Diabetes mellitus & blood glucose monitoring


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  • Extreme thirst Frequent urination dry skin hunger blurred vision drowsiness nausea
  • Extreme thirst Frequent urination dry skin hunger blurred vision drowsiness nausea
  • Extreme thirst Frequent urination dry skin hunger blurred vision drowsiness nausea
  • Diabetes mellitus & blood glucose monitoring

    1. 1. Pickaway-Ross Medical Careers IIPickaway-Ross Medical Careers II Diabetes MellitusDiabetes Mellitus Symptoms, Treatment, Crisis & Measuring Blood Glucose Levels
    2. 2. Key TermsKey Terms Diabetes Mellitus (sugar diabetes) is a disease in which the body cannot produce or use insulin properly. Insulin is a hormone produced by the pancreas that allows the glucose in the blood stream to enter into cells to be used as energy.
    3. 3. ObjectivesObjectives  Distinguish between the types of diabetes mellitus.  Identify signs and symptoms of diabetes mellitus.  Describe risk factors for diabetes mellitus.  Explain the complications of diabetes mellitus  Discuss treatment of diabetes mellitus.  Recognize the signs and symptoms hypo and hyperglycemia  Identify nurse aide actions to treat hypo and hyperglycemia .  Demonstrate blood glucose monitoring procedure.  Measure and document accurate blood glucose.  Employ standard of care for diabetic clients
    4. 4. Diabetes Mellitus: TypesDiabetes Mellitus: Types Named according to age of onset & need for insulin Type I Usually occurs early in life (children, teens, & young adults) Rapid Onset Pancreas produces little or no insulin Insulin dependent More severe Higher risk of complications •Live longer with disease
    5. 5. Diabetes Mellitus: TypesDiabetes Mellitus: Types Type II (Non-insulin dependent) Adult-onset; typically obese Can occur at any age Slow onset Controlled with diet and/or oral medications that stimulate the pancreas to secrete insulin Can become insulin dependent (Type I) Gestational Diabetes Diabetes develops during pregnancy Typically goes away after pregnancy Higher risk for Type II later in life
    6. 6. Signs & SymptomsSigns & Symptoms 1. Excessive thirst (polydipsia) 2. Excessive urination (polyuria) 3. Increased frequency in eating (polyphagia) 4. Recent loss of weight (without trying/dieting) 5. Delayed healing in wounds 6.Dry, itchy skin 7.Losing feeling or tingling in the feet 8.Blurred vision 9.Fatigue
    7. 7. Risk FactorsRisk Factors Family History of the disease Type I Whites Type II  Older Overweight African-American Native Americans Hispanics
    8. 8. ComplicationsComplications •Blindness •Kidney damage/renal failure •Nerve damage •Damage to gums and teeth •Heart & blood vessel disease from fatty deposits •Foot & leg wounds & ulcers •Infection & gangrene •Amputation
    9. 9. TreatmentTreatment Goal: Control of diet, exercise and medication. Type I Daily insulin therapy Healthy eating Exercise Type II  Healthy eating Exercise Oral medications Compliance by the patient and regular glucose monitoring help keep the balance of treatment.
    10. 10. InsulinInsulin Given as a subcutaneous injection by RN, allows the body to use glucose Types of insulin - long lasting or short acting Insulin injections are timed to peak during meal time and after meals A patient may receive several types of insulin Blood sugars regulate the amount of insulin ordered Normal blood sugar levels: 70 - 110 mg/dl
    11. 11. Hyperglycemia: High Blood SugarHyperglycemia: High Blood Sugar Too much food, too little insulin, stress or illness Undiagnosed Diabetes Onset may be gradual Symptoms 1. Extreme thirst/dry mouth 2. Frequent urination 3. Dry skin 4. Hunger 5. Blurred vision 6. Drowsiness 7. Nausea Can progress to DIABETIC COMA
    12. 12. Hyperglycemia: Diabetic ComaHyperglycemia: Diabetic Coma Ketoacidosis (DKA) Blood sugar - 250 mg/dl or above  Symptoms 1. Extreme dry mouth/thirst 2. Sweet or fruity odor to the breath (Juicy Fruit) 3. Nausea and/or vomiting 4. Weakness or dizziness 5. Confusion 6. Rapid, deep respirations 7. Drowsiness 8. Dry, flushed skin Eventually lose consciousness/die without tx
    13. 13. Hyperglycemia: Diabetic ComaHyperglycemia: Diabetic Coma Treatment Place in a position of comfort Monitor respirations Need immediate medical treatment •Fluid Replacement •Electrolyte Replacement •Insulin Therapy
    14. 14. Hypoglycemia - Low Blood SugarHypoglycemia - Low Blood Sugar Failure to eat proper amounts, vomiting after taking insulin, or taking excess insulin Sudden onset Symptoms 1. Hunger 2. Fatigue; weakness 3. Trembling; shaking 4. Sweating 5. Headache 6. Dizziness; feeling faint Can progress to INSULIN SHOCK
    15. 15. Hypoglycemia – Insulin ShockHypoglycemia – Insulin Shock Blood sugar - 60 mg/dl or below Symptoms 1. Behavior change 2. Confusion 3. Clumsy and jerky 4. Restless, anxious 5. Palpitations 6. Rapid pulse 7. Low blood pressure 8. Convulsions Eventually lose consciousness/brain damage/death
    16. 16. Hypoglycemia – Insulin ShockHypoglycemia – Insulin Shock Treatment Restore blood sugar levels to normal ASAP Conscious •Drink fruit juice or sugared (not diet) soda •Eat sugar in form of candy, cubes or tablets Unconscious •Requires immediate emergency care •Glucagon injection 1.
