Question Answered step-by-step 6 Nursing Care of the Patient With Endocrine Disease Karen K…. 6Nursing Care of the Patient With Endocrine DiseaseKaren K. GittingsUnfolding Case Study #36  JennyJenny is a 56-year-old female who is scheduled for a routine health care provider’s (HCP) visit to follow-up on her hypertension. She reports no significant complaints other than her vision being blurry; she states, “I need to go to the eye doctor to have my eyes checked.” At the conclusion of her visit, the HCP orders a basic metabolic panel (BMP) and complete blood count (CBC) to be drawn. Jenny receives a phone call 2 days later from her PCP’s office to schedule an appointment for later that day. Jenny is told that her blood sugar is elevated. At her appointment, Jenny and the nurse begin by reviewing Jenny’s risk factors for diabetes.1. Identify risk factors commonly associated with diabetes mellitus: (Select all that apply) Obesity Age less than 45 years Caucasian race Family history History of gestational diabetes History of delivering babies over 9 pounds    Jenny reports that her mother and grandmother were diabetics. She is also over 45 years old and overweight at 5′  2″ inches  and 200 pounds. Jenny still finds it hard to believe that she could be diabetic since she is feeling okay; she asks the nurse to explain to her how diabetes occurs. 2. The nurse educating Jenny on type 2 diabetes determines that she understands the information when she states: A. “I am not producing any insulin because of a problem with my immune system.””I will need to take insulin for the rest of my life.””I’m not making enough insulin or my body isn’t as sensitive to it.””I won’t need to make any dietary changes if I take my medicine.”3. Match the type of diabetes in Column A with its typical characteristics in Column B. Answers in Column A can be used more than once.            Column A                                         Column BType 1 diabetes  _______ Onset is usually under 30 years oldType 2 diabetes  _______ Patient is often thin at time of diagnosis                                 _______ Treated with diet, exercise, and oral agents                                 _______ Patient is often obese at time of diagnosis                                 _______ Antibodies are present in the body                                      _______ Patients require insulin for life By the time it is Jenny’s turn to see her PCP, she has a beginning understanding about diabetes. Her PCP sits with her and begins by reviewing her laboratory results. Her fasting plasma glucose from her last visit was 236 mg/dL. The PCP lists some typical signs and symptoms of diabetes, and he asks Jenny if she is experiencing any of them.4. Identify common clinical manifestations associated with diabetes mellitus: (Select all that apply)PolyuriaDecreased appetiteDecreased fluid intakeVision changesFatigue     Jenny reports that her vision has been blurry, but she thought that she needed new glasses. She also recognizes that she has been drinking and urinating more than usual. Based on her symptoms and elevated fasting plasma glucose, the physician suspects Jenny has type 2 diabetes.To further confirm the diagnosis, the HCP orders a random fingerstick blood sugar and Hemoglobin A1C (HgbA1C). 5. Briefly explain how a HgbA1C is used to evaluate blood glucose compared to a random blood glucose level.        Jenny’s blood results are ready within a short period of time. Her fingerstick blood sugar is 286 and her HgbA1C is 9%. Her physician orders metformin 500 mg orally twice a day, and Jenny is scheduled to meet with a diabetes educator in 2 days.6. Identify three ways in which metformin acts to maintain normal blood glucose levels: A. _______________________________  B. _______________________________ C. _______________________________Jenny meets with the diabetes educator as scheduled. During her appointment, they discuss many topics including nutrition and exercise. The educator begins by talking about meal planning and caloric needs.7. For obese patients who are diabetic, the key to treatment is: ______________________.8. Identify the food groups that are part of the Exchange List system and give one example of a specific food within each group:______________________________     9. Identify whether the following statements about nutrition in the diabetic patient are true or false:__________A. Soluble fiber lowers blood glucose levels by slowing the rate of glucose absorption from these foods.__________B. Alcohol used in combination with chlorpropamide (Diabinese) may cause facial flushing, warmth, nausea, and vomiting.