Diabetes mellitus is a chronic disease characterized by high blood glucose levels resulting from insufficient insulin production or utilization. It manifests as two primary types: type 1 autoimmune disease destroying pancreatic beta cells and type 2 metabolic disease caused by insulin resistance. Complications include microvascular and macrovascular diseases, diabetic ketoacidosis, hyperosmolar hyperglycemic syndrome, and chronic renal failure. Nursing care focuses on stabilizing glucose levels, educating patients on self-care, and optimizing therapeutic regimen management through addressing potential barriers.
Diabetes is a chronic illness that requires continuing medical care and patient self-management education to prevent acute complications and to reduce the risk of long-term complications.
Diabetes is a chronic illness that requires continuing medical care and patient self-management education to prevent acute complications and to reduce the risk of long-term complications.
Advanced PharmacologyDiabetes is a group of metabolic diseasmilissaccm
Advanced Pharmacology
Diabetes is a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both. ( McCance & Huether 2019). Per The American Diabetic Association (ADA) each year 1.5 million Americans are diagnosed with diabetes. There are different types of diabetes in this paper we will differentiate between the various types and focus on type 2 diabetes.
Comparison of different types of diabetes including drug treatment
Type 1 Diabetes: caused by Beta-cell destruction leading to absolute insulin deficiency ( pancreas stops producing insulin) . This is the most common form of diabetes. Patients with type 1 diabetes are insulin-dependent. About 75% of them develop before the age of 30. Patients are prone to diabetic ketoacidosis. Type 1 diabetes is secondary to other diseases such as pancreatitis, it is also said to be caused by genetic predisposition and environmental factors. It is most common in people of African and Asian descent. Clinical manifestations of type 1 diabetes include Polydipsia, polyuria, polyphagia, weight loss, and fatigue. Patients with type 1 diabetes take different types of insulin. Rapid-acting (Lispro ), short-acting ( regular insulin ) intermediate-acting ( NPH), long-acting (glargine).
Type 2 Diabetes; is caused by the progressive loss of b-cell insulin secretion frequency on the background of insulin resistance ( insulin becomes resistant, may be produced but does not do its job). Patients with type 2 diabetes are usually not insulin dependent but might be insulin requiring depending on the severity of hyperglycemia. Not ketosis-prone but may form ketones under stress. obesity in the abdominal region. Mostly occurs in those 40years of age and above . has a strong genetic predisposition and is often associated with dyslipidemia and hypertension. Prevalence is highest among American Indians and Alaska Natives and lowest among non-Hispanic whites. Clinical manifestations of type 2 diabetes are nonspecific but the most common ones are; recurrent infections ( boils and carbuncles, skin infections, and prolonged wound healing ), genital pruritus, visual changes, paresthesias, fatigue, and Acanthosis nigricans ( brown to black pigmentation in body folds associated with insulin resistance ). Treatment of diabetes type two involves lifestyle modifications like weight loss which results in improved insulin sensitivity, and glucose tolerance, and preserves beta-cell function. In cases where diet and exercise yield unsatisfactory results, first line of drugs for type 2 diabetes is Sulfonylurea, and in some cases insulin is added if the oral hypoglycemic agents do not work. they are nine classes of oral hypoglycemic agents with metformin being the drug of choice.
Gestational Diabetes Mellitus ( GDM); Any degree of glucose intolerance with onset or first recognition of symptoms during pregnancy. Caused by insulin resistance combined with inad ...
Diabetes, a chronic medical condition affecting millions worldwide, is characterized by elevated blood sugar levels that result from the body's inability to properly produce or use insulin.
Insulin, a hormone produced by the pancreas, plays a crucial role in regulating blood glucose and facilitating its entry into cells for energy.
There are two main types of diabetes: Type 1, where the immune system mistakenly attacks insulin-producing cells, and Type 2, characterized by insulin resistance and inadequate insulin production. Managing diabetes often involves a combination of lifestyle changes, such
as a healthy diet and regular exercise, and medications designed to
regulate blood sugar levels.
In this context, various medications play pivotal roles, from traditional
insulin therapies to a diverse array of oral and injectable options for Type 2
diabetes.
This introduction provides a foundation for exploring the medications
commonly prescribed for diabetes management, offering insights into their
mechanisms of action and the diverse strategies employed to empower
individuals in effectively navigating this complex and chronic condition
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.
