Diabetis Mellitus - diabetes nurse teachings PDF

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Instructed regarding proper blood sugar testing via finger-stick, by using different fingers on a daily basis to prevent tissue damage, by using aseptic techniques. Instructed regarding Diabetes Mellitus Disease process, signs and symptoms, nature of the disease, cause and diabetic precautions, explained the role of insulin in metabolic process of breaking down polysaccharides and the consequences of its over- or under- production by pancreas. Instructed regarding s/s of hyperglycemia such as polyuria, polydipsia, fatigue, malaise, drowsiness, anorexia, headache, abdominal pains, muscle cramps, nausea, vomiting, and blurred vision, hypotension, weak thread pulse, fruity acetone breath at later stages, stupor, and coma. Instructed regarding s/s of hypoglycemia, including pale, moist skin, tremors, weakness, perspiration, SOB, dry mouth, slurred speech, instructed on the first actions, including having a glass of orange juice, candy or pepsi immediately, taking a rest and checking BS q 15-20 minutes, emphasized the importance of having orange juice in the refrigerator at all times in case of hypoglycemic reaction. Instructed regarding diabetic diet and proper nutrition, including having small, frequent, balanced meals w/ low sugars and carbohydrates. Instructed not to overdose the insulin and not to change the brand before consulting the physician. Instructed regarding correct insulin withdrawal, correct angle, needle size and dosage by using aseptic technique. Instructed regarding sliding scale, including having sliding scale written and placed on most seen place to remind constantly to health care provider w/ the emergency phone numbers. Instructed regarding proper insulin storage in the refrigerator, not in the freezer and to watch for expiration date on the vial. Instructed regarding proper insulin preparation, including gentle rolling of insulin bottle between palms prior to withdrawal for a few seconds, then cleansing the top with alcohol pad/swab, withdrawing insulin in inverted, upright position, proper calibration of insulin syringe, then removing excess air and administering the medication. Instructed regarding rotation of insulin injection sites subcutaneous only to prevent lip dystrophy and proper disposal of sharps and needles into the red sharps container. Instructed that development of any sore, wound, changes in color of any digits/toes/fingers and any sign of numbness of lower and upper extremities must be reported to MD/SN immediately. Instructed regarding complications such as diabetic retinopathy or development of very poor eyesight, which may lead to blindness if not detected and treated early. Instructed regarding monthly MD follow-up visit to appropriately monitor blood sugar level and treat or change insulin dosages/brand if needed. Instructed regarding hypoglycemic oral medications compliance on a daily basis as an important part of Diabetes Mellitus management/treatment. Instructed regarding proper calibration and cleaning of glucometer every week or as needed, battery check and replacement, proper storage when not in use to maintain accurate results of blood sugar levels. Instructed regarding the importance of daily tolerable exercises combined with dietary regimentation as essential part of Diabetic management as well as to promote good well-being, optimal body functioning contributing to adequate glucose utilization combined with insulin management. Instructed regarding the importance of rest periods between exercises, range of motion and prescribed - 1500, 1800, 2000 calorie ADA diet, w/2GM Na, low cholesterol, fat and adequate fluid hydration. Instructed regarding infection control, universal precautions and measures to prevent of any acquired infections. Instructed regarding proper skin care, maintaining good skin integrity with daily personal hygiene, personal care, foot care, including pedicure/manicure, avoiding cutting nails, and bare foot walking, wearing well fitting shoes and socks at all times to prevent accidental injury and infection. Instructed to report to MD of unusual weight changes within short periods of time such as 10 lbs weight loss/gain within one week period. Instructed that daily activity modification such as activities causing dizziness, severe pain should be modified to prevent any exacerbation.

