Case study 5 donna needs to understand the signs and

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Unformatted text preview: diabetic control. What range of blood glucose should she be advised to aim for? Case Study 5. Donna needs to understand the signs and symptoms of hypoglycemia so that she can quickly intervene to prevent life-threatening complications. How can she recognize hypoglycemia and what should she do when it occurs? 6. Donna’s health care provider plans to routinely monitor glycosylated hemoglobin levels (HbAM1c). What information can be gained from this laboratory test? 7. Donna should be aware of the potential acute and longterm complications of diabetes mellitus. What are they? Case Study Case A 58-year-old man with long-standing insulin-treated type 2 58-year-old diabetes has been diagnosed with right lower extremity cellulitis. He has taken a prescribed oral antibiotic for the past week but has not noticed much improvement. For the last 2 days, he has complained of intermittent fevers and chills, nausea with poor oral intake, and proximally spreading erythema over his right leg. On the evening of admission, a friend notices that he is markedly confused and calls 911. In the emergency room, he is oriented only to his name. Is tachypneic, breathing deeply at a rate of 24/min. He is febrile at 38.8°C. His blood pressure is 120/80, but his heart rate is elevated at 112 bpm. elevated On examination, this patient is a delirious, unkempt man with a On fruity breath odor. His right lower extremity is red and tender to palpation. Serum chemistries reveal glucose of 488 mg/dL. Urine dipstick is positive for ketones. mg/dL. Case Study Case 1. Describe the causes of ketoacidosis in this Describe diabetic patient. 2. What is the cause of his altered mental 2. What status? 3. Describe the patient's respiratory pattern. 3. Describe What is the pathophysiological mechanism? Example Test Questions Questions Signs and symptoms of hypoglycemia include all of the following except: include A. pallor B. tremors C. fever D. altered consciousness Exercise for the patient with Type II diabetes may result in: diabetes A. improved renal function A. improved B. decreased insulin resistance C. decreased risk of eating disorder C. development D. increased low-density lipid levels Early diabetic nephropathy can be recognized by: recognized A. B. C. D. Anuria Glycosuria Hypertension Microalbuminuria Which of the following indicators is most helpful in evaluating long-term blood glucose management in patients with diabetes mellitus? a. Blood glucose levels b. Urine glucose levels c. Glycosylated hemoglobin levels (HbA1c) d. Clinical manifestations of hyperglycemia Which of these patients is most at risk for nonketotic hyperglycemic hyperosmolar coma? A. A 9-year-old boy with Type I diabetes, 9-year-old B. C. D. following supersized milkshake and hamburger. hamburger. A 37-year-old women who develops 37-year-old gestational diabetes. gestational A 76-year-old man with Type II diabetes 76-year-old who has the flu. who An 82-year-old woman with Type II diabetes An who misses lunch. who Type II Diabetes is best described as: A. a resistance to insulin by insulin-sensitive tissues. B. the need for lispro instead of regular insulin. C. an increase of glucagon secretion from a cells of the pancreas. D. the presence of insulin autoantibodies that destroy ß cells in the pancreas. The first lab test that indicates Type I Diabetes is causing the development of diabetic nephropathy is: A. Dipstick for urine ketones B. Increase in serum creatinine C. Protein on urinalysis D. Cloudy urine on urinalysis...
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