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Type 1
 Type 2
 Gestational (GDM)
 Other specific conditions resulting in
hyperglycemia

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
Hyperglycemia
 Polyuria
 Polydipsia
 Polyphagia
 Ketone bodies
 Hemoconcentration, hypovolemia, hyperviscosity,
hypoperfusion, and hypoxia
 Acidosis, Kussmaul respiration
 Hypokalemia, hyperkalemia, or normal serum
potassium levels

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ACUTE COMPLICATIONS OF
DIABETES
Diabetic ketoacidosis
 Hyperglycemic-hyperosmolar state (HHS)
 Hypoglycemia from too much insulin or too little
glucose

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CHRONIC COMPLICATIONS OF DIABETES
Macrovascular/microvascular disease
 Retinopathy (vision problems)
 Nephropathy (kidney dysfunction)
 Neuropathy (nerve dysfunction)

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MACROVASCULAR COMPLICATIONS
Cardiovascular disease
 Cerebrovascular disease

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MICROVASCULAR COMPLICATIONS
Eye and vision complications
 Diabetic neuropathy
 Diabetic nephropathy
 Male erectile dysfunction

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METABOLIC SYNDROME
Also called syndrome X
 Classified as simultaneous presence of metabolic
factors known to increase risk for developing type 2
diabetes and cardiovascular disease

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
HEALTH PROMOTION AND MAINTENANCE

Control of diabetes and its complications is major
focus for health promotion activities
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ASSESSMENT
History
 Blood tests






Fasting plasma glucose (FPG)
Oral glucose tolerance test (OGTT)
Other blood tests
Screening
Ongoing assessment—glycosylated hemoglobin assays,
glycosylated serum proteins and albumin, urine tests,
tests for kidney function
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TESTING SENSATION
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TREATMENT OPTIONS
Oral therapies
 Insulin therapies
 Nutritional considerations
 Exercise
 Surgical intervention
 Foot care
 Wound care

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PATIENT EDUCATION
Insulin storage
 Dose preparation
 Syringes
 Blood glucose monitoring
 Infection control measures
 Diet therapy

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ACTIVITY: PATIENT WITH A DIABETIC
CONDITION
1.
2.
3.
4.
5.
6.
7.
8.
Etiologies, risk factors, comorbidities
Assessment findings
Diagnostic tests
Nurse’s role
Interdisciplinary team’s role
Treatment/intervention priorities
Teaching/health promotion information
Community resources
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A 23-year-old patient with a history of type 1 diabetes
is admitted to the ED with nausea and abdominal
pain. His respiratory rate is 34/min with deep
breaths and a fruity smell to his breath. He is
responsive, but difficult to arouse.
What does the nurse suspect is happening with
this patient?
2. What serum glucose level would the nurse expect
to see with this patient?
1.
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(cont’d)
The student nurse asks why the patient is breathing
so rapidly and deeply. What is the nurse’s best
response?
A. “His serum pH is high and this is a compensatory
mechanism.”
B. “His serum pH is low and this is a compensatory
mechanism.”
C. “His serum potassium is high and this is a
compensatory mechanism.”
D. “His serum potassium is low and this is a
compensatory mechanism.”
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
(cont’d)
In the ED, the patient is diagnosed with diabetic
ketoacidosis (DKA).
What is the nurse’s first priority for managing this
condition?
A. Airway assessment
B. Fluid and electrolyte correction
C. Administration of insulin
D. Administration of IV potassium
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(cont’d)
Twenty minutes later, the patient is admitted to the ICU for
DKA management. The patient is receiving IV regular insulin
with frequent finger sticks to check his glucose level. His
potassium level is 2.5 and IV potassium supplements have been
ordered.
What assessment must be made before giving the IV potassium?
A.
B.
C.
D.
Production of at least 30 mL/hr of urine
Level of consciousness and orientation
Finger stick glucose of less than 200 mg/dL
Respiratory rate of less than 24/min
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(cont’d)
Two days later the patient is recovered and is preparing for
discharge. His wife asks about what they can do to prevent this
from happening again.
What should the nurse teach the patient and his wife? (Select all
that apply.)
A.
B.
C.
D.
E.
Check blood glucose levels every 4 to 6 hours if anorexia,
nausea, or vomiting is experienced.
Check urine ketones when blood glucose is greater than 300
mg/dL.
Decrease fluid intake when nausea and vomiting occur.
Watch for and report any illness lasting more than 1 to 2
days.
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Monitor glucose whenever the patient is ill.
CHAPTER 67
Audience Response System Questions
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21
QUESTION 1
What percent of the United States population has
diabetes?
A.
B.
C.
D.
3.2%
5.6%
8.3%
10.1%
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QUESTION 2
Which symptom requires immediate intervention
during a hypoglycemic episode?
A.
B.
C.
D.
Confusion
Hunger
Headache
Tachycardia
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QUESTION 3
When should a patient with type 1 diabetes avoid
exercise?
A.
B.
C.
D.
When serum glucose is less than 150
During colder months
When ketones are present in the urine
When emotional stressors are high for the patient
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