APU - UNRS 212 - Medical- Surgical Nursing I Simulation Assignment - Learner Preparation
Learning Objectives: Upon completion of this Simulation and Preparation the student will:
1. Comprehend the pathophysiology of diabetes, signs, symptoms and interventions in a crisis.
2. Design an individualized plan of care for the nursing management of a patient with diabetes including hypo and hyperglycemia and teaching.
3. Prioritize the implementation and approach to the nursing care of a patient with diabetes in an acute crisis and for daily maintenance.
4. Evaluate the patient’s response to interventions and modifies the nursing care as appropriate for the patient with ...view middle of the document...
ii. The kidneys excrete glucose along with water and electrolytes in an attempt to get rid of the excess glucose.
d. What acid-base disturbances are commonly seen and why do they occur?
i. Excessive ketone bodies.
ii. The lack of insulin causes the breakdown of fat (lipolysis) into free fatty acids and glycerol. The liver then converts the free fatty acids into ketone bodies. Insulin is what prevents this from occurring.
e. What are the pathophysiologic differences between Type I and Type II diabetes? How are each diagnosed?
i. In type 1 diabetes, the islet cell autoantibodies responsible for β-cell destruction are present for months to years before the onset of symptoms. The individual with type 1 diabetes requires insulin from an outside source (exogenous insulin) to sustain life. Without insulin, the patient will develop diabetic ketoacidosis (DKA), a life-threatening condition resulting in metabolic acidosis.
ii. In type 2 diabetes, the pancreas usually continues to produce some endogenous (self-made) insulin but the insulin that is produced is insufficient for the needs of the body, is poorly used by the tissues, or both. The most powerful risk factor is obesity, especially abdominal and visceral adiposity.
iii. Each are diagnosed through the following diagnostic studies:
• Hemoglobin A1C level: 6.5% or higher
• Fasting plasma glucose level: higher than 126 mg/dL
• Two-hour plasma glucose level during OGTT: 200 mg/dL (with glucose load of 75 g)
• Classic symptoms of hyperglycemia with random plasma glucose level of 200 mg/dL or higher
f. Describe the signs and symptoms displayed by a client with hyperglycemia–acute crisis. Contrast DKA with HHNS.
i. Signs and symptoms of DKA include dehydration, poor skin turgor, dry mucous membranes, tachycardia, and orthostatic hypotension. Early symptoms may include lethargy and weakness. As the patient becomes severely dehydrated, the skin becomes dry and loose, and the eyes become soft and sunken. Abdominal pain may be present and accompanied by anorexia, nausea, and vomiting. Kussmaul respirations (rapid, deep breathing associated with dyspnea) are the body’s attempt to reverse metabolic acidosis through the exhalation of excess carbon dioxide. Acetone is noted on the breath as a sweet, fruity odor.
ii. HHHNS produces fewer symptoms in the earlier stages; therefore blood glucose levels can climb quite high before the problem is recognized. The higher blood glucose levels increase serum osmolality and produce more severe neurologic manifestations, such as somnolence, coma, seizures, hemiparesis, and aphasia.
g. What conditions or situations may precipitate or cause this type of crisis?
i. Common causes of DKA include illness...