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3. Why is it important to support the clients head and neck with sandbags and pillows?
CUSHINGS SYNDROME
SITUATION: A 62-year-old woman has been taking 10 mg prednisone PO for over
two years to control pulmonary inflammation from COPD. When assessing the
client, the nurse notes she has a round appearing puffy face, a large abdomen, and
thin arms and legs. There are multiple bruises on the womans arms and legs.
1. What is the relationship between the womans chronic use of the steroid drug
prednisone and her physical appearance?
2. Why should the nurse cautioin the client not to stop taking her oral steroid deug
without consulting health practitioner first?
3. The nurse observes the nursing diagnosis risk for injury: fractures on the clients
nursing care plan. Why is the client at risk for fractures?
DIABETES MELLITUS
SITUATION: A 43-year-old female client has a 24-year history of Type 1 DM. She
lives with her husband and two teen-aged daughters. The client has been able to
adequately manage her DM, care for her family and work full-time as a cook at the
local elementary school cafeteria, where she enjoys cooking and interacting with the
children. The clients past medical history includes common childhood illnesses,
tonsillectomy at age 6, and vaginal hysterectomy at age 39 for dysfunctional uterine
bleeding secondary to fibroid tumor growth. She is 5 4 tall and weighs 138 pounds.
1. What are the similarities and differences between Type 1 and Type 2 DM.
TYPES OF DM
TYPE 1
SIMILARITIES
DIFFERENCES
TYPE 2
2. List the common clinical manifestations that occur from DM, noting those that occur
early in the disease process, those that occur late in the disease process.
A. Early clinical manifestations
B. Late clinical manifestations
3. What are the major consequences of insulin deficiency to each of the following
organs/tissues, and what is the overall result of such consequences?
ORGAN/TISSUE
CONSEQUENCES
LIVER
SKELETAL MUSCLE
ADIPOSE TISSUE
OVERALL RESULT
Additiona Information: The client visits her health care practitioner yearly unless
she experiences problems. Two years ago she was diagnosed with hypertension
secondary to her DM and was placed on the drug metoprolol (Lopressor) 50 mg bid
and a low-salt diet to control her blood pressure. Her daily insulin dose was also
adjusted because her GHb (glycosylated hemoglobin) was elevated. Other
medications include 1 mg estradiol daily and OTC Advil (ibuprofen) for occasinal
headaches.
4. What does the clients elevated glycosylated hemoglobin level imply?
5. What is the relationship between the clients hypertension and her DM?
6. Is there reason for concern about the clients combination of prescribed and OTC
medications? Why or why not?
SITUATION: The client has self-administered 35 units of NPH human insulin and
20 units of regular human insulin at 7:30 AM each morning since her last visit to the
clinic, which she feels is controlling her DM well. She inconsistently monitors her
blood glucose levels because she dislikes pricking her own fingers and believes that
she can feel when her blood glucose is not within normal limits. The client intakes
between 1300 and 1400 calories each day per the American Diabetic Association
exchange system, which includes an evening snack.
7. While this client has slef-administered her own insulin for years, many clients need to
be taught the skill. Cite at least four principles a newly diagnosed diabetic should be
taught about insulin and its administration.
8. What is the underlying principle supporting the American Diabetes Association
exchange list and how does the client use it to calculate her daily dietary intake?
9. Should the client be counseled regarding monitoring her blood glucose level? Why or
why not?
10. Cite at least 5 signs and symptoms that should be taught to diabetic clients and their
significant others, because they indicate the presence of hypoglycemia.
11. What are the most common reasons why diabetic clients develop hypoglycemia?
12. Prioritize the following nursing diagnoses for this client, with 1 being the highest
priority. Support your reason for selecting your top three priorities.
______ Altered nutrition: less than body requirements
______ Risk for injury
______ Management of therapeutic management
______ Risk for infection
______ Sensory/perceptual alterations