated serum creatinine levels at 1.5 mg/dL and a reduced estimated glomerular filtration rate (eGFR) of 55 mL/min/1.73m², suggesting early-stage chronic kidney disease (CKD). Urinalysis was positive for microalbuminuria, reflecting early nephropathy potentially linked to the patient's persistent hyperglycemia and hypertension.

Retinal examination by an ophthalmologist revealed the presence of microaneurysms and cotton wool spots, indicative of non-proliferative diabetic retinopathy. This finding correlates with the patient's symptom of blurred vision and underscores the need for improved blood sugar management to prevent further retinal damage. The patient's lipid profile also showed elevated LDL cholesterol at 135 mg/dL, despite being on atorvastatin, necessitating a review of his cardiovascular risk management plan.

These diagnostic findings highlight the interconnected nature of diabetes complications and emphasize the need for comprehensive management strategies. The primary care team, including nursing staff, must now focus on reinforcing lifestyle modifications, optimizing pharmacological treatment, and coordinating with specialists to address the emerging nephropathy and retinopathy. This approach aims to prevent progression to more severe complications such as end-stage renal disease or proliferative retinopathy, thereby improving the patient's overall prognosis and quality of life.

Section 2

Change in Patient Status:

Over the subsequent weeks, the patient’s condition began to exhibit subtle yet significant changes that warranted close monitoring. During a routine follow-up, the patient reported increased fatigue and mild swelling in the lower extremities, symptoms that prompted the healthcare team to conduct a thorough assessment. Vital signs revealed a blood pressure of 148/92 mmHg, higher than previous readings, highlighting concerns about inadequate hypertension control. A repeat urinalysis indicated worsening proteinuria, with albumin levels rising, suggesting progression of nephropathy. Concurrently, the patient’s fasting blood glucose levels remained elevated, averaging around 160 mg/dL, further underscoring the ongoing struggle with glycemic control.

These changes in the patient’s status necessitated a reevaluation of the current management plan. The interdisciplinary team, including the primary care provider, endocrinologist, and nephrologist, convened to revise the treatment strategy. The decision was made to adjust the patient’s antihypertensive regimen, incorporating a higher dose of an ACE inhibitor, and to intensify diabetic management by adding an SGLT2 inhibitor, known for its renal protective effects. The team also emphasized the importance of dietary modifications, particularly sodium restriction, and reinforced adherence to the statin therapy to address cardiovascular risk factors.

The patient was advised to engage in more frequent self-monitoring of blood glucose and blood pressure at home, with the nursing staff providing education on recognizing signs of worsening nephropathy and retinopathy. A follow-up appointment was scheduled in four weeks to assess the effectiveness of these interventions and to ensure that the patient’s condition stabilizes. This proactive approach aims to mitigate further complications, prevent the escalation to advanced kidney disease, and safeguard against cardiovascular events, thereby enhancing the patient’s overall management and quality of life.

Section 3

Response to Interventions:

Four weeks later, the patient returned for the follow-up appointment, eager to discuss the changes since the last visit. During this period, the patient diligently adhered to the enhanced management plan, incorporating the new medications and dietary modifications. Upon examination, the healthcare team noted that the patient’s vital signs had improved, with blood pressure readings averaging 138/86 mmHg, indicating better hypertension control. Additionally, the patient reported feeling slightly less fatigued and observed a reduction in lower extremity swelling, suggesting a positive response to the adjusted therapy.

Laboratory results provided further insights into the patient’s progress. The fasting blood glucose levels had decreased to an average of 140 mg/dL, reflecting improved glycemic control. Repeat urinalysis showed a slight decrease in proteinuria, with albumin levels stabilizing, which was an encouraging sign indicating the potential slowing of nephropathy progression. These improvements underscored the efficacy of the SGLT2 inhibitor in addressing both glycemic and renal concerns, aligning with the team’s objectives.

Despite these positive developments, the patient disclosed experiencing occasional episodes of dizziness and increased thirst, raising concerns about potential side effects or the need for further adjustments. The healthcare team recognized the importance of ongoing monitoring and decided to schedule more frequent follow-ups to closely observe these symptoms. They also reinforced the importance of continued lifestyle modifications and adherence to medication. This proactive approach aimed to sustain the current improvements while preventing new complications, thereby optimizing the patient’s health outcomes and quality of life.

Section 4

During the subsequent follow-up visit, the patient presented with new complaints that prompted further evaluation. Although blood pressure and fasting glucose levels remained stable, the patient reported increased episodes of dizziness and persistent polydipsia, which had worsened since the last appointment. The clinical team conducted a comprehensive assessment, noting that the patient’s heart rate was slightly elevated at 98 beats per minute, and there was a modest decrease in skin turgor, hinting at possible dehydration. These findings raised concerns about the patient's fluid and electrolyte balance, possibly linked to the SGLT2 inhibitor's diuretic effect.

Laboratory tests revealed that the patient's serum sodium level was 130 mmol/L, indicating mild hyponatremia, and serum potassium was slightly low at 3.4 mmol/L. The team recognized these electrolyte imbalances as potential contributors to the patient’s symptoms of dizziness and increased thirst. Additionally, an HbA1c test showed a reduction to 7.2%, which was an improvement but necessitated careful consideration of potential side effects from the current medication regimen.

In response to these findings, the healthcare team decided to adjust the patient's treatment plan. They reduced the SGLT2 inhibitor dosage and increased monitoring of the patient’s electrolyte levels. The team also emphasized the importance of maintaining adequate hydration, modifying fluid intake recommendations to counteract the medication's effects. This approach aimed to alleviate the patient’s symptoms while sustaining the achieved improvements in glycemic control. The team scheduled a follow-up visit in two weeks to reassess the patient's status and ensure that the adjustments effectively addressed the concerns, thereby preventing further complications and enhancing the patient’s quality of life.

Section 5

Two weeks later, the patient returned for the scheduled follow-up visit. During the initial assessment, the clinical team noted that the patient's dizziness had decreased, and polydipsia was somewhat improved, suggesting a positive response to the adjusted treatment plan. The patient's vital signs showed a heart rate of 88 beats per minute, indicating a reduction from the previous elevated heart rate, and blood pressure remained stable at 128/76 mmHg. Despite these improvements, the patient mentioned experiencing mild muscle cramps and occasional fatigue, prompting further evaluation of electrolyte balance.

Laboratory tests were conducted to ensure the effectiveness of the interventions. The results revealed that serum sodium levels had improved slightly to 133 mmol/L, while serum potassium levels had increased to 3.6 mmol/L, both moving closer to normal ranges. However, the patient's creatinine level showed a slight elevation at 1.3 mg/dL, raising concerns about potential impacts on renal function, possibly exacerbated by the SGLT2 inhibitor and the patient's hydration status. Given these findings, the healthcare team recognized the need for ongoing monitoring and further adjustments as necessary.

In response, the team decided to continue the reduced dosage of the SGLT2 inhibitor but also introduced a potassium supplement to address the persistent mild hypokalemia. Additionally, they provided guidance on dietary adjustments to support electrolyte balance and kidney health. The patient was advised to increase intake of potassium-rich foods while maintaining adequate hydration. A follow-up appointment was scheduled in another two weeks to reassess renal function and electrolyte levels, ensuring that the current management strategy continues to support the patient's overall health without introducing new complications.