diabetes
TRANSCRIPT
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Diabetes: Are you diabetic?
Kristen A Geroulis RNChamberlain College of Nursing
NR 305 Health AssessmentProfessor Jennifer Thyes
April 17 2011
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Outline
• Introduction• Summary of Relevant Evidence• Health Assessment Stragies• Screening Guidelines• Prevention Strategies• Conclusion
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INTRODUCTION
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• Diabetes is “a chronic, multisystem, metabolic syndrome of gradual onset charcterized by insufficent body tissue response to insulin and impaired pancreatic production of insulin”
• (Strayer & Schub, 2011).
• Diabetes was the 7th leading cause of death in America in 2006
• (Molinaro, 2011).
• Diabetes is a leading cause of heart disease, stroke, amputations, pregancy complications, high blood pressure, blindness, kidney disease, and nervous system disease
• (http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2007.pdf)
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SUMMARY OF RELEVANT EVIDENCE
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Signs and Symptoms
• Polyuria (increased urination)
• Polydipsia (increased thirst)
• Polyphagia (increase hunger)
• Unexplained changes in weight
• Fatigue• Recurrant infections• Prolonged wound
healing• Vision changes
• (Strayer & Schub, 2011).
•
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Risk Factors
• Family History• Previous Gestational
diabetes (became diabetic while preganant)
• Abnormal fasting blood glucose
• Abnormal glucose tolerace
• Obesity• Sedentary Lifestyle• Increased Age• Hypertension• Polycystic Ovarian
Syndrome• Dyslipidemia
• (Strayer & Schub, 2011).
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Viewpoints of Disease Management
• Keep blood glucose between 70 – 110 mg/dl• Following a balanced diet– Balance foods that raise sugar with foods that
don’t affect blood sugar• Regular exercise– 30 minutes of moderate aerobic exercise
(swimming or walking) most days of week• Taking prescibed medications
• (Moshang, 2005)
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Viewpoints of Disease Management
• Stop smoking – with appropriate support.• Reduce blood pressure to below 140/80mmHg
–medication may be required.• Reduce cholesterol level with diet and statin
therapy.• Reduce weight to body mass index (BMI)
below 25 (ideally).• (Whittaker, 2010).
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Current Literature on Nursing Interventions
• Work in collaboration with community groups to – raise awareness of the seriousness of diabetes– risk factors and strategies for preventing diabetes in a
culturally sensitive and appropriate manner• Public Health Nurse may advocate for a national
social marketing campaign to support and promote awareness of risk factors associated with diabetes, ways of reducing the risks, identifying those at high risk and those who are undiagnosed
• (Price, 2008).
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HEALTH ASSESSMENT STRATEGIES
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Expected Normal Findings
• Fasting plasma glucose <100 (Strayer & Schub, 2011).
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Expected Abnormal Findings
• Fasting plasma glucose of >126 (Strayer & Schub, 2011).
• Glycosylated hemoglobin (HbA1C) level increased >6.5% (Strayer & Schub, 2011).
• Abnormal levels of acetone or glucose in urine (Strayer & Schub, 2011).
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Description of Assessment Techniques
• Complete history and physical• Family History• Any abnormal blood glucose levels• High cholestrol level• Blurred vision• Yeast infection• Urinary Tract Infection• Dry, itchy skin
• (Moshang, 2005).
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Screening Guidelines
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Current Guidelines for Screening Population
• Asymptomatic individuals over 40 years old should be screened every 3 years.
• People with additional risk factors should be screened earlier or more frequently
• A1C and glycemic goals are 7.0% or lower for most individuals and 6.0% or lower when it can be safely achieved.
• All diabetic individuals should have A1C measured every 3 months.
• (Hoffman-Goetz, Donelle, & Thomson,2009).
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Implementation of guidelines into nursing practice
• Aim for good glycaemic control, defined as HbA1c < 6.5%*• Monitor HbA1c every 3 months in addition to regular glucose self-
monitoring• Refer all newly diagnosed patients to a unit specialising in diabetes
care where possible• Address the underlying pathophysiology, including the treatment of
insulin resistance• Treat patients intensively so as to achieve target HbA1c < 6.5%*
within 6 months of diagnosis• Implement a multi- and interdisciplinary team approach to diabetes
management to encourage patient education and self-care and share responsibility for patients achieving glucose goals
• del Prato, Felton, Munro, Nesto, Zimmet, & Zinman, 2005).
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PREVENTION STRATEGIES
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Non-Drug measures to Reduce Incidence
• Eat a balanced diet• Exercise• Stress Reduction• Educated individuals about risk factors of
diabetes• Encourage individuals to have a body mass
index below 25
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Measures to deal with high-risk patients• Measure weight, blood pressure, and calculate
BMI. • Inspect feet for lesions or abnormalities if one or
more high-risk foot conditions are present. • Review self-monitoring glucose record.• Review/adjust medications to control glucose,
lipids, blood pressure. Include regular use of low dose aspirin (if there are not contraindications) for cardiovascular disease prevention, as appropriate.
