<ul><li>Hypothyroidism </li></ul><ul><li>underactive state of the thyroid gland    hyposecretion of </li></ul><ul><li>thy...
 
 
 
<ul><li>Med. Mgt . – thyroid replacement therapy </li></ul><ul><li>Levothyroxine  (Synthyroid) ,  liothyronine  </li></ul>...
 
<ul><li>Hyperthyroidism </li></ul><ul><li>over-secretion of the thyroid gland </li></ul><ul><li>also called thyrotoxicosis...
<ul><li>Hyperthyroidism  (cont.) </li></ul><ul><li>DX:  > elevated T3, T4 values </li></ul><ul><li>abnormal findings in th...
<ul><li>Grave’s Disease </li></ul><ul><li>disorder char. by one or more of the ff: </li></ul><ul><ul><li>diffuse goiter </...
<ul><li>Thyroid Storm or Crisis </li></ul><ul><li>a  medical emergency     pts. develop severe </li></ul><ul><li>manifest...
<ul><li>Complications : </li></ul><ul><ul><li>cardiovascular disease (HPN, Angina, CHF) </li></ul></ul><ul><ul><li>Exophth...
<ul><li>Pathophysiology: </li></ul><ul><li>hypertrophy and hyperplasia of the thyroid gland </li></ul><ul><li>excessive se...
<ul><li>Anxiety </li></ul><ul><li>Flushed, smooth skin </li></ul><ul><li>Heat intolerance </li></ul><ul><li>Mood swings </...
 
 
 
 
 
<ul><li>Nsg. Interventions: </li></ul><ul><li>Provide calm, restful envt.  </li></ul><ul><ul><li>physical comfort, cool en...
<ul><li>Nsg. Interventions: </li></ul><ul><li>Provide emotional support </li></ul><ul><li>Provide eye care </li></ul><ul><...
<ul><li>Post-op care after Thyroidectomy </li></ul><ul><li>O2 therapy, suction secretions </li></ul><ul><li>Monitor for si...
<ul><li>Post-op Complications: be alert for the possibility of: </li></ul><ul><li>1. Tetany   (due to hypocalcemia caused ...
<ul><li>Post-op Complications: be alert for the possibility of: </li></ul><ul><li>3. Thyroid storm  </li></ul><ul><li>- li...
 
<ul><li>Diabetes Mellitus </li></ul><ul><ul><li>is a chronic disorder of carbohydrate, protein, and </li></ul></ul><ul><ul...
<ul><li>Types </li></ul><ul><li>Insulin – Dependent Diabetes Mellitus (IDDM) or Type I </li></ul><ul><ul><li>destruction o...
 
<ul><li>Clinical Manifestations ( Signs and Symptoms) </li></ul><ul><li>- Polyuria  - weakness </li></ul><ul><li>- Polydip...
<ul><li>Fasting Blood Sugar (FBS) </li></ul><ul><ul><li>NPO for 12 hours </li></ul></ul><ul><ul><li>Normal value= 80-120 m...
<ul><li>4 . Glycosylated hemoglobin </li></ul><ul><ul><li>Provides information about blood glucose level during the previo...
<ul><li>Interventions for Diabetes Mellitus </li></ul><ul><li>A.Dietary Management </li></ul><ul><ul><li>Follow individual...
<ul><li>Interventions for Diabetes Mellitus </li></ul><ul><li>A.Dietary Management </li></ul><ul><ul><li>Advise use of com...
<ul><li>B. Teach pt. on correct administration of insulin and other hypoglycemic agents. </li></ul><ul><ul><li>insulin in ...
<ul><li>Factors that influence the body’s need for insulin </li></ul><ul><li>   need  : trauma, infection, fever, severe ...
 
<ul><li>Management of Hypoglycemia </li></ul><ul><li>Give  simple sugar orally if pt. is conscious  and can swallow – oran...
<ul><li>Preventing Hypoglycemic Reactions Due to Insulin </li></ul><ul><li>Instruct the pt. as follows: </li></ul><ul><li>...
 
Oral Antidiabetic Agents
<ul><li>Teach pt. to estabilish and maintain a pattern of regular exercise </li></ul><ul><li>Benefits of exercise  :  </li...
<ul><li>Teach pt. to practice good personal hygiene and positive health promotion to avoid diabetic complications </li></u...
 
<ul><li>Diabetic Ketoacidosis (DKA) Coma </li></ul><ul><li>S/Sx: </li></ul><ul><li>polyuria, thirst </li></ul><ul><li>naus...
 