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journey
Ms diabetes mellitus
1. Diabetes mellitus
Diabetes mellitus (DM) is a chronic disease that causes high blood glucose
levels. It results from insulin nonproduction, insufficient insulin production, or
inadequate insulin utilization. DM causes carbohydrate, protein, and fat
metabolism disturbances in two primary forms: autoimmune disease that destroys
islets of Langerhans pancreatic beta cells, which produce insulin, and metabolic
disease caused by insulin resistance, with a resulting defect in compensatory
insulin production.
Pathophysiology
Insulin allows cells to use glucose as energy or to store it as glycogen. It also
stimulates protein synthesis and free fatty acid storage in adipose tissues. A
deficiency compromises body tissues' access to essential nutrients for fuel and
storage.
Complications
■ Microvascular disease (including retinopathy, nephropathy, and neuropathy)
■ Dyslipidemia
■ Macrovascular disease (including coronary, peripheral, and cerebral artery
disease)
■ Diabetic ketoacidosis
■ Hyperosmolar hyperglycemic nonketotic syndrome (HHNS)
■ Excessive weight gain
■ Skin ulcerations
■ Chronic renal failure
Assessment (only potential abnormalities listed)
NURSING HISTORY BY FUNCTIONAL HEALTH PATTERN
Health perception and management
Type 1
■ Family history of diabetes
■ Age younger than 30
■ Flulike syndrome with acute symptom onset
Type 2
■ Family history of diabetes
■ Age older than 45
2. ■ Gradual symptom onset
Nutrition and metabolism
Type 1
■ Increased thirst (polydipsia)
■ Increased appetite (polyphagia)
■ Weight loss
■ Ketosis
■ Nausea (occasionally)
Type 2
■ Polydipsia
■ Polyphagia
■ History of high−refined carbohydrate, high-calorie diet
■ Excess weight (possible recent weight gain)
Elimination
Type 1
■ Polyuria
■ Constipation
■ Diarrhea
Type 2
■ Nocturia
■ Polyuria
■ Constipation
■ Diarrhea
■ Diuretics (taken for another condition)
■ Acute or recurrent urinary tract infections (UTIs)
Activity and exercise
Type 1
■ Sudden weakness
■ Increased fatigue
■ Sleepiness
Type 2
■ Weakness and fatigability (gradually increasing)
■ Lack of regular exercise
Cognition and perception
Type 1
■ Dizziness
3. ■ Orthostatic hypotension
■ Abdominal pain
Type 2
■ Pruritus
■ Poorly healing skin infections
■ Myopia
■ Blurred vision
■ Muscle cramping
■ Abdominal pain
■ Extremity numbness, pain, or tingling
■ Irritability
Sleep and rest
Type 1
■ Sleep disturbance (due to nocturia)
Type 2
■ Sleep disturbance
■ Drowsiness after meals
Sexuality and reproduction
Type 2
■ Loss of sex drive
■ Erectile dysfunction
■ Recurrent vaginitis or vaginal infections
Roles and relationships
Types 1 and 2
■ Role strain
■ Workplace disruption due to treatment responsibilities or complications
Coping and stress management
Types 1 and 2
■ Noncompliance due to denial
PHYSICAL EXAMINATION
Integumentary
■ Poorly healing skin wounds, especially on feet
■ Skin infections
■ Warm, flushed, dry skin (in diabetic ketoacidosis [DKA])
Respiratory
■ Deep, rapid (Kussmaul's) respirations
■ Fruity breath odor (in DKA)
4. Cardiovascular
■ Tachycardia
■ Orthostatic hypotension
■ Hypertension
■ Cool extremities
■ Decreased pulses
Gastrointestinal
■ Abdominal distention
■ Decreased bowel sounds
■ Abdominal tenderness
Neurologic
■ Drowsiness
■ Confusion
■ Coma (in DKA)
■ Altered reflexes
Renal and urinary
■ Vaginal discharge
■ Perineal irritation
DIAGNOSTIC STUDIES
■ Random serum glucose test reveals a level greater than or equal to 200 mg/dl.
■ Fasting serum glucose test reveals a level greater than or equal to 126 mg/dl
(confirms DM).
