A nurse is reviewing the plan of care for a patient with poorly controlled diabetes mellitus who exhibits signs of peripheral neuropathy, blurred vision, and elevated blood pressure. Which intervention should the nurse prioritize to address the patient's current complications and prevent further progression?

A) Educate the patient about the importance of medication adherence and regular blood glucose monitoring.

B) Schedule an immediate ophthalmology consultation to assess for diabetic retinopathy.

C) Initiate a dietary plan focused on reducing LDL cholesterol and triglyceride levels.

D) Refer the patient to a nephrologist for evaluation of elevated urinary microalbumin levels.

A nurse is caring for a patient with poorly controlled type 2 diabetes, as evidenced by a hemoglobin A1c level of 9.2%. The patient also presents with symptoms of peripheral neuropathy, blurred vision, and elevated blood pressure. Which of the following interventions should the nurse prioritize to address the patient's condition comprehensively?

D) Coordinate with the healthcare team to adjust the patient's antihypertensive and antidiabetic medication regimen.

A) Encourage the patient to increase physical activity and reduce dietary sodium intake.

B) Educate the patient on the importance of daily foot care and regular podiatrist visits.

C) Schedule a referral to an ophthalmologist for a comprehensive eye examination.

D) Coordinate with the healthcare team to adjust the patient's antihypertensive and antidiabetic medication regimen.

A patient with diabetes reports worsening of neuropathy symptoms and new onset of intermittent claudication. An ankle-brachial index (ABI) shows a result of 0.85, indicating mild peripheral artery disease (PAD). Which nursing intervention is most appropriate to address both the cardiovascular and neuropathic complications in this patient?

C) Educate the patient on the importance of smoking cessation and initiate a structured walking program.

A) Encourage the patient to increase dietary intake of saturated fats to improve energy levels.

B) Recommend the patient to avoid physical activity to prevent exacerbating the pain.

C) Educate the patient on the importance of smoking cessation and initiate a structured walking program.

D) Advise the patient to use heating pads on the legs to improve circulation and reduce pain.

A patient with diabetes is experiencing symptoms of intermittent claudication and burning pain in the feet, indicating peripheral artery disease (PAD) and worsening diabetic neuropathy. The nurse is reviewing the patient's care plan. Which nursing intervention is most important to prioritize to address these conditions?

B) Educate the patient on the importance of daily foot inspections to prevent further complications.

A) Encourage the patient to increase dietary intake of high-fiber foods to improve overall health.

B) Educate the patient on the importance of daily foot inspections to prevent further complications.

C) Instruct the patient to take frequent rest breaks during physical activity to alleviate calf pain.

D) Recommend the use of compression stockings to improve circulation in the lower extremities.

A patient with type 2 diabetes and peripheral artery disease has shown improvement in blood pressure and LDL cholesterol levels following recent interventions, but continues to experience neuropathic pain. Which nursing intervention is most appropriate to support the patient's ongoing management of diabetes and its complications?

B) Educate the patient on the importance of regular foot care to prevent complications related to neuropathy.

A) Advise the patient to increase their physical activity to further improve cardiovascular health.

B) Educate the patient on the importance of regular foot care to prevent complications related to neuropathy.

C) Suggest the patient reduce their carbohydrate intake to lower fasting blood glucose levels.

D) Encourage the patient to use over-the-counter pain relievers for neuropathic pain management.

A nurse is evaluating a patient with diabetes who has recently started a new treatment plan. The patient reports adherence to medications and participation in an exercise program but continues to experience discomfort in her calves during long walks. The patient's blood pressure has improved, and her lipid profile shows reduced LDL cholesterol levels, but her fasting blood glucose remains elevated. Given these findings, which nursing intervention is most appropriate to address the patient's current symptoms and enhance glycemic control?

B) Suggest the patient discuss the addition of a GLP-1 receptor agonist with her physician to improve glycemic control and address neuropathic symptoms.

A) Encourage the patient to increase the intensity of her exercise program to improve blood glucose levels.

