NURS 1027 Test 3 Review PDF

lOMoARcPSD|31047557 NURS 1027 TEST 3 Review Nursing Theory for Practical Nurses II (George Brown College) Scan to open on Studocu Studocu is not sponsored or endorsed by any college or university...

lOMoARcPSD|31047557 NURS 1027 TEST 3 Review Nursing Theory for Practical Nurses II (George Brown College) Scan to open on Studocu Studocu is not sponsored or endorsed by any college or university Downloaded by athraa emad ([email protected])  lOMoARcPSD|31047557 Respiratory Conditions Pulmonary Edema  Occurs acutely as a result of HF  Manifestations o Respiratory distress o Air hunger o Central cyanosis o Agitated and anxious o Frothy and blood tinged sputum o Confusion o Orthopnea o Inability to speak in full sentences Nursing Assessment & diagnostic investigation  Respiratory assessment-includes?  Fluid balance  Chest x-ray  Peripheral edema  Vital signs  LOC  Precipitating factors Nursing Diagnosis o Excess fluid volume  Tissue perfusion, pulmonary  Ineffective breathing pattern  Impaired gas exchange Medications  Lasix Downloaded by athraa emad ([email protected])  lOMoARcPSD|31047557  Inotropes to improve contractility and when clients can’t tolerate reduction in BP  Vasodilators: Nitroglycerine  Oxygen therapy  Morphine Nursing Interventions  Monitor pulse oximetry, resp (rate, rhythm, depth, and effort)  Auscultate breath sounds  Administer oxygen  High fowlers  Monitor weight; I/O (catheterize)  Vital signs and ECG  Administer medications, monitor results Pneumonia  Who is at risk: o aging, chronic diseases, air pollution, altered consciousness, inhalation or aspiration of noxious substances, immuno- suppressed drugs, prolonged immobility, smoking, URTIs Manifestations of pneumonia  High fever, chills, diaphoresis  Chest discomfort  Nonproductive cough  Nausea and vomiting  Crackles on auscultation  Dyspnea, tachypnea, orthopnea  O2 sat may be normal or low  lethargy, changes in mental status  Other: headache, myalgia, nasal congestion, sore throat, dehydration  Severe cases: flushed cheeks, central cyanosis of lips and nail beds Downloaded by athraa emad ([email protected])  lOMoARcPSD|31047557 Diagnostic Tests  History  Physical examination  Chest x-ray  Sputum culture and sensitivity  Gram stain of sputum  Pulse oximetry or ABGs Complications of Pneumonia  Unresolved pneumonia  Respiratory failure  Pleural effusion  Confusion  Sepsis/ shock  Atelectasis  Death Collaborative Care  Antibiotic therapy  Oxygen for hypoxemia  Analgesics for chest pain  Antipyretics  Activity is restricted and rest encouraged Nursing Diagnosis: Pneumonia  Ineffective breathing pattern related to?  Ineffective airway clearance  Acute pain (chest)  Imbalanced nutrition: less than body requirements  Activity intolerance Planning Downloaded by athraa emad ([email protected])  lOMoARcPSD|31047557  Clear breath sounds  Normal breathing patterns  No signs of hypoxia  Normal chest x-ray  No complications related to pneumonia Pneumonia Management  Antibiotics based on the organism identified Supportive treatment:  Teach nutrition, hygiene, rest, regular exercise to maintain natural resistance o Hydration (2-3 L/ day, unless contraindicated) o Bedrest may be needed until infection begins to clear o Oxygen therapy  Strict asepsis o Other medications: antipyretics, antihistamines, nasal decongestants, etc o Pneumococcal vaccine for high-risk groups for prevention  In severe cases: o endotracheal intubation, mechanical ventilation Pneumonia – Nursing Interventions  Monitor resp and O2 Sats status  Auscultate breath sounds  Humidification may be used to loosen secretions, by face mask or with oxygen  Coughing techniques  Position to maximize resp efforts  Chest physiotherapy Asthma  Chronic inflammatory disease of the airways Downloaded by athraa emad ([email protected])  lOMoARcPSD|31047557  Onset and occurrence at any age  Inflammation leads to airway resistance and obstruction  Acute episodes last minutes, hours to days with symptom-free periods in