<ul><li>Hyperglycemic, Hyperosmolar, Non-Ketotic Coma (HHNC) </li></ul><ul><ul><li>can occur when the action of insulin is...
<ul><li>Interventions for DKA and Hyperosmolar Coma </li></ul><ul><li>Regular insulin IV push or IV drip </li></ul><ul><li...
<ul><li>Long-term Complications of DM </li></ul><ul><li>Vascular Changes </li></ul><ul><li>) Macroangiopathy – hardening a...
INSULIN ONSET PEAK DURATION Ultra  rapid acting  Insulin analog ( Humalog) 15 mins. 2-4 hrs. 6-8 hrs. Rapid acting: Regula...
 
 
 
 
 
 
 
 
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Review Endocrine Disorders

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Review Endocrine Disorders

  1. 2. <ul><li>Hypothyroidism </li></ul><ul><li>underactive state of the thyroid gland  hyposecretion of </li></ul><ul><li>thyroid hormone </li></ul><ul><li>most common in women, middle-age </li></ul><ul><li>Causes : </li></ul><ul><ul><li>thyroidectomy </li></ul></ul><ul><ul><li>pituitary / hypothalamic dysfunction </li></ul></ul><ul><ul><li>iodine deficiency </li></ul></ul><ul><ul><li>autoimmune thyroiditis (Hashimoto’s disease) – immune </li></ul></ul><ul><ul><li>system attacks the thyroid gland </li></ul></ul><ul><ul><li>idiopathic (unknown) </li></ul></ul><ul><li>DX: decreased T3, T4 </li></ul><ul><li>Elevated TSH, cholesterol </li></ul>
  2. 6. <ul><li>Med. Mgt . – thyroid replacement therapy </li></ul><ul><li>Levothyroxine (Synthyroid) , liothyronine </li></ul><ul><li>Expected effects: diuresis,  puffiness, improved reflexes </li></ul><ul><li>and muscle tone,  PR </li></ul><ul><li>Nsg. Interventions </li></ul><ul><ul><li>provide a warm environment, conducive to rest </li></ul></ul><ul><ul><li>avoid use of all sedatives </li></ul></ul><ul><ul><li>assist client in choosing  calorie,  cholesterol diet </li></ul></ul><ul><ul><li> fluid and fiber to relieve constipation </li></ul></ul><ul><ul><li> physical activity and sensory stimulation gradually as </li></ul></ul><ul><ul><li>condition improves </li></ul></ul><ul><ul><li>monitor cardiovascular response to increased hormone </li></ul></ul><ul><ul><li>levels carefully </li></ul></ul><ul><ul><li>provide info. about prescribed medications (name, dosage, side effects) and importance of lifelong medical supervision </li></ul></ul>
  3. 8. <ul><li>Hyperthyroidism </li></ul><ul><li>over-secretion of the thyroid gland </li></ul><ul><li>also called thyrotoxicosis, tissues are stimulated by </li></ul><ul><li>excessive thyroid hormone </li></ul><ul><li>a recurrent syndrome, may appear after emotional </li></ul><ul><li>stress or infection </li></ul><ul><li>occurs mostly in women 20-50 yrs old </li></ul><ul><li>Causes : adenoma, goiter, viral inflammation, auto-immune glandular stimulation, grave’s disease - most common cause </li></ul>
  4. 9. <ul><li>Hyperthyroidism (cont.) </li></ul><ul><li>DX: > elevated T3, T4 values </li></ul><ul><li>abnormal findings in the thyroid scan </li></ul><ul><li>Goiter – enlargement of the thyroid gland </li></ul><ul><li>due to  stimulation of the thyroid gland by TSH </li></ul><ul><li>Simple goiter – enlarged thyroid gland </li></ul><ul><li>due to iodine deficiency, intake of goitrogenic foods  cabbage, turnips, soybeans </li></ul><ul><li>may be hereditary </li></ul>
  5. 10. <ul><li>Grave’s Disease </li></ul><ul><li>disorder char. by one or more of the ff: </li></ul><ul><ul><li>diffuse goiter </li></ul></ul><ul><ul><li>hyperthyroidism </li></ul></ul><ul><ul><li>infiltrative opthalmopathy  exophthalmos </li></ul></ul><ul><li>seen in females under age 40 </li></ul><ul><li>result from stimulation of the thyroid gland by </li></ul><ul><li>thyroid-stimulating immunoglobulins (TSI) </li></ul><ul><li>cause is unknown, may be hereditary, gender-related, </li></ul><ul><li>often occurs after severe emotional stress or </li></ul><ul><li>infection </li></ul>
