Which of the following is a primary reason for the nurse to perform a foot examination on a patient with diabetes during a routine follow-up visit?

B) To check for signs of peripheral neuropathy

A) To assess the patient's ability to walk

B) To check for signs of peripheral neuropathy

C) To evaluate the patient's blood pressure control

D) To determine the patient's respiratory rate

What is the primary purpose of performing monofilament testing on a diabetic patient's feet during an assessment?

B) To evaluate sensation and detect neuropathy

C) To check for signs of infection

D) To determine the need for insulin adjustment

What dietary recommendation should the nurse provide to a patient with slightly elevated LDL cholesterol to help reduce cardiovascular risk?

A) Increase saturated fat intake

What is the primary goal for managing a patient's HbA1c level in diabetes care?

B) To maintain HbA1c levels below 7%

A) To increase HbA1c levels above 8%

B) To maintain HbA1c levels below 7%

C) To ensure HbA1c levels reach 10%

D) To keep HbA1c levels constant regardless of value

Which of the following laboratory results indicates effective glycemic control in a diabetic patient?

B) Fasting blood glucose of 130 mg/dL

C) LDL cholesterol of 150 mg/dL

D) Blood pressure of 140/90 mmHg

A patient with type 2 diabetes returns for a follow-up visit after three months. Her HbA1c has decreased to 6.8%, and her LDL cholesterol is 110 mg/dL. What is the primary reason the healthcare team decided not to start statin therapy immediately?

B) The healthcare team wants to observe the effects of lifestyle changes over a longer period.

A) The patient's LDL level is already at the target goal.

B) The healthcare team wants to observe the effects of lifestyle changes over a longer period.

C) Statin therapy is only initiated if the LDL level exceeds 130 mg/dL.

D) The patient is on multiple medications and adding a statin could cause interactions.

What is the primary purpose of performing a monofilament test on the patient who reports tingling in her fingertips and toes?

B) To assess for sensory loss in the peripheral nerves

A) To evaluate the patient's blood circulation

B) To assess for sensory loss in the peripheral nerves

C) To check for signs of infection in the extremities

D) To measure the strength of peripheral pulses

What is the primary purpose of performing a monofilament test in patients with diabetes?

B) To evaluate sensory loss in the feet

A) To assess blood glucose levels

B) To evaluate sensory loss in the feet

D) To determine cholesterol levels

Which of the following interventions is most important for the nurse to emphasize to the patient with early signs of peripheral neuropathy?

B) Perform daily foot care, including checking for cuts and sores.

A) Increase the intake of high-sugar foods to counteract tingling sensations.

B) Perform daily foot care, including checking for cuts and sores.

C) Reduce physical activity to prevent further nerve damage.

D) Apply heating pads to the feet to improve circulation.

Which of the following actions should the nurse prioritize to prevent complications related to the patient's early peripheral neuropathy?

A) Encourage daily foot care and inspect for any cuts or sores.

B) Increase the patient's exercise regimen to improve cardiovascular health.

C) Advise the patient to consume a high-protein diet to aid nerve function.

D) Suggest the patient decrease her carbohydrate intake to manage blood sugar levels.

diabetes - Nursing Case Study

Pathophysiology

• Primary mechanism: In diabetes, the body either doesn't produce enough insulin or can't use it effectively. Insulin is a hormone that helps cells absorb glucose from the blood for energy. Without proper insulin function, glucose levels in the blood rise, leading to hyperglycemia.

• Secondary mechanism: Over time, high blood glucose damages the blood vessels and nerves. This damage impairs circulation and nerve function, particularly in the extremities, which can lead to complications.

• Key complication: One common complication is diabetic neuropathy, where nerve damage causes numbness or pain, especially in the feet. This increases the risk of injuries and infections, emphasizing the need for regular foot care in diabetic patients.

