Page 1404 - Saunders Comprehensive Review For NCLEX-RN
P. 1404

diabetic neuropathy.
                                             5. Client instructions (Box 46-13)
                                E. Urine testing
                                             1. Urine testing for glucose is not a reliable indicator of
                                                the blood glucose level and is not used for monitoring
                                                purposes.
                                             2. Instruct the client in the procedure for testing for urine
                                                ketones.
                                             3. The presence of ketones may indicate impending
                                                ketoacidosis.
                                             4. Urine ketone testing should be performed during
                                                illness and whenever the client with type 1 diabetes
                                                mellitus has persistently elevated blood glucose levels
                                                (higher than 250 mg/dL [13.9 mmol/L] or as
                                                prescribed for 2 consecutive testing periods).
                    VIII. Acute Complications of Diabetes Mellitus

                                        A. Hypoglycemia

                                             1. Description
                                                             a. Hypoglycemia occurs when the blood
                                                                glucose level falls below 70 mg/dL
                                                                (3.9 mmol/L), or when the blood
                                                                glucose level drops rapidly from an
                                                                elevated level.
                                                             b. Hypoglycemia is caused by too much
                                                                insulin or too large an amount of an
                                                                oral hypoglycemic agent, too little
                                                                food, or excessive activity.
                                                             c. The client needs to be instructed always
                                                                to carry some form of fast-acting
                                                                simple carbohydrate with him or her
                                                                (Box 46-14).
                                                             d. If the client has a hypoglycemic
                                                                reaction and does not have any of the
                                                                recommended emergency foods
                                                                available, any available food should be
                                                                eaten; high-fat foods slow the
                                                                absorption of glucose, and the
                                                                hypoglycemic symptoms may not
                                                                resolve quickly.
                                                             e. Clients who experience frequent
                                                                episodes of hypoglycemia, older
                                                                clients, and clients taking β-adrenergic
                                                                blocking agents may not experience
                                                                the warning signs of hypoglycemia
                                                                until the blood glucose level is
                                                                dangerously low; this phenomenon is
                                                                termed hypoglycemia unawareness.


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