Professional Documents
Culture Documents
I. Definition:
Diabetes is a metabolic disorder affecting the way the body uses digested food for
growth and energy. As a person eats, digestive juices break down the food into a simple sugar
called glucose. Glucose is the main source of fuel for the body.
After digestion, glucose passes into the bloodstream to be used by body cells for
growth and energy. In order for glucose to get into the cells, insulin must be present. Insulin is a
hormone produced by the beta cells of the pancreas, an organ behind the stomach.
Insulin, a hormone produced by the pancreas, controls the levels of glucose in the
body by regulating the production and storage of glucose. In diabetic state, the cells may stop
responding to insulin or the pancreas may stop producing insulin entirely. This leads to
hyperglycemia which may result in acute metabolic complications such as diabetic
ketoacidosis (DKA) (a metabolic derangement in type 1 diabetes that results from a
deficiency of insulin.) , hyperglycemic hyperosmolar nonketotic syndrome(HHNS) (a
metabolic disorder of type 2 diabetes resulting from a relative insulin deficiency initiated by
inter-current illness that raises the demand for insulin; associated with polyuria and severe
dehydration.). Long-term effects of hyperglycemia contribute to macrovascular complications
(coronary artery disease, cerebrovascular disease and peripheral vascular disease), chronic
microvascular complications (kidney and eye disease), and neuropathic complications (disease
of the nerves).
Classification of Diabetes:
• Fatigue and weakness, dry skin, skin lesions or wounds that are slow to heal, and
recurrent infections.
• The onset type 1 diabetes may also be associated with sudden weight loss or
nausea , vomiting, or abdominal pains, if DKA has developed.
Nursing management of the patient with diabetes can involve treatment of a wide
variety of physiologic disorders, depending on the patients health status and whether the
patient is newly diagnosed or seeks care for an unrelated health problem. Because all diabetic
patient must master the concept and skills necessary for long-term management of diabetes
and its potential complications, a solid educational foundation is necessary for competent self-
care and is ongoing focus of nursing care.
Key areas for Prevention and Control
• Maintain body weight and prevent obesity through proper nutrition and physical activity
or exercise.
• Encourage proper nutrition – Eat more dietary fiber, reduce salt and fat intake, avoid
simple sugars like cakes and pastries; avoid junk foods.
• Advice smoking cessation for active smokers and prevent exposure to second hand
smoke. Smoking along diabetics increases risk for heart attack and stroke.
Before the discovery of insulin in 1921, all people with type 1 diabetes died within a
few years after the appearance of the disease. Although insulin is not a cure for diabetes, it was
the first major breakthrough in diabetes treatment.
Today, daily injections of insulin are the basic therapy for type 1 diabetes. Insulin
injections must be balanced with meals and daily activities, and glucose levels must be closely
monitored through frequent blood sugar testing.
Diet, exercise and blood testing for glucose are also the basis for management of type
2 diabetes. In addition, some people with type 2 diabetes take oral drugs and insulin to lower
their blood glucose levels.
People with diabetes must take responsibility for their day-to-day care. Much of the daily
care involves trying to keep blood sugar levels from going too low or too high. When blood
sugar levels drop too low -- a condition known as hypoglycemia -- a person can become
nervous, shaky and confused. Judgment can be impaired and the person may lose
consciousness. The treatment for low blood sugar is to eat or drink something with sugar in it.
A person also can become very ill if blood sugar levels raise too high, a condition known
as hyperglycemia. Hypoglycemia and hyperglycemia can occur in people with type 1 or type 2
diabetes and both are potentially life-threatening emergencies.
Doctors knowledgeable in diabetes therapy, blood sugar control and complications
should monitor people with the disease. Some people see doctors who specialize in diabetes
called endocrinologists or diabetologists. People with diabetes often visit ophthalmologists for
eye examinations, podiatrists for routine foot care, dietitians for help in planning meals,
diabetes educators for instruction in day-to-day care, and psychologists or counselors to help
deal with the emotional burdens of chronic disease.
The goal of diabetes management is to keep blood glucose levels as close to the
normal range as safely possible. A government study, sponsored by the National Institute of
Diabetes and Digestive and Kidney Diseases (NIDDK), proved that keeping blood sugar levels
as close to normal as safely possible reduces the risk of developing major complications of
diabetes.
The 10-year study, called the Diabetes Control and Complications Trial (DCCT), was
completed in 1993 and included 1,441 people with type 1 diabetes. The study compared the
effect of two treatment approaches, intensive management and standard management, on the
development and progression of eye, kidney and nerve complications of diabetes. Researchers
found that study participants who maintained lower levels of blood glucose through intensive
management had significantly lower rates of these complications.
Hypertension
I. Definition:
Hypertension, also referred to as high blood pressure, HTN or HPN, is a medical condition
in which the blood pressure is chronically elevated. In current usage, the word
"hypertension".without a qualifier normally refers to arterial hypertension.
Hypertension can be classified either essential (primary) or secondary. Essential
hypertension indicates that no specific medical cause can be found to explain a patient's
condition. Secondary hypertension indicates that the high blood pressure is a result of (i.e.,
secondary to) another condition, such as kidney disease or tumours (pheochromocytoma and
paraganglioma). Persistent hypertension is one of the risk factors for strokes, heart attacks,
heart failure and arterial aneurysm, and is a leading cause of chronic renal failure. Even
moderate elevation of arterial blood pressure leads to shortened life expectancy. At severely
high pressures, defined as mean arterial pressures 50% or more above average, a person can
expect to live no more than a few years unless appropriately treated.
In individuals older than 50 years, hypertension is considered to be present when a
person's systolic blood pressure is consistently 140 mm Hg or greater or when the diastolic
blood pressure is consistently 90 mm Hg or greater. Beginning at a systolic pressure of 115 and
diastolic pressure of 75 (commonly written as 115/75 mm Hg), cardiovascular disease (CVD)
risk doubles for each increment of 20/10 mmHg. Prehypertension is defined as blood pressure
from 120/80 mm Hg to 139/89 mm Hg. Prehypertension is not a disease category; rather, it is a
designation chosen to identify individuals at high risk of developing hypertension. The Mayo
Clinic specifies blood pressure is "normal if it's below 120/80". Patients with blood pressures
over 130/80 mm Hg along with Type 1 or Type 2 diabetes, or kidney disease require further
treatment.
If your blood pressure is extremely high, there may be certain symptoms to look out for,
including severe head ache, fatigue or confusion, vision problems, chest pain, difficulty in
breathing, irregular heart beat and blood in the urine. Other clinical efffects are absent until
complications develop from vascular changes.
Prepared by:
Geofel C. Abejero
dice_147@yahoo.com
February 20, 2009
Health Care 1 (SY 2008-2009)