The client who was diagnosed with diabetes mellitus 1 year ago is ...

[DyllonKazuo]

The client who was diagnosed with diabetes mellitus 1 year ago is hospitalized in diabetic ketoacidosis after a religious fast. The client tells the nurse, I have fasted during this season every year since I became an adult.
 
  I am not going to stop now.. The nurse is not knowledgeable about this particular religion. What is the best action for this nurse? 1. Tell the client that it is different now because of the diabetes.
   2. Do some research into the meaning of fasting in this religion.
   3. Ask family members of the same religion to discuss fasting with the client.
   4. Request a consult from a diabetes educator.

Question 2

An older client is being screened for tuberculosis. The client's family questions why purified protein derivative (PPD) testing is done twice. Which of the following is the most appropriate response by the nurse?
 
  1. The treatment for TB is 6 months of medication, and we want to make sure the first PPD was done correctly prior to starting the medication..
   2. Different medication is used in the second PPD..
   3. The first PPD was not interpreted in the correct time frame of 48 to 72 hours..
   4. The second PPD provides a more accurate reading because the older person's immune system may be sluggish and not adequately react to the first exposure..

[angrybirds13579]

Answer to Question 1

4. Request a consult from a diabetes educator.

Rationale:
The diabetes educator should be contacted to work with the client on strategies that might allow the fasting to occur in a safe manner. Telling the client that life is different now does not support religious beliefs. Research into the meaning of fasting in this religion would be educative for the nurse, but the client requires more immediate intervention. Asking the family to talk to the client might help, but the diabetes educator would be able to provide more direct and helpful information for the client.

Answer to Question 2

4. The second PPD provides a more accurate reading because the older person's immune system may be sluggish and not adequately react to the first exposure..

Rationale:
PPD testing is done in a 2-step process due to the slowing of the older adult's immune system response. Treatment for TB for 6 months is not a reason to complete the PPD twice. PPD testing is not done twice because different medication is used. Evaluating the test at the wrong interval is not the reason that the PPD is done twice on the elderly client.