nursingcareofptwithdiabetes.ppt

7/23/2019 nursingcareofptwithdiabetes.ppt

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Diabetes MellitusDiabetes Mellitus

Definition: metabolic disorder

characterized by hyperglycemia due to

an absolute or relative lack of insulin or

to a cellular resistance to insulin

Major classifications

1. Type 1 Diabetes

2. Type 2 Diabetes


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mpact on health of !mericanpopulation

1. "i#th leading cause of death due tocardiovascular effects resulting in atherosclerosis$coronary artery disease$ and stroke

2. %eading cause of end stage renal failure

&. Major cause of blindness '. Most fre(uent cause of non)traumatic

amputations


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Diabetes Mellitus

*. Diabetes affects estimated 1*.+ million

people ,1-.& million are diagnosed *.'

million are undiagnosed/

0. ncreasing prevalence of Type 2 Diabetesin older adults and minority groups ,!frican

!merican$ !merican ndian and ispanic

populations/

+. stimated 11 3 of older 4. ". population

,0* 5 +'/ have diabetes


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Diabetes Type 1

Definition

1. Metabolic condition in 6hich the beta cells ofpancreas no longer produce insulin characterizedby hyperglycemia$ breakdo6n of body fats andprotein and development of ketosis

2. !ccounts for * 5 1- 3 of cases of diabetes mostoften occurs in childhood or adolescence

&. 7ormerly called 8uvenile)onset diabetes orinsulin)dependent diabetes ,DDM/


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9athophysiology 1. !utoimmune reaction in 6hich the beta cells that

produce insulin are destroyed 2. !lpha cells produce e#cess glucagons causing

hyperglycemia

isk 7actors 1. ;enetic predisposition for increased susceptibility

%! linkage

2. nvironmental triggers stimulate an autoimmuneresponse a.


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Manifestations

1.9rocess of beta cell destruction occurs

slo6ly hyperglycemia occurs 6hen ?-5 @-3 is destroyed often trigger

stressor event ,e. g. illness/


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Diagnostic tests

a. =lood glucose greater than 2*- mgAd%

b. =lood p less than +.&

c. =lood bicarbonate less than 1* m(A% d. etones present in blood

e. etones and glucose present in urine

f. lectrolyte abnormalities ,Ea$ $ >l/ ;. serum osmolality F &*- mosmAkg ,normal

2?-)&--/


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Diabetes Mellitus

D!

"igns and symptoms

ussmals respirations

=lo6 off carbon dio#ide to reverse acidosis

7ruity breath

EauseaA abdominal pain

Dehydration

%ethargy

>oma

9olydipsia$ polyuria$ polyphagia


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Treatment

a. e(uires immediate medical attention and usuallyadmission to hospital

= .7re(uent measurement of blood glucose and treataccording to glucose levels 6ith regular insulin ,mildketosis$ subcutaneous route severe ketosis 6ithintravenous insulin administration/

c. estore fluid balance: initially -.@3 saline at *-- 5

1--- m%Ahr. regulate fluids according to clientstatus 6hen blood glucose is 2*- mgAd% addde#trose to intravenous solutions


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Diabetes Mellitus

D!

d.>orrect electrolyte imbalance: client often is

initially hyperkalemic

!s patient is rehydrated and potassium in pushed backinto the cell they become hypokalemic

Monitor levels

e. Monitor cardiac rhythm since hypokalemia puts

client at risk for dysrrhythmias

f. Treat underlying condition precipitating D!

;. !cidosis is corrected 6ith fluid and insulin

therapy and rarely needs bicarb


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Diabetes Type 2

!. Definition: condition of fastinghyperglycemia occurring despite

availability of bodyGs o6n insulin =. Bas kno6n as non)insulin

dependent diabetes or adult onset

diabetes =oth are misnomers$ it can be found in

children and type DM may re(uire insulin


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Diabetes Mellitus

"yndrome I or Metabolic "yndrome >hronic$ lo6 grade inflammatory process

;ives rise to diabetes type 2$ ischemic heartdisease$ left ventricular hypertrophy

;roup of disorders 6ith insulin resistance as themain feature

ncludes Cbesity especially around the 6aist and abdomen

%o6 levels of physical activity igh blood pressure

ncreased blood cholesterol ,high %D%$ lo6 D%$ hightriglycerides


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9athophysiology a. yperglycemia leads to increased urine output and

dehydration b. idneys retain glucose glucose and sodium rise

c. "evere hyperosmolar state develops leading tobrain cell shrinkage

Manifestations a. !ltered level of consciousness ,lethargy to coma/

b. Eeurological deficits: hyperthermia$ motor andsensory impairment$ seizures

c. Dehydration: dry skin and mucous membranes$e#treme thirst, tachycardia$ polyuria$ hypotension


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Diabetes Mellitus

=. ypoglycemia ,insulin reaction$

insulin shock$ Jthe lo6sK/: lo6 blood

sugar

1.Mismatch bet6een insulin dose$

carbohydrate availability and e#ercise

2.May be affected by intake of alcohol$

certain medications


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Treatment for severe hypoglycemia is oftenhospitalization

a. >lient is unresponsive$ has seizures$ or has alteredbehavior blood glucose level is less than *- mgAd%

b. f client is conscious and alert$ administer 1* gm ofsugar

c. f client is not alert$ administer 1. 2* 35 *-3 solution of glucose intravenously$

follo6ed by infusion of *3 de#trose in 6ater

2. ;lucagon 1 mg by subcutaneous$ intramuscular$or intravenous route follo6 6ith oral or intravenouscarbohydrate

d. Monitor client response physically and also bloodglucose level


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>lassifications and actiona."ulfonylureas

1. !ction: "timulates pancreatic cells to

secrete more insulin and increasessensitivity of peripheral tissues to insulin

2. 4sed: to treat non)obese Type 2diabetics

&. #ample: ;lipizide ,;lucotrol/$>hlorpropamide ,Diabinese/$ Tolazamide,Tolinase/


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Diabetes Mellitus

b.Meglitinides

1. !ction: stimulates pancreatic cells to

secret more insulin

2. Taken just before meals$ rapid onset$limited duration of action

&. Major adverse effects is hypoglycemia

'. 4sed in non)obese diabetics *. #ample: epaglinide ,9randin/$

Eateglinide ,"tarli#/


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Eursing >are !. !ssessment$ planning$ implementation 6ith

client according to type and stage of diabetes =. 9revention$ assessment and treatment of

complications through client self)management andkeeping appointments for medical care >. >lient and family teaching for diabetes

management D. ealth promotion includes education of healthy

life style$ lo6ering risks for developing diabetes forall clients . =lood glucose screening at & year intervals

starting at age '* for persons in high risk groups


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Diabetes Mellitus

>. isk for injury: 9revention of accidents$falls and burns

D. "e#ual dysfunction

1. ffects of high blood sugar on se#ualfunctioning$

2. esources for treatment of impotence$se#ual dysfunction

.neffective coping 1. !ssisting clients 6ith problem)solving

strategies for specific concerns


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nursingcareofptwithdiabetes.ppt