Mr. X's blood glucose level is 250 mg/dl and he has ketones in his urine. What advice should a nurse give him… - DSSSB -28 August 2019 (Shift-2)

DSSSB -28 August 2019 (Shift-2)

Medical & Surgical Nursing

Hard

Appeared in: DSSSB -28 August 2019 (Shift-2)

Explanation

The presence of ketones in the urine alongside a blood glucose level of 250 mg/dL indicates a state of significant insulin deficiency.
In this metabolic state, the body cannot use glucose for energy and is instead breaking down fat, producing ketones.
Exercise would stimulate the release of counter-regulatory hormones (like glucagon), which would further increase blood glucose and ketone levels.
This paradoxical rise in glucose and ketones significantly increases the risk of developing Diabetic Ketoacidosis (DKA), a medical emergency.

Option A: The frequency of exercise (once a week) is irrelevant. Any exercise is contraindicated when blood glucose is high and ketones are present.
Option C: Similar to the other options suggesting exercise, this is incorrect because the patient's current metabolic state makes any physical exertion dangerous.
Option D: While regular, consistent exercise like brisk walking is beneficial for diabetes management, it is unsafe under the current conditions of hyperglycemia with ketonuria.

Clinical Relevance

Nursing practice connection: Knowing Exercise guidelines for patients with diabetes, specifically in the context of hyperglycemia and ketonuria helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
This scenario highlights a critical patient safety instruction. Advising a patient in this state to exercise could precipitate a life-threatening episode of Diabetic Ketoacidosis (DKA).
Nurses play a vital role in educating patients about 'sick day rules' and self-management, which includes knowing when not to exercise.
What if? If the patient's blood glucose was 250 mg/dL but there were NO ketones in the urine, the advice would change. The nurse could advise the patient to proceed with caution, engage in light to moderate exercise, and monitor their blood glucose levels closely before, during, and after the activity.

How to Approach the Question

First, identify the key clinical data provided in the question: Blood glucose is 250 mg/dL and ketones are present in the urine.
Recognize that this specific combination (hyperglycemia + ketonuria) is a significant clinical warning sign.
Recall the physiological effects of exercise. While it usually lowers blood sugar, in a state of insulin deficiency, it can paradoxically raise it.
Understand that the presence of ketones means the body is already in a state of metabolic stress (fat breakdown for energy).
Conclude that adding the stress of exercise would be dangerous and could lead to DKA.
Evaluate the options based on this conclusion. Any option that suggests exercising is incorrect, making 'Do not exercise' the only safe and appropriate advice.

Concept Tested & Keywords

Concept Tested: Exercise guidelines for patients with diabetes, specifically in the context of hyperglycemia and ketonuria.
Stem keywords: blood glucose, 250 mg/dl, ketones in urine, exercise
Lead-in keywords: advice, nurse
Clinical cues: The combination of blood glucose >250 mg/dl and positive ketones is a critical finding that indicates a contraindication to exercise.

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E6 Medicine Harrison 22e Part 2 p. 1110-1112