Diabetes interview prep 2.5.docx

**What is Diabetes?** When we eat our sugar levels get higher so our pancreas releases insulin and enzymes to break down the sugar to feed into the cells so we can be active. The cells gets sugar and potassium.As a results of this our blood sugar lowers in to a normal or balanced state. When we don...

**What is Diabetes?** When we eat our sugar levels get higher so our pancreas releases insulin and enzymes to break down the sugar to feed into the cells so we can be active. The cells gets sugar and potassium.As a results of this our blood sugar lowers in to a normal or balanced state. When we don't eat the pancreas releases a backup hormone name Glucagon , but it acts oppositely to insulin. Glucagon acts as a signal that tells our liver to release store Glycogen and turn it into Glucose when blood sugar is low.Glycogen is a stored form of Glucose , Glycogen is the tank that keeps the small pieces of Glucose inside to keep to use for extra fuel when your body needs it. Type 1 diabetic can be genetical or autoimmune , it occurs when the pancreas has been destroyed by the body and cannot produce no insulin or is barely producing any. Type 2 is based on our lifestyle such as diet and exercise routine , this occurs when the body is producing insulin but the cells are so overworked that they don't open easily so the sugars stays in the blood.Treatments are are diet and exercise changes and oral medication and sometime insulin injection. Gestesional occurs like type 2 and it goes away after birth. Pre diabetes means that you have a higher normal blood sugar level with life style changes it can be reversed but if let untreated it can lead to type 2. Peaks times must be monitor below the trust or ward score like 4 or 3 Blood glucose levels might need to monitored before meals and at bedtime or every 6 hours due to nutritional supplements. The target glucose is between 4mmol/L and 7mmol/L before eating and beetween 8-9 mmol/L after a meal A hypo is consider a score lower than 4mmol/L A hyperglycaemic episode done after fasting is over 7mmol/L that's a high level. And any other test done at any time over a 11mmol/L is a hyperglycaemic episode. **[Insulin]** Onset is when the insulin starts working Peak is the insulin is working the hardest to prevent hyperglycaemia Duration is when the insulin is out of patients system Rapid acting insulin the most common ones are Lispro, Novolog is normally giving in following a sliding scale. The the blood sugar levels need to be check 15 minutes before lunch or every six gours. If the blood glucose are high Novolog is administered. The onset of the rapid acting insuli like novolog is 30 mins the peak is 1-2 hours and the duration is 3-5 hours. Short acting insulin most common ones are actrapid and humilin also known as soluble insulin. The onset of this insulin is 30-60 minutes the peak is 3 hours and the duruation is 8 hours..So is taken before meals to stop your blood glucose levels from increasing when you eat carbohydrates. Intermediate acting also called isophane insulin or basal insulin insulin the most common ones are Humulin 1 and Insulatad.The onset is 1-2 hours , it peaks in 10 hours and the duration is 11 to 24 hours Long acting insulin has 3 different types of long acting insulin, detemir (Levemir,) , Glargine (Lantus), Degludec(Tresiba). Overnight insulin.The onset is (30-40 minutes).It doesn't peak for 18 hours and duration 24 hours hours. Complications; A Hyperglycaemic episode occurs when our blood glucose levels are to high. The main symptoms are excess urination,fatigue, excessive thirst and hunger the excess hunger symptom occurs when the cells are not getting enough sugar.The main causes of a hyperglycaemia episode are sepsis , stress from surgery ,skipping insulin doses and steroids. The treatment of the episode is to give a dose of insulin. [Long term problems:] From long-term blood sugar levels the blood gets turned into mud , and leads to the destruction and scars of the blood vessels and it also leads to more infection since bacteria loves sugar. Ultimately it will also leads to the destruction of all the organs.This can also lead to stroke due to narrow blood vessels which a burst from aneurysms or gets clots. It can also lead to diabetic ketoacidosis (DKA) and hyperglycaemic state (HHS). Nursing interventions - Check the patients glucose levels - Assess their symptoms - Do a test for DKA - If prescribe provide a fast acting insulin like novarapid to help bring down the glucose levels as per the patient's sliding scare protocol. Check back in 3o mins to see the effects of the insulin. - Provide IV fluids, potassium supplements or insulin therapy if critical. These will help to resuscitate the fluids lost and to replace electrolytes that been lost. Encourage fluid intake if the patients is conscious with water. - Evaluate the patients pump if they have one for any malfunction ,leakage or dislodgment. - Continue to monitor the patient for any additional symptoms or complications. - Document the episode on Hive and the interventions that have been done and the patients' symptoms. So all the other member of the patients MDT team can view it. A Hypoglycaemic episode occurs when our blood glucose levels are low which can lead to rapid brain death. The symptoms are sweating or clammy , cool pale skin, irritability , hunger , lack of coordination and sleepiness. The main treatments are to give them Lift which is a glucose liquid(Glucojuice) Glucose tablets or Glucogel, other treatments include food with sugars such as fruit juice or low fat milk. If the patients is asleep we administer or nonresponse a glucagon or glucose intravenous infusion should be given. And with patients who are alcoholic a thiamine supplements should be given. The main causes of a Hypo episode are exercise , alcohol or insulin peak times. Complications Long term complications are increased her related conditions , eye disease , problems with the blood vessels or kidney disease. Nursing Interventions Conscious Patients and able to swallow; - Provide the patient with fast acting carbohydrates like glucose tablets , or a sugary drink like Lift Glucojuice or pure fruit juice. - Recheck blood glucose levels after 10-15 minutes - If the blood glucose levels remain the lower or if the symptoms persist then I would repeat the treatment Non Conscious Patients or Confused or unable to swallow: - I would administer glucagon via IM injection or If the glucagon was not available I would administered and IV infusion of 10% or 20% of glucose. And with patients who were alcoholic I would administer a thiamine supplement with or following the IV glucose. - After 10-15 minutes I would reached the patient's blood glucose levels until they are above 4mmol/l. - If the patient is bale to regain consciousness a long acting carbohydrate should be given to the patient immediately to help their body recover and to help replenish their glycogen stores.such as milk or a slice of bread or a two digestive biscuits. - I would then investigate the underlying issue that lead to hypoglycaemic episode like reviewing their medication or insulin doses or investigate if they missed any meals or forgot to do exercise. - Then I would document the time and symptoms , the blood glucose levels and the interventions provided to help stop the hypoglycaemic episode. - I would then educate the patients to recognize any early signs of hypoglycaemia and teach the importance of regular meals. Diabetic Ketoacidosis (DKA) occurs when there is a severe insulin deficiency, without insulin the glucose can't enter the cells to provide energy. So the body starts to break down fat for energy which produces ketones which are acidic and they can lead to build up in the blood. The liver process fat into a fuel called ketones which causes the blood to become acidic that's why it is called ketoacidosis. This could be caused by missed insulin doses , infections (Sepsis) or illness It is more common in people with type 1 diabetis. The key symptoms are - deep , rapid breathing (to get rid of the excess acid), - fruity-smelling breath (due to ketones), - nausea ,vomiting , stomach pain - Extreme thirst , frequent urination - Confusion and drowsiness (as the acidosis worsens) Severe DKA can lead to confusion or agitation and in rare cases cerebral edema. Nursing interventions - I would assess the severity of the DKA by checking the patients blood Glucose levels , I would test for ketones in the urine, Do a set of observations - Blood gas analysis , Monitor potassium levels. - Start on IV of saline after some litters of saline I then after would switch and start them on 5% glucose with saline. To avoid hypoglycemia but also to continue with help dehydration and replenish electrolytes. The goal is to replace half of the estimated water and sodium lost over the period of 12-24 hours. - Start them on IV insulin therapy depending on the severity, I would use a short acting insulin.The insulin rate that would be given hourly would changed depending on the changing blood glucose level readings. - Check renal function - Maintain acid -base imbalance by monitoring the level of acidosis - Check for the underlying issue such as infection or any other complications.I would do blood cultures , urine samples and chest x-rays. If infection was detacted I would comminucate this to the doctor to prescribe antibiotics to admister. Hyperglycaemic Hyperosmolar State (HSS) Occurs when the body is resistant to using glucose through insulin.Which means the glucose is not absorbed by the cells so it stays in the blood which increases the blood glucose levels.Natuarally the water will naturally move from the area of low concentration to an are high solute concentration to balance things out. So water inside the cells will gradually move into the bloodstream to to balance things out it is called the osmotic effect. When the water leaves the cells and enter the blood it cause cellular dehydration. In order to get rid of the excess glucose the kidneys try to get rid of it via urine which also leads to a significant water loss and other electrolytes like sodium which makes the dehydration worse And the blood becomes very concentrated which cause hyperosmolarity which causes water to be pulled out of the cells and into the bloodstream which leads to cell dehydration. There is some insulin present which makes it different to DKA where there is almost none and it doesn't have to break down fats to turn into ketones. The symptoms are - extreme high blood glucose levels greater than 33mmol/L , - severe dehydration - significally increase of different solutes in the plasma which is making it thicker and concentrated - Fever , fatigue - Confusion.. The