  6. 11. <ul><li>Thyroid Storm or Crisis </li></ul><ul><li>a medical emergency  pts. develop severe </li></ul><ul><li>manifestation of hyperthyroidism </li></ul><ul><li> temp., tachycardia, dysrhythmias </li></ul><ul><li>worsening tremors, restlessness </li></ul><ul><li>delirious or psychotic state or coma </li></ul><ul><li>abdominal pain </li></ul><ul><li> BP and  RR </li></ul><ul><li>Precipitated by a major stressor : </li></ul><ul><ul><li>infection </li></ul></ul><ul><ul><li>trauma or surgery (thyroidectomy) </li></ul></ul><ul><ul><li>inadequate treatment </li></ul></ul>
  7. 12. <ul><li>Complications : </li></ul><ul><ul><li>cardiovascular disease (HPN, Angina, CHF) </li></ul></ul><ul><ul><li>Exophthalmos – abnormal protrusion of the eyeballs </li></ul></ul><ul><ul><ul><li>caused by abnormal deposits of fat and fluid in </li></ul></ul></ul><ul><ul><ul><li>the retroocular tissue </li></ul></ul></ul><ul><ul><li>Corneal abrasion </li></ul></ul><ul><ul><li>Thyroid storm or crisis  life-threatening </li></ul></ul><ul><ul><li>hypermetabolism and excessive adrenergic </li></ul></ul><ul><ul><li>response (  HR,  RR,  BP) </li></ul></ul>
  8. 13. <ul><li>Pathophysiology: </li></ul><ul><li>hypertrophy and hyperplasia of the thyroid gland </li></ul><ul><li>excessive secretion of thyroid hormone  </li></ul><ul><li>hypermetabolic condition </li></ul><ul><li>exaggeration of all metabolic processes </li></ul><ul><li> metabolic rate, excessive heat production </li></ul><ul><li> appetite </li></ul><ul><li> neuromuscular and CVS activity </li></ul><ul><li>hyperactivity of sympathetic NS </li></ul><ul><li>personality changes </li></ul>
  9. 14. <ul><li>Anxiety </li></ul><ul><li>Flushed, smooth skin </li></ul><ul><li>Heat intolerance </li></ul><ul><li>Mood swings </li></ul><ul><li>Diaphoresis </li></ul><ul><li>Tachycardia </li></ul><ul><li>Palpitations </li></ul><ul><li>Dyspnea </li></ul><ul><li>Weakness </li></ul><ul><li>Wt. loss </li></ul>Assessment Findings
  10. 20. <ul><li>Nsg. Interventions: </li></ul><ul><li>Provide calm, restful envt. </li></ul><ul><ul><li>physical comfort, cool envt. temp., bathe frequently w/ cool water </li></ul></ul><ul><ul><li>provide adequate rest, avoid muscle fatigue </li></ul></ul><ul><ul><li> stressors in the envt.—  noise and lights </li></ul></ul><ul><ul><li>relaxation techniques </li></ul></ul><ul><li>Provide adequate nutrients </li></ul><ul><ul><li> calorie,  protein, balanced diet (4,000-5,000 cal/day) </li></ul></ul><ul><ul><li> fluid intake </li></ul></ul><ul><ul><li>Restrict stimulants (tea, coffee, alcohol) </li></ul></ul><ul><ul><li>small, frequent feedings if hypermotility is present </li></ul></ul><ul><ul><li>Daily wt. </li></ul></ul>
  11. 21. <ul><li>Nsg. Interventions: </li></ul><ul><li>Provide emotional support </li></ul><ul><li>Provide eye care </li></ul><ul><ul><li>eye drops, dark glasses, patch eyes if necessary </li></ul></ul><ul><ul><li>elevate head of bed for sleep </li></ul></ul><ul><ul><li>restrict dietary sodium </li></ul></ul><ul><ul><li>assess adequacy of lid closure </li></ul></ul><ul><li>Be alert for complications </li></ul>
  12. 22. <ul><li>Post-op care after Thyroidectomy </li></ul><ul><li>O2 therapy, suction secretions </li></ul><ul><li>Monitor for signs of bleeding and excessive edema </li></ul><ul><li>elevate head of bed 30 o , support head and neck – to </li></ul><ul><li>avoid tension on sutures </li></ul><ul><li>check dressing frequently, check behind the neck for </li></ul><ul><li>bleeding </li></ul><ul><li>assess for signs of resp. distress, hoarseness </li></ul><ul><li>(laryngeal edema or damage) </li></ul><ul><li>keep tracheostomy set in patient’s room for emergency </li></ul><ul><li>use </li></ul>
