Uploaded by Rucelyn Campita

Diabetes

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CARE FOR

THE

CLIENT

WITH

(CLINICAL MANIFESTATION,

ASSESSMENT & DIAGNOSTIC FINDINGS,

OVERALL MANAGEMENT OF DIABETES

AND NURSING MANAGEMENT)

CLINICAL MANIFESTATION

Classic clinical manifestations of all types of diabetes include the “three Ps”:

Polyuria

Polydypsia

Polyphagia

Other symptoms include:

Fatigue and weakness

Dry skin

Sudden vision changes

Tingling or numbness in hands or feet

Skin lesions or wounds that are slow to heal and recurrent infections.

Type 1 diabetes may be associated with sudden weight loss or nausea, vomiting, abdominal pains if DKA has developed.

ASSESSMENT AND DIAGNOSTIC

FINDINGS

CRITERIA FOR THE DIAGNOSIS OF DIABETES

American Diabetes Association (ADA, 2004)-Diagnostic criteria for Diabetes Mellitus

1. Symptoms of diabetes plus casual plasma glucose concentration equal to or greater than 200 mg/dL (11.1 mmol/L). Casual is defines as any time of day without regard to time since last meal. The classic symptoms of diabetes include polyuria, polydypsia, polyphagia and unexplained weight loss.

or

2. Fasting Plasma Glucose (FPG) or Fasting Blood Sugar (FBS) greater than or equal to 126 mg/dL (7.0 mmol/L). Fasting is defined as no caloric intake for atleast 8 hours.

or

3. Two-hour postload glucose equal to or greater than 200 mg/dL (11.1 mmol/dL) during an oral glucose tolerance test. The test should be performed as described by the World Health

Organization, using a glucose load containing the equivalent of 75 g anhydrous glucose dissolved in water.

4. In the absence of unequivocal hyperglycemia with acute metabolic decompensation, these criteria should be confirmed by repeat testing on a different day. The third measure is not recommended for routine clinical use.

ABNORMAL LABORATORY VALUE FOR

GLUCOSE

Fasting Plasma Glucose (FPG) or Fasting

Blood Sugar(FBS)

126 mg/dL (7.0 mmol/L) above

Random Plasma Glucose (RPG) or Random

Blood Sugar (RBS)

200 mg/dL (1.1 mmol/L) above

NORMAL LABORATORY VALUE FOR

GLUCOSE

Glucose, Fasting: 70-110 mg/Dl

Glucose, monitoring: 60-110 mg/dL

Glucose, 2-hr postprandial: < 140 mg/dL

OVERALL MANAGEMENT OF DIABETES

Five components in Diabetes management:

1. Nutritional therapy

2. Exercise

3. Monitoring

4. Pharmacologic therapy

5. Education

1.) Nutritional Therapy

o o

 o o

 o

Meal Planning and Related Teaching

Caloric requirements

Caloric distribution

Carbohydrates

Fats fiber

Other Dietary Concerns

Alcohol consumption

Sweeteners

Misleading Food Labels

2. ) Exercise

General Precautions for Exercise in

People With Diabetes

Use proper footwear and, if appropriate, other protective equipment.

Avoid exercise in extreme heat or cold.

Inspect feet daily after exercise.

Avoid exercise during periods of poor metabolic control.

3.) Monitoring

Self-Monitoring of Blood Glucose

Continuous Glucose Monitoring

System

Glycated Hemoglobin

Urine Glucose Testing

Testing for Ketones

4.) Pharmacologic Therapy

Insulin Therapy and Insulin

Preparations

Insulin Regimens

Two general approaches to insulin therapy:

- Conventional Regimen

- Intensive Regimens

Insulin Regimens

Two general approaches to insulin therapy:

- Conventional Regimen

- Intensive Regimens

Complications of Insulin Therapy

- Local Allergic Reactions

- Systemic Allergic Reactions

- Insulin Lipodystrophy

- Resistance to Injected Insulin

- Morning Hyperglycemia

Alternative Methods of Insulin Delivery

- Insulin Pens

- Jet Injectors

- Insulin Pumps

- Implantable and Inhalant Insulin

Delivery

- Transplantation of Pancreatic Cells

Oral Anti-diabetic Agents

Sulfonylureas

Non-sulfonylureas

Biguanides

Alpha-glucosidase inhibitors

Thiazolidinediones

Other pharmacologic therapy

Pramlintide (Symlin)

Exanatide (Byetta)

5.) NURSING MANAGEMENT

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Patient Education

Developing a Diabetic Teaching Plan

Organizing Information

Assessing Readiness to Learn

Determining Teaching Methods

Implementing the Plan

Teaching Experienced Patients

Teaching Patients to Self-Administer

Insulin

- Storing Insulin

- Selecting Syringes

- Preparing the Injection: Mixing Insulins

- Withdrawing Insulin

- Selecting and Rotating the Injection Site

- Preparing the Skin

- Inserting the Needle

- Disposing of Syringes and Needles

Promoting Home and Community-Based

Care

- Teaching Patients Self-Care.

- Continuing Care

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