BSN, RN
Isolation:
Code Status:
Weight:
198 lbs
Height:
5’4”
Maria Rodriguez
52 y/o
Female
Provider:
Dr. Sarah Chen, MD
Allergies:
Penicillin (hives), Sulfa drugs (rash)
Emergency Contact:
Juan Rodriguez (Husband) | 555-XXX-4567
Insurance:
Blue Cross Blue Shield
Chief Complaint
"I've been so thirsty and tired for weeks. Today I felt really confused and dizzy at work, and my vision was blurry."
Medical History
- Hypertension (diagnosed 5 years ago)
- Obesity
- Hyperlipidemia
- Depression
Home Medications
- Lisinopril 20mg PO daily
- Atorvastatin 40mg PO daily
- Sertraline 50mg PO daily
What aspects of this patient's presentation are classic signs/symptoms of hyperglycemia, and what is the pathophysiological basis for each?
Classic signs/symptoms and their pathophysiological basis:
Polydipsia (excessive thirst): High blood glucose levels cause osmotic diuresis, leading to dehydration and increased thirst.
Polyuria (frequent urination): Excess glucose spills into the urine, pulling water along with it due to osmotic effects.
Blurred vision: Hyperglycemia causes fluid shifts in the lens of the eye, altering its shape and refractive ability.
Fatigue: Cells are unable to use glucose effectively for energy due to insufficient insulin.
Weight loss: Lack of insulin forces the body to break down fat and muscle for energy.
Dry mucous membranes and poor skin turgor: Signs of dehydration due to fluid loss.
What are the priority nursing interventions for this patient, and why are they critical at this stage?
Priority nursing interventions:
Initiate IV Fluids: Correct dehydration and restore intravascular volume to prevent hypovolemic shock.
Administer Insulin Drip: Lower blood glucose levels gradually to prevent complications like cerebral edema.
Monitor Blood Glucose Hourly: Ensure the glucose levels are trending down appropriately and detect hypoglycemia early.
Monitor Electrolytes: Potassium levels need close monitoring as insulin can cause intracellular shifts, leading to hypokalemia.
Neurological Assessments: Detect worsening confusion or signs of cerebral edema.
Provide Emotional Support: Help the patient and family process the new diabetes diagnosis and associated anxiety.
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Maria Rodriguez
52 y/o
Female
Provider:
Dr. Sarah Chen, MD
Allergies:
Penicillin (hives), Sulfa drugs (rash)
Emergency Contact:
Juan Rodriguez (Husband) | 555-XXX-4567
Insurance:
Blue Cross Blue Shield
Chief Complaint
"I've been so thirsty and tired for weeks. Today I felt really confused and dizzy at work, and my vision was blurry."
Medical History
- Hypertension (diagnosed 5 years ago)
- Obesity
- Hyperlipidemia
- Depression
Home Medications
- Lisinopril 20mg PO daily
- Atorvastatin 40mg PO daily
- Sertraline 50mg PO daily
What criteria would need to be met to transition this patient from IV insulin to subcutaneous insulin?
Criteria for transition to SC insulin:
Stable Blood Glucose: Glucose levels are within a manageable range (e.g., <200 mg/dL) and trending down consistently.
Resolved Symptoms: Patient is alert, oriented, and no longer experiencing confusion or dizziness.
Electrolyte Balance: Potassium and other electrolytes are within normal ranges.
Ability to Tolerate Oral Intake: Patient is eating meals, enabling the use of mealtime insulin (Novolog).
Patient Competency: Patient demonstrates understanding of self-administration of subcutaneous insulin and glucose monitoring.
What key elements should be included in the initial diabetes education for this patient?
Key elements of initial diabetes education:
Understanding Blood Sugar: Teach the importance of monitoring glucose levels and maintaining them within a target range.
Insulin Administration: Demonstrate proper technique for subcutaneous injections and explain timing (e.g., Lantus for long-acting, Novolog for meals).
Signs of Hyper/Hypoglycemia: Educate on symptoms of high (e.g., thirst, frequent urination) and low (e.g., shakiness, sweating, confusion) blood sugar and what actions to take.
Diet and Nutrition: Introduce the concept of carb counting and a diabetes-friendly diet.
Exercise: Emphasize regular physical activity and how it affects blood sugar.
Follow-Up Care: Stress the importance of endocrinology appointments and ongoing management.
Medication Adherence: Ensure the patient understands their medications and potential side effects.
Click Blur To Reveal Answer
Maria Rodriguez
52 y/o
Female
Provider:
Dr. Sarah Chen, MD
Allergies:
Penicillin (hives), Sulfa drugs (rash)
Emergency Contact:
Juan Rodriguez (Husband) | 555-XXX-4567
Insurance:
Blue Cross Blue Shield
Chief Complaint
"I've been so thirsty and tired for weeks. Today I felt really confused and dizzy at work, and my vision was blurry."
Medical History
- Hypertension (diagnosed 5 years ago)
- Obesity
- Hyperlipidemia
- Depression
Home Medications
- Lisinopril 20mg PO daily
- Atorvastatin 40mg PO daily
- Sertraline 50mg PO daily
What discharge teaching points are essential for this patient's successful transition to self-management?
Essential discharge teaching points:
Blood Glucose Monitoring: Reinforce frequency and technique for checking blood sugar and recording results.
Insulin Administration: Confirm understanding of insulin types, doses, and timing.
Dietary Guidelines: Explain how to follow an ADA (American Diabetes Association) diet and manage carbohydrate intake.
Lifestyle Modifications: Discuss weight loss strategies, regular exercise, and stress management.
Follow-Up Care: Emphasize the need for follow-up with endocrinology and primary care within 1-2 weeks.
Sick Day Rules: Teach how to manage blood glucose during illness, including staying hydrated and checking blood sugar more frequently.
What are the key warning signs the patient should be taught to recognize that would require immediate medical attention?
Warning signs requiring immediate attention:
Signs of Hypoglycemia: Shakiness, sweating, confusion, weakness, or fainting.
Signs of Hyperglycemia: Persistent high blood sugar levels (>300 mg/dL), increased thirst, and frequent urination.
Diabetic Ketoacidosis (DKA): Symptoms such as fruity-smelling breath, rapid breathing, abdominal pain, nausea, or vomiting.
Severe Dehydration: Dry mouth, sunken eyes, or reduced urine output.
Vision Changes: Blurry vision that does not improve.
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