Diabetes mellitus is a chronic condition characterized by high blood glucose levels. There are three main types - type 1 caused by lack of insulin production, type 2 caused by insulin resistance, and gestational diabetes during pregnancy. Acute complications include hypoglycemia from too much insulin and diabetic ketoacidosis from lack of insulin. Long term complications damage the heart, blood vessels, nerves, eyes, and kidneys. Proper management of diabetes includes monitoring blood sugar, administering insulin as needed, and treating acute complications promptly to prevent further health issues.
Definition of diabetes - introduction - classification of diabetes - etiology of diabetes type 1 and type 2- risk factors for diabetes - diagnosis of diabetes - clinical manifestations of diabetes type 1 and type 2- investigations for diabetes - treatment of diabetes - non-pharmacological treatment and pharmacological treatment - pharmacotherapy of type 1 and type 2 - acute complications of diabetes and treatment
Diabetes mellitus -INTRODUCTION,TYPES OF DIABETES MELLITUSvarinder kumar
INTRODUCTION
TYPES OF DIABETES MELLITUS
DIAGNOSE TEST FOR DIABETES MELLITUS
MECHANISM OF ACTION OF INSULIN (IDDM)
HERBAL DRUG TREATMENT FOR DIABETES
LIFESTYLE FOR TYPE 1 AND TYPE 2 DM
NEW ANTI DIABETIC DRUGS
Diabetes mellitus (DM) has routinely been described as a metabolic disorder characterized by hyperglycemia that develops as a consequence of defects in insulin secretion, insulin action, or both.
Such a deficiency results in increased concentrations of glucose in the blood, which in turn damage many of the body's systems, in particular the blood vessels and nerves.
1. Microvascular (due to damage to small blood vessels).
2. Macrovascular (due to damage to larger blood vessels).
Definition of diabetes - introduction - classification of diabetes - etiology of diabetes type 1 and type 2- risk factors for diabetes - diagnosis of diabetes - clinical manifestations of diabetes type 1 and type 2- investigations for diabetes - treatment of diabetes - non-pharmacological treatment and pharmacological treatment - pharmacotherapy of type 1 and type 2 - acute complications of diabetes and treatment
Diabetes mellitus -INTRODUCTION,TYPES OF DIABETES MELLITUSvarinder kumar
INTRODUCTION
TYPES OF DIABETES MELLITUS
DIAGNOSE TEST FOR DIABETES MELLITUS
MECHANISM OF ACTION OF INSULIN (IDDM)
HERBAL DRUG TREATMENT FOR DIABETES
LIFESTYLE FOR TYPE 1 AND TYPE 2 DM
NEW ANTI DIABETIC DRUGS
Diabetes mellitus (DM) has routinely been described as a metabolic disorder characterized by hyperglycemia that develops as a consequence of defects in insulin secretion, insulin action, or both.
Such a deficiency results in increased concentrations of glucose in the blood, which in turn damage many of the body's systems, in particular the blood vessels and nerves.
1. Microvascular (due to damage to small blood vessels).
2. Macrovascular (due to damage to larger blood vessels).
Heart failure (HF) is a common cardiovascular condition with increasing incidence and prevalence. Unlike western countries where heart failure is predominantly a disease of elderly, in India it affects younger age group. Heart failure is a chronic condition in which the heart cannot pump enough blood and oxygen to support other organs in your body.
Angina also known as angina pectoris is a medical condition characterized by chest pain usually left sided due to inadequate blood supply (ischemia) to the heart muscles due to obstruction (like presence of blood clot), narrowing or contraction (vasospasm) of the supplying coronary arteries.
Chronic obstructive pulmonary disorders COPD is a [preventable and treatable disease with some significant extra pulmonary effects that may contribute to the severity in individual clients.
It is characterized by airflow limitation that is not completely reversible.
Myocardial infarction (MI), commonly known as a heart attack, occurs when blood flow decreases or stops to a part of the heart, causing damage to the heart muscle. The most common symptom is chest pain or discomfort which may travel into the shoulder, arm, back, neck, or jaw.
