NCLEX RN Practice Question # 422

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CARE OF THE DIABETIC CLIENT UNDERGOING SURGERY

Preoperative care

  • Check with physician regarding withholding oral hypoglycemic medications or insulin.
  • Some long-acting oral antidiabetic medications are discontinued 24 to 48 hours before surgery.
  • Metformin (Glucophage)may need to be discontinued 48 hours before surgery andmaynot be restarted until renal function is normal postoperatively.
  • All other oral antidiabetic medications are usually withheld the day of surgery.
  • Insulin dose may be adjusted or withheld if IV insulin administration during surgery is planned.
  • Monitor blood glucose level.
  • Administer IV fluids as prescribed.

Intraoperative care

  • Monitor blood glucose levels frequently.
  • Administer IV short- or rapid-acting insulin as prescribed to maintain the blood glucose level lower than 200 mg/dL.

Postoperative care

  • Administer IV glucose and regular insulin infusions as prescribed until the client can tolerate oral feedings.
  • Administer supplemental short-acting insulin as prescribed based on blood glucose results.
  • Monitor blood glucose levels frequently if the client is receiving parenteral nutrition.
  • When the client is tolerating food, ensure that the client receives an adequate amount of carbohydrates daily to prevent hypoglycemia.
  • Client is at higher risk for cardiovascular and renal complications postoperatively.
  • Client is also at risk for impaired wound healing.

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