between  Attacks often occur at night or early morning  Attacks triggered by allergens, activity, respiratory infections Triggers of asthma Allergens  May be seasonal or year-round, depending on exposure to allergen o House dust mites; cockroaches; furry animals; pollens; molds  Can trigger asthma attacks o Cigarette or wood smoke; Vehicle exhaust; Diesel particulate; Elevated ozone levels; Sulphur dioxide; Nitrogen dioxide Diagnostic Studies  Detailed history and physical exam  Pulmonary function tests  Chest x-ray  ABGs  Oximetry  Allergy testing Diagnostic Tests- Pulmonary Function Tests  Measures how well the lungs take in and exhale air and how efficiently they transfer oxygen into the blood.  Used to diagnose obstructive lung diseases (asthma, COPD).  Records the amount and the rate of air that is breathed in and out over a specified time.  Some of the test measurements are obtained by normal, quiet breathing, and other tests require forced inhalation or exhalation after a deep breath. Medication Used For Asthma Downloaded by athraa emad ([email protected])  lOMoARcPSD|31047557 Two Categories 1. Relievers (quick-relief/short acting)  Short –Acting B2 Adrenergic Agonists (Salbutamol, Ventolin) 2. Controllers (Maintenance Therapy)  Long acting beta2 agonists (Salmeterol) combinations  Anti-inflammatory Agents (Cortef)  Leukotriene receptor antagonists  Anticholinergic (atrovent) Nebulizers vs MDI Nursing Management- Nursing Assessment  Health history o Especially of precipitating factors and medications  ABGs  Lung function tests  Physical examination o Use of accessory muscles o Diaphoresis, Cyanosis, Lung sounds Nursing Diagnosis- Planning Overall Goals o Participate in activities of normal life (including exercise and other physical activity) with little to no interference. o Normal or near-normal pulmonary function o Have the asthma under control. o Few or no adverse effects o Adequate knowledge to participate in and carry out management Nursing Interventions  Assist client to identify factors that trigger attacks  History- family, work, environment Downloaded by athraa emad ([email protected])  lOMoARcPSD|31047557  Medication history and compliance  Positioning, planning, DB&C  Monitor respiratory status for progression/resolution o Breath sounds o Vital signs o Dyspnea o Administer O2 & medications if needed Promote airway clearance: o Administer medications as prescribed (such as?), monitor response o Administer fluids o Assist with intubation and respiratory support if needed Minimizing anxiety: o Maintain a calm approach o Keep patient informed about procedures o Check-in frequently o Call bell in reach o Allow family to sit with patient  Health teaching: o Asthma as a chronic inflammatory disease o Definition of inflammation and bronchoconstriction o Purpose and action medication(s) o Proper breathing o How to perform peak flow monitoring Peak flow results Green Zone  Usually 80% to 100% of personal best  Remain on medications. Downloaded by athraa emad ([email protected])  lOMoARcPSD|31047557 Yellow Zone  Usually 50% (60%) to 79% of personal best  Indicates caution  Something is triggering asthma. Red Zone  56% to 60% or less of personal best  Indicates serious problem  Definitive action must be taken with health care provider. COPD A disease state characterized by airflow limitation, preventable, manageable but progressive Risk Factors: o Tobacco smoke (active or passive) causes 80-90% of COPD o Air pollution o Occupational exposure (coal, cotton, grain) o Infections, heredity, and aging Chronic Bronchitis Manifestations: o Presence of a cough/sputum production for at least 3 months o Cough may worsens in cold, damp weather, or in presence of irritants o History of smoking, frequent respiratory infections Emphysema A chronic, end stage lung disease, usually caused by smoking.  