B) Suggest the patient discuss the addition of a GLP-1 receptor agonist with her physician to improve glycemic control and address neuropathic symptoms.

C) Advise the patient to reduce carbohydrate intake further to lower fasting blood glucose levels.

D) Recommend increasing the dosage of the current antiplatelet agent to further enhance cardiovascular outcomes.

A patient with type 2 diabetes has been on a GLP-1 receptor agonist for several weeks and presents with stable blood pressure, improved fasting blood glucose, weight loss, but also new-onset ankle swelling. Which nursing action is most appropriate to address the potential complication indicated by the swelling?

C) Discuss with the physician the need for further renal assessment

A) Recommend the patient increase fluid intake to reduce swelling

B) Elevate the patient's legs and reassess in the next visit

C) Discuss with the physician the need for further renal assessment

D) Advise the patient to reduce physical activity to minimize discomfort

A patient with type 2 diabetes on a GLP-1 receptor agonist presents with improved glycemic control and weight loss but reports new-onset ankle swelling. Which nursing action is most appropriate to address this finding?

B) Consult with the physician regarding potential renal function assessment.

A) Advise the patient to increase fluid intake to manage swelling.

B) Consult with the physician regarding potential renal function assessment.

C) Recommend discontinuation of the exercise program to reduce discomfort.

D) Increase the dosage of the GLP-1 receptor agonist to enhance cardiovascular benefits.

A patient with early-stage diabetic nephropathy is being treated with an ACE inhibitor. During a follow-up visit, the patient reports occasional dizziness and has a slight drop in systolic blood pressure upon standing. What is the most appropriate nursing intervention to address the patient's symptoms and prevent further complications?

C) Instruct the patient to rise slowly from sitting or lying positions to reduce the risk of orthostatic hypotension.

A) Advise the patient to increase sodium intake to counteract the dizziness.

B) Recommend the patient take the medication at bedtime to minimize dizziness during the day.

C) Instruct the patient to rise slowly from sitting or lying positions to reduce the risk of orthostatic hypotension.

D) Encourage the patient to drink more fluids to ensure adequate hydration and prevent dizziness.

A patient with early-stage diabetic nephropathy is experiencing occasional dizziness after starting an ACE inhibitor. What is the most appropriate nursing intervention to address this side effect while maintaining the therapeutic goals?

B) Advise the patient to rise slowly from sitting or lying positions to prevent dizziness.

A) Encourage the patient to increase their fluid intake to counteract dizziness.

B) Advise the patient to rise slowly from sitting or lying positions to prevent dizziness.

C) Recommend the patient discontinue the ACE inhibitor and consult with their physician immediately.

D) Suggest the patient take the medication at bedtime to minimize the impact of dizziness during daytime activities.

diabetes - Nursing Case Study

Pathophysiology

• Primary mechanism: Insulin deficiency or resistance leads to impaired glucose uptake by cells, resulting in elevated blood glucose levels (hyperglycemia). This is a central feature of both Type 1 and Type 2 diabetes, where either insulin production is insufficient (Type 1) or cells are less responsive to insulin (Type 2).

• Secondary mechanism: Chronic hyperglycemia damages blood vessels and nerves through glycation, where excess glucose binds to proteins, disrupting their function. This process contributes to long-term complications such as cardiovascular disease, neuropathy, and retinopathy.

• Key complication: Diabetic ketoacidosis (DKA) can occur, especially in Type 1 diabetes, when the body resorts to breaking down fats for energy due to insufficient insulin, leading to the production of acidic ketones and resulting in metabolic acidosis, requiring urgent medical attention.

