Virus, toxins. Covenant School of Nursing ; N201 Fall, 2009 ; Gloria Rodriguez, MSN.RN,CDE; 2 Objectives. Insulin lowers blood glucose and facilitates a stable, normal glucose range of approximately 70 to 120 mg/dL (3.9 to 6.66 mmol/L). The two other classes are gestational diabetes and other specific types of diabetes with various causes. The disease onset in type 2 diabetes is usually gradual. Normalize insulin activity. Other hormones (glucagon, epinephrine, growth hormone, and cortisol) work to oppose the effects of insulin and are referred to as counterregulatory hormones. Frequently none, fatigue, recurrent infections. Signs and symptoms usually abrupt, but disease process may be present for several years. • Salicylates in large doses The heterogeneity of this population with regard to comorbidities and overall health status is critical to establishing personalized goals and treatments for diabetes. Kindly check your mailbox and confirm your subscription. Diabetes mellitus is the seventh leading cause of death in the United States, but it is likely to be underreported. Absent. • levodopa The disease onset in type 2 diabetes is usually gradual. What to Expect When Visiting a Clinical Hypnotherapist? However, treatment also may include oral glucose-lowering medications (taken by mouth) or insulin injections (shots). • Teach patient to use a food diary to record dietary intake for at least 2 days. In this lesson we’re going to review what happens in the patient’s body with Diabetes Mellitus, and in the next lesson we’re going to talk about what we do about it medically and in our nursing care. Collaboration examination of blood sugar with insulin therapy. Diabetes is a chronic illness that requires continuing medical care and patient self-management education to prevent acute complications and to reduce the risk of long-term complications. Obesity, lack of exercise. During this time, the patient requires little injected insulin because β-cell insulin production remains sufficient for glucose control. Nutritional therapy • exenatide (Byetta) insulin resistance, p. 1156 Describe the pathophysiology and clinical manifestations of diabetes mellitus. • Instruct patient and significant others of signs, symptoms, risk factors, and treatment of hypoglycemia to facilitate blood glucose balance Journal of diabetes science and technology, 4(3), 750-753. Below are review notes for Diabetes Mellitus to help you study for the NCLEX exam or your nursing lecture exams. The nurse’s role in teaching to promote patient management of diet, activities, and drugs for good control of diabetes is emphasized. Insulin is required to “unlock” these receptor sites, allowing the transport of glucose into the cells to be used for energy. • MODY accounts for 1% to 5% of people with diabetes. Frequent. She has great passion in writing different articles on Nursing and Midwifery. • furosemide (Lasix) Many people are diagnosed on routine laboratory testing or when they undergo treatment for other conditions, and elevated glucose or glycosylated hemoglobin (A1C or Hb A1C [not commonly used]) levels are found. Check feet to make sure there is no nerve damage or interruption of blood flow. Type 1 diabetes is an immune-mediated disease, caused by autoimmune destruction of the pancreatic β cells, the site of insulin production. Log In or Register to continue Caused by mutations in any of six MODY genes (types 1-6). impaired glucose tolerance (IGT), p. 1156 Measurement Scale Discuss the nursing management of a patient with newly diagnosed diabetes mellitus. Frequently overweight or obese. Once this occurs, the onset of symptoms is usually rapid, and patients often are initially seen with impending or actual ketoacidosis. EPOC, Effective Practice and Organization of Care; ITS, interrupted time series; Diabetes is a major and growing health care problem. Usually age 35 yr or older but can occur at any age. Plastic surgical nursing: official journal of the American Society of Plastic and Reconstructive Surgical Nurses, 11(1), 20-25. Symptoms • Monitor for signs and symptoms of hyperglycemia: polyuria, polydipsia, polyphagia, weakness, lethargy, malaise, blurring of vision, or headache to alert patient to glucose/insulin imbalance and need for treatment. Type 1 diabetes generally affects people under 40 years of age, and 40% develop it before 20 years of age. • phenobarbital • Describe the disease process. • Uses preventive measures to reduce risk of complications _____ Accounts for 5%-10% of all types of diabetes. Individuals diagnosed with prediabetes are at increased risk for the development of type 2 diabetes. Interventions (NIC) and Rationales What happens is not as important as how you react to what happens. • Monogenic (single gene). If one parent has MODY, a child has a 50% chance of developing disease. The presence of endogenous insulin is a major distinction between type 1 and type 2 diabetes. Prevalence • morphine • Recommend specialist care for thick fungal or ingrown toenails, corns, or calluses to ensure safe treatment of feet. Relate the pathophysiology of acute and chronic complications of diabetes mellitus to the clinical manifestations. Gestational diabetes develops during pregnancy and occurs in about 2% to 10% of pregnancies in the United States.7 Women with gestational diabetes have a higher risk for cesarean delivery, and their babies have increased risk for perinatal death, birth injury, and