Contenu connexe Similaire à Chapter 067 (20) 1. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
Chapter 67
Care of Patients with Diabetes
Mellitus
2. 2Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
Insulin Physiology
3. 3Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
Types of Diabetes
Type 1
Type 2
Gestational (GDM)
Other specific conditions resulting in
hyperglycemia
4. 4Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
Absence of Insulin
Hyperglycemia
Polyuria
Polydipsia
Polyphagia
Ketone bodies
Hemoconcentration, hypovolemia,
hyperviscosity, hypoperfusion, and hypoxia
Acidosis, Kussmaul respiration
Hypokalemia, hyperkalemia, or normal serum
potassium levels
5. 5Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
Acute Complications of Diabetes
Diabetic ketoacidosis
Hyperglycemic-hyperosmolar state (HHS)
Hypoglycemia from too much insulin or too
little glucose
6. 6Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
Chronic Complications of Diabetes
Macrovascular/microvascular disease
Retinopathy (vision problems)
Nephropathy (kidney dysfunction)
Neuropathy (nerve dysfunction)
7. 7Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
Macrovascular Complications
Cardiovascular disease
Cerebrovascular disease
8. 8Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
Microvascular Complications
Eye and vision complications
Diabetic neuropathy
Diabetic nephropathy
Male erectile dysfunction
9. 9Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
Health Promotion and Maintenance
Control of diabetes and its complications is
major focus for health promotion activities
10. 10Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
Assessment
History
Blood tests
Fasting plasma glucose (FPG)
Oral glucose tolerance test (OGTT)
Other blood tests
Screening
Ongoing assessment—glycosylated hemoglobin
assays, glycosylated serum proteins and albumin,
urine tests, tests for kidney function
11. 11Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
Testing Sensation
12. 12Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
Treatment Options
Oral therapies
Insulin therapies
Nutritional considerations
Exercise
Surgical intervention
Foot care
Wound care
13. 13Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
Patient Education
Insulin storage
Dose preparation
Syringes
Blood glucose monitoring
Infection control measures
Diet therapy
14. 14Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
Activity: Patient with a Diabetic
Condition
1. Etiologies, risk factors, comorbidities
2. Assessment findings
3. Diagnostic tests
4. Nurse’s role
5. Interdisciplinary team’s role
6. Treatment/intervention priorities
7. Teaching/health promotion information
8. Community resources
15. 15Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
A 23-year-old patient with a history of type 1 diabetes is
admitted to the ED with nausea and abdominal pain.
His respiratory rate is 34/min with deep breaths and a
fruity smell to his breath. He is responsive, but difficult
to arouse.
1. What does the nurse suspect is happening with this
patient?
2. What serum glucose level would the nurse expect to
see with this patient?
Notes de l'éditeur Glucometer for measuring serum glucose levels. Proinsulin, secreted by and stored in the beta cells of the islets of Langerhans in the pancreas, is transformed by the liver into active insulin. Insulin attaches to receptors on target cells, where it promotes glucose transport into the cells through the cell membranes. Placement sites of monofilaments for testing of protective sensation. The manifestations point to diabetic ketoacidosis.The patient’s glucose level is most likely >300 mg/dL.