Abnormal distention of air spaces and alveoli  Signs and symptoms o Shortness of breath o Barrel-shaped chest Downloaded by athraa emad ([email protected])  lOMoARcPSD|31047557 o Wheezing o Fatigue o Weight loss COPD Manifestations  3 primary symptoms: cough, sputum production and dyspnea on exertion  Cough and sputum often precede airflow obstruction  Barrel chest  Accessory muscles Clinical Manifestations  Develops slowly  Diagnosis is considered with o cough. o sputum production. o dyspnea. o exposure to risk factors.  Dyspnea usually prompts medical attention. o Occurs with exertion in early stages o Present at rest with advanced disease  Causes chest breathing o Use of accessory and intercostal muscles o Inefficient  Characteristically underweight with adequate caloric intake  Anorexia  Chronic fatigue Physical examination findings o Prolonged expiratory phase o Wheezes Downloaded by athraa emad ([email protected])  lOMoARcPSD|31047557 o Decreased breath sounds o ↑ Anterior–posterior diameter  Bluish-red colour of skin o Polycythemia and cyanosis Classification Classified as o Mild o Moderate o Severe o Very severe Complications  Cor pulmonale  Exacerbations of COPD  Acute respiratory failure  Peptic ulcer disease  Depression/anxiety Diagnostic Tests  PFT’s: spirometry FEV & FVC , etc.  Arterial blood gases o Low PaO2 o ↑ PaCO2 o ↓ pH o ↑ Bicarbonate level found in late stages of COPD  CXR/CT maybe used  Walk test (6 min.) to determine O2 desaturation in the blood with exercise  ECG can show signs of right ventricular failure COPD Management Downloaded by athraa emad ([email protected])  lOMoARcPSD|31047557  Smoking cessation!!!  Medications: bronchodilators, corticosteroids,  Oxygen therapy  Treatment tailored to disease  Surgery: o Lung volume reduction to improve elasticity and function o Lung transplant Nursing Diagnosis  Ineffective airway clearance  Impaired gas exchange  Imbalanced nutrition: less than body requirements  Disturbed sleep pattern  Risk of infection Planning a. Prevention of disease progression 2. Ability to perform ADLs 3. Relief from breathlessness and other respiratory symptoms 4. Improvement in exercise tolerance and nutrition 5. Prevention and treatment of exacerbations 6. Improved overall quality of life 7. Reduction in premature mortality Interventions  Positioning  Monitor resp and O2 sats  Breathing exercises  Activity pacing/Physical conditioning  Self-care activities Downloaded by athraa emad ([email protected])  lOMoARcPSD|31047557  Oxygen therapy/humidifier  Hydration/Nutrition  Education (smoking cessation/Medication(s)  Coping Breathing Techniques Pursed lip breathing  Helps person to remain calm during SOB  Helps prevent/reduce trapped air in lungs and inhale more fresh air (promote carbon dioxide elimination) o Inhale through nose slowly with mouth closed (like smelling a flower) o Exhale through mouth with pursed lips (lips in a whistle/kissing/blowing candle out position) o Exhale twice as long as inhale (2 seconds in, 4 seconds out) o Continue until SOB resolved Diaphragmic Breathing  With COPD the diaphragm does very little work in breathing  This pattern helps calm SOB by helping to prevent/reduce trapped air in lungs & inhale more fresh air  This technique aids in use of 02  One hand on upper chest & other on abdomen just above waist  Relax shoulders & neck  Breath in through nose let abdomen come out as far as it will Nutritional Therapy o Weight loss and malnutrition are common among those with COPD. o Rest (30 min.) before eating o Use a bronchodilator before meals. Downloaded by athraa emad ([email protected])  lOMoARcPSD|31047557 o 5–6 small meals a day o High-calorie, high-protein diet o 2–3 L fluid intake per day, taken between meals o Cold foods may cause less fullness than hot foods o Avoid: Foods that require a great deal of chewing  Exercises and treatments 1 hour before and after eating  Gas-forming foods Tuberculosis Etiology and pathophysiology  Spread via airborne droplets when infected person o Coughs o Speaks o Sneezes o Sings  Organisms are dispersed in room and can be inhaled.  Brief exposure rarely causes infection.  