Copyright © 2007 Lippincott Williams & Wilkins. Diabetes in my family Slide 1 My grandmother was a...
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Transcript of Copyright © 2007 Lippincott Williams & Wilkins. Diabetes in my family Slide 1 My grandmother was a...
Copyright © 2007 Lippincott Williams & Wilkins.
Diabetes in my family
Slide 1
My grandmother was a Type 2 Diabetic.
My husband’s cousin is a Type 1 Diabetic
Copyright © 2007 Lippincott Williams & Wilkins.
Slide 2
Timby/Smith: Introductory Medical-Surgical Nursing, 9/e
Chapter 57: Caring for Clients With Diabetes Mellitus
Copyright © 2007 Lippincott Williams & Wilkins.
Slide 3
Copyright © 2007 Lippincott Williams & Wilkins.
Slide 4
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Slide 5
Diabetes Mellitus
Prediabetes MellitusCan lead to
Type 2 diabetesHeart diseaseStroke
Impaired fasting glucose (IFG)
100 to 125 mg/dL Impaired glucose tolerance (IGT)
140 to 199 mg/dL
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Slide 6
Diabetes Mellitus
Hyperglycemia Associated: Other disorders; their managementPancreatitis; adrenocortical hormones
Pathophysiology and Etiology Type 1 diabetes mellitus (IDDM)
Juvenile diabetes; no insulin producedLipolysis; ketones; ketoacidosisAutoimmune disorder
Type 2 diabetes mellitus (NIDDM)Insulin resistant; insufficient insulin; inherited
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Slide 7
Diabetes Mellitus
Pathophysiology and EtiologyType 2 diabetes mellitus (NIDDM) (cont’d)
Obesity—trigger; glycosuria; impaired renal threshold; ketonemia; Kussmaul respirations
Assessment Findings Signs and symptoms
Polyuria; polydipsia; polyphagia; weight loss; dehydration; blurred vision; thirst; infections: Skin, urinary tract, vaginal
Diagnostic findingsUrinary tests; blood tests; glucometer; hemoglobin A1c test
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Slide 8
Diabetes Mellitus
Medical Management Depends on type of diabetesDiet and weight loss: Major component of treatmentExercise
Reduces need for insulin Improves blood circulation
InsulinTypes of insulin
Human; beef and porkAlternatives to injection
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Slide 9
Diabetes Mellitus
Medical Management Insulin (cont’d)
Administration of insulin
Dosage: u-100; typeIV; subcutaneous; lipoatrophy; lipohypertrophyInsulin pen Jet injector Insulin pump
Figure 57-8 Absorption of
Insulin through
(A) A needle (B) Jet Injector
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Slide 10
Diabetes Mellitus
Medical Management Oral antidiabetic agents-type 2
1.Sulfonylureas and meglitinidesSAM- insulin releaser 2.Biguanides and thiazolidinediones BAT- insulin sensitizer (GI complications)3.Alpha-glucosidase inhibitors (balancer)-glucose formation is slowed, 15 mintues AC *interferes with conversion of Carbs, can not give juice must give glucose tablets or injection
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Pancreas transplantation- Life long Immunosuppressant drugs
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Islet Cell Transplantation2 pancreas, pigs, used in 12hours, no steroids with immunosuppressant drugsVery little Insulin/can eat whatever!
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Slide 13
Diabetes Mellitus
Nursing Management History: medical; drug; allergy; familyWeight; head-to-toe physical examination; vital signsObserve for physical changes; edema; visual changesClient and family education
DietTreatment: Insulin administration; blood glucose monitoring; urine testing; rotation of injection sites
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Slide 14
Diabetes Mellitus
Nursing Management Client and family education (cont’d)
Exercise; weight reduction Drinking adequate water; skin care; foot care Signs and symptoms of hyperglycemia and hypoglycemiaIntegration of dietary exchange list
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Slide 15
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Slide 16
Acute Complications of Diabetes Mellitus: Diabetic Ketoacidosis (DKA) Pathophysiology and Etiology
Brittle diabetes; noncompliance with treatment; infection Acidotic state; coma
Assessment FindingsWeakness; thirst; anorexia; vomiting; drowsiness; abdominal pain; Kussmaul respirations; low BPBlood glucose; urine test; laboratory tests; blood pH
Copyright © 2007 Lippincott Williams & Wilkins.
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Acute Complications of Diabetes Mellitus: Diabetic Ketoacidosis
Medical ManagementMain goals
Reduce the elevated blood glucoseCorrect fluid and electrolyte imbalancesClear the urine and blood of ketones
IV Insulin; glucoseIsotonic fluidPotassium replacements
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Slide 18
Acute Complications of Diabetes Mellitus: Diabetic Ketoacidosis
Nursing ManagementMonitor
IV infusions; vital signs; urinary output
CheckSerum electrolyte findings; blood glucose level
Check forKetones; hyperkalemia
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Slide 19
Acute Complications of Diabetes Mellitus: Hyperosmolar Hyperglycemic Nonketotic Syndrome Pathophysiology and Etiology
Results from serious illness; diuresis; blood glucose >500; pH normal range
Assessment Findings Hypotension; mental changesExtreme thirst; dehydration; tachycardiaFever; neurologic signsPhysical examination; blood glucoseSerum potassium; sodiumSerum osmolarity
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Slide 20
Acute Complications of Diabetes Mellitus: Hyperosmolar Hyperglycemic Nonketotic Syndrome Medical Management
Insulin administration; correction of fluid and electrolyte imbalances; CVP
Nursing Management Assess for electrolyte imbalancesBlood glucose levels Implement medical orders for insulin Evaluate hydration status; skin turgor; vital signs; electrolyte studies Observe neurologic, cognitive symptoms
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Slide 21
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Slide 22
Long-Term Complications of Diabetes
Tissue or Organ Affected
What Happens Complications
Blood vessels Fatty material (atherosclerotic plaque) builds up and blocks large or medium-sized arteries in the heart, brain, legs, and penis.The walls of small blood vessels are damaged so that the vessels do not transfer oxygen to tissues normally, and the vessels may leak.
Poor circulation causes wounds to heal poorly and can lead to heart disorders, strokes, gangrene of the feet and hands, erectile dysfunction (impotence), and infections.
Eyes The small blood vessels of the retina are damaged.
Decreased vision and, ultimately, blindness occur.
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Slide 23
Kidney Blood vessels in the kidney thicken.Protein leaks into urine.Blood is not filtered normally.
The kidneys malfunction, and ultimately, kidney failure occurs.
Nerves Nerves are damaged because glucose is not metabolized normally and because the blood supply is inadequate.
Legs suddenly or gradually weaken.People have reduced sensation, tingling, and pain in their hands and feet.
Autonomic nervous system
The nerves that control blood pressure and digestive processes are damaged.
Swings in blood pressure occur.Swallowing becomes difficult.Digestive function is altered, and sometimes bouts of diarrhea occur.Erectile dysfunction develops.
Skin Blood flow to the skin is reduced, and sensation is decreased, resulting in repeated injury.
Sores and deep infections (diabetic ulcers) develop.Healing is poor.
Blood White blood cell function is impaired.
People become more susceptible to infections, especially of the urinary tract and skin.