Heart failure (HF) is a common cardiovascular condition with increasing incidence and prevalence. Unlike western countries where heart failure is predominantly a disease of elderly, in India it affects younger age group. Heart failure is a chronic condition in which the heart cannot pump enough blood and oxygen to support other organs in your body.
Angina also known as angina pectoris is a medical condition characterized by chest pain usually left sided due to inadequate blood supply (ischemia) to the heart muscles due to obstruction (like presence of blood clot), narrowing or contraction (vasospasm) of the supplying coronary arteries.
Chronic obstructive pulmonary disorders COPD is a [preventable and treatable disease with some significant extra pulmonary effects that may contribute to the severity in individual clients.
It is characterized by airflow limitation that is not completely reversible.
Myocardial infarction (MI), commonly known as a heart attack, occurs when blood flow decreases or stops to a part of the heart, causing damage to the heart muscle. The most common symptom is chest pain or discomfort which may travel into the shoulder, arm, back, neck, or jaw.
Diabetes mellitus refers to a group of diseases that affect how the body uses blood sugar (glucose). Glucose is an important source of energy for the cells that make up the muscles and tissues. It's also the brain's main source of fuel.
Diabetes mellitus (DM) is a syndrome of chronic hyperglycaemia is due to one of two mechanisms:
Inadequate production of insulin , or
Inadequate sensitivity of cells to the action of insulin.
It affects more than 220 million people worldwide, and it is estimated that it will affect 440 million by the year 2030
"Diabetes" comes from the Greek word for "siphon", and implies that a lot of urine is made.
The second term,"mellitus" comes from the Latin word, "mel" which means "honey", and was used because the urine was sweet.
• The onset of type 1 diabetes may also be associated with sudden weight loss or nausea, vomiting, or abdominal pains, if DKA has developed.
Nursing Management · Monitor blood sugar and use a sliding scale to treat high levels of glucose · Educate patient about diabetes · Examine feet .
Diagnosis involves measuring blood glucose levels. Ongoing specialized assessment and evaluation for complications are essential for diabetes management.
A review of the investigation and management of diabetic ketoacidosis in newly diagnosed type I diabetes. Patient details have been changed and anonymised to protect the identity of the individual.
The endocrine pancreas
Islets of Langerhans (endocrine pancreas) contain 4 major
and 2 minor cell types.
●Major cell types:
1.β cell produces insulin.
2.α cell secretes glucagon.
3.δ cells contain somatostatin, which suppresses
both insulin and glucagon release.
• DM is a heterogeneous group of syndromes characterized by
an elevation of fasting blood glucose caused by absolute or
relative deficiency of insulin
• Hyperglycemia in diabetes results from defects in insulin
secretion ( destruction of β cells of the pancreas ), insulin
action, or most commonly both.
• Diabetes is the leading cause of adult blindness and
amputation and a major cause of renal failure, nerve damage,
heart attacks, and strokes.
• Most cases of diabetes mellitus can be separated into two
groups
- Type 1 (insulin-dependent DM)
- Type 2 (noninsulin dependent DM)
Type 1 Diabetes Mellitus
• Onset: usually during childhood
• Caused by absolute (complete) deficiency of insulin:
- Maybe caused by both:
1. autoimmune attack of b-cells of the pancreas, i.e. a
genetic determinant that allows the β cells to be
recognized as “nonself”
2. environmental factors as viral infection or toxins
• Rapid symptoms appear when 80-90% of the b-cells
have been destroyed
• Commonly complicated by diabetic ketoacidosis (DKA)
• Treated only by insulin
• the islets of Langerhans become
infiltrated with activated T
lymphocytes, leading to a
condition called insulitis .
• Over a period of years, this
autoimmune attack on the β cells
leads to gradual depletion of the
β-cell population. However,
symptoms appear abruptly when
80%–90% of the β cells have been
destroyed.
• At this point, the pancreas fails to
respond adequately to ingestion
of glucose, and insulin therapy is
required to restore metabolic
control and prevent lifethreatening ketoacidosis.
