Professional Documents
Culture Documents
Dosen Pembimbing :
Mrs. Dian
Oleh kelompok 3
1. Alfinia yulita
2. Dita novelia
3. Larisa pasla dedhia
4. Yosi oktavia nengsih
Kelas 1B
BAB I
INTRODUCTION
1.1 Background
Diabetes is one of the first diseases describe with an Egyptian manuscript
from c. 1500 BCE mentioning "too great emptying of the urine."The first
described cases are believed to be of type 1 diabetes.Indian physicians around the
same time identified the disease and classified it as madhumeha or honey urine
noting that the urine would attract ants.The term "diabetes" or "to pass through"
was first used in 230 BCE by the Greek Appollonius Of Memphis.The disease
was rare during the time of the Roman empire with Galen commenting that he had
only seen two cases during his career.
Type 1 and type 2 diabetes were identified as separate conditions for the first
time by the Indian physicians Sushruta and Charaka in 400-500 AD with type 1
associated with youth and type 2 with being overweight.The term "mellitus" or
"from honey" was added by the Briton John Rolle in the late 1700s to separate the
condition from diabetes insipidus which is also associated with frequent
urination.Effective treatment was not developed until the early part of the 20th
century when the Canadians Frederick Banting and Charles Best discovered
insulin in 1921 and 1922]This was followed by the development of the long acting
NPH insulin in the 1940s.
1.2 Purpose
1. to find out how nursing care
2. to find out which nursing diagnosis
BAB II
CONTENS
2.1Definition
Diabetes mellitus is a condition in which the pancreas no longer produces
enough insulin or cells stop responding to the insulin that is produced, so that
glucose in the blood cannot be absorbed into the cells of the body.
Diabetes mellitus is a chronic disease that causes serious health
complications including renal (kidney) failure, heart disease, stroke, and
blindness.
Risk factors for type 2 diabetes mellitus are greater for some ethnicities, as
mentioned before. Furthermore, those people who have a family history of type 2
diabetes, who are overweight or inactive also face a greater risk of type 2 diabetes
mellitus.
Diabetes mellitus affects a variety of people of all races, ages and nations.
It is unkown why some people develop type 1 diabetes.
It may be linked to environmental factors or a virus however it has been
estabilished if there is a family history of type 1 diabetes then there is a higher risk
of developing type 1 diabetes.
Symptoms include frequent urination, lethargy, excessive thirst, and
hunger. The treatment includes changes in diet, oral medications, and in some
cases, daily injections of insulin.
Symptoms of diabetes can develop suddenly (over days or weeks) in
previously healthy children or adolescents, or can develop gradually (over several
years) in overweight adults over the age of 40. The classic symptoms include
feeling tired and sick, frequent urination, excessive thirst, excessive hunger, and
weight loss.
Diabetes is suspected based on symptoms. Urine tests and blood tests can
be used to confirm a diagnose of diabetes based on the amount of glucose found.
Urine can also detect ketones and protein in the urine that may help diagnose
diabetes and assess how well the kidneys are functioning. These tests also can be
used to monitor the disease once the patient is on a standardized diet, oral
medications, or insulin.
Research continues on diabetes prevention and improved detection of
those at risk for developing diabetes. While the onset of Type I diabetes is
unpredictable, the risk of developing Type II diabetes can be reduced by
maintaining ideal weight and exercising regularly. The physical and emotional
stress of surgery, illness, pregnancy, and alcoholism can increase the risks of
diabetes, so maintaining a healthy lifestyle is critical to preventing the onset of
Type II diabetes and preventing further complications of the disease.
6. Activity Intolerance
Diabetes mellitus (DM) is a chronic diseases characterized by insufficient
production of insulin in the pancreas or when the body cannot effectively use the
insulin it produces. This leads to an increased concentration of glucose in the
bloodstream (hyperglycemia). It is characterized by disturbances in carbohydrate,
protein, and fat metabolism.
