Critical Thinking Exercise No.9 Nursing Management of The Client With DIABETES MELLITUS (Case Study 3)

Republic of the Philippines
UNIVERSITY OF NORTHERN PHILIPPINES

Tamag, Vigan City
2700 Ilocos Sur
College of Nursing
Website: www.unp.edu.ph Mail: [email protected]
CP# 09177148749, 09175785986
CRITICAL THINKING EXERCISE NO.9

Nursing Management of the Client with DIABETES MELLITUS
(Case Study 3 )
______________________________________________________________________________________
SITUATION: M.W., a 76 year old widower with Type 2 NIDDM (non-insulin dependent DM) ,injured
his right great toe when walking to the bathroom during the night. Poor healing of the injured
extremity with subsequent color change resulted. The toe continued to develop dark, bluish black
color. He complains of of a loss sensation to the foot. An amputation of the toe was required for
peripheral vascular disease as related to the diabetic process. Prior to hospitalization, M.W. was
taking an oral hypoglycemic agent to control his diabetes. Due to unstable blood sugars, regular
insulin was ordered QID according to a sliding scale dose. Two days after surgical procedure, the
client transferred from an acute care facility to an extended facility.
__________________________________________________________________________________
The medical orders on admission include:
o Glyburide (Glynase) 1.5 mg PO BID
o Glucometer checks QID, AC and HS
o VS every day
o Fasting blood sugar weekly
o Diet: 2000 calorie
o Humulin R SC 30 mins. AC and HS to the ff. scale:
Regular Insulin Sliding Scale before meals Goal: 70-200 Glucose Night (HS) Sliding Scale to
prevent AM hypoglycemia
Blood sugar Mild Moderate Aggressive Blood sugar Treatment

level mg/dL Thin, NPO, or Ave. weight On steroids or mg/dL
elderly and intake infected
< 60 4 oz OJ or 1 4 oz OJ or 1 4 oz OJ or 1 < 60 4 oz OJ or 1
amp D50. amp D50. amp D50. amp D50.
Check glucose Check glucose Check glucose Check glucose
q 15 q 15 q 15 q 15
mins.Notify mins.Notify mins.Notify mins.Notify
primary care primary care primary care primary care
provider provider provider provider
60-150 No insulin No insulin No insulin 60-150 No insulin

150-200 No insulin 3 units 4 units 150-200 No insulin
201-250 2 units 5 units 6 units 201-250 2 units
>400 Notify primary Notify primary Notify primary >400 Notify primary
care provider care provider care provider care provider
______________________________________________________________________________________
Additional Information: The nurse on the night shift reports that M.W.’s glucometer measurement
at HS was 185. He received 5 IU of Humulin R SC. The nurse documents that M.W. did not sleep well
during the night after admission. He was found wandering in the hall on two occasions and was
assisted to bed after urination of a small volume.
__________________________________________________________________________________
Answer the following comprehensively.
1. Rank the following actions the nurse should perform for priority care of this client.
_______ Obtain the VS.
_______ Provide the client breakfast.
_______ Check the capillary blood sugar via glucometer.
_______ Assist the client to the toilet.
_______ Prepare the morning medication
__________________________________________________________________________________
Situation: The client’s temperature is 98.2 F, PR is 68 bpm, RR is 16cpm. The nurse compares the
medication admission record with the supply of glyburide that is labeled 3 mg per tablet. M.W. eats
approximately ¾ of his breakfast. The capillary blood sugar measured 100 mg/dL. He voided 100 mL
dark, malodorous urine.
__________________________________________________________________________________
2. In relation to the current data, indicate the most appropriate nursing action.
_______ Withhold the glyburide due to a low blood sugar.
_______ Administer ½ tablet of the glyburide.
_______ Administer 1 ½ tablets of glyburide.
_______ Check the capillary blood sugar 30 minutes PC.
3. Based on the preceding information, the nurse adds what nursing diagnosis to the plan of
care?
4. Rank the potential etiologies for the client’s nursing diagnosis ( 1 is most likely and 4 is
least likely)
________ Hyperglycemia
________ Hypoglycemia
________ Urinary retention
________ Unfamiliarity with environment
5. M. W.’s night awakenings may be best determined by which diagnostic information?
________ Complete blood count
________ Doppler ultrasound of peripheral arteries
________ Glucose tolerance test
________ Urinalysis

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Republic of the Philippines

UNIVERSITY OF NORTHERN PHILIPPINES

CRITICAL THINKING EXERCISE NO.9

Blood sugar Mild Moderate Aggressive Blood sugar Treatment

60-150 No insulin No insulin No insulin 60-150 No insulin

Answer the following comprehensively.

5. M. W.’s night awakenings may be best determined by which diagnostic information?

________ Complete blood count

________ Doppler ultrasound of peripheral arteries

________ Glucose tolerance test

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