copyright 2013, 2010, 2006, 2002 by saunders, an imprint of elsevier inc. care of patients with...
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Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
Care of Patients with Diabetes Mellitus CHAPTER 67
CARE OF PATIENTS WITH DIABETES
MELLITUS
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
INSULIN PHYSIOLOGY
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
Type 1 Type 2 Gestational (GDM) Other specific conditions resulting in
hyperglycemia
TYPES OF DIABETES
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Hyperglycemia Polyuria Polydipsia Polyphagia Ketone bodies Hemoconcentration, hypovolemia,
hyperviscosity, hypoperfusion, and hypoxia Acidosis, Kussmaul respiration Hypokalemia, hyperkalemia, or normal serum
potassium levels
ABSENCE OF INSULIN
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ACUTE COMPLICATIONS OF DIABETES Diabetic ketoacidosis Hyperglycemic-hyperosmolar state (HHS) Hypoglycemia from too much insulin or too
little glucose
Copyright © 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)
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
MACROVASCULAR COMPLICATIONS Cardiovascular disease Cerebrovascular disease
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MICROVASCULAR COMPLICATIONS Eye and vision complications Diabetic neuropathy Diabetic nephropathy Male erectile dysfunction
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
METABOLIC SYNDROME Also called syndrome X Classified as simultaneous presence of
metabolic factors known to increase risk for developing type 2 diabetes and cardiovascular disease
Copyright © 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
Copyright © 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
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TESTING SENSATION
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TREATMENT OPTIONS Oral therapies Insulin therapies Nutritional considerations Exercise Surgical intervention Foot care Wound care
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PATIENT EDUCATION Insulin storage Dose preparation Syringes Blood glucose monitoring Infection control measures Diet therapy
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ACTIVITY: PATIENT WITH A DIABETIC CONDITION1. Etiologies, risk factors, comorbidities2. Assessment findings3. Diagnostic tests4. Nurse’s role5. Interdisciplinary team’s role6. Treatment/intervention priorities7. Teaching/health promotion information8. Community resources
Copyright © 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?
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
The student nurse asks why the patient is breathing so rapidly and deeply. What is the nurse’s best response?
A. “His serum pH is high and this is a compensatory mechanism.”
B. “His serum pH is low and this is a compensatory mechanism.”
C. “His serum potassium is high and this is a compensatory mechanism.”
D. “His serum potassium is low and this is a compensatory mechanism.”
(cont’d)
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
In the ED, the patient is diagnosed with diabetic ketoacidosis (DKA).
What is the nurse’s first priority for managing this condition?
A. Airway assessmentB. Fluid and electrolyte correctionC. Administration of insulinD. Administration of IV potassium
(cont’d)
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
Twenty minutes later, the patient is admitted to the ICU for DKA management. The patient is receiving IV regular insulin with frequent finger sticks to check his glucose level. His potassium level is 2.5 and IV potassium supplements have been ordered.
What assessment must be made before giving the IV potassium?
A. Production of at least 30 mL/hr of urineB. Level of consciousness and orientationC. Finger stick glucose of less than 200 mg/dLD. Respiratory rate of less than 24/min
(cont’d)
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
Two days later the patient is recovered and is preparing for discharge. His wife asks about what they can do to prevent this from happening again.
What should the nurse teach the patient and his wife? (Select all that apply.)
A. Check blood glucose levels every 4 to 6 hours if anorexia, nausea, or vomiting is experienced.
B. Check urine ketones when blood glucose is greater than 300 mg/dL.
C. Decrease fluid intake when nausea and vomiting occur.D. Watch for and report any illness lasting more than 1 to
2 days.E. Monitor glucose whenever the patient is ill.
(cont’d)
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
CHAPTER 67Audience Response System Questions
21
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
QUESTION 1What percent of the United States population has diabetes?
A. 3.2% B. 5.6%C. 8.3% D. 10.1%
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
QUESTION 2Which symptom requires immediate intervention during a hypoglycemic episode?
A. Confusion B. Hunger C. Headache D. Tachycardia
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
QUESTION 3When should a patient with type 1 diabetes avoid exercise?
A. When serum glucose is less than 150 B. During colder months C. When ketones are present in the urineD. When emotional stressors are high for the
patient
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