A patient with diabetes presents with symptoms of peripheral neuropathy and signs of possible diabetic retinopathy. Which nursing intervention should be prioritized to address the patient's current condition?

A) Educate the patient on the importance of daily foot care and proper footwear to prevent injuries.

B) Refer the patient to an ophthalmologist to assess and manage potential retinal changes.

C) Instruct the patient on a low-sodium diet to manage potential cardiovascular complications.

D) Schedule a physical therapy consultation for muscle strengthening exercises to address leg fatigue.

A nurse is planning care for a patient with diabetes who presents with symptoms of peripheral neuropathy and blurred vision. Which nursing intervention is the highest priority for preventing further complications in this patient?

D) Emphasize the need for strict blood glucose monitoring and control.

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

B) Schedule the patient for a comprehensive ophthalmologic examination.

C) Instruct the patient on the importance of maintaining a balanced diet and regular exercise.

D) Emphasize the need for strict blood glucose monitoring and control.

A patient with poorly controlled diabetes presents with microalbuminuria. Which of the following interventions is most critical in preventing the progression of diabetic nephropathy?

A) Initiating an ACE inhibitor therapy

B) Increasing carbohydrate intake

C) Reducing protein intake significantly

D) Administering a diuretic to manage increased urinary output

A patient with poorly controlled diabetes has been diagnosed with microalbuminuria. Which nursing intervention is most appropriate to help slow the progression of kidney damage?

B) Educate the patient on the importance of blood pressure control

A) Encourage the patient to increase protein intake

B) Educate the patient on the importance of blood pressure control

C) Suggest the patient drink more fluids to flush the kidneys

D) Advise the patient to limit physical activity to reduce stress on the kidneys

A patient with diabetes mellitus and hypertension is being treated with an ACE inhibitor and has implemented lifestyle changes, including a low-carbohydrate diet and increased physical activity. The patient reports dizziness and lightheadedness, and blood pressure is recorded at 95/60 mmHg. Which priority action should the nurse take based on this assessment?

C) Encourage the patient to monitor blood pressure and symptoms, and report to the healthcare provider.

A) Instruct the patient to increase fluid intake to manage blood pressure.

B) Advise the patient to stop taking the ACE inhibitor immediately.

C) Encourage the patient to monitor blood pressure and symptoms, and report to the healthcare provider.

D) Suggest the patient reduce physical activity levels to prevent further hypotension.

A patient with type 2 diabetes mellitus on an ACE inhibitor presents with occasional dizziness and lightheadedness, particularly in the mornings. The nurse notes a blood pressure of 95/60 mmHg and a decrease in hemoglobin A1c to 7.8%. Which nursing intervention is most appropriate to address the patient's current condition?

B) Encourage the patient to continue current lifestyle modifications and monitor blood pressure closely.

A) Instruct the patient to increase fluid intake, especially in the morning, to prevent dehydration.

B) Encourage the patient to continue current lifestyle modifications and monitor blood pressure closely.

C) Advise the patient to skip the morning dose of the ACE inhibitor to prevent hypotensive episodes.

D) Recommend the patient increase carbohydrate intake at breakfast to stabilize blood glucose levels.

A patient with diabetes presents with new-onset tingling in the feet, persistent hypotension, and a decline in kidney function. Which nursing intervention is most appropriate to address the patient's symptoms while considering his overall condition?

D) Suggest spacing out the timing of antihypertensive medication doses.

A) Increase fluid intake to improve blood pressure.

B) Encourage strict glycemic control to prevent further neuropathy.

C) Advise reducing physical activity to prevent dizziness.

D) Suggest spacing out the timing of antihypertensive medication doses.

A patient with diabetes presents with increased episodes of dizziness, lightheadedness, and new-onset tingling in the feet. The nurse notes persistent hypotension and a decline in renal function. Which action should the nurse prioritize during this follow-up visit?

C) Collaborate with the healthcare provider to adjust the medication regimen to address hypotension.

A) Increase the dose of the ACE inhibitor to improve renal outcomes.

B) Educate the patient on dietary sodium restriction to manage blood pressure.

C) Collaborate with the healthcare provider to adjust the medication regimen to address hypotension.

D) Focus on initiating insulin therapy to further improve glycemic control.

A patient with diabetes and declining renal function presents with symptoms of peripheral neuropathy and edema. The healthcare provider decides to switch the patient's medication from an ACE inhibitor to an ARB and initiate low-dose gabapentin. What is the most appropriate nursing intervention to prioritize in this scenario?

A) Monitor the patient's blood pressure and educate on potential hypotensive episodes.

