Diabetes objectives PDF

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Diabetes Mellitus 

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Describe the pathophysiology and clinical manifestations of diabetes mellitus  Improper metabolism of carbohydrates, fats and proteins  Abnormal insulin production  Impaired insulin utilization  Elevated blood glucose, called hyperglycemia  Current theories link the causes of diabetes to genetic, autoimmune, and environmental factors Differentiate between type 1 and type 2 diabetes mellitus  Type 1 diabetes i. Type I diabetes is characterized by the absence of endogenous insulin. ii. Type I diabetes is an autoimmune disorder, in which the body develops antibodies against insulin and/or pancreatic B-cells that produce insulin. This eventually results in not enough insulin for a person to survive. iii. Rapid onset, manifestations are acute: 1. 3 P’s a. Polydipsia (excessive thirst) b. Polyuria (frequent urination) c. Polyphagia (excessive hunger) iv. Will require exogenous insulin for the rest of their life. v. No cure.  Type 2 diabetes i. The most prevalent type of diabetes, accounting for approximately 90% to 95% of patients with diabetes ii. Type 2 is characterized by a combination of inadequate insulin secretion and insulin resistance. Pancreas usually produces some endogenous insulin however the body either does not produce enough insulin or does not use it effectively, or both. iii. Usually controlled with diet and exercise, although may need insulin at times. iv. Manifestations:  3 P’s  Fatigue  Recurrent infections  Candida infections  Prolonged wound healing  Visual changes v. No cure. Describe the interprofessional care of a patient with diabetes mellitus  Goal of diabetes management is to reduce symptoms, promote well-being, prevent acute complication related to hyper- and hypoglycemia, and prevent or delay the onset and progression of long-term complications.

Diabetes is a chronic disease that requires daily decisions about food intake, blood glucose monitoring, medication, and exercise. Patient teaching which enables the patient to become the most active participant his or her own care, is essential to achieve glycemic goals. i. ALL individuals with Type I diabetes require insulin Describe the role of nutrition and exercise in the management of diabetes mellitus  Individualized nutrition therapy, consisting of counseling, education, and ongoing monitoring, is a cornerstone of care for people with diabetes and prediabetes.  Type I i. Nutrition 1. Base their meal planning on usual food intake and preferences balanced with insulin and exercise patterns. Patient coordinates insulin dosing with eating habits and activity pattern in mind.  Type II i. Nutrition 1. Emphasizes achieving glucose, lipid, and BP goals. Weight loss is recommended for all individuals with diabetes who are overweight or obese. 2. Nutritionally adequate meal plan with appropriate serving sizes, a reduction of saturated and trans fats, and low carbohydrates can decrease calories consumption.  Exercise i. Regular consistent exercise is an essential part of diabetes and prediabetes management. ii. ADA recommends 150 min/wk (30 mins, 5 days/week) iii. Any new exercise program for patients with diabetes can be started after medical clearance. Discuss the nursing management of a patient with newly diagnosed diabetes mellitus  Ineffective health management related to deficient knowledge of diabetes management and lack of understanding of diabetes management plan  Risk for unstable blood glucose levels relate to infrequent blood glucose monitoring and of following diabetes management plan  Risk for injury related to decreases tactile sensation, episodes of hypoglycemia  Risk for peripheral neurovascular dysfunction related to vascular effects of diabetes  Your role in health promotion is to identify, monitor, and teach the patient at risk for diabetes. Describe the nursing management of a patient with diabetes mellitus in the ambulatory and home care settings  The goals of diabetes self-management education are to match the level of selfmanagement to the patient’s individual ability so that he or she can become the most active participant possible. Relate the pathophysiology of acute and chronic complications of diabetes mellitus to the clinical manifestation 