__________C. Nutritive sweeteners have no effect on blood glucose levels.10. The nurse educating Jenny on exercise determines that she needs further instruction when she states:”Exercise will lower my blood glucose level.””I should try to exercise at the same time each day.””Walking is generally a safe form of exercise.””I should exercise more when my glucose levels are more than 250 mg/dL.” Jenny is given a blood glucose monitor with instructions for self-monitoring of her glucose levels. Once Jenny’s blood glucose level is stabilized, she is instructed to test at least two to three times per week.11. Identify other circumstances in which more frequent testing is recommended: (Select all that apply) Missing a mealtime Symptoms of hypoglycemia Changes in medications During periods of increased stress Times of illness The diabetes educator explains to Jenny how metformin works to control her blood glucose level. Jenny expresses concern that she may have to use insulin if the metformin is ineffective, but the nurse explains that there are many other oral agents available that can be tried before moving to insulin. 12. Match the medication in Column A with its drug classification and action in Column B.            Column A                                                        Column B A. chlorpropamide (Diabinese)  _____  Alpha-glucosidase inhibitor; delays intestinal absorption of complex carbs B. glipizide (Glucotrol)  _____  First-generation sulfonylurea; stimulates beta cells of the pancreas to secrete insulin C. metformin (Glucophage)  _____  Nonsulfonylurea insulin secretagogue; stimulates the pancreas to secrete insulin D. acarbose (Precose)  _____  Second-generation sulfonylurea; stimulates beta cells of the pancreas to secrete insulin E. nateglinide (Starlix)  _____  Biguanide; inhibits production of glucose by the liver    As Jenny’s appointment draws to an end, the diabetes educator teaches her about hypoglycemia and long-term complications.13. The nurse educating Jenny on hypoglycemia determines that she understands the information when she states:”I won’t get hypoglycemic when I am only taking metformin.””If I feel my blood sugar dropping, I will eat some chocolate candy.””My family should be educated on how to help me if I become hypoglycemic.””Hypoglycemia most often occurs 1 hour after meals.”14. Identify the macrovascular and microvascular complications that can occur with diabetes:          Macrovascular                      Microvascular______________________  1. ____________________________________________  2. ____________________________________________      15. Identify foot care techniques recommended for diabetic patients (Select all that apply) Assess feet daily Lotion the feet, especially between the toes Use hot water for soaking the feet Trim toenails straight across Never walk barefoot     Health Science Science Nursing NURSING NUR2392 Share QuestionEmailCopy link Comments (0)

Question Answered step-by-step 6 Nursing Care of the Patient With Endocrine Disease Karen K…. 6Nursing Care of the Patient With Endocrine DiseaseKaren K. GittingsUnfolding Case Study #36  JennyJenny is a 56-year-old female who is scheduled for a routine health care provider’s (HCP) visit to follow-up on her hypertension. She reports no significant complaints other than her vision being blurry; she states, “I need to go to the eye doctor to have my eyes checked.” At the conclusion of her visit, the HCP orders a basic metabolic panel (BMP) and complete blood count (CBC) to be drawn. Jenny receives a phone call 2 days later from her PCP’s office to schedule an appointment for later that day. Jenny is told that her blood sugar is elevated. At her appointment, Jenny and the nurse begin by reviewing Jenny’s risk factors for diabetes.1. Identify risk factors commonly associated with diabetes mellitus: (Select all that apply) Obesity Age less than 45 years Caucasian race Family history History of gestational diabetes History of delivering babies over 9 pounds    Jenny reports that her mother and grandmother were diabetics. She is also over 45 years old and overweight at 5′  2″ inches  and 200 pounds. Jenny still finds it hard to believe that she could be diabetic since she is feeling okay; she asks the nurse to explain to her how diabetes occurs. 2. The nurse educating Jenny on type 2 diabetes determines that she understands the information when she states: A. “I am not producing any insulin because of a problem with my immune system.””I will need to take insulin for the rest of my life.””I’m not making enough insulin or my body isn’t as sensitive to it.””I won’t need to make any dietary changes if I take my medicine.”3. Match the type of diabetes in Column A with its typical characteristics in Column B. Answers in Column A can be used more than once.            