A clinic nurse receives a phone call from a client who has type 1 diabetes mellitus (DMT1). The client reports a fever and cough for the past day and a current blood glucose of 400 mg/dL

QUESTION

A clinic nurse receives a phone call from a client who has type 1 diabetes mellitus (DMT1). The client reports a fever and cough for the past day and a current blood glucose of 400 mg/dL. Which of the following instructions should the nurse make?
“Check your urine for ketones.” “Go immediately to the emergency department.” “Avoid eating and drinking for 2 hours, then re-check your blood glucose.” “Check your blood glucose every 30 minutes for the next 2 hours.”

ANSWER

The nurse should instruct the client to “Check your urine for ketones.”

Here’s a detailed explanation of why this is the appropriate instruction:

Elevated blood glucose levels, such as the reported 400 mg/dL, in a client with type 1 diabetes mellitus (T1DM) can be a sign of potential diabetic ketoacidosis (DKA). DKA is a severe complication of diabetes characterized by hyperglycemia (high blood glucose levels), ketosis (elevated ketones in the blood), and metabolic acidosis (decreased blood pH). It is a medical emergency that requires prompt assessment and intervention.

Checking urine for ketones is a crucial step in assessing for DKA. When blood glucose levels are high for an extended period, the body may start breaking down fat for energy, leading to the production of ketones. Ketones can be detected in the urine using simple test strips. If ketones are present, it indicates that the client’s diabetes management needs immediate attention.

The other options are not appropriate for the following reasons:

“Go immediately to the emergency department”: While this might be necessary if the client’s condition deteriorates or if ketones are detected in the urine, it’s essential to assess ketone levels first. Urgent care might be required, but it depends on the presence and severity of ketosis.

“Avoid eating and drinking for 2 hours, then re-check your blood glucose”: Delaying action for two hours when blood glucose is already significantly elevated is not advisable. High blood glucose, along with other symptoms like fever and cough, warrants an immediate assessment for potential DKA.

“Check your blood glucose every 30 minutes for the next 2 hours”: While frequent monitoring of blood glucose is essential, the priority in this situation is to assess for ketones as a potential sign of DKA. Checking blood glucose alone may not provide enough information to address the urgent concern.

In summary, instructing the client to check their urine for ketones is the most appropriate initial action when faced with a reported fever, cough, and significantly elevated blood glucose levels in a person with T1DM. If ketones are detected, further medical evaluation and management, which may include going to the emergency department, should follow.