B) Teach the patient exercises to improve vibratory sensation in the feet.

C) Instruct the patient on increasing fluid intake to manage kidney function.

D) Advise the patient to consume more potassium-rich foods to support kidney health.

A patient with progressive renal impairment and diabetic neuropathy is experiencing dizziness and fluid retention. The healthcare provider decides to switch from an ACE inhibitor to an angiotensin receptor blocker (ARB). What is the primary rationale for this medication adjustment in the context of the patient's condition?

B) To enhance renal protection while minimizing the risk of hypotension

A) To improve blood glucose control and reduce diabetic complications

B) To enhance renal protection while minimizing the risk of hypotension

C) To directly treat neuropathy symptoms and decrease burning sensations

D) To effectively manage fluid retention and reduce ankle swelling

Diabetes - Nursing Case Study

Pathophysiology

• Primary mechanism: Insulin resistance - In type 2 diabetes, cells in muscles, fat, and liver don't respond well to insulin, a hormone that regulates blood glucose levels, leading to elevated blood sugar. The pancreas compensates by producing more insulin, but eventually, it can't keep up.

• Secondary mechanism: Beta-cell dysfunction - Over time, the increased demand for insulin strains the pancreatic beta cells, reducing their ability to produce sufficient insulin. This contributes to persistent hyperglycemia.

• Key complication: Chronic hyperglycemia - Persistently high blood glucose levels cause damage to blood vessels, leading to complications like neuropathy, retinopathy, and nephropathy, which are critical for nurses to monitor in diabetic patients.

Patient Profile

Demographics:

58-year-old male, construction worker

History:

• Key past medical history: Diagnosed with type 2 diabetes 8 years ago, hypertension, hyperlipidemia

• Current medications: Metformin, lisinopril, atorvastatin

• Allergies: Penicillin

Current Presentation:

• Chief complaint: Increasing fatigue and numbness in feet

• Key symptoms: Frequent urination, blurred vision, persistent thirst, tingling sensation in feet

• Vital signs: Blood pressure 148/92 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 examination to gather more information about the patient's symptoms and overall condition. The patient reports increased fatigue, which is impacting his ability to work efficiently at his construction job. He mentions that his legs feel heavy and he often experiences tingling in his feet, especially at night. Upon inspection, the nurse notes decreased sensation to light touch and vibration in the patient's feet, suggesting signs of peripheral neuropathy. Further examination reveals dry, cracked skin on the feet, which raises concerns about his foot care and potential for infection due to compromised sensation.

The nurse also performs a retinal screening due to the patient's complaint of blurred vision, a common symptom associated with diabetic retinopathy. Although the screening is limited, the findings suggest possible microvascular changes, which warrants further evaluation by an ophthalmologist. Recognizing the potential for both neuropathy and retinopathy, the nurse prioritizes these findings in the patient's care plan, emphasizing the importance of strict blood sugar control and regular follow-up appointments to manage these diabetes-related complications effectively. These initial assessment findings highlight the need for comprehensive management and close monitoring to prevent further deterioration and additional complications.

Section 2

Following the initial assessment, the patient undergoes several diagnostic tests to further evaluate his condition and potential complications related to his diabetes. The lab results reveal a hemoglobin A1c level of 9.0%, indicating poor long-term blood sugar control. Additionally, the patient's fasting blood glucose is recorded at 180 mg/dL, corroborating his elevated A1c. These results confirm the need for more aggressive management of his diabetes to prevent further complications.

The nurse also notes a change in the patient's urinary output, with a recent increase in frequency and volume. A urinalysis is conducted, revealing the presence of microalbuminuria, an early marker of diabetic nephropathy. This finding suggests the kidney's filtration barrier is compromised, likely due to prolonged hyperglycemia. The nurse educates the patient about the significance of this finding and the importance of adhering to prescribed medications, dietary modifications, and regular monitoring of blood glucose levels to protect renal function.

Recognizing the interconnected nature of these complications, the healthcare team develops a comprehensive treatment plan. This includes the introduction of an ACE inhibitor to help preserve kidney function, adjustments to the patient's insulin regimen, and setting realistic goals for lifestyle changes. The nurse emphasizes the need for the patient to attend follow-up appointments with a nephrologist and an ophthalmologist to closely monitor the progression of nephropathy and retinopathy. Through these interventions, the team aims to stabilize the patient's condition and prevent the advancement of diabetes-related complications, while also preparing to address any future changes in his clinical status.