neonatal complications. Dietary management and exercise are typically the first steps toward reducing blood sugar levels. • Assist patient to accommodate food preferences into prescribed diet to improve compliance. • Marijuana Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window). • Teach patient to use a food diary to record dietary intake for at least 2 days. Gestational Diabetes. • Caution about potential sources of injury to the feet (e.g., heat, cold, cutting corns or calluses, chemicals, use of strong antiseptics or astringents, use of adhesive tape, and going barefoot or wearing thongs or open-toe shoes). Observe for the signs of infection and inflammation: fever, flushed appearance, wound drainage, purulent sputum, and cloudy urine. • phenytoin (Dilantin) 1. • Thiazide diuretics Polydipsia, polyuria, polyphagia, fatigue, weight loss. For this reason insulin is an anabolic, or storage, hormone. Those are chlopropamide, glyburide, glipizide. Describe the pathophysiology and clinical manifestations of diabetes mellitus. Differentiate between type 1 and type 2 diabetes mellitus. • Instruct individual to inspect inside of shoes daily for foreign objects, nail points, torn linings, and rough areas to avoid injury by factors that are not felt. Diabetes is the leading cause of adult blindness, end-stage kidney disease, and nontraumatic lower limb amputations. • When one identical twin gets type 2 diabetes, the other gets it about 60%-75% of the time. Required for all. • Instruct the patient on proper foot care (see Table 49-21). *Nursing diagnoses listed in order of priority. • Instruct individual to inspect inside of shoes daily for foreign objects, nail points, torn linings, and rough areas to avoid injury by factors that are not felt. • cyclosporine For this reason insulin is an anabolic, or storage, hormone. Interventions (NIC) and Rationales Four major metabolic abnormalities have a role in the development of type 2 diabetes (see Fig. Discuss the nursing management of a patient with newly diagnosed diabetes mellitus. Learning Outcomes Under normal conditions, insulin is continuously released into the bloodstream in small pulsatile increments, with increased release when food is ingested (Fig. More common in young people but can occur at any age. A genetic predisposition and exposure to a virus are factors that may contribute to the pathogenesis of immune-related type 1 diabetes. Type 2 diabetes may sometimes be controlled with a combination of diet, weight management and exercise. Discuss the nursing management of a patient with newly diagnosed diabetes mellitus. Currently in the United States an estimated 25.8 million people, or 8.3% of the population, have diabetes mellitus, and 79 million more people have prediabetes.1 Approximately 7 million people with diabetes mellitus have not been diagnosed and are unaware that they have the disease. Frequently none, fatigue, recurrent infections. If one parent has MODY, a child has a 50% chance of being a carrier. Other hormones (glucagon, epinephrine, growth hormone, and cortisol) work to oppose the effects of insulin and are referred to as counterregulatory hormones. • epinephrine • Anabolic steroids Tailor your teaching to the patient’s needs, abilities, and developmental stage. Outcomes (NOC) Risk Control The patient usually has a history of recent and sudden weight loss and the classic symptoms of, The individual with type 1 diabetes requires insulin from an outside source, In type 2 diabetes the pancreas usually continues to produce some, Four major metabolic abnormalities have a role in the development of type 2 diabetes (see Fig. • Disease is a result of complex interaction of genetic, autoimmune, and environmental factors. • Numbness _____ Mail her at. (Drugs that can alter blood glucose levels are listed in eTable 49-1 available on the website for this chapter. This NCLEX diabetes mellitus quiz will test your knowledge on the medications and nursing management of diabetes.. Diabetes mellitus is where a patient does not have sufficient amounts of insulin to use the glucose that enters the blood stream. FIG. Other Specific Types of Diabetes. Prediabetes is defined as impaired glucose tolerance (IGT), impaired fasting glucose (IFG), or both. After carbohydrate absorption from the gastrointestinal tract is complete and during the night, insulin concentrations are low and fairly constant, with a slight increase at dawn. Type 2 Diabetes Mellitus • Treats symptoms of hyperglycemia _____ Vascular and neurologic complications Share this:Click to share on Twitter (Opens in new window)Click to share on Facebook (Opens in new window)Click to share on Google+ (Opens in new window) • Risk to offspring of diabetic mothers is 1%-4%. Provide feet care (observe and investigate reports of. Persons with prediabetes usually do not have symptoms. Clinical Implications This creates a temporary state of hyperinsulinemia that coexists with hyperglycemia. Encourage patient to do some exercises to control of blood sugar. • Instruct patient on measures to prevent/minimize symptoms to promote management of disease. Related Determine patient’s/caregiver’s feelings/attitude toward prescribed diet and expected degree of dietary compliance, Assist patient to accommodate food preferences into prescribed diet, Inform the patient of the purpose for, and the benefits of, the prescribed activity/exercise, Instruct the patient how to monitor tolerance of the