Transmission usually requires close, frequent, or prolonged exposure.  Cannot be spread by hands, books, glasses, dishes, or other fomites.  Inhaled bacilli pass down bronchial system and implant themselves on bronchioles or alveoli.  Multiply with no initial resistance.  Replicates slowly and spreads via the lymphatic system Clinical Manifestations  Insidious  Low grade fever, night sweats, fatigue, weight loss Diagnostic Studies  TB skin test, CXR  Bacteriological studies Downloaded by athraa emad ([email protected])  lOMoARcPSD|31047557 o Stained sputum smears examined for acid-fast bacilli} Required for diagnosis o QuantiFERON-TB (QFT)  Rapid blood test (few hours)  Does not replace cultures  Reported to public health  Contact with others, immunocompromised, substance abuse Nursing Assessment  Assess for o Productive cough o Night sweats o Afternoon temperature elevation o Weight loss o Pleuritic chest pain o Crackles over apices of lungs Nursing Diagnosis o Ineffective airway clearance related to copious excessive mucus, retained secretions  Risk of infection (of others) as evidenced by insufficient knowledge to avoid exposure to pathogens  Ineffective health management r/t insufficient knowledge of therapeutic regimen, insufficient support Planning  Goals o Comply with therapeutic regimen. o Have no recurrence of disease. o Have normal pulmonary function. o Take appropriate measures to prevent spread of disease.  Comply with the therapeutic regimen Downloaded by athraa emad ([email protected])  lOMoARcPSD|31047557  No reoccurrence of disease  Have normal pulmonary function  Take appropriate measures to prevent the spread of the disease Nursing Implementation  Health Promotion  Ultimate goal in Canada is eradication o Selective screening programs in high-risk groups to detect TB o Identify contacts of patient with TB  Acute intervention o Airborne isolation o Receive 4 drug therapy o Immediate medical workup  Teach client o Cover nose and mouth with tissue when coughing, sneezing, or producing sputum o Handwashing after handling sputum-soiled tissues  Ambulatory and home care o Ensure that patient can adhere to treatment. o Teach symptoms of recurrence. Evaluation  Expected outcomes o Complete resolution of disease o Normal pulmonary function o Absence of any complications o No transmission of TB Pneumothorax  Occurs when air enters the pleural space Downloaded by athraa emad ([email protected])  lOMoARcPSD|31047557  May be due underlying disease (bleb in COPD) or a wound in chest wall (surgery, trauma, procedures)  Tension pneumothorax is a life-threatening complication Pneumothorax: Manifestations  Degree depends on size and cause of pneumothorax o Sudden pleuritic pain o Dyspnea o Tachypnea, tachycardia o Anxiety o Air hunger/ respiratory distress o Accessory muscle use o Decreased or absent breath sounds o Altered chest wall movement Collaborative Care  Depends on cause/severity  Goal is to remove air from pleural space  Aspiration of pleural space  Chest tube with drainage device connected suction and with a water seal  Oxygen as needed  Pain management  Antibiotics if required Pneumothorax: Manifestations  Degree depends on size and cause of pneumothorax o Sudden pleuritic pain o Dyspnea o Tachypnea, tachycardia o Anxiety Downloaded by athraa emad ([email protected])  lOMoARcPSD|31047557 o Air hunger/ respiratory distress o Accessory muscle use o Decreased or absent breath sounds o Altered chest wall movement Chest Tubes  Tube inserted between ribs into pleural space  Attached to water-sealed drainage system to remove extra air or fluid from pleural space using negative pressure  May be connected to suction if ordered  Daily CXR required Obesity and Care of the Bariatric Client Manifests as an abnormal increase in the proportion of fat cells  Primarily occurs in the visceral and subcutaneous tissues of the body Complex interaction of genetic, nutritional, physiological, psychological, behavioural, environmental, and social factors that create imbalance between energy