A nurse in a provider’s office is collecting data from an older adult client who has type 2 diabetes mellitus. Which of the following findings is a manifestation of hyperglycemia?

Choice A Reason:

Resuming the use of contact lenses 48 hours after retinal detachment surgery is not recommended. Postoperative care guidelines typically advise against wearing contact lenses until the eye has sufficiently healed to prevent irritation and infection. The exact duration will depend on the surgeon’s assessment and instructions.

Choice B Reason:

Driving 12 to 24 hours after the procedure is not advisable. Patients are usually instructed to avoid driving until their vision has stabilized and they have received clearance from their eye doctor. This period can vary but often extends beyond the first 24 hours post-surgery to ensure safety.

Choice C Reason:

Lying with the face up for 2 weeks following the procedure is incorrect. In many cases, patients are required to maintain a face-down position to help the retina reattach properly, especially if a gas bubble was used during surgery. The specific positioning instructions will depend on the type of surgery performed and the surgeon’s recommendations.

Choice D Reason:

Refraining from lifting objects that weigh over 15 lb is an appropriate instruction. Heavy lifting can increase intraocular pressure and strain the eye, potentially disrupting the healing process. Patients are generally advised to avoid strenuous activities and heavy lifting during the recovery period to ensure optimal healing.

Choice A Reason:

Administering IV levothyroxine is the priority intervention for a patient with myxedema coma. Myxedema coma is a severe form of hypothyroidism that requires immediate thyroid hormone replacement to correct the deficiency and stabilize the patient’s condition. Intravenous levothyroxine is preferred because it provides a rapid increase in thyroid hormone levels, which is crucial for reversing the life-threatening symptoms of myxedema coma, such as hypothermia, bradycardia, and altered mental status.

Choice B Reason:

Starting broad-spectrum antibiotics is not the primary intervention for myxedema coma. While infections can precipitate myxedema coma and should be treated if present, the immediate priority is to address the severe hypothyroidism with thyroid hormone replacement. Antibiotics may be administered if an infection is suspected or confirmed, but they do not directly address the underlying thyroid hormone deficiency.

Choice C Reason:

Administering corticosteroids immediately is important but not the highest priority. Corticosteroids are often given to patients with myxedema coma to treat potential adrenal insufficiency, which can coexist with severe hypothyroidism. However, the primary intervention remains the administration of thyroid hormone replacement to correct the hypothyroid state.

Choice D Reason:

Initiating fluid restriction is not appropriate for managing myxedema coma. Patients with myxedema coma often require careful fluid management to address potential hyponatremia and maintain hemodynamic stability. Fluid restriction is not a standard intervention for this condition and does not address the critical need for thyroid hormone replacement.