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Acute Complications  Diabetic ketoacidosis (DKA) is a life-threatening condition caused by a profound deficiency of insulin. It is characterized by hyperglycemia, ketosis, acidosis, and dehydration. It is most likely to occur in people with type 1 diabetes as compared to type 2. (can be seen in type 2 too)  Hyperosmolar hyperglycemic syndrome (HHS) is a life-threatening syndrome that can occur in the patient with diabetes who is able to produce enough insulin to prevent DKA but not enough to prevent severe hyperglycemia, osmotic diuresis, and extracellular fluid depletion.  Hypoglycemia, or low blood glucose, occurs when there is too much insulin in proportion to available glucose in the blood.  Hypoglycemia is often related to a mismatch in the timing of food intake and the peak action of insulin or oral hypoglycemic agents that increase endogenous insulin secretion.  A critical role of the nurse is the prompt recognition of hypoglycemia and the initiation of appropriate treatment dependent on the patient’s status. Chronic complications  Chronic complications primarily include end-organ disease from damage to blood vessels from chronic hyperglycemia. These are divided into two categories: macrovascular complications and microvascular complications.  Macrovascular complications are diseases of the large and medium-sized blood vessels (heart, peripheral vascular system, and brain) that occur with greater frequency and with an earlier onset in people with diabetes.  Microvascular complications effect the tiny vessels of the eyes, kidneys, and nerves. They result from several pathways, all, in response to chronic hyperglycemia.  Diabetic retinopathy refers to the process of microvascular damage in the retina because of chronic hyperglycemia. There are two types: proliferative and nonproliferative. Because the earliest and most treatable stages produce no vision changes, teach patients with diabetes to have an annual dilated eye examination.  Diabetic nephropathy is a microvascular complication associated with damage to the small blood vessels that supply the glomeruli of the kidneys. Teach patients to get screened annually for albuminuria. A measurement of albumin-creatinine ratio from a urine specimen may also be done to assess renal function.  Diabetic neuropathy is nerve damage that occurs because of the metabolic derangements associated with diabetes mellitus. 60-70% of patients with diabetes have some form of neuropathy. The two major categories of diabetic neuropathy are sensory neuropathy, which affects the peripheral nervous system, and autonomic neuropathy.  The most common form of sensory neuropathy is distal symmetric neuropathy, which affects the hands and/or feet bilaterally.  Autonomic neuropathy can affect nearly all body systems and lead to hypoglycemic unawareness, delayed gastric emptying (gastroparesis), constipation, diarrhea, urinary retention, and sexual dysfunction.

Complications of the Feet and Lower Extremities  Foot complications are one of the most common causes of hospitalization in the person with diabetes. Sensory neuropathy is a major risk factor for lower extremity amputation.  Proper care of foot ulcers is critical to prevent infections.  Because of the loss of protective sensations, proper care of the feet in patients with diabetes is critical. Integumentary Complications  Up to two thirds of patients with type 1 and type 2 diabetes develop diabetes-related skin problems. Common skin complications include acanthosis nigricans, dermatopathy, and necrobiosis lipoidica diabeticorum.  Because skin is prone to injury, special care must be taken to protect it from injury and ulceration. Infection  A patient with diabetes is more susceptible to infections due to a defect in the mobilization of inflammatory cells and impaired phagocytosis by neutrophils and monocytes.  Antibiotic therapy for infections, which must be prompt and vigorous, has prevented infection from being a major cause of death in patients with diabetes. Psychosocial Considerations  Patients with diabetes have increased rates of mental health disorders, particularly depression. Assess patients for the signs and symptoms of depression at each visit.  Individuals with type 1 diabetes, particularly young women, have an increased risk of developing an eating disorder in comparison to people without diabetes. Open and collaborative communication is critical for identifying these behaviors early.   Explain the interprofessional care and nursing management of a patient with acute and chronic complications of diabetes mellitus 

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Nursing responsibilities for the patient receiving insulin include proper administration, assessment of the patient’s response to insulin therapy, and teaching of the patient regarding administration of, storage, adjustment to, and side effects of insulin, particularly recognition and management of hypoglycemia. Proper administration and assessment of the patient’s use of and response to oral and noninsulin injectable agents, as well as teaching the patient and family about these drugs, are all part of the nurse’s role. The goals of diabetes self-management education are to enable the patient to become the most active participant in his or her care, while matching the level of selfmanagement to the ability of the individual patient....