2.3 Types
Diabetes mellitus occurs in four forms classified by etiology: type 1, type
2, gestational diabetes mellitus, and other specific types. Heres a breakdown of
the types:
2.4 Statistics
Diabetes affects 18% of people over the age of 65, and approximately
625,000 new cases of diabetes are diagnosed annually in the general population.
Conditions or situations known to exacerbate glucose/insulin imbalance include
(1) previously undiagnosed or newly diagnosed type 1 diabetes; (2) food intake in
excess of available insulin; (3) adolescence and puberty; (4) exercise in
uncontrolled diabetes; and (5) stress associated with illness, infection, trauma, or
emotional distress. Type 1 diabetes can be complicated by instability and diabetic
ketoacidosis (DKA). DKA is a life-threatening emergency caused by a relative or
absolute deficiency of insulin.
Prevent complications.
Discharge Goals
Homeostasis achieved.
Complications prevented/minimized.
Diagnostic Studies
Electrolytes:
Urine: Positive for glucose and ketones; specific gravity and osmolality
may be elevated.
Desired Outcomes
a. Identify interventions to prevent/reduce risk of infection.
b. Demonstrate techniques, lifestyle changes to prevent development of
infection.
Nursing Interventions
Rationale
Nursing Interventions
Rationale
Monitor vital signs and mental status.To provide baseline from which to
compare abnormal findings.
Call the patient by name, reorient as needed to place, person, and time.
Give short explanations, speak slowly and enunciate clearly.Decreases confusion
and helps maintain contact with reality.
Schedule and cluster nursing time and interventions.To provide
uninterrupted rest periods and promote restful sleep, minimize fatigue and
improve cognition.
Keep patients routine as consistent as possible. Encourage participation in
activities of daily living (ADLs) as able. Helps keep patient in touch with reality
and maintain orientation to the environment.
Protect patient from injury by avoiding or limiting the use of restraints as
necessary when LOC is impaired. Place bed in low position and pad bed rails if
patient is prone to seizures. Disoriented patients are prone to injury, especially
patient
3. Powerlessness
Nursing Diagnosis
Powerlessness
May be related to
a. Long-term/progressive illness that is not curable
b. Dependence on others
Possibly evidenced by
a. Reluctance to express true feelings; expressions of having no
control/influence over situation
b. Apathy, withdrawal, anger
c. Does not monitor progress, nonparticipation in care/decision making
Nursing Interventions
Rationale
Nursing Diagnosis
Imbalanced Nutrition Less Than Body Requirements
May be related to
a. Insulin deficiency (decreased uptake and utilization of glucose by the
tissues, resulting in increased protein/fat metabolism)
b. Decreased oral intake: anorexia, nausea, gastric fullness, abdominal pain;
altered consciousness
c. Hypermetabolic state: release of stress hormones (e.g., epinephrine,
cortisol, and growth hormone), infectious process
Possibly evidenced by
a. Increased urinary output, dilute urine
b. Reported inadequate food intake, lack of interest in food
c. Recent weight loss; weakness, fatigue, poor muscle tone
d. Diarrhea
e. Increased ketones (end product of fat metabolism)
Desired Outcomes
a. Ingest appropriate amounts of calories/nutrients.
b. Display usual energy level.
c. Demonstrate stabilized weight or gain toward usual/desired range with
normal laboratory values.
Nursing Interventions
Rationale
interventions. Note: Chronic difficulties with decreased gastric emptying time and
poor intestinal motility may suggest autonomic neuropathies affecting the GI tract
and requiring symptomatic treatment.
Provide liquids containing nutrients and electrolytes as soon as patient can
tolerate oral fluids then progress to a more solid food as tolerated. Oral route is
preferred when patient is alert and bowel function is restored.
Identify food preferences, including ethnic and cultural needs.
If
patients food preferences can be incorporated into the meal plan, cooperation
with dietary requirements may be facilitated after discharge.