Metabolic changes of type 1 DM
1-Hyperglycemia: increased glucose in blood, Due to:
Decreased glucose uptake by muscles & adipose tissues &/or
Increased hepatic gluconeogenesis
2-Ketoacidosis:
• increased ketone bodies in blood (in untreated or
uncontrolled cases) results from increased mobilization of
fatty acids (FAs ) from adipose tissue, combined with
accelerated hepatic FA β-oxidation and synthesis of 3-
hydroxybutyrate and acetoacetate.
• in 25 – 40% of newly diagnosed type 1 DM
• in stress states demanding more insulin (as during
infection, illness or during surgery)
• In patients who have no compliance with therapy
3- Hypertriglyceridemia: increased TAG in blood
• Released fatty acids from adipose tissues are
converted to triacylglycerol. Triacylglycerol is
secreted from the liver in VLDL to blood.
• Chylomicrons (from diet fat) accumulates (low
lipoprotein lipase in DM due to decreased
insulin)
• Increased VLDL & chylomicrons results in
hypertriacylglyceridemia
INTERTISSUE RELATIONSHIP IN T1DM
Diagnosis of type 1 DM
• Clinically:
Age: during childhood or puberty (< 20 years of age)
- Polyuria (frequent urina
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
India Clinical Trials Market: Industry Size and Growth Trends [2030] Analyzed...Kumar Satyam
According to TechSci Research report, "India Clinical Trials Market- By Region, Competition, Forecast & Opportunities, 2030F," the India Clinical Trials Market was valued at USD 2.05 billion in 2024 and is projected to grow at a compound annual growth rate (CAGR) of 8.64% through 2030. The market is driven by a variety of factors, making India an attractive destination for pharmaceutical companies and researchers. India's vast and diverse patient population, cost-effective operational environment, and a large pool of skilled medical professionals contribute significantly to the market's growth. Additionally, increasing government support in streamlining regulations and the growing prevalence of lifestyle diseases further propel the clinical trials market.
Growing Prevalence of Lifestyle Diseases
The rising incidence of lifestyle diseases such as diabetes, cardiovascular diseases, and cancer is a major trend driving the clinical trials market in India. These conditions necessitate the development and testing of new treatment methods, creating a robust demand for clinical trials. The increasing burden of these diseases highlights the need for innovative therapies and underscores the importance of India as a key player in global clinical research.
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
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Medical Technology Tackles New Health Care Demand - Research Report - March 2...pchutichetpong
M Capital Group (“MCG”) predicts that with, against, despite, and even without the global pandemic, the medical technology (MedTech) industry shows signs of continuous healthy growth, driven by smaller, faster, and cheaper devices, growing demand for home-based applications, technological innovation, strategic acquisitions, investments, and SPAC listings. MCG predicts that this should reflects itself in annual growth of over 6%, well beyond 2028.
According to Chris Mouchabhani, Managing Partner at M Capital Group, “Despite all economic scenarios that one may consider, beyond overall economic shocks, medical technology should remain one of the most promising and robust sectors over the short to medium term and well beyond 2028.”
There is a movement towards home-based care for the elderly, next generation scanning and MRI devices, wearable technology, artificial intelligence incorporation, and online connectivity. Experts also see a focus on predictive, preventive, personalized, participatory, and precision medicine, with rising levels of integration of home care and technological innovation.
The average cost of treatment has been rising across the board, creating additional financial burdens to governments, healthcare providers and insurance companies. According to MCG, cost-per-inpatient-stay in the United States alone rose on average annually by over 13% between 2014 to 2021, leading MedTech to focus research efforts on optimized medical equipment at lower price points, whilst emphasizing portability and ease of use. Namely, 46% of the 1,008 medical technology companies in the 2021 MedTech Innovator (“MTI”) database are focusing on prevention, wellness, detection, or diagnosis, signaling a clear push for preventive care to also tackle costs.
