Pathophysiology/Description Priority Laboratory Tests/Diagnostics
• Diabetes is a multisystem disease of glucose metabolism Diagnosis made with one of the following
that is marked by hyperglycemia
◦ Fasting blood glucose 126 mg/dL or higher
• It relates to impaired usage of insulin, abnormal production
◦ A1C of 6.5% or higher
of insulin or both occurring at the same time
◦ Using a glucose load of 75 g during an oral glucose
• Two most common types of diabetes mellitus are types 1
tolerance test, a two-hour plasma level that is equal to or
and 2. Type 2 diabetes is the most prevalent
greater than 200 mg/dL
• Type 2 is marked by insulin resistance, inadequate insulin
◦ Random blood glucose greater than or equal to 200
secretion or a combination of both
mg/dL in a client who has the classic symptoms of
◦ Insulin resistance: Body tissues do not respond to hyperglycemia or is in a hyperglycemic crisis
insulin’s action due to unresponsive or insufficient
◦ The first 3 items above must be repeated to confirm
numbers of insulin receptors
the diagnosis. However, the fourth does not need to be
◦ Inadequate insulin secretion: Cells of the pancreas repeated
become fatigued and so insulin production is decreased
• Risk factors
Priority Interventions or Actions
◦ Family history. More likely to get the condition if there are
first degree relatives with it Administer medications and monitor blood glucose for
◦ Obesity or overweight. Fat cells are resistant to insulin effectiveness of dosage
◦ Certain ethnicities. It is more prevalent in Asian Monitor meal intake
Americans, African Americans, Hispanics, Pacific Islanders
Schedule meeting with dietician to talk with client about
and Native Americans
nutrition planning
◦ Being older than 40 years of age
• Schedule meeting with diabetic educator to ensure client’s
• Type 2 diabetes has a gradual onset. Many persons do not knowledge needs are met
know they have the condition until it is detected on routine
lab testing
• Diabetes is a life-altering condition
Priority Potential & Actual Complications
Nephropathy, leading to kidney failure, neuropathy, leading
Priority Assessments or Cues to sores and amputations and retinopathy, leading to
blindness
Ask about symptoms such as polydipsia, polyuria, Hyperglycemic hyperosmolar syndrome, hypoglycemia
polyphagia, fatigue, recurrent infections, visual changes and
poor wound healing. Determine blood glucose level Conditions related to the heart, brain and blood vessels
Ask about management of the condition such as meal • Gastroparesis
planning and medication administration • Fungal infections
• Measure vital signs
Perform skin assessment, focusing on feet. Diabetes causes Priority Nursing Implications
neuropathy and individuals with the disease can have
wounds on their soles without knowing it. Untreated wounds Understand that most people with diabetes, even if the
can lead to amputations condition is controlled without medications, will require
medicines at some point because of the progressive nature
• Perform neurological assessment, focus on the eyes. of the condition
Blindness is a major complication of diabetes
Persons with type 2 diabetes who take oral medications can
• Review labs, including kidney function tests. Nephropathy is
a major complication of diabetes require insulin in times of stress, as in acute illness
• Determine social support Metformin must be stopped for surgery or if having a
procedure that uses a contrast medium. Resume 48 hours
• Assess client’s understanding of disease management
post procedure but get creatinine level first. Not stopping
the drug will increase the risk of metformin-induced lactic
acidosis
300 Priority Exemplar NurseThink.com
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