Type 1 Diabetes Nursing Interventions (Plus CRITICAL THINKING TIPS!)

Hey there my friend. My name is Christina Rafano from nursingsos.com and in this video today we're going through the nursing interventions that you might do for a patient with type 1 diabetes. I will also walk you through the key NCLEX points and the critical thinking points that are most likely to show up on your exams so you'll be a lot more prepared. So hit that subscribe button and click the notification bell and let's dive in. Now, before we dive in, I want to make sure that you know about my free nursing school study guide pack that I have for you. It is a pack of 10 study guides for some of the key med, surgery disorders that you need to know about in nursing school. So you can click the link down below in the description to snag them to help make your studying easier. Easier. So big, big key point for you here for any time you're studying in nursing school. This is a big, big deal, my friend. Whenever you're trying to learn the signs and symptoms of a disorder or what you'll assess for or what nursing interventions that you'll need to do, a key thing to remember is that you always want to connect it back to the pathophysiology of what's actually happening with that disorder. You know that nursing exams different than the exams that you took in your prereqs, right? Like we know this, your prereqs were so much more about memorization and just remember facts, right? That is not the case in nursing school though, right? Nursing school is all about critical thinking and thinking like a nurse, right? We've all heard that phrase nursing exams in the nclex. They're going to be testing you on how well you know the info and how well you can apply it to a patient situation, question, priority questions and case scenarios. And this is all critical thinking, my friend. So that's why whenever I teach the signs and symptoms of a disorder or nursing assessments or interventions, I'm always going to walk you through the critical thinking behind it all because that is what you need to pass your exams. So there are three key nursing interventions that you need to know for a patient with type 1 diabetes. So let's list them here and then we're going to go through all of that critical thinking behind them so that you can understand why we do these interventions so that you can be more prepared for your nursing exams. So the nursing interventions here are to give insulin, give fluids, and to do a whole lot of patient education. So let's talk about the critical thinking part of all of this during diabetes type 1, the pancreas isn't making any insulin at all. This is actually an autoimmune disorder where the body itself itself is destroying the insulin producing cells in the pancreas, the beta cells. So with these beta cells being destroyed, the pancreas can't make any insulin. And if there's no insulin to move glucose into the body cells to use for energy, then the cells will use fats for energy instead. And this makes ketones, which are acids. Now here's a memory trick for you. Think A, B, C, D, autoimmune beta cells destroyed. Now, something that's really, really important to know, and this is a big, big critical thinking point for you, is that the body is always wanting to stay in balance. It doesn't want to swing too far any which way, especially when it comes to the ph. So when all of this fat is broken down, more and more ketones are made which are acids, and, and the blood then becomes acidic. And the more acidic the blood gets, the lower and lower the ph becomes. This does not make the body happy. And this is called acidosis, where the blood becomes acidic. And this is why type 1 diabetes can lead to acidosis where the blood becomes acidic. And acidosis causes a whole lot of problems on its own because the body really has a hard time functioning when that ph is out of balance. Now I have a whole other video on diabetic ketoacidosis for you, so if you need to learn about that one too, definitely be sure to check that video out. I'll put the link below in the description. So when you think about type 1 diabetes, you should be thinking of about a lack of insulin. And this can cause blood sugar levels to rise and even possibly acidosis. So when the patient has that elevated blood sugar level, you'll want to give insulin as prescribed to bring it back down to normal. You'll need to constantly being assessing their blood glucose levels during their treatment because you don't want to really drop their blood sugar level too fast. And here's why this is a big, big, big critical thinking point for you. Nursing school exams. Love this one. The body is always wanting to be in balance, right? So if you drop the blood glucose fast, the water in the body will try to rebalance itself and move from the intracellular fluid called the ICF to the extracellular fluid called the ecf. And if this happens too fast, fluid will move into the cerebral spinal fluid to try to maintain that balance. And this, my friend, can lead to swelling in the Brain, which is called cerebral edema and can cause increased intracranial pressure. Now, this