  13. 23. <ul><li>Post-op Complications: be alert for the possibility of: </li></ul><ul><li>1. Tetany (due to hypocalcemia caused by accidental removal of parathyroid glands) </li></ul><ul><ul><li>assess for numbness, tingling or muscle twitching </li></ul></ul><ul><ul><li>Chvostek’s sign and Trousseau’s sign </li></ul></ul><ul><ul><li>Ca+ gluconate IV </li></ul></ul><ul><li>2. Hemorrhage </li></ul><ul><ul><li>WOF: hypotension, tachycardia, other signs of hypovolemia </li></ul></ul><ul><ul><li>WOF: irregular breathing, swelling, choking---possible hemorrhage and tracheal compression </li></ul></ul><ul><ul><li>WOF: early signs of hemorrhage: repeated clearing of the throat, difficulty swallowing </li></ul></ul>
  14. 24. <ul><li>Post-op Complications: be alert for the possibility of: </li></ul><ul><li>3. Thyroid storm </li></ul><ul><li>- life-threatening </li></ul><ul><li>- sudden  release of thyroid hormone </li></ul><ul><li>- fever, tachycardia, increasing restlessness and </li></ul><ul><li>agitation, delirium </li></ul><ul><ul><li>administer food and fluid with care (dysphagia is common) encourage client to gradually  ROM of neck </li></ul></ul><ul><ul><li>teach about medications, frequent follow-up </li></ul></ul><ul><ul><ul><li>total thyroidectomy – life long replacement medication (T3, T4) </li></ul></ul></ul><ul><ul><ul><li>subtotal thyroidectomy – careful monitoring of return of thyroid function </li></ul></ul></ul>
  15. 26. <ul><li>Diabetes Mellitus </li></ul><ul><ul><li>is a chronic disorder of carbohydrate, protein, and </li></ul></ul><ul><ul><li>fat metabolism resulting from insulin deficiency or </li></ul></ul><ul><ul><li>abnormality in the use of insulin </li></ul></ul><ul><li>Predisposing factors: </li></ul><ul><li>exact cause of diabetes mellitus remain unknown </li></ul><ul><li>genetic / hereditary predisposition </li></ul><ul><li>viruses </li></ul><ul><li>pancreatitis </li></ul><ul><li>pancreatic tumor </li></ul><ul><li>autoimmune disorder </li></ul><ul><li>obesity (overweight people require more insulin </li></ul><ul><li>to metabolize the food they eat or the number of insulin receptor sites in cells is decreased) </li></ul>
  16. 27. <ul><li>Types </li></ul><ul><li>Insulin – Dependent Diabetes Mellitus (IDDM) or Type I </li></ul><ul><ul><li>destruction of beta cells of the pancreas  little or no </li></ul></ul><ul><ul><li>insulin production </li></ul></ul><ul><ul><li>requires daily insulin admin. </li></ul></ul><ul><ul><li>may occur at any age, usually appears below age 15 </li></ul></ul><ul><li>Non Insulin–Dependent Diabetes Mellitus (NIDDM) or Type II </li></ul><ul><ul><li>probably caused by: </li></ul></ul><ul><ul><ul><li>disturbance in insulin reception in the cells </li></ul></ul></ul><ul><ul><ul><li> number of insulin receptors </li></ul></ul></ul><ul><ul><ul><li>loss of beta cell responsiveness to glucose leading to </li></ul></ul></ul><ul><ul><ul><li>slow or  insulin release by the pancreas </li></ul></ul></ul><ul><ul><li>occurs over age 40 but can occur in children </li></ul></ul><ul><ul><li>common in overweight or obese </li></ul></ul><ul><ul><li>w/ some circulating insulin present, often do not require </li></ul></ul><ul><ul><li>insulin </li></ul></ul>