In addition, there has also been a lasting impact on consumer and medical demand for home care, supported by the pandemic. Lockdowns, closure of care facilities, and healthcare systems subjected to capacity pressure, accelerated demand away from traditional inpatient care. Now, outpatient care solutions are driving industry production, with nearly 70% of recent diagnostics start-up companies producing products in areas such as ambulatory clinics, at-home care, and self-administered diagnostics.
CHAPTER 1 SEMESTER V PREVENTIVE-PEDIATRICS.pdfSachin Sharma
This content provides an overview of preventive pediatrics. It defines preventive pediatrics as preventing disease and promoting children's physical, mental, and social well-being to achieve positive health. It discusses antenatal, postnatal, and social preventive pediatrics. It also covers various child health programs like immunization, breastfeeding, ICDS, and the roles of organizations like WHO, UNICEF, and nurses in preventive pediatrics.
We understand the unique challenges pickleball players face and are committed to helping you stay healthy and active. In this presentation, we’ll explore the three most common pickleball injuries and provide strategies for prevention and treatment.
2. What is diabetes?
Diabetes mellitus (DM) is a chronic condition that is
characterized by raised blood glucose levels
(Hyperglycemia).
3. What is insulin?
• Insulin : is a hormone produced by beta cells of the
islets of Langerhans in the pancreas gland.
4. Pancreas secretes 40-50 units of insulin daily in two steps:
• Secreted at low levels during fasting ( basal insulin
secretion)
• Increased levels after eating (prandial)
• An early burst of insulin occurs within 10 minutes of
eating
• Then proceeds with increasing release as long as
hyperglycemia is present
8. Type 1 DM
Type 1 diabetes is also called insulin-dependent
diabetes.
It used to be called juvenile-onset diabetes, because it
often begins in childhood.
It is an autoimmune condition. It's caused by the body
attacking its own pancreas with antibodies.
In people with type 1 diabetes, the damaged pancreas
doesn't make insulin.
This type of diabetes may be caused by a genetic
predisposition. It could also be the result of faulty beta
cells in the pancreas that normally produce insulin
9.
10. Type 2 DM
The most common form of diabetes is type 2 diabetes,
accounting for 95% of diabetes cases in adults.
Type 2 diabetes is often a milder form of diabetes than
type 1.
With Type 2 diabetes, the pancreas usually produces
some insulin. But either the amount produced is not
enough for the body's needs, or the body's cells are
resistant to it.
Insulin resistance, or lack of sensitivity to insulin,
happens primarily in fat, liver, and muscle cells.
11.
12.
13. Gestational DM
It is often diagnosed in middle or late pregnancy. Because
high blood sugar levels in a mother are circulated through
the placenta to the baby.
Gestational diabetes must be controlled to protect the
baby's growth and development.
Having gestational diabetes does, however, put mothers at
risk for developing type 2 diabetes later in life.
With gestational diabetes, risks to the unborn baby are
even greater than risks to the mother.
Risks to the mother include needing a cesarean section
due to an overly large baby, as well as damage to heart,
kidney, nerves, and eye.
14.
15. Epidemiology
• It is uncommon in infants, increase in frequency until
adolescence and then drops sharply.
• Diabetes mellitus affects about 17 million people, 5.9
million of whom are undiagnosed. In the United States,
approximately 800,000 new cases of diabetes are
diagnosed yearly.
• Diabetes is especially prevalent in the elderly, with up
to 50% of people older than 65 suffering some degree
of glucose intolerance.
• Seasonal variation has also been noted with children
being diagnosed more often in winter than summer
months.
• Diabetes Mellitus is found most frequently in persons
over 40years of age who are obese and who have a
family history of diabetes.
20. Diagnostic test for DM
it includes:
Physical Examination
Blood glucose 4 types: FBS, PPBS, RBS, OGGT
Urine Analysis Urine Sugar / Urine Protein /Urine
Microalbumin / Ketones
HbA1C
Insulin
ICA (islent cell antibody) for type I
KFT
ECHO
21.