• Review self-management skills, progress toward behavior change goals, dietary needs, and physical activity as indicated.
• Assess for coping, depression, or other mood disorder.
• Counsel on smoking cessation and alcohol use.• Review interventions for weight loss. • Obtain A1C in patients whose therapy has
changed or who are not meeting glycemic goals (twice a year if at goal with stable glycemia).
• Annually: • Obtain fasting lipid profile (every two years if patient has
low-risk lipid values). • Obtain serum creatinine to estimate glomerular filtration
rate and stage the level of chronic kidney disease. • Perform urine test for albumin-to-creatinine ratio in
patients with type 1 diabetes more than five years and in all patients with type 2 diabetes.
• Refer for dilated eye exam by an ophthalmologist or optometrist to detect retinal and other eye complications. If normal and the patient is not at high risk, the eye care specialist may advise an exam every two to three years.
• Perform comprehensive foot exam to check circulation, sensation, lesions, or changes in shape, and identify high-risk feet.
• Refer for dental/oral exam at least once a year to prevent periodontal disease, mouth infections, and loss of teeth.
• Administer influenza vaccination.• Review need for other preventive care or treatment.
» http://ndep.nih.gov/publications/PublicationDetail.aspx?PubId=108#page9
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CONCLUSION
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Importance of disease• “Estimated economic costs of undiagnosed diabetes in
2007 is $18 billion ($2864 per person), including medical costs of $11 billion and indirect costs of $7 billion” (Zhang et al., 2009).
• “Approximately $14.9 billion (8.6%) of the economic burden of diagnosed diabetes is associated with Type 1 diabetes, including medical costs of $10.5 billion and indirect costs of $4.4 billion.” (Dall et al., 2009)
• “Costs associated with Type 2 diabetes are $159.5 billion, including medical costs of $105.7 billion and indirect costs of $53.8 billion.” (Dall et al., 2009)
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Need for Evidence in Managing and Preventing Disease
• Diabetes can lead into:– Macrovascular complications• Coronary Artery Disease (CAD)• Peripherial Artery Disease (PVD)
– Microvascular complications• Retinopathy• Nephropathy• Neuropathy
• (Moshang, 2005)
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Implications for Nursing
• Knowing risk factors for diabetes• Diabetes education for patients• Encourage healthy balanced diet• Encourage 30 minutes of aerobic exercise daily• Patients trust nurses, therefore they will listen
when the nurse gives information• Collaborate with other healthcare providers to
give patinet the best care.
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References• Dall, T., Mann, S., Zhang, Y., Quick, W., Seifert, R., Martin, J., & ... Zhang, S. (2009). Distinguishing the economic
costs associated with type 1 and type 2 diabetes. Population Health Management, 12(2), 103-110. Retrieved from EBSCOhost.
• del Prato, S., Felton, A., Munro, N., Nesto, R., Zimmet, P., & Zinman, B. (2005). Improving glucose management: ten steps to get more patients with type 2 diabetes to glycaemic goal. International Journal of Clinical Practice, 59(11), 1345-1355. Retrieved from EBSCOhost.
• Hoffman-Goetz, L., Donelle, L., & Thomson, M. (2009). Clinical guidelines about diabetes and the accuracy of peer information in an unmoderated online health forum for retired persons. Informatics for Health & Social Care, 34(2), 91-99. Retrieved from EBSCOhost.
• Molinaro, R. (2011). Diabetes cases on the rise: current diagnosis guidelines and research efforts for a cure. MLO: Medical Laboratory Observer, 43(2), 8-15. Retrieved from EBSCOhost.
• Moshang, J. (2005). Type 2 diabetes: growing by leaps and bounds. Nursing made Incredibily Easy!, 20-34.• Price, E. (2008). Public health nursing and diabetes prevention. JOCEPS: The Journal of Chi Eta Phi Sorority,
53(1), 20-23. Retrieved from EBSCOhost.• Strayer, D., & Schub, T. (2011). Diabetes Mellitus, Type 2. Retrieved from EBSCOhost.• Whittaker, K. (2010). Diabetes... this article is based on NS481 Hill J (2009) reducing the risk of complications
associated with diabetes. Nursing Standard. 23, 25, 49-55. Nursing Standard, 25(10), 59. Retrieved from EBSCOhost.
• Zhang, Y., Dall, T., Mann, S., Chen, Y., Martin, J., Moore, V., & ... Quick, W. (2009). The economic costs of undiagnosed diabetes. Population Health Management, 12(2), 95-101. Retrieved from EBSCOhost.