common causes are infections, heart attack ,stroke other acute illness, medications like steroids and diuretics, dehydration or missed doses of insulin. Nursing Interventions; The goal is to reduce the blood glucose levels and to rehydrate without causing a rapid shifts that could lead to cerebral edema. If suspected :. - Check their previous blood test to check their serum sodium levels, their potassium levels , the concentration of solutes in the blood - Asses the patient their neurological status - I would check the patient blood glucose levels. - Then I would do a set of observations - I would assess their input and output during the past few days to check for signs of dehydration - I would notify the doctor right away so he can prescribe IV fluids Then I would commence an IV of 0.9% saline 1L for over an hour also taking into consideration the patient systolic blood pressure.In order to help with fluid deficit. -. I would check the patient blood glucose levels hourly and blood gas - I would start a low molecular weight heparin to prevent blood clots or arterial thrombosis - I f I suspect sepsis I will also consider administering IV antibiotics. - If the levels of sodium were to keep increasing but the osmolality I would continue with the 0.9% of saline but if the osmolality is not dropping fast enough I would increase the fluid rate or switch to 0.45% saline. - If necessary I will start insulin if the blood glucose were to not decrease with the fluids alone or if they were a significant ketonemia would start with a lose dose insulin infusion to help lower the blood sugar. - Firstly I would assess the patient symptoms , assess their mental state then - I would check their blood glucose levels - Do a set of observations - I would explain to the nurse in chage as well the ongoing situations and the planned intervations.And inform the doctor in charge to prescribe the IVs - Then I would start the patient on a an IV of 0.9% saline 1L for over an hour also taking into consideration the patient systolic blood pressure.In order to help with fluid deficit. - I would send blood samples and blood cultures to the lab.. - I would catharize the patient or get a nurse who is signed off to do it so I can track the patients output. I would also look back on their intake chart to check for any signs of dehydration. - If the sepsis were to be confirmed I would administered IV antibiotics. - During the process I would continuously check the patients blood glucose levels and electrolytes via venous blood gas.And documenting any changes on HIVE and communicating the doctor and the nurse in charge. - If required once prescribed by the doctor I would start an insulin infusion via to bring down the blood glucose levels gradually. I would administer the IV insulin therapy to the patient via **NMC Code :** Care, Compassion, Commitment, Courage ,Competence and communication **About me :** Tell us about yourself ? Hi name is Precious I graduated from the university of Manchester in December 2023. I would describe myself as empathetic and passionate individual , with strong sense of commitment to care for others. These traits helped realise that I wanted to go into nursing I want to make people feel supported and that their voices were heard during these vulnerable and hard moments. Outside of nursing what are your interest ? Well I often read , go to the gym , **[Interview questions]** [Nursing Based questions;] Why do you want to be a nurse ?, An example where I demonstrate effective communication? What was a time you went above and beyond ? This was during one of my shifts on a general ward , I had went in to do the patients observations and to check if the patient was alright. I noticed she was quite upset so I actively listen to her and she expressed she had been trying to ger hair washed for quite some time and that she had multiple people but with the ward being quite busy no had had chance to help , she was feeling quite insecure regarding to her hair since it had been a few days since she had washed it due to her arm being on a cast she had felt like a burden. So I reassured an told her that she was not burden and that she mattered just as much as any other patient in this ward. I told her that if she was comfortable I would help her washed her hair in the shower once I completed my observations and communicated it to the nurse I was working with. describe how I wash her hair and styled it and how it brought a smile to her face. How do you resolve conflict or do you manage a frustrated patient? Patient feeling trap in the ward ( or patient refusing to take medication ) The first thing I would do is remain calm and composed. Then I would give them my full attention and listen to the patient concerns and letting them express their felling's. I would acknowledge their feeling and reassure them ,and express that are taken seriously that their concerns. Then I would provide them with the relevant information to clarify the situation. Then I would offer solutions that can lead us to positive outcomes. I would remain professional and emphasis the trust commitment to their wellbeing and care. What are your strengths and weaknesses? **[Strengths;]** I would say a strength of mine is my flexibility and ability to adapt to different environment. **[Weakness;]** Lack of experience , however I am strongly motivated to