  17. 29. <ul><li>Clinical Manifestations ( Signs and Symptoms) </li></ul><ul><li>- Polyuria - weakness </li></ul><ul><li>- Polydipsia - fatigue </li></ul><ul><li>- Polyphagia -  blood sugar / glucose level </li></ul><ul><li>- weight loss - (+) glucose in urine (glycosuria) </li></ul><ul><li>nausea / vomiting </li></ul><ul><li>- changes in LOC (severe hyperglycemia) </li></ul><ul><li>(sleepiness, drowsiness  coma) </li></ul><ul><li>- recurrent infection, prolonged wound healing </li></ul><ul><li>altered immune and inflammatory response, prone to </li></ul><ul><li>infection (glucose inhibits the phagocytic action of WBC  </li></ul><ul><li> resistance) </li></ul><ul><li>genital pruritus – (hyperglycemia and glycosuria favor fungal growth : candidal infection – resulting in pruritus, common </li></ul><ul><li>presenting symptom in women) </li></ul>
  18. 30. <ul><li>Fasting Blood Sugar (FBS) </li></ul><ul><ul><li>NPO for 12 hours </li></ul></ul><ul><ul><li>Normal value= 80-120 mg/dl </li></ul></ul><ul><ul><li>140 mg/dl or more – diagnostic of DM </li></ul></ul><ul><li>Postprandial blood sugar </li></ul><ul><ul><li>Blood is withdrawn 2 hrs. after a meal </li></ul></ul><ul><ul><li>N value = < 120mg/dl </li></ul></ul><ul><ul><li>200 mg/dl or more is diagnostic of DM </li></ul></ul><ul><li>Oral Glucose Tolerance Test (OGTT) </li></ul><ul><ul><li>NPO 12 hrs, no smoking, coffee or tea, minimize activity, minimize stress </li></ul></ul><ul><ul><li>obtain FBS, administer 100 gm. Glucose by mouth diluted in juice; obtain blood and urine specimen after 1, 2 and 3 hrs. </li></ul></ul><ul><ul><li>N value = blood glucose rise to 140 mg/dl in the 1 st hour and returns to normal by 2 nd and 3 rd hrs. </li></ul></ul><ul><ul><li>Abnormal = blood glucose does not return to normal by 2 nd and 3 rd hrs.; all urine specimen positive for glucose </li></ul></ul>
  19. 31. <ul><li>4 . Glycosylated hemoglobin </li></ul><ul><ul><li>Provides information about blood glucose level during the previous 3 months </li></ul></ul><ul><ul><li>bec. glucose in the bloodstream attaches to some of the hemoglobin and stay attached during the 120-day lifespan of the RBC </li></ul></ul>
  20. 32. <ul><li>Interventions for Diabetes Mellitus </li></ul><ul><li>A.Dietary Management </li></ul><ul><ul><li>Follow individualized meal plan and snacks as scheduled </li></ul></ul><ul><ul><ul><li>Balanced diabetic diet – 50% CHO, 30% fats, 20% CHON, vitamins and minerals </li></ul></ul></ul><ul><ul><ul><li>diet based on pts. size, wt., age, occupation and activity </li></ul></ul></ul><ul><ul><li>2. Pt. must have adequate CHO intake to correspond to the time when insulin is most effective </li></ul></ul><ul><ul><li>Routine blood glucose testing before each meal and at bedtime is necessary during initial control, during illness and in unstable pts. </li></ul></ul><ul><ul><li>Do not skip meals </li></ul></ul><ul><ul><li>Measure foods accurately, do not estimate </li></ul></ul><ul><ul><li>Less added fat, fewer fatty foods and low-cholesterol </li></ul></ul>
  21. 33. <ul><li>Interventions for Diabetes Mellitus </li></ul><ul><li>A.Dietary Management </li></ul><ul><ul><li>Advise use of complex carbohydrates to help stabilize blood sugar. Meal should include more fiber and starch and fewer simple or refined sugars. </li></ul></ul><ul><ul><li>Avoid concentrated sweets, high in sugar (jellies, jams, cakes, ice cream) </li></ul></ul><ul><ul><li>If taking insulin, eat extra food before periods of vigorous exercise </li></ul></ul><ul><ul><li>Avoid periods of fasting and feasting </li></ul></ul><ul><ul><li>Keep weight at normal level, obese diabetics should be on a strict weight control program and should lose weight. </li></ul></ul>
