copyright 2013, 2010, 2006, 2002 by saunders, an imprint of elsevier inc. care of patients with...

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


INSULIN PHYSIOLOGY


Type 1 Type 2 Gestational (GDM) Other specific conditions resulting in

hyperglycemia

TYPES OF DIABETES


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


ACUTE COMPLICATIONS OF DIABETES Diabetic ketoacidosis Hyperglycemic-hyperosmolar state (HHS) Hypoglycemia from too much insulin or too

little glucose


CHRONIC COMPLICATIONS OF DIABETES Macrovascular/microvascular disease Retinopathy (vision problems) Nephropathy (kidney dysfunction) Neuropathy (nerve dysfunction)


MACROVASCULAR COMPLICATIONS Cardiovascular disease Cerebrovascular disease


MICROVASCULAR COMPLICATIONS Eye and vision complications Diabetic neuropathy Diabetic nephropathy Male erectile dysfunction


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


HEALTH PROMOTION AND MAINTENANCE Control of diabetes and its complications is

major focus for health promotion activities


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


TESTING SENSATION


TREATMENT OPTIONS Oral therapies Insulin therapies Nutritional considerations Exercise Surgical intervention Foot care Wound care


PATIENT EDUCATION Insulin storage Dose preparation Syringes Blood glucose monitoring Infection control measures Diet therapy


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


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?


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)


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)


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)


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)


CHAPTER 67Audience Response System Questions

21


QUESTION 1What percent of the United States population has diabetes?

A. 3.2% B. 5.6%C. 8.3% D. 10.1%


QUESTION 2Which symptom requires immediate intervention during a hypoglycemic episode?

A. Confusion B. Hunger C. Headache D. Tachycardia


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

copyright 2013, 2010, 2006, 2002 by saunders, an imprint of elsevier inc. care of patients with...

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