Connective tissue
Glucose is not metabolized normally, causing tissues to thicken or contract
Carpal tunnel syndrome and Dupuytren's contracture develop
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Slide 24
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Slide 25
Acute Complications of Diabetes Mellitus: Hypoglycemia
Pathophysiology and Etiology Hyperinsulinism—blood glucose <60 mg/dLContributing factors: Diet; exercise; alcohol
Assessment Findings Signs and symptoms: Nausea; drowsiness; hunger; malaise; excessive perspiration; confusion; coordination difficulty; personality or behavior changesDiagnostic findings: Symptoms; history; blood glucose levels; glucometer test
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http://www.youtube.com/watch?v=zLrsCnBvQFo
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Slide 27
Acute Complications of Diabetes Mellitus: Hypoglycemia
Medical Management Administration of 15 to 20 g of simple carbohydrate as soon as possibleGlucagon; IV administration of 50% glucoseComplex carbohydrates
Nursing Management Oral source glucose-conscious clientImplements medical orders for parenteral medicationsMonitor blood glucose levelMeasures to prevent hypoglycemia
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Slide 28
Chronic Complications of Diabetes Mellitus: Peripheral Neuropathy Pathophysiology and
Etiology Poor glucose control; decreased blood circulation to nerve tissue Motor neuropathy; sensory neuropathy; autonomic neuropathy
Assessment Findings Signs and symptoms: Pain; swollen feet
Figure 57-8 Neuropathic ulcers occur on pressure
points
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Slide 29
Chronic Complications of Diabetes Mellitus: Peripheral Neuropathy Assessment Findings
Signs and symptoms: Disturbing sensations; digestive, urinary, and sexual dysfunction; dizziness; smaller skeletal musclesDiagnostic findings: Neurologic examination; screening test; electromyography
Medical Management Diet; exercise; pain relief measuresDrug therapy; antibiotic therapyDrugs to reverse diabetic neuropathies
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Slide 30
Chronic Complications of Diabetes Mellitus: Peripheral Neuropathy Nursing Management
Teaching plan: Management; potential complicationsFoot carePrecautions for autonomic neuropathy, digestive problems Compliance with prescribed medications and dosageReferral to urologist
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Slide 31
Chronic Complications of Diabetes Mellitus: Diabetic Nephropathy Pathophysiology and Etiology
Glomerular deterioration; five stages Assessment Findings
Swollen feet and handsGradually increasing BPTirednessWeaknessUrinalysisSerum creatinine testRenal creatinine clearance test
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Slide 32
Chronic Complications of Diabetes Mellitus: Diabetic Nephropathy Medical Management
Control blood glucose levels, hypertension Drug therapy; Dietary protein reduction; smoking cessation
Nursing ManagementMonitor blood glucose and hemoglobin A1c resultsCheck for albuminuria Smoking cessation measuresExplain the therapeutic regimen
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Slide 33
Chronic Complications of Diabetes Mellitus: Diabetic Retinopathy Pathophysiology and Etiology
Vascular changes in retina Types
NonproliferativeProliferative—blindness
Assessment Findings Diminished visual acuityOpthalmic examination; fluorescein angiography
Figure 57-11 Top: In the normal eye Bottom: In diabetic retinopathy
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Slide 34
Chronic Complications of Diabetes Mellitus: Diabetic Retinopathy Medical Management
Laser photocoagulation; vitrectomy; ACE inhibitor
Nursing ManagementEncourage therapeutic regimen for tight glucose controlClient education
Complications of diabetes Regular ophthalmic examinationsMedication
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Slide 35
Copyright © 2007 Lippincott Williams & Wilkins.
Slide 36
Chronic Complications of Diabetes Mellitus: Vascular Disturbances Pathophysiology and Etiology
Thickening of arterial walls; coronary artery disease Insensitivity to leptin; hyperlipidemia
Assessment Findings Cool extremities; leg crampsGangrene; skin ulcers; myocardial infarctions Laboratory tests; angiographyDoppler ultrasonic flow studies
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Slide 37
Chronic Complications of Diabetes Mellitus: Vascular DisturbancesMedical and Surgical Management
Lipid-lowering measures; vasodilatorsPlatelet aggregation reduction drugsAmputationInsulin; antidiabetic drugs
Nursing ManagementRelated to
Type of vascular disturbance Client’s signs and symptoms
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Slide 38
General Considerations
Nutritional ConsiderationsNutrition therapy: Cornerstone of treatment Diet depends on the type of diabetesIndividualized meal plansExchange lists to simplify meal planningConsistency in the total amount of carbohydrate consumed influences blood glucose level
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Slide 39
General Considerations
Pharmacologic ConsiderationsProperties of insulin: Onset; peak; duration Clients may be sensitive to minute insulin dose changesInsulin; oral antidiabetic drugs: Control hyperglycemia, but do not cure diabetesOral antidiabetic drugs along with insulin therapy decreases the incidence of hypoglycemia (with IDDM)
Copyright © 2007 Lippincott Williams & Wilkins.
Slide 40
General Considerations
Gerontologic ConsiderationsProvide sufficient time, instruction, and assistance to learn self-careActive involvement of client and familyPlan meals and treatment based on eating and sleeping habits of older adults Emphasize foot care Review all drugs for any that may interact with oral antidiabetic drugs
Copyright © 2007 Lippincott Williams & Wilkins.
Slide 41
End of Presentation