Diabetes Test 3
Take into account the following patient: a 46-year-old male with type 2 diabetes, moderate hypertension, hyperlipidemia, and a BMI of 26 who was previously sedentary. If this patient intends to begin a moderate-intensity exercise plan, what additional assessment may be warranted?
Explanation:
This person is older than 40, was previously sedentary, has risk factors for CVD, and is starting a program that is more vigorous than brisk walking, which is a light program. A stress test with an ECG may be necessary in this case. According to the available data, the DEXA scan and the ankle-brachial index are not required.
Your DSME program should include the following guidelines: inviting family members to join, asking patients about any food preferences or limits, and being mindful of your speaking rate and tone of voice. What particular type of consideration are these policies addressing?
Explanation:
Several strategies are used to address the cultural traits/barriers of your community, including inquiring about dietary choices and limits, inviting family involvement, and modulating your speaking rate and tone. Remember that what might be objectionable to one culture may be sensitive to another's culture. This emphasizes how crucial it is to understand your patient population. Although preparedness for change, low literacy/numeracy, and inadequate assistance are significant factors, the measures outlined in the scenario do not address them.
It's critical to identify any potential obstacles to patients who are not following the instructions in their care plan when it comes to self-monitoring blood glucose. Which of the following was not a barrier that patients in recent research mentioned?
Explanation:
In a recent poll, patients did not list lost little objects like glucose meters as a barrier to care (Tenderich, 2013). Cost, discomfort, a lack of appropriate training, and ongoing assistance are common hurdles, as are others like physical limitations (dexterity/visual impairment), cognitive deficiencies, time constraints, and inconvenience, as well as emotional elements like worry or anxiety.
Which of the following behaviors is the surest sign that the patient is only very minimally change-ready?
Explanation:
The patient disputes the doctor's recommendation for DSME and denies having diabetes. She is not ready to make changes in light of her diagnosis, as evidenced by her refusal to accept it. A patient who is crying might be feeling anxious or depressed because she thinks she will have to give up her favorite meals. She might not be prepared to change, but that is not a guarantee. Option (The patient observes your presentation but says nothing) is inaccurate because, even if the patient's silence sometimes suggests a resistance to change, it's also possible that they are paying close attention to the demonstration. Answering review questions incorrectly may indicate that the patient misunderstood the material or did not see or hear it, but it does not necessarily mean that they are unwilling to change. Option (The patient volunteers to answer a review question at the end of class but completely gets the answer wrong). She must be at least interested because she responded.
You evaluate patients in your capacity as a clinic's diabetes educator while also educating them on a range of self-care techniques. Which instructional approach offers the best chance to evaluate and instruct students on insulin self-administration?
Explanation:
A skill like administering insulin can be demonstrated so that the patient can learn by watching, hearing, and then acting. The instructor can see the patient's degree of competency during the return demonstration and then fix errors. It takes a little more time and works best in one-on-one or small group settings, but this teaching method is the most efficient for teaching and evaluating clinical skills. A written test may be used to evaluate knowledge, but it does not give the teacher the chance to evaluate the patient's method or give the student the best chance to learn. A printed handout or instructional video can provide guidance to some extent, but neither one offers a way to gauge the patient's capacity to self-administer insulin. The demonstration is best supported by these tools. The assessment may include vocal acknowledgement of understanding, but it is insufficient to gauge a patient's level of competency with a self-care skill like administering insulin.
Which of the following related medical nutrition therapy and diabetes is untrue, as per ADA Standards?
Explanation:
It is untrue that only diabetics who are underweight, overweight, or obese should receive medical nutrition therapy. MNT is actually advised for all diabetics, regardless of dietary state. In many situations, such as when a patient has celiac disease in a child, is hospitalized, is pregnant, has co-morbidities that are impacted by diet, or has prediabetes, a registered dietitian should also be closely involved in the patient's diabetes care plan to help with individualized meal planning.
What is the ideal glycemic target for pregnant women with previous diabetes (provided the target can be attained without extreme hypoglycemia) as per the ADA consensus statement on managing preexisting diabetes for pregnancy (2008)?
Explanation:
The ideal glucose objectives are: pre-meal/fasting glucose: 60 to 99 mg/dL; peak postprandial: 129 mg/dL; HbA1c 6 percent, according to the 2008 consensus statement on managing pregnant with pre-existing diabetes. Options (Pre-meal/fasting glucose: 70 to 100 mg/dL; peak postprandial: 120 mg/dL; A1c 6.5%) and (Pre-meal/fasting glucose: 70 to 110 mg/dL; peak postprandial: 140 mg/dL; A1c 7 percent) are not rigorous enough, while option (Pre-meal/fasting glucose: 60 to 90 mg/dL; peak postprandial: Although this may need to be altered for each person, it should be noted that during pregnancy, glucose is not considered hypoglycemia until the level is less than 60 mg/dL.
Which teaching approach is most likely to increase patient retention?
Explanation:
An instructional technique that caters to visual, aural, and tactile learning modalities is small group discussion around a table where patients show skills to one another. Studies demonstrate that individuals remember things best when they not only see and hear them but also when they say and do them. The engagement (teaching back) makes it memorable. All other possibilities are sound tactics, but they won't probably result in the highest retention rates.
Which patient record component is most crucial to take into account when determining the risk of hypoglycemia in relation to exercise?
Explanation:
When evaluating the risk of hypoglycemia in relation to exercise, the medication regimen is the most crucial aspect to take into account. The main risk factors are insulin and insulin secretagogues; if you don't take any of these drugs, your risk of hypoglycemia during exercise is minimal. Food intake may need to be modified for patients taking these drugs, and hypoglycemia should be prevented, predicted, identified, and treated with great care.
A patient with gestational diabetes (GDM) believes she got the condition as a result of overindulging in her favorite snack, popcorn, in the first trimester. She is adamant that if she doesn't eat anything else while she is pregnant, she won't need to start taking insulin, and her blood glucose levels will go back to normal. What emotional stage (akin to the Kubler-Ross phases of grief) is connected to the diagnosis of a chronic condition that you evaluate in your patient?
Explanation:
The stage of bargaining is characterized by incorrect justifications and/or incorrect remedies. To cure their diabetes, the patient strikes a "contract" with themselves, their provider, God, or other people. This stage is frequently accompanied by extreme compulsive behavior. Disbelief in the diagnosis characterizes denial, whereas irritation, indignation, fear, or guilt describe anger. Feelings of pessimism and difficulty creating or maintaining excellent self-care routines are characteristics of frustration and depression, which can strike at any time. The phase of acceptance is when the patient starts to take an active role in their treatment and asks for clarification and assistance.
By having the patient perform a blood glucose test, you can evaluate her blood glucose monitoring approach. Which of the following behaviors represents poor technique?
Explanation:
Blood flow may be obstructed by milking the lanced finger at the tip. Additionally, it can distort the outcomes by putting more interstitial fluid in the sample. When milking a finger, a patient should start at the base and work their way up to the tip, or milk the finger before lancing. All other options are respectable alternatives. Alcohol is unneeded and may potentially bias the sample, thus soap and water are suggested. As long as a sufficient drop is generated, the patient's preferred puncture depth may be used. There will be less pain the shallower the depth setting. Patients should be encouraged to utilize the results-tracking method that works best for them.