  22. 34. <ul><li>B. Teach pt. on correct administration of insulin and other hypoglycemic agents. </li></ul><ul><ul><li>insulin in current use may be stored at room temp., all others in ref. or cool area </li></ul></ul><ul><ul><li>avoid injecting cold insulin  lead to tissue reaction </li></ul></ul><ul><ul><li>roll insulin vial to mix, do not shake, remove air bubbles from syringe </li></ul></ul><ul><ul><li>press (do not rub) the site after injection (rubbing may alter the rate of absorption of insulin) </li></ul></ul><ul><ul><li>avoid smoking for 30 mins. after injection (cigarette smoking  absorption) </li></ul></ul><ul><ul><li>Rotate sites </li></ul></ul><ul><ul><li>Failure to rotate sites may lead to Lipodystrophy </li></ul></ul><ul><ul><li>Lipodystrophy – localized disturbance of fat metabolism </li></ul></ul><ul><ul><li>Ex. Lipohypertrophy – thickening of subcutaneous tissue at injection site, feel lumpy or hard, spongy </li></ul></ul><ul><ul><ul><li> result to  absorption of insulin  making it difficult to control the pt.’s blood glucose </li></ul></ul></ul>
  23. 35. <ul><li>Factors that influence the body’s need for insulin </li></ul><ul><li> need : trauma, infection, fever, severe psychological or physical stress, other illnesses </li></ul><ul><li> need : active exercise </li></ul><ul><li>Hypoglycemia </li></ul><ul><ul><li>low blood glucose (usually below 60mg/dl) </li></ul></ul><ul><ul><li>results from too much insulin, not enough food, and/or excessive physical activity </li></ul></ul><ul><ul><li>may occur 1-3 hrs after regular insulin injection </li></ul></ul><ul><li>S/Sx: </li></ul><ul><li>Sweating, tremor, pallor, tachycardia, palpitations and nervousness </li></ul><ul><ul><li>caused by release of epinephrine from the CNS when blood glucose falls rapidly </li></ul></ul><ul><li>Headache, light-headedness, confusion, numbness of lips and tongue, slurred speech, drowsiness, convulsions and coma </li></ul><ul><ul><li>caused by depression of the CNS because of  glucose supply of brain cells </li></ul></ul>
  24. 37. <ul><li>Management of Hypoglycemia </li></ul><ul><li>Give simple sugar orally if pt. is conscious and can swallow – orange juice, candy, glucose tablets, lump of sugar </li></ul><ul><li>Give Glucagon (SQ or IM) if pt. is unconscious or cannot take sugar by mouth </li></ul><ul><li>As soon as pt. regains consciousness, he should be given carbohydrate by mouth </li></ul><ul><li>If pt. does not respond to the above measures, he is given 50 ml of 50% glucose I.V. or 1000 ml of 5%-10% glucose in water I.V. </li></ul>
  25. 38. <ul><li>Preventing Hypoglycemic Reactions Due to Insulin </li></ul><ul><li>Instruct the pt. as follows: </li></ul><ul><li>Hypoglycemia may be prevented by maintaining regular exercise, diet and insulin </li></ul><ul><li>Early symptoms of hypoglycemia should by recognized and treated </li></ul><ul><li>Carry at all times some form of simple carbohydrate (orange juice, sugar, candy) </li></ul><ul><li>Extra food should be taken before unusual physical activity or prolonged periods of exercise </li></ul><ul><li>Between-meal and bedtime snacks may be necessary to maintain a normal glucose level. </li></ul>
  26. 40. Oral Antidiabetic Agents
  27. 41. <ul><li>Teach pt. to estabilish and maintain a pattern of regular exercise </li></ul><ul><li>Benefits of exercise : </li></ul><ul><ul><li>promotes use of CHO & enhances action of insulin </li></ul></ul><ul><ul><li> blood glucose levels </li></ul></ul><ul><ul><li> need for insulin </li></ul></ul><ul><ul><li> the no. of functioning receptor sites for insulin </li></ul></ul><ul><li>perform exercise after meals to ensure an adequate level of blood glucose </li></ul><ul><li>carry a rapid-acting source of glucose during exercise </li></ul><ul><li>excessive or unplanned exercise may trigger hypoglycemia </li></ul><ul><li>take insulin and food before active exercise </li></ul>