Patient Profile

Demographics:

45-year-old female, office administrator

History:

• Key past medical history: Diagnosed with type 2 diabetes six months ago, mild hypertension

• Current medications: Metformin 500 mg once daily, Lisinopril 10 mg once daily

• Allergies: No known allergies

Current Presentation:

• Chief complaint: Routine follow-up for diabetes management

• Key symptoms: Occasional fatigue, increased thirst

• Vital signs: Blood pressure 128/82 mmHg, heart rate 76 bpm, respiratory rate 18 breaths per minute, temperature 98.6°F, weight 160 lbs, height 5'6", BMI 25.8

Section 1

Initial Assessment Findings:

During the routine follow-up appointment, the nurse conducts a thorough assessment of the patient to evaluate her current diabetic management and identify any emerging issues. The patient reports feeling generally well but mentions experiencing occasional fatigue and increased thirst, which she attributes to her busy work schedule. Upon examination, the nurse finds that her blood pressure is well controlled at 128/82 mmHg, and her heart rate is steady at 76 bpm. Her respiratory rate is normal at 18 breaths per minute, and her temperature is 98.6°F, indicating no signs of acute infection or illness.

The nurse also performs a foot examination, noting the importance of regular foot care in patients with diabetes. The patient's feet show no visible signs of ulcers or sores, but there is a slight decrease in sensation during monofilament testing on the soles, suggesting early signs of peripheral neuropathy. This finding highlights the need for enhanced education on foot care and monitoring for any changes. The nurse advises the patient on the importance of daily foot inspections, proper footwear, and the need to report any new symptoms immediately.

Building on these initial findings, the nurse orders a set of laboratory tests, including HbA1c, to assess the patient's long-term blood glucose control. The nurse also schedules a follow-up appointment to discuss the lab results and potential adjustments to her diabetes management plan. The patient is encouraged to maintain her current medication regimen, continue monitoring her blood pressure, and engage in regular physical activity to support her overall health and well-being. This proactive approach aims to prevent further complications and ensure that her diabetes remains well-managed.

Section 2

New Diagnostic Results:

A week after the initial appointment, the patient returns to the clinic for her follow-up visit to discuss the lab results. The nurse reviews the results with the patient, explaining that her HbA1c level is 7.2%, slightly higher than the target goal of under 7% for optimal diabetes management. This indicates that while her blood glucose control is generally stable, there is room for improvement to prevent potential long-term complications. The nurse reassures the patient that this is a manageable situation and provides an opportunity to further fine-tune her diabetes care plan.

The nurse also reviews other lab results, noting that the patient's lipid profile shows a slightly elevated LDL cholesterol level of 130 mg/dL, which is above the recommended level of less than 100 mg/dL for diabetic patients. Her triglycerides and HDL cholesterol are within normal ranges, but the nurse emphasizes the importance of addressing the LDL level to reduce cardiovascular risk. The patient's kidney function tests are normal, with a creatinine level of 0.9 mg/dL and an estimated glomerular filtration rate (eGFR) of 90 mL/min/1.73 m^2, indicating no current signs of kidney damage.

Based on these findings, the nurse collaborates with the patient to develop a more focused plan that includes dietary modifications, such as reducing saturated fats and increasing fiber intake, as well as considering the addition of a statin medication if lifestyle changes do not sufficiently lower her LDL cholesterol. The patient is encouraged to maintain regular physical activity and continue monitoring her blood glucose levels to achieve better control. The nurse sets a follow-up appointment in three months to reassess her progress and adjust the management plan as needed, ensuring the patient's diabetes remains well-managed and complications are minimized.

Section 3

Response to Interventions:

Three months later, the patient returns to the clinic for her scheduled follow-up appointment. The nurse begins the visit by reviewing the patient’s self-monitoring blood glucose records, which indicate improved glycemic control with fasting blood glucose values consistently between 90-110 mg/dL. This improvement reflects the patient's adherence to dietary modifications and increased physical activity. The patient reports feeling more energetic and has even noticed a slight weight loss, which she attributes to her healthier eating habits and regular exercise routine.