23. Instructed regarding proper eye care and annual eye screening test with eye doctor to determine initial signs and symptoms of diabetic retinopathy and blindness. 24. Instructed regarding proper use of prescribed oral hypoglycemic or a/diabetic agents and diabetic diet as an important part of diabetic regimen. 25. Instructed regarding the use of diabetic medical alert bracelet for immediate identification of patient’s condition in case of emergency outside of patient’s home when no available family member who knows the patient’s condition is present. 26. Instructed regarding the importance of regular MD follow up visits to determine client’s response to the oral hypoglycemic treatment. 27. SN instructed Pt/pcg about Diabetes Mellitus Disease process, signs and symptoms, and nature of the disease. Verbalizes understanding. 28. SN instructed pt/pcg about proper blood sugar testing by finger stick, using different fingers on a daily basis, using aseptic techniques. 29. SN instructed pt/pcg signs and symptoms of hypoglycemia; sweating, tremors, pallor, tachycardia, palpitation, headache, lightheadedness, confusion, nervousness, slurred speech, lack of coordination staggering gait, double vision, drowsiness and possible convulsions and coma if not immediately treated. 30. SN instructed pt/pcg emergency treatment of hypoglycemia; one glass of orange juice, 1-2 tsp. of sugar stirred to mixture and immediately administered, then follows up with early meal served. 31. SN explained demonstrated pt/pcg and gave a Handout with pictures and signs of hypoglycemia which has been translated in Armenian already. 32. SN instructed pt./pcg other symptoms of hyperglycemia such as hypotension, weak thready pulse, fruity acetone breath and later stages, stupor and coma. Pt. instructed if this s/sx occurs seeks prompt med. attention. 33. SN explained demonstrated pt/pcg and gave a Handout with the pictures and signs of hyperglycemia which has been translated in Armenian already. 34. Pt/pcg. has been instructed by SN about correct insulin withdrawal, drawing the Regular insulin/short acting/ clear insulin first before the longer/intermediate acting or less clear insulin to avoid contaminating the vial, if this is indicated with sliding scale insulin mixture. 35. SN instructed pt/pcg about proper insulin storage either at room temperature or in the refrigerator, not in the freezer. 36. SN instructed pt/pcg about sliding scale numbers and be able to repeat the parameters and taped a very large written sliding scale in front of pt’s refrigerator with the exact name of the insulin MD’s phone and family members phone number. 37. SN instructed pt/pcg proper insulin preparation, gently rolling of insulin bottle between palms prior to withdrawal for few second, then cleanse top with alcohol pad/swab, withdrawing insulin in inverted upright position. 38. SN instructed pt/pcg: not to change the dosage, strength, brand, or mixture of insulin without consulting the physician and notifying the nurse. 39. Pt/pcg has been instructed by SN about rotation of insulin injection sites subcutaneously only to prevent lip dystrophy. SN noted return demonstration. 40. SN instructed Pt/pcg regarding precaution when taking insulin such as limit cigarette smoking because it decreases the amount of insulin absorbed when given SQ. avoid alcohol and aspirin, which may increase effect of insulin. 41. SN informed pt/pcg never omit meals, carry a snack at all times in case of low blood sugar, wear medical identification bracelet, keep follow-up appointments with physician and laboratory. 42. SN instructed pt/pcg about diabetic diet, proper nutrition, and three well spaced meal and one snack at night, there should be no more than 5 to 6 hours of mealtime apart during the day and no more than 12 hours after the last meal or snack until breakfast the following day. 43. SN instructed on safety procedures for accidental insulin overdose. Overdose is manifested by symptoms of hypoglycemia. Mild hypoglycemia may be treated by ingestion of oral glucose. Severe hypoglycemia is a life threatening emergency, call 911; treatment consists of IV glucose, glucagons, or epinephrine. 44. SN instructed pt/pcg the importance of Diabetic diet: Instructed also re: NO CONCENTRATED SWEES such as ice cream, chocolates, etc. Emphasize the importance of having emergency orange

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juice in the refrigerator and hard candies in their bags when pt. travels or when hypoglycemia occurs. Instructed Pt/pcg by SN to eat appropriate amount of nutrients such as 60% carbohydrates (at least 50% complex carbohydrates), 20% proteins, 20% fats (at least 15 polyunsaturated fats). SN instructed pt/pcg about prescribed diet, 1800, calorie ADA diet, with 2GM Na, low cholesterol, low fat diet if there is hypertension and left sample menu to patients home. SN instructed pt/pcg regarding of adequate fluid hydration, low glucose soups, water, and milk, tea broth to maintain tissues/cells integrity and improve body resistance. SN instructed pt/pcg the importance of daily tolerable exercises combined with dietary regimentation as essential part of Diabetic management to promote good well being. SN instructed pt/pcg the importance of