    17. 17. Specimen Collection - PlanSpecimen Collection - Plan Standard precautions Required prerequisites for test i.e., fasting Organization of equipment
    18. 18. Specimen Collection - ProcedureSpecimen Collection - Procedure 1. Correct patient 2. Explanation & teaching (patient & family) - provide clear explanations 3. Prepare client and environment 4. Obtain specimen  Right patient  Right amount of specimen  Right time
    19. 19. General GuidelinesGeneral Guidelines Understand that collection of specimen may cause anxiety, embarrassment, or discomfort Provide support for the patient Children may benefit from support from parents or care providers during specimen collection Aseptic technique for collection of all specimens Know facilities policies and procedures Be aware of deviations from normal values that may occur as a result of certain medications or diet
    20. 20. Glucose TestingGlucose Testing Glucose testing may be done by urine or blood Blood testing more accurate & has replaced urine Frequency- ordered by physician 1. Fasting 2. 30 minutes prior to meals (AC) 3. 2 hours after meals (PC) 4. Bedtime (HS)
    21. 21. Glucose TestingGlucose Testing Blood Tests: 1. Venipuncture 2. Capillary blood by skin puncture Capillary blood is desirable: When venipuncture cannot be performed When reducing the frequency of needle sticks in desired & less painful
    22. 22. Measuring Blood GlucoseMeasuring Blood Glucose The ease of a skin puncture makes the procedure possible for patients to perform at home  Skin puncture performed by a hand held lancet or an automatic lancet device  Self-testing can be performed by two methods: 1. Reading a reagent strip 2. Use of a reflectance meter (Accucheck)  Both methods require a large drop of blood  Follow manufacturer’s instructions
    23. 23. Finger Stick SitesFinger Stick Sites Sites for skin punctures: finger tips, ear lobes, and heels (infants)  Finger tips most common  Avoid sites that are swollen, bruised, cyanotic, scarred, or calloused (poor blood flow)  Callouses are frequent on the thumb & index finger  Preferred fingers - middle & ring finger  Use the side of finger
    24. 24. Finger Stick SitesFinger Stick Sites
    25. 25. Performing Skin PuncturePerforming Skin Puncture Standard precautions Have patient wash hands & position comfortably Assemble equipment & open lancet or lancet device & alcohol wipes Calibrate meter according to instructions Donn clean gloves Inspect patient’s fingers Warm site if cold (rub or apply warm wash cloth)
    26. 26. Performing Skin PuncturePerforming Skin Puncture Hold finger with thumb and forefinger in a dependent position & massage gently toward puncture site Clean site with alcohol (allow site to dry) Place lancet device against side of finger & push release button (hold lancet perpendicular to site & pierce site in one continuous movement)
    27. 27. Performing Skin PuncturePerforming Skin Puncture Wipe away first drop of blood First drop usually contains a large amount of serous fluid Lightly squeeze site to allow a large drop of blood to form
    28. 28. Blood Glucose TestBlood Glucose Test Reagent strip - Check strips for expired dates; place large drop of blood on strip and time according to instructions Glucose meter: Be sure meter is calibrated properly (coding) Perform control testing according to policy Place large drop of blood on reagent strip Press meter timer (many machines have automatic timers) Apply pressure to site until bleeding stops Discard lancet in sharps container
    29. 29. Urine Testing for GlucoseUrine Testing for Glucose  Easy to perform and painless  Double-voided specimen for best results  Certain medications can cause false positives i.e., tetracyclines, sulfonamides, ascorbic acid  Dip reagent strip (check for expired dates) into urine. Compare to color chart, reading at designated time  Follow manufacture instructions
    30. 30. DocumentationDocumentation Report results to RN immediately Document (diabetic flow record) Time specimen was collected Site used Test results Patient tolerance of procedure Other observations or patient complaints
    31. 31. Care of Diabetic PatientsCare of Diabetic Patients The Patient Care Assistant: •Accurate recording of vital signs •Blood tests performed as ordered •Accurate bedside testing •Dietary trays delivered on time •Correct diet & correct food •Accurate I&O •Notify RN if patient does not eat, NPO for tests, observation of signs & symptoms, patient complaints, test results