22. Nursing Diagnoses
• Imbalanced nutrition related to increase in stress
hormones (caused by primary medical problem) and
imbalances in insulin, food, and physical activity
• Risk for impaired skin integrity related to immobility
and lack of sensation (caused by neuropathy)
• Deficient knowledge about diabetes self-care skills
(caused by lack of basic diabetes education or lack of
continuing in-depth diabetes education
32. ACUTE COMPLICATION
1. Hypoglycemia
Hypoglycemia (abnormally low blood glucose level)
occurs when the blood glucose falls to less than 50 to 60
mg/dL . It can be caused by too much insulin or oral
hypoglycemic agents, too little food, or excessive physical
activity. Hypoglycemia may occur at any time of the day
or night. It often occurs before meals, especially if meals
are delayed or snacks are omitted. For example,
midmorning hypoglycemia and Middle-of-the-night
hypoglycemia
33. Clinical Manifestation:-
• In mild hypoglycemia:-
sweating, tremor, tachycardia, palpitation, nervousness,
and hunger.
• In moderate hypoglycemia:
Concentrate headache, lightheadedness, confusion,
memory lapses, numbness of the lips and tongue, slurred
speech, impaired coordination, emotional changes,
irrational or combative behavior, double vision, and
drowsiness.
• In severe hypoglycemia:-
disoriented behavior, seizures, difficulty arousing from
sleep, or loss of consciousness.
34. Emergency Measures:-
For patients who are unconscious and cannot swallow,
an injection of glucagon 1 mg can be administered either
subcutaneously or intramuscularly.
Glucagon is a hormone produced by the alpha cells of
the pancreas that stimulates the liver to release glucose
(through the breakdown of glycogen, the stored glucose).
Injectable glucagon is packaged as a powder in 1-mg vials
and must be mixed with a diluent before being injected.
After injection of glucagon, it may take up to 20 minutes
for the patient to regain consciousness.
In the hospital or emergency department, patients who
are unconscious or cannot swallow may be treated with 25
to 50 mL 50% dextrose in water (D50W) administered
intravenously.
35. Management :-
Immediate treatment must be given when hypoglycemia
occurs. The usual recommendation is for 15 g of a fast-
acting concentrated source of carbohydrate such as the
following, given orally.
Adding table sugar to juice may cause a sharp increase
in the blood glucose level, and the patient may experience
hyperglycemia for hours after treatment.
The blood glucose level should be retested in 15
minutes and retreated if it is less than 70 to 75 mg/dL
36. Patient education:-
• It is important for patients with diabetes, especially
those receiving insulin, to learn that they must carry some
form of simple sugar with them at all times.
•Patients are advised to refrain from eating high-calorie,
high fat dessert foods (eg, cookies, cakes, doughnuts, ice
cream) to treat hypoglycemia.
•The high fat content of these foods may slow the
absorption of the glucose, and the hypoglycemic
symptoms may not resolve as quickly as they would with
the intake of carbohydrates.
37. 2. Diabetic Ketoacidosis
DKA is caused by an absence or markedly inadequate
amount of insulin. This deficit in available insulin results
in disorders in the metabolism of carbohydrate, protein,
and fat. The three main clinical features of DKA are:
• Hyperglycemia
• Dehydration and electrolyte loss
• Acidosis
40. MANAGEMENT OF DKA
Restore circulating blood volume and protect against
cerebral, coronary, and renal hypo-perfusion.
Treat dehydration with rapid IV infusion of 0.9 or
0.45% normal saline (NS) as prescribed; dexotrose is
added to IV fluids when the blood glucose level
reaches 250 to 300 mg/dl.
Treat hyperglycemia with insulin administered
intravenously as prescribed.
Correct electrolyte imbalances (potassium level may be
elevated as a result of dehydration and acidosis).
Monitor potassium level closely
41. NURSING MANAGEMENT
• Monitor vital signs.
• Monitor urinary output and for signs of fluid overload.
• Stabilize the patient’s airway,breathing,circulation
• Assess cardiac monitoring and pulse oxymetry.
• Monitor serum glucose hourly and urine ketone
• Monitor basic electrolyte,osmolarity and venous PH
every 4 hourly until pt is stable.