Include SO in meal planning as indicated. To
promote
sense
of
involvement and provide information to the SO to understand the nutritional
needs of the patient. Note: Various methods available or dietary planning include
exchange list, point system, glycemic index, or pre selected menus.
Observe for signs of hypoglycemia: changes in LOC, cold and clammy
skin, rapid pulse, hunger, irritability, anxiety, headache, lightheadedness,
shakiness.
Hypoglycemia can occur once blood glucose level is reduced and
carbohydrate metabolism resumes and insulin is being given. If the patient is
comatose, hypoglycemia may occur without notable change in LOC. This
potentially life-threatening emergency should be assessed and treated quickly per
protocol. Note: Type 1 diabetics of long standing may not display usual signs of
hypoglycemia because normal response to low blood sugar may be diminished.
Perform fingerstick glucose testing. Beside analysis of serum glucose is
more accurate than monitoring urine sugar. Urine glucose is not sensitive enough
to detect fluctuations in serum levels and can be affected by patients individual
renal threshold or the presence of urinary retention. Note: Normal levels for
fingerstick glucose testing may vary depending on how much the patient ate
during his last meal. In general: 80120 mg/dL (4.46.6 mmol/L) before meals or
when waking up; 100140 mg/dL (5.57.7 mmol/L) at bedtime.
Administer regular insulin by intermittent or continuous IV method: IV
bolus followed by a continuous drip via pump of approximately 510 U/hr so that
glucose is reduced by 50 mg/dL/hr. Regular insulin has a rapid onset and thus
quickly helps move glucose into cells. The IV route is the initial route of choice
because absorption from subcutaneous tissues may be erratic. Many believe the
continuous method is the optimal way to facilitate transition to carbohydrate
metabolism and reduce incidence of hypoglycemia.
Administer glucose solutions: dextrose and half-normal saline.
Glucose solutions may be added after insulin and fluids have brought the
blood glucose to approximately 400 mg/dL. As carbohydrate metabolism
approaches normal, care must be taken to avoid hypoglycemia.
Provide diet of approximately 60% carbohydrates, 20% proteins, 20% fats
in designated number of meals and snacks. Complex carbohydrates (apples,
broccoli, peas, dried beads, carrots, peas, oats) decrease glucose levels/insulin
needs, reduce serum cholesterol levels, and promote satiation. Food intake is
Possibly evidenced by
a. Increased urinary output, dilute urine
b. Weakness; thirst; sudden weight loss
c. Dry skin/mucous membranes, poor skin turgor
d. Hypotension, tachycardia, delayed capillary refill
Desired Outcomes
Demonstrate adequate hydration as evidenced by stable vital signs,
palpable peripheral pulses, good skin turgor and capillary refill, individually
appropriate urinary output, and electrolyte levels within normal range.
Nursing Interventions
Rationale
Symptoms may have been present for varying amounts of time (hours to
days). Presence of infectious process results in fever and hypermetabolic state,
increasing insensible fluid losses.
Monitor vital signs: Note orthostatic BP changes. Hypovolemia may be
manifested by hypotension and tachycardia. Estimates of severity of hypovolemia
may be made when patients systolic BP drops more than 10 mmHg from a
recumbent to a sitting then a standing position. Note: Cardiac neuropathy may
block reflexes that normally increase heart rate.
Respiratory pattern: Kussmauls respirations, acetone breath.
Lungs
remove carbonic acid through respirations, producing a compensatory respiratory
alkalosis for ketoacidosis. Acetone breath is due to breakdown of acetoacetic acid
and should diminish as ketosis is corrected. Correction of hyperglycemia and
acidosis will cause the respiratory rate and pattern to approach normal.
Respiratory rate and quality, use of accessory muscles, periods of apnea,
and appearance of cyanosis. In contrast, increased work of breathing, shallow,
rapid respirations, and presence of cyanosis may indicate respiratory fatigue
and/or that patient is losing ability to compensate for acidosis.
Temperature, skin color, moisture, and turgor.
