Professional Documents
Culture Documents
DIABETES
Type 1 Diabetes
Risk factors
Family history of diabetes (e.g., parents or siblings with diabetes)
Obesity (i.e., 20% over desired body weight or body mass index 30
kg/m2)
Race/ethnicity (e.g., African Americans, Hispanic Americans, Native
Americans, Asian Americans, Pacific Islanders)
Age 45 years
Previously identified impaired fasting glucose or impaired glucose
tolerance
Hypertension (140/90 mm Hg)
High-density lipoprotein (HDL) cholesterol level 35 mg/dL (0.90 mmol/L)
and/or triglyceride level 250 mg/dL (2.8 mmol/L)
History of gestational diabetes or delivery of a baby over 9 lb
TYPE 2 DIABETES
Risk factors
obesity, age, previous identified impaired fasting glucose or impaired
glucose tolerance,
hypertension 140/90 mm Hg, HDL 35 mg/dL or triglycerides 250
mg/dL,
history of gestational diabetes or babies over 9 pounds
Symptoms of Diabetes
Common symptoms of diabetes:
Three Ps
Polyuria
Polydipsia
Polyphagia
Extreme fatigue , weakness
Blurry vision
dry skin, skin lesions or wounds that are slow to heal, recurrent
infections
Weight loss - even though you are eating more (type 1)
Tingling, pain, or numbness in the hands/feet (type 2)
DIAGNOSTICS
Fasting Plasma Glucose (FPG): greater than or equal to 126mg/dl
Casual (Random) plasma glucose concentration: Greater than or equal to
200mg/dl
Two-hour postload glucose (Oral Glucose tolerance test): greater than or
equal to 200mg/dl
Hemoglobin A1C
HYPOGLYCEMIA
Abnormally low blood glucose level <70
Causes: too much insulin or oral hypoglycemic agents, excessive physical
activity, and not enough food
Adrenergic symptoms: sweating, tremors, tachycardia, palpitations,
nervousness, hunger
Central nervous system symptoms: inability to concentrate, headache,
confusion, memory lapses, slurred speech, drowsiness
Severe hypoglycemia: disorientation, seizures, loss of consciousness,
death
3 or 4 glucose tablets
4 oz of fruit juice or regular soda
6 to 10 hard candies
2 to 3 tsp of sugar or honey
Emergency Measures:
If the patient cannot swallow or is unconscious:
Subcutaneous or intramuscular glucagon (1 mg)
25 to 50 mL of 50% dextrose solution IV
HYPERGLYCEMIA
>110
NEED INSULIN!!!!!!!!!
Look for a reason (i.e- stress, infection, missed medication?)
Symptoms:
dry mouth,
extreme thirst
frequent urination
drowsiness
TREATMENT
2. Oral medication
3. Insulin (Syringe, Pen, or Pump)
COMPLICATIONS
Skin Complications (wounds, sugar isn't good for wound healing)
Eye Complications - nerve damage (Retinopathy)
Neuropathy
Foot Complications- (neuropathy) frequent checks, no lotion
between toes
DKA (Ketoacidosis) & Ketones
Hyperosmolar non-ketotic syndrome (HHNS)
Kidney Disease(Nephropathy)- lack of bld flow to kidney
High Blood Pressure (Hypertension)
Stroke
Gastroparesis
Heart Disease
Mental Health
ASSESSMENT OF DKA
Blood glucose levels >300 to 1,000
Severity of DKA not only due to blood glucose level
Ketoacidosis is reflected in low serum bicarbonate, low pH; low PCO2
reflects respiratory compensation (Kussmauls respirations)
Ketone bodies in blood and urine
Electrolytes vary according to degree of dehydration; increase in
creatinine, Hct, BUN
TREATMENT OF DKA
Rehydration with IV fluid
IV continuous infusion of regular insulin
Reverse acidosis and restore electrolyte balance
Note: rehydration leads to increased plasma volume and decreased
K; insulin enhances the movement of K+ from extracellular fluid into
the cells
Monitor blood glucose, renal function and urinary output, ECG,
electrolyte levels, VS, lung assessments for signs of fluid overload
Treatment of HHS
Rehydration
Insulin administration
Monitor fluid volume and electrolyte status
Prevention
BGSM
Diagnosis and management of diabetes
Assess and promote self-care management skills
Nursing Diagnosis
Risk for infection
Risk for disturbed sensory perception
Powerlessness
Imbalanced nutrition less than body requirements
Deficient fluid volume
Fatigue
Knowledge Deficit
Nursing Interventions
Monitor blood glucose
Administer medications as prescribed
Provide education
Monitor VS and I&O
Refer to a diabetic educator
Monitor for complications
MEAL PLANNING
Consider food preferences, lifestyle, usual eating times, and cultural
and ethnic background
Review diet history and need for weight loss, gain, or maintenance
Caloric requirements and calorie distribution throughout the day;
exchange lists
Carbohydrates: 50% to 60% carbohydrates; emphasize whole grains
Fat: 20% to 30%, with >10% from saturated fat and <300 mg
cholesterol; protein: 10% to 20%
Fiber: 25 g daily; refer to Table 51-2
Carbohydrate Counting
Food changes into Blood Glucose!
Carbohydrates= up to 100%
Protein= 50-60%
Fat= less than 10%
DIABETES INSIPIDUS
MANIFESTATIONS:
Urine Chemistry (Dilute): Decreased urine specific gravity and
decreased urine osmolality
-Serum Chemistry (concentrated): Hypernatremia, increased serum
osmolality, hypokalemia
-Polyuria and polydipsia: Increased urine output and crave excessive
amounts of water
-Dehydration, weight loss, and dry skin
-Hemoconcentration
Nursing Interventions
weigh daily
monitor urine output and urine specific gravity
assess the clients blood pressure and heart rate
maintain fluid and electrolyte balance
Client Education
lifetime vasopressin replacement therapy
report weight gain or loss, polyuria, or polydipsia
monitor fluid intake and urine output
avoid foods with diuretic action