• Determine and treat any underlying causes of DKA eg;
pneumonia,UTIand MI.
42. 3. Hyperglycemic Hyperosmolar Nonketotic
Syndrome
• HHNS is a serious condition in which hyperosmolarity
and hyperglycemia predominate, with alterations of the
sensorium.
43.
44. Clinical manifestation:-
• hypotension,
• profound dehydration (dry mucous membranes, poor
skin turgor),
• tachycardia,
• variable neurologic signs (eg, alteration of sensorium,
seizures, hemiparesis).
• The mortality rate ranges from 10% to 40%,
45. Diagnostic evaluation:-
• laboratory tests, including
• blood glucose (600 to 1,200 mg/dL)
• electrolytes, BUN,
• complete blood count,
• serum osmolality,
• arterial blood gas analysis.
• Physical Examination for Mental status changes, focal
neurologic deficits, and hallucinations
46. Medical Management
fluid replacement, correction of electrolyte imbalances,
and insulin administration.
insulin is usually administered at a continuous low rate
to treat hyperglycemia, and replacement IV fluids with
dextrose are administered when the glucose level is
decreased to the range of 250 to 300 mg/dL.
close monitoring of volume and electrolyte status is
important for prevention of fluid overload, heart failure,
and cardiac dysrhythmias.
Central venous or arterial pressure monitoring
Potassium is added to IV fluids when urinary output is
adequate.
47. Nursing Management :-
• close monitoring of vital signs, fluid status, and
laboratory values.
• prevent injury related to changes in the patient’s
sensorium secondary.
• Fluid status and urine output are closely monitored
because of the high risk for renal failure secondary to
severe dehydration
• careful assessment of cardiovascular, pulmonary, and
renal function important throughout the acute and
recovery phases of HHNS
49. MACROVASCULAR COMPLICATIONS
Diabetic macrovascular complications result from changes
in the medium to large blood vessels. Blood vessel walls
thicken, sclerose, and become occluded by plaque that
adheres to the vessel walls. Eventually, blood flow is
blocked. Three major macrovascular complications are:-
Coronary artery disease
Cerebrovascular disease,
peripheral vascular disease
50. Coronary artery disease
Myocardial infarction is twice as common in diabetic
men and three times as common in diabetic women.
. Coronary artery disease may account for 50% to 60%
of all deaths in patients with diabetes.
One unique feature of coronary artery disease in
patients with diabetes is that the typical ischemic
symptoms may be absent. Thus, patients may not
experience the early warning signs of decreased
coronary blood flow and may have “silent” myocardial
infarctions.
silent myocardial infarctions may be discovered only as
changes on the electrocardiogram.
51. Cerebrovascular disease
Cerebral blood vessels are similarly affected by
accelerated atherosclerosis.
Occlusive changes or the formation of an embolus
elsewhere in the vasculature that lodges in a cerebral
blood vessel can lead to transient ischemic attacks and
strokes.
People with diabetes have twice the risk of developing
cerebrovascular disease
recovery from a stroke may be impaired in patients
who have elevated blood glucose levels at the time of and
immediately after a stroke.
symptoms of cerebrovascular disease may be similar to
symptoms of (HHNS or hypoglycemia),
52. Peripheral vascular disease
Atherosclerotic changes in the large blood vessels of the
lower extremities are responsible for the increased
incidence (two to three times higher than in non-diabetic
people) of occlusive peripheral arterial disease in patients
with diabetes.
Signs and symptoms of peripheral vascular disease
include diminished peripheral pulses and intermittent
claudication (pain in the buttock, thigh, or calf during
walking).
The severe form of arterial occlusive disease in the lower
extremities is largely responsible for the increased
incidence of gangrene and subsequent amputation in
diabetic patients.
Neuropathy and impairments in wound healing also play
a role in diabetic foot disease.
53. Management:-
Prevention and treatment of the commonly accepted risk
factors for atherosclerosis.
Diet and exercise are important in managing obesity,
hypertension, and hyperlipidemia.