Column A                                         Column BType 1 diabetes  _______ Onset is usually under 30 years oldType 2 diabetes  _______ Patient is often thin at time of diagnosis                                 _______ Treated with diet, exercise, and oral agents                                 _______ Patient is often obese at time of diagnosis                                 _______ Antibodies are present in the body                                      _______ Patients require insulin for life By the time it is Jenny’s turn to see her PCP, she has a beginning understanding about diabetes. Her PCP sits with her and begins by reviewing her laboratory results. Her fasting plasma glucose from her last visit was 236 mg/dL. The PCP lists some typical signs and symptoms of diabetes, and he asks Jenny if she is experiencing any of them.4. Identify common clinical manifestations associated with diabetes mellitus: (Select all that apply)PolyuriaDecreased appetiteDecreased fluid intakeVision changesFatigue     Jenny reports that her vision has been blurry, but she thought that she needed new glasses. She also recognizes that she has been drinking and urinating more than usual. Based on her symptoms and elevated fasting plasma glucose, the physician suspects Jenny has type 2 diabetes.To further confirm the diagnosis, the HCP orders a random fingerstick blood sugar and Hemoglobin A1C (HgbA1C). 5. Briefly explain how a HgbA1C is used to evaluate blood glucose compared to a random blood glucose level.        Jenny’s blood results are ready within a short period of time. Her fingerstick blood sugar is 286 and her HgbA1C is 9%. Her physician orders metformin 500 mg orally twice a day, and Jenny is scheduled to meet with a diabetes educator in 2 days.6. Identify three ways in which metformin acts to maintain normal blood glucose levels: A. _______________________________  B. _______________________________ C. _______________________________Jenny meets with the diabetes educator as scheduled. During her appointment, they discuss many topics including nutrition and exercise. The educator begins by talking about meal planning and caloric needs.7. For obese patients who are diabetic, the key to treatment is: ______________________.8. Identify the food groups that are part of the Exchange List system and give one example of a specific food within each group:______________________________     9. Identify whether the following statements about nutrition in the diabetic patient are true or false:__________A. Soluble fiber lowers blood glucose levels by slowing the rate of glucose absorption from these foods.__________B. Alcohol used in combination with chlorpropamide (Diabinese) may cause facial flushing, warmth, nausea, and vomiting.__________C. Nutritive sweeteners have no effect on blood glucose levels.10. The nurse educating Jenny on exercise determines that she needs further instruction when she states:”Exercise will lower my blood glucose level.””I should try to exercise at the same time each day.””Walking is generally a safe form of exercise.””I should exercise more when my glucose levels are more than 250 mg/dL.” Jenny is given a blood glucose monitor with instructions for self-monitoring of her glucose levels. Once Jenny’s blood glucose level is stabilized, she is instructed to test at least two to three times per week.11. Identify other circumstances in which more frequent testing is recommended: (Select all that apply) Missing a mealtime Symptoms of hypoglycemia Changes in medications During periods of increased stress Times of illness The diabetes educator explains to Jenny how metformin works to control her blood glucose level. Jenny expresses concern that she may have to use insulin if the metformin is ineffective, but the nurse explains that there are many other oral agents available that can be tried before moving to insulin. 12. Match the medication in Column A with its drug classification and action in Column B.            Column A                                                        Column B A. chlorpropamide (Diabinese)  _____  Alpha-glucosidase inhibitor; delays intestinal absorption of complex carbs B. glipizide (Glucotrol)  _____  First-generation sulfonylurea; stimulates beta cells of the pancreas to secrete insulin C. metformin (Glucophage)  _____  Nonsulfonylurea insulin secretagogue; stimulates the pancreas to secrete insulin D. acarbose (Precose)  _____  Second-generation sulfonylurea; stimulates beta cells of the pancreas to secrete insulin E. nateglinide (Starlix)  _____  Biguanide; inhibits production of glucose by the liver    As Jenny’s appointment draws to an end, the diabetes educator teaches her about hypoglycemia and long-term complications.13. The nurse educating Jenny on hypoglycemia determines that she understands the information when she states:”I won’t get hypoglycemic when I am only taking metformin.””If I feel my blood sugar dropping, I will eat some chocolate candy.””My family should be educated on how to help me if I become hypoglycemic.””Hypoglycemia most often occurs 1 hour after meals.”14. Identify the macrovascular and microvascular complications that can occur with diabetes:          Macrovascular                      Microvascular______________________  1. ____________________________________________  2. ____________________________________________      15. Identify foot care techniques recommended for diabetic patients (Select all that apply) Assess feet daily Lotion the feet, especially between the toes Use hot water for soaking the feet Trim toenails straight across Never walk barefoot     Health Science Science Nursing NURSING NUR2392 Share QuestionEmailCopy link Comments (0)