Although fever, chills,
and diaphoresis are common with infectious process, fever with flushed, dry skin
and decreased skin turgor may reflect dehydration.
Assess peripheral pulses, capillary refill, and mucous membranes.
Indicators of level of hydration, adequacy of circulating volume.
Monitor I&O and note urine specific gravity.Provides ongoing estimate of
volume replacement needs, kidney function, and effectiveness of therapy.
Weigh daily. Provides the best assessment of current fluid status and
adequacy of fluid replacement.
Maintain fluid intake of at least 2500 mL/day within cardiac tolerance
when oral intake is resumed. Maintains hydration and circulating volume.
Promote comfortable environment. Cover patient with light sheets. Avoids
overheating, which could promote further fluid loss.
Investigate changes in mentation and LOC. Changes in mentation can be
due to abnormally high or low glucose, electrolyte abnormalities, acidosis,
decreased cerebral perfusion, or developing hypoxia. Regardless of the cause,
impaired consciousness can predispose patient to aspiration.
Insert and maintain indwelling urinary catheter.
Provides for accurate
ongoing measurement of urinary output, especially if autonomic neuropathies
result in neurogenic bladder (urinary retention/overflow incontinence). May be
removed when patient is stable to reduce risk of infection.
6. Fatigue
Nursing Diagnosis
Fatigue
May be related to
a. Decreased metabolic energy production
b. Altered body chemistry: insufficient insulin
c. Increased energy demands: hypermetabolic state/infection
Possibly evidenced by
a. Overwhelming lack of energy, inability to maintain usual routines,
decreased performance, accident-prone
b. Impaired ability to concentrate, listlessness, disinterest in surroundings
Desired Outcomes
a. Verbalize increase in energy level.
b. Display improved ability to participate in desired activities.
Nursing Interventions
Rationale
Discuss with patient the need for activity. Plan schedule with patient and
identify activities that lead to fatigue.Education may provide motivation to
increase activity level even though patient may feel too weak initially.
Alternate activity with periods of rest and uninterrupted sleep.To prevent
excessive fatigue.
Monitor pulse, respiratory rate, and BP before and after activity.Indicates
physiological levels of tolerance.
Discuss ways of conserving energy while bathing, transferring, and so
on.Patient will be able to accomplish more with a decreased expenditure of
energy.
Increase patient participation in ADLs as tolerated. Increases confidence
level, self-esteem and tolerance level.
Other Possible Nursing Care Plans.Knowledge Deficit regarding disease
process/treatment and individual care needsmay be related to unfamiliarity with
information, misinterpretation, possibly evidenced by requests for information,
of
instructions,
and
BAB III
CLOSING
3.1 CONCLUSION
Diabetes mellitus is a condition in which the pancreas no longer
produces enough insulin or cells stop responding to the insulin that is produced, so
that glucose in the blood cannot be absorbed into the cells of the body.
Diabetes mellitus is a chronic disease that causes serious health
complications including renal (kidney) failure, heart disease, stroke, and
blindness.
Risk factors for type 2 diabetes mellitus are greater for some ethnicities, as
mentioned before. Furthermore, those people who have a family history of type 2
diabetes, who are overweight or inactive also face a greater risk of type 2 diabetes
mellitus.
Diabetes mellitus affects a variety of people of all races, ages and nations.
It is unkown why some people develop type 1 diabetes.
It may be linked to environmental factors or a virus however it has been
estabilished if there is a family history of type 1 diabetes then there is a higher risk
of developing type 1 diabetes.
Symptoms include frequent urination, lethargy, excessive thirst, and
hunger. The treatment includes changes in diet, oral medications, and in some
cases, daily injections of insulin.
Symptoms of diabetes can develop suddenly (over days or weeks) in
previously healthy children or adolescents, or can develop gradually (over several
years) in overweight adults over the age of 40. The classic symptoms include
feeling tired and sick, frequent urination, excessive thirst, excessive hunger, and
weight loss.
References