is super, super dangerous. It's a medical emergency. So it's really, really important that you always assess your patient and be very, very careful when giving insulin and fluid treatment. So big, big critical thinking point right there for you. Now let's talk about fluid treatment. Type 1 diabetes causes hyperglycemia, which causes that dehydration. So when the blood is filled with sugar, there's not enough water to dilute it all. So the patient will be dehydrated, and they may need IV FL help to rehydrate. Now, fluid treatment will depend on what the doctor has ordered and really how dehydrated they are. But typically, you'll give normal saline, lactated ringers, half normal saline, or 5 to 10% dextrose in half normal saline. Now, here's a fun memory trick for you. If it's high, we need to drop it. Okay? Think isotonic, hypotonic, and dextrose. So all of these fluids, they serve different purposes. So let's walk through each of them. In a patient with type 1 diabetes who has progressed into ketoacidosis, this is the fluid routine that you might see at clinical and do. And of course, it all depends on their blood sugar level. But normal saline or lactated ringers is usually given first because these solutions are isotonic, meaning that they are not going to force fluid any which way. Those solutions, they're going to stay inside the blood vessels, which is where we want them. Now, half normal saline may be used after normal saline or lactated ringers in order to hydrate the cells, because half normal saline solution, it's going to push some fluid inside the cells rather than just staying outside of the cells like normal saline or lactated ringers do. You may also give 5 to 10% dextrose in half normal saline as that blood glucose level drops to around 250 to 300 milligrams per deciliter. Now, this can be confusing. Why would we give when we're trying to drop the patient's blood glucose level? Well, this is super, super important because we don't want to drop it too much and especially too fast. We are basically controlling that blood glucose level by giving some more glucose and controlling the rate that it decreases. If we just give normal fluids without glucose plus all that insulin, that insulin could drop the blood glucose level way too fast and way far. And so when the blood glucose level reaches about between 250 to 300 milligrams per deciliter. You might give glucose along with the fluids, depending on the doctor's orders. So that's the rationale for each of those IV fluids. And finally, you'll do a lot of patient education. Type 1 diabetes is a lifelong condition because their body can't make insulin, right? This is an autoimmune condition. So you'll teach them how to store and administer their insulin correctly. You'll need to work with their dietitian to help reinforce their prescribed diet plan and teach them how to monitor their blood glucose levels and their urine ketones at home. Those are really, really important. And a big, big NCLEX key point for type 1 diabetes is the guidelines for sick day. So if the patient is sick, you'll educate them on staying hydrated and fed, eating as normally as possible, taking their insulin like normal, and calling their doctor when they have signs of diabetic ketoacidosis. Things like moderate or high ketones in the urine and if their breath has a fruity odor, if they have fast and deep respirations called called kussmaul respirations, these are fast and deep. And if hyperglycemia continues or if they have changes in their level of consciousness and they should check their urine ketones each time they urinate and check their blood glucose level every four hours. That's a big, big deal. You can use the memory trick sick to help you remember this. Stay hydrated and fed, give insulin call if having signs of ketoacidosis and check ketones and glucose. Now that NCLEX loves to test you on that one, so you can use that memory trick to help remember that. Now I know this is a lot of info to go through, so let's walk through some NCLEX questions, Henclex practice questions to help really make it all come together for you and stick in your brain. So question number one here for type 1 diabetes is the nurse is working with a patient who has just been diagnosed with type 1 diabetes. The patient asks the nurse why she needs insulin injections. The nurse's best response is based on the understanding that during type 1 diabetes, a the body cells become resistant to the insulin produced by the pancreas, B, the pancreas slows down insulin production and is not sufficient to regulate blood glucose, C the liver produces excessive glucose overwhelming the available insulin or D the body's immune system destroys the pancreatic beta cells leading to an absolute insulin deficiency. Alright, so looking at this list we can see based on what we just talked about in the Video is that the correct answer is D, because this how type 1 diabetes works the body's immune system, it's destroying those pancreatic beta cells leading to an absolute insulin deficiency. So the patient is insulin deficient. So this is because that type 1 diabetes mellitus, it's an