learn and I am receptive any feedback I reserve I am confident that with the skills I develop from three years as a student nurse and combined with skills and knowledge from tris role can help me overcome this weakness. How would you make a addition into this ward and what skills would you bring? I bring a solid understanding of diabetes care, particularly in managing blood glucose levels and wound care. During my community placement, I gained valuable experience in caring for diabetic foot ulcers and treating necrotic wounds, which deepened my clinical skills. I\'m also confident in educating patients, helping them understand their diagnosis and supporting them in making necessary lifestyle adjustments. I believe that I emphasize empathy, patience, and clear communication to ensure my patients feel heard and supported. My attention to detail helps me work effectively within the team, allowing us to provide safe, high-quality care while maintaining a positive work environment. What sets you apart from the other candidates? Why do you want to work with our organisation ? I would say with the extended researched I discovered that Northern Care alliance focuses on creating a very supporting environment and collaborative work environment where nurses are valued and empowered to contribute decision making.The trust commitment to managing chronic diseases such as diabetes provides several opportunities for multidisciplinary collaboration. What do you known about our diabetes care program? The norther care alliance offers a diabetes care program that peaked my interest because the trust offers comprehensive services for both hospital and community settings. For example the trust manages acute diabetes emergencies such as dka and hhs during patients hospital stays for other conidiations. What do you know about diabetes? I know that diabetes is an chronic disease that affects 4.4 million people.I know that it can occur when the body can't not produce enough insulin or can't use the insulin that is made properly. The most common types of diabetes are Type 1 where the pancreas is not producing any insulin or enough insulin so the sugar stays in the blood it can be hereditary or it can be caused by a virus that trigger the immune system. Type 2 occurs when the doesn't produce insulin or the body cells are to overworked to respond to insulin which prevents the glucose from entering the cells which causes build of sugar in the blood. This occurs due to diet , exercise , hormonal imbalance like PCOS and it can also be hereditary. There is also gestational diabetes which can occur when the body can't make enough insulin during pregnancy. It usually goes away after birth. What your experiences with diabetes nursing? During placement with diabetes and endocrine specialised nursing had allot of time to learn about the outpatient aspect of the treatment of diabetes via the devices to monitor their blood glucose levels. I also learned about the controversy how not allot of people were promoting libre 2 sensors since allot had been recalled due to false readings so allot of patients who came to the clinic had to have new ones installed. How do you maintain confidentiality? I would maintain confidentiality by assuring that physical records are stored in a locked cabinet where only authorized members can access. I when assessing electronic records like HIVE I would make sure to use my log in a never share my password , and always log out of after use to prevent any unauthorized access into the patient information. When discussing information about the patient with the other members of the MDT team I would have this private conversations in an area that it couldn't be overheard.The same with discussing information with the patient that's is sensitive or intimate I would have these discussions in a private room or make sure that curtains where drawn. [Scenario questions;] How would you manage diabetes? What do you think are the main responsibilities of a diabetes nurse? The responsibilities of a diabetes nurse are blood glucose monitoring , insulin administration, management of complications, patient educations, medications management, wound care, MDT collaborations, offer emotional support and maintaining accurate and through patient records. - To monitor the patient blood glucose with regular checks and insulin administration and any side effects. - To manage any complication that would arise such as hyperosmolar hyperglycaemic state , or diabetic ketoacidosis and prompting out nursing intervention in order to treat them early on. - I would have to educate patients on lifestyle changes , recognizing signs of a hypo or hyperglycaemia and foot care to avoid ulcers. - Performing wound care and - To work and collaborate with , dieticians, ,psychologist podiatrist ,diabetes specialist and social workers to create an person cantered care plans. - To Maintain accurate patients records for example blood glucose levels or insulin administration. - And finally to offer emotional support for the patient and their family members diabetes can be very emotional challenging. How would you manage a hypoglycaemic episode? If the patient was conscious and able to swallow I would provide them with a fast acting carbohydrates like Glucojuice. Then I would recheck their blood glucose levels after 10-15 mins If the levels have not increased then