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[align=center] *Assessment and Management of Patients With Diabetes Mellitus* [/align]
* Diabetes mellitus: is a group of metabolic diseases characterized by elevated levels of glucose in the blood (hyperglycemia) resulting from defects in insulin secretion, insulin action, or both (American Diabetes Association [ADA], Expert Committee on the Diagnosis and Classification of Diabetes Mellitus, 2003).
Normally a certain amount of glucose circulates in the blood. The major sources of this glucose are absorption of ingested food in the gastrointestinal (GI) tract and formation of glucose by the liver from food substances.
* Classification of Diabetes:
There are several different types of diabetes mellitus; they may differ in cause, clinical course, and treatment. The major classifications
of diabetes are:
• Type 1 diabetes (previously referred to as insulin-dependent
• Type 2 diabetes (previously referred to as non-insulindependent diabetes mellitus)
• Gestational diabetes Mellitus (ADA, Expert Committee on the Diagnosis and Classification of Diabetes Mellitus, 2003)
• Diabetes mellitus associated with other conditions or syndromes
* Assessment AND DIAGNOSTIC FINDINGS:
An abnormally high blood glucose level is the basic criterion for the diabetes diagnosis.
Fasting plasma glucose (FPG) levels of 126 mg/dL (7.0 mmol/L) or more or random plasma glucose levels exceeding 200 mg/dL (11.1 mmol/L) on more than one occasion are diagnostic of diabetes.
The oral glucose tolerance test and the intravenous glucose tolerance test are no longer recommended for routine clinical use. See Chart 41-3 for the ADA’s diagnostic criteria for diabetes mellitus (ADA, Expert Committee on the Diagnosis and Classification of Diabetes Mellitus, 2003).
Plasma glucose values may be 10% to 15% higher than whole blood values, which are obtained with finger sticks (Porth, 2002).
In addition to the assessment and diagnostic evaluation performed to diagnose diabetes, ongoing specialized assessment of patients with known diabetes and evaluation for complications in patients with newly diagnosed diabetes are important components of care.
* Nursing Management:
Nursing management of the patient with diabetes can involve treatment of a wide variety of physiologic disorders, depending on the patient’s health status and whether the patient is newly diagnosed or seeks care for an unrelated health problem.
Nursing management of the newly diagnosed patient and the patient with diabetes as a secondary diagnosis is presented in subsequent ections of this chapter. Because all diabetic patients must master the
concepts and skills necessary for long-term management of diabetes
and its potential complications, a solid educational foundation is necessary for competent self-care and is an ongoing focus of nursing care.
Diabetes mellitus is a chronic illness requiring a lifetime of special self-management behaviors. Because diet, physical activity, and physical and emotional stress affect diabetic control, patients must learn to balance a multitude of factors.
They must learn daily self-care skills to prevent acute fluctuations in blood glucose, and they must also incorporate into their lifestyle many preventive behaviors for avoidance of long-term diabetic complications
* DEVELOPING A DIABETIC TEACHING PLAN:
Changes in the health care delivery system as a whole have had a major impact on diabetes education and training. Patients with new-onset type 1 diabetes have much shorter hospital stays or may be managed completely on an outpatient basis; patients with new-onset type 2 diabetes are rarely hospitalized for initial care.
There has been a proliferation of outpatient diabetes education and training programs, with increasing support of third-party eimbursement.
For some patients, however, exposure to diabetes education during hospitalization may be the only opportunity for learning self-management skills and preventing complications.
* Assessing Readiness to Learn:
Before initiating diabetes education, the nurse assesses the patient’s
(and family’s) readiness to learn (Beebe & O’Donnell, 2001). When patients are first diagnosed with diabetes (or first told of their need for insulin), they often go through various stages of the grieving process. These stages may include shock and denial, anger, depression, negotiation, and acceptance. The amount of time it takes for patients and family members to work through the grieving process varies from patient to patient. They may experience helplessness, guilt, altered body image, loss of self-esteem, and concern about the future. The nurse must assess the patient’s coping strategies and reassure patients and families that feelings of depression and shock are normal.