autoimmune disorder, right? So the body's immune system actually attacks and destroys those insulin producing beta cells in the pancreas. So this means that there's a total lack or almost complete lack of that endogenous insulin production by the pancreas. So insulin injections, those are needed to keep the body functioning. Now with answer A, Insulin resistance is the primary characteristic of type 1 to type 2 diabetes, not type 1. Now answer B is also wrong for the same reason. Insufficient insulin production, that's more characteristic of type 2 diabetes. Diabetes where the pancreas might still produce some insulin. And now Whereas in type 1 diabetes there's almost a total lack of that insulin production just altogether. And now then answer C. While the liver does play a role in that glucose regulation, excessive glucose production by the liver, that's not the primary cause of hyperglycemia in type 1 diabetes. That lack of insulin is the main problem here. So the correct answer to this question is D. Now let's walk through question number two. A patient with type 1 diabetes mellitus has a blood glucose level of 450mg per deciliter and is exhibiting deep rapid respirations and a fruity odor on their breath. The nurse recognizes these findings as A hypoglycemia, B, hyperosmolar hypoglycemic syndrome, hhs C, diabetic ketoacidosis or DKA or D, dawn phenomenon. Now the correct answer here is C, diabetic ketoacidosis or DKA for short, like we talked about in the video, right? The combination of severe hyperglycemia, the KHU's small respirations, those are the the body's attempt to compensate for metabolic acidosis. It tries to get rid of all that excess acids. So those fast and deep respirations and in the fruity breath order, this is caused by the presence of ketones. These are classic signs of DKA or diabetic ketoacidosis. Now answer A is incorrect. Hypoglycemia, because hypoglycemia is characterized by low blood glucose level and symptoms like sweating or tremors or confusion and then hyperosmolar hyperglycemic syndrome. HHS typically occurs in type 2 diabetes and that involves very high blood glucose level without significant ketone production. So answer B then is incorrect and then dawn phenomenon. Now this one's kind of interesting. This is a rise in blood glucose level in the early morning hours, but it wouldn't cause these acidosis symptoms. So here in this question, answer D is also incorrect. So the correct answer here is C. Now let's do another practice question. Question 3. A patient with type 1 diabetes is sick with a viral infection and is experiencing nausea and vomiting. The nurse provides education about sick day management. Which of the following instructions is most crucial for the patient to follow? A discontinue insulin administration until oral intake improves. B monitor blood glucose levels more frequently at least every four hours. C increase the intake of sugary fluids to prevent hypoglycemia, or D decrease their usual insulin dose to compensate for reduced oral intake. So looking at this list, the correct answer here is B. Like we talked about, monitor blood glucose levels more frequently, at least every four hours. So this is because during an illness, stress hormones, they can cause blood glucose levels really to fluctuate significantly. So the patient will need to more frequently check their blood glucose level to wash for hyperglycemia or hypoglycemia. Now answer A is wrong because insulin should generally not be discontinued during illness in type 1 diabetes because that could lead to DKA because of that lack of their endogenous insulin production. And even though staying hydrated is important, consuming large amounts of sugary fluids can really worsen hyperglycemia, especially if the insulin doses aren't adjusted appropriately or properly. So answer C here is also incorrect and for answer D, insulin insulin doses may need to be adjusted during an illness, but this should be done based on frequent blood glucose monitoring and they should also get guidance from their doctor. The patient shouldn't decrease their insulin dose just because they aren't drinking as much fluids as normal. So here for this question, the correct answer is B. Now this is really, really important. I know we talked about this a little bit, but I just wanted to mention again because it's so important, you've got to know about diabetic ketoacidosis for your nursing exams because your nursing exams and the nclex, they love, love, love, love to test you on it, like a lot. So be sure to check out this video here where I walk you through the must know nursing interventions for a patient with diabetic ketoacidosis or dka. And be sure to get the free nursing school study guide pack that I have for you. Put a link down below to that in the description for you to snag it. And if you like this video, hit that like button. Share it with a friend who can also use help in nursing school. And of course subscribe and hit the bell so you never miss a video. And as always my friend, go become the nurse that God created only you to be. And I will see you next time on the nursing school show.