Nursing Care of the Patient With Endocrine Disease

Jenrry is a56-year-old female who is scheduled for a routine primary care provider’s (PCP) visit to follow-up on her hypertension. She reports no signi-ficant 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 PCP orders a basic meta- bolic 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. Nursing Care of the Patient With Endocrine Disease

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Exercise 6-lz Select øl.l tltøt øþþly Identify risk factors commonly associated with diabetes mellitus:

E Obesiry fl ege less than 45 years E Caucasianrace I Family history D History of gestational diabetes E History of delivering babies over 9 pounds

eResource 6-l: To review risk factors associated with diabetes, consult Epocrates Online: [Pathway: -+ hnpt//online.epocrates.com -> select the “diseases” tab -+ enter “Diabetes” into the search field -+ review content related to “risks”]

Jsnny reports that her mother and grandmother were diabetics. She is also over 45 years old and overweight at 5 feet 2 inches anld 2OO 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.

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216 CHAPTTR 6: ENDOCRINE DISEASE

Exercise 6-22 Multiple-cltoí.ce question The nurse educating Jenny on type 2 diabetes determines that she understands tþs information when she states:

A. “I am not producing any insulin because of a problem with my immune system.”

B. “I will need to take insulin for the rest of my life.,’ c. “I’m not making enough insulin or my body isn’t as sensitive to it.,, D. “I won’t need to make any dietary changes if I take my medicine.”

Exercise 6-32 Møtcbing 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.

ColumnA Column B A. Type L diabetes Onset is usually under 30 years old B. Type 2 dial¡etes patient is often thin at time of diagnosis Nursing Care of the Patient With Endocrine Disease

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

G) ;ffi::i,””,’J ^ä¿'”äîîî#.”å:*t’#i;:lË:iffi,îå:ä. _enter “Type 2 Diabetes” into the search field -+ in the “overview,’section, select “pathophysiology” and review content]

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 hãr hboratory re- sults. 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 experi- encing any of them.

Exercise 6-4: Select ølt tbat øþpty Identify coÍunon clinical manifestations associated with diabetes mellitus

E rolyuria E Decreased appetite Q Decreased fluid intake E Vision changes fl natigue eResource 6-3: For more information regarrding clinical manifestations associated with diabetes mellitus, refer to the Merck Manual: fpathwayt www.merckmanuals.com + select “Merck Manual of Diagnosis and

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CFIAPTER 6: ENDOCRINE DISEASE Questions 217

o

Therapy” –> enter “Diabetes” into the search field + select “Diabetes Mellitus (DM)” -à select “Symptoms and Signs” and review content]

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 phy- sician suspects Jenny has type 2 diabetes.

eResource 6-4: To learn more about the diagnostic work-up for Jenny, refer to Medscape on your mobile device: [Pathway: Medscape *) enter “Type 2 Diat¡etes” into the search fleld + select “Type 2 Diabetes Mellitus” -+ select “‘$7’orkup” and review content]

To further confirm the diagnosis, he orders a random fingerstick blood sugar and Hemoglobin A1C (HgbAlC).

Exercise 6-52 Sbort ønsu)er Briefly explain how a HgbAlC is used to evaluate blood glucose compared to a ran- dom blood glucose level.

o eResource 6-5zTo learn more about HgbAlC, refer to Medscape on yourmobile device: [Pathway: Medscape -+ enter “A].C” into the search field -+ select “Hemoglobin A1C testing”and review content]

Jenny’s blood results are ready within a short period of time. Her fingerstick blood sugar is 286 and her HgbAlC is 9%. Her physician orders metformin 500 mg orally twice a day, andJenny is scheduled to meet with a diabetes educator in2 days.

Exercise 6-6: Fill-in Identify three ways in which metformin acts to maintain normal blood glucose levels: Nursing Care of the Patient With Endocrine Disease

1

2

3

o eResource 6-6:To review patient teaching regarding metformin withJenny, refer to Epocrates on your mobile device: [Pathway: Epocrates -> enter “metformin” into the search field + select “metformin” -) scroll down to review “common reactions” and other relevant content]

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.

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218 CHAPTER 6: ENDOCRINE DISEASE guestions

rxefcrse o- / 2 .Íttt-Nt . For obese patients who are diabetic, the key to treatment is:

Exercise 6-8: Fùll-in Identify the food groups that are part of the Exchange List system and give one ex- ample of a specific food within each group:

Exercise 6-9: True orfølse Identify whether the following statements about nutrition in the diabetic patient are true or false:

1. Soluble fiber lowers blood glucose levels by slowing the rate of glucose absorption from these foods.

2. Alcohol used in combination with chlorpropamide (Diabinese) may cause facial flushing, warmth,.rrauseal and vomiting.

3. Nutritive sweeteners have no effect on blood glucose levels.

Exercise 6-l0t Multìple-cltoíce question The nurse educating Jenny on exercise determines that she needs further instruction when she states:

A. “Exercise will lower my blood glucose level.,, B. “I should try to exercise at the same time each day.,, C. “Walking is generally a safe form of exercise.,’ D. “I should exercise more when my glucose levels are more than

25O mgldL;’

o eResource 6-72 To learn more about nutritional management of patientswith diabetes, refer to Medscape on your mobile device: [pathway: Medscape -+ enter “nutrition” into the search field -+ select “Nutritional Management of Patients with Diabetes” and review content]

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 fwo to three times per week. Nursing Care of the Patient With Endocrine Disease