OBJECTIVES
1. Demonstrate application of pharmacology,
pharmacotherapeutic, assessment, and pathophysiologic
principles related to glucose regulation.
2. Discuss factors that influence glucose regulation and
integrate current evidence-based knowledge.
3. Apply Virginia Henderson’s Unique Functions Theory.
4. Reflect on potential teaching tools for nursing education.
OVERVIEW: GLUCOSE REGULATION
• Definition
• Scope and Categories
• Risk Factors
(Giddens, 2012)
PATHOPHYSIOLOGY
• Endocrine system
• Insulin (pancreas)
• Glucagon (pancreas)
• Secondary Processes
• Cortisol
• Epinephrine
• Hyperinsulinemia
(Giddens, 2012) (McCance & Huether, 2014)
HYPERGLYCEMIA
(McCance & Huether, 2014)
HYPERGLYCEMIA: CLINICAL MANIFESTATIONS
•
Type 1 Diabetes (Insulin deficient)
• Autoimmune deficiency
• Secondary to other disease
•
Type 2 Diabetes (Insulin resistant)
• Environmental & genetic components
• Metabolic syndrome
•
Gestational diabetes (glucose intolerance)
•
Physiologic complications:
• Blood vessels: vessel membrane changes, hypertension, PVD, cardiovascular
disease
(McCance & Huether, 2014)
HYPOGLYCEMIA
•
Exogenous factors
• Medications or exercise
•
Endogenous factor
• Pancreatic tumor
•
Functional factors
• Liver disease
•
Symptoms:
• tachycardia, palpitations,
diaphoresis, tremors, confusion,
visual changes, and seizures.
•
Brittle Diabetes
(Giddens, 2012) (McCance & Huether, 2014)
ASSESSMENT SKILLS
Symptomatic history
Vision
Skin:
• Acanthosis nigricans
• Vascular changes
Central Obesity
Diagnostic tools:
• Fasting BG
• Hemoglobin A1c
• Glutamic acid decarboxylase
• Associated problems
(Ball, Dains, Flynn, Solomon, & Stewart, 2015) (Giddens, 2012) (McCance & Huether, 2014)
RESEARCH STUDY
Systematic review using a priori research
protocol to review the effectiveness of
lifestyle interventions on high risk
individuals & individuals already dx with
type 2 diabetes
Lifestyle interventions effectively decrease risk
for diabetes
Lifestyle interventions did NOT decrease
cardiovascular outcomes for those with
Type 2 diabetes
Schellenberg, Dryden, Vandermeer, Ha, & Korownyk, 2013
PHARMACOLOGY & PHARMOCOTHERAPEUTICS
Oral antidiabetic agents
Insulin
•Short duration; rapid acting
•Short duration; slower acting
•Intermediate duration
•Long duration
Glucose
Glucagon
(Giddens, 2012) (Lehne, 2013)
PHARMACOLOGY & PHARMOCOTHERAPEUTICS
(Giddens, 2012)
THEORY
Virginia Henderson’s Unique Functions of Nurses Theory
• “the unique function of the nurse is to assist the individual, sick
or well, in the performance of those activities contributing to
health or its recovery that the person would perform unaided
given the necessary strength, will, or knowledge. And to do this
in such a way as to help the individual gain independence as
rapidly as possible” (Henderson, 1997, p. 22).
(Henderson, 1997)
CONCEPT TEACHING TOOLS
• Case Studies
• Develop critical thinking
• Understand collaboration to meet
needs
• A Conversation Map
• Create a group of patients who
have diabetes
• Stimulate discussions on self-care
and interventions
(Sandstrom, 2006) (Strang, Bagnardi, & Williams, 2010)
CONCEPT TEACHING TOOLS
• Concept Map
• Understand
connections &
system relationships
• Varied learning
styles, aid the visual
learners
SELF REFLECTION
CONCLUSION
REFERENCES
Ball, J., Dains, J., Flynn, J., Solomon, B., & Stewart, R. (2015). Seidel’s guide to physical
examination (8th ed.). St. Louis: Elsevier.
Giddens, J. (2012). Concepts for nursing practice. St. Louis: Elsevier.
Henderson, V. (1997). Basic principles of nursing care (2nd ed.). Washington D.C.: International
Council of Nurses.
Lehne, R. (2013). Pharmacology for nursing care (8th ed.). St. Louis: Elsevier.
McCance, K., & Huether, S. (2014). Pathophysiology (7th ed). St. Louis: Elsevier.
Sandstrom, S. (2006). Use of case studies to teach diabetes and other chronic illnesses to nursing
students. Journal of Nursing Education, 45(6), 229-232. Retrieved from http://0web.b.ebscohost.com.libcat.ferris.edu/ehost/detail?sid=83455b40-2eda-4b73-87ea39d99bca682f%40sessionmgr113&vid=4&hid=122&bdata=JnNpdGU9ZWhvc3QtbGl2Z
Q%3d%3d#db=cin20&AN=2009209781
Shellenberg, E., Dryden, D., Vandermeer, B., Ha, C., & Korownyk, C. (2013). Lifestyle
interventions for patients with and at risk for type 2 diabetes. Annals of Internal
Medicine, 159( 8), 543-551. doi: 10.7326/0003-4819-159-8-201310150-00007
Strang, S., Bagnardi, M., & Williams, S. (2010). Tailoring a diabetes nursing elective course to
millennial students. Journal of Nursing Education, 49(12), 684-686. doi:
10.3928/01484834-20100831-05