■ Urinalysis reveals glycosuria and, in type 1, ketonuria. (Urine microalbumin is
the earliest indication of diabetic renal disease.)
■ Glucose tolerance test reveals a level greater than or equal to 200 mg/dl in the
2-hour sample.
■ Blood insulin level is absent or minimal in type 1, and low, normal, or high in
type 2.
■ Glycosylated hemoglobin test detects elevations or wide fluctuations in blood
glucose over time; greater than 8% indicates poor glucose control in either type
1 or type 2.
■ Arterial blood gas studies can reveal metabolic acidosis, particularly common
in type 1, with compensatory respiratory alkalosis.
■ Electrolyte panel (needed to establish baseline) may be normal or reveals
hyponatremia or hyperkalemia associated with dehydration or DKA (type 1).
5. ■ Blood urea nitrogen (BUN) levels (needed to establish baseline) may be normal
or elevated in DKA or HHNS.
■ BUN and creatinine levels (needed to establish baseline) may be normal or
elevated in the presence of renal involvement.
Nursing care plan
Nursing diagnosis
Nursing priorities
Risk for unstable glucose level related to inadequate ■ Prevent or minimize complications when
endogenous insulin (type 1 DM) or inadequate
establishing treatment regimen to control altered
endogenous insulin and insulin resistance (type 2
glucose metabolism.
DM)
Deficient knowledge (self-care) related to newly
■ Establish a diabetes control regimen,
diagnosed complex chronic disease
emphasizing self-care.
Ineffective therapeutic regimen management related ■ Optimize management of personal therapeutic
to lack of material resources, lack of support, or
regimen.
ineffective coping
Other potential nursing diagnoses: Ineffective coping related to denial ■ Risk for imbalanced fluid volume
related to physiologic manifestations of disease process ■ Risk prone health behavior related to inability to
modify lifestyle with change in health status
Risk for unstable glucose level related to inadequate
endogenous insulin (type 1 DM) or inadequate
endogenous insulin and insulin resistance (type 2 DM)
EXPECTED OUTCOME
The patient will maintain a stable blood glucose level.
Suggested NOC Outcomes
Neurological status: Consciousness
NURSING INTERVENTIONS
Intervention type
Intervention
Rationale
Collaborative
Administer insulin or oral
antidiabetic medications, as
ordered.
Collaborative
Monitor fingerstick blood glucose
levels according to facility
protocol, clinical status, and
before giving antidiabetic
medications. Follow established
Insulin increases cellular
glucose uptake and decreases
gluconeogenesis. Exogenous
insulin is essential for
controlling type 1 DM and may
also be used in type 2 DM.
Oral agents stimulate beta
cells to secrete insulin, block
glucose absorption in the small
intestine, increase insulin
sensitivity in peripheral tissue,
or reduce glucose production
in the liver.
Assessment of glucose levels
is essential for monitoring the
patient's response and
adjusting treatment. Checking
the glucose level and
6. protocol for withholding the dose
based on normal values.
Collaborative
Collaborative
Collaborative
Collaborative
Note differences in peak action
and duration of action for various
antidiabetic medications.
■ Rapid-acting insulins (insulin
aspart) peak between 1 and 2
hours.
■ Short-acting insulins (regular,
Humulin R), peak within 2 and 4
hours.
■ Intermediate-acting insulins
(NPH, lente) peak between 6 and
12 hours.
■ Long-acting insulins
(Ultralente, insulin glargine) peak
between 10 and 30 hours.
■ Oral antidiabetic drugs with a
24-hour duration peak on the
average between 3 and 4 hours.
Establish and maintain an I.V. fluid
infusion, as ordered. Monitor for
dry mucous membranes, poor skin
turgor, cracked lips, abdominal
pain, elevated urine specific
gravity, elevated hematocrit, and
other signs or symptoms of
dehydration. Keep an accurate
intake and output record.
Document daily weight.
Observe for signs and symptoms
of medication-induced
hypoglycemia. Reactions are most
likely to coincide with peak insulin
effect or late or missed meals,
depending on the type of insulin
and the patient's response. If a
reaction occurs, notify the
physician, measure blood glucose
level, and treat immediately with
oral glucose, I.V. glucose, or
glucagon, depending on protocol
and the patient's responsiveness.
Recheck blood glucose in 10
minutes. Feed the patient a small
snack of carbohydrate and protein
if his next meal is more than 1
hour away.