expenditure and energy intake increasing evidence that obesity is not a problem resulting from a lack of willpower and self-control but, instead, is a pervasive, progressive, and serious chronic condition that is strongly associated with a variety of comorbid conditions and has a major effect on the physical, mental, social, cultural, and economic health of those affected. Classifications of body weight and obesity  Primary or secondary obesity  Excess caloric intake for the body’s metabolic demands (primary obesity)  Results from various congenital anomalies, chromosomal anomalies, metabolic problems, or CNS lesions and disorders (2 nd Obesity)  Body mass index (BMI)  Degree to which a client is classified as underweight, healthy (normal) weight, overweight, or obese  Common clinical index of obesity or altered body fat distributio Downloaded by athraa emad ([email protected])  lOMoARcPSD|31047557  BMI of 30–40 kg/m2 classified as obese  BMI of more than 40 kg/m2 classified as morbidly obese  Waist circumference  Hip circumference  Waist-to-hip ratio (WHR)  Less than 0.80 is optimal Body Shape  Android obesity: Apple  Gynoid obesity: Pear  Genetics play an important role in determining body fat distribution patterns. Etiology  Genetic–biological basis  Environmental factors, Psychosocial factors  Energy intake exceeds energy output.  Processes leading to obesity are much more complex and still undergoing investigation.  Causes of obesity involve significant genetic–biological susceptibility factors highly influenced by environmental and psychosocial factors Health Risks Associated with Obesity  Cardiovascular problems  Respiratory problems  Diabetes mellitus  Gastrointestinal and liver problems  Psychosocial issues Nursing and Conservative Collaborative Management: Obese Clients Nursing assessment Client may withhold information out of embarrassment or shyness Provide acceptable reasons to client for personally intrusive questions Respond to concerns about diagnostic tests Interpret outcomes Downloaded by athraa emad ([email protected])  lOMoARcPSD|31047557 Size Appropriate Equipment Needs for Patient and Nurse Safety  Commodes and wheelchairs  Stretcher, scales  Bed, chair, bedpans  Blood pressure cuff, pulse oximetry Nursing assessment Health history Time of obesity onset Diseases related to metabolism and obesity Medications Objective Height, weight, BMI, waist circumference Nursing diagnoses  Obesity  Impaired skin integrity  Ineffective breathing pattern  Chronic low self-esteem Planning: goals  Modify eating patterns.  Participate in a regular physical activity program.  Achieve weight maintenance or loss to a specified level.  Maintain weight loss to a specified level.  Minimize or prevent health problems related to obesity. Nursing implementation When no organic cause can be found for obesity, it should be considered a chronic, complex disease. Supervise a plan:  Successful weight loss, requiring a short-term energy deficit  Successful weight control, requiring long-term Downloaded by athraa emad ([email protected])  lOMoARcPSD|31047557  All opportunities for client education should stress healthy eating and physical activity.  Nutritional therapy -Restricted food intake is a cornerstone. Discourage fad diets Drug Therapy  Classified into two categories -↓ Food intake by reducing appetite or increasing satiety -↓ Nutrient absorption Nutrient absorption-blocking drugs They work by blocking fat breakdown and absorption in intestine. Undigested fat is excreted in the feces. Orlistat (Xenical) Collaborative Surgical Therapy Bariatric surgery is used to treat morbid obesity. Currently it is the only treatment found to have a successful and lasting impact for sustained weight loss. Stringent criteria for consideration for surgery Three categories: restrictive, malabsorptive, or a combination of both Selection Criteria for Bariatric Surgery?  