The use of medications to control hypertension and
hyperlipidemia may be indicated.
Smoking cessation is essential.
Control of blood glucose levels may reduce triglyceride
levels and can significantly reduce the incidence of
complications.
When macrovascular complications do occur, treatment is
the same as with nondiabetic patients.
patients may require increased amounts of insulin or may
need to switch from oral antidiabetic agents to insulin
during illnesses.
54. MICROVASCULAR COMPLICATION
Although macrovascular atherosclerotic changes are
seen in both diabetic and non-diabetic patients, the
microvascular changes are unique to diabetes. Diabetic
microvascular disease (or microangiopathy) is
characterized by capillary basement membrane
thickening. Changes in the microvasculature include :-
Micro-aneurysms
intraretinal hemorrhage,
hard exudates,
focal capillary closure.
55. 1. DIABETIC RETINOPATHY
Diabetic retinopathy is retinopathy (damage to the retina)
caused by complications of diabetes mellitus, which can
eventually lead to blindness. It is an ocular manifestation of
systematic disease which affects up to 80% of all diabetic
patients.
56.
57. Clinical Manifestation:-
Retinopathy is a painless process.
In nonproliferative and preproliferative retinopathy,
blurry vision secondary to macular edema occurs in
some patients.
Hemorrhaging include floaters or cobwebs in the visual
field, or sudden visual changes including spotty or
hazy vision, or complete loss of vision.
Diagnostic evaluation
ophthalmoscope
fluorescein angiography
60. Nursing Management:-
Education focuses on prevention through -
regular ophthalmologic examinations
blood glucose control and self-management of eye care
regimens.
The effectiveness of early diagnosis and prompt
treatment is emphasized in teaching the patient and
family.
If vision loss occurs,nursing care must also address the
patient’s adjustment to impaired vision and use of
adaptive devices for diabetes self-care as well as
activities of daily living.
61. 2. DIABETIC NEPHROPATHY
Nephropathy, or renal disease secondary to diabetic
microvascular changes in the kidney, is a common
complication of diabetes.
About 20% to 30% of people with type 1 or type 2 diabetes
develop nephropathy, but fewer of those with type 2 diabetes
progress to ESRD.
after the onset of diabetes, and especially if the blood
glucose levels are elevated, the kidney’s filtration mechanism
is stressed, allowing blood proteins to leak into the urine. As
a result, the pressure in the blood vessels of the kidney
increases.
62. Clinical Manifestation:-
Worsening blood pressure control
Protein in the urine
Swelling of feet, ankles, hands or eyes
Increased need to urinate
Less need for insulin or diabetes medicine
Confusion or difficulty concentrating
Loss of appetite
Nausea and vomiting
Persistent itching
Fatigue
Diagnostic Test:-
blood proteins
urine dipstick test
63. Management:-
Maintaining near-normal blood glucose
Control of hypertension (the use of angiotensin-converting
enzyme [ACE] inhibitors, such as captopril, because control of
hypertension may also decrease or delay the onset of early
proteinuria)
Prevention or vigorous treatment of urinary tract infections
Avoidance of nephrotoxic substances.
Adjustment of medications as renal function changes
Low-sodium diet
Low-protein diet
In chronic or end-stage renal failure, two types of treatment are
available: dialysis (hemodialysis or peritoneal dialysis) and
transplantation.
Renal disease is frequently accompanied by advancing
retinopathy that may require laser treatments and surgery.
64. 3. DIABETIC NEUROPATHY
Diabetic neuropathy refers to a group of diseases that
affect all types of nerves, including peripheral
(sensorimotor), autonomic, and spinal nerves.
The disorders appear to be clinically diverse and depend
on the location of the affected nerve cells.
The prevalence increases with the age of the patient
The duration of the disease may be as high as 50% in
patients who have had diabetes for 25 years.