  28. 42. <ul><li>Teach pt. to practice good personal hygiene and positive health promotion to avoid diabetic complications </li></ul><ul><li>teach pt. about diabetic foot care </li></ul><ul><li>teach pt. the adjustments that must be made in the event of minor illness (e.g. colds, flu) </li></ul><ul><ul><li>continue taking insulin or oral hypoglycemic agents </li></ul></ul><ul><ul><li>maintain fluid intake </li></ul></ul><ul><ul><li> frequency of blood testing or urine testing </li></ul></ul><ul><li>help pt. identify stressful situations in lifestyle that might interfere with good diabetic control </li></ul><ul><li>encourage good daily hygiene </li></ul><ul><li>advise regular eye exams </li></ul><ul><li>teach aggressive care for minor skin cuts and abrasions </li></ul>
  29. 44. <ul><li>Diabetic Ketoacidosis (DKA) Coma </li></ul><ul><li>S/Sx: </li></ul><ul><li>polyuria, thirst </li></ul><ul><li>nausea, vomiting, abdominal pain –-- due to acidosis </li></ul><ul><li>weakness, headache, fatigue --- due to acidosis and F/E imbalance </li></ul><ul><li>dim vision, flushed face </li></ul><ul><li>dehydration, hypovolemic shock (  PR,  BP, dry skin, wt. loss) </li></ul><ul><li>hyperpnea (Kussmaul’s breathing) </li></ul><ul><li>acetone breath (fruity odor) </li></ul><ul><li>lethargy  COMA </li></ul><ul><li>Blood glucose level > 250-350 mg/100 ml. </li></ul>
  30. 46. <ul><li>Hyperglycemic, Hyperosmolar, Non-Ketotic Coma (HHNC) </li></ul><ul><ul><li>can occur when the action of insulin is severely inhibited </li></ul></ul><ul><ul><li>seen in pts. w/ NIDDM, elderly persons w/ NIDDM </li></ul></ul><ul><li>Precipitating factors: </li></ul><ul><li>infection, renal failure, MI, CVA, GI hemorrhage, pancreatitis, CHF, TPN, surgery, dialysis, steroids </li></ul><ul><li>S/Sx: </li></ul><ul><li>polyuria  oliguria (renal insufficiency) </li></ul><ul><li>lethargy </li></ul><ul><li> temp,  PR,  BP, signs of severe fluid deficit </li></ul><ul><li>Confusion, seizure, coma </li></ul><ul><li>Blood glucose level > 600 mg/100 ml. </li></ul>
  31. 47. <ul><li>Interventions for DKA and Hyperosmolar Coma </li></ul><ul><li>Regular insulin IV push or IV drip </li></ul><ul><li>0.9% NaCl IV – 1 L during the 1 st hr, 2-8 L over 24 hrs. </li></ul><ul><li>administer sodium bicarbonate IV to correct acidosis </li></ul><ul><li>Monitor electrolyte levels, esp. serum K+ levels </li></ul><ul><li>administer K+, monitor UO hourly (30ml/hr) </li></ul>
  32. 48. <ul><li>Long-term Complications of DM </li></ul><ul><li>Vascular Changes </li></ul><ul><li>) Macroangiopathy – hardening and damage of the walls of large arteries </li></ul><ul><ul><li>Coronary Artery Disease </li></ul></ul><ul><ul><li>CVA (Stroke) </li></ul></ul><ul><ul><li>Peripheral vascular disease – foot ulcers and gangrene </li></ul></ul><ul><li>b. ) Microangiopathy – destruction of small blood vessels </li></ul><ul><ul><li>Retinopathy – damage to retinal capillaries; hemorrhage, blindness </li></ul></ul><ul><ul><li>Nephropathy – damage microcirculation of kidneys; CRF </li></ul></ul><ul><li>2. Neuropathy </li></ul><ul><ul><li>Damage to the neurons caused by vascular insufficiency and  blood glucose </li></ul></ul><ul><ul><li>Sensory and motor impairment </li></ul></ul><ul><ul><li>Numbness, tingling, pain in extremities </li></ul></ul><ul><ul><li>Painless neuropathy </li></ul></ul><ul><ul><li>Impotence </li></ul></ul>
  33. 49. INSULIN ONSET PEAK DURATION Ultra rapid acting Insulin analog ( Humalog) 15 mins. 2-4 hrs. 6-8 hrs. Rapid acting: Regular ( Semilente ) ½-1 hr 2-4 hrs. 6-8 hrs. Intermediate: NPH ( Lente ) 1-2 hrs. 7-12 hrs. 24-30 hrs. Long acting: Protamine Zinc ( Ultralente ) 4-6 hrs. 18 + hrs 30-36 hrs.
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