A preoperative nurse assesses a client who has type 1 diabetes ...

[jman1234]

A preoperative nurse assesses a client who has type 1 diabetes mellitus prior to a surgical procedure. The client's blood glucose level is 160 mg/dL. Which action should the nurse take?
 
  a. Document the finding in the client's chart.
  b. Administer a bolus of regular insulin IV.
  c. Call the surgeon to cancel the procedure.
  d. Draw blood gases to assess the metabolic state.

Question 2

A nurse assesses a client with diabetes mellitus 3 hours after a surgical procedure and notes the client's breath has a fruity odor. Which action should the nurse take?
 
  a. Encourage the client to use an incentive spirometer.
  b. Increase the client's intravenous fluid flow rate.
  c. Consult the provider to test for ketoacidosis.
  d. Perform meticulous pulmonary hygiene care.

[shayla]

Answer to Question 1

ANS: A
Clients who have type 1 diabetes and are having surgery have been found to have fewer complications, lower rates of infection, and better wound healing if blood glucose levels are maintained at between 140 and 180 mg/dL throughout the perioperative period. The nurse should document the finding and proceed with other operative care. The need for a bolus of insulin, canceling the procedure, or drawing arterial blood gases is not required.

Answer to Question 2

ANS: C
The stress of surgery increases the action of counterregulatory hormones and suppresses the action of insulin, predisposing the client to ketoacidosis and metabolic acidosis. One manifestation of ketoacidosis is a fruity odor to the breath. Documentation should occur after all assessments have been completed. Using an incentive spirometer, increasing IV fluids, and performing pulmonary hygiene will not address this client's problem.

[jman1234]

TYSM

[AngeliqueG]

Excellent