Make sure the patient is served
the prescribed therapeutic diet at
consistent times.
withholding the dose if the
level is acceptable prevents
medication-induced
hypoglycemia. Protocols for
withholding doses vary
depending on the antidiabetic
medication ordered and the
patient's status.
Awareness of these
characteristics helps the nurse
correlate onset and duration of
signs and symptoms with
peaks and troughs in serum
drug levels.
Accurate intake and output
documentation and daily
weights are essential for
assessing fluid status and for
early detection of inadequate
renal function. Daily weight is a
gross indicator of general fluid
and nutritional status.
Insulin reactions can occur
with relative suddenness. Oral
glucose is used for mild to
moderate hypoglycemia when
the patient can swallow;
parenteral glucagon or glucose
is used when the person is
unconscious or can't swallow.
The patient with DM—
especially type 1 DM—needs
diet guidelines tailored to meet
his specific needs. Consistent
carbohydrate intake distributed
throughout the day is
fundamental to all types of
7. Collaborative
Collaborative
Observe for signs and symptoms
of DKA (in type 1 DM only):
■ Early: nausea; fatigue;
polyuria; dry, flushed skin; dry
mucous membranes; thirst; and
tachycardia.
■ Late: vomiting, poor skin
turgor, lethargy, Kussmaul's
respirations, acetone breath,
hypotension, and abdominal pain.
If the patient's condition suggests
DKA, notify the physician
immediately.
Observe for signs and symptoms
of HHNS (in type 2 DM), including
lethargy or stupor, fatigue,
drowsiness, confusion, coma,
seizures, intense thirst, and very
dry mucous membranes. If the
patient's condition suggests
HHNS, notify the physician
immediately.
[Additional individualized
interventions]
medical nutrition therapy for
DM because it helps stabilize
blood glucose levels.
Insulin and oral antidiabetic
drugs are prescribed to fit the
normal diet schedule; a missed
or delayed meal can lead to
hypoglycemia.
Rapid identification of DKA
allows for prompt treatment
and prevents more serious
complications.
Rapid identification of HHNS
allows for prompt treatment
and prevents more serious
complications.
Suggested NIC Interventions
Hyperglycemia management: Intravenous (IV) therapy; Laboratory data
interpretation; Neurologic monitoring
Deficient knowledge (self-care) related to newly
diagnosed complex chronic disease
EXPECTED OUTCOME
The patient will demonstrate proficiency in injection technique and produce
evidence of site rotation documentation (if insulin is ordered); discuss disease
management in relation to medication, diet, exercise, and stress; demonstrate
proper foot care; discuss hypoglycemia and hyperglycemia and their appropriate
treatments; initiate diet planning with dietitian and plan adequate diet for 3-day
period; and perform and interpret blood glucose tests accurately.
Suggested NOC Outcomes
Knowledge: Disease process; Knowledge: Health behavior; Knowledge:
Treatment regimen
8. NURSING INTERVENTIONS
Intervention type
Intervention
Rationale
Independent
Provide information regarding
disease process, treatment
regimen, and reduction of risk
factors to improve health status.
Independent
Teach the significance of insulin or
oral antidiabetic medications for
disease control. Demonstrate
injection techniques, and observe
the patient's performance.
Independent
Involve the patient, his family, and
dietitian in planning a therapeutic
diet. Reinforce nutritional
guidelines. Encourage supervised
weight loss if the patient is
overweight. Ensure that the
patient has been given written diet
guidelines before discharge.
Provide referral for further
questions and special situations
(such as "sick day" management,
pregnancy, dining out, exercise,
use of alcohol, or complications).
Teach blood glucose testing
methods for home use. Observe
patient demonstrations for
accuracy of testing, interpretation
of results, calibration, and
documentation. Provide target
glucose ranges. Encourage the
patient to keep a daily record of
glucose monitoring.
Emphasize the importance of
regular activity and exercise and
of maintaining the same level of
activity from day to day. Teach the
patient to check his blood glucose
level before exercise and
consume a carbohydrate snack if
blood glucose is lower than 100
mg/dl.
Providing information may help
the patient comply with the
treatment plan and adjust his
lifestyle appropriately to reduce
risk factors.
Patient understanding is
essential for home
management of DM.