I would repeat the treatment once more this time with glucose tablets. Non Conscious Patients or Confused or unable to swallow: - I would administer glucagon via IM injection or If the glucagon was not available I would administer and IV infusion of 10% or 20% of glucose. And with patients who were alcoholic I would administer a thiamine supplement with or following the IV glucose. - After 10-15 minutes I would re checked the patient's blood glucose levels until they are above 4mmol/l. - If the patient is bale to regain consciousness a long acting carbohydrate should be given to the patient immediately to help their body recover and to help replenish their glycogen stores.such as milk or a slice of bread or a two digestive biscuits. - I would then investigate the underlying issue that lead to hypoglycaemic episode like reviewing their medication or insulin doses or investigate if they missed any meals or forgot to do exercise. - Then I would document the time and symptoms , the blood glucose levels and the interventions provided to help stop the hypoglycaemic episode. - And lastly I would then educate the patients to recognize any early signs of hypoglycaemia and teach the importance of their regular meals. How do you manage hyperglycaemia episode? Firstly I Would - Check the patients glucose levels - Assess their symptoms - Test their urine for DKA - When prescribed I would provide a fast acting insulin like novarapid to help bring down the glucose levels as per the patient's sliding scare protocol. Check back in 3o mins to see the effects of the insulin. - Provide IV fluids, potassium supplements or insulin therapy if critical. These will help to resuscitate the fluids lost and to replace electrolytes that been lost. Encourage fluid intake if the patients is conscious with water. - Evaluate the patients pump if they have one for any malfunction ,leakage or dislodgment. - Continue to monitor the patient for any additional symptoms or complications. - Document the episode on Hive and the interventions that have been done and the patients' symptoms. So all the other member of the patients MDT team can view it. How would you manage a diabetic ketosis episode (DKA)? Nursing interventions - I would assess the severity of the DKA by checking the patients blood Glucose levels , I would test for ketones in the urine, Do a set of observations - Blood gas analysis , Monitor potassium levels. - Start on IV of saline after some hours I would then switch and start them on 5% glucose with saline. To avoid hypoglycaemia but also to continue with help dehydration and replenish electrolytes. The goal is to replace half of the estimated water and sodium lost over the period of 12-24 hours. - Then I would Start them on IV insulin therapy depending on the severity, I would use a short acting insulin.The insulin rate that would be given hourly would changed depending on the changing blood glucose level readings. - Check renal function - Maintain acid -base imbalance by monitoring the level of acidosis - Check for the underlying issue such as infection or any other complications. I would do blood cultures , urine samples and chest x-rays. If infection was detected I would communicate this to the doctor to prescribe antibiotics to administer. How do you manage Hyperosmolar hyperglycaemic state (HSS)? If suspected hhs the first I would do is - Check the patient blood glucose levels - Do set of observations - Assess the patient symptoms and their neurological status - I would do a blood gas analysis to measure the patients electrolytes (including potassium)and blood pH and gases in real time - Do a set of blood cultures and blood samples and send them to the lab.To check for any signs of infection or any other underlying complications. - While wating for the results to prevent further fluid loss I would notify the doctor of the patient current stage and to get them to prescribe a 0.9% saline IV fluids and a insulin infusion to get started. - I would also monitor the patient input and output chart and create a plan. - Based on the continuous blood glucose levels I would administer a insulin infusion to help bring down the blood glucose levels. - I would be continuously be monitoring the patient blood glucose levels , potassium levels , serum osmolality and input and output to avoid complications such as hypokalaemia or hyperkalaemia, fluid overload , cerebral oedema and DVT hourly. - I would remember to maintain the patient comfort and mobility and regular checks on the foot and skin - Document any interventions and communicate with the other members of the mdt to ensure the treatment plan needs to be changed What would you do if you see that a patient has develop a foot ulcer? If I were to discover that the patient had develop a foot ulcer the first thing - Examine the wounds colour ,odour, size depth, signs of infection or necrosis , redness, bone visibility , discharge or and location of the ulcer. I would then categorize the ulcer using the Wagner scale. To help determine the appropriate care plan for the patient - I would also inspect the skin surrounding the wound for any maceration. - After this I would take a picture of the wound and document its characteristics. - Following infection control policy I provide wound care by cleaning the wound with saline and applying a dressing. Also while doing the dressings I would