66. Clinical Manifestation:
1.Peripheral neuropathy is the most common form of diabetic
neuropathy. Your feet and legs are often affected first,
followed by your hands and arms. Signs and symptoms of
peripheral neuropathy are often worse at night, and may
include:
• Numbness or reduced ability to feel pain or temperature
changes
• A tingling or burning sensation
• Sharp pains or cramps
• Increased sensitivity to touch — for some people, even the
weight of a bed sheet can be agonizing
• Muscle weakness
• Loss of reflexes, especially in the ankle
• Loss of balance and coordination
• Serious foot problems, such as ulcers, infections,
deformities, and bone and joint pain
67. 2. Autonomic neuropathy:- The autonomic nervous system controls your
heart, bladder, lungs, stomach, intestines, sex organs and eyes. Diabetes
can affect the nerves in any of these areas, possibly causing:
A lack of awareness that blood sugar levels are low (hypoglycemia
unawareness)
Bladder problems, including urinary tract infections or urinary
retention or incontinence
Constipation, uncontrolled diarrhea or a combination of the two
Slow stomach emptying (gastroparesis), leading to nausea, vomiting,
bloating and loss of appetite
Difficulty swallowing
Erectile dysfunction in men
Vaginal dryness and other sexual difficulties in women
Increased or decreased sweating
Inability of your body to adjust blood pressure and heart rate, leading
to sharp drops in blood pressure after sitting or standing that may cause
you to faint or feel lightheaded
Problems regulating your body temperature
Changes in the way your eyes adjust from light to dark
Increased heart rate when you're at rest
68. 3. Radiculoplexus neuropathy (diabetic amyotrophy):-
Radiculoplexus neuropathy affects nerves in the thighs,
hips, buttocks or legs. Also called femoral neuropathy or
proximal neuropathy, this condition is more common in
people with type 2 diabetes and older adults. This
condition is often marked by:
Sudden, severe pain in your hip and thigh or buttock
Eventual weak and atrophied thigh muscles
Difficulty rising from a sitting position
Abdominal swelling, if the abdomen is affected
Weight loss
69. 4. Mononeuropathy :- Mononeuropathy involves damage to a
specific nerve. The nerve may be in the face, torso or leg.
Mononeuropathy, also called focal neuropathy, often comes
on suddenly. It's most common in older adults. Although
mononeuropathy can cause severe pain, it usually doesn't
cause any long-term problems. Symptoms usually diminish
and disappear on their own over a few weeks or months.
Signs and symptoms depend on which nerve is involved and
may include:
Difficulty focusing your eyes, double vision or aching behind
one eye
Paralysis on one side of your face (Bell's palsy)
Pain in your shin or foot
Pain in your lower back or pelvis
Pain in the front of your thigh
Pain in your chest or abdomen
Numbness or tingling in your fingers or hand,
A sense of weakness in your hand and a tendency to drop
things
70. Complication:-
1. Loss of a limb
2. Charcot joint.
3. Urinary tract infections and urinary incontinence
4. Hypoglycemia unawareness
5. Low blood pressure.
6. Digestive problems
7. Sexual dysfunction
8. Increased or decreased sweating
71. Medical Management:-
analgesics (preferably nonopioid)
tricyclic antidepressants;
phenytoin, carbamazepine, or gabapentin (antiseizure
medications);
(an antiarrhythmic);
transcutaneous electrical nerve stimulation (TENS).
Orthostatic hypotension may respond to a diet high in
sodium.
Treatment of diabetic diarrhea may include bulkforming
laxatives or antidiarrheal agents.
Constipation is treated with a high-fiber diet and adequate
hydration; medications, laxatives, and enemas may be
necessary when constipation is severe.
72. Nursing Management:-
Foot care :- Daily foot care and inspection. Always wear
protective shoes/slippers. Wear good-fitting shoes. Cotton
socks vs nylon socks. Avoid home remedies for corns,
calluses, ingrown toe nails. Cut nail straight across. Avoid
temperature extremes. Seek immediate medical attention
for any injury or problem.
Fall prevention for postural hypotension
Prevention of aspiration, attention to hyper/hypoglycemia
with gastroparesis
Prevention of urinary retention
Monitor for fixed heart rate with activity.