11.7 Clinical Reasoning and Decision-Making Activities

Complete the following questions. Refer to the answer key to check your answers.

1. A client has been started on a sulfonylurea (Glyburide) to help control their type 2 diabetes. This client reports that they often skip meals.
   1. Is this medication a good option for this client?
   2. The client says they used to be on metformin but got switched to glyburide. What might have been the rationale?
2. A 22-year-old client is a type 1 diabetic, and enjoys going to the occasional party with his friends. He likes to have some alcoholic drinks. What advise should be provided, recognizing that he will drink alcohol at the party?
3. A type 2 diabetic client has had the disease for many years. There has been a progressive increase in oral anti-diabetic medications and now they will be started on insulin. The physician has said that they will continue on their SBLT-2 inhibitor and metformin.
   1. What is the benefit of adding insulin but still keeping the other oral meds?
   2. What might be important medication teaching to start on insulin (basal and bolus)?
4. A 75-year-old type 1 diabetic client has been on insulin since they were in their early 20’s. They have managed very well over the years, managing their blood glucose levels through following the required insulin and healthy lifestyle requirements. Despite their efforts, they have developed some complications, and currently is dealing with a diabetic foot ulcer. The home health nurse is at the home for a dressing change on the diabetic foot wound. The client tells the nurse that lately, they have had trouble with their blood sugar levels being as consistent as they were a few months ago. The nurse asks some question and does an assessment, noticing hardened areas on the client’s abdomen where the client has been repeatedly injecting the insulin.
   1. What are the hardened areas that can occur with repeated insulin injections?
   2. What is the complication that can occur because of this finding? What is the solution?

Note: Answers to the Clinical Reasoning Activities and Critical Thinking questions can be found in the Chapter 11: Endocrine System Medications: anti-diabetic medications answer key – Fundamentals of Nursing Pharmacology – 2nd Canadian Edition  section at the end of the book.