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Assessment and Management of Patients With Diabetes Mellitus

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Title: Assessment and Management of Patients With Diabetes Mellitus


1
Assessment and Management of Patients With
Diabetes Mellitus
  • Prepared by Dr. ImanAbdullah

2
Out Line
  • Definition of diabetes mellitus
  • Risk factors for diabetes mellitus
  • Diabetes and its classification
  • Overview in type I and 2 diabetes
  • Pathophysiology of diabetes
  • Clinical manifestations of diabetes
  • Diagnostic findings of diabetes
  • Management of diabetes
  • Monitoring glucose levels and ketones
  • Pharmacologic therapy
  • Insulin therapy

3
Out Line
  • Complications of insulin
  • Oral antidiabetic agents
  • Nursing management
  • Patient education
  • Acute complications of diabetes
  • Nursing process for patient newly diagnosed with
    diabetes mellitus
  • Patient education (foot care)
  • Long-term complications of diabetes
  • Special issues in diabetes care
  • Nursing process for patient with diabetes as a
    secondary diagnosis

4
Learning Objectives
  • On completion of this lecture, the student will
    be able to
  • Differentiate between type I and type 2.
  • Describe etiologic factors associated with
    diabetes.
  • Relate the clinical manifestations of diabetes to
    the associated pathophysiologic alterations.
  • Explain the dietary modifications used for
    management of people with diabetes.
  • Describe the relationships among diet, exercise,
    and medication.
  • Differentiate between hyperglycemia with DKA and
    HHNS

5
Cont.
  • Describe management strategies for a person with
    diabetes to use during sick days.
  • Describe the major macrovascular, microvascular,
    and neuropathic complications of diabetes.
  • Use the nursing process as a framework for care
    of patients with diabetes.

6
Diabetes Mellitus
  • Definition
  • Is a group of metabolic diseases characterized by
    increased levels of glucose in the blood
    (hyperglycemia) resulting from defects in insulin
    secretion, insulin action, or both.
  • Risk Factors for Diabetes Mellitus

7
Diabetes and its Classification
  • Type I diabetes Insulin-dependant diabetes
    (IDDM).
  • Type II diabetes non Insulin-dependant diabetes
    (NIDDM).
  • Gestational diabetes mellitus.
  • Diabetes mellitus associated with other
    conditions or syndrome.

8
Overview
  • In type I diabetes
  • In type 2 diabetes

9
Pathophysiology of Diabetes
  • Type I diabetes
  • Type 2 diabetes
  • Gestational Diabetes

10
Clinical Manifestations
  • Clinical manifestations of all types of include
  • Three Ps polyuria, polydipsia, and polyphagia
  • Fatigue and weakness
  • Sudden vision changes
  • Tingling or numbness in hands or feet
  • Dry skin
  • Skin lesions or wounds that are slow to heal
  • Recurrent infections

11
Diagnostic Findings
  • Criteria for the diagnosis of diabetes mellitus
  • Symptoms of diabetes plus casual plasma glucose
    concentration equal to or greater than 200mg/dl.
  • Fasting plasma glucose greater than or equal to
    126mg/dl (7.0mmol/L).
  • Two-hour postload glucose equal to or greater
    than 200mg/dl during an oral glucose tolerance
    test.
  • If fasting glucose level are normal, the
    diagnosis must be based on a Glucose Tolerance
    test.

12
Management
13
Monitoring Glucose levels and Ketones
  • Self-Monitoring Blood Glucose (SMBG)
  • Continuous Glucose Monitoring System (CGMS)
  • Glycated Hemoglobin
  • Urine Glucose Testing
  • Testing for Ketones

14
Pharmacologic Therapy
  • Insulin Therapy and
  • Insulin Preparations
  • Insulin preparations vary according to three main
    characteristics
  • Time course of action
  • Species ( source)
  • Manufacturer

15
Insulin Regimens
  • There are two general approaches to insulin
    therapy
  • Conventional
  • And intensive

16
Complications of Insulin
  • Local Allergic Reactions
  • Systemic Allergic Reactions
  • Insulin Lipodystrophy
  • Resistance to Injected Insulin
  • Morning Hyperglycemia

17
Alternative methods of Insulin Delivery
  • Insulin Pens
  • Jet injectors

18
Cont.
  • Insulin Pumps
  • Implantable and inhalant insulin delivery
  • Transplantation of pancreatic cells
  • Implantable and inhalant insulin delivery
  • Transplantation of pancreatic cells

19
Oral Antidiabetic Agents
  • Sulfonylureas
  • Biguanides
  • Nursing Management
  • Patient Education

20
Acute Complications of Diabetes
  • There are three major acute complications of
    diabetes
  • related to short-term imbalances in blood glucose
    levels
  • Hypoglycemia
  • Diabetic ketoacidosis (DKA)
  • Hyperglycemic hyperosmolar nonketotic syndrome
    (HHNS)

21
Gerontologic Considerations
  • In elderly patients with diabetes, hypoglycemia
    is a particular concern for many reasons
  • Elderly people frequently live alone and may not
    recognize the symptoms of hypoglycemia.
  • With decreasing renal function, it takes longer
    for oral hypoglycemic agents to be excreted by
    the kidneys.
  • Skipping meals may occur because of decreased
    appetite or financial limitations.
  • Decreased visual acuity may lead to errors in
    insulin administration.

22
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23
Nursing Process
  • The patient newly diagnosed with diabetes
    mellitus
  • Assessment
  • Nursing Diagnosis.
  • Potential Complications
  • Planning and Goals
  • Nursing Intervention
  • Evaluation

24
Patient education (foot care)
  • Take care of your diabetes

25
Cont.
  • Inspect your feet every day
  • Wash your feet every day

26
Cont.
  • Keep the skin soft smooth

27
Cont.
  • Smooth corns and calluses gently
  • Trim your toenails each week or when needed

28
Cont.
  • Wear shoes and socks at all times
  • Protect your feet from hot and cool
  • Keep the blood flowing to your feet
  • Check with your health care provider.

29
Long-Term Complications of Diabetes
  • The general categories of long-term diabetic
    complications are
  • Macro vascular
  • Micro vascular
  • Neuropathy

30
Foot and Leg Problem
  • Three diabetic complications contribute to the
    increased
  • risk of foot problems and infections include
  • Neuropathy
  • Peripheral vascular disease
  • Immunocompromise
  • Management (teaching proper foot care )

31
Special Issues in Diabetes Care
  • Patient with diabetes who are undergoing surgery
  • Management of Hospitalized Patients With Diabetes
  • Hyperglycemia During Hospitalization
  • Hypoglycemia During Hospitalization
  • Common Alteration in Diet
  • Hygiene
  • Stress

32
Nursing Process
  • The Patient With Diabetes as a Secondary
    Diagnosis
  • Assessment
  • Nursing Diagnosis
  • Potential Complications
  • Planning and Goals
  • Nursing Intervention
  • Evaluation

33
Reference
  • Brunner, L. and Suddarath, D. (2010). Text Book
    of Medical Surgical Nursing. 12th Edition. J.B.
    Lippincott Williams Wilikins, Library of
    Congress Catalging-in-Publication Data.

34
  • Thank You
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