* Outcome Criteria for Determining Effectiveness of Self-Injection of Insulin Education:
1. Identifies information on label of insulin bottle:
• Type (eg, NPH, regular, 70/30)
• Species (human, biosynthetic, pork)
• Manufacturer (Lilly, Novo Nordisk)
• Concentration (eg, U-100)
• Expiration date
2. Checks appearance of insulin:
• Clear or milky white
• Checks for flocculation (clumping, frosted appearance)
3. Identifies where to purchase and store insulin:• Indicates approximately how long bottle will last (1,000 units
per bottle U-100 insulin)
• Indicates how long opened bottles can be used Syringes
1. Identifies concentration (U-100) marking on syringe
2. Identifies size of syringe (eg, 100-unit, 50-unit, 30-unit)
3. Describes appropriate disposal of used syringe
* Preparation and Administration of Insulin Injection:1. Draws up correct amount and type of insulin
2. Properly mixes two insulins if necessary
3. Inserts needle and injects insulin
4. Describes site rotation:
• Demonstrates injection with all anatomic areas to be used• Describes pattern for rotation, such as using abdomen only or using certain areas at the same time of day • Describes system for remembering site locations, such as horizontal pattern across the abdomen as if drawing a dotted line
* Knowledge of Insulin Action:
1. Lists pre******ion:
• Type and dosage of insulin
• Timing of insulin injections
2. Describes approximate time course of insulin action:
• Identifies long- and short-acting insulins by name• States approximate time delay until onset of insulin action• Identifies need to delay food until 15 to 30 minutes after injection of rapid-acting insulin (lispro, aspart).
• Knows that longer time delays are safe when blood glucose level is high, and time delays may need to be shortened when blood glucose level is low
* Incorporation of Insulin Injections Into Daily Schedule:
1. Recites proper order of premeal diabetes activities:
• May use mnemonic device such as the word “tie,” which helps the patient remember the order of activities (“t” = test [blood glucose], “i” = insulin injection, “e” = eat)• Describes daily schedule, such as test, insulin, eat, before breakfast and dinner; test and eat, before lunch and bedtime
2. Describes information regarding hypoglycemia:
• Symptoms: shakiness, sweating, ervousness, hunger, weakness• Causes: too much insulin, too much exercise, not enough food• Treatment: 15 g concentrated carbohydrate, such as two or three glucose tablets, 1 tube glucose gel, 0.5 cup juice
• After initial treatment, follow with snack ncluding starch and protein, such as cheese and *****ers, milk and *****ers, half sandwich.
3. Describes information regarding prevention of hypoglycemia:
• Avoid delays in meal timing.• Eat a meal or snack approximately every 4 to 5 hours (while awake).• Do not skip meals.• Increase food intake before exercise if blood glucose level is <100 mg/dL.
• Check blood glucose regularly.
• Change insulin doses only with medical supervision.• Carry a form of fast-acting sugar at all times.• Wear a medical identification bracelet.• Teach family, friends, coworkers about signs and treatment of hypoglycemia.
• Have family, roommates, traveling companions learn to use
injectable glucagon for severe hypoglycemic reactions.
4. Maintains regular follow-up for evaluation of diabetes control:
• Keeps written record of blood glucose, insulin doses, hypoglycemic
reactions, variations in diet
• Keeps all appointments with health professionals• Sees physician regularly (usually two to four times per year)• States how to contact physician in case of emergency• States when to call physician to report variations in bloodglucose levels.[/align]
[align=center] حــــــــــــســـــــHOKــــــــن [/align][/frame][/align][/align]
التعديل الأخير تم بواسطة hasankh2003 ; 07-24-2009 الساعة 09:01 AM.
[align=center]MY DEAR :hasankh2003
THANK YOU FOR THIS SUBJECT
THAT WE ARE NEED TO KNOWING IT
WITH MY BEST WISHES[/align]
[align=center]السلام عليكم ورحمة الله وبركاته
حياكِ الله أختي المحديني ...
سُعِدتُ بمرورك وتشريفك للموضوع بمرورك ...
وفقكِ الله أختي
وعليكم السلام ورحمة الله وبركاتة
مشكوراخي علي طرح الموضوع جدا رائع ومرتب
تقبلي مروري اختك زيزو
التعديل الأخير تم بواسطة غصون الغامدي ; 07-30-2009 الساعة 05:50 PM.
Thousand thanks to the subject
Best greetings to you
جزآك الله خيرآ
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