rest periods between exercises, range of motion exercises. Instructed pt. to check the blood glucose before exercise and have someone to stay with her during exercise. SN informed ptpcg regarding of proper disposal of sharps and needles into the red sharps guard container and when its time to collect, only by the SN and must not be thrown into the garbage can. SN instructed pt/pcg to report development of any sore, wound, changes in color of any digits/toes/fingers and any sign of numbness of lower and upper extremities to MD/SN immediately. SN informed pt/pcg to be careful during of any acute illness such as ordinary colds, flu, etc. be careful because Diabetes is very hard to control in these days. These days called SICK DAY ROUTINES. Pt has been instructed by SN about Diabetic complications such as; diabetic retinopathy or degeneration/development of very poor eyesight which may lead to blindness if not detected and treated early. SN instructed pt/pcg about proper skin care, maintaining good skin integrity with daily personal hygiene, personal care. SN instructed pt/pcg on the measures to protect skin in urinary incontinence. Wash skin well and pat dry after each incontinent episode. Use ointment to protect skin from moisture. SN informed Pt/pcg: DM can contribute to foot problems in 2 ways: 1. Decreased feeling in the feet, so that injuries cuts and scrapes may go unnoticed. 2. It can cause decreased circulation to the feet, resulting in a reduced blood supply that may be insufficient to fight infection and heal wounds. The risks of developing foot problems can be greatly reduced if you follow the principles of foot care. SN instructed Pt/pcg: Wash your feet everyday, use warm water, not hot and a mild soap. Don’t soak your feet. Pat your feet dry with a soft towel, making sure to dry between the toes. Don’t rub the skin vigorously. Never put cream between your toes. Use foot powder. Change stockings daily. SN instructed pt. about proper foot care, avoid nails pedicure/ manicure to prevent accidental injury and infection resulting from such. Instructed pt. on measures regarding foot care such as inspect feet daily, report any foot problems to podiatrist or physician, wash feet daily with warm soap and water, and pat dry, especially between toes, wear shoes that support and fit properly, avoid going barefooted, avoid exposing feet to extreme temperature. SN instructed pt. proper eye care and annual eye screening test with eye doctor to determine initial signs and symptoms of Diabetic retinopathy and blindness. SN instructed pt/pcg regarding preventing diabetic complications such as: Pt’s care for her eyes and teeth. Pt’s should examine her eyes by an ophthalmologict at least once a year. He may detect any damage, which can cause blindness, before symptoms appear. Informed pt. that early treatment may prevent further damage. SN instructed pt/pcg regarding of Pt’s care for her skin. Pt/pcg. Informed that breaks in her skin can increase her risk of infection. So she needs to check her skin daily for cuts and irritated areas, and see doctor if necessary. Bathe daily with warm water and a mild soap, and apply a lanolin-based lotion afterward to prevent dryness. Pat skin dry thoroughly. SN instructed pt that “Prediabetes” have impaired fasting glucose levels (100 to 125 mg/dl).They have impaired glucose tolerance(fasting glucose less than 126 mg/dl and a glucose level between 140 and 199 mg/dl 2 hours after taking an oral glucose tolerance test). Sn instructed pt that Type 2 diabetes usually occurs in adulthood. The pancreas does not make enough insulin to keep blood glucose (sugar) levels normal. Many people do not know they have this type. This type is becoming more common because of age, obesity, and a lack of exercise.

65. Sn instructed pt that Type 2 diabetes usually occurs in adulthood. The pancreas does not make enough insulin to keep blood glucose (sugar) levels normal. Many people do not know they have this type. This type is becoming more common because of age, obesity, and a lack of exercise. 66. SN instructed pt/pcg and demonstrated insulin syringe preparation. SN informed first: wash hands thoroughly, assemble equipment: syringe, insulin, alcohol. Check that you are using appropriate type of insulin and that it has not expired. Then check that you are using appropriate type of syringe. Roll insulin bottle gently to mix it. Cleanse top of bottle with alcohol. Pull plunger of syringe back the number of units of insulin to be injected, not allowing the needle to touch anything. 67. SN continued to reinforce the pt/pcg regarding proper insulin preparation, gentle rolling of insulin bottle between palms prior to withdrawal for few second, then cleanse top with alcohol pad/swab, withdrawing insulin in inverted upright position, proper calibration of insulin syringe, then remove excess air and administer only exact units ordered. PCG demonstrated to do instruction but pcg unable due to afraid to harm and not correct calibration. 68. SN continued to informed pt/pcg: Insert needle into the bottle and inject air. Invert the bottle and syringe and slowly withdraw prescribed amount of insulin, being sure the needle in under the fluid level. Check syringe for air bubbles and remove by tapping the syringe, draw up more insulin if necessary fir accurate amount. 