Clinical Topic #7 Diabetes Management Student Guide

Objectives: Student will: Discuss pathophysiology, assessments, and nursing interventions or the prevention and treatment o diabetic ulcers! Describe the purpose and process o blood glucose and urine "etones monitoring! Di erentiate between various insulin preparations! #$plain how to mi$ insulins accurately! Describe administration o insulin with various devices! Discuss pathophysiology, symptoms and interventions or hypoglycemia! FYI Normal Blood Glucose Levels: Kee states 60-110 mg/dL, Fundamentals 70-105 mg/dL, and Lewis 70-120 mg/dL. Students will only be tested on values wit in no!mal o! abno!mal limits "o! all o" t ese !anges. #oweve! students may want to lea!n t e Lewis level "o! ease in t!ansition to subse$uent semeste!s. Nursing Diagnosis: %mpaired Tissue %ntegrity &lood 'lucose, (is" or )nstable %n ection, (is" or *C: +ypoglycemia,+yperglycemia Discussion Questions: -! .hat puts the diabetic patient at ris" or oot ulcers/ Diabetic patients are at ris" o developing diabetic neuropathy, more speci ically, sensory neuropathy! Sensory neuropathy can cause loss o sensations li"e numbness o hands and eet and the sensations o temperature! .hen loss o sensations occur, it ma"es it harder or the patient to identi y when in0ury or in ection occurs, ma"ing it more di icult or the patient to identi y when s"in brea"down is occurring!

1! +ow would you assess the eet o a patient with diabetes/ %n a hospital setting % would chec" capillary re ill o the toes! % would loo" or any redness, swelling, blisters, or cuts on the oot! % would recommend they receive a screening using a mono ilament to asses 23*S! 4! .hat might you teach a patient to prevent diabetic oot ulcer development/ .ash 5eet daily with mild soap and warm water

 *at dry gently, especially between toes #$amine eet daily or cuts, blisters, swelling, and tender areas )se mild oot powder or sweaty eet (epeat s"in in ections and non6healing sores .ear clean, absorbent soc"s or stoc"ings that have not been mended 7! Describe appropriate interventions to promote healing o oot ulcers! Casting may be appropriate in order to redistribute weight on the plantar sur ace o the oot! 3ther orms o wound control or oot ulcers would include: debridgement, dressings, advanced wound healing products such as (egrane$, vacuum6assisted closure, ultrasound, hyperbaric o$ygen, and s"in gra ting! 8! Describe purpose and procedure or blood glucose monitoring! The monitoring o a person9s blood glucose level allows them to ma"e sel 6management decisions regarding diet, e$ercise, and medication! 3ne method o monitoring a persons blood glucose level is by the use o portable blood glucose meter, which ta"es a small drop o capillary blood and assesses the amount o glucose within it! :nother way o measuring a person9s blood glucose is by the use o a Continuous 'lucose Monitoring system! This system uses needles inserted subcutaneously that assess the blood glucose level every -68 minutes! ;! Describe the purpose and procedure or urine "etones monitoring! Monitoring urine "etones helps to prevent the development o conditions such as "etonuria or even worse, diabetic "etoacidosis! To monitor urine "etones, you will need testing dipstic", and a sterile urine cup! Collect the urine in the sterile cup, and using the testing dipstic", dip it into the urine! : positive result can indicate lac" o insulin and diabetic acidosis! 7! #$plain how insulin preparations are di erent/ %denti y onset, pea" and duration or each! %nsulin is prepared base on the patients speci ic pattern o blood glucose levels, li estyle, eating, and activity patterns! The patient may receive mi$ed insulin, or they may receive multiple di erent doses! (apid :cting o 3nset: -8mins o *ea": ;<6=<min o Duration: 467hrs Short :cting

o 3nset: 4<6;<mins o *ea": 164 +ours o Duration: 46; +ours %ntermediate :cting o 3nset:167hr o *ea": 76-< hr o Duration: -<6-; hr

2ong :cting o 3nset: -61 hr o *ea": no *ronounced *ea" o Duration: 17>hr

?! .hat are the devices currently used to administer insulin/ %nsulin can currently be administered with an insulin pen, insulin syringes, an insulin pump, as well as through an %@!

=! .hat is the appropriate method or mi$ing two di erent insulin preparations/ .ash +ands 'ently rotate insulin bottle i cloudy .ipe o tops o vials with alcohol sponge %n0ect the appropriate amount o air into both vials %nvert vial & and draw bac" the medication (emove the needle, insert it in vial : and withdraw the medication

-<! #$plain the medical order or Acorrection doseB or Asliding scale!B

The term Asliding scaleB or Acorrection doseB re ers to the progressive increase in the pre6 meal or nighttime insulin dose, based on pre6de ined blood glucose ranges! Sliding scale insulin regimens appro$imate daily insulin reCuirements! --! .hat is hypoglycemia/ .hat are the causes and symptoms/ +ypoglycemia is having a low level o glucose within the blood! This can occur when the glucose within the blood is used too Cuic"ly, not enough glucose is being produced or absorbed, or the amount o insulin in the blood is too high! Symptoms include, con usion, sweating, diDDiness, nausea, and sleepiness! -1! +ow is hypoglycemia treated/ %ngesting sugars into the body helps to treat hypoglycemia! :lso ta"ing Meglitinides daily help to lower the chance o hypoglycemia rom happening in the irst place!