Must be 18 years old or older  BMI > 35 kg/m2 and one or more comorbidities: hypertension; diabetes; cardiac disease; obstructive sleep apnea or BMI > 40 kg/m2  Multiple attempts to lose weight in a medically supervised program Surgical Management Procedure outcome: 1. Restrictions: decrease food intake 2. Malabsorption: interferes with ingested nutrition absorption 3. Hormonal changes: chemical signals thatcontrol hunger Downloaded by athraa emad ([email protected])  lOMoARcPSD|31047557 Goal of surgery is to have an average weight loss of 61% of pre surgery weight  One year from referral to surgery  Follow-up appointments for 1 year post surgery  Although not reversible – patient can still regain all weight if not following dietary recommendations SURGICAL INTERVENTIONS FOR MORBID OBESITY Restrictive Surgery: Adjustable gastric banding (AGB) Vertical sleeve gastrectomy Malabsorptive Surgery: Biliopancreatic diversion (BPD) with or without duodenal switch Combination of Restrictive and Malabsorptive Surgery: Roux-en-Y gastric bypass (RYGB) Gastric Banding Advantages:  Adjustable}Reduces the size of the stomach(eat less; fewer calories; lose weight  No stapling, cutting, or intestinal re-routing  Least invasive surgical approach  Lowest mortality and complication rate Downloaded by athraa emad ([email protected])  lOMoARcPSD|31047557 Disadvantages:  Initially, weight loss is slower compared to the gastric bypass procedures  Weight loss is variable  It is not an effective treatment for sweet-eaters  Everyone requires multiple band adjustments Combination of Restrictive and Malabsorptive Surgery: LRYGB  Considered to “golden standard” of obesity surgery Advantages:  Has low complication rates  Excellent client tolerance  Stomach size is decreased with a gastric pouch anastomosis that empties directly into jejunum. Disadvantages:  Some vitamin and mineral deficiencies can occur. Iron, calcium, Vit B12, and multivitamins.  The bypassed portion of the stomach, duodenum, and segments of the small intestine cannot be easily visualized using X-ray or endoscopy if problems such as ulcers, bleeding or cancer should occur.  This surgery is meant to be permanent. Cosmetic Surgeries to Reduce Fatty Tissue and Skin folds Ideal candidates have  achieved weight reduction.  excess skin folds or fat. Surgery for cosmetic reasons  Lipectomy  Liposuction Nursing Management: Obese Client Undergoing Surgery (Cont.) Nursing implementation (Cont.)  Ambulatory and home care Downloaded by athraa emad ([email protected])  lOMoARcPSD|31047557  Clients who have just had bariatric surgery have been unsuccessful in maintaining a prescribed diet in the past.  reducing intake because of anatomical changes.  The client must learn to adjust intake sufficiently with regard to nutrition and maintaining a stable weight.  Diet  Monitor for possible complications. Diet  Postoperative diet: liquid diet  In 2 months after surgery wll start on a solid foods  6 small feedings totaling 600 to 800 calories per day  Eating more slowly, taking small size bites, chewing foods well, eating foods that are not dry or tough, and avoid high sugar food. Evaluation Outcomes  Long-term weight loss  Improvement in obesity-related comorbidities  Integration of healthy practices into daily routine  Monitoring possible adverse effects of surgical therapy  Improved self-image Diabetes Classification of Diabetes  Type 1  Type 2  Gestational Downloaded by athraa emad ([email protected])  lOMoARcPSD|31047557 Type 1 and 2 TYPE 1- 10% of diabetics  Inability to produce insulin, destruction of beta cells in pancreas  Impaired ability to store glucose Downloaded by athraa emad ([email protected])  lOMoARcPSD|31047557  Requires outside source of insulin  Abrupt onset  Onset any age but usually 35 but now in younger clients  May be associated with other conditions (PCOS) Gestational  Glucose intolerance with pregnancy, placental hormones increase insulin resistance  Up to 3.8% of women affected  Resolves with delivery but significantly higher risk for development of Type 2  Older age, hypertension Clinical Manifestations  “Three Ps” o