Patient Profile

Demographics:

56-year-old female, 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 20 mg daily, Aspirin 81 mg daily

• Allergies: Penicillin

Current Presentation:

• Chief complaint: Increased fatigue and tingling in feet

• Key symptoms: Blurred vision, frequent urination, unintentional weight loss, numbness in extremities

• Vital signs: Blood pressure 150/95 mmHg, heart rate 88 bpm, respiratory rate 18 breaths per minute, temperature 98.6°F, blood glucose level 210 mg/dL

Section 1

Initial Assessment Findings:

During the initial assessment, the nurse conducts a thorough evaluation of the patient's symptoms and physical condition. The patient reports increased fatigue and tingling in her feet, raising concerns of peripheral neuropathy, a common complication associated with prolonged hyperglycemia. On examination, the nurse notes reduced sensation in the patient's lower extremities, confirmed by monofilament testing, which suggests diabetic peripheral neuropathy. The patient also mentions blurred vision, which could indicate diabetic retinopathy or fluctuating blood glucose levels affecting the lens of the eye. Additionally, the patient’s elevated blood pressure of 150/95 mmHg suggests suboptimal control of hypertension, a significant risk factor for cardiovascular complications in diabetic patients.

Laboratory tests are ordered to further evaluate the current status of the patient's diabetes management and to investigate potential complications. The results reveal a hemoglobin A1c level of 9.2%, indicating poor long-term glycemic control. Lipid profile results show elevated LDL cholesterol and triglycerides, which, coupled with hypertension, increases the patient's risk for cardiovascular disease. The nurse also notes elevated urinary microalbumin levels, suggestive of early diabetic nephropathy. These findings corroborate the concerns of diabetes-related complications, necessitating adjustments in the patient's management plan to prevent further deterioration.

The comprehensive assessment findings guide the nursing team to prioritize interventions aimed at optimizing the patient's glycemic control and addressing the complications identified. A multidisciplinary approach, including the involvement of a diabetes educator, dietitian, and possibly a nephrologist, is recommended to provide comprehensive care. The patient is counseled on the importance of medication adherence, lifestyle modifications, and regular monitoring of blood glucose levels to manage her diabetes effectively. The nurse plans to follow up closely with the patient to monitor her response to the revised treatment plan and to prevent the progression of complications.

Section 2

As the patient progresses through her treatment plan, the nurse observes a change in her status, particularly in her cardiovascular health and neuropathy symptoms. During a routine follow-up, the patient reports experiencing intermittent claudication, characterized by pain and cramping in her calves during physical activity, which resolves with rest. This symptom, coupled with the previously noted hypertension and dyslipidemia, raises the suspicion of peripheral artery disease (PAD), a common vascular complication in diabetics. An ankle-brachial index (ABI) is conducted, yielding a result of 0.85, confirming the presence of mild PAD.

Additionally, the patient's tingling in her feet has progressed to occasional burning pain, indicating a potential worsening of her diabetic peripheral neuropathy. Despite efforts to optimize her glycemic control, her recent fasting blood glucose remains elevated at 180 mg/dL. This suggests that further intervention is necessary to prevent further nerve damage and cardiovascular complications. The nurse discusses these developments with the patient's physician, leading to an adjustment in her medication regimen, including the addition of a statin for better lipid control and an antiplatelet agent to address the PAD.

These changes are coupled with an intensified focus on lifestyle modifications, emphasizing the importance of smoking cessation, regular foot care, and a structured exercise program to improve circulation and overall cardiovascular health. The patient is referred to a physical therapist to develop a tailored exercise plan, balancing activity with her PAD and neuropathy symptoms. The care team remains vigilant, planning regular follow-up appointments to monitor the patient's progress and adjust the treatment plan as needed to mitigate the risks of further complications and enhance her quality of life. This holistic approach aims to empower the patient through education and support, fostering an active role in managing her chronic condition.

Section 3

Several weeks following the implementation of the adjusted treatment plan, the patient returns for a follow-up appointment. During the visit, the nurse conducts a comprehensive assessment to evaluate her response to the interventions. The patient reports adhering to her medication regimen and has actively participated in the structured exercise program developed by the physical therapist. She expresses a sense of optimism about her health, but also notes that she still experiences some discomfort in her calves during longer walks, though it appears less severe than before.