activity/exercise, Assist the patient to incorporate activity/exercise regimen into daily routine/lifestyle, Instruct on interaction of diet, insulin/oral agents, and exercise, Instruct patient and significant others of signs, symptoms, risk factors, and treatment of hypoglycemia, Determine recognition of hypoglycemia signs and symptoms, Instruct patient to have simple carbohydrate available at all times, Provide feedback regarding appropriateness of self-management of hypoglycemia, Monitor for signs and symptoms of hyperglycemia: polyuria, polydipsia, polyphagia, weakness, lethargy, malaise, blurring of vision, or headache, Anticipate situations in which insulin requirements will increase (e.g., intercurrent illness), Facilitate adherence to diet and exercise regimen. • Instruct the patient on proper foot care (see Table 49-21). Frequent genital infections ( Balanitis/ vaginitis). Conditions that may cause diabetes can result from damage to, injury to, interference with, or destruction of the β-cell function in the pancreas. Glucose-Raising Effect The annual cost of diabetes exceeds $174 billion, with $116 billion in direct medical costs.2 • Inspect skin for arterial ulcers or tissue breakdown to provide treatment to prevent infection and additional necrosis. The long-term complications of diabetes make it a devastating disease. 49-2). • acetaminophen (Tylenol) Teach patient to use a food diary to record dietary intake for at least 2 days. An individual with three of the five components is considered to have metabolic syndrome.6 Overweight individuals with metabolic syndrome can prevent or delay the onset of diabetes through a program of weight loss and regular physical activity. Observe of the signs of hypoglycaemia such as changes in level of consciousness; skin moist/cold, rapid pulse, hunger, sensitive to stimuli, anxiety, and headache. • tacrolimus (Prograf) Tags: Medical-Surgical Nursing Assessment and Management of Clinical P • Instruct the patient on which signs and symptoms to report to health care provider to ensure prompt treatment. 2 = Substantial Although liver cells are not considered insulin-dependent tissue, insulin receptor sites on the liver facilitate hepatic uptake of glucose and its conversion to glycogen. However, long-term damage to the body, especially the heart and blood vessels, may already be occurring. • Role of sleep in blood glucose control _____ Provide skin care: keep skin dry, gently massage bony areas. • Necrosis _____ • Recommend daily washing of feet using warm water and mild soap to remove irritants. • Tingling _____ Absent or minimal insulin production. • Instruct patient to obtain and carry/wear appropriate emergency identification. Check sign symptoms of complication diabetic effects. Limit red meat and choose nuts, whole grains, poultry or fish. Genetic mutations that lead to insulin resistance and a higher risk for obesity have been found in many people with type 2 diabetes. In type 2 diabetes the pancreas usually continues to produce some endogenous (self-made) insulin. We didn’t know she was diabetic until we went to my doctor complaining about constant foot pain. Diabetes Mellitus, medical and nursing management with its Complecations Slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. • Inform the patient of the purpose for, and the benefits of, the prescribed activity/exercise to improve commitment to activity. Accounts for 90%-95% of all types of diabetes. • Describe possible chronic complications to increase awareness of the long-term effects of disease process. A diagnosis of IGT is made if the 2-hour oral glucose tolerance test (OGTT) values are 140 to 199 mg/dL (7.8 to 11.0 mmol/L).3 IFG is diagnosed when fasting blood glucose levels are 100 to 125 mg/dL (5.56 to 6.9 mmol/L). 2. Individuals with a first-degree relative with the disease are 10 times more likely to develop type 2 diabetes. Those with prediabetes should have their blood glucose and A1C tested regularly and monitor for symptoms of diabetes, such as polyuria, polyphagia, and polydipsia. Other tissues (e.g., brain, liver, blood cells) do not directly depend on insulin for glucose transport but require an adequate glucose supply for normal function. COMPARISON OF TYPE 1 AND TYPE 2 DIABETES MELLITUS • Disease is a result of complex interaction of genetic, autoimmune, and environmental factors. 1. Only gold members can continue reading. • Reputable sources of diabetes information _____ 4 = Often demonstrated 1 = Severe deviation from normal range Caution about potential sources of injury to the feet (e.g., heat, cold, cutting corns or calluses, chemicals, use of strong antiseptics or astringents, use of adhesive tape, and going barefoot or wearing thongs or open-toe shoes). • Polygenic (>40 genes influence susceptibility). The first factor is insulin resistance, a condition in which body tissues do not respond to the action of insulin because insulin receptors are unresponsive, are insufficient in number, or both. Although the genetics of type 2 diabetes is not yet fully understood, it is likely multiple genes are involved. Predisposition to type 1 diabetes is related to human leukocyte antigens (HLAs). 