Section 3

Several weeks into the revised treatment plan, the patient returns for a follow-up appointment, and the nurse conducts a thorough assessment to evaluate his response to the interventions. Notably, the patient reports feeling more energetic and has successfully incorporated dietary changes, such as reducing carbohydrate intake and increasing physical activity, into his daily routine. However, he also mentions experiencing occasional dizziness and lightheadedness, particularly in the mornings. Upon examination, the nurse records the patient's blood pressure at 95/60 mmHg, lower than previous readings, suggesting a possible side effect of the ACE inhibitor. The nurse suspects the medication might be contributing to the hypotensive episodes and plans to discuss potential adjustments with the healthcare provider.

Laboratory tests are repeated to assess the impact of the treatment changes. The patient's hemoglobin A1c has decreased to 7.8%, indicating improved glycemic control, though still requiring further management. The fasting blood glucose level has also decreased to 140 mg/dL, showing progress but still above target levels. Yet, the urinalysis continues to show microalbuminuria, suggesting persistent renal stress. These results prompt the healthcare team to consider further renal protective measures and to closely monitor blood pressure, as the current medication dosage might need recalibration.

Given these developments, the nurse emphasizes the importance of continuing lifestyle modifications and maintaining adherence to the medication regimen while coordinating with the healthcare provider to adjust the treatment plan as needed. The patient is encouraged to keep a daily log of blood pressure readings and symptoms to provide a comprehensive picture at his next appointment. The nurse also reinforces the necessity of regular follow-ups with the nephrologist to monitor kidney function and address any further complications promptly, ensuring the patient's journey towards optimal diabetes management remains on track.

Section 4

A few weeks later, the patient returns for another follow-up appointment, reporting an increase in episodes of dizziness and lightheadedness, now occurring not only in the mornings but also intermittently throughout the day. He also mentions new-onset tingling in his feet, which he finds particularly concerning. During the assessment, the nurse notes a blood pressure of 90/58 mmHg, indicating persistent hypotension. The patient's heart rate is 88 beats per minute, and his respiratory rate is 16 breaths per minute. While his blood pressure remains low, his heart rate is within normal limits, suggesting that the hypotension is not accompanied by compensatory tachycardia.

The nurse reviews the patient's latest laboratory results, finding that the hemoglobin A1c has slightly improved to 7.5%, showing continued progress in glycemic control. However, the urinalysis still reveals microalbuminuria, and the estimated glomerular filtration rate (eGFR) has decreased to 60 mL/min, indicating a decline in kidney function. These findings suggest that the renal stress is ongoing despite earlier interventions. The nurse also notes that the patient's electrolytes are within normal ranges, which is reassuring but does not explain the hypotension.

In collaboration with the healthcare provider, the nurse considers the need to adjust the patient's medication regimen, including a possible reduction in the dosage of the ACE inhibitor to alleviate the hypotensive episodes. The tingling in the feet raises concerns about peripheral neuropathy, a common complication of diabetes, prompting the healthcare team to explore additional interventions to address nerve health. The nurse educates the patient about the importance of foot care and monitoring for signs of neuropathy, emphasizing the need for continued vigilance in managing his diabetes. With a comprehensive plan in place, the patient is scheduled for a follow-up with both the primary care provider and a nephrologist to ensure close monitoring of his renal function and overall health status.

Section 5

During the next follow-up appointment, the patient reports that the episodes of dizziness have decreased slightly, but he still experiences occasional lightheadedness throughout the day. More concerning, the tingling in his feet has progressed to a burning sensation, particularly noticeable at night. On physical examination, the nurse observes decreased vibratory sensation in the patient’s toes, an early indicator of peripheral neuropathy. Additionally, the patient mentions noticing increased swelling in his ankles by the end of the day, suggesting potential fluid retention.

The nurse reviews the most recent diagnostic results, which reveal a further decline in kidney function with an eGFR now at 55 mL/min. This indicates progressive renal impairment, warranting closer monitoring by the nephrologist. The urinalysis continues to show persistent microalbuminuria, confirming ongoing renal stress. The healthcare team is concerned about the possibility of diabetic nephropathy progressing, given the declining kidney function and the presence of neuropathy symptoms.

In response to these findings, the healthcare provider decides to adjust the patient's medication regimen further, considering a switch from the current ACE inhibitor to an angiotensin receptor blocker (ARB) to address both the renal protection and hypotensive episodes more effectively. The patient is educated about the potential benefits and side effects of this change. Additionally, the team recommends starting a low-dose gabapentin to manage the symptoms of neuropathy and discusses lifestyle modifications, such as dietary sodium restriction and leg elevation, to alleviate the edema. The patient is advised to maintain regular follow-up appointments with both the primary care provider and the nephrologist to closely monitor his condition and adjust the treatment plan as necessary.