69. SN instructed patient to Insert the needle into the bottle and inject air, Invert the bottle and syringe, and slowly withdraw prescribed amount of insulin, being sure that the needle is under the fluid level, Check the syringe for air bubbles, and remove by tapping the syringe. Draw up more insulin, and discard excess if necessary for accurate amount. 70. Sn instructed patient Verify that you are using appropriate type of syringe (only insulin syringe). Roll the insulin bottle gently to mix it, Cleanse top of bottle with alcohol, Pull plunger of syringe back the number of units of insulin to be the needle to touch anything. 71. SN instructed pt/pcg and demonstrated procedure for insulin injection. First wash hands, prepare the injection site by swabbing the center of the area with alcohol and rotating outward in a circular manner about two inches, pinch skin approximately two inches with thumb and forefinger at injection site, not touching the area that was cleaned. Inject needle into the skin using a quick, firm motion at a 90 degree angle. Inject insulin slowly into the tissue, Cover tip of needle with alcohol pat and withdraw needle, holding swab over site briefly. 72. Sn instructed patient Types of insulin are Humolog, Novolog (very short acting).The onset of action is 5 to 15 minutes, and the peak effect is after 30 to 60 Minutes, Regular (short acting). The onset of action is 30 minutes. The peak effect is after 2 to 5 hours, NPH (intermediate acting). The onset of action in 1 to 2.5 hours. The peak effect is after 8 to 14 hours, Lente (intermediate acting). The onset of action is 1 to 2.5 hours. The peak effect is after 8 to 12 hours. 73. Sn instructed patient possible adverse reactions to insulin, Hypoglycemia or low blood sugar: Headache, Sweating, Hunger, Nervousness, Weakness, Restlessness or sweating during sleep. Hyperglycemia or high blood sugar: Flushed, Dry skin, Nausea, Fatigue, Headache Dizziness, Allergic reaction (seek emergency treatment) 74. SN instructed patient list that contain about 15 grams of carbohydrate Three glucose tablets, Onehalf cup of fruit juice or regular soda, Six or seven hard candies (not sugar free), One tablespoon of honey or sugar and Go to the emergency room if symptoms persist. 75. SN instructed patient can list measures to safely use insulin pump. The insulin pump is used for continuous (24 hour) insulin delivery. The insulin pump has a pump reservoir and a computer chip that allows the user to control the exact amount of insulin being delivered and is battery operated. 76. SN instructed patient can demonstrate syringe preparation, Wash hands thoroughly, Assemble equipment: syringe, insulin, alcohol swab, Check that you are using appropriate type of insulin and that it has not expired. 77. SN instructed patient to contact your physician if you are unable to keep down food, liquids or medications, your illness lasts more than 24 hours, and you have blood sugars higher than 240 mg/ml for more than 1 day 78. SN instructed patient Monitor factors that affect amount of insulin required: 1. Follow diet closely as instructed.2. Exercise daily in constant amounts.3. Use stress management techniques.4. Obtain prompt treatment for any infections 5. Test blood sugar more frequently if a change in diet, activity, stress, illness, or infection occurs, and notify the physician.

79. SN instructed pt/pcg the two types of fiber. The fiber speeds up movement of food in bowel and promotes bowel regularity. Food sources include asparagus, peas, kidney beans, pinto beans, and whole wheat. 80. SN instructed patient on proper insulin withdrawal and SQ injection. 81. SN instructed pt/pcg the two types of fiber second type is: Soluble fiber. It slows down the movement of food and lowers cholesterol. Food sources include rolled oats, broccoli, Brussels sprouts, grape-fruit, apples, pinto and navy beans. 82. Sn instructed patient to Possible causes of hypoglycemia (low blood sugar) include the following: An excessive amount of insulin, inadequate amount of food, Excessive exercise . 83. Sn instructed patient when Low blood sugar occurs Eat some form of simple carbohydrate as soon as possible, Sources of concentrated simple carbohydrates are sweetened fruit, juice, candy, cake frosting, or glucose tablets. 84. Sn instructed patient that she can state management of diabetes during illnesses Take your insulin or oral medications, Test your blood sugar before each meal and at bedtime, follow your meal plan, if you can eat. If you are not eating, take in at least 4 ounces of sugar-containing beverage every hour. Encourage fluids to maintain hydration 85. Sn instructed patient to be aware of possible emergency complications like Diabetic hyperglycemic hyperosmolar coma is caused by complications of type 2 diabetes and extremely high blood glucose (sugar) levels without presence of ketones. 86. SN instructed patient that Diabetic ketoacidosis results from extremely high blood sugar levels causing metabolic acidosis. Symptoms are as follows: Increased thirst and urination, Nausea, Deep and rapid breathing, Abdominal pain, Sweet-smelling breath, Loss of consciousness. 87. SN instru...