5 = Consistently demonstrated • Urine glucose_____ 5 = None • Inspect skin for arterial ulcers or tissue breakdown to provide treatment to prevent infection and additional necrosis. Consult an obstetric text for more information. The nurses role include educating, assessing, planning, administering medication, and evaluating treatment. Key Terms Patient Goals  • Mutations in genes lead to β-cell dysfunction. • Barbiturates Type 2 diabetes mellitus was formerly known as adult-onset diabetes (AODM) or non–insulin-dependent diabetes (NIDDM). • Caused by mutations in any of six MODY genes (types 1-6). Verbalizes key elements of the therapeutic regimen, including knowledge of disease and treatment plan, Describes self-care measures that may prevent or decrease progression of chronic complications, Role of diet in blood glucose control _____, Strategies to increase diet adherence _____, Role of exercise in blood glucose control ____, Role of sleep in blood glucose control _____, Correct use of insulin/prescribed medication/nonprescription medication _____, When to obtain assistance from a health professional _____, Reputable sources of diabetes information _____, Appraise the patient’s current level of knowledge related to specific disease process, Discuss rationale behind management/therapy/treatment recommendations, Instruct patient on measures to prevent/minimize symptoms, Discuss lifestyle changes that may be required to prevent future complications and/or control the disease process, Instruct the patient on which signs and symptoms to report to health care provider, Refer the patient to local community agencies/support groups, Participates in recommended exercise program _____, Uses glucose logs to monitor blood glucose level over time___, Performs correct procedure for blood glucose testing _____, Monitors frequency of hypoglycemic episodes _____, Uses diary to monitor blood glucose level over time _____, Obtains health care if blood glucose levels fluctuate outside of recommended parameters _____, Performs treatment regimen as prescribed _____. The long-term complications of diabetes make it a devastating disease. 7. Blood Glucose Level Once this occurs, the onset of symptoms is usually rapid, and patients often are initially seen with impending or actual ketoacidosis. Provide cognitive and emotional support to patient. Type 1 diabetes or (also known as insulin-dependent diabetes mellitus (IDDM) and juvenile diabetes melliuts) is a chronic illness characterized by the body’s inability to pro… self-monitoring of blood glucose (SMBG), p. 1167 A large body of evidence exists that supports a range of interventions to improve diabetes … Diabetes mellitus disease commonly referred to a group of metabolic disease characterized by hyperglycaemia resulting from insufficiency secretion of insulin, less insulin action or both. management for the patient with diabetes. Diabetes Mellitus: Types, Symptoms, Causes, Treatments. Dietary Management and Physical Exercise: Insulin are available for optimal metabolism when the food that was eaten is absorbed. • Performs treatment regimen as prescribed _____ This report was written to highlight the main aspects of nursing management for patients with Type 2 diabetes. Four major metabolic abnormalities have a role in the development of type 2 diabetes (see Fig. • Cause and contributing factors _____ Diabetes Self-Management • Assist the patient to incorporate activity/exercise regimen into daily routine/lifestyle because it is an integral part of diabetes control. 49-1). Maintain your blood cholesterol and triglyceride (lipid) levels as near the normal ranges as possible. Take whole grains and whole grains products over highly processed carbohydrates. Successfully Subscribed. For this reason insulin is an, Other hormones (glucagon, epinephrine, growth hormone, and cortisol) work to oppose the effects of insulin and are referred to as. • Recommend daily foot inspection over all surfaces and between the toes looking for redness, swelling, warmth, dryness, maceration, tenderness, or open areas to identify and provide early treatment of foot lesions. Verbalizes key elements of the therapeutic regimen, including knowledge of disease and treatment plan 5 = Consistently demonstrated _____ Eventually, as more β cells are destroyed and blood glucose levels increase, the honeymoon period ends and the patient will require insulin on a permanent basis. Insulin is required to “unlock” these receptor sites, allowing the transport of glucose into the cells to be used for energy. Diabetes caused by medical conditions or medications can resolve when the underlying condition is treated or the medication discontinued. Prone at onset or during insulin deficiency. • Pedal pulse strength (left) _____ Measurement Scale • Facilitate adherence to diet and exercise regimen to promote diabetes control. • Risk to offspring of diabetic fathers is 5%-6%. • Encourage the patient to exercise as tolerated to increase peripheral circulation. It is an intermediate stage between normal glucose homeostasis and diabetes where the blood glucose levels are elevated, but not high enough to meet the diagnostic criteria for diabetes. 1. Sign and symptoms of diabetes mellitus are in the following: There are different causes for diabetes mellitus which are in the below: Various diagnosis ways for diabetes mellitus are mentioned in the below: There are different treatment processes for diabetes mellitus. Susceptibility ( 40 % develop it before 20 years of age, and collaborative care the. Expert writers has created this bespoke sample nursing report that shows the quality that is guaranteed with nursing. 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