78. A client is admitted with diabetic ketoacidosis (DKA). Five months ago, the hemoglobin A1c (HgbA1c) was 9.4%; currently it is 10.3%. Based on this information, a nurse should:
78. A client is admitted with diabetic ketoacidosis (DKA). Five months ago, the hemoglobin A1c (HgbA1c) was 9.4%; currently it is 10.3%. Based on this information, a nurse should:
. Record this expected finding.
. Recheck the HgbA1c after the DKA is resolved.
. Provide diabetic teaching.
. Ask the physician about longer-acting insulin.
Test-Taking Tip
Know that the HgbA1c level is too high, needing teaching.
Content Area: Adult Health, Endocrine; Integrated Process: Nursing Process, Analysis; Cognitive Level: Analysis; Client Need/Subneed: Physiological Integrity/Reduction of Risk Potential/Laboratory Values
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Answer 1 is incorrect because clients with diabetes should manage blood sugar at a level that would result in an A1c of less than 7%. An intervention is required to help this client better manage diabetes. Answer 2 is incorrect because the A1c would not change acutely with resolution of DKA. Answer 3 is correct because the A1c gives a number that reflects the average blood sugar over the last 3 months. Clients with diabetes are told to try to keep the A1c less than 7% (sometimes less than 6.5%). This high level, which is getting worse, means that the client needs better management of the diabetes. Client teaching is the correct way to help a client manage this chronic disease. Answer 4 is incorrect because this client's diabetes is out of control. First, an assessment must be done to determine why the blood sugars have been chronically high. Longer-acting insulin may or may not be part of a reasonable intervention for this client.