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1 of 59
Term
The nurse is assigned to the care of a patient diagnosed with type
2 diabetes. In formulating a teaching plan that encourages the
patient to actively participate in management of the diabetes, what
should be the nurse's initial intervention?
Assess patient's perception of what it means to have diabetes.
Ask the patient to write down current knowledge about diabetes.
Set goals for the patient to actively participate in managing his
,diabetes.
Assume responsibility for all of the patient's care to decrease stress
level.
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Increased triglyceride levels
Macrovascular complications of diabetes include changes to large- and
medium-sized blood vessels. They include cerebrovascular, cardiovascular,
and peripheral vascular disease. Increased triglyceride levels are associated
with these macrovascular changes. Increased HDL, decreased LDL, and
decreased VLDL are positive in relation to atherosclerosis development.
Assess patient's perception of what it means to have diabetes.
For teaching to be effective, the first step is to assess the patient.
Teaching can be individualized after the nurse is aware of what a
diagnosis of diabetes means to the patient. After the initial assessment,
current knowledge can be assessed, and goals should be set with the
patient.
Assuming responsibility for all of the patient's care will not facilitate the
patient's health.
Microangiopathy is specific to diabetes and most commonly affects the capillary
membranes of the eyes, kidneys, and skin.
Microangiopathy occurs in diabetes mellitus. When it affects the eyes, it is called
diabetic retinopathy. When the kidneys are affected, the patient has nephropathy.
When the skin is affected, it can lead to diabetic foot ulcers.
Macroangiopathy can occur in either type 1 or type 2 diabetes and contributes to
cerebrovascular, cardiovascular, and peripheral vascular disease. Sexual
impotency and slowed gastric emptying result from microangiopathy and
neuropathy.
, Cheese
Cheese is a product derived from animal sources and is higher in fat and calories
than vegetables, fruit, and poultry. Excess fat in the diet is limited to help avoid
macrovascular changes.
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2 of 59
Term
A nurse is teaching a patient how to promote healing following
abdominal surgery. What should be included in the teaching (select
all that apply.)?
Select all that apply.
Take the antibiotic until the wound feels better.
Take the analgesic every day to promote adequate rest for healing.
Be sure to wash hands after changing the dressing to avoid infection.
Take in more fluid, protein, and vitamins C, B, and A to facilitate
healing.
Notify the health care provider of redness, swelling, and increased
drainage.
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, Excessive thirst
The classic symptoms of diabetes are polydipsia (excessive thirst), polyuria,
(excessive urine output), and polyphagia (increased hunger). Weight gain,
fatigue, and blurred vision may all occur with type 2 diabetes, but are not classic
manifestations.
Autoimmune response
With aging, autoantibodies increase, which lead to autoimmune diseases
(e.g., systemic lupus erythematosus, acute glomerulonephritis, rheumatoid
arthritis, hypothyroidism). Cell-mediated immunity decreases with decreased
thymic output of T cells and decreased activation of both T and B cells.
There is a decreased or absent delayed hypersensitivity reaction.
Immunoglobulin levels decrease and lead to a suppressed humoral immune
response in older adults.
Be sure to wash hands after changing the dressing to avoid infection.
Take in more fluid, protein, and vitamins C, B, and A to facilitate healing.
Fluid is needed to replace fluid from insensible loss and from exudates
as well as the increased metabolic rate. Protein corrects the negative
nitrogen balance that results from the increased metabolic rate and that
needed for synthesis of immune factors and healing. Vitamin C helps
synthesize capillaries and collagen. Vitamin B complex facilitates
metabolism. Vitamin A aids in epithelialization. The health care provider
should be notified if there are signs of infection. If prophylactic antibiotics
are prescribed, they must be taken until they are completely gone. Initially
analgesics are taken throughout the day (e.g., every 3 to 4 hours) as
needed. Infection must be avoided with aseptic procedures, including
washing the hands before changing the dressing.
The wound will be left open and heal from the edges inward.
With secondary healing, the wound is left open and heals from the edges inward
and from the bottom up. With primary intention, the wound edges are stapled or
sutured, and healing occurs until the contraction of the healing area closes the
defect and brings the skin edges closer together to form a mature scar. With