A nurse is caring for a client with type 2 diabetes mellitus… | 마이메르시 MyMerci
Adult Health
문제
A nurse is caring for a client with type 2 diabetes mellitus who has developed diabetic nephropathy. Which nursing intervention should be the priority to prevent further progression of kidney damage?
The nurse is developing a care plan for a client with diabetic nephropathy to prevent further renal complications.
1Encourage increased protein intake to maintain nutritional status
2Monitor blood glucose levels every 4 hours during hospitalization
3Implement strict blood pressure control measures and monitor for hypertension✓ 정답
4Increase fluid intake to promote kidney function and prevent dehydration
해설
Strict blood pressure control is the most critical intervention to prevent progression of diabetic nephropathy, as hypertension accelerates kidney damage in diabetic patients.
심화 해설
Core Nursing ExplanationKey Concept Analysis: This question assesses the priority nursing intervention for a patient with Diabetic nephropathy, a common microvascular complication of diabetes. The core pathophysiology involves damage to the glomeruli (the kidney's filtering units) due to chronic hyperglycemia. This damage leads to proteinuria and a progressive decline in the Glomerular filtration rate (GFR). A key accelerating factor in this progression is Hypertension, which puts additional mechanical stress on the already fragile glomerular capillaries, worsening the damage.
Answer Rationale: Key Point! For a patient with established diabetic nephropathy, the single most important modifiable factor to slow its progression is strict blood pressure control. Clinical guidelines consistently target a blood pressure of
임상 시나리오
Nursing Clinical Practice GuideClinical Scenario: Mr. Johnson, 58, with a 15-year history of type 2 diabetes, is admitted for cellulitis. His chart notes "Diabetic Nephropathy, Stage 3." His blood pressure on admission is 148/92 mmHg.
Nursing Intervention Strategy:
Assessment: Obtain a full set of vital signs, focusing on BP. Check for peripheral edema. Review medications—is he on an ACE inhibitor/ARB? Obtain daily weights. Review labs: serum creatinine, eGFR, urine albumin-to-creatinine ratio.
Planning & Implementation: The priority is to get his BP under control. Administer prescribed antihypertensives on time. Collaborate with the provider to ensure the regimen is appropriate (e.g., an ACE inhibitor is on board). Implement a low-sodium diet. Educate Mr. Johnson on the critical link between BP and his kidney health.
Evaluation: Monitor BP trends. Is it moving toward the target of 30% from baseline (report to provider).
Patient Education Flow: 1) Explain why BP control protects kidneys. 2) Teach home BP monitoring technique. 3) Review low-sodium diet choices. 4) Emphasize medication adherence. 5) Instruct to report swelling, shortness of breath, or changes in urine output.
A Word from Your Senior Nurse
"In the hustle of a medical-surgical floor, it's easy to focus on the admitting diagnosis (like cellulitis). But as a nurse, your holistic view is your superpower. For Mr. Johnson, the infection is the acute issue, but his diabetic nephropathy is the chronic, life-altering one. By prioritizing his blood pressure control during this admission, you're not just treating a number—you're actively preserving his kidney function for years to come. On the NCLEX and at the bedside, always ask: 'What is the greatest threat to this patient's long-term health right now?' For diabetic nephropathy, the answer is almost always hypertension."
핵심 개념
Diabetic Nephropathy — A progressive kidney disease caused by damage to the glomerular capillaries from chronic hyperglycemia, leading to proteinuria and declining GFR.
Glomerular Filtration Rate — The best overall index of kidney function. It estimates how much blood is filtered by the glomeruli each minute. A declining GFR indicates worsening kidney disease.
ACE Inhibitor (Angiotensin-Converting Enzyme Inhibitor) — A class of antihypertensive medication (e.g., lisinopril, enalapril) that is first-line for diabetic nephropathy due to its renal-protective effect of reducing intraglomerular pressure.
Albuminuria — The presence of albumin (a protein) in the urine. It is an early and key marker of diabetic kidney damage.
Hypertension — High blood pressure. In diabetic nephropathy, it is a major modifiable risk factor that accelerates the progression of kidney damage.
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