A nurse is caring for a client who has recently been admitted to a medical ward.

Exhibits

omplete the diagram by dragging from the choices below to specify what condition the client is most likely experiencing, 2 actions the nurse should take to address that condition, and 2 parameters the nurse should monitor to assess the client's progress.

Rationale for Correct Choices:

• Type 2 diabetes mellitus: The client’s elevated blood glucose (200 mg/dL), high HbA1c (8.5%), polyuria (increased thirst), blurred vision, numbness in feet, and unsteady gait are classic signs of poorly controlled type 2 diabetes. These findings indicate chronic hyperglycemia affecting multiple systems.
• Provide nutritional counseling: Proper diet management is essential for controlling blood glucose, preventing complications, and promoting weight management in clients with type 2 diabetes. Education on carbohydrate counting and balanced meals helps improve long-term glycemic control.
• Encourage regular physical activity: Exercise enhances insulin sensitivity, helps lower blood glucose levels, improves cardiovascular health, and supports overall functional ability in older adults. Tailored activity programs can reduce complications from diabetes.
• Blood glucose levels: Monitoring blood glucose allows the nurse to evaluate the effectiveness of interventions such as diet, exercise, and medications. Regular checks help prevent hyperglycemia and related acute complications.
• Blood pressure readings: Diabetes increases the risk of hypertension and cardiovascular disease. Tracking blood pressure helps detect early complications and guide interventions to reduce cardiovascular morbidity.

Rationale for Incorrect Choices:

• Chronic kidney disease: The slightly elevated creatinine (1.2–1.3 mg/dL) may indicate early kidney involvement, but it does not explain the constellation of polyuria, blurred vision, numbness, or tremors. CKD is more of a complication than the primary condition.
• Congestive heart failure: Symptoms like fatigue and unsteady gait could be seen in heart failure, but the client’s normal oxygen saturation, absence of edema, and elevated blood glucose point away from heart failure as the primary diagnosis.
• Alzheimer’s disease: Cognitive decline is the hallmark of Alzheimer’s. This client presents with physical symptoms of hyperglycemia and peripheral neuropathy rather than memory or cognitive deficits.
• Administer pain medication: While neuropathic pain may occur later, the priority is controlling blood glucose and addressing underlying metabolic causes, not routine analgesia at this stage.
• Schedule frequent blood transfusions: There is no indication of anemia or blood loss requiring transfusion; this is unrelated to diabetes management.
• Increase fluid intake: Encouraging hydration may support kidney function, but it does not address the underlying hyperglycemia or neuropathy and is secondary to more direct interventions like nutrition and exercise.
• Oxygen saturation: The client’s oxygen saturation is normal and not a primary concern in type 2 diabetes without respiratory involvement.
• Heart rate: While relevant for overall assessment, heart rate does not directly reflect glycemic control or hypertension in this scenario.
• Serum creatinine levels: Creatinine should be monitored over time for renal complications, but it is not immediately useful for assessing the effectiveness of diabetes interventions at this stage.