The nurse then discusses the results of the patient’s recent lab tests. The HbA1c level has decreased to 6.8%, achieving the target goal of less than 7%. This result suggests that the interventions have been effective in improving her overall blood glucose management. Additionally, the patient's LDL cholesterol level has dropped to 110 mg/dL. While it remains slightly above the optimal level for diabetic patients, the downward trend indicates progress. Given the positive changes, the healthcare team decides to continue monitoring rather than immediately starting statin therapy, allowing more time for lifestyle interventions to have a further impact.

During the assessment, the nurse also checks the patient's vital signs and finds that her blood pressure is well-controlled at 122/78 mmHg, and her pulse is a regular 72 beats per minute. The patient expresses satisfaction with her progress and is motivated to maintain these lifestyle changes. The nurse provides positive reinforcement, emphasizing the importance of ongoing self-care and regular follow-ups to ensure sustained success. A new appointment is scheduled for another three months, with the plan to reassess her lipid profile and HbA1c to determine the next steps in her diabetes management.

Section 4

Three months later, the patient returns for her follow-up appointment with a sense of enthusiasm, eager to discuss her continued journey towards better health. During the initial assessment, the nurse notes that the patient has maintained her weight loss, shedding an additional 5 pounds since the last visit. This weight loss is contributing positively to her overall metabolic health. She reports feeling more active and less fatigued throughout the day, which she credits to her ongoing commitment to a balanced diet and regular exercise.

The nurse reviews the patient's latest lab results, which continue to show encouraging trends. The HbA1c level has further decreased to 6.5%, indicating sustained improvement in glycemic control. The patient's LDL cholesterol has also improved, now at 102 mg/dL, approaching the optimal range for diabetic patients. Her triglycerides have decreased to 140 mg/dL, and her HDL cholesterol has increased to 52 mg/dL, both positive indicators of cardiovascular health. Blood pressure remains stable at 120/76 mmHg, and her pulse is a steady 70 beats per minute.

Despite these improvements, the patient mentions experiencing occasional tingling in her fingertips and toes, a new development since her last visit. Recognizing the potential for early signs of peripheral neuropathy, the nurse discusses the importance of regular foot care and monitoring for any changes. The healthcare team decides to perform a monofilament test to assess for any sensory loss and recommends a referral to a podiatrist for further evaluation if necessary. The nurse emphasizes the importance of continuing lifestyle modifications and regular monitoring to prevent and manage potential complications. An appointment is scheduled for another three months, with plans to reassess her progress and address any new concerns that may arise.

Section 5

Three months later, the patient returns for her scheduled follow-up, appearing cheerful and noticeably more energetic. During the initial assessment, the nurse observes that the patient has maintained her weight, with no further loss or gain, and continues to adhere to her balanced diet and exercise routine. The patient reports feeling generally well but mentions that the tingling sensation in her fingertips and toes has persisted. She notes that it occasionally disrupts her sleep, making her eager to find ways to manage this new symptom.

The nurse reviews the latest lab results, which show that the patient's HbA1c level has stabilized at 6.5%, maintaining good glycemic control. Her LDL cholesterol has decreased slightly to 98 mg/dL, her triglycerides have dropped to 135 mg/dL, and her HDL cholesterol has risen to 55 mg/dL. These improvements indicate continued progress in her cardiovascular health. The patient's blood pressure reads at 118/74 mmHg, and her pulse remains steady at 72 beats per minute. Despite these positive indicators, the nurse decides to investigate the tingling sensation further by performing a detailed sensory examination of the patient's extremities.

The monofilament test reveals minimal sensory loss in both feet, suggesting early peripheral neuropathy. To prevent further complications, the nurse re-emphasizes the importance of daily foot care, including checking for any cuts, sores, or changes in skin condition, and recommends wearing supportive footwear. A referral to a podiatrist is made to provide a comprehensive evaluation and possible interventions to manage the neuropathic symptoms. The nurse also suggests incorporating specific exercises that may help improve nerve function and reassures the patient that her proactive approach to health management is crucial in addressing these minor complications. An appointment is set for another three months to monitor her progress and adjust the care plan as needed.