A nurse provides diabetic education at a public health fair. Which disorders should the nurse include as complications of diabetes mellitus? (Select all that apply.)

Choice A rationale: For a young adult with newly diagnosed type 1 diabetes mellitus, annual eye examinations by an ophthalmologist are recommended starting five years after the diagnosis. The risk of diabetic retinopathy, a microvascular complication, increases over time with chronic hyperglycemia. Therefore, maintaining a regular schedule for eye exams is crucial for early detection and management of vision changes.
Choice B rationale: This statement is incorrect as it suggests waiting for a vision problem to develop or until a later age. Regular, proactive screening is essential for managing diabetes. Diabetic retinopathy often progresses without noticeable symptoms in its early stages, so waiting for a change in vision can lead to delayed treatment and more significant damage.
Choice C rationale: This statement is inaccurate because while vision can be affected, it does not necessarily change quickly in the early stages. The recommendation for annual or even more frequent exams is based on the duration of diabetes and the presence of any complications, not an assumption of rapid change. For a newly diagnosed client, the standard is annual exams after a few years.
Choice D rationale: This statement is dangerously incorrect. Chronic hyperglycemia is a major risk factor for several eye diseases, including diabetic retinopathy, cataracts, and glaucoma. All clients with diabetes, regardless of age or how well-controlled their blood sugar is, are at risk for these complications and require regular, scheduled eye examinations to monitor for early signs of damage.

Choice A rationale: Encouraging incentive spirometry is a pulmonary intervention designed to prevent atelectasis and pneumonia by promoting deep breathing. While important post-surgically, it does not address the metabolic emergency indicated by the fruity breath odor, which is a classic sign of excessive ketone production from fat metabolism due to severe insulin deficiency.
Choice B rationale: Increasing intravenous fluids could worsen fluid overload in a dehydrated client without addressing the underlying metabolic imbalance. Although fluid resuscitation is part of the treatment for severe hyperglycemia, the primary intervention involves insulin administration to correct the metabolic derangement and halt ketone production, which is the root cause of the fruity odor.
Choice C rationale: The fruity breath odor is caused by the exhalation of acetone, a type of ketone body produced during lipolysis when glucose is unavailable for cellular energy. This indicates the body is in a state of ketoacidosis, a life-threatening complication of uncontrolled diabetes. Consulting the provider for immediate testing and treatment is the priority action.
Choice D rationale: Performing meticulous pulmonary hygiene, such as suctioning and chest physiotherapy, is indicated for clients with respiratory secretions or compromised lung function. While important for general post-operative care, it does not address the specific metabolic emergency of ketoacidosis indicated by the fruity breath odor, which requires immediate medical intervention.