Observing the patient's
injection technique and
providing opportunities for
supervised practice help
ensure accuracy.
Involving the patient and his
family with dietary planning
helps ensure compliance at
home. Written materials help
minimize misunderstanding.
Referral ensures an ongoing
source of dietary information.
Independent
Independent
Independent
Tell the patient to be aware of
increased susceptibility to
infections; discuss ways to avoid
exposure. Review signs of
infection, such as redness,
Successful home management
of DM requires that the patient
perform self-monitoring to
ensure that the prescribed
regimen of medication, diet,
and exercise remains
appropriate to needs.
Exercise stimulates
carbohydrate metabolism,
lowers blood pressure, aids in
weight control, and may help
avert or minimize circulatory
complications by increasing
levels of high-density
lipoproteins. Exercise induces
blood glucose fluctuations, and
increases or decreases in
activity may require dietary or
medication changes. Checking
his blood glucose level before
exercising and eating a
carbohydrate snack, if
indicated, minimizes the
patient's hypoglycemia risk.
Awareness of signs of infection
may help ensure prompt
treatment.
9. Independent
swelling, exudate, and fever.
Emphasize the importance of
prompt, appropriate treatment of
even minor injuries to avoid
serious complications.
Discuss ways to prevent the
vascular complications of DM,
such as proper leg and foot care.
Emphasize the need to use
protective footwear. Teach the
patient about potential eye
complications, symptoms of UTI,
and renal impairment. Help the
patient understand the
significance of careful disease
control.
DM is characterized by
degenerative vascular changes
that predispose the patient to
infections, ulcerations, and
gangrene, particularly of the
legs and feet. Proper foot care
and protective footwear reduce
the risk of complications from
altered peripheral perfusion.
Careful disease control can
help minimize the
complications caused by DM.
[Additional individualized
interventions]
Suggested NIC Interventions
Teaching: Disease process; Teaching: Foot care; Teaching: Individual; Teaching:
Prescribed activity/exercise; Teaching: Prescribed diet; Teaching: Prescribed
medication; Teaching: Procedure/treatment
Ineffective therapeutic regimen management related to
lack of material resources, lack of support, or ineffective
coping
EXPECTED OUTCOME
The patient will verbalize an understanding of the need for lifestyle changes, ask
appropriate questions, verbalize feelings about diagnosis, participate actively in
disease control planning, have resource deficits resolved or appropriate referrals
completed, and have a home visit or outpatient follow-up appointment scheduled.
Suggested NOC Outcomes
Compliance behavior; Knowledge: Diet; Knowledge: Treatment regimen;
Participation in health care decisions; Treatment behavior: Illness or injury
NURSING INTERVENTIONS
Intervention type
Intervention
Rationale
Independent
Assess the patient's resources,
including financial status, physical
abilities, and family support
system.
Involve the patient's family in all
teaching and planning.
Financial status, physical
disabilities, and lack of support
can interfere with successful
home treatment.
Family members may help
reinforce teaching and
encourage compliance.
Home visits allow assessment
of environmental factors that
may contribute to
noncompliance.
Independent
Independent
Arrange appropriate follow-up
home health visits.
10. Independent
Independent
Refer the patient and his family to
community resources and mutual
support groups.
Encourage verbalization of
feelings, and support healthy
coping behaviors.
Community or mutual support
groups can offer ongoing
education and support.
Expression of feelings is a
necessary prelude to
acceptance of the disease and
active, responsible
management. Supporting
healthy coping behaviors helps
maintain the patient's
independence and sense of
self-control—both essential for
compliance.
[Additional individualized
interventions]
Suggested NIC Interventions
Behavior modification; Decision-making support; Health system guidance;
Mutual goal-setting; Patient contracting; Self-modification assistance; Selfresponsibility facilitation
Teaching checklist
■ Disease and its implications
■ Medication regimen (purpose, dosage, administration schedule, and adverse
effects)
■ Signs and symptoms requiring urgent medical treatment
■ Blood glucose testing procedure and results
■ Dietary changes
■ Signs and symptoms, prevention, and treatment of hypoglycemia and
hyperglycemia
■ Exercise regimen
■ Foot care
■ Signs and symptoms of complications, the need to report them, and appropriate
treatment
■ Community resources and support
■ Ways to obtain emergency medical treatment
■ Follow-up care