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  • 1. Timby/Smith: Introductory Medical-Surgical Nursing, 10/e Chapter 51: Caring for Clients with Diabetes Mellitus Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 2. Diabetes Mellitus • Metabolic Disorder of the Pancreas: CHO, fat, protein metabolism; Chronic disorder • Metabolic Syndrome – Abdominal obesity; HTN; Elevated LDP, triglycerides, blood glucose levels; Low HDL • 90-95% Acquire Disorder as Adults • 7th Cause of Death in U.S.; 23.6 million in U.S. have DM (estimate) • Incidence increased among African Americans, Latinos, Native Americans, Asian Americans Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 3. Question Is the following statement true or false? Diabetes mellitus is a disorder of the pancreas affecting sugar metabolism. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 4. Answer False. Diabetes mellitus is a disorder of the pancreas affecting carbohydrate, protein, and fat metabolism. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 5. Diabetes Mellitus • Prediabetes Mellitus – Can lead to • Type 2 diabetes • Heart disease • Stroke – Impaired fasting glucose (IFG): 100 to 125 mg/dL – Impaired glucose tolerance (IGT): 140 to 199 mg/dL Figure 51-1 Islet of Langerhans in the pancreas Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 6. Diabetes Mellitus • Hyperglycemia – Associated: Other disorders; Management – Pancreatitis; Adrenocortical hormones • Pathophysiology and Etiology – Type 1 diabetes mellitus (IDDM) • Juvenile diabetes; No insulin production • Lipolysis; Ketones; Ketoacidosis • Autoimmune disorder – Type 2 diabetes mellitus (NIDDM) • Insulin resistant; Insufficient insulin; Inherited Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 7. Question Is the following statement true or false? Type 2 DM results from a lack of insulin production. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 8. Answer False. Type 2 DM results from insulin resistance or insufficient insulin production. Type 1 DM is caused by no insulin production. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 9. Diabetes Mellitus • Pathophysiology and Etiology – Type 2 diabetes mellitus (NIDDM) (Cont’d) • Obesity—trigger; Glycosuria; Impaired renal threshold; Ketonemia; Kussmaul respirations • Assessment Findings – Signs and symptoms • Polyuria; Polydipsia; Polyphagia; Weight loss; Dehydration; Blurred vision; Thirst; Infections: Skin, urinary tract, vaginal – Diagnostic findings • Urinary tests; Blood tests; Glucometer; Hemoglobin A1c test Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 10. Diabetes Mellitus • Medical Management – Depends on type of diabetes – Diet and weight loss: Major component of treatment – Exercise • Reduces need for insulin • Improves blood circulation – Insulin • Types of insulin: Human; Beef and pork • Alternatives to injection Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 11. Diabetes Mellitus • Medical Management – Insulin (Cont’d) • Administration of insulin • Dosage: U-100; Type • IV; Subcutaneous; Lipoatrophy; Lipohypertrophy • Insulin pen • Jet injector • Insulin pump Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 12. Diabetes Mellitus • Medical Management – Oral antidiabetic agents-type 2 • Sulfonylureas and meglitinides • Biguanides and thiazolidinediones • Alpha-glucosidase inhibitors – Pancreas transplantation – Islet cell transplantation • Nursing Management Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 13. Diabetic Ketoacidosis (DKA) • Pathophysiology and Etiology – Brittle diabetes; Noncompliance with treatment; Infection – Acidotic state; Coma • Assessment Findings – Weakness; Thirst; Anorexia; Vomiting; Drowsiness; Abdominal pain; Kussmaul respirations; Low BP – Blood glucose; Urine test; Laboratory tests; Blood pH Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 14. Question Is the following statement true or false? Diabetic ketoacidosis results from a client being a “brittle” diabetic or noncompliance with DM treatment. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 15. Answer True. Diabetic ketoacidosis results from a client being a “brittle” diabetic or noncompliance with DM treatment. It typically occurs in Type 1 DM. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 16. Diabetes Mellitus Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 17. Diabetic Ketoacidosis • Medical Management – Main goals • Reduce the elevated blood glucose • Correct fluid and electrolyte imbalances • Clear the urine and blood of ketones – IV Insulin; Glucose – Isotonic fluid – Potassium replacements • Nursing Management Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 18. Hyperosmolar Hyperglycemic Nonketotic Syndrome • Pathophysiology and Etiology – Results from serious illness; Diuresis; Blood glucose >500; pH normal range • Assessment Findings – Hypotension; Mental changes – Extreme thirst; Dehydration; Tachycardia – Fever; Neurologic signs – Physical examination • Diagnostic Findings: Blood glucose; Serum potassium, sodium; Serum osmolarity Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 19. Hyperosmolar Hyperglycemic Nonketotic Syndrome • Medical Management – Insulin administration – Correction of fluid and electrolyte imbalances – CVP • Nursing Management Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 20. Hypoglycemia • Pathophysiology and Etiology – Hyperinsulinism—blood glucose <60 mg/dL – Contributing factors: Diet; Exercise; Alcohol • Assessment Findings – Signs and symptoms: Nausea; Drowsiness; Hunger; Malaise; Excessive perspiration; Confusion; Coordination difficulty; Personality or behavior changes • Diagnostic Findings: Blood glucose levels; Glucometer test Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 21. Hypoglycemia • Medical Management – Administration of 15 to 20 g of simple carbohydrate as soon as possible – Glucagon – IV administration of 50% glucose – Complex carbohydrates • Nursing Management Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 22. Peripheral Neuropathy • Pathophysiology and Etiology – Poor glucose control; Decreased blood circulation to nerve tissue – Motor neuropathy; Sensory neuropathy; Autonomic neuropathy • Assessment Findings – Signs and symptoms: Pain; Swollen feet Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 23. Peripheral Neuropathy • Assessment Findings – Signs and symptoms: Disturbing sensations; Digestive, urinary, and sexual dysfunction; Dizziness; Smaller skeletal muscles • Diagnostic findings: Neurologic examination; Screening test; Electromyography • Medical Management – Diet; Exercise; Pain relief measures – Drug therapy; Antibiotic therapy; Drugs to reverse diabetic neuropathies • Nursing Management Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 24. Diabetic Nephropathy • Pathophysiology and Etiology – Glomerular deterioration; Five stages • Assessment Findings: Swollen feet and hands; Gradually increasing BP; Tiredness; Weakness; Urinalysis • Diagnostic Findings: Serum creatinine test; Renal creatinine clearance test • Medical Management: Control blood glucose levels, hypertension – Drug therapy; Dietary protein reduction; Smoking cessation • Nursing Management Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 25. Diabetic Retinopathy • Pathophysiology and Etiology – Vascular changes in retina – Types • Nonproliferative • Proliferative—blindness • Assessment Findings – Diminished visual acuity – Opthalmic examination; Fluorescein angiography Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Figure 51-11
  • 26. Diabetic Retinopathy • Medical Management – Laser photocoagulation; Vitrectomy; ACE inhibitor • Nursing Management – Encourage therapeutic regimen for tight glucose control – Client education • Complications of diabetes • Regular ophthalmic examinations • Medication Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 27. Vascular Disturbances • Pathophysiology and Etiology: Thickening of arterial walls; Coronary artery disease; Hyperlipidemia • Assessment Findings: Cool extremities; Leg cramps; Gangrene; Skin ulcers; Myocardial infarctions • Diagnostic Findings: Laboratory tests; Angiography; Doppler ultrasonic flow studies • Medical and Surgical Management: Lipid-lowering measures; Vasodilators; Platelet aggregation reduction drugs; Amputation; Insulin; Antidiabetic drugs • Nursing Management Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 28. End of Presentation Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins