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Chapter 067

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  • Glucometer for measuring serum glucose levels.
  • Proinsulin, secreted by and stored in the beta cells of the islets of Langerhans in the pancreas, is transformed by the liver into active insulin. Insulin attaches to receptors on target cells, where it promotes glucose transport into the cells through the cell membranes.
  • Placement sites of monofilaments for testing of protective sensation.
  • The manifestations point to diabetic ketoacidosis.The patient’s glucose level is most likely >300 mg/dL.
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    • 1. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.Chapter 67Care of Patients with DiabetesMellitus
    • 2. 2Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.Insulin Physiology
    • 3. 3Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.Types of Diabetes Type 1 Type 2 Gestational (GDM) Other specific conditions resulting inhyperglycemia
    • 4. 4Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.Absence of Insulin Hyperglycemia Polyuria Polydipsia Polyphagia Ketone bodies Hemoconcentration, hypovolemia,hyperviscosity, hypoperfusion, and hypoxia Acidosis, Kussmaul respiration Hypokalemia, hyperkalemia, or normal serumpotassium levels
    • 5. 5Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.Acute Complications of Diabetes Diabetic ketoacidosis Hyperglycemic-hyperosmolar state (HHS) Hypoglycemia from too much insulin or toolittle glucose
    • 6. 6Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.Chronic Complications of Diabetes Macrovascular/microvascular disease Retinopathy (vision problems) Nephropathy (kidney dysfunction) Neuropathy (nerve dysfunction)
    • 7. 7Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.Macrovascular Complications Cardiovascular disease Cerebrovascular disease
    • 8. 8Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.Microvascular Complications Eye and vision complications Diabetic neuropathy Diabetic nephropathy Male erectile dysfunction
    • 9. 9Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.Health Promotion and Maintenance Control of diabetes and its complications ismajor focus for health promotion activities
    • 10. 10Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.Assessment History Blood tests Fasting plasma glucose (FPG) Oral glucose tolerance test (OGTT) Other blood tests Screening Ongoing assessment—glycosylated hemoglobinassays, glycosylated serum proteins and albumin,urine tests, tests for kidney function
    • 11. 11Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.Testing Sensation
    • 12. 12Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.Treatment Options Oral therapies Insulin therapies Nutritional considerations Exercise Surgical intervention Foot care Wound care
    • 13. 13Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.Patient Education Insulin storage Dose preparation Syringes Blood glucose monitoring Infection control measures Diet therapy
    • 14. 14Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.Activity: Patient with a DiabeticCondition1. Etiologies, risk factors, comorbidities2. Assessment findings3. Diagnostic tests4. Nurse’s role5. Interdisciplinary team’s role6. Treatment/intervention priorities7. Teaching/health promotion information8. Community resources
    • 15. 15Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.A 23-year-old patient with a history of type 1 diabetes isadmitted to the ED with nausea and abdominal pain.His respiratory rate is 34/min with deep breaths and afruity smell to his breath. He is responsive, but difficultto arouse.1. What does the nurse suspect is happening with thispatient?2. What serum glucose level would the nurse expect tosee with this patient?