check for any signs of infection such as warmth , redness or pus. - I would then relive pressure of the area by lifting it with pillows and wedges. - I would create a reposition plan to prevent further trauma to the ulcer or pressure. - I would also do a referral for the podiatrist if necessary, then I would document any interventions that applied. - Finally I would continue to monitor the ulcer for any changes in size , signs of infection and the signs of healing. And continue to monitor the patient blood glucose levels. How would you deal with challenges? How would you deal a patient family member who is unhappy with your care? Active listening to the patient or family members concerns without any interruptions. I would acknowledge their feelings and reassure them that concerns are taken seriously. After actively listening and reassuring them I would provide them with a clear actionable solution.If while listening to my solution they unhappy with the care I would explain to them steps being taken to address the issue and involve the nurse in charge if necessary. I would also be honest about the limitations while explaining to the patient or family member that certain decisions are made. After addressing their concern I would check in with patient or family member later on to make sure they felt satisfied with the resolution., How would you ensure that you complete all your task in a busy shift? How do you ensure that you complete all your tasks during a busy shift? Answer: To manage my time effectively, - I start by reviewing the handover notes and patient care plans at the beginning of my shift. This allows me to prioritize the most urgent tasks and create a mental or written checklist. - I also check in with my team to identify any potential bottlenecks or areas where we might need extra support. Throughout the shift, I regularly reassess the situation and reprioritize if necessary, ensuring that critical tasks such as medication administration or patient assessments are completed on time. - Additionally, I make use of electronic documentation to streamline charting and avoid duplication of effort How would you handle a situation where there is an emergency, but you still have other patients who have medications due or have observations due ? What would you do if you gave the patient the wrong dose or has an allergic reaction? - Firstly stop any treatment ensure the patient is okay , - Determine the severity of the allergic reaction check for any rash , itching , difficult breathing or swelling. - If severe administer emergency medications such as antihistamines - Do set of observations. Prepare oxygen or any other intervention if needed. - Check blood glucose leevls - Notify the nurse in charge and the doctors - Document the incident - If the patient has an insulin due withhold the insulin for now until the allergic reaction is under control - Coordinate and communicate with the doctor to adjust the insulin if necessary and document any changes A patient refuses insulin because they're afraid of needles. How do you handle this? - Demonstrate empathy by acknowledging their fear, explaining the importance of insulin, and offering alternative options like insulin pens or education on needle use to ease anxiety. Can you describe a situation where you had to deal with a rapidly changing workload? How did you maintain quality care for all patients? During a particularly busy shift, we admitted several new patients who needed immediate care. As a student nurse, I couldn't take on the most urgent cases, but I helped with the smaller ones that the experienced nurses trusted me with. I quickly assessed and triaged patients, supported my colleagues by handling less critical cases, and kept open communication with the team. By working together and staying flexible, we managed the heavy workload and ensured high-quality care for everyone. What happens if patients is scoring or has symptoms of sepsis? I would firstly stop what treatment they are undergoing , do a set observations, followed up by a set of bloods including cbc , blood cultures , lactate levels. After this I would inform both the nurse in charge and I would inform the doctor in charge of the patient so they can prescribe some antibiotics while waiting for the resilts of blood cultures.I would start on a set of Iv fluids. If they a line in situ I would probably take some samples and send it to the lab. What happens if a patient has a severe reaction to treatment? The first thing I would do is to assess the patient and the severity of the reaction then I would stop any ongoing treatment to prevent further exposure. If the patient is experiencing a severe reaction I would administer emergency medication like an EpiPen or adrenalin.If the patient is wheezing I would provide them with oxygen , I would inform the nurse in charge and doctor and provide the with the specific treatment , the starting time and the patient current state. I would do a set of obvs , provide them with further support such as intravenous fluids or antihistamines. I would document the incident and continue to monitor. **Questions for them :** Can you provide with a. bit more information regarding the preceptorship programme? What the opportunities for professional development and advancement does this unit offer? How does this unit promote diversity , equality and inclusion?