The clinical manifestation that would alert the nurse to decreased kidney function in a patient with DM is the presence of protein in the urine. This is known as proteinuria, and it indicates that the kidneys are not functioning optimally. When the kidneys are damaged, they may leak protein into the urine instead of keeping it in the bloodstream where it is needed for various functions in the body.
1. Urine specific gravity (SG) of 1.033: This can indicate the concentration of the urine, but it alone is not a specific indicator of decreased kidney function. It may be influenced by factors such as hydration status.
2. Elevated capillary blood glucose (BG) level: This is a common symptom in diabetes mellitus and is not a direct indicator of kidney function. High blood glucose levels can lead to various complications, including kidney damage over time.
3. Presence of ketone bodies in the urine: Ketones in the urine can indicate a state of ketosis, which occurs when the body is using fat for energy instead of glucose. While ketones in the urine are important to monitor in diabetic patients, they are not a direct indicator of decreased kidney function.
In summary, among the given options, the presence of protein in the urine (proteinuria) is the most specific clinical manifestation that would alert the nurse to decreased kidney function in a patient with diabetes mellitus.
