A mentor early in the author's own career once warned of "not knowing what you don't know. Engaging in continuing education through professional journal reading, conference attendance, and networking, along with active clinical practice, contributes to an NP's expanding knowledge base.
Adult diabetes mellitus: Thinking beyond type 2 | CE Article | NursingCenter
Patient safety is always first. Preferable referral centers will have a nationally accredited DSME program for initial and ongoing support.
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Similarly, for those patients who are not responding to therapy, reevaluation of the diagnosis, including lifestyle and medication adherence, is crucial. An urgent need exists for NPs with specialty level skills in diabetes management due to a confluence of factors, including the endocrinology physician shortage, epidemic obesity rates with resultant diabetes, and patient desire for NP care. Autoantibodies include:. Centers for Disease Control and Prevention. National diabetes statistics report: estimates of diabetes and its burden in the United States. Ambulatory care visits and physician office use.
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How many nurse practitioners provide primary care? It depends on how you count them.
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Adult diabetes mellitus: Thinking beyond type 2
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Arterial pH was 6. The patient has hyperglycemia, ketosis, and metabolic acidosis.
Therefore, he has DKA. In addition, because of the pre-existing fever, cough, localized rales on auscultation and high white blood cell count, a respiratory tract infection should be considered. The patient is also dehydrated and has impaired renal function. Determination of the effective serum osmolality and anion gap should be performed in all patients presenting with potential DKA. Serum osmolality can be measured directly in the laboratory or be calculated. Typically DKA is a high anion gap metabolic acidosis while serum osmolality may vary from normal to high.
In addition a chest X-ray should be performed and blood cultures be obtained to check for lower respiratory tract infection and isolate the pathogenic bacteria. Immediate infusion of normal saline and intravenous insulin should be initiated as described in the text. Because his serum potassium level is in the normal range, 10 mEq of potassium should be added to each liter of normal saline infused. Serum potassium levels should be checked at 2, 6, 10, and 24 hours and appropriate adjustment to the dose must be made.
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In addition, ml of bicarbonate plus 10 mEq of potassium in ml of water can be administered in 1 hour because pH is 6. Arterial pH and bicarbonate should be re-checked in 30 minutes and, if uncorrected, infusion of a similar or lower amount of bicarbonate should be repeated as discussed in the text. If infection is confirmed, intravenous administration of antibiotics should begin while waiting for the results of blood cultures. The patient was treated with fluids and electrolyte replacement and intravenous insulin for 48 hours.