Question

The client scheduled for a pacemaker insertion has been taking metformin (Glucophage) for control of diabetes mellitus. Which instruction should the nurse give the client taking metformin? A. Take the medication as ordered the morning of the procedure. B. Let the doctor know if he is having burning when he urinates. C. Use insulin the morning of the procedure to control his blood glucose levels. D. Take half the dosage of the medication the morning of the procedure.

Short answer

Answer: Use insulin the morning of the procedure to control their blood glucose levels.

Step-by-step solution

rule out least relevant options

We can rule out options A and D as taking metformin the morning of the procedure with or without adjustments could potentially cause hypoglycemia or other complications during the procedure. This leaves us with options B and C.

Analyze the remaining options

Option B focuses on the patient's urinary symptoms, which may be important but is not the main concern for this specific situation. Option C suggests using insulin to control blood glucose levels the morning of the procedure, which is more relevant as it provides a better alternative to taking metformin on the day of surgery.

Choose the most appropriate option

Based on the analysis, the most appropriate instruction for the patient taking metformin would be option C, which is: use insulin the morning of the procedure to control their blood glucose levels.

Key concepts

Nursing Procedures

When preparing a client for a procedure like a pacemaker insertion, nursing procedures play a critical role in ensuring patient safety and optimum outcomes.

One of the fundamental nursing procedures in such situations involves medication management – understanding when to withhold certain drugs and when to administer alternatives. It is essential to evaluate the patient's current medication regimen and make necessary adjustments based on the upcoming procedure. For example, metformin, a common medication for diabetes management, might be contraindicated on the day of a surgical procedure to prevent complications such as lactic acidosis or hypoglycemia, especially when a patient will have a prolonged fasting period.

A nurse should also be adept at providing clear preoperative instructions to the patient about medication adjustments. In this way, thorough knowledge and application of nursing procedures contribute to a safe perioperative experience for the patient.

Diabetes Management

Effective diabetes management requires an in-depth understanding of how various factors, including medications, physical stress, and procedures, affect blood glucose levels.

In the context of surgical procedures, proper planning is crucial to maintain glucose control while avoiding adverse events. Temporary discontinuation of metformin, for instance, is often recommended due to the risk of lactic acidosis. Instead, short-acting insulin might be administered on the morning of surgery to provide a safer and more controllable means of managing blood glucose levels. This switch to insulin helps prevent the potential for hypoglycemia or hyperglycemia during the fasting period and procedure.

Additionally, close blood glucose monitoring before, during, and after the procedure is a key component of diabetes management in a surgical setting. This monitoring allows for timely adjustments to the insulin dose as needed to maintain glucose within a target range.

Medication Administration

Medication administration is a pivotal aspect of nursing care, especially when dealing with chronic conditions such as diabetes.

Nurses must be knowledgeable about the pharmacokinetics and pharmacodynamics of medications like metformin and insulin to manage their administration effectively. In the case where a patient is undergoing surgery, medication regimens may need alteration. Understanding the necessity to withhold certain medications, like metformin, to prevent interactions with the surgical procedure and anesthesia is an important nursing responsibility.

Administering an alternative, such as insulin, requires precise dosing and timing to achieve the desired glycemic control. Nurses must also be prepared to educate patients on these temporary medication changes and the rationale behind them, ensuring compliance and reducing the risk of complications.