Upon examination, the nurse observes that the patient's blood pressure has improved, now measuring 135/85 mmHg, indicating a positive response to the addition of the statin and antiplatelet agent. However, her recent lab results show a fasting blood glucose level that remains elevated at 170 mg/dL, suggesting that her glycemic control still requires further refinement. The nurse also notes that the patient's lipid profile has improved, with her LDL cholesterol reduced to 90 mg/dL, reflecting the effectiveness of the statin therapy.

While the patient's cardiovascular status shows signs of improvement, her neuropathy symptoms have not significantly abated. She continues to experience burning sensations in her feet, which now occasionally disturb her sleep. The nurse discusses these findings with the physician, who considers adjusting the diabetes medication regimen to include a GLP-1 receptor agonist, aiming to enhance glycemic control and potentially provide neuropathic pain relief. This collaborative approach underscores the importance of continuous monitoring and individualized patient care to address the multifaceted challenges posed by diabetes and its complications.

Section 4

Several weeks after the initiation of the GLP-1 receptor agonist, the patient returns for another follow-up appointment. During the visit, the nurse conducts a thorough assessment to gauge the patient's response to the updated medication regimen. The patient reports feeling more energetic and notes a mild reduction in the burning sensations in her feet, although they remain a persistent issue. Encouraged by these improvements, she has continued to participate in her exercise program, albeit with caution due to intermittent calf discomfort.

Upon examination, the nurse finds that the patient's blood pressure is stable at 132/82 mmHg, indicating continued cardiovascular benefits from her current treatment plan. Notably, her fasting blood glucose has decreased to 145 mg/dL, demonstrating improved glycemic control since the addition of the GLP-1 receptor agonist. The nurse also observes that the patient's weight has decreased by 5 pounds, which may contribute to her enhanced energy levels and is consistent with the weight loss effects associated with GLP-1 medications.

Despite these positive developments, the nurse identifies a new concern: a slight swelling in the patient's ankles, which the patient had not previously noticed. This finding suggests the potential onset of diabetic nephropathy, a common complication of diabetes characterized by kidney damage. Recognizing the complexity of managing multiple diabetes-related issues, the nurse consults with the physician to discuss the possibility of further renal assessment, such as a urine albumin-to-creatinine ratio test, to better understand the extent of kidney involvement and to refine the treatment approach. This collaborative decision-making process highlights the need for ongoing vigilance and adaptability in managing chronic conditions like diabetes, ensuring a comprehensive approach to patient care.

Section 5

In the weeks following the discovery of ankle swelling, the patient undergoes a urine albumin-to-creatinine ratio test, which reveals a mildly elevated albumin level. This result confirms early-stage diabetic nephropathy, prompting the healthcare team to adjust the patient's treatment plan to mitigate further renal damage. The physician prescribes an ACE inhibitor, known for its renal-protective effects in diabetic patients, and advises the patient on the importance of maintaining optimal blood pressure and blood glucose levels to slow the progression of kidney disease. The nurse supports the patient by providing education on the new medication, emphasizing the need for adherence to the treatment regimen and monitoring for potential side effects such as dizziness or dry cough.

During a subsequent follow-up appointment, the nurse conducts another comprehensive assessment. The patient's blood pressure has improved to 128/78 mmHg, and her fasting blood glucose remains stable at 140 mg/dL, reflecting the beneficial effects of the combined medication strategy. However, the patient reports occasional episodes of dizziness, which she attributes to the new medication. The nurse performs an orthostatic blood pressure test and finds a slight drop in systolic pressure upon standing, suggesting the need for careful monitoring of her fluid intake and electrolyte balance.

Recognizing the potential for further complications, such as electrolyte imbalances or worsening nephropathy, the nurse collaborates with the physician to develop a tailored care plan. This includes regular monitoring of renal function, adjustments in antihypertensive therapy as necessary, and dietary modifications to reduce sodium intake. The nurse reinforces the importance of lifestyle changes, such as consistent exercise and dietary management, to help control the underlying diabetes and support overall health. Through this proactive and holistic approach, the healthcare team aims to prevent the progression of complications and enhance the patient's quality of life.