Polyuria o Polydipsia o Polyphagia  Fatigue, vision changes, tingling or numbness in hands or feet, dry skin, skin lesions or prolong wound healing, and recurrent infections  Type 1 may have sudden weight loss, nausea, vomiting, and abdominal pain if DKA has developed Diagnostic Tests  Fasting blood glucose: >7.0 mmol/L (fasting 8 hrs)  Random glucose: >11.1 mmol/L  Hgb A1C: >6.5%  Urine for ketones (type 1) and sugar Downloaded by athraa emad ([email protected])  lOMoARcPSD|31047557  Treatment goal is to normalize blood glucose levels Nursing Assessment  Health history  Subjective & objective data  NURSING DIAGONSES  Ineffective self-health management r/t insufficient knowledge as evidenced by continued hyperglycemia  Imbalanced nutrition: more than body requirements r/t intake in excess of activity expenditure by hyperglycemia or weight gain  Risk of injury r/t decrease tactile sensation  Risk for peripheral neurovascular dysfunction r/t vascular effects of diabetes Planning Overall goals: 1. To be active participant in the management of the DM regimen 2. To experience few or no episodes of hypoglycemia or acute hyperglycemic emergencies 3. To maintain blood glucose levels at normal or near-normal levels 4. To prevent, minimize, or delay the occurrence of chronic complication of DM 5. To adjust lifestyle to accommodate DM regimen with a minimum of stress Nutritional Therapy  Consider food preferences, lifestyle, usual eating times, and cultural or ethnic background  Review diet history and need for weight loss, gain, or maintenance  Consider caloric requirements and calorie distribution throughout the day  Carbohydrates: 50% to 60% carbohydrates, emphasize whole grains  Fat: 20% to 30%, with >10% from saturated fat and >300 mg of cholesterol  Protein: Contribute 15% to 20% of total energy consumed  Fibre  Provide exchange lists Downloaded by athraa emad ([email protected])  lOMoARcPSD|31047557 Glycemix Index  Describes how much a food increases blood glucose  Recommendations: combining starchy food with protein- and fat-containing food slows absorption and glycemic response  Raw or whole foods tend to have lower response than cooked, chopped, or pureed foods  Eating whole fruits rather than juices decreases the glycemic response owing to fiber slowing absorption  Adding food with sugars may produce lower response if eaten with foods that are more slowly absorbed Other Dietary Concerns  Alcohol  Nutritive and nonnutritive sweeteners  Reading labels Role of the nurse  Be knowledgeable about dietary management Downloaded by athraa emad ([email protected])  lOMoARcPSD|31047557  Communicate important information to the dietitian or other management specialists  Reinforce patient understanding  Support dietary and lifestyle changes Exercise  Lowers blood glucose levels  ↑ insulin receptor sites  Aids in weight loss  Lowers cardiovascular risk Exercise Precautions  Exercise when blood sugar levels are elevated (above 14 mmol/L) and ketones are present in urine should be avoided  Insulin normally decreases with exercise; patients on exogenous insulin should eat a 15-g carbohydrate snack before moderate exercise to prevent hypoglycemia  If exercising to control or reduce weight, insulin must be adjusted  Potential exists for postexercise hypoglycemia  Need to monitor blood glucose levels Exercise Recommendations  Encourage regular daily exercise  Gradual increase in exercise period is encouraged  Modify exercise regimen to patient needs and presence of diabetic complications or potential cardiovascular problems  Exercise stress test for patients older than age 30 who have two or more risk factors is recommended  Gerontologic considerations Acute Complications of Diabetes  Hypoglycemia  Diabetic ketoacidosis (DKA)  Hyperglycemic hyperosmolar nonketotic syndrome (HHNS), or hyperosmolar nonketotic coma, or hyperglycemia hyperosmolar syndrome (HHS) Hypoglycemia Downloaded by athraa